Why do clinicians and managers struggle to work together?

With an army of more than 1.5 million staff, a £116bn budget and millions of patients to look after, it’s crucial that the NHS is well managed. But three years ago the landmark Francis report warned of serious problems. “Clinicians must be engaged to a far greater degree of engagement in leadership and management roles,” it said. “The gulf between clinicians and management needs to be closed.”

Has the relationship between clinical and managerial staff improved since then? Last year, research by the Nuffield Trust suggested financial pressure was compounding the problem, with many staff worried that “relationships are likely to deteriorate over the coming year”. The report concluded: “There is a long way to go.” We asked clinicians and managers to share their personal experiences of this fragile relationship.

Manager: ‘When I first started it was hard to get clinical staff to work with people like me, but things are changing’

I find it quite rare that clinicians and managers don’t get on. There’s not really a big difference. It’s just that they’re being pushed in very different ways.

National targets cause quite a lot of trouble, because you end up having a really tricky middle-management layer. They’re getting shouted at from above, from the senior director level, to meet their key performance indicators (KPIs). They’re also getting shouted at from clinicians, who see the KPIs as dehumanising.

For me, the sort of issue that I come up against is trying to release staff to do improvement work. I end up being the middle man; I want to get clinical staff out of their workplace for a few days, but I can also see from a management perspective that taking people out for that much time is not an option.

You get really weird setups, where consultants are managed by somebody who’s paid maybe half their salary. They think: “I know you’re my manager, but I also know you can’t tell me what to do, and I’ll do whatever the hell I want.” It becomes difficult for managers to change things and implement new ways of working. They’ve got to be skilled in the art of emotional intelligence. It’s almost manipulation – they need to impart ideas into people’s brains without a direct command.

When I first started, it was hard to get clinical staff to work with people like me – and to want to engage with change and improvement. But recently, we’re finding that staff are coming to us and saying: “We’re struggling, can you come and help us?”

My manager was about to risk my patient’s life for the sake of a government-inflicted target

A&E nurse: ‘One manager risked a patient’s life for the sake of a target’

We have managers who you rarely see in person. They are simply a barking voice on the other end of the phone. They harass you endlessly when a patient is coming close to breaching the four-hour target in A&E. I get relentless phone calls; if they actually let me get off the phone and do my job I could focus on managing and preventing breaches.

It’s rare that they ever come down as a supporting presence in the department. Some of them have a clinical background, but you rarely see them rolling their sleeves up and digging in to help us out. I feel alienated from managers.

Once, I was working with critically unwell people and a patient was coming up to a four-hour breach. We’re fined for each breach. Someone in a suit approached, took the brakes off the patient’s trolley, and started to push them out. He said: “This patient is about to breach, we need to get him to the ward.” The response was: “This man’s blood pressure is dangerously high. You won’t make it to the ward.” This manager was about to risk the patient’s life for the sake of a government-inflicted target.

Clinical manager: I’ve got a very responsive senior management team

I’m fairly lucky, I don’t have a heavy-handed senior management team and they’re very responsive. If I go along and say I have an issue, they listen. I didn’t set out to be a clinical manager, but managerial responsibilities come with the grade. The advantage is I know what the job is; I’ve had to do it.

I work in a small health board so it’s reasonably easy to communicate with each other. People are around and we’ve got good face-to-face relationships. I think when you’ve got a much bigger organisation, it’s harder to do that.

NHS manager: ‘The health service runs because managers and clinicians get on’

Running the NHS is an incredibly complicated operation, so I guess it’s not surprising if there’s a lack of understanding about what managers are doing all day. But most of the time, the NHS runs because managers and clinicians get on – not despite the fact that they don’t.

Sometimes it’s the managers who are seen as making the tough decisions and implementing the policies no one likes. But actually, in the parts of the NHS that are really succeeding, those decisions will always be made in partnership with clinical colleagues and leaders. And they’ll always have what’s right for patients and their families at the heart of it.

Managers share an awful lot of the same motivations as doctors, nurses, therapists and scientists. They have a lot more in common with clinical staff than we’re given credit for.

Junior doctor: ‘I don’t know who my manager is’

I’ve worked with some managers who are diabolically awful, and it makes it really hard to get your work done. As a junior doctor, it’s difficult to interact with senior management. We’re not invited to any of their meetings; we’re not consulted on anything.

Recently, I worked in a hospital where they sacked all the phlebotomists because they needed to save money, and said: “Well, the junior doctors can take those bloods anyway.” We can, but there’s only so many things you can do at a time. So they get done sporadically through the day, when you’ve got two minutes to spare. It means that if your results don’t get back until 8pm, then a lot of older people won’t be able to get home afterwards, so they’re stuck in hospital for another night, wasting money. If any junior doctor had been invited to the meeting where they decided that, we could have warned them. But there’s no relationship with management, and there’s no consequences if they get things wrong.

Consultant: ‘Managers see things from a very different angle: it’s all numbers and targets’

At the moment, it’s very much: “Here’s your list of patients, get on with it.” People start to resent that after a while. The fundamental change that needs to happen is that managers have more exposure to patients, and doctors have more exposure to management.

Managers see things from a very different angle: it’s all numbers and targets. Operations might get cancelled because somebody in the booking office has put together an operating list without knowing the details of the case, the complexities of it, and how fast or slow that particular surgeon is. It would make sense if doctors had a lot more input into how every day is run, what equipment is procured, and so on. People do try to engage, but it’s incredibly difficult to make those changes.

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Why do clinicians and managers struggle to work together?

Girls from poorer families in England struggle to afford sanitary protection

Girls from low-income families across England are struggling to afford sanitary protection, with many teachers buying tampons for their students or seeking help with supplies from charities and voluntary groups, the Guardian has been told.

Charities, campaigners and teachers say that the problem is happening in cities and rural areas across the country, describing girls missing school, using donations, or wearing makeshift protection during their period.

The issue came to light after it was reported that a charity in Leeds, Freedom4Girls, was contacted by a local school who were worried about truancy among teenage girls when they had their period. The charity, which provides products to women in Kenya, agreed to do the same for local girls.

