New analysis reassures patients and doctors

Guest Blog by Dr Iseult Roche, Associate, 2020health

New analysis from researchers at University of Manchester have found there is no weekend death effect for NHS emergency patients and that such a view, held by some, has been “a statistical artefact”

The retrospective observational study analysed hospital admissions over a 10-month period of over 12 million A&E attendances and almost five million emergency admissions between April 2013 and February 2014. About 20% of these emergency admissions were referrals via primary care¹.

It was identified that hospitals admit less patients who are less severely ill at weekends. This skews results and inaccurately suggests that mortality rates at weekends appear greater than mid-week.

Professor Matt Sutton said: “Hospitals apply a higher severity threshold when choosing which patients to admit to hospital at weekends – patients with non-serious illnesses are not admitted, so those who are admitted at the weekend are on average sicker than during the week and more likely to die regardless of the quality of care they receive.”

Researcher Rachel Meacock said: “The so-called ‘weekend effect’ is a statistical artefact and extending services will not reduce the number of deaths. In relation to potential extended hours for senior doctors, it is actually possible that this could potentially increase the number of weekend admissions of less severely ill patients which could increase NHS costs.”

This has been welcomed by doctors alike, who have felt that the unnecessary fear of weekend care has frightened patients and doctors in some cases. Doctors and other NHS staff try their best to care for patients and carry out their role to the best of their ability, regardless of days of the week and welcome this reassurance.

The British Medical Association welcomed the research findings, with Dr Mark Porter reported as saying: “This huge and robust study confirms what doctors have been saying all along”.

¹ Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission. Journal of Health Services Research and Policy 6 May 2016; doi: 10.1177/1355819616649630 [abstract]
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Charity finds children with autism most likely to miss out on eye care

Guest Blog by SeeAbility

National sight loss and disability charity SeeAbility has found that three quarters (75%) of children with no history of eye care tested as part of their Children in Focus Campaign were noted to have Autistic Spectrum Disorder (ASD). They are estimating over 33,000 children with ASD in England’s special schools could be missing out on routine eye care

The charity has been sight testing children in a number of special schools since 2013 Screen Shot 2016-05-05 at 13.58.05and its second annual report titled ‘28 times more likely’, named becaue children with learning disabilities are 28 times more likely to have a serious sight problem. The report also exposes:

• Over half of children tested had a vision problem

• 43% of pupils seen for the first time had no history of eye care

• 85% of those discharged from hospital eye clinics had no follow up community eye care

• 36% of children seen needed glasses

It follows SeeAbility’s 2015 Children in Focus Campaign launch, which revealed nearly four in ten children attending special schools in England have no history of eye care. After an additional year of sight testing behind them, SeeAbility now says a large proportion of that group are children with ASD1.

Although every child in England is entitled to a free NHS sight test to pick up on any problems with vision and help prevent avoidable sight loss, many children with ASD
can struggle to access community optical practices or hospital eye clinics where these sight tests are delivered. The environment or waiting time might be too stressful or overwhelming and parents may be worried that their child cannot cope.

With over half of children tested by SeeAbility having a vision problem, their sight testing model targets children at the highest risk of sight problems and brings eye care to the more convenient and familiar place of school. There are added benefits like providing glasses – including specialist frames – sharing strategies to help children get used to the new experience of wearing glasses and helping teachers to understand what a child can see in school.

From 2014-2015 there were over 460,000missed or cancelled paediatric outpatient eye care appointments. In the SeeAbility sight testing model, if a child is too ill or anxious – both likely reasons for not attending a hospital eye clinic – their appointment is simply rearranged and allocated to another child on the day. The model also stops children and their parents requiring time out of school and work to attend.

Screen Shot 2016-05-05 at 13.57.46

SeeAbility is calling on the government and NHS England for a national programme to provide routine eye care for children in special schools across England. Because children with learning disabilities can be reliant on hospitals for more routine eye care or check ups, the charity believes that their model could help ease some of the pressure on the NHS.

“I’m constantly being told by people that they thought someone was already carrying out this service for children with disabilities,” says Lisa Donaldson, Clinical Lead of the Children in Focus Campaign.

“The simple fact is, while there are areas of good practice, this is not happening on a national scale. The SeeAbility sight testing model meets a recognised health inequality and reaches children who are unable to access community eye care and their right to a free NHS sight test. We would like to see a national programme that works for the child and builds the importance of vision into their education, giving them greater independence, a better education, and saving the NHS and care services money in the long run.”


1 It should be noted that this information about ASD was based on the forms collected from the children prior to the specialist sight test which asked for primary special educational need. The charity explains in the report it is highly likely many of these children will have a mixture of other needs or other diagnoses that would be recorded by their GP or in their Education, Health and Care Plan.

