Most legal restrictions imposed to halt coronavirus restrictions have been lifted across the country from 19 July. However, coronavirus remains a serious health risk. It is important to stay cautious and help protect yourself and others.

Amid rising cases of coronavirus, Dr Ammara Hughes, a GP Partner with Bloomsbury GP Surgery and COVID vaccine hub, and a Clinical Director of Central Camden Primary Care Network, talks about the various steps one can take to manage the risks of coronavirus.  

At long last, we have a summer to enjoy! The sun is shining, the school’s out for the summer, and we are coming out of lockdown after what seems an age.

It’s been a testing time for us all and like many readers, I was so happy to have a holiday last week, swimming in the sea off the coast of Devon.

The pandemic is, however, far from over. We have to, in the words of our new health secretary, “learn to live with the virus”. That may be the case, but we certainly don’t want to be living with the consequences of the virus.

Go, take a jab!

It was a mere six months ago that we hosted the former health secretary at our COVID vaccination hub in Bloomsbury Surgery. How times have changed since then!

Our Camden hub was one of the first sites to go live in the country, and over 30000 vaccines later, we are still going strong. The borough sites combined have delivered nearly 250,000 vaccines.

But we have some way to go. Less than half of the under 40s population in Camden eligible for a vaccine have so far taken up the offer. Yet this is the group now most likely to contract COVID as we come out of lockdown.

Why, you may ask? Simple. Pubs, restaurants and music venues are open and the younger population are most likely to take advantage in larger groups. Places to celebrate milestones, meet new people and generally let your hair down after the tough times that have gone before. Lots of unvaccinated people in close proximity, talking, laughing, singing, dancing and generally having a good time. With current estimates of the COVID rates being 325 per 100000 in Camden, the chances of contact with someone who later tests positive for COVID is reasonably high.

So back to living with the virus, rather than the consequences. The first step is to get a vaccine. All over 18s have now had the offer of at least one vaccine, and over the coming weeks, everyone will have been invited for the second jab as well. The evidence that the vaccines work, is overwhelming. The majority of people seriously ill in hospitals are unvaccinated or partially vaccinated, and these patients are getting younger. Yes, deaths are far lower than at the start of the pandemic, but every life lost to COVID is one too many.

Long COVID

We have a new nemesis in the COVID story now. Long COVID. More people may be surviving the virus, but this new poorly understood condition is incredibly debilitating and indiscriminate. Fit and healthy adults suddenly finding they can’t climb stairs without needing a lie down when they reach the top. Brain fog, kidney problems and some too ill to return to work or normal life. As doctors, we’re unsure how to support these people as there isn’t a specific treatment, and for their family and friends, it’s heartbreaking to be as helpless in their recovery journey. We don’t know if these patients will ever fully recover. Only time will tell. So I ask you all, if you haven’t already, please take up your offer of a vaccine. The vaccine won’t stop you from ever getting COVID, but it will stop you from getting seriously ill with COVID.

COVID vaccine clinics are open all week at various locations across the borough, so please do come and see us. Health professionals are always available to answer any questions you might have about the vaccine, and we will only give you the vaccine with your consent if you’re happy to go ahead.

The mask debate

I popped into the supermarket near work today and was pleasantly surprised to see almost everyone in the store wearing a mask. The sense of social responsibility was a joy to see. My view as a health professional is we should wear a mask in confined spaces where we can’t socially distance. I’m very glad the Mayor of London has made it compulsory on public transport, and it remains compulsory in health settings.

COVID is airborne. You spread it by coughing, talking, singing, sneezing.  Wearing a mask helps reduce the spread and is designed to protect others.

Now the rules on masks have changed, some people may choose not to wear them. So picture this. Next time you queue for a coffee or wait in line in the supermarket, pause a moment and think about the person in front of you. What is their life like? They may have just been diagnosed with cancer. They may have a disabled child who remains at high risk from COVID. They may have an elderly relative in a care home they go to see. All of us wearing masks in busy indoor spaces like these will protect the most vulnerable. This is why I wear a mask. Not to protect me, but to protect others.

