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

Demonstrations matter – they create the kind of power politicians despise

The tide is turning and you can feel it on the streets of the world’s capital cities. On Sunday, hundreds of peaceful protesters were arrested in Moscow and St Petersburg, after thousands massed in unsanctioned demonstrations against corruption.

There were similar scenes in Minsk, where punitive taxes on the unemployed have driven people to the streets. In February, half a million Romanians forced their government to abandon a law pardoning corrupt officials, by taking to the streets.

In Britain, in the month of March, three major protests have taken place: a demo to save the NHS that drew up to 250,000 people; a 30,000-strong march against racism; and, on Saturday, a protest in favour of staying in the EU, again numbering more than 100,000 people.

National demonstration in London to protest agains the state of the NHS. Photograph: W Szymanowicz/Barcroft Images

And when Donald Trump’s repeal of Obamacare failed in Congress, although the blow was struck by rebel Republican lawmakers, the force behind it surely came from the thousands of people who swarmed into town hall meetings to berate their representatives in the runup to the vote.

The point is not that “mass action works” – it rarely does, on its own. The point is that it’s not futile. Putting your body on to the street, or into a mass meeting, or getting it thrown into a police van – as happened to hundreds of Russians and Belarusians this weekend – creates power of the kind professional politicians despise.

If you want to understand how irked the political class feels when people exercise their right to protest, study the Twitter feed of MP Owen Smith. The one-time Labour leadership contender didn’t join the Save the NHS demo – but he did find time, at the very moment a quarter of a million people were on the streets – to belittle them. He tweeted to a follower: “Is that how we save it then? With a march? I always thought it was better to win elections and then fund it properly.”

Brief though it is, Smith’s tweet encapsulates an entire political philosophy. The people who ignored Smith’s advice and marched for the NHS understood what the closeted technocrats do not. Mass action creates its own dynamics; they can be massive and far-reaching – despite the scant and bland coverage all demos get on TV and in the press.

In the first place, assembling in a large crowd shows you that you are not alone. And it informs you in great detail about the kind of people you are not alone with. On the NHS demo, it was obvious that huge numbers of NHS workers had turned out, alongside user groups often led by elderly people. Why is that interesting? Because in the modern, privatised and corporatised NHS, the staff are afforded few collective outlets for expression. Coming together – not just as “nurses from Doncaster” but nurses, doctors and patients from Doncaster – breaks down the invisible walls institutional life creates.

On Saturday’s Unite for Europe march, it was – by all accounts – the liberal salariat that predominated. A lot of sarcasm has been aimed that way by the Labour left and the media right but, again, such mass gestures are about finding each other, testing out arguments, and creating and transforming messages.

Unite for Europe march, London. Photograph: Valerio Berdini/Rex/Shutterstock

If you add to all this the experience of resistance to Trump in the US, the global picture becomes interesting. On 21 January the US experienced possibly the biggest mass mobilisation in its history – with an estimated 4.2 million people protesting against Trump’s inauguration in towns and cities across America.

What social media adds to such mobilisations is not just visibility but the intensification of the shared experience. Each block of 1,000 protesters on any demo in the developed world is really a thousand nodes on a network containing tens of thousands of other nodes. It is a moving and incessant information-distributing machine.

And that is why the first move of any government that wants to curtail democracy is to curtail the right to demonstrate. Putin outlawed the majority of planned demos last weekend, but they went ahead regardless. Slammed into the police vans were not just brave but faceless Russians, but people with Facebook and Twitter followers all over the planet.

That’s why demonstrations matter and why, in the name of resisting the growing kleptocracy, racism and authoritarianism of political elites, we should keep on demonstrating.

But demonstrations are never enough. Just as 30,000 people on the streets usually merits only a colourful picture and a caption in the newspaper, what they did afterwards is barely recorded at all. This is why revolts and revolutions always surprise elites, and a media conditioned to see the world through the elite’s viewfinder.

“When the people decide to live …” wrote Tunisian poet Abu al-Qasim al-Shabi, “chains will be broken”. Those words were widely shared in 2011 during the Arab spring.

Revolts happen because elites push things so far that large numbers of ordinary people conclude there is no other option but to resist.

You can do some things at the ballot box: the defeat of Geert Wilders in the Netherlands, the humbling of Paul Nuttall in Stoke-on-Trent and – hopefully – the defeat of Marine Le Pen in France on 7 May. But some challenges require you to don a pink hat, or – as the Russians did – hang a designer sports shoe around your neck, paint an amusing sign, march, take pictures and tweet them to your friends.

When the people decide to live, demonstrations are what they do: and there’s a lot of people demonstrating it as spring gets under way.

Demonstrations matter – they create the kind of power politicians despise

10 Natural Stress Relief Tips & How to Create a Serene Space

After the holidays, we all need time for stress relief. Starting the New Year off with a routine of taking time for yourself to unwind is the best gift you can give yourself.

Creating a serene space at home is the best part. If you want to try yoga or meditation, make it a project to clear out a space in a room for just that activity. De-clutter the area; keep it simple, perhaps a candle, an iPod player for meditation music, and a small table for incense or jewelry. Keep the floor clean so that it is inviting to sit there or do yoga. Leave the cell phone out of the room while you are meditating, so that there are no distracting sounds. Even choosing an outside area is a great idea, as you get the fresh air, the sounds of the birds, and the peace of being in nature.

5 Yoga Poses to try

Yoga reduces cortisol and adrenaline, both hormones that make us feel stressed and overwhelmed. But the key to a reduction in those hormones is a steady practice that happens regularly. Try these poses for a deep stretch and a chance to take some deep breaths and relax.

