New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation

Nazar, H. et al. (2016) BMJ Open.6:e012532. Published online: 14 October 2016

drug-bottle-1674888_960_720Objectives: To evaluate an electronic patient referral system from one UK hospital Trust to community pharmacies across the North East of England.

Setting: Two hospital sites in Newcastle-upon-Tyne and 207 community pharmacies.

Participants: Inpatients who were considered to benefit from on-going support and continuity of care after leaving hospital.

Intervention: Electronic transmission of an information related to patient’s medicines to their nominated community pharmacy. Community pharmacists to provide a follow-up consultation tailored to the individual patient needs.

Primary and secondary outcomes: Number of referrals made to and received by different types of pharmacies; reasons for referrals; accepted/completed and rejected referred rates; reasons for rejections by community pharmacists; time to action referrals; details of the follow-up consultations; readmission rates at 30, 60 and 90 days post referral and number of hospital bed days.

Results: 2029 inpatients were referred over a 13-month period (1 July 2014–31 July 2015). Only 31% (n=619) of these patients participated in a follow-up consultation; 47% (n=955) of referrals were rejected by community pharmacies with the most common reason being ‘patient was uncontactable’ (35%, n=138). Most referrals were accepted/completed within 7 days of receipt and most rejections were made >2 weeks after referral receipt. Most referred patients were over 60 years of age and referred for a Medicines Use Review (MUR) or enrolment for the New Medicines Service (NMS). Those patients who received a community pharmacist follow-up consultation had statistically significant lower rates of readmissions and shorter hospital stays than those patients without a follow-up consultation.

Conclusions: Hospital pharmacy staff were able to use an information technology (IT) platform to improve the coordination of care for patients transitioning back home from hospital. Community pharmacists were able to contact the majority of patients and results indicate that patients receiving a follow-up consultation may have lower rates of readmission and shorter hospital stays.

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Health secretary promises to end maternity ‘blame culture’

National Health Executive | Published online: 17 October 2016


Families who suffer problems during childbirth as a result of failings in care could claim compensation without legal proceedings under new proposals.

The DH said there is a danger that clinicians are being discouraged from speaking openly about mistakes which led to births going wrong, including children developing disabilities, out of fear of litigation.

It said it would open a consultation on introducing a rapid resolution and redress scheme, which would investigate incidents. Where harm was found to be avoidable, it could offer families regular financial support without the need for legal proceedings, as well as counselling, case management and legal advice.

Jeremy Hunt, the health secretary, said: “Our NHS maternity staff do a fantastic job under huge pressure. But even though we have made much progress, our stillbirth rates are still amongst the highest in Western Europe and many on the frontline say there is still too much of a blame culture when things go wrong – often caused by fear of litigation or worry about damage to reputation and careers.

“These comprehensive measures will give practical support to help trusts improve their approach to safety – and help to foster an open and transparent culture so that the courts become a last resort not an automatic first step. By learning from proven methods in countries like Sweden we hope to achieve a dramatic reduction in the number of tragedies where babies are lost or injured for life.”

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Funding a healthy future

The Chartered Institute of Public Finance & Accounting (CIPFA) and Public Finance have published Funding a healthy future: the health and care deficit diagnosed.

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This collection of essays examines the future of health and social care in the face of an ageing population, financial constraints and Brexit.

This is the fourth in a series of papers designed to stimulate discussion on key public finance and policy issues.

Additional link: Public Finance press release

Is mental health crisis care in crisis?

The NHS Confederation Mental Health Network has published Is mental health crisis care in crisis?


Despite the clear policy direction and pledged government investment, funding has not reached the front line of care and significant challenges remain for providers to meet demand and for individuals to get the help they need.

This briefing explores the gap between the policy around mental health crisis care and reporting on the ground.  It includes case study examples which show that by operating as a whole system, local areas are developing new ways of working in mental health crisis care.

Mental health toolkit for schools and colleges

With half of all diagnosable mental health disorders established by the age of 14, there is a strong case to promote children and young people’s mental health | Public Health England | Anna Freud National Centre for Children and Families

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Public Health England and the Anna Freud National Centre for Children and Families are committed to improving health outcomes for children, young people and their families, and collaborated to fund and develop this toolkit.

