Category Archives: Stress Management

Half of pupils expelled from school have mental health issue, study finds

Half of all pupils expelled from school are suffering from a recognised mental health problem, according to a study.

Those who are permanently excluded find themselves at a significant disadvantage, with only one in a hundred going on to attain five good GCSEs, which are often used as a benchmark of academic success.

The majority will end up in prison, says the study by the Institute for Public Policy Research, which estimates that of the 86,000-strong prison population, more then 54,000 were excluded at school.

The IPPR says its research lays bare the “broken system” facing excluded pupils. It flags up high levels of mental health issues among permanently excluded students – at least one in two, compared with one in 50 pupils in the wider population.

The thinktank also highlights the disadvantages such children face, as those excluded are four times more likely to grow up in poverty and twice as likely to be living in care. They are also seven times more likely to have special educational needs than those who are not excluded, the report claims.

After exclusion, the study says there is a downward spiral of underachievement, with teachers in schools catering for excluded pupils twice as likely to have no educational qualifications.

Kiran Gill, an IPPR associate fellow and founder of The Difference, which works to improve mental health provision for excluded pupils, described the system as “burningly unjust”.

She said: “Theresa May says she is committed to improving the mental health of young people. Addressing the most vulnerable children being thrown out of England’s schools is a good place to start. Because unequal treatment of mental health may be an injustice, but the discrimination of school exclusions is a crime.

“If the government is serious about real action on mental health, there needs to be dedicated funding and thought through solutions rather than sticking plasters on the symptoms of the problem.”

The IPPR research was published before the government’s latest annual figures on permanent and fixed period exclusions from schools in England in 2015-16, which is scheduled to be released on Thursday.

Responding to the report, the Department for Education said any decision to exclude should be lawful, reasonable and fair, and should only be used as a last resort in response to serious breaches of a school’s behaviour policy.

“This government is committed to working with local authorities and schools to ensure children in alternative provision receive a high quality education,” a DfE spokesperson said.

“We are strengthening the links between schools and NHS mental health staff and have announced plans for every secondary school to be offered mental health first aid training. Later this year we will publish a green paper with proposals for further improving mental health services.”

  • In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

HPV vaccine: anger over decision not to extend NHS scheme to boys

A decision not to vaccinate boys against a cancer-causing sexually transmitted infection has been condemned by health bodies and campaigners.

The Joint Committee on Vaccination and Immunisation (JCVI), which has been reviewing the human papilloma virus (HPV) vaccination programme, concluded that it was “highly unlikely to be cost-effective” to extend the scheme to include adolescent boys as well as girls.

Since 2008, all girls aged 12 to 13 are offered the HPV vaccination as part of the NHS childhood vaccination programme, and the JCVI has been considering whether to include boys on the scheme since 2014.

Up to eight out of 10 people will be infected with the virus at some point in their lives and it has been linked to one in 20 cases of cancer in the UK, according to health professionals. Campaigners have been calling for a gender-neutral approach to the vaccination, which would ensure that 400,000 school-age boys are not left at risk.

The committee, which has yet to publish its final recommendation, said in an interim statement that studies “consistently show” boys are afforded “considerable herd protection” when there is high uptake of the vaccine in girls.

Critics called the decision “indefensible”. The Faculty of Sexual and Reproductive Healthcare (FSRH), a membership body for healthcare professionals who work in sexual and reproductive health, said the decision should be reversed when the JCVI meets again in October.

Asha Kasliwal, the FSRH president, said the interim decision to deny boys the HPV vaccination was a huge missed opportunity for improving long-term sexual and reproductive health outcomes and tackling gender inequality.

Kasliwal said: “FSRH aims to improve women’s sexual and reproductive health, especially access to contraception. However, HPV affects not only women, but also men, and FSRH firmly believes that men and boys are vital in contributing to secure women’s reproductive health and rights.

“We support boys’ and men’s right to access high-quality [sexual and reproductive healthcare] services and live a life free of sexually transmitted infections such as HPV.”

Peter Baker, director of the campaign group HPV Action, said the decision was about saving money and not improving health: “It is astonishing that the government’s vaccination advisory committee has ignored advice from patient organisations, doctors treating men with HPV-related cancers, public health experts and those whose lives have been devastated by HPV.”

Baker said HPV Action would urge ministers to make the right decision and said there might also be grounds for a legal challenge on the grounds that a decision to leave boys and men at risk breaches equality law.

