Diversity, devolution, innovation: building an NHS fit for the 21st century

It was “the can-do crowd”, according to the NHS England chief executive, Simon Stevens. Those who gathered at the Health and Care Innovation Expo 2016 in Manchester were certainly hungry for the latest cutting-edge practice and the hottest technology on show.

But Brexit uncertainty, funding anxieties and the unresolved junior doctors’ dispute added a sharp edge to debate on how the health and care system can be transformed into one fit for 21st century purpose. And scarcely a session passed without warnings from patients’ and service-users’ representatives that people were feeling left out of the loop on plans for change.

Paul Baumann, NHS England’s chief financial officer and, as he said, “chief devolutionist” responsible for regional autonomy on health and care spending, set the tone for the reformers when he warned that the latest drugs and technologies would be unaffordable for the NHS unless it did “everything else differently”. This would require “bold innovation and bold leadership”.

But David Cartwright, a patients’ representative from Oldham, summed up the frustration of the opposing camp when he asked Baumann and leaders of the Greater Manchester devolution project: “When are you going to tell our communities what we are going to get and what we are not going to get?”

Public consultation on STPs assured

Stevens picked up on the mood and used his keynote speech to try to offer reassurance, particularly with respect to the 44 sustainability and transformation plans (STPs) being developed by local care leaders to transform systems across the whole of England.

He said he would be issuing a notice stressing the need for formal public consultation on the changes proposed by the STPs, which may include closure of hospital services. But he added: “I hope that people will give NHS and local government leaders the respect that what they are trying to do is incredibly difficult, but incredibly important.”

Matthew Swindells, NHS England’s national director for commissioning, said the aim was to get all plans for STPs “assured” by the end of December so that they could be aligned with operational plans effective from April 2017. Challenged on the tightness of the timescale, he said: “We don’t have time to take longer. Every day we decide to have another committee meeting rather than getting on with making hard decisions, we are not making optimal use of health and social care from the money available.”

Technology is the key

The health secretary, Jeremy Hunt, announced plans to create an “ivy league” of global exemplar hospitals to fast-track digital excellence.

Naming the initial 12 trusts each to receive up to £10m in funding, Hunt said the idea would be to “buddy up” each one with a leading US hospital such as the Cleveland or Mayo clinics to bring them up to the standard of the best in the world. Less tech-ready trusts would be prepared in subsequent waves. Hunt also promised “instant access” to personal online health records. He said: “This puts power back into the hands of the patients.”

These announcements came on the back of publication at Expo of the final report of the Wachter review of NHS digital readiness, highlighting the need for clinical input in achieving digital transformation.

The review’s author and professor at the University of California, Dr Robert Wachter, stressed the need to “reimagine tasks” rather then superimpose technology on old working methods. He said: “That is why we need to involve young people in this process. They need to look at workstreams and question why we do it that way, with fresh eyes.”

The digital revolution is, however, raising concerns about appropriate use of personal information. Dame Fiona Caldicott, the national data guardian, speaking about her review of public trust in the use of health and social care data, warned: “People no longer accept things being done to them without their knowledge.” Her review sets out 10 standards for data use, informing individuals and conditions for opting out.

Innovation needs to be implemented faster

There is no shortage of medical and health innovations to transform what NHS England’s medical director, Sir Bruce Keogh, described as the “biggest semi-integrated health system in the world”. But he pointed out that “ideas are only as good as their uptake”.

Discussing the challenge of achieving innovation at scale, Keogh outlined the NHS innovation accelerator programme (NIA) – the brain child of a junior doctor, Dr Mahiben Maruthappu. In its first year, the NIA funded 17 fellows whose ideas and processes were accessed by 3 million patients in six months, Maruthappu said, with a further cohort of fellows due to be announced in October, focusing on disease prevention, early identification and long-term conditions.

Devolution

Devolution plans are now being developed in areas covering some 55% of England, following Greater Manchester’s lead in setting up the NHS’s first devolved health and social care partnership, which came into being in April.

Jon Rouse, chief officer of the partnership, making his first speech after just 20 days in post, said no one should be under the illusion that devolution was “magic dust”. Although there was already satisfaction in the development of dementia-friendly pharmacies and Pride in Practice, a new standard of excellence in healthcare for gay, lesbian and bisexual patients, the biggest achievement so far was the bringing together of a strategic partnership of 37 NHS, local government and social organisations.

