Local difficulties in the cash-strapped National Health Service | Letters

I pity the civil servants in the Department of Health who are forced to give platitudinous responses to the press (Leak reveals doubts over ‘seven-day NHS’, 23 August). In 2012 the then secretary of state for health, Andrew Lansley, fought tooth and nail (using taxpayers money) to hide the risk assessment done before the disastrous health and social care bill, despite intervention by the information commissioner. There, the “worst case scenario” has occurred after the passage of the Health and Social Care Act 2012. Civil servants are right to be worried that there is not enough money or sufficient trained staff available to carry out the policy, as there is insufficient money to run the NHS as it exists, providing a five-day elective (planned) and seven-day emergency service.

The lack of detailed planning of the proposed service is analogous to the way the Cameron government approached the EU referendum. What the NHS needs is more money to deal with rising demand, which could easily be found by scrapping the wasteful tendering processes which have resulted in almost £20bn of contracts going to the private sector since 2013, reviewing PFI debts costing over £2bn per year, reducing expenditure on the CQC, which has become unwieldy but arguably has failed to prevent hospital disasters, and reducing the six-figure salaries that too many top managers are now paid. Private contracts are expensive and have not yielded the promised innovation or improved services.
Wendy Savage
President, Keep Our NHS Public

• Most people will agree that the NHS is the jewel in the crown of British life and prized by almost everyone. David Nicholson wrote on his retirement as chief executive of the NHS, “It is built into what it is to be British” (Sunday Times, 2 March 2014).

Yet it is “threadbare, scrappy, perilously understaffed and barely held together by legions of nurses, doctors and allied health professionals” (These leaks show Hunt’s deception on the seven-day NHS, 23 August).

As a retired NHS physician and former independent MP, I talk to many people about the NHS and, without exception, they would willingly accept an increase in income tax, if it was hypothecated to the NHS, and if all measures for increasing efficiency and economy within the NHS had been adopted.

Would the Guardian consider carrying out a survey of its readers to assess the support for such a measure to rescue our beloved NHS?
Richard T Taylor
Kidderminster, Worcestershire

• You report that NHS England expects local doctors, hospitals and councils to work together in each of 44 “footprint” areas for the “first time on shared plans” (Revealed: plans to fight NHS deficit, 26 August). We recall how, in a 1968 green paper, health minister Kenneth Robinson proposed just such area health boards, to meet his paramount requirement that all the different kinds of care and treatment should be readily available to the individual citizen. We, who were involved in the preparation and promotion of those novel ideas in 1968, can but hope that our successors will get past the green stage.
Dora Pease and Tim Nodder
Ministry of Health long-term study group 1967-74

• Save Our Hospitals: Hammersmith and Charing Cross has been campaigning for more than four years against the downgrading of hospitals in north-west London, where we have already lost two A&Es, with dire effects on other A&Es in the area, and where two further major acute hospitals, Charing Cross and Ealing, are to be downgraded to as yet undefined local hospitals. As you note, these hospitals will be little more than glorified urgent care centres (Councils reject plans to ‘transform’ NHS, 26 August).

Already all hospitals in NW London are working at full capacity, failing to meet A&E targets, and with accelerated population growth in NW London, out-of-hospital care is even less likely to meet the health needs of our local population.

For four years we have been asking the local health authorities for the evidence that the proposed out-of-hospital provision can replace acute in-hospital care. For four years we have been promised this evidence. And for four years we have been presented with no evidence that suggests the changes can work.

It has become increasingly clear that financial considerations are driving the plans for this new top-down restructuring of the NHS. The outcome will be even greater privatisation of the NHS.

That two council leaders have been prepared to stand up to the NHS bullies and reject this attack on local health provision and local democracy is admirable. We know that the leaders of Hammersmith & Fulham and Ealing councils have the support of the local population as well as local campaign groups.
Merril Hammer
Chair, SOH: Hammersmith & Charing Cross

• Among your articles on the “sustainability and transformation plan” for the NHS, you mentioned the current efforts to remodel healthcare in North, West and East Cumbria. My local community hospital is threatened with removal of all inpatient beds. Alston Moor is a sparsely populated area of high moorland with four of the five roads leading over high passes; all are slow, frequently impassable in winter. The nearest hospitals are 20 miles from Alston, another five miles for some parts of Alston Moor; the nearest main hospital is over 30 miles away, in Carlisle. There is no meaningful public transport; even by car, it takes 40 minutes to the smaller hospitals, an hour to Carlisle.

