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10 Nisan 2017 Pazartesi

Let’s put our NHS worries in perspective – and celebrate what we have | Ann Robinson

The latest GP story to scare us witless says that a “record number of GP practices closed last year, forcing thousands of patients to find a new surgery”. Pulse, the GP website, highlighted NHS England data that shows nearly 100 practices closed in 2016 – a 114% increase on 2014 – and that more than a quarter of a million people have had to change practice. Cue claims that GPs aren’t coping with increased demand, the NHS needs more cash and staff – and that the whole system is teetering on the brink of collapse.

But what’s the true picture? Are you likely to find yourself without a GP any time soon? Is the service contracting? And is the closure of a GP practice always a bad thing?

People get understandably upset when a much loved, familiar, local service shuts down. It doesn’t matter if it’s a GP surgery, library, community centre or takeaway. I’ve been registered at the same GP practice for 30 years; I never go, but I was quite discombobulated when I got a letter saying that one of the long-serving doctors was retiring. If I had memory impairment and long-term health problems, I’d be upset and anxious if the whole practice closed down and I had to move somewhere unfamiliar.

But let’s keep this story in perspective; there are 7,674 GP practices in England, so the closure of 92 practices means that 98.8% remain open. Primary healthcare services are not necessarily contracting; in 2014 there were 5,729 more GPs and 1,688 more practice nurses employed by GPs than 10 years earlier. Admittedly, a lot of those GPs and nurses work part time, and there’s also more work done in primary care now. So no one’s saying that there’s not a case for more money, training and efficiencies. It’s just that it’s not fair to paint an apocalyptic vision of sick people roaming the streets of England, looking in vain for a doctor to treat them.

Every person with an NHS number has the right to be registered with a GP and get primary care services, and access to hospital-based services if needed. If you assault your GP and are removed from the practice, the local clinical commissioning group (CCG) will refer you to a specialist GP who takes on the role of caring for the violent, abusive or just unmanageable. If you kill someone and go to prison, you have access to a doctor. There is literally nothing you can do in the UK that means you forfeit the right to see a GP. If all your local GP practices are full, the CCG has an obligation to find you one. Asylum seekers and refugees are also entitled to NHS care while waiting for their application to be processed and are encouraged to register with a local GP surgery.

The overwhelming majority of us who live in the UK will be registered with a GP from the day we’re born to the day we die. And in an era where Obamacare is under attack in the US, it’s worth celebrating what we’ve got in this country. Sure, the system’s not perfect, but there’s no evidence that any one system works better across all parameters; and no one can argue with the fact that our system is equitable.

GP treating an elderly patient — ‘GPs are more inspected, regulated and scrutinised than ever before – and quite right too.’ Photograph: Alamy

31 Mart 2017 Cuma

Let’s applaud Simon Stevens: the NHS boss with a plan | Deborah Orr

One trouble with dropping targets is that such a decision tends to create a target. The head of NHS England, Simon Stevens, has outlined many sensible goals in his proposals for the future of the health service. But attention has focused on one thing. In order to take the strain off A&E departments and improve cancer treatment, Stevens has decided to drop the target whereby 92% of routine surgery is carried out within 18 weeks of a GP referral. The moment that some ghastly failure can be personalised in the form of an iconic victim of this change, Stevens will be held personally responsible. He is the target now.

Why is Stevens taking this risk? Largely because the government has made it clear that the extra funding Stevens needs will not be forthcoming. But it’s also another attempt at a nudge, to GPs and to patients. People can be aggressively passive about their health. They want doctors to fix it for them. GPs are wary of berating patients into losing weight and exercising more, especially now, when patients have read on the internet all about the operation they can get. The promise of elective surgery within 18 weeks, I’m afraid, only encourages both GP and patient to kick the can down the road. The hope is that the removal of the target will encourage GPs and patients to opt first for physiotherapy, which is what all sensible people should be doing anyway.

Some of the problem is with us, and our demands. We trail off to the GP with our colds and beg for antibiotics

Around 150 urgent treatment centres are being planned, to take the strain off A&E, which NHS chiefs say still attracts about 3 million people each year with minor ailments. Stevens is hoping to persuade all GP practices to offer evening and weekend appointments, so that A&E departments don’t become one-stop-shops over the weekend. Astoundingly, Stevens is also demanding that all A&E departments should introduce “comprehensive front-door clinical streaming”. Here in my metropolitan elite bubble, I’d imagined that all A&E departments had been assessing all walk-ins by medical need for decades. It’s easy to forget just how much sheer inertia is inevitable when dealing with a beast as large and complex as the NHS.

Stevens also addresses the system’s two most glaring failures – the lack of integration with social care and the relatively slender access to mental health services. On the first, Stevens aims, through closer coordination between hospitals and councils, to free up potentially 3,000 hospital beds. On the second, the aim is to provide talking therapies to 200,000 more people. These are ambitious goals. Considering the lack of investment, they are valiantly optimistic. Sometimes, people doing tough work need a bit of encouragement and applause. Stevens is one of them.

An ambulance — ‘Some of the problem is with us, the users, and our demands. We trail off to the GP with our colds and beg for antibiotics; we call ambulances because our friend is very drunk.’ Photograph: Yui Mok/PA

21 Mart 2017 Salı

Good social workers are invaluable. So let’s give them proper support | David Brindle

About three in every 10 people in Britain think social workers help with household chores like cooking and cleaning, with personal care like washing and dressing, and with childcare. Two in 10 reckon they will nip to the shops for you. Asked to choose from a given list of professionals they consider important providers of mental health support, 69% of people identify psychiatrists and 65% GPs – but only 41% pick social workers.

These findings come from a ComRes survey commissioned by Think Ahead, the fast-track training graduate scheme for mental health social workers, to mark this week’s World Social Work Day. As Lyn Romeo, England’s chief social worker for adults, comments with a certain understatement, “there is still more to do to communicate the crucial role of social workers”.

That was to have been the role of the short-lived College of Social Work, set up by ministers in 2010 with plans for it to grow to become a royal college on a par with those for the most esteemed professions, but shut down in chaos five years later. News that the College of Occupational Therapists is to become royal – richly deserved, by the way – has rubbed a good deal of salt into that wound.