A recent poll conducted by HPV Action showed that 94% of GPs backed the expansion of the programme, with the same proportion saying if they had a son, they would want them to receive the vaccination. Both positions were also supported by 97% of dentists.

Mick Armstrong, the chair of the British Dental Association, said: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible. The state has a responsibility to offer all our children the best possible defence.

“Dentists are on the frontline in the battle against oral cancer, a condition with heart-breaking and life-changing results. Ministers can choose to sit this one out, or show they really believe in prevention.”

The JCVI said: “The JCVI is consulting on its interim findings to ensure that the most appropriate and up-to-date evidence has been used, and that reasonable assumptions have been made where evidence is limited or unavailable. Once the consultation is completed, the JCVI will develop and publish its final advice.”

Chile takes steps to legalize abortion in certain cases

Chile’s senate has narrowly passed a bill to legalize abortion in certain cases, in a win for President Michelle Bachelet’s center-left coalition and for rights groups that have campaigned for years against the country’s strict ban.

After a long and sometimes fractious overnight debate, the senate voted to legalize abortion when a woman’s life is in danger, when a fetus is unviable and when a pregnancy results from rape.

Chile is one of only a handful of countries worldwide where abortion is illegal without exception. The ban was put in place during the closing days of Augusto Pinochet’s 1973-1990 dictatorship, and Bachelet pledged reform when she took office for the second time in 2014.

The bill will now be returned to Chile’s lower house to be reconciled with a version passed there. That is expected to happen within the week, allowing it to become law.

Senate approval had been seen as the biggest hurdle for the measure, given opposition from some Christian Democrats within Bachelet’s own coalition, as well as lawmakers from the right wing Chile Vamos bloc.

“It’s a historic morning,” Bachelet said in front of the presidential palace after the bill passed. “The senate approved depenalizing abortion in three cases, which means we can be a country where women can make the best decision possible when faced with such situations.“

Although Chile is seen as one of Latin America’s more socially conservative countries and the Roman Catholic Church retains significant influence, polls show around 70% of Chileans favor the easing the abortion ban.

However, the conservative opposition has pledged to challenge the measure in the courts.

“It has been a sad day for Chile,” said Jacqueline van Rysselberghe, a senator for the far-right UDI party. “We are going to take it to the constitutional tribunal (to try to block it).”

MS treatments: life-changing, but hard to access

More than 100,000 people in the UK have multiple sclerosis (MS), the most common cause of serious physical disability in working age adults, according to the MS guidelines set out by the National Institute for Health and Care Excellence.

Although the condition is regarded as relatively rare and public awareness of it is low, recent innovations in treating and assessing MS are creating a fresh focus on the disease. Research suggests, for example, that MRI scans – already used in diagnosis – may be useful in predicting how MS will progress. In addition, a new drug therapy just approved in the US offers help for symptoms in the most chronic form of the condition. But, given that the drug has yet to be licensed in Europe, can the UK keep up with the latest innovations in the treatment of MS?

This was the backdrop to a recent roundtable discussion, supported by biotech company Sanofi Genzyme. Are the tools for assessing MS fit for purpose? How can early diagnosis and treatment be sped up? What matters to patients? These were among the questions explored by a panel of experts.

What is MS?

MS is a lifelong neurological condition that affects the central nervous system and involves damage to the coating around the nerve fibres. Symptoms, varying in severity from mild or remitting to debilitating, include difficulties with walking, balance, vision and speech. In its most chronic form, MS can cause blindness and severe disabilities.

While there is no known cure, the past 20 years has seen a shift from no available treatments to the creation of drug modifying therapies (DMTs) to help control symptoms in some types of the condition. Dr Klaus Schmierer, reader in clinical neurology at Queen Mary University of London and consultant neurologist at Barts Health NHS Trust, said: “MS treatment has really taken off and been revolutionised. We need to pick up that pace.”

There are three types of MS. About 85% of people diagnosed have relapsing-remitting MS (RRMS), with episodes of new or increasing symptoms that worsen then improve over time. About 65% of people with RRMS may develop secondary progressive MS, involving fewer or no relapses but increased disability. The remaining 10-15% of people are diagnosed with primary progressive MS PPMS, which involves worsening symptoms that build up over years without remission.

Recently, the first licensed drug treatment for people with PPMS was approved in the US. The drug, which can slow the rate of progressive MS, is under review by the European Medicines Agency.

