Could shared medical appointments help the NHS and patients?

In medicine, the private one-to-one consultation is sacrosanct.

Yet shared medical appointments have been used successfully for years at the Cleveland Clinic in the US. Patients appreciate them. They compare experiences with other patients, learn from their questions, gain more advice than they might otherwise, and improve their understanding of their symptoms.

For the hospital, the gains are seen in improved outcomes, higher patient satisfaction, dramatically reduced waiting times and lower costs.

Here, then, is an innovation that could help the NHS, caught between rising demand and squeezed budgets, which is leading to longer waiting lists and growing discontent. By sharing appointments, more patients could be treated more quickly, reducing waiting times, saving costs, yet raising standards of care.

They have been tried by GPs in Edinburgh, Sheffield and Newcastle, following the lead of doctors in the US and Australia. As a surgeon, I can see the potential benefits in bringing together patients undergoing the same procedure for pre- and post-surgical care.

Shared appointments are not appropriate for all patients or all conditions. They should always be offered, never imposed, and patients would always retain the option of a one-to-one consultation, if that was what they preferred. There might, however, be trade offs. Patients might be offered a one-to-one consultation in four weeks or a shared appointment in 48 hours.

They can yield real benefits in the routine care of chronic illnesses such as asthma, diabetes and heart disease, where patients can learn from and motivate each other. We already know the secret of Weight Watchers’ success lies in creating peer pressure among group members who compete to see who can shed most pounds. Alcoholics Anonymous similarly allows people to share a problem and begin to tackle it together. There are websites such as PatientsLikeMe which connect people to others with similar conditions.

However, shared medical appointments work differently from self-help groups. Each patient is examined by the doctor, diagnosed and prescribed treatment in exactly the same way as they would be in a one-to-one consultation. The benefit for the patients comes from observing how the other patients are managed, or manage themselves. In one example, a patient with heart disease was persuaded to get on an exercise bike by hearing about a teenager with a heart condition who had a passion for basketball.

The doctors are spared having to repeat the same information a dozen times a day, saving time and costs. Whereas a heart patient might require a half-hour appointment for a routine follow-up visit, with a shared appointment six or seven patients could be seen in 90 minutes.

In certain cases, only part of the appointment might be shared. For example, in a typical shared appointment for female patients at the Cleveland Clinic, the doctor performs breast and pelvic examinations and discusses test results in private, while the remainder of the appointment includes the other patients.

Given these benefits, it is surprising that shared appointments have not been taken up more widely. In an article in the New England Journal of Medicine, Professor Kamalini Ramdas of London Business School and I suggest there are four principal reasons: the lack of rigorous scientific evidence of their value, the absence of easy ways to pilot them, missing incentives and lack of awareness among both patients and clinicians.

There is another reason. Innovations in healthcare typically take 17 years to spread, from proof of principle to widespread uptake. And this is an average – some take decades.

We need smart ideas – and disruptive innovators to implement them – if we are to improve the outlook for patients and for the NHS. Shared appointments is an idea worth pursuing.

Lord Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London. He was a Labour health minister from 2007–09.

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Could shared medical appointments help the NHS and patients?

Shared concerns unite all sides of the euthanasia debate | Peter Beresford

Brigit Forsyth, the actor best know as Thelma in Whatever Happened to the Likely Lads? is currently playing a terminally ill musician on stage. Her character in Killing Time says she’s a “prime candidate for a one-way trip to Switzerland”. Forsyth has disclosed that her GP grandfather helped dying patients end their lives and that she is in favour of euthanasia. Her comments are the latest in a long line of opinions on legalised assisted dying reported in the press, which has a habit of oversimplifying the complex arguments for and against. And this seems to be damaging our ability to hold meaningful public debate on the subject.

With this in mind, a study funded by the Joseph Rowntree Foundation sought the views of people with strongly opposed opinions on the matter. Participants in both groups included people with palliative care backgrounds, older and disabled people, those from organisations concerned with care and support and individuals from academic, social work and policy backgrounds.

What emerged is a surprising amount of common ground. People with apparently polarised views on legalising the right to die often shared areas of interest and concern. It is these areas that should form the basis for further public discussion, argues the report, Assisted Dying: Developing the Debate, which is published on Wednesday by the Shaping Our Lives network of user-led groups, service users and disabled people.

