Utopian dreams: the TPA object to evidence-based support for pregnant mums

In an ideal world, pregnant mothers wouldn’t smoke, we’d all walk to work and no one would eat junk food. On BBC Radio Kent this morning I put the rational, evidence based case for encouraging mums-to-be to quit smoking through the tried and tested scheme of giving vouchers for fresh fruit and vegetables for every week that they don’t smoke. It’s a win-win-win scenario: low cost – healthier mum – healthier baby. Started in Dundee over eight years ago as the ‘Give it up for Baby’ scheme, this smoking cessation support has been shown to be one of the most effective ways of encouraging mothers to quit.

However the Tax Payers Alliance (TPA) object, pouring scorn on mothers who should know better, saying we already spend loads on teenage mums and claiming this scheme is adding to our national debt.

Yet their argument for non-interference based on rising debt is idealistic economics; their repeated accusations of nannying contradicts their concern for prudent use of taxes; their claim that mothers should need no incentives to make good choices ignores reality.

Economically, the long-term costs to the nation of low birth-weight babies born to mums who smoke can be enormous. In addition to the extra post-natal support to help babies gain weight, the risks to the child include breathing problems, sleep apnea, heart problems, jaundice, chronic lung disorders and infections. Some go on to have long-term problems with hyperactivity, development and school achievement.

The extra cost of just one baby born prematurely due to the mother smoking could outweigh the entire-cost of offering a hundred mothers weekly £12.50 grocery vouchers for quitting. The TPA mean well, and it is right to ensure that we don’t rack up more debt. However our concern should be that taxes are spent in the most effective way possible, and whilst others can preach about their Utopian idyl, the rest of us should focus on the evidence, intelligent incentives and the best way to deliver a caring economy.

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Why the NHS becoming more Parkinson’s friendly can deliver a better person-centred experience

Guest blog by Laura Cockram, Policy and Campaigns Manager at Parkinson’s UK 

Laura Cockram March 2015127,000 people across the UK are living with Parkinson’s – a progressive, neurological condition with no cure. Around a third of people with Parkinson’s develop symptoms before 65, and one in 100 before 40.

Everyone with Parkinson’s is different but it usually affects movement with people experiencing rigidity, tremor, slowness of movement and sudden freezing. However people with the condition also experience as many as 40 non-movement related symptoms which can be just as debilitating, including anxiety, depression, fatigue, pain, continence issues, memory problems and sleep disturbance.

The NHS is a key election issue for every party in the race to No.10 and Parkinson’s UK urge the new government to follow these 4 steps to make the NHS more Parkinson’s friendly and deliver a better person-centred experience.

  1. 1. Person-centred care that’s co-ordinated: Every party talks about integrated or co-ordinated care and it’s widely recognised delivering this consistently is challenging. However, the Better Care Fund has started some of this work with health and social care commissioners pooling budgets to reduce emergency hospital admissions. The lesson the new government should learn is to ensure the voluntary sector is fully involved in planning these interventions for it to truly work.

RDXXX-Election-InfographicProviding person-centred joined-up care in the community helps people to stay well and out of hospital. A recent report found people with Parkinson’s are more likely to be admitted to hospital as an emergency. The cost to the NHS for people with Parkinson’s in England alone is nearly £200 million a year – £3,338 per patient, compared to £1,417 for a planned non-emergency hospital stay.

  1. 2. Listen to people affected: We regularly hear from people with Parkinson’s and their friends and families about how they can be ignored by professionals when in hospital, usually meaning they don’t get their medication on time, suffer a deterioration in their health and possibly stay in for extended periods.

With such a complex condition where symptoms fluctuate and medication regimes are complicated (some people with the condition have to take up to 30 tablets, maybe five or six times a day at very specific times) people with the condition and their carers are usually the experts in what works to control their Parkinson’s.

The NHS constitution outlines patients and carers rights, however people with Parkinson’s and their carers don’t always experience this when in hospital. This is why we’re supporting John’s campaign so carers, friends and families are able to stay with people with dementia in hospital. To be truly effective, this must be extended past dementia and to those with Parkinson’s and other complex long term conditions.