The toolkit aims to raise awareness amongst school and college staff of the range of validated tools that are available to help measure subjective mental wellbeing amongst the student population. This, in turn, will help school and college leaders make use of school and college level data to identify the mental wellbeing needs of students and determine how best to address these. Efforts taken by schools and colleges to promote the physical and mental health of the student population creates a virtuous circle, reinforcing attainment and achievement that in turn improves student wellbeing, enabling students to thrive and achieve their full potential.

Download the toolkit here

Areas of NHS will implode this winter, expert warns

Parts of the NHS “will implode” this winter, an expert has warned, as new figures show falling A&E performance over the past few months. | The Guardian


Dr Mark Holland, the president of the Society for Acute Medicine, said the days when summer used to provide a respite for busy emergency departments had gone, and instead the NHS faced an “eternal winter”.

The NHS was “on its knees” and a major increase in hospital admissions due to flu or the sickness bug norovirus could lead to collapse, he added.

Holland spoke out as new figures show that waiting times in A&E units in England this summer have been worse than for most winters stretching back more than a decade.

One in 10 patients waited more than four hours in A&E during June, July and August – worse than any winter in the past 12 years bar one, analysis by the BBC showed. Only last winter marked a worse performance since the target was launched in 2004.

Related: The King’s Fund responds to latest NHS performance statistics

The State of health care and adult social care

The Care Quality Commission (CQC) has published The state of health care and adult social care in England 2015/16.

This annual report provides an overview of health and social care in England looking at trends, highlighting examples of good and outstanding care, and identifying factors that maintain high-quality care.

It finds that most services provide people with good care, but variation exists. Some care services are closing, increasing pressure on other services including GPs and hospitals.  The report highlights that the sustainability of the adult social care market is approaching a tipping point.

Additional links:  CQC press release | Health Foundation

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Flu vaccination programme in England

As part of their Stay Well This Winter campaign, Public Health England has announced it is extending the flu vaccination programme in England to children in school year three.   An additional 600,000 children will be offered protection against flu.

As well as offering protection to these children aged 2 to 7 years, it will help reduce the spread of this infection to the most vulnerable in the community, particularly younger children, the elderly and those with long-term conditions.

Children aged 2, 3 and 4 can now get the vaccination from their GP. The school vaccination programme gets underway later this week, with parents of children in years 1, 2 and 3 being asked permission for their child to get the free nasal spray vaccination at school. A survey showed that nearly 4 out of 10 (37%) parents of eligible children are unaware of the nasal spray. PHE and NHS England have launched a TV, radio and online advertising campaign to target parents and at risk groups.

Children and families

The National Audit Office has published Children in need of help or protection.

This report finds that the Department of Education (DfE) has recognised since 2010 that child protection services are not good enough but its subsequent response has not yet resulted in better outcomes. Spending on children’s social work including on child protection, varies widely across England and is not related to quality. Neither the DfE nor authorities understand why this spending varies.

Read the full document here

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Let’s address the perfect storm of factors leading to obesity in disadvantaged children | via @ConversationEDU


More children are now growing up in societies that facilitate weight gain and obesity by creating environments where a healthy choice is not the cheapest or the easiest option.

Our recent review identified a range of factors likely to influence a child’s increased weight gain. These include maternal factors, prior to and during pregnancy. Diet, smoking, being overweight or obese when becoming pregnant, gaining excess weight during pregnancy and developing gestational diabetes can all increase the risk of the child being overweight. A father being overweight or obese at conception is also a risk for the child’s future weight.

In the early months and years of a child’s life, many factors pose a risk to becoming overweight. These include the child not being breastfed or being breastfed for too short a time.

A child’s risk of obesity is also strongly affected by the diet they learn to enjoy from the start of life, so early food exposures are important. For instance, weaning children off milk and onto sweetened drinks rather than water, or introducing sweet or high-fat biscuits as snacks rather than fruits or vegetables will promote preferences for sugar and fat that can be difficult to change.

The lack of physical activity and sleep, and more screen time, were also flagged as important influences in children’s obesity risk.

While the factors that will promote child overweight and obesity are wide ranging, the uniting factor is that nearly all of them are more common among people experiencing disadvantage.

Read the full article here