Tag Archives: Care

‘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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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

UK universities call for joined-up mental health care for students

Mental health services are failing to adequately support students when they leave home and move to university, allowing them to fall through the gaps at a time of increased vulnerability and stressful new pressures, according to research.

With suicide rates among students on the rise and a sharp increase in demand for mental health support – as much as three-fold in some institutions – universities have acknowledged in a report that current services are letting students down.

The Universities UK report, Minding Our Future, states that the number of students dropping out with mental health problems has more than trebled in recent years and several universities in the UK have seen a number of student suicides over a short period of time.

It calls for urgent action involving a partnership of national and local government, schools, colleges, the NHS and universities, to work together to “join up” mental health care services for students to ensure that a generation of young people are not failed.

UUK is the representative body for UK universities. Its report says one of the key challenges is the transition from services students have depended on at home to a new city, and the transfer of records from one service to another. It also calls for improved links between local NHS services and the support that universities provide.

Student accounts included in the report illustrate the difficulties they face. “After I was discharged I had no mental health or GP support while I was back during the holidays,” said one undergraduate. “Since I was home for four weeks at Christmas and another four at Easter, this was a problem.”

“There always seems to be a lag in transferring records between GPs and my records have been misplaced more than once,” said another.

“Quick access to mental health services is a problem,” said another student. “Referrals take a long time; talking therapies take much, much longer. In the interim, students are missing classes, falling behind with coursework and needing help. The impact on grades can be huge.”

Almost half of all school leavers now go on to university, reflecting the diversity of the wider population, and with 75% of all mental illness developing by the age of 24, the report says university can be a time of acute vulnerability as students grapple with the new challenges of independent learning and living.

Student suicides have steadily increased from 108 in 2001 to 134 in 2015, with a 15-year low in 2007 of 75. There are currently 2.3 million students studying in UK universities.

Professor Steve West, the vice-chancellor of University of the West of England Bristol and chair of UUK’s mental health in higher education advisory group, said: “The system of mental health care for students must be improved. Health services aren’t properly designed to help students as they move from home to university. This is too important to ignore and we must not fail a generation by not doing what is required.

“I call on national and local government, schools, colleges, the health service, voluntary organisations and universities to work together. This will give us the best chance of supporting students through the significant transitions they face during their early lives.”

Paul Jenkins, the chief executive of the Tavistock and Portman NHS trust, added: “We need to improve the links between local NHS services and the support that universities provide. It requires a partnership approach at the local level to assess needs and to design and deliver services for students.

“It is essential that these young people are provided with the right support at each step of the pathway.”

  • 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 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

UK universities call for joined-up mental health care for students

Mental health services are failing to adequately support students when they leave home and move to university, allowing them to fall through the gaps at a time of increased vulnerability and stressful new pressures, according to research.

With suicide rates among students on the rise and a sharp increase in demand for mental health support – as much as three-fold in some institutions – universities have acknowledged in a report that current services are letting students down.

The Universities UK report, Minding Our Future, states that the number of students dropping out with mental health problems has more than trebled in recent years and several universities in the UK have seen a number of student suicides over a short period of time.

It calls for urgent action involving a partnership of national and local government, schools, colleges, the NHS and universities, to work together to “join up” mental health care services for students to ensure that a generation of young people are not failed.

UUK is the representative body for UK universities. Its report says one of the key challenges is the transition from services students have depended on at home to a new city, and the transfer of records from one service to another. It also calls for improved links between local NHS services and the support that universities provide.

Student accounts included in the report illustrate the difficulties they face. “After I was discharged I had no mental health or GP support while I was back during the holidays,” said one undergraduate. “Since I was home for four weeks at Christmas and another four at Easter, this was a problem.”

“There always seems to be a lag in transferring records between GPs and my records have been misplaced more than once,” said another.

“Quick access to mental health services is a problem,” said another student. “Referrals take a long time; talking therapies take much, much longer. In the interim, students are missing classes, falling behind with coursework and needing help. The impact on grades can be huge.”

Almost half of all school leavers now go on to university, reflecting the diversity of the wider population, and with 75% of all mental illness developing by the age of 24, the report says university can be a time of acute vulnerability as students grapple with the new challenges of independent learning and living.

