Posts Tagged ‘healthcare’

Two years ago we opened Leeds Anxiety Clinic and it has been a big success. Depending on your value of success. We have been very busy and are inundated with clients, which is a business success, but perhaps not a success for the state of society’s mental health.

We are now expanding and have opened a second branch in London, the Islington Anxiety Clinic. If you are in the London area and are looking for support in managing your anxiety, we’re here to help.

Last week, Venla had what appeared at the time to be a seizure (she’s totally fine by the way, in case you’re worrying!). So, taking no chances, the daycare rang for an ambulance. It’s standard procedure for under-twos to be taken to hospital. Here are a few observations.

The NHS staff were lovely

At every step, we ran into nice people. It started with our paramedic who I loved, not just because his name is also Chris, but also because he too could make a passible career as a Ross Nobel impersonator.

Everyone was good with kids and happy to see Venla. Now, you might think that was a given, given that we went to children’s A&E and then the children’s observation unit. But, when Elina gave birth to Venla, one of the pediatric consultants came around to check on her and he was completely flummoxed by her clothing fastening system, complaining he always got it wrong. Apparently, you can work with babies for your whole career and still not really know what to do. None of this this time.

Hospitals are ill-prepared for healthy curious children

Venla was pretty unhappy at daycare and in the ambulance (constantly switching between crying and excited yelling “in a nee-naw!”) but once we got to hospital she quickly returned to her usual self.

This was okay in the waiting room where they had toys and walls to contain her. But once we were in an examination room, or worse the ward of the CAT unit, she couldn’t care less about the toys. All she wanted to do was touch every expensive medal device and open every draw she could find.

She could easily do this because many of the draws were placed at an excellent height for a toddler. Worse, many of them were open-sided to allow medical staff to grab items quickly in an emergency. It also allows toddlers to grab things.

It occurs to me that hospitals are used to dealing with docile sick children who cuddle up with their parents. Or maybe who feel well enough to push some buttons or do a bit of colouring. But a curious child like Venla, who feels back to her full strength. That has trouble written all over it. After five hours of chasing her up and down hospital corridors and around hospital wards, we were both exhausted.

There is a lot of inefficient beaurcacy

At least it feels inefficient. Maybe it is there for a reason. But I was ill prepared for the whole process.

When we got to daycare, the daycare staff were telling the paramedic what had happened. I assumed the paramedic would be taking notes and these notes would then be handed on to the rest of the hospital staff.

But we were asked to describe what had happened. Even though we weren’t there. When I was getting a brief summary from the paramedic and the daycare staff, I didn’t realise that I should have been taking notes because I was going to be tested on it later.

But apparently, I was. First by the nurse in A&E, then the A&E doctor, then the A&E nursery nurse, then the CAT unit nurse, then the CAT unit doctor. Even though neither of us had witnessed it. Why the notes weren’t simply handed over is unclear.

The whole thing was free

It was nice to be left with a bill of £0, which would have been tens of euros in Finland, or tens of thousands in the United States. Which, for a Friday night out as a family, seems like a cheap win.

We’re pleased to announce that Leeds Anxiety Clinic has opened its doors. Here are my personal thoughts about it.

I’ve been working in mental health for around five years now, running the charity Anxiety Leeds, blogging over at Worfolk Anxiety and conducting research into mental health technology as part of my master’s degree. Getting involved with a company like this seems the next logical step.

The feedback we’re getting at the moment is that Leeds IAPT has a 9-month waiting list. Therapy takes time to work, so if you’re looking for help, realistically you’re looking at more than a year of your life before you can see any change. That’s too long.

And whether you go via the NHS, or you go via private therapy, you will usually get a generalist. Some organisations run “mental health” group sessions, for example. You might be a high functioning anxiety sufferer but you find yourself sat next to a schizophrenic. They’re both very different conditions that require different skills. Or your counsellor also does bereavement or addiction, and sidelines with anxiety. They don’t have the specialist skill set. It’s like taking your boat to Kwik Fit because “all vehicles are pretty much the same”.

