Home exercises ‘effective’ at reducing rheumatoid arthritis hand problems

HOME hand exercises provide huge benefits for people with rheumatoid arthritis, researchers from the University of Salford have found.

In the first ever review of its kind, researchers found that home exercise programmes improved patients’ grip strength and hand movement while reducing the amount of pain they experienced, but that high-intensity programmes were the most effective.

Rheumatoid arthritis often causes problems such as pain, stiffness and joint swelling in the hands as an early symptom of the disease, with women’s grip strength reduced on average to less than half within six months of diagnosis.

These problems sometimes mean people are unable to carry on working while 59 per cent of people develop hand deformities within a decade of developing the condition.

Although medication can improve symptoms, it does not stop the loss of muscle function and occupational therapists and physiotherapists often teach home hand exercise programmes as a way of managing the illness – although the type of exercise and number of sessions varies widely. Little work has been done to assess how effective they can be.

Professor Alison Hammond and Dr Yeliz Prior from the University’s School of Health Sciences looked at home hand exercise trials involving 665 patients with an average age of 59.

They had taken part in a range of exercise programmes included squeezing, pinching and rolling therapeutic putty, squeezing hand exercise balls and pulling against resistance bands.

Their report, published in the British Medical Bulletin, concludes that those who had done exercises using therapeutic putty giving medium – or stronger –  resistance at high intensity did best. 

People regularly doing such exercises reported improvements in grip strength, hand movement and their ability to carry out everyday tasks, as well as experiencing less hand pain. Longer-term, if they keep doing them, these benefits continue.

Alison Hammond, Professor in Rheumatology Rehabilitation at the University of Salford, said: “Rheumatoid arthritis effects nearly 700,000 people in the UK, with many suffering hand problems which can be both agonising and can reduce their ability to work and carry out everyday tasks. We have found that hand exercise programmes are an effective way of reducing these problems, but that high intensity resistive exercises are by far the best and most cost-effective method.

“We found that the most effective programmes were high intensity and supervised by therapists for four or more sessions at first, to make sure people with arthritis can do the exercises right, steadily build up resistance and get into the habit of doing them. These resulted in consistent improvements. In comparison, low-intensity, low-resistance programmes, taught in just one session – which is common practice in the NHS – don’t produce these results.

“Our findings showed that people should do between four and six resistive hand exercises performed at high intensity – such as 10 repetitions of each exercise performed daily, and then up to three times a day as their hands improve. Although this takes 20 minutes or so a day, they can be spread through the day and easily done when taking a break or watching TV.”


New resources are being made available to employers, training providers and employment professionals to help alleviate London’s social care skills shortages from today.

Through Ambition London, funded by JP Morgan Chase Foundation, two new toolkits are being made available to promote the rewards and tackle common misconceptions of careers in health and social care sector.

Both the health and Adult social care sectors faces an acute shortage of skilled workers with too few entrants, poor career progression and poor retention. As London’s population gets older, more has to be done to support employers built attractive career pathways in these vital sectors.

These toolkits, developed with experts from Skills for Care and the National Skills Academy for Health, clearly articulate the benefits of a rewarding career in both the social care and health sectors and provides training providers and employment professionals with better information to support people who are unemployed or in long-term low-paid work. In addition, the toolkits promote information on the careers and training routes for job roles within these professions and promote Advanced Learner Loans as a funding route for those individuals who wish to invest in their skills and progress their career.

Stephen Evans, chief executive at Learning and Work Institute, which runs Ambition London, said:

“We are all going to have to rely on health and social care services in some way during our lives and all of us expect the highest quality services for our loved ones. Not only is this vital sector under enormous pressure financially, but shortages in skilled workers are set to get worse as we rely less on migrants post-Brexit unless urgent action is taken. That’s why we’re proud to be working with partners to promote the excellent career opportunities available in social care and help those who work with jobseekers to enter and progress in the profession.”

Ali Rusbridge from Skills for Care, said,

“We know that we’ll need around 275,000 more workers in adult social care by 2025 to meet the growing demand for services. In a sector where the average age of workers is 43 years old, we’re working with employers to inspire the next generation of care workers.  We have been delighted to be involved in Ambition London and to develop materials which help set individuals’ ambition for working in social care in East London.”

