Managing medicines for adults receiving social care in the community

This guideline covers medicines support for adults (aged 18 and over) who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. It gives advice on assessing if people need help with managing their medicines, who should provide medicines support and how health and social care staff should work together.

What do people think of autism services for children and young people?

There are around half a million people in England on the autism spectrum. Read our new briefing on what people have told local Healthwatch about their experiences of care and where improvements could be made.

NHS leaders must beware wishful thinking

When it comes to doing more for less money, those leading NHS transformation initiatives will require a dose of realism, writes Nigel Edwards on the Nuffield Trust's blog.

Glucocorticoid supplementation during ovarian stimulation for IVF or ICSI

Cochrane Database Syst Rev. 2017 Mar 27;3:CD004752. doi: 10.1002/14651858.CD004752.pub2. [Epub ahead of print]

The safety and effectiveness of glucocorticoid administration in women undergoing controlled ovarian hyperstimulation for IVF/ICSI cycles (until the day of oocyte retrieval) is unclear due to the small number of studies and low event rates. Whilst glucocorticoids possible increase the clinical pregnancy rate, there may be little or no impact on live birth rate. More research is needed.

UHCW Research: S. D. Keay

Public Satisfaction With The NHS And Social Care In 2016: Results And Trends From The British Social Attitudes Survey

The findings from the British Social Attitudes survey show 63 per cent of people were satisfied with the NHS. Satisfaction remains high by historic standards, but is seven percentage points below its peak of 70 per cent in 2010.

NHS Women On Boards: 50:50 By 2020

This report from NHS Employers examines the steps the NHS needs to take to reach the target of equal gender representation on boards by 2020.

Model Hospital expanding to ambulance, specialist acute, community and mental health trusts

As part of our work to implement Lord Carter’s hospital productivity recommendations, the Model Hospital online information system is expanding to include early benchmarking data for ambulance, specialist acute, community and mental health trusts.

The data will go live on Monday 17 April and you can access it via the Model Hospital website. This letter provides a full overview.

opens in a new window

What’s Stopping You Appointing A Patient Director? An open letter to all healthcare organisations

Very few organisations employ a patient director, a senior executive responsible for turning all the rhetoric about involvement and patient-centred care into reality.

In an open letter to healthcare chief executives, David Gilbert, patient director at Sussex MSK Partnership, asks what’s stopping other organisations from following suit.  

Use of whole genome sequencing to diagnose TB

Whole genome sequencing is now being used to identify different strains of tuberculosis (TB).

This is the first time the technique has been used as a diagnostic solution for managing a disease on this scale anywhere in the world. 

Skin-to-skin contact improves breastfeeding of healthy babies

Early skin-to-skin contact improves breastfeeding of healthy full-term babies. Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth.

From the NIHR Dissemination Centre.

Response to concerns about our guidance for doctors on attempting CPR and DNACPR orders

Clarification on the GMC's guidance on the Treatment and care towards the end of life,

Cetuximab and panitumumab for previously untreated metastatic colorectal cancer

New NICE Technology Appraisal Guidance on cetuximab (Erbitux) and panitumumab (Vectibix) for previously untreated RAS wild-type metastatic colorectal cancer in adults.

Alectinib for previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer (terminated appraisal)

NICE is unable to make a recommendation about the use in the NHS of alectinib for anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer previously treated with crizotinib, for this technology appraisal, because no evidence submission was received from Roche.

Brexit, Trade and Health

Now that Article 50 has been triggered, Britain’s formal process for exiting the European Union will begin. 

There is much uncertainty surrounding Brexit, particularly regarding the future trade and investment relationship between the UK and the EU, as well as between the UK and third states. What are the potential implications of Brexit on trade and investment from the perspective of health?

2018/19 flu CQUIN guidance

As part of the new CQUIN for 2017/18 and 2018/19 there will be a continued focus on flu vaccination targets for frontline healthcare workers that will be matched with progressive payments.

The flu uptake rate is one of three indicators within the improving staff health and wellbeing section, which is assigned 0.25 per cent of the total provider budget. The flu uptake indicator has a weighting of 33.3 per cent of 0.25 per cent (0.0833 per cent) of the total provider budget.

Integration and the Development of the Workforce

This working paper reveals how integration of the fields of health and social care will require organisations to break down traditional barriers in how care is provided. Please note that free registration is required in order to download this publication.

Latest NHS sickness absence figures - November 2016

The latest figures from NHS Digital show that NHS staff sickness absence has increased from 4.34 per cent in November 2015 to 4.46 per cent in November 2016.

Report shows change in NHS workforce over time

The report, Healthcare Workforce Statistics England, September 2016, Provisional Experimental, shows that at 30 September, 2016, there were 1.20 million FTE staff working for the NHS in England, compared to 1.17 million at the same point in 2015.

NHS England to issue new guidance on low value prescription items

NHS England will be leading a review of low value prescription items from April 2017 and introducing new guidance for Clinical Commissioning Groups (CCGs), with a view to substantially saving NHS expenditure in this area.

NHS England will work with clinicians and clinical commissioning groups to develop guidelines initially around a set of 10 medicines which are ineffective, unnecessary, inappropriate for prescription on the NHS, or indeed unsafe, and that together cost the NHS £128m per year. In developing the guidance, the views of patient groups, clinicians, commissioners and providers across the NHS will be sought.

NICE says pancreatic cancer drug is not cost effective for routine NHS use

Pegylated liposomal irinotecan is used for treating metastatic pancreatic cancer that has progressed after being treated by a different therapy.

NICE says that for metastatic pancreatic cancer the drug is not beneficial enough to justify its high cost for routine NHS use

Hope for those stuck in mental health institutions

There is a chink of light that could transform the lives of thousands of people with learning disabilities, needlessly stuck in mental health institutions away from homes, families and communities. On Wednesday, the public affairs committee will hear from Simon Stevens, head of NHS England, and others, on reducing the number of people with learning disabilities in mental health hospitals to improve their quality of life.

Climate change's toll on mental health

When people think about climate change, they probably think first about its effects on the environment, and possibly on their physical health. But climate change also takes a significant toll on mental health, according to a new report released by the American Psychological Association and ecoAmerica entitled Mental Health and Our Changing Climate: Impacts, Implications, and Guidance.

A guide to writing your first mental health tribunal report

What are social circumstances reports and how should you go about completing one? A mental health social worker offers advice

New Perinatal Bursary Scheme will help mothers seeking specialist mental health services

Thousands of mothers will benefit from improved specialist perinatal mental health services, as the Royal College of Psychiatrist, NHS England and Health Education England announces funding to support 10 new perinatal psychiatrists inareas currently lacking this specialist care.

A bursary scheme will fund training in perinatal mental health for psychiatrists who are already consultants in other areas of psychiatry.

These newly trained perinatal consultants will then go on to lead new Perinatal Mental Health services in their local area.

Brexit and the mental health sector

The potential implications of Brexit on mental health services were outlined to senior mental health leaders recently, by Elisabetta Zanon and Danny Mortimer of the NHS European Office and NHS Employers. 

Cortisol excess hits natural DNA process and mental health hard

High concentrations of the stress hormone, Cortisol, in the body affect important DNA processes and increase the risk of long-term psychological consequences. These relationships are evident in a study from the Sahlgrenska Academy on patients with Cushing's Syndrome, but the findings also open the door for new treatment strategies for other stress-related conditions such as anxiety, depression and post-traumatic stress.

Missed opportunities. Children wait ten years for mental health support

Children and young people with mental health difficulties go an average of ten years between first becoming unwell and first getting any help, according to an evidence review published today by Centre for Mental Health.

Missed Opportunities, by Lorraine Khan, reviews recent evidence about the mental health of children and young people in the UK. It finds that mental health problems are very common among young people, but awareness is poor and most attempts by parents to get help for their children are unsuccessful.

Food for thought: mental health and nutrition briefing

What we eat and drink affects how we feel, think and behave. With a recent study finding more than 1 in 6 people experience a mental health problem each week, the need for effective approaches to understanding and improving mental health has never been greater.

