Clive Flashman

@Hugh Wilkins - aren't all politicians experts in everything then? 😉

A response by Lisa Rickers, a nurse specialist: "Yes the one size fits all approach is rarely effective. It would be great to personalise this with a shared agreement between you and your GP with review dates and how you can collect a repeat prescriptions between each review."

A response by Guy Gross, COO at Teladoc: "Similar principle to PAM score"

A response by Elaine Bousefield, digital mental health founder: "Yep that would make sense except there would need to be a protocol written to define what is meant by an ‘expert patient.’ It is doable though"

A response by Jono Broad, digital QI lead for Primary Care at NHS England: "I fully understand the situation and would agree with you with one caveat I would want this checked at an annual review and if agreed I would then want the patient to be able to self prescribe from a list of medication that is approved so we would not then have to use this important resource at all within an agreed framework. One day we will be able to manage our own care better."

A response by Loy Lobo, past president of the Digital Health Section of the Royal Society of Medicine: "This is what happens when tech is used to make healthcare more "efficient" and it ends up making the relationship between the doctor and patient transactional. If the GP really knew you, either as a person as they used to, or from your data as they ought to now, maybe this would not happen."

A response by Ayelet Baron, futurologist and author: "Imagine a future where the doctor is no longer at the center of sickcare ... it's coming. And we need you fully breathing!" A response to her by Dr Gyles Morrison, a clinical UX expert: "Yep, this is the sort of products I work on. We need to shift the power from clinicians to patients." A further response by Ayelet Baron: "Gyles, only when we each step into our power. And wouldn't it be amazing when we no longer call people patients once they step into the system. One of the conscious leaders in my first book shares a story of how dehumanizing it is when we visit a doctor and put on a gown. We are immediately seen as a patient and we can be perfectly healthy. We need healthy language to support healthy people and not just focus on disease. Pioneers in health and wellness who are focusing on our holistic four bodies are putting the human in the center. I've experienced some incredible new systems that are preventive. But it takes us, like Clive, to see the opportunity in everything and imagine a healthy reality that supports the vast majority of us, not the few. It's insane that in the US the first question you are asked when contacting the system is what's your insurance and what pharmacy are you at. For those of us who take no pharmaceuticals, it's quite bizarre."

A response by Vijay Luthra, from Capita Healthcare: "Spot on Clive. Globally, clinicians and administrators in healthcare systems need to take account of patient literacy and digital inclusion. There are some patients who are perfectly capable of managing significant aspects of their own care and with the burden of chronic disease increasing, these people should be empowered and equipped to do so and thereby relieve some of the burden on clinicians and health ecosystems."

A response by Hisham Haq, co-founder at SLOSH AI Solutions: "Hey Clive, the vast majority are not as qued on. On a real basis had someone use their inhaler like a perfume! What will help is when your GP knows you and even then you need to see the people to make sure they come in for their review. Everyone can learn all the time and things change." I responded: "I guess the trust is a two way street, and continuation of care with the same GP is an element of that, and increasingly rare these days." Hisham responded: "Clive, true and not valued or appreciated where it is delivered. Hence a dying art."

A response from Jonathan Gregory, an Oncologist: "Hi Clive, I couldn't agree more. It sounds like my asthma is very similar to yours. I have an identical interaction with the GP when I need a repeat prescription every 2 years or so, despite being a hospital clinician. There is also the issue of more regular repeat prescriptions, I appreciate there is a need for some medication review - side effect checks, are they still needed etc, but there are long term patients who are also 'experts' who have to chase about for repeat prescriptions every 4-8 weeks for years on end and a GP has to sign them off (probably not really considering the issue) - do we really want to use GP's for such low value tasks that also do not deliver value for patients?"

A response from Saira Arif, from ORCHA: "I am also an asthma sufferer Clive...another thing in common 🙂 since the age of 4 ... I think what you are suggesting is spot on. We must catch up one day, I've got some stories!"

A response from @HelenH, CEO of Patient Safety Learning: "I have the same issue. Also I have monthly repeat medications for another long term condition, but have rather weirdly started getting monthly asthma inhalers - prevention and treatment. More than I need. I’ll have to go back and get them to change that. Not a very flexible or customer responsive system."

