Science & Health – The Daily Opinion

Great Expectations: The Cost of Misunderstanding the NHS

The NHS has a big problem. I’m not talking about questionable financial management, the dangers of excessive entanglement with the private sector, or even superbugs on the wards. The biggest problem I see in the NHS today is a chronic lack of understanding on the part of the public. The very group of people it was set up to assist is contributing to its downfall.

Sitting in a waiting-room in a hospital department recently, I couldn’t help but overhear some of the comments made by other patients. One gentleman, perusing the reading material set out by the water cooler, complained that the magazines available were old issues. Another voiced the opinion that the department’s nurses didn’t ‘look professional enough’. Yet another, upon hearing that she would be seen by a locum doctor as her usual clinician had been called away on an emergency, demanded to know why she should bother turning up for her appointment if her doctor didn’t.

Expensive uniforms. Robotic medical professionals. Magazine subscriptions. Such are the expectations of a service set up first and foremost to provide decent and affordable healthcare for all who need it. Of what possible relevance would the latest issue of Heat be to your health? How could the last-minute substitution of one doctor for another equally well-qualified one be less convenient than having your appointment cancelled? And why on earth would you think that spitefully missing your appointment would be hurting anyone but yourself?

It’s on this last point that I would like to concentrate – because, actually, you aren’t only hurting yourself. Each missed appointment has a knock-on effect on patients, doctors, and hospital services. Allow me to take you through the process.

Imagine you have an ongoing health problem of some kind. Let’s say it’s a skin condition. It flares up like eczema, but the usual creams and ointments don’t seem to have any effect. You’re scratching your elbows down to the bone and climbing the walls in frustration, so your GP refers you to Dermatology. You are sent an appointment letter from your chosen hospital, asking you to attend on a certain date.

At this point, the following people are already involved in your care:

Your GP, who referred you
A Consultant Dermatologist, who checked over your referral letter to assess whether you had been referred to the correct department
A secretary, who scheduled your appointment, created the letter and sent it to you

These people are paid to work in the NHS. The NHS is paid for through taxes. Taxes are paid by you.

Let’s continue.

So now the wheels have been set in motion. You have your appointment date, but – glory be! – your inflamed skin has miraculously cleared, and you see no need to attend your appointment. Fair enough. It’s your health, it’s your decision. At this point, according to the information detailed in your hospital appointment letter, you contact the Dermatology department to let them know that you no longer need the appointment. They now have an empty slot in that day’s schedule, which they fill by offering it to another patient who needs it, which helps to cut down their waiting-list.

Only… you don’t contact Dermatology. It’s only the NHS, after all – it isn’t like a private medical clinic, or even the dentist, who would charge you if you didn’t give at least twenty-four hours’ notice of cancellation. The NHS doesn’t charge anyone, because it doesn’t actually cost anything.

Before we debate the ridiculousness of that viewpoint, let’s return to our scenario.

We now have two conflicting realities: one, in which you have decided you won’t be attending your appointment, but haven’t let the hospital know this; and two, in which the hospital has arranged for a highly-trained specialist in skin complaints to review you and offer their expert medical opinion in order to help you.

The day of your appointment arrives. Over in the Dermatology department, the receptionist has created a file for you in anticipation of it being filled with notes about your condition. Down the hall, a trained medical professional is waiting in his (or her) office to help you, not knowing that you won’t be turning up. He can’t just call in the next patient, because perhaps you’re running a few minutes late. Perhaps he could use the time to answer some of the many written queries that arrive from GPs and patients every day, but again, he can’t really get stuck into anything, because you might be about to walk through that door.

Any minute, now.

Had you attended your appointment as planned, the clinician would have then dictated a letter to your GP, which would then be typed by the departmental secretary and sent out. Your lack of attendance doesn’t mean that this doesn’t happen. The clinician still dictates a letter to let your GP know that you didn’t attend, and the secretary still types it and sends it. This is part of what is called continuity of care. Communication keeps everyone informed.

Let’s just remind ourselves how many people are currently involved because you asked for help:

Your GP
One secretary
One receptionist
One Consultant Dermatologist

And now for some very rough numbers (because I’m no statistician) – please take the following as averages:

A GP earns around £100,000pa (call it £50/hr) – 15 minutes spent seeing a patient and making the referral therefore costs around £12.50
An NHS secretary earns £23,500pa (call it £12/hr) – 20 minutes spent typing a couple of letters, scheduling an appointment, and printing and sending said letters costs £4 (not counting the cost of stationery and postage)
An NHS receptionist earns £16,500pa (call it £8.50/hr) – 10 minutes making up a file costs around £1.50
A consultant earns around £100,000pa – the initial consultation (or, in our scenario, the vacant slot intended for it), plus time to dictate a letter and make any necessary onward referrals within the hospital network, takes about one hour (often longer, in fact) of their time, at a cost of £50.

