July 2016

Health Management and Innovation Update

July 2016

General

A little slow off the blocks this month but we have been hanging on for the political situation to settle down, only it doesn’t seem to be settling at all, so here’s July’s Bulletin with some analysis of the post-Brexit situation.

The following two articles are from the HSJ. You must have a registered account (available to all trust staff) to access the articles. If you are having difficulties, contact the Library

Stevens: Government must deliver on Brexit funding promises

This seismic shock to British public life will have three major implications for the NHS

Five big issues for health and social care after the Brexit vote

In the aftermath of the Brexit vote, the Kings Fund considers what lies ahead for the health and care system and the five big issues that will need to be considered.

Local News

We begin with a fantastic piece of local research from the Trust which demonstrates how therapies staff are taking on board the values and ethos of the Ambitions:

The value of clinical judgment to inform videofluoroscopy outcomes: Delivering safe care for individuals with swallowing difficulties.

WSFT Speech & Language Therapy (SLT) Team share findings from their recent scoping study which explores the collective value of clinician knowledge and bedside assessment skills to inform videofluoroscopy (swallow x-ray)outcomes when supporting individuals with dysphagia (swallowing difficulties). This report explains how the SLT team were intrigued to understand how looking at their pooled knowledge and skills could guide service improvement. Aligned to Ambition 2 ‘Delivering Safe Care’, this is a great example of how collaborative working across the Trust can lead to practical gains at a patient, staff and Trust level. In addition to increasing staff confidence, it has provided some interesting ideas for developing the SLT service. It shows the potential for further expansion and/or replication across settings. The SLT team are looking forward to sharing their unique study beyond WSFT to make a positive difference to the delivery of care for individuals with swallowing difficulties.

Deliver Personal Care

Deliver Safe Care

Deliver Joined-up Care

Support a Healthy Start

Support a Healthy Life

Support Ageing Well

Support All Our Staff

Public perceptions of the NHS

The BMA commissioned BritainThinks to conduct an online survey of 1240 adults living in England to question their perceptions of the NHS as of June 2016. The survey concentrates on general perceptions of the NHS, public health and seven-day services. (BMA, June 2016)

Engaging patients and communities in the community health needs assessment process
This guide presents a model for engaging patients, their families and community members at each step of the process of developing a community health needs assessment. (Hospitals in Pursuit of Excellence (HPOE), June 2016)

2015 adult inpatient survey: statistical release

This survey provides information on the experiences of people admitted to an acute or acute specialist NHS hospital in England in 2015. The results indicate that there have been small, but statistically significant improvements in a number of areas, compared with previous surveys. This includes patients’ perceptions of the quality of communication between medical professionals and patients, the standards of hospital cleanliness, the availability of help to eat when needed, the number of nurses on duty and being involved in decisions about their care and treatment. (CQC, June 2016)

Public & patient partnerships: how they can address inequality & finance gap in health & care.

Both values-based and evidence-based considerations increasingly point to patient and public involvement as being key factors in achieving better patient outcomes. The UK would appear to have a very promising foundation for extending and promoting the wider adoption of patient leadership and communities as co-designers of services. Nevertheless, research also suggests that few people really know what effective public or patient involvement means or how to implement it effectively. It argues that while it’s a positive idea to involve the patient, it is important to be both practical and specific about what this actually means in practice. (NHS Confederation, June 2016)

"Hiding who I am": exposing the reality of end of life care for LGBT people

This report looks at the barriers that prevent lesbian, gay, bisexual and a Trans person (LGBT) from accessing end of life care and highlights their real-life experiences. Its findings indicate that nearly three-quarters (74 per cent) of LGBT people are not confident that health and social care services provide sensitive end of life care for their needs. As a result, access to care is often delayed and LGBT people are more likely to experience unmanaged symptoms and pain at the end of their lives. (Marie Curie, June 2016)

Deficits in the NHS 2016

This briefing draws on data from the Kings Fund quarterly monitoring reports, secondary research and interviews with health care leaders to consider commissioner and provider finances in the round and to provide an overview of the factors that have led to the NHS going into deficit. It goes on to outline some of the strategies being employed to restore financial balance, before drawing together our thoughts on the implications of these strategies for the NHS this year and in the longer term.

Communications and engagement toolkit: for teams in service change programmes

This toolkit from NHS Improvement is designed to help communications and engagement teams involved in health system-wide change or transformation programmes.

The toolkitincludes:

  • a step-by-step guide to the different phases of a potential service change programme and the role of communications and engagement within it
  • a breakdown of each phase, setting out aims, approach, audience, deliverables and success criteria
  • a set of useful resources, example documentation that may be produced throughout the process and lessons learned from previous relevant work

Capacity and consent: new tool to support your decision making

  • Does my patient have capacity to make this decision about their care? Is there a valid and applicable advance refusal of treatment?
  • What should I do if my patient lacks capacity to consent to treatment and no one has been appointed to make decisions for them?

