Category Archives: Heart Disease

One in eight people set to have type 2 diabetes by 2045, says study

One in eight people in the world will have type 2 diabetes by 2045 if obesity continues to climb at the present rate, according to a new study.

Last year, 14% of the global population was obese and 9% had type 2 diabetes. By 2045, 22% will be obese and 14% will be suffering from type 2 diabetes, estimates presented at the European Congress on Obesity in Vienna suggest.

The implications of the expanding numbers are severe for health systems in every country. Diabetes UK estimates that the NHS spends £14bn a year on the disease already, which is about 10% of its budget. People with diabetes need monitoring, treatment and care for the serious potential complications which can include amputations and blindness.

The study was carried out by scientists funded by the pharmaceutical company Novo Nordisk, which makes diabetes treatments, together with the Steno Diabetes Centre in Gentofte, Denmark, and University College London. They say that to prevent type 2 diabetes rates rising above 10%, obesity levels must come down by a quarter.

The institutions collaborated to launch the Cities Changing Diabetes programme in 2014 to accelerate the global fight against urban diabetes. The program began with eight cities: Copenhagen, Rome, Houston, Johannesburg, Vancouver, Mexico City, Tianjin and Shanghai. These have since been joined by a further seven cities: Beijing, Buenos Aires, Hangzhou, Koriyama, Leicester, Mérida and Xiamen.

“These numbers underline the staggering challenge the world will face in the future in terms of numbers of people who are obese, or have type 2 diabetes, or both. As well as the medical challenges these people will face, the costs to countries’ health systems will be enormous,” said Dr Alan Moses of Novo Nordisk Research and Development in Søborg, Denmark.

“The global prevalence of obesity and diabetes is projected to increase dramatically unless prevention of obesity is significantly intensified. Developing effective global programs to reduce obesity offer the best opportunity to slow or stabilise the unsustainable prevalence of diabetes. The first step must be the recognition of the challenge that obesity presents and the mobilisation of social service and disease prevention resources to slow the progression of these two conditions.”

The researchers have calculated the likely rise in obesity for individual countries. If current trends in the US continue, obesity will increase from 39% in 2017 to 55% in 2045, and diabetes rates from 14% to 18%. To keep diabetes rates in the US stable between 2017 and 2045, obesity must fall from 38% today to 28%.

In the UK, they say, current trends predict that obesity will rise from 32% today to 48% in 2045, while diabetes levels will rise from 10.2% to 12.6%, a 28% rise. To stabilise UK diabetes rates at 10%, obesity prevalence must fall from 32% to 24%.

“Each country is different based on unique genetic, social and environmental conditions which is why there is no ‘one size fits all’ approach that will work. Individual countries must work on the best strategy for them,” said Moses.

The tide could be turned, he said, “but it will take aggressive and coordinated action to reduce obesity and individual cities should play a key role in confronting the issues around obesity.”

Food industry in England fails to meet sugar reduction target

The food industry has failed to hit its target of cutting sugar by 5% over the past year, with experts describing the results as “hugely disappointing” and suggesting the government may be forced to introduce a tax, as with sugary drinks.

Public Health England had called for a cut of 20% of sugar in the products we buy to take home and eat in cafes by 2020, with 5% in the first year. In a massive new report, PHE shows food manufacturers and supermarkets have cut out 2% over the first 12 months, but much more has been achieved in some areas and by some companies than others.

Only three food groups of the eight measured have managed at least a 5% reduction: sweet spreads and sauces, yoghurts and fromage frais, and breakfast cereals. There has been no sugar reduction in biscuits and chocolate bars, although we consume less because they have become smaller. Puddings, meanwhile, have actually become sweeter.

While PHE applauded the industry’s efforts, some critics slammed them as inadequate. The Royal College of Paediatrics and Child Health (RCPCH) described the results in the first year as “hugely disappointing” and said the government would soon have no choice but to ditch the voluntary approach for mandatory targets.

“At best, this is industry being slow to react. At worst – and in reality – it seriously calls into question industry’s engagement with the voluntary approach,” said Prof Russell Viner, president of the RCPCH.

The Obesity Health Alliance also spoke of disappointment and called for a revamped obesity plan. “We have seen the success of the soft drinks industry levy in turbo-charging reformulation in sugary soft drinks,” said its lead, Caroline Cerny. “We also know that stronger marketing restrictions, including a 9pm watershed on TV, would help protect children from relentless exposure to junk food, and encourage manufacturers to make their foods healthier. Now is the time for the government to protect our children’s health with a truly world-leading obesity plan.”

