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.”
Lisa Dalgleish, health and care solicitor at leading law firm BLM, looks into some of the challenges and liability risks resulting from the proliferation of digitalised healthcare and new technologies.
The BBA, the trade association representing the UK banking sector, has reported that there are 9.6 million log-ins to internet banking every day and £2.9 million is moved by customers using banking apps every single week. Meanwhile, online retail purchases were made by 81% of Brits last year. When it comes to booking holidays, finding your dream destination, paying for it and then printing out the plane tickets from the comfort of your own sofa, purchasing is now more convenient than ever.
Against the continued rise in popularity for the convenience of digital solutions across all aspects of our daily lives, is the healthcare sector on track to keep pace with the ever-evolving digital world?
Last year only 2 per cent of the population engaged with a digitally enabled transaction with the NHS, according to the Department of Health’s National Information Board (NIB).
Efforts to increase digitalised healthcare provision in the UK are now essential for the NHS and beyond. In fact, NIB’s ‘Personalised health and care 2020: a framework for action’ states that: ‘Better use of technology and data is a prerequisite for supporting and enabling the key developments needed to reshape the health and care system.’
mHealth, wearable and implantable technologies, medical equipment and devises connected to ‘the Internet of Things’, remote consultations, diagnoses and treatments and a variety of other healthcare innovations, once only the predictions of science fiction and now real, are set to hit unprecedented heights in 2016 and beyond.
But with new technologies come new risks – so what implications should we be aware of? How can we manage all of the data – personal and extremely valuable data – that is produced by these new technologies? What are the key vulnerabilities? Is ‘medjacking’ the biggest emerging threat?
‘Medjacking’ is a term coined to describe the use of malicious software (‘malware’) as a means to launch cyber attacks on healthcare systems. This is usually done by hackers placing malware on networked medical devices – giving them the ability to remotely control medical equipment.
Medical devices may be vulnerable to attacks on their security systems that are installed by the manufacturers. Some manufacturers, especially those with low budgets for cybersecurity, turn to open source code and libraries for security solutions. They may be using older, more exploitable code, with known vulnerabilities in their products.
Where security systems are managed solely by the manufacturer’s external technicians, healthcare providers are totally dependent on manufacturers to maintain security.
Cyber attacks on healthcare providers
Medical devices have emerged as a new target for cyber attacks. In a report published in June 2015, one cyber defence company reported a case at an unnamed hospital where hackers were able to plant malware in surgical blood gas analysers.
The hackers then used the equipment as a back door to find passwords throughout the hospital’s IT systems and leak sensitive information. Another case involved hackers creating a backdoor access point through a hospital’s X-ray system.
The information that healthcare providers hold is more valuable than payment card information held by retailers. Health organisations often have complete profiles of people including national insurance numbers and medical health information that is impossible to change in light of a data breach. Health data attacks give hackers the information they need to commit identity fraud and organisations are vulnerable if their security systems are not sufficiently robust.
The healthcare industry is now using ‘apps’ in the same way as the fitness industry, to track patient health and assist with treatment compliance.
This year has seen the launch of Apple’s ‘iWatch’, which is able to monitor heart rate, blood glucose, sweat and sleep patterns. Various other fitness bands offer a variety of options for capturing an individual’s key health data, and consultants are predicting that up to 75% of the global population will be expected to use devices like this in the future.
We are also moving into an era of ‘implantables’. Google’s smart contact lens has the potential to monitor a person’s glucose levels or other vital signs. Drug companies are working on implantable smart pills that work with Bluetooth to inform doctors and family members if a patient has taken his or her medicine.
The progression from remote health monitoring to health apps will see patients monitoring and assessing their own health issues and managing their own prescriptions, relying on applications to inform patients to take clinical action and make diagnoses.
A new generation of bionics that can connect wirelessly with the nervous system and enabling ‘feeling’ sensations is now available to patients in the UK. These devices are implanted directly into the nerve to process and transmit signals wirelessly to an external device.
