Author: Alison Griffiths

The news that nine percent more deaths were recorded in 2022 than in 2019 (the last year before the pandemic) has naturally given rise to a fair amount of debate. It may well be that we have to wait for the results of in depth studies before we see a more definitive indication of the causes of excess mortalities. In the meantime, various theories have been put forward as to why the second half of 2022 in particular saw more deaths than would otherwise be expected.

During the course of the pandemic, concerns were raised that patients were delaying approaching their doctors or finding it difficult to receive an accurate diagnosis when consultations were managed at a distance. It was therefore recognised that the potential for untreated conditions to require greater intervention, once diagnosed, than would otherwise be the case could lead to excess deaths. For example, a recent BBC report, highlighted a reduction in the number of new prescriptions for blood pressure medication or statins during the covid period.

The ongoing effect of having had covid has also been put forward as another potential reason for people dying earlier than expected. One study reported in the BMJ [1] concluded that “Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population.” This includes an increased risk of cardiovascular disease following covid infection.

This theory is bolstered by another BMJ report [2] which highlighted the fact that whilst an analysis of the ‘underlying cause of death’ for conditions such as heart disease and stroke have not shown an increase, this changes dramatically when looking at the wider causes of death mentioned on death certificates. In particular, death certificates mentioning cardiovascular disease and diabetes have been seen to be substantially in excess of the norm since April 2022.

The ongoing pressures on the health service have also been put forward as a potential reason for some excess deaths. From delays in seeing a GP and starting treatment to pressures on the ambulance and emergency services; it is inevitable that pressures on the health service have the potential to affect patient outcomes.

This is one reason why there is an increasing emphasis on the part played by pharmacists and other health practitioners in delivering healthcare solutions. The more that healthcare professionals across the board can contribute to delivering patient outcomes, the greater the potential for improved acute patient outcomes. Of course, that spreading of the burden is only effective if it can be done without over-stressing other elements of the healthcare service. In part that means finding ways to work smarter rather than harder, to optimise patient consultation times without adversely affecting patient care.

Strategies such as digitising patient records can help here, enabling patient notes to be shared across healthcare professionals as required. Not only does this reduce delays in referrals, it also avoids needless time spent in requiring the patient to repeat their history to each successive healthcare professional. 

The problem of excess deaths isn’t confined to the UK. Speaking to Sky, NHS England chief strategy officer Chris Hopson highlighted that countries such as Germany, Spain and Italy are also experiencing higher mortality rates than normal. That’s why further research is required to identify the underlying factors and put mitigation strategies in place. Pending that research, the more that can be done to spread the excess healthcare workload, the better.

[1] https://www.bmj.com/content/372/bmj.n693

[2] https://www.bmj.com/content/379/bmj.o2524

“When health as a fundamental human right is upheld by all countries and all sectors, we lay a strong foundation for building the world we all want and deserve.”

That quote from the World Health Organisation (WHO) perfectly illustrates why in 2017 it decided to launch International Universal Health Coverage Day. The day, which is held on 12^th December each year, aims to showcase international efforts to prioritise health care for all people, communities and organisations across the world.

The theme for 2022 is: “Build the world we want: A healthy future for all.” According to the WHO primary health care which is based on a ‘whole of society’ approach is the most effective way to bring health and well-being closer to people. Accordingly, the WHO is calling for societies and economies to be designed to prioritise everyone’s health.

The WHO comments that improvements have been made in the delivery of universal healthcare since it first started to promote the idea of health care for all some seventy-five years ago. However, the WHO also acknowledges that inequalities in service coverage and financial hardship still exist in many countries, especially among vulnerable and hard to reach populations.

This year’s event is overshadowed by the impact which the Covid pandemic had on universal healthcare with the effects having been exacerbated by the current global economic recession. These, the WHO say are likely to halt progress seen in recent times, particularly among disadvantaged populations.

Even in a country such as the UK which, thanks to the NHS, has had a primary healthcare system since 1948 we have seen the effects of Covid on healthcare delivery. The combination of delayed treatments and the ongoing health impacts of those affected by long covid have helped to put the service under even more strain than before.