Student suicides have steadily increased from 108 in 2001 to 134 in 2015, with a 15-year low in 2007 of 75. There are currently 2.3 million students studying in UK universities.

Professor Steve West, the vice-chancellor of University of the West of England Bristol and chair of UUK’s mental health in higher education advisory group, said: “The system of mental health care for students must be improved. Health services aren’t properly designed to help students as they move from home to university. This is too important to ignore and we must not fail a generation by not doing what is required.

“I call on national and local government, schools, colleges, the health service, voluntary organisations and universities to work together. This will give us the best chance of supporting students through the significant transitions they face during their early lives.”

Paul Jenkins, the chief executive of the Tavistock and Portman NHS trust, added: “We need to improve the links between local NHS services and the support that universities provide. It requires a partnership approach at the local level to assess needs and to design and deliver services for students.

“It is essential that these young people are provided with the right support at each step of the pathway.”

  • 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 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

UK universities call for joined-up mental health care for students

Mental health services are failing to adequately support students when they leave home and move to university, allowing them to fall through the gaps at a time of increased vulnerability and stressful new pressures, according to research.

With suicide rates among students on the rise and a sharp increase in demand for mental health support – as much as three-fold in some institutions – universities have acknowledged in a report that current services are letting students down.

The Universities UK report, Minding Our Future, states that the number of students dropping out with mental health problems has more than trebled in recent years and several universities in the UK have seen a number of student suicides over a short period of time.

It calls for urgent action involving a partnership of national and local government, schools, colleges, the NHS and universities, to work together to “join up” mental health care services for students to ensure that a generation of young people are not failed.

UUK is the representative body for UK universities. Its report says one of the key challenges is the transition from services students have depended on at home to a new city, and the transfer of records from one service to another. It also calls for improved links between local NHS services and the support that universities provide.

Student accounts included in the report illustrate the difficulties they face. “After I was discharged I had no mental health or GP support while I was back during the holidays,” said one undergraduate. “Since I was home for four weeks at Christmas and another four at Easter, this was a problem.”

“There always seems to be a lag in transferring records between GPs and my records have been misplaced more than once,” said another.

“Quick access to mental health services is a problem,” said another student. “Referrals take a long time; talking therapies take much, much longer. In the interim, students are missing classes, falling behind with coursework and needing help. The impact on grades can be huge.”

Almost half of all school leavers now go on to university, reflecting the diversity of the wider population, and with 75% of all mental illness developing by the age of 24, the report says university can be a time of acute vulnerability as students grapple with the new challenges of independent learning and living.

Student suicides have steadily increased from 108 in 2001 to 134 in 2015, with a 15-year low in 2007 of 75. There are currently 2.3 million students studying in UK universities.

Professor Steve West, the vice-chancellor of University of the West of England Bristol and chair of UUK’s mental health in higher education advisory group, said: “The system of mental health care for students must be improved. Health services aren’t properly designed to help students as they move from home to university. This is too important to ignore and we must not fail a generation by not doing what is required.

“I call on national and local government, schools, colleges, the health service, voluntary organisations and universities to work together. This will give us the best chance of supporting students through the significant transitions they face during their early lives.”

Paul Jenkins, the chief executive of the Tavistock and Portman NHS trust, added: “We need to improve the links between local NHS services and the support that universities provide. It requires a partnership approach at the local level to assess needs and to design and deliver services for students.

“It is essential that these young people are provided with the right support at each step of the pathway.”

  • 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 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

UK universities call for joined-up mental health care for students

Mental health services are failing to adequately support students when they leave home and move to university, allowing them to fall through the gaps at a time of increased vulnerability and stressful new pressures, according to research.

With suicide rates among students on the rise and a sharp increase in demand for mental health support – as much as three-fold in some institutions – universities have acknowledged in a report that current services are letting students down.

The Universities UK report, Minding Our Future, states that the number of students dropping out with mental health problems has more than trebled in recent years and several universities in the UK have seen a number of student suicides over a short period of time.

It calls for urgent action involving a partnership of national and local government, schools, colleges, the NHS and universities, to work together to “join up” mental health care services for students to ensure that a generation of young people are not failed.

