The healthmatters blog; commentary, observation and review
Medtech company unveils tech to improve diabetes management
The age of finger-pricking will soon be over with the announcement of a non-invasive method for measuring the body’s blood glucose levels from German medical technology company, DiaMonTech.
DiaMonTech has created technology for a medical device which directly measures the presence of glucose molecules in the blood through an invisible infrared laser, giving a reading of a user’s blood glucose level within 15 seconds. All users need to do is place their finger on a sensor on the device and their blood glucose levels will be displayed in real-time.
With 400 million people suffering from diabetes worldwide, this new device will liberate many from the antiquated means of pricking their fingers and the potential health risks it carries. DiaMonTech’s technology enables unlimited measurements and consistent, constant reporting on the presence of glucose in the blood, giving greater control over managing your diabetes.
The breakthrough patented technology was developed by DiaMonTech’s Head of R&D, Professor Werner Mäntele, Director of the Biophysics Institute at Goethe University in Frankfurt. With over 30 years of experience in spectroscopy, Professor Mäntele’s leading work on molecule detection enabled the team to create an advanced laser, capable of measuring blood glucose with pinpoint accuracy.
“Developing a non-invasive device for the management of diabetes has been our top priority since day one,” says DiaMonTech’s CEO, Thorsten Lubinski. “With so many other devices that require a break to the skin, and with millions worldwide suffering from this disease, we made it our mission to help make the day-to-day monitoring of diabetes more manageable and less intrusive.”
“Unlike previous diabetic monitoring methods, which have focused on one particular layer of the skin to measure blood glucose, DiaMonTech’s approach means blood glucose is measured with ‘depth-profiling’,” says Professor Mäntele. “This method allows us to measure one’s skin at a multitude of different depths and is fine-tuned to measure glucose molecules rather than a high-level overview.”
A series of devices are planned with a larger desktop unit, ‘DMT Base’, scheduled for release in 2018, a pocket-sized device ‘DMT Pocket’ scheduled for 2019 and a smart-wristband, ‘DMT Band’, which will continuously monitor blood glucose, scheduled for 2021. Each device will be compatible with Android and iOS mobile devices, allowing you to check your information in real-time.
Health at a Glance 2017 says that all OECD countries have seen life expectancy at birth increase by over 10 years since 1970 to reach an average of 80.6 years. Life expectancy at birth is highest in Japan (83.9 years), and Spain and Switzerland (83 years each), and lowest in Latvia (74.6) and Mexico (75).
New analysis in the report reveals that if smoking rates and alcohol consumption were halved, life expectancies would rise by 13 months. A 10% increase in health spending per capita in real terms would, on average, boost life expectancy by 3.5 months. However it is not just spending per se, but also how resources are used, that makes the difference in life expectancy. There is a large variation in the link between changes in health spending and in life expectancy: in the United States, for example, health spending has increased much more than in other countries since 1995, yet life expectancy gains have been smaller.
Health spending per capita has grown at around 1.4% annually since 2009, compared to 3.6% in the six years up to 2009. Average spending per capita has now reached about USD 4 000 per year. Spending is highest in the US, at USD 9 892 per person, and 17.2% of GDP. Health spending was also 11% or more of GDP in Switzerland, Germany, Sweden and France.
Reducing wasteful spending is key to maximise the impact of public resources on health outcomes, and Health at a Glance illustrates areas where spending could be more effective. For example:
- Increased use of generics in most OECD countries has generated cost-savings, accounting for more than 75% of the volume of pharmaceuticals sold in the US, Chile, Germany, New Zealand and the United Kingdom, but less than 25% in Luxembourg, Italy, Switzerland and Greece.
- Antibiotics should only be prescribed when absolutely necessary, yet antibiotic prescriptions varied more than three-fold across countries, with Greece and France reporting volumes much higher than the OECD average.
- The share of minor surgeries provided on a same-day (rather than inpatient) basis is now common in most OECD countries. For example, day surgery now accounts for 90% or more of all cataract surgeries in 20 of the 28 OECD countries with comparable data. However less than 60% of cataract surgeries are performed on a same-day basis in Poland, Turkey, Hungary and the Slovak Republic.
The report also shows that health care quality is improving:
- Over 80% of patients report positive experiences in terms of their time spent with a doctor, easy-to-understand explanations and involvement in treatment decisions.
