The app that aims to tackle the chronic NHS midwife shortage

The findings of a new NCT report, which revealed that tens of thousands of women were having to seek help at accident and emergency (A&E) departments or with their GP because they cannot reach a midwife, do not come as a surprise to Hannah Harvey.

Harvey has been a midwife for five years. She says that while she and her colleagues care deeply about the women they look after, a nationwide shortage of midwives and government cutbacks to training bursaries mean they often struggle to provide the necessary support to new mums. According to the report by the NCT (pdf) and National Federation of Women’s Institutes, 36% of women who were not able to see a midwife as often as they required postnatally said that it caused them a great deal of concern while almost a third (31%) said that it resulted in a delay of a health problem (for them or their baby) being diagnosed and treated. The Royal College of Midwives (RCM) estimates England has a shortfall of 3,500 midwives.

“It’s really difficult,” says Harvey, who works in West Sussex. “Of course [as midwives] we want to provide round-the-clock care, to spend two or three hours with a new mum teaching her how to breastfeed, and offering the other support she needs, but there’s just not the capacity to do it. We’ve got to look at other ways of helping people.”

It was this challenge, alongside spotting a review that found high numbers of pregnant women use the internet to search for advice, that prompted Harvey to take matters into her own hands. In July 2016, she launched Ask the Midwife, an app that enables mums-to-be to contact midwives for advice.

“I [wanted to] create something where users could ask questions and get a fast response from a midwife, instead of using Google or parenting forums, where you’re not getting professional advice,” says Harvey.

“I saw it as a way of helping the women, [somewhere] they could go and access advice and the extra care they needed and they wanted. It’s also a platform to alleviate the pressure on the NHS and the midwives working in the community and the hospitals, who don’t have the time to spend with people who might want a bit more help with their newborn baby.”

Harvey initially used £10,000 of her own savings and raised £50,000 from friends and family to help develop and launch Ask the Midwife on iOS last year. Eight months after starting the business, the app has 4,000 users across the UK, and a network of 45 registered midwives. Harvey initially found the midwives by advertising for consultant positions, even receiving 500 applications in three days. Each midwife gets paid 25% commission per question or chat they answer. Many of the midwives still work for the NHS but use Ask the Midwife to earn extra money. Harvey estimates that 15-20% of conversations need to be escalated to an in-person consultation.

For the expectant mothers, there’s a small charge (from 99p) to ask a question, increasing to £19.99 a month for support during the nine months of pregnancy and up to 12 weeks postnatally. This includes unlimited use of the “ask” and live chat services, with responses from a registered midwife promised within an hour. Midwives are available seven days a week, 14 hours a day, with plans to make it a 24-hour service in the near future.

“We get a lot of early pregnancy questions, after someone goes to their GP but before they have their first midwife appointment at eight to 10 weeks. And then, postnatally, we get a lot of breastfeeding and feeding questions. If you’ve never had a newborn baby before, you don’t know what is normal.”

Digital technology is rising in popularity among expectant mothers. According to the NCT’s study, 34% of women are choosing to use an app to support their pregnancy – two thirds (65%) used apps to track milestones, such as when the baby kicked or to track contractions, and a third (32%) used digital technology to access information about diet, lifestyle or health issues. Popular apps include BabyBump, What to Expect (from the authors of What to Expect when you’re Expecting), and My Pregnancy Today, although the majority available have been developed in the US.

Jacque Gerrard, the RCM’s director for England says such digital technology can be useful, as long as the advice is backed up by evidence-based information and carries a health warning. “Women have access to mobile phones, the internet and they want instant answers, so I think [such digital technology] is a positive step,” she says. “But what I would say is it has to be used with caution. Sometimes women do need access to a midwife or a doctor and that’s got to be the first point of contact. The NHS does provide access to a midwife 24/7, 365 days of the year, no matter where you are in the country.” The RCM is itself currently developing a hub for pregnant women, including a live help function.

Harvey is in talk with NHS trusts who are considering piloting her service in their areas, and says she’d eventually like to be able to offer the service for free – although finding funding will be the first priority; she’s currently plotting an investment round with angel investors. There are also plans to expand into other countries once the market is established in the UK.

But it’s been a learning curve for the midwife, who still juggles working night shifts with developing the business. “It’s completely different to my NHS work,” she says. “I’ve never been an entrepreneur, but the fact that I’m getting that feedback from people saying this is something they want is keeping me going and giving me that drive and determination to make sure it succeeds.” Harvey says the feedback so far has been very positive and the app recently won best parenting app and best educational app at the Mumii Family awards.

“[Entrepreneurship] has been the best experience I’ve had,” she says. “I was at a baby show in London recently and somebody said she’d used my app in early pregnancy and it was the best money she’d ever spent. She had been really worried she was losing her baby, her GP hadn’t reassured her and she didn’t know where to go. She had a 10-minute chat with one of the midwives and felt really reassured. Then she realised I was the one she’d spoken to and she burst into tears, giving me a hug. That for me felt like the icing on the cake – this is why I’m doing it, this is why I’ve put all the hard work in.”

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The app that aims to tackle the chronic NHS midwife shortage

Let’s talk about cancer: the Manchester project that aims to save lives

Security guard Gilbert Morris will stop at nothing to talk to other black men like himself about cancer screening. He once defused a late-night fight in a Manchester club by asking five scuffling men whether they had had their prostate tested.

“It was like I had a magic wand that lowered their aggression,” laughs Morris. “They stopped in their tracks and put their fists down. Two of them said their fathers had prostate cancer and another’s uncle had it. We ended up sitting round the table talking about their fears of having their privates looked at.”

