The doctor on your Xbox? The NHS needs more digital ambition

Imagine a world where doctors and nurses glance at their watch to see patient updates, where virtual reality headsets are used to consult on medical procedures, or where patients could interact with their doctor through their television or media console.

All of this, and a great deal more, is achievable with the technology we have today, but both the NHS and its technology suppliers are yet to embrace what’s possible and make these scenarios happen.

The health secretary, Jeremy Hunt, has called for an “NHS for the smartphone age”, but mobile and digital means and offers healthcare so much more; something technology consumers are very aware of.

Large touchscreen devices, smart watches, other wearables, smart TVs, virtual reality displays and even games consoles are just a few of the digital devices available to consumers. But mobile health (mHealth), both in the UK and many other parts of the world, still largely falls far short of embracing the potential range of devices.

Meanwhile, clinical staff qualifying today in their 20s and 30s have grown up with mobile technology. They have smartphones, consoles, tablets and wearables. They use FitBits, health apps and messaging platforms.

A lot of frustration can be found among those professionals who want to use this technology in their working environments to improve care.

But chat platforms like WhatsApp have been known to cause challenges to IT teams. Information governance rules do not allow the use of many consumer apps in the NHS, in an attempt to avoid the potential for sensitive patient data to move to servers beyond the UK, and the subsequent loss of an audit trail.

But, while trusts cannot permit the use of WhatsApp by staff, the convenience of these messaging platforms still presents the risk of the technology being used under the radar, with people finding ways round traditional IT management policies. NHS technology leads are searching for ways to overcome the challenge – of addressing the demands of professionals while also safeguarding patient data.

Chat apps could be used to book an appointment at the doctors’ surgery or the hospital

A demand has emerged from staff to be able communicate instantaneously and share real-time information with colleagues through secure chat. But do mobile chat apps have the potential to transform NHS interaction for patients too?

In customer-service settings across other industries, bots, which pull information from applications and services, allow questions to be answered through natural language in a similar manner to the voice interaction on iPhone and Android devices. The same chat style interfaces, with which people are increasingly comfortable, could make a major difference to how patients interact with the NHS.

Chat apps could be used to book an appointment at the doctor’s surgery or the hospital. A patient can simply ask for an appointment next week and, in turn, the app speaks to tell them: “I have an appointment next Wednesday.”

When even augmented reality technologies like Pokemon Go have been recognised for their potential health and wellbeing benefits, consumer expectations about technology and the NHS is growing bolder. There are some promising signs that healthcare is starting to think differently, and it is reassuring to see an increasing number of media reports on new mobile innovations.

A greater focus on using technology for patient monitoring has been seen in the last 12–18 months. More local authorities are looking at patient information apps to prevent hospital admissions. And new mobile innovation tenders suggest a recognition that investment in mobile solutions is now needed. But all this barely scratches the surface of what can be done.

NHS providers, and the wider care community, now have a huge opportunity to really push the boundaries of what mobile technology can deliver and take advantage of both emerging and widely used technologies. If they take this opportunity, they could dramatically enhance their offering to patients and to the staff responsible for their care.

You could create fully interactive NHS apps for Apple TV. Console devices such as the Microsoft Xbox One Kinect could be used to assess a person’s posture and fitness, and provide suggestions for improvement. Wearable devices such as smartwatches could contribute to the government’s preventative medicine agenda.

It isn’t easy. Healthcare organisations can become bogged down in the day to day, and need to focus their finite IT resource on delivering large clinical systems or a new electronic patient record. To make this brave, new mHealth vision a reality the NHS cannot carry the responsibility alone. Tech suppliers need to think about their users, and think beyond mobile.

How long will it be before a doctor or nurse can use an app on their watch to access patient information? How long before a patient can book their clinical appointments via their Xbox, or record their own vital signs through tablet applications? It’s clear we need to do this now.

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The doctor on your Xbox? The NHS needs more digital ambition

UK’s sad lack of ambition in tackling obesity | Letters

The food industry targets cheap junk food at children and adults and this has caused the wave of obesity in the UK (Experts condemn ‘watering down’ of obesity strategy, 18 August). The taxpayer pays for the consequences and this is eroding the NHS. This is a prime example of the “tragedy of the commons”, in which the exploitative activity of the few damages the interests of the many. The government intends to continue to protect the food industry and so is ignoring this tragedy of the commons. So much for the promise made by Theresa May when she became Tory leader to “unite our country … not for the privileged few but … for every one of us”.

