NHS could face bill of over half a billion pounds from Brexit

A new briefing from the Nuffield Trust shows the NHS could face large costs if retired British people living in other EU countries decide to return to UK in the event of their healthcare being withdrawn after Brexit.

Improving quality and safety in healthcare

Providers that have been rated 'good' for safety by the Care Quality Commission (CQC) show how they are improving quality and safety in their organisations.

Severe Sepsis and Septic Shock: Clinical Audit 2016/17

This Royal College of Emergency Medicine audit shows an improvement in the proportion of patients receiving the best care for severe sepsis and septic shock, but that improvements are needed to make treatment available faster.

Stroke in Childhood: Clinical guideline for diagnosis, management and rehabilitation

Stroke in Childhood 2017 is a nationally developed evidence-based clinical guideline, from the RCPCH, for all UK paediatricians and healthcare professionals involved in the regulation or practice of the care of children and young people who have had or are suspected of having a stroke.

What does the public think about NHS and social care services?

The Health Foundation commissioned Ipsos MORI to do a survey of the general public in Great Britain on their views about funding of the NHS, as well as the provision of NHS and social care services.  Key findings include:

• Protecting the NHS from cuts is important to the majority of the general public.
• Nearly two-thirds of people think that taxes should be increased to fund the NHS.
• Nine in 10 people (88%) agree that the NHS should be tax funded, free at the point of use, and provide comprehensive care for all citizens.
• Only 12% of people think the general standard of NHS care has improved over the past year.
• While almost a third of people (30%) don’t have a preference for where they receive NHS-funded care (ie from an NHS or non-NHS provider), there has been an increase in the number of people preferring to go to an NHS-provided service.
• Half of respondents (50%) think the NHS often wastes money.

Election briefing: A sustainable workforce

This is the third in a series of Health Foundation briefings ahead of the June 2017 general election. It focuses on the fundamental challenges facing the NHS and social care workforce in England, pointing to a combination of issues around recruitment, retention and morale.

UK audit of quantitative thyroid uptake imaging

Nuclear medicine communications (April 27, 2017).

A national audit of quantitative thyroid uptake imaging was conducted by the Nuclear Medicine Software Quality Group of the Institute of Physics and Engineering in Medicine in 2014/2015. The aims of the audit were to measure and assess the variability in thyroid uptake results across the UK and to compare local protocols with British Nuclear Medicine Society (BNMS) guidelines.

UHCW Research: J. Cullis

Balloon Eustachian tuboplasty treatment of longstanding Eustachian tube dysfunction

The Journal of Laryngology & Otology, DOI: https://doi.org/10.1017/S0022215117000974. Published online: 15 May 2017

To evaluate the subjective and objective outcomes of balloon dilation Eustachian tuboplasty in patients with recurrent, previously treated chronic Eustachian tube dysfunction.

UHCW Research: T Singh, V Taneja, K Kulendra, M Farr, J Robinson and D Rejali 

Prophylaxis of postoperative endophthalmitis after cataract surgery

Expert Review of Ophthalmology Volume 12, 2017 - Issue 3 Pages 261-268

Endophthalmitis is a rare but an extremely serious complication of intraocular surgery. We have summarized, in a single flowchart, a pragmatic list of important prophylactic preoperative, intraoperative and postoperative steps for preventing this devastating complication and provide effective and safe prophylaxis.

UHCW Research: Akshatha Ranganath and Atul Bansal

Prevalence and associations of obstructive sleep apnea in South Asians and White Europeans with type 2 diabetes: a cross-sectional study

Journal of Clinical Sleep Medicine. 13 (4) (pp 583-589), 2017.

Objective was to assess and compare obstructive sleep apnea (OSA) prevalence in South Asians and White Europeans with type 2 diabetes mellitus (T2DM). Secondary aims included exploring possible causes for observed ethnic differences.

UHCW Research: Ali, A.

Multiple roles of glyoxalase 1-mediated suppression of methylglyoxal glycation in cancer biology-Involvement in tumour suppression, tumour growth, multidrug resistance and target for chemotherapy

Seminars in Cancer Biology. (no pagination), 2017. Date of Publication: February 28, 2017.

Glyoxalase 1 (Glo1) is part of the glyoxalase system in the cytoplasm of all human cells. It catalyses the glutathione-dependent removal of the endogenous reactive dicarbonyl metabolite, methylglyoxal (MG). MG is formed mainly as a side product of anaerobic glycolysis. It modifies protein and DNA to form mainly hydroimidazolone MG-H1 and imidazopurinone MGdG adducts, respectively. Abnormal accumulation of MG, dicarbonyl stress, increases adduct levels which may induce apoptosis and replication catastrophe. In the non-malignant state, Glo1 is a tumour suppressor protein and small molecule inducers of Glo1 expression may find use in cancer prevention. Increased Glo1 expression is permissive for growth of tumours with high glycolytic activity and is thereby a biomarker of tumour growth. High Glo1 expression is a cause of multi-drug resistance. It is produced by over-activation of the Nrf2 pathway and GLO1 amplification. Glo1 inhibitors are antitumour agents, inducing apoptosis and necrosis, and anoikis. Tumour stem cells and tumours with high flux of MG formation and Glo1 expression are sensitive to Glo1 inhibitor therapy. It is likely that MG-induced cell death contributes to the mechanism of action of current antitumour agents. Common refractory tumours have high prevalence of Glo1 overexpression for which Glo1 inhibitors may improve therapy.

UHCW Research:. M. O. Weickert

Improving The Wellbeing of People with Opioid Treated Chronic Pain – The I-Wotch Study Protocol

BJP ASM Poster Abstracts 2017. First Published May 3, 2017 

I-WOTCH will evaluate the effectiveness and cost effectiveness of a patient-centred multicomponent self-management intervention for people living with chronic non-malignant pain, that targets withdrawal of strong opioids on activities of daily living and opioid related adverse events.

UHCW Research: Shyam Balasubramanian

Developing A Complex Multi-Modal Self-Management Behaviour Change Intervention: Theories, Processes and Materials

BJP ASM Poster Abstracts 2017. First Published May 3, 2017 

 
The Improving the Wellbeing of people with Opioid-Treated CHronic pain (I-WOTCH) study aims to enable those with persistent non-malignant pain to self-manage their pain better, reduce opioid use and improve their quality of life. We report the complex intervention-development approaches, the pilot process evaluation, and the patient-facing material required.

UHCW Research: Shyam Balasubramanian

Catheter-free nephrectomy: A safe change to routine practice

Journal of Clinical Urology.  First Published May 26, 2017 

The aim of this article is to assess any difference in length of stay (LOS), complications and readmission rates between patients who had catheter-free nephrectomy compared to those who had a catheter inserted as routine peri-operatively.

UHCW Research: E. F. Zimmermann.

Maternal feeding practices and children's eating behaviours: A comparison of mothers with healthy weight versus overweight/obesity

Appetite, Volume 116, 1 September 2017, Pages 395–400. doi.org/10.1016/j.appet.2017.05.033

This study aimed to explore differences between mothers with healthy weight versus overweight/obesity in a wide range of their reported child feeding practices and their reports of their children's eating behaviours. Mothers (N = 437) with a 2-6-year-old child participated. They comprised two groups, based on their BMI: healthy weight (BMI of 18.0–24.9, inclusive) or overweight/obese (BMI of 25.0 or more). All mothers provided demographic information and completed self-report measures of their child feeding practices and their child's eating behaviour. In comparison to mothers with healthy weight, mothers with overweight/obesity reported giving their child more control around eating (p < 0.001), but encouraged less balance and variety around food (p = 0.029). They also had a less healthy home food environment (p = 0.021) and demonstrated less modelling of healthy eating in front of their children (p < 0.001). There were no significant differences in mothers' use of controlling feeding practices, such as pressure to eat or restriction, based on their own weight status. Mothers with overweight/obesity reported their children to have a greater desire for drinks (p = 0.003), be more responsive to satiety (p = 0.007), and be slower eaters (p = 0.034). Mothers with overweight/obesity appear to engage in generally less healthy feeding practices with their children than mothers with healthy weight, and mothers with overweight/obesity perceive their children as more avoidant about food but not drinks. Such findings are likely to inform future intervention developments and help health workers and clinicians to better support mothers with overweight/obesity with implementing healthful feeding practices and promoting healthy eating habits in their children.

