The healthmatters blog; commentary, observation and review
Responding to King’s Fund analysis which has found central government cuts have forced councils to reduce planned spending on public health services by £85 million, Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations in England, Wales and Northern Ireland, said:
“The government’s whole approach to reforming health care has been based on the promise of a radical upgrade in prevention and public health, yet all we have seen is cut after cut in this budget. It is self defeating to reduce public health spending while looking to transform care.
“Our members report direct cuts to front-line services, including the treatment of substance misuse, smoking cessation and sexual health. Further gaps in out-of-hospital and social care funding intensifies the pressures on health services.”
A new report suggests that a more strategic role for ‘traditional’ community hospitals might be timely within the NHS in England.
According to research by RAND Europe, the European Observatory on Health Systems and Policies, and Bournemouth University, community hospitals could play a more active role in meeting the challenges facing the NHS, in particular in larger hospitals. This includes easing pressures on A&E and servicing people with long-term conditions. Currently 15 million people in England have a long-term condition, which takes up 50 per cent of GP visits, 70 per cent of the days patients spend in hospitals and 70 per cent of the overall NHS budget.
The study, funded by the National Institute for Health Research (NIHR), is against the background of an increased focus on shifting services closer to people’s homes and delivering more integrated care locally. However, there is no defined role for community hospitals in the English health service, with many largely responding to the needs of larger hospitals. At present, there are around 300 community hospitals in England, 219 of which have beds. A number of community hospitals have faced closure during the past ten years, and some still face uncertain futures.
The study highlights a number of lessons for NHS England on how to incorporate community hospitals into the English health system based on comparable models in five other countries – Norway, Finland, Italy, Australia and Scotland.
The report notes that community hospitals are able to provide a wide range of services, covering the entire spectrum of care provision, from preventative and primary care, through to inpatient and outpatient medical and surgical care. It highlights evidence of improved patient experience and satisfaction associated with community hospitals, while staff valued key aspects of the service, including its ease of access and sense of ‘homeliness.’
However, the often remote location of community hospitals means it can be difficult to attract and retain staff, and maintain a diverse employee skill-set. Infrastructure and IT can also be a challenge, particularly where community hospitals are seeking to deliver integrated care. In addition, the cost-effectiveness of community hospitals is not clear, and the current evidence base remains limited.
The full report is available here: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr05190/#/abstract
“The social care shortfall is edging ever closer to a full blown crisis” – Nick Sanderson, CEO of Audley Retirement comments on Care Quality Commission report
Nick Sanderson, CEO, Audley Retirement Villages said:
“The social care shortfall is edging ever closer to a full blown crisis and we now find ourselves in a situation where underfunding is at such a critical point, the quality of care itself is falling. More than ever people are having to watch their loved ones experience an appalling quality of care; just further evidence that existing care practices are both undesirable and deeply flawed.
“There may be no ‘one answer’ on how we deal with the creaking care system, but we do know that high quality housing options with flexible care available is a model that works. No matter what their age or care needs, people clearly prefer to be at home as they age, rather than in a nursing or care home. If there were more options which allowed older people to continue to live in their own homes, but bring in support where needed, it would go a long way to improving quality of life. It’s certainly no quick fix, but we need to stop wringing our hands and ignoring the benefits that high quality retirement property delivers.”
NHS Prescription Charges Stop Patients Receiving Life-Changing Medication
The National Rheumatoid Arthritis Society (NRAS) today releases four shocking statistics to highlight how the cost of an NHS prescription in England is impacting on the lives, health and wellbeing of people living with Rheumatoid Arthritis (RA), following a report released by the Prescription Charges Coalition.
1. Nearly a third (31%) of people with RA who have been issued a prescription from their GP have not collected it due to the cost. This means one in three people with RA do not take their medicine as prescribed.
2. Three quarters of those surveyed are not aware of the NHS Low Income Scheme (76%) and therefore many people are paying for their medication when they are entitled to free prescriptions.
3. Half of the people surveyed with RA do not have a Prescription Prepayment Certificate – because they feel it is not worth obtaining one, or it will be too expensive for a fluctuating condition.
4. Over half (55%) of people that missed medications due to the cost, claim that by not taking some of their medication, it has a direct and noticeably negative impact on their health.
