Discussions

An Apple A Day

‘The patient’s perspective is at the heart of any discussion about integrated care. Achieving integrated care requires those involved with planning and providing services to impose the patient’s perspective as the organising principle of service delivery’ (Shaw et al 2011, after Lloyd and Wait 2005)

Over the last seventeen years there has been more technological and scientific advancement than that which occurred since mankind began which, when you think about it, is a staggering amount of progress. I think it’s fair to say that we now have at our fingertips the greatest opportunities with which to control and repair our health, by way of science and the digital revolution.

What I find particularly fascinating is the role that technology plays in both proactive and reactive healthcare. At one end of the scale we are a multi demographic community of health conscious technophiles, citing Apple’s Health app and wearable technology like Fitbits among our favourite, and at the other, there are those who have fallen prey to the many internal and external factors that increase the chance of conditions like cancer and heart disease, finding themselves beholden to technology by way of communications, diagnostics and medical devices for treatment.

An ageing population and an increase in long term conditions, for example, diabetes, heart failure, pulmonary hypertension, affecting 15 million people at present, have a huge impact on the health system with a need for an extra £5 billion expenditure predicted by 2018, according to a Department of Health report.

One thing for certain is that technology will play a key role in our health, from both a preventative and a cure standpoint. Long term conditions in the UK account for 70% of health and social care spending, and one of the NHS’s long standing strategies is cost reduction through the use of technology and an out of hospital care strategy.

The aforementioned report also states that the use of technology has reduced:

  • Death rates by 45%
  • Visits to Accident and Emergency departments by 15%
  • Emergency admissions to hospitals by 20%

The current UK healthcare system, designed during the post World War 2 era, was set up to focus on the diagnosis and treatment of illness and to, therefore, be reactive. This acute care model is embedded, not only in our healthcare system but within our society.

As a child of the seventies, we put our trust in family doctors and I can invariably remember the sense of relief felt by both parents and grandparents after a visit confirmed there was nothing to worry about, usually accompanied by a prescription of sorts but never with an educational briefing as to what we could do to improve our own health. That’s not to cast aspersions in any way, it was simply a part of healthcare’s journey before shifting into a new paradigm.

Over the last forty or so years, a new era has emerged. The 1980’s bore witness to a new wave of gurus who brought health and fitness into the mainstream via the popular medium of the day, television. Our family practitioners, nurses and consultants alike became increasingly keen to promote holistic alternatives as opposed to a reliance on treatment, a trend that has risen dramatically in recent years and one that has evolved to new technological mediums.

A key area of focus for proactive care is to classify individuals based on four key risk factors that lead directly to over 90% of chronic disease:

  1. Tobacco use
  2. Alcohol consumption
  3. Physical inactivity
  4. Unhealthy eating

As seen in the recent Public Health England sugar tax campaigns, the focus is very much about taking control of one’s own destiny, in this instance by diet and the reduction of sugar consumption to prevent future diseases like diabetes. I mean when all said and done, it’s one thing that it will ease pressure on the NHS but let’s face it, the quality of our lives will be improved, not to mention longevity, and that is clearly more important than money to us and our families.

So what does the future of healthcare look like?

A return to that old adage of ‘an apple a day keeps the doctor away’, which in essence is the very heart of proactive healthcare, seems imminent. Millennials could herald a new era of healthcare; technologically savvy and passionate about personal fulfilment and good health, new generations are already taking responsibility for their own wellbeing.

It would appear that those ‘bought in’ to technology will soon revel in virtual reality fitness studios and healthcare programmes, and those who are part of the chronic and acute healthcare systems will see the continued roll out of virtual wards and all manner of high technology devices, such as palliative care and pain management systems, all fully portable and with the capabilities for external monitoring. Meanwhile the likes of Verily, formerly Google Life Sciences, has ambitious projects lined up such as its glucose detecting contact lens.

And let me skip briefly to Big Data, the encouraging link between proactive and reactive healthcare whereby our health records (every minute detail of our physical and mental health) could be stored in one digital location, accessible by anyone who can have a tangible impact on our health, including us! Such a wealth of data could be used to not only develop care plans that suit us most efficiently but, as the holy grail of healthcare transformation and sustainability, will enable analytics algorithms to predict and help prevent sickness.

With a combined top down (technological innovations), bottom up (citizens taking responsibility for their own healthcare) approach, and despite the constant political bickering about the NHS, my experience of which has always been first class just to interject, it would appear that the future is extremely bright for healthcare in the UK and, what’s most encouraging, is that we each have the power to play our part in a combined effort to positively influence our future.

