Why axeing 18-week surgery target won"t create more capacity in A&E

Press coverage of the recent Next steps on the NHS Five Year Forward View [pdf] concentrated heavily on the argument that a lower 18-week elective surgery target in 2017/18 will make it easier to recover performance against the four-hour accident and emergency target. But false linkages between the two targets are hiding the real risk for the NHS.

While the lower elective surgery target is a welcome, but painful, acceptance of reality, the linkage between the two targets is neither direct nor strong. And overemphasising that linkage underplays the serious risks the NHS faces next winter.

NHS performance between December 2016 and March 2017 showed the service is running a higher risk in the provision of urgent care than at any point over the past decade.

The 95% four-hour A&E target isn’t a particularly good measure of that risk – the Royal College of Emergency Medicine argues that 75% performance against the four-hour standard is the “magic mark for safety … when it becomes very overcrowded and … unsafe”. Better measures of patient safety risk are the levels of hospital bed occupancy, ambulance handover delays and the number and frequency of long hospital trolley waits.

All of these took a significant turn for the worse last winter. A third of hospitals had bed occupancy rates of 100% on at least one day. Many reported trying to manage bed occupancy levels well over the recommended 85%-90% level for weeks on end. This required continual, difficult, “one in, one out” admission/discharge decisions that usually led to worse care for the patients concerned. Ambulance diversions – hospitals turning away ambulances because they were full – were up 85% compared with the previous year.

While the NHS as a whole just about coped with record levels of demand, a number of local systems were overwhelmed for periods of time, putting patients at unacceptable risk.

Hospital and ambulance trust leaders are now concerned about their ability to manage this growing risk and that the number of systems in danger of failing over next winter is rising. Their colleagues in community and mental health report similar pressures, risks and concerns though, frustratingly, we either don’t have the public data to show this or the data is too new to be robust.

Aiming for a lower 18-week elective surgery target will, in many instances, make little difference, for three reasons.

First, many hospitals are now undertaking such relatively low levels of elective activity that they are, in the words of a recent Health Foundation Report, “becoming more of an emergency service” (pdf). Relaxing elective surgery performance targets won’t help them much.

Second, most hospitals have already scaled back their elective work over the crucial winter period. Indeed, they were formally instructed to do so by NHS Improvement. Relaxing the elective surgery target won’t create much extra winter capacity as it has already largely been freed up anyway.

Third, urgent and emergency care performance is not just about hospitals. While concentrating more hospital capacity on emergency, as opposed to elective, care may help a little, it does nothing to address the problem of capacity constraints in primary and social care, and the ambulance, community and mental health sectors.

The NHS can no longer do everything. Trying to hit the elective surgery target would have required the service to abandon proposed increases in cancer, mental health and primary care funding. But relaxing the target does have unwelcome side effects. As the £300m deterioration in last year’s trust finances in the third quarter showed, reducing elective surgery seriously hits trust financial performance just when we are trying to recover it. Delaying surgery also risks turning some cases into emergencies, adding to the urgent care burden.

Good urgent care largely depends on supply and demand across a local geography. The NHS struggles with winter pressures because we don’t have enough capacity. If we want to manage growing risk, we have to increase capacity to match growing demand.

We need to boost capacity in primary care, where the number of GPs is falling, not rising. We need to increase capacity in out-of-hospital care, not reduce the number of out-of-hospital beds by 8% as happened between winter 2016 and winter 2017. We need to grow capacity in social care, not cut the number of care packages available, to reduce delayed transfers and enable hospitals to properly manage their patient flow. And we need to increase temporary capacity in both acute hospitals and ambulance services too, if that’s what’s needed. It’s important to note that we added eight extra hospitals’ worth of temporary acute bed capacity last winter and still struggled.

What we shouldn’t do is kid ourselves that relaxing the 92% 18-week elective surgery target is any real substitute for that extra urgent and emergency care capacity. It isn’t.

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Why axeing 18-week surgery target won"t create more capacity in A&E

My teenage cousin is having a crisis, but her mother won’t get her the help she needs

My cousin is 16, and apparently going through a crisis. She hates college, skips classes and has spoken to my grandmother often of hating her life and not enjoying anything any more. My grandmother is in bits about this and has tried to talk to my cousin’s mother, her daughter, about getting her some help. However, my aunt’s response has been, “She’s not going to turn out mental like the rest of you people.” (Other members of the family, including me and my grandmother, have had mental health problems.)

My cousin enjoys watching videos and playing video games, but her parents have banned them and see them as an example of her laziness. She is not sleeping either, so her constant exhaustion is taken as yet more evidence of laziness.

What terrifies me is that this is what my mother did to me, and I can only see it getting worse. When I began self-harming in my teens, my mum also banned me from my one hobby, screamed at me when I had a panic attack and slapped me when she found out I had self-harmed.

I had problems with substance abuse and dropped out of school. I moved away from home as soon as I could.

I am now in my mid-20s, and not close to anyone in my family apart from my grandmother. I have now moved somewhere else and, although I don’t see my parents, I am in contact with them. I haven’t seen my cousin for a few years and have no contact details for her. Anyway, I am not sure how, “Hi, I know we haven’t spoken in years but you remind me of me” would go down. I am trying to help my grandmother find a way to talk to my aunt in a manner that won’t enrage her, but my grandmother is a very non-confrontational person and, as much as she is trying to help my cousin, having to confront my aunt has only resulted in my grandmother being screamed at and threatened with losing contact with her grandchild.

I don’t know how to help my grandmother or my cousin, but I feel as if I have to do something, or history may repeat itself.

That you have come so far from a very toxic and unsupportive environment is incredible and a real credit to your strength of character.

It is great that you are so caring about your cousin and grandmother, but I think there is a lot of over-identifying going on. Your cousin doesn’t sound as if she is in a great place, but the facts pertaining to her were thin. The rest of your letter was about your experiences within the family and your fears of what might happen. I am not trying to minimise how you feel, or what is happening in the slightest – but the key is to separate the different strands so you can work on the right bits at the right time.

I consulted Stuart Hannah, a child and adolescent psychotherapist (childpsychotherapy.org.uk), who said: “The news about your cousin is filtered through your grandmother, via her daughter [your aunt].”

News filtered through people who have their own agenda or narratives can get distorted and then there is less likelihood of anyone getting the help and support that is right for them.

I disagree that it is not worth contacting your cousin: I think you should get in touch. Sure, if you go in there with “you remind me of me” that may not be conducive to further communication. But if you make a different sort of contact, more of a general “hi”, and see what happens, that may be really helpful to her in time (don’t expect miracles straight away). After all, you are not that much older than her, a mere decade, and you share a grandmother. There should be lots of other things to talk about so she feels she has someone to talk to if she feels like it – so it’s about her agenda, not anyone else’s.

It sounds as if you have a lot of issues you haven’t dealt with yourself and I wonder if you have some support (apart from your grandmother). If you do, you could come at this situation with less of your own baggage and would be better able to support your grandmother.

I don’t know what the conversations with your grandmother are like, but Hannah counsels: “How can you offer [your grandmother] something different? Something that isn’t judgmental or blaming [that she seems to get from her daughter]. You can listen from a neutral place. Don’t go down the slagging-off route [if you do], and suspend judgment of family members. If you can hear your grandmother’s experience, that may in turn help her listen to her daughter.”

Being empathic is great – however, if we over-identify with a situation (and both you and your grandmother might be), then the danger is, when we hear about something similar we can start to overlay our own experiences on to this new situation. This stops us seeing what is really going, and it imbues everything with extra emotion.

I think, given everything you have said, there is an element of trying to save your younger self, and that’s laudable, but there is a limit to how much you can do. You may also find this website helpful:

Youngminds.org.uk

Your problems solved

Contact Annalisa Barbieri, The Guardian, Kings Place, 90 York Way, London N1 9GU, or email annalisa.barbieri@mac.com. Annalisa regrets she cannot enter into personal correspondence.

Follow Annalisa on Twitter @AnnalisaB

My teenage cousin is having a crisis, but her mother won’t get her the help she needs

Why Won’t My Doctor Listen to Me? The Sad Reality for Those With Post-Concussion Syndrome

A Sad Reality for So Many With Concussion and Post-Concussion Syndrome

Nearly every day in clinical practice patients report to us (one way or another), “My doctor doesn’t listen to me!” This concern is far more prevalent in those suffering the effects of concussion and post-concussion syndrome. The same sentiment is often offered when it comes to how their family and friends act.

There are several theories as to why many doctors don’t take the time to listen. You can explore these at length with a simple internet search. Here, I will explore briefly some of the better know reasons and, more importantly, what I have come to see is the real truth behind why so many are being ignored. And, in many cases, being dismissed and belittled by their trusted health care providers.