This data is calculated from the following written parliamentary answers to questions tabled by Siobhain McDonagh MP 1) Paediatric ophthalmology outpatient appointments www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2016-02-22/27616  2) Other paediatric eye care outpatient appointments, excluding “orthotics” which was mistakenly included www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2016-03-04/29822/


Check 2020health’s latest research, the Foresight Project Report
which discusses the potential impact of technology on the UK optical sector.

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People with Parkinson’s forced to hide or lie about their condition

Guest Blog by Steve Ford, Chief Executive, Parkinson’s UK

New research, released by Parkinson’s UK to mark Parkinson’s Awareness Week (18th – 24th April), shows that nearly two fifths (37%) (1) of people living with the condition have felt the need to hide their symptoms or lie about it – cutting people off from vital support at a time when they’re trying to deal with a life changing diagnosis.

Screen Shot 2016-04-18 at 22.04.31

127,000 people are living with Parkinson’s in the UK, with one person being diagnosed with the condition every hour. (2)The charity estimates that 42,000 people are delaying sharing this diagnosis with someone close to them. (3)

Those who delayed telling family or friends said it was because of:

• Not knowing how to bring it up (36%)
• Not wanting to accept their diagnosis (33%)
• Being unable to find the words (28%)
• Thinking they would be stigmatised (21%) or look weak (19%).

The charity is concerned by the findings, which reveal a worrying level of emotional repercussions for people diagnosed with Parkinson’s, with over a third of those surveyed experienced negative emotions in the year following their diagnosis.

Over a third (37%) of those surveyed experienced negative emotions in the year following their diagnosis, with the news having the hardest emotional impact on younger people with Parkinson’s.  Many people reported feeling ‘like their world had ended’ (18%), ‘like they were grieving’ (14%) or ‘like they didn’t know who to turn to’ (13%).

For David Plummer, wildlife photographer, from West Sussex, after six months of on-going tests, being diagnosed with the condition caused him panic, claustrophobia, and difficulty sleeping. And it’s still something he doesn’t like to talk about –often trying to hide it if symptoms are showing.

Positively, nearly half of people who have shared their diagnosis with their immediate family reported feeling ‘able to accept they had Parkinson’s’, while one in four reported feeling relieved (27%), and 15% say they felt glad they didn’t have to hide their symptoms anymore.

As the UK’s leading charity, supporting those with the condition, Parkinson’s UK is determined to that each and every person with Parkinson’s is aware of the support available so they can feel equipped to have these difficult conversations. Offering advice, information and support to anyone affected by Parkinson’s, through their website www.parkinsons.org.uk or calling their confidential helpline on 0808 800 0303.

Screen Shot 2016-04-18 at 22.03.02


1. Based on a prevalence of 127,000 people living with Parkinson’s in the UK, this equates to 46,990 people
2. Parkinson’s UK (2009) Parkinson’s prevalence in the United Kingdom
3. Estimated from a figure of 33% of those surveyed and based on a prevalence of 127,000 people living with Parkinson’s in the UK.

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Ovarian Cancer – Make women AND GPs more aware of the symptoms

Guest Blog by Annwen Jones, Chief Executive of Target Ovarian Cancer

In March every year, women with ovarian cancer, their family and friends, the ovarian cancer charities, health professionals, corporates and more all come together for Ovarian Cancer Awareness Month – to raise awareness and funds for ovarian cancer.

Ovarian cancer can be devastating. Far too many women are diagnosed late, once the cancer has already spread, making treatment more difficult. But we know that when a woman is diagnosed at the earliest stage, her chance of surviving ovarian cancer for five years or more doubles from just 46 per cent to more than 90 per cent, which shows why early diagnosis is so vital.

There have unfortunately been very few drugs developed for the treatment of ovarian cancer in the past 20 years, and there is an urgent need for progress. If we matched the achievements in breast cancer in the last 20 years, over 3,000 more women would survive each year. This is why, very early on as a charity, we launched a UK-wide research grants programme specifically for ovarian cancer.

ovarian-cancer-in-numbers-infographic-branded-hi-resOver a quarter of women are diagnosed through emergency presentation – meaning they are diagnosed very late, with more invasive treatment and lower survival chances. This figure is falling, as a result of the fantastic work that has already been done, but it is still unacceptably high. I speak far too often with women who have been diagnosed late. It is their stories, not the statistics, that give me the passion for improving early diagnosis, for raising awareness.

