NHS mental health services failing young people, say psychiatrists

Seven in 10 psychiatrists deem Child and Adolescent Mental Health Services to be inadequate at best, Guardian survey finds.

NHS services for the soaring numbers of children who have self-harmed, tried to end their life or are having a breakdown are woefully substandard and risk prolonging their suffering, according to their psychiatrists.

Mental health trusts in Manchester combine to strengthen services

Patients will see a range of benefits when Manchester Mental Health and Social Care Trust and Greater Manchester West Mental Health NHS Foundation Trust join together to become a single organisation from 1 January 2017.

Read more HERE.

Smoking cessation in secondary care: mental health settings

Guidance and self-assessment framework for NHS mental health trusts to develop local action to reduce smoking prevalence and the use of tobacco.

Scale of avoidable loss of life by suicide is unacceptable

The Government must prioritise a clear implementation strategy and increase support for public mental health and early intervention services if it is to bring down the unacceptable suicide rate, says the Health Committee in its interim report into suicide prevention.

• Read the report summary
• Read the report conclusions and recommendations
• Read the full report: Suicide prevention: interim report

Improving access to mental health services

Centre for Mental health welcomes public accounts committee report on improving access to mental health services.

The Science Behind Gift Giving

There’s a science to gift giving, with new research suggesting that giving an experience rather than a material item can strengthen a relationship.

The new study from Cindy Chan, an assistant professor at the University of Toronto Scarborough’s Department of Management and the Rotman School of Management, finds experiential gifts are more effective at improving relationships from the recipient’s perspective.

Most Eating Disorder Patients Eventually Recover

Around two out of three women with anorexia nervosa or bulimia nervosa will eventually recover in their lifetime, according to a new study at Massachusetts General Hospital (MGH).

Read more HERE.

How easy is it to get help for a mental health problem? Five different stories

How easy is it to get help with mental health problems in the UK? It’s a topical issue, with reports of long waiting lists and some people being sent miles from home for treatment. Our mental health services are struggling to meet demand – and the government has vowed to invest more money to make improvements in England.

Christmas is an isolating time for people with mental health problems

Christmas is a time for joy, celebration and bringing together family and friends to share this merriment. While taking nothing away from this much needed festivity, spare a thought for those who are less advantaged – particularly those with mental health problems.


Mental illness transcends all ages and backgrounds. Almost one in four adults have a mental illness at some point in their lives, such as stress, anxiety, depression or psychosis.

Spotting the signs of modern slavery: key advice for social workers

Human trafficking, forced labour and debt bondage are all forms of modern slavery. Social workers need to be aware of the potential signs.

Here, we present some of the key facts and pieces of advice for social workers.

Radiotherapy: learning from errors

Development of learning from radiotherapy errors: supplementary guidance. This document:

• presents the causative factor taxonomy
• presents the refinement to the radiotherapy pathway coding which includes the introduction of the safety barrier taxonomy
• provides guidance on the application of the taxonomy
• shares submission procedures for coding with radiotherapy staff and risk managers for inclusion in national analysis
• encourages local application of the taxonomies to improve local learning from radiotherapy error and near miss events (RTE)

One group of drugs used to treat Crohn’s disease is unlikely to prevent relapse

Anti-inflammatory drugs called 5-aminosalicylic acids (5-ASAs) do not prevent relapses of Crohn’s disease when compared to placebo at one year.

From the NIHR Dissemination Centre

Antibiotics are probably of no benefit for acute asthma attack

The antibiotic azithromycin does not appear to reduce symptoms or change other outcomes in adults seeking emergency care for an acute asthma attack. However people not already taking antibiotics were hard to find.

From the NIHR Dissemination Centre

Low-dose sedative reduces sudden confusion after major surgery in older adults

Giving a low-dose sedative to older adults in intensive care after surgery reduces sudden confusion, also known as delirium, without increasing the risk of adverse effects.

From the NIHR Dissemination Centre

When Someone Asks For Your Assistance To Die

RCN guidance on responding to a request to hasten death.

Seven-day services: clarification of the four priority clinical standards

In response to clinical feedback, NHS Improvement has clarified its guidance on the clinical standards for providers completing the self-assessment survey.

Safe staffing for adult inpatients in acute care

A guide from NHS Immprovement to help standardise staffing decisions in adult inpatient wards in acute hospitals.

See also Safe staffing in learning disability services.

Female genital mutilation: RCN guidance for sexual health care

The publication Female Genital Mutilation: An RCN Resource for Nursing and Midwifery Practice (RCN, 2016) provides detailed information on aspects of FGM. With advances in understanding and updated legislation, there is a need for more specific support for those working in some defined areas of health care practice. 

As a result, this publication acts as a supplement and focuses on those professionals working in sexual health care services, such as sexual health clinics, genitourinary medicine (GUM) clinics and children services.

The nature, scope and value of ophthalmic nursing

New document from the Royal College of Nursing in the nature, scope and value of ophthalmic nursing.

Making the Best of Brexit for the NHS

Position statement form the Royal College of Surgeons.

Leading surgeons have urged government and the NHS to use Brexit to improve patient safety in the UK. The Royal College of Surgeons (RCS) says giving job security to NHS staff from the European Union (EU), testing the language skills and competence of non-UK healthcare staff, enforcing more rigorous standards for medical devices and drugs, and relaxing training time restrictions for surgeons should now be a priority.

According to the RCS, the UK, like other EU countries, has often been required to accept the lowest common denominator of standards across Europe, sometimes putting patients at risk. A new position paper from the RCS,Making the Best of Brexit for the NHS, outlines areas of opportunity that could strengthen patient safety, as well as risks to the NHS, now that the UK has voted to leave the EU.

Maternal and neonatal health safety collaborative

A three-year programme from NHS Improvement to support improvement in the quality and safety of maternity and neonatal units across England.

The application and enrolment process is now open.  NHS Improvement will review all applications and notify you of your wave towards the end of January 2017.

New drug proves effective for both types of MS

"A drug that alters the immune system has been described as 'big news' and a 'landmark' in treating multiple sclerosis," BBC News reports. The drug, ocrelizumab, proved effective in two related studies, for treating both the primary progressive and the relapsing remitting types of multiple sclerosis (MS).

NHS Choices' Behind the Headlines' team has focused its analysis on the second study, as relapsing remitting MS is the most common type, accounting for around 80% of cases.

Guideline 142:Management of osteoporosis and the prevention of fragility fractures

Quick reference guide from SIGN for their guideline on the management of osteoporosis and the prevention of fragility fractures.

Oestrogen deficiency symptoms in postmenopausal women: conjugated oestrogens and bazedoxifene acetate

New Evidence Summary from NICE:

In a randomised controlled trial (RCT; n=332), at week 12, conjugated oestrogens and bazedoxifene 0.45 mg/20 mg statistically significantly reduced the average daily number of moderate and severe hot flushes from baseline compared with placebo. In another RCT (n=664) in women with vulvar or vaginal atrophy, at week 12, there were statistically significant improvements compared with placebo in some but not all primary outcomes in the conjugated oestrogens and bazedoxifene 0.45 mg/20 mg group. Statistically significant improvements in certain elements of quality of life compared with placebo were seen in both RCTs. However, no active comparator was included, making it difficult to establish the effectiveness of conjugated oestrogens and bazedoxifene 0.45 mg/20 mg compared with existing treatments. Because of the small number of women exposed and short duration of exposure, the available safety data do not allow for assessment of whether the incidence of rare but important adverse events including cardiovascular or cerebrovascular events, venous thromboembolism or cancer (including breast or ovarian cancer) are increased in women taking conjugated oestrogens and bazedoxifene compared with placebo, or other treatments.

Working Together To Investigate Health And Social Care Complaints

This report from the Local Government Ombudsman outlines how adopting an integrated approach to investigating complaints about health and social care can lead to significant benefits. It discovered that many of the problems experienced have been caused by the complex way in which health and social care is provided at a local level.

2017/19 national tariff published

NHS Improvement and NHS England have launched the 2017/19 national tariff.

NHS England to fund Bionic Eye Surgery

NHS England has today announced that it will provide funding for further testing of the Argus II, also known as the Bionic Eye.

