Recommendations for urgent and emergency mental health care

NHS Clinical Commissioners and RI International publish recommendations for urgent and emergency mental health care | via NHSCC

NHSCC RI
Image source: http://www.nhscc.org

A new report, ‘Be the change: Ensuring an effective response to all in psychiatric emergency equal to medical care,’ outlines ten recommendations that if fulfilled would make urgent and emergency psychiatric health care ‘minimally adequate’, and calls on governmental agencies, policy makers and health and social services to take radical action to address inequalities and improve mental health crisis care.

The recommendations were agreed by delegates at an international summit in May 2018, hosted by NHS Clinical Commissioners and RI International. The ten recommendations, aimed at government, policymakers and those implementing health and social services, are to:

  1. End the current fragmentation of care through an integrated, systematic approach to behavioural health crisis care at the national level.
  2. Actively develop crisis service alternatives to the usual emergency measures of formal assessment and psychiatric inpatient care.
  3. Include special consideration to cater for armed forces veterans.
  4. Implement an integrated health information exchange capable technology solution to enable seamless care across organisations.
  5. Develop balanced scorecard dashboards that display real-time, meaningful data and outcome measures that support continuous quality improvement.
  6. Embed users, peers and carers should be embedded in the design and leadership of crisis systems; peer support staff should be trained and integrated in crisis service delivery.
  7. The zero-suicide aspiration should be owned by governmental agencies, policy makers and those implementing health and social services.
  8. Family and friends should be fully engaged in crisis care and inappropriate barriers created by confidentiality or privacy need to be sensitively overcome.
  9. Implement a single national three-digit crisis hub number that drives easy access in which all callers are welcome, the crisis is defined by the caller, and which is promoted via intelligent social media to get the word out to those who need it.
  10. Significant system-wide investment is needed to deliver these recommendations.

The report also concludes that the aim must be to provide 100% access to services to those in a behavioural health crisis and to aspire to zero suicide in healthcare settings. It calls for an approach equal to medical care to ensure an effective response to all in psychiatric emergency.

Full report: Be the change. Ensuring an effective response to all in psychiatric emergency equal to medical care. Recommendations from the first international summit on urgent and emergency behavioural healthcare

Fitter Better Sooner

New patient information toolkit aimed at advising patients on how to prepare for going in to hospital and encouraging them to improve their health before surgery | Royal College of Anaesthetists  

The Fitter Better Sooner toolkit is aimed at patients but delivered by care providers. The toolkit materials can be used in ‘teachable’ moments with patients in order to encourage them to actively participate in their own healthcare choices and enjoy the benefit of a healthy lifestyle after surgery. The toolkit consists of one main leaflet, six specific leaflets on some of the most common surgical procedures and an animation which can be shown in clinics or on portable devices.

Full document: Preparing for surgery: Fitter Better Sooner

Future Alzheimer’s treatment

Report suggests joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients | RAND Corporation

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  • The burden of Alzheimer’s disease in high-income countries is expected to approximately double between 2015 and 2050. Recent clinical trial results give hope that a disease-modifying therapy might become available in the near future. The therapy is expected to treat early-stage patients to prevent or delay the progression to dementia.
  • This preventive treatment paradigm implies the need to screen, diagnose, and treat a large population of patients with mild cognitive impairment. There would be many undiagnosed prevalent cases that would need to be addressed initially, and then the longer-term capacity to address incident cases would not need to be as high.
  • Researchers used a simulation model to assess the preparedness of the health care system infrastructure in six European countries — France, Germany, Italy, Spain, Sweden, and the United Kingdom — to evaluate, diagnose, and treat the expected number of patients.
  • Projected peak wait times range from five months for treatment in Germany to 19 months for evaluation in France. The first year without wait times would be 2030 in Germany and 2033 in France, and 2042 in the United Kingdom and 2044 in Spain. Specialist capacity is the rate-limiting factor in France, the United Kingdom, and Spain, and treatment delivery capacity is an issue in most of the countries.
  • If a disease-modifying therapy becomes available in 2020, we estimate the projected capacity constraints could result in over 1 million patients with mild cognitive impairment progressing to Alzheimer’s dementia while on wait lists between 2020 and 2050 in these six countries.

Recommendations

  • In addition to increasing specialist and infusion capacity in each individual country, joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients.
  • A combination of reimbursement, regulatory, and workforce planning policies, as well as innovation in diagnosis and treatment delivery, is needed to expand capacity and to ensure that available capacity is leveraged optimally to treat patients with early-stage Alzheimer’s disease.

Full report: Assessing the Preparedness of the Health Care System Infrastructure in Six European Countries for an Alzheimer’s Treatment | RAND Corporation

Men’s health: nurse-led community projects

Men’s health: nurse-led projects in the community |  The Queen’s Nursing Institute

family-1921637_1280This report aims to provide information and guidance to community nurses who want to work more effectively on men’s health.  It includes information on a range of men’s health and wellbeing projects that the Queen’s Nursing Institute supported in 2017 with funding from the Burdett Trust for Nursing.

The report also includes wider information about men’s health including details of additional information and support.

