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Improving lives is not hust about having a larger house, more salary, more entertainment, but is to improve health (physical, mental and social), well-being and raise awareness of public health.

Through clinical practice, service improvements and innovation, people’s lives become better and make ourselves, patients and our communities healthier. (Future Learn 2014)

Improving lives is having opportunities and choices to improve quality of life, and be respected by others.(Prime ministers strategy unit, 2005)

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Improving Lives: New Asthma Treatment Set for Wider NHS Distribution

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Improving Lives: New Asthma Treatment Set for Wider NHS Distribution

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Case
Laura Foster (2018), a health reporter from BBC News, reported that a new treatment for severe asthma will be set to be made more widely available for on the NHS in the UK by the end of 2018. National Institute for Health and Care Excellence (NICE) (2018) was the supporter behind the proposal, as they said, “it can be offered more routinely”, after it was proved to be safe and effective.

What is Bronchial Thermoplasty?

This treatment, bronchial thermoplasty (BT), is defined by Asthma UK (2018) as “A medical procedure that some people with severe asthma can have to help open their airways. It’s a radiofrequency heat treatment that reduces the amount of thickened smooth muscle on the inside walls of the airways”.

Number of Asthma patients

In fact, a recent figure from Asthma UK shows that 1,434 people died from asthma in 2015, when some 5.4 million people in the UK have asthma - but for more than 200,000 of them (3.7%) the asthma is so severe, it can be life-threatening (Foster, 2018).

Saving More Lives & Improving Lives

But, with BT made more accessible, optimistically, a much larger majority of asthma suffers are eligible to receive this non-pharmacologic and device-based treatment than before. While some symptoms are too minor to arouse attention, for example, coughing, some are lethal and fatal, such as breathlessness and a tight chest. Yet, throught BT, their symptoms can be much relieved or even cured in the future.

Substitute of Medication

BT could be an alternative treatment when medication does not work. In Bronchial thermoplasty: a review of the evidence, Wilhelm and Chipps (2016) concluded that while a conventional treatment with a high-dosed inhaled corticosteroid (ICS), a second controller medication, and/or systemic corticosteroids fails or having poor control of asthma symptoms due to many factors, such as poor inhaler technique, persistent environmental exposures, or confounding comorbidities of psychological factors, obesity and smoking-related diseases, BT might warrant consideration of doctors and patients, which means it could be the hope of saving lives even if medication does not help against deterioration.

Shorter Treatment Period

The treatment period of BT is shorter than that of conventional pharmacological methods, yet it is more effective than medication. About medications, for example, ICS, the most effective controller of asthma (Barnes 2010), it needs to be taken daily for best results. “Some improvement in asthma symptoms can be seen in 1 to 3 weeks after starting inhaled steroids, with the best results seen after 3 months of daily use” (DerSarkissian, 2019). Still, NICE (2018) claims that BT is usually delivered in 3 sessions with an interval of at least 3 weeks between each session, which largely shortens the treatment period.
(By William)

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Improving Lives: New Asthma Treatment Set for Wider NHS Distribution

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Improving Lives: New Asthma Treatment Set for Wider NHS Distribution

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Higher Cost-effectiveness

In addition, Zein et al. (2015) argued that BT is a cost-effective treatment for asthmatics at high risk of exacerbations. Continuing to follow asthmatics treated with BT beyond 5 years will help inform longer efficacy and support its cost-effectiveness, which means it costs less for BT treatment. In Bronchial thermoplasty in asthma: current perspectives, Laxmanan and Hogarth (2015) also stressed the stability and reliability of BT, as they argued, “Several clinical trials have demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT. In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life”.

With Fewer Side Effects to Improve Quality of Life
With respect to side effects, Asthma UK stated that “The most common short-term risk is that your asthma symptoms get worse before they get better”, still, “The long-term risks and benefits of bronchial thermoplasty aren’t yet fully understood. This is because it hasn’t been around for a long time, and the procedure hasn’t been carried out on enough people to get a full picture of the benefits” in 2019. But, according to DerSarkissian (2019), while inhaled steroids have few side effects, especially at lower doses, using systemic steroids (steroids taken by mouth or by injection in high doses that can affect the entire body) may leads to severe mental or physical side effects including weight gain, bone loss, upset stomach, slowing of growth and mood or behaviour changes.

