Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia

New NICE technology appraisal guidance on ponatinib (Iclusig) for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia in adults.

Ponatinib is recommended, within its marketing authorisation, as an option for treating chronic‑, accelerated‑ or blast‑phase chronic myeloid leukaemia in adults when:

• the disease is resistant to dasatinib or nilotinib or
• they cannot tolerate dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate or
• the T315I gene mutation is present.

Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia

New NICE technology appraisal guidelines on blinatumomab (Blincyto) for treating Philadelphia-chromosome-negative precursor B-cell acute lymphoblastic leukaemia in adults.

Blinatumomab is recommended within its marketing authorisation as an option for treating Philadelphia-chromosome-negative relapsed or refractory precursor B-cell acute lymphoblastic leukaemia in adults, only if the company provides it with the discount agreed in the patient access scheme.

Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease

New NICE technology appraisal guidance on everolimus (Afinitor) and sunitinib (Sutent) for treating neuroendocrine tumours in adults.

Everolimus and sunitinib are recommended, within their marketing authorisations, as options for treating well- or moderately differentiated unresectable or metastatic neuroendocrine tumours (NETs) of pancreatic origin in adults with progressive disease.

Etelcalcetide for treating secondary hyperparathyroidism

New NICE technology appraisal guidance on etelcalcetide (Parsabiv) for treating secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis.

Etelcalcetide is recommended as an option for treating secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis, only if:

• treatment with a calcimimetic is indicated but cinacalcet is not suitable and
• the company provides etelcalcetide with the discount agreed in the patient access scheme.

Pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer

New NICE technology appraisal guidance on pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer.

Pembrolizumab is recommended for use within the Cancer Drugs Fund as an option for untreated PD-L1-positive metastatic non-small-cell lung cancer in adults, only if:

• their tumours express PD-L1 with at least a 50% tumour proportion score and have no epidermal growth factor receptor- or anaplastic lymphoma kinase-positive mutations
• pembrolizumab is stopped at 2 years of uninterrupted treatment and no documented disease progression
• the conditions in the managed access agreement for pembrolizumab are followed.

Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma

New NICE technology appraisal guidance on brentuximab vedotin (Adcetris) for treating CD30-positive Hodgkin lymphoma in adults.

Brentuximab vedotin is recommended as an option for treating CD30‑positive Hodgkin lymphoma in adults, only if:

• they have relapsed or refractory disease after autologous stem cell transplant and
• the company provides brentuximab vedotin at the price agreed with NHS England in the commercial access agreement.

Risks vs rights: how social workers handle one of the toughest jobs in mental health

One of the most important roles in our mental health system is also one of the least known about. Every day, approved mental health professionals (AMHPs) have to assess whether a person’s mental health crisis has become so severe that they need to be detained for their own safety, or that of others, under the Mental Health Act.

This complex and finely balanced judgment call is often made in difficult circumstances. It demands AMHPs weigh up the risks against a person’s human rights. Detaining a person against their will takes away their liberty. But if they are refusing care, it could be the only way to get much-needed, potentially life-saving, support.

Read more HERE

Magnesium Shows Promise for Treating Mild-Moderate Depression

A reported 350 million people worldwide suffer from depression, and current pharmacological approaches using selective serotonin reuptake inhibitors (SSRIs) carry a hefty price tag and the risk of side effects.

A recent study published in the journal PLoS One, shows that over-the-counter magnesium appears safe and effective to treat mild to moderate depression.

PTSD in children quickly and effectively treatable within hours

Children and adolescents with posttraumatic stress syndrome (PTSD) can be successfully treated with only a few hours of EMDR or cognitive behavioral writing therapy (CBWT). This is the finding of a new research paper by the University of Amsterdam (UvA) and GGZ Rivierduinen (Trauma Center for Children and Youth). The paper was published in the Journal of Child Psychology and Psychiatry.

The inpatient healthcare economy for people with learning disabilities and/or autism spectrum disorder

Centre for Disability Research, University of Lancaster (CeDR) - 
This report analysis the market for inpatient services for people with learning disabilities in England. The analysis finds that approximately half of these services are run by the independent sector, services which are valued at over a quarter of a billion pounds per year. The report calls for greater scrutiny and accountability for the independent sector to ensure high quality of care and patient safety.

• Report

Head injury: assessment and early management

Updated NICE guidance on the assessment and early management of head injury.

In June 2017, we updated recommendations 1.2.8 and 1.4.12 with cross-references to related NICE guidelines, and an outdated research recommendation was deleted.

Uterine suspension using mesh (including sacrohysteropexy) to repair uterine prolapse

New Interventional Procedures Guidance from NICE on uterine suspension using mesh (including sacrohysteropexy) to repair uterine prolapse in women.

Current evidence on the safety of uterine suspension using mesh (including sacrohysteropexy) to repair uterine prolapse shows there are serious and well-recognised complications. The evidence on efficacy is adequate in quantity and quality. Therefore, this procedure can be used provided that standard arrangements are in place for clinical governance, consent and audit.

Sacrocolpopexy using mesh to repair vaginal vault prolapse

New Interventional Procedures  Guidance from NICE on sacropolpopexy using mesh to repair vaginal vault prolapse in women.

Current evidence on the safety of sacrocolpopexy using mesh to repair vaginal vault prolapse shows there are serious but well-recognised safety concerns. The evidence on efficacy is adequate in quantity and quality. Therefore, this procedure can be used provided that standard arrangements are in place for clinical governance, consent and audit.

Infracoccygeal sacropexy using mesh to repair uterine prolapse

New NICE interventional procedures guidance on infracoccygeal sacropexy using mesh to repair uterine prolapse in women.

Current evidence on the safety of infracoccygeal sacropexy using mesh to repair uterine prolapse shows there are serious but well recognised complications. The evidence on efficacy is inadequate in quality. Therefore, this procedure should not be used unless there are special arrangements in place for clinical governance, consent and audit or research.

Infracoccygeal sacropexy using mesh to repair vaginal vault prolapse

New NICE Interventional procedures guidance on infracoccygeal sacropexy using mesh to repair vaginal vault prolapse in women.

Current evidence on the safety of infracoccygeal sacropexy using mesh to repair vaginal vault prolapse shows there are serious but well-recognised complications. The evidence on efficacy is inadequate in quality. Therefore, this procedure should not be used unless there are special arrangements in place for clinical governance, consent, and audit or research.

Multimorbidity Quality Standard

This quality standard covers clinical assessment, prioritising and managing healthcare for adults aged 18 years and over with 2 or more long-term health conditions (multimorbidity). At least 1 of these conditions must be a physical health condition. It describes high-quality care in priority areas for improvement.

Spondyloarthritis in over 16s: diagnosis and management

This new guideline from NICE covers diagnosing and managing spondyloarthritis that is suspected or confirmed in adults who are 16 years or older. It aims to raise awareness of the features of spondyloarthritis and provide clear advice on what action to take when people with signs and symptoms first present in healthcare settings. It also provides advice on the range of treatments available.

In June 2017, we updated recommendation 1.2.7 to clarify the advice on what imaging should be done.

SecurAcath for securing percutaneous catheters

New medical technologies guidance from NICE.on SecurAcath for securing percutaneous catheters

Recommendations:

• The case for adopting SecurAcath for securing peripherally inserted central catheters (PICCs) is supported by the evidence. SecurAcath is easy to insert, well tolerated, associated with a low incidence of catheter-related complications and does not usually need removing while the catheter is in place.
•  SecurAcath should be considered for any PICC with an anticipated medium- to long-term dwell time (15 days or more).
• Cost modelling shows that SecurAcath is cost saving compared with adhesive securement devices if the PICC remains in place for 15 days or longer. Estimated cost savings range from £9 to £95 per patient for dwell times of 25 days and 120 days, respectively. Cost savings result from shorter maintenance times and less need for device replacement with SecurAcath. Annual savings across the NHS in England from using SecurAcath are estimated to be a minimum of £4.2 million.

Eliglustat for treating type 1 Gaucher disease

Highly specialised technologies guidance from NICE.