• Standing Forward Bend (holding both your elbows to further pull your upper body downwards) – This is a perfect pose for back pain & for all of those hours spent sitting


• Triangle Pose – stretches so many muscles and brings the heart open


• Downward-Facing Dog – releases the back, stretches the upper back, and stretches the hamstrings. Be sure to raise your butt up as high as you can to release the weight from your wrists.


• Supine Twist – A gentle twist that helps back pain and releases tension


• Low Lunge – a great pose for releasing tension in the hips and stretching hip flexors.

Be sure to not over-stretch as you can cause ligaments to tear resulting in months of recovery. Go slowly and feel the edge of your abilities. Then back away from that edge. Stretching should feel good, not painful.

If yoga is not for you, try a different exercise routine. Even joining a team boot camp can be fun, but make sure it is made for your level of fitness. Dance workouts also are a lot of fun and make the time pass quickly. Exercise is very beneficial for the brain, and has been shown to be just as effective as anti-depressants. Even walking for 30 minutes several times per week gives the same brain benefit as high intensity exercise.

Drink at least 8 glasses of filtered water every day

When you are dehydrated or not getting enough water, your cortisol levels rise in your brain, which causes stress. Fill up bottles ahead of time and put them in the fridge for cold, refreshing water. Try adding bruised lemon slices, cucumber slices, even fruit like raspberries. Make sure to drink water from a good water filter that takes pharmaceuticals, pesticides, and fluoride out of the water.

Take Lemon Balm for stress relief

Extract: 10-15 Drops in water.

Tea: keep the lid on the teapot as the terpenes in Lemon Balm are in the steam.

Lemon Balm is great for relieving restlessness, anxiety, and insomnia. Studies have shown that combining Lemon Balm with Valerian was very effective for anxiety and insomnia.  If you are taking medications or are pregnant, consult your doctor before taking Lemon Balm or Valerian.

Read a favorite novel or book

Reading calms the brain and helps us to focus on one thing instead of being distracted. Reading a novel allows us to escape into a fantastical world or just another person’s life. I make it a point to only read books with characters who are good people, who strive to do the right thing, versus books where the majority of characters are evil, intent on causing havoc, etc. I feel stress melt away when I’m reading about good people. I’m inspired by them and hopeful for them!

A study at the University of Sussex found that reading reduced stress by 68%, better than listening to calming music or drinking a hot cup of tea.

Meditate

Many studies have been done on meditation for stress-relief. The best kind of meditation is one where you are not forcing your mind to be present. But rather, you are noticing how your mind wanders, and you are listening to your breath. Notice the mind wander and then accept it, let it go. Imagine the negative thoughts as a balloon, choose a color for it, picture it in your head, and let it float up into nothingness. Even 5-10 minutes of meditation every day can make a huge difference in your stress levels. Try doing a short meditation at the end of your yoga session and it might be easier to fit in. Or do it right before falling asleep at night. Make it easy and fun, not a bunch of work.

Create something

Learn to cook, draw, paint, create a scrapbook, or make a simple piece of furniture. These types of hobbies make you feel like you are creating something tangible and real. Hobbies provide you with “eustress”, a good kind of stress that makes you feel challenged and excited. However, too much eustress (from too many appointments and activities) can turn into chronic stress that makes us go into “fight or flight” mode and burnout. If most of your hobbies involve lots of other people, try doing a hobby that is solo. It will give you the time to reflect. Plus, if you’re doing it at home you can set up your environment for peace and serenity.

Laugh more

Be with people who you love & who make you joyful! That face-to-face time is priceless and it is gone in an instant. Enjoy it now.

Garden or Be Outside Every Day

Time in nature is so important for stress relief. Sitting in the sun with your eyes closed and meditating is a powerful stress reliever. Experiencing the beauty of the outdoors gives us peace. Replace your nightly TV-watching with a walk with your spouse or a friend. A study has shown that watching TV is the same as being low-level stressed whereas heart rates were calm while watching nature out of a window. To be happy and peaceful in life, we need to interact with nature, even if it means smelling a flower or watching ducks at a pond. Make it a priority to take walks during lunch or a nightly walk after work.

Journal 3 Things You Are Grateful for Today

Make it a habit to write down 3 things you are grateful for every day. Your sense of accomplishment and self-worth will increase by doing this. You will feel less of a need to be constantly busy. It will also help you to pinpoint the important things in your life that you might not be focusing on. Or perhaps it will help you see that certain people in your life need to know how grateful you are for their presence and love.

Lavender Essential Oil

Lavender Essential Oil is very relaxing and calming for our nervous system. Diffuse it into the air or dab a drop on your feet before bed. Try mixing a spray of 50% witch hazel + 50% water + 5 drops of lavender essential oil, shake it, and spray it on your pillow before bed.

Stress relief using natural methods is a great way to gently guide your body into a new year full of happiness and productivity. I am happiest creating things, being in nature, and spending time with loved ones. But sometimes we also forget to make time for ourselves. Take time every day to do something just for yourself, that makes YOU happy. That happiness will radiate throughout your life and touch others.

Disclaimer: The information contained in this article is intended for educational purposes only and is not a substitute for advice, diagnosis or treatment by a licensed physician. It is not meant to cover all possible precautions, drug interactions, circumstances or adverse effects. You should seek medical care for any health issues and consult your doctor before using alternative medicine or making any changes to your regimen.

