The healthmatters blog; commentary, observation and review
Female genital mutilation
FORWARD is a leading African women-led not for profit organisation working on female genital mutilation, child marriage and other forms of violence against women and girls in the UK and Africa; It offers young people the chance to gain skills and help create change in their communities. FORWARD’s Young People Speak Out (YPSO) programme provides skills, training and support for young people (16 -25) and works with them to create projects, events and workshops in their local communities as a way to raise awareness about the practice and impact of FGM in the UK. The programme includes youth training, youth advocates, organizing public awareness events and projects, providing emotional support for victims of FGM, and raising FGM awareness by organising school events. FORWARD is not only giving young people a voice, it is creating a platform for lasting change through youth engagement and raining. If you would like to get more information about FORWARD, FGM, YPSO upcoming events, free training and opportunities as well as projects or to interview the team, please contact firstname.lastname@example.org
Demoralisation widespread in the NHS? Seemingly not.
Results from the 2016 NHS Staff Survey, published on March 7th, portray a service striving to provide good patient care – with continued engagement from staff despite a pressured work environment. The 2016 NHS Staff Survey, co-ordinated by Picker, involved 316 NHS organisations in England. Over 982,000 NHS staff were invited to participate using an online or postal self-completion questionnaire and 423,000 did so, a response rate of 44%. Full-time and part-time staff who were directly employed by an NHS organisation on September 1st 2016 were eligible. Fieldwork for the survey was carried out between late September and early December 2016.
The acting CEO of Picker commented: “The results suggest staff continue to remain motivated with overall staff engagement continuing in an upward trend since 2012. Over half of all staff (59%) reported that they often or always look forward to going to work with 74% of staff feeling enthusiastic about their job. Furthermore the proportion of staff reported feeling unwell due to work related stress is at its lowest since 2012, down by 37%. Although work pressures still remain a concern, with nearly one in three (30%) feeling unable to meet all the conflicting demands on their time at work.
Overall staff engagement has shown sustained improvement over the last five years, as has staff willingness to recommend their organisations as a place to work or receive care. These are very positive results and welcome good news for the NHS. Although there are a number of positive trends over the last five years, some results for 2016 remain concerning. Staff continue to work under significant pressure: 47% say that there are not enough colleagues at their organisation for them to do their job properly, and three in five (59%) reporting working unpaid overtime each week. Similarly, 60% of staff reported coming to work in the last three months despite feeling too unwell to fulfil their duties, and most of these staff (92%) said that they put themselves under pressure to come to work. Continued commitment from staff in spite of the pressures they face reflects their dedication to the health service”.
News from Nowhere notes the discrepancy between claims of widespread demoralisation in the NHS and Picker’s findings, and looks forward to reading explanations. The Health Service Journal suggested that the 2016 Staff Survey results matched up well with CQC inspection results. For example, of the bottom 10 acute trusts on staff recommending their Trust to a friend or family member, four are in special measures. Does this mean that demoralisation is localised rather than widespread?
The Royal Society of Public Health has called for a reduction in the maximum bet that can be placed in one game on Fixed Odds Betting Terminals (FOBTs) from £100 to £2. FOBTs have been described as the ‘crack cocaine’ of gambling, with their capacity to be played rapidly and repeatedly representing a serious addiction risk. There are over 30,000 FOBTs on high streets across the UK, on which regular players spend an average of £1,209 annually. This is considerably higher than the average £427 spent annually on over the counter bets such as those on horse racing and other sports.
The RSPH is concerned that gambling on FOBTs is fueling financial problems, which in turn is damaging the health and wellbeing of users in a variety of ways, from poor mental health and an increased risk of suicide to the breakdown of personal relationships. Its’ report can be found at Fixed Odds Betting Terminals – Assessing the Impact.
Kings College London has also published a review of research evidence about gambling-related harm experienced by people with dementia, mental health problems, learning disabilities and other cognitive impairments (such as acquired head injury). You can read it at:
Where is the spare capacity?
NHS England’s Next Steps on the NHS Five Year Forward View (published on March 31st) effectively abandons the 18 week target for elective surgery. The commercial sector was quick to point out that it had spare capacity to treat NHS patients – at a cost set by the NHS – and that it could play an important role in helping meet elective surgery waiting time targets.