Eliglustat is recommended within its marketing authorisation for treating type 1 Gaucher disease, that is, for long-term treatment in adults who are cytochrome P450 2D6 poor, intermediate or extensive metabolisers. Eliglustat is only recommended when the company provides it with the discount agreed in the patient access scheme

Multiple frequency bioimpedance devices to guide fluid management in people with chronic kidney disease having dialysis

New diagnostics guidance from NICE

There is currently not enough evidence to recommend the routine adoption of the BCM – Body Composition Monitor to guide fluid management in people with chronic kidney disease having dialysis in the NHS. Further research is recommended to show the effect of using the BCM – Body Composition Monitor on clinical outcomes (see section 6.1).

Centres that are currently using the BCM – Body Composition Monitor to guide fluid management are encouraged to take part in research and data collection (see section 5.18).

Centres that do not currently use the BCM – Body Composition Monitor to guide fluid management should only do so as part of a research study, such as the BISTRO trial.

The capped expenditure process explained

The financial pressures facing the NHS in 2017/18 are significant. Providers of hospital, ambulance, community and mental health services are expecting to overspend their budgets by nearly £500 million this year, and commissioners are also seeing their budgets come under further pressure as the NHS remains in a period of relatively slow funding growth.

To respond to this financial pressure NHS England and NHS Improvement introduced a capped expenditure process (CEP) to provide tighter controls on NHS spending. This is the latest addition to a wide range of actions to address financial challenges in the NHS (see Table).

Securing a sustainable NHS workforce for the future

NHS Improvement has launched a major new programme to improve staff retention in trusts across England and bring down the leaver rates in the NHS by 2020.

Nurses and all clinical staff are the backbone of the NHS and this retention programme will highlight why there's been an increase in staff choosing to leave and provide support to trusts so they can hold on to this expertise and experience.

Send us your compassionate care award entries!

The call has gone out for more entries for this year’s Kate Granger Compassionate Care Awards.

The Chief Nursing Officer for England, Professor Jane Cummings, urged people to nominate colleagues and teams, while also revealing the entry closing date has been extended to 10 July.

Pembrolizumab and olaratumab now available on the CD

Pembrolizumab (Keytruda) for lung cancer and olaratumab (Lartruvo) for sarcoma are now available on the CDF while more data is gathered on their value. Both drugs will remain on the CDF until they are reviewed again by NICE.

Pembrolizumab is used to treat advanced lung cancer in people who have specific protein and genetic markers. It was recently recommended by NICE as a second line option for some patients with lung cancer. This new guidance is for those with untreated lung cancer which could see around 1,400 new patients benefiting from this treatment.

Liver Disease quality standard

This quality standard from NICE covers the identification, assessment and management of chronic liver disease in adults, young people and children, and cirrhosis in adults and young people. It describes high-quality care in priority areas for improvement. It does not cover treatment for liver cancer.

This has now been published.

Antidepressants were the area with largest increase in prescription items in 2016

NHS Digital must be quoted as the source of these figures

Antidepressants saw the greatest numeric rise of all British National Formulary (BNF) therapeutic areas for prescription items dispensed in the community in England in 2016, according to a report published today by NHS Digital.

The report Prescriptions Dispensed in the Community 2006-2016 shows that for the fourth successive year, prescription items for antidepressants showed the greatest numeric rise. They increased by 3.7 million items (6.0 per cent), from 61.0 million to 64.7 million between 2015 and 2016.

More Intense Mental Distress Tied to Greater Risk of Death in Heart Patients

Patients with coronary heart disease who experience persistent moderate to severe mental distress face a much higher risk of death, according to a new study published online in the journal Heart. But no such link was found for those experiencing persistent mild or occasional distress over the long term.

Although prior research has suggested a link between anxiety/depression and an increased risk of heart attack and stroke, most of these studies were conducted soon after the event, and were based on a single assessment, say the researchers. And the definitions of chronic/persistent stress in other longer term studies have varied widely.

A healthy state of mind: improving young people’s mental fitness

This report focuses on how to create a mental health system which supports young people earlier and with far greater flexibility than currently exists.  It argues for the reform of the mental health system to provide greater support for the majority of young people who will not receive treatment from specialist CAMHS whilst ensuring that those in urgent need of clinical intervention receive immediate help. 

Mental Health Alliance report outlines Mental Health Act concerns

The Mental Health Alliance, a coalition of 65 organisations including the Mental Health Network, has published a new report on the Mental Health Act highlighting concerns that the Act overlooks the dignity and human rights of people with mental illness.

The report, A Mental Health Act fit for tomorrow, led by Rethink Mental Illness on behalf of the Alliance, includes the views of over 8000 people who either use mental health services or work in the field as carers and professionals.

Secondary school staff get mental health 'first aid' training

From June 2017, teachers in secondary schools around the country will take part in a new training programme to help them identify and respond to early signs of mental health issues in children.

The programme, backed in the first year by £200,000 in government funding, and delivered by the social enterprise Mental Health First Aid, will start with 1,000 staff and extend in years 2 and 3 to cover every secondary school in England. They will receive practical advice on how to deal with issues such as depression and anxiety, suicide and psychosis, self-harm, and eating disorders.

NICE launches a competition for developers of healthcare technologies

NICE Scientific Advice has launched a competition for small or medium sized companies, charities and academic research groups, who are developing transformative products that have the potential to change patients’ lives and/or save the NHS money.

The NICE AdviSeME Prize is open to products (pharmaceuticals, devices, diagnostic test/tools, cell/gene therapies, healthcare apps) in the early clinical stages of development. To be considered the technologies should demonstrate clinical credibility and target a population with a high unmet clinical need. In addition they need to have a potential beneficial impact on either; survival and/or health-related quality of life, costs to the NHS or the use of healthcare resources and/or access to healthcare.

The winner will receive a free Light Scientific Advice Service from NICE, usually costing £15,000.

Enabling change through communities of practice: Wellbeing Our Way

In June 2014, National Voices set out to explore and test how communities of practice could facilitate the spread of large-scale change across England’s voluntary sector working for health and wellbeing.

Wellbeing Our Way was born from the belief that voluntary and community sector organisations, alongside people with long-term health needs, can play a powerful role in creating a health and care ‘system’ which works for everyone: a system which values people’s strengths, is based in their communities, and enables people to make decisions based on their personal preferences and priorities.

Incidences of rota gaps surge

Around two-thirds of hospital doctors have experienced rota gaps in the last 12 months, a new survey has found.

The BMA quarterly survey also found that 65 per cent of hospital doctors and 48 per cent of GPs reported vacancies in their departments and practices.

Report on transition of care between childhood and adulthood for people with diabetes

NHS Digital has published a new report that charts the care of young people with Type-1 diabetes as they move from paediatric to adult services.

The National Diabetes Transition Audit (NDTA) links datasets from the adult and paediatric national diabetes audits and examines whether the transition between childhood and adulthood has an effect on care.  The report includes figures on the percentage of people who are receiving the nine NICE recommended care processes, as well as the percentage of people who have met the NICE treatment targets for diabetes care.

The report also examines how young people with Type-1 diabetes are monitored against risk factors4 associated with diabetes care as well as Diabetic ketoacidosis (DKA) inpatient admissions.

NHS England’s Chief Scientific Officer’s Knowledge Transfer Partnership winners announced

NHS England, in partnership with the National Measurement System (NMS) has announced the winners of its first Chief Scientific Officer’s (CSO) Knowledge Transfer Partnership Programme.

The bespoke 12 month development programme gives clinical leaders in healthcare science the opportunity to create, test and implement innovative ideas to improve patient care and identify new approaches to measurement and outcomes.

The programme involves collaboration at a senior level with partner organisations across the UK’s National Measurement System (NMS) at leading centres of excellence in science and technology. It is designed to enable senior healthcare scientists to remain in clinical service whilst building long term partnerships between clinical, research and industry teams.

This collaboration and learning from other science led organisations is crucial to putting science and innovation at the heart of the NHS, delivering the next steps on the five year forward view and ensuring sustained improvements to scientific services for patient benefit.

