The healthmatters blog; commentary, observation and review
Today (17 October 2017) the Care Quality Commission (CQC) published the results of the Emergency Department Survey 2016; a nation-wide survey of more than 40,000 people who attended emergency and urgent care departments, which sought to understand their experiences. The results suggest that most patients have a positive experience when it comes to interactions with NHS doctors and nurses, despite a marked increase in the numbers attending NHS Emergency Departments in recent years. The years between 2005/6 and 2015/6 has seen an increase in emergency department attendance of 10%; this equates to over one million additional people attending the departments in 2016 than 2006.
The survey included people who attended one of 137 acute and specialist NHS trusts during September 2016, and is part of the National Patient Survey Programme (NPSP) managed by the Survey Coordination Centre, based at Picker. Despite the increasing number of attendees to emergency departments, 73% of patients said they definitely had enough time to discuss their condition with a doctor or nurse. In addition, 78% of these reported that their doctors and nurses listened to what they had to say. CEO of Picker, Chris Graham, said “The challenges facing emergency departments are well publicised. More people are attending, increasing the challenge of providing timely, effective care for every patient. Despite this, most patients report positive experiences, which stands as testament to the efforts of NHS staff working in busy departments.” “But there are mixed results for some areas of person-centred care that are important to patients: for example, only 69% of patients reported that their doctor or nurse explained the nature of their condition and treatment in a way that they could understand.” Three quarters (75%) of respondents “definitely” had confidence in their doctors and nurses, with a further 18% having confidence in them to a certain degree.
However, the survey highlighted issues that arise when patients leave the facilities; 30% of respondents weren’t given enough information about which danger signs of their condition or treatment to watch out for on returning home; and 37% were not given enough information about what side-effects of their medication they should watch out for. Furthermore, 45% of respondents stated that their home situation was not taken into account when they left the emergency department, and 34% were not informed as to when they could resume normal activities, such as driving. Chris Graham responded “Emergency departments fulfil an important role in healthcare. Firstly, they address the urgent needs of patients who present with a wide range of conditions, symptoms, and severity of needs. Equally, they have a role in directing patients on to other services for follow-up care and treatment: in some cases this will involve hospital admission, but in others patients may be referred back to GPs or on to other services.” “The importance of this co-ordinating role cannot be understated, because it impacts demand and pressure felt throughout the system – including in emergency departments themselves. It is therefore worrying to see poorer results for people’s experiences of discharge from emergency departments. Patients who leave without awareness of potential danger signals to watch for, or understanding what to do if they have problems, are at risk of poorer health outcomes and requiring further unplanned care.” “Improving people’s experiences of leaving emergency departments should be a priority, particularly as services prepare to face the pressures of another busy winter.”
New study in The BMJ: Weight Watchers Diabetes Prevention Programme significantly reduces risk of Type 2 diabetes
A new, 1 year UK-based study published today (Tuesday 17th October) in The BMJ, Open Diabetes and Research and Care indicates that overweight and obese adults at risk of developing type 2 diabetes who were referred to Weight Watchers®, the world’s leading community based weight management provider, lost significantly more weight and saw greater reductions in their blood sugar levels than the level defined as success recommended by Public Health England (PHE).
And what’s more, close to 80% of eligible patients offered the programme, participated, demonstrating very high engagement levels.
The independent research, commissioned by the London Borough of Bromley Local Authority, looked at whether an augmented Diabetes Prevention Programme (DPP) delivered by Weight Watchers using a primary care referral pathway could reduce the progression of type 2 diabetes in those at risk of developing the disease.
166 patients were referred to Weight Watchers DPP from 14 GP practices across Bromley. Patients were offered the programme, which included a special welcome session followed by Weight Watchers meetings for 48 weeks, supported by trained Coach and specific curriculum. This real world study was conducted by Carolyn Piper and Dr. Agnes Marossy in the Public Health department at the London Borough of Bromley Local Authority, Zoe Griffiths, Head of Programme and Public Health, Weight Watchers UK and Dr. Amanda Adegboye at the University of Westminster.