Since then more teachers have come forward to discuss the issue openly, with many contacting charities for help or telling how their schools already support girls in the same situation. Hayley Smith, founder of Flow Aid, a campaign working to provide free sanitary products to the homeless, said that she had a request from a London primary teacher, who worked in multiple schools in the capital, on Monday asking to her to provide sanitary products to young girls who could not afford them.

Smith said: “Teenagers and young girls are being forced to wrap or stuff toilet paper down their knickers, to prevent them from bleeding all over themselves while at schools. The cost of sanitary products are just too much for some girls and their families, and it’s leading to missing school and it’s putting their health at risk.”

“It’s absolutely despicable in the 21st century that girls are being forced to comprise their education simply because an absolute necessity is unavailable and not affordable.”

Smith is now looking at distribution channels to ensure students get supplies. “I work with Ealing Soup Kitchen and St Mungo’s and I am asking them if they have any links in primary schools we can distribute to,” she said. The campaigner added that she is also looking at creating drop off or donation points where people can give products to local schools.

Donations have already been given in Beverley, a market town in east Yorkshire. Councillor Chris Linthwaite, from Molescroft parish council, said the Friends of Longcroft School, a voluntary group, had to step in and provide sanitary donations after an investigation highlighted it as a problem. “Basic school equipment, items of uniform including 80 pairs of shoes were needed too.” The school confirmed the donations.

Rosy Candlin ofEvery Month, a campaign to create packs of menstrual products for people experiencing homelessness or poverty in Manchester, said she had been into a school in Rochdale to talk about this issue, with students raising funds for students who could not afford products.

She agreed there was still a lot of stigma: “For a family to say ‘we cannot afford food’ that’s so much easier to ask for. But because of the shame put on mensuration it’s much harder. Even in food banks we have to tell me to make it explicit that they carry our packs as people less likely to ask for them.”

Candlin says that often people use socks instead or they will simply skip school, as was the case in Leeds.” There’s a lot of girls who use lots of tissue to create makeshift protection, or they will have just a few pads and leave them in for longer, so it becomes unhygienic and unhealthy so there are no real good options.”

The Guardian also heard from dozens of teachers who said that they regularly provide pads and tampons for their students. One teacher in Manchester, who asked to remain anonymous, said: “This year I have a student who has benefited from free sanitary products. The student mentors and I put together two bags of essential toiletries including pads. She does pick up extra supplies every so often. So has another girl in the class. They would benefit from being able to tap into a guaranteed national provision – it’s less embarrassing when you feel you are not the only one.”

Another teacher from Newcastle said: “There is a core group of girls who regularly need to use staff-bought sanitary products. I buy the same brands I use myself, I just make sure I buy extra when they’re on offer.”

One teaching assistant from Surrey said last week someone in her department helped out a pupil who had only been given one sanitary towel for the day by her mother. “The girl came to a member of our department as she did not know what to do. It is not unusual for this to happen and we have a supply of sanitary towels and spare knickers for that purpose.”

Bothana Tashani of Freedom4Girls said that since the story about what was happening in Leeds went public they have heard from teachers, students and organisations all around the UK. “We were not surprised when we were first contacted by a school in Leeds about it. It’s upsetting because no one has talked about it before as there is a lot of shame and embarrassment around not being able to afford sanitary products.”

Tina Leslie of Freedom4Girls has now launched a crowdfunding page to raise money for research into the scale of the issue in the UK, calling for a comprehensive, nationwide study on the issue.

The news comes as a bill is about to go through the Scottish parliament to make it a requirement for schools to provide pads and tampons. A petition has since been started in the UK forTheresa May and the UK government to do the same.

Conservative MP Jason McCartney has since said he will raise the issue in parliament. He has said that he wants to get a group of MPs together to start a campaign for free sanitary products for young girls in need.

Girls from poorer families in England struggle to afford sanitary protection

‘Stark choice’ as schools struggle to foot bill for poorer students

Kevin Prunty is executive head teacher at Cranford community college, a high-achieving school in Hounslow, west London. His pupils are ambitious and successful, but many come from disadvantaged backgrounds.

Like other schools serving deprived areas, Cranford find itself increasingly playing a sophisticated welfare role in its community. It is also footing the bill for uniforms, PE kits, shoes, lunches and educational trips from a diminishing budget, to subsidise parents who cannot afford to meet the costs.

But with school budgets under pressure and further cuts expected there are fears they will not be able to continue to fill the gap.

“Schools know already that there are sizeable further cuts to funding on the way – and whilst we are currently able to fund these additional needs – it will soon become more difficult and perhaps impossible to justify doing so,” says Prunty.

Kevin Prunty, head of Cranford community college in west London, with Seema Malhotra MP. Photograph: Alicia Canter for the Guardian

He says it’s not possible to measure the additional cost in the sense of how many uniforms, how many trips, how many meals. Instead he describes the kind of scenarios his staff deal with on a daily basis to illustrate the level of need.

A year 7 boy needs additional support but his symptoms don’t meet the threshold to qualify for child and adolescent mental health services (Camhs).

An educational welfare officer helps a family where the father is suffering from a mental illness and keeps telling his children they are terminally ill. Another colleague intervenes to help a child with impaired hearing.

Someone else takes a pupil out to buy a suit for a job interview for a traineeship. It’s not just the money – they coach them for the interview and make sure the suit fits properly. “There’s nobody to say whether the arms are too long, so some of our staff take the responsibility,” says Prunty.

And things are getting worse. Since pupils returned to school in September, staff have noticed an increase in the number of children who are not eligible for free school meals who come in without any money for lunch. Inevitably the school provides – it all costs and meanwhile budgets are shrinking.

The Institute for Fiscal Studies has estimated that increasing costs and growing pupil numbers will result in an 8% cut in funding per student by 2020 and an inquiry has been begun by the public accounts committee to examine the financial sustainability of schools.

The sector would like to hear there is more money for schools in the autumn statement later this week – the reality is that schools like Prunty’s are likely to lose out in the long-awaited redrafting of the national funding formula (NFF) in which money from well-funded urban schools working with disadvantaged families is expected to move to less well-funded schools in less needy areas.