There is a fresh plan, however. From 2018, part of the brief of a proposed new regulator for social workers in England will be “to promote and maintain public confidence” in the profession. The mandate for the organisation, provisionally titled Social Work England (SWE), is contained in the children and social work bill currently before parliament. After a rocky start, it enjoys broad support.

One reason SWE is being welcomed is that it will give social work its own regulator again after six years under the generic Health and Care Professions Council. A second is that ministers accept it cannot be self-financing, at least in the short term, and are underwriting it by £16m in its first two years. And the most significant reason is that an initial idea for it to be run direct by Whitehall has been ditched.

Just how independent it will be remains moot: a quango accountable to government, not parliament, it will need ministerial approval of the professional standards it polices. But the social work world sees the lifting of the spectre of regulation by a government department as a clear win.

Another success being celebrated is the withdrawal of clauses from the bill that would have allowed councils to seek exemptions from children’s social care law to test innovative ways of working. Critics saw the idea as erosion of vital safeguards and mounted a strong, successful campaign against it – but the issue was almost certainly settled when Eileen Munro, the leading social work academic often cited by ministers in support of professional reform, opposed it.

However, real tensions remain between the government’s social work reform vanguard led by Isabelle Trowler, chief social worker for children, and the bulk of the sector establishment, with plans for accreditation tests for children’s social workers looming as a new flashpoint. But there is a sense of a thawing in relations.

Herbert Laming, sector elder statesman and crossbench peer who led both the seminal inquiry into the death of Victoria Climbié, which published its report in 2003, and a review of child protection six years later following the Baby P affair, hopes the thaw continues. He tells me: “What social work needs above all at this time is a bit of tender loving care.”

In a lecture on Wednesday at the University of Suffolk, Lord Laming will spell out the enormously high expectations that society has of frontline workers’ skills and judgment when dealing with vulnerable children and adults. The task, he will say, has been made infinitely more difficult by austerity, which is why he joined the call for withdrawal of the exemption clauses at this point even though he understood and backed the case for innovation.

Social workers are crying out for support and encouragement, Laming says. He is surely right. There has been too much stick and not enough carrot in the mix of late.

Good social workers are invaluable. So let’s give them proper support | David Brindle

1 Şubat 2017 Çarşamba

Let’s talk about cancer: the Manchester project that aims to save lives

Security guard Gilbert Morris will stop at nothing to talk to other black men like himself about cancer screening. He once defused a late-night fight in a Manchester club by asking five scuffling men whether they had had their prostate tested.

“It was like I had a magic wand that lowered their aggression,” laughs Morris. “They stopped in their tracks and put their fists down. Two of them said their fathers had prostate cancer and another’s uncle had it. We ended up sitting round the table talking about their fears of having their privates looked at.”

The success of this 51-year-old six footer in communicating the risk of cancer is being harnessed by health chiefs in Greater Manchester as part of the launch of a social movement to sign up 20,000 people as cancer champions.

The idea, led by Greater Manchester Cancer Vanguard Innovation, (part of Greater Manchester Cancer – the cancer programme of Greater Manchester’s devolved health and social care partnership), is to use people power to create a cultural shift in one of the UK’s cancer hot spots, and make it normal to talk about screening, healthier lifestyle options and catching symptoms early.

Working with the voluntary sector, the aim is to sign up 5,000 cancer champions by autumn 2017, and to reach 20,000 by 2019. Mobilising this cancer army is one of a series of measures to cut premature cancer deaths in the area by 1,300 by 2021.

Gilbert Morris developed prostate cancer in his 40s and couldn’t find anyone to talk to about it. Photograph: Karen Wright

26 Ocak 2017 Perşembe

We are rightly proud that our NHS is free. Let’s keep it that way | Ann Robinson

Imagine you have a big, greasy, warty growth on your back. It’s embarrassing, catches on your clothes and means you avoid swimming or exposing your back on holiday. Your GP confirms that it’s not cancer and says it’s a seborrhoeic wart. That’s great, but you’d like it removed. Your GP says you can’t be referred for removal on the NHS because it’s a cosmetic problem.

So what should you do next? Live with it? Pay a private skin specialist to remove it (likely to be over £120 to have it scraped or frozen off)? Or have a stand-up fight with your GP?

There’s another option being proposed by a group of GPs; let your GP do it, and pay a fee. At the moment, NHS GPs aren’t allowed to charge their registered patients for standard NHS care. But charging for non-NHS extras, like sick certificates for insurance companies, reports for health clubs that you’re fit to exercise, diving certificates and other optional extras, is allowed.

The British Medical Association (BMA) explains that GPs sometimes charge fees because “they are self-employed and they have to cover their costs – staff, buildings, heating, lighting, etc – in the same way as any small business. The NHS covers these costs for NHS work, but for non-NHS work, the fees charged by GPs contribute towards their costs.”

But until now, the permission to charge for non-NHS work has been limited to certificates and administrative tasks. The idea of allowing GPs to charge for clinical work that isn’t available on the NHS is much more challenging. After all, we are rightly proud of the fact that we don’t need to take a credit card or cheque book when we go to the GP. It’s anathema to many that this situation may change.

The controversial proposal has been spelled out by Dr Prit Buttar, chair of Oxfordshire’s local medical committee (LMC), who told Pulse magazine there had been discussions about rolling out the system nationally by the end of 2017. Under the proposed plans, GPs would be able to provide private services to their own patients by working through a third party company, which would take payment from patients and pay GPs for their time.

The plan is to extend the scope of non-NHS services that GPs can offer to patients for a fee. So if you want to see your GP outside of NHS-contracted hours (generally 8am-8pm), you could pay to see him/her privately instead of relying on the out-of-hours services that GPs employ to provide cover from 8pm-8am. At the moment, that wouldn’t be allowed. If you want to see a GP for a routine appointment at 9pm, you can’t. If it’s urgent, there are walk-in centres and NHS 111. If you’re mortally ill or wounded, there’s A&E.

As a GP who starts seeing patients at 7.30am, I can’t imagine why a GP would want to see private patients at 9pm. Or have the strength to work a 12-hour day and then keep going into the night. But, more importantly, I think it will taint the precious patient-doctor relationship that relies on trust that the GP is acting in your best interests, free at the point of delivery and unsullied by any profit motive.