A £1.4m UK research project lead by Newcastle University aims to develop novel electronic devices that connect to the forearm neural networks to allow two-way communications with the brain. This could allow the hand to communicate directly with the brain, sending back real-time information about temperature, pressure and shear force. A £5.3 million award from the Engineering and Physical Sciences Research Council will also be used to develop smart trousers, to help disabled and older people walk and biosensors to monitor how patients use equipment or exercise during rehabilitation.
Where the data sent through such devices is not encrypted, there is greater potential for a hacker to intercept or even modify that data. The former poses a security risk, the latter a threat to human health.
Technology can provide many answers to the challenges faced by healthcare providers. It can provide new and effective treatments, where patients can be treated away from hospitals and surgeries, reduce the scope for human error and result in costs savings.
However, the increasing use of technology means that more and more data is being held by healthcare providers and the high value of that data means that they have become increasingly attractive targets for hackers.
The focus of technological development therefore needs to be as much on the security of the data obtained as on the effectiveness of the devices themselves. Whilst there have not been any reported UK data breaches involving cyber attacks against healthcare providers so far, healthcare providers should be prepared.
To answer this question, we have examined previously unpublished results from the British Social Attitudes (BSA) survey. In the 2014 surveyand in 2002, respondents were asked to rate how much they trusted NHS doctors, nurses and hospital managers to put the interests of their patients above the convenience of the hospital.
The results (see Figure 1) showed that overall, nurses were the most trusted group closely followed by doctors, with hospital managers trailing behind.
However, a closer look reveals a reduction in some levels of trust: the proportion of respondents reporting that they trusted nurses ‘just about always’ dropped from 30 per cent in 2002 to 21 per cent in 2014. Statistical testing suggests this is a true reduction, and not due to chance variation in the survey.
It is important to note that the available data does not give a picture of any fluctuation in levels of trust between 2002 and 2014 and that there are many factors that may have affected trust in nurses. That said, if this is a sustained drop in trust, it may be the case that public scandals involving nurses could be a potential contributing factor, for example, the public outcry and extensive media coverage surrounding the quality of care at Mid Staffordshire NHS Foundation Trust and the subsequent findings of the Francis Inquiry, which began in 2010 and published its final report in February 2013.
By contrast, public trust in doctors remained broadly unchanged and encouragingly, trust in NHS hospital managers improved. The proportion of respondents reporting that they trusted managers ‘just about always’ or ‘most of the time’ increased from 21 per cent in 2002 to 29 per cent in 2014.
Who trusts doctors and nurses?
People who have had recent contact with NHS services (defined as personal contact with inpatient or outpatient services in the past 12 months) were more likely to trust NHS doctors and nurses ‘just about always’ than those who had not (20 per cent compared to 11 per cent for doctors, and 25 per cent compared to 13 per cent for nurses). Recent personal contact did not appear to affect trust in NHS hospital managers.
This difference may reflect genuine relationships of trust built between individuals and the doctors and nurses who care for them, but also perhaps a degree of gratitude for the care that individuals have received. The difference may also be partially driven by negative media reporting having a greater influence over the views of those with no recent personal contact.
Trust also appears to be related to age: older respondents were more likely to trust doctors and nurses ‘just about always’ than younger respondents (see Figure 2). This is perhaps partly because older groups were more likely to have had recent contact with health services, or it may reflect generational differences in attitudes and expectations regarding ‘professional’ status.
The BSA survey also asked about trust in well-known institutions, including parliament, government and the media; when asked whether they tended to trust these institutions, just 1 per cent responded that they trusted the media a great deal, 2 per cent trusted government a great deal and 3 per cent trusted parliament a great deal. Although the questions were phrased differently, they provide an insight into the different levels of trust that the public places in doctors and nurses compared to those working in other sectors. By comparison to other groups, doctors and nurses appear to enjoy a high and enduring level of public trust.
