An answer to rising costs and chronic illness

Our health services are at and in many places beyond breaking point. While we can hope the new government will restore some of the funding it is clear that health needs and costs are continuing to rise. In the next 15 years those living with a major illness are forecast to rise by 2.5 million to 9.1 million (i). 

So what can tackle rising costs and massively rising ill-health?

In this blog I will look at part of the answer that is already being tried with some wonderful results in terms of cutting costs and improved health outcomes. Perhaps the best articulation of the approach is the book “The Community Cure. Transforming Health Outcomes Together” by James Maskell (ii).

Maskell notes that we are facing a profound and worsening epidemic of loneliness and this is exacerbating chronic disease. He cites many examples of isolation as a social determinant of health including a 2017 questionnaire-based study where Medicare recipients older than 50, who ultimately were defined as “lonely”, experienced death rates 31% higher than their peers who did not self-identify as socially isolated. 

This research is not new - there is loads showing a range of health conditions associated with loneliness and social isolation, including heart disease and stroke, type 2 diabetes, rheumatoid arthritis and cancer. Even recovery following heart surgery can be compromised by isolation.

In the book Maskell argues that to counter this we should turn to group medical appointments; a supportive community provides the space to help develop healthy behaviors - a key to reversing chronic illness. This also can ‘shift our collective focus to prevention and root cause resolution’.

The book looks at the many ways group medical visits are being used - and the powerful evidence of them as a treatment for the loneliness epidemic. 

One of the examples Maskell looks at is the work of Dr Jeffrey Geller’s. This doctor found that patients who lacked support systems accessed medical care at a greater rate, so he decided to create a support system by forming group visits with a cohort of diabetes patients. Geller notes “People’s loneliness improved, people’s depression improved, they lost weight … blood pressure reduced by 5-10 points, and hemoglobin A1C also reduced”. 

I’ve personally seen the benefits of a group of people coming together and supporting each other - the peer-led Wigwam cancer support groups are a great example. See my blog post on this; ‘What makes the biggest difference to our healing’: https://yestolife.org.uk/what-can-make-the-biggest-difference-to-our-healing/

I’ve also seen benefits accruing from groups like the Cancer Exercise group at Stratford Park Leisure Centre supported by Stroud District Council. I believe there is huge potential for more of this intentional coming together.

One obvious possibility might be the one-off prehab talk now being run by local cancer services. Could that be expanded into a series of group activities looking more at nutrition, exercise, sleep, stress and more? This of course doesn’t mean there will not be some individual appointments but the bulk of issues can be raised in the groups. One of the findings into researching this approach showed that folk didn’t have time to raise key stuff in an individual appointment but there was time in the groups. Furthermore some patients were more shy to raise issues and found it useful that others in the group asked those questions.

‘Confidentiality’ I hear some folks cry. Yes any group work needs to consider this issue, Maskell has a section in his book on this, but it seems clear to me that group visits don’t destroy a patients privacy. What they do offer is a safe space for folks to be vulnerable and this can be a key part in healing.

Maskell writes: “We need more connection, more empathy, more social connectivity, and less loneliness, less social isolation. In a culture and society that emphases and prioritises privacy, we’ve inadvertently contributing to the very epidemic we’re trying to solve."

Maskell provides many resources for those interested in starting their own group visits, primarily through his website, “Evolution of Medicine.” I also know there are many skilled practitioners within our NHS who no doubt already have the skills to develop this approach.

With families and communities no longer meeting our needs we have seen what Maskell calls ‘total commodification’. We need ever more money to pay for counselling, babysitters, care and more - these were once shared by the community itself. It seems we now only look to the market or government for solutions. It’s time for a refocus…..group appointments are a way whose time has come. It would be great to see if there are opportunities to expand these ideas in Gloucestershire?

Update 10.01.25: Just heard this useful podcast re James Maskell: https://creators.spotify.com/pod/show/robin-daly6/episodes/James-Maskell--Diana-Lindsay-e2sjofc

There are many other podcasts with James Maskell on his website and online. Here are a couple:

Dr Chatterjee interview: https://drchatterjee.com/the-secret-to-radically-improving-your-health-that-nobodys-talking-about-with-james-maskell/

Oncologist Nasha Winter's interview: https://www.youtube.com/watch?v=HJanBC_xi3o&t=1s

Here are a couple more of my blogs looking at the impact of social support and community:

See blog about building a community of Wigwam Cancer Support Groups:

https://myunexpectedguide.blogspot.com/2021/05/building-community-of-peer-led-support.html

See blog on social prescribing and anti-social prescribing: 

https://myunexpectedguide.blogspot.com/2019/12/social-prescribing-for-people-living.html

Notes:

1. https://www.health.org.uk/reports-and-analysis/reports/health-in-2040-projected-patterns-of-illness-in-england
2. https://thecommunitycure.com/getyourcopy

Reiki proven to provide symptom relief

Research out last month showed that energy healing, in the form of Reiki therapy, can provide significant symptom relief in cancer patients receiving standard treatments. In this study published in the Journal of Pain and Symptom Management, they found that patients given Reiki during chemotherapy experienced a clinically significant improvement in nausea, pain, fatigue anxiety.

As someone who took a basic reiki course many years ago I don't doubt this - while my brain can hardly compute how it could work I have seen first hand the evidence of improved wellbeing when reiki has been used. I also used it for myself when I was going through radiotherapy and do return to it when it feels the right approach.