You can see where Dr Buttar and co are coming from; people want choice and convenience in all areas, including healthcare. That includes the freedom to have an ugly wart removed or to see your own doctor late in the evening by mutual consent. GPs want to respond to people’s needs and wishes but are only contracted and paid by the NHS to provide a limited range of services. The NHS can’t fund a limitless range of interventions, because taxpayers don’t want to pay huge taxes so that you can get your wart removed.

So where does this leave us? The NHS restrictions are not sacrosanct and can be challenged; for instance, it’s hard to get varicose veins treated on the NHS – but guidelines from the National Institute for Health and Care Excellence (Nice) state that if you have symptoms like pain and aching, you should be referred for assessment and treatment. Your GP is your advocate within the system; helping you to navigate referral pathways and fighting your corner when needed.

What faith can you have that your GP is doing their best for you if they stand to personally gain by offering you a private alternative? It’s a slippery slope all right; the wrong solution to a pressing problem.

We are rightly proud that our NHS is free. Let’s keep it that way | Ann Robinson

13 Ocak 2017 Cuma

Let’s be honest about socialism’s paradoxes | Letters

The question arising from Owen Jones’s article (How the Tories are victimising young people, 12 January) has to be: is socialism choking itself to death on its own inherent contradictions? Has the past 50 years been a good period in history, or has it not? If it could be repeated, should it be repeated? If the parental generation has spent its children’s future, how does the next generation suppose it can avoid doing the same to its children?

Jones reports that rates of depression and anxiety among the young have increased by 70%; a third feel they will have a worse standard of living than their parents; 42% feel owning a home is an unrealistic prospect. If we compare the last 50 years with preceding periods of history, it is apparent that the last 50 years has been the aberration. The parental generation enjoyed a higher standard of living, not because it worked for it, but because it mortgaged (borrowed) from subsequent generations.

When socialists argue that a socialist government could renew the country with a different tax regime, they implicitly argue that the Tories haven’t done such a bad job of running the country. The evidence in the rest of Jones’s article suggests that failure is endemic in that class. Britain is poor because it has been running a trade deficit for 40-odd years. Austerity was the hangover from decades of overindulgence. Brexit is the tantrum that comes from the loss of self-worth. Unfortunately, youthful optimism is no substitute for gainful employment. We need to be more honest about the excreta we are sitting in.
Martin London
Henllan, Denbighshire

• John Harris’s recommendation of universal basic income as a key Labour policy is sensible (Opinion, 13 January). It is, as he says “a given that work will define a declining share of most of our lives”. In their thought-provoking 2015 book, Inventing the Future, Postcapitalism and a World Without Work, Nick Srnicek and Alex Williams argue that we should welcome that fact, even demand full automation, and, among other things, introduce UBI. Then, as Harris also says, tax avoidance is naturally an obvious target for Labour, though awkwardly a moving target: it is transnational and the avoiders move. Therefore one other policy Labour must promote more strongly is a land value tax. Land cannot be secreted away in treasure islands.
John Airs
Liverpool

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Let’s be honest about socialism’s paradoxes | Letters

22 Aralık 2016 Perşembe

High-quality abortion services come at a price, so let’s pay it | Ann Furedi

Abortion today is an extremely safe, straightforward procedure, provided in a highly regulated environment. One in three women in the UK will have an abortion in her lifetime, funded by the NHS (except if she lives in Northern Ireland). This will usually take place within an NHS hospital or in a centre run by one of the independent charitable providers – the British Pregnancy Advisory Service (BPAS) or Marie Stopes International (MSI). But just because it is safe doesn’t mean corners can be cut, or providers can pick and mix from rules and regulations, as was unearthed in the course of the care quality commission’s investigation of MSI.

Some of the failings found at MSI have no implications for safety. The batch signing of abortion forms, for example, has no clinical significance – it is simply a legal requirement that all women have their abortion request legally authorised by two doctors. But the other problems uncovered – from clear deficits in clinical governance at the top level through to problems with safeguarding and consent, to the report of the appalling handling of a vulnerable patient – can leave us in no doubt that the CQC was not over-reacting when it requested MSI suspend its services over safety concerns earlier this year.

With NHS funds shaved, the price commissioners will pay is driven down

Clinical supervision and governance structures, training and upskilling staff and recruiting the right people to leadership positions takes time – and money. Adhering to legal requirements that have no clinical benefit may be irksome and expensive, but that’s life. If you operate in a highly regulated environment and believe women deserve high-quality care, these measures are not optional.

Abortion is an easy procedure when everything goes right – but you can’t run a clinical service on the assumption that everything runs to plan. The best doctors experience patients who develop complications, unexpected problems arise in the healthiest patients, clients need access to good counselling services and support. Research and innovation is essential to determine best practice. This costs – but it’s not just a matter of cost but of commitment, and focus on values.

The BPAS has been delivering not-for-profit services since the 1967 Abortion Act came into force, providing high-quality, compassionate care that the NHS either could not, or would not provide from its own facilities. It was founded by a former abortion law reformer who saw that the inability of the NHS to meet women’s needs would push them into paying extortionate sums for poor-quality care by private doctors.

In the 1970s, MSI joined BPAS as a charitable provider. Today some 200,000 women a year in the UK have an abortion. MSI provides about a third of all abortion care , BPAS a further third, and the remainder are performed in NHS premises.

In a parody of market economics, the two charities now compete with each other and with local NHS hospitals for regional contracts to provide NHS abortion services. With NHS funds shaved, the price commissioners will pay is driven down. In the current commissioning environment a cheaper service will trump a quality service almost every time.

We all deserve an honest and open discussion about how this essential women’s healthcare service is commissioned and provided in an environment of cost-cutting. On the brink of the 50th anniversary of the Abortion Act, BPAS is absolutely clear, abortion must be fully decriminalised and women finally trusted to make their own reproductive choices for themselves – and they must be able to exercise those choices in clinics providing safe, high-quality abortion care.