By Rachel McClelland

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If Disney Ran Your Hospital – An Interview with Free Lee

Fred Lee is an American Author who is a nationally recognised expert and consultant in patient relations and service excellence.  His book ‘If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently’ was awarded the 2005 Book of the Year from American College of Healthcare Executives.  Here he talks to us about the differences between patient service and patient experience…

What is the similarity between hospitals and Disney?
I did not see the similarity myself in the beginning. The book that enlightened me was a book by two economists called, The Experience Economy, Where Work is Theater and Every Business a Stage. Their hypothesis is, that we need to add one more economic sector to commodities, goods and services. When we buy a ticket to a theater or a holiday destination, we are not looking for something tangible like commodities, goods or services, but an intrinsic memorable emotional experience or story to tell. They write:

“All prior economic offerings (commodities, goods and services) remain at arms-length, outside the buyer, while experiences are inherently personal. They actually occur within any individual who has been engaged on an emotional level. The result? No two people can have the same experience—period.”

In other words, commodities, goods and services are extrinsic and temporary, but experiences are by definition intrinsic and leave an emotional imprint on one’s memory that may last a lifetime. That is a world of difference from picking up your dry cleaning or getting the oil changed in your car, or ordering pizza, or dropping by the market to pick up a loaf of bread.

Hospitals and Disney are both in the Experience business, not just the Service business. Nobody comes out of a theater and talks about the service they received. They talk about how the experience made them feel. Theater, however, is about all the emotional experiences of human beings from the things that make us laugh to the things that make us cry—the two icons of theater. Tom Hanks was the voice of Woody in Disney’s Toy Story, because Disney is primarily all about comedy. But Tom Hanks also played a person dying of Aids in the movie, Philadelphia, which was a tragedy. Hospitals are on the tragedy end of the experience continuum, not the comedy end.

So Disney tries to meet the emotional needs of a family to have fun together. Hospitals, on the other hand, are dealing with emotional needs of a family going through, fear, anxiety, pain and loss together. Both are emotional at the core, even though the emotions are vastly different. So I could say: “A hospital without compassion would be like Disney without fun.”

Why is patient perception so important?
Surely I do not need to convince anyone in medicine of the importance of the patient’s state of mind in the healing processes of the body. Patient perceptions are the basis of their emotions and state of mind. Ever since biological science discovered, first in animals and then in humans, the profound relationship between emotional distress and disease outcomes, there has been an explosion of clinical studies that prove the negative link between distress, fear, and anxiety, and immune function.

Almost every major University Medical Center is now doing their own research in Psychoneuroimmunology, which is the study of the effect of a patent’s state of mind (perceptions) on their immune system. You can easily find studies which show, based on objective physiological markers, that empathetic connection between clinician and patient can affect better outcomes in wound healing, infection fighting, diabetes control, readmission to hospital, hypertension, open heart surgery, complications, and a host of others. Even insurance companies have shown that 72% of all medical malpractice claims could have been prevented by a better doctor patient relationship.

The great psychiatrist, Harry A. Wilmore, wrote, “The failure to empathize is the basis of most of the unhappy doctor patient relationships.”

Can you give a few examples of what hospitals can learn from Disney?
• Focus on the whole family, not just the patient
• Do everything possible to meet people’s emotional needs, not just their physical needs.
• Make courtesy and compassion more important than efficiency.
• Use the power of imagination to put yourself in the guest’s shoes. Or, “What must this person be feeling?”
• Use the theater metaphor instead service as your guide. Like:
“In this scene, what do we want the audience (patient) to see, hear and feel?”
• Co-design processes with actual users (patients)

How exactly can hospitals bridge the gap between ‘good’ and ‘great’?
We need to define the terms. For me, “good” means meeting universal service expectations like courtesy and respect.

But, “great” means exceeding universal service expectations by assessing and responding to a patient’s emotional state of mind, reducing their fear and stress, by listening to their story, empathizing with them, and instilling hope and trust with assurance.

Can you give a few tools/advice?
We cannot operationalize compassion like we can courtesy behaviors, because we cannot script it. It must come from the heart. People don’t need tools for compassion. Clinicians simply need to be persuaded of its importance in the human healing process. What we need are managers who call their staff “caregivers” instead of employees, and explain the WHY of caring, and talk about its importance every day.

After all, the word “patient” comes from the root word “pathos”, which means “one who suffers.” And the word “nurse,” comes from same root as “nurture” which is how we minister to one who suffers. And the word “compassion” means to enter into another person’s pathos with kindness and understanding.

It concerns me that we seem to be losing these long held traditional values in medicine–what we once called the “art of medicine” as opposed to just the “science of medicine.”