He has already had to address a £1m shortfall in the budget caused by a cut in grant funding from the government and rises in pension costs, national insurance costs and below-inflationary salary rises. He has managed to balance the budget but twelve jobs had to be cut – four teachers and the rest support staff.

At another school in the area, a principal who asks not to be named says he increasingly feels like a debt collector, having to chase up parents who owe the school money. As families at his school struggle to make ends meet, many are building up large debts. Some owe hundreds of pounds for school lunches and he estimates that parental debt is costing the school £10,000 a year.

Last year the school handed out 45 uniform grants worth £100 each to parents in need. Then there are equipment grants for things like scientific calculators. He feels for the parents, many of whom are in low paid jobs and are surprised to find they are not entitled to free school meals for their children. “There’s a lot that’s adding to pressure on parents. It’s uncomfortable to be talking to them about the money they owe the school. But that money is money we are not spending on teachers,” he says. “Schools are not in the debt management business. It’s not sustainable to be running this level of debt.”

The issue has been raised by Seema Malhotra, Labour MP for Feltham and Heston, who has become increasingly concerned about the hidden burden on schools’ budgets. “Schools are being faced with a stark choice,” she said. “Let children from poorer backgrounds miss out on educational opportunities and experiences, or pick up the costs and take on financial debt. Budgets are already under pressure and with further cuts to school funding, helping families in need is set to get harder.”

At Springwest Academy in nearby Feltham, which also serves a community with high levels of disadvantage, there are similar concerns. Pastoral mentors deal with calls day in and day out from families with worries about housing and finances; school uniforms and shoes are being paid for more frequently out of the school’s hardship fund and almost four out of ten pupils (38.3%) are referred for counselling or other mental-health support.

Victoria Eadie is chief executive of the Tudor Park Education Trust which includes Springwest. “It does worry me what’s going to happen. I don’t know a school in Hounslow that is not having to go though some form of restructuring and quite severe cuts.” Until now her school, like others, has been able to step in to support the neediest. With further cuts, she says, “schools will not be able fill the gap”.

‘Stark choice’ as schools struggle to foot bill for poorer students

Four in five UK councils struggle to provide older people"s care – survey

Four in five UK local authorities have insufficient care for older people in their area, with the shortage most acute for some of the most vulnerable in society, research suggests.

The Family and Childcare Trust surveyed councils across the country and found they are struggling to meet needs amid a background of growing demand, budget cuts and recruitment difficulties.

The survey is published on the same day as an undercover investigation by BBC Panorama is to be broadcast, exposing shocking neglect at two Cornwall care homes, including vulnerable people being left unattended and a nurse saying she will use morphine to “shut up” a resident.

The deficit identified by the Family and Childcare Trust means more than 6.4 million people aged 65 and over are living in areas that do not have enough older people’s care to meet demand.

Only one in five councils reported having enough older people’s care in their area to meet demand, the survey found.

Just under half (48%) of the 182 councils (out of 211) that responded said they had sufficient availability of home care and a similar proportion (44%) reported having enough places in extra care homes, which allow people to live independently with 24-hour emergency or on-site support.

Only a third of local authorities said they have enough nursing homes with specialist support for dementia, which is predicted to affect one million people in the UK by 2025.

Claire Harding, head of research at the Family and Childcare Trust, which works closely with the government and local authorities, said: “It is inexcusable that vulnerable people are left unable to find the care that they need.

“We urge government to make sure there is enough care for everyone who needs it. In order to do this, we need robust data on where there are gaps in care, a funding system that truly meets the cost of providing care, and clear information for families.

“Without these steps, families will continue to struggle to find care and to meet the numerous care costs on their shoulders.”

The survey also highlighted large regional variations, with just 7% of outer London councils reporting enough older people’s care to meet demand. The only area where more than half of local authorities reported sufficient care was the north-east, where 57% responded positively.

The findings will add to the sense of crisis surrounding social care, with delayed transfers of care – when patients are medically fit to leave hospital but unable to be safely discharged – at record levels.

Council and NHS leaders, as well as the Care Quality Commission, have called for urgent action, with the chancellor, Philip Hammond, facing pressure to increase social funding in Wednesday’s autumn statement.

Inner London councils pay the highest rates for residential care for older people, at £649 a week per place, compared with the lowest rate of £464 in north-west England, according to the survey. The UK average for a residential place was revealed to be £27,113 a year.

A Department of Health spokeswoman said: “This government is committed to making sure older people throughout the country get affordable and dignified care. That is why we are significantly increasing the amount of money local authorities have access to for social care, by up to £3.5bn by 2020.”

Monday’s Panorama sees reporters go undercover at Clinton House in St Austell, and St Theresa’s, in Callington, near Plymouth, both owned by the Morleigh Group.

Hidden camera footage captured one resident left on a bed pan for 40 minutes and an out-of-date prescription supplement relabelled for use by another resident.

Clinton House is being closed as a result of safety concerns and St Theresa’s is under investigation by authorities along with two other Moreleigh Group homes.

Moreleigh Group said it had already removed the staff involved and reviewed its systems and procedures, prior to receiving information from Panorma. Cornwall council apologised for the failings.

Four in five UK councils struggle to provide older people"s care – survey

Puerto Rico officials struggle to translate Zika virus fears into action

Every time it rains in San Juan, Dr Brenda Rivera-Garcia walks around her home emptying containers of standing water, likely wearing long sleeves, and almost certainly wearing mosquito repellant. Rivera-Garcia is the state epidemiologist in Puerto Rico, a woman tasked with tracking every single Zika-infected pregnant woman in the US territory.

Less than two weeks after the US health and human services administration declared the spread of Zika on the island an epidemic, Rivera-Garcia said it’s not frustration or anger that overtakes her when she adds a new woman’s name to a list of roughly 700 confirmed to be infected with the disease.

It’s sadness.

“Every time I have to add a pregnant woman to that list, I just think of what’s going to be of this pregnancy,” she said, her eyes visibly wet. “What’s going to be of this child later on, and, it’s, it’s – it breaks my heart.”

As much as 25% of the island’s population could have the disease by the end of mosquito season, the Centers for Disease Control and Prevention estimates, and up to 50 pregnant women each day are infected on the island.

A recent study projected as many as 270 babies could be born with the debilitating birth defect microcephaly, between now and mid-2017. In a normal year, doctors expect 16.