People prefer shorter compression stockings to prevent blood clots

People having surgery prefer wearing knee length to thigh length compression stockings to prevent deep vein thrombosis (DVT). They are more likely to wear knee length stockings correctly and for the recommended time.

From the NIHR Dissemination Centre

Nitrofurantoin is as effective as other long-term antibiotics for preventing recurrent urinary tract infections

The antibiotic nitrofurantoin works as well as other long-term antibiotics for preventing recurrent urinary tract infections in women. However gastrointestinal side effects were more common in people on nitrofurantoin. The potential for inducing less antibiotic resistance compared to trimethoprim is a potential advantage of nitrofurantoin but this wasn’t a specified outcome for this review.

From the NIHR Dissemination Centre

Chronic kidney disease: network meta-analysis compares the effectiveness of calcium-based and non-calcium-based phosphate binders

New Medicines Evidence Commentary from NICE:

A network meta-analysis that included 28 studies (n=8,335) found that calcium-basedphosphate binders increased mortality compared with sevelamer, with an absolute mortality increase of 43 per 1,000 people treated. This network meta-analysis did not consider the cost effectiveness and relative safety of the different phosphate binders and there were some limitations. It is difficult to say whether the difference in mortality is related to harmful effects of calcium-based binders or beneficial effects of sevelamer. The NICE guideline on hyperphosphataemia in chronic kidney disease recommends calcium acetate as the first-line phosphate binder in adults with stage 4 or 5 CKD, with calcium carbonate an option for people who find calcium acetate unpalatable or intolerable. Non-calcium-based phosphate binders are recommended in certain circumstances, for example if hypercalcaemia develops.

Reducing infections in the NHS

Health Secretary Jeremy Hunt has launched new plans to reduce infections in the NHS. He announced government plans to halve the number of gram-negative bloodstream infections by 2020.

Dasatinib, nilotinib and imatinib for untreated chronic myeloid leukaemia

New NICE Technology Appraisal Guidance on dasatinib (Sprycel), nilotinib (Tasigna) and imatinib (Glivec) for untreated chronic myeloid leukaemia in adults.

Everolimus with exemestane for treating advanced breast cancer after endocrine therapy

New NICE Technology Appraisal Guidance on everolimus (Afinitor) for treating advanced breast cancer in adults after endocrine therapy.

Dasatinib, nilotinib and high-dose imatinib for treating imatinib-resistant or intolerant chronic myeloid leukaemia

New NICE Technology Appraisal Guidance on dasatinib (Sprycel), nilotinib (Tasigna) and high-dose imatinib (Glivec) for treating imatinib-resistant or intolerant chronic myeloid leukaemia in adults.

Pertuzumab for the neoadjuvant treatment of HER2-positive breast cancer

New NICE Technology Appraisal Guidance on pertuzumab (Perjeta) for treating HER2-positive breast cancer that is locally advanced, inflammatory, or early-stage with a high risk of recurrence, in adults.

Crizotinib for previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer

New NICE Technology Appraisal Guidance on crizotinib (Xalkori) for previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer in adults.

Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens

New  Technology Appraisal Guidance from NICE on eribulin (Halaven) for locally advanced or metastatic breast cancer in adults who have had 2 or more courses of chemotherapy.

CEU Statement: Combined hormonal contraception and venous thromboembolism

Statement from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists' Clinical Effectiveness Unit about some fatal cases of venous thrombosis that were associated with use of combined hormonal contraception.

Shared commitment to quality from the National Quality Board

This framework from NHS England provides a nationally agreed definition of quality and guide for clinical and managerial leaders wanting to improve quality. The approach has been agreed across NHS and social care organisations to provide more consistency and to enable the system to work together more effectively.

Irreversible electroporation for treating prostate cancer

New NICE interventional procedures guidance on irreversible electroporation for treating prostate cancer in adults. This involves using electrical pulses to destroy the cancer cells.

Extracorporeal shockwave therapy for Achilles tendinopathy

New Interventional Procedures Guidance from NICE on extracorporeal shockwave therapy for treating Achilles tendinopathy in adults. This involves passing shockwaves through the skin to the affected area.

Radiation therapy for early Dupuytren's disease

New Interventional Procedures Guidance from NICE on radiation therapy for early Dupuytren’s contractures in adults. This involves directing low energy X-rays at the affected tissue.

Considering equality & health inequalities is essential for STPs

The purpose of Sustainability and Transformation Plans is to help ensure health and social care services in England are built around the needs of local populations.

It is difficult to see how this can be achieved without considering the different needs within a local population.

Based on the experience of the Care Quality Commission (CQC), The Race Equality Foundation and The Five Year Forward View guidance on Engaging local people, published by NHS England, this process of “equality and health inequalities analysis” should be systematic and logical – but it can be simple. For example, an STP footprint could look at the following six questions:

• For each priority or workstream, what do we know already about the access, experience and outcomes for people with each of the “protected characteristics” covered by the Equality Act 2010 – or other groups that might be facing inequalities in health access and outcomes?
• What do we know about the potential impact of STP plans on workforce equality in the local health and social care economy?
• What does this mean for targeted engagement – to fill gaps in our knowledge or because a group will be particularly affected by STP plans so need to be involved on an ongoing basis?
• What does this evidence and engagement tell us about how we can maximise opportunities to advance equality and minimise risks to equality in our plans?
• What concrete changes need to be made to implementation plans?
• What do we need to do in the future to monitor and evaluate the impact of our plans on promoting equality and tackling health inequalities?

Pulmonary sarcoidosis: infliximab

A randomised controlled trial (RCT) found that, in 138 people with stable pulmonary sarcoidosis, infliximab improved mean percent of predicted forced vital capacity (FVC) at week 24 by 2.5% compared with placebo; this was statistically significant. However, although some individual patients with stable disease, especially those with more severe symptoms, may see greater benefits, it is unclear whether this small, average improvement in this disease-oriented outcome is clinically important on a population basis. There were no statistically significant differences between infliximab and placebo in health-related quality of life, dyspnoea and 6‑minute walking distance at week 24.

NICE Evidence Summaries

How Hospital Activity And Funding In England Have Changed Over Time

This new analysis from the King's Find finds that the number of admissions to hospital are rising steeply and are outstripping increases in the NHS budget. It highlights the potential for rising hospital admissions to jeopardise the plans set out in the NHS five year forward view, which is based on an assumption that growth in hospital activity would be reduced to 1.3 per cent a year rather than the current rate of a 3.6 per cent increase per year. The paper argues that finding ways of moderating demand for hospital care should be prioritised and that the best hope for this lies in strengthening community services.

Latest staff sickness absence figures - August 2016

The latest figures released by NHS Digital show that NHS staff sickness absence has remained the same at 3.92% in August, compared to August 2015.

Beyond Brexit: Assessing Key Risks To The Nursing Workforce In England

This paper, from the Institute for Employment Studies, analyses data at national and trust level to map the regions and NHS trusts in England who may be most vulnerable to the associated risks of Brexit and population growth. The analysis forecasts that areas with a high projected rate of population growth of over-85s and above average employment of nurses from the European Economic Area are most at risk of facing greater pressures in those health economies.

New care centres to improve services for millions with complex needs

‘Early Adopter’ sites have been added  to NHS England's Integrated Personal Commissioning (IPC) programme, giving18 IPC footprints across 33 CCGs. Significant interest has been shown from Sustainability and Transformation Plans (STPs) who have incorporated the IPC model into their local plans as a means of transforming care and creating a sustainable health economy.

NHS bursary reform

Update on changes to healthcare education funding for student nursing, midwifery and allied health students.

Transformation fund call to bid

To support the implementation of the Five Year Forward View vision of better health, better patient care and improved NHS efficiency, NHS England has created a transformation fund. This funding will enable local areas to deliver on key ambitions identified by the independent cancer and mental health taskforces. Additionally NHS England will continue to build on the Transforming Care priority for those with learning disabilities and kick start, at scale, revolutions for diabetes treatment and prevention

All bids should be explicitly linked to the relevant local STP plans. This process is open to any STP, although individual organisations or alliances may bid on behalf of an STP for this funding; submission of applications must be via STPs.