UHCW Research:Caroline Meyer

Endoscopic full thickness removal of non-lifting colonic polyps

Interventional Procedures Guidance from NICE on endoscopic full thickness removal of non-lifting colonic polyps. This involves using a special device to remove the polyp and seal the bowel wall closed afterwards.

HSJ Value in Healthcare Awards 2017: Emergency, Urgent & Trauma Care

In November 2014 Sherwood Forest Hospitals was the second to the bottom in the ED four-hour target performance in England. The ED department had been rated as ‘inadequate’ for safety in 2015 and the trust had 17 patients breach 12 hours during December 2014 and January 2015.

The trust recognised that this was not just a problem for ED to solve and so created the Emergency Flow Programme, which is organisation wide.

Cancer Registration Statistics, England: 2015

Cancer diagnoses and age-standardised incidence rates for all cancer sites by age, sex and region.

An investigation into the potential role of brain angiogenesis inhibitor protein 3 (BAI3) in the tumorigenesis of small-cell carcinoma: a review of the surrounding literature

J Recept Signal Transduct Res. 2017 May 24:1-10. doi: 10.1080/10799893.2017.1328441. [Epub ahead of print]

Brain angiogenesis inhibitor protein 3 (BAI3) is from the adhesion group of seven-transmembrane spanning G protein-coupled receptors (GPCRs) and has been identified via gene expression profiling as being upregulated in small-cell lung cancer (SCLC) tumors. It has subsequently been validated as a sensitive and specific immunohistochemical marker for SCLC, helping to differentiate these tumors from morphologically similar large-cell neuroendocrine (LCNEC) malignancies. It is, however, still unclear as to the role BAI3 proteins might play in SCLC and indeed how they might contribute to tumorigenesis. Interestingly, the pattern of staining observed on immunohistochemistry was in fact nuclear as opposed to the membranous staining pattern expected of transmembrane-bound molecules. This fact has lead the authors to believe that the protein receptor is structurally altered in SCLC and that this modification may confer different behavioral properties that contribute toward tumorigenesis. Nuclear localization is not unique to BAI3 and has been reported in a number of GPCRs and frequently correlates with survival outcomes. BAI3 has the potential to act as target for pharmaceutical intervention inline with developing trends in molecular pathology aiming to provide personalized, treatment regimes based on tumor-specific mutation profiles. The adhesion group of the GPCR superfamily is still poorly understood. We present a review of the existing literature regarding the role they play in both physiological and disease states and the mechanisms by which they influence a range of cellular processes.

UHCW Research: Thomas, N. and Snead, D.

Microbiological problems and biofilms associated with Mycobacterium chimaera in heater-cooler units used for cardiopulmonary bypass

J Hosp Infect. 2017 Apr 26. pii: S0195-6701(17)30228-1. doi: 10.1016/j.jhin.2017.04.014. [Epub ahead of print]

The role of heater-cooler units (HCUs) in the transmission of Mycobacterium chimaera during open heart surgery has been recognized since 2013. Subsequent investigations uncovered a remarkable global outbreak reflecting the wide distribution of implicated devices. HCUs are an essential component of cardiopulmonary bypass operations and their withdrawal would severely affect capacity for life-saving cardiac surgery. However, studies have demonstrated that many HCUs are contaminated with a wide range of micro-organisms, including M. chimaera and complex biofilms. Whole genome sequencing of M. chimaera isolates recovered from one manufacturer's HCUs, worldwide, has demonstrated a high level of genetic similarity, for which the most plausible hypothesis is a point source contamination of the devices. Dissemination of bioaerosols through breaches in the HCU water tanks is the most likely route of transmission and airborne bacteria have been shown to have reached the surgical field even with the use of ultraclean theatre ventilation. Controlling the microbiological quality of the water circulating in HCUs and reducing biofilm formation has been a major challenge for many hospitals. However, enhanced decontamination strategies have been recommended by manufacturers, and, although they are not always effective in eradicating M. chimaera from HCUs, UK hospitals have not reported any new cases of M. chimaera infection since implementing these mitigation strategies. Water safety groups in hospitals should be aware that water in medical devices such as HCUs may act as a vector in the transmission of potentially fatal water-borne infections.

UHCW Research: L. Dawkin

Buprenorphine for managing opioid withdrawal

Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of substitution treatment.

This Cochrane Systematic Review's objective was to assess the effects of buprenorphine versus tapered doses of methadone, alpha2-adrenergic agonists, symptomatic medications or placebo, or different buprenorphine regimens for managing opioid withdrawal, in terms of the intensity of the withdrawal syndrome experienced, duration and completion of treatment, and adverse effects.

New workforce supply resource from NHS Employers

The resource has been set up to help organisations consider the political and social context they are employing staff in, and to develop a workforce strategy that is wide ranging, yet achievable. It addresses the challenges employers face in terms of planning for educating, recruiting, developing and retaining their staff.

What are STPs and why do they matter?

Chris Ham, CEO of the King's Fund has written this article which examines STPs and how their success is important to the future shape and well-being of the NHS. It suggests STPs need to strengthen their leadership and governance and ensure they have the capacity and capability to implement their proposals; NHS England and NHS Improvement need to work together to oversee STPs; and the scope of STPs needs to be narrowed to focus on the most important priorities in each area of England

How to support integration to promote care for people with multimorbidity in Europe?

The complex care needs of people with multimorbidity heighten the demand for integrated care. This European Observatory on Health Systems and Policies' policy brief identifies the most promising service arrangements for integrated care and examines how to support coordination and promote collaboration between care professionals and, strengthen professional competencies.

Sepsis: quality standard Draft for consultation

This DRAFT quality standard on sepsis from NICE is expected to contribute to improvements in rates of mortality, long-term disability, and organ failure, and in length of hospital or ICU stay in people with sepsis.

Infant formulas containing hydrolysed protein for prevention of allergic disease and food allergy

Allergy is common and may be associated with foods, including cow's milk formula (CMF). Formulas containing hydrolysed proteins have been used to treat infants with allergy. However, it is unclear whether hydrolysed formulas can be advocated for prevention of allergy in infants.

To compare effects on allergy and food allergy when infants are fed a hydrolysed formula versus CMF or human breast milk. If hydrolysed formulas are effective, to determine what type of hydrolysed formula is most effective, including extensively or partially hydrolysed formula (EHF/PHF). To determine which infants at low or high risk of allergy and which infants receiving early, short-term or prolonged formula feeding may benefit from hydrolysed formulas.

Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis.

Cochrane Systematic Review to determine the effectiveness of interventions that promote Shared Decision Making for children and adolescents with CF aged four to 18 years.

Pharmacological interventions for recurrent abdominal pain in childhood

Between 4% and 25% of school-aged children at some stage complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with their daily lives. When no clear organic cause is found, the children are managed with reassurance and simple measures; a large range of pharmacological interventions have been recommended for use in these children.

There is currently no convincing evidence to support the use of drugs to treat RAP in children. Well-conducted clinical trials are needed to evaluate any possible benefits and risks of pharmacological interventions. In practice, if a clinician chooses to use a drug as a 'therapeutic trial', they and the patient need to be aware that RAP is a fluctuating condition and any 'response' may reflect the natural history of the condition or a placebo effect, rather than drug efficacy.

See also Dietary interventions for recurrent abdominal pain in childhood.

Shared care across the interface between primary and specialty care in management of long term conditions

Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care.

This Cochrane Systematic Review's aim was to determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review.

Mindfulness-focused childbirth education leads to less depression

A new study shows mindfulness training that addresses fear and pain during childbirth can improve women's childbirth experiences and reduce their depression symptoms during pregnancy and the early postpartum period.

Coping after a traumatic event

RCPYSCH are signposting guidance on coping after a traumatic event in light of recent attacks.

Recorded dementia diagnoses, April 2017

NHS Digital collect and publish data about people with dementia at each GP practice, so that the NHS (GPs and commissioners) can make informed choices about how to plan their services around their patients needs.

For the first time this publication includes a dementia diagnosis rate indicator. As not everyone with dementia has a formal diagnosis, this statistic compares the number of people thought to have dementia with the number of people diagnosed with dementia, aged 65 and over.
Please access the diagnosis rate indicator through the online interactive tool HERE.

Social care, the NHS and other services

Adult social care is part of a complex system of services and support – including the NHS. How well the various components of a person’s care are integrated can impact on their personal experience of care. This video explains the importance of different services working together to provide care. This is the fourth and final video in our 'Bite-sized social care' series intended to help explain social care in England: what it is, how it’s provided and paid for, and how it works with the NHS and other services.