Ailsa Bosworth, CEO at NRAS commented: “RA is a debilitating, frightening and potentially life-limiting condition. The fact that so many people living with this disease are failing to get the help their GPs prescribe in terms of medication is a travesty. Everyone, regardless of their medical condition, should receive the medication they need to manage their health and improve their daily life.”
People with RA, their families, friends and colleagues can contact the NRAS helpline for advice on any of the above issues – free-phone 0800 298 7650 or email email@example.com.
Healthcare innovators are being invited to submit their ideas for a prestigious annual competition recognising innovation and excellence in healthcare.
Now in its 14th year, the Bright Ideas in Health Awards encourage, celebrate and reward the outstanding innovation and excellence emerging from front line NHS staff and SMEs in the North East and North Cumbria.
Highlighting the NHS staff and healthcare SMEs working to improve patient care throughout the region, this year’s hopeful healthcare pioneers are being encouraged to submit their inventions and innovative ideas as the contest opens for entries.
Dr Nicola Wesley, Director of Innovation at the Academic Health Science Network for the North East and North Cumbria (AHSN NENC), said: “Over the past 14 years the Bright Ideas in Health Awards have grown to become one of the most highly sought after accolades in the region’s healthcare sector.
“The awards showcase the outstanding examples of practice and innovation achievements of frontline staff and budding entrepreneurs that help to improve patient care, like no other event.
“For winners, the recognition gives a huge boost to their teams and organisations. It enhances their projects, raises morale and can help to secure backing and finance.”
The event is organised by RTC North in partnership with the Academic Health Science Network for the North East and North Cumbria (AHSN) and the NIHR Clinical Research Network North East and North Cumbria.
This year there are seven categories: Innovative Technology or Device, Service Improvement, Patient Safety and Quality Improvement, Outstanding Industry Collaboration with the NHS, Primary and Community Care, Research Delivery Impact, sponsored by NIHR Clinical Research Network North East and North Cumbria and Most Innovative NHS Education Provider, sponsored by Health Education England North East.
The winners of each category will receive a cash prize to help progress their ideas as well as specialist support from organisers RTC North, the AHSN NENC and the Clinical Research Network NENC.
Last year’s ceremony saw success for a range of pioneering ideas including an improved IVF egg collection procedure to save both clinician and embryologist time and a fixation device for use in ophthalmic imaging.
One of the winners of the Patient and Public Involvement Award was a project aimed at empowering GP practice patients to become ‘Practice Champions’.
Sheinaz Stansfield, Practice Manager at Oxford Terrace and Rawling Road Medical Group in Gateshead, was part of the team from NHS Newcastle Gateshead Clinical Commissioning Group that led the ‘Practice Champions’ project, which won the Patient and Public Involvement – Making Research Better award.
The team developed 39 patients as ‘Practice Champions’ who have been trained to support the GP practice, other patients and the broader community, with the aim of taking a population health and wellbeing approach to the provision of GP services.
Sheinaz said: “Winning a Bright Ideas in Health Award for the Practice Champions initiative has been a fantastic accolade for our team. The prize money has helped to fund a full year’s group work and events allowing us to build on the programme, improving services for our practice population.
“Going forward new relationships with patients and communities will have to be developed to address future challenges. The work within our practice at Oxford Terrace Medical Group has gone beyond this to enable patients and communities to work in a ‘liminal space’ understanding both perspectives to work collaboratively to address health inequalities and focus on a patient centered approach to wellbeing.”
Julia Newton, Medical Director of the AHSN NENC, said: “The awards are not only an accolade in their own right but play a key role in making the region’s healthcare industry the great success it is today.
“With the support of our sponsors, we are honoured to once again be able to celebrate the achievements of hardworking people who focus their time and efforts on striving to improve care for their patients.
“I’d encourage anyone with a great idea – whether it’s a groundbreaking piece of technology or a better way of delivering a service – to enter the competition. You could be crowned one of our winners.”
This year’s Awards ceremony, which is sponsored by Health Education England-North East, Sintons, Archer IP, University of Teesside and NHS Newcastle Gateshead CCG, South Tees Hospitals NHS Foundation Trust, City Hospitals Sunderland NHS Foundation Trust and supported by the Emerging Electronics Manufacturing Centre, CPI, will take place at the Hilton Hotel Newcastle Gateshead on Wednesday November 15th.