She has fallen at the first hurdle. She is following Michael Gove’s pre-Brexit advice that “people in this country have had enough of experts”. She has not challenged the might of the food lobby.

Predictably the food lobby continues to complain about the nanny state, just as did the tobacco lobby. The government had to be nanny when it introduced anti-smoking laws, vaccination programmes, seatbelt laws, clean air acts and all those other laws that make life worthwhile.

The government eventually took on and defeated the smoking lobby. It will have to do the same with the food lobby. The food industry has a big advantage over tobacco in that people will still have to eat, so big food can carry on selling food and making profits, but it will be healthy food. Why are we waiting?
Ann and Neil Holmes
Bromsgrove, Worcestershire

• The government’s obesity strategy published today was an opportunity to tackle childhood obesity and household food insecurity that has been missed. While welcoming some positive elements in the strategy, such as the targets for reducing sugar content in food and drink, and the commitment to the Healthy Start scheme, we are dismayed by the government’s lack of ambition.

We know from the significant bank of evidence that exists on childhood obesity that in order to tackle it we need limits on food marketing to children, continuation of vital public health schemes, and strong targets for the reduction of childhood obesity. Instead the government’s strategy relies on voluntarism, an approach that has so far failed to make any real inroad into childhood obesity.

We need a strategy that can stand up against the major spending power of the big food and drink brands. The seven biggest brands alone spend more than £300m a year on marketing, over 10 times the amount spent on the government’s flagship healthy eating initiative. But this strategy has failed to deliver.

It is time for the government to make a real statement on tackling childhood obesity in the UK. We simply can’t afford not to.
Geoff Tansey Chair, Fabian Commission on Food and Poverty
Jeanette Orrey Co-founder, Food for Life
John Middleton President, Faculty of Public Health

• Expecting the food industry to police itself with regard to junk food is like waiting for the oil industry to tell people not to drive their cars or for arms sellers to advise gun owners not to shoot.

Is it too idealistic to hope for a more ethical form of capitalism whereby manufacturers have a moral responsibility to avoid – or at least limit – any harm caused through the production and sale of their goods? Given how unlikely this is in a world driven by economic growth and profit margins, we need a government that will exercise the necessary controls to protect citizens from the excesses of the corporate world.
Fiona Carnie
Bath

• The UK faces a massive obesity crisis which Action on Sugar says could “bankrupt the NHS”. However, we need to think not just about reducing sugar consumption, but promoting physical activity too.

We have invested strategically, and successfully, in promoting Olympic cycling. Yet all over Britain, parents are deterred from allowing their children to cycle to school for fear of road danger.

The Dutch spend £24 per person annually on creating a cycle-friendly environment, and 49% of pupils there cycle to school. By contrast, the UK government proposes investment in its draft Cycling and Walking Investment Strategy (CWIS) of just £2 per person next year, falling to a paltry 72p by 2020. It’s hardly surprising that 1% of school trips in Britain are cycled, and our obesity rates are significantly higher.

As part of its obesity plan, shouldn’t the government use some of its sugar tax revenues for enabling non-athletes of all ages to cycle safely for day-to-day journeys? That would be a hugely cost-effective way not only to tackle obesity, but also congestion, air pollution and climate change. By creating people-friendly streets and communities, it would surely be a fantastic vote-winner too.
Roger Geffen
Policy director, Cycling UK

• The government has started consulting on the introduction of a tax on sugary drinks. We are already seeing marketing for sugar-free drinks as being healthier than the originals, and they will now be cheaper. But there is no evidence that artificial sweeteners are healthier than sugar, so we can help the manufacturers with their marketing while doing nothing to improve children’s health.
Michael Peel
Winscombe, Somerset

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

UK’s sad lack of ambition in tackling obesity | Letters

New advancement ambitions need to have ambition and the United kingdom need to set the agenda | Jim Murphy

Thanks to the millennium improvement goals, illnesses that used to wipe out complete communities are in retreat. Photograph: AFP/Getty

Let us buck the doom and gloom of the nightly information bulletins for a minute and kick off with some cheer. According to the Gates Basis, the globe is – by practically any measure – far better than ever.