- Avoidable hospital admissions for chronic conditions such as diabetes and asthma have fallen in most OECD countries, indicating an improving quality of primary care.
- Fewer people are dying following heart attack or stroke. Improvements are particularly striking among heart attack patients in Finland, and stroke patients in Australia.
- Across OECD countries, five-year survival rates for breast cancer were 85% and just over 60% for colon and rectal cancers, with survival rates improving in most countries over time.
While smoking rates continue to decline, there has been little success in tackling obesity and harmful alcohol use, and air pollution is often neglected:
- Smoking rates have decreased in most OECD countries, but around one in five adults still smoke daily. Rates are highest in Turkey, Greece and Hungary and lowest in Mexico.
- Across the OECD, alcohol consumption has declined since 2000. However, consumption has increased in 13 countries over the same period, most notably in Belgium, Iceland, Latvia and Poland. Moreover, one in five adults regularly binge drink across the OECD.
- 54% of adults in OECD countries today are overweight, including 19% who are obese. Obesity rates are higher than 30% in Hungary, New Zealand, Mexico and the United States.
The report, together with country notes and more information, is available at http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm.
Belfast today, Home Counties tomorrow!
This health service funding business is easy, ask any Ulster politician. Recently all five Trusts in Northern Ireland consulted on proposals for significant cuts in services in order to meet their legal duty to stay within their 2017/18 budgets. If implemented, the cuts would have potentially impacted severely on the health of people in Northern Ireland. Fortunately the Department of Health (Northern Ireland), announced shortly after the consultation ended that the worst of the cuts would not go ahead, and that additional funding would be made available for both health and education. There are lessons here. First, health and social care are integrated in Ulster but the downside is that Trusts must stay in budget, like English local governments but unlike the English NHS. Second, money will be found when necessary – necessity in this case being the dependence of May’s government on Ulster MPs. So, logically, friends of the NHS should make the Conservative government pay handsomely to avert loss of seats. Did anyone say ‘Stuff Integration’ or ‘Progressive Alliance’?
Will the love-hate relationship between the NHS and information technology ever change? University Hospitals of Leicester Trust pulled out of the East Midlands Radiology consortium after meeting with radiologists, amid mounting concerns for patient safety and repeated system failures. The consortium was developed to link eight hospital trusts’ imaging systems to deliver savings and improve care, but it has been prone to breakdowns. The Health Service Journal (31st October 2017) reported that some consultants sent images on CDs via taxis for specialist review. This is bad news, because the IT story about imaging has been a positive paragraph in the wider and less optimistic tale about the NHS’ adoption of new technology. No more, it seems.
So how will the NHS adapt to Artificial Intelligence (AI)? Latest research suggests that AI could detect cancer in less than a second. A trial has found that AI systems were able to distinguish potentially dangerous bowel tumours from harmless growths with high levels of accuracy. In the trial the AI system was able to distinguish tumours in endoscopy images with 94 per cent accuracy (Laura Donnelly, Daily Telegraph, 29th October 2017). But will NHS users prefer a friendly face to a silicon chip when it comes to using AI diagnostically? Information Management Company OpenText says yes! Its research suggests that that UK consumers, too, see the advantages of the technology: A quicker diagnosis was identified as the biggest benefit, with one in three (33%) UK consumers believing robots would reach a decision on their condition much faster; As well as faster diagnosis, one in four (25%) British consumers believe they would get a more accurate diagnosis from AI; A quarter of UK consumers (25%) said robot technology would mean they wouldn’t have to rely on booking an appointment with a GP, while 24% said the biggest benefit would be no longer having to take time off work to visit a doctor. So who would perform the endoscopy, ask News from Nowhere’s moles?
If AI is going to be a problem for the NHS, what about ‘customer journey management technology solutions’? Software company Qmatic (www.qmatic.com/ukhealth), thinking about numerous outpatient and GP appointments being missed, offers solutions. Healthcare facilities need to walk in the patient’s shoes by thinking about where the experience starts and deploying an approach that is connected throughout the entire patient journey. For example, implementing an online booking system enables healthcare facilities to reduce the number of failed appointments by delivering mobile reminders to patients who have upcoming appointments. This ensures patients are aware of their consultations and can cancel or reschedule these if necessary. It’s key that the online booking process is connected to staff profiles and availability. When connected, it can increase efficiency and deliver a great patient service by facilitating ease of booking, notifications and reminders and can be agile to patient changes.