The closing date for entries is Monday September 11th, 2017. To submit entries, visit:
- Workers in excellent health are more aware of the need to plan financially for retirement
- Only 35% of people in the UK take their health seriously by establishing good habits
- Only 40% consider their long-term health when making lifestyle choices
A global study looking at people’s outlook for retirement revealed that a successful and enjoyable retirement requires a focus on both good financial habits and a healthy lifestyle. The research carried out in countries spanning Europe, the Americas, Asia and Australia, highlights that achieving retirement aspirations requires more than saving, investing and planning, it also depends on staying in good health. Workers around the world share aspirations for an active retirement but relatively few are taking steps to safeguard their health or prepare financially. One of the key findings globally is that there is an alarming disconnect between people’s good intentions and their actions, according to recent research from Aegon.
Many people believe that they are in excellent or good health today, but are they taking sufficient action to help ensure they can stay healthy as they age? When it comes to older age, 82% of people in the UK say they have some concerns about their future health, but there’s a real gulf between their concerns and current behaviours, with surprisingly few taking adequate steps to safeguard their health:
- Only 35% of people currently take their health seriously by carrying out regular self-checks or having routine medical check-ups
- Only two fifths (40%) consider their long-term health when making lifestyle choices, for example, trying to avoid stress
- Alarmingly 46% don’t exercise regularly and 44% expose themselves to harmful behaviours like drinking too much or smoking
Retirement has become an active stage of life, which people associate with staying socially connected, participating in their local community and for a growing number, keeping working. Maintaining good health is an essential pillar for each of these activities.
In the UK, the majority (75%) of people associate positive words with retirement. The most widely held retirement aspirations are, travelling (55%), followed closely by spending time with friends and family (52%) and pursuing new hobbies (41%). A noteworthy 28% of people in the UK mention a desire to work in some capacity in retirement.
The survey also reveals that workers who are in excellent or good health have a more positive financial outlook about their future retirement compared with those in fair or poor health. Those in excellent health (46%) are over three times more likely to be confident of achieving a financially comfortable retirement than those in fair health (13%).
Steven Cameron, Pensions Director at Aegon said:
“Finding ways to develop good savings habits and to maintain a healthy lifestyle from an early age are key factors for a successful retirement. Those who adopt multiple healthy activities are also more likely to be financially prepared for retirement than those who don’t.
“Retirement planning has traditionally focused very heavily on finances, without sufficient consideration of health. A successful retirement requires maintaining good health and being financially secure. However, many people are failing to prepare in ways that can increase their likelihood of success.
“Health has the potential to have major impacts on people’s retirement plans. For example when taking the decision about when to stop working and enter retirement the timing is often dictated by health factors. And while we all aspire to a long and healthy retirement, this may involve saving more to make the most of these years.”
We are so used to the attacks on the NHS from the Daily Mail that we forget that it can be merciless to private medicine too. A critical article by Lois Rogers for the Mail’s on-line edition on June 12th provoked the Association of Independent Healthcare Organisations (AIHO) to respond.
Rogers’ attack begins with the story of a man (a Director of a high-end car company) who underwent surgical removal of the prostate (no small procedure) in a private hospital, only to be told years later that the surgery had not been necessary. According to the Mail’s journalist he is just one of at least 66 people, many of whom were treated privately, who believe they were misdiagnosed or underwent unnecessary surgery at the hands of the same surgeon, Manu Nair.
EXPOSED: How the NHS is paying millions to private surgeons for operations that we may not need – and could even HARM us
The quality of care received by NHS patients in private hospitals is under review
Insiders fear countless people are paying for needless, expensive operations
There’s also been a sharp rise in complaints from unhappy or worried patients
Those treated in private hospitals are often not compensated if things go wrong
By Lois Rogers for The Daily Mail Published: 22:06, 12 June 2017 | Updated: 13:57, 14 June 2017
This story is the tip of a much bigger iceberg in private hospital care, Rogers asserts, citing a number of experts who express concern about patients being at risk of needless treatment or botched surgery in the private sector. Whilst the NHS is far from immune, says the Mail story, the private sector seems to face particular problems with lack of scrutiny of what surgeons are doing.
