The healthmatters blog; commentary, observation and review
Liverpool activist Greg Dropkin has weighed the claims of the NHS’ RightCare initiative, and found them wanting. (RightCare: wrong answers Journal of Public Health November 2017). RightCare is an NHS England programme that identifies opportunities for savings and quality improvements and describes itself as ‘a proven approach that delivers better patient outcomes’.
Greg Dropkin’s challenges the modelling assumptions made by RightCare (which have that all-to-easy flavour of a corporate consultancy about them), and the misinterpretation of dissimilar outcomes as opportunities for improvement. The difficulties of measuring unwarranted variation are well known, and have been documented by Appleby and others in a 2011 Kings Fund report (Variations in health care: the good, the bad and the inexplicable). Unwarranted variation is a slippery notion, even though it appears to be widespread in clinical practice.
The RightCare approach has advantages for the NHS, giving NHS England, the DoH and the Treasury the results they want – the appearance of better quality care with the impression of lower costs. It contributes to the current magical thinking about NHS finances, well displayed in the November Budget’s allocation of insufficient funding to services under considerable strain. Sadly, Dropkin’s argument is unlikely to dent this magical thinking much, first because the NHS being a centralised hierarchy within which conformity is highly valued, and secondly because the May government is as intransigent about the NHS as it is conflicted in the Brexit negotiations.
Worse, from the public’s point of view, is that faulty RightCare judgements may result in misallocation of resources through the allied CROC (Co-ordinated Reallocation Of Capacity) programme. For example, if the solution to unwarranted variation in cancer outcomes seems to be proton beam therapy (as some specialists and some commercial companies might suggest), the NHS will have to invest in plant and machinery, or buy treatment time in the small but growing network of commercial proton beam treatment centres.
However, if RightCare did not exist we would have to invent it. It attempts to address variations in the five tractable conditions that drive secondary care use (heart disease, hypertension, COPD, CKD and atrial fibrillation), and it is interested in under-use as well as over-use of services. Given that the care pathway standardisations introduced by QOF seem to have only limited impact on clinical outcomes or service use, this makes sense.
An example is RightCare’s Falls and Fragility Fractures Pathway, which defines the core components of an optimal service for people who have suffered a fall or are at risk of falls and fragility fractures. The NHS claims to be working on this, but other priorities have overshadowed falls and fractures, despite their huge cost. The Royal College of Physicians 2010 report Falling Standards, Broken Promises, documents the neglect of this problem. RightCare is right to pick up the problem, and its proposals for a pathway are appropriate and overdue.
The 2011 King’s Fund report recommended changing the focus of initiatives against unwarranted variation from achieving outcomes to fixing care processes (especially shared decision making). This favours pathways, which may be picked up by the Get It Right First Time initiative (GIRFT) as much as by RightCare. (Digression: Why does the NHS have two organisations trying to tackle unwarranted variation? Because they have both evolved from different NHS fiefdoms! The NHS may be centralised but it is not monolithic)
Shared decision-making is a noble enough idea, but in the NHS’s current toxic climate it too can be warped. ‘Choosing Wisely’ is a programme that aims to discourage doctors from using interventions that are not supported by evidence, free from harm and truly necessary. (Malhotra A et al Choosing Wisely in the UK BMJ 2015;350:h2308). The NHS in North West London recently asked the public their views on Choosing Wisely, a scheme which it said was “to help reduce waste”. Its proposals for consideration were: encouraging patients to buy medicines over-the-counter when they could; GPs to avoid prescribing medicines that could be purchased; and patients to collect their own repeat prescriptions rather than let pharmacies collect them. What begins as an attempt to improve the quality of care ends as a means to transfer costs to the user.
An incoming Labour administration should change RightCare without abandoning it. Duplication of effort is usually unhelpful, so RightCare and GIRFT should be merged. The emphasis on outcomes and the optimistic claims of savings must both go, to be replaced by evidence-based pathways that regulators could audit and evaluate. And campaigners could harry those in NHS middle management who try to sneak in service reductions or co-payments as part of a quality improvement drive.
