The healthmatters blog; commentary, observation and review
Last week, the BBC’s Tomorrow’s World launched Secrets of Happiness, a national survey to gather data on wellbeing. Here, the former President of the British Psychological Society and the Centre’s community lead Peter Kinderman, who is involved in the ‘citizen science’ research project, sets out how the results might help us better understand the relationship between mental health and wellbeing.
The relationship between mental health and wellbeing is a complex, and fascinating, issue in our work at the Centre. Surprisingly, in 2018, we still don’t really understand the fundamental interconnections. Few would argue against the need to offer much better mental health services, but the idea that ‘human misery’ is, in part, ‘caused by mental illness’ is a little more controversial. One group of psychologists commented that “… people suffer when bad things happen to them. [It is] obvious that ‘mental illness’ will predict ‘misery’ … These two terms relate to the same experiences”.
DIFFERENT PATHWAYS FOR WELLBEING AND MENTAL HEALTH
In 2013, we found that there were different pathways for poor wellbeing, anxiety, and depression. Low levels of subjective wellbeing were associated with social isolation and low levels of adaptive coping. Alternately, mental health problems were associated with negative life events and rumination. This is consistent with the idea that mental health and wellbeing lie on ‘two continua’: that it’s possible to have high levels of wellbeing (with appropriate support) even if we experience specific mental health problems.
That specific mental health problems and subjective wellbeing might have different causal mechanisms, and different mediating psychological processes is interesting and important. It makes the topic more complex, and that’s before we consider the different trajectories and causal factors that might apply to community, rather than individual, wellbeing.
FLUID RELATIONSHIP BETWEEN WELLBEING AND MENTAL HEALTH
It seems too simplistic to suggest that our wellbeing and our mental health are merely two opposing poles of a single continuum. It’s clearly possible to have low levels of wellbeing without experiencing mental health problems. But it is also easy to see how our wellbeing can be threatened by mental health issues, especially if we don’t have appropriate help. This implies that the relationship may be asymmetrical (a technical statistical challenge for researchers). This may mean that the relationships are different for different kinds of challenges, whether that is different threats to our wellbeing (loneliness or poverty, perhaps) or different mental health problems (depression, hearing voices, self-harm, for example).
NEW CITIZEN SCIENCE PROJECT ON WELLBEING
In collaboration with the University of Liverpool, Dr Sara Tai at the University of Manchester and BBC’s Tomorrow’s World, we have launched a ‘citizen science’ research project to investigate these questions.
As many thousands of people – including you – can complete our survey, we should be able to tease out at least some of these relationships. It will give us a better understanding of social factors such as income; employment and loneliness; our family history of mental health problems; the events that happen to us, both in our childhood and in recent months; and the ways in which we make sense of, understand, and respond to those events.
Importantly, we hope to be able to collect data at two time points. This allows us to predict both wellbeing and mental health – anxiety and depression – over a six-week period, much more powerful in scientific terms.
Sampling and representation in the survey
This kind of research is complex. And a little controversial. For example, our research uses crowd-sourced data from an entirely unrepresentative group of people with uncertain motivation accessing the website, without any kind of purposive or stratified sampling. This is very different from the careful, epidemiologically rigorous, approach used by organisations such as the Office for National Statistics, although we are using the standard methodology recommended for the measurement of wellbeing.
I have to confess to being a pragmatist – one of the joys of working with the Centre is that it is about bringing the best available evidence to bear for policy makers. It’s focussed on quality, but also on practicality. When we get the opportunity to reach out to large numbers of people, we should grasp it. Even when the sampling is non-random, it allows us to explore statistical relationships between many different inter-related factors with much greater precision that would be possible with more carefully-controlled, but smaller, samples.
Here, we are not attempting to map or survey wellbeing or mental health across the UK population, nor to draw conclusions about epidemiology or prevalence (issues for which, admittedly, our methodology would be weak). And we should always be aware of the limitations and weaknesses of our research methodologies.
What we should be able to say, with more detail, how social and environmental issues affect our mental health and wellbeing, how the ways in which we think about, understand and react to these events influence their impact, and a little more about the complex relationship between wellbeing and mental health.
Without doubt, our research will lead to even more questions and discussion (possibly even disagreement)… but that’s a good thing!