If there are no inpatient beds, there will be no nurses. If there are no nurses, there will be no nurse-led minor injuries unit, and all will have to get to A&E in Carlisle. Without the hospital, our GP surgery is not viable (the relatively low returns of GP services for a mere 2,000 people are supplemented by the hospital work).

What family will want to live here with children if there are no medical services? Without children, our schools are doomed. What older person will want to live here knowing that their dying days will be spent in a hospital far from family and friends? What carer will cope with the burden of their task with no respite care?

How can it be OK to destroy a community? First they came for the small rural communities and I did not speak out because I did not live in a small rural community…
Alice Bondi
Alston, Cumbria

• Join the debate – email guardian.letters@theguardian.com

Local difficulties in the cash-strapped National Health Service | Letters

Cargill"s Massive Bet On Fish--and the Industry"s Difficulties Ahead

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The organization of aquaculture doesn’t typically make headlines&nbsp unless of course a firm like Cargill treads into the sector, which is precisely what was recently reported when it announced it was buying Norwegian salmon feed supplier, EWOS &nbspfor an estimated $ one.5 billion. The company produces and distributes feed in Norway, Chile, Scotland, [...]

Cargill"s Massive Bet On Fish--and the Industry"s Difficulties Ahead

NHS funds difficulties will get worse subsequent year, finance chiefs believe

Pressure on A&E units and the need to hire more nurses are driving up costs for NHS care providers, the Healthcare Financial Management Association found. Photograph: Bethany Clarke/Getty Images

The NHS’s financial problems are set to worsen next year, with more hospitals ending up in the red, the health services’s finance managers have warned.

Growing demand for care, pressure on A&E units and the need to hire more nurses to ensure high standards of treatment are driving up costs for NHS care providers, the Healthcare Financial Management Association found.

Its survey of 188 finance directors of NHS organisations found that just 12% of 129 hospital finance directors believe their trust will achieve its financial targets in 2015-16, while 44% do not.

Similarly, just one in four finance directors in GP-led clinical commissisoning groups, who commission and pay for care, said they would meet their targets.

Professor John Appleby, chief economist at the King’s Fund thinktank, said: “This report echoes our own surveys and highlights a truth now widely acknowledged within the NHS – that it is heading towards a financial crisis in 2015-16, if not before.” The HFMA’s report is published amid speculation that ministers are being lobbied by senior Liberal Democrats to give the service a £2bn bailout this autumn in order to keep it running smoothly.

A mere 2% of hospital finance chiefs and 11% of their clinical commissioning group counterparts think the Better Care Fund – the government’s flagship policy to reduce demand for NHS care by looking after more people at home by taking £2bn away from hospitals – will help improve the services they provide when it starts next April, the HFMA found.

Julia Manning, chief executive of 20/20 Health, another thinktank, said the NHS could save billions by reducing fraud and waste and urged politicians to have an honest debate about what the NHS can be expected to deliver.

More positively, 92% of NHS finance bosses expect the quality of care to improve or stay the same over the next few years, despite the expectation of increasingly widespread financial distress.

The Department of Health said it expected the NHS to live within its means. “We’ve taken tough decisions to protect the NHS budget and the system is on track to make £20bn savings this parliament to reinvest into frontline care. We are confident that the NHS will continue to make the savings necessary to meet rising demand”, said a spokesman.

“Trust chief executives need to have a tight financial grip to keep delivering high quality services whilst making the savings necessary to meet rising demand.”

Dr Mark Porter, leader of the British Medical Association, accused the coalition of cutting investment in the NHS, fragmenting care and prioritising the tendering of services to private firms. As an example of the “bizarre market culture” that has emerged, he said that in Bedfordshire and Milton Keynes, the management consultant firm McKinsey, carrying out a £3m review of services, has written to 500 providers, including dissolved UK trusts and one in the US offering “faith-based” healthcare, for expressions of interest in running local services.

NHS funds difficulties will get worse subsequent year, finance chiefs believe

Social care difficulties lead to hospital bed blocking, says Age Uk

‘Deepening troubles in social care mean patients can’t be discharged, according to new investigation.’ Photograph: Photofusion/Rex

Practically 2m bed days in hospitals have been wasted since 2010 because deepening difficulties in social care imply patients can not be discharged, in accordance to new study.

Some elderly patients are currently being trapped in hospital for up to thirty days – a day longer than 4 years ago, on regular – whilst waiting to be transferred to a residential property, despite getting match to depart.

An estimated total of one,928,255 bed days have been misplaced to the NHS in England considering that 2010, at a value of £526m, at a time when hospitals have been under increasing pressures, in accordance to Age Uk.

