Category Archives: Well-being

 

Make the UK the safest place world to have a baby!

Why is the UK still not in the top ten countries for infant mortality and for maternal deaths? Why? We are a rich country. We have an established high-quality health service. Healthcare is supposed to be accessible to all. How come babies and mothers die or are badly hurt at birth? How come Black and Ethnic minority babies suffer most? Why do poor areas have worse outcomes than wealthy areas? Why is infant mortality rising? (The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors). Are there fundamental problems with core policy documents like the maternity review “Better births”? These are painful questions.

Our campaign wants real improvements for mothers and babies. This posting is not intended as a clinical paper, it is a discussion amongst activists and concerned citizens about where the problems lie. A key set of participants in this discussion are mothers who have given birth, including those who have lost babies, grandmothers and other birth partners, and women who could not conceive.

Our campaign published our Maternity Manifesto during the election but though well shared on Facebook, it did not get into any parties’ manifesto.

We also called a national meeting on issues in maternity care.

What then are the factors that result in UK outcomes at birth worse than other advanced countries?

The answers include shortage of NHS funding, staffing shortages, poor management in some hospitals, staff in fear of speaking out, some policies and procedures, disrespect towards the women carrying the baby, and, as cited in the East Kent enquiry, a lack of practical understanding by staff and by mums of the need to “count the kicks” in the latter part of pregnancy. The introduction of charges for migrant women has also caused deaths. NHS material seems to centre the cause on mothers who smoke, or who are overweight. (Now smoking in pregnancy is plain stupid, it really is, and most mums would not do so if they were not addicted. Don’t do it!). However, other countries, Greece for example, who smoke more, have better outcomes in pregnancy than does the UK. Wider problems like obesity and diabetes, and even women giving birth older, are mentioned in the literature about this. Again, the age of the mother as a factor, but this is only partly true. Giving birth older is often safer than giving birth too young. Globally it is most often young girls who die in childbirth.

Answers may lie in the financially and emotionally vulnerable place that pregnant women occupy in our society, including poverty, violence and stress. Poverty and inequality are factors in infant mortality; “The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).” (Our bold for emphasis).

The UK is a rich advanced country, with a long history of universal healthcare but we have rising infant mortality. “Rising infant mortality is unusual in high-income countries, and international data show that infant mortality has continued to decline in most rich countries in recent years” and “In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend“.

Poverty is not the sole cause of high Infant Mortality though, Cuba has good outcomes equal to the UK for infant mortality. Cuba is very poor indeed and the UK is one of the wealthiest economies (sadly Cuba does less well on maternal deaths).  

Research shows out of 700,000 births a year in England and Wales, around 5,000 babies are stillborn or die before they are a month old”. 5,000 babies each year. There have been major news stories about baby deaths in many hospitals, notably in ShropshireEast Kent and Morecombe Bay.

Maternal deaths. The UK is not in the top ten countries with the lowest infant mortality rate, neither is it the safest place to give birth. In 2015-17“209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.” In 2016 The UK ranked 24th in the world in Save the Children’s Mothers’ Index and Country Ranking Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia, Belgium, Austria, Italy, Switzerland, Singapore, Slovenia, Portugal, New Zealand, Israel, Greece, Canada, Luxembourg, Ireland, and France, all did better than the UK. The situation in some other countries is massively worse than here but that is no excuse. But these baby and mothers’ deaths must stop. We cannot sit back and let these deaths continue.

Let’s be clear, the situation for women in pregnancy and childbirth is massively better than before the NHS, and is head and shoulders better than in the USA today. But maternal mortality is an issue here in the UK, and a huge issue in poorer countries, especially where women give birth without a trained professional being in attendance. Quite rightly professionals and campaigners in the UK participate in international endeavours to improve this situation. The NHS should be training and sending midwives to those countries, instead, it is recruiting midwives from poorer countries. In Europe we have cuts in healthcare through Austerity; in the global south, the same concept of cutting public services to the bone is called Restructuring.

Why is the UK, a rich country with (almost) universal health care not doing better by its mothers and babies? Look at just this case and see the problems in the provision of maternity care;

Archie Batten

Archie Batten died on 1 September 2019, shortly after birth.

When his mother called the hospital to say she was in labour, she was told the QEQM maternity unit was closed and she should drive herself to the trust’s other hospital, the William Harvey in Ashford, about 38 miles away.

This was not feasible and midwives were sent to her home but struggled to deliver the baby and she was transferred by ambulance to QEQM where her son died. Archie’s inquest is scheduled for March. (BBC).

We know that temporarily “closing” maternity units because they are full is a common occurrence. Women then have to go to a different hospital. Induction of labour can be halted because the unit is full. It is not a pleasant situation for mothers. Some maternity units have closed permanently, meaning mothers have to travel further for treatment, at a time when the ambulance service is under great strain (though being in labour is not considered an emergency for the ambulance service!).

Shortage of Midwives and consequent overwork for the existing staff. The UK has a shortage of three thousand five hundred midwives. The midwife workforce is skewed towards older midwives who will retire soon.

Gill Walton, general secretary and chief executive of the Royal College of Midwives said “We know trusts are facing huge pressures to save money demanded by the government, but this cannot be at the expense of safety. We remain 3,500 midwives short in England and if some maternity units regularly have to close their doors it suggests there is an underlying problem around capacity staffing levels.

Training midwives is not just about recruiting new starters to university courses. There need to be sufficient training places in the Hospitals who are already working flat out, leaving little time for mentoring of students, as well as places in the Universities. Alison Edwards, senior lecturer in midwifery at Birmingham City University, who says: ‘It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it.

‘You need more tutors, more on-site resources and, perhaps more importantly, more mentors and capacity in placement areas – which is currently under immense strain.’ 

One student midwife wrote about her experiences in this letter, where she described very hard work without either pay or good quality mentoring.

The government and the NHS call for Continuity Care from Midwives. This means the same midwife or small team of midwives cares for the mother through her pregnancy, birth and postnatal period. We too believe this would be wonderful if it were possible. It is however impossible with the existing ratio of midwives to mothers. Providing continuity of care to the most vulnerable mothers is a good step. NICE have reduced this to the idea of each woman having a named midwife. One to One a private midwife company claimed to provide this but was unable to continue trading, and went bust leaving the NHS to pick up the pieces.