These findings are supported by the results of surveys by other organisations: Ipsos MORI’s latest polling found that doctors were the most trusted profession, with 90 per cent of respondents trusting them to tell the truth. In contrast, just 16 per cent of respondents trusted politicians and 22 per cent trusted journalists to do likewise. This poll showed that trust in doctors has been consistently high while trust in politicians has been consistently low for the past 30 years.
These insights into public opinion may be relevant to the current high-profile dispute between government and the medical profession over doctors’ contracts and seven-day working. Who will the public support? Will this make a difference to the outcomes of the debates? Both sides are now negotiating a new agreement following talks supported by the Advisory, Conciliation and Arbitration Service. But while the industrial action planned for earlier this month has been postponed, there remains a possibility of future strikes if a prompt resolution is not reached. Might this cause erosion of public trust in doctors, which has, until now, been so steadfast? Or will public favour stretch to supporting doctors over strike action?
The British Social Attitudes survey is conducted annually by NatCen. The King’s Fund funds questions relating to health, and reports on these each year.
The BMA has marched its junior doctors up to the top of the hill, and marched them down again. The manoeuvre appears to have scared the Secretary of State for Health enough to make him back down on imposing a new contract for doctors in training. It has emboldened the BMA enough for it to resume the negotiations that it had broken off in October 2014. Jeremy Hunt looked tired and worn, which probably serves him right for intervening in an industrial dispute and making it worse.
On Saturday 28th November the BMA announced that, after two days of talks with the Advisory, Conciliation and Arbitration Service (ACAS), it seemed “increasingly unlikely that we will be able to avert Tuesday’s (1 December) industrial action”. Before the planned strike Dr Yannis Gourtsoyannis, of the BMA Junior Doctors Committee, described in a message to “our fellow NHS workers, trade unionists and campaigners” how the junior doctors were resisting the “imposition of a contract that we feel would jeopardize the profession, patient care and the NHS for a generation”. He signed off with the very doctorish phrase “Kind Regards”, but added the unusual (for medicine) flourish “and Solidarity”.
By Monday November 30th the BMA was able to announce that it had agreed to temporarily suspend its proposed strike action and the Department of Health had similarly agreed to temporarily suspend implementation of a contract without agreement. Time runs out for negotiations on January 13th 2016, but the negotiating period may be extended.
Calling off the strike at short notice did not necessarily avoid disruption of NHS services; thousands of outpatient appointments and planned operations had been rescheduled, but at least military doctors were not deployed.
So what was at stake in all this conflict? Three things stand out from the joint memorandum of understanding published on November 30th.
The first is that there is no more money on the table. The cost-neutral offer made by the employers in November 2015 remains the basis for further negotiation. Pay protection – a strong demand amongst Junior Doctors – will need to come from within the current budget for medical staffing, so there must be losers as well as winners amongst doctors in training. This probably means that overtime payments will decline.
The second is that part of the government’s aim was to secure safe and effective medical staffing in hospitals every day of the week. All parties in the arbitration supported the idea that the quality of care and patient outcomes (including death rates) would be the same every day of the week. Admission of ill people to hospital peaks around 4pm, and these people take four to five hours to diagnose, stabilise and transfer to wards (or operating theatres). The current contract treats work after 7pm as unsocial hours, qualifying for overtime payments. The proposed new contract aims to move the boundary for unsocial hours (on weekdays) to 10pm, so reducing the salary bill during periods of peak activity. Redesignation of Saturday between 7am and 7pm as normal working time will also reduce salary costs for those working at weekends, without reducing their working time.
The third is that the dispute is presented in very different ways to different audiences. Junior Doctor organisers, reporting on the opening rounds of negotiation to colleagues, have focussed on establishing pay protection, pay for all work done and some form of protection for academics.
These details are important to Junior Doctors but not necessarily to the rest of us. We are given the message that the Junior Doctors are saving the NHS – a clear message on demonstrators’ placards – and that the government’s desire for a new contract puts the whole NHS in jeopardy.