During this winter period, it has become clear that the National Health Service (NHS) in the UK is under even more than the usual additional strain. With routine operations already being cancelled to manage emergency treatment, hospitals cannot afford any delayed discharge of patients because of the knock-on impact on available beds. However, evidence suggests that delayed discharge is once again on the rise.
The rise of delayed discharge
The media is already making headlines from numerous figures, including:
- Delayed discharge currently costs the NHS £900 million a year, including over £100 million in Scotland;
- Up to 8,000 deaths a year may be caused by increases in delayed discharge; and
- Delayed discharge has risen 52 per cent in the last three years.
Delayed discharge, also known as “bed-blocking”, occurs when patients are well enough to be discharged from hospital, but remain there because they do not have the correct care, support or equipment at home or in the community to continue their recovery. These patients can often spend weeks in hospital when they could be cared for at home or in the community, where their recovery might well be quicker. This practice is putting unnecessary pressure on A&E departments and wards, increasing waiting times and staffing costs, and often leading to cancelled operations.
This is not a simple problem. It occurs at the boundary between health and social care (and perhaps more importantly, their budgets), and involves issues relating to family responsibilities. Various solutions have been trialled to address the issue, with mixed results but often increasing costs. These have included increasing the supply of nursing staff, building more care homes, keeping a ready supply of equipment in hospitals and changing the system of managing people coming to A&E, as well as merging health and social care organisations and budgets.
Developing patient flow modelling
No single organisation will ever hold all the answers to delayed discharge or bed-blocking. Cooperation is always going to be the best way to attempt to manage the problem, and, indeed, to improve patient outcomes across the system.
However, individual organisations can improve matters, for example, by use of patient flow modelling. This is a discrete simulation model which will allow hospitals to improve patient management, bed control, the logistics supporting the movement of patients and overall bed use.
The model includes:
- Patient points of entry;
- Recovery units;
- Hold time thresholds;
- Routing process; and
- Staffing levels/beds.
It can be used to model complex interactions between patients and units, key decision points, and ‘what if’ scenarios. It also provides comprehensive KPIs that can help managers in hospitals and social care understand the causes and effects of delayed discharge. This is important because these vary considerably around the country, and the solutions are therefore different. Understanding the ‘pinch points’ and problem areas means that tailored solutions can be put in place to manage delayed discharge at particular hospitals, or in specific areas or regions, and help improve patient outcomes as well as reduce cost.
Developing a data-informed NHS
Hospitals have not traditionally made decisions based on extensive data analysis. However, this type of modelling offers them a chance to increase efficiency and address their problem areas.
Understanding the problem is still only the first step towards addressing it, but it is an important one. Solving issues of delayed discharge will require hospitals to work closely with social care and community providers, to develop a fully integrated care model. Nobody is suggesting that this will be easy, but ensuring that the model is based on evidence – and not just ‘gut feeling’ – will make it more likely to succeed. This, in turn, will result in better patient outcomes, increased efficiencies and cost savings for the NHS and its partners. That’s something we all want to see
Mark Frankish, SAS Data Scientist, SAS UK
- Research from the 2017 Britain’s Healthiest Workplace survey (BHW) has revealed that employees lose, on average, the equivalent of 30.4* days of productive time each year as they take time off sick and underperform in the office as a result of ill-health (otherwise known as presenteeism)
- This is equivalent to each worker losing six working weeks of productive time annually
- Productivity loss due to physical and mental health issues is costing the UK economy an estimated £77.5** billion a year
- Worryingly, employee work impairment and the associated productivity loss appears to be on a worsening trend, up from 27.5 days and £73 billion respectively in 2016
Shaun Subel, Director of Corporate Wellbeing Strategy at VitalityHealth, said: “The Britain’s Healthiest Workplace results illustrate the significance of the productivity challenge facing the UK, but importantly also point to an exciting alternative in how employers can approach this problem.
“For too long, the link between employee lifestyle choices, their physical and mental health, and their work performance has been ignored. Our data demonstrates a clear relationship – employees who make healthier lifestyle choices benefit from an additional 25 days of productive time each year compared to the least healthy employees, and also exhibit higher levels of work engagement and lower levels of stress. As a result, effective workplace health and wellbeing solutions can deliver tangible improvements in employee engagement and productivity, and make a significant impact on an organisation’s bottom line.”
*Figure calculated using an average work impairment of 11.7% and an average working year of 260 days. Work impairment is calculated using the Work Productivity and Activity Impairment (WPAI) Scale across the 31,950 employee participants in Britain’s Healthiest Workplace 2017.
