The healthmatters blog; commentary, observation and review
World Cancer Day (4 February) provides a good opportunity to highlight the little-known fact that men are much more likely than women to develop and die from cancer – and by a considerable margin. The global male age-standardised cancer incidence rate is 205 per 100,000 and the male mortality rate is 126. The comparable respective figures for females are 165 and 83.
The global data reveals very clearly just how badly men’s health is faring in many areas in addition to cancer:
- Male life expectancy, at 68 years, lags five years behind female life expectancy. There is not a single country in which male life expectancy exceeds female. Overall, the gap between the sexes has actually widened since 1970 and will widen further by 2030 – by then, male life expectancy is expected to be seven years shorter than female life expectancy.
- Men have a >40% probability of dying between the ages of 50 and 74 while women have probability of <30%.
- The global suicide rate in men is almost twice that in women; the European region has the biggest male:female ratio (4.0).
Despite these and other worrying indicators, including those relating to male risk-taking (tobacco, alcohol, diet, etc.), occupational health and use of healthcare services, men’s health is seldom discussed at the national or international levels. It is a classic case of a problem hiding in plain sight.
Just three national governments – Australia, Brazil and Ireland – have developed national strategies to tackle men’s health. Virtually all other governments, and global agencies like WHO, the World Bank and the Gates Foundation, are focused primarily on the health of women. Women’s health is hugely important, of course, especially given the multiple disadvantages they face, but this need not necessitate a lack of attention to men’s health. The health of men and women need not be seen as a zero sum game.
In fact, improving men’s health would be good for women too. Healthier men would be productive for longer, contributing more to family incomes, and would have less need of caring support, most often provided by their female partners or daughters. Men with better mental health and with lower levels of alcohol misuse are also less likely to perpetrate gender-based violence.
Better men’s health would also save a considerable amount of money. Men’s premature mortality and morbidity costs the United States economy some £335 billion annually while the economic burden associated with smoking, excess weight, alcohol and physical inactivity in Canadian men has been estimated at about £18 billion a year. The evidence-base for tackling men’s health is now increasingly robust and widely available. Gender-sensitive interventions have been shown to reduce men’s risk-taking, improve their use of health services, increase their participation in screening programmes, enhance their mental health and wellbeing, and encourage them to be more actively involved in the health of their partners and children. There is certainly no longer any need for fatalism when contemplating taking action with men.
Professor Sir Michael Marmot, one of the world’s leading authorities on the social determinants of health, looked at gender in a report for the WHO on health inequalities in Europe. He argued that national governments should now develop strategies that ‘respond to the different ways health and prevention and treatment services are experienced by men [and] women … and [ensure] that policies and interventions are responsive to gender.’
In a more recent report on health inequalities specifically in the UK, Marmot highlighted the fact that deprivation has a bigger negative impact on men’s health outcomes than women’s and called for a greater policy focus on men’s health to help tackle this.
The WHO Constitution says that ‘the highest attainable standard of health [is] a fundamental right of every human being.’ It is time for health organisations at all levels to acknowledge the problems facing men as well as women and to develop coherent and sustained strategies for tackling them. Continued inaction is no longer an ethical option.
Peter Baker is Director of Global Action on Men’s Health (www.gamh.org), a NGO launched in 2014 with the aim of encouraging national governments and international health organisations to take action to improve male health. Peter was previously Chief Executive of the Men’s Health Forum charity in the UK and has written extensively on men’s health issues.
International medical charity Doctors of the World is today launching a website to help refugees find free healthcare.
The ClinicFinder website is the first of its kind: a mobile-web application to provide simple and clear information about free primary healthcare and medical services for refugees and migrants across Europe.
The website, designed by Daniel Yu, CEO of Reliefwatch, uses GPS location to show on a map the nearest free health clinics and what services can be accessed. It allows refugees to search by location (e.g. Berlin, Athens) and by specific service required (e.g. Children, Survivor of Violence), and it can also be used as a clinic directory for health professionals. Language options currently include English, Arabic, Farsi and French.
There are already over 70 health clinics in 16 countries mapped on ClinicFinder, and the site encourages people to add the locations of other eligible clinics (free to access, non-government provided) so the number is expected to grow substantially.
Doctors of the World is reaching out to organisations and health professionals helping refugees across Europe and encouraging them to show their patients the website and explain how it can help them as they continue their journey.
ClinicFinder was developed after Doctors of the World UK approached TechFugees, a tech community initiative focussing on solutions to help refugees, and were introduced to Daniel Yu who has donated his time and expertise to support the project.
Gareth Walker, International programme manager, Doctors of the World UK:
“A difficult journey is made dangerous when people have no idea where they can get help when they need it. ClinicFinder is designed with vulnerable refugees in mind, providing a resource for them to find the free medical help that the European public has made available. It is a map of humanitarian effort, and deserves to be shared as widely as possible”
Daniel Yu, CEO Reliefwatch:
“Like many people, I watched in horror as the refugee crisis in Europe deepened in 2015 and knew that I needed to do something. With my background in programming and as CEO of ReliefWatch, which helps organisations track medical supplies in developing parts of the world, I completely understand Doctors of the World’s aim to provide essential, potentially life-saving information to the most disadvantaged. My hope is that ClinicFinder becomes a vital extra tool for the refugees to access healthcare wherever they are or are heading to.”
