Uncategorized Archives - Clinic Appointments

Need to exercise more – get on your bike

What’s your exercise regime? Do you even have one or do good intentions falter under the pressure of work? If exercise falls into the occasional rather than regular category then two reports which have come out in the last month may give you pause for thought.

The first from the World Health Organisation (WHO) says that worldwide a lack of exercise is putting one in four people at risk from a range of conditions including heart disease, some cancers and type-2 diabetes. More worryingly, although this global figure is little changed from 2001 the report says that the higher the income country, the more likely we are to be sedentary. For example, in the UK 36% of people (32% men, 40% women) are now classed as being inactive; undertaking less than 150 minutes of moderate activity or 75 minutes of vigorous exercise per week.

What’s the solution? Well it seems as though we may do well to take the lead from the recently concluded Tour of Britain and get on our bikes. A study from America has concluded that people who exercise regularly report 43% fewer days of poor mental health than those who don’t exercise. Perhaps unsurprisingly those taking part in team sports fare best, benefitting from the social aspect of team work as well as the exercise, but cyclists aren’t far behind. So if time pressures and schedules prevent attendance at team practices and matches, then cycling is a good alternative.

Better still, you don’t need to cycle a lot to help your mental health levels. The researchers concluded that 45 minutes of exercise undertaken between three and five times a week is associated with the lowest risk to mental health. Exceed those levels and the researchers say you won’t gain any extra benefit.

With that in mind, in a technology-led always-on world how do we free up enough time to fit in three 45 minute cycles each week? Well, one way is to take a leaf out of the technology book and take some processes online. For example, why spend time in invoicing when payment card information can be taken at the time of booking? Similarly, why spend time in manual filing and retrieving of documents when an online system can make records available at the touch of a button?

Even small tweaks such as these can add up to a measurable time saving. And even if you don’t spend every freed up minute on exercise, the extra free time could be used to enhance your work/life balance. Either way, with work pressures reduced it could go some way towards helping to maintain a healthy lifestyle which in turn brings good mental and physical benefits. And of course, when we feel good then it is far easier to project a positive image which in turn helps those colleagues and clients who we come into contact with on a regular basis.

What’s your exercise regime? Getting on our bikes may not be the right solution for all of us but nevertheless maybe it is time to look again at how we exercise and stand up for the health of the nation.

Caring for older workers

When we talk about the problems of an ageing society it is all too easy to focus on those who may be in need of long-term care either through illness or injury. As a result we concentrate on areas such as the provision of health services including physiotherapy and osteopathy, nursing and home care. But there is another aspect of ageing populations which perhaps deserves greater focus. That is the challenge posed by older workers within an ageing workforce.

According to the Office for National statistics (ONS) by 2020 one third of the UK workforce will be aged over fifty. Fuelled by a number of factors including a rising state pension age and the government’s scrapping of the mandatory retirement age in 2011, people are generally looking to stay in the workforce far longer than was even the case a few years ago.

However, an ageing workforce brings its own problems, not the least of which is age discrimination. In July 2018 the House of Commons Women and Equalities Committee reported that more than one million people aged over fifty who wanted to work were being locked out of the workforce due to age discrimination. Now we have a report from insurance company Aviva which reveals that 44% of those aged over fifty feel unsupported at work, compared with 25% of those aged 25 to 34.

What is the solution? Aviva suggest that employers need to provide rounded support for older workers in which their well-being, financial and work-related needs are considered. So one area for consideration may be to offer reduced hours or flexitime; helping people to optimise their time at work without becoming too fatigued. Other options might include access to healthcare services such as physiotherapy or podiatry, or bringing wellness clinics into the workforce in order that workers can discuss and obtain solutions for a range of health issues.

Caring for older workers also means enabling them to work smarter rather than harder. Although the Aviva study revealed that older workers are more confident about their ability to keep up with tasks and their own individual skill set than younger workers; that doesn’t mean that employers should become complacent about anybody’s ability to cope with daily tasks. Where technological solutions exist it simply makes sense to deploy them; thereby freeing up time which can be better utilised in other ways. And what’s good for employees is also good for employers.