What the Studies Show

• Time. Most primary care physicians are pressured by the demands of heavy patient loads and declining insurance reimbursement. That leaves you as the patient at the mercy of a provider that may only give you one minute or less to voice your concerns. For those of you with concussion there are often far too many to list!


• Distraction. Electronic records, insurance forms, mobile devices, and excessive patient volume can cause doctors to get caught up in things that are not right in front of them. That is you, the patient. If a doctor is distracted, they will not do a great job at listening.


• Bias. Many doctors spend less time with individuals based on their race, gender, and other factors such as socioeconomic status. Also, patients that come in with recurring complaints are more likely to be dismissed or ignored.

I believe these are accurate (although unacceptable) reasons for many being short-changed when it comes to their provider’s attention. But, there are more accurate reasons doctors don’t do a great job of listening when it comes to the laundry list of struggles that can accompany concussion and post-concussion syndrome.

The Rest of the Story

• Ignorance. This may seem like a harsh term to many (particularly the doctors). What it simply means is that most primary care providers lack the knowledge and information necessary to properly question, screen, and refer for these types of injuries.


• Invisible. Concussions are not seen on CT scans or found in blood work. These are silent injuries that result in functional problems with balance, vision, cognitive abilities, emotions, and more. Conventional medical approaches are not well suited for these conditions. Therefore, doctors are less inclined to listen to problems they cannot treat.


• Overwhelming. The number of symptoms and conditions that can result from a hit to the head are staggering (we’ve compiled a list of over 50!). Your doctor, when presented with 5, 10, or more complaints, may focus only on 1 or 2 as this is what they are accustomed to.


• Unknown. Even with all the attention given to concussion over the past several years in sports, the media, and movies; this is still uncharted territory for most providers in mainstream medicine. The challenge is, this is most common route taken when one has a concussion.

So, How Do I Get Someone to Listen (and, how do I get help!)

The internet is full of strategies to get your provider to listen better to you. This, however, is not the focus of this article. And, it will not serve you well to try and get those that do not understand concussion to listen to you! You need to seek out the services of a qualified functional neurologist (most often a chiropractic neurologist) who is well versed in the art of listening, and, who understands the multitude of symptoms those with concussion and post-concussion syndrome experience. Only then will you be able to find answers as to what the best method of treatment will be for you. Concussions are real, and so are the symptoms and the solutions!

Why Won’t My Doctor Listen to Me? The Sad Reality for Those With Post-Concussion Syndrome

Don’t dread old age. I’m 94, and I won’t spend my last years in fear of the Tories | Harry Leslie Smith

I have lived a very long time. Tomorrow, it will be exactly 94 years ago that a midwife with a love of harsh gin and rolled cigarettes delivered me into my mother’s tired, working-class arms. Neither the midwife nor my mother would have expected me to live to almost 100 because my ancestors had lived in poverty for as long as there was recorded history in Yorkshire.

Nowadays, when wealth is considered wisdom, too often old age is derided, disrespected or feared, perhaps because it is the last stage in our human journey before death. But in this era of Trump and Brexit, ignoring the assets of knowledge that are acquired over a long life could be as lethal as disregarding a dead canary in a coal mine.

I have been living on borrowed time since my birth in Barnsley all those years ago: I survived both the depression and the second world war. Even in advanced old age, because I walked free of those two events, I feel like a man who beat all the odds in a high-stakes casino. It’s why I’ve embraced each season of my life with both joy and wonderment because I know our time on Earth is a brief interlude between nonexistence.

Still, many people persist in thinking that old age is the end of one’s usefulness or purpose, which could explain why the news that women in South Korea can expect to live into their 90s has been badly received. Some fear the indignity that old age may bring, or the dependence it may cause because of physical or mental impairment. On occasion I too worry that before death sets in on me that it may rob me of the elements that make me who I am. But ultimately, having experienced the profound indignity of extreme poverty during the 1930s and the sheer terror of war in the 1940s, I know that life must be battled until the bitter end.

Eternity is just around the corner for me but I don’t fear my death. I only regret that death will end my dance to the music of time, no matter how slow the waltz has become to allow me keep up. I know that my physical wellbeing and dignity may yet be affected adversely by the government’s self-created social care crisis but I will not spend either my last years or days living in fear of the Tories. I cannot because I have seen their kind before in the 1930s and 1980s and know that the only way we can beat the tyranny of austerity is through our own personal defiance.

People should not look at their approaching golden years with dread or apprehension but as perhaps one of the most significant stages in their development as a human being, even during these turbulent times. For me, old age has been a renaissance despite the tragedies of losing my beloved wife and son. It’s why the greatest error anyone can make is to assume that, because an elderly person is in a wheelchair or speaks with quiet deliberation, they have nothing important to contribute to society. It is equally important to not say to yourself if you are in the bloom of youth: “I’d rather be dead than live like that.” As long as there is sentience and an ability to be loved and show love, there is purpose to existence.

I learned a long ago time ago that there was wisdom and beauty that could be mined from the memories of those in the sunset of life. It is why as a boy I listened in rapt attention to my granddad as he lay dying from cancer and told me about his life both as soldier and miner during the reign of Queen Victoria.

All of you, when young, will make your own history: you will struggle, you will betray some and others will betray you. You will love and lose love. You will feel profound joy and deep sorrow and during all of this you will grow as an individual. That’s why it is your duty when you get old to tell the young about your odyssey across the vast ocean of your life. It is why when death does come for me – even if it mauls me with decrepitude before it takes me – I will not lament either my old age or my faded youth. They were just different times of the day when I stood in the sun and felt the warmth of life.

Don’t dread old age. I’m 94, and I won’t spend my last years in fear of the Tories | Harry Leslie Smith

GPs working longer hours won’t ease the pressure on the NHS | Letters

Re your readers’ stories of the NHS (‘He stayed on that trolley in A&E for the next 12 hours’, 14 January), the government is putting out a spew of misinformation to cover the 2% reduction, as a percentage of GDP, it has imposed on funding of the NHS since 2010. The people on trolleys waiting for a bed are not the worried well who are accused of blocking up A&E departments. They are people who have already been assessed as needing beds. These beds are full not just because people cannot be moved out of hospital but because the number of hospital beds has been steadily reduced over the last 20 or more years, so that the UK now has 2.8 beds per 1,000 of population, compared with 8.6 in Germany and 6.2 in France. The forthcoming sustainability and transformation plans propose further cuts.

The government prefers to blame “bed blocking” because people are remaining in hospital “unnecessarily”. But people who are fit for medical discharge are waiting for social care packages and there has been a £4.6bn cut in social care funding since 2010. What is happening is an inevitable result of the deliberate and cavalier reductions in local government funding since 2010. The motion in parliament last Thursday, calling for extra funding for social care now and a new funding settlement for health and social care in the March budget, was rejected. Conservative MPs who have deplored the situation in their local press voted with the government. How do these MPs justify their refusal to vote to fund social care properly?

Care costs money. Whenever we in Save Our Hospital Services ask if people will pay more income tax to ensure the NHS is properly funded, there is an overwhelming “yes” in response. There is also huge anger among the public at what is being done to health and social care. The government will reap what it sows.
Ruth Funnell
Save Our Hospital Services

• The illogicality of the prime minister’s response is breathtaking (Stay open seven days a week, May tells GPs, 14 January). Anyone who has been responsible for helping someone in their 80s or 90s get to the doctor will know that what is needed is a decent choice of appointments between about 10am and 5pm. Spreading appointments over extended hours will make these much harder to get, so leading to increasing numbers presenting at A&E.

It is blindingly obvious that taking the same number of doctors’ appointments and spreading them more thinly is no solution. Appointments at 7.45pm on Saturday or 8am on Sunday may suit those in work but they are not, by and large, the people arriving at A&E departments.
Jenny Boehm
London

• The GPs have quite rightly pointed out that seven-day appointments will not work. However, it may be time for some patients to make more of an effort. To avoid an appointment interfering with my working day I can join the queue for our practice’s open access 8am surgery Monday to Friday. If I get there for 7.40am, I can be back on the street by 8.15am and get on with the rest of the day. If patients reckon that GP appointments clash with going to work, then going sick or booking half a day’s holiday may be appropriate options. If your healthcare matters to you, you have no need to slide into consumer mode.
Geoff Reid
Bradford

• Is the Jeremy Hunt who stated that “We need to have an honest discussion about the purpose of A&E departments” (Hunt ditches target as A&E crisis deepens, 10 January) the same Jeremy Hunt who took his own child to A&E with a minor illness because he didn’t want to wait for a GP appointment?
Dr Clive Richards
Bristol

• I am pleased that Theresa May and Jeremy Hunt are challenging the entitled approach of the medical profession. Our GPs earn double what their French counterparts do. If the BMA had not ruthlessly exploited the public esteem for doctors to access salaries and pensions beyond the dreams of other citizens, there could be many more GPs with the same personnel budget. The NHS cannot just consume our entire public expenditure – we do need to do other things with these resources.

