US teenager dies after succession of caffeine drinks in two hours

A teenager in the US died because he consumed too many high-caffeine drinks in a short space of time, a coroner has said.

Davis Allen Cripe died last month, about an hour after collapsing in his high school near Columbia, South Carolina. The 16-year-old had consumed a latte from McDonald’s, a large Mountain Dew drink and a highly caffeinated energy drink in just under two hours, Richland county coroner Gary Watts said.

Doctors said Davis died from a “caffeine-induced cardiac event causing a probable arrhythmia”, according to Watts.

He added that the teenager was considered healthy and the autopsy showed no sign of an existing undiagnosed heart condition.

“This is not a caffeine overdose,” said Watts. “We’re not saying that it was the total amount of caffeine in the system, it was just the way that it was ingested over that short period of time.”

Davis weighed about 90kg but would not have been considered morbidly obese, according to Watts, who added that he would have been unharmed by the same amount of caffeine on another day.

“We’re not trying to speak out totally against caffeine,” said Watts. “We believe people need to pay attention to their caffeine intake and how they do it, just as they do with alcohol or cigarettes.”

The particular energy drink Davis drank was not known but a witness said it was from a container the size of a large soft drink.

According to caffeineinformer.com, a McDonald’s latte has 142 milligrams of caffeine, a 20-ounce Mountain Dew has 90 mg, and a 16-ounce energy drink can have as much as 240 mg.

The US Food and Drug Administration and European Food Safety Authority both say that caffeine consumption of up to 400mg a day – about four or five coffees – is believed to be safe for adults. The EFSA says 200mg a day is safe for women who are pregnant or breastfeeding and that single doses of up to 200mg do not give rise to safety concerns. The American Academy of Pediatrics discourages the consumption of caffeine and other stimulants by children and teenagers.

Caffeine has been linked to previous deaths, although the cases are few and far between and the link not always clear-cut. In 2011, 14-year-old US schoolgirl Anais Fournier, who had a pre-existing heart condition, died after drinking two cans of Monster energy drink, containing a total of 480mg of caffeine. The company denied any responsibility.

In 2015, two students at Northumbria University, were were left fighting for their lives after they were accidentally given the equivalent of 300 cups of coffee in a botched experiment. They eventually made a full physical recovery.

Tony Heagerty, professor of medicine at Manchester University, said it was likely that Davis had a genetic heart condition, which may not have revealed itself in the autopsy, and that the caffeine put stress on his heart.

“I think the caffeine must have interacted with something wrong with this heart,” he said. “If you are an unfortunate person with a pre-existing condition and put yourself in a stressful situation by drinking too much caffeine you are in danger.”

But he said the levels consumed by Davis would not be harmful to the overwhelming majority of people, except for making them feel strange.

Mike Knapton, associate medical director at the British Heart Foundation, said: “It is well known that caffeine increases a person’s heart rate but it can also trigger more serious effects, including heart palpitations, in those who are more sensitive to caffeine.

“People with cardiac abnormalities, including inherited heart conditions, and those who drink toxic amounts of caffeine are more susceptible to the side-effects of caffeine. Tragic accidents like this are rare but, with increasingly strong coffees and caffeinated drinks on the market, moderation is key to monitoring your caffeine intake.”

Caffeine – what are the dangers?

The World Health Organisation recognises caffeine use disorder and caffeine dependence as illnesses.

Drinking large amounts of coffee can lead to unpleasant side-effects such as irritability, problems sleeping, restlessness, according to the NHS.

It can also result in babies having a low birth weight, which can increase the risk of health problems in later life, or miscarriage.

Caffeine constricts the coronary arteries, leading to a temporary rise in blood pressure. If drunk in sufficient quantities it causes calcium to be discharged from inside cells and causes the heart to beat faster. In the most extreme cases – caffeine toxicity – it causes major organs to shut down.

Symptoms of a caffeine overdose include dizziness, nausea, vomiting, convulsions and a high heart rate.

US teenager dies after succession of caffeine drinks in two hours

Dying patients waiting hours for pain relief in NHS funding shortfall

Dying patients are waiting up to eight hours to receive pain relief because of cuts to district nursing services during the NHS’s unprecedented budget squeeze, a new report has revealed.

Severe financial pressures on the NHS are leading to longer waits for treatment and a short-sighted and growing rationing of care that is storing up problems for the future, according to a study by the King’s Fund health thinktank.

The report quotes one unnamed manager of a hospice saying: “The district nurses working at night are not able to give effective response times; you can wait up to eight hours … for patients experiencing pain and discomfort in the last two to three days of their life, it has a massive impact. It’s a frightening time for patients.”

The King’s Fund research has found that district nursing and sexual health services are among the areas of care most affected by six years of the NHS in England receiving annual budget increases of 1.2%, far less than its historic average of 3.7% rises.

It highlights how the diminishing number of district nurses are struggling to give patients prompt high-quality care because they are increasingly overworked.

The need to balance budgets and the smaller numbers of district nurses are prompting some NHS bodies to restrict their eligibility criteria for patients seeking help, refusing it for those with serious mobility problems unless they are completely housebound.

“We heard some examples of providers attempting to limit access. This was mainly through tightening referral criteria, particularly in relation to patients being ‘housebound’. Increasingly, if patients are able to visit their general practice (even if doing so is challenging), they will not be eligible to receive care from district nurses,” the report states.

The past two years have seen a loss of one in seven (14.8%) district nursing posts. “There is a significant gap between demand for district nursing and the available resources in terms of funding and staff numbers,” researchers found. Heavier workloads are contributing to 20% vacancy rates in some places.

The report also warns: “Pressures in district nursing are affecting the quality of patient care. Staff are increasingly rushed. Visits have become more task-focused, and there is less opportunity for thorough assessments. This dilution of quality may damage patient experience and outcomes.”

Many services provided by acute hospitals have been “relatively protected” despite the lack of investment in the NHS in recent years, the authors say.

However, genito-urinary medicine services have been hard hit, with cuts of up to 20% in 2014/15-2015/16 in some places in the budgets for testing for and treatment of sexually transmitted infections. “This has resulted in fewer clinics and reductions in staff in some areas, while there have also been cuts to prevention and outreach services. This could put patients and the general population at greater risk of infection,” the report adds.

The number of hip replacements has also started to fall, despite growing demand for them caused by the ageing population. Slightly fewer were carried out in 2015-16 than the year before as NHS clinical commissioning groups (CCGs) sought to save money by making surgery conditional on losing weight or giving up smoking. Waiting times for the procedure have also lengthened and more patients are waiting longer than the supposed maximum 18 weeks.

“It’s a disgrace that as a result of the Tory funding squeeze many elderly people are forced to live in prolonged agony and without independence because they are denied a hip replacement in reasonable time,” said Jonathan Ashworth, the shadow health secretary.

“Patients are unfairly suffering the consequences of a deliberately underfunded NHS at breaking point,” said Dr Mark Porter, chair of council at the British Medical Association.

The King’s Fund warns that rationing of care will become ever more common. “Although NHS funding growth began to slow in 2010/11, it appears to have taken some time for financial constraints to impact on patient care, and our data suggests that these impacts will spread and intensify,” the report adds.

The Department of Health has told CCGs not to ration care, despite the tight financial constraints it has imposed. NHS England said only: “Ultimately these are legally decisions for CCGs, but informed by best evidence and national guidance where appropriate.”

Dying patients waiting hours for pain relief in NHS funding shortfall

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Paramedics spend 500,000 hours outside busy A&Es, say auditors

Paramedics last year spent 500,000 hours outside hospitals with a patient in the back of their ambulance because A&E staff were too busy to accept them, an official inquiry has revealed.

That was the equivalent of 41,000 12-hour ambulance shifts being taken up with waiting instead of crews being able to attend to other emergencies, according to a report by the National Audit Office.

