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.

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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

How much healthcare policy is based on evidence?

New medicines prescribed by the NHS must pass clinical trials and cost-benefit tests, but not all health policies go through such a rigorous process

The NHS relies on scientific evidence to assess new medicines: drugs are only authorised if they pass clinical trials, and offered only if they pass a cost-benefit test. But similar research into healthcare policy is often used to fuel arguments rather than guide decisions.

The dispute between the health secretary, Jeremy Hunt, and the British Medical Association over junior doctors’ contracts is tied to the government’s plan to introduce seven-day working in the English NHS. Hunt justified this with a BMJ paper that found around 11,000 more people die within 30 days of being admitted to hospital on Friday, Saturday, Sunday or Monday, compared with admissions on other days of the week.

But the writers stated it was not possible to say how many of the 11,000 excess deaths could be prevented, and “to assume that they are avoidable would be rash and misleading” – a statement highlighted by BMJ editor Dr Fiona Godlee in October when she complained about Hunt’s use of the figure. However, the writers also said that the result “raises challenging questions about reduced service provision at weekends”.

It’s worth comparing for instance, how new medicines are assessed by the National Institute for Health and Care Excellence (Nice) on whether they provide extra years of life for less than £20,000, adjusted for the quality of those extra years, with the measures used for the cost-benefit analysis of seven-day working. A paper published inHealth Economics in May, using estimates of excess deaths purely among emergency patients, concluded that emergency seven-day working would fail this financial test.

Anderson says the Department of Health funds studies evaluating policies, but these tend to take place after implementation, rather than as a part of a pilot process. “I think government policy moves on quickly, while good research takes time.”

Read the full article via the Guardian Healthcare Network

NHS 111 survey reveals callers pleased with the service

NHS 111 has received excellent satisfaction ratings in a new service evaluation survey.

Led by the Royal College of Paediatrics and Child Health RCPCH , in partnership with NHS England, The Health Foundation and the Picker Institute, the review of 111 services in North West London revealed 84% of people calling the helpline ‘got what they needed’, while 80% said they would call NHS 111 again if they had the same problem.

The review investigated calls made to NHS 111 by parents and carers living in North West London.

One stage involved surveying 1,000 parents and carers who rang NHS 111 between March and June 2015. In another stage, the feasibility of linking NHS 111 calls with out of hours GP and secondary care services was studied.

Carry on reading via NHS England

Better Endings – right care, right place, right time

NIHR Dissemination Centre’s Themed Review on end of life care.

Helping people to die with dignity, compassion and comfort is an important goal of any health service. Recent accounts have provided rich insights into some of the challenges for healthcare professionals trying to meet the needs of people at the end of life, ranging from reports of inequalities in access to specialist palliative care to skills and training gaps for general staff caring for the dying.

Better Endings is the NIHR Dissemination Centre’s first Themed Review. It brings together evidence from the NIHR, focusing largely on the quality and organisation of care. The review aims to help those delivering, planning or using end of life services to ensure that the right care is delivered in the right place at the right time.

Download themed review

The review also highlights examples of service innovations around end of life care in different parts of the country, which are being evaluated through NIHR projects.

Professor Bee Wee, National Clinical Director for End of Life Care

Watch the extended interview

Read more via NIHR Dissemination Centre

Obesity in pregnancy: infant health service utilisation and costs on the NHS

Morgan, K. et al. (2015) BMJ Open 2015;5:e008357 doi:10.1136/bmjopen-2015-008357

Objective To estimate the direct healthcare cost of infants born to overweight or obese mothers to the National Health Service in the UK.

Design Retrospective prevalence-based study.

Setting Combined linked anonymised electronic data sets on a cohort of mother–child pairs enrolled on the Growing Up in Wales: Environments for Healthy Living (EHL) study. Infants were categorised according to maternal early-pregnancy body mass index (BMI): healthy weight mother (18.5≤BMI<25 kg/m2; n=342), overweight mother (25≤BMI≤29.9 kg/m2; n=157) and obese mother (BMI≥30; n=110).

Participants 609 singleton pregnancies with available health service records and an antenatal maternal BMI.

Primary outcome measure Total health service utilisation and direct healthcare costs for providing these services in the year 2012–2013. Costs are calculated as cost of the infant (no maternal costs considered) and are related to health service usage from birth to age 1 year.

Results A strong association existed between healthcare usage cost and BMI (p<0.001). Mean total costs were 72% higher among children born to obese mothers (rate ratio (RR) 1.72, 95% CI 1.71 to 1.73) compared with infants born to healthy weight mothers. Higher costings were attributed to a significantly greater number (RR 1.39, 95% CI 1.04 to 1.84) and duration (RR 1.55, 95% CI 1.37 to 1.74) of inpatient visits and a higher number of general practitioner visits (RR 1.10, 95% CI 1.03 to 1.16). Total mean additional resource cost was estimated at £65.13 for infants born to overweight mothers and £1138.11 for infants born to obese mothers, when compared with infants of healthy weight mothers.

Conclusions Increasingly infants born to mothers with high BMIs consume additional health service resources in the first year of life; this was apparent across inpatient and general practitioner services. Considering both maternal and infant health service use, interventions that cost less than £2310 per person in reducing obesity early pregnancy could be cost-effective.

 View the full article via BMJ Open