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Mental health support in schools: ‘Families don’t have to spend years on waiting lists’

When Grace Hartill was 11, she began to show the first signs of anxiety. Within a few years, the Barnsley schoolgirl had become withdrawn and had stopped wanting to see her friends.

“It was awful,” she says. “I didn’t want to leave my bedroom because I felt like if I did, something would happen to me or somebody I loved. Home was where I felt safest, so I just isolated myself. I barely went to school.”

As her mental health worsened, she was referred to child and adolescent mental health services (Camhs) but was on the waiting list for two years. When she finally did get treatment, it didn’t help. She adds: “Camhs and the other services I tried just didn’t help. I felt like the therapists didn’t want to be there.”

It wasn’t until a groundbreaking service, MindSpace, launched in her school that Grace began to experience some relief. Funded by Barnsley clinical commissioning group (CCG) through its Future in Mind fund, the initiative works by embedding mental health practitioners in secondary schools so children don’t have to be taken out of school to access treatment. The scheme, originally piloted last academic year by 10 schools and officially launched in October 2017, aims to tackle poor mental health while bypassing traditional services, which are seeing rising demand coupled with insufficient capacity.

Consisting of three primary health practitioners, a parent counsellor, a family support worker and an emotional health support worker, the MindSpace team offers one-to-one sessions and groups for specific issues such as bereavement. It is led by Michelle Sault, head of extended services at the Wellspring Academy Trust, who came up with the idea after running a pupil referral unit, and seeing children who she believed didn’t belong there.

“I think school is where a young person should be,” Sault says. “There are a lot of discrepancies in Camhs, and in schools that don’t have funding to provide as much pastoral support as is needed these days. It’s an injustice in a sense that young people aren’t supported earlier before things escalate.”

Before the launch of MindSpace, Grace’s mother, Lisa Robinson, was at her “wit’s end”; her son was struggling with anxiety and behavioural issues, and she also has mental health problems. She remembers: “None of us were in a good place. I thought we should give it a go and it will either work or it won’t. Thankfully it did. Grace was soon able to identify when she was having anxiety attacks and to understand that she wasn’t going to die.”

Within a few months, there was a marked improvement in the household. Both children were going to school without problems and Robinson, who was one of 63 parents who also received counselling, felt better than she had in years. “I think it’s amazing to have it in schools so that families don’t have to spend years on waiting lists and the whole family can be helped,” she says.

Grace agrees: “It made all three of us happier. It’s like we were searching for something that wasn’t there and then it came along. It really worked wonders. Compared to other services I tried, I felt like MindSpace really wanted to be there and they wanted to listen to me. They understood what I was going through and made me realise I wasn’t the only one going through it.”

Funding for the £1.3m programme, which is delivered in all Barnsley secondary schools, is guaranteed until at least 2020. In its first year, more than 200 young people have been supported and more than 100 teachers trained by Sheffield-based mental health charity Chilypep. The training is being rolled out to all staff in all the schools – and one of the key aims is to create an environment where everyone can be open about mental health and wellbeing.

Patrick Otway, head of commissioning for Barnsley CCG, says that while no formal evaluation has been published yet, numerous positive case studies have been gathered – and a full impact assessment is on the cards. “In 2013, we had gathered evidence that there was very little support for young people in Barnsley for lower level emotional needs,” he says. “At the time, there was no funding to develop the service – so when the Future in Mind report and funding became available, the CCG already knew what was needed.”

Statistics show that one in 10 children has depression, anxiety or another diagnosable mental health problem – so the MindSpace team hope to see the model rolled out nationally. Brigid Reid, chief nurse for the CCG, says it’s this combining of health and education that makes the scheme successful. “Having [Sault’s] insights into how schools work and what students and parents need, think and feel – and to marry that with the expertise of the practitioners employed, that’s what makes it unique,” she says.

Mental health practitioner Angela Yildiz agrees. “Education and health do work well together,” she says. “Initially there were some difficulties given this has never been done. But the teachers really work with me, not against me.”

For Kate Davies, headteacher at one of the schools, Darton college, the best thing about the scheme is it means teachers can concentrate on what they do best. “The concept of having trained mental health practitioners as part of the school – and ours really is part of the team – is so simple yet so obvious,” she says.

For Robinson’s family, the difference has been almost unbelievable, especially in Grace. “One day Grace came home from school and just said casually that she was going to her friend’s house. I could not believe what she was saying. That was the turnaround for Grace. She is now doing performing arts at college and is learning to drive. It’s the best decision I made as a mum, and as an individual.”

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Mental health support in schools: ‘Families don’t have to spend years on waiting lists’

When Grace Hartill was 11, she began to show the first signs of anxiety. Within a few years, the Barnsley schoolgirl had become withdrawn and had stopped wanting to see her friends.