The success of this 51-year-old six footer in communicating the risk of cancer is being harnessed by health chiefs in Greater Manchester as part of the launch of a social movement to sign up 20,000 people as cancer champions.

The idea, led by Greater Manchester Cancer Vanguard Innovation, (part of Greater Manchester Cancer – the cancer programme of Greater Manchester’s devolved health and social care partnership), is to use people power to create a cultural shift in one of the UK’s cancer hot spots, and make it normal to talk about screening, healthier lifestyle options and catching symptoms early.

Working with the voluntary sector, the aim is to sign up 5,000 cancer champions by autumn 2017, and to reach 20,000 by 2019. Mobilising this cancer army is one of a series of measures to cut premature cancer deaths in the area by 1,300 by 2021.

Gilbert Morris developed prostate cancer in his 40s and couldn’t find anyone to talk to about it. Photograph: Karen Wright

The cancer death rate in Greater Manchester is 10% higher than the national average, according to Cancer Research UK figures. Manchester comes bottom out of 150 local authorities for premature deaths (under 75 years). Cancer experts reckon that around 40% of cancer deaths could have been prevented by screening or lifestyle changes, the potential for saving lives in Greater Manchester is great, since 6,700 people died of the disease in 2013.

Cancer champions programme director, Jenny Scott, explains: “By creating champions we will create support for active lifestyle changes. We need to engender people’s interest and then it will spread like a wave. I hope that people will soon be chatting about what they can do – whether it be at the bus stop or a football match.”

This radical approach is the result of a realisation that health systems are not having an impact in many sectors of society.

Morris’s story underlines this. He developed prostate cancer in his 40s and could not find anyone to talk to about it. He volunteered with the Manchester-based Black Health Agency to highlight the heightened risk of the disease in the African-Caribbean community. As his experience shows, the mention of prostate cancer can stop people in their tracks.

Morris says: “Doctor does not always know best, because some men never go to the doctor. I will speak to men anywhere – at a street corner or a bus stop. I am not embarrassed about talking about it, because if I can save one life I have done my job.”

He joins 1,000 plus existing volunteers willing to become cancer champions. More will be recruited through formal links between local authorities, Action Together and Voluntary Sector North West. Interested individuals will be put in touch with voluntary organisations across the 10 local authority areas, and receive advice and training. Workshops and publicity campaigns are planned. A web platform is also being built where people can become a champion and share their experience.

The rewards of volunteering are rich according to cancer champion Zoe Ashworth, a 29-year-old single parent from Stockport. She spends around three hours a fortnight at a nearby GP surgery in a deprived area calling people who have not returned their bowel cancer screening kits.

“Volunteering gives me real personal satisfaction,” says Ashworth. “Of all the people I have called, every single one has agreed to receive a screening kit. My friends will not listen to anybody else, but they can’t get away from me!”

Findings from the cancer champions project, will be combined with other data and public health information, to create a national dashboard to help prevent avoidable deaths across the rest of the UK. It will also be shared with cancer alliances being set up all round the country.

Leading Greater Manchester’s social movement projects, Ben Gilchrist, sees the cancer champion work in the context of a step change in society, in which many people no longer take their health messages from a health system.

He is clear that volunteering is not a replacement for NHS and public services, or a cost-cutting measure but the “right thing to do” to empower communities.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Let’s talk about cancer: the Manchester project that aims to save lives

Baby bracelet aims to save newborns in India from hypothermia

At the upmarket Cloudnine hospital in Gurgaon, the latest accessory among parents is a temperature-taking bracelet for newborns.

The bracelets, made by Bangalore-based startup Bempu, constantly monitor a baby’s temperature and sound an alert if it goes too high or too low. Doctors use the bracelets while babies are in neonatal intensive care or prescribe them for babies being discharged.

“New mothers are very worried about whether their babies are too warm or too cold,” says Dr Sanjay Wazir, director of the neonatal intensive care unit at the hospital. “[The bracelets] are better than a thermometer because they are continuously monitoring the baby’s temperature.”

In India, 8 million prematurely-born underweight babies every year are at high risk of developing hypothermia, where body temperatures fall below 36.5C, which contributes to fatal conditions such as asphyxia, sepsis and pneumonia. India has the highest number of infant deaths caused by premature birth, most of which could be prevented. Maintaining a newborn’s body temperature is critical to its survival.

Baby in Gudalur wearing a Bempu bracelet. Photograph: Bempu

Bempu is currently running a pilot scheme in the desert state of Rajasthan, funded by health foundation WISH, which aims to make its bracelets a staple free handout for all babies discharged early from government hospitals.

The chaos of government hospitals can lead to oversights when monitoring newborns’ temperatures, says Gini Morgan, head of public health at Bempu, which has benefitted from grants from the Bill and Melinda Gates Foundation, USAid, UK Aid and other agencies.

“The beds are always filled, the entire family is in the waiting room every day, there are often three babies in one incubator, where there should be only one. There’s a lack of staff, the nurses are overworked, running around with competing priorities. In all that, its hard to manage all these high-risk babies.”

Many hospitals discharge babies early to free up cots, or because parents need to return to remote villages and cannot afford to wait for long periods at the hospital. “Parents travel to district hospitals and they need to get back home,” Morgan explains. “Every day that they’re away from work, they’re missing a pay check.”

Once home, parents are less likely to notice symptoms of hypothermia or have adequate information about how to keep babies warm. Half the world’s newborn babies die at home, almost all of those who die are in developing countries. Hypothermia is one of the leading contributors to these deaths. Fortunately Bempu bracelets are powered by a battery that runs for a month, the critical period for newborns.

