Sunday, 26 August 2012

Obfuscation over Getting Tougher, Fitter, and Possibly Poorer Working for the NHS

There was a flurry of related NHS people stories last week. The first to catch my eye was the report from the Health and Social Care Information Centre on the comings and goings of different staff during the year May 2011/12. It seems that some 89926 people left the NHS in England, but only 77522 of these posts were filled. Whilst this 12000 shortfall is significant, the overall headcount of professional employees has reduced by almost 20000 people since September 2009. In addition, those people the Department of Health likes to call ‘NHS infrastructure support workers’ also fell by about 20000 from 236000 to 216000 over the same period. Managers and senior managers lost 5000 and 2000 positions respectively.

Of interest to this School is that these figures reveal qualified nursing, midwifery and health visiting staff posts have reduced by almost 5000 in the last two years. Yet when Anne Milton, ex Grammar School girl and fully qualified nurse, now Health Minister, was asked about these reductions she said there are 2400 more clinical staff working in the NHS than there were two years ago in May 2010, including over 3700 more doctors, and over 900 extra midwives’ and ‘funding will increase by £12.5 billion over the next three years, protecting the NHS for the future’ she concluded. In response Peter Carter of the RCN, said ‘The RCN will continue to oppose job cuts locally and nationally on behalf of our members and the patients they care for.’

Such sterling words will be music to the ears of Dr Graham Henderson (husband of Anne Milton) as he works in the field of community medicine – and it seems the community is getting sicker. The Insight Research Group published a report last week; The Austerity Britain Report which looked at the impact of the economic recession is having on people. The study’s participants were GPs working across the UK who were asked about the health of their patients and how this had changed over the past 4 years.

The GPs felt that worries over financial security coupled with many people working longer hours had led to a 77% increase of new mental health cases over the last 4 years (54% reported the greatest increase being anxiety, 46% felt it was depression). Additionally, 64% of the GPS reported patients drinking significantly more alcohol, whereas there had been a 38% increase in requests for help to give up smoking (cost being the most often reason cited). Likewise there was a reported 17% increase in patients requesting terminations due to financial concerns and a 34% increase in the numbers of patient putting off starting a family until their financial security improved. 60% of patients were cancelling sporting activities due to financial concerns and 54% cancelling gym membership due to work demands.

Such big increases don’t appear to be reflected in the sickness rate of NHS staff. The NHS Information Centre has published annual data for the level of sickness absence among health service staff, showing an overall rate of 4.12% for 2011/12 compared to a rate of 4.16% in 2010/11. I found it interesting that despite the continuing bad news about the economy, sickness rates in the NHS have only fallen by this tiny amount, nothing to do I suspect with the introduction across many parts of the NHS of more punitive sickness/absence policies. However, 0.4% is still a massive 15.56 million day lost to sickness.

Unfortunately for some NHS workers the misery doesn’t stop there. The South West Pay, Terms and Conditions Consortium which employs some 68000 NHS workers last week published its ideas for making further savings. They are suggesting that if the average sized hospital were to cut the pay of staff by 1% across the board, it would produce annual savings of around £1.4 million; adding another hour on top of the contracted 37.5 hour working week (for no extra cash) would lead to gains of £2.6 million; and by reducing annual leave entitlement by 2 days would generate over £750000 a year. The Foundation Trust Network, which represents the most financially successful hospitals in England – including members of the South West consortium – said 'that given the scale of the savings required in the NHS it was understandable that the time has come for some trusts to explore all their options’. Whichever way this turns out it is not good news for the education sector, already suffering because of the changes to university fees and bursary arrangements.

Perhaps slightly ironically, I’m off to Sweden in a few hours to present at a European conference on how a more effective relationship between the NHS and Universities can improve the educational preparation of nurses. Just time for a cup of tea I think before I go. Ho hum as they say.

Sunday, 19 August 2012

Medical Hocus Pocus, Goodbye Mark, and Feeding the Digital Mind

Following my return from annual leave last week, by lunch time on Monday all memories of my two week break had been filed in that mind folder labelled ‘Summer Holiday 2012’. It was full on. And Monday night I was to be found at the Double Tree by Hilton Hotel having dinner with colleagues from the the other three Universities in Great Manchester.

It was an interesting evening with creative conversations and a challenging menu. One of the starters was frog’s legs. Thankfully nobody chose this dish as their starter. My Compressed Apple and Ginger Ice Cream desert was a surprising mini feast on its own though. We were there as part of a shared desire to increase the collaboration between the four Universities.

One of the topics of the evening’s discussions was around our input, as educationalists and researchers, to the Greater Manchester Academic Heath Sciences Network (AHSN). We had received feedback from the Department of Health and an invitation to submit by the end of September, a fully costed bid to become an AHSN. AHSN are a new initiative aimed at bringing together providers of health care services, academics and industry in finding new ways of translating research into new approaches to services and in so doing improve the health and well being of the population. It is an exciting opportunity.

