Patients need motivation to recover. The NHS must offer hope | Kate Allatt

Our NHS is under attack from all angles. People are living longer, we don’t eat well or exercise enough. Yet we expect more from the NHS; more people are visiting A&E departments and minor injury units year on year, and costs are rising.

How do we tackle this? What if we focus on marginal gains, the performance strategy that helped British Cycling to success in multiple Olympics?

This is an approach that focuses on “small incremental improvements in any process adding up to a significant improvement when they are all added together”. Could this improve patient outcomes and reduce waste in the health service?

One incremental enhancement we could seek in the NHS might be to improve our understanding of and response to the barriers to patient motivation. For example, could we find a way of encouraging stroke survivors to practise their rehabilitation exercises as frequently and intensively as they are prescribed? Patient adherence to rehabilitation regimes after discharge from hospital is described as “less than ideal”. By addressing these barriers, we will be more able to efficiently allocate therapy time, and thereby reduce GP appointments and hospital readmissions.

You might wonder what makes me an expert on this.

L​owering ​​patients’ expectations of ​recovery​ can be extremely damaging

In February 2010, at the age of 39, I had a huge brainstem stroke and was diagnosed with locked in syndrome. I was on life support and in intensive care for nine weeks, and was then written-offin rehabilitation after a further six weeks. My husband received a phone call telling him that I would never walk or talk again.

Over eight painstaking months in rehabilitation, I obsessively willed my body back to life, practising actions or movements 450 times per week. Slowly I learned how to do basic things like eat again, and at the end of it all I walked out of hospital. I went for a run on the first anniversary of my stroke. I’m now a motivational speaker and go to the gym every day.

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I never gave up pushing my body to improve: to speak, to eat, to run and to hug my kids. I managed to use my bad prognosis to galvanise my recovery, but the risk is that lowering patients’ expectations of recovery can be extremely damaging. Recovery should be measured in terms of improvements, not “getting better” – and that is always possible. My only focus, with three young children at home, was on when I would achieve my goals, not if.

Since embarking on my career in advocacy and stroke activism, I’ve found many reasons why patients lack the motivation to try to help themselves. They may be suffering from post traumatic stress disorder, which is common after a stroke and, just like depression, it affects mood and motivation levels. The side effects of the drug treatments for strokes – sleeping pills and muscle relaxants – can also affect motivation. After a brain injury many patients suffer varying levels of executive dysfunction affecting the set of mental skills that help to get things done, which can be mistaken for apathy or laziness. The overwhelming tiredness felt by those suffering from neurological fatigue can leave patients unable to complete normal daily tasks and therefore non-compliant with their treatment plans. It may be that some patients simply hate exercising or have no family support.

It is futile prescribing a stroke rehabilitation plan if – for any of these reasons – the patient is unmotivated before the therapy session starts or they are left at home trying to manage their own condition. The NHS should be offering hope and encouragement to motivate patients. And to do that, they need to listen to expert patients.

My advice to the King’s Fund Leadership Summit is that we need a better understanding of patient motivation to help rebuild the lives of stroke survivors. If patients adhere to clinical advice about practising their exercises as frequently and intensively as I did, just imagine how much we could improve their outcomes and reduce the waste in the NHS. But to do this we must understand the complex reasons why patients don’t do this already and listen to those who have struggled through similar experiences.

I don’t promise anything when I speak to people now – I just offer possibilities. I talk about how to optimise improvement, but never use the word recovery. After a life-changing event none of us will ever be the same as we were, even if we physically improve really well. We need to embrace that new self and strive to be the best version of ourselves that we can be, both in hospital and back home.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Patients need motivation to recover. The NHS must offer hope | Kate Allatt

Kate Granger inspired all of us in the NHS to be more compassionate

He’d been rushed the day before to our surgical emergency unit. An elderly man, crying out in pain, he’d looked haggard, gaunt and frightened as we wheeled him straight to the CT scanner. Now, stripped of his clothes and draped in a gown, he stared up in trepidation as my consultant surgeon, impatient to be done with his morning ward round, stopped by the bedside. Without so much as an introduction, this experienced doctor broke the news to the patient of his terminal illness by turning to the bedside entourage and muttering, perfectly audibly: “Get a palliative care nurse to come and see him.” No one had even told “him” he had cancer.

