Dear SCH Reader, well here we are at the end of summer, heading into the autumn season, with leaves having already made a descent from the heat-waves of this past unprecedented (oh there’s that word again) summer. Trusting that you’re fit and well, here’s your round up of health news from the past month

4^th – Frontline – Physiotherapy Mag: ‘CSP (Chartered Society of Physiotherapy) says pay award for NHS staff in England is ‘nowhere near enough’’

The UK government announced on 19 July that NHS staff in England would receive a flat rate increase of £1,400, backdated to 1 April. Those at the top of pay bands 6 and 7 will receive a higher amount so that the rise equates to four per cent. But with inflation moving towards double figures, the award falls far short of meeting the increased cost of living.

Clare Sullivan, a CPS director of employment, said: ‘This offer is nowhere near enough. It is a pay cut in real terms at a time when members need their pay to keep pace with the cost of living more than ever before’.

15^th – Metro: ‘Dozens of hospital roofs are at risk of collapse, minister admits’

More than 30 hospital buildings in England have roofs so rotten they could collapse at any moment, ministers have admitted. Hinchingbrooke in Cambridgeshire and Frimley Park in Surrey are among 16 hospital trusts known to have the deteriorating roofs made of reinforced autoclaved aerated concrete (RAAC). Some trusts are using hundreds of steel pillars to hold up the roofs, which were erected between the 1960s and 1990s but only have a 30-year lifespan. Hinchingbrooke has banned patients weighing more than 19st from surgery in two of its theatres in case they collapse through the floor.

The Queen Elizabeth hospital in Norfolk’s chief executive Caroline Shaw compared the situation to a ‘ticking timebomb’. She told The Sunday Times: ‘The roof is liked a chocolate ‘Aero’ bar – there are bubbles in the concrete and we’re checking it daily to make sure those bubbles don’t break and the roof doesn’t come down.’

The department of health said it was taking action to improve health infrastructure across the country and had set aside more than £685millkion to address issues relating to RAAC.

17^th – Cover magazine: ‘Mental health services set for £10 million boost during winter months’

Mental health charity Mind says funding is “not enough.” The government has pledged an additional £10 million towards mental health services for the upcoming winter months in a bid to deal with anticipated demand.

The boost also includes the deployment of mental health professionals to emergency call

centres to help support people in crisis who may need to be signposted. The NHS will receive the equivalent of 7,000 more beds during the winter periods through the creation of new hospital beds, virtual ward spaces and other measures targeted at improving patient outflows. Meanwhile, GP services will be supported by additional social prescribing link workers and care-coordinators during the busy winter period.

18^th – VitalityHealth: ‘Say cheese! The mental health benefits of smiling’

The late Phyliss Diller, one of the funniest stand-up comedians of our time said it best: “A smile is a curve that sets everything straight.” There is a lot of controversy over how many of the 43 facial muscles it takes to smile. But everyone agrees that when you smile your body creates feel-good endorphins and even a forced smile causes positive changes in our bodies.

Smiling helps our bodies release cortisol and endorphins that provide numerous health benefits, including reduced blood pressure, increased endurance, reduced pain and can provide a boost to your immune system. Smiling may also help reduce symptoms associated with anxiety. The muscle movements of a smile stimulate the amygdala (the part of your brain that allows you to feel emotion) by releasing neurotransmitters that signal to the body that you’re feeling happy and causes the body to slow its breathing and heart rate. Smiling can increase levels of hormones like dopamine and serotonin in the body which are associated with feelings of happiness and reduced stress, respectively.

Your smile can also benefit those around you. We all know that smiles are contagious, so infect your friends with happiness! When you are smiling and happy, you are ‘paying it forward’ by encouraging others to smile too. There is no better time than right now to get smiling. The second week of August kicks off National Smile Week, which actually originally started as a campaign for dental health. So, be sure to take great care of your smile with proper mouth hygiene including brushing, flossing, limiting sweets and sugars, and getting regular dental cleanings. (don’t forget – you can earn Vitality Points for teeth cleanings!) But let’s focus on finding reasons to smile each and every day.

How can you ensure you are smiling daily and reaping the associated health benefits?

• Challenge your children or friends to a contest to see who can smile the longest.
• When things get tough during the day, challenge yourself to smile. Take a deep breath and know you’ve got this.
• Smile at someone you don’t know and see them smile back; making others happy is sure to keep you smiling.
• Surround yourself with people who make you laugh. To laugh you have to smile first.
• Smile out of gratitude for all the blessings that surround you in life.

19^th – The Lancet Psychiatry – Medical Journal: ‘Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1,284,437 patients’

Findings –

We identified 1,487,712 patients with a recorded diagnosis of COVID-19 during the study period, of whom 1,284,437 (185,748 children, 856,588 adults, and 242,101 older adults; overall mean age 42-5 years (SD 21.9); 741,806 (57.8%) were female and 542,192 (42.2%) were male) were adequately matched with an equal number of patients with another respiratory infection. The risk trajectories of outcomes after SARS-CoV-2 infection in the whole cohort differed substantially. While most outcomes had HRs significantly greater than 1 after 6 months (with the exception of encephalitis; Guillain-Barre syndrome; nerve, nerve root, and plexus disorder; and parkinsonism), their risk horizons and time to equal incidence varied greatly. Risks of the common psychiatric disorders returned to baseline after 1-2 months (mood disorders at 43 days, anxiety disorders at 58 days) and subsequently reached an equal overall incidence to the matched comparison group (mood disorders at 457 days, anxiety disorders at 417 days). By contrast, risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the 2-year follow up period.