Ambulance crews are meant to take no more than 15 minutes to hand over a patient to A&E staff and another 15 minutes to prepare their vehicle to get back on the road. “Each failure to meet this standard results in a poor experience for the patient and a delay in an ambulance crew being available for a new emergency call,” the report says.

Last year just 58% of ambulances transferred their patient within 15 minutes and 65% were ready to leave a quarter of an hour later.

All but one of the 10 NHS regional ambulance trusts are breaching 999 call response targets, services are desperately short of paramedics and funding has not kept pace with a surge in the number of patients who need an ambulance.

The NAO report says: “Ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services. Introducing new models of care has helped but there are signs of stress, including worsening performance against response time targets.”

Ambulances are meant to arrive at the scene of 75% of Red 1 and Red 2 calls within eight minutes. Red 1 calls involve life-threatening emergencies such as patients who have suffered a cardiac arrest, are not breathing and do not have a pulse. Red 2 calls are less immediately time-critical but involve events such as a heart attack or stroke. Green 1 calls have a target of 20 minutes.

In 2015-16 the West Midlands ambulance service was the only one of the 10 trusts in England to meet the three main targets, the NAO found.

The NAO flags up a 10% vacancy rate for paramedics, and ambulance trusts’ difficulties in retaining staff, as obstacles to tackling what it describes as “significant challenges”.

It says the ageing population, growing number of patients with alcohol or mental health problems and lack of health services outside hospitals all help to explain the rapidly growing demand for care. The number of calls to ambulance services and transfers from the NHS 111 telephone advice service rose from 7.9m in 2009-10 to 10.7m in 2015-16 – an average year-on-year increase of 5.2%.

Phil McCarvill, deputy director of analysis at the NHS Confederation, which represents NHS trusts including ambulance services, said underfunding elsewhere in the health and care system was a key reason ambulance trusts were under pressure.

“Our highly skilled and dedicated ambulance personnel are working incredibly hard to make sure people get the right care where and when they need it, but they are having to respond to unprecedented demand for health and care services,” he said.

“If we are to relieve the current pressures on ambulance services, we also need to see the right balance of resources going into community, primary care and social care.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “The health secretary says he wants to make the NHS the safest healthcare system in the world, but these figures show patient care and safety is being severely compromised.

“When thousands of patients are stuck outside A&E departments, ambulances can’t get to other emergencies on time. People suffering from serious conditions such as a stroke will be left with serious disabilities and other life-long problems, and there is a serious risk of lives being lost because emergency calls are delayed.”

Case studies

Rachel, Newcastle upon Tyne: “I was ordered an ambulance by NHS Direct due to a suspected brain haemorrhage. My boyfriend offered immediately to drive me to A&E but they insisted on sending an ambulance, and he was told to wait outside ready to receive the paramedics. Forty-five minutes later we were still waiting, and when we were able to speak to someone we were told that it was in the system but hadn’t been dispatched yet.

“We drove to hospital and were seen immediately. Given that we offered to drive from the outset, it was an unnecessary delay and, had the ambulance arrived, would have been an unnecessary journey.”

Paul Baggaley, Newark: “I came across a pedal cyclist lying in the road after falling off his bike on a slippery surface. A young carer stopped with us and called for an ambulance after five minutes of convincing him that he needed to be seen by hospital. He had injuries and a broken helmet after cracking his head on the road. After coming back to his senses he informed us of two spinal operations he had suffered so we didn’t move him. We kept him warm with blanket and kept him talking.

“After 20 to 30 minutes I rang 101 for police assistance to help with traffic. They arrived in 15 to 20 minutes. We stayed 20 minutes then had to leave. After we had done what we had to do, we came back past that way and still no ambulance. He was lying on the cold ground for over an hour.

“The East Midlands ambulance service is the poorest performing service in the country and things seem to be worst where we are because we are 23 miles from the nearest A&E and so ambulance service is continually stretched.”

Paramedics spend 500,000 hours outside busy A&Es, say auditors

The Guardian view on shorter working hours: not just for the rich | Editorial

Philip Hammond threatened in his interview with the German newspaper Welt am Sonntag to turn Britain into a low-tax offshore sweatshop, although he expressed a personal preference for a European model of social organisation. Just how distant his preference is from his threats is clear from some recent developments in Europe: the French have passed a law limiting the use of email out of hours; the Dutch and Finns are thinking about a universal basic income, and in Sweden the city of Gothenburg is evaluating an experiment that allowed care workers in an old people’s home to work six-hour shifts instead of eight-hour ones for the same full-time pay and benefits.

The idea has been tried on a small scale elsewhere in Sweden many times over the last 10 years, but almost always at “creative” or desk-based jobs. Dedicated physical work, as is involved in a care home, seems an entirely different category. Successive scandals at Amazon, Sports Direct, and similar places have accustomed us to the idea that a modern economy is distinguished by the most sophisticated possible exploitation of the workers who actually move things (or even humans) around by those who manipulate algorithms and exhort the rest of us to productivity.

The Swedish experiments suggest that there is a better way, and a better perspective to think about this than simply productivity, narrowly considered. They represent more than a victory for unionised labour and its allies in the endless struggle against capital. At the moment the experiment is justified on the grounds that the workers who had to work less felt less stressed and reported sick less often. They would, wouldn’t they? It still cost their employers extra money to replace them, and it’s not clear that there is the political will, in Sweden or elsewhere, for taxpayers to contribute further to the wellbeing of council employees. But there are other ways to look at the matter, starting with asking: what is the purpose of work?

The question worth asking is not whether shorter hours made the workers feel better, but whether it caused them to do their jobs better. In the case of creative industries, the answer is obvious, and to some extent measurable: there really is a limit to the amount of time that can productively be spent on sustained intellectual effort every day. Once that is exceeded, more work produces less worthwhile product. Some of the things necessary to fill a long working day, like meetings and email, actually erode the capacity to produce anything valuable. This isn’t surprising. Professional athletes have to be careful not to overtrain. Why not professional athletes of the mind and the imagination? Teachers and social workers burn out. There need be no shame in this: people are not machines, and work that demands inner resources demands also that they be given time to be replenished.

But care work, too, makes demands on the intellect, the emotions, and the capacity for attentiveness, which are hard to measure but go far beyond the physical. Anyone who has looked after small children understands this and knows that it would be almost impossible to keep up periods of intense engagement for as much as eight hours. Old people are not less demanding, deserving, or less in need of attention. If they are propped up in front of a television screen and left to vegetate for hours this isn’t productivity but institutionalised meanness and indifference.

In practice, and by long, bad tradition, every kind of health work is associated with crushingly long hours. The doctor on call and the A&E nurse can both work to the point of impaired judgment far beyond exhaustion, sustained only by the knowledge that they are desperately needed. In this country, at the moment, we can hope for no more than a very slight amelioration of these conditions. But the European experiments suggest that there might be a radically different and better way in some other future far from Brexit Britain.

The Guardian view on shorter working hours: not just for the rich | Editorial

GPs working longer hours won’t ease the pressure on the NHS | Letters

Re your readers’ stories of the NHS (‘He stayed on that trolley in A&E for the next 12 hours’, 14 January), the government is putting out a spew of misinformation to cover the 2% reduction, as a percentage of GDP, it has imposed on funding of the NHS since 2010. The people on trolleys waiting for a bed are not the worried well who are accused of blocking up A&E departments. They are people who have already been assessed as needing beds. These beds are full not just because people cannot be moved out of hospital but because the number of hospital beds has been steadily reduced over the last 20 or more years, so that the UK now has 2.8 beds per 1,000 of population, compared with 8.6 in Germany and 6.2 in France. The forthcoming sustainability and transformation plans propose further cuts.

The government prefers to blame “bed blocking” because people are remaining in hospital “unnecessarily”. But people who are fit for medical discharge are waiting for social care packages and there has been a £4.6bn cut in social care funding since 2010. What is happening is an inevitable result of the deliberate and cavalier reductions in local government funding since 2010. The motion in parliament last Thursday, calling for extra funding for social care now and a new funding settlement for health and social care in the March budget, was rejected. Conservative MPs who have deplored the situation in their local press voted with the government. How do these MPs justify their refusal to vote to fund social care properly?