I do not buy the notion that some people have the ability to empathize or be kind, and others do not. It’s a human innate ability. It only needs to be stimulated and inspired every day by great managers. That’s the purpose of my book, which contains at least fifty suggestions and stories designed to inspire more caring from our caregivers.

Is it possible to measure patient perception? And if yes: how?
The answer is NO. But we can still get feedback.

For instance, we can aggregate and quantify the percentage of patients who answered “yes” or “no” to objective questions like, “Did the doctor explain things in words you could understand?” Or, “Did you have to wait more than a week for an appointment?” Or, “Were you treated with courtesy and respect?”

But how do you measure how a person “felt” about the way they were treated during their stay, especially since they may have interacted with 80 or more different people during that time.

W. Edward Deming, the father of TQM (Total Quality Management), Six Sigma, Lean, and PDSA, which are all about what can be measured, wrote in his most influential book, Out of the Crisis.

“The most important numbers for management are unknown and unknowable. What is the value, for instance, of the multiplying effect of a happy customer and the opposite effect of an unhappy customer?”

So Deming would assert that patient perceptions cannot be objectively measured or quantified.

When we use the term “good to great” we are alluding to a book by that name written by Jim Collins. Here is Jim Collins on things that cannot be measured:

“Some leaders try to insist, “The only acceptable goals are measurable,” but that’s actually an undisciplined statement. Lots of goals—(like positive attitude, love, compassion, trust, loyalty, quality of life and motivation)—are worthy but not quantifiable. But you do have to be able to tell if you’re making progress.”

I agree. However, if we accept the importance of qualitative information, we can certainly understand patient perceptions through their stories, comments, complaints, and fan mail. I encourage hospital leaders to start their journey to patient engagement by making a list of all the adjectives and adverbs in fan mail from patients. This will provide an accurate qualitative guide to what makes the difference between good and great. My wife, Aura, did this when she was the Chief Nursing Officer at a 300 bed hospital. By far the most common words used by a fan were: Caring, Cared, Cares, Compassion, Kindness, Warm, Concerned, Comforting, Listened, Reassuring, Tender, Loving, etc. I doubt it would be much different in The Netherlands.

This is not a new thing. The limitations of objective measurement have given rise to major disciplines like:
Narrative Medicine
Experience Based Design (NBD)
Empathic Design
User co-design
Empathy based improvement

My book belongs on the same shelf as the many books and articles that have been published in these disciplines.

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NHS – the National Home Service

Out-of-hospital initiatives are at the forefront of UK government plans to modernise the way the NHS delivers care.

THE NHS often gets a bad press for being slow to adopt new medical technologies or practices. But when it comes to out-of-hospital initiatives, the health service is no slouch.

Earlier this year, NHS England chief Simon Stevens announced that the government was working closely with innovators like Verily (formerly Google Life Sciences) and Philips Healthcare to deploy the latest technology in a bid to overhaul the way care is delivered. At the heart of the shift is the firm belief that modern methods of gathering information and remotely monitoring vital health signs can be paired to improve the management of chronic conditions. In short, the aim is to allow more patients to be managed in their own homes rather than hospital. The NHS Test Beds will try out a variety of new systems for improving health care delivery through technology. The ambitious programme requires extensive co-operation between government departments, NHS hospitals, clinical commissioning groups and community care providers. But if it works, it could change the face of NHS care for good.

So what exactly are these pilot projects, where are they taking place and how will they benefit patients?

North-east London
An ambitious project to promote healthy ageing across a million-strong population, this pilot scheme aims to help patients manage their own conditions and remain as independent as possible. For example, it will include an online tool for those with dementia, a social network app which offers peer-to-peer support safely online with guidance from credible organisations and institutions, and a device which assesses falls risk and mobility.

Greater Manchester
In the Greater Manchester areas of Heywood, Middleton and Rochdale, the latest technology will be deployed to try and predict which patients are most at risk of long-term conditions. Verily, along with drug firm MSD, local GPs and academics, will analyse trends in areas such as heart failure and lung diseases like Chronic Obstructive Pulmonary Disease, to identify patients most likely to benefit from tele-health, tele-care and tele-medicine technology. Doctors hope to use predictive techniques to pre-empt serious illness.

Lancashire and Cumbria
Here, Philips is involved with numerous agencies to try and find ways to support the frail elderly and people with long term conditions to remain out of hospital. The idea is to use new technological approaches to spot those likely to benefit from additional support and help them self-care at home through improved education and telehealth technologies.