That’s £68 wasted, according to this rather conservative estimate of time and money spent. That doesn’t include all those little extras like postage, stationery, electricity. I guess if we wanted to include those we could round this figure up to £70. So that’s £70 of public money – your money – down the tubes every single time a patient does not attend an appointment and doesn’t let the hospital know. Taking into account NHS England’s recent estimate that 6.9 million hospital appointments are missed every year in the UK, that’s a sizeable chunk of public money gone for no good reason.

If we, the public, thought of the NHS as a “real” business, rather than a fantasy world where doctors and nurses toil merrily all day and night for free just for the warm fuzzy feeling of knowing that they’re doing good, we’d more easily be able to compare costs and make the right decision – to spend a few minutes and less than 50p cancelling an appointment by phone, or to waste £70 and a good couple of man-hours by not doing so. It’s a financial no-brainer.

And yet the status quo persists, the NHS continues to haemorrhage money, and many people continue to complain about the services. But is it any wonder some of the waiting-lists are so long if patients habitually miss their appointments and fail to give any notice that a slot has become available? And is it any wonder that so many departments are grossly overspending, given the amount of money wasted on empty appointment slots, rescheduling, and extra letters?

I think so many people miss their appointments because they take the NHS for granted. They see it as a free service that they can take or leave. The money that funds it is taken out of our wages straight off – we never see that money so we don’t see it as a loss when it’s inefficiently spent. It isn’t perceived as being the same as missing a private appointment, where you’re charged for it if you don’t cancel in time and the money comes straight from your own pocket. But it is, in a very real, if less direct, sense, money taken out of your pocket and tipped down the drain. And in the case of missed appointments, it’s a very preventable waste of money.

We take the NHS for granted because we don’t think about how it works. We don’t understand it and we only talk about it when it disappoints us. We make demands of it as if it has limitless funds; we complain about the money being wasted, yet we refuse to acknowledge our part in that wastage. This is our own money we’re throwing away! These doctors and admin staff are here to help you, but they can’t help you if you don’t turn up and they certainly don’t deserve your vitriol when the service you receive is inevitably less than perfect. We need to meet the NHS halfway for it to work efficiently and cost-effectively. We have a responsibility for our own health and a responsibility for our public services. It’s time for each and every one of us to recognise our part in it.

Researchers Reveal Giant Glacier Melt Rate

As scientists try to establish a realistic prediction for how much sea levels can be expected to rise globally, a new set of results yielded from a new study in Antarctica have revealed how the continent’s longest glacier is being melted by the warm ocean flowing beneath it, at a rapid rate.

The Pine Island Glacier – measuring an impressive 31 miles long – has always been of great interest and eager scientists are finally able to monitor its behaviour more closely after the first successful research trip to the treacherous ice sheet.

Although it has been known since the end of the 1980s that the ice shelf is melting from beneath, its remote and tricky location had made it an impenetrable site. “In my 35 years doing fairly large oceanographic projects, the Pine Island Glacier one tops it in terms of its complexity and challenge,” said Professor Tim Stanton, the leader of the research team.

“But it’s clear that it’s very important to understand how these massive ice shelves are influenced by changes in the ocean. These observations will provide the basis for improving global climate models.”

An expedition in 2007 saw the first successful attempt to land on the Antarctic’s fastest flowing glacier, after determined efforts by the team to navigate the wind-whipped area. However, the trip ended in disappointment when logistical problems forced them to abandon their efforts for the much-needed research.

This was followed by a further attempt in 2011, which was thwarted by bad weather conditions. The team reached their location too late in the season and were left unable to carry out their investigations.

Finally in the December of 2012, the team of international scientists – including NASA and the British Antarctic Survey- finally embarked upon a fully-successful trip, installing the necessary instruments to generate the much longed-for results.

This trip was again repeated in January of 2013 and these long-anticipated expeditions created three new research camps which were set up in the centre of the glacier. Now finally, scientists have been able to establish specific measurements relating to its deterioration.

Drilling down into at least 450m of ice, using hot-water drills, the team installed a set of instruments below the shell. They were able to generate readings relating to both the speed and temperature of the water flowing beneath – measurements which previous satellite readings and airborne data had been unable to offer accurate results for.

