The Guardian view on changes to the NHS: transformative but not sustainable | Editorial

The headlines are all about the money. The NHS England boss Simon Stevens’ progress report, published on Friday at roughly the halfway point of his strategy document, the Five Year Forward View, consists of 75 pages studded with cuts in a bid to show that his organisation is not the basket case that the prime minister, Theresa May, is said to believe it is.

Hospitals throughout England are to be asked to free up 2,000 to 3,000 beds to improve the flow of patients needing urgent or emergency care. It will be done by abandoning waiting time targets for the kind of procedures, like new hips and knees, that fill the elective surgery lists. The clinical evidence in favour of some surgical interventions is to be carefully re-examined: that may mean not offering some operations at all. GPs are being asked to stop prescribing common medication that can be bought over the counter. Here is the evidence that the NHS, in an era of unprecedented financial pressure, is trying to manage on a budget that, although it has been broadly protected so far, is in fact unsustainable. Two-thirds of NHS trusts and foundation trusts were in deficit last year; by the end of this parliament, spending as a share of GDP – at 8.5%, already below the average of the 15 richest countries in Europe – is expected to fall further behind.

But after an unedifying exchange at the start of this year between Mr Stevens and Mrs May about the increase in NHS spending over at parliament (she said £10bn, he said £8bn – he is right), the NHS England boss wants to send a quite different message to government. The “Next Steps” document acknowledges the financial pressures, but describes a system in transformation that is broadly succeeding in delivering more for less in every priority area from cancer to mental health. It highlights progress towards restructuring health provision by area, integrating health and social care, and tackling bottlenecks in hospital discharges through bottom-up, locally led coordination in so-called sustainability and transformation plans (STPs). Making this work, so that demand for costly hospital care is reduced, was central to the original vision of the forward view.

Since this is the NHS, reform is never easy. Supporters of change, like NHS workers in Dorset, say their incentive is better patient care. Critics say it’s just about saving money. The recent budget included £325m to help the first nine STPs get off the ground and the autumn budget is expected to bring more of the same; not enough to stop the closure of much-loved, politically sensitive maternity units and cottage hospitals. The process of change is already slow and tentative. Protest slows it further, and reduces popular support for it. And, as the Nuffield health thinktank argues, the recruitment crisis for both GPs and district nurses is adding to the difficulties of keeping vulnerable people out of hospital.

The second challenge is a huge own goal made by the Conservatives: the Lansley reforms brought in by the 2012 Health and Social Care Act, which imposed mandatory open competition for all new contracts for services. Mr Stevens sees the sustainability and transformation plans as a way of getting round the fragmented and often failing structures that are now obstacles in the path of joining up different services. But there’s talk of legal challenge from private sector providers, such as VirginCare. The logical course of action is to repeal the act. Mrs May, as a new prime minister, could get away with it. If the STPs deliver the improvements that their advocates believe they will, then a new parliament could declare the act – and many of the reforms of the past 30 years, stretching back to Ken Clarke’s introduction of the internal market – a blind alley. Meanwhile, Mr Stevens can only hope he has persuaded Mrs May and Mr Hammond that NHS England is not a bottomless pit for precious taxpayers’ money, but a flexible, efficient organisation that is worth the big cash injection it desperately needs.

The Guardian view on changes to the NHS: transformative but not sustainable | Editorial

Prescription changes will help the NHS | Letters

The news that the NHS is to remove certain medications from its list of prescribed items (Report, 28 March) may come as a shock to some, but for anyone working in healthcare the step is an obvious one, which may act as a much-needed pressure release valve.

According to government data, each 11.7 minute trip to the GP costs the NHS £45; add to that the cost of prescribing (£3.83 per item) and we are nearing £50. Now compare that with the price of purchasing one of the items listed, directly from a pharmacy, eg Omega 3 capsules (you can get 30 for £6.65). It doesn’t take a genius to see why the NHS is struggling to cope.