Chocolate confectionery has a very long way to go. A Terry’s Chocolate Orange contains 58.5g of sugar per 100g. A Cadbury Crunchie contains 65g per 100g. Of the top 20 brands, only Nestlé’s Kit Kat Chunky has decreased in sugar (now at 52.7g per 100g) – by reducing the portion size and calorie count – and Cadbury’s Double Decker has actually gone up.

Among ice creams, Wall’s Cornettos and Magnums contain a bit less sugar, but its Soleros contain more. Starbucks has reformulated its chocolate brownies and carrot cake with less sugar. Tesco and Waitrose are among the supermarkets to cut the sugar in their own-brand breakfast cereals and so has Jordans, although Dorset muesli still has 23.4g of sugar and Kellogg’s Crunchy Nut contains 35.3g per 100g.

The puddings category, however, has failed to make progress. Ambrosia rice pudding, Mr Kipling sponge pudding and Nestlé Aero chilled mousse were all found to have increased in sugar content and/or calories.

Sugar

The detail of the report is designed to incentivise the food industry to do more and provide a baseline for measuring what it does over the coming years. PHE says next year’s report will give a clearer picture of the adequacy of the industry’s response.

Steve Brine, public health minister, hinted that the industry could be compelled to do more. “We lead the world in having the most stringent sugar reformulation targets and it is encouraging to see that some progress has been made in the first year,” he said.

“However, we do not underestimate the scale of the challenge we face. We are monitoring progress closely and have not ruled out taking further action.”

By contrast with the voluntary 5% sugar reduction in foods, the tough measure taken against sugary drinks in the form of the sugar tax is getting results. The PHE report said that sugar has been reduced by 11% in soft drinks and the average calories in single drink are down by 6%.

The data also shows that people are buying more drinks with less sugar – below the 5g per 100ml where the tax kicks in. That could be a result of publicity around high-sugar drinks or because of price.

Juice and milk-based drinks for children are now to be included in the PHE sugar-reduction programme, because they are not subject to the tax. PHE wants manufacturers and retailers to cut the sugar levels in juice-based drinks by 5% by 2021 and end sales of single drinks, including smoothies, larger than 150ml. Milk-based drinks should have 20% less sugar and no single drink should be larger than 300ml.

PHE’s chief executive, Duncan Selbie, said “tackling the obesity crisis needs the whole food industry to step up, in particular those businesses that have as yet taken little or no action”.

A quarter of children who start primary school are overweight or obese – and that rises to a third by the time they leave for secondary school at 11.

“This is about tackling the nation’s obesity crisis,” said Dr Alison Tedstone, chief nutritionist at PHE. “Too many children and adults suffer the effects of obesity, as does society, with our NHS under needless pressure. Obesity widens economic inequalities, affecting the poor the hardest.”

The Food and Drink Federation (FDF) said companies were engaging with what are sometimes difficult technical issues.

“As PHE correctly point out, reformulation takes time – it can’t happen overnight,” said Tim Rycroft, director of corporate affairs. “Sugar reduction has considerable technical challenges; sugar plays a variety of roles beyond sweetness in food including colour, texture and consistency. It is for these reasons that we have long said that the guidelines are ambitious and will not be met across all categories or in the timescale outlined.

“Obesity poses a huge public health challenge in the UK, and food and drink companies are well aware of their role in addressing this issue. For the last decade the UK’s food and drink companies have been reformulating their products to reduce sugar, calories, fat and salt, as well as limiting portion sizes. In fact, over the last five years FDF members have reduced calorie content in the average basket by 5.5%, and sugar content by 12.1% – and there is more work in the pipeline.”

He also called for cafes and restaurants to do more. “In many categories, the calorie content per portion of food served in cafes, coffee shops and restaurants is almost double that of manufacturers and retailers,” he said. “This is at a time when 25% of total calorie consumption takes place outside the home.”

Ex-footballer Terry Butcher accuses British army of failing his son

The former England football captain Terry Butcher has accused the British army of failing his son, who died after developing post-traumatic stress disorder (PTSD).

Butcher told an inquest on Monday that Christopher, 35, had turned to alcohol and drugs after being discharged from the armed forces in April 2015, due to the mental health condition.

“Christopher passed away several months ago. But, in reality, the Chris that we all knew and loved had ceased to exist years before,” Butcher told Ipswich coroner’s court.

“Diagnosed with severe post-traumatic stress disorder, his life spiralled downwards as the demons took control of his mind. In truth after intense tours of Iraq and Afghanistan he became a victim of war.