**Figure calculated using ONS statistics for the period July-September 2017, and making adjustment for part-time workers. £26,468 average wage; 32.324 million people in work (of which 8.439 part-time); 10.8% cost of lost productivity as a proportion of total wage bill (calculated from Britain’s Healthiest Workplace 2017).
***The Britain’s Healthiest Workplace research process took place between February and August 2017. It looked at a number of lifestyle, mental wellbeing, clinical risk and productivity factors amongst 31,950 employees, together with a broad view of leadership and cultural dimensions and organisational policies, practices and facilities that could directly impact on employee health, across 167 companies. Results based on UK workforce as reported by each company surveyed.
Emotional strains, financial pressures and family feuds: new study reveals the plight of UK’s informal carers
New research among more than 2,000 UK adults commissioned by HealthTech start-up WeMa Life has revealed the struggles informal carers face. The independent, nationally representative survey found:
- 15% of UK adults currently consider themselves to be informal carers – equating to 7.85 million people
- On average, an informal carer spends 13 hours a week taking on duties such as cooking, cleaning and caring for someone close to them
- 53% of informal carers say the role has had a significant impact on their emotional state
- 30% of carers have fallen out with friends and family because of tensions around their responsibilities
- Two fifths (39%) say the financial burden of being an informal carer has prevented them from leading the lifestyle they want
- 35% would pay for professionals to take on the carer duties but cannot afford to do so
- 77% of informal carers across the UK – 14.08 million people – think they ought to get more support from the Government
Acting as an informal carer is causing significant stress and financial strain to almost 8 million people across the UK, new research commissioned by HealthTech start-up WeMa Life has revealed.
An informal carer is any individual giving regular, on-going assistance to another person – typically a family member, friend or neighbour – free of charge. According to WeMa Life, 15% of UK adults currently consider themselves an informal carer, equating to 7.85 million people across the country, while a further 10.5 million (10% of UK adults) have previous acted as an informal carer for someone.
On average, these informal carers – both presently and from years gone by – spend 13 hours a week performing these duties. Moreover, the study uncovered that being an informal carer has had a huge impact on their day-to-day lives.
More than half (53%) of informal carers say the role has put them under notable emotional stress, with 30% stating that they have fallen out with friends or family members because of tensions around the responsibilities they have taken on.
Almost two fifths (39%) of informal carers have been prevented from leading the lifestyle they want or previously had because of the financial strain of the role. Meanwhile, 35% say they would pay for professionals to take on the carer duties but cannot afford to do so.
As a result of the significant disruption it causes to their lives, the overwhelming majority (77%) of informal carers believe the Government must do more to offer financial, emotional or educational support to informal carers across the UK.
Rohit Patni, CEO and co-founder of WeMa Life, commented on the findings: “Today’s research sheds light on a hugely important issue. Whether for a close friend, elderly relative or long-time neighbour, many people at some stage in their life take on the responsibility of being an informal carer for someone close to them. However, in doing so they are clearly putting a massive financial and emotional strain on their day-to-day lives.
“More support is clearly needed for the country’s informal carers. Technology stands to make things far easier, with digital solutions making it simpler for people to manage and monitor their health. But the survey has also uncovered a clear desire among informal carers for the Government to offer greater support to those sacrificing time and money to care for their loved ones.”
- VitalityHealth research reveals average life expectancy in the UK is reduced by more than four years as a result of poor lifestyle choices and other health risk factors
- 10% of employees can expect to have their life expectancy reduced by 10 or more years predominantly due to their lifestyle choices
- Premature death within the working age population is projected to cost the UK economy £125bn over the next decade.
Research from VitalityHealth has identified a significant longevity challenge facing the UK, with life expectancy being reduced by more than four years, predominantly due to individuals’ poor lifestyle choices*.
This research is based on analysis of people’s long term health using VitalityHealth’s Vitality Age algorithm. Vitality Age measures the impact of lifestyle, clinical and mental health factors on a person’s life expectancy. The disparity between Vitality Age and chronological age – termed the Vitality Age Gap – describes the number of years that an individual could expect to lose, or gain, in life expectancy as a result of their lifestyle choices and other risk factors.