Shared concerns included clear agreement that palliative care for terminally ill people is inadequate. Whether for or against assisted dying, participants showed a willingness to discuss quality of life for terminally ill people, the value placed on good-quality care, and how to invest in and provide access to this care in the face of economic inequality.

Participants recognised that the debate on legalising assisted dying was taking place in an unequal society: we often place lower social value on older, sick, and disabled people. The research identified a willingness to discuss prevailing societal values, including the concept of “being a burden” on society; the value society placed on social care and support work; and our social attitudes towards death and dying. “How should assisted dying be funded?”, “Where should it be performed?”, and “What methods and means of self-administering a fatal dose should be used?”, were just some of the common questions raised.

Despite disagreement about the extent to which detailed processes and safeguards should be included in assisted dying legislation, participants from across the spectrum of opinion generally agreed that the “how” questions were not being discussed in enough depth.

Areas of shared understanding also emerged when respondents discussed ethical and existential ideas around death and dying, including the psychological aspects of pain and suffering, both for individuals and their loved ones. “All participants had a wish to find the best way forward with compassion for people who are terminally ill, regardless of being for or against legalising assisted dying,” the report concludes.

The study shows that the issues are far more complex than much of the public debate has so far allowed. Death and dying is a core issue for human beings, and public debate must reflect this. It is time to embrace the personal, social, policy and ethical issues that participants have highlighted.

Back in the theatre, Forsyth’s dying musician is visited by a young carer (Zoe Mills) who feels it is her duty to help put older people out of their misery. According to the reviews, she comes to realise that life and death is more nuanced.

Shared concerns unite all sides of the euthanasia debate | Peter Beresford

Five Christmas miracles shared by healthcare professionals

The patient who called in tears to say a new kidney had been found

I used to be a clinical nurse specialist in kidney transplantation. Prior to that I had been in charge of home heamodialysis and cared for many patients in remote areas. On Christmas Eve I had been working and went to bed around midnight. At 1am I had a call from a patient of mine whom I had looked after on home dialysis. A kidney had become available and he had been called in for a transplant. He was in tears. He told me he had been waiting for this moment for six years but now that the time had come he felt so sad. He was sad that a family was devastated at the loss of a loved one on Christmas Day but happy to have the chance of a new life. I reassured him that the family who had lost a loved one would be comforted that the kidney was being gifted to such a wonderful man who would use the opportunity to lead a full life.

He then told me that he would remember this Christmas Day for the rest of his life and that, on receiving the call, I was the first and only person he wanted to talk to. He said: “You are an outstanding nurse. Wish me luck. Hopefully this is my last day of needing dialysis. Thank you for always being there. I never thought I would say this but I’ll miss you!” He had a transplant that day and had over a decade of healthy kidney function. That Christmas was one of my best ever.

Director of nursing education, Abu Dhabi

The baby born while a choir sang carols outside

While I’m always a little sad to be away from my family, I’m lucky enough to be part of a wonderful work team. We have our own traditions and put lots of effort into celebrating Christmases spent together. We’ve won the best decorated ward three years running, we all wear Christmas jumpers and eat our NHS Christmas dinners in the canteen together. Our receptionist even comes in on Christmas morning dressed as Santa to deliver our secret Santa gifts. As we work in maternity, anyone who can’t be discharged home to be with family is normally more than happy to be spending their Christmas with us as they’re getting one of the best gifts delivered on Christmas Day. Last year when we started the Christmas Day shift we only had one woman in labour; she needed to be delivered by caesarean section and was taken into theatre. At the same time the brass band and choir had arrived on the ward to sing carols. They stood just outside the theatre and performed When a child is born and Away in a manger while our first baby of that Christmas was born. While all births are wonderful to be a part of, this one was unforgettable; there wasn’t a dry eye in the theatre.

Midwife, London

The Christmas dinner that brought warring colleagues together

This year will be my first Christmas off this century. I’ve spent the last 15 working with people with learning disabilities in residential care homes. It’s always a great day. Life and bodily functions go on, but the Christmas spirit is always wide and the enthusiasm of the people we support is contagious. Being left in an empty London and watching everyone I know make their way back home is strangely liberating. I’ll feel odd moving with the crowds this year.

One year I was managing a home where there had been a lot of issues with staff and staff tension. It was my first Christmas there and I was determined to make it a special day for everyone. We made so much effort to make it work. We were all eating together with Christmas songs in the background; everyone was wearing a paper hat and a colleague and I burst into tears as a result of what we had achieved.