“These circumstances are all too familiar. Our country has a number of veterans suffering from the same condition, released from the armed forces too early and having to rely on an overloaded NHS that is ill-equipped and underfunded to cope.”

Butcher, who struggled to hold back tears during the hearing, said the armed forces’ duty of care towards personnel had been “discarded too easily, which has resulted in a growing number of our veterans turning to anything that might help including alcohol, drugs and suicide as a means of alleviating the flashbacks and nightmares”.

The inquest heard how Christopher, a former captain in the Royal Artillery, had been haunted by nightmares and flashbacks about the deaths of comrades and civilians in Afghanistan.

Butcher found his son’s body wedged between his bed and a wall when he went to check on him on the morning of 16 October last year at his home in Suffolk.

A postmortem failed to identify Christopher’s cause of death, but found he had an enlarged heart, which could have been caused by drug use. Toxicology tests revealed he had non-lethal levels of cocaine and heroin in his body, as well as prescription drugs he had been taking for several years. A makeshift crack pipe in a sunglasses case was also found in his room.

Suffolk’s assistant coroner, Dr Dan Sharpstone, concluded that Christopher died from an enlarged heart due to uncertain causes with a background of drug use and PTSD.

Butcher remembered his son as a man who had a “glittering career in the army ahead of him, a loving wife and dreams of having children of his own. His unnecessary death has deprived us of a wonderful son, husband, brother and grandson, friend and comrade”.

Sharpstone said: “When people serve in the armed forces, they give everything in the defence of our country and this may result in death or serious injury. However, it can also result in PTSD.”

  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

London hospitals to replace doctors and nurses with AI for some tasks

One of the country’s biggest hospitals has unveiled sweeping plans to use artificial intelligence to carry out tasks traditionally performed by doctors and nurses, from diagnosing cancer on CT scans to deciding which A&E patients are seen first.

The three-year partnership between University College London Hospitals (UCLH) and the Alan Turing Institute aims to bring the benefits of the machine learning revolution to the NHS on an unprecedented scale.

Prof Bryan Williams, director of research at University College London Hospitals NHS Foundation Trust, said that the move could have a major impact on patient outcomes, drawing parallels with the transformation of the consumer experience by companies such as Amazon and Google.

“It’s going to be a game-changer,” he said. “You can go on your phone and book an airline ticket, decide what movies you’re going to watch or order a pizza … it’s all about AI,” he said. “On the NHS, we’re nowhere near sophisticated enough. We’re still sending letters out, which is extraordinary.”

At the heart of the partnership, in which UCLH is investing a “substantial” but unnamed sum, is the belief that machine learning algorithms can provide new ways of diagnosing disease, identifying people at risk of illness and directing resources. In theory, doctors and nurses could be responsively deployed on wards, like Uber drivers gravitating to locations with the highest demand at certain times of day. But the move will also trigger concerns about privacy, cyber security and the shifting role of health professionals.

The first project will focus on improving the hospital’s accident and emergency department, which like many hospitals is failing to meet government waiting time targets.

“Our performance this year has fallen short of the four-hour wait, which is no reflection on the dedication and commitment of our staff,” said Prof Marcel Levi, UCLH chief executive. “[It’s] an indicator of some of the other things in the entire chain concerning the flow of acute patients in and out the hospital that are wrong.”

In March, just 76.4% of patients needing urgent care were treated within four hours at hospital A&E units in England in March – the lowest proportion since records began in 2010.

Using data taken from thousands of presentations, a machine learning algorithm might indicate, for instance, whether a patient with abdomen pain was likely to be suffering from a severe problem, like intestinal perforation or a systemic infection, and fast-track those patients preventing their condition from becoming critical.

“Machines will never replace doctors, but the use of data, expertise and technology can radically change how we manage our services – for the better,” said Levi.

Another project, already underway, aims to identify patients who are are likely to fail to attend appointments. A consultant neurologist at the hospital, Parashkev Nachev, has used data including factors such as age, address and weather conditions to predict with 85% accuracy whether a patient will turn up for outpatient clinics and MRI scans.

In the next phase, the department will trial interventions, such as sending reminder texts and allocating appointments to maximise chances of attendance.

“We’re going to test how well it goes,” said Williams. “Companies use this stuff to predict human behaviour all the time.”

Other projects include applying machine learning to the analysis of the CT scans of 25,000 former smokers who are being recruited as part of a research project and looking at whether the assessment of cervical smear tests can be automated. “There are people who have to look at those all day to see if it looks normal or abnormal,” said Williams.