“It was awful,” she says. “I didn’t want to leave my bedroom because I felt like if I did, something would happen to me or somebody I loved. Home was where I felt safest, so I just isolated myself. I barely went to school.”

As her mental health worsened, she was referred to child and adolescent mental health services (Camhs) but was on the waiting list for two years. When she finally did get treatment, it didn’t help. She adds: “Camhs and the other services I tried just didn’t help. I felt like the therapists didn’t want to be there.”

It wasn’t until a groundbreaking service, MindSpace, launched in her school that Grace began to experience some relief. Funded by Barnsley clinical commissioning group (CCG) through its Future in Mind fund, the initiative works by embedding mental health practitioners in secondary schools so children don’t have to be taken out of school to access treatment. The scheme, originally piloted last academic year by 10 schools and officially launched in October 2017, aims to tackle poor mental health while bypassing traditional services, which are seeing rising demand coupled with insufficient capacity.

Consisting of three primary health practitioners, a parent counsellor, a family support worker and an emotional health support worker, the MindSpace team offers one-to-one sessions and groups for specific issues such as bereavement. It is led by Michelle Sault, head of extended services at the Wellspring Academy Trust, who came up with the idea after running a pupil referral unit, and seeing children who she believed didn’t belong there.

“I think school is where a young person should be,” Sault says. “There are a lot of discrepancies in Camhs, and in schools that don’t have funding to provide as much pastoral support as is needed these days. It’s an injustice in a sense that young people aren’t supported earlier before things escalate.”

Before the launch of MindSpace, Grace’s mother, Lisa Robinson, was at her “wit’s end”; her son was struggling with anxiety and behavioural issues, and she also has mental health problems. She remembers: “None of us were in a good place. I thought we should give it a go and it will either work or it won’t. Thankfully it did. Grace was soon able to identify when she was having anxiety attacks and to understand that she wasn’t going to die.”

Within a few months, there was a marked improvement in the household. Both children were going to school without problems and Robinson, who was one of 63 parents who also received counselling, felt better than she had in years. “I think it’s amazing to have it in schools so that families don’t have to spend years on waiting lists and the whole family can be helped,” she says.

Grace agrees: “It made all three of us happier. It’s like we were searching for something that wasn’t there and then it came along. It really worked wonders. Compared to other services I tried, I felt like MindSpace really wanted to be there and they wanted to listen to me. They understood what I was going through and made me realise I wasn’t the only one going through it.”

Funding for the £1.3m programme, which is delivered in all Barnsley secondary schools, is guaranteed until at least 2020. In its first year, more than 200 young people have been supported and more than 100 teachers trained by Sheffield-based mental health charity Chilypep. The training is being rolled out to all staff in all the schools – and one of the key aims is to create an environment where everyone can be open about mental health and wellbeing.

Patrick Otway, head of commissioning for Barnsley CCG, says that while no formal evaluation has been published yet, numerous positive case studies have been gathered – and a full impact assessment is on the cards. “In 2013, we had gathered evidence that there was very little support for young people in Barnsley for lower level emotional needs,” he says. “At the time, there was no funding to develop the service – so when the Future in Mind report and funding became available, the CCG already knew what was needed.”

Statistics show that one in 10 children has depression, anxiety or another diagnosable mental health problem – so the MindSpace team hope to see the model rolled out nationally. Brigid Reid, chief nurse for the CCG, says it’s this combining of health and education that makes the scheme successful. “Having [Sault’s] insights into how schools work and what students and parents need, think and feel – and to marry that with the expertise of the practitioners employed, that’s what makes it unique,” she says.

Mental health practitioner Angela Yildiz agrees. “Education and health do work well together,” she says. “Initially there were some difficulties given this has never been done. But the teachers really work with me, not against me.”

For Kate Davies, headteacher at one of the schools, Darton college, the best thing about the scheme is it means teachers can concentrate on what they do best. “The concept of having trained mental health practitioners as part of the school – and ours really is part of the team – is so simple yet so obvious,” she says.

For Robinson’s family, the difference has been almost unbelievable, especially in Grace. “One day Grace came home from school and just said casually that she was going to her friend’s house. I could not believe what she was saying. That was the turnaround for Grace. She is now doing performing arts at college and is learning to drive. It’s the best decision I made as a mum, and as an individual.”

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.

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Charlie Gard cannot spend ‘significant time’ in hospice, court rules

Charlie Gard’s parents have been unable to fulfil their wish to have him kept on life support systems for a “significant” period of time after he is moved to a hospice, Great Ormond Street hospital (Gosh) has said.

Connie Yates and Chris Gard had hoped that they would be able to spend “a week or so” in a hospice with their son before he was moved off a ventilator. But Gosh said that would require a 24/7 intensive care team and a high court judge gave Charlie’s parents until noon on Thursday to source one.

Mr Justice Francis laid out an alternative – default – position, which would involved a shorter time in hospice, if they were unsuccessful.