Medical professionals need to understand that in the 21st century they are not the only people with education and skills, and that they must adjust their expectations to allow the NHS to live within its means. The public need to take the stars from their eyes and look hard at value for money in NHS spending. Aneurin Bevan said he had to stuff the mouths of doctors with gold to form the NHS – this is still true today. At last we have a government prepared to argue for realism and fairness, to allow our national spending priorities to come more into balance.
Name and address supplied

• Amid all the debate about the current crises in NHS A&E departments, the role of employer policies has attracted little attention. The growth of zero-hours contracts and the so-called gig economy means many workers have uncertain working hours. In such circumstances, committing to GP appointments is potentially problematic. Walk-in A&E departments offer an obvious way of avoiding this difficulty.

Meanwhile, a significant proportion of the workforce faces the prospect of losing pay when absent for medical reasons as a consequence of the poor nature and coverage of occupational sick pay schemes. Once again, the 24-hour nature of A&E offers a means of avoiding this problem.
Professor Phil James
Middlesex University

• Tucked away in the bottom right-hand corner of page 4 (Rates pain for hospitals, 12 January) is news that astonishes me. I had no idea that the NHS has to pay business rates. The estimated annual sum is £377m. More disturbing, however, is the news that private providers such as Nuffield Health enjoy an 80% rebate because they are registered as charities. Private providers enjoy a rebate as charities, while the NHS is classed as a business. Verily, “For he that hath, to him shall be given: and he that hath not, from him shall be taken even that which he hath” (Mark 4:25).
Joseph Cocker
Leominster, Herefordshire

• I volunteer at a nursery school. This term the theme is “people who help us”, and in a corner a hospital has been created, complete with pictures of bones, a reception desk, waiting area and bed. The children have tiny uniforms and medical equipment. The staff and I decided that for complete authenticity we need a “waiting time approximately 5 hours” sign, and make all the children wait outside in the corridor.
Jean Austin
Crawley, West Sussex

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

• Read more Guardian letters – click here to visit gu.com/letters

GPs working longer hours won’t ease the pressure on the NHS | Letters

Democrats embracing Tea Party tactics? That won"t work without a new ideology | Jamie Peck

While Republican lawmakers were colluding with vice president-elect Mike Pence about how best to repeal — and probably not replace — the Affordable Care Act on Wednesday, President Obama held a meeting of his own. Unlike many previous meetings of his, Republicans were not invited. He did not “reach across the aisle.”

Instead, the outgoing president laid out a strategy to oppose Republican efforts to repeal his signature healthcare legislation, a move that could kick up to 30 million Americans off health insurance. That strategy involves pushing the phrase “Make America Sick Again,” refusing to “rescue” Republicans by helping them pass bound-to-be-Randian replacement measures and referring to the resulting disaster as “Trumpcare,” as in: “I would have gotten my leg set by a doctor, but thanks to Trumpcare, I’m using Scotch tape.” The political fallout, he said, must solely hurt the Republicans. (Sounds like someone is finally jumping on the Bernie “time to admit you lied” Sanders train.)

Contrast this with remarks made back in April in which Obama warned his party against becoming too much like the Tea Party. Speaking to a group of law students in Chicago, he worried that Democrats would “stake out positions so extreme, they alienate the broad public.” He’s hardly become Eugene Debs, but it seems he’s come around to a more confrontational strategy. (Funny how your priorities change when you go from quelling a left-insurrection to trying to quell a right one.)

In instructing his party to openly vie for power and engage in the muck of actual politics rather than genteel tinkering, the president became the latest and most high-profile advocate of an idea that’s finally picking up steam in mainstream Democratic circles: copying the Tea Party, a faction which, for better or for worse, was and remains devastatingly effective at carrying out its program.

Beginning immediately after Obama’s 2008 election, a vocal, ideologically-driven minority of “activists” began storming town hall meetings, pressuring Republican representatives to resist Obama no matter what he tried to do and purging their party of anyone deemed insufficiently reactionary. Eight years later they enjoy a unified right-wing government and undisputed dominance of the Republican Party. Gone are the days when Congressional Republicans will let themselves be cucked by compromise. It’s high time the Democrats sunk to their level.

A 23-page Google document titled “Indivisible: A Practical Guide for Resisting the Trump Agenda” has been spreading around Washington faster than John Podesta’s risotto recipe. Written by a group of Congressional staffers who witnessed the rise of the Tea Party firsthand, it lays out a number of practical ways progressive activists and lawmakers can defend the incremental gains of the Obama era using Tea Party tactics, minus the physical intimidation and rabid racism.

Operating on a local level, acting defensively and waging constituent phone call campaigns are all ideas that can easily be appropriated. Considering the razor-thin margins by which Republicans won in many states, it should not be hard to frighten Republican representatives with the prospect of getting voted out.

Activists can also empower (or pressure, as the case may be) Democratic lawmakers to stand up for progressive principles, and this means tugging the political spectrum back to the left. Republicans have long known it’s foolish to start negotiations in the middle. They stake out extreme positions — a six-week abortion ban, a complete gutting of the Office of Congressional Ethics — so they can bargain down to what they actually want — a 20-week abortion ban, a “bipartisan” gutting of the OCE.

In contrast, Democrats said they were open to replacing Obamacare before Congress was even in session, voted to authorize the Iraq War and competed throughout the 1990s to show they could put black people in prison and dismantle the welfare state with the best of them. They let the ACA’s public option fall to the threat of a filibuster from Joe Lieberman, which they could have easily withstood if they’d wanted to. Even now, they deride the Tea Party’s tactics as childish and crass, when the truly crass thing is that 45 million people are living in poverty in the richest country in the world.

Of course, what the Google doc and the president fail to mention is that this only works if the Democrats are progressive in the first place; there can be no left-Tea Party without an organizing ideology. Which brings me to another Tea Party tactic: the purge.

While some Democrats (Elizabeth Warren, logical left-Tea Party choice for DNC chair Keith Ellison) are already reasonably progressive and more can potentially be dragged left by political expediency, many are simply too committed to neoliberal ideology and/or beholden to monied interests to be rehabilitated. Which means some pink-slipping and primary-challenging is in order.

Time travelers from the New Deal era would be confused to learn the leftmost major party’s 2016 nominee for president ran her primary campaign against the $ 15/hour minimum wage, tuition-free college and single-payer healthcare, deriding these common sense reforms as pie-in-the-sky fancies on the level of Trump’s wall, and only begrudgingly adopting certain elements of them once it became clear the left wing of her party might revolt.

In the general election, Trump exploited establishment Democrats’ longstanding support of labor-opposed trade deals to stake out a leftward position that threw the Clinton campaign for a loop. Despite the benefit of hindsight, many in the party’s leadership still refuse to recognize the role these failures played in their 2016 defeat.

For all the New Democrats’ talk of pragmatism over ideology, it seems the truly practical thing would be to grow some sort of ideological backbone. Those who refuse to do so must be left in the woods.

The good news is that once this happens, progressive activists and lawmakers will be able to use Tea Party’s tactics better than the Tea Party itself, because the left has actual grassroots movements.

Black Lives Matter, Fight For $ 15 and Bernie Sanders’ remarkable campaign are all examples of regular people coming together to effect change that put the Tea Party’s “grassroots” theatrics to shame.

If these movements have already achieved some modest victories on their own, imagine what they’ll be able to do with the legislative and monetary powers of a newly invigorated Democratic Party at their disposal. What the party may lose in large donations, it will gain in small ones, votes and the ability to fix this mess.

And that’s worth spilling some tea along the way.

Democrats embracing Tea Party tactics? That won"t work without a new ideology | Jamie Peck

Testing sore throats at pharmacies won’t solve anything | Margaret McCartney

Are GPs to throw away the traditional box of wooden tongue depressors? People with sore throats are soon to be offered a new service – at the pharmacy. The NHS Innovation Accelerator, an organisation responsible for helping “with the adoption of promising new treatments and technologies”, has approved a new Sore Throat Test and Treat service that NHS England says is “evidence based and cost saving”.

My head is in my hands. This is neither evidence based nor shown to be cost effective, and may actually make pressure on the NHS worse.