Might staff resent ceding certain duties to computers – or even taking instructions from them? Prof Chris Holmes, director for health at the Alan Turing Institute, said the hope is that doctors and nurses will be freed up to spend more time with patients. “We want to take out the more mundane stuff which is purely information driven and allow time for things the human expert is best at,” he said.

When implementing new decision-making tools, the hospital will need to guard against “learned helplessness”, where people become so reliant on automated instructions that they abandon common sense. While an algorithm might be correct 99.9% of the time, according to Holmes, “once in a blue moon it makes a howler”. “You want to quantify the risk of that,” he added.

UCLH is aiming to circumvent privacy concerns that have overshadowed previous collaborations, including that of the Royal Free Hospital in London and Google’s DeepMind, in which the hospital inadvertently shared the health records of 1.6 million identifiable patients. Under the new partnership, algorithms will be trained on the hospital’s own servers to avoid any such breaches and private companies will not be involved, according to Holmes.

“We’re critically aware of patient sensitivity of data governance,” he said. “Any algorithms we develop will be purely in-house.”

Questions also remain about the day-to-day reality of integrating sophisticated AI software with hospital IT systems, which are already criticised for being clunky and outdated. And there will be concerns about whether the move to transfer decision-making powers to algorithms would make hospitals even more vulnerable to cyber attacks. Hospital IT systems were brought to a standstill last year after becoming victim to a global ransomware attack that resulted in operations being cancelled, ambulances being diverted and patient records being unavailable.

Williams acknowledged that adapting NHS IT systems would be a challenge, but added “if this works and we demonstrate we can dramatically change efficiency, the NHS will have to adapt.”

Community services are key to the NHS. Why are they still marginalised? | Chris Hopson

The NHS is overstretched, underfunded, and short-staffed. Pressures are growing. The results were there for all to see last winter. Staff run ragged, patient discharges delayed, standards of care slipping. It’s the same story right across health and social care.

The good news is there is a plan to ease these pressures by providing more care closer to home, freeing up much-needed resources for the sickest patients. This plan draws together the right skills from different services so that the care people receive is carefully coordinated and tailored to their needs. It focuses on helping us all to stay well, and live independently. Who would argue with that?

Yet this is not a new plan. It’s actually been around in various guises, under different governments, for many years – most recently in the Five Year Forward View, which underpins a lot of NHS strategy today. The idea is to support and strengthen NHS community services, which currently employ around one-fifth of health service staff and account for 100m patient contacts in England every year. These include community and district nurses, physios, speech and language therapists, school nurses, podiatrists, sexual health services and end-of-life care.

In our new report, NHS community services: taking centre stage, we highlight examples of innovation and good practice which are transforming the way care is delivered, meeting the needs of local people, keeping them well, helping them live independently even with serious, complex conditions – and easing pressures on other services. It can be done.

We also identify the barriers that have prevented schemes such as these from taking root across the country. The harsh reality is that these services are not sufficiently understood or prioritised at a national or local level. In a survey of NHS trust leaders for our report, more than 90% said that community services receive less national attention than other parts of the NHS.

At local level, fewer than 20% said community services were very influential in the current programme to modernise and integrate local health and care services.

While these services continue to be marginalised, they will be underfunded. We see from our survey that more than half of community trusts reported that funding in their area had fallen this year. Nearly a third had reduced staffing levels. And workforce concerns are a particular problem for community services. Since 2010, the community nursing workforce has contracted by 14%. District nurse numbers are down by 44%. It’s clear that the expectation is that workforce pressures will get worse still in the coming year.

All this at a time when demand for community services is going through the roof. This is not just about a growing and ageing population with more complex conditions. Thanks to advances in care and treatment, it is now possible to look after people at home who, 10 or 20 years ago, would have needed to stay in hospital. You only have to look at impact schemes such as the Hospital at Home service in Sussex to see the benefits for patients and staff, and the financial savings for the NHS.

Despite this, our survey showed that more than 90% of trusts thought the gap between funding and the demand for services will grow in the next 12 months.

It is bad news for people who have to wait longer – often lonely, anxious and in pain – for the care they need at home. It means delays for patients who could be discharged from hospital if the right treatment or rehabilitation were available. And it could mean that people are unable to die in the manner and place of their choosing.

No one is suggesting this will be easy to fix. NHS community services come in a range of shapes and sizes, with different approaches in different places. This diversity can be a strength – but the contract and tendering process is complex, and sometimes puts the NHS at a disadvantage. We need to seize the opportunities presented by the push for integrated care and the prime minister’s commitment to increase long-term health and care funding, and bring NHS community services centre stage.

