Emergency bowel surgery audit

The Healthcare Quality Improvement Partnership has published Third Patient Report of the National Emergency Laparotomy Audit (NELA) December 2015 to November 2016.  This report includes data from the second Organisational Audit performed in October 2016 and from the third annual cycle of patient-data collection. The Organisational Audit provides information on how hospitals have organised their emergency surgical service, and whether this service meets published standards for facilities and governance.

Nursing workforce is heading for a ‘perfect storm’

The RCN has published research today which indicates that the nursing workforce is heading for a ‘perfect storm’ | RCN


Data analysed by the RCN for its Labour Market Review and evidence to the NHS Pay Review Body reveals that half of nurses are aged 45 or over and within 10 years of being eligible for early retirement.

Ten years ago just a third of the nursing workforce in England was aged 45 or over. This means the health service will be more reliant than ever on finding new staff. The research also highlights an unprecedented number of risk factors which will affect the future supply of safe staffing levels.

These include the ageing workforce, rising demand, uncoordinated workforce planning, changes to student nurse funding, real terms cuts to nurse pay and the impact of Brexit on international recruitment.

To alleviate the retention crisis, the RCN is calling on the Government to scrap the 1% pay cap for NHS staff, warning that unless nurses’ pay reflects the increase in cost of living, trusts will struggle to attract enough staff to provide safe patient care.

Read the full release here

Not so fast: how to slow activity growth

Ginsbury, S. Nuffield Trust. Published online: 21 Oct 2016


As edicts go it is neither the most catchy nor the most inspiring, but the new NHS must-do was finally articulated in last month’s joint operational planning guidance from NHS England and NHS Improvement: activity growth moderation.

Activity growth moderation means what it says on the tin: slowing the pace at which the amount of activity the NHS does grows. That’s not the same as an absolute reduction in the level of activity or number of patients being treated but it does mean reducing the amount of care provided in the future compared the amount of care that would be providing were activity to continue to grow at the current trend.

That current trend is around three per cent extra care a year – measured in terms of more patients, with more complex needs, receiving more advanced health care, at a higher quality. All things being equal, the current level of funding would be able to sustain an activity growth rate nearer 2.4 per cent a year. But that would leave zero headroom to cope with periodic shocks such as a disease epidemic or the potential fall-out from Brexit. Perhaps for that reason, NHS England aims to reduce growth by one percentage point.

Read the full blog post here

Achieving better outcomes for musculoskeletal (MSK) conditions

Valori, R. NHS England Blog. Published online: 20 October 2016


In this blog, Roland Valori takes a closer look at some of the attempts to reduce variation in clinical outcomes and improve productivity of services for musculoskeletal conditions and diseases. These include using techniques such as ‘Audit and Feedback’, demonstration projects, whole service redesign and a variety of other quality improvement initiatives at local and national level.

The impact of these approaches varies and even when change is achieved, it is often difficult to sustain. Accreditation will help achieve a more sustained approach to improvement in quality. It supports and enhances these varied approaches providing a quality mark for patients and commissioners.

Some accreditation schemes such as the endoscopy and audiology schemes are linked to commissioning. The CQC is using information from accreditation schemes to inform its inspections and has indicated it would like to see more widespread accreditation of clinical services.

The development of schemes thus far has been unplanned. As a result there is considerable variation in approach that leads to unwarranted burden on scheme providers, provider organisations and clinical teams.

Read the full blog post here

Preventing and Treating Adolescent Obesity

The Society for Adolescent Health and Medicine. (2016) Journal of Adolescent Health.59(5) pp. 602-606

Image source: Jixuan Zhou – Flickr // CC BY-NC-SA 2.0

Executive Summary and Positions

Adolescent obesity is an international problem that is a major public health concern with short- and long-term health consequences. Its prevention and treatment require that all health care professionals (HCPs) work together. To date, very little evidence supports effective treatment approaches for adolescents.

This position paper provides expert consensus and evidence wherever possible to increase professionals’ ability to prevent, screen, treat, and advocate effectively for obesity prevention and healthy weight promotion. Our positions are summarized in the following section:

  1. .HCP should have the knowledge, skills, and resources to prevent and treat obesity while incorporating the biopsychosocial stages of adolescent development.
  2. For all adolescent patients, the committee recommends that HCP:
    a. Determine weight status by calculating body mass index (BMI) and identifying BMI percentile for age and sex.
    b. Assess for medical complications.
    c. Screen for behaviors, including nutrition and physical activity, and family history, that increase the risk of, or worsen, obesity.
    d. Reinforce healthy behaviors, and when appropriate, counsel adolescents regarding body-image, inappropriate dieting, and weight stigmatization.
  3. Once a diagnosis of obesity has been established, HCP should work with dietitians, behavioral health providers, and exercise specialists to guide the patient through an evaluation for comorbidities, deliver evidence-based lifestyle counseling, and if indicated, refer to more intensive treatment options such as weight loss surgery, monitored diets, or residential care.

HCPs are uniquely positioned to advocate for changes within and outside the health care setting to address the obesity epidemic. Areas for advocacy include: increasing availability of clinical and community resources to prevent and treat obesity; leveraging support for adolescent-focused research; promoting environmental and policy changes related to healthy eating and active living; improving reimbursement for multidisciplinary care; eliminating policies and practices that stigmatize obese adolescents both explicitly and implicitly; and integrating the prevention approaches of the obesity and eating disorder fields that address weight-related disorders.

Read the full article here

A mixed methods study to understand patient expectations for antibiotics for an upper respiratory tract infection

Gaarslev, C. et al. Antimicrobial Resistance & Infection Control. Published online: 20 October 2016


Background: Antimicrobial resistance is a public health challenge supplemented by inappropriate prescribing, especially for an upper respiratory tract infection in primary care. Patient/carer expectations have been identified as one of the main drivers for inappropriate antibiotics prescribing by primary care physicians. The aim of this study was to understand who is more likely to expect an antibiotic for an upper respiratory tract infection from their doctor and the reasons underlying it.

Methods: This study used a sequential mixed methods approach: a nationally representative cross sectional survey (n = 1509) and four focus groups. The outcome of interest was expectation and demand for an antibiotic from a doctor when presenting with a cold or flu.

Results: The study found 19.5 % of survey respondents reported that they would expect the doctor to prescribe antibiotics for a cold or flu. People younger than 65 years of age, those who never attended university and those speaking a language other than English at home were more likely to expect or demand antibiotics for a cold or flu. People who knew that ‘antibiotics don’t kill viruses’ and agreed that ‘taking an antibiotic when one is not needed means they won’t work in the future’ were less likely to expect or demand antibiotics. The main reasons for expecting antibiotics were believing that antibiotics are an effective treatment for a cold or flu and that they shortened the duration and potential deterioration of their illness. The secondary reason centered around the value or return on investment for visiting a doctor when feeling unwell.

Conclusion: Our study found that patients do not appear to feel they have a sufficiently strong incentive to consider the impact of their immediate use of antibiotics on antimicrobial resistance. The issue of antibiotic resistance needs to be explained and reframed as a more immediate health issue with dire consequences to ensure the success of future health campaigns.

Read the full article here

New plans to modernise community pharmacies

Changes include a reward system for high quality service and a pharmacy access scheme for isolated areas with higher health needs. | Department of Health

7992-2Plans to modernise community pharmacies, which will ensure a better quality service for patients and relieve pressure in other parts of the NHS, have been announced by the government.

This forms part of the government’s ambition to modernise the community pharmacy sector and make the most of pharmacists’ skills in all health care settings, including GP surgeries and care homes, to provide the highest level of
care to patients.

Read more via Department of Health