Importantly, the issue of longevity and reduced life expectancy is not confined to old ages. In order to assess the impact of poor lifestyle choices and other risk factors on mortality risk amongst the working age population, VitalityHealth has analysed the Vitality Ages of UK employees undertaking its Britain’s Healthiest Workplace study.
In the 2017 study, 88% of employees had a Vitality Age greater than their chronological age, with 10% having a Vitality Age Gap of 10 or more years older than their chronological age, meaning their life expectancy is drastically reduced.
This drastic reduction in life expectancy means that many people can be expected to die before reaching retirement, and the increased risk of premature death has ramifications for employers and the general economy. Based on these findings, VitalityHealth estimates that the UK will see approximately 30,000 deaths each year among the working age population driven primarily by lifestyle health factors. When projected over a 10-year period, this equates to over 4 million working years lost, translating into a £125bn cost to the UK economy. Additionally, these figures do not reflect the full cost and impact for employers, who are faced with the need to recruit and train a replacement to overcome the loss of an experienced employee.
Shaun Subel, Director of Corporate Wellness Strategy at VitalityHealth, said: “The concept that unhealthy lifestyles are impacting on people’s long-term health and mortality risk is well established. However, too often this is thought of as a retirement-age problem, when in fact it is having a significant impact for the working-age population, and for the wider UK economy.
“Fortunately, our research has demonstrated that lifestyle factors are by far the greatest driver of premature deaths, meaning that the majority of them are eminently preventable. For example, 40% of these deaths are due to lack of physical activity and poor nutrition alone.
“For employers, the benefits of improved employee health and wellbeing go beyond reducing the risk of an employee dying prematurely. We have seen from our research that healthy employees are significantly more productive, with as much as 25 additional days of productive time each year compared to their unhealthy counterparts. As a result, wellness has no trade-offs – by investing in the health and wellbeing of their staff employers can enjoy the benefit of a higher performing and more productive workforce, while enabling their employees to live healthier, happier and longer lives.”
There has been a large rise in the volume of social work research undertaken in the UK over the past 20 years but one topic remains stubbornly under researched: student funding in social work education. This is all the more surprising when we remember the attention given to tuition fees in the last three general elections. In June 2017, the Department of Health and Social Care Policy Research Programme commissioned the Social Care Workforce Research Unit to undertake a short review of the social work bursary.
We had already done a similar piece of work so we had not expected to uncover a large research evidence base. However, it still seems surprising that there is so little research on social work students finances given that many social work students are drawn to social work after being in care or experiencing discrimination or poverty.
Research findings are just one influence on the policy making process. This may be even more nebulous when the evidence base is thin. Nevertheless, we thought there were eight possible policy options based on the material we identified:
- Prior to the introduction of the bursary, there was a steep rise in international recruitment in the late 1990s because of declines in the numbers of social work students. The social work bursary should be maintained for at least the period leading up to Brexit to maintain a stable supply of student numbers and avoid the risk of over reliance on international recruitment to fill vacant social work posts.
- The Centre for Workforce Intelligence (2016) predicted that demand for social workers would have increased by a third between 2015-2035. Cross departmental discussions between the Department of Health and Social Care and the Department for Education could be held to update estimates about the number of social workers needed in adult and children’s services, while recognising that unforeseen events can always affect the best laid plans. (A good example of this is the Cheshire West judgment which increased the number of Deprivation of Liberty Safeguards.)
- The key to cost-effective social work education is retention because it means that organisations are not playing ‘catch up’ to match the number of newly qualified social workers with those who are leaving before the age of retirement. There is a role for discussions with the new regulator Social Work England about its possible role in collecting data on retention rates among registrants that can be used in research and workforce planning.
- There is some evidence that the social work bursary has helped attract a more diverse range of social work students. An impact assessment would help answer questions about the contribution the bursary makes to maintaining diversity within the profession.
- Future announcements about the bursary need to be made in time to allow potential applicants sufficient time to make alternative arrangements – for instance to apply to study part time.
- Currently there is considerable diversity in qualifying routes to become a social worker. What would be the consequences if monopoly suppliers developed in social work education? A risk assessment could be undertaken to consider what might happen if this occurred.
- It is estimated that two-thirds of graduates will never pay off their student loans. There is potential to examine the extent of non-repayment of student loan debt among moderate earners such as social workers, nurses and teachers and consider whether there are other options for student finance.
- We know very little about the extent to which social work students access student services and other sources of financial information, such as the Money Advice Service, for financial advice. Are steps needed to help students make the most of these services?