Additionally, the system needs to be linked to the patient arrival. This is particularly important for outpatient clinics, which can be difficult to navigate, as there are numerous individual waiting areas. Self-service check-in kiosks, mobile applications or even robot helpers – all enabled with appointment scanning technology – can notify staff of the arrival of the patient and provide the patient with the information they need to put them at ease and assure them they are in the process. Healthcare providers will know exactly where their patients are at all times and why they are there, this reduces delays in providing a healthcare service. Connected solutions such as these are able to direct patients to the right service point at the right time and reduce the need for staff intervention, creating a smoother, efficient patient journey.
Ultimately, says Qmatic, great patient service is a journey that begins before the examination room and endures long afterward with a dedicated and personal follow-up, which a connected online booking system and arrival solution can enable. In fact, by implementing patient journey management technology solutions, clinics, hospitals, pharmacies and labs can create a seamless patient journey, improve the speed and quality of service, increase employee productivity, lower patient anxiety, and secure the bottom line.
General practitioners are under increasing pressure to scale up, by making federations and super-practices, or by merging with Acute Hospital trusts. The Royal Wolverhampton Trust in the West Midlands is now running nearly a fifth of GP practices in its area, after incorporating its eighth practice as part of a vertical integration programme it began in 2016. The integration of the latest practice last week takes the trust’s population coverage with GP services from 41,327 to 52,862. This has happened despite Royal Wolverhampton trust not being one of NHS England’s national vanguard sites. Perhaps being unencumbered by NHS England’s anxious experimenters has advantages?
Not to be left out, Clinical Commissioning Groups are merging. For example, the six CCGs covering Staffordshire have appointed a single ‘accountable officer’. According to the Health Services Journal (November 3rd 2017), the Staffordshire and Stoke on Trent sustainability transformation partnership (STP), which the six CCGs are a part of, is in the national capped expenditure process and faces significant financial challenges. One CCG, East Staffordshire, is in very large contract dispute with Virgin Care. HSJ readers did not spare their words: “A basket-case of a health economy whose weak, disorganised commissioners were bullied for years by a monopolising, avaricious community trust and dysfunctional acute trusts”. Ooh er!
Mergers of CCGs have reduced their number from 211 in 2013 to 195 next year, and the HSJ (7th November 2017) is speculating about a total of around 150 (so back to primary care trusts), or even 50, or possibly just 20-30 regional managers. There’s never a dull moment in the modern NHS, and there could be no better time to choose a management career in it.
Alzheimer’s Research UK, the UK’s leading dementia research charity, has welcomed a government plan to speed up the way new treatments are introduced on the NHS. The plan takes forward several recommendations from last year’s Accelerated Access Review – which examined how advances in medicine could be made available to patients faster – and could have major implications for future dementia treatments.
Among the actions announced is the creation of a new ‘Accelerated Access Pathway’ for selected breakthrough treatments and medical technologies that fill an unmet need, transform patients’ lives or dramatically improve efficiency. This pathway would streamline the regulatory process to allow these treatments to be made available up to four years earlier – but the report warns that any new medicines leading to increased costs for the NHS would need to be offset by other, cost-saving treatments. Meanwhile, companies would also be expected to offer new treatments and technologies to the NHS at the best possible value for money.
Hilary Evans, Chief Executive of Alzheimer’s Research UK, said:
“Today’s announcement marks a real step in the right direction and could have major implications for people with dementia. With no treatments yet available to stop or slow the diseases that cause dementia, there is a huge unmet need, and we hope the approach announced today will ensure that people with dementia will not have to wait for medical advances to reach them. The ambitions outlined today have the potential to transform the way breakthrough treatments are delivered to the people who need them, and it’s vital that their views are at the centre of any decision-making about which treatments are classed as ‘breakthrough’.
“We recognise that new treatments for dementia could pose a challenge for NHS budgets, so early discussions between the NHS and drug companies will be crucial to allow our health services to plan ahead. At Alzheimer’s Research UK it’s our mission to bring about the first life-changing treatment for dementia by 2025, which is why we will be working to support these discussions and develop solutions to this challenge.”
