Studienübersicht Onkologie Dezember 2012Preoperative chemoradiotherapy versus chemotherapy alone in NSCLC patients with mediastinal lymph node Bevacicumab, pemetrexed and cisplatin, or erlotinib and bevacizumab, non-squamous NSCLC stratified by EGFR-mutation status. phase II including biopsy at A Randomized, Double-Blind, Phase 3 Study of Docetaxel and Ramucirumab versus Docetaxel and Pla
Microsoft word - split hwbb report 11.9.13.docxReport for Brighton and Hove Health and Wellbeing Board (HWBB) and Clinical Commissioning Group (CCG) 9.8.13 By John Kapp, 22, Saxon Rd Hove BN3 4LE, 01273 417997, email@example.com CURING THE NHS AND DEPRESSED PATIENTS BY MASS-COMMISSIONING THE MINDFULNESS COURSE The crisis in the NHS is caused by the following factors, which can be solved locally by councillors initiating culture changes: a) The overprescribing of drugs, which generally do more harm than good with side b) The failure of the old Primary Care Trust (PCT) to commission sufficient effective drug-free treatments, so that patients go untreated, even though GPs want to prescribe them, and patients want them. c) The fear of whistle blowers that will they will lose their jobs if they say things that are politically incorrect (such as the above) d) The prevalent culture among public sector staff of ignoring representations from The commonest conventional treatment for depression is antidepressant drugs. Talking therapies are commissioned, such as Cognitive Behaviour Therapy (CBT) but it is only effective in only a small minority of patients, and the waiting time is up to a year. Mindfulness courses are much more cost effective, but have such long waiting times as to be unavailable unless patients are suicidal. To show the disparity between drugs and drug-free treatments, last year in England there were 50 million monthly prescriptions written for antidepressant drugs. Pro rata 1.25 m prescriptions were written in Sussex, and 250,000 written in the city of Brighton and Hove. The latter presumably went to 21,000 out of the 30,000 depressed patients in the city. They may have helped by masking their symptoms, but drugs do not even claim to cure depression. To prevent, heal and cure depression, patients and sick staff need 16 hours of tuition in mindfulness courses teaching self help tools to cope with it’s cause, which is stress. However, the number of these provided in Sussex last year were less than 8,000 for 160,000 depressed patients, so the waiting time was 20 years. To create a mental health service worthy of the name ‘service’, GPs have to be able to prescribe these courses as easily as Prozac. My deputation proposes that the Council and NHS jointly plan to commission and provide at least 10,000 patients places annually in the city. This would require 500 courses pa, which could be run by 20 full time facilitators running 25 courses pa, for 20 patients per course. That would cost the NHS about £1.25 mpa, which is only about 2% of the mental health budget of £55 mpa and £200 per patient treated. This is a more cost-effective treatment than the drugs replaced, so should be paid for from the drugs budget. This will also improve staff morale and patient confidence, so help cure the crisis in the NHS. This scale of provision cannot be achieved by the present public sector tendering process, which is too bureaucratic, (100 page tender documents) long-winded (taking a year) and un-necessary. It was the PCT’s provider-centred way of excluding non-drug treatments, and has no place in a new patient-centred NHS. A scheme should be set up whereby GPs prescribe vouchers which patients can exchange for courses with existing facilitators who are presently running them in the private sector, and are retrospectively paid, as pharmacists are for drugs. I hope that the HWBB will accept and implement this proposal. That the policy of the PCT, as stated on 18.3.13: ‘We have no plans to procure additional complementary therapy services at this stage,’ be changed to: ‘The CCG are considering Mr Kapp’s proposal to mass-commission the mindfulness course to enable GPs to prescribe it as easily as Prozac, and will report back to the next meeting of the HWBB on 27.11.13.’ 3 Mr Kapp’s deputation as minuted, (reproduced from the draft minutes of the Council meeting on 18.7.13). 18.2 Mr. Kapp thanked the Mayor and stated that;“15 years ago I was a Councillor like you. For the last 13 years I’ve been a patient representative and a critical friend of the NHS campaigning like Julia Bailey. For the last 3 years I have been facilitating the 8 week Mindfulness Course which teaches people self help tools by which to manage their conditions. This course was featured last week on the Horizon program which showed that it can produce spectacular results in reducing intrusive negative thoughts as demonstrated by the presenter Doctor Michael Mosley. There are 30,000 depressed people in the City who could benefit from this course. My proposal is to mass commission this course and mass provide it so that less people would need to go to A+E. Implementing it would meet some of the recommendations of the Francis report and the report published last Tuesday by Sir Bruce Keogh. It’s only fair to say that the NHS already do commission this course so that they can check the box‘complies with nice guidelines’ however so few facilitators are commissioned to provide it that the waiting time for the 160,000 people in Sussex is more than 20 years unless you are suicidal. This is tantamount to non provision and it risks commissioners being taken to judicial review without a legal to stand on. I’m one of more than 25 facilitators in the City who provide this course for clients who pay the going rate of a few hundred pounds. The poor patients can’t afford this sort money so do without and suffer the consequences. This is a cause of health inequalities. To reduce health inequalities for the last 5 years, I have been campaigning for commissioners in the NHS and the Council to reduce this excessive waiting time by opening up the market to facilitators in the 3rd sector like me. To be ready to contract with the NHS and the Council, 3 years ago I created a company called SECTCo for short, this stands for Social Enterprise Complementary Therapy Company. SECTCo’s slogan is:‘medication to meditation.’ SECTCo’s mission statement is: ‘Give a man a pill, and you mask his symptoms for a day. Teach him mindfulness, and he can heal his life.’ I sent hundreds of e mails, documents, to commissioners but no one would engage with me and all seemed to have decision paralysis. I know that the law changed only 4 months ago on the 1stof April. Since then, you Councillors have the responsibility for Public Health, so I am calling on you to play doctor to these commissioners and cure their decision paralysis. Please jointly set up with the NHS, a voucher system which would empower GP’s to prescribe this mindfulness course as easily as they could Prozac. This would enable patients to access the course from existing 3rd sector providers within a few weeks. This is not privatisation by the backdoor but simply reducing waiting times for effective treatment which Labour did when they were in power and which has all party support.” 18.3 Councillor Jarrett replied, “Improving mental health and wellbeing has been a priority for the City Council and the Clinical Commissioning Group and there’s considerable joint work in pursuing the same. The 2013 Mental Health Commissioning Prospectus was, as you know, a joint initiative between the Clinical Commissioning Group and the City Council. You will also know that there is now a Brighton and Hove Wellbeing Service which aims to improve access to psychological and support services for people with common mental health conditions such as anxiety and depression. This contract was awarded following a competitive tendering process and includes as part of the specification a range of evidence-based treatments including Mindfullness Cognitive Behavioural Therapy. General practitioners across the city are referring patients to this new service. The city council and Clinical Commissioning Group will be retendering mental health promotion contracts next summer following approval of the Public Health Commissioning paper at P&R committee on 11th July 2013. The defined outcomes will reflect the mental wellbeing strategy that is being developed through the Health and Wellbeing Board and is likely to follow the Five Ways route: Connect, Be Active, Take Notice, Keep Learning, Give and the Public Health, NHS and Adult Social Care outcomes frameworks. Many other locally commissioned programmes across the City Council and Clinical Commissioning Group deliver on Five Ways. These include joint work of Public Health with the Sports Development Team, Be Active, considerable City Council and Clinical Commissioning Group community development and equalities work, Connect, Adult Learning Schools, Keep Learning, Volunteer training and coordination, Give, and a large arts and culture programme, Take Notice, including a proposal for specific arts and culture work for World Mental Health day this year. Mindfulness courses are also delivered independently by several local voluntary organisations such as Mind and MindOut, and you will be aware that there are several local independent practitioners of mindfulness. The City Council and Clinical Commissioning Group will continue to work together on the mental health and wellbeing agenda, and promote mindfulness where there is evidence for its effectiveness. Mental wellbeing will remain a priority on the current Health and Wellbeing Strategy. I should emphasise that Health and Wellbeing Board is a Council committee. It cannot instruct the Clinical Commissioning Group to do anything nor would it wish to. We work in partnership.” 18.4 The Mayor thanked Mr. Kapp for attending the meeting and speaking on behalf of the deputation. She explained that the points had been noted and the deputation would be referred to the Health & Wellbeing Board for consideration. The persons forming the deputation would be invited to attend the meeting and would be informed subsequently of any action to be taken or proposed in relation to the matter set out in the deputation. 4 Mr Kapp’s deputation as printed on the supplemental agenda paper, including 2 pages of references. Deputation concerning the Curing the NHS’ Dementia by Mass Commissioning
the MBCT Course
(Spokesperson) – Mr Kapp
I am a complementary therapist, and a facilitator of the Mindfulness Based Cognitive
Therapy (MBCT) 8 week course (1) which is NICE-recommended (2) to improve
mental health by teaching people self-help tools by which to better manage their
emotions, so they don’t need to go to A&E. There are more than 20 facilitators in the
third sector of the city (3) providing this course for clients who pay the going rate
(£150-370). This course is provided free on the NHS, but the waiting time is 20 years
unless you are suicidal. (4) causing health inequalities as the poor can’t afford it.
3 years ago, to reduce the waiting time, I created the Social Enterprise
Complementary Therapy Company (SECTCo) (5) whose slogan is: ‘medication to
meditation’, and whose mission statement is: ‘Give a man a pill, and you mask his
symptoms for a day. Teach him mindfulness, and he can heal his life’. To get public
sector contracts I sent hundreds of e mails, documents, phone calls, to
commissioners. These were not answered, because there was no-one at home who
could make a decision, even to say: ‘no’. The NHS did turn 65 last week, and
decision paralysis is a symptom of dementia. Even Jeremy Hunt says it is sick. My
experience proves that it has dementia. For the sake of both doctors and patients,
we need to cure it. I am the Julia Bailey of Brighton, and pleading for your help now,
The government has done it’s part by filling the democratic deficit in health. You are
now responsible for public health, and for directing the strategy of the new Clinical
Commissioning Group, (CCG). I am therefore calling on you councillors to play
doctor to the CCG and cure it’s demented paralysis by banging heads together.