Fiona Booth, AIHO Chief Executive said: “The NHS has had to make some difficult decisions on how to balance available funding between growing service demands. However it’s important to remember the independent sector has capacity to help the NHS deliver services for patients. Providing timely hip and knee operations benefits the whole economy. Our recent ‘Joint Working’ report showed that hip and knee operations being carried out by the independent sector contributed an estimated £540 to £692 million to the UK economy each year through reduced employee sick days, knock-on business productivity, welfare and benefit savings, and savings to the NHS. These savings demonstrate that it’s in everyone’s interest to ensure people are still receiving quick access to elective operations”
It’s not just a matter of beds and theatre time. ‘Next Steps’ makes commitments around developing 150 Urgent Treatment Centres, introducing new multi-disciplinary Rapid Diagnostic and Assessment Centres and supporting hospitals sort out delayed discharges. David Hare, speaking for NHS Partners, the trade association representing the widest range of independent sector providers of NHS clinical services, said: “We believe that the independent sector has a key role to play in all three of these areas. We also welcome the commitment that ‘third party experts’ will be deployed to support with population health management capabilities within Accountable Care Systems”.
- Survey* of 6,600 people over 12 months found that sedentary people who increased activity levels to 150 minutes a week (21 minutes a day) – currently the government recommended level, saw life expectancy increase of 3.1 years
- People who increased their activity levels to 90 minutes saw an increase of almost three years (2.7 years) and exercising just 60 minutes a week saw an increase of more than two years (2.4 years)
- The research was calculated through analysis of each individual’s ‘Vitality Age’, an aggregate measure of wellness that evaluates the gap between physical body age and actual age. By surveying members before and after they made changes to their everyday behaviour, the data pinpointed the impact of behaviour on life expectancy
- Further research found the main barriers preventing people from taking part in sport or exercise include time constraints (31%), the expense (21%) and people not enjoying it (19%)
- Vitality’s ‘Everyday Athlete’ campaign aims to inspire the nation to make small changes to realise lasting health improvement, whether it’s getting off the bus a stop early, walking up the stairs rather than taking the lift, or walking the dog for an extra 10 minutes a day.
Vitality Ambassador Jessica Ennis-Hill said: “I am delighted to support the Everyday Athlete campaign – it’s a fantastic way to spread the message about the benefits of health and wellbeing in a fun and inspiring way. I truly believe in the core message of the campaign, which is that everyone, regardless of their current health and fitness, can take small steps to live a happier and healthier life. Being an Everyday Athlete doesn’t mean you have to run a marathon or climb a mountain, it just means changing everyday behaviours such as walking up the stairs rather than taking the lift, or getting off a bus stop or two early to walk the rest of the way to where you want to go. This campaign shows how easy it is for people to make small changes that can really benefit their short and long term health.”
Ten life hacks to becoming an ‘Everyday Athlete’
|Everyday Athlete activities||Calories burnt in a week (Women)||Calories burnt in a year (Women)||Calories burnt in a week (Men)||Calories burnt in a year (Men)||Details|
|One hour of gardening||279||14508||332||17264||One hour of vigorous gardening a week, multiplied by 52 weeks|
|Walking upstairs at work daily||93||4464||111||5328||Assuming a total of 5 minutes of walking upstairs a day, based on 48 working weeks in the year|
|Walking around house while carry an infant||285||14820||339||17628||Assuming a 15lb baby and walking 10 mins a day|
|Getting off the bus a stop early and walking||175||9100||208||10816||Assuming the walk between bus stops is 5 minutes each way, 5 times a week|
|Taking the baby for a walk in the pram||349||18148||415||21580||Assuming a 20 minute walk 5 days a week, based on 48 working weeks in the year|
|Doing 30 minutes of standing at the office everyday||385||20020||460||23920||Details calculated usinghttp://www.juststand.org/tabid/637/default.aspx|
|One hour of house work a week||210||10920||249||12948||Assuming one hour of vigorous house cleaning|
|Washing the car once a week||157||8164||187||9724||Assuming 45 minutes of car cleaning|
|Walking to the station everyday||524||25152||623||32396||Details. Assuming a 30 minute walk a day, 5 times a week, based on 48 working weeks in the year|
|Walking the dog an extra ten minutes a day||244||12688||291||15132||An extra 70 minutes|
* Research calculated through analysis of each individual’s ‘Vitality Age’,
The Cavendish Coalition has responded to the triggering of Article 50 by calling on the Government to safeguard the UK’s ability to recruit and retain staff with the skills needed to deliver high quality health and social care to local communities.
The coalition, a group of 34 social care and health organisations working to ensure the system is properly staffed after the UK leaves the EU, has set out what the Government needs to focus on during EU withdrawal negotiations to maintain safe, high quality health and social care services.
We have today written to the Secretaries of State for the Home Department, Exiting the European Union and Health making clear our offer to work with the Government to help inform a future immigration system where public service value is used as a key assessment of ‘skill’ as opposed to salary, and which guarantees the status of EU staff already working in health and care.