Bempu bracelets are powered by a battery that runs for a month, the critical period for newborns. Photograph: Bempu

“It’s not the same as using a thermometer because the device is constantly monitoring the baby’s temperature. Say you take the baby’s temperature now, it can fall after 30 minutes, and you may not notice,” says Dr Wazir, who hopes a crowdfunding campaign will help supply Bempu bracelets to underprivileged mothers at his Premature Babies Foundation, ahead of the winter months, when the risk of hypothermia rises.

But the bracelets alone are not enough, says Dr Vishnu Bhat from the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, who conducted an independent study of their accuracy, the results of which are yet to be published. “We found that the nurses were taking temperatures more accurately than the Bempu bracelets. But the bracelets were good, we found they gave an accurate temperature reading between 85-90% of the time,” he said.

“The bracelets would be useful to mothers who live far from the hospital, the alarm system provides a warning to the mother that the baby is unwell. It would also be good in postnatal wards where nurses are in short supply. But of course, the temperature is not the only issue, mothers need to be trained, they need to be told what to do if the temperature is too low or too high,” he said.

Baby bracelet aims to save newborns in India from hypothermia

From Dutch hospital to Afghan clinic: new VR app aims to link 8.5m doctors

Imagine you’re a doctor in Swindon and a patient with a chewing tobacco habit turns up with unusual tongue lesions. What if you could, at the press of a few buttons, locate and get instant advice from the Mumbai-based world expert on cancers related to chewing tobacco?

This is the vision for a new app which aims to transform the way in which 8.5 million doctors around the world share their knowledge and skills.

MDLinking – an expert directory, instant messaging service and video source – began trialling a beta version for iPhones in May this year and aims to launch its full Apple and Android versions before 2017.

The Dutch startup, which has €2.5m of seed funding, has several hundred testers in the Netherlands, 4,000 registered doctors so far and is in talks with organisations including Médecins Sans Frontièresand the Aga Khan Development Network (AKDN) about using its free software.

“The original idea was that if doctors worldwide connect with each other and share knowledge, healthcare will improve on a global level” says Alec Behrens, co-founder of Booking.com and founding partner of MDLinking.

Instant messaging

Many doctors are already using instant messaging tools to discuss patient cases. A 2015 survey found more than 30% of doctors surveyed said they were sending patient related information over services such as WhatsApp.

Vascular surgeon Hans Flu, co-founder of MDLinking, came up with the idea for the secure healthcare network when he realised just how much his colleagues were using WhatsApp. He had privacy concerns over the app and worried about its plans to share account information with parent company Facebook.

Ultimately, however, Flu wants to find a solution to what he sees as the big problem in the medical world: communication. “If you communicate badly, the patient’s going to suffer, and this is a key element that everyone can improve. This is a tool developed by medical doctors, for medical doctors, that is free.”

As well as being a directory and secure instant messaging tool (it only accepts vetted medical professionals), the start-up is using virtual reality technology to record operations from multiple viewpoints, to form an interactive teaching tool – especially for countries where operating theatres are scarce.

Dr Hans Flu, co-founder of MDLinking Photograph: Hans Flu

Gijs Walraven, director for health at AKDN – which operates a non-profit, private healthcare system in developing world communities – is interested in collaborating with the MDLinking tool.

“AKDN’s work in health is mainly in sub-Saharan Africa, central and south Asia,” he says. “In these countries, there are fewer medical doctors and they have much more limited opportunities to consult with colleagues on difficult cases as well as to [access] education. New ways to interact at a distance and in a secure manner could play a very important role to improve this.

“Learning new operating techniques and how to better diagnose using the innovative video techniques that MDLinking is developing could be a real breakthrough.” And it works both ways, he says: “Healthcare providers in rural settings in Afghanistan have knowledge and skills that could be beneficial to health practitioners in London.”

Teaching by virtual reality

Dr Gijs van Acker, a surgeon at Medisch Centrum Haaglanden hospital in the Netherlands, first created teaching videos for his vascular surgery website a decade ago. “One of my residents was Hans Flu, and when he started MDLinking I said, ‘You need something that’s educational’. We wanted to make something more intuitive than 2D films,” he says.

They came up with virtual reality combined with the view-selection interface, allowing users to flick to different sections of the operation. Traditional teaching methods can’t compete, according to van Acker, who says that dead body tissue loses its colour, so isn’t the same teaching experience, while students observing actual operations are often distracted by nerves.

He has recorded four 3D operations for MDLinking so far and – thanks to a partnership providing Samsung equipment – these are viewable via mobiles and virtual reality headsets.

As the app is free, the business plans to raise revenue by broadcasting sponsored medical conference content and acting as a recruitment site for international medical placements. It wants to establish video centres in different places around the world using tools and facilities available there – for example, treating appendicitis in remote Africa.

Kiran Jobanputra, deputy head of the Manson Unit at Médecins Sans Frontières in London, says the organisation is looking into MDLinking as it develops a medical IT strategy. “Until something is piloted and evaluated, it is hard to say, but I do see potential in this app,” he says. “Having been a field doctor, I came up against huge difficulty getting access to information, particularly relevant technical advice.”

He says MSF medical experts at the London HQ and its telemedicine platform have time, context and connectivity limitations. “MSF clinicians are using WhatsApp groups of colleagues to get rapid, relevant advice – although it’s not an official MSF tool, and some people in the organisation might not agree with it,” he says. “That MDLinking ‘LinkedIn’ function to join or create a new group of people happy to give their opinion, with regional experience, has huge potential.

