On targets: How targets can be most effective in the English NHS

Natalie Berry, Tim Gardner, Isobelle Anderson: October 2015 | The Health Foundation

on target report

On targets: How targets can be most effective in the English NHS explores how national targets can be used most effectively to improve the quality of care provided by the NHS in England. It builds on what is known about the impact of targets to identify good practice in designing and implementing new or improved targets.

This report was informed by a review of existing evidence, research into public attitudes and engagement with clinicians and managers from across the NHS and from national organisations including those with expertise in setting, managing and reviewing targets.

Key recommendations

  • National bodies involved in setting and managing targets must urgently develop a collective understanding about how current targets fit with their vision for the NHS over the next 5-10 years. Reviewing and potentially changing existing NHS performance targets will require strong political leadership.
  • Before deciding on a new national target, policymakers must consider whether it is the most appropriate means of achieving the desired outcome. Our report identifies five factors whose presence will increase the likelihood of targets effectively improving performance.
  • Any new target should be designed pragmatically (to manage gaps that may exist in the evidence base), collaboratively (with both patients and health care professionals) and iteratively (informed by regular review and adapted over time as necessary). The Health Foundation’s feedback loop model provides a framework to support policymakers in keeping new and existing targets under review.
  • To implement targets effectively, policymakers should focus less on penalties and more on supporting local commissioners and providers to develop the capacity and capability to make sustainable improvement. The creation of NHS Improvement provides an opportunity to refresh the approach to target management.

via On targets: How targets can be most effective in the English NHS | The Health Foundation.

NHS Workforce Statistics – July 2015, Provisional statistics

HSCIC Statistics

Provisional monthly figures for headcount, full-time equivalent, role count and turnover of NHS Hospital and Community Health Service (HCHS) staff groups working in England (excluding primary care staff).

As expected with provisional statistics, some figures may be revised from month to month as issues are uncovered and resolved. No refreshes of the provisional data will take place either as part of the regular publication process, or where minor enhancements to the methodology have an insignificant impact on the figures at a national level.

However, the provisional status allows for this to occur if it is determined that a refresh of data is required subsequent to initial release. Where a refresh of data occurs, it will be clearly documented in the publications.

The monthly publication is an accurate summary of the validated data extracted from the NHS’s HR and Payroll system. It has a provisional status as the data may change slightly over time where trusts make updates to their live operational systems.

Given the size of the NHS workforce and the changing composition, particularly during this period of transition, it is likely that we will see some additional fluctuations in the workforce numbers over the next few months, reflecting both national and local changes as a result of the NHS reforms.

These statistics relate to the contracted positions within English NHS organisations and may include those where the person assigned to the position is temporarily absent, for example on maternity leave.


Find more via Find data – Health & Social Care Information Centre.

Dementia—not all about Alzheimer’s

The Lancet: Volume 386, No. 10004, p1600, 24 October 2015


Dementia resulting from Alzheimer’s disease has catapulted into the public’s consciousness in the past few years. However, dementia has many causes—not just Alzheimer’s, and the symptoms of non-Alzheimer’s dementias can be very different. A three-paper Series in The Lancet summarises the most common non-Alzheimer’s disorders that cause dementia. In the first, Jee Bang and colleagues discuss frontotemporal dementia. The disorder has three variants: behavioural-variant, associated with behavioural deficits; non-fluent variant primary progressive aphasia, with language deficits; and semantic-variant primary progressive aphasia, a disorder of semantic knowledge and naming.

Related Series:

Non-Alzheimers dementia: The Lancet, Published: October 23, 2015
Non-Alzheimer’s dementias remain relatively unknown and often poorly diagnosed. More research is needed, not only for effective pharmacological interventions with disease-modifying effects, but also better differential diagnostic techniques to ensure the proper management and care of patients. A Series of three papers summarises the most common non-Alzheimer’s disorders that cause dementia: frontotemporal, Lewy body, and vascular. Read more

Related articles:

  • Jee Bang, Salvatore Spina, Bruce L Miller. Frontotemporal dementia. The Lancet, Volume 386, Issue 10004, 24–30 October 2015, Pages 1672-1682
  • Zuzana Walker, Katherine L Possin, Bradley F Boeve, Dag Aarsland. Lewy body dementias. The Lancet, Volume 386, Issue 10004, 24–30 October 2015, Pages 1683-1697
  • John T O’Brien, Alan Thomas. Vascular dementia. The Lancet, Volume 386, Issue 10004, 24–30 October 2015, Pages 1698-1706

via Dementia—not all about Alzheimer’s – The Lancet.

Improving UK healthcare: Nuffield Trust Strategy 2015 – 2020

The Nuffield Trust has launched a five-year strategy outlining how they will work with and support those leading change in the NHS. The Nuffield Trust will:

  • Improve the evidence base that leads to better care for people in the UK through research and analysis
  • Use it’s independence to provide expert commentary, analysis and scrutiny of policy and practice
  • Bring policy-makers and NHS staff together to raise issues and identify solutions

Work will focus on five key areas, selected for the opportunities to contribute to solving problems in the coming years:quality of carenew models of health care deliveryworkforceolder people and complex care; and providing independent scrutiny of government policies and the performance of the system.

Also of interest…as part of the new strategy, The Nuffield Trust have five new priority areas of work: quality of care; new models of care; workforce; older people and complex care; and NHS reform. Explore these priority areas via this new interactive tool.

Management of adult diabetes services in the NHS

The National Audit office has published The management of adult diabetes services in the NHS: progress review. This report shows that progress has been made in reducing the additional risk of death for people with diabetes and the additional risk of diabetes-related complications has been stable or has reduced for most complications. However, it estimates there are still 22,000 people dying each year from diabetes-related causes that could potentially be avoided.