Please set up a ‘chemist shop’ voucher system by which GPs can prescribe the
MBCT course as easily as Prozac. This would boost their morale by restoring their
original function as teachers, (6) Then patients could access the course free within a
few weeks from the third sector, so wouldn’t need to go to A&E. This will fill the
disconnect (7) between drugs and talking therapies, and restore patients’ trust.
Please do not dismiss this proposal automatically as ‘privatisation by the back door’.
It is just a way of reducing waiting times for effective treatment, which has had all
support nationally for more than 7 years. (8). Opening up the market to local
complementary therapists would create local jobs and keep the money in the local
economy, benefitting our citizens, rather than swelling the profits of drug companies.
It will also improve health, reduce inequalities (9) and save taxpayers’ money.
First recommendation. The Council authorises the CCG to engage with
SECTCo to do 2 pilot trials of the MBCT course for £5,000 (10) and to engage a
researcher to evaluate them, and report back to Council in November.
Trial 1. Up to 12 patients referred from a GP surgery in Hove.
Trial 2. Up to 12 sick council staff.
Second recommendation. The Council instructs the CCG to consider this
proposal to set up a voucher system for the MBCT course in the city, and report
back to the Health and Wellbeing Board (HWB) at its next meeting on 11.9.13.
1 Author. I took this MBCT course myself 5 years ago in the voluntary sector in Brighton, paying
for it. It transformed my health, so I took the teacher training and have run 7 courses to date, for a
of about 70 students. A researcher conducted a trial last year in which 22 students took part. They
increased their positivity score by 20% on average, and the best half of 11 students improved by 30%.
2 The evidence base for the MBCT course
a) NICE Clinical Guidelines CG 23, (Dec 2004) and CG 123 (May 2011) for patients who had
suffered previous bouts of depression. Other trial results are given below:
b) The trials in 2002 (Teasedale et al) halved the 5 year relapse rate for patients who
had suffered 3 previous bouts of depression.
c) It has a 30 years evidence base from more than 500 clinical trials, showing it to be
effective in improving mental health for almost anybody, including drug and alcohol
addicts, see Breathworks, Manchester (Gary Hennessey) www.breathworks.org.uk
d) It is used by Transport for London, with 20,000 staff, where it has reduced staff
absence by 73%.
e) It is being taught in schools, where is improves performance in all areas, and there
are moves to get it included in the core curriculum. www.mindfulnessinschools.org
f) A Survey by the Mental Health Foundation showed that 3 out of 4 doctors think that
all patients would benefit from mindfulness. www.bemindful.co.uk/mbsr/evidence
g) A recent trial of 15,000 patients shows that talking therapies are better than drugs.
(Source: PLOS Medicine, 2013; 10: e1001454)
h) Polls show that 3 out of 4 patients want free complementary therapy on the NHS.
(Foundation for Integrated Health, 2009).
3 Third sector provision of the MBCT course
There are 30,000 depressed patients in the city, and potentially they all have the statutory right to a
MBCT course under the NHS constitution if their doctor says it is clinically appropriate, as it is a
treatment which is NICE-recommended. If all those patients asked their GP for a prescription for this
course, and if 20 patients were to be treated together in a class, to deliver their statutory obligation the
CCG would need to commission 1,500 courses over say 3 years, say 500 courses pa.
A full time MBCT facilitator can provide up to 25 courses pa, (one course on each day of the week, - 5
per week – on a cycle repeating 5 times per year) so to provide 500 courses pa the CCG would need
to commission 20 facilitators.
There are more than 20 MBCT facilitators already teaching this course in the city’s third sector, so
could be mobilised to treat patients on GP referral if contracted by public sector commissioners, as
proposed. These courses could be provided for £2,500 per course, (10) and £125 per patient treated,
which is far cheaper than drugs. The total cost would be £1.25 mpa, which is about 2% of the city’s
mental health budget of £55 mpa.
4 Waiting times for the MBCT course are given in my paper: ‘Co-creating a patient centred NHS’
11 pages, 19.6.13 and www.reginaldkapp.org, section 9.56, and other papers there and on
5 Social Enterprise Complementary Therapy Company, (SECTCo) was founded by the author on
4.5.10. It’s website is www.sectco.org.uk. Its business plan (written 3 years ago) can be seen on
www.reginaldkapp.org, section 9.39, including a list of its 143 complementary therapist founding
members in section 5.