The NHS will review 10 items, in the first instance including travel vaccines (these should arguably be self-funded as they fall into the lifestyle category), and erectile dysfunction medication (affordable non-branded options are available from your pharmacy). Access to gluten-free food was once restrictive, but it’s now in all major supermarkets. As a pharmacist, I welcome this move: it saves money, puts the onus back onto the patient to take responsibility for their own health and reiterates that pharmacies should be the first port of call for minor ailments. But we mustn’t forget that, while the price of these items may be affordable for some, for others, paying for their medication is just not an option – one size does not fit all, so exceptions will need to be made.
Stuart Gale
Frosts Pharmacy, Banbury

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Prescription changes will help the NHS | Letters

Government finances face near-£6bn hit over changes to personal injury payouts

The government’s finances will take a near-£6bn hit as a result of the increased bill faced by the NHS and other parts of the public sector as a result of changes made to the way compensation awards for botched operations and other errors are calculated.

The lord chancellor, Liz Truss, announced a cut to the so-called Ogden discount rate last month which is pushing up the payouts to claimants but increasing the cost to organisations such as the NHS.

The Office for Budget Responsibility said the government was now setting aside an extra £1.2bn a year to meet the expected costs to the public sector – and it would push up car insurance premiums by around 10% .

Robert Chote, chair of the OBR forecasting unit, said: “The overall effect is to increase borrowing by £1.8bn this year and around £1bn each year thereafter.”

The Association of British Insurers, which wants an overhaul of the system, described the costs as extraordinary.

Huw Evans, ABI director general, said: “Today’s budget confirms a massive £6bn hit to the NHS caused by the lord chancellor’s decision to cut the personal injury discount rate to -0.75%”.

The rate was previously 2%. “This extraordinary bill for taxpayers – bigger than any other in this budget – shows how absurd this avoidable decision was,” he added.

Government finances face near-£6bn hit over changes to personal injury payouts

Drug Abuse: Detour In to Behavioral Changes

Many find their way in just by the urge to look into something new and for the rest, it’s a way to release stress and escape depression, completely oblivious to the lasting effects. Either way, drug abuse can’t be justified. Drugs can save a life and also ruin one just like Hussar A. D. mentioned in his article Drug Effectiveness and Safety. Few moments of escape from reality is what many of us seek but don’t realize the lasting effects of it. It does not take much time to turn abuse into an addiction. Whether the drug controls you or you control the drug, the gradual changes in physical and mental state of an individual immediately signals to internal physical harm to that individuals’ body, as chemical reactions stimulated artificially and leaves the lasting effects of the abuse.

Different drugs “satisfy” people differently. The Passages Malibu article Personality Changes With Drug Dependency breaks down effects of different drugs. The article clearly identified how drugs only help achieve momentary pleasures or sanctuary but nothing longer. Common behavioral changes include being aggressive, impulsive, selfish, ignorant, irresponsible, short-term memory loss and losing mental balance to think properly. Such effects lead to hallucination, overconfidence, egoist behavior and even depression.

 Classifying effects of drug abuse can’t be generalized rather be listed, with no doubt that any effect could hit anyone addicted to drug abuse.

Risky behavior: The initial effects to impact someone are risky behavior traits a person develops, commonly dressed as aggression. Once adapted to drug abuse, the person tends to react more aggressively than before. Being ignorant towards everything around are also symptoms. All such behaviors lead drug abusers to be introverts in nature.

Dazed and Confused: A person might initially feel the effects of hallucination to be the “fun and nutty” part of drug abuse but will soon realize how confusing the brain  signals can get, sometimes leading the person to lose power of imagination. When in normal state, a person would no longer be able to visualize things better, making him feel to go back to drugs as a creative enhancement. The sense of dependency that stems from the notion of enhancement is probably the root of all evil.