It's rare that I post personal information of any kind on a website such as this, but this really irked me so felt it was worth sharing. Context: I've been an Asthma sufferer since the age of 3 years old. I know exactly how to manage my condition having had it for over 50 years, and have always used a blue ventolin inhaler as and when necessary (perhaps once every 2-3 months). I have not had any serious issues with my Asthma for at least 20 years, and then only in Hayfever season. Issue: I only renew my inhaler when it expires, every 2 years or so. Therefore it is not listed on my repeat medications list. My most recent one had just run out, so I needed a replacement. Action: I emailed the GP's website as I knew I was meant to, and received an automated email back saying that I would receive a response within 5 working days. So far so good. Response: I received another email response 2 days later (pretty good!) saying that the GP would have to call me to run through why I needed a new inhaler. GP call: The GP rang on the set day and within the allocated time window and started asking me how often I used the inhaler, for what, and did I really need that or the preventative one (which I've had before). At the end of our 10 minute call, she agreed that I just needed a replacement blue ventolin inhaler, as I had asked for in the first place. What a waste of the GP's time, and mine!! It made me think that it would be a helpful thing if certain patients with decades of experience in managing their condition(s) in a very stable way could be classed as 'expert patients' on their GP record. This could save a huge amount of wasted time on both sides!! This blog post first appeared on Linkedin on 30 October 2022. I will post some of the responses to it below for added insight.

New study results in more precise language in the federally mandated warning about this possibility. (Article from the USA) Women who choose to use an intrauterine device, or IUD, for birth control should be aware of the very small possibility that the device could puncture their uterus. They should know how to recognize that circumstance if it occurs, according to a new study published in The Lancet. The U.S. Food and Drug Administration mandated the study to evaluate women's risks when an IUD is placed in the year after giving birth and when an IUD is placed during the period that a woman is breastfeeding a baby. These results were compared, respectively, with non-postpartum insertions and insertions in non-breastfeeding individuals, explained UW Medicine’s Dr. Susan Reed, the study’s lead author. Across the study cohort of 327,000 women, the percentage of perforation cases diagnosed within five years of IUD insertion was 0.6 %, the study concluded. The risk of perforation increased by nearly seven times if it was inserted between four days and six weeks postpartum, and increased by about one-third if inserted during the span of breastfeeding. The risk of an IUD-related perforation was relatively lower when inserted in women who were more than a year beyond delivery, in women who had never had a baby, and when the insertion occurred at delivery. Read full article here

Monitoring heart patients via a smartphone app prevented readmissions and sped up discharges in a pilot scheme that its developers hope will be introduced across the country. Patients sent data including their blood pressure, heart rate, oxygen levels and details of developing symptoms to their clinical team on an app. The figures were collated on a “dashboard”, which flagged any signs that a patient might need medical help, allowing doctors and nurses to bring them into hospital or alter their medication as required. The 12-week pilot by Huma, a healthcare technology company based in London, involved 40 patients at Cwm Taf Morgannwg University Health Board in south Wales and Betsi Cadwaladr University Health Board in north Wales. Click here to read full article (paywalled)

A hospice is using virtual reality (VR) to help patients relax and transport them away from their beds. St Giles Hospice, which has bases in Lichfield and Sutton Coldfield, said the headsets allowed patients "to escape the realities of their present situation". "I've never experienced anything quite like it in my life - I was totally lost in the moment," Janet, 71, said. The VR experiences include cities of the world, space, and wildlife. Beth Robinson, Occupational Therapist at St Giles Hospice, said the VR headsets helped patients "immerse themselves into a calming space". To read the full article, click here

Dr Penny Kechagioglou, Chief Clinical Information Officer and Deputy Chief Medical Officer at University Hospitals Coventry and Warwickshire, kindly shared her thoughts on digitising patient reported outcome measures in a blog for HTN. The UK digital transformation wave is mainly characterised by the roll-out of electronic health records and is an opportunity to transform patient care by collecting and analysing patient reported outcome measures digitally. A recent study at the European Society of Medical Oncology open journal (Modi, 2022) showed that patient reported outcome measures are predictive of cancer patient treatment response and quality of life for physical and mental parameters. The knowledge of patient reported outcomes (PRO) and experience (PRE) measures can be valuable in the monitoring of individual patient symptoms in clinic or remotely in the community and also for aggregating and interpreting population health data. To read the full article, click here

@Paul Butler McLees - the research is being sponsored by OUH and the lead researcher has an OUH email, so it appears valid to us despite the fact that OUH is not a MH trust.

@Emma Plumb, @annmariemalley, @Paul Butler McLees, @Helen Roberts, @Dr Judith Skargon, @Dr Shahana Hussain, @Ntalumbwa

I was just listening to a podcast interview between Dr Rangan Chatterjee and Matthew McConaughey (In the series 'Feel better, live more'). Matthew M. mentioned that he came from a highly resilient family. If someone fell over, his mother would tell them to get right back up straight away and carry on. He added that he thought that while this resilience was generally a good thing, there should be (what he called) a 'loophole' in it so that there was time to learn why they have fallen over to begin with. Was there a crack in the pavement that needed to be avoided? That way, it wouldn't happen again in the future. This made me think about whether there really was a conflict between resilience in organisations and the need to learn from failure. What do you think??