Faced with a wait for to see a GP, it means effectively people will be able to access care faster if they pay for it

The pilot study – which occurred in Boots stores (whose head office analysed the data) – was not a randomised controlled trial. It showed it was possible for pharmacies to assess people with sore throats and use a “point of care” rapid antigen test to determine who should get antibiotics. This might sound superficially sensible. But the National Institute for Health and Care Excellence (Nice) does not recommend this rapid antigen test because it has a poor sensitivity for picking up relevant bugs.

It is already known – from randomised clinical trials – that this test does not help beyond normal care. Furthermore there has been no full cost-effectiveness analysis – let alone an independent cost-effectiveness analysis – of the Boots scheme. Without comparing the pilot to usual care, we have no way of knowing whether more or fewer antibiotics were prescribed. It is a travesty of evidence-based policymaking.

This scheme may actually increase demand on the NHS, fragmenting services but without improving care. More than half of the patients in the study said that if the pilot had not been available, they would have either have done nothing or treated themselves without assistance.This, if it held true, meant that antibiotics were subsequently used just because the scheme was there. Isn’t that good? Not necessarily.

The study concluded that if the pilot hadn’t been available then there could have been a “delay seeking medical treatment when it was needed”. But it didn’t show this, and not all bacterial throat infections need to be treated. In fact, antibiotics reduce the length of time of a sore throat by an average of 16 hours, with only a modest impact on complications such as ear infections. Balanced against common side-effects of antibiotics such as diarrhoea, as well as antibiotic resistance, there is often not a clear-cut reason to prescribe. This scheme expands the market for medicine, without clear benefits. Earlier is not always better. It gets worse.

In the pilot, patients paid £7.50 for the test and £10 for “antibiotics if required”. This is a clear subversion of the free at the point of use principle of the NHS. NHS England has not been able to tell me what the funding for the new service will be, where it will come from, or whether patients will still have to pay. Faced with a wait for a free appointment with a GP, it effectively means that people will be able to access care faster if they pay for it. Commissioners with stretched budgets may be content with that. But it should be absolutely resisted.

The relentless argument from rightwing thinktanks is that we need to charge for NHS appointments; and that the funding deficit in the NHS is so acute that all options should be on the table. But it is a dreadful argument. People who are poor have the biggest risk of earlier death and earlier disease. The very principle of the NHS – based on need, not ability to pay – subverts the otherwise natural course of allowing better healthcare to be only in the domain of the already better off.

This scheme isn’t the kind of change we need in the NHS. Sir Bruce Keogh, NHS England’s medical director, has said of it “innovation is not an option but a necessity if we are to built a sustainable NHS”. But “innovation” should not be an excuse for policymaking that isn’t evidence-based. There are far better ways to ensure that the NHS is sustainable.

The NHS does need more money. But it also needs to stop wasting money and effort on inadequately tested – or proven to be non-cost effective – but popular political policies. Take the health checks scheme or dementia screenings, for example – known to be ineffective and even harmful, through causing false positive diagnosis and over-treatment. Millions have been needlessly wasted that should have spent on useful care.

Similarly, there are multiple pressures on general practice that have been generated by appalling but avoidable political policy. The current benefits system is associated with worsening people’s mental health and has created an enormous amount of bureaucracy for GPs, which reduces the availability of appointments. And that is even before we get to the money and time spent administering to the competition and commissioning of the Health and Social Care Act, without evidence of gains for patients.

We are in the midst of an NHS financial crisis. If we want it to survive, we need real innovation. That means the bravery to stand up for evidence-based policymaking, and ensure that NHS policy always considers harms, and aims to reduce waste – and health inequalities.

Testing sore throats at pharmacies won’t solve anything | Margaret McCartney

After an expensive and lengthy medical degree, I won"t become a doctor

Breaking bad news is an essential skill taught to us at medical school, one that I had to employ when explaining to my friends and family that after seven tough years at university, I’m leaving the profession.

If I take a step back and look at where it all began, I see a 17-year-old with a supportive, medically-oriented family who were absolutely certain of their child becoming a doctor. My entire childhood was a subliminal path towards making this choice, from having Scrubs or House on TV daily, to admiring the respect with which everyone addressed my father at his clinics.

Despite having a clear inclination towards technology, and general geekiness, I chose to continue my medical degree for lack, or perhaps fear, of pursuing other options. It was, however, not long into my training before I started dabbling with non-medical opportunities while masking them as “CV-beefers” for my medical career. This included spending two weeks traveling across Sweden and the Netherlands with a group of like-minded and skilled individuals, helping to improve their healthcare systems using technology.

The pressure that comes from understanding the importance of the job you’re preparing for, life or death in the case of medicine, results in students wanting to study and perfect each topic to a point where other interests are boiled off. Eventually, I started reprioritising my interests over this urge for academic perfection.

Along the way, my drive to become a doctor has diminished by increasing disillusionment of working for the NHS. This is not to say the NHS isn’t a fantastic organisation and one we should be immensely proud of. My main gripe as someone with a strong entrepreneurial gene is that it isn’t an institution that embraces innovation. For me, the deal-breaker is that the NHS doesn’t treat its employees as individuals and isn’t open to new ideas. I feel I could have a bigger impact on healthcare working outside the NHS rather than for it – this is why I aim to pursue a career as a doctorpreneur, not a doctor.

Coming to this decision has led me back towards my passion for exploring technology and despite the demands placed on me by my full-time university course, I have launched a tech company called Synap, which is already having a big impact on the way thousands of students study for exams.

But while entrepreneurship is the right path for me and, I believe, many other medical students with a passion for innovation – it’s not right for everyone.

My family have come to terms with my decision to leave the profession because they know I am driven enough to succeed. Have they questioned the time and money spent on a degree I won’t be pursuing as a career? Of course, but they also believe that my time spent at Leeds University is an investment for the future. The medical skills and training I’ve learned and developed are transferable to so many areas of my life and I know they will make me a better businessman.

There’s a lot I love about medicine and the NHS, but being a doctorpreneur will provide me with an opportunity to help more people from the outside.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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

After an expensive and lengthy medical degree, I won"t become a doctor

Healthcare innovations won’t cure global health inequality – political action will | Ben Ramalingam

The science fiction author William Gibson famously quipped the future is here, it’s just not evenly distributed. There is arguably no greater manifestation of our uneven world than that of healthcare. In the wealthiest countries, thousands of people in their 60s and 70s are kept alive with cardiac pacemakers that are remotely monitored over the internet, and adjusted by algorithms with no human intervention. In poorer states, three-quarters of a million children under five are dying each year because of shit in their water.

What can explain such unevenness, and what might be done about it? A scan of the proceedings at the World Health Summit in Berlin, which starts on Sunday, and where technological innovation is one of the major themes, is revealing. “Despite the exponential growth of scientific and technological development, low- and middle-income countries are still largely excluded from access to appropriate and affordable health technologies. Therefore novel technological devices need to be developed that can address health problems and improve quality of life,” reads the blurb for Monday’s keynote session.

Is this “must try harder” assessment correct? Is the solution to stark inequities in global health outcomes, and the enduring exclusion of developing countries from the benefits of innovation, to do more and better innovation?

Certainly, innovation for improved global health is arguably needed more than ever with the need to combat new and emerging diseases from Ebola to Zika and to find better ways of tackling non-communicable diseases such as cancer. But when we look at the innovations made in response to Ebola, we should pause for thought.

One stark example: in November 2014, when the Ebola outbreak was raging through west Africa, the US Food and Drug Administration went through an expedited approval process for a one-hour Ebola test, reducing the time for results by five hours from the previous fastest machines. The problem was that few west African countries had the resources to acquire the $ 40,000 machines or the skills to run them. They were, however, to be found in many US hospitals.

Or another example: Medécins Sans Frontières (MSF) helped to trial and demonstrate the effectiveness of new tests for TB in low income and humanitarian settings in 2011-12. But the price of the test made it prohibitive for many countries until a large public-private initiative emerged to subsidise the cost of the tests for 145 developing countries that were most affected by TB. Only then could this innovation benefit those who needed it most.

These are far from the only stories of how the poorest are excluded from the innovations that they need most. Once the stories start to accumulate, they turn from a trickle to a river to a flood. And one has to start wondering whether the old adage about famines is not relevant here: famines rarely result from a lack of food, rather it is lack of access to food. Similarly, the inequalities in tackling health problems are not because of a lack of innovation, but because of a lack of access to innovation. The binding constraints, I would argue, are seldom technical but instead related to the political and economic choices, which determine how innovations get funded, resourced and supported, by whom and for whom.

What to do in the face of such a system? The answer is to fight the innovation and political battles at the same time. We have to identify the gaps, and to test and trial the best new ideas that can address longstanding challenges faced by the world’s most vulnerable people, and build the evidence base that these ideas really can make a difference. Political leaders need to ensure that the scaling of new solutions includes those people who need innovation most, and who are most likely to be excluded from its benefits.