This may sound counterintuitive when so a lot of men and women are struggling at home, but extreme poverty all around the planet has halved considering that 1990, a record amount of women attend college, and illnesses that once wiped out total communities are in retreat.

All of this is partly thanks to the internationally agreed millennium improvement targets. Though they did not get every little thing proper, the MDGs set clear and concise targets. From eradicating poverty and boosting education to tackling condition and mom-and-infant mortality, the targets assisted target minds and funding on core, achievable aims.

International representatives will gather in New York on Monday to finalise their proposals for worldwide improvement for the following 15 many years. Or, as the UN puts it, the 13th session of the open working group on sustainable advancement targets.

Of course, it is not really as straightforward or as effective as the Make Poverty Historical past campaigns. No wonder the approach is but to capture the world’s imagination. But make no error, this is a real opportunity to modify our planet for the far better.

With the right ambitions, we can wipe out excessive poverty, safe health coverage at all ages and commence to reverse climate adjust. That is a thrilling prospect – which is why these negotiations need to have an urgent injection of radical ambition led by the United kingdom.

Nevertheless, the British government is not doing adequate to push factors forward. Negotiations on improvement are a very genuine example of how the isolation this country is falling into – which so delights the Tory back benches – is not just poor for Britain, but undesirable for all people who hope for an equitable globe.

When Labour was in energy, Tony Blair and Gordon Brown employed hard-won political capital to convince and to cajole other wealthy states into playing their element. David Cameron and his government need to get off the sidelines and do the very same.

At the negotiations this week, there are 3 factors this government ought to push for. 1st, the United kingdom should lead calls to spot the battle against climate adjust at the heart of any new agreement. It need to push for a commitment to preserve the global rise in temperature beneath 2C to turn out to be leading priority, as properly as retaining pledges on environmental sustainability.

The climate is the central advancement issue of the next century. If we fail to tackle the alterations in our atmosphere, all the gains we make elsewhere – from wellness and poverty to foods and sanitation – will be reversed.

Second, the United kingdom ought to use its status as the house of the NHS and a planet leader in public wellness to demand a headline commitment on universal coverage.

As the celebration that founded the NHS, healthcare for all is central to Labour’s beliefs. There is convincing proof that universal well being coverage prospects to much better outcomes, reduces inequality and helps avert one hundred million individuals a yr from descending into poverty. That is why we want to see universal well being coverage integrated at goal level.

On poverty, the United kingdom ought to lengthen further than a simple program to eradicate the chance of any individual getting to survive on just $ 1.25 (73p) a day. It should raise the bar and call for an ambitious new target of $ 2. The new targets are scheduled to expire in 2030, but nowadays, more than 1 billion men and women dwell on $ 1-two a day. We can not merely overlook that level of poverty for the subsequent 15 years.

Of course, the up coming advancement targets must concentrate on more than climate modify, poverty and universal healthcare, but we consider that is a excellent spot to concentrate our efforts. In addition, the objectives should handle inequalities in gender and training, resource scarcity, illness and hunger, sanitation, governance and the rule of law. And they have to maintain respect for, and recognition of, human rights and much else in addition to.

The United kingdom has a robust record on development. We have assisted steer the planet to groundbreaking agreements – the time has come for Britain to do so once again. There is no time to shed – there are hundreds of thousands of lives to conserve.

New advancement ambitions need to have ambition and the United kingdom need to set the agenda | Jim Murphy

Why is thinness the ultimate female ambition?

_{More healthy position model? Actress Christina Hendricks (REUTERS)}

Personally, I loathed being thin. I felt weak, absent and terrified vulnerable, knock-downable, unsexed childlike, but painfully elderly. My unpadded bottom hurt when I sat my jutting hip bones caught on doorframes and furniture. Just lying down was unpleasant. My appetite vanished and with it my appetite for existence.

And so I rebuilt myself – gradually, sensibly – with excellent fats, slow-releasing carbs and mountains of protein. I counted calories for the initial time in my existence – to place fat on – and started my days with 700-calorie Mr Powerful breakfasts. The events when I could last but not least deal with a total pizza or a plate of fragrant curry have been red-letter days, celebrated with male allies. It took operate, and time but each and every pound felt like a victory.