Sheffield
This pilot targets serious chronic illnesses such as diabetes, mental health problems, respiratory disorders and high blood pressure, all of which can lead to unnecessary hospital admissions. A local ‘intelligence centre’ is being set up – with the help of tech giants like IBM and GE Finnamore – to identify and target those most at risk of relapse in a bid to keep them well, independent and out of hospital by securing the clinical support they need when they really need it.

Birmingham and Solihull
A mental health project here aims to team medical expertise with the strategic , marketing and digital skills of Accenture. The aim is to provide more proactive support for those with psychiatric issues through online back-up, regular risk assessments and crisis intervention plans. Predictive analytics will be used to try and identify those most likely those heading for a mental health episode, allowing mobile crisis team members to intervene in time to prevent admissions.

Announcing the plans earlier this year, Life Sciences Minister George Freeman MP said: ‘We are determined to ensure the NHS can remain a pioneer of new treatments and models of care, so that UK patients will be amongst the first in the world to benefit from these hugely exciting medical advances, made possible by the life sciences industry in partnership with the NHS. ‘Not only does it demonstrate the NHS’s attractiveness as a place to test and develop revolutionary new products, it is also another important step towards creating a truly twenty-first century NHS.’

Alongside these initiatives, there are also 15 Academic Health Service Networks across the UK. These are groups that aim to turn innovation into mainstream clinical practice – as quickly as possible. They are made up of NHS providers, commissioning groups, universities, research bodies and social care providers. These groups are charged with exploring ways to use technology to get the very best value out of the NHS budget – primarily by keeping patients out of hospital.

In Hounslow in London, for example, an extra £190m a year is being spent on out of hospital services, including integrated care and more access to general practice. GPs in the area are already starting to identify patients at highest risk of unscheduled admission to hospital. Practice nurses then co-develop a care plan with the patient and carer (where appropriate), ensuring that all the services the patient needs are working together to prevent them attending hospital when they don’t need to. A care navigator then works with the GP, the community matron and the social worker to support the highest risk patients. Diabetes is the number one target but the plan is to roll it out to respiratory illness too.
It all makes clinical sense. But does it make financial sense? Definitely.

It’s estimated that one in four people in hospital in the UK could be looked after in their own homes or the community. And some estimates suggest for every £1 spent in hospitals, alternative community care can be provided for 70p.

By Pat Hagan

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Have Rucksack, Will Travel!

Carolyn Wheatley, from the charity PINNT (supporting people at home with parenteral and enteral nutrition), charts the ups and downs of long-haul travel when you depend on home artificial feeding. 

I felt so organised  – yet so unprepared – for my journey to New York.

Organised in terms of meticulous planning, flight, connecting flight, hotels, medical supplies (fluids and ancillaries), communicating with my homecare company and nutrition team, medical letters, excess baggage arrangements – the list was endless.

But unprepared in terms of packing personal luggage. Come on, a girl needs good co-ordination and a selection of shoes. You have to be prepared for all eventualities!

Why New York? Well, I was fortunate to be attending a patient conference in Saratoga Springs, New York state. I am not a first time attendee. This is actually my third trip to the ‘Big Apple’ and I am in fact a seasoned conference traveller in the USA. It’s where I saw my first ambulatory parenteral infusion pump many years ago. I had ‘pump envy’, or should I say ‘freedom and lifestyle choice envy’.

It’s a long story but thanks to visiting this same conference many years ago I, along with a dear friend Dawn, returned to the UK and started to campaign for freedom and lifestyle choices by encouraging the introduction of ambulatory pumps into the UK.

But as I settled into my seat prior to take off the usual discussion took place with the air hostess about not being able to keep my rucksack with me during take-off. After explaining that I was connected to it (on long flights I always keep hydrated by infusing saline) she agreed it was okay to keep it with me. Presumably because she realised I couldn’t be safely stowed in the overhead locker along with the rucksack! Of course, I had made pre-flight arrangements. But as many people in my position will know, these aren’t always filtered down to the crew.

I’m fed via a central venous catheter every night with a three litre bag of parenteral nutrition. I may be gutless and in need of artificial nutrition but I do try and make the most of the investment so many people have made in me in terms of giving me back my life.

That said, taking your own ‘food’ on holiday isn’t everyone’s idea of fun. But for me it’s essential. I am not a fussy eater, simply unable to eat sufficient to sustain my life. I’m not complaining – no menus to drool over, no calorie counting; that’s been done for me, a twelve hour infusion of parenteral nutrition every night keeps me going. The menu, if you like, is pre-set.

