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Chief executive of NHS urges AHPs to restructure the way care is delivered to patients

Allied health professionals have been urged to ‘simultaneously improve quality and productivity’ in order to meet the massive financial challenges currently facing the NHS.

Speaking at the Chief Health Professions Officer’s conference 2009, held in London on 6 and 7 October, David Nicholson, chief executive of the NHS, told AHPs that the scale of the challenge is to grow the NHS by 11 per cent over the next two years, without receiving any further funding from government.

Referring to Lord Darzi’s Next Stage Review, Mr Nicholson said: ‘We knew that, having been through 10 years where the NHS grew by a third or more, growth rates would become slower’. But he was keen to stress that ‘this is not about taking money away, but about using the money we have better’.

A whole series of drivers, including demographics, new technologies, and National Institute for Health and Clinical Excellence (NICE) recommendations, will put increased pressure on the system, adding up to a shortfall of around £15-20 billion, he said. The big challenge is to recycle this within the system.

Despite making ‘the strongest case possible’ to government for more money, he said, ‘we know the cash is not there’. One option to deal with the challenge is for ‘slash and burn’, or arbitrary freezes, but ‘we know that this does not work and affects different parts of the service in an unplanned and unmanaged way’, he pointed out.

The biggest contribution to saving money and recycling it around the system will be the way AHPs restructure the way care is delivered to patients, he concluded. ‘Look at the evidence for productivity gains, they are all at the interfaces between services, in the places where patients get a “raw deal” with duplication,’ he declared.

‘Transforming services in those areas are key to unlocking quality of services and reducing costs.’

Admitting that this is not something that can be done from the top down, Mr Nicholson said the critical issue is leadership. ‘It requires people like you to accept the challenge’.

Source: http://www.cot.org.uk/homepage/news/?l=l&ListItemID=1078&ListGroupID=261
Copyright College of Occupational Therapists, Thursday 8th October 2009

Twitter could provide 'innovative solutions' for long-term conditions

Research by a Bournemouth University web professional suggests that social networking website Twitter could be an effective means of delivering improved quality of life to people suffering from long-term conditions.

The research, which looked at blogging and microblogging among practitioners, patients, and support groups has identified Twitter as a possible means of improving the personalised nature of health care delivery and support.

Author Andy Pulman, from Bournemouth University’s School of Health & Social Care, said that Twitter “could cultivate and inspire private, focused group conversations between people with chronic conditions and offer an effective targeted information channel for practitioners”.

Speaking about his paper, Pulman said: “Twitter has evolved beyond its basic functionality to provide a variety of alternate uses, some of which are health-related and which might offer opportunities in relation to improving health. I feel that the internet, mobile technology and web applications like Twitter are ideal candidates for providing innovative solutions to help deliver improved health-related quality of life. My ongoing research in this area aims to find out if this is the case.”

For more information on Twitter, please visit our Twitter page at http://www.twitter.com/OESHealthcare

Source: http://www.nursingtimes.net/nursing-practice-clinical-research/long-term-conditions/twitter-could-provide-innovative-solutions-for-long-term-conditions/5007223.article
Copyright Nursing Times, Sunday 11th October 2009

Why am I the short fat one?

My identical twin brother Chris is 2cm taller than me. Barely noticeable you would think. I can see what it is like to be him by standing on tip-toes just a little and frankly the world does not look much different from up there. Nonetheless it bothers me: I could have been that tall. I have exactly the same genes as my brother. Genes that, in the right environment, could have made me a full 185cm tall as opposed to my current 183cm. Something, somewhere went wrong and I got stunted. Not by much but it is a reminder of what could have been. And that is the real problem.

It is not the height, not that trousers fit him a little better or that he does not need to reach as far to change a light bulb. It is that I wonder how many other things I am missing out on. Ten points of IQ here, some grey hair there. Perhaps I will need glasses at age 35 instead of 40. Most people do not have any way of knowing whether or not they are getting the most out of their genes but if you have a twin sibling then you have an exact comparison. So how did these differences arise?