Steve Iliffe, November 2017
The survey, conducted by researchers YouGov, included two questions for 20,000 participants: ‘Would you support increasing the basic rate of National Insurance from 12% to 13% and using the money raised to increase spending on the NHS?’ and ‘Would you support increasing the basic rate of income tax from 20% to 21% and using the money raised to increase spending on the NHS?’
Support at 58% for increasing National Insurance is strongest among ABC1s and the over-55s. A total of 27% oppose with 15% undecided.
Backing is above 50% in all areas of England, Scotland and Wales, with the highest in the South West, lowest in London.
Approval for increasing the basic rate of income tax from 20% to 21% is less strong at 48% with 36% opposed and 16% undecided.
Agreement is stronger from ABC1s and older people. It is highest in the South West and lowest in the West Midlands.
Niall Dickson, Chief Executive of the NHS Confederation, which represents organisations across the healthcare system, said:
“It is up to government how it raises funds for public services, but these figures clearly show not only that the public across the UK supports more resources for the NHS, but that they are willing to pay more tax to bring that about.
“The case for more money for both health and social care has been made and it is overwhelming. Just about everyone is calling on the Chancellor to act – from the health secretary himself, the head of NHS England and all our members who actually run the system, to the medical royal colleges, local government, as well as those representing patients, users and carers.
“Without action, our health and care system will continue to deteriorate; millions will wait, more will suffer and some will die. It is now clear that, even within government, the cries for more funding are unequivocal.
“It is time to do the Chancellor to do right thing – our members are happy to be held to account but their plea is ‘give us the financial tools to do the job’.”
Medtech company unveils tech to improve diabetes management
The age of finger-pricking will soon be over with the announcement of a non-invasive method for measuring the body’s blood glucose levels from German medical technology company, DiaMonTech.
DiaMonTech has created technology for a medical device which directly measures the presence of glucose molecules in the blood through an invisible infrared laser, giving a reading of a user’s blood glucose level within 15 seconds. All users need to do is place their finger on a sensor on the device and their blood glucose levels will be displayed in real-time.
With 400 million people suffering from diabetes worldwide, this new device will liberate many from the antiquated means of pricking their fingers and the potential health risks it carries. DiaMonTech’s technology enables unlimited measurements and consistent, constant reporting on the presence of glucose in the blood, giving greater control over managing your diabetes.
The breakthrough patented technology was developed by DiaMonTech’s Head of R&D, Professor Werner Mäntele, Director of the Biophysics Institute at Goethe University in Frankfurt. With over 30 years of experience in spectroscopy, Professor Mäntele’s leading work on molecule detection enabled the team to create an advanced laser, capable of measuring blood glucose with pinpoint accuracy.
“Developing a non-invasive device for the management of diabetes has been our top priority since day one,” says DiaMonTech’s CEO, Thorsten Lubinski. “With so many other devices that require a break to the skin, and with millions worldwide suffering from this disease, we made it our mission to help make the day-to-day monitoring of diabetes more manageable and less intrusive.”
“Unlike previous diabetic monitoring methods, which have focused on one particular layer of the skin to measure blood glucose, DiaMonTech’s approach means blood glucose is measured with ‘depth-profiling’,” says Professor Mäntele. “This method allows us to measure one’s skin at a multitude of different depths and is fine-tuned to measure glucose molecules rather than a high-level overview.”
A series of devices are planned with a larger desktop unit, ‘DMT Base’, scheduled for release in 2018, a pocket-sized device ‘DMT Pocket’ scheduled for 2019 and a smart-wristband, ‘DMT Band’, which will continuously monitor blood glucose, scheduled for 2021. Each device will be compatible with Android and iOS mobile devices, allowing you to check your information in real-time.
Health at a Glance 2017 says that all OECD countries have seen life expectancy at birth increase by over 10 years since 1970 to reach an average of 80.6 years. Life expectancy at birth is highest in Japan (83.9 years), and Spain and Switzerland (83 years each), and lowest in Latvia (74.6) and Mexico (75).
New analysis in the report reveals that if smoking rates and alcohol consumption were halved, life expectancies would rise by 13 months. A 10% increase in health spending per capita in real terms would, on average, boost life expectancy by 3.5 months. However it is not just spending per se, but also how resources are used, that makes the difference in life expectancy. There is a large variation in the link between changes in health spending and in life expectancy: in the United States, for example, health spending has increased much more than in other countries since 1995, yet life expectancy gains have been smaller.
