Night time eating? Heart disease coming

That late night snack may be comforting and the perfect end to a day. However, if research is proven to be right, it could be the cumulative cause of heart disease.

Scientists have always known that night shift workers are at greater health risks than workers who work regular patterns. Which is why if you divided the pay shift workers receive by the hours worked, you would find that they have a higher hourly rate compared to those who do the same job during normal hours. That extra pay is to compensate for what is commonly perceived as the extra demand of working during the night, at a time your body is looking to shut down for a rest. The external pressures of going against your body, over a prolonged period, can exert a toll on the body.

Scientists in Mexico researching the links between diet and the human body tested their hypotheses on rats. The rats were fed food at a time when their bodies would normally be at rest, and the results showed that the fats from food remained longer as triglycerides in the body’s bloodstream for longer, because their bodies were at a resting state and not primed to break down food.

Bearing in mind that the research was done on rats, and while some results may have bearing on humans and some may not, what points could we take from these research results?

Having high levels of triglycerides in one’s body means that the risk of cardiovascular diseases such as heart attacks are significantly increased. Hence, if you are eating late at night, you may be at greater risk. Although the research is only at its infancy, they could suggest that the body is better when it comes to the processing of fats, when it is at its most active state, as it comes at more of a natural time.

What can you do if you work shifts? You may not have much control over the food you eat, but you can take steps towards eating a healthier diet and make time for regular exercise so the overall risk of heart disease is lowered. And if you do not work shifts, but work during the day, a big meal late at night is also best avoided for you.

Why mental health problems will never go away

Many people will experience mental health difficulties at some point in their lives. As people go through life the demands on them increase, and over a prolonged period these can cause difficulty and ill health. These problems can manifest themselves both in mental and physical ways.

What kind of demands do people experience? One of these can be work-related. People may experience  stresses of looking for work, having to work in jobs which do not test their skills, or be involved in occupations  which require skills that are seemingly difficult to develop. Another common theme with adults that causes stress is having to work in a job which increasingly demands more of them, but does not remunerate them accordingly. In other words, they have to work more for less, and have to accept the gradual lowering of work conditions, but are unable to change jobs because they have already invested so much in it in terms of working years, but cannot leave and start afresh because the demands of a mortgage to pay off and a young family to provide for means they cannot start on a lower rung in a new occupation. Over a prolonged period, this can cause severe unhappiness.

Is it surprising that suicide affects men in their thirties and forties? This is a period for a man where work demands more, the mortgage needs paying, and the family demands more of his time and energy. It is unsurprising that having spent long periods in this sort of daily struggle, that men develop mental health problems which lead some to attempt suicide. But mental health does not just affect men. Among some of the this some women have to deal with are the struggles of bringing up children, the work life balance, the unfulfilled feel of not utilising their skills, and feeling isolated.

One of the ways ill health develops mentally is when people spend too long being pushed too hard for too long. Put under these kind of demands, the body shuts down as a self preservation measure. But the demands on the person don’t just go away. You may want a break from work. But this may not be possible or practical. In fact, the lack of an escape when you are aware you need one may be a greater trigger of mental illness, because it increases the feeling of being trapped.

It is little wonder that when people go through periods of mental ill health, an enforced period of short-term rest will allow them to reset their bearings to be able to continue at work, or return to work with some level of appropriate support. But this is only temporary.

With mental ill health problems, lifestyle adjustments need to be made for sufficient recovery.

Under the Equality Act (2010), your employer has a legal duty to make “reasonable adjustments” to your work.

Mental ill health sufferers could ask about working flexibly, job sharing, or a quiet room, a government report suggests.

The practicality of this however means more cost to the employer in having to make adjustments to accommodate the employee, and unless the employee is a valued one, whom the employer would like to keep, often the case is that they will be gradually phased out of the organisation.

In fact, when an employee attains a certain level of experience within an organisation, employers often ask more of them because they know these employees are locked in to their jobs, and have to accept these grudgingly, or risk losing their jobs, which they cannot do if they have dependents and financial commitments.
And you know the irony of it? The mental ill health sufferer already knows that. Which is why they don’t speak out for help in the first place.

If these employees complain, employers simply replace them with younger employees, who cost less, and who are willing to take on more responsibilities just to have a job. Any responsibilities the redundant employee had simply get divided up between his leftover colleagues, who are in turn asked to take on more responsibilities. They are next in line in the mental health illness queue.

And what if you are self employed? And have to work to support yourself and your dependents? The demands of the day to day are huge and don’t seem to go away.

You can see why mental health is  perceived a ticking time bomb. Organisations are not going to change to accommodate their employees because of cost, but keep pressing them to increase productivity without pay, knowing that they cannot say no, and when all the life and juice has been squeezed out of them, they can be chucked away and replaced with the next dispensable employee.

A ticking time bomb.