The full paper, published in Science, describes the team’s studies and reveals just how severe the melting is. At some places, the rate is as high as 6 centimetres (2.36 inches) per day- equating to approximately 22 metres (72 feet) per year.

“What we have brought to the table are detailed measurements of melt rates that will allow simple physical models of the melting processes to be plugged into computer models of the coupled ocean/glacier system,” Stanton explained.

“These improved models are critical to our ability to predict future changes in the ice shelf, and glacier melt rates of the potentially unstable Western Antarctic Ice Sheet in response to changing ocean forces.”

Organ Donation: Are You In?

You shouldn’t worry. It’s never going to happen to you, is it? It’s always that thing that you read about in the papers; the statistic on the news; a story that comes up over a coffee about a friend of a friend.

When it comes to organ donation, you could presume that your only connection to it will be in deciding whether or not you might make the noble decision to donate your organs in the event of your unfortunate demise.

But what if your heart starts to fail? It has been beating every minute of every day of every month of every year of your life…what if all along you had a silent fault waiting to strike? Or, what if you ended up developing end-stage lung failure or your diabetes became so bad that you needed a new kidney…

And then you realise that only 31% of the UK population is registered to become organ donors.

Then you are told that, as an adult, the average wait for a kidney is over three years; the median for a lung transplant over one year and the wait for a heart, an average of 253 days.

And what if you aren’t well enough to survive that wait?

An estimated 1,000 people die each year waiting for a life-saving organ, according to the NHS. The very unfortunate truth is that there are always more people needing organs than there are healthy ones available from donation. At present in the UK there are over 10,000 people needing a transplant. Whilst the wait for organs can obviously be different for all patients, the delay is always going to be inevitable while there is such a severe shortage of organs available for transplantation.

And sadly, for many the wait is just far too long.

Waiting time can also be negatively influenced by the disparity in the number of organ donors from certain ethnic backgrounds including those from south-Asian, African and African-Caribbean communities. This is particularly so because, for example, black people have an increased chance of developing kidney failure – three times more so – than the rest of the UK population. Ethnicity is so important because tissue and blood type compatibility are much more likely to prove a match; crucial in the success of transplantation.

The vital element within the UK system has always been consent; people have to actively ‘opt-in’ and give their consent to organ donation by actively adding themselves to the register, having a donor card or by otherwise discussing their wishes with their loved ones. Wales, however, has recently broken away from the system in favour of the ‘opt-out’ system – where consent is presumed for all unless the person has chosen to opt-out. A system which inevitably provokes much debate with the religious and ethical issues that arise. In both systems though, the final decision falls to the next-of-kin.

So let’s face it, ‘opt-in’ or ‘opt-out’, the bottom line is this: In the utterly devastating and tragic event of a loved-one’s death, there could still be the potential of passing on the incredible gift of life – even to several people.

And when that question of organ donation is broached, will you know what they would want the answer to be? Would you have the knowledge, and indeed the strength, to recognise the wishes of the person you love? Will you be certain enough to follow through their request – whether it be in favour of donation or not?

The bottom line is that we need to talk about it. We need to know. And we need to act on it.

For more information and to find instructions on how to join the organ donor register go to: NHS Choices Organ Donation

Tweeting Astronaut Chris Hadfield To Retire

Commander Chris Hadfield – the Canadian astronaut who shot to fame with his tweets from space – is to retire from the Canadian Space Agency.

Making unique use of social media to report on his work and to send amazing pictures of Earth from the perspective of space, 53-year-old Hadfield managed to capture and captivate the world’s attention, and also to reignite people’s interest in space exploration.

However, it was on his last “day” in space, when he sang a rendition of David Bowie’s “Space Oddity”, when the song went viral and he became something of a superstar of space exploration. Since returning to Earth, Hadfield has remained very much on top of his game, continuing to tweet and post about matters relating to the planet, and its “role” within the greater context of space.

Hadfield announced his retirement at a press conference outside Montreal yesterday after having received a visit from Canadian Prime Minister Stephen Harper, and will return to live in Canada shortly. Speaking of his space venture, Hadfield said that “it has been an incredible adventure”, and commented on his ISS project, which saw him achieve international fame, as being “a kind of pinnacle of my entire career… since I was a little dreaming kid of nine years old thinking of flying into space.”

Indeed it is true that Hadfield’s ambition has seen him become the first at many endeavours, including being the first Canadian to spacewalk, and the first Canadian to visit the Russian Space Station MIR in 1995.

Of course, more recently, Hadfield has become both the first man to tweet from space – thereby proving that it can actually be done – and the first man to film a music video in space (albeit a relatively low budget one).