Take the health sector for example. Why spend time in booking appointments over the phone when online booking services are available? Similarly, why telephone clients to remind them that their appointment is due when SMS messaging services could deliver reminders directly to phones? And whilst exercise in moderation is recommended in order to keep joints supple, do we really need to spend hours bending and stretching as we file patient notes, when electronic records are available?

63% of those in work aged over fifty are currently planning to retire later than they thought they would just ten years ago. The more support that employers can give to these older workers, the longer businesses will benefit from their skills and experience.

The NHS – 70 years young

1948: a time of austerity, of taking stock and coming to terms with the aftermath of war. The initial euphoria of victory has worn off and the work of rebuilding shattered lives, homes and infrastructure is underway. But this too was a time of hope and ambition; a determination not simply to rebuild the past but to create the future. One of the great projects to arise from that time was the National Health Service (NHS).

Seventy years on and the NHS continues to deliver its initial promise to provide healthcare which is free at the point of delivery. The road hasn’t always been smooth and in a strange way the NHS’s success has been the root cause of one of its prime challenges. Pioneering research allied to a drive to develop new techniques and skills has helped people to live on average ten years longer nowadays than at its inception; in the process placing additional strains on resources.

Nevertheless we shouldn’t underestimate the impact which the NHS has had not simply on lives but also on society. For example, this writer’s mother joined the NHS as a nurse in the year of its birth. Following initial training in England she was offered an opportunity to further her skills, firstly in France and then in America; a far cry from post-blitz London and offering a level of mobility which may not have been so available for young women before the war. Those skills that she learnt at the infancy of the NHS were then used throughout her life to benefit others.

This is only one story, but as we had heard time and time again over recent weeks it is the individual stories which demonstrate the true worth of our health services. Stories of lives saved or transformed thanks to pioneering techniques; stories of humanity and compassion; and tales highlighting the dedication of those who have followed the path of medicine in order to help others.

But whilst it may be true that in part the NHS is the victim of its own success, technological advances are already making a measurable difference. Online appointment booking, automated appointment reminders and digital records are all helping to reduce admin time. Remote health monitoring is removing the need for multiple hospital appointments, whilst the availability of video links brings specialist knowledge to remote areas of the country. And new developments are coming out all the time. Who would have thought only a few years ago that cancer treatments could be personalised based on an individual’s genetic make-up?

When the NHS started seventy years ago innovations such as these would never have been envisaged, let alone possible. In seventy years time they may be seen as somewhat old-fashioned, replaced by ever improving technologies delivering individual healthcare. But progress or not, one thing remains at the heart of our national health service and that is the relationship of care between those in need and the doctors, nurses, physiotherapists, osteopaths and other health professionals who provide lifelong health services.

A revolution in health care

According to the World Economic Forum we are standing on the brink of change, a time in which the Fourth Industrial Revolution is taking hold of the world. Looking back into the past, the first industrial revolution ushered in an era of mechanisation, process driven and with people merely seen as cogs in the industrial wheel. Then came electric power and mass production followed by the third industrial revolution which ushered in the use of information technology as a driver of automated production.

The fourth Industrial Revolution is one step further on, driven by a ‘fusion of technologies that is blurring the lines between the physical, digital, and biological spheres.’ Put simply, technology has gone so far and is so interconnected that people have stopped becoming cogs in the wheel and instead are the prime drivers of service delivery.

In other words, what differentiates businesses nowadays is user excellence. As a result technological developments are increasingly being focused towards delivering great customer outcomes rather than simply as a way of reaching a mass audience or delivering cost savings.

What’s that got to do with delivering healthcare? Well in this regard there is no difference between the way in which we look to deliver customer or patient outcomes. So much so that there is an increasing recognition that targeting healthcare delivery towards an individual patient can significantly improve recovery. For example, we look to gene mapping as a means of best identifying cancer treatments, or we look to devise treatment plans which fit in with a patient’s lifestyle.

