The healthmatters blog; commentary, observation and review
82% of older consumers are confused by government advice on healthy eating
Understanding current advice on nutrition can be difficult: new figures show 82% of UK consumers aged over 55 are confused by government advice on healthy eating and nutrition, a higher level than amongst the general adult population (75%). At the same time, more than half of people in the UK say they are not influenced by the ‘traffic light’ nutritional labelling system.
As Helen Willis, dietitian at apetito and Wiltshire Farm Foods, comments: “In light of the UK’s ageing population and recent reports from Age UK and the Alzheimer’s Society highlighting problems and challenges in social care, a broader discussion about nutrition for older people is also urgently overdue. As the new chair of the Royal College of GPs, Dr Helen Stokes-Lampard, said recently, nutritional advice such as five-a-day might not always be realistic and GPs sometimes need to tailor the advice to the individual. More than three million older people in the UK are at risk of malnutrition, and consumer confusion on nutritional issues isn’t helping the situation.”
Given this, a new report, TheKnowledge: Eating for Health, published today by apetito, the UK’s leading creator and supplier of meals for the health and social care sector, calls for a new national discussion about ‘Eating for Health’. Eating for Health recognises the highly individual nature of nutrition, especially when it comes to older people.
The report is a collection of insights and perspectives on health and wellbeing in our society with an emphasis on taking a broader view of nutrition and its contributing factors. It includes a survey of 1,000 UK consumers, as well as perspectives and case studies from experts across the health and social care sectors such as Care England, the Malnutrition Task Force and NHS England. TheKnowledge: Eating for Health calls for action in five key areas to improve the nutrition of older people in the UK.
Consumer confusion can be exacerbated by broad-brush nutritional guidelines that aren’t always relevant to older or vulnerable people. Eating for Health involves looking at nutrition through the lens of the individual’s health needs. TheKnowledge explores the importance of personalised nutrition management, recognising the complex interplay between health and diet, the importance of hydration, and the social aspects of eating. It includes five calls to action, providing specific recommendations to support health and social care professionals:
- We need to shift the conversation from healthy eating to Eating for Health, with the growing and very different challenges of obesity and under-nutrition. One size does not fit all
- Diet and nutrition must play a more prominent role in healthcare professional training in order to recognize the part nutrition plays in recovery from illness
- Hydration is easily overlooked but must not be forgotten as one the six key nutrients needed to preserve health
- Patients in hospitals and residents in care settings deserve to eat ‘good’ food which will support their recovery, regardless of whether it meets a particular campaign standard
- Let’s not forget the dining experience and the vital part it plays in Eating for Health. The nutritional value of an uneaten meal is zero.
Helen Willis, dietitian at apetito and Wiltshire Farm Foods, commented: “It should come as no surprise that the majority of people in the UK are confused by general advice on eating – healthy eating is a complex issue, and such advice is often very broad. Our nutritional needs are as individual as we are, and for older people and those with health issues, these needs can be complex. it is vital that doctors and healthcare professionals are given the tools they need to support their patients from a nutritional as well as a broader health perspective.”
Fiction and delusions in the NHS
As the Sustainability and Transformation Plans (STPs) roll in they tell us something important and deeply worrying about the culture of our NHS. That so many senior figures allow their names to be associated with works of fiction tells us they accept the top down bullying that pollutes the health service. They have no fear of any accountability other than to those who instructed them in writing their fiction and who enforced secrecy until plans conformed to the mandated line.
And it is fiction. Fiction now being critically and sceptically examined thanks to the ludicrous attempt at keeping things secret having backfired. In their Five Year Forward View (FYFV) the leadership of the NHS shared their estimate that there would be a £30bn funding gap by 20/21. They said that by making efficiency gains and moving to a better system this could reduce to £8bn. For this the NHS would recover, become sustainable and go back to meeting its targets. The government met the £8bn. What could go wrong?
From the very outset many pointed out that the efficiency assumptions were wildly optimistic and that there would also have to be investment in social care (to take pressure off the NHS). There would also be large, albeit one-off, costs of transition to be met. Since the 5YFV was launched some of its assumptions have unpicked. Its baseline was out because the NHS started from a £3bn deficit, not a balanced position. There have been cuts to Public Health funding; a further deterioration in social care; and drastic cuts to the availability of capital funding – all having detrimental impact on the Plan. Goal posts have moved as additional requirements have been added, like 24/7 working, without any additional funding. Then there is Brexit and the inevitable inflationary pressures.