As panic began to rise in my patient’s face, I remember catching the ward sister’s eye to see her cringing alongside me. The ward round had already swept on. I felt sick, complicit in something barbaric. But, as an inexperienced house officer barely qualified as a doctor, I scuttled dutifully after my boss, leaving someone else to pick up the pieces.

Related: I want my legacy to be that the NHS treats all patients with compassion

For the past five years, one woman has unleashed a quiet revolution to banish such casual brutality from our NHS. My fellow doctor Kate Granger died on 23 July from a rare and aggressive form of sarcoma. Three years ago – without introducing himself or even looking her in the eye – a doctor issued her with a death sentence by telling her that her cancer was inoperable. She told delegates at the annual NHS Confederation conference in 2014: “Without any warning or asking if I wanted anyone with me, he just said, ‘Your cancer has spread’. He then could not leave the room quickly enough and I was left in deep psychological distress. I never saw him again.”

Aged 29, Kate harnessed the inhumanity of her treatment that day to become a tireless campaigner for kindness and compassion in the NHS. Her idea was simple but brilliant. She wanted NHS staff to build vital, caring relationships with their patients by – at the very least – introducing themselves by name. Her #hellomynameis campaign, launched with a single tweet, turned into a nationwide NHS movement, with more than 400,000 frontline NHS staff and innumerable hospital trusts backing it.

Dr Kate Granger’s #hellomynameis campaign has turned into a nationwide movement. Photograph: Dominic Lipinski/PA

Kate didn’t know it but she, more than any other individual, inspired in me zero tolerance of the inadvertent, accidental, all too frequent inhumanity we in the caring professions sometimes display towards our patients. Though we met only once, and I never felt able to tell her she was my unsung heroine, her example imbues my daily practice. Each morning, I prepare for my ward round by slinging a stethoscope round my neck, clipping a pager to my waistband and pinning my name badge carefully to my collar. No patient of mine will know me only as an anonymous, identikit doctor. I greet every one of them with my name and a smile.

The truth is that through her dual perspectives as doctor and patient, Kate forced all of us in the NHS to confront uncomfortable truths about the ways we may unintentionally strip our patients of their dignity and individuality. For me, it started in medical school when, over many months, I dissected skin from muscle, sinew from bone until I’d mastered human anatomy through the precision flaying of a human corpse, but had been forced to wall off something primitive within me that would, from now on, temper empathy with new-found detachment.

That process continued after qualification. If doctors allowed our emotions free reign on the ward, if we empathised in full with the life and death enormities that suffuse every hospital, we’d be useless with grief, no good to anyone. To function, we have to keep ourselves in check, at least to some degree.

Perhaps more than anything, the enemy of compassion in today’s NHS is understaffing. When doctors and nurses are too few on the ground we are left scrabbling, exhausted and demoralised, merely to keep our patients safe. Taking time to connect with our patients as fellow human beings is all too often squeezed out.

Kate reminded us all that kindness, though freely dispensed, is priceless. If we lose our humanity, we are shadows of the doctors we should be. I like to believe that her legacy in part will be that every one of your doctors and nurses might sometimes, thanks to her, intone the same silent plea: “When you lie before me in your hospital bed, distressed, frightened, in pain, vulnerable, may the day never come that I cease to see an individual, a human being in front of me.”

I know I do. Thank you, Kate, for your inspiration.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Kate Granger inspired all of us in the NHS to be more compassionate

Our sperm donor system is impotent. Time for a rethink | Kate Brian

‘Patients are typically faced with a choice among a lengthy wait for a United kingdom donor or starting up remedy proper away, with a selection from a wide selection of overseas donors.’ Photograph: Alamy

It was a programme I presented for BBC Radio four, The New Viking Invasion, about our escalating use of donor sperm from Denmark, which sparked the recent debate about the shortage of donors in the United kingdom. Despite some rather excitable coverage, there is no proof that this is element of a wider trend for Scandinavian chic, traceable to a really like of Nordic design and Television detective dramas. Rather, our growing reliance on imported sperm has more to do with a gap in our system which is currently being effectively filled by slick and effective Danish sperm banking institutions.

