Quarterly magazine of BackCare, the UK’s National Back Pain Association
AUTUMN n 2016
FREE TO MEMBERS
The prescription that gets people outdoors also in this issue: Self help Practical tips for avoiding back pain when driving Workplace Reducing risk for an ageing working population Community Exciting plans unveiled for the 2017 Back Pain Show
www.backcare.org.uk
2 TALKBACK NEWS
JOIN OUR GROWING NATIONAL NETWORK TODAY The BackCare branches are a network of local support groups up and down the country. They are run by local members who organise educational, social and fundraising events. You can find your local branch in the listing, right. If you’d like to start a branch in your area, please contact branches@backcare.org.uk
TALKBACK l AUTUMN 2016
CAMBRIDGE Contact: Ms Mary Griffiths Telephone: 07787 990214 Email: blincomary@gmail.com
READING Contact: Telephone: Email:
Mr David Laird 0118 947 0709 davidlaird@talktalk.net
DERBY Contact: Telephone: Email:
Mrs Christine Sissons 01332 763636 chris.sissons@btinternet.com
SALISBURY Contact: Telephone: Email:
Mrs Barbara White 01722 333925 white.alan@btinternet.com
ESSEX Contact: Telephone: Email:
Mrs Lyndee Oscar 01206 804353 lyndee@kidsbacks4thefuture.co.uk
SOUTHAMPTON Contact: Mrs Jo Goudge-Riley Telephone: 02380 464170 Email: goudgeriley@gmail.com
HARROGATE & DISTRICT Contact: Mrs Lin Tippey Telephone: 01423 865946 Email: keithandlin2@btinternet.com
SWANSEA (WALES) Contact: Ms Gloria Morgan Telephone: 01792 208290 Email: gloriamorgan@talktalk.net
HULL & EAST RIDING Contact: Mrs Beryl Kelsey Telephone: 01482 353547 Email: kelsey59@kelsey59.karoo.co.uk
WEST LONDON Contact: Mrs Teresa Sawicka Telephone: 020 8997 4848 Email: tere_ss@yahoo.co.uk
LOTHIAN (SCOTLAND) Contact: Mrs Jean Houston Telephone: 0131 441 3611 Email: jean.houston@blueyonder.co.uk
WEST MIDLANDS Contact: Mrs Thelma Pearson Telephone: 01902 783537
POOLE & BOURNEMOUTH Contact: Mrs Patricia Bowman Telephone: 01202 710308 Email: patriciabowman@ntlworld.com
WINCHESTER Contact: Ms Gillian Rowe Telephone: 023 8025 2626 Email: gillianmrowe@hotmail.com
TALKBACK LEADER 3
The challenges of ageing and ageism LIFE expectancy has risen continuously since the nineteenth century, but scientists are now debating whether there may be a limit to human longevity after all. Evidently, the age at death of the world’s oldest person (Jeanne Calment, 122) has not been bettered since the 1990s and (if we disregard the yet-to-be-verified reports of a 145-year-old man from Indonesia), this suggests to some that a ceiling has been reached and that our lifespan may be “fixed and subject to natural constraints”. More of us are living for longer – at least for the time being. This remarkable achievement demonstrates modern medicine’s triumph over premature mortality and one of the principal challenges we are fortunate to be facing today is how we go about extending the period of old age that is spent in good health. It’s ironic then, that UN health targets* to reduce premature deaths from diseases such as cancer, stroke, diabetes and dementia conflict so profoundly with this ambition. Essentially, it means those who succumb after the age of 70 are judged not to have died “prematurely” and therefore are not prioritised for health interventions. Many public health experts would prefer to see the World Health Organisation (which led the development of the targets) focus instead on cutting illness for all ages, which would arguably save more lives – and be somewhat less discriminatory. In the meantime, there are practical things we can do at an individual level to inject a little more life in our years – wherever we might be
in this timeframe. Locally driven initiatives such as prescriptions for outdoor pursuits can deliver immediate and lasting benefits for those with time to spare. Or if, like growing numbers in their 70s and 80s, you’re not the retiring type, you may decide you still have a lot to offer the workplace. For those struggling with chronic pain, simple adjustments in lifestyle may not be enough to bring about a rosier outlook. The many varied treatments explored in the sections of TalkBack mostly consider the “whole person” – body and mind – and aim to tackle the underlying causes of pain while helping to restore a feeling of hope and positivity. We’d be pleased to hear about your experiences – the successes and the failures.
Contents
What’s your heart age?
6
Women developing back pain earlier, says BCA 11
Not everyone experiences stress in the same way 16
Richard Sutton Editor LETTERS TO THE EDITOR:
talkback@backcare.org.uk
* UN member states are expected to cut premature deaths from diseases such as cancer, stroke, diabetes and dementia by one third by 2030.
We welcome articles from readers, but reserve the right to edit submissions. Paid advertisements do not necessarily reflect the views of BackCare. Products and services advertised in TalkBack may not be recommended by BackCare. Please make your own judgement about whether a product or service can help you. Where appropriate, consult your doctor. Any complaints about advertisements should be sent to the Executive Chair. All information in the magazine was believed to be correct at the time of going to press. BackCare cannot be responsible for errors or omissions. No part of this printed publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the copyright holder, BackCare. ©BackCare
BackCare BackCare, Monkey Puzzle House, 69-71 Windmill Road, Sunbury-on-Thames TW16 7DT Tel: +44 (0)20 8977 5474 Email: info@backcare.org.uk Website: www.BackCare.org.uk Twitter: @TherealBackCare Registered as the National Back Pain Association charity number 256751. TalkBack is designed by Pages Creative www.pagescreative.co.uk and printed by Severn, Gloucester.