• Video

Supporting strategic commissioning: collaborative working between CCGs and AHSNs

This report aims to show how collaboration between CCGs and AHSNs can bring positive benefits to local patients and populations. It recommends that the most successful collaborations between CCGs and AHSNs will be ones that focus on a specific issue rather than on providing more general support. It also states that projects that focus on delivery at scale, will be the most impactful making AHSNs natural partners for commissioners working as a part of an STP.

• Report

Voices of medicine: changes in doctor–patient communication

This article looks at the changing communication strategies between the doctor and the patient over the years.

Royal College of Surgeons & Bowel Cancer UK to invest half a million pounds in bowel cancer surgical research

Bowel Cancer UK, in partnership with the Royal College of Surgeons of England, announce £500,000 funding for bowel cancer surgical research to establish the UK’s first Colorectal Cancer Surgical Research Chair and establish a network of Bowel Cancer UK Colorectal Cancer Surgical Research Fellows.

Risk assessment is key to osteoporosis care, says NICE

Updated guidance sets out priorities for better management of osteoporosis in adults, including assessing risks and preventing bone fragility fractures.

The National Institute for Health and Care Excellence (NICE) quality standard, published in April, says healthcare professionals should consider all options to prevent and treat fractures as part of their care for people with osteoporosis.

Chartered Society of Physiotherapy provides new guidance on fentanyl patches in physiotherapy practice

The CSP has published guidance for members who treat patients who wear transdermal fentanyl patches, which are prescribed to treat severe pain.

The document aims to increase awareness among physiotherapists about potential risks associated with the patches.

It includes a recommendation that physios should carefully monitor patients who wear transdermal patches while having aquatic hydrotherapy.

NHS efficiency map

This map is a tool that aims to promote best practice in identifying, delivering and monitoring cost improvement programmes in the NHS. It contains links to a range of tools and guidance to help NHS bodies improve their efficiency.

• Map

Election briefing : a sustainable workforce - the lifeblood of the NHS and social care

This briefing focuses on the challenges facing the NHS and social care workforce in England, pointing to a combination of issues around recruitment, retention and morale. It highlights that the future workforce for the NHS and social care sector is at risk without urgent action from the incoming government to establish a sustainable and joined up workforce strategy.

• Briefing

Social care: a step forwards or a step backwards?

This briefing examines the manifesto proposals for social care and outlines the current state of social care provision and funding.

• Briefing

NHS Employers announces the Diversity and Inclusion Partners 2017/18

Following a rigorous selection process, 30 NHS organisations have been chosen to be part of our 2017/18 diversity and inclusion partners programme.

The successful organisations are awarded partner status after demonstrating that they are delivering against six measurable criteria:

• improving patient access and experience
• empowered, engaged and well-supported staff
• inclusive leadership at all levels
• better health outcomes for all
• commitment to the partners programme
• their organisation will benefit from taking part in the programme

You can find more information about the 2017/18 diversity and inclusion partners on the partner’s web page.

Latest NHS sickness absence statistics published

The latest figures released by NHS Digital show that NHS staff sickness absence has increased from 4.49 per cent in January 2016 to 4.66 per cent in January 2017.

The data considers sickness absence rates and total days lost supplied by staff groups, Health Education England (HEE) regions and organisations.

New workforce supply resource from NHS Employers

NHS Employers has developed a range of new workforce supply web pages to support healthcare employers.

Employers in the NHS are keen to work together to address one of their biggest conundrums: how to plan a workforce that meets the changing demands of our population. NHS Employers are committed to helping you to develop a workforce which is big enough, and one which is skilled, adaptable, engaged and healthy.

The new web resource is set up to help you to consider the political and social context you’re working in, and to develop a workforce strategy that is wide ranging, yet achievable. It addresses the challenges employers face in terms of planning for, educating, recruiting, developing and retaining their staff.

Visit the new workforce supply web pages to access guidance on effective employment practice and education policy.

GMC unveils new standards to boost flexibility of doctors' training

New standards to make postgraduate training more flexible for doctors have been unveiled by the General Medical Council (GMC).

The standards, detailed in a new document Excellence by design: standards for postgraduate curricula, provide a framework for the approval and provision of postgraduate medical education and training across the UK.

NHS estates. Review of the evidence

The government considers the NHS estates to have a key role in delivering efficiency, and in supporting the transformation of services set out in the NHS five year forward view. To enable the estates to fulfil this role, the government is intending to develop a long-term strategy for their use. As a first step, it has commissioned Sir Robert Naylor to undertake an independent review of NHS estates and property.

New report reveals the value of occupational health for the UK workforce

A new report Occupational health: the value proposition published by the Society of Occupational Medicine sets out the importance of occupational health services and the benefit they can bring.

The report looks at the value that occupational health services can give in reducing long term sickness and promoting a healthy workplace culture. In the UK in 2015/16, an estimated 25.9 million working days were lost due to work-related illness, while an estimated 4.5 million days were lost due to workplace injury.

Proper Planning Prevents…NHS cyber attack

What lessons can be taken for future major incident planning from the NHS cyber attack? Helen Buckingham reflects and reports back from our New Cavendish Group.

Contributing surgeons and centres must validate their cataract audit data on the NOD audit website before 1 June 2017

From the Royal College of Ophthalmologists:

Following the analysis of the first prospective audit data collected on cataract operations from 1 September 2015 to 31 August 2016, contributing surgeons and centres will be able to view their data on the NOD audit website prior to inclusion in the Audit annual report and the Clinical Outcomes Publication.

The NOD team encourages all contributing surgeons and centres to check their data by 1 June 2017, ahead of the report publication. Please inform as many of your colleagues as possible to check their individual data on the NOD audit website.

Simulated Ocular Surgery (SOS) hosts dedicated RCOphth channel on forthcoming Simulation Gallery website

The Royal College of Ophthalmologists is pleased to announce that Simulated Ocular Surgery (SOS) has agreed to host a dedicated RCOphth channel on their new Simulation Gallery website will launch on 22 May 2017.

We are inviting trainees and trainers to submit digital recordings of surgical techniques for both whole and sections of operations.  These will be hosted on the RCOphth channel which is expected to be a showcase for exemplars of simulated and real-life surgery.  Submissions will be reviewed for consideration by a team of reviewers lead by Professor Stephen Vernon VP.

Surgeons call for review of private sector transparency and safety standards

Following Ian Paterson’s abhorrent actions, the President and Vice-Presidents of the Royal College of Surgeons (RCS) have issued an open letter today (Wednesday 17 May) reassuring the public that rogue doctors should now be caught by modern rules governing medical practice. However, they warn there is no room for complacency and the RCS today calls for a review by the next Government of how safety standards and transparency can improve, particularly in the private sector.

In UK, Online Self-Help Tool Aids Bipolar Parents

A new U.K. study finds that online self-management support for parents with bipolar disorder leads to improvements in parenting and child behavior.

Researchers from the Spectrum Centre for Mental Health Research at Lancaster University recruited 97 parents with bipolar disorder who have children aged between three and ten years old.

Focus on mental health at Malvern College

MALVERN College is to host a second annual conference for school leaders of primary and preparatory schools on mental health. 

The talk in September will feature experienced educationalists from Malvern College and ‘The Self Esteem Team’ who have advised government and over 300 schools.

They will present the latest well-being strategies which nurture a positive and proactive school culture and help children establish firm foundations for a successful education and a fulfilling adulthood.

More information can be found at malverncollege.org.uk/conferences 

How food can improve your mental health

Approximately one in four of us will experience a mental health problem each year in England.

As part of our fight against this, we have a very much underutilised tool - food.

Food and mental health is discussed in BBC One's Doctor in the House

Provision of community care: who, what, how much?

This briefing analyses information on the community care contracts held by 78 per cent of CCGs in England to enable better understanding of the provision of these services. It finds that NHS providers hold more than half of the total annual value of contracts in the sample, while private providers held 5 per cent of the total annual value, but 39 per cent of the total number of contracts issued.

• Briefing

New standards for pharmacy professionals come into effect

All pharmacy professionals in Great Britain will have to meet new standards for pharmacy professionals. These came into effect on 12th May.  The nine standards describe how safe and effective care is delivered through person-centred professionalism, and replace the standards of conduct, ethics and performance.