High-quality abortion services come at a price, so let’s pay it | Ann Furedi

20 Kasım 2016 Pazar

Zika: Let"s give women the contraception they so desperately want

As Zika continues to spread through the western hemisphere, the women’s health aspect of the virus has not entered the public conversation. Perhaps more than the failure to control mosquito populations, lack of access to widespread, effective contraception is the root cause of microcephaly in most of Latin America and the Caribbean, and yet remains the least talked about aspect of the epidemic.

Ebola, like HIV before it, offered an impetus to improve general healthcare infrastructure in west Africa, as international money and political will joined the fight against the epidemic. For all its negatives, the Zika outbreak similarly provides an opportunity to press strongly for universal access to contraception and reproductive services for women in all Zika-affected countries, but this opportunity is being largely overlooked.

To prevent babies being born with microcephaly, the Centers for Disease Control and Prevention (CDC) and the World Health Organisation are choosing to encourage “delaying pregnancy”, as well as to recommend mosquito nets and protective spray to those who are already pregnant. Without putting any resources behind widespread contraception, this is merely lip service and fails to deal effectively with the problem. Only 62.5% of Latin American women use some form of contraception [pdf], and in Haiti, only 34% of women have access to contraception. In the US, 45% of pregnancies are unintended, and 65% in Puerto Rico are as well [pdf]. Health authorities in El Salvador estimate that as many as 90% of pregnancies may be unintended, and Haiti, without an effective public health system or quotable statistics, is likely not far off from this figure.

Dr. Vince DeGennaro, Dr. Jean Renald Cornely, Dr. Valery Caleb Suprien, Nurse Ursilia Saintil in a gynecology exam room at Hospital Bernatd Mevs in Port au Prince, Haiti. — Doctors Vince DeGennaro, Jean Renald Cornely and Valery Caleb Suprien with nurse Ursilia Saintil in a gynaecology exam room at Hospital Bernatd Mevs in Port au Prince, Haiti. Photograph: Grace Tillyard/IHI

26 Ekim 2016 Çarşamba

The fetishisation of work is making us miserable. Let’s learn to live again | Anna Coote

Mounting pressures at work are taking a heavy toll on life at home. Employees say their bosses want them to put job before family, and many are expected to be on call around the clock. More than one in four say they work longer hours than they want to, we learn from the latest YouGov poll.

It’s not a pretty picture: an economy where high levels of stress and anxiety are normal, where people get ill because they’ve lost control of their time, where marriages are damaged and children suffer. And yet, it’s a picture we’re invited to applaud. Our political leaders idolise “strivers” and “hard-working people”, not “chilled-out, caring dads”, for example. The longer and harder we work, the more admirable we are supposed to be.

I am old enough to remember lunchtime. When my workmates and I went out to a nearby eaterie for at least an hour, scoffed a proper meal and probably a glass of wine. These days, like most worker bees, I stay at my desk with my fork and Tupperware pot, nose glued to the screen. And I‘ve become so mesmerised by the modern working culture that I’d be quite shocked to find a colleague dining out at lunchtime. No booze, no siestas, no playtime.

It seems a bit odd when we hear so much about automation and “the end of work”. If the robots are coming, why are we rushed off our feet? In fact, it’s all part of the same picture.

All the main UK political parties insist that the only successful economy is one that grows, preferably faster than other economies. Growth calls for greater productivity: getting more output per unit of input. The system is greedy for more resources, but workers and machines have to do more for less. More efficient processes (including more robots) reduce the amount of human input required. So those who have jobs must work harder – and longer hours – to hang on to what they’ve got and to keep the economy growing.

Meanwhile, since robots can’t do everything yet, there are new flurries of low-end jobs with zero-hours contracts, insulting pay and no security. This class has been called the “precariat” and much of it thrives on the over-busyness of other workers. It ferries people home at night (Uber), delivers fast food (Deliveroo) and fixes things around the house (TaskRabbit). Many precarious workers have to do two or three jobs just to make ends meet. So they are under heavy pressures too, often torn between poverty and an intolerable work-life balance.

What can we do about it? First, take back control of the workplace. This means workers in all settings finding ways to organise and build up bargaining rights. For the casualised precariat, it could mean building new digital platforms to rival the technological giants that have cornered the market so far.

Second, let us never forget that this is a challenge for men as well as women. Much of the stress and unhappiness that women experience at work is because they take on most of the unpaid work at home. Until men really share the housework and childcare, they are unlikely to be powerful advocates for a more humane regime in the workplace.

And third, let’s move to shorter hours of paid work for everyone, not just women. This has long been argued by the New Economics Foundation and there is growing evidence of its many benefits. Nobody should have to work more than four days or 30 hours a week, even in today’s 24-7 economy. As some jobs are automated out of existence, others could be created to cover the hours left unworked by the newly unstressed.

It should be a gradual shift, with minimal impact on pay. For example, suppose all workers over 50 take a one-hour cut in their working week each year. If they start with a 40-hour week, they can be doing 30 hours at 60 and 20 hours at 70. And suppose all young people entering the labour market for the first time start on a 30-hour week – and stay that way, with each new cohort adding to the numbers, until it becomes the new “normal”. What if all workers in organisations where there is an annual round of pay negotiations were to trade a bit more time each year for a smaller pay rise?

All this should go hand in hand with a higher minimum wage, more generous child benefit and a more secure “social income” in terms of high-quality services that are collectively funded and provided (education, health and social care, childcare, housing and so forth). If lousy wages force people to work around the clock, the problem is pay: it’s not a sensible argument against shorter hours.

If 30 hours became the new standard working week, for women and for men, across all kinds of jobs, from doctors to delivery drivers, from teachers to task-rabbits, there would be a lot less stress and anxiety at work and at home. We’d have more control over our lives, more time to look after one another. We could slow down and relax more – and rely less on carbon-intensive fast food and travel. We’d have more time to be active in our communities and in politics. We’d have more time to campaign for a new working culture that respects love, family and friendship instead of fetishising “hard work”. And most importantly of all we could build an economy that enables people to flourish, instead of one that is entirely fixated on growth.

