Latest Quarterly Monitoring Report finds Patient care deteriorating

Half  of NHS trust finance directors think patient care in their area has got worse over the last year, while just six per cent said it has improved | The King’s Fund

Analysis for the Kings Fund latest Quarterly Monitoring Report suggests that the NHS is heading into winter on a knife edge with performance worse than at this time last year against a number of key indicators:

  • 89.7 per cent of A&E patients were seen within four hours in September compared to 90.6 per cent of patients in September last year.
  • 89.4 per cent of patients waiting for treatment in August had been waiting up to 18 weeks for treatment in August, compared to 90.9 per cent in August last year. This is missing the target of 92 per cent. There are now 4.1 million people waiting for treatment, the highest number since 2007.
  • Emergency admissions are three per cent higher in September compared to the same time last year.

The report also shows that NHS finances remain precarious.  Less than half of NHS trusts (45 per cent) expect to meet their financial targets this year, while commissioners are being forced to make tough decisions to reduce spending such as making people wait longer for planned treatment.

Trust finance directors also report widespread problems attracting nursing staff. The main reasons for this are the shortage in staff being trained; morale and work-life balance; and pay restraint.

Full report: The Kings Fund Quarterly Monitoring Report November 2017

Reducing delayed transfers of care over winter

NHS Improvement has written to the chief executives of all trusts providing community services setting out actions they must implement to reduce delayed transfers of care over winter. | NHS Improvement | HSJ

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NHS Improvement  chief executive Jim Mackey has said trusts must help improve delayed discharges over winter and listed six actions they need to carry out in the next six months:

  1. Facilitate the sharing of patient data with acute and social care partners and from 7 November ensure daily situation reports are completed “to enable better understanding of community services at a national level”.
  2. Jointly assess discharge pathways with local partners including “being an active participant in the local acute provider’s discharge and hosting operational discussions daily where necessary to discharge patients in community settings”.
  3. Develop “discharges hubs” over the next six months and beyond, designed to be a single point of access for patients moving between acute and community services.
  4. Ensure a “robust patient choice policy” is implemented.
  5. Clarify to partner organisations what services the trust offers to patients.
  6. Ensure collection of patient flow data and data on plans to improve patient flow.

Full detail is given by NHS Improvement who have produced the following  report to help improve flow into and out of community health services:

Flow in providers of community health services: good practice guidance

Related HSJ article: Trust chiefs given new instructions to tackle winter DTOCs

Increasing number of nurses and midwives leaving profession

Data published by the Nursing and Midwifery Council (NMC) shows there continues to be an increase in the number of nurses and midwives leaving its register over the last 12 months.

Overall, the number of nurses and midwives on the register has started to drop for the first time in a decade:

  • There were just under 690,000 nurses and midwives registered to work in the UK in September – over 1,600 less than there were the year before
  • The register showed just over 36,200 EU nurses and midwives – over 2,700 less than a year before
  • Over the last 12 months the number of UK graduates leaving the profession has increased by 9%
  • The number of nurses and midwives from Europe leaving the register has also increased by 67%
  • The number joining the register from the EU has dropped from 10,178 last year to 1,107 this year, a decrease of 89%

The NMC Register can be viewed here

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Image source: www.nmc.org.uk

Related:

How alcohol and drug treatment helps to reduce crime

Report re-affirms how important drug treatment is in cutting crime, as well as preventing alcohol and drug-related deaths and helping people recover from dependence. | Ministry of Justice | Public Health England

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In England, almost 300,000 adults get help for drug and alcohol dependency each year. Most people receiving drug treatment are addicted to heroin or crack cocaine, or both, and many commit crimes to fund their addiction.

New analysis published last week by the Ministry of Justice (MoJ) has added to the evidence of how alcohol and drug treatment can help to prevent crime.

The analysis revealed that:

  • In 2012, nearly 133,000 people started treatment for drugs and alcohol, 35% of which had a criminal conviction recorded against them in the two years previous
  • Overall 44% of people in treatment hadn’t offended again two years after starting treatment
  • The number of recorded offences by people in treatment fell by a third over the two years, from 129,000 to 86,500
  • People who had been in prison before starting treatment, and those who dropped out and came back to treatment, were more likely to reoffend
  • People who successfully completed their treatment, or were still in treatment at the end of the two years, were less likely to reoffend

Full story at Public Health England

Full report: The impact of community-based drug and alcohol treatment on re-offending

Risk factors & Alzheimers Disease: Sleep disturbance, depression and anxiety

Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants | Aging & Mental Health

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Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Shanna L. Burke et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety  | Aging & Mental Health | Published online: 27th Oct 2017

 

End of life care for homeless people

The Care Quality Commission and Faculty for Homeless and Inclusion Health have published A second class ending: exploring the barriers and championing outstanding end of life care for people who are homeless.

This report draws on research findings which explored the challenges to palliative care for homeless people in London.  It explores homeless peoples’ views and experiences of palliative care and aims to understand how they believe support could be improved.  It includes a series of case studies and recommendations.

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Image source: http://www.cqc.org.uk

Key discussion points

  • The needs of homeless people are not well understood or considered by health and care services. Where services do exist, they are often fragmented and work in relative isolation.
  • These issues are exacerbated by a lack of training and support for frontline staff.
  • Identifying homeless people who may be dying is difficult. Involving homeless people in decisions about their treatment and care means striking the right balance between supporting them and respecting their individual choices.
  • Actively linking health care, social care, housing and voluntary services may improve the care options available.
  • Working together will help continuity of care – this needs a collaborative effort across services.
  • There must be a strategic, equality-led approach at a local level, delivering personalised care. We share examples of excellent primary care and specialist community services.
  • Hospices and primary care organisations in particular can play a key role in championing an equality-led approach.

Additional link: CQC press release