Tag Archives: Healthcare

How unexpected chats spark ideas to transform healthcare | Anna Howells

How often does the chat you didn’t expect to have end up being the best conversation of your day?

It might be with a colleague you don’t often get a chance to talk to, the person from another team you never have quite enough time to sit down with, or someone you happen to bump into. Such unexpected conversations can spark ideas, open up new ways of thinking and help solve problems.

To encourage these conversations, Kaleidoscope Health and Care partnered with the Guardian Healthcare Professionals Network to send brown paper envelopes with £100 to five lucky recipients to spend on whatever they liked – as long as it was in the cause of having an unexpected conversation on the theme of health and care.

We startled a few finance departments, which sent incredulous emails enquiring what the envelope full of money was for. Coffees, lunches and train tickets were all options; we didn’t mind. All we asked was that winners spent the money within a month, had fun doing so and wrote us two 750-word blogs about the conversations.

To be in with a chance of receiving an envelope, we asked applicants to blog about their best unexpected conversation to date. We were blown away by the response. Entries came from as far away as Pakistan. Applicants from a variety of professions entered, including occupational therapists, policymakers, GPs and charity chief executives. The resulting blogs covered a host of topics, ranging from elderly care to US politics.

Did these conversations fulfil our aim? We think they did – or at least laid the foundations. Our project revealed that unexpected conversations can take place wherever you are, between people of all ages.

Becks Fisher’s unexpected conversation with a US pharmacist while on the campaign trail for Hillary Clinton led her to think differently about our healthcare system – both how lucky we are to have it but also how fragile it is.

Rhiannon is a pharmacist unlike any I have encountered in the UK. She does dispense medications, and she can help people with weight management, self-limiting illness and flu shots, but that’s not what she spends most of her time doing … For her patients, a prescription isn’t the drugs they will take, it is a wish list of those they might take if they have means to do so.

More than one applicant chose to blog about care for older people. Charlotte Williams, chief of staff for UCLPartners Academic Health Science Partnership, described a conversation focused on thinking differently about how we consider elderly patients.

The best unexpected conversation I had was with a geriatrician I was working with a few years ago. She had the view that no older person she looked after was a single unit. She felt that the best physicians – or any member of the clinical team – knew to treat the unit, to ask as much about the accompanying support as the person … in the chair or on the trolley.

For occupational therapist Melissa Purkis and a nurse, the conversation considered innovative solutions to care.

We talked about the initiative in the Netherlands where residential and nursing homes are pairing up with colleges and universities to provide affordable living spaces for students, in return for the students interacting with the older people. In an age where the disparity between young and old is developing like a gaping chasm, and there are numerous reports about loneliness in both younger and older people, it surely makes sense to counter this.

We learned that an unexpected conversation between Kath Parsons and a Macmillan Cancer Support officer led to the establishment of the Older Peoples Advocacy Alliance, the only national organisation supporting independent advocacy for older people.

When the pair discussed a Macmillan report which found older people are often at a disadvantage when it comes to receiving cancer care, their conversation sparked an idea to recruit older people who have been affected by cancer to support their peers.

Peer advocates walk side by side with older people, providing whatever support is needed, from emotional support to housing, benefits or social care advice, treatment needs, and planning for end of life.

Prof Mah Muneer Khan learned that children can be unexpectedly knowledgeable about hand hygiene, which is promising in a world where there are more than 1.4m cases of healthcare-associated infections at any given time.

Our “Unexpected Fellows” have since had more conversations and blogged the results. We hope they inspire you to think about how you can get more of the unexpected into your everyday.

Anna Howells is a partner at Kaleidoscope Health & Care

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

How unexpected chats spark ideas to transform healthcare | Anna Howells

How often does the chat you didn’t expect to have end up being the best conversation of your day?

It might be with a colleague you don’t often get a chance to talk to, the person from another team you never have quite enough time to sit down with, or someone you happen to bump into. Such unexpected conversations can spark ideas, open up new ways of thinking and help solve problems.

To encourage these conversations, Kaleidoscope Health and Care partnered with the Guardian Healthcare Professionals Network to send brown paper envelopes with £100 to five lucky recipients to spend on whatever they liked – as long as it was in the cause of having an unexpected conversation on the theme of health and care.