Health spending per capita has grown at around 1.4% annually since 2009, compared to 3.6% in the six years up to 2009. Average spending per capita has now reached about USD 4 000 per year. Spending is highest in the US, at USD 9 892 per person, and 17.2% of GDP. Health spending was also 11% or more of GDP in Switzerland, Germany, Sweden and France.
Reducing wasteful spending is key to maximise the impact of public resources on health outcomes, and Health at a Glance illustrates areas where spending could be more effective. For example:
- Increased use of generics in most OECD countries has generated cost-savings, accounting for more than 75% of the volume of pharmaceuticals sold in the US, Chile, Germany, New Zealand and the United Kingdom, but less than 25% in Luxembourg, Italy, Switzerland and Greece.
- Antibiotics should only be prescribed when absolutely necessary, yet antibiotic prescriptions varied more than three-fold across countries, with Greece and France reporting volumes much higher than the OECD average.
- The share of minor surgeries provided on a same-day (rather than inpatient) basis is now common in most OECD countries. For example, day surgery now accounts for 90% or more of all cataract surgeries in 20 of the 28 OECD countries with comparable data. However less than 60% of cataract surgeries are performed on a same-day basis in Poland, Turkey, Hungary and the Slovak Republic.
The report also shows that health care quality is improving:
- Over 80% of patients report positive experiences in terms of their time spent with a doctor, easy-to-understand explanations and involvement in treatment decisions.
- Avoidable hospital admissions for chronic conditions such as diabetes and asthma have fallen in most OECD countries, indicating an improving quality of primary care.
- Fewer people are dying following heart attack or stroke. Improvements are particularly striking among heart attack patients in Finland, and stroke patients in Australia.
- Across OECD countries, five-year survival rates for breast cancer were 85% and just over 60% for colon and rectal cancers, with survival rates improving in most countries over time.
While smoking rates continue to decline, there has been little success in tackling obesity and harmful alcohol use, and air pollution is often neglected:
- Smoking rates have decreased in most OECD countries, but around one in five adults still smoke daily. Rates are highest in Turkey, Greece and Hungary and lowest in Mexico.
- Across the OECD, alcohol consumption has declined since 2000. However, consumption has increased in 13 countries over the same period, most notably in Belgium, Iceland, Latvia and Poland. Moreover, one in five adults regularly binge drink across the OECD.
- 54% of adults in OECD countries today are overweight, including 19% who are obese. Obesity rates are higher than 30% in Hungary, New Zealand, Mexico and the United States.
The report, together with country notes and more information, is available at http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm.
Belfast today, Home Counties tomorrow!
This health service funding business is easy, ask any Ulster politician. Recently all five Trusts in Northern Ireland consulted on proposals for significant cuts in services in order to meet their legal duty to stay within their 2017/18 budgets. If implemented, the cuts would have potentially impacted severely on the health of people in Northern Ireland. Fortunately the Department of Health (Northern Ireland), announced shortly after the consultation ended that the worst of the cuts would not go ahead, and that additional funding would be made available for both health and education. There are lessons here. First, health and social care are integrated in Ulster but the downside is that Trusts must stay in budget, like English local governments but unlike the English NHS. Second, money will be found when necessary – necessity in this case being the dependence of May’s government on Ulster MPs. So, logically, friends of the NHS should make the Conservative government pay handsomely to avert loss of seats. Did anyone say ‘Stuff Integration’ or ‘Progressive Alliance’?
Will the love-hate relationship between the NHS and information technology ever change? University Hospitals of Leicester Trust pulled out of the East Midlands Radiology consortium after meeting with radiologists, amid mounting concerns for patient safety and repeated system failures. The consortium was developed to link eight hospital trusts’ imaging systems to deliver savings and improve care, but it has been prone to breakdowns. The Health Service Journal (31st October 2017) reported that some consultants sent images on CDs via taxis for specialist review. This is bad news, because the IT story about imaging has been a positive paragraph in the wider and less optimistic tale about the NHS’ adoption of new technology. No more, it seems.