The fetishisation of work is making us miserable. Let’s learn to live again | Anna Coote

26 Haziran 2014 Perşembe

Karen Middleton: "Let"s add existence to many years, not just many years to life"

Working on a rehabilitation consultation project in Tower Hamlets was “a complete life changer,” say

Operating on a rehabilitation consultation undertaking in Tower Hamlets was ‘a total life changer’, says Karen Middleton. Photograph: David Harrison

For some former large-ranking public servants, leaving the NHS means consultancy, a directorship, or a rewarding position at some transatlantic arriviste.

But following 28 years, Karen Middleton has left NHS England’s offices as chief allied wellness professions officer for what her colleagues contact the “other side”. Getting trained initially as a physiotherapist at St Mary’s hospital in Paddington, London, just before practising in Essex and east London, she has headed property.

In February Middleton became chief executive of the Chartered Society of Physiotherapists (CSP) – a entire body that represents 52,000 physiotherapists in the Uk. It really is not quite as outdated as its Georgian headquarters in London, but since 1894 the CSP has been the key association, and much more recently trade union as well, for physiotherapists.

Despite their crucial care for individuals with cancer, heart failure, persistent obstructive pulmonary illness, stroke and sports activities injuries, physiotherapists have a minimal profile in contrast with several other healthcare professionals. Perhaps this is why Middleton insists that her most considerable achievement at NHS England was in obtaining greater recognition for physiotherapists and the other allied health specialists (AHPs), such as podiatrists, occupational therapists, radiographers and speech and language therapists. “Even though we’re nowhere close to where I’d like to be in terms of visibility, now there’s considerably greater recognition of the role of AHPs in each and every care pathway,” she says, “and which is been as a result of some important pieces of operate.”

Amid these, she contends, are the introduction of independent prescribing for physiotherapists and podiatrists and self-referral pilots. These showed that individuals who self-refer to physiotherapy get fewer days off function and are half as probably to be off work for more than a month, compared with these referred via standard routes. This implies the NHS is ready to conduct fewer x-rays, give out fewer medication and make fewer referrals to orthopaedic experts.

Then there have been the NHS support improvement programmes. In excess of twelve months, AHP services regarded as to be carrying out poorly by the former strategic health authorities had been redesigned. Waiting occasions were cut, even though clinical outcomes and patient knowledge had been improved at no extra price.

Middleton says: “The key to all thirty of these services redesigns was that the clinicians foremost the redesign commenced with the patient view of what essential to occur.” She believes that service planners are now considerably more aware of the value of patient view, but have concerns about acquiring a genuinely representative picture – like, for example, the voices of men and women with finding out disabilities.

Almost 20 many years ago Middleton worked on a rehabilitation consultation undertaking in Tower Hamlets, east London. “It was a full lifestyle changer,” she says. “I believed that I knew and understood what men and women who necessary rehab desired, but [investing] a month just listening to people’s stories fully transformed my perception.”

There was the physically disabled lady in a ground floor flat who asked for her windows to be cleaned so she could see the planet outside – not the electric wheelchair Middleton had expected. And individuals were considerably much more concerned about improving the co-ordination and administration of solutions than the clinical interventions.

Her experiences in Tower Hamlets enthused her about the potential of digital technologies to streamline patient solutions and empower clinicians. A single of the most effective resources for Middleton has been the NHS Atlas of Variation, which compares companies and outcomes. She wants to include an NHS Atlas of Variation for rehabilitation, so physiotherapy solutions across the country can be compared.

Asked why rehabilitation is still not integral to NHS acute care, Middleton murmurs: “How extended have you received?” She goes on to say that in terms of policy, targets or outcomes measures, the NHS is too targeted on mortality costs as an alternative of on what transpires when lives have been saved.

“Even though AHPs – and specifically physios – have a huge contribution to make in terms of saving lives, by way of avoiding falls and respiratory care, the true vital additional value of AHPs is not merely in including years to life, but life to many years.” She is alarmed by statistics displaying that by 2035 46% of males and 40% of females in the Uk will be obese and needs to see physiotherapists major the march for physical exercise.

As the CSP chief, Middleton programs to devote a day each week with physiotherapists, many of whom encounter uncertainty simply because of monetary pressures and down-banding of expert posts. Then there is the fantastic privatisation of NHS solutions. Must NHS physiotherapists be anxious? “Properly I do not feel there is a ‘great’ privatisation,” she says. “The final time I saw the figures it was four% of services. But there is no doubt that the plurality of provision is there.”

For Middleton, plurality could indicate unnecessary expenses – for tendering and contract management for illustration – and she is concerned that it could compromise much-necessary integration and co-ordination of companies. She is not confident, even so, that privatisation threatens NHS physiotherapists: “If they are providing excellent high quality care that is expense effective, secure, a fantastic encounter for sufferers, why would a commissioner go elsewhere?”

Speaking on the shift to 7-day operating in the NHS, Middleton says she believes it’s what the public needs and that it really is backed up by the findings of NHS England’s national health care director Sir Bruce Keogh (published in December 2013) about improved mortality rates, and lowered length of hospital stays and readmission costs. She cites the instance of Birmingham Heartlands hospital, which has launched 7 day working within present sources.

Her departure from the NHS has been an emotional affair and Middleton realises how significantly the service has been component of her recognize. At her leaving get together she told colleagues that her work will constantly be foremost about sufferers – regardless of whether she’s with the NHS or on the “other side”.

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Karen Middleton: "Let"s add existence to many years, not just many years to life"

1 Haziran 2014 Pazar

If we cannot do it on our personal, then let"s shed excess weight collectively

If people were too excess fat, I mentioned, then that was because they were too darn greedy and if they wished to get thinner then they need to eat significantly less. Basic, I said. The much more we “medicalised” the dilemma, the much less men and women would get responsibility – and the fatter we would all turn into.

Effectively, I am afraid that in the past two button-busting decades, I have been proved right at least about the last point. We are now the second fattest nation in the globe, and I am alarmed to find out that Londoners are now even fatter than New Yorkers. We have weight problems levels of 67 per cent amongst guys and 57 per cent amongst girls. We are the official lard-arses of Europe.