We startled a few finance departments, which sent incredulous emails enquiring what the envelope full of money was for. Coffees, lunches and train tickets were all options; we didn’t mind. All we asked was that winners spent the money within a month, had fun doing so and wrote us two 750-word blogs about the conversations.

To be in with a chance of receiving an envelope, we asked applicants to blog about their best unexpected conversation to date. We were blown away by the response. Entries came from as far away as Pakistan. Applicants from a variety of professions entered, including occupational therapists, policymakers, GPs and charity chief executives. The resulting blogs covered a host of topics, ranging from elderly care to US politics.

Did these conversations fulfil our aim? We think they did – or at least laid the foundations. Our project revealed that unexpected conversations can take place wherever you are, between people of all ages.

Becks Fisher’s unexpected conversation with a US pharmacist while on the campaign trail for Hillary Clinton led her to think differently about our healthcare system – both how lucky we are to have it but also how fragile it is.

Rhiannon is a pharmacist unlike any I have encountered in the UK. She does dispense medications, and she can help people with weight management, self-limiting illness and flu shots, but that’s not what she spends most of her time doing … For her patients, a prescription isn’t the drugs they will take, it is a wish list of those they might take if they have means to do so.

More than one applicant chose to blog about care for older people. Charlotte Williams, chief of staff for UCLPartners Academic Health Science Partnership, described a conversation focused on thinking differently about how we consider elderly patients.

The best unexpected conversation I had was with a geriatrician I was working with a few years ago. She had the view that no older person she looked after was a single unit. She felt that the best physicians – or any member of the clinical team – knew to treat the unit, to ask as much about the accompanying support as the person … in the chair or on the trolley.

For occupational therapist Melissa Purkis and a nurse, the conversation considered innovative solutions to care.

We talked about the initiative in the Netherlands where residential and nursing homes are pairing up with colleges and universities to provide affordable living spaces for students, in return for the students interacting with the older people. In an age where the disparity between young and old is developing like a gaping chasm, and there are numerous reports about loneliness in both younger and older people, it surely makes sense to counter this.

We learned that an unexpected conversation between Kath Parsons and a Macmillan Cancer Support officer led to the establishment of the Older Peoples Advocacy Alliance, the only national organisation supporting independent advocacy for older people.

When the pair discussed a Macmillan report which found older people are often at a disadvantage when it comes to receiving cancer care, their conversation sparked an idea to recruit older people who have been affected by cancer to support their peers.

Peer advocates walk side by side with older people, providing whatever support is needed, from emotional support to housing, benefits or social care advice, treatment needs, and planning for end of life.

Prof Mah Muneer Khan learned that children can be unexpectedly knowledgeable about hand hygiene, which is promising in a world where there are more than 1.4m cases of healthcare-associated infections at any given time.

Our “Unexpected Fellows” have since had more conversations and blogged the results. We hope they inspire you to think about how you can get more of the unexpected into your everyday.

Anna Howells is founder of Kaleidoscope Health & Care

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

Universal healthcare in America? Not a taboo now, thanks to Bernie Sanders | Ross Barkan

There was a time, not too long ago – the iPhone, Facebook and Twitter all existed – when the two leading Democratic candidates for president of the United States didn’t support the right of gay people to marry.

“I believe marriage is between a man and a woman. I am not in favor of gay marriage,” the inspiring tribune of hope and change, Barack Obama, declared in 2008. His rival, Hillary Clinton, concurred. Gay people shouldn’t be able to marry.

By 2012, Obama backed same-sex marriage. Clinton followed suit, later than most Democrats, in 2013. Three years later, when she would run for president again, there was not a leading Democrat anywhere – name a city, a county – who didn’t support same-sex marriage.

Single-payer healthcare, thanks to Bernie Sanders, may be the new gay marriage.

Once radical and taboo in mainstream Democratic circles, endorsing universal healthcare coverage is now de rigueur for anyone who seriously wants to run for president on the Democratic side in 2020. Kamala Harris, the California senator who seemed to be taking the Clinton route to the nomination by courting her Hamptons donors, is now co-sponsoring Sanders’ Medicare-for-all bill.

There are 16 Democratic senators in total supporting the bill, a remarkable number considering where the healthcare debate was two years ago when Sanders first campaigned for president as a democratic socialist long-shot. At the time, pundits, political operatives, and countless elected officials dismissed the single-payer Sanders dream as a disingenuous moonshot.

