Obesity – a big problem but a shared responsibility

Guest Blog by Robin Millar, Acting Chief Executive, 2020health

fatchancethumbnailObesity is a complex issue – like health itself, it affects how we live our daily lives, the environment in which we live and work and how we feel about ourselves. In our 2015) report, “Fat Chance?” we noted that it was upwardly and downwardly mobile sections of society that correlated with obesity – not just the poorer and more deprived areas.

It is also emerging as a defining – and confounding – challenge for 21st century public services. A sickness model of health services struggles to cope when a ‘cure’ actually lies beyond its reach, before services are even involved.

We should not miss either the importance of this moment – or the opportunity that comes from acting now. The question is, does the release of the government’s new strategy mark a different, prevention led approach alongside a more coordinated public service response? Because it is only when we take hold of this bigger picture that we will begin to address the challenge.

obesitythumbnailIn our 2014 report, “Careless Eating Costs Lives” we recommended establishing a permanent cross departmental government task force on obesity to flush out important and diverse perspectives on the problem – economics, social and environmental factors, health implications, media messages, sports and activity, food industry all have an influence. We also recommended that all new policies should be reviewed and assessed against an ‘obesity test’  – asking “how do these policies help to improve the nation’s health?”

The strategy did recommend a phasing in of a “sugar tax” but was otherwise silent on these, as it was largely on advertising and promotion.

However we do see points that are to be welcomed in it and point to a change of approach.

Schools for example, are a key battleground. 1 in 9 children enter primary school obese – too high in itself. But worse, 1 in 5 children leave primary school obese. The hour of exercise a day for primary school children is a good measure: it recognises the success of initiatives such as the Scottish “mile a day” and builds good habits for the future. But exercise is only one part of the puzzle.

In our report we also called for practical cookery skills and food education to be a part of the school curriculum for pupils up to the end of key stage 3 (age 14). The very effective EPODE approach originating from France, demonstrates the value of reconnecting children with the food system and food supply, by helping to instil a better understanding of what it means to live healthily.

However, this kind of consistent and thorough strategy is difficult in the UK educational system with a plethora of interested players. A further challenge for schools is fitting this into an already crowded timetable – “another priority”.

Many are calling for more punitive action – pulling hard on the favoured political levers of tax and legislation. However our empirical evidence shows that simply ‘pushing’ and legislating does not work particularly well. Further action should explore ‘nudging’ in appropriate ways and it is appropriate that more forceful action could be taken if the industry do not respond.

However, we believe that “Making health personal” means an approach that recognises personal responsibility for regulating our consumption – personal responsibility – and then supporting this through state legislation. The new Strategy attempts to strike that balance with a light touch. Taxes in 2018, giving industry a chance to act, will be reviewed in 2020.

With increasing localisation of decision making, there is also an opportunity here for Local Authorities and Health & Wellbeing Boards to work with communities and residents to introduce their own guidance for healthy towns and homes etc. We called for all HWBs to recognise the importance of nutrition and obesity through access to those professional specialisms, and explicit measures/specification in their JSNA to inform effective strategies to tackle obesity.

This might include reviewing licensing for fast food outlets to control the location and numbers of outlets in a local community. Particular on fast food outlets appearing to ‘favour’ spots close to schools. Or ensuring that walk and cycle ways joining communities enable more exercise as part of a daily routine of shopping or work.

In our report we highlighted and called for incentives for those who become active partners in their health by quitting smoking, reducing weight, walking a set number of steps etc. – and increased awareness, coordination and reach of the government’s ‘Healthy Start’ Voucher scheme

By the admission of some businesses, this strategy could have gone further – but it also marks an encouraging shift in approach. It is important we discuss responsibility: government could have done more, certainly. But it’s not just about what government can do, but what we must do for ourselves.

When it comes to our health – and weight – we can have a say in our own outcomes long before we become consumers of health services. This strategy must mark the start of that conversation.

