Achieving parity of resource, access and outcome for mental health in England

This report outlines the British Medical Association’s findings about the state of mental health in England and offers recommendations for improvements.

Recent NHS England and government commitments recognise the importance of parity of esteem between physical and mental health. However, Doctors remain extremely concerned about the state of mental health services and the ability to deliver on commitments to achieve parity. Mental health services remain a long way behind most physical health services in terms of their resourcing, patient ability to access care and overall patient outcomes.

Key findings from the report

  • Under a third of children with mental health problems in England are able to access the care they need.
  • Those with a severe mental illness in England on average die 15 to 20 years earlier than the general population.
  • Suicide is the leading cause of death among young people in the UK aged 20-34 years, and for men in the UK aged under 50.

 

Summary of recommendations

  • Funding – Double expenditure on mental health care, and spend more on wards, research and in primary care and public health. Child and adolescent mental health services require an investment standard to ensure funding commitments are met.
  • Access – Adequately resource proposed standards and review trusts which place high numbers of patients in beds far from their homes.
  • Workforce – Implement realistic and measurable workforce goals and recruitment campaigns to target sub-specialties, such as old age psychiatry and learning disability psychiatry.
  • Prevention – Establish a cross-government body to write a joint strategy on public mental health. Develop a ‘mental health in all policy’; mental health impacts assessments for all new policy proposals.

Full document: Beyond parity of esteem: Achieving parity of resource, access and outcome for mental health in England | BMA

Mental health workforce report

This report assesses progress of commitments made by NHS England, NHS Improvement and Health Education England to support and expand the mental health workforce | BMA

Recent commitments to support and expand the mental health workforce have fallen short of their goals. To assess progress against these commitments and identify where further action is required, The British Medical Association (BMA) have analysed workforce data and conducted a survey of healthcare professionals working in the sector. This has helped to build a picture of the state of the mental health workforce in England.

Key findings from the report

  • Many of the mental health workforce commitments in stepping forward to 2020/21 and the five year forward view for mental health are not on track to be met.
  • The mental health workforce has had little growth over the past 10 years, many of the key staff groups either remaining at a similar level since 2009 or declining.
  • Demand within mental health services is rising – since 2016 there has been a 21% increase in the number of people who are in contact with mental health services (1.4 million in 2019 vs 1.1 million in 2016).
  • Recruitment into psychiatric specialties remains a key challenge with many psychiatric specialties facing under-recruitment year on year.
  • Workforce shortages in mental health are affecting staff workload, wellbeing, morale and the ability for staff to provide good quality of care.

Full report: Measuring progress: Commitments to support and expand the mental health workforce in England

How to build effective teams in General Practice

This guide draws on insights from research, policy analysis and leadership practice to outline ways in which practices can create and sustain effective teams, as they come together to form primary care networks | The Kings Fund

The need for collaboration and communication underpins much of the guide and links to further reading and case studies to support each section are provided. The guide looks at the following questions:

  1. What are the fundamentals of effective teams?
  2. Which roles should you recruit?
  3. How can you make best use of new roles?
  4. How can teams communicate effectively?
  5. Do you need to re-design your physical space?
  6. How can you ensure supportive management and accountability?
  7. How can you work across organisations?
  8. How should you engage with your patients?
  9. How can you manage yourselves effectively?

Full document: How to build effective teams in general practice

First-time marathon runners benefit from reduced blood pressure

Full reference: Bhuva, A. N. et al | 2020| 

A new study argues first-time marathon runners, training and completion of the marathon resulted in reductions in blood pressure and aortic stiffening in healthy participants that were equivalent to a four-year reduction in vascular age. The greatest benefits were seen in older, slower male marathon runners with higher baseline blood pressure.

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Dr Charlotte Manisty, an author of the study, says “Our study highlights the importance of lifestyle modifications to slow the risks associated with aging, especially as it appears to never be too late as evidenced by our older, slower runners”  (Source: University College London).

UCL Marathon running makes arteries younger and lowers blood pressure

Abstract

Background Aging increases aortic stiffness, contributing to cardiovascular risk even in healthy individuals. Aortic stiffness is reduced through supervised training programs, but these are not easily generalizable.

Objectives The purpose of this study was to determine whether real-world exercise training for a first-time marathon can reverse age-related aortic stiffening.

