Julie Whittaker's Blog

Country: United Kingdom

Organisation: Expect Health

Blog link: http://www.3four50.com/blog/juliewhittaker

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Your health - whose responsibility

10th Aug 2010

The Government is urging the public to take more responsibility for its health to cut smoking and drinking and take more exercise.But in this week's BBC’s Scrubbing Up, Professor Richard Ashcroft, a bio-ethics expert at Queen Mary, University of London, warns that will-power is often too weak. Secretary of State for Health Andrew Lansley has repeated said its time for people to take more responsibility for the health of themselves and their families. Lansley argues that if we want to see people eating healthier diets, smoking less, and taking more exercise, then an approach based on lecturing people, supervising what they eat, and banning things would fail - unless people's behaviours changed too.He is not saying - as conservatives (small c) often do - that it is none of the state's business what people eat. Quite the opposite: he was explicitly arguing for the state having a role in changing how people behave. Mr Lansley is arguing that we need to look at the ways we try to encourage healthy eating, giving up smoking, etc. Do they work? Or do they sometimes achieve the opposite of what we intended?A prime example is smokers; despite knowing the damage their vice causes, the instant fix they get from a cigarette overrides any consideration for long-term wellbeing”But politicians who advocate patients taking greater control of their own healthcare fail to understand what really motivates people.It's all very noble, but recent behavioural science research challenges the idea that people are rational decision-makers where their personal health is concerned. People are not always in full control of their behaviour.The problem is not really that we all have things we like, and knowingly eat or drink, which aren't all that good for us. Most of us know that a little of what you fancy does you good, and most of the time we're right. Sometimes we'll knowingly "trade off" different goals we have: I want that ice cream, and I want lose weight, and right now I choose the ice cream, knowing that the plan to lose weight is taking a hit. But that's a conscious choice, even if I regret it later.The problem is that often we make these sorts of choices unconsciously, or make mistakes. Or our commitment to our goals is weaker than we think. Or - hardest of all - our will is weak. My behaviour is shaped by forces I don't know about, don't understand, and even when I do, I find hard to resist or control.Health education is only part of the story. Some health information campaigns are very compelling – such as smoking campaigns which use children talking about their parents' lung cancers. But evidence shows that they do not have the strong effect on most of the population. In addition, these campaigns rarely have the seductive appeal of the advertising of the tobacco and alcohol industries. Health campaigns are rarely about pleasure and enjoyment or are rarely cool.Lecturing people fails both because no one likes to be hectored, and because people don't necessarily learn from it. And they have other sources of information as well.Usually what drives me is circumstance, habit and short term reward. So the trick is to find ways to rewire my habits, change my circumstances, and make the rewards pull me in ways I want to go, and not in ways that are harmful to me. And that's hard. On the surface it is also hard to see how getting industries which have an interest in getting me to buy their (potentially harmful) products in increasing quantities can be trusted with promoting health education and health behaviour change at the same time. But the need to be part of the solution, with government advertising budgets being slashed and the Change4Life scheme being handed over to the private sector, this is a serious concern to many working for public health. These companies have the answers on how to seduce the public – can they use this information to change the way we behaviour and change our habits for ever – we wait to see.
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Most recent comment by Justin Zaman on 8th Sep 2010

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Andrew Lansley lead NHS Reform

13th Jul 2010

Secretary of State for Health, Andrew Lansley presented his healthcare reform plans in parliament yesterday. It represented on one of the biggest shake ups in the health system since the NHS was founded. A t the heart of the plans is a more patient-focused, clinically led organisation – putting those who are receiving and delivering treatment in charge of how the funds are spent. But how successful will this be in practice?

GPs and GP Consortia will lead the way – are they ready for this? How many GPs want to spend their time worrying about commissioning services? Andrew Lansley might see this as “liberating the NHS from the old command-and-control” but is it really only passing the buck to those in the front line who are busy dealing with treating patients? Is the removal of PCTs from the role of commissioning one step too far in provision of healthcare?

