NHS Commissioning of Specialised Services

This Commons Library briefing paper looks at the commissioning of specialised services by the NHS in England, for patients with rare or complex conditions | House of Commons Library

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How the commissioning process works is set out in further detail, as well as analysis of the financial management and transparency of specialised commissioning, and recent reforms introduced by NICE and NHS England, including reforms to the Cancer Drugs Fund.

The specialised commissioning budget for 2017/18 is £16.4 billion, 14.9% of the total NHS budget, and is set to rise to 15.8% by 2020/21 to reflect the increasing use of new treatments for previously untreatable conditions.

In its 2016 report, the National Audit Office (NAO) highlighted problems that NHS England had experienced in living within its budget. Some of the reasons for this included an underestimation of the budget required to effectively commission services when NHS England took over commissioning responsibility in 2013, as well as a lack of effective data on how services are commissioned on a regional basis, and problems with effective negotiation of prices with pharmaceutical companies.

This briefing paper looks in details at some of the issues highlighted by the NAO, and recent changes to the commissioning process that allow for a greater degree of cost control.

Constructive conversations with citizens when implementing new models of care

Wicked issues – complex problems that cannot be solved in a traditional fashion – are endemic in the NHS. They are nothing new. But the current challenges facing the NHS, social care and others are arguably the most ‘wicked’ yet | SCIE

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Image source: SCIE

This report summarises the findings from a research study which sought to explore how we can better broker constructive conversations with citizens to tackle wicked issues when implementing new models of care. The research was undertaken by the Social Care Institute for Excellence, working in partnership with PPL and the Institute for Government and funded by the Health Foundation’s Policy Challenge Fund.

“I’m Still Here”: Personhood and the Early-Onset Dementia Experience

The current study examined the lived experience from the point of view of four adults younger than 65 with dementia, particularly how they perceive their personhood | Journal of Gerontological Nursing

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Using interpretative phenomenological analysis as the research approach, findings revealed that the EOD experience can be incorporated into six themes: (a) A Personal Journey, (b) Navigating the System, (c) The Stigma of Dementia, (d) Connecting to the World, (e) A Story Worth Telling, and (f) I’m Still Here. Participants’ stories, as presented via these six thematic threads, reveal that individuals with EOD can have a strong sense of personhood. Findings are discussed and situated within the current EOD body of knowledge, and new knowledge is presented. Implications for practice and recommendations for future research are discussed.

Full reference: Sakamoto, M.L. et al. (2017) “I’m Still Here”: Personhood and the Early-Onset Dementia Experience. Journal of Gerontological Nursing. 43(5) pp. 12-17

Eggs can significantly increase growth in young children

Eggs significantly increased growth and reduced stunting by 47 percent in young children, finds a new study from a leading expert on child nutrition | ScienceDaily

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Eggs significantly increased growth and reduced stunting by 47 percent in young children, finds a new study from a leading expert on child nutrition at the Brown School at Washington University in St. Louis. This was a much greater effect than had been shown in previous studies.

Eggs were shown to increase standardized length-for-age score and weight-for-age score. Models indicated a reduced prevalence of stunting by 47 percent and underweight by 74 percent. Children in the treatment group had higher dietary intakes of eggs and reduced intake of sugar-sweetened foods compared to control.

80% of under-twos in England didn’t visit an NHS dentist last year

Faculty of Dental Surgery says ‘widespread misunderstanding’ among parents over when to visit dentist leads to children having to have rotten teeth removed

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The Faculty of Dental Surgery (FDS) at The Royal College of Surgeons has analysed on the latest NHS Digital dental statistics for children and found that approximately 80% of children between the age of one and two didn’t visit an NHS dentist in the twelve months leading up to March 31st 2017.

The FDS is warning that there is a widespread misunderstanding among parents about when a baby should visit the dentist. NHS dental check-ups for children are free. Official Public Health England guidance states that parents and carers should ensure their child has a dental check-up as soon as their teeth start to appear, which is usually at around six months old.

Many of the 9,220 cases of tooth extractions performed in hospitals on children aged one to four during 2015/16 can be attributed to tooth decay, which the FDS points out is 90% preventable.

Does home-based primary care improve patient outcomes?

An Overview Of Home-Based Primary Care: Learning From The Field | Commonwealth Fund

This Commonwealth Fund briefing synthesises the evidence and expert perspectives on how outcomes and costs are affected by utilising home-based primary care for housebound or functionally-limited patients. It finds that successful home-based primary care uses multidisciplinary teams, behavioural insights, social support and rapid response to acute care needs to reduce care costs and improve patient outcomes.

The briefing concludes that successful home-based care practices have achieved robust savings, but the future of the model will rely on innovative payment models and training initiatives.

Digital technology and adolescent conduct problems

Adolescents spend an unprecedented amount of time using digital technology to access the Internet and engage with social media. There is concern that this continuous connectivity could increase their mental health symptoms, especially for at-risk adolescents. | Journal of Pediatric Nursing

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A new US study has reported that on days that at-risk adolescents used technology more, they experienced more conduct problems and higher attention-deficit hyperactivity disorder (ADHD) symptoms compared to days when they used digital technologies less.

However, the study also found that on days when adolescents spent more time using digital technologies they were less likely to report symptoms of depression and anxiety.

Key findings:

•Daily digital technology use by at-risk adolescents is associated with worse mental health symptoms.
•Higher levels of digital technology use were associated with increases in next-day conduct problems.
•Attention-deficit hyperactivity disorder symptoms increased with increased digital technology use.
•When adolescents spent more time using digital technologies they reported fewer symptoms of depression and anxiety.

Full reference: McBride, Deborah L. Daily Digital Technology Use Linked to Mental Health Symptoms for High-risk Adolescents. Journal of Pediatric Nursing: Nursing Care of Children and Families. Published online 7th June 2017