Measuring quality of health care in the NHS: Giving a voice to the patients

The high profile role that the NHS played in Brexit and recent general election campaigns demonstrates that the health care system remains foremost in the minds of all political parties when considering how to present their policies | The Health Foundation

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These campaigns put a spotlight on the sustainability of the health care system, but may have also fuelled a fear over deteriorating health system performance. In 2017, the NHS was recently ranked by the Commonwealth Fund as the best performing health care system out of 11 countries, including Germany, Australia and the United States. However, 82% of the general public expressed concerns about the future of the NHS in a survey following the 2017 General Election, with quality of care identified as one reason for dissatisfaction previously. Arguably, this disparity may be the result of intense media coverage of the human and financial pressures on the NHS, which could have shaped public perception to some extent. However, it might also point to a deeper disparity: a disconnect between the general assessment of measurable health system performance versus the quality of care perceived by patients when accessing the NHS.

One reason for this relates to the difficulty in measuring quality of health care at the system level. Quality in the context of health care is a multi-dimensional framework that captures six domains:

  • Effectiveness
  • Efficiency
  • Equity
  • Safety
  • Timeliness
  • Patient-centeredness.

Read the full blog post by Rocco Friebel here

CCG medicines optimisation service

The Pharmaceutical Services Negotiating Committee has published a case study on Bath and North East Somerset CCG medicines optimisation service.   

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To reduce excessive prescribing BANES CCG commissioned community pharmacy to actively review their patients medication and to look for opportunities to optimise their care. The community pharmacists identified items to either not dispense or optimise and then worked with the CCG employed practice support pharmacists to make the changes permanent on a patient’s record.

In the first eight weeks of the service (18th May 2017 – 12 July 2017) the five initial pilot
pharmacies have identified £15,421 of annualised savings of which £9,396 have been actioned by the surgery, with £2,498 rejected and £3,528 awaiting resolution in the surgery. Currently 120 medicines optimisation opportunities have been identified by the community pharmacies with 69 being actioned by the CCG pharmacists.

The average annual saving per actioned suggestion is £136 (£9,396 / 69).  The £30 professional fee is only paid to the community pharmacist once the change has been actioned by the surgery. The 69 approved changes resulted in £2,070 being paid in a professional fee, which represents a return on investment of 1 : 4.5 (£2,070 : £9,396). In year two, the CCG will continue to gain the benefits of these savings with no additional professional fee.

Full case study: Bath and NE Somerset CCG Medicines Optimisation Service

Point of care testing in primary care

Research concerning point of care testing (POCT) in primary care finds that the total expected cost of using POCT to deliver an NHS Health Check in primary care is lower than the laboratory-led pathway.  It also minimises DNA rates and only requires one visit from the patient.

Abstract:
Objective: To determine if use of point of care testing (POCT) is less costly than laboratory testing to the National Health Service (NHS) in delivering the NHS Health Check (NHSHC) programme in the primary care setting.

Design: Observational study and theoretical mathematical model with microcosting approach.

Setting: We collected data on NHSHC delivered at nine general practices (seven using POCT; two not using POCT).

Participants: We recruited nine general practices offering NHSHC and a pathology services laboratory in the same area.

Methods: We conducted mathematical modelling with permutations in the following fields: provider type (healthcare assistant or nurse), type of test performed (total cholesterol with either lab fasting glucose or HbA1c), cost of consumables and variable uptake rates, including rate of non-response to invite letter and rate of missed [did not attend (DNA)] appointments. We calculated total expected cost (TEC) per 100 invites, number of NHSHC conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based pathways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters.

Main outcome measures: We collected data on cost, volume and type of pathology services performed at seven general practices using POCT and a pathology services laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices.

Results: TEC of using POCT to deliver a routine NHSHC is lower than the laboratory-led pathway with savings of £29 per 100 invited patients up the point of cardiovascular disease risk score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DNA appointment.

Conclusions: TEC of using POCT to deliver an NHSHC in the primary care setting is lower than the laboratory-led pathway. Using POCT minimises DNA rates associated with laboratory testing and enables completion of NHSHC in one sitting.

Full reference: Does use of point-of-care testing improving cost-effectiveness of the NHS Health Check programme in the primary care setting?  A cost-minimisation analysis

 

New model of Primary Care provision

New report from the Nuffield Trust evaluates an initiative called the Primary Care Home (PCH) model developed by the National Association of Primary Care (NAPC).

The primary care home model was developed by the National Association of Primary Care as a response to workforce challenges, rising demand and opportunities to shape transformation in local health and care systems across England.

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Image source: nuffieldtrust.org.uk

This report from the Nufield Trust suggests that the new models of primary care provision are showing early signs of success but will need more resources and support for these models to work well on a permanent basis.

The evaluation found that participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals while also stimulating new services and ways of working, tailored to the needs of different patient groups.

It was judged to be too early in the scheme’s development for the Nuffield Trust to quantify impacts on patient outcomes, patient experience or use of wider health services.

Full report: Primary Care Home. Evaluating a new model of primary care.

Related: New primary care model needs resources, say experts | OnMedica

Physical inactivity levels in adults aged 40 to 60 in England

Public Health England has released data on brisk walking levels and physical inactivity in people aged between 40 and 60 in England from 2015 to 2016.