UUK is the representative body for UK universities. Its report says one of the key challenges is the transition from services students have depended on at home to a new city, and the transfer of records from one service to another. It also calls for improved links between local NHS services and the support that universities provide.

Student accounts included in the report illustrate the difficulties they face. “After I was discharged I had no mental health or GP support while I was back during the holidays,” said one undergraduate. “Since I was home for four weeks at Christmas and another four at Easter, this was a problem.”

“There always seems to be a lag in transferring records between GPs and my records have been misplaced more than once,” said another.

“Quick access to mental health services is a problem,” said another student. “Referrals take a long time; talking therapies take much, much longer. In the interim, students are missing classes, falling behind with coursework and needing help. The impact on grades can be huge.”

Almost half of all school leavers now go on to university, reflecting the diversity of the wider population, and with 75% of all mental illness developing by the age of 24, the report says university can be a time of acute vulnerability as students grapple with the new challenges of independent learning and living.

Student suicides have steadily increased from 108 in 2001 to 134 in 2015, with a 15-year low in 2007 of 75. There are currently 2.3 million students studying in UK universities.

Professor Steve West, the vice-chancellor of University of the West of England Bristol and chair of UUK’s mental health in higher education advisory group, said: “The system of mental health care for students must be improved. Health services aren’t properly designed to help students as they move from home to university. This is too important to ignore and we must not fail a generation by not doing what is required.

“I call on national and local government, schools, colleges, the health service, voluntary organisations and universities to work together. This will give us the best chance of supporting students through the significant transitions they face during their early lives.”

Paul Jenkins, the chief executive of the Tavistock and Portman NHS trust, added: “We need to improve the links between local NHS services and the support that universities provide. It requires a partnership approach at the local level to assess needs and to design and deliver services for students.

“It is essential that these young people are provided with the right support at each step of the pathway.”

  • 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 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

UK universities call for joined-up mental health care for students

Mental health services are failing to adequately support students when they leave home and move to university, allowing them to fall through the gaps at a time of increased vulnerability and stressful new pressures, according to research.

With suicide rates among students on the rise and a sharp increase in demand for mental health support – as much as three-fold in some institutions – universities have acknowledged in a report that current services are letting students down.

The Universities UK report, Minding Our Future, states that the number of students dropping out with mental health problems has more than trebled in recent years and several universities in the UK have seen a number of student suicides over a short period of time.

It calls for urgent action involving a partnership of national and local government, schools, colleges, the NHS and universities, to work together to “join up” mental health care services for students to ensure that a generation of young people are not failed.

UUK is the representative body for UK universities. Its report says one of the key challenges is the transition from services students have depended on at home to a new city, and the transfer of records from one service to another. It also calls for improved links between local NHS services and the support that universities provide.

Student accounts included in the report illustrate the difficulties they face. “After I was discharged I had no mental health or GP support while I was back during the holidays,” said one undergraduate. “Since I was home for four weeks at Christmas and another four at Easter, this was a problem.”

“There always seems to be a lag in transferring records between GPs and my records have been misplaced more than once,” said another.

“Quick access to mental health services is a problem,” said another student. “Referrals take a long time; talking therapies take much, much longer. In the interim, students are missing classes, falling behind with coursework and needing help. The impact on grades can be huge.”

Almost half of all school leavers now go on to university, reflecting the diversity of the wider population, and with 75% of all mental illness developing by the age of 24, the report says university can be a time of acute vulnerability as students grapple with the new challenges of independent learning and living.

Student suicides have steadily increased from 108 in 2001 to 134 in 2015, with a 15-year low in 2007 of 75. There are currently 2.3 million students studying in UK universities.

Professor Steve West, the vice-chancellor of University of the West of England Bristol and chair of UUK’s mental health in higher education advisory group, said: “The system of mental health care for students must be improved. Health services aren’t properly designed to help students as they move from home to university. This is too important to ignore and we must not fail a generation by not doing what is required.

“I call on national and local government, schools, colleges, the health service, voluntary organisations and universities to work together. This will give us the best chance of supporting students through the significant transitions they face during their early lives.”