Palliative Care in the Emergency Department: A Systematic Review

Emergency departments (EDs) receive a variety of patients: those with unexpected injuries or trauma, chronic disease exacerbation or progression and existing advanced disease or terminal illness. Thus expectations of attendees can vary greatly. However the primary focus of EDs is acute management.The provision of tailored palliative care (PC), that meets the unique needs of people with advanced disease, is often difficult in the ED. The main objective of this qualitative synthesis was to increase understanding of the ED experience of people with advanced disease, their relatives and healthcare professionals.

Emerg Med J 2016;33:919-920 doi:10.1136/emermed-2016-206402.38

New resources launched and webinar scheduled on e-cigarette use in pregnancy

Two new resources on the use of e-cigarettes during pregnancy have been launched to help midwives in their consultations with women. An infographic and a briefing has been produced by the Smoking in Pregnancy Challenge Group.

The RCM has also launched an online training module on i-learn entitled Very brief advice on smoking for pregnant women.

Supplementary feeding of preterm babies by cup rather than bottle helps breastfeeding success

For women who chose to breastfeed their preterm baby, supplementary feeds with a cup, compared with a bottle, led to improved breastfeeding rates at discharge and up to six months later.

From the NIHR Dissemination Centre

Surgical clot removal within seven hours of stroke improves function

For ischaemic stroke caused by a blood clot, early surgical clot removal alongside medical treatment improves functional outcomes at three months compared with medical treatment alone.

From the NIHR Dissemination Centre

Assisted reproduction using donated eggs has higher risk of complications for mothers and babies

Assisted reproduction with donated eggs carries about double the chance of some risks for mothers and babies when compared to pregnancies from natural conceptions or assisted reproduction using the woman’s own eggs. These risks include high blood pressure and pre-eclampsia, preterm birth, low birthweight and a higher risk of caesarean section. In multiple pregnancies, high blood pressure and pre-eclampsia can affect more than 25% of mothers carrying multiple pregnancies following donated eggs.

From the NIHR Dissemination Centre

Infusion therapy standards: rapid evidence review

This report summarises the rapid review of evidence undertaken to support development of updated RCN Standards for Infusion Therapy, last published in 2010.

Salary sacrifice changes - actions for employers

NHS Employers has developed a slide pack to support employers following the announcement that tax and employer national insurance advantages of salary sacrifice schemes will be removed from April 2017.

It includes the latest information on the changes and key actions for you to consider. It will also help you to think about how the changes will affect your employees and reward offer.

Stoma accessories and quality of life

BJN 24(Sup 17) p. S22. DOI: http://dx.doi.org/10.12968/bjon.2015.24.Sup17.S22

UHCW Research: Abby Barnwell

Index of cancer survival for clinical commissioning groups in England: adults diagnosed 1999 to 2014 and followed up to 2015

Data from the Office of National Statistics on 1-year cancer survival for all cancers combined, three cancers combined and for breast, colorectal, and lung cancer.

New Professional Standards Authority publications

Initial evaluation of the feasibility of prohibition order schemes for unregulated health and care workers in the UK provides detailed information on what prohibition order schemes are and looks at them in relation to health and social care.

Professional identities and regulation - a literature review -  the PSA reviews whether regulation affects professional identity and the impact this can have on patient care.

Blood transfusion quality standard

New quality standard from NICE covering the general principles of blood transfusion in adults, young people and children over 1 year old. It describes high-quality care in priority areas for improvement. It does not cover specific conditions that blood transfusion is used for.

Mining routinely collected acute data to reveal non-linear relationships between nurse staffing levels and outcomes

BMJ Open. 2016 Dec 16;6(12):e011177. doi: 10.1136/bmjopen-2016-011177.

Nursing is a safety critical activity but not easily quantified. This makes the building of predictive staffing models a challenge. The aim of this study was to determine if relationships between registered and non-registered nurse staffing levels and clinical outcomes could be discovered through the mining of routinely collected clinical data. The secondary aim was to examine the feasibility and develop the use of 'big data' techniques commonly used in industry for this area of healthcare and examine future uses.

UHCW Research: M. Radford

CCG Long Term Conditions Pack

These packs contains data on a number of disease areas and elements of care. The pack is split by stages along a long term conditions pathway and enables a local health economy to look at an element, for example disease detection or prescribing, across multiple disease areas.

The pack contains a number of new indicators not included in previous packs. It also includes case studies, tools and guidance to support CCGs to make improvements to long term conditions care in their local health economy.

Surgical site infections (SSI) surveillance: NHS hospitals in England

This annual report, published by Public Health England, covers surgical site infection (SSI) data collected by NHS hospitals and independent sector NHS treatment centres.

Improving Care for People with Long Term Conditions

This report, published by the RPS in Scotland, argues that pharmacist led care of people with long term conditions could deliver better results and be more cost effective. It focuses on the role of the pharmacist as part of a multidisciplinary approach to tackling the challenges facing the NHS in providing the highest quality care and support for people with long term conditions.

HIV testing: increasing uptake among people who may have undiagnosed HIV

This NICE and PHE guideline covers how to increase the uptake of HIV testing in primary and secondary care, specialist sexual health services and the community. It describes how to plan and deliver services that are tailored to the local prevalence of HIV, promote awareness of HIV testing and increase opportunities to offer testing to people who may have undiagnosed HIV.

See also HIV testing in England: 2016 report

NHS reference costs 2015 to 2016

This document provides the most up-to-date information about how NHS expenditure was used to provide health care by NHS trusts and NHS foundation trusts. Reference costs are the unit costs to the NHS for providing defined services in a given financial year to NHS patients in England.

Nuffield Winter Insight: Winter Bed Pressures

This Nuffield Trust briefing is the first in a series looking closely at some of the big issues behind pressure on the NHS in winter months. This briefing focuses on the findings of a new analysis of bed occupancy levels from NHS England situation reports for last winter.

Postpartum Haemorrhage, Prevention and Management (Green-top Guideline No. 52)

This updated RCOG guideline provides information about the prevention and management of postpartum haemorrhage (PPH), primarily for clinicians working in obstetric-led units in the UK; recommendations may be less appropriate for other settings where facilities, resources and routine practices differ.

NHS England announces £101 million of new funding for new care model vanguards

NHS England has announced £101 million of new funding to support and spread the work of the new care model vanguards.

In addition to the funding, the vanguards will continue to receive support from NHS England and other national bodies to implement their plans, including how they harness new technology including apps and shared computer systems. They are also receiving help to develop their workforce so that it is organised around patients and their local populations.

NHS England to fund ground-breaking new mitochondrial donation clinical trial

NHS England has announced it will make up to £8m available over five years to fund the treatment costs of a five year clinical trial of mitochondrial donation – a form of IVF in which the future baby’s mitochondrial DNA comes from a donor egg, to avoid passing on inherited mitochondrial diseases.

Sexual and reproductive health in England: local and national data

This information provides an overview of the information available on sexually transmitted infection (STIs), HIV, contraception, conception and abortion and where to access it. It is divided into indicators (used for tracking progress), detailed local information (collation and interpretation of local intelligence) and national resources (tables and reports).

Newborn blood spot screening: failsafe procedures

The failsafe processes document maps failsafe measures against the Map of Medicine pathway for newborn blood spot screening.

The newborn blood spot failsafe solution (NBSFS) is in use by maternity units across England. It identifies babies who have missed newborn blood spot (NBS) screening.

The documents here set out the procedures for NBSFS and include feedback forms.

The heart failure drug levosimendan doesn’t improve outcomes in adults with severe infections

Septic shock is a life-threatening condition resulting from serious infection.

Adding levosimendan to the usual care of adults with septic shock did not reduce the risk of death up to 28 days, nor the degree of damage to essential body organs. It probably also increased patients’ risk of abnormally fast heart rate and increased the time they needed mechanical ventilation.

From the NIHR Dissemination Centre

Extended hours in primary care linked to reductions in minor A&E attendances

Practices which offered additional appointments showed a reduction in the number of their patients attending emergency departments (also known as A&E) for minor conditions. There was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. The study did not evaluate whether or not this is cost saving to the health service as a whole nor if health outcomes were improved.

From the NIHR Dissemination Centre

New apprenticeship levy guidance

HM Revenue and Customs (HMRC) has published guidance for employers that details how to calculate and pay the apprenticeship levy.

The guidance outlines the rules around what constitutes the pay bill and includes a link to HMRC’s PAYE tools to help employers work out how much they need to pay.