Care costs money. Whenever we in Save Our Hospital Services ask if people will pay more income tax to ensure the NHS is properly funded, there is an overwhelming “yes” in response. There is also huge anger among the public at what is being done to health and social care. The government will reap what it sows.
Ruth Funnell
Save Our Hospital Services

• The illogicality of the prime minister’s response is breathtaking (Stay open seven days a week, May tells GPs, 14 January). Anyone who has been responsible for helping someone in their 80s or 90s get to the doctor will know that what is needed is a decent choice of appointments between about 10am and 5pm. Spreading appointments over extended hours will make these much harder to get, so leading to increasing numbers presenting at A&E.

It is blindingly obvious that taking the same number of doctors’ appointments and spreading them more thinly is no solution. Appointments at 7.45pm on Saturday or 8am on Sunday may suit those in work but they are not, by and large, the people arriving at A&E departments.
Jenny Boehm
London

• The GPs have quite rightly pointed out that seven-day appointments will not work. However, it may be time for some patients to make more of an effort. To avoid an appointment interfering with my working day I can join the queue for our practice’s open access 8am surgery Monday to Friday. If I get there for 7.40am, I can be back on the street by 8.15am and get on with the rest of the day. If patients reckon that GP appointments clash with going to work, then going sick or booking half a day’s holiday may be appropriate options. If your healthcare matters to you, you have no need to slide into consumer mode.
Geoff Reid
Bradford

• Is the Jeremy Hunt who stated that “We need to have an honest discussion about the purpose of A&E departments” (Hunt ditches target as A&E crisis deepens, 10 January) the same Jeremy Hunt who took his own child to A&E with a minor illness because he didn’t want to wait for a GP appointment?
Dr Clive Richards
Bristol

• I am pleased that Theresa May and Jeremy Hunt are challenging the entitled approach of the medical profession. Our GPs earn double what their French counterparts do. If the BMA had not ruthlessly exploited the public esteem for doctors to access salaries and pensions beyond the dreams of other citizens, there could be many more GPs with the same personnel budget. The NHS cannot just consume our entire public expenditure – we do need to do other things with these resources.

Medical professionals need to understand that in the 21st century they are not the only people with education and skills, and that they must adjust their expectations to allow the NHS to live within its means. The public need to take the stars from their eyes and look hard at value for money in NHS spending. Aneurin Bevan said he had to stuff the mouths of doctors with gold to form the NHS – this is still true today. At last we have a government prepared to argue for realism and fairness, to allow our national spending priorities to come more into balance.
Name and address supplied

• Amid all the debate about the current crises in NHS A&E departments, the role of employer policies has attracted little attention. The growth of zero-hours contracts and the so-called gig economy means many workers have uncertain working hours. In such circumstances, committing to GP appointments is potentially problematic. Walk-in A&E departments offer an obvious way of avoiding this difficulty.

Meanwhile, a significant proportion of the workforce faces the prospect of losing pay when absent for medical reasons as a consequence of the poor nature and coverage of occupational sick pay schemes. Once again, the 24-hour nature of A&E offers a means of avoiding this problem.
Professor Phil James
Middlesex University

• Tucked away in the bottom right-hand corner of page 4 (Rates pain for hospitals, 12 January) is news that astonishes me. I had no idea that the NHS has to pay business rates. The estimated annual sum is £377m. More disturbing, however, is the news that private providers such as Nuffield Health enjoy an 80% rebate because they are registered as charities. Private providers enjoy a rebate as charities, while the NHS is classed as a business. Verily, “For he that hath, to him shall be given: and he that hath not, from him shall be taken even that which he hath” (Mark 4:25).
Joseph Cocker
Leominster, Herefordshire

• I volunteer at a nursery school. This term the theme is “people who help us”, and in a corner a hospital has been created, complete with pictures of bones, a reception desk, waiting area and bed. The children have tiny uniforms and medical equipment. The staff and I decided that for complete authenticity we need a “waiting time approximately 5 hours” sign, and make all the children wait outside in the corridor.
Jean Austin
Crawley, West Sussex

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GPs working longer hours won’t ease the pressure on the NHS | Letters

NHS crisis: "My frail mum was forced to wait on the floor for eight hours"

Dozens of hospitals in England have had to declare a black alert – a status that means its emergency care facilities and beds are under extreme pressure – this week after becoming so overcrowded that they could no longer guarantee patient safety.

It follows a warning from the British Red Cross that the NHS is facing a “humanitarian crisis” this winter, claims that have been denied by Jeremy Hunt, the health secretary. We asked for your stories of the health service over the past few weeks. Here are a few of the responses we received:

Sylvie Newman, 63, Worcester: ‘A trolley isn’t the right place to put a person having a heart attack’

My husband got into bed at midnight on New Year’s Day and had trouble breathing. He also felt a tightness in his chest. He has a family history of heart disease so we called 999. We live in a rural part of Worcestershire but the paramedics were with us within 10 minutes. After their usual checks they said he needed to be admitted to hospital. We arrived there 20 minutes later.

My husband was wheeled into A&E on his ambulance trolley, and he stayed on that trolley for the next 12 hours.

The NHS staff there were working flat out to deal with the patients around them. While the staff were cool and collected there was chaos all around: patients on trolleys and ambulances arriving with new people. Three local hospitals had been diverting patients because they were swamped too. But there was no space here either – I saw an ambulance unable to unload a patient because of overcrowding. I counted 24 other ambulance trolleys around the corridors. There were a lot of older people around and everyone who was there looked like they needed to be there.

After five hours they said my husband wouldn’t be going home and that he’d had a heart attack. It was another seven hours before he went upstairs for an angioplasty and a stent. The A&E staff were under immense pressure, having to deal with far too many patients, but they did an amazing job.

It was shocking to find out he’d had a heart attack. That was a scary thing because you don’t know how it will end. The wait was worrying. We hadn’t gone to bed that night because he couldn’t rest on a trolley. It wasn’t the right place for a person in the middle of a heart attack.

I want to emphasise that the NHS staff were brilliant and reassuring; they kept us informed of progress the whole time. However, they are under unsustainable pressure and I fear for the future of our health service.

Robert Woodbridge, 57, Kent: ‘My wife had just had a stroke, but there were no beds and specialist staff to help’

Robert Woodbridge

My wife went outside to put the bin bags out when she got a headache on 5 January. She seemed disorientated, so I sat her down and then she started having a stroke. I immediately called 999. It took 30 minutes for the paramedics to get there but when they arrived they were brilliant.

The challenge came when we arrived at A&E. We had to wait in the ambulance because there were no beds. This meant the ambulance staff were forced to stay with us for three hours. During that time my wife got a CT scan. Eventually she went into accident and emergency in the middle of the night. It wasn’t until the next day, at 5pm, that she was placed on a ward.

My wife wasn’t comfortable at all during her trolley wait, but there was nothing anyone could do. It was so busy I thought something out of the ordinary had happened but staff said it was like this all the time.

My emotions were, and still are, all over the place. I don’t think I will relax until my wife is back home with me. While I was waiting with her I felt so helpless. In that situation all you want is for your loved one to be seen but help wasn’t forthcoming. Most of our stay that night was on a trolley in a room usually reserved for gynecology patients. It’s lucky there was no one there that needed the space.

I don’t want to blame the paramedics or any staff at the NHS. They do a wonderful job and do their best to take care of patients when they arrive. But the issue is with the government and the lack of funding to our healthcare services. The state we are in is because of policy decisions coming from higher up.

Barbara Procter, Wales: ‘No one as frail as my mum should lie on the floor for eight hours waiting for help’

On 5 January my 82-year-old mother had a fall and we had to wait eight hours for an emergency ambulance to arrive. She was in pain and lying on the floor. We couldn’t move her as we thought she had broken either her leg or hip. That was at 7.15pm and the ambulance turned up at 3.25am. She left for hospital at 4.45am. I sat next to her on the floor in one of the longest nights of my life.