79% of eligible patients engaged in the programme. At 12 months, those who had attended the welcome session and started attending meetings (114) achieved a mean reduction in HbA1c (glycated haemoglobin) of 2.84mmol/mol (from 43.42 +1.28 to 40.58 +3.41). Of those with comparable data, 49% returned to normoglycaemia (were no longer at high risk of developing type 2 diabetes) and a further 20% significantly reduced their risk of developing type 2 diabetes. This was associated with a mean weight reduction of 10kg and a mean reduction in BMI of 3.2kg/m2 (from 35.5kg/m2 +5.4 to 32.3kg/m2 +5.2) as well as increases in physical activity.
The researchers concluded that offering a primary care referral route partnered with Weight Watchers DPP can considerably reduce the risk of type 2 diabetes.
This evidence comes as type 2 diabetes, both incidence and prevalence in the UK is rising dramatically. Type 2 diabetes is closely linked to obesity and can therefore be reversed by weight loss.
Lead author Carolyn Piper Public Health Manager at the London Borough of Bromley Local Authority says: “Type 2 diabetes is one of the most significant public health challenges of our time. A new diagnosis of type 2 diabetes is made every two minutes in the UK with the risk of developing the disease significantly influenced by our lifestyles. It’s within our power to reverse the ever increasing tide of type 2 diabetes with the right education and support. We undertook this research in the real world to show that the disease can easily be reversed using existing resources and providers in a more effective way at a time when budgets are being squeezed.”
Zoe Griffiths, Head of Programme and Public Health, Weight Watchers UK adds: “The evidence for reducing type 2 diabetes is well established but what this study demonstrates is how to implement prevention programmes in the real world utilising existing referral pathways and offering programmes that people want to go to. These real world outcomes echo and build on evidence of the effectiveness of this programme, found in a randomised controlled trial1 published in the American Journal of Public Health which compared Weight Watchers DPP to standard care.
“The lifestyle changes achieved in the intervention, measured by weight loss, translated into considerable reductions in diabetes risk, with an immediate and significant public health impact. Through GPs referring at risk patients to a programme that provides intense support via weekly meetings, digital tools including an app, a vibrant online community and specific curriculum, more effective and efficient lifestyle change can be achieved than interventions delivered by primary care alone.
“We’d welcome the opportunity to work with Public Health England as part of the Healthier You: NHS Diabetes Prevention Programme rollout. Close to 80% of eligible patients who were offered the Weight Watchers DPP programme engaged, illustrating the significant scale that could be achieved by working together.”
Whilst NHS staff were already offered the vaccination for free to protect patients and the public, the Government recommended that social care workers were immunised but asked employers of social care workers to pay for the vaccine. The ILC-UK has long highlighted the need to fund the vaccine for social care workers, to protect the extremely vulnerable people under their care.
The flu epidemic in care homes in Wigan last winter, which lead to thirty cases of flu, eight deaths, and Wigan Infirmary and the North West Ambulance Service facing additional pressures, is a case study of the toll that low uptake of flu vaccination among care home staff can have on residents and the NHS.
However, the ILC-UK is also urging the Government to ensure that domiciliary care workers are also reimbursed for the immunisation, so that they can protect the people they care for from influenza this winter.
David Sinclair, Director of the International Longevity Centre – UK said:
‘Influenza is a serious illness which does kill.
For years the ILC-UK highlighted that it made little sense to offer NHS staff the vaccination for free, whilst asking employers of social care workers to pay for the jab, as their staff also care for the most vulnerable people in our society.
Protecting older people through offering the flu vaccine to social care workers free of charge is a common sense approach that will save lives this winter. However, we are urging the Government to go further and ensure that domiciliary care workers are reimbursed when they receive the vaccine on the high street so that they too can protect the people under their care’.
Now the Labour Party’s objectives for the NHS are clearer, the real politics begins. If May’s government collapses, as looks increasingly possible, Labour will need to project its tactical policies for the NHS forcefully, both to rise above the din of Brexit and to see off Tory claims to be the party of the NHS. As always, the devil will be in the detail. The plausibility of how it plans to cope with the winter bed crisis will matter – what will the promised £500 million actually be spent on? How will a Labour Secretary of State for Health manage delayed transfers of care? If market mechanisms in the NHS are to be rolled back, how will this happen and how far will it go?