We are also calling for a straightforward and responsive transitional system for people from the EEA during the period between any ‘cut off’ date after which EU nationals coming to live and work in the EU will not be guaranteed leave to remain and having a new and operational immigration system.
Cavendish Coalition co-convener Danny Mortimer said:
“It is absolutely critical that the Government takes all possible measures to safeguard the supply of health and social care workers needed to continue delivering safe, high quality care.
“We are ready and available to support the Government in a way which allows it to plan a future immigration system which assesses skill levels based on public service value, as opposed to salary. This will be central to the PM’s commitment to make the UK a magnet for global talent.
“It is also vital that any transitional system provides clarity and certainty so that people entering the UK are clear on their status – as certainty supports stability and sustainability in health and social care.
“Such a system must be flexible enough to allow social care and health to recruit from Europe when staffing needs cannot be met through additional domestic recruitment and training.”
Drop in US drug approvals but no similar trend is seen in EU
Glasgow, United Kingdom (March 28, 2017) – NDA Group announced findings from their fourth annual comparison of drug approvals in Europe and the United States, ahead of this year’s DIA EuroMeeting in Glasgow. This year’s Status of New Drug Approvals report emphasises the need for a streamlined global development and commercialisation process across the world’s two biggest markets.
The report – based on preliminary research figures from the EMA and FDA websites in January 2017 – found that there has been a drop in US approvals but not in EU. For 2016 there were 74 new drug approvals granted in the US and EU. Of these new products, 19 were approved only in the EU, 19 only in the US, and 36 were granted in both regions. However 17 drugs that were approved in the EU in 2016 had received prior approval in 2015 or earlier in the US, while only six products registered in the US in 2016 were previously approved in the EU.
Johan Strömquist, CEO, NDA Group “Understanding the evolving regulatory landscape and requirements is a key concern for the drug developing industry, as is it for us at NDA. It is intriguing to see how expedited pathways shape this year’s statistics just like it did last year, but with a very different outcome. It’s also interesting to see the continued rise of smaller companies in the percentage of products taken to market.”
“Our analysis for 2016 shows that NDA maintains an exceptional position in supporting new drug product approvals in Europe. During the last four years NDA supported over 40% of the new drugs approved with a broad range of services. I’m also excited to see the increase of products going through the FDA that received NDA’s support. NDA supported over 20% of new drugs that achieved approval by the FDA during 2016.”
Terese Johansson, PhD, NDA’s consultant behind the research commented: “The findings show that FDA has had a significant drop in drug approvals but continues to grant more expedited and nonstandard review approval status than the EMA. The drop is not as pronounced in the EU but is likely to be more prominent in 2017. Expedited drug development and nonstandard review approval pathways are the new norm in the US, but in the EU special approval procedures are not as common. The US situation could be explained by the increased use of the shorter nonstandard approval pathways since there has also been a significant increase in complete response letter (CRL). During 2016 FDA issued 14 CRLs, compared to just two in 2015.”
“The report also highlights the continued trend that many companies first seek approval in the US. Both the EU and US show increases in drug approvals from small and medium sized pharma but big pharma still dominates the drug approval statistics. The busiest therapeutic area was oncology.”
citizenAID was distressed to see the events in London unfolding yesterday and its sympathies go out to all those involved in the attack. citizenAID would also like to take this opportunity to praise the emergency services for their response to the event and the sacrifices that they make each day to keep the public safe.
citizenAID is an app and pocket guide that has been developed to advise members of the public on what they can do in the aftermath of a multiple casualty incident to keep safe and provide vital first aid for the injured people around them.
citizenAID has been set up by a team of senior clinicians with civilian and military experience and is a part of the Queen Elizabeth Hospital Birmingham Charity. This military experience has been gathered during recent conflicts in Iraq and Afghanistan and has been the basis of the information provided in the guide. For more information please see citizenaid.org
Professor Sir Keith Porter, co-author of citizenAID, said “On behalf of citizenAID I urge everyone to download the free app (available on iTunes and Google Play) and familiarise themselves with the information on it. The app gives people the information that they need to keep safe in the immediate aftermath of a multiple-casualty incident and shows them how they can help to save the lives of the injured people around them.”
Artificial intelligence to help create automated virtual GPs to advise patients online in ground-breaking university partnership
Orbital Media, digital and social specialists, and the University of Essex have today announced they are joining forces to use artificial intelligence to save the NHS millions of pounds per year by creating automated online GPs to revolutionise the way patients are treated.