This briefing focuses on how nutrition can be effectively integrated into public health strategies to protect and improve mental health and emotional wellbeing. It discusses what we know about the relationship between nutrition and mental health, the risk and positive factors within our diets and proposes an agenda for action.

WHO suicide fact sheet

Every year close to 800 000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15–29-year-olds globally in 2015.

Key facts

• Close to 800 000 people die due to suicide every year.
• For every suicide there are many more people who attempt suicide every year. A prior suicide attempt is the single most important risk factor for suicide in the general population.
• Suicide is the second leading cause of death among 15–29-year-olds.
• 78% of global suicides occur in low- and middle-income countries.
• Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.

Read the Suicide fact sheet

Latest MedTech Alerts Now Available

The latest Horizon Scanning Research and Intelligence Centre Medtech Alerts on innovative new and emerging medical diagnostics have been uploaded:

• Portable neuromodulation stimulator for traumatic brain injury
• Portable neuromodulation stimulator for multiple sclerosis
• Magnetically enhanced diffusion system for acute ischaemic stroke

Management of Unerupted Maxillary Incisors

Guideline form the Royal College of Surgeons on the management of unerupted maxilliary incisors.

Nurse specialist in menopause

The Royal College of Nursing has published this document on the role of the nurse specialist in managing and supporting women with menopause.

Mitochondrial disorders in children: Co-enzyme Q10

This evidence summary from NICE discusses 3 case reports in a total of 6 children with mitochondrial disorders. Because this evidence is very limited, this evidence summary also discusses the best available evidence on the use of co-enzyme Q10 in adults and young people with mitochondrial disorders.

Zio Service for detecting cardiac arrhythmias

NICE has developed a medtech innovation briefing (MIB) on the Zio Service for detecting cardiac arrhythmias.

Mollii suit for spasticity

NICE has a developed medtech innovation briefing on Mollii suit for spasticity.

Bair Hugger for measuring core temperature during perioperative care

NICE has developed a medtech innovation briefing (MIB) on Bair Hugger for measuring core temperature during perioperative care.

HIV testing: Quality standard consultation

The new draft quality standard from NICE aims to improve the uptake of HIV testing among adults (aged 18 and over) and young people (aged 16-18) who may have undiagnosed HIV. This would mean they could have timely treatment to reduce the risk of onward transmission.

2017 Child Health Profiles

Public Health England has published the 2017 Child Health Profiles.  They are a valuable tool for local government and health services in helping them to understand their communities’ needs, so that they can work to improve the health and wellbeing of children and young people and reduce health inequalities.

Evidence of ocular side effects of SSRIs and new warnings

Acute angle-closure glaucoma (AACG) may cause symptoms including eye pain, changes in vision, or swelling and redness and can rapidly lead to permanent blindness if not treated.1 Medications can precipitate AACG through adrenergic or anticholinergic-mediated pupillary dilation that results in the physical obstruction of the outflow of intraocular fluid in susceptible individuals. Case reports and a previous large database study from Ontario, Canada,2 have suggested an association between new use of selective serotonin reuptake inhibitors (SSRIs) and AACG. The potential mechanism underlying this association is unclear but may be related to effects on norepinephrine or serotonin receptors in the iris and ciliary body of the eye.

Evidence Based Mental Health, 20, (1) 27, 2017 (use your Athens username and password to access)

Workplace Wellbeing Charter: analysis of take-up and impact

RAND were asked to assess the implementation and take up of the Workplace Wellbeing Charter which was developed by Public Health England. The charter aimed to support employers in delivering evidence-based workplace health improvement activities. The study found that the charter contributed to staff wellbeing but that improved monitoring data was required to effectively evaluate the progress of the charter.

NHS trust FMA guidance: 2016 to 2017

Financial monitoring and accounts and management information forms (FMA) for NHS trusts to complete the 2016 to 2017 quarter 3 and year-end finance returns.

Geographic patterns of cancer survival, England: 2015

Survival at 1 year and 5 years after diagnosis improved for the 8 cancers examined in this report (colon, breast, cervix,prostate, oesophagus, stomach, bladder, lung) among adults diagnosed in England between 2003 and 2010. Differences in net survival between the 4 NHS Regions are generally small, of the order 1% to 3%. Survival improved slightly but consistently in all 4 regions for 7 of the 8 cancers.

University of Cambridge awarded £40m to create world-leading health care improvement research institute

The Health Foundation has announced the University of Cambridge has been chosen to establish and run a new improvement research institute, the first of its kind in Europe.

The Health Foundation will be awarding in the region of £40 million over a period of 10 years.

Paraneoplastic endocrine syndromes

Endocr Relat Cancer March 24, 2017 ERC-17-0036. doi: 10.1530/ERC-17-0036

The majority of neoplasms produce symptoms related to mass effects to surrounding tissues and/or through the development of metastases. However, occasionally neoplasms, with or without endocrine differentiation, acquire the ability to secrete a variety of bioactive substances or induce immune cross-reactivity with the normal tissues that can lead to the development of characteristic clinical syndromes. These syndromes are named endocrine paraneoplastic when the specific secretory components (hormones, peptides or cytokines) are unrelated to the anticipated tissue or organ of origin. Endocrine paraneoplastic syndromes can complicate the patient's clinical course, response to treatment, impact prognosis and even be confused as metastatic spread. These syndromes can precede, occur concomitantly or present at a later stage of tumour development, and along with the secreted substances constitute the biological "fingerprint" of the tumour. Their detection can facilitate early diagnosis of the underlying neoplasia, monitor response to treatment and/or detect early recurrences following successful initial management. Although when associated with tumours of low malignant potential they usually do not affect long-term outcome, in cases of highly malignant tumours, endocrine paraneoplastic syndromes are usually associated with poorer survival outcomes. Recent medical advances have not only improved our understanding of paraneoplastic syndrome pathogenesis in general but have also enhanced their diagnosis and treatment. Yet, given the rarity of endocrine paraneoplastic syndromes, there is a paucity of prospective clinical trials to guide management. The development of well-designed prospective multicentre trials remains a priority in the field in order to fully characterise these syndromes and provide evidence-based diagnostic and therapeutic protocols.

UHCW Research: Georgios K. Dimitriadis and M Weickert

Potential new treatment for non-freezing cold injury: is Iloprost the way forward?

Journal of the Royal Army Medical Corps Published Online First: 23 March 2017. doi: 10.1136/jramc-2016-000672 

Non-freezing cold injury (NFCI) remains largely under-reported, and is of particular importance in the armed forces where its prevalence is greatest. Iloprost, a synthetic prostaglandin I2 analogue, has previously been used with some success in the treatment of vasospastic and freezing cold injuries, although its role in NFCI remains unclear.

The use of iloprost in the treatment of NFCI is discussed and its use in a condition which physicians consistently struggle to treat effectively is considered. Careful counselling is recommended as symptoms may be worsened.

UHCW Research: Anne-Marie Ionescu, Sarah Hutchinson, Mehtab Ahmad and Christopher Imray

Addition of GLP-1 agonist ('Bydureon') and SGLT-2 inhibitor (Dapagliflozin) combination therapy: A case of significant weight loss and improved glycaemic control in a poorly-controlled patient with concurrent depression

Diabetic Medicine. Conference: Diabetes UK Professional Conference 2017. United Kingdom. Conference Start: 20170308. Conference End: 20170310. 34 (pp 102-103), 2017.

Here we describe a 57 year old man with Type 2 diabetes and depression, referred with hyperglycaemia. Drugs comprised metformin 1g BD, gliclazide 80mg BD, and sitagliptin 100mg. Initial weight was 88.2kg, BMI 27.5. HbA1c was 59mmol/mol having fallen from 84 with addition of sitagliptin, so he was initially referred to the dietitian to improve lifestyle. As HbA1c had recently improved, additional agents were not added. At six months, HbA1c was 77mmol/mol, and diet/lifestyle intervention did not suffice. At this point, dapagliflozin 10mg was added (replacing gliclazide). Three months later, HbA1c remained elevated (73mmol/mol) but weight fell (2kg). He then commenced once-weekly exanatide (bydureon), replacing sitagliptin. Four months later, HbA1c fell to 57mmol/mol, and weight fell to 80.2kg (further 6kg). Following eight months of SGLT2/GLP-1 combination therapy weight fell to 78kg (total 10.2kg loss) and HbA1c to 54mmol/mol. This case
highlights important points. SGLT2 inhibitors, (whilst often offering a more predictable response), may not induce the required response. Addition of GLP-1 agonists in combination may be beneficial when other options are limited, potentially avoiding the need for insulin. This case highlights a return to normal BMI in an overweight patient, and HbA1c to target, following addition of dapagliflozin/bydureon combination therapy. This, together with insulin avoidance is in the context of poor motivation due to depression reducing effectiveness of lifestyle advice. This combination
may have promise going forward in the context of poor control and if lifestyle interventions are unlikely to be effective (i.e. in those with poor mobility, or psychiatric disease as in this case).

