The healthmatters blog; commentary, observation and review
Trials and tribulations on the left
Health Service Journal columnist Andy Cowper says in his latest blog that Labour’s policy of saving the NHS from privatisation does not have much traction beyond the party’s political base. Can we be so sure? Is Prof Steven Hawking part of Labour’s political base? An astonishingly clever man, Hawking repeats the Tolkienesque story that all changes in the NHS are designed to replace it with a US-style health insurance system. This endorsement of a myth could have public impact, given the authority of its source.
Conspiracy theories run deep, especially amongst those with paranoid tendencies, and because they are crude simplifications they have the advantage of not being intellectually taxing. They create an anti-politics that finds demonic enemies to mobilise people against. When you next join a rally to save an A&E department or a maternity unit or a much-loved if shabby local hospital, check out the protestors’ rationality, tone and depth of knowledge.
The NHS may have brought this upon itself, doing most of its work in secret and fostering a shroud-waving political culture, but that will not be easy to turn round. Labour does indeed have a problem, being vulnerable to theological thinking in an area where logical thinking would be more use. In the past shadow health leaders like Robin Cook and Frank Dobson canvassed opinion about policies widely, sometimes to the annoyance of in-house lobby groups like the Socialist Health Association. Now the sources of expertise are different – the BMA has less credibility – and have been outsourced, to the Kings Fund and Nuffield, or to Deloitte and PwC.
What is to be done about the NHS?
Whilst we are on the topic of Labour policy, let’s face some facts. For the first time the NHS will shrink, this winter. Up to now its budget growth has been limited, from 3-4% extra per year to 1-2%. This shrinkage (in budget per capita) will lead to service reductions and staff losses. Both NHS Hospital and Community Trusts are financially vulnerable, and last year became dependent on other income streams like car parking fees, local government transfers, research grants, private patients and retailing. In response to the shrinkage Trusts will sell land, delay (or dispense with) some treatments, merge to combine and reduce back-office functions, increase efficiency and reduce waste, and reconfigure services to increase productivity. There will be another A&E crisis, because A&E departments are unable to recruit enough staff, and are dependent on very expensive agency workers. There will also be a problem in hospital discharge, depicted as “bed blocking” (DTOCs- delayed transfer of care), despite investment in social care this year.
The context in which these challenges occur may determine the outcome. Privatisation has largely failed. Most entry of commercial organisation into NHS provision has been in community- services, not the hospital network (which takes 75% of the NHS budget). Private management of hospitals has been a disappointment for the marketeers, which are looking at different strategies, like sharing new facilities with the NHS. The Health & Social Care Act 2013 was meant to trigger a wave of privatisation, comparable to the 1983 ‘big bang’ privatisation of local authority and NHS care homes, but this has not happened. The privatisation of care homes haunts the Tories, because of the market’s failure to run care homes well; the ‘dementia tax’ hastily withdrawn from the 2017 Conservative election proposals shows how vulnerable they are. For all that, marketization of the NHS continues, with purchaser-provider split, targets, incentives,’ bullying’, and endless consumer satisfaction surveys impacting on everyday clinical work; a new round of PFI is even being proposed. Staffing shortages are a problem across the NHS, but are worse in the North, and in services outside the metropolitan areas. A prolonged pay freeze in a period of austerity compounds the problems of the NHS.
What could a Labour government do to restore stability in the NHS? Increased public spending may move towards sectors that have been harder hit than the NHS – social care, prisons, possibly education. Combatting waste and increasing efficiency seem desirable actions, and reconfiguring services to increase productivity is arguably in the public interest. How can the staff shortages be reduced? Could it be that Labour’s future health policy will look quite similar to its predecessor’s, but with a bit more cash?
Down the hatch?
Public health initiatives are often contested. The UK’s alcohol guidelines were reviewed last year, reducing men’s recommended intake to 14 units per week, in line with women’s intake, and moving from daily recommendations to weekly. The Chief Medical Officer, who is responsible for the guidelines, was quoted to have said there was ‘no safe level’ of drinking.
A new initiative, Drinkers’ Voice Ltd, has emerged to promote the health and wellbeing benefits of drinking alcohol. Its’ National Coordinator, Amy O’Callaghan says: “There is clearly a lack of trust in the government’s tone on alcohol advice. So much so that most people have just stopped listening to them altogether. For too long, the anti-alcohol lobby has been able to spread myths about drinking and, at the same time, choosing to ignore the health benefits moderate drinking can bring us. We think this has led to nervousness from the government who issued new guidelines last year which are among the lowest in Europe. Now, we want drinkers to have their say. Drinkers’ Voice want people across the country to join them in exposing these myths, talk openly about the benefits and risks of drinking, and bring some rationality to the debate”.
Current spokesperson for Drinkers’ Voice, Charlie Hooson-Sykes, says: “There is a culture of shame that is being promoted around alcohol which doesn’t take into consideration the positives: The celebratory elements, the community, the culture. We want to be the voice of those who like a glass of rosé on a Friday night, a glass of champagne on their birthday or a beer in front of the telly”.
