The healthmatters blog; commentary, observation and review
Figures obtained by the BBC and published at the end of February 2016 revealed that more than two-thirds of trusts and health boards in the UK are actively trying to recruit from overseas. There are currently almost 6000 vacant medical posts in the UK and many millions of pounds are being spent each month on locum cover to fill these gaps in service delivery. The difficulties with overstretched provision in the NHS sadly make our own UK graduates look to opportunities elsewhere, and 2015 saw the highest ever number of UK graduates apply to the GMC for the paperwork that allows them to apply for jobs in other countries.
Whilst the staffing problem is UK wide, significant regional differences exist with rural areas and areas which are perhaps perceived as less glamorous being the hardest hit. Cumbria is one such area with some services and hospitals on the very limits of viability. According to the NHS Success Regime – North, West and East Cumbria Progress Report (February 2016) the region has ‘a workforce recruitment and retention problem that presents a major barrier to improved quality, performance and sustainability’ and this is a long standing problem. The fact remains that it is much more difficult to attract staff to some parts of the country whether they have been trained in the UK or elsewhere. Many initiatives have been trialled to improve recruitment in these areas including financial incentives, but none have yet met with sustained success.
There is however evidence from more than one country to suggest that doctors tend to look for work in areas where they have been trained. According to a report from the Higher Education Careers Services Unit (HECSU), for the UK as whole, 71% of employed graduates remain close to their home regions for work. The same study also found that outside London, the North West retains more domiciled graduates and more students who studied locally than any other English region. The University of Central Lancashire (UCLan) has already demonstrated that this holds true for dentistry. In recent years UCLan created a dental course unlike any other in the country with dental students living and studying in regional centres rather than remaining in a central city base. Around 63% of students trained in this way have chosen to continue to practice in the region following graduation suggesting that this model of education is helpful in assisting regional recruitment of skilled NHS professionals.
The medical School at UCLan has recently developed an MBBS with the first cohort of students joining the school in 2015. The course makes use of UCLan campus sites in Preston,East Lancs and West Cumbria and has worked closely with the NHS Trusts and GPs in these areas to develop partnerships to further develop medical education and research in their locality. The NHS Trusts, all of whom have challenges with medical recruitment, believe that the close working relationship with the medical school will help in the recruitment and retention medical staff moving forward. All hope that graduates from the school will see the benefits of working in the area and will seek employment with the Trusts on graduation. However, due to restrictions on numbers of UK funded medical student places the school is currently only able to accept self funding international students and is unable to take either UK or EU students and it is likely that many of the graduates will return to their home countries on graduation.
We work very closely with our partner NHS Trusts to look at ways to assist with their recruitment challenges and have already developed a number of initiatives to recruit high calibre staff to the areas such as joint NHS / university posts and opportunities for career development in research and education. In West Cumbria we have worked with all NHS stakeholders to develop the West Cumbria Medical Education Centre (WCMEC) with the aim of becoming a centre of excellence in remote and rural medical education and research. All our partnership Trusts are of the belief that the inclusion of UK students on our course would greatly assist in the sustainability of their medical workforce in years to come and actively supporting all our efforts in helping to bring this about.
However, whilst we are only able to educate self funded non-EU students the problems with staff recruitment and retention in these severely challenged areas are likely to remain. After graduation UCLan international medical graduates are unlikely to remain in the area for the long-term, meaning the positive impact they have on the region is likely to be temporary.
We hope the decision-makers will agree that where students are trained influences where they seek future employment and will feel able to allow UCLan to train a number of UK students in these “Cinderella” areas to help ensure that these severely challenged Trusts have some equity in the staffing supply of high calibre medical graduates to their region.
Cathy Jackson, head of medical school, University of Central Lancashire
Higher Education Careers Services Unit (HECSU) in Graduate Market Trends
Please support GMB domestics and caterers facing cuts
DEMONSTRATION THURSDAY 24th MARCH 12-2pm
Meeting at St George ’s Blackshaw Road entrance
Marching from St George’s to Tooting Broadway and back at 12:00 and 1:30pm (to time with GMB members’ shifts)
St George’s NHS Trust and Mitie, their private catering and cleaning contractor, have signed a deal to reduce the privatised cleaning and catering service right across the hospital. Patients and workers will be put at risk.