Candace Miller, Executive Director Learning Services and Consultancy, National Skills Academy for Health, said,

“The health sector is ever evolving and the need to provide a highly skilled workforce, who can apply those skills to a variety of settings and specialist roles, continues to be a challenge. Ensuring employers, learners and providers have the right information advice and guidance about programmes and the funding routes available is key to achieving this aim. Providing access to this information allows individuals to take ownership of their career and thrive in the workplace.”

 Hang Ho, Head of the JPMorgan Chase Foundation for Europe, the Middle East and Africa, said:

“Addressing skills shortages is key to ensuring the success of any economy particularly in growth sectors like health and social care. We are passionate about ensuring the maximum number of people are able to benefit from the jobs created in these important sectors and that existing employees are supported with progression and the chance to improve their skills. The new toolkits will help employers address difficulties in attracting and retaining new workers, which left unchecked, will not only have a negative impact on the UK economy, but long term, on the quality of life for those who depend on these services.”

 The toolkits are available for download at: http://sfh.skillsplatform.org/ambition/

New working paper from Skills for Health shows high-quality development is key to workforce integration

Skills for Health has today published a working paper examining a crucial issue for the future of the healthcare sector: the successful integration of the health and social care workforces.

‘Integration and the Development of the Workforce’ will provide healthcare organisations with insight and guidance on how their workforce needs to adapt to support successful integration.

Developed in coordination with health and social care employers in the UK and internationally, the paper is the third in Skills for Health’s series of research papers on the health sector workforce, ‘Our Health Heroes in Focus’ .

By working more closely together, health and social care providers will be able to pool their skills, knowledge and resources to increase efficiency and quality of care. However, integration will require breaking down and redrawing traditional boundaries in the way care services are managed and delivered, meaning the two workforces will need to work in a completely different way.

Jon Parry, Principal Research Manager at Skills for Health, said, ‘Integrating the health and social sectors will require moving from a top-down, centrally-managed health system to one that delivers both health and social care seamlessly, shaped around the needs of the patient.

‘Successful integration will not be achieved through simply introducing new policies, but through the concerted effort of those working every day in health and social care.’

This paper explores the high-quality, persistent and effective workforce development that is essential to ensure their buy-in and support them to make this change.  Individuals will need to change mindsets, build relationships beyond traditional boundaries and develop their knowledge of other roles and organisations.

Jon Parry continued, ‘The integration agenda will be increasingly important for the foreseeable future, with the healthcare sector’s workforce being a vital component in ensuring its success. Such fundamental change will not happen overnight; organisations will need to consider the long-term support needed.

‘We hope this paper and the others in the series provide a useful contribution to the sector’s thinking about the development of its workforce in this crucial area.’

Download ‘Integration and the Development of the Workforce’ here.

For more information about Skills for Health visit www.skillsforhealth.org.uk.

First UK Professor of Kidney Care appointed at London South Bank University

Professor Nicola Thomas at London South Bank University (LSBU) has just been appointed the first Professor of Kidney Care in the UK.

Throughout her career Nicola Thomas has worked within the renal speciality and has gained extensive clinical, teaching and research experience. Her clinical interest lies in the care and management of chronic kidney disease within primary care.

Professor Thomas also holds honorary nurse consultant post at Barts Health NHS Trust where she is involved in running the East London Community Kidney Service. Her specific expertise lies in patient and carer involvement in education and research.

Nicola Thomas said, “I am delighted that London South Bank University has recognised my work and it is an honour and a privilege to contribute to the improvement of care of people who have kidney disease through my teaching and research. This promotion is also very important for the development of renal nursing practice in the UK.”

Professor Warren Turner, Dean of LSBU’s School of Health and Social Care, said,

“This is fantastic news – not only for Nicola, who has worked so hard and well deserves this honour – but for LSBU’s School of Health and Social Care.

“There are a number of medical doctors in the UK with the title of Professor, but Nicola is the first nurse to be awarded a Professorship specifically for kidney care. Nicola’s new role will help to put the spotlight on renal research carried out at LSBU.”

Nicola also holds the position of Deputy Vice President (Education) of the British Renal Society and is the Editor of the Journal of Renal Care. She has previously been President of the European Dialysis and Transplant Nurses Association/European Renal Care Association.