Drinker’s Voice aims to become a movement of normal people talking about how drinking in moderation plays a positive role in their lives, and is seeking supporters and donations. It has interesting people in leading positions, like Henry Byron Davies, a Conservative politician and ex-police officer, who was ousted as MP for Gower in 2017. Another officer of the company, Dr William McCrea, is a consultant cardiologist in Swindon who recommends two small (125ml) glasses of red wine a day (ideally the cheaper young wine made from grapes grown on higher slopes, because of their anti-oxidant content) to his patients. Dr Richard Harding contributed to the 1995 Sensible Drinking guidelines and gave evidence to the 2012 update emphasising the health benefits of limited alcohol consumption. Colin Valentine is chairman of the Campaign for Real Ale. One of Drinkers’ Voice’s spokespersons is libertarian Josie Appleton, author of ‘Officious: rise of the busybody state’ published by Zero Books. This is a company that is well worth watching, in NfN’s view. You can find out more about Drinkers’ Voice by going to www.drinkersvoice.org.uk
New data has revealed that cases of suspected carbon monoxide (CO) poisoning in children are on the rise across the UK, with cases in the West Midlands up by 58%.
Campaign group Project SHOUT tracks the numbers of those attending A&E with suspected carbon monoxide poisoning, which has exposed an increase in the total number of cases of under 18s since 2015 throughout the UK, with more than 500 cases reported in the last year alone.
Worryingly, the number of suspected CO cases across all age groups in the West Midlands also increased by 90%.
Children are particularly susceptible to the deadly gas, also known as the silent killer, as you can’t see it, smell it or taste it. Due to their less developed nervous system, and higher frequency of breaths leading to an increased consumption of oxygen, children process carbon monoxide differently than adults and may be more severely affected by it.
To compound the issue even further, recent research from npower discovered that only 4% of parents can identify symptoms of carbon monoxide poisoning, clearly highlighting the lack of awareness of the deadly gas amongst the UK population.
Rob Lyon, campaign director for Project SHOUT, said: “These numbers are very concerning and highlight the fact that we need to do more to tackle the dangers of carbon monoxide and raise awareness of the symptoms.”
Approximately 50 people needlessly die each year from carbon monoxide poisoning and thousands more are treated in hospital.
Carbon monoxide is produced when fuel doesn’t burn properly, usually from badly fitted or poorly maintained appliances. Common sources of CO are gas and oil boilers, gas hobs and fires, log burners, open fires and BBQ’s.
Symptoms of CO poisoning are often mistaken for something else, particularly colds and flu.
Common symptoms include dizziness, headaches, nausea and generally feeling unwell.
Alarms are the only way to detect CO poisoning as you can’t see it, smell it or taste it. With two-thirds of homes unprotected by an alarm, an estimated 40 million people are at risk.
80% of residents in properties that DO have an alarm admit that they have no idea whether it works or not as they never test it.
Make sure your gas appliances are initially installed and serviced regularly by a qualified GAS SAFE registered engineer.
Know the symptoms, they are often mistaken for something else.
Get an alarm; it’s the only way to detect the deadly gas.
Know what to do if your alarm goes off.
Rural residents are more concerned about declining healthcare services than any other issue, according to the preliminary results of a wide-ranging survey.
Health topped the list of the topics of most concern to rural residents – ahead of public transport, rural housing and rural crime.
The survey of 1901 people was conducted on behalf of Rural England Community Interest Company  by researchers from the Countryside and Community Research Institute, based at the University of Gloucestershire , and in partnership with the Rural Services Network .
The survey – believed to be the largest of its kind for many years – highlighted a range of issues with health services of most concern to respondents.
Full findings are due to be published later this autumn.
However, the preliminary ‘headline’ – summary results are being published at this year’s annual Rural Services Network Rural Conference – held at the University of Gloucestershire’s Cheltenham campus on Wednesday, 6 September .
RSN chair Cecilia Motley said: “The theme of this year’s Conference is ‘The Infrastructure of Success – New Routes to Economic Growth’.
“What we mean by ‘Infrastructure’ is all those things essential to economic and community well-being.
“So we include health services and care, reliable, affordable fast speed broadband and mobile connectivity; affordable homes to meet the needs of local people; reasonable public transport; accessible training and development opportunities; good quality schools and the accessibility and affordability of all of the essential services provided by local government.
“These preliminary results are very timely to aid discussions at the Conference.
“Confirmation that health – together I suspect with Social Care – is the main preoccupation for rural communities will surprise many people who might think other issues are more pressing, as past surveys (by others) have shown.”
“This early evidence of concern about healthcare provision comes at a time when many countryside communities face the withdrawal of vital GP services, NHS Service re-configurations and general recruitment difficulties. NHS Providers are already expressing grave concerns about what they are describing as the worse winter in recent history .
“Although rural residents have other concerns – such as lack of affordable housing, poor public transport, often non-existent mobile and broadband connectivity and fears over the future of rural schools – health provision, social care and accessibility has risen sharply up the rural agenda.”
The aim of the survey was to canvass rural opinion with a view to creating, for the first time it is believed, a statistically valid representative panel of people to highlight the need for the adequate provision of rural public services and other policy issues affecting rural areas.
Largely rural shire areas score badly on some Public Health Outcomes Framework (PHOF) indicators, according to a recent report by the Rural England Community Interest Company .
