Age UK’s Personalised Integrated Care Programme: Evaluation Of Impact On Hospital Activity

Nuffield Trust | February 2019 | Age UK’s Personalised Integrated Care Programme: Evaluation Of Impact On Hospital Activity

Age UK commissioned the Nuffield Trust to conduct a detailed evaluation of a scheme providing personalised care for older people. Given the severe pressure on health and care services across England, could this scheme help local systems by reducing the numbers of people being admitted to hospital in an emergency?
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Read the full piece from Nuffield Trust

Download the publication Age UK’s Personalised Integrated Care Programme


NICE Consultation: Chronic obstructive pulmonary disease in over 16s: diagnosis and management (2019 update)

NICE | February 2019| Chronic obstructive pulmonary disease in over 16s: diagnosis and management (2019 update) In development [GID-NG10128]

The consultation on Chronic obstructive pulmonary disease in over 16s: diagnosis and management (2019 update) is open, NICE is inviting people to review and comment on this draft guideline. The consultation closes on 5 March 2019 at 5pm

See NICE for full details

Cerebral palsy in adults

NICE guideline [NG119] | January 2019 |Cerebral palsy in adults

This guideline covers care and support for adults with cerebral palsy. It aims to improve health and wellbeing, promote access to services and support participation and independent living.

NICE has also produced guidelines on cerebral palsy in under 25s: assessment and management and spasticity in under 19s: management.

Full details from NICE 

Delivering effective governance and accountability for integrated health and care

NHS Clinical Commissioners | February 2019 | Delivering effective governance and accountability for integrated health and care

NHS Clinical Commissioners has released a new explainer for the NHS and local authorities outlines possible solutions for the governance and accountability challenges brought by the move to integrated health and care.

NHS organisations and local authorities are already working closely together to join up approaches to delivery and this will become even more important as the journey towards more integrated approaches to planning for health and care continues via ICSs, as set out in the NHS Long Term Plan earlier this year.

But we know from our members that there are several important differences in governance and accountability between the NHS and local authorities, which creates challenges when seeking to integrate systems and structures (Source: NHS Clinical Commissioners)

NHS Clinical Commissioners Download the explainer

Standing desks with a support package reduce time sitting at work

NIHR | January 2019 | Standing desks with a support package reduce time sitting at work

National Institute for Health Research reports how an office-based intervention involving a height-adjustable workstation and instruction package reduced the amount of time spent sitting for 146 NHS workers. Using a height- adjustable work station reduced time sat by between 60 to 90 minutes less per day at six and 12 months compared with the control group.


Sitting for long periods is a risk factor for ill health even in people meeting recommended levels of physical activity. Reducing time sitting at work could have health and economic benefits, but the evidence is limited. This trial was fairly small, involving 146 NHS workers. No firm conclusions can be drawn as to whether reduced sitting time may translate into effects on musculoskeletal health, work performance or sickness absence. However, the results are promising and will be important if shown to be effective and cost-effective for individuals and their employers when implemented more widely.

A larger NIHR-funded study involving council workers is underway which may provide further evidence and cost data.

Read the full Signal here 

Full reference:

Edwardson, C. | 2018|Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial|BMJ|10.3310/signal-000717


To evaluate the impact of a multicomponent intervention (Stand More AT (SMArT) Work) designed to reduce sitting time on short (three months), medium (six months), and longer term (12 months) changes in occupational, daily, and prolonged sitting, standing, and physical activity, and physical, psychological, and work related health.

Cluster two arm randomised controlled trial. Setting National Health Service trust, England.


37 office clusters (146 participants) of desk based workers: 19 clusters (77 participants) were randomised to the intervention and 18 (69 participants) to control.


The intervention group received a height adjustable workstation, a brief seminar with supporting leaflet, workstation instructions with sitting and standing targets, feedback on sitting and physical activity at three time points, posters, action planning and goal setting booklet, self monitoring and prompt tool, and coaching sessions (month 1 and every three months thereafter). The control group continued with usual practice.
Main outcome measures

The primary outcome was occupational sitting time (thigh worn accelerometer). Secondary outcomes were objectively measured daily sitting, prolonged sitting (≥30 minutes), and standing time, physical activity, musculoskeletal problems, self reported work related health (job performance, job satisfaction, work engagement, occupational fatigue, sickness presenteeism, and sickness absenteeism), cognitive function, and self reported psychological measures (mood and affective states, quality of life) assessed at 3, 6, and 12 months. Data were analysed using generalised estimating equation models, accounting for clustering.