Aside from vaccinating patients, General Practice is open across the borough, and we are busier than ever. It’s crucial we see people safely and are able to help with their problems effectively. We’re approaching flu season soon and we have no idea what the winter might bring. During the lockdown, we haven’t built up our natural immunity against common viruses. Many children about to start nursery have spent nearly half their lives in lockdown. As the country opens up, we are bound to see a surge in non-COVID viral illnesses.  Now more than ever, the NHS needs its workforce.  So please wear a mask to help us stay well, and in turn, help others stay well too. 

Physiotherapists Heidi Ridsdale (left) and Rachel Okin (right) work in the NHS Central North West London’s (CNWL) Long Term Conditions (LTC) Team as Highly Specialist Physiotherapists. They took some time out to talk about their enthusiasm for a telehealth approach to Long COVID Recovery. This is their version of how they collaborated with Living With to develop an app called ‘Living With COVID Recovery’. 

 

Long COVID

It is estimated that around 10% of survivors of COVID-19 exhibit signs and symptoms for a period of 12 weeks or longer and which is often described as Long COVID or Post-COVID Syndrome (NICE, 2020). The SARS-CoV-2 is a novel virus and there is no textbook on it nor on Long COVID recovery so this work is all new.  

We worked creatively and innovatively to develop and implement a pathway and therapeutic approach to support Long COVID recovery using an app developed by Living With called Living With Covid Recovery.

Our experience since the summer of 2020 of supporting people recovering with Long COVID has developed our therapeutic knowledge and understanding of the challenges that recovery from this new illness poses.  

An Engaging Tool

The app is a very engaging tool that recognises the scope of the presentation of people recovering from Long COVID.

Central and North Western London CCG (CNWL) has been the first Community NHS Trust to pilot this app and has been able to contribute to the development of the therapeutic information and functionality of it. 

With the pressures on staffing (including those being redeployed to the acute services supporting COVID and other essential and urgent work), CNWL realised that there was a likely tidal wave of patients coming their way who would be requiring some type of rehab. This lack of staffing meant it would not be possible to meet the demand of patients recovering from COVID.

The understanding of post-viral symptoms from other Long-Term Conditions(LTCs) meant that they started looking towards digital solutions to manage the volume of work.

CNWL was approached by an app developer at a crucial time so we decided to look into it.

Barts Health NHS Trust had already been using it to support the management of patients in their acute clinic. University College London Partners were involved and as CNWL in Camden works so closely with UCLH it made sense to look into the app further.

We worked with the app developer to make it work for community services and provided our input clinically around goal-setting and use.

It has been a really rewarding process of co-production. Living With and UCLH have a grant from the National Institute for Healthcare Research (NIHR): the data generated by patients is part of wider research into Post-COVID Syndrome which will help understand the condition and how best to treat it. It’s a really exciting and emergent field!

Self-Management

The philosophy behind the app is one of self-management where people recovering from Long COVID are encouraged to be responsible for their own behaviour and wellbeing with support and coaching from the therapist.

There is a proactive, structured and contemporaneous approach that creates knowledge, skills and confidence in the person.

Heidi: “We piloted this in Camden because our LTCs Teams are co-located at St Pancras Hospital (South Wing), so the different community services could work together in jointly managing the patient cohort”.

“Additionally, our long-standing relationship with UCLH expediated referrals from the Post-COVID Clinic and turned the pilot into a successful pathway and intervention” very quickly.

Rachel: “In July and August 2020 we started to notice that people participating in exercise regimes and ‘pushing through’ were ‘crashing’ with worsening fatigue, pain, breathlessness, and anxiety. All had had an acute COVID illness but many hadn’t needed hospitalisation; they also tended to be a younger cohort”.

“Part of our approach is to get patients added to the app and we find the majority of people have positive experiences and have liked using it”

 It is a younger perhaps more tech-savvy cohort, but we noticed that some self-described technophobes (including Heidi herself) actually find it easy to use; a disadvantage to be addressed is for people whose first language is not English.

The Library

The app has a library about signs and symptoms – fatigue, cognition (‘brain fog’), mood, anxiety, depression, joint and muscle pain, chest pains, rashes and breathlessness. All are based on known validated outcome measures.

As the data is generated by the patients using the app, this feeds into the algorithms that help to set the parameters for when patients are getting better or need more clinical input, which helps to ensure that we understand how Covid is similar or different from other long-term conditions. The more data we have, the better we are able to fine-tune the triggers within the app.