Nationally the NHS is underfunded and looks set to continue so. Much of the problem comes from a long period of underfunding. We spend less than 9.8 per cent of GDP on health. Switzerland, Germany, France, Sweden, Japan, Canada, Denmark. Belgium Austria Norway and the Netherlands all spend more. That places the UK 13th in the list of high spenders on health care. The US spends 16.9 %. (although a lot of that money is diverted from patient care to the big corporations and insurance companies). The NHS was the most cost-efficient health care service in the world.

Underfunding causes staff shortages. Some errors at birth come from staff being overworked and making mistakes.

Some, our campaign believes, flow from fundamental flaws in government policy such as in the Maternity Review, where the pressure is on staff not to intervene in labour.

 Listen to the Mother. Some of the deaths are from women not being heeded in pregnancy and childbirth. This is backed up in reports from mothers, including some quoted in the big reviews mentioned above. However, overworked and tired staff who know labour like the back of their hand can easily stop heeding an inexperienced mother.

Poverty kills mothers and babies. As we said above, some deaths, poor baby health, and injuries come from growing maternal poverty and ill-health. Low-income families find it hard to afford good food. Food poverty affects a staggering number of children. The charity UNICEF estimates that “2.5m British children, or 19%, now live in food-insecure households. This means that there are times when their family doesn’t have enough money to acquire enough food, or they cannot buy the full variety of foods needed for a healthy diet. In addition, 10% of these children are also classified as living in severe food insecurity (the European average is 4%) and as a result, are set to experience adverse health.”

Studies show that;

The Independent inquiry into inequalities in health (Acheson 1998) found that a child’s long term health was related to the nutrition and physique of his/her mother. Infants whose mothers were obese had a greater risk of subsequent coronary heart disease. Low birth weight (under 2500 g) was associated with increased risk of death in infancy and with increased risk of coronary heart disease, diabetes and hypertension in later life. Accordingly, the Inquiry recommended, ‘improving the health and nutrition of women of childbearing age and their children, with priority given to the elimination of food poverty and the reduction of obesity’. (NICE )

A significant number of deaths of new mothers come from mental health issues that spiral out of control. Some of these will be newly developed conditions and some existing conditions made worse by pregnancy and childbirth. Mothers family and professionals must all be on the alert and intervene early. There are good ways to treat mental health in pregnancy.

Reducing the social and economic stresses around pregnancy would also help reduce the deaths and suffering

When Birth goes wrong it can be a dreadful experience for everyone involved. In most cases, the panic button brings in a well-drilled team of experts who can solve nearly every problem and do it calmly. At other times, it is dreadful, as described in the coverage of the birth and death of baby Harry Richford. Harry Richford was born at the Queen Elizabeth the Queen Mother Hospital in Margate in 2017 but died a week later. https://www.bbc.co.uk/news/uk-england-kent-51097200

Sands, the baby death charity explains that there are many causes of babies dying before birth. Crucially important is that mothers are heeded when they are concerned and that everyone Counts the Kicks

 

Maternity is not the only area of the NHS that suffers. There have been serious mistakes in NHS planning including closing far too many beds. The NHS closed 17,000 beds and now is working beyond safe bed occupancy. There are 100,000 staff vacancies. Waiting times in A and E are dreadful, as are waiting times for cancer treatment. NHS managers and the Government have taken the NHS far from the Bevan model of healthcare (for history read this).

Press coverage. How does the press cover the NHS, and baby deaths? There are very real problems in the NHS and maternity care but the coverage in the press of these problems seems to switch on and off in strange ways, often to suit Conservative Party political requirements. The NHS and the Government are masters of propaganda and news manipulation. The public needs to learn to judge the news and to look both for actual problems and look out for bullshit and manipulation. Why was news of the arrest of the nurse from the Countess of Chester hospital headlines on the 70th Anniversary of the NHS? Why was the news of the understaffing there not given similar nationwide publicity? Why have we heard little or nothing since?

If the government can switch the blame to the professionals in the NHS (but not their mates the high admin of the NHS), then they seem to be happy to publicise the problems. In other cases, problems are swept under the carpet.

Professionals expect to (and do) take responsibility for their own actions. Mistakes will be made. It is impossible to go through life without some mistakes. When we are dealing with life and death mistakes can be catastrophic, even where there is no ill intent.

Malicious action is rare.   There are the terrible cases of serial murderer Harold Shipman, and the convicted surgeon Ian Paterson who falsely told women, they had breast cancer and operated on them unnecessarily. The hierarchical system in the NHS and the lack of regulation in private hospital, which was described as “dysfunctional at almost every level” allowed that harmWe have not found such a case in maternity.

Unintentional bad practice, however, has also harmed babies. No one went to work intending to harm in the events publicised in the Morecombe Bay Enquiry into the deaths of 11 babies and one mother. It was said that “The prime responsibility for ensuring the safety of clinical services rests with the clinicians who provide them, and those associated with the unit failed to discharge this duty over a prolonged period. The prime responsibility for ensuring that they provide safe services and that the warning signs of departure from standards are picked up and acted upon lies with the Trust, the body statutorily responsible for those services.”

The Enquiry described what happens like this “In the maternity services at Furness General Hospital, this ‘drift’ involved a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk.”

The Furness General Hospital was pushing for Foundation Trust status at the time and was not exercising the necessary supervision.

“Maternity care is almost unique amongst NHS services: the majority of those using it are not ill but going through a sequence of normal physiological changes that usually culminate in two healthy individuals. In consequence, the safety of maternity care depends crucially on maintaining vigilance for early warning of any departure from normality and on taking the right, timely action when it is detected. The corollary is that, if those standards are not met, it may be some time before one or more adverse events occur; given their relative scarcity in maternity care, it is vital that every such occurrence is examined to see why it happened.

So, many factors come into play in such incidents of harm to mother and baby. Professionals too can be emotionally wrecked by tragedy.

Huge personal and professional lessons can be learned from a detailed review of cases where mistakes are made. There is a whole literature about learning from mistakes. The worst such incidents are referred to as Never Events. This is just one article about such errors but there is a whole field of research devoted to it. Serious Mistake Reviews often happen at the end of shifts, and in the worst cases, may lead to long public enquiries.

NHS as a research organisation One of the great virtues of the NHS is the research base it offers professionals. What happens in the NHS which covers 62 million people is studied, evaluated, and researched. This is invaluable to staff and above all to patients. Sadly this research is also of interest to big business especially to those who sell health insurance and to the big corporations who have their ‘snouts’ in the NHS ‘trough’. Research for the common good is clearly different from research to make money. We see that regularly in big pharma. Cheap effective medicines do not make money for the companies. Yet the government is giving away our medical data to companies to make a profit.

