Sunday, 30 October 2016

Forget 42, the answer is actually 0.06% – and I wouldn't be at all surprised if Edith isn't turning in her grave

I've 2 people to thank  for my extra hour in bed this morning. The first is Judith S who at 12.15 last night reminded me I had an extra hour to write my blog and of course William Willett. Now Willett, (like Judith, was a member of the #EarlyRisersClub - that is people who start their day around 05.00) liked to get a round of golf in first thing in the morning. He didn't understand why so many people stayed in bed while the sun was shining. Willett lobbied the British Government to introduce Daylight Saving Time (DST). He died in 1915 before this was introduced in May of the following year. We have been putting our clocks forward in the Spring and back by 1 hour in the Autumn ever since.

Research on the effect of DST has consistently shown that burglary, violent crime, traffic accident rates all fall when the clocks go forward in the Spring. On the down side, researchers at the Karolinska Insistute in Sweden, found that heart attacks rose by 5% during the same period. More prosaically, DST meant that dairy farmers often had problems with confused cows needing to be milked. Today many UK farms use robotic milking systems, where cows are free to walk into a milking parlour at any time and be milked by a machine, and completely free from human intervention.

However, human interventions did feature in my reading last week. I read the recently published report The Use of Psychological Therapies (IAPT) in England. IAPT services are NHS approved brief intervention therapies for people with depression or anxiety. Last year there were 1,399,088 new referrals of which 953,522 resulted in people entering treatment. Just over 50% completed their course of treatment, with 55% of patients from the least deprived areas recovering whereas only 35% from the most deprived areas did. Challenging socio-economic factors and the stigmatisation of mental health problems continue to be contributing factors that result in these disappointing outcomes.

Predicting outcomes in health care is often difficult to do. Take the example of the creased ear lobe and its link to a higher risk of heart disease. Franks sign, as it's sometime known as, is a diagonal ear lobe crease that was named after Dr Sanders Frank. In 2014 a large Danish study involving some 11000 participants clearly showed there was an association between ear lobe creases and cardiovascular disease. It is an association and not a predictive sign. And before you rush to your mirror there are other more reliable tests available. 

Demonstrating reliability and generalisablity in research is critical. I'm not sure the claims made in the Cavell Nurses Trust report 'Skint, shaken, yet still caring'. published last week really demonstrated this. Edith Cavell was a British nurse who during the First World War saved the lives of soldiers from both sides without distinction or favour. The charity provides support and help to the 2152000 nurses, midwives and health care assistants who work in the NHS. Last year they helped some 1400 individuals who for various reasons found themselves in difficult circumstances last year as well as providing £500,000 in financial support.

The Cavell report uses Daily Mail style headlines in publishing its results. It compares nurses, midwives and health care assistants with other groups in the population. Nurses were said to be twice as likely to be unable to afford the 'basic necessities' of life. These were described as a home in decent state of repair, being able to replace broken furniture or repairing a faulty fridge or cooker. 61% of nurses said their health was good - 74% of the rest of the population claim good health. Nurses were said to be 3 times more likely to have experienced domestic abuse in the last year. Most nurses and midwives are generally as happy as the rest of us, but they reported higher levels of anxiety than other groups. Disappointingly there was no discussion as to what might account for these findings.

According to the Office of National Statistics the average UK salary is £27,600. The average nurse salary is £26,252, which compares well to the average salaries of some other employment groups; Occupational Therapists £26,037; Dispensing Opticians, £23,458; Bus Drivers £22,176; Teachers £18,604; and Care Workers £12,650.  For others groups the comparisons are not so good; Pilots £90,146; Doctors £69,463; Professors £49,679; Quantity Surveyors £41,086; and Midwives £29,448. Its not clear to me as to why such differences might mean that nurses have greater financial problems than the rest of us.  

It is absolutely true that the UK health care system is experiencing huge pressures. For all those working in the NHS will feel the impact of these pressures. Stress, physical illness, anxiety and sheer exhaustion are likely to be the result for many.  However, I doubt these experiences would give rise to greater rates of domestic abuse being experienced by nurses than the rest of us. The Cavell Trust Action Plan, sets out a series of  'good deeds' but these don't really help in answering these questions. And sadly, apart from being slightly sensationalist, I'm not sure what this report was aimed at achieving, and I don't think it does anything positive for those it purports to champion... 

...and by the way, the clocks go forward again on March 26th 2017.