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Responding to health staff shortages

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.

Extreme heat warning

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 17th July has now been extended to take in Monday 18th and Tuesday 19th 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/

Raising awareness

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 13th to 19th 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 13th to 19th 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.

Boosting password security

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.

Smart solutions

The news that the NHS is rolling out a smart watch to help with the monitoring and treatment of Parkinson’s patients is just one of a long line of health innovations which are making the most of smart technology. Worn around the clock for six days, the watch contains sensors which enable clinicians to assess the progress of the disease in patients. This in turn will help to identify whether current medication may need updating or whether additional therapies such as physiotherapy may be of benefit.

Developed by the University of Plymouth in conjunction with the local hospital trust, the monitor can also digitally remind patients to take their medications. Lead clinician, Dr Camille Carroll, an associate professor in Neurology at the University of Plymouth and an Honorary Consultant Neurologist at University Hospitals Plymouth NHS Trust commented that the device: “helps to provide reassurance for patients and also means that NHS staff can provide a comprehensive six-monthly review, while also allowing hard-working staff to free up clinical capacity for those who need face-to-face appointments.”

 This project demonstrates the way in which the development of technological solutions has the power to transform health services. Some of these solutions are simple but can have a marked impact on patient care and outcomes. Developments such as the sending of patient reminders via SMS may seem obvious now but they help to optimise patient attendance. Similarly, digitising patient records may not seem as remarkable as it once did but the ability to retrieve and share information electronically can not only save time but could also improve outcomes; particularly in patients with multi-care needs.

Another area which is proving beneficial to patient outcomes is the harnessing of video-conferencing and instant communications in order to share knowledge. The BMJ recently reported on the way in which video-conferencing is not only helping surgeons in the UK, Europe and elsewhere to train and support colleagues in Ukraine in the treatment of battlefield injuries, it is also being used in other fields, such as in Kenya to improve caesarean section outcomes.

 There are also a number of new projects in the pipeline, all of which have the power to transform monitoring and treatment of health issues. Announced in March 2022, the latest tranche of digital health partnership award winners include the use of a secure video platform to support young people with epilepsy, and the use of digital health solutions to transform outpatient care for those with chronic kidney disease. Other award winners deploy remote monitoring programmes in areas as varied as paediatric cardiac care, asthma care, and wound management. All these aim to reduce the need for multiple appointments whilst improving the level of care. Along the way this helps to free up clinical time, thereby increasing the number of people who can be treated at any time.

The number and variety of smart solutions will only grow as technology improves and as health services learn to harness the power of existing technology. Some solutions may be complex, some simple, but the outcome is improved patient care within in a health service which makes the most of available resources.

Managing stress

There’s nothing new about stress. So much so that the stress response, or fight or flight response as it is perhaps more widely known, was first developed by our distant ancestors in response to threats which they encountered within their environment.

Some of those long ago threats may no longer be there but the response remains, being triggered by real and perceived threats to our health and wellbeing. And when the stress response kicks in it doesn’t really matter if it has been triggered by a speeding car hurtling towards you, being placed in a situation which triggers a phobia, or a repeating pattern which causes psychological distress. Whatever the cause, the stress response is real; flooding our system with substances such as adrenaline and cortisol and causing changes in areas such as heart rate, breathing and blood flow.

Whilst the stress response changes might be necessary in a sudden life or death situation, triggering those responses on a regular and ongoing basis can lead to permanent damage not only to the cardiovascular system, but also to areas such as eyesight, the immune system and digestion. That’s why stress management is so important; not simply to overcome the immediacy of response but also to prevent long term impacts on health.

It’s hardly surprising therefore that the whole of April has been devoted to stress awareness. First instigated in 1992, Stress Awareness Month seeks to raise awareness both of the impact of stress and potential ways of mitigating stress. For 2022 Stress Awareness Month has chosen the theme of community. It’s a particularly apt theme, following on as it does from two years in which lockdowns lead to isolation at work, at home, and in the community.

Studies have shown that isolation can lead to depression and stress. Conversely, socialising with others, having someone to talk to or enjoy activities with can help to reduce stress levels. That community feeling can come from anywhere. It might arise in the home or in the neighbourhood, in a social club or at work. To this end the charity Mates in Mind has launched a series of resources in tandem with Stress Awareness Month. These include a ‘Let’s talk stress’ factsheet to help facilitate open conversations about workplace stress and a ‘Managing and reducing Workplace stress’ handbook.

The handbook lists a number of causes of stress in the workplace including a lack of support from supervisors and colleagues. It also makes the valid point that stress can build up over time, especially when a succession of potentially small things are left unresolved. The handbook then goes on to highlight potential signs of stress before outlining steps which employers and colleagues can play in managing workplace stress and supporting individuals.