I want to say now that paramedics, dispatchers and A&E staff were all excellent but resourcing was clearly the issue. Ambulances were in a queue at the hospital as there was no room in A&E. My mum was taken from the ambulance to get an x-ray and then back to the ambulance again. It wasn’t until later that they found her a space in accident emergency assessment.

Luckily my mother hadn’t broken any bones but she had badly sprained her knee. She is back home now. Nobody as frail as my mum should have to lie on the floor for eight hours waiting for an emergency service. How is that acceptable?

Andrew, 37, Wickham: ‘My frail mother was in the A&E unit for over 24 hours’

My mother was taken into hospital on 1 January. She had been complaining of serious chest pain, so an ambulance visited her care home – it took them four hours to arrive – and took her to our local A&E department.

My mother suffers from Alzheimer’s and upon arriving at hospital she was seen by the cardiac nurse before being moved to a corridor under the supervision of a nursing assistant for seven hours. There she waited for an assessment bed to become available. She became extremely agitated during this period. She had another ECG which showed a change to her sinus rhythm, which she received medication for. Finally, after 9pm an assessment bed was found and we left her in the care of the hospital in the understanding that she was being moved to a ward. But when I followed this up in the morning it turned out she hadn’t been moved because there was a lack of beds. They said she would be moved to a bed during the day as the consultant wanted to see her later. Reassured (but not entirely happy) I left, but when I called up in the afternoon I was told was she was being discharged that day. They said there weren’t any beds available in the hospital so they sent her back to the care home with tests not completed. My frail mother was in the A&E unit for over 24 hours. The staff even forgot to give us her discharge paperwork. I believe that the staff helped as much as they could but they are completely overworked.

Susan Perkins, 62, Hampshire: ‘We waited 13 hours to get on a ward. I was worried he’d have another stroke’

On Saturday my husband started to feel unwell and he described the symptoms of a minor stroke. He rang the 111 number and they said they would call him back but after two hours he had still not heard anything. I thought his symptoms sounded very worrying and that he needed medical attention quickly if it was a stroke. So I rang the 111 number again insisting we get help and they eventually called back an hour later.

A woman protests outside the Department of Health in in London on 12 January. Photograph: Daniel Leal-Olivas/AFP/Getty Images

We were then given an appointment to see the out-of-hours GP located at our nearest hospital. We were there at 3.30pm. The GP ran tests and said she also was concerned my husband had suffered a minor stroke. She rang the medical registrar who said to send us straight through.

We thought the next stage would be quick, but we had a huge wait – it wasn’t until 9.15pm that someone saw us again. I complained twice that we got seen. They kept saying they were waiting for a doctor to see us but it just didn’t happen. This seemed odd as the medical registrar was supposed to be expecting my husband – it later transpired that the real reason for the delay was there was no cubicle for my husband to be seen in. During this time I was sick with worry that he could have another stroke. For two hours we were repeatedly told that he was next on the list.

My husband decided he had enough of waiting (after five hours in A&E) and decided to leave. I went to the reception desk and told them that my husband had insisted I take him home, that I didn’t think this was a good thing to do but I couldn’t persuade him to stay. This prompted some action and about five minutes later a doctor came out and helped to persuade my husband to go back in and be seen.

When a doctor came and we found out that he had most likely had a minor stroke, things sped up and he was admitted. He had a CT scan and an ECG later that evening, followed by an MRI on the Sunday and an ultrasound on the Monday. We would have been waiting even longer if we hadn’t complained and said we were leaving.

Tom Lawrence, 25, London: ‘My lung abscess was misdiagnosed. NHS staff make mistakes when overworked’

Around Christmas I developed a fever and pain in my chest. I was coughing up little bits of blood and when I was examined in A&E – because my lungs were clear – I was diagnosed with muscle pain. I was advised to get paracetamol and ibuprofen for the fever.

But it felt like it was more serious than that. I developed pneumonia and a lung abscess this time last year and it felt similar to that. So I waited a day and made my way back to hospital. When I arrived it was very overcrowded. The reception said there were no doctors and advised me to visit another A&E in London. I decided to wait another day, telling myself that I would go to my GP in the morning and get a referral. Unfortunately the next day my surgery was closed so I called 111 who arranged an appointment for me at another hospital.

They listened to my chest, also said it sounded clear, but that given my history it wasn’t worth taking the risk and would be best if I had an x-ray. When that came back the doctor said they had seen something they “didn’t like the look of” and I gave me a prescription for five days of amoxicillin, which she said would clear my infection up. I was due to travel the next day to Amsterdam to visit family for Christmas and was told that I could do so. But when I left the country my condition worsened and I went to the GP who called the lung specialist at one of the hospitals in Amsterdam. They arranged for me to go and have an x-ray and a CT scan. At hospital I was diagnosed with a lung abscess and was admitted into care. The doctors there were surprised that it hadn’t been spotted in the UK and that they had let me travel.

I suspect I slipped through the net because I’m young and the likelihood of lightening striking twice is slim. Most of the hospitals I visited were completely overrun. When there are too many patients for doctors and the medical staff are overworked mistakes are bound to be made.

Dr Liam Brennan, president, Royal College of Anaesthetists: ‘These are no longer winter pressures, but perennial pressures’

In my 34 years as a frontline doctor I have never seen the breadth and scale of the relentless demands across the whole health and social care system that I see today. These are no longer “winter pressures”, but perennial pressures. I fear these are indicative of a system too often at breaking point, in urgent need of additional funds and reform. All too often there are simply not enough beds, staff and other resources to go around.

All healthcare professionals are finding it harder and harder to deliver safe and effective patient care. Many of my colleagues are distressed, demoralised and exhausted, physically and mentally, as they battle every day to do their best for patients in an increasingly beleaguered system.

The UK is spending less of our national wealth on our healthcare needs than most comparable nations. At this existential point in the NHS 69-year history, we desperately need an urgent injection of funds to alleviate the immediate crisis followed by a national conversation involving patients, healthcare professionals and politicians about the future of our NHS.

Without these actions and as someone whose family relies heavily on the NHS, I fear for the future.

NHS crisis: "My frail mum was forced to wait on the floor for eight hours"

More than 2m people wait over four hours in A&E, figures show

More than 2 million people had to wait more than four hours at A&E units last year, a sharp rise on the previous year, official NHS figures have shown.

The latest annual data from NHS Digital shows that more people than ever before were treated at an accident and emergency unit in England last year – the first time the figure has risen above 20m – which suggests shortstaffed units are under increased pressure.

In 2015-16, 20,457,805 people attended either an emergency department at an acute hospital or an urgent care centre or walk-in centre. That was about 900,000, or 4.6%, more than the previous year.

The NHS experienced a surge in demand last winter, similar to the one this year that has prompted widespread claims from medical groups that the service is in crisis.

While A&E attendances between April and December 2015 rose by just 2.2% to 15.2m, compared with the same period a year earlier, they shot up by 12.2% between January and March 2016 to 5.2m, again compared with the same quarter in 2015.

A&E attendances

More patients are waiting longer before they leave A&E. In 2015-16 a total of 2,090,200 people were not dealt with for at least four hours and one minute, well up on the 1,638,058 seen the year before. Last year, 5.2 million people waited between three and four hours for care, up from the 2.4 million who did so in 2007-08, and the 4.9 million who did so in 2014-15.

NHS waiting times

The figures, which underline the relentless and ongoing increase in demand for A&E care, come a day after the health secretary sparked a huge political row by vowing to water down the NHS’s commitment to treat and then admit, transfer or discharge 95% of patients within four hours of their arrival.

Jeremy Hunt told MPs: “This government is committed to maintaining and delivering that vital four-hour commitment to patients. But since it was announced in 2000 there are nearly 9m more visits to our A&Es, up to 30% of whom NHS England estimate do not need to be there. And the tide is continuing to rise.

