The healthmatters blog; commentary, observation and review
What people management practices can improve wellbeing? And how can we track and measure job quality in the UK?
NHS Confederation: Winter stats prove hospitals suffering because of insufficient out-of-hospital care
Responding to NHS England’s winter situation report, Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare system, said:
“Preliminary figures are indicating that services are already under a huge amount of strain – and that’s without a flu outbreak and cold weather. A weather warning has already been issued for this weekend – so things are likely to get worse.
“The Ambulance sector is under real pressure with continuing rising emergency activity and delays at some hospitals. Like everyone else, they are just-about-coping, but that’s largely thanks to the fact we are better prepared for winter than ever before.
“It’s vital we remember that winter planning and resilience isn’t just about hospitals and emergencies – it’s also about local services such as GP surgeries and mental health provision.
“Only by focusing more on out-of-hospital care can we even begin to reduce the demand on the hospitals which are now at bursting at the seams.
“The number one priority needs to be fundamental reform of social care provision – but sadly the political class continues to kick the issue down the road.”
Alzheimer’s Research UK is asking the government to give more priority to dementia as plans develop to support the Life Sciences sector.
The Sector Deal announced today (6 December) represents yet another step forward by government to establish the UK as a global leader in health research. However, Alzheimer’s Research UK, the UK’s leading dementia research charity, would like to see a solid plan for how the government will address the rising threat posed by Alzheimer’s and other dementias, currently the leading cause of death in the UK.
This is particularly important as plans released in recent weeks have failed to include Alzheimer’s or dementia in name, including in the government’s Ageing Society grand challenge.
Dr Matthew Norton, Director of Policy and Strategy for Alzheimer’s Research UK, said:
“To meet the needs of an ageing society, dementia must be a focal point for the strategy, as well as in the support outlined in plans like the Life Sciences sector deal. Alzheimer’s Research UK is asking government to consider how it will include dementia, the UK’s leading cause of death, as plans for the Life Sciences Strategy develop.
“The development of the Health Advanced Research Programme (HARP) will be critical in how the government addresses dementia. We look forward to seeing additional information on HARP and so-called ‘moonshot’ programmes that could be crucial for achieving early diagnosis for conditions like dementia, which can develop 20 years before symptoms appear.
“We are glad to see the government highlight the importance of including charities in the development of these programmes, and would encourage discussions to take place as early as possible. Alzheimer’s Research UK would like to see the government include a wide range of charities in discussions to ensure benefits are maximised across a number of important health areas.
“Dementia presents a growing public health issue that will not resolve itself. The condition currently affects 850,000 people in the UK, with that number predicted to grow to over a million in just seven years. We must make dementia a priority if we are to bring about the first life-changing treatment and bring an end to the devastation it causes for families not just in the UK, but around the world.”
Three quarters of Brits have cured an ailment or illness after Googling the symptoms on the internet, a study found.
Research revealed that seven in ten of us now self-diagnose and treat minor health issues rather than try and secure an appointment with their local GP.
It also emerged the average adult now believes they can beat two thirds of all bugs, viruses and illnesses without professional medical attention.
And that has lead to the typical adult only actually visiting their doctor twice a year.
A spokesperson for Future You, which commissioned the study, said: “I know a lot of people who would rather soldier on than go and see a doctor for a cough or a cold.
“And a lot of people with less severe symptoms know that a bit of rest, some healthy food and a good night’s sleep can be enough to let you recover and set you straight again.”
The study also found 75 per cent of Brits have warded off sickness with a trusty home remedy in the past.
And more than seven in ten are convinced a change to their diet at one time or another in their lives has helped to improve their general health.
Despite our inquisitive ways, only one third of keen ‘keyboard doctors’ have ever made their GP aware they have researched their symptoms ahead of their visit.
When illness occurs, two in five of us are reluctant to book an appointment with our GP, preferring to treat the symptoms ourselves or wait for the problem to resolve itself.
Seventy eight per cent are unlikely to bother their GP if they came down with a cold, and a quarter would rather wait for their conjunctivitis to clear up on its own rather than book an appointment.
Two thirds reckon they have the means at home to cure themselves of a troubling cough, and sixty four per cent are prepared should a sore throat strike.
One in five Brits surveyed by OnePoll wouldn’t deem arthritis or joint pain a serious enough ailment to warrant a visit to the doc, and 66 per cent would avoid the dentist’s chair even if a toothache flared up.
However, chest pain raises particular concerns, with only four per cent confident they could identify the cause of a sore chest, and nine in ten aren’t sure in their abilities to clear up a chest infection without specialist advice.
When it comes to trusty home remedies three in five swear by a hot glass of honey and lemon to beat a croaky throat, and 17 per cent turn to citrus fruit to reduce symptoms when suffering from a fever.
According to self-treating Brits it’s mum who’s most likely to recommend a home remedy when ill-health hits, but one in ten have even been recommended an obscure cure by their doctor.
Forty one per cent take pre-emptive health action and add supplements and vitamins to give their diet a boost.
When it comes to popular food health trends, one in six are familiar with the 80/20 diet, and twelve per cent believe they could identify inflammation-fighting foods like Turmeric.
Twenty six per cent believe Turmeric can help to increase the level of antioxidants in the body, and one in ten think the plant can help to improve brain function.