Now that he has become, essentially, a multi-record breaker in space exploration, Hadfield has certainly earned a break from his hard work, promising his wife that they would move back to Canada one day when his space work was complete.

However, as he has declared plans to continue giving presentations and promoting space exploration, it is apparent that this is not the last we will be hearing from Hadfield, and he will continue to be a prominent figure in the space industry.

‘Scarless’ surgery? Check out NOTES

Surgery is a daunting prospect. The thought of another human-being rummaging around in your insides is enough to turn anybody a bit pale with worry. Oh- and as an added bonus- the chances are, you are going to be left with a lovely scar to commemorate the event.

Well actually, that may not necessarily be true…

Pushing the boundaries of existing minimally-invasive technologies, surgeons are currently attempting the amazing feat of being able to complete certain procedures without the need for incisions. Via, shall we say, naturally existing access routes within the body.

Yes: it is what you are thinking.

The rectum, vagina, urethra and also the mouth are all channels utilized in NOTES (Natural Orifice Transluminal Endoscopic Surgery) in order for doctors to gain access to internal areas needing to be operated on.

The basic principle of NOTES has been an established means for diagnostic tests and simple therapies for a while- for example, inserting a camera into the throat to better view of internal structures (known as endoscopy). Now however, this technology is being explored in an exciting new capacity.

The potential to be able to complete full surgical procedures through already-present orifices in the body, means that new openings do not have to be created and therefore surgeons can try to avoid putting patients through the physical trauma of being cut open. Instruments, including a camera, can be inserted into these sites, allowing for surgeries to be performed in an incredibly minimally invasive way.

When compared with conventional laparotomy (standard open surgery, requiring a substantial incision into the abdomen) and laparoscopy (minimally invasive surgery, which uses small incisions into the abdomen, followed by the insertion of instruments into the body via ports), NOTES comes with a range of potential benefits.

The major advantages can mostly be attributed to the lack of an external wound site. This key achievement of NOTES means that the patient does not have to suffer the additional pain of wound-healing; does not have the risk of developing an incisional hernia and crucially; has reduced risk of surgical site infection.

Post-operative infection is one of the most common complications of surgery and can be deadly; by taking away an external healing site it severely reduces the chances of germs getting to the surgical site and creating a nasty infection.

Added to this, there could also be a reduced requirement for anaesthesia and shorter hospital stays too. But inherently unique to this surgery, is that it is ‘scarless’. This is even to the extent that on occasions when another camera is needed to be inserted from the outside, a very small incision is made into the belly button, in such a location whereby the cut will be hidden within folds of the skin.

Research and training are currently in progress to help propel NOTES to its full potential. With this technology already proving its feasibility in human trials, mainly in the field of general surgery- from removal of the appendix to biopsies to the treatment of intestinal cancers- it may not be too long before this technique establishes itself as a significant evolutionary step in modern surgical methods.

Photo credit: TopNews.in

First Mars Colony On The Horizon

The search for potential astronauts to help create the first Mars colony is well underway.

On Monday, Dutch company Mars One officially launched a reality-show type bid on Twitter and YouTube to recruit volunteers to be part of the pioneering space missing, and so far they have been contacted by up to 10,000 people.

The trip will leave Earth in 2022, with a view to reaching Mars in 2023. It will involve four people spending seven months in a small capsule during the journey, and the trip will be one way, with no reasonable expectation of return. But the sheer popularity of this mission upon its launch shows that there is no shortage of people willing to be the first ambassadors in the next step of space exploration.

It will be a unique test to see if humans really are capable of living and even populating outside Earth, but another key motive for sending people to live there is to determine, more accurately, is Mars is capable of sustaining other forms of life.

Executive director of Explore Mars, an organisation devoted to exploring life on Mars, said that “there is a strong, growing body of evidence that there could be subsurface life on Mars. However, we may not be able to confirm that unless we send people.” Simply, there are limits to what current robots can achieve physically compared to humans, in terms of drilling and digging, and humans could most likely undertake in a few minutes what a current make of man-made robot can do in an entire day.

However, for the advantage of sending human explorers to Mars, there is a disadvantage. People will inevitably bring with them billions of microbes and bacteria which will potentially compromise the eco-balance of Mars and any life that may be found there. This is a risk of which the Mars pioneers are well aware, and the general consensus is that every precaution will be undertaken to minimise the biological impact of the primary Mars colony.

Certainly, the mission will not be without risk to either the human colony or to existing life on Mars, but now that the limits to current robot exploration are drawing close, to send people to Mars as a next step makes sense.