Category Archives: Health Care

Health care and treatment in the UK

Deborah Harrington’s interesting posting on “The Myths and Legends of Hypothecated National Insurance” (March 29 2018) in particularly relevant in the light of media speculation about hypothecated taxes or National Insurance contributions to pay for health or social care.

In Wales there is a further variation on this general theme with Professor Gerry Holtham (Dept. of Regional Economics at Cardiff Metropolitan University ) proposing the establishment a social care levy for Wales. (See link below)

The levy, based on weekly payments between £1.75 and £7, would differ from a tax in that the receipts would not go into a general government budget but rather into a separate social care fund with its own independent trustees. “A portion of ..(the fund) receipts would go to local authorities to expand social care provision straight away. The greater part of the receipts would be held back for future needs and meanwhile invested to grow over time and enable even greater social provision to be made in the future as the population ages.”

And following the National Assembly for Wales having secured its own tax raising powers at the beginning of October 2017 the Welsh Government Finance Secretary, Mark Drakeford, signaled that a levy to support social care was one of the new tax ideas he was considering.

Solving Social Care. And more besides

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Many women consider breast reconstruction surgery after having a mastectomy or lumpectomy. As of now, the most common options included saline and silicone breast implants. However, breast reconstruction surgery has made gigantic leaps and comes forward with more natural ways to rebuild the look and shape of the breast. Although the plastic surgeon can work with the breast surgeon at the same time and immediately reshape and restore the natural appearance of the breast with the remaining tissue, and, of course, the areola and nipple, after the cancerous tumor is removed, there are more options for women that do not want to undergo this combination of operations in one go or those that have already had their breast surgery and are now considering breast reconstruction surgery.

Microvascular Free Flap Techniques in Breast Restoration

Until a while ago, most surgeons would use microvascular free flap techniques to have the entire breast reconstructed with the patient’s natural tissue. During this procedure, the plastic surgeon transferred tissue (including fat and muscle) from other body areas, usually from the upper back, the lower belly (“the six pack muscle”) or the rectus, to the breast. However, surgeons are now less in favor of these techniques and prefer more advanced options that leave the muscles intact. One such option is a method called Deep Interior Epigastric Perforator Artery flap technique, where the plastic surgeon transfers skin, tissue, and small blood vessels, but no muscle, from the patient’s abdominal area to the breast.

Fat Grafting

Fat grafting is a much promising technique already widely used by leading plastic surgeons around the world with impressive results. During the procedure, using high end liposuction like SmartLipo™ the surgeon removes excess fat deposits from the patient’s thighs of flanks (the area between the hip and the ribs), purifies it, and then carefully injects it into the breast.

Besides allowing women that have had a mastectomy or lumpectomy to have their breast reconstructed (on re-made in its entirely), fat grafting is proven to be highly effective in patients with breast cancer that have undergone radiation treatment. Being very different from chemotherapy, where drugs are used to treat cancer, radiation therapy is a form of x-ray therapy. The two types of radiotherapy used for breast cancer are cobol-based radiation therapy and linear accelerator radiotherapy. Both come with side effects, which include the burning or darkening of the skin with some peeling over the treated area (in this case, the breast). Moreover, radiation therapy might also cause tightening of the skin, and pain at the mastectomy site. Fat grafting (sometimes, combined with stem cell transfer) is found to improve the pain many women experience after undergoing a mastectomy and improve the appearance of the skin. Therefore, besides helping correct breast volume, contour, and shape deformities, fat grafting is also effective in treating irradiated breast tissue and alleviating pain following a mastectomy.

When it comes to volume loss concerns, it is proven that patients that receive higher volumes of injected fat (>151cc) show significantly slower loss of volume. They also demonstrate greater retention of volume overall than patients receiving less than 50cc fat.

Why Fat Over Other Methods?

Unlike with other techniques used to breast plastic and reconstructive surgery, fat grafting comes with a particular appeal. First, and foremost, fat is an excellent biocompatible filler material that is not only available in abundance within the patient’s body but also a material that can be easily collected and processed so that it can be injected in small, controlled amounts. Where scientists now turn their focus is in developing new techniques that will allow more enhanced harvesting, processing, and placement of the fat in order to deliver even more predictable, reliable, and consistent results.