There are also “errors” that happen when everyone is following accepted procedures and protocols; “untoward events, complications, and mishaps that resulted from acceptable diagnostic or therapeutic practice”. Procedures within the NHS can be robust and well researched, and problems still occur.

https://www.mamaacademy.org.uk/news/mbrrace-saving-lives-improving-mothers-care-2019/

Research matters. Only by studying outcomes can these errors be revealed. A classic example is the once customary practice of episiotomy, cutting a woman to prevent tears to the perineal skin in childbirth, which is now no longer used except in an emergency. Research both formal and informal changed that practice. As another example of such research, Liverpool Women’s hospital has been involved in research about the benefits of leaving the baby attached by the cord if they are born unwell. NHS staff and other health professionals, academics and pressure groups are working hard to improve outcomes for mothers and babies. Each mothers death is reviewed in the MBRRACE-UK report

https://mamadoc.co.uk/the-maternal-mortality-report-we-should-all-learn-from/

Never again. The tragedy of the death of a mother and or baby is felt by that whole extended family. Most families want to know it will never happen again. Cover-ups and lies mean it will happen again, so brutal honesty is needed.

 

The aftermath of medical treatment or neglect which causes real harm is complex. Whether the outcome is death, life long impairment, or long term physical and mental health issues, these are very significant events for all concerned.

Campaigners in Liverpool campaign for SEN funding to be returned. 2019

If a baby is born with life-changing impairments, the baby is left facing catastrophic difficulties and the mother and family can face major heartbreak and hardship. The huge love we have for our kids (may it long continue), whatever their issues, does not prevent the financial, housing and employment issues families with disabled children face. Nor does it guarantee the best educational opportunities, SEN is being battered by cuts. but parents and teachers are fighting back.

 

The cost of financial “compensation” from an injury to a newborn is huge because it is life long. The cost of this “compensation” used to be carried by the government but the system changed to make hospitals “buy” insurance from a government body which is set up like an insurance company. The cost to the hospital is charged on the basis or earlier claims, like car insurance. Obstetrics make the highest claims of any section of the NHS.

Liverpool Women’s Hospital had a huge case (not about babies) some years ago, arising from a surgeon who left many women damaged after incontinence operations. Their total bill, over 5 years, according to the Echo, was £58.8 million. “The NHS trust has been forced to pay out £58.8m in the last five years for both recent and historic negligence cases.

The limited work we do, as a campaign, in holding the hospital to account, leads us to believe lessons have been learned by the hospital. However, in every hospital, there are pressures which could lead to problems. These pressures include financial and organisational, problems of management ethos, and the potential for bullying, the distrust by the staff of their management, and disrespect for whistleblowers.

The NHS has gone through years of reorganisation after reorganisation. In that time the financial and government pressure has been to complete the re-organisation, or face catastrophic consequences so very many hours of admin and senior doctor time has been wasted on this process. That time could have been focussing on saving babies.

At STP and national level, there are other problems. The NHS is intensely political. There are deep structural problems. (We believe the NHS should return to the Bevan Model of health care)

The NHS is not only deprived of adequate funding, but it has also been forced to implement many market-based changes, including the internal market, outsourcing and commissions of services to for-profit companies. These market-based structures are expensive.

The NHS has also seen dire staff shortages resulting from stupid decisions like removing bursaries, not training enough doctors and the hostile environment to migrant staff.

There are moral and financial issues in all cases of such errors. The hurt to the babies is our priority.

Baby deaths and severe injury at birth have complex roots. Though what happens in the hospital is crucial, it is not just what happens in the hospitals that matter. The stress, poverty and anxiety many mothers endure during pregnancy do sometimes affect the outcomes for the child. Many women are still sacked for being pregnant but families can rarely cope with just one wage (do fight back against sacking pregnant women!). See Maternity Action for details. Both mums and midwives can call Maternity Action for advice.

Low pay or the dreaded universal credit can make food heating and rent all too expensive. This can lead to food poverty. Women do not yet have real equal pay but mothers have the worst pay of all  Benefits are no longer allowed for a third child. even though most claimants are working. Whether parents are working or not, every child has a right to food and shelter, be they first or 10th child. The child gets no choice!

Not every pregnant woman is in a stable caring relationship. Housing, especially private renting, becomes more difficult when women are pregnant. Who can forget the story of the homeless woman giving birth to twins in the street? Pregnancy is often the time when domestic violence is inflicted on a woman but it is the time when women are least able to walk away. Poverty kills babies too.

Please join us in campaigning for better outcomes for all mothers and babies in the NHS and across the globe. We want this to start a discussion, so please send us your views. and information

 

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One on International Trade dispute settlements and the other on Social Care.

These are not official SHA policy.

Issues for the NHS during UK Trade deal Negotiations

As socialists we have an almost irreconcilable set of principles

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2 informative and extremely worrying videos from our Vice Chair, Dr Brian Fisher on the dire state of social care in England.

Video 1: the current state of social care.

This brief video, made for Reclaim Social Care, outlines what social care is and how it operates at the moment in England.

https://photos.app.goo.gl/6kqUa7nbCjg2CEjt9

Video 2: the impact of the cuts to social care:

This brief video, made for Reclaim Social Care, outlines the impact of the cuts to social care. It ends with a plea to avoid voting Tory – sadly, that aspect is redundant now. The Tories have pledged more money for social care and that is likely to make a difference. But not enough to change things significantly on its own. And as the IFS says, austerity is “baked in” to a swathe of Tory plans.

https://photos.app.goo.gl/W2cZz5h7WRbW9v2S8

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Patients still make enquiries at busiest hours, despite 24/7 online access

· University of Warwick publishes first independent evaluation of one of the main providers of online consultation platforms

· Targeting services at younger patients and those with general administrative enquiries could be most effective

· “In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes.” Says supervising author.

Patients are using online consultations in the same way they would arrange a consultation via traditional means, a new independent evaluation by the University of Warwick reveals.

Despite this, the study identifies several opportunities to tailor online platforms to specific patient requirements and improve their experience.

Primary care researchers from Warwick Medical School have today (26 March) published the first independent evaluation of one of the main providers of online consultation platforms in NHS general practice. Published in the British Journal of General Practice, it provides independently analysed information on the types of patients that are using online triage systems, how and when patients are using this platform, and what they think of it.

Online triage is a system in which patients describe their problems via an online form and subsequently are telephoned by a GP to conduct a telephone consultation or arrange a face-to-face consultation. Practices aim to respond within one hour of receiving the request.