How will it benefit the patients? Well, there will be more freedom to choose your GP and the services you require for treatment, those with long-term conditions will have the freedom of a personalised budget which are all very positive – but needs to be seen in the context of current economic realities. Stronger integration of social and healthcare budgets at a local level makes sense to ensure that the patients requiring both receive seamless services. But in this time of economic restraint, although the Healthcare budget is ring-fenced – the social care budgets are not and will be subject to the Autumn spending review.

Much of the change outlined in White Paper is positive especially when it comes to integrating the patient into the care plan – this was at the heart of the Darzi report. Providing the envisaged benefits is more difficult - the patients must have a good understanding of what they need and how to find the treatments and services they need and assess whether these are the best for them. Is there money and time for patient education? How will they know what questions to ask? Will the GPs have time and resources to deal with a patient-centric system? It requires a fundamental shift in thinking and resources to implement this part of the plan.

Will this new system work? – only time will tell. In any market system there are winners and losers but it has the potential to lead to even more localised postcode lotteries for treatment and some patients not getting the treatments they deserve or are entitled to, alternatively it could be the success we all hope for.

The White Paper states “Our goal is an NHS which achieves results that are amongst the best in the world” : Mr Lansley we wait to see.

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Investment in Innovation – a priority for patients

30th Jun 2010

The pharmaceutical industry’s funding of research and itssuccess rates in developing new medicines both fell last year, reports AndrewJack from the Financial Times this week following the release of the CMRInternational* annual year book.

According to the report investment in the research anddevelopment across the pharmaceutical companies has fallen and failure rates ofnew drugs have increased. In search ofsavings the drug companies have now cut back on their R&D to only 15% ofsales.

Sales from new products have remained low and account foronly 7% of total drug sales, and as low as 2.3% among the larger companies whocontinue to rely on older products which will soon lose their exclusivity andsee prices drop as the drugs come off patent.

CMR estimated that for every 12 drugs entering pre-clinicalresearch, only two make it to Phase 3 and just one is submitted to theregulators for approval as safe and effective in patients.

In addition, the pharmaceutical companies are concentratingpredominantly on treatments for cancer, which seems risky given NICE’s recenthistory of turning down approval of cancer drugs because the price beingcharged is too high. The returns couldbe lower than expected and therefore even more reduced spending on R&D.

What are the implications for patients and their quality ofliving? It appears that innovation innew treatments may well slow down or be concentrated only areas where there arelarge numbers of patients...and therefore a larger return on investment. There will be more use of older generic drugsnot giving the patients the choice they should have.

Supporting innovation is key to finding new cures – patientsneed call on the Government through the Department of Business, Innovation andScience to sponsor more research with the Medical Research Council. TheMRC supports research that will improve human health and gives high priority to research that is likely to make a realdifference to clinical practice and the health of the population.

This is an ideal opportunity tobring all the parties involved together - Government, academia and industry towork together to ensure that investment in innovation remains a top priority infinding treatments for life threatening diseases and make sure that patientshave the best chance of a good a quality of life possible.

*The CMR International Institute forRegulatory Science (the Institute) is the vehicle through which theinternational pharmaceutical industry, regulatory authorities and academiameet, debate and develop regulatory policy. www.cmr.org

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Patients need to take charge

8th Jun 2010

Andrew Lansley, Secretary of State for Health, has set out his vision for the NHS wanting to improve outcomes by making the patients the driving forces of improvements to the NHS... not just being beneficiaries of care but as participants with shared decision-making.

It wants the patient to take more active role in their treatment choices through informative comparative data about standards and patient experience, engaging them more fully in their decision making and by allowing real time feedback – believing these will improve the overall care experience.

In addition, continuing the work of the previous administration it want to concentrate on taking a holistic approach to health by looking at the entire patient pathway from preventative health and well being measures, through to hospital and community care.

Part of the process in making this happen will be the payment system to the hospital. When patients are admitted to hospital, the payment to the hospital is reliant on the patient having received treatment does not need further related treatment for 30 days. It is hoped that this will improve quality and performance and shift the focus to the outcome for the patient, rather than the volume of activity paid to the hospital.

All this sounds like good news for patient care but it relies on the patient being able to make these decisions from data provided. But there is no mention of the education required by the patients and healthcare providers to make this system work. Part of the reason for patients returning to their doctor or hospital is that they have not followed their treatment regimen and become ill again.