Please help GMB members resist these cuts!
Please do bring your banners, be visible and help us make some noise!
For more info contact Kieron Merrett, GMB Regional Organiser, on 07866 441 656 or firstname.lastname@example.org
Ordering repeat prescriptions, speaking to GPs online, attending video appointments are the most popular ways patients are using new technologies.
An overwhelming number of UK patients are currently using technology to access doctor’s appointments and medication, according to new research into patient behaviours and the healthcare ecosystem. 62% of Britons have used technology to access healthcare, according to a study of 1,014 British adults carried out by on-demand video GP consultation service, PushDoctor.co.uk. According to the data, ordering repeat prescriptions (29%) is currently the most popular way Britons are using technology to access healthcare services. More than 1 in 5 (22%) have communicated with a GP online – e.g. via live chat, whilst 1 in 7 (17%) have already used video consultation services to speak to a GP. Those aged 18-24 and 35-44 are driving adoption of these technologies. Convenience is leading this step change, with almost one in three (30%) claiming they would consult a GP via video if it meant they could have an appointment when and where they wanted. Meanwhile, 27% would do so if it meant they could have an immediate or same day appointment, and 1 in 4 (26%) if they couldn’t travel to their GP surgery.
In this talk, Prof. Kathy Murphy and Prof. Dympna Casey talk about the use of companion robots to combat loneliness in people with dementia.
Prof. Kathy Murphy (NUI Galway) has a clinical background in older people’s services and Emergency Department Nursing and she held posts at clinical nurse manager level in both. She has worked in nursing education with research interests in care of older people, dementia and chronic disease management. Prof. Dympna Casey (NUI Galway) has a clinical background in care of older people. She has a interest in promoting healthier lifestyles for older people in particular people with dementia and in examining ways of building resilience and supporting/maintaining the health and functional capacity of older people. She is currently leading an EU Funded Horizon 2020 project entitled MARIO (Managing Active & Health Aging with the use of caring service robotics) within the thematic section ‘Societal Challenge on Health, Demographic Change and Wellbeing’.
Prof. Dympna Casey (RGN, BA, MA) also from NUI Galway, has a clinical background in care of older people. She has a keen interest in promoting healthier lifestyles for older people in particular people with dementia and in examining ways of building resilience and supporting and maintaining the health and functional capacity of older people. She is currently leading an EU Funded Horizon 2020 project entitled MARIO (Managing Active & Health Aging with the use of caring service robotics).
Prof. Kathy Murphy (NUI Galway) has a clinical background in older people’s services and Emergency Department Nursing and she held posts at clinical nurse manager level in both. For the last 25 years she has worked in nursing education with research interests in care of older people, dementia and chronic disease management.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community.
Dr. Quentin Young, who served as national coordinator of Physicians for a National Health Program (PNHP) from 1992-2014, and who also served the organization’s past president, died on March 7 in Berkeley, California, where he had been under the watchful eyes and care of his daughters and other family members. He was 92.
In addition to his work with PNHP, Dr. Young co-founded and chaired for many years the Chicago-based Health and Medicine Policy Research Group.
Dr. Young was known for his sharp, clear-eyed analysis of social and economic problems, particularly in health care, his deep commitment to social justice and racial equality, his quick wit, his in-suppressible optimism, personal courage, and his ability to inspire those around him to join him in the battle for a more equitable and caring world.
Beginning in the late 1980s, he was perhaps the nation’s most eloquent and high-profile spokesperson for single-payer national health insurance, or improved Medicare for all, and was a vigorous champion of single-payer legislation, notably “The Expanded and Improved Medicare for All Act,” H.R. 676, sponsored by Rep. John Conyers Jr. and others.
Dr. Young graduated from Northwestern Medical School and did his residency at Cook County Hospital in Chicago. During the 1970s and early 1980s, he served as chairman of the Department of Internal Medicine at Cook County, where he established the Department of Occupational Medicine. In 1983, Chicago Mayor Harold Washington appointed him president of the Chicago Board of Health, where he served with distinction. From 1952 to 2008, he was an internal medicine doctor in private practice in Chicago’s Hyde Park community, where he lived most of his life.