6 The word ‘doctor’ comes from latin ‘doctare, to teach,’ so prescribing courses would improve their
morale. 60% of GPs are in imminent danger of burnout. (Pulse magazine)
7The disconnect between drug and talking therapies
The cause of the NHS’s sickness is a disconnect between
the needs of patients for which they go to the doctor, namely treatments to prevent, the only mass treatments on offer, namely drugs which do not even claim to meet those needs, but only mask the symptoms. Everyone knows that street drugs (like fags and booze) are dangerous and harmful, but to get them you have to spend your own money. Prescription drugs are no less dangerous and harmful, but the commissioning system gives doctors no alternative but to massively overprescribe drugs, giving them away like sweets at a childrens’ party, breaking their Hippocratic oath: ‘do no harm’, as all drugs have harmful side effects. Last year they wrote a billion monthly prescriptions to about half the population, which means that on average 30 million of us are taking 3 prescription drugs, which are slowly poisoning us with side effects. An inverse care law applies, which shows that the more prescription drugs we collectively take, the worse public health becomes. To add insult to injury, last year drugs cost us as taxpayers £15 bn, which lined to pockets of private multinational drug companies who have been convicted and fined billions of dollars for putting profits before patients. This disconnect is the reason why: NHS staff morale is at an all time low, as they work for a monstrous system which gives doctors no alternative but to prescribe harmful drugs on demand. Patients have lost faith and trust in this monstrous system, which serves no-one but the drugs companies.
Clinical commissioning means that GP commissioners (who see 40 patients per day) have taken the
place of PCT managers (who never saw any patients, so never knew whether the treatments worked
that they were buying). Patients can ask for MBCT courses, but GPs can only prescribe them if the
CCG sets up a system (such as this proposal) to mass-provide them.
8 Privatisation by the back door?
No, it just reduces waiting times, as the Labour government did In 2006 for talking therapy. They
opened up the market by recruiting 10,000 therapists from the private sector for Cognitive Behaviour
Therapy (CBT) under the Improving Access to Psychological Therapies (IAPT) programme. Two
later they opened up the market for hip and knee replacements to Independent Treatment Centres.
These policies were successful and popular, and so would this proposal to open up the market to
9 Reducing health inequalities
The cause of health inequalities.is the rich get the health benefit from complementary therapies which
the poor can’t afford. This proposal would reduce them by GPs giving patients free vouchers for
courses, which they can cash near them. To walk their talk, ‘physician heal thyself,’ doctors too
access the MBCT course that they prescribe. This new system would produce 3 benefits to public
health: reduction of harmful side effects from drugs, effective treatments, less cost to the taxpayer. (4)
Our e petition on the council website from Nov 2009 got 445 signatures, and there is another up now
10 Cost implications of these 2 trials SECTCo provides 2.5 hours per week, for 10 days and pay
facilitators £1,250 at £50 per hour, and assistants £750 at £30 per hour. Room hire is £500, so our
tariff price is £2,500 per course, negotiable.
The following material which has come up since the deputation was written on 10.7.13. 5 Mr Kapp’s response to Cllr Jarrett’s response to his deputation Thank you for your response to my deputation to Council on 18.7.13. I am pleased that it was referred to the Health and Wellbeing Board, that mental wellbeing will remain a priority in the current Health and Wellbeing Strategy, and that you recognise the value of mindfulness courses as a treatment for mental sickness. The policy of the PCT in regard to mindfulness courses was clearly stated on 18.3.13 by Anne Foster in answer to my Freedom of Information question, as follows: ‘We have no plans to procure additional complementary therapy services at this stage.’ The purpose of my deputation was to change that policy to a massive expansion in the provision of mindfulness courses. It is not clear from your response whether you support this expansion, or not, and you did not answer my recommendations. You mention the retendering for the mental health promotion contracts next summer (2014) as if it would result in more mindfulness courses being available for patients. The tendering process for the Community Mental Health Support programme, (for which SECTCo bid unsuccessfully in July 2012) did result in new mindfulness courses being provided under the Wellbeing service. I welcome this service as an excellent initiative, but only 2 extra facilitators were commissioned to run them, which will only reduce the waiting time from it’s present 20 years by about 3 weeks. I am calling for a hundred-fold increase, and a radical change in the way that facilitators are contracted, by means of a voucher system. You mentioned the minutes of the Policy and Resources committee of 11.7.13. I have looked at these, and concluded that they formerly record the handing over of Public Health from the PCT to the Council together with it’s budget of about £18 mpa. However, they did not imply the policy changes that I am seeking. Your response does not address the crisis in the NHS, (as described by the LSE, Francis and Keogh reports) and in our local A&E department, which has the worst waiting times in the country. Neither did it address my deputation’s calls to set up a voucher system by which GPs could prescribe the mindfulness course as easily as Prozac. I hope that you and the CCG officers will now address these issues, and also consider the following additional material which has arisen since I wrote my deputation on 10.7.13. 