It’s a bit of a nuisance at times and I have to admit it would be easy to skip a night. Yet the consequences wouldn’t upset anyone but me. Why would I risk making myself ill for the sake of a ten minute set up process? Home parenteral nutrition equals life for me and that’s motivation enough on those nights when I could easily cut corners.

The first part of my trip this time was to a small town outside New York to represent PINNT at a conference. And if I’m honest, I was feeling rather proud. Travelling with HPN for eight days is no mean feat. Lots of excess baggage and lots of bag counting to ensure all are present and correct, especially when catching a connecting flight. It’s anything but relaxing. There are lots of ‘what ifs’, the main one being what if something gets lost or broken in transit. That’s why it’s so important to have a ‘what if’ list and be prepared for problems. There are factors you can control but there are many that are also unforeseeable. The crucial thing is to have a back-up plan for how the disappearance of this very special baggage could be resolved in a timely and appropriate fashion. Oh and did I mention I was travelling with a colleague who has enteral tube feeding? So in essence it was potentially double trouble if something went wrong.

We finally arrived at the conference hotel and with little rest it was straight into the conference the next day. First on the list was a workshop by the Oley Foundation Ambassadors, a USA organisation that represents those needing home intravenous and tube feeding. As the UK Ambassador it’s a great opportunity to be updated with Oley business, then brainstorm with fellow ambassadors on how to fulfil our roles. As I am based in the UK my role is different but it’s wonderful when I can help someone when they worry about travelling to the UK. There are always laughs along the way as we all network to support patients.

The next two days were a mixture of plenary sessions and workshops. Again, great to find out what’s new, different or how to showcase UK processes and procedures. Mingling with fellow home artificial nutrition people always raises the question of travel, given that we’ve come all the way from the UK. We met a friend there from Czech Republic who had travelled with her parenteral nutrition too so we were all quizzed as to how we did it. It’s always a healthy debate and highlights the difference in cold chain transportation, multi-chamber bags and stability data for packaging, along with appropriates storage when in a hotel or holiday accommodation.

I should be able to accept the problems we face when storing supplies on the move. But I can’t. Most of the HPN patients I meet are happy to use ice from the ice machines at the hotel to keep their PN cold. I still can’t get my head round that because, here in the UK, we are taught very differently.

After a fabulously interactive educational conference we had time to stop off in New York City itself. Leaving the tranquil surroundings of Saratoga Springs and arriving in Times Square was part two of our educational trip. Similar routine; lots of baggage which was slightly depleted due to usage but sill more than your average traveller, sorting out fridges and working out how much and when to fit in essential feeds!

But there was no time to worry as we set out into the evening to absorb the electrifying atmosphere. Bright lights and crowded pavements. Enticing restaurants and bars at every turn, not so attractive when you are limited to what you can take in orally. Still, absorbing the atmosphere was good enough for us. Being in town on 4th July was also a great buzz with a splendid firework display.

Leaving aside all the excitement there is a serious side to travelling with artificial nutrition. I’ve often wondered whether, when a traveller dependent on artificial feeding asks for medical consent to travel, does the person in charge understand the consequence of their response? I firmly believe anyone electing to travel with artificial nutrition needs to assume responsibility for their decision.

For all those asking ‘Can I go on holiday?’ it might be better to start with where and when? It’s not just about being fit to fly. It’s also about being responsible for the preparation and planning.

PINNT often receive calls from people who say they didn’t appreciate all that was involved in travelling. I advocate choice; choice in being able to make decisions about your own life, or that of your child’s. But it needs to be an informed decision. PINNT produce Holiday Guidelines and Talking Points Information sheets that certainly aid the process of travel.

Reflecting on my trip to New York, I am always grateful that I managed to enjoy another wonderful experience. I’m not sure about you but while away I always say ‘where next?’

Well, for me, where next is Australia.

That will be another great adventure, so the meticulous planning has already started. The airline isn’t being as accommodating as I’d like in terms of excess baggage and that’s an obstacle to overcome. And as this trip involves a wider team of people on both sides of the world, communication is key.

But as long as I have the ability to travel and I can obtain appropriate travel insurance I will keep asking that question – ‘where next?’

By Carolyn Wheatley

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Healthy Mind, Body and Spirit

Janet Wrathall has ten years of Naturopathic Medicine clinical experience. She has undergone training in the UK and internationally and with some of the most talented forward thinking innovators in the Natural Medicine Sector.  Here she talks to us about her passion.

“Naturopathy is effectively an independent alternative healthcare profession in its own right, but it does aim to work in an integrated way with the modern allopathic medical model when required.

“Its roots are in the ancient traditions, but this century has seen its coming together with scientific study. Particularly with the realm of quantum medicine, which is beginning to explain why acupuncture may work and that our bodies do not just work at a bio-chemical level, but at an energetic sub atomic level where there is a sea of communication between the atoms. If this communication network is blocked then our bodies cannot function at an optimum level. Heavy metals are one of the worst culprits e.g. mercury in teeth fillings and vaccinations or chemicals in the atmosphere, foods, drink and body care products.

“State registered Naturopaths (ND) receive extensive training in anatomy, physiology and pathology as well as modern western assessment techniques. They have to have an excellent understanding of how the body works and what happens when things go wrong. They are also trained in one or two specialist areas like modern herbal medicine, nutrition or homeopathy.

“Naturopathic medicine works on all levels; body, mind and spirit. It uses various modalities, such as herbal medicine, hydrotherapy, ground breaking energy medicine systems as mentioned, diet and nutrition, in depth detoxification/cleansing programmes, counselling, musculoskeletal and emotional balancing to help conquer health issues. From the common cold to very serious conditions like MS and rheumatoid arthritis, naturopathic medicine can help.

“All these treatments help to clear the body of a build-up of toxic waste and therefore the reduction of inflammation, which is essentially what disease is all about.

“Initially an in depth assessment is done in order to establish the root cause of the disease followed by unique body fit treatment plan.

“Naturopaths are basically biological forensic scientists putting the clues together and then starting from ground zero in our approach to first cleanse the body and then rebuild it back to a balanced and vital state.”

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Happiness is a Choice

Toni Mackenzie is a North West based Hypnotherapist, Life Coach and Counsellor. Here she tells us that everything stems from thoughts, which instigate feelings, create vibrations and ultimately attract our own unique reality.

“My work is about helping people to feel calm, relaxed, confident, and ultimately, happy. So many people don’t realise that happiness doesn’t come from other people, outside experiences, or material goods, enjoyable though those things may be! Neither happiness, nor unhappiness, are caused by what’s going on outside of us, happiness is an inside job. How we feel depends upon how and what we think, and no-one can control our thoughts except ourselves.

“Most of the time we are unaware of the thousands of thoughts that are going around in our heads throughout the day, and the fact that so many of them are negative. Once we do become aware of them, and learn how to change them, we can begin to change our lives and be able to feel happy pretty much all of the time.

“Of course there are times when something genuinely distressing happens, such as being diagnosed with a serious illness, or the death of a loved one. I’m not suggesting we should just easily shrug off our fear or sadness at such times, I’m talking about all the every day trivial things we can allow ourselves to feel upset, annoyed, frustrated, envious, fearful or angry about. Often things we can’t change, things that happened back in the past, things that just may possibly happen in the future – things that really don’t need to affect how we feel in the ‘here and now’.

“As a qualified and experienced Hypnotherapist, Psychotherapist, EFT Tapping Practitioner, NLP Therapist and Life Coach, I have many tips, tools and techniques on how you can do this and I’m going to share one of them with you now. It’s the rubber band ‘Thought-Stopping Technique’, and this is how it works…

“Put a rubber band around your wrist and whenever it catches your eye, pause, and check what your ‘inner chatterbox’ is saying. If it’s criticising, complaining, moaning, worrying, comparing yourself to others, telling yourself off, saying something ‘isn’t fair’, or anything else negative, firmly command it to ‘STOP!’. Then ping your elastic band, and replace the negative thought with a positive one. Initially, as soon as your attention is distracted, the ‘chatterbox’ will creep back in again because it’s not used to being stopped, but keep doing it for a few days and it will begin to get the message.

“If you commit to doing this for several consecutive days, you’ll soon find that those old negative thoughts are hardly ever there, and if they occasionally do pop up, you notice them straight away and stop them in their tracks! As you begin to focus on all the good things in your life, and the many things you have to be thankful for, to live in the present moment instead of the past or the future, and to be kinder to yourself, you will discover that you are the creator of your own happiness.”

Credit: Toni Mackenzie (http://www.innerdepths.co.uk)

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The Next Generation of Midwives

The choices of the next generation of midwives will impact those available to the next generation of mothers. By Ali El Moghraby.

Andrea Robertson has just qualified as a midwife. She sites her journey from being a staff nurse to becoming an NHS midwife as ‘a calling’. She continues to be in awe of the profession she has spent the last two years studying towards.

“Every day I admire and respect the experienced midwives when they are at work,” she says. “Midwives care so much for the women and families who come into their labour wards. They work really hard to give those women the birth that they want.”

Andrea is excited about the support she is going to give to women and she has a plan for how she wants to achieve that. “I am looking forward to gaining experience in the NHS,” she says, “but I think I will become an independent midwife in the future.”