For many years Dr. Young hosted a popular program on WBEZ, Chicago’s public radio station, where he discussed health and social issues and took calls from listeners.
In 1998, he had the distinction of serving as president of the American Public Health Association and in 1997 was inducted as a Master of the American College of Physicians. In 2009 he was appointed Health Advocate for the state of Illinois by Gov. Patrick Quinn.
In addition to his distinguished career as a physician, Dr. Young was a leader in public health policy and medical and social justice issues. He was Dr. Martin Luther King Jr.’s personal physician during the latter’s stays in Chicago, and during the civil rights era he served as national chairman of the Medical Committee for Human Rights.
In 1999, Physicians for a National Health Program established the “Quentin D. Young Health Activist Award” to honor physicians and other health professionals who exemplify Dr. Young’s commitment to social justice. It is regarded as PNHP’s highest award.
In his 2013 autobiography, “Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause,” Dr. Young wrote as follows:
“From my adolescent years to the present, I’ve never wavered in my belief in humanity’s ability – and our collective responsibility – to bring about a more just and equitable social order. I’ve always believed in humanity’s potential to create a more caring society.
“That viewpoint has infused my relations with family, friends, patients and medical colleagues. It’s been a lifelong, driving force to promote equality and the common good, and I believe it has served me well.
“I suppose being a physician has made it easier for me to work toward this goal. Easier, that is, than if I had chosen a different occupation. I’ve spent a lifetime trying to help others – in my daily rounds, in my clinic, as a hospital administrator, at demonstrations, in my work with health advocacy groups – and it all adds up to deeply rewarding career. Few people have such good fortune.
“But as you’ve no doubt noticed in the preceding pages, my views and actions have also propelled me into sharp conflict with institutions and person who would perpetuate injustice. That was true yesterday; it remains true today. My work is unfinished.”
Dr. Robert Zarr, president of Physicians for a National Health Program
Physicians for a National Health Program (www.pnhp.org) is an organization of 20,000 US physicians who advocate for single-payer national health insurance. It was founded in 1986.
TOBACCO will continue to devastate UK lives, with around 1.35 million new cases of smoking related illnesses expected to occur over the next 20 years according to a new report published today (Wednesday) No Smoking Day.
If recent trends were to continue, Cancer Research UK and the UK Health Forum calculate that this shocking total – equivalent to a city the size of Sheffield – would include 580,600 cases of cancer.
If recent trends were to continue, the number of smokers would be on track to fall to 10 per cent by 2035, but Cancer Research UK is urging the government to adopt a bold ambition for a tobacco free UK – meaning only around five per cent smoke in the next 20 years.
Achieving this ambition could mean 97,000 fewer new cases of smoking-related disease over the next 20 years, including around 36,000 cases of cancer.
Stop Smoking Services and mass media campaigns to help hard-to-reach groups quit smoking are two essential measures to help save lives from tobacco. Both these measures are being hit hard by government cuts.
Tobacco will continue to have a greater impact on the less well off than the wealthier in society. Around 15 per cent of men and women from the most deprived groups are predicted to smoke in 2035, compared to just 2.5 per cent from the more affluent.
If recent trends were to continue, in 2035 alone, tobacco-related diseases could cost an additional £3.6 billion a year – made up of £542m to the NHS and £3.03bn to wider society.
Achieving a tobacco-free ambition would then avoid around £67m in direct NHS costs, and £548 million in indirect societal costs in 2035.
Alison Cox, Cancer Research UK’s director of cancer prevention, said: “Decades of work have gone into reducing the number of people who will be affected by a tobacco related illness. There’s been great progress, but unless more is done, another generation of lives will be devastated by smoking.
“Recent figures have started to show that the decline in smoking rates is stalling so these estimates could be considered optimistic. If we lose focus then the burden of preventable disease could threaten the sustainability of the NHS and social care.”
Alongside publication of the report, Cancer Research UK is submitting more than 16,000 signatures of support for its “Cough Up Big Tobacco” campaign to Parliament. The overwhelming show of support aims to make the tobacco industry pay around one penny for every cigarette sold in the UK. This tobacco levy would be one way of funding the current shortfall in money available to fund local stop smoking services.