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Nobody in this world is unhealthy by choice. Everyone who does not have their ideal body is compromising it because of his lifestyle or other responsibilities that take priority. Even so, many people try to remain fit and healthy using various ways. Some people try to do the usual “exercise more and eat less” routine while some people use various pills or foods that could help them lose weight, like the GenF20, which boosts or regulates hormone levels to make our bodies healthier. The ideal way is to do all of this while taking up some regular habits that could aid you in becoming absolutely fit and healthy.

Exercise regularly

The best way to remain fit is by being physically active. The ideal way to lose weight is by burning more calories than you consume, which can be done by taking up regular exercise. It does not have to be a hectic gym routine or anything that takes up too much time out of your day, to remain fit and healthy even a daily light exercise routine of 15 minutes is also enough.

Know what foods you should eat

It is ideal to consume foods from all food groups, though that must change depending on the kind of body and routine you have. For example, older people or those with diabetes must not consume too many carbohydrates or fats while an active person in his teenage needs both of these along with equal portions of proteins and fibers to remain fit.

Portion control

A habit that everyone who wishes to be fit and healthy should take up is that of portion control. You should not take too much of any kind of food, no matter how healthy or too little of any kind of food, no matter how unhealthy. Eating any kind of food in a controlled manner will allow you to feel less full, bloated or lethargic. Eat everything in moderation!

Stay away from harmful substances

Try to only take in natural substances for fitness purposes, like GenF20. Stay away from chemical additions to the body, for example steroids. Also, remember that smoking is extremely harmful to the fitness of the human body, along with any other kinds of drug or substance that may be abused. Excessive amounts of caffeine are also known to cause damage to many systems in the body. Many drugs either make you eat excessively, hinder your body’s metabolizing mechanism or make you lose appetite, thus making you skinny and unable to perform tasks that require energy.

Keep your mind at peace

Peace of mind is under-estimated for keeping a healthy body by most people. Remaining happy and stress free, although, has proven to be one of the keys of remaining fit. Stress causes people to develop irregular eating patterns or causes them to become inactive. This sometimes leads to greater psychological issues like anorexia or bulimia. Thus, mental health is not to be taken lightly when try to remain healthy.

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It’s no secret that the general population is growing at a rate faster than ever before. As it stands, the UK has a population of 64.1 million – a number which is predicted to reach 70 million mid-2027, just 10 years from now.

The world’s population is expanding at a similar rate, with more than 7 billion people on the planet currently and urban populations rapidly developing and branching out.

The healthcare systems supporting these huge urban populations will find themselves under strain, as more and more health issues arise due to people living in such close proximity to each other and the pollutants existing in such cities.

Slums are being erected more and more in some of the world’s largest countries, such as India, Brazil, South Africa and Mexico – the number of people in the world living in slums reached 863 million in 2014 – and these have significant effects on the environment and the people who live in them. In turn, healthcare services for those who can afford it are being impacted and, due to poor sanitisation, such close confinements and the sheer number of people in one place, there are a number of cases of serious illnesses such as cholera and diarrhoea.

In China, the air pollution in the country’s large cities is causing serious respiratory issues as breathing the air in Beijing is likened to smoking 40 cigarettes a day. Therefore, healthcare services in the country are significantly under strain as the population suffers due to the radical urbanisation the country is undergoing.

Focusing on the UK alone, the strain such a huge population can have on a free health service is threatening to its ability offer the best care. The NHS currently deals with more than 1 million patients every 36 hours and is already under great strain. As the population grows, this issue will only increase along with it. Patient safety is currently the major issue, as under strain and overworked staff make decisions that could further jeopardise health because they are unable to think clearly.

The strain extends further than patient care too, supply and demand for items such as medical supplies and protective equipment will rise and there could also be a threat to the amount of available antibiotics and medicines to treat injuries and illnesses.

So what can we do?