“I suspect the educational content will still require connectivity of too high bandwidth. We’re not testing MDLinking at the moment but if it comes on to Android, which is the main smartphone operating system in the contexts we work in, we probably will.

“The sharing economy isn’t new – in our medical studies we are taught ‘see one, do one, teach one’ – but barriers to sharing information are getting lower.”

From Dutch hospital to Afghan clinic: new VR app aims to link 8.5m doctors

Sepsis campaign aims to save thousands of lives

Thousands of lives could be saved by urging unwell patients and their loved ones to ask doctors to check for sepsis, experts said as they announced a new campaign to raise awareness of the devastating condition.

Every year, sepsis, or blood poisoning, kills nearly a third of the 150,000 people it affects. But campaigners say better care could save as many as 13,500 lives, as well as up to £314m from NHS budgets.

After a report this month strongly criticised hospital bosses and doctors over the avoidable death of a 12-month-old boy from sepsis, Jeremy Hunt, the health secretary, has agreed to help lead a campaign to encourage patients and doctors to look out for the symptoms of the condition.

The announcement came after Melissa Mead, whose infant son William died in 2014, and representatives from the UK Sepsis Trust (UKST) met Hunt at the Department of Health on Tuesday. Mead said she was “relieved and delighted” by the decision to launch the campaign.

“There’s going to be posters, there is going to be leaflets, there is going to be symptom cards, there is going to be a 90-second video which is going to be blanketed across social media to make sure we engage with the community when they are sitting on their sofas at home,” she said.

“It is really, really important that this is a campaign which continues to roll and have a journey and an evolution.

“Personally, I feel relieved because I’m here because William died but, equally, I’m stood here and we represent 44,000 people who die every year and 150,000 people who suffer with sepsis. This isn’t a one-off story, it affects so many people’s lives and it’s very important.”

Ron Daniels, chief executive of UKST, said the campaign was due to launch in mid-September. “This is being seen by the government as a priority, and an ongoing campaign. We discussed budgeting for next year, as well as for this year, and in the years beyond,” he said.

“What we are going to see is heightened awareness of the word ‘sepsis’, through the use of social media, direct marketing, posters in GPs surgeries, emergency departments and pharmacists, [as well as] the use of corporate partners to get the message out there.”

A major aim of the campaign, Daniels said, would be to prompt patients and their carers to ask: “Could it be sepsis?” He cited research published last year that found that where sepsis patients presented at hospital late, in more than 60% of cases it was because they had not contacted doctors.

“It wasn’t GPs missing it, it wasn’t ambulance services or 111 saying you’re fine to stay at home. It was people not picking up the phone to start with,” Daniels said. “And the delays were not a few hours, they were typically one to four days, and that can obviously be the difference between life and death. So it’s that piece of evidence that’s really spurred us to engage with the public, to get sepsis into their vocabulary, and empower them to ask the question.”

Sepsis can be triggered by any minor infection, or an injury as simple as a cut or an insect bite. Sufferers’ immune systems go into overdrive as they try to fight off the infection, causing their bodies to begin self-destructing by attacking their own tissues and internal organs.

Without early treatment, it can lead to shock, multiple organ failure, and death. But survivors also face serious consequences if they are not treated in time. Daniels said: “Between a fifth and a quarter of survivors have life-changing after effects. These can be physical. They can, in extreme circumstances, lose limbs. They can be more subtle physical problems like chronic fatigue or problems with muscle and joint pain.

“They can be psychological, which ranges from sleep disturbances, personality changes and anxiety through to post-traumatic stress disorder. And they can have cognitive problems. Around 15% of people who survive sepsis, particularly if they’ve needed intensive care, can’t perform as well as they did previously.

“What this means is that people struggle to return to work in their previous roles, and the psychological issues, as well as the physical issues, mean that people’s relationships are strained and relationships break down. Survival, if recognition has been delayed, can be life-changing and the potential consequences to the economy from this fiscal burden of people not being able to return to work [is] huge.”

Early symptoms of sepsis include fast breathing or a fast heartbeat, high or low temperature, chills and shivering. However, sufferers may or may not have a fever. Severe symptoms can develop soon after and include blood pressure falling low, dizziness, disorientation, slurred speech, mottled skin, nausea and vomiting.

Following the death of William Mead, the National Institute for Health and Clinical Excellence (Nice) said that doctors and nurses should treat people who show signs of sepsis with the same urgency as those suspected of suffering heart attacks. A separate report into the boy’s death criticised GPs, out-of-hours services and a 111 call handler who failed to spot he had sepsis caused by an underlying chest infection and pneumonia.

His mother said she hoped that the campaign, Nice guidelines, and the investigation into her son’s death would help to prevent future tragedies. “William died in 2014 and it was a year later that we received the NHS England report,” Mead said earlier on Tuesday.

“It’s taken seven months to reach this stage but, equally, you can’t put something out there that is not going to work and is not going to be engaging.

“Especially with the Nice guidelines, which came out last week, on sepsis, we’re in a position now we’re going to have joined-up writing and joined action and everyone is going to be thinking the same thing.

“I’m hoping today will be the last meeting, I’m not anticipating any more meetings.”

Sepsis campaign aims to save thousands of lives

Exclusive: Deepak Chopra Aims To Set World Record

Deepak Chopra advised me right now that he plans to set the Guinness Record for the world’s biggest meditation gathering up coming month. It is the first such attempt at a title Guinness says needs 15,000 participants. Calling from his Southern California headquarters in Carlsbad, the ideal-promoting writer and extremely paid New Age thinker, as constantly, has even loftier ambitions: “We would love to have two million individuals all around the planet join us.”