Fifteen months on, I am doubtless a small overweight, rounded by festive carousing. Even so, I regard this kind of adjustments with objective interest: rear a little plumper, thighs more Amazonian, encounter entering its late Elvis mode. I am genuinely happier becoming in ostensibly “worse” form. I favor my body contoured. I relish getting strong, potent, able to carry suitcases for tourists and lift prams up measures. I like filling my garments, not obtaining them hang limply off me. I feel grownup, nourished, myself.

I have totally no need to resemble a stick-thin supermodel, or emaciated Angelina Jolie. I want to search healthier, à la Sophie Dahl when she was neither teen-plump nor model-scrawny ravishingly curvaceous, even, like Monica Bellucci or Christina Hendricks and be Kate Winslet-like in my capacity to hoist Richard Branson’s (reluctant) mom more than my shoulder and rescue her from the flames.

No other woman I have talked to about this could start to realize this welcoming of weight. “What do you suggest you want to put it back on?” they asked in horror. “You’ve acquired what we all prolonged for.” A brilliant friend confided that her guiltiest secret was feeling joy after she was in a auto crash simply because she had “never been more thin”.

Candida Crewe’s 2007 memoir, Consuming Myself, argued that the author’s “normal abnormality” concerning food – read through (barely) practical anorexia – is the “everywoman disease”. I attacked it in print at the time for perpetuating the stereotype that thinness is all women care about. Now, I truly feel forced to concede that, in no way possessing dieted, not being aware of my recent fat and harbouring no sexual feelings about chocolate, it is I who am the (wholesome) freak.

Anorexia seemed nevertheless happily uncommon in the prelapsarian Eighties in which I grew up, despite the fact that my psychiatrist father was treating situations. There was one lady in my state school sixth kind with an consuming disorder she had picked up at boarding school, who managed to inflict her “eating’s cheating” mantra upon a single other.

_{Apostle of thinness: Wallis Simpson (REX)}

Only at Oxford did I get started to appreciate the scale of the dilemma, understanding that freighted phrase “body image”. I remember sitting in the obligatory group therapy circle, feeling as if I was struggling with a foreign language as so several vivid, lovely women confessed to hating their bodies. I felt astounded, incredulous, giddied.

Later on, one member arranged an experiment in which we had been to consume biscuits in front of a mirror for half an hour, and publish down how we felt. I did it, didn’t get it, felt a tad bored. Later on, one particular of the other participants had to be hurried away by ambulance, spurred into a meltdown that necessary psychiatric assist. Once more, I was shocked. No a single else seemed shocked. It was regrettable, but we had clearly been playing with fire.

Some 90 per cent of grownup ladies are stated to experience physique image anxiety, from unfavorable ideas to total-blown self-loathing. A handful of many years in the past, I was asked to comment on investigation that suggested hundreds of thousands of women suffer from such unfavorable self-picture that they may possibly feel too inhibited to attend perform, or depart the property. The survey by YouGov for Tesco, advised that as a lot of as 8.3 million (a lot more than one particular in 3) ladies have cancelled social engagements on account of appearance nervousness, with employers estimated to lose £114.4  million a 12 months to self-disgusted absenteeism.

A third of women questioned could not bear to obtain clothes in the appropriate dimension nearly two-thirds averted their very own reflections. Over a third had rejected sex due to physique horror, although just beneath half keep away from physical exercise in public believing this inappropriate for a female in excess of a size 14 (the United kingdom average becoming a sixteen). We have been, it appeared, in the grip of a self-consciousness epidemic transforming British womanhood into a collection of perform-shy agoraphobics. If this self-hatred is a damaging influence on adult females, then it is even more terrifying amongst girls. Thinness rather than good grades would seem to be the universal pre-pubescent aim, “fat” the ultimate playground insult. Girls as youthful as 5 now routinely fear about their weight, explained a parliamentary report last year, while half of 14-year-outdated women have been on a diet to modify their entire body form.

The quantity of pre-teen young children taken care of in hospital for consuming problems has tripled in 4 years, according to NHS figures. There were a lot more than 6,500 children and youngsters handled in hospital in 2010‑11 for problems such as anorexia, compared with one,718 in 2007-08. The figures contain 443 who received treatment ahead of the age of 13 – a more than threefold rise. Among them were 79 youngsters significantly less than ten when beginning remedy, 56 aged five or underneath – anorexic behaviour picked up as toddlers.