In doing so, it is worth looking to the work of organisations such as MSF, which do an admirable job of balancing the scientific and political aspects of advocacy in their Access to Medicines campaign. But we should also remember the work of pioneers, from Florence Nightingale to John Snow, who worked tirelessly to ensure their ideas benefited those in society who needed them the most.

The speakers and delegates at the World Health Summit should remember this pioneering spirit, which fused the spirit of medical discovery with political advocacy. And they should ensure that any statement calling for more and better medical technologies is quickly followed by a statement recognising that technology should at best be seen as a complement to, but never a substitute for, political action.

Healthcare innovations won’t cure global health inequality – political action will | Ben Ramalingam

"Fat but fit" won"t prevent type 2 diabetes risk, study finds

Maintaining a healthy weight is the single most effective way to reduce your risk of type 2 diabetes, no matter how much you hit the gym, new research has found.

An Australian study of more than 30,000 people has found being physically active won’t protect you from developing the disease if you are already overweight or obese.

According to the research, those who were obese – even if they were physically active and spent little time sitting – had five times the risk of developing type 2 diabetes compared with people of normal weight, even those who had lower levels of physical activity and who sat more.

People who were overweight had twice the risk as people who were of normal weight and less active.

The Sax Institute said the 45 and Up Study, presented in Sydney on Tuesday, debunked the myth that being “fat and fit” would reduce your risk of type 2 diabetes.

Lead researcher Thanh-Binh Nguyen from the University of Sydney said their research suggested being physically active is not as important as maintaining a healthy weight when it came to preventing diabetes and highlighted the importance of a healthy diet.

“Once you are overweight being physical active doesn’t help you that much in terms of preventing type 2 diabetes. It helps you if you can manage to reduce your weight, so it’s important to continue to be physically active and to adopt a healthy diet,” the researcher said.

Diabetes Australia says one of the most important aspects of diabetes management is to maintain a healthy body weight.

Being overweight not only increases your risk of heart disease, stroke and some cancers, but it also makes your diabetes harder to manage.

Previous research has found that if you have prediabetes (impaired fasting glucose or impaired glucose tolerance), losing 5 to 10% of your current body weight can prevent type 2 diabetes in up to nearly 6 out of 10 people.

This equates to losing five to 10kg for a person who weighs 100kg.

Diabetes Australia says small changes in diet, such as reducing portion sizes and swapping to low-fat dairy products, can help people to achieve a healthy body weight and manage diabetes.

"Fat but fit" won"t prevent type 2 diabetes risk, study finds

The NHS secret is out. And local communities won"t like it

When Simon Stevens became NHS England’s chief executive in April 2014 he disavowed his predecessor David Nicholson’s radical centralisation of specialist hospital treatment into far fewer places.

Stevens also went further, using his first interview in the post to pledge to maintain local hospitals. Every NHS leader, and every MP, knows how attached the great British public is to the bricks and mortar of their local NHS. The last thing Stevens wanted was to face opposition by campaign groups, councillors and MPs to a particular A&E or maternity unit being downgraded or closed, and certainly not a wave of such protests in many parts of England simultaneously battling to save much-loved local services.

Yet that is the growing risk he now faces as a result of the 44 regional sustainability and transformation plans (STPs). The disclosure of controversial changes planned in north-west London, Leicestershire and the West Midlands – including entire hospitals being downgraded or closed – could easily result in England-wide protests.

NHS bosses say the plans are necessary for the sake of better care, modernisation and financial balance but an angry, disbelieving public is expected to fight tooth and nail against the loss of the local services.

The standoff over STPs has been coming for months and prefaces major political battles ahead which will involve unprecedented examination of the government’s record on and plans for the NHS. Are STPs part of an undeclared Tory plot to prepare the NHS for much greater privatisation after 2020? Or are they designed to move the health service from an illness treatment service to one that prevents ill-health in the first place?

Until now, STPs have been shrouded in secrecy. NHS England, which is driving the process, advised the boards of acute hospital trusts to discuss the plans in the private session of their monthly meetings. Labour MP Justin Madders, a shadow health minister, recently outlined his concern about the lack of public attention so far on “Jeremy Hunt’s opaque and secretive reorganisation of the NHS, which is being drawn up behind closed doors at this very moment through sustainability and transformation plans”. That deliberate hiding from public view of plans for significant changes to how and where patients are cared for is now over, earlier than NHS England planned. The public debate about what NHS services need to look like in order for the country’s most cherished institution to survive is now under way, and not before time.

Official NHS documents, albeit laden with the service’s usual array of buzz phrases, set out the purpose of STPs. NHS England calls them “blueprints [which] will be place-based, multi-year plans built around the needs of local populations”. It continues: “STPs are geographic areas in which people and organisations work together to develop robust plans to transform the way that health and care is planned and delivered for their populations.”

The overall rationale is simple: transform how care is organised and provided in order to keep the NHS sustainable as a system of healthcare. But it will be hugely difficult to convince a sceptical public to back such far-reaching changes.

Whether Jeremy Hunt or Theresa May likes it or not, the belated disclosure of the STPs will lead to fierce scrutiny of the government’s performance on and plans for the health service. Are the proposals helping to prepare the service for much greater privatisation after 2020? Have they only come about because the government has for years been giving the NHS much less money than it needs to deal with the rapid, relentless rise in demand it is facing as a result of the ageing population and the emerging disaster of lifestyle-related illness? Or are they a sincere attempt to make a stay in hospital the last resort because people are much better looked after in or near their homes by GPs, nurses, therapists and specialists?

For NHS chiefs such as Stevens, rapid progress on STPs is an urgent priority. They see the changes that STPs will usher in as the best way to achieve three key aims: to improve people’s health; to tackle the fact that there is still far too much variation in the quality of care many patients receive; and to address the £30bn gap in NHS funding which is projected to have emerged by 2020-21. Ministers have pledged to provide £8bn of the £30bn. But Stevens and Jim Mackey, head of the service’s financial regulator, NHS Improvement, have to find the other £22bn. Almost no one in the NHS thinks it can be done, but STPs are their way of trying. They have to satisfy the Department of Health, and it has to persuade the Treasury, that the NHS can sort out a financial mess that, incidentally, it did not create.

Reconfiguration of hospital services – NHS-speak for shutting things such as A&E and maternity units – is a key part of their plans. NHS Improvement last month told the leaders of the 44 STP footprints to plan for “the consolidation of unsustainable services”. The growing fear among NHS campaigners is that the definition of “unsustainable” has already been agreed behind closed doors, and that it will lead to a huge reorganisation of NHS services.

The whole STP process is fraught with risk and uncertainty. As Hugh Alderwick of the King’s Fund points out, closing bits or all of hospitals does not necessarily save money or improve care. There is also the fact that, as the Nuffield Trust health thinktank’s chief executive, Nigel Edwards, points out, care still has to be provided somewhere and that still costs money.

Crucially, for services to be delivered outside rather than inside hospitals there has to be enough capacity in GP and other community-based forms of care. There isn’t, especially with family doctors already struggling to meet demand. They have no spare capacity. There are also, as some of the STP plans admit, too few staff across the NHS to make this bright new dawn a reality. All these practical considerations may prove even more significant obstacles to the implementation of this covert reorganisation of the NHS than public and political concern.

The NHS secret is out. And local communities won"t like it

When I leave someone suicidal I"m scared they won"t be there the next day

Leaving a suicidal man in the hands of colleagues was hard

During my eight years in social care, I have struggled, like everyone in support roles, with the dreaded fear. It’s a fear that finds you not just at work but on your lunch break, during the commute, in the bath … everywhere. I recently supported a young man in his early twenties who has a long history of mental health problems and was alcohol dependent. It was the anniversary of a bereavement, and he was intoxicated, self-harming and suicidal so I spent hours with him calming him down and putting plans in place. I stayed late – you do in this role, it’s not 9 to 5 – but the time came when I needed to hand over to my colleague.

You have to trust your team when you leave someone like that. But then you leave after having been in an intense crisis situation and you close the door behind you and you’re in the street with people just walking their dogs, doing normal things. You go home thinking over everything you did and wondering what you’ll be told when you go back the next morning.