A Gosh spokeswoman said: “Sadly, as the judge has now ruled, there is simply no way that Charlie, a patient with such severe and complex needs, can spend any significant time outside of an intensive care environment safely.

“The risk of an unplanned and chaotic end to Charlie’s life is an unthinkable outcome for all concerned and would rob his parents of precious last moments with him.

“As the judge has now ruled, we will arrange for Charlie to be transferred to a specialist children’s hospice, whose remarkable and compassionate staff will support his family at this impossible time.”

Charlie’s parents had issued a plea on Wednesday evening for a paediatric intensive care consultant to come forward to help them spend “some peaceful time with our baby boy”.

The alternative timetables for Charlie’s death were agreed on Wednesday but with members of the press and public excluded and remain confidential.

Francis’s order, made public on Thursday, states: “In the absence of agreement between the guardian and Gosh and the proposed intensive care treating team for provision of intensive care in a hospice setting for an extended period of a few days, by 12 noon 27 July 2017, it shall be lawful and in the best interests of Charlie …. for artificial ventilation to be withdrawn after a period set out in the confidential annexe.”

Before the members of the press and public were excluded on Wednesday, Francis had said that in the absence of an intensive care team being found by the parents, Charlie would “be transferred to a hospice and extubated [have his tube removed] shortly thereafter”.

Victoria Butler-Cole, the lawyer for Charlie’s guardian, had earlier referred to the choice being between Charlie spending a period of hours or days on the ventilator when transferred out of hospital.

After the terms of the order were agreed in private on Wednesday, as the press and public were allowed back into the court room, Yates sobbed angrily: “I don’t want to be in the same room as him,” words said to be aimed at the judge. She also said: “What if it was your child?” and: “Hope you’re happy with yourself,” before leaving the court in tears.

She and her husband, who was absent from court on Tuesday and Wednesday to spend time with their son, originally said it was their “last wish” for Charlie to die at home but reluctantly gave up on that hope in the face of opposition from Gosh.

On Monday, Charlie’s parents abandoned their fight to allow him to be flown to the US for experimental treatment for mitochondrial disease, having determined it was no longer viable because of muscular atrophy he had suffered while the case went through the courts.

But the case unexpectedly returned to court on Tuesday as Gosh and Charlie’s parents once again found themselves at odds, this time over where he should spend his final hours.

Theresa May should spend any political capital she has left on mental health

“I’ve contemplated killing myself a few times.” Sensing the pause in my throat the 19-year-old young man quickly followed: “But obviously I didn’t, I self-harmed instead. It was the only way they’d take me seriously.”

This young man went on to explain to me how, from an early age, his parents had suspected he was autistic but hadn’t taken him to be tested. At school, his emotional and mental health began to rapidly deteriorate. Bullying led to severe panic attacks, which meant rarely leaving the house. Throughout all this he had bounced from one counsellor or support service to another. Finally the panic attacks became so bad he was admitted to hospital. At first he felt “relieved” at the attention, but when he found out the waiting time for a specialist appointment would be three months his condition regressed. He felt he had no option left but to self-harm to get the right help.

This story was shared with me as part of a focus group conducted for the recently released report A Healthy State of Mind from Localis, the thinktank for which I am director. The four participants sketched out a wretchedly consistent picture of a young people’s mental health service letting down too many, too often. We are at risk as a nation of failing an entire generation of vulnerable young people who need specialist support.

The system, bedevilled by months-long waiting lists because it fails to differentiate between those in crisis and those close to it, makes vulnerable young people feel like nobody cares and nothing can be done. The solution is urgent reform, but where to start?

The most obvious place to provide support is in schools. Localis analysis shows 75% of local mental health plans mention school-based approaches – 40% of those plans refer specifically to school-based counselling. And yet, when you get into the detail, a meagre 3% actually plan to commission school-based services. Of course, an effective mental health system for young people is about more than school-based services, but it’s hard to imagine one without them.

Norman Lamb, former minister for mental health, criticised the “inertia of implementation” at our report’s launch, arguing the coalition government set the right direction with the report Future in Mind but local failures to deliver and commission services are responsible. According to Lamb: “The £1.4bn (we) leveraged has been funneled into other parts of the NHS to prop up budgets. The money hasn’t been spent on young people’s mental health services.”

Performance locally varies considerably. Take the strength and difficulties questionnaire which every child in the looked after system must be assessed against. The questionnaire is a screening tool that helps professionals understand the level risk of a young person faces with regards to their mental health.

Despite completion of the questionnaire being a statutory duty for councils, the national average completion rate is only 75%. There are 62 councils that fall below the national average and there are even a handful which record 0% completion rates. This means for the most vulnerable young people, those in care, it’s too often a case of pot luck whether your council assesses you or not.