Paul Jenkins, the chief executive of the Tavistock and Portman NHS trust, added: “We need to improve the links between local NHS services and the support that universities provide. It requires a partnership approach at the local level to assess needs and to design and deliver services for students.

“It is essential that these young people are provided with the right support at each step of the pathway.”

  • 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 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

UK universities call for joined-up mental health care for students

Mental health services are failing to adequately support students when they leave home and move to university, allowing them to fall through the gaps at a time of increased vulnerability and stressful new pressures, according to research.

With suicide rates among students on the rise and a sharp increase in demand for mental health support – as much as three-fold in some institutions – universities have acknowledged in a report that current services are letting students down.

The Universities UK report, Minding Our Future, states that the number of students dropping out with mental health problems has more than trebled in recent years and several universities in the UK have seen a number of student suicides over a short period of time.

It calls for urgent action involving a partnership of national and local government, schools, colleges, the NHS and universities, to work together to “join up” mental health care services for students to ensure that a generation of young people are not failed.

UUK is the representative body for UK universities. Its report says one of the key challenges is the transition from services students have depended on at home to a new city, and the transfer of records from one service to another. It also calls for improved links between local NHS services and the support that universities provide.

Student accounts included in the report illustrate the difficulties they face. “After I was discharged I had no mental health or GP support while I was back during the holidays,” said one undergraduate. “Since I was home for four weeks at Christmas and another four at Easter, this was a problem.”

“There always seems to be a lag in transferring records between GPs and my records have been misplaced more than once,” said another.

“Quick access to mental health services is a problem,” said another student. “Referrals take a long time; talking therapies take much, much longer. In the interim, students are missing classes, falling behind with coursework and needing help. The impact on grades can be huge.”

Almost half of all school leavers now go on to university, reflecting the diversity of the wider population, and with 75% of all mental illness developing by the age of 24, the report says university can be a time of acute vulnerability as students grapple with the new challenges of independent learning and living.

Student suicides have steadily increased from 108 in 2001 to 134 in 2015, with a 15-year low in 2007 of 75. There are currently 2.3 million students studying in UK universities.

Professor Steve West, the vice-chancellor of University of the West of England Bristol and chair of UUK’s mental health in higher education advisory group, said: “The system of mental health care for students must be improved. Health services aren’t properly designed to help students as they move from home to university. This is too important to ignore and we must not fail a generation by not doing what is required.

“I call on national and local government, schools, colleges, the health service, voluntary organisations and universities to work together. This will give us the best chance of supporting students through the significant transitions they face during their early lives.”

Paul Jenkins, the chief executive of the Tavistock and Portman NHS trust, added: “We need to improve the links between local NHS services and the support that universities provide. It requires a partnership approach at the local level to assess needs and to design and deliver services for students.

“It is essential that these young people are provided with the right support at each step of the pathway.”

  • 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 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

The last decade of health and social care in the UK – in 10 charts | Lord Ara Darzi

This year is one of anniversaries. It’s 70 years since the NHS was created and 10 years since my last review of the service, which focused on the quality of healthcare. It seems, therefore, like the perfect moment to step back and reflect on where we find ourselves today.

With this in mind, I recently launched another review, commissioned by the Institute for Public Policy Research (IPPR) and with analytical support from management consultancy Carnall Farrar. The review aims to assess the progress we have made and the challenges we face in the future. Telling the story of the last decade in the NHS, our interim findings are both interesting and important.

Quality has improved

It is impossible to pick up a newspaper without seeing a story about the crisis in the NHS. But behind the headlines resides a fascinating story. Despite the gloom – and ever rising numbers of patients – the quality of care has improved, from cancer to trauma, stroke to diabetes, mental health to maternity.

1. Despite higher numbers of stroke patients, mortality rates have gone down

Stroke mortality in the NHS


Illustration: HES, Carnall Farrar Analysis

2. Cancer survival rates have improved – albeit from a low base

Cancer mortality rates


Illustration: NHS England, Carnall Farrar Analysis

Yet we must not get complacent. There is still too much variation in the quality of care: the distance between the best and the rest remains far too wide. And in too many areas – cancer and mental health services, in particular – progress has been from a low base while other countries perform significantly better. High quality care for all is still not a reality.

