Patients with health anxiety are increasingly common. Photo: Getty
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Health anxiety – the silent epidemic ignored by the NHS

A doctor gives his perspective on our most overlooked widespread medical condition: anxiety about our health.

"Thank you for waiting, Mr Collins. We have now completed all our tests and are very pleased to let you know that they are completely normal. You can now be discharged."

Mr Collins’ face falls. "But I’ve still got the symptoms," he says. "I’m no better than when I came to see you three months ago and you did all these tests."

"I quite appreciate that, Mr Collins," the doctor replies. "But there is nothing more that cardiology/respiratory medicine/endocrinology/gastroenterology/neurology can do for you. Perhaps it might be related to stress. Goodbye."

This conversation, or variations of it, crops up hundreds of times a day in hospitals up and down the country. Each one of these "consultant episodes", as they are called in official statistics, costs an average of £600, takes up valuable out-patient or A&E time unnecessarily, and clogs up an already over-worked system. As many as one in five of all consultations in hospitals come into this category.

So what is going on here and why is nothing being done about it? The condition Mr Collins has is called health anxiety, a somewhat modified term that overlaps with the older one of hypochrondriasis, a condition long thought to be untreatable. People with health anxiety worry excessively about their health and one of their main tasks in life is to monitor it constantly.

When they get symptoms such as chest pain, breathlessness, muscle twitching, headache and the many other symptoms that to most others are regarded as fairly trivial, they fear they may have a serious illness. So chest pain equates to a heart attack, breathlessness to lung cancer, muscle twitching to motor neurone disease, and headache to brain tumours. The patient’s personal health monitor moves into overdrive and an appointment is made with the doctor or, if regarded as an emergency, leads to a 999 call or a trip to the A&E department.

All the evidence suggests this condition is becoming more common; it is being reinforced by searching symptoms online. You have to wait for a medical appointment, but the internet doctor is available around the clock. It knows everything and nothing – you get a full list of all the underlying causes of symptoms, but precious little about their likelihood. And the health-anxious patient is inexorably drawn to the description of the least common but most serious conditions, and this only reinforces their anxieties. The internet version of health anxiety is now known as "cyberchondria".

About one in 16 people suffer from health anxiety, and most of those with the condition have had it for several years. So why is nothing apparently being done about this silent epidemic that represents a major source of suffering and a drain on resources in the NHS? 

There are three clear reasons: 

The first is that most people with health anxiety do not think they have a disorder and so defend their health-seeking behaviour, often tenaciously, and make appointment after appointment with as many doctors who are prepared to listen to them.

The second is that most doctors in general hospitals are not trained to recognise health anxiety, only to diagnose or exclude conditions within their speciality, and do not realise that there are successful psychological treatments available for the condition that are so much better than the standard reassurance currently being meted out. Nurses in general hospitals have been shown to be highly effective therapists for health anxiety and can be readily trained.

The third is the perverse incentive of what is called "payment by results" – the system by which hospital trusts are paid by the number of people they see and the assessments and interventions associated with their care. It is not really payment by results, merely payment by activity, even if the activity is pointless.

This paradoxically leads to people with health anxiety being more likely to be over-investigated, as each test brings in extra cash, even though most are largely unnecessary. In our own experience, we have encountered this in suggesting at one trust that a new service be set up for people with health anxiety. A business case was prepared but we very quickly had a response, along the lines of: "This is a no-brainer. If we introduce this service we will lose money. Please go away."

So what can be done now? In the NHS five-year plan accepted by all political parties before the election, chair of NHS England Simon Stevens gave special attention to initiatives to improve mental health and made this plea: "Over the next five years, the NHS must drive towards an equal response to mental and physical health, and towards the two being treated together."

Yes indeed it must, but even if implemented, this would not improve the care of those with health anxiety unless we can increase recognition of the condition by all staff in general hospitals, provide a proper cost-effective service for the condition, and get rid of the perverse funding incentive.

When Andy Burnham visited us at the Royal College of Psychiatrists before the election to promote "parity of esteem" for mental health, I asked him about this unintended consequence of payment by results, as this was introduced by the Labour government ten years ago.  He agreed it needed major reform as it was no longer fit for purpose. Let us hope the present government can also see the light.

Peter Tyrer is a doctor.

Photo:Getty
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Why isn't Labour putting forward Corbynite candidates?

Despite his successes as a candidate, the organisational victories have gone the way of Corbyn's opponents. 

The contest changes, but the result remains the same: Jeremy Corbyn’s preferred candidate defeated in a parliamentary selection. Afzhal Khan is Labour’s candidate in the Manchester Gorton by-election and the overwhelming favourite to be the seat’s next MP.

Although Khan, an MEP, was one of  the minority of Labour’s European MPs to dissent from a letter from the European parliamentary Labour party calling for Jeremy Corbyn to go in the summer of 2016, he backed Andy Burnham and Tom Watson in 2015, and it is widely believed, fairly or unfairly, that Khan had, as one local activist put it, “the brains to know which way the wind was blowing” rather than being a pukka Corbynite.

For the leader’s office, it was a double defeat;  their preferred candidate, Sam Wheeler, was kept off the longlist, when the party’s Corbynsceptics allied with the party’s BAME leadership to draw up an all ethnic minority shortlist, and Yasmine Dar, their back-up option, was narrowly defeated by Khan among members in Manchester Gorton.

But even when the leadership has got its preferred candidate to the contest, they have been defeated. That even happened in Copeland, where the shortlist was drawn up by Corbynites and designed to advantage Rachel Holliday, the leader’s office preferred candidate.

Why does the Labour left keep losing? Supporters combination of bad luck and bad decisions for the defeat.

In Oldham West, where Michael Meacher, a committed supporter of Jeremy Corbyn’s, was succeeded by Jim McMahon, who voted for Liz Kendall, McMahon was seen to be so far ahead that they had no credible chance of stopping him. Rosena Allin-Khan was a near-perfect candidate to hold the seat of Tooting: a doctor at the local hospital, the seat’s largest employer, with links to both the Polish and Pakistani communities that make up the seat’s biggest minority blocs.  Gillian Troughton, who won the Copeland selection, is a respected local councillor.

But the leadership has also made bad decisions, some claim.  The failure to get a candidate in Manchester Gorton was particularly egregious, as one trade unionist puts it: “We all knew that Gerald was not going to make it [until 2020], they had a local boy with good connections to the trade unions, that contest should have been theirs for the taking”. Instead, they lost control of the selection panel because Jeremy Corbyn missed an NEC meeting – the NEC is hung at present as the Corbynsceptics sacrificed their majority of one to retain the chair – and with it their best chance of taking the seat.

Others close to the leadership point out that for the first year of Corbyn’s leadership, the leader’s office was more preoccupied with the struggle for survival than it was with getting more of its people in. Decisions in by-elections were taken on the hop and often in a way that led to problems later down the line. It made sense to keep Mo Azam, from the party’s left, off the shortlist in Oldham West when Labour MPs were worried for their own seats and about the Ukip effect if Labour selected a minority candidate. But that enraged the party’s minority politicians and led directly to the all-ethnic-minority shortlist in Manchester Gorton.

They also point out that the party's councillor base, from where many candidates are drawn, is still largely Corbynsceptic, though they hope that this will change in the next round of local government selections. (Councillors must go through a reselection process at every election.)

But the biggest shift has very little to do with the Labour leadership. The big victories for the Labour left in internal battles under Ed Miliband were the result of Unite and the GMB working together. Now they are, for various reasons, at odds and the GMB has proven significantly better at working shortlists and campaigning for its members to become MPs.  That helps Corbynsceptics. “The reason why so many of the unions supported Jeremy the first time,” one senior Corbynite argues, “Is they wanted to move the Labour party a little bit to the left. They didn’t want a socialist transformation of the Labour party. And actually if you look at the people getting selected they are not Corbynites, but they are not Blairites either, and that’s what the unions wanted.”

Regardless of why, it means that, two years into Corbyn’s leadership, the Labour left finds itself smaller in parliament than it was at the beginning.  

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.