GP appointment systems – patient survey

How food can improve your mental health

As part of our fight against this, we have a very much underutilised tool – food.

In BBC One’s Doctor in the House, I try to help 34-year-old Emma Gleeson, who has been experiencing anxiety, depression and panic attacks for many years.

She was 19 when she really began struggling with mental health.

Following a severe episode of pneumonia, she ended up in intensive care in a coma.

When she woke up she was petrified. She developed an extreme fear of death, and this can precipitate her panic attacks.

During an attack, Emma feels terrified, and can often scream out loud.

It is extremely worrying for her family and can be scary to onlookers.

Emma has tried various medications and counselling therapies but was still struggling and getting three to four panic attacks per day.

One of the ways in which I helped her was by changing her food choices.

Despite being sceptical at first, I was able to show Emma the hidden power of food in helping her mental state.

“I had been living on a diet of takeaways, fizzy drinks and general processed and convenience foods for as long as I can remember, and didn’t for one moment think that what I ate was contributing in any way to the anxiety and panic attacks I’d been experiencing for years,” she said.

“Since meeting and spending time with Dr Rangan, he has changed my entire outlook on food, and why certain foods were potentially having a negative impact on my mental health.

“I now only buy and cook with fresh food, I make my own stocks, I eat plenty of fish and I try to reduce the amount of sugar I consume.

“I feel so much better and intend to keep this up.”

The evidence of food’s link to mental states has been growing.

A landmark 2015 article in the prestigious Lancet journal stated that nutrition may be as important to mental health as it is to cardiology, endocrinology and gastroenterology.

Plus, a small but important interventional Australian study from earlier this year showed that a modified Mediterranean diet significantly helped many patients with severe depression within 12 weeks.

Unfortunately, this has not translated into routine patient care and most doctors still do not discuss food with their mental health patients.

This has to change.

‘Mentally stronger’

Many of us do not think about how food can impact the way we feel, but we all know the feeling of using food as a quick pick-me-up.

When we are feeling a little tired, a little stressed or a little low, we often reach for a sugary snack to help us feel good in the short term.

But, this can actually make things worse in the long term.

The food you are eating is literally “shocking” your body.

By changing her diet, as well as reducing her alcohol intake, Emma experienced a reduction in anxiety, an improvement in mood and fewer panic attacks.

She also described feeling mentally stronger, having a clearer head, more energy and a greater ability to cope with stress.

It has also encouraged her to be more active and do more things at weekends, which also helps her mental health.

Of course, there can be many other factors to consider with mental health problems and it is always worth getting advice from a qualified healthcare professional.

There can be many other important factors to consider with mental health problems, such as emotional trauma and stress, but we should not underestimate the power of changing our food to improve our mood.

Techniques that you can try at home

As a doctor, I like to empower my patients. Here are four of the tips that helped Emma, that can also help you:

1. Reduce sugar and processed foods

Sugar, food that contains sugar, or even food that is converted quickly into sugar, such as many breakfast cereals, cause your blood sugar to rapidly rise.

Within two to three hours your sugar levels then start to fall.

At this point, you may not only feel hungry, you can feel “h-angry” as well – hungry and angry.

Low and falling blood sugar levels can cause a rise in your body’s stress hormones, cortisol and adrenaline.

This can have a negative impact on your mood.

2. Increase your intake of Omega-3 fats

This is an essential nutrient for brain function and may protect against anxiety and other psychiatric disorders.

Foods high in Omega-3 fats include fatty fish (salmon, mackerel, anchovies), grass-fed meat, seeds and leafy vegetables.

3. Eat more tryptophan-containing foods like pork, chicken, seeds and walnuts

Tryptophan is an amino acid the body converts into serotonin, your feel-good neurotransmitter.

Eat them with a healthy carbohydrate source such as sweet potatoes, which helps to transport more tryptophan into your blood.

4. Feed your gut bugs

Some scientists refer to the trillions of gut bugs that live inside us, the gut microbiota, as the brain’s peacekeepers.

It is thought that having a healthy population of gut bugs can have a significant influence on your mood via the gut-brain axis.