Acupuncture can help with back pain and migraines 18
Lack of local support puts strain on A&E 20 TALKBACK l AUTUMN 2016
4 TALKBACK NEWS
Unsafe hospital discharges unacceptably high, say MPs THE incidence of unsafe discharge from NHS hospitals is unacceptably high as a result of political maladministration, says a Public Administration and Constitutional Affairs Committee report. The report looks at the work already carried out by the Health Service Ombudsman which highlighted cases that illustrated the human costs of poor discharge, causing suffering and distress for patients, their carers and relatives. Poor patient discharge can take the form of both delayed transfers of care, where patients are kept in hospital longer than is necessary, and premature or early discharge, where patients are discharged before it is clinically safe to do so, or without appropriate support in place. The Committee’s inquiry found that the discharge failures identified by the PHSO report were not isolated incidents but examples of problems that patients, relatives and carers are experiencing more widely. Chairman of the Committee, Bernard Jenkin MP, said: “Hospital staff seem to feel pressured to discharge patients before it is safe to do so. Hospital leadership must reassure their staff that organisational
Image: Pressfoto – Freepik.com
pressures never take priority over personcentred care. And staff need to feel a level of trust and openness that enables them to raise concerns about unsafe discharge.” At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. This is political maladministration, the Committee states. The Government has accepted
the recommendations of earlier reports to merge the Local Government Ombudsman with the PHSO as part of a new and comprehensive Ombudsman Service, which will mean it will be able to investigate the administration of health and social care together more effectively. Plans have also been developed to tackle the structural disconnect between health and social care, including through the Discharge Programme Board, the Better Care Fund and the long-term integration policy, though these are far from implemented. Responding to the MPs findings, chairman of the Local Government Association’s Community Wellbeing Board, Izzi Seccombe, said: “Getting people out of hospital more quickly and back living at home will only work properly if councils get enough resources throughout the whole year to fund adequate provision of care services.” The LGA is calling for £700m of the funding earmarked for social care through the Better Care Fund by the end of the decade to be brought forward now, to ease the severe strain on services supporting the elderly and vulnerable.
“Inconsistent” rehab after stroke can impede recovery
Having direct access to the physiotherapy service can speed progress
TALKBACK l AUTUMN 2016
STROKE patients in England face hugely inconsistent care once they leave hospital, an audit of services by the Chartered Society of Physiotherapy (CSP) has shown. Reforms in recent years ensure patients receive intensive rehabilitation in the immediate aftermath of their stroke before being discharged from hospital. But many then have to wait weeks to see a physiotherapist to continue their rehabilitation, which potentially stalls their progress and risks a deterioration in their condition. In areas where patients could access an early supported discharge service (or they were categorised as urgent), the vast majority saw a physiotherapist within three days. But where no such service existed (around a third of hospitals), or they were considered non-urgent, only 15% of patients were able to access community-based physio in less than a week.
Little more than one in four NHS clinical commissioning groups said stroke patients could self-refer back into a community rehabilitation service when they needed specialist support. This means patients often face unnecessary obstacles, such as seeking a fresh referral from their GP, when having direct access to a service would help to support the management of their condition. Catherine Pope, chair of council at the CSP, said: “Effective rehabilitation gives people back their independence, allowing them to return to work or simply to resume everyday activities. It is crucial it is regular and timely in those early days.” l An estimated 152,000 people a year have a stroke l 76% of stroke survivors have physical deficits.
TALKBACK NEWS 5
Image: melodi2/freeimages.com
Debate needed about how to pay for social care in the future THE CARE and support older people receive increasingly depends on where they live and how much money they have rather than their needs, according to a new report by the health think tank the King’s Fund and the Nuffield Trust. Six consecutive years of cuts to local authority budgets, rising demand for services and shortages of staff have left the social care system increasingly unable to meet the needs of the older people who depend on it. The report finds this is placing an unacceptable burden on unpaid carers and is leaving rising numbers of older people who have difficulty with the basic activities of daily living – such as washing, dressing and getting out of bed – without any support at all.
The report highlights evidence that reductions in fees paid by local authorities and other cost pressures such as the National Living Wage are squeezing the incomes of residential and home care providers. It warns that an increasing number are likely to leave the market or go out of business, potentially leaving older people without the care they depend on. The report highlights a growing funding gap within the existing, inadequate system which will reach at least £2.8 billion by 2019/20 as public spending on adult social care shrinks to less than 1% of GDP. If the government is unwilling to properly fund and expand the current system, the report says it must be honest with the public
about what they can expect from local authority services so they can plan ahead and make their own arrangements. It calls for a fresh debate about how to pay for social care in the future. Ruth Thorlby, deputy director of Policy at the Nuffield Trust said: “The number of older people needing care is increasing and yet we are continuing to put less money in. Unmet need is rising, providers are threatening to pull out of contracts, the wellbeing of carers is deteriorating, access to care is getting worse. A government that wants to create ‘a country which works for everyone’ should not tolerate the oldest and most vulnerable falling into a social care system riddled with holes.”
TALKBACK l AUTUMN 2016
Telling people their heart is older than it should be is shown to be a more effective way to get them to change behaviour and improve cardiovascular health
Image: Asierromero/freepik.com
6 TALKBACK PUBLIC HEALTH
What’s your heart age?
TALKBACK l AUTUMN 2016
A STAGGERING four in five (79.2%) people over 30 have a heart age older than their chronological age, making them more likely to have a potentially fatal heart attack or stroke. That is according to a study of 575,000 people funded by the British Heart Foundation (BHF). To mark World Heart Day (29 September), the BHF, Public Health England and NHS Choices encouraged people to use an online tool to find out how old their heart is and know their cardiovascular risk. The older a person’s heart age, the higher their risk of a cardiovascular event, such as a stroke or heart attack. A heart age greater than 70 increases the risk significantly. Nearly nine in 10 men under 40 (87%) had a heart older than they were, compared to 41% of women of the same age. Of these, over a quarter (28%) had a heart age greater than their chronological age by at least five years. The study, the largest of its kind, also found a significant proportion of the public were unaware of their own cardiovascular risk factors; four in five people did not know what their cholesterol levels were and almost half (49.5%) did not know or input their blood pressure. Cardiovascular disease (CVD) causes more than a quarter of all deaths in the UK, around 155,000 people a year, and coronary heart disease is the UK’s single biggest killer.