6 The Council’s One Planet strategy for health and happiness is furthered by SECTCo’s proposal We congratulate the Council for becoming in April a One Planet Council, the first in the world. The aims are set out in the Sustainability Action Plan (April 2013). The Health & Happiness section on p64-68 of that plan sets out 44 policies, of which 36 would be promoted if the Council adopts our proposal for mass-commissioning the mindfulness course. We have annotated these below. It can be seen that 25 out of 44 paragraphs have 5 stars, and a further 9 paragraphs have 3 or 4 stars, so our proposal would have a positive effect on 36/44 policies. One Planet Council - Health & Happiness ‘The philosophy underpinning One Planet living is to create a sustainable future, in which happy and healthy people thrive and contribute to the overall aim of maintaining the earth’s resources for future generations. This principle focuses on the values, beliefs, factors and actions to promoting health and happiness in both our workforce and city wide employed communities. Within the council, this work is led by its Human Resources and Organisational Development team (HROD), in partnership with internal teams and partners within the local and national community to create a sustainable and happy workforce. High level objectives – where we want to get to One Planet Council: 1*****Identifying and reducing localised health inequalities through partnership working, improving access to affordable resources 2*****Creating an environment where employees are able to take personal responsibility for improving their own health and wellbeing 3*****Improving access to work and retention of employees with health related condition 4*****Reducing sickness absence through proactive, preventive measures 5Targeting and addressing specific issues within the work environment 6*****Respect’ being an organisational value and council colleagues show respect to each other and their perceptions confirm this Where we are now The council recognises that its employees are its most valuable resource. The People Strategy 2011-15 outlines senior leadership commitment to; providing clarity on organisational purpose and ambition, a description of expected workforce behaviours, a revised individual performance management system that measures the ‘what’ and the ‘how’ of delivery and a supportive learning & development programme. 7*****For the organisation, wellbeing is not just about quality of life, but also about the organisation’s culture, its leadership and its resources. 8Feedback from the most recent staff survey demonstrated that the council has flexible working arrangements that are recognised and appreciated by the workforce. 9*****We have selected a new occupational health provider and since 2012 have supported colleagues to manage their own physical and mental health and wellbeing. 10The council monitors employee wellbeing and satisfaction and can provide evidence of work-based improvements. 11*****The council recognises that (nationally) despite improvements to working conditions, sickness absence is still increasing. New and innovative approaches to addressing this are under review. Page 65 of 71 12*****A review on our approach to the highest cause of absence (stress) is currently underway 13****Colleague involvement and engagement is important to us and we see engagement as both an ‘outcome’ and a ‘process’. 14We continue to develop our employment policies to retain skills and experience and meet the needs of all generations in the workforce and working patterns and styles. 15*****Our involvement in the Healthy Cities Partnership means we work with key partners to target health inequalities through access to current resources and initiates rethinking our traditional approach to health and engaging employees. 16***Recognition of the detrimental impact of workless-ness on populations and the positive impact that work has on health and that work is good for health. What We’re Going to Do: results – Nov/Dec 2013 Investors In People Reviews – ongoing and accessibility and in response campaigns for to National initiatives Cancer awareness interventions. annually. Develop an awareness campaign immunisations by on blood borne viruses that can choice. Page 64 of 71 Health and Happiness – One Planet City One Planet Living is defined as a future where it is easy, attractive and affordable for people to lead happy and healthy lives within a fair share of the earth’s resources. This section focuses on initiatives which promote health and happiness. 21*****This section includes areas of work overseen by the newly established Health and Wellbeing Board, as well as the Healthy City Partnership. 22****From April 2013 local authorities take the lead for improving the health of their local communities. Therefore there is a currently transitional period around funding and this action plan will need to be updated. High level objectives – where we want to get to 23***The One Planet vision is to make it easy, attractive and affordable for people to lead happy, healthy lives within their fair share of the earth’s resources. 24*****The Council, partner organisations, communities, residents work together to support people to achieve and maintain a healthy life and to reduce health inequalities across the City. 25*****Brighton and Hove will make the most of community assets in order to improve health and wellbeing. 26*****Local services will be designed with physical and mental wellbeing in mind and local people will be involved in shaping wellbeing. 27*****The aspiration is a reduction in the difference in healthy life expectancy between communities through greater improvements in more disadvantaged communities. This is a high level outcome in the new national Public Health Outcomes Framework. However currently this requires Census data to construct at Local Authority, and thus it will only be reported every 10 years. Differences in overall life expectancy are now available annually for local authority areas. Other outcome indicators that are relevant include: 28*****Emotional wellbeing: Improved self reported wellbeing 29*****Promote active living: o 30***A greater proportion of physically active adults and fewer physically inactive adults o 31The proportion of children and young people using active travel as their main method of travelling to and from school. 