Sustainability and transformation in the NHS

Sustainability and transformation in the NHS |  The National Audit Office

This report examines the progress the Department of Health and Social Care, NHS England and NHS Improvement have made towards achieving financial balance.  It provides a summary of the financial position of NHS England, CCGs and trusts. It also looks at what the Department, NHS England and NHS Improvement have done to support local NHS bodies to improve their financial positions; and examines the support the national bodies have given local NHS bodies to help them work better in partnership.

Full document: Sustainability and transformation in the NHS


Making sense of accountable care

This report from the Kings Fund explores accountable care, and looks at the following questions:

  • Why is there so much interest in accountable care?
  • What is accountable care?
  • How does accountable care fit into the current legislative framework for the NHS?
  • What is happening in practice?
  • What does accountable care mean for commissioning?
  • What’s happening with new care models?
  • What’s happening in accountable care systems?
  • How is accountable care being implemented?
  • What has accountable care achieved?
  • Is accountable care about making cuts and privatising services?

The report concludes that accountable care should be supported because it offers the best hope for the NHS and its partners to provide the integrated health and care services required to meet the needs of the growing and ageing population. However, the author say that it will not deliver results quickly which is why national and local leaders need to make a commitment over the long term to developing accountable care as the main way of providing and funding care in the future.

Full report: Making sense of accountable care | Kings Fund

See also: Accountable care explained | Kings Fund blog

Psychosocial interventions for people with dementia

New research finds good evidence to suggest that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills for people with dementia | Aging & Mental Health

Objectives: Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works.

Methods: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted.

Results: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews.

Conclusion: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.

Full reference: McDermott, O et al. | Psychosocial interventions for people with dementia: a synthesis of systematic reviews |Aging & Mental Health | Published online 17 Jan 2018

View the full article here


Healthy High Streets

This report is aimed at local decision makers and examines how high streets are used as an asset to improve the overall health of local communities.

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This review provides a rapid assessment of evidence relating to pedestrian friendly, healthy high streets in urban settings, with specific reference to design interventions and street furniture. Evidence relating to both children and adults is considered, alongside groups who may have specific needs or preferences such as older people, younger people, disabled people  and different ethnic groups.

For optimum health promotion, high streets should:

  • be inclusive of people from all walks of life
  • be easy to navigate, including crossings
  • provide shade, shelter and places to stop and rest
  • be walkable and provide options for cycling
  • have low levels of noise and air pollution
  • provide things to see and do
  • have a health-promoting retail offer
  • ensure people feel relaxed and safe
  • consider the local context of the high street, its features and current use, and how all these factors interact with one another

The review illustrates how, across a broad range of local stakeholders, a greater understanding of how place and people interact could help realise the potential of our high streets, and contribute to health and economic gains of our local communities.

Full review: Healthy High Streets: Good Place Making in an Urban Setting

Revised Never Events policy and framework

The Never Events policy and framework sets out the NHS’s policy on Never Events. It explains what they are and how staff providing and commissioning NHS-funded services should identify, investigate and manage the response to them.

Never Events are serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level, and should have been implemented by all healthcare providers.

The main changes to the revised policy and framework are:

  • the removal of the option for commissioners to impose financial sanctions on trusts reporting Never Events
  • to align the Never Events policy and framework with the Serious Incident framework, to achieve consistency across the two documents (a revised Serious Incident framework will be published later in 2018)
  • revisions to the list of Never Events, including two additional types of Never Event.

Full document: Never Events policy and framework – revised January 2018

See also: Never Events list 2018


Adoption and spread of innovation in the NHS

This report, commissioned by the Academic Health Science Network, looks at opportunities to accelerate the adoption of service innovation in the NHS, drawing on findings from eight case studies of successful spread of innovation in the NHS | Kings Fund


From new communication technologies for patients with long-term conditions, to new care pathways in liver disease diagnosis, to new checklists for busy A&E departments, the report details the highs and lows of an innovator’s journey through the NHS.

While thousands of patients are now receiving new innovative treatments for arthritis, diabetes, cardiovascular disease and chronic liver disease, thanks to successful innovations, the report outlines the significant barriers that stand in innovators’ paths.

The case studies reveal common themes:

  • Providers need to be able to select and tailor innovations that deliver the greatest value given local challenges and work in the local context.
  • Fragmentation of NHS services remains a barrier to adoption and spread of innovation, making it harder to develop shared approaches and transmit learning across sites.
  • New innovations may appear simple to introduce but can have a domino effect – triggering a series of changes to diagnosis and treatment, revealing new patient needs and resulting in big changes to staff and patient roles. That’s why staff need time and resources to implement them.
  • As long as the NHS sets aside less than 0.1% of available resources for the adoption and spread of innovation, a small fraction of the funds available for innovation itself, the NHS’s operating units will struggle to adopt large numbers of innovations and rapidly improve productivity.

Full report: Adoption and spread of innovation in the NHS


Funding system failing people with continuing healthcare needs

Report suggests the Government must take steps to improve the complex process for obtaining funding which is beset with delays and poor-quality assessments. | Public Accounts Committee

NHS continuing healthcare (CHC) funding is intended to help some of the most vulnerable people in society, who have significant healthcare needs. This report finds that too often people’s care is compromised because no one makes them aware of the funding available, or helps them to navigate the hugely complicated process for accessing funding. Those people that are assessed spend too long waiting to find out if they are eligible for funding, and to receive the essential care that they need.

This report from the Public Accounts Committee finds that the Department of Health and NHS England recognise that the system is not working as well as it should but are not doing enough to ensure CCGs are meeting their responsibilities, or to address the variation between areas in accessing essential funding.

Full report: NHS continuing healthcare funding: Thirteenth Report of Session 2017–19