The death of QOF?

The death of QOF? | BMJ Talk Medicine Podcast

The Quality and Outcomes Framework (QOF) is one of the most ambitious pay-for-performance schemes introduced into any health system. It’s now being scrapped by bits of the NHS, and is under reform elsewhere.

Martin Marshall, GP and professor of Health Improvement at University College London, thinks it’s time to rethink the experiment. This BMJ Talk Medicine podcast discusses how we got here, what we’ve learned, and what will replace QOF.

Full editorial: The future of the Quality and Outcomes Framework in England

Cyber attack and the NHS

Investigation: WannaCry cyber attack and the NHS | The National Audit Office

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This report investigates the NHS response to the cyber attack in May 2017 and the impact it had on health services.  The report concludes that the attack could have been prevented if the NHS had followed IT security best practice.

The key findings of the investigation are:

  • The Department was warned about the risks of cyber attacks on the NHS a year before WannaCry and although it had work underway it did not formally respond with a written report until July 2017
  • The attack led to disruption in at least 34% of trusts in England although the Department and NHS England do not know the full extent of the disruption
  • Thousands of appointments and operations were cancelled and in five areas patients had to travel further to accident and emergency departments
  • The Department, NHS England and the National Crime Agency have said that no NHS organisation paid the ransom, but the Department does not know how much the disruption to services cost the NHS
  • The cyber attack could have caused more disruption if it had not been stopped by a cyber researcher activating a ‘kill switch’ so that WannaCry stopped locking devices
  • The Department had developed a plan, which included roles and responsibilities of national and local organisations for responding to an attack, but had not tested the plan at a local level
  • NHS England initially focused on maintaining emergency care
  • NHS Digital have said that all organisations infected by WannaCry shared the same vulnerability and could have taken relatively simple action to protect themselves
  • The NHS has accepted that there are lessons to learn from WannaCry and is taking action.

Full report: Investigation: WannaCry cyber attack and the NHS

See also: NHS ‘could have prevented’ WannaCry ransomware attack | BBC News 

Improving the care of people living with dementia admitted to hospitals

This review seeks to identify primary research and use its findings to develop explanations of what characteristics of dementia-friendly initiatives in hospitals make them work, in what circumstances, and why | BMJ 

Abstract

Objectives To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.

Design A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.

Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.

Eligibility criteria Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.

Results Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.

Conclusions This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.

Full reference: Handley M, Bunn F, Goodman C. | Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review | BMJ Open 2017; 7:e015257

See also: Dementia care in hospital: training, leadership and culture change needed | The Mental Elf

Review Of Children And Young People’s Mental Health Services: Phase One Report

This report confirms many of the issues raised in the Five year forward view for mental health and comments on the difficulties children and young people face in accessing appropriate support for their mental health concerns from a system that is fragmented and where services vary in quality | Care Quality Commission 

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This report is the first phase of a major thematic review requested by the Prime Minister in January 2017. The Care Quality Commission (CQC) has drawn on existing reports, research and other evidence and its inspections of children and young people’s mental health services, as well as conversations with young people to identify the strengths and weaknesses of the current system.

CQC has found that, whilst most specialist services provide good quality care, too many young people find it difficult to access services and so, do not receive the care that they need when they need it. One young person told CQC that they waited 18 months to receive help.

This report also lays the foundations for the next phase of CQC’s review. Phase two will seek to identify where has there been real change in the system, where change has been slower and what was needed to drive better care.

Improving healthcare access for people with learning disabilities

Guidance for social care staff on how to help people with learning disabilities get better access to medical services to improve their health | Public Health England

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The health charter for social care and accompanying guidance provide information about the steps organisations and providers can take to improve the health and wellbeing of the people they support. There are practical tips as well as links to further information and useful resources.

There is also a self-assessment tool to enable organisations signed up to the health charter to measure progress and develop an action plan for improvements.

The series of short information sheets show social care staff how they can help people with learning disabilities to get better access to health services.

The documents can be accessed via Public Health England

Emergency re-admissions to hospital

Healthwatch has published an analysis of data from hospital trusts examining emergency readmission data from the last five years.

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Seventy two hospital trusts responded to the Healthwatch enquiry; their data indicate that emergency readmissions have risen by a fifth since 2012/13:

  • Between 2012/13 – 2016/17 the number of emergency readmissions rose by 22.8%. This compares with a 9.3% rise in overall admissions to hospitals during the same period.
  • The numbers of emergency readmissions within 24 hours rose even faster with a 29.2% increase
  • The number readmitted within 48 hours account for 1 in 5 of the overall total of emergency readmissions (21.6%)

Healthwatch is calling on the NHS to do more to understand why people are returning to hospital after being discharged.

Full story at Healthwatch

Mental health and employment

Thriving at Work: a review of mental health and employers | Lord Dennis Stevenson and Paul Farmer | Department for Work and Pensions and Department of Health

Thriving at Work sets out what employers can do to better support all employees, including those with mental health problems to remain in and thrive through work.

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Image source: http://www.gov.uk

The report includes a detailed analysis that explores the significant cost of poor mental health to UK businesses and the economy as a whole. It puts the annual cost to the UK economy of poor mental health at up to £99bn, of which £33bn –  £42bn is borne by employers.

The review quantifies how investing in supporting mental health at work is good for business and productivity. The most important recommendation is that all employers, regardless of size or industry, should adopt 6 ‘mental health core standards’ that lay basic foundations for an approach to workplace mental health:

  • Produce, implement and communicate a mental health at work plan
  • Develop mental health awareness among employees
  • Encourage open conversations about mental health and the support available
    when employees are struggling
  • Provide employees with good working conditions and ensure they have a healthy
    work life balance and opportunities for development
  • Promote effective people management through line managers and supervisors
  • Routinely monitor employee mental health and wellbeing

The report also highlights examples of good practice such as  the mental health first aid courses at Thames Water and, at Aviva, the promotion of e-learning modules to help identify and self-identify when people need support.

Full report: Thriving at Work: a review of mental health and employers

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