More troubling is the low likelihood of services being able to hit the government and NHS England’s target of 35% of young people with a clinically diagnosable mental health condition receiving specialist community based support by 2020-21. Localis analysis suggests 58% of local areas are on course to miss their target. In some areas this will mean thousands of young people missing out on the specialist support they need. Even if government hits its modest target of 35%, Localis estimates that by 2020-21 approximately 555,000 young people in need of specialist mental health support will still not be receiving it.

The government should commit to a programme of mental health services reform, not just the repeal of outdated legislation. It should accelerate the investment in the promised 3,000 GP-based mental health therapists and implement the Carter review’s recommendation that teacher training include a mandatory module on mental health. It should also be bold and take a percentage of the pupil premium and mandate that it is used for the provision of mental health support in schools.

What political capital the prime minister has left should be spent addressing our mental health crisis, particularly for young people. Mental health was one of the “burning injustices” Theresa May called out on the steps of Downing Street last July. She should not forget this commitment. Significant reform would be a worthwhile legacy.

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Do women’s periods synchronise when they spend time together?

Talk to a woman about her period and she will probably give you an example of the time her cycle aligned with a friend, partner, colleague or family member. Many of us have noticed that the closer we get to another woman the more we seem to get crampy, grumpy, tired, bloated and spotty at the same time. It’s as if our uteruses, in a monthly show of solidarity, are saying hey, why not go with the flow? Let’s do this painful, stigmatised, and bloody expensive thing together, and take advantage of the three-for-two tampon offers in the process.

However, a new scientific study – thought to be the largest of its kind – has found data showing women’s periods do not synchronise when they live together after all. The study – carried out by period tracking and fertility app Clue in partnership with the University of Oxford – received 1500 responses, which were narrowed down to 360 pairs of women. Analysing three consecutive cycles in each pair, the research found the vast majority – 273 pairs – had a greater difference in period start dates at the end of the study than at the beginning. In other words, menstrual syncing is a myth up there with periods being tied to the waxing and waning of the moon. Not only that, women’s menstrual cycles are more likely to diverge than come together over time.

“It’s very unlikely that cycle syncing is a real phenomenon,” says Clue’s data scientist Marija Vlajic. “Menstrual syncing amongst the sample we had did not exist. We’ve also done some statistical tests and found that the difference in cycles actually grows. This doesn’t mean that pairs go out of sync – it means they were never in sync in the first place. It’s the nature of two mathematical series that keep repeating: the series will diverge as the numbers grow.”

This has been my experience. I have been with my female partner for 13 years, living together for 11 years. In that time, our periods have never synced for more than a month or two, because our cycles are different lengths.

“Exactly,” Vlajic says. “So there will be a time every six months, say, when your periods sync but that doesn’t mean the difference is getting smaller.” Has Vlajic ever experienced her period syncing with another woman? “My background is scientific,” she notes. “So when I say to my friends that I have my period and they have theirs too I don’t conclude that we are syncing. I just think it’s information bias; our brains looking for patterns.”

Still, the belief in menstrual synchrony persists, with a study published in 1999 revealing that 80% of women believed in the phenomenon and 70% saying they enjoyed it. The editor who commissioned this piece told me that she syncs with her sister whenever they spend time together and gets her period at the same time as her closest colleague. The idea has been around for centuries, though because menstrual health has long been overlooked by the scientific research community it was not until 1971 that it was first documented in a study.

In a Harvard research paper titled Menstrual Synchrony and Suppression, psychologist Martha McClintock tracked 135 female college students living in the same dorm and found “a significant increase in synchronisation of onset dates”. She concluded: “the evidence for synchronicity is quite strong, indicating that in humans there is some interpersonal physiological process which affects the menstrual cycle.”

The idea that pheromones enable women to become sexually receptive at the same time has been researched in various groups as well as in rats, baboons and chimpanzees. Themain evolutionary explanation is that it permits female species to avoid being monopolised by a single dominant male. But McClintock’s paper has been discredited on methodological grounds and a whole host of other studies, like this new one, continue to prove that menstrual synchrony is a myth.

So why won’t we let this one go? And how does Vlajic explain all the anecdotal evidence of our periods synchronising? “I like the idea myself of this dominant super uterus in a group of women that makes everyone adjust their cycles,” she admits. “I can see how it gives you a special connection with a woman to go through that at the same time. It feeds into a feeling of connection, support, and sisterhood. Even though we do it every month, t Periods are personal and the thought of sharing with someone makes the idea powerful. That’s why we continue to look for patterns even when they don’t exist.”

Chitra Ramaswamy

Don’t dread old age. I’m 94, and I won’t spend my last years in fear of the Tories | Harry Leslie Smith

I have lived a very long time. Tomorrow, it will be exactly 94 years ago that a midwife with a love of harsh gin and rolled cigarettes delivered me into my mother’s tired, working-class arms. Neither the midwife nor my mother would have expected me to live to almost 100 because my ancestors had lived in poverty for as long as there was recorded history in Yorkshire.