Diagnosis, referral and the problem of delays

GPs are the gatekeepers to diagnosis: they cannot diagnose themselves but can refer patients with suspected MS to a neurologist who confirms or rules out the condition. However, the variable symptoms in all types of MS make it a challenge for GPs to decide on when to refer. Debbie Quinn, policy adviser to the UK MS Specialist Nurse Association, said: “GPs are in a very difficult position – where is that threshold? Because some symptoms will come and go for a few years. A lot of the time symptoms will appear like a trapped nerve.”

George Pepper, who was diagnosed with RRMS at 22 and is co-founder of social network Shift MS, said his diagnosis was relatively fast due to his serious symptoms. “I had some discomfort in my shoulder – I didn’t put it down to neurological symptoms. It persisted and, understandably, the GP put it down to a trapped nerve.”

When Pepper developed eyesight problems a few weeks later, the GP knew he had optic neuritis – inflammation of the optic nerve that is associated with MS. That, said Pepper, “was a red flag to my GP”. Attendees also heard that the shortage of neurologists undermines diagnosis rates. Not all hospitals have neurology departments, or magnetic resonance imaging (MRI), which is one of the main methods of diagnosing MS.

“We are still quite short of neurologists. When you look at the current distribution, it is something like one neurologist in 100,000 of the population,” said Schmierer, adding that the UK compares badly to the rest of Europe, which has one neurologist per 25,000 people.

MS Society research showed that 39% of patients wait more than a year to be diagnosed. Dr Jeremy Hobart, consultant neurologist at Plymouth Hospitals NHS Trust said: “There’s a delay in the condition being recognised; a delay in referral to a neurologist; a delay in seeing a neurologist and in the timing of investigations, and in the reporting of those investigations.”

Dr Ann Robinson, a north London GP, suggested diagnosis might be quicker if GPs used the urgent referral system currently in place for patients suspected of having cancer. This would mean patients being referred to a neurologist within two weeks, rather than waiting, in some cases, more than a year. However, Robinson acknowledged that funding constraints make this difficult: “There are no resources or political will to fund a two-week wait.”

Unpopular drugs

Another challenge in MS treatment is the relatively low takeup of available drug therapies. The UK, according to the Association of British Neurologists, is ranked 25 out of 27 European countries for the number of people with the relapsing form of MS who use DMTs. MS Society interim director of research Susan Kohlhaas said: “When people have access to MS nurses and neurologists and feel informed about the treatment out there, they’re much more likely to be on treatment.”

Hobart suggested lowering the investigation threshold to drive up rates of diagnosis: “We have to lower the threshold for investigation … to pick up those who do have the disease.”

However, lower thresholds would be costly, warned London GP Dr Kate Adams. Referring to the fact that MRI scans can cost upwards of £130, she said that while GPs do not limit referrals, “there’s only so much money in the health system”.

Dr Raju Kapoor, consultant neurologist at the National Hospital for Neurology and Neurosurgery in London, said increased costs caused by speeding up diagnosis could be offset by improved health as people stay in work for longer. He said: “We’re getting into health economics – if you remove the lag, we will save money.”

Another approach to improving diagnosis, said Kapoor, is better contact between GPs and the neurologists to whom they refer patients. Kapoor said: “It’s rare for a GP to contact me directly, but when they do it’s actually quite rewarding because you can solve things very fast.” Adams regularly contacts specialists directly, and in Plymouth, said Hobart, GPs directly contact radiologists specialising in the central nervous system to discuss MRI.

Could testing be simpler?

Future strategies, said Peer Baneke, MS International Federation chief executive, could involve spending on new diagnostic tools, such as blood tests. Blood tests are currently used to rule out conditions similar to MS, but Baneke said: “Is it realistic to expect at some stage you could have a different marker for MS that would give an indication of the diagnosis?”

Attendees discussed off-label prescribing options – using medicines outside the terms of their licence if based on evidence and in patients’ best interests. However, as Kapoor said, “the fact we’ve been so rigid has meant we’ve not exposed our patients to a lot of potentially toxic drugs”.

Might the new NHS online system to manage high-cost drugs, Blueteq, result in drug therapies being rationed? No, according to Kapoor: “It’s about what’s on the label, so if a patient says ‘I want a high-cost, high-potency drug’ but they can’t have it, this isn’t based on it being high cost, it’s because the drug isn’t licensed for that particular situation.”