The digital revolution is important to how we take this opportunity forward. But Tuesday night I found myself at the Horwich Heritage Centre, and digital technology and health were the furthest things from my mind. I was attending a lecture on Medicine and Magic given by one Peter Watson. Interestingly, when I walked into the room I was mistaken for him, and although I offered to present the lecture, the real speaker arrived. He had longish, silver hair, was at least a foot shorter than me, and wore a shirt that had a definite air of lumberjack about it.

The lecture was mildly amusing in parts and dwelt mainly on stories of quack medicine, discerning the sex of the unborn baby using keys, transferable cures, often involving string, Wise Women (a precursor to the modern day midwife), the use of herbs in treating certain ailments and the universality of Gin as a cure all. There was very little medicine or magic involved and nothing was said about the myth of medicine – I didn’t, however ask for a refund of my £1.50 entrance fee.

He wasn’t a Mark Rapely - and sadly Mark died last week of cancer. Mark was a person I admired. He spent a lifetime challenging the bio-medical view of mental health. He was someone who taught psychology differently! He never ever backed away from saying the really challenging things that many of us think but seldom say. Mark will be missed.

Wednesday evening I was out with the Schools Professors, dining at Abode. The restaurant had an offer for a two course or three course meal, and they certainly had an idiosyncratic way of dealing with this. The waiter brought our first course – which was a mixture of starters and mains, and then our second course which was a mixture of mains and deserts. I found myself eating my desert next to someone who was eating his Hake – not a good situation. When I complained, I was asked ‘what’s the problem you had ordered two courses and that’s what we served’. I won’t be going back there in a hurry. The company was good though!

Thursday night was night in, just thinking about just how hard things get at times. Friday I was at an AHSN stakeholders meeting where we got to present the work undertaken to date. There were 29 CEOs, or their deputies from all the health care providers across the Greater Manchester area. These organisations provide health care to an immediate population of 3 million and a population within an hour’s travel, of some 11 million. It was a great event and I learnt a lot about what had already been achieved in the North West in harnessing digital approaches to health care.

The existing examples were staggering. For example digital dictation, a method of recording and managing natural speech, typically used in the NHS for creating letters and reports and clinical notes, saved Salford Royal NHS Foundation Trust over £500k last year. The former North West Strategic Health Authority estimate savings of £7 million to £18 million per year are currently being achieved across the region.

Tele-health uses equipment to monitor people’s health in their own home. The Department of Health Whole System Demonstrator programme reports significant reductions in emergency admissions (20%) and mortality rates (45%). Whereas telemedicine, used to provide interactive healthcare, is widely used in 6 acute trusts and 7 PCTs across Lancashire and Cumbria who are making savings of £1.8 million annually. NHSmail is the secure email and directory service available to all NHS staff. The system has been accredited for the transfer of patient identifiable data such as referrals and discharge summaries. NHSmail provides a service which sends appointment reminders via text messages. All services using this approach have reduced ‘Did Not Attend’ often as much as a 50% reduction in DNAs at a saving of £31 per appointment.

Online meeting services use technology to enable meetings and consultations to happen without the need for people to be physically in the same location. It includes the use of audio, web and video conferencing. There are potentially huge financial benefits. On average, savings of over £92 per person for each meeting can be achieved. However, I have it from very reliable sources that while NHS colleagues in London DoH offices use this to avoid coming up to Leeds, they do expect all of us to get in the train and travel down to their meetings.

Thankfully, on Friday evening I only had to travel back to the Double Tree by Hilton Hotel to attend my last meeting of the week. Frogs legs, magical doctors and all use of digital technology was banned, and it was good just to have a face to face conversation without any distractions.

Sunday, 12 August 2012

The Painful Pathway to Well-being (Male Grooming)!

Now for a while I have been worried about my eyebrows. They have, over time, become reminiscent of the famously bushy examples unashamedly sported by the Labour politician Denis Healey. In the early 1970s, as Shadow Chancellor, he was reported to have said (although he staunchly denied ever saying it) that he would ‘tax the rich until the pips squeak’. In 1974, he became Chancellor of the Exchequer. His approaches to managing the economy were not a great success.

However his bushy eyebrows and soft-spoken wit earned him a favourable reputation with the general public. When the media were not present, his humour was equally caustic but also more risqué. For example: ‘These fallacies [pronounced 'phalluses'] are rising up everywhere’, he retorted at a meeting of the Leeds University Labour Society. Labour lost the 1979 general election to the Conservatives (led by Margaret Thatcher), following the so called Winter of Discontent in which Britain had been brought to a virtual standstill by endless public sector strikes.

It was those Denis Healey like bushy eyebrows I could see every morning in the bathroom mirror, and they had been playing on my mind for a while. Now as it happens, my local Tesco’s had opened a so called Hair and Beauty Saloon. For the price of buying a Chicken at Oxfam (£5) they were advertising trimming ones eyebrows, using thread. What I had not anticipated was finding myself sitting in a reclining chair in the middle of aisle 6, with a woman wielding a double-length of twisted thread which she moved rapidly over my eyebrows from one side to another. I can tell you now that when she started to move those threads, my eyebrow hair got absolutely ripped out.

