Capital spending in the NHS

The capital budget of the Department of Health and Social Care is used to finance long-term investments in the NHS in England. This includes spending on new buildings, equipment and IT, improvements to and some maintenance of NHS trusts, and research and development.

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In this briefing, The Health Foundation analyses trends in the capital budget, comparing the UK with international averages. Using annual data from all NHS trusts in England, the report then focusses on trends in the capital spending of NHS trusts to analyse where money has been spent and where there are areas of need.

The briefing also analyses the implications of recent capital spending, with a specific focus on NHS trusts’ maintenance backlog, and conclude with a discussion of the trends in capital spending and capital levels, and implications and recommendations for future health care.

Full briefing: Failing to capitalise: Capital spending in the NHS

 

Mental health services: Addressing the care deficit

This new report reveals deep disquiet among NHS mental health trust leaders about a substantial care deficit resulting from the impact of growing social and economic hardship in their communities | NHS Providers

This report looks at the levels of demand reported by frontline leaders across the range of services they provide, and examines what lies behind the growing pressures. In particular the report identifies widespread concerns about benefits cuts and the impact of universal credit. It also suggests that loneliness, homelessness and financial hardship are adding to pressures on NHS mental health services.

The report reveals a significant unmet need for a number of mental health conditions – particularly community services for adults and children, gender identity services and crisis home treatment teams – and NHS commissioning decisions have resulted in services being cut or reduced. Our survey indicated that 69% of mental health leaders are worried about maintaining the quality of services over the next two years.

To overcome the demand challenge facing mental health services, the authors suggest national policy must focus on increased support for both mental health and public health.

Full detail at NHS Providers

See also: NHS bosses: Benefit stress driving mental health care demand | The Guardian

 

Public satisfaction with the NHS and social care in 2018

Since 1983, NatCen Social Research’s British Social Attitudes survey has asked members of the public in England, Scotland and Wales about their views on the NHS and health and care issues more generally.  Alongside the Nuffield Trust, in this publication the King’s Fund  explores the findings from the 2018 survey.

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

The BSA is a ‘gold standard’ survey and is conducted the same way every year, with the data provideing a rich time trend going back to 1983. This adds a depth and context to the findings that no other measure of NHS satisfaction provides. As a result, when satisfaction changes in the BSA, we are as confident as we can be that it reflects a genuine change in public attitudes.

Key findings

Satisfaction with the NHS overall in 2018

  • Public satisfaction with the NHS overall continued to fall in 2018. Overall satisfaction was 53 per cent – a 3 percentage point drop from the previous year and the lowest level since 2007.
  • Older people were more satisfied than younger people: 61 per cent of those aged 65 and over were satisfied with the NHS compared to 51 per cent of those aged 18–64.
  • Satisfaction levels also differed between supporters of different political parties: 58 per cent of supporters of the Conservative party were satisfied compared to 51 per cent of supporters of the Labour party.
  • The four main reasons people gave for being satisfied with the NHS overall were: the quality of care; the fact that the NHS is free at the point of use; the range of services and treatments available; and the attitudes and behaviour of NHS staff.
  • The four main reasons people gave for being dissatisfied with the NHS overall were: long waiting times; staff shortages; a lack of funding; and money being wasted.

Full detail at The King’s Fund

Full publication: Public satisfaction with the NHS and social care in 2018: Results from the British Social Attitudes survey

See also:

[NICE Technology Appraisal Guidance] CADScor system for ruling out coronary artery disease in people with symptoms of stable coronary artery disease Meditech innovation briefing [MIB174]

Meditech innovation briefing [MIB174] | March 2019 | CADScor system for ruling out coronary artery disease in people with symptoms of stable coronary artery disease

NICE has developed a medtech innovation briefing (MIB) on CADScor system for ruling out coronary artery disease in people with symptoms of stable coronary artery disease.

 

Only half of practices considered their premises to be fit for present needs

BMA | February 2019 | Only half of practices considered their premises to be fit for present needs

The BMA survey on General Practice (GP) premises was open to complete online in Autumn (from 31 October to 21 November 2018), 1000 GP practices participated in the survey and the BMA received a good response from across England. 

