Sustainability and Transformation Plans: what we know so far

Discussion paper from Nuffield Trust

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Sustainability and Transformation Plans (STPs) – the 44 regionally specific blueprints for improving health and social care services and finances for the coming five years – are taking shape, and final versions are expected to be submitted in the coming weeks.

This discussion paper reflects the work in progress from one third of STP areas, as captured in July and August 2016. It shows that the scale of the STP process is large and ambitious, and the speed with which plans are being pulled together is astonishing. So far, the plans are not sufficient to close the funding gap, but, if implemented well and combined with high-quality local efficiency improvement, they would go some way to doing so and would demonstrate the capability of the NHS and social care system to deliver.

This paper points to some important trends, ideas to be explored and issues that need to be resolved in order to ensure success.

Related:   How are Sustainability and Transformation Plans coming together?


Public health post-2013

The House of Commons Health Committee has published Public Health post-2013.

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This report concludes that since local authorities took control of public health from the NHS, they have been dealt an in-year cut of £200 million last year and now face further real terms cuts to public health budgets.  The Committee believe these cuts to be false economy as they not only add to the future costs of health and social care but risk widening health inequalities.

The committee highlighted the growing mismatch between spending on public health and the significance attached to prevention in the NHS 5 Year Forward View. The Committee wants to see a Cabinet Office minister given specific responsibility for embedding health across all areas of Government policy at national level.

Tackling falling child vaccination rates

vaccination-1215279_960_720NICE is developing priorities to help ensure unvaccinated children across the country get the protection they need.  In some areas of the country, fewer than 1 in 5 children are vaccinated against diseases such as polio and diphtheria. Experts have warned that unless uptake rates improve there is a risk of these diseases making a comeback.

Last year only a quarter of local authorities met World Health Organization targets to vaccinate 95% of children against measles, mumps and rubella.  A draft quality standard from NICE, out for consultation until 29 September, sets out how to drive up the number of under 19s who receive vaccinations.

Understanding quality in district nursing services

Understanding quality in district nursing services. Learning from patients, carers and staff. | Kings Fund

District nursing services play an important role in helping people to maintain their independence by supporting them to manage long-term conditions and treating acute illnesses – and demand for such services is increasing. These services will be key to the success of policies that aim to provide more care closer to home.

This report from The Kings Fund  investigates what ‘good’ district nursing care looks like from the perspective of people receiving this care, unpaid carers and district nursing staff and puts forward a framework for understanding the components involved. It also looks at the growing demand–capacity gap in district nursing and the worrying impact that this is having on services, the workforce and the quality and safety of patient care. The report makes recommendations to policy-makers, regulators, commissioners and provider organisations as to how to start to address these pressures.

Transition between inpatient mental health settings and community or care home settings

NICE has published Transition between inpatient mental health settings and community or care home settings (NG53).

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This guideline covers the period before, during and after a person is admitted to, and discharged from, a mental health hospital. It aims to help people who use mental health services, and their families and carers, to have a better experience of transition by improving the way it’s planned and carried out.

Additional link: NICE press release

Chart: How stressful GPs in the UK find their job via

The Health Foundation | Published online: August 2016

  • 59% of GPs in the UK describe their job as extremely or very stressful, higher than anywhere else in the Commonwealth Fund Survey. Just 5% of GPs find general practice not too or not at all stressful.
  • By way of comparison, in Australia, only one in five (21%) of GPs find their job extremely or very stressful, and less than the one in four (24%) who find it not at all or not very stressful.
  • Of the UK respondents planning to leave medicine for a different career, 77% said their role as a GP was extremely or very stressful, compared to 49% of those who plan to stay. Improving stress levels will be critical to retention of GPs.
Image source: The Health Foundation

In our report Under Pressure, we looked at the satisfaction of GPs, as well as care coordination and use of electronic medical records in general practice. The report is UK-focused analysis by the Health Foundation of the Commonwealth Fund’s 2015 survey of primary care physicians across 11 countries, which included several UK-specific questions funded by the Health Foundation.