Ticagrelor for preventing atherothrombotic events after myocardial infarction

New NICE technology appraisal guidance on on ticagrelor (Brilique) for preventing atherothrombotic events after myocardial infarction in adults.

Epiduroscopic lumbar discectomy through the sacral hiatus for sciatica - guidance (IPG570)

New NICE Interventional Procedure Guidance on epiduroscopic lumbar discectomy through the sacral hiatus for sciatica in adults. This involves removing the part of the spinal disc pressing against the spinal nerve, to relieve pain.

Gloucestershire clinical MSK group wins joint working award

A musculoskeletal (MSK) clinical programme group, which includes physios, has been recognised for its excellent cross-organisation work with Gloucestershire’s health and social care community by winning the Together we achieve category of the Gloucestershire Health and Social Care Awards 2016.

The award was in recognition of their work to establish a shared vision of an integrated MSK model across multiple organisations, including Gloucestershire Care Services NHS Trust and Gloucestershire Hospitals NHS Trust.

Universal healthcare without the NHS: towards a patient-centred health system

This report from the Institute of Economic Affairs (IEA) recommends that the NHS emulates the best elements of various European health care systems, whilst retaining universal health care access, in order to improve the quality of care and performance. Proposals include opening the market to both non-profit and for-profit insurers, and the introduction of tax rebates for patients wishing to opt out of NHS care.

Hypothermia: prevention and management in adults having surgery

This updated NICE guideline covers preventing and managing inadvertent hypothermia in people aged 18 and over having surgery. It offers advice on assessing patients’ risk of hypothermia, measuring and monitoring temperature, and devices for keeping patients warm before, during and after surgery.

Colonic thickening on computed tomography—does it correlate with endoscopic findings? A protocol for systematic review

Systematic Reviews20165:213 DOI: 10.1186/s13643-016-0381-7

Colonic mural thickening is often a finding in standard computed tomography (CT) scans of the abdomen. It often presents clinician with a dilemma on when a further endoscopic evaluation is needed, especially in the absence of guidelines. The aim of this systematic review is to evaluate the significance of bowel wall thickening and to assess its correlation with endoscopy.

UHCW Research: Ramesh Arasaradnam

Running May Enhance Brain Connections

While the cardiovascular benefits of running are widely acknowledged, new research discovers it may also improve brain connections.

University of Arizona (UA) researchers compared MRI brain scans of young adult cross country runners to young adults who don’t engage in regular physical activity. They discovered the endurance runners’ brains have greater functional connectivity than the brains of more sedentary individuals.

Body Image Problems Tied to Alcohol Issues

Read about new research linking body image misconceptions among teen-aged girls with alcohol consumption.

Notably, teen girls who report and act on body image confusion have an increased risk of heavy drinking than girls of the same age without body image misperceptions.

Why it’s good business to pay attention to mental health

One in four people suffers from mental health issues in their lifetime, yet the stigma still attached to discussing it in some circles means it remains a delicate topic.

Those circles very much include places of work, where the fear of being labelled weak, incapable or hysterical by colleagues means many struggle in silence, rather than seek help. In the world of business and finance, and the professions that feed into those sectors, such as law, accounting and advertising, where staff often come under huge amounts of pressure to outperform, mental well-being has not historically been high up on the executive agenda.

Now, thanks in part to the increasing awareness raised by high profile cases such as the stress-related insomnia experienced by Lloyds Banking Group boss Antonio Horta-Osorio in 2011, it looks as if this could be changing.

We Need To Change How We Talk About Mental Health

Until relatively recently, mental illness was described in law as ‘lunacy’ which is a term dating from the days when it was genuinely believed that mental illness was caused by the influence of the moon as the word stems from the Latin lunaticus, meaning ‘of the moon’. Sadly, popular perception and representation of mental illness hasn’t come all that far since Victorian, or even Roman times.

This article discusses the need for a change.

Deaths of people with learning disabilities or mental health problems not always given adequate attention

A CQC review of the way NHS trusts review and investigate deaths has found that opportunities to learn from patient deaths are being missed – and too many families are not being included or listened to when an investigation takes place.

Alcohol Use and Abuse on Rise in Older Adults

New research finds that alcohol use is on the rise in adults age 50 and over, a factor that may led to dangerous behavior and deleterious physical health issues among both women and men.

Experts explain that alcohol is the most commonly used psychoactive substance among older adults. In this cohort, alcohol consumption is linked to unique risks — in even lower amounts — compared to younger persons.

Study Finds CBT Best Therapy for IBS

Irritable bowel syndrome (IBS) is a painful and sometime debilitating condition that affects roughly one adult in 10. Previous studies have found that, on average, psychotherapy is just as effective as medications in reducing the severity of symptoms of this gastrointestinal disorder.

Although experts initially believed the type of psychotherapy used for the condition did not matter, a new study suggests one particular type of therapy is the most effect.

UnitingCare missed the wood for the trees

The King’s Fund has published an analysis of the reasons behind the failure of the UnitingCare contract.

In 2013, commissioners and providers in Cambridgeshire and Peterborough went through a procurement process to award a new five-year, £725 million community services contract. The clinical commissioning group (CCG) received 60 expressions of interest and shortlisted 10 consortia, before selecting UnitingCare – a partnership of two foundation trusts – in October 2014. UnitingCare’s final offer was £27 million less than the lowest of the offers from other bidders.

Nobody, it seems, was quite sure what they were bidding for. Even the incumbent provider was unsure how much it cost to deliver the services. None of the bidders could be sure how quickly they might reduce costs or improve outcomes. The deal collapsed after only six months, an inevitability once the gulf between funding and costs became apparent...

Combined Performance Summary, October 2016

Performance statistics for October 2016 have been released by NHS England, covering the following:

• the NHS 111 service;
• ambulance quality indicators;
• A&E attendances and emergency admissions;
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care, cancer services;
• delayed transfers of care; and
• early intervention in psychosis.

A combined performance summary is available at: https://www.england.nhs.uk/statistics/combined-performance-summary/

Smoking cessation policy and practice in NHS hospitals National Audit Period: 1 April – 31 May 2016

The 2016 national BTS Smoking Cessation Audit was the first comprehensive audit of smoking cessation activity using BTS and NICE standards for secondary care. 

The audit showed poor recording of smoking status in medical notes. Few people who smoked were asked if they would like to stop smoking or be referred to a specialist stop smoking service and only a tiny fraction of people addicted to tobacco were offered nicotine replacement or other pharmacotherapies in hospital to reduce the symptoms of nicotine withdrawal.

Behavioural and drug treatment together help those with lung disease stop smoking

Smokers with chronic obstructive pulmonary disorder (COPD) given drug treatment alongside behavioural therapy were more than twice as likely to stop smoking by six months as those given behavioural treatment alone. There was also some evidence that high intensity behavioural treatment is more effective than usual care or lower intensity therapy.

From the NIHR Dissemination Centre

Caring for patients who refuse blood: A Guide to Good Practice for the Surgical Management of Jehovah’s Witnesses and Other Patients Who Decline Transfusion

This document from the Royal College of Surgeons provides guidance on the surgical management of Jehovah’s Witnesses and other patients who withhold consent to blood transfusion. It takes into account and expands on the principles set out in Good Surgical Practice (RCS, 2014), Consent: Supported Decision-Making – A Guide to Good Practice (RCS, 2016) as well as guidance from the GMC and NICE, to enable surgeons and their teams to provide high-quality care to Jehovah’s Witness and other patients who refuse blood transfusion while respecting their right to make autonomous decisions about treatment.

XprESS multi sinus dilation system for treating chronic sinusitis

NICE medical technologies guidance on the XprESS multi-sinus dilation system for treating chronic sinusitis after medical treatment has failed.

Safeguarding women and girls at risk of FGM

Practical help to support NHS organisations developing new safeguarding policies and procedures for female genital mutilation (FGM).

RCM Guidance on Implementing the NICE Safe Staffing Guideline on Midwifery Staffing in Maternity Settings

This guidance from the Royal College of Midwives aims to support senior midwives and NHS managers in implementing NICE safe staffing guidance in maternity services

Getting The Midwifery Workforce Right

This report from the Royal College of Midwifery outlines how maternity services should be organised, funded and staffed. It discusses the role of the midwife and approaches for services to enable them to make safe and effective staffing decisions

Learning, Candour And Accountability: A Review Of The Way NHS Trusts Review And Investigate The Deaths Of Patients In England

This national review from the CQC has found that the NHS is missing opportunities to learn from patient deaths and that too many families are not being included or listened to when an investigation happens. The report looked at how NHS trusts across the country identify, report, investigate and learn from the deaths of people using their services.

