The 7 day NHS- a Joke

Why I Don't Want a Seven Day NHS Treating My Family

 1 day ago | Updated 23 hours ago

• Dr Zoe Norris GP working in the NHS

Jeremy Hunt has announced with a not insignificant amount of aggression, that he intends to force through seven day working for NHS hospital consultants, regardless of whether a contract can be agreed at the negotiating table with the British Medical Association (BMA). There is inevitably a lot of anger about this, but I was met with the usual derisory comments when I tweeted my thoughts. That some careers in medicine are now a lifestyle choice. That it's good for patients. That thousands of patients die at weekends and its the doctors' fault.

Anyone in their right mind knows by now that the Department of Health and Jeremy Hunt are lying through their teeth about the NHS. Those extra doctors in the Conservative manifesto? No, they're not coming. He admitted this and the fact that there was "flexibility" in the figures because it turns out it's hard to recruit GPs at the moment. (Gasps from the entire medical profession - who knew??!) Instead you're getting the new role of Physician Assistants straight from the American model of healthcare which is universally accepted as being top notch for everyone in the population there... They will train for only two years, and are intended to replace doctors in taking histories from patients and examining them. They can't prescribe yet, but plans are underway to allow them to. Clearly we have been overdoing it as a nation with a reputation for the best medical schools in the world, with our wasteful five years at University, two years junior doctor training, and five-10 years minimum to specialise as a GP or hospital doctor. I wish I'd known this before I had to take out those tuition fee loans.

Now he wants to unilaterally impose contract change as the monopoly employer of hospital consultants, to force seven-day-a-week routine working. That annual review for the cancer you had four years ago, can now be done on Saturday at 4pm. You can bring your elderly relative through the reduced public transport system to have their pre-op assessment on a Sunday at 6pm. You can enjoy your colonoscopy at 9am on a Bank Holiday. This is not URGENT care, it is routine care. Do not fall into Mr Hunt's trap of thinking there are no consultants in hospitals from 5pm on a Friday, till 9am on a Monday morning. He wants you to think that. It is a lie. I have a few problems with his latest ridiculous idea.

1) Like the rest of the NHS, there is a massive shortage of consultants. Key specialities like A&E and psychiatry cannot recruit, much like general practice. Enforced changes to the consultant training is happening, as the government try to rush through new doctors, with all grades of hospital doctor expressing huge concerns that this will lead to consultants qualifying without having the chance to spend enough time training as they want to. If you push routine cover onto a depleted workforce, you either cause dangerous working conditions in the form of excessively long hours (hands up who wants the over-tired 68-year-old consultant operating on them at the end of an 80 hour week?), or you sacrifice mid-week care and create the same situation on another two days a week.

2) Consultants are amazing. They work incredibly hard and I have massive respect for them. But filling the hospital with these highly trained, skilled professionals on a Saturday and Sunday will be useless, because they do not work alone. Mr Hunt needs to unilaterally alter the contracts of all junior doctors, all nurses, nurse practitioners, phlebotomists, theatre staff, receptionists, secretaries, administrators, managers, catering staff, and I am sure many others. He also needs to employ all of social services to work a full seven days as they too currently have a duty team on call at evenings, nights and weekends. There's a lot of these groups that have unions. I wonder if he's considered that. Until he looks beyond the simplistic idea of more consultants = more patients seen, imposing his seven day contract is absurd. And guess what? This will cost money. That thing the NHS doesn't have and the government aren't prepared to invest.

3) The government is about to change the law on strike action. This isn't a coincidence. In future, more than 40% of union members will have to take part in a vote to strike, with over 50% voting in favour of the action for it to pass. Considering the current government was elected to rule the country on 36.9% of the national vote, and they have found the money to just give themselves a 10% pay rise, it's a bitter pill to swallow. They have ignored the recommendations of the independent pay bodies for NHS staff, but have acceded to those for Westminster. NHS staff have always been held to ransom as any talk of strike action leads to rapid allegations of patient harm. To be crystal clear, no one wants patients to come to any harm. We are all patients too, with loved ones treated by the NHS. But that is why we are trying to kick up a fuss. Ultimately this plan of Mr Hunt's, implemented as he proposes, will harm patients. There will be no continuity in secondary care, and it is almost lost entirely in primary care now. Running stretched medical teams on a full shift-based rota means a literal handover of patients, with key decisions made by different staff several times a day. These are the sickest most complex patients. They need the care of a firm of their own doctors.

A truly seven day NHS is something we should aspire towards. I don't disagree with that. But as with everything else, it is the timescale and funding which is wholly unrealistic and will inevitably lead to harm to patients. Can he not remember the waiting time breaches of last winter? Is he ignoring the GP practices closing across the country? This is not doctors wanting a lifestyle choice. Our first role is to act in our patients best interests, as an advocate for them. Why does Mr Hunt refuse to listen to the profession, both at national and grass roots level? Why is he hell bent on chasing headlines and not on improving care and patient safety? He bangs on about not repeating events at Mid-Staffs, but patient care IS being compromised and will only be more so, if common sense continues to be so hugely ignored in the decision making process. The NHS can be better, if he takes a second to stop this headlong rush towards disaster.

