STPs will need a change in law to succeed, says report

A report from London Southbank University argues that in order to deliver a better future for the NHS, all 44 STPs would need to be given legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role | NHS England

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Image source: LSBU

We commissioned this report as a reality check on the Sustainability and Transformation Plan process as a whole; to provide an opportunity for review; and to reconvene around the issues that need a sub-regional approach.

This report is a significant contribution to the myths and realities of the Sustainability and Transformation Plans and the process of their development. By starting from the actual situation in each STP footprint, this report grounds the plans in the reality of the local context, and provides a firm basis for any collective decision-making. Many of the STPs (the documents) are not clear about the full extent of the current situation (the baseline from which they are making their plans), which makes the collective STP leadership task extremely difficult.

 

Getting research into policy in health – The GRIP-Health project

For many, the idea that health policy should be informed by evidence is an obvious goal. And indeed, the global health community has widely called for increased use or uptake of research and evidence, in health policymaking | LSE Health and Social Care Blog

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However, a vast majority of these calls have been made without explicit recognition of the decidedly political nature of policymaking, and without consideration of how this may affect the use of evidence to inform decisions.

Indeed, calls for ‘evidence-based’ policymaking have become ubiquitous in recent years, applied in social sectors such as health, education, crime prevention and many others. Many have seen these calls deriving from the successes of the ‘evidence based medicine’ movement – a movement that has helped to ensure that clinical practice is informed by rigorous assessments of evidence of effects of different treatment options.

The GRIP-Health research programme was funded by the European Research Council to bring an explicitly political lens to the study of evidence use for health policymaking in low, middle and high income countries. It draws particularly on policy studies theories to consider how the nature of the policy process, the politicised features of health decisions, and the existing institutional arrangements for policymaking in different countries all can work to shape which evidence is utilised, and how it is utilised to inform or shape health policy decisions.

Winter warning: managing risk in health and care this winter

Leaders of NHS trusts in England are deeply concerned about the NHS’s ability to respond to mounting pressures next winter, according to a new report published today by NHS Providers.

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Winter Warning highlights the worries of many NHS trusts that extra funding for social care, partly allocated to ease winter pressure on the health service, is not consistently getting through to the NHS.

The report sets out in detail how the NHS responded earlier this year to what many consider to be the toughest winter on record. Despite extraordinary efforts from staff, the health and care systems struggled to cope under sustained pressure.

A key factor was the sharp rise in delayed transfers of care (DTOCs), for patients who were ready to be discharged, often because of difficulties in lining up suitable social care.

The government’s response in the spring budget was to use the £1 billion of extra social care funding for the current financial year to try to reduce social care-related NHS DTOCs, and so ease pressure on trusts.

The clear message in Winter Warning is that, in many places, this is not happening.

  • Overview
  • Report

A&E cuts will hit 23m people, British Medical Association says

Nearly 23 million people in England – more than 40% of the population – could be affected by proposed cuts to A&E departments, doctors are warning | BBC News

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The analysis of NHS plans by the British Medical Association also warned the changes were being rushed through without the evidence they will work. The proposals have been put forward by local managers seeking to make savings under the direction of NHS England. Bosses have argued services in the community will be boosted in return.

Under the so-called “sustainability and transformation programme” (STP), England has been divided into 44 areas and each asked to come up with its own proposals.

After analysing local plans, the BMA found:

  • 18 of them, covering a population of 22.9 million, involved the closing or downgrading of an A&E department
  • 14 of them, responsible for 17.6 million patients, propose closing or merging a hospital
  • 13 of them, covering a population of 14.7 million, have put forward closing hospital beds

Read the full news story here

Why UK hospital staff find it difficult to make improvements based on patient feedback

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services | Social Science and Medicine

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This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.

A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback.

Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’.

  • First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise.
  • Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment.
  • Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted.

Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

Full reference: Sheard, L. et al. (2017) The Patient Feedback Response Framework – understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Social Science & Medicine. 178. pp. 19-27.

 

Government ‘reneging on promise to fund 10,000 extra nursing places’ | via @guardiannews

Scrapping nursing bursaries was supposed to expand training places – but that pledge has been quietly dropped, universities say | The Guardian

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Universities are warning that the government is quietly reneging on its promise to provide 10,000 new nursing degree places, intended to relieve pressure on the NHS.

Student nurses must spend 50% of their degree working under supervision, usually in a hospital. But universities have told Education Guardian that not a single extra nursing training place has been funded or allocated for the future. It would cost £15m over five years to fund training placements for 10,000 new nurses, according to the Council of Deans of Health, the body that represents university faculties of nursing.

Applications to study nursing in the new 2017-18 academic year have slumped by 23% compared with last year, after the abolition of bursaries. The government said last year it would free up £800m and pay for an extra 10,000 places by ending bursaries and shifting student nurses to the standard system of £9,000-a-year tuition fees supported by loans. Angry academics now say this was a hollow promise.

Read the full news story here

Missing data has risked GPs’ patient care

Missing patient data that was mistakenly held in storage for years has led to around 1,700 cases of potential harm caused to GPs’ patients, according to a report published today by the National Audit Office (NAO) | OnMedica

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The NAO’s Investigation: clinical correspondence handling at NHS Shared Business Services report details the watchdog’s investigation into how NHS Shared Business Services (NHS SBS) – an agency contracted by the government to run some back-office operations in the NHS – handled unprocessed clinical correspondence.

Significant amounts of important data on patients including test results and diagnoses were delayed mistakenly between 2011 and 2016 by the NHS Shared Business Services agency before they were delivered to hospitals and GP surgeries.

This data, which included copies of test or screening results, and communications about planned treatment following appointments with other healthcare providers, was sent by hospitals and other GPs to practices where the patient had moved away or was unknown, so needed to be redirected.