Indeed this is not the only research supporting energy healing - a great book I read a couple of years ago is David Hamilton's 'Why Woo-Woo Works, The Surprising Science Behind Meditation, Reiki, Crystals and Other Alternative Practices'. There is a whole chapter on Reiki including research on using it with cancer patients to lessen the impact of treatments.

Change NHS: a look at submissions

In November 2024 the UK public were invited by Health & Social Care Secretary, Wes Streeting, to contribute ideas to rescue the NHS; “Our NHS is broken, but not beaten. Together we can fix it.” See details here: https://change.nhs.uk/en-GB/

Amazingly the previous government left Cancer care out of its 10-year plan altogether. Given the scale of the current statistics this was surely deeply misjudged. In this blog I cover the excellent response by Yes to Life and note some other key points.

Robin Daly, Founder and Chair of Yes to Life, writes: "This was the introduction to Change NHS, a once-in-a-lifetime opportunity to have our say, that we at Yes to Life immediately knew we had to respond to. Although there are no certainties as to what effect this unprecedented public input will have, we felt the need to express clearly the changes we would like to see, and to argue the case that these will provide solutions to many of the key ills affecting UK healthcare in the twenty-first century".

Yes to Life have now made their submission public. It relates strongly to the Charter for Oncology that Yes to Life published earlier this year. This Charter sets out "the ethos for an entirely new relationship between those delivering and those in need of healthcare, one that opens up unlimited potential for rapid improvements in resources, methods and most importantly results, as well as approaches to prevention and health promotion that are currently totally absent from mainstream healthcare".

Don't forget to sign the petition for the Charter: https://www.change.org/p/implement-the-yes-to-life-charter-for-oncology-in-all-nhs-cancer-units

The Yes to Life submission by Robin Daly and Dr Penny Kechagioglou, NHS Oncologist and Lead Advisor to Yes to Life on Integrative Oncology, can be read at: https://yestolife.org.uk/wp-content/uploads/2024/12/Change-NHS-Booklet-1.pdf

The Charter is a key element of the submission but also there are other key points that they make in more detail than I note here - these include:

- The need for a deep cultural shift towards patient-centred care (not lip service) - it has been enshrined in the NHS Charter but is still barely discernible. Similarly we need a return to clinical judgement as a key element of evidence-based decisions.

- Integrative Oncology as a model of care is well developed in other countries, cost-effective and has better clinical outcomes; lifestyle changes are key yet the NHS is ill-equipped to deliver

- Prevention is ultimately where solutions lie

- More collaboration both within the NHS and with external providers

- More than half of Cancer patients adopt lifestyle or complementary approaches independently but are unsupported during and after treatment. Clinicians don't need to be experts but do need to know facts when it comes to its potential. Training key to help with changes.

- Improvements to data

The Patients Association

Many organisations and individuals are submitting responses  to Change NHS. One of the others I've read is by the Patients Association - see here. Their submission also strongly calls for the patient voice to be heard. It is full of detail and is informed by 290 responses to a call they made for comments. They found that the respondents to their survey were generally in favour of the three shifts proposed by the Government – shifting from hospitals to the community; from analogue to digital; and from sickness to prevention. There was also an understanding about the challenges that may arise from implementing these shifts. 

Among the key points are calls for shorter waiting times, integrated digital health records, better prevention strategies, and equitable care for underserved groups. Workforce recruitment and retention, alongside stronger patient partnerships, were also seen as critical to success.

One key issues that impacts on the NHS that needs emphasising is around how social determinants of health impact patients. This includes external factors that contribute to a patient’s health and wellbeing, like their income level, if they have access to safe housing, and whether they come from a minoritised community, like being Black or LGBTQ+. This is huge and something this blog has touched on in the past. Again as we've argued in the past part of the answers involve really involving patients.

Lastly here's a link to World Cancer Research Funds submission which also has some good stuff: https://www.wcrf.org/wp-content/uploads/2024/12/Comments-10-year-health-plan-England-Dec-2024.pdf

Getting the oral microbiome right

Last year I posted a link to a video about the importance of dental care - see here - it seems our oral microbiome is increasingly been seen as a key element in our health. Anyone interested in this could do well to listen to this podcast with Dr Victoria Sampson (pictured) - nearly 800,000 views in the last two weeks since it's been out: https://www.youtube.com/watch?v=p3fSwd1cF08&t=118s 

A friend has recently seen Victoria Sampson and shared how useful the test of her oral microbiome was - sadly at £350 a pop it is likely to be out of reach of many but it is exciting to see this field develop. In the video Victoria shares what you can do to look after your teeth and much more. 

We have known for a while about the importance of the microbiome and cancer - here's a paper from 2019 that looks at the health of the microbiome and how that impacts on prostate cancer. Consideration of the oral microbiome is newer - who knew we even had one of those?!! 

Research is at a very early stage but here's a paper from 2020 saying: "Several meta-analyses have confirmed the suspicion that periodontal disease should be considered as a risk factor in several types of cancers. In fact in a meta-analysis by Corbella et al., they found that a statistically significant association was found for all cancers studied, both combined and individually (digestive tract, pancreatic, prostate, breast, corpus uteri, lung, hematological, esophageal/oropharyngeal and Non-Hodgkin lymphoma)."

One study from 2022 looking at pancreatic cancer notes: "In summary, poor oral health, oral microbial dysbiosis and the development and progression of PC are interlinked. However, the underlying mechanisms of the oral microbiota’s influence in PC diagnosis and treatment have yet to be elucidated. Thus, these data beg for further research, particularly as it relates to mechanisms, human diversity and the implementation of precision medicine."