AbbVie puts creativity at heart of health problem-solving with unique group of experts including animators and gamers
Today, global research-based biopharmaceutical company, AbbVie, is announcing a unique line-up of experts from the creative, health and tech industries, including Aardman (the studio behind Wallace & Gromit and Shaun the Sheep). The experts, who are part of the Live:LabTM project, have been brought together to tackle the complex health issue of the ‘Fear of Finding Out’ (FOFO) – a major psychological barrier which prevents people from seeking medical advice when they have worrying symptoms[iii].
Former Health Minister, Alan Milburn, is chairing the group of Live:LabTM collaborators who comprise filmmakers, animators, gamers, data specialists and health experts – with the likes of award-winninggame designers Glitchers, medical virtual reality experts FundamentalVR, the Open Data Institute, Professor Sir Muir Gray and TV doctor Dr Zoe Williams, joining the line-up.
The experts will draw on their experience on the power of storytelling and characters, the benefits of data and tech, and real-life medical experience. The aim is to create a positive new approach to help the public and NHS to overcome barriers that stop people coming forward for early diagnosis and treatment.
A new short film is being released today, documenting the Live:LabTM collaborators meeting to discuss ways new technologies and data collection can revolutionise our approach tackling barriers to health.
Studies show that addressing concerns in middle age can double individuals’ chances of being healthy when you are 70[iv]. Live:Lab’sTM aim is to help people feel positive and empowered to take control of their own health and wellbeing, which in turn will help them to overcome the barriers that prevent them from seeking health advice and delay diagnosis. Live:LabTM complements NHS England’s ‘Five Year Forward View’ by focusing on improving health prevention, supporting a more sustainable NHS.[v] Never before has the ‘Fear of Finding Out’ been addressed by such a broad range of experts, collectively.
Speaking about the project Live:LabTM collaborator, Sir Muir Gray CBE, said: “We’re increasingly seeing evidence which shows that people respond far better to positive health messages, which in turn means they are more likely to engage with the health service. I’m a firm believer that healthcare is what you do for yourself and through the work we’re doing with Live:LabTM, we’re hoping to devise a solution which will help people feel empowered and in control of their health and wellbeing.”
Heather Wright, Executive Producer and Head of Partner Content at Aardman and Live:LabTMcollaborator, comments: “I am passionate about the NHS and I was a little surprised that a major pharmaceutical company, like AbbVie, would want to look outside the industry for answers and explore the territory of preventative health. I was even more surprised when I first learnt about who else is part of Live:LabTM – from game developers, to tech experts. The aspirations for Live:LabTM, such as breaking down barriers to form progressive partnerships to support the NHS, are something I really respect. I feel we have the potential to help make a real change to healthcare.”
Jérôme Bouyer, AbbVie General Manager, commented: “As an innovation led science company we, and in fact healthcare organisations more widely, are used to thinking in terms of logic and evidence. We come at problems from the world of fact based evidence. But life experience shows that we’re not always logical in how we think about our own health. The decisions we make have a big impact on what help we can get from doctors. If we are going relieve the huge strain on the NHS, we must get creative and we can only do this by bringing in the most creative minds from outside of healthcare. This is what AbbVie is trying to encourage through this collaboration.”
The Live:LabTM collaborators are:
- Rt Hon Alan Milburn – former Secretary of State for Health
- Simon Bullmore, Open Data Institute – a non-profit company with a mission to inspire people to innovate with data
- Julia Manning, Chief Executive, 2020health – an independent, social enterprise think tank whose mission is to ‘make health personal’
- Aardman – world leading and multi-award winning British studio which produces series, advertising, interactive entertainment, attractions and feature films; like Wallace & Gromit andShaun the Sheep
- Glitchers – a company creating innovative gaming products including Sea Hero Quest, an award-winning mobile and virtual reality game which collects spatial navigation data to inform dementia research
- Professor Sir Muir Gray – founder of the National Library for Health and the first person to hold the post of Chief Knowledge Officer of the NHS
- Dr Zoe Williams – media medic, GP and clinical champion for the RCGP’s clinical priority ‘Physical Activity and Lifestyle’
- Dr Carmen Lefevre – research associate and research lead at the UCL Centre for Behaviour Change
- Alison Hardy – health behaviour change expert and founder of Headstrong Thinking
- Fundamental VR – medical VR simulation specialist that delivers virtual reality haptic ‘flight simulators’ for surgery
- Dr Angel Chater – chartered psychologist, and a reader in Health Psychology and Behaviour Change at the University of Bedfordshire
- Chrissie Wellington OBE – Global Head of Health & Wellbeing, Parkrun, and British triathlete
- Daniel Hulme, CEO of Satalia – a company pushing the boundaries of data science, optimisation and artificial intelligence to solve the most difficult problems in industry
Further background on all of the collaborators can be found on the Live:LabTM website, which is also where the second short film in the Live:Lab TM series an be viewed.