Some psychotic episodes 'may be triggered by immune disorders'

Some psychotic episodes 'may be triggered by immune disorders' The Independent reports

Researchers from Oxford University found around 9% of people presenting with psychotic symptoms also had signs of immune dysfunction.

They found these people had antibodies in their blood linked to a condition called antibody-mediated encephalitis.

In this condition, antibodies made by the immune system mistakenly attack the surface receptors of brain cells, causing hallucinations, paranoia and delusions – a group of symptoms collectively known as psychosis.

STPs not doing 'justice' to mental health face intervention

Sustainability and transformation plan footprints that have not “done justice” to mental health will be offered support next year, NHS England’s national mental health director has said.

Claire Murdoch said after the 2017-19 contracting negotiations finish this month, her team will begin trying to help STPs improve their plans for the sector.

Children's mental health services are struggling. Can teachers help?

Teachers aren’t trained to spot mental health problems and could benefit from NHS-commissioned research and expertise.

When you train as a teacher, one thing you rarely consider is what you’d do if you were confronted with say a confused teenager convinced they were a religious prophet, or being on a school trip and finding a student carving the word DIE into their forearm. Any job that exposes you to the great stream of humanity will force you into proximity with the misery that runs through it. And the problem is, as a teacher you’re expected to do something about it.

Airports urged to do more to assist travellers with autism, dementia and mental health issues

Airports in Britain are being urged to provide better support for passengers with “hidden disabilities” under new guidelines issued by the Civil Aviation Authority (CAA).

The new guidance, developed in collaboration with various disability organisations, was issued last week in a bid to help reduce stress and anxiety for passengers with conditions including dementia, autism, mental health problems, hearing loss, visual impairment and mobility issues when travelling through an airport or onboard an aircraft.

Government revises Care Act guidance after Supreme Court loss

The government has updated the Care Act statutory guidance after it lost a Supreme Court case on ordinary residence disputes.

The Department of Health has reviewed and updated the guidance following the Supreme Court judgment in July in the case of R (on the application of Cornwall Council) v Secretary of State for Health.

The updates, which can be read from paragraphs 19.17 to 19.43 of the guidance, set out changes in the approach that should be used to determine ordinary residence or disputes between councils in relation to adults who lack capacity to decide where to live and looked-after children who are transitioning to certain adult social care services.

If telecare doesn’t work then why are councils still investing in it?

A research project aims to identify what local authorities want from telecare following evidence that it does not improve outcomes.

When the Department of Health (DH) published its Building telecare in England guidance in 2005, there was some concern about the strength of evidence behind this policy. To settle the issue, it commissioned a major study – the Whole System Demonstrator Project (WSD).

Ambitions for Palliative and End of Life Care A national framework for local action 2015-2020

The Ambitions framework was developed by a partnership of national organisations across the statutory and voluntary sectors. It sets out a vision to improve end of life care through partnership and collaborative action between organisations at local level throughout England

Nurses lack confidence in escalating or identifying children at risk of abuse and neglect

On the face of it, nurses are well placed to safeguard children, but asking them about their experiences reveals barriers which hinder that role. The research points towards areas where support could help nurses fulfil their legal and ethical duties better.

In a review of published qualitative research, including surveys, interviews and focus groups, nurses say they have insufficient confidence to report child abuse issues. They often feel a need to convince other professionals, viewed as above them in the hierarchy, before taking action. Some see child protection services as unhelpful; lacking faith that they will take appropriate safeguarding action. There is also a tension between being seen as caring, compassionate and trustworthy, and watching for abuse and neglect in vulnerable families.

From the NIHR Dissemination Centre

Regulation and roles of the hyaluronan system in mammalian reproduction

Reproduction (Cambridge,England) 153.2 (February 2017): R43-R58.
Hyaluronan (HA) is a non-sulphated glycosaminoglycan polymer naturally occurring in many tissues and fluids of mammals, including the reproductive system. Its biosynthesis by HA synthase (HAS1-3) and catabolism by hyaluronidases (HYALs) are affected by ovarian steroid hormones. Depending upon its molecular size, HA functions both as a structural component of tissues in the form of high-molecular-weight HA or as a signalling molecule in the form of small HA molecules or HA fragments with effects mediated through interaction with its specific cell-membrane receptors. HA is produced by oocytes and embryos and in various segments of the reproductive system. This review provides information about the expression and function of members of the HA system, including HAS, HYALs and HA receptors. We examine their role in various processes from folliculogenesis through oocyte maturation, fertilisation and early embryo development, to pregnancy and cervical dilation, as well as its application in assisted reproduction technologies. Particular emphasis has been placed upon the role of the HA system in pre-implantation embryo development and embryo implantation, for which we propose a hypothetical sequential model. © 2017 Society for Reproduction and Fertility.

UHCW Research: Hartshorne, Geraldine M.

Akt as a potential prognostic marker in neuroendocrine tumors: A possibility?

International Journal of Endocrine Oncology. 3(4) (pp 281-284), 2016

Neuroendocrine tumors (NET) include intestinal and pancreatic NET (P-NET), bronchiopulmonary NET (BP-NET), pheochromocytomas, paragangliomas, neuroblastoma, medullary thyroid carcinoma,

pituitary tumors, small cell lung cancer and Merkel cell tumors. The diversity and relative rarity of these tumors create important challenges to our understanding of their molecular biology and also to identifying markers of prognosis or response to therapy.

UHCW Research: H. L. Robbins

Parental strategies used in the family meal session of family-based treatment for adolescent anorexia nervosa: Links with treatment outcomes

International Journal of Eating Disorders  ePub ahead of print. DOI: 10.1002/eat.22647

Examine relationships between parental mealtime strategies used in the family meal session of family-based treatment (FBT) and adolescent outcomes at EOT (session 20). Parental verbal eating prompts during the family meal may be effective in promoting short-term weight gain. During the family meal session, parents should be encouraged to maintain a direct focus on their adolescent child's eating behaviour which may assist their child with food consumption and potential weight gain. Further research examining food-based interactions among parents and their adolescent child with AN is needed. Copyright © 2016 Wiley Periodicals, Inc.

UHCW Research: C. Meyer

Code of practice for histocompatibility and immunogenetics (H&I) services

Code of practice for histocompatibility and immunogenetics (H&I) services has been updated by the Royal College of Pathologists.

Guidelines on autopsy practice: Sudden death with likely cardiac pathology

Guidelines on autopsy practice:Sudden death with likely cardiac pathology has been updated by the Royal College of Pathologists.

Shaping leadership behaviours

Dan Robertson the diversity and inclusion director at the Employers Network for Equality and Inclusion (ENEI) is a global expert on workplace inclusion, unconscious bias and leadership decision making.

At the diversity and inclusion conference in September Dan spoke about how the behaviours of inclusive leaders can be applied in the health and social care sector to achieve cultural change.

Take a look at Dan's conference presentation and watch a short video in which he reflects on the day and summarises what inclusive leadership behaviours look like in a modern organisation.

English language requirements for public sector workers

The government has issued final guidance to help employers ensure that their staff in customer-facing roles speak English to an appropriate standard.

Keeping medicine brilliant

The morale of the medical workforce in the UK is at a low ebb and has continued to fall for much of the past decade.

This Keeping Medicine Brilliant report will serve as an evidence base to allow us to develop practical solutions to the issues highlighted throughout.  The RCP believes that it is essential that the following domains are addressed in a holistic way to improve the morale and wellbeing of doctors:

• Work
• Physical environment needed for work
• Interpersonal relations in the workplace
• Hospital administration and policies
• Personal characteristics
• Career, education and training
• External/home circumstances
• Patient safety

Managing allegations of abuse: An NSPCC factsheet

This factsheet looks at how allegations of abuse by an employee or volunteer should be handled by organisations.