One prime example of this has been highlighted on the Chartered Society of Physiotherapy website. The Western Isles Hospital in Stornoway has linked up with a Glasgow orthopaedic surgeon who specialises in hand injuries. Initial assessments take place via a video-conferencing link with x-rays viewed over the National PACS system. Not only does this save patients the cost and time of a trip to Glasgow for initial assessment, it also speeds up decision-making. If there then is an identified need for surgery, preoperative procedures can be carried out in Stornoway; thereby minimising the time which patients have to spend away from their home base.

This is a perfect example of the way in which integrated technology can not only improve the patient experience but also treatment outcomes. It also illustrates the way in which digitising patient records can help to improve consultation options with patient information being rapidly shared over secure systems. Of course, electronically storing patient records also helps the practitioner; enabling them to call up records quickly and easily as well as saving the time taken in manual filing and retrieval.

Setting people outcomes at the heart of process may require a re-evaluation of the way in which we work. It may also cause us to question the reason behind certain processes, and to evaluate whether there may be alternative approaches which would improve delivery. The fourth Industrial Revolution isn’t simply a revolution in the way in which we use technology, it is also a revolution in attitudes and approaches which truly sets people first.

Don’t stress about mental health

Stress; it seems that wherever we look we can’t get away from it. Whenever we talk about a setback or a problem, or even when we tell the tale of encountering a minor inconvenience then almost inevitably the word stress appears in the telling. So much so that we are in danger of trivialising what can be a very real condition and the underlying cause of ongoing health problems.

Now let’s say at the outset that we are in no way advocating a return to the old days in which we never questioned, never complained, and grinning and bearing it was the only option. That certainly wasn’t the solution; leading as it did to multiple issues including individual and family breakdown. And it is also true that we shouldn’t dismiss those seemingly trivial claims of stress out of hand. For those who are just about coping with life changing events such as bereavement, sometimes it is the minor issues that prove ‘to be the straw that breaks the camel’s back;’ arriving unexpectedly and making an impact when there is no personal resilience left.

So maybe the word stress is bandied around too much, but we should in no way ignore what is a very real condition. That’s why is so important that stress has been chosen as the theme for the 2018 mental health week (14-20 May). Introducing the week the Mental Health Foundation comments that:

“While stress isn’t a mental health problem in itself, it can lead to a range of mental health problems such as depression and anxiety, and even self-harm and suicide. By tackling stress, we can go a long way to tackling mental health problems.”

Equally importantly, MIND highlights the way in which stress can not only affect eating and sleeping patterns but also can cause our bodies to release cortisol and adrenaline; all of which can affect our physical health in the long term. So how much of a problem is stress? Well, a survey for carried out by MIND for Mental Health Week came up with the startling conclusion that in the last year three in four of us have been so stressed that we have felt overwhelmed or unable to cope, with one in three feeling suicidal.

Now whilst there is no one magic solution, there are things that we can all do to help to relieve stress in ourselves and others. The first is to acknowledge that stress is real and to open up discussions about stress both at home and in the workplace. The second is to look at our work life balance, taking time to ensure that we aren’t spending time on processes which could better be done in other ways. MIND suggests that identifying triggers, organising time and addressing some of the causes of stress are just three ways in which we can start to learn to deal with pressure and remove stress.

For example, if we can find a way to enable health professionals to concentrate on patient treatments rather than admin then they can maximise their output without compromising much needed personal time. Similarly, taking steps to ensure that patients don’t miss much needed appointments can help to speed up recovery and rehabilitation; thereby helping to relieve any stress or anxiety caused by managing a health condition.

There are times in life when each and every one of us will encounter an event which almost inevitably leads to our feeling stressed. But they should be the exception rather than the rule. By taking control of day-to-day events, and most importantly by being open in sharing feelings and needs we can all take a step forward in managing stress both in ourselves and others.

Time for Chip and PIN card payment

Is the cheque obsolete as a payment method? Well not quite according to the Cheque and Credit Clearing Company which reveals that in the UK in 2017 some four hundred and five million cheques were issued either as payments or to draw cash. Nevertheless this does represent a 15% reduction in cheque volumes and continues a trend seen in previous years of cheques being replaced by faster or direct card payment methods.

As a result direct payment forms are seeing a corresponding increase in volume with a 23% rise in single immediate payments in 2017. Interestingly, perhaps because of the fall in cheque payment volumes, the average value of a cheque actually increased by 5% in 2017 to £1217. Nevertheless, the way in which public perception is changing in respect of acceptable forms of payment does help those businesses which are looking to move away from cheques as a form of payment.

So what has replaced cheques as the preferred payment method? A recent survey revealed that 42% of people in the UK see credit or debit card with pin number as their preferred method of payment. Contactless methods of payment are also rising in popularity; although the majority of those interviewed indicated that they were happy with the current £30 contactless limit, citing security concerns should the limit rise.

What does the move away from cheques mean for businesses? Well, for a start it could mean a chance to speed up receipt of payments whilst simultaneously reducing administration time. Take a private healthcare business such as a chiropractor or physiotherapist for example. Relying on cheque payments often meant time spent in paperwork, in drawing up invoices after the time of the appointment, posting them out and then waiting for cheques to be posted back. Even if the cheque payment was made at the time of the appointment, administration time was still required to take the payment to the bank and await clearance.

Simply by taking card payment details as part of the appointment process, at a stroke all of that burdensome administration time can be avoided. With card details to hand, as soon as the appointment has taken place, the card payment can be taken. Moreover, by pre-authorising the payment at the time of booking, health practitioners can be reassured that funds are available to pay for treatment.

There is another benefit of pre-authorising card payments and that is client attendance rates. Provided the health practice ensures the client is fully aware of potential non-attendance fees, clients are far more likely to attend appointments or to telephone well in advance should they be prevented from doing so. This not only helps to ensure clients receive the treatment they need at the time at which it is most effective, it also helps to ensure that treatment times are fully utilised. Not only did this maximise potential income for the health practice, it also means that practitioners are not turning aside potential clients due to fully booked treatment times and then finding that some of those slots are left vacant due to no-shows.

Is the cheque obsolete? Well no, not quite, but with chip and pin card payment systems to hand practices at least should be working to encourage automated payments for the benefit of the practice and its potential clients.

Treating the person not the condition

The importance of treating the patient not the condition has been brought into sharp focus by a Cambridge University study published in the British Journal of General Practice. Reviewing the health records of more than 400,000 adults, the study revealed that 30% of females and 24.4% of males were suffering from more than one health condition, otherwise known as multimorbidity. Moreover, those who reported experiencing more than one health condition accounted for 52.9% of GP consultations and 78.7% of prescriptions.

Breaking down the statistics by underlying cause, the most prevalent conditions according to the report were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). Interestingly, those aged between eighteen and forty-four or having been identified as having lower socio-economic status were more likely to report a combination of physical and mental conditions.

Whilst the findings may not come as a huge surprise to health professionals, nevertheless they do serve to highlight the way in which individual conditions should not be treated in isolation. As the report’s authors highlight “multimorbidity has a substantial impact on various health services ranging from general practice to end-of-life care.” Moreover, gaining a better understanding of the complex relationships between conditions could help the health service in general to target resources appropriately. As Dr Duncan Edwards, one of the authors commented “It may be that we need to think about a drastic restructuring of services: no longer will people be seen in ‘single disease’ services but in new multimorbidity clinics designed for the future.”

Where does this leave health professionals in the meantime? For some, it may simply a question of heightening awareness rather than changing practices. For example, physiotherapists, osteopaths and chiropractors are well used to thinking holistically when treating muscle and ligament pain. That’s because carrying the body differently in response to an injury is very likely to lead to referred pain or contribute to additional musculoskeletal damage.

Where the challenge becomes more complex is when it crosses disciplines; for example where obesity gives rise to a range of conditions including chronic pain, hypertension, diabetes and depression. In these instances whilst the potential causal link may be understood, care may be provided by a number of health specialists. Not only does this condemn the patient to multiple doctor and hospital appointments, a delay in treating one aspect of the condition may contribute negatively to the chance of recovery in other areas.

