4000 people now signed up to Working Win in South Yorkshire

South Yorkshire and Bassetlaw Integrated Care System  | July 2019 | 4,000 people sign up to new employment trial in the Sheffield City Region

Working Win is a health- led employment trial which launched in May 2018, it is testing a new type of support for people struggling to find or stay in work due to health problems;  and now has 4,000 people signed up to receive support to find or stay in work whilst living with a health condition.


 The trial divides participants into two groups: one half receive a new type of one-to-one support called Individual Placement and Support, the other group (the control group) are directed to existing support services. 

The trial has been commissioned by Sheffield City Region with funding from NHS England. South Yorkshire Housing Association are responsible for delivering the support to those who volunteer to take part. Working Win is enabling people in the South Yorkshire region with physical and mental health conditions access employment support (Source: South Yorkshire and Bassetlaw Integrated Care System).

Full details about the trial are available from South Yorkshire and Bassetlaw Integrated Care System 

NIHR Signal: Insights into the transfer between children’s and adults’ services for young people with selected long-term conditions

NIHR | July 2019 | Insights into the transfer between children’s and adults’ services for young people with selected long-term conditions

A new Signal from NIHR provides an insight from young people with type 1 diabetes, autistic spectrum disorder (ASD) and cerebral palsy about their experiences of transferring between children’s and adults’ services.

Estimates suggest that around 15% of young people (aged between 11 and 15) have long-term conditions that require ongoing care. At age 16 when young people transfer from children’s services to adults’ services- a process known as transition-  is a time of increased vulnerability due to potential loss of care continuity and the challenges of adolescence. This study explores the problem holistically to gain a fuller understanding of the issues involved to pinpoint the most effective interventions.

The study included  374 young people across 27 NHS Trusts, which included the formation of a young people’s advisory group,assessing what they saw as beneficial features of transition programmes, and interviews with staff such as commissioners of adult services.

Looking at the total score across the five quality of health domains, (range 5 to 15 with lower scores indicating better health), those with type 1 diabetes scored 5.2, whereas young people with autistic spectrum disorder or cerebral palsy scored 7. Scores tended to be worse for all participants after transfer.

The signal highlights that the quality of life scores fell in all conditions after transfer, suggesting that there are improvements to be made across the board. This study identifies three key features that services need to offer, namely meeting a member of the adult team, having parental involvement and encouraging health self-efficacy (Source: NIHR)

NIHR Signal Insights into the transfer between children’s and adults’ services for young people with selected long-term conditions

Full reference: Colver, A., et al. |2019 | Facilitating the transition of young people with long-term conditions through health services from childhood to adulthood: the Transition research programme| Vol. 7|4| doi: 10.3310/signal-000793


Background As young people with long-term conditions move from childhood to adulthood, their health may deteriorate and their social participation may reduce. ‘Transition’ is the ‘process’ that addresses the medical, psychosocial and educational needs of young people during this time. ‘Transfer’ is the ‘event’ when medical care moves from children’s to adults’ services. In a typical NHS Trust serving a population of 270,000, approximately 100 young people with long-term conditions requiring secondary care reach the age of 16 years each year. As transition extends over about 7 years, the number in transition at any time is approximately 700. Objectives Purpose – to promote the health and well-being of young people with long-term conditions by generating evidence to enable NHS commissioners and providers to facilitate successful health-care transition.