Focusing on patient safety has paid off

In the wake of a number of high profile patient safety controversies in recent years, the health secretary has rightly made patient safety a priority. This would appear to be paying off: harm free care is increasingly the norm, instances of pressure ulcers are down, and most healthcare-associated infections are falling. While we can still do better, we have made progress.

3. Harm free care is increasingly the norm

harm-free care


Illustration: NHS Safety Thermometer, Carnall Farrar Analysis

Rationing has returned

If quality has been maintained or improved, the same is not true for access to services. In the NHS, the timeliness of everything from ambulance response times, to A&E waiting times, to getting a GP appointment has deteriorated. But the most shocking example is in social care where, despite a significant increase in the number of people in need of care, there has been a decline in the number of people accessing the support they need, with a corresponding rise in informal care.

4. The proportion of patients waiting for more than four hours in A&E has increased

a&ewait


Illustration: NHS Digital, Carnall Farrar Analysis

5. The number of people stuck in hospital beds (delayed transfers of care) has increased

delayed-transfers-of-care


Illustration: NHS Digital, Carnall Farrar Analysis

6. There has been a steep decline in the number of people receiving state funded adult social care

socialcareusers


Illustration: NHS Digital, Carnall Farrar Analysis

Public satisfaction is declining

Patient satisfaction in the NHS has held up well over the last decade but public satisfaction has started to fall. Just 57% of the population is satisfied with the NHS – down 6% since 2016 – and just 23% are satisfied with social care, according to King’s Fund analysis of the 2017 British Social Attitudes survey. This is probably partly a reflection of ongoing media coverage of the so-called crisis in health and care.

7. Public satisfaction with the NHS has started to fall

public-satisfaction


Illustration: British Social Attitudes Survey, Carnall Farrar Analysis

The most austere decade

It has been a decade of austerity for healthcare: the service has had to make do with slower funding growth – or cuts in the case of social care – despite a growing and ageing population. This has put huge pressure on the frontline.

8. In real terms, NHS funding growth has been the lowest on record since 2010

fundinggrowth


Illustration: IFS, Office for Life Sciences, Carnall Farrar Analysis

The NHS has, somewhat successfully, tried to manage this through increased efficiency

9. NHS efficiency has been significantly higher than in other periods

productivityvsfudninggrowth


Illustration: IFS, Office for Life Sciences, Carnall Farrar Analysis

The NHS has tried to manage this slow-down in funding growth by delivering “more for less”. This has – to some degree – been successful: efficiency in the NHS is higher than its historic rate, achieved by holding down costs – such as staff pay – and by reforming the way the service works – particularly a focus on prevention, and the integration of health and social care.

Running out of road

However, there is growing evidence that the sources of efficiency the NHS has relied on over the last decade are unlikely to yield the scale of gains needed in the future. The most significant of these is staff pay, which will rightly start to grow again after seven years of the public sector pay gap. Another source of efficiency has been the reduction in the amount of money paid to hospitals for each procedure they undertake, which is now resulting in significant deficits.

10. Net staff satisfaction with pay and rising inflation has put an end to the public sector pay cap

staff-satisfaction


Illustration: NHS Staff Survey, IPPR Analysis

A long-term funding and reform plan

The pressures we have seen in health and care over the last decade – in particular, an ageing and growing population – will continue over the years to come. But the 2020s will also be a decade of opportunity, with technology opening up exciting new possibilities for human health. However, the health and care system can only run if it is able to walk. In its current state, we risk the opportunities of the 2020s passing us by.

The time has come for the government to abandon austerity and put forward a long-term funding plan for health and social care. But money alone will not be enough; we will need a bold reform plan for the NHS and social care to be fit for the 21st century. With this is mind, we turn our attentions to the future in the form of detailed funding and reform plan, which will be published in the coming months. On its 70th birthday, the gift the NHS needs most is a pragmatic plan to secure it for future generations.