The deviousness of dementia

The deviousness of dementia

By Dasha Kiper | The Guardian

In November 2010, when I was 25 years old, I moved in with a man who was 98. This man, whom I’ll call Mr Schecter, wasn’t a friend or relation or anyone I knew. He was a Holocaust survivor in the first stages of dementia, and I’d been hired to look after him. Although my background was in clinical psychology, I was by no means a professional caregiver. I was employed because Mr Schecter’s son – I’ll call him Sam – had seriously underestimated his father’s condition. Sam’s mistake was understandable. The most obvious paradox of dementia is the victim’s frequent inability to recognise it, and Mr Schecter went about his life as though burdened by the normal aches and pains of aging rather than by an irrevocable and debilitating illness. If he put the laundry detergent in the oven or forgot which floor he lived on, he’d shake his head and sigh, Mayn kop arbet nisht(“my head doesn’t work”). But it was a lament, not a diagnosis. And this denial, both clinical and profoundly human, led Sam to misjudge the illness as well.

Mr Schecter lived in a two-bedroom apartment on a pleasant, tree-lined street in the Bronx. For a man nearing 100, he was amazingly spry. Short, solidly built, with a firm handshake, Mr Schecter exhibited at our first meeting all the hallmarks of dementia. He repeated himself, his mind wandered, and he asked the same questions over and over. He also insisted that he didn’t need help, that he still went to work (he had, of course, stopped), and that if I rented a room from him, it would be on a month-by-month basis. More than anything else, he wanted me to understand that he had agreed to the arrangement only as a concession to his son.

Carry on reading via The deviousness of dementia | Dasha Kiper | Society | The Guardian.

The rise and rise of generic prescribing | The BMJ

BMJ 2015;351:h5507

Generic prescribing has made great savings for the NHS, but John Appleby warns that reproducing this success is not likely to provide a quick fix for current financial woes

Over the past 30 years there has been a remarkable change in the prescribing patterns of general practitioners. With the NHS facing a further five years of squeezed funding, and evidence of widespread overspending in the first quarter of this year as NHS providers attempt to meet growing demands,1 2 could the switch GPs have made to generic prescribing hold lessons for the productivity challenge the NHS faces?

Since the mid-1970s spending on primary care prescribing in the English NHS has grown fourfold in real terms—to £8.1bn in 2014-15 (fig 1⇓). This partly reflects the growth in the volume of prescribed items overall—from 285 million in 1976 to just over 1 billion in 2014-15.3 4 5 6 But it also reflects a change in the type of medicines prescribed and dispensed, and changes in their prices.

A key change has been the switch away from proprietary drugs still under patent to cheaper (but chemically identical) generic medicines.

Total spending on primary care prescribing by type of prescription and dispensing in England, 1976-77 and 2014-15 (2014-15 prices)

Carry on reading via The rise and rise of generic prescribing | The BMJ.

Screen all adults for high blood pressure, US panel recommends | The BMJ

BMJ 2015;351:h5514

All adults aged 18 and older should be screened for high blood pressure, but before treatment starts the diagnosis should be confirmed by either home blood pressure monitoring or, preferably, ambulatory blood pressure monitoring (ABPM), the US Preventive Services Task Force has concluded.1

The evidence that ABPM was best for diagnosing hypertension was “convincing,” the task force said in recommendations released on 13 October, adding, “Although the criteria for establishing hypertension varied across studies, there was significant discordance between the office diagnosis of hypertension and 12 and 24 hour average blood pressures using ABPM, with significantly fewer patients requiring treatment based on ABPM.”

High blood pressure, which often has no signs or symptoms, is a major contributing factor for heart failure, myocardial infarction, stroke, and chronic kidney disease. It affects about 30% of the US adult population and accounts for more than 362 000 deaths in the United States each year.

Adults aged 18 to 39 with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be rescreened every three to five years, the task force recommended. Adults aged 40 or older and those at increased risk for high blood pressure should be screened yearly. People at increased risk include those who have high-normal blood pressure (130-139/85-89 mm Hg), those who are overweight or obese, and African-Americans.

Read the full article via Screen all adults for high blood pressure, US panel recommends | The BMJ.

New NICE Guidance: [NG16]

Dementia News

Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset

This guideline covers mid-life approaches to delay or prevent the onset of dementia, disability and frailty in later life. The guideline aims to increase the amount of time that people can be independent, healthy and active in later life.

Who is it for?

  • Commissioners, managers and practitioners with public health as part of their remit, working in the public, private and third sector
  • The public.


The guideline includes recommendations on promoting a healthy lifestyle to reduce the risk of or delay the onset of disability, dementia and frailty by helping people to:

  • stop smoking
  • be more active
  • reduce their alcohol consumption
  • improve their diet and,
  • lose weight and maintain a healthy weight if necessary.


Evidence used to create this guideline (full guideline)

Guideline development process

How we develop NICE guidelines

Read the full…

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European Antibiotic Awareness Day

The objective for the 2015 Antibiotic Guardian campaign is for at least 100,000 healthcare professionals and members of the public to have committed to at least one pledge for prudent use of antibiotics on the Antibiotic Guardian website.

Antibiotic Guardian

These letters are to the NHS, local authorities, professional organisations and universities to:

  • inform about Antibiotic Guardian
  • request the registration of planned activities

To help Public Health England (PHE) identify opportunities to promote events, avoid duplication of effort and help inform the annual EAAD evaluation report,PHE invites organisations to register planned activities for EAAD via the online registration form.

via European Antibiotic Awareness Day: letters to NHS, local authority and professional organisations – Publications – GOV.UK.