This includes the provision of health checks, mental health services, access to health screening and late HIV diagnosis.
In terms of rural public transport, the survey findings come as little surprise with significant reductions in public transport services across rural areas as a result of government cuts in financial support for local government services .
And when it comes to rural housing, campaigners have long warned that high prices mean people are often unable to afford to buy their own home in the communities where they were born .
Meanwhile, a National Rural Crime Network report in 2015 warned that crime in the countryside was costing as much as £800m annually – putting further pressure on already stretched police forces .
Councillor Motley said: “There is a lot of concern among rural communities about the impact of public service cuts on services generally.
“Rural areas have always had thinner services than in other areas and funding cuts are hitting those services very hard – rural people, businesses and communities are still having a very difficult time.”
 Rural England is a Community Interest Company which brings together rural networks and stakeholders to improve the rural evidence base. It commissions, undertakes and disseminates rural research and encourages debate about its findings. For further details, visit http://ruralengland.org.
 The survey was undertaken by researchers at the Countryside and Community Research Institute (CCRI), a partnership between the University of Gloucestershire, the Royal Agricultural University and Hartpury College. It is the largest specialist rural research centre in the UK. For details, visit http://www.ccri.ac.uk.
 The Rural Services Network seeks to provide a voice for rural communities by representing rural services, networking between rural service organisations and establishing and broadcasting best practice in rural service provision. It comprises SPARSE Rural, the Rural Assembly, the wider Rural Services Partnership and the RSN Community Group. The organisation works with Rural England, a stand-alone CIC research group. For details, visitwww.rsnonline.org.uk.
 For more details about the Rural Conference, visit http://www.rsnonline.
 See “The worst is yet to come for the NHS – hospital chiefs” (BBC Online, 3 September 2017) http://www.bbc.co.uk/
 See “The State of Rural Services 2016” (Rural England, January 2017) https://ruralengland.
 See “Council cuts ‘threat’ to rural bus services” (BBC Online, 4 February 2016) http://www.bbc.co.uk/
 See “New research lifts the lid on the ‘hidden crisis’ of rural homelessness” (Hastoe Group, 10 July 2017) http://www.hastoe.com/
 See “Largest ever survey of crime in rural areas reveals an unprecedented £800m crime bill” (National Rural Crime Network, 15 September 2015) http://www.
NHS Confederation chief exec and Brexit Health Alliance co-chair Niall Dickson comments on life sciences strategy
Life sciences, the development of cutting-edge medical innovations in exciting areas like biotech and genomics, is one of the most successful sectors of the UK economy. The industry generates around £66 billion each year, is twice as productive as America’s equivalent and three times more productive than Germany’s. But we can do better still, and the NHS can play a vital role in driving Britain’s future prosperity in this area.
With the aim of making “the UK the best place in the world to invest in life sciences”, the launch of Government’s Industrial Strategy Green Paper in January was welcomed by many but the links between it and the health sector were, at best, implicit. Today, geneticist Sir John Bell publishes the Government’s specific strategy for life sciences. If this is to fulfil its potential, the NHS must be supported, encouraged and resourced to play its part.
There are four areas where action is required to make this happen.
First, it is essential that the right conditions are created to encourage NHS institutions to take part in research and innovation. A recent report by Sir Robert Naylor on NHS estates set out how NHS Trusts could be incentivised to realise additional value from their land, including by allowing the receipts of any sales to be retained locally. A similar approach could be pursued in research, with profits from discoveries shared by the NHS Trusts most heavily involved in collaborating on the development of breakthroughs. The health service can help industry evaluate and test products and adopt them at scale. Risks may be taken by Trusts but rewards shared with NHS institutions that contribute significantly to new treatments’ development and delivery.
At the same time industry and the NHS must embrace the digital future – and that means linking data between the different parts of the healthcare system. The UK’s comprehensive healthcare system could capture data, measure outcomes, and provide evidence that, in turn, could help industry market innovations across the world.
Secondly, we need a much less risk averse culture in which regulators and others at the centre are willing to support innovation. Many NHS leaders talk about a top-down “fear of failure” that prevents them from taking risks in terms of research-led, personalised care. We need a new message from the centre, signalling a greater willingness to support research.
Thirdly, if we are to retain and enhance the UK’s status as a world leader in life sciences, we will need to reflect seriously on wider investment in the health service. Too often research can be squeezed out when organisations are struggling with the day to day – the case for a fundamental review of funding is unanswerable and, without it, there are dangers to effective support for life sciences.
Finally we need to support and develop the vital relationship between our university teaching hospitals and their academic partners. Almost 20 per cent of England’s NHS Trusts are university hospital trusts, where academic, research, education and clinical work is inextricably linked. It is within university hospitals that much of the ground work takes place, and the success of the life sciences strategy will depend to a significant degree on the support of these Trusts and their partners. It is important that their voices are heard as the strategy is taken forward.
In many of our political debates about structures and processes, we tend to fight the last war, not anticipate the next one. Critically we underestimate the impact of science and technology. We must not do so now. The benefits of a greater focus on life sciences are unarguable. We need to take forward progress in key areas such as genomics and our understanding of the biology of ageing, and to use biomedical engineering to enable older people to live independently at home for longer.