Doctors of the World UK
Doctors of the World is a humanitarian medical charity whose volunteer doctors and nurses care for refugees and migrants at clinics across Europe including Greece and the Balkans, as well as the UK. It has been helping people in Calais since 2003.
Doctors of the World volunteer medics from the UK are currently working in Slovenia, in Idomeni on the Greece-Macedonia border as well as living on ferries crossing from Lesvos to Athens.
The charity is part of the Médecins du Monde network, which delivers over 350 projects in more than 80 countries through 3,000 volunteers.
In the UK, the charity runs clinics in east London and Brighton that provide medical care, information and practical support to excluded migrants and refugees.
Daniel Yu is the founder and CEO of Reliefwatch, a platform for organizations in the developing world to track supplies through basic mobile phones. Daniel developed the idea behind Reliefwatch while living in Sinai, Egypt and northern Jordan where he witnessed availability issues for basic products. Prior to founding Reliefwatch, Daniel worked as a programmer and attended the University of Chicago where he focused on International Studies and Arabic.
Negotiations between the government and general practitioners are underway, but if the mood amongst British Medical Association members is anything to go by, the negotiations will be tough. The leader of the BMA’s GPs, Dr Chaand Nagpau, speaking on Saturday 30th January at the Special Conference of Local Medical Committees warned that patient safety is being compromised as general practice faces an “emergency” situation caused by GP services being starved of resources and staff.
“Patients are being short-changed on a daily basis, with nine in ten GPs stating that workload pressures are damaging the quality of care to patients. This is a disgrace in a system in which the government promotes quality and safety as central to the NHS.
“It’s not safe nor sustainable for GPs to see patients with complex multiple morbidity in ten minutes, many of whom will be on over ten different medications, and with heightened risk of medical error. It’s not safe for GPs to have up to seventy patient contacts daily in the style of a conveyor belt, and on top of that plough through hundreds of clinic letters, pathology results and reams of repeat prescriptions.
“It’s not safe for GPs to be examining patients while simultaneously having to take urgent calls from hospitals, district nurses and social workers, and also be called for an emergency home visit at the same time. It is not safe for practices struggling with unfilled vacancies to be forced to carry on registering patients when they haven’t the doctors or nurses. And it’s not safe to fuel the political hyperbole of routine seven days services, taking GPs away from ill elderly housebound patients in greater need. To put it simply, it is not safe to carry on the way we are, and which is why this conference is highlighting that general practice is quite literally in a state of emergency.”
Dr Nagpaul also criticised the Care Quality Commission (CQC), which the BMA believes is adding further stress to general practice, saying:
“It’s tragic that GPs and practices live in a climate of fear, in which the CQC takes no account of your circumstances, and blames, names and shames you even if you’re running on empty with skeleton staff, or locked into inadequate premises not of your own choosing. Eight out of ten practices said preparing for CQC inspections was “very stressful” at a time of already rock bottom morale, and eighty percent of GPs stated they’re more likely to want to leave the profession as a result.
A BMA survey also showed CQC refusing to reschedule inspections even in extenuating circumstances when the lead partner or practice manager was off sick, adding further stress and tarring practices with a public label based on visiting them on the wrong day. Yet CQC has the double standard of unilaterally cancelling inspections at a moment’s notice.
Calling on the government to act to stop the crisis overwhelming general practice, Dr Nagapaul added:
“We are sick of hearing just words. We don’t want to hear about last year’s money rebadged as a new resource. We don’t want to be to be told about what may or not happen in 2020. What we need to know is what the government is going to now do to enable one million patients daily to receive a safe and sustainable GP service today.
I’m constantly told by ministers that the greatest battle is getting money out of the Treasury. My message to the Chancellor is to use his financial nouse- stop penny-pinching and be pound wise, grab yourself a bargain while there are GPs out there because once they’re gone they’re gone. General practice costs £136 for all-in unlimited care and home visits per patient per year, which is less than the price of walking through a single outpatient clinic door once.
I urge government to do the right thing for patients and equally the right thing for a GP workforce whose goodwill continues to be shamefully exploited. And to protect and nurture a discipline that’s not just the jewel in the NHS’s crown but a beacon of personalised continuity of care internationally. And to make 2016 the year in which we begin the revival of UK general practice so that we have a future generation of GPs to look after a future generation of patients.”
Read the full speech here: Chaand Nagpaul Speech
Care must be driven by the needs of individuals rather than rigid institutions and structures. That is the main message from an independent report published today.
The Commission on Improving Urgent Care for Older people is calling for a fundamental change to the way care for older people is designed and delivered. Experts, drawn from across the health and care sector, have called for a radical new approach to urgent care for older people.