Rouse said: “Judge us later down the line by how we make progress on patient experience and clinical experience. Devolution is complex, it’s dynamic and difficult, but it’s worthwhile.”

People come first

Jane Cummings, chief nursing officer for NHS England, issued a call to arms to recognise and promote the diversity of the workforce. It was, she said, “frankly appalling” that there were so few black and minority ethnic directors of nursing. Making special mention of health workers from the rest of Europe, worried by Brexit, Cummings said: “Diversity makes us a better service.”

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Diversity, devolution, innovation: building an NHS fit for the 21st century

Tall story? Men and women have grown taller over last century, study shows

Men and women have grown taller over the last century, with South Korean women shooting up by more than 20cm (7.9in) on average, and Iranian men gaining 16.5 cm (6.5in). A comprehensive global study looked at the average height of 18-year old men and women in 200 countries between 1914 and 2014.

The results reveal that while Swedes were the tallest people in the world in 1914, Dutch men have risen from 12th place to claim top spot with an average height of 182.5cm (5ft 11.9 inches).

Latvian women, meanwhile, rose from 28th place in 1914 to become the tallest in the world a century later, with an average height of 169.8cm (5ft 6.9in).

With an increase in height seen across the century in every country around the world, the British have also gained a few inches. Both men and women have added around 11cm (4.3 in) to their height since 1914, with the average man now 177.5cm (5ft 9.8in) tall and the average woman boasting a height of 164.4cm (5ft 4.7in).

Mean height change since 1914 – women

James Bentham, a co-author of the research from Imperial College, London, says that the global trend is likely to be down primarily to improvements in nutrition, hygiene and healthcare. “An individual’s genetics has a big influence on [their] height … but once you average over whole populations genetics plays a less key [role],” he added. “Most populations would grow to roughly similar heights if they were all in the same conditions.”

A little extra height brings a number of advantages says Elio Riboli, co-author of the paper and director of the School of Public Health at Imperial College, London. “The good news is that being taller is associated with longer life expectancy,” he said. “This is largely due to a lower risk of dying of cardiovascular disease among taller people.” But, Riboli warns, while taller people have been found, on average, to have larger salaries and higher levels of education, there are downsides, with greater height potentially associated with an increased risk of some cancers.

The research was published in the journal eLife by the NCD Risk Factor Collaboration, a network of nearly 800 health scientists worldwide. The scientists drew on almost 1500 sources, including government health studies and military data, to model changes in the height of 18-year-olds across 200 countries over 100 years from 1914.

The results show that men are taller than women around the world, while for both sexes European countries now scoop the top 10 positions for height, with Dutch men and Latvian women the tallest for their sex. That, says Bentham, could be down to the introduction of a welfare state in many European countries.

By contrast, men from Timor-Leste are the shortest, with a height of 159.8cm (5ft 3in), while the title for shortest women remains with the female population of Guatemala, who have an average height of 149.4cm (4ft 10.8in).

But while height has increased around the world since the eve of the first world war, the researchers found that the degree of change varied greatly between countries.

Mean height change since 1914 – men

While South Korean women have shot up by just over 20cm (7.9 in) since 1914, men in South Africa have grown by just 1.4 cm (0.55 in) over the century. American men, meanwhile, have plateaued in height since the 1960s, resulting in a drop from third place in 1914 to 37th place in 2014. That, the authors suggest, could be down to worsening levels of nutrition and greater inequalities.

The trend in many countries of north and sub-Saharan Africa is also cause for concern says Riboli. While the research shows that height increased in countries such as Uganda and Niger during the early 20th century, the trend has reversed in recent years, with height decreasing among 18-year-olds.

“One reason for these decrease in heights in Africa is the economic situation in the 1980s,” said Alexander Moradi of the University of Sussex, who was not involved in the study. The nutritional and health crises that followed the policy of structural adjustment, he says, led to many children and teenagers failing to reach their full potential in terms of height. “I think one thing that one should keep in mind in these studies is that height is a useful indicator of how nutrition and health is developing and that these are closely related to the overall economic development [of a country], ” he added.

Bentham believes the global trend of increasing height has important ramifications. “How tall we are now is strongly influenced by the environment we grew up in. In turn, our height affects both our life expectancy and our health as adults,” he said. “If we give children the best possible start in life now, they will be healthier and more productive for decades to come.”