The key survey findings:

  • Only half of practices considered their premises to be fit for present needs (this figure is lower than when last asked in 2005 when 60% thought their premises were fit for present needs)
  • This number falls to just over 2 in 10 practices when asked if they thought their premises was fit for the future(population growth) (this is very similar to when asked in 2005).
  • The last significant modification or extension to premises took place in the mid-2000s (2005), on average, pre-dating many of the increases in patient demand and population growth witnessed over the last decade.
  • Following successful application, some practices reported waiting as little as one month to received improvement grant funding while others up to around one year (Source: BMA).

Read the press release Half of GP practice buildings not fit for purpose, BMA survey reveals

You can read the survey results from the BMA website

Effectiveness of Treatments and Diagnostic Tools and Declining Mortality in Patients With Severe Sepsis: A 12-Year Population-Based Cohort Study

Chen, K. F., Tsai, M. Y., Wu, C. C., & Han, S. T. |2019| Effectiveness of Treatments and Diagnostic Tools and Declining Mortality in Patients With Severe Sepsis: A 12-Year Population-Based Cohort Study| Journal of intensive care medicine|0885066619827270.

The Journal of Intensive Care Medicine has published the findings of a study that looks at the effectiveness of treatments and diagnosis tools on patients with severe sepsis. 

Abstract

Sepsis is a major cause of morbidity and mortality worldwide. With the advance of medical care, the mortality of sepsis has decreased in the past decades. Many treatments and diagnostic tools still lack supporting evidence. We conducted a retrospective population-based cohort study with propensity score matched subcohorts based on a prospectively collected national longitudinal health insurance database in Taiwan. Severe sepsis-associated hospital admissions from 2000 to 2011 based on International Classification of Diseases, Ninth Revision, Clinical Modification codes of infections and acute organ dysfunction were identified. To compare the effectiveness of treatment and diagnostic tool, propensity scores were generated to match the comparable control groups. During the 12-year period, 33 375 patients and 50 465 hospitalizations of severe sepsis were identified. The age-standardized 28-day in-hospital mortality decreased significantly from 21% in 2008 to 15% in 2011 with increasingly implemented treatment and diagnostic tool. After propensity score matching, procalcitonin and lactate testing, transfusion of packed red blood cell, albumin, balanced crystalloid, and use of dopamine  were found to be significantly associated with lower mortality rate. However, inconsistent findings need to be further validated.

Rotherham NHS staff can request the article from the Library & Knowledge Service 

 

Urinary catheter tools

NHS Improvement | February 2019 | Urinary catheter tools

NHS Improvement has developed these tools collaboratively with national experts to support providers in delivering consistent evidence based catheter care. They are designed to help support the system to consistently manage and remove urinary catheters (Source: NHS England). 

 

Full details from NHS Improvement 

Catheter passport

Catheter passport — patient section

JAMA research: Overlapping surgeries are generally safe

Sun, E. | 2019 |  Association of Overlapping Surgery With Perioperative Outcomes |  JAMA  | 321 | (8) | P.762–772  |  doi:10.1001/jama.2019.0711

The findings of a study recently published in JAMA, reports that overlapping surgery- surgeons moving from one surgical operation to another on the same patient- was not associated with differences in in-hospital mortality but this practice did increase surgery length. 

Question  Is overlapping surgery, in which a primary surgeon is involved in more than 1 case simultaneously, associated with worse perioperative outcomes compared with nonoverlapping surgery?

Findings  In this retrospective cohort study of 66 430 adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality (adjusted rate, 1.9% vs 1.6%) or postoperative complications (adjusted rate, 12.8% vs 11.8%) but was significantly associated with increased surgery length (adjusted length, 204 vs 173 minutes).

Meaning  Overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.

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Abstract

Importance  Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes.

Objective  To determine the association between overlapping surgery and mortality, complications, and length of surgery.

Design, Setting, and Participants  Retrospective cohort study of 66 430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge.

Exposures  Overlapping surgery (more than or equal to 2 operations performed by the same surgeon in which more than or equal to 1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed).

Main Outcomes and Measures  Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration.

Results  The final sample consisted of 66 430 operations (mean patient age, 59 [SD, 15] years; 31 915 women [48%]), of which 8224 (12%) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality or risk of complications. Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes. Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients.

Conclusions and Relevance  Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.

The article is available to Rotherham NHS staff, contact the Library for a copy

In the news: OnMedica Overlapping surgeries are generally safe