Screen Shot 2016-08-18 at 22.37.22


Posted in Uncategorized | Tagged , , , , | Leave a comment

The challenge remains: healthcare needs reform

Comment by Robin Millar, Acting Chief Executive, 2020health

On a day of changing faces around the Cabinet table, the Prime Minister has retained Jeremy Hunt as Secretary of State for Health – and he has retained the challenge of reforming the NHS.

The pressures on health care have been growing for years. Expectations have grown with excellence in care. Demand for services is increasing and 21st century health challenges such as obesity are emerging before our eyes.

The delivery of health care is creaking. Space is limited, staffing is stretched and funding is tight. Workforce morale is low and recruitment fears have filled the front pages. Scandals over quality will linger long in the public memory. Barely a part of the health care system is untouched by these concerns. The 20th century solutions we have are not the way forward. Innovation is the watchword, transformation plans now cover every part of the country and figures are scrutinised for early signs that Simon Steven’s 5 Year Forward View is being delivered.

But if it was needed, events of recent weeks have framed a further, stark warning for the Secretary of State: what was Brexit if it was not a rejection of an Institution that had become disconnected from voters?

Robin Millar, Acting Chief Executive of 2020health said:
“If adapting the NHS to be fit for the 21st century was easy, it would have been done by now. Brexit is bringing in a new era for government in the UK. Does the new Prime Minister’s promise of “more control over your lives” herald a much needed, long hoped for reform to health care? A different approach that will ensure healthcare of the future is more personal and local?“

Work by 2020Health has highlighted:

• “A Shared Responsibility – Tackling Inequalities in Health Across Greater Manchester” (2015) Good health outcomes from working with people to prevent problems and reduce service demands
• “Personal Health Budgets: a revolution in personalisation” (2013) Healthcare interventions must move beyond industrial, one-size-fits-all models and recognise the lived experience of the individual, ‘making health personal’
• “Going with the Flow” (2014) A need for managed public debate to depoliticise the NHS and involve us all in decision making to ensure we have an NHS for the future.
• “Fat Chance” (2015)

Robin Millar is a Board member of 2020Health and Acting Chief Executive while CEO Julia Manning takes a two month sabbatical.


Posted in EU, Health and Wellbeing, Health reform, Jeremy Hunt, NHS, NHS England, NHS reforms, Public Health | Tagged , , , , | Leave a comment


Guest Blog by Ali Oliver, Chief Executive, Youth Sport Trust

Screen Shot 2016-06-20 at 11.21.52

With the European football championships underway in France and the Rio Olympic and Paralympic Games on the horizon it is set to be another memorable summer of sporting excitement, and hopefully success. Sport has an incredible ability to unite us and that is never more evident than when major sporting events take place.

This week the Youth Sport Trust aims to create its own memorable sporting moments as National School Sport Week gets underway. Schools across the country will be hosting sporting events and competitions with the aim of encouraging their pupils to be physically active and take part in more sport. There will be moments when young people will demonstrate their own aspirations and have their resilience tested as they strive for their personal best – be that competing against other classmates or trying a new sport for the first time. This year we are encouraging schools to take part in the Sainsbury’s Active Kids Paralympic Challenge which we have developed in partnership with ParalympicsGB. It is a fully inclusive programme that gives young people an introduction to different Paralympic sports.

National School Sport Week is not just about getting children to do more sport during Screen Shot 2016-06-20 at 11.23.42the week. It is about putting PE and sport at the heart of our schools and highlighting
that developing physical literacy and an active lifestyle is just as crucial to a child’s education as learning to read and write. It is also about giving a platform for young people to celebrate their sporting achievements, compete or try something new, but most of all it is about encouraging mass participation and fun.

Ultimately, we want young people to make sport and physical activity a consistent
part of their daily life. We know that active children perform better across all areas of school life, have greater social and emotional wellbeing, and are more likely to develop the life skills they need to go on to be successful in the world of work. However, the challenge of getting young people to be physically active is significant. The rise in childhood obesity is no secret and presents significant challenges, whilst caution is needed to ensure the advancement of technology doesn’t lead to a digitally distracted generation that is disengaged from physical activity.

