Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

NHS New Structure and Heatwaves

767 views

Published on

Julia Hamer, Directorate Manager of Respiratory Medicine at University Hospital South Manchester talks to our patients about the new structure of the NHS and how it effects us.
Graham Atherton talks about health precautions when we are experiencing a heatwave and speaks of a subject suggested by patients: Adverse effects of medications.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

NHS New Structure and Heatwaves

  1. 1. LED BY GRAHAM ATHERTON SUPPORTED BY NAC CENTRE MANAGER CHRIS HARRIS NEW STRUCTURE OF THE NHS AND HOW IT EFFECTS US JULIA HAMER - DIRECTORATE MANAGER OF RESPIRATORY MEDICINE NATIONAL ASPERGILLOSIS CENTRE UHSM MANCHESTER Support Meeting for Aspergillosis Patients & Carers Fungal Research Trust
  2. 2. Programme  1.30 Julia Hamer– NAC Manager  2.00 Graham Atherton – Your subject  2.30 Patients Discussion (Break)  3.00 Group discussion/Requests for information  Artificial organs – kidney  Food for patients meeting?  Patients survey  3.20 Q & A from the floor or online
  3. 3. Changes in Commissioning in forChanges in Commissioning in for the National Aspergillosis Centrethe National Aspergillosis Centre 2013/142013/14
  4. 4. NHS EnglandNHS England  NHS England will play a key role in the Government’sNHS England will play a key role in the Government’s vision to modernise the health service with the key aimvision to modernise the health service with the key aim of securing the best possible health outcomes forof securing the best possible health outcomes for patients by prioritising them in every decision it makes.patients by prioritising them in every decision it makes.  Formally established as the NHS Commissioning BoardFormally established as the NHS Commissioning Board on 1 October 2012, NHS England is an independenton 1 October 2012, NHS England is an independent body at arm’s length to the Government.body at arm’s length to the Government.  http://www.england.nhs.uk/http://www.england.nhs.uk/
  5. 5. Clinical Commissioning GroupsClinical Commissioning Groups  Clinical Commissioning Groups are responsible for planning and designing local health servicesClinical Commissioning Groups are responsible for planning and designing local health services in England. They do this by 'commissioning' or buying health and care services including:in England. They do this by 'commissioning' or buying health and care services including:  Planned hospital carePlanned hospital care  Urgent and emergency careUrgent and emergency care  Rehabilitation careRehabilitation care  Community health servicesCommunity health services  Mental health and learning disability servicesMental health and learning disability services  To do this Clinical Commissioning Groups work with patients and health and social care partnersTo do this Clinical Commissioning Groups work with patients and health and social care partners (e.g. local hospitals, local authorities, local community groups etc) to ensure services meet local(e.g. local hospitals, local authorities, local community groups etc) to ensure services meet local needs. CCG boards are made up of GPs from the local area and at least one registered nurseneeds. CCG boards are made up of GPs from the local area and at least one registered nurse and one secondary care specialist doctor.and one secondary care specialist doctor. Clinical Commissioning Groups are responsible for arranging emergency and urgent careClinical Commissioning Groups are responsible for arranging emergency and urgent care services within their boundaries, and for commissioning services for any unregistered patientsservices within their boundaries, and for commissioning services for any unregistered patients who live in their area.  General Practices have to belong to a Clinical Commissioning Group.who live in their area.  General Practices have to belong to a Clinical Commissioning Group.
  6. 6. Specialised ServicesSpecialised Services CommissioningCommissioning  Specialised services are those provided in relatively fewSpecialised services are those provided in relatively few hospitals, accessed by comparatively small numbers ofhospitals, accessed by comparatively small numbers of patients but with catchment populations of more thanpatients but with catchment populations of more than one million. These services tend to be located inone million. These services tend to be located in specialist hospital trusts that can recruit staff with thespecialist hospital trusts that can recruit staff with the appropriate expertise and enable them to develop theirappropriate expertise and enable them to develop their skills.skills.  Specialised services account for approximately 10% ofSpecialised services account for approximately 10% of the total NHS budget, spending circa £11.8 billion perthe total NHS budget, spending circa £11.8 billion per annum. The commissioning of specialised services is aannum. The commissioning of specialised services is a prescribed core responsibility of NHS England.prescribed core responsibility of NHS England.
