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The healthmatters blog; commentary, observation and review

MEASURING NATIONAL WELLBEING: QUALITY OF LIFE IN THE UK, 2018

Posted by on Apr 25, 2018 in Blog | 0 comments

MEASURING NATIONAL WELLBEING: QUALITY OF LIFE IN THE UK, 2018

The Office for National Statistics releases its annual article on the wellbeing of the UK. Rhian Jones and Chris Randall, Quality of Life, Office for National Statistics share the headlines.

Once a year, we report progress against a set of headline indicators covering ten areas including our health, natural environment, personal finances and crime.

Traditionally, this has focused mainly on headline figures for the whole population. To increase the value of our work to decision-makers and in keeping with our aspiration to ‘leave no one behind’, we are taking a new approach. We now look beneath the overall figures to understand how people of different ages may be struggling or thriving in the UK today.

KEY FINDINGS

  • Older people fare well, but 75+ less satisfied with health

Those aged 65 and over are currently faring better on many measures of social and financial wellbeing than their younger counterparts. However, it is important to remember that people aged 65 and over represent a diverse group, with those over 75 particularly noting less satisfaction with health as people move into their 80s.

  • Younger adults experience poorer mental health, loneliness and unemployment

Among younger adults (broadly from 16 to 24), we have highlighted a range of ways in which their experiences of life in the UK today appear to be more challenging. Compared to older people, they are more likely to be:

  • physically active
  • more satisfied with their physical health.

However, they also:

  • are more likely to report symptoms of mental ill health
  • are less likely to feel they have someone to rely on or a sense of belonging in their neighbourhood
  • have higher rates of unemployment and more frequently report loneliness.

This matters both at an individual level and for society as a whole, in terms of how well we will be able to sustain high levels of national wellbeing into the future.

  • Early and middle aged adults less satisfied with work-life balance

Those in their early and middle years are generally more likely to be in employment but face several challenges that may be linked to more demands placed on their time and the more difficult balance between work and family commitments. In particular, those people aged 25 to 54 are less likely to be satisfied with their leisure time.

NEXT STEPS

This year, we are establishing a Centre of Expertise on Ageing and Demography. This will set out our ambition for a comprehensive and coherent workplan for improving the evidence on the impacts of an ageing population.

We will also be establishing a Centre of Expertise for Inequalities. The aim of this centre will be to ensure that the right data are available to address the main social and policy questions about fairness and equity in our society, that the relevant analysis is taken forward and that we are using the most appropriate methods.

Both these centres will involve partnerships across government, academia and other organisations to identify where better evidence is needed and to make better use of new and existing data sources.

HAVE YOUR SAY!

The end of the high street gym? Health mad Brits turn to online tech

Posted by on Apr 25, 2018 in Public Health | 0 comments

The end of the high street gym? Health mad Brits turn to online tech
Almost a third of UK adults use health apps every week, with 21% doing so instead of visiting personal trainers or gyms

One in ten have even used technologies to detect or diagnose a medical condition

New research among more than 2,000 UK adults by WeMa Life has uncovered the number of people using technology to examine, manage and improve their health. It found:

  • 28% of people use health apps on a weekly basis, up from 23% a year ago
    • The figure rises to 44% among millennials (18-34 year olds)
  • 61% of users say health apps help them to incorporate healthier practices, exercise techniques or mental health tips into their daily life
  • 25% also own a piece of wearable technology to monitor or manage their health
  • 9% of people have used apps or wearable tech to detect a medical condition or health issue
    • A further 12% use apps, wearable devices or online tools to monitor an on-going health problem
  • A fifth (21%) of UK adults say they now use online videos, apps and wearable tech instead of going to the gym or seeing personal trainers
  • Almost half (46%) think technologies are going to reduce the UK’s reliance on public healthcare, cutting down how often we need to see medical professionals
  • This reflects a growing trend of Brits opting to self-manage their health and wellbeing – 39% of Brits favour using search engines over going to see a pharmacist or GP

Health apps, online tools and wearable technologies are having a significant impact on the way people across the UK public are managing and improving their own health, new research by WeMa Life has found.

The HealthTech platform commissioned an independent survey among more than 2,000 UK adults to reveal the impact of new tech on the health and wellbeing sector. It found that 28% of people currently use health apps on a weekly basis, up from 23% a year ago. Furthermore, the figure rises to 44% among millennials (18-34 year olds).