“So, if we are to protect our four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”

Labour and the Liberal Democrats said Hunt was letting down patients by saying that the four-hour pledge – which has existed since 2004 though initially with a target of 98% – should not apply to the 30% of people who attend A&E with a minor ailment.

Theresa May’s spokeswoman insisted on Tuesday that Hunt had made no change to the four-hour pledge when he addressed MPs.

“The point that the health secretary was making in the house yesterday is a point that the government has made before, which is about making sure that A&E is there for people for what it says on the tin – accident and emergency. It’s not about non-urgent care,” she said when asked if Hunt had weakened the target.

There was, the spokeswoman said, “more to be done to make sure that the public understand” when they should go to A&E departments. Hunt had briefed the cabinet on Tuesday about the pressures facing A&E, she added.

“The target is a target for accident and emergency,” she said. “I understand what accident and emergency should be about. If I have a cold, I’m not going to go to accident and emergency and expect to be treated for a cold within four hours.”

Asked whether the four-hour target originally featured this distinction, she said: “There’s a commitment that accident and emergency is for emergency care.”

NHS organisations say inadequate GP and social care services outside of hospitals, including sometimes long waits to see a family doctor, are prompting more and more people to use A&E.

Growing numbers of patients who arrive at hospital through A&E are having to be admitted as a medical emergency, with 4.1m such cases last year. But that remains about one in five of all attendees, and not a growing proportion, despite the growing numbers of older people and the often complex medical conditions they present with.

Four million (19.8%) other patients were discharged to be followed up by their GP, and 2.6m (12.7%) were referred to a specialist clinic or outpatients department, NHS Digital’s data shows.

NHS England also produces data on A&E activity. While it covers every type-one unit, urgent care centre and walk-in centre in England, NHS Digital’s figures are based on just 87% of such places, though they do include every hospital emergency department.

“This report confirms what we have been saying, that hospitals are coming under increasing pressure but in the main are continuing to cope,” said a spokesman for NHS England.

“In fact, these figures show that last year the median time to assessment was 11 minutes and, on average, patients left A&E just two hours and 40 minutes after arriving. This shows the fantastic job staff are doing in ensuring patients get the urgent care they need.”

NHS England repeated its plea to the 30% of people believed to be turning up at A&E unnecessarily to seek care elsewhere, such as with a GP, pharmacist or NHS111.

More than 2m people wait over four hours in A&E, figures show

Acutely ill children waiting nine hours for beds in intensive care

Seriously ill children are waiting up to nine hours for an intensive care bed to become available, while others are being transported up to 120 miles from their homes to receive the medical treatment they urgently need, senior paediatricians have revealed.

In the last two weeks, at least 17 children with acute illnesses requiring intensive care have had to be transported out of their regions because of a lack of beds. Some paediatric intensive care units, treating the most seriously ill children, are worked at 150% of their capacity, such is the level of demand and lack of resources, according to the Paediatric Intensive Care Society. As of Friday night, there were just four beds available in England and one in Belfast.

The revelations illustrate the stress being faced by the NHS this winter. New figures provided by the Labour party additionally show that, in October, only 67.3% of ambulances for the most seriously ill adults and children, who are not breathing or do not have a pulse, arrived on the scene within eight minutes of being called, against a target of 75%.

Dr Peter-Marc Fortune, a consultant paediatrician and president of the Paediatric Intensive Care Society, said the network of intensive care units had been officially designated “critcon 2” at a national level, meaning that the system was running at “full stretch”.

Last week the Observer revealed that units in London and Leicester were at full capacity.

Fortune said the situation was now “hottest” in the north of England and added that he feared paediatric intensive care units nationally could in the coming days be designated as “critcon 3”, defined as an unprecedented situation under which three of the four regions declare themselves as working at maximum capacity.

He said: “I have heard back from about a third of the units in the country. None of them were running at less than capacity. And there were reports of anything up to 150% of what would be the commissioned full level.

“I would not suggest that anyone has come to any harm, and it is important to say that. However, we are concerned that the system is stretched to capacity and that any further stress on the system will risk a reduction in safety standards.

Dr Peter-Marc Fortune, president of the Paediatric Intensive Care Society

“We are in this position because we commission a certain number of beds in the country and during the year that capacity copes.

“But we believe, anecdotally, it runs above the international safety standard of 85% of capacity. Most units are reporting that over the year. When we come to the pinch points, which is traditionally the second and third weeks of December, you are obviously going to stress the system at that time. It is being pushed to its absolute limits.”

Fortune said he was aware in the last two weeks of a child having to be transported 120 miles to an intensive care bed, and a second case in which an acutely ill child had to wait nine hours before a free bed could be identified.

He said: “Fortunately with that particular child we were able to deliver all the therapies via our mobile team. There are therapies that require a child to be physically in an intensive care unit. We are being forced into a triage situation because we don’t have the ability to move children immediately into beds full time.

“While our mobile teams – of which there are only one or sometimes two for a brief period of time in each of the regions – are tied up they cannot respond to another case, perhaps in a different general hospital. People there will be very able to do the initial care but as things step up they cease to be in a comfort zone. It’s certainly not ideal.”

Fortune, who called for a review of paediatric critical care services being undertaken by the NHS to address the lack of resources, added: “In itself the time on the road is not a problem as long as the child doesn’t become unstable in that time. And our teams are very good at getting them stable. But you clearly want them to be able to get from a place of security to the ultimate place of security, which is intensive care, as fast as possible. And that ideally does not mean travelling 120 miles.”

Details of the current situation have emerged as a report from the Paediatric Intensive Care Audit Network (Picanet) lays bare the strains on the system. In 2015, only a third (29%) of the country’s paediatric intensive care units (PICUs) met the nursing establishment levels currently recommended by the Paediatric Intensive Care Society.

One in five referrals for admission to a PICU are refused, with nearly two thirds of these refusals due to no staffed bed being available. The report notes: “While most children who require a PICU bed will eventually be admitted, the process of approaching many PICUs to find a bed is time-consuming and stressful for parents and carers and hospital staff.”

Referring to the data for last weekend, a spokesman for NHS England said: “Figures published on Friday show PICU occupancy across England was 85%, proving that beds are indeed available when needed.”

Acutely ill children waiting nine hours for beds in intensive care

Drink THIS 2 Hours Before Bed To Sleep Like a Baby

Drink THIS 2 Hours Before Bed To Sleep Like a Baby

Functioning longer hours ‘increases stroke risk’

The very likely toll of extended operating hours is uncovered in a significant new study which demonstrates that workers nevertheless at their desks into the evening run an increased risk of stroke – and the longer the hours they put in, the larger the threat.

The biggest study ever conducted on the problem, carried out in 3 continents and led by scientists at University University London, discovered that these who perform far more than fifty five hrs a week have a 33% increased threat of stroke compared with those who operate a 35- to forty-hour week. They also have a 13% increased risk of coronary heart ailment.

The findings will confirm the assumptions of numerous that a prolonged-hrs culture, in which men and women function from early in the morning until finally effectively into the evening, with function also intruding into weekends, is possibly dangerous to well being.

The researchers, publishing their findings in the Lancet health-related journal, say they are not able to state categorically that long hours result in folks to have strokes – but their research demonstrates that there is a hyperlink, and it gets more powerful as thehours people place in get longer.

“Sudden death from overwork is often induced by stroke and is believed to outcome from a repetitive triggering of the anxiety response,” they write. “Behavioural mechanisms, this kind of as physical inactivity, may well also link prolonged doing work hours and stroke a hypothesis supported by evidence of an enhanced risk of incident stroke in men and women who sit for extended intervals at function.

“Physical inactivity can boost the threat of stroke by means of numerous biological mechanisms and hefty alcohol consumption – a threat factor for all sorts of stroke – might be a contributing element simply because staff working lengthy hours appear to be somewhat more prone to risky drinking than are people who operate normal hours.”