Lives of the NHS Staff Improved
For the professional working with the NHS, the first beneficiary will be community first responders and staff members in A&E departments. When patients having a asthma attack, they will be treated firstly by them. However, after highly effective BT treatment, there will not be as many patients with asthma attack as before, and therefore workloads and physical and mental stress of staff will be reduced and lightened.

Conclusion

Overall, the wider distribution of BT meets the NHS value - Improving Life.
For asthma patients, It helps and saves more people than before by offering them a novel treatment, therefore morbidity and mortality in a community could be reduced; with much fewer side effects, it improves the quality of life of patients in or after the treatment by less physical and mental side effects or sufferings caused by the treatment itself; nonetheless it is a non-pharmacologic process, it will be in effect more quickly; when medication lets down, BT will have a strong control of acute and severe asthma, increasing the chance to survive. Besides, BT is a lighter financial burden due to its higher cost effectiveness, thus more patients will be able to receive treatment as BT costs less.
For the NHS staff, instead of directly improving their lives, BT improves their quality of life in a roundabout way simply by relieving patients' condition and therefore reducing their work pressure especially when they need to deal with dozens of patients with different diseases.
Although BT is an up-and-coming treatment for asthma, surprisingly it has brought much more benefits than expected.

(By William)

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Population health is the distributions of health outcome within a group of individuals. It focuses on promoting physical and mental health outcomes, improving well-being and reducing health inequalities (Kindig & Stoddart, 2011).

According to Country Health Ranking Model (2014), there was only a 20% of a person's health outcomes could assess to good quality of health care, which posted a significant threat of health of local people and communities.

Furthermore, according to survey done by Public Health England (2018), the gap of healthy life expectancy between the most and least deprived area of England is approximately 19 years for both males and females.

Due to certain environmental conditions, social problems and family disputes, people are more likely to have a poor quality of life and they may be more likely to develop a series of conditions, such as respiratory, heart disease, diabetes and dementia in the next 20 years! (White, 2019)

Population ageing and growing burden of disease (prevalence of long-term conditions) required care within NHS and social health care ( Alderwick et al., 2015). Population Health Management is an emerging approach for the local health care institutions to work together on data. Different treatment plans and new models of proactive care has been coming up with the utilization of collective public resources to achieve the maximum impact (Public Health England, 2018).

With maximization of resources, it does keep everyone in count by looking at the population health, instead of just focus on the sicks or those consume healthcare resources (Orlowski, 2019). Moreover, the programme covers across the NHS and several public services, for instance, councils, schools, voluntary sector and housing association. They all play important role in addressing their own issues which improve people's health and well-being.

According to a study of  Lancashire and South Cumbria (2019), they combine data on people living with long term conditions and mobility disability, who has the highest numbers of GP and A&E appointments. This facilitates the team to allocate more personalized and follow-up care such as home adaptions and visits to take care the people living with deficiency.

This scheme enables systems and local teams to know and look for the best solutions based on their professionalism. This targeted approach focus on specific problems and needs within a population rather than just one practice (McManners, 2018), which cover a wider determinants of health.

Moreover, it does cherish the collaboration between different healthcare professionals in NHS and social sectors. Through designing new models and care plans, they can work together to make people's lives better and support people with ongoing conditions as well as improve their quality of life, and the cycle of poor health is no longer existed.

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After group discussions, our cases have met improving lives-the NHS Value.

With the development of medical technology (BT Treatment for Asthma), continuous inventions of new medicine (Cannabis-based Medicines) and a popping up well-designed program for the wellbeing of all walks of life (Population Health Management Programme), the benefits that these aforementioned deeds of the NHS have outweighed the aftermath of medication errors.

Based on scope of people life improved, Population Health Management Programme has covered every aspect of people’s life including physical and mental health and basic living conditions (providing housing). The NHS has formed an ally between healthcare provider and social sectors to improve people’s quality of life comprehensively by every means available, preferentially first considering the interests of the underprivileged and socially deprived, as well as these professionals contributing their life to society, which is an act of not just improving people’s lives, also maximize our resources for the benefit of the whole communities. In the same time, with new treatments and medicines coming up, numerous ways of relieving and curing health conditions and help patients are emerging, especially those desiring to survive and in desperate need of a helping hand, which does improve their quality of life. Furthermore, these two cases improve others’ lives in an indirectly way, including GPs, first responders and healthcare professionals, by reducing their workloads (more effective treatments and medicines).