During the research, health apps were defined as an application on a smartphone or tablet that helps someone monitor or improve their health. Uses of such apps can include: analysing exercise and fitness sessions; tracking or advising on food and drink intake; monitoring sleeping patterns; helping with mental health issues; or communicating with medical professionals to book their services or seek their advice.

WeMa Life’s research found that 61% of health app users say they use them to easily incorporate healthier practices, exercise techniques or mental health tips into their daily life. It comes as Deloitte predicts the global digital health – or HealthTech – market is due to reach a value of £43 billion in 2018.

Elsewhere, the study showed that 25% of UK adults own a piece of wearable tech to monitor or manage their health. Moreover, a fifth (21%) of UK adults say they now use online videos, apps and wearable tech instead of going to the gym or seeing a personal trainer.

The survey also uncovered more notable findings. It revealed that 9% of people in the UK have used apps or wearable tech to detect a medical condition or health issue, while a further 12% use apps, wearable devices or online tools to monitor an on-going health problem.

Reflecting the value of these new technologies in improving how people can manage their health, 46% of respondents said they think new tech is going to reduce the UK’s reliance on public healthcare, cutting down how often we need to visit a GP or hospital. This reflects a broader trend of Brits opting to self-manage their health, with 39% of those surveyed already stating that they use search engines over going to see a pharmacist or GP.

Rohit Patni, CEO and co-founder of WeMa Life, commented: “The HealthTech industry has grown at pace in recent years – there are now a plethora of apps, devices and online platforms that empower people to lead happier and healthier lives. Today’s research reveals just how far-reaching this trend has been, with people now relying on these tools instead of traditional methods of detecting, monitoring or treating health issues.

“Not only does HealthTech improve people’s knowledge of their mental or physical wellbeing, but it’s also vital in connecting consumers with health and care businesses or medical professionals. In doing so, it’s clear that apps and online tools now have an important role to play in bridging gaps and filling cracks within the wider healthcare sector.”

Mobile device usage increasing in healthcare, but patient use not being optimised, says Qmatic

Posted by on Apr 25, 2018 in NHS | 0 comments

Mobile device usage increasing in healthcare, but patient use not being optimised, says Qmatic

New research highlights that while healthcare institutions are employing mobile devices, they’re not taking advantage of use for both staff and patients

Recent research has revealed an increased adoption of mobile devices in the healthcare sector, with 90% of healthcare organisations stating that they plan to implement or are currently implementing a mobile device initiative. While these statistics are encouraging to see, patient journey management specialist, Qmatic states that healthcare organisations aren’t realising the full potential of mobile device usage in patient waiting areas.

The research – which interviewed 600 healthcare IT decision makers across the world – highlights that mobile devices are most commonly used in nurse’s stations and administrative offices, with 72% and 63% respectively stating that the technology is currently used in these situations. However, mobile devices are least being used in patient waiting areas, with only 38% employing the technology in this situation.

Vanessa Walmsley, Qmatic UK MD said: “While it’s great to see that healthcare IT decision-makers are realising the benefits of mobile devices for both staff and patients, many are missing out on additional efficiency gains and increased patient satisfaction through implementing mobile device initiatives for patient waiting areas.”

Healthcare managers can significantly improve the experience of patients at outpatient departments and in waiting areas by enabling them to use their mobile device to check-in for a pre-booked appointment or select a walk-in service such as phlebotomy and join a virtual queue. This technology eliminates the friction of patients having to wait in line to see a receptionist and reduces staff pressures and gives patients information about where to go and which clinician to see, efficiently guiding patients to the right place and ensuring that they are fully informed about the status of their appointment.

Vanessa added: “Not only does this kind of use of a mobile device save precious time for the user, it also provides staff with key information so they can prepare for the patient’s appointment, and delivers valuable data to healthcare authorities to help them adjust their operations in real-time to match patient numbers.”

Qmatic offers Mobile Ticket, a solution that enables patients to simply open a web app, or scan a QR code if they prefer, and receive all the details they need regarding their appointment.