Rosemary Hansen is a published author on Amazon, a Traditional Foods Chef, and a devoted Mama. You can learn more about her Pure Living Course + nourishing tips at: www.RosemaryPureLiving.com

Sources:

https://brainscape.com/blog/2011/06/water-less-stressed/

https://www.verywell.com/what-you-need-to-know-about-eustress-3145109

https://www.verywell.com/the-health-benefits-of-lemon-balm-89388

http://www.stress.org/military/combat-stress/management/

Kahn, PH, Friedman B, Gill B et al. A plasma display window?—The shifting baseline problem in a technologically mediated natural world. Journal of Environmental Psychology, 2008; 28: 192-199

https://www.takingcharge.csh.umn.edu/reading-stress-relief

http://www.health.harvard.edu/blog/mindfulness-meditation-may-ease-anxiety-mental-stress-201401086967

10 Natural Stress Relief Tips & How to Create a Serene Space

NHS to create specialist centres for childbirth mental health problems

The NHS is set to overhaul services for women who develop mental health problems around childbirth in a bid to ease the suffering caused by postnatal depression and reduce the number of new mothers who kill themselves or their baby.

NHS England is putting £40m into new specialist treatment centres for the one in five women whose pregnancy, birth or experience afterwards triggers serious psychological problems, including anxiety, depression and psychosis.

Claire Murdoch, its national mental health director, said these centres would end a “postcode lottery” in which two in three women currently affected missed out on vital help. While 14,000 new mothers each year received specialised support, the planned expansion of care would enable another 30,000 to do so by March 2021, said Murdoch, a former mental health nurse who also runs the Central and North West London NHS foundation trust in London.

“It’s self-evidently true that the current provision of these services is inadequate. There is a big postcode lottery. Some areas just do not have specialist community perinatal services available,” she added.

The money will be put into new community mental health units solely for women with perinatal mental health problems in 20 parts of England. They will be staffed by consultant psychiatrists specialising in such conditions, nurses with experience in the field, occupational therapists, psychologists and nursery nurses. Each will also run a buddying service in which women who have already experienced childbirth-related mental health problems will support those going through that or at risk of that.

Childbirth-related mental health conditions are estimated to cost the UK £8.1bn a year, or about £10,000 per birth.

Prof Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, said: “Around one in five women develop a mental illness during pregnancy or in the first year after delivering their baby, and one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems.

“Despite these alarming figures, in almost half of the UK, pregnant women and new mothers have no access to specialist maternal mental health services and only 3% of [NHS] clinical commissioning groups [in England] have a maternal mental health service strategy,” she added.

The Royal College of Midwives backed the move but said that every maternity unit needed to have a specialist maternal mental health midwife on staff to help women in sometimes desperate need.

“We cannot continue to read the constant reports of the number of women killing themselves because they were not identified earlier and treated or because of the lack of trained staff or as a result of lack of services. It’s heartbreaking and we can do better as a country,” said Janet Fyle, the college’s professional policy advisor.

The NCT, the parenting charity, welcomed the NHS’s “positive plan” but warned that even if all 20 units were set up by 2021 as promised, there will still be “a long way to go” before all mothers who need help get it, said Elizabeth Duff, its senior policy adviser.

“There are nearly 300,000 women in the UK who suffer from mental health problems postnatally or when pregnant each year and the funding aims to reach 30,000 women in 20 areas, so there’s still a long way to go,” she added.

NHS England is also pledging to spend another £120m putting psychiatrists and specialist nurses into A&E units so that patients undergoing a mental health crisis when they turn up at an emergency department get better help.

NHS England plans to introduce new waiting-time standards to ensure that any such patient is seen by a mental health specialist within an hour of their arrival in A&E and also given a plan for their care within four hours.

NHS to create specialist centres for childbirth mental health problems

"People are nicer to each other when they move more slowly": how to create happier cities

When Charles Montgomery first started talking about urban happiness, people laughed at him. As his colleague Omar Dominguez explains, “happiness is kind of an out-there concept for some people”.

Montgomery and Dominguez work at Happy City, a Canadian organisation named after Montgomery’s 2013 book, which makes the case for retrofitting cities for happiness and argues that streets, parks, shopping centres, housing estates – indeed most urban infrastructure – can be designed to make people feel happier, behave better and be kinder.

“If we give a damn about human wellbeing in cities, we need to study the emotional effects of spaces and systems,” says Montgomery. “We need to use evidence to help fix the horrific mistakes we’ve made over the last century.”

To beat the sceptics, the team at Happy City gathers evidence from psychology, neuroscience, public health and behavioural economics. They know that hospital patients who can see trees through their bedside windows heal faster than those who only see brick walls. They know that commuters at rush hour suffer more anxiety than fighter pilots or riot police facing angry mobs. They even know that the friendliest front gardens are precisely 10.6ft deep.

And they conduct their own research, particularly around Montgomery’s theory that the most important ingredient for human happiness is social connection. An experiment in Seattle found that passersby are four times more likely to help lost tourists on lively streets filled with lots of small shops than on pristine, but essentially characterless, blocks, where people tend to move more quickly.

“We think the kindness effect was a result of velocity,” says Montgomery. “People are nicer to each other when they move more slowly and have time to make eye contact.”

At the Project for Public Space conference in Vancouver from 12 to 15 September 2016, Happy City will host walking tours of the city. Participants will be hooked up to sensors that measure their physiological arousal, enabling scientists to test people’s physical and emotional responses to their surroundings, as they walk through community gardens or down dark alleys.

‘An explosion of interest’

But the real problem is that this kind of evidence rarely makes it outside academia. With one foot in research and another in urban planning, Happy City tries to bridge the gap between them. It is a consultancy, advising local governments, developers and any other organisations that have control over how cities grow, including the World Health Organisation.

Montgomery says he’s seen an “explosion of interest in the field” of happiness and urban planning over the past three years – and not just from Scandinavian countries. “I’m especially thrilled to see that property developers are embracing the wellbeing agenda,” he says.

Happy City has helped British Land, the UK’s largest real estate investment trust, to weave wellbeing principles into its new development practices.