People aged over 85 are the fastest growing age group in England, while the population of those aged over 65 is expected to increase by 50 per cent by 2030. It is critical that the health and care system adapts to meet the needs of today’s population. Growing Old Together, published today, sets out key principles for revolutionising the way that urgent care for older people is delivered, focusing on how people receive the right care based on their needs and wishes. By changing the way services to older people are organised, we can improve their care and relieve the growing pressure on acute hospitals, so that they can focus on providing timely, high quality care for those who really need it. This means addressing issues across the system.
Eight key principles for improving urgent care for older people are identified in the report. These principles have been influenced by innovative care models across the country, and conversations with senior leaders across the care system, clinical experts and carers.
Together the principles set out a vision for joined up, personalised and proactive care. This includes:
- Always starting with care driven by the person’s needs and personal goals.
- Care co-ordination that offers older people a single point of contact to guide them through an often complex system.
- Prioritising proactive and preventive care so that the health and care system is not structured around “short-term” reactive fixes but instead long-term solutions for helping people to maintain their independence where possible. This includes encouraging social interaction to help people to stay well, and out of hospital.
Dr Mark Newbold, Chair, Commission on Improving Urgent Care for Older People said:
“We have talked too much in the past about integrating the providers of services and not enough about integrating care around people. It is the coordination of personal care for individuals that really matters. It is unacceptable to expect older people and carers to navigate a very complex system.
“Older people do need to access A&E at times, and the best hospitals tailor their service to meet their needs. But all too often, older people are forced to go to A&E because the alternative services that would help them be cared for at home are not available at the time they need them.
“We want to help people to stay well both mentally and physically and receive care that responds to care needs and personal wishes. Achieving this is better for both the individual and the wider care system.”
The report includes compelling evidence of the success of initiatives across the country that have improved care and reduced pressure on the health service but says this needs to happen nationally. Changing the health service from delivering short-term fixes for older people to helping them to keep well demands strong local leadership. We should back dynamic leaders to join up care while ensuring that outcome and performance measures allow local leaders to focus on individual needs, delivered by the whole health and care system.
The following innovative examples of integrated care were examined as part of the report:
- By using a geriatric assessment team, Sheffield Teaching Hospital has cut down hospital stay days from 5.5 days to 1.1 days.
- Introducing a care co-ordinator function commissioned by Age UK in Cornwall has resulted in a 31 per cent reduction in all hospital admissions and a 26 per cent reduction in non-elective admissions.
- By providing a home based emergency assessment and treatment service, North East London Foundation Trust and London ambulance service have saved around £108,000 by avoiding ambulance trips and reducing the need for A&E admission and assessment.
Read the full report here: http://www.nhsconfed.org/
Cancer Research UK is today (Tuesday) calling on the Government to make the tobacco industry pay* for the damage it causes and help reduce the number of people killed by its deadly product.
Earlier this month a report published by Cancer Research UK** revealed that cuts to public health funding mean local Stop Smoking Services are being closed down.
In response, the charity is launching a new “Cough Up” campaign, and wants the public to support a simple solution to the problem – making the tobacco industry pay for public health services and mass media quit campaigns to help save thousands of lives.
By charging the industry around 1p per cigarette sold in the UK, an extra £500m could be raised and spent directly on tobacco control.
Smoking continues to kill more than 100,000 people in the UK every year and the tobacco industry makes a profit of more than £4,000 for every UK death caused by tobacco.
Internationally, the tobacco industry makes around £30 billion in profit.
Tobacco use costs England alone approximately £13.8 billion each year; this includes the direct costs to the NHS as well as lost work days and productivity due to smoking-related illness.
Andrew Riley, a retired musician aged 62 from Preston, was diagnosed with a rare type of blood cancer two years ago. He started smoking in his early 20s and by the time he was diagnosed he was smoking around 40 cigarettes a day.
Andrew said: “The moment I received my cancer diagnosis I knew I had to stop smoking. My GP put me in touch with my local Stop Smoking Services and they were absolutely brilliant.
“I had smoked for most of my adult life and didn’t think I’d ever give up, but thanks to Stop Smoking service I did. I’m pretty sure I wouldn’t have been able to do it on my own.
“I signed up for 12 weeks and saw a really helpful lady face to face every week. I stopped smoking two weeks into the sessions and have never looked back. I can really notice the difference since quitting and that was two years ago. These services are vital and I’m fully behind Cancer Research UK’s campaign to get the tobacco industry to cough up.”
Alison Cox, Cancer Research UK’s director of cancer prevention, said: “For too long the tobacco industry has had an easy ride, making money without having to spend a single pound on the damage its products cause. It continues to profit from selling a highly addictive and lethal product that causes illness and death. Tobacco companies make billions of pounds every year, so we’d like to see them using their profits to keep Stop Smoking Services open and fund advertising campaigns to help people quit. At a time when health budgets are stretched, this is a simple solution to a lethal problem. We urge the Government to make the industry cough up.”