The financial considerations of investing in medicine and medical research

BBC News reports that a drug that would reduce the risk of HIV infection would result in cost savings of over £1bn over 80 years. Pre-exposure prophylaxis, or Prep, would reduce infection and hence lower the treatment costs for patients in the long term.

The catch? There is one. It’s the long term.

The cost of the treatment and prevention is such that its provision for the first twenty years – bundling together the cost of medical research and production of medicine – would result in a financial loss, and parity would only be achieved after a period of about thirty to forty years; this period is hard to define because it is dependent on what the drug would cost in the future.

Prep combines two anti-HIV drugs, emtricitabine and tenofovir. The medical trials behind it have concluded it has an effective rate of over one in five when it comes to protecting men who have unprotected sex with men from HIV infection. The exact figure is close to 86%.

Prep can be used either on a daily basis, or on what has been termed a sexual event basis – using it for two days before, during and after periods of unprotected sex.

The research model analysed the potential impact of Prep and found that it could reduce infection rates by over a quarter. The cost of the treatment itself, comparative to the cost of treating infection, would result in a saving over one billion pounds over eight years.

However, it does raise a few ethical questions. If the National Health Service is aiming to be a sustainable one – and one of the aims of sustainability is to empower citizens to take responsibility for their own health –  shouldn’t it be considering less about how it will balance the books, but spend more on education for prevention in the first place? The cost of producing Prep on the NHS would be £19.6 billion over 80 years; while the estimated savings from treatment would be £20.6 billion over the same period. Educating people not to have unprotected sex with those at the risk of HIV arguably would result in a higher saving over a lower time period. Perhaps the NHS should consider ways of reducing cost more significantly, rather than latching on to a cheaper prevention drug immediately. If consumer behaviour is not going to change, symptoms are still going to surface, and the provision of Prep on the NHS may only encourage less self-regulation and awareness.

Airbnb style recuperation for hospital patients

Would you welcome a stranger into your home? Would you have a spare room set aside for them? Perhaps not. But what if you were paid to do so? This is what some hospital bosses are considering to relieve overcrowding in hospital wards, that patients do their recuperating in private homes, rather than in the hospital. You offer a room if you have one available, and the hospital rents it from you for a patient. It is like an airbnb for hospitals.

On the face of it, this seems like a good idea. Hospital overcrowding is lessened, home owners get a bit of spare cash, the recuperating patient gets a bit of company … everyone’s happy. Patients staying out of hospitals mean that the backlog of operations can be cleared more quickly, resulting in a better streamlined NHS that benefits every citizen.

This idea is being piloted by the startup CareRooms. “Hosts”, who do not necessarily need to have previous experience in healthcare, could earn £50 a night and up to maximum of £1000 a month putting up local residents who are awaiting discharge from hospital. The pilot will start with 30 patients and the hope is that this will expand.

AgeUK claims that patients were being “marooned” in hospitals, taking up beds while 2.2 million days are lost annually to delayed transfers of care.

The specifics, however, do not seem to hold up to scrutiny. Who is responsible for the overall welfare of the patient? Once a patient is transferred to this “care” home, the responsibility of medical care is devolved to someone with basic first-aid training.

Prospective hosts are also required to heat up three microwave meals each day and supply drinks. Unfortunately it opens the issues of safeguarding, governance and possible financial and emotional abuse of people at their most vulnerable time.

The recuperating patients will “get access to a 24-hour call centre, tele-medical GP and promised GP consultation within four hours.”

The underlying question, though, is would you, though, want your loved ones to be put through this kind of care?

This is cost-cutting at its worst. The NHS is cutting costs, cutting ties and cutting responsibilities for those supposedly under its care. It would be a sad day if this kind of devolved responsibility plan became approved.

Pressures faced by the NHS

The good news is that every day, the vast majority of the 63.7 million people eligible to use the NHS, don’t need to. And every day you don’t need to use the NHS, someone else benefits. Most people are very capable of looking after themselves most of the time, self-treating for minor ailments and knowing when and where to seek help for serious illness. 90 per cent of symptoms are self-treated but an estimated fifty-two million visits to general practice each year are still for conditions that would get better with time. Self-care is likely to improve further when those who want it are given access to and control over their medical records and data, and technology is better used to direct you to the right information when you need it. In the meantime, a friendly pharmacist can often save you a trip to the GP.

The bad news is that demand in many areas outstrips both the supply of services and the funding for them. Patients who need care are having to wait longer for it, and too many referrals are rejected as not urgent enough, when the NHS should be doing its utmost to prevent emergencies.

There is a very, very big mental illness iceberg out there and it’s showing no signs of melting.

Life is tough enough for NHS staff, but imagine what it’s like for these children and their carers who can’t get any care at all? The pattern of services struggling – or simply not being able to cope safely – with the demands placed on staff is common across the NHS. Waiting times are creeping up, emergency departments are overflowing, people struggle to get a GP appointment, services are being restricted and rationed and lots of people are having to fend for themselves.The technology and choices patients now face can be very complex, but the strength of the NHS lies in its humanity and the ethos that as a society we should pool our resources to care for and protect the most vulnerable.