The prebiotic fibre contained in vegetables help your gut bugs to proliferate, so the best way to maintain a healthy population is to increase your intake of vegetables, as well as fermented foods such as sauerkraut.

Best options are leeks, onions, garlic, artichokes and cruciferous vegetables like broccoli and cauliflower.

You have the ability to improve the way you feel by controlling what you put on your plate.

Southwark Council responds to London Bridge attack

Cllr John said: “This was a pointless and horrific attack which has caused real and great harm but will achieve nothing. As ever, the emergency services have responded heroically , and I would like to thank them for all they have done and continue to do following these awful events.

“Just one attack of this sort is devastating, but as a city and a country we have suffered far too much in recent months. Southwark is an amazing borough and we are strongest when we stand together, support one another, and choose unity in the face of hatred.”

Anyone affected by the events on Saturday night please visit the Home Office website at for guidance and support.

Stirling University to launch home dementia app

The app, which is being designed by the university’s dementia centre, will also recommend changes that could be made to the building.

Lighting, colour, contrast and noise in the home can all affect people who are living with dementia.

The university said it would take about 20 minutes to assess a two-bedroom home using the free app.

Users will be asked questions about their surroundings and will be asked to take photographs.

The dementia database – called Iridis – will then recommend changes that could be made, which could range from changing a light bulb to reconfiguring whole bathrooms.

Stirling University said it was the first app if its kind in the world.

Lesley Palmer, from the university’s Dementia Services Development Centre, said: “This is a unique opportunity to revolutionise how we improve day-to-day life for older people and people living with dementia around the world.

“We are creating a simple way for anyone to assess how dementia-friendly their environment is, and find out how to improve their surroundings.

“With around 50 million people estimated to be living with dementia worldwide, there is an immediate need to invest in our aging population and provide improved services and facilities.”

Dementia is one of the main causes of disability later in life, ahead of cancer.

The app, which will be available to download in September 2017, is being designed in collaboration with construction experts Space Group.

This startup wants to solve the social care crisis with AI

The social care crisis – as demonstrated with the Conservative Party’s disastrous manifesto pledge – is one of the biggest issues facing the NHS. Spending squeezes have led to bed-blocking in hospitals; while low wages and poor working conditions are causing carers to leave the industry in droves.

One social care startup thinks that a solution might lie in AI. Cera, founded by Ben Maruthappu, a former innovation adviser to NHS England, is a startup that wants to provide smarter social care using an Uber-style platform to match carers and patients. The startup has to date raised £2.7 million in early funding, and in March signed a partnership with Barts Health NHS Trust, as well as several clinical commissioning groups and hospitals in London to test its solution.

Now the startup is revealing an unusual step: it’s launching an AI assistant. Called Martha, the assistant was created by fellow London-based startup Bloomsbury AI, and is designed answer questions from patients and carers during visits. “AI can be even more impactful with the elderly than with the young and healthy,” Maruthappu tells WIRED. The chat bot will be available online and also by text message – a design choice made to target its elderly users. “If you’ve had dementia, or a stroke, you don’t necessarily use a smartphone,” says Maruthappu.

Martha’s capabilities are somewhat underwhelming right now – AI chatbots are becoming virtually ubiquitous – but Maruthappu says it’s just the start. In the near future, the company says, it hopes to use the AI to parse patients’ digital records, and provide health alerts to patients or carers based on that data. For example: noting unusual symptoms or behaviours that might indicate pneumonia, which can be fatal amongst elderly patients.

“Information tracked longitudinally can be extremely useful [in care],” says Maruthappu. “It can predict when these people are going to be unwell.” In addition, he hopes the system will be able to answer common questions or complaints that otherwise might require GP or hospital attention, reducing demand on the system.

“Our algorithms learn to answer more and more questions over time, and our system integrates seamlessly with Cera’s existing communication channels,” said Bloomsbury AI CEO Guillaume Bouchard in a statement. “This happens by reading Cera’s comprehensive documents, which are continuously updated as they grow their services and by asking questions to Cera’s experts when the answer is not obvious.”