'Painless' flu vaccine skin patch shows promise

"A 'painless' sticking plaster flu jab that delivers vaccine into the skin has passed important safety tests in the first trial in people," BBC News reports. Results of a small phase 1 trial were encouraging, with no serious side effects reported.

The patch, around the size of a standard plaster, contains 100 "microneedles" – tiny needles containing the vaccine, which then dissolve after delivering a dose.

The trial including 100 people in the US and aimed to see whether the patch was safe and tolerable and may be able to deliver flu vaccine as effectively as an injection.

People who had the patch found it less painful, but were more likely to get redness and itching where the patch had been applied.

There were signs that the patch was just as effective as standard injection in terms of antibody response, but larger studies will be needed to confirm this.

Gathering feedback from families following the death of their baby: A resource to support professionals in maternity care

Many parents who have experienced bereavement want to offer feedback to ensure lessons are learned and good practice is shared. The Maternity Bereavement Experience Measure questionnaire and supporting resource is designed to seek feedback from bereaved parents where a baby or babies have died during pregnancy or shortly after birth. It should also enable commissioners and providers to collect and understand women’s insight from all communities, cultures and ethnic groups to help explore where local improvements may be needed.

HCPC - standards of education and training and guidance

The Health and Care Professions Council (HCPC) has released revised Standards of education and training (SETs) and guidance.

The SETs are the standards against which the HCPC assesses education and training programmes.

Key changes include:

• new standards requiring interprofessional education, learner involvement and supporting learners to raise concerns;
• strengthening the link between the SETs and the standards of conduct, performance and ethics; 
• making key terminology broader, inclusive and up to date with current terminology used in the sector.

Toolkit: for communications and engagement teams in service change

This document from NHS Improvement provides useful information on effective communications and engagement for teams going through programmes that might require service change.

Tumor Segmentation in Whole Slide Images Using Persistent Homology and Deep Convolutional Features

Chapter in book Medical Image Understanding and Analysis: 21st Annual Conference, MIUA 2017 Proceedings. From page 320. eISSN 9783319609645. Springer 2017

UHCW Research: Yee-Wah Tsang

Effectiveness of ulipristal acetate

Journal of Obstetrics and Gynaecology Research. Conference: 25th Asian and Oceanic Congress of Obstetrics and Gynaecology. Hong Kong. 43 (pp 89-90), 2017.

Audit of women, receiving ulipristal acetate as 1st line (EC) was compared to a retrospective audit of women who received levonorgestrel as 1st line. Results: 662 women received ulipristal acetate, 1 required a TOP. 1397 received levonorgestrel of which 5 required TOP. This is shown below in the table with the failure rate. [TABLE PRESENTED] The odds ratio (of the failure rates) between ulipristal acetate compared to levonorgestrel is 0.50. (Calculation: Odds Ratio = 0.0015106 / 0.0030157 = 0.50091189). Conclusion: This demonstrates that the change in faculty guidance is justified and data from studies suggesting ulipristal acetate is more effective than levonorgestrel is reflected in clinical practice.

UHCW Research: Rimmer M

People with learning disabilities: making reasonable adjustments

These guides explain why reasonable adjustments must be made to services and what adjustments help people with learning disabilities access services.  They have recently been updated.

Action needed to prevent confusion over medicines

Only about a third (37%) of the public trust evidence from medical research, compared to approximately two-thirds (65%) who trust the experiences of their friends and family, according to the Enhancing the use of scientific evidence report launched by the Academy of Medical Sciences.

Tackling variations in clinical care: Assessing the Getting It Right First Time (GIRFT) programme

The Getting It Right First Time (GIRFT) programme from the King's Fund aims to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices.

It uses national data to identify the variations and outcomes, shares that data with all those concerned with a service – not only clinicians, but also clinical and medical directors, managers and chief executives – and monitors the changes that are implemented.

The programme began with orthopaedics and is now being rolled out to 32 different surgical and medical specialisms across the English NHS. Through an informal assessment of the programme, this paper sets out what the programme is, why it is needed, what is different about it, what it has achieved, what challenges it faces and what potential it has. It also contains vignettes illustrating hospitals’ experiences of the programme.

Capital collaborations between the NHS and local authorities

CIPFA and the HFMA have worked together to produce this briefing as an initial output from a joint workshop on capital funding in the NHS.

The briefing provides background on the local authority and NHS funding mechanisms, including the prudential code under which local authority treasury management and borrowing is determined. It sets out the problems that NHS bodies currently face in relation to capital funding and identifies some opportunities for working together on capital projects.

Principles of Consent Guidance for nursing staff

This RCN document aims to provide information to registered nurses and other nursing staff to guide their practice around consent.

Winter warning: managing risk in health and care this winter

This report from NHS Providers highlights concerns from NHS leaders around the ability of the health system to respond to mounting pressures next winter. It argues that the extra £1bn social care funding committed to easing delayed transfers of care will not be sufficient with 91 per cent of trusts reporting a lack of capacity in social care. The report calls for a funding injection of £350m to ensure that there is enough capacity across the system and to ensure adequate resourcing.

BMA ARM polling 2017

Ahead of the BMA Annual Representatives Meeting, Britain Thinks were asked to conduct a public opinion survey of over 1000 people in England to explore patient satisfaction with NHS care and public views on the future of the service.

Delivery costs extra: can STPs survive without the funding they need?

This report from the British Medical Association analyses all 44 STP plans and highlights concerns around poor engagement with clinicians, patients and the public and the challenging timeline of STP implementation without upfront funding to deliver the plans. The report is also accompanied by a paper summarising each STP plan and a glossary of commonly used acronyms.

Projects led by physios triumph at HSJ awards

Physiotherapists were among the winning teams at this year’s Health Service Journal (HSJ) Value in Healthcare Awards, which celebrates outstanding efficiency and improvement in the NHS.

They included a physio-led team from Leicester, which won in the training and development category of the awards.

Diabetes Education

The Effective Diabetes Education Now (EDEN) team from Leicester Diabetes Centre, a collaboration between the local NHS trust and university, received recognition for developing pioneering technology for a diabetes training programme for healthcare professionals.

The team are using artificial intelligence algorithms to generate course recommendations for diabetes training, and to monitor response rates and the training needs of thousands of healthcare professionals.

Standardising chemotherapy doses

A physio-led team from NHS England were named the winners in the pharmacy and medicines optimisation category of the awards.

The team were recognised for their work to standardise chemotherapy drug doses across England, through the implementation of a standardised approach to dose banding.

Diagnostic ultrasound physios

A team of extended scope physiotherapists, from Homerton University Hospital NHS Trust in London, received recognition for providing point-of-care diagnostic ultrasound in the community.

Mental health experts criticise new Netflix film about anorexic girl

Mental health experts have said a Netflix trailer for a film about a teenage girl with anorexia could trigger psychological issues for sufferers and should come with a warning.

To the Bone, which is released next month, tells the story of 20-year-old Ellen, who struggles with anorexia and enters a group recovery home for help. But while its director says the film is intended as “a conversation starter about an issue that is too often clouded by secrecy and misconceptions”, critics say the film risks glamourising and trivialising anorexia

Wheelchair services data published for January–March 2017

NHS England has published wheelchair data for January-March 2017 (Q4)

1 in 5 Kids with Tourette Syndrome Meet Autism Criteria

A new study shows that about one in five children with Tourette syndrome also meet criteria for autism. But the researchers believe this prevalence may be due to a similarity in symptoms rather than actual autism.

Researchers at the University of California San Francisco (UCSF) tested 294 children and 241 adults with Tourette’s for autism, using a self-reporting test called the Social Responsiveness Scale. The findings show that 22.8 percent of the children reached the cutoff for autism, versus 8.7 percent of the adults. In the general population, autism is estimated to affect only 0.3 to 2.9 percent, according to studies cited in the paper.

Meeting us where we're at

Excluded and vulnerable young people often experience multiple risk factors for poor mental health, exacerbated by services that are experienced as ‘hard-to-reach’, which can lead to wide health inequalities.

Research consistently demonstrates that people experiencing material, racial and social disadvantage face poorer life chances. These can include risks to their mental health and becoming caught in cycles of offending.