These days, it is not just heterosexual couples with fertility troubles who are utilizing sperm from donors, but also much more and far more single girls and lesbian couples who want to start families. We can’t meet our national demand, and about a quarter of registered sperm donors come from overseas. The Danes, who can supply a broad selection of donors from specialist sperm banking institutions, are supplying an ever-rising proportion of our sperm imports. In contrast to fertility clinics in the United kingdom, the Danish sperm banks just deal in donor sperm and do not offer you other fertility treatment options.

Since the programme was aired, a number of United kingdom fertility clinics have been fast to level out that they can provide locally recruited sperm donors. Unfortunately, it is not often straightforward for folks who want to use donor sperm to get this info, as there is no co-ordinated system to connect sufferers with the clinics which have Uk sperm donors offered. Utilizing an overseas donor could not at first appear to develop any issues, but the longer-phrase impact could be an situation. Each and every Uk donor is constrained to commencing ten households here an overseas donor will have the identical limit in the United kingdom, but his sperm might be sent about the globe and be utilized to start off families in a lot of other countries – and there are no global limits on the amount of households an person donor can generate.

Fertility clinics in the Uk operate in a hinterland where the boundaries in between personal and NHS remedy are blurred: several private clinics have contracts to treat NHS individuals, although their NHS counterparts may possibly be treating large numbers of patients privately. With everybody competing for patients and contracts there is little incentive to share. It is not surprising that clinics may be reluctant to refer a patient to a unit which has United kingdom donors accessible, as this would suggest shedding the patient to one more clinic. Alternatively, sufferers are frequently faced with a decision in between a lengthy wait for a Uk donor or the alternative of beginning treatment method correct away, with a option from a wide selection of overseas donors.

Recruiting sperm donors can be pricey and time consuming, as only a single in each and every 20 men who decide on to do so will make the grade. Not only do they have to have substantial good quality sperm, they must also pass well being checks and go via exams to rule out the threat of passing on any diseases. If they are productive they will get £35 for each and every donation, but it is the want to assist other folks, rather than the cash, which motivates most donors.

Most fertility clinics simply will not have the time or assets to set up donor recruitment operations. There is no cash to be produced from screening the 95% of prospective donors who will be deemed to be unsuitable soon after going by means of the method. For each personal fertility clinic, donor treatment method is a reasonably tiny component of what they do, and it can be difficult to make recruiting donors cost-efficient unless you are working on a relatively large scale.

There have been suggestions that one remedy to the shortage of donor sperm in the United kingdom would be to let males to donate beyond the existing lower off age of 40, but that is assuming that the problem could be resolved by widening the pool of males who are eligible to donate. The adjust to the principles surrounding donor anonymity in 2005, which meant that donor-conceived men and women have the proper to locate out identifying specifics about their donor, has also been blamed for our shortages, but it is usually accepted amid fertility experts that this is not the actual lead to. Perhaps what we actually need to have if we are to minimize our reliance on overseas donors is a a lot more radical answer. Whether or not that is a co-ordinated method, with regional centres sharing the expense of recruitment, some central source of info detailing availability for these who need to use donors, or even one particular large nationwide sperm financial institution, it truly is clear that change is necessary.

Maybe if fertility clinics have been able to perform together as portion of a nationwide support rather than competing towards a single yet another, we would create a technique that could meet patients’ needs.

Our sperm donor system is impotent. Time for a rethink | Kate Brian

Why was Hayling Island care residence voted ideal in the United kingdom by residents| Kate Murray

From the outside, it is a fairly undistinguished looking spot. Two houses knocked into 1 on an ordinary street, with walls that its proprietor says are quickly to get a a lot-required fresh coat of paint. There is no signal to tell you that this is a care residence, allow alone perhaps the best care residence in the United kingdom.

However that is what St Leonards rest property on Hayling Island in Hampshire is, in accordance to a current survey of more than 21,000 care house residents across the country. St Leonards, owned and run by husband and wife group Frank and Mary Bartlett for more than 17 years, came out best in the Your Care Rating poll which also incorporated residents of big personal and not-for-profit care providers this kind of as Barchester, Care Uk, Anchor and the Abbeyfield Society.