  1. 3. Add Parkinson’s to the list of exemptions for prescription charges: We estimate just over 7,000 people with Parkinson’s in England pay for their prescriptions. However, the cost for many can be prohibitive and there’s a lack of awareness of pre-payment certificates that can be used to reduce and spread the cost of medication. Also the list of exemptions for prescription charges was last reviewed in 1968, way before numerous medications for Parkinson’s were approved.
  1. 4. Access to the full range of treatments available: Providing people with the full range of treatments to control their symptoms would enable people with Parkinson’s to take control of their condition. We are eagerly awaiting the decision in July on whether NHS England will commission Duodopa – a treatment for people with the condition where all other oral medications have failed and surgery has been deemed inappropriate.

The treatment while costly is only suitable for a small cohort of patients and has been proven effective in controlling Parkinson’s symptoms and enabling people with the condition to regain their independence and even return to work.

As part of this year’s Parkinson’s Awareness Week (20-26 April), we’re calling on the new government to make the NHS more Parkinson’s friendly and deliver a better person-centred experience.

And we have staff across the UK poised to work with commissioners and professionals to advise where these improvements could be made.

To find out more about how you can support Parkinson’s Awareness Week, or our campaigns, visit www.parkinsons.org.uk

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Keeping the Spirit of Bevan Alive

We are delighted to be able to report that nominations are now open for the Bevan Foundation’s third annual Bevan Prize for Health and Wellbeing.

Screen Shot 2015-04-15 at 12.38.07The Prize, which is sponsored by the Open University, UNISON and the Aneurin Bevan Society, will be awarded to an individual and an organisation that have made an exceptional commitment to advancing health and wellbeing in their field, while embodying the founding principles of the NHS. A third prize will be awarded for lifetime achievement at the discretion of the judges.

Past winnersScreen Shot 2015-04-15 at 12.37.23 include Cecilia Anim, current President of the Royal College of Nursing, Susan Semple, who works with the homeless community in Belfast and Professor Dame Carol Black (left), the 2014 winner of the Lifetime Contribution Award.

Jeremy Miles, Secretary of The Bevan Foundation said: “The NHS is one of our most cherished national institutions. This prize, named for the architect of the NHS, Aneurin Bevan, will once again celebrate all that is best about the Health Service and recognise those individuals and organisations that are making a positive contribution to equality of access to health and equality of health outcomes.”

A panel made up of David Brindle (Public Services Editor, The Guardian); Baroness Finlay of Llandaff; and Jaselle Williams (Trustee, Bevan Foundation) will judge  nominations and award the 2015 Prize this July in the House of Commons, London.

If you know an organisation or individual that you feel should be acknowledged for their contribution to healthcare and improving care for patients please see below

Further information about the 2015 Bevan Prize is available from the Bevan Foundation’s website. 

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The voice of nursing is loud and clear

Guest Blog from the Royal College of Nursing

As we approach the General Election few issues are provoking more debate than the future of the NHS.

Health care is a top priority for almost every voter, from patients and their families to those working in the health care system. Nursing staff make up the majority of the health care workforce and, with approximately 1800 in each constituency, no one can deny that in this election – nursing counts.

The NHS is facing serious crises across the UK and politicians need to listen to nurses if they are to begin solving these issues.

With this in minScreen Shot 2015-04-14 at 22.07.10d, the RCN has launched our manifesto campaign, Nursing Counts, to reflect the priorities of UK nurses, midwives, health visitors and health care support workers, and address what needs to be done if patients are to receive the care they need and deserve.

The manifesto circles three main objectives, the first of which is improving patient care.

Nurses are dedicated to providing the upmost standards of care to their patients but, as with most professions, the right conditions are required for them to perform their roles effectively.

Following significant pressure on NHS funding in recent years, staffing levels have dropped to the point at which nursing staff are stressed, pressured and overworked. Most importantly many staff don’t feel they can provide the care they want to for their patients. A recent review by the BBC found that the number of NHS staff taking time off sick due to stress and mental illness had doubled since 2010, an unsurprising figure given current staff shortages and workload pressures. Nurses also need to feel able to raise concerns when they feel patients are at risk, if we are to improve levels of care, but the NHS has found at least a third feel unable to do so. The new government needs to address these issues if they are to improve the NHS and deliver a health service that has patient care at its heart.

The second objective for the next government is to value nursing. Despite being some of the hardest working staff in the UK, nurses have endured job cuts, pay stagnation and the down-banding of their posts for many years, and morale is at an all-time low. The recent paltry 1% pay increase does not make up for nurses’ tireless commitment to their patients despite an apparent lack of appreciation in political circles. The RCN calls for the country’s next leaders to recognise the value of nursing, in order to improve the working lives of its current nursing staff and to encourage more to join the profession. If nursing is continually run down then we will see less and less people joining the profession and costly recruitment from overseas increasing.

Investing in the health and care systems is the RCN’s third imperative. The large scale cuts the NHS has endured have left many areas bereft, particularly in fields like community nursing. Levels of care in the community must increase if we are to take pressure off our hospitals and primary care settings. With more nurses leaving the profession than entering it, the next government needs to prioritise long-term investment in workforce planning to develop a sustainable structure for 21st century health care.

Following the launch of the manifesto earlier this year, candidates from the Conservatives, Liberal Democrats and Labour were invited to RCNHQ for a hustings event to debate how they plan to solve the problems facing the nursing profession. At the RCN event, Conservative minister Dr Dan Poulter MP, Liberal Democrat Minister Norman Lamb MP and Labour’s shadow health secretary Andy Burnham MP, all pledged their support for the goals RCN manifesto, but disagreed on how they planned to put this into action.

The RCN is concerned that the payments nurses receive for working unsocial hours could be coming under threat by future Governments as a way to save money. When questioned, Andy Burnham committed not to attack the current unsocial payments for nurses, while Norman Lamb recognised the importance of paying staff fairly while stopping short of a full commitment. Dr Dan Poulter spoke of the need to improve patient care at nights and weekends and pledged not to cut nurses’ pay, but again, did not go as far as to make a commitment to upholding unsocial hours payments.

Future funding of the NHS was an obvious issue of contention. Norman Lamb committed to providing the £8bn required to fill the funding gap identified by head of NHS England, Simon Stevens. Andy Burnham promised to commit to full integration to prevent money going solely to acute trusts and bypassing other important sectors, he said this model would provide necessary savings for the NHS which would be reinvested. Dr Dan Poulter said that his party would give the NHS the money it needs, though did not specify how much he considered this to be.

Integration was an area of more harmony between the parties, with all agreeing on its vital importance. In his closing remarks, Dr Dan Poulter committed to further investment in preventative care, and finding greater efficiencies through procurement and technology. Both Norman Lamb and Andy Burnham have pledged full integration of health and care services should they be the next Secretary of State.

Supporting the manifesto is a great first step but we need to see action on health from whoever it is that takes the keys to Numbers 10 and 11 in May. Our members have spoken in forming this manifesto. It’s vital that their voices are listened to.

To find out more about the Nursing Counts campaign, please visit: elections.rcn.org.uk Screen Shot 2015-04-14 at 22.07.47

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Health Tech and You: Helping to reach a tipping point

By Matt James, Senior Researcher at 2020health

In our previous blog we were looking at the value of the personalised health agenda. But having vision and developing policy based on that vision is one thing. Identifying the ‘how to’ steps to achieving it in reality is quite another.

Re-reading Malcolm Gladwell’s bestseller ‘The Tipping Point‘ recently and reflecting on the first year of HT&Y has got me thinking about the future of both health tech and the HT&Y initiative.

Gladwell helped to popularise the term ‘tipping point’ as that seemingly magical moment when ideas and trends reach a certain point and spread like wildfire.

What lessons can we learn from this as the HT&Y initiative develops?  How can we achieve a tipping point which goes beyond just a deluge of new tech to one which ushers in a revolution in people using technology effectively in order to take responsibility for their own health and well being?

In his book Gladwell identifies three key factors which help to achieve the Tipping Point, two of which I think have relevance to the health tech revolution:

  • • The Stickiness Factor
  • • The Power of context

A) The Stickiness Factor
In any form of epidemic, the messenger matters. The message is important but if the messenger is not effective in communicating the message, it will not spread.  Messengers are what makes something spread.  In Gladwell’s words, the message becomes sticky.

LightBoxIn the health tech revolution we are witnessing this in a very clear way. Once health advice and support becomes practical and personal, be it through an app or piece of wearable technology, it becomes memorable. It can help create change so much so it can spur someone to action.

In response this calls for a radical rethink of the role of clinicians and the expectations of the public of them. The traditional doctor-patient relationship is changing from patriarchical to more of a dialogue marked by joint decision making.

Technology should certainly not ended up replacing the GP but a new form of relationship needs to be established based around the clinician and patient partnering together. With more information at their fingertips the patient is becoming more proactive as opposed to passive, entering into a dialogue with the clinician as opposed to just acting upon the advice given. As an expert, the clinician has a key role to help bring understanding and educate the patient as to what the information and data really means for them.

This represents a significant change in the way medicine is practiced and will inevitably be seen as a challenge by some clinicians. However if the move to more personal responsibility for health and well being is regarded as the only effective way to respond to the corresponding demographic, economical and social changes in our world then this change needs to happen. It will involve a shift in culture which promotes the active participation of patients, supporting them to manage their own health – staying healthy, making informed choices of treatment, managing conditions and avoiding complications – and the use of health tech to do this in the most appropriate way.

b) The Power of Context
Put simply humans are sensitive to and strongly influenced by the environment in which they live. Cultural attitudes influence health care behaviours and if there is no clear sense of what actually motivates people to engage in a particular behaviour, there is no point in introducing new technology, however innovative it might seem, that is thought to change behaviour.

Research indicates that innovation in healthcare can only work if people are in a position to change their behaviour. Behaviour modification specialists say this requires capability, opportunity and motivation.

This calls for change. Change not only in how the NHS operates and is designed but how the clinical workforce is trained and equipped so that they can help maximise the capability, opportunity and motivation that health tech solutions can offer.

It is difficult to imagine the NHS prescribing health and well being tech devices to patients today. Looking to the future though, this could become a NHS_Logoreality but requires a change in the model the NHS uses and combines technology to deliver care, a point highlighted by the recent NHS
Five Year Forward report. The National Information Board’s report Personalised Health and Care 2020 recognises that better data can help to “transform innovation, helping to create new collaborations between the NHS, technology companies and patients to unlock the potential of data, technology and digital to create products for smarter, faster and better healthcare”. ¹

As the Chief Executive of Proteus Digital Health – creators of digital medicines which promise to connect each pill you take to the wealth of information available online –  tweeted just this week, “Innovation in digital health is about value to the patient, not the developers”.

It’s not just a case of more new tech, it is identifying and recognising the value it brings to peoples’ lives.

Skating to the future
Health Tech & You has only just begun. In order to realise its full impact and reach the tipping point it will be crucial to look to the future and try to interpret where it is going.

When asked the secret of his success, the great ice hockey player Wayne Gretzky famously said:  “I skate to where the puck is going to be, not where it has been”.  The HT&Y initiative is positioned to play its part in helping us all skate to where the puck of health tech is going, rather than merely where it has been.

¹National Information Board. 2014. Personalised Health and Care 2020: Using Data and Technology to Transform Outcomes for Patients and Citizens. A Framework for Action.  p. 43

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Health Tech and You: Leading in the personalisation of health care

By Matt James, Senior Researcher at 2020health

AXAPPP-21The weather might have not have been particularly spring like but the Design Museum certainly lit up the waterfront beside the Thames in a vivid display promoting the Health Tech and You Awards (HT&Y) ceremony.

Inside the atmosphere was no different: bursting with life and buzzing with anticipation of the announcement of the various category winners. The evening really was a celebration of some of the best in personal health technology innovations. Thanks to the dedication and skill of the curation team the HT&Y exhibition celebrates a unique mix of innovative entries from individuals, designers, developers, entrepreneurs and healthcare professionals from the UK and around the world.

Where do we go from here?

But as the initial fervour of this year’s awards dies down and the public exhibition continues to run at the Design Museum until 26 April 2015, what next for HT&Y? Where do we go from here?

ExhibitionAs the text on one of the exhibition walls boldly declares: “This is a health tech revolution”. Revolutions speak of an overthrowing of an existing pattern of doing things in favour of adopting a new approach. This is a revolution that we are all still very much living through with new devices and solutions coming onto the market every month. This is precisely one of the reasons HT&Y will continue to champion the and inspire entrepreneurs be they designers, clinicians or the public to reach new heights of innovation.

The underlying values of the HT&Y initiative is that advances in digital technology will create a greater sense of patient autonomy and professional accountability, helping to empower citizens and patients to become more active participants in their medical care. Digital health becomes more than just delivering more efficient care, but better quality care as well.