Nowadays, when wealth is considered wisdom, too often old age is derided, disrespected or feared, perhaps because it is the last stage in our human journey before death. But in this era of Trump and Brexit, ignoring the assets of knowledge that are acquired over a long life could be as lethal as disregarding a dead canary in a coal mine.

I have been living on borrowed time since my birth in Barnsley all those years ago: I survived both the depression and the second world war. Even in advanced old age, because I walked free of those two events, I feel like a man who beat all the odds in a high-stakes casino. It’s why I’ve embraced each season of my life with both joy and wonderment because I know our time on Earth is a brief interlude between nonexistence.

Still, many people persist in thinking that old age is the end of one’s usefulness or purpose, which could explain why the news that women in South Korea can expect to live into their 90s has been badly received. Some fear the indignity that old age may bring, or the dependence it may cause because of physical or mental impairment. On occasion I too worry that before death sets in on me that it may rob me of the elements that make me who I am. But ultimately, having experienced the profound indignity of extreme poverty during the 1930s and the sheer terror of war in the 1940s, I know that life must be battled until the bitter end.

Eternity is just around the corner for me but I don’t fear my death. I only regret that death will end my dance to the music of time, no matter how slow the waltz has become to allow me keep up. I know that my physical wellbeing and dignity may yet be affected adversely by the government’s self-created social care crisis but I will not spend either my last years or days living in fear of the Tories. I cannot because I have seen their kind before in the 1930s and 1980s and know that the only way we can beat the tyranny of austerity is through our own personal defiance.

People should not look at their approaching golden years with dread or apprehension but as perhaps one of the most significant stages in their development as a human being, even during these turbulent times. For me, old age has been a renaissance despite the tragedies of losing my beloved wife and son. It’s why the greatest error anyone can make is to assume that, because an elderly person is in a wheelchair or speaks with quiet deliberation, they have nothing important to contribute to society. It is equally important to not say to yourself if you are in the bloom of youth: “I’d rather be dead than live like that.” As long as there is sentience and an ability to be loved and show love, there is purpose to existence.

I learned a long ago time ago that there was wisdom and beauty that could be mined from the memories of those in the sunset of life. It is why as a boy I listened in rapt attention to my granddad as he lay dying from cancer and told me about his life both as soldier and miner during the reign of Queen Victoria.

All of you, when young, will make your own history: you will struggle, you will betray some and others will betray you. You will love and lose love. You will feel profound joy and deep sorrow and during all of this you will grow as an individual. That’s why it is your duty when you get old to tell the young about your odyssey across the vast ocean of your life. It is why when death does come for me – even if it mauls me with decrepitude before it takes me – I will not lament either my old age or my faded youth. They were just different times of the day when I stood in the sun and felt the warmth of life.

Paramedics spend 500,000 hours outside busy A&Es, say auditors

Paramedics last year spent 500,000 hours outside hospitals with a patient in the back of their ambulance because A&E staff were too busy to accept them, an official inquiry has revealed.

That was the equivalent of 41,000 12-hour ambulance shifts being taken up with waiting instead of crews being able to attend to other emergencies, according to a report by the National Audit Office.

Ambulance crews are meant to take no more than 15 minutes to hand over a patient to A&E staff and another 15 minutes to prepare their vehicle to get back on the road. “Each failure to meet this standard results in a poor experience for the patient and a delay in an ambulance crew being available for a new emergency call,” the report says.

Last year just 58% of ambulances transferred their patient within 15 minutes and 65% were ready to leave a quarter of an hour later.

All but one of the 10 NHS regional ambulance trusts are breaching 999 call response targets, services are desperately short of paramedics and funding has not kept pace with a surge in the number of patients who need an ambulance.

The NAO report says: “Ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services. Introducing new models of care has helped but there are signs of stress, including worsening performance against response time targets.”

Ambulances are meant to arrive at the scene of 75% of Red 1 and Red 2 calls within eight minutes. Red 1 calls involve life-threatening emergencies such as patients who have suffered a cardiac arrest, are not breathing and do not have a pulse. Red 2 calls are less immediately time-critical but involve events such as a heart attack or stroke. Green 1 calls have a target of 20 minutes.

In 2015-16 the West Midlands ambulance service was the only one of the 10 trusts in England to meet the three main targets, the NAO found.

The NAO flags up a 10% vacancy rate for paramedics, and ambulance trusts’ difficulties in retaining staff, as obstacles to tackling what it describes as “significant challenges”.

It says the ageing population, growing number of patients with alcohol or mental health problems and lack of health services outside hospitals all help to explain the rapidly growing demand for care. The number of calls to ambulance services and transfers from the NHS 111 telephone advice service rose from 7.9m in 2009-10 to 10.7m in 2015-16 – an average year-on-year increase of 5.2%.