Despite this, most cases in people under 75 are preventable. Factors like high blood pressure and high cholesterol, as well as smoking, diet and a lack of exercise, can increase someone’s risk of developing CVD. One disease from the cardiovascular family, like diabetes, makes another, like chronic kidney disease, more likely. To stop this cycle, the BHF’s Heart Age Tool can motivate people to think about their risk factors before problems develop, and aims to empower individuals to manage these risk factors and minimise risk. Almost a million people (960,000) have used the tool since its launch in February last year. The new version will recommend interventions and advice on how to lower cardiovascular risk. It can show how to reverse the ageing of the heart by, for example, stopping smoking. Dr Mike Knapton, associate medical director at BHF, said: “Knowing your heart age is vital to taking control of your health. Armed with this knowledge, you can start to make changes to help protect yourself against cruel and life-changing events such as heart attack and stroke. The younger you start making small but significant changes, the greater the return on your investment in your health.” www.bhf.org.uk/heartage
TALKBACK PUBLIC HEALTH 7
One in four diabetes sufferers unaware of their condition NEW DATA from Public Health England estimates that 3.8 million people in England aged over 16 had diabetes in 2015, around 9% of the adult population. Around 90% of diabetes cases are Type 2, which is largely preventable or manageable by lifestyle changes and provides additional benefits for health and wellbeing. The likelihood of developing Type 2 diabetes is increased by being overweight (although family history, ethnicity and age can also increase risk). PHE’s new Diabetes Prevalence Model suggests that one in four people with diabetes (approximately 940,000) are unaware of their condition. The disease can lead to serious complications including foot amputation and kidney disease and is associated with an increased risk of stroke and heart attack. The number of people with diabetes has been steadily increasing and tackling it is fundamental to the sustainable future of the NHS. The proportion of people who have
diabetes increases with age: 9% of people aged 45 to 54 have diabetes, but for over-75s it is 23.8%. Diabetes at older ages has even bigger health implications as people are more likely to be suffering from other diseases, particularly cardiovascular diseases. Diabetes is more common in men (9.6% compared with 7.6% women) and people from south Asian and black ethnic groups are nearly twice as likely to have the disease compared with people from white, mixed or other ethnic groups, (15.2% compared to 8.0%). The Healthier You: NHS Diabetes Prevention Programme (NHS DPP) has been designed to help those at high risk of Type 2 diabetes reduce their risk of developing the condition, by being offered a referral to an improved diet, weight loss and increased physical activity programme. The NHS DPP will have full coverage across England by 2020. By then, up to 100,000 people will have access to its services each year.
ABOUT DIABETES Diabetes refers to a condition where the amount of glucose in your blood is too high. There are two main types of diabetes: l Type 1 diabetes develops when the body is unable to produce any insulin l Type 2 diabetes develops when the body is unable to produce enough insulin or the body’s cells don’t react to insulin Visit your GP as soon as possible if you experience the main symptoms of diabetes, which include: l feeling very thirsty l urinating more frequently than usual, particularly at night l feeling very tired l weight loss and loss of muscle bulk l itching around the penis or vagina, or frequent episodes of thrush l cuts or wounds that heal slowly l blurred vision Type 1 diabetes can develop quickly over weeks or even days. Many people have Type 2 diabetes for years without realising because the early symptoms tend to be general. www.nhs.uk
Based on current population trends, by 2035, 4.9 million people will have diabetes, says Public Health England Image: Karen Barefoot/freeimages.com
TALKBACK l AUTUMN 2016
8 TALKBACK COMMUNITY
Exciting plans unveiled for 2017 Back Pain Show A WIDE range of exciting therapies, products and services associated with the treatment of back pain and MSD will be on show when the Back Pain Show returns in the spring. The two-day exhibition and conference, which takes place at St Andrews Stadium, Birmingham on Friday and Saturday 19 and 20 May, provides the one-stop shop for all those who suffer from back and neck problems along with the health professionals who look after them. Organised on behalf of BackCare – the National Back Pain Association – the exhibition will feature expert help and advice, free-to-join classes such as yoga and Pilates, insights into new treatments, massages and therapies, along with special seminars and presentations. As well as people suffering from back pain who will get free entry, the two packed days will attract professionals including doctors,
nurses, physiotherapists, pharmacists, orthopaedic surgeons, osteopaths, chiropractors, clinic managers, sports injury specialists, alternative therapists, occupational therapists, pain consultants, as well as HR managers and health and safety managers. BackCare’s executive chairman, Dr Brian Hammond said: “A visit to the show is essential for all those who suffer the torture of back pain. We will be demonstrating the very latest in pain control and management, exhibiting new products and services and offering sound, professional advice on limiting problems associated with back pain. For the professionals who work in the health service and private practice, the show offers great opportunities for professional development.” Admission to the exhibition for the general public will be free. www.thebackpainshow.co.uk
New manual handling feature THE Back Pain Show is relevant to an astonishing 75% of the population who are likely to experience back pain at some point in their lives. In 2017 – for the first time – the Back
Pain Show is introducing a section on manual handling, looking at the problems caused by poor lifting and handling techniques and how – with the right knowledge – you can keep safe.
Interested in exhibiting? THE Back Pain Show 2017 provides a unique opportunity to get your name in front of a highly influential audience. There is no other gathering of members of the public and professionals exclusively focused on back healthcare and manual handling anywhere else in the country. A major marketing and PR campaign will ensure that the show is well-publicised through professional publications, consumer media, health and fitness publications plus all relevant websites and via social media. To attract the professionals to the
TALKBACK l AUTUMN 2016
show, the organisers are putting together a full two-day programme of seminars and presentations with top speakers. The event will also stage BackCare’s annual AGM. So why not get yourself in front of this high-value audience by taking space and demonstrating and selling your products and services, providing expert help and advice, or offering classes such as yoga and Pilates? Contact Jill Gibson for details on available exhibition space: 07787 566623 www.thebackpainshow.co.uk
TALKBACK COMMUNITY 9
Film and DVD
Core exercises that support you in daily activities TWO new DVDs from sports therapist Garry Toms examine the role of exercise in the management of back pain and helping individuals lead a “pain free, healthy and active lifestyle”. The author has 30 years’ experience working in the world of health and fitness, where his particular expertise has been in treating clients with sports injuries, hip and knee replacements and those with injuries resulting from accidents. As the managing director of a number of specialist back care clinics, Garry takes the lead in exercise rehabilitation and the treatment of pain and muscular dysfunction. His new DVD, “Back Pain – Exercise Rehabilitation”, has been created from decades of observations and research into back pain. He said: “Over the years, I have found that when specific core muscles have stopped firing due to some past trauma or stress, then a particular muscle and its trigger
points and nerve endings fail to work in their correct sequence when you go to move. This correct sequence failure causes other muscles to take over and work far harder than they should do. As a consequence, posture changes, leading to bad habits being developed when standing or leaning forwards.” The core exercises highlighted in the DVD show the user how to isolate particular muscles to be receptive to “action” signals from the brain, and begin to support you correctly once again in daily routines. A second DVD, “Exercise for the Over50s”, emphasises the need for a healthy and conditioned body in order to go about daily jobs, hobbies and activities. These exercises are designed for the older generation and do not involve any specialist equipment – they can all be performed within your own home. www.garrytoms.com
Film and DVD
Film shows how stress can endanger lives A NEW film launched by the British Safety Council, The Last Word, shows how stress can lead to injury and fatalities at work – particularly where concentration is vital for safety, such as working in construction, driving, or in health and social care. Stress is often discussed in relation to sickness absence. However, it’s less reported how many accidents are related to stress at work. Whether it is workrelated stress or stress that people bring to work, stress can put at risk the safety of employees and members of the public. Matthew Holder, Head of Campaigns and Engagement at the British Safety Council, said: “Evidence shows that stress significantly contributes to injuries in sectors such as construction, transport
and agriculture. In the medical profession, stress is a major predictor of work-related accidents and there are strong links between fatigue and sharps injuries. “We made The Last Word to warn people that being tired, distracted and unable to concentrate fully can make simple tasks like climbing a ladder more dangerous.” www.britsafe.org l Stress is believed to be a major cause of accidents in the workplace, with evidence showing that 60-80% of accidents are related to workplace stress (source: European Foundation for the Improvement of Living & Working Conditions)
TALKBACK l AUTUMN 2016
10 TALKBACK COMMUNITY
The delights of taking the path less travelled A “WALKS AND TALKS” event in Huddersfield in September challenged participants to use their feet to gain a greater appreciation of the modern world and its ways. The World Congress of Psychogeography comprised two days of walks and talks from the University of Huddersfield’s Heritage Quay. Almost 100 delegates signed up for the event, which covered a range of topics and different outings – such as the town centre walk titled “The Northern Powerhouse in a post-Brexit world”, intended to stimulate thoughts about consumerism, surveillance, security and ownership.