Jo Moriarty is Senior Research Fellow and Deputy Director at the Social Care Workforce Research Unit. The report, which she co-authored with Jill Manthorpe, is available for download.
In January 2018, the cybersecurity world was hit by two Intel vulnerabilities, Meltdown and Spectre, affecting a substantial number of the world’s computer processors designed by Intel, AMD and ARM. From smartphones to PCs, supplied by any vendor and running almost any operating system, the vulnerabilities affected practically any modern computer.
Despite some patches being issued for the devices affected by these vulnerabilities, there has not been a complete solution and the vulnerabilities still represent a significant security risk to the health industry, especially with regards to the medical devices that it relies on so heavily. These medical devices are controlled by an application, meaning they can be directly compromised by Meltdown and Spectre. Unfortunately, because these vulnerabilities are part of the processor, the security protections that are usually in place are irrelevant. The vulnerabilities exist in the underlying system architecture of the medical devices, so can be exceptionally long-lived, providing attackers with sufficient time to develop direct attacks.
What are the effects?
The health industry relies on the use of so many medical devices every day, including things like MRI machines and pacemakers. It is likely for these devices to be compromised, putting patient data and safety at risk.
The vulnerabilities create the possibility for hackers to steal very sensitive patient information and personal data. This is to do with the memory of the application. For example, a hacker would be able to figure out how and when sensitive data is accessed or transmitted, then steal that specific information related to that patient from memory before it is sent over the network encrypted by SSL of the Operating System.
Equally, through vulnerabilities like Meltdown and Spectre, unauthorised people may gain access to more personal information from the backend systems. Credentials and keys required to access connected or backend systems, if exposed, would allow an attacker to further compromise systems containing more information and that of many patients.
It’s no quick fix
When it comes to mitigating the vulnerabilities on devices, it is going to take time to patch and update the large number of systems affected and, it could be that not all medical devices will ever get updated. Although some patches have been issued, many have been recalled as they haven’t helped, in some cases they have actually made things worse. The most poignant example is that Intel recently pulled back the patches they issued for Spectre. The process is already fairly slow, and patch recalls are certainly not going to help.
Despite these patching difficulties, it is still possible to increase the security around Spectre, and application protection can provide this.
Protecting applications against Spectre involves hiding key materials, hiding data, and making the application and its control flow more difficult to instrument. There are several techniques which facilitate this, including white box cryptography, data encryption and control flow obfuscation. With white box cryptography, the key to the data is never resident. This means for attackers to gain access to any data, they would have to pull back and reverse most of the application before figuring out how to replay the authentication, making it very difficult to make any progress towards accessing patient data.
Meanwhile, changing the control flow makes it more difficult to instrument the application and identify areas of interest, meaning identifying the registers or the memory locations in order to extract information becomes a lot harder. Encrypting the data within these registers or memory locations then adds another layer of protection as it hides the important values when not immediately needed. If an attacker does manage to exfiltrate the register or memory location, if the data is encrypted, they would have to figure out how to decrypt that piece of data which, unless they have the key, is significantly difficult to do.
What does the medical industry need to do?
With cybersecurity beginning to frequent the national news, more and more people are worrying about the security of their devices, applications, and internet. When it comes to medical devices, patients may start to feel less comfortable with those used for their treatment. Companies need to start promoting the efforts they are making to secure their medical devices, and the applications are used to control them. Whilst they do not need to flaunt their security strategy in front of attackers, patients need to be able to feel confident the medical devices being used for their treatment have been properly secured. Much of the time it is unlikely doctors or hospital staff will be able to explain the security behind the devices they are using. It comes down to the argument of clinical functionality and treatment being a higher priority than cybersecurity. Really, it is the manufacturers of the devices who are responsible for ensuring and demonstrating the security of the medical devices
Rusty Carter, VP of Product at Arxan Technologies
Healthcare presents a major opportunity for start-ups aiming to transform industries using technological innovation. The NHS is a healthcare delivery system on a massive scale. Our system needs to adapt to meet coming challenges – an ageing population and increasingly complex health and care needs. As demand increases, finances and workforce capacity are not keeping up. Incremental change will not supply the necessary solutions. Instead “step change” innovation is needed.
Technological innovation can enable disruptive change, but the NHS needs to look both within, for ideas generated by front-line staff in response to unmet needs and to industry to find innovative solutions to service redesign challenges.