So how will the NHS adapt to Artificial Intelligence (AI)? Latest research suggests that AI could detect cancer in less than a second. A trial has found that AI systems were able to distinguish potentially dangerous bowel tumours from harmless growths with high levels of accuracy. In the trial the AI system was able to distinguish tumours in endoscopy images with 94 per cent accuracy (Laura Donnelly, Daily Telegraph, 29th October 2017). But will NHS users prefer a friendly face to a silicon chip when it comes to using AI diagnostically? Information Management Company OpenText says yes! Its research suggests that that UK consumers, too, see the advantages of the technology: A quicker diagnosis was identified as the biggest benefit, with one in three (33%) UK consumers believing robots would reach a decision on their condition much faster; As well as faster diagnosis, one in four (25%) British consumers believe they would get a more accurate diagnosis from AI; A quarter of UK consumers (25%) said robot technology would mean they wouldn’t have to rely on booking an appointment with a GP, while 24% said the biggest benefit would be no longer having to take time off work to visit a doctor. So who would perform the endoscopy, ask News from Nowhere’s moles?
If AI is going to be a problem for the NHS, what about ‘customer journey management technology solutions’? Software company Qmatic (www.qmatic.com/ukhealth), thinking about numerous outpatient and GP appointments being missed, offers solutions. Healthcare facilities need to walk in the patient’s shoes by thinking about where the experience starts and deploying an approach that is connected throughout the entire patient journey. For example, implementing an online booking system enables healthcare facilities to reduce the number of failed appointments by delivering mobile reminders to patients who have upcoming appointments. This ensures patients are aware of their consultations and can cancel or reschedule these if necessary. It’s key that the online booking process is connected to staff profiles and availability. When connected, it can increase efficiency and deliver a great patient service by facilitating ease of booking, notifications and reminders and can be agile to patient changes.
Additionally, the system needs to be linked to the patient arrival. This is particularly important for outpatient clinics, which can be difficult to navigate, as there are numerous individual waiting areas. Self-service check-in kiosks, mobile applications or even robot helpers – all enabled with appointment scanning technology – can notify staff of the arrival of the patient and provide the patient with the information they need to put them at ease and assure them they are in the process. Healthcare providers will know exactly where their patients are at all times and why they are there, this reduces delays in providing a healthcare service. Connected solutions such as these are able to direct patients to the right service point at the right time and reduce the need for staff intervention, creating a smoother, efficient patient journey.
Ultimately, says Qmatic, great patient service is a journey that begins before the examination room and endures long afterward with a dedicated and personal follow-up, which a connected online booking system and arrival solution can enable. In fact, by implementing patient journey management technology solutions, clinics, hospitals, pharmacies and labs can create a seamless patient journey, improve the speed and quality of service, increase employee productivity, lower patient anxiety, and secure the bottom line.
General practitioners are under increasing pressure to scale up, by making federations and super-practices, or by merging with Acute Hospital trusts. The Royal Wolverhampton Trust in the West Midlands is now running nearly a fifth of GP practices in its area, after incorporating its eighth practice as part of a vertical integration programme it began in 2016. The integration of the latest practice last week takes the trust’s population coverage with GP services from 41,327 to 52,862. This has happened despite Royal Wolverhampton trust not being one of NHS England’s national vanguard sites. Perhaps being unencumbered by NHS England’s anxious experimenters has advantages?
Not to be left out, Clinical Commissioning Groups are merging. For example, the six CCGs covering Staffordshire have appointed a single ‘accountable officer’. According to the Health Services Journal (November 3rd 2017), the Staffordshire and Stoke on Trent sustainability transformation partnership (STP), which the six CCGs are a part of, is in the national capped expenditure process and faces significant financial challenges. One CCG, East Staffordshire, is in very large contract dispute with Virgin Care. HSJ readers did not spare their words: “A basket-case of a health economy whose weak, disorganised commissioners were bullied for years by a monopolising, avaricious community trust and dysfunctional acute trusts”. Ooh er!
Mergers of CCGs have reduced their number from 211 in 2013 to 195 next year, and the HSJ (7th November 2017) is speculating about a total of around 150 (so back to primary care trusts), or even 50, or possibly just 20-30 regional managers. There’s never a dull moment in the modern NHS, and there could be no better time to choose a management career in it.