UHCW Research: Border D.K., Leyden E., Clayton W. and Barber T.M.

Upper margin of the lamina-guided lateral mass screw placement in the sub-axial cervical spine

British Journal of Neurosurgery. Conference: 2017 Spring Meeting of the Society of British Neurological Surgeons. United Kingdom. Conference Start: 20170329. Conference End: 20170331. 31 (2) (pp 120), 2017

The present study explores the anatomical feasibility of a new technique of lateral mass fixation, in which the screws are inserted close to the union of the upper margin of the ipsilateral lamina with the lateral mass and directed along the upper margin of the lamina.

UHCW Research: Amit A., Shad A., Dardis R., Saxena A. and El-Maghrabi H.

Cognitive behavioural therapy for non-motor symptoms of Parkinson's disease: a clinical review

This study found a growing evidence base that CBT (modified to account for PD-specific problems) is effective in the treatment of PD psychiatric symptoms. Where controlled study design was used, moderate effect sizes are reported for the efficacy of CBT for depression, including with distance administration of CBT. The effects were sustained during follow-up which was between 1 and 6 months.

Evidence Based Mental Health, 20, (1) 15, 2017 (Log in with your Athens username and password)

National death rates from hepatitis C in England fall

There has been good progress towards reducing deaths from the hepatitis C virus (HCV) in England, according to the latest report which provides recommendations for what can be done to achieve the World Health Organisation’s goal to eliminate it as a major public health threat by 2030.

While new cases of HCV-related end stage liver disease and hepatocellular carcinoma in England have remained relatively stable over the last five years, there has been an 8% decrease in deaths from these indications in the last year

Electronic Prescribing and Medicines Administration (ePMA) Network

There is now an NHS network for discussing anything related to electronic Prescribing and Medicines Administration (ePMA) solutions. This is to be used as a national point of contact for any queries related to ePMA solutions.

Informed Choice? Giving Women Control Of Their Healthcare

This report from the All Party Parliamentary Group on Women's Health has found that across the country women are not being treated appropriately when it comes to their physical, mental and gynaecological health. It highlights the need for improvements in the quality of care for women with fibroids and endometriosis in particular.

Innovation In Regulation

The Human Fertilisation and Embryology Authority (HFEA) and the Human Tissue Authority (HTA) have published documents showing how their approach to regulation supports innovation.

• HFEA strategy
• HTA strategy

A year of plenty?: an analysis of NHS finances and consultant productivity

This analysis from The Health Foundation show that NHS providers saw relatively little of the income growth for the NHS as a whole, and that productivity for consultants and the wider workforce in acute hospitals has been falling.

New Guide for occupational therapists to support understanding of Patient Group Directions

The College of Occupational Therapists has released a new guide to help its members understand patient group directions, a legal mechanism which when in place will allow them to supply and administer medicines to patients and service users.

Overseas police checks for Tier 2 applicants required from 6 April

From 6 April 2017, Tier 2 (general) visa applicants and their adult dependant(s) will be required to provide a criminal record certificate from each country they have lived in consecutively for 12 months or more in the past ten years. The requirement has been designed to strengthen safeguards against individuals with a criminal history who are seeking to come to the UK.

New midwifery supervision model coming soon

A new model of clinical supervision for all midwives in England, advocating for education and quality improvement (A-EQUIP), will come into effect on 1 April.

Pioneering venture launched to help solve 'capital finance conundrum'

The Local Growth Academy, an exciting cross-sectoral venture, has been launched to help NHS organisations understand how to access the new and emerging finance mechanisms determining local infrastructure planning.

With capital finance severely constrained yet critical to realising the ambitions of local plans, the Local Growth Academy aims to build NHS organisations’ capacity to maximise their contribution and involvement in local developments.

Malignant hypercalcaemia related to parathyroid hormone-related peptide (PTHrP) secretion from a metastatic pancreatic neuroendocrine tumour (NET).

BMJ Case Rep. 2017 Mar 22;2017. pii: bcr2017219692. doi: 10.1136/bcr-2017-219692.

A 54-year-old woman presented to our centre with acute abdominal pain and vomiting. Routine blood tests showed severe hypercalcaemia (>4 mmol/L). Serum parathyroid hormone (PTH) was suppressed. CT scan detected a pancreatic mass and some liver lesions, initially suspicious for metastatic pancreatic adenocarcinoma. Liver biopsy however revealed the presence of a well-differentiated, grade 1, metastatic neuroendocrine tumour (NET) where prognosis is considerably better. Serum PTHrP was raised, indicating paraneoplastic hypercalcaemia, most likely secondary to the pancreatic NET. Following injection of a short-acting somatostatin analogue octreotide, serum PTHrP levels normalised within 24 hours, causing a rapid drop of serum calcium below the lower limit of normal and an immediate compensatory rise of serum PTH. Ongoing treatment with long-acting somatostatin analogues together with replacement with calcium carbonate, vitamin D3 and once weekly alendronic acid resulted in stable normal adjusted calcium levels over a 3-month follow-up period.

UHCW Research: Symington M, Davies L, Kaltsas G and Weickert MO

The time to value our staff is now

Staff morale is reaching crisis point – so what can policy-makers and senior leaders do to tackle the problem?

New equality objectives to target inequality in health and social care

The CQC has published ambitious new equality objectives for 2017 - 19. Despite progress on equality, people from some equality groups are still less likely to receive good quality health and social care.

Through its inspections, the CQC will check that providers make person-centred care work for everyone, from all equality groups. We will look at how they are meeting the new Accessible Information Standard, which applies to disabled people who have information and communication needs, for example, deaf people or people with a learning disability. 

Quality Premium guidance 2017-19

The Quality Premium is intended to reward clinical commissioning groups (CCGs) for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities.

Ethical Procurement for Health Workbook

This Ethical Procurement for Health(EPH) Workbook aims to provide practical guidance for organisations in the health and social care sector to embed labour standards considerations into procurement and supplier management activities.

Support for healthy breastfeeding mothers with healthy term babies

To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.

To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.

To examine the effectiveness of different care providers and (where information was available) training.

To explore the interaction between background breastfeeding rates and effectiveness of support.

Cochrane Database of Systematic Reviews

Calcium and phosphorus supplementation of human milk for preterm infants

Review to determine whether addition of calcium and phosphorus supplements to human milk leads to improved growth and bone metabolism of preterm infants without significant adverse effects

Cochrane Database of Systematic Reviews

Breastfeeding education and support for women with twins or higher order multiples

To assess effectiveness of breastfeeding education and support for women with twins or higher order multiples.

Cochrane Database of Systematic Reviews

Screening pregnant women for GBS not recommended

The latest recommendations from UK National Screening Committee (UK NSC) include not screening pregnant women for group B streptococcus (GBS).

Seventh National Pulmonary Hypertension Audit published

The National Audit of Pulmonary Hypertension sets out to measure the quality of care provided to people referred to pulmonary hypertension services in England and Scotland.

For the first time, the National Audit of Pulmonary Hypertension Annual Report has used standards against which to measure clinical practice. These standards were retrospectively applied and are intended to provide a benchmark for what the service intends to achieve in future years

The Effect of Hospital Ownership on Quality of Care: Evidence from England

This research from the Centre for Health Economics investigates whether quality of care differs between public and private hospitals in England with data on 3.8 million publicly-funded patients receiving 133 planned (non-emergency) treatments in 393 public and 190 private hospital sites. The authors found no quality differences between hospitals specialising in planned treatments and other hospitals, nor between for-profit and not-for-profit private hospitals

How health care is funded

The way that health care is funded varies between different countries. Here the King's Fund explains the main models used to finance health care: taxation, private health insurance and social health insurance. It outlines how each model works in its purest form, while recognising that most countries typically pay for health care using a combination of methods.