Take for example mobile devices which are playing an increasing role in the digital economy. Experiencing more growth than computer sales worldwide, mobile devices are  helping to drive the digital economy ever further. In 2013 mobile phone subscriptions worldwide reached nearly 7 billion in 2013 so it is perhaps not surprising to think that most people have a mobile phone. What is more astounding to read is that the number of mobile devices that exist in the world already exceeds the world’s population. Where once mobile web usage was one of the primary functions of the mobile phone (alongside the obvious making and receiving of calls), this has been superceded by the growth in mobile app.  Exercise, body weight and dieting apps are amongst the most popular downloaded health apps. As Miah & Riches note, the increasingly ubiquitous presence of mobile devices ensures their place as a core driver of health engagement.

Transforming the digital divide

But is simply having greater access to new technology helping to bolster people’s health? Not necessarily and this is my key point. Whilst technology has closed one divide, it has opened up another. It is to this scenario that the HT&Y initiative can respond.

Greater access to technology has reduced the digital divide, but the transformation in digital platforms from Web 1.0 (passive receiver of information) to Web 2.0 (user generated content, interoperability, collaboration) has opened up the digital literacy divide. Depending upon a person’s digital literacy skills will help to determine their capacity to experience that greater level of autonomy, personal insight and understanding of health and professional accountability which digital health was supposed to usher in.

Acknowledging this helps to pose exciting possibilities for the future.  The health tech revolution is not just about more tech per se. It is also about recasting our learning and understanding of the body and health beyond the traditional sites this has occurred in previously.  As Miah & Riches comment, “What took place in each of these areas of society was locked behind institutional systems, such as schools, universities, doctor‘s surgeries and hospitals”. This has relevance to not just citizens but also clinicians, tech developers and innovators.

The mobile device and its growing capability power represents the democratisation of health in a way we have yet to understand or truly articulate.

In the next blog we will explore the conditions required to make that transformation.

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The next government must make high quality cancer care a priority during, and after, the upcoming general election

Guest Blog by Ellie Rose, Public Affairs Manager, Macmillan Cancer Support

Ellie RoseThere are now 2.5 million people living with cancer in the UK. By 2020, this is estimated to rise to 3 million. And by the end of next year alone, it is estimated that around 1000 will be diagnosed with cancer every day. How will the health and social care system cope with these growing numbers when people’s needs are not being met today?

This is a colossal challenge, and one which cannot be met without urgent action from political leaders. With less than two months to go until the General Election, it is time for all political parties to make a choice about the future of cancer care in this country. So Macmillan is calling on all Westminster parties to commit to making changes in three key policy areas in order to improve the lives of everyone affected by cancer.

1000-people-alternativeThe first is delivering cancer outcomes that match the best in Europe. In the UK survival rates for almost all common cancers lag behind European averages. Addressing this will require increasing the number of people who are diagnosed early; ensuring that everyone is able to access the right treatment for them, irrespective of age or location; and supporting people to live well with and beyond cancer. Only with action on all three fronts will we make the significant improvements needed to achieve the best cancer outcomes in Europe

Secondly, urgent change is needed on improving the culture of compassion and transparency in the NHS. Whilst the majority of people with cancer receive good care, we know that there are still too many examples of people not being treated with the dignity and respect they deserve. The latest Cancer Patient Experience Survey (CPES) showed that patients affected by rarer cancers, younger patients, older patients, ethnic minorities and patients treated in London hospitals report a worse experience. To address this Macmillan believes that more accountability is needed. NHS Trusts should be required both to put actions plans in place based on their annual CPES result and to report on progress. This will reduce inequalities and ensure that everyone with cancer is treated with dignity and respect.

The last (but by no means least) area where change is needed is at the end of life. We know that while around 79% of people want to die at home, only around a third of people are able to. Providing free social care to support people at the end of life would ensure that people have the necessary support to die in the place of their choosing. It would also help to prevent family members and loved ones who are caring for people at the end of life reaching an emotional or physical crisis point in their own lives. Research has shown that this would not only improve the quality of care received, but would also save around £345m for the NHS.

The cancer challenge facing the UK is growing every day. It is vital that all political parties ensure that cancer is prioritised in their manifestos. They must commit to delivering the best outcomes in Europe, dignity and respect for all patients, and free social care at the end of life. Together this package will help us avoid the looming cancer care crisis.

Time-to-choose-headerTo find out more about how you can support our campaign please visit macmillan.org.uk/GeneralElection2015

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