North West volunteers have their fingers on the pulse of health technology

A team of volunteers has been recruited to help spot friends and relatives at risk of a stroke.

The AF Ambassadors have been signed up by the Innovation Agency, the Academic Health Science Network for the North West Coast, to identify people who may have atrial fibrillation (AF) – an irregular heart rate which can lead to a life-threatening stroke.

One in five strokes is caused by AF and the North West has one of the highest AF related stroke rates in the UK. Each stroke costs the NHS and social care services around £24,000 in the first year alone.

The Innovation Agency is spreading the use of AliveCor Kardia devices – portable Electrocardiogram (ECG) monitors which attach to the back of a mobile smartphone and display a heart rate reading on an app.

AliveCor’s technology captures the heart rate of the user in just 30 seconds and shows an alert if the user’s heart rate is outside the normal range.

When this happens, the Ambassador will advise the person to visit their GP as soon as possible and will email an ECG trace to the user’s doctor or send it to the person themselves so they can show it to a healthcare professional.

Kim Hughes, a stroke survivor from Walton, is one of the first AF Ambassadors. She said:

“A quarter of people who have a stroke are under 65 and I was just 33 when I had mine. I didn’t even realise I’d had a stroke. I just lost all the feeling down one side. I was trying to do my daughter’s hair and I couldn’t move my arms properly then afterwards I kept getting migraines and was sleeping all the time.”

Following a brain scan at The Royal Liverpool University Hospital, Kim was shocked to discover that she’d had a stroke. “I thought strokes only happened to older people – I was petrified.” she said.

It has been 11 years since Kim had her stroke and she is living proof that life can be good again. She said: “The first three years were really hard but I would like to reassure survivors that there is life after stroke. Keeping positive helps, as well as setting yourself small goals each day.”

Kim keeps herself busy volunteering for The Brain Charity at The Walton Centre and is enjoying her new role as an AF Ambassador.

“I want to help prevent strokes because I know the damage they can cause to the victims and their families. I’m going to be testing people for AF at the Disability Awareness Day in Warrington this weekend.”

Scott Smith, community development manager for the Stroke Association, has also become an AF ambassador. He said: “AF is a contributing factor in up to one in five strokes in the UK and it is estimated there could be another half a million people in the UK with undiagnosed AF.

“Prevention of strokes is one of our aims so we’re delighted to be working with the Innovation Agency. If using the app can prevent one person having a stroke then it’s worth it every time.”

Debbie Parkinson, Patient and Public Involvement Lead for the Innovation Agency said: “Our new AF Ambassadors will help to spread the word about AF and hopefully raise awareness in their communities and reduce the incidence of strokes.

“We have tasked them to test 50 people each on their Kardia Mobile. It’s a brilliant innovation and very easy to use.”

The Innovation Agency is recruiting more AF Ambassadors and anyone who would like to get involved should call Debbie on 01772 520250 or email


A group of parents who each lost a teenager to meningitis have issued a hard-hitting warning to other parents to ensure their children take up a lifesaving vaccine against the disease.

Parents including; Michelle Bresnahan, Paul Gentry, Julia Styles and Ailsa Sugrue  – are spearheading charity Meningitis Now’s campaign to increase Men ACWY vaccine uptake amongst young adults.

United in their grief, they have taken the brave step to speak out about the pain of their loss to prevent similar tragedies happening to other families.

Speaking on behalf of the group, Michelle Bresnahan said: “We all know only too well how devastating this disease can be and have seen the worst it can do, destroying young lives and tearing apart those who remain. 

We want to appeal to all parents to ensure their children are vaccinated, especially those who are heading off to university this autumn.

“We’re also calling on parents to ask another parent in their son’s or daughter’s friendship group to do likewise – the more awareness we can raise the better.

“If by speaking out and sharing our tragic stories we can persuade other parents and their children to act then our children’s deaths will not have been in vain.

“No one should be left counting the cost of inaction when there is a quick and effective vaccination freely available.”

Meningitis Now’s campaign coincides with a campaign by Public Health England to increase vaccination rates among young people.

The Men ACWY vaccine has been offered to all 17 and 18-year-olds and all university entrants, aged 19-25, free on the NHS since August 2015, to combat the rise in Men W cases in adolescents. But cases continue to increase in England, from 30 in 2011/12 to 210 last year (2015/16), up from 176 the previous year.

Meanwhile uptake of the vaccine across the country remains stubbornly low at about one-third of those eligible.