Senior support worker, Sussex

Related: Silence your phone and let go of guilt: 10 tips to improve your wellbeing at work

I worry when people with mental health problems are in crisis and have no support

Time constraints and a demanding caseload mean that at times I feel I’m just putting a sticking plaster on situations as we’re expected to work fast from assessment until discharge. I worry about the individuals that fall through the net. IAPT services appear to cherry pick those with low level support needs that will provide them with the best outcomes This leaves those with more substantial needs who have suicidal thoughts, or dual diagnosis unable to access counselling or cognitive behavioural therapy. I worry that genuine care for people seems to be missing from the service; my colleagues have judgmental attitudes and a lack of empathy. When I’m not there, I fear that people won’t be visited unless they hit a crisis. Even then, I worry about the lack of support from the crisis team. We’re meant to take people to A&E, which is a waste of NHS money. They often refuse to help so the police are called, who can’t help. All they need is some additional daily home treatment to get them through it.

Mental health social worker, Lancashire

Who looks after older people with advanced dementia?

In the past I’ve worried about the people we’ve looked after who were incapable of being alone because they had advanced dementia. One would walk around outside in the middle of the night, claiming they had been kidnapped and needed to get home. The police wanted to detain another under the Mental Health Act but the doctor refused. We have also reported numerous instances of service users being abused physically, emotionally, financially and sexually, only to be told by the relevant authorities they were private matters between husband and wife. Not enough is done to protect people. That is until it is the carers at fault and then people are up in arms about it.

Community team leader for a home care agency, North Devon

I was held at knife point by a five-year-old, but being taken off the case just made me worry about the family more

I worry about not having sufficient time to spend with families to really make a difference. My time is so thinly spread that I’m having a mediocre impact at best. I fear for families that are offered support but, due to caseloads and lack of funds, this doesn’t come to fruition.

One family sticks out in my memory. The dad was disabled, the mum was attending IT courses to help her get back to work and they had three children under seven, the oldest of whom had significant behavioural problems. The family felt like they had been passed from pillar to post and that the health team, school and social care were letting them down.

I have been held at knife point on two occasions while working and one of the incidents was in this family’s home. It was the normally well behaved middle child, aged five, who held the knife to my head while I was trying to help the older one. The parents were devastated and called the police themselves but no further intervention was offered. I was pulled out of working with them and it was stepped up to a social worker who didn’t know their history. The family had to retell the story, which must have been frustrating considering that the eldest child took a good year to put her trust in me.

Family support worker, east Midlands

Related: Social work is a high-stress job – support from peers is invaluable

We are humans, making human decisions. What if that decision is wrong?

You can’t always be there to make sure everyone is OK. Leaving work when someone is sick, substance affected or suicidal makes you fearful. I worked with a young woman who had experienced a lot of trauma and struggled with mental health issues. One afternoon she said she was having hallucinations and was concerned she may harm someone as a result. I took her to A&E and stayed three hours late with her. You try to make a difference in the social care sector, but there are always worries, especially given that we are humans, making human decisions. What if that decision is wrong? You often second guess yourself and wonder: “What if I had done that differently?”

Resident support worker, east Sussex

I hate not being able to make a difference when it really matters

I worry about children getting stuck in one part of the system and missing out on support that would make a difference. I was working with a 13-year-old girl last year at risk of child sexual exploitation who was recommended a different care plan to what she needed. Within a few months it was discovered that the girl had been groomed by an adult offender on the internet and he was arrested. Only then was she moved to the appropriate child protection plan.

Senior family support worker, Surrey

If you are experiencing suicidal thoughts, the Samaritans can be contacted on 116 123 in the UK. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

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When I leave someone suicidal I"m scared they won"t be there the next day

Mental health services won"t help children in temporary care settings

“How can a child who is psychologically in a very bad place settle unless they get mental health support?” asks independent reviewing officer Sukhchandan Kaur. She is talking about a 15-year-old boy who was neglected for years and slipped through the social care net until his early teens and has been placed with several foster carers who have been unable to manage his behaviour. Child and adolescent mental health services (Camhs) will not work with him.

“I’ve appealed twice,” she says in despair. “They’ve not even assessed him. For him to be assessed, he would have to be accepted as a referral. And they won’t.”

Kaur’s role is to act as an advocate for children looked after by her local authority, and she is furious she cannot secure the mental health treatment this boy needs. “I am banging my head against a brick wall,” she says.

Camhs’ refusal to assess and treat children who are removed from families into state care before they are in a settled placement was criticised in a recent Education Select Committee report on mental health services for children in care.

‘We’re so used to them saying no that we don’t even refer any more’

Emily Boardman, Turpin & Miller solicitors

The report pointed out that the mental health of looked after children is significantly worse than that of their peers. Almost half of children in care have a diagnosable mental health disorder, and they are four times more likely to have a mental health condition than those not in care.

The MPs’ investigation found that there were “serious and deeply ingrained problems with the commissioning and provision” of Camhs” for children in state care. Neil Carmichael MP, select committee chair, told the Guardian: “We were concerned at the lack of speed regarding diagnosis, and lack of appropriate response thereafter.”

As complex trauma in childhood is likely to affect looked-after children into adulthood, Carmichael is pushing for Camhs to be available for care leavers up to the age of 25.

Camhs is reluctant to assess and treat children who have suffered extremes of neglect and abuse unless they are settled in a permanent placement. This, as the report pointed out, is contrary to statutory guidance “which states that looked-after children should never be refused a service on the grounds of their placement”.

Nevertheless, Camhs’ refusal to accept any referral before a permanent decision about a child’s future has been made has become so absolute that family lawyers acting for young people in care proceedings say they’ve given up asking. “We’re so used to them saying no that we don’t even refer any more,” says Emily Boardman, head of the family department at Turpin Miller solicitors in Oxford.

Once settled, a looked after child may be granted an assessment but will not be accepted for therapeutic treatment unless they meet a high threshold of need. Natasha Finlayson, chief executive of the Who Cares? Trust which works with care leavers, says: “Young people [have to] present with a psychiatric illness. If you can see the blood running down their arms from self harming, or if they’ve [attempted] suicide, then they’ll get access.”

Related: Tackling underfunding in children’s mental health services

Finlayson is scathing about the standardised, off-the-shelf treatments that tend to be offered which, she says, stand little chance of long-term success for this most vulnerable group of children. “We need expertise in and help around sexual abuse, early trauma, domestic violence, attachment, and for children who’ve experienced multiple moves within the care system, compounding their sense of abandonment and loss,” she says.

The medical model Camhs has operated does not work for the sorts of mental health issues these young people have, she adds. There are therapists who specialise in supporting looked-after children with complex trauma, but with cuts now biting deep, some specialist teams have lost staff or been disbanded.

Lack of a permanent placement “cannot be and should not be” a barrier to young people in care being able to access Camhs, says Sally Holland, the children’s commissioner for Wales. The Welsh Assembly, she says, has just created strict new targets for Camhs services in Wales: an urgent referral must now be seen for assessment in 48 hours, and a non-urgent one in 28 days.

Holland insists that more thought must be given to how therapeutic treatment is presented to children so they feel more willing to engage. “There’s not nearly enough alternative or earlier help. There should be primary care teams delivering help at a much earlier stage, and we need to keep putting a lot more resource into those and supporting carers, foster carers and teachers.”

Finlayson believes that Camhs needs to change its approach to young people in care. Of Camhs’ blanket refusal to treat children until they are in a stable placement – a process that still, typically, takes from six months to a year, and even upwards – she says the clinical position is “misguided” and “totally unsuitable”.

Related: What service users want to change in mental health policy

Holland agrees: “Looked after children and children adopted from care may have many issues, none of which hits a threshold, but taken together, cause them significant difficulties,” she says. “We should not be putting up artificial institutional barriers: it should not be ‘do they meet our criteria’ but ‘what do they need?’ They should be getting accelerated help, rather than being banned from help.”

The Education Select Committee recommended that looked after children should have priority access to mental health assessments on entering care. It’s not enough, says Jackie Sanders, director of public affairs at the Fostering Network: “We were very disappointed that the report fell short of recommending that looked after children should also have priority access to subsequent treatment … A prioritisation of looked after children for assessment but not treatment will have little or no impact on their access to mental health services.”

Whatever happens in future to change the delivery of mental health care to children in council care, the damage has been done for Kaur’s young charge. Despite some difficulties, she says, he was bright and doing well at school, but his behaviour after several placement moves has deteriorated to the point no school will take him. The effect of Camhs’ refusal to offer treatment is, Kaur says, “devastating”.

“Those repeated rejections means he’s now losing hope,” she says. “How can I help him to get that mental health support he needs to overcome this sense of despair?”

Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) and like us on Facebook to keep up with the latest social care news and views.

Mental health services won"t help children in temporary care settings

What your “hooker” dentist won’t tell you

With all the information available but mostly dispensed regarding root canal treatments, a dentist friend of mine sent me a questionnaire/consent form that the majority of root canal practitioners never reveal.

The following paragraphs are listed separately on the form and each paragraph must have the patients acknowledgement otherwise the procedure will not be administered.