Unmanageable GP workloads at ‘critical point’, new report warns

GP Pressures

GP Pressures

“My job makes me feel utterly, totally stressed, depressed and suicidal. I realise I have to change something soon to save my sanity.”

“Not being able to deliver safe or quality care is both demotivating and frightening – how long before I make a major mistake, because I am just too drained and shattered to pick up on an important cue?”
“I am shocked to see how many GPs in early or mid-career are solving this problem on an individual basis by cutting down their sessions or moving out of general practice altogether.”
These are just some of the quotes from over 1000 GPs from across the UK who have been surveyed for the new report, ‘Diagnosing the GP crisis: voices from the front line of primary care’, released on Tuesday 14 March.
The report reveals the unprecedented effect of unmanageable workloads on GPs – on their own wellbeing, on their ability to perform their duties safely, and on the future retention and recruitment of doctors into general practice.
Key findings include:
  • Unmanageable workloads are compromising the quality and consistency of the care that GPs are able to provide: 85% say that the volume of their workload prevents them from doing their job well.
  • Unmanageable workloads are forcing GPs out of the profession and contributing to a recruitment crisis: more than 90% have either left or considered leaving due to increasing workloads, or have reduced their hours in order to cope.
  • Less than a third (30%) would choose to train as a GP if they were given the option now.
The findings suggest that the effects of unmanageable workloads may prevent the NHS from meeting its target to recruit and train 5000 new doctors into general practice over the next five years.
The report is part of a wider campaign by GP education provider Red Whale that aims to counter negative perceptions of GPs, highlight the issues they face, and provide them with professional support.
“We know that GPs want to provide high-quality, consistent care to their patients, but in many cases the vast and unmanageable workloads that they face prevent them from being able to do so,” says Caroline Greene, GP and Business Development Director at Red Whale.
“This report shows that the impact of those workloads has reached a critical point, leaving many GPs feeling unable to safely and effectively do their jobs, and forcing others out of general practice altogether.
“We are listening to what GPs are saying, and we want those in charge of making decisions to listen too, before it’s too late.”

The Diseases Around us are Still Evolving – Are we?

Bird Flu

Bird Flu

It seems like every few years, a new disease comes along and spreads like wildfire, leaving a trail of death and devastation in its wake. Are we getting worse at fighting off infections, or are they getting better at invading our bodies?

A lot of the diseases that humans tend to catch regularly, like the common cold or flu, have actually evolved with us over millions of years. This is called co-evolution. Just as we evolve to battle them a little better, they evolve to attack in a slightly different way that bypasses our new defence – it’s an ongoing arms race.

Lots of bacteria and viruses have developed very clever ways of avoiding our immune systems so they can survive in our bodies. Some are able to go into hiding, like the herpes virus (spread by physical contact) which causes cold sores. This hides in the large junctions between nerve cells (called ganglia) in the head and spine, waiting for you to get ill or stressed. It then travels back towards your face and causes those unmistakable blisters.

Others are attacked and taken up by white blood cells because of the immune response, but are able to escape. Instead of being destroyed by the white blood cell like normal, they go on to cause further illness. This strategy is used by a particularly nasty bacterium called Shigella dysenteriae (spread by contaminated water and poor hand washing practices) – this infects the large intestine and causes severe bloody diarrhoea.

Different animals have different types of cell surface signatures that microbes either can or can’t interact with. If it can, then the germ can attach to or get inside of the cell and cause illness – like having the right key to unlock a door. Bird cells only have a single type of signature, but pig cells have their own different type of signature as well as the same sort of signature as birds.

This means pigs can be infected by both pig and bird diseases, and these diseases can then interact with each other. Additionally, the signature found only on pig cells is actually compatible with humans. So pigs can act as mixing bowls of bird (avian) and pig (swine) illnesses, creating new diseases and then passing them on to humans. This is actually one way that new kinds of flu are ‘made’ or evolve. When these new strains crop up, our immune systems don’t quite know how to deal with them at first, and depending on how unpleasant the virus is, they may even cause death.