Dr Tom Nutt, chief executive at Meningitis Now, said: “This is a brave step by these parents to speak out and a timely reminder to others to make sure young people get the Men ACWY vaccine.

“Teenagers are the second most at risk group of contracting meningitis after babies and toddlers and up to a quarter of students carry the bacteria that can cause meningitis compared to one in ten of the general population.

“Over 17 per cent of all cases of Men W occur in the 14 to 24 age group, with first year students being at particular risk.

“We remain deeply concerned about the low level of vaccine uptake – just 33% last year, which remains disappointingly below the 2015 uptake rate of 38%.” 

“It’s vital that young people and their parents are not complacent about the threat of meningitis – we urge them to take up this lifesaving vaccine.”

Those who are due to leave school this summer, or who are aged 17 – 18 and not in school (born between 1 September 1998 and 31 August 1999) are now eligible for the vaccine and should contact their GP practice.

Dr Mary Ramsay, Head of Immunisation at PHE said:

“The MenACWY vaccination programme will save lives and prevent lifelong and devastating disability.

“We have seen a rapid increase in Men W cases across England in recent years and vaccination is the most effective way of protecting against infection.

“Young people are particularly at risk as they are carriers of the disease. Being in confined environments with close contact, such university halls, hostels when travelling, or attending festivals, increase the chances of infection if unprotected.

“Get vaccinated as soon as possible, remain vigilant and seek urgent medical help if you have concerns for yourself or friends.”

New entrants to higher education (university freshers) are also eligible. Anyone who is eligible and has missed vaccination in previous years remains eligible up to their 25th birthday and is urged to have the MenACWY vaccine.“

Meningitis Now is working towards a future where no one in the UK loses their life to meningitis and everyone affected gets the support they need.

It does this by funding research into vaccines and prevention, raising awareness so people know what to look for and what action to take if they suspect meningitis and rebuilding futures by providing dedicated support to people living with the impact of the disease.

For more information and to donate visit

Royal Free – Google DeepMind trial failed to comply with data protection law

The ICO has ruled the Royal Free NHS Foundation Trust failed to comply with the Data Protection Act when it provided patient details to Google DeepMind.

The Trust provided personal data of around 1.6 million patients as part of a trial to test an alert, diagnosis and detection system for acute kidney injury.

But an ICO investigation found several shortcomings in how the data was handled, including that patients were not adequately informed that their data would be used as part of the test.

The Trust has been asked to commit to changes ensuring it is acting in line with the law by signing an undertaking.

Elizabeth Denham, Information Commissioner, said:

“There’s no doubt the huge potential that creative use of data could have on patient care and clinical improvements, but the price of innovation does not need to be the erosion of fundamental privacy rights.

“Our investigation found a number of shortcomings in the way patient records were shared for this trial. Patients would not have reasonably expected their information to have been used in this way, and the Trust could and should have been far more transparent with patients as to what was happening.

“We’ve asked the Trust to commit to making changes that will address those shortcomings, and their co-operation is welcome. The Data Protection Act is not a barrier to innovation, but it does need to be considered wherever people’s data is being used.”

Following the ICO investigation, the Trust has been asked to:

  • establish a proper legal basis under the Data Protection Act for the Google DeepMind project and for any future trials;
  • set out how it will comply with its duty of confidence to patients in any future trial involving personal data;
  • complete a privacy impact assessment, including specific steps to ensure transparency; and
  • commission an audit of the trial, the results of which will be shared with the Information Commissioner, and which the Commissioner will have the right to publish as she sees appropriate.

The undertaking we have asked the Trust to sign, and the letter outlining the conclusions of the ICO’s investigation, have both been published today.

The Information Commissioner has also published a blog, looking at what other NHS Trusts can learn from this case.

Outcomes following metal-on-metal hip revision have improved but could get even better, new study finds

A new study has found that outcomes following metal-on-metal hip revision surgery performed for abnormal reactions to metal have improved since the initial reports were published over five years ago, and are now similar to the outcomes in patients with other types of hip replacement undergoing revision surgery. The observed differences are in part due to increased surgical experience, researchers at the University of Oxford have suggested. However, the researchers proposed that surgeons had the potential to improve outcomes even further.

Approximately 1.5 million patients worldwide have received metal-on-metal hip replacements for painful arthritis. Abnormal reactions to metal can develop which may cause surrounding tissue damage. Many patients with these reactions require further operations, known as revision surgery. This is concerning as most patients who received this type of hip replacement are young and active. Therefore, poor results after these further operations would have a significant impact on a patient’s quality of life.

The biggest study in the world of its kind, published today (Monday 3 July 2017), used National Joint Registry data on 2,535 metal-on-metal hip replacement patients undergoing revision surgery performed for abnormal reactions to metal (also known as adverse reactions to metal debris – ARMD). The study, funded by Arthritis Research UK and the Orthopaedics Trust, was carried out by researchers based at the University of Oxford.

The research team also identified some factors that the surgeon can modify during revision surgery, which could potentially improve the outcomes for patients further. These factors specifically related to which of the original metal-on-metal hip components were removed by the surgeon, and which material the surgeon used for the articulation at the revision procedure. These latest findings are important as surgeons have currently received very little guidance about how best to treat these patients.

On the study’s findings, one of the authors, Mr Gulraj Matharu, commented:

“Early studies in this area highlighted catastrophic short-term outcomes for patients undergoing revision for abnormal reactions to metal, with up to one third of patients requiring further surgery known as re-revision. Therefore, it is encouraging to observe substantially improved outcomes following hip revision surgery performed for abnormal reactions to metal.  This is positive news as there are still many patients who have metal-on-metal hip replacements that may require revision surgery in the future.

“It is important that surgeons have robust information concerning the expected outcomes of this type of surgery in order to appropriately discuss potential risks with patients.  The findings from our study should help support this dialogue between surgeons and patients.

“Additionally, our findings identified risk factors associated with a poor outcome but which surgeons could actually modify during the revision procedure. Surgeons should therefore be mindful of these when making decisions regarding the type of hip reconstruction to perform. Doing so may help to further reduce the rate of subsequent failure following ARMD revision, which would be beneficial to our patients.”

Dr Stephen Simpson, director of research and programmes at Arthritis Research UK; comments:

“This study will be welcome news to the 56,000 people living with metal-on-metal hip replacements in the UK.  This research could help the small percentage of those patients who may need to undergo revision surgery, by not only assisting in decision making but also by improving the outcomes of the surgery through advice for surgeons.

“There would seem to be real value in reviewing and carefully considering the recommendations made within this study by healthcare professionals.”

The findings have been published in the Bone and Joint Journal. The study was also selected as part of a prestigious ‘Game Changers’ session at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting earlier this year.

The search is on for the best NHS suppliers and partnerships in the North West.

Supplier of the Year 2016 (1)

Supplier of the Year 2016 (1)

Applications are invited for the NHS in the North West Excellence in Supply Awards 2017 – recognising the work of businesses, third sector bodies and the NHS in working together to provide great patient care.

Last year’s overall winner was Falck Medical Services, who work with a dedicated NHS team in the North West and North Wales Transport Service, NWTS, to provide an ambulance service to transfer critically ill children.

There are 12 categories and the deadline for entries is 31 July. Applications can be made at:

Chair of the event organisers NHS North West Procurement Development and chief executive of one of the event sponsors, the Innovation Agency, Dr Liz Mear, said: “There are many different ways that our NHS partners are improving the way they deliver care, through partnerships with businesses, charities and other organisations.

“It is great to showcase examples of collaborations which are making care better for patients and service users – and more efficient for health services. These awards are a fantastic opportunity to recognise these examples.”

Mick Guymer of NHS North West Procurement Development, said:

“This is the chance to build relationships with NHS trusts and be recognised and valued as an important partner. I urge anyone with a great product or service who is passionate about the work they do in the NHS, to apply.

“The awards have grown year on year and are now supported and recognised by senior NHS stakeholders as the pre-eminent accolade for suppliers’ achievements.”

The awards will be presented at an event at the Village Hotel, Blackpool, on Thursday 19 October.

Unique event aims to provide technology solutions for healthcare issues in Cornwall

‘Maximising Technology in Health and Care’ event on 4th July

For the first time in Cornwall, the NHS and other healthcare professionals are being brought together with pioneering health technology companies, to see how they can work together to benefit people across the region and beyond.

On July 4th Cornwall Council and Falmouth University will co-host Independence Day: Maximising Technology in Health and Care, a health technology event at Falmouth University.

The health tech industry is worth billions and the digital revolution, which has already reshaped many other sectors, is transforming healthcare. Experts say that by 2020 the global value will be around £37bn, with the UK thought to be on course to take around five percent.