Drawing on official publications, the charity showed that the average wait faced by a patient needing grab rails or ramps fitted at property has risen by eleven.five% to 27.three days, while a social care bundle now requires 28.six days to be arranged, 5% longer than in 2010.

The lengthening delays have occurred at a time when neighborhood councils have reduce £1.2bn from their social care budgets and the eligibility criteria for assistance have been tightened so support is offered to fewer folks, despite the ageing population.

“This marked rise because 2010 in the length of time individuals are currently being forced to linger in hospital since of a delayed assessment, care property area, property care package deal or house adaptation is an final result of the crisis in social care”, explained Caroline Abrahams, Age UK’s charity director. “It is crazy to waste high-priced NHS resources in this way.”

A bed in an NHS hospital fees about £1,900-a-week compared with £530 generally charged by residential homes.

Social care difficulties lead to hospital bed blocking, says Age Uk

Babies born in private hospitals a lot more most likely to have well being difficulties

Babies born to healthy mothers in private hospitals are more likely to suffer health problems and be readmitted to hospital in the weeks after birth than those delivered in the public system, a University of Western Sydney study shows.

Looking at nearly 700,000 “low-risk” births in New South Wales, researchers found that 5% of babies born in private hospitals suffered birth trauma such as damaged scalps, jaundice or broken bones, and were readmitted to hospital within 28 days. In public hospitals it was 3.6% of newborns.

Resuscitation at birth, feeding difficulties, sleep issues and behavioural disorders were also higher in babies born in private hospitals, the report, published on Tuesday in the British Medical Journal, said.

Higher rates of medical intervention in private hospital births were the likely culprit, according to the study’s lead author, UWS midwifery professor Hannah Dahlen.

An earlier study found that delivery interventions such as the use of forceps or vacuums, induced or caesarian births and epidurals occurred 20% more often in the private system.

“It is this intervention that’s causing that morbidity,” Dahlen said. “The more times, for example, you put implements or a suction cap on a baby’s head, the more likely you are to cause some trauma.”

Expectant mothers in private care delivered their babies earlier, with 43% of births occurring in the first 40 weeks of pregnancy compared with 39.7% in public hospitals. Early term delivery may also be associated with infant morbidity, the report said.

Dahlen said the study had broader implications for “the current federal and state governments’ agenda around privatising of health”.

“The bottom line is, if you’re paying more for health in Australia, it doesn’t necessarily guarantee a better outcome for low-risk babies and women.”

She said a “surgical bias” in private care led to medical procedures that were not needed, particularly as private patients tended to be “the healthiest, well-off women”.

“Giving birth at home, or giving birth in a midwife-led unit that’s not even connected to a hospital, you have better outcomes,” she said.

Babies born in private hospitals a lot more most likely to have well being difficulties

Weighted Blanket Can Support A lot more Than Just Sleep Difficulties

It is named a weighted blanket and it may be the secret weapon you’re searching for as a parent of a high-energy kid. The bed cover is filled with plastic poly pellets comparable to these used in Beanie Babies for a heavier truly feel that produces a normal calming impact in some kids — or even an entire fourth grade class. When word acquired out among parent close friends at my son’s college that a Southern California solution called The Magic Blanket was turning moody 10-yr-olds into nicely-rested angels, everyone began tucking in. Here’s the story:

Historically, weighted blankets are used as element of occupational therapy for young children encountering sensory problems, anxiousness, pressure or concerns associated to autism. But even youngsters with no such a diagnosis find critical positive aspects. Right after a week beneath his new sixteen-pound blue chenille Magic Blanket, my son, who’s 10, was sleeping far more soundly and waking up happier and far more centered than he has in ages. Real magic? Not actually but as other mother and father started reporting related benefits, I determined to check out in with the item developer, Keith Zivalich, whose organization is based in Valencia, California.

Zivalich came up with the idea 15 years ago when his daughter draped a Beanie Little one more than his shoulder although he was driving. “It was a lizard that was extended and hugged my shoulder, and felt rather great,” he says. “I believed, ‘Wouldn’t it be excellent if you had a blanket that hugged you that way?’” Zivalich’s wife designed a prototype and then had some produced at a factory in Los Angeles. He gave some to friends to try out, like a unique wants instructor, who right away identified how therapeutic a tool the blanket can be.

“That extra pressure on the body is beneficial for youngsters of all sorts, but notably for little ones with autism and sensory processing disorder,” Zivalich says. The extra fat, he says, triggers the brain to release neurotransmitters like serotonin and dopamine that improve moods and induce a calming impact. Temple Grandin has been the most outspoken advocate for using deep touch pressure to soothe special wants children, school students and animals.