The researchers examined routine information from 5140 patients at nine general practices using the askmyGP platform over a 10 week period. Highest levels of use were between 8 am and 10 am on weekdays (at their highest on Mondays and Tuesdays) and 8 pm and 10 pm at weekends, mirroring the busiest time for patients contacting their practice via telephone.

Supervising author Dr Helen Atherton, from Warwick Medical School, said: “With online platforms there is an assumption that having a 24/7 ability to make contact with a general practice will cater to those who wish to deal with their health problem at a convenient time, often when the practice is shut, and that being online means they will perhaps share different problems than they would over the telephone or face-to-face.

“In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes. This suggests that patients’ consulting behaviour will not be easily changed by introducing online platforms. Therefore practices should be clear as to exactly why they are introducing these online platforms, and what they want to achieve for themselves and their patients in doing so – the expectation may well not meet reality.”

The NHS Long term plan sets out that over the next five years all patients will have the right to online ‘digital’ GP consultations. The main way these are being delivered is via online consultation platforms. The online platforms claim to offer patients greater convenience and better access and to save time and workload for GPs, however there is currently a lack of independent evidence about their impact on patient care and care delivery.

Patient feedback analysed as part of the study showed that many found the askmyGP system convenient and said that it gave them the opportunity to describe their symptoms fully, whilst others were less satisfied, with their views often depending on how easily they can normally get access to their practice, and on the specific problem they are reporting.

The study found that two thirds of users were female and almost a quarter were aged between 25 and 34, corroborating existing evidence. The commonest reason for using the service was to enquire about medication, followed by administrative requests and reporting specific symptoms, with skin conditions, ear nose and throat queries and musculoskeletal problems leading the list.

The researchers argue that practices should avoid a ‘one size fits all’ approach to implementing online consultations and should tailor them to suit their practice populations and model of access, considering whether it is likely to add value for their patient population.

Dr Atherton adds: “Individual online consultation platforms are uniform in their approach, patients are not. We found that patient satisfaction is context specific – online consultation is not going to be suitable for all patients and with all conditions and that one approach is unlikely to work for everyone.

“Practices could focus on encouraging people to deal with administrative issues using the platform to free up phone lines for other patients. It could be promoted specifically to younger patients, or those who prefer to write about their problems and not to use the telephone. Clear information for patients and a better understanding of their needs is required to capture the potential benefits of this technology.”

· ‘Patient use of an online triage platform; a mixed-methods retrospective exploration in UK primary care’ published in the British Journal of General Practice, DOI: 10.3399/bjgp19X702197

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For everyone who couldn’t make the Conference, here is Alison Scouller’s ( Vice Chair ) speech. An audio file is also posted.

Jean Hardiman Smith

Hello Alison Scouller here, sorry I can’t be with you. These are my thoughts to accompany the SHA discussion document before you. We decided to write this policy as part of our wider policy work, as we had no statement of the SHA’s perspective on maternity care.
I’m a retired midwife who worked in hospital, community and latterly as a midwifery lecturer in South Wales. To devise a policy I took inspiration from the Save Liverpool Women’s Hospital campaign’s manifesto for maternity and worked initially with two Welsh members, Billie Hunter, Professor of Midwifery and Gill Boden who is a campaigner for AIMS, and another Midwifery Professor Mavis Kirkham from Sheffield as well as liaising with our secretary Jean Hardiman Smith. Since then we have revised the policy considerably, following suggestions and contributions from Central Council members.
We have taken on board the particular concerns of the Liverpool campaigners in the context of the creeping privatization of the English NHS, but in writing this policy we had to have a policy which is applicable across the UK. Therefore the first paragraph sets this out. .
We decided that the right to access contraception and abortion that should form part of another document about reproductive rights, including fertility treatment, and that here we should focus on care for pregnancy.
As you can see in point 1) we put the importance of addressing poverty centre stage, and the overarching importance of good nutrition from pre to post pregnancy, in fact throughout everyone’s life! We decided not to be too specific on particular public health measures, as our policy has to be applicable in different versions of the NHS and the wider context. We also included the issue of other forms of stress and their detrimental effect on pregnancy outcomes, both in terms of women and babies.
The next 2 points emphasize the importance of those at the centre of maternity care needing to be listened to, whether it’s about their own individual situation or in terms of general observations about how care should be. Planning for care should of course reflect diversity in all communities. In order to address inequalities in society, whilst all should receive the same level of care, extra provision should be there for some, as was recognized by previous Labour Governments in projects such as Sure Start.
We went on to identify issues related to specific stages in pregnancy itself, having covered the pre pregnancy period. In point 6) Antenatal care is clearly crucial to ensure that women are aware of as many aspects of their health as possible, such as family history, normal physiological changes of pregnancy, Body Mass Index , any pathological conditions already present or precipitated by pregnancy, and how these may impact on their pregnancy outcomes. It needs to be accessible as early in pregnancy as needed. It should be as local to women as possible and include at least one home visit, unless the woman does not wish for this, with her named midwife.
When we talk about antenatal education this does not mean in a formal, school type environment but can range from physically meeting in a group setting with a midwife to having education available on CDs, online and via social media. It’s not just about being given information for example about how labour may progress but also learning practical skills to cope with it, such as exercise and relaxation. It’s also about what happens after the birth and coping strategies for parents. The social and support aspects of women and family members meeting with others going through a similar experience are usually the most valued by those enjoying group education. Of course specific needs have to be catered for, so that some women may prefer to attend women only groups and prefer less formal settings.
The evidence for the effects of adverse childhood experiences on people’s ability to be good parents is now quite compelling, hence point 7)
In relation to point 8) We know from research and experience that women’s wishes in relation to place of birth are determined by many factors, and these are very varied. Health care professionals must strive to provide as much evidence based information to enable women and their families to make the right choices for them. All places of birth carry some risks, with home birth and stand alone birth centres there are always concerns about access to ‘back up’ in emergencies. On the other hand there are risks associated with unnecessary intervention (mistimed, inappropriate and even dangerous) in childbirth, both in terms of mortality but also morbidity of mothers and babies I think Lesley page coined the phrase ‘too much too soon, too little too late’ to summarise the problems unfortunately still occurring. The other thing to bear in mind is the importance of antenatal care and education in ensuring safe outcomes. If that care is as it should be, then women at risk of complications are less likely to have poor outcomes because care will have been tailored to mitigate those complications.
Moving on to point 9) we identify the importance of continuity of care. This can be difficult to achieve in cash strapped services but has been consistently shown in research and other feedback to be a key concern for women and promotes positive outcomes.
Finally we put in relation to after birth, points 10) and 11). Physical, emotional and mental health are equally important here. Increasing breastfeeding rates would make a huge difference to children’s health, yet initiation and continuation of breastfeeding rates in the UK remain low. Once again peer support has been shown to be critical to breastfeeding success, as well as support from midwives and health visitors.
In the past, care of women’s mental health has lacked coordination between midwives, health visitors, GPs and community mental health nurses. Equally where babies have been compromised by maternal complications before or during birth and/or being born preterm then neonatal special and intensive care cots should to be available as needed.