Anything that tests a disease’s ability to survive in your body can provoke evolutionary changes. This is how antibiotic resistance starts. Inappropriate use of antibiotics – that is doctors having prescribed them when they aren’t needed, and/or patients not taking them properly – can expose germs to amounts of antibiotic that aren’t strong enough to kill them.

As the saying goes, what doesn’t kill you makes you stronger! The bacteria are able to get used to the antibiotic and develop immunity or resistance. This is how ‘superbugs’ like MRSA (often found in hospitals) and multidrug-resistant tuberculosis (MDR-TB) come about. MDR-TB is a particular problem because tuberculosis is usually treated with combinations of very strong antibiotics over a long period of time, these drugs are kept in reserve – used only for this especially difficult-to-treat disease. That means it’s quite scary that TB is evolving resistance, this is why drug companies are searching for new and improved antibiotics.

Although we humans may think of ourselves as being very advanced, our species went through a ‘population bottleneck’ tens of thousands of years ago. This means a significant proportion of the human population at the time was wiped out, and their genes were lost. The resulting loss of genetic diversity means that modern day humans are incredibly similar in terms of their genes, and we have to wait for random mutations to occur in order for evolution to take place. So our ability to evolve to prevent or better combat infectious disease, is much slower when compared to the speed bacteria, viruses and infectious fungi can evolve at.

One notable human mutation in this context is sickle cell disease. Although the disease itself (which is genetic, not infectious) has lots of unfortunate symptoms, in some cases it does in fact give protection from malaria. This is because the parasite which causes malaria makes sickled cells collapse after infection.

As progressive as our technologies and innovation may be, there could soon come a time when we run out of antibiotics, or we cannot adapt fast enough to fight these newly emerging diseases. Could it be possible that we might lose this arms race?

Article by Catherine Butterfield of University Birmingham for Blog About Healthcare


Three new apprenticeship standards for support workers in healthcare in England are now ready for use.

A steering group of healthcare employers, chaired by Kay Fawcett, OBE and Jane Hadfield, North Bristol Trust have developed these standards with employers, as part of the governments Trailblazer Apprenticeship activity.  These new standards are being developed by all sectors in England in response to the 2012 Richard Review of Apprenticeships.  The review puts employers in the driving seat to ensure that apprentices develop the right skills, knowledge, value and behaviours that are required for them to be effective in the workplace.

Each Standard is a short document giving an overview of what the apprentice should know and be competent to do on completion of their apprenticeship.

On-programme learning helps apprentices develop their skills and knowledge over a period of time.  The standard is not prescriptive in how this should be delivered and may or may not require the apprentice to complete an accredited qualification.  The standard outlines how long the apprenticeship should take and, if not already achieved, the apprentice will have to take English and Maths.

When the employer, supported by the on-programme training provider, feels that the apprentice is ready it’s time for End Point Assessment. End Point Assessment organisations are registered with the Skills Funding Agency and employers need to select one of these recognised bodies to carry out the process.  Criteria of what should be assessed in the End Point Assessment is defined in the assessment plans that accompanies each of the standards.  Once the End Point Assessor is satisfied that the apprentice meets the assessment criteria they will give the apprentice a grade (pass, merit, distinction) and the apprentice will be awarded their certificate.

The apprentice is now job-ready and can apply for a post.

Healthcare Support Worker

A generically written standard that can be applied to train apprentices for a range of different roles.  Role specific learning is evidence within the assessment process which observes the learner during their normal course of work.


12-18 months

Employers can choose whether to use an accredited occupational competence qualification e.g. clinical healthcare support at level 2 or to develop their own in-house training

Senior Healthcare Support Worker

This standard has a range of options specific to certain support roles:

  • Adult nursing support
  • Maternity support
  • Theatre support
  • Mental health support

In development:

  • Children and young person support
  • Allied health profession support


18-24 months

A range of accredited occupational competence qualifications at level 3 as described within the individual option

Assistant Practitioner

A generically written standard that can be applied to train apprentices for a range of different roles.  Role-specific learning is evidenced within the on-programme qualification and during the end point assessment process.