This March, we’ve launched a campaign to make noise and shout out about the symptoms, because early diagnosis saves lives. So before I go any further, here they are:

  • Persistent pelvic or abdominal pain (that’s your tummy and below)
  • Increased abdominal size/persistent bloating – not bloating that comes and goes
  • Difficulty eating or feeling full quickly
  • Needing to wee more urgently or more often than usual

These symptoms will be frequent (happening more than 12 times per month), persistent, and new to you. Anyone who is regularly experiencing these symptoms should see their GP and explain that they are concerned about ovarian cancer.

Women who are concerned about ovarian cancer should try to keep a diary of how they are feeling – using our Symptoms Diary app or downloading a version from our website.

social-01During Ovarian Cancer Awareness Month this March, we’re asking everyone to Start Making Noise: #StartMakingNoise. Shout about the symptoms. Early diagnosis saves lives. We’re asking everyone to make a noise about the symptoms – to share them on social media, to tell your friends. We have a range of fundraising activities too – you could Bake Some Noise, or Dress Louder to raise money. Whatever you choose to do, please make sure that you and your loved ones are aware of the symptoms of ovarian cancer.

Late diagnosis is a major issue for women with ovarian cancer and their families. Ovarian Cancer Awareness Month gives us all an opportunity to come together to make women and GPs more aware of the symptoms and the vital importance of early diagnosis. It’s so essential that we all work together to make sure every woman in the UK has the best, rather than the worst, chance of survival.

The UK’s leading ovarian cancer charity, Target Ovarian Cancer works to improve early diagnosis, fund life-saving research and provide much-needed support to women with ovarian cancer. 

2020health’s policy work on Cancer includes an  event recently held in Westminster on ‘Personalised Medicine‘ which included a section on cancer drugs.  Through its other work, it has also advocated for the need to improve early diagnosis and treatment.

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Do we care enough to ask what is behind the biggest recent annual rise in death rates?

The Telegraph lead with provisional statistics from the ONS this morning on the steepest annual rise in death rates since the second world war. They are right that alarm bells should be ringing, and urgent questions should be asked:

Is this related to the data in yesterday’s Mental health Taskforce Report showing a scandalous lack of services for those with serious mental illness, which is on the rise and which we know causes premature death.

Is it the cuts in social care biting, meaning people can’t leave hospital and return home because there is no one to care for them, relation, friend or state?

Is it related to the epidemic of loneliness, where social isolation actually leads to losing the will to live?

Or are we already reaping what we have sown in lifestyle diseases such as obesity and liver disease (we have the worst incidence in Europe) from overconsumption of food and alcohol? We have had countless public health warnings that poor lifestyles will cut years from our life expectancy, and we’ve gone on sending out mixed messages about eating and drinking and still have no effective obesity strategy.

Once again this research SHOULD force a public discussion about the true costs of public services, and remind us of our role in caring for our neighbour. The last question is, do you care enough to demand that debate?

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Mental Health Taskforce show services are still like having ambulances for only half the country

Our Comment on the Mental Health Five Year Forward View, published February 15th.

Mental health services are still like having ambulances for only half the country – Questions on needs and costs are still unanswered.

2020health welcomes the emphasis on parity of esteem, practical whole-life support and reducing inequalities at the centre of the Mental Health Taskforce’s Report, out today. The report contains 58 recommendations, and we welcome the government’s commitment to an extra £1bn investment in services, in the workforce and in data collection for informed decision making.

Julia Manning, Chief Executive of 2020health said: “Real progress is being made on reducing the stigma and increasing the understanding of mental health. Anyone with experience of mental illness, either through their work family or friends, knows that there is a dual investment problem: inadequate prevention and early intervention, and insufficient provision for those with established mental illness.

“The recent figures showing a 21% increase in suicides amongst mental health patients in England over the last 3 years[1] is a heart-breaking reminder that demand for support and treatment is not being met. There is massive variation in services across the country, and the only time you find out whether you are in an area that actually has a service is when you or someone close to you needs help. This is a scandalous situation which if it were the case for ambulances, would be causing national outrage.

“The report calls for a fully-costed workforce review to be undertaken, but nowhere in the report do they estimate the actual cost of providing a quality service across the country, so that as when you call for help from the GP and ambulance service, you know there will be the appropriate person to assist you.

“An extra £1bn sounds a lot but budgets over the past few years have been cut[2] so this could simply be a return to previous levels of spending. Budgets are so fragmented between  CCGs, Local Authorities, NHS England and Innovation funds it is difficult to know what the true figures are. What we do know is that up to 13% of the NHS budget went on mental illness, when it constitutes 23% of the burden of disease. A £1bn increase is less than a one per cent increase in spending on mental illness (total NHS Budget £113bn).