The money would be used to pay for Stop Smoking Services and advertising campaigns to support smokers to quit. It is a measure recommended in the Smoking Still Kills report and endorsed in the Cancer Strategy for England.
Jane Landon, deputy chief executive of the UK Health Forum said: “Our projections show smoking will still take a terrible toll on people’s health and the economy and increasingly this will be borne by the less well off in our society. All smokers should be offered the chance to quit and Stop Smoking Services, supported by high profile media campaigns are the best way to achieve this”
Sir Kevin Barron MP, vice chair of the All Party Parliamentary Group on Smoking and Health said: “Smoking still kills 100,000 people in the UK each year and increasingly the burden falls on the poorest communities. The Government can’t be complacent and must set bold ambitions to achieve a tobacco free future, matched with the necessary funding to make this happen. Making the Tobacco Industry pay for vital Stop Smoking Services and mass media campaigns through a levy will help reduce the number of people smoking and save lives.”
Dementia has become a political problem, with the Prime Minister intervening in the debates about how best to respond to the growing numbers of people with the condition. Special payments to GPs for spotting people with dementia have been quietly withdrawn, but there is no shortage of planning for new services for people with dementia, and of course for more investment in research.
The UK Government has published its plans for tackling dementia over the next Parliament, with a blueprint that will see it aim to boost dementia diagnosis rates, encourage research and make the UK the most dementia friendly society in the world by 2020.
The plan, published on Sunday 6th March, outlines a series of commitments including:
An aim for 10% of people with a dementia diagnosis to take part in research. Join Dementia Research – a scheme that matches people to suitable studies, run by the National Institute for Health Research in partnership with Alzheimer Scotland, Alzheimer’s Research UK and Alzheimer’s Society – will play a crucial role in helping to meet this target.
A pilot scheme to extend discussions of dementia risk reduction to the NHS Health Check for people over 40. Alzheimer’s Research UK, together with other organisations, will help to develop this pilot.
Moves to improve the quality of care for people with dementia.
Hilary Evans, Chief Executive of Alzheimer’s Research UK, said: “Since the first Prime Minister’s Dementia Challenge was launched we’ve seen real progress in the fight against this devastating condition, and the beginnings of a social movement to rally people behind that fight. There is still much work to do, and Alzheimer’s Research UK welcomes this plan which signals a strong commitment to build on the achievements of recent years. We look forward to working with the Government to deliver action on research and help accelerate the development of much-needed new treatments, preventions and improvements in diagnosis.”
David Mayhew, Chairman of Alzheimer’s Research UK and the Prime Minister’s Dementia Envoy, added: “The UK is leading the way in the fight against dementia, and this blueprint once again shows real leadership from the UK Government in its efforts to tackle the condition. This plan lays out a clear direction for driving forward improved care, new treatments and greater awareness, and it will be important to link this strategy to international efforts if we are to have the greatest impact. We must push ahead with renewed urgency – the 850,000 people with dementia in the UK are counting on us.”
By contrast, a new study indicates that people who perceive dementia symptoms as an illness feel more negative than those who see it as an inevitable part of getting older. Researchers from the University of Exeter interviewed people who had recently been diagnosed with dementia, and who had symptoms such as memory loss, difficulty concentrating or carrying out daily tasks. The study, supported by the Economic Social Research Council and the National Institute for Health Research, and by the European Regional Development Fund, found that people who saw these symptoms as an illness reported lower mood than those who saw it simply as part of the aging process.
Professor Linda Clare, of the University of Exeter, who led the study, said: “There’s a big emphasis on earlier diagnosis of dementia, but our evidence raises the crucial question of the extent to which giving a diagnostic label really benefits people. Some people do want their difficulties acknowledged with a diagnosis, but our research shows that many others understand what is happening to them as part of a normal process of ageing. For this group, we may be better targeting support and information based on their symptoms or the type of everyday difficulties they are having, rather than focusing on giving a diagnostic label. This is a relatively small study and we must now conduct further work to confirm this to ensure we are providing the best support in this crucial area of health diagnosis, which has enormous implications for how people adjust and cope with these changes in later life.”