Support the campaign and add your name to the petition to make the industry cough up by going to: http://www.cruk.org/big-
Older patients and people with long term conditions and mental health problems will be among the first to benefit from a major new drive to modernise how the NHS delivers care, according to NHS England Chief Executive Simon Stevens speaking at the World Economic Forum in Davos on Friday 22nd January
Simon Stevens launched the first wave of NHS Innovation ‘Test Beds’. These collaborations between the NHS and innovators – including Verily (formerly Google Life Sciences), IBM and Philips – aim to harness technology to address some of the most complex issues facing patients and the health service.
Frontline health and care workers in seven areas will pioneer and evaluate the use of novel combinations of interconnected devices such as wearable monitors, data analysis and ways of working which will help patients stay well and monitor their conditions themselves at home.
Successful innovations will then be available for other parts of the country to adopt and adapt to the particular needs of their local populations.
For example, the plans announced in Davos include:
Patients with diabetes in the West of England being equipped with remote monitoring and coaching technology to allow them to better self-manage their condition;
Older patients in Rochdale who are most at risk of critical health events being identified using data analysis, and supported to use telecare and remote devices in their homes so that their doctors can provide timely and tailored help as soon as they need it, and;
People in Birmingham at risk of serious mental illness will be able to make use of technology and apps to manage their condition, linked to a hub which can despatch the right specialist staff at the right time to help if a crisis looks likely.
Addressing the 46th Annual Meeting of the World Economic Forum, which was themed ‘Mastering the Fourth Industrial Revolution’, Simon Stevens said: “Over the next decade major health gains won’t just come from a few ‘miracle cures’, but also from combining diverse breakthroughs in fields such as biosensors, medtech and drug discovery, mobile communications, and AI computing. Our new NHS Test Beds programme aims to cut through the hype and test the practical benefits for patients when we bring together some of these most promising technologies in receptive environments inside the world’s largest public, integrated health service.”
Public & Private Initiatives
A joint programme between NHS England, the Office for Life Science, the Department of Health and the Department for Culture, Media and Sport, NHS Test Beds will bring together local health bodies including Clinical Commissioning Groups, hospital trusts, primary and community care providers with a wide range of innovators from home and abroad.
The Government’s Life Sciences Minister George Freeman MP said: ” We are determined to ensure the NHS can remain a pioneer of new treatments and models of care so that UK patients will be amongst the first in the world to benefit from these hugely exciting medical advances, made possible by the life sciences industry in partnership with the NHS. “Not only does it demonstrate the NHS’s attractiveness as a place to test and develop revolutionary new products, it is also another important step towards creating a truly twenty-first century NHS”.
Each Test Bed will use a different combination of innovations, from both large and small organisations, to address a locally-identified clinical challenge. These include supporting people with diabetes and other long term conditions to manage their care better; supporting older people to stay independent at home; better support for people at risk of mental health crisis, and; improving how we predict care needs for both individuals and local populations.
The changes made will be rigorously evaluated, with the aim to provide evidence which will give more areas the confidence to adopt the innovations over the coming years.
The shape of things to come?
The first wave of Test Beds includes five health and care Test Beds and two ‘Internet of Things’ Test Beds. The sites will be spread across different areas of England, including the West of England, Surrey, Sheffield and Birmingham.
The five NHS Test Beds chosen are:
Care City Health and Care Test Bed – which will promote healthy ageing across a million-strong population in North East London. Bringing together UCLPartners, Health Analytics, Orion Health and 9 other innovators, the partnership will test and evaluate combinations of innovative technologies that can help patients to manage their own health conditions and to remain as independent as possible, supported by carers who will receive the information and connections they need coordinate care. For example, this will include an online tool for those with dementia, a social network app which offers peer-to-peer support safely online with guidance from credible organisations and institutions, and a device which assesses falls risk and mobility.
Long Term Conditions Early Intervention Programme – which will see the NHS in Heywood, Middleton and Rochdale working with Verily (formerly Google Life Sciences), MSD (a trade name of Merck & Co., Inc., with headquarters in Kenilworth, NJ, USA), Health E Research and the Greater Manchester Academic Health Science Network to help healthcare professionals better identify and support patients at risk of long term conditions using the most advanced new predictive techniques. This will involve analysing trends and patterns related to conditions like heart failure and some lung diseases such as Chronic Obstructive Pulmonary Disease to identify patients who would most benefit from tele-health, tele-care and tele-medicine technology. These patients will benefit from a more personalised service, in particular being proactively offered additional physician support and access to technology.
Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed – which will see the NHS, including two New Care Model Vanguard sites, partner with Philips and a number of SMEs and social enterprises to support the frail elderly and people with long term conditions to remain well outside of hospital and avoid unnecessary admissions. They will test new approaches to identifying patients that can benefit from additional support and help them to self-care at home through improved education and telehealth technologies.
Perfect Patient Pathway Test Bed – aims to create the ‘perfect patient pathway’ to bring substantial benefits for patients in the Sheffield City Region suffering from long term conditions, such as diabetes, mental health problems, respiratory disease, hypertension and other chronic conditions. The Test Bed will keep patients with long term conditions well, independent and avoiding crisis points which often result in hospital admission, intensive rehabilitation and a high level of social care support. Working in partnership with GE Finnamore, IBM and 13 smaller innovators, the local health and care system will set up an integrated intelligence centre to help get people the help they need, when they need it most.