Emotions: The daily dose of drugs kicks in with one being more emotional and reactive to the surrounding. The hazy state of mind causes abusers to be unable to take decisions for themselves. Frustration becomes common places.

Self-control: Hallucination sort of freezes mind for a short period of time, effecting brain functions in a long term. But more importantly, it alters with motor functions and perception of an individual, leaving deep-seated problems to deal with.

All reasons conclude to one fact only:  drug abuse places you in a vicious cycle that makes you go back to the same illusion, keeping you away from reality. Escaping reality was never an answer; dealing with all problems and facing life head-on has always been the answer that champions digest for breakfast. It is important to know how long drugs stay in your system and what steps you should take to prevent damage and make your way towards recovery. Understand that drug abuse, or relapses can always be stopped with love and care from friends and family. The Stem4 organization found how one can overcome the difficulties in regular life or escape the loop of drug abuse. Their study suggested to look into self-esteem and ones’ power to deal with reality as a strength to overcome such effects by himself. Drugs are not the final answer, realizing the unproductive outcome of it is the biggest boost of self confidence and social involvement. It’s never too late!

Dave Hawthorne is a public health professional living in Scottsdale. He loves to write about healthy living, fitness and nutrition. In his free time he usually goes out for cycling. 

Drug Abuse: Detour In to Behavioral Changes

Can health and care deliver changes and keep the public on side?

“I have too much care. I need less care. I am quite capable of leading my own care. For those of us with chronic, long-term conditions, self-management is the key.”

That was Carrie Grant, judge and vocal coach on TV talent shows and one of the on-stage hosts at Expo 2016. She has Crohn’s disease, which causes inflammation of the digestive system, and is one of 15 million people in England who live with at least one long-term condition, including almost six in 10 people aged 60 or over.

If the NHS and social care system is to survive in its present form, and is to be able to afford the innovations on show at Expo, then people like Grant will have to do much more to monitor and medicate their own conditions. Yet too often the system assumes they need a service.

Carrie Grant at Expo 2016. Photograph: Tom Hampson/NHS England

Jeremy Taylor, chief executive of National Voices, a coalition of health and care charities in England, said he had been deeply impressed by a presentation at Expo by Salford Dadz, a project begun with NHS funding that brings together fathers who might otherwise be reluctant to engage with health or other agencies.

“What matters to them is particularly not having another bloody service – they want to get out and do stuff,” said Taylor. “Sometimes what’s needed, and has the most transformative effect on people’s lives, isn’t something that the NHS and social care deliver.”

Such thinking is part of the puzzle being wrestled with by those behind the new sustainability and transformation plans (STPs) for setting health and care on a sustainable footing. But not everyone gets the message – and not many STP teams have yet proved capable of delivering it to a sceptical public.

As Sir Bruce Keogh, NHS England’s medical director, argued in opening Expo, the paradox facing planners is that many people are defending a system they know to be deficient because they are frightened of change. “We are quite content with our expectations of our NHS,” he said. “We have to tackle that.”

Keogh warned of a “quadruple pincer” gripping the system: soaring demand for care, escalating costs, a funding straitjacket and public nervousness about change.

Can transformation come soon enough? Jon Rouse, chief officer of the Greater Manchester devolved health and care partnership, estimated it would take five to 10 years to start to realise the full benefits – though he acknowledged that he would in the interim need to demonstrate some early results.

Simon Stevens, NHS England chief executive, offered the cautionary tale of the stethoscope, invented 200 years ago this year in France, which was but initially resisted fiercely by many doctors but ultimately became transformative in medical practice. And he also warned of Amdahl’s law. According to this theory, usually applied to computing, transformation of an entire system occurs only at the pace of the slowest part to change. “We cannot solve this unless we solve the whole process,” said Stevens. “Hence the critical importance of the STPs.”

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Can health and care deliver changes and keep the public on side?