On reducing inequalities:

“We understand that this is a five year plan and that the authors have wanted to keep their demands realistic, but they have missed the opportunity to alert the public to the massive gulf in provision of services for people with mental illness. Even if everything this document ask for is delivered by the government, we would still have 40% of people not getting support when they first experienced psychosis (Recommendation 16), and we wouldn’t know whether there was enough provision for women with post-natal depression or men with anxiety or those living with severe mental illness  (Recommendations 14, 15 & 19). As the Report says itself, we simply don’t have the data in many cases to know what the level of need is.

“What we do know is that there aren’t enough doctors[3], especially for children, and stricter criteria for giving help to young people means that fewer children are getting the help that they desperately need. However there are evolving, effective digital interventions and we are glad that promoting these have been supported (Recommendation 28).

On practical whole-life support:

“In 2020health’s 2015 Head of Wellbeing report[4], we described the concept of a senior, strategic, full-time coordinator of whole-school wellbeing who would prioritise prevention and early intervention. A named mental health lead in schools is not enough. We think especially that there is a real opportunity for using new digital technologies such as apps for anxiety and online support forums that are second nature to young people. We remain convinced that a Head of Wellbeing position could bring about game-changing improvement in the mental and emotional experience of young people, and their teachers.

On parity of esteem:

“In our Whole in One report on depression (2015), we also called for more community based therapy, better collation of evidence and data and support in the workplace, so we are pleased to see this reflected by the Mental Health Taskforce. However if they were serious about parity of esteem, they would have asked as we did for NICE guidelines (purely advisory) to become recommendations (which carry legal weight). At present, only advisory guidelines appear to apply to all treatments (including medicines) for depression, as well as service access and treatment pathways (see NICE guidelines [CG90]).[5]

Our Key concerns:

  • £1bn sounds a lot but it could simply be returning us back to previous spending levels
  • Criteria for referral to CAMHS is not mentioned at all; access to CAMHS is severely restricted as the workforce is so overstretched – what improvement can parents and schools expect to see?
  • We need to know what all agencies with budgets for mental illness are spending on mental health, year on year, not just CCGs
  • Prevalence surveys once every seven years on mental illness not frequent enough – we haven’t done a survey on children since 2004
  • Government should calculate the national need and budget for tier 2, 3 and 4 mental health services so the public understand the level of need and cost

– Ends –

MHT FYFV Report References to:

Costs

Page 3

  • Mental health problems represent the largest single cause of disability in the UK. The cost to the economy is estimated at £105 billion a year – roughly the cost of the entire NHS.

Page 4

  • For example, in the case of Type 2 diabetes, £1.8 billion of additional costs can be attributed to poor mental health. Yet fewer than 15 per cent of people with diabetes have access to psychological support. Pilot schemes show providing such support improves health and cuts costs by 25 per cent.

Inadequate provision

Page 4

  • Fewer than 15per cent of localities provide effective specialist community perinatal services for women with severe or complex conditions, and more than 40 per cent provide no service at all.

Page 7

Mental health accounts for 23 per cent of NHS activity but NHS spending on secondary mental health services is equivalent to just half of this.

Page 9

  • The Care Quality Commission (CQC) found that just half of Community Mental Health Teams (CMHTs) are able to offer a 24/7 crisis service today.
  • Only a minority of A&E departments have 24/7 liaison mental health services that reach minimum quality standards, even though peak hours for people presenting to A&E with mental health crises are 11pm-7am.
  • There has been no improvement in race inequalities relating to mental health care since the end of the 5-year Delivering Race Equality programme in 2010.

Page 11

  • The provision of psychological therapies for people with common mental health problems has expanded hugely in recent years. But it is still meeting only 15 per cent of need for adults.

Page 24

  • Comprehensive liaison mental health services are currently available in only one in six (16 per cent) of England’s 179 acute hospitals. The situation is better for paediatric mental health liaison, with 79 per cent of hospitals reporting cover, but these frequently do not operate out of hours.

Comment * on Recommendation 14: NHS England should invest to increase access to integrated evidence-based psychological therapies for an additional 600,000* adults with anxiety and depression each year by 2020/21 (resulting in at least 350,000 completing treatment), with a focus on people living with long-term physical health conditions and supporting 20 000 people into employment. There must also be investment to increase access to psychological therapies for people with psychosis, bipolar disorder and personality disorder.