Expect Health believes that to prevent this there needs to be buy-in of the patient to be jointly responsible for their care from first diagnosis and this needs to be part of the education process to make this vision for the NHS can succeed.

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Asda Champions Cancer Drugs...

26th May 2010

As NICE continues to reject many cancer drugs on the grounds of lack of value for money and no evidence proving a tangible benefit to extending quality of life – patients and their carers have no alternative but to fund the cost of their drugs out of their own pockets. According to charities this relates to up to 16,000 patients per year. What a surprise it must be to these patients to find that the pharmacies are making a large profit out of selling these drugs on private prescriptions but in order to get the best price the patients need to shop around as some pharmacies are making up their products by 76%!In response to this Asda has announced this week that it is to sell cancer drugs on a not-for-profit basis as thousands of NHS patients continue to be denied medicines that are deemed too expensive. The supermarket giant has called on other pharmacists to follow its lead and lower the price of all cancer drugs that are prescribed privately, to give patients access to drugs that are not always available on the NHS. This move could save cancer patients thousands of pounds on the cost of treatments that may extend their lives by weeks, months or years. As an example of the mark ups - the lung cancer drug Iressa will be sold by Asda for £2,167.71 for a pack of 30 while Lloyds Pharmcy charge £2,601.2, Boots £3,251.57 at Boots and top of the list Superdrug £3,253.56. Asda said it had checked the price of seven of the most commonly privately prescribed cancer drugs in British pharmacies and had found mark-ups of up to 76 per cent. It is bad enough paying for very expensive cancer treatment and that patients and their carers are having spend to their life savings to fund the cost of the drugs but then having to shop around for the best deal is outrageous. Expect Health believes that this initiative goes someway towards alleviating the cost for those who can afford to pay but still reinforces an unfair two-tier healthcare system. Surely all treatments recommended by doctors should be available to those who need them and not by whether you can afford to buy them.

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Innovative thinking boosts NHS Funds

13th May 2010

Two thoughts which don't usually go together:

Hospital meals being tasty
with
Sustainability of local economies as a priority for an NHS hospital trust

But one hospital trust in the UK is saving over £ millions a year in patient catering costs doing both. It has made special arrangements to source all its food from local farmers and suppliers.

Nottingham City Hospital have switched to a menu of foods cooked with fresh ingredients, saving of £ 2.50 per patient per day. The saving cuts both ways: as a result of the hospital contract several local farmers and other providers were saved from going under, and all the rest enjoy a susatainable source of income.The hospital contract supports local farmers and other providers and hass saved a number from going under. Ninety per cent of the fresh food comes from the East Midlands and it is the only hospital trust to receive a Soil Association award from Prince Charles.

The NHS is often accused of lack of innovation when it comes to patient care;here is an example of a simple idea which has much improved the quality of the food, has created a safe source of income for the local economy and is saving £ 6 million of the trust's budget and 150,000 food miles to boot. The six million pounds saved can thus fund front line services and help support them during a period of anticipated deep cuts.

Just think what positive impact such a piece of creative thinking imight have if it were applied nationally! How much the NHS could save to be redirected to patients and care? How many other services could be transformed to make the patient experience better with a bit of imagination?

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Do we need to cut to save?

12th Apr 2010

Today’s papers are critical of the salaries of the top NHS chief executives, in light of the need to save money and cut costs in this area. But these figures represent a mere drop in the ocean compared to the overall budget for the NHS or the savings that will need to be made. Those are not in question. The king’s fund has identified a £ 21 billion gap in funding in two -years time!

Are there other areas worth considering where costs can be saved without cutting the services? Expect health believes there are!

The NHS prescribes just over £ 8 billion pounds worth of drugs every year - how many are not taken correctly or even at all? Does this potential waste of NHS resources offer an opportunity to save costs?