A variety of emerging and established technologies are likely to play a huge part in leading innovation in healthcare in the next decade, from artificial intelligence to 3D bio scanning and printing, and precision medicine such as biomarker based diagnostics and therapeutics, robotics, blockchain and the Internet of Things (IOT).
A current example of a service improved through technological innovation can be found in the EarFold® implant invented by Mr Norbert Kang, a consultant plastic surgeon from Hertfordshire. EarFold® is an alternative procedure to correct prominent ears, which is thought to affect 1-2% of the UK population. The procedure inserts a material called a Shape Memory Alloy under the skin of the ear. In time cartilage re-forms around the implant, and the ear bends permanently into its new shape. This rapid and effective process, under local anaesthetic, has fewer side effects than normal otoplasty surgery and is far less intrusive.
Mr Kang had his idea after a patient died under general anaesthetic, during conventional otoplasty surgery to pin back her ears. With the help of medical technology consultancy Health Enterprise East, Mr Kang formed a spin-out company with West Hertfordshire Hospitals NHS Trust called Northwood Medical Innovation in 2010. Five years later, the company was bought by global pharmaceutical company Allergan and the product is now selling widely across Europe.
Hurdles to be jumped
As opportunities beckon there are unavoidable challenges in the UK healthcare system. The NHS needs to focus on improving value for every pound that it spends, but technology developers need commercial returns on investments to re-invest in further generations of products.
If these possibly competing interests are to balance, developers need access to clinical experts within the health service, to help them develop products that offer improved health outcomes at lower costs. User needs drive innovation, so insight in to those needs from the perspective of both service and patient is critical in the early stages of product development.
Examining the future of healthcare over the years to come, there are many drivers for change. There is an increasing need for new Models of Care including more patient-centred, personalised medicine, and better service integration. This can be achieved through better use of ICT and communication tools, and could see the beginning of the seven-day NHS. New treatments for chronic disease such as diabetes, cardiac disease, stroke, lung disease, and cancer will be needed, including increasingly targeted drugs, earlier and more accurate diagnoses, new technologies and health delivery systems. There will also be a drive toward less invasive, more out-of-hospital care.
These innovations can be holistically encouraged by drawing together respective service and patient needs, clinical insight and entrepreneurial technology developers from the UK’s thriving start-up community. These developers will save both time and cost during the product development phase. Meanwhile, the benefit to the NHS will come in affordable and appropriate products, with patients profiting through access to new treatments, more personalised services and increased empowerment.
Markets: we have been warned
The privatisation of adult social care is a 30-year process that has grown unchecked, made worse by austerity politics. Should the private sector lose interest and leave the market, the consequences will be grave. Bob Hudson writes that, whilst it is not feasible to eliminate a model that has become so deeply embedded, improvement is possible. He explains how this would include a combination of better funding and smarter commissioning. To read the full argument, go to http://blogs.lse.ac.uk/politicsandpolicy/adult-social-care-is-privatisation-irreversible/
From contracting out to spining off
The Health Services Journal reports that 3,000 NHS estates and facilities staff – cleaners, porters and maintenance teams – are employees of eight NHS Trust owned subsidiaries. Most of these workers have been transferred from the parent Trust. The Journal’s research suggests that a further 8,000 NHS employees may be transferred to similar subsidiary companies in the near future. The number of staff moving depends on the extent of outsourcing to private suppliers. These spin-off companies may pay less VAT (a loop hole that will close quickly, NfN moles say) as well as saving on pay by recruiting new staff on less expensive non-NHS contracts. NHS Trust staff that are currently transferring will retain NHS terms and conditions. (Lawrence Dunhill HSJ 14/2/18)
Health and homelessness
A new study that maps primary health care services for people who are homeless in England finds significant variation in the type of service available, with some areas poorly covered.
Of the 900 homelessness projects (hostels and day centres) that were surveyed by the researchers, only 43% were linked to a specialist primary health care service. Homelessness projects in smaller towns and rural areas, and those working with young people who are homeless, were much less likely to be served by a specialist primary health care service.
In this study information was collected from 243 homelessness projects not linked to a specialist primary health care service about their views and experiences of primary health care arrangements for their clients:
- One in 10 managers of such projects (11%) said that their clients experienced ‘a lot’ of difficulties accessing primary health care services;
- Nearly half (47%) said that their clients experienced ‘some’ difficulties;
- Fewer (43%) said that there were no problems;
- Difficulties were most commonly reported by managers of projects in parts of NHS Midlands and East Region, and the South West and South East Regions.
