Reducing waste and inefficiency

It has been suggested that nudges – approaches that steer people in certain directions while maintaining their freedom of choice – might offer an effective way to change behaviour and improve outcomes at lower cost than traditional policy tools.

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Nudges have been applied across a wide range of areas in the UK and globally. However, there is relatively little in the way of coverage of nudge-type behaviour change interventions to health care specifically and some uncertainty about how effective nudges are in bringing about desirable behaviour change.

This review begins to address this gap by:

  1. providing a map of the evidence of the application of nudge-type interventions in health care
  2. considering opportunities for reducing inefficiency and waste in health care.

The review identifies:

  • nudge-type interventions with potential to increase efficiency and reduce waste in health care
  • areas of inefficiency and waste to which nudge-type interventions might be productively applied
  • opportunities and considerations for those looking to introduce nudge-type interventions

Reference: Behavioural insights in health care: Nudging to reduce inefficiency and waste

Annual HIV incidence fell by a third from 2000 to 2014

BMJ 2015; 351

The annual number of adults and children newly infected with HIV fell from 3.1 million in 2000 to 2.1 million in 2014, show new figures released by the World Health Organization for world AIDS day on 1 December.1

The decline in the number of new infections was even steeper in Africa, which saw a 40% drop (from 2.3 million to 1.4 million) over the same period.

The number of people receiving treatment has also increased substantially, with an estimated 16 million taking antiretrovirals in 2014, 11 million of whom were in Africa. In 2000 just 11 000 people in Africa received antiretrovirals.

WHO’s report describes how the increase in treatment has had a big effect on life expectancy in Africa, which in most countries plummeted between 2000 and 2005. In Zimbabwe, for example, average life expectancy between 1985 and 1990 was around 63 years. This fell to just over 40 years between 2000 and 2005 but has started to rise again, and between 2010 and 2015 it was at around 55. Over the same period life expectancy in Namibia fell from around 62 to 53 years but is now about 64.

Carry on reading via BMJ

Clinicians told to embrace digital technology

NHS England

Doing nothing is no longer an option when it comes to clinicians embracing digital technology and information.

That was the clear message from Beverley Bryant to the Sustainable Healthcare Conference staged at the King’s Fund.

Image source: Wikipedia

NHS England’s Director of Digital Technology told delegates: “There are two jobs: to put technology into the hands of patients and to make sure health and care is joined up to itself.

The conference came as a one-year-on progress report was issued by the Sustainable Healthcare Steering Group.

In its update, the Steering Group calls for:

  • A fully funded plan for how NHS digital systems will be made interoperable.
  • The creation of a list of NHS endorsed apps
  • Enabling people to navigate the health and care system so patients always know who their main point of contact is to meet their changing health and care needs.
  • Patients being able to access and co-manage their own health records, and allow records to be accessed by other health or care workers when appropriate.
  • Health professionals have the tools and training to encourage both shared decision-making and supported self-management, particularly for people with long term conditions.

Carry on reading via NHS England

Supporting victims of modern slavery through healthcare services

Department of Health: 2nd December

The PROTECT (Provider Responses, Treatment and Care for Trafficked People) research project recently published its independent findings in the ‘British Medical Journal Open’ journal. Sponsored by DH, the research shows that up to 1 in 8 NHS professionals reported having contact with a patient they suspected may have been trafficked.

Further findings published by the Lancet Psychiatry show that hospital mental health services are seeing trafficked people with a range of diagnoses, including depression, post-traumatic stress disorder and schizophrenia.

Many trafficking survivors talk of experiencing physical violence and psychological abuse. Research evidence shows they have poor mental health and many, especially women, are sexually abused and may acquire sexually transmitted infections as well as having to cope with unwanted pregnancies and abortions.

The research highlights how important it is that the health system has an understanding of modern slavery and the need for training tools to support health professionals in identifying and providing support for victims. The DH e-learning tool for staff on identifying and responding to modern slavery has been updated and is available on the largest e-learning portal for NHS staff: e-Learning for Healthcare.

Read the full news story via

UK pays among ‘lowest prices’ for cancer drugs

‘The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology.’ – BBC Health

cancer drugs
Image source: Derek K. Miller

While the UK, Greece, Spain and Portugal pay the least, on average, for the drugs they use, Germany, Sweden and Switzerland pay the most.

The authors said more transparency was needed because some countries risked overpaying for drugs.

The pharmaceutical industry said the UK was getting a fair deal on medicines.

Prices of cancer drugs have risen steeply in recent years, placing major stress on many healthcare systems, including the NHS.

The report said drugs had accounted for nearly a third of the EU’s 51 billion euro (£37bn) cancer healthcare spending in 2009.

View the report abstract via the Lancet Oncology

Carry on reading the full commentry via BBC Health News

Collaboration in general practice

The Royal College of General Practitioners and the Nuffield Trust have published Collaboration in general practice: surveys of GPs and CCGs.  Commissioned by NHS England, this slide pack presents the results of two online surveys which aimed to examine the landscape of collaboration in general practice: one distributed to GPs; and the other distributed to clinical commissioning groups.


The surveys were undertaken from July to November 2015 and aimed to provide a snapshot of the pace and scale of large-scale collaboration in general practice in England. They include responses from 94 CCGs and 982 GPs and practice representatives.

Continuous improvement of patient safety

This report synthesises the lessons from the Health Foundation’s work on improving patient safety. Part I illustrates why improving safety is so difficult and complex, and why current approaches need to change. Part II looks at some of the work being done to improve safety and offers examples and insights to support practical improvements in patient safety. In Part III, the report explains why the system needs to think differently about safety.

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The report includes specific resources to contribute to the next phase of safety improvement in the NHS:

  • For leaders of provider organisations, three practical steps are given that need to be taken to build an organisation-wide approach to continually improving safety. We have also brought together ten Health Foundation resources to support leaders to do this.
  • For government, quality regulators and national bodies with a remit for patient safety, The Health Foundation sets out its vision for an effective safety system, which current activities and ambitions should be assessed against.

Transferring from hospital to home: New guideline

This guideline covers the transition between inpatient hospital settings and community or care homes for adults with social care needs. It aims to improve people’s experience of admission to, and discharge from, hospital by better coordination of health and social care services.

NICE logo

The guideline includes recommendations on:

Full reference: Transition between inpatient hospital settings and community or care home settings for adults with social care needs NICE guideline Published: 1 December 2015


Prevention Review: Landscape Paper

Mental Health Foundation

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Image source: MHF

This paper launches a series of reviews which will examine prevention activity at different stages of the life course and pay particular attention to pressure points such as transitions and particular vulnerability and exposure to adversity associated with this life stage

Prevention operates at different levels:

1. Primary prevention – Stopping mental health problems from occurring in the first place by using ‘upstream’ approaches.

2. Secondary prevention – Identifying the earliest signs that mental health is being undermined and ensuring early intervention is available to minimise progression into a more serious mental health problem.

3. Tertiary prevention – Working with people with established mental health problems to ensure the earliest path to sustainable recovery and to reduce the social, economic and health losses often resulting from living with a mental health problem.

prevention review pic
Image source: MHF

Read the full report here