Artificial intelligence is booming in healthcare right now: from DeepMind’s efforts to enhance nurses’ work flows, to AIs reading CT scans, to drug discovery. And the combination of an underserved aging population – with a fair amount of accured wealth – has led to a recent flowering of startups in the sector: notably, the US-based startup Honor has raised more than $60million; Berlin-based Careship has also raised $4million; while in London, Vida are also seeking to disrupt the sector.

General Election Manifestos 2017

 Conservative Party Manifesto

Accessibility

• review disabled people’s access and amend regulations if necessary to improve disabled access to licensed premises, parking and housing
• create a new presumption of digital government services by default and an expectation that all government services are fully accessible online, with assisted digital support available for all public sector websites
• roll out Verify identification service, enabling one single, common and safe way for people to provide verification to all parts of government online services by 2020 – using own secure data that is not held by government
• Verify will eventually be made more widely available, so that people can safely verify their identify to access non-government services such as banking – expected for 2025

Benefits

• no plans for further radical welfare reform in this parliament but continue the roll-out of Universal Credit
• maintain the Triple Pensions Lock until 2020, and when it expires introduce a new Double Lock, meaning that pensions will rise in line with the earnings that pay for them, or in line with inflation – whichever is highest
• means test Winter Fuel Payments – the money released will be transferred directly to health and social care
• re pensioners – maintain free bus passes, eye tests, prescriptions and TV licences, for the duration of this parliament

Education and Skills

• replacing 13,000 existing technical qualifications with new qualifications, known as T-levels, across fifteen routes in subjects including construction, creative and design, digital, engineering and manufacturing, and health and science
• invest in further education colleges to make sure they have world-class equipment and facilities and will create a new national programme to attract experienced industry professionals to work in FE colleges
• discounted bus and train travel for apprentices
• new right to request leave for training for all employees
• new national retraining scheme – with costs of training met by the government, with companies able to gain access to the Apprenticeship Levy to support wage costs during the training period

Equality and human rights

• enact a Great Repeal Bill, converting EU law into UK law
• once EU law has been converted into domestic law, parliament will be able to pass legislation to amend, repeal or improve any piece of EU law it chooses, as will the devolved legislatures, where they have the power to do so
• will not bring the European Union’s Charter of Fundamental Rights into UK law
• will look into repealing or replacing the Human Rights Act once the process of Brexit has finished
• commitment to remain signatories to the European Convention on Human Rights for the duration of the next parliament – however British troops will in future be subject to the Law of Armed Conflict, which includes the Geneva Convention and UK Service Law, not the European Court of Human Rights

Heating and services

• work with providers of everyday essential services, like energy and telecoms, to reduce the extra costs that disability can incur

Housing

• meet 2015 commitment to build a million homes by the end of 2020 and half a million more by the end of 2022
• enter into new Council Housing Deals with local authorities to help them build more social housing – these will be new fixed-term social houses, which will be sold privately after ten to fifteen years with an automatic Right to Buy for tenants, the proceeds of which will be recycled into further homes

Social care and health

• align the future basis for means-testing for domiciliary care with that for residential care, so that people are looked after in the place that is best for them
• the value of the family home will be taken into account along with other assets and income, whether care is provided at home, or in a residential or nursing care home
• single capital floor, set at £100,000 – no matter how large the cost of care turns out to be, people will always retain at least £100,000 of their savings and assets, including value in the family home
• extend the current freedom to defer payments for residential care to those receiving care at home, so no-one will have to sell their home in their lifetime to pay for care
• forthcoming green paper will also address system-wide issues to improve the quality of care and reduce variation in practice (see page 65 of the manifesto)
• increase NHS spending by a minimum of £8 billion in real terms over the next five years
• give patients, via digital means or over the phone, the ability to book appointments, contact the 111 service, order repeat prescriptions, and access and update aspects of their care records, as well as control how their personal data is used
• first new Mental Health Bill for thirty-five years
• publish a green paper on young people’s mental health before the end of this year
• recruit up to 10,000 more mental health professionals
• specific task to improve standards of care for those with learning disabilities and autism – will work to reduce stigma and discrimination and implement in full the Transforming Care Programme
• new GP contract to help develop wider primary care services
• reform the contract for hospital consultants to reflect the changed nature of hospital care over the past twenty years
• make it a priority in Brexit negotiations that the 140,000 staff from EU countries can carry on working in the UK – but commitment to continue training more staff within UK
• new NHS numbers are not issued to patients until their eligibility has been verified
• increase the Immigration Health Surcharge, to £600 for migrant workers and £450 for international students