The effort takes location Friday, August 8, at noon EST on the final day of Chopra’s yearly meditation event named the Seduction of Spirit. Despite the fact that only all around 300 participants are anticipated in particular person with Chopra at the session in Toronto, many more will very likely attend almost via reside stream. Specifics about the event can be discovered right here.

Chopra is no stranger to publicity campaigns in the identify of increased consciousness. Not lengthy in the past, in a knock at James “The Amazing” Randi’s million-dollar challenge  to anyone who can scientifically show a supernatural or paranormal capacity, Chopra supplied the exact same sum to skeptics who can show that the paranormal is bunk — or much more specifically, to anybody who can demonstrate “how electrochemical activity in the brain generates the appearance of a 3-dimensional planet.”

Deepak Chopra intent on receiving his Guinness

As you ponder that, contemplate the inspiration behind following month’s occasion. Chopra says meditating in groups “raises the collective consciousness that’s portion of a universal domain of awareness. The far more men and women are expanding their awareness, the far more we can alter society for the greater.”

Chopra will lead the guided meditation in a session with motivational speaker Gabrielle Bernstein, and he concentrate will be planet peace. “If we focus our intention on peace in huge groups like this, we can reach a critical mass and make peace sustainable,” he says.

For a deeper comprehending of Chopra’s perform, you can study an in-depth interview with him I conducted with him about consciousness, quantum physics and other mysteries of life. His next guide, The Long term of God, releases this fall in conjunction with a new public television series of the identical title. Chopra is also searching ahead to breaking next month’s record. “The hope is to eventually get one hundred million individuals involved in creativing a crucial mass of peace,” he says. “But that’s for the potential.”

In the meantime, breathe in, breathe out and have a wonderful day.

Stick to me on Twitter Twitter at @davidhochman and @letterfromLA.

Exclusive: Deepak Chopra Aims To Set World Record

Los Angeles aims to make Obamacare universal in much more than just identify

On a sunny weekday morning just east of downtown Los Angeles, a crowd of about 75 folks rallied outside the LA County/USC Healthcare Center. They toted signs with slogans like “Healthcare is a Human Right” and “Salud Para Todos” (“Health for All”).

“How can we say we dwell in a just and humane society,” stated a single speaker, “without providing for the sickest and most vulnerable between us?”

This wasn’t 2009, when the Affordable Care Act was a hot stage of debate. It occurred just last week. The activists organized the rally to urge the LA County board of supervisors to boost funding to a plan named Healthy Way LA that is spearheading an experiment to cover these who are uninsured or can’t afford or qualify for Obamacare.

If it performs, the notion could revolutionize healthcare in American cities – if it can handle the problems of scale for millions of sufferers and funding from strapped municipal budgets.

A bridge for the uninsured

While the Reasonably priced Care Act has diminished the ranks of the uninsured across the country, it was never ever designed to provide entirely universal wellness coverage. Estimates present that 31 million folks nationwide will remain uninsured.

Los Angeles, with its enormous reduced-revenue population and greatest concentration of immigrants anyplace in the country, may possibly be the epicenter of the continuing uninsured crisis in America. Someplace close to one million county residents will continue to be uninsured even following the law alterations.

“You have one million men and women in a county with out entry to major overall health rewards, there’s a really very good possibility that you will have a whole lot of sick people, who will get other people sick,” says Tom Holler of OneLA, a faith-primarily based coalition pushing for more funding for the uninsured.

The query the protesters have been tackling is this: how do cities and states fill the gap between the men and women who are covered by Obamacare and individuals who are not?

“In our view, the Cost-effective Care Act helps make large strides to lessen the uninsured,” explained Anthony Wright of Overall health Accessibility California. “Now it is more feasible for states and counties to finish the work.”

The creator of ‘medical homes’

In Los Angeles, Dr Mitchell Katz heads the county Division of Overall health Companies. He has his own vision for how to cover those that Obamacare failed to capture: making use of existing community wellness centers and clinics to supply reduced-cost primary and preventive care to any uninsured individual who enrolls. He calls these “medical homes.”

The healthcare property acts like a principal care medical professional: it collects the health care data of uninsured individuals, develops prolonged-phrase relationships with them and refers them to experts when needed. The promise is to provide a regular provide of healthcare, keeping sufferers from waiting so prolonged that they wait for catastrophic sickness and only use emergency rooms to see a physician at all.

“If you have 1 spot you can go to repeatedly that knows you, has your case history, can give you care within or outdoors their facility, you’re far more inclined to use primary care and preventive companies,” says Tangerine Brigham, who ran the managed care services division and aided style HealthySF, and followed Mitchell Katz south to do the exact same for Los Angeles.

The medical residence concept is a hybrid. It has elements of socialized medicine, the place largely public dollars supports universal clinics. It also has aspects of managed care – the private-sector alternative that numerous Americans are acquainted with from their healthcare strategies via operate.

“Just becoming in a position to make an appointment is practically a revolutionary concept in public healthcare,” says Shana Alex Lavarreda, Director of Well being Insurance Research at UCLA’s Center for Well being Policy Study.

Katz has some experience with this concept of health-related houses: he came to Los Angeles from San Francisco, in which he created Healthful SF, a productive system whose ambition is to provide universal healthcare, rather than universal health insurance. The plan was effective. “It genuinely did set up some thing close to universal access to healthcare inside of the borders of San Francisco,” stated Anthony Wright of Health Access California.

If Katz can scale up his notion, and replicate that success in Los Angeles, the nation’s 2nd-largest city, he believes he will have a verified model for any city to comply with.

Nonetheless, it will not be easy. Expense is 1 barrier. So far, although the medical house model at HealthySF has enhanced patient outcomes and elevated coverage, “that’s not translating into the healthcare method spending less money general,” Lavarreda says.