Full report:   Men’s health: nurse-led projects in the community

Rethinking acute medical care in smaller hospitals

Nuffield Trust | October 2018| Rethinking acute medical care in smaller hospitals

A major new report from the Nuffield Trust outlines a set of radical new approaches for running acute medical services in smaller hospitals struggling with workforce shortages, spiralling costs and increasingly complex models of care (Nuffield Trust).

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Image source: nuffieldtrust.org.uk
Full details from the  Nuffield Trust 

Losing weight soon after a diabetes Type 2 diagnosis could prevent long-term damage, says new research

College of Medicine and Integrated Health | October 2018 | Losing weight soon after a diabetes Type 2 diagnosis could prevent long-term damage, says new research

University of Newcastle researchers discovered that losing weight soon after a diabetes Type 2 diagnosis could prevent long-term damage. The research was presented at the European Association for the Study of Diabetes  conference recently held in Berlin. 

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The scientists reported that following a a strict diet sooner could prevent further damage to the pancreas; researchers found that those who ate more healthily 2.7 years after diagnosis were more likely to go into remission than those who didn’t begin eating a reduced calorie intake for at least 3.8 years (Source: College of Medicine and Integrated Health).

Read the full news item at the College of Medicine and Integrated Health 

Sepsis: a personal story

NHS England | September 2018 | Sepsis: a personal story

A learning disability nurse describes how she is working to raise awareness of sepsis so that more people are able to spot the signs earlier and get the treatment they need, in a recent blog post on NHS England’s blog.

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She writes about what Derbyshire are doing to help to alert primary care and other clinicians.

  • Every learning disability update for the learning disability annual health check now mentions sepsis and the findings from the LeDer reviews both local and national.
  • Medical students and adult branch student nurses have learning disability awareness afternoons and we include sepsis on that training.
  • We are working with local people with a learning disability and their families and carers to spot the signs of sepsis by sharing easy read information. Our Learning Disability Partnership Board health sub group is having a dedicated sepsis slot in October and the plans from that will then go to our partnership boards.
  • A learning disability student nurse on placement with us created an easy read leaflet about sepsis to help his own and his fellow students learning and to help us support people with a learning disability.
  • We include sepsis awareness in our health action planning and constipation training for social care providers and carers.
  • Sepsis has been highlighted within the specialist NHS learning disability clinical reference group and information was presented at the learning disability service wide physical health event at the end of last year and shared around all staff.

Source (NHS England)

Early diagnosis of cancer

The Department of Health and Social Care has announced plans for the earlier diagnosis of cancer. 

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As part of the long-term plan for the NHS, a package of measures will be rolled out across the country with the aim of seeing 3 out of 4 of all cancers detected at an early stage by 2028.  The plan will:

  • overhaul screening programmes
  • provide new investment in state-of-the-art technology to transform the process of diagnosis
  • boost research and innovation

Screening programmes will be made more accessible and easier to use. They will be based on the latest breakthrough research and technology. Those at risk will be able to benefit from options including:

  • new tests for bowel cancer
  • mobile lung screening units
  • the roll-out of rapid diagnostic centres across the country with same-day testing

Full story: Government announces plans for earlier diagnosis for cancer patients

Improving quality and cost

Approaches to better value: improving quality and cost | The Kings Fund

  • The NHS is increasingly focusing on how it can improve the value of its services, to deliver the highest quality health outcomes for patients at the lowest possible cost.
  • This report shares learning and insight from three NHS hospital trusts that have developed organisation-wide strategies for value improvement. It draws on interviews, roundtables and site visits with senior leaders in the NHS who are committed to developing better value services.
  • The report suggests a wide variety of approaches are being taken to improve value in the NHS. These include top-down programmes that focus on a wide range of clinical services from their inception, to value improvement strategies that are more organically grown from a few individual services until they cover a wider breath of hospital-based care.
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Image source: http://www.kingsfund.org.uk
  • While there are differences in how organisations are approaching value improvement, there are also several common conditions for success. These include fidelity to a clearly defined strategy that brings the various strands of value improvement work together; recognition that value improvement is a long-term commitment that will require considerable staff time and resources; and a new leadership approach that requires continuous engagement with frontline clinicians and managers.

Full report: Approaches to better value: improving quality and cost

Summary available here

Maths, baths and computer models: ways to make health services more efficient

Nuffield Trust | October 2018 | Maths, baths and computer models: ways to make health services more efficient

In a new post on the Nuffield Trust’s blog, Chris Sherlaw-Johnson looks at different approaches being used to improve the efficiency and effectiveness of health services, and explains the value they could bring to the NHS.

Sherlaw- Jones also cites other health care applications stream describing how mathematical and computer models are used to improve the efficiency and effectiveness of health services.

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These  include:

  • Developing a predictive model using information on the referral forms for breast cancer screening to establish the risk of abnormal screening results. Then hospitals can investigate the consequences of choosing different thresholds for identifying high-risk women, using a computer simulation that models the processes of screening, diagnosis and treatment, and their influences on clinical outcomes.
  • Using mathematical formulae of queueing behaviour to evaluate different approaches for reducing overcrowding in emergency departments and achieving the four-hour target. This has been used to explore what would happen if, for example, low acuity patients were managed differently, or if beds were freed up quicker.
  • Developing a system for helping surgeons plan their schedules based on what is known about their case mix.
  • Using computer modelling to help design the layout of a hospital.

Read the full post at Nuffield Trust