If you are in doubt about your patient’s capacity to make a decision about their treatment, a new interactive online tool will help you identify the steps you need to take.

(GMC, June 2016)

Cutting unnecessary emergencies
In the latest blog marking World Continence Week, a specialist nurse from South London’s Health Innovation Network describes the work going on across emergency departments:

At South London Health Innovation Network we are working to reduce catheter-associated urinary tract infections by 30 per cent by 2017 and to improve patient wellbeing and recovery. (NHSE, June 2016)

Strategic quality improvement: an action learning approach

The King’s Fund was commissioned by Oxleas NHS Foundation Trust to work with their Quality Board to facilitate an assessment of its existing approachestoquality improvement and to develop a strategy for future work. This case study details the approach and philosophy behind this work, which involved working with the trust’s five directorates to develop their ability to appraise their own approach to quality improvement with a view to improving performance, achieving better clinical outcomes and building further on the trust’s capacity as a learning organisation. (The King’s Fund, May 2016)

How changes in clinical practice can deliver better value

Watch and download presentations from The King’s Fund’s recent (22nd June) conference, which shared best practice approaches on working collaboratively with patients and offer practical guidance on how to implement improvements Learn from innovative examples where there have been demonstrable improvements in the quality of care delivered, as well as reductions in cost, as a result of changes made by clinical teams. (The King’s Fund, June 2016)

Decisions relating to cardiopulmonary resuscitation (CPR)

This latest 2016 revision of guidance is in response to public and professional debate about CPR decisions, and to recent statutory changes and legal judgments. The key ethical and legal principles that should inform all CPR decisions remain, but even greater emphasis has been placed on ensuring high-quality timely communication, decision-making and recording in relation to decisions about CPR. (BMA, June 2016)

Inpatient prescribing systems used in NHS Acute Trusts across England: a managerial perspective

The individualised patient prescription chart, either paper or electronic, is an integral part of communication between healthcare professionals. The aim of this study is to ascertain the extent to which different prescribing systems are used for inpatient care in acute hospitals in England and explore chief pharmacists' opinions and experiences with respect to electronic prescribing and medicines administration (EPMA) systems. Authors conclude that while mandatory fields may be appropriate for core prescribing information, but the expansion of their use needs careful consideration. (European Journal of Hospital Pharmacy, June 2016)

An automated medication system reduces errors in the medication administration process: results from a Danish hospital study.

An original article by Bettina WulffRisør, Marianne Lisby, & Jan Sørensen.(European Journal of Hospital Pharmacy, 2016;23:189-196) N.B. Login with your Athens ID for the full article.

Clinician and pharmacist joint-working strategies for better care outcomes.

Electronic prescribing led to poorer communication between GPs and pharmacist, how a 3 monthly meeting has managed to reduce wastage and repeat medication prescribing. (The Academy of NHS Fabulous stuff, June 2016)

Kings Fund Integrated Care Bulletin July 2016

Stepping up to the place: the key to successful health and care integration

Bringing together health and social care has been a constant and dominant policy theme for many decades, and many places around the country are already demonstrating the potential to do things differently. The Association of Directors of Adult Social Services, Local Government Association, NHS Clinical Commissioners and NHS Confederation believe it is time to put integrated systems and services to the test, to translate aspirations into action, and to ensure they deliver for our citizens. This briefing aims to describe what a fully integrated, transformed system should look like based on evidence. (NHS Confederation, June 2016)

Supporting integration through new roles and working across boundaries

This report looks at the evidence on new roles and ways of spanning organisational workforce boundaries to deliver integrated health and social care. (The King’s Fund, June 2016)

Cardiovascular disease: integrated care pilot to improve patient outcomes closer to home: Quality & Productivity case study

The British Heart Foundation (BHF) funded and evaluated a 2- year project at 9 NHS organisations across the UK. This case study is based on the East Cheshire project. Within the context of a growing elderly population and better survival of people with CVD conditions, this project aimed to support patients to remain in the community for as long as is clinically possible, avoid hospital admissions and reduce length of stay. (NICE, May 2016)

Working together: how health, social care and fire and rescue services can increase their reach, scale and impact through joint working

This document showcases work by the fire and rescue services to help reduce demand for other services through prevention, including health and social care. Underlying risk factors that ultimately result in fires, such as smoking and alcohol consumption, also have a strong impact on health. Fire and rescue services are applying the principles of early intervention and prevention, to these health-related risk factors, resulting in a reduced demand for the services of others, whilst also continuing to reduce demand for fire and rescue. (NHSE, June 2016) News summary
See also: Principles for a “Safe and well visit” by the Fire & Rescue Service