Here is how one BMA Divisional secretary informed his members about the reopening of negotiations.
“”….the future of the NHS is not a minor subject, and that’s what is really at stake. Doctors’ and nurses’ working conditions are central to the provision of a high standard of health care. The agenda is to further down grade us all: our Junior colleagues were only the first. We hear that changes in the Consultant’s contract are imminent. Nurses will surely follow. GPs are slightly different but are also under great pressure. All in the name of making the NHS more attractive to private bidders”.
He went on to remind readers of Edmund Burke’s saying: “The only way for Evil to flourish is for good people to do nothing”
So the conflict is not only about the potential exploitation of medical labour, but also about resisting privatisation of the health service – an evil that could flourish if this conflict over unsocial working hours is resolved in favour of the government.
This might strike some as odd. How will an argument about overtime payments (amongst other job-related concerns) lead to privatisation of an industry? Even if the connection was obvious, why does the public display of concern about privatisation appear now, deployed in support of a conflict over a contract? Why did it not appear before, say around the Health & Social Care Act, which openly proposed marketization of NHS services?
It might be tempting to see the use of a political slogan in a contract dispute as cynical opportunism. Although understandable, this would obscure what is happening even further. There is a sense that protecting doctors is protecting the NHS. The BMA has always conflated the interests of the profession with the interests of the public; what is good for the doctor is good for the patient. It has been able to do this because the logic is partially correct – try operating without a surgeon, or an anaesthetist. All other disciplines and roles – nursing, management, physiotherapy, portering, cleaning, radiography, catering and so on – are necessary to run a hospital but not sufficient to run a health service. Given what hospitals do (save lives), doctors are their lynchpins. And when we say “NHS” what we usually mean is hospitals.
The problem is that doctors want hospitals run on their terms, which are not necessarily shared by others, including NHS management. Hospital managers need to roster medical staff to meet patients’ needs, but junior doctors would like to work as few unsocial hours as possible, preferably at advantageous pay rates. It is difficult to see how this conflict of desires can be resolved within the budget currently available for medical staffing. More funding may be needed to give each side what it wants, and that will require a political fight within government.
So another round of Saving the NHS seems likely, when the quiet but difficult debates around the negotiating table give way to catastrophizing rhetoric before the TV cameras. This will be a relief to political campaigners who have been struggling to get much attention for their efforts to prevent privatisation. Labour’s attempt to play the saviour of the NHS in May 2015 was an electoral flop, and independent campaigns desperately need a shot of energy. By an irony of history this may come from the BMA, which once opposed the idea of a national health service.
Steve Iliffe 6/12/15
A free online course led by world-renowned experts at the University of Exeter will offer participants the opportunity to explore how developments in the field of genomics are transforming knowledge and treatment of conditions such as diabetes.
Genomic Medicine: Transforming Patient Care in Diabetes is the latest in the University’s series of Massive Open Online Courses (MOOCs). Registration is now open for the four week course, which introduces the topic of genomics using the University of Exeter Medical School research expertise into diabetes to illustrate the impact of current genomics knowledge and genomic testing.
The course uses the huge advances in the field of genetics that have been made in the last 10 years to illustrate how genomics can inform our understanding of disease risks for individuals, families and populations, looking at patterns of inheritance as well as genetic mutations, gene discovery and genomic sequencing.
Participants on the four week course are guided through their study by Professor Maggie Shepherd , and Dr Anna Murray and Professor Sian Ellard, lead educators and experts from the University’s genomics research group.
Lead educator on the course, Professor Sian Ellard, said: “The University of Exeter has recently celebrated 20 years of ground-breaking molecular genetics research and has been at the forefront of incredible advances in the genomics of diabetes. We are now able to use test DNA to pinpoint the precise mutation which has triggered the form of diabetes, meaning we can deliver more targeted and effective treatment. This is an incredibly fast growing area of research, as we strive to find ever more effective treatments and hopefully, a cure. The development of this course means we are able to open up the fascinating subject of genomic medicine for everyone, making the subject accessible for all.
