Waiting Times and Attendance Durations at English A&E Departments

The Strategy Unit & NHS Midlands and Lancashire Commissioning Support Unit | February 2019 | Waiting Times and Attendance Durations at English A&E Departments

A new report from The Strategy Unit presents a detailed view of presents a detailed review of the demand-side, supply-side, practice and emergent factors that lead to 4-hour breaches with a particular focus on changes that have taken place since 2010.


Waiting Times and Attendance Durations at English A&E Departments reviews both commonly cited causal factors and a range of more novel hypotheses.  It sets out the causal theories underpinning each factor and seeks statistical evidence in support of them.  Finally, the analysis scales the relative impact of each causal factor and aims to provide an explanation for the recent deterioration in A&E waiting times within the limits of national datasets.  New insights emerge which have the potential to reshape the received wisdom about the performance of A&E departments, carrying important implications for healthcare policy and system leadership (Source: The Strategy Unit).

Waiting Times and Attendance Durations at English Accident and Emergency Departments

Social determinants of health

This briefing presents the main findings from research commissioned by the Health Foundation, and carried out by the FrameWorks Institute, analysing public understanding, expert opinion and media narrative around health in order to develop more effective approaches to communicating evidence | The Health Foundation

The Health Foundation is working with the FrameWorks Institute to develop a deeper appreciation of the ways in which people understand and think about health in order to develop more effective approaches to communicating evidence.

This briefing presents the main findings from research analysing public understanding, expert opinion and media narrative around health. It also presents findings from questions sponsored by the Health Foundation in the 2017 British Social Attitudes survey.

Four key challenges are identified that communicators must tackle to achieve wider public acceptance of the evidence on the social determinants of health.

The briefing concludes by reiterating that by building wider understanding of the social determinants beyond those working in the field, we can build support for the policies and programmes needed to reduce health inequalities and improve health.

Key points
  • Despite extensive evidence for the impact of social determinants on people’s health, public discourse and policy action is limited in acknowledging the role that societal factors such as housing, education, welfare and work play in shaping people’s long-term health.
  • There are many reasons for this, but one factor that merits greater attention is the way in which the evidence is communicated to and understood by the public.
  • The FrameWorks Institute has identified a range of ‘cultural models’– common but implicit assumptions and patterns of thinking – that give deeper insight into how people think about what makes them healthy.
  • Understanding which cultural models promote – or obscure – people’s awareness of the importance of social determinants is an important first step in developing effective ways of framing the evidence.

Full briefing: Reframing the conversation on the social determinants of health | The Health Foundation

Dementia 2020 challenge: progress review

This document summarises the views of stakeholders on the progress of the challenge on dementia so far and sets out actions for the final 2 years of the challenge | Department of Health and Social Care

In 2015, the Dementia 2020 Challenge was launched. The Challenge aims to
make England, by 2020, the best country in the world for dementia care, support,
research and awareness. The Challenge identified 18 key commitments under four
themes: Dementia Awareness; Health and Care Delivery; Risk Reduction; and
Research and Funding.

Since then, significant progress has been made. The Dementia Diagnosis Rate is
above the Challenge’s target of 66.7%. There are now 2.78 million Dementia
Friends and 412 Communities have committed to becoming Dementia Friendly in
England and Wales (as of January 2019), and over one million NHS staff have
attended dementia awareness raising sessions.

During 2018, stakeholders from the health and social care system, and the charitable sector, were asked to comment on the progress of the actions set out in the Challenge on dementia 2020 implementation plan and what else needed to be done to complete them.

This report summarises the responses and sets out revised actions for 2018 to 2020.

Full report: Dementia 2020 Challenge: 2018 Review Phase 1

Brexit: the implications for health and social care

Brexit has major implications for health and social care in England. In this ‘long read’, the Kings Fund looks at some of the latest developments that could impact the health and care system in England.


The deadline of 29 March 2019, set when Article 50 was triggered, is rapidly approaching but many important issues are still to be resolved. Brexit has already had an impact, especially on the recruitment and retention of EU nationals in some parts of the workforce which is contributing to shortages of key staff. In addition, the ongoing debate in parliament and uncertainty about whether a deal can be agreed mean considerable work has gone into preparations for a no-deal Brexit.

The Department of Health and Social Care has published guidance for organisations to prepare contingency plans and has established a national operational response centre to lead on responding to any disruption to the delivery of health and care services.

This long read, originally written by Helen McKenna and published on 13 December 2017, has been updated by Beccy Baird on 22 February 2019 and explores the following topics:

  • Staffing
  • Accessing treatment
  • Regulation
  • Cross-border co-operation
  • Funding and finance

Full detail at the Kings Fund

NIHR Signal: Combining mirtazapine with other antidepressants is not effective for treatment-resistant depression

NIHR | February 2019|Combining mirtazapine with other antidepressants is not effective for treatment-resistant depression

An NIHR Signal is highlighting the findings of a trial that found adding mirtazapine to first-line antidepressants for adults with treatment-resistant depression does not improve symptoms when compared with placebo (dummy pills). People taking mirtazapine are more likely to experience side effects, and stop taking their treatment.