Management of Bladder Pain Syndrome (Green-top Guideline No. 70)

This RCOG guideline, a joint initiative with the British Society of Urogynaecology (BSUG), aims to provide evidence-based information for primary and secondary care clinicians on the symptoms and treatment options for bladder pain syndrome (BPS) in women.

National Clinical Audit of STIs and HIV: Feasibility Study Report

The UK has a significant problem with sexual ill health, with half a million sexually transmitted infections (STIs) diagnosed in 2014, many more undiagnosed and a worsening profile.

 In 2014, the Healthcare Quality Improvement Partnership (HQIP) commissioned MEDFASH (Medical Foundation for HIV and Sexual Health) to conduct a feasibility study. The purpose was to explore and evaluate the feasibility, and inform the design, of a future national clinical audit of STIs and HIV, specifically concerning the management of HIV1 , gonorrhoea, chlamydia, and syphilis.

Key concerns identified were the impact and onward transmission of STIs, the growing threat of antimicrobial resistance (AMR) in gonorrhoea, and continuing high rates of late HIV diagnosis.

National Vascular Registry 2016 Annual Report

The National Vascular Registry (NVR) aims to provide comparative information on the performance of NHS vascular units and so support local quality improvement. It also aims to inform patients about major vascular interventions delivered in the NHS.

This report provides a description of the care provided by NHS vascular units, and contains information on the process and outcomes of care for: (i) patients undergoing carotid endarterectomy, (ii) patients undergoing abdominal aortic aneurysm (AAA) repair, (iii) patients undergoing a revascularisation procedure (angioplasty/stent or bypass) or major amputation for lower limb peripheral arterial disease (PAD).

Draft guideline for neonatal services and early intervention

A new practice guideline focusing on occupational therapy in neonatal services and early intervention is currently under development, and the guideline group would like your views on the consultation draft.

Nursing Degree Apprenticeship: Factsheet

This DH briefing outlines information on the new nursing degree apprenticeship which will enable people to train to become a graduate registered nurse through an apprentice route.

Neuro gym claims it could save £60k on NHS physio service

Neuro rehab gym sessions in an NHS hospital are reducing re-referrals, saving money and could be replicated, said Darren Beales, lead physio with Kingston Community Neuro Rehabilitation Team.

The project started when the rehab team identified a need for people with long-term neurological conditions to exercise at the hospital. Conventional gyms were not equipped to meet their needs, said Mr Beales. 

He said the gym had eliminated re-referrals back to the Kingston service among attendees. He estimated the cost saving to the NHS at £1,000 per person. Given that between 50 and 60 people are currently attending the classes, that could amount to £60,000.

Gut feelings: How the microbiome may affect mental illness and interact with treatment

All of us who have experienced a 'nervous stomach' under periods of stress suspect that there is a link between our gut and our mood. Now researchers have received strong scientific support for exactly this link.

As noted by Dr. Vicki Ellingrod -- the Chair of this session, "Current state-of-the-art research in both animal models as well as humans point to the link between the gut microbiota and mood and anxiety models, as well as the potential for psychiatric medications to directly affect the gut microbiome."

Local authorities 'spend close to nothing on mental health' - The Independent

Less than one per cent of local authorities' public health budget is spent preventing mental health problems, according to data obtained by charity Mind

Using the Freedom of Information Act, Mind found the proportion of health budgets spent on preventing mental health problems has fallen year on year for the last three years.

Health and wellbeing communications guide

NHS Employers has published a new guide for NHS health and wellbeing leads, to support them to deliver their health and wellbeing programme and supporting interventions.

This communications guide includes sections on planning your communications, building evaluation into your plan, how to appropriately choose your communications channels and developing a health and wellbeing brand - all while working with communications colleagues.

Cancer Statistics: In Brief

Briefing on cancer statistics by the House of Commons Library.

Wheelchair data for July to September 2016

NHS England has published wheelchair data for July to September 2016 (Q2).

It shows an increase in waits of more than 18 weeks for a wheelchair by children compared to the previous quarter.There has also been an increase in adults waiting over 18 weeks. Submissions for Q3 will be open from 3 to 16 January 2017. CCGs will need to use this data to develop improvement plans

Sustainable development in the health and care sector - annual performance maps

These interactive online maps outline how the health and care system is doing on sustainable development. They show how the system across England’s is performing by regions - which can be shown either by NHS or PHE area boundaries.

Euro heart index 2016

This report by Health Consumer Powerhouse provides a ranking of cardiovascular healthcare systems in 30 countries across four key areas: prevention, procedures, access to care and outcomes, measured on 31 indicators. Heart care in France ranks first among the 30 measured countries. It finds that heart care has improved in almost every country since the last report but the gaps across Europe threaten equity.

NHS reference cost assurance programme: findings from the 2015/16 audit

Findings from an audit of the 2014/15 reference cost submissions of 79 acute NHS trusts and foundation trusts.

Uncertainty and risk in HTA decision making

The quality of decision-making in key public sector bodies dealing with resource allocation is a major determinant of their efficiency. One of the most difficult and contentious areas of decision-making is the way that uncertainty is dealt with. This report from the Office of Health Economics is concerned with uncertainty as it affects the cost effectiveness aspects of health HTA.

Quality at a cost

Quality at a cost is the fourth annual statement from QualityWatch, a joint research programme from the Nuffield Trust and Health Foundation.  Amid growing pressures on the NHS, including budget constraints and increasing demand, the report identifies some aspects of care that are performing well, but also highlights continuing problems, including access to services and a slowing down of improvement in performance.

Exercise can help older people stay independent and mentally well, says NICE

Older people who are at risk of losing their independence, or of a decline in mental wellbeing, should be offered tailored exercise in the community.

This is according to a new quality standard published on 5 December by the National Institute for Health and Care Excellence (NICE).

It focuses on interventions that could help to maintain and improve the independence and mental wellbeing of people aged 65 or older.

CSP professional adviser Carley King said: ‘Physiotherapy can have a massive role in sign-posting older people to activities they can participate in and be part of the local community.
‘To some, this might not seem relevant to the physio role, but it’s all part of making every contact count.’

The mental health of children and young people in England

Public Health England -
These reports describe the importance of mental health and wellbeing among children and young people and the case for investment in mental health. They also summarise the evidence of what works to improve mental health among children and young people in order to inform local transformation of services.

• Report for England
• Report for London
• Public Health England - publications

Working out the genetic risk for ADHD

Genetics play a strong part in the development of attention-deficit/hyperactivity disorder (ADHD), but the path from a gene to risk for the disorder has remained a black box to researchers. A new study suggests how the risk gene ADGRL3 (LPHN3) might work. ADGRL3 encodes the protein latrophilin 3, which regulates communication between brain cells. According to the study, a common variation of the gene associated with ADHD disrupts its ability to regulate gene transcription - the formation of mRNA from DNA that leads to expression of the gene.

MRI scans detect 'brain rust' in schizophrenia

A damaging chemical imbalance in the brain may contribute to schizophrenia, according to research presented at the American College of Neuropsychopharmacology Annual Meeting in Hollywood, Florida.

Managing mental health at work

Problems with wellbeing or mental health do not need to limit your career. Here's some advice for employees and employers.

The government is breaking promises on child mental health

If mental health is the Cinderella service of the NHS, then child and adolescent mental health services is the Cinderella service of the Cinderella service. It’s a cliche that bears repeating, because the reality of children’s mental health services in this country still falls woefully short of the vision set by the Liberal Democrats and Conservatives during the coalition government. Read more HERE

‘It is awful to tell a parent you don’t believe they can care for their child safely’

The subject of adoption is one of the most contentious issues within social work. It is crystalized in mystique due to the unspoken nature of care proceedings and the uncomfortable subject matter that leads to a care plan of adoption being proposed.

Vitamin D supplements can reduce risk of asthma attacks

People with mild to moderate asthma experience fewer severe asthma attacks if they take vitamin D supplements.

This review found that the average number of asthma attacks was equivalent to about one every four years in those taking vitamin D, compared to nearly one every two years in those taking a placebo. Half as many people attended hospital for asthma treatment each year when taking vitamin D (3%) compared with those not taking vitamin D (6%). These reductions were clinically and statistically significant.

From the NIHR Dissemination Centre

New mesothelioma lung cancer data shows increase in 1 year survival despite regional variation in treatment

The second mesothelioma report, launched by RCP London, demonstrates improvement in the number of people diagnosed with malignant pleural mesothelioma (MPM) surviving for more than 1 year*.