Meeting us where we’re at summarises our evaluation of three pioneering projects in London developed by MAC-UK. The projects use the INTEGRATE approach, characterised by engaging young people through co-designing and co-delivering projects, and by securing referrals through peers.

VISION 2020 UK – Pathway for Children and Young People (0 to 25 years) with Vision Impairment, and their Families

VISION 2020 has published a pathway for children and young people with vision impairment.

It is a best practice, generic pathway that requires health, social care, education and the voluntary sector to work collaboratively to meet the needs of the child or young person and their family.

Each baby counts - 2015 summary report

Three quarters (76%) of cases of stillbirth, neonatal death and brain injury during childbirth might have had different outcomes with different care, according to a report by the Royal College of Obstetricians and Gynaecologists. The conclusion is based on a review of cases that underwent local review in 2015

State of the art cancer-treating cyclotron arrives at UK’s first high energy proton beam centre at The Christie

A state of the art proton beam therapy machine, the ‘cyclotron’, will be installed at the specialist cancer hospital The Christie in Manchester.

Proton beam therapy is a specialist form of radiotherapy that targets certain cancers very precisely, increasing success rates and reducing side-effects. It targets tumours with less damage to surrounding healthy tissue and is particularly appropriate for certain cancers in children who are at risk of lasting damage to organs that are still growing. While The Christie and UCLH centres are being built, all clinically eligible NHS patients will continue to be funded to travel overseas for treatment with NHS England’s established partner centres in America and Switzerland.

Obstructive Sleep Apnoea and Polycystic Ovary Syndrome; a comprehensive review of clinical interactions and underlying pathophysiology

Clin Endocrinol (Oxf). 2017 Jun 22. doi: 10.1111/cen.13392. [Epub ahead of print]

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women of reproductive age. PCOS is associated with multiple co-morbidities including, obesity, insulin resistance and type 2 diabetes, as well as mood disorders and impaired quality of life (QoL). Obstructive sleep apnoea (OSA) is also a common medical condition that is often undiagnosed, particularly in women. OSA is associated with a similar spectrum of comorbidities to that observed in PCOS, including manifestations of the metabolic syndrome and impaired QoL, whilst obesity frequently constitutes a common denominator in the pathophysiology of both OSA and PCOS. Hence, it is not surprising that OSA and PCOS may co-exist in women of reproductive age, and the current clinical guidelines on the management of PCOS recommend screening for OSA symptoms in overweight/obese women with PCOS. In this review, we examine the relationship between OSA and PCOS and explore the potential underlying mechanisms that link these two conditions.

UHCW research: H. Kahal, I Kyrou, H. S. Randeva

OC-057 Undetectable faecal immunochemical test for haemoglobin excludes colorectal cancer in symptomatic patients: a prospective uk study

Gut 2017;66:A30-A31

The diagnosis of colorectal cancer (CRC) in primary care can be challenging as symptoms are variable with poor specificity. We investigated the diagnostic accuracies of faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP) in symptomatic patients referred from primary care for urgent lower gastrointestinal investigations via the two-week wait colorectal pathway.

UHCW Research: M. M. Widlak, C. L. T|homas, C. Tomkins, C. Darby, N. O'Connell, S. Wurie, L. Burns, C. Harmston, R. P. Aradaradnan, C. Evans and C. U. Nwokolo

Fibroblast growth factors: new insights, new targets in the management of diabetes

Minerva endocrinologica42.3 (September 2017): 248-270. 

This review presents a brief overview of the FGF family, describing the mode of action of the different FGFs subgroups, and focuses on FGF1 and FGF15/FGF19, which appear to also represent promising new targets for the treatment of obesity and type 2 diabetes.

UHCW Research: M. O. Weickert

Sustainability and transformation plans: how series are the proposals? A critical review

This report from the London South Bank University, School of Health and Social Care argues that in order to deliver a better future for the NHS all 44 STPs would need to be given legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role.

It also recommends that STP leaders need to plan ahead based on the reality of their current situation, identify changes that are evidence-based, develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector. Alongside the main report, 44 sub-reports are available, each critically reviewing the plans for each STP locality.

Adult weight management: guidance for commissioners and providers

This collection of guidance, interventions and datasets from Public Health England aims to support commissioners and providers of tier two adult weight management services.

The guidance outlines findings from qualitiative research providing insight into patient experience of weight management services, evidence to support commissioning, and further information on evidence-based behaviour change techniques.

A lung health service: Doncaster pharmacy direct referral for chest x-ray

The Accelerate, Coordinate, Evaluate (ACE) Programme is an early diagnosis programme that supports the NHS outcome of preventing people from dying prematurely. This report presents a summary from the Doncaster site which piloted a pharmacist direct referral to chest x-ray pathway which aimed to improve the diagnosis of lung cancer. It outlines early findings from the pilot project and suggestions for rolling out a similar pathway.

The Rising Cost of Clinical Negligence: Who Pays the Price?

This report from the Medical Protection Society estimates that clinical negligence costs in the NHS have increased by 72 per cent over the last five years and that costs could reach £2.6bn a year by 2022. It argues that there should be reasonable compensation for patients who suffer harm due to clinical negligence but that this must be balanced against society's ability to pay. The report makes recommendations for legal reforms around clinical negligence compensation.

Guidelines for the Management of Cancer of the Colon, Rectum and Anus

ACGBI's Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017):

• Introduction
• Diagnosis, Investigations and Screening
• Surgical Management
• Multidisciplinary Management
• Follow Up, Lifestyle and Survivorship
• Audit and Outcome Reporting
• Pathology Standards and Datasets
• Anal Cancer

Using inherent and elective behavior to improve hand hygiene monitoring in health care

Am J Infect Control. 2017 Jun 16. pii: S0196-6553(17)30288-2. doi: 10.1016/j.ajic.2017.03.032. [Epub ahead of print]

This study established a method for collecting hand hygiene (HH) performance data based on behavioral drivers (inherent or elective) that can be used by infection preventionists (IPs) to improve practice. Further, we explored the influence that task and setting has on HH behavior. A significant effect was found between task and setting that has implications for improving the usefulness of HH measurement, with positive feedback reported regarding the new measurement method.

UHCW Research: Dawson C, Wells F and, Prevc K

How safe are our children? 2017: The most comprehensive overview of child protection in the UK

This NSPCC report compiles and analyses the most robust and up-to-date child protection data that exists across the 4 nations in the UK for 2017.

The report sets out 20 different indicators. Each indicator looks at the question of 'how safe are our children?' from a different perspective. They also include historic data, to help track progress over time.

Enhancing the use of scientific evidence to judge the potential benefits and harms of medicines

This report from the Academy of Medical Sciences highlights the difficulties patients and some healthcare professionals face in using evidence from research to judge the benefits and harms of medicines, and calls for concerted action to improve the information patients receive. It calls for a range of actions including improvements to patient information leaflets, better use of medical appointments and a larger role for NHS Choices as the ‘go to’ source of trusted information online for patients and carers, as well as healthcare professionals.

NHS Urgent Medicine Supply Advanced Service Pilot: Toolkit for Pharmacy Staff

A practical guide from NHS England on how to deliver the NHS Urgent Medicine Supply Advanced Service.

NICE approves COPD treatment roflumilast for routine NHS use

Thousands of patients to benefit from roflumilast, also known as Daxas, to treat chronic obstructive pulmonary disease (COPD) after NICE says it should be more widely available.

Roflumilast is recommended as an option to treat adults with severe COPD whose symptoms continue to worsen despite other treatments. It is a once-a-day tablet that works to reduce irritation and swelling in airways of people with COPD.

Joint NMC/RCN statement regarding Decisions Relating to Cardiopulmonary Resuscitation

Guidance from the British Medical Association, the Resuscitation Council (UK), and the RCN regarding anticipatory decisions about whether or not to attempt resuscitation in a person when their heart stops or they stop breathing. The NMC is supportive of this guidance.

Is your CCG meeting the national mental health investment standard?

More than one in ten CCGs are failing to meet the national Mental Health Investment Standard, RCPsych analysis shows.

