Tackling multiple unhealthy risk factors

This report shares learning and insight from services that are using innovative ways to address the problem of multiple unhealthy risk factors in their populations | The King’s Fund

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

This new report from the King’s Fund draws on interviews and information from eight case studies in local authorities and the NHS and updates the evidence base on tackling multiple unhealthy risk factors.

Previous research by The King’s Fund has shown that unhealthy behaviours cluster in the population. Around seven in ten adults do not follow guidelines on tobacco use, alcohol consumption, healthy diet or physical activity, yet most behaviour change services address these behaviours separately, not reflecting the reality of people’s lives.

Most services included in the report are local authority led and are integrated health and wellbeing services. These provide behavioural advice and support to people across a range of different behaviours, including smoking, weight management and physical activity.

Full report: Tackling multiple unhealthy risk factors: emerging lessons from practice

Summary available here

Under pressure – a long hard winter for our health service

Nuffield Trust Newsletter: February 2018


As the cold weather continues, the Nuffield Trust reflects on how the health and social care sectors have been coping with extra pressure this winter in a series of blogs.

Meeting the demands of winter and beyond:

The resilience of those working in the NHS and social care is being tested to its limits this winter. With the current cold snap postponing any early end to the pressure on services,  Assistant Director of Policy, Ruth Thorlby, looks back at how health and social care have been surviving this season’s extra pressures, and where action is needed now in advance of next winter.

What do winter pressures mean for paediatric care?

Children make extensive use of the NHS, yet adult care tends to dominate the winter pressures debate. Clinical Fellow Dr Susannah Pye looks at how pressures on services impact on patients like 9-month-old Ollie.

Winter pressures data: where are the blind spots?

Clinical Fellow Dr Becks Fisher says the pressures reported in hospitals are painfully felt in the community too, but we don’t have comprehensive data to show what this means in practice.

NHS 111: understanding the impact on urgent and emergency care

NHS 111 has been criticised for directing a high proportion of patients to A&E, which may add to pressures felt during winter. But are callers to NHS 111 less likely to visit A&E if they speak to a doctor or nurse?

Two projects aiming to relieve pressure on busy services

Two improvement projects supported by the Health Foundation have been thinking differently about ways of reducing pressure on stretched services – pressures which often become most visible and acute during winter.

The Health Foundation Newsletter is available here

Improving the experience of care and support for people using adult social care services

This guideline covers the care and support of adults receiving social care in their own homes, residential care and community settings | National Institute for Health and Care Excellence (NICE)

This NICE guideline aims to help people understand what care they can expect in residential and community settings, and to improve their experience by supporting them to make decisions about their care.


The guideline has been developed by a committee of people who use services, and carers and professionals. It has used information from a review of research evidence about people’s experiences of care and support, and from expert witnesses. The committee also gave consideration to the potential resource impact of the recommendations. The recommendations are considered to be aspirational but achievable.

It includes recommendations on:

It is for:

  • Practitioners working in adult social care services in all settings.
  • Service managers and providers of adult social care services.
  • Commissioners of adult social care services.
  • People using services (including those who fund their own care) and their families, carers and advocates.

Full reference: People’s experience in adult social care services: improving the experience of care and support for people using adult social care services | NICE guideline [NG86]

See also:  NICE interactive flowchart – People’s experience in adult social care services


Reimagining community services

The King’s Fund has published Reimagining community services: making the most of our assets.  This report looks at the current state of community services and explores how the health and care system needs to change to enable these services to meet the needs of the population now and in the future.  It proposes ten design principles that should inform the future planning and provision of care.

Community services: what do we know about quality?

Community services:  what do we know about quality? | The Health Foundation | Nuffield Trust 

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

This QualityWatch report looks at trends in routinely collected national quality measures in 18 community trusts in England.  The report finds that a lack of routinely reported data and the absence of appropriate indicators present challenges to monitoring quality in this area.

Some of the key findings of the report were:

  • Care in community trusts was predominantly delivered by professionally qualified clinical staff such as community health nurses, allied health professionals and community health visitors.
  • These staff were roughly as satisfied with their jobs as staff in all NHS trusts, although they were less likely to recommend their trust as a place to work.
  • The median waiting time for an outpatient appointment was three days longer in the community than across all trusts in England.
  • Patients using services offered by community trusts would generally
    recommend them to a friend and were less likely to experience harm
    compared to those using services provided by non-community trusts.

Full report: Community services: what do we know about quality?

Related Nuffiled Trust blog: Why is it so hard to measure quality in community services?

Community mental health survey 2017

Latest survey from Care Quality Commission (CQC) looks at the experiences of people receiving community mental health services


A survey of over 12,000 people who received care or treatment for a mental health condition found around two-thirds of respondents reported a positive experience of overall care.

The vast majority of respondents said that they knew how to contact the person in charge of their care if they had concerns. Higher proportion of respondents this year also knew who to contact out of hours if they were experiencing a crisis.

However, concerns remain about the quality of care some people experience when using community mental health services. There has been little notable improvement in survey results in the last year in the majority of areas.

The CQC believe the results suggest scope for further improvements in a number of areas including: crisis care, access and coordination of care, involvement in care, monitoring the effects of medication and receiving additional support.

Further detail via Care Quality Commission

Full analysis: 2017 Community Mental Health Survey Statistical release

Related:  CQC Report Finds ‘Major Issues’ Surrounding Access To Mental Health Care

Reducing delayed transfers of care over winter

NHS Improvement has written to the chief executives of all trusts providing community services setting out actions they must implement to reduce delayed transfers of care over winter. | NHS Improvement | HSJ


NHS Improvement  chief executive Jim Mackey has said trusts must help improve delayed discharges over winter and listed six actions they need to carry out in the next six months:

  1. Facilitate the sharing of patient data with acute and social care partners and from 7 November ensure daily situation reports are completed “to enable better understanding of community services at a national level”.
  2. Jointly assess discharge pathways with local partners including “being an active participant in the local acute provider’s discharge and hosting operational discussions daily where necessary to discharge patients in community settings”.
  3. Develop “discharges hubs” over the next six months and beyond, designed to be a single point of access for patients moving between acute and community services.
  4. Ensure a “robust patient choice policy” is implemented.
  5. Clarify to partner organisations what services the trust offers to patients.
  6. Ensure collection of patient flow data and data on plans to improve patient flow.

Full detail is given by NHS Improvement who have produced the following  report to help improve flow into and out of community health services:

Flow in providers of community health services: good practice guidance

Related HSJ article: Trust chiefs given new instructions to tackle winter DTOCs