Folks who operate long hrs are also far more probably to ignore the warning indicators, they say – leading to delays in obtaining treatment.

Mika Kivimäki, professor of epidemiology at UCL, and colleagues looked individually at heart condition and at stroke. For coronary heart illness, they pulled together 25 studies involving far more than 600,000 males and girls from Europe, the USA, and Australia who have been followed for an common of 8.five many years.

They then pooled and analysed the information that had been collected. This developed the locating of a 13% boost in the possibilities of a new diagnosis of heart condition or hospitalisation or death.

For stroke, they analysed data from 17 research involving virtually 530,000 males and ladies who were followed up for an typical of seven.two years. They located a 1.3 times larger chance of stroke in people working fifty five hours or more, in contrast with individuals doing work a regular 35- to forty-hour week.

Relevant: How to avert a stroke in middle age

This association remained even right after taking into account health behaviours such as smoking, alcohol consumption and bodily exercise, and normal cardiovascular threat aspects which includes large blood strain and large cholesterol.

The longer the functioning week, the larger was the danger of stroke. People working amongst 41 and 48 hrs had a 10% greater chance of stroke, and individuals working 49 to 54 hours had a 27% elevated risk.

Prof Kivimäki said the scale of the study had allowed the crew to be much more exact about the well being toll of long hours than ever just before. He suggested that doctors should get note of the achievable hazards to their difficult-working patients. “Health professionals should be conscious that operating extended hrs is connected with a considerably enhanced chance of stroke, and possibly also coronary heart ailment,” he explained.

In a commentary in the journal, Dr Urban Janlert from Umeå University in Sweden writes that the European Working Time Directive, meant to limit the day to 48 hrs, is not in result in all nations. “Long working hours are not a negligible occurrence. Amongst member nations of the OECD, Turkey has the highest proportion of people functioning far more than 50 hrs per week (43%), and the Netherlands the lowest (much less than 1%).

“Although some nations have legislation for doing work hours … it is not always implemented. For that reason, that the length of a operating day is an essential determinant mostly for strokes, but probably also for coronary heart disease, is an essential obtaining.”

Dr Tim Chico, reader in cardiovascular medication at the University of Sheffield, said the research did not demonstrate extended doing work hours can lead to stroke or heart disease. “It is practically undoubtedly impossible to show regardless of whether there is a direct website link as this would need 1000′s of men and women to be randomly allotted to function a lot more or less hrs and followed up for many years to see if this changes the chance of stroke, even though retaining all other behaviours the very same in between groups,” he said.

For a lot of folks, cutting down on working hours would be hard or extremely hard, he explained. “Most of us could lessen the amount of time we commit sitting down, enhance our physical exercise and increase our diet plan whilst doing work and this may well be much more crucial the far more time we commit at perform. We must all contemplate how the operating setting could be altered to advertise healthier behaviour that will lessen strokes, irrespective of how long we perform.”

Functioning longer hours ‘increases stroke risk’

Half who miscarry "wait 24 hours for a scan" - Mumsnet

“I had to wait 6 months to get counselling and lost six months of my existence as I was not coping with the loss,” one particular girl wrote.

And while 58 per cent of respondents wanted additional health-related care, just 26 per cent were presented it.

“The hospital explained they’d request a well being visitor to get in touch with me. That was two months ago nobody has been in touch,” replied an additional.

^{The survey located that aftercare following miscarriage is woefully inadequate. Photo: ALAMY}

In 2012, Nationwide Institute for Overall health and Care Excellence (Nice) advice stated that miscarrying at property would be the default clinical response for girls undergoing miscarriage before the 13th week of pregnancy. But these outcomes show this policy is leaving women with out the assistance they need: only 15 per cent of females who miscarried at property, following a scan, felt they had the proper assistance, data and ache relief to cope.

“I was told, more than the telephone, to ‘just sit on the toilet and hopefully it will all come out’,” recalled a single Mumsnet user.

Eleven ladies were asked to retailer their miscarried foetus at residence – some reportedly in the fridge – prior to additional tests currently being carried out.

Only a quarter of the girls surveyed spoke of their experiences to pals and only 13 per cent told wider loved ones.

A campaign for greater care

Mumsnet users are campaigning for far better care in situation of miscarriage. They are calling for straightforward improvements in the treatment patients acquire like: supportive employees, accessibility to scanning, secure and appropriate spots for therapy, good info and powerful treatment method and joined-up care.

Many of the factors are integrated in greatest-practice advice from the Department of Well being. But the analysis exhibits that, also usually, it’s not becoming implemented.

Mumsnet is now asking for a parliamentary dedication to strengthening miscarriage care.

^{Mumsnet founder Justine Roberts (right) is campaigning for better miscarriage care. Photo: ABBIE TRAYLER-SMITH.}

Justine Roberts, the founder of Mumsnet, explained: “There’s no escaping the ache of a miscarriage. But for this to be compounded by lack of treatment method, pain relief, very good care – or just plain human kindness – is fully unacceptable.

“We are calling on the three primary parties to contain a pledge in their manifestos to enhance miscarriage care, primarily based on the ideas in our code.”

Cathy Warwick, chief executive of the Royal College of Midwives, added: “Midwives and other overall health professionals have an important role to play in supporting ladies and families via the bodily and psychological influence of miscarriage.

“Kind, compassionate and empathetic communication about care and remedy is an important stage to assistance households. It is specifically important that there is successful communication amongst the hospital, GP and midwife to supply ongoing assistance or guidance, as essential.”

Half who miscarry "wait 24 hours for a scan" - Mumsnet

Ed Miliband says you are going to see your GP in 48 hours. We have been here ahead of

We’ve been here before: a political guarantee from Labour to assure all individuals a GP appointment within 48 hours. Another soundbite has been delivered with no real concept the place Ed Miliband intends to magic up the army of major care doctors required to provide it. Final time this was enforced, individuals were unable to book advance appointments due to the fact GPs had to clear their diaries to accommodate political victory in the waiting time numbers game. Continuity of care was even more eroded, and it was deeply unpopular with patients who could get an preliminary appointment but not the follow-up.

GPs would adore to be in a position to see their sufferers with no delay, with continuity and longer encounter-to-encounter appointments. But this simply can not be delivered with no addressing the workforce shortfall on the front line of the NHS.

In the lengthy-term, the remedy will only come when we commence valuing principal care in healthcare school instruction and style postgraduate training with the demands of individuals in mind. Currently the job preferences of junior medical professionals and the need to fill education posts in our hospitals trump lengthy-phrase preparing. It was great to hear this recognised by Simon Stevens, the new Chief Executive of NHS England, when he appeared just before the Overall health Select Committee.

It will take numerous years to train GPs but significantly less time to deliver returners back into practice. Half of today’s GPs are girls a result in for celebration but also for better forward preparing for the actuality that numerous will consider a career break for child care responsibilities. Women are not a “drain” on the NHS. The majority want to get back into practice and frequently do so alongside other vital roles inside of the support. It makes fiscal sense to put more return-to-practice schemes in place for medicine and nursing to inspire back this experienced workforce.

Provided the growing complexity of the health problems managed in principal care, the quantity of appointments we need rises each and every 12 months. This nevertheless, bumps into a long-predicted retirement bulge of complete-time male GPs and an ongoing shift of sources into hospitals from the community.

The Better Care Fund aims to reverse this movement but it won’t supply far more GPs.

It is time to search instead at better diversity on the front line of wellness care? Bringing in a greater assortment of skills from pharmacists and nurse practitioners will be essential if we are to make certain individuals can see a medical professional inside of 48 hrs.

It will not be helped by Ed Miliband sprinkling top-down directives like fairy dust.

Dr Sarah Wollaston is the Conservative Member of Parliament for Totnes

Ed Miliband says you are going to see your GP in 48 hours. We have been here ahead of

Frédéric Gros: If you walk for many hours, you can escape your identity

It is a sunny spring Sunday and – joy! – I am off to Paris to go for a walk. Not any old walk, but a stroll with a guy who truly knows about strolling: Frédéric Gros, a professor of strolling. A philosopher of walking.