Once you phase inside the front door, you get an concept of just what it is that won 15-bed St Leonards the top spot. It might not have the most up-to-date decor but there is a homely feel and workers, residents and their families are all keen to pay tribute to the large-good quality care and household ambiance it delivers. “It’s an remarkable spot,” says Diane Searle, whose 83-12 months-outdated mother Joyce Sivershas dementia and lives in the house. “It was the hardest thing I’ve ever had to do placing my mum into care, but it was like coming home when she came here. Mum is usually comfy, they fuss close to the residents like they’re their personal mums and they’ve been excellent for me as well, giving me help.”

10 of the beds are at present occupied – 3 are funded or part-funded by social solutions and the rest are self-funders.

Frank Bartlett, who worked as a healthcare microbiologist in Saudi Arabia prior to moving back to the United kingdom to get more than the property, says: “The spot isn’t going to seem considerably from the outdoors, but within we like to feel there is a heart of gold. We try out to run a family members-pleasant care house. The residents are your mums, dads or aunties and we treat them accordingly – like our family.”

Photograph: Sean Smith for the Guardian

That signifies workers generating time for “golden moments” with residents, in which they just sit and chat or hold their hands. It also indicates the Bartletts assisting out staff with car restore expenses or vacation expenses the place they can, inspiring a rare loyalty in a sector exactly where lower shell out charges frequently imply high turnover and inconsistent care. The Bartletts’ proud boast is that they have never ever had to utilize agency workers and a lot of of the 14-strong group have been doing work at the home for years. “The employees are at the heart of it – you need kind, trustworthy employees who care about the people they are seeking following,” says Mary Bartlett.

High-profile circumstances of abuse have typically dominated coverage of the care home sector. Without a doubt, on Hayling Island in the past 12 months alone, five care employees have been identified guilty of abuse in two separate situations, a single involving a residence exactly where two employees took humiliating photos of older residents, the other a different residence where three personnel covered up residents’ injuries. For older men and women or their families considering residential care obtaining a spot that will offer you a risk-free, satisfied and dignified house can seem to be a challenging activity.

The Your Care Rating poll is only a single of myriad distinct organisations supplying evaluations of care properties. Other people include the Very good Care Manual and Find Me Very good Care, which is produced and managed by the Social Care Institute for Excellence. 

A important explanation behind the launch of Your Care Rating, devised two many years ago by a group of care residence operators, was the scrapping of the star rating system of assessing homes by the social care regulator, the Care Good quality Commission (CQC).

Your Care Rating chair Douglas Quinn, who also chairs expert care home building and improvement organization Castleoak, says that a lot of people working in the care house sector noticed the need to have for a way of offering much more details for likely residents – and driving up specifications. “It really is about obtaining a way of providing residents a powerful voice, to capture independently what they feel about their care, to comprehend what they want and see whether or not they are receiving it,” says Quinn.

“The previous star rating was a great impetus to inspire folks to attempt and get as many of their homes to either great or excellent – and we hope what we’re performing can be even far more of a driver as it’s about residents’ views.”

Polling is carried out by Ipsos Mori. Care property managers distribute the Your Care Rating questionnaires to residents, but take no further component in the method, with advocates and family members asked to help if required and visual aids accessible for those who may struggle, for illustration if they have dementia. Residents then mark components of their care including staffing, residence comforts, getting a say and quality of life.

Although Your Care Rating has 32 organisations signed up and says it is the greatest survey of care residence residents in the Uk, it only takes in a small proportion of the 450,000 care home residents. But Quinn says it offers an encouraging snapshot of the sector. The typical score for the 1,055 homes rated was 871 factors out of a attainable 1,000 – St Leonards scored 991.

Quinn says great men and women are the important ingredient in higher-quality care. “A truly excellent care house manager and a great steady group of workers are so essential. Displaying compassion, real care and a true knowing of people’s requirements goes a extended, lengthy way. Yes, pay could be an problem but it’s not the only answer. You have to worth personnel, and provide job opportunities and coaching. That aids retain people and provide that consistency and great top quality care.”