The spokesperson added: ” Turmeric has been used as a traditional remedy in India for thousands of years including for coughs and colds. Only more recently have we learned that the good stuff in turmeric is curcumin.
“And the secret to getting more of the good stuff to your body is to use other ingredients to boost absorption (bioavailability) as we do by using soy lecithin in Turmeric+.”
TOP 20 AILMENTS MOST LIKELY TO BE TREATED AT HOME
1. Common cold
2. Sore throat
5. Cold sore
8. Warts / verucas
16. Allergic reaction
17. Arthritis and joint pain
18. Swollen glands
20. Chest infection
Deployment of resources and appointment attendance can be improved through effective patient journey management
The NHS is operating under unprecedented financial pressure, with funding barely keeping pace with demand, as demographic changes mean more and more people are utilising its services. However, a focus on the patient journey can play a crucial role in processing outpatients by minimising the effects of bottlenecks like reception desks and enabling healthcare authorities to deploy their resources more effectively. This is according to Vanessa Walmsley, Managing Director at Qmatic, who suggests that healthcare authorities must implement a patient journey management strategy that guides patients to the right service point at the right time to reduce the need for staff intervention, allowing them to focus on more value-added activities.
Vanessa explained: “Outpatient clinics often involve several different patient procedures in one visit and these procedures need to be co-ordinated to ensure a frictionless and well-organised process. A holistic patient journey management strategy can help healthcare authorities to make this process more efficient, guiding patients right through booking their outpatient appointment, keeping them informed of the status of their appointment and giving them vital information about where to go when they arrive at the hospital.”
A good patient arrival process involves a smooth check-in based on a well-managed appointment. It can be offered either by a helpful staff member at the door equipped with a mobile tablet to concierge patients and provide support, or self-serve kiosks and even robot helpers. Patients can select kiosk options or simply scan a bar code or QR code from their appointment confirmation. As a result, the patient receives just the right amount of information and it subsequently reduces the need to seek staff intervention or advice reducing the strain on resources.
A well executed patient journey management strategy can also steer patients to off-peak hours through an intelligent calendar booking system. The result of this is that the number of patients visiting the clinic becomes more predictable, allowing for better planning of resources so that more clinical time can be spent with individual patients and improving quality of care. Missed appointments, however, can be a significant drain on healthcare services’ resources. As such, implementing a patient journey management strategy that can send reminders to patients, via SMS or email, about their appointment can help to reduce the incidence of missed appointments.
Vanessa concludes: “From enabling authorities to deploy their resources more efficiently, to improving appointment attendance and the agility of healthcare services to respond to walk-in patients, healthcare authorities can significantly improve the efficiency of processing outpatients with a well-managed patient journey. However, healthcare authorities must consider the people they serve, and recognise that many of their patients may choose to interact with their services through more traditional channels. They must ensure that they give all their patients a choice of how they access their services, from the moment they book their appointment, to their arrival at the facility and their progression through the outpatient process.”
For further information on how to improve the patient experience, view Qmatic’s latest eBook:www.qmatic.com/ukhealth
Alzheimer’s Research UK is asking the government to increase financial support for dementia research as part of its Industrial Strategy plans.
The Industrial Strategy white paper launched today (27 November) outlines a commitment to research and development and the life science sector, and emphasises the need to support an ageing population. Alzheimer’s Research UK, the UK’s leading dementia research charity, is arguing that the focus on healthy ageing must include a plan to bolster research in dementia, which is now the UK’s leading cause of death.
The charity is asking the government to use the additional £7bn in research and development funding, billed as the “biggest ever increase in public funding of R&D”, to increase its annual investment in dementia research to a minimum of £132m by 2022. This represents a doubling from the current annual investment of £66m.
In addition, Alzheimer’s Research UK would like to see dementia research overtly included in the following proposed initiatives:
-Health Advanced Research Programme (HARP)’s early diagnosis platform that would work to help diagnose diseases like Alzheimer’s that develop before symptoms appear.
-Increased tax credits offered for research & development that helps encourage pharmaceutical companies to take on costly research into new treatments that is riskier but could bring significant rewards if successful.
-Systems that coordinate anonymised patient information to provide researchers with large-scale population data, like the Digital Innovation Hubs.
-Strengthening research innovations in clinical sciences, health and medical sciences, and biological sciences, which fall behind other UK research fields according to the white paper.
Hilary Evans, Chief Executive of Alzheimer’s Research UK, said:
“The government has made encouraging progress in building infrastructure and financial support that could help bring about the first life-changing treatment for dementia, and we must not lose this momentum. Today’s white paper estimates that one in three children born today could live to 100, but we also know that a third of them will develop dementia in later life unless new treatments and preventions can be found.
“A commitment to early diagnosis, like the proposed Health Advanced Research Programme (HARP), is central to efforts to develop effective treatments. Meanwhile the development of Digital Innovation Hubs represents the kind of big data approach that is necessary to tackle the world-wide threat dementia poses. Dementia research must be a collaborative effort, and Alzheimer’s Research UK is committed to working with the government and partners around the world to undertake the best research possible.
“With increased funding in dementia research in recent years, the UK has seen a doubling in the number of researchers and findings produced, the highest percentage increase in the world. However, funding for dementia research still lags behind other serious conditions.
“As we prepare for people to live longer than ever before, we must place an emphasis on overcoming dementia and other conditions that rob people of quality of life in their later years.”
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.