It’s important we act now, to lower the potential strain on health services in the future, here are a few key ways to do this:

  • Encourage healthier living – obesity is rising in the world and this is one of the major contributing factors to the strain healthcare services are currently experiencing. Eating well and exercising more will improve general health across a population.
  • Businesses can implement healthcare plans in the workplace – many people get ill but their symptoms worsen because they do not want to pay for a check up at the dentist or antibiotics from the doctor. A healthcare service such as Bupa can cut costs and ensure people remain healthy.
  • More free phone services – People who simply want to talk about their symptoms should be able to call and speak to an advisor. The NHS 111 service took 1,351,761 calls in December 2016 alone, suggesting more support is required for this service.
  • Stronger support for mental health services and charities – Support for those suffering with mental health issues such as anxiety and depression can find that their symptoms worsen if they don’t seek help, but the current healthcare system isn’t prepared for this. Free advice services and support networks can lighten the load on healthcare providers such as the NHS, as well as offering people the help they need.

The growing population will continue to have a significant impact on the healthcare services around the world, with the above points implemented we can help reduce this strain.

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On November 1st 2016 the Welsh Government’s Cabinet Secretary (Minister) for Health, Well-being and Sport, Vaughan Gething, announced the establishment of a Parliamentary Review which will look at the key challenges facing the health and social care services in Wales.

He said  “ … (it) will review the best available evidence to identify key issues facing our health and social care services and draw out the challenges that these will present over coming years. For example, there are challenges with NHS finances within a reducing Welsh Government budget, workforce planning, recruitment and retention, and meeting the rising demands of healthcare and rising public expectations. The review will examine options for the way forward and will then make recommendations about what the health and care service of the future could look like.”

The review was initiated as part of the “Moving Wales Forward” agreement between Welsh Labour and Plaid Cymru underpinned by wider cross party consultation and discussion.

The current Welsh health strategy, “Together for Health “ is due for revision and the Cabinet Secretary hopes that the Parliamentary Review will be completed in time to inform its replacement. This seems sensible and should give the Review a sharp operational focus.

However such a relatively short time window may not provide sufficient opportunity for the Review to engage in the innovative thinking needed to come up with the radical proposals that an under-resourced health and social care service is likely to need just to sustain itself and survive.

The Review will be led by the former Chief Medical Officer for Wales, Dr Ruth Hussey, supported by an an independent panel drawn for a wide range  of experienced backgrounds predominantly from outside Wales. It will be supported by a stakeholder reference group made up of representatives of professional bodies and social service organisations within Wales. Faced with such an strong resource, which has attracted cross party political support, the Welsh Government might wish to consider asking the Review for a relatively early report to help with the revision of its overall strategy and then requesting it to give additional thought as to what Welsh health and social care is likely to need for the medium and longer term.

 

http://gov.wales/topics/health/nhswales/review/?lang=en

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Health is wealth. To maintain a healthy body, you need to consume a balanced diet, exercise on a regular basis along with taking sufficient amount of sleep. To avoid unwanted maladies, people consult medical experts. With globalisation at its peak, it is easy to access almost everything. Everything is turned online. With the inclusion of medication in the globalisation spectrum, you can know about your health from home without visiting physicians. Many patients today are seeking advice from online doctors. Online medical consultations are a norm today. Below are few pros and cons of online health consultancy:

Pros:

  • Online health adviser is not limited by actual boundaries. You can access to reputed doctors throughout the world that would otherwise not be available to you. For some reason, if you are not able to leave your home and access to the traditional treatment centres, services like these would provide you with an advantage.
  • Self-diagnosis is a dangerous option. You can look for the cures on Google relevant to your symptoms, but it can never substitute for consulting a doctor. Websites are providing online consultations and online pharmacies like Europa Pharmacy.
  • It is cost effective. Visiting a doctor in person could cost you more than seeking for online medical advice.
  • Most online health service providers operate 24 hours.

Cons:

  • To reach a better decision, doctors take help of diagnostic reports. Online consultation acts like a barrier to fetch reports.
  • It opens a new door for selling prescription drugs. Scam operations are present that target on selling cheap medications.
  • There is no transparency in the sense that you cannot be sure about the qualification of the doctor.