In addition, these cases demonstrate professionalism and excellence which the NHS has been long pursued. The innovative technologies such as BT and Cannabis- based medicines demonstrates their quality of discretion, spirits of exploration. Although there are medicine errors happening unpurposely, the NHS frontline staff are not the ones to blame, because they may be too busy to sort everything out well.

Hopefully, the NHS keeps meeting up the values and standards they have set, in order to improve not just patients’ lives physically, mentally and socially, but communities' and society's as well.

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Not improving lives: Staff number are up, but staff are under greater pressure.

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Not improving lives: Staff number are up, but staff are under greater pressure.

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One of the challenges or problems that National Health Service’s facing, in terms of improving lives, is the workforce. In 2017, NHS England published the staff survey of the National Health Service. This survey was compulsory for all the NHS Trusts – foundation trusts, acute and specialist hospital trusts, ambulance service trusts, mental health, community and learning disability trusts – but voluntary for other parts of the NHS such as clinical commissioning groups, social enterprises and commissioning support units. Obviously, the number of staff was high but they were under great pressure. Based on the result of 2014, there had been an increased for about 8000 more doctors and nurses working in the NHS (NHS Hospital & Community Health Service (HCHS) monthly workforce statistics – Provisional Statistics, 2014 to 2017). However, even there was an increase, they still lack doctors and other professionals (The NHS in 2017, 2017).

The staff engagement has risen since 2012 to 2017. Some staff were very pleased with their work, some of them were saying that their work made a difference for patients while some felt trusted to do their job very well. However, staff that responded bad incidents was at its lowest from 2012. This was also the year when the staff gave their concerns but this section got the highest number from the last 2011. The survey also showed what concerns of the staff of NHS were. 52% of numbers of staff were satisfied with the opportunities for flexible working. However, on the left side, there were 36.7% numbers of staff that was stressed because of work. 11.9% said they experienced discrimination at work and these result had been changing but with the same level from 2012. 15% of staff reported they had experienced physical violence from patients, relatives or members of the public and these result have not changed since 2012 (2016 NHS Staff Survey, 2017). The latest NHS survey revealed crisis for caring of staff. In every year, the record of level of stress is high that causes damage to the health such as sleep disorders and depression to the staff of NHS. Around 40% of reports is about concerning staff being unwell resulted of work stress from the previous years. This also affects the staff way of working with patients that may result to bullying, harassment and discrimination.  The NHS in England are doing survey every year but even after 15 years of surveying, there are still getting high levels of bullying and discrimination and the gap of improvements is almost constant every year. (West, 2019).

It's good that NHS are making actions towards NHS staff by doing surveys but surveys alone are not enough. Surveys reminds them where do they need to focus and improve more. NHS must give staff support or focus in terms of giving them good treatment. Prioritizing not only patients but also those people who are willing to take good care and give full support to the NHS patients. In a work, for it to be able to have a good outcome, people should look at each other especially if it is a worker. If a workers were stressed, discriminated or even harrassed, there is no way that they could do their job well or even stay there. People who are not happy with what they are doing is not improving their lives. NHS should give their full action, if they are giving the staff good treatment, the staff would be willing to pay them back by doing good in their work and give the patients enough care because they are also taken care of by their employers.

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Alderwick H., Ham C., Buck D. (2015), Population health systems: Going beyond integrated care, London, The King's Fund, 2015, p.3

Alex Matthews-King, (2018) NHS medication errors contribute to as many as 22,000 deaths a year, major report shows
Available at: https://www.independent.co.uk/news/health/nhs-medication-errors-deaths-prescription-drugs-jeremy-hunt-york-university-health-a8224226.html
[ Accessed 25 Nov, 2019]

Asthma UK (2018) UK asthma death rates among worst in Europe. Available at: https://www.asthma.org.uk/about/media/news/press-release-uk-asthma-death-rates-among-worst-in-europe/ (Accessed at: 22 November 2019).

Asthma UK (2018) Bronchial thermoplasty. Available at: https://www.asthma.org.uk/advice/severe-asthma/treating-severe-asthma/bronchial-thermoplasty/ (Accessed at: 22 November 2019).