Attendees agreed that treatment decisions should be made jointly by patients and professionals. Pepper said his severe symptoms drove him to immediately consider “the top shelf” of drug therapy. However, he described the patient experience as “hugely variable”. He raised concerns that members of the social network for MS that he founded, Shift MS, may shun available treatment because they are not adequately informed. “I see a lot in our community talking of opting out of treatment – they just don’t particularly want to have treatment,” he said, adding: “I don’t think the implications of that decision are made clear – it’s hugely important to engage people with MS to empower themselves as early s as possible.”

Many around the table echoed Hobart’s optimism that “in relapsing forms of the condition, we can alter the natural history”. In addition, said Kapoor, new developments on the horizon for the progressive form of MS, mean “we are in a better place to control the disease”. The consensus, Robinson concluded, was that treatment must be more efficient – regardless of the type of MS. “Anything that makes access to neurologists and care of patients better is going to impact on people living with MS.”

At the table

David Brindle (chair) Public services editor, the Guardian

Dr Kate Adams GP and Guardian contributor

Susan Kohlhaas Interim director of research, MS Society

Debbie Quinn Policy adviser, UK MS Specialist Nurse Association

Dr Jeremy Hobart Consultant neurologist Plymouth Hospitals, NHS Trust

Dr Raju Kapoor Consultant neurologist, National Hospital for Neurology and Neurosurgery

Dr Ann Robinson GP and Guardian contributor

Peer Baneke Chief executive, MS International Federation

George Pepper Co-founder, Shift MS

Dr Klaus Schmierer Consultant neurologist, Barts Health NHS Trust

Sick patients dying ‘unnecessarily’ in NHS because of poor care

Some of the sickest patients that hospitals treat are dying unnecessarily because they receive poor care, blighted by shortages of staff and equipment, a new NHS inquiry has revealed.

A death rate of one in three among inpatients who need emergency help with breathing is already high by international standards, and is getting worse.

The analysis by the National Confidential Enquiry into Patient Outcome and Death of NHS services for the 50,000 patients a year who receive emergency oxygen treatment uncovered a series of major flaws in the care they received. It described its findings as “shocking”.

The growing numbers of patients who receive non-invasive intervention (NIV) – oxygen through a face mask – usually have chronic obstructive pulmonary disease, pneumonia or other conditions which mean they cannot breathe unaided. Despite their lives being at risk, the vast majority receive sub-standard care, according to an in-depth examination of 353 patients during February and March.

“The care of these patients was rated as less than good in four out of five cases. The mortality rate was high: more than one in three patients died,” the inquiry found. “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.” In addition, investigators found from examining case notes that “the quality of medical care provided was often poor. This poor care included both non-ventilator treatment and ventilation management, which were frequently inappropriate”.

Dr Mark Juniper, a co-author of the report and NCEPOD’s lead clinical coordinator for medicine, said the sheer extent of problems he and his colleagues uncovered meant their hard-hitting conclusions were justified.

“This is a major problem which is resulting in unnecessary loss of life. Four out of five patients didn’t receive care that we as doctors would be happy to receive. That’s quite an indictment. That’s shocking because all these patients are at risk of dying.”

NIV in emergency situations is meant to reduce the risk of dying from 20% to 10%. However, NCEPOD found that the death rate among UK patients is 34% – “really troubling”, said Juniper. By contrast, it is only 18% in Spain while France has cut its death rate in recent years from more than 20% to 10%. The UK death rate has been rising steadily since the 30% recorded in 2011.

Two out of five hospitals at some point had been unable to cope with the number of patients who needed NIV because they lacked equipment. “Lack of ventilators is a common problem, even though a basic machine costs about £1,000 to £2,000. When there are too many patients, some end up receiving other medical treatment that’s not as good as ventilation. That will give them a higher risk of dying.”

Other failings researchers found included a lack of nurses, meaning that less than half of hospitals are able to provide the staffing ratio – one nurse to two NIV patients – which guidelines since 2010 have said should be in place. One in five patients who received NIV either did not need it, or needed to be on life support in an intensive care unit instead. In 47% of cases doctors did not convert the patient’s vital signs, such as their temperature, blood pressure and oxygen levels, into an “early warning score” to help dictate the treatment they received. Doctors were often “really poor” at documenting the condition of patients on NIV, probably because of understaffing.