32*****Age Friendly City: indicator to be defined as part of Stage 1 of this initiative which is to ensure our physical and social environment promotes healthy and active ageing and a good quality of life for older residents. Page 68 of 71 ‘ 33*****Alcohol and substance misuse services: Successful completion of drug treatment 34***Improving sexual health: Reduced repeat sexually transmitted infections 35****Improve health and wellbeing through the workplace: Number of workplaces who are engaged in supporting employee’s in improving their health & wellbeing. Where we are now 36*****Brighton and Hove residents are happier, more satisfied & feel their life is more worthwhile compared with the UK average (Office for National Statistics 2012). However, the local Joint Strategic Needs Assessment 2012 highlights that the City has higher than average mental ill health needs and persistent health inequalities.i 37The local City Tracker survey shows a high level of satisfaction with Brighton and Hove as a place to live. 38*****The newly established shadow Health and Wellbeing Board has developed a Health and Wellbeing Strategy for Brighton and Hove. This will be published in 2013. The strategy has five key priorities including Emotional Health and Wellbeing (including Mental Health), dementia, smoking, healthy weight and nutrition, and cancer & cancer screening. A mental health promotion strategy for the City is being written to support the Emotional Health and Wellbeing action plan. 39****Brighton and Hove is a member of the World Health Organisation (WHO) Healthy City programme. The Healthy City Partnership has overseen action to promote active living, healthy workplaces and healthy urban environments. 40*****Programme Boards for alcohol, substance misuse and obesity have recently been established to coordinate tackling these challenging areas. A programme board for sexual health will be established during 2013. Membership of WHO Global Network of Age Friendly Cities has been agreed by the council as part of plan to achieve Age Friendly City Status. What we’re going to do 41*****Develop and deliver an emotional wellbeing promotion strategy to inform development of the strategy action plan, focusing on the ‘five ways to wellbeing’: connect; be active; take notice; keep learning; give. 43*****Measure local progress 2013 Mental Health implementation plan (the national strategy – will include determinants of mental wellbeing such as parenting, green spaces, older people at risk of isolation). 44***Launch and delivery of 7 Public sector staff absence rates could be massively reduced with mindfulness courses Much of the above mentioned Council’s health and happiness strategy addresses the welfare of their staff. The Council employs 12,000 staff, who have an average staff absence rate of 4% (implying that 480 staff are off sick at any time). The local NHS including primary care probably employs another 8,000, totalling 20,000. This is the number for whom the HWBB is now responsible, and about 800 are off sick. This makes the HWBB an employer comparable in size to Transport for London (also with 20,000 staff) As mentioned in my deputation, they provide mindfulness courses for sick staff, and have reduced their absence by 73%. I believe that the city could achieve similar beneficial reductions in staff absence if the HWBB adopts my proposal, and provides a mindfulness course service for all their sick public sector staff. SECTCo is willing to negotiate a contract to run these courses in public sector offices, and private sector venues, such as Revitalise (86, Church Rd Hove BN3 2EB (opposite Hove town hall) To minimise disruption to working hours, they could be offered 3 times per day, before work (say 730-830am, in the lunch break (say 1230-130pm) and after work (say 530-630pm) The MBCT syllabus is normally 2 hours per week for 8 weeks. This could be compressed to 1 hour per week, as the mindfulness in schools course has done. This is called ‘ .b’ and presents the same material more speedily, using video clips. I have done the teacher training for this course, and have the teaching aids, which I would make available. 8 Dr Michael Moseley’s Horizon programme on mindfulness, shown on BBC2 on 10.7.13. This 1 hour TV programme shows the effectiveness of the mindfulness course as experienced by a sceptical doctor, who admitted that he had been suffering from chronic insomnia for over 20 years. Dr Moseley was wired up to brain scanning machines before starting this 8 week course, and after completing it 7 weeks later. His machine scores improved by a factor of 3, and there was a noticeable improvement in his posture, attitude and positivity, which was remarked on by his wife. I had the same experience when I did the course 5 years ago, and have observed it in most of the 70 students I have taught. This was confirmed by the questionnaire results of the 22 who took part in a research trial last year. I recommend councillors and commissioners to watch this programme, and take the course themselves. 9 Sir Bruce Keogh’s report, published on 11.7.13 As a result of this damning report, the government took the unprecedented step of placing 11 hospitals under emergency measures. It shows that the whole NHS has a serious crisis in staff morale. It is our NHS, and we all have a responsibility to do what we can to heal it. For example, I have previously taken part in the peer review of hospitals as a patient representative, so am on the list. On 31.7.13 I was requested to volunteer again, which I gladly did. My theory about the cause of the catastrophic loss of morale in NHS staff, and loss of confidence in patients, (mentioned In my deputation) is a general lack of faith in the effectiveness of drug treatments. Drug-free treatments exist, but are insufficiently commissioned to be readily available within short waiting times. This results in drugs being so massively over-prescribed (a billion monthly prescriptions in 2012) as to generally do more harm than good. My proposed solution is to mass-commission and mass-provide the mindfulness course for staff and patients, and de-commission over-prescribing drugs. This will be funded from the drugs saved, at reduced cost overall, as drug free treatments are more cost-effective than drugs. 