“But we’re seeing an awakening in other parts of the world, too,” says Montgomery, referring to Ahura Builders, which invited Happy City to hack the designs for a community of 8,000 people in Punawale, India. “Our happiness interventions included breaking up imposing superblocks, investing in quiet streets that are safe and friendly for pedestrians and creating a village heart to which residents could walk and shop.”

Another project was based in Mexico City. Chaotic, crowded and with high levels of crime, it’s an unusual setting for the happiness agenda. But in the autumn of 2014 the local government’s innovation unit commissioned Happy City to do a three-day “happiness audit” of Colonia Doctores, a poor neighbourhood in the south-west of the city.

Dominguez, Happy City’s director of operations and sustainability, gathered together public officials, city planners, architects and – most importantly – local residents. On the first day they discussed key principles that influence wellbeing, such as access to nature and the ability to have positive social interactions on a daily basis.

“One of the key concerns in Mexico is safety. What people do when they’re concerned about their safety is to fortify,” says Dominguez. “Actually, one of the best things you can do is generate a sense of trust and calm.”

On the second day the group toured Colonia Doctores, applying the principles to physical aspects of the neighbourhood and on the third they presented their findings. Recommendations included opening a new museum and pedestrianising an area outside the local wrestling arena, turning it into a cultural corridor around Mexican wrestling. “That sense of community is good for their wellbeing,” says Dominguez.

‘Happiness is good for the bottom line’

One thing the Happy City team is really passionate about is making the business case for happiness. “Building healthier, happier places is not more expensive. In fact, these places save society money in the long run,” says Montgomery.

He can, of course, point to the proof. People who are socially connected are more resilient and more productive at work. Cities that encourage social interaction foster greater levels of creativity and trust, both of which correlate with GDP growth.

There’s an app that analyses the cost to society of commuting: driving to work incurs costs you might not think of, such as infrastructure, accidents, pollution, congestion and lost productivity due to ill health. Cycling, meanwhile, offers savings to the healthcare system and improved productivity from exercise – making that bike lane look like a great investment, Montgomery says.

The private sector also has a lot to gain from from designing workplaces where employees can be more productive, or shopping centres that encourage loyalty from customers and businesses. Some developers understand that places that promote health and happiness are also good for their bottom line, says Montgomery.

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"People are nicer to each other when they move more slowly": how to create happier cities

"Moonshot" cancer panel calls for US to create national research database

Top US cancer scientists have urged the Obama administration to create a national cancer database for clinicians and patients as part of a slew of recommendations presented on Wednesday by the White House-supported cancer “moonshot” panel.

Vice-president Joe Biden assembled the scientists as part of the administration’s effort to make the US the country that cures cancer “once and for all”.

The Cancer Moonshot Blue Ribbon Panel report said the recommendations, if implemented, “will transform our understanding of cancer and result in new opportunities to more effectively prevent and treat the disease”.

The ten recommendations include existing programs that need more funding – such as research to update guidelines for patient symptom control – and brand new initiatives including a human tumor database to monitor and analyze multi-dimensional cell behavior.

The panel also called for the creation of a network of databases for patients to profile their cancers and pre-register for clinical trials; the organization of a cancer immunotherapy clinical trial network; and the study and development of therapies that prevent or overcome drug resistance.

The panel also recommended initiatives to improve the understanding of a protein tied to pediatric cancers; increase monitoring and management of symptom care and treatment; support development of new testing and treatment technologies; and improve prevention and early detection.

But the funding necessary to fulfill these recommendations has not been approved by Congress despite lobbying by the Obama administration, which said it hoped to spend $ 1bn on the program.

“Congress should seize this historic opportunity – when researchers are on the brink of so many new and potentially life-saving developments in diagnostic tests and treatments – to boost funding for the NIH [National Institutes of Health] and NCI [National Cancer Institute],” said Gary Reedy, CEO of the American Cancer Society (ACS) and the not-for-profit organization’s action network, ACS CAN, in a statement.

The ACS said in January that it expects 1.6m new cancer cases to be diagnosed in 2016, the equivalent of about 4,600 new diagnoses each day.

Barack Obama announced that he had tasked Biden with leading the moonshot program in his final State of the Union address in January. The program aims to accomplish “a decade’s worth of cancer research progress in five years”.

It is a personal effort for Biden, whose son, Joseph “Beau” Biden III, died from brain cancer in 2015 at the age of 46. Last year, Biden helped secure a $ 264m increase in federal funding to the National Cancer Institute in the spending bill.

The panel report is a major step in that direction, and will be presented to the National Cancer Advisory Board on Wednesday, where it is expected to be formally accepted.

To determine the recommendations, the country’s top cancer scientists were divided into seven working groups to focus on elements like immunology and clinical trials. More than 1,600 ideas and comments were also submitted by the public.

Along with the recommendations, the panel also listed policy issues that needed to be addressed so that the recommendations could be efficiently implemented, including laws around patient privacy, the clinical trial system and insurance coverage.

Biden and Obama have acknowledged that it is unlikely cancer will be cured in the next five years, but they have said the moonshot program could create unprecedented strides in the fight against the disease.

“The key for us now is to put a lot more money into research,” Obama said in January. “If we do, I think we’re going to see some really big breakthroughs soon.”

"Moonshot" cancer panel calls for US to create national research database

"Soft-touch" physicians create 10m needless prescriptions a 12 months, says Wonderful

About a single in 4 prescriptions issued for antibiotics in England each and every 12 months – about 10m in all – are probably to be pointless as individuals deliberately search for “soft-touch” doctors who give in to their demands for the medicines, a foremost well being official has stated.