However online medical consultancy is at its boom these days. People still use them because it does provide them sufficient level of comfort in all aspects. But how does it work? There are numerous websites available where you can seek medical advice. Doctors get paid for the answer they provide to the patients, so this can to some extent support the validity of their answers. Some websites allow you to contact doctors from best hospitals. Their blogs provide reliable solutions to everyday common health conditions such as stress issues. JustDoc, one of the websites, allows you to contact doctors through audio and video calls. You can even attach your medical reports if you have one assist the doctor working on you. Sometimes you may get an instant answer depending on the nature and severity of the disease. Lab tests can be performed and shipped directly to your doorstep, which further is convenient. Doctors can sign up on any of their desired website which will provide them with a platform to practice medicine online. They just have to create a profile entering required details such as qualifications and specialities. These websites enable the doctors to connect to their potential clients online and making them earn handsome amount of money.

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Wales is the only part of the UK where “deemed consent” to organ donation applies. The means that any deceased who is over 18 years, is mentally competent and who had lived in Wales for  12 months is deemed to have given consent to organ donation unless they have formally registered their objection.

About a decade ago, the UK had a low organ donation rates (13 / million population) compared to countries such countries as Spain, USA and France. As well it had a much lower rate of next of kin refusal. In Wales around three people per month died while waiting for an organ donation with about 300 people on a transplantation list.

The issue was considered by the National Assembly for Wales Health and Well-being Committee in 2008. Though its report did not recommend  “presumed consent”, the Welsh Government felt there was sufficient public support for the proposal and indicated its intention to legislate on the matter. A commitment to do so was included in the Welsh Labour, Plaid Cymru and Liberal Democrat’s manifestos for the 2011 National Assembly election.

The Bill was introduced into the National Assembly in December 2012. Over the next year an extensive debate and consultation took place. There was broad support for its purposes though concern was expressed, by Christian and Islamic faith groups in particular, that “deemed consent” was not real consent and that it undermined the altruistic virtue of the gift of donation.

A key feature of the legislation was its “soft opt-out” option whereby close relatives are involved in the donation decision with particular attention being paid to any evidence that the deceased may not have wished to have their organs donated.

In the run up to the beginning of the legislation in December 2015 there was an major campaign to both explain the new legislation and to raise awareness on the wider organ donation need in Wales. The legislation will require the Welsh Government to maintain a programme of promoting public awareness and to report on progress.

At the end of the first year of the legislation the Welsh Government reported “… the latest figures show that 39 organs from patients whose consent was deemed have been transplanted into people who are in need of replacement organs.

In the two years prior to the introduction of the new system of deemed consent, .. (we) made significant efforts to inform the public of the exact nature of the upcoming changes in respect of transplantation activities. During this period the number of organs transplanted increased each year, from 120 between the 1 December 2013 and 31 October 2014, to 160 between 1 December 2015 and 2016.

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Ravissent

There is nothing wrong with a woman wanting to have a bigger breast size or firmer breasts. The feeling of having an enhanced bosom can lend a great deal of confidence to a woman and give her the extra feelings of self-esteem and self-worth that she really needs psychologically to feel better about herself and succeed. There are plenty of options available in today’s world to achieve and enhanced look of your breasts, but you want to take great care in choosing just the right one for yourself. You will want consider all of the options available to and look at Ravissent and other products like it at Top Breast Enhancements so that you can choose the best natural breast enhancement pills for you.

Each Method is Different

There are many different methods available today, from devices to exercises to surgery to pills and creams and each one not only carries its own benefits and drawbacks but each one can have different results for different women. This alone can help to make it difficult for you to decide just which can be the best solution for you personally. You are going to want to take a close look at the options before you and look at what the best points of each and the downsides of each can be for you. You may find, that when you have started to look into everything, that the options available to you through the natural enhancement product market are the best and safest for you to try. Once you have looked at that you must then go through all of the different products available to you.

Looking Closely at a Product

You want to examine the natural products closely so you can gain a solid understanding of the ingredients used, the recommended dosage and any potential side effects of the different offerings so you can help decide which might work best for you. When you look at Ravissent, you will note that it makes use of many of the typical ingredients found in other natural pills and creams that can provide you with bigger and firmer breasts, such as L-tyrosine, saw palmetto, fenugreek, blessed thistle and other herbs and plant extracts. These have all proven effective in stimulating phytoestrogens to help mimic hormone levels in your body to increase tissue production in the breasts. You will find that when you take the recommended dosage of this product that you can achieve positive results in about four to six months.

