Taking the value-based agenda forward: The five essential components of value-based approaches to health and care

NHS Confederation | July 2018 | Taking the value-based agenda forward: The five essential components of value-based approaches to health and care

A new paper from NHS Confederation explores the central challenge of how to take value-based healthcare to the next stage and embed it across the whole system.

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It explores five key characteristics/factors which we believe can support the wholesale adoption of value-based healthcare approaches. These are:

  • Learning and adapting through the adoption of innovation
  • Managing risk
  • Making best use of data
  • Thinking about pathways across the whole system
  • Listening to patients.
    (NHS Confederation

The full paper can be read at NHS England 

Adult inpatient survey 2017

Care Quality Commission | June 2018 | 2017 Adult Inpatient Survey

The Care Quality Commission (CQC) has recently published the 2017 Adult Inpatient Survey.  Their results from the 2017 inpatient survey, compared with results from surveys dating back to 2009, show gradual improvements in a number of areas. This includes patients’ perceptions of:

  • the quality of communication between themselves and medical professionals (doctors and nurses)
  • the quality of information about operations or procedures
  • privacy when discussing their condition
  • quality of food
  • cleanliness of their room or ward

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However, the results also indicate that responses to some questions are less positive or have not improved over time. This includes patients’ perceptions of:

  • noise at night from other patients
  • emotional support from staff during their hospital stay
  • information on new medications prescribed while in hospital
  • the quality of preparation and information for leaving hospital

Certain groups of patients consistently reported poorer experiences of their time in hospital, including:

  • patients with mental health conditions
  • younger patients (aged 16-35 years)
  • patients with Alzheimer’s or Dementia

2017 Adult Inpatient  Survey Statistical release

2017 Adult Inpatient Survey: Quality and Methodology Report

Stop antibiotics before resistance ‘tipping point’

University of Bristol | July 2018 | Stop antibiotics before resistance ‘tipping point’

New research involving scientists at the University of Bristol shows that rather than completing a course of antibiotics, patients should stop taking antibiotics as soon as possible.

The scientists examined how microbial communities – groups of microorganisms that share a common living space in the body – reacted to different antibiotic cycling patterns, which involves the  medication being restricted or increased.

microscope-385364_1920The team used sugars alongside the drugs  to reflect variable sugars in human patients, which led to the discovery that  changes both in the duration and dose of antibiotics used and in sugar level had an impact on  resistance.  They found that while the introduction of an antimicrobial reduced the microbial communities  they started to thrive once the antimicrobial was withdrawn, this is because, unwittingly, a critical point was passed during treatment.

The team’s findings suggest that resistant species can increase within the body even after an antibiotic is withdrawn, this could lead to the microbials becoming resistant to the treatment (Source: University of Bristol).

The findings have just been published in  the journal Nature Ecology & Evolution 

Abstract

Microbes rarely exist in isolation, rather, they form intricate multi-species communities that colonize our bodies and inserted medical devices. However, the efficacy of antimicrobials is measured in clinical laboratories exclusively using microbial monocultures. Here, to determine how multi-species interactions mediate selection for resistance during antibiotic treatment, particularly following drug withdrawal, we study a laboratory community consisting of two microbial pathogens. Single-species dose responses are a poor predictor of community dynamics during treatment so, to better understand those dynamics, we introduce the concept of a dose-response mosaic, a multi-dimensional map that indicates how species’ abundance is affected by changes in abiotic conditions. We study the dose-response mosaic of a two-species community with a ‘Gene × Gene × Environment × Environment’ ecological interaction whereby Candida glabrata, which is resistant to the antifungal drug fluconazole, competes for survival with Candida albicans, which is susceptible to fluconazole. The mosaic comprises several zones that delineate abiotic conditions where each species dominates. Zones are separated by loci of bifurcations and tipping points that identify what environmental changes can trigger the loss of either species. Observations of the laboratory communities corroborated theory, showing that changes in both antibiotic concentration and nutrient availability can push populations beyond tipping points, thus creating irreversible shifts in community composition from drug-sensitive to drug-resistant species. This has an important consequence: resistant species can increase in frequency even if an antibiotic is withdrawn because, unwittingly, a tipping point was passed during treatment.

Full reference:

Beardmore, R.E. et al |2018| Drug-mediated metabolic tipping between antibiotic resistant states in a mixed-species community | Nature Ecology & Evolution | ePub | https://doi.org/10.1038/s41559-018-0582-7

Computer therapy can help people with aphasia find lost words

University of Sheffield | June 2018 | Computer therapy can help people with aphasia find lost words

Sheffield University’s School of Health and Related Research (ScHARR) has trialled an innovative form of computer therapy to help people with aphasia. Aphasia is a language disorder, which is caused by an injury to the brain, can make it difficult for people to talk, understand, read and write (via University of Sheffield)..