People keep a diary and Symptom Checker including specific evidence-based Patient Reported Outcome Measures (PROMS) across both mental and physical wellbeing which is monitored by a clinician for a few months.

The person can send messages to the team and they are able to respond in a timely fashion. They work very closely with psychological services in IAPT/Talking Therapies, based at Camden and Islington NHS Foundation Trust, who have been very helpful.

Coaching

The work is based on the principles of health coaching – with a strong set of clinical skills to help explain and moderate self-reported symptoms, so that people can take on more self-care, confidently, as they recover.

Heidi: “people have to be clinically safety-netted because the app is not for emergencies”. It is clearly explained in the app that if someone is really struggling with say breathlessness or chest pain and needs to access medical help they should call their GP, 111 or 999 for immediate advice.

More can be read about the Living With Group (who developed this App) here: https://www.livingwith.health/

Rachel: “At the beginning, there’s a thorough discussion with each patient about what their goals are – this could be that they want to go back to work, or restart some role, including the sports they previously did and they want to do so again; a few were previously super-fit people who want to get back into it. Many have not been unwell before and very often they want to get back to their role in the world – it’s like they have lost their footing…”.

The fatigue diary, the Symptom Tracker and PROMs allow people to track and grade their own recovery, and though this may not be linear it supports them in identifying what makes their symptoms worse and when they are progressing well. It gives them confidence and knowledge about how they can manage their own body’s recovery.

After six weeks of recording how they are feeling and responding, patterns have emerged and the dashboard can show people how their symptoms are shifting but also what might have exacerbated them.

We use a set of questions to identify how confident someone is at managing their ongoing recovery at entry into the pathway and on discharge. At 12 weeks the plan is to discharge the majority of people from the app where they will continue to self-manage their recovery from what they’ve learned.

Some people may need longer to develop their knowledge and confidence and will stay on the app for a longer time frame.

At discharge people will be removed from the app ‘dashboard’ so no longer be able to message the clinician nor will they be monitored by the service but will continue to have access to the patient library, symptom tracker and PROMS.

Although not guaranteed at the moment it is hoped that if patients deteriorate at a later date they will be able to self-refer back into service if required.

Both of us enjoyed the work. Rachel puts it “this has really provided us with an opportunity to work closely with patients, to be able to recognise their triggers and patterns around their symptoms. This in turn has meant we can help a patient improve, potentially before a significant deterioration, and that’s rewarding. In fact, it has made us reflect on the role digital health can play for all people with a long term condition”.

If you wish to access information around your Long Covid recovery – please go to the NHS website. This is free for all to use and has a range of information about Long Covid and managing the effects on your physical, mental and emotional wellbeing.

©CNWL May 2021

Central and North West London NHS Foundation Trust own the copyright to this work. We are happy for it to be used by anyone and ask that if used CNWL are acknowledged.

Have your say – Healthwatch Camden wants to hear from people who have experienced Long COVID. If you are a Camden resident and think you might be struggling with Long COVID, or have recovered from Long COVID, please email anna.walsh@healthwatchcamden.co.uk to get involved.

A local Camden resident shares her personal story on how attending a breast cancer screening programme helped her to detect cancer at an early stage leading to a successful treatment. She is now completely cured of cancer. 

I’m over 70, which means I no longer get called for breast screening but can still request it. In April, I realised I hadn’t had a mammogram for more than 3-years so, I booked an appointment at the Kentish Town centre (Central and East London Breast Screening Service Tel: 0203 3758 2024). There were no lumps in my breast, so I wasn’t at all concerned hence I was surprised when, a few days later, someone telephoned me and asked me to come for further tests. Just 10-days after my initial mammogram, I was being seen by a doctor at the Barts Breast Cancer Centre for an ultrasound scan and biopsy. A week later, I met the senior Consultant at the Centre who gave me the bad news that I had breast cancer and the good news, that it was only a few millimetres in diameter, so caught very early, thanks to the mammogram. 

After some more investigations, blood tests, scans etc., I was operated on as a day patient. It is called breast conservation surgery, where only the cancerous area is excised. My breast has hardly changed shape, and I am still wearing the same bras as before. 

It’s now 2-months after the operation, and I’ve just finished a 5-day course of radiotherapy, an insurance policy to catch any cancer cells that might still be lurking. I’ve had no side effects. 