Doctors working in private hospitals earn more if they do more treatment, and so have a financial incentive to be interventionist, even ‘gung ho’, about operations. They are not subject to the same monitoring and scrutiny as in the NHS, according to Brian Toft, visiting professor of patient safety at Brighton and Sussex Medical School. And private hospitals don’t have to monitor outcome trends to detect substandard surgeons either, he claimed. According to the Mail’s story, the Royal College of Surgeons published an open letter to the Government calling for private hospitals to be required to disclose data on botched operations, so rogue surgeons can be identified.
Professor Toft is joint author of a 2015 report, ‘How safe are NHS patients in private hospitals?’, published by the Centre for Health and the Public Interest think-tank, which the Mail journalist reported as saying that risks to patient safety ‘remain widespread’.
The report argued that NHS patients should be made aware of these risks before being treated in private hospitals. Linda Millband, a lawyer representing 500 patients who underwent unnecessary breast surgery, said to the Mail: ‘NHS hospitals have regular multi-disciplinary team reviews of patient care, but there is no requirement for anything similar in private hospitals. Private hospitals consider themselves above the law and above the standards followed by the NHS.’ The article then goes on to mention by name NHS consultants who have been accused of over-treating patients in the private sector. Read more at: http://www.dailymail.co.uk/health/article-4597524/EXPOSED-NHS-pays-millions-private-surgeons.html#ixzz4l1HcaqS)
While surgeons in the NHS are covered by the NHS Litigation Authority, in the private sector it is the surgeons themselves who bear financial responsibility if things go wrong. They are legally required to arrange their own insurance cover, but in some cases have operated without this, says the Mail. About £10 million was paid from public funds to compensate 250 NHS patients in a recent case of botched surgery, but Rogers believes that many private patients who have undergone unnecessary surgery may never be compensated.
Unsurprisingly the AIHO was not pleased by these claims and responded sharply, pointing out that surgeons in the private sector are all responsible to the General Medical Council, mostly work for the NHS (where they are scrutinised), and work privately in hospitals that are inspected by the Care Quality Commission.
The AIHO insists that the ‘independent’ (private) sector is actively working with NHS England and other relevant bodies to bring the level of reporting of surgery in line with the NHS’s own. Independent hospitals are already required to provide detailed data on every private episode of care, and they are beginning to publish performance measures for 149 common procedures at over 250 hospitals. That is just a beginning, says the AIHO, but it is of immediate benefit to patients, and is better than anything that has existed before. More will soon follow, according to the AIHO, including measures of consultant performance in 2018.
The AIHO says “failings of a handful of rogue surgeons does not represent the high quality and compassionate care delivered day in and day out by the independent sector as a whole”.
This spat matters. Treating NHS patients is big business for private hospitals. 530,000 surgical procedures were carried out on NHS patients in the private sector in 2016. A third of all NHS-funded hip and knee replacements are now being carried out in private hospitals. The NHS paid the private sector £8.7 billion for services last year, amounting to 28 per cent of private hospitals’ income. The private hospital sector constitutes a source of spare surgical capacity for the NHS, which is obliged to ensure that private hospitals are inspected and judged as closely and critically as NHS hospitals. Private hospitals are in effect in the NHS’s public domain (as distinct from the state-run public sector) when they do NHS work. They are, then, like GPs, dentists, pharmacists and other contractees to the NHS, and they have to perform according to NHS rules. That is why the Mail sees them as fair game for the critical journalist.
Steve Iliffe 26/6/17
At the time of writing Britain is basking in glorious sunshine and we are in the midst of a record breaking heatwave. The media is full of “sun safety” tips and advice – but did you know hiding from the sun can be as dangerous as getting too much exposure?
Most of us in the UK are Vitamin D deficient. This is mainly because during the dull and dreary months – which let’s face it, is most months – we don’t get enough sunlight.
While Vitamin D levels are generally higher in summer, it’s not the same for everyone. The process of producing Vitamin D becomes less effective with age, meaning older people are more likely to be Vitamin D deficient, as are pregnant or breastfeeding women, people with certain chronic medical conditions (affecting the kidneys or bowel), or on certain medications.