  • Chris Hopson is chief executive of NHS Providers, the association of acute, ambulance, community and mental health services

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Italy’s far right use Irish vote to boost anti-abortion campaign

Activists and far-right politicians have seized on Italy’s low birth rate and the attention on Ireland’s referendum on abortion to boost their pro-life campaign.

As the 40th anniversary of Italy’s legalisation of abortion approaches, the renewed effort also comes as the far-right League, which contains many anti-abortion militants, stands on the brink of forming a government with the anti-establishment Five Star Movement following inconclusive general elections in March.

Ahead of the 22 May anniversary, ProVita, the Italian pro-life association, has published a booklet repeating debunked claims that women who have an abortion could be more prone to breast cancer and suicide or become alcoholics or drug addicts.

Quick guide

The Irish abortion referendum

The Irish abortion referendum

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Photograph: Clodagh Kilcoyne/X03756

The move came after authorities in Rome covered up a huge poster featuring an 11-week-old foetus in the womb on a wall in the Vatican area in April. A message alongside the image said: “You are here because your mother has not aborted you.”

“The plan was to intensify the campaign ahead of the anniversary,” said Alessandro Fiore, a spokesman for ProVita. “But we increased it even more after the poster was censored; we were contacted by many people from across Italy who wanted to do something similar in their towns. The Irish referendum, by chance, also helps to strengthen our message.”

Toni Brandi, the president of ProVita, joined counterparts in Ireland on a recent visit, as the country prepares for a landmark referendum on liberalising strict abortion laws on 25 May.

Italians voted to legalise abortion in a similar plebiscite in 1978. But 70.4% of gynaecologists still refuse to terminate pregnancies for moral reasons, which means it is almost impossible for women to access a safe procedure. That number is around 90% in southern regions, while in the central Molise region only one doctor carries out terminations. Last year a woman in Padua, a city in the northern Veneto region, had to visit 23 hospitals before finding one that would end her pregnancy. Doctors in Rome who do not object to the procedure are banned from going for jobs at hospitals managed by the Vatican.

Politicians from the League and smaller far-right party Brothers of Italy are helping to galvanise the pro-life campaign. Massimiliano Romeo, a senator with the League, said: “Six million children have been killed in the womb [since 1978], then they say we have to import migrants to boost the population.”

If the League succeeds in entering government, the party has pledged to make it a priority to better inform women of what they say are the physical and psychological consequences of abortion.

But claims that abortion leads to depression and suicide, causes cancer and affects future fertility have long been dismissed by medical organisations.

Emma Bonino, a politician who had an illegal abortion at a young age, was at the forefront of bringing about the enactment of the so-called Law 94. Until 1978, illegal abortions were the third-biggest cause of death for women in Italy.

“The campaigning by this group is nothing new,” Bonino, a former foreign minister, said. “They have been there for the last 40 years, as a minority movement – they have the right to exist and express their opinion but we have always managed to fight them. Our duty now is to fight organised conscientious objection – which actually has nothing to do with conscientiously objecting but career.”

Many medics fear being pushed out of the system or not being hired if they perform abortions. And those that do are often shamed. In the late 1990s a doctor killed himself after being exposed for terminating pregnancies in secret.

Ministry of Health data shows that the number of abortions performed each year fell from 233,976 in 1983 to 84,926 in 2016, while the number of moral objectors has risen. Unwanted pregnancies also significantly decreased after Law 94 was introduced, as people could avail themselves of information about contraception which until then had been forbidden thanks to a ban stemming from the Benito Mussolini-era.

There is no data available on the real demand for abortion or on the numbers carried out illegally. In recent years a significant demand is said to come from migrant women who have been forced into prostitution.

Silvana Agatone, a gynaecologist in Rome who does not object, said one of the reasons the health ministry is able to register a decline is because medics who once performed abortions, and who were required to report each procedure, have retired.

“They no longer get as many report cards each month but it doesn’t mean to say women are no longer having abortions,” she said. “It means that illegal abortions are increasing.”

There are fears that access to safe abortion will become even more difficult in future, as fewer medical students are receiving training.

“The Catholic-right has conquered the hospitals – there are so many militants,” said Elisabetta Canitano, a gynaecologist and president of the feminist association Vita di Donna.

“Even if the foetus is incompatible with life – they say ‘God sent it, so God will take it when he decides’. They insist that the woman must go ahead with the pregnancy, even if the child is then sent to a hospice to die.”