We’re aiming to fix both of these problems by providing specialist care, with a range of options to suit different circumstances. Including some educational events that we’re planning to announce shortly.

All of this runs alongside my existing commitments to research and Anxiety Leeds, which will be unaffected by anything we’re doing here. Although, I very much hope that what we do at the charity will be informed by anything we learn at LAC, so that we can continue to improve the group.

In 2013, BBC Magazine ran an article about the Finnish Baby Box: a box containing loads of useful stuff that every expectant parent is given. The idea became popular all over the world. When the royals popped their sprog out, the Finnish government even sent them a box.

In a new article by BBC Magazine, published earlier this month, they discuss various start-up companies that have attempted to replicate the concept as a business for the rest of the world.

Finnish Baby Box seems to do quite a good job of it. For £320 you get a range of 50 different items, similar to the actual box contents. Of course, there is a Moomin edition too, that clocks in at £480.

Elsewhere however, people seem to have done an excellent job of entirely missing the point. Both British Baby Box and the US-based Baby Box Co sell boxes with almost nothing in them.

From their marketing, you might be mislead into thinking that buying a cardboard box and having your baby sleep in it somehow reduced infant mortality. There is no evidence for this. It’s true that Finland does have one of the lowest infant mortality rates in the world. Almost half that of the UK. However, the success of their system is down to three things:

1. When you have a baby in Finland, you go to special baby centres. Here you have all of our antenatal and postnatal care until the child starts school. It’s all in one place, making it easy to access care services.
2. You have to go to all the antenatal services to get the box. So everyone does, even if they only want the box.
3. The box is full of useful stuff like a mattress, baby clothes, blanket, toiletries and most other stuff you need to care for a new born.

The fact that it all comes in a cardboard box is almost irrelevant. That is not to say that some Finnish parents do not use it as the baby’s first bed. Some do. Many just use it to store baby’s things in however. Which makes total sense because, when you think about it, why would sleeping in a cardboard box be beneficial for your baby?

If people want to sell their own version of the baby box, they are free to do so. However, it is misleading to suggest that there is any evidence that the box is beneficial. Finland’s success comes from their wide adoption of their antenatal care system and high quality products given to new parents, not some kind of magical effect of sleeping in a cardboard box.

Chatting with Baby Box Co

Since publishing this article, I have spoken with Jennifer Clary, CEO of Baby Box Co. You can read more about the interview here.

BBC on baby box effectiveness

In March 2017, the BBC published another follow-up article entitled “Do baby boxes really save lives?”, raising the same questions that I discussed in this post. It includes Emily Oster, who is the author of a book I highly recommend, Expecting Better. You can read the BBC article here.

One Wednesday I had a hospital appointment, and was given a prescription request form that I was told to hand in at my local GPs (Colton Mill). Which I did. They said it would be ready by Friday.

That’s an annoying long time, but given that last time I had a prescription it took them nearly a month to fill it I thought I would give them to the following Tuesday until I went to collect it.

On Tuesday I went there at 4:30pm to find the place with the shutter down and no sign of life.

On Wednesday I phoned them. No answer. I phoned their partner surgery The Grange who assured me that they were open and they would investigate, asking me to phone back later. I phoned Colton Mill again. Still no answer. I phoned The Grange again. They said there was nothing on my record but when I was able to give them the name of the consultant and hospital department I had been at, said they would ring through to try and get a new copy of the form.

On Thursday I phoned Colton Mill at 9am. they answered, telling me they had no idea about the form I had handed in, but said The Grange had added a note to my file with the treatment request. she said they needed 48 hours for a prescription request so I should phone back tomorrow. I tried to press them on the 48 hours but they shrugged off all responsibility.

Not daring to trust it to a phone conversation on the Friday, I decided I would go down there and I could just stand at reception and moan until they got a doctor to sign it for me. So I raced over on my lunch hour, foregoing my usual sandwich. However, when I got there I was told that the prescription had been electronically sent to Boots, without having asking me, and as such they couldn’t give it to me.