If there was now an independent (Office of Budget Responsibility- like) assessment it would show that something like an additional £20bn is required. It would also suggest additional transitional (and capital) funding was vital and that the time scales for full achievement of transition must be a lot longer.
The scale of this reality gap is why so many are deeply concerned about the continuing deterioration of our care system – some warning of crisis and collapse. Into this we must now factor the 44 STPs, which are the local plans to deliver the 5YFV. They were based on the same deeply flawed and unrealistic assumptions of the original 5YFV case. Most of these plans are now published. Most blithely forecast that the impossible will be achieved in a kind of collective cognitive dissonance.
A few plans do give a more realistic and honest assessment pointing out that even with their best efforts a major funding gap will remain. Some just put in the projected miracle but use a risk rating approach to show miracles won’t happen. But some plans are truly delusional.
A few STP areas will achieve great things and most will make some improvements; but they will not deliver the NHS the 5YFV describes. We will continue to see deterioration with longer waits, further access restrictions and maybe even more charges round the margins. The long term trend in improving outcomes will slow down and in some instances reverse.
There is or perhaps was a once- in-a-generation opportunity to change our health and social care system for the better. It is about to be thrown away. It may just be possible to make the 5YFV and the STPs into something worthwhile, but who in the collective leadership of the NHS is going to speak out?
Richard Bourne
Cyber security risk management: just what the doctor ordered
The health sector is suffering from a cyber security open wound – it is fast becoming one of the most highly targeted sectors for cyberattacks and data breaches. Traditionally, the financial services industry was the main target for cyber attackers but many organisations have since bolstered their defences.
With the Information Commissioner’s Office (ICO) handing out an increasing number of penalties and fines for data breaches in the health sector, the often out-dated, compliance-based frameworks are no longer enough to deal with today’s more sophisticated, targeted and persistent cyber threats. Traditional operational resilience arrangements, which were more often geared to dealing with physical threats, are also no longer enough.
The legislative and regulatory landscape is also changing, with the new European Union (EU) General Data Protection Regulation (GDPR) due to come into force in 2018 which will increase the maximum penalty for data breaches.
NCC Group recently carried out a Freedom of Information (FOI) request, which revealed that 47% of NHS Trusts in England have been hit by ransomware in the past year. This form of attack restricts access to systems in some way, often by encrypting files and then demanding a ransom to obtain access. With NHS Trusts holding a range of sensitive data on patients and employees, a piece of ransomware could cause serious disruption to services and ultimately impact patient care.
Worryingly, cyber threats are not limited to external hackers and criminals gangs. In the NHS, many breaches occur as a result of some sort of accident or incident on the inside. This could include sending personal health data to the wrong place, individual, or emailing third-parties; the loss and theft of paperwork; loss and theft of unencrypted devices; or a failure to redact third-party data in documents before release.
Despite the widely reported and significant repercussions of a cyberattack or breach, the healthcare sector still lags in terms of its preparedness for cyber threats.
What makes the health sector so vulnerable to cyberattacks?
https://ico.org.uk/action-weve-taken/data-security-incident-trends/
NHS trusts and healthcare organisations potentially hold one of the largest pools of aggregated personal sensitive details in the UK, including National Insurance numbers, date of birth, height, weight, descriptions of physical appearance and any health conditions. Healthcare insurers and hospitals in particular, can often be an almost completely unguarded “data treasure chest” to hackers.
This data is a valuable commodity to trade on the black market, much more so than financial information alone, and could be used extremely effectively by fraudsters to commit identity fraud, or even blackmail victims. Healthcare organisations also develop a great deal of intellectual property through research and development, the invention of medical devices, new forms of treatment and test data.
The NHS has spent almost three decades investing in digital technologies to automate processes, support clinical care and increase the accuracy of medical records. Furthermore, use of big data analytics and new technologies has considerably changed the way health data is being used, accessed, analysed and shared between healthcare professionals. However, these advancements are often meshed with outdated and vulnerable systems. In addition, the melting pot of connected mobile devices also makes the health sector a frequent target. Recent reviews of the resilience of medical devices in the US have pointed to widespread failure to protect equipment like such as drug infusion pumps, defibrillators, X-ray machines and electronic patient record systems from remote manipulation. Medical devices are now exposed to the same security threats as any other IT component. Yet, defences of these devices, as well as their integrated ecosystems, are far less mature.