Objectives – (1) to work with young people to determine what is important in their transitional health care, (2) to identify the effective and efficient features of transitional health care and (3) to determine how transitional health care should be commissioned and provided. Design, settings and participants Three work packages addressed each objective. Objective 1. (i) A young people’s advisory group met monthly throughout the programme. (ii) It explored the usefulness of patient-held health information. (iii) A ‘Q-sort’ study examined how young people approached transitional health care. Objective 2. (i) We followed, for 3 years, 374 young people with type 1 diabetes mellitus (150 from five sites in England), autism spectrum disorder (118 from four sites in England) or cerebral palsy (106 from 18 sites in England and Northern Ireland). We assessed whether or not nine proposed beneficial features (PBFs) of transitional health care predicted better outcomes. (ii) We interviewed a subset of 13 young people about their transition. (iii) We undertook a discrete choice experiment and examined the efficiency of illustrative models of transition. Objective 3. (i) We interviewed staff and observed meetings in three trusts to identify the facilitators of and barriers to introducing developmentally appropriate health care (DAH). We developed a toolkit to assist the introduction of DAH. (ii) We undertook a literature review, interviews and site visits to identify the facilitators of and barriers to commissioning transitional health care. (iii) We synthesised learning on ‘what’ and ‘how’ to commission, drawing on meetings with commissioners. Main outcome measures Participation in life situations, mental well-being, satisfaction with services and condition-specific outcomes. Strengths This was a longitudinal study with a large sample; the conditions chosen were representative; non-participation and attrition appeared unlikely to introduce bias; the research on commissioning was novel; and a young person’s group was involved. Limitations There is uncertainty about whether or not the regions and trusts in the longitudinal study were representative; however, we recruited from 27 trusts widely spread over England and Northern Ireland, which varied greatly in the number and variety of the PBFs they offered. The quality of delivery of each PBF was not assessed. Owing to the nature of the data, only exploratory rather than strict economic modelling was undertaken. Results and conclusions (1) Commissioners and providers regarded transition as the responsibility of children’s services. This is inappropriate, given that transition extends to approximately the age of 24 years. Our findings indicate an important role for commissioners of adults’ services to commission transitional health care, in addition to commissioners of children’s services with whom responsibility for transitional health care currently lies. (2) DAH is a crucial aspect of transitional health care. Our findings indicate the importance of health services being commissioned to ensure that providers deliver DAH across all health-care services, and that this will be facilitated by commitment from senior provider and commissioner leaders. (3) Good practice led by enthusiasts rarely generalised to other specialties or to adults’ services. This indicates the importance of NHS Trusts adopting a trust-wide approach to implementation of transitional health care. (4) Adults’ and children’s services were often not joined up. This indicates the importance of adults’ clinicians, children’s clinicians and general practitioners planning transition procedures together. (5) Young people adopted one of four broad interaction styles during transition: ‘laid back’, ‘anxious’, ‘wanting autonomy’ or ‘socially oriented’. Identifying a young person’s style would help personalise communication with them. (6) Three PBFs of transitional health care were significantly associated with better outcomes: ‘parental involvement, suiting parent and young person’, ‘promotion of a young person’s confidence in managing their health’ and ‘meeting the adult team before transfer’. (7) Maximal service uptake would be achieved by services encouraging appropriate parental involvement with young people to make decisions about their care. A service involving ‘appropriate parental involvement’ and ‘promotion of confidence in managing one’s health’ may offer good value for money. Future work How might the programme’s findings be implemented by commissioners and health-care providers? What are the most effective ways for primary health care to assist transition and support young people after transfer? Funding The National Institute for Health Research Programme Grants for Applied Research programme.

Full article available here 

Latest HSIB report focuses on technology to reduce risk of X-ray findings getting lost

Healthcare Safety Investigation Branch | July  2019 |Latest HSIB report focuses on technology to reduce risk of X-ray findings getting lost

The Healthcare Safety Investigation Branch (HSIB)has published their latest report, Investigation into failures in communication or follow-up of unexpected significant radiological findings.  The report underlines that lack of follow-up or communication of unexpected significant findings can have a serious or life-threatening impact on patients. This was seen in the reference case that informed the investigation. In that event, a 76-year old woman had a chest X-ray showing a possible lung cancer which was not followed up and resulted in a delayed diagnosis. The patient died just over two months after her diagnosis.

The HSIB’s report highlights the pivotal role of technology in reducing the risk of x-ray findings being lost.

Image source: hsib.org.uk

The HSIB’s investigation identified that there:

  • are multiple opportunities for error in the processes used to communicate unexpected findings
  • are many steps that have to be completed successfully before the patient is informed
  • is variance in how clinicians receive findings and how they acknowledge receipt of them. (Source: HSIB)

Full report 

Summary report

BMJ study: 5 % of patients exposed to preventable harm across medical settings

BMJ | 2019| Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

A systematic review with meta analysis observes that the prevalence of preventable patient harm across a range of settings, their analysis indicates that approximately 1 in 20 patients are exposed to preventable harm. The study findings suggest that preventable patient harm was more prevalent in advanced specialties such as intensive care or surgery. 


Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

Design Systematic review and meta-analysis.

Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated.

Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).

Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

The article is available to read in full from the BMJ 

In the news: OnMedica One in 20 patients exposed to preventable harm in medical care

Making general practice a great place to work – a practical toolkit to improve the retention of GPs

BMA, Royal College of General Practitioners, NHS England & NHS Improvement | July 2019 | Making general practice a great place to work – a practical toolkit to improve the retention of GPs

The BMA, Royal College of General Practitioners, NHS England & NHS Improvement have developed a toolkit-Making general practice a great place to work – a practical toolkit to improve the retention of GPs– is aimed at system leaders and clinical leads working across primary care to develop robust local retention action plans that provide GPs with the support they require to develop fulfilled careers in general practice.
It also aims to tackle issues at practice, network and system level that may be impacting on local GP retention.



To support implementation of this toolkit, £12 million is being made available to STPs this year with further funding to follow in 2020/21. This is part of a wider approach and further guidance will follow on the introduction of fellowships for newly qualified
GPs, the development of the local training hub infrastructure to support local activity, and development of the multi-disciplinary team, building on strong growth to date (Source: BMA, Royal College of General Practitioners, NHS England & NHS Improvement).

Making general practice a great place to work


Report of the 4th Survey of Liaison Psychiatry in England (LPSE-4)

NHS England & Liaison Faculty of the Royal College of
July 2019|Report of the 4th Survey of Liaison Psychiatry in England (LPSE-4)

Liaison Psychiatry is the sub-specialty of psychiatry which addresses the mental health needs of people in general clinical settings.
In England, Liaison Psychiatry is growing as a specialty, in part because of evidence showing that well-resourced services make acute hospitals function more efficiently; shorter admissions, fewer readmissions. 


England issues a survey to the Liaison Psychiatry services in acute hospitals with Emergency Departments in England; the survey tracks Government targets which require half of all these services to be at ‘Core 24’ level by 2021. Data were returned by all 175 of the acute hospitals in England with EDs

NHS England finds that a major potential barrier to continuation of this good rate of growth is workforce; psychiatrists more than other professionals (Source:  NHS England and Liaison Psychiatry in England) (Source: NHS England)

Report of the 4th Survey of Liaison Psychiatry in England (LPSE-4) 

OnMedica Workforce issues threaten continued expansion of liaison psychiatry services


Healthcare leaders call on Government to prioritise alcohol prevention

The British Medical Association (BMA) and other leading healthcare organisations have written to the public health minister expressing their concerns over the impact that alcohol is having on the nation’s health urging the Government to prioritise a new alcohol strategy.

In the letter to Seema Kennedy MP, the BMA board of science chair, Professor Dame Parveen Kumar, along with the chairs of the Royal Colleges, warn of the ‘escalating risk to public health’.

The letter warns that despite recent strategies for obesity and tobacco, there has been a “lack of strategic focus” and asks that the Government prioritises alcohol in the same manner and works to urgently produce an updated and ambitious national alcohol strategy.

Cancer Research UK funding tops half a billion pounds

Cancer Research UK raised £540m in fundraising income in the last financial year, an increase of 2 per cent over the previous year, in one of its most successful fundraising years so far.

This increase was in part thanks to more money raised from legacy donations, Race for Life and Stand Up To Cancer, which all raised more than the previous year.  And an additional £2m was raised via Facebook charitable giving, an innovative new fundraising platform that launched towards the end of the year.

Total income for the year was £672m, an increase of 6% on the previous year, which includes fundraising income as well as £125m income from charitable activities – the largest amount ever received, which will be reinvested in research.

Key achievements outlined in Cancer Research UK’s annual report and accounts,  include:

  • Securing a strong commitment to early cancer diagnosis in the NHS Long Term Plan.
  • Three new international Grand Challenge teams awarded £20m each over the next five years, to solve long-standing mysteries in cancer research
  • Launching the Cancer Research UK City of London Centre, a £14m investment to create a world-leading cancer therapeutics research hub.
  • Launching a new Brain Tumour Award funding scheme, to accelerate progress in research on brain tumours.

Full press release at Cancer Research UK

Quick Guide: allied health professionals enhancing health for people in care homes

NHS England | July 2019 | Quick Guide: allied health professionals enhancing health for people in care homes

NHS England has produced a quick guide to support local health and social care systems in improving the health of people living in care homes, with practical examples of how the allied health professions (AHPs) can support implementation and roll-out of the framework for enhanced health in care homes.

Quick Guide: allied health professionals enhancing health for people in care homes