Severe Mental Illness Linked to Increased Risk for Cardiovascular Disease

An international study of more than 3.2 million people with severe mental illness has revealed a substantially increased risk for developing cardiovascular disease compared to the general population.

Led by King’s College London, the research shows that people with severe mental illness (SMI), including schizophrenia, bipolar disorder, and major depression, have a 53 percent higher risk for having cardiovascular disease, with a 78 percent higher risk of developing cardiovascular disease over the longer term.

Anorexia May Have Both Psychiatric, Metabolic Roots

Scientists have identified the first genetic locus for anorexia nervosa and have discovered that the eating disorder may be partially tied to metabolic factors associated with type I diabetes and autoimmune disorders.

A genetic locus refers to the location or “address” on a chromosome whereby a gene for a particular trait is located.

This powerful genetic study was conducted by the Psychiatric Genetics Consortium Eating Disorders Working Group, an international collaboration of researchers at multiple institutions worldwide. It involved a genome-wide analysis of DNA from 3,495 individuals with anorexia nervosa and 10,982 unaffected individuals.

Mental health and new care models

While some of the vanguard sites developing new care models report promising early results from adopting a whole-person approach, the full opportunities to improve care through integrated approaches to mental health have not yet been realised. 

This report draws on our recent research with vanguard sites in England, conducted in partnership with the Royal College of Psychiatrists. We found that where new models of care have been used to remove the barriers between mental health and other parts of the health system, local professionals saw this as being highly valuable in improving care for patients and service users. But there remains much to be done to fully embed mental health into integrated care teams, primary care, urgent and emergency care pathways, and in work on population health.

Virtual Dementia Clinics

Dementia diagnosis in Cumbria now four times faster thanks to ‘virtual clinics’

New virtual clinics in the Memory Matters team at Cumbria Partnership NHS Foundation Trust means patients suspected of having dementia are able to be diagnosed four times faster than before due to streamlining the dementia diagnosis process.

LEAD-it – Key Outcomes (University Hospitals of Leicester NHS Trust)

The LEAD-it approach to recruitment and retention of medical staff at University Hospitals of Leicester Emergency Department (ED) has made great improvements to patient care and staff morale by employing international medical graduates (IMG’S) who want to learn and expand their knowledge to improve and enhance patient care. The on-going success of the project is measured by the following key outcomes:

• Reduction in the number of vacant training/trust posts.
• Reduction in temporary staff usage lowering premium spend.
• ED productivity improvements
• Reduction in risk to patients (safety), service (targets) & Trust (reputation)
• Improved reputation of ED as a good place to work

Older People in Acute Care Improvement Programme

With the number of older people increasing in our population, the need to ensure that they receive appropriate care in our healthcare system also increases. The ‘Improving Care for Older People in Acute Care’ workstream is a two-year programme to improve the care for older people in acute care. This work complements the scrutiny programme currently taking place to identify strengths and areas for improvements across hospitals in NHS Scotland.

Mental health and community providers - lessons for integrated care

In 2015 a group of nine mental health and community provider NHS trusts came together, hosted by the Mental Health Network (MHN), to share learning and explore how the multispeciality provider model can drive the delivery of integrated mental and physical healthcare.

This briefing explores how mental health and community provider organisations are approaching this challenge and distills the key points and lessons learned from the wide-ranging discussion.

The future of the mental health workforce

Over the last few decades, mental health services have experienced great change in the way that they are designed and delivered. More recent national developments, including The Five Year Forward View and the report of the Mental Health Taskforce, emphasise the need to adopt new models of care, to meet rising demand, and to better integrate the way care is delivered to a population with complex physical and mental health needs. However, resources are limited and workforce development takes time to achieve.

This ongoing project explores, given this context, what the future mental health workforce should look like over the medium to long term (beyond the next five to ten years).

This first discussion paper presents data on the current picture of the workforce and emerging findings from the research to identify the challenges and opportunities that lie ahead for the mental health workforce.

The Confusion Care Pathway

The Confusion Care Pathway has been developed by the dementia/delirium working group at London North West Healthcare NHS Trust as a guide to best practice in supporting people with dementia, delirium and/or cognitive impairment and their carers.

The Burden of Stroke in Europe

The Stroke Alliance for Europe (SAFE) and the Stroke Association have published The burden of stroke in Europe. This report examines the stroke care pathway across Europe. It looks at the burden of stroke, stroke prevention, stroke as a medical emergency, acute stroke care and rehabilitation and longer term support. The report predicts that by 2035 the number of new strokes across Europe is likely to increase by a third.

Standards for the Weighing of Infants, Children and Young People in the Acute Health Care Setting

Publication outlining the RCN's position in relation to the weighing of infants, children and young people and includes guidance on preparing them for weighing, timing and frequency of measurement, record keeping and auditing and benchmarking.

Protecting Your Organisation From Ransomware

This guidance from the National Cyber Security Centre (NCSC) outlines how to prevent a ransomware incident and what to do if your organisation is infect. It suggests simple steps to help organisations prevent a cyber attack. In response to the recent ransomware campaign, the NCSC has also published guidance for IT systems administrators which outlines responses to this specific cyber attack.

• Organisational guidance
• Administrator guidance

EQW2017 - Widening Participation

As part of Equality, Diversity and Human Rights Week, NHS Employers will be focusing on widening participation.

The NHS Employers Widening Participation programme creates a sustainable approach for employers to engage with different community groups. The programme aims to work with employers in the NHS to:

• understand the reasons why the recruitment in the NHS is not representative of the communities it serves
• support employers to change their behaviours and organisational cultures to help widen participation into employment
• provide tools and resources for employers to understand their local opportunities for engaging with and recruiting from community groups
• promote support, advice and guidance available to employers and managers across the NHS to enable local improvement in widening participation.

State of child health: Sustainability and Transformation Partnerships

Following analysis of STPs, this report from the RCPCH, argues that the plans are failing to take into account the needs of infants, child and young people. It finds that while most STPs set out the case for change well and cover important key themes such as prevention, early intervention, more care delivered in the community, better mental health services and integrated working, there is a lack of detail underpinning the vision. It concludes that the lack of profile given to infants, children and young people (who comprise 25 per cent of the UK population) by the majority of STPs, is a cause for concern.

Sodium and Potassium Intake in Healthy Adults in Thessaloniki Greater Metropolitan Area—The Salt Intake in Northern Greece (SING) Study

Nutrients 2017, 9(4), 417; doi:10.3390/nu9040417

A reduction in population sodium (as salt) consumption is a global health priority, as well as one of the most cost-effective strategies to reduce the burden of cardiovascular disease. High potassium intake is also recommended to reduce cardiovascular disease. To establish effective policies for setting targets and monitoring effectiveness within each country, the current level of consumption should be known. Greece lacks data on actual sodium and potassium intake. The aim of the present study was therefore to assess dietary salt (using sodium as biomarker) and potassium intakes in a sample of healthy adults in northern Greece, and to determine whether adherence to a Mediterranean diet is related to different sodium intakes or sodium-to-potassium ratio. A cross-sectional survey was carried out in the Thessaloniki greater metropolitan area (northern Greece) (n = 252, aged 18–75 years, 45.2% males). Participants’ dietary sodium and potassium intakes were determined by 24-hour urinary sodium and potassium excretions. In addition, we estimated their adherence to Mediterranean diet by the use of an 11-item MedDietScore (range 0–55). The mean sodium excretion was 175 (SD 72) mmol/day, equivalent to 4220 (1745) mg of sodium or 10.7 (4.4) g of salt per day, and the potassium excretion was 65 (25) mmol/day, equivalent to 3303 (1247) mg per day. Men had higher sodium and potassium excretions compared to women. Only 5.6% of the sample had salt intake <5 g/day, which is the target intake recommended by the World Health Organization. Mean sodium-to-potassium excretion ratio was 2.82 (1.07). There was no significant difference in salt or potassium intake or their ratio across MedDietScore quartiles. No significant relationships were found between salt intake and adherence to a Mediterranean diet, suggesting that the perception of the health benefits of the Mediterranean diet does not hold when referring to salt consumption. These results suggest the need for a larger, nation-wide survey on salt intake in Greece and underline the importance of continuation of salt reduction initiatives in Greece

UHCW Research: Francesco P. Cappuccio

Presence of complement activating donor specific antibodies is associated with poor renal allograft survival: Two centre retrospective study

American Journal of Transplantation. Conference: 17thAmerican Transplant Congress, ATC2017. United States. 17 (pp 428-429), 2017. Date of Publication:April 2017.