“The course is open to anyone with an interest in how this genomic era is changing medical science, as well as individuals who just want to learn more about the future of genomic medicine. Throughout the course there will be lots of opportunity for people to debate the impact and value of genomic testing and how this can lead to improvements in clinical care”.
Elements of the course will reflect the current understanding of the strategies for genomic testing and will use patient experiences to explore the mechanisms of diabetes and the genetic diagnosis for the disease.
The online course will also introduce bioinformatics resources and techniques used to interpret the wealth of genomic data generated by the latest laboratory techniques.
The Genomic Medicine: Transforming Patient Care in Diabetes online course begins on 22 February 2016 and takes place over four weeks. Participants can register now via the Future Learn website.
Whilst the care industry has evolved massively over the past 75 years, one thing has remained constant: societies’ love of its older generation. Socio-economic factors have changed hugely, which has forced the care industry to adapt the way in which it operates. However, love, respect and a desire to look after the vulnerable has remained consistent throughout the ages.
The last 75 years has seen care evolve through three previous, clearly definable ages: care within the family, residential (the big growth in retirement homes in the 1970s and 80s) and homecare starting in the 1990s. I believe we are now entering the “Fourth Age of Care”.
Since its inception in 1992, homecare has evolved enormously. Prior to working in the homecare industry, I witnessed the telecoms and internet boom during the 1990s and can honestly say that neither of those industries were evolving as rapidly as homecare is now. Take MS for example; back then, nobody would have predicted that aggressive MS could or would be treated in the home. There is also much greater awareness around learning disabilities and autism in the general population, and these people now require proper care. On top of this, homecare is increasingly becoming relied upon to relieve pressure on the NHS.
These societal changes are bringing about massive challenges in the homecare industry. It must adapt the way in which it operates as the UK population of those over 85 is set to double over the next 20 years. The care industry is being challenged from all quarters on quality and cost. Families also want greater transparency of the care provided and the complexity of care required outside of hospital settings is increasing. And our own research shows that 82% of those with relatives in care would choose a care service that receives real-time feedback on care notes and medication.
The key to meeting these challenges is to create a fully connected care community. There are not too many £5 billion industries where – if something goes wrong with the customer – they are passed into a process like that in homecare; where the home carer calls the supervisor, who is then in touch with the care manager, who will contact the pharmacy and the family, who will speak to the surgery and occupational therapist. In no other industry are there so many important stakeholders notified by single, point-to-point communications. The link between all parties needs to be made much stronger, much more interconnected.
With these monumental changes in society, I feel we are entering a Fourth Age of Care, an interconnected age of care.
The Fourth Age of Care is a substantial shift in care provision to meet the needs of families who demand better transparency, and the care services who need to reduce risk, to the different care stakeholders (pharmacies, social services, community nurses) who need to be connected. Products like the PASSsystem from everyLIFE Technologies is helping care services address the challenges, and benefit from the opportunities, of a new age in care. The technology allows for electronic care planning, real-time medication and care note reporting. In other words, it is helping stakeholders within the homecare industry become more interconnected.
Paul Barry, CEO of everyLIFE Technologies.
Alzheimer’s Research UK has appointed three Chief Scientific Officers to drive its £30million Drug Discovery Alliance. The Alliance, which unites three Drug Discovery Institutes at the University of Cambridge, the University of Oxford and University College London, is a unique drug discovery venture in dementia research.
The Alzheimer’s Research UK Drug Discovery Alliance will couple the deep disease knowledge and biology expertise of the academic community with high quality, innovative drug discovery capabilities. The Alliance will accelerate the discovery of novel, effective therapeutics for Alzheimer’s disease and other neurodegenerative diseases.
Dr John Skidmore, Dr John Davis and Prof Paul Whiting will head up the Cambridge Drug Discovery Institute, the Oxford Drug Discovery Institute and the UCL Drug Discovery Institute, respectively. Together, they bring decades of drug discovery experience, spanning the pharmaceutical and biotechnology industries, as well as academia.