Every single year we have to widen our cinema seats and reinforce the floors of our ambulances. As this paper reviews, more and more soldiers are manufactured to leave the army for getting, frankly, too excess fat to charge at the enemy. Our charter jets puff and groan and spew out unconscionable quantities of fossil fuels as they lug our biomass to the Mediterranean – and the fatter we get, the greater the chance to our health. The a lot more overweight we are, the a lot more likely we are to have cancer, heart illness, stroke: the large causers of early and preventable death. The national fatness issue charges the NHS at least £16 billion a yr in extra and needless cost.

If you are technically obese – as most of us now are – you are statistically reducing your existence expectancy by 3 or 4 many years. If you are morbidly obese, you are probably forsaking ten years of existence – 10 years of entertaining viewing your children and grandchildren develop up.

Practically nothing looks to end us consuming also significantly – neither my savage libertarian sermons in the Telegraph, nor the bossing and nannying of the state. We are akratic. We know what we ought to do, but we can’t look to make ourselves do it. We know what is in our interests – minimize out chips, cake, bread, cheese, crisps and so on and consume a lot more fruit – but we cannot summon up the steady willpower to adhere to the rules.

Brooding on this difficulty, I wondered if we could construct a diverse psychological framework. What if it wasn’t just about us: our selfishness, our weakness of will, our very own abusive relationships with meals. Probably folks might be much more ready to exercising discipline – to make a sacrifice – if it could be witnessed to be for everybody’s sake, for everybody’s wellness.

People are usually capable of remarkable acts of kindness and altruism. Seldom are men and women happier and a lot more energetic than when carrying out items for other people. So at City Hall we have all embarked – about 150 of us, I think – on a prepare to shed fat with each other.

We all stood on a some giant business scales not individually, so that no one felt any individual embarrassment or stress, and we didn’t have the anxiousness of other folks seeing how considerably we weighed. We did it in groups of about 12 at a time. We recorded who was in the groups, and the total fat, and we agreed that in a couple of months we would attempt to drop five per cent.

There is no coercion, no bullying, and it goes with out saying that the entire factor is fully voluntary. It is a joint effort and a bit of a laugh. But the key factor is that I now know that unless of course I keep it up – and refuse the lascivious winks of the cheese and the cake – then I will not just be failing to do the appropriate thing by myself. I will be failing to do the correct point by the group.

I want to drop weight or I’ll let the side down. In a few months’ time we will all get back on the scales and see how we have completed. Will it perform? Every single psychological text book will almost certainly say that you only get outcomes by attractive to people’s naked self-interest. Properly, we have attempted that, and it is going nowhere. Let’s try staff spirit. It is really worth a shot.

If we cannot do it on our personal, then let"s shed excess weight collectively

30 Mayıs 2014 Cuma

The "booze Britain" stereotype is flagging now let"s finish it off | James Nicholls

‘The dynamics of drinking culture are complex, but the political query is whether decreasing connected harms is a job for government, civil society or the alcohol industry.’ Photograph: Yui Mok/PA

This week the Well being and Social Care Details Centre released its most recent update on alcohol consumption and harm in the United kingdom. It showed that alcohol consumption in Britain was continuing to fall, as it has been for a amount of many years, but also that the harms caused by alcohol were starting up to show indications of dropping as well. These encouraging trends recommend we might be seeing a change in some facets of British consuming culture, but how most likely are they to be sustained?

To read a lot of the news reporting on alcohol, you might be forgiven for pondering the British are an incorrigible nation of boozers – and that most of these drinkers are young girls who finish up lying on benches or kerbs, such is the ubiquity of stock pictures in reporting nowadays. The actuality is considerably a lot more complicated.

For most of the 20th century, Britons drank moderately in comparison to our Victorian forebears and our continental neighbours. British consuming usually involved a lot more of the rapid binge than the long soak acquainted in parts of the continent, but our all round consumption was comparatively minimal.

Then, in the final two decades of the 20th century, there was a transformation. Amongst 1980 and 2004, per capita consumption in Britain increased by all around thirty%, a massive proportion of which was due to a large enhance in wine drinking between both men and women. Wine revenue rose more than 150% in that time period, even though beer consumption fell. We began consuming more at house than ever prior to, which meant a lot more corks popping at dinner parties but also more pub closures. Supermarkets led the way in selling the notion that alcohol was an indispensable part of the weekly store. All this added up to a cultural shift within a generation.

Even so, since 2005 average consumption has fallen to amounts close to people in 1992, a trend that appears most pronounced among the typically vilified sixteen-24 age group. The recession has been one particular factor in lowering consumption – people just have less money to devote on booze – but it is by no signifies the only one particular. For reasons that are not entirely clear, there has been a downswing in consuming amongst the younger age group.

Alcohol-related deaths have also dropped slightly, down 4% given that 2011. To place that fall in context, even though, alcohol-relevant mortality is still 19% larger than in 2001. That is not anything any society can be complacent about. In addition, there are many regional and social variations: consumption and harm degree are lowest in London, and significantly greater in Scotland, the north-west and the north-east.

Another issue is inequality. These in the poorest communities are numerous occasions much more probably to suffer alcohol-associated overall health problems – regardless of consumption becoming relatively increased, on typical, between the far more affluent – and in a number of deprived places harm charges continue to rise. There are a lot of plausible explanations for this – poor housing and diet regime, pressure, limited entry to healthcare, various patterns of consumption, larger prices of dependency – but the reality is that we don’t entirely comprehend why.

Alcohol Research United kingdom, with Liverpool John Moores University, is funding study into this “alcohol harm paradox” which will, hopefully, offer some answers. We are also supporting a study of the most severely dependent drinkers in Glasgow and Edinburgh. The part of cheap white cider and price reduction vodka in maintaining the habit of these desperately addicted individuals (many of whom have died in the course of the research) is an indictment of the firms that continue to make and supply this kind of products.

The dynamics of consuming culture are complex, but the political question is no matter whether minimizing related harms is a work for government, civil society or the alcohol sector. This government, getting initially manufactured fantastic play of its commitment to intervention, has opted for sector self-regulation. Minimal unit pricing has been abandoned, and the a lot-vaunted early-morning restriction orders and late-evening levies have been left to wither on the vine as trade bodies challenge neighborhood authorities across the nation when they try out to get them introduced.