Now, the man who told Obama to lay off Bain Capital (Cory Booker) and the woman who once voted in favor of withholding federal funds from sanctuary cities (Kirsten Gillibrand) are co-sponsors of Sanders’ bill. Times, indeed, have changed.

Sanders is an unusual politician because he’s been willing to lead on an issue before its broad popularity was established. For decades, he has roamed the political wilderness crying out for European or Canadian-style single-payer healthcare. He has done it through Democratic and Republican administrations, no matter the electorate’s political orientation at any given time. It is something he earnestly believes in.

But most politicians, as gay marriage proved, have few firmly-held convictions beyond what they assume the public expects of them. If the people seem to cry out for war, we go to Iraq. If enough people say marriage is between a man and a woman, it stays that way. Few politicians are willing defy conventional wisdom. Politics is ultimately a game of self-preservation. Polls determine values.

The movement towards single-payer is humane and sensible. It is also a reflection of the changing zeitgeist and the power of the Sanders movement, which represents the future of the party. As the nation’s most well-liked politician and the hero of millennials, he is now the ringmaster. Clinton’s bitter book tour, if anything, is an affirmation of this.

No one should discount just how arduous the road ahead remains. Single-payer would substantially disrupt our current system, now arrayed around employer-based health insurance. It’s an expensive and inefficient system, but there are people who like the health coverage offered by their employers.

Taxes would rise as healthcare costs are shifted over to the government. This is a trade-off other industrialized countries are willing to make – they also pay their doctors less – but one Americans aren’t used to. Mustering political will to eventually pass such legislation will be another Herculean challenge, as Obamacare was in 2010.

There is an argument, valid in its own way, that the safer approach is to just repair Obamacare. Offer a public option to compete with private insurers. Increase subsidies. Watch premiums fall, insurance companies cry.

Yet a party so moribund as the Democrats needs a worthwhile goal, and single-payer is it. There should be others, like a massive jobs program to halt the erosion of stable work that automation and globalization is killing for good.

In the meantime, freeing healthcare from the clutches of predatory insurance companies is what all Democrats should be thinking about. Better to have Democratic groupthink about guaranteeing healthcare than going to war or keeping people from getting married.

Universal healthcare in America? Not a taboo now, thanks to Bernie Sanders | Ross Barkan

There was a time, not too long ago – the iPhone, Facebook and Twitter all existed – when the two leading Democratic candidates for president of the United States didn’t support the right of gay people to marry.

“I believe marriage is between a man and a woman. I am not in favor of gay marriage,” the inspiring tribune of hope and change, Barack Obama, declared in 2008. His rival, Hillary Clinton, concurred. Gay people shouldn’t be able to marry.

By 2012, Obama backed same-sex marriage. Clinton followed suit, later than most Democrats, in 2013. Three years later, when she would run for president again, there was not a leading Democrat anywhere – name a city, a county – who didn’t support same-sex marriage.

Single-payer healthcare, thanks to Bernie Sanders, may be the new gay marriage.

Once radical and taboo in mainstream Democratic circles, endorsing universal healthcare coverage is now de rigueur for anyone who seriously wants to run for president on the Democratic side in 2020. Kamala Harris, the California senator who seemed to be taking the Clinton route to the nomination by courting her Hamptons donors, is now co-sponsoring Sanders’ Medicare-for-all bill.

There are 16 Democratic senators in total supporting the bill, a remarkable number considering where the healthcare debate was two years ago when Sanders first campaigned for president as a democratic socialist long-shot. At the time, pundits, political operatives, and countless elected officials dismissed the single-payer Sanders dream as a disingenuous moonshot.

Now, the man who told Obama to lay off Bain Capital (Cory Booker) and the woman who once voted in favor of withholding federal funds from sanctuary cities (Kirsten Gillibrand) are co-sponsors of Sanders’ bill. Times, indeed, have changed.

Sanders is an unusual politician because he’s been willing to lead on an issue before its broad popularity was established. For decades, he has roamed the political wilderness crying out for European or Canadian-style single-payer healthcare. He has done it through Democratic and Republican administrations, no matter the electorate’s political orientation at any given time. It is something he earnestly believes in.

But most politicians, as gay marriage proved, have few firmly-held convictions beyond what they assume the public expects of them. If the people seem to cry out for war, we go to Iraq. If enough people say marriage is between a man and a woman, it stays that way. Few politicians are willing defy conventional wisdom. Politics is ultimately a game of self-preservation. Polls determine values.

The movement towards single-payer is humane and sensible. It is also a reflection of the changing zeitgeist and the power of the Sanders movement, which represents the future of the party. As the nation’s most well-liked politician and the hero of millennials, he is now the ringmaster. Clinton’s bitter book tour, if anything, is an affirmation of this.

No one should discount just how arduous the road ahead remains. Single-payer would substantially disrupt our current system, now arrayed around employer-based health insurance. It’s an expensive and inefficient system, but there are people who like the health coverage offered by their employers.

Taxes would rise as healthcare costs are shifted over to the government. This is a trade-off other industrialized countries are willing to make – they also pay their doctors less – but one Americans aren’t used to. Mustering political will to eventually pass such legislation will be another Herculean challenge, as Obamacare was in 2010.

There is an argument, valid in its own way, that the safer approach is to just repair Obamacare. Offer a public option to compete with private insurers. Increase subsidies. Watch premiums fall, insurance companies cry.

Yet a party so moribund as the Democrats needs a worthwhile goal, and single-payer is it. There should be others, like a massive jobs program to halt the erosion of stable work that automation and globalization is killing for good.

In the meantime, freeing healthcare from the clutches of predatory insurance companies is what all Democrats should be thinking about. Better to have Democratic groupthink about guaranteeing healthcare than going to war or keeping people from getting married.

Republicans are radicalizing Democrats. Just look at healthcare | Lawrence Jacobs

The determined push by Donald Trump and congressional Republicans to rollback President Barack Obama’s health care reform is radicalizing the Democratic party. The backlash is empowering the progressive wing of the party and forcing moderates to shift toward the left. When the Democrats are back in power – and that day will come – the change will be dramatic.

Obama’s health care reform (known as “Obamacare”) followed the broad contours of Bill Clinton’s “third way” approach of offering government incentives to induce the private sector to do good. Obamacare aimed to expand private health insurance coverage by offering tax credits and creating an accessible online “marketplace” of quality health plans. It also cracked down on gaming by insurers who avoided the sick and on individuals who ducked insurance but still wanted all of us to pay for their medical care when they showed up in emergency rooms or in urgent care.

The elegant blueprint for Obamacare’s marketplaces has collided with a complex reality. Many consumers found the complexity of the online process off-putting and the deductibles and co-pays too high. The blueprint anticipated eager private sector partners; in reality, most of the country’s largest private insurers recoiled at the risk of Obamacare saddling them with substantial losses and pulled out, which inconvenienced tens of thousands of Americans.

The vast majority of states (including blue states) refused to implement the marketplaces and, where states did implement it, some, like Minnesota, found it difficult to work. Overall, enrollment reached 12 million in 2016 but fell short of the non-partisan Congressional Budget Office’s expectations.

Obamacare’s limitations may well have been tackled overtime, if it was treated like earlier landmark social welfare programs. After all, Social Security and Medicare faced unexpected problems before Richard Nixon and Ronald Reagan led bipartisan efforts to stabilize them under the motto: build on what works, fix what doesn’t.

But Obamacare was given the boot by Trump and congressional Republicans, incinerating the Democratic expectation that public/private partnerships would draw moderate Republicans to the “fix it” agenda. Although a few Republicans held back from supporting repeal, the shrunken Republican party middle did not hold under pressure from ultra-conservatives. The result: repeal passed repeal by one vote in the House and the Senate came within a single vote of approving it.

The Democratic Third Way also failed to attract business. The pullout of Obamacare’s marketplaces by most large insurers revealed the limits of public incentives in the face of Wall Street demands for strong profits and low uncertainty.

The strongest repudiation of the public/private approach comes from the most surprising source – Republicans. Obamacare’s most governmental programs were accepted by the repeal legislation that Senate Republicans nearly passed embraced.

Senate Majority Leader Mitch McConnell agreed to let stand the expansion of Medicaid to 11 million Americans as well as the enormous new benefits in Medicare’s prescription drug benefit. Here’s the irony: Democrats created Obamacare’s marketplaces as a fig leaf to Republicans who in turn targeted them by shrinking subsidies, undercutting protections for pre-existing medical conditions, and more.

The sobering reality of 2017 is propelling Democrats to shift toward a full-on government approach that does not rest on winning over the shrinking number of Republican moderates and business partners.