‘Care BnB’- the town where the mentally ill lodge with locals

Maria Lenaerts was seven years old when she came home from school one day to find a stranger at the kitchen table. It was September 1942 in Nazi-occupied Belgium.

The young man looked afraid. He did not say a word to her. “He was sitting at the table like this,” she recalls, hiding her head in her arms. “He didn’t understand anything.”

This was her first encounter with Jefkae Harbant, then an 18-year old with a learning disability and no place to call home. He was born in the French-speaking part of Belgium and did not speak a word of Dutch. Neither Maria nor her parents knew any French.

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What is the Upside?

News doesn’t always have to be bad – indeed, the relentless focus on confrontation, disaster, antagonism and blame risks convincing the public that the world is hopeless and there is nothing we can do.

This series is an antidote, an attempt to show that there is plenty of hope, as our journalists scour the planet looking for pioneers, trailblazers, best practice, unsung heroes, ideas that work, ideas that might and innovations whose time might have come.

Readers can recommend other projects, people and progress that we should report on by contacting us at theupside@theguardian.com

Despite the language barrier, Maria’s parents, who were cattle farmers in the Flemish lowlands, had decided to take the young man in. This was not only an act of wartime charity, but came from a centuries-old tradition of stretching out a hand to people on the margins of society.

For hundreds of years, residents in the Belgian town of Geel have been giving a home to strangers with severe mental health problems or learning disabilities.

This is not a bed for a night or a few weeks. Many boarders stay with the same family for years, often decades. Somehow a tradition from the age of Chaucer has survived and evolved into part of Flanders’ state healthcare system. In 2018, 205 people are Geel boarders, although home care is now only for those with mental health problems, not learning disabilities.


A tradition from the age of Chaucer has survived and evolved into part of Flanders’ state healthcare system

In an age that is more aware of the crushing toll of mental illness, the homecare system has made this small town near Antwerp a curiosity. One in four people will experience mental health problems in their lives, according to the well-known World Health Organisation estimate, while a majority say their pain is deepened by stigma.

Geel’s model of acceptance and “radical kindness” – to cite one medical journal – has stirred interest around the world. Academics and journalists have flocked to the small Flemish town searching for inspiration from an “innovation” that is 700 years old.

Geel traces its boarding tradition to the 13th century, when people with all kinds of illnesses made a pilgrimage to the local Saint Dymphna’s church. According to the brutal legend, Dymphna was an Irish saint who was murdered in the town. Pilgrims travelled many miles to her church in Geel, searching for miracle cures. When there was no more room in the church sick bay, locals gave them a place to stay.

The Geel homecare tradition was incorporated into the state in the 19th century, eventually ending under the umbrella of the Psychiatric Care Centre (OPZ). Most boarders have severe mental illnesses, such as schizophrenia or personality disorder. “They have a long history of disease and referrals. They are not capable of living alone,” says Mieke Celen, a psychiatrist at OPZ, who oversees the matchmaking process between foster families and patients.

Foster families are never told the patient’s diagnosis, although they do get warning about behaviour that they might expect: can they live with someone who smokes or walks around the house during the night? Dr Celen says few relationships break down.

One study of 17 foster relationships over five years, by the Belgian academics Eugeen Roosens and Lieve Van de Walle, found that only two families dropped out of the programme during the period.

Geel’s medical professionals say the system makes a lot of sense. Boarders have better outcomes than patients in hospital: they take less medication and have fewer acute episodes, says Celen.

Success means “having a life as normal as possible”, says Wilfried Bogaerts, an OPZ psychologist. “The programme is about life. It is not a miracle cure, it is not a magic system, but it is about finding this person the right place to live at the right time.

“Very often there is a severe chronic problem that cannot be cured completely, so we try to make the best of it. We accept the limitations but then try to make the life of a boarder as good as possible.”

Saint Dymphna’s church Geel


Geel traces its boarding tradition to the 13th century, when ill people made a pilgrimage to Saint Dymphna’s church. Photograph: Judith Jockel for the Guardian

For advocates, Geel’s forte is seeing the person, not a bundle of stigmatised labels straight from a medical textbook. Boarders are given responsibilities in the household, says Bogaerts: “They take care of the dog, go to the shop, do the dishes … so patients are needed and wanted.”

For some observers, there is not enough evidence that the scheme really works. “There has been very little evaluation about the impact of this,” says Professor Sir Graham Thornicroft at King’s College London. “In terms of outcomes for individuals, we don’t know about readmission rates, or satisfaction rates, or quality of life, or things we would normally want to assess for people with long-term needs.”