RAIDPlus Integrated Mental Health Urgent Care Test Bed – which will see Birmingham and Solihull Mental Health NHS Foundation Trust partner with Accenture to offer more proactive support for people at risk of mental health crisis. Patients across Birmingham and Solihull will have access to digital tools such as online support, risk assessments and crisis intervention plans that will enable care professionals to better support patients to manage their conditions in the community. In addition the Test Bed will use predictive analytics technology to better identify those at risk of crisis, enabling mobile crisis workers and tele-triage workers to provide prevention support before a crisis arises.
The Internet of Things
The two Internet of Things (IoT) Test Beds are:
Diabetes Digital Coach – a project led by the West of England AHSN in partnership with Diabetes UK and technology companies including Hewlett Packard Enterprise. Bringing together mobile health self-management tools (wearable sensors and supporting software) with the latest developments in connecting monitoring devices (Internet of Things), the Test Bed will enable people with Type 1 or Type 2 diabetes to ‘do the right thing at the right time’ to self-manage their condition. It will also encourage more timely and appropriate interventions from peers, healthcare professionals, carers and social networks.
Technology Integrated Health Management (TIHM) – a collaboration between Surrey and Borders Partnership NHS Foundation Trust and an array of health technology providers which will help people with dementia to live in their own homes for longer. Individuals and their carers will be provided with sensors, wearables, monitors and other devices, which will combine into an ‘Internet of Things’ to monitor their health at home. This will empower people to take more control over their own health and wellbeing, as well as enabling health and social care staff to deliver more responsive and effective services.
The IoT Test Beds are part of IoTUK, an integrated £40 million, three-year Government programme that seeks to advance the UK’s global leadership in IoT and increase the adoption of high quality IoT technologies and services throughout businesses and the public sector.
Test Beds have been developing their proposals over the last nine months with support from the 15 Academic Health Science Networks (AHSNs). The successful projects were chosen on their ability to address local clinical challenges through innovation, at a large scale, and on the strength and commitment of their local leadership to be able to change established ways of working. They were also required to demonstrate their ability to evaluate and collect evidence of the improvements made for patients, which can then be used to support the spread of successful innovations to other areas.
Global Leadership in health technology
Given an unprecedented opportunity to demonstrate their solutions at large scale on a global stage, it is envisaged that successful Test Bed partners will deliver wider financial benefits to the NHS and the UK economy as they are rolled out in other areas at home and abroad.
Commercial technology companies are understandably enthusiastic about this Government initiative. Neil Mesher, Managing Director of Philips UK and Ireland, said: “Philips is proud to be involved in this pioneering new project. We believe this type of collaborative approach between industry and health & care providers is an excellent opportunity to improve patient outcomes whilst at the same time reducing the total cost of care. Supporting patients to meet their own individual goals is an objective Philips are delighted to be involved with.”
Andy Conrad, Chief Executive Officer of Verily, said: “This partnership between the NHS, MSD and Verily will determine if data analysis technology can help the NHS better prevent, detect and manage disease. Our hope is to help create a more preventative model for managing long term conditions like heart failure and lung disease.”
The ‘connected healthcare’ market – new technology that’s changing how people look after their health and access health services – is projected to be worth £37bn ($61bn) globally and £1.9bn in the UK by 2020, according to a recent PricewaterhouseCooper analysis. The analysis explores the megatrends collision between changing demographic and social patterns and today’s vast technological breakthroughs which are shaping how people live more connected lives.
According to Quentin Cole of PricewaterhouseCooper: “Significant growth in the ‘connected’ healthcare market is going to create huge opportunities. In the UK that could be worth almost £2bn. By 2020 we expect it will be worth £37bn globally, an average increase of 33% each year. Much of that growth will come from online prescriptions and an expansion in mHealth with both the public and private sectors making investments in this area.
“Technological advances open up enormous possibilities that will transform how we receive our healthcare as well as impacting life expectancy itself. But with technology comes issues around security of data, personal responsibility and even what constitutes a ‘healthy life’ that will challenge us as individuals and as providers.”
Making up this global market, the mobile health (mHealth) services market is expected to be worth £27bn ($45bn) globally by 2020, the mHealth devices market will grow to £8.5bn ($14bn) and the online prescriptions market will be worth £1.2bn ($2bn).
PwC forecasts that the global mHealth services market will grow at an average annual rate of 31% from 2014 to 2020 to £27bn ($45bn). The mHealth services market includes wellness, prevention, diagnostic and monitoring services.
PwC forecasts that the global mHealth devices market will grow at an average annual rate of 37% from 2014 to become a £8.5bn ($14bn) global market in 2020. mHealth devices include blood glucose meters, cardiac monitors and blood pressure monitors, Pulse oximetry, neurological monoitoring, sleep monitors and wearable fitness and heart rate meters make up this segment. Blood glucose meters, and cardiac and blood pressure monitors will be the main drivers of growth.