18-24 months

A range of accredited occupational competence qualifications such as  foundation degrees or level 5 diplomas

Telehealth Needs Secure Patient Identification Practices

Michael Magrath, Director of Healthcare Business Development, VASCO

Michael Magrath

Telehealth can become a game changer as it pertains to how care is delivered. And a very welcomed one at that. However, there is a danger that it is lacking even the very basic security mechanisms put in place by other heavy lifters in the digital services community such as banking and personal finance. I have attempted to find out why that is and if telehealth may put us, as patients, at risk for cybercrime and ID theft.

In the case of The U.S. Department of Health and Human Services (HHS), it defines telehealth as “as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”

As wonderful as telehealth is, it comes with risks, particularly around trust and security. If we use the States as an example, I am well aware that telehealth service providers are HIPAA – the Health Insurance Portability and Accountability Act – Compliant, but that is really just the floor in terms of security. With our healthcare system in the cross hairs of cyber criminals, “the floor” is no longer acceptable in the States and equally the security bar would need to be raised by the NHS.

Indeed, in America, some States require that the healthcare provider and the patient meet in-person before engaging in telehealth, while others have no such requirement. Applying equally in the UK, there would need to be a solid chain of trust throughout the system. That starts with knowing that the parties involved are who they claim to be. Is the patient really who they say they are? Perhaps it is the patient’s brother, an identical twin. Most important, is the healthcare provider who they claim they are? Telehealth could expose patients to this 21st century technology approach to fraud, identity theft, medical record errors and potential lawsuits.

As with all areas of healthcare, telehealth requires accurately identifying the patient. HHS cautions on its website, “Processes related to patient identification are complex and require careful planning and attention to avoid errors.” The fact is, physicians and other providers are trained in medicine and are typically not trained to identity proof patients, nor should they have to be bothered. Identity proofing should be performed by a third party, certified by a Government-approved Provider.

Moreover, patients have a right to know that the person on the other end of a videoconference call is really a doctor. Imposters posing as physicians and practicing medicine is not only illegal, but it runs the risk of undermining trust in the entire telehealth movement.

Beyond identity proofing, authenticating into telehealth systems needs to provide higher confidence and trust. Issuing a static password for parties to access telehealth is not acceptable and could lead to hacking of and the compromising of protected health information. I look forward to utilising telehealth in the future, but I will feel more reassured knowing that the NHS has taken the proper steps to know that I am who I am and also have elevated security and authentication beyond the floor to protect my privacy and security.

For more details about VASCO’s security solutions for healthcare visit https://www.vasco.com/solutions/healthcare-information-security/index.html

Michael Magrath, Director of Healthcare Business Development, VASCO

Gain control of health information at the patient point of care

Chris Strammiello, Vice President of Global Alliances & Strategic Marketing, Nuance Communications.

Gain control of health information at the patient point of care

Hospitals face the dual challenge of making patients’ health information easier to share while keeping it more secure – Smart technology at the MFP enables hospitals to gain control of this complex environment.

The growing use of smart devices at the point of care exacerbates the dual, yet contradictory, challenges confronting hospital IT directors and compliance officers: making patients’ health information easier to access and share, while at the same time keeping it more secure.

A major problem is that there are just too many touch points that can create risk when sharing protected health information (PHI) inside and outside of the hospital. In addition to securing communications on mobile phones, tablets and laptops, these tools can send output to smart multifunction printers (MFPs) that not only print, but allow walk-up users to copy, scan, fax and email documents. This functionality is why the Office of the National Coordinator for Health Information Technology in the States now defines MFPs as workstations where PHI must be protected. These protections need to include administrative, physical and technical safeguards that authenticate users, control access to workflows, encrypt data handled on the device and maintain an audit trail of all activity.

Accurate, effective and secure use of patient information at point of care

Hospitals need to adopt an approach that automatically provides security and control at the smart MFP from which patient information is shared and distributed. This approach must also support the use of mobile computing technologies, which are helping to bring access to patient information and electronic health records (EHR) to the point of care.

Advanced secure information technology and output management solutions can help hospitals protect patient health information by adding a layer of automated security and control to both electronic and paper-based processes. These solutions can minimise the manual work and decisions that invite human error, mitigate the risk of non-compliance and help hospitals avoid the fines, reputation damage and other costs of violations and privacy breaches.

