Urgent care commissioning standards guidance

NHS England has published Commissioning standards: integrated urgent care.  This document outlines the standards which commissioners should adhere to in order to commission a functionally integrated 24/7 urgent care access, treatment and clinical advice service.  It aims to bring urgent care access, treatment and clinical advice into much closer alignment through a consistent and integrated NHS 111 service model

Learning from an intrepid pioneer: integrated care in North West London

by Judith Smith and Gerald Wistow for the LSE Health and Social Care Blog

Putting integrated care into practice

There is broad agreement in policy circles that integration of health services and social care is something that really should be sorted out, and soon. Evidence from the Nuffield Trust and LSE evaluation of the largest of the original 14 National Integrated Care Pioneer sites announced by the then Health Minister Norman Lamb in 2013 suggests that this is in fact much more difficult than it might at first appear.

Our research – from February 2014 to April 2015 – sought to provide an independent assessment of the way in which the WSIC programme was designed and implemented in its early stages, and how far it was on track towards achieving its objectives. It was commissioned by Imperial College Health Partners (ICHP), and funded by ICHP and the collaboration of clinical commissioning groups (CCGs) in North West London.

WSIC’s territory stretches out from Westminster to the outer suburbs and comprises two million people with significant variations in their levels of deprivation and health status. The programme brings together a complex web of agencies including eight clinical commissioning groups (CCGs), seven local authorities, nine hospital trusts, four providers of mental health and/or community services and over 400 GP practices.

We found that the North West London approach to developing integrated care was large in scale, ambitious and very well resourced, when compared with other integrated care pioneers. This was reflected in the scope and scale of its management and development resources, its extensive programme for co-designing new models of care, and the impressive commitment it showed to involving local people and organisations in its planning and governance.

Read the full article via Health and Social Care – Learning from an intrepid pioneer: integrated care in North West London.

Survey of Early adopter steering committee members

New ways to engage with research evidence

Evidence-Based Practice: why aren’t we doing it?

By Andre Tomlin for the Mental Elf

It’s 20 years since evidence-based medicine (EBM) first hit our shores (Sackett et al, 1996) and in that time we have seen this approach to practicing medicine move from a position of heresy to one of absolute orthodoxy. So how come we’re not all doing it?

A decade ago I was struck (in the billiard room) by Dr Glasziou with an Evidence Pipeline. I’ve never felt quite right since. It’s a simple idea, that there are seven stages along which evidence needs to travel, in order to reach patients. Even with good (i.e. 80%) adherence at each stage, the chances of evidence reaching practice is only about 21%.

Glasziou and Haynes show how leaks along the evidence pipeline prevent research getting into practice.

Our own recent White Paper has highlighted the avalanche of reliable research that buries all of us working in mental health every day (Badenoch et al, 2015). Clearly, finding relevant and reliable evidence remains a huge challenge, but just as important are lack of time, the motivation to engage with research, skills to appraise and understand evidence, and the wherewithal to use research in practice. This evidence-based practice malarkey is hard!

The conclusions of our White Paper were:

  • The currency of our knowledge degrades over time
  • Research is inaccessible to the majority who don’t have the skills to appraise it or use it in practice
  • It’s impossible to keep up to date with the quantity of research now being produced
  • We need accessible, usable and reliable summaries of new evidence
  • Blogs and social media can help us find, use and discuss relevant evidence

You won’t be surprised to hear me extolling the virtues of blogging and tweeting as a great way to learn about new evidence, but it doesn’t end there.

André Tomlin – New ways to engage with research evidence: 6 top tips for #NPNR2015

Read the full article via New ways to engage with research evidence

Backlash against “pinkwashing” of breast cancer awareness campaigns

BMJ 2015;351:h5399

pink bow

Big business is keen to jump on the breast cancer awareness bandwagon but do its messages around screening do more harm than good? Meg Carter reports

Each October, breast cancer awareness month provides an annual focus for pink ribbon themed campaigns—many of which are backed by commercial partners eager to be seen to support a worthy cause.

The pink ribbon began as a grassroots movement, with survivors wearing ribbons to show solidarity with each other.1 But it was quickly appropriated by commercial businesses such as Estée Lauder and breast cancer organisations, led by the US based Susan G Komen Foundation, to show support ranging from financial donations to goodwill.2

The amount of cash raised with commercial backing can be substantial. America’s Breast Cancer Research Foundation, founded by former Estée Lauder senior vice president Evelyn Lauder, has raised £207m ($320m; €280m) in donations since 1993. Asda’s Tickled Pink campaign, meanwhile, has raised £44m for Breast Cancer Care and Breast Cancer Now since 1996.3

However, commercial involvement in breast cancer campaigning has drawn criticism from organisations such as US group Breast Cancer Action (BCA), which works to raise awareness of the more questionable cause related marketing activities by businesses, known as “pinkwashing.”

BCA, which runs an initiative called Think Before You Pink, is critical of the inappropriateness of some commercial partnerships—one engineering firm produced pink drill bits for fracking, for example4—and lack of transparency about how much money companies actually donate. And it condemns an overemphasis in campaign messaging on breast cancer screening.

via Backlash against “pinkwashing” of breast cancer awareness campaigns | The BMJ.

Patient falls in hospitals: An increasing problem

Geriatric Nursing: Volume 36, Issue 5, September–October 2015, Pages 342–347

Despite six decades of worldwide efforts that include publishing virtually hundreds of related epidemiological-type studies, there has been an increase (estimated to be 46% per 1000 patient days from 1954–6 to 2006–10) in the number of patient falls in hospitals and other health care facilities.These still occur most frequently near the bedside or in the bathroom, among mentally confused or physically impaired patients, and often involve those with greater comorbidity.

The reasons that hospitals during the past half century have demonstrated a significant increase in patient falls per discharge or per patient days are numerous, are not completely surprising, and are certainly interrelated: improved accident reporting systems; on the average older, more impaired, more acutely ill, and more heavily sedated patients; and, less time spent by nursing personnel at the bedside.

Most safety committees are not as effective as they should be, since they have difficulty in implementing a long-term, aggressive, facility-wide prevention program. Within that context, it may be worthwhile to discuss the advantages of nursing leadership rather than a representative of the facility’s management staff to chair these safety committees.

via Patient falls in hospitals: An increasing problem.

Commissioning excellent nutrition and hydration

New guidance to raise awareness of the importance of good nutritional care

Nutrition and hydration guidance

NHS England has today published new guidance to help ensure patients receive excellent nutrition and hydration care.

The guidance has been produced to address the issues raised within ‘Hard Truths’ and the Francis Report; and to the concerns of patient, carers and the public with regard to malnutrition and dehydration.

Malnutrition is still a concern for the health service and is more common than many people expect – affecting more than three million people in the UK at any one time.

Around 1 in 3 patients admitted to hospital or who are in care homes are malnourished or at risk of becoming so.

Poor nutrition and hydration not only harms patients’ health and wellbeing, it can also reduce their ability to recover and leads to increased admissions to hospitals and care homes.

The new guidance draws together the most up-to-date evidence based resources and research to support commissioners to develop strategies to help ensure excellent nutrition and hydration care in acute services and the community.

It also outlines why commissioners should make this issue a priority – how to tackle the problem, how to assess the impact of commissioned services and highlighting the good work which is already underway.

via NHS Commissioning » Commissioning excellent nutrition and hydration.