i) Institute for Health Metrics and Evaluation (IHME). GBD Compare – Public Health England. Seattle, WA: IHME, University of Washington, 2015. Available at: http://vizhub.healthdata.org/gbd-compare [Last Accessed: 11 February 2016]
[ii] 2020health: The Fear of Finding Out – Identifying psychological barriers to symptom presentation and diagnosis in the UK. 2017. Available at http://www.2020health.org/2020health
[iii] 2020health: The Fear of Finding Out – Identifying psychological barriers to symptom presentation and diagnosis in the UK. 2017. Available at http://www.2020health.org/2020health
[iv] Lang, I. A., et al. (2012). Healthy Behaviours in Middle Age and Long-Term Consequences for Mortality, Physical and Cognitive Function, and Mental Health. J Epidemiol Community Health. 66:A1-A66
[v] NHS England. Five Year Forward View. Available at: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf [Last Accessed: April 2017]
[vi] Dryden, R. et al., 2012 What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health 2012, 12:723
[vii] Public Health England – Modern life responsible for ‘worrying’ health in middle aged’. Available at:https://www.gov.uk/government/news/modern-life-responsible-for-worrying-health-in-middle-aged [Accessed Jan 2017)
[viii] Public Health England – Living healthily in midlife can double your chances of being healthy at 70 and beyond. Available at:https://www.gov.uk/government/news/phe-launches-one-you [Accessed Jan 2017].
Mental Health Network welcomes findings of Stevenson-Farmer independent review into workplace mental health
“We welcome this report’s approach to prioritising the mental health of the workforce and keeping mental health high on the healthcare agenda.
“Key to alleviating some of the pressures we are currently seeing within the mental health sector is the support offered to individuals before they reach crisis. Empowering employees to look after their own mental health is a crucial step towards this.
“The evidence shows that improving employee mental health is both beneficial to the individual and good for business, paying dividends in terms of morale, retention and productivity.
“The NHS has made great progress in this area. For example, the South London and Maudsley NHS Foundation Trust has introduced several initiatives as part of its happier@work project.
“This programme includes workshops on mental health awareness; skills workshops for managers; and practical skills for peace of mind, managing wellbeing and stress awareness.
“The more support the Government offers to spread these types of initiatives, the better.”
Stroke claims an estimated 6.2 million lives globally each year: World Stroke Organization
How happy we are can have a long-term impact on our risk of suffering a stroke, a leading US-based doctor has said ahead of World Stroke Day activities on Sunday, October 29.
Andrew Russman, D.O., Head of the Stroke Program and Medical Director of the Comprehensive Stroke Center at the Cleveland Clinic, says emotional wellbeing is often a deciding factor in whether we make healthy or unhealthy lifestyle choices. Even mild stress or feelings of unhappiness can lead to major health incidents.
“If we look at stress, as a prime example, people will very often deal with the emotional upset by making bad lifestyle choices, such as increased smoking or alcohol use, or eating junk food,” said Dr. Russman. “That leads to obesity, high blood pressure, diabetes, all coming together as a significant increase in our risk of stroke.”
A stroke occurs when there is a problem getting blood to the brain, either because of a blockage or a ruptured blood vessel. When this happens, the brain does not get enough oxygen, causing brain cells to die. Stroke claims an estimated 6.2 million lives globally each year, according to the World Stroke Organization, more than AIDS, tuberculosis and malaria combined. It is also a leading cause of disability.
A number of factors increase the risk of stroke:
- Excess weight — Obesity can lead to heart disease and high cholesterol, which can lead to a stroke.
- Heart problems — Strokes are six times more likely to occur in people with cardiovascular disease. Atrial fibrillation, one of the most common heart rhythm problems, increases your risk of stroke by about five times.
- High blood pressure — Strokes are four to six times more likely in people with hypertension.
- High cholesterol — People with high cholesterol are at double the risk of having a stroke.
- Heavy drinking — This increases the risk for stroke and cardiovascular disease.