Complement fixing donor specific antibodies (DSA) as detected by presence of C3d at the time of rejection is associated with poor graft outcome;no studies have explored the role pre-transplant; especially in Human leucocyte Antigen-Antibody incompatible transplants (HLA-AIT).
Analysed 117 patient samples either complement dependent cytotoxicity (CDC) or Flow Crossmatch(FC) positive at pre-conditioning who underwent direct transplantation after
desensitisation. C3d (Immucor) assay was performed and the results correlated with early antibody mediated rejection (EAMR) (within first 30 days) and death censored allograft survival (DCGF).

UHCW Research:  Babu, A., Krishnan N., Higgins R. and; Daga S.

Can pre-treatment cdc titres predict graft outcomes in HLA incompatible transplants?

American Journalof Transplantation. Conference: 17th American Transplant Congress, ATC2017. United States. 17 (pp 411), 2017. Date of Publication: April 2017.

Complement Dependent Cytotoxic (CDC) (non-augmented) cross matching and Flow cytometric (FC) cross matching are two commonly used techniques to identify anti-Human Leucocyte Antigen (HLA) antibodies. Preformed antibodies cause rejection by binding to HLA antigens expressed

on the endothelium of vessels in the transplanted kidney. It has been shown by Higgins etal that transplanting across HLA incompatibility has good outcomes if CDC crossmatch was negative. In that study, death censored graft survival in the CDC negative (but DSA positive) group was

88.6% compared to 54.2% in the CDC positive group. The aim of this study is to look at the predictive value of pre-treatment CDC titres in relation to graft survival.

UHCW Research: Prasad A., Yuvaraj A. and Krishnan N.

Oncoplastic techniques: Attitudes and changing practice amongst breast and plastic surgeons in Great Britain

Breast. 2017 May 12;34:58-64. doi: 10.1016/j.breast.2017.04.010. [Epub ahead of print]

The availability, acceptability and practice of oncoplastic surgery has increased over the last 5 years. This study aims to describe how the breast and plastic surgical workforce has adapted to provide oncoplastic breast surgery.

UHCW Research: Challoner T., Skillman J., Vourvachis M. and Hardwicke J.

Fourth quarter revalidation report demonstrates continued success

Revalidation has recently celebrated its one year anniversary and the NMC has published its fourth quarterly report. The final quarter of the first year has continued to show how successful revalidation has been with 48,598 nurses and midwives renewing their registration during this period.

Safe And Effective Staffing: The Real Picture

This report from the RCN calls for the rest of the UK to follow the example of Wales and enshrine safe staffing levels in law following analysis which shows that there is approximately 40,000 unfilled nurse posts in England with a further 12,000 health care support worker vacancies.

NICE Draft guideline on cataracts in adults: management

The National Institute for Health and Care Excellence (NICE) has opened a consultation on draft guidelines for cataracts in adults, closing 23 June 2017.

The guideline covers managing cataracts in adults aged 18 and over. It aims to improve care before, during and after cataract surgery by optimising service organisation, referral and surgical movement, and reducing complications. It further aims to improve the availability of information for people with cataracts before, during and after cataract surgery.

Nursing degree apprenticeship now available

The registered nurse apprenticeship standard is now available. Setting out the common core skills and knowledge required for all nursing students, the nurse apprenticeship standard incorporates the options to study specialisms in adult nursing, children’s nursing, mental health and learning disabilities.

Latest guidance for the NHS on protecting against cyber attack

NHS Digital has produced guidance documentation for NHS organisations impacted by the cyber incident. This information has been sent directly to NHS organisations via CareCERT bulletins but it can also be accessed on the NHS Digital website via the link above.

Staff engagement and workforce challenges

In his latest blog, Steven Weeks, policy manager and staff engagement lead at NHS Employers reflects on the recent event Staff Survey 2016 results: The Next Steps.

Steven talks about how we can help each other with some of the workforce challenges we face by sharing our ideas, innovations and methods. He shares some of the great work that's happening in other parts of the NHS, such as NHS Blood and Transplant, and their approach to engaging with a diverse range of staff.

Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults

This Cochrane Systematic Review concludes that as RCTs excluded patients with severe CDI, no conclusions can be drawn regarding efficacy of antibiotics (AB) in severe CDI. The lack of 'no treatment' control studies does not allow for conclusions regarding AB treatment in patients with mild CDI (except withdraw initiating AB).

Reducing Catheter Associated Urinary Tract Infections (CAUTI’s) at a District General Hospital Can change be sustained?

This shared-learning tool describes how Chesterfield Royal Hospital developed an improvement strategy to reduce catheter-associated urinary tract infections after data revealed rates were double the national average.

Enabling professionalism in nursing and midwifery practice

Enabling professionalism in nursing and midwifery practice, from the NMC, is a guide aimed at all nurses and midwives and sets out what ‘professionalism’ can look like in everyday practice.

National recruitment campaign proposed for adults’ social workers

A national recruitment campaign for social workers in adults’ services is needed to combat the shortages of experienced specialists, such as best interest assessors, according to Skills for Care chief executive, Sharon Allen.

Personalized Music Can Help Calm Nursing Home Residents with Dementia

A new study has found that nursing homes that implemented an individualized music program to help seniors cope with Alzheimer’s disease and related dementias found success, with fewer residents exhibiting disruptive behaviors, as well as fewer residents on antipsychotic and antianxiety medications.

Prisons need profound culture change to prevent loss of life from suicide

Prisons need a profound culture change to prevent people from losing their lives through suicide, according to a report published today by Centre for Mental Health and the Howard League for Penal Reform.

Preventing suicides: staff perspectives, is the last of four reports from a year-long investigation into suicide in prisons by the two charities, find that distress, self-harm and suicide attempts are too often seen as manipulative rather than signs of need and vulnerability among prisoners. And staff shortages, a ‘toxic’ working environment and a failure to recognise the traumatising impact of prison for both prisoners and staff all contribute to an unsafe environment.

Hip fracture: management

This guideline covering managing hip fracture in adults. It aims to improve care from the time people aged 18 and over are admitted to hospital through to when they return to the community, has been updated.

Intravenous fluid therapy in adults in hospital

This guideline covering the general principles for managing intravenous (IV) fluid therapy in hospital inpatients aged 16 and over with a range of conditions has been updated.

Type 2 diabetes in adults: management

This guideline covering the care and management of type 2 diabetes in adults (aged 18 and over), has been updated. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications.

NaviCam for diagnosing gastrointestinal tract conditions

NICE has developed a medtech innovation briefing (MIB) on NaviCam for diagnosing gastrointestinal tract conditions.

Hemosep for cell salvage

NICE has developed a medtech innovation briefing (MIB) on Hemosep for cell salvage.

Virtual chromoendoscopy to assess colorectal polyps during colonoscopy

New NICE diagnostics guidance on virtual chromoendoscopy (VCE) using NBI, FICE or i-scan to assess colorectal polyps of 5 mm or less during colonoscopy.

Irreversible electroporation for treating pancreatic cancer

New NICE Interventional Procedures Guidance on using irreversible electroporation for treating pancreatic cancer. This involves inserting special needles into the tumour in the pancreas. Short electrical pulses of a high voltage current are then passed through the needles. The aim is to destroy the cancer cells.

The future of renal patient support is bright

An estimated 15 million patients in England have at least one long-term condition or chronic illness... It is also estimated that 30% of the UK population with long-term or chronic illnesses account for about 70% of NHS spending (de Silva, 2011).

With a growing older population, CKD prevalence is a general concern. The RPSG will look to focus on contributing evidence-based care/practices and integrating of knowledge in a wider sense.

UHCW Research: Andrew Morris

Respiration driven excessive sinus tachycardia treated with clonidine

BMJ Case Rep. 2017 Apr 28;2017. pii: bcr2016216818. doi: 10.1136/bcr-2016-216818.

A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, β blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.

UHCW Research: Hayat, S.

The Effect of Alpha1-Proteinase Inhibitor (A1-PI) Therapy on Changes in Regional Lung Density: Post-Hoc Analysis of the RAPID/RAPID Extension Trial

American Journal of Respiratory and Critical Care Medicine 2017;195:A7395


UHCW Research: D. Reed,

Life expectancy for people with HIV now 'near normal'

"Young people on the latest HIV drugs now have near-normal life expectancy because of improvements in treatments," BBC News reports.

The report says advances in antiretroviral drug treatments reduce the risks of serious complications.