Part of the dilemma is that it is challenging to track a population that tends to favor emergency rooms instead of standard medical professionals one more issue is that healthcare residences could be just also new to prove they save funds on lengthy-term healthcare expenses.

A supplement to Obamacare

Katz’s LA experiment is not a replacement for Obamacare it truly is a supplement to it. Healthy Way LA, the motor vehicle for bringing the health-related home notion to the county, grew out of a statewide low-cash flow well being plan developed as a bridge to the launch of Obamacare this yr.

Healthful Way LA enrolled in excess of 300,000 county residents at virtually two dozen local community clinics at the time. Several of these individuals at some point passed into Medicaid, following its expansion underneath Obamacare.

Yet Obamacare advertising has been so effective that healthcare demand is booming in the county, even for the uninsured. “We’ve observed a 40% increase in patient volume above the previous numerous months,” says Jim Mangia, CEO of St John’s Properly Little one and Household Center, a non-revenue clinic in Los Angeles.

As a end result, the Department of Wellness Providers will relaunch Healthier Way LA this fall. Its objective is to cover all residents at no expense who stay uninsured right after Obamacare, and whose cash flow is much less than 138% of the federal poverty degree.

Under the relaunch, clinics will have enrollment professionals on internet site, so if they get stroll-ins who could be eligible for Medicaid or other public wellness packages, they can register them on the spot. The county and nonprofit community clinics are working to figure out the capitated price, a finite pool of cash that would be offered to cover every personal member of the health care property. This ought to give clinics an incentive to decrease fees. There will be no exclusions based mostly on immigration status.

Katz believes the managed-care relaunch will allow him to stretch scarce dollars, and views it as a 1st step towards universal care. But he informed the Los Angeles board of supervisors in late March that the plan would still likely serve only 100,000 individuals to start, and the county has a price range of only $ 55m that it really is unlikely to scale up – even even though healthcare advocates believe it need to be triple the dimension at $ 165m.

That would be significantly less than one% of LA County’s $ 26bn budget, which is already operating at a surplus – “price range dust in the scheme of things”, says Mangia, a robust advocate of the program.

The LA County budget will fuel additional protests like the a single last week, leading up to a vital May possibly twenty board of supervisors meeting.

“We strategy to impose tremendous grassroots and political pressure, and I believe they’ll stage up,” says Mangia. “Why wouldn’t we want to cover everyone? This would have a profound ripple effect across the nation, for wellness care entry, universal coverage and even immigration reform.”

The ‘medical home’ thought

Receiving to that level indicates creating a program that can deal with the well being troubles of a sprawling metropolis. Los Angeles County has interpreted a statewide mandate to cover the uninsured broadly, committing to support fund a program to cover everybody, such as the undocumented.

Which is no tiny activity. Los Angeles County consists of 88 cities with more than 10 million residents, dozens of languages, and at least 400,000 undocumented immigrants.

Analysts estimate there are anyplace from 800,000 to one.two million uninsured across Los Angeles County, such as mixed immigration standing families where some youngsters are covered and other folks are not. The county had to deal with the barrier of getting undocumented immigrants comfortable with using a publicly supplied support without having worry of deportation. And it’s hard to even find and talk in the proper language to LA’s uninsured, allow alone supply them with continuing care.

“We have been worried about no matter whether it would translate,” Anthony Wright says. “We were pondering, what are you going to do to Mitch?”

“The magnitude and scale is completely various,” says Shana Alex Lavarreda of UCLA, who says she supports the program. “In San Francisco you had tens of thousands, right here you have millions of uninsured to deal with.”

The undocumented and healthcare

The LA crowd took a distinct interest in immigrants, each legal and undocumented, the latter of which are barred from getting Medicaid or utilizing the Obamacare insurance exchanges, even to obtain health insurance coverage with their personal funds.

A bill from state senator Ricardo Lara would let the undocumented accessibility to Medicaid and the insurance coverage exchanges, using state cash to evade the federal ban. But until finally that takes place, and right up until immigration reform offers a path to citizenship, counties like Los Angeles have this enormous uninsured population to deal with.

With the undocumented comprising as significantly as half of the uninsured population in Los Angeles, the issue has echoes of the roiling immigration debate.

“Immigrants are this kind of an crucial element of California’s economy and society, they need to be included in the wellness technique,” explained Anthony Wright of Overall health Accessibility California.

“We’re dealing with segregated wellness care in America,” says Victoria Ortega, a program director at the local community wellness center Clinica Romero, at the rally. “We did not tolerate it in the schooling technique we shouldn’t tolerate it in the wellness care program either.”

Graciela Villeda, an uninsured and undocumented resident, told the rally at LA County/USC Healthcare Center that she has gall stones, and that Healthier Way LA does not cover the surgical procedure she would require to get rid of them. “She would have to be dying for the operation to be covered,” said Iliana Garcia, her daughter. Garcia extra that her neighborhood in Boyle Heights has only two clinics for Healthful Way LA, and even many of those enrolled discover the nearest clinic also far to accessibility.

“These men and women deserve the identical healthcare as any person else,” said Dr Brownell Payne of Crenshaw Health Partners. “It does not matter if you are undocumented or the president. We all have red blood cells. This is not about money, it’s about taking care of our men and women.”

Los Angeles aims to make Obamacare universal in much more than just identify

Risk to psychological wellness programme that aims to get sufferers back to operate

South London and Maudsley NHS basis trust’s individual career management programme assesses the demands of sufferers and tailors its solutions.