Of course Labour may not win an election, snap or planned. As Compass has warned, the Labour coalition is fragile. If May’s government survives Labour will have to live with Hunt Supremacy for a while longer, and because political rhetoric has limited value, will need some practical ideas about effective Opposition. Two events in the last week offer some possibilities; the King’s Fund report and webinar on the development of an accountable care organisation in the Canterbury region of New Zealand, and John Appleby’s review of PFI in the NHS, published by the Nuffield Foundation. The former has much to teach about integrating health and social care, and the latter offers new – and rational – thinking about PFI arrangements.
The Canterbury story was explained in the webinar by two leaders from the District Health Board and a large GP federation. They described the situation a decade ago in terms familiar to anyone in the NHS; clinicians trying to integrate a fragmented system but often inadvertently working against each other; hospital gridlock; and a common feeling that if only other people would sort themselves out, all would be well.
Creating an integrated local health service required investment in general practice, starting with the organisation of out of hours services, and growing collaboration around care pathway developments, not structural changes. Resources were created for GPs to support their patients in the community more easily, and hospital admissions declined. Effort went into relationship building, influencing the private provider organisations (the majority) and letting go of history in which grievances were prized possessions. Making the process of change clinician-led and management- enabled stabilised the primary care workforce, avoiding the problems we currently have. The leadership of the changes avoided consultation, with its undertones of decisions already made elsewhere, and sought dialogues instead. Likewise, debates about funding and contracts were postponed because early exposure to them demonstrated that nothing could change. Realistic timescales were sought – none of the quick fixes that plague the NHS. The integrated system works on the basis of not wasting people’s time (patients and professionals) and stressing its operational principles of “no wait, no harm, no waste”. The cancellation of a single elective procedure because of emergency care counts as failure. These might be principles that Labour could bring to the NHS.
Of course this may be too good to be true. The King’s Fund regularly leads its followers on visits to the collective farm that worked. Canterbury may well be the new Torbay, full of experience of positive change but hard to replicate once off home turf. The New Zealand speakers in the seminar mentioned that the earthquakes of 2010 and 2011 exposed the local health services’ fragility, and this realisation made change essential not optional. We are unlikely to have this kind of social and economic stimulus to change.
John Appleby dissects the scale, size and costs of NHS PFI schemes, which vary enormously. He concludes that it is not necessarily the case that PFI scheme were poor value for money. Early schemes were not always good deals, but as the NHS gained more experience of PFI it negotiated better terms. For example, Tees, Esk and Wear NHS Trust, which has paid off one PFI scheme, judged that its more recent schemes were good value and has left them in place.
A Labour Government could find ways to end PFI schemes early but the question is at what cost and opportunity cost? Would such repayments be money well spent, or could they provide more benefit if spent on something else? The drive for PFI has weakened. Seventeen new PFI schemes were expected to reach final construction in the NHS between 2011 and 2018, compared with 92 in the nine years from 2002. This may change again. Trusts needing to increase their capital budgets have been encouraged to open new PFI projects rather than borrow money directly. This will create some challenges for Labour, whether in office or in Opposition.