NHS England has already said that it is looking to save billions from the health budget by embracing technology. Kathy Byrne, Chief Executive of NHS hospital Royal Cornwall Hospital Trust says, “Within such a large organisation as the NHS, we’re always amazed at the talent, innovative ideas and opportunities proposed to us by some of the smaller players in the tech sector, but rarely have the chance to meet so many health technology businesses in one place. Maximising Technology in Health and Care on 4th July provides a fantastic opportunity to meet the businesses and entrepreneurs and start those conversations about their products and services that have so often led to improving the healthcare system.”

This event is set to provide a unique and rare opportunity for businesses and entrepreneurs to showcase their products and services to the healthcare sector, a system comprised of numerous organisations renowned for being notoriously hard to penetrate, especially for SME’s.

The national healthcare ecosystem is undergoing a dramatic, fundamental shift with rising healthcare costs, increased demand on systems and growing, ageing populations placing our health and social care systems under unprecedented pressure. With its unique sense of entrepreneurship, community and sense of place, Cornwall is responding to this global challenge in a radical way – utilising and capitalising on emerging technologies and maximising the region’s opportunities through research and innovation.

Head of Inward Investment at Invest in Cornwall, Cornwall Council’s arm’s length economic development company Cornwall Development Company, Nicola Lloyd says “We’re not only focusing on local companies, but also international businesses that enable Cornwall to thrive on inward investment and new ideas and innovation developed around the world. In recent years, we have seen a growing interest in international businesses relocating to the region and we’re delighted to see a strong pipeline ahead. This not only reinforces the strength of the opportunities and capabilities in Cornwall for foreign direct investment, but these global companies also bring a foreign energy to the region generating more jobs as a result.”

Cornwall Council Chief Executive, Kate Kennally, says “We believe we have got a unique opportunity in Cornwall to join up health and social care. Our geography, means that we have got coterminous health and social care organisations which are partnering with leading institutions such as Falmouth University to look at ways in which we can deliver integrated healthcare in rural, digitally enabled communities to improve outcomes and give people more choice and control. We have got a range of businesses interested in partnering with us, so I am delighted that we are hosting with Falmouth university a health technology event in Cornwall. We hope to promote the organic growth of partnerships between health technology businesses from across the world and representatives from the NHS, local government and health and care organisations – ensuring the right people are in the right place at the same time.”

Two key examples of such partnerships are EPIC and Smartline. Both of which have recently secured funding within the region. The EPIC (E-health Productivity and Innovation in Cornwall and the Isles of Scilly) project is designed to improve the use of technology in both health and social care with the hope of improving the health and wellbeing of people in Cornwall and improve the Cornish economy in this sector. Smartline: Smart wellbeing inspired by the community, is a research and innovation project aimed at supporting the development of the eHealth and eWellbeing market in Cornwall and the Isles of Scilly.  Smartline will help Cornish SMEs develop innovative products, processes and services by increasing understanding of how technology can be used to improve people’s health and wellbeing.

Dr Tim Taylor, Senior Lecturer in the University of Exeter Medical School and Smartline Principal Investigator says “Our objective is connecting communities to help individuals take back control of their health and wellbeing. Cornwall has been the perfect starting point for this project as the infrastructure, talent, necessary resources and general sense of community already exists, helping to ensure that we are in the best place possible to organically grow the development of the eHealth and eWellbeing market in the region by linking innovation to cutting edge research and working closely with Cornish SMEs’ to support research and development in this field.”

Professor Ray Jones, Plymouth University says “The University of Plymouth will organise 10 locality groups around Cornwall and identify problems in health and social care that have possible technology solutions. In turn, EPIC will develop their ideas and help them apply for funding set aside to support individual projects. Creative England will play a crucial role in helping technology businesses diversify into the health and care sector. Cornwall is the ideal location for EPIC due to the amount of entrepreneurial companies looking to partner with organisations within the region, enabling them to export to the rest of the UK or internationally. Already proving successful, we’re delighted this event has been organised to fully explore the opportunities and partnerships available.”

In addition to representatives from these two projects, the event will feature key note speakers, market places to explore the most innovative health technology businesses and above all provide a networking opportunity for all relevant parties to discover more about the newest opportunities within the health technology sector.

Can Sustainability and Transformation Plans deliver a better future for the NHS?

“In short, ‘No’, not unless they change direction”, say the authors of a new report, entitled ‘Sustainability and Transformation Plans: How serious are the proposals? A critical review’, published today (Wednesday 14 June 2017) by London South Bank University.