Work

• target to get 1 million more people with disabilities into employment over the next ten years
• legislate to give unemployed disabled claimants or those with a health condition personalised and tailored employment support
• for businesses employing former wards of the care system, someone with a disability, those with chronic mental health problems, and those who have been unemployed for over a year, will be given a holiday on employers’ National Insurance Contributions for a full year
• give employers the advice and support they need to hire and retain disabled people and those with health conditions
• harness the opportunities of flexible working and the digital economy to generate jobs for those whose disabilities make traditional work difficult
• increase the National Living Wage to 60 per cent of median earnings by 2020 and then by the rate of median earnings
• the Government is awaiting the results of the Taylor review but a new Conservative government will act to ensure that the interests of employees on traditional contracts, the selfemployed and those people working in the ‘gig’ economy are all properly protected
• amend health and safety regulations so that employers provide appropriate first aid training and needs assessment for mental health
• consider the findings of the Stevenson-Farmer Review into workplace mental health support, working with employers to encourage new products and incentives to improve the mental health and wellbeing support available to their employees
• train one million members of the public in basic mental health awareness and first aid to break the stigma of mental illness

 Labour party manifesto

The Labour party has also produced a separate document, entitled Funding Britain

Aim on Disability

Labour supports a social model of disability and pledges to remove the barriers in society that restrict opportunities and choices for people with disabilities. The previous Labour government signed the UN Convention on the Rights of Persons with Disabilities (UNCRPD). The next Labour government will sign the UNCRPD into UK law.

Benefits

• scrap the punitive sanctions regime
• scrap the Bedroom Tax
• increase Employment and Support Allowance (ESA) by £30 per week for those in the work-related activity group
• scrap the Work Capability and Personal Independence Payment assessments and replace them with a personalised, holistic assessment process that provides each individual with a tailored plan, building on their strengths and addressing barriers
• implement the court decision on Personal Independence Payment (PIP) so that there is real parity of esteem between those with physical and mental-health conditions
• end the privatisation of assessments (Atos, Maximus, Capita)
• end the pointless stress of reassessments for people with severe long-term conditions
• repeal cuts in the UC limited capacity for work element
• increase Carer’s Allowance by £11 to the level of Jobseekers’ Allowance.
• scrap cuts to Bereavement Support Payment.
• reform and redesign UC, ending six-week delays in payment and the ‘rape clause’
• guarantee the state pension ‘triple lock’ – throughout the next Parliament. It will rise by at least 2.5 per cent a year or be increased to keep pace with inflation or earnings, whichever is higher
• Winter Fuel Allowance and free bus passes will be guaranteed as universal benefits
• protect the pensions of UK citizens living overseas in the EU or further afield

Education and Skills

• scrap Conservative plans for schools to pay the apprenticeship levy
• extend schools-based counselling to all schools to improve children’s mental health
• deliver a strategy for children with special educational needs and disabilities (SEND) based on inclusivity, and embed SEND more substantially into training for teachers and non-teaching staff, so that staff, children and their parents are properly supported
• restore the Education Maintenance Allowance for 16 to 18-year-olds from lower and middle income backgrounds
• free, lifelong education in Further Education (FE) colleges, enabling everyone to upskill or retrain at any point in life
• replace Advanced Learner Loans and upfront course fees with direct funding, making FE courses free at the point of use, including English
  for Speakers of Other Languages (ESOL) courses
• set targets to increase apprenticeships for people with disabilities, care leavers and veterans, and ensure broad representation of women, BAME, LGBT and people with disabilities in all kinds of apprenticeships
• maintain the apprenticeship levy but ensure high quality by requiring the Institute for Apprenticeships and Technical Education to report on an annual basis to the Secretary of State on quality outcomes of completed apprenticeships to ensure they deliver skilled workers for employers and real jobs for apprentices at the end of their training.
• Set a target to double the number of completed apprenticeships at NVQ level 3 by 2022
• reintroduce maintenance grants for university students
• abolish university tuition fees