To find out more about Qmatic Mobile Ticket visit http://lp.qmatic.com/mobile-ticket-uk

 

Surge in number of men calling support line for emotional help

Posted by on Apr 24, 2018 in Public Health | 0 comments

Surge in number of men calling support line for emotional help

Macmillan Cancer Support says increase in calls due to a shift in male attitudes towards talking about emotions

 Macmillan Cancer Support reveals its helpline recorded a surge in calls for emotional support and counselling from male callers[i] last year.  The charity hopes to encourage even more men with cancer to ask for help, as part of its Just Say the Word campaign, with partners from across the construction, home improvement, electrical and technology sectors.

On average, eight men per day called the charity last year to talk about their feelings, compared to an average of six per day in 2016[ii] – an increase of around a third. Professionals at the charity have also reported men accessing emotional support through its online community and face to face appointments.

The other most common issues that men called the helpline for included advice in accessing benefits, managing pain and information about cancer treatment.

Dr Anthony Cunliffe from Macmillan Cancer Support, said: “A cancer diagnosis can impact so many aspects of your life such as your health, finances and relationships. These changes can cause emotional strain so it’s encouraging to see more and more men talking about how they feel.

“We’ve seen a change in the way people think – men are no longer expected to deal with emotional issues on their own. From Princes Harry and William, to comedian Johnny Vegas, brave men have spoken publicly about their emotions, helping us all realise it’s okay to talk about our feelings. Despite this shift, there is still a long way to go and it’s crucial that men ask Macmillan for help before reaching crisis point.”

Despite the increase in men asking for emotional support on Macmillan’s helpline, more women continue to call the line than men. Last year, Macmillan received an average of 175 calls from women per day, compared to 76 calls from men per day. [iii]

However, men are 22% more likely to get cancer and 45% more likely to die from cancer than women[iv]. Macmillan also reports that 49% of men diagnosed with cancer experience anxiety during treatment and 25% felt depressed when they were diagnosed. [v]

Macmillan is encouraging even more men to access the emotional support it offers. Professionals on the charity’s helpline are there to be a listening ear and to signpost people to appropriate local services like counselling sessions or financial advice.  Alternatively, people can log on to Macmillan’s Online Community if they would rather speak online.

Pete Dolan, 35 from Shropshire works for Travis Perkins and was diagnosed with testicular cancer in 2015. “When I was going through treatment I really struggled emotionally, but I was bottling my feelings up as I wanted to be strong for my family. The fear that I wouldn’t see my kids grow up was almost too much to cope with. I just couldn’t shake the fear that was hanging over me – it was the hardest thing I’ve ever been through.

 “I called Macmillan’s support line and they were brilliant. They helped me talk through these fears and anxieties and to process what I was going through. I know a lot of my male friends think it’s a sign of weakness to ask for help, especially in the building trade, but I don’t know what I would have done without Macmillan’s support.”

To encourage more men with cancer to ask for help, Macmillan is bringing together nine of its partners from the construction, home improvement, electrical and technology sectors: Benchmarx Kitchens and Joinery, CEF, ISG, Mace, Selco Builders Warehouse, telent Technology Services, Topps Tiles, Travis Perkins and Wolseley, for their ‘Just Say the Word’ campaign. Through this, Macmillan hopes to reach and empower men across the UK to take control of their health and seek the support they need.

For more information about the campaign and the support services Macmillan Cancer Support is offering, visit www.macmillan.org.uk/saytheword

84% of healthcare employees are looking for better physical and mental wellbeing workplace support

Posted by on Apr 17, 2018 in Blog, NHS | 0 comments

84% of healthcare employees are looking for better physical and mental wellbeing workplace support

With a rise in workplace-related stress, illnesses and mental health issues, almost two thirds (63%) of working adults in the healthcare industry believe that businesses are not doing enough to support the physical and mental wellbeing of their employees, according to a new study released today.

  • 75% believe that some of the National Insurance payments should be redirected towards improving wellbeing 
  • 81% do not believe the NHS has enough budget for wellbeing services 
  • 67% think the Government should be doing more to promote wellbeing
  • 84% think their employer could do more to support the physical and mental wellbeing of employees 
  • 67% would use wellbeing services if their employer provided them
  • 33% of line managers were unaware of the potential health issues related to sedentary behaviour*

Current treatments such as health check-ups, cognitive behavioural therapy and chiropractic treatment are provided by the NHS, through National Insurance contributions, but 81% of those surveyed by Westfield Health stated that the NHS does not have the budget to provide wellbeing services like these.

