Children and teens let down by mental health inpatient services in England

Inpatient provision for children and young people with mental health problems. Emily Frith | Education Policy Institute | via OnMedica

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Image source: epi.org.uk

A report from the Education Policy Institute has found that 12% of  child mental health inpatient units failed to meet basic requirements for staff to patient ratios.

Nearly a quarter (24%) of units struggle to employ permanent staff – up from 17% since 2014/15. Temporary bank and agency staff make up 19% of child mental health inpatient pay costs.

Staff shortages affect the quality of patient care, so a sustained focus on recruitment of skilled staff to work in child and adolescent mental health services is needed, recommends the report.

The report also found:

  • inpatient mental health services for young people on average fail to meet 7% of minimum quality of care standards
  • The issue of bed shortages can mean that children with mental health problems are admitted to adult wards
  • Eating disorders were the most common reason for a young person being admitted to hospital in 2015/16
  • Young people are being left in hospital for longer than necessary due to a lack of community services with the trend getting worse – the number of delayed discharge days in December 2016 – February 2017 42% higher than in the same period the previous year

Full story at OnMedica

Download full report: Inpatient provision for children and young people with mental health problems.

Costs of inpatient falls in hospitals

This review provides an overview of the scale of inpatient falls and the benefits to the NHS if the rate of falls was reduced in hospitals.

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As part of NHS Improvements work to reduce harmful inpatient falls and improve patient safety, the review helps answer the following questions:

  • What is the incidence of inpatient falls in hospital in England?
  • What are the estimated costs hospitals incur as a result of inpatient falls?
  • What are the potential cost savings from reducing falls by implementing well-evidenced multidisciplinary interventions?
  • What are the potential savings to hospitals from taking these actions?

Full report: The incidence and costs of inpatient falls in hospitals

Dementia care in hospitals

National Audit of Dementia Care in General Hospitals 2016-2017: Third Round of Audit Report | HQIP

This report presents the results of the third round of the National Audit of Dementia (NAD) with collected data between April and November 2016.

The National Audit of Dementia (care in general hospitals) measures the performance of general hospitals against criteria relating to care delivery which are known to impact upon people with dementia while in hospital.

The previous (second) round of audit, (reporting in 2013), showed that while significant progress in the care provided to people with dementia in general hospitals had taken place, some aspects of care still needed to evolve.

The full report and findings are available to download here

Communication difficulties experienced by deaf male patients during their in-hospital stay

Studies available have described several specific issues affecting healthcare accessibility by deaf people, but to date, no research has reported the experience of deaf patients with in-hospital communication | Scandinavian Journal of Caring Sciences

The aim of the study was to explore the communication experience of deaf patients with regard to their in-hospital stay. A purposeful sample of participants was selected. The data collection process was based on a focus group. The focus groups were conducted in Italian sign language and videorecorded; subsequently, the entire conversation was faithfully transcribed. A qualitative content analysis of the transcription was performed and the findings are reported using the Consolidated Criteria for Reporting Qualitative Research approach.

Four themes have emerged:

  • experiencing a common vulnerability: the need for reciprocal understanding and sensitivity,
  • being outside the comfort zone: feeling discriminated against once again,
  • perceiving a lack of consonance between care and needs and
  • developing a sense of progressively disempowerment.

The experience of deaf individuals during their in-hospital stay may be critical: they are exposed to protracted communication and interaction with healthcare providers and an environment that is not prepared and designed for these vulnerable patients. Two levels of strategies should be identified, implemented and developed to increase the quality of communication with deaf people during hospitalisation, both at the hospital/health system level and at the healthcare professional/clinical level.

Full reference: Sirch, L. et al. (2017) Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study. Scandinavian Journal of Caring Sciences. Vol. 31 (no. 2) pp. 368–377

Caring for acutely ill patients

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The King’s Fund has published Organising care at the NHS front line: who is responsible? 

The report looks at the reality of caring for acutely ill medical patients at the NHS front line and asks how care in hospitals can be improved. It comprises a series of essays by frontline clinicians, managers, quality improvement champions and patients, and provides detail about how clinical care is currently provided and how it could be improved.

The report highlights that providing safe and high-quality care for acutely ill medical patients has always been challenging but has become more so as the volume and complexity of work has increased. Amongst its recommendations is that there should be a much stronger focus on how care is organised on hospital wards and in clinics throughout the NHS and greater standardisation of care processes.

The full report can be downloaded here

Children should be more involved in healthcare decisions that affect them

Research at hospitals in Ireland revealed that children find it difficult to have their views heard | Imelda Coyne for The Conversation

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The children said that doctors and nurses were “nice” and “kind”, but some tended to carry out medical procedures without seeking their opinions or telling them beforehand. Some parents helped children to be included in talks about their care, but other parents answered questions on their behalf, told them to stay quiet and withheld information from them. Some parents also told their child to stay quiet and not annoy the doctor or nurse. Being excluded from discussions made some children feel sad, frustrated and angry. As one 14-year-old girl put it: “It made me feel like a piece of machinery; they weren’t actually talking to me.”

Read the full blog post here

Older People’s Care in Acute Settings

The Older People’s Care in Acute Setting project content has been developed in partnership with British Geriatric Society and  explores the pathway that people take through the acute hospital, beginning in A&E and assessment units, and moving through to inpatient wards and supported discharge teams | NHS Benchmarking

Three key messages have emerged from the 2016/17 project that impact on the quality of care delivered for older people;

  • the use of CGA is increasing;
  • readmission rates are rising;
  • delayed transfers of care continue to grow.
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Image source: NHS Benchmarking

Further findings from the Older People’s Care in Acute Settings 2016 project (2015/16) data include:

  • 40% of organisations have a dedicated geriatric team located in the A&E department. The average number of hours that these teams are available during the week is 9 hours, at weekends this reduces to 6 hours.
  • 77% of trusts delivered Comprehensive Geriatric Assessments on the elderly care wards, and 42% delivered these assessments on other specialty wards.
  • The ratio of qualified to unqualified nursing staff on the care of the elderly wards was found to be 55% registered and 45% unregistered. The RCN recommends a ratio of 65:35 skill mix for “ideal, good quality care,” and 50:50 for “basically safe care” across the participants (Safe staffing on older people’s wards, RCN, 2012).
  • 85% of trusts operate Early Supported Discharge schemes, and 77% of trusts have an Integrated Discharge team.
  • The average time for a continuing healthcare assessment to be undertaken is 10 days.
  • 74% of organisations set estimated discharge dates within 24 hrs of admission.
  • 83% of delayed transfers of care were attributable to people age 65 and over in 2015/16.
  • 56% of patients admitted to the care of older people wards had been admitted to hospital within the previous 12 months.
  • 14% of pay costs spent on bank & agency across the pathway.

The full report is available here