Despite these threats, NCC Group’s recent research has revealed that board and executive management teams in healthcare organisations still see cyber security as an IT-level issue rather than a board level risk. Many executives still struggle to understand ‘the cyber threat’ and how it could potentially impact their organisation. Furthermore, cyber security training is still handled as a tick-box exercise to satisfy wider compliance requirements, rather than addressing fundamental skills and knowledge gaps to reduce the likelihood of a major data breach.
NCC Group also found that on a maturity scale of one (initial) to five (optimised), most NHS Trust Cyber Incident Responses (CIR) struggled to achieve a score of above two (defined). The research also revealed that there was also a lack of formalised, documented CIR policy and no formalised method for classifying or prioritising cyber incidents based on severity or impact. There was also a lack of cyber incident scenario planning and table top exercises for senior management.
What is at stake?
The consequences of cyberattacks are no longer limited to IT systems alone. As we have seen with recent high profile breaches, they can also impact reputation and confidence and lead to potential regulatory or legal ramifications. The ICO is now taking data breaches in the health sector very seriously and we have seen some NHS Trusts being fined in excess of £150,000.
How will the GDPR change things?
The health sector is responsible for controlling and processing a significant amount of personal data, not just in terms of the provision of care, but also in terms of research and employment. From 25th May 2018, all organisations collecting and processing personal data in the EU will have to comply with the GDPR. All organisations processing health data will need to review their existing policies, procedures, and practices to ensure compliance.
The new regulation also requires organisations to notify the data protection authority of a breach within 72 hours, as well as requiring them to conduct a Privacy Impact Assessment (PIA) prior to processing high risk personal data.
Establishing a cyber security risk management programme
Unless cyber security becomes a priority for both national and local health organisations, there is a real risk that high-profile incidents – which will happen and will become public – have the potential to very severely dent public confidence. With compliance requirements and fines looming, it’s now more important than ever for healthcare organisations to start implementing formal cyber security strategies. The key priority for healthcare organisations between now and when the EU GDPR comes into effect will be ensuring steps are in place to minimise the impact of breaches and ensure that when things go wrong, everyone involved knows what to do.
Planning and implementing a cyber security risk programme is one way for healthcare organisations to mitigate the risks associated with cyber threats. An effective programme should cover people, processes and technology and should be part of the organisation’s overall risk management strategy. It should also include initiatives for prevent, detect, respond and learn measures, as shown in the diagram below.
Cyber security training and awareness should be tailored according to job role and function. For example, a software developer should receive a different level of secuity training compared with a clinician. Cyber security awareness among staff should also be regularly measured, and cyberattacks need to be handled by a specially trained team who understand the implications and can react in the correct manner.
There is no doubt that cybercrime is on the rise, and the threats are evolving. But if the healthcare sector is to remain resilient, organisations need to accept this and plan accordingly in order to protect themselves, their staff and most importantly, their patients.
Haroon Malik, principal consultant at NCC Group
News from Nowhere – STP update, mental health & care of seriously ill children
News from Nowhere’s roving reporter on STP news, the state of mental health services, a crisis in Children’s palliative care funding and to lighten the mood – medicine as a career.
No better but at least no worse?
The newly published results of the Picker Institute’s 2016 Community Mental Health Survey demonstrates how difficult it is to bring about service improvements in an austere economic climate. Declines in communication, involvement and effective coordination that occurred between 2014 and 2015 have not been reversed, but also have not worsened.
The Care Quality Commission Survey, developed and co-ordinated by Picker, was completed by over 13,000 people, many of whom would have liked greater access to services. More than half of respondents (53%) felt that they had not always seen NHS mental health services often enough, and over a third (37%) were not given enough time as they might have liked to discuss their needs and treatment.
The best outcomes are achieved through shared decision making between clinicians and service users, but respondents to the survey report significant room for improvement in this area. 10% of people said that they had not been involved in deciding what treatments or therapies to use and a further 34% said they had only been involved “to some extent”. Similar proportions said that their care agreement didn’t fully take their personal circumstances into account. Despite a proclaimed commitment to parity of esteem there have been few improvements in the areas of care that are most important to users.
Services for seriously ill children
Children’s palliative care charity funding is facing a crisis. There are 40,000 children and young people with life-shortening conditions in England and the number is growing. The cost of caring for an increased number of children with complex health conditions is rising, but government funding is declining.
A survey of statutory funding for children’s hospice and palliative care charities in England – conducted by Together for Short Lives and Hospice UK’s – looked at funding by local authority, Clinical Commissioning Groups and NHS England, and reveals a bleak outlook.