A successful life sciences strategy can help us speed up the availability of new treatments, centralise and share knowledge and specialisms, better integrate trials, and address the key clinical research challenges. The real beneficiaries will be patients and taxpayers – creating a lasting partnership will help our citizens get better and get better off.
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People in the UK are underestimating the cost of elderly care by £7bn[i] every year, according to research from Scottish Widows’ independent think tank, the Centre for the Modern Family. On average, UK adults estimate that residential care would cost £549 a week – when in reality it costs on average £866 for a place in a nursing home – leaving a shortfall of £317 every week[ii].
More worryingly, the deficit could be significantly higher in reality, since one in four (25%) people admit they have no idea how they would cover these costs for themselves or a relative. Only 15% of people are saving money on a monthly basis to pay for their own care when the time comes, and almost half (49%) say they avoid thinking about the issue because it makes them feel stressed. With an ageing population and growing care costs, the nation could be facing a care funding crisis.
Families footing the bill
Instead, half (49%) of UK adults say they will have to rely on a relative to help them cover the costs. This could leave families in a difficult financial situation, particularly as more than four in ten (42%) people have £2,000 or less in life savings to fall back on, meaning they could only cover the cost of care for a maximum of two-and-a-half weeks.
Half (50%) of UK adults believe the responsibility of helping parents to pay for care should be shared between siblings. However, almost half (48%) of those over the age of 55 still haven’t discussed who will take on this responsibility in their family. With more than nine out of ten (92%) people not saving anything to help their parents or other older relatives, this could lead to a significant shortfall in support, particularly as people estimate they could only afford to spend £69 a week on care for their parents.
A lack of understanding of the benefits system could also be problematic for many. Almost one in four people (24%) claim they would need, or expect, to rely entirely on state support, but two in five (42%) admit they don’t actually understand what benefits – both practical and financial – they would be entitled to.
An over-reliance on relatives to provide financial support already has a significant impact on families. Almost one quarter (23%) of those caring for a family member say it has put a strain on their finances. One in ten (12%) have been forced to make sacrifices to cover the cost of care for themselves or a relative, with a quarter (24%) of those people making major adjustments such as re-mortgaging their house. A similar proportion (22%) have been forced to make a moderate sacrifice such as taking on a second job to cover the costs.
Supporting relatives practically and financially also puts emotional strain on families. Of those providing care, four in five (80%) say it has had an effect on them, with more than a quarter (27%) admitting it has put a strain on their close relationships. Although women are more likely to say they have less time to themselves (48%) than men (34%) when caring for a relative, men (30%) are more likely to feel their family relationships have been impacted than women (23%).
Jane Curtis, Chair of the Centre for the Modern Family and non-exec director of Lloyds Banking Group Insurance, said: “The number of people in care in the UK will almost double by 2035. Our research shows that an over-reliance on relatives and the state could put families in serious financial difficulty. It can seem difficult to know how to prepare for the future, but to avoid a financial care crisis we all need to have an honest discussion on later life care as early as possible so no one is left footing a bill they can’t afford.
“As for state provision, it’s clear that many people simply don’t understand the social care benefits and support system. Providing clarity and raising awareness of what is and isn’t available is critical to helping people prepare for the longer-term future.”
i) We calculated based on underestimated price of residential nursing care per week (£317) (£866-£549) multiplied by current number of UK over-65s in care (421,100 according to the latest Laing & Buisson and detailed in Age UK’s ‘Later Life in the UK, August 2017’ report) including with nursing and multiplied by 52.
[ii] According to regional cost figures from Laing & Buisson Care of Older People, including England, Wales, Northern Ireland and Scotland:
|Adult population||Cost of care home with nursing per week||Amount spent in total||Percentage of national spend|
|All of UK||51,767,000||£866||£44,830,222,000||100%|
|Yorkshire and Humberside||4,270,777||£755||£3,224,437,013||8.25%|
A Newcastle University study claims that rapidly rising numbers of older people with substantial care needs will create a requirement for 71,000 extra care home places by 2025. The research – Is late-life dependency increasing or not?- was published in the Lancet on 15th August 2017
The study raises concerns about how the new places will be paid for and estimates that within four years £940 million will be required for social care in England. “If dependency prevalence remains constant, we estimate that by 2025 there will be an additional 353,000 older people with substantial care needs,” according to the project leader, Professor Carol Jagger. “While many of these people will live in the community, at current rates of provision this will mean a shortfall of more than 71,000 care home places by 2025. Our findings have considerable implications for relatives as older people will have complex needs, requiring sustained input from family carers or social care teams to support independent living.”
The number of years spent with substantial care needs for adults aged over 65 nearly doubled between 1991 and 2011, increasing from 1.1 to 2.4 years for men, and from 1.6 to 3 years for women. Sir Andrew Dilnot, a leading economist who led a government-commissioned review of social care funding, said spending on the care of older people would need to “increase substantially and quickly, although this increase does not mean that every individual will need large amounts of care.”