PwC forecasts that the global E-prescriptions network will grow at an average annual rate of 40% from 2014 to 2020 to £1.2bn ($2bn). This growth is mainly driven by government-sponsored programmes enabled by better healthcare infrastructure and data storage facilities.
Quentin Cole concludes: “Change is coming to the healthcare industry. The connected healthcare market’s growth will come from increasing use of smartphones, easy and cheap internet access, and an increasing worldwide focus on preventative medicine. The sector needs to prepare for the new, more direct relationships with consumers – and develop capabilities and skills that look very different from those they operate with today. “We’re already seeing many tech-enabled new entrants disrupting the healthcare industry, so there is huge potential for growth in the sector. It raises questions as to who will be best placed to take advantage of the opportunities connected healthcare brings.”
Steve Iliffe, January 2016
VitalityHealth today announced it has teamed with the Financial Times to launch Britain’s Healthiest Workplace. The survey will measure employer and employee responses to questions about health and lifestyle, providing an overview of Britain’s workplace culture and an understanding of how health can be improved.
The survey, originally launched as Britain’s Healthiest Company in 2013, has become the UK’s largest annual workplace wellness survey. The 2015 survey received over 32,500 employee responses from 112 companies. With its rebrand, Britain’s Healthiest Workplace is set to become more inclusive and will incorporate a wider range of workplaces ranging from private sector to third sector and public sector, giving a holistic overview of the nation’s health. And for the first time companies with a workforce of just 20 employees or more will also become eligible to take part in the survey.
Britain’s Healthiest Workplace will culminate with an awards ceremony in London in September 2016. Previous winners of Britain’s Healthiest Company include Johnson & Johnson, Microsoft, Adidas UK, Nomura and Sweaty Betty.
The Financial Times will publish a report incorporating the findings of the Britain’s Healthiest Workplace survey. Titled ‘Health at Work’, the report will be published in September 2016.
Neville Koopowitz, CEO at VitalityHealth, said: “We are delighted to be partnering with the Financial Times for the launch of Britain’s Healthiest Workplace. As workplace wellness becomes an increasingly pertinent issue around the UK’s boardrooms, we are proud to celebrate those organisations that are championing healthy employee behaviour and investing in the mental and physical wellbeing of their staff.”
“The Financial Times is keen to increase debate and action on workplace health,” said Andrew Jack, the FT’s head of curated content. “It is an issue of growing importance for employers and employees of all sorts around the world, and good practices to improve prevention and wellbeing make good personal and business sense.”
Britain’s Healthiest Workplace was developed by VitalityHealth and is delivered in partnership with the University of Cambridge, RAND Europe, the Financial Times and Mercer.
Registration for Britain’s Healthiest Workplace is now open and all companies with 20 employees or more are encouraged to register. Registration will close on 18 March 2016. To register go to healthiestworkplace.co.uk
BOWEL cancer is more likely to be diagnosed at the earliest stage if it is picked up by screening, according to new figures* released by Cancer Research UK and Public Health England’s National Cancer Intelligence Network today (Friday).
For the first time, data shows the stage (one to four) at which cancer is detected by the different routes to diagnosis – through screening, by a GP referral**, or as an emergency.
Of the cases picked up by bowel screening (where the stage at diagnosis was known), more than one third (37 per cent) were caught at the earliest stage (stage one) while fewer than one in ten (8 per cent) were advanced (stage four).
This compares to four in ten (40 per cent) of bowel cancers diagnosed as an emergency being stage four for those cases with known stage. The figures also show that more than a fifth (22 per cent) of bowel cancers were advanced (stage four) by the time people go to the doctor and are then diagnosed.
Patients whose cancers are picked up at an earlier stage almost always have better chances of survival because treatment is more likely to be effective than it is for those diagnosed at a later stage.
Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “For the first time we’re able to see specifically how advanced or how early cancers are when they are diagnosed via different routes within the health system.
“Early diagnosis means better survival and late diagnosis is bad news for patients, so we need to learn how to avoid it. This new information really helps us understand the best ways to diagnose cancer and where the health service should target resources.
“Bowel cancer in particular has a lot of room for improvement, so it’s great news that there’s a recommendation to use a new updated bowel cancer screening test called FIT. We know this is an easier test for people to use at home and that both men and women are more likely to use it, so it’s vital this is rolled out as quickly as possible across England. It’s also important that people go to their doctor if they notice symptoms such as blood in their poo or a change in their normal bowel habit such as looser poo, pooing more often or constipation, even if they’ve recently had a bowel screening test.”
The full publication also contains data about people in England diagnosed in 2012 and 2013 by stage for bladder, breast, bowel (colorectal), kidney, lung, melanoma, non-Hodgkin lymphoma, ovarian, prostate and uterine cancers.
Of the total 574,500 cases diagnosed in 2012 and 2013, screening picked up the highest proportion of early stage cancers – 63 per cent stage one (19, 486) vs three per cent stage four (823).