It also cover user charges. Although no European or OECD (Organisation for Economic Co-operation and Development) country relies on user charges as a primary source of health care funding, all countries incorporate at least some element of user charging into the funding mix.

Achieving digital maturity: Hedging our bets

In September 2015, NHS organisations were divided into 84 regions and instructed to draw up plans – Local Digital Roadmaps (LDRs) – to make better use of technology, including a route to providing paperless care by 2020. Just a few months later, the Sustainability and Transformation Plan (STP) was conceived and NHS organisations were divided again, this time into 44 regions. STP areas were told that LDRs should feed into and inform STPs, even though some STPs encompassed more than one.

Organisational excellence or whole-system change? Sophie Castle-Clarke weighs up Global Digital Exemplars vs Sustainability and Transformation Plans.

STPs need significantly more work and resource to create whole-system transformation, and the likelihood of achieving it by 2020 is miniscule. But given that’s the case, perhaps it would make more sense to put any available resource into creating a digitally advanced system rather than achieving digital maturity in individual hospitals – particularly given that those furthest behind are likely to need most support.

Severe asthma report - the unmet need and the global challenge

Asthma UK has published Severe asthma: the unmet need and the global challenge. This publication examines the need to improve the prospects for people with severe asthma. The report sets out the challenges of treating this complex condition and the opportunity for the scientific community to come together to make new treatments available more quickly.

Norovirus: guidance, data and analysis

This guidance collection from Public Health England covers the symptoms, diagnosis, management and epidemiology of norovirus.

Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit

Among adults with suspected infection admitted to an ICU, an increase in SOFA score of 2 or more had greater prognostic accuracy for in-hospital mortality than SIRS criteria or the qSOFA score. These findings suggest that SIRS criteria and qSOFA may have limited utility for predicting mortality in an ICU setting.

JAMA. 2017 Jan 17;317(3):290-300. doi: 10.1001/jama.2016.20328.

Review of emerging technologies for hearing loss

The NIHR Horizon Scanning Research and Intelligence Centre has completed a horizon scanning review of emerging health technologies for the management and reduction of the negative consequences of hearing loss.

Delivering better oral health: an evidence-based toolkit for prevention

An evidence based toolkit from Public Health England to support dental teams in improving their patient’s oral and general health.

Delayed Walking May Signal Spontaneous Gene Anomalies in Autism

A team of NIMH intramural and grant-supported researchers has discovered a pattern of behavioral and genetic features seen in some cases of autism spectrum disorder (ASD) that could ultimately lead to identification of subgroups and improved treatment.

Nurses and pharmacists can prescribe as effectively as doctors

Prescribing by suitably-trained pharmacists and nurses offers similar outcomes to prescribing by doctors, at least in the management of chronic conditions.

From the NIHR Dissemination Centre

Tennessee Hospital Association Uses AHRQ Tools To Boost Patient Safety

AHRQ resources used by the Tennessee Center for Patient Safety—the quality and safety unit of the Tennessee Hospital Association (THA)—helped 120 member hospitals reduce safety events by more than 1,000 and readmissions by more than 1,500 between 2012 and 2014.

The THA relied upon several AHRQ tools, particularly the Comprehensive Unit-based Safety Program (CUSP) and Re-Engineered Discharge (RED) toolkits to prevent numerous safety challenges

Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department

Among patients presenting to the emergency department with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than did either SIRS or severe sepsis. These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting.

JAMA. 2017 Jan 17;317(3):301-308. doi: 10.1001/jama.2016.20329.

Evidence-based diagnostic model for mental illness

Researchers have has developed a new, evidence-based alternative to the mental health field's long-established diagnostic tools for the classification, treatment, and research of mental disorders. The Hierarchical Taxonomy of Psychopathology (HiTOP) addresses what the authors say are limitations to the reliability and validity of traditional models.

NHS procurement transparency: NHS standard contract

Updated guidance is available to all NHS trusts on the actions to take to increase openness and clarity about NHS procurement.

Health psychologists now treating functional heartburn, Crohn's Disease, IBS and other GI disorders

Health psychologists have begun treating gastrointestinal disorders that are strongly affected by stress, including irritable bowel syndrome (IBS), Crohn's disease, functional heartburn, functional dyspepsia and ulcerative colitis. Read more HERE.

Elotuzumab for previously treated multiple myeloma (terminated appraisal)

NICE was unable to make a recommendation about the use in the NHS of elotuzumab for previously treated multiple myeloma because no evidence submission was received from Bristol–Myers Squibb.

Bevacizumab for treating EGFR mutation-positive non-small-cell lung cancer (terminated appraisal)

NICE was unable to make a recommendation about the use in the NHS of bevacizumab for treating epidermal growth factor receptor mutation-positive non-small-cell lung cancer because no evidence submission was received from Roche.

Tenofovir alafenamide for treating chronic hepatitis B (terminated appraisal)

NICE was unable to make a recommendation about the use in the NHS of tenofovir alafenamide for treating chronic hepatitis B because no evidence submission was received from Gilead.

Ibrutinib with bendamustine and rituximab for treating relapsed or refractory chronic lymphocytic leukaemia after systemic therapy (terminated appraisal)

NICE was unable to make a recommendation about the use in the NHS of ibrutinib with bendamustine and rituximab for treating relapsed or refractory chronic lymphocytic leukaemia after systemic therapy because no evidence submission was received from Janssen-Cilag

Seven day self-assessment: update to collection period and deadlines

The latest seven day self-assessment data collection is underway. The new and shorter data collection period runs from 15 March to 12 April 2017.

To give you enough time to complete the work, we’ve increased the data collation time from three to six weeks. The submission deadline is now 24 May 2017.

Data on patient safety incidents reported to the NRLS

• Organisation patient safety incident reports: provides a breakdown of patient safety incidents recorded on the NRLS by NHS providers
• National data on patient safety incident reports: provides a national overview of patterns and trends in the incidents recorded on the NRLS

Self-care everybody’s talking about it

A discussion paper by Self Help UK on behalf of Regional Voices. It highlights the need to support patients to better manage their own health and the need for greater recognition of the potential for voluntary and community services contribution towards this.

A day in the life of social work

This research, carried out in partnership with Community Care, finds that many social workers are struggling with their caseloads and longer working hours due to staff shortages and budget cuts. These insights are taken from feedback from over 2000 social work professionals and it aims to provide an insight into the typical working day of social care staff.

• Report

Dementia-friendly housing charter

This charter aims to help housing professions better understand dementia and how housing, its design and supporting services can help improve and maintain the wellbeing of people affected. Free registration is required in order to access the charter.

Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer

This updated NICE guideline covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer

NICE recommends anastrozole is offered for 5 years to postmenopausal women at high or moderate risk of breast cancer unless they have severe osteoporosis. And clinicians should consider offering it to women at moderate risk of breast cancer.

Women at high risk who have not been through the menopause should continue to be offered tamoxifen

NHS National Tariff Payment System 2016/17

Update on the NHS National Tariff Payment System for 2016/17.

Mental health workers struggle with stigma about their own issues

Understanding around mental health is improving: campaigns such as Time To Change have drawn public awareness to the issue and employers are realising the affects of dedicated wellbeing support to staff – which have led to a 30% reduction in mental health-related absences. But surprisingly, stigma still exists for those working in mental healthcare themselves.

Young people need to be met where they're at by services, says new Centre for Mental Health briefing

Young people involved in gangs or at risk of offending can benefit from a radical approach to offering mental health support developed by the charity MAC-UK in three pioneering projects in London, according to a briefing published today by Centre for Mental Health.

Meeting us where we’re at, by Graham Durcan, Sally Zlotowitz and Jessica Stubbs, brings together evidence from three projects that worked with young men in Camden and Southwark using the INTEGRATE approach.

Intensive case management for severe mental illness

Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input.