We looked at the spending of 203 CCGs across England and found that 29 – or 14.3% – are not meeting the standard set by NHS England for 2017/18.

During the next financial year the picture is not much better. Twenty one CCGs (10.3%) have failed to meet the standard.

This is despite NHS England requiring CCGs to increase investment in Mental Health services in line with their overall increase in allocation each year.

Read more HERE

Autism self-assessment framework exercise

This report presents the findings from the fourth Autism self-assessment exercise carried out by local authorities (LAs) between July and November 2016. It shows the LAs progress towards meeting the requirements of the Autism Act.

The report is accompanied by personal stories from self-advocates, their families’ and carers.

Elevated rate of autism symptoms found in children with Tourette syndrome

Around one in five children with Tourette syndrome, a neurological disorder characterized by involuntary movements and vocalizations, met criteria for autism, a study shows. But this prevalence may be more a reflection of similarity in symptoms than actual autism, according to the study's researchers.

One in 6 women with learning disabilities has attempted suicide

The lifetime prevalence of suicide attempts was much higher for women who had been diagnosed with learning disabilities (16.6 percent) compared to women who had not (3.3 percent), new research has found. Men with learning disabilities also were more likely to have attempted suicide compared to men without learning disorders (7.7 percent vs 2.1 percent).

Depressed patients more likely to be prescribed opioids

Patients with low back pain who were depressed were more likely to be prescribed opioids and receive higher doses, research has found. Understanding these prescribing patterns sheds new light on the current opioid epidemic and may help determine whether efforts to control prescription opioid abuse are effective.

'Little brain' plays a major role in schizophrenia

The cerebellum is among the most affected brain regions in schizophrenia, new research has found. Compared to healthy individuals, cerebellar volume was smaller in patients with schizophrenia. The study is the largest brain imaging study to date on the cerebellum in schizophrenia, with important implications for our understanding of the disorder.

A Healthy State of Mind: improving young people's mental fitness

Localis, an independent cross-party think tank, has launched a new report on young people’s mental health. The report aims to identify what the system requires to be able to work better to both offer immediate help to those with serious conditions and a wide and flexible variety of support for all those who feel they need it.

This was carried out with data obtained from Freedom of Information requests to CCGs and Foundation Trusts in England; interviews with experts in the field; roundtables of NHS and local government leaders; and focus groups with young people themselves. The Children’s Society and NSPCC also contributed as members of an advisory panel.

New Tool Helps Predict Cognitive Deficits in Parkinson’s

Although Parkinson’s disease (PD) is typically thought of as a movement disorder, approximately 25 percent of patients also experience cognitive deficits.

A newly developed research tool may help predict a patient’s risk for developing dementia and could enable clinical trials aimed at finding treatments to prevent the cognitive effects of the disease.

Investigators at Harvard Medical School and the Ann Romney Center for Neurologic Diseases at Brigham and Women’s Hospital spearheaded development of the computer-based risk calculator

Well-led framework

As part of NHS Improvement's commitment to simplifying its regulatory approaches, they've worked closely with the the Care Quality Commission (CQC) to bring together their respective approaches resulting a fully joint well-led framework structured around eight key lines of enquiry.

The new framework maintains focus on strong integrated governance and leadership across quality, finance and operations, and in line with the changing operating environment, increases emphasis on organisational culture, improvement and system working.

Latest NHS sickness absence statistics - February 2017

NHS Digital latest figures show that NHS staff sickness absence has consistently reduced since February 2012, which was showing at 4.48 per cent. In February 2017 sickness absence was down to 4.29 per cent.

Prevalence and treatment of hypovitaminosis D in the haemodialysis population of Coventry

J Steroid Biochem Mol Biol. 2016 Nov;164:214-217. doi: 10.1016/j.jsbmb.2016.02.009. Epub 2016 Feb 11.

Low serum 25(OH)D and associated bone and non-bone related problems are not well appreciated in end stage renal disease (ESRD). Vitamin D treatment strategies in the UK currently focus almost exclusively on calcitriol [1,25(OH)2D], alfacalcidol or paricalcitol. In ESRD hypovitaminosis D is associated with bone loss, muscle weakness, falls, fractures and increased inflammation. National guidelines changed in 2014 and now recommend the diagnosis and treatment of low serum 25(OH)D in all patients with glomerular filtration rate (GFR) less than 30ml/min/1.73m2. However as yet there are no standardized guidelines for dosage, frequency and monitoring in ESRD patients. Following a systematic review of the literature we developed a clinical guideline for cholecalciferol supplementation at University Hospitals of Coventry and Warwickshire, UK. The guideline recommends 40,000IU cholecalciferol weekly for patients with 25(OH)D <50nmol/L and 20,000IU weekly for patients with 25(OH)D 50-75nmol/L; to be continued long term unless levels increase to ≥150nmol/L. To date we have measured 25(OH)D levels in 385 in-center haemodialysis patients. Virtually all patients (95%) had serum 25(OH)D levels <75nmol/L (65% deficient, <30nmol/L; 30% insufficient, 30-74nmol/L). Only 5% of patients had optimal levels (≥75nmol/L). Our data indicates that hypovitaminosis D is prevalent in the haemodialysis population in Coventry and Warwickshire and this is likely to reflect UK haemodialysis patients, highlighting the need for a national supplementation guideline.

UHCW Research: Huish, S. A., Fletcher, S. and Bland R.

New time-saving data collection system

NHS Improvement has developed an innovative, automated data collection system which will save the NHS thousands of hours each year.

The simple system, which works with all NHS applications, places a server on to your systems that automatically “pulls” data from your databases, removing the need for you to export and upload the data manually. All of the winter sit rep data that you'd normally upload manually on a daily basis, will be automatically uploaded to our databases. 

We know the current manual system of uploading the winter sitrep data can take up to 45 mins per day so this new proecss will save you valuable time. Through our Emergency Care Improvement Programme (ECIP), we've already successfully implemented the system in more than 40 trusts.
The system will also be used to populate an emergency care dashboard, giving you deep insight into how patients flow through your emergency department and where there maybe bottlenecks. 

Advanced Clinical Practitioner Apprenticeship Standard

Want to comment on plans for setting the standard for a master’s level advanced practice apprenticeship?

The Apprenticeship Standard for Advanced Clinical Practitioner has been drafted to reflect the content of the draft National Framework for Multi-professional Advanced Clinical Practice. This important Framework defines the core capabilities for Advanced Clinical Practitioners and recommends the standard of education.

Please download a copy of the draft standard before you start this survey so that you can refer to it whilst you are completing it.

NHS England to invest in building the right support for people with a learning disability

Patients with a learning disability, autism or both are set to benefit from over £10 million investment by NHS England to help them lead more independent lives, closer to their friends and family.

The funding will support fourteen local Transforming Care Partnerships – made up of NHS organisations, local authorities and NHS England commissioners, working closely with people who use services, their families and providers – to develop new, high-quality, community services for people in their area.

New programme will assess how digital therapies can help treat anxiety and depression

NICE is to start assessing new digital therapies that will help treat more people with anxiety and depression.

Guided self-help, which can track people’s mood or advise on breathing exercises for example, is recommended by NICE guidance to help treat mild to moderate anxiety and depression.

As part of NHS England’s Improving Access to Psychological Therapies (IAPT) programme, NICE has been asked to assess digital applications or computer programmes, which will sit alongside face-to-face, phone and online therapy.

Teamwork in maternity units key to reducing baby deaths and brain injuries during childbirth

A detailed analysis of all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015 has identified key clinical actions needed to improve the quality of care and prevent future cases, reveals a summary report from the Royal College of Obstetricians and Gynaecologists’ (RCOG) Each Baby Counts initiative.

HEE publish report on improving juniors doctors' morale

Following a research exercise on the morale of junior doctors in the NHS, Health Education England (HEE) has published a report highlighting the issues many trainee doctors face, and how the NHS can address them.

Some of the negative findings include:

• 50 per cent of trainees were suffering from burnout
• 80 per cent of trainees felt their job caused excess stress
• 25 per cent of trainees felt their job had a serious impact on their mental health.