Co-organiser of the congress Dr Alex Bridger is a senior lecturer in psychology at the university and the author of a forthcoming book on psychogeography, a creative approach to travelling around urban environments and allowing “chance or spurof-the-moment decisions” to jolt you into a new awareness of your surroundings. Other walks and talks involved writers, researchers and creative artists; among the locations were public parks, hidden mine workings and migrant areas of town. A scavenger’s hunt invited walkers to follow a trail around the university’s campus in search of items and stories. www.heritagequay.org
JOIN US! BackCare’s hugely popular Carol Concert takes place on Monday 12 December at 6.30pm. Join us at the Queen’s Chapel of the Savoy for a rich tapestry of choral masterpieces brought to you by the Tredici Choir directed by one of Britain’s leading choral conductors, Richard Thomas. Donations towards refreshments welcome. Queen’s Chapel at The Savoy, Strand, London WC2A 0DA.
Thirty years of support for back pain sufferers in Salisbury
Members and physios from the Salisbury branch of BackCare enjoying the anniversary celebration AROUND 36 members of the Salisbury branch of BackCare and their guests gathered at the Grasmere House Hotel in Salisbury to celebrate the branch’s 30th anniversary. Chairperson Louise Gilbert welcomed the national charity’s executive chair Dr Brian Hammond who praised the branch for its valuable work. In August 1986, Sherry Fletcher and three of her patients with chronic back
TALKBACK l AUTUMN 2016
pain formed a local branch of NBPA. The branch was offered the use of the Duke of Cornwall Spinal Treatment Centre hydrotherapy pool at Salisbury District Hospital. Thirty years on, the branch has been running three hydrotherapy sessions a week under the supervision of Sherry and her fellow physios Jo Hankey and Georgie Duff. Salisbury branch contacts: Barbara White on 01722 333925 or white.alan@btinternet.com.
WITHIN days of the celebration, the branch received notification from Salisbury NHS Trust that the hydrotherapy pool was to be placed under new management and that in the interim the sessions would have to cease. The branch is now working hard to get the pool sessions fully restarted. Branch treasurer Alan White said: “We cannot guarantee that normal service will be restored, but we are hopeful that the significant benefits these sessions provide for members and the savings to the NHS by keeping patients out of GP surgeries and hospital departments will be achieved again in the near future, albeit those lost benefits and savings will take a long time to rebuild.” l Access to facilities is a key issue for BackCare members. If you are encountering similar problems to Salisbury, tell us. talkback@backcare.org.uk
TALKBACK WOMEN’S HEALTH 11
Women are developing back pain earlier, BCA research shows
WOMEN in the UK are starting to suffer with back and neck pain as young as 28, according to new research from the British Chiropractic Association (BCA). More than a fifth (22%) of women who have struggled – or currently struggle – with back or neck pain say they do so daily and 24% have suffered for more than 10 years. Men fare a little better – first battling back and neck pain from the age of 32. Housework / DIY and sleeping / mattresses were more common triggers for women, while men were more likely to point to exercise as the cause of their back or neck pain. For both men and women, lifting and carrying was the most common trigger. BCA chiropractor Rishi Loatey said: “People battling pain often aren’t taking proactive measures to combat the effects of modern lifestyles, for example, limiting the amount of time spent sitting down or hunched over a mobile phone or laptop. There’s rarely one big trigger for back or neck pain, and my patients are often surprised at the difference they feel just by making simple changes to their daily routines.” The BCA has issued some golden rules for protecting back health and preventing some of the key pain triggers. Perfect your lifting and carrying technique When lifting, make sure your legs are at
least your hips’ width apart with the knees bent. Keep your head and shoulders directly above your waist and keep the weight you are carrying as close to you as possible – avoid twisting. Take regular breaks When doing housework or DIY, make sure you vary your activity and try to spend no more than 20-30 minutes on any one thing. Take breaks to avoid being in the same position for too long, this will help relieve the build-up of tension in your lower back. Stop the slouch Relax when sitting into your seat, making sure you have your bottom against the seat back with your shoulder blades touching the back rest of the chair. Try to ensure that your hips are higher than your knees.
Get a good night’s sleep Recognise the warning signs that it’s time to change your mattress; you wake up feeling stiff or aching, your mattress is misshapen or sagging or you can feel individual springs. If your mattress is over seven years old, you might want to think about buying a new one. Warm up When exercising or playing sport, it may seem obvious, but make sure your muscles are prepared by gradually increasing the intensity of your warm up, to avoid lack of flexibility and injury. Promote a good posture Having and maintaining a good posture can help to keep back pain at bay. To promote a good posture, try incorporating some simple exercises into your daily routine.