Despite this improvement, overall survival rates still remain poor, with only 43% of patients still alive at one year from initial diagnosis. The report uses data from over 2,000 patients diagnosed with MPM in England during 2014, the largest dataset for mesothelioma in the UK.

Supporting the trust on the journey to financial recovery

New case study from Doncaster and Bassetlaw Hospitals NHS Foundation Trust shares their experiences of how they've improved their staff engagement levels through a new strategy and improvement directorate.

NHS Employers

End of life care for infants, children and young people with life-limiting conditions: planning and management

This new NICE guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.

Key Performance Indicators - Revisions

NHS England's revised Key Performance Indicators (KPIs) aim to improve understanding of how the urgent care system is performing overall and drive up performance to ensure patients receive the best possible clinical outcomes through a more balanced consideration that more accurately reflects the three domains of quality (providing patient safety, effective care, and delivering a positive patient experience).

Editor Note: Cardiovascular Diseases and Their Management

J Cardiovasc Dis Diagn 2016, 4:3 DOI: 10.4172/2329-9517.1000e112

In volume 4, issue 3, of the journal 5 articles were published discussing the risk factors of cardiovascular diseases and recent trends in cardiac surgery. These wide ranging articles from across the world make interesting reading and are contributory to our current knowledge on these areas.

UHCW Researech: Prithwish Banerjee

Tibial plateau fractures – review of current concepts in management

Orthopaedics and Trauma ePub ahead of print. http://dx.doi.org/10.1016/j.mporth.2016.10.005

Tibial plateau fractures represent a wide spectrum of injury patterns and encompass degrees of severity that are challenging to treat by even experienced orthopaedic trauma surgeons. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture.

UHCW Research: Mateen H. Arastu

Confidential Enquiry into Maternal Death 2016

MBRRACE-UK is pleased to announce the publication of the findings of the third MBRRACE-UK confidential enquiry into maternal deaths

Postoperative day one serum alanine aminotransferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients

Hepatobiliary Pancreat Dis Int. 2016 Dec;15(6):655-659

Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase (ALT) correlate with patient outcome after liver resection. We assessed whether postoperative day 1 (POD 1) ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient's morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.

UHCW Research: Bhogal RH, Nair A, Papis D, Hamady Z, Ahmad J, Lam FT, Khan S, and Marangoni G.

Tips on applying attachment theory in social work with adults

Attachment theory will be a familiar concept for social workers who work with children; a model to understand how early experiences of care influence a child’s strategies for gaining protection and comfort. But it may be less well known that the theory can also be of use to practitioners who work with adults.

Attachment strategies aren’t just used in childhood, but continue across the whole course of a person’s life. So if social workers can understand the strategies an adult is using, and the behaviours that can result from this, they can make assessments and plans that are more likely to help the person make changes and access support.

Clark Baim, a psychodrama psychotherapist and co-director of training provider Change Point Ltd, has developed Community Care Inform Adults‘ guide to using attachment theory to work with adults.

Launch of new patient and public pages on HRA website

The Health Research Authority is pleased to launch the new patient and public section on their website. This area is for patients and members of the public looking for information on the research the HRA regulates and approves, taking part or getting involved in research and how the HRA involves the public in the work we do.

New resource to help managers effectively respond to concerns

Health Education England (HEE) has worked with the National Guardian's Office to develop a new online resource for managers, to enable them to effectively deal with public interest concerns. Responding to concerns identifies appropriate ways of handling issues raised and supporting staff through the process.

The online tool has been develop as a part of a suite resources designed to teach staff the importance of speaking up and inform them of what support is available, as part of HEE's Learning to be safer programme of work. It compliments Raising a concern which was made available earlier this year.

Guiding Principles for Patient Experience Excellence

A new white paper by The Beryl Institute shares eight guiding principles, reflects on why they are critical components of successful patient experience efforts and offers examples of each principle in action.

Major national investment in NHS radiotherapy machines and in improving local cancer services

NHS England’s chief executive Simon Stevens has announced the first wave of hospitals to benefit from a major national investment in NHS radiotherapy machines alongside £200m of funding over two years to improve local cancer services.  These include UHCW.

The Frontline Battle: An Inquiry into the Impact of Alcohol on Emergency Services

The report from the All-Party Parliamentary Group on Alcohol Harm reveals the full extent of the pressures and dangers that alcohol related problems place on emergency services. It discusses the impact on staff, the impact on service provisions and the effect on time and resources.

Medical professionalism matters

The GMC's Medical professionalism matters report is the culmination of 18 months of events and conversations with the medical profession, from GPs, consultants and trainees who work on the ground, to royal colleges, training providers and employers.

Among the most frequently raised issues during the seven UK-wide events were the lack of time and support to make a reality of reflective practice – at every stage of a doctor’s career. Doctors also cited problems around professional isolation, fragmentation of care for patients and poor communication.

One of the biggest complaints was about the yawning communication gap between primary and secondary care, which many felt had worsened in the last 20 years. Meanwhile many felt that doctors in training were especially vulnerable because their constant rotations meant they never feel part of a team.

Improving mental health services in immigration detention: action plan

This is a joint action plan between the Department of Health, NHS England and Home Office on improving mental health services in immigration detention.

It considers the provision of mental health services and wider welfare issues for vulnerable adults in immigration removal centres and residential short term holding facilities in England.

Weight Problems Increase Risk for Bipolar Teens

New research suggest medications alone do not increase the risk of being overweight or developing obesity among adolescents with bipolar disorder. But there appears to be a direct relationship between obesity and greater severity of bipolar disorder.

Was 2016 A Tipping Point For Mental Health?

Was 2016 really the year that saw conversations about mental health take their place in the public domain. Was it the year that we got closer than ever before to finally doing away with the stigmas that have shrouded mental health problems for so long? And, is it possible that all of the shocking political events we have witnessed have actually played a role in putting us all more in touch with our collective emotional wellbeing? Read more HERE

Government to revive controversial ‘exemption’ plans in social work bill

The government will revive controversial proposals in the Children and Social Work Bill that were thrown out by the House of Lords last month.

Peers voted to delete the so-called ‘innovation’ clauses from the Children and Social Work Bill. But the government will table amendments this week to re-instate the proposals in what ministers labelled a “much altered and improved” form.

The original proposals allowed councils to apply for exemptions from children’s social care law to “test new ways of working”.

The government said the powers would allow services to cut red tape and safely trial innovations. Opponents, including Labour and a coalition of more than 30 organisations, claimed the measures threatened legal protections for vulnerable children.

Six councils pilot ‘named social worker’ scheme

Six councils will give people with learning disabilities and their families a named social worker to help challenge decisions about their care, under a government scheme.

The Department of Health is investing £460,000 for the local authorities to trial the move for six months. The government has given each council the flexibility to design the specifics of the role but wants the named social worker to act as the primary point of contact for families and advocate for them.

New report shows the way ahead to tackle delays and duplication across health and social care

The Health Foundation and the Advancing Quality Alliance (AQuA) have published The challenge and potential of whole system flow, a guide to help local NHS and social care leaders to work together to improve productivity, patient experience and the quality of services.

The report says poor flow not only wastes time, energy and money, it can hurt patients and is deeply frustrating for people working in health and social care. The report cites common examples of poor flow: ambulances queuing outside hospitals; stretched emergency departments; problems getting a GP appointment; and mental health patients being transferred hundreds of miles for a bed.

The report argues that the current context for health and care providers – including significant financial pressures and the emergence of new local partnerships (the Sustainability and Transformation Plan partnerships in England) –present an opportunity for a serious focus on tackling flow across NHS and social care systems.

Survival rates for patients receiving lung cancer surgery continue to rise

The new report published by the Royal College of Physicians (RCP) and the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) demonstrates further improvements in survival rates following lung cancer surgery as the number of operations to treat the disease increases.

Rising from 95.5 to 96.2% over 2 years from 2012 to 2014, the consistent improvement in the number of people living longer than 90 days after surgery, together with an increase in number of operations to treat lung cancer, is encouraging.

Joint leadership and development framework launched

Developing People - Improving Care is the first version of a national framework to guide local, regional and national action to support staff to develop improvement and leadership capabilities to deliver continuous improvement in local health and care systems and gain real pride and joy from their work.