Phil McCarvill, deputy director of analysis at the NHS Confederation, which represents NHS trusts including ambulance services, said underfunding elsewhere in the health and care system was a key reason ambulance trusts were under pressure.

“Our highly skilled and dedicated ambulance personnel are working incredibly hard to make sure people get the right care where and when they need it, but they are having to respond to unprecedented demand for health and care services,” he said.

“If we are to relieve the current pressures on ambulance services, we also need to see the right balance of resources going into community, primary care and social care.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “The health secretary says he wants to make the NHS the safest healthcare system in the world, but these figures show patient care and safety is being severely compromised.

“When thousands of patients are stuck outside A&E departments, ambulances can’t get to other emergencies on time. People suffering from serious conditions such as a stroke will be left with serious disabilities and other life-long problems, and there is a serious risk of lives being lost because emergency calls are delayed.”

Case studies

Rachel, Newcastle upon Tyne: “I was ordered an ambulance by NHS Direct due to a suspected brain haemorrhage. My boyfriend offered immediately to drive me to A&E but they insisted on sending an ambulance, and he was told to wait outside ready to receive the paramedics. Forty-five minutes later we were still waiting, and when we were able to speak to someone we were told that it was in the system but hadn’t been dispatched yet.

“We drove to hospital and were seen immediately. Given that we offered to drive from the outset, it was an unnecessary delay and, had the ambulance arrived, would have been an unnecessary journey.”

Paul Baggaley, Newark: “I came across a pedal cyclist lying in the road after falling off his bike on a slippery surface. A young carer stopped with us and called for an ambulance after five minutes of convincing him that he needed to be seen by hospital. He had injuries and a broken helmet after cracking his head on the road. After coming back to his senses he informed us of two spinal operations he had suffered so we didn’t move him. We kept him warm with blanket and kept him talking.

“After 20 to 30 minutes I rang 101 for police assistance to help with traffic. They arrived in 15 to 20 minutes. We stayed 20 minutes then had to leave. After we had done what we had to do, we came back past that way and still no ambulance. He was lying on the cold ground for over an hour.

“The East Midlands ambulance service is the poorest performing service in the country and things seem to be worst where we are because we are 23 miles from the nearest A&E and so ambulance service is continually stretched.”

Half a million older people spend every day alone, poll shows

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Scale of loneliness among over-60s revealed as Age UK develops scheme to provide support and companionship

Half a million people over the age of 60 usually spend each day alone, with no interaction with others, and nearly half a million more commonly do not see or speak to anyone for five or six days a week, a poll suggests.

Age UK, which commissioned the research, said the results highlighted a growing number of chronically lonely older people, which was placing increasing demand on health services.

Related: Jo Cox’s campaign to tackle loneliness lives on with help of friends

Related: Loneliness is a hazard of old age. A phone call can mean a lot | Michele Hanson

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NHS to spend £130m upgrading or replacing radiotherapy machines

Cancer treatment is to get its biggest boost in 15 years, according to NHS England, which has said it will spend £130m upgrading or replacing radiotherapy machines to improve the survival chances of hundreds of thousands of patients.

The upgrade of at least 100 linear accelerator (Linac) machines across the country will ensure more patients get state-of-the-art treatment called intensity-modulated radiotherapy, which can target the tumour very precisely without damaging surrounding healthy tissue. New machines are more accurate and can deliver a higher dose to the cancer cells, which will reduce the amount of time a patient has to spend in radiotherapy and hopefully increase cure rates.

Radiotherapy is an important part of cancer treatment, after surgery to remove the tumour, and cures more people than cancer drugs. The Linac machines used to deliver it are supposed to be replaced after 10 years, but 20% of them in England are older than that.

The machines installed in the last decade need a software upgrade, according to Harpal Kumar, chief executive of Cancer Research UK. Kumar headed the independent Cancer Taskforce, which drew up the NHS cancer strategy and recommended the investment in radiotherapy machines.

“One of the things we were quite clear about in the strategy was that if you look at the proportion of treatment that is delivered as intensity-modulated radiotherapy across the country, it varies quite widely,” said Kumar. “Uptake varies two to three-fold across the country. About half the machines in the country are going to be upgraded in the next two years.”

About four in 10 cancer patients – all those who receive radiotherapy – will get improved treatment, said NHS England, which amounts to around 130,000 people a year.

Cally Palmer, NHS England’s national director for cancer and chief executive of the Royal Marsden cancer hospital, said the money would be forthcoming from the NHS budget “because cancer has been prioritised over other things. The decision has been made that we need to get radiotherapy right.”

Mia Rosenblatt, assistant director of policy and campaigns at Breast Cancer Now, said: “We are delighted by today’s announcement of investment into new Linacs: radiotherapy is an essential treatment for breast cancer patients, and upgrades to radiotherapy equipment is much overdue.

“However, it is still too early to tell if the strategy will be successful and the next year will be the real test of how the strategy will benefit breast cancer patients in England. We will continue to follow progress carefully.”