Democrats and their progressive policy experts are debating a new paradigm that focuses on expanding Medicare but differs over scope. The most liberal position has been advanced by Bernie Sanders and insists on expanding Medicare to all.

More cautious Democrats worry about the political hit from enormous new taxes and warnings to seniors about threats to a program they rely upon. Democratic moderates favor “Medicare for More” that would open the program to near retirees in their early 50s.

As Democrats joust over these two options, there will be broad agreement about expanding Medicaid to all states and improving the affordability of prescription drugs for non-retirees.

Republican efforts to blow up Obamacare may propel the expansion of government by convincing even moderate Democrats that truly liberal programs that visibly deliver new coverage and benefits are good politics and better policy.

This may one of the juiciest ironies of the Trump presidency.

  • Lawrence Jacobs is the Director of the Center for the Study of Politics and Governance at Humphrey School of Public Affairs at the University of Minnesota

Will the healthcare data revolution spell the end for doctors’ autonomy?

NHS Improvement’s drive to raise clinical standards is prising open the sensitive issue of doctors’ autonomy, and shows how the legal and professional boundaries of medicine are constantly shifting.

The Get It Right First Time programme is uncovering massive and unacceptable differences in performance, such as a 25-fold variation in orthopaedic surgical site infection rates.

Now colorectal surgeon John Abercrombie has used his report into general surgery performance to challenge the high degree of autonomy enjoyed by British surgeons.

He contrasts the demanding training and assessments required to qualify with the laissez-faire approach to subsequent professional development.

The rules are so lax that a surgeon could carry on practising unaware of new operating techniques, care pathways or developments in infection control.

This goes some way to explaining why new approaches to care takes so many years to permeate every part of the NHS.

Abercrombie calls for routine monitoring of performance measures such as infection and readmission rates, and for the surgical Royal Colleges to introduce tougher rules around continuing professional development. This could include visits to units which are delivering the best outcomes.

The report implicitly criticises medical directors for failing to drive through quality improvements such as standardised approaches to care, pointing out how similar roles in Germany and the US govern the way care is delivered.

Surgeons are highly protective of their autonomy. When then chief medical officer Sir Liam Donaldson began his big push around the turn of the century to improve patient safety he came up against surgeons who regarded standardised safe procedures as an infringement of their artistic freedom. The huge variations uncovered by the Right First Time programme demonstrate that many surgeons still don’t trouble themselves to find out the safest way to do their job.

The boundaries of medical behaviour are policed largely by the General Medical Council, the courts and, increasingly, data. Over the last two decades the GMC has been transformed from an organisation dominated by doctors and bearing more than a passing resemblance to a gentlemen’s club to one with an independent voice, strong lay representation and a focus on patient safety and raising standards.

The GMC’s regular checks on doctors’ competence through the revalidation process highlight the importance of constant professional improvement – but Abercrombie’s report shows that aspects of this system lack rigour.

In recent weeks there have been signs that the attitudes of the criminal courts to doctors is shifting again. According to the BMJ four doctors were convicted of gross negligence manslaughter between 2012 and 2015, and three went to prison. But a Court of Appeal ruling in July in the case of an optometrist could have important implications for doctors.

While examining a boy’s eyes the optometrist failed to spot symptoms of a brain condition. The court overturned the conviction for gross negligence manslaughter on the grounds that it undermined the legal test of “foreseeability”, which requires proof of a “serious and obvious risk of death” at the time of the error.

This ruling may go some way to assuaging fears of a creeping criminalisation of healthcare staff who make mistakes.

But increasingly it will be data that makes and breaks professional reputations. The healthcare data revolution driven by pioneers such as Tim Kelsey, Sir Bruce Keogh and Sir Brian Jarman lifted the veil of mystique surrounding medical skill and has exposed individuals and institutions to ever more penetrating analysis of their performance.

The theory has been that transparency would stimulate doctors’ innate competitiveness so they would strive to match the best in their profession. While this is true for many, the data reveals doctors, medical directors and hospitals who seem undisturbed by their poor outcomes for patients.

At some point the next wave of the data revolution will break over the health service, with medical disciplines gradually establishing the limits of variation that will be tolerated. Surgeons and others will have to surrender more of their autonomy and be subjected to more stringent personal development in the interests of raising standards.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

Will the healthcare data revolution spell the end for doctors’ autonomy?