Barnes P. J. (2010). Inhaled Corticosteroids. Pharmaceuticals (Basel, Switzerland), 3(3), 514–540. doi:10.3390/ph3030514

Blair. T, (2005) Improving the life chances of disabled people was published by the Prime Minister’s Strategy Unit Available at: https://navigator.health.org.uk/content/improving-life-chances-disabled-people-was-published-prime-minister%E2%80%99s-strategy-unit (Access at 27th, Nov. 2019)
DerSarkissian, C. (2019) Asthma Treatment: Steroids and Other Anti-Inflammatory Drugs. Available at: https://www.webmd.com/asthma/guide/asthma-control-with-anti-inflammatory-drugs#1 (Accessed at: 24 November 2019).

Foster, L. (2018) New asthma treatment set for wider NHS distribution. Available at: https://www.bbc.co.uk/news/health-45359343 (Accessed at: 22 November 2019).

Furlong C (2018),

100,000 job vacancies as NHS pushed to limit, Available at: https://www.thetimes.co.uk/article/100-000-job-vacancies-as-nhs-pushed-to-limit-3q0v9p8gv

(Accessed at: 25 November 2019)

Healthierlsc.co.uk. (2019). [online] Available at: https://www.healthierlsc.co.uk/application/files/9115/6098/4299/StrategicNarrative_revision_Boardversion260419.pdf [Accessed 24 Nov. 2019].

Laxmanan, B., & Hogarth, D. K. (2015). Bronchial thermoplasty in asthma: current perspectives. Journal of asthma and allergy, 8, 39–49. doi:10.2147/JAA.S49306

McManners, J. (2019). NHS England » Population Health Management: an opportunity to break the cycles of poor health. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/blog/population-health-management-an-opportunity-to-break-the-cycles-of-poor-health/ [Accessed 24 Nov. 2019].

(no author) (2019) How is Epidyolex used Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/epidyolex [ Accessed 24 Nov. 2019]

National Institute for Health and Care Excellence. (2018) The condition, current treatments and procedure’ in Bronchial thermoplasty for severe asthma. Available at: https://www.nice.org.uk/guidance/ipg635/chapter/2-The-condition-current-treatments-and-procedure (Accessed at: 24 November 2019).

National Institute of Neurological Disorders and Stroke  23 Oct. 2018 Available at: https://medlineplus.gov/seizures.html [Accessed 24 Nov. 2019]
NHS 2016 Staff Survey (2017). [online] NHS England. Available at: www.england.nhs.uk/2017/03/staff-survey/[Accessed 23 November 2019].

NHS Hospital & Community Health Service (HCHS) monthly workforce statistics – Provisional Statistics, calculated for November 2014 to November 2016 (2017). [online] NHS Digital. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics [Accessed 23 November 2019].

Orlowski, A. (2019). Vive la révolution in population health management. [online] The Nuffield Trust. Available at: https://www.nuffieldtrust.org.uk/news-item/vive-la-revolution-in-population-health-management [Accessed 24 Nov. 2019].

Public Health England (2018) Population Health Management Flatpack: A guide to starting Population Health Management England: NHS England, 2018, p.6
NHS England (2019). NHS England » Population Health and the Population Health Management Programme. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/integratedcare/building-blocks/phm/ [Accessed 24 Nov. 2019].

Public Health England (2018). Chapter 5: inequalities in health. [online] Available at: https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-5-inequalities-in-health [Accessed 24 Nov. 2019].

The NHS in 2017 (2017). [online] NHS England. Available at: https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/the-nhs-in-2017/ [Accessed 23 November 2019].

West, M. (2019). The NHS crisis of caring for staff: what do we need to do? [online] The King's Fund. Available at: https://www.kingsfund.org.uk/blog/2019/03/nhs-crisis-caring [24 November 2019].

White, J. (2019). NHS England » Population Health Management – a mystical topic or tomorrow’s solution?. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/blog/population-health-management-a-mystical-topic-or-tomorrows-solution/ [Accessed 24 Nov. 2019].
Wilhelm, Chelle Pope et al. (2016) Bronchial thermoplasty: a review of the evidence. Annals of Allergy, Asthma & Immunology, Volume 116, Issue 2, 92 – 98

Zein, J. G., Menegay, M, C., Singer, M. E., Erzurum, S. C., Gildea, T. R., Cicenia, J. C., Khatri, S, Castro, M, Udeh, B. L. (2015) ‘Cost effectiveness of bronchial thermoplasty in patients with severe uncontrolled asthma’, National Center for Biotechnology Information, 53(2), pp. 194-200. doi: 10.3109/02770903.2015.1072552.