Dr John Skidmore is a medicinal chemist, with a wealth of expertise working in the neurodegeneration and pain disease areas at GSK. Most recently, he has been leading drug discovery projects at the University of Cambridge, funded through the Wellcome Trust’s Seeding Drug Discovery Scheme. He said:
“Drug discovery in an academic setting has gained traction over recent years and the pharmaceutical industry is no longer the sole port of call for target development and lead optimisation. Nearly a fifth of drugs recently approved by the EMA originated from academic and publicly-funded drug discovery programmes, and we’ve seen particular successes in the field of oncology. Dementia is a huge area of unmet clinical need and one that we can tackle by uniting the growing understanding of the underlying disease provided by academia with the broad drug discovery expertise of the Drug Discovery Alliance.”
Dr John Davis has 20 years of drug development expertise, from target to Phase IIa, and has helped steer a dozen drug candidates into clinical development. Discussing the Drug Discovery Alliance’s approach, he said:
“We’ll be taking a broad and collaborative approach to target identification, drawing on discoveries being made by academic researchers in the UK, as well as further afield. We also seek to augment our target development capabilities, making extensive use of disease specific in vitro and in vivo models for robust validation. The Oxford Drug Discovery Institute is well placed for biomarker discovery and the theme of companion biomarkers will run through the drug discovery pipeline; in the first instance to demonstrate target engagement and then for selection and stratification in clinical trials.”
Prof Paul Whiting has built his career through over 20 years of pharmaceutical neuroscience drug discovery, and has published extensively in the field. He said:
“The Drug Discovery Alliance is a fantastic opportunity to make tangible steps towards treatments for neurodegenerative diseases. While we will draw on individual strengths within our host institutions to drive innovation and progress, the three Institutes will keep an open dialogue to maximise potential for developing promising targets. We are interested in hearing from academic scientists with ideas and proposals for exploration as potential therapeutic targets, and encourage informal dialogue.”
As well as seeking academic partners, the Drug Discovery Alliance is looking to interact with industrial collaborators to support the development of the portfolio through a variety of drug discovery functions. The three CSOs are now recruiting to their drug discovery teams to drive forward the work of the Alliance.
Dr Simon Ridley, Director of Research at Alzheimer’s Research UK, said:
“The Alzheimer’s Research UK Drug Discovery Alliance is an ambitious and joined up approach to Pharma-standard drug discovery within major academic centres of dementia research, and one of only a few such approaches in the world. We’re delighted to welcome on board three experienced CSOs, who share our vision and drive. The Drug Discovery Alliance is a call to action to the academic community and will act as a conduit between basic research and treatments in the clinic. The CSOs will collaborate extensively to ensure multiple parallel approaches are tested and developed – a concerted effort to tackle society’s greatest medical challenge.”
The Bromley by Bow Centre and Macmillan Cancer Support have partnered to create an innovative social prescribing service for people living with and beyond cancer in East London. The service helps people on a one-to-one basis to improve their wellbeing. This includes support by trained professionals to explore needs, set personal goals and access local community services. Services may include work and welfare advice, as well as taking part in art classes, walking, gardening and meditation groups.
Nikki Cannon, Senior Macmillan Development Manager for London says: “Every day, more than 80 people in London hear the devastating news that they have cancer. This number is set to nearly double by 2030, which will result in thousands more people in the area needing medical, practical and emotional support”
“For this reason, we’re proud to have partnered with the Bromley by Bow Centre to launch this innovative service which will help people affected by cancer in the area, during and after treatment, so that no one faces cancer alone.”
Patients over 18 with any cancer type in Tower Hamlets, City and Hackney, Newham and Waltham Forest can access the service; by referral through GP practices, hospitals and self-referral.
For further information please visit the The Bromley by Bow Centre website or call 020 8709 9840.