So is National Insurance becoming unfit for purpose? Employees in the healthcare industry don’t seem to know, with 13% of employees knowing how much National Insurance they pay and only 45% knowing how much of the contribution goes where, be it the NHS, social security or their state pension.

With an ageing workforce and more hours spent in the office than ever, should the NHS’s frontline resources continue to be used for wellbeing services? The research found that 67% of workers in the healthcare industry would like to see the Government do more to promote their physical and mental wellbeing. And the vast majority 84% believe that their employers are specifically not doing enough to help employees deal with work-related stress, anxiety and other mental health issues.

Similar to the recent rollout of the workplace pension opt-out, could a government-backed auto-enrolment scheme for wellbeing programmes – funded by employers and by a portion of employees’ National Insurance contributions – be one of the solutions to address the NHS’s long-term financial needs?

Certainly the appetite is there in the healthcare industry with employees particularly prone to sedentary behaviour, poor nutrition and sleep deprivation, impacting on their overall health and productivity. As a result, 67% of employees stated they’d use wellbeing services if their employer provided them.

The top things they would like to be offered are:

  1. Health check-ups 57%
  2. Emotional wellness 55%
  3. Access to a gym 51%

David Capper, Commercial Director of Westfield Health, said: “The total number of UK working days lost to stress, anxiety and depression resulting from long working hours is 12.5million days. Therefore, it makes sense for employers to relieve some of the pressure through wellbeing initiatives. Not only would they be supporting our economy, they’ll make huge cost savings by looking after their staff’s health, with presenteeism now costing businesses up to three times more than absenteeism**.

“From sleep to nutrition and mental health to physical fitness, there are so many elements that contribute to your overall wellness, happiness and healthiness. In the healthcare industry, staff are particularly prone to being sedentary for long periods of time without a break at work, which puts them at serious risk of developing health problems such as heart problems, diabetes, cancer and weight gain.

“It’s more than free fruit in the office and discounted gym memberships. As business leaders, we need to create a culture where our people’s health and wellbeing is prioritised to drive confidence, capability, inspiration and ultimately prosperity.”

For more information about workplace health and wellbeing, please call 0331 227343 or visit the Westfield Health website.

Case for more money for health and social care has been made, says NHS Confederation

Posted by on Apr 12, 2018 in Blog, NHS | 0 comments

Case for more money for health and social care has been made, says NHS Confederation
Responding to the British Social Attitudes survey on public attitudes to NHS funding, 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 that more of the public across the UK support more resources for the NHS and 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 government to act.

“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 the cries for more funding are unequivocal.

“Our members are happy to be held to account but their plea is ‘give us the financial tools to do the job’. All fundraising options must be kept on the table.”

State of UK’s wellness revealed… and there’s room for improvement

Posted by on Apr 5, 2018 in Blog, Public Health, Steps towards Health and Wellbeing | 0 comments

State of UK’s wellness revealed… and there’s room for improvement

A new study into the nation’s wellbeing has revealed that British people rank their wellness as “average”, with time spent outside and time spent sedentary being key areas for improvement nationwide.

  • On average, Brits spend over eight hours a week on ‘me time’, although one in five say they are “not content”

  • Almost half of the nation spend less than an hour outside every day, which doctors reveal contributes to lower levels of wellness

  • Industry experts reveal lifestyle changes that will improve wellness

The findings are from a new report by leading health and fitness app, MINDBODY. Working with health and wellness professionals, the study of 2,000 UK adults considered the wellness habits of the nation, using a five-point Likert scale. Respondents were asked to rate their hours of sleep, sedentary hours, stress and anxiety levels, headspace (or ‘me time’), eating and drinking habits, time spent outside, current physical and mental health, and level of social satisfaction.