After this very painful experience, I sent an email to a colleague regaling them of this experience, and I admit, possibly seeking some kind of sympathetic support. What I got back was the comment that ‘if I thought eyebrow trimming was painful just wait until I try period pain and childbirth’. Now being a man, it is unlikely that I shall ever get to experience either of these.

But interestingly, in a recent study, psychologist Jennifer Kelly from the Atlanta Centre for Behavioural Medicine reported that women experience [chronic] pain longer, more intensely and more often than men. Women are also more likely than men to experience multiple painful conditions simultaneously, which can lead to psychological distress. Dr Kelly noted that genetic and hormonal differences may be the main reason for any differences, but was clear that social and psychological factors are also important.

Dr Kelly also posited that women tend to focus on the emotional aspects of pain whereas men tend to focus on the physical sensations they experience.

In terms of eyebrow trimming, I can say with complete sincerity there was no emotional attachment being experienced between my inner self and those pesky eyebrow hairs. It just really hurt! So I shall just have to learn to live with the Denis Healey in me. Tomorrow, I make my return to work and I am sure by midday, all of this will seem a long way away.

Sunday, 5 August 2012

A Maiden in a Tower, Damsels at my Feet, a Young Princess, and Snow Angels

Last week I was on holiday in one of my most favourite places of all time, the Solway Coast of Scotland. The weather was fine, I watched the sea as it came in and went out twice a day, 6 novels of the crime/thriller genre were read, and many miles were walked with Cello on deserted beaches, through fertile fields and along paths snaking their way through lush woodlands. My sun tan was topped up, a fine selection of real ales was sampled and too many lazy lunches indulged in. That there was no internet of phone coverage made for a peaceful time free from the incessant ping of a new email arriving at work.

Maybe it was the lack of access to the news that resulted in my not knowing about the Rapunzel like maiden trapped in the ruins of Kirkcudbright (pronounced kerr-coo-bree) Castle. Once I found out I was able to promptly affect a rescue and still have time to spend some time with Rosie, owner of The White House Gallery. Kirkcudbright has had a long association with the Glasgow art movement, however, over the past five years or so, it is from this gallery that I have been buying the work of Urpu Sellar, the Finnish creator of some of the quirkiest ceramic sculptures I have ever seen.

Unfortunately I had to come back to Manchester for an Academic Health Science Network meeting on Friday (more of which in a subsequent post). So yesterday I was able to walk on High Rid once more with Cello. The morning sun, which was warm from early on, brought out hundreds of damselflies. These beautiful dragonfly like insects flew, with spectacular dips and swoops around my feet as I walked around the waters edge. It was an almost magical feeling to see so many out in the sunshine living their very short lives so energetically.

And being reconnected with the internet also brought a couple of interesting surprises. For some reason Facebook feels it has to let me know when anyone who was once a 'friend' on my previous Facebook account post a thought, a picture or whatever. Although I never use this social network anymore, it appears that once you have an account you have it forever. Well yesterday I was alerted to the fact that my middle daughter apparently likes a photograph I was ‘tagged’ in. Intrigued I opened up this photograph (and it’s not one I have anywhere) to find it was taken some 30 years ago. At the time I was living in Wales and my hair was still dark and not grey. It was also in my pre-black only era. But it was lovely to see my daughter in her ‘I’m a little Princess' phase though. I suspect one of my brothers will have posted it, but where he got it from is anyone’s guess.

The second surprise was seeing an announcement that the Snow Angels were preparing plans to reduce the number of deaths in the North West that are caused by cold weather. Now I know our summer so far hasn’t been up to much but this seemed an extreme case of forward planning. Even Tesco’s haven’t got their Christmas stock on the shelves yet. But it is a serious health and social care issue. In November 2009 the Office for National Statistics reported an estimated 36,700 excess winter deaths (the term used for deaths caused by cold weather) for the period 2008/09 which was a 49% increase over the previous year. The majority of these deaths occurred in people aged 75 years and over. For some reason some parts of the North West seemed to have a higher problem than others. For example, there were 209 deaths in Cheshire West and Chester in 2009/10, some 40% more than any other part of the North West. The key risk criteria are age, female, respiratory or cardiovascular conditions, living alone, or living in nursing or residential care.

Operation Snow Angel is designed to support older and vulnerable people in the local community by bringing together existing services and improving access to these services, providing support to the most vulnerable people in the local community through Snow Angel volunteers, and supporting local neighbourhoods to assist people through periods of extreme cold weather. The role of these Snow Angels will be to respond to requests for assistance during periods of extreme cold weather to ensure that people are kept safe and warm. Specific duties include assistance with path clearance, making sure that people are warm, assistance with shopping, and referrals to other agencies when appropriate.

It sounds like a great scheme. I have a few days left before returning to work, and I shall spend much of this time in the garden making my own preparations for the forthcoming winter.

And OK, I will be watching the last week of the Olympics. They have been fantastic games so far - my favourites have to be Jess Ennis (that was some 800 m) and Mo Farah - what wonderful athletes - both of whom personify the Olympic spirit!