Commenting on the study, Nick Sanderson, CEO of Audley Retirement, said: “Britain’s ageing population brings with it significant societal challenges. High amongst the worries faced by this group is the question of later life living and the possibility of needing care. Both the NHS and local authorities are struggling to cope with the mounting pressure and traditional care packages are coming under increasing strain. Many people would ultimately prefer to remain at home as they age so it’s crucial we facilitate the development of housing that allows them to do this. High quality retirement properties with care available as and when required prepares people for changes to their health whilst enabling them to maintain their independence. There may be no simple answer to how we deal with the creaking care system, but we know the retirement village model is one that works, and we have a responsibility to drive that forward.”
It’s been a tough few weeks for the NHS, criticised over its legacy IT systems, alleged weakness to cyber-attacks and constantly under scrutiny for its spending and investment decisions. Yet, even with these high profile challenges in mind, no-one can deny it’s one of the UK’s most treasured and relied-on organisations. Our National Health Service plays a vital role in the nation’s health by providing free critical care to all regardless of background or income, even though its doctors and nurses face major budget and resourcing constraints each and every day.
The organisation is under major pressure to improve the quality of its services and financial management, even against a backdrop of financial constraints. Even with stretched budgets and challenging economic conditions, the NHS must make further investments in digital transformation programmes in order to deliver a fully rounded quality patient service and cut growing costs.
A House of Lords committee recently backed the Government to make technology uptake an ‘urgent priority’. As an organisation delivering vital services on a national scale, the NHS has already seen pockets of benefits from investments in bold initiatives to improve diagnoses and treatments, such as big data analytics, artificial intelligence (AI) and the Internet of Things (IoT). However, the pace of IT adoption across the health service has varied from trust to trust, and even across departments within trusts, which means achieving consistency across the country has long been a challenge.
With that in mind, this feature will investigate how the NHS can improve patient care through technology without compromising its values as an organisation that’s free and open to all. Additionally, I’ll take a look at what a truly digital NHS could look like and how this would improve patient services in terms of accessibility, availability and engagement with treatment plans and wider services.
Building a multi-channel health service
There are already ambitious plans in place for improving the NHS through the use of smarter IT and increased access to technology. The government has also initiated its policy to make the service ‘paperless’ by 2020, ensuring all documents are digital to improve the flow and consistency of patient information.
It was also recently announced that the NHS was investing in a new AI-powered ‘chat-bot’ service to provide support and information for mothers. This interactive resource will provide 24/7 access to approved guidance around breastfeeding, reducing the time spent on phone lines and relieving pressure on the health service, whilst ensuring mothers are given the information they need.
As some of you may already know, the first few months of parenting are typically awash with anxiety, late night trips to the hospital or frantic phone calls asking for advice and guidance. This rush for information – from breastfeeding advice to treating colic – is never ending and can require 24-hour support.
Of course, nobody wants to be making regular trips to the local hospital, so this chat-bot service provides a digital-first solution with advice, guidance and reassurance at a user’s fingertips. This new service provides cost-effective around the clock support, while also preventing unnecessary hospital visits and reducing waiting times on inbound calls into the NHS helplines.
Driving NHS IT forward
Recent research from Nuance also revealed that nearly half of NHS Trusts (43%) are investing in artificial intelligence (AI) technology, to enable patients to ‘self-help’ when accessing services. This new data, obtained under the Freedom of Information (FoI) Act, revealed that many NHS Trusts are considering harnessing technology – such as virtual assistants, speech recognition technology and chat-bots – to ease the pressure on healthcare workers across their organisations.
The research also revealed a developing approach to mobility. Nearly half (47%) of trusts now permit staff to work ‘on the go’ using mobile devices to more efficiently complete tasks such as developing patient records, saving those working in the community valuable travel time and expense.
An intelligent future
AI and chat-bots are clearly the latest buzzwords in the technology industry, but for the NHS, the power of these technologies could mean much more than just implementing ‘gimmicky’ new tools at a reduced cost. This technology has the potential to transform the wider NHS, supporting patients to self-help, as well as helping doctors with suggested diagnoses or long-term care proposals.
We are in an age in which citizens, customers and patients are all seeking the ability to self-help, to self-diagnose and to self-determine. Our NHS can meet these objectives by investing in intelligent technology that not only saves doctors, nurses and healthcare professionals vital time, but that also truly puts patients in the driving seat when considering their health and overall wellbeing.
Frederik Brabant, MD, Chief Medical Information Officer at Nuance
Due to people beginning to live longer in Britain, their health needs become more specific, meaning they need a certain type of care that will guarantee they live the best life possible. What this means, is that care homes need to use greater amounts of, and more intelligent, assistive technologies.
Greater living environments will need to be created for patients who need long-term care. This will ensure that patients are cared for appropriately when those in care require increasing amounts of supervision and attention.
Focusing on quality
Quality of care homes will be the new focus of those that are funded privately and through social care within the next 20 years. This is because it has been suggested that this strategy has the potential for people to ‘live healthier and longer lives’, as Jane Ashcroft suggested in the Silver Chic report in the future of care homes.
Design of care homes will remain important. For example, to help residents to be exposed to sunlight for the longest periods of time possible. As well as this, connectivity will also be a priority to help combat loneliness. To do this, care villages will use small bridges intersecting various gardens so that residents will closer to both their natural environment and other residents within the community.