Cuts mean that local authorities are now only contributing 1% of the money charities need to provide palliative care to seriously ill children. This is despite the duty that councils have to provide short breaks (respite) to all disabled children and young people.
On average, the overall amount of statutory funding for charities providing children’s palliative care continues on a downward trajectory, falling year on year (22% in 2015/16 compared to 23% in 2014/15 and 27% in 2013/14).
Rising care costs are not matched by statutory funding. The cost of delivering lifeline care and support to seriously ill children in 2015/16 was nearly 10% greater than it was in 2014/15.
There is heavy reliance on the Children’s Hospice Grant: Nearly 60% of children’s hospice services say they would be forced to reduce their services if the NHS England children’s hospice grant was no longer available. And over two thirds would be most likely to cut short breaks – leaving families, without respite care, at breaking point. NHS England is consulting on this grant and evidence from this report suggests it needs to be greatly increased.
Charities delivering palliative care are worried that unless funding arrangements change they will not be able to meet the needs of these children and may have to cut existing services. This compounds the existing inequitable funding for children’s palliative care across the country.
The UK government could follow the example of the Scottish Government, which has recently committed £30 million funding to Children’s Hospice Association Scotland (CHAS) over the next five years. A national inquiry into the state of children’s palliative care funding in England would be a first step to putting this problem right.
Medicine as a career
The Universities and Colleges Admissions Service (UCAS) has just released details of medical school applications for the 2017 entry. Some had expected that applications would decline following the junior doctor conflict.
The number of individual applicants for the 2016 entry was 20,100 and success at gaining a place depended on country of origin. Success rates were 40% for UK applican
ts, 10% for EU applicants and 20% for non-EU applicants.
The 2017 UCAS data are just for applications. The total number of applications has fallen by about 5% – from 20,100 to 19,210. First-time applicants from the UK are almost the same at 12,150 for 2016 compared to 12,090 for 2017, but applicant numbers for 2017 are actually higher than for the 2015 entry. The biggest drop has occured in EU and other non-UK applications, which fell by 16% and 6% respectively. Medicine still seems to be an attractive career choice for UK students but Brexit may have had an impact on applications from other countries.
STP update – the disease spreads?
NHS Sustainability and Transformation Plans will have to deliver billions in cuts BMA analysis has found that NHS sustainability and transformation plans (STPs) will have to deliver £22bn in cuts by 2020/2021 in order to balance health and social care spending across 44 ‘footprint’ areas, raising serious concerns about cuts to services and the impact on patient care.
Officials in each area have been asked by NHS England to predict in their STPs the financial hole they face in their budgets and set out how they can close it. The savings figures were found in papers from 42 of the 44 areas across England.
The BMA believes that sustainability and transformation plans could help develop health policies more suited to local needs and help integrate services across health and social care. However, it has serious concerns about the ways in which some of these plans have been put together and that they will be used as a cover for delivering cuts.
The BMA is calling for:
- The plans to be published as soon as possible;
- Genuine public and professional consultation on any proposed changes;
- All proposals within the plans to be realistic and evidenced based;
- All STPs to be funded appropriately to ensure they can deliver what has been promised
Improving patient care to be the priority for each and every plan, rather than STP schemes being used to cut back budgets and services. Despite the weasel words “genuine” and “appropriately”, News from Nowhere has yet to see a better plan of action. NHS Sustainability and Transformation Plans will have to deliver billions in cuts BMA analysis has found that NHS sustainability and transformation plans (STP) will have to deliver £22bn in cuts by 2020/2021 in order to balance health and social care spending across 44 ‘footprint’ areas, raising serious concerns about cuts to services and the impact on patient care. Officials in each area have been asked by NHS England to predict in their STP schemes the financial hole they face in their budgets and set out how they can close it. The savings figures were found in papers from 42 of the 44 areas across England.
The BMA believes that sustainability and transformation plans could help develop health policies more suited to local needs and help integrate services across health and social care. However, it has serious concerns about the ways in which some of these plans have been put together and that they will be used as a cover for delivering cuts.
The BMA is calling for:
- The plans to be published as soon as possible;
- Genuine public and professional consultation on any proposed changes;
- All proposals within the plans to be realistic and evidenced based;
- All STP schemes to be funded appropriately to ensure they can deliver what has been promised;
Improving patient care to be the priority for each and every plan, rather than STP schemes being used to cut back budgets and services.
Despite the weasel words “genuine” and “appropriately”, News from Nowhere has yet to see a better plan of action.