Equality and human rights

• Labour will legislate to make terminal illness a protected characteristic under the Equality Act.
• give British Sign Language full recognition as a recognised language

Hate crime

• ensure that under the Istanbul Convention, disability hate crime and violence against women with disabilities is reported annually, with national actions plans to address these issues

Heating

• introduce a Homes Fit for Heroes programme that will insulate the homes of disabled veterans for free
• Winter Fuel Allowance guaranteed as a universal benefit

Housing

• make new three-year tenancies the norm for private renters, with an inflation cap on rent rises
• remove government restrictions that stop councils building homes and begin the biggest council building programme for at least 30 years
• ditch Conservatives’ ban on long-term council tenancies to give council tenants security in their homes
• scrap the Bedroom Tax
• reinstate Housing Benefit for under-21s
• suspend the right-to-buy policy for council and social housing to protect affordable homes for local people, with councils only able to resume sales if they can prove they have a plan to replace homes sold like-for-like

Poverty

• Labour will introduce a new Child Poverty Strategy

Social care and health

• increase the social care budgets by a further £8 billion over the lifetime of the next Parliament, including an additional £1 billion for the first year.
• implement the principles of the Ethical Care Charter, already adopted in 28 council areas, ending 15-minute care visits and providing care workers with paid travel time, access to training and an option to choose regular hours
• create a National Care Service, which will be built alongside the NHS, with a shared requirement for single commissioning, partnership arrangements, pooled budgets and joint working arrangements – in its first years, the service will require an additional £3 billion of public funds every year, enough to place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care.
• ensure that everyone with a long-term condition, such as those with diabetes, will have the right to a specialised care plan, and access to condition-management education
• commitment to making Britain autism friendly

Work

• commission a report into expanding the Access to Work programme
• strengthen access to justice for people with disabilities by enhancing the 2010 Equality Act, enabling discrimination at work to be challenged
• work with employers, trade unions and public services to improve awareness of neurodiversity in the workplace and in society
• give all workers equal rights from day one, whether part-time or full-time, temporary or permanent
• ban zero hours contracts
• raise the Minimum Wage to the level of the Living Wage
• ban unpaid internships
• abolish employment tribunal fees

Lib Dem manifesto

Benefits

• uprate working-age benefits at least in line with inflation
• abandon the two-child policy on family benefits and abolish the two children‘rape clause’
• reverse cuts to housing benefit for 18-21-year-olds and increase the rates of Jobseeker’s Allowance and Universal Credit for those aged 18-24 at the same rate as minimum wages.
• reverse cuts to Employment Support Allowance to those in the work-related activity group.
• increase Local Housing Allowance (LHA) in line with average rents in an area
• scrap the ‘bedroom tax’, whilst also incentivising local authorities to help tenants ‘downsize’.
• scrap the Work Capability Assessment and replace it with a new system, run by local authorities according to national rules, including a ‘real world’ test that is based on the local labour market
• withdraw eligibility for the Winter Fuel Payment from pensioners who pay tax at the higher rate (40%)
• retain the free bus pass for all pensioners
• ensure that those using food banks are aware of their rights and how they can access hardship payments where relevant
• maintain pensions triple lock
• let both parents earn before their Universal Credit is cut and also reverse cuts to the Family Element
• reverse cuts to Work Allowances in Universal Credit

Education and skills

• ensure that all teaching staff have the training to identify mental health issues and that schools provide immediate access for pupil support and counselling
• reinstate maintenance grants for the poorest students

Equality and human rights

• extend the Equality Act to all large companies with more than 250 employees
• oppose any attempt to withdraw from the ECHR or abolish or water down the Human Rights Act
• introduce a digital bill of rights that protects people’s powers over their own information, supports individuals over large corporations, and preserves the neutrality of the internet
• end the ministerial veto on release of information under the Freedom of Information Act, and take steps to reduce the proportion of FOI requests where information is withheld by government departments