A significant difference between groups (in favour of the intervention group) was found in occupational sitting time at 12 months. Differences between groups (in favour of the intervention group compared with control) were observed for occupational sitting time at three months and six months and daily sitting time at six months  and 12 months. Group differences (in favour of the intervention group compared with control) were found for prolonged sitting time, standing time, job performance, work engagement, occupational fatigue, sickness presenteeism, daily anxiety, and quality of life. No differences were seen for sickness absenteeism.

The full paper has been published in the BMJ

Screen time and young people’s mental health and psychosocial wellbeing

Senior medical officers’ release recommendations and advice for parents and carers regarding screen time and children and young people’s mental health and psychosocial wellbeing | Department of Health and Social Care

In 2018, the UK Chief Medical Officers commissioned independent researchers to map published research on screen time, social media, and children and young people’s mental health.  This research was published in January 2019 in the report Screen-based activities and children and young people’s mental health and psychosocial wellbeing: a systematic map of reviews , and today The Department of Health and Social Care have published the UK Chief Medical Officers’ (CMO) commentary on this research.

In the document, the CMOs said, in the UK most children and young people had grown up with internet-enabled technology in their home or school. Many had early access to smartphones and similar devices that can be used outside the home or school.

The internet and social media could be a force for good in society, said the CMOs, as they helped to promote social contact and children could access advice, education, support and information, while apps were increasingly being used to help young people manage health conditions and access online learning.

However, at the same time, parents and carers, children and educational professionals, health professionals, academics and politicians had expressed concern that the amount of time children spent engaged in screen-based activities could be detrimental to their physical and mental health.


What does the guidance recommend parents do?

There are several recommendations for parents, which the chief medical officers say will help keep children safe and healthy.

These include:

  • not using phones and mobile devices at the dinner table – talking as a family is very important for development
  • keeping screens out of the bedroom at bedtime
  • talking as a family about keeping safe online and about cyber-bulling and what children should do if they are worried
  • not using phones when crossing a road or doing any other activity that requires a person’s full attention
  • making sure children take a break from screens every two hours by getting up and being active
  • policing their own use too – parents should give their children proper attention and quality family time and never assume they are happy for pictures to be shared

Full document: UK Chief Medical Officers’ (CMO) commentary on ‘Screen-based activities and children and young people’s mental health and psychosocial wellbeing: a systematic map of reviews’

Original review: Screen-based activities and children and young people’s mental health and psychosocial wellbeing: a systematic map of reviews


NHS managers need support to use tools to ensure safe nurse staffing levels

NIHR | February 2019| NHS managers need support to use tools to ensure safe nurse staffing levels

This NIHR Signal highlights a realist review which involved a literature review to develop theories around how workforce planning and deployment tools and technologies work in context and to identify any barriers or facilitators to implementation. This theoretical understanding was developed in workshops involving NHS staff, patient and public representatives. Telephone interviews were undertaken with NHS managers including team leaders in hospital and community settings. Further interviews were conducted to refine theories. From this emerged seven principles, ‘context-mechanism-outcome’ conditions. These were agreed might help NHS managers use workforce planning tools effectively and enhance safe nurse staffing (Source: NIHR).


The research focuses on acute adult care.


Background Policy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.

Objectives The review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.

Design A realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.

Participants NHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.

Results Workforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.

Limitations The evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.

Conclusions and recommendations The synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.

Read the full NIHR Signal here

At the forefront of improving care – a year in review 2017/2018

Health Education England | January 2019 |At the forefront of improving care –
a year in review 2017/2018

Health Education England (HEE) has highlighted the growing influence and increasingly enhanced role of allied health professionals in its new publication At the forefront of improving care – a year in review 2017/2018.

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The document focuses on three areas: 

The contribution of AHPs to the HEE priority areas- – primary care, urgent and emergency care, mental health, cancer and maternity

Supporting vulnerable professions- – podiatry, prosthetics and orthotics, orthoptists and therapeutic radiography

Workforce, career and professional development-– apprenticeships, return to practice, AHP careers and professional development and Advanced Clinical Practice.

Source: HEE

Allied Health Professionals at the forefront of improving care – a year in review 2017/2018

See also:

HEE publishes update on developing and strengthening AHP roles