Researchers used data from 88,504 people with HIV from Europe and North America to track improvements in survival since 1996, when antiretroviral therapy (ART) was introduced.

ART involves using a combination of drugs that helps prevent the virus from replicating inside the body and attacking the immune system.

The researchers calculated that a 20-year-old starting treatment today could live to 67 years.

New online system for healthcare apprenticeship standards

A new website has been launched to provide a one-stop shop to find apprenticeship standards commonly used in healthcare settings.

Healthcare Apprenticeships Standards Online (HASO) will help employers find the most up-to-date information and download standards that are currently in development, or are approved and ready to use. The launch follows recent changes to apprenticeships, including the introduction of the levy, and a shift in attitudes as more employers look to apprenticeships as a way to train staff in clinical and non-clinical roles.

Royal College of Surgeons respond to new research on the effectiveness of knee arthroscopy surgery

Knee arthroscopy should not be performed in almost all patients with degenerative knee disease, a panel of international experts have said in The BMJ today. The experts say that the surgery does not, on average, result in a lasting improvement in pain or function - and they say further research is unlikely to alter this advice.

In response to the research, Mrs Scarlett McNally, council member for the Royal College of Surgeons said:

“This review applies to a particular type of knee surgery which orthopaedic surgeons are already moving away from for people with arthritis. Following the Cochrane review in 2008, and the subsequent revision of NICE guidance, surgeons now only consider knee arthroscopy as a suitable course of action for patients that have issues with their knee unexpectedly catching or giving way. Surgeons also only offer it to patients that have not responded well to non-surgical treatment, particularly weight loss and strengthening exercises, after at least 3 months. That said, any new research is always welcome and it is important that surgeons use this as an opportunity to remind themselves that they should only offer this procedure in very particular circumstances.

Quality of care in the English NHS: In the balance

Waiting times for many NHS urgent and emergency services in England were at their worst in 2016/17 for the last five years, but there is so far little evidence that the quality of care for some of the big killers – like heart attack, stroke and cancer – is deteriorating. This is the main message from the second pre-election briefing from the Health Foundation,Quality of care in the English NHS: In the balance.

Monthly performance statistics, March 2017

Performance statistics for March 2017 have been published by NHS England. These cover the following:

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

Perinatal Pathway For Babies With Palliative Care Needs

This pathway is designed to support all professionals working in fetal medicine, anetental, neonatal and maternity services to deliver sensitive and timely support, enabling families to spend time with their baby in a more home-like environment, and with as little technologically dependent care as possible.

Ibuprofen linked to increased risk of heart attacks

"Taking painkillers for just one week 'raises the risk of a heart attack'," the Daily Mail reports. The report is based on a new analysis that found a link between anti-inflammatory painkillers like ibuprofen and heart attack risk.

Researchers looked at data from 446,763 people and found some evidence that all commonly-used non-steroidal anti-inflammatory drugs (NSAIDs) appear to increase the risk of heart attack, and that the risk rises in the first week of use. The study found the risk was highest with higher doses.

However, the study does leave some unanswered questions. Researchers only looked at effects among those prescribed the drugs and not those using over the counter, so they may not be representative of the general population.

See response to this study from the RCGP and the RCoA's Faculty of Pain Medicine.

Pupils' mental health improved through school-based program

School-aged children can be taught to better their mental health through intervention programmes delivered at school, suggests a new study carried out in east London and led by an academic at Queen Mary University of London (QMUL).

Fathers crucial role in child's mental health - Centre for Mental Health

Fathers have a critical yet poorly recognised role in giving their children the best chance of good mental health throughout their lives, according to a briefing paper published today by Centre for Mental Health.

Fatherhood, by Lorraine Khan, reviews evidence about the role of fathers in children’s mental health. It finds evidence that fathers have a big influence on their children’s mental health yet few get any help or support to fulfill their potential as parents.

Unheard voices of people with dementia

This report contains the findings of a consultation with people affected by dementia. It reveals that nearly half of the UK adults questioned had not started saving for the care and support they might need in the future, and a third agreed that before being asked, they had not considered the cost of dementia care and support. It brings together the views of more than 3,850 people with dementia, carers and the public, in a series of in-depth interviews and face-to-face and online surveys.

• Report

NHS must do more to future-proof its MRI capacity, say imaging experts

The Royal College of Radiologists is urging hospitals to formulate clear plans to replace outdated equipment, after a survey revealed half of healthcare organisations do not have set renewal plans, and more than a third of older magnetic resonance imaging (MRI) scanners are not scheduled for replacement.

Preventing healthcare associated gram-negative bacterial bloodstream infections

An improvement resource from NHS Improvement to help health and social care economies reduce the number of gram-negative bloodstream infections (BSIs) with an initial focus on Escherichia coli (E.coli).

Addition of gemcitabine to paclitaxel, epirubicin, and cyclophosphamide adjuvant chemotherapy for women with early-stage breast cancer (tAnGo): final 10-year follow-up of an open-label, randomised, phase 3 trial

Lancet Oncol. 2017 May 4. pii: S1470-2045(17)30319-4. doi: 10.1016/S1470-2045(17)30319-4. [Epub ahead of print]

The addition of gemcitabine to anthracycline and taxane-based adjuvant chemotherapy at this dose and schedule confers no therapeutic advantage in terms of disease-free survival in early breast cancer, although it can cause increased toxicity. Therefore, gemcitabine has not been added to standard adjuvant chemotherapy in breast cancer for any subgroup.

UHCW Research: C. J. Poole

Effective events for local quality improvement following national clinical audit

The Healthcare Quality Improvement Partnership has published Effective events for local quality improvement following national clinical audit. This guide contains information to aid the planning, organisation and delivery of effective quality improvement workshops and how to follow up and maintain momentum. It includes checklists, website links, templates and case studies.

Open innovation in health: A guide to transforming healthcare through collaboration

NESTA has published Open innovation in health: a guide to transforming healthcare through collaboration. This guide explores examples of open innovation in the field of health from around the world. It analyses the ways that companies, governments, researchers and citizens are collaborating to improve the innovation process, from the way that problems are identified to how new products and services are created and then adopted by providers of healthcare

Better prescribing might prevent thousands of strokes in the UK

One third of people who had a first stroke in the UK between 2009 and 2013 had known risk factors and were not taking the drugs that might have prevented their stroke.

Electronic general practice records from almost 30,000 people who had a stroke showed that about 60% had risk factors that meant they might have been eligible to take cholesterol-lowering, anti-clotting or blood pressure medication. But 54% of these people had no recent prescription for the appropriate drug(s).

The researchers estimate that almost 12,000 strokes a year in the UK could be prevented if everyone eligible for preventive drugs took them.

From the NIHR Dissemination Centre

The Benefits Of ID Scanning: King's College Hospital NHS Foundation Trust

This case study from NHS Employers shares King's College Hospital NHS Foundation Trust's experience of implementing scanning equipment and software to retrospectively check staff documentation.

New equality objectives to target inequality in health and social care

The CQC has published ambitious new equality objectives for 2017 - 19.  The new objectives for the next two years focus on our regulatory role in improving equality. Through our inspections, we will check that providers make person-centred care work for everyone, from all equality groups – for example for lesbian, gay, bisexual and transgender people using adult social care or mental health inpatient services. 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. We will also ensure that we communicate with everyone who contacts us in a way that is accessible for them.

Election briefing: NHS and social care funding – three unavoidable challenges

This is one of three Health Foundation briefings ahead of the June 2017 General Election, and focuses on NHS and social care finances.  It aims to clarify the debate on three main challenges:

• Funding and social care: how big a problem is it?
• Funding and the NHS: are two years of famine ahead?
• Funding for social care and the NHS: how much might be needed beyond 2020?

Perfect Patient Information Journey

The Patient Information Forum has published Perfect patient information journey: phase 1 summary report. This is the report from phase one of a project aimed at creating a model pathway to support the ‘perfect patient information journey’ for people with long-term conditions. This phase involved conducting research on previous efforts to embed information into patient pathways, as well as talking to patients, healthcare professionals and commissioners, to identify key themes related to the provision of high quality information.

Elective care guide

Guidance for NHS staff involved the delivery of acute elective care who want to understand how best to manage and deliver referral to treatment (RTT) pathways and standards.

New consultation on digital health records for children

The Royal College of Physicians' (RCP's) Health Informatics Unit is currently hosting a consultation to seek views from parents and carers, health and care professionals and industry on the content of a new set of standards for a digital health records for children.