The differences between identical twins - people who should be exactly the same - are becoming increasingly useful to medical researchers interested in everything from mental illness to our ability to do maths.

Long term changes

Most people are used to thinking of our DNA as a fairly fixed code, a bit like a blueprint for a building. We know that some things can change the code itself - exposure to radiation can cause mutations that lead to an increased risk of cancer for example - but usually the code remains the same. However, production of the molecules for which our genes are responsible - things like digestive enzymes and muscle protein - is constantly getting switched on and off. And it seems that some environmental influences can have much more lasting effects - permanently activating or inactivating certain genes.

It is becoming apparent that this aspect of genetic control - a process dubbed epigenetics - is very important in human health. In 1944 there was a severe famine in Holland. The children born during this period are more susceptible to diabetes, obesity and heart disease compared to siblings who were older during the famine. It seems that the period of starvation prompted their bodies to switch certain genes on or off to cope with the lack of food. These changes may, in subsequent times of plenty, have made them gain weight and get diabetes.

This change in the particular genes we express is controlled chiefly through a process called "methylation" in which chemical groups are attached to the DNA molecule to tell the body whether or not to use the "methylated" genes. It is one of the ways in which our bodies' attempt to adapt to changing environments. Twins play a key role in discovering more. In the summer of 2009 Chris and I joined the twin research study at St Thomas's Hospital where we were investigated in great detail. They measured our height, weight, bone density, grip strength even ability to hear if a nursery rhyme is in tune. All these are traits that are to some extent genetic.

Other differences

It turned out that we are different in more ways than height. For a start I was 15kg heavier than my brother. Of the thousands of twins enrolled in the research program only 10 were more different in weight than us. Professor Tim Spector who leads the research unit was frank: "You're (he meant me) a disgrace." My excess weight, unlike my brother's excess height, is easily explained. I have been living in America and eating too much. So far, no surprises.

But environmental exposure to a lot of cheap, high-fat food in America may have caused more than temporary weight gain. It may have permanently altered the way my genes are expressed. Scientists are only just beginning to understand these processes but it is possible that I may have permanently altered my metabolism to accommodate those extra pounds: the health effects could last a long time.

Key role in disease

Epigenetics seems to play a role in a large number of diseases. Twins studies show us that some cancers are not caused by DNA mutations but by epigenetic changes, which potentially offers new targets for drugs. Similarly with heart disease or diabetes we might one day be considering therapies that change our epigenetics. This is a long way off but twin studies are beginning to shed new light on how our bodies react to the environment.

What about my missing 20mm of height? It is probably an epigenetic effect caused by some long forgotten environmental difference when we were little. I will never get it back but if it is of use to medical science I can live without it.

Copyright BBC Health News – Wednesday 30^th September 2009

Source: http://news.bbc.co.uk/1/hi/health/8280431.stm

Time to get tougher on obesity?

One in three adults in the UK will be obese by 2012, according to UK researchers. Chris Oliver is an orthopaedic trauma surgeon in Edinburgh who had gastric band surgery to lose weight but believes it is not the solution for everyone. He thinks we all need an annual weight check and firmer treatment from our doctors to control our weight

'Morbid obesity'

Three years ago I could hardly climb up a flight of stairs - with a body mass index of over 53 and a weight of over 27 stone (171kg) I had become virtually immobile due to morbid obesity. The inability to lose weight and the realisation that obesity had ruined my life caused me to have an adjustable laparoscopic band surgical procedure early in 2007. I had unsuccessfully tried various diets but had failed to lose any significant weight. My morbid obesity had overtaken my life. I wrote a living will and went for it. As a surgeon I was well aware of the operative risks. You just know too much! After this surgical procedure I lost over ten stone (63.5kg)in weight and forced myself back to physical fitness. I realised that the band was a tool to help me change my life.

'Prejudice and discrimination'

Many people really do not understand obesity. There is a great deal of prejudice and unfair discrimination. Obesity is now one of the most significant health problems to affect the Western world. What was the inspiration to change? I obviously wanted to get fit again and be healthy but most of all after my weight loss surgery I realised that this was a second chance at life and that each day we live is so valuable. Much of my motivation came from an inspiration to do things I had done earlier in life and wanted to do again before it was too late.

'Risks'

Adjustable laparoscopic gastric band surgery is not the solution for all those that are obese, like all medical interventions, it has risks that must be carefully considered.

Patients presenting themselves for this kind of weight loss surgery must not have unrealistic expectations; they must learn to change their relationship with food and to have a new lifelong positive attitude to exercise. Early after my surgery I set myself a series of graduated targets: aquafit, swim, spin cycle, cardio gym, cycle, resistance gym, run, white-water kayaking, sprint triathlon, endurance cycling and who knows what next?

'Obesity epidemic'

However, I now believe that society must do much more to control the mass epidemic of obesity. Health care policy for obesity should make yearly annual checks on body mass index for children and adults freely available. Although annual weight checks could not be enforced, guidance and clear implications of being obese should be given much more directly and forcefully. More controlled weight loss programmes and the benefits of daily exercise must be made more acceptable.

The current policies just seem too soft. If I had been weighed every year and had a rigorous health check I might have listened and not put on all that weight. We need to be much more proactive, in assessing obesity and its dire consequences on society. I really might have thought twice if my own weight had been checked on a regular annual basis.

Copyright BBC Health News – Wednesday 30^th September 2009

Source: http://news.bbc.co.uk/1/hi/health/8279577.stm

Private clinics face safety check

Safety checks are being carried out at all private clinics used to cut NHS waiting times in England after a man died during a routine operation. Dr John Hubley bled to death during a gall bladder operation at Eccleshill Treatment Centre in Bradford in 2007. It subsequently emerged that there were no emergency blood supplies on site and key medical equipment was unavailable. The Care Quality Commission, which regulates healthcare in England, is now looking into procedures at all clinics.

The Department of Health said there was a robust system of checks and balances in place to ensure patient safety. The private clinics that are being inspected are known as Independent Sector Treatment Centres and exclusively treat NHS patients as part of an initiative to reduce NHS waiting lists. At an inquest late last year it emerged that the Eccleshill Treatment Centre had been inspected by the Care Quality Commission's predecessor, the Healthcare Commission, five months before Dr Hubley died and cleared as "fit for purpose". The coroner said the Healthcare Commission had missed major flaws in the clinic's emergency plan and described these flaws as "woefully inadequate". During evidence the coroner described aspects of the clinic's plan to fetch blood in an emergency as "Mickey Mouse".

In a statement the Care Quality Commission said: "The death of Dr Hubley was an absolute tragedy. "All those involved, including the regulator, should question what was done and ask whether they should do more to minimise the chances of recurrence. "Our predecessor organisation, the Healthcare Commission, examined the situation closely. "Having reviewed the regulatory action taken, important lessons have been identified for us to learn from. In order to assure ourselves that the risk to patients is minimised, we are checking with all registered independent treatment centres that they have robust and appropriate systems in place. No regulator can give a cast iron guarantee that such an incident will not happen again, or that all potential issues can be identified every time. But we can promise to work tirelessly to protect the safety of patients, continuously asking how we might do better."

The Eccleshill Treatment Centre now has emergency blood and equipment on site and a coroner found that there were no continuing issues at the clinic arising from the death of Dr Hubley. The clinic told Panorama that Dr Hubley's was the only death after 22,000 surgical procedures. The Department of Health said the Independent Sector Treatment Programme had been a success and pointed to extremely high patient satisfaction rates.

In particular they claimed to have reduced the suffering of hundreds of thousands of patients who might otherwise have had to wait long periods for their operations. It said patients could expect the same standard of care in Independent Sector Treatment Centres as in the NHS and there was a robust system of checks and balances in place to ensure patient safety.

Health minister Mike O'Brien told the BBC in a statement that Dr Hubley's death was "deeply regrettable". "This incident was thoroughly investigated and new procedures have been put in place to reduce the chances of incidents like this happening again," he said.

Copyright BBC Health News – Wednesday 30^th September 2009

Source: http://news.bbc.co.uk/1/hi/england/8282147.stm


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