People’s experience of accessing general practice remains positive, with almost 9 in 10 patients reporting in 2014-15 that they could get an appointment. Patient satisfaction with access is, however, gradually and consistently declining, and a fifth of patients report opening hours are not convenient, according to today’s report from the National Audit Office.
Worsening access to general practice matters: if patients cannot access general practice they are more likely to suffer poorer health outcomes or to use other, more expensive, NHS services such as accident and emergency departments.
The NAO found that there is considerable variation in access between different patient groups: older patients were more likely than younger patients to report that they were able to access appointments. The NAO also found that people from a white ethnic background reported better access than those from other ethnic groups. Differences in GP practices’ working arrangements also affect the proportion of patients who can get appointments.
Nationally, 92% of people live within 2 kilometres of a GP surgery, but there are stark differences between urban and rural areas. Only 1% of people in urban areas do not have a GP surgery within 2 kilometres, compared with 37% in rural areas.
Demand for general practice is increasing as the population grows and people live longer, often with multiple medical conditions. However, the Department of Health and NHS England do not have up-to-date data to estimate the number of consultations. The organisations that the NAO spoke to considered that general practice is under increasing pressure, with demand rising by more than capacity.
The NAO identified that problems in recruiting and retaining GPs are increasing, with 12% of training places in 2014/15 remaining unfilled. GPs make up only 29% of the general practice workforce, so alone are unlikely to be able to deal with the rising demand for services. Practices are increasingly using other staff to help manage demand.
Today’s report finds that deprived areas tend to have a lower ratio of GPs and nurses to patients, and where the ratio is lower it is harder for patients to get appointments. The distribution of general practice staff across the country does not reflect need. NHS England allocates funding to local areas using weighted populations that reflect factors such as demographics, health needs and local costs. Despite this, inequalities remain, with the combined number of GPs and nurses in each local area ranging from 63 to 114 per 100,000 weighted population.
Among the NAO’s recommendations are that NHS England should improve the data it collects on demand and supply in general practice, and research how different practices’ appointment-booking and other working arrangements drive variations in access. While making changes designed to improve access, NHS England should analyse the impact on different patient groups.
Amyas Morse, head of the National Audit Office, said today:
“Against the background of increasing demand and pressure on NHS resources, the challenge is how to maintain people’s positive experience of accessing general practice and reduce variation. The Department of Health and NHS England are working to improve access, but are making decisions without fully understanding either the demand for services or the capacity of the current system.
“Better data is needed so that decisions about how to use limited resources to best effect are well-informed.”
Funding for general practice in 2014-15
An estimate of the number of general practice consultations in 2014-15
Of patients in 2014-15 said they could get an appointment when they last tried to book one
GP practices in England in 2014, with 125,300 full-time equivalent staff
Full-time equivalent GPs (including trainee GPs) at September 2014
Average number of hours GP practices are open per week
Of patients live within 2 kilometres of a GP surgery
63 to 114
Range in the number of GPs and nurses per 100,000 people, after adjusting for factors such as age and need
Of general practice training places were unfilled in 2014/15
Of patients in 2014-15 said it was not easy to get through to the GP practice on the telephone
Following the Spending Review by Chancellor George Osborne, Stephen Burke the director of Good Care Guide comments as follows: “The Chancellor has failed to tackle the growing care crisis. Increases of up to 2% in council tax and in the Better Care Fund are completely inadequate to meet the funding gap in care for older and disabled people. They will make the care system even more of a lottery.
“With an ageing population and rising demand for care, shrinking budgets mean that many more elderly people will go without help. They will be forced to pay for care themselves, or rely on family and friends for help, or struggle on their own. There will be a massive impact on the NHS as more older people will need hospital and emergency care.
“There is now the very real prospect of the mass closure of care homes and home care providers because of the continued squeeze on fees paid by councils. There will be huge consequences for older people and for the NHS.
“By 2020 the care crisis will force the vast majority of older people needing care and their families to fend for themselves. There will be no security of care for those who need it most.”