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Exercise, dreaded by many, appreciated by all. It can often be difficult to build up the motivation in order to throw yourself into a workout – however most find that once they have got over that no-motivation hurdle they have more stamina than they realised.

If motivation doesn’t come easily to you, then there are some things that you can do to get yourself and your body in the mood for exercise…

  1. Setting Goals
    One of the simplest ways to motivate yourself is by setting yourself realistic goals.
    By setting goals you then have something to work towards, which will drive your commitment to working out. Your goals can be as simple as increasing your general fitness levels, increasing strength in specific areas such as arms and legs, losing fat or toning/sculpting your abs – whatever it may be, once you have something you want to get from working out, you are more likely to want to work out on a regular basis.
  2. Find yourself a ‘gym buddy’
    Working out alone can often be a little bit daunting, so why not find a friend to come with you? Having a gym buddy isn’t only good for the company, but you can help each other out by sharing tips and exercises, supporting each other when working with weights and encouraging each other to reach your goals.
  3. Eat good food
    The food you put into your body has a huge impact on your motivation and making a few tweaks to your diet could be the difference between sitting on the sofa watching the soaps and getting a high intensity gym session. Fast food and takeaways tend to make you feel sluggish, whereas if you fuel yourself with fruit, vegetables and carbohydrate rich foods, you will have much more energy to put into a workout.
  4. Work with a personal trainer
    Booking in a session with a personal trainer puts you accountable for someone else’s time, and knowing you have somewhere to be at a specific time is likely to get you out of the house. Working with a personal trainer can be really helpful, they can help you pick out the right exercises to meet your goals and correct any mistakes you may be making during your workout. If the idea of paying for someone to help you work out doesn’t appeal to you, then you could even take up an online training course and become your own personal trainer!
  5. Have a plan
    We are all guilty of turning up to the gym not knowing what we want to work on that day, which more often than not results in standing around looking clueless and desperately typing ‘leg exercises’ into Google. Putting together a workout plan will solve all of your problems. Before you go to the gym, think about which muscle group you want to work on and put together a workout routine that focuses on that particular muscle group. Going into the gym with a plan will not only improve your motivation, it will also rid you of any of that pre-workout anxiety!
  6. Tailor your workout around your mood
    If you’ve had a long day at work which has left you feeling tired and quite demotivated, the last you want to do is an intense, high energy workout and there is nothing wrong with that, but instead of skipping a workout and regretting it the next day, you can easily plan your session around how you are feeling. If you are feeling tired, you can focus on stretching, foam rolling and some flexibility moves, or if you are feeling a bit more energetic, you can focus on cardio and weight training. No matter the intensity of your workout, doing something is always better than nothing.
  1. Listen to music
    Listening to music can help you to zone out and forget about your surroundings, encouraging you to focus on only yourself and stop looking out for what other people are doing. Listening to upbeat music will help you keep rhythm and make that tiresome workout a little more bearable.
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In a world that’s quickly becoming nature-deprived, the benefits of actually getting out into our gardens and taking care of the little patch of land we have is a hotter topic than ever. Whether your garden is vast and filled with greenery, or smaller and kitted out with charming teak garden benches, there is so much that we can do to improve not only the space we have, but it has also been argued that gardening can improve our health too – but is this true? Here, we’re looking into the world of gardening, and just what benefits it can have in regards to our health and wellbeing.

Stress Relief

Trading in your mobiles, computers and TV for the bushes, flowers and general greenery in your garden can do you a world of good. We’re only human, and as humans we have a limited capacity of concentration and directed attention per day, and most of this is used up on our devices. Hours spent on a computer at your desk at work, or an entire commute spent answering emails on your phone can be stressful not only on our attention spans, but on our mood in general.  Putting down the electronics and getting out into the dirt can work wonders for relieving stress.

Mental Health

Our mental wellbeing is just as important as our physical, and this is often something that we tend to forget. While gardening does come with its physical health benefits too, the mental health benefits are certainly worth more than just a mention. The calm, repetitive nature of some gardening can not only relieve stress, but studies have also shown that it can improve symptoms of depression and anxiety too. It gives us the opportunity to step away from our day job and just focus on something much simpler for a time, and this relaxation can do our minds wonders.

Exercise

Sunshine, fresh air and just getting out there are all great for our physical health, and when you add gardening into the mix, it can even be classed as a form of exercise! Gardening can often involve a lot of action which is great for getting your blood pumping, and your muscles moving. While it’s hardly quite the level of a rowing machine or going for a run, gardening is still a great low-impact exercise, which is especially useful for those who may be unable to partake in the more strenuous of exercises.

Nutrition

This point mostly applies to those looking to grow and eat their own fruit and vegetables from their gardens. Food grown yourself is not only some of the most nutritious and freshest you can find, but it’s also the most satisfactory. Knowing that you’ve nurtured your vegetables from being seeds, to fully-grown, edible goods is more than a good enough reason to get out there and get planting. If you have children, get them involved too! Not only will it help you get them outside and active too, but by letting them get involved in growing food, they’re more likely to eat it at the end of it. The curiosity and wonder behind growing plants is encouragement enough, so if your children are tricky about eating their greens, try and grow some!

All in all, there’s no denying that gardening has its health benefits. Whether it’s simply the ideal stress relief, or you’re in need of a little low-impact exercise, getting out into our gardens and trying our hands at a bit or pruning and preening can be beneficial in all kinds of ways. So, what are you waiting for?

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It’s estimated over 95% of people worldwide have some form of health problem. From both mental and physical illness, it’s almost guaranteed you or someone you know will be affected by some form of health concern at least once during your lifetime.

However, whilst the majority of health problems are relatively minor and can be easily managed with the right care and medication, there are plenty that are considered to be major crises. For example, it’s estimated over 1.6 million people in the US alone were diagnosed with cancer last year, with almost half of them expected to die from the disease.

