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Call 4 Concern leaflet - Royal Berkshire NHS Foundation Trust

• People living in the poorest neighbourhoods in England will on average die seven years earlier than people living in the richest neighbourhoods.
• People living in poorer areas not only die sooner, but spend more of their lives with disability – an average total difference of 17 years.
• The Review highlights the social gradient of health inequalities - put simply, the lower one's social and economic status, the poorer one's health is likely to be.
• Health inequalities arise from a complex interaction of many factors – housing, income, education, social isolation, disability - all of which are strongly affected by one's economic and social status.
• Health inequalities are largely preventable. Not only is there a strong social justice case for addressing health inequalities, there is also a pressing economic case. It is estimated that the annual cost of health inequalities is between £36 billion to £40 billion through lost taxes, welfare payments and costs to the NHS.
• Action on health inequalities requires action across all the social determinants of health, including education, occupation, income, home and community.

• All patients should be informed of the risks of general anaesthesia, including the possibility of AAGA, before their surgery.
• When consenting patients, practitioners should use a form of words that proportionately conveys the risks of AAGA.
• Consent for sedation should emphasise that the patient will be awake and therefore may have recall for at least parts of the procedure.
• Practitioners should identify certain situations or certain patient factors as constituting a higher risk for AAGA (including organisational factors such as overbooked or reorganised surgical lists) and highlight these at the WHO premeet/team brief.
• During induction of anaesthesia, practitioners should adhere to suitable dosing of intravenous agent, check anaesthetic effect before paralysis or instrumentation of the airway and maintain anaesthetic administration, including during transfer of patients (which is facilitated by a simple ABCDE checklist).
• If AAGA is suspected during maintenance (e.g., by patient movement), prompt attention should be paid to giving verbal reassurance to the patient, increasing analgesia, and deepening the level of anaesthesia.
• For cases requiring paralysis, the minimum dose of neuromuscular blocking drugs (NMBDs) that achieves sufficient neuromuscular blockade for surgery should be used, and the nerve stimulator is an essential monitor to titrate the dosing of NMBDs to this minimum.
• Where total intravenous anaesthesia (TIVA) is used, practitioners should adhere to the relevant recently published guidelines.
• At emergence, practitioners should first confirm that surgery is complete, then ensure NMBDs are adequately reversed before allowing the patient to regain consciousness. Practitioners should then manage the patient experience, particularly during awake extubation, by speaking to the patient.
• Cases of AAGA should be managed using the NAP5 pathway as a guide.

You will then be able to download a dietary advice sheet that gives basic information and suggestions for improving nutritional intake. If you are worried about your weight or having difficulty eating, make sure you talk to your GP or a healthcare professional.

The dietary advice sheet was developed in partnership with a number of professional organisations.

NB this site is intended for adult self-screening only.

What should be done?

In order to support the NHS to radically improve patient outcomes, we need to break the negative cycle in cancer care. To address this challenge, the Patients Association and Bristol-Myers Squibb are working alongside experts and patients from across the cancer space to identify new models of service delivery, showcase best practice, and provide real improvements in patient care. This short video explains how:

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• how patients can make changes to their behaviour to improve safety
• suggested actions that patients can take
• possible barriers to involving patients in improving their safety.