The defect causes infants of mothers infected with the virus to be born with abnormally small heads, and suffer life-long developmental disorders. Some will have trouble walking. Others may have hearing or vision loss, trouble swallowing or seizures. Many are likely to have shortened life expectancy.

But health officials have had difficulty translating those projections into urgency among many Puerto Rico residents, who have been dogged in the past by tropical diseases with more apparent symptoms, such as Dengue and Chikungunya. Indeed, the government’s efforts to control the virus seem hampered at every turn, thwarted by apathy, lack of trust, misinformation, insecticide resistance and even architecture.

“The system doesn’t work so of course people are going to be skeptical,” said Joe Torra, 40, a professional driver in San Juan.

Referencing colonialism, Torra said: “The best way to control minds is to control bodies.”

A health worker prepares insecticide before fumigating a neighborhood in San Juan on 27 January 2016. Photograph: Alvin Baez / Reuters/Reuters

‘False alarms’

Denisse Velazquez, 36, stood under the shade of a tree in Old San Juan, one of the hardest hit municipalities, as she said that the government “created false alarms”.

Juan Martinez, 43, said that with “all these diseases we have seen, it’s something normal”, referring to periodic outbreaks of Dengue the island has struggled with since the 1980s, and the recent Chikungunya outbreak. “In the Caribbean there has always been mosquitoes.”

Even tourism officials have reinforced the view that Zika risk has been overblown.

“From the very beginning the numbers that were given were based on projections. The reality is that as of today, less than half of 1% of the population has the virus,” Clarisa Jimenez, CEO of the Puerto Rico Hotel and Tourism Association, told CNBC’s Squakbox. “The only issue here is if you’re pregnant.”

Jimenez focused on the roughly 10,600 Puerto Ricans who had, at the time, been diagnosed with Zika by the CDC. The figure is an underestimate, because four out five infected people have no symptoms and likely do not know they are ill.

Now, near the end of August, the health department of Puerto Rico and the CDC have diagnosed 12,800 Zika infections, including more than 670 in pregnant women, believed to represent only a fraction of actual infections.

So far, only one child has been born with microcephaly. But experts expect that number to increase dramatically in coming months, particularly from September to December.

Health professionals believe the most dangerous time for a pregnant woman to be infected is in her first trimester, though more research is needed. Those pregnancies are expected to begin coming to term this fall.

“Right now, most of the births we have seen are among second and third trimester infections,” said Rivera-Garcia. “For us, it’s not just a number. There’s a family behind that number.” Doctors suspect that even these cases, which are less dramatic in appearance, could result in problems that won’t manifest until much later.

The island’s timetable of epidemic infection is about one year behind Brazil’s. In December 2015, as cases of microcephaly began to surge in Brazil, cases of locally acquired infections were just beginning to show up in Puerto Rico.

“When you’re involved in major epidemics, and particularly this one for some reason, I’ve been unable to disconnect,” said Dr Francisco Alvarado-Ramy, a senior CDC official and native Puerto Rican who helps lead the federal government’s response to the epidemic. He is stationed at the Dengue Branch, an outpost in San Juan established to combat another virus spread by the same mosquito as Zika, the aggressive Aedes aegypti.

“The moment that I go to the sleep to the moment that I wake up, my mind seems to be around Zika all the time, trying to think if there’s any other thing we can do,” he said.

“When something goes wrong, it’s also a very fast way down, downstairs in terms of your emotional well-being. We’re trying to prepare our staff, as well, if we start seeing a lot of people with bad outcomes how to handle that emotionally.”

Employees with the municipal government collect used tires on 7 August 2016 in the Rio Piedras section of San Juan, Puerto Rico. Photograph: Angel Valentin/Getty Images

Cat, Dog, Mosquito

“We have in Puerto Rico a dog, a cat and a mosquito,” said Carmen Deseda, the former state epidemiologist who battled several epidemics of Dengue, a hemorrhagic fever that can incapacitate a person for weeks. “The problem is not the mosquito, it’s the virus.”

Deseda expressed a view common among Puerto Ricans: the mosquito is here to stay, fumigating won’t work, so the government better find some other way to deal with this.

She was among many prominent opponents of fumigating the island with an insecticide called Naled, a solution proposed by the CDC and used on about 6m acres of land each year in Florida. Many residents were outraged that the federal government would, in their view without permission, spray chemicals over the island.

“When they said that I was very upset,” said Miguel Pellot, 48, the owner of a smoothie stand called Fruta Fruit in San Juan. “¿Como se dice, una falta de respeta?” he said, asking how to express lack of respect in English.

“For people here, this is nothing new. We’ve had mosquitoes here since we were born,” Deseda said. “They don’t feel threatened by the mosquito, because it’s been always with them.”

Deseda said government fumigation encourages apathy among the population. “The government is doing something so they don’t have to anything.”

Ceda Velez, a 36-year-old woman working a juice stand near San Juan’s cruise ship ports said she was in favor of government fumigation.

“We use repellant, but at least it would help with where the mosquitoes breed, to kill the mosquitoes,” she said in Spanish. “I worry.”

Puerto Rico won’t fumigate with Naled from planes, as Florida does. And even if Puerto Rican authorities decided to fumigate street-side from trucks, only about 12 on the island are outfitted to spray for mosquitoes. Regional resistance to insecticides has also confounded eradication efforts.

Some residents believe the island was a guinea pig for past federal government experiments, that Zika was mild and posed no risk, that they weren’t going to stop “living”, or were simply misinformed about how to prevent exposure.

“I had, yes, but I drink Tylenol, y ya,” said Naara Nieves, 39, who stood outside at noon in San Juan proselytizing, a gregarious evangelist of Jehovah’s Witness. “I think the women who are pregnant, is bad, but for me, no.”

Marylin Vigo, who was visiting her sister on the island from Brooklyn, New York, said her relatives called her “paranoid” for even slathering on mosquito repellent.

“She goes, ‘Ugh! That doesn’t mean you’re going to get Zika, because of mosquito bites,’” Vigo said, describing her sister’s reaction. This is despite her sister’s belief that Vigo’s 29-year-old nephew just contracted the virus.