Common features of best working environments were:

• Supervision - named consultants, contact for emergencies, weekly contact with trainee.
• Protected time - clinical work structure, study leave and reflection time, personal life respected.
• Valued by employer - attention to facilities, CEO attend induction, investment in learning.

ACT Therapy Can Ease Depression & Anxiety of Rheumatoid Arthritis

A new European study has found that Acceptance and Commitment Therapy, a form of cognitive-behavioral therapy (CBT) and mindfulness, provided a significant reduction in self-reported depression and anxiety among individuals with rheumatoid arthritis.

Acceptance and Commitment Therapy focuses on psychological flexibility and behavior change. The approach provided significant reduction in self-reported depression and anxiety among patients participating in a pain rehabilitation program.

Risky Behaviors May Worsen PTSD Symptoms

Emerging research suggest that engaging in risky behavior — itself a symptom of posttraumatic stress disorder— could in turn lead to worse PTSD symptoms.

The discovery of evidence for a link between risky behavior and PTSD has led to the inclusion of “reckless and self-destructive behavior” as a symptom of PTSD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the handbook used to diagnose psychiatric conditions.

Top tips on managing professional boundaries in social work

As with all professions, social workers are expected to uphold key boundaries to protect themselves, their clients and the organisation they work for. These boundaries are meant to ensure that relationships between social workers and clients remain professional, even when working on very personal and difficult issues.

Neuroimaging technique may help predict autism among high-risk infants

Functional connectivity magnetic resonance imaging (fcMRI) may predict which high-risk, 6-month old infants will develop autism spectrum disorder (ASD) by age 2 years, according to a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Mental Health (NIMH), two components of the National Institutes of Health. The study is published in the June 7, 2017, issue of Science Translational Medicine.

Cognitive behavior therapy significantly reduced depression and anxiety in chronic pain patients

Acceptance and Commitment Therapy, a form of cognitive behavioral therapy that focuses on psychological flexibility and behavior change, provided a significant reduction in self-reported depression and anxiety among patients participating in a pain rehabilitation program, new research has demonstrated.

Mental health beds shortfall puts patients at 'intolerable' risk

Commissioners are planning to spend millions of pounds on extra acute mental health services, after shortfalls in beds in a controversial new service placed patients at “intolerable” risk.

Read more HERE (login required)

Long-stay rehabilitation services

This briefing reviews evidence from Care Quality Commission inspection reports of inpatient rehabilitation services in England. It finds that while many people receive high quality care close to home from rehabilitation services, a minority spend periods of many months and sometimes years in hospital. Some are placed far from home in locked wards and become isolated from their families and dislocated from their local health and care services. It calls on the government and the NHS to provide clear direction for the development and improvement of local community and hospital services for people with complex mental health needs. It also calls on NHS providers and CCGs to ensure they offer local services to people requiring rehabilitation support and that they maintain contact with people admitted to hospitals out of their local area.

• Report

New colleagues to support mental health services

NHS Improvement have expanded their nursing team to provide more intensive support to NHS mental health services across England.

Read more HERE

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

Journal of Receptors and Signal Transduction,Volume 37, 2017 - Issue 4

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: Michael Thomas and David Snead

Dementia long term condition scenario

In this new long term condition scenario from NHS RightCare – using a fictional patient, Tom – we examine a dementia care pathway, comparing a sub-optimal but not atypical scenario against an ideal pathway. At each stage we have modelled the costs of care, to the commissioner and the impact on the person and their family’s outcomes and experience.

Digital leadership in London's NHS

For the first time, NHS providers in London have revealed the extent to which smartphones, the Internet and Bluetooth are improving patient care and look set to save the capital’s NHS millions each year.Guy’s and St Thomas’ NHS Foundation Trust expects to save £2.5 million each year by reducing missed appointments through an app called DrDoctor which gives patients much more say in selecting a date and time of their choice, resulting in “no show” rates falling by 40%.

Local growth and the NHS: Building the foundations of a healthy economy

By influencing local strategic economic planning, the NHS can improve its service to the community, have a much greater say in devolved strategic discussions and secure long-term, additional funding into the health service.

This briefing explores the context within which local growth is increasingly shaping local economic planning and the NHS’ role in contributing to this agenda.

It will be of interest to sustainability and transformation plan leads, NHS chairs, chief executives and non-executive directors, as well as directors of finance, strategy, HR, transformation and public health.

Where next for commissioning?

NHS Providers has launched a new publication series “Provider Voices” which promotes the views of leaders from a range of trusts and other parts of the service on some of the key issues facing the NHS today.

The first report Where next for commissioning? includes eight interviews that address concerns including the role of Sustainability and Transformation Partnerships (STPs) and accountable care systems (ACSs), the challenge of integrating health and care commissioning, and the future of the purchaser-provider split.

Linking and sharing routine health data for research in England

Research using de-identified routine health data can provide unique insights to improve population health. England has a wealth of routine health data from sources such as electronic records and public health surveillance systems.

However, due to challenges in linking and sharing these datasets their potential to enable powerful, efficient research that informs health policy and services is not being realised. How can we gain the greatest benefits to society from the collection of routine health data?  The PHG Foundation tries to answer this question

Sustainability and transformation plans: moving towards implementation

Presentations from an King's Fund event in Manchester held on June 6th about sustainability and transformation plans.

Two new bite-size guides to insight and feedback published

Two further bite-size guides to patient insight have been launched to help CCGs and providers to carry out qualitative research and to gather feedback from people with a learning disability.

Quarterly performance of the NHS provider sector: quarter 4 2016/17

The NHS provider sector's deficit has been cut by two-thirds in the financial year just ended – from £2.4 billion in 2015/16 to £791 million in 2016/17.

These figures represent an improvement of £1.7 billion, driven by savings of over £3.1 billion with over £700 million saved on locum and agency use in the year.

This is against a backdrop of rising demand and a significant increase in delayed transfers of care. Our analysis shows that providers experienced a 24.5% increase in delayed days in 2016/17 compared to 2015/16.

Three projects chosen for research into system efficiency and sustainability in health and social care

Three new research projects have been awarded grants by the Health Foundation, as part of its £1.5 million Efficiency Research Programme.  They will explore innovative approaches to achieving greater system efficiency and sustainability in health and social care in the UK.

Allocative efficiency in end-of-life care Lead organisation: Imperial College London

This research project will look at whether improvements in the efficiency of health and social care delivery at the end of life could enable access to higher-quality and more personalised care for patients.

WORKTECC: Workforce Operations that Realise Knowledge-based Transformational Efficiency gains in Community Care Lead organisation: University College London (UCL)

This research project aims to identify the scope for transformational efficiency gains in home-based NHS care. It will assess whether workforce operations used by other industries could deliver improved efficiency, and if so, how.

Efficiency, cost and quality of mental health care provision Lead organisation: The University of York

This research project will look at the efficiency, cost and quality of current mental health care provision, assess organisational factors, and estimate how mental health trusts can make changes to improve their efficiency and cost effectiveness.

How can we assess how well providers review, investigate and learn from deaths?

The CQC would like your views on how we can strengthen the way we look at whether NHS trusts learn from deaths to improve the care they provide.

They'd particularly like to hear from families and carers, but are interested in the views of health professionals too. You can tell them what you think by taking part in our online survey. The survey closes at 6pm on 14 July.

Interactive dashboard provides new insight into cervical screening coverage

GPs and health organisations will be able to improve cervical screening rates thanks to an innovative new online data tool.It is hoped that the interactive dashboard will help identify areas where screening levels could be improved and encourage work to boost coverage.

The dashboard will provide more detailed and timely information about cervical screening and will help Clinical Commissioning Groups (CCGs), GP practices and local authorities to improve coverage rates for the potentially lifesaving test, which are currently falling.

New type of treatment for Crohn’s disease is approved by NICE

Following NICE recommendations, patients with Crohn’s disease will have routine NHS access to drug ustekinumab, which offers a new way of treating the condition.

Ustekinumab (also called Stelara, manufactured by Janssen) will be available for patients with moderate to severe Crohn’s disease.