The study, involving collaborators from Bangor and Cardiff universities and published in the Journal of Alzheimer’s Disease, interviewed 64 people who had been given a diagnosis of mild to moderate Alzheimer’s Disease or dementia. They completed interviews and questionnaires and in each case a family member or close friend was also interviewed. Despite the diagnosis, nearly two thirds of this group did not consider themselves to be “ill”, but saw the condition as a sign of ageing.
Those who considered themselves to have an illness had lower mood and described more emotional consequences including anger, sadness, embarrassment and a loss of confidence.
The paper, “I Don’t Think Of It As An Illness”: Illness Representations in Mild to Moderate Dementia, is published in the Journal of Alzheimer’s Disease, by Linda Clare, Catherine Quinn, Ian Rees Jones and Robert T Woods. Read the full article here.
The “Healthier in the EU” website (www.healthierin.eu) launched on March 4th, announces the campaign’s advisory board, team, mission, blog pieces and provides dozens of supporting statements and signatures from leading UK health professionals.
Healthier in the EU (“Healthier IN” for short) is a grassroots campaign set up to raise the voice of UK health professionals, carers, patients and researchers in the EU referendum debate.
The advisory board comprises some of the UK’s top names in healthcare – from nursing to health researchers and patients:
John Bowis, former Minister of Health (1992-1996)
Anne Marie Rafferty, the first Professor of Nursing Policy in the UK
Lord Nigel Crisp, former Chief Executive of the NHS in England (2000-2006)
Robert Johnstone, chair of Access Matters, a pan disability consultancy
Dr Clare Gerada, former Chair of the Council of the Royal College of General Practitioners
Richard Horton, Editor-in-Chief of The Lancet
Dame Glenis Willmott, MEP (Labour), led the European Parliament work on Clinical Trials legislation
Dr Charles Tannock, MEP (Conservative), member of the European Cancer Patient Coalition
Sir Simon Wessely, President of Royal College of Psychiatrists
Tamara Hervey, Professor of EU Law at the University of Sheffield
Kate Bushby, Clinical Academic Professor at Newcastle Upon Tyne Hospitals
Sir Harry Burns, Professor of Global Public Health at Strathclyde University.
Professor Sir Ian Gilmore, past-president of the Royal College of Physicians (RCP)
Sir Andy Haines, Professor of Public Health and Primary Care at the the London School of Hygiene & Tropical Medicine
The campaign’s message is that the EU allows the UK to pool resources with our closest neighbours to tackle important issues from public health (air pollution, tobacco, chemicals) to health innovation (medicines approvals, research networks) to large frameworks of healthcare (cross-border healthcare, international patients’ groups). These all have a direct effect on our wellbeing.
Health threats ignore borders, so we need to build international teams to match. Health innovation is best done at scale, so we need international teams to deliver. The EU is the right framework for meeting these challenges. Finally, our freedom of movement arrangement with the EU enables us to have the best mix of highly specialised skills, boosts our research capacity and helps to make our health service one of the most efficient in the world.
The EU is working. Staying in makes us stronger as a nation and healthier individually.
For further information contact: Dr Mike Galsworthy. email@example.com
Cash-strapped authorities across the UK have a new opportunity to take major health projects forward after the door was opened for a new form of private finance model to be widely adopted.
The Non-Profit Distributing (NPD) Model is an alternative to the much-maligned Private Finance Initiative (PFI) in which surplus profits are reinvested in the public sector rather than going to the private sector as unpopular “windfall” payments. The future of NPDs was in doubt because of a ruling by the Office for National Statistics (ONS) that one such project should be classified as being owned by the public sector. This decision meant that public sector authorities would be liable for capital charges – effectively making future NPD projects a non-starter.
But after a key agreement was reached over a major project in Scotland, it now appears that this hurdle has been overcome, making properly-structured NPD projects an attractive option for health projects such as the building of new hospitals. Crucially, surplus funds generated through NPD schemes can be reinvested in local communities, so that as well as delivering high value schemes, they can also contribute to local wellbeing and regeneration.
Simon McCann, a partner in the commercial team at law firm Blake Morgan and a specialist in NPD projects, said: “I’d expect that this development will now kick-start the adoption of NPD projects across the UK. “NPD projects can be adopted by any public authority in the UK, subject to the normal approvals processes, and do not require any new legislation. “As long as the projects are properly structured, there is no reason why they cannot become the “new PFI” without being associated with the perceived pitfalls of the old model.”