Money worries biggest cause of stress for adults
Research by health and wellbeing charity Central YMCA has revealed a 52% divide in wellbeing scores between the most and least financially confident people in society, money worries, being extremely worried about money, causes a 33% fall in wellbeing. Financial stability is the factor most affecting the wellbeing of UK citizens, according to a new report.
Being happy with your finances causes a 19% uplift in wellbeing scores, while being extremely worried about money causes a 33% fall, according to research undertaken for the report – which questioned a nationally representative sample of 1,000 UK adults on 14 statements relating to wellbeing and how various lifestyle factors affect these.
Britain’s financial inequality gap is said to be widening, with research by Oxfam this year revealing that the richest 1% of the UK population owns more than 20 times the wealth of the poorest fifth.
Another 2015 study by the London School of Economics found that young people in their 20s were 18% worse off than 20 year olds were just five years ago, indicating the speed of change.
“The issues affecting wellbeing in today’s society are complex and wide-ranging” said Rosi Prescott, chief executive at Central YMCA, “so it comes as no surprise to see that lifestyle factors including activity, relationships, finances, mental stimulation, and experiences of education, have a significant impact on the quality of our lives. Sadly, the growing financial inequality in today’s society is enormously corrosive to the wellbeing of those affected”.
Other factors significantly impacting wellbeing were: lacking good relationships, which led to a 50% swing in scores; lacking mental stimulation, which brought about a 48% divide; while a 32% gap was present between the most and least physically active residents in the UK.
Rosi added: “It’s now vital that we recognise the importance of working towards achieving a healthy balance of physical activity, mental stimulation, and positive relationships – all which have a significant impact on our feelings of wellbeing. As a reduction in any of these can seriously undermine our ability to flourish.”
In total, the average Brit scored 6.13/10 on an index for their overall wellbeing, while the three wellbeing statements that the general population were the least likely to agree with were:
- I’ve had energy to spare (5.0/10)
- I’ve been feeling relaxed (5.65/10)
- I’ve been feeling good about myself (5.73/10)
The activities people reported as most likely to boost wellbeing were being on holiday (66%), being with family (56%), and when socialising with friends (49%).
For the full report findings please visit: http://www.ymca.co.uk/
Research reveals what we really mean when we say ‘ I’m fine ‘
A survey into the emotions of the nation has revealed that Brits are feeling ‘fine’. Apparently. A study of 2,000 Britons has found that the average adult will say ‘I’m fine’ 14 times a week, though really just 19 per cent mean it. Almost a third of those surveyed said they often lie about how they are feeling to other people, while one in ten went as far to say they always lie about their emotional state.
And this dishonesty goes both ways, with 59 per cent of us expecting the answer to be a lie when we ask others “How are you feeling?”
Jenny Edwards, Chief Executive of the Mental Health Foundation who commissioned the research said: “While it may appear that most of us are happy openly discussing feelings, these survey results reveal that many of us are really just sticking to a script.
“This creates an illusion of support. On the surface, we’re routinely checking in with each other but beneath that, many of us feel unable to say how we’re really feeling.”
Men are more than twice as likely to be dishonest to others when it comes to their emotions, with 22 per cent admitting they always lie about how they feel, compared to 10 per cent of women.
Women however are more likely to be hurt emotionally. Forty one per cent have regretted opening up to someone in the past, compared to 29 per cent of men. Conversely, 44 per cent of those surveyed said that they have regretted asking somebody how they were doing after receiving an answer they weren’t prepared for.
As for those ‘fine’ Brits, 34 per cent use “I’m fine” as a response because it is more convenient than explaining how they really feel, while 23 per cent say it because they think the person asking isn’t really interested. Strangely, we are more likely to reveal our true feelings to a stranger than our work colleagues, while our grandparents bring out the honest side in us, with less than one per cent of the sample willing to fib to gran or grandad.
We are also three times more likely to disguise our feelings from Mum than from Dad, and feel more comfortable discussing our emotions on social media and online forums than with our friends directly. When quizzed on the people in their lives they receive emotional support from, a fifth of Brits said they could use a lot more guidance and support, while 28 per cent think they would benefit from more supportive people in their lives.
In a question aimed at uncovering our attitudes towards our own emotions, just one in ten people enjoy opening up, while the majority remain indifferent to expressing themselves to others. Fifty two per cent actively dislike discussing their emotions, and one in seven say they do not have an outlet in their lives where they can express how they truly feel.