On average, the UK scored 28 out of a possible total of 45. Each question was scored out of five, which breaks down as:

  • Hours of sleep – Score 3.5 (6 hours and 36 minutes per day average)

  • Sedentary hours – Score 3.2 (The nation is sedentary for 5 hours 13 minutes per day)

  • Stress/anxiety levels – Score 3.2 (24% of UK adults are ‘always’ or ‘regularly’ stressed/anxious on an average day)

  • Headspace / ‘me time’ – Score 3.6 (The nation gets an average 8hrs 46 minutes per week)

  • Eating/drinking habits – Score 3.2 (On average, Britons view their eating/drinking habits as “somewhat healthy”)

  • Time spent outside – Score 2.1 (On average the nation gets two hours outside per day, but almost half spend less than an hour outside)

  • Current physical health – Score 3.2 (Overall, Britons describe their physical health as just “average”)

  • Current mental health – Score 3.3 (One in five people say they are “not content”)

  • Social satisfaction – Score 3.3 (Nearly a quarter (23%) say they are not satisfied with their social habits)

Hours of sleep and ‘me time’ are where Brits rank their habits highest, although the average amount of sleep still falls short of the recommended seven to nine hours² at just over six-and-a-half (6hrs 36 minutes).

Overall, none of the factors ranked significantly highly, with time spent outside showing as one of the main areas that detracts from overall wellness. According to MINDBODY’s research, whilst the national average for time spent in the great outdoors is two hours per day, almost half of the UK spend less than an hour outdoors in an average day.

Dr Ment, a Consultant Cardiologist at Spire Parkway Hospital in Solihull, said: “More exercise in the fresh air means more oxygen to the lungs. This can help our white blood cells to function properly –  fighting and killing bacteria and germs. It will also increase the amount of serotonin – the happy hormone – produced in your body, which is nature’s way of improving your mood.”

Dr Mark Silvert, Consultant Psychiatrist in London at The Blue Tree Clinic, added: “Exercise has many known benefits for good mental health. Studies have shown it can be as good for you as other treatments such as medication or therapy if you are suffering from things like ADHD, anxiety or depression.

“When we exercise we get a boost of endorphins which gives a feeling of happiness and well-being, we benefit from feeling better within our bodies, which can improve self-confidence and our physical health. Going to a gym or doing team sports can reduce isolation in an age where we can spend countless hours on our smart phones of tablets without leaving our homes for entire weekends.

“Getting outside into the fresh air is an almost forgotten past time. Get a dog, it will help you think of looking after “man’s best friend” and the bond between people and pets is also known to be healing when we are not feeling good.”

MINDBODY highlights in its corresponding report that all components of the Wellness Index are intrinsically linked, and the findings suggest there is room for development in all areas, which could ultimately boost the nation’s overall outlook on wellness.

Millennials (18-24s) had the lowest wellness score (26/45) and baby boomers (age 55+) had the highest at 29 out of 45. The average score did increase with age, with anxiety levels, mental wellness, sleep, and eating habits showing greatest improvement; suggesting that younger generations are feeling life’s pressures the most.

Kevin Teague, MD, commented on the research: “This (research) was key for us having a holistic view of the UK fitness market. MINDBODY has more data than any other entity in the world for what people do inside a studio, but we didn’t have a comprehensive picture of British wellness outside of the gym.”

Charlotte Newton, Senior Manager EMEA Marketing, added: “Wellness has become something of a buzzword in recent years, however the nation is now really beginning to sit up and pay attention to daily habits and how they affect overall wellbeing. It’s encouraging to see from the findings that, although the majority of the scores aren’t significantly high across the board, there are none that are worryingly low either, suggesting that we are moving in the right direction.

“The recent attention around wellness, both mental and physical, is hugely positive and we absolutely want to encourage more conversation and action around this topic. Hopefully our Wellness Index can form the foundations of conversations nationwide around how the UK can embrace wellness.”

To read the Wellness Index in full, and find out more about the nation’s fitness, wellbeing, health and social habits, please email: eupress@mindbodyonline.com

 

The smart way to safeguard against Legionella in hospitals and healthcare

Posted by on Mar 28, 2018 in NHS, Public Health | 0 comments

The smart way to safeguard against Legionella in hospitals and healthcare

Not even healthcare organisations are exempt from Legionella outbreaks. Andy Smith, National Business Development Manager, Clearwater Technology, explains how they can be best avoided

For hospitals and healthcare organisations, preventing patients, staff and visitors from contracting Legionnaire’s disease is an everyday battle. The potentially fatal disease is at its most deadly in healthcare facilities, with new-born and elderly patients the most susceptible due to immunosuppression.

Legionnaire’s is caused by bacteria that can lurk in water systems and managing the risk should be of major importance in healthcare facilities. In order to safeguard patients, staff and all other visitors, facilities must implement effective Legionella control schemes that include regular monitoring. Only then can the risk be effectively controlled.