A programme at South London and the Maudsley NHS basis believe in (Slam), which supplies tailored careers advice and coaching to patients, is threatened by budget cuts.

Slam’s person career management (ICM) programme, which occupational psychologist Claire Value says is the only a single of its sort in the Uk, goes beyond basically acquiring an individual into a task. It assesses the needs of individual customers and tailors its providers accordingly, which could suggest support with a CV or interview abilities, or long-term a single-to-one particular help.

Care and assistance services minister Norman Lamb said: “This was a locally-led selection, but I comprehend that Slam have adapted their support to make sure patients do not drop out.” Value, even so, believes the trust has experimented with challenging to “preserve hold of the support” and factors out that all mental well being trusts are struggling to give companies due to lack of obtainable funding.

“It is just been completely terrible,” she complains. “Honest sufficient if the require had decreased, but the need is rising. A lot more and far more folks are going off sick from operate with stress-associated sickness. Far more and far more individuals are unemployed and encountering mental well being problems since of that.

Lamb’s commitment to assisting more individuals with psychological wellness problems gain and sustain employment is set against a dismal background in which about 70% of functioning-age grownups in England with a psychological overall health situation are unemployed.

Last year, Department for Work and Pensions figures showed the Work Programme identified jobs for only 5.3% of folks with disabilities, like psychological illness, claiming employment help allowance, against an anticipated sixteen.five%.

In response to Guardian Healthcare concerns about the require for better employment providers, Lamb says that, on twenty January 2014, his department published a study into how the employment prospective customers for people with mental overall health problems, this kind of as anxiousness and depression, can be enhanced. The document sets out 25 priorities for adjust, which includes generating certain that health and employment companies work more closely together.

Even so, Price tag insists that, inside the government’s different techniques, she has however to see any proof that an individual approach to careers guidance is being proposed.

Normally, psychological health trusts with ample money for careers guidance opt for individual placement help (IPS), a US model that consists of an employment adviser based mostly within a local community mental overall health crew who gets sufferers into paid employment, but with no addressing their education, coaching or occupation improvement requirements.

Value says: “IPS is effective for individuals who are really motivated to locate a occupation and are inclined to do any sort of function. And that is fantastic, because some individuals have been out of function for so prolonged, 25 years or more. But I think it is only assisting a tiny percentage of patients.”

Primarily based on feedback from men and women mandated to the Perform Programme, she believes that, although the programme is intended to offer tailored assistance, that is not what individuals knowledge: “In practice, they do not get personal help they get shoved into a space with 50 other individuals”.

For some people, nonetheless, currently being in operate damages their mental overall health and at Slam the ICM model is used to assist patients who knowledge bullying, lack of job progression or discrimination at operate. “We can also liaise with the employer to aid the client sustain their part, or move to one more business if that is the very best alternative for them,” says Slam careers coach Catherine Di Lella.

Amongst 2006-08 the ICM support grew in response to the demands of individuals, but funding cuts have resulted in its group of twenty getting cut back to 9. Seven occupation coaches in secondary care worked with people with extreme psychological sickness, but only two stay to cover that demand.

A main hurdle for the Slam staff is that, regardless of constructive feedback from clientele, the model lacks clinical evidence. In 2011, even so, Slam and King’s School London launched a joint randomised managed trial to handle this.

The primary target of the trial, which is due to be assessed later this yr, is an financial evaluation: costing the time invested with every single client, plus the cost savings on rewards and a reduction in the use of NHS companies since folks are in function.

Mental overall health is the single largest result in of disability in the Uk, greater than cancer or cardiovascular disease. But when it comes to investing in employment help, Di Lella believes the government is hunting to make quick-phrase financial savings by favouring less expensive, generic, target-focused services. In her expertise, people with mental health conditions are unlikely to stay in function with no an exploration of the variety of jobs that suit their personality and inspiration.

Absolutely everyone is capable of perform, she argues: “No matter how low that particular person feels, or how anxious, there is a way back in. It may well be a longer journey, but with the right help it truly is definitely possible.”

This write-up is published by Guardian Professional. Join the Healthcare Professionals Network to acquire regular emails and exclusive provides.

Risk to psychological wellness programme that aims to get sufferers back to operate

Dutch scheme aims to reintegrate alcoholics by giving them beer

The males streaming in and out of a modest clubhouse in east Amsterdam could almost be construction staff at the end of a challenging day, taking off their orange reflective vests and cracking jokes as they suck down a couple of Heinekens, waiting for their shell out cheques.

But it truly is only noon, the men are alcoholics and the beers themselves are the pay out cheque.

In a pilot project that has drawn consideration in the Netherlands and around the globe, the city has teamed up with a charity in the hope of enhancing the neighbourhood and possibly the lives of the alcoholics – not by attempting to remedy them, but by offering to fund their drinking outright.

Participants are offered beer in exchange for light perform collecting litter, consuming a decent meal and sticking to their schedule.

“For a whole lot of politicians it was really hard to accept: ‘So you are giving alcohol?’” the Amsterdam East district mayor, Fatima Elatik, said. “No, I am providing people a sense of standpoint, even a sense of belonging. A sense of feeling that they are Ok and that we need them and that we validate them and we never ostracise our people, due to the fact these are folks that reside in our district.”

In practice, the two groups of ten males have to present up at 9am 3 days a week. They start off off with two beers, function a morning shift, consume lunch, get two much more beers, and then do an afternoon shift ahead of a final beer. Sometimes there is a bonus beer. The complete every day shell out package comes to €19 (£16), in beer, tobacco, a meal and €10 money. Participants say a whole lot of that funds also goes in direction of beer.