Mark Baker, director of clinical practice at the National Institute for Health and Care Excellence (Great), has warned that the increasing crisis of antimicrobial resistance, in which profligate use of medicines has permitted bacteria to develop resistance, threatened healthcare and the “whole basis of medicine”. He also explained infections would have to be handled by surgical treatment if drugs no longer worked.

Baker is director of clinical practice at the National Institute for Wellness and Care Excellence (Great), whichNice on Tuesday published advice on the concern for medical professionals, dentists, podiatrists, pharmacists and other experts.

Expectations of getting antibiotics have been now “entrenched”, stated Baker. “There are men and women who are addicted to the concept of possessing antibiotics. If they know there is a soft-touch doctor then they go to them.” If they did not realize success with one medical professional, they would attempt yet another or even search the internet to supply the medicines, he said.

Except if the most recent advice was translated into action, he explained there would have to be a rethink in practice “because we have invested 60 years assuming that most infections will be cured by antibiotic drugs”.

If these no longer worked, explained Baker, “then we will have to rediscover and relearn how to treat infections surgically and I do not feel anyone desires to be in that position”.

Associated: Considering of asking your medical professional for antibiotics? Consider once again | Sarah Boseley

The advice calls for prescribers to examine with individuals the very likely nature of their condition, the positive aspects and harms of quick prescribing, and choices this kind of as “watchful waiting” or delayed prescribing, when prescriptions are issued only soon after microbial samples taken from individuals have been examined.

It demands much more rigorous neighborhood policing of prescribing practice, with expert teams monitoring and evaluating information from distinct hospitals, GP practices and other prescribers.

Cases of very high, escalating or reduced volumes of prescribing ought to be examined.

Baker stated an open and transparent culture must permit well being specialists to query colleagues’ prescribing practices when they had been not in line with local or nationwide tips and no causes have been given for those choices.

There was a lot of really great practice, stated Baker, but examples of undesirable practice may, as a final alternative, be referred to skilled regulators this kind of as the Basic Healthcare Council (GMC).

Tim Ballard, vice-chair of the Royal University of GPs, mentioned the guidance “to give the appropriate antibiotic at the proper dose at the appropriate time” was wise.

“But we can come underneath enormous pressure from individuals to prescribe antibiotics, even when we know they are not the correct course of action. People need to realise that this is hazardous for every single and everyone of us, not just ‘other people’.”

He explained it may be counterproductive and unhelpful to involve disciplinary procedures when GPs already faced “very tough and demanding conversations” with individuals.

The college would be searching to regulators to support GPs who refused to prescribe unnecessary antibiotics and then faced complaints from patients.

Separate advice for patients, probably backed up by NHS public education campaigns, is anticipated following yr.

The Division of Health mentioned: “Tackling the overuse of antibiotics is a global issue that has an effect on everybody – government, patients, physicians, dentists and vets treating animals – not just GPs.

“In buy to make certain we have effective antibiotics for generations to come, we are raising worldwide awareness of the dangers of resistance to antibiotics and offering resources for GPs to support prescribing choices.”

Niall Dickson, chief executive of the GMC, said doctors should only prescribe if they had been pleased that this would serve the patient’s requirements.

“Where they take into account that the treatment method would not benefit the patient, they do not have to offer it.”

However, the GMC saw the Wonderful recommendations as “being a lot more about modifying the norms of practice typically than pursuing person doctors”.

Connected: Resistance is not futile – how to tackle drug-resistant superbugs

The dangers of antibiotic resistance initial grew to become a significant situation in the Uk in the late 1990s when they were raised by Sir Liam Donaldson, the then chief health care officer. His successor, Dame Sally Davies, took up the cudgels in 2013, with David Cameron calling for international action the following yr.

Professionals worry the crisis is deepening, with no new class of antibiotics or other major scientific growth in 30 many years.

A total of 41.6m prescriptions have been issued in England in 2013-14, costing the NHS £192m.

Prior Good guidance on the use of antibiotics to deal with respiratory tract infections, issued in 2007, was aimed at cutting prescribing by 22%. After an first dip, it started to increase once more.

A survey final year suggested more than a quarter of physicians prescribed antibiotics even when they have been not certain they were medically required, and nine in 10 felt underneath strain from individuals to prescribe them. Other figures suggest practically all individuals who inquire for antibiotics get them.

"Soft-touch" physicians create 10m needless prescriptions a 12 months, says Wonderful

Three ways to create major care model for modern Britain

Twenty-five per cent of A&ampE admissions could be handled elsewhere, analysis suggests. Photograph: Christopher Thomond

Reviews of a postcode lottery for British patients have drawn attention to the stark variations in between general practices across the Uk. This invites some reflection as to what factors unify the NHS, and begs the question of whether or not a a single-size-fits-all model of major care can exist in modern day Britain.

When the population is as scattered and various as it is in the United kingdom, it is inevitable that principal care companies in different locations will need to be adapted to better suit nearby demands. What this disparity also highlights is the want to target a lot more closely on the basic problems at the heart of the overall health service.

In recent many years there has been an emerging trend of patients heading straight to A&ampE rather than pursuing household or major care choices, which might reflect shifting social attitudes as significantly as the limited availability of nearby GPs.

There are 3 strategies that could create a powerful model of major care, all of which would call for the implementation of considerable reform. These processes would function together to produce an integrated system, and tackle the problem of needlessly duplicated companies.

one Introduce a tariff

The first reform that would reduce expenses and create a much more successful model of care is the introduction of a tariff that does not spend for needless treatments. This would alleviate a excellent deal of strain on both main and secondary care, and transfer important companies to neighborhood health care centres.