TALKBACK l AUTUMN 2016
12 TALKBACK ADVERTORIAL
Who else needs chronic Chronic pain is one of the most challenging and difficult conditions people face treating safely and effectively. There is now a new safe pain therapy device that is economical and effective for many individuals suffering with chronic back pain for many years. Pain itself often modifies the way the central nervous system works so that a person actually becomes more sensitive and gets more pain with less provocation. That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular – the brain and the spinal cord. It’s well understood that the
extent of tissue injury does not explain the level of pain, and chronic pain can be maintained even after an initial injury has healed. ActiPatch’s neuro stimulation continuously disrupts this signal to allow a good night’s sleep and restores daily activities. The Pain Management publication published a Registry Study of 5,000+ using an ActiPatch 7-Day trial device report a baseline VAS pain score of 8+ of which 2/3 had more than 57% pain relief. This reflects that many individuals respond poorly to drug therapies.
ACTIPATCH LONG-TERM USE: ● 2/3 (including opioid users) reported moderate to complete elimination of pain medications ● 2/3 reported improved sleep ● 3/4 increased physical activity ● 4/5 experienced a substantial improvement in overall quality of life.
TALKBACK ADVERTORIAL 13
pain relief? This data demonstrates that ActiPatch has a higher response rate and is much more effective than common chronic pain drugs and other therapies for chronic back pain. ActiPatch is drug-free, and unlike medications, there are no adverse effects. It is safe for people with diabetes, the elderly, and those with heart and lung disease. ActiPatch can be used safely 24 hours a day for extended pain relief. ActiPatch long-lasting pain relief has been proven to help people get a good night’s rest. It’s the new pain reliever that lets you be your best! ActiPatch is now available at Lloyds Pharmacy, Boots, Superdrug and Gordons Chemist stores and costs only £24.99 for 720 hours of treatment.
ABOUT THE AUTHOR Ian Rawe is the Director of Clinical Research at BioElectronics Corporation, the manufacturer of ActiPatch® Therapy.
TALKBACK l AUTUMN 2016
14 TALKBACK SELF HELP
PHOTOS COURTESY OF JULIA WOODMAN
Is your daily commute driving Many of us spend quite long periods in our cars each day. All too often this contributes to back, neck or shoulder pain and stress. Researcher and Alexander Technique teacher Julia Woodman continues this series of articles with some practical steps that you can take to make your daily commute a bit easier.
Sitting slumped or more supported
TALKBACK l AUTUMN 2016
SEATS – from chairs and sofas to car seats – tend to be designed more for how they look than for fitting in with human anatomy and function. In the design of car seats, safety is rightly a big concern as everything possible needs to be done to give maximum protection in the event of an accident. However, I would suggest that car manufacturers could do a lot more to design seats that do not have a detrimental effect on our longterm health. Most car seats tend to tip the driver/passenger into a c-shaped slump, which puts pressure on the spine, joints and internal organs. Instead, car seat designers could help encourage a more upright position, as shown in the contrasting images below. So, what can we do to improve our existing car seats? Here are some suggestions to try out:
l Most cars allow some adjustments to be made to the height and position of the driver’s seat and steering wheel, so do explore all the options to find out what causes you the least strain. l Use a foam block or wedge to make the seat as flat and as level as possible to allow yourself to balance on your sitting bones (see below). l If the chair back is sloping backwards, bring it more vertical. If necessary use a foam block, wedge or cushion to help you stay more upright with a firm support behind you. l Try a small cushion at shoulder blade level (use elastic to attach it to the seat back).
How are you sitting?
It’s worth spending some time trying out the tips above. In my car, I now sit on a foam block that makes the seat level rather than bucket-shaped, and I have a foam wedge behind me as well as a small cushion at shoulder level − all of this allows me to sit upright, balanced on my sitting bones and without the headrest poking into me. However, even the best equipment in the world may not be enough to prevent backache. The most important factor is yourself and your “human ergonomics”. This is where the Alexander Technique can be so helpful. An Alexander teacher can enable you to discover how to drive with less effort and stress, sitting easily in balance, holding the steering wheel with less tension – and “rising above” the antics of fellow road users. If you’re trying to sit up straight or hold yourself upright
TALKBACK SELF HELP 15
you to despair? then you’re not on the right track. Good posture − like that seen in most toddlers − is effortless. It takes time, and Alexander work, to wake up the deep postural muscles that are the hallmark of a “strong back”, but a good start is to develop an awareness of your sitting bones and the support from underneath. So, find a reasonably firm chair to sit on and slide your hands under your bottom from each side so that you’re briefly sitting on your hands. Can you feel the bony parts of yourself that you’re sitting on? These are our sitting bones, the rocker-shaped bottom of the pelvis. Now you’ve found them, take your hands away and try gently shifting yourself forwards or backwards to get a sense of how to balance on them, allowing your weight to drop straight down through the chair.
How are you seeing?
Modern lifestyles, particularly the widespread use of mobile technology, are having the effect of narrowing our attention and visual field. Our vision is becoming more like a spotlight that focuses only on the specific object that our attention is currently on. This way of seeing can become a habit, one which is not helpful when driving! A safe driver is aware of everything around the current focal point, so that while looking at the road ahead, they will still immediately see movement at the periphery of their vision, such as if the door of a parked car they’re about to pass begins to open. If your visual field seems quite narrow or twodimensional and you’re
Skeleton driver balanced on its sitting bones and close-up of the back of the pelvis and lower spine, showing the sitting bones in contact with the supporting surface below interested in improving it, begin by spending a few minutes each day, perhaps when out on a walk, gazing at something and noticing the shapes and colours of what’s around it (these won’t be in focus). Initially, don’t experiment with this when driving in case it distracts you. Developing more natural, “panoramic” (more three-dimensional) vision can take time and practice but it will pay dividends in whatever you’re doing.
How are you thinking?
No doubt, you’ll be familiar with the stress of trying to get to an appointment in time and being delayed by traffic. And as we all know, stress usually makes back pain worse. The Alexander Technique helps us to shift our attention on to prioritising “looking after ourselves” (keeping our poise) rather than
over-focusing on the goal of getting there on time. Another unwelcome aspect of driving is other drivers behaving selfishly or aggressively. The next time another driver does something that annoys you, see if you can take a second and, rather than reacting unthinkingly, continue to keep your awareness of the road ahead and notice the support of the seat coming up through your sitting bones and the distance up to the crown of your head. Then slowly and gently exhale through your lips, as if you were blowing a small feather away. Repeat a couple of times, noticing the in-breath automatically coming in through the nose and the continuous cycle of breath with no holding. So do explore these ideas and see if you can discover a way of driving for a happier back.