According to NICE* it is thought that between a third and half of all medicines prescribed for long-term conditions are not taken as recommended. This represents a loss to patients, the healthcare system and society. The cost of not taking a medication correctly is both personal and economic. Non-adherence may limit the use of the medicines resulting in a lack of improvement or deterioration in the health of the patients. It’s not just the cost of the medication that is wasted but there are also the knock- on effects arising from increased demands on healthcare resources (especially expensive hospitalisation that may occur) if the patient’s health gets worse.

Non-adherence should not be seen as the patient’s fault. It is a much more complex phenomenon which relates to the way healthcare is delivered, how the prescription is explained and agreed with the patient, and the support provided to ensure that mediation is taken correctly and the total regimen is followed.

Non-adherence causes can be intentional or unintentional. Unintentional non-adherence happens when patients want to follow the agreed treatment but are unable to do so by barriers beyond their control: maybe poor recall, or inability to understand instructions, problems using the treatment or simply forgetting to take it. All these can be addressed by better and more personalised healthcare delivery.

Intentional non-adherence occurs when the patient decides not to follow the treatment recommendations. This can be best understood by examining the beliefs and preferences that influence the person’s perceptions of the treatment, and the motivation and/or pressure to start and continue with it.

NICE offers guidelines to ensure that adherence improves, the guideline recommends how healthcare professionals can help patients by involving them in the treatment decisions and insisting on follow up and support. Specifically, NICE recommends:

· a frank and open, no-blame, approach, which recognizes that non-adherence maybe the norm; putting emphasis on encouraging patients to discuss non-adherence and any doubts or concerns that they have about treatment;

· a patient-centred approach that encourages informed adherence

· Identification of specific perceptual and practical barriers to adherence for each individual, both at the time of prescribing and during regular reviews, because perception, practical problems and adherence may change over time.

How much better would patients, healthcare professionals and the NHS budget be if this guideline were followed and effective? If only 10% of the NHS drug budget could be saved through better, personalised treatment plans, this would equate to slightly less than 1 billion in savings… 1 billion pounds a year against a more personal approach to patient communications! Not difficult to do if the will is there.

Definitely worth doing -- better medicine, better outcomes and less costs. Is it possible?

*NICE clinical guideline 76

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Popping Pills for Britain!

6th Apr 2010

The media commentated on a report last week suggesting that the UK has become a nation of pill poppers with the number of prescriptions per person rising from 8 to 16 per annum over the last 20 years.
Professor Joan Busfield, from the University of Essex, suggested that the doubling of prescriptions over the past 20 years is down to doctors being too ready with their biros. The paper is entitled a pill for every ill, published in the social science and medicine journal, and the author suggests that doctors are partly responding to patient demand and partly to aggressive marketing by the pharmaceutical companies. The paper also repeats claims against the pharmaceutical companies of "disease mongering" - creating disease that never existed before; or providing medications for everyday ailments that the public never worried about before such as pills to overcome shyness.
Disappointingly, the paper is too simplistic in its anti-industry cynicism. Pharmaceutical companies have funded research over the last 20 years that has allowed us to understand more about the causes of diseases. Companies have developed better and more convenient medications and delivery and diagnostic devices; they have provided education to healthcare professionals and , where allowed to patients too on how to treat and how to treat and live with medical conditions. Some of them have also focused efforts on learning more about what might prevent diseases in the first place. I am not an apologist for the pharmaceutical industry, and the companies' past practices have given rise to much justified criticism. But, surely patients have the right to receive the best treatments available to improve or maintain their quality of living ?

One area not addressed in this paper is the misuse of prescription drugs - patients having seen their doctor and receiving their prescription and then not taking their drugs properly or even at all. Can the quality of living, as well as the NHS budget, improve more if time is spent explaining the treatment better? The national frameworks for key diseases -- in effect the national strategy for managing cancer, heart, diabetes and mental diseases, all establish patient education as a key principle of good and effective practice. And, yet, reality on the ground is either patchy -- dependent on the specific decision of each pct board, or non existent in some cases. Perhaps the time has come to calculate the real cost of not popping the pills correctly and dramatise the fact that patients who do not feel able to follow their medication regimen either cause more damage to themselves or increase the burden on the doctor by visiting the surgery more than necessary. Clearly, the waste of drugs that are not used, or misused, can go a long way toward funding the frontline services of the NHS, that all claim they want to preserve and all know must be cut.