Brexit And The NHS: Election 2017

This briefing from the NHS Confederation outlines the priorities identified by NHS Confederation for the new incoming government. It calls for all political parties to commit to a series of pledges on Brexit ahead of the upcoming general election.

Celebrating good care, championing outstanding care

This report from the CQC shares a collection of short case studies of good practice shown by care providers that are rated good or outstanding overall. It also features the views of some people responsible for care quality and what they do to drive improvement.

Seven-day Services - England, October 2015 - September 2016, Experimental statistics

This report from NHS Digital on 7-day services includes indicators on the following topics: Mortality within 30 days of admission by week-part of admission to hospital, emergency readmissions within seven days of discharge from hospital by day of discharge, length of stay following an emergency admission to hospital.

Effectiveness of yoga in treating major depression evaluated

New research indicates that the benefits of hatha yoga in treating depression are less pronounced in early treatment, but may accumulate over time.

Virtual reality for psychiatric treatment?

A growing body of evidence suggests that virtual reality (VR) technology can be an effective part of treatment for phobias, posttraumatic stress disorder, and other mental health conditions, according to a research review.

Surviving or Thriving? The state of the UK's mental health

We all have mental health. Good mental health is an asset that helps us to thrive. This is not just the absence of a mental health problem, but having the ability to think, feel and act in a way that allows us to enjoy life and deal with the challenges it presents. Yet it can be easy to assume that ongoing stress is the price we have to pay to keep our lives on track. It is time to challenge that assumption. Read more HERE.

Benefits of Dementia Befrienders into an acute hospital wards

People with dementia account for approximate 3.2 million hospital bed days per year with about 25% beds occupied at any one time.

Some of the most common reasons for their admission include falls,  urinary tract infections, chest infections and stroke.

Following a review of dementia care in hospitals by the CQC (Cracks in the Pathway, CQC 2014) it was suggested that these patients were likely to experience poor care at some point along their pathway.

James Paget Universities Hospitals NHS Trust staff describe an innovative volunteer scheme.

Global Review of Antipsychotic Drugs Finds Benefits Outweigh Risks

An international group of experts has concluded that, for patients with schizophrenia and related psychotic disorders, antipsychotic medications do not have negative long-term effects on patients’ outcomes or the brain.

In fact, the benefits of these medications are much greater than their potential side effects, according to the researchers.

The findings, by Jeffrey Lieberman, M.D., chairman of psychiatry at Columbia University College of Physicians, and colleagues from institutions in the United States, Germany, the Netherlands, Austria, Japan, and China, were published in the American Journal of Psychiatry.

Retirement Leads to Less Stress – But Not If You’re Poor

New research suggests that retirement may widen inequalities in stress and health.

The new study, published in the Journal of Gerontology, shows that poorer people, or people in low status occupations, often have poorer health and higher biological stress response levels upon retirement, while people in high status jobs have lower stress levels.

Increased Investment in mental health research falls a long way short of what is needed

The Medical Research Council (MRC) set out a timely strategy to focus more attention on mental ill health, but it doesn’t come close to rectifying decades of underfunding.
Jenny Edwards CBE, Chief Executive of the Mental Health Foundation said.

Blood test may lead to targeted therapy for prostate cancer

"A blood test has been developed that could help target treatment for men with advanced prostate cancer," BBC News reports. The test could help identify men unlikely to respond to drugs such as enzalutamide.

Enzalutamide and abiraterone are additional treatments for men for whom standard hormonal treatment has not worked, or has stopped working.

Treatment success varies; some men get little benefit, while others have responses that last many years. The new test – if confirmed – could help doctors know in advance who is likely to benefit.

Reward In The NHS: Good Practice And Innovation Taking Place Across The NHS On Reward

This report, published by NHS Employers, captures the themes, good practice, and innovation that have emerged from NHS Employers' Total Reward Engagement Network over the last year. It focuses on key elements of reward and how organisations are changing their approach to reward.

New case study looks at reducing agency spend

In a new case study, published by NHS Employers, The Leeds Teaching Hospitals NHS Trust shares its experience and advice on how to reduce medical agency spend.

A clinical audit to assess the compliance of documentation of the urinary catheter care bundle in the inpatient units of Berkshire Healthcare NHS Foundation Trust

From the NICE shared learning database

A clinical audit was undertaken covering the Trust’s inpatient units in order to assess the compliance of staff in the use of documentation for a catheter care bundle for patients with an indwelling catheter in line with the NICE clinical guideline for Healthcare-associated infections: prevention and control in primary and community care (CG139) and the NICE Quality Standard 61 for Infection control and prevention.

A comparative analysis of whole genome sequencing of oesophageal adenocarcinoma pre- and post-chemotherapy

Genome Res. 2017 May 2. doi: 10.1101/gr.214296.116. [Epub ahead of print]

The scientific community has avoided using tissue samples from patients that have been exposed to systemic chemotherapy to infer the genomic landscape of a given cancer. Esophageal adenocarcinoma is a heterogeneous, chemoresistant tumor for which the availability and size of pretreatment endoscopic samples are limiting. This study compares whole-genome sequencing data obtained from chemo-naive and chemo-treated samples. The quality of whole-genomic sequencing data is comparable across all samples regardless of chemotherapy status. Inclusion of samples collected post-chemotherapy increased the proportion of late-stage tumors. When comparing matched pre- and post-chemotherapy samples from 10 cases, the mutational signatures, copy number, and SNV mutational profiles reflect the expected heterogeneity in this disease. Analysis of SNVs in relation to allele-specific copy-number changes pinpoints the common ancestor to a point prior to chemotherapy. For cases in which pre- and post-chemotherapy samples do show substantial differences, the timing of the divergence is near-synchronous with endoreduplication. Comparison across a large prospective cohort (62 treatment-naive, 58 chemotherapy-treated samples) reveals no significant differences in the overall mutation rate, mutation signatures, specific recurrent point mutations, or copy-number events in respect to chemotherapy status. In conclusion, whole-genome sequencing of samples obtained following neoadjuvant chemotherapy is representative of the genomic landscape of esophageal adenocarcinoma. Excluding these samples reduces the material available for cataloging and introduces a bias toward the earlier stages of cancer.

UHCW Research: Sothi, S.

The Winter’s Tale: leadership lessons from emergency departments under pressure

The Institute of Healthcare Management (IHM) has launched its new report, The Winter’s Tale. The second report, in collaboration with Richard Vize, is the culmination of a series of in-depth interviews undertaken with acute trusts across England about their experiences of surviving another winter.

GOC publishes guidance on gaining valid consent

The General Optical Council (GOC) has published guidance on obtaining valid consent to assist registrants in meeting its standards of practice.

Complex picture of NHS community care revealed by new analysis

New analysis by the Health Foundation has revealed that while the biggest contracts for community care are held by NHS providers, the health service is also reliant on services offered by charities, local authorities and private sector companies. Most contracts are short-term and the majority of non-NHS contracts are for relatively small sums.

Children and young people’s mental health - the role of education

As part of a joint inquiry into children and young people's mental health, the Health and Education Committees found that financial pressures are restricting the provision of mental health services in schools and colleges. The report suggests that the next Government review the effects of the budget reductions in the education sector.

• Report

Scientists Find High-Risk Gene for Tourette Syndrome

Scientists have identified the first “high-confidence” risk gene for Tourette syndrome (or Tourette disorder) as well as three other probable risk genes. Their findings, published in the journal Neuron, are a step forward in understanding the biology of the disorder and may aid in the search for better treatments.

Requests for help with mental health problems on rise, says footballers’ union

The number of footballers seeking help for mental health problems is rising, the Professional Footballers’ Association has said.

Aaron Lennon continues to receive treatment for a stress-related illness after the Everton winger was detained under the Mental Health Act on Sunday after Greater Manchester police became concerned for his welfare on a busy road in Salford. Lennon, who has won 21 England caps, was taken to hospital and is continuing to receive care with the support of his club.

Psychology should be valid second science for medical students, psychiatrists say

Psychology should be offered as an alternative to a secondscience by all medical schools, the Royal College of Psychiatristssays in its General Election manifesto launched today.

Currently only one medical school, Sheffield, offers psychology as an alternative to a second science or mathematics.

It means many students interested in mental health may be put off from applying to study medicine because they think their interest in psychology will rule them out.