Jefkae Harbant is exceptional, even by the standards of Geel family care. When the Guardian visits, his 94th birthday is only a few days away. A cake has been ordered. Friends invited. There will be a family party.

He still remembers the day he arrived on the family farm nearly 76 years ago. “He was not afraid, but it was difficult for an 18-year-old boy who came to an unknown environment,” recounts his care worker, Michelle Lambrechts, who acts as an interpreter.

Maria is now 82 and has lived with Jefkae nearly all her life. When her father died in 1982, she became his foster “mother”, even though she is younger.

After decades under the same roof, legal formalities have melted away. He is really a brother, she says, speaking through an interpreter, sitting in the house she has lived in all her life. There was was never a question that he would leave the family.

Harbant’s foster father is Maria’s husband, Jules Teunkens, a retired glass-factory worker, now 86. Maria and Jules married in 1957. A 60th wedding anniversary mug bearing their black and white younger selves is sitting on a shelf crowded with bric-a-brac. While her husband worked at the factory, Maria Lenaerts brought up their three children and worked on the family farm. And Jefkae helped, milking the cows and tending vegetables.

Maria Lenaerts, 82, says Jefkae Harbant, 94, is like a brother, even though she is officially his foster mother.


Maria Lenaerts, 82, says Jefkae Harbant, 94, is like a brother, although she has been his foster parent since her father died in 1982. Photograph: Judith Jockel for the Guardian

The family are rarely apart. Although social services offer respite care for holidays, Harbants does not like to stay at the hospital, recounts Lambrechts. “When Jefkae went to the ward, he cried a lot. He cries and he cries for hours because he doesn’t want to sit on the ward – he wants to be at home.”

The number of families who take in boarders is in sharp decline, as Geel’s rural, churchgoing traditions fade into the past. More women are working. Fewer people farm the land. The traditional foster family is disappearing.

Demand from patients is also falling. People with severe mental health problems no longer face the stark choice of hospital or boarding; many are opting for other kinds of residential care.

Geel reached its peak on the eve of the second world war, when 3,736 borders lived in the town. The numbers have been falling ever since and the decline has accelerated in the last two decades: in 2006 there were 46o borders, today 205. Younger families are proving hard to attract.

The OPZ thinks the Geel model can survive, but would like the state to increase payments to families from the current maximum of €600 (£535) a month. “The openness of the community is pretty high,” Bogaerts says. “We should compensate families more so it is more attractive.”

Maria Lenaerts would recommend taking in boarders, yet she doubts that the system fits with how people live now. “It won’t last,” she says. “People have a lot of activities and recreation – they don’t have time.”

None of her children or grandchildren have taken in any boarders.

This article is part of a series on possible solutions to some of the world’s most stubborn problems. What else should we cover? Email us at theupside@theguardian.com

Cancer patient waited 541 days for NHS treatment, report says

The longest waits for cancer treatment in England have soared since 2010, with one patient waiting 541 days, analysis suggests.

Two-thirds of NHS trusts reported having at least one cancer patient waiting more than six months last year, while almost seven in 10 (69%) trusts said they had a worse longest wait than in 2010. This was reflected in the average longest wait rising to 213 days – 16 days longer than in the year the Conservatives entered government.

The official target requires at least 85% of cancer patients to have their first treatment within 62 days of referral by their GP, but this has not been met for 27 months in a row.

More than 100,000 people have waited more than two months for treatment to start since the target was first missed in January 2014.

The longest waiting times data was obtained by Labour through freedom of information requests to England’s 172 acute and community health trusts, to which 95 responded.

Jonathan Ashworth, the shadow health secretary, said: “The number of people needing cancer treatment has risen sharply in the past 10 years and the government has simply failed to increase availability of services at the rate required.

“The truth is that the brilliant efforts of NHS staff around the country to deliver the best for their patients are being hampered by tight NHS budgets. Years of underfunding and abject failure to invest in the frontline doctors and nurses we need, means Theresa May is letting down cancer patients.

“Now we know the astonishing truth that some patients are waiting a year or more just to get treatment. It’s simply not good enough.”

The number of patients waiting more than 62 days last year was double that in 2010 (26,693 compared with 13,354), including 10,000 who waited for more than three months, NHS statistics show.

Every trust bar two who replied to Labour’s survey said that at least one patient had waited more than 62 days for treatment.

The figures also showed a deterioration in longest waits for two other key cancer targets since 2010.

After receiving a diagnosis of cancer, patients should receive their first definitive treatment within a month (31 days) and after an urgent referral for suspected cancer they should see a consultant within two weeks.