Read more about the effectiveness of ICM in the Cochrane Database of Systematic Reviews. 

Social workers' role in mental health 'misunderstood', survey finds

The role of social workers in mental health services is “greatly misunderstood” by the public, according to research published by fast-track social work training scheme Think Ahead.

A survey of over 1000 British adults found only a third (33%) knew social workers were involved in deciding whether someone should be detained under the Mental Health Act. Social workers who are qualified as Approved Mental Health Professionals lead on this work. Click on the link above for more findings.

Nuffield report on moving care into the community

The Nuffield Trust has written a report assessing whether moving care out of hospitals will save money. Out-of-hospital care is a key element of many Sustainability and Transformation Plans (STPs), and aims, not only to improve health and patient care but also to reduce costs.

Mental health in emergencies

During and after emergencies, people are more likely to suffer from a range of mental health problems.

Some people develop new mental disorders after an emergency, while others experience psychological distress. Those with pre-existing mental disorders often need more help than before.
WHO-recommended psychological first aid involves humane, supportive and practical help to people who are suffering after a crisis. This support should be provided to people in ways that respect their dignity, culture and abilities. It covers both social and psychological support.

Psychological and psychiatric help need to be made available immediately for specific, urgent mental health problems as part of the health response.

Communities affected by emergencies need long-term access to mental health care as adversity is a potent risk factor for a wide range of mental health problems.

2017-18 NHS Mandate and Mental Health

The Department of Health has published the NHS mandate for 2017-18. This sets out the government’s objectives for NHS England, as well as its budget.

It builds on the previous multi-year mandate, which came into effect on 1 April 2016 and set long term objectives and goals to 2020, this updated mandate focuses on the same 7 high-level objectives and sets out the main aims in each area for the financial year 2017 to 2018 to achieve the 2020 goals.

Extraurethral (non-circumferential) retropubic adjustable compression devices for stress urinary incontinence in women

New NICE Interventional Procedures Guidance on extraurethral (non-circumferential) retropubic adjustable compression devices for stress urinary incontinence in women. This involves putting 2 small balloons on either side of the tube that carries urine from the bladder to support it and reduce leaks.

Sacrocolpopexy with hysterectomy using mesh to repair uterine prolapse

New Interventional Procedures Guidance on sacrocolpopexy with hysterectomy using mesh to repair uterine prolapse. This involves attaching mesh from the top of the vagina to the base of the spine to support the pelvic organs after the womb has been removed.

External Cephalic Version and Reducing the Incidence of Term Breech Presentation (Green-top Guideline No. 20a)

This 2nd edition of this RCOG guideline summarises the evidence regarding the routine use of external cephalic version (ECV) for breech presentation.

Management of Breech Presentation (Green-top Guideline No. 20b)

This new 4th edition of this RCOG guideline provides up-to-date information on methods of delivery for women with breech presentation.

Liverpool NHS trust’s AHP strategy to forge links between physios and researchers

Cooperation between physiotherapists and researchers at the Royal Liverpool and Broadgreen University Hospitals NHS Trust could be strengthened by the trust’s first strategy for allied health professions (AHPs).

A key objective of the three-year strategy, launched at the end of 2016, is to open up opportunities for AHPs to participate in research to improve patient services.

Parkinson’s disease with end-of-dose motor fluctuations: opicapone

This new NICE evidence summary reviewed 1 randomised placebo- and active-controlled trial in people with Parkinson's disease of at least 3‑year duration, who were taking a stable dose of levodopa and experiencing end-of-dose motor fluctuations. Most participants were also taking other Parkinson's disease medicines, most commonly a dopamine agonist. There are limited data on the use of opicapone as a first choice adjunct therapy to levodopa.

Hyperhidrosis: oxybutynin

This new NICE evidence summary includes 4 studies (3 randomised controlled trials [RCTs] and 1 quasi-randomised controlled trial) that investigated oxybutynin 2.5 mg to10 mg for treating hyperhidrosis in adults. All the studies compared oxybutynin with placebo and were in non-UK settings.

Awards spotlight NHS improvement projects driven by patient feedback

Winners selected for patient insight awards, have been announced at a Patient Experience Network ceremony in Birmingham.

The awards in the Friends and Family Test and Patient Insight for Improvement categories have gone to five initiatives that set a gold standard for use of patient and staff insight to shape healthcare and that could be mirrored in other areas to benefit patients across the country.

The overall winner is Nottingham University Hospital NHS Trust for the Think Drink Project, an initiative in Nottingham to reduce the time that patients have to go without food and drink prior to operations. 

Other category winners are:
Ipswich Hospital NHS Trust (Accessibility Category) for their Frailty Assessment Base, a project linking all the healthcare processes across hospital and community services that are concerned with the frailty needs of older people to help reduce admissions, increase confidence and enable patients to go home;
Leicester City Clinical Commissioning Group (Primary Care Category) for an insight initiative to understand the health needs of homeless people and asylum seekers in Leicester to better inform the design of primary healthcare services;
Northumbria Healthcare NHS Foundation Trust (Staff Category) for their compassion-based training for maternity staff in Northumbria;
West Leicestershire Clinical Commissioning Group (Other NHS-Funded Services Category) for work to balance the views and needs of patients and staff when redesigning non-urgent patient transport services.

Sports clinic launches appointments app

A private orthopaedic and sports injury clinic has introduced an app so that patients can arrange appointments on their iPhones.

The iOS App was launched in March and the practice, the Fortius Clinic, intends to make the app available for Android users this summer.

A spokesperson for Fortius said patients can use the app to book new consultations, follow-ups, imaging appointments, upload and view documents, as well as pay outstanding balances and check payment history.

NHS to notify heart surgery patients of small risk of infection caused by heater cooler units

The NHS is taking the precautionary step of writing to patients who have had certain types of open heart surgery to inform them that they may have a low risk of having contracted an infection caused by Mycobacterium chimaera (M. chimaera).

NHS mandate 2017 to 2018

NHS mandate 2017 to 2018

NHS mandate 2016 to 2017 has also been updated

National flu immunisation programme plan

National flu immunisation programme for 2017 to 2018.

State of Patient Experience 2017: Initial Key Findings

This study, conducted by the Beryl Institute, engaged almost 1,700 respondents from 26 countries representing six continents sharing the challenges and opportunities they are facing and the steps they are taking to address the patient experience.

This year’s study continues a critical gathering of information about what organizations across the care continuum are doing to drive patient experience excellence and provides a unique opportunity to uncover and track trends on how experience efforts are evolving.

Interventions for prevention of bullying in the workplace

Bullying has been identified as one of the leading workplace stressors, with adverse consequences for the individual employee, groups of employees, and whole organisations. Employees who have been bullied have lower levels of job satisfaction, higher levels of anxiety and depression, and are more likely to leave their place of work. Organisations face increased risk of skill depletion and absenteeism, leading to loss of profit, potential legal fees, and tribunal cases. It is unclear to what extent these risks can be addressed through interventions to prevent bullying.

This Cochrane Systematic Review explores the effectiveness of workplace interventions to prevent bullying in the workplace.

Equality, Diversity and Human Rights Week 2017

The sixth Equality, Diversity and Human Rights Week #EQW2017 will take place from 15 to 19 May 2017.

Equality, Diversity and Human Rights Week is a platform for organisations to highlight their work to create a fairer, more inclusive NHS for patients and staff. This year's theme diverse, inclusive, together was chosen to reflect the move across the health and care sector towards collaboration and integration.

Mission impossible? The task for NHS providers in 2017/18

This report from NHS Providers presents a detailed assessment of the demands that are being placed on NHS trusts through the NHS planning guidance. These are compared against next year’s significantly lower funding increases, revealing a currently unbridgeable gap.

Protecting whistleblowers seeking jobs in the NHS

This DH consultation seeks views on draft regulations that prevent an NHS employer from discriminating against applicants who appear to have been whistleblowers.  It closes on 12th May.

New NHS target aims to improve experience of leaving hospital

The Government has published what it wants the NHS to deliver over the next 12 months.

Included in the updated 2017/18 mandate is a new target to reduce to 3.5% the number of instances where a patient is ready to leave hospital for home, or another service, but is unable to do so.