The Barts Breast Cancer Clinic filled me with confidence; it is incredibly efficient and well run but manages to be very caring and supportive at the same time. Like every patient, I was allocated a key worker, a Clinical Nurse Specialist, who helped coordinate my treatment and was readily available on the phone to answer my queries and to allay my anxieties. Everyone I met was friendly and helpful, and there was minimal waiting around.

I feel privileged to have received such exemplary care and was reassured that they would be keeping an eye on me for the next 5-years. But I also know that I am almost certainly completely cured of cancer that was too small to detect except by a mammogram. 

 

About the local cancer awareness campaign

Healthwatch Camden is supporting North Central London Cancer Alliance in encouraging people who have symptoms that may be suggestive of cancer to contact their GP practice. The campaign also aims to increase the number of people taking part in screening for breast, bowel or cervical cancer when invited.

If you have any of the following symptoms:

• Unexpected bleeding, like blood in your poo, pee or spit
• Unexplained lump
• Unexplained pain that lasts three weeks or more
• A persistent cough that lasts three weeks or more
• Unexplained weight loss

You should contact your GP practice to arrange a check.

It may be nothing serious – in fact, more than 9 out of 10 people are not diagnosed with cancer.

However, finding cancer early makes it more treatable.

That’s why it’s also important to take part in routine cancer screening when invited.

The way you make an appointment may have changed, but your GP practice is open for check-ups and screenings, and healthcare professionals are available to see you safely.

Watch this video to find out more about why early contact with your GP is important. 

Visit the website to know more. 

We met the blogger during our Cancer awareness session that we held with Camden Carers.

This year, Camden Mela was held on 17 October 2021 for the public after a gap of two years when the pandemic put off almost all the physical events. 

Bloomsbury Festival, Camden Mela and the British Library jointly celebrated the 50th anniversary of the Independence of Bangladesh. Spotlight is on Bengali culture with music, dance, street food, talks.

When we received the proposal to participate at the mela, we jumped at the opportunity – our first face-to-face participation at a community event after almost two years. My colleague, Shelly and I represented Healthwatch Camden at the mela. We displayed our banner and information about us. We had our branded pens and beautiful cloth bags as giveaways to people coming to our stall.

We were super excited to leave the comforts of our home and go back into the community to meet people face-to-face and to hear their experiences. The mela allowed us to interact with residents from diverse backgrounds and helped us gather experiences of the health and social care services in Camden.

Many people came to us to share their suggestions on issues that the local NHS should be focusing on. Some of the suggestions were better dental service, better pay and working conditions to care workers, face-to-face access to GP services, support for parents with children with disabilities, more elderly support, diabetes awareness and increased funding to NHS.

“Government not funding NHS enough, trying to privatise it. Very worrying. Save our wonderful NHS.”

 

“Leave our NHS alone. Help them continue their fantastic work”

LONG COVID SURVEY

The Mela also allowed us to spread awareness about Long COVID research we are doing in association with other Healthwatchs in North Central London- Enfield, Barnet, Haringey and Islington. We realised that many people were not aware of the term Long COVID. They may have the symptoms, but they thought it was the continuation of their COVID symptoms.

There were a couple of Camden residents who shared their experiences of Long COVID with us and even filled the survey.

We were thrilled to meet the ex-counsellor of Camden and organiser of the Mela, Nasim Ali, partners from other voluntary sectors, and local media after so many months of meeting them over Zoom. We also relished some delicious Bangladeshi cuisine.

We both felt very pleased to meet residents and to talk about our role in Camden. We informed people about our recent works on NHS Dentistry, and ongoing projects on Cancer awareness and Long COVID. After suffering from Zoom fatigue, it was so good to go out and meet people in public spaces and to just listen to them. we do hope that we get many such opportunities in the near future as there is nothing better than meeting people in person.

The Christmas season is often associated with carol singers, festive lights, the tantalizing prospect of snow, and is looked forward to as a time to spend with family and close friends. However, whether or not Christmas is your favourite time of the year, many will be able to understand why a large proportion of people find it stressful or anxiety-inducing. 

Christmas-related stress and anxiety can contribute to a serious decline in mental well-being over the short term, or longer, which can have lasting negative impacts. [1] Whatever the cause of those anxieties or stresses, there are things that can be done to mitigate their impact of them on your mental well-being. 