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50 days to the General Election .....

16th Mar 2010

Only 50 Days to the General Election (more or less depending on Mr Brown) The three major parties have issued their thoughts on the future of the NHS, and on the way it might change under their leadership.

Gordon Brown’s Labour party highlights its 11 key achievements since taking office in 1997; and re-states that it will continue to build on the current centralised structure to provide more options for the patients. David Cameron’s Conservative agenda will change the NHS structure, claiming to give more power locally to decide how the money is spent based on choices by patients. Nick Clegg’s Liberal Democrats also call for more local say in how the NHS is run, discussing personal care plans in the name of empowering the patient to make decisions.

The idea of empowering patients is not new. It has been part of the political rhetoric for more than a decade: starting from the “free market within the NHS” notion of the last Conservative government all the way to the Darzi report, which placed the patient at the centre of decision-making about treatment and the organisation of care delivery.

But there is a gap here between this noble aim and the facts: patients’ knowledge of what ails them, of what is needed to treat, of what is available and what is possible is limited. And without this knowledge, in fact without knowing how personal choices and behaviours affect the outcomes of treatment, there is no empowerment at all. And, here, is where all three manifestos are uniformly silence. There is little in the manifestos that reflect the critical importance of health education. There is even less about the need to integrate psychological and cultural support as part of treatment. These “softer” or “human” aspects of care, shown by many studies to provide better long-term outcomes and to improve quality of living, take away money and resources from direct, and politically more visible, front-line services.

To be truly patient driven, care must be personalised to the needs and circumstances of the individual. Only the persons concerned, and in certain cases their carers, can define what quality of living means to them. Healthcare is more than medicines or surgery. It is also more than doctors, nurses or hospitals. It is about helping the person under care to live as normally as possible for the longest time possible. Alas, for politicians, this is a longer time horizon than a five-year Parliamentary term.

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Most recent comment by Tony Harrison on 19th Mar 2010

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I never thought it would happen to me

5th Oct 2009

Having worked in healthcare communication for the last 10 years...I always thought I would be prepared if I needed to face a serious medical condition.

But nothing prepares you for the moment you find out a parent has cancer...not only has my father been diagnosed with cancer but it's stage 4 already. He has cancer within his bones and the reason for late diagnosis is that there were no outward symptoms until his shoulder started hurting a couple of months ago.

Its an overwhelming feeling and something difficult to get your head around the fact that it is happening let alone deal with information about treatment management and what you need to do. I cannot imagine what its like for Dad...a scientist who wants to get the facts but has no idea about how to deal the emotional side....just like the rest of us. There are lots of questions and very few answers- there are just no definitive answers.

The quest to find out more is fraught with difficulties - wanting to know enough but not too much to be frightened possible consequences I searched carefully through the web and settled on the Macmillan site (www.macmillan.org.uk) which tells you everything you need to know in a gentle and not scary way. I always thought I would want to know everything but do you know what, when it happens to you - you probably don't. The thought of cancer is so overwhelming you can only take in so much knowlege at once...

So as a professional in the healthcare communication business, wanting to make things different for patients and the people around them, I now have a very new perspective on how to communicate information and look forward to putting this into action with the people I work with at Expect Health (www.expecthealth.org.uk).

Its only s1x weeks since I found out Dad's cancer so still pretty shocked but look forward to sharing my journey along this path.

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This is an archived web site, please go to www.3FOUR50.com to see our most recent updates

Latest Blogs

Julie Whittaker's Blog

Your health - whose responsibility

10th Aug 2010

Most recent comments

Andrew Lansley lead NHS Reform

13th Jul 2010

Investment in Innovation – a priority for patients

30th Jun 2010

Patients need to take charge

8th Jun 2010

Asda Champions Cancer Drugs...

26th May 2010

Innovative thinking boosts NHS Funds

13th May 2010

Do we need to cut to save?

12th Apr 2010

Popping Pills for Britain!

6th Apr 2010

50 days to the General Election .....

16th Mar 2010

Most recent comments

I never thought it would happen to me

5th Oct 2009