The Alexander Technique is a taught self-care approach which offers people of any age or ability a way to improve their health and wellbeing. It can be applied in all situations in everyday life and can lead to better balance, co-ordination and freedom of movement and confidence www.julia-woodman.co.uk www.alexandertechnique. co.uk
TALKBACK l AUTUMN 2016
16 TALKBACK WORKPLACE
Stress in the workplace is relative, says US study WORKPLACE stress is relative and not everyone experiences stress in the same way or to the same degree. New thinking on the characteristics of stress among business professionals is offered by recent research in the United States. Deloitte’s study of more than 23,000 professionals found only 29% were often or always stressed and that there was a statistically significant variation in how respondents react to workplace stressors. Making an error topped the list of workplace stressors, with 82% of respondents indicating errors caused stress. Other types of situations experienced as stressful by respondents included: l A challenging workload, with long hours or juggling of multiple responsibilities (52%) l Moments of conflict, like getting reprimanded or delivering a difficult message (52%) l Situations that create urgency, like critical projects or time pressure (46%) l Face-to-face interactions, like delivering a presentation or meeting a new stakeholder (45%). Responses to stress questions were correlated with respondents’ patterns of behaviours and preferences based on Business Chemistry, a system designed to facilitate stronger relationships and better teamwork in the workplace. There are four primary Business
Image: freepik.com
TALKBACK l AUTUMN 2016
Chemistry types, which highlight similarities and differences in working styles: Guardians, who strive for certainty and stability, and Integrators, who value connection, were more likely to find all situations more stressful than Pioneers, who seek possibilities and love to explore, and Drivers, who love a challenge. Overall, most respondents reported modest levels of stress. Fourteen per cent reported being stressed only rarely and 57% reported being stressed sometimes, while 26% reported being stressed often, and 3% reported being always stressed. “Much likely depends on that person’s working style and preferences,” says Kim Christfort, National Director of Deloitte’s Greenhouse Experience team which was responsible for the report. “For example, while an urgent assignment might go against a Guardian’s preference for deliberate and methodical decision making, it may energise a Driver who tolerates risk and favours a brisk work pace. For leaders, understanding what motivates workers can help resolve workplace conflicts, empower staff and lead to better results as a team.”
Suzanne Vickberg, the Applied Insights Lead at Deloitte, added: “Organisations may want to pay special attention to their inward-focused team members to understand what might be done to reduce stress levels. Inward-focused types may bring particular strengths that can add value to a team — like conscientiousness, strong listening skills and detail-focus. Their tendency to be sensitive to others’ experiences and reactions can help improve team collaboration and performance, but they are often the most stressed – and overlooked – members of the team.” Coping strategies for dealing with stress included (in order of preference): l Action strategies, like diving right in and tackling the issue head-on l Cognitive coping strategies, like stepping back and thinking through possibilities l Groundwork, like getting organised or seeking further information l Interpersonal coping strategies including talking with someone and bouncing ideas l Taking time out to do something else, like socialising or exercising. www.businesschemistry.deloitte.com
TALKBACK WORKPLACE 17
Image: Massimo Zunino/freeimages.com
Reducing risk for an ageing workforce GROWING numbers of employers are adapting their premises in order to accommodate an ageing workforce. One in four UK workers is now aged over 50 and by 2030 the number of people in the UK over the age of 65 will have risen by 50%. In addition, the number of people over the age of 85 will have doubled. One futurologist Rohit Talwar, who helps businesses look at how the world will look in the future, has gone so far as to predict that children born today could work until they are 100 (and live to be 120). Older workers can bring a lot of benefits into the workplace. As the population ages, so it stands to reason that people will continue to work for longer. It may be necessary for employers to adapt their premises or incorporate specific products and equipment in order to accommodate older workers and they may need to ensure their health and safety policies and risk assessments are relevant to these workers. Assumptions shouldn’t be made about a worker’s capabilities solely because of his or her age. However, it is important to consider every individual’s physical capabilities, as well as any mobility issues, in relation to their job role, says Dominic Slingsby from workplace equipment supplier Slingsby. “Obvious areas where we
have seen lots of organisations investing include furniture and chairs, which might be designed to be ergonomic and offer high levels of support. In addition, safety footwear can become even more important for older workers in order to reduce the risks of slips and trips as far as possible.” Key considerations for organisations that employ an ageing workforce include: l Regular risk assessments for employees l Incorporate tasks into workstations that require the employee to change positions frequently l Design workstations so that arms remain below shoulder level and avoid repetitive motions that require workers to reach above their head l Try to reduce the amount of physical force that workers need to exert in manual handling operations l Restrict maximum loads that workers are required to lift or introduce equipment to ease the process l Offer job sharing or part-time schedules for workers. It shouldn’t be assumed that certain jobs are too demanding for certain workers and employers should make decisions based on capability and objective risk rather than age. www.slingsby.com
Occupational illnesses MORE than a million workers suffer illnesses caused by their work, despite most occupational illnesses being preventable. Figures from the Health and Safety Executive reveal some 27.3 million working days were lost due to work-related ill health or injury in 2014/15; 1.2 million people worked during that period suffering an illness they believed was caused, or made worse, by their work. Some of the most common conditions include stress, repetitive strain injuries, back pain, musculoskeletal disorders, asthma and a range of skin conditions, which can all be triggered or exacerbated by work. Employers must carry out regular risk assessments and invite employees to voice concerns about potential hazards. Rigorous procedures should also be implemented to ensure that all incidents of work-related ill health are reported. www.hse.gov.uk
TALKBACK l AUTUMN 2016
18 TALKBACK PAIN MANAGEMENT
In the UK, back pain is responsible for 37% of all chronic pain in men and 44% in women. To cope with the condition, 74% of people use painkillers as a quick fix to relieve discomfort. However, painkillers often mask the problem and don’t address many of the underlying causes of lower back pain, says the British Acupuncture Council. TALKBACK l AUTUMN 2016
Ten ways traditional can help ease your ba WITH 2.3 million acupuncture treatments carried out each year, traditional acupuncture is one of the most popular complementary therapies practised in the UK today. It involves gently placing extremely fine, sterile needles at specific points on the body to trigger a healing response. Alison Savory, a qualified member of the BAC, said: “With traditional acupuncture we look at the root of the condition as well as the symptoms to try to promote longer-term health and wellbeing.” Here, Alison offers her advice about how traditional acupuncture can provide a long-term health benefit. 1) Talk about it Don’t live with pain, have it treated! If you’re not happy with your current situation or diagnosis, get another opinion. Traditional acupuncturists will
be happy to discuss your problem and help you understand whether acupuncture can help you, before you commit to having any treatment. 2) Tailored for you Traditional acupuncture is a therapy that treats the whole person as an individual. This means each patient is treated as a unique individual so the acupuncture points chosen for one person with lower back pain may be different for another person with the same symptoms. 3) Pinpoint pain Contrary to popular belief, traditional acupuncture is not scary and painful, it’s actually a relaxing experience. Some people, of course, will be naturally wary of the needles but in fact, they’re single use, sterile and the same width as a human hair so they’re extremely
fine! To guarantee a high standard of safety and care, it’s important to find a fully qualified and insured acupuncturist registered with the British Acupuncture Council. 4) Natural pain relief By stimulating nerves located in muscles and other tissues, traditional acupuncture helps release “happy” hormones including endorphins and oxytocin, which are the body’s own natural pain-relieving hormones. These hormones can change the way the body processes pain, helping to reduce discomfort and distress. 5) Reduces inflammation Traditional acupuncture has also been shown to reduce inflammation and swelling by stimulating blood flow to the affected area and dispersing excess fluids to promote healing and aid recovery.