Hate crime

• tackle bullying in schools

Housing

• three-year tenancies for private renters

Social care and health

• implement a cap on the cost of social care
• develop a Carer’s Passport scheme to inform carers of their NHS rights
• create a cross-party health and social care convention, bringing together stakeholders from all political parties, patients groups, the public and professionals from within the health and social care system to carry out a
  comprehensive review of the longer-term sustainability of the health and social care finances and workforce, and the practicalities of greater integration
• equal care for mental health – a number of measures – see pages 19 and 20 of the manifesto
• move towards a health and social care system that empowers and encourages people to better manage their own health and conditions and to live healthier – via various strategies (see pages 22 and 23 of the manifesto)
  lives
• support the Armed Forces Covenant and ongoing work to support veterans’ mental health

Transport

• continue the Access for All programme, improving disabled access to public transport as a key priority
• increase accessibility to public places and transport by making more stations wheelchair accessible
• improve the legislative framework governing blue badges
• set up a benchmarking standard for accessible cities
• bring into effect the provisions of the 2010 Equality Act on discrimination by private hire vehicles and taxis

Work

• raise awareness of, and seek to expand, Access to Work
• create a formal right to request a fixed contract and consult on introducing a right to make regular patterns of work contractual after a period of time
• scrap employment tribunal fees
• separate employment support from benefits administration – making Jobcentres places of training and support into work
• improve links between Jobcentres and Work Programme providers and the local NHS to ensure all those in receipt of health-related benefits are getting
  the care and support to which they are entitled
• accelerate the roll-out of Individual Placement and Support, to get people with mental ill-health back into work

‘Oldest old’ abandoned by care system as 800,000 struggle with essential tasks

What is an Activity of Daily Living?

Age UK’s research into the failing social care system leading up to the General Election has focused on the staggering number of older people who do not get the help they need with Activities of Daily Living (ADLs).

ADLs are simple and essential everyday tasks, including washing, eating, getting out of bed, dressing, going to the bathroom and walking.

30% of over 80s have unmet care needs

There are around 2,622,000 people over 80 living in England. Almost a million have at least one ADL, and thousands are affected by several different ADLs. Shockingly, as these figures show, more than half of those with three or more ADLs have been worst affected by the gap in availability of adequate social care.

Of the 926,000 over 80s with at least one Activity of Daily Living:

• 53% get no assistance at all
• Of those who do get help, for 70% it does not fully meet their needs
• 794,000 do not receive any help or receive support that does not always meet their needs

Of the 260,000 people over 80 with three or more Activities of Daily Living:

• 33% are not receiving any help
• 56% have unmet needs due to not receiving enough help

Older people should get better social care: read Carmel’s story

Age UK focuses on dignity for older people in its election manifesto for change

As the 2017 General Election approaches on 8 June, Age UK is urging the next Government to ensure that older people receive dignified care at home, in hospital and in care homes.

We are asking the Government to continue its ‘twin track approach’ of emergency funding alongside developing an effective long term plan for sustainable social care.

Download our election manifesto: Dignity in older age and a life worth living (PDF 780 KB)

Designed by patients: the mental health centre saving the NHS £300,000 a year

Soft, neatly folded blankets hang invitingly over the backs of the modern but comfy armchairs in the Gellinudd Recovery Centre’s communal living room. In the en suite bedrooms, there are white waffle slippers and dressing gowns embroidered with the centre’s tree symbol.

Staff and guests – those who stay are not termed patients – join forces to cook, clean and tend the fruit and veg they then sit down to eat together at Gellinudd, which is the UK’s first inpatient mental health centre to be designed by service users and their carers. “If you’re a psychiatrist you’ll still be expected to be in the kitchen chopping vegetables alongside everyone else,” says the centre’s director, Alison Guyatt.

Over three years, via consultation meetings attended by up to 50 people and annual general meetings attracting as many as 300, service users and carers who are also members of the Welsh charity Hafal, which runs the centre, have influenced everything from the policies and procedures to the decor, facilities and recovery-focused activities on offer.

“They’re the experts,” says Guyatt. “They can say how it feels to be on the receiving end of care, how anxious you would be, what your concerns would be. They have such powerful stories to tell.” The lack of privacy and dignity in hospital settings, together with old and decrepit buildings that provide little access to fresh air, were common themes among those who gave input. “A lot of them feel very clinical, rather than homely and welcoming,” Guyatt says.