It is recommended by NICE as an option for treating the disease in adults who have had little or no response, or an intolerance to existing therapies.

More A&E funding to help hospitals prepare for winter

The Secretary of State for Health Jeremy Hunt has announced a second wave of funding to ease pressure on hospital emergency departments ahead of next winter.

A further £20.74 million has been awarded to 27 hospitals in England, which follows an initial £55.98 million given to 70 hospitals in April. This money is part of the dedicated funding announced in the Spring Budget to ensure local A&Es are prepared for the additional demands that winter brings.

NHS moves to end “fractured” care system

The head of NHS England has pledged to end the “fractured” health and social care system that leaves too many patients “passed from pillar to post” by giving local leaders and communities more control over how they improve health and social care.

Addressing the NHS Confederation in Liverpool, Simon Stevens announced nine areas in England – covering some seven million people – which will be the forefront of nationwide action to provide joined up, better coordinated care breaking down the barriers between GPs and hospitals, physical and mental healthcare, social care and the NHS.

Eight ‘accountable care systems’ (ACSs) will bring together local NHS organisations, often in partnership with social care services and the voluntary sector. They build on the learning from and early results of NHS England’s new care model ‘vanguards’, which are slowing emergency hospitalisations growth by up to two thirds compared with other less integrated parts of the country.

Kadcyla new deal for breast cancer patients given green light in final draft guidance

Kadcyla is currently being funded through the Cancer Drugs Fund (CDF). The new agreement means if there are no appeals against the new draft guidance, the drug will move out of the CDF into routine NHS funding later this summer. This will mean eligible patients will no longer have to apply for funding and the drug will be paid for in the normal way.

International Code for Planning, Commissioning and Providing Technology Enabled Care Services

CECOPS has developed a first-ever International outcomes-based Code of Practice for Planning, Commissioning and Providing Technology Enabled Care Services (TECS).


The end-to-end Code can help organisations prepare for engaging with TECS, as well as providing a quality framework for procurement and provision of services, simplifying the commissioning and tendering of services. It can also help with assessing, progressing and accelerating organisational readiness.


This new Code brings together all these technologies in one truly integrated framework. Uniquely, this Code, which sets out standards covering every aspect of services, offers an end-to-end and whole-system approach, ranging from the early planning stages through to post-implementation of services. It can be looked at as a value-chain solution that interlinks those responsible for planning and commissioning services with service users, through the activities of clinicians and providers.

Study: 10 Years of Data Show Pre-Symptom Early Stage of Alzheimer’s

Older adults with elevated levels of brain-clogging amyloid plaques — but otherwise normal cognition — experience faster mental decline suggestive of Alzheimer’s disease, according to a new study led by USC researchers that looked at 10 years of data.

Children’s Hospital Passport

The Hospital Passport contains important information, such as medical history, medications and baseline health for the child, and also contains information about how a child communicates; how they express pain and anxiety, their likes and dislikes.

The practitioner should read the Hospital Passport prior to meeting the patient so that they may build up a rapport and put into place any reasonable adjustments. This could include communication technique, or the way a medical intervention is carried out. This enables staff to understand the child in a unique way and therefore prevent any diagnostic overshadowing and discrimination due to disability.

New Protocol Predicts Effectiveness of Interventions for Adult Autism

Researchers have created a protocol to predict individual treatment effectiveness for adults on the autism spectrum.

Investigators from the Center for BrainHealth at the University of Texas at Dallas and George Washington University used functional magnetic resonance imaging (fMRI) to identify if a virtual environment-based training program lead to changes in brain areas that are associated with social skills.

Researchers discovered that adults on the autism spectrum with greater activity in the social brain network prior to the training improved more in emotion recognition than those who showed less activity.

Reckless behavior fuels ongoing stress for some with PTSD

For those with posttraumatic stress disorder, risky and harmful behaviors could lead to more trauma and, in turn, worse PSTD symptoms over time, research concludes.

Joanna D. Lusk, Naomi Sadeh, Erika J. Wolf, Mark W. Miller.Reckless Self-Destructive Behavior and PTSD in Veterans: The Mediating Role of New Adverse Events.Journal of Traumatic Stress, 2017; DOI: 10.1002/jts.22182

Glaucoma: diagnosis and management (update)

NICE has opened a consultation on draft guidelines on diagnosis and management of glaucoma, closing 4 July 2017.

This is a partial update of the 2009 clinical guideline on Glaucoma: diagnosis and management of chronic open-angle glaucoma and ocular hypertension. The sections new or updated in this year’s version are:

• Guideline committee and scope
• Methodology
• Case-finding, diagnosis and monitoring
• Service models
• Prognostic risk tools
• Treatment of ocular hypertension, suspected chronic open-angle glaucoma and chronic openangle glaucoma

All other sections and recommendations for the 2009 guideline remain unchanged.

Stevens sets out programme of action for NHS

Meeting the A&E waiting time target and turning the corner on primary care investment will be key priorities for the NHS over the next 12 to 14 months, the head of NHS England has said.

Speaking at Confed17, Simon Stevens said the NHS will need to achieve the 95 per cent four-hour A&E waiting time target by the end of this year – echoing statements made by health secretary Jeremy Hunt this morning.

Further ‘overriding priorities’ include primary care, mental health and cancer treatments waiting times. “This needs to be firmly on our agenda for the year ahead,” he said.

Look after current staff to secure the future NHS workforce

‘Retention retention retention’ was the mantra of Ian Cumming on day two of Confed17, with a call to secure a sustainable NHS workforce by looking after the staff we already have.

Showing figures on retention and supply, he highlighted the paradox of a large workforce shortfall, despite more people than ever wanting to take up nursing and medicine.

Between 2016 and 2018, 87,000 nurses will leave, not retire from, the NHS. And though 84,000 will come back, only 64,000 newly qualified nurses will start in that period.
More flexibility needed

Insufficient flexibility in working patterns was the main reason for nurses leaving the NHS, according to HEE statistics. Addressing this root cause and looking after the staff we already have is essential, he said.

Mr Cumming suggested short, medium and long-term solutions to tackle the problem, including increased flexibility, new roles such as physician associates, and increased use of volunteers

Physios join Microsoft for ground breaking cystic fibrosis tech project

A university physiotherapy department is working with Microsoft to develop computer games that motivate children with cystic fibrosis (CF) to complete breathing exercises to clear their lungs.

NHS expenditure

This briefing from the House of Commons Library documents NHS expenditure since 1948. It also contains a summary of the structure of the NHS and how it is financed.

Acting without delay: How the independent sector is working with the NHS to reduce delayed discharge

This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care.

Cardiac resynchronization therapy and its role in the management of heart failure

Br J Hosp Med (Lond). 2017 Jun 2;78(6):312-319. doi: 10.12968/hmed.2017.78.6.312.

The prevalence of heart failure is increasing and it is associated with significant mortality and morbidity. Optimal medical therapy improves outcome, but heart failure continues to have a substantial impact on both the individual patient and wider society. Over the last two decades, cardiac resynchronization therapy has revolutionized the treatment of selected patients who have heart failure. Cardiac resynchronization therapy significantly reduces mortality and hospitalization through reverse cardiac remodelling. This review informs non-specialists about cardiac resynchronization therapy and for which patients it should be considered.

UHCW Research: McAloon CJ, Hayat S and Osman F

WHO updates Essential Medicines List with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, tuberculosis and cance

New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to the WHO Model list of essential medicines for 2017. Other additions include medicines for HIV, hepatitis C, tuberculosis and leukaemia.

Quantifying the ‘Lung at Risk’ in COPD: Does Emphysema Beget Emphysema?

Am J Respir Crit Care Med. 2017 Jun 13. doi: 10.1164/rccm.201705-0962ED. [Epub ahead of print]

UHCW Research: David G Parr

Trustworthy Collaboration - the challenges of building trust across health systems

Trustworthy Collaboration, written for NHS Employers by Prof Veronica Hope-Hailey of the University of Bath, explores the challenges of building trust across health systems, in the context of the 50 vanguard sites tasked with delivering transformational change through new care models.

