Quality Improvement in Urgent and Emergency Care (NHS Improvement / NHS England / Department of Health)

Summary

An earlier BBC News description of the problem:

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Reference

Cawley, L. (2017). Four-hour accident and emergency waits rise 300% at some hospitals. London: BBC Health News, March 16th 2017.

Further context and introductory analysis:

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Reference

Pym, H. (2017). Can the NHS cope better next year? London: BBC Health News, March 10th 2017.

Preparations for Winter: National Priorities for Acute Hospitals

A growing collection of practical resources is available from NHS Improvement, on improving urgent and emergency care services.

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Reference

Improving patient flow through urgent and emergency care. [Online]: NHS Improvement, July 2017.

This relates to:

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Reference

Good practice guide: focus on improving patient flow. London: NHS Improvement, July 14th 2017.

The main contents headings – covering the main areas for improvement (regarding safety, efficiency and effectiveness) in local urgent and emergency care programmes – include:

  • Why focus on patient flow?
  • Making it happen – good principles of patient flow.
  • The 10 areas for focus.
    • Ambulance handovers.
    • Primary care streaming.
    • Emergency departments.
    • Mental health.
    • Clinical decision units.
    • Ambulatory emergency care.
    • Acute assessment.
    • Frailty.
    • Specialties.
    • Admission, transfer, delays in discharge.
  • Appendix 1: The SAFER patient flow bundle and Red2Green days.
  • Appendix 2: Trusted assessment.

A collection of case studies:

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Reference

Case studies: focus on improving patient flow. London: NHS Improvement, July 14th 2017.

On trusted assessment schemes, which are said to be an important aspect of best practice for reducing delays in transfers of care between hospital and home:

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Reference

Developing trusted assessment schemes: essential elements. London: NHS Improvement, July 31st 2017.

Further documents in this series are expected soon…

Planning For Winter Pressures in A&E (NHS Improvement / NHS England)

The recommendations discussed above were developed in the context of growing pressures within the system. The following document examines how NHS England’s Emergency Medicine and Urgent Care system coped with Winter pressures last year in detail, and considers improvements for the coming Winter season.

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Reference

A review of winter 2016/17. London: NHS Improvement and NHS England, Summer 2017.

Planning For Winter Pressures in A&E (Department of Health)

The following report tackles the 27 conclusions and recommendations in the Health Select Committee’s November 2016 report on “Winter pressures in A&E Departments”.

Full Text Link

Reference

Government Response to Health Select Committee Report on Winter Pressure in Accident and Emergency Departments. Presented to Parliament by the Secretary of State for Health by Command of Her Majesty. London: Department of Health, July 2017. Cm. 9485.

Posted in Acute Hospitals, BBC News, Commissioning, Department of Health, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, Integrated Care, Management of Condition, National, NHS, NHS England, Non-Pharmacological Treatments, Person-Centred Care, Quick Insights, Standards, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Seventy Thousand Extra Care Home Places Required in England by 2025? (BBC News / Lancet)

Summary

Researchers at Newcastle University have confirmed the general view that people are living longer, but that the later years of life often require high levels care (whether in people’s own homes or in residential care). They estimate that there will be a further 350,000 people with high care needs by 2025.

Life expectancy increased by more than four years for both men and women to 82.6 and 85.6 years respectively between 1991 and 2011, while the number of those years spent with substantial care needs rose much more rapidly, from 1.1 to 2.4 for men and 1.6 to 3 years for women.

The Government has responded claiming that local authorities have been awarded an extra £2 billion per year to help develop a social care system which is more sustainable and better able to meet the demands of an ageing population, while reducing regional inequalities in the provision of care.

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Reference

Time spent frail in old age ‘doubles’. London: BBC Health News, August 16th 2017.

This relates to:

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Reference

Kingston, A. Wohland, P. [and] Wittenberg, R. [et al]; Cognitive Function and Ageing Studies Collaboration (2017). Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS). Lancet. August 15th 2017. [Epub ahead of print].