Implement a temperature control regime

Legionella bacteria naturally breed in fresh water; and therefore may be impossible to completely eradicate from any influent water source. Legionella become active when water is between 20C and 60C in temperature, therefore a temperature control regime is commonly used as a control measure for Legionella bacteria. In these instances, monitoring and record keeping is a major element of managing the risk, and providing evidence of risk management. Diligent record keeping is also critical to monitor the effectiveness of the control regime.

Introduce secondary disinfection measures

A further step in controlling the risk is introducing secondary disinfection measures. Secondary disinfection is the process of preventing the growth of pathogens throughout the entire water system by maintaining a consistent quality in the microbiological makeup of the water. Continuous secondary disinfection solutions can include Chlorine Dioxide (ClO2) dosing, Ultra-Violet (UV) disinfection and other chemical dosing systems. They can help reduce the cost of operation by minimising the requirement for hyper-chlorination procedures.

Secondary disinfection systems can be installed and maintained by some water treatment providers but these solutions can be applied to various different systems in different ways, therefore hospitals and healthcare organisations should enlist providers with extensive expertise in the healthcare sector. A solution that includes inline monitoring, remote control systems and alarms will go further in helping to manage the risk and strengthen the water safety plan.

Monitor cooling towers, water tanks, boilers, pipework closely    

The presence of rust, sludge, scale and organic matter in water systems provides an ideal environment for Legionella bacteria that can breed freely. Cooling towers and boilers, commonly used in hospitals and healthcare sites, can be a breeding ground for these if not managed effectively. Effective management should include risk assessment, an effective chemical treatment regime, regular inspection and optimisation. The same goes for water tanks, pipework, and domestic systems where scale and other matter can build up as a result of ineffective management of plant and equipment such as cooling towers and boilers.

Make limited budgets go further with expert water treatment providers

With limited budgets and resources, it’s a challenge for hospitals and healthcare organisations to effectively keep track of their water temperatures while maintaining a consistent log that can prove the Legionella risk is being well managed. This is not simply a case of providing proof that temperature control measures are in place – it must also be proven that a full control scheme is in place with regular risk assessments being conducted.

Hospitals and healthcare organisations must therefore look to their water treatment providers to assist with the creation and implementation of control schemes that include the monitoring and regular logging of water temperatures on-site. The water treatment provider may also carry out all necessary risk assessments and provide transparent, easy-to-access reporting including GPS and time stamps with a fully documented trail, ensuring that, should the HSE investigate the site, those responsible for the site’s health and safety will have the peace of mind that all the required evidence of risk management can be provided.


It is paramount that hospitals and healthcare organisations enlist the expertise of water treatment providers that have experience and expertise in this sector, with a clear awareness of the challenges, and legislation specific to hospitals and healthcare facilities. The chosen water treatment provider must be able to tailor its services to individual hospital or healthcare businesses to ensure that the water treatment solutions are both economical and effective for the size and scale of water systems on each individual site.

With these services and measures in place, hospitals and healthcare organisations can continue their roles in serving the public with the peace of mind that legionella risk is being managed effectively.

 

The Third Era of health and social care

Posted by on Mar 27, 2018 in ERA 3, Public Health | 0 comments

The Third Era of health and social care

The Third Era group is a small network of academics, care professionals, managers and politicians who share an interest in making our health and social care systems better.  They share the view that as the era of markets and competition ends there will be a valuable opportunity to address some of the long-term issues which face our care systems. The group’s emphasis is on solutions that a progressive government could implement.

The group is coordinated by Prof Steve Iliffe and Richard Bourne, who have published a series of articles drawing on discussions within the group.  See  http://www.healthmatters.org.uk/era-3/  We welcome further contributions; please send them to Steve Iliffe (s.iliffe@ucl.ac.uk) or Richard Bourne (richardbourne@msn.com).

What Should Labour Do?

That our care system is in crisis is regularly reported. We know a lot about what is bad.  Honest analysis suggests we also have serious long-term problems that cannot be wished away. If Labour wins the next election what should it do to make our care systems better, in the short, medium and longer terms?  The Third Era group is debating possible solutions.

“Better” for us means increasing population wellbeing; maximising happiness by dealing with the social determinants of poor health and implementing policies which disproportionately favour the most deprived, the less well-off and the least powerful.  It should be better also in ways the public actually want; shorter waits, easier to access and use, continuity in care. And it should be better in the technical sense of quality.  

Some of the ideas about enabling the development of a better care system were set out by Don Berwick, but we have anglicised these, added to them and built in the ideological context.  As with Berwick we believe the new Era will not be a return to the Bevanite bureaucracy of the 1970’s, nor to the markets and competition that followed it.

From this mix of requirements, wishes and ideology a consensus is emerging about some of the key features of a better health and social care system under Labour.  

  • Non market (mostly tax funded) –stability in funding
  • Joined up (healthcare brought into the family of public services)
  • Joined up (weakening boundaries between health and social care, physical and mental health, primary and secondary care)
  • Tackling inequalities
  • Open and transparent
  • Democratic and participative
  • Social model predominates, not the medical model.
  • Devolved (local decisions about how care is organised and provided)
  • Responsive to communities, embracing shared decision making

We are beginning to describe the gap between where we are now and where we would like to be, and as a group we are debating how the gap might be closed.

There is a lot of evidence out there that helps us.  At system level we can observe Scotland and Wales as well as many EU neighbours, all of whom have systems that provide comprehensive universal care.  There is also some evidence of what does or does not work in terms of models of care, pathways and service frameworks , more recently from the upheavals in England prompted by the 5 Year Forward View.  This set of political experiments has begun to suggest some challenges for reformers. The hardest is that context and local factors are hugely important.

What works well in semi-rural A may not work as well in urban B.  Rolling out good practice cannot be enforced. Small scale success often cannot be scaled up.  All roads appear to lead not to Rome but back to where you started. There has to be a lot of flexibility around allowing local systems to innovate, adapt and even to fail.  Reorganisation and restructuring does not achieve much; teambuilding, relationships and networks are far more important. The big isolated national NHS – top down, do what you are told, managed by shouting – is no longer an appropriate model.

Lurking behind this are the issues that are unresolved, and which are rarely even discussed.  Should NHS principles be extended, should all care be free? How are the parts of the system held to account – who deals with failures and problems?  Who controls the funding flow? Do we have local as well as national sources for funding? What is reserved for national and what is permitted to the local?  How do we build the capacity for a better managed but more accountable system? How will vested interests be overcome for the common good? How long do we wait for improvements?  Labour’s generally well received 2017 Manifesto sheds little light on these key issues.

Labour does have an absolute commitment to greater funding and to repeal of the marketisation legislation.  But the money spoken of so far is not enough and what replaces the legislation poses nasty questions. Initially Labour can increase funding and that could bring some early benefits, especially in social care.  Labour can and should remove the barriers to developing better care by legislation to remove the markets and competition. It can do many things to raise staff morale. It could target specific issues like long waits by throwing money at them.  It can kick off the necessary work to plan for change and invest in change initiatives. It can facilitate more devolution and local decision making.

In the medium term it will have to build capacity for change.  It can over time look at the requirements for more staff, scanners, ambulances, theatres – some of which have long lead times, so it should start now.  Investment in human infrastructure is needed for better management, better informed Councillors, robust planning, and strengthened communities.

The longer term may in part just be the roll out of short term measures, but must be used to shift the conversations and change expectations and beliefs.  The previous Labour government implemented many progressive changes but tried to pretend they had not because of electoral anxieties – so it never altered the national debate.  The long-term goal is an irreversible shift in opinion to favour a public, comprehensive, universal system that cares for us all

Midwifery; not just numbers

Posted by on Mar 27, 2018 in Blog | 0 comments

Midwifery; not just numbers

More than 3,000 midwifery training course places will be created over the next four years as part of plans to meet NHS staffing demands.

However, this plan isn’t as simple as recruiting thousands more students as they requires the infrastructure to support them. We need more tutors, more on-site resources and perhaps more importantly, more mentors  and capacity in placement areas – which currently are under immense strain. Not only that, currently numbers of applicants are being put off by lack of funding and we have seen a drop in applicants.

Regarding a named midwife,  this has been in every maternity report since  Baroness Cumberlege’s  ‘Changing Childbirth’ report in 1993. Whilst small pockets of midwives do run this form of Midwifery to expect every midwife to be on call 24/7 for nine months is not really practical or feasible.

Alison Edwards- Senior Lecturer in Midwifery at Birmingham City University