When Zivalich’s company launched in 1998, he planned to get in touch with the solution The Unique Beanie Blanket and filed a trademark application. Ty Corporation, the business behind the Beanie Babies brand, wasn’t pleased and had lawyers concern a cease and desist buy.  “After a woman wrote in saying this was her ‘magic blanket,’ it hit us that we had an even far better name,” he says.

The Magic Blanket is designed to be just huge ample to cover the body, extending from the chin just past the toes (larger and it would be as well heavy). Children’s blankets are 36 inches wide and, yes, he helps make grownup blankets, as well, which run 42 inches across. They come in chenille, fleece, flannel and cotton.

Zivalich says he sells 1000′s of blankets that retail between $ 60 and about $ 175. It is a niche product with many rivals, such as Mosaic Weighted Blanket and SensaCalm. 

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

 

Weighted Blanket Can Support A lot more Than Just Sleep Difficulties

Two Examples Highlight Difficulties Of Demonstrating The Advantage Of Digital Health Technologies

We are consistently advised healthcare is “ripe” for disruptive innovation, a approach of inventive destruction enabled by the interesting new technologies of digital wellness.  Yet, the robust demonstration of nearly any substantive advantage (beyond probably transient delight and toxic self- absorption) has been slow in coming.

The issues of moving a well being-associated technologies from guarantee to effect are illustrated nicely by two recent attempts to cautiously evaluate the benefits of intriguing new units.

The Propeller Wellness Inhaler Keep track of

The initial research (NCT01509183) was sponsored by Asthmapolis (now Propeller Wellness), and sought to examine regardless of whether use of the company’s inhaler monitoring device resulted in enhanced asthma control, the study’s main endpoint.  Manage, measured by the Asthma Management Test (ACT) would be assessed at four, 8, and 12 months.

The device senses inhaler use – in this study, the use of quick-acting “rescue” inhaler medicines, especially — and communicates data to sufferers (via an app) and to companies (via reports and adjust of standing alerts), according to MedPage These days.  In this examine, asthmatic individuals who had seasoned a “healthcare utilization event” in the preceding yr were randomized into either an energetic group , acquiring the gadget and connected data, or a group obtaining a deactivated gadget that offered no supplemental data.

As research co-writer Bob Quade explains in an e mail, “the fundamental intervention is information.

At a nationwide meeting last November, interim outcomes have been presented.  These data unveiled slight enhancements in the ACT in the lively arm compared to the management arm in each adults and children, differences not statistically important.

Nonetheless, extra evaluation discovered topics in the actively monitored group utilized rescue inhalers drastically significantly less often than the manage group.  Maybe most strikingly, inpatient days were diminished from .225 per particular person per yr in manage group to .087 in lively group emergency area visits decreased marginally (from .141 per particular person per yr in manage group to .103 in lively group) as nicely.

This reduction in utilization is claimed to be associated with a financial savings of $ 688.05 per patient (compared to baseline)  subjects  in the handle group, notably, were identified to save $ 281.95 per patient compared to baseline, suggesting a regression to the indicate impact, not surprising offered that subjects had been selected based on experiencing a healthcare event in the previous year (most asthma sufferers really don’t knowledge occasions in any given 12 months).  It is also feasible that basically participating in the examine may possibly have contributed to a adjust in utilization (the Hawthorne impact at operate).  Each choices were  acknowledged by Quade.

Nonetheless, the energetic group nevertheless exhibited a dramatic cost savings (~$ 400 per patient) linked with decreased utilization in contrast to the management group, in spite of the lack of significant adjustments in asthma handle as measured by ACT scores.  This presents a actual puzzle.

Some, such as wellness guru Al Lewis (author of Why No person Believes The Numbers, and much more just lately, Surviving Workplace Wellness) appear at these outcomes incredulously.

“Their personal numbers do not add up,” he asserts in an e mail.  “First, they say it’s not statistically a considerable difference.”

“Even if it had been significant,” Lewis continues, the difference reported on the ACT “is one thing like two.2% improvement in the score.  Then, they claim an inpatient reduction of 62%. This violates a number of of the guidelines in Why No person Believes.  First, costs can not decline that significantly and 2nd, the price reduction has to tie to the quality improvement.”

An alternative explanation, even so, is that there are improvements in care not reflected in the ACT measure for instance, if the intervention does not prevent exacerbation but catches them early ample to allow them to be managed as an outpatient rather than an inpatient, this could theoretically conserve substantial bucks, nevertheless be challenging to select up on the ACT.