More than 270 people from 21 NHS Speech and Language departments across the UK took part in the trial . Their  findings show patients were able to increase their speech and language practice spending 28 hours a week on average compared to 3.8 hours of the traditional speech and language therapy during a six month period.

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The research team has found there are a number of benefits to using this type of therapy  for people affected by aphasia in comparison to usual speech and language therapy alone. Their findings also show that people with aphasia can learn new words even after a long time post-stroke with computer therapy, they were saying the words six months after their computer therapy had ended (Source: University of Sheffield).

The full news story is here 

How should the extra NHS funding be spent?

The King’s Fund | July 2018 | How should the extra NHS funding be spent?

The King’s Fund  has published a long read on its blog, discussing how the extra  NHS funding should be spent.

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It explores the question- in relation to a number of topics

  • learning from the past
  • context
  • improving productivity
  • priorities
  • population health
  • a new deal
  • social care
  • future workforce
  • how to make it happen

Learning from deaths: Information for families

NHS England | July 2018 | Learning from deaths: Information for families

NHS England has produced information for families following a bereavement, it has been prepared with the support of families, trusts and other stakeholders. These documents aim to explain what happens next; including information about how to comment on the care your loved one received and what happens if a death will be looked into by a coroner.

Information for families following a bereavement 

Information for families following a bereavement

Learning from deaths: Guidance for NHS trusts on working with bereaved families and carers

NHS England | July 2018 | Learning from deaths: Guidance for NHS trusts on working with bereaved families and carers

The learning from deaths national guidance is for NHS trusts on working with bereaved families and carers. It advises trusts on how they should support, communicate and engage with families following a death of someone in their care (NHS England).
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The guidance can be downloaded here

Related:

Information for families following a bereavement 

Information for families following a bereavement

Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology

Office of Health Economics | July 2018 | Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology

The Office of Health Economics has undertaken a literature review which  examines whether there is evidence to support the assumption that the quality of life (QoL) of  long-term cancer survivors (LTCS) can be similar to that of age-/sex-matched population samples.  The review included 20 papers which represented  23 studies covering a range of cancers, with the LTCS in the studies were more likely to have experienced early-stage cancer relative to late-stage cancer (Source: Office of Health Economics).

The news release is available from the Office of Health Economics 

The literature review can be downloaded from the OHE

Preparing the healthcare workforce to deliver the digital future

Health Education England | June 2018 | The Topol Review Preparing the healthcare workforce to deliver the digital future

Health Education England (HEE) has published its interim report on preparing the healthcare workforce for future developments. The review is considering four key questions:

  1.  How are technological (genomics, digital medicine, artificial intelligence (AI) and robotics) and other developments likely to change the roles and functions
    of clinical staff and their support in all professions over the next two decades?
  2. What are the implications of these changes for the skills required?
  3. For which professions or sub-specialisms are these likely to be particularly significant?
  4.  What does this mean for the selection, curricula, education, training, development and lifelong learning of current and future NHS staff?
Preparing the healthcare workforce
Image source: .hee.nhs.uk

Based on its work so far, HEE’s Review is proposing three key principles, which should govern the NHS’s future workforce strategy, these are: 
• Patients: If willing and able to do so, will be empowered by new tools to become more actively involved and engaged in their care. The patient generated data will be interpreted by algorithms enabling personalised self-management and self-care.
• Evidence: The introduction of any technology must be grounded in robust research evidence and a fit for purpose and ethical governance framework that patients, public and staff can all trust.
• Gift of time: Whenever possible, the adoption of technology should be used to give more time for care, creating an environment in which the patient-clinician relationship is enhanced.

The Interim Report June 2018- A Call for Evidence is at HEE 

£10 million research competition launched to tackle antimicrobial resistance

Department of Health and Social Care | July 2018 | £10 million research competition launched to tackle antimicrobial resistance

The Department of Health and Social Care DHSC has launched a competition to address antimicrobial resistance (AMR) in humans.  The competition is designed to find innovative scientific solutions to the problem of AMR which threatens the treatability of infections and potentially means modern medical advancements could be at risk of being reversed. 
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The £10 million will be made available in research grants funded through a Small Business Research Initiative (SBRI). It is being run by Innovate UK on behalf of the Department of Health and Social Care, with the aim of supporting the implementation of the UK Five Year Antimicrobial Resistance Strategy. (Source: DHSC)

See DHSC for the full news release 

Details of the competition are at Department of Health and Social Care