Warning: Neck Changes Might Lead To Stroke

Following a neck adjustment — also recognized as cervical manipulative treatment and typically employed by chiropractors and other healthcare providers — men and women are at enhanced chance for cervical dissections (tears), which can lead to stroke, according to a scientific statement released by the American Heart Association/American Stroke Association. Despite the fact that a lead to-and-impact connection is far from being proved, the groups say that healthcare providers ought to inform their sufferers about the association prior to starting up the procedure.

“Most dissections involve some trauma, stretch or mechanical stress,” mentioned José Biller, lead writer of the scientific statement, in an AHA press release. “Sudden movements that can hyperextend or rotate the neck — such as whiplash, particular sports activities movements, or even violent coughing or vomiting — can outcome in CD, even if they are deemed inconsequential by the patient.”

Recent knowledge about cervical dissection is limited to situation-management research and clinical reviews, making it extremely hard to set up a result in-and-effect connection. In some circumstances, an option explanation might be that patients in the early stage of cervical dissection may possibly go to a chiropractor or other healthcare provider for relief of their neck soreness.

“Although a cause-and-impact relationship in between these therapies and CD has not been established and the risk is most likely low, CD can end result in critical neurological injury,” stated Biller.

Superficial dissection of the proper side of the neck, showing the carotid and subclavian arteries. (Photo credit score: Wikipedia)

Warning: Neck Changes Might Lead To Stroke

How Will Boomer, Gen-X, Millennial Doctors React To Well being Care Changes?

With American overall health care in the midst of speedy transformation, the two doctors and patients will be forced to adapt to changes stemming from the Cost-effective Care Act, also recognized as “Obamacare.”

Of program, everybody responds to modify differently. But is it feasible to predict how physicians will adapt to wellness care reform primarily based on the year they have been born? The answer could surprise some individuals and even force them to feel in a different way about who provides their care in the future.

How Various Are The Generations, Really?

A whole lot of information exists on the traits that define and differentiate generations. While none of that data can paint a completely correct image of any one particular medical professional, the analysis does allow us to cover the canvass in broad strokes:

Child Boomers (born 1946-1964) are known for their function ethic and prolonged-phrase commitment to a single organization. They’ve been prepared to trade function-daily life balance for specialist success, recognition and financial protection.

Generation Xers (born 1965-1983) are comfy moving in between jobs and don’t see themselves functioning for any 1 organization their total lives. They have a tendency to prioritize a balanced lifestyle above monetary gain.

Millennials (born 1984-existing) anticipate to work with numerous employers and seek out cross-cultural and global opportunities. They too worth versatility in their work-daily life balance. They don’t thoughts functioning hard but want to be judged on their output and outcomes, not the complete quantity of hrs they place in.

And in contrast to their predecessor generations, millennials have a disproportionately more powerful entrepreneurial spirit and favor to perform in efficient, rapidly-moving, staff-based organizations.

How Generations Of Doctors Will Take care of Adjust

Not all generational generalities are foolproof: Some little one boomer physicians are as higher-tech as the savviest millennials and plenty of Generation X doctors put in lengthy hours.

But on the total, there are fundamental distinctions in doctors’ operate styles, communication routines and all round fondness for change in the context of a swiftly evolving wellness care planet.

Bidding Farewell To The Solo Practice

A lot of little one boomer doctors invested whole careers developing up little and solo practices. But once they retire, will newly skilled millennial physicians rush to buy up their practices? Not probably.

Analysis from the past decade shows a expanding quantity of residents looking for salaried employee positions at hospitals, overall health systems and other overall health care organizations.

Whereas boomers worth the independence of running their personal workplace – and obtaining their identify on door – younger generations of medical doctors choose the better function-lifestyle balance and predictability that more substantial employers offer you.

But what about the millennial generation’s “entrepreneurial spirit”? Will they be ready to drive change in reasonably rigid hospital and well being care techniques or will they be stifled? Hopefully, several of the following generation will decide on to redirect their entrepreneurial energy by taking on leadership roles inside of greater organizations. For now, it stays to be observed how younger medical doctors will cope with the frustrations and complexities of the current wellness system’s bureaucracy.