Alzheimer’s Research UK, the UK’s leading dementia research charity, has welcomed a government plan to speed up the way new treatments are introduced on the NHS. The plan takes forward several recommendations from last year’s Accelerated Access Review – which examined how advances in medicine could be made available to patients faster – and could have major implications for future dementia treatments.
Among the actions announced is the creation of a new ‘Accelerated Access Pathway’ for selected breakthrough treatments and medical technologies that fill an unmet need, transform patients’ lives or dramatically improve efficiency. This pathway would streamline the regulatory process to allow these treatments to be made available up to four years earlier – but the report warns that any new medicines leading to increased costs for the NHS would need to be offset by other, cost-saving treatments. Meanwhile, companies would also be expected to offer new treatments and technologies to the NHS at the best possible value for money.
Hilary Evans, Chief Executive of Alzheimer’s Research UK, said:
“Today’s announcement marks a real step in the right direction and could have major implications for people with dementia. With no treatments yet available to stop or slow the diseases that cause dementia, there is a huge unmet need, and we hope the approach announced today will ensure that people with dementia will not have to wait for medical advances to reach them. The ambitions outlined today have the potential to transform the way breakthrough treatments are delivered to the people who need them, and it’s vital that their views are at the centre of any decision-making about which treatments are classed as ‘breakthrough’.
“We recognise that new treatments for dementia could pose a challenge for NHS budgets, so early discussions between the NHS and drug companies will be crucial to allow our health services to plan ahead. At Alzheimer’s Research UK it’s our mission to bring about the first life-changing treatment for dementia by 2025, which is why we will be working to support these discussions and develop solutions to this challenge.”
AbbVie puts creativity at heart of health problem-solving with unique group of experts including animators and gamers
Today, global research-based biopharmaceutical company, AbbVie, is announcing a unique line-up of experts from the creative, health and tech industries, including Aardman (the studio behind Wallace & Gromit and Shaun the Sheep). The experts, who are part of the Live:LabTM project, have been brought together to tackle the complex health issue of the ‘Fear of Finding Out’ (FOFO) – a major psychological barrier which prevents people from seeking medical advice when they have worrying symptoms[iii].
Former Health Minister, Alan Milburn, is chairing the group of Live:LabTM collaborators who comprise filmmakers, animators, gamers, data specialists and health experts – with the likes of award-winninggame designers Glitchers, medical virtual reality experts FundamentalVR, the Open Data Institute, Professor Sir Muir Gray and TV doctor Dr Zoe Williams, joining the line-up.
The experts will draw on their experience on the power of storytelling and characters, the benefits of data and tech, and real-life medical experience. The aim is to create a positive new approach to help the public and NHS to overcome barriers that stop people coming forward for early diagnosis and treatment.
A new short film is being released today, documenting the Live:LabTM collaborators meeting to discuss ways new technologies and data collection can revolutionise our approach tackling barriers to health.
Studies show that addressing concerns in middle age can double individuals’ chances of being healthy when you are 70[iv]. Live:Lab’sTM aim is to help people feel positive and empowered to take control of their own health and wellbeing, which in turn will help them to overcome the barriers that prevent them from seeking health advice and delay diagnosis. Live:LabTM complements NHS England’s ‘Five Year Forward View’ by focusing on improving health prevention, supporting a more sustainable NHS.[v] Never before has the ‘Fear of Finding Out’ been addressed by such a broad range of experts, collectively.
Speaking about the project Live:LabTM collaborator, Sir Muir Gray CBE, said: “We’re increasingly seeing evidence which shows that people respond far better to positive health messages, which in turn means they are more likely to engage with the health service. I’m a firm believer that healthcare is what you do for yourself and through the work we’re doing with Live:LabTM, we’re hoping to devise a solution which will help people feel empowered and in control of their health and wellbeing.”
Heather Wright, Executive Producer and Head of Partner Content at Aardman and Live:LabTMcollaborator, comments: “I am passionate about the NHS and I was a little surprised that a major pharmaceutical company, like AbbVie, would want to look outside the industry for answers and explore the territory of preventative health. I was even more surprised when I first learnt about who else is part of Live:LabTM – from game developers, to tech experts. The aspirations for Live:LabTM, such as breaking down barriers to form progressive partnerships to support the NHS, are something I really respect. I feel we have the potential to help make a real change to healthcare.”