This NIHR-funded trial took place in 106 general practices in England, recruiting 480 adults with mild to severe depression. All participants had been taking selective serotonin reuptake inhibitor (SSRI) or serotonin-noradrenaline reuptake inhibitor (SNRI) antidepressants for at least six weeks but were still depressed.

Read the NIHR Signal here 

Read our blog post on this Study finds combining mirtazapine with other antidepressants is not effective for treatment-resistant depression in a sample of depressed patients

People with chronic obstructive pulmonary disease exacerbations prefer early discharge, then treatment at home

National Institute for Health Research (NIHR) | February 2019 |People with chronic obstructive pulmonary disease exacerbations prefer early discharge, then treatment at home

A randomised controlled trial (RCT) aimed to see if treating people at home was effective and cheaper for those at low risk of dying from an exacerbation of COPD according to the DECAF clinical prediction tool.  The study followed 120 people admitted to three hospitals in England with a COPD exacerbation who had a DECAF score of 0 or 1. This indicated a low risk of dying; about half of people fall into this category. People were assigned to either stay in hospital or have “hospital at home.”

This study supports the current move towards assisted discharge schemes supported by hospital at home for selected people with exacerbations of COPD. The evidence adds data, and the authors note that those cared for at home prefer this option. The DECAF score seems a practical choice for assessing risk (Source: NIHR).

Read the full NIHR Signal  

See also:

BMJ editiorial 

Dedicated care before and after surgery offers patients a ‘teachable moment’ to improve long term health

Royal College of Anaesthetists | February 2019 | Dedicated care before and after surgery offers patients a ‘teachable moment’ to improve long term health

 A new report by the Royal College of Anaesthetists, A teachable moment: delivering perioperative medicine in integrated care systems, showcases a number of innovative and award-winning programmes in hospitals across England that are improving patient care before, during and after surgery.

The College’s report highlights how NHS England’s new integrated care systems (ICSs) can facilitate this wider adoption of perioperative pathways of care. The range of initiatives included in the report address a number of the priorities of the Long Term Plan for the NHS, including cancer recovery, cardiovascular care and paediatric services.


Image source: rCoa.ac.uk

The report focuses on the first-wave of 10 ICSs across England, and is timely, given that the Long Term Plan for the NHS includes an ambition for all of England to be covered by an ICS by April 2021.

The report looks at a number of initiatives at various stages of the perioperative period, including in preparation for surgery. One of these initiatives is the WESFIT programme that is exploring the benefits of exercise for patients undergoing cancer treatment (Source: Royal College of Anaesthetists)

Full details from the Royal College of Anaesthetists 

A teachable moment: delivering perioperative medicine in integrated care systems

Staying fit and mentally active linked with reduced dementia risk

Researchers in Sweden have found that women who exercise and stay cognitively active during midlife have a reduced risk of dementia in older age | Neurology | via Alzheimer’s Research UK

In 1968, Swedish researchers began studying a group of 800 women in midlife, between the ages of 38 and 54, and measured the amount of time they spent doing cognitively stimulating activities, including reading books and writing. The team also recorded how much physical activity the women did including walking, and intense training like swimming.

The team followed the volunteers until 2012 to see if they went onto develop dementia. They found that those who were more engaged in physical activity and spent more time doing cognitive tasks had a lower risk of developing the condition.


Objective:  To investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years.

Methods:  A population-based sample of 800 women aged 38–54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia, Alzheimer disease, vascular dementia, mixed dementia, and dementia with cerebrovascular disease were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression.

Results:  We found that cognitive activity in midlife was associated with a reduced risk of total dementia and Alzheimer disease during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia and dementia with cerebrovascular disease. The results were similar after excluding those who developed dementia before 1990, except that physical activity was then also associated with reduced risk of total dementia.

Conclusion: Our findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

Full story at Alzheimer’s Research UK

Full reference: Najar, J. et al. | Cognitive and physical activity and dementia. A 44-year longitudinal population study of women | Neurology | First published February 20, 2019


Social Prescribing Day 14 March 2019

Elemental | n.d | Social Prescribing Day

To mark the first global social prescribing day on March 14 2019 Elemental, the UK’s largest digital social prescribing provider, are giving away resource packs which include E-books, infographics, how-to-guides and webinar recordings.


Socail pres
Image source: elementalsoftware.co/social-prescribing-day-2019


Email sign up is required to access the resource packs

Full details from Elemental 

Mental Wellbeing Commission report

mental wellbeing

As part of Health Education England’s health and care workforce strategy, the NHS Staff and Learners’ Mental Wellbeing Commission set out to discover and review evidence of good practices for the mental health and wellbeing of staff and learners in NHS organisations. The Commission has examined successful interventions from around the country, to identify what has worked well and what could be adopted widely.

This final report, written to support the new NHS Long Term Plan, has been produced for the consideration of the Secretary of State for Health and Social Care. The recommendations made in the report will be considered as part of arrangements to develop the Workforce Implementation Plan which is underway and will be published in April.

Full report: NHS Staff and Learners’ Mental Wellbeing Commission

Summary: Mental Wellbeing Commission Report 

See also: Mental health and wellbeing support for NHS staff: government pledges overhaul | Department of Health and Social Care