“With these very sick patients the NHS needs to improve a lot – and fast, because lives are at stake,” said Juniper.

Dr Mike Davies, a consultant in respiratory medicine and spokesman for the British Thoracic Society, which represents lung specialists, said the findings had to “act as a stimulus to improve care for NIV patients. We need a concerted effort across the NHS to help reduce avoidable deaths.”

Professor Lesley Regan, who chairs NCEPOD, said the NHS had to learn lessons from the inquiry, given how many patients receive inadequate care. “Many hospitals fail to grasp the size of the problem, as acute NIV usage is all too easily hidden due to poor coding.”

NCEPOD has also found inaccurate coding causes problems among patients who have had a tracheostomy or have sepsis or acute pancreatitis.

She wants hospitals to appoint “local champions” to assess the state of NIV services and ensure that they have the staff and equipment needed.

Sick patients dying ‘unnecessarily’ in NHS because of poor care

Some of the sickest patients that hospitals treat are dying unnecessarily because they receive poor care, blighted by shortages of staff and equipment, a new NHS inquiry has revealed.

A death rate of one in three among inpatients who need emergency help with breathing is already high by international standards, and is getting worse.

The analysis by the National Confidential Enquiry into Patient Outcome and Death of NHS services for the 50,000 patients a year who receive emergency oxygen treatment uncovered a series of major flaws in the care they received. It described its findings as “shocking”.

The growing numbers of patients who receive non-invasive intervention (NIV) – oxygen through a face mask – usually have chronic obstructive pulmonary disease, pneumonia or other conditions which mean they cannot breathe unaided. Despite their lives being at risk, the vast majority receive sub-standard care, according to an in-depth examination of 353 patients during February and March.

“The care of these patients was rated as less than good in four out of five cases. The mortality rate was high: more than one in three patients died,” the inquiry found. “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.” In addition, investigators found from examining case notes that “the quality of medical care provided was often poor. This poor care included both non-ventilator treatment and ventilation management, which were frequently inappropriate”.

Dr Mark Juniper, a co-author of the report and NCEPOD’s lead clinical coordinator for medicine, said the sheer extent of problems he and his colleagues uncovered meant their hard-hitting conclusions were justified.

“This is a major problem which is resulting in unnecessary loss of life. Four out of five patients didn’t receive care that we as doctors would be happy to receive. That’s quite an indictment. That’s shocking because all these patients are at risk of dying.”

NIV in emergency situations is meant to reduce the risk of dying from 20% to 10%. However, NCEPOD found that the death rate among UK patients is 34% – “really troubling”, said Juniper. By contrast, it is only 18% in Spain while France has cut its death rate in recent years from more than 20% to 10%. The UK death rate has been rising steadily since the 30% recorded in 2011.

Two out of five hospitals at some point had been unable to cope with the number of patients who needed NIV because they lacked equipment. “Lack of ventilators is a common problem, even though a basic machine costs about £1,000 to £2,000. When there are too many patients, some end up receiving other medical treatment that’s not as good as ventilation. That will give them a higher risk of dying.”

Other failings researchers found included a lack of nurses, meaning that less than half of hospitals are able to provide the staffing ratio – one nurse to two NIV patients – which guidelines since 2010 have said should be in place. One in five patients who received NIV either did not need it, or needed to be on life support in an intensive care unit instead. In 47% of cases doctors did not convert the patient’s vital signs, such as their temperature, blood pressure and oxygen levels, into an “early warning score” to help dictate the treatment they received. Doctors were often “really poor” at documenting the condition of patients on NIV, probably because of understaffing.

“With these very sick patients the NHS needs to improve a lot – and fast, because lives are at stake,” said Juniper.

Dr Mike Davies, a consultant in respiratory medicine and spokesman for the British Thoracic Society, which represents lung specialists, said the findings had to “act as a stimulus to improve care for NIV patients. We need a concerted effort across the NHS to help reduce avoidable deaths.”

Professor Lesley Regan, who chairs NCEPOD, said the NHS had to learn lessons from the inquiry, given how many patients receive inadequate care. “Many hospitals fail to grasp the size of the problem, as acute NIV usage is all too easily hidden due to poor coding.”

NCEPOD has also found inaccurate coding causes problems among patients who have had a tracheostomy or have sepsis or acute pancreatitis.