To deliver a better future for the NHS, the authors argue that the 44 existing Sustainability and Transformation Plans (STPs) for the NHS in England, initiated by NHS England in December 2015, would need to be given the legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role.

The report also recommends that STP leaders need to plan ahead based on the reality of their current situation, identify changes that are evidence-based, develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector.  At present some elements of these recommendations are missing in all of the 44 published STPs.

Overall, this critical review reveals a distinct lack of comprehensive planning and evidence-based policy making, in all 44 STPs, of sufficient quality needed to deliver the level, pace and scale of change required for the future transformation of the NHS.

The report finds that none of the STPs are ready for implementation due to:

·        The funding shortfalls,

·        The lack of legislative framework to support collaboration across health and care,

·        The lack of clarity on the role of the STP and its leadership,

·        The challenge of collaborating across multiple organisations in financial challenge,

·        The speed of planning that was required,

·        The failure to ensure engagement with local government,

·        The lack of clarity about accountability to citizens,

·        The failure to produce adequate business plans,

·        The lack of workforce plans (two thirds without any detail),

·        The lack of focus on reducing demand before switching resources away from the acute sector.

The authors propose that a viable business case must first be established in order to take full account of the proposed changes to the health and care system and to ensure that sufficient staffing and adequate capital are made available to establish new services and prove their effectiveness, before existing services are reduced. The STPs need clarity on their accountability and authority, and legislative change to enable collaboration.

Co-author of the report, health economist, Seán Boyle said: “The health and care system needs time to develop partnerships, and a legislative and accountability framework that fosters collaboration.”

“That is why this report recommends a constructive overhaul of each of the 44 STPs, looking at the appropriate framework for that work in terms of geographic area and what parts of the health and care system should be involved including the stakeholders for that area of work, the partnership agreements required and the accountability to the population of the proposed changes.”

Professor Rebecca Malby at LSBU’s School of Health and Social Care, who commissioned the report said, “There is an acute need for the evidence base supporting the case for change in each of the 44 STPs within the NHS to be substantiated further before the Service commits to launching plans for widespread ‘transformation’.  STPs also need time to clarify and develop their leadership function – moving from a top down command and control approach to a planning and enabling approach.”

Professor Warren Turner, Dean of LSBU’s School of Health and Social Care said: “Faced with tightening financial pressures on the NHS and social care the weakness or absence of serious workforce plans means there is little reason to believe that these ambitious reductions in demand and pressure on acute services will be achieved in the timescale proposed.”

More information

Read a full copy of the report and commentary here, under ‘Research’.

The 44 sub-reports can be read here.

Read a blog by Professor Rebecca Malby about the findings and the potential here.


Northern Ireland start-up, Connected Care Solutions, founded by local entrepreneur Deepak Samson, is set to make a big impact on the ageing population with Ethel, the elderly care smart hub, which is now being used by the Shetland Islands Council, under the EU-funded RemoAge project.

Ethel is an innovative touchscreen tablet that allows families and carers to stay in touch with their elderly loved one, via use of an ‘always-on’, large touchscreen tablet.  The tablet has a simple to use interface, specifically designed for those unfamiliar with technology that allows an older person to contact a pre-set list of contacts like family members, a carer or doctor simply by tapping the screen.  Ethel also allows additional functionality such as medication reminders, when to do exercises, etc. and can also send instant SMS alerts to family or carers if a user fails to respond to medication prompts.

Speaking about the recent success of the business Chairman of Lisburn & Castlereagh City Council’s Development Committee, Councillor Uel Mackin, said:  “Deepak is an inspirational innovator and a fantastic example of how working with the Council can enrich your business. He is fully engaged with the Council and has participated in the Council’s Business Start-up and Graduate Programme, as well as taking part in the highly successful Lisburn Castlereagh at Westminster investment event. His vision for the business is commendable and we are delighted to continue to work with Deepak through ongoing mentoring support to help grow his export base.”

Deepak explains: “I am the classic accidental entrepreneur. I only ever wanted to help people access their families or care providers where face-to-face interaction was impossible or impractical. I was a health service manager, had no formal background in development of technology, but it seemed obvious to me that there had to be an easier way to allow an ageing population to stay in touch in a simple way. The support I have received from the Council has been so valuable to me personally and to my business.  I would urge anyone with that Entrepreneurial spark to contact the Council to see how they can assist.”