In partnership with Innovate UK, the project will exploit Artificial Intelligence (AI) and Machine Learning technology to provide medically approved health advice to the increasing numbers of users who seek medical information online. The technology developed, via the partnership, will be used to serve interactive advice via groundbreaking, photo realistic avatars. Information supplied by the platform will focus on minor ailments such as colds, coughs, flu and hay fever. These self-treatable conditions currently account for a significant proportion of GP time and are identified by the Proprietary Association of Great Britain (PAGB) as one of the five examples of wastage in the NHS system¹, amounting to a cost of £2 billion per year².
The resulting technological solution will provide a visual, reliable and robust online health advice service, to meet the rapidly growing demand for online ‘symptom searches’.
Due to its public importance and potential impact, the 30 month project will be part-funded by the Engineering and Physical Sciences Research Council (EPSRC), The Economic and Social Research Council (ESRC) and Innovate UK. Taking place through the university’s Knowledge Transfer Partnership (KTP) initiative – a world-leading programme that helps businesses innovate by connecting them to the UK’s wealth of academic resources – the project will be managed by a carefully recruited Computer Scientist – known as the KTP Associate – who will base themselves at Orbital Media full-time and work closely with the Academic team.
Orbital Media CEO, Peter Brady, commented on the importance of this innovation to the NHS: “GPs are currently under immense pressure, with significant amounts of money devoted to dealing with minor ailments. This comes at a time when the NHS is required to find £22 billion of efficiency savings by 2020³. The potential for AI technologies to help relieve pressure from the heavily burdened primary care system is significant. Even if we can reduce the cost spent on minor ailments by as little as 1%, the potential saving to the NHS would be approximately £20 million per annum. AI has a key role to play in supporting future healthcare needs and this is just the beginning of our exploration into its potential applications within healthcare pathways. It’s hugely exciting for Orbital Media to be at the foreforont of this cutting edge technology, which could produce genuinely revolutionary improvements for our healthcare system.”
Dr Luca Citi from the School of Computer Science and Electronic Engineering at the University of Essex added: “Artificial intelligence and machine learning technology have the potential to transform so many aspects of our everyday lives. We are excited about this opportunity to work with Orbital Media to see how we can share our expertise to have a significant impact on how health services might be delivered in the future.”
¹ PAGB Five Examples of Waste in the NHS;
² PAGB Self Care, Making the case for self care at the heart of the heath agenda, assessed July 2016.
³ PAGB Five Examples of Waste in the NHS; http://www.pagb.co.uk/content/uploads/2016/11/Five-examples-of-waste.pdf
UK employees work some of the longest hours in Europe, but produce 30% less per hour than workers in France, Germany and the US (according to the London School of Economics). Low productivity has been a thorn in the side of successive Governments and predictions for any future change are pessimistic. Whatever form Brexit takes, it will further expose the UK to global competition and stark comparisons in areas like productivity.
Looking from a health and wellbeing perspective, the productivity conundrum doesn’t look so complicated. The harder employers push their staff to be productive – focusing on efficiencies in practices, cost-savings from digital working, ‘always on’ availability – the less they get from people over time. On a rational level, all the changes are sensible, but they are also mechanical. People wither under the combination of pressures and productivity suffers.
As the Willis Health & Productivity Survey Report 2015 argued, employers need to think more holistically when it comes to what impacts on productivity, not just trying to pull levers that ratchet up what employees do in the time available.
Employee wellbeing is based on inter-relationships between work and home life, physical and mental health. The work we’ve been doing at Bluecrest with our employer partners is based on this understanding of the importance of taking a ‘public health’ approach: making low-cost health screenings available to all staff; providing comprehensive anonymised data to inform wellbeing strategies; and spending time with employers to explain trends and what they could be doing to improve organisational health overall and for particular groups of staff.
The workplace culture and environment can be the root of poor mental wellbeing as a result of unrealistic time pressures and targets, strained relationships and bullying. But also has the potential to be the basis of a positive culture of wellness, supporting health and wellbeing initiatives.
Secondly there’s the personal dimension. Whether employees look after their own health – at the basic level of getting sleep, eating well, taking exercise – is fundamental. There’s also the issue of their personal values, beliefs and attitudes to work, and their ability to cope with demands from relationships, finances and responsibilities like caring for family.
And thirdly, the impact of risks to health. Ongoing medical conditions (such as obesity, diabetes, heart disease etc) have all been shown to decrease productivity. Undiagnosed conditions, both physical and mental, have the potential to lead to more serious health problems. Early recognition and flagging any increased risks to health is vital to help employees avoid chronic long-term conditions.