The study also explored the emotional profile of the participants. When asked which emotions they expressed most commonly, a third of respondents chose anxiety. Eighteen per cent chose depression, 15 per cent chose boredom and 11 per cent chose loneliness. More encouragingly, 21 per cent said they felt affection most frequently, and 20 per cent chose love.
Jenny Edwards continued: “The people around us in our lives are crucial for our mental health; people with strong connections live happier, healthier and longer lives than those without. That’s why we all need a healthy network of friends and family who we are comfortable to confide in when we need to.
“Next time someone asks “how are you?”, try going off the standard script and say the truth instead of ‘I’m fine’ and see how a more meaningful conversation unfolds.”
The Mental Health Foundation has launched an ‘I’m Fine’ campaign to encourage Brits to open up about mental health and ‘bring back meaning’ to daily life.
UK Government deliberately inducing an NHS crisis – News from Nowhere
Inducing an NHS crisis?
NHS Improvement is talking about an “NHSI bond” as a kind of equity release scheme for hospitals with spare land that want to sell it off, and get some fast money up front to invest in modernisation, land sales often being lengthy events. This idea is a response to the Department of Health’s capital budget being frozen at £4.8bn a year over the course of this parliament, which in real terms means it is being cut. The capital budget covers all NHS spending on buildings, equipment and IT and has been repeatedly raided in recent years to put funds into the revenue accounts of struggling NHS Trusts, so that they can pay wages and buy drugs. A further £1.2bn transfer from the NHS capital budget to its revenue budget is planned for 2016-17
One consequence of this raiding is a big increase in the backlog of maintenance problems at NHS trusts, where over 18% of the Estate pre-dates the foundation of the NHS in 1948. Many parts of the NHS need better IT, better diagnostics and safe, well designed buildings. Most of the 44 Sustainability and Transformation Plans will include bids for capital investment to underpin the changes they plan in services. These are unlikely to be granted by the present government, which is sceptical about the NHS’s ability to use capital effectively. Many trusts have built facilities that have too much or too little capacity, whilst others have forced through unaffordable plans, in the expectation of being bailed out. Some have benefitted from having valuable land. Very little investment has been designed to support new models of care, but instead most has gone into the same mid-20th century model of medicine. And there has been too little thought about capital- for-labour substitution.
On top of the planned capital-to-revenue transfer, that part of the Department of Health’s revenue budget not allocated to NHS England is likely to fall from £10.5bn to £8.6bn by 2020-21. Much of that reduction will come from the £1.2bn Health Education England currently spends funding bursaries for nurse education. These will be replaced with student loans from 2017-18. A further saving will be made by cutting public health spending, which will fall in cash terms by £300m by 2020-21.
Few in the NHS see this situation as sustainable. The investment in new technologies that could streamline medical care and possibly save some revenue in the future is blocked by dwindling capital budgets that are being used to maintain cash flow. To many this looks like a deliberate attempt by the government to induce a crisis.
Agency staff
Difficulties in recruiting and retaining staff have meant that Trusts have increasingly relied on expensive agency staff. Last year NHS England capped expenditure on agency staff, but it has only partially worked. So far this year agency expenditure on agency staff has been £1.5bn, some £312m less than the same period in 2015-16, but still 16% above the plan. Trusts are currently forecasting that annual expenditure on agency staff will be £900m less than last year’s actual spend of £3.6bn. Nevertheless the forecast remains £200m above target.
Whilst we are on the subject of workforce, those who believe that the NHS is on its knees may be surprised to learn that some parts of it are growing in the usual NHS way – by adding more staff. One Trust has announced that it has altered its plan to add over 4,000 full time equivalent jobs, reducing the expansion to just under 1,000, and so saving more than 3,000 salaries, pension contributions and the like. Is this the way to save, by foregoing expansion? Are cuts in intended growth really cuts?
Quote of the month
Ben Clover of the Health Services Journal says it like it is:
The own-goal secrecy of the STP process and the search for any radical content in the plans can obscure what an organisational mess many of them are. In any STP there will be the statutory bodies – commissioners and providers – each with their own board and subcommittees. The leads from these organisations make up the membership of the STP, which is not a statutory body. But although they don’t legally exist, everyone must comply with what an STP says because their authority is mandated by NHS Improvement (a non-statutory body made up of two statutory bodies stuck together) and NHS England (a statutory body). London Eye, Thursday 17th November 2016
Who needs skill?