In both cases, as with the 62 days target, two-thirds of trusts had lengthier longest waits last year than in 2010. The average longest wait to start definitive treatment rose to 90 days – three higher than in 2010 – with one patient waiting 254 days. The average longest wait for a consultant appointment increased to 66 days – eight time higher than seven years ago – with the worst example being a patient who waited 377 days.

In an ideal world, people would start treatment within a month of being diagnosed, according to Cancer Research UK.

Sara Bainbridge, a policy manager at the charity, said: “Part of the reason why hospitals are struggling to meet the target is because NHS diagnostic services are short-staffed. The government must make sure there are more staff to deliver the tests and treatment that people need on time. The long-term plan for the NHS, which is being developed now, is a good opportunity to be more ambitious about cancer survival and increase staff numbers.”

Andrew Kaye, the head of policy at Macmillan Cancer Support, said: “These findings show that despite the tireless work of doctors and nurses, it appears that some cancer patients are still enduring shockingly long waits to start treatment.

“Long delays can put people under incredible stress at an already difficult time and could also mean that someone’s health could take a turn for the worse.”

A spokesman for the Department of Health and Social Care said: “Cancer care has improved significantly in recent years, with around 7,000 people alive today who would not have been if mortality rates stayed the same as in 2010.

“Nobody should wait longer than necessary for treatment and, despite a 115% increase in referrals since 2010, the vast majority of people start treatment within 62 days – backed by our £600m investment to improve cancer services.”

Suffer hay fever? Don’t blow your nose | Brief letters

It’s not just trees (We can’t chop down all these trees and not harm ourselves, 15 May). The railway ecosystem includes many other types of plant. On my trips from Winchester to Waterloo in the 1960s, I saw everlasting peas (Lathyrus latifolius) in full flower, cascading down the banks. There are still pockets of plant diversity on the route between Cambridge and King’s Cross, thanks to Margaret Fuller, wife of the crossing keeper at Shepreth, as recorded in The Illustrated Virago Book of Women Gardeners (ed Deborah Kellaway; 1995).
Margaret Waddy
Cambridge

David Cox offers some good advice (Seven ways to deal with hay fever, G2, 14 May) but misses out the real game-changer. Hay fever sufferers must not blow their noses. Everyone seems to know not to rub an irritated eye, but not that blowing has much the same effect on the nasal passages – congestion, irritation, and more discharge.
Dr Stuart Handysides
(Retired GP), Ware, Hertfordshire

Woody Guthrie’s words of long ago apply: Some rob you with a six-gun and some with a fountain pen (Carillion fall blamed on hubris and greed, 16 May). Why no prosecutions?
Huw Kyffin
Canterbury

Is it my imagination or is the royal romance, and lead-up to the wedding, beginning to sound a little like the plot of Notting Hill Part II (Markle’s father ‘may miss her wedding after surgery’, 16 May)?
Tony Hart
Formby, Merseyside

Who is giving Prince Harry away?
Marion McNaughton
Warburton, Cheshire

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Suffer hay fever? Don’t blow your nose | Brief letters

It’s not just trees (We can’t chop down all these trees and not harm ourselves, 15 May). The railway ecosystem includes many other types of plant. On my trips from Winchester to Waterloo in the 1960s, I saw everlasting peas (Lathyrus latifolius) in full flower, cascading down the banks. There are still pockets of plant diversity on the route between Cambridge and King’s Cross, thanks to Margaret Fuller, wife of the crossing keeper at Shepreth, as recorded in The Illustrated Virago Book of Women Gardeners (ed Deborah Kellaway; 1995).
Margaret Waddy
Cambridge

David Cox offers some good advice (Seven ways to deal with hay fever, G2, 14 May) but misses out the real game-changer. Hay fever sufferers must not blow their noses. Everyone seems to know not to rub an irritated eye, but not that blowing has much the same effect on the nasal passages – congestion, irritation, and more discharge.
Dr Stuart Handysides
(Retired GP), Ware, Hertfordshire

Woody Guthrie’s words of long ago apply: Some rob you with a six-gun and some with a fountain pen (Carillion fall blamed on hubris and greed, 16 May). Why no prosecutions?
Huw Kyffin
Canterbury

Is it my imagination or is the royal romance, and lead-up to the wedding, beginning to sound a little like the plot of Notting Hill Part II (Markle’s father ‘may miss her wedding after surgery’, 16 May)?
Tony Hart
Formby, Merseyside

Who is giving Prince Harry away?
Marion McNaughton
Warburton, Cheshire

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters