The healthmatters blog; commentary, observation and review
The thing that happened
The 48 hour walk out of junior doctors on March 9th and 10th 2016 did not gain as much mainstream media coverage as the previous one day stoppages. Nor did it trigger government concessions on the new junior doctor contract. So on March 18th the British Medical Association (BMA) announced plans for an “escalation” of strike action over the Government’s decision to impose a new contract on junior doctors.
The chairman of the BMA’s junior doctor committee (JDC), Dr Johann Malawana, said the “exact nature” of the action would be confirmed shortly. A few days later the BMA announced a full walkout by junior doctors, including those working in emergency services at the end of April. In each of the junior doctor strikes so far, emergency staff have remained in post.
A&E doctors are among those most concerned about the new contract and pressure for a full walkout has been growing among BMA members frustrated that the union has so far proved powerless to prevent the Government imposing a new contract. This is scheduled to come into effect in August 2016, cutting pay for Saturday working in exchange for an uplift in basic pay.
Dr Malawana added: “We have shown solidarity, stated our case clearly and passionately to the public, and done everything possible to avert what could be the worst of all worlds for junior doctors – the refusal of the Government to get back around the table forces us down this road.”
Public opinion polls show high levels of support for the junior doctors and social media carry testimonials from individuals expressing no anger, sometimes even gratitude, about their postponed hospital appointments. Yet there is also a sense that the dispute has gone on too long. Writing for the Guardian on March 13th, Sonia Sodha said: So what’s the link between Saturday pay and patient safety? A BMA spokesperson told me the Saturday pay dispute will further damage junior doctor morale, with knock-on impacts for patient safety.
Let’s call a spade a spade. This is a workplace dispute about terms and conditions, not a campaign to save the NHS. There are bigger and more immediate risks to patient safety: hospital trusts under great financial strain struggling to meet safe nursing levels; cuts to social care budgets putting immense pressure on hospital beds.
This echoes a ‘plague on both your houses’ piece in The Economist on February 12th which sympathised with the junior doctors and criticised the Health Secretary Jeremy Hunt (whilst deeming him well intentioned). Unable to decide which side it favoured, The Economist blamed the British public for being an “electorate that notionally adores the NHS, propels a mushy song by health workers to the top of the Christmas charts, happily accepts the left’s bogus insinuations that the only alternative is an American-style private health-care model, equally happily votes for Tory politicians promising to expand services to weekends and yet, despite all this, shows remarkably little willingness to pay more in tax towards what remains a relatively cheap system”.
Whilst not taking The Economist too literally, we might learn something useful from two particular economists, Roland Benabou and Jean Tirole, whose 2009 essay “Over My Dead Body: bargaining and the price of dignity” casts some light on the current dispute. They say: “Concerns of pride, dignity, and the desire to “keep hope” about future options often lead individuals and groups to walk away from reasonable offers, try to shift blame for failure onto others or take refuge in political utopias. Costly impasses and conflicts result”.
Both sides blame the other, and the junior doctors – many of whom genuinely believe they are saving the NHS – have found a political dystopia. As the junior doctors’ leader puts it, failure to achieve the BMAs objectives will bring about “the worst of all possible worlds”, which seems an odd conclusion after months of argument and negotiation had apparently brought both parties closer to a resolution. Exactly how will an uplift in basic pay but a reduction in Saturday overtime pay constitute the worst of all possible worlds?
The thing that didn’t
On Friday March 11th the Private Member’s Bill – called the National Health Service Bill but publicised as the NHS Reinstatement Bill by its proponents – went to Parliament for a second reading. It was an ambitious piece of legislation that aimed to abolish the purchaser-provider split in the NHS, end contracting and re-establish public bodies and public services accountable to local communities. In other words, it was intended to roll back the marketization of the NHS. More specifically it sought to re-establish the Secretary of State’s (SoS) legal duty as to the National Health Service in England, and to repeal section 1 of the National Health Service (Private Finance) Act 1997 and sections 38 and 39 of the Immigration Act 2014, amongst other changes.
Before the debate there was a lively handover ceremony for the 60,000 strong petition supporting the Bill outside the Department of Health, with Caroline Lucas MP (the sponsoring MP), NHS campaigners and junior doctors. Action then shifted to a rally outside the House of Commons. Labour MPs Rachael Maskell and Grahame Morris came to show their support, and speakers from Unite, Doctors for the NHS, Keep our NHS Public and many local NHS campaign groups and junior doctors addressed the spirited crowd.
Inside the House of Commons the opportunity for the Bill getting sensible debating time rapidly disappeared (as happens in most Private Members’ Bills) because Conservative MPs filibustered, leaving the NHS Bill with precisely 17 minutes. As Peter Roderick, lawyer and co-author of the NHS Bill said “17 lousy minutes. A contemptuous Parliament unworthy of the people.“
He went on to say “If enough Labour MPs had turned up, it might have been possible to stop the Tory MPs talking by putting a closure motion. When this was pointed out by Caroline Lucas, the shared smirks on the faces of silent Heidi Alexander, Labour shadow health minister, and the junior health minister Ben Gummer, gave the game way. The Tories didn’t want a proper NHS debate, neither did Labour’s health team and together they made sure it didn’t happen. Body language speaks louder than words. Filibustering, empty benches, silence, smirks and front bench deals are contemptuous responses to tens of thousands of people. They are also counter-productive. This second NHS Reinstatement Bill will fall. But the spirit is high and the commitment to bring a third, and a fourth, and a fifth – until a proper public NHS is restored – is stronger than ever”.
The NHS Bill’s supporters were very annoyed, understandably so given this was their second failure to get the Bill debated in Parliament. They remain defiant, planning another attempt at getting the Bill back to the House of Commons, and are angry at Labour’s growing disinterest.
The Labour Opposition said it supported the overall objectives of the Bill, in particular the principles restoring accountability to the Secretary of State for the delivery of health services and the requirement that a comprehensive health service continues to be provided free of charge. However, the Bill was seen as poorly constructed and in need of a great deal more thought and effort to get it into a workable state. Even worse, there were concerns in the Labour Party that some of the other parts of the Bill would require another wholesale reorganisation of the health service. The top-down reorganisation of the NHS, brought about by the Coalition’s Health and Social Care Act 2012, threw the NHS into turmoil, cost over £3bn and eroded staff morale. Labour understandably wants to avoid a repetition of such shock therapy.
Let’s call a spade a spade. Why should the Parliamentary Labour Party invest time and energy in a Bill to turn back the clock on NHS marketization – some of which Labour had initiated – which has no prospect of being passed? Particularly at a time when it is writing its election manifesto and contemplating an election before the end of the present parliamentary term – referendum results being an unknown quantity at this stage. By the time Labour in whatever form regains government office the needs of the NHS may be different. Anyway, is turning back the political clock really possible, or is it just a nostalgic dream? Why is it preferable to look backwards to a proper public NHS (whatever that might mean) than to face forwards and solve the problems of the NHS as they evolve? Are we being encouraged to take refuge in political utopias?
Steve Iliffe 28/3/16
In a letter to the Home Secretary, the BMA has warned that some of the most vulnerable people in England could be put at risk by the Government’s U-turn decision to stop the NHS from becoming responsible for the healthcare of those in police custody.
Individual police forces currently provide healthcare for those in custody – often some of the most vulnerable people in society, including those suffering from mental illness and drug and alcohol addictions. The BMA has repeatedly raised concerns about the varying levels of care across the UK, and has called for an improvement to the current standards since 2009.
From April 2016, the responsibility for the provision of healthcare was due to be transferred to the NHS, to help ensure the necessary standards for treating highly vulnerable individuals with distinct healthcare needs.
These standards were to include:
- Consistency in standard of delivery
- More robust clinical governance
- Approved standards of training and experience of healthcare professionals
- Better integrated care for those detainees whose criminal behaviour is a result of poorly-addressed mental health problems and substance abuse
Writing to the Home Secretary, the BMA has expressed its disappointment at the Government’s announcement that the transfer of responsibility will no longer go ahead. It has questioned the justification for such a U-turn on policy, and has requested an explanation of how the spending review settlement directly affected the decision not to transfer commissioning responsibilities.
Dr Mark Porter, said:
“The BMA is extremely disappointed by the Government’s decision, especially given its close proximity to the intended date of transfer.
“The level of healthcare in police custody varies greatly across the country. Doctors are concerned about what this U-turn will mean to the planned improvements to the service and how this will ultimately affect those receiving treatment and care – often some of the most vulnerable people in society.”
Each year, as the nights draw in and the weather worsens, increased pressures on the country’s health service push it almost to breaking point. A combination of staffing challenges, demand and capacity imbalances, poor patient flow and other local factors impact the NHS’ ability to deliver. Never was this more evident than last year, when the health service experienced a winter crisis that prompted the Government to allocate a record £700m to alleviate the pressure.
That said, whilst winter pressures are predictable the situation appears to be worsening each year, and it will be the same in 2016/17 if hospitals and their local health systems are unable to break the cycle. Indeed there appears to be a growing consensus across system leaders and political parties of all persuasions that funding injections are no longer the only response required to support healthcare organisations experiencing such pressure.
In order to weather the winter months, NHS organisations must prepare early – easier said than done. Whilst building and maintaining resilience across their systems for this winter, organisations can learn the lessons to ensure they are best prepared for delivery next winter.
Clearly, this is not straight forward, and there are no quick fixes. However, there are three key steps that health economies can take to support sustainable performance improvement across all their organisations.
The first step is to reframe demand and capacity planning. Demand and capacity analyses are undertaken as part of the annual planning round, but these plans are typically focused on individual acute trusts and based on historic values. Taking a system-wide approach, there is an opportunity to broaden demand and capacity planning to cover the entirety of the emergency care pathway – recognising that hospital pressures can be alleviated by understanding all pressure points, not just those within the acute setting itself.
The second key approach is to support continuous improvements in patient flow through the hospital. During the summer months, and without the intense pressure seen in winter, pressure points are often left undiscovered, and therefore opportunities are missed to address potential break points. By identifying pinch points earlier, and supporting improvements in patient flow prior to winter, prolonged periods of under performance can be avoided.
Finally, to ensure a sustained performance, it is vital to strengthen operational management and governance. System Resilience Groups (SRGs) are the nationally prescribed structures responsible for strengthening delivery performance. There is a real opportunity for SRGs to become increasingly effective by managing operational pressures in real time. To do so, SRGs can take the opportunity to review their governance and consider establishing operational sub-groups that have delegated authority to proactively manage winter pressures. They could also agree and monitor key performance indicators (KPIs) across the whole system in real time, to help identify and address specific challenges.
Clearly, our NHS is under significant and growing pressure for all the reasons we understand: ageing populations, growing costs, rising public expectations, and so on. There is no ‘silver bullet’ and creating time to identify ways of alleviating this pressure is difficult. However, at a time when short-term funding increases are increasingly recognised as not being the ‘answer’, a focus on longer-term solutions is essential.
In response to the news that the government is launching a care homes website, Stephen Burke, Director of Good Care Guide, said: “We welcome transparency in care. Families need as much ‘live’ information as possible when choosing care. That’s why we launched Good Care Guide in 2012.
“But we question why the government is setting up a care home website when there are review sites in existence and the Care Quality Commission and NHS Choices already publish much of the data. Local authorities also have a duty to provide information and advice about care.
“Good Care Guide is an independent site that enables families to review childcare and eldercare that they use. Good Care Guide covers every care provider in England, Scotland and Wales, not just care homes. The site enables older people to choose between care homes and home care services. It also enables families to choose childcare services like nurseries, nannies and children’s centres. We work closely with CQC, Ofsted and care regulators in Scotland and Wales to ensure that families choosing care can access inspection reports as well as reviews and other information about care providers and what to look for. Good Care Guide has had well over two million visitors and thousands of reviews.
“We know from reviews left on Good Care Guide that many older people and their families are not happy with the quality of some care homes. Government would do better to fund care properly and support CQC to be more robust in its regulation of care homes. Care is in crisis and the government is yet again trying to divert attention from the real issues of funding and staffing.
“It also has it’s own widget, please see – https://www.goodcareguide.
For more information visit www.goodcareguide.co.uk
This briefing produced by The King’s Fund, the Nuffield Trust and The Health Foundation, provides an independent assessment of where the Spending Review leaves the NHS and social care.
Now that the dust has settled on the Chancellor’s announcements, our three organisations have come together to help ensure the debate is informed by a clear and objective analysis of the funding position and its implications for health and social care services.
- Total health spending in England will rise by £4.5 billion in real terms between 2015/16 and 2020/21.Looked at over the whole of this parliament, this will result in an increase of 0.9 percent a year, almost identical to the rate of increase over the last parliament. This is much less than expected following the announcement of the NHS settlement.
- This is because the Spending Review defined ‘NHS’ spending as NHS England’s budget, not the whole of the Department of Health’s budget – the definition used by previous governments.
- While NHS England’s budget will rise by £7.6 billion in real terms over the period, other health spending will fall by more than £3 billion, a 20 per cent cut.
- The additional investment will be front-loaded with a significant increase in 2016/17 which is very welcome. However, much of this money will be absorbed by dealing with deficits among NHS providers and by additional pension costs.
- With much smaller increases in later years, the NHS will struggle to maintain services, let alone invest in new models of care and implement seven-day services. This places even more emphasis on the huge challenge of finding £22 billion in productivity improvements by the end of the parliament.
- Public health spending will fall by at least £600 million in real terms by 2020/21, on top of £200 million already cut from this year’s budget. This will affect a wide range of services including health visiting, sexual health and vaccinations.
- Overall, the NHS is halfway through the most austere decade in its history. Public spending on health in the United Kingdom as a proportion of GDP is projected to fall to 6.7 per cent by 2020/21, leaving us behind many other advanced nations on this measure of spending.
- A number of uncertainties make the settlement for social care difficult to gauge but spending is likely to be broadly flat in real terms over the parliament.
- New powers to raise Council Tax by up to 2 per cent to spend on social care will provide flexibility for local authorities but are unlikely to raise as much as the government suggests and could disadvantage deprived areas with low tax bases.
- Additional money for social care provided through the Better Care Fund from 2017/18 is welcome but risks arriving too late with the sector already on the brink of a crisis and a further significant cut in funding to follow next year.
- The additional funding will not be enough to close the social care funding gap which we estimate will be somewhere between £2 billion and £2.7 billion in 2019/20, depending on how much is raised through the Council Tax precept.
- Social care also faces additional cost pressures from implementing the National Living Wage which will add another £800 million to these estimates, leaving an estimated total funding gap of between £2.8 billion and £3.5 billion by the end of the parliament.
- Public spending on social care as a proportion of GDP will fall back to around 0.9 per cent by 2019/20, despite the ageing population and rising demand for services. This will leave thousands more older and disabled people without access to services.
Key business challenge for 2016:
- The financial and emotional cost of the ageing population is one of the key issues facing society – considered by some to be a ‘time bomb’ that will take economies to a new crisis point
- The number of people aged 85 or over will reach 3.5 million by 2034 and account for five per cent of the total population, according to the Office for National Statistics
- Technology could have the answer – but only if businesses wake up to the challenge and get behind an innovation ‘space race’ in 2016
How to care for the oldest members of society is a pressing issue for the global economy but, despite their fast growing numbers and obvious need of support to remain independent, they are being neglected by technological innovators according to the Chief Executive Officer of new healthcare technology business.
According to projections by the Office for National Statistics, by 2034 the number of people aged 85 or over will be 2.5 times higher than in 2009. The cost of this ageing population is one of the key issues facing society with predictions of it crippling the country’s economy.
But healthcare technology company Protelhealth believes that the ageing population is a challenge that can be met and embraced with ingenuity and innovation. The firm already operates a successful e-business offering innovative healthcare products, however, Protelhealth’s Chief Executive Officer Norman Niven is concerned that not enough of the nation’s technological fire power is being put behind such products. He is urging entrepreneurs and technology innovators to grasp this challenge as a priority.
Mr Niven comments: “We have established an excellent platform through which new products for independent living can be taken to market, backed by guidance on the best product for each requirement. Yet our biggest challenge is a lack of products that both do the job and are acceptable to discerning consumers.
“Technology for younger consumers is delivered at an unprecedented rate, and they benefit from having innovative technology at the core of their day-to-day lives”, continues serial entrepreneur Niven. “From Fitbit activity trackers, through smart meters, to phone-linked home security systems – and yet we expect our parents and grandparents to rely on ugly and out-dated technologies such as emergency buttons and fall cords. This is something that cannot continue.”
The Protelhealth team believes that security, dignity and independence in old age are within the UK’s grasp, if – and only if – businesses develop the technological solutions needed to support the elderly and unwell to live at home successfully and for longer.
The firm has already launched telmenow.com – a website designed specifically to offer advice and innovative products to support those living at home. It showcases fresh and effective products such as the Pebbell GPS Tracking Device, trueCall call monitoring device and AliveCor® Smartphone Heart Monitor. And yet the pool from which to select effective and acceptable products is small.
Niven explains: “Our target consumers are proud and independent people who want to enjoy their later years in the same way they have lived, but to date product developers and technology innovators have not embraced them as a target audience. This is particularly shocking as they are one of the fastest growing consumer groups in the UK.”
Protelhealth’s appeal for 2016 is for UK technology to undertake a drive that resembles the ‘space race’ of the 1960s. President John F. Kennedy’s statement that the USA would land a man on the moon galvanised industry and science in the US to make major leaps to achieve his goal. In the same way, a period of focused attention on a clear goal could lead the UK to a period of accelerated and successful technological advancement. In driving for dignified home support for our oldest old, UK industry could achieve significant commercial success, and guard against spiralling healthcare and welfare costs.
Norman Niven concludes: “The generation that cared for its families and for the UK through times of turmoil, is now being poorly served by the generation that it raised. This is not due to lack of concern but the nature of modern society, whereby children can live many hundreds of miles from their parents and both men and women work full time. And yet the middle aged consumer relies heavily on technology to make many of their most basic actions possible.
“2016 is a critical year and one that could witness dramatic change. If consumers are more demanding, and businesses more innovative, the future welfare of the nation’s parents and grandparents can be improved dramatically. The UK could – and should – provide a benchmark for the world in using innovation to protect and support its most vulnerable residents, and we need to do so soon.”
- 47% are willing to be diagnosed digitally instead of face-to-face with their GP
- 67% would use wearable technology to monitor long-term medical conditions
- The majority already using healthcare technology report improved health
- 55% agree the NHS should provide free technology to help people play an active role in improving their health
Almost half (47%) of UK adults would be happy to be diagnosed remotely through digital health technology rather than face-to-face with a doctor, according to Aviva’s latest Health Check UK report. Men in particular are happy to replace a trip to the doctor with a digital diagnosis (53% versus 42% of women).
The growing appetite for digital health technology (including wearable health monitors, health advice mobile apps and video consultations with doctors) could remove the need for some doctor appointments and alleviate pressure on stretched healthcare services, helping the 58% of adults who struggle to get an appointment with a GP at a convenient time.
In a show of support for NHS plans to remotely monitor long-term illnesses, more than two thirds (67%) of UK adults agree they would be happy for a long-term medical condition (such as diabetes or heart disease) to be managed through remote digital monitoring. Those who are overweight (68%) or obese (71%) are particularly likely to be in favour of remote monitoring, perhaps as they are typically more likely to experience these types of illnesses.
Almost three in five adults (57%) agree digital health technology could improve their health or wellbeing, including 60% of overweight and 58% of obese people.
Although usage of wearable health technology – such as heart rate, symptom, or sleep pattern monitors worn as a bracelet or watch – is relatively low across the wider population, younger age groups are most active with this kind of technology. Almost one in six (15%) of those aged 25-34 use a physical activity monitor (compared to 8% overall) while 9% of 25-34s use a sleep pattern monitor (vs. 4% overall).
Among those adults who already use wearable technology, the majority report benefits to their health. For example, 63% of all age groups using a physical activity monitor say it has improved their health, rising to 66% of those with a heart rate monitor.
Many of those who are not currently using wearable health technology are open to doing so in the future. Three in five (60%) non-users would use a physical activity or heart rate monitor in the future, while 52% would consider using a sleep pattern monitor.
Table 1: Uptake of wearable health technology and the benefits to health
|Physical activity monitor||Heart rate monitor||Sleep pattern monitor|
|% of UK adults currently using this||8%||4%||4%|
|% who say this has improved their health||63%||66%||50%|
|% who don’t use now but would be open to doing so in the future||60%||60%||52%|
Healthcare technology used for prevention as well as cure
As well as diagnosing and managing health conditions, health technology can also be used to prevent avoidable illnesses caused by poor lifestyle choices. Almost four in five adults (78%) agree that avoidable illnesses are putting too much pressure on the NHS as obesity rates continue to rise.2
Using the internet to access information about health and wellbeing is already commonplace, with 63% using the internet for this purpose. However, there is growing appetite for mobile apps which can also be used to actively monitor and improve physical wellbeing. These include nutrition tracker apps, medication reminder apps and physical activity trackers, such as running apps which allow the user to log runs, monitor overall progress and set future goals.
Almost one in six (15%) use a physical activity tracker app and 46% would do so in the future, while one in ten (9%) use a nutrition or diet tracker app and 38% are open to doing so.
As interest in digital health technology increases, 55% believe the NHS should provide free health technology to help people play an active role in improving their own health.
Dr Doug Wright, Medical Director for Aviva UK Health says,
“As mobile apps and healthcare technology integrate into everyday life, growing numbers are willing to put their trust in digital help or diagnosis. Using technology to identify common illnesses or help manage a long-term condition can remove the need for a face-to-face GP appointment, alleviating pressure on doctors and freeing up time for more urgent health matters.
“At Aviva we already offer some of our corporate customers a virtual health service app – babylon – which gives them quick and convenient access to family GPs, specialist consultants, and state of the art health monitoring and treatment.
“Technology can also aid proactive health management, allowing us to track and improve our health to avoid developing certain conditions in the first place. Many of us will already have this technology in the palm of our hands, or waiting under the Christmas tree this December. As well as using technology for entertainment and social media, people could be using it to get a greater understanding and control of their health and fitness. “
As winter bites care homes are coming under increased pressure to support the NHS by providing a layer of intermediate care that will help reduce the burden on acute hospital services.
Traditionally however care home residents experience 40-50%1 more emergency admissions and Accident & Emergency (A&E) attendances than the general population aged 75 and over, so any increased role has to be supported by improved patient management.
Under pressure staff, cost pressures and poor connectivity with primary care all contribute to a lack of proactive symptom management. Simply monitoring residents’ blood pressure, weight and hydration levels with information being fed directly into GP systems will help maintain health and prevent escalation to more specialist services. It will also be vital to the creation of additional intermediate care capacity. Digital health specialist, Inhealthcare, believe their new vital signs monitoring service can reduce emergency admissions of care home residents by acting as an early warning system.
Their care home service includes measuring the residents’ weight, hydration, blood pressure, heart rate and SPO2.