The five-year forward review of health practices in the UK had already identified the need for treating patients holistically. This study sheds further light on the reasoning behind that review as well as calling into question the current structure of health services within this country. Treating the condition in isolation may not restore the patient to full health and could even lead to further complications. As Professor Helen Stokes-Lampard, Chairman of the Royal College of GPs, commented: “This large-scale, comprehensive research is further evidence of the increasing complexity of cases that GPs are dealing with, and the inadequacy of the standard 10-minute consultation.”

Too cold for snow: An Olympic lesson

If you are a fan of winter sports then there is a fair chance that the Winter Olympic Games may deliver a pinnacle of sporting viewing. However, as all sports fans know only too well, truly memorable contests come about when athletes are able to perform to the best of their ability. And that requires optimum conditions.

With that in mind it was somewhat concerning to see the weather reports ahead of the 2018 Winter Olympic Games which predicted wind chill factors as low as -25°. Some of the teams were reporting skis warping thanks to the effect of extreme cold on snow crystals and concerns abounded over the effect of unusually low temperatures on athletes. Ironically; despite the cold, or perhaps because of it, there was also concern over snow levels with machines being brought into supplement natural precipitation.

At the time of writing, a few days in to the games, high winds have also proved hazardous with some athletes unhappy at having to compete in what they considered were dangerous conditions. Under such extremes, successfully completing courses is more a lottery than a game of skill; something which no athlete wishes to encounter at the end of four years hard training.

From the safety of our sofas it is hard to imagine the physical and mental effect of extreme cold on the body. Low temperatures can sap brainpower, slowing down decision-making and reducing coordination; not something you want when faced with the challenge of extreme downhill skiing through slalom gates or over jumps. Preparation and training, inbuilt muscle awareness allied to physiotherapy and other physical and health support can go some way towards helping athletes to overcome conditions; but at the end of the day when the weather becomes so extreme inevitably accidents and injuries will occur.

And when breaks, fractures and ligament damage occur, our Olympic athletes are put in the same position as any recreational skier. There is an imperative to heal as quickly as possible in order to return to the normal routine. The only difference is that whilst for most of us that everyday routine will be away from the slopes, for Winter Olympians the slopes are their way of life.

This is where physiotherapists and other health professionals truly come into their own. For whilst naturally there is a core treatment plan in order to rehabilitate the injured limb, at the same time athletes have to undergo a programme of training which helps their whole body stay as strong and supple as possible. One leg may be broken but that’s no excuse not to continue to exercise appropriately in order to ensure that core and arm strength and tone are not lost.

It’s a lesson which we can all benefit from; the fact that one injury should not be allowed to affect the entire body. No matter whether we’ve followed our Olympic heroes on to the slopes or injured ourselves in some other fashion, the more we work with health professionals to ensure rehabilitation across the entire body, the better chance we have of regaining full strength and mobility as swiftly as possible.

Flu: Catch it, report it, deliver care

In December we wrote about the challenges faced by A&E departments and in the process made a passing mention of the effects of winter flu on the health service. Now that potential has become a reality with “Australian flu” rapidly spreading across the country and in the process placing even further strains on health provision.

At the time of writing according to the Influenza survey operated by Public Health England, there are only a few pockets of resistance which have yet to report flu cases with many areas heading rapidly towards the red, or very high, end of reported cases. Having said that, whilst any flu is a matter for concern, according to PHE the number of cases reported to date is broadly in line with previous years.

The flu survey, which was originally launched in 2009 in response to the swine flu epidemic, is part of a pan-European initiative to monitor influenza like illnesses. These are described as sudden onset symptoms displaying:

at least one of Fever (chills); Malaise; Headache; Muscle pain and
at least one of Cough; Sore throat; Shortness of breath

More than 7,500 people across the UK already participate in the flu survey but Public Health England would like more people to take part by signing up online in order to boost research and understanding. In the meantime there are a number of measures which people can take, either on their own or in the workplace, to reduce the spread of flu. These include regularly washing hands, sanitising common work areas such as phones and keyboards and encouraging the use of tissues to catch and bin coughs and sneezes.

