Dementia in older age: barriers to primary prevention and factors

These documents help commissioners and researchers make decisions about prioritisation of primary prevention measures relevant to dementia.

This review, by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and Political Science (2016), shows that there is evidence that the risk of dementia is increased by:

• physical inactivity
• current smoking
• diabetes
• hypertension in mid-life
• obesity in mid-life and depression

It also shows that mental activity can reduce the risk of dementia.

To promote primary prevention of dementia, it is important to understand both the barriers to primary prevention and factors which facilitate primary prevention.

Brain Stimulation Aids Cognitive Performance in Schizophrenia

Emerging research suggests brain stimulation could be used to treat cognitive deficits frequently associated with schizophrenia.

Investigators from King’s College London explain that current interventions are ineffective for the deficits which can impact short-term memory and decision making, and lead to severe impairments in people with schizophrenia.

The cognitive disconnect can make it difficult for an individual with schizophrenia to adequately plan, sustain necessary focus and attention, and remember information — factors which have a significant impact on day-to-day life.

NIHR Dissemination Centre Obsessive Compulsive Disorder (OCD)

This resource features research into psychological and pharmacological treatment options for obsessive compulsive disorder and new research on using self-help materials, combined with modest levels of support from mental health practitioners.

Anaesthetic management of a patient with multiple pterygium syndrome for elective caesarean section

International Journal of Obstetric Anesthesia , Volume 31 , 96 - 100 

We report a case of a pregnant woman with multiple pterygium syndrome who presented for elective caesarean section. Neuraxial anaesthesia failed and the backup plan of awake intubation was extremely difficult.

UHCW Research: V. Daga, C. Mendonca, F. Choksey, J. Elton and S. Radhakrishna

Hipsprint reaches 5,000 hip fracture records

Hipsprint, the CSP’s national audit of hip fracture rehabilitation, is designed to provide invaluable insight into the rehabilitation of people after fracturing their hips. It was launched on 1 May and will be running to 31 October. The first phase will remain open for members to enter data on new patients until 31 July.

The research aims to map each patient's rehab journey over a 120-day period. It will now move into the community phase, tracking patients' experiences after leaving hospital.

Behind Closed Doors: Can we expect NHS staff to be the shock absorbers of a system under pressure?

This briefing from the Point of Care Foundation highlights the latest evidence on NHS staff, their experience at work, the pressures they face and the consequences for patients

Improving digital literacy

The effective use of information and digital technologies is a key enabler in delivering health and social care now and in the future. 

Developed by Health Education England and the RCN, the publication outlines why digital capabilities are so important in the provision of the best care; why the right digital knowledge, skills, behaviours and attitudes are important and relevant to each and all of us working in health and care; and what those digital capabilities are.

Musculoskeletal conditions and multimorbidities report

The purpose of this report from Arthritis Research UK is to explore why and how musculoskeletal health should be considered as part of multimorbidity. It examines why the presence of musculoskeletal disease such as osteoarthritis or back pain can have an overall impact on the health, wellbeing and independence of a person living with multimorbidity. The report highlights the extent of the challenge ahead.

Decommissioning health care: identifying best practice through primary and secondary research a prospective mixed-methods study

This NIHR study aims to formulate theoretically grounded, evidence-informed guidance to support best practice in effective decommissioning of NHS services. It finds that there is a lack of robust evidence to guide decommissioning, but among experts there is a high level of consensus for three good-practice principles: establish a strong leadership team, engage clinical leaders from an early stage and establish a clear rationale for change.

Professional standards for pharmacy services: an updated draft for consultation

Feedback and comments are being sought on these updated hospital pharmacy standards from the Royal Pharmaceutical Society. The standards outline what a high-quality hospital pharmacy service should look like and aim to support the development of a transparent and open culture. This consultation closes on 11 September 2017.

Latest NHS sickness absence statistics - March