Consider Your Options

You will want to take a close look at Ravissent and other natural breast enhancement creams before you decide on just which one might be the best choice for you. Look closely at the Topbreastenhancements.com reviews so that you can read what other women have experienced and what the success rates are like. You can then get a better feel as to which can provide you with the enhancement you need the most so you can end up with the larger breasts that look the best for you.

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In this era of busyness, a large number of people have forgotten, “The greatest wealth is Health”. Heaven knows that life is not life without health; it is just a condition of languor and suffering – an image of death. In today’s fast-moving world, most of the people seem very busy as busy bees; in fact, they work from dawn to dusk. Even they do not care about their health. You have to make some space in your life for being healthy.

Do you know an easy way to take care of your health and fitness matters in the shortest amount of time? If no, bear in mind that Fitness Trackers are the best gadgets to take care of your health around the clock. Without having any doubt, whatsoever that inactivity can lead to a lot of health-related issues. Even fitness trackers monitor your level of activity and reveal the data on your Smartphone.

Now you will surely get your tracker as quick as a flash, but how will you find the best one that will perfectly fit your needs. Don’t worry! In this article, you will find some best fitness trackers with ease.

Let’s have a look on some best fitness trackers accessible in the market. If you want to do some in-depth research about the fitness bands, click here.

fitness trackers

  • Garmin Vivo smart HR+

As an activity tracker, it offers automatic tracker. Also, delivers phone alerts and notification on time.   Moreover, it tracks heart rate 24 hours a day and 7 days a week and it can be used with both Android and IOS. In short, it is a fantastic and huge upgrade model.

  • Fitbit Charge 2

It helps you stay active and motivated throughout the day. Furthermore, it has a large display screen, gives a guided breathing exercise, and the most accurate measurement of sleeping tracking.

It gives you good battery timing. Also, it looks utmost stylish due to its sleeker design and silver body polish. In short, it is one of the best trackers for the general use.

  • Apple Watch Series 2

It is one of the best fitness trackers for the iPhone users. Are you looking for the Apple’s smart watch? So, Apple Watch Series 2 is the best option for you without fail. Due to its built-in GPS system, it helps you out to keep track of your workouts without using your phone.

In addition, it has water resistant capabilities up to 50 meters.

Another key thing to remember that Series 2 Apple Watch processor is 50 times faster than the Series 1 Apple Watch, and it has a sensor that tracks the heart rate.

  • Samsung Gear Fit 2

It is one of the best fitness trackers for the Samsung/or Android users. Do you want to get Android smart watch cum activity tracker? So, Samsung Gear Fit 2 is undoubtedly one of the best options for you. It features an appealing slim design with an AMOLED display, and without a doubt, its notification support is excellent. Moreover, it tracks the heart rate with the plenty of fitness metrics effectively, and also, Cost effective. The glorious thing is that it has built-in GPS and able of playing music to Bluetooth headsets.

 

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but they don’t relieve pressure from A&Es

The rise and fall of the NHS walk-in centre

Walk in health services of one form or another feature in many healthcare systems, including Canada and the United States. In England, the first NHS walk-in centre opened in the late 1990s but only became prominent in the late 2000’s following a policy initiative that led to the opening of around 150 new facilities.

Offering extended hours and with no requirement for patients to pre-book or register, many new centres had proved highly popular with local residents with minor illnesses and injuries such as colds, eye infections, sprains and cuts. But despite this popularity, during the last parliament around a fifth of the facilities shut their doors, with a number of others, for example in Redruth, Hereford, and on Teeside, also currently at risk.

Taking sides

Why the services should have closed in such numbers is not immediately clear: the scale of local opposition to some closures – for example in Jarrow, Worcester and Southampton – was intense. Their supporters argue they reach new groups of patients, provide easy and convenient access to care, and take pressure off other stretched NHS services.