Her reason for this is that the NHS is not able to give women one to one care. “For example, when a woman has queued behind 40 others to have her baby weighed and her blood pressure checked, she’s not likely to be comfortable talking about her feelings to a stranger,” explains Andrea. “But if she knows her midwife, it’s easier to say ‘I am feeling strange today’ or ‘can I just sit down and have a chat with you’ if that’s what she needs.”

For Andrea, the increasingly litigious nature of midwifery makes her uncomfortable when she thinks about the effect it has on the level of medical intervention seen in labour wards. Having spent six weeks in Africa where mother and infant mortality rates are higher than in the UK, she is able to put the impact of litigation on the medicalisation of midwifery here into a bit of perspective. “In Africa, it is accepted that women and babies can die in childbirth,” says Andrea. “While no-one should die in labour, our culture of needing to blame someone if the worst does happen means that midwives are questioning themselves rather than having faith in their own judgement. So midwives are more likely to focus on what could go wrong and send a woman for a procedure than trust their decisions and give the women time to birth her baby herself,” she says.

As Andrea embarks on what she sees as her destiny, the future of the profession lies in her and her peers’ hands.  How many choose to turn their back on the NHS and become independent midwives remains to be seen.

By Ali El Moghraby

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Choices Start with which Advice To Take

Nicola Nicholson went against her consultant’s advice and chose an independent midwife for her second child.

‘I see no reason for you to not have a successful natural birth after a caeserean section, but as you are high risk, you will need to be on the labour ward for continuous monitoring.’

These are the words of my consultant, which felt strangely contradictory. I was in early pregnancy with my second child, following a pretty harrowing experience with my first baby, which ended in an emergency caeserean section. A heated exchange of words followed, as I explained that being forced to lie back strapped to machines would in no way allow me to birth my baby naturally. I was told in no uncertain terms that to do anything other than this would put my life and that of my baby at risk.

The thought of this filled me with dread, so I began to do my own research. The more I thought about it the more I knew that hospital was the last place in the world I wanted to be.

So I asked a good friend who is a midwife, whether she thought I would be crazy to have my baby at home. She explained the risks to me in terms of probabilities and this enabled my husband Charlie and I to make what we felt was quite an easy decision. We felt the benefits of being at home far outweighed any undue risks.

We decided to pay an independent midwife to look after us during the remainder of my pregnancy and the birth. We wanted to know that the person present on the day would be experienced in home birth and would not rush us into hospital unless there really was a genuine need. This turned out to be the best investment we could have made.

Our midwife, Meg, had decades of experience in natural births, understood all the risks and totally trusted in her own abilities and those of the birthing mother to be able to do it just as nature intended. She was an incredible support, especially when I had the hospital pressuring me to go in for an induction because my baby was ‘overdue’. Meg kept saying if I wanted to birth my baby naturally, I needed to leave it alone. Do nothing, but chill out, it will come when it is ready.

I spent a lot of my pregnancy visualising what my perfect birth would be, and in the end , it was exactly that! My waters broke around 11.30pm so Charlie called the midwife and our doula and began filling the birthing pool. We had decided to have a doula for our home birth to provide extra support to him and Meg, and this also proved to be a very worthwhile investment.

Meg arrived soon after, and observed me quietly and un-intrusively. There were no internal examinations, just a few whispered questions and then she quietly told me that I could get into the pool.

What a wonderful relief warm water is! I was in my kitchen, with a few candles and some soft music playing, with Meg, Charlie and Louise working in whispers around me. I didn’t hear all the exchanges that occurred, I was in my own zone, completely surrendered to the moment. Not once did I ever allow myself to think anything other than ‘I can do this’ and I never felt out of control or overwhelmed.

Our beautiful baby girl, Isabelle Rose, was born just after 4.30am, peacefully in the pool. An hour later, her older brother Ben trotted downstairs, immediately noticed some chocolate biscuits by the fireplace and didn’t even realise that he had a new sister!

What a stark contrast to our first birth experience, which ended up being filled with bright lights, pain and fear. Hindsight is a wonderful thing, but so is the power of a woman’s body. Given the right circumstances and being allowed to do what we all instinctively know, we call all birth like goddesses. Trust your instincts, we’ve being doing this for millennia.

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Home Alone

The good news is we’re all living longer. The bad news is nobody seems quite sure how Britain’s health and social care infrastructure will cope with the far-reaching consequences of this increased longevity. 

At Marie Curie, Dr Jane Collins has been spearheading changes that are taking the organisation beyond the confines of its traditional role in palliative care.