Post-COVID-19 risk trajectories differed in children compared with adults: in the 6 months after SARS-CoV-2 infection, children were not at an increased risk of cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures. Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days). A sizable proportion of older adults who received a neurological or psychiatric diagnosis, in either cohort, subsequently died, especially those diagnosed with dementia or epilepsy or seizures. Risk profiles were similar just before versus just after the emergence of the alpha variant. Just after (vs just before) the emergence of the delta variant, increased risks of ischaemic stroke, epilepsy or seizures, cognitive deficit, insomnia, and anxiety disorders were observed, compounded by an increased death rate. With omicron there was a lower death rate than just before the emergence of the variant, but the risks of neurological and psychiatric outcomes remained similar.

Interpretation –

This analysis of 2-year retrospective cohort studies of individuals diagnosed with COVID-19 showed that the increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout. The differing trajectories suggest a different pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern. The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects. Our findings are relevant to understanding individual-level and population-level risks of neurological and psychiatric disorders after SARS-CoV-2 infection and can help inform our responses to them.

26^th – Daily Mail: ‘As an NHS doctor, I implore you… beg, borrow or steal to go private; A&E consultant Dr. Emma Jones writes startling account of how the health service she loves is at breaking point

It’s just before 8am on a Monday morning and my A&E department is heaving. I’ve been on-call all weekend – I’m shattered – but I don’t have time to dwell on it. Our traffic-light system is a sea of red: red for staffing, meaning we’re low on doctors and nurses; red for capacity, meaning we have far too many patients; and red for acuity, meaning a terrifying number of those patients are severely ill. Some of them are dependant on a ventilator. Some won’t make it to the end of the day, let alone the end of the week. The final traffic light is inevitable, then: red for flow, meaning far more patients are being admitted to hospital than being sent home.

The bottom line is that, from a safety point of view, my department is stretched beyond capacity. The same is true for almost every A&E in the UK at almost any given time. If my department is under this much strain in the height of summer, when there’s usually some respite, come October it’ll be Armageddon. Welcome to the frontline of British medicine. With 25 years of specialising in A&E treatment, training junior doctors and managing NHS trusts, I can testify to how a decade of austerity has eroded every structure supporting our organisation.

Brexit led to chronic staff depletion. Then came Covid, which put unprecedented stress on the service, but also provided a scapegoat for every pre-existing problem. To understand the state of healthcare system, consider how it now spends over £2billion a year on settling negligence claims. Even as a senior employee and stalwart supported of the NHS, my advice to patients is this: forget it. Beg, borrow or steal to go private instead.

Outside my hospital in the Midlands, emergency patients are frequently triaged in the ambulance that collected them. They are having blood tests and X-rays inside that ambulance, supervised by the paramedic crew that brought them in. If their diagnostics come back favourably, following consultation with a doctor, they might be discharged without ever having left the back of the vehicle.

Even if those patients receive an acceptable standard of care, the ambulances involved are out of commission for up to nine hours. The turnaround in 80 per cent of cases involving an ambulance should take 10 – 15 minutes for paramedics to unload, hand over and get back on the road. It doesn’t matter if it’s one, five, ten or fifteen ambulances that can’t respond to the welter of emergency cases we face every day. And it costs lives.

28^th – Mail on Sunday: ‘Patients forced to crowd-fund for eye cancer chemo that should be on NHS’

Britons with eye cancer are resorting to crowdfunding and selling their homes to pay for a life-extending procedure that should be free on the NHS. The treatment, ‘chemosaturation’, gives sufferers an extra 15 months of life and even a cure in some cases. Based on this data, NHS spending watchdog the National Institute for Health and Care Excellence judged it cost-effective, approving it last year for patients with advanced disease. But the Mail on Sunday has learned of patients paying six-figure sums at private clinics for chemosaturation because NHS England, which controls surgical budgets, refuses funding.

Doctors believe patients require three rounds of treatment for it to be effective. Trial data

showed that 90 per cent of eye-cancer patients with liver tumours had tumour shrinkage after chemosaturation. Researchers found two-thirds survived for a year, and a third more than two years. Last year NICE (National Institute for Clinical Excellence) concluded chemosaturation was safe and effective. For drugs, a decision like this means patients automatically receive the approved treatment on the NHS. But because it also involves surgery – and requires significant hospital resources – final sign-off for its funding lies with NHS England.

Janna Clark was diagnosed with eye cancer in February 2018, just a day before her ten-year-old son George was given the all-clear from blood cancer. She says that due to the stress of caring for her son, she ignored the initial symptoms. ‘I had headaches, dizziness, my vision was blurred and I’d get flashes of lights’, she says. After doctors found the cancer, Janna underwent chemotherapy and had her right eye removed. But in February 2021, scans showed the disease had spread to her liver. Last month she was told there was nothing more the NHS could do. Janna, who lives with her partner Jay, is now trying to raise money for three sessions of chemosaturation at a London clinic, each costing £40,000.

There’s your monthly round-up for another month, and let’s hope that the reduced focus on pandemic related articles continues into October. As summer morphs into autumn, with the inevitable drop in temperatures, coupled with the worrying cost of heating this year, please remember that before central heating our parents and grand-parents got through the colder months quite healthily simply by wearing extra warmer layers! In fact there is a school of thought that says that our immune systems get stronger and more robust, and therefore less susceptibility to seasonal coughs, colds and illness and disease in general, by not being mollycoddled by artificial heat.

Until October then, please stay fit and healthy,

Yours sincerely

Daniel Donoghue

MD, Surrey Circle Health

Whole of Market Specialist PMI Healthcare Brokers