- Smoking — If you smoke, you double your risk for stroke compared to nonsmokers.
Dr. Russman says that while specific data on the impact of mental or emotional health on the likelihood of stroke is limited, research is emerging that shows a link. One Japanese study published earlier this year used unemployment as commonly identifiable sign that someone had experienced a period of high personal stress, and analyzed the histories of around 40,000 men and women aged 40 to 59 years.
“The results showed a clear correlation between the stress caused by job loss, and increased smoking, alcohol use, high blood pressure and diabetes, and ultimately to an increase proportion that suffered a stroke,” said Dr. Russman. “This didn’t only apply to those who experienced long-term or multiple periods of unemployement. Even just one incident of job loss increased the risk.”
When a person does experience a stroke, being able to recognize the signs can greatly increase the odds of a better outcome. Time is critical, and time saved can make the difference that allows a person to walk again, or to go home instead of going into a nursing home.
Some people will experience warning signs before a stroke occurs, which is called an ischemic attack, or a mini stroke.
To check for signs of a stroke, and to respond appropriately, always remember the words ‘BE FAST’:
B = Balance – Is the person having trouble with balance?
E = Eyes – Is the person having visual problems?
F = Face – Is there droopiness in the face?
A = Arms – Is there any weakness in the arms or legs?
S = Speech – Is the person having difficulty speaking?
T = Time – Time to call for an ambulance.
World Stroke Day is observed on October 29 each year, and is an initiative of the World Stroke Organization. It aims to underscore the serious nature and high rates of stroke, raise awareness of the prevention and treatment of the condition, and ensure better care and support for survivors.
Cutting corners, spoiling lives?
Child and adolescent health services have been having a very hard time over the last few years, with referrals exceeding staff capacity, a shortage of in-patient beds and transfer of young people with severe mental illnesses or behaviour problems to distant units for care. The commercial sector has been involved in children’s mental health service provision, just as in learning disability and adult psychiatry, and the results have too often been ugly.
The HSJ broke the news on October 24th that a third private sector operated children’s mental health unit – Watcombe Hall in Torquay, run by the Huntercombe Group – had closed during a CQC inspection. It has now closed indefinitely after several safeguarding inquiries were launched. Torbay Hospital raised the alarm about young people with malnutrition and dehydration being admitted from the unit.
Watcombe Hall is the third privately run children’s mental health unit to close. The other two other units, both run by Cygnet Health Care, have subsequently reopened. The CQC report on Watcombe Hall highlighted:
- Patients’ physical health was not always checked – one patient had not eaten or drunk for four days.
- Weighing of patients with eating disorders did not always follow medical instructions.
- Staff had not received specific training in caring for young people with eating disorders.
- A group of three young people overpowered staff before absconding from the unit.
- There was a high level of serious incidents, including 18 in the first three months of 2017, as well as 38 staff injuries in six months.
- Four patients were restrained 29 times or more during their stay on the unit.
- Staff turnover affected care quality and new staff were not adequately trained, inducted and supervised. Only half of staff had up to date safeguarding level three training despite this being mandatory.
- Some young people had not engaged in any activities for three months and use of outside areas and the gym was very limited.
- Inspectors saw a young person climb a fence and abscond, during the CQC inspection.
NHS hospitals could carry out 280,000 more non-emergency operations a year by organising operating theatre schedules better, according to a study in 100 NHS Trusts conducted by NHS Improvement, that was leaked to the BBC on October 24th. The research, using data from 2016, found more than two hours were wasted each day on the average operating list. The study says avoidable factors like late starts led to the loss of time.
Ex A&E doctor Chris McCullough, CEO and Co-Founder of Rotageek has a few things to say on this matter. “The real issue, not mentioned in this study, is one of ineffective use of data to schedule and manage hospital resources. Hospitals are run at such high capacity that operations are actually often delayed until managers know they have a bed available for patients arriving for surgery. Ready-to-start surgical teams cannot start a procedure by anaesthetising patients until a bed has been allocated. In turn, this won’t happen until the ward medical team have created space by seeing all patients and sent people home. As a result, operations start later than planned and waste theatre capacity.
“The only way to solve this crisis is for the NHS to use the data it already has available to better manage and predict hospital capacity and patient flow – impacted by variables such as the quantity and condition of patients, available staff and their skillset, as well as medical resources.