  7. 7. Clinical Reference GroupsClinical Reference Groups  CRGs cover the full range of specialised services andCRGs cover the full range of specialised services and are responsible for providing NHS England with clinicalare responsible for providing NHS England with clinical advice regarding these directly commissioned services.advice regarding these directly commissioned services. The CRGs are made up of clinicians, commissioners,The CRGs are made up of clinicians, commissioners, Public Health experts and patients and carers, and arePublic Health experts and patients and carers, and are responsible for the delivery of key ‘products’ such asresponsible for the delivery of key ‘products’ such as service specifications and commissioning policies, whichservice specifications and commissioning policies, which enable NHS England to commission services fromenable NHS England to commission services from specialist providers through the contractingspecialist providers through the contracting arrangements overseen by its Area Teams.arrangements overseen by its Area Teams.  There will be 75 CRG’s in total.There will be 75 CRG’s in total.
  8. 8. Funding StreamsFunding Streams  Initially via CCGInitially via CCG  May switch to Specially CommissionedMay switch to Specially Commissioned fundingfunding  May change later in treatment back toMay change later in treatment back to CCGCCG
  9. 9. Changes from the PatientChanges from the Patient PerspectivePerspective  NoneNone  Only difference may be for funding for theOnly difference may be for funding for the expensive drugs (Pozaconozole,expensive drugs (Pozaconozole, Micafungin etc). The processes for futureMicafungin etc). The processes for future funding these remains unclear still.funding these remains unclear still.
  10. 10. Any questions?Any questions?
  11. 11. Suggest a subject Rather than have all of our talks led by NAC staff and their expertise we are trying a new idea whereby we ask patients & carers to suggest topics for us to talk about We will mainly use local staff for these talks (i.e. me for many subjects or another available staff member if appropriate)
  12. 12. Suggest a subject Can be on any relevant subject you would like to hear our opinion or get our help with Send suggestions to admin@aspergillus.org.uk Pass notes to me at clinic or at the meeting Phone them in (24 hrs) at 0161 291 5866
  13. 13. HEATWAVE  http://www.nhs.uk/Livewell/Summerhealth/Pages/Heatwave.asp
  14. 14. Heatwave An average temperature of 30°C by day and 15°C overnight would trigger a health alert (this figure varies slightly around the UK). These temperatures can have a significant effect on people's health if they last for at least two days and the night in between.
  15. 15. Heatwave The Meterological Office has a warning system that issues alerts if a heatwave is likely. Level one is the minimum alert and is in place from June 1 until September 15 (which is the period that heatwave alerts are likely to be raised). The minimum alert simply means that people should be aware of what to do if the alert level is raised. If a level two alert is issued, there is a high chance that a heatwave will occur within the next few days. The level three alert is when a heatwave is happening. The level four alert is when a heatwave is severe.
  16. 16. Problems caused by heatwave The main risks posed by a heatwave are: dehydration (not having enough water) overheating, which can make symptoms worse for people who already have problems with their heart or breathing heat exhaustion heatstroke
  17. 17. Heatwave – what can we do? Shut windows and pull down the shades when it is hotter outside. If it’s safe, open them for ventilation when it is cooler. Avoid the heat: stay out of the sun and don’t go out between 11am and 3pm (the hottest part of the day) if you’re vulnerable to the effects of heat. Keep rooms cool by using shades or reflective material outside the windows. If this isn't possible, use light-coloured curtains and keep them closed (metallic blinds and dark curtains can make the room hotter).
  18. 18. Heatwave – what can we do? Have cool baths or showers, and splash yourself with cool water. Drink cold drinks regularly, such as water and fruit juice. Avoid tea, coffee and alcohol. Stay tuned to the weather forecast on the radio or TV, or at the Met Office website. Plan ahead to make sure you have enough supplies, such as food, water and any medications you need. Identify the coolest room in the house so you know where to go to keep cool. Wear loose, cool clothing, and a hat if you go outdoors.
  19. 19. Heat exhaustion headaches dizziness nausea and vomiting muscle weakness or cramps pale skin a high temperature If this happens, move somewhere cool and drink plenty of water or fruit juice. If you can, take a lukewarm shower or sponge yourself down with cold water. Heatstroke can develop if heat exhaustion is left untreated, but it can also occur suddenly and without warning.
  20. 20. Heatstroke  headaches  nausea  intense thirst  sleepiness  hot, red and dry skin  a sudden rise in temperature  confusion  aggression  convulsions  loss of consciousness  If you suspect someone has heatstroke, call 999 immediately. Heatstroke can result in irreversible damage to your body, including the brain, or death.
  21. 21. Summary Educate Prepare Prevent Vigilance – look out for weather warnings  Much of south of England now at level 3 Keep cool, keep drinking cool drinks
  22. 22. Subjects Fran Capitanio  Side effects of medication and methods of dealing with that on top of dealing with a flare up of disease Mike Leach  is there a half life to the aspergillus. if the anti fungal is working should there be a patterned reduction in IgE
  23. 23. What are side effects?  A side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequences of the use of a drug.
  24. 24. What causes them? All drugs taken orally act on the whole body so can act on parts we don’t want them to! Some effects are unwanted effects of the main action of the drug – for example steroids are useful because they suppress inflammation. However that also means they lower the efficiency of our immune system – it’s the same system that causes inflammation!