Ensuring a different atmosphere at Gellinudd, which opened in April 2017, was therefore critical. Members met the architects in the earliest stages, and Guyatt arranged for furniture makers to bring chairs, tables and beds to consultation events to be tested.

Hafal believes co-produced, recovery-focused services improve outcomes for patients and reduce costs. It has estimated that Gellinudd, which was developed with Big Lottery funding of £1m and £500,000 from the Welsh government’s Invest to Save scheme, will generate year-on-year NHS savings of £300,000 in Wales.

Could the model be copied elsewhere in the UK? Commissioners are increasingly interested in co-production, according to Grazina Berry, director of performance, quality and innovation at the Richmond Fellowship, a voluntary sector mental health support provider that involves its users in shaping services. But the resources to make it happen are not necessarily available.

“We’re seeing many more opportunities coming up which directly ask for co-produced innovations,” Berry says. “But the money to match that isn’t always there because funding is reducing. We as a provider can say we’ll implement a whole range of innovative services. But to prove they work we want to evaluate them, and evaluation costs money.” Berry has no doubt that services designed with users bring better outcomes: “They give power to the people who understand recovery the most.”

At the National Survivor User Network (NSUN), a charity which helps mental health service users shape policy and services, managing director Sarah Yiannoullou believes the extent to which service users are listened to remains patchy. “There are some really good examples where the rhetoric is starting to become the reality, but it’s not consistent,” she says.

“I think we’re still in a system where the medical model is dominant and there’s this culture that the professional still knows best. The problem for the voluntary sector is that quite often what you say works and helps is regarded as anecdotal or dismissed as not credible.”

But it is crucial service users are listened to: “Meaningful, effective involvement can transform people’s lives, improve the quality and efficiency of services and develop the resilience of communities,” says Yiannoullou. “If commissioners and clinicians really listen to us, respect us and treat us as equals then our experience of services will improve.”

Loneliness among older people: a new epidemic

A weekly phone call or visit from a volunteer are among the solutions to help ease the loneliness epidemic affecting 1.2 million older people in England, according to campaigners.

Age UK, says that 1.2 million older people are chronically lonely and that this has an adverse impact on mental health, and the challenge will increase as our population ages. In the next 20 years, England’s over-85 population is set to rise from nearly
1.3 million people to just under 2.8 million.

Caroline Abrahams, Age UK charity director says: “Loneliness can have an impact on older people’s health and wellbeing. And this is particularly true when it comes to mental health, with older people’s depression often brought on by, or exacerbated by loneliness.”

NHS figures reveal that depression affects around
22% of men and 28% of women aged over 65 in England, but, according to the Royal College of Psychiatrists,
85% of older people with depression receive no NHS help at all. The spotlight on older people initiative – a group of nine older people’s organisations led by the Jo Cox Commission on Loneliness – says that more than half the users of over-50s social networking site Gransnet who say they are lonely have never discussed loneliness with anyone.

But solutions do exist, says Abrahams: “There is no quick fix or single policy solution to eradicate loneliness but there are reasons to hope that we can change things for the better.” An Age UK and Campaign to End Loneliness 2015 report, Promising Approaches to Reducing Loneliness and Isolation in Later Life, reveals good practice. For example, it says interventions involving help with transport or technology “can be the glue that keeps people active and engaged”.

The report highlights successes such as face-to-face or telephone befriending projects, including the Royal Voluntary Service’s Dorset Befriending Service, offering home visits to older people. The project began after a local GP’s concerns that older patients would visit the doctor primarily because they were isolated. Another initiative, The Silver Line, is a 24-hour, free helpline for information and companionship. In addition, British Red Cross community connectors are volunteers who identify and attend local activities with lonely older people.

The Campaign to End Loneliness is developing a national initiative to tackle loneliness through community collaboration. Laura Alcock-Ferguson, the campaign’s director, adds: “At a local level across the UK, health authorities should be developing clear plans to reduce loneliness and social isolation in their local areas.”

Dr Amanda Thompsell, chair of the old age psychiatry faculty at the Royal College of Psychiatrists, says organisations developing support projects must also include older people and carers as well as psychiatrists, GPs, and the social care sector. Thompsell suggests awareness of loneliness could also be incorporated into the school curriculum: “Inter-generational contact has been shown to be particularly effective in combating loneliness and we often forget how much children can learn from older people.”