The Buckinghamshire, Oxfordshire and Berkshire West Sustainability and Transformation Plan seeks to achieve £34.2m of workforce savings by the “use of generic support workers (across health and social care), reduction of nursing grade input, increased use of healthcare assistants and physicians associates and more flexible uses of emergency care practitioners and advanced nursing practitioners”.
This approach may not be soundly evidence-based. A recent research study suggests that diluting the nursing skill mix increases the risk of patient death. (Linda Aiken and colleagues Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, published on-line on 5 November 2016)
Strictly Come Dancing – Walzing to Wellbeing!
One of the excitements of the autumn TV schedules is Strictly Come Dancing. For me, like 10 million other viewers, it is compulsory Saturday evening viewing as well as being a useful topic for small talk in all kinds of situations and with all kinds of people. I am old enough to remember its predecessor programme Come Dancing which was nowhere near as compulsive viewing. Or it may have been that, being considerably younger, my interests lay elsewhere.
Strictly Come Dancing is for me pure entertainment and as such is an antidote to worries about Brexit and President elect Trump and to the Seasonal Affective Disorder which is so prevalent in these cloudy sunless Isles.
It is in fact a promoter of wellbeing among its viewers. But, more than this. It has a positive impact on the popularity and practice of dancing which is at the same time a good vehicle for physical exercise and a framework for positive social interaction, both of which promote individual wellbeing of a more enduring kind.
As a child of the fifties and early sixties dancing was not really on the agenda until I went up to university where it provided a convenient milieu for meeting members of the opposite sex. We did a bit of ensemble dancing at primary school to entertain parents at the annual summer open day but it did not figure on my boys only grammar school curriculum – perish the thought – where physical exercise of a rather more muscular variety was greatly prized.
So learning to dance became a high priority at university and mastering a simple walz, quick step, cha cha cha and jive were priority extra curricular activities in my first undergraduate year. Skip jive and the Twist surfaced in my second year and were particularly enjoyable passing crazes. My wellbeing score went off the scale for a year or two.
Dancing is of course as old as homo sapiens. It is unlikely that any human society (at any rate until the invention of puritanism) has denied itself the excitement and pleasure of dancing. Dances in primitive cultures all had as their subject matter the changes experienced by people throughout their lives, changes that occurred as people grew from childhood to old age, those they experienced as the seasons moved from winter to summer and back again, changes that came about as tribes won their wars or suffered defeats.
Two sorts of dance evolved as cultures developed: social dances on occasions that celebrated births, commemorated deaths, and marked special events in between; and magical or religious dances to ask the gods to end a famine, to provide rain, or to cure the sick. The medicine men of primitive cultures, whose powers to invoke the assistance of a god were feared and respected, are considered by many to be the first choreographers, or composers of formal dances. Dancing of both sorts was we know an important part of ancient Egyptian, classical Greek and Hindu cultures.
As we know it today, social dancing is an activity that can be traced back to three sources: the courts of Europe, international society, and primitive cultures. Among noblemen and women of 16th- and 17th-century Europe, ballroom dancing was a popular diversion. After the political upheavals of the 18th and 19th centuries, dances once performed by the aristocracy alone became popular among ordinary people as well. In America dances that were once confined to the gentry who first led the newly established Republic passed to the common folk. By the mid-19th century, popular dances attracted many participants who performed minuets, quadrilles, polkas, and waltzes, all of European origin.
Another important influence came from Ireland, whose clog dances were first brought to America in the 1840s. After being adapted by local performers, clog dance steps became the tap dances done to this day.
But, enough of history; is there a public health issue here? The answer is very definitely yes.
So long may Strictly Come Dancing appear on our screens and in the cause of improving our health and wellbeing perhaps we need a Commissioner for Dancing and to elevate it to an Olympic sport?
Paul Walker, November 2016
135,000 Alcohol related deaths predicted by 2035
Alcohol related deaths will rise to around 135,000 cancer deaths over the next 20 years and will cost the NHS an estimated £2 billion in treatments, according to estimates from a new report* by Sheffield University, commissioned by Cancer Research UK**.
The new figures, published today (Friday), reveal that by 2035 the UK could see around 7,100 cancer deaths every year that are associated with alcohol. Of the cancer types included in the report, oesophageal cancer is set to see the largest increase, followed by bowel cancer, mouth and throat cancer, breast cancer and liver cancer.
The report also forecasts that there will be over 1.2 million hospital admissions for cancer over the 20 year period, which will cost the NHS £100 million, on average, every year. The results were based on analyses that assume alcohol drinking trends will follow those seen over the last 40 years, and takes recent falls in alcohol consumption, including among young people, into account.