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Data released by Public Health England (PHE) has shown that the amount of activity people do starts to tail off from the age of 40. PHE estimates 40% of 40- to 60-year-olds take a brisk 10-minute walk less frequently than once a month.

The analyses were carried out by PHE using data from Sport England’s Active Lives Survey, which is designed to measure participation in sport and physical activity in England.

PHE  say just 10 minutes a day could have a major impact, reducing the risk of early death by 15%. To help, the government agency is promoting a free app – Active 10 – which can monitor the amount of brisk walking an individual does and provide tips on how to incorporate more into the daily routine.

In addition, the PHE framework ‘Everybody active, every day’ has been updated. This framework aims to make active lifestyles a reality for all, with 4 areas for action which will:

  • change the social ‘norm’ to make physical activity the expectation
  • develop expertise and leadership within professionals and volunteers
  • create environments to support active lives
  • identify and up-scale successful programmes nationwide

Full document:
Everybody active, every day: an evidence-based approach to physical activity

Related: BBC News: Middle-aged told to walk faster

The Guardian: 6 million middle-aged people take no exercise

Improving care and support for children and young people with mental health problems

Three Royal Colleges have jointly agreed five shared principles designed to improve care and support for children and young people with mental health problems.

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The Royal College of General Practitioners, The Royal College of Paediatrics and Child Health and The Royal College of Psychiatrists have issued a position statement saying that as well as the commissioning of specialist treatment, an effective child and young people’s (CYP) mental health system required:

  • acknowledgment that CYP mental health is everybody’s business and should be supported by a shared vision for CYP mental health across all government departments
  • a preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion
  • a system of national and local accountability for population-level CYP mental health and well-being, delivered via integrated local area systems
  • training and education for the whole children’s workforce in their role and responsibilities for CYP mental health
  • more support, both from specialist services and other sectors, for professionals dealing with CYP who do not meet referral threshold to CAMHS.

Full document: Position statement on children and young peoples’ mental health

Substance misuse in older people

Action is needed to deal with growing levels of substance misuse in people aged over 50, claims BMJ editorial 

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Researchers in the UK and Australia said the number of people aged over 50 who were experiencing problems from substance misuse was growing rapidly and the numbers receiving treatment were expected to treble in the US and double in Europe by 2020.

In both the UK and Australia, dangerous levels of drinking are declining, except among people aged 50 years and older, they said. One of the authors warns that the issue goes beyond drinking, citing illicit drugs such as cannabis, and commonly prescribed medications such as opioid painkillers as also being an issue.

Full  editorial:  Rao, R. & Roche, A.  Substance misuse in older people: Baby boomers are the population at highest risk  BMJ 2017;358:j3885

Related : Baby boomers’ drink and drug misuse needs urgent action, warn experts | The Guardian

NHS funding and privatisation: the facts

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A lecture and article by the scientist Professor Stephen Hawking outlining his views on the NHS have prompted a lively debate about a number of issues.

Here the Kings Fund looks at the facts about two of these: whether the NHS is being privatised and if it has been given the funding it needs:

Is the NHS being privatised?
The involvement of the private sector in the NHS is a hotly contested topic. Private companies have always played a role in the NHS, but critics claim that their increasing involvement is evidence of growing privatisation of care and is undermining the service’s core values.

Does the NHS need more money?
In recent years, spending on the NHS has been protected while other budgets, such as those for local government services and policing, have been subject to significant cuts. Despite this, health services are facing unprecedented financial and operational pressures, with many NHS organisations in deficit and key performance standards being missed.

New scheme launched to help NHS whistleblowers

A nationwide pilot to help NHS whistleblowers back into work is being launched | NHS England.

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Image source: Truthout.org – Flickr // CC BY-NC-SA 2.0

The Whistleblowers Support Scheme will offer a range of services including career coaching, financial advice and mediation for primary care staff who have suffered as a result of raising concerns about NHS practice. Working Transitions has been appointed to run the pilot until March 2018.

The scheme has been designed with the help of former staff who have also had experience of whistleblowing and the impact it can have on staff.

Sir Malcolm Grant, Chair of NHS England, said: “It is simply inexcusable that talented, experienced staff should be lost to the NHS as the result of raising the legitimate concerns that help the health service improve.

Read the full news story here

 

Breastfeeding: five ways it can be encouraged responsibly

Our behaviour is driven by the environment in which we live: public attitudes, financial constraints, and support from others all affect our confidence and ability to act | The Conversation

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Despite increasing breastfeeding rates being a strategic priority globally, the involvement of many governments often only goes so far as unhelpful messages extolling women to breastfeed. These don’t work because they don’t change the environment in which women are trying to breastfeed. They might tell women breastfeeding is important but they don’t offer practical support, change negative public attitudes, or help women delay going back to work. All of this pushes many women to stop breastfeeding before they are ready.

Rather than focusing on telling women to breastfeed, governments must recognise their wider public health responsibility, and work to create an environment that actually supports breastfeeding. It shouldn’t be left to charities and volunteers alone. Support should be part and parcel of society – and implementing a new strategy is not as difficult as you might think.

Read the full blog post here