The Scottish government had been developing and using NPD as an alternative to PFI since 2008 and had successfully delivered around 15 major road, education and hospital projects with the model.
A key aspect of NPDs is that the projects are delivered through a Special Purpose Vehicle (SPV) in which both the public and the private sector have a shareholding.
It was this that led to problems when in July 2015, ONS ruled that one NPD project, the Aberdeen Western Peripheral Route, must be classified as being owned by the public sector because of the degree of public sector control. It now appears the Scottish Government has reached an agreement with ONS on a model that can be treated as “off balance sheet”. The key change is that the public sector has much less control of the SPV. The proposed structure is that the private sector would own 60%, 20% would be owned by a charity, 10% by Scottish Futures Trust, which is an arm of Scottish Government, and 10% by the procuring authority.
Simon McCann added: ”Particularly interesting is the involvement of a charity because this could greatly expand the opportunities for using major projects to deliver social and community benefits, such as targeted employment and training for the long term unemployed and other disadvantaged groups. “Therefore this recent development presents a real opportunity for cash-strapped authorities across the UK to take infrastructure projects forward and deliver major local growth and regeneration.”
Commissioning adult social care services through personal budgets and direct payments is an important way of giving care users more choice and control over their services. When implemented well they improve users’ quality of life. The Department of Health, however, requires a deeper understanding of the best ways to implement personalised commissioning, according to the National Audit Office.
Local authorities spent £6.3 billion on long-term community care in 2014-15. Around 500,000 adults in England received personal budgets in 2014-15, varying between 10% and 100% of users across authorities. The Care Act made personal budgets mandatory for all eligible users from April 2015. Much of the positive evidence for personalising commissioning, however, is old or relates to subgroups of users. The NAO believes there is a strong case for better use of existing surveys and evidence gathering, so the Department and its national partners understand the relationship between the different ways to commission personalised services for users, and improvements in user outcomes. The Department is extending personal budgets in healthcare and has an ambition that between 50,000 and 100,000 people will have a personal health budget by 2020.
The NAO found that some authorities have transformed their care and support processes to ration their resources fairly, share information about a broad range of local services, and monitor and manage spending on personal budgets efficiently, while others are finding personalising commissioning a challenge as they seek to save money, and are constrained in how they can personalise care by the need to reduce overall spending.
There are circumstances under which personalised commissioning can reduce the costs of care. For example, around 120,000 users with direct payments employ personal assistants to provide personal care, which is generally a cheaper option than homecare. The Care Act guidance, however, acknowledges that responding to users’ needs and their desired outcomes can increase the cost of care. The NAO also found that some authorities are struggling to manage and support their local care markets as well as we would expect of a well-functioning public service market.
The Department expects the value-for-money of personalised commissioning to come from improved outcomes for users, not necessarily from savings, which differs from local authorities’ expectations that savings can be made by personalising care. The Department’s monitoring regime does not enable it to fully understand how personal budgets and direct payments improve outcomes. In addition, the Department has not investigated how services can be personalised when money is tight. It is not clear whether local authorities will achieve the spending reductions they have forecast without putting user outcomes at risk.
Amyas Morse, head of the National Audit Office, said today:
“Giving users more choice and control over their care through personal budgets and direct payments can improve their quality of life, but much of the positive evidence for personalised commissioning of adult care services is old.
“The Department now needs to gain a better understanding of the different ways to commission personalised services for users, and how these lead to improvements in user outcomes.”
- 500,000 – approximate number of adults in England whose social care services were paid for through local authority personal budgets in 2014-15
- £6.3bn – spending by local authorities on long-term social care for adults in the community, 2014-15
- 7% – eal-terms reduction in spend on adult social care by local authorities between 2010-11 and 2014-15
|88%||median proportion of users with personal budgets per local authority in 2014-15|
|22%||median proportion of users with direct payments per local authority in 2014-15|
|84%||proportion of local authority directors of adult social services who report that increasing personalisation is a high (43%) or medium (41%) priority area for savings in 2016-17|
|£0||amount that the Department of Health expects to save from personalisation|
|26%||proportion of long-term social care users who said it was difficult to find information about support in 2014-15|