“By analysing the flow and pattern of patients, from admittance to surgery through to final discharge, hospitals can predict the effect of any scenario on each individual hospital department and the system as a whole. This simulation offers several benefits; it can monitor hospital operations, predict future bottleneck days or weeks, diagnose where and what could be done to avoid or fix problems, and it can assess where more staff are needed to help plan for accurate hiring.
At the moment, the NHS is forced to be reactive to scheduling when it could actually be much more proactive. Management can only see a problem when it’s too late, as they are unable to make sense of all the moving components within the system. This means it is impossible to have certainty over where to make real efficiencies, let alone anticipate capacity problems in real-time for elective patients.”
News from Nowhere’s moles agree, and ask: why haven’t all hospitals sorted this, it is not a new story?
A&E attendances, not as rushed as some say?
On 17th October the Care Quality Commission (CQC) published the results of the Emergency Department Survey 2016, co-ordinated by the Picker Institute. The survey was ; a nation-wide survey of more than 40,000 people who attended emergency and urgent care departments, which sought to understand their experiences. The results suggest that most patients have a positive experience when it comes to interactions with NHS doctors and nurses, despite a marked increase in the numbers attending NHS Emergency Departments in recent years.
The years between 2005/6 and 2015/6 have seen an increase in emergency department attendance of 10%; this equates to over one million additional people attending the departments in 2016 than 2006.
The survey included people who attended one of 137 acute and specialist NHS trusts during September 2016, and is part of the National Patient Survey Programme (NPSP) managed by the Survey Coordination Centre, based at Picker. Despite the increasing number of attendees to emergency departments, 73% of patients said they definitely had enough time to discuss their condition with a doctor or nurse. In addition, 78% of these reported that their doctors and nurses listened to what they had to say.
Only 69% of patients reported that their doctor or nurse explained the nature of their condition and treatment in a way that they could understand. Three quarters (75%) of respondents “definitely” had confidence in their doctors and nurses, with a further 18% having confidence in them to a certain degree.
The survey highlighted problem that arose when patients left the department or unit; 30% of respondents weren’t given enough information about danger signs watch out for on returning home; and 37% were not given enough information about what medication side-effects they should watch out for. About 45% of respondents stated that their home situation was not taken into account when they left the emergency department, and 34% were not informed about when they could resume normal activities, such as driving.
A caveat from Health Matters: The 2016 survey of emergency departments involved 137 acute and specialist NHS trusts with a Type 1 accident and emergency department. Type 1 departments are consultant-led A&E departments with full resuscitation facilities operating 24 hours a day, 7 days a week. Forty nine of these trusts also had direct responsibility for running a Type 3 department and patients from these departments were included within the survey for the first time in 2016. Type 3 departments are minor injury units and urgent care centres that treat patients for minor injuries and illnesses, and which can be doctor or nurse led.
Kiron Chatterjee and Ben Clark of the Centre for Transport & Society at UWE Bristol explain the findings from their ESRC study of Commuting and Wellbeing.
Many of us spend longer commuting to work than we would like and find our journeys stressful, but how detrimental is commuting to our wellbeing?
The journey to and from work is a routine activity undertaken on about 160 days of the year by those who are full-time employed in England. The average one-way commute time is 30 minutes, hence commuting consumes about one hour per day for the average commuter. However, one in seven commuters has a commute time of one hour or more, spending at least two hours per day commuting.
The impact of commuting on wellbeing has been studied before, but results have been inconclusive and we do not have a complete picture of how commuting affects different aspects of wellbeing.
Our study, funded by the Economic and Social Research Council, took advantage of Understanding Society, the UK Household Longitudinal Study which tracks the lives of a large, representative sample of households in England. The data set allowed us to examine how changes in different aspects of wellbeing from one year to the next were related to changing commuting circumstances for more than 26,000 workers in England over a five-year period.
As set out in our summary report, we found that, all else being equal, every extra minute of commuting time reduces job satisfaction, reduces leisure time satisfaction, increases strain in people’s lives and worsens mental health.
The graph below shows job satisfaction (as measured on a 7-point scale) declines with commute time. Interestingly, the exception is the small proportion of workers with extreme commutes of over 90 minutes each way.
The effects of commuting on employee wellbeing were found to vary depending on the mode of transport used to get to work:
- Those who walk or cycle to work do not report reductions in leisure time satisfaction in the same way as other commuters, even with the same duration of commute. Presumably, active commuting is seen as a beneficial use of time.