The Royal College of Radiologists said the money was not enough. “Although the funding announced is to be welcomed, if the government wishes to achieve world class cancer outcomes by 2020, significantly more investment in radiotherapy services is required at least up to the equivalent level announced for Scotland,” said Dr Jeanette Dickson, vice president, clinical oncology.

In March, Scotland’s first minister, Nicola Sturgeon, announced a £50m investment in radiotherapy services.

NHS England’s commitment was made on the day it reported on progress in the first year of the current cancer strategy. Exploratory work on how to increase the early diagnosis of cancer patients had been a main priority, said Palmer. Those who are diagnosed early have a better chance of cure.

Do you spend a lot on fitness? Seven people reveal their exercise budget

The latest sportswear, healthy cookbooks, Fitbits, apps and after-work classes – exercise and wellbeing is big business these days. Consumer spending on UK gym membership soared by 44% in 2015 and sales of sportswear grew by by 9.5% in 2014. So how much do you spend staying in shape?

We asked readers about their monthly fitness (including sportswear, health food etc) and weekly exercise spend, calling for people to reveal how much they were willing to pay. We also asked for stories of people who manage to exercise on next to nothing. We received 473 responses. Here are some excerpts from the comments we received, condensed and edited for clarity.

Sian Melonie, 32, from London: ‘I spent more than £1,000 on a juice retreat’

Spend on exercise a week: £37.50
Spend on fitness per month: £25
Hours spent exercising: 15

Sian Melonie


Sian Melonie: ‘Most pressure to be fit comes from my parents – my mum, sister and step-mum all worry about their looks’

I have a Classpass which lets me access a variety of fitness classes around London. So with this pass you pay £110 a month and you get access to lots of different fitness sessions – you can attend three a month at each studio and it’s a rolling contract so I set myself a goal of doing 20 to 25 a month. It ends up being better value than wasted gym membership. The most I have ever spent on exercise was more than £1,000 for a week at a juice retreat.

I used to go for cheaper alternatives, such as running and going to cheaper gyms, but it didn’t seem to really work. ClassPass allows me to mix it up and do different exercises to challenge my body. I’ve never struggled with my finances because of the cost of exercise but I have spent a lot in the past.

In terms of other fitness spending I buy good quality food as I prefer to put unprocessed foods in my body. I also spend lots on clothes. Most pressure to be fit comes from my parents – they may not appreciate that but my mum, sister and stepmum all worry about their looks. However, the rise of Instagram and Facebook also adds to this. Knowing that l am doing something about it and getting stronger with each class that l do takes the pressure off me feeling bad about myself – knowing I am working towards a goal makes me feel better about myself. I have lost inches from my waist and I am more focused on toning up than losing weight. I am also much stronger and can do planks, burpees and press-ups.

Kelly, 50, from London: ‘The fact I know I will lose money if I don’t see my personal trainer helps to motivate me’

Spend on exercise a week: £200
Spend on fitness a month:
£1,000
Hours spent exercising: eight

I have a personal trainer twice a week , a tennis class once a week and I go to group lessons too. I am also a member of a tennis and golf country club, which is about £200 a month. The combination of playing tennis and going to the gym has been good for my body. I have always been into fitness but recently I’ve got better at doing exercises that specifically help me as a tennis player.


Having someone there helps to motivate me and pushes me more

Kelly

If I could pay less on exercise then that would be great. I guess if I didn’t go to such an expensive club I could save. I could also maybe not have a personal trainer twice a week, but have it once instead. I just find it hard on my own. I always think next month I will do just one personal training session a week, but that never quite happens. Having someone there helps to motivate me and pushes me more. It depends on your personality but, for me, having someone there waiting for me and the fact that I will lose money if I don’t go means I can’t create excuses for not going.I feel fitter and look leaner and that has an impact on how I feel about myself. There’s also the endorphin release aspect that helps as I tend to have slumps in my mood and working out helps with that.

Woman working out in fitness


‘There’s also the endorphin release aspect that helps as I tend to have slumps in my mood.’

Cearon O’Flynn, 34, from Kent: ‘Cycling to work saves me money in petrol each week’

Spend on exercise a week: £15
Spend on fitness a month: £15
Hours spent exercising: 10

Cearon O'Flynn


Cearon O’Flynn: ‘Exercising saves me money as I don’t have to drive to work.’

My biggest expense is my bike, it was £800, although through the cycle-to-work scheme I’ve paid for it now. I cycle to work; this keeps me fit and saves me about £20 a week on petrol. I then use that bike to cycle more over the weekend. I love cycling because it keeps me healthy, makes me feel comfortable and allows me to run around with my kids. Exercising saves me money as I don’t have to drive to work. This eases my financial burdens.