Of the cancer types included in analysis, screening is available for breast cancer for women and bowel cancer for men and women.
Dr Anne Mackie, director of screening at Public Health England, said: “This new research on the stage at which people are diagnosed suggests that screening has an important part to play in achieving earlier diagnosis of bowel cancer. Everyone aged 60 to 74 in England receives an invitation to be screened along with some information to help them decide.”
Of those patients diagnosed following a GP referral, just over a third (34 per cent) were stage one compared to just over a fifth (22 per cent) at stage four.
More than half (58 per cent) of all cancers diagnosed as an emergency were diagnosed at stage four compared to around a tenth (11 per cent) at stage one.
* Full publication available on request
** GPs can either send patients through a routine referral or an urgent referral for tests depending on the symptoms.
Britain’s spending on its health service is falling by international standards and, by 2020, will be £43bn less a year than the average spent by its European neighbours, according to research by the King’s Fund.
The UK is devoting a diminishing proportion of GDP in health and is now a lowly 13th out of the original 15 EU members in terms of investment, an analysis for the Guardian by the thinktank’s chief economist shows.
Prof John Appleby also found that the government’s decision to increase the NHS’s budget by far less than the anticipated growth in GDP meant the service would miss out on what would have been an extra £16bn by 2020.
Ministers highlight that they are giving the NHS in England an increasing share of overall government spending, ringfencing its budget and handing it annual increases totalling £8.4bn in real terms by 2020-21, despite very tight public finances.
But the King’s Fund figures have cast doubt on ministers’ repeated claims that they are giving the NHS generous cash settlements. Critics argue that Britain is becoming “the sick person of Europe” in terms of health spending because the sector receives one of the lowest levels of investment compared with many European countries, such as France and Germany.
Appleby warns that Britain’s status as an increasingly “low spender” might mean the NHS cannot deliver improvements in the quality of care and outcomes from treatment that patients want.
“No amount of spin from ministers can disguise the fact that this decade is set to be marked by the longest and deepest squeeze on NHS finances in a generation. Our country is increasingly looking like the sick person of Europe, with spending on health falling far behind other neighbouring countries,” said Heidi Alexander, the shadow health secretary.
“This squeeze on health spending is bad for the NHS and it is bad for patients. It is clear that our health service is going to need much more money than this government is prepared to spend.”
That health spending as a proportion of GDP has been “slipping backwards” means Britain is now behind Finland and Slovenia on that measure, according to a league table of the Organisation for Economic Cooperation and Development’s 34 member countries, Appleby added.
In an article for the King’s Fund detailing his findings, Appleby writes: “UK GDP is forecast to grow in real terms by around 15.2% between 2014-15 and 2020-21. But on current plans, UK NHS spending will grow by much less – 5.2%.
“This is equivalent to around £7bn in real terms, increasing from £135bn in 2014-15 to £142bn in 2020-21. But if spending kept pace with growth in the economy, by 2020-21 the UK NHS would be spending around £158bn at today’s prices – £16bn more than planned.”
The latest OECD data shows that the UK spent 8.5% of its total GDP on healthcare in 2013, though that includes a small amount of private spending, such as private medical insurance. “This placed the UK 13th out of the original 15 countries of the EU and 1.7 percentage points lower than the EU-14’s level,” Appleby said, referring to the EU 15 without the UK.
“If we were to close this gap solely by increasing NHS spending, and assuming that health spending in other UK countries was in line with the 2015 spending review plans for England, by 2020-21 it would take an increase of 30% – £43bn – in real terms to match the EU-14’s level of spend in 2013, taking total NHS spending to £185bn.”
The result of failing to keep pace with international health spending is that the gap has started to widen between Britain and many of its neighbours.
“Whatever the flaws of international comparisons, it’s clear that the UK is currently a relatively low spender on healthcare, with a prospect of sinking further down the international league tables,” Appleby said.
When he was prime minister in 2000, Tony Blair promised to increase health spending to the then EU average of 8.5% of GDP, a pledge Labour fulfilled under Gordon Brown in 2009.
However, given the huge sums thrown up by both Appleby’s calculations, Alexander refused to say whether Labour would commit to increasing health spending to either the EU average, which is now 10.1%, or as a proportionate share of rising GDP.
Norman Lamb, a Liberal Democrat health minister in the coalition until last May, said the Office for Budget Responsibility had recently acknowledged that the NHS in England would receive a falling percentage of national income until 2020.
Lamb said: “These new figure show why we can’t just keep sleepwalking into a disaster. The NHS and care systems will crash if we carry on as we are because the current amount [going into the NHS] is not enough and everyone in the NHS knows it.”
He called for political parties and others to join in a “national conversation” on how much money the health and social care systems would need in coming years, given the ageing population, and how it should be paid for.
Stephen Dorrell, the ex-Conservative health secretary who is now the chair of the NHS Confederation, said he suspected ministers would give the NHS in England more than the promised £10bn before 2020 and that funding would grow again, by somewhere between £16bn and £43bn, soon after 2020.