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Not improving lives: medication errors (patients) 

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Not improving lives: medication errors (patients) 

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The NHS makes hundreds of millions of medical prescribing errors and mix ups which contribute to many deaths and economic loss. Errors and mix ups include failures of proper monitoring patients on powerful drugs, poor communication between GPs and hospitals, and giving patients the wrong medication.

According to a major report commissioned by the Government, there are 22,300 deaths a year and it is estimated that 61.4 million and 4.8 million errors occur in England per annum that have potential to cause moderate or severe harm respectively. On average, 712 deaths a year were definitively linked to adverse drug reactions being the main cause of death. This demonstrates the significance of prescribing errors in harming people’s life. (King, 2018)

Moreover, according to the research conducted by university academics in Manchester, Sheffield and York (2018), 230 million medication errors take place in the NHS and the cost of errors stands at £1.6 billion a year.  This shows that the economic loss caused by medical errors harming people’s quality of life.

There are few reasons contributing to the huge number of medical errors. Firstly, NHS is not properly funded which does not have enough funding, capacity and support. Secondly, NHS does not have a well-organized staff management system in which there are intense resource and workforce pressures. These post a concern on the quality of service provided by the GPs and their teams. As revealed in the government data(Furlong,2018), there is also 100,000 job vacancies in NHS England , which lead to a huge negative impact on patient safety.

These medical errors on drugs do harm, worsen their condition or even manslaughter people as well as worsen therquality of life. Besides, these medical errors will waste lots of resources of country, leading to unnecessary economic loss, hence lower the quality of life of people. Furthermore, human and medical resources are wasted which decrease the quality of service provided and quality of life of people.

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Improving lives:Cannabis-based medicines: Two drugs approved for NHS

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Improving lives:Cannabis-based medicines: Two drugs approved for NHS

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Recently NHS in England has approved two cannabis -based medicines. These two cannabis-based medicines are used to treat epilepsy and multiple sclerosis. The new guidelines from the drug advisory body NICE are followed, which has looked at products for several conditions. This move has been welcomed by charities, but some campaigners said that the drugs need more research before they are accessed.

Doctors are able to prescribe Epidyolex for children who have Lennox Gastaut Syndrome and Dravet syndrome, because these two syndromes could cause multiple seizures a day. Epidyolex is a medicine used in addition to clobazam, another epilepsy medicine, to treat patients from the age of two years who have Lennox-Gastaut syndrome or Dravet syndrome, rare types of epilepsy that begin in childhood and can continue into adulthood.Symptoms include multiple types of seizure (fits), abnormal electrical activity in the brain, learning disability and behavioural problems. (EUROPEAN MEDICINES AGENCY 2019) More children can reduce suffering from this sickness. Seizures are symptoms of a brain problem. They happen because of sudden, abnormal electrical activity in the brain. When people think of seizures, they often think of convulsions in which a person's body shakes rapidly and uncontrollably, but not all seizures cause convulsions. There are many types of seizures and some have mild symptoms. Seizures fall into two main groups. Focal seizures, also called partial seizures, happen in just one part of the brain. Generalized seizures are a result of abnormal activity on both sides of the brain. (Seizures 2018) Seizures could lead to children feel very tired all the time because their muscles are continuously contracting and relaxing. They would be so hard to get focused as they don’t have energy.

The oral solution, which contains cannabidiol (CDB), could reduce the number of seizures by up to 40% in some children that shown by clinical trials. Children could have more energy to play, learn and interaction with friends and family. Have a much happier life.

The manufacturer GW Pharmaceuticals has agreed to lower the price for NHS. Originally it cost between £5,000 and £10,000 per patient each year. More family can pay of the medication fee. This could reduce the economic pressure for the parents.

It is estimated that there are 3000 people with Dravet syndrome and 5000 with Lennox-Gastaut syndrome in England. This is a quite common problem in England.

There is another drug that contains a psychoactive component of cannabis, THC, which is the Sativex. This has been approved for treating muscle stiffness and spasms, known as spasticity, in multiple sclerosis. Law was set up that allow specialist doctor to prescribe cannabis medicines. This very important because these medicines need doctors’ professional decisions whether it is appropriate to use these drugs. This prevents to make things much worst.

This truly improves the live of patients because when there is any new drugs that are invented, there are a long process to ensure that this medicine is safe for patients to take in these medicines. This long process could prevent making problems much worse than before. After that patients can use this medicine to reduce the pain that they are suffering or even cure their sickness. It really help patients to live more happier and comfortable.