Strictly speaking, he is actually a professor of philosophy who writes about walking, but this is nitpicking. What do I care? I really like strolling. Absolutely nothing offers me better pleasure than strolling uphill, for hours, in purchase to rest under some flimsy piece of nylon material and then do it all yet again the next day.

This distinct stroll is not up a mountain, it really is in the Bois de Vincennes, Paris’s largest green room, but nonetheless. I am looking forward to a lungful of fresh air and the sort of insightful aperçus that potentially are offered only to a Frenchman with a secure academic position and a command of one of the much more expressive Latinate languages.

Strolling is not sport, he says, in the very first line of his guide, A Philosophy of Walking. Sport is a discipline, “an ethic, a labour”. It is a efficiency. Strolling, on the other hand, “is the greatest way to go much more gradually than any other approach that has ever been discovered”. If you want to go quicker, he says, will not walk. Do one thing else: drive, slide, fly.

I am hunting forward to going far more gradually. However I am worried about my footwear. I am wearing Nike trainers. Are they as well sporting? Gros would seem as if he may be much more of a leather brogues type of man. He can make a jibe at individuals who try to commodify walking and promote it back to us as “trekking”. Who insist on “outstanding socks”. And specific trousers with too numerous pockets.

My trousers have the usual quantity of pockets. And reading his guide has made me prolonged to be in a wild area with nothing at all to do but stroll. I want to go over the observations from his book: that walking is an escape from the notion of identity that there is a variety of serenity that comes with basically following a path that walking is a type of pure living.

This is the plan, even though the first indication that issues might not go exactly as I imagine comes as I wait in line for the Eurostar. Ping! An electronic mail lands in my inbox: “Carole, could you send me some concerns you will inquire prior to we meet? If I could prepare some, I would be much less stressed.”

Stressed? This does not seem right. Gros’s book, a surprise bestseller in France, talks of walking as a kind of “existence scoured bare” as a way of “experiencing the true”. Its pages are filled with calm reflections on the joys of moving gradually. He just doesn’t sound as if he should be the stressy type.

“It is the English,” he says when I last but not least meet him in a cafe opposite the Bois de Vincennes. He has a sheaf of printed out pages – answers to concerns I sent him earlier, a glass of rosé on the go (“I am nervous. Coffee will not support”) and an amused PhD student who he’s brought along for what he calls “translation aid”, however I suspect “moral help” may possibly be closer to the mark.

Do not be stressed, I tell him. I loved the book. It’s an examination of the philosophy of various thinkers for whom strolling was central to their function – Nietzsche, Rimbaud, Kant, Rousseau, Thoreau (they are all males it really is unclear if women never stroll or do not believe) – and Gros’s own ideas on the topic. It really is a passionate affirmation of the straightforward life, and joy in easy items. And it truly is beautifully written: clear, simple, exact the opposite of most academic creating. But, when I say this to Gros, he waves his hand. “I think it is almost certainly the translation. I do not consider it was so well written in French.” And he requires a nervous swig of his rosé.

Why are you nervous, I request. You must have carried out interviews before. “They have been in French,” he says. “And also… Um… I’m not so certain I am intriguing.”

It looks Gros has not acquired to grips with enjoying the sort of media-academic demi-god that these circumstances require. He’s one particular of the world’s top authorities on Foucault, and later on Arianna, his PhD pupil, lets slip that he grew to become a complete professor at thirty, which is practically unheard of, specially in the arts. And he has the sort of seems – tall, dark, Gallic – that could simply lend themselves to playing the older adore interest in a Television health care drama. But there he is, nervously glugging his wine and seeking across the table at me in a state of mild terror.

The cafe is noisy, and we choose to head out on our stroll. I am desperate to deflect him from his pages of very carefully prepared answers, and I figure interviewing him on the hoof may be the very best way. But the Bois is active. The Sunday strollers are out in force.

“This is the issue with strolling in the city,” says Gros. There are clouds of midges and gaggles of youngsters and we finish up circling a small patch of scrubby ground with overflowing litter bins. “I like to stroll for many hrs,” he says. “But in Paris…” We finish up retreating to a bench.

As a philosopher, his interest is in “ordinary issues”, he says. In Britain, academic philosophy is, largely, analytical philosophy. It is concerned with logic, with language. Whereas in France, he belongs to “a new generation that is concerned with the… quotidien. The daily.”

And you see the philosophy of walking as part of the philosophy of the everyday?

“Yes. It is nonetheless looking at the concerns of eternity, solitude, time and space… But on the basis of expertise. On the basis of quite simple, quite ordinary factors.”

He’d always appreciated strolling but it was only when he started out his philosophical scientific studies that Gros started out noticing how several excellent philosophers had been also great walkers. “That is, it was not just that strolling was a distraction from their operate. It was that walking was genuinely their element. It was the condition of their operate.”

And it was from this that he started out to feel about a guide. Each and every philosopher prospects to a reflection on various topics. So Rimbaud is the commencing stage for Gros’s thoughts on escape. Nerval on melancholy. Rousseau, who claimed to be unable to perform, or even feel, when not strolling, on the concept of becoming in a state of nature. And, my favourite, Thoreau, the writer of the very first philosophical treatise on walking, whose creating Gros quotes on simplicity and frugality and wilderness and the big difference among revenue and benefit.

Walking is of no revenue, it is only advantage, he says. Although the ideal quote of his is about when considering any course of action, 1 need to inquire: could someone do it in my place? And if the answer is yes, give it up.

“Yes. You can be replaced at your function, but not for your walk. Living, in the deepest sense, is anything that no 1 else can do for us.”

Walking, says Gros, is “exploring the mystery of presence. Presence to the world, to other people and to oneself… You find out when you walk that it emancipates you from space and time, from… vitesse.”

Speed?

“Yes, speediness. It emancipates you from speediness. And Rousseau says in his Confessions, when you stroll all is achievable. Your long term is as open as the sky in front of you. And if you stroll numerous hrs, you can escape your identity. There is a second when you stroll several hrs that you are only a entire body walking. Only that. You are no one. You have no historical past. You have no identity. You have no past. You have no potential. You are only a entire body walking.”

The 18th-century Genevan philosopher Jean-Jacques Rousseau claimed to be unable to perform, or even think, when not walking. Photograph: Roger-Viollet/Rex Functions

It’s the sort of observation that, possibly, operates far better with a French accent. But I purchase it. I really like every thing about strolling. The meditative state that it induces. The puppy tiredness at the finish of the day. The simply being in elegance. Or, as Gros would have it: “The sedimentation of the presence of the landscape in your entire body.”

Is there a school of philosophy that thinks that walking is not a match subject to study? “Yes! Yes, I do not think my colleagues would think about this a serious academic guide. It is as well transparent.

“And I experimented with to evoke some really serious philosophers this kind of as Nietzsche but the concerns I wanted to ask had been not, ‘What is the soul?’ or, ‘What is the relation among physique and area?’

“My queries were, ‘Where have they walked?’ ‘How have they walked?’ ‘How a lot of hours per day have they walked?’ I tried to see if their design of walking could be a manifestation of their thought. So, for instance, you have Kant with his stroll. Every day the very same stroll. The exact same time, the same place…”

He comes across as a very uninteresting man.

“He is!”

Does that also come through in his philosophy?

“We can say that there is a discipline at the forefront of it, yes.”

Nietzsche, on the other hand, is extremely unboring. He was the first philosopher Gros found. And the one who persuaded him to examine philosophy.

What prompted you to start off reading Nietzsche? Had been you a teenager?

“Yes!”

Had been you a depressed teenager?

“Yes!”

What result did Nietzsche have?

“There is an power in Nietzsche’s functions and this assisted me. You have the same energy in the act of strolling. You need power when you have to stroll for numerous hours.”

Have there been factors in your daily life where you’ve found walking useful to your psychological state?