A cultural gulf

One of the most cited differences between Puerto Rico and the mainland is the lack of screened windows and air conditioning, which hamper mosquito-borne diseases spread in places like Texas.

Tropical breezes course uninhibited through flung open doors, patios and unscreened louvre window shades. The open roofs of Spanish-influenced architecture let in rain drained away by a floor grate.

“If you go to the communities, people love to sit out on their patio, play dominoes, play music, have a barbecue, and that’s difficult to do in a screened in porch, or take advantage of the Caribbean leeward breezes,” said Rivera-Garcia. “It certainly changes your way of life.”

So the Puerto Rico Department of Health is focused on behavioral and cultural change.

River-Garcia said past epidemics of diseases with severe symptoms like Chikungunya have not driven people to engage in practices like wearing repellant and investing in screened windows.

“That’s why we – from the get-go in January – we said, ‘OK, we need behavioral science studies. We need to understand what will be that one driver, or the drivers, to effect behavior change.”

Even for those who might want screens, it could be a real burden.

Nearly half the population, 46%, lives in poverty. The average per capita income is just $ 19,600, making an air conditioned bedroom unattainable.

A raft of other science conducted on the island is looking at other solutions. Children of Zika-infected mothers will be followed until they are three years old. Alvarado and his team collect blood and placenta samples from Zika-infected women who give birth and miscarry.

Traps are being reengineered at the Dengue branch, including the promising, pesticide-free innovation of a bucket that uses fermenting hay and water to trap mosquitoes.

“It drives me to keep trying and see where can we improve, what else can we do,” said Rivera-Garcia. “I think for all the responders both local and stateside with many Puerto Ricans in various areas of expertise – they’re coming back, donating their time, or asking for deployments in Puerto Rico.”

Puerto Rico officials struggle to translate Zika virus fears into action

In Healthcare, Apple Will Struggle To Match Enormous Samsung Ambitions

Apple went public last week with its new Overall health Kit, the SDK for well being applications on iOS eight, and its partnership with the Mayo Clinic. Rival Samsung, although, is previously way down the road into healthcare on many fronts such as the gadget, the platform, health-related diagnostics, imaging, patient records accessibility and far more. Samsung has the large image in its sights.

Apple, even so, is just launching into the health sector. As well small too late from Apple? That was hardly the mood soon after WWDC. And Apple will bring its outstanding branding electrical power and ease of use to the sector, although Samsung brings muscle and aggression.

But let’s be clear. Samsung is properly entrenched in health.

Apple Apple earned plaudits final week from an adoring audience but Samsung moved into health two many years earlier with its Galaxy S3. Its Note and Galaxy smartphones are now integrated with its own monitoring gadget, the Gear Match.

So far, so excellent. Samsung will be a worthy competitor with its well being-oriented units and providers. But the endgame in wellness is integration. Who will manage the romantic relationship in between patient and overall health care supplier, who will management the information?

Apple chose to announce its wellness app and overall health kit along with a new partnership with renowned health institution – the Mayo Clinic.

English: Mayo Clinic Rochester Minnesota – Gonda Building (3rd Avenue SW) (Photograph credit score: Wikipedia)

That may possibly be very good for demonstrating some of the rewards of health monitoring but The Mayo Clinic is just one particular institution. Its relevance is symbolic. Far more essential in the long run is its partnership with Epic Methods, a hospital details techniques provider. Details Week believes it will give Apple huge credibility in the hospital surroundings.

Meanwhile Samsung has selected a variety of routes into overall health.

Just prior to Apple’s announcement Samsung announced SAMI – “the Samsung Architecture for Multimodal Interactions, a cloud-based open software program platform capable of bringing together diverse data from a variety of sources for examination.”

Samsung also showed a modular wearable gadget (albeit a “reference architecture” rather than a shipping solution) that is capable of accepting plug-in sensors from third-get together hardware developers.

Individuals measures have been interpreted as a spoiling gesture on the eve of Apple’s WWDC. But Samsung has been positioning itself in overall health care in a a lot a lot more comprehensive way than Apple has.

While SAMI may be a method for how to get information from a variety of wearable devices and integrate them in a dashboard, Samsung’s true ambition is “to grow to be a global leader as a healthcare business via joining collectively its show, semiconductor, and mobile businesses”.

In other words, for Samsung, overall health is about bringing it all with each other. It funnels a good deal of that power by means of its subsidiary Samsung Medison.

Via Samsung Medison and its core electronics business, Samsung has a growing business in healthcare imaging and diagnostics (for illustration in Ultrasound technological innovation and X-Ray), health care Cloud, and in mobile patient data access inside hospitals.

In Healthcare, Apple Will Struggle To Match Enormous Samsung Ambitions

A protected spot to keep: the struggle to discover housing for America"s mentally ill sufferers

At any offered time, there may possibly be a couple of hundred homeless individuals in Seattle’s Pioneer Square neighborhood, huddling beneath the overpasses from the persistent Washington rain. It is a familiar place for Geraldine, who has invested the past twenty many years caring for her 38-yr-previous son, who is mentally ill.

When her son is not in prison or in hospital, Geraldine, 64, tends to make every day visits to a 3-block area to bring him foods, drink and warm clothes. She is aware of the color of his sleeping bag, and seeks it out amongst the dozens of other folks in among the shopping carts and trash bags. Sometimes he rejects her aid. Other instances, he provides her presents to other individuals on the street.

Often, her son has lost a lot more weight, and his hair is far more unkempt. His eyes search distant and strained.

These days, however, instead of going to Pioneer Square, Geraldine makes a weekly journey to a psychiatric hospital, in which her son is being taken care of for schizophrenia.

It is the longest Geraldine’s son has been stably housed since his preliminary diagnosis practically twenty years in the past, but she’s afraid he will finish up back on the streets, in prison, or dead – because of the lack of protected, prolonged-phrase housing accessible to men and women with extreme psychological sickness.

“It’s all-consuming. I consider about it all the time, even when I am performing factors I take pleasure in,” Geraldine advised the Guardian. “Then I believe about him and how he is residing.”