Further background on the likely shortfall in the number of UK care homes beds for elderly people in the more imminent future:

Full Text Link

Reference

Fenwick, S. (2017). Care homes face ‘huge shortfall’ in available beds. London: BBC Health News / BBC Radio 4’s You and Yours, August 2nd 2017.

Posted in BBC News, Commissioning, Community Care, Department of Health, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), In the News, Integrated Care, Management of Condition, National, Non-Pharmacological Treatments, Person-Centred Care, Quick Insights, Standards, Statistics, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 2 Comments

Suggestions for Improving the Management of Diabetes in People Living with Dementia (BMC Medicine)

Summary

The results of recent research into this topic.

Full Text Link

Reference

Bunn, F. Goodman, C. [and] Reece Jones, P. [et al] (2017). What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Medicine. July 28th 2017; 15(1): 141.

The earlier protocol for this review:

Full Text Link

Reference

Bunn, F. Goodman, C. [and] Malone, JR. [et al] (2016). Managing diabetes in people with dementia: protocol for a realist review. Systematic Reviews. January 7th 2016; 5: 5.

What Is the Realist Approach to Research?

Further information / explanation is available.

Posted in Assistive Technology, Commissioning, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), Integrated Care, Management of Condition, Models of Dementia Care, NHS, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, Systematic Reviews, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

More Spent on the NHS Than Previously Thought (BMJ / BBC News)

Summary

Previous estimates concerning the proportion of UK GDP spent on the NHS were probably on the low side:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Appleby, J. [and] Gershlick, B. (2017). Keeping up with the Johanssons: How does UK health spending compare internationally? BMJ. August 3rd 2017; 358: j3568.

Commentary and analysis from the BBC:

“ …the UK spent 9.8% of GDP on healthcare (including both the NHS and private health) in 2014. This was slightly above the average of 9.7% for the EU 15 (the member states before the new joiners in 2004)”.

Full Text Link

Reference

Pym, H. (2017). How much cake is cut for health spending? London: BBC Health News, August 11th 2017.

More Good News

The NHS was judged to operate with a relatively high level of efficiency in its use of resources, in a recent international comparison table.

Posted in BBC News, Charitable Bodies, Commissioning, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), Health Foundation, In the News, International, National, NHS, Nuffield Trust, Quick Insights, Standards, Statistics, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Unmet Social Care Needs of Older People Living in Their Own Homes (Ipsos MORI / NIHR / Age UK / NatCen Social Research / Independent Age)

Summary

Ipsos MORI, in association with the NIHR School for Social Care Research, Age UK, NatCen Social Research and Independent Age, have produced a report exploring the nature and extent of “unmet needs” for social care among older persons living in their own homes.

This research involved analysis of survey data from the English Longitudinal Study of Ageing (ELSA) and Health Survey for England (HSE), and found that probably over half of older people with social care needs have unmet needs. This is true of both people eligible for local authority support and for self-funders. People living alone appear to be particularly vulnerable.

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Reference

New report finds that unmet needs in social care among older people are widespread. Press Release. [Online]: Ipsos MORI, July 20th 2017.

This relates to:

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Reference

Unmet Need For Care. Final Report. Independent research funded by NIHR School for Social Care Research. London: Ipsos MORI; NIHR School for Social Care Research; NatCen Social Research; Age UK; [and] Independent Age, July 2017.

There is also an Executive Summary.

The main section headings comprise:

  • Setting the scene: participants’ care needs and support received.
    • Identifying types of needs.
    • Support received.
    • Onset and development of care needs.
    • Local authority contribution towards care costs or adaptations.
  • The hidden nature of unmet needs.
    • Reluctance to admit to having unmet needs.
    • What types of needs go unmet?
    • Even when needs are met, in full or in part, sources of support were often precarious.
    • The changing boundaries between met and unmet needs.
  • Why are some needs unmet?.
    • Lack of planning ahead.
    • Not wanting to be a burden.
    • The costs, affordability, and willingness to pay for care and support.
    • Interactions with Local Authorities.
    • Some needs can’t be met.
    • Lack of bespoke information and advice.
    • Difficulty accessing sources of information and advice.
    • Resilience, identity and independence.
    • Lack of confidence.
    • Reduced mobility and limited access to public transport.
  • The impact of unmet needs.
    • Links with mental health.
    • Links with well-being.
    • Social contact and well-being.
    • Impact on health and dignity.
  • Conclusion.
    • How care needs develop and how they are met.
    • The extent of unmet need and hidden unmet need.
    • The precarious nature of support and the transition from needs being met to unmet and vice versa.
    • Predictors of unmet need.
    • Resilience, coping and identity.
    • Mobility.
    • Social isolation.
    • Unmet needs and well-being.
Posted in Age UK, Charitable Bodies, Commissioning, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, Management of Condition, Mental Health, National, NIHR, Non-Pharmacological Treatments, Patient Care Pathway, Person-Centred Care, Personalisation, Quick Insights, Standards, Statistics, UK NSC, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Approaches to the Reduction of Preventable Hospital Admissions: a Systematic Review (BMJ Open)

Summary

A recent systematic review examined the alternatives to hospital admission for older patients at risk of unplanned hospitalisation. The broad categories of interventions considered were (i) improved use of paramedic / emergency care practitioners, (ii) interventions based in emergency departments, (iii) community hospitals and (iv) hospital-at-home services.

While detailed information about cost-effectiveness and patient acceptability is lacking at present, the authors consider that the results so far indicate many of the options available are safe and probably would reduce avoidable use of limited resources / acute care capacity.

Full Text Link

Reference

Huntley, AL. Chalder, M. Shaw, ARG. [et al] (2017). A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission. BMJ Open. August 1st 2017; 7(7): e016236.

Posted in Acute Hospitals, Commissioning, Community Care, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, Management of Condition, Models of Dementia Care, National, NHS, Non-Pharmacological Treatments, Person-Centred Care, Quick Insights, Standards, Statistics, Stroke, Systematic Reviews, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Technological Support for People Living With Dementia / Their Carers (SCIE)

Summary

The Social Care Institute for Excellence (SCIE) has produced a collection of web pages which explore the potential of new technology to support people living with dementia, and their families / carers. Suggested applications of information technology include access to information, entertainment / reminiscence materials and advice, plus the assistance and reassurance provided by telemonitoring and remote support.

“Used sensitively and thoughtfully, technology enhances rather than replaces human relationships and interactions”.

Full Text Link

Reference

Technology supporting people living with dementia and their carers. [Online]: Social Care Institute for Excellence (SCIE), July 2017.

Section headings comprise:

  1. Introducing technology: offers basic guidance on getting-off to a good start when introducing unfamiliar new technologies.
  2. Using technology for keeping in touch: discusses the wide range of communication channels open to people with dementia for keeping in-touch with family and friends, to maintain greater independence and meaningful relationships.
  3. Using technology for recording and maintaining a life story: covering the use of technology to create a summary of each person’s biographical experiences, their significant relationships, their likes and dislikes etc. Awareness of such biographical / personal details is an important foundation for the provision of person-centered care.
  4. Using technology for entertainment: this is about how technology offers unprecedented opportunities for recreation, fun and learning, for both patients and their carers / families.
  5. Using technology to inform, stimulate and engage: self-explanatory, but this section reveals much more than meets the eye.
  6. Being creative with technology: covering the opportunities new technology offers persons with dementia express themselves most creatively.
  7. Using technology to stay independent: exploring the scope for cost-effective means of technology-based support, without necessarily compromising care quality.
  8. Using technology in care homes: considering alternative methods to improve the care and support of residents.
Posted in Assistive Technology, Charitable Bodies, Commissioning, Community Care, For Carers (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, Management of Condition, Models of Dementia Care, National, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, SCIE, Telecare, Telehealth, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment