Resources to support safer modification of food and drink

NHS Improvement | June 2018Resources to support safer modification of food and drink

NHS Improvement has  issued a resource alert to eliminate use of the imprecise term ‘soft diet’ and assist providers with safe transition to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework, which introduces standard terminology to describe texture modification for food and drink.

Resources to support safer modification of food and drink are here

In the media:

BBC News Patients ‘choked on hospital soft food’

The Telegraph  Safety alert after hospital patients choke on hash browns and peas

Mail Online Hundreds of NHS patients have choked, with two DYING, after being fed solid food when it should have been minced or puréed because they had difficulty swallowing, reveals damning report

Allied Health Professions supporting patient flow

This quick guide demonstrates how NHS emergency care, in particular patient flow through the health and care system, benefits from allied health professionals | NHS Improvement

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Bringing the AHP workforce into patient flow planning can improve quality, effectiveness and productivity.

Each section gives a brief overview of the contribution that AHPs have made to deliver safe, effective patient care and flow, followed by case studies which demonstrate how AHPs:

  • work in the community keeping people safe and well at home
  • ‘front door’ assess, diagnose and treat patients in emergency departments, ambulatory care and assessment units
  • support avoidance of hospital admission
  • enable early rehabilitation and reducing overnight admissions
  • drive ‘Home First’ (discharge to assess) to avoid in-hospital deconditioning of frail, older people.

Full detail: Quick guide: allied health professions supporting patient flow

More than 50 % of patients visiting GPs have multimoribidities, finds Cambridge University study

A new study that is published in the British Journal of General Practice demonstrates that over 14 million people in England have multimorbidities. The researchers provide an up-to-date and comprehensive description of multimorbidity — where patients have two or more currently active, long term conditions.  They found over 50 per cent of GP consultations are now with patients with multimorbidity.
This study looked at the experiences of 404,000 patients within the Clinical Practice Research Datalink (CPRD).  CPRD database is a nationally owned resource of millions of anonymised patient GP records, over the last 30 years it has underpinned 2,000 research articles (via Cambridge University)
heart-1698840_1280The full article can be accessed from the British Journal of General Practice 


Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.

Aim To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation.

Design and setting Retrospective cohort study, undertaken in England.
Method The study used a random sample of 403 985 adult patients (aged over 18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified.

In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions.

Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

Full reference: Cassell, A. et al  | 2018 |The epidemiology of multimorbidity in primary care: a retrospective cohort study | British Journal of General Practice |ePub |  D

Workload in general practice

Ensuring patient safety through control of workload and demand management in general practice | The British Medical Association (BMA)


General practice in England has seen consultation rates soar by nearly 14 per cent between 2007 and 2014, while the 12 months between 2016-17 saw the total number of full-time equivalent GPs fall by 3.4 per cent.

The BMA suggest that this increase in workload is because of growing patient need (complex multi-morbidity) as well as a result of the widespread recruitment and retention crisis and a lack of long-term investment in general practice. It is argued that the issue of GP workload must be addressed urgently.

This document seeks to address the current challenges in primary care.  It sets out a strategy aimed at improving safety and quality of patient care by recommending the development of agreed workload limits at a local level supported by national guidance.

Full document: Workload Control in General Practice. Ensuring Patient Safety Through Demand Management

Learning from vanguards

The NHS Confederation has published the following briefings sharing learning from vanguards:

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Annual Asthma Survey

Asthma UK has published its annual asthma survey. “Falling through the gaps: why more people need basic asthma care” indicates two thirds of people are not receiving basic care for their asthma and that there are variations in care across the country. 

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Asthma affects the lives of 5.4 million people across the UK. Every year,  Asthma UK  runs an Annual Survey to find out about people’s experiences of living with asthma and the quality of care they receive.

This year’s report included new questions on asthma triggers, and the use of technology in asthma and health management. The survey also repeated questions about the care patients received for their asthma.

The key findings from the survey include:

  • Over a quarter of  people surveyed reported that they used an app to track their health, used wearable devices and/or booked a GP appointment online

  • Less than a third of people who had been admitted to hospital for their asthma received the appropriate follow up care

  • People with asthma aged 18-29 receive the lowest levels of basic care, while those aged 70-79 receive the highest level

Funding system failing people with continuing healthcare needs

Report suggests the Government must take steps to improve the complex process for obtaining funding which is beset with delays and poor-quality assessments. | Public Accounts Committee

NHS continuing healthcare (CHC) funding is intended to help some of the most vulnerable people in society, who have significant healthcare needs. This report finds that too often people’s care is compromised because no one makes them aware of the funding available, or helps them to navigate the hugely complicated process for accessing funding. Those people that are assessed spend too long waiting to find out if they are eligible for funding, and to receive the essential care that they need.

This report from the Public Accounts Committee finds that the Department of Health and NHS England recognise that the system is not working as well as it should but are not doing enough to ensure CCGs are meeting their responsibilities, or to address the variation between areas in accessing essential funding.

Full report: NHS continuing healthcare funding: Thirteenth Report of Session 2017–19