  25. 25. What causes them? Toxicity: Amphotericin B is known to be toxic to kidneys – except it isn’t! The chemical used to dissolve it in water is toxic! Allergic reactions – any drug Skin – very common for topical drugs Gastrointestinal upset – very common Unpredictable – Itraconazole and heart failure Can be serious! Be aware!! Always report to your doctor if on any drug
  26. 26. Information The leaflet you get with your pack of drug will contain all of the side effects identified by the manufacturer when it was testing the drug for safety – but it often doesn’t contain ALL side effects When testing ALL other drugs are stopped so as to be able to just see what the drug under test does. In the real world the drug will be taken with many other drugs – and drugs can interact with each other causing more side effects
  27. 27. Drug Side effect - reporting Medicines and Healthcare Producers Regulatory Agency (MHRA) ‘Yellow Card’ system https://yellowcard.mhra.gov.uk/ It is important for people to report as these are used to identify side effects and other problems which might not have been known about before. If a new side effect is found, the MHRA will review the way that the medicine can be used, and the warnings that are given to people taking it to minimise risk and maximise benefit to the patient.
  28. 28. MHRA website
  29. 29. Interactions – what are they? Typically, interactions between drugs come to mind (drug- drug interaction). However, interactions may also exist between drugs and foods (drug-food interactions), as well as drugs and medicinal plants or herbs (drug-plant interactions).
  30. 30. Interaction – when do they occur? Typically, interactions between drugs come to mind (drug- drug interaction). However, interactions may also exist between drugs and foods (drug-food interactions) – alchohol! as well as drugs and medicinal plants or herbs (drug-plant interactions) Grapefruit & azole! Be aware!
  31. 31. Interaction – are they dangerous? Usually the effects are mild, but it can get more serious Antifungal (azoles) are notorious for side effects as they will interfere with many other drugs. They tend to disrupt the system (cytochrome P450) that breaks down other drugs leading to higher doses = problems with toxicity Drugs interfered with include prednisone!
  32. 32. What can be done? Interactions  Reduce / re-evaluate dose of both drugs  use different drug (a different antifungal perhaps)  Use another drug to treat side effect  Read your pack leaflet to note side effects  Be aware that any new problem could be a side effect – even if you are not on a new drug  See your doctor and tell them about it!  Check antifungals against our database
  33. 33. Database – side effects Several available online  Drugs.com  For antifungals see Antifungal drug Summaries of Product Characteristics (SPC): http://www.aspergillus.org.uk/secure/treatmentindex/index.p hp Offline – your pharmacist/doctor
  34. 34. Database - Interactions Drugs.com is good overall Aspergillus website has a dedicated database for antifungals that we keep up to date http://www.aspergillus.org.uk/nac/interactions/patientch oosegeneric.php* *also available as an Android and iPhone App under ‘antifungal interactions’ Offline - Pharmacist & doctor
  35. 35. Regrown organs
  36. 36. Regrown organs - progress Kidney – complex organ Has been stripped down & rebuilt using stem cells (rat) and then re-implanted into host Works with 5-10% efficiency compared with original – thought to be sufficient to avoid transplant!
  37. 37. Does aspergillus have a halflife? Mike Leach is there a half life to the aspergillus? If the anti fungal is working should there be a patterned reduction in IgE I will assume Mike is talking about ABPA
  38. 38. Immune system Our immune system has many parts that can correspond to several different waves of attack against infection  Physical barriers (skin, mucus)  Immediate non-specific (no memory)  Adaptive (specific – provides immunity) http://www.aspergillus.org.uk/newpatients/immun e.php
  39. 39. IgE Immunoglobulin E (IgE) – an antibody Also have IgA, IgG, IgM – each plays a different role IgE main role – defence against parasites! Normally very low levels IgE is released as soon as an infection is detected – the hypersensitivity response. Gets all immune cells ready for action – allergy!
  40. 40. IgE
  41. 41. IgE
  42. 42. Role in disease People with lots of IgE circulating tend to be atopic – very sensitive to particular antigens (pollen, mould) When stimulated triggers release of large amounts of histamine Causes airway constriction, inflammation, runny nose eg hay fever Once stimulus goes symptoms disappear as no more IgE made.
  43. 43. ABPA Aspergillus permanently irritating sensitive lung tissue IgE permanently stimulated Scarring We can suppress IgE & histamine production using steroid drugs Also seem to be able to do it using antifungal in many cases Anti – IgE drugs eg Xolair
  44. 44. Flare - up Suspect some new tiny growth irritating lung ? Reaction to more moulds in the outside air Other infections Other IgE stimulating allergens Steroid dose increased = fast relief=no new scarring As we shut down IgE production patients feels better – measured IgE falls. Usually use total IgE measurements but can do Aspergillus-specific IgE
  45. 45. Other Ig’s Indicate infection rather than allergy Will cover this next month!
  46. 46. Thank You “The best chance we have of beating this illness is to work together” Living with it, Working with it, Treating it Fungal Research Trust

×