Marie Curie now recognises that it’s not just the clinical needs of the terminally ill that require servicing but the psychological strain of being ‘home alone’ while facing illness.

Volunteer Scheme

“In recent years, we have recognised that people who perhaps live on their own and are approaching the end of their life are often very socially isolated,” says Dr Collins. “There has been quite a lot about this in the press lately, particularly about men.

“So we have devised a volunteer scheme called Helper Volunteers, where a volunteer goes into somebody’s home for up to three hours a week. Their role is to provide emotional and practical support. But it mainly centres around emotional support for people who are rather isolated.”

Dr Collins describes Marie Curie as a ‘roll your sleeves up’ type of operation. Its core activity is providing nursing care in people’s homes.

But while the obvious focus is the person who is terminally ill, it’s the families of those affected, she says, who probably glean the greatest benefit.

“Often it may be that the husband or wife is able to get a good night’s rest knowing their loved one’s got with them someone who’s very experienced in caring for those approaching the end of their life.

“The family is as important to the way we work as the person who needs the care. We know the two most important things for people approaching death is pain control and having family and friends around.”

But she has a problem with the term ‘end of life’, or at least the way most people perceive it.

Understandably, the image that springs to mind for most of us is of someone struggling for breath as they enter their final hours and minutes.

Precious Time

In fact, there is good evidence that end of life can be prolonged by encouraging the right lifestyle. Exercise, for example, can boost strength and buy precious time.

“Thinking about a rehabilitation programme might sound odd in the context of terminal illness but it isn’t odd at all. People who are losing weight because they have got a terminal illness may get into a vicious cycle where they don’t get out and they don’t get any exercise so they get weaker. What we want is for people to have as good a life as they can, until they have their last breath.”

She points to the positive effects on lifespan from the terminally ill continuing to pursue their favourite hobbies.

“For example,” she continues, “we are one of the beneficiaries of the National Gardening Scheme. There’s good evidence that the benefits of seeing living things and being out in the fresh air can be a boost. Even being able to look out of the window and see trees can provide a benefit.”

Starting out

Dr Collins’ passion for palliative care stems, ironically, not from years of working with those nearing the end of life but those just starting out in it.

A paediatrician by ‘trade’, she worked as a consultant paediatric neurologist at Guys Hospital in London and then at Great Ormond Street Hospital, before serving an 11-year stint as the latter’s chief executive.

“I felt it was time for a change and I have always been really interested in palliative care,” Dr Collins explains. “‘As a neurologist I looked after children for whom there were limited treatment options and recognised the devastating impact that had on families, particularly if their child died.

“I had a longstanding interest in palliative care for children and so when I was thinking ‘what am I going to do now’ and saw the job (Marie Cure chief executive) advertised, I felt that it was a very natural move.”

But she’s under no illusions at the size of the task she faces if the terminally ill and their families are to get the support they need as they face death together.

Dr Collins recognises that the lone voice of a single charity – however high profile – wields less clout than the collective force of interested parties working in unison.

Together with a number of other charities and educational organisations (including the Cicely Saunders Institute at Kings College), Marie Curie has compiled a hit list of topics that should get politicians’ attention in the run-up to next year’s general election.

She says: “One of the most important things for people is getting access to social care.

“We know from a variety of different pieces of work that have been done by us and by others that one of the reasons why people who want to die at home aren’t able to and get admitted to hospital instead is a lack of social care. That’s not to say some people don’t need to die in hospital rather than home. But many don’t.

“Social care is more complicated than health care because it’s means tested and so one of the main things we’re asking for is free social care in the last three months of life.

“Obviously, it’s quite tricky to define when your last three months are. But it’s at least something which people can start to get their heads round.

“Local authorities and their partners who are providing social care will have to understand that some people might not survive three months and some people might survive longer. This is one of the things that we are very much promoting. It already has some political traction but we’d like it to have more. We will keep talking about it and one of the advantages of working in partnership is we have a louder voice collectively than we do separately.”

The Impact

But why does a good death even matter?

Again, says Dr Collins, “it’s not only about the person who is dying but the impact on those they leave behind. In short, people remember the bad times as much, if not more, than the good.

“I meet people and tell them I’m the chief executive of Marie Curie and they will often recount their experiences of somebody they’ve loved who’s died. It could have been very recent, or it might have been 20 years ago. But there’s something enduring about the experience for those left behind. If their loved one didn’t have what they wanted, their pain wasn’t managed or they just were not listened to, that stays with people in a way that is not helpful to them.

“What should we be aiming for? For everybody to feel that a death was as good as it can be. That might sound funny. But it is what we all want for each other.”

By Pat Hagan.

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