Perhaps this is why you will never see this form if it gets in the way of the Almighty Sign – $ $ $ .

Root canal treatment, also called endodontic treatment involves removing the nerve tissue (called pulp) located in the center of the tooth and its root or roots (called the root canal). Treatment involves creating an opening through the biting surface of the tooth to expose the remnants of the pulp, which then are removed. Medications may be used to sterilize the interior of the tooth to prevent further infection. Root canal treatment may relieve symptoms such as pain and discomfort.

Each empty root canal that can be located is filled. Occasionally, a post is also inserted into the canal to help restore the tooth. The opening in the tooth is closed with a temporary filling. At a later appointment, a crown may be placed. It is a separate dental procedure not included in this discussion.

Twisted, curved, accessory, or blocked canals may prevent removal of all inflamed or infected pulp. Since leaving any pulp in the root canal may cause your symptoms to continue or worsen, this might require an additional procedure called an apicoectomy. Through a small opening cut in the gums and surrounding bone, any infected tissue is removed and the root canal is sealed. An apicoectomy may also be required if your symptoms continue and the tooth does not heal.

Once the root canal treatment is completed, it is essential to return promptly to begin the next step in treatment. Because a temporary seal is designed to last only a short time, failing to return as directed to have the tooth sealed permanently with a crown or filling can lead to other problems such as deterioration of the seal, resulting in decay, infection, gum disease, fracture, and the possible premature loss of the tooth.

Root canal treatment is intended to allow you to keep your tooth for a longer time, which will help to maintain your natural bite and the healthy functioning of your jaws. This treatment has been recommended to relieve the symptoms of the diagnosis described above.

I understand that following treatment I may experience bleeding, pain, swelling, and discomfort for several days, which may be treated with antibiotics. I will immediately contact the office if conditions worsen or if I experience fever, chills, sweats, or numbness.

I understand that I may receive a local anesthetic and/or other medication. In rare instances patients have a reaction to the anesthetic, which may require emergency medical attention, or find that it reduces their ability to control swallowing. This increases the chance of swallowing foreign objects during treatment. Depending on the anesthesia and medications administered, I may need a designated driver to take me home. Rarely, temporary or permanent nerve injury can result from an injection.

I understand that all medications have the potential for accompanying risks, side effects, and drug interactions. Therefore, it is critical that I tell my dentist of all medications I am currently taking, which are: (refer back to office registration form).

I understand that holding my mouth open during treatment may temporarily leave my jaw feeling stiff and sore and may make it difficult for me to open wide for several days. However, this can occasionally be an indication of a further problem. I must notify your office if this or other concerns arise.

I understand that occasionally a root canal instrument may break off in a root canal that is twisted, curved, or blocked with calcium deposits. Depending on its location, the fragment may be retrieved or it may be necessary to seal it in the root canal (these instruments are made of sterile, non-toxic surgical stainless steel, so this usually causes no harm). It may also be necessary to necessary to perform an apicoectomy, as described above, to seal the root canal.

I understand that during treatment the root canal filling material may extrude out the root canal into the surrounding bone and tissue. Occasionally, an apicoectomy mat be necessary for retrieving the filling material and sealing the root canal.

I understand teeth that receive root canal treatment may be more prone to cracking and breaking over time, which may require removal and replacement with a bridge, partial denture or implant. In some cases, root canal treatment may not relieve all symptoms. The presence of gum disease (periodontal disease) can increase the chance of losing a tooth even though root canal treatment was successful.

I understand that root canal treatment may not relieve my symptoms and I may need my tooth extracted.

I understand that if I do not have root canal treatment, my discomfort may continue and I may face the risk of a serious, potentially life-threatening infection, abscesses in the teeth and bone surrounding my teeth and eventually, the loss of my tooth and/or adjacent teeth.

I understand that depending on my diagnosis, alternatives to root canal treatment may exist, which involve other disciplines in dentistry. Extracting my tooth is the most common alternative to root canal treatment. It may require replacing the extracted tooth with a removable or fixed bridge or an artificial tooth called an implant. I have asked my dentist about the alternative and associated expenses. My questions have been answered to my satisfaction regarding the procedures, their risks, benefits, and costs.

No guarantee or assurance has been given to me by anyone that the proposed treatment or surgery will cure or improve the condition(s) listed above.

I consent to the root canal treatment as described above by Dr. —–.

I refuse to give my consent for the proposed treatment as described above.

I have been informed of and accept the consequences if no treatment is administered.

I attest that I have discussed the risks, benefits, consequences, and alternatives with __________ (patient’s name) who has had the opportunity to ask questions, and I believe my patient understands what has been explained.

Here’s the short version:

Root canals cause the tooth to rot and emit toxins. While the tooth is intact the toxins proliferate the body. If one is lucky enough to have the showing tooth break, the toxins will have the opportunity to come out of the body. A root canal is a temporary fix, eventually leading to extraction and a partial bridge if need be. So, if a tooth needs root canal work, have it pulled and explore your options. That will eliminate needless toxins in your body.

Yeah, yeah, if the tooth can be saved for a while, why not? Do you really want toxic poison circulating throughout your body until you eventually go through the extraction process?

About implants:

Dental implants are metal screws, typically of titanium, that are surgically inserted into the jaw to act as an anchor for a replacement tooth (the crown). While titanium is often described as a metal that doesn’t react with tissues, there is evidence to suggest otherwise. The Bristol Wear Debris Team found that debris from joint replacements made from metals such as titanium, nickel, chrome and cobalt had worked their way into the liver, spleen, lymph nodes and bone marrow (J Bone Joint Surg, 1994; 76B: 701-12).

Dental implant surgery is very intrusive and, while surgical techniques for the procedure have improved the success rate, complications can arise. These include peri-implantitis, a bacterial inflammation that can lead to jawbone loss; nerve damage; hematoma (blood clot) in the floor of the mouth, causing possible airways obstruction; and sinusitis (Med Oral Patol Oral Cir Bucal, 2004; 9 [suppl]: 63-9; 69-74; Int J Oral Maxillofac Implants, 2004; 19: 731-4; Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2001; 92: 597-600; J Oral Maxillofac Surg, 1992; 50: 285-7).

The bottom line: find a holistic dentist opposed to fluoridation, implants and root canals. They are very rare but they are out there. Try a search for IABDM – International Academy of Biological Dentistry and Medicine and/or HAD – Holistic Dental Association.

Aloha!

To learn more about Hesh, listen to and read hundreds of health related radio shows and articles, and learn about how to stay healthy and reverse degenerative diseases through the use of organic sulfur crystals and other amazing superfoods, please visit www.healthtalkhawaii.com, or email me at heshgoldstein@gmail.com or call me at (808) 258-1177. Since going on the radio in 1981 these are the only products I began to sell because they work.
Oh yeah, going to www.asanediet.com will allow you to read various parts of my book – “A Sane Diet For An Insane World”, containing a wonderful comment by Mike Adams.
In Hawaii, the TV stations interview local authors about the books they write and the newspapers all do book reviews. Not one would touch “A Sane Diet For An Insane World”. Why? Because it goes against their advertising dollars.

What your “hooker” dentist won’t tell you

Food items We Won’t Have If We Maintain Letting Bees Die

About 1-third of the world’s crops rely on the honeybees for pollination. The past decades honeybees have been dying at an alarming fee. Fewer bees will sooner or later lead to significantly less availability of our preferred whole food items and it will also drive up the charges of several of the fruits and veggies we consume on a day-to-day basis.

Although some actions have been taken in the past, our bees are nevertheless dying and something needs to be carried out to make confident our most favored food items do not go into extinction.

What’s Triggering Enormous Bee Deaths?

About fifty years in the past our world looked a total good deal different. Bees had an abundance of flowers to feast on and there were fewer pests and illnesses threatening their meals chain. These days even so, nature has to make spot for industrialization and our bees are getting a tough time locating very good pollen and nectar.

And if clearing their dinner tables from great high quality food wasn’t bad ample already, farmers are extensively employing herbicides and insecticides, which trigger a phenome known as Colony Collapse Disorder (CCD) exactly where bees get disorientated and poisoned and can not discover their way back to the hive. Or when they deal with to get back, they die from intoxication.

“We want excellent, clean foods, and so do our pollinators. If bees do not have adequate to eat, we will not have enough to consume. Dying bees scream a message to us that they can not survive in our existing agricultural and urban environments,” states Marla Spivak, an American entomologist, and Distinguished McKnight University Professor at the University of Minnesota.

Record of Foods We Will Have To Go without having If The Bees Go

While we do not need to have bees to pollinate all our food simply because they either self-pollinate or rely on the wind (like rice, wheat, and corn), several of our favorite foods will disappear from our kitchen tables.