Evolution of technology in our care homes
Royal Blind – (https://www.royalblind.org/care-for-older-people).specialists in care homes for the blind and care homes in Paisley – has assessed how care homes will be run in the future, and the technologies that will revolutionise the way people are cared for.
Technology is becoming more advanced as quality within our care homes becomes a priority. It is helping to ensure that patients remain safe within care homes while allowing them to live longer, healthier lives.
To help those living with dementia, clusters within buildings can be coloured variously with different lighting so that they are able to recognise their own living quarters. These types of technologies then, are specifically designed to ensure patient comfort, and help to guarantee their safety while living in care. Also care homes are now beginning to utilise sensors in rooms and systems within the building that alert staff when a patient has fallen, or when they have stopped moving.
Independence within the care home
To ensure that people within the care system feel independent, technology that is continuously improving will help residents live in a more self-sufficient way and will help with their specific needs.
Current technology can help monitor steps taken and the distanced travelled, as well as the heart rate of a patient. In the future, they will help to monitor fluid retention and respiratory rates, helping to lower hospital admissions, allowing patients to understand their own symptoms more effectively before they require medical assistance.
Robotics in care
Robotics will help calm down dementia sufferers who have to deal with extreme stress, used through robotic pets that can respond to human touch and respond in intelligent way.
Robots will be used to carry out general tasks that need to be carried our daily, whereas wearable robotic suits will help patients who suffer from arthritis to stand and walk. Giving them a better quality of life within the care system.
To make life easier, tasks that might be difficult will all be robotically controlled. Controlled curtains alongside voice commands that also control lights and other devices will be used to help those who are blind and have visual impairments. Care homes will be improving for both patients, their family and the staff that work within the home. The technologies that are already being utilised, and the systems that are being proposed, will help patients lead more independent and comfortable lives so that they can live a happier and healthier life for longer.
For many midwives working on the front line, the latest figures revealing that maternity wards in England were forced to close 382 times in 2016 will come as no surprise. During the 33 years that I was a midwife, sadly, I also saw many maternity units close and it’s extremely worrying to see that it’s still happening. A closed unit is a very busy unit and for both the pregnant women in the ward and the nurses, it can be an extremely stressful time. Once a ward is closed, many pregnant women can be pulled from pillar to post and forced to go to alternative hospitals, which can cause added stress at a time that is already quite daunting for them. This uncertainty around where mothers will be able to give birth is leaving some in fear that they could be caught out, and won’t have the time to reach the nearest ward that is open.
Women need to know they are in safe hands when they are giving birth. But to arrive at their maternity unit to find it is too busy and they have to be turned away disrupts the whole ethos of antenatal care. The point of antenatal care is to provide woman with the knowledge and ability to be calm and in control when their labour starts – yet for some, the calm birth they have been promised is not mirrored in the services provided when a unit is closed or is short of staff. In the serious cases we’ve seen at Fletchers Solicitors, women have been left in labour for lengthy periods of time without a midwife with them, or the midwife has been expected to care for two women at the same time. There have also been instances where women have had to wait to be induced as staff were not available to start the procedure.
But perhaps the most concerning consequence of the staff shortages has been delays in operations taking place. We recently handled a case where a client was left waiting for a tear to be repaired for three and a half hours following a traumatic birth. As a result, she suffered excessive blood loss and needed an urgent blood transfusion. From these figures, it’s clear that our maternity services are suffering a severe staffing crisis. We are now at a crucial point where staffing and capacity issues must be addressed as a matter of urgency to improve the safety of maternity services. We must work to prevent more women from being turned away from the hospital where they had planned to give birth. It’s up to the Government to start investing in the future of our NHS to alleviate the pressures on already overworked staff, otherwise resources are only going to become more stretched and unsustainable.
Carline Ashton, in-house midwife at Fletchers Solicitor
The state health service (NHS) in Britain has been a huge success fulfilling the vision of its founders; it has freed the poor from the fear of illness, provided assured careers for its staff, coped with demographic change, an information revolution, the rise of new and professional management and technological innovation. It remains free at the point of use, funded from general taxation, free from market imperatives and part of the fabric of the welfare state.
In 2018 it will have been in existence 70 years, most people in Britain have no pre-NHS experience. It is taken for granted, “We contribute according to our means and receive according to our needs” regardless of age, race, gender or social class.
In 1959 I entered Medical School and retired in 2015. I have worked in the NHS as a hospital doctor, a principal in general practice, a Director of Public Health, an Academic in Social Medicine & Public Health and for some nine years in Africa and Papua New Guinea as a clinician and academic; I have worked for locum agencies and done private practice. I have been a Manager and taught management skills. There has been involvement with NICE, the BMA, the RCGP, the IBS and the Faculty of Public Health. I believe that the NHS, with some reforms and a new model has an even more important role in the future.
The present model of the NHS is outdated, inefficient and often inappropriate- what follows is a personal vision for the future of the service over the next 25 years. This model is sustainable, evidence based, effective, caring and would deliver real health gain for the people of Britain within a reasonable envelope of time and money
50-70% of doctors’ workload should be performed by clinical practitioners/ medical assistants/ nurse practitioners. We need 50% fewer doctors, differently trained.