The financial expenditure on food and presents can make December, and the Christmas period, the most expensive time of the year for many people. It can lead to people dipping into savings, building up unwanted debt, or relying on borrowed money from family or friends.

The prospect of paying back that money can lead to lots of anxiety, and money-related concerns are top of the list when it comes to stress in the UK. [2]

Sometimes, the best way to avoid those stresses is to minimize the impact of the Christmas season on expenditure by reducing it all together or spreading it over a longer time frame.

There are several creative ways to lessen financial pressure during the Christmas season. One way is to reduce the number of presents you buy by organising a secret Santa among family or friends.

A long list of presents can be daunting, and it can be hard to decide what to get for people when there are so many gifts to buy. By arranging to get presents for one person, you’re not only reducing your financial expenditure, but you also make it easier to focus on choosing a great gift. That way, everyone involved in the secret Santa can receive presents which have more thought put into them, and spend less money while they’re at it.  

On top of presents, food and drink can end up taking a significant chunk out of the Christmas budget, but it doesn’t have to be as expensive as you might think. Often alcoholic beverages can end up costing just as much, if not more, than the food.

 To avoid over-spending on too much booze, set yourself a reasonable budget for alcoholic drinks and stick to it. This sounds easy but in practice, it can be hard. [3]

If you manage to be disciplined, however, and limit how much you purchase, you could see a noticeable difference in how much you spend. In place of the alcohol, you could try and make some festive cocktails that are cheaper, and don’t come with the threat of a nasty hangover.[4]

They can also help prevent excessive drinking over the Christmas period, which can have its own negative implications for mental well-being. By turning away from the booze, you can reduce your financial pressure, and protect your mental well-being while making a positive change for your health.  

By following these steps, you can lessen your anxiety about financial pressures and protect your mental well-being over the Christmas period. However, financial concerns aren’t the only source of Christmas related anxiety and stress.

If Christmas is daunting for another reason, take a look at the accompanying infographic to see more practical tips on how to mitigate against stress and anxiety, maintain your mental well-being, and enjoy your Christmas period as much as possible.

Below, you can view the mental health at Christmas infographic:

References

[1] https://healthwatchcamden.co.uk/blog/2020/05/21/wide-range-services-camd…

[2] https://www.moneyhelper.org.uk/en/savings/types-of-savings/saving-money-…

[3] Covered more comprehensively in the Rehabilitation for drugs and alcohol in London article

[4] https://www.drinkaware.co.uk/news/festive-mocktails-for-christmas

Read the blog from Holly Norman, Interim Programme Director, North Central London Cancer Alliance on what steps they are taking to reduce inequity and improve access to cancer services in Camden and neighbouring boroughs in North Central London.

This year the World Cancer Day theme is closing the gap in cancer care – that means making sure that all sections of the population, regardless of their circumstances, receive timely, high-quality treatment, care, and support.  I am glad to say we are always striving to ensure this is a top priority.  Health inequalities in cancer care are unfortunately very real and in a diverse population like NCL with significant areas of deprivation, we know factors like this influence how early cancer is detected, survival rates, and how well people live with cancer.

We are reviewing each one of our projects in our work programme to ensure that we are designing and delivering them with tackling health inequalities at the forefront of our minds.

Cancer screening plays a significant role in improving the earlier diagnosis of cancer. In Camden and other north London boroughs, there is a lower-than-average uptake of cervical screening and this is worrying for us. This test is important for picking up changes in the cervix cells, which could become cancerous if left unchecked. Last year we ran the YouScreen Study which is assessing whether offering a self-sampling kit will improve the number of people who get screened regularly.

Later this month there will be a London-wide cervical screening campaign, aimed at encouraging younger women, Black and Asian women, and trans and non-binary people to attend their screening appointments. Look out for the advertising on the streets and on social media.

We are also developing a cancer care registry with Cerner, the organisation that provides our digital services. The registry is essentially a digital database that helps clinicians in north-central London support patients by bringing together important information about the quality of cancer care they are receiving. It will include data about care planning and treatment, details about patients’ broader health issues. It will also show where patients are waiting for important aspects of their care, such as assessments to spot whether they need additional support with their mental health. The information will help GPs and other primary care services see how the care provided supports all local cancer patients.