How Will Boomer, Gen-X, Millennial Doctors React To Well being Care Changes?

Cholesterol linked to brain changes that result in Alzheimer"s disease

However, the larger ranges of “good” cholesterol – large density lipoprotein which can be obtained from meals this kind of as nuts and olive oil – were identified to have a possible protective effect that lowered beta amyloid plaques.

Physicians presently recommend folks to lessen the volume of bad cholesterol and boost the great cholesterol they consume due to the results these have on heart condition.

Professor Bruce Reed, a neurologist at the University of California who led the review, said: “Unhealthy patterns of cholesterol could be straight triggering the greater ranges of amyloid identified to contribute to Alzheimer’s, in the same way that this kind of patterns encourage heart ailment.

“Our examine shows that each larger levels of excellent cholesterol and reduce ranges of bad cholesterol in the blood stream are connected with decrease levels of amyloid plaque deposits in the brain.”

Excessive levels of bad cholesterol in the blood are already acknowledged to enhance the chance of heart illness by triggering blood vessels to narrow and harden.

Excellent cholesterol, nevertheless, seems to shield towards heart condition and are thought to assist to clear these fatty deposits in blood vessels.

Earlier scientific studies have also linked higher ranges of cholesterol to Alzheimer’s disease, and earlier this year scientist proposed this may possibly be due to the cholesterol leading to cells to divide incorrectly.

This may possibly lead to a create-up of the harmful amyloid protein in brain cells that type tangles and so impair the way they perform.

The most current study looked at 74 guys and women who were a lot more than 70 many years old and examined their blood cholesterol ranges.

Their brains have been also scanned employing tracer chemical compounds that bind to amyloid plaques to examine.

3 of these taking portion suffered from mild dementia, 38 had mild cognitive impairment and 33 had no memory problems at all.

The researchers discovered that large amounts of LDL and reduced amounts of HDL had been each linked with more amyloid in the brain although higher amounts of HDL seemed to be linked to lower amount of plaques.

The findings are published in the journal JAMA Neurology.

Professor Reed said the findings could lead to new techniques of helping to minimize the growth of Alzheimer’s in men and women who are at danger.

He said: “It also suggests a strategy of reducing amyloid ranges in individuals who are middle aged, when such develop-up is just commencing.

“If modifying cholesterol levels in the brain early in lifestyle turns out to reduce amyloid deposits late in daily life, we could possibly make a substantial difference in reducing the prevalence of Alzheimer’s, a aim of an enormous volume of investigation and drug improvement energy.”

The researchers mentioned that anyone with an LDL degree over one hundred milligrams per decilitre of blood and an HDL of less than 40 mg/dL appeared to be at greatest risk.

Latest analysis has suggested that statins, the medicines taken by hundreds of thousands of individuals to decrease their cholesterol, could also aid to decrease the danger of dementia by a third.

Dr Laura Phipps, from the British charity Alzheimer’s Analysis United kingdom, warned, however, that there was nevertheless inadequate proof to advise that cholesterol lowering medication such as statins must be utilised to treat Alzheimer’s.

She stated: “This study discovered an association in between substantial cholesterol and amounts of amyloid in the brain, which can be an early indicator of Alzheimer’s.

“While this study did not investigate the mechanism behind the hyperlink, the findings include to present evidence that cholesterol could play a role in the Alzheimer’s illness procedure.

“Despite this, clinical trials carried out to date have not offered proof to suggest cholesterol-lowering statin treatment as a way to deal with or avoid Alzheimer’s.

“Existing evidence suggests the ideal way to preserve our brain wholesome is to consume a balanced diet program, sustain a healthier weight, not smoke, workout often and keep blood pressure and cholesterol in verify.”

Cholesterol linked to brain changes that result in Alzheimer"s disease