Inhealthcare’s Simon Jones, “Care homes can play a central role in filling the intermediate care vacuum – but only if the staff have the correct knowledge and skills, services are connected to local primary care providers and care is proactive. Whilst many homes already monitor vital signs, few integrate information into the NHS – a central requirement if escalation to secondary care is to be avoided.”
Inhealthcare’s CEO Bryn Sage, “The NHS have called for a clear strategy to free up hospital beds for those in need; firstly, by preventing avoidable hospital admissions and secondly, by supporting timely hospital discharge. Our vital signs monitoring service can do this by bridging the gap between secondary and community care.”
Inhealthcare’s technology integrates patients’ data into GP systems, improving the coordination between care homes and the local NHS because results can be viewed by all departments. If readings fall outside of a patient’s normal range, the appropriate NHS team is alerted. This means changes in health are highlighted early on, reducing the likelihood of hospital admission. The service supports earlier hospital discharge because it gives clinicians the confidence that if the patient is discharged, their full needs will be being met with regular and close monitoring.
Inhealthcare’s new service builds on their proven success of digitising existing care pathways*. NHS County Durham and Darlington Foundation Trust (CDDFT), one of the largest integrated acute and community services providers in England, adopted Inhealthcare technology to introduce an undernutrition monitoring service for elderly patients in 80 care homes. Ian Dove, the trust’s Business Development Manager says, “The NHS has known for a long time that care homes and the voluntary sector could expand out-of-hospital care delivery, if they could be more effectively integrated into local health and social care economies. The Inhealthcare platform provides the flexibility and interoperability we need to implement radically new models of care.”
1.Quality Watch. Focus on: Hospital admissions from Care Homes. January 2015. Accessed December 2015: http://www.health.org.uk/sites/default/files/QualityWatch_FocusOnHospitalAdmissionsFromCareHomes.pdf
- County Durham and Darlington Undernutrition Case Study October 2015
Actress Phyllida Law tells of challenges of caring for her mother: “You couldn’t leave the house”
Actress Phyllida Law – mother to actresses Emma and Sophie Thompson – has told of the impact of dementia on her mother and the challenges of caring for her, as Alzheimer’s Research UK launches a new report highlighting the heavy toll dementia takes on family carers. The report, Dementia in the Family: the impact on carers, comes as new polling reveals that nearly a third (31%) of non-retired people aged 55 and over are worried that their family members will have to care for them in later life, and shows the realities of daily life for carers who are looking after their loved ones. In-depth case studies in the report reveal how dementia changes family relationships, leaving people feeling socially isolated, and affects both the health and finances of family carers. The findings underline the importance of research to provide new treatments capable of reducing care needs for people with the condition.
In a new YouGov survey commissioned by Alzheimer’s Research UK, the UK’s leading dementia research charity, three in 10 non retired people aged 55 and over in the UK said they were concerned that in later life, their family would need to care for them.Dementia in the Family shines a spotlight on experiences shared by many of the 700,000 people in the UK who are caring for a loved one with dementia. Through in-depth interviews with four families who are living with the condition, the report shows that carers find their role both challenging and rewarding.
The carers spoke of the way dementia has affected relationships within their families, at times creating unwanted tensions as well as changing how carers interact with the person with dementia. Interviewees told how their caring role, which sees them prioritise their responsibilities to their loved ones over their social lives, has left them isolated from friends and other family members. Although many felt their role was rewarding and had strengthened the bonds between them and their loved one, all the carers experienced high levels of stress and had faced financial costs associated with the condition.
Phyllida Law has first-hand experience of the toll a caring role can take, having looked after her mother, Meg, for several years after dementia took hold. She said:
“The night time was particularly difficult: at dusk my mother would often think she was in the wrong house, or she would call for breakfast in the middle of the night, not knowing what time it was. When you’re worn out because you haven’t slept, you can be in danger of losing your temper, and that’s very hard. I wasn’t as isolated as some people, and I was lucky because I had help from the people in my mother’s village and from my two daughters [Emma Thompson and Sophie Thompson], who also helped me financially. But caring for Ma, you couldn’t leave the house without taking her with you, so you did feel very stuck a lot of the time.