For all our education, and opportunities that would make our grandmothers green with envy, thinness would appear to be the ultimate female ambition. By some means, women and bodyweight troubles have grow to be equated: not only is excess fat a feminist concern – as psychologist and campaigner Susie Orbach taught us in her seminal 1978 review – it is a much more fundamentally female 1. This leaves me – what? – insufficiently female? It is an accusation that has been levelled.

An ex-lover’s female pals professed to detest me due to the fact I don’t a lot like pudding, anything they took to be a mark of smug superiority (it isn’t – I will consume any amount of cheese). I as soon as wrote an article revealing that I do not like chocolate – cue an avalanche of dislike mail telling me I had “betrayed the sisterhood” and “obviously detest women”. Lately, I admitted to a pal that I had hit somebody over the head with a loaf of bread: “You eat bread?” she goggled.

In this context, the ultimate taboo is – like me – to admit zero angst about consumption. Ladies who consume too a lot, girls who consume too small, girls who consume only during months in which an “r” seems – all this is considered par for the program. It is me – the female who eats for nourishment and pleasure – who is considered the pervert .

In the wake of January, none of us is a stranger to the current crop of whacko regimes – five:2, four:three, new Atkins, previous Atkins, Dukan, raw food, green juicing, no sugar, paleo, blood group, or my existing favourite, the werewolf diet, in which acolytes eat according to lunar cycles. Meanwhile, the “bikini bridge”, that little indentation beside the sacrum, has replaced the “thigh gap” as index of accepted skinniness, despite having commenced as a BuzzFeed parody of a cultural fixation.

Celebrity magazines promote on the back of who has put on fat and who has shed it (typically, the really identical “slebs” figure in each categories on a complex alternating schedule) starlet and paparazzi careers are born and made on the excess fat-thin cycle and its oscillation amongst “good” and “bad”. If the strain is there for E-listers, for A-listers it is off the scale. As Tina Fey joked at the current Golden Globes ceremony: “Matthew McConaughey did wonderful operate this 12 months. For his function in Dallas Consumers Club, he misplaced 45lb, or what actresses contact ‘being in a movie’.” Lena Dunham, creator of hit US comedy Girls, is the exception to this skeletal sorority, and, by God, do not we get to hear about it.

Include to this our (justifiable) anxiousness with regards to weight problems, and our collective thinness infatuation reaches fever pitch. Nevertheless, as specialists are beginning to reach consensus, the weight problems crisis might be a merchandise of our thinness mania, and the diet sector that generates and supplies its baffled appetites. Diet program foods and lunatic regimes in the long run make us gain more excess weight, as eating gets disordered, swinging between binge and purge dieting currently being self-defeating in a way that “normal” consuming is not. By eating typically, I’m the same dress dimension as I was when I hit puberty – not thin, but not unwanted fat.

I would like to say that I see some hope, but I really don’t, not with no a collective selection to battle for it. To be certain, we have the different Dove campaigns and 2013’s exhortations to be “Fit Not Thin”. Nonetheless, this quite phrase conjures the winner of two Olympic gold medals Rebecca Adlington weeping over comparisons amongst her physique and that of a model in final year’s I’m a Celebrity… Get Me Out of Right here! We have been advised the Olympics would inspire women to see their bodies differently, but even amongst its champions the goal is to belittle ourselves.

Patriarchy ghettoised women by defining them as becoming about the entire body only: hysterics whose sole modes of expression have been to ingest and expel. At the minute when we are lastly wrestling totally free of its stranglehold, girls are currently being frogmarched straight back into the very same impasse. Worse, we are undertaking this to ourselves, self-harming physically and psychologically.

It is time we stopped decreasing ourselves. Time we remembered that a physique is much more than stomach, hips and thighs. It is heart, lungs, and brain. Personally, I will proceed embodying rebellion. I shall place on weight when I overdo the food and drink, and I shall drop it once more when daily life calms down. This is the standard, human way of things. And if this helps make me significantly less of a girl, then I’ll settle for “human being”.

Why is thinness the ultimate female ambition?