Tall story? Men and women have grown taller over last century, study shows

In the 19th century it was clean consuming water, now its healthy behaviour | Sally Davies

Local government could act to restrict the results of alcohol, tobacco and quick foods by incorporating a overall health effect evaluation into the approval processes for preparing applications. Photograph: Matt Cardy/Getty Pictures

The first wave of public wellness action occurred in the wake of the industrial revolution. It was mainly aimed at bettering environmental problems: the provision of clean consuming water, enhanced sewage disposal and safer foods. There was also legislation to improve functioning problems and protect children.

It was throughout this period that John Snow identified the supply of the 1854 Soho cholera epidemic as the public water pump on Broad Street, following conversations with regional residents and clever linking of information. It was later identified that the public properly had been dug only 3 feet from an outdated cesspit. Snow’s review is regarded by a lot of as the founding event of the science of epidemiology and is an early demonstration of the value of very good public well being practice.

Defending people from these types of threats stays at the heart of our public health method. We continuously face new infectious disease threats, such as antimicrobial resistance. But public well being practice is evolutionary, driven by waves of well being challenges and continuous improvement in our understanding and information. Every new wave reflects major shifts in pondering about the nature of society and wellness.

The most latest wave – roughly from the 1960s to existing – has encompassed identifying effective interventions that prolong healthful existence, higher comprehending of the leads to of disease, action close to risk factors and life-style, and addressing social inequalities in overall health.

The greatest problems dealing with societies in the 21st century are the altering burden of disease and development of resistance of microbes to remedy. This indicates that men and women and society alike need to take more obligation for well being.

Three items will support to attain this: incentives for wholesome behaviour promotion of a healthier option as the default choice and tackling environments that advertise unhealthy behaviour.

Various groups in society are probably to contribute in diverse methods. Governments need to have to make certain that public wellness policy is informed by evidence, is rigorously assessed and coordinated successfully across Whitehall. My part as chief health-related officer is unique, as I am a civil servant but have a statutory duty to give independent advice to government. It is my job to make certain that public overall health and antimicrobial resistance is at the forefront of politicians’ minds.

Meanwhile, the wide remit of nearby government – which contains infrastructure organizing, waste and recycling, leisure and tourism, and social care – gives a number of possibilities to promote healthier environments. Action could consist of reduction of the density and spot of alcohol, tobacco and quickly-foods shops. This could be done by incorporating a wellness influence evaluation into approval processes for planning.

The private sector can also play a element as employers, as building- and land-owners, and by way of its affect on customers. In particular, market has a part in promoting the wellness of its workforce, along with a broader duty to society as a complete.

Attaining all this will imply a huge adjust in social norms. There is expanding evidence of the power that social networks exert on behaviour. For healthy behaviour to come as common, institutional, social and physical environments all want to help this shift in the collective mindset. It can only function as a holistic, collaborative hard work.

Several of these ideas are not new and there is sturdy evidence for their significance, emanating for illustration from the Ottawa Charter and the Planet Overall health Organisation’s Commission on the Social Determinants of Overall health. But we need to have a new wave of leaders, in households, social networks, organisations and wider society – collectively driving a adjust towards more healthy behaviour.

•The Guardian Society Professionals web site for people doing work in the public servies is revisiting Beveridge’s five giant evils of the welfare state. Lengthy-term and continual overall health situations are a modern social evil. Find out how social professionals are helping to increase care at theguardian.com/societyprofessionals

In the 19th century it was clean consuming water, now its healthy behaviour | Sally Davies

The "Sex Talk" For 21st Century Mother and father

“Would you rather have your very first kiss on YouTube?” My 9 year old son asked, “Or a transcript of everything you explained on your very first date offered on Google?” It was like he had just entered some new 21st Century iteration of Lacan’s “Mirror Phase.” He was abruptly conscious that what he does on the Net is public.

The “Mirror Phase” is a way of describing how the ego develops as an observer of the self. Imagine that second when a youngster encounters and comprehends his personal reflection in a mirror. Put basically, French psychoanalyst Jacques Lacan’s used this picture to describe the developmental second when a kid 1st experiences and embodies the stress in between internal and external identity.

My son’s query produced me wonder if, in the recent planet, psychoanalysts might require to add yet another encounter of the self: the 1st experience with the public nature of digital networked life. After all, a substantial portion of identity is presently caught up in how a single participates in social media and the manifestation of a character “brand.” Probably people who believe Facebook is narcissistic are complicated psychological theories that borrow reflection imagery.