“A treatment that could help people like my mother would be unimaginable. It’s extraordinary to think of the advances that have been made for diseases like cancer, and it would be wonderful to see that for dementia.”
Hilary Evans, Chief Executive of Alzheimer’s Research UK, said:
“For many people the festive season is a time to think about family, but for countless families across the UK dementia is taking a heavy toll, leaving people socially isolated and struggling financially. The experiences highlighted in this report will be recognised by people up and down the country who are dealing with the challenges of caring for a loved one with dementia.
“A diagnosis of dementia ripples far beyond the person affected, it touches whole families, and we owe it to them to do all we can to tackle it. Across the UK over 700,000 people are caring for someone with dementia, but it’s estimated that if we could delay the onset of dementia by five years, by 2050 we could reduce the number of carers by a third. Research has the power to bring about new treatments and preventions that could transform lives, but to reach that goal we must invest in research now.”
Just 38% of women start rehabilitation following heart attack, angioplasty or surgery
More than 24,000 female heart patients are missing out on crucial rehabilitation, putting them at risk of further heart attacks, according to a new report1 from the British Heart Foundation (BHF).
Just 38 per cent of female patients who have a heart attack, angioplasty or bypass surgery receive any cardiac rehabilitation.
Analysis shows that cardiac rehabilitation services are neglecting female heart patients, with just over 14,000 taking part in cardiac rehabilitation out of 38,500 eligible female patients in England in 2013/14. A further 5,500 women could take part if services fixed the current gender imbalance and matched male uptake levels (52%).
In England, around 122,000 patients are eligible for cardiac rehabilitation but just 47 per cent receive it, despite a government target2 of 65 per cent.
In some parts of the country patients had to wait as long as seven weeks to start rehabilitation following a heart attack3, nearly double the recommendation of starting within 28 days.
When someone suffers a major heart event, such as a heart attack, and need life-saving surgery or medicine-based treatment, they should then be referred for rehabilitation to help their recovery and reduce the risk of another heart attack.
But at some rehabilitation centres, as few as ten per cent of patients are women, partly because services are failing to refer and encourage female patients to take part. There are also concerns that older women and men are not attending cardiac rehabilitation following a medically managed heart attack.
The National Audit of Cardiac Rehabilitation (NACR), which is funded by the BHF and hosted at the University of York, combines data from 164 centres in England, as well as centres in Wales and Northern Ireland.
Cardiac rehabilitation offers physical activity support and lifestyle advice, such as exercise classes and dietary guidance, to help people living with heart disease manage their condition and reduce their risk of associated heart events.
Rehabilitation can help reduce the number of deaths by 18 per cent over the first six to twelve months2 and can cut readmissions by a third (31%).
Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, said: “It is appalling that less than half of eligible female heart patients receive cardiac rehabilitation. Thousands of women are missing out on a vital step in their recovery, increasing their risk of another heart attack.
“That’s why health services urgently need to make rehabilitation more accessible to women, who are either not referred or are put off attending, to help save more lives.”
Professor Patrick Doherty, Director of the NACR, said: “This report shows that while some programmes promote an attractive rehabilitation service and have really high uptake of female patients, the majority of programmes struggle to ensure enough women take part.
“Service providers and commissioners should take action to improve the appeal of the programmes and promote them in a way that motivates female patients to attend. A range of options should be offered including community and self-management approaches, all of which have been shown to benefit patients.”
Nichola Brown, 52, from London, had a stent fitted after a heart attack in 2012. She took part in cardiac rehabilitation once a week, for six weeks, and still continues to go to the gym.
Nichola said: “When you’re recovering from a heart attack it can be quite scary, but my cardiac rehabilitation programme was brilliant. You get access to experts such as specialist cardiac nurses, nutritionists, and exercise instructors to educate and help you. At the end of rehabilitation I was feeling much better and still continue to go to the gym. More women should be encouraged to take part, it’s just so important.”