Treat Me Right! manager, London

The girl who survived life-threatening injuries from a car crash

Over 30 years ago on Christmas Eve morning a teenage girl was transferred from a district general hospital to the regional cardio-thoracic intensive care unit where I worked, having sustained serious chest injuries in a car crash. I was in charge of the unit for the late shift on Christmas Day, and looked after her for the shift. She was on a ventilator and heavily sedated. I can remember her parents at her bedside and explaining every procedure I was carrying out to keep them as well informed as possible and to de-mystify an often frightening environment for families. It was touch and go and she had numerous life threatening emergencies over the next few weeks. No one knew whether she was going to make it, but she did and was discharged a few months later. She returned to the hospital where she had originally been admitted to thank the staff for her initial care. We received a letter from the consultant there telling us he couldn’t believe she’d survived her injuries and praising us all to the skies. I bumped into her a few years later; she was doing her nurse training and wanted to specialise in intensive care.

Senior staff nurse, intensive care, London

The elderly woman who shared Christmas lunch with her family for the first time in years

I no longer work over Christmas, but my favourite memory of doing so was learning that one of my clients, who was over 100 years old, had a daughter who lived around the corner from the sheltered scheme. Her daughter was too elderly and unwell to collect her mother, so I arranged to take her to her daughter’s house where she had Christmas lunch with her daughter, grandchildren and great grandchildren. It still makes me happy to think of it.

Sheltered scheme manager, London

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Five Christmas miracles shared by healthcare professionals

Young children can be "damaged" by becoming shared between parents, youngster expert claims

Fathers’ rights groups have branded the feedback manufactured by Penelope Leach, one particular of Britain’s major parenting authorities, “worrying” and towards widespread sense.

Ms Leach, a former president of the National Childminding Association who has written a amount of books about caring for youngsters, claims making it possible for underneath fives to remain with their fathers produces “unhealthy attachment troubles.”

She also claims in her most recent guide, Loved ones Breakdown, that there was “undisputed evidence” that a time period of separation from their mother can adversely influence a child’s brain improvement.

She argues that “When individuals say that it is ‘only fair’ for a father and mom to share their 5-yr-outdated daughter on alternate weeks, they imply it is honest to the adults – who see her as a possession and her presence as their right – not that it is fair to the youngster.”

She also mentioned when attorneys bid for their consumer to have overnight accessibility with their youthful youngsters they are ignoring proof about the distressing and damaging affect on the kid.

Leach said the rights of the child must constantly outweigh those of the mother and father and extra: “It can be damaging to the child to divide time equally amongst the mother and father.”

Ian Maxwell, from Households Want Fathers, told the Independent on Sunday that society had moved on from traditional attachment theory when bonds amongst mother and little one had been observed as the strongest.

He added: “The bond between fathers and youngsters is just as essential and we would query the evidence Ms Leach is citing for the primacy of the maternal bond.”

He explained her argument did not accord with widespread sense was described her claims as “worrying.”

Leach has previously drawn criticism for her earlier bestselling guide, Your Little one &amp Little one: From Birth to Age 5, published. In this she claimed only mothers could care correctly for their children.

She has also attracted controversy soon after she claimed scientific evidence showed that leaving a infant to cry could have an effect on the improvement of its brain and make it susceptible to nervousness in later life.

Young children can be "damaged" by becoming shared between parents, youngster expert claims

Shared Lives: a neighborhood-based technique to supporting adults

In an era of shrinking social care budgets and a increasing elderly population, politicians are increasingly referring to the need for care to come “from the community”. David Cameron viewed this notion of collective responsibility as the driving force behind the “massive society”, and final year the wellness secretary, Jeremy Hunt, referred to as for the restoration of “the social contract amongst generations”.

Shared Lives is a scheme rooted in the neighborhood neighbourhood, which aims to fix a whole host of useful concerns. If you are an grownup who requirements assistance, and do not have a household capable to provide it, then choices can be restricted: moving to a residential residence, obtaining care workers come to you. Both can be unappealing or impractical. Shared Lives gives an substitute: living with an individual or family members who have signed up to turn into carers.

It is a nationwide network of companies, administered by way of councils at a regional level. Michelle Williams manages the Shared Lives service for Surrey council, which relaunched in 2012 but has been close to in various guises for numerous years. “It is just about people sharing their homes and lives,” she says. “What we do is recruit men and women and families who supply help and accommodation inside their very own houses to individuals who may possibly have a range of wants.”