NHS Improvement’s drive to raise clinical standards is prising open the sensitive issue of doctors’ autonomy, and shows how the legal and professional boundaries of medicine are constantly shifting.

The Get It Right First Time programme is uncovering massive and unacceptable differences in performance, such as a 25-fold variation in orthopaedic surgical site infection rates.

Now colorectal surgeon John Abercrombie has used his report into general surgery performance to challenge the high degree of autonomy enjoyed by British surgeons.

He contrasts the demanding training and assessments required to qualify with the laissez-faire approach to subsequent professional development.

The rules are so lax that a surgeon could carry on practising unaware of new operating techniques, care pathways or developments in infection control.

This goes some way to explaining why new approaches to care takes so many years to permeate every part of the NHS.

Abercrombie calls for routine monitoring of performance measures such as infection and readmission rates, and for the surgical Royal Colleges to introduce tougher rules around continuing professional development. This could include visits to units which are delivering the best outcomes.

The report implicitly criticises medical directors for failing to drive through quality improvements such as standardised approaches to care, pointing out how similar roles in Germany and the US govern the way care is delivered.

Surgeons are highly protective of their autonomy. When then chief medical officer Sir Liam Donaldson began his big push around the turn of the century to improve patient safety he came up against surgeons who regarded standardised safe procedures as an infringement of their artistic freedom. The huge variations uncovered by the Right First Time programme demonstrate that many surgeons still don’t trouble themselves to find out the safest way to do their job.

The boundaries of medical behaviour are policed largely by the General Medical Council, the courts and, increasingly, data. Over the last two decades the GMC has been transformed from an organisation dominated by doctors and bearing more than a passing resemblance to a gentlemen’s club to one with an independent voice, strong lay representation and a focus on patient safety and raising standards.

The GMC’s regular checks on doctors’ competence through the revalidation process highlight the importance of constant professional improvement – but Abercrombie’s report shows that aspects of this system lack rigour.

In recent weeks there have been signs that the attitudes of the criminal courts to doctors is shifting again. According to the BMJ four doctors were convicted of gross negligence manslaughter between 2012 and 2015, and three went to prison. But a Court of Appeal ruling in July in the case of an optometrist could have important implications for doctors.

While examining a boy’s eyes the optometrist failed to spot symptoms of a brain condition. The court overturned the conviction for gross negligence manslaughter on the grounds that it undermined the legal test of “foreseeability”, which requires proof of a “serious and obvious risk of death” at the time of the error.

This ruling may go some way to assuaging fears of a creeping criminalisation of healthcare staff who make mistakes.

But increasingly it will be data that makes and breaks professional reputations. The healthcare data revolution driven by pioneers such as Tim Kelsey, Sir Bruce Keogh and Sir Brian Jarman lifted the veil of mystique surrounding medical skill and has exposed individuals and institutions to ever more penetrating analysis of their performance.

The theory has been that transparency would stimulate doctors’ innate competitiveness so they would strive to match the best in their profession. While this is true for many, the data reveals doctors, medical directors and hospitals who seem undisturbed by their poor outcomes for patients.

At some point the next wave of the data revolution will break over the health service, with medical disciplines gradually establishing the limits of variation that will be tolerated. Surgeons and others will have to surrender more of their autonomy and be subjected to more stringent personal development in the interests of raising standards.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

‘My bursary was essential’: readers on ending healthcare training bursaries

From Tuesday, anyone who wants to train to become a midwife, a nurse, or to go into other allied healthcare professions like speech or physiotherapy will have to start paying tuition fees, and will no longer have access to an NHS bursary to cover their living costs.

The department of health says replacing the bursaries with student loans will free up about £800m a year to create additional nursing roles by 2020, but the NHS is already struggling to fill 40,000 vacant nursing posts.

We asked readers whether they would still train to go into these professions today without financial aid. Here’s what they said.

‘I take a home about £12.50 an hour – getting into £50,000 of debt for that is a joke’ – palliative care nurse from the north west

I qualified in my thirties with a young family. I was lucky my husband was in work at the time and that I got an extra allowance as I had young kids. There is no way I would have been able to do nursing without the bursary – today I would just become a health care assistant instead. Even as a nurse now for many years my wage combined with my husband’s barely covers essentials. What a joke that I would consider getting into £50,0000 of debt for a job with huge responsibilities, loads of stress and terrible hours. I take home £12.50 an hour.