She wants hospitals to appoint “local champions” to assess the state of NIV services and ensure that they have the staff and equipment needed.

Woman who fears daughter faces FGM gets deportation reprieve

Theresa May has intervened to halt the deportation of a woman who claimed that her three-year-old daughter would face female genital mutilation if they returned to Nigeria.

The decision to refuse Lola Ilesanmi’s application to remain in the UK has been withdrawn and the prime minister has ordered Brandon Lewis, the immigration minister, to personally oversee a review of her case.

Ilesanmi, 29, alleged that she was beaten, forced to have an abortion and had her face “smashed with an iPad” by her estranged husband because of her refusal to subject their daughter to FGM. He has denied the allegations.

May wrote a letter to Ilesanmi’s MP, Hannah Bardell of the Scottish National party, stating that she regarded FGM as “abhorrent” and that Amber Rudd, the home secretary, had heard her account.

In her letter, the prime minister said: “FGM is a crime, it is child abuse and will not be accepted in this country. This government will not tolerate a practice that can cause extreme and lifelong physical and psychological suffering to women and girls.

“I made my commitment to end this practice clear during my time as home secretary … This government takes the issue of FGM very seriously and remains committed to ending FGM within a generation.”

Ilesanmi, who worked as a business analyst with RBS for four years in Livingston, Scotland, had a joint visa with her husband. He is believed to have told Home Office officials that they were estranged after she and her daughter fled the marital home. The Home Office subsequently refused Ilesanmi leave to stay in the UK.

Bardell appealed for May to intervene at prime minister’s questions in the House of Commons earlier this month.

Hannah Bardell, left, with Nicola Sturgeon


Hannah Bardell, left, with Nicola Sturgeon. Photograph: Jeff J Mitchell/Getty Images

The MP said she was very glad about May’s intervention and added: “Lola needs leave to remain to restart her life in Livingston … Leave to remain is not yet guaranteed and is vital for the safety of Lola and her young family.”

Ilesamni has previously said that she wants to rebuild her life in Scotland, her home for the past six years. “I am not here for benefits, I am not here to seek help from the government,” she told the BBC. “I am an educated woman I just want to continue to empower myself so that I can continue to contribute to society, to contribute to the community.

“All I ask is just to get my life back together and to not allow this man to win because that would be the height of abuse.”

A report released last week disclosed that more than 9,000 attendances to NHS services in England in 2016 involved the identification or treatment of FGM. The data, covering the period from April 2016 to March 2017, includes figures from NHS trusts and GP practices.

The findings show that there were 9,179 attendances in the past year in which FGM was identified or treatment was given or a woman with FGM had given birth to a baby girl. In total, 5,391 attendances were recorded in the system for the first time, including 114 cases involving girls under the age of 16.

What is the role of patients in healthcare? Live discussion

The role of the patient is changing. Gone are the days when they were a passive recipient of care. Doctors are now expected to engage patients in their own health, care and treatment. There are also a number of initiatives to foster patient involvement in the design, planning and delivery of health services.

With advances in technology, there is scope for patients to have more control over their care. A raft of apps and digital innovations can help keep patients with long-term conditions at home longer. Patients now manage their own health with the support of doctors.

In a column for the Healthcare Professionals Network, commentator Richard Vize wrote: “The ubiquitous availability of medical information is irrevocably putting more power in the hands of patients.”

He added that in the UK, access to information is growing in a random and patchy way, while the ability of patients to use that information effectively in their discussions with doctors and other clinicians is entirely at the whim of the professional who is seeing them.

How can this be changed? What is the role of technology in empowering patients and healthcare professionals? What examples are there of patients being involved in designing and delivering health services? How can patient feedback play a part? Join our expert panel on Thursday 20 July from 12.30pm to 2pm to answer these questions and more.

The live chat is not video or audio-enabled but will take place in the comments section (below). If you would like to feature on the panel or propose questions, please get in touch via sarah.johnson@theguardian.com or @GdnHealthcare (#Gdnpatients) on Twitter.

Discussion commissioned and controlled by the Guardian, funded by Brother

The panel so far

Michael Seres, blogger and devises social media strategies around patient engagement. He was diagnosed aged 12 with the incurable bowel condition Crohn’s disease

Angela Coulter, senior researcher at the department of public health, University of Oxford

Sophie Castle-Clarke, fellow in health policy, Nuffield Trust

James Munro, chief executive, Care Opinion