A freedom of information request by HSJ has for the first time revealed a complete list of participants in NHS England’s maternity safety support programme, with 28 trusts involved since its inception in 2018. London North West University Healthcare Trust, Northern Lincolnshire and Goole Foundation Trust, and Worcestershire Acute Hospitals Trust all entered the scheme at the start, due to pre-existing quality and safety concerns. The trusts were all subsequently removed, having been deemed to have made improvements, but have since been placed back in it following inspections by the Care Quality Commission (see table below). HSJ asked the trusts to explain why they had re-entered the scheme, and why it had failed to deliver sustainable improvements the first time, but they declined to comment. NHSE said in a statement: “Trusts are placed on the maternity safety support programme according to complex criteria, including local insight and external performance measures, including CQC ratings. “Following the success of the programme since its creation in 2018, its criteria was widened to strengthen its role in proactively improving safety and enabling earlier intervention where there are concerns — this has allowed support to be offered to more trusts than in previous years.” However, it would not provide further details on the new entry criteria. Three further trusts — Barts Health, North Devon Healthcare, and the Queen Elizabeth Hospital King’s Lynn — have previously exited the programme and not so far re-entered. Trusts such as Shrewsbury and Telford and East Kent — which have been at the centre of major maternity scandals — have been on the improvement scheme for all four years. Peter Walsh, chief executive of the patient safety charity Action against Medical Accidents, said: “The number of NHS maternity services being found to be needing improvement is worrying. We welcome the fact that NHS England is devoting resources to support trusts to improve their maternity services, but there should be much more transparency about this. “The criteria for needing this support should be published, and indeed should have been subject to consultation.” Helen Hughes, chief executive of patient safety charity Patient Safety Learning, said there should be transparency about resource allocation and the criteria used to make decisions, adding: “It doesn’t appear that this information is easily accessible and in the public domain and rather begs the question, why not?” NHSE said trusts receiving support from the programme detail this in their board papers, although HSJ found this is not always the case. It added trusts are made aware of the rationale for inclusion on an individual basis. NHSE and the Department of Health and Social Care last year described the maternity safety support programme as the “highest level of maternity-specific response”. They have said the programme “involves senior clinical leaders providing hands on support to provider trusts, through visits, mentoring, and leadership development”. Full article here (paywalled) Original source: Health Service Journal

· Trusts told to identify actions to “immediately stop all delays” · Letter calls for issue to be discussed at every board meeting · It follows concern over harm to patients from delays Trusts and integrated care systems are being told by NHS England and Improvement to take urgent action to ”immediately stop all delays” to ambulance handovers, which will require “difficult choices”. A letter yesterday from NHS England’s medical director, director for emergency and elective care, and its regional directors was sent to all local chief executives and chairs yesterday. It also says they should discuss the issue of ambulance handovers at every board meeting they hold, warns that “corridor care” is “unacceptable as a solution”, and says ambulances should not be used as “additional ED cubicles”. The move comes amid signs of large numbers of very long handover delays, and concern about the risk to patients from this and the knock-on damage to ambulance response times. Read the full article here (paywalled) Original source: Health Service Journal

New analysis from Diabetes UK predicts that, without significant government action, up to 5.5m people in the UK could be living with diabetes by 2030. The prediction is based on analysis of statistics from Public Health England and The Association of Public Health Observatories. It means that as many as 1-in-10 UK adults could be living with diabetes within a decade. Additional analysis carried out shows that up to 17 million people - 1-in-3 UK adults - could be at an increased risk of developing type 2 diabetes by 2030, unless there's commitment from the governments of the UK to urgently invest in diabetes care and prevention. It is known that there's been progress in diabetes care, such as the hundreds of thousands of people who have been supported by the NHS Diabetes Prevention Programme. But we need more action to stop our prediction from coming true. That's why Diabetes UK are calling on the UK Government to: Make more funding available to enable more people to avoid a diagnosis of type 2 diabetes through increasing access to proven preventative measures, such as the NHS Diabetes Prevention Programme Support far more people diagnosed with type 2 diabetes to go into remission where possible Improve access to weight management services  Ensure that everyone has the access to the care and diabetes checks they need – including tackling the backlog – as we move out of the pandemic. The effects of the pandemic are still being felt in diabetes care. Millions of people with type 1 and type 2 diabetes haven't had vital health checks when they needed them, and thousands of diagnoses of type 2 diabetes have been delayed or missed. Read full article here Original source: Diabetes UK