Evidence suggests that the more alcohol you drink, the higher the risk of cancer. UK government guidelines, published earlier this year, advise that both men and women drink no more than 14 units of alcohol a week.
The latest figures follow a Cancer Research UK study published earlier in the year that showed 9 in 10 people are unaware of the link between alcohol and cancer.
The report also examined the impact of introducing a minimum unit price for alcohol in England. It found that over 20 years a 50p minimum price per units of alcohol could reduce deaths linked to alcohol by around 7,200, including around 670 cancer deaths. It would also reduce healthcare costs by £1.3 billion. This follows a recent court decision in Scotland which found that a minimum unit price would not break European law.
Alison Cox, the Director of Prevention at Cancer Research UK, said: “These new figures reveal the devastating impact alcohol will have over the coming years. That’s why it’s hugely important the public are aware of the link between alcohol and cancer, and what they can do to improve their risk.
“If we are to change the nation’s drinking habits and try to mitigate the impact alcohol will have then national health campaigns are needed to provide clear information about the health risks of drinking alcohol.”
Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, said: “These latest Alcohol related deaths figures show the serious consequences for individuals, the NHS and society if the UK government continues to ignore the consequences of the nation’s drinking. In particular they reinforce the need for a minimum unit price (MUP) for alcohol. It is clear from the report that MUP will save lives, including those lost to cancer, and ease the burden on our health service. Importantly, MUP will do this while leaving moderate drinkers and prices in pubs and bars unaffected.
In addition, we need mandatory health information on the labels of all alcoholic products, informing the public of the link between alcohol and cancer, and the new low-risk drinking guidelines.
The public have the right to know about how their drinking impacts their health, so that they are empowered to make informed choices.”
No willpower required: families adopt healthy behaviours through trial and error
Forgoing a reliance on motivation, families can adopt healthy behaviours — eating better and exercising more — by following a new approach that focuses on the redesign of daily routines. In a series of pilot tests of the approach — known as “SystemChange”— by nursing scientists at Case Western Reserve University USA, families and individuals changed unhealthy habits by systematically manipulating their environments, despite wavering willpower.
“We’re not relying on individual motivation,” said Lenette Jones, a research post-doctoral fellow at the Frances Payne Bolton School of Nursing. “We take the onus off of people to change and, instead, focus on a set of strategies to change a family’s activities and routines.”
SystemChange stands in contrast to popular strategies that rely on cognitive behaviour change and personal effort to improve health. Outlined in a paper in the journal Nursing Outlook, the approach has proven effective for reducing screen time, improving sleep and medication adherence, and developing the healthy eating and exercise habits of patients with chronic conditions—such as diabetes or hypertension—that are managed better with diet plans and habitual physical activity.
To learn SystemChange, families meet with a health professional, such as a nurse, trained in the approach, over four to five months to design and monitor the success of family-designed small experiments. For example: a family wants to increase the number of fruits and vegetables they eat per week. They decide to test small experiments and stock fruits and vegetables on the easiest to reach shelves in the refrigerator (instead of in drawers) and also pack at least one of these items in a child’s lunch each day. After two weeks, the family can see quantitatively if they’ve eaten more of these foods. If not, with the guidance of their designated health professional, they design a different experiment to try over the next two weeks.
“Instead of focusing on the numbers on the scale that may not move, or feeling like a failure if you don’t reach a goal of losing 5 pounds—this strategy allows you to focus effort on the family changing habits together, such a eating two vegetables a day instead of one, or not turning on the television certain days of the week,” said Jones, a co-author on the paper. “There’s no feeling bad about yourself if you fail at an experiment. If the family doesn’t meet a goal, they move on and design another experiment, until they are successful,” said Jones, who studies how lifestyle changes can improve hypertension in African-American women.
SystemChange has also been tested in both HIV-positive and cardiac rehabilitation patients, and is a key part of a National Institutes of Health funded study to curb obesity in children in urban areas. The approach does not require a high level of literacy and is easily standardized.
“This approach takes the ‘I’ out of behavior change,” Jones said. “It focuses on manipulating the environment, to assist families to make small changes over time—it’s a team effort.”
For a full account of the SystemChange approach, see: Shirley M. Moore, Lenette Jones, Farrokh Alemi, Family self-tailoring: Applying a systems approach to improving family healthy living behaviors Nursing Outlook July–August, 2016 Volume 64, Issue 4, Pages 306–311 DOI