Tania, 49, from High Wycombe: ‘I spend a significant portion of my household budget on exercise’

Spend on exercise a week: £50 (minimum)
Spend on fitness a month: £300
Hours spent exercising: 12

Tania with her dog


Tania: ‘My biggest expense is probably on running shoes, but you can’t compromise on quality.’

I pay for quality exercise classes, as well as doing free stuff such as running. My biggest expense is probably on running shoes, but you can’t compromise on quality – I spend about £120 every six months. Physiotherapy is also expensive and I usually get a few sessions when something goes wrong. I do Taekwondo with an excellent instructor; it costs £55 a month but I can train as often as I like. It’s excellent for the body, mind and soul, and great value for money.

I’ve tried doing classes at my gym, which cost £6 a session, but they are usually packed so I don’t get the same level of attention from the instructors. It’s important to do certain exercises, such as pilates, in small groups so you can make the most out of it. I spend a significant portion of my household budget on exercise but I see it as an investment. I spend the money to be healthy and set a good example to my kids. It’s also a great way to socialise too.

Sam Thompson, 24, from York: ‘It’s very enjoyable to cycle everywhere, and it’s cheap’

Spend on exercise a week: £0
Spend on fitness a month: £0
Hours spent exercising:
eight

My biggest exercise expense is probably bike maintenance; I’ll spend on average a few hundred pounds a year on tyres, chains, cassettes, brake pads, new cables, etc. I think I’m about as cheap as it’s possible to be – if I were to spend the same time running, I’d probably get through the same cash on shoes.

Cycling. My bike doesn’t tell me how many calories I’ve burned, but humans have managed for millennia without knowing whether they’ve burnt off that extra slice of cake (though admittedly, we’ve spent millennia without the option of an extra slice of cake). Seeing the English countryside and fresh air is far more enjoyable than labouring in the identikit gym down the road with all the other sweaty people. It’s very enjoyable to cycle everywhere, and it has the positive side-effect that it keeps me healthy.

Not owning a car makes using a bike for everything sound a lot better value. Cycling everywhere costs about half what I’d spend on insurance each year.

Daniel Coleman, 41, from Bracknell: ‘I hired a personal trainer when I was 40 and going through mid-life stuff’

Spend on exercise a week: £5
Spend on fitness a month: £50
Hours spent exercising: five

Daniel Coleman


Daniel Coleman: ‘I got the running bug after doing an obstacle course and have really got into it this year.’

I generally run to keep fit – I run about 5km every day after work and have a budget gym membership. I have set a little challenge for myself this month to run every day but I used to run three times a week. It’s something I’ve discovered this year and before that I had a personal trainer and cycled to work. I hired a personal trainer when I hit 40; I was going through some mid-life stuff, but after having him for a year I gained the confidence to train on my own.

I got the running bug after doing an obstacle course and have really got into it this year. I like how quick and easy running is, and it doesn’t take up much of my day doing it. I am very motivated by goals, so I set myself the target of running 5km in under 24 minutes this year. I mix cheaper activities (eg running in the woods) and more expensive stuff (eg a personal training session) depending on mood. I don’t spend much else on fitness, except I occasionally treat myself to a brand of top.

Clare Riley, 56, from London: ‘I should probably just cancel my gym membership but I keep it as a safety net’

Spend on exercise a week: £75
Spend on fitness a month: £25
Hours spent exercising: three


I do an hour with a personal trainer a week and two bootcamp classes that I pay extra for. I do them locally in London and they are about £12 to £13 each. I haven’t always been into fitness, but when I reached 50 I concentrated on it more as your metabolism slows down, etc. I do spend a lot compared to some people, but it works for me.

I also have gym membership, which costs me £25 a month. I don’t go to the classes at the gym as much though as the standard of tuition isn’t great. I should probably just cancel my gym membership altogether but I keep it as a safety net and sometimes go to pilates there.

What I spend is fair in terms of the market rate and my trainer is very good. The boot camp also gives me a good level of cardio fitness, so it really does make a difference. As you get older, it gets more important to stay healthy. I don’t want to go into old age not being mobile and getting out of breath easily. I want to stay in shape for as long as possible.

Dan, 44, from Bristol: ‘It’s not always easy to pay for it all, but what bigger priority is there than health?’

Spend on exercise a week: £100
Spend on fitness a month: £400
Hours spent exercising: four

I have a personal trainer and gym membership. I also spend monthly on clothes, healthy food and race entry fees. Surely the reason why people spend so much on exercise is because there isn’t an alternative. Lots of us would spend two hours a day running or cycling if we could, but we are all in offices for most of the day. I mean, for six months of the year it’s dark when you leave work so going to the gym is the easy option. On weekends it’s also hard to find the time to exercise outdoors because I want to spend time with my family. I’d rather spend Saturday morning with my four-year-old than training. It’s not always easy to pay for it all, but what bigger priority is there than health? We all come alive when we make a hard physical effort, it’s in our genes.