Nevertheless, flu is placing a strain on health resources with elective surgeries being postponed and health staff, including backroom employees, being redeployed in order to maximise care time. Although only the most serious cases should end up in hospital, inevitably pressure on hospital resources has a knock on effect right throughout the health system. For example, physiotherapists and others may have to continue to provide a level of ongoing care for those whose operations have been postponed. Similarly, with pressure on hospitals to discharge patients in order to free up bed space, additional post-operative treatments may have to be carried out in the community, adding to pressure on health resources.

All this at a time in which health professionals including physiotherapists and osteopaths together with their own support staff may be short staffed due to flu. As with any patient-facing service there is little option for people to work from home. Nevertheless, sending staff home when they feel unwell does make sense if it avoids them passing illness around the health practice. This is where a virtual assistant service may come in handy. Delegating routine tasks such as phone answering and diary handling over to an external virtual assistant service enables continuity of care whilst maximising front line resources. Similarly, switching to an online patient records service could save administrative time and enable patient details to be available at the touch of a button rather than found by searching in a filing cabinet.

However the flu season develops it pays to plan and be aware. By catching possible cases early staff can be sent home before they affect others. Online reporting will help to monitor the outbreak and provide data for future research whilst moving processes online could help to provide continuity of care. The flu season affects everyone in the health sector; it’s never too late for all of us to play our part.

Waiting for A&E care

Accident & Emergency; we can’t live without it but it appears that increasingly we are having to be patient if we have need of its services. So much so that research carried out by the BBC has revealed that in the past year three million A&E attendees had to wait in excess of four hours in order to be treated.

To put that in context, nearly twenty-four million people were treated or admitted within the four hour time band. Or to put it another way, if each A&E attendee visited once then 41% of the UK’s population stepped through the A&E doors in just one year. It’s hardly surprising therefore that the president of the Royal College of Emergency Medicine, Dr Taj Hassan, commented to the BBC that the A&E system had been “stretched to its very limits.”

Accepting that the answer probably isn’t going to come from finding the money required to set up and staff an additional twenty A&E units, health services across the UK are looking to new ways of coping with demand; adopting a variety of methods in order to reduce footfall and speed up throughput. Whilst the Department of Health has turned aside suggestions that patients should be required to receive a referral from their doctor or NHS 111 before visiting A&E, it is true that just 20% of those attending A&E have first tried to access health advice via the 111 service. Perhaps if they had sought alternative advice either from 111 or their local pharmacy they would not have resorted to A&E for help with broken false fingernails, splinters in finger, paper cuts or shaving cuts; all of which featured in the 2016 top ten list of inappropriate trips to A&E in Cambridgeshire.

It’s hardly surprising therefore that a number of health trusts have been launching awareness campaigns in a bid to educate people on A&E alternatives including one video from NHS Wakefield Clinical Commissioning Group set to the tune of the 12 days of Christmas. Inappropriate visits aside, health authorities are also working to free up beds in order to speed up treatment times. Measures here include partnering with care homes and other health care professionals in order to deliver more health care in the community.

Undoubtedly this will put additional pressure on external health care services but perhaps it will also help to ensure that treatment is available at the most appropriate point of contact. For example, another on the Cambridgeshire inappropriate visit list was an individual who had suffered months of back pain without calling on the services of a health professional. Had they been given access to a physiotherapy service they could have saved themselves months of pain and saved the A&E department from having to assess their needs.

The winter flu season is not yet upon us and that will undoubtedly bring further challenges for A&E departments as will an increase in demand for treatment of strains and sprains as a result of icy conditions. Many of these conditions can be treated equally well by health providers such as pharmacists, physiotherapists or chiropractors. We’ve already seen pharmacists take up the strain in respect of flu jabs; perhaps this is the start of a wider acceptance of alternative providers helping to deliver health care in the UK.

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