At the same time, commissioners closing centres argue they represent a poor use of funds as many attendees have minor conditions that have little need for medical attention, and those that do could readily be treated elsewhere.  Some have cited the need to fund seven-day-a-week access to GP services as a more pressing priority.

While not the whole story, one important question in these debates is whether walk-in centres divert patients from attending busy hospital A&E departments. This may be desirable since crowding at A&E is associated with high mortality and can have knock-on effects by reducing the capacity for hospitals to carry out planned medical treatments. In addition, many attendees at A&E have low severity needs which could be safely treated outside a hospital setting. Treating these patients as emergency cases in hospitals is considerably more expensive than treating them in walk-in clinics.

Building the evidence: do walk-in centres divert patients from A&E?

Until recently there was no conclusive hard evidence – from either side of the Atlantic – either way. When surveyed, around a quarter of patients attending walk-in centres say they would otherwise have attended a hospital A&E. However, academic research using statistical methods has been unable to detect any such effect.

My research provides new evidence that goes some way to filling this gap. Combining detailed information contained in hospital records with difference-in-difference statistical techniques, I provide credible estimates of how patients’ use of A&E departments changes in response to the opening or closure of a new walk-in centre close-by.

Two main findings emerge. The first is that walk-in centres do significantly divert patients away from attending A&E. The second, however, is that relative to the number of patients attending walk in clinics the effect is small, with calculations suggesting only around five to 20 per cent of patients attending a walk-in clinic would otherwise have gone to casualty. The implication is that they only make a small dent on the overall A&E figures.

The research points to something of a dilemma for decision-makers. Easy access services such as Walk-in Centres are popular, which suggests they are valued by patients. The evidence suggests they do make a small contribution to relieving pressure at over-stretched emergency services, but with low diversion rates from A&E they may be an expensive way to do so. The cold reality of a chilly funding climate points to hard choices in allocating scarce NHS resources to best meet local demand. With this in mind, fights over the remaining centres look set to continue.

this article first appeared on LSE Business Review.

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The use of technology in the UK’s hospitals is advancing rapidly. Over the years patients have become used to being connected to a whole variety of pieces of electronic equipment in order to maintain and monitor their health but the development of mobile technologies as well as progressive diagnostic tools mean that our hospital care is set to change still further.

Look to the future 

Hospital beds may change in shape and design, most wards are furnished with ripple beds in order to reduce the possibility of bedsores, but the kind of bed castors here are still attached to these beds for ease of movement. Of course electrical connectivity is a necessary part of the modern hospital castor wheel. Other equipment on the hospital ward will change beyond recognition.

Tricorders may become commonplace

One area that will change is the field of medical diagnosis. A recent article in The Guardian suggested that the diagnostic gadget as used in the US TV series Star Trek might become a commonplace feature within the next five years. The suggestion is that the gadget will be ‘capable of diagnosing a set of 15 diseases without the presence of a medical professional.’ This isn’t quite doctoring by robotics, it’s more a question of computers becoming more adept in the way in which they handle medical information and how they analyse this data.

Remote operations

Dr Peter Diamandis, who is in the forefront of medical technology exploration, believes that robotics will play a greater part in medicine. Already a system exists, known as Da Vinci, that allows surgeons to control a robot used in surgery as part of an operation from anywhere in the globe. Eventually, Diamandis visualises a world where robots will carry out surgical operations without any human input at all.

Changing the present 

Video consultations are becoming commonplace in UK hospitals. The authoritative Kings Fund highlights the Airedale Hospital’s telehub where patients don’t have to physically attend the hospital for an Outpatients’ appointment, the consultation is carried out through a video link. The hospital has recently published figures that show a ‘35% reduction in hospital admissions and a 53% reduction in patient visits to A&E’ as a result of use of the telehub.

Changes in mental health treatment

Online Cognitive Behavioural Therapy (CBT) is already being trialled across the UK. Some detractors argue that patients may self-edit when filling in online questionnaires about their mental conditions, whereas others believe that in the absence of visiting a real therapist at least the patient will benefit from answering the questions and the data amassed online will be analysed by psychological experts. The Big White Wall is another example of how patients suffering from anxiety may be able to access online help.