New drug shows promise in preventing heart attacks

"The cholesterol drug that outperforms statins: Patients on the medication are '27% less likely to suffer a heart attack'," the Daily Mail reports.

The drug, evolocumab, makes the liver more effective at removing "bad" cholesterol from the blood.

But the Mail's headline is somewhat misleading, as evolocumab was given along with statins and not as a replacement for them.

New Ophthalmic Guidance available

The following guidance has been updated by the Royal College of Ophthalmology:

• Ophthalmic Imaging
• Managing an outbreak of postoperative endophthalmitis
• Ophthalmic Pathology
• Quality safety and clinical governance in ophthalmology: An overview
• Clinical Audit and Clinical Effectiveness in Ophthalmology
• Standards for Virtual Clinics in Glaucoma Care in the NHS Hospital Eye Service 

Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction

Psycho-Oncology. 6 March 2017 DOI: 10.1002/pon.4397

Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post-mastectomy breast reconstruction.

UHCW Research: Alan Park, Jo Skillman, Kate McCarthy and Elizabeth A. Grunfeld

Reprogramming of the retinoic acid pathway in decidualizing human endometrial stromal cells

PLOS One March 2, 2017 http://dx.doi.org/10.1371/journal.pone.0173035

Upon breaching of the endometrial surface epithelium, the implanting embryo embeds in the decidualizing stroma. Retinoic acid (RA), a metabolite of vitamin A, is an important morphogen during embryonic and fetal development, although the role of the RA pathway in the surrounding decidual cells is not understood. Here we show that decidual transformation of human endometrial stromal cells (HESCs) results in profound reprogramming of the RA signaling and metabolism pathways.

UHCW Research: Jan J Brosens

Early multicentre experience of ultra-mini percutaneous nephrolithotomy in the UK.

Journal of Clinical Urology. 10 (2) (pp 124-128), 2017.

 Ultra-mini percutaneous nephrolithotomy (UMP) is a novel technique recently introduced allowing percutaneous renal access to stones using a specially modified 11 or 13 Fr sheath, a 6 Fr nephroscope, and permits laser fragmentation and stone evacuation. This study aimed to review the early practice of UMP in the UK. Methods: All centres in the UK which had performed UMP were contacted to submit data. Data were submitted to a central database from nine centres around the UK who performed UMP between July 2013 and December 2014. Data were collected on patient, stone, operative factors and outcomes. Results: A total of 32 UMP cases were performed in the contributing centres. Stone size ranged from 7 mmx5 mm to 24 mmx24 mm across the 32 cases, with a mean of 13 mmx10 mm. Stone-free rates were excellent with 31/32 cases stone-free post procedure; 26/32 patients were left without a nephrostomy tube. Complications were uncommon; there were two Clavien 1 complications in this series (6%). Conclusion: This study has shown the efficacy of UMP during its introduction into UK practice. It is likely that UMP will become a useful addition to the armamentarium to treat renal stones, especially smaller stones in the lower pole calyx, and in specialised cases such as paediatric stone disease and in patients with stones in calyceal diverticulae.

UHCW Research: T. J. R. Blacker

Aligning depression treatment to patient need leads to efficient care

Not all depressed patients need intensive therapy, according to new research. Instead, prognosis can drive treatment.

Depression looks different in every person, making it a challenge to ensure that each receives the appropriate care. Many patients get treatment too intensive for their condition while others don't get enough.

Mental health of adults in contact with the criminal justice system

This NICE guideline covers assessing, diagnosing and managing mental health problems in adults (aged 18 and over) who are in contact with the criminal justice system. It aims to improve mental health and wellbeing in this population by establishing principles for assessment and management, and promoting more coordinated care planning and service organisation across the criminal justice system.

Yoga and Controlled Breathing May Ease Depression

New research suggests a 12-week integrative health intervention may significantly reduce depressive symptoms.

Columbia and Harvard researchers discovered training in Iyengar yoga classes and coherent breathing provided considerable benefits for individuals with major depressive disorder.

However, frequency of the training was important as participants who took three yoga classes a week were more likely to achieve lower depression scores than subjects who took two classes.

The article is coauthored by Richard Brown, M.D., and John Eric Jensen, Ph.D., and appears in The Journal of Alternative and Complementary Medicine.

Brain Health Food Guide for Older Adults

Canadian scientists have developed a food guide to help adults over 50 preserve their thinking and memory skills as they age.

“There is increasing evidence in scientific literature that healthy eating is associated with retention of cognitive function, but there is also a lot of misinformation out there,” says Dr. Carol Greenwood, co-author of the Brain Health Food Guide.

Family Members Can Play Important Role in Autism Diagnosis

New research finds the observations and then feedback from family and friends can play a key role in the early diagnosis of autism, aiding effective treatment options.

Investigators at the Seaver Autism Center for Research and Treatment at Mount Sinai discovered children who have older siblings or frequent interaction with grandparents are diagnosed with autism spectrum disorders (ASD) earlier than those who do not.

Women who eat their veggies at lower risk of psychological stress

Published in the British Medical Journal Open, the longitudinal study of more than 60,000 Australians aged 45 years and above measured participants fruit and vegetable consumption, lifestyle factors and psychological distress at two time points, 2006-08 and 2010.

Key findings
People who ate 3-4 daily serves of vegetables had a 12 per cent lower risk of stress than those who ate 0-1 serves daily.

People who ate 5-7 daily serves of fruit and vegetables had a 14 per cent lower risk of stress than those who ate 0-4 serves daily.

Women who ate 3-4 daily serves of vegetables had an 18 per cent lower risk of stress than women who ate 0-1 serves daily.

Women who ate 2 daily serves of fruit had a 16 per cent lower risk of stress than women who ate 0-1 serves daily.

Women who ate 5-7 daily serves of fruit and vegetables had a 23 per cent lower risk of stress than women who ate 0-1 serves daily.

Dance movement therapy for dementia

Dementia is a collective name for different degenerative brain syndromes which, according to Alzheimer's Disease International, affects approximately 35.6 million people worldwide. The latest NICE guideline for dementia highlights the value of diverse treatment options for the different stages and symptoms of dementia including non-pharmacological treatments. Relevant literature also argues for the value of interventions that acknowledge the complexity of the condition and address the person as a whole, including their physical, emotional, social and cognitive processes. At the same time, there is growing literature that highlights the capacity of the arts and embodied practices to address this complexity. Dance movement therapy is an embodied psychological intervention that can address complexity and thus, may be useful for people with dementia, but its effectiveness remains unclear. Read more HERE.

Social work: essential to integration

Department of Health -
This document should be used to support and inform local and regional health and social care integration initiatives. It explains: the critical contribution that social workers make to integrated services; how social work is essential to the whole system; and the necessity of support to ensure integration succeeds in providing the services people need. It also includes ‘top tips’ for directors of adult social services and for principal social workers to assist in progressing the integration agenda.

• Advice note
• Department of Health - publications

Safe, sustainable and productive staffing in mental health services

This resource is developed by NHS Improvement to help commissioners and providers of NHS-commissioned services create, review and sustain, safe and effective specialist mental health services. We're asking for feedback on this before publishing a final, revised version later this year.

Factors That Predict Failure in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

Am J Sports Med 15 March 2017 http://dx.doi.org/10.1177/0363546517691961

Anatomic graft placement in anterior cruciate ligament (ACL) reconstruction has become the preferred technique for many surgeons. The predictive factors for graft failure in anatomic single-bundle ACL reconstruction are relatively unknown.  The purpose of this study was to determine the risk factors for graft failure and the relative importance of those factors in anatomic single-bundle ACL reconstruction.

UHCW Research: Thomas, Michael ^, Thompson, Peter and Spalding, Tim 

Guidance on decontamination of buildings, infrastructure and open environment

This guide has been produced by the Cabinet Office for those in the public and private sector responsible for contingency planning. It gives basic information on the decontamination and remediation that may be required following a deliberate or accidental release of CBRN (chemical, biological, radiological or nuclear) materials.

AAGBI calls for a change to the culture around night shift working

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) sets out its three-point plan to address the culture surrounding doctor fatigue in hospitals and tackle the problem of excessive fatigue, which is known to impair decision making, with consequences for both doctors and their patients.

1. Support publication of a national survey about junior doctor fatigue, covering accessibility of hospital rest facilities, commuting after working night shifts and the impact of fatigue on physical and psychological health.
2. Roll out of a fatigue education programme informing doctors and their managers about fatigue and how they can reduce its risks.
3. Defining the standards for adequate rest facilities and cultural attitudes towards rest in hospitals.

Displaying referral to treatment data

An example of how NHS staff can display referral to treatment (RTT) data to identify and predict performance issues, and react to them in a timely way.

National Diabetes Foot Care Audit Report 2014-2016

The National Diabetes Foot Care Audit (NDFA) is a measurement system of care structures, patient management and outcomes of care for people with active diabetic foot disease.

Key messages

• Structures – The basic framework for effective prevention and management of diabetic foot disease is often missing. 
• Processes – People with new foot ulcers who get to the specialist foot care service quickly, do best
•  Outcomes – Six months after first expert assessment one third of people still have unhealed ulcers. 

National Diabetes Inpatient Audit England and Wales, 2016

The National Diabetes Inpatient Audit (NaDIA) measures the quality of diabetes care provided to people with diabetes while they are admitted to hospital whatever the cause, and aims to support quality improvement

Together For Health – A Neurological Conditions Delivery Plan

This document from NHS Wales is designed to develop and improve services for people with neurological conditions. It focuses on meeting population need, tackling variation in access to services and reducing inequalities across seven themes:

• Raising awareness of neurological conditions
• Timely diagnosis of neurological conditions
• Fast and effective care
• Living with a neurological condition
• Children and young people
• Improving information
• Targeting research

Medicines optimisation dashboard update

The quarterly refresh of the Medicines Optimisation dashboard has now been completed. Data from the dashboard can be used to help develop plans to ensure that all patients achieve the best possible outcomes from their treatment.

The Medicines Optimisation dashboard page of NHS England’s website contains more information about how medicines optimisation is aligned to NHS RightCare.

ENDURALIFE powered CRT-D devices for treating heart failure

New Medical Technologies Guidance from NICE on ENDURALIFE-powered CRT-D devices for treating heart failure.

NICE gets go-ahead to fast-track more drug approvals

The changes to the NICE drug evaluation process will see the introduction of a new fast-track option for appraising treatments which offer exceptional value for money. The aim is for them to be available to patients a month after they are licensed.

Others include:

• A budget impact test, where drugs that will cost more than £20m in any one of their first three years of use will trigger commercial discussions between the company and NHS England to mitigate the impact on the rest of the NHS.
• Where agreement to minimise the impact of those drugs cannot be reached, NHS England will be able to choose to apply to NICE for an extended period in which to introduce the drug in a phased way. This will usually be for no more than three years.
• Drugs for very rare diseases will be evaluated against a sliding scale, so that the more the medicine costs the greater the health benefit it must provide in order to be approved for routine NHS use by NICE.

CEU Clinical Guidance: Emergency Contraception

This document updates previous Faculty of Sexual & Reproductive Healthcare (FSRH) guidance and aims to summarise the available evidence on emergency contraception (EC). The guidance is intended for use by health professionals providing EC.

A computational method for three-dimensional reconstruction of the microarchitecture of myometrial smooth muscle from histological sections

PLoS One. 2017 Mar 16;12(3):e0173404. doi: 10.1371/journal.pone.0173404. eCollection 2017.

The fibrous structure of the myometrium has previously been characterised at high resolutions in small tissue samples (< 100 mm3) and at low resolutions (∼500 μm per voxel edge) in whole-organ reconstructions. However, no high-resolution visualisation of the myometrium at the organ level has previously been attained.

We have developed a technique to reconstruct the whole myometrium from serial histological slides, at a resolution of approximately 50 μm per voxel edge

UHCW Research: S James

Control of Asbestos Regulations 2012: post implementation review

This HSE review examines how the Control of Asbestos Regulations 2012 are working.

Reshaping the workforce to deliver the care patients need

This research report from the Nuffield Trust argues that there is an urgent need to rethink the nature of the NHS workforce if new care models are to succeed in meeting the needs of patients in the future.

Child vision screening resources consultation

The UK National Screening Committee (UK NSC) recommends school-entry screening for vision problems. Until now, however, no national resources have existed to support local authorities in commissioning and delivering high quality, consistent services.

Public Health England (PHE) therefore convened a vision screening group to produce and disseminate such materials and have now released a consultation seeking views on these.

The consultation is open for six weeks and the closes on 25 April 2017.

Information and Digital Technologies Clinical Requirements 2020

This AoMRC report looks at the use of data and technology in healthcare and concludes that uptake has been slow. It finds that there is now an increasing focus on learning how to use technologies to improve delivery of care for patients. This document aims to ensure that clinical priorities are met and reflected at a national level.

Enhancing junior doctors' lives

A comprehensive update report has been published by Health Education England highlighting the progess made by Health Education England to enhance juniors doctors’ working lives

Common concerns involved issues that sat outside the contract itself and included: lack of timely information about rotations and on-call duties; different interpretations of the many rules around flexibility in training; and the rising costs of developing as a professional.

Hepatitis C in England 2017 report

This report from Public Health England concludes that the UK was well placed to meet WHO GHSS goals to reduce HCV-related morbidity and mortality, yet more needed to be done to reduce the persistently high numbers who remain undiagnosed and to reduce the number of new infections.

NHS prescription charges from April 2017

The prescription charge will increase by 20 pence from £8.40 to £8.60 for each medicine or appliance dispensed. The cost of the prescription prepayment certificates (PPCs) for another year. The 3 month PPC remains at £29.10 and the cost of the annual PPC will stay at £104, allowing unlimited prescriptions within a specified time period.

Estimating The Economic Burden Of Respiratory Illness In The UK

This report from the British Lung Foundation finds that lung disease costs the economy £11 billion every year. Of this, almost £10 billion is spent on direct costs to the NHS: GP appointments, time in hospital, treatments and medication. It calls for the government to support the first ever taskforce for lung health.

Health and Social Care Funding – Interim Report

An interim report sharing progress of findings from an independent panel of healthcare experts on solutions to the health and social care crisis.

A panel of a independent specialists with extensive experience in the fields of health, social care and health economics are working to develop a response to the funding crises facing health and social care service in the UK. The panel were brought together by Shadow Health Secretary, Norman Lamb MP, to provide a view on the financial problems facing health and social care and provide possible solutions to them.

Winning projects announced for latest round of Maternity Challenge Fund

Three projects are each being awarded £50,000 by NHS England to explore innovative ways to use women’s and their partners’ feedback to improve maternity services.

The winning trusts are: Gloucester Hospitals NHS Foundation Trust; Southport and Ormskirk Hospital NHS Trust; and Northumbria Healthcare NHS Foundation Trust.

Physicians worried about future patient safety, whistleblowing and rota gaps

A new survey from the Royal College of Physicians shows that 74% of physicians are worried about the ability of their service to deliver safe patient care in the next 12 months.

The survey results are published in NHS reality check: Delivering care under pressure

Research highlights the challenges of preventing diabetes with group education sessions

In people at high risk of type 2 diabetes, the educational programme ‘Let’s prevent’ had minimal impact on blood sugar control, and cholesterol. Overall it did not prevent people developing diabetes, though the risk was reduced for the 29% of people who attended all three sessions.

From the NIHR Dissemination Centre

Immunoglobulin: when to use

PHE's immunoglobulin handbook, providing guidance on administering immunoglobulin to prevent serious disease.

Ambition to halve healthcare associated Gram-negative bloodstream infections/CDI objectives update

NHS Improvement will lead a national programme to halve healthcare associated Gram-negative bloodstream infections by March 2021. This letter provides an overview of the programme and the offer we will soon launch to the health sector to achieve this ambition.

Organisations are contractually obliged to ensure no more than a set number of CDIs occur in a financial year. This guidance sets out how those thresholds are calculated and set, and provides details of each organisation’s 2017/18 threshold.