We have also been advised that the alcohol industry’s “accountability deal” is working. Some 253m units – a quarter of the 1bn the industry pledged to remove from the market place among 2012 and 2016 – have been lower in 2012-13. Nonetheless, while a billion units sounds like a lot, our consumption yearly is closer to 50 billion. Furthermore, the vast bulk of that fall resulted from worldwide brewers cutting the power of their foremost lagers from five% alcohol to four.8% by volume to minimize the quantity of duty paid to the exchequer. It has subsequently been sold as a shining illustration of corporate social responsibility, and an illustration – contrary to the actuality – of why voluntary regulation is much more efficient than government policy.

It’s constantly tempting so say, “Ah the British drinker – plus ça modify“. In reality, considerably adjustments, and it modifications in response to vogue, advertising and marketing and economic trends – but also government action. Judging from their vociferous campaigns towards minimum alcohol pricing, alcohol taxation and stricter licensing powers, considerably of the market wants the recent declines in consumption to be stemmed. The question for our society is whether or not we agree – and that implies generating tough selections about our challenging relationship with alcohol.

The "booze Britain" stereotype is flagging now let"s finish it off | James Nicholls

26 Nisan 2014 Cumartesi

Let"s Get Critical About Video Games

The 11th Yearly Games For Alter festival took spot in New York City as portion of the Tribeca Film Festival.

Video games For Modify is a distinct variety of video game festival, a single where video games that aim to employ social modify get center stage. So-known as “serious games” and “social affect games” are the target of the festival.

Of course, I’ve frequently believed that the language we use to categorize video games is problematic. Following all, we need to be significant in our consideration of all video video games. They all have social impact. We don’t contemplate non-fiction books to be severe although lumping fiction into a category named “commercial.” We acknowledge that most film and tv media has social affect irrespective of its intention. Why are we so baffled about video games? I really don’t have the reply. Let me know if you do.

Each year, I go to Video games For Modify simply because it is the spot where game developers that are truly pushing the boundaries of video games showcase their perform. At the festival, we see games that reimagine the act of gaming–what can it do? What can it imply? We see games that consider critically about finding out, educating, enjoying, and storytelling.

This year’s big award winner was Lucas Pope’s “Papers Please,” a game that also ranked very first in Forbes’ Prime five Indie Games of 2013.

I won’t publish significantly about it, as it has presently been covered (click the hyperlinks if you want specifics).

Fundamentally, it is a game that forces gamers to believe about the realities of border control, the dangers of electrical power, and the way our personal guesses can have enormous influence on other people’s lives. You play as an immigration inspector tasked with controlling the flow of immigrants. There are smugglers, spies, terrorists, and vacationers. Can you distinguish? Who will get in? Who’s turned away?

Immigration is a sizzling problem. Another game featured at the festival was “The Migrant Trail.” The game’s developers describe it this way:

“THE MIGRANT TRAIL presents a 1st-individual journey by way of Arizona’s desert borderlands. Play as an undocumented immigrant trying to cross the Arizona desert and/or a border patrol agent attempting to secure the border. “

The-Migrant-Trail5

Unlike “Papers Please,” which centers around bureaucracy and protection, “The Migrant Trail” is about survival. It helps make us conscious of just how substantial the stakes are along the U.S. border.

“Every yr an unknown amount of migrants cross via the harsh Sonoran desert from Mexico into Arizona. They pay out $ 1500-$ 2500 to join a crossing get together, that is led by for employ guides referred to as Coyotes. If a single are not able to preserve up, twists ankle or runs out of water, he or she is left behind and numerous die. On average, the stays of 200 dead migrants are found every year. It’s not acknowledged how a lot of are never ever identified.”

“The Migrant Trail” is free to perform right here. You can take the position of either migrant or border patrol.

A single of my favored award winners was “Mission US: Cheyenne Odyssey,” developed by THIRTEEN, American Social Historical past Undertaking, and Electric Funstuff. It won the award for the “Most Significant Impact” award.

The game, which you can play for free of charge here, is described as an interactive way to find out historical past. Designed for college students grades five-8, the game immerses college students in a historic context.

If you stick to me on Forbes, you know that I publish a lot about educational games. I cover the way games can be utilised in a classroom setting. Most of individuals games are plagued by a type of mechanical comprehending of learning. That is, they envision the game as a device that will somehow insert expertise into learners, or as some thing which helps make retention more productive. Information, wisdom, and educational are mistakenly understood as the method of distributing facts and content.

“Mission US: Cheyenne Odyssey” is diverse. It brings background to existence. No, it is not specifically sensible. It plays like a wise, present day version of the “Choose Your Very own Adventure” novels that I loved as a child. I say it brings background to daily life since it focuses on the genuine, each day choices that one particular Cheyenne boy, Tiny Fox, has to make.

It is interesting to me to imagine college students finding out background in this kind of a way that they see how fast choices have influence not only on personal survival, but also on the trajectory of a collective future.

As constantly, Games For Alter was total of thoughtful programming and fantastic gameplay. “We are thrilled to see such expressive and high-high quality video games from both commercial and independent developers,” mentioned Games for Change, President Asi Burak. “By combining their passions and undeniable talent, these developers have succeeded not just financially, but also in presenting imagined-provoking gameplay with genuine-world influence.”

Mothers and fathers, if you have children that are outdated sufficient to get the themes in these video games, playing together is a wonderful way to begin a conversation.

For a checklist of all the games featured at Video games For Adjust, visit http://www.gamesforchange.org/perform/

Jordan Shapiro is author of FREEPLAY: A Video Game Guide to Highest Euphoric Bliss, a book about how playing video games can transform psychological attitudes. For information on Jordan’s upcoming books and events click right here.

Let"s Get Critical About Video Games

28 Mart 2014 Cuma

Let"s not mince words - unwanted fat can be a death sentence

These ailments are all Go Right to A&ampE, Do Not Pass Go, Do Not Gather £200 corollaries of being obese, as nearly two thirds of British grownups now are. And a quarter of these are obese.

The figures are supposed to double by 2050, despite the fact that I’m not sure how we can have “four thirds” – maybe, like our waist measurements, moobs and cankles, fractions are ballooning in size, also? Or will our sloppy wodge of adipose tissue flop over and cover Normandy and parts of Britanny as effectively?

