The healthmatters blog; commentary, observation and review
The increasing numbers of older people with dementia and older people from minority ethnic groups in the UK present new challenges for many housing services according to Gearing Up: Housing, Ethnicity and Dementia, a report jointly published today by Age UK. Researchers, Valerie Lipman and Jill Manthorpe from the Social Care Workforce Research Unit at the Policy Institute at King’s examined the ways in which Housing Associations in England and Scotland are preparing themselves for tenants who develop dementia especially those who are from minority ethnic groups. The increasing numbers of older people with dementia and from minority ethnic backgrounds is challenging many parts of society, but the true impact on housing services is often overlooked.
The study asked if the older people’s social housing sector is prepared for the growing numbers of older people from minority ethnic groups who may wish to move to older people’s housing in later life (or who are already social housing tenants) and who may have dementia or develop it later. It found that while most Housing Associations had already planned how to meet the needs of their tenants from diverse ethnic groups, there was little awareness that many of these tenants might already have dementia. Similarly those Housing Associations that were making preparations for higher numbers of tenants with dementia were not always considering matters of ethnicity, religion and culture.
Not all training on dementia for housing workers covers cultural and ethnicity matters that are relevant to dementia care, and not all training on race equalities covers dementia – this really needs to be addressed concluded the researchers. One of the most interesting discoveries was that Housing Associations rely so heavily on healthcare professionals when making adaptations; and did not feel confident in co-ordination such support. Overall good practice in meeting the housing and care needs of people who develop dementia needs to be matched by good practice in meeting their cultural, religious and ethnic-related needs. These all need to be considered together when it comes to providing good housing care and support. Existing good practice in this sector needs sharing and other services such as primary care should pay more attention to housing matters.
The report was funded by Age UK with finance from the Department of Health as part of its Health & Care Voluntary Sector Strategic Partner Programme.
Michael Meacher MP, who died earlier this year at the age of 75, was a junior minister in Health & Social Security before Thatcher’s victory in 1979, and subsequently was opposition spokesman on health (among other posts). He had a homely approach to political thinking about the NHS. In opposition he drew on the knowledge and experience of three unofficial advisors – a social scientist, and epidemiologist and a general practitioner – to develop health policy for Labour. The trio would be invited to meet Mr Meacher in a room in the House of Commons, or sometimes (when he forgot to book the room) in the nearby gardens, for a brief review of changes in the NHS and a discussion of policy options. There was no agenda and no minutes, nor was it ever clear that the discussions shaped Labour’s responses to Thatcher’s claim that the NHS was “safe” with her.
Mr Meacher’s successors as health spokesman – especially Frank Dobson and Robin Cook – developed wider and more formal consultation networks, including the British Medical Association, which upset those in the Socialist Health Association at the time who saw the BMA as the enemy. It is not clear that the wider approach to policy making made much difference, except perhaps to the relationships between the BMA and Blair’s governments, at least initially. There is a PhD thesis in there somewhere.
Another recent obituary, of Professor Giovanni Berlinguer, reminds News from Nowhere moles of the pleasure this Communist stalwart of Public Health Medicine experienced when explaining to leftists worried about privatisation that markets had existed before capitalism, existed within capitalism and would exist after capitalism. Even in health care.
Five headline indicators of national success: Good Jobs, Wellbeing, Environment, Fairness and Health
NEF’s major new report, Five headline indicators of national success: A clearer picture of how the UK is performing is published today. You can read the report at http://www.neweconomics.org/headlineindicators
The report proposes five headline indicators of the UK’s overall success, measuring Good Jobs, Wellbeing, Environment, Fairness and Health. The indicators have been developed using evidence of what matters most to British people.
The most recent data and trends in the five indicators show that even when things are going well according to standard measures, the public’s priorities are not sufficiently addressed by current economic and social policy-making.
For example, while the headline employment rate has increased over recent years, our Good Jobs indicator shows a decline in the proportion of the labour force in secure, decently paid jobs.
The report calls on the Office for National Statistics to adopt the five indicators as headline measures – a call which is backed by 25 organisations from across British society, including businesses, trades unions, charities and community organisations. The endorsing organisations are listed here.
Rob Webster, Chief Executive, NHS Confederation said:
“There is an unprecedented consensus that we can only address the problems facing the NHS if we invest in the future of our nation’s health by helping people to stay well. Open any report from any director of public health in any part of the country and you can see health inequalities and poor health putting pressure on NHS services and blighting people’s lives.
“From our 2015 challenge to the Five Year Forward View, there is agreement that public health has a vital role to play, alongside care in people’s homes, in hospitals, and in the community. Investment in public health is critical for achieving a sustainable NHS and for addressing inequalities across society.