Carers come in all shapes and sizes: households, people, couples. They are individuals who provide up their home to an grownup with assistance requirements. This can be somebody with a understanding disability or psychological wellness problem, or an elderly individual: the service aids men and women with a assortment of different needs. The Surrey scheme, says Williams, is hunting to extend its remit to older people with dementia. And the variety of support supplied varies based mostly on the individual’s preferences and individuals of the carer. It can consist of occasional day visits to complete-time living, and anything in amongst. The essential issue is that it occurs inside the carer’s residence.

Clare Very best, forty, has Down’s syndrome. She lived with her mother and father, but when her mum died, and her dad became abruptly unwell, she necessary somewhere to go – and did not want to move into a residential property. Via Shared Lives she was matched with Alex and Greg Clare, a married couple with 4 kids, and has been residing with them full-time for the final 3 many years.

“We just looked at obtaining a alter of lifestyle,” says Alex Clare, when asked why they determined to get involved. “We’re really family members-centred, and considered it would be nice to contain a person with a finding out disability with that. We talked about it for really some time, due to the fact we wished to make sure everyone was pleased with it.” What did her youngsters consider? “They were totally fine about it, they treat Clare as a single of the family.”

The method of matching a individual to a family members can get a extended time, as “it’s really a commitment from each events”, says Williams. “It wants to be as nicely considered out and worked through as feasible.” At first, a particular person is referred to the Shared Lives scheme by their care manager or social worker, and is assessed to see what they want out of the arrangement: what variety of items are non-negotiable, and the level of support they are looking for. Then Shared Lives workers seem into the carers they have who may possibly be ready to meet that need. If there is much more than one particular potential match, the client is introduced to a handful of people and decides who they get on with greatest.

Anybody who wants to grow to be a carer has to go by way of a rigorous process to ascertain regardless of whether they would be ideal. This involves supplying references, a criminal data verify, and checking with their landlord or home loan provider that they would be satisfied for them to use their property for this function. As soon as a particular person or loved ones has been accepted, they undergo instruction in safeguarding, wellness and security, and Shared Lives values. It is these values, says Williams, that are most critical in a carer. “It really is not always about qualifications, though frequently men and women come with some variety of background in social care. It truly is about obtaining some commitment and compassion, and willingness to open their property up, and welcoming a person into their local community.”

Each Alex and Greg Clare have caring backgrounds: he has been a understanding disabilities neighborhood nurse, and she skilled as a psychiatric nurse and has also been a childminder. Alex isn’t going to believe that a caring background is necessary, but possibly aided them to recognize what it was going to entail. “We do motivate Clare to be as independent as possible, and we’ve been capable to teach Clare a good deal of expertise – simple capabilities like cooking, and she can now stroll into town on her own and come back, which she was in no way capable to do prior to. But I can not say [a caring background] is crucial. For anyone who has anything they want to offer or give, Shared Lives is a lovely scheme for that.”

Since moving in with Alex and Greg, Clare has turn into rooted in the community, and manufactured a robust network of buddies – like reconnecting with men and women she went to college with. She has a large loved ones, with “tons of sisters”, and sees them when or twice a week. “Given that I moved, my life has changed. It has acquired greater,” says Clare. “On Tuesday mornings, I volunteer at the Certain Commence centre, with babies, and we do baby massage.” She goes to a community centre a couple of mornings a week, and is also carrying out an adult schooling course. And she has a boyfriend, who she met at a community group. “It was enjoy at very first sight,” she tells me happily. What made her choose Alex and Greg to reside with, in the very first spot? “They are a very good couple. Which is why I got to know them.”

The Surrey scheme has just more than 30 individuals living in Shared Lives areas, with an additional 10 waiting to be matched. Nationally, it is used by about twelve,000 people. Shared Lives schemes are at the moment council-funded, with cash frequently coming from a person’s individual budgets. Carers get some income to cover time and expenses, but are not paid by the hour, and – like all carers – do a massive amount that is not paid. By going into a Shared Lives property, rather than residential care or an different, an yearly average saving of £13,000 is manufactured for each and every individual by councils.

“It is been totally rewarding for Greg and I,” says Alex. “By means of Clare we have produced lots of new buddies as effectively. It truly is not a 9 until 5 occupation, it’s seven days a week, but you get to share your experiences, and be concerned in your client’s experiences, and laugh at tons of blunders.”

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Shared Lives: a neighborhood-based technique to supporting adults