Whether you are living with cancer or want to know more about symptoms to be aware of, we hope you find the information in this special e-bulletin helpful. We are grateful to Healthwatch Camden for keeping cancer on the health agenda for the borough’s residents.

For more information about cancer symptoms and cancer screening visit our small c website. 

Follow us on Twitter @nclcancer

This is the second blog by Dr Michael Weider, Principal Dentist of the Maldent Dental Practice and Implant Centre. In his first blog published on this website, he dispelled some of the myths about the NHS dental services. In this blog, he is talking about the continuous multiple issues that NHS dental practices are facing and hence making it difficult for them to treat patients.

What’s changed since my last Blog…?

Well – unfortunately not much.

Dental practices are still working under reduced NHS capacity conditions with most practices maintaining the enhanced infection control regime to protect patients and staff. Many practices are experiencing staff absences due to the virus.

We are all working hard to service our regular patients and we try and accommodate emergencies. Inevitably the problem of access to NHS dentistry for new patients is still acutely problematic.

The problems that have surfaced in NHS dentistry during the pandemic highlight the underlying faults in the contracting arrangements of NHS Dentistry that the profession has been actively seeking to improve for many years.

As a dentist, it is clear that the present dental contract is – in the words of an MP only last week – ‘not fit for purpose’. This message is slowly getting through. It requires a root and branch overhaul taking into account modern-day preventive dentistry and less focus on target-driven activity.

The profession was working with the NHS in piloting new ways of working. All these pilots have just recently been scrapped, however – leaving those pioneering practices in the lurch.

Dentists are eager to provide an NHS service that is the envy of the world. We see dentistry as an important cog in the wheel of the holistic health of our patients but our hands are tied by the limits of the dental contract under which we work.

It’s time for a change.

Forums – like Healthwatch, like your local MP – can make a huge difference to drive change. Our Local Dental Committee in Camden is spearheading a campaign to communicate this message of change and welcome all feedback.

Write to Healthwatch. Write to your local MP. Together we will try a bring dentistry post-pandemic to the 21^st century.

We at Healthwatch Camden have been receiving numerous phone calls and emails on the challenges faced by the residents in accessing NHS dental practices. Please write to us at info@healthwatchcamden.co.uk if you are having similar issues. 

With the start of ‘Carers Week’, we thought there was no better time than now to share the following content that aims to celebrate the carers in our communities. It includes some eye-opening statistics around carers, plus some suggestions as to how we can help make their lives a little easier. Produced by ‘First Aid.co.uk’. 

Our Healthcare industry relies on compassion and commitment from those people who want to offer elderly, disabled and paediatric patients the kindness and care they need.  This can come in the form of palliative care or aged care, to name a couple. These heroes of the profession work across a 24 hour period holding hands, helping with feeding and cleaning, plus listening to the good old days, to ensure the best quality of care for those needing that additional support.

We forget that our elderly would not survive without these generous and caring people, who take on the task of support and commitment which we, as family, cannot always offer in their hours of need. During the Covid 19 Pandemic, many carers stayed within the care homes, not going home at the end of their shift. They did this to continue to make sure the residents were supported in every way, minimising the risk of infection by not seeing their own families, or taking the children to school, or cooking that evening meal, in order to be on hand for those needing such devoted care.

There are also many family carers who are not recognised for the commitment they have made to support parents and the elderly within the home environment. Many are working or are at school and take on the task of managing caring responsibilities alongside everyday life, without being supported themselves or having anyone else to talk to.

Carers UK is the only national membership charity for carers in the UK and, according to their statistics, as many as 1 in 8 adults (roughly 6.5 million people) are active carers. As a result of this voluntary caring, they estimate that the UK economy is actually being saved £132 billion per year!

When it comes to young carers it is believed that there are roughly 800,000 of them, aged 5-17 years old, looking after an adult in the UK. Children are naturally vulnerable but young carers tend to be a hidden element in society, taking on responsibilities that may lead to missing out on vital childhood experiences. The Children’s Society states that 27% of young carers aged 11-15 end up missing school, a situation that means that their compassion in looking after a loved one could lead to wide-ranging consequences as they face being disadvantaged in the longer term. This disagreeable situation is made all the worse by the statistic that says 1 in 3 young carers suffer from a mental health issue.