‘My bursary was essential – I am the first to go to university in my family’ – midwifery student from London

I will qualify as a registered midwife in September. I am on clinical placements at least 37.5 hours a week, alongside studying full time for a Bachelor of Science degree. How could I find a part-time job that would fit alongside this? Especially as I often have to work night shifts and weekends. Huge responsibilities also come with this course – we are each expected to deliver at least 40 babies across the three year programme.

I received a full NHS bursary, £450 a month, for three years. It was essential for allowing me to afford the cost of living in London, especially since I come from a working-class family and am the first in the family to go to university. Even with the bursary, my colleagues and I still experienced financial hardship. Choosing to undertake the course without the bursary would have been a difficult decision to make.

‘18-year-olds are not deterred but everyone else is’ – university nursing admissions tutor

The removal of the NHS bursary will definitely have a big effect on recruiting. Adult branch nursing will be well under recruitment targets. Applications for child nursing and midwifery are down but ok. Big difference here is we have more 18-year-olds applying – they have to take a loan no matter what they study at uni, so are not deterred. The worst reduction in applications is from mature applicants already working as NHS care assistants.

If students are going to have to take out loans, the NHS should pay them back when they start working for them – it would mean they don’t have to pay upfront for people who drop out, but also not deter applicants worried about debt. This issue is not just about loans or bursaries though – the NHS should also bring back secondments – health care assistants used to be able to carry on working for NHS with a full time wage while studying at university.

‘Is the sacrifice worth it?’ – occupational therapy student from London

I’m from the last cohort to receive a bursary and I’m training to help stroke and dementia patients return to independent living. I previously worked in a well paid job in corporate communications and without an NHS bursary I would have never been able to make a career change. I’m still paying off the debt from my first undergraduate degree and I have used my savings to fund most of my accommodation and living costs as the bursary isn’t sufficient to live on alone.

I changed career because I wanted to work in a field where I felt I was making a positive impact on a personal life but it is concerning hearing about the stress, hours, pay freezes and cuts going on in the NHS. It makes you wonder as a career changer whether the sacrifice is worth it.

‘Nursing students will be subsidising the NHS by working for free’ – substance misuse specialist

I love my work, it’s always challenging and different every day. I trained as a mature student when my children were at school. The bursary allowed me to pay for after school childcare and I would not have been able to do it without that funding. I think the removal of the bursary will have a particularly negative impact on mental health and learning disability nursing, which tend to be more appealing to older students with some life experience rather than school leavers. It is hard enough to study at university with children but being unable to afford childcare is likely to make it impossible for many. It certainly would have prevented me from training.

Nursing students are are now going to be expected to in effect “subsidise” the NHS by working for free whilst accruing debt that their potential wages mean that they will be unable to ever pay off. I have not had a pay rise for years but am expected to keep expanding my role to make up the shortfall in junior doctors hours.

‘I would not encourage anyone to enter nursing today’ – health visitor from the north west

I started working in the NHS in 1972 as a cadet nurse at the age of 16 and went on to train as a midwife, health visitor and also lectured at a university for a while. I returned to my current job following David Cameron’s call for people to return to the profession. My current role has changed significantly though since I first qualified in the 1980s. Health visiting was originally about primary health from ‘cradle to grave’ but now it is about ensuring targets are met and my role is almost synonymous with being a social worker. I would certainly not enter the profession under the terms that students face today. Nor would I encourage anyone to do so. The university programmes are woefully inadequate for preparing students for when they qualify, hence the high drop out rate of newly qualified staff. The removal of the bursary will decimate the profession.

‘I am worried it will deter men from applying’ – student mental health nurse from Preston

I left a long career in engineering to go into mental health as it was always close to my heart for personal reasons. As a mature student, I had the financial obligations of a mortgage, a wife to support and a car to run. University life is challenging as we are either in class four to five days a week or doing placements full time. Placements are effectively working for the NHS full time for free. You often have to travel 30 or more miles each way and shifts usually start before 7am and last 12 or 13 hours. The bursary I currently get is £300 per month which barely covers my living expenses. I have to work as a health care support worker to top it up in what spare time I have. But at least when I qualify next year I will not have any debt hanging over me.

To have £50,000 of student finance to pay back at 6.1% interest as a middle-aged man would have meant I wouldn’t have done nursing. I have already taken a big pay cut so having debt is definitely going to put off mature students like me who have a lot to offer. Men in this profession are already outnumbered 7 to 1 but we can build therapeutic relationships with other men with mental health issues where women just can’t.