It was about a week just before my son’s ninth birthday and he had been thinking a great deal about dating, eros, and romance lately. I could inform because he stored making passing remarks about it. YouTube, Google, Kissing. This was new territory for me. I sat for a minute with a bit of anxiety about the conversation that was coming and then I answered his query, “I select my very first kiss on YouTube. No matter how awkward that seems to be, it is not as negative as the clumsy methods we consider to express puzzling feelings to individuals before we genuinely know how.”

It was a hint I was fishing. I hoped he’d ask me to elaborate and I could launch into a total scale sex talk. I desired him to start off the discussion.

Each and every time I’ve experimented with to have similar conversations it has been clumsy. I did an anatomy lesson last 12 months, opening with, “come right here, there’s one thing I want to talk to you about.” That didn’t perform. Also hefty. It infused the discussion with unnecessary stress. I wished it to feel standard, like an daily conversation. Providing youngsters normalized and dignified vocabulary to talk about private elements is known to be one particular of the best preventative measures we can take against abuse. The sex taboo is problematic. It can create a culture of concern where children are as well scared to talk with their mothers and fathers as they understand to make sense of their quickly shifting bodies and desires. Producing little ones really feel safe about talking openly to their mothers and fathers about sex is essential.

A few days soon after the initial awkward conversation, I downloaded the sex ed app “Birdees” to the iPad mini and informed my son I essential him to assist me review an app for an report. It was tricky but it worked. I discovered that there was a lot he did not know about his very own anatomy, words like “scrotum,” “testicle,” and “anus.” When it came to female anatomy, he only knew the phrases “vagina” and “boobies.” Utilizing the app permitted us to have an ordinarily awkward conversation with out the trouble. The illustrations in the app had been modest and completely age proper. Regrettably, Birdeesapp is temporarily unavailable We downloaded it months ago. Even now, there is a whole lot of information on the Birdees web site and hopefully they’ll release an up to date model of the app quickly.

There are a lot of wonderful books that assist to teach reproductive anatomy to primary age kids. You actually do not want an app. Despite the fact that there are new strategies of content material delivery, human anatomy hasn’t changed.

Nevertheless, it is curious that a discussion of YouTube and Google inspired the conversation in my home. It raises familiar queries about the modifying nature of socialization and about how public and private existence are knowledgeable in the 21st Century.

Unfortunately, so much of our discussion about the new digital actuality of kids’ expertise misses the important points. We tend to get misplaced in irrelevant moral debates, worrying about what’s great or negative, resisting against adjustments that seem to be inevitable. Digital technological innovation is here to remain, we need to have to fear about how we interact with it–and how we teach our kids to interact with it.

The problems is that even though we’re occupied judging the encounter, labelling it as ‘bad,’ ‘distracting,’ or ‘narcissistic,’ our kids learn not to talk to us about it at all. Would you speak to somebody about anything they are certainly judgmental about? Probably not. Neither will you youngsters. They’ll just sneak into the social internet when nobody’s searching and figure out how to behave by themselves. It is like learning the rules of the playground with out adult supervision. Cyberbullies will prevail. Quickly, you may possibly be surprised to learn that your children have an total virtual lifestyle that is designed without mature guidance.

danah boyd (she does not use capital letters), is author of It’s Complicated: The Social Lives Of Networked Teenagers. She place it nicely in her March 2014 interview with the NY Occasions, “My son is going to develop up seeing his mothers and fathers making use of devices and so I’m much more interested in figuring out approaches to help him enjoy these resources than I am in instantiating restrictions that I couldn’t model.” She’s talking about her really youthful son in this quote, but danah boyd is an specialist on the methods teens use the web. Her research shows that teenagers are “desperate for the chance to leave their properties to collect with pals.” Teenagers with no the freedom to do so turn “to social media to produce and inhabit networked publics” (p. 201).

When my son asks me whether it is greater to have a 1st kiss on YouTube or a initial date on Google, he’s unconsciously asking me to assist him perform out the guidelines of a networked public. He’s asking me for advice as he experiments with early sexual feelings inside of the social realities of this new globe. I’m glad he feels secure enough to request me. Probabilities are, your kids are asking for the exact same guidance, are you existing adequate to hear the query?

Jordan Shapiro is author of FREEPLAY: A Video Game Manual to Optimum Euphoric Bliss, and MindShift’s Guidebook To Games And Learning For info on Jordan’s upcoming books and events click right here.