The researchers identified 123 specialist primary health care services, spread across the five NHS England regions. Some were a specialist health centre primarily for people who were homeless, some were mainstream GP practices that provided additional services to people who were homeless, some were a mobile homeless health team that ran clinics in hostels and day centres used by homeless people, and a few were provided by volunteer health staff.
In 29 of the 35 largest cities in England outside London at least one specialist health service was identified. Of the 32 London boroughs and the City of London, only 14 were known to have a specialist primary health care service.
Dr Maureen Crane, the study’s lead researcher, said: ‘At present there are evidence gaps to guide health service commissioners and providers about the most appropriate types of primary health care services for people who are homeless. Better understanding of the effectiveness of different models in different settings is crucial if their primary health care needs are to be successfully addressed.’
Homelessness is a growing problem in many areas across England, and can have a devastating impact on health and well-being. People who are homeless and sleeping rough or staying in hostels and shelters have significantly higher levels of physical and mental ill-health, and problematic drug and alcohol use, than the general population. There are many difficulties in addressing their health care needs.
Copies of the report are available on request. For more information, please contact email@example.com / 0207 848 7443.
Innovation, innovation, innovation!
The NHS is famous for inventing new treatments and tools, and then not using them. A way round this is being pursued by joint ventures between commercial, academic, local government and clinical organisations. A good example of this is Medtech Accelerator, a joint venture with NHS innovation hub Health Enterprise East (HEE) bolstered by investment worth £500,000 from Essex County Council.
Medtech Accelerator is a joint venture between the NHS and regional business partners, including Health Enterprise East (HEE), New Anglia and Greater Cambridge Greater Peterborough (GCGP) Local Enterprise Partnerships (LEPs), the Eastern Academic Health Science Network (AHSN) and Essex County Council.
The organisation supports innovators within the NHS at the earliest stages in the product development pathway, by offering funding as well as practical advice on commercialisation and regulatory issues to help ensure that innovations that are inspired from the frontline of the NHS get to market as quickly as possible. The awards are aimed at supporting proof of concept work with the view to creating future spin-out companies that will be established across the region.
Medtech Accelerator has so far funded seven individual projects, with awards amounting to £670,000. One project within the portfolio has also allowed Medtech Accelerator to take its first equity holding in a spin-out company. Projects that have received financial backing range from enhanced tissue ablation technology, used in the treatment of tumours, to a safer technique for administering anaesthesia. This funding has brought innovators closer to selling and marketing their innovations, and given them access to guidance at crucial junctures on issues such as building and designing prototypes and conducting human study trials. Read more at www.medtechaccelerator.co.uk
To screen or not to screen?
Prostate cancer has hit the headlines recently for being more common than breast cancer, and, inevitably, there are calls for screening. Should the NHS set up a screening programme? The much-esteemed Academic Health Economists weekly commentary on health services (aheblog.com/2018/02/05/chris-sampsons-journal-round-up-for-5th-february-2018/) says “not yet”. This is because over-detection and over-treatment are common and harmful. A recent systematic review of cost-effectiveness models evaluating prostate-specific antigen (PSA) blood tests as a basis for screening found 10 studies with results that are not consistent. None of the UK-based cost-per-QALY estimates favoured screening. A lack of good data seems to be part of the explanation for the inconsistency in the findings. “It could be some time before we have a clearer understanding of how to implement a cost-effective screening programme for prostate cancer”, conclude the economists.
Responding to the Home Affairs Committee’s immigration report, Cavendish Coalition co-convenor, Nadra Ahmed, said:
“This report highlights the huge challenges faced by UK employers in securing their current and future workforce during a period of great uncertainty.
“The health and social care system remains under intolerable pressure and so we simply cannot afford to lose the talented EU staff we currently employ. Faced with shortages of key staff and skills which cannot be met domestically, it’s imperative we do not continue to see fewer colleagues choosing the UK.
“We welcomed the December confirmation that the rights of EU citizens will be protected– but now is the time for more detail.
“Employers and staff urgently require clarity on the next steps – not just for those who are currently in the UK, but for those who arrive during the transition period and beyond
“The Cavendish Coalition remains ready and willing to support the Government during this critical phase of negotiations.”