Whilst many cases of cancer (and other major health concerns) are diagnosed early, there are millions of cases in which it comes completely out of the blue. Without warning, your life could be catapulted into a state of health crisis, and it can be extremely difficult to handle it if you’re not prepared.

So, if you’ve suddenly received a major health diagnosis or simply want to learn some coping mechanisms to be prepared for anything that may arise in the future, here are some top tips to handle serious health problems and stay as positive as possible!

Health Crisis - be positive

Realize you’re not alone

When faced with a sudden health diagnosis that has the potential to turn your life upside down, it’s very easy to feel isolated and alone, thinking absolutely no one in the entire world will understand what you’re going through.

Whilst every individual case will be different, it’s crucial to remember that there will be thousands, if not millions, of people worldwide going through the same health crisis as you, and it’s likely they’ll be a great support system to help you cope.

Getting online is a great way to connect with other like-minded people in a similar situation to you. Not only will you get to speak to others who really understand what you’re experiencing, you’ll also likely receive tips and methods to help manage your disease or condition in the most appropriate way. In fact, you may even make some new friends which is a definite bonus!

To emphasize the power and support online groups can provide, take a look at these breast cancer stories written by real people simply to share their experience with others.

Keep a journal

Whilst this may not immediately come to mind as a coping mechanism, writing a journal whilst going through a health crisis is a simple yet extremely effective method of tracking your thoughts and emotions.

In addition to physical symptoms, health problems will inevitably have an effect on your emotions too. So, in order to cope with them and understand exactly how you’re processing the diagnosis, keeping a daily journal will significantly help you come to terms with how you’re feeling both physically and mentally.

It’s also a great way to keep track of your symptoms too, vital for detailing the progress of your disease and monitoring how your body is responding to any treatments you may be receiving.

Take care of yourself

A health crisis will often involve multiple trips to the hospital for tests and examination. Whilst this is crucial for the management of virtually any health problem, it’s important to take yourself away from the hospital mindset and have some ‘me time’.

If at any point you feel things are getting too overwhelming and intense on the medical side, arranging something like a spa day is ideal for winding down and giving your body and mind some much-needed TLC. But, if this isn’t possible, simply having a bubble bath with candles and relaxing music is a simple way to pamper yourself whilst keeping close to home and your loved ones.

Stay positive

After receiving a life-changing diagnosis, it’s completely natural to feel like your life may be coming to an end. Whilst it’s normal to feel this way, this kind of negativity won’t help in the long-run.

Staying upbeat and keeping a positive mindset is often much easier said than done. But, if you sit back and appreciate everything you’ve done in your life and the little every-day things we so often take for granted, gratitude will follow and you’ll soon find your initial negativity melting away and being replaced by wanting to enjoy your life to the full whilst you still can.

Handling a major health crisis is tough, and anyone who thinks otherwise is probably kidding themselves. But, whilst it will be challenging, there’s no reason you can’t manage and handle it with positivity and continue to love both your life and yourself.

Melissa Sakow is the Communications Director at SHARE Cancer Support, a non-profit organization founded in 1976 that is dedicated to building a network and community for women affected by breast and ovarian cancer.

Image credits

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 The Community Empowerment Evidence Network

Power can determine how we function, how we access resources for health, and how good we feel about ourselves, our lives and our futures. Sir Michael Marmot highlighted the importance of this kind of individual control or power:

how much control you have over your life – and the opportunities you have for full social engagement and participation – are crucial for health, well-being and longevity. It is inequality in these that plays a big part in producing the social gradient’. i

There is growing evidence that an individual’s level of power to influence decisions in workplace and healthcare settings and in the living environment impacts on their health.ii Current evidence shows that the more power or control over their lives a person has, or feels they have, the better it is for their health and wellbeing.

While there seems to be lots of action aimed at empowering communities, there is currently very little evidence on how such interventions actually impact on individuals’ health and wellbeing (positively or negatively). Close inspection of the evidence on things like collaborative health promotion and volunteering shows that such interventions rarely empowered people to shape decisions. This stresses the important point that simply being involved does not necessarily mean that you are empowered. Furthermore, when people appeared to be empowered through interventions, health and wellbeing impacts were rarely measured as part of evaluations, with most studies focussing on the extent or quality of service deliveryiii. It is undeniable that we need more health and wellbeing-focussed evaluations of community empowerment interventions, and we also need to bring together the limited evidence that is currently available. Both evidence synthesis and better focussed primary evaluations will help to strengthen future evidence and improve the quality of interventions that are offered. The Community Empowerment Evidence Network (CEEN) is an email group for researchers, practitioners, policy makers, and community groups who produce or use evidence on community empowerment. Emails to CEEN, including attachments, are stored in a searchable archive. CEEN is therefore a new and much needed depository for discussion, theory and evidence on the health and wellbeing impacts of community empowerment interventions.

If you are CEEN to join, please subscribe to the network here www.jiscmail.ac.uk/CEEN, then post your comments, questions, case studies and evaluations to CEEN@jiscmail.ac.uk.

i Marmot M (2004) Status Syndrome: How Your Social Standing Affects Our Health and Longevity. Bloomsbury: London.

ii Examples of systematic review level evidence: (a) Theorell T, Hammarström A, Aronsson G, et al. (2015) A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health. 15:738. (b) Shay L, Lafata J (2015) Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision making. 35(1):114-31. (c) Durand M-A, Carpenter L, Dolan H, et al. (2014) Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLOS ONE. 9(4):e94670. (d) Whitehead M, Orton L, Pennington A, et al. (2014) Is control in the living environment important for health and wellbeing, and what are the implications for public health interventions? Public Health Research Consortium: London.

iii Examples of systematic review level evidence: (a) O’Mara-Eves A, Brunton G, McDaid D, et al. (2013) Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Research. 1(4). NIHR Journals Library: Southampton. (b) Jenkinson C, Dickens A, Jones K, et al. (2013) Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers. BMC Public Health. 13:733. (c)

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Believe it or not, there’s a direct correlation between your personal health and fitness and your ability to perform as an entrepreneur.

Think about it: between having the mental stamina to trek through the tough times or the ability to make huge decisions at a moment’s notice, being at the top of your game health-wise is always a plus for business owners.

However, there is no blanket approach to improving your well-being. After all, some of us may have health issues that have gone undiagnosed over the years despite taking care of ourselves. Meanwhile, some of us may have let our well-beings fall to the wayside in lieu of dollars and cents.