Appleby, J (2017) “Making sense of PFI”. Nuffield Trust explainer. www.nuffieldtrust.org.uk/resource/making-sense-of-pfi
Steve Iliffe 8/10/17
After decades of short term funding, reactive policy making and short planning cycles we should be delighted to finally see genuine moves to longer term thinking with things like the establishment of the Foresight projects in England and the Well-being of Future Generations Act in Wales. And these do seem to have helped to stimulate policy makers and public sector organisations to at least start to think and plan for the longer term. For example in Wales there is a requirement for Public Service Boards to develop and published Well-being plans with supporting assessments that include evidence of long-term thinking. This has been supported by the publication of a tool by the Public Health Observatory in Wales that offers some insights on potential trends for 5 key health & lifestyle indicators over the next 10 years based on present and past data. And whilst looking 10 years ahead is a move forward for public sector planners is this really ‘long-term thinking’ and just how useful is trend data? Given the major global and domestic fiscal and political changes, there are likely to be significant confounding factors not accounted for in the present trend analyses that I believe will seriously impact on current projections particularly when considered in the genuinely long-term including;
- The emerging, though not yet acknowledged, increasing outward migration of disillusioned working age adults, predominantly from the present 10-30yrs of age, middle income group leaving higher education with an increasing burden of debt initiated by student loans and low and diminishing job prospects that are poorly aligned to their qualifications, aspirations and expectations. (Eisenhammer S, 2012; The Economist, 2014))
- An increasing outward migration of UK based foreign workers forced out by economic and social uncertainty in an increasingly hostile policy environment; couple with a dramatic reduction in inward migration resulting from xenophobic immigration policies. (ONS, 2017)
- The increasing number of present 10-30yrs age lower and middle income group (many, though not all, burdened by student debt) entering an insecure and low paid employment market with frequent episodes of unemployment, a punitive benefits system, no access to the housing market and unable to contribute to a pension scheme.
- An exponentially continuing upward trend in mental health problems beginning at an earlier age (under 10 yrs) resulting from social pressures fuelled in part by emerging social technology and in part by increasing expectations; coupled with increasing numbers of adults and older adults exposed to increasing work and financial pressures. (Campbell D & Marsh S, 2016)
- The unaccounted impacts of extending the retirement age across the population irrespective of the nature of the work, leading to workforce imbalances as older workers are forced into premature retirement through sickness (Principally as a result of musculo-skeletal disease, injuries, diabetes, CVD and dementia) leading to increased pressures on those trying to pick up the slack left by the increasing sickness absences. (Staubli S & Zweimuller J, 2013).
- The increasing reliance on a rapidly diminishing resource of young and working age adult informal carers for the increasingly older and frailer population with increasing care needs.(Age UK, 2017)
- The continuing demographic shift in alcohol and substance misuse from younger to older generations. (Conelly A et. al; 2017)
- The continuing personal and social financial impacts of gambling (particularly online) on poverty, homelessness etc. particularly among younger and working age adults. (NHS Digital, 2017)
On a more positive note there are likely to be some improvements in some of the ‘lifestyle’ related chronic diseases as social norms change: This could include:
- Slowly reducing prevalence of obesity (There is some evidence of overall rates of childhood obesity levelling off, and in some cases falling, in some of the worst affected countries. E.g. USA, England) although there will continue to be a socio-economic inequality. (Sahota B, 2015)
- Tobacco use continuing its downward trend as ‘vaping’ becomes more popular. (Press Association, 2017)
If these less concrete predictions were to happen the health impacts would of course be significant and, more alarmingly, further compound inequalities with an ever increasing health and social divide between the ‘haves’ and ‘have not’s’. But perhaps of even more concern will be the increasing generational inequalities as present and emerging social and political trends isolate the ‘noughties’ generation with inevitable trickle down impacts on our children & young people, the very generation we so vociferously claim to be our primary priority? We have been aware for some time of the demographic time bomb of an ageing population and the increasing demands it is already placing on increasingly stretched health resources. However I would suggest we have not yet woken up to the more frightening prospect of this ‘betrayed’ generation whose capacity to contribute to their own health needs has been massively compromised, never mind the expectation that they will be able to contribute to supporting the health needs of their parents! The political and public health prioritisation on maternal and child health that we are witnessing is hard to challenge but the health and well-being of future generations cannot operate in isolation and is wholly dependent on addressing the needs of our present generations’ right across the life course. It is ludicrous to put all our eggs into one ‘early years’ basket and ignore the needs of the rest (the bulk) of our population because to do so will result in a downward spiral that will negate any investments that we are presently making in our children and young people. Why bother working upstream if you’re building a dam further down? All you end up with is a flood and tens of thousands of displaced people.
These demographic considerations don’t of course take account of other possible major confounders such as war, austerity as the new ‘norm’, global warming, Brexit, antibiotic resistance, food scarcity, increasing automation etc. but they do highlight the limitations of horizon scanning that is reliant on statistical trend data.
There is a school of thought that we are now entering a third revolution in health following the shift from communicable disease to non-communicable disease in the 20th Century and now from non-communicable disease we are in an ‘epidemiological transition’ to the 3rd era of ‘positive health’ where health is recognised as a “resource for everyday life” (Breslow L, 2004). In the same way as we had to adapt our thinking to accommodate the notion of non-communicable disease, including the causes, effects and measurement, we must now re-orientate our thinking to the notion of ‘health as a resource’. If we do subscribe to that approach then we must also recognise its place as it competes in the modern world with other resources, both personal and societal. In that context it is not surprising that the ‘burden of disease’ that we have recognised over the last century is changing again to reflect the social and ecological changes that are leading to a move away from the ‘lifestyle’ paradigm that has dominated recent decades to the ‘personal resource’ model where the focus will be on mental illness (anxiety, depression, OCD, etc.) and age-related diseases (dementia, osteo-arthritis, sensory impairments, particular cancers etc.) and where the wider social determinants including economic, political, environmental and commercial play an increasingly important role.
There is undoubtedly a place for trend data; it is based on known quantifiable facts and provides a valuable and visually compelling picture of where we have been and where we could be going, if nothing were to change. It doesn’t, however, represent a true picture because of course things do change. But the things that change are often not quantifiable or predictable over the long term, which is why methods such as Foresight that provides different scenarios that account for potential changes in the macro economic and political world can add that critically important dimension to forward planning that a simple reliance on trend data never will.
Age UK (2017), Briefing: Health and Care of Older People in England 2017, Feb 2017,http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/The_Health_and_Care_of_Older_People_in_England_2016.pdf?dtrk=true
Breslow L (2004), The Third Revolution in Health, Annual Review of Public Health, Vol. 25:- (Volume publication date 21 April 2004) https://doi.org/10.1146/annurev.pu.25.022604.100011
Campbell D & Marsh S (2016), Quarter of a million children receiving mental health care in England,the Guardian, Monday 3 Oct 2016; https://www.theguardian.com/society/2016/oct/03/quarter-of-a-million-children-receiving-mental-health-care-in-england
Conolly A, Fuller E, Jones E, Maplethorpe N, Sondaal A, Wardle H (2017), Gambling behaviour in Great Britain in 2015 Evidence from England, Scotland and Wales, Pub: NatCen Social Research.http://content.digital.nhs.uk/media/25063/Gambling-behaviour-in-Great-Britain-Full-report-v4/pdf/Gambling_behaviour_in_Great_Britain-Full_report-v4.pdf
Eisenhammer S (2012), Britain faces “brain drain” as jobs dry up, Reuters, November 12, 2012,http://uk.reuters.com/article/uk-graduates-braindrain-idUKLNE8AB01K20121112
NHS Digital (2017), Statistics on Alcohol, England, 2017 [NS], http://www.content.digital.nhs.uk/catalogue/PUB23940
Office for National Statistics (2017), Migration Statistics Quarterly Report: August 2017,https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/internationalmigration/bulletins/migrationstatisticsquarterlyreport/august2017
Press Association (2017), Smoking rate in UK falls to second-lowest in Europe, The Guardian, 15thJune 2017, https://www.theguardian.com/society/2017/jun/15/smoking-rate-in-uk-falls-to-second-lowest-in-europe
Staubli S & Zweimuller J (2013), Does Raising the Early Retirement Age Increase Employment of Older Workers?, J Public Econ, http://dx.doi.org/10.1016/j.jpubeco.2013.09.003 doi: 10.1016/j.jpubeco.2013.09.003
Sahota B (2015), Recent UK trends in childhood obesity, British J Obesity, http://www.britishjournalofobesity.co.uk/journal/2015-1-1
The Economist (2014), “And don’t come back”, The Economist, https://www.economist.com/news/britain/21611102-some-5m-britons-live-abroad-country-could-do-far-more-exploit-its-high-flying-expats-and
Welsh Government (2015), Well-being of Future Generations (Wales) Act 2015 – The Essentials, Pub: Welsh Government, May 2015. http://thewaleswewant.co.uk/sites/default/files/Guide%20to%20the%20WFGAct.pdf
Malcolm Ward FFPH,MPH,PG Dip.
Mental health practitioners are being embedded in secondary schools across Barnsley in a pioneering multi agency initiative to tackle poor mental health among children.
The £1.3m scheme is being funded by Barnsley Clinical Commissioning Group and delivered in all 10 Barnsley secondary schools by Wellspring Academy Trust, an agenda-setting multi academy trust which operates schools across Yorkshire and Lincolnshire.
Teams of mental health nurses will work with young people whilst trained counsellors will work with parents and carers. Tutors will provide group classroom-based intervention on topics such as self-harm, depression and suicide. Teaching staff will receive mental health training to help identify those needing support.
The MindSpace initiative was piloted during the past academic year and supported more than 200 young people including 63 parents before it was scaled up for the forthcoming year.
This new multi service approach to mental health provision bypasses waiting lists for traditional mental health services which have experienced rising demand and insufficient capacity. It ensures schools can tackle problems quickly and links mental health professionals, educators, families and young people in an entirely new way.
Early intervention has been proven to reduce exclusion rates, minimise family disruption and stem educational failure.
“MindSpace is the first step towards changing the whole culture around mental health and education,” said Mark Wilson, CEO of Wellspring Academy Trust, which aims to expand the instantly scalable service to other areas.
“We need to make it much easier for children to talk about mental health and seek support. This step change takes ambition but with multi agency collaboration it’s entirely possible and we owe it to young people to make this happen.
“We listened to young people during the pilot of this project and they overwhelmingly told us they want access to mental health professionals.
“By working in partnership with the CCG, CAHMS services (Child and Adolescent Mental Health Services) and local education authority, we can significantly reduce the pressure on families, schools, social services and the youth justice system. The benefits are far reaching for everyone concerned.”
A report released in 2015 revealed more than half of all mental illness starts before the age of 14 and 75% by 18. Statistics show that an average of three children in every classroom has a diagnosable mental health problem.
Barnsley has higher levels of self harm and substance misuse than the national average and a 2015 report of Year 9 children in six Barnsley schools by Social Sense found that 24% said they were depressed most days and 29% had harmed themselves as a result of feeling stressed or anxious.[i]
MindSpace is precisely the kind of multi agency partnership that the Government demanded more of when it announced children’s mental health as a priority in January 2017.
The Government called for all teachers to be trained in mental health first aid. MindSpace will train both teaching and non teaching staff and children and their parents will be able to self refer. The aim is to train more than 240 teachers this academic year.
MindSpace officially launches on October 5 when commissioners, educators, politicians and influencers gather in Barnsley to hear more details.
For more details about MindSpace contact Michelle Sault, Head of Extended Services at Wellspring Academy Trust on 01226 720 742.
[i] In 2014/15 a company called ‘Social Sense’ were commissioned to carry out their survey, with schools in Barnsley, which is called ‘R U Different’, they surveyed year 9 pupils in 6 schools (4 mainstream and 2 special schools). Some of the relevant findings are:- Ø 16% of respondents said they ‘often’ felt bullied at school; Ø 24% said they felt anxious or depressed ‘most days’; Ø 29% said that they had harmed themselves as a result of feeling depressed or anxious.
A new research report calls for a change in approach in the treatment of psychosis in dementia, to find alternatives to highly damaging antipsychotics.
Up to two thirds of people with Alzheimer’s disease experience psychotic episodes, yet the distressing symptom is still widely under-recognised and is challenging to treat. Current antipsychotic treatments have little impact on alleviating symptoms, yet can have devastating side effects, leading to 1,660 unnecessary strokes and 1,800 unnecessary deaths in the UK every year.
Psychotic symptoms are linked to faster cognitive and functional decline and accelerated death rates.
Both psychotic symptoms and treatment side effects are more extreme in other types of dementia, including Parkinson’s Disease Dementia and Lewy Body Dementia. In these people, commonly prescribed antipsychotics can be particularly damaging, quadrupling risk of stroke and death.
Now, an international group of experts, including researchers from the University of Exeter Medical School, is calling for new approaches to clinical trials to yield effective new treatments for the neuropsychiatric symptoms of Alzheimer’s. The effort aims to facilitate a better understanding of the underlying mechanisms of these symptoms, which include psychosis, agitation, apathy, depression and sleep disturbances. These ideas are summarized in a new paper, “Neuropsychiatric Signs and Symptoms of Alzheimer’s Disease: New Treatment Paradigms,” published in the journal Alzheimer’s & Dementia: Translational Research & Clinical Interventions.
The expert group was convened through the Alzheimer’s Association Research Roundtable – an ongoing effort that brings together experts in the field from academia, industry, and government to address ways to overcome barriers to drug development.
Clive Ballard, Professor of Age-Related Diseases at the University of Exeter Medical School, is the lead author for the paper’s section on psychosis. He said new treatments that worked in a different way to current antipsychotics are yielding promising results in relieving symptoms without adverse outcomes, but said outcome measures needed to be standardised to ensure they were meaningful to both clinicians and people with dementia and carers.
Professor Ballard said: “We have been stuck in this damaging cycle of prescribing antipsychotics for people with dementia, despite the fact that there are minimal benefits and lots of harms as a result. We now urgently need new drugs and new non-drug interventions, so we can improve treatment of these distressing symptoms to millions of people worldwide.
“At Exeter we are already developing specific psychological therapies, running clinical trials of novel drug approaches and using-cutting edge genetic techniques to identify new targets for safe and effective therapies and to allow us to use current treatments in a more focussed way.”
Psychosis and other neuropsychiatric symptoms are often among the first signs of dementia, yet are often not recognised as a warning sign. Together, these symptoms cause substantial distress for both people with dementia and their caregivers, and contribute to people moving into residential care earlier, placing financial burden on the social care system.
Labour promised much for the NHS at its’ recent Conference. Here are some reactions.
The NHS faces one of the toughest winters in its history. Last year hospitals were already stretched far beyond their capacity, with more than four thousand extra beds having to be opened. Financially, trusts face a £6bn hole in their budgets this year. Add a bad outbreak of flu into the picture, and the outlook is truly grim. A one-off financial bung (Labour pledges a £500m winter bailout) is not going to solve these problems. The shortages of beds and staff have been years in the making, and cannot simply be reversed in a few months. We need a long term funding settlement for health and social care so that the NHS can actually plan on the basis of having enough resources. All political parties have been avoiding this question for too long. The Nuffield Trust’s 2017 General Election finances paper showed that the pledges of all political parties before the election fell short even of a level which would keep NHS spending at the same proportion of national income as it is today. Their commitments fell far short of even our minimum calculation of what the Health Service would need.
Nigel Edwards, Nuffield Trust Chief Executive
Delegates were ecstatic when the party supported an NHS that was universal, comprehensive, free at the time of need and paid for out of taxation – overcoming years of support for an NHS that was universal, comprehensive, free at the time of need and paid for out of taxation and which tried to deliver decent care.
Organised chanting greeted further announcements pledged to end the scandal of PPI, banning further adverts and taking all hospitals in house – a variation on the hospital at home approach. A guarantee would be given that no hospital or clinic or unit or service or anything would be changed, ever. And NHS land and derelict buildings are ours to roam over – Not For Sale.
All involvement of the private sector would cease on day one (an amendment that this was too late was lost) with existing contracts torn up before the eyes of Richard Branson. All GP practices would be taken over and staff TUPEd into the NHS.
In the spirit of integration, social care would be renamed Other NHS care and also be made free and available on prescription from any one of the new professionalised (graduate only) care support workers. So called informal carers (such as partners) would be rebadged as NHS employees and paid the living wage or as agenda for change determined.
In transforming care, anyone whose role included words like manager or director would be made redundant as workers would coproduce with other consensual adults. Oversight would be provided by health boards made up of appointed good people who had more than 3 years membership of Keep Our NHS Public.
Market structures like Trusts would be reorganised and brought under workers control. Arrogant isolated units like Barts. or Great Ormond Street or Papworth would be broken up and dispersed.
Cheering broke out as it was announced that this brighter future would be signalled by returning to the 1970’s; bringing back 2 year minimum waits for treatment, warehousing of the elderly and those with any mental health issues, doing without IT and finance people, and restoring the right of doctors to ensure long waits so their private practice was not threatened. Modern notions like technology or public and patient involvement and shared decision making were denounced as part of the neo-liberal plot to a standing ovation.
Asked about experts claiming this would all cost a lot of money a spokesperson for Momentum said that this would be achieved by taxing well off people. They added that the plans for change were being worked out by a panel of non-experts drawn from campaigners, activists and people who had overheard something down the pub. True vison from a government in waiting.
Roger Lyon-Smith, Freelance journalist
Appearances of unity over health policy ended at Labour conference with a challenge to the recent Manifesto of Jeremy Corbyn which was agreed just a few months ago. The gap between ideologues and realists was exposed in the speeches on the composite resolution on the NHS. This was a resolution so well considered that it began with an opening sentence that was factually untrue, claiming that 44 contracts with accountable care organisations had been signed. The rationale was based on the view that everything happening in the NHS was part of a plot, led by Simon Stevens, and fuelled by neoliberal forces. It was so well drafted that it had the same bullet point twice! Yet somehow reality was parked and votes followed factional position.
For this faction there is only one issue in care policy – the structure of the NHS – or the ownership of the means of production. The bigger crises in social care and in housing are as nothing. The almost insoluble crisis around staffing in the NHS and wider care sector post Brexit does not matter. The future for the NHS is to return to the structures of the 1970’s and in so doing remove every trace of the private sector (except possibly GPs, pharmacists, dentists, opticians, specialist mental health care, etc.). How this might be achieved and at what cost is irrelevant. If the ownership is right then the workers’ control that will follow will be enough to overcome all problems.
This position takes them way beyond the 2017 Manifesto and in direct collision with Jeremy Corbyn who signed it off. It was a Manifesto almost everyone else described as a key part of Labour’s strong election performance. A Manifesto that had its roots in the party’s policy development process which established a wide consensus and which was agreed by all the party’s key bodies. Labour actually has a faction that does not trust Jeremy Corbyn on the NHS!
The other faction actually thinks about patients and care and what might be good for them – suggesting that no top down reorganisation of structures has ever done much for patient care. The real issue is how to ensure adequate funding and the investment of money, time and expertise to resolve (over quite a long period) both the short term and the more difficult longer term problems.
Current party policy is built very solidly on keeping the fundamental principles of the NHS – universal, comprehensive, free and funded from taxation, and even beginning to apply these same principles more widely. And built on reversing the increased role of the private sector in the NHS and the costs associated with tendering and complex procurement – it’s in the Manifesto and was set out in policy documents. The gulf is between those who think the future lies in the past and those who want a future where a Labour government (or perhaps two successive governments) brings improvements across our care system on the same scale and with the same drive that led to the start of the NHS 70 years ago.
With the current state of care a huge reorganisation on a scale never seen before would probably do immense damage to the delivery of care. For the present, dealing directly with the current crisis, making what we have work far better and eliminating some of the barriers to better care accompanied by increased funding and greatly improved pay and conditions is a better option. Let us all get behind Jeremy and the Manifesto.
Alan Walters, health policy analyst
Responding to the call for a £500m winter bail-out for the NHS, Niall Dickson, Chief Executive of the NHS Confederation, which represents organisations across the entire health and care system, said:
“In many ways the winter crisis is actually now an all year round crisis with hospitals and Emergency Departments struggling to meet demand and with bed occupancy at unsustainable and unsafe levels. Although additional money is always welcome, in terms of the next few months there is a limit to how much additional resources can make a difference. In many cases Trusts are simply not able to recruit the staff they need.
“Last year we were fortunate with the weather and the absence of a major virus – this year we may not be so lucky.
“We need to recognise just how dependent each part of the system is on other services – struggling or non-existent social care, shortages of community nurses and hard pressed GPs and mental health services will all have an impact on each other and on the Emergency Department.
“This must not just be left to Emergency Departments – every part of the system, from medical and nursing staff throughout hospitals, to all community and care services will be gearing up to do what they can to help during the next few months and they must be given all support that is possible – but we continue to argue that the system needs both reform and significant additional funding if it is to cope with the challenges of the next few years.”