With this approach, vulnerabilities with capturing and sharing PHI are reduced with a process that ensures:

• Authorisation — only authorised staff can access specific devices, network applications and resources with password or smartcard based authentication. Network authentication is seamlessly integrated with the document workflow and to ensure optimal auditing and security, the documents containing PHI are captured and routed to various destinations such as email, folders, fax and EHR systems.

• Authentication — user credentials must be verified at the device, by PIN/PIC code, proximity (ID), or by swiping a smart card access documents containing PHI. Once authenticated, the solution controls what users can and cannot do. It enables or restricts email or faxing and prohibits documents with PHI from being printed, faxed or emailed.

• Encryption — communications between smart MFPs and mobile terminals, the server and destinations, such as the EHR, are encrypted to ensure documents are only visible to those with proper authorisation.

• File destination control — simultaneously monitors and audits the patient information in documents, ensuring PHI is controlled before it is ever gets to its intended destination.

• Content filtering — automatically enforces security policies to proactively prevent PHI from leaving the hospital by filtering outbound communications and intercepting documents – rendering misdirected or intercepted information unreadable to unauthorised users.

Deploying smart computing technology to meet compliance

While it’s clear that hospitals continue to deploy smart technologies to deliver more efficient point of care to patients, those technologies continue to provide vexing security and compliance challenges. However, implementing a flexible and scalable solution that adds a layer of automated security and control to both electronic and paper-based processes significantly reduces non-compliance risks.

The solution should include five important attributes: authentication; authorisation; encryption; file destination control; and content filtering. For example, electronic orders, referrals, reports and other sensitive information can be completed on smartphones, tablets, or laptops, electronically signed and safely and securely delivered to EHR.

With these security enhancements in place, hospitals can confidently open their networks and gain control of smart device proliferation in their patient point of care processes.



Awarding organisation, SFJ Awards has released a new qualification that recognises the knowledge and skills required for healthcare professionals to conduct effective investigations in their workplace.

The development of the Level 5 Investigating Serious Incidents in Healthcare Qualification was led by Leeds Teaching Hospitals NHS Trust. It comes after the 2016 national review by the Care Quality Commission found that the NHS is missing opportunities to learn from patient deaths and that specialised training and support is not readily provided to staff completing investigations.

Representatives from Leeds Teaching Hospitals NHS Trust, Leeds Community Healthcare Trust, Hull & East Yorkshire Hospitals NHS Trust and Harrogate and District NHS Foundation Trust formed a working group to develop the course which is now available nationally for quality assured centres to offer.

The qualification covers subject areas including the initial reviewing of an incident, investigative questioning and completing the investigation. Its introduction is intended to bring consistency to the investigative practices of healthcare organisations across the UK.

Louise Povey, Serious Incident Investigations and Learning Manager at Leeds Teaching Hospitals NHS Trust said: “In many years of delivering investigation training, it has always been frustrating that there is a lack of consistency in how investigations are conducted across NHS Trusts. I am thrilled that a recognised qualification has now been developed by SFJ Awards in conjunction with Leeds Teaching Hospitals NHS Trust.

“The qualification will enable healthcare staff to plan an investigation, conduct interviews with staff to identify the contributory factors and root cause and to make recommendations to reduce the risk of recurrence. This will provide a consistent standard, maximise learning opportunities and provide a professional framework for investigators when submitting reports to commissioners, Coroners Court, CQC and partner agencies.”

Adrian Jackson, Managing Director of SFJ Awards said: “SFJ Awards is delighted to be offering this important new qualification, providing a standard for all investigators to work to and our commitment to maintaining and improving investigation skills in this area.

“SFJ Awards would like to thank Leeds Teaching Hospitals NHS Trust for leading this initiative and all of those involved for contributing to this development.”

Key points about the new Investigating Serious Incidents in Healthcare Qualification:

Subject areas covered by the qualification are:
the principles of investigating serious incidents
the initial review of an incident
investigating a serious incident
investigative questioning and interviews
completing an investigation
SFJ Awards will offer the qualification nationally, to maintain quality and consistency the qualification will only be available via selected quality assured centres.
The qualification includes an assessment element; trainees must complete multiple choice tests and practical examinations during a real-time investigation

More information on the Investigating Serious Incidents in Healthcare Level 5 Qualification is available from the SFJ Awards website or through contacting an advisor at info@sfjawards.com or 0114 284 1970.