  • Lord Darzi is the Paul Hamlyn chair of surgery at Imperial College London and a surgeon working in the NHS. He was a health minister from 2007 to 2009

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As an NHS palliative care doctor, I say: let Alfie Evans die with dignity | Rachel Clarke

Of all the comments from all the opportunists seeking to make political capital from a dying child, the most asinine, surely, comes from former US congressman Joe Walsh. The talk radio provocateur took to Twitter this week to ask: “Why does an American need an AR-15?” His answer: “To make sure what’s happening to #AlfieEvans never happens here. That’s why.” As an NHS palliative care doctor, I assume Walsh is advocating semi-automatic assault rifles to protect against people like me. As a mother, I can scarcely comprehend someone using a child’s plight to make a case for the weapons used in many of America’s bloodiest school shootings.

Liverpool toddler Alfie Evans has spent most of his desperately short life reliant on mechanical ventilation in a neonatal intensive care unit. Born apparently healthy, he has never toddled and never will. A progressive neurodegenerative disorder has so corroded his brain that, in the words of high court judge, Mr Justice Hayden, a recent MRI scan shows “a brain that had been almost entirely wiped out”, leaving Alfie in a semi-vegetative state. The family division of the high court has rejected multiple legal challenges from Alfie’s parents, Tom Evans and Kate James, to prevent Alder Hey children’s hospital withdrawing Alfie’s treatment and to fly him to Bambino Gesù, a paediatric hospital in the Vatican. Accordingly, against parental wishes, Alfie has now been detached from his ventilator, with palliative care plans in place to ensure his comfort.

Rarely do doctors’ and parents’ wishes misalign so catastrophically that the courts are required to resolve what form of medical management is in a child’s best interests. Usually – even amid all the anguish and heartbreak of paediatric terminal illness – both clinicians and family come to recognise, however reluctantly, the point at which valiant efforts at saving life have instead become the prolongation of dying.

Yet giving up hope can be unbearably painful. I shall never forget a paediatric oncology colleague describing, blinded by his tears, how the mother of one of his young patients had thrown herself from the hospital roof, unable to endure the knowledge that her child’s cancer was terminal. I have held fathers as they collapse in my arms, seen a mother biting her own arm in her grief, and wondered, over and over, at the vastness of the pain this world can inflict on its youngest, most undeserving and innocent. Indeed, Mr Justice Hayden described this week “a father whose grief is unbounded and whose sadness, as I have witnessed in this court, has an almost primal quality to it.”


Withdrawal of care is neither killing nor murder, but enables a patient to die with comfort and dignity

The sheer rawness of anticipatory grief can obliterate reason. What helps, I have learned, in palliative medicine, is time, space, calm and quiet. Yet Alfie Evans’s parents have been surrounded this week, at Alder Hey, by a mob of supporters who attempted to storm the entrance of the hospital, terrifying other young patients and their parents. A wider army of armchair vigilantes have stoked the vitriol – and their own agendas – from the comfort of their sofas.

Alfie’s doctors, already subjected to death threats, have been described online as pursuing “a court-ordered execution”. Even the pope has weighed in, while former Arkansas governor, Mike Huckabee, has commented that “Brits have decided some kids just aren’t worth that much and are disposable.”

And from former presidential potential nominee Ted Cruz, there was this. “It is a grim reminder that systems of socialized medicine like the National Health Service (NHS) vest the state with power over human lives, transforming citizens into subjects.”

In fact – to my enormous pride – the NHS has kept Alfie alive for nearly two years, at no cost to his family, and without any judgments concerning the value of his life. But intensive care is only ever a temporary support for failing organs while a reversible pathology is treated. In Alfie’s case, multiple doctors from multiple countries have all agreed that his illness is irreversible, progressive and terminal. Withdrawal of care is therefore neither killing nor murder, but enables him to die with comfort and dignity.

To witness powerful media, political and religious voices deploying grossly inflammatory and misleading rhetoric at the expense of a child is grotesque. Misuse of words is the antithesis of everything we strive, as doctors, to do for our patients. Clear, empathic communication can heal, build trust, assuage fears, instil hope – and help a patient and their family come to terms with the unavoidable. Capitalising on a family’s grief is none of the above: it is simply – and inexcusably – exploitative. May Alfie Evans rest in peace.