Critically, organisations need to move away from simply viewing investment in wellness as purely about cost reduction (the Return on Investment) and towards a focus on the `Value of Investment` looking at a wider set of outcome metrics: absenteeism, worker morale, employee turnover, presenteeism costs, workers compensation, disability, employee loyalty and tenure. All of these factors add up to a significant impact on productivity.
Employers that adopt a public health culture will be best placed to improve productivity. When the University of Birmingham looked at workplace wellbeing programmes and their impact, it pointed to the importance of interventions that target whole organisational cultures and practices; run sustained programmes, such as annual health screenings, and by tailoring the health and wellbeing offerings to particular groups of staff and their needs.
Health benefits can’t keep being seen as just a perk, separate from issues of business performance. Join up the thinking and there’s a solid platform for turning productivity levels around for the long-term.
Dr Nick Summerton, GP and Medical Director at Bluecrest Wellness, www.bluecrestwellness.com
Paula Kathrens, an employment specialist at law firm Blake Morgan, said: “Today’s consultation is good news for NHS staff and ultimately good news for the NHS and the public it serves. The health sector has one of the highest instances of whistleblowing reporting and currently the law does not protect job applicants who have blown the whistle in a previous employment. This is one area where the UK whistleblowing legislation differs significantly from protection against discrimination under the Equality Act 2010. Under the Equality Act 2010, not only are job applicants protected against discrimination generally, but there are victimisation provisions which protect job applicants who have made a discrimination complaint against a previous employer.
“By contrast a worker who has blown the whistle against a previous employer might be protected from reprisals, but only if they are already working for the new employer. In all employments, but particularly the NHS, this leaves a big gap for whistleblowers who are not yet re-employed and looking for another job. Following the Mid Staffs inquiry and the Francis Review it was recognised that action needed to be taken to challenge the culture within the NHS that deterred staff from raising concerns and legislation was passed in 2015 to pave the way for protection for applicants in the NHS. The consultation launched today is on the detail of the regulations. They are based on the regulations which prevent blacklisting for trade union reasons.
“In the draft regulations, the emphasis is on whether “it appears to the NHS employer” that the job applicant has blown the whistle – it does not matter if in fact it turns out that they have not done so. It will also be for the NHS employer to prove that there has not been discrimination, rather than for the job applicant to prove that there has. It will be interesting to see the case law developments in this area.
“Discriminatory conduct by NHS staff in the course of recruiting a whistleblower, or an agent on behalf of the NHS employer, would be treated as if it had been done by the employer itself. It would not matter if the NHS employer did not know or approve of the conduct. It will be a defence for the NHS employer to show it took all reasonable steps to prevent its staff or agents from discriminating. This mirrors the defence currently under the Equality Act 2010 and places an emphasis on the employer to show it has put in place thorough training and done everything it can to develop a culture where such discrimination is not tolerated.
“As with other whistleblowing claims, under the draft regulations, the amount of an award for a successful claim will be what is fair in the circumstances, with no maximum ceiling. Employment Tribunals will, however, be required to take into account a number of specified factors. An award could even be increased if an Employment Tribunal has made a recommendation that the NHS employer takes action to remove or reduce the effect of the discrimination on the job applicant, and the NHS employer has not done so. There are also ways that a job applicant could restrain an employer from discriminating against him or her.
“The consultation on the draft regulations is open until 12 May 2017. At the same time, the European Commission has just launched a consultation on whistleblower protection across the EU. The UK’s whistleblowing laws were introduced completely independently of the EU and are in many ways more robust than those in other EU Member States, but it will be interesting to see what conclusions are drawn about the best way of protecting whistleblowers across the EU.”
Cancer Research UK is urging NICE to reconsider proposals to introduce a £20 million impact test on new drugs which include vital end-of-life medication. Presently the National Institute for Health and Care Excellence (NICE) decides which medicines are good value for money for NHS England.
The new proposals are to have an extra affordability test which could mean that from next month NHS England will be able to delay drugs if the total cost to the health service is more than £20 million a year.
Sarah Woolnough, Cancer Research UK’s executive director of policy and information, said: “If NICE thinks a cancer treatment is clinically effective and represents value for money, then patients should receive it without delay. A system that could add up to a three year delay before patients can access treatments deemed clinically and cost effective is unacceptable. Cancer patients may lose their lives whilst they wait.
“We need to decide whether we want a world class health system in the UK, and if so we need to pay for it.
“Manufacturers should be encouraged to price drugs responsibly, but we hope the Government will reconsider the introduction of this new test, otherwise it will be patients, their families and carers who could pay the heaviest price.”