Martin Green, chief executive of Care England, the organisation that represents care companies, says: “The stuff some men and women might feel critical like how deep the carpet is isn’t going to make for a excellent services. Obviously you need to have to have specified minimums on the bodily setting but the most essential bit is how the person who utilizes the service experiences it and if you can connect these two issues you are very far on the way to delivering top quality.”

From October, the CQC is reintroducing a new ratings technique with four grades from exceptional to inadequate, with each and every care house awarded a rating by March 2016.

Andrea Sutcliffe, chief inspector of adult social care at the CQC, says: “We will price adult social care providers against the five important concerns that matter most to the individuals who use them – are they protected, caring, powerful, nicely-led and responsive to people’s demands?

“Ratings will supply far more meaningful info about the quality of the services for companies and the public. It is crucial for folks who use solutions, their households and carers to obviously see and comprehend our judgments and how services in their spot are carrying out.”

Quinn sees no conflict with the inspectors’ ratings technique and Your Care Rating which, he stresses, is about generating residents’ voices heard. Green says care property operators are committed to doing work with the CQC to enhance the high quality of care. “The regulator ought to be identifying when companies are failing and if they do not increase, it need to be closing them,” he says. “We want the sector to be about good quality and outcomes – there must be no spot for poor top quality.”

Back at St Leonards, Marian Thompson, 75, is clear on what counts as great for care house residents like her. She says: “It really is the employees. They all get difficulty with us and it truly is just so friendly. It really is a property from property.”

Why was Hayling Island care residence voted ideal in the United kingdom by residents| Kate Murray

Anti-abortion clinics must be plainly labelled as this kind of – or shut down | Kate Smurthwaite

A pro-choice campaigner in Northern Ireland. Unsafe practices must be ended ‘by legalising abortion in Northern Ireland and around the world’. Photograph: Reuters

The battle for a woman’s correct to decide on when it comes to abortion is normally framed in terms of geographical boundaries, time limits and clinic regulation. For a woman going through that knot of panic from a missed period or devastating news – sickness, task reduction, relationship breakdown – throughout a planned pregnancy, these things are essential. But to have genuine handle in excess of what is happening to her, she also demands clear and accurate information about her options.

So it was particularly terrifying to read in the Day-to-day Telegraph this week that “crisis pregnancy centres” are alleged to be routinely lying and scaremongering to suit their own religiously driven anti-choice agenda.

At the very same time, a report launched right now by the sexual well being organisation Brook alleges that these organisations are misleading ladies up and down the nation, which includes in schools and prisons.

These organisations have beneficial and official-sounding names such as the Central London Women’s Centre and CareConfidential. The latter is even linked to on the NHS’s official site webpage on abortion. At 1st glance they seem like any other medical centre.

The details they offer, however, isn’t going to meet the specifications we count on from NHS-accredited health care tips providers. Numerous are telling ladies there is a link between abortion and infertility. The Royal School of Obstetricians and Gynaecologists says there is no proof of such a website link for legal abortion. The risks are true but only for ladies who have illegal, “backstreet” abortions. The conclusion we need to draw is the urgent need to have to end these unsafe practices by legalising abortion in Northern Ireland and about the world.

They also report a website link – refuted by the RCOG, Breakthrough Breast Cancer and Cancer Analysis Uk – amongst abortion and breast cancer. Nearly a third of the centres investigated by Brook had been authoritatively talking about “submit-abortion syndrome”, a disorder not recognised by any medical physique. In reality, the most typical response to abortion is, unsurprisingly, relief.

Most bizarrely of all, the Telegraph reported that two counsellors visited by its reporters have been generating the entirely unfounded and sickening claim that possessing an abortion could turn a lady into a little one sex abuser.

What all this cynical scaremongering fails to take into account is that abortion is not something that women select because it matches their handbag.

Women do not pay a visit to these centres prior to determining to have unsafe intercourse. Condoms never check out these centres prior to they choose whether or not or not to split. Antibiotics will not wander in asking if they ought to interact with the contraceptive pill. Rapists are not queued up outdoors flicking via sexual overall health literature.

These females are already experiencing crisis pregnancy. The alternative to abortion is carrying the pregnancy to term and delivering it. And that does have direct back links to bodily and mental well being hazards such as infections, bodily harm and postnatal depression. There’s also the threat of being a parent when you will not want to be and there’s no acquiring round the fact that that can make a full mess of your total life.