The NHS is nearly always buckling under the demands placed on it, partly because it’s a victim of its own success. Improvements in public health, wealth and healthcare since the NHS was founded sixty-seven years ago have been stunning. In 1948, half the population died before the age of sixty-five. Now, the average life expectancy is over eighty. One in three children born today will live to one hundred, but one in four boys born in Glasgow still won’t make it to sixty-five. The UK is still a very unequal society, and the rich not only live fifteen years longer than the poor, but they have up to twenty years more healthy living. Life is very, very unfair, which is why we need to fight poverty and build the confidence, courage and resilience in our children to live well, as well as improve and fund the NHS. Those who pay for it most often use it least. It’s the badge of honour for living in a humane society.

And we nearly all need it eventually if we want help or treatment. One in two people in the UK will get cancer, one in three will get diabetes and nearly everyone will get heart disease. Many of these diseases will be contained rather than cured. Obesity appears unstoppable. Liver disease, kidney disease, lung disease, musculoskeletal disease, depression and anxiety are all on the increase. Mental illnesses cost the UK over £70 billion a year, one in three of us experiences mental health problems every year and one in three people over sixty-five will die with dementia. Many people with dementia live for many years, even if they haven’t been diagnosed and treated. Dementia alone already costs the economy more than cancer and heart disease put together.

These chronic diseases account for 70 per cent of the NHS budget, although many can be delayed if not prevented by a healthier lifestyle. Those with three or more incurable diseases are usually on multiple medications, the combined effects of which are unknown. Many older patients on multiple drugs struggle to take them properly, and there’s a delicate balance between benefit and harm. Loneliness is often a far bigger problem.

The NHS and social care system is crucially dependent on millions of unpaid volunteers and carers, and many very dedicated but poorly paid care workers. The round-the-clock pressures and responsibilities they face are huge. If carers went on strike, the NHS and social care service would collapse overnight. Keeping it all afloat is a massive, collaborative effort and we are far too reliant on institutionalized care, rather than supporting people in their homes.

More women give birth in hospital than need or want to be there, so those who really need to have hospital births don’t always get safe care. Far too many frail elderly patients, many with dementia, end up in acute hospitals, often the most frightening and disorientating place they can be. Far too many people with mental illness end up in police custody and far too many people die in hospital when they want to die at home. We can change this, if services join up, and patients and carers receive the right training and support. Having chemotherapy or dialysis at home can transform not just your healthcare but your whole life. It doesn’t happen nearly enough.

Fixing the NHS and social care system will not be quick or easy, even if we put more money in. In many instances, it would often be kinder to have less high-tech, expensive intervention than more. If all we ever did in the NHS was capture the ideas and feedback from frontline staff, patients and carers, and use it to continuously improve a stable system that everyone understood, the NHS would be out of sight as the world’s best. We have to spend every available penny supporting and joining up the frontline – the NHS is not about the bricks and mortar, it’s about mobilizing and motivating a brilliant workforce to serve patients and give you as much control as you want over your care. And to do that, you need to find your voice and we need to listen to you.

Research done by the Health Foundation, When Doctors and Patients Talk, found that NHS staff are often as anxious and fearful as you are during consultations. They are anxious and frightened of missing an important diagnosis, not being able to give patients what they are entitled to, not being able to practise the standards of care they’d like to, having to deal with justifiable anger, missing a target they have been ordered to hit, being asked to do something they do not feel competent to do, or having to look after so many patients in such a short space of time they just do not feel safe. The ever-present fear is that they simply cannot cope safely with the demand. Just as we shouldn’t blame people for being ill or old or overweight, we shouldn’t blame NHS staff for not being able to always provide the highest standards of care. Praise, kindness and understanding are much better motivators.

And there’s plenty to be thankful for. The Commonwealth Fund in America compares the health systems in eleven countries and ranks them according to eleven measures: quality of care, effective care, safe care, coordinated care, patient-centred care, access, cost-related problems, timeliness of care, efficiency, equity, and healthy lives. You might expect Austria, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland or America to thrash us. In fact, the 2014 ranking (based on 2011 data) puts the UK top of the healthcare table overall, and first in eight of the eleven categories. It came second in equity to Sweden, and third behind Switzerland and the Netherlands for timeliness of care. The NHS is far from perfect, but we should celebrate and publicize the amazing care it often gives, try to improve the good care it usually gives and quickly address the poor care it occasionally gives, so further harm is prevented.

To improve, the NHS needs to be simplified so that anyone can understand it. We pretend to distinguish between healthcare and social care, but it’s all ‘care’ and it should be joined into one care system, with those with the greatest need treated by one team with one named person responsible for coordinating your care. And we must all do everything we can to live well. In the NHS, the staff spend too much time diving into the river of illness, pulling people out and trying to put them back together that no-one has time to wander upstream and look at who’s pushing you in.