The Mayor, Councillor Brian Bloomfield, MBE said:  “The news that Deepak is working with various NHS Trusts, Local Authorities, Hospices, Domiciliary Care agencies and Housing Associations in England, Scotland and Northern Ireland, is very exciting.  The product created by Deepak will clearly lead to significant efficiency savings for Trusts and provide a much better patient experience, so it is beneficial to many.   The demand for the product is growing and with requests from all around the world Connected Care Solutions is set to be one of Lisburn Castlereagh’s fastest growing tech businesses.”

Deepak is supported in his efforts to grow his suite of innovative products and enhance his export capability through the Lisburn & Castlereagh City Council’s Business Support and Investment Programmes and also through Invest NI.

To find out more about Ethel go to: or follow @ETHELsmarthub

End of life care planning: Why it should be everyone’s concern

To mark Dying Matters Awareness Week (May 8-14), Michelle Brown, Deputy Head of Department for Healthcare Practice, explains why everyone – young or old – should make sure they know what end of life care planning involves.

What is end of life care planning?

There is little doubt that end of life care is important to everyone. People generally recognise that both they themselves, and those around them, may have specific fears, wishes, or requests when it comes to the end of life care.

Starting any discussion surrounding end of life care can induce anxiety among health and social care professionals but also generate anxiety in those close to the person who is reaching the end of their life and to the individual facing that prognosis. Without those discussions however, there is a definite risk that the individual’s wishes may not be determined or, worse still, professionals and loved ones run out of time before they can put plans into place.

Everyone has a right to the highest quality care no matter what diagnosis, geographical area, age, socioeconomic status and, in addition, marginalised groups should have equal access e.g. travellers, prison population. Having those key, important discussions in a timely manner is vital in being able to determine a person’s wishes regarding the end of life.

When to initiate end of life care planning

A shared anxiety may be ensued concerning when to initiate palliative and end of life care. Tools have been initiated, for example, The Gold Standards Framework Prognostic Indicator Guidance, to aid professionals with the difficult decision about when the right time to discuss end of life planning is. Thinking about the surprise question asked in this guidance can be helpful in informing that decision surrounding end of life planning discussions. The surprise question is:

  • Would you be surprised if this person died within the next 6-12 months?

This should not be the only consideration. Experience surrounding discreet and obvious deterioration can all help to identify when a person is nearing the end of life. Ascertaining that they are nearing the end of life can help to ensure they receive the support, care and interventions which may aid a ‘good death’ rather than patients experiencing urgent care that has not been anticipated and the patient has had very little time to think about what they would want or worse still no time to discuss their wishes.

Communication and its importance in end of life care

The National Council for Palliative Care pledges to raise awareness surrounding death, dying and bereavement using, among numerous publications, the Dying Matters website. Their current work surrounds the question ‘what can you do?’ and its aim is to get more people active in planning for death and dying.

There are, however, numerous barriers to achieving high quality, end of life care in addition to lack of planning. These include lack of recognition that a person was approaching end of life, failure to communicate effectively to carers/ family, people kept in hospital unnecessarily, lack of education and knowledge and lack of understanding surrounding commissioning resources for end of life care. This means that there are significant challenges in delivering end of life care in a proactive, effective manner, in a patient’s place of choice.

Discussing end of life care requires constant reiteration; checking and information provision as people can change their mind particularly when they are faced with new fears, concerns and/or symptoms on a daily basis.

To ensure there is a mutual understanding and awareness regarding the current issues in the patient’s journey, the plan of care, any new symptoms or concerns that may present, and regular discussion utilising a holistic approach, is vital in ensuring a responsive approach to their care needs. Communication in palliative care sets the tone for all the care which may be required because without effective communication, patients and relatives may be left feeling isolated, unaware of the current situation presented and begin to lack trust in those providing care.

Patient rights

Patients have the right to self-determination. In other words, their autonomy should be maximised. When approaching the end of life, a patient’s right to make decisions rather than decisions being made for them is even more crucial to facilitate a patient-centred experience. Care delivered which is in conflict with the patients’ wishes falls far short of what they deserve; therefore clear communication is paramount.

A compassionate and non-judgmental approach is crucial in allowing those who are nearing the end of their life to be open and honest. A poor or less than adequate assessment/ discussion may leave those being cared for feeling anxious, upset or frustrated, or that they are misunderstood or not listened to.

Making every moment count with an individual at the end of life is crucial as this may be the last contact a health or social care professional has with the dying person making it the last thing that anyone does for them. Ensuring care remains patient-centred and maximising any opportunity to hear the patient’s wishes and preferences is fundamental as a patient approaches the end of their life.

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.”