From keyhole surgery to online diagnostic apps for smartphones, medical technology is changing quickly. Healthcare professionals are learning how to work with these changes in order to improve patient care. As for replacing people with robots, that’s a whole different ballgame….

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Comin’ in on a wing and a prayer
Comin’ in on a wing and a prayer
Though there’s one motor gone
We can still carry on
Comin’ in on a wing and a prayer
(Adamson and McHugh [1943] – songwriters)

Previous research estimates that 39 per cent of offenders experience a mental illness whilst on probation. Suicide rates in prison rightly receive much media attention, yet suicide rates in probation are also much elevated in comparison to the general population but receive little consideration. Mental health treatment requirements exist as a sentencing option for the courts when considering prison or probation for an offence, but they’re rarely used. Nationally, they constitute 0.1 per cent of all requirements.

The health of probationers compares highly unfavourably with the general population, and even with the more unhealthy of the population (the lower social classes). This is the case for both physical and mental health.

Many offenders have (co-occurring) substance misuse problems. In the first two weeks following release, mortality rates are 12 times higher than for the general population. In a nested case control study, Bingswanger and colleagues established some of the clinical risk factors involved. These included: injecting drug use; tobacco use; cirrhosis; panic disorder and use of psychiatric medications. Probationers also experience elevated levels of long-term illness and disability.

The need for continuing and integrated healthcare is clear.

However, issues like mistrust of healthcare professionals, transient lifestyles, negative attitudes amongst healthcare staff towards offenders, problems with inter-agency communication, and inflexible/insufficient service provision mean that offenders’ access to healthcare is less than their needs. Many offenders are not registered with a GP and only access healthcare during crises.

To improve the health of this population and reduce health inequalities it is essential that they have access to health services which meet their needs. This would also enable us to uphold the principle of equivalence and reduce both re-offending and the use of crisis services (and the costs associated with this).

Probation services and arrangements for commissioning healthcare for offenders have both been the subject of recent reforms. Probation provision is now split into the National Probation Service – a public-sector service managing high-risk offenders; and Community Rehabilitation Companies – a mix of private and voluntary sector agencies managing medium and low-risk offenders.

Clinical commissioning groups should now commission healthcare for offenders on probation, but previous research suggests that many of them are unaware of this responsibility. The most recent study found that in 2013, 7 per cent of these groups directly funded healthcare in probation, a figure that declined to 1 per cent in 2014. Such commissioning should be informed by Joint Strategic Health Needs Assessments overseen by Directors of Public Health. It is iniquitous that all 136 prisons in England and Wales have been subject to local health needs assessments by either NHS England Area Teams or local public health groups whereas the same is true of only 25 per cent of probation services.

Some Mental Health Trusts do fund ‘own account’ mental health services into probation from their block contracts, but again this proportion has declined from 70 per cent in 2013 to 61 per cent in 2014. The two most likely services provided were clinics in probation offices and support for multi-agency public protection arrangements – the latter being a statutory responsibility. Clinic services vary but often consist of two hours per week where a mental health professional is available to give advice. There has also been a recent national initiative to provide professional support in probation for those with personality disorder. However, the impact of this scheme has yet to be reported.

Previously, government has outlined a role for the probation service in England and Wales in offender health involving advising the courts on alternatives to prison, and working in partnership with other agencies to ensure that offenders’ health and social care needs are addressed. There are links between health and offending, and health interventions can reduce crime. Improved health has been cited as a pathway out of re-offending, and considering offenders’ physical and mental health needs in sentence planning using the Offender Assessment System screening tool is an established part of probation staff’s role. However, there are concerns that local-level partnerships between probation and health services may break down following the restructure of probation and (for the reasons stated above), improving offenders’ health and access to healthcare remains a challenge.

Due to this high level of health needs and disproportionately low level of service access, the NHS, through clinical commissioning groups, should be commissioning healthcare locally for probationers with an in-depth understanding of needs and with a view to removing current barriers to service access for this population. Until then ‘we’re comin’ in on a wing and a prayer’.

First published on the LSE British Politics and Policy blog.

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