For years, a group of around 50 rowdy, ageing alcoholics had plagued a park in east Amsterdam, annoying other park-goers with noise, litter and occasional harassment.

The city had experimented with a number of hard solutions, including adding police patrols and temporarily banning alcohol in the park outright, such as for household barbecues and picnics. Elatik explained the city was investing €1m a year on various prevention, therapy and policing programmes to deal with the dilemma, and nobody was satisfied.

Meanwhile, the modest nonprofit Rainbow Group Foundation and its predecessors had been experimenting with ways to get support for alcoholics and drug addicts in the region.

Floor van Bakkum of the Jellinek clinic, 1 of the city’s ideal-acknowledged addiction remedy clinics, said her organisation had a really distinct strategy to treating alcoholism. She has a number of reservations about the Rainbow programme, but approves of it in basic.

She explained a “harm-reduction technique” created sense only when there was no real hope an alcoholic could be cured.

“The Rainbow group tries to make it as easy as achievable [for alcoholics] to reside their lives and that they make as minor as achievable nuisances to the atmosphere they are living in,” she said. “I believe it is great that they are performing this.”

The idea was just that troublemakers may well consume significantly less and cause less trouble if they could be lured away from their park benches with the guarantee of cost-free booze. The Rainbow leader, Gerrie Holterman, explained beer was the obvious choice, since it was easier to regulate consumption. Rainbow still harbours the ambition to remedy alcoholics and move them back to mainstream society and sees the perform-for-beer programme as a 1st step.

“I think now that we are only productive when we get them to drink much less for the duration of the day and give them some thing to believe about – what they want to do with their lives,” Holterman mentioned. “This is a begin to go in the direction of other projects and perhaps one more variety of work.”

She conceded there had only been one person so far who had moved from the programme to standard lifestyle. Several participants have located the guidelines also demanding and dropped out. But she explained nuisance in the park had been reduced, neighbours had been happy and there was a waiting record of candidates who needed to participate.

Elatik stated she could not quantify the price of the programme. Its spending budget comes partly from donations to Rainbow, partly from city funds, but it is less than €100,000.

The foreman of one group participating in the scheme, Fred Schiphorst, takes his job significantly. He wears a suit and tie under his reflective vest. He said he was handled with more respect in the neighbourhood, but admitted his off-the-job consuming was nonetheless up and down.

One more participant, Karel Slinger, 50, stated his lifestyle has not been transformed. He is nevertheless an alcoholic, but he mentioned on the complete items had transformed for the much better.

“Yes, of course, in the park it is wonderful weather and you just drink a whole lot of beer,” he said of his outdated existence. “Now you come here and you are occupied and you have one thing to do. I cannot just sit nonetheless. I want anything to do.”

Dutch scheme aims to reintegrate alcoholics by giving them beer

Rethink the Pink Aims at Assisting Girls Restore & Protect Their Well being

The annual Women’s International Summit for Overall health runs for forty days January by way of March and grows in reputation every single 12 months. In 2014, Want presents the Rethink the Pink summit (affiliate website link), starting on January 29 and aiming at raising awareness about women’s health. “Why run for the remedy?” the summit organizers request, giving a distinct kind of approach that entails standing up to the cause of cancer instead. The summit will handle achievable causes of breast cancer, this kind of as circulation-cutting underwire bras, toxic cosmetics and even radiation from mammograms. Wish promotes holistic approach to overall health, sustainable consuming and attractiveness care that’s more normal.

The Girl behind the Undertaking

Tera Warner is the creator of Physique Enlightenment system promoting healthful lifestyle for women and the organizer of Want. A lot more than 100,000 ladies are component of the BE network, which encourages them to boost their self-really worth as opposed to managing excess weight. Warner was a keynote speaker at numerous conferences, addressing this kind of concerns as excess weight loss, entire body image, normal detox and more. By way of her plan, she encourages females to get far better sleep, consider a lot more walks and consume normal meals.

Rethink the Pink Speakers

Wish brings with each other several excellent speakers, like medical doctors, nutritionists, activists, cancer survivors and holistic therapists. Right here are the profiles of just some of the speakers you will discover at the Rethink the Pink summit.

Ruth Heidrich

Dr. Ruth Heidrich is a nutrition and workout specialist and a daily life-prolonged runner, who was diagnosed with breast cancer much more than 30 many years ago. Right after the surgical treatment, she decided towards radiation and chemotherapy, turning to a vegan diet as an alternative. In addition to getting to be cancer totally free, she was also capable to overcome arthritis and enhance her bone density thanks to this technique, despite the reality that osteoporosis runs in her household. She wrote numerous books on the subjects of senior fitness, working and raw foods, and lectured at many universities.

Veronique Desaulniers

Dr. Veronique Desaulniers believes that your DNA is not your destiny. She maintained wellness practices since 1979, concentrating on women’s wellness in specific for the final 10 years of her occupation. She retired following getting diagnosed with breast cancer, and utilized a organic method to overcome the disease. Her holistic suggestions consist of neutralizing electromagnetic pollution in one’s residing room, as nicely as paying out more attention to emotional elements such as forgiveness.

William Davis

Dr. William Davis is the writer of Wheat Stomach and a company believer that to become more healthy, individuals need to exclude all wheat from their diet programs. He says that as many as 80% of all sufferers he sees these days are either diabetic or pre-diabetic, and backlinks a great deal of these circumstances to wheat flour creating substantial increases in blood sugar amounts. He promotes wheat elimination combined with other dietary concepts as a way of preventing heart condition.

Click right here to sign up fo the Summit.

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Rethink the Pink Aims at Assisting Girls Restore & Protect Their Well being