Those steps can be as simple as redesigning workflow to reduce points of stress or raising awareness of support mechanisms which are available when workloads become too heavy to manage. Whatever the pathway, the key to successful stress management comes from awareness coupled with open dialogue. Stress is a very real part of all our lives. Learning how to acknowledge, manage and mitigate it could help those lives to be longer, more healthy and more fulfilling.

Calling support

Nearly 1.9million diagnostic tests were carried out by the NHS in January 2022. Add in the 1.8million calls fielded by NHS 111 in the same month and it is not difficult to see why some areas of our health services are stretched. Particularly so, as the same report from NHS England revealed that, despite 1.2million people starting consultant-led treatment in January, the waiting list for routine hospital procedures reached 6.1million.

There is little doubt that health services staff are working to manage the backlog which grew throughout the pandemic. There is also little doubt that people and services are stretched; particularly so as covid may have reduced in severity but it has not gone away. A separate report by NHS England revealed that in acute hospital trusts alone an average of 55,832 members of staff were off sick each day in the week prior to the 10th March. That’s hardly surprising. Whilst covid is still around in any form, increased levels of absenteeism are to be expected.

All of this means that the ‘delivery plan for tackling the Covid-19 backlog of elective care’ which was announced in February may, in its initial stages at least, come under pressure. And that could have a knock on effect right across healthcare services in the UK.  Acknowledging this the sponsors of the plan, Sir David Sloman and Sir James Mackey, comment that :

“Recovering elective services is going to require a huge, collective effort from systems and providers. This is not just in hospitals but across the entire health and social care system. We will only be successful in delivering these commitments if we are to draw on the collective ingenuity, determination, and resilience of teams across the country.”

That resilience in part is going to depend on inbuilt system flexibility. When working under pressure, it only takes a small change in resources to derail carefully planned schedules. By identifying key pinch points, health providers may be able to devise backup solutions which can kick in as required.

For example, some users call on our call handling service to manage all incoming calls but we can also act as an overflow call handling solution as required. So if a health practice’s reception team are short staffed, we can step in and help to keep call management and diary services on track. Not only will this help to ensure a smooth throughput of patients, it can also act to reduce internal pressures and therefore better enable clinicians to concentrate on patient treatments.

Another way of helping to ensure that appointment times are optimised is by sending out reminders either by SMS text messaging or e-mail. Not only can reminders help to ensure attendance, they can also prompt individuals to get in touch and cancel or rearrange appointments if they are unable to attend. This in turn enables the health practice to call on other prospective patients to fill gaps in schedules; thereby helping to speed up treatment times and clear any covid backlog.  

Heart Attack: Dial 999

“You know that feeling when your chest feels so tight that you have to really concentrate hard in order to breathe?” No? Well neither did a heart consultant when this writer tried to describe symptoms to them. And yet, according to the NHS, “a sensation of pressure, heaviness, tightness or squeezing across the chest” is one of the symptoms of a heart attack.

Luckily in this writer’s case what they had experienced was down to something else. But that tale shows just how hard it can be to correctly identify the potential signs of a heart attack. More so when an individual is experiencing one of the less well known symptoms such as sweating or a feeling of uneasiness.

And yet, the earlier that a heart attack is identified, the greater the chances of survival. Nowadays some seventy percent of individuals experiencing a heart attack will survive but that figure climbs to over ninety percent with early hospital treatment. That’s a significant increase. It’s no wonder therefore that the NHS has this month launched a campaign to increase heart attack awareness.

So would you dial 999? A survey revealed that whilst 62% of us would dial 999 if they or a loved one was experiencing commonly known heart attack symptoms, that figure fell to 45% for less well known symptoms. And whilst 70% of individuals surveyed recognised pain in the chest as a heart attack symptom, that figure dropped to 41% of individuals who recognised sweating as a symptom. Dropping still further down the awareness stakes, just 27% knew that feeling weak, lightheaded, or a feeling of general unease could also potentially signal a heart attack.

The full list of potential symptoms can be found on the NHS campaign website. It is also worth noting that men and women can experience heart attacks in different ways. As the campaign website says: “While the most common symptom of a heart attack in both men and women is chest pain, women are more likely to experience other symptoms such as shortness of breath, nausea/vomiting and back or jaw pain.”

That difference in experience led to a 2016 study by the University of Leeds to conclude that women had a 50% greater chance of having an initial misdiagnosis than men. The study also found that nearly 30% of patients overall received an initial diagnosis which differed from their final heart attack diagnosis.

It’s hardly surprising therefore that the NHS campaign message is twofold. Firstly, study and be aware of potential heart attack symptoms. Secondly, if you suspect a heart attack, don’t delay in calling 999. As Dr Charmaine Griffiths, chief executive of the British Heart Foundation, said: “Every minute counts when you’re having a heart attack – it’s a medical emergency, and immediate treatment could be the difference between life and death. It can be easy to dismiss early symptoms of a suspected heart attack, but don’t think twice about dialling 999. The NHS and our emergency services are there for everyone, and one quick call could save your life”.

Cold weather alerts

From the winter vomiting virus to spring hay fever, summer heat strokes to autumn seasonal affective disorders (SAD); every season has its peak illnesses. Of course, any of these can occur at any time, but health professionals are aware that as the seasons turn so too do differing conditions come to the fore.

With that in mind, as health professionals just how do you prepare to meet the differing challenges which the changing of the seasons throws up? It’s not always easy. Whilst some conditions, such as SAD which is triggered by shortening day length, are fairly easy to predict; others may depend on more variable factors.

For example, whilst summer rains might initially help allergy sufferers by washing pollen out of the air, a couple of days later with plant growth having been triggered by the rain you may well find an increase in pollen or mould levels, leading to an increase in allergy presentations. Or to look at another scenario, winter slips and falls are far more likely to occur in icy conditions than on comparatively milder days.

What this adds up to is a need for weather to be taken into account in resource planning. Local forecasts may be of help here, especially when viewed alongside national resources such as the Met Office’s cold weather alert service.

Operating from 1 November to 31 March each year in conjunction with the UK Health Security Agency (UKHSA), the cold weather alert service aims to reduce the impact of severe cold weather on people’s health. It does so by not only predicting weather severity but also providing advice to individuals, communities and agency on how they should prepare and manage differing scenarios.

Building on an alert level 0 which looks towards all year round planning, four other levels look towards steps required to manage anything from mild winter conditions (Level 1) to a major weather incident (Level 4.) So, for instance, Level 2 looks for social and healthcare services to work to ensure that they are prepared to take swift action to reduce the risk of harm from a period of cold weather whilst Level 3 requires those agencies to take specific actions in order to protect high-risk groups.

At the time of writing we are facing alert level 1 in the three northernmost regions of England with alert level 2 across the rest of the country. The level 2 alert specifically warns of a “70% probability of severe cold weather between 1800 on Thursday 13 Jan and 0900 on Monday 17 Jan in parts of England. This weather could increase the health risks to vulnerable patients and disrupt the delivery of services.”

Information such as this helps health providers to create flexible solutions which can be triggered depending on need. Even something as simple as being able to transfer phone calls to a virtual assistant service when demand is high could help with resource management. When the pressure is on to treat as many individuals as possible, the ability to outsource some routine administration matters such as phone answering or even the booking of appointments could just tip the balance towards effective care when it is most needed.

It’s good to talk

Sometimes when things get too much, a quiet chat can make all the difference. And generally the first people we would turn to are friends, family, or colleagues. But there are times when those informal talks aren’t enough. Times when we need something more to help us to recover our equilibrium. That’s where talking therapy can come into play.

Perhaps traditionally seen as an option for those suffering from stress, anxiety, or depression; taking therapy can take a number of forms. These include Cognitive Behaviour Therapy (CBT), counselling, behavioural activation, and guided self help. This variety of options available enables people to receive the optimum therapy that will best suit themselves and their condition.

Whilst some therapies may work best in a face to face situation, in a number of instances talking therapy can be carried out over the phone, perhaps with the call being supplemented by work books and information sent to the home. That ability to carry out telephone talking therapies has proved to be extremely beneficial during lockdown. So much so that according to statistics released by the NHS a record 634,649 individuals completed a talking therapy course in the 2020/21 period. That is a rise of five percent on the previous year. And that’s only the start. The NHS long term plan aims to help 1.9 million adults with talking therapies by the year 2023/24, with a focus on long term conditions. This is in addition to the provision of private treatment options.

Not only did the number of people undergoing talking therapy rise year on year, the average number of sessions in a course of treatment also rose to 7.5 from 6.9 the previous year. Whether that rise in treatment length is due to patients requiring greater amounts of help, or simply the provision of phone sessions freeing up extra time is unknown. Certainly the fact that in the period in question 90% of people started treatment within six weeks of identifying a need, again a rise on the previous year, with 51.4% of those completing a course being seen to have recovered from anxiety or depression is to be commended. On the other hand, it has been estimated that the number of adults in England with depression has doubled since the start of Covid; revealing an even greater need for talking therapy provision.

It’s another example of the strain which health services across the board are facing. And it can at times seem as though no matter how many technical solutions are put in place to save time, that time is taken up in meeting additional patient needs. That doesn’t mean we shouldn’t look towards time saving solutions such as switching calls to a virtual assistant service, putting appointments online, or digitising patient notes. On the contrary, the more time can be saved in streamlining routine administration tasks, the better. But in the spirit of ‘physician heal thyself’ there are times when it pays to step back, to take time out to renew and refresh, or maybe just to talk.

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