Also, the darker your skin tone, the more sunshine your body requires for this process – meaning people of Mediterranean or African heritage require more sunshine to maintain good Vitamin D levels, and are more likely to be deficient in the UK.
Why is Vitamin D important?
You know that Vitamin D is good for our bones, but most of us don’t realise the true importance of Vitamin D, and how a lack of this Vitamin can affect our health.
Our skin plays a big role in producing Vitamin D, which is activated by sunlight. In more technical terms, Vitamin D regulates the levels of two important minerals associated with bone health – calcium and phosphate. These are absorbed via a gut, in a diet rich, and are used in bones, teeth and muscles.
That’s why, a deficiency in Vitamin D can result in bone pain, muscle weakness and general tiredness. In severe cases, this can even lead to conditions such as brittle bones, rickets in children and osteomalacia in adults.
The Need For Vitamin D vs Staying Safe in The Sun!
When we talk about ‘sun exposure’, simply sitting by a window isn’t good enough – you’ve got to actually go outside to properly expose your skin to sunlight! But don’t worry, we’re not insisting on an hour’s sunbathing every day to get sufficient exposure – many doctors recommend that spending just ten minutes a day outside with good sunlight exposure on your arms (and legs, if possible!) is sufficient in maintaining a good level of Vitamin D.
However, there’s a fine line between getting enough sunshine and over-doing it!
Spending too much time in strong sunshine can lead to sunburn, where too much UV radiation from the sun damages the skin. This doesn’t just result in the short-term effects of pain and redness (and if you’re really unlucky – blistering, swelling and a splitting headache too!), but can have significant long-lasting, harmful effects on your skin. It’s estimated that getting sunburn, even just every couple of years, can triple your risk of developing skin cancer.
To prevent sunburn, make sure you wear sunscreen (at least factor 30, with UVA and UVB coverage!) when spending more than ten or so minutes in the sun. Reapply this every few hours, or after taking a dip in the pool or sea. Cover up with appropriate clothing, especially hats and sunglasses with UV protection, and avoid direct sun exposure in the hottest hours of the day during summer – usually between 11am and 3pm.
It’s difficult to maintain the right balance of sun exposure all year long, but it’s also incredibly important in the maintenance of your skin and bone health! Your GP is a great source of advice on any regarding sunburn, skin cancer, or Vitamin D deficiency, if you had any concerns regarding these topics.
If you do happen to be Vitamin D deficient, for whatever reason, your doctor will usually recommend taking supplements, such as “colecalciferol” or “ergocalciferol”, available from most pharmacies and even supermarkets. Kids who are deficient can take ‘vitamin drops’, as a Vitamin D supplement.
For more information visit www.londondoctorsclinic.co.uk
Dr Seth Rankin, Founder of London Doctors Clinic (www. Londondoctorsclinic.co.uk)
Ruth Powell, Clinical Negligence specialist at the law firm BL Claims Solicitors, said: “Most of those people would be shocked to discover that dermal fillers are only subject to the same level of regulation in the UK as ballpoint pens and toothbrushes. When it comes to those who carry out filler procedures it’s rather like the Wild West out there – pretty much anybody can do it.
“It is reported that fillers, laser hair removal and Botox account for nine in 10 procedures, and approximately 75 per cent of the market in terms of money spent. There is a widely held view that this market is partly driven by pressure to look good from TV, magazines and social media – particularly the “selfie culture”. It is perhaps not surprising that people are tempted by advertising for a quick fix to their wrinkles after seeing perfectly-posed pictures of smooth-skinned celebrities on Facebook, Snapchat or Instagram.”
Responding to the Queen’s Speech, Mental Health Network chief executive Sean Duggan said: “We welcome the Government’s commitment to prioritising mental health and the planned reform of mental health legislation which is much needed. The Mental Health Act has played an important role in supporting people who have reached the point of crisis, but it is nearly 35 years old and clearly needs refreshing.
“It would have been a mistake to scrap it and start from scratch without undertaking a full review. So we support the proposal for reform and in particular identifying why the number of detentions under the act have risen by around 10 per cent year-on-year since 2010/11.”