2 Redeploy the NHS workforce

Allocating healthcare pros to distinct sectors or levels of care would utilise the various talent set existing in the NHS and enrich the good quality of patient remedy. By redeploying personnel to areas that desperately call for added assistance we would also be in a position to get rid of the want for hospital or stroll-in centre visits, which are far much more pricey to run than GP surgeries.

Recent initiatives to spread much more providers and NHS employees across secondary and primary care units demonstrate growing considerations about strain on A&ampE. There is clearly broad support for increasing the function of principal care. Despite the fact that the growth of health-related premises to pharmacies, dentists, and optometrists, as properly as modernised consulting rooms, has confirmed helpful in retaining patients and easing the strain on other primary care companies, it is the redeployment of secondary solutions to frontline care that will have the most substantial impact on the NHS.

three Dispose of NHS assets

The third and probably most controversial means of releasing funds and consolidating care is the disposal of NHS assets. The explanation for the controversy is the prevalent misconception that closing healthcare facilities equates to occupation losses. The reality is that the United kingdom well being support possesses a quantity of useful assets locked up in estates that are not fulfilling their function in an efficient way.

The problematic side impact of pinpointing surgeries in particular areas is that it can detract from the overall situation dealing with the NHS. Premises improvement in the NHS needs to return to the public dialogue, as there stays a freeze on funding for developing modern day, integrated facilities.

In order to meet the increasing demands of patients there has to be a viable substitute to A&ampE. The emergency consultation is the security net for the central program, but is now often working as the reluctant initial port of contact for patients who consider there is nowhere else to go.

With figures suggesting that 25% of A&ampE admissions could have been taken care of elsewhere, and three-quarters of GP practices are potentially unfit for goal, higher good quality major care premises have to be a priority.

The 3-strand strategy for rebuilding the NHS is not a easy one, nor is it a quick resolve. It demands some tough selections for healthcare legislators and companies as effectively as a seismic shift in public attitudes to looking for health-related attention. Nevertheless, it is possible and it is the essential route in direction of a sustainable, valuable long term for healthcare.

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Three ways to create major care model for modern Britain

Major Health-related Organizations Create Ambitious Diabetes Registry

Our knowledge of diabetes right now is a bit like the way blind guys understand an elephant. With a myriad of isolated perspectives it is practically not possible to gain a broad overview. Now, a new initiative from a group of significant health-related organization will look for to offer the resources to better see a complete picture of the elephantine issue of diabetes.

The American University of Cardiology, the American Diabetes Association, the American School of Physicians, and the Joslin Diabetes Center announced today that they will launch the Diabetes Collaborative Registry, which they say is “aimed at tracking and enhancing the top quality of diabetes and cardiometabolic care across the principal and specialty care continuum.”

Diabetes sufferers these days “receive treatment options across healthcare specialties for a multitude of connected circumstances,” in accordance to the announcement. “The Diabetes Collaborative Registry will let for a longitudinal examine of diabetes presentation, progression, management and outcomes, even as sufferers acquire remedy from multidisciplinary care teams.”

The Diabetes Collaborative Registry will use engineering from the ACC’s PINNACLE Registry, which can bring with each other electronic health-related information designed by main care doctors, endocrinologists, cardiologists, and other health care companies. But the new registry will go past PINNACLE and incorporate a broader selection of data “to consist of additional measures pertinent to a wider group of suppliers who are concerned in the coordinated care and treatment method of diabetes.”

On a useful degree, the registry will enable “practices, providers and patients… to track adherence to functionality measures at the supplier and practice level, compare performance to national benchmarks, target high quality improvement areas and ultimately transform the quality of care provided to patients.” Researchers will also now be capable to employ information from diverse outpatient providers.

“Cardiovascular illness is the leading result in of death amongst individuals with diabetes, and there is a clear require for cross-specialty management of diabetes patients,” mentioned the ACC President Patrick O’Gara, in the announcement. “By consolidating patient information, this registry will permit main care doctors and experts who treat patients with diabetes to compare information and accessibility genuine-time metrics on individuals in all stages of the disease.”

“Diabetes is not one particular disease but a complicated set of diseases and too often prospects to significant and possibly existence-threatening problems, such as cardiovascular and kidney disease, as nicely as nerve harm, amputation, blindness and a multitude of other wellness difficulties,” explained the ADA’s Chief Scientific and Healthcare Officer Robert Ratner. “We hope that a cross-specialty, clinical registry will in the long run let us to boost the top quality of care — and consequently quality of lifestyle — for all men and women residing with diabetes by giving researchers a clearer image of what’s taking place to patients at a variety of stages of their ailment. Improved information assortment need to aid us increase patient outcomes.”

The founding sponsor of the registry is AstraZeneca. The registry expects to announce additional partners in the coming months and is open to accepting extra sponsors.

“Blind monks examining an elephant” by Itcho Hanabusa. LOC description: Ukiyo-e print illustration from Buddhist parable displaying blind monks examining an elephant. Each and every man reaches a distinct conclusion based on which portion of the elephant he has examined. one print : woodcut, shade. (Photograph credit: Wikipedia)

Major Health-related Organizations Create Ambitious Diabetes Registry

Last but not least, training to create United kingdom care workers" capabilities, but no income to spend for it | Justine Cawley

The professional knowledge, behaviours and capabilities essential in social care continue to be significantly underdeveloped. Photograph: Rex Features

Tomorrow sees the Kingsmill review publish its report into working conditions in the care sector. Like final month’s Panorama investigation of abuse of older men and women in care properties, it will highlight the urgent require for nicely-trained, skilled and compassionate social care personnel. Older people’s care wants are diverse and increasingly complicated, ranging from acute and continual sickness to dementia and palliative care, in addition to mobility concerns and psychological wellness troubles.