Clinicians e.g. Nurse practitioners can be trained in three years or less; they are less costly to train and employ, they are more likely to remain attached to a particular work site over time; their clinical care is more conservative and less costly than doctors (use of investigations, prescriptions).Their career aspirations are different, they are often content to remain at this professional grade for a working lifetime, competent and experienced..
Many medical procedures can be performed by non-doctors without impairing the outcome achieved. A clinical practitioner can be taught a complex procedure which is perfected over time e.g. Caesarean section, hernia repair, cataract removal, administration of a general anaesthetic. A good deal of health care is routine and repetitive working on well-designed algorithms. The medical skill is in determining the most appropriate management and care e.g.an operation, an investigation, and in determining a treatment plan on the basis of a presumed if tentative diagnosis.
The doctor-in primary or secondary care does not need to do the procedure him/her self-provided there is the expertise available. The doctor is managing, teaching and supervising a team of10+ others in the ward, the theatre or in primary care, most importantly the doctor is looking critically at workload, effectiveness and outcome, the doctor is auditing the work of the unit. (A platoon in the British Army is 25-30 soldiers; they bond together and work effectively and loyally)
A Salaried Service;
Primary Care in the 21st.century needs to be streamlined into the main health service.
The private contractor status of the GP should end and be replaced by a salaried service with training, refreshers, promotions and a definite career structure. Four or five primary care doctors (equivalent in status and paygrade to Consultants in secondary care) would co-ordinate the work of some 100 people in the care of a patient population of 25-50,000
The polyclinic model ( energy efficient, purpose built and ease of access to its population means demolition, compulsory purchase and capital investment) is best, with on-site physiotherapy, psychology, minor surgery, social work, laboratory, radiology and day beds There must be a single linked medical record, accessible, used by and updated by all the caring agencies and the patient/person. There should be visiting/linked consultation with secondary care e.g. OPD, teleconsultation, domiciliary visits.
A clinic serving 25-50,000 people would be fully staffed from 7.00 to 23.00 with consultations-booked and urgent access through the day, telephone/skype consultations, e-mail and provision of house visits as necessary, mainly performed by clinical practitioners working with a doctor lead.
Staff would work 8 hour shifts which might be staggered two hourly i.e. 7am-9am-11am-1pm-3 pm and the numbers/mix of staff determined by patient flow and workload. The service would operate daily (Sunday to Sunday) and staff would work five, eight hour shifts (40 hours) with 4 of those hours reserved for catch up ,paperwork, audit)
Out of Hours (OOH) from 11pm to 7am the clinic would be open with a small team including a doctor. OOH emergencies would be directed there with ability to perform telephone triage, advice, short term admission for observation and domiciliary visits.
Overtime and additional money for unsocial hours should be abolished. All “on-call” work should be acknowledged and paid at 50%.
All clinical staff would be contracted to be available for all shifts shared equally and a maximum 40 hour week. The overall employment package should take account of the demanding hours (salary, subsidised food, rest facilities-showers, beds, car parking working environment, crèche, and holidays) and the need to nurture the workforce, develop its skills and reward long service financially (study leave, retraining ,seniority awards at 10/15/25 years of service)
.Part-time contracts would take account of shifts offered e.g. a P/Timer available for all shifts but working a 40 hour week would have 50%of the Full/T salary. A P/T unavailable for unsocial hours working 20 hours per week would receive 10-20% less.
These agencies should be taken over and run by the state as part of the health care service;
Presently these companies are competing with one another in the market place, their main concern is to produce profits and reward shareholders. It is proposed that with a single, state agency there would be an agreed tariff of payments appropriate to the skill- type and grade of the employee, the timing and duration of employment and the administrative costs of the agency.
As it would not be a service run for profit, the fees charged would be less and the formal registration/assessment of applicants ensures standardisation and quality of locum work. Arguably with better terms and conditions for health care employees, gaps needing urgent cover and long term vacancies would be less.
An improved contract and conditions would mean that fewer staff would feel impelled to take on extra shifts for financial reasons or disillusion with working in the service.
No fault compensation is the best way of controlling and reducing the increasing sums paid out and the cost of defence premiums for workers while eliminating expensive and prolonged litigation
. The costs to the state health system are a significant part of the whole budget and yet this money is, in one sense, largely wasted.
The accusation, investigation, “trial” can take many months; it can damage the litigator and have grave consequences for the professionals involved-stress, burnout, suicide and inevitable decline in the quality of their clinical work.
A rapid investigation to determine the problem and its remedy should run in parallel with agreed financial payments available once the harm done has been assessed and its impact upon the litigator determined by a neutral arbiter.
If clinical/system error is found this can then be examined, reported and corrected without jeopardy to the clinician.
Professional bodies-GMC, GNC would still be involved and take further action if appropriate.
The Private Sector:
The role and purpose of the Private sector needs re-examination
The private sector and its use is part of the freedom of individuals-as patients or as clinicians. The private sector can set standards for quality and patient care. In this sense it can show the state service what may be accomplished, albeit, with often more resources-staff, buildings, facilities.