Six principles for engaging people and communities: putting them into practice

This document is about creating person-centred, community-focused approaches to health, wellbeing and care. It builds on the proposed new relationship with patients and communities set out in the NHS Five Year Forward View. The publication demonstrates why the principles are important, and provides a guide to putting them into practice, offering case examples of the principles in action. Throughout the document there are questions to provoke thought, reflection and challenge at a local level. (National Voices, June 2016)

Turbo charging integrated care – Dr Phillip Bennett-Richards

The nationalnew care models programmeis bringing together local health and care systems as vanguards to radically redesign care for the populations they serve. In the latest of a series of blogs, the chair of the Tower Hamlets Together vanguard discusses how they are using the national support offered to boost their efforts. (NHS England, June 2016)

Putting patients in control of their care

The Workstream Lead at Hartlepool & Stockton on Tees CCG, one of nine sites putting the Integrated Personal Commissioning Emerging Framework into action, shares how the programme is beginning to transform services for older people with complex health needs. (NHSE, June 2016)

RCPCH Quality improvement resource pack goes live

A new resource to introduce and improve situation awareness in hospitals is now available on the Royal College of Paediatrics and Child Health’s website.

This free, online resource pack aims to improve communication, build a safety-based culture and deliver better health outcomes for children and young people. (RCPCH, June 2016)

Surgery for obese people with diabetes could save the NHS £100 000 a patient, finds study

Using bariatric surgery to treat obese patients with type 2 diabetes could save the NHS around £95 000 (€123 000; $137 000) a patient across their lifetime, British researchers have found. The savings come mostly from reduced drug usage as a result of remission of diabetes. (BMJ Open, June 2016)

Note: You will need your Athens ID to access full text article.

The National Diabetes Inpatient Audit 2015

The National Diabetes Inpatient Audit 2015 sets out to measure the quality of diabetes care provided toinpatients. The report itself presentsthe 2015 results and analyses the changes in activity and outcomes over the last four contributory years (2010 to 2013). (Health Care Quality Improvement Partnership (HQIP), June 2016)

PA system to stop smoking at HywelDda hospitals

A PA system is launched at hospitals in mid and west Wales to discourage smokers from lighting up. HywelDda University Health Board is the first in Wales to launch the "Push the Button" system to curb smoking at Carmarthenshire, Ceredigion and Pembrokeshire hospitals. (BBC News, 12th June 2016)

Revolutionising UK lung cancer management – Dr Sam Hare

An innovative method of carrying out lung biopsies at Barnet Hospital could free up hundreds of hospital beds and provide earlier lung cancer diagnosis by increasing tenfold the number of potentially life-saving tests carried out each year. Chest radiologist Dr. Sam Hare explains why his team’s ambulatory lung biopsy method should be rolled out across the NHS. (NHSE, June 2016)

Discharging older patients from hospital

This NAO reportexamines how effectively the health and social care system is managing the discharge of older patients from hospital. (NAO/DH, June 2016)

Why is it more difficult than ever for older people to leave hospital?

David Oliver looks at the findings of a new National Audit Office report (above) and considers why hospitals are still failing to discharge older people in a timely way. (The King’s Fund, June 2016)

The English social care system in 2016

These graphics illustrate some of the key findings from the 2016 budget survey by the Association of Directors of Adult Social Services (ADASS), which gives an insight into the current situation of the English social care system.

Leadership strategies for creating a quality improvement culture

Download or watch - highlights of the King’s Fund’ssixth annual leadership and management summit, held on 25th May 2016, which discussed how health care leaders can develop cultures focused on delivering high-quality, continually improving care

NHS workforce race equality standard: 2015 data analysis report for NHS trusts

This report shows results of the experiences of BME and white staff from the staff survey 2015 at every NHS trust across England. It looked at four indicators across acute trusts, ambulance trusts, community provider trusts, and mental health and learning disability trusts. The results show a picture of variation across the health service with some trusts making progress, whilst others still have a considerable way to go. (NHSE, June 2016) Press release

NHS Staff Health & Wellbeing: CQUIN supplementary guidance

The guidance highlights different ways in which employers can provide health and wellbeing schemes at work for staff. (NHSE, June 2016) Press release (half-way down the page)

NHS Healthy workforce: the role of senior / board & clinical leads

The health and wellbeing team has developed two new role descriptors, for a senior/board lead and a clinical lead, to help NHS organisations identify leaders with the right skills to drive and champion staff wellbeing across the organisation. (NHS Employers, June 2016)

Tackling bullying and harassment in the NHS - new resources launched

The Health, Safety and Wellbeing Partnership Group (HSWPG) has launched new resources and an infographic to support NHS organisations to develop cultures where staff are free from the fear of intimidating behaviour. (NHS Employers, June 2016)