America’s mental wellness care crisis: crucial information, day two

Ever given that her son disappeared from house as a teenager, he has ping-ponged through jails, homeless shelters, halfway homes and the streets, and Geraldine has spent that time operating to uncover him a protected spot.

She emails, calls and meets advocates, politicians and administrators on her son’s behalf. She is not cozy offering her surname – her complaints within the system have induced her to be a recognized identify, and she is afraid those complaints will affect her son’s possibilities to acquire sufficient care. She also asked that her son not be named.

Geraldine, who has two other young children, believes secure housing is the only way her son can control his schizophrenia and lead a risk-free, wholesome life. Regardless of becoming her son’s main caregiver, Geraldine doesn’t have the sources to provide him with the so-called “supportive housing” she believes he demands, and which, study displays, could preserve him from returning to jail or the emergency area.

Gretchen Locke, at social policy thinktank Abt Associates, has researched homelessness for a lot more than 20 years, and is a company believer in the electrical power of supportive housing.

“It truly does facilitate stable housing, and also decreases the use of expensive crisis care, which is often exactly where homeless men and women end up. If [people with mental health troubles] are not stably housed, they’re far more inclined to end up in the emergency area or jail or detox and these type of pricey security net solutions,” Locke mentioned.

“Stable housing can offer a platform for addressing mental sickness that may not have been addressed in the past.”

As soon as in supportive housing, mentally unwell individuals depend less on other costly services, according to a University of North Carolina Charlotte research from February this yr.

Researchers located that the total hospital bill for 61 chronically homeless grownups – 38 of whom had a mental sickness – decreased by $ one.8m in excess of one particular year that they spent in supportive housing. When in housing, residents had a 78% reduction in emergency room visits and a 79% reduction in days spent at the hospital.

Supportive housing programs don’t usually pay for themselves, but simply because mentally unwell individuals tend to use much more pricey providers, the expenses of putting them in supportive housing are frequently offset by decreases elsewhere, stated Dennis Culhane, a professor of social policy at the University of Pennsylvania and the director of study for the Nationwide Center on Homelessness among Veterans at the US Division of Veterans Affairs.

“Being homeless requires a variety of dehumanizing experiences, and also greatly puts folks at threat of victimization and publicity to injury – as nicely as becoming marginalized,” mentioned Culhane. “Housing, by its nature, affords individuals safety: socially, physically and emotionally. So it’s actually about transforming people’s good quality of lifestyle.”

Chart: shortage of public psychiatric beds by state in 2010

Geraldine is an professional on these type of supportive housing packages, and is a acquainted encounter to workers at one of the packages in Bellevue, which she hopes her son can get into when he’s discharged.

In January 2013, more than 387,800 people had been homeless, in accordance to government estimates. A 2006 review shows that 20 to 25% of the single grownup homeless population has some form of significant psychological illness. That suggests someplace in between 70,000 to 96,000 homeless people have extreme mental illness.

The sum of supportive housing is growing, but turnover is reasonably reduced in those units, and the demand is high.

Left with out trustworthy housing, Geraldine’s son has been hospitalized involuntarily at least 4 occasions. Hospitals are typically overwhelmed by the amount of individuals in search of psychiatric care, in element simply because the amount of psychiatric beds accessible decreased by 14% from 2005 to 2010, according to the Treatment Advocacy Center.

The different to hospital care – prison – terrifies Geraldine. “Folks tell me to stay away and see what happens,” she said. “I know what takes place. He ends up in jail.” Her son has been incarcerated at least twenty instances.

Geraldine has been looking following her son for 20 many years. Photograph: Amanda Holpuch for the Guardian

Incarceration is a pretty widespread fate for folks with extreme psychological illness. Jails residence ten occasions as a lot of mentally unwell men and women as state hospitals, according to an April 2014 Therapy Advocacy Center report. The 3 biggest state-operated mental health amenities in the US are Cook County jail in Illinois, LA County jail, and New York’s Rikers Island jail, where a homeless veteran on anti-psychotic medication was “baked to death” in March.

Speaking to a congressional panel in March, Cook County sheriff Thomas Dart explained how his jail was an example of the way mental sickness has been “criminalized” in the US.

“While some mentally sick folks are charged with violent offenses, the bulk are charged with crimes seemingly committed to survive, like retail theft, trespassing, prostitution and drug possession,” Dart stated.

Dart explained that in 2013, more than 1,200 males had been in the psychological overall health dorm of his jail for an regular keep of 87 days before they even went to trial. At that rate, it expense a lot more than $ twelve,000 to residence each particular person, for a complete of far more than $ 14m.

“Far too numerous instances, they are launched to the community, where the vicious and predictable cycle begins over,” Dart said.

The 1st time Geraldine’s son went missing, she known as jails and hospitals across the western US, eventually discovering him at a jail in Arizona, the place he was being held on an assault charge. He had been missing for nearly a 12 months by then. Geraldine still doesn’t know how he produced it from Washington to Arizona in that time – he left property with out funds.

She bailed him out of the jail and place him in a hotel space, exactly where he created calls in the middle of the night and flooded the bathroom since, convinced the shower curtain was covered in germs, he refused to use it. Geraldine could inform her son was afraid of her, but she didn’t know anything about mental sickness, and assumed his behavior was drug related.

She left he ended up in jail again. She came back he was put in a hospital. She moved to Arizona he was discharged to a halfway property. Then he violated probation by having marijuana in his method and was put in jail again.

“Which is the beginning, and it has not changed,” Geraldine said. “Wherever he is, I fly there, and consider to get him support.”

Geraldine is now an unofficial professional on how to get prison guards, hospital staff and municipal staff to give her details they swear they aren’t supposed to tell her. She routinely skirts government bureaucracy to get her son simple necessities, like an identification card he essential in order to apply for positive aspects.

“I have been fortunate – would he push that hard? Or know to? Would he have any person in his daily life to do that? Would my sons do that? Even if they want to, I will not feel they would. It truly is taken 20 years to discover what to push and what not to push.”

Geraldine conservatively estimates that she’s invested $ one hundred,000 on her son in the previous ten many years. That cash does not include his hospital stays, which are absorbed by the hospital, or jail time, which is paid for by taxpayers.