However there can be conflicts of interest when health workers work across both sectors. The private sector tends to “cream off” cold, standard, surgical procedures; it provides little data on its work and profit; it does not contribute to the training of staff. Its first priority is for profit and to the shareholder and it can withdraw its service at any time with no consequence to itself
These areas need to be clarified and an agreed code of conduct determined with necessary sanction if failure to comply. A strong, thriving private sector should be limited to 10%of the whole health care of the UK in any year.
A long term and flexible strategy,
The future direction of Information Technology (IT) in health is particularly difficult to predict as its applications multiply, as computing power expands and as human beings learn to use and become safe and comfortable with the digital revolution. Here change will come quickly altering the way people use the service, the response of clinicians, clinical investigation and robotic devices in human care. At the same time the system must have the ability to provide access, confidentiality and safety.
The clinical record needs to available to all clinicians involved with a person. It need to be updated in real time and patient friendly so that the patient can participate in the record and ensure its accuracy
It is suggested that to ensure continued and adequate investment, maintenance and cyber security that 0.25% of the health budget be ring fenced for this purpose.
Need, demand, fairness and transparency
A new model needs to be considered
The most difficult elements of health care to determine are need and outcome, presently the system is often managed on a mixture of demand, new technology, demographics, expediency, pragmatism and politics. There are recurrent funding crises, staff feeling ignored, ill-prepared and with little say while the media often concentrate on failures with a blame culture fuelled by high expectation and expensive, time consuming litigation.
Management decisions and the decision pathways are not transparent. They are difficult to challenge and are rarely revisited.
It is proposed that for every main specialty- i.e.
(Surgery) General Surgery, Cardiac Surgery, Orthopaedics, Obstetrics, ENT, Ophthalmology etc.
(Medicine) Sexually transmitted disease, Nephrology, Neurology, Dermatology etc.
(Mental Health) Psychiatric illness, Learning Disability etc.
(Support services) Radiology, Pathology, Microbiology, Haematology etc.
(Public health) Communicable disease control, Health Promotion etc.
That a group of key individuals (maximum 20 people) be proposed-
Consultants in specialty, Nurses, GP’s, Patient representatives, Managers of the service, Epidemiologists and Health Economists (the epidemiological and health economic methods and models would be standardised across all the groups).
The group would be chaired by an independent manager and would try to determine the real population normative needs in the next 3-5 years taking account of new technologies, evidence from clinical trials, incidence, prevalence, prevention and outcome. The aim is to recommend a “bread and butter” service to meet the needs of a UK population in the first part of the 21st.century.The key factors are ethical awareness, environmental impact and clinical/cost efficiency, effectiveness and measurable benefit e.g. DALY’s, QALY’s, morbidity and mortality
Their recommendations, once agreed could be translated into the requirements for skilled staff, equipment and buildings with the essential logistics and infrastructure to provide. The consensus which emerged would be the best estimate of population need for a population of 500,000 with concessions for age, gender, race and deprivation and the anticipated health gain. The process of discussion and reasoning would be transparent and could be challenged
All the specialties would report and a global sum established. Government would then decide how much of the GDP was available for health care and thus the percentage which could be realistically funded-possibly 60-70% at best. It would mean that every specialty was funded at 70%-cardiac surgery or learning disability. If more or less funding was available then the 70% might be raised to 75% or lowered to 65%.
Funding then in place the group would monitor the effects of this pattern of delivery by auditing agreed outcomes or proxies and to see how their estimates were appropriate.
The group would review their service every three years to reflect changing patterns of disease, socio-demographic change, and new technologies. Over several cycles the whole process would become better informed and better understanding of need and outcome emerge.
The local management responsible for the health care of 500,000people would commission on the basis of these recommendation and the provider networks would have a clear indication of longer term service development. Arguably there should be some flexibility, a leeway of 1-2% in “commissioning/providing” to take account of local factors.
Health Care in the UK needs to be rethought; it needs to be evidence based and affordable. The decisions around health need to be transparent and the reasoning open to scrutiny and challenge. The tools to achieve this are now available.
At present there is uncertainty about the real funding needs and optimal skill mix to best meet the health needs of the UK population.
Up to date information, the changing nature of clinical interaction and accurate, timely health records require a funded, safe system provided through a national, agreed and funded Information strategy.
Every member of staff needs to be developed, nurtured, and reskilled over his/her career; they must be routinely involved in contributing ideas and in planning the service
Shift work (8-12 hours) and a standard 40 hour week for all staff is recommended
The number of doctors should be reduced and new or existing Clinical grades expanded to replicate much of the work doctors do. E.g. Nurse practitioner, Physician’s Assistant.
Primary Care should become a salaried service, the independent contractor status is no longer appropriate. The service would be led by doctors and serve population hubs of 25,000 people based upon a polyclinic model
Locum agencies should be an integral part of the health service
No fault compensation would be less costly, less distressing and more effective in providing early compensation, avoiding a blame culture and learning from errors
The patient voice, interaction and perspective is essential in planning and auditing health care
A different methodology based on the epidemiology of common conditions and their management is suggested which tries to link need with outcome and uses health economics to determine costs The present tools, while not perfect are adequate and over several cycles would be improved.
. This model should be debated, refined and then trialled.
Peter Sims Saturday, 05 August 2017