Small bore connectors: an introduction to safe use

From April 2017, new safety connectors for neuraxial equipment will become available in the NHS. These connectors are used for devices including spinal needles, neuraxial syringes, epidural catheters and filters.

National Guidance on Learning from Deaths

Guidance from NHS England to help standardise and improve the way acute, mental health and community Trusts identify, report, review, investigate and learn from deaths, and engage with bereaved families and carers.

Urgent care needs to undergo a channel shift

STPs will want to understand how they can prioritise their local investment to maximise return in terms of activity, system efficiency and the potential for financial savings that can be reinvested in services.

As part of its Urgent and Emergency Care Review, NHS England aims to connect all UEC services together so the overall system becomes more than just the sum of its parts.

The current reality is that much UEC activity is not taking place in the setting that is right for the patient and most efficient for the NHS. The interventions the UEC review has set out are intended, when taken collectively, to help shift care to the most appropriate setting.

The channel shift model is now available to be populated by local footprints using their local data, supported by a comprehensive user guide.

The channel shift model toolkit and user guide will help commissioners to plan strategically and facilitate service design. They set out 16 intervention models which include ambulatory emergency care, co-location of urgent care centres, GP extended hours, care homes falls response training and Rapid response services.

NHS efficiency map updated

The HFMA and NHS Improvement have worked in partnership to update and revise the NHS efficiency map. The map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency.

Don't hide mental health issues

The invisible nature of mental health problems, the fact that they do not show up on an x-ray, that no blood test can diagnose depression, underlies much of the discrimination people with mental health issues face. Humans are strongly predisposed to believe in what they can see. For many people, it is hard to accept that severe anxiety, for example, might incapacitate someone from leaving their house as genuinely as if they were suffering from a physical paralysis. The fact that the problem cannot be seen makes it easier to dismiss. They could, if they really wanted to; they’re just not trying hard enough; everyone gets stressed sometimes, and so on. Of course, the help a person with anxiety needs to enable them to leave the house will be different from that of a person with a physical disability, but that doesn’t make the need any less real. Read more HERE.

Heart disease and depression combination

New research has discovered that depression is the strongest predictor of death in the first decade following a diagnosis of coronary heart disease.

Investigators at the Intermountain Medical Center Heart Institute in Salt Lake City will present their results at the American College of Cardiology’s 66th Annual Scientific Session in Washington, D.C.

They found people with coronary heart disease who are diagnosed with depression are about twice as likely to die compared with those who are not diagnosed with depression.

Warning over 'neglected' elderly mental health services

The president elect of the Royal College of Psychiatrists has warned mental health services for older people are being “neglected” and she will make a priority for the college.
 
In an interview with HSJ, Wendy Burn said while a lot of good work had been done with older patients with dementia, those with mental health problems such as depression and anxiety needed more specialist support.

Wendy Burn takes over as president of the Royal College of Psychiatrists in June

Dr Burn, a consultant old age psychiatrist, was elected as the college’s 15th president in January and will succeed Professor Sir Simon Wessely in June for a three year term. She said older people have massive mental health needs that require specialist rather than general interventions.

Public health working with the voluntary, community and social enterprise sector: new opportunities and sustainable change

The case studies in this report show how public health and the voluntary, community and social enterprise sector (VCSE) are working together to make a real difference to people's health and wellbeing. The case studies demonstrate how harnessing the skills, enthusiasm and expertise of VCSE organisations and volunteers can help to improve population health and reduce health inequalities.

• Report
• LGA publications

Report on the risk assessment of methyl 2-[[1-(cyclohexylmethyl)-1H-indole-3- carbonyl]amino]-3,3-dimethylbutanoate (MDMB-CHMICA) in the framework of the Council Decision on new psychoactive substances

This risk assessment report presents the summary findings and the conclusion of the risk assessment carried out by the extended Scientific Committee of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on the new psychoactive substance methyl 2-[[1-(cyclohexylmethyl)-1H-indole-3-carbonyl]amino]-3,3-dimethylbutanoate, commonly abbreviated to MDMB-CHMICA. The report is intended for policy makers and decision makers in the institutions of the European Union.

Narcolepsy with or without cataplexy in adults: pitolisant

New Evidence Summary form NICE:

Narcolepsy is a rare, disabling long‑term brain disorder that can result in excessive daytime sleepiness, sleep attacks, cataplexy, sleep paralysis, excessive dreaming and disturbed nocturnal sleep.

This evidence summary reviewed 2 small randomised controlled trials (RCTs) of pitolisant 5–40 mg per day in adults with narcolepsy with or without cataplexy. Compared with placebo, pitolisant improved excessive daytime sleepiness, improved time awake in a darkened room and reduced the weekly cataplexy rate. Pitolisant was also compared with modafinil in a non-inferiority analysis (an analysis designed to test if it was not worse than modafinil for improving excessive daytime sleepiness by a pre-specified amount). Non-inferiority to modafinil was not shown.

Patients’ needs must be central to negotiations on Brexit

The Royal College of Radiologists (RCR) calls on the Government to put patients and their carers at the heart of negotiations on exiting the European Union:

• The UK must continue to have access to a European licensing process for new medical treatments. 
• Patients and their doctors must continue to have the same level of access to clinical trials through European trials governance rules. 
• There must be continued free movement of medical professionals to avoid worsening the situation in medical specialties that are already on the National Shortage Occupation List and which include clinical radiology. 
• The planned Immigration Skills Charge4 of £1000 per year on the NHS for each worker coming to the UK from outside the European Union should be scrapped.
• There should be legal assurance of the rights of EU citizens in the UK including their free access to NHS care. 

Guidance for handling medicolegal samples and preserving the chain of evidence (2e)

Updated guidance from the Royal College of Pathologists.

GPAS 2017 updates

The Royal College of Anaesthetists has updated its Guidelines for the Provision of Anaesthesia Services (GPAS).

The 2017 edition includes a further five chapters that have been developed using the College’s NICE-accredited process for chapter development. These are:

• Guidelines for the Provision of Paediatric Anaesthesia Services
• Guidelines for the Provision of Anaesthesia Services for an Obstetric Population
• Guidelines for the Provision of Ophthalmic Anaesthesia Services
• Guidelines for the Provision of Anaesthesia Services for Burn and Plastics Surgery 
• Guidelines for the Provision of Anaesthesia Services for Intra-operative Care

More undergraduate medical education places

The expansion of undergraduate training places aims to increase the home-grown medical workforce by 25%. Currently more than 6,000 university training places are available each year for prospective new doctors. This will increase by up to 1,500 each year from September 2018.

It costs £230,000 to train a doctor in England and proposals set out in a consultation include plans to obtain a return on this investment. The proposals include newly trained medics serving a minimum term with the NHS, with those who leave before this time is up having to repay some of the fees that the NHS invests in them.

Domestic abuse: a resource for health professionals

New guidance from the Department of Health to help all NHS staff and allied healthcare partners in their response to victims of domestic violence and abuse.

Understanding NHS financial pressures: how are they affecting patient care?

This King's Fund report examines the impact of NHS financial pressures on patient care across four different parts of the health system: genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal services.

Understanding Devolution: A Critical Appraisal Of The Greater Manchester Devolution Deal

This paper from the New Economics Foundation presents an assessment of the devolution process in Greater Manchester so far and highlights key issues for consideration for future devolved local areas.

RNIB pilots self-advocacy initiative for eye patients to prevent sight loss

RNIB (Royal National Institute of Blind People) is trialling a patient self-advocacy project in partnership with The Royal College of Ophthalmologists, the Macular Society and International Glaucoma Association.

Ask & Tell encourages patients to ask their eye doctor when their next appointment should be and to tell reception staff so it is kept.

Ask & Tell also creates awareness with reception and administration staff in eye clinics about the importance of follow up appointments to avoid preventable sight loss. During the six month pilot, patients can access a range of Ask & Tell resources and information online and in the eye clinic to support them to look after their sight.

Eight elements of workplace wellbeing

A new poster and web section has launched by NHS Employers to show the eight elements that are critical to delivering a robust and effective health and wellbeing offer for your staff.

Key behaviours	Actions
Leadership	Know your data
Shared strategic vision	Prevention
Engagement	Intervention
Communication	Evaluate and act