Risk of aspirin-related bleeding is higher in the over-75s

"People over 75 taking daily aspirin after a stroke or heart attack are at higher risk of major – and sometimes fatal – stomach bleeds than previously thought," BBC News reports.

The study involved around 3,000 adults from Oxford who were prescribed aspirin due to previous heart attack or stroke. Researchers followed these patients for up to 10 years to see how many of them were admitted to hospital with bleeds.

They found that for under-75s the annual risk of bleeding is around 1%. However adults over the age of 75 have three times the risk of a major bleed compared with younger adults, particularly bleeds of the stomach and upper digestive tract.

The researchers estimate that routinely prescribing proton pump inhibitor (PPIs) could drastically reduce these risks in older adults. PPIs are drugs that help protect the lining of the stomach and so reduce the risk of a bleed.

Report on abortion statistics in England and Wales for 2016

Statistics and commentary from the Department of Health on abortions carried out in 2016.

Help us shape the data collection process on cancer waiting times

Implementing the new cancer waiting time standard is a key aim of the cancer improvement programme we're developing with NHS England.

As part of this, NHS Digital's Burden Advice and Assessment Service (BAAS) team is evaluating an application to collect data for this programme.

This consultation seeks views from your operational leads working in and across cancer services on the changes to the dataset and submission process proposed for implementation from April 2018.

NHS trusts tell their stories of improvement

What do NHS trusts do to turn themselves around? Our collection of case studies on eight trusts looks at the steps each one took on its own improvement journey.

Each of the eight trusts is one that has progressed from a low CQC rating to a higher one – or has left special measures, the package of support designed to help trusts with significant challenges. The eight trusts we spoke to are:

• University Hospitals of Morecambe Bay NHS Foundation Trust
• East Lancashire Hospitals NHS Trust
• Cambridge University Hospitals NHS Trust
• Wexham Park Hospital
• University Hospitals Bristol NHS Foundation Trust
• Barking, Havering and Redbridge University Hospitals NHS Foundation Trust
• Leeds Teaching Hospital NHS Foundation Trust
• Mid Essex Hospital Services NHS Trust

CQC relaxes stance on ‘bed limit’ for learning disability services

The Care Quality Commission has relaxed proposals to introduce a cap on the number of beds a learning disability service can have as a condition of registration.

The regulator attracted criticism after publishing draft guidance that appeared to restrict registration to facilities housing six people or fewer, in line with National Institute for Health and Care Excellence (NICE) policy on autism accommodation.

Following a consultation period, the CQC has published an amended version of its document, ‘Registering the right support’, in which the language has been softened. The new guidance says that the CQC “will not adopt ‘six’ as a rigid rule” for providers of any service for people with a learning disability and/or autism.

CQC - tell us your views on our next phase of regulation

The CQC is consulting on a further set of proposals which will help shape our next phase of regulation of health and social care in England.

For the next eight weeks, anyone with an interest is encouraged to have their say.

The proposals include:

• Changes to the regulation of primary medical services such as GPs and dentists and adult social care services such as care homes and home-care services.
• This includes the frequency and intensity of our inspections and how we monitor, provide and gather intelligence.
• Improvements to the structure of registration and our definition of ‘registered providers’.
• Further information on how we'll monitor, inspect and rate new models of care and large or complex providers.

Revised guidance on returning to practice published

THE HCPC has published revised guidance on returning to practice.

Specific changes
One of the main changes to the guidance is the inclusion of a flow chart that clearly depicts the returning to practice process and assists the reader in determining whether returning to practice requirements apply to them.

We have also provided clarity around what we mean by ‘practising your profession’ and the difference between the supervisor and counter-signatory roles. The guidance also now signposts to professional bodies for further guidance on profession-specific practice and periods of updating.

We would like to thank everyone that contributed to the review of the guidance.

The shrinking value of the commissioning pound

This briefing from NHS Clinical Commissioners shows that rising inflation, along with a growing population, has resulted in a real terms decrease in the value of the CCG funding allocations. The analysis projects that by 2019/20, CCG funding will diminish by £5.72 per person on average when compared with 2016/17 funding.

CCG lay members, non-executive directors and STP governance and engagement

This report, published in partnership with NHS England, summarises the discussions at four regional workshops which focused on the role of lay members and non-executive directors in STPs. 

It discusses the importance of governance and accountability and developing working relationships across STP footprints. It also captures a number of case studies highlighting where there has been good practice in involving lay members and non-executive directors across STPs

SAS Anaesthetists – Securing our Workforce

The SAS Anaesthetists – Securing Our Workforce report on the outcomes of the RCoA’s 2016 SAS survey is now available after being released today at the College’s annual Summer Symposium meeting.

Online learning modules developed by respiratory physiotherapists.

The 15 interactive modules from the Scottish Physiotherapy in Critical Care Practice Development Group are designed to update band 5 physiotherapists with the latest clinical information about respiratory care. They cover arterial blood gasses, airway clearance techniques, manual hyperinflation, tracheostomy, ventilation and other topics.

The information, interactive tests and quizzes in each module can form part of physiotherapists’ continuous professional development (CPD). University lecturers can also access them for their own CPD.

Although they have been designed for the NHS in Scotland, they can be accessed by physiotherapists in other parts of the UK.

End of antiviral medicine prescribing for 2016/17 influenza season

In light of surveillance data indicating that circulation of influenza in the community has returned to baseline levels, the Department of Health has published an alert to inform prescribers working in primary care and pharmacy teams that antiviral medicines should no longer be prescribed.

Health and work: infographics

A series of infographics from Public Health England intended to help raise awareness and understanding of the relationship between health and work.

A physiotherapist has produced a competition-winning YouTube video, which explains the findings of a review of research on using exercise for depression.

Cynthia Srikesavan, a post-doctoral research assistant in physiotherapy at the University of Oxford, created the video in response to a contest run by Cochrane UK, a not-for-profit organisation that produces independent and accessible health information.

The competition challenged health professionals to create a resource that could share the findings a Cochrane review, relevant to their practice, with their peers and colleagues.

Dr Srikesavan told Frontline: ‘I chose a 2013 review on exercise for depression, because I think it’s a very relevant topic for physiotherapists.

The video highlights the review’s conclusion that there is no high quality evidence to recommend exercise as a standalone intervention or one that can replace anti-depressants or psychological therapies for adults with depression.

Professional certificate recognised by NHS national diabetic eye screening programme

The College of Optometrists and Public Health England have mapped the college-accredited professional certificate in medical retina to the new level three diploma for health screeners (diabetic eye).

The alignment will allow optometrists who study for the updated professional certificate in medical retina to cover all requirements for the level three diploma, with the exception of the diabetic retinopathy imaging unit, without carrying out the majority of the NHS England diabetic eye screening programme (DESP) training.

National Guardian's Office launches new directory/Trial of case review process

The National Guardian's Office (NGO), responsible for providing leadership and advice for Freedom to Speak Up guardians has published a new national directory of guardians.

Also the National Guardian for the NHS, Dr Henrietta Hughes has launched a 12 month trial of her case review process for NHS trusts and foundation trusts.

Dr Hughes will review the handling of concerns along with the treatment of individuals who have spoken up, where there is evidence that good practice has not been followed. Priority will be allocated to cases that offer the the greatest potential for learning, allowing for failings to be addressed. The purpose of case reviews is to support trusts so they can identity how they can improve their processes and the support offered to staff.

New data show 96% drop in nurses from EU since July last year

New figures have revealed a 96% drop in the number of nurses from the EU registering to practise in the UK since July last year.

The figures were obtained by the Health Foundation from a Freedom of Information request to the Nursing and Midwifery Council (NMC). They show that after a sharp decline from a high of 1,304 in July last year to 344 two months later in September, numbers have continued to fall, with just 46 EU nurse registrants in April this year.

The UK has repeatedly used international recruitment as a stop gap measure to fill staffing shortages, and since 2008 the majority of international nurses registering in the UK have come from within the EU.  But the fall in EU registrants suggests that a more sustainable long-term approach to workforce planning is urgently needed.