But the professional understanding, behaviours and skills essential in social care continue to be significantly underdeveloped. Care-property staff are the forgotten workforce and are typically regarded as to be the lowest of the reduced by their counterparts in the NHS. As today’s residential houses have replaced NHS lengthy-remain hospitals, it is essential that personnel have the range of expertise, abilities and practice to cope.

Most care residences never have medical doctors on phone so are dependent on out-of-hours services and GP locums. Extended waits for a go to suggest that personnel need to have to know what they are performing, as there is typically just a registered nurse in a care property and not even that in a residential home. To make matters worse, there are not adequate people doing work in social care: our ageing population needs this workforce to increase by one million folks.

In purchase to provide much more specialist education and training, we have developed a perform-based mostly degree program called Elizabeth Care, specialising in the care of older folks in all care settings. The initial program commences at the end of Might at the University of Surrey, for men and women previously operating in social care. This is the first program created for nurses and care residence employees searching following older folks.

The curriculum is based mostly on a framework that measures the patient, family-member and workers encounter, with modules in man or woman-centred care, compassion in care and individual and professional growth.

Recruitment for a foundation degree will commence in January. A professional pathway will for that reason become a actuality, guaranteeing that anybody coming into the social care sector can have a genuine career, with promotions and spend rises as they complete their coaching. It signifies that a younger particular person coming into at apprenticeship degree can rise by means of the ranks from an enriched care practitioner to fully qualified nurse specialising in the care of older folks, rather than getting poached by the neighborhood supermarket for increased pay out.

Although all three principal political parties endorsed this initiative, the lack of funding is jeopardising its existence. Even though NHS trusts have typical access to income for instruction and improvement of their staff, individuals in smaller sized nursing and care residences are finding it difficult to afford our program, even even though they are seeking right after NHS individuals.

Health Education England has an annual earnings of £5bn and £95,000 is invested on education and training in the NHS each minute, but next to nothing at all is offered for employees in social care. An example of how minor is invested on nurses in nursing properties and other neighborhood settings is illustrated by a local university that was allotted just £5,000 a 12 months in government funding to spend on education care-home staff. Even though some courses cost as little as £570, it would not pay out for any person wishing to complete a longer program or our degree, which expenses £7,790.

There must be other sources of funding, but Skills for Care, which administers its very own workforce advancement fund and is responsible for the grownup social-care workforce, is a “bad relation” and doesn’t fund increased-level qualifications, prioritising rather apprenticeship qualifications.

Professor Martin Green, chief executive of Care England, which represents independent care companies, says: “While the government spends billions on coaching and has publicly welcomed this new qualification, it seems unwilling to place its money in which its mouth is. This leaves nurses and care employees out on a limb, forcing committed men and women to fund any instruction from their personal sources. This is merely unacceptable. The government should allow the NHS and the training bodies to make income available to our forgotten workforce.”

Last but not least, training to create United kingdom care workers" capabilities, but no income to spend for it | Justine Cawley

Bettering housing can support create greater healthcare

By 2018, integrated overall health and social care will be the norm, the government has pledged. No longer will sufferers have to keep in hospital longer than they need to have to – or be readmitted earlier than they should be – just since wellness and social care employees are not doing work properly adequate together. This guarantee of a truly joined-up well being and care method is backed by a pooled £3.8bn Far better Care fund, and 14 areas across England are previously pioneering new methods of bringing well being and care solutions collectively.

But with all this target on integration, is there a location at the table for one particular support that really is key to delivering greater health and help – housing? The hyperlinks in between housing and health are properly identified: the Constructing Research Establishment estimates that bad housing charges the NHS at least £600m a 12 months, even though housing charity Shelter says young children residing in bad housing are almost twice as most likely to suffer from bad overall health as other youngsters. And housing organisations, functioning at the heart of neighborhood communities, are typically nicely-utilised to providing further providers to help their residents’ physical and psychological wellbeing.

However there are fears that, in the drive to join up well being and social care, the contribution housing companies can make dangers currently being overlooked.

Authorities from wellness, care and housing not too long ago came together at a roundtable occasion to talk about the opportunities for integration and how housing can be put centre stage. The discussion, held underneath the Chatham Property rule, in which remarks are not attributed to enable for frank debate, was hosted by the Guardian in association with housing and care provider Midland Heart.

There was agreement that housing should be central to contemplating about overall health and wellbeing – and not just for older folks who may possibly want added assist to stay in their very own homes in their later on years, but at every stage in daily life. As one particular participant put it: “It truly is the top quality of the housing we give for children even before they go to college that will figure out their existence probabilities. People’s well being standing is driven by their education status, their employment status – and their housing standing.”

Commissioning providers

So what is going wrong? Why is it that housing providers aren’t having much more conversations with the overall health specialists commissioning solutions? “How have we received to the position where clinical commissioning groups and physicians do not know what their sufferers are obtaining in help?” a single contributor asked. “How have we acquired to the position exactly where housing is just seen as bricks and mortar and nothing at all further?”

Partly, participants explained, the problem lies in the traditional silo mentality that has prevailed in the public and voluntary sectors for years in which organisations have got on with their own enterprise without having making connections to other companies.

Partly, as well, it really is in the complexity of diverse funding streams and a varied housing landscape the place several social housing suppliers may well be operating in a single area. Then there’s the fact that some social landlords have other priorities, like new advancement, or that housing has occasionally adopted what a single participant characterised as a ‘toddler approach’ – trying out great new projects, but then moving on to something else. Alternatively there should be a dedication to a modify of technique across the method, which could see great pilot tasks rolled out at scale. “There are egotistical infrastructures with chief executives and finance directors managing a dispersed stock of five,000 residences across a city and treating funding as if it truly is their own money,” explained a single speaker. “My challenge to the housing sector is to comprehend their relative privilege – they have a moral duty to increase their game and contribute their assets to getting part of the resolution.”