The framework focuses on developing four critical capabilities:

• systems leadership, for staff who are working with partners in other local services on ‘joining up’ local health and care systems for their communities;
• established quality improvement methods that draw on staff and service users’ knowledge and experience to improve service quality and efficiency;
• inclusive and compassionate leadership, so that all staff are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve; and
• talent management to support NHS-funded services to fill senior current vacancies and future leadership pipelines with the right numbers of diverse, appropriately developed people.

Survey finds early physio for cardiac surgery patients varies across UK

A UK-wide survey of physios working at cardiothoracic centres has revealed wide variations in rehabilitation for cardiac patients following surgery.

Electronic Palliative Care Co-ordination Systems (EPaCCS) National Data Project

Electronic Palliative Care Co-ordination Systems (EPaCCS) enable the recording and sharing of people’s care preferences and key details about end of life care.

Last year NEoLCIN undertook a study to better understand the impact of EPaCCS nationally, look at geographical variations in EPaCCS data, understand the potential challenges/barriers and opportunities associated with collating EPaCCS data. The study also explored the effectiveness of EPaCCS in achieving people’s preferences for care and supporting the co-ordination of care and advance care planning.

End of Life Care (EoLC) Knowledge Hub

Struggling to keep up to date and informed on changes impacting on palliative and end of life care? Not sure where to find the latest resources and improvement examples?

Then visit the tailor made national End of Life Care (EoLC) Knowledge Hub for a ‘one stop shop’ of palliative and EoLC information.

Bedside tracheostomy may be at least as good as traditional surgical techniques

Bedside tracheostomy procedures in intensive care units were at least as good as surgical tracheostomies, usually done in theatre.

From the NIHR Dissemination Centre

The Role of Natural Killer Cells in Human Fertility (Scientific Impact Paper No. 53)

In this Scientific Impact Paper from the RCOG, the data relating to NK cell function will be reviewed and recommendations made regarding the measurement of NK cells in women with reproductive failure.

Local Endometrial Trauma (Endometrial Scratch): A Treatment Strategy to Improve Implantation Rates (Scientific Impact Paper No. 54)

This Scientific Impact Paper from the RCOG discusses the evidence for endometrial trauma and improved implantation rates, the mechanisms by which implantation may improve, timing and technique for inducing endometrial trauma and who may benefit.

The enlarged extraocular muscle: to relax, reflect or refer?

Eye , (2 December 2016) | doi:10.1038/eye.2016.248

All cases of NTR-EOME should be viewed with a high level of clinical suspicion for systemic neoplasia, especially when the SR is involved. FBCT can help to identify a primary systemic cause. FBPET-CT is best reserved for cases negative on FBCT or for staging and monitoring systemic disease. NTR-EOME can be associated with significant mortality (25%), hence warrants prompt and thorough systemic investigation.

UHCW Research: P Mehta and H S Ahluwalia

Multi-Disciplinary Working – What are the barriers?

The RCOphth hosted an evening event on Thursday 1 December 2016, at which a panel discussed: “Multi-Disciplinary Working – What are the barriers?”.

A recurring theme of the evening was the need for good communication between the different professional groups. It was noted that high quality care was most likely to be delivered where there was a culture of respect for different disciplines, but sometimes extended roles were viewed with suspicion. It was acknowledged that tensions between different groups existed but many of these could be overcome by effective clinical leadership.

Communication should include systematic feedback on referrals. It was observed that there was a significant variation in the quality of referrals into the hospital eye service; most were of a high quality but a small minority of optometrists were too ready to refer and audit was a good tool for identifying those who needed specific support.

Nursing staff using personal mobile phones for work purposes

The RCN does not support the use of staff personal mobile phones for routine provision of services. Staff personal mobile phones should never be used to record, transmit or store a patient’s personal details, health information, or images of the patient.

NICE recommends new lung cancer drug pembrolizumab

Pembrolizumab works by targeting a specific protein on the surface of cells which is involved in the body’s immune response to cancer.

In draft guidance NICE has said that adults with advanced lung cancer, that test positive for this protein, should have access to pembrolizumab.

Diagnostic accuracy of faecal biomarkers in detecting colorectal cancer and adenoma in symptomatic patients

Aliment Pharmacol Ther. 2016 Dec 1. doi: 10.1111/apt.13865. [Epub ahead of print]

The aimm of this study was to assess using faecal immunochemical test for haemoglobin (FIT) or faecal calprotectin (FCP) to detect CRC and adenoma in symptomatic patients referred from primary care.

UHCW Research: M. M. Widlak, S. Smith, C. L. Thomas, C. U. Nwokolo, S. Wurie, L. Burns, C. Harmston, C. Evans, C. Tomkins , N. O'Connelland R. P. Arasaradnam

Improved dashboard to help optimise the use of medicines

In 2014 NHS England launched its medicines optimisation dashboard to help inform local discussions about how to improve patient outcomes and get better value from our medicines spend. Since then it has been evaluated and modified based on what commissioners, prescribers and other healthcare providers want to see. Visit the new and improved dashboard to explore how you can use it to optimise medicines use for patients.

Chest pain of recent onset: assessment and diagnosis

New recommendations have been added to NICE guidance on Chest pain of recent onset: assessment and diagnosis for the assessment and diagnosis of acute chest pain and the assessment and diagnosis of stable chest pain.

Transition between inpatient hospital settings and community or care home settings for adults with social care needs

This new NICE quality standard covers admissions into, and discharge from, inpatient hospital settings for adults (aged 18 years and over) with social care needs. It describes high-quality care in priority areas for improvement. It does not cover inpatient mental health settings, which will be covered by a quality standard on transition between inpatient mental health settings and community or care home settings.

Catheter impregnation, coating or bonding for reducing central venous catheter-related infections in adults

This Cochrane Review informed a practice changing update on Dynamed Plus. It found that antimicrobial coatings that appear to reduce risk of central venous catheter-related bloodstream infection include minocycline-rifampicin, chlorhexidine silver sulfadiazine, silver, and heparin, but antimicrobial coatings do not appear to reduce risk of sepsis or mortality

Campaign against painful hysteroscopy

The Campaign Against Painful Hysteroscopy is concerned that a sizeable minority (5-25%) of patients have reported severe pain during this procedure. Some of the common themes experienced during the procedure were:

• Lack of information/no information about the choices of pain relief available before, during and after the procedure;
• An assumption by hysteroscopists and hysteroscope manufacturers that there would only be “discomfort” and not as experienced by some patients, varying levels of pain from mild to intolerable;
• An assumption by hysteroscopists that a ‘vocal local’ is effective relief against severe pain;
• An assumption that if acute pain is only short-lived (such as during a uterine biopsy) then it doesn’t matter.

Last-line antibiotics are failing: options to address this urgent threat to patients and healthcare systems

This ECDC briefing aims to draw the attention of policymakers to examples of measures that can be taken at national and local levels to halt the spread of highly resistant bacteria. Case studies illustrating successful implementation of such measures, are also highlighted.

Superbugs: real problem, real work

An enterprising team at Attenborough Surgery in Bushey, Hertfordshire took the evidence and NICE recommendation and launched a pilot project to reduce antibiotic prescribing for people with respiratory infections. Patients were offered the CRP test and those not prescribed antibiotics, or offered a delayed prescription, were given written self-care advice. The results were impressive.

• 70% of patients presenting with a suspected lower respiratory tract infection had low levels of C-Reactive Protein (CRP <20mg/L)
• Prescription of antibiotics was reduced by 23% (8% of patients were prescribed antibiotics on their first visit during the winter that CRP testing was introduced, compared with 31% the previous winter)
• Unscheduled follow-up visits within 28 days for patients who were not prescribed antibiotics fell by more than 50%

How the technology used in Airedale and Partners vanguard is changing care for people in care homes

In one of the most rural parts of the National Health Service, clinicians are becoming skilled in having a “webside manner” – as we harness the full potential of telemedicine to test out and develop a new model of care for the NHS.

Airedale and Partners' innovation is built around a 24/7, 365 day per year digital hub that provides care homes with immediate video access to a clinical advice service provided by senior nursing staff, supported by clinicians drawn from a range of specialties.

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