Geraldine has misplaced a self-designed organization and had cancer 4 times. She commenced to see a therapist for the first time in March and recently took up doing exercises again. She works 7 days a week, in element simply because this has been her most hard economic 12 months ever, and in part to try to take her thoughts off her son.

In December, Geraldine went to Seattle’s mental overall health court in an try to preserve her son institutionalized. While there, she had to take the stand and testify about her son’s psychological wellness. She had to recount the times he attacked her, his stints in jail, the early hrs he’d spent pacing outside her suburban apartment and his delusions, which includes the instances that he has believed he is Jimmy Carter, or Jesus. And she had to talk about the premonition he had that, in 2015, he killed his mother.

“You have to say all the worst items you could probably say or they are not going to hold him,” Geraldine explained. “It’s heartbreaking. It is betraying. It’s the worst [thing] in the globe and you get rid of all trust.”

America’s psychological well being care crisis: join the conversation

Even though she was in the courthouse, she held the elevator door for a man or woman pushing a wheelchair. When she turned to appear at the guy in the wheelchair as it came up up coming to her, she recognized it was her son. Seeing him vulnerable and disheveled, she started to cry. That’s when, she said, he advised her: “You asked for this, mom. This is what you wanted.”

Of course, that was not what she wanted. Her dream is to be ready to afford a home with a guest house, so her son can be in a risk-free, steady scenario and even now have some type of independence. Given that that is a financial impossibility, she hopes she can at least get him a risk-free area to keep when he is discharged from the psychiatric hospital, a prospect that terrifies Geraldine and could take place any time.

For now, the judge hearing Geraldine’s son’s situation ruled that he should keep in hospital. Still, he’s at the greatest location he’s been since his original diagnosis. He operates at the hospital cafe and is reading through books on how to turn into a peer counselor. Even though he is safely off the streets, her largest preoccupation is where he will end up subsequent and how long he will be able to function towards the daily life they the two want for him, one particular in which he can handle his signs just before his progress is halted or reversed.

“As a parent you think, I indicate, I know I manufactured a lot of blunders, I worked all my life … Everyone wishes they had completed particular items differently,” explained Geraldine. “I just come to feel like, with all of this I nonetheless can’t, I nevertheless cannot change anything. I will not think in living in concern, I believe in becoming optimistic and hoping that there is an answer and believing in one thing.”

A protected spot to keep: the struggle to discover housing for America"s mentally ill sufferers

Skeptics will always face an uphill struggle against pseudoscience | Michael Marshall

If the scientific skepticism motion have been to decide on a mascot, we could do a good deal worse than Sisyphus: the figure from Greek mythology doomed by the gods to devote eternity pushing a boulder uphill, only to watch it roll back down yet again the moment he rests. Few other analogies actually capture the frustrations and seeming futility of counteracting a extensively held pseudoscientific belief.

Possibly worse, it is not ample for us simply to push back against the outrageous claims of pseudoscience, and those who capitalise on the bereaved and the vulnerable (whether knowingly or unknowingly) – we also have to do so responsibly. We can’t afford to use the dirty tricks employed by some of these we criticise, lest we lose our very own integrity and with it no matter what persuasive energy we might have had.

Equally, we can’t afford to advocate rationalism with the identical brashness and rudeness displayed by some pseudoscientists, because our truths are sadly significantly less welcome than their comforting untruths. It is effortless to persuade an individual of a falsehood if it is anything they desperately want to hear. They will even spend you for the privilege, and defend you to the hilt.

This is the Greek tragedy of the contemporary skeptical motion. If we’re cursed to play the function of Sisyphus and forever push our boulder up the mountain, we’re also fated to do so with a single hand tied behind our back. Rest assured, these advocating explanation will forever encounter an uphill battle, and any victories will be slow and challenging – and the minute we stop pushing, the boulder will inexorably roll back.

So why do we bother? If each and every victory only holds back the tide for a whilst, what’s the level? It is a question I’ve been taking into consideration a great deal of late, and I feel the answer lies in social duty, humility and an awareness of our own susceptibility. It is as well simple to see ourselves as getting beyond belief, or above belief: “There but for the grace of a god I don’t believe in go not I, for I am smarter than that, and I are not able to be fooled.”

Personally, I don’t buy that mentality for a second. Intelligence is no guard against pseudoscience – wise individuals basically find smarter methods to justify their belief in the unjustifiable. Rather, the genuine defence towards succumbing to seductive nonsense is an awareness of our own intellectual limitations and the cognitive flaws to which we are all prey. Or, in short, skepticism.

Skepticism is an anti-virus system for the brain: it merely supplies the resources to examine suggestions, combined with the knowledge that can get the weight out of undesirable concepts. Realizing that psychics have distinct techniques of asking concerns that make it sound as though they’re supplying data implies you are alive to the trick when you hear it. Awareness of regression to the suggest and confirmation bias may possibly quit you attributing your recovery to the copper band on your wrist or the sugar pill on your tongue. Knowing that President Kennedy’s seat in his car was raised to make him far more visible to the crowd will take the mystique out of the trajectory of that magic bullet.

But the anti-virus application analogy isn’t ideal, since after you have been infected with a “logic virus” it is hard to uncover and delete it, due to the fact it covers its tracks so well. Folks who fall for the seductive claims of psychics do so not simply because they’re wilfully flouting reality, but because there’s a phenomenal emotional sway that goes with the mystical. We have all misplaced a person near to us, and we have all felt the pain of bereavement. As skeptics, we have no magical solution to that soreness.

At their lowest ebb, at their most vulnerable, that is when folks are most at threat of taking a logical misstep that, when made, is extremely hard to reverse. And that applies not just to the “illogical handful of”, but to every a single of us, due to the fact we are all prone to moments of weakness. It is portion of the human problem, and it will take an act of near-perverse will to break that pattern, since it’s so deeply ingrained in our cultural and evolutionary psyche.

But that’s why it’s so crucial that we as skeptics and rationalists phase up: when someone is in a negative area, it’s the obligation of everybody who is aware of them – and even folks who really do not know them – to view their back. Because when I’m in that place myself, when I’m at my lowest ebb and feel as although actuality offers no hope, I want there to be men and women who end me walking – blinded by vulnerability – into an open manhole.