But universal health provision is not simply a matter of treating existing conditions. Prevention too plays an important part. Take the Chief Medical Officer’s recent call for the UK to do more to reduce air pollution. Recognising the progress which has been made towards tackling outdoor air pollution, Professor Chris Whitty comments that we should not ignore the impact which indoor air pollution can have on health.

We spend around 80% of our time indoors and yet indoor air pollution is still in many instances not seen as a priority in designing and managing buildings; particularly public spaces. In order to address this the Chief Medical Officer has called for work to be undertaken to find ways of ensuring effective ventilation in indoor spaces whilst minimising energy use and heat loss. Research, the CMO says, should also look at ways of reducing indoor air pollution including reducing the sources of that pollution.

Taken together indoor and outdoor air pollution have been linked with a range of health conditions including lung cancer, cardiovascular problems and asthma. It’s a perfect illustration of why the WHO sees health provision in terms of societies and economies; with every agency uniting to deliver health coverage for all.

As we slide past the middle of November we have to admit that, so far, autumn has been a fairly mild affair. So much so that Armistice Day 2022 was the warmest on record. Is this warm autumn going to continue or should we be preparing for storms ahead?

According to the Met Office’s long range forecast it’s a bit of a good news, bad news scenario. On the positive side, although the Met office doesn’t rule out the chance of stormy weather at times, they say that the risk of strong winds and storms is less than normal. However, whilst we may see fewer strong gales than in recent years, the risk of excess rainfall is being supplanted by a greater chance of a colder winter.

If the Met Office is right, that means more frost and ice. And if that happens then potentially there will be an increasing demand on health services as pedestrians slip and fall and traffic slides in the icy conditions. And it’s not just physical health which can be affected; with a Met Office survey released in October 2022 revealing that 41% felt their mental health was affected by winter weather.

Planning for such eventualities means finding ways to deliver continuing care without unnecessarily tying up vital resources. Truth be told, at the time of writing there is no way to be certain when this colder weather will arrive. As the Met Office’s Chief Meteorologist, Professor Paul Davies, commented “the science, as yet does not allow for specific detail on, for example, the number of nights of frost, rain or snow over the coming months or when specifically severe weather may occur.” 

That can make planning difficult. How do you agree holiday leave or structure shifts based on likely demand/resource matrices if you don’t know when that demand is likely to occur? And is it really the best use of scares resources to take on extra staff just in case they might be needed when poor weather hits?

One solution could be to develop processes which can be flexed as demand requires. For example, a health practice might decide to appoint a call answering service such as that provided by Clinic Appointments. Available either on a permanent or ‘at need’ basis; having calls answered by an external agency helps to relieve administration burdens, particularly when resources may be stretched. With calls answered in the name of the health practice, clients need not know that you have outsourced the call function.

Our call handlers can screen out unwanted sales calls and answer general enquiries leaving you free to concentrate on patient treatments. Add in the diary management option and we can also book and update appointments as well as send out appointment reminders if required. Over 97% of calls are answered within three rings, providing a professional response for health patients.

Best of all with the option of an overflow or permanent services, health practices have a potential call management solution which can flex as the needs of the business change in response to the weather or to any other factor. The Met Office may not be predicting storms this winter but flexible planning solutions could help health practices to weather any other seasonal pressures that this winter may bring.

Last month we wrote about a campaign to reduce the stresses which health practitioners encounter on a daily basis. In our article we highlighted a few coping strategies suggested by the BMA. And we looked at how even simple administration changes such as sending out appointment reminders by SMS text or taking credit card details at the time of booking could help to reduce the number of missed appointments; a potential source of stress for practitioners and patients alike.

There is another reason why something as simple as SMS text reminders could make a marked difference to some individuals; the menopause. Whilst every individual’s experience of the menopause is personal to them, cognitive difficulties are relatively common. So much so that research conducted for World Menopause Day on 18^th October by the Chartered Institute of Personnel and Development (CIPD) revealed that nearly two thirds of women who were experiencing menopause symptoms found they were less able to concentrate. No wonder therefore that the theme for the 2022 day is ‘cognition and mood.’

A paper released by the International Menopause Society highlighted some of the cognitive difficulties experienced by those transitioning menopause including disturbances in daily life, trouble concentrating, and forgetting appointments and events. With that in mind, even something as simple as SMS text reminders can make it easier for individuals to manage their daily lives without missing out on important health checks. From this writer’s personal experience, another source of stress is the fear that appointments have been written down incorrectly. This has led to a need to phone the health practitioner to double check, something which could have been avoided had SMS texts been issued.

This leads us on to another important issue, the effect which the menopause could have not just to patients but also to those working within health practices. The CIPD research mentioned above also revealed that sixty percent of those surveyed found that menopause symptoms had a negative impact on their work. When everyday actions can seem stressful, the more that processes can be automated the better. For example, digitising patient records might seem like a simple solution. But being able to retrieve information at the touch of a button rather than searching through paper files can help to relieve stress; particularly if there is a concern that ‘brain fog’ might have led to mis-filed information. Solutions such as these may go some way  towards helping the more than 50% of people who reported increased stress levels during the menopause.

Finally, it is important to be clear that every individual’s journey will be personal to them and that symptoms may come and go over time. The effect on friends, family, and colleagues cannot be underestimated. As the NHS employer’s website commented: “Menopause is not just a gender or age issue; it is an organisational issue.  It can impact on colleagues both directly or indirectly. Awareness on this topic is fundamental and reducing the stigma attached to it is vital so that more people will talk openly about it so it can begin to be normalised and people can get the support they need.”

How are you? Three simple words which convey a wealth of meaning as expressions of enquiry, of concern, and of genuine care. Of course, in the spirit of the stiff British upper lip the instinctive answer is to say that you are OK. But there are times when giving that answer is to deny yourself and to deny the people around you the chance to help.

Quite simply, it’s OK to not be OK.

Acknowledging this, the BMA’s General Practice branch has come up with a ten point plan to help their colleagues to manage in stressful times. Quite frankly, many of the suggestions could equally apply not only to practitioners across the health service but in other walks of life as well.

The plan includes some of the more obvious coping strategies such as providing access to support groups, pairing less experienced staff with more experienced colleagues, and rotating staff between high and low stress activities. But it also stresses the need for people to check in with each other, for individuals to feel able to speak up if they are struggling and for senior staff to stress the message that it is OK to not be OK.

The overall message is simple, health practitioners cannot provide the best levels of care for patients if they are in need of care themselves. And right now that’s a challenge. Statistic after statistic demonstrate just how much strain the health service is under. A BMA analysis in September 2022 talks about a growing backlog of care with one in eight people in England waiting for treatment.  

And despite the announcement of some thirty-five thousand new healthcare support workers having signed up to join the NHS in 2022, the pressure to provide the highest level of care for patients still remains. That’s’ why statistics which were released earlier in 2022 with revealed that across the country there were more than one million missed appointments each month are so disconcerting. When demand for services is already high, optimising face-to-face or face-to-screen time is key to ensuring that as many people as possible are able to receive the treatment they need as early as possible.

In response to these statistics the then Chancellor, Rishi Sunak, floated the idea of charging no-shows £10 a time. The response to this proposal was mixed; but there are other ways of helping to ensure that people are more likely to attend booked appointments. Simple solutions such as sending out appointment reminders by SMS text have been shown to reduce the number of missed appointments. And for those health practitioners who charge for their services, being able to take credit or debit card details at the time of booking and to charge a fee if the patient fails to turn up for their appointment has proved to be another way of boosting attendances.

What do simple steps such as these have to do with practitioner health? Well, when the pressure is on, sitting waiting for a no-show whilst being aware that you could have been treating someone else can be a source of frustration and stress. Taking even simple steps to optimise patient access may not seem like much but they could have positive results for patients and for health practitioners alike.  

“The National Health Service and the social care sector are facing the greatest workforce crisis in their history.” Parliament’s ongoing inquiry into workforce: recruitment, training and retention in health and social care didn’t pull any punches as it issued its latest report into the sector in July 2022. Setting out the levels of shortage across doctors, nurses, and midwives, the report goes on to highlight the ever increasing demand on the health and social care sector which will result in a further 475,000 positions in health and 490,000 in social care within a decade.

As a result of the existing and future anticipated shortage the report comments that nearly 90% of BMA members think the Government’s aim to tackle the Covid backlog with the existing workforce is either “totally or mostly” unachievable. Of greater concern is the toll which the report indicates is being put on the health of NHS workers, leading either to the need to take time off or to individuals leaving the profession. In response the Royal college of Physicians called for ‘better workforce planning informed by patient demand.’

The shortage of trained doctors and nurses is not confined to NHS surgeries or hospitals. A BBC report at the beginning of August 2022 revealed that ninety percent of dental practices are not accepting new NHS adult patients with eighty percent not taking on children. Commenting on the report The British Dental Association commented that NHS dentistry was at a ‘tipping point.

Statistics such as these demonstrate the challenge facing the health sector. In a bid to overcome that challenge, in recent years we’ve seen the rise of smart systems which are designed to take some of the administrative burden away from health practitioners. Simple solutions such as SMS texting have already resulted in a measurable decrease in appointment no-shows whilst the ability to make appointments online has helped to improve patient accessibility. Other innovations such as digitising patient notes have not only saved administration time, they have also enabled clinicians and health professionals to better share information; collaborating in order to improve patient outcomes.

And these are only the tip of the iceberg. Innovations in patient treatment and care have been seen across a range of services; from apps which enable people to be monitored whilst living at home to robot-assisted surgery which enables surgeons to perform surgical procedures with a greater level of control than before. Innovations such as these are designed to improve patient outcomes and speed up recuperation whilst reducing the day to day burden on health services.

The Parliamentary report made seventy-three recommendations across health and social care. These covered areas such as workforce planning, recruitment, training, and the retention of staff. This last area considers the availability of flexible working patterns alongside pay and working conditions. Working culture including the challenges faced by those who are recruited overseas also came in for a number of recommendations as did the need to ensure continuity of care for individuals across health and social care systems.

An amber extreme heat warning covering must of the country has been issued by the Met Office. Coming almost exactly one year on from the first ever amber warning, this extreme heat  warning which was originally only in force for Sunday 17^th July has now been extended to take in Monday 18^th and Tuesday 19^th July 2022.

With daytime temperatures climbing into the 30s and night time temperatures also higher than normal, the amber weather warning should not be taken lightly. The Met Office warns that ‘population-wide adverse health effects are likely to be experienced’ which could potentially lead to serious illness or danger to life. Importantly, it’s not just those who are already seen as vulnerable who may be affected.

Accordingly, the Met Office has reiterated the standard Government advice that 999 services should be used in emergencies only. However, it is worth noting that even before the amber heat warning was issued, all ten ambulance services across England had already declared a critical incident meaning that response times are likely to be stretched.

So what can health providers do to help their patients at this time. It is worth noting that the Met Office warn that transport delays are likely, with road closures and cancellations to rail travel expected due to the effects of heat on infrastructure. Even moderate delays, the Met Office say,   could lead to ‘significant welfare issues’ for those stuck in traffic or on trains. And it won’t just be patients affected with staff too being potentially caught up in the delays.

With the standard advice being not to travel unless necessary it may therefore be worth considering a review of appointments booked for the days affected. This, with a view to rearranging appointment times or days, particularly for the most vulnerable patients.

Admittedly there will be some appointments which should not be delayed. But is there any scope for being a little more flexible on times, perhaps shifting appointments due to take place in the hottest parts of the day to earlier in the morning or later in the evening? Remember, excess heat can not only lead to irritability it can also affect our ability to concentrate on mental or skilled tasks. So moving appointments may not only help your patients as they travel to your practice, it might also help to ensure that your service to patients is not affected by the heat.

 And whilst it may be too late to check that any air conditioning is working well, it might be worth ensuring that staff and patients have access to chilled water and a cool area within the building. This cool area could also be used for patients who wish to delay their journey home until the hottest part of the day has passed.

Finally, make sure that your people are aware of and can react to and appropriately treat the symptoms of heat exhaustion and heat stroke. The link to the NHS advice on these conditions can be found here. [1]

[1] https://www.nhs.uk/conditions/heat-exhaustion-heatstroke/

What week is it? Sometimes it can be hard to keep track of time, with work days merging into an endless stream punctuated by weekends or days off.  But take a look around and you might well find milestones, special events which can help to break up the pattern and inject fresh awareness and outlook.

Take the current week of the 13^th to 19^th June 2022 for example. There are no Bank Holidays, nor even school holidays, to break up the time. And yet, this week is special with not one, nor two, but three national campaigns to focus in on.

Let’s start with Men’s Health Week. Run by the Men’s Health Forum, this campaign calls on men to give themselves an MOT, to ‘take notice of what’s going on in your body and mind’ and to take action. Prostate cancer diagnosis fell by 29% between 2019 and 2020 due to covid lockdowns so that is one area of concern. But the MOT also looks at a range of areas from pulse and blood pressure rates to weight and mental awareness, encouraging men to check for common areas of potential concern and to take action.

With blood pressure and weight in mind, it is also the British Nutrition Foundation’s Healthy Eating Week. The aim of the week is to encourage everyone to have “a healthier and more sustainable diet.” Each day has a theme from Monday’s focus on fibre to Friday’s reduce food waste with 5 a day, protein, and hydration filling the other days.

What we eat can affect our health, so it is perhaps pertinent that the 13^th to 19^th June is also Diabetes Week. Promoted by Diabetes UK, the week is designed not only to celebrate those who are living with diabetes but also to promote awareness of the condition. Alongside events for everyone to get involved in there is also a ninety minute diabetes CPD course for non-specialist health care professionals, helping to provide the knowledge and skills required to better support diabetes patients.

For those in the health care profession, week’s such as these can be invaluable; not simply as ways of generating targeted publicity but also as a means to help patients to be aware of risks and opportunities and to take action to improve their own health. A general leaflet or quick chat is one thing; a national campaign is quite another. And whilst some patients may be galvanised by national publicity to check their own health and make appointments to discuss any concerns, health professionals can also proactively use these campaigns in order to reach out to those under their care.

Being aware of forthcoming campaigns can also enable health professionals to plan workloads and to ensure that they have the resources available should a particular action week result in an increase in patient calls. Even something as simple as having a call answering service on standby to take overflow calls or provide simple information could help health professionals to optimise the results from action weeks. Raising awareness is after all only the start of the journey to improving health and lifestyles.

How secure is your business? Do you check visitors in and out of the office, perhaps restrict access to certain confidential files, or work on a need to know basis? Or perhaps you operate a more free and open style, trusting your people to know what should and shouldn’t be shared and to act in the best interests of the organisation.

Whatever your approach, there may be one area which is leaving your company information open to the world; your passwords. According to a 2019 Data Breach investigations report by Verizon, 80% of data breaches are caused by weak and compromised passwords and little has changed since. It seems as though, despite the danger, the temptation to use easy to remember passwords overcomes any concern about data breaches.

A more recent survey by NordPass revealed that the top passwords used by CEOs, executives, business owners and managers have little changed over time. There are a few variants on a theme but overwhelmingly ‘123456’, ‘password,’ and ‘qwerty’ seem to be the password of choice. Those of a more adventurous nature may look towards animals and mythical creatures with ‘dragon’ and ‘monkey’ coming top of that list; whilst others may simply opt for the inclusion of family or pet names.

If that is the tone being set at the top of organisations, it is hardly surprising that others lower down the ranks fail to take password security as seriously as they might. That’s one reason why World Password Day, which takes place towards the beginning of May each year, gives prominence to the promotion of strong passwords which are less likely to be hacked.

So what is a strong password? You might think that randomness equals strength. And it does, to an extent. However, make the password too random and it becomes so hard to remember that it will be written down; not something you want for password security. As an alternative, in 2016 the UK’s National Cyber Centre recommended using a combination of three random words such as ‘coffeetrainfish.’ These are hard for hackers to guess and yet are far easier for individuals to remember.

When you are looking at password management, don’t forget your phone system. If individual phones, or the system itself, are still using the default passwords they came with on installation then they are open to hacking. And once your phone system is vulnerable then not only can phishing attackers gain access to an apparently secure line, fraudsters may also be able to use your system to run up expensive calls to premium numbers. Add in the potential for hackers to access caller details and it is easy to see how data breaches can cost businesses their livelihoods and reputation.

Apart from ensuring that default ‘1111’ or similar pass codes are not being used, another option is to ensure that unused extensions are not left available. Callagenix’s Extension Control App and ACD Login Service enable supervisors to switch extensions on and off as required; perhaps something to consider if offices are to be left empty over the extended Jubilee Bank Holiday weekend.