“Absolutely. There is an component of repetition in the act of strolling exactly where you can overlook. And there is a tiredness. A peacefulness. I feel that when you are really alone you have a fragility. The emotions are more intense. You have far more of the feeling of the eternity of things. There are moments of vibration among your own physique and the landscape.”

You’re sounding like a hippy now, Frédéric, I say.

“I am!”

Now the Earth is vibrating.

“You are proper!”

Not that this is always a negative point. I really like the bit in the book where he writes about the act of packing a rucksack and the perpetual question that you uncover your self asking. “Is it essential?” On my last hiking trip, I inform him, I weighed my T-shirts to find the lightest ones. I weighed my knickers. I sawed my toothbrush in half with a bread knife. (I admit it: this was a step as well far.) But contemplating about placing anything in a rucksack and schlepping it up a mountain on your back is really a great test for thinking about no matter whether you genuinely do really require something, is not it, I say?

“It is.”

Do you manage it? Does that lesson come via when you’re at Ikea?

“I attempt to have that same psychological perspective every day. But it is difficult. The problem is that I…”

“Neglect?”

“No, I never fail to remember. I lie. I say, ‘Oh yes, this is really necessary?’”

What? Like a sports automobile? You say, ‘Yes, it is vital. I want that Ferrari?’

“Not a sports automobile but… Other items.”

A single of the items that comes across most strongly in the guide is a sense of escape. The freedom of leaving things behind. It sounds as if an academic philosophy division is a spot to get away from. Is that true?

“Quoi?” He appears confused and then Arianna, the PhD pupil, translates and they almost fall off the bench laughing.

“Yes! I’m not positive you have to create this. But I have a severe problem with academics. I think that I have imposter syndrome. I truly feel myself an imposter in philosophy. I believe this book about strolling is the 1st way to discover it. I’m creating another guide about disobeying. I think there is a link amongst walking and disobedience. I am writing about disobedience and getting ready myself to disobey.”

Disobey what?

“Academia.”

To leave it?

“If I have the courage, yes.”

Gros did not set out to become an academic. He went to Mexico City for two years and taught French. “And then I came back and I attempted to locate some interesting factors in my own life… But I didn’t know any! Absolutely nothing. It is quite embarrassing for me.”

So you imagined you’d read about the interesting lives of other folks?

“Yes. When I experimented with to write this book I wrote chapters about these elders since I think their lives are interesting. If my existence were fascinating, I feel I wouldn’t have to write. If you compose, it really is due to the fact your daily life isn’t essential.” He appears at me embarrassed. “Possibly it is diverse for you?”

Immanuel Kant took the same stroll at the identical time every single day. His route by means of the park in Königsberg, Prussia (now Russia), later on came to be known as ‘The Philosopher’s Walk’. Photograph: Alamy

I appreciate meeting individuals who are much more interesting than me, I inform him. And then I request him about the apogee of his guide, his definitive strolling experience, when he talks about how, in the mountains of the Cévennes, his favourite spot, in a time period of fine weather, he simply abandoned his rucksack. He invested two days strolling, alone, carrying completely practically nothing.

“It was this feeling of lightness. This fragility. There is nothing in between you and nature.”

Except being a bit hungry?

“A bit.”

There is a quote from Thoreau in the book, where he says that it is not the tyranny of public view that traps us. Instead, we are shackled by our personal judgments of ourselves. Do you believe that?

“I do.”

So what is the judgment that you have of by yourself that shackles you?

“This is tough. Yes, yes. No, no, no. Just 1 minute. I have a judgment. Yes…”

And he rolls his eyes and for a prolonged minute he just stares into room and thinks. Arianna and I sit and watch him.

“No, no, no, I am pondering.”

We wait for an additional lengthy minute. This is wonderful, I say. I interview lots and lots of individuals and they quite seldom ever feel just before giving an reply. I think this may be a first.

“It is a horrible query.”

“It is a horrible question. But you happen to be a philosopher, Frédéric. You are supposed to be considering about this stuff. It’s your occupation.”

“Yes, it is my work. So… Yes, the issue for me is that the books I have written have permitted me to understand to know, but the difficulty is what they have masked. You see. I know that the books I have written permit me to understand lots of items. But they have masked the troubles.”

You indicate that they have masked your real thoughts or feelings? Or they have masked you from living daily life.

“Yes. From residing. From living existence.”

So, do you think that you personally would have been much better off going for a stroll than creating a book about strolling?

“Yes… But… I had not adequate courage.”

Oh dear! Perhaps you want to go for a actually massive walk. 3 months or some thing. Is that anything you’d like to do?

“Yes. Of program. But existence is… complicated.”

Isn’t that the issue, I say – that there are almost certainly a lot of people who will read through the guide and say, ‘Oh, it truly is all really properly to speak about communing with nature, but I have received 3 little ones and a home loan and a wife.’

“Yes, and me, also.”

In reality he has two kids, now youngsters, and “they used to love to walk. I tried to teach them the joie de la marche. They walked 7, eight, 9 hours. I led them everywhere. But now… they refuse.”

They will come back to it, I say. But then I have started saying all method of comforting things to the philosopher of walking, which includes telling him that he demands to go for a walk. “Are you going somewhere great this summertime?”

“No. I do not consider. No.”

Perhaps strolling can be a state of thoughts in your head, I propose. Perhaps the concept of going for a walk can be as effective as in fact going for a stroll?

“No, no, no. I consider that the act of walking… stays essential.”

He has began to search depressed. So, you do not handle to walk significantly on a day-to-day basis? He shakes his head. Perhaps you ought to get a dog, I say. Then you have to walk even on a moist Tuesday in February.

We sit in silence for a bit.

So, Frédéric, you have written a entire guide about the straightforward daily life and joy of walking simply because your lifestyle is as well challenging to in fact go walking? Is this what occurred?

“Yes… But it is a lot more challenging than that.”

We finish the interview and go and drink wine. Gros appears done in. Arianna seems to be amused.

“You see,” he says. “I was right to be nervous! French journalists do not ask these type of questions. I… truly feel maybe I have a crise tomorrow.”

Oh dear. I hope not. Just read through your book, I tell him. Go for a stroll. Disobey.

Frédéric Gros will be speaking at the Bristol festival of ideas on Wed 14 May, 6-7pm

Frédéric Gros: If you walk for many hours, you can escape your identity

GPs" surgeries to open all hours in £50m reforms

The GP Access Fund will suggest that patients at one,147 practices across England will be capable to see their medical doctor outside standard working hrs. Photograph: Ferenczy Europress/FEB

Hundreds of thousands of sufferers will be ready to see their GPs in evenings and on weekends with £50m of government funding created offered to lengthen opening times, it is to be announced.

David Cameron, the prime minister, will say on Monday that far more than 7.5 million men and women will be supplied elevated entry to GP companies through extended opening times and new consultation methods making use of Skype, e mail and cellphone.

The £50m GP Accessibility Fund will indicate that sufferers at 1,147 GP practices across England will be ready to see their family members medical doctor outdoors standard working hours, like late-night and weekend appointments or use 1 of the modern consultation tools for convenience.

It was initially imagined that close to 500,000 folks would benefit from the modifications but due to substantial levels of interest it has been rolled out to cover more GP companies.

Cameron will also announce strategies to improve care services for the elderly.

About 800,000 folks above the age of 75 and those with a lot more severe wellness complaints will get tailored care, co-ordinated by just a single neighborhood GP.

The overall health minister, Norman Lamb, informed the Telegraph: “It truly is quite challenging for folks with hectic lives to get appointments with GPs so let’s just get smarter with the use of technologies.”

He said: “We have received to break away from this treadmill of the 10-minute appointment which drives GPs crazy and which leaves patients often annoyed.”

Lamb additional that as older men and women became far more tech-savvy the use of email and video chat for consultations would aid people who were also hectic to attend face-to-face consultations.

GPs" surgeries to open all hours in £50m reforms