- Bus commuters feel the negative impacts of longer journey times more strongly than users of other modes of transport. This could relate to the complexity of longer journeys by bus.
- Meanwhile, longer duration commutes by rail are associated with less strain than shorter commutes by rail. We think this is explained by those on longer rail journeys being more likely to get a seat and to have comfortable conditions to relax or even to work.
- Those who work from home are found to have higher job satisfaction and leisure time satisfaction, but working from home is clearly not possible for everyone on a daily basis.
Our findings have particularly important implications for employers. An additional 20 minutes of commuting each day was found (on average) to have the equivalent effect on job satisfaction as a 19% reduction in income – this is a loss of £4,080 per annum for someone earning £21,600 (the median value for our sample). We found a gender difference for this result with longer commute times having a more negative impact on women’s job satisfaction than men’s. This is likely to be related to the greater household and family responsibilities that women tend to have. We also found that employees with longer commute times are more likely to change job, and this has implications for employee retention.
The overall message for employers is that job satisfaction can be improved if workers have opportunities to reduce their time spent commuting, to work from home, and/or to walk or cycle to work – such commuting opportunities are likely to be good news for employee wellbeing and retention and hence reduce costs to businesses.
While we found that longer commute times have adverse wellbeing effects for job satisfaction, and even more markedly for leisure time satisfaction, they were not found to have a large impact on life satisfaction overall. Our analysis showed that this is because longer commute times are taken on for jobs which provide higher salaries and other benefits which serve to increase life satisfaction.
This does not mean that the negative wellbeing impacts of longer commutes can be disregarded. It is important to recognise the negative impacts on job satisfaction, leisure time satisfaction and mental health. People are only likely to continue to accept that a long commute is a price to pay if it is unavoidable and a social norm.
The Commuting & Wellbeing study was funded by the Economic and Social Research Council (ESRC) (Grant Number ES/N012429/1). The project was led by Dr Kiron Chatterjee at the University of the West of England (UWE Bristol) and ran for eighteen months from February 2016 to July 2017. A summary report from the study is available athttps://travelbehaviour.com/outputs-commuting-wellbeing/
- Over 1.8 million people in UK have it, but two in five people (43%) with psoriasis are afraid to go outside for fear of being judged
- Over one in 10 won’t go on holiday (14%), or to the gym (14%) and more than one in 20 won’t go out to meet friends (7%), due to the physical and emotional impact of the debilitating condition
- Furthermore, 50% of people admitted they feel embarrassed to talk about their lifelong battle with psoriasis and a quarter (26%) feel stuck in a helpless treatment loop with limited options
THE autoimmune skin condition that affects nearly one in 50 people in the UK has knocked the nation’s confidence, according to new research.
In a poll by Philips Healthcare*, a shocking two in five people (43%) who live with psoriasis revealed the condition has lowered their self-esteem, put up a social barrier and stopped them from going outside.
The chronic disease – which appears as raised, red patches on the skin – is having such an emotional impact on Brits that more than one in 10 sufferers refuse to go on holiday (14%), or to the gym (14%) and more than one in 20 won’t go out to meet friends (7%).
In fact, 50% of people surveyed admitted they feel embarrassed to even talk about their psoriasis, while the majority (75%) simply turn to creams in hope of a quick fix.
Despite 60% of Brits currently suffering from or having suffered with a skin disease at some point during their lifetime, when visiting their GP, some of those with psoriasis revealed they feel stuck in a treatment loop (26%), not a priority (23%), frustrated (15%), ignored (16%) and believe their GP is clueless (14%).
Expert dermatologist, Professor Cherio said: ‘The poll highlights not only the social stigma of the condition, but also the limitations individuals feel when faced with treatment options. It is concerning that 1 in 10 have never tried anything at all and I can only assume this is due to a lack of awareness around psoriasis.
Studies continue to show that treating the disease is your best bet to improve your quality of life and reduce the risk of developing comorbidities.’
Prof. Dr. Matthias Born, Director Clinical & Scientific Affairs and Principal Scientist at Philips, says: ‘Psoriasis complicates millions of daily lives and disrupts countless relationships. For this reason, Philips Light Therapy team set out to create a world-first treatment for psoriasis sufferers to give them back control of the condition. Philips BlueControl enables users to manage symptoms at home and on the go.’