Read the full article here

Implementing a pressure ulcer prevention bundle in an adult intensive care

Tayyib, N. Coyer, F. & Lewis, P. Intensive and Critical Care Nursing. Published online: August 28, 2016

B0007099 Hospital ward
Image source: Alex Williamson – Wellcome Image // CC BY-NC-ND 4.0

Background: The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change.

Aims: The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance.

Method: An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist.

Results: Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants’ demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda = 0.29, F (3, 8) = 6.35, p < 0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants.

Conclusion: The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study’s findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements.

Read the abstract here

Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial

Dixon, P. et al. BMJ Open. 6:e012352

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Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objectives: To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.

Design: A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.

Setting: Patients recruited through primary care, and intervention delivered via telehealth service.

Participants: Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.

Intervention: A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.

Primary and secondary outcome measures: Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.

Results: 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.

Conclusions: There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.

Read the full article here

Managers’ use of nursing workforce planning and deployment technologies: protocol for a realist synthesis of implementation and impact

Burton, C. et al. BMJ Open. 6:e013645


Introduction: Nursing staffing levels in hospitals appear to be associated with improved patient outcomes. National guidance indicates that the triangulation of information from workforce planning and deployment technologies (WPTs; eg, the Safer Nursing Care Tool) and ‘local knowledge’ is important for managers to achieve appropriate staffing levels for better patient outcomes. Although WPTs provide managers with predictive information about future staffing requirements, ensuring patient safety and quality care also requires the consideration of information from other sources in real time. Yet little attention has been given to how to support managers to implement WPTs in practice. Given this lack of understanding, this evidence synthesis is designed to address the research question: managers’ use of WPTs and their impacts on nurse staffing and patient care: what works, for whom, how and in what circumstances?

Methods and analysis :To explain how WPTs may work and in what contexts, we will conduct a realist evidence synthesis through sourcing relevant evidence, and consulting with stakeholders about the impacts of WPTs on health and relevant public service fields. The review will be in 4 phases over 18 months. Phase 1: we will construct an initial theoretical framework that provides plausible explanations of what works about WPTs. Phase 2: evidence retrieval, review and synthesis guided by the theoretical framework; phase 3: testing and refining of programme theories, to determine their relevance; phase 4: formulating actionable recommendations about how WPTs should be implemented in clinical practice.

Ethics and dissemination: Ethical approval has been gained from the study’s institutional sponsors. Ethical review from the National Health Service (NHS) is not required; however research and development permissions will be obtained. Findings will be disseminated through stakeholder engagement and knowledge mobilisation activities. The synthesis will develop an explanatory programme theory of the implementation and impact of nursing WPTs, and practical guidance for nurse managers.

Read the full article here

“What about diet?” A qualitative study of cancer survivors’ views on diet and cancer and their sources of information

Beeken, R.J. et al. (2016) European Journal of Cancer Care. 25(5). pp. 774–783


Given the abundance of misreporting about diet and cancer in the media and online, cancer survivors are at risk of misinformation. The aim of this study was to explore cancer survivors’ beliefs about diet quality and cancer, the impact on their behaviour and sources of information. Semi-structured interviews were conducted with adult cancer survivors in the United Kingdom who had been diagnosed with any cancer in adulthood and were not currently receiving treatment (n = 19).

Interviews were analysed using Thematic Analysis. Emergent themes highlighted that participants were aware of diet affecting risk for the development of cancer, but were less clear about its role in recurrence. Nonetheless, their cancer diagnosis appeared to be a prompt for dietary change; predominantly to promote general health. Changes were generally consistent with healthy eating recommendations, although dietary supplements and other non-evidence-based actions were mentioned. Participants reported that they had not generally received professional advice about diet and were keen to know more, but were often unsure about information from other sources.

The views of our participants suggest cancer survivors would welcome guidance from health professionals. Advice that provides clear recommendations, and which emphasises the benefits of healthy eating for overall well-being, may be particularly well-received.

Read the full article here