We must give every young person access to high quality PE and sport, and there can be no excuses for not doing so. Evidence shows that when high quality PE and sport is delivered in schools it aids and enhances the learning of pupils across all subjects, can improve school ethos and pupils’ sense of belonging, and raises aspirations for young people to achieve their personal best.

In 2012 a report in the Journal of Sport Sciences stated that a ‘physically active lifestyle during childhood is positively associated with brain and cognitive health. Children who are more aerobically fit have improved brain function, higher academic achievement scores and superior cognitive performance than less fit children’. Similarly, in 2013 the Journal of Physical Activity and Health reported that ‘Engagement in regular physical activity is recognised to contribute a range of positive outcomes, specifically; physical and mental health, social wellbeing, cognitive and academic performance.’

So, National School Sport Week is one moment in the year to celebrate PE and sport, but it can be the start of so much more for young people and can change their lives. And when it comes to the Euro 2016 football championship and Olympic and Paralympic Games?  I, like many others, have my fingers crossed for sporting success. But please, no penalty shoot-outs this year!

In 2020health’s discussion paper Head of Wellbeing: An essential post for secondary schools? one of the key findings was ‘greater engagement of young people in physical activity through a broadening of opportunities’.

Posted in Childhood Obesity, Children | Tagged , , , , | Leave a comment

Baby Boomer women and tech – new report

Guest blog by Kathy Mason Associate, 2020health

Elder care with technology appeals most to Baby Boomer women
Two thirds of 55-75 year olds would be interested in using technology to help their parents as they get older. Help with medication, memory, fall detection, instant communication and health metrics such as blood pressure and heart rate were liked, but people questioned were much more wary of tech for dressing, eating and personal care.

In 2020health’s paper out today Health technologies – are older people interested? 700 baby-boomers were asked about their willingness to use innovation in caring for their parents, only when it came to dressing did fewer than half think they wouldn’t want to use it. Fascinatingly, given that so much tech publicity is geared towards men, often women were more likely than men to be happy to use technology.

Julia Manning, Chief Executive of 2020health, which undertook the survey, said: “We are much more accepting of tech solutions to help with daily living and the tech sector needs to realise that women are much more interested in digital solutions than they think. If you pick up a technology magazine, all the advertising is directed at men!”

Despite our familiarity with stair-lifts, only 65 per cent of men said they would consider them for their parents, whereas 76 per cent of women said they would be happy to do so. Despite this, when men were asked which was more dignified, using robotics to help get up stairs or having human help, 60 per cent said the technology solution was more dignified.

Robotic assistance for dressing is being pioneered in Japan, where one in eight people are over the age of 75. Although people were generally more wary of robotic help, women were 20 per cent more interested in using it for their ageing parents, compared with men. In the UK, competitions such as the annual AXA PPP sponsored Health Tech & You Awards, held in April, show that the new assistive technology space is growing rapidly. Innovation such as the GyroGear Steady Glove assists people by counteracting hand tremors; Dermaspray is a devise that sprays precise doses of medication for those with reduced hand movements and, for those with walking difficulties such as in Parkinson’s, ‘Walk with Path’ is an aid simply [to] taking the next step.
“The more access we can get to innovation, new technologies and ingenious solutions, the more we can offer people healthy options using technology,” said Gordon Henderson, Director of Digital & Innovation, AXA PPP healthcare.

The full Discussion Paper Health technologies – are older people interested? is available to download from the 2020health website.

2020health, AXA PPP and the Design Museum are founding partners of the Health tech and You Awards, an annual competition to showcase the best consumer facing, digital health technologies.

Posted in Elderly, Emerging technologies, Health and Wellbeing, Healthcare, Innovation, Preventative healthcare, Self-care, Technology | Tagged , , , , , , | Leave a comment

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]
Posted in A&E, Hospitals, Patients | Tagged , , , , | Leave a comment

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.

Posted in Uncategorized | Leave a comment

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.

Posted in Uncategorized | Leave a comment