What can you do to help improve your health that you may have been overlooking over the years?

Improve Your Ability to Focus

Although conditions such as ADHD are often attributed to children, the fact remains that many adults suffer from the condition as well. If you find yourself consistently disorganized, unable to sit still for any given task or consider yourself to be a poor listener, you may suffer from hyperactivity yourself.

Although it’s easy to disregard such symptoms as they seem like common behavior, ADHD can severely impact your productivity and should be taken seriously. As such, you’ll need to see a medical professional to receive a proper diagnosis and treatment. Although there are a variety of treatment options, you can save money on your medication through online discounts such as this Vyvanse coupon.

Deal With Depression and Anxiety

Depression and anxiety are often treated as identical because of their similar symptoms; however, they are two separate conditions. In many cases, depression leads to anxiety which makes it difficult for entrepreneurs to engage with their businesses or family members. Feelings of lethargy or constant fear can be crippling to entrepreneurs who suffer from either condition, both in their professional and personal lives.

Both conditions are likewise difficult to diagnosis without speaking to a professional. Rather than fall prey to the stigma of mental health conditions, it’s important for business owners to consider treatment options such as cognitive behavioral therapy rather than hope their symptoms go away on their own. Such therapy serves as an alternative to immediately relying on prescription medication and can help suffers get to the root of their condition.

Consider Drinking Less

Although many entrepreneurs embrace the “work hard, play hard” lifestyle, it’s undoubtedly not for everyone. If you’ve struggled with alcoholism in the past or wonder in the back of your mind if your drinking habits are catching up with you, it may not hurt to take a break from booze to see how your body responds.

Between losing weight and improving your sleep quality, less alcohol translates into more productive behavior in general. While some people may get away with tapering themselves off of alcohol or quitting cold turkey, some people can live just fine with a few drinks now and then. If you’re in a situation where most of your social and business interactions are somehow fueled by alcohol, however, chances are you need to rethink your priorities for your sake of your health, family and business.

Remember: your health plays a significant role in your success as an entrepreneur. The better the take care of yourself, the more likely you are to increase your bottom line.

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You can forget about those quick fixes that you can find in your local drug store. If you are really wanting to fight against the process of aging, the main tool that you will need is exercise. Yes, there are plenty of over the counter remedies that you can get, and yes, these might mask some of the effects of aging, but if you want to fight against the process itself, you will need to begin with your body, from the inside, and work your way out.

That being said, if you have issues such as arthritis, that can make physical exercise something that is incredibly painful, or even near impossible, there are other ways that you will be able to remain active and mobile. Take the Quingo, for example. This is a mobility scooter that you can use to remain able to go places and do things. With this scooter, you will no longer need to remain housebound simply because you have difficulty walking.

Let’s take a look at some of the other things that you can use to fight against aging and its effects.

Collagen

One of the things that we will have to come to terms with as we age, is our looks. It is unreasonable to think that we will always look the way we did when we were 20. Because of this, and the fight to remain young-looking, there are a plethora of anti–aging creams and solutions that are available. From Botox to collagen injections, and even plastic surgery, the possibilities are nearly endless. You can also use collagen as a topical treatment though. Collagen is important to our bodies for a multitude of reasons that include bone and joint health as well as for the suppleness and elasticity of our skin. If you don’t want to use topical collagen as a solution to aging though, you might want to include it in your diet.

Cosmetic Dentistry

It is true that many people are concerned with their appearance as they age. One of the big things that can bother them with regards to their appearance is their smile. Cosmetic dentistry is a tool that can be used to keep your smile looking great regardless of your age. Things like crowns and veneers can go a long way in keeping your smile looking young and fresh. Oral health is important to your overall health too.

For the Housebound

Not all people up there in age are able to get up and go out very easily. Aside from home healthcare, though, there are other needs that have to be met with these patients. For example, if you have a housebound loved one or are housebound yourself, where does your food come from? Not everyone can afford to order in every day. That isn’t healthy anyway. You will also need to consider medicine and any necessary medical supplies. The good thing is that we live in an age where all of these things can be ordered online and delivered right to our door. If you don’t happen to have very much experience with computers, there are still plenty of places that offer deliveries for products that you can order over the phone.

Health Care Measures

Aging people tend to be hospitalized a bit more than healthy young people. Many regimens recommended in hospital discharges require taking medicines on a daily basis, checking glucose levels, or any number of other things. These things might not seem so important if you don’t have someone who can remind you to do them.

However, if you want to remain healthy, maintenance is a really big deal. You should remain in contact with either a nurse or your doctor, or even the pharmacist. You should always be proactive when it comes to the maintenance of your health. It is also critical to understand the health needs. This can include things like how often you should see a doctor, how to go about getting your daily exercise, using mobile health tools, that can include mobility aids or even smart pill bottles that will remind you when your medicines need to be taken. All of these things can be viewed as tools that can help fight against aging.

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Addressing the social determinants of health is an important foundation for the health and wellbeing of our citizens. The fundamentals of life such as access to clean water and safe waste disposal; housing which provides enough space, clean air and efficient heating; education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all be assessed and developed as a holistic approach to public health.

Local and national democratically accountable governments need to hold these strategic responsibilities and be supported by public health officers at Chief Medical Officer level in national governments and District Directors of Public Health at local government level. These officials need to be professionally independent chief officers and be required to report annually on the health of their populations with reference to other populations and assessing health inequalities and their recommendations on priorities.

Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.

  • The nation’s Chief Medical Officers (CMOs) will be required to report annually on the health of their populations to their governments. The UK CMOs will be required to submit an annual report directly to Parliament charting progress in UK comparative performance in terms of population health, health inputs, care processes and patient outcomes (both patient and clinician reported). Such a report will need to consider the UK health outcomes in an international context.
  • Directors of Public Health within local authorities should be adequately resourced executive directors able to make recommendations which must be integral to decision-making by the council’s chief officers.
  • Social care and other local authority provision and relevant services and proposed developments should be included in public health plans.
  • All local authority policies and plans should be subject to an environmental and health impact assessment.
  • All policies in government will be subject to an assessment of their impact on the public’s health.
  • Strategies and plans for wellbeing should be agreed at local, sub-regional and regional level and should be used to guide decisions about service provision, major investments and reconfigurations.
  • Infectious diseases require attention to high uptakes of vaccination and immunisation and the promotion of hand hygiene and the reduction in the use of antibiotics to help prevent the growth in antimicrobial resistance.
  • The public health remit must include promoting health, protecting health as well as effective (evidence based) health and social care. All these three domains of practice require robust systems of appraisal of evidence, systematically collated knowledge and information.