‘Scrapping the bursary isn’t a bad idea – it’s not enough to live on anyway’ – healthcare assistant from London

I’m applying next year to do nursing. I actually think scrapping the bursary wasn’t an entirely bad idea. It wasn’t enough money to live on. My sister is a nurse and she had to work to cover her living costs while studying on top of also doing clinical placements, which was very difficult for her. At the moment, I’m working to save money for university. However, I plan to also take out student loans and apply for any grants universities offer – with the cost of living in London I don’t want to be worrying about money when studying such a demanding course.

I think removing the bursary will obviously affect the amount of people going into nursing – statistics show that the amount of applications this year have already dropped by a quarter. We aren’t attracting applicants and seasoned nurses are leaving not because there is something wrong with being a nurse, but because there is something wrong with the NHS. It is an underfunded, bureaucratic and disrespected institution. The workload for doctors and nurses is too high. I personally plan to leave and work in Canada when I qualify.

Does healthcare for all hold the key to Tanzania’s future? – podcast

Subscribe and review: iTunes and Soundcloud, and join the discussion on Facebook and Twitter

As Tanzania attempts to get healthcare to all corners of the country, The Elders – an independent group of global leaders co-founded by Nelson Mandela and working together for peace and human rights paid an official visit to the country.

They were in Tanzania to offer help and advice to the government in preparation for what they hope will be a set of reforms culminating in universal healthcare.

In this month’s Global development podcast, Lucy Lamble visits Tanzania to explore efforts to bolster the country’s health coverage. She is joined by Graça Machel, human rights advocate, former minister and elder; Mary Robinson, former Irish president, UN high commissioner for human rights and elder; and Robert Yates, project director of the Universal Health Coverage Policy Forum at London’s Chatham House.

How does the US healthcare system compare with other countries?

Despite US legislation in 2010 that moved the country closer to achieving universal healthcare, costs have continued to rise and nearly 26 million Americans are still uninsured according to the Congressional Budget Office.

As Republicans decide whether to repeal or replace the struggling healthcare policy, how does the existing US healthcare system compare with those in other countries?

Broadly speaking, the World Health Organization (WHO) defines universal health coverage as a system where everyone has access to quality health services and is protected against financial risk incurred while accessing care.

A brief history of the healthcare systems used today

Among the 35 OECD member countries, 32 have now introduced universal healthcare legislation that resembles the WHO criteria.

In Germany, the world’s first national health insurance system shows how UHC often evolves from an initial law. Originally for industrial labourers, cover gradually expanded to cover all job sectors and social groups, with today’s German workers contributing around 15% of their monthly salary, half paid by employers, to public sickness funds.

Established in 1948 to be free at the point of use, the UK’s NHS has almost totemic status for Britain’s rising, ageing population who scrutinise it like perhaps no other policy area. While care from GP services to major surgery remains free as intended, the system is under unprecedented financial strain from a funding gap estimated to be in the billions.

Under France’s state-run equivalent of the UK’s NHS, the majority of patients must pay the doctor or practitioner upfront. The state then reimburses them in part or in full. Workers make compulsory payments into state funds used to reimburse between 70% and 100% of the upfront fees, while many people pay into other schemes to cover the balance.

In the mid-1960s, the United States implemented insurance programs called Medicare and Medicaid for segments of the population including low income and elderly adults. In 2010, Obamacare became the closest the US has come to a system of UHC. A legal mandate now requires all Americans to have insurance or pay a penalty. About 26 million people remain without health insurance despite these advances.

Spending compared with life expectancy

Life expectancy in the US is still lower than other developed countries, despite health funding increasing at a much faster pace.

scatter

Who provides healthcare and how is it paid for?

How healthcare is funded has a direct effect on the level of healthcare people have access to.

How could the US healthcare system change?

Donald Trump ran on a campaign to repeal and replace the Affordable Care Act, popularly known as Obamacare, but discord among Republicans has highlighted the political challenges faced with implementing a healthcare system, much less trying to change it.

With millions still uninsured and the financial burden of healthcare still quite high, the current US policy falls short of the WHO threshold.

Thus far, separate bills introduced in the House and the Senate were estimated to see steep increases in the number of uninsured from current levels.

Estimated uninsured under existing and proposed healthcare plans

Graphic