Jérôme Bouyer, AbbVie General Manager, commented: “As an innovation led science company we, and in fact healthcare organisations more widely, are used to thinking in terms of logic and evidence. We come at problems from the world of fact based evidence. But life experience shows that we’re not always logical in how we think about our own health. The decisions we make have a big impact on what help we can get from doctors. If we are going relieve the huge strain on the NHS, we must get creative and we can only do this by bringing in the most creative minds from outside of healthcare. This is what AbbVie is trying to encourage through this collaboration.”
The Live:LabTM collaborators are:
- Rt Hon Alan Milburn – former Secretary of State for Health
- Simon Bullmore, Open Data Institute – a non-profit company with a mission to inspire people to innovate with data
- Julia Manning, Chief Executive, 2020health – an independent, social enterprise think tank whose mission is to ‘make health personal’
- Aardman – world leading and multi-award winning British studio which produces series, advertising, interactive entertainment, attractions and feature films; like Wallace & Gromit andShaun the Sheep
- Glitchers – a company creating innovative gaming products including Sea Hero Quest, an award-winning mobile and virtual reality game which collects spatial navigation data to inform dementia research
- Professor Sir Muir Gray – founder of the National Library for Health and the first person to hold the post of Chief Knowledge Officer of the NHS
- Dr Zoe Williams – media medic, GP and clinical champion for the RCGP’s clinical priority ‘Physical Activity and Lifestyle’
- Dr Carmen Lefevre – research associate and research lead at the UCL Centre for Behaviour Change
- Alison Hardy – health behaviour change expert and founder of Headstrong Thinking
- Fundamental VR – medical VR simulation specialist that delivers virtual reality haptic ‘flight simulators’ for surgery
- Dr Angel Chater – chartered psychologist, and a reader in Health Psychology and Behaviour Change at the University of Bedfordshire
- Chrissie Wellington OBE – Global Head of Health & Wellbeing, Parkrun, and British triathlete
- Daniel Hulme, CEO of Satalia – a company pushing the boundaries of data science, optimisation and artificial intelligence to solve the most difficult problems in industry
Further background on all of the collaborators can be found on the Live:LabTM website, which is also where the second short film in the Live:Lab TM series an be viewed.
i) Institute for Health Metrics and Evaluation (IHME). GBD Compare – Public Health England. Seattle, WA: IHME, University of Washington, 2015. Available at: http://vizhub.healthdata.org/gbd-compare [Last Accessed: 11 February 2016]
[ii] 2020health: The Fear of Finding Out – Identifying psychological barriers to symptom presentation and diagnosis in the UK. 2017. Available at http://www.2020health.org/2020health
[iii] 2020health: The Fear of Finding Out – Identifying psychological barriers to symptom presentation and diagnosis in the UK. 2017. Available at http://www.2020health.org/2020health
[iv] Lang, I. A., et al. (2012). Healthy Behaviours in Middle Age and Long-Term Consequences for Mortality, Physical and Cognitive Function, and Mental Health. J Epidemiol Community Health. 66:A1-A66
[v] NHS England. Five Year Forward View. Available at: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf [Last Accessed: April 2017]
[vi] Dryden, R. et al., 2012 What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health 2012, 12:723
[vii] Public Health England – Modern life responsible for ‘worrying’ health in middle aged’. Available at:https://www.gov.uk/government/news/modern-life-responsible-for-worrying-health-in-middle-aged [Accessed Jan 2017)
[viii] Public Health England – Living healthily in midlife can double your chances of being healthy at 70 and beyond. Available at:https://www.gov.uk/government/news/phe-launches-one-you [Accessed Jan 2017].
Mental Health Network welcomes findings of Stevenson-Farmer independent review into workplace mental health
“We welcome this report’s approach to prioritising the mental health of the workforce and keeping mental health high on the healthcare agenda.
“Key to alleviating some of the pressures we are currently seeing within the mental health sector is the support offered to individuals before they reach crisis. Empowering employees to look after their own mental health is a crucial step towards this.
“The evidence shows that improving employee mental health is both beneficial to the individual and good for business, paying dividends in terms of morale, retention and productivity.
“The NHS has made great progress in this area. For example, the South London and Maudsley NHS Foundation Trust has introduced several initiatives as part of its happier@work project.
“This programme includes workshops on mental health awareness; skills workshops for managers; and practical skills for peace of mind, managing wellbeing and stress awareness.
“The more support the Government offers to spread these types of initiatives, the better.”
Stroke claims an estimated 6.2 million lives globally each year: World Stroke Organization
How happy we are can have a long-term impact on our risk of suffering a stroke, a leading US-based doctor has said ahead of World Stroke Day activities on Sunday, October 29.
Andrew Russman, D.O., Head of the Stroke Program and Medical Director of the Comprehensive Stroke Center at the Cleveland Clinic, says emotional wellbeing is often a deciding factor in whether we make healthy or unhealthy lifestyle choices. Even mild stress or feelings of unhappiness can lead to major health incidents.
“If we look at stress, as a prime example, people will very often deal with the emotional upset by making bad lifestyle choices, such as increased smoking or alcohol use, or eating junk food,” said Dr. Russman. “That leads to obesity, high blood pressure, diabetes, all coming together as a significant increase in our risk of stroke.”
A stroke occurs when there is a problem getting blood to the brain, either because of a blockage or a ruptured blood vessel. When this happens, the brain does not get enough oxygen, causing brain cells to die. Stroke claims an estimated 6.2 million lives globally each year, according to the World Stroke Organization, more than AIDS, tuberculosis and malaria combined. It is also a leading cause of disability.
A number of factors increase the risk of stroke:
- Excess weight — Obesity can lead to heart disease and high cholesterol, which can lead to a stroke.
- Heart problems — Strokes are six times more likely to occur in people with cardiovascular disease. Atrial fibrillation, one of the most common heart rhythm problems, increases your risk of stroke by about five times.
- High blood pressure — Strokes are four to six times more likely in people with hypertension.
- High cholesterol — People with high cholesterol are at double the risk of having a stroke.
- Heavy drinking — This increases the risk for stroke and cardiovascular disease.
- Smoking — If you smoke, you double your risk for stroke compared to nonsmokers.
Dr. Russman says that while specific data on the impact of mental or emotional health on the likelihood of stroke is limited, research is emerging that shows a link. One Japanese study published earlier this year used unemployment as commonly identifiable sign that someone had experienced a period of high personal stress, and analyzed the histories of around 40,000 men and women aged 40 to 59 years.
“The results showed a clear correlation between the stress caused by job loss, and increased smoking, alcohol use, high blood pressure and diabetes, and ultimately to an increase proportion that suffered a stroke,” said Dr. Russman. “This didn’t only apply to those who experienced long-term or multiple periods of unemployement. Even just one incident of job loss increased the risk.”
When a person does experience a stroke, being able to recognize the signs can greatly increase the odds of a better outcome. Time is critical, and time saved can make the difference that allows a person to walk again, or to go home instead of going into a nursing home.
Some people will experience warning signs before a stroke occurs, which is called an ischemic attack, or a mini stroke.
To check for signs of a stroke, and to respond appropriately, always remember the words ‘BE FAST’:
B = Balance – Is the person having trouble with balance?
E = Eyes – Is the person having visual problems?
F = Face – Is there droopiness in the face?
A = Arms – Is there any weakness in the arms or legs?
S = Speech – Is the person having difficulty speaking?
T = Time – Time to call for an ambulance.
World Stroke Day is observed on October 29 each year, and is an initiative of the World Stroke Organization. It aims to underscore the serious nature and high rates of stroke, raise awareness of the prevention and treatment of the condition, and ensure better care and support for survivors.
Cutting corners, spoiling lives?
Child and adolescent health services have been having a very hard time over the last few years, with referrals exceeding staff capacity, a shortage of in-patient beds and transfer of young people with severe mental illnesses or behaviour problems to distant units for care. The commercial sector has been involved in children’s mental health service provision, just as in learning disability and adult psychiatry, and the results have too often been ugly.