This review highlights the difficulties of rigorously demonstrating the benefit of a digital well being intervention that appears to make a globe of sense.  It seems logical, even evident, that improved monitoring of rescue inhaler use, coupled with improved, fast communication with individuals and companies would enhance disease management.  As examine principal investigator Rajan Merchant points out, it enables the care of asthma sufferers to transition from episodic to steady – a single of the key ambitions of digital overall health.

I look forward to examining a peer-reviewed publication when the examine is finished later on this 12 months, and all data are go through out.  My suspicion is that there may ultimately be a price-savings attained (vs the handle group), and perhaps ultimately a modest improvement in asthma manage.   Whether this economically justifies the use of the intervention will need to have to be determined, given the expense of the units and software, and the further supplier time potentially needed.

Two Examples Highlight Difficulties Of Demonstrating The Advantage Of Digital Health Technologies

Review: It really is Not As well Considerably Wish, But Too Small Self-Manage That Gets Us In Difficulties

Picture a seesaw in your brain. On one particular side is your want method, the network of brain locations associated to in search of pleasure and reward. On the other side is your self-management system, the network of brain locations that throw up red flags prior to you engage in risky conduct. The difficult concerns facing scientific explorations of conduct are what helps make the seesaw hefty on either side, and why is it so difficult to attain balance?

A new study from University of Texas-Austin, Yale and UCLA researchers suggests that for several of us, the situation is not that we’re too hefty on desire, but rather that we’re too light on self-control.

Researchers asked examine participants to play a video game made to simulate danger-taking although hooked up to a magnetic resonance imaging (MRI) scanner. The game is called Balloon Analogue Threat Activity (BART), which previous study has shown correlates effectively with self-reported danger-taking such as drug and alcohol use, smoking, gambling, driving with out a seatbelt, stealing and engaging in unprotected intercourse.

Magnetic resonance imaging (MRI) series of a human head (Photograph credit score: Wikipedia)

The research team used specialized software program to search for patterns of activity across the entire brain that preceded a person’s making a risky option or a protected option while enjoying the game.

The software program was then used to predict what other subjects would pick for the duration of the game primarily based solely on their brain action. The outcomes: the software accurately predicted people’s alternatives 71 % of the time.

What this implies is that there is a predictable pattern of brain activity linked with picking to take or not consider hazards.

“These patterns are reputable ample that not only can we predict what will happen in an added test on the identical individual, but on folks we haven’t seen ahead of,” said Russ Poldrack, director of UT Austin’s Imaging Investigation Center and professor of psychology and neuroscience.

The specially intriguing part of this review is that the researchers had been able to “train” the application to recognize particular brain areas linked with chance-taking. The results fell within what’s typically acknowledged as the “executive control” regions of the brain that encompass issues like psychological emphasis, working memory and interest. The patterns identified by the computer software suggest a lessen in intensity across the executive control areas when someone opts for danger, or is just contemplating about doing some thing risky.

“We all have these desires, but no matter whether we act on them is a function of handle,” says Sarah Helfinstein, a postdoctoral researcher at UT Austin and lead author of the research.

Coming back to the seesaw analogy, this analysis suggests that even if our want method is level, our self-control method appears to slow down in the face of danger less intensity on that side of the see noticed naturally elevates intensity on the other side.

And that’s beneath normal problems. Include variables like peer strain, rest deprivation and drug and alcohol use to the equation, and the imbalance can only grow to be more pronounced.

That is what the next phase of this study will focus on, says Helfinstein. “If we can figure out the variables in the world that influence the brain, we can draw conclusions about what actions are best at assisting men and women resist risks.”

Ideally, we’d be in a position to stability the see saw — enabling healthful discretion as to which risks are really worth taking. Whilst it’s evident that too much publicity to threat is dangerous, it’s equally true that as well little publicity to risk leads to stagnation.

We are, after all, an adaptive species. If we’re never ever challenged to adapt to new hazards, we stop learning and building, and sooner or later we sink into boredom that, ironically, sets us up to consider ever much more radical risks. And that way, we’re sensible to bear in mind, madness lies.

The research seems online this week in the journal Proceedings of the Nationwide Academy of Sciences.

You can discover David DiSalvo on Twitter @neuronarrative and at his web site, The Everyday Brain. His most current guide is Brain Changer: How Harnessing Your Brain’s Power To Adapt Can Adjust Your Daily life.

Review: It really is Not As well Considerably Wish, But Too Small Self-Manage That Gets Us In Difficulties