10 Is Nick Clegg backing my campaign by joining dementia friends? Dementia has been top of the health agenda for a year, following publication in June 2012 of the London School of Economics report showing that 750,000 depressed patients were not receiving proper treatment. This campaign got a boost on 1.8.13, when Nick Clegg sent an e mail that he had become a dementia friend, together with 10,000 others, including me. He gave a link to NHS Direct sites giving the gory details about dementia, written by the Alzheimer’s Society. The message from this site is that anyone concerned about memory loss should get checked out for a dementia diagnosis from their GP. People fear going mad even more than they fear death, so this message could result in many people taking this up on behalf of aging parents. It is difficult to get appointments with GPs, so is this causing excessive waits at A&E? The site says that there are already 800,000 cases of dementia in England, and forecasts this to rise by 200,000 (25%) by 2020. Locally in the city we have 1/200 of the national population, so this statistic means that 4,000 patients have dementia, and this will rise by 1,000 to 5,000 in 2020. There is no conventional cure for dementia, so GPs cannot offer patients losing their memory anything but doom and gloom of increasing dependency. Having to tell patients this (and other) gloomy prognosis is soul destroying, and may account for why surveys show 60% of GPs are on the point of burn out. (as reported in Pulse magazine) The mindfulness course can prevent dementia, and if taken early, can reverse it, as I say in my paper: ‘Can mental sickness be prevented, healed and cured? Medication to meditation,’ dated 20.2.13. I circulated this paper in February to councillors and staff on the HWBB both by e mail, and in hard copy. It’s summary can be seen on www.sectco.org.uk. If the HWBB adopts my proposal, GPs would only have to deliver this doom and gloom scenario to those whose dementia was far advanced. Early onset cases could be offered a mindfulness course, which would teach them what they can do for themselves. Instead of accepting the prognosis that the number of dementia patients has to rise by 25%, we in the city could confidently target the number of dementia cases to fall by 1,000, to 3,000 by 2020. Cases from my family give evidence that this is possible. my mother (who was a psychiatrist) was diagnosed with Parkinsons disease when aged 57. She was an invalid, and died a bad death of cancer aged 67, in 1966. Meditation courses were not available then. In 2000, I lost my first wife (Janet) to cancer, (when I was 64) after 37 years of marriage, which plunged me into depression. A year later I met my second wife, who introduced me to meditation, which I have practiced regularly. My memory and general health have dramatically improved, and I feel better than I did 20 years ago. Given the support that I was rich enough to be able to pay for, I believe that many or even most old people could do the same. On 24.7.13, I received from DoH an online survey about the following proposed new clause of patients’ rights under the NHS constitution: 6. You have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible. The waiting times are described in the Handbook to the NHS Constitution To be of use to patients, these waiting times have to be a few weeks not years. For example, for hip replacements, this is 18 weeks (4 months) The present 20 year waits for the mindfulness course is 100 times too long. As mentioned, the purpose of my deputation is to change the old PCT’s stated policy on 18.3.13 to: ‘have no plans to reduce them’ . The CCG and HWBB took over from the PCT on 1.4.13, but do not have to adopt all the PCT’s policies. In this case, if they do, they will be vulnerable to being taken to judicial review by dis-affected patients. The chairman of NICE, Sir Michael Rawlin, publicly said a year ago (Today programme 2.4.12) that commissioners who fail to commission NICE-recommended treatments are breaking the law, and could be put in the hot seat without a legal leg to stand on. I have warned the PCT about this, as I don’t want this to happen. 12 NHS constitution – public involvement On 24.7.13, I received from DoH an online survey about the following proposed new clause of patients’ rights under the NHS constitution: 23. You have the right to be involved, directly or through representatives, in the planning of healthcare services commissioned by NHS bodies, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. I have been trying to be involved directly in the planning of healthcare services since I became a patient representative, 13 years ago. Most of my letters and e mails were not even acknowledged, let alone answered. When they had to be answered (as with my freedom of information questions) the attitude was grudging, as if my suggestions were unwelcome intrusions to their more important work, and I was frequently fobbed off. This silo attitude (a ‘glass wall’) between staff and patients is harmful to both alike, because it isolates them from their common humanity, and the reason why staff sought a caring career. This isolationism contributes to the crisis in staff morale and patients’ lack of confidence. This is just a habit, which can be broken with good leadership. The government is right to emphasise the need for a culture change, (as John Major did 20 years ago when he created the citizens’ charter) but actual change can only come from local leaders, such as councillors. My experience after a decade of campaigning is that the unwritten rule throughout the public sector is to ignore all communications from the public as if they had never been made. E mails are not acknowledged, nor answered. Phone calls do not get through to the staff concerned. If answered by a colleague, they cover up, saying that the person wanted is not there, or busy. Requested messages to phone back are ignored. Requests for meetings face to face receive the same treatment. This attitude has some benefit to staff, which is why it has continued and