The HSJ broke the news on October 24th that a third private sector operated children’s mental health unit – Watcombe Hall in Torquay, run by the Huntercombe Group – had closed during a CQC inspection. It has now closed indefinitely after several safeguarding inquiries were launched. Torbay Hospital raised the alarm about young people with malnutrition and dehydration being admitted from the unit.
Watcombe Hall is the third privately run children’s mental health unit to close. The other two other units, both run by Cygnet Health Care, have subsequently reopened. The CQC report on Watcombe Hall highlighted:
- Patients’ physical health was not always checked – one patient had not eaten or drunk for four days.
- Weighing of patients with eating disorders did not always follow medical instructions.
- Staff had not received specific training in caring for young people with eating disorders.
- A group of three young people overpowered staff before absconding from the unit.
- There was a high level of serious incidents, including 18 in the first three months of 2017, as well as 38 staff injuries in six months.
- Four patients were restrained 29 times or more during their stay on the unit.
- Staff turnover affected care quality and new staff were not adequately trained, inducted and supervised. Only half of staff had up to date safeguarding level three training despite this being mandatory.
- Some young people had not engaged in any activities for three months and use of outside areas and the gym was very limited.
- Inspectors saw a young person climb a fence and abscond, during the CQC inspection.
NHS hospitals could carry out 280,000 more non-emergency operations a year by organising operating theatre schedules better, according to a study in 100 NHS Trusts conducted by NHS Improvement, that was leaked to the BBC on October 24th. The research, using data from 2016, found more than two hours were wasted each day on the average operating list. The study says avoidable factors like late starts led to the loss of time.
Ex A&E doctor Chris McCullough, CEO and Co-Founder of Rotageek has a few things to say on this matter. “The real issue, not mentioned in this study, is one of ineffective use of data to schedule and manage hospital resources. Hospitals are run at such high capacity that operations are actually often delayed until managers know they have a bed available for patients arriving for surgery. Ready-to-start surgical teams cannot start a procedure by anaesthetising patients until a bed has been allocated. In turn, this won’t happen until the ward medical team have created space by seeing all patients and sent people home. As a result, operations start later than planned and waste theatre capacity.
“The only way to solve this crisis is for the NHS to use the data it already has available to better manage and predict hospital capacity and patient flow – impacted by variables such as the quantity and condition of patients, available staff and their skillset, as well as medical resources.
“By analysing the flow and pattern of patients, from admittance to surgery through to final discharge, hospitals can predict the effect of any scenario on each individual hospital department and the system as a whole. This simulation offers several benefits; it can monitor hospital operations, predict future bottleneck days or weeks, diagnose where and what could be done to avoid or fix problems, and it can assess where more staff are needed to help plan for accurate hiring.
At the moment, the NHS is forced to be reactive to scheduling when it could actually be much more proactive. Management can only see a problem when it’s too late, as they are unable to make sense of all the moving components within the system. This means it is impossible to have certainty over where to make real efficiencies, let alone anticipate capacity problems in real-time for elective patients.”
News from Nowhere’s moles agree, and ask: why haven’t all hospitals sorted this, it is not a new story?
A&E attendances, not as rushed as some say?
On 17th October the Care Quality Commission (CQC) published the results of the Emergency Department Survey 2016, co-ordinated by the Picker Institute. The survey was ; 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 have 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.
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.
The survey highlighted problem that arose when patients left the department or unit; 30% of respondents weren’t given enough information about danger signs watch out for on returning home; and 37% were not given enough information about what medication side-effects they should watch out for. About 45% of respondents stated that their home situation was not taken into account when they left the emergency department, and 34% were not informed about when they could resume normal activities, such as driving.
A caveat from Health Matters: The 2016 survey of emergency departments involved 137 acute and specialist NHS trusts with a Type 1 accident and emergency department. Type 1 departments are consultant-led A&E departments with full resuscitation facilities operating 24 hours a day, 7 days a week. Forty nine of these trusts also had direct responsibility for running a Type 3 department and patients from these departments were included within the survey for the first time in 2016. Type 3 departments are minor injury units and urgent care centres that treat patients for minor injuries and illnesses, and which can be doctor or nurse led.