Food items in the danger zone include:

• Apples


• Mangos


• Kiwi Fruit


• Peaches


• Berries


• Onions


• Pears


• Alfalfa


• Cashews


• Avocados


• Passion Fruit


• Beans


• Cruciferous greens


• Cacao/Coffee


• Cotton


• Lemons and limes


• Carrots


• Cucumber


• Cantaloupe


• Watermelon


• Coconut


• Beets


• Turnips


• Chili peppers, red peppers, bell peppers, green peppers


• Papaya


• Eggplant


• Vanilla


• Tomatoes


• Grapes


• Several seeds and nuts

A considerable drop in population, or full extinction, of honeybees will make these food scares or even non-existent. So to keep our body healthier and our kitchen table exciting we have to consider action prior to it is as well late.

What You can Do

• Plant bee friendly plants in your garden or green community space.


• Restrict the use of pesticides or use organic options.


• Acquire neighborhood, organically grown make and honey to assistance the beekeepers and farmers in your spot.


• Donate to non-profit organizations, like Pollinator Partnership, to support protect, grow, and strengthen bee populations.

Sources: CNN,  NCBI, and onEarth.

Really don’t neglect to download my Cost-free Book “Amy’s House Kitchen”, packed with my family’s preferred healthy, clean and delicious recipes. Or connect with me on Facebook or Google+

If you are interested in detoxing, clean consuming, shedding bodyweight, and modifying your lifestyle with out feeling hungry and counting calories, click here

Food items We Won’t Have If We Maintain Letting Bees Die

PiYo: the perform-out that won"t make you cry

There probably isn’t a single fitness lover on the planet who hasn’t heard of the Insanity exercise. The hardcore interval coaching programme practised by a host of celebrities is the most profitable at-house fitness DVD ever made. Pushing its army of followers to “dig deep” for 60 days to obtain the physique of their dreams, the optimum-intensity program fronted by former choreographer Shaun T became so well-known final year that it was expanded into a gym class.

Insanity worked since it delivered what it promised. If you have been prepared to high-knee, frog-squat and switch-kick as hard as attainable for 60 days, you have been guaranteed to transform your entire body into a lean, imply athletic machine.

But then Beachbody, the American firm behind Insanity, realised that not everyone was prepared or willing to sweat a number of buckets to get into shape. Some folks needed a gentler method without compromising on results. So along came PiYo.

Just lately launched in the Uk, the most current providing from the Beachbody crew is an eight-week, at-house programme designed by 45-12 months-old celebrity trainer and mom-of-two Chalene Johnson. Like its far more higher-affect predecessor, PiYo also aims to burn up up to 1,000 calories per session. But the surprising thing is that it requires no weights, jumps or any strain on the body.

“I desired to create some thing that was dynamic, and produced men and women truly feel athletic and have a strong core, but with flexibility, too,” says Johnson. “I wished to wake up in the morning and not feel beaten up. I was sick of only seeing fitness programmes on tv exhibiting individuals jumping up and down, and landing on their hands and feet as if they were shock absorbers.”

^{Beyond Insanity: Nilufer Atik stretches out as instructor Will Brereton assists her via a sequence of lower-affect PiYo movements}

Johnson, a former paralegal who holds the planet record for the most fitness videos ever developed, came up with the thought for PiYo after seeing an acrobatic show by Cirque du Soleil with her husband in Las Vegas several many years in the past.

“I was amazed by how gorgeous the performers’ physiques were and the way they skilled. They had been pouring with sweat, nevertheless have been so flexible. The next day, just by likelihood, I was at a gymnasium when I saw a single of the cast members and a good friend introduced me. I watched her train and believed, ‘That’s what I want to do.’ ”

Battered by years of higher-affect cardio and strength function, Johnson also had suffered injury soon after damage via instruction and educating, and now, in her 40s, realised her body couldn’t get much far more.

“Two many years in the past, I couldn’t function out for a period of 9 months due to damage. I received wholesome once more, then pulled a hamstring and had to get yet another three months off. Then I received healthy once again and cracked a rib,” she says.

“I went to see a kinesiologist [a expert in human movement] and he informed me I required more versatility training, so I place the PiYo programme collectively. As with all of my exercises, I did it for myself very first.”

Johnson had tried yoga and Pilates, but found the static positions painfully boring. She was also disappointed by the lack of aesthetic improvement and wanted a workout that would stretch her muscle groups as effectively as increase her body shape.

Combining what she had noticed on stage in Las Vegas with her favourite Pilates and yoga moves, Johnson produced a new work out to lengthen and tone muscle groups while maintaining enough pace to burn undesirable physique body fat. As a end result, people unable to carry out greater-intensity sessions simply because of injury could nevertheless get the muscle-sculpting positive aspects of a resistance exercise and the cardio positive aspects of a heart-racing regimen without feeling as if they had completed either. And, most importantly, they could wake up the following morning without feeling stiff and sore.

“My aim was to guarantee that someone who was extremely obese and couldn’t leap up and down to get the effects of cardio could nonetheless do this whilst receiving more powerful and sculpting their entire body employing just their very own physique bodyweight. It had to be something that looked entirely different from anything else out there.”

It may possibly be challenging to feel that a exercise primarily based on gentler kinds of exercising, such as yoga, could aid to take away extra bodyweight and create muscle, but the secret is in the way the poses are used. Alternatively of becoming held for agonising amounts of time, they morph into a consistently moving, quickly-paced movement of sequences. It’s the exact same with the Pilates-design moves also. The exerciser is led by means of dozens of repetitive, microscopic core sequences to tighten, tone and flatten the abdomen.

^{PiYo Plank}
PiYo speeds every little thing up, such as your final results, whilst minimising aches and pains. The three-DVD bundle comprises eight routines together with an introductory class, various from 45-minute to shorter 25-minute exercises. Every workout focuses on a distinct area, such as reduce or upper physique upper body, core and glutes or sculpting and sweating. The workout routines are certainly exclusive, incorporating everything from warrior 1 and downward dog yoga poses to curtsy lunges and side plank flips. There are also modified versions of the trickier workouts for newcomers. There might not be any jumping around, but you definitely really feel that you have exerted your self by the end of a class.

“The workouts I place into this work out are my dream workouts,” says Johnson. “Whenever I did a yoga or Pilates class, I usually felt like I had to go and do a cardio or strength coaching session afterwards to truly feel as if I’d had a suitable exercise, and I just did not see the advantages of basically becoming versatile.

“You really don’t see a woman strolling down the street and believe, ‘Wow, she appears super-flexible.’ But you do see a particular person across the area and consider, ‘They must operate out due to the fact they have wonderful muscle tissue.’ You just do not consider about the bodily rewards of versatility, so I wanted to come up with anything that provided this, yet delivered almost everything else, also. So far, the results have been incredible,” she says.

Do consider this at house: a PiYo work out

Attempt these signature moves for a PiYo work out at home. You can do the circuit after, or repeat it 5 times with a minute rest in amongst each and every circuit for a tougher workout. Remember to warm up with a 5-minute jog on the spot very first.

PIYO CROSS

Start in a sumo squat position, then round your back and tuck your forearms between your legs as you stretch out your spine. In 1 fluid motion, come back up into a sumo squat, opening your arms out and pushing the shoulder blades together so your palms are at the sides of your head and dealing with forwards. Preserve tucking and opening 20 occasions.

PIYO PLANK

Begin in a press-up place and bend your correct leg so the heel goes towards the buttock. Then flip that leg behind you so the foot is on the floor and increase your proper arm up in the direction of the sky into a side-plank place, with your right leg nevertheless bent and your left leg straight. Then increase your hips as you stretch the correct arm over your head. Return to the plank place just before repeating on the other side. Do 10 every side.

RUNNER’S POSE

Equivalent to dead lifts, this operates the hamstrings and glutes without having the same strain. Standing on your right leg, lift the left foot off the floor. Maintaining the left knee bent, tilt forward as you push the leg behind you and then tilt backward somewhat as you swing the knee forward and up to waist level. Hold moving the leg backward and forward in a single leg “running” movement. Execute 20 on every leg.

THE BEAST

On your hands and knees, lift up on to your toes, raising the knees off the floor by a couple of inches, without having moving the hips. Use your core to hold the position and stabilise for a single minute.

THE KICK By way of

Starting in the beast position, lift your proper arm as you rotate your appropriate shoulder back and then push the left leg out straight to the right side. Come back to the beast place and repeat on the opposite side. Complete 10 doubles.

beachbody.co.uk/solution/fitness-coaching/piyo-workout.do

PiYo: the perform-out that won"t make you cry