become the norm. They cannot be held to account for not answering communications because they can pretend that they were never received. Although I have never worked for the public service, from what I have seen in the media, staff that blow the whistle are hounded out, and lose their jobs. However, the long term effect of this is bad for everyone. It results in imprisoning both staff and public into separate silos, in a monster system which both feel powerless to change. The service which the public pay for in their taxes deteriorates, until it reaches crisis point, as has happened to the NHS. I ask the members of the HWBB to initiate a culture change in the Council and NHS’s 20,000 staff, as private sector leaders do for customer care. They simply need to change the present rule of automatically rejecting the communications from the public to welcoming them, and consider them carefully, and referring them up as appropriate. This will result in better services, better outcomes, improved staff morale, and meet some of the recommendations of the Francis and Keogh reports. 13 Joint Strategic Needs Assessment for the mindfulness course According to the local public health statistics, there are 30,000 depressed patients in the city, and 160,000 in Sussex. The MBCT course is NICE-recommended, so patients have the statutory right to it if their GP says it is clinically appropriate for them. GPs therefore have an implied statutory duty to consider prescribing the course to all those patients for whom it is clinically appropriate, which is presumably all of them, numbering 30,000 in the city and 160,000 in Sussex. To discharge that implied duty, GPs would have to offer a course to all these patients. This they cannot do at present, because the old PCT commissioners did not give them the corresponding statutory right to prescribe it. This does not apply to drugs. The PCT have contracts with the 37 pharmacies in the city to honour the delivery of all drugs prescribed within a few days at most. Some 250,000 monthly prescriptions for antidepressants were delivered to patients in the city last year, which was enough for 21,000 depressed patients to take them continuously. (However, it has widely been reported in the media that they don’t work, and cause harmful side effects) However, the PCT commissioners have only commissioned enough contracts with mindfulness facilitators to provide for at most 8,000 patient places pa, out of 160,00 depressed patients in need, hence a 20 year wait. This is why only about 1 in 100 (those who are suicidal) get offered a course at present. This disparity can be illustrated by imagining the scenario that there were no pharmacies in the city, because the PCT had never commissioned contracts with them. (I believe that this was the situation in the Soviet Union, which is why advanced non-drug treatments like Scenar were developed) Every prescription for drugs given you by your GP had to be taken to Lanchester House, and you simply had to wait until you were called to come and collect your drugs, which sometimes took years. In the meantime you either got better, or worse. That is the situation for patients who want drug-free treatments, like CBT and MBCT courses, free on the NHS. However, they are plentifully available in the private sector at a few weeks notice, if you are rich enough to pay the going rate for them. 14 How many mindfulness course interventions were provided last year? The above figures are guestimates, as I have not been able to find out accurate figures, because of the secrecy mentioned in paragraph 12 above. Until July 2012, Sussex Partnership Foundation Trust (SPFT) had the sole contract for mental health services throughout Sussex. My figure of 20 years for the waiting time in Sussex was guestimated from figures given me 2 years ago by Robert Marx, who is in charge of facilitator training for SPFT. He said that he had trained about 20 new facilitators in 2010/11, but he would not tell me how many courses they were contracted to run. I just assumed that they provide 20 facilitators to run 20 courses per year with 20 patients per course, so treat 8,000 patients pa. One fifth of these 8,000 patient places, namely 1,600 places pa, can be attributed to the city. To update these figures, on 29.7.13 I rang Robert Marx, who said that they are now running courses back to back (ie continuously without breaks) but he again refused to give me any figures. My assumption of 20 courses pa per facilitator assumes that they are run back to back, so I believe that this 8,000 figure is historically an over estimate, and the actual waiting time was longer than 20 years. It could be 40 or 60, or longer. The new contract with Brighton Integrated Care Service (BICS) includes mindfulness courses, which is greatly to be welcomed. I was told by BICS (Helen Curr) last January that 2 mindfulness facilitators had been engaged, and were to start running MBCT courses from last Feb. I have left many messages asking her to tell me how many courses and patients they have run courses for to date, but she has not responded. This is typical of the unco-operative attitude mentioned in paragraph 12. All I can do is guestimate. Assuming BICS have already run 6 courses, for 10 patients per course, about 60 patients would have been treated to date. This could be projected to treat 100 in a whole year. This will only reduce the 20 year waiting time for 30,000 depressed patients by 3 weeks. The planning of future services should not be based on adversarial guestimating. I recommend the HWBB to collect and publish reliable statistics about the true present provision of the mindfulness courses service. GPs need to know how many patient places are annually contracted for these courses, so that they know how many patients they can refer.
perspectives on pain a d d r e s s i n g p a t i e n t n e e d s Mixing up the medicine cabinet How to combine prescription, over-the-counter and herbal meds logically and safely why you may want to offer your pain patients treatments that are alternative or complementary to prescription drugs. First of all, and there may be issues of quality and other pathologies. Quite