ENVIRONMENT/CLIMATE CHANGE

  • The NHS must maximise environmental sustainability and engage with the strategy that protects and improves health within environmental and social resources now and for future generations.
  • Such sustainability strategies mean reducing carbon emissions, minimizing waste and pollution, building resilience to climate change and nurturing community strengths. See separate section on sustainability and planetary public health (in preparation with David Pencheon of the NHS Sustainability Unit).

AIR QUALITY

  • We will take urgent steps to reduce the air pollution caused by road traffic, particularly by diesel engines.
  • We will reconsider strengthening the regulation of vehicles, taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
  • All this in the context of decreasing coal fired electricity generation and proportionately increasing the use of renewables.

FOOD AND DRINK

  • We will remove the VAT exemption from sugar and raise tax on the simple sugar content of drinks and foods such as breakfast cereals. 
  • We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers by standardised information in the form of WHO recommended traffic lights and standard information wherever it is sold.
  • We will ban the use of trans fats in food products and push for the ban to be extended internationally.
  • We will introduce minimum unit pricing for alcohol and encourage lower alcohol products.  We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol.
  • The sale of tobacco and alcohol in supermarkets should be regulated so separate areas are identified to display and pay ensuring better supervision and differentiating alcohol and tobacco from a normal family shopping basket.
  • Tax should be proportionate to alcohol strength

HOUSING

  • We will introduce minimum standards for healthy housing construction to ensure sustainable housing quality and reduce the risk of adverse impacts such as fuel poverty through inefficient heating/insulation.
  • Internal ventilation is also required to reduce the risk of house dust, fumes to ensure clean air.
  • Housing should be located near green spaces and close to play ground amenities for children.

WORKFORCE

  • In conjunction with a strengthened Health and Safety Commission, we will introduce measures to ensure that workers feel more in control of their own work. Workers and their trade unions should be represented on company boards?
  • Occupational health will become a responsibility of the NHS to provide a national service with local generalist and more specialist regional resources.
  • A healthy workplace must be the expectation and employers be held to account on best practice and minimum standards in line with health (both physical and mental) and safety legislation.

DRUGS AND TOBACCO

  • The taxation system will make healthier products like fresh fruit and vegetables more affordable while making less healthy processed food products better regulated and relatively more expensive.
  • We will progressively raise tobacco tax and the age below which it is unlawful to supply tobacco to young people.
  • Personal, social and health education (PSHE) will be compulsory in schools appropriate to the age of the child and directed to inform and empower children to look after themselves. 
  • We will bring forward proposals to reform the law on misuse of drugs to minimise risk which will include alcohol, tobacco and other drugs.

TRANSPORT/ SPORT.

  • The Active Travel (Wales) Act 2013 will be extended to England so every local authority will be required to publish details of expenditure on transport measures divided between walking, cycling, public transport and motor vehicles.  
  • We will rebalance the transport budget so that 10% is spent consistently over the length of the parliament on the needs of pedestrians and cyclists
  • We will remove VAT from bicycles and encourage cycle to work and other workplace incentives.
  • We will progressively ensure access for all to affordable public transport
  • Physical activity should be encouraged in schools with whole school activities, travel to school schemes as well as specialist sports teaching.
  • All local authorities must introduce 20mph speed limits on all residential roads so this speed becomes the urban road norm.
  • Transport policies need to be strengthened so that city centres are largely free of private cars with access ensured by efficient public transport, cycle and pedestrian access.
  • Overall transport policies should be biased towards walking and cycling, bus and trains and vehicles that are increasingly electric or other low carbon fuels.
  • We recommend that transport policy should accept a hierarchy of walking >cycling >public transport, to include good provisions for disabled people
  • Air transport needs to be increasingly regulated and air fuel tax applied. We must actively encourage more use of continental trains as an alternative to short haul flights.

CHILDREN

  • We will ensure children have received high quality PSHE through their school years so they are aware of gender and sexual and interpersonal relationships, understand the distortions of on line pornography and be empowered to say no.
  • We will ensure contraception and sexual health clinics are easily accessible to reduce the risk of sexually transmitted diseases and unwanted pregnancy
  • More investment in the training and employment of midwives and Health Visitorss to ensure that sufficient support from midwives and health visitors is available for women and babies, especially solo parents and young mothers,
  • We will increase benefit rates for pregnant women so that they can afford a healthy diet and suitable accommodation.
  • Every school must have a named school nurse and a school counsellor, for which more funding will be required
  • Children’s mental health services need to be improved and made adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.
  • We will ensure that there is parity of treatment in health and social care services in respect of both youth and age. 
  • Services must be improved in transition from child to teenager and teenager to adult

HEALTH INEQUALITIES

  • Improving health requires addressing the social determinants of poor health based on the principle that there is a role for an interventionist state, for redistribution of wealth and power, and a role not just in planning and commissioning but in delivery. 
  • Labour’s long-term goal is to break the link between a person’s social class, their social situation and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this.
  • We recognize the importance of the early years (pregnancy and first 5 years of life) and there should be workplace benefits to enable generous maternity and paternity leave, state nursery provision and safeguarding along the lines of Scandinavian countries.
  • The establishment of an Office of Health Equity to promote and monitor the application of the Fair Society, Healthy Lives policies of giving every child the best start in life; enable all children, young people and adults to maximize their capabilities and have control over their lives; create fair employment and good work for all; ensure a healthy standard of living for all; create and develop healthy and sustainable places and communities and strengthen the role and impact of ill health prevention.
  • Health impact assessment of all government policy will be used to reduce inequalities in income and wealth and those caused by trade, foreign and defense policy

THE IMPORTANCE OF COMMUNITIES

  • NHS agencies and providers will ensure that every locality has a thriving third sector largely funded by grants rather than contracts.
  • NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so.
  • Health agencies will play an active part in deploying community development to improve health protection through community empowerment, help tackle health inequalities and encourage responsive statutory agencies.

This document is one of a series developed by the SHA that underpin our recommendations for the Labour Party Manifesto. Each has been developed with contributions from many experts and curated by Brian Fisher through an SHA Policy Commission. They remain in draft and have not been approved by SHA Central Council. They offer an opportunity to explore policy in more detail through debate. They are timely as the NHS is such a key part of the election.

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