The "Sex Talk" For 21st Century Mother and father

What 12 Many years a Slave tells us about 21st century black psychological health

twelve Years a Slave ‘reminds us of the current tension in between psychiatry and the black community’, writes Patrick Vernon. Photograph: Sportsphoto Ltd./Allstar

I had the privilege of attending the film preview of twelve Years A Slave organised by Damaris, a movie training charity, which made a totally free official neighborhood resources pack to assistance a debate on the key issues in the movie. The Oscar-nominated film’s narrative supplies a historical context of overall health inequalities and could be employed as a resource on cultural identify and diversity for any frontline worker, senior manager, commissioner and clinician delivering well being and social care solutions.

The film also reminds of us of the existing stress in between psychiatry and the black neighborhood which is further reinforced with deaths and inquiry processes, like those of Rocky Bennett and Sean Rigg.

Freedom is a clear theme in the film. The expression of freedom was frequently an anathema to plantation owners, the financial markets and politicians. In the 1850s, slaves working away or damaging white plantation owners’ property had been diagnosed with the developed psychological disorder drapetomania and dysaethesia aethiopis. The treatment was extreme beating, castration, a foot chopped off, or lynching.

These days, a quantity of support customers and campaigners see the diagnosis of schizophrenia as the modern equivalent, in which the therapies are medication with a range of side results and restricted talking therapies.

Jonathan M. Metzl’s book, The Protest Psychosis, provides an examination of the historical past of the diagnosis of schizophrenia. In the 1930s and 1940s in America, it was aimed at white middle class women even though in the 1960s it was redefined and racialised for black individuals associated with the Black Power Movement or linked to violent or criminal exercise.

The psychological well being charity Rethink published its report in 2012 referred to as Schizophrenia – The Abandoned Sickness that manufactured a variety of recommendations. An different commission was also established from a black, Asian and minority ethnic (BAME) point of view to challenge the notion of this label and its detrimental impact on black communities.

The situation of the legacy of enslavement, especially all around the crisis in the psychological health and criminal justice program dealing with the black community, is even now appropriate nowadays. The in excess of representation of black men and, increasingly ladies, in psychatriatic care and prisons is a single of the greatest indictments for 21st century Britain. Now, much more young children and teens are caught as victims or perpetrators of knife and/or gun crime. There needs to be a major rethink and policy growth with regards to racial inequalities exactly where mental overall health is one factor of the wider issues affecting BAME communities.

The suggestions made by the Centre for Psychological Well being report Breaking the Circle of Fear, 1st launched more than 10 years ago, contributed to the improvement of the Department of Overall health policy close to delivering race equality. The report also influenced the improvement and launch of Catchafiya, the 1st nationwide black services consumer led motion supported by the Afiya Believe in. The report’s suggestions along with other reports over the final number of many years is still relevant right now as the modifications inside of providers are still in suspended animation as the vitality and leadership for transformation modify feels light years away.

Because there is no consensus or collective method to tackling racial inequalities in mental well being services, politicians and policy makers are thus influenced by clinicians in offering answers.

The present mainstream discourse presented by psychiatrists and academics articulated in the AESOP study undertaking seeking at psychological illness inside the Caribbean community was that you can’t blame mental wellness solutions for the above representation of black men and women as they are responding to the signs from society.

In the meantime, new trends in psychosis and psychological sick health are emerging inside black, and other, communities which could be accelerated throughout this period of austerity as the marginalised are pushed to the extremes in all factors of their lives. We do need to have to generate space and a new agenda by exploring structural racism in society and its affect on companies by coming to terms with historical inequalities to develop the proper conditions around reconciliation and believe in that has the prospective to transform policy producing and services development.

The meaning of emancipation in the context of tackling mental wellness inequalities could be portion of the strategy about parity of esteem. This could be extended beyond physical and mental health to include race, gender and LGBT equality as a mantra to tackle more than representation in inpatient care, extend culturally relevant talking therapies, revisiting commissioning designs and empowering services end users, carers and the wider community close to leadership and accountability.

We also want a debate inside of the black community on the legacy of enslavement which influences our individual and loved ones relationships, and cultural identity. And, we have to counter the stigma, stereotypes and misunderstanding which existing black individuals as mad, negative and hazardous!

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What 12 Many years a Slave tells us about 21st century black psychological health