“We need the upcoming spending review to protect public health budgets, reflecting the Government’s commitment to transform and improve the way care is delivered to patients.”
BMA urge Government to give real and urgent consideration to Public Health England’s recommendations in delayed sugar report
Professor Sheila Hollins, BMA board of science chair, said:
“Doctors are increasingly concerned about the impact of poor diet, which is responsible for up to 70,000 deaths a year, and has the greatest impact on the NHS budget, costing £6bn annually.
“We urge the Government to give real and urgent consideration to Public Health England’s recommendations including restricting the marketing of high-sugar products, reducing promotions of sugary food and drink, and introducing a 10-20 per cent sugar tax.
“While sugar-sweetened drinks are very high in calories they are of limited nutritional value and when people in the UK are already consuming far too much sugar, we are increasingly concerned about how they contribute towards conditions like diabetes.
“It is concerning that a decision was made to delay publication at the same time as the BMA published its own report into the impact of sugar on children and young people, which included calls for a 20 per cent tax on sugary drinks alongside action to restrict the pervasive marketing strategies used by the food and drink industry. It is vital that the government takes on board the concerns already raised by doctors, and now echoed by Public Health England.”
The 2015 Community Mental Health Survey results, published today, reflect troubling and sizeable declines in service user experiences. The fact that many of these incidences are occurring in the areas that matter most to patients is even more so.
The Care Quality Commission Survey, developed and co-ordinated by Picker Institute Europe, was completed by over 13,000 people and found delivering effective person-centred care to be a key concern, with involvement, or the evident lack of it, to be particularly eye opening. More than two in every five (44%) respondents said that they were not involved as much as they wanted to be in agreeing the care they would receive, while a similar proportion were not fully involved in discussions about their care at care review meetings.
Support of people’s wider wellbeing and quality of life could also be significantly better with only two in five people responding that mental health professionals “always understood what is important to you in your life” (41%) or “always help you with what is important to you.” (41%)
Commenting on the results, Dr Andrew McCulloch, Chief Executive at the Picker Institute said; “We welcome today’s publication, and call on all mental health providers across the country to absorb the results and act accordingly. Communication, active involvement and effective co-ordination are known to be core to quality person-centred care provision, but the survey results show declines or stagnation in all of these areas, between 2014-2015. Although we recognise that services are facing the dual challenges of rising demand and increasing financial pressures, meeting these cannot be at the cost of delivering quality care.”
The results also suggest that more could be done to ensure that services match users’ personal circumstances.
Commenting further Dr McCulloch said; “When mental health services are effective, they can support people’s wider wellbeing, but when they aren’t they can also undermine it. Mental health is a long term struggle, many people need to and want to live everyday lives despite their condition, services need to be co-designed and structured in a way that supports them to do this. Focused action on understanding and responding to users experiences is needed urgently to arrest these declines.”
Progress has been made in reducing the additional risk of death for people with diabetes and the additional risk of diabetes-related complications has been stable or has reduced for most complications, according to today’s report from the National Audit Office. However, there are still 22,000 people estimated to be dying each year from diabetes-related causes that could potentially be avoided.
In 2013-14, an estimated 3.2 million people aged 16 or over in England had the disease, and each year another 200,000 people are newly diagnosed. The estimated cost of diabetes to the NHS in England in 2010-11 was £5.6 billion, 69% of which was the cost of complications, such as amputation, blindness, kidney failure and stroke.
Today’s report on the Department of Health, its arm’s-length bodies and the NHS, finds that performance in delivering key care processes and achieving treatment standards, which help to minimise the risk of patients developing complications in the future, is no longer improving. In 2012-13, 60% of patients received all the care processes except eye screening, and 36% achieved all 3 treatment standards to control blood glucose, blood pressure and cholesterol levels. Very few newly diagnosed patients are recorded as attending structured education that could help them to manage their condition and reduce the risk of developing complications.
In 2013, people with diabetes in England were 34% more likely to die that year than the general population, an improvement since 2011 when they were 44% more likely to die. Since the NAO last reported on diabetes services, the relative risk for people with the disease developing complications has not changed or has reduced for most complications. However, the increase in the number of people with diabetes means that the absolute number of diabetes patients with complications is rising.
There are significant variations across England in delivering key care processes, achieving treatment standards and improving outcomes for diabetes patients. For example, across clinical commissioning groups: the percentage of people with diabetes receiving all the recommended care processes, apart from eye screening, ranged from 30% to 76% in 2012-13; and the additional risk of death among people with diabetes within a one-year follow-up period, ranged from 10% to 65%.
In addition, some groups of diabetes patients receive worse routine care and treatment and have poorer outcomes. Younger people with type 1 and type 2 diabetes and all people with type 1 diabetes receive fewer of the recommended care processes and are less likely to achieve all 3 treatment standards. This can lead to poorer outcomes. For example, the relative risk of premature death for young women (aged 15 to 34) with type 1 diabetes is particularly high.
The NAO finds that although the percentage of beds in acute hospitals in England occupied by people with diabetes increased from 14.8% in 2010 to 15.7% in 2013, diabetes specialist staffing levels have not changed since it last reported on diabetes services.
Amongst the NAO’s recommendations is that NHS England should set out how it intends to hold clinical commissioning groups to account for poor performance in delivering key care processes, the 3 treatment standards and longer-term outcomes.
Amyas Morse, head of the National Audit Office, said today:
“Our previous report on diabetes services showed that there was an improvement in delivering the 9 key care processes that the NHS has identified as essential for diabetes patients. Data available since then shows that these improvements have been reflected in an uplift in long-term outcomes for these patients.
“However the improvements in delivery of these key care processes have stalled, as today’s report shows, and this is likely to be reflected in a halt to outcomes improvement for diabetes patients.”
estimated cost to the NHS of diabetes in England, in 2010-11
people in England were estimated to have diabetes in 2013-14, with 2.8 million diagnosed
people in England estimated to be dying each year from diabetes-related causes that could potentially be avoided
|59%||of registered diabetes patients received all eight key care processes, monitored through the National Diabetes Audit, in 2012-13|
|36%||of registered diabetes patients were achieving all three diabetes-related treatment standards for blood glucose, blood pressure and cholesterol levels, in 2012-13|
|Fewer than 4%||of newly diagnosed diabetes patients were recorded as having taken up a structured education programme, in 2012-13|
|10% to 65%||variation in the additional risk of death among people with diabetes, within a one-year follow-up period, compared with the general population|
|55%||of patients reported that they were able to take control of their own diabetes care while in hospital to the extent they would have liked, in 2012-13|
Study reveals importance of healthcare professionals asking about violence and abuse. New guidance based on survivors’ experiences on how to improve services published
A major new study, published today by DMSS, NatCen Social Research, Truth and CWASU, and involving over 120 interviews with health professionals and survivors of abuse, shows overwhelming support for “routine enquiry” – the process of asking adult service users about prior experience of violence and abuse in mental health assessments.
However, even though routine enquiry has been Department of Health policy since 2003, the study reveals that it is still inconsistently applied and that some healthcare professionals lack confidence in asking people about experiences violence and abuse or responding to disclosures.
The study, funded by the Department of Health Policy Research Programme, found:
– Despite people with extensive experience of violence and abuse being 5 times more likely to suffer from a mental health problem such as depression the relationship between violence and abuse and mental health is often overlooked. Survivors commented that some staff did not seem to regard their past history of abuse as relevant to their mental health.
– Lack of understanding in primary care – Some survivors had received a dismissive response from health service workers, including GPs and those working in in-patient services.
– Staff reluctant to ask – Interviews with service providers found that while some have implemented routine enquiry effectively others can be reluctant to ask about violence and abuse, in part due to lack of confidence in how to respond, and assumptions about it not being appropriate to some people or in some circumstances, and concerns about a lack of follow-up services being available.
– Lack of available support – this concern is founded; voluntary sector services for survivors reported considerably reduced funding in recent years while also struggling to support people with significant mental health issues, for whom no suitable NHS services were being provided. This was echoed by survivors of abuse.
In response to these findings, the REVA study has published briefings for mental health professionals, Primary Care Trusts and commissioners on how services for survivors of violence and abuse can be improved based on survivors’ own experiences.
Mental health service users welcomed being asked about abuse even though disclosure could be difficult and they had the following recommendations for mental health professionals:
• Ask about abuse as early as possible
• Ask with interest and concern (rather than as a ‘tick box’ requirement)
• Ask more than once (as people may not feel able to respond at first)
• Ask of everyone, and
• Responses to any disclosure should be helpful and empathetic; ideally they should be followed up with good services and support, but a lack of availability of services should not be used an excuse to not ask about experiences of abuse.
Following on from interviews with service users and service providers, the REVA project team also developed and tested a Supporting Survivor Outcomes (SSO) tool.
The tool makes it possible to test the effectiveness of mental health interventions, while also giving helpful feedback to users of mental health services about their own progress. It differs from other tools by including measures that go beyond the clinical to encompass the impacts of violence and abuse on everyday life. It also provides an opportunity for service users to give direct feedback on the appropriateness and quality of services.
Feedback from service users involved in the pilot was very positive:
“I think it’s really useful because when I read this I find out about myself – what I can and what I can’t [do] and what is happening – it’s useful, it’s really useful […] Normally I always think about my kids, my house, other things. When I do this then it gives me a chance to think [about] what I am.”
“…because [the questions] relate to how you do your daily activities or the way you interact with other people, they make you think, it makes you think whether you have actually managed or you haven’t, whether there is a problem … that you’re not aware of, or you’re not conscious about”
The study lead, Dr Sara Scott, said: “This study has given us a new insight into the experiences of survivors of violence and abuse in the health service. While many had a positive experience, there remains too much inconsistency and in some cases a lack of understanding and support. In response to this we have published guidance for people at each level of mental health services – from the commissioners and Trusts to front line mental health professionals. This guidance is of particular importance because it gives insights into how services can be improved directly from the users themselves.”
1 DMSS Research provides evaluation and research to health and social care organisations in the public and voluntary sectors. www.dmss.co.uk/
2. NatCen Social Research. Britain’s leading large independent social research institute with experts in qualitative and quantitative social research. www.natcen.ac.uk
3. Truth. A global research consultancy, specialising in insight, innovation and strategic thinking www.Truth.ms
4. The Child and Woman Abuse Studies Unit. CWASU, at London Metropolitan University, is a centre of excellence with an international reputation for research, evaluation, training and consultancy. www.cwasu.org/
Nursing and Midwifery Council responds to announcement that nurses are to be added to Shortage Occupation List
Responding to today’s announcement by the Secretary of State for Health, Jeremy Hunt, that nurses will temporarily be included on the Shortage Occupation List, NMC Chief Executive and Registrar, Jackie Smith, said:
“As the regulator for the nursing and midwifery professions, the NMC ensures that everyone on our register is capable of practising safely and effectively. Our processes for admitting nurses and midwives who have trained outside the EU are clear, robust and effective.
“Applicants must be able to demonstrate that they have the knowledge, understanding and application of professional skills at the right level and they must also go through a full identification check as well as meet the English language requirements.
“We understand that placing nursing on the Shortage Occupation List may prompt a significant increase in the numbers of overseas-trained nurses wishing to join the NMC’s register. We are confident that we have the resources and capacity to process an increased volume of applications over the coming months.
“Once we have all the completed documentation we aim to process applications from non-EU trained nurses within 70 days and we are currently meeting that target. We will monitor this timescale carefully to ensure that we are continuing to meet expectations.”
When someone loses their sight, it is vital that they are signposted to specialist support to ensure they are able to adjust and overcome the challenges of blindness. Currently in the UK, tens of thousands of ex-Service men and women are battling severe sight loss and could be eligible for help and support from Blind Veterans UK, but they don’t realise it.
Blind Veterans UK has been providing vital sight services and support to veterans with vision impairment for 100 years. The charity has three centres in Brighton, Sheffield and Llandudno, North Wales, as well as a network of welfare officers around the UK, providing rehabilitation, equipment, training and emotional support to help veterans adjust to life with sight loss, regardless of when or how they lost their sight.
The effects of sight loss can be devastating and can often leave people feeling unable to do many of the things they used to enjoy. As well as helping veterans to regain the independence and confidence that is so often lost when someone loses their sight, through vital training in areas such as independent living, mobility and cooking skills, Blind Veterans UK also provides veterans with the opportunity to take part in recreational activities, helping them to discover new hobbies, revisit old one and meet other people in a similar situation.
When Royal Navy and SAS veteran William Turner developed glaucoma, which robbed him of his sight, he found it hard to adjust. But, after a friend told him about the Blind Veterans UK, he got in touch to request support. As well as helping him to adjust to life with sight loss through equipment and training, William has also been able to discover a new love – painting. Despite having not painted since school, the staff at the charity’s Llandudno centre encouraged him to pick up a paintbrush, and he hasn’t looked back since.
William says: “The art bug has definitely bitten, I have carried my easel up the Malvern Hills just to sit there and paint and I often find myself getting carried away and painting on A4 paper into the early hours of the morning.
“Seeking Blind Veterans UK’s support has been the best thing that could have happened to me. The Llandudno centre staff are very positive and friendly and their can-do attitude is infectious.”
Blind Veterans UK’s No One Alone campaign is reaching out to the tens of thousands of veterans in the UK now battling severe sight loss, but don’t currently realise the support available. It doesn’t matter when or how a veteran lost their sight, or when they served, Blind Veterans UK can help.
If you work with, or know of, an Armed Forces or National Service veteran who is now battling severe sight loss, refer them to Blind Veterans UK for free, lifelong support by calling 0800 389 7979 or visiting www.noonealone.org.uk.