Finally, when I managed to get to Boots on the Saturday they did indeed have it. 10 days after I was prescribed it. It does technically beat last time though.

Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong is a book by David Goldhill about the American healthcare system.

Their healthcare is comparable to that provided by the NHS. However we rank better because we spend only a third of the money the US does. Someone told me they spend more tax money than we do, even before the insurance costs, though I do not have a source for that.

Goldhill points out a number of problems, some common across all healthcare systems, others specific to America:

• Holistic care, phsycholical factors in recovery and control of infections are often overlooked – for example making the ward look nice, keeping records electronically and emptying the bins before they overflow.
• Insurance systems do not make sense because healthcare is not a risk, it is an inevitability.
• There are incentives to take medication – you can take statins to lower your blood pressure, or you can lead a healthy and active lifestyle. Your insurance pays for the former but not the latter.
• There is little focus on cost in insurance-based systems.
• 68% of hospital beds in America are provided by non-profit hospitals, yet they do not produce better results than for-profit ones.
• Medical errors, hospital-acquired infection and over-treatment kill as many people as many major medical conditions

His solution is to crap the insurance system and replace it with a loan based system. A typical American will spend around $1,300,000 on healthcare over their life-system so Goldhill suggests giving them that as fund, with a small insurance system for catastrophic conditions that cost more (though he argues nobody would charge more in a market-based system).

On a tangent, he also talks about how state assistance to buy a house actually helps rich home-owners rather than first-time buyers. I blogged about this in June.

Reading it, it made me glad we have the NHS. Of course, it may be a case of the grass is always greener where you live (which is now a thing) as the NHS is proving highly ineffective for me at the moment. Overall, as I said at the start though, we probably get the better deal spending far less on health care for a slightly better life expectancy.

On October 20th I had an appointment with a specialist. He prescribed me a new medication and told me to hand the form in at my GPs (Colton Mill). I duly did this.

Unfortunately, having a job and all, I had to be at work the entire time the surgery was open, and so asked them to send the prescription to their sister surgery, The Grange, who had a 7am start on a Monday.

Having BT turning up at my house on the next Monday, meant that I couldn’t actually get there that Monday, so I had to go the Monday after, which was then the 10 November. When I got there, they said it had been sent to the wrong place, and I had to come back a different day.

This meant that I had to wait until 17 November to go back. At which point they said they had sent it to the wrong place again. This time I put my foot down and told them they had to sort it out. After a lot of messing about, they eventually got a doctor to write out a new one.

Finally I had my prescription 28 days after I was actually prescribed it.

Of course you could argue that had it been more urgent I could have taken emergency time off work and gone there every day. And you’r right, I could, and this would have got me it faster.

But is this the healthcare system we deserve? A healthcare system where you have to choose between being healthy and being unemployed? Such a system would be damaging to society because it would mean you would have to choose between being unhealthy (high costs further down the line for the NHS) or being unemployed (high costs for society paying out in unemployment benefits).

After writing her book Self-Made Man, Norah Vincent found herself struggling psychologically. So she checked herself into a psychiatric hospital, whereupon she got her next idea for a book. The result is “Voluntary Madness: My Year Lost and Found in the Loony Bin”.

In the book she checks herself into three different hospitals – a downtown public one named Meriwether, a private Catholic facility named St Luke’s, and an alternative therapy centre named Mobius.

She has no problems getting in. As she says, you can only look back and see the mental health problem. This is exactly the feature Daniel Kahneman talks about in Thinking, Fast and Slow. Staff at psychiatric hospital (or indeed anyone, but you would expect these people to be able to) cannot tell the difference between the sane and in the insane. Not that there is necessarily a line between the two.

The results are rather predictable. Meriwether is a cold, clinical hellhole, St Luke’s is tolerable and Mobius comes off the best.