Caring to change: How compassionate leadership can stimulate innovation in health care

This paper from the King's Fund looks at compassion - which involves attending, understanding, empathising and helping – as a core cultural value of the NHS and how compassionate leadership results in a working environment that encourages people to find new and improved ways of doing things.

It also describes four key elements of a culture for innovative, high-quality and continually improving care and what they mean for patients, staff and the wider organisation:

• inspiring vision and strategy
• positive inclusion and participation
• enthusiastic team and cross-boundary working
• support and autonomy for staff to innovate.

Statins side effects 'have been overstated,' says study

"Side effects from statins 'really are all in the mind'," The Times reports. A new study found people taking statins were more likely to report side effects, such as muscle aches, but only if they knew they were taking the drug.

The researchers said this demonstrates the so-called "nocebo effect", the opposite of the placebo effect, where people experience side effects only because they expect to get them.

UK health spending

Briefing from the Institute for Fiscal Studies analysing how UK public spending on health has changed over time, and both the short- and long-run pressures faced by the health service.

Using data to retain staff webinar

In this webinar from NHS Employers, you'll hear how one NHS organisation set up a dashboard which intuitively forecasts trends in workforce data, allowing teams to manage retention hotspots before they occur. You'll also learn how another trust saw a return rate of over 50 per cent of exit questionnaires when they included an online option. This has allowed staff in the organisation to raise concerns and the trust to address them promptly and efficiently.

Keeping patients at the heart of the NHS: RCP's four-point plan for government

The Royal College of Physician's (RCP's) new Keeping patients at the heart of the NHS: RCP's four-point plan for government manifesto puts patients firmly at the centre of Brexit patient negotiations. The plan, created for the next UK government, sets out a series of evidence-based recommendations to support better patient care, ensure the NHS is adequately resourced to provide that care, and how the government can support people to live healthier lives in future.

Organising care at the NHS front line: Who is responsible?

This report from the King's Fund looks at the reality of caring for acutely ill medical patients at the NHS front line and asks how care in hospitals can be improved.

The role of the independent sector in the NHS: Busting the myths

This publication from the NHS Confederation takes a look at the independent sector and dispels four myths on its role in the NHS.

Prehospital Care of Spinal Cord Injuries in India

Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation32(S1):S165 · April 2017

Study/Objective: Prehospital Care of Spinal Cord Injuries in India.

UHCW Research: Chris Turner

Sa1049 The Virtual Electronic Chromoendoscopy (Vec) Score in Ulcerative Colitis Exhibits Very Good Inter-Rater Agreement in Scoring Mucosal and Vascular Changes After Computerised Module Training: A Study Across Academic and Community Practice

Gastrointestinal Endoscopy May 2017 Volume 85, Issue 5, Supplement, Pages AB169–AB170

Mucosal healing is the desired therapeutic endpoint for clinical trials in ulcerative colitis (UC). However, conventional white light endoscopy may fall short of capturing the full spectrum of inflammatory change; whereby histology and virtual electronic chromoendoscopy (VEC) can show ongoing disease activity even when Mayo scores suggest healing (Iacucci et al. Endoscopy 2015). Applicability of VEC scoring requires determination outside the expert setting; thus, our aim was to provide external validation among trainees, consultant gastroenterologists and colorectal surgeons, practicing across six general and specialist centres.

UHCW Research: Monika M. Widlak and Stephen Ward

MRI Study Shows Brain Structure Differences in Bipolar Patients

The brains of people with bipolar disorder show distinct differences in regions associated with inhibition and emotion, according to a new magnetic resonance imaging (MRI) study published in the journal Molecular Psychiatry. In addition, these differences may be even more prominent in those with psychosis. Read more HERE.

Emergency Departments Could Play Significant Role in Reducing Suicide Attempts

NIH-funded research shows an intervention that includes follow-up phone calls reduces the risk of future suicide attempts for people at risk.

Suicide is the tenth leading cause of death in the United States. A significant proportion of individuals who die by suicide have made a prior suicide attempt, and often access emergency care (ED) services. Research funded by the National Institute of Mental Health (NIMH) now shows hospital emergency departments can play a vital role in lowering the number of suicide attempts among adults by as much as 30 percent.

Multi Agency Crisis Assessment Service (MACAS)

A project to stop people in mental health crisis spending hours in a police cell or in A&E while waiting for mental health services is up and running across Cumbria.

For some time now the county’s health and social care providers and Cumbria Constabulary have been working together to develop a pilot programme called the Multi Agency Crisis Assessment Service (MACAS).

The programme was made possible thanks to a funding bid made by the Office of the Police and Crime Commissioner to the Home Office. Too many times in the past have people in mental health crisis been sitting for hours in police cells or A&E while mental health services are accessed – this is completely inappropriate and potentially damaging for the person who is in need of help.

Personalized psychiatry matches therapy to specific patients with depression

Selecting the antidepressant that will be most effective for a specific patient suffering from depression can be a 'try and try again' process. Examining new personalized and precision psychiatry approaches, a new study shows that body mass index, sex of the patient, and symptom profile can be used to determine a personalized treatment that guides antidepressant choice and significantly improves patient outcome.

Manifesto for Better Mental Health

The Mental Health Policy Group - a coalition of six organisations working together for better mental health, has launched the Manifesto for Better Mental Health ahead of the 2017 General Election.

The manifesto focuses on four key areas of improvement:

• Ensure fair funding for mental health services
• Give children a good start in life
• Improve health services for people with mental health problems
• Better lives for people with mental health problems

Designing a New Molecular Probe: The Potential Role for Tilmanocept (Lymphoseek®) in the Assessment of Patients with Painful Hip and Knee Joint Prostheses.

Open Orthop J. 2017 Mar 22;11:212-224. doi: 10.2174/1874325001711010212. eCollection 2017.

There is a potential new role for Tilmanocept, which can be utilised with both PET-CT and SPECT-CT technologies. Tilmanocept is a relatively new radiopharmaceutical which has a potential role in the imaging assessment of painful joint prosthesis.

UHCW research: Adesanya O, Hutchinson C.

Do medical images aid understanding and recall of medical information? An experimental study comparing the experience of viewing no image, a 2D medical image and a 3D medical image alongside a diagnosis

Patient Education & Counseling (PATIENT EDUC COUNS), Jun2017; 100(6): 1120-1127. (8p)

This study compared the experience of viewing 3D medical images, 2D medical images and no image presented alongside a diagnosis.

When presented alongside a diagnosis, medical images may aid patient understanding, recall and trust in medical information.Practical Considerations: Medical images may be a powerful resource for patients that could be utilised by clinicians during consultations.

UHCW Research: Wellings, Richard, Hutchinson, Charles

RCOG statement on drug treatment for excessive blood loss after childbirth

A major trial published in The Lancet shows that a cheap and widely available medication can reduce deaths from severe bleeding after childbirth, the leading cause of maternal mortality worldwide. The study of 20,000 women from 21 countries shows that maternal deaths were reduced by 31%, and urgent surgery to stop life-threatening bleeding was decreased by 36%, if the tranexamic acid was given within three hours of delivery.

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:

"The results of this important trial are very welcome and show that early administration of a cheap, widely available and heat-stable drug can reduce the number of maternal deaths from excessive bleeding after childbirth, also known as postpartum haemorrhage (PPH). The medication can also reduce the need for urgent surgery to stop life-threatening bleeding. "

Apprenticeship update and resources

The Education and Skills Funding Agency (ESFA) have issued an update containing a range of information relevant to apprenticeships, including the new national minimum wage rates.

New guidance for trailblazers has also been published by The Institute for Apprenticeships (IFA).

The new how-to guide reflects the updated policy and processes of the recently established IFA and provides stage-by-stage guidance on the development of new apprenticeships, replacing the previous guidance.

People performance management toolkit

NHS Employers' People performance management toolkit has been updated to help you deal confidently with performance management challenges.

No regrets: how talking more openly about death could help people die well

This report from Macmillan Cancer Support finds that more than 62,000 people die of cancer in hospitals each year in the UK despite a significant majority stating that they would like to die at home. It reveals the challenging obstacles that people face when discussing death and highlights the need for better communication to help people plan for their final days.

Brexit And Health And Social Care - People And Process

This report from the House of Commons Health Committee explores the impact of the UK's withdrawal from the European Union on the provision of health and social care. The initial findings have highlighted the need for the Department of Health to plan comprehensively for any contingencies dependant on Brexit and the need for a pragmatic approach to workforce planning.