Individuals clinics deliberately passing off lies and horror stories as medical reality want to be closed down. People that continue to be need clear signage on their doors, internet sites and literature stating that they are anti-abortion organisations and that their suggestions should be taken, if at all, with that in thoughts. The NHS demands to preserve its distance and make certain females are not getting referred to these centres.

And 1 far more point. We require to do far better with intercourse schooling. We need to have a key overhaul of the existing decade-outdated set-up to generate something comprehensive, truth-based mostly and compulsory that reaches youthful females, and men, ahead of this type of crisis ever does.

Anti-abortion clinics must be plainly labelled as this kind of – or shut down | Kate Smurthwaite

Yes, I at times Google my individuals. Is this surprising? | Kate Adams

‘Googling and gaining even more details about individuals has its pitfalls. If it is utilised for healthcare purposes, can the information be relied upon?’ Photograph: Corbis Super RF/Alamy

Like Dr Haider Warraich, I have to admit to sometimes Googling individuals I have witnessed. When I ask colleagues and GP buddies no matter whether they do the identical, there’s a resounding “yes”.

Someone is well-known or has claimed notoriety of some sort during a consultation – who wouldn’t be curious and look for to discover out far more? More than the many years I’ve Googled the odd rock star, movie-maker, writer, actor and others. GPs are sociable beings and interested in people.

The social side of men and women, who they are and what they do, can be essential and pertinent to the dilemma they deliver to the consultation. It is uncommon for me not to know what somebody does as they leave my consulting space. Curiosity often will get the better of me but I truly feel it aids me build a rapport and a better understanding of the individual.

I’m not presented with fame extremely often. Hackney, in east London, with its large charges of deprivation, is not quite Hollywood. I also operate for the NHS. I believe the true celebs mostly see doctors privately. Seeing a person famous, nonetheless, does generate a bit of excitement in an otherwise regimen day.

Getting said that I never feel doctors in the Uk Google their patients routinely. If I am puzzled about a person I have seen – it may possibly be their behaviour or a existence history that isn’t going to seem to be to include up – it is not Google I turn to, but their healthcare information. In the NHS we have accessibility to data for the bulk of the population from when they have been born, and at times these can be fairly revealing. Medical doctors working in a hospital or in some other context may possibly not have this wealth of details to hand, so may turn to Google as an alternative.

Googling and gaining more details about patients has its pitfalls. If it is used for medical functions, can the information be relied upon? Most celebrity gossip almost certainly couldn’t. But if folks have uploaded photos and individual info to a public room, then this is what they have picked to say about themselves. Would they want their medical doctor to see it, though? In a globe more and more dominated by social media, I’m amazed how freely individuals share personal data that could backfire if others go looking.

What do physicians do if they uncover out on the internet that 1 of their patients has a drug habit? If there have been child protection concerns we would have a skilled duty to act on this information. But what about an adult on a drug binge, with no responsibility for others? If this is clinically appropriate, how may possibly a doctor introduce details gleamed from the public domain into a conversation that has not been initiated by the patient?

Keeping believe in in the doctor–patient relationship is quite crucial. Can a patient believe in a medical professional who presents information that has not been presented inside the confines of the consultation? Likewise, GP colleagues have been unnerved by individuals who have Googled them. It would seem to encroach on the personal when the physician wishes to be in skilled mode, and yet again might impact mutual trust.

The relevance of maintaining professional boundaries is engrained in us from day one particular of health-related college. No patient has ever told me that I have been Googled. I never consider I would mind but I may possibly wonder why and truly feel it was irrelevant to the romantic relationship that I have with them as their medical professional.

Perhaps there are power problems at perform here. 1 get together to the consultation understands far more than the other. For some individuals, Googling and trying to discover out about your medical doctor could be an attempt to redress this imbalance. Even so, patients are unlikely to discover anything at all salacious. Our regulatory and professional bodies, the Common Healthcare Council and British Medical Association, are very clear on this, which is very good general suggestions for absolutely everyone. Just, will not put something out there that could come back to haunt you.

Yes, I at times Google my individuals. Is this surprising? | Kate Adams