By now, any person carrying far more than a handful of additional heft will be feeling cross or unhappy or at least aggrieved. Allow she who has no muffin leading cast the 1st creamy cronut and all that. Properly, speaking as one particular who has variously been as well massive and as well tiny and has recently taken up kick-boxing to slap my BMI into its rightful area, I know what I’m talking about.

It is not just about the strain on the well being service and the £50billion financial toll. It is a public heath crisis that ruins lives and demands to be tackled – like smoking – a single individual at a time. But how? Much more than 3 quarters of dad and mom (77 per cent) with obese or even obese youngsters presume, or at least assert, that they are perfectly healthy. Or at least the new normal.

In current instances, “acceptance” has been elevated to mankind’s highest virtue. This is totally appropriate, when it applies to these previously discriminated against owing to race, religion, disability, sexuality and yes, dimension. But enshrining equality ought not to preclude intervening when a person we care about is smoking or consuming, or in this instance consuming themselves into an early grave.

Most of us wouldn’t hesitate to mention, in a spirit of real concern, if a friend’s daughter was looking as well thin. But hand on heart, who between us would dare to level out that her son was too effectively upholstered?

There is a simplistic assumption that even mentioning fat problems will lead each teenager to swing like a pendulum in the direction of size zero starvation, which just is not borne out by the evidence. A lot more lives will be blighted by weight problems than anorexia.

Evolution, which programmes us to consume in times of lots, tends to make no allowance for the round-the-clock availability of cheap, fat, sugary, addictive foods. Our genetic lottery plays a function in storing unwanted fat, and even though desk-bound operating lives burn us out, they don’t burn calories – so it is all feast and no famine.

An overweight friend, gaily shedding pounds with the five:two diet program, mischievously suggests a classification of people’s size similar to that employed in the Paralympics: as a result, instead of employing the “fat” word, a series of letters and numbers would denote girth and so forth. I can not see even silver-tongued Nigel Farage getting that certain Brave New World notion to fly. But we do require to have a wise conversation, which signifies shelving the guilt trip and the defensiveness. And, no matter whether we like it or not, the chips, booze and chocolate.

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EMMA WATSON’S Demonstrate AND Inform REVEALS Far more THAN JUST HER KNICKERS

Emma Watson (above) would seem like a wonderful, sensible lady: no visible tattoos, shiny hair, insisted on finishing her degree so that she has a fall-back position if the total international stardom issue does not perform out.

But. Having bemoaned the lack of difficult, adult roles following her stint as Hermione in the Harry Potter series, the 23-yr-old has now tweeted a photograph of the entire contents of her make-up bag (such as her Commando Better Than Nothing knickers) like a hyperventilating teenage YouTuber.

Not that I’m complaining it proved an education to me at any fee. Tide instantaneous stain remover need to be in each woman’s armoury, Giorgio Armani skin flash radiance booster would transform the school run (even if my spangled Oscar de la Renta train does get caught in the vehicle door), and who knew Tom Ford created lipstick? Well, apart from A-Listers.

I really do not believe her motive was blatant solution placement – our Em has banked ample not to require freebies of dry shampoo – and it was plainly in the show-and-inform spirit of the age. But. It is not terribly Hedda Gabler now, is it?

Maybe Emma wants to accept she’s not really ready to put away childish things, which may well clarify why, for now, she keeps obtaining presented ingénue retreads.

It may well appear aggravating, but she’s in a unusual and covetable position for any actress actually looking forward to increasing older.

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JOANNE MILNE’S JOY OF SOUND

Who could fail to be moved by images of Joanne Milne, weeping with emotion as she heard sound for the very first time in her forty years of deafness?

Joanne, who was born without having hearing and then lost her vision in her twenties, obtained cochlear implants last month. This week they were ultimately switched on, and as a nurse recited the days of the week into her headphones, the charity employee broke down in tears at the sound of a human voice.

Joanne has because been launched to music – John Lennon’s Imagine was the initial track she listened to, followed by a compilation comprising a song from every 12 months since her birth, lovingly picked by her friends.

She is drunk on birdsong and traffic and the sound of lights getting switched on. Lord understands how she’ll cope when she stumbles upon the opening chords of Rhapsody in Blue or the 1st, exquisitely melancholy notes of Satie’s Gymnopédie No one.

But all these are so considerably background noise when in contrast to the sound of laughter and babies crying, idle chatter, cheering or merely whispered endearments.

It was Helen Keller who observed that while blindness separates folks from factors, deafness separates people from folks.

Following half a lifetime locked in silence, Joanne Milne has last but not least broken free of charge. Even to my jaded ears, the days of the week have never sounded sweeter.

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25 Many years Collectively IS NO JOKE

It’s April Fool’s day on Tuesday, when the newspapers will be positively chocca with wildly improbable stories about, oh, I do not know, David Cameron wresting key EU concessions from the Germans. Oh he has, has he? Gosh.

Anyway, the April one joke is technically supposed to put on off at midday, but at times it doesn’t.

At times, the giddy merriment lasts 25 years, which is how prolonged, because the very coup de foudre, my husband and I will have been with each other. And prior to you even contemplate undertaking the maths, let’s just say I was younger. Quite, really youthful.

Though we did not wed for more than a decade, I contemplate 1989 to be the crucible of shock and awe, as that was when I set about making an attempt to modify him.

My partner, on the other hand, claims that 2000 is 12 months zero, which is partly due to bloody-minded pedantry in excess of the date of our actual marriage vows, and partly a troubling reluctance to bankroll a solid silver filter for the dishwasher or what ever other gewgaw is customary to mark the date of domestic enslavement.

Over the past 25 many years, we’ve weathered the deaths of mother and father and the births of children, been painfully winded by life’s calamities and, just usually enough, lifted substantial on sudden thermals of utter joy.

So we really do not require to acquire one particular one more cripplingly pricey, tritely clear presents in order to express our really like and appreciation for 1 an additional. But, darling, if you are reading through this, I might have acquired you a small some thing. Just so you know.

Let"s not mince words - unwanted fat can be a death sentence