Methods Untrained healthy individuals underwent 6 months of training for the London Marathon. Assessment pre-training and 2 weeks post-marathon included central (aortic) blood pressure and aortic stiffness using cardiovascular magnetic resonance distensibility. Biological “aortic age” was calculated from the baseline chronological age-stiffness relationship. Change in stiffness was assessed at the ascending (Ao-A) and descending aorta at the pulmonary artery bifurcation (Ao-P) and diaphragm (Ao-D). Data are mean changes (95% confidence intervals [CIs]).

Results A total of 138 first-time marathon completers (age 21 to 69 years, 49% male) were assessed, with an estimated training schedule of 6 to 13 miles/week. At baseline, a decade of chronological aging correlated with a decrease in Ao-A, Ao-P, and Ao-D distensibility by 2.3, 1.9, and 3.1 × 10−3 mm Hg−1, respectively (p less than 0.05 for all). Training decreased systolic and diastolic central (aortic) blood pressure by 4 mm Hg (95% CI: 2.8 to 5.5 mm Hg) and 3 mm Hg (95% CI: 1.6 to 3.5 mm Hg). Descending aortic distensibility increased (Ao-P: 9%; p = 0.009; Ao-D: 16%; p = 0.002), while remaining unchanged in the Ao-A. These translated to a reduction in “aortic age” by 3.9 years (95% CI: 1.1 to 7.6 years) and 4.0 years (95% CI: 1.7 to 8.0 years) (Ao-P and Ao-D, respectively). Benefit was greater in older, male participants with slower running times (p less than 0.05 for all).

Conclusions Training for and completing a marathon even at relatively low exercise intensity reduces central blood pressure and aortic stiffness—equivalent to a ∼4-year reduction in vascular age. Greater rejuvenation was observed in older, slower individuals.

The Library & Knowledge Service can provide a copy of this article for Rotherham NHS staff, contact us 

BBC News Running marathon cuts years off ‘artery age’

 

The effect of health lifestyle habits on life expectancy and type 2 diabetes

Li, Y. | 2020  |Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study | BMJ |368|  doi: https://doi.org/10.1136/bmj.l6669

A new cohort study that uses data from the Nurses’ Health Study (NHS) and 28 years of follow-up in the Health Professions Follow-up Study (HPFS) to look at the impact of habits on lifestyle has been published in The BMJ. The team behind the research examine the effect of healthy lifestyle factors on life expectancy free of cancer, cardiovascular disease, and type 2 diabetes. Participants of both studies completed questionnaires about their diet, exercise, smoking status, and other factors (questions on the use of postmenopausal hormone replacement therapies and reproduction related questions were asked in the NHS only). Data on the participants’ age, ethnicity, and family history on the presence or absence of diabetes, cancer, or myocardial infarction (in first degree relatives)- this was collected via biennial questionnaires. 

Their observations suggest that a healthier lifestyle was associated with a lower risk of cancer, cardiovascular disease, and diabetes as well as mortality, with an increased total life expectancy and number of years lived free of these diseases (Source: Li et al, 2020).

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Abstract

Objective To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases.

Design Prospective cohort study.

Setting and participants The Nurses’ Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366).

Main exposures Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (less than or equal to 30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).

Main outcome Life expectancy free of diabetes, cardiovascular diseases, and cancer.

Results The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (more than or equal to 15 cigarettes/day) or obese men and women (body mass index more than or equal to 30), their disease-free life expectancies accounted for the lowest proportion (less than or equal to 75%) of total life expectancy at age 50.

Conclusion Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.

Read the full article at the  BMJ

In the news:

BBC News Healthy habits ‘deliver extra disease-free decade’ 

 

Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’

Royal College of General Practice | January 2020 | Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’ 

Responding to a feature that ran in The Sunday Times (in last Sunday’s edition, 5 January 2019), Professor Martin Marshall, Chair of the Royal College of GPs, said: “It is totally unacceptable to expect patients to wait weeks for a GP appointment. Patients -and GPs – deserve better. 

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“However, the situation in which we find ourselves has not happened overnight, and the College has been sounding the alarm bells for many years.

Over 1m patients are seen in general practice every day, and GPs are doing their best but the service cannot keep stretching. There are limits beyond which GPs can no longer guarantee safe care to patients and the potential for error or misdiagnosis increases.

“There is also the risk that long waiting times for a GP appointment will deter some patients from seeing a GP at all, which could mean they seek help at a much later stage when the problem is much more serious.