*In 2013/14 just over 700,000 individuals were treated by IAPT services; 319,904 individuals who were initially recognised as ‘clinical cases’ finished a course of treatment; 143,833 (45%) were diagnosed as recovered (HSCIC, 2014a)[6]

[1] Mental health deaths in NHS up by more than a fifth over three years, new figures show- http://www.independent.co.uk/life-style/health-and-families/health-news/mental-health-deaths-in-nhs-up-by-more-than-a-fifth-new-figures-show-a6834196.html

[2] http://blogs.channel4.com/factcheck/factcheck-mental-health-budget-cut/20617 e.g. 43 out of 56 mental health trusts in England surveyed found there had been a real terms cut of 8 per cent in funding between 2010/11 and 2014/15, worth around £600m

[3] MHT Page 35: Health Education England indicate a 6.3 per cent vacancy rate for NHS consultant psychiatrist posts, and over 18 per cent of core training posts in psychiatry are currently vacant. Psychiatry has the slowest rate of growth and the highest drop-out rate of any clinical specialty. Between 2013/14 and 2014/15, referral rates increased five times faster than the Child and Adolescent Mental Health Services (CAMHS) workforce

[4] Manning J and Paxman J: Head of Wellbeing – an essential post for secondary schools? 2015

[5] 2020health: Paxman J and Manning J: Whole in One: Achieving equality of status, access and resources for people with depression 2015 – page 34

[6] 2020health: Jon Paxman and Julia Manning: Whole in One: Achieving equality of status, access and resources for people with depression 2015 Page 15

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What can be done to help rocket boost MedTech into everyday healthcare?

Guest Blog by Dr Michelle Tempest, Partner at Candesic, Health & Social Care Consultancy 

Despite MedTech being central to the future of healthcare, digital implementation often struggles to get into the top 3 priorities of stakeholders who have to contend with A&E four hour targets, delayed transfers between care settings, chronic staff shortages and a savings gap of over £22bn. For those who have invested in a radically changed IT system, such as Addenbrooke’s hospital in Cambridge (who imported the EPIC system from the US) it did not offer immediate success and instead toppled the heads of the CEO and CFO of the NHS trust.

In November 2014, the Government highlighted four elephants in the room that hold back IT healthcare progress:

1) Too much bureaucracy
2) Lack of accountability
3) High cost
4) Concern over data security

However, perhaps there is a fifth elephant? The mother of all the others: the need for pro-active MedTech procurement. Linking IT from home to hospitals is key to unlocking future healthcare. Failing to get systems to communicate with each other is the nail in the coffin for any promising UK MedTech industry.

Reviewing current and developing MedTech products in terms of the ‘home to hospital pathway’ it is clear that there are eleven distinct markets (Fig.3). Taking this a step further and individually analysing over 300 different technologies, less than 1% of products the ability to communicate up and down the care pathway (Fig.4). This lack of inter-operability is an immediate snag to current IT procurement, whose job it is to create integrated and technology-enabled, linked care systems.

Slide3

Slide4

Thus far procurement has oscillated between top down command and control national arrangements, to bottom up ‘letting a thousand different flowers bloom’.  The analogy is that procurement has tried and failed with forced marriage and failed on random selection. So, perhaps it is time for MedTech procurement to be brought into the modern age that it aims to inhabit? One way help navigate and improve procurement would be for a match-making approach – a sort of ‘MedTech Tinder’.   ‘MedTech Tinder’ could proactively use ‘intelligent digital matching’ which could learn to be better at matching than Cupid himself. Indeed such algorithms that match suppliers and consumers was initially the ‘market design’ of Nobel prize winning economists Al Roth and Lloyd Shapley.  This method is no stranger in the clinical setting where Professor Roth’s best known example is the kidney exchange platform that matches donors and recipients which went onto increase the number of feasible life-saving operations. Any new MedTech Tinder matching platform could be as simple as A,B,C:

A. Accountable:  account for all current IT/ digital/ MedTech systems across acute and community settings,
B. Bridge knowledge gap: bridge the information gap across NHS and social care and track progress on communication between systems, aiming to increase inter-operability,
C. Collaborative:  highlight similar issues, proactively keeping purchasers and providers informed, matching innovators to problems and solutions to care organisations.

Such a ‘MedTech Tinder’ platform need not be expensive to implement and would highlight when a solution has already been acquired by one part of the health and social care system and the transparency would help keep costs down.  The Five Year Forward View explicitly requested to unleash “energy and enterprise” and in parallel with high speed broadband and 4G services and Wi-Fi in all hospitals – the stage is set for such an advancement. So, to help MedTech find love this winter, ‘MedTech Tinder’ could prove to be the match made in heaven for the UK export MedTech market.

#Letsdoit #MedTechTinder #MedTechmatch

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