Why are these carers not recognised or financially supported? Often they are overlooked due to the fact it seems they are coping, but no one asks the question, “What can we do to help?” An empathetic response is all the more pressing with the current ‘cost of living’ crisis that we are facing.

Instead, the care industry is stretched so far that it can feel like bureaucrats are just turning a blind eye, rather than being proactive.

So, what can we do to make this better for the carers?

• Understand the needs of the patient and the people caring for them

• Offer the support each individual needs, rather than assuming they can cope

• Provide community groups for the carers, young and old, offering financial advice as many struggle

• Give the carer respite days and holiday breaks

• Ensure additional educational help for those younger carers

• Offer compassion and a listening ear, someone they can turn to in their hour of need.

With the annual Carers Week taking place in June, you can visit the website and search by your postcode to discover what activities are going on in your area to help celebrate carers and raise awareness for the challenges of caring. Beyond this, there are various campaigns that you can lend your voice towards, in an effort to help pressurise the legislative and economic organisations to be more progressive in recognising and tackling the challenges for carers within our society.

A good place to start your research is with the NHS itself; their page of ‘carer facts’ provides links to various surveys and studies, all of which deliver compelling evidence as to why we need more investment in this industry and in the countless individuals who don’t do it as a profession but rather as a necessity.

In view of Healthwatch Camden continuing to receive calls from our residents on the lack of available NHS dental appointments, I decided to look into the reasons as to why. Having retired from dentistry 18 months ago, this involved a major catch-up. Research included borrowing journals from former colleagues, attending both a Local Dental Committee meeting and a convention for practice owners, together with speaking to associate (non-practice owner) dentists.

Let’s start with good news. As of 1^st July, the Chief Dental Officer (CDO) lifted all restrictions imposed during the pandemic with regards to providing treatment, meaning practices will now be able to fulfil 100% of their NHS contracts. However, although more appointments will become available, with a backlog of two years of treatment needs, waiting lists will still be in place. Compound this with staff absence from being Covid positive, staff fatigue from operating under layers of additional PPE and a general recruitment crisis, it is likely Healthwatch Camden will continue to field enquiries from concerned patients for some time.

Dentists are working with a contract imposed in 2006. A contract described by a Parliamentary Health Select Committee as “not fit for purpose”. The CDO made minor changes to this contract, however these adjustments do not mean more funds to treat patients – but merely relate to the way a practice can claim for treating high needs patients using existing funds. Apathy with the lack of meaningful changes has resulted in many practice owners returning their NHS contract. Regrettably, under current legislation, the funds from these contracts cannot be redistributed to practices wishing to treat more NHS patients. Result: even more patients denied NHS care and having to seek private dentistry.

According to NHS data, the number of dentists providing NHS care in England fell by over 3,000 in the last two years. Many more have significantly reduced the number of days per week they devote to NHS patients. This lack of dentists has left an estimated four million people without access to NHS dental care. Factor in the large numbers of dental nurses, hygienists, therapists, and technicians that have left, either the NHS or the profession completely – we can understand why patients, including in Camden, are reporting problems registering for NHS care.

Patients may well ask why dentists are choosing to leave the NHS. The aforementioned NHS contract is target driven and inflexible. Being finite, it does not allow a successful practice to accept more NHS patients. Instead, once the quota of NHS care under the contract is fulfilled, further patients can only be seen privately. There is a plethora of form filling, using valuable chairside time that clinicians would much prefer to spend with their patients instead. The contract also does not compensate for the huge rises in the cost of running a dental practice. Thus the increase in interest rates, utility bills, laboratory fees for crowns and dentures, staff wages, purchase of clinical materials and PPE, disposal of clinical waste, to name just a few, are not covered by the finite sum of the existing contract. These pressures can render an NHS practice as non-viable, resulting in closure with loss of jobs and NHS appointments. In contrast, private practices are able to increase treatment prices to remain viable.

However, despite all this gloom, Camden dentists are reporting that they are beginning to see new patients on the NHS. Indeed NHS England has requested all practices to regularly update websites to keep patients informed of waiting list times. Patients should continue to contact practices to ascertain willingness to be accepted for NHS treatment.

Healthwatch Camden in conjunction with Camden & Islington Local Dental Committee will continue to press NHS England for a better contract with more localised funding.