When they do, the roundtable was advised, like with Midland Heart’s new facility to aid hospital patients make the transition back to independent residing (see box), the positive aspects can be enormous.

“When we get it correct, we can supply some genuinely excellent providers that make a tangible variation to people’s lives,” 1 participant said. Several social landlords saw themselves as “component of the social material” with a duty to their communities, another contributor explained.

Harnessing that dedication is essential. “The behaviours we need are not competitive behaviours – we want to be collaborative, visionary and supportive,” the roundtable was informed. “It does not matter who supplies issues – the issue is how considerably have we received and how can we lengthen it. We require to engage the public differently, to be collaborative with us to commit the public pound far better.”

With a backdrop of austerity and spending cuts, the essential to locate far better ways of acquiring much more from shrinking public assets is clear. Several help companies have been lost or are at threat and housing companies are getting to make the situation for the worth of preventative help solutions in the face of enormous demand for acute services. However the quite scale of the cuts to nearby government companies implies housing will have a important function to perform on the frontline. “The reality is in about 3 years’ time there will be 4 people left standing in the neighborhood: one particular is the college teacher, a single is the GP, 1 is the police office and the fourth is the housing officer,” a contributor explained.

To that listing, yet another mentioned, could be extra a fifth player – the resident, and housing suppliers have a responsibility to create and support them and to perform with them in offering the appropriate help in their region.

Integration demands to be real, but, as a single participant pointed out, it is a concept which is been talked about for years without having considerably progress – so there is some cynicism that things will boost beneath the Better Care fund. That is why constructing powerful relationships across sectors will be essential to new, practical joined-up solutions. So as well will be a lead from government.

And overall health, care and housing specialists could assist generate the climate for national action, by taking a lead from 1 of the most influential well being campaigns of current years, as a single participant explained. “The well being sector has been so very good at speaking to the public about smoking – what we need is to make that type of connection and get the public a lot more on side about this. In which the public goes, politicians will follow.”

And if there’s a nationwide commitment, some of the amazing person examples of collaboration amongst well being, social care and housing sectors could be replicated to deliver about actual modify across the program.

The all-embracing adjust in technique the roundtable talked about will consider time to attain. But in the meantime, modern partnerships on the ground are showing how housing providers can make a real difference. “We can move swiftly, consider a bit of a possibility on projects on a smaller basis and then roll them out,” explained one particular speaker.

“What is required is national leadership that provides suppliers and commissioners permission to have those conversations,” 1 contributor summed up. “Is not it time to construct a coalition of the inclined? Let’s move past the debate that some companies want to do this and some don’t and some commissioners want to and some will not and let us concentrate on these who do. Absolutely nothing spreads like great practice.”

In focus

For an older particular person trying to get back to their very own residence following a hospital remain, the smallest things can at times seem like insurmountable barriers. Negotiating a carpeted space with a walking frame right after just making use of it on hospital lino, acquiring utilized to a provide of tablets or merely cooking a meal once more may possibly need a bit of practise. That’s exactly where an innovative partnership model developed by Midland Heart with Heart of England NHS foundation believe in is assisting to show the way forward.

Cedarwood, a 29-bed reablement service at Very good Hope hospital in Sutton Coldfield, was opened last November. It has already started to make a actual distinction both to individuals who want to regain their independence and to the NHS, freeing up hospital beds that would otherwise have been occupied by sufferers who have been not really ready to go residence on their own. With a night at Cedarwood costed at around a third of the expense of a hospital bed, there’s a significant saving to the NHS – and potentially to social companies budgets too, as individuals who have utilised the service are likely to be capable to sustain their independence for longer.

This is just the sort of partnership politicians and policy-makers ought to be encouraging, the roundtable heard. “There is a great message of hope that comes from Cedarwood and other projects which housing suppliers lead,” one particular participant said. “It really is an instance of real collaboration from the bottom up not the top down. We require to get excellent regional projects like this working at scale – without having the government producing it more difficult.”

At the table

David Brindle (Chair) Public services editor, the Guardian

Ruth Cooke Chief executive officer, Midland Heart

Richard Humphries Assistant director, policy, Kings Fund

Prof John Bolton Independent advisor, JRFB going to professor, Institute of Public Care

Dr Simon Duffy Chair, Housing and Assistance Alliance

Sara Beamand Director, care and support, Midland Heart

Vic Rayner Chief executive officer, Sitra

Domini Gunn Director of well being and wellbeing, Chartered Institute of Housing

Jane Harris Managing director, campaigns and engagement, Leonard Cheshire Disabilities

Cllr Steve Bedser Cabinet member for health and wellbeing, Birmingham city council

Sandie Keene President, Association of Directors of Adult Social Providers

Les Lawrence Deputy chair, Heart of England NHS Foundation

Martin Routledge Head of operations, In Management

Roundtable report commissioned and managed by the Guardian. Discussion hosted to a short agreed with Midland Heart. Funded by Midland Heart. Get in touch with Mark Lacey on 020 3353 3727 (mark.lacey@theguardian.com). For details on roundtables pay a visit to: theguardian.com/sponsored-articles

Bettering housing can support create greater healthcare

Should Disney create a plus-size princess? | Poll

A high-school lady is petitioning Disney to generate more plus-sized characters in its films. She argues: “Disney films are very influential and wide-spread, and they impact the lives of a lot of young children, specifically girls. It would be revolutionary for Disney to display help to a group of women who are otherwise horrendously bullied by the media.” What do you feel?

Should Disney create a plus-size princess? | Poll