Ministers declined to comment on Appleby’s figures. The Department of Health said it was giving the NHS the extra money that its chief executive, Simon Stevens, had said it needed by 2020 in order to keep providing good care while also changing how services operate.
“Rather than there being a political decision about levels of spending on healthcare, for the first time ever, the NHS said collectively in the Five Year Forward View what it needed for the future to transform services for patients,” a spokesman said.
“We’re meeting our side of the bargain, with £10bn more from a strong economy, raising the NHS budget to the highest level in its history and increasing spending every year. We will also ensure the NHS gives good value for taxpayers.”
CANCER MOST FEARED DISEASE IN BRITAIN – BUT MORE THAN 8 MILLION BRITISH ADULTS TAKE NO ACTION TO REDUCE THEIR RISK
- British adults more worried about being diagnosed with cancer than other serious illnesses
- Yet more than 8 million say they take no action at all to reduce their risk
- Only a third do regular exercise (37%) or maintain a healthy weight (37%) to reduce their risk of developing the disease
- Half (54%) are confused by conflicting reports on the causes of cancer
- High proportions of the population did not identify weight (62%), diet (61%) or smoking (29%) as influencing a person’s risk of developing cancer
More than eight million British adults (17%) admit they take no preventive action to reduce their risk of developing cancer, despite it being the most feared serious illness in Britain, new research from Aviva shows.
More people are worried about being diagnosed with cancer (58%) than dementia/Alzheimer’s (45%), heart disease (34%) or a stroke (32%). Women are particularly worried about being diagnosed with cancer (62% vs. 54% of men), perhaps because breast cancer – which predominantly affects women – is the most common cancer.2
Despite this, millions are failing to take simple lifestyle precautions to reduce their risk of developing the disease. Only a third say they maintain a healthy weight (37%) or do regular exercise (37%) to help prevent the disease developing. And despite overexposure to UV radiation being the main cause of skin cancer3, less than half (46%) minimise their exposure to the sun or use a high factor sun cream.
Advice from the World Health Organization (WHO) states that processed meats such as bacon and sausages can increase the risk of colorectal cancer, while red meats are considered likely to be carcinogenic4. However, only 29% of British adults have cut down on this food group to reduce their risk.
Table 1: Many fail to take active steps to reduce their risk of developing cancer
|Which, if any of the following do you do to reduce your risk of developing cancer?||% who do this|
|Minimise exposure to sun or use sun-cream||46%|
|Maintaining a healthy weight||37%|
|Limit consumption of red/processed meat||29%|
|I do not take any steps to reduce my risk of cancer||17%|
Lack of understanding around cancer prevention leaves Britain at risk
An estimated four in 10 cases of cancer could be prevented, largely through lifestyle changes5. However, the lack of action being taken to reduce the chance of developing the disease is partly due to poor understanding among British adults of the factors that increase cancer risk.
For example, although tobacco is the single biggest avoidable cause of cancer in the world, 29% of British adults did not identify smoking as a cancer risk factor. An even larger proportion did not identify diet (61%) and weight (62%) as influencing a person’s risk of developing cancer, despite these being major causes6. And although it has been proven to cause seven types of cancer6, over half (56%) did not identify consumption of alcohol as a cancer risk factor.
Understanding is particularly poor among younger age groups – only 57% of 18-24s believe smoking to be a cancer risk factor, compared to 79% of over 65s.
This lack of understanding is worsened by conflicting reports on the causes of cancer. More than half (54%) of British adults say they feel confused by reports of what to do and what not to do to reduce their risk. Among these, 26% say it makes them feel worried about what to do for the best, while 21% become ambivalent about cancer advice as a result.
British adults positive about future of cancer treatments and survival rates
Positivity about the progress being made in treatments and survival rates for cancer could be another reason people are failing to take preventive measures. More than three quarters of British adults (78%) expect to see cancer survival rates improve over the next 20 years, while four in five (82%) believe cancer drugs and treatments will improve in the same period.
People are also optimistic that a cure for cancer will be found in the next 50 years, with half (50%) in agreement.
Dr Doug Wright, Medical Director for Aviva UK Health says,
“We now know that one in two people born after 1960 in the UK7 will get cancer in their lifetime. It has become very much embedded in the psyche of the nation, and represents one of people’s greatest health fears. Yet despite our high collective awareness of the disease, too many are failing to take any action at all to reduce their cancer risk. This is compounded by a lack of awareness surrounding the main causes of cancer, despite many high profile campaigns.
“It’s estimated that four in 10 cases of cancer can be prevented, largely through lifestyle changes5. Maintaining a healthy weight and diet will not only reduce your risk of cancer, but other serious illnesses such as type II diabetes and heart disease too. The same is true of smoking – it can be a hard habit to kick, but the fact this is the single biggest preventable cause of cancer in the world should act as strong motivation. Cancer drugs and survival rates may be expected to improve, but that is no reason to become complacent. Prevention is ultimately much more effective than treatment.”