“Pressure of workload is taking its toll on the health and wellbeing of GPs themselves. For too many, the job has become untenable, with the result that they are burning out and leaving the profession before their time.

“It is extremely encouraging that we have more GPs in training than ever before, but it takes a long time to qualify and we need urgent action to retain existing GPs and ensure they are supported to remain in the profession and that the job of a frontline GP becomes ‘do-able’ again.” (Source: RCGP)

Related:

The Times Eleven million patients wait more than three weeks to see GP

Story also reported in:

BBC News GP shortages cause ‘unacceptable’ patient waits

The impact of mindfulness-based interventions on doctors’ well-being and performance: A systematic review

Scheepers, R. A., Emke, H., Epstein, R. M., & Lombarts, K. M. |2019| The impact of mindfulness‐based interventions on doctors’ well‐being and performance: A systematic review| Medical Education |

A team of researchers from the Netherlands and the US has systematically reviewed and narratively synthesised findings on the impacts of mindfulness based interventions (MBIs) on doctors’ well-being and performance. 

Abstract
Objectives: The well-being of doctors is at risk, as evidenced by high burnout rates
amongst doctors around the world. Alarmingly, burned-out doctors are more likely to
exhibit low levels of professionalism and provide suboptimal patient care. Research suggests that burnout and the well-being of doctors can be improved by mindfulness-based interventions (MBIs). Furthermore, MBIs may improve doctors’ performance (eg in empathy). However, there are no published systematic reviews that clarify the effects of MBIs on doctor well-being or performance to inform future research and professional
development programmes. We therefore systematically reviewed and narratively synthesised findings on the impacts of MBIs on doctors’ well-being and performance.

Methods: We searched PubMed and PsycINFO from inception to 9 May 2018 and
independently reviewed studies investigating the effects of MBIs on doctor wellbeing or performance. We systematically extracted data and assessed study quality
according to the Medical Education Research Study Quality Instrument (MERSQI),
and narratively reported study findings.
Results: We retrieved a total of 934 articles, of which 24 studies met our criteria; these
included randomised, (un)controlled or qualitative studies of average quality. Effects
varied across MBIs with different training contents or formats: MBIs including essential mindfulness training elements, or employing group-based training, mostly showed
positive effects on the well-being or performance of doctors across different educational and hospital settings. Doctors perceived both benefits (enhanced self- and otherunderstanding) and challenges (time limitations and feasibility) associated with MBIs.
Findings were subject to the methodological limitations of studies (eg the use of selfselected participants, lack of placebo interventions, use of self-reported outcomes).

Conclusions: This review indicates that doctors can perceive positive impacts of
MBIs on their well-being and performance. However, the evidence was subject to
methodological limitations and does not yet support the standardisation of MBIs
in professional development programmes. Rather, health care organisations could
consider including group-based MBIs as voluntary modules for doctors with specific
well-being needs or ambitions regarding professional development.

The full article is available to read from Wiley 

Testicular cancer: study finds one cycle of chemo just as effective

Cullen, M., et al |2020|The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis|European Urology|

European Urology has published a paper based on a study that looked at the efficacy of one cycle of chemotherapy for patients with testicular cancer rather than two.  While standard treatment in Europe involves two cycles of chemotherapy the researchers of this trial  show that one cycle has few adverse effects and comparable outcomes
to those seen with two cycles. 

Abstract
Background: Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2 ), and cisplatin (BE360P) chemotherapy, or surveillance.
Objective: To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P.
Design, setting, and participants: A total of 246 patients with vascular invasion–positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study.
Intervention: One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1–3, and cisplatin 50 mg/m2 on days 1–2, plus antibacterial and granulocyte colony stimulating factor prophylaxis.
Outcome measurements and statistical analysis: The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of 5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr.
Results and limitations: The median follow-up was 49 mo (interquartile range 37–60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3–
3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3–4 febrile neutropenia occurred in 6.8% of participants.
Conclusions: BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population.
Patient summary: Removing the testicle fails to cure many patients with high-risk primary testicular cancer  since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes
to those seen with two cycles

The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of  Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in 
High-risk, Stage 1 Nonseminomatous or Combined Germ Cell
Tumours of the Testis

In the news:

BBC News Testicular cancer: ‘Kinder’ chemotherapy is ‘just as effective’