Rachel Clarke is a palliative care doctor

As an NHS palliative care doctor, I say: let Alfie Evans die with dignity | Rachel Clarke

Of all the comments from all the opportunists seeking to make political capital from a dying child, the most asinine, surely, comes from former US congressman Joe Walsh. The talk radio provocateur took to Twitter this week to ask: “Why does an American need an AR-15?” His answer: “To make sure what’s happening to #AlfieEvans never happens here. That’s why.” As an NHS palliative care doctor, I assume Walsh is advocating semi-automatic assault rifles to protect against people like me. As a mother, I can scarcely comprehend someone using a child’s plight to make a case for the weapons used in many of America’s bloodiest school shootings.

Liverpool toddler Alfie Evans has spent most of his desperately short life reliant on mechanical ventilation in a neonatal intensive care unit. Born apparently healthy, he has never toddled and never will. A progressive neurodegenerative disorder has so corroded his brain that, in the words of high court judge, Mr Justice Hayden, a recent MRI scan shows “a brain that had been almost entirely wiped out”, leaving Alfie in a semi-vegetative state. The family division of the high court has rejected multiple legal challenges from Alfie’s parents, Tom Evans and Kate James, to prevent Alder Hey children’s hospital withdrawing Alfie’s treatment and to fly him to Bambino Gesù, a paediatric hospital in the Vatican. Accordingly, against parental wishes, Alfie has now been detached from his ventilator, with palliative care plans in place to ensure his comfort.

Rarely do doctors’ and parents’ wishes misalign so catastrophically that the courts are required to resolve what form of medical management is in a child’s best interests. Usually – even amid all the anguish and heartbreak of paediatric terminal illness – both clinicians and family come to recognise, however reluctantly, the point at which valiant efforts at saving life have instead become the prolongation of dying.

Yet giving up hope can be unbearably painful. I shall never forget a paediatric oncology colleague describing, blinded by his tears, how the mother of one of his young patients had thrown herself from the hospital roof, unable to endure the knowledge that her child’s cancer was terminal. I have held fathers as they collapse in my arms, seen a mother biting her own arm in her grief, and wondered, over and over, at the vastness of the pain this world can inflict on its youngest, most undeserving and innocent. Indeed, Mr Justice Hayden described this week “a father whose grief is unbounded and whose sadness, as I have witnessed in this court, has an almost primal quality to it.”


Withdrawal of care is neither killing nor murder, but enables a patient to die with comfort and dignity

The sheer rawness of anticipatory grief can obliterate reason. What helps, I have learned, in palliative medicine, is time, space, calm and quiet. Yet Alfie Evans’s parents have been surrounded this week, at Alder Hey, by a mob of supporters who attempted to storm the entrance of the hospital, terrifying other young patients and their parents. A wider army of armchair vigilantes have stoked the vitriol – and their own agendas – from the comfort of their sofas.

Alfie’s doctors, already subjected to death threats, have been described online as pursuing “a court-ordered execution”. Even the pope has weighed in, while former Arkansas governor, Mike Huckabee, has commented that “Brits have decided some kids just aren’t worth that much and are disposable.”

And from former presidential potential nominee Ted Cruz, there was this. “It is a grim reminder that systems of socialized medicine like the National Health Service (NHS) vest the state with power over human lives, transforming citizens into subjects.”

In fact – to my enormous pride – the NHS has kept Alfie alive for nearly two years, at no cost to his family, and without any judgments concerning the value of his life. But intensive care is only ever a temporary support for failing organs while a reversible pathology is treated. In Alfie’s case, multiple doctors from multiple countries have all agreed that his illness is irreversible, progressive and terminal. Withdrawal of care is therefore neither killing nor murder, but enables him to die with comfort and dignity.

To witness powerful media, political and religious voices deploying grossly inflammatory and misleading rhetoric at the expense of a child is grotesque. Misuse of words is the antithesis of everything we strive, as doctors, to do for our patients. Clear, empathic communication can heal, build trust, assuage fears, instil hope – and help a patient and their family come to terms with the unavoidable. Capitalising on a family’s grief is none of the above: it is simply – and inexcusably – exploitative. May Alfie Evans rest in peace.

Rachel Clarke is a palliative care doctor