Cigarettes and Plain Packaging: Does it actually matter?

Cigarettes and plain packaging; Does it actually matter?

Brands do have an appeal. That’s why Tobacco companies spend millions promoting a brand and defending the right to keep the brand prominent on retailer shelves.

Brands create expectations in the mind of the user and the mind of the person watching the user. Brands create and exploit the “emotional connect”. Using a brand makes people feel good about themselves and has prestige appeal.

Branding is especially significant where young people are involved. In the UK about 600 children start smoking every single day. This equates to 200000 children per year. In a declining smoking market like the UK, it is vitally important for the tobacco companies to attract the next generation of paying customers before they kill off their current customers. Young people are far more likely to be affected by branding than the older long term smoker who may be happy with roll ups.

In the UK, the packaging will most likely just have a brand name and make along with a stark health warning. This already has been in force in Australia for a few years and has been recently adopted in Ireland too.

The tobacco companies feel that this brand masking will lead to increased smuggling, possibly more illegal activity and will affect struggling retailers. They feel people may use more rollups. THIS IS RUBBISH and has all been proved wrong.

So what happens when you use plain packaging for cigarettes?

Firstly it makes the packet less appealing. Young people associate colours like drab brown or olive with more harms.

Secondly consumers think it tastes worse. This is akin to coffee tasting better in white cups than takeaway cups.

Thirdly plain packaging increases negative feelings and perception and people have more thoughts of quitting

Financially, excise and customs duty from sales of cigarettes fell 3.4% in Australia. This proves that plain packaging did affect cigarette sales. EVEN A 2% REDUCTION IN SMOKING INITIATION FOR YOUNG PEOPLE MEANS 4000 FEWER NEW SMOKERS EACH YEAR. This is a goal worth aspiring to.

It is also easy to see why food companies are worried. High refined sugar products may be next on the hit list.

Midlife satisfaction and sleep quality

Life Satisfaction Affects Sleep in Midlife

Megan Brooks

June 15, 2015

 

SEATTLE, Washington — Middle-aged adults who are more satisfied with their life are apt to fall asleep faster than their less satisfied peers, a new study hints.

In analyzing survey data from 3950 adults who took part of the Midlife in the United States II (MIDUS-II) study, researchers found that those with higher life satisfaction reported shorter sleep-onset latency (SOL).

"Life satisfaction is interlinked with many measures of sleep and sleep quality, suggesting that improving one of these variables might result in improvement in the other," lead author Hayley O'Hara, recent graduate of Ohio Northern University in Ada, told Medscape Medical News.

She presented her research, conducted under the supervision of Megan Clegg-Kraynok, PhD, at Ohio Northern, here at SLEEP 2015: the Annual Meeting of the Associated Professional Sleep Societies.

A Hectic Time

In the MIDUS-II study, a 6-item life satisfaction survey was used to group participants as having low, medium, and high levels of satisfaction, and a subjective measure of minutes it takes to fall asleep was used to measure SOL. Participants had a mean age of 57 years, and 55% were women.

"I was interested in the midlife in the MIDUS-II dataset as they managed to collect a great amount of data from a population that is not as well studied," O'Hara said in an interview. "Midlife is a busy time in one's life with family, jobs and other responsibilities that make it difficult to recruit for any kind of research."

A review of the literature suggests there is a lot of research on well-being and sleep deprivation, she noted, "but not much within the facet of life satisfaction. Life satisfaction is one of many factors that are contained within well-being."

A one-way analysis of variance showed that the effect of satisfaction on SOL was significant (P < .001), with low life satisfaction related to delayed sleep onset during midlife, she reported.

Respondents with higher life satisfaction reported shorter SOL, and only those with high life satisfaction were within the normal range of SOL. "Sleep-onset delay among those with low life satisfaction could be the result of worry and anxiety," O'Hara said.

"This poster is fantastic. It's simple but it has a lot to say," Christopher Winter, MD, medical director of the Martha Jefferson Hospital Sleep Medicine Center in Charlottesville, Virginia, and member of the American Academy of Sleep Medicine, noted in an interview with Medscape Medical News. "It shows that how happy you are with your life correlates with how long it takes you to fall asleep," he said.

"If your house is being foreclosed on or your wife is cheating on you and you have a lot of things on your mind, it may take you a little while to fall asleep and but that's okay. The problem is that often these people will go to bed not when they are sleepy, but when they want to be done with the day," Dr Winter said.

He also said having some trouble falling asleep is not a reason to turn to sleeping pills. "People want to be able to control their sleep like a switch. When they get in bed at night at 11 pm, they want to fall asleep immediately. If they're awake for more than 5 minutes thinking about their life, they get depressed," Dr Winter commented.

"Some people get a powerful negative feeling when it takes them an hour or so to fall asleep," he added. "They think it's a problem, so much so that wanting to escape that negative feeling can easily make people commit to taking sleep pills for the rest of their lives. That's why a lot of people drink themselves to sleep, they want to check out quickly. If they don't, they see it as a failure," Dr Winter said.

A "key" message for these people: "worry less about it," he concludes.

The MIDUS II study is funded by the National Institute on Aging. The authors and Dr Winter have disclosed no relevant financial relationships. 

SLEEP 2015: Annual Meeting of the Associated Professional Sleep Societies. Poster 84. Presented June 8, 2015.

Fermented foods and anxiety

Social Anxiety? Fermented Foods May Help

Megan Brooks

June 15, 2015

 

A diet rich in fermented foods and beverages likely to contain probiotics may help curb social anxiety in young adults, especially those who are highly neurotic, new research suggests.

"While our study cannot definitely determine a causal relationship between fermented food consumption and social anxiety, in combination with the preclinical and clinical studies, our findings suggest that eating more fermented foods can decrease social anxiety," Matthew Hilimire, PhD, an assistant professor in the Department of Psychology, College of William and Mary, Williamsburg, Virginia, told Medscape Medical News.

"Future studies could test potential applications, such as supplementing drug or cognitive-behavioral therapy with fermented foods," he said.

The study was published in the August 15 issue of Psychiatry Research and is available online.

Gut-Brain Interaction

The study included 710 students enrolled in introductory courses in psychology at the College of William and Mary. The participants completed questionnaires about fermented food consumption, neuroticism, and social anxiety.

The questionnaire asked about a variety of foods, including yogurt; kefir or food or beverages that contain yogurt; soy milk; miso soup; sauerkraut; dark chocolate; juices that contain microalgae; pickles; tempeh; and kimchi.

"Not all of these foods necessarily had active cultures, but they have the potential to contain probiotics and bioactive peptides," Dr Hilimire said.

In an interaction model that controlled for demographics, general consumption of healthful foods, and frequency of exercise frequency, the researchers found that exercise frequency, neuroticism, and fermented food consumption significantly and independently predicted social anxiety.

Fermented food consumption also interacted with neuroticism in predicting social anxiety. That is, in students with high degrees of neuroticism, a higher frequency of fermented food consumption correlated with fewer symptoms of social anxiety.

These observations are in line with previous preclinical and clinical trials suggesting that probiotics can have an anxiolytic effect, the researchers say. However, this is the first study to examine the relationship between probiotics and social anxiety, they point out.

"Our study was not able to address the mechanisms because it was a survey of normal eating patterns, social anxiety, and personality. However, previous preclinical studies have suggested potential mechanisms," Dr Hilimire told Medscape Medical News.

"For example, probiotics reduce the permeability of the gut, so harmful substances don't leak out. Probiotics also reduce inflammation of the gut. Because anxiety is often accompanied by gastrointestinal symptoms, reducing gut inflammation helps alleviate those symptoms," he explained.

"Probiotics have also been shown to modify the body's response to stress, and stress response is highly linked to mental health disorders, such as social anxiety. In addition, consumption of fermented milk has been shown to reduce the brain's response to negative facial expressions. By reducing the brain's response to negative social stimuli, social anxiety symptoms might be reduced," Dr Hilimire noted.

Public Health Implications

Commenting on the findings for Medscape Medical News, Bonnie J. Kaplan, PhD, who studies nutrition and mood at the University of Calgary, in Alberta, Canada, said research on the gut microbiome is expanding enormously, as is research on genetic influences on mental disorders.

"This study is interesting in how it ties together several relevant threads of personality, food intake, and exercise ― specifically, personality traits presumed to reflect genetic predisposition, such as neuroticism, a measure of social phobia and anxiety, reported exercise levels, and dietary intake of fermented foods as well as fruits and vegetables."

"Also of interest is the fact that the information was not collected from a clinical sample of people with diagnosed anxiety disorders...participants were first-year psychology students in an American liberal arts university. This means the results have implications for broad, population health," said Dr Kaplan.

"The authors interpret their results as indirect evidence that probiotics (assumed to be in the fermented foods) are combating anxiety. This final point is an inference that will need further research," she added.

As reported previously by Medscape Medical News, Dr Kaplan's own research has shown a strong link between higher levels of nutrient intake and better mental health ― adding to the growing body of evidence demonstrating the critical role of diet in mood disorders.

The authors and Dr Kaplan report no relevant financial relationships.

Psychiatry Res. 2015;228:203-208. Abstract

Methadone Script

We will comprehensively look through your medical, psychiatric, social and substance misuse treatment needs before jointly deciding on a plan of care. It is possible to start a prescription after the first review. We are not limited to prescribing methadone or subutex or suboxone and can look at other prescribing options like Dihydrocodeine. We cannot prescribe Heroin or Diamorphine

About Private Addiction Clinic

We are based in Stoke on Trent and offer private addictions treatment to Staffordshire and surrounding counties. We are a highly experienced, Consultant Psychiatrist led team, which specialises in treatment for Heroin addiction, Alchohol dependence, Stimulant misuse and Diazepam reduction programmes.