Ignoring the challenge is not an option, as Thompsell says: “Failure to tackle loneliness will lead to more pressure on services which are already overwhelmed.”

Buurtzorg: the Dutch model of neighbourhood care that is going global

The Dutch may be renowned for tulips and Edam cheese, but these days it’s their innovative district nursing and homecare model that is exciting global interest. Buurtzorg, which translates as “neighbourhood care”, is seen by its many enthusiasts as a key part of the solution to challenges facing healthcare systems across the world.

From Aberdeen to Shanghai, the Buurtzorg approach is being seized on by policy-makers as a means of enabling people with care needs to live independently with much less formal support. Potential cost savings of up to 40% have been calculated.

At the same time, the model is said to be hugely popular with the nursing teams who run it because it frees them from management control and unleashes their entrepreneurial creativity. And it is very simple.

Buurtzorg was founded 10 years ago by a 56-year-old nurse, Jos de Blok, and started with an initial team of four. The system that evolved deploys teams of up to 12 nurses, who are responsible for between 40 and 60 people within a particular area. There are now around 900 teams in the Netherlands, supported by no more than 50 administrators and 20 trainers.

The principle underpinning the model is that the nurse acts as a “health coach” for the individual and their family, emphasising preventive health measures but also delivering necessary care themselves or calling on others to do so. The golden rule is that nurses must spend 61% of their time in direct contact with the people they support.

An evaluation by consultancy KPMG in 2012 found that although the care might be costlier per hour than under a traditional approach, it was of higher quality and better appreciated by those in receipt. Crucially, only half as much care was typically required.

“What I see in a lot of countries is that systems are increasingly complicated and frustrations are becoming worse and worse,” says de Blok. “I want to show that it’s easy to change.”

De Blok will be talking change at the 25th annual European Social Services Conference in Malta at the end of June, organised by the European Social Network. In some cases, he will be preaching to the converted: Buurtzorg is being trialled in the UK and Sweden, with Germany and Austria soon to follow, as well as in the US, Japan, China, Taiwan and South Korea.

But others at the conference will need convincing that the model can be transplanted into other health systems and nursing cultures as easily as he suggests.

One issue is funding: the Dutch model is tailored to payments by health insurance companies, not a state healthcare system like the NHS or means-tested social care. Another is the scrapping of hierarchies and specialisms within the nursing teams: a Buurtzorg nurse might administer wound care, but may also help someone to wash or get dressed.

A third challenge is that the model requires management to back off and allow their teams considerable latitude, with much less performance monitoring than has become the norm in, for instance, the UK. Bureaucracy is reduced to a minimum.

“We have tried to prevent it becoming a meetings structure,” says de Blok, describing how his teams are encouraged to think freely in finding answers to people’s care needs, drawing on other professionals and volunteers. “The autonomy is better when [the teams] build their own networks to solve problems.”

The Buurtzorg approach has even been extended to what in the UK would be recognised as home help, after the organisation stepped in to rescue a failing Dutch provider two years ago. By cutting its overheads dramatically, the provider has not only been saved but has expanded by more than 60% to 4,000 employees.

It is significant, therefore, that one of the most advanced UK Buurtzorg pilots is being run by Cornerstone, a Scottish homecare charity, while others closer to the original nursing concept are developing at sites including Aberdeen, Angus, Dumfries and Galloway, and Borders.

In England, the model has been taken up by the Guy’s and St Thomas’s NHS foundation trust in south London as well as integrated health and care services in Tower Hamlets, east London, and in west Suffolk. Active interest has come from Kent and Cheshire West, among others, and 300 people recently attended the first presentation in Wales by Public World, a consultancy working with Buurtzorg.

De Blok insists he is relaxed about the model being adapted to suit local circumstances. Buurtzorg is a non-profit organisation – though it makes a surplus for reinvestment – and it does not seek to franchise the model under licence.

“I’m not interested in money,” de Blok says. “I see so many people searching for a new way of doing things in all the places I visit. It’s all about creating something different from the bottom up.”