How much we can draw from this, I am not sure. Firstly, you have to look at clinical outcomes and Norah being a sample of one is merely an anecdote about her experience rather than data to draw any conclusions from. Secondly, Mobius only take a select band of mental health issues, and so it is difficult to compare them like-for-like.

It is difficult to compare the financial costs of them because they are all in the United States, where prices are warped by the insurance system where there is little incentive to keep costs down. However, the fact that her insurance company pulled the plug because she was allowed out for runs and not drugged up to the eyeballs speak quite poorly of the US system. It would be interesting to read a similar book looking at British hospitals to compare the differences.

There are some no-brainers that we should take away from the book. Not providing health meals, or a gym, is just stupid. There is loads of clinical evidence to suggest a healthy physical lifestyle helps with mental health too, so these things should probably be the first things you put in.

Providing fresh air, using drugs sensibly, treating people like human beings, giving them a clean bathroom and some proper therapy would all probably be helpful too. However, it would be naive to think that there are not complex social reasons why these are not always provided.

In some ways, mental health could be the most exciting area of healthcare to work in. I suggest this because a lot of the ideas mentioned above are both a) easily to implement and b) would probably improve clinical outcomes.

Improving outcomes for cancer for example is really difficult. We need to find a whole new treatment, lab test it and role it out. Cancer Research UK spends nearly half a billion pounds a year on this. In comparison, to improve some mental health outcomes, you need to buy a treadmill. They’re £150 on eBay.

Of course that is a massive over-simplification and if it really was that easy you would hope that we would have done it by now. Nevertheless, it feels like we have room to make some positive changes in mental health that are easier than with physical health. Hopefully, with increased funding and research focusing on these areas, those changes will come.

If Stephen Hawking were British, he would be dead. That is what one critic of Obamacare said.

You can probably safely assume then that the author did not consult the latest World Health Organisation rankings of the world’s healthcare systems. It was getting increasingly out of date, with the latest rankings being published in 2010. However, even back then it could be seen that Britain ranked a reasonable 18th while the United States could only manage 37th, equal with Costa Rica.

However, a new study by The Commonwealth Fund has ranked the NHS at the top.

It is quite a selective list. No Spain or Italy for example, both who ranked excellently in WHO’s 2000 report, along with many very small nations such as San Marino that arguably do not count. But does include a health selection of systems including France (the 2000 first place) and Sweden and Norway that you would expect to do very well in all things quality of life.

In fact Britain does so well that it comes first in every category but three – equity (joint second), timeliness (third) and healthy lifestyles (tenth).

Click for a larger view.

Not everyone agrees with the report though. The Euro Health Consumer Index (EHCI) produce rankings also and their 2013 report puts Britain a lot further down the list.

Click for a larger view.

However, as I will almost certainly lead a happy life in the belief that I do have the best healthcare in the world, I’m going to choose to believe the former. Go NHS!

The UK currently has an opt-in system for organ donation. That means that unless you have specifically opted-in to donate your organs after you die, the NHS cannot have them. Sort of. Actually, whether you are signed up or not, they just ask the family. The NHS advice that making your views clear can be helpful. But actually, it is fairly irrelevant.

So a graph like this might look pretty scary:

But actually, it is not a complete disaster, because they will just ask the family anyway. I still think it would be worthwhile for the UK to switch to an opt-out system though. In general, you get higher donation rates in countries with an opt-out system.

If they also just ask the next of kin, it is not immediately obvious why this should be the case. Perhaps the relatives are less likely to say no if they do not feel the individual felt strongly enough to opt out, or perhaps there is just a general culture of that being the done thing. I am just speculating, I have no idea.

To me though, I wonder why there would be an opt-out at all?

What is the point? I cannot think of a good reason why the NHS should not just have a free right to help themselves to my organs after I am dead.

Perhaps you could make the argument that the family don’t like the idea. Or that it makes some people uncomfortable with the idea that their organs will be removed after they are gone. But organ donations save lives. Are these the reasons that are worthy of condemning someone to death? I would argue they are not.