Michael Marshall is the project director for the Good Considering Society and vice president of the Merseyside Skeptics Society. He tweets as @MrMMarsh.

Skeptics will always face an uphill struggle against pseudoscience | Michael Marshall

NHS will "struggle to survive" on austerity budgets, warns outgoing chief

But without having them potential NHS leaders would preside in excess of a ”managed decline”.

Sir David explained: ”I will not consider the wheels are going to come off tomorrow. But we’ll see a position the place people have to reduce the quantity of nurses on the wards and have to lessen the drugs that we give to men and women.

”I can see all of these factors occurring unless we embrace this modify.”

The reformation – to delivery of care rather than the construction of the overall health service – is crucial to make sure the NHS can cope with increasing demand, he said.

Among the crucial alterations is the require for a significant centralisation of hospital providers to improve top quality of care.

Sir David suggested that rather of each hospital obtaining a classic accident and emergency unit, there would be ”between forty and 70 main emergency centres across the country, with all other centres feeding into them in a network”.

That would not mean people other hospitals losing their emergency departments altogether, he explained, but they would no longer deal with the most significant of circumstances.

”The other individuals will (nevertheless) take 70 per cent or 80 per cent of the sufferers who at present turn up at A&ampE units and deal with them as normal.”

The 300 organisations that offer specialised NHS solutions, such as cardiac or cancer care or organ transplantation, should be reduced to among 15 and thirty.

A big proportion of hospital care ought to also be transferred to local community settings to support the NHS cope with an ageing population, a rise in patients with one or far more lengthy-term issue this kind of as asthma or diabetes, and demand for new remedies. GP providers should also be accessible every hour of each and every day.

Sir David advised the Guardian: ”We know this modify can be carried out. And we know that a lot more preventive operate in the community decreases demand on hospitals and that concentrated specialised solutions prospects to much better outcomes for individuals.

”But it’s tough to picture carrying out all those issues without having some monetary flexibility to allow us to do that, some type of adjust fund that would allow us to do that.”

This further funds would permit existing hospitals to be run whilst new solutions are designed in the community.

Sir David stated that without having the overhaul there could be a decline in quality in the NHS, which could lead to a collapse in public support for the well being support and a rise in private healthcare.

He explained it was ”unavoidable” that the up coming government would have to uncover extra funds to fund the adjustments.

NHS will "struggle to survive" on austerity budgets, warns outgoing chief

One Son’s Struggle to Maintain His Aging Mother and father Young

My mother and father, in their sixties, complain about muscle and joint soreness every morning when they climb out of bed.  They say their initial steps are painful and halting with tingling in their feet and hands.   As they stroll about the property and brew their initial cup of coffee, the stiffness gradually subsides and they are capable to go about their active day.  What’s leading to this and how can I support?

Mom and Dad are probably encountering the discomfort of osteoarthritis triggered by irritation.  Are copious amounts of aspirin and NSAID’s the reply?  They worry about the results on their liver if they eat them each single day.  Acetaminophen was shut to currently being banned by the FDA only 3 years in the past, but it remains prevalent in so a lot of ache medications.  It brings about an increased risk of cancer, skin reactions, autism, hearing loss and can be FATAL.

So what are some organic therapies that will improve their overall health?  How can they decrease the inflammation in their joints?  What can I do to preserve assist them continue to be independent?

My solution is to consider a three prong approach to the dilemma.  First is retaining the mind younger and sharp.  Second they will want to boost their total energy amounts.  Lastly our dad and mom need to have to remain active and consume right to maintain their joints limber.

The brain is an extraordinary muscle that will function longer and tougher for you the a lot more you physical exercise and feed it.  It consumes up to twenty% of the total calories your entire body exhausts day-to-day.  The brain is like a race vehicle that needs to be firing on all cylinders to function best.  It wants meals that will give it the large octane fuel it operates on.   It calls for a big sum of oxygen to hit best velocity.  The engine, the heart, needs to be moving oxygenated blood rapidly into the veins.  Ultimately people veins require to be versatile and huge to feed the tiniest cells.

Exercise is an absolute need to.  The heart requires a great quantity of vitality to push all the blood and oxygen into your brain.  Typical exercising, including cardiovascular, need to grow to be regimen.  A cardiovascular regimen will make the lungs more effective at absorbing and converting oxygen.  The veins in our entire body turn into much less pliable as we age.  Their have been some scientific studies suggesting that omega-3s are capable to improve elasticity in veins.

The brain is produced out of about 40% of the omega-three DHA.  DHA can only be discovered naturally created in breast milk and marine algae.  Make sure your dad and mom are eating at least four servings of fatty fish, like mackerel &amp herring, for EPA or DHA each week.  If they are not, then basically feed their brain from the only other principal supply of EPA and DHA in phytoplankton.

Workout the brain with puzzles and totally free on the internet brain games. Make confident they stay social with their fiends and household.  They also want to assist, give them small tasks that can assist you out without triggering as well a lot stress on them.  It will help them stay at their sharpest!

Our vitality ranges are established by several factors.  Once once more, physical exercise is the ideal way to increase people and power levels.  Program, schedule, schedule!!  That’s the trick to working out!  When your body becomes accustomed to its new regimen it will speedily show its rewards.

Make positive your parents are receiving lots of fresh fruits and greens.  Consuming raw vegetables has fantastic fiber and gives them a boost of power.  Keep the fruits coming for their antioxidants.  This new fish oil replacement provides all the omega-3 advantages without the undesirable taste or large pills.   It’s also a lot easier to digest than oily fish tablets.

Stretching and yoga are fantastic approaches to remain limber!  A quick evening stroll about the neighborhood or by way of the grocery market place can go a lengthy way for their tendons and ligaments.  Preserve the cartilage wholesome be feeding it proline, the constructing block of tendons and ligaments.  Proline will aid develop and strengthen all of their joints, offering them the freedom to get up and encounter yet another day.

I’ve been helping them adhere to these easy actions for the final 18 months.  They are the two visibly more energetic with less soreness.  Watching them play with the grandkids let’s me know that I’m assisting absolutely everyone as much as one man or woman can.

One Son’s Struggle to Maintain His Aging Mother and father Young