TALKBACK PAIN MANAGEMENT 19
acupuncture ack pain 6) Get moving again! Many patients find that even after one session of traditional acupuncture their movement and mobility will be improved and their muscles don’t feel as stiff. The number of sessions needed will depend on each individual and whether their pain is chronic. A traditional acupuncturist will put together a bespoke treatment plan during your initial consultation. 7) Minimise medication Many back pain sufferers are tired of being continuously on medication. Traditional acupuncture can potentially reduce the need for the long-term use of medications without the side effects often attributed to some pharmaceutical drugs. 8) Better outlook The holistic approach of traditional acupuncture means
the whole person is treated, body and mind. These two are often linked, especially when there is chronic pain. Once a patient has started to feel the benefit of treatment, the therapy can often restore a feeling of hope and positivity. 9) Cost-effective A 2006 study published in the British Medical Journal (BMJ) showed that a short course of acupuncture compared with “usual NHS care” was costeffective in the long term for persistent lower back pain. 10) Complementary If you’re reliant on your painkilling tablets, you’ll be pleased to hear traditional acupuncture works just as effectively alongside modern medication. In fact, it can even speed up the recovery process. Be sure to consult with your GP before undertaking numerous treatment plans.
A migraine is a complex neurological condition, which can affect the whole body and can result in many symptoms, sometimes without a headache at all
ACUPUNCTURE AND MIGRAINES RESEARCH has shown that traditional acupuncture can be very beneficial in the treatment of migraines as it tends to lessen the frequency and severity of attacks. NICE (National Institute for Health and Care Excellence) recommends acupuncture as a treatment option for headaches and migraines. Migraines can manifest in very different ways and a fully qualified acupuncture practitioner will want to know, among other things, exactly where the pain is located, what the nature of the pain is and whether the patient has any accompanying symptoms. An individual diagnosis and treatment plan is then tailored to the patient based on this information and on their general health history. To find a fully qualified traditional acupuncturist in your area, contact the British Acupuncture Council. www.acupuncture.org.uk
TALKBACK l AUTUMN 2016
20 TALKBACK CARERS
Lack of local support puts strain on A&E
Image: sxc
LACK OF appropriate support in the community is increasing the pressure on A&E, according to new research by Carers UK. The report “Pressure Points” found that four in ten carers who have taken the person they care for to A&E in the past 12 months believe their admission could have been prevented. Carers identified serious difficulties accessing primary and community support services, with one in five saying they had no option but to use A&E because it was impossible to see a district nurse or a GP out of hours, and one in 10 saying they didn’t know where else to go. There were more than 500,000 more visits to A&E in the first quarter of 2016, representing a 10% change on the same period last year. This growing demand on the NHS is also forcing many people to be discharged from hospital too early, often without the right support in place at home, which in some cases has led to readmissions. Heléna Herklots, Chief Executive of Carers UK, said: “Most care provided in England is not by doctors, nurses or care workers, but by family and friends. A lack of consultation, support and information at the point their loved one is discharged from hospital means many families are taking on a caring role in a crisis and feel unprepared. This isn’t sustainable and is leading to many people being readmitted to hospital shortly after they’ve been discharged, piling more pressure on an already stretched NHS. “With more families picking up caring responsibilities and older people with care needs being encouraged to stay at home for longer, a step-change is urgently needed to boost investment in community services and involve carers in decisions about the support they, and their loved ones, need to manage at home.”
Carers UK is calling for: l A Carer Friendly NHS programme, introducing a new duty on the NHS to identify carers and promote their health and wellbeing, as well as policies which ensure carers are involved in decision making around hospital admissions and discharges, and the adoption of a Carer Passport scheme
TALKBACK l AUTUMN 2016
l Increased funding for social care, with the Government putting in place a sustainable funding settlement for social care and ring fencing funding for carer breaks l Greater access to social care and healthcare in the community, including looking to new technologies to facilitate
virtual health consultations and access to electronic patient records l Greater support from primary care services to better help carers look after their own health, including annual health checks for carers and free flu jabs. www.carersuk.org
TALKBACK CARERS 21
Image: Bedneyimages – Freepik.com
As the population ages, we are going to need thousands more care workers to support increased need
80,000 care staff could be at risk because of Brexit CARE services for elderly and disabled people could be at risk because nearly 80,000 workers in the sector in England don’t have British citizenship and could lose their right to work in the UK following the vote for Brexit. That’s the warning from new research by Independent Age, the older people’s charity, and the International Longevity Centre-UK (ILC-UK). It says the risk is made worse because of failures to recruit enough British-born workers to meet the increasing demands of an ageing population. Around 1.43 million people currently work in the adult social care sector in England. Recruitment and retention of staff in the sector is a major challenge, with turnover rates and vacancy rates having risen significantly in the past 10 years. The social care watchdog the Care Quality Commission has previously warned of the impact of staff shortages on the safety and quality of social care.
Post-referendum, the status of EU migrants working in the UK remains unclear and the Prime Minister has yet to guarantee the rights of EU workers – or those from the EEA (European Economic Area). Simon Bottery, director of Policy at Independent Age said: “Care services for elderly and disabled people have come to rely on migrant workers, especially from the European Union, so the consequences could be severe if they are unable to work here in future. “As with the NHS, we need to secure the right for these essential workers to remain in the UK. But in the longer term we have to recruit more British born workers to social care and that means making sure they are well paid, well trained and secure in their jobs. That can’t happen without a commitment to fund the care sector properly.” l Of the almost 84,000 EEA migrants in the social care workforce, around 78,000 do not have British citizenship.
PROFITS UP IN UK CARE HOME SECTOR THE care homes sector remains a strong proposition for investors, with profitability increasing from 27.1% in 2014/15 to 27.5% in 2015/16, according to the latest research from Knight Frank. Knight Frank’s 2016 Care Homes Trading Performance Review shows that the sector has continued to be resilient despite ongoing economic uncertainty, with average weekly fees rising by 2.7% to £694. Increased life expectancy has driven the fifth consecutive year of care home occupancy with rates currently standing at 88.4%. With the number of people aged 80 and over in the UK expected to exceed five million by 2035, demand in this sector will continue to rise. Furthermore, demand is outstripping supply as rising staff costs due to factors such as the National Living Wage is forcing closure of unviable care homes. Staff costs have risen 3.2% this year amounting to 58.2% of income, and this is projected to continue over the next 12 months.
TALKBACK l AUTUMN 2016
22 TALKBACK OUTDOORS
How a change in prescription Doctors prescribing exercise outdoors to patients would get more people doing physical activity and help reduce obesity.
Image: Arcelia Vanasse/freeimages.com
RATHER than just issue prescriptions for medicines, if GPs wrote down moderate physical activity goals, it would benefit patients who are obese or overweight. These could include outdoor walks, activities in parks, or family exercise classes run by the local council. Some GPs already take part in schemes to get patients exercising and enjoying the great outdoors, such as in
Dartmoor and Exmoor. Councils, which have responsibility for public health, want to see the measures rolled out nationwide. The Local Government Association, which represents more than 370 councils, is calling for a similar model to the “green prescription” in New Zealand that gets people outdoors, to be introduced in England and Wales. In New Zealand, where the
THE ENERGY IMBALANCE Obesity is a complex problem with many drivers, including our behaviour, environment, genetics and culture. However, at its root obesity is caused by an energy imbalance: taking in more energy through food than we use through activity.
TALKBACK l AUTUMN 2016
FUNDING FOR FAMILY ACTIVITY The Sport England Strategy “Towards an Active Nation” (2016) set out a new investment of £40m into projects which offer new opportunities for families and children to get active and play sport together. This investment will focus on helping children acquire a basic level of competence in sport and physical activity as well as supporting them to have fun, regardless of their level of ability. scheme has been running since 1998, eight out of every 10 GPs have issued green prescriptions to patients. These are forwarded to a patient support person who encourages the patient to be more active through phone calls, face-to-face meetings or a support group. Progress is reported back to the GP.
A recent survey of patients given green prescriptions in the country found 72% noticed positive changes to their health, 67% improved their diet and more than half (51%) felt stronger and fitter. The latest guidelines for health professionals say that one in four patients would
TALKBACK OUTDOORS 23
can help reduce obesity Pilot schemes around the UK
Dartmoor and Exmoor
Green prescription-type pilots have been trialled in Devon and Somerset. A three-year scheme is under way where GPs are encouraging patients to visit the national parks as part of their treatment or as an alternative to medication. Surgeries provide Walking for Health Packs to promote walking in the outdoors. If successful, the scheme could be rolled out to national parks elsewhere. www.dartmoor.gov.uk exercise more if advised to do so by a GP or nurse. Research published in the British Medical Journal found that a green prescription can improve a patient’s quality of life over a year and help people live longer, healthier lives. “Not every visit to a GP is necessarily a medical one,” said Izzi Seccombe, chairman of the LGA’s Community Wellbeing Board. “Writing formal
Liverpool
Liverpool City Council and Liverpool Clinical Commissioning Group are delivering a £2.9m Liverpool Active City Strategy which includes GP referral schemes and activities in parks to tackle obesity and improve people’s health and wellbeing. www.liverpoolccg.nhs.uk prescriptions for exercise would encourage people to do more physical activity. “There are some instances where, rather than prescribing a pill, advising on moderate physical activity outdoors could be far more beneficial to the patient. This could be going on organised walks, conservation work with a local park group, or gardening at home. “The green prescription
COST TO THE ECONOMY We spend more each year on the treatment of obesity and diabetes than on the police, fire service and judicial system combined. It was estimated that the NHS in England spent £5.1 billion on overweight and obesity-related ill-health in 2014/15.
Dorset
East Riding
model is something that could help tackle major health conditions such as obesity and diabetes. There are already some good examples where this is being piloted in the UK, and it is something we should consider nationwide.” Steven Ward, Executive Director at ukactive, said Britain was in the grip of a “cradle to grave” physical inactivity crisis and believes the great outdoors is a fantastic gateway for getting people moving again. ukactive runs its own intervention programme “Let’s Get Moving”, which empowers at-risk patients to take part in regular physical activity.
He added: “Physical activity has been hailed as a miracle cure which can help to treat and prevent more than 20 lifestyle-related diseases and if GPs were to prescribe this it would bring huge benefits to people’s physical and mental health.”
Weymouth and Portland Borough Council is part of the Natural Choices group which runs activities for GPs to refer patients to. These include walks, conservation work, gardening and sailing. The programme is part of Live Well Dorset, commissioned by Public Health Dorset. www.dorsetforyou.gov.uk
East Riding of Yorkshire Council has developed an IT system which connects GPs with leisure centres so they can book patients directly on to an exercise-on-referral scheme. Patients are met by a trainer who is able to tailor a programme to suit the individual. www.eastridingleisure.co.uk
...AND NOW FOR THE GOOD NEWS! Natural England says that for every £1 spent on healthy walking schemes, the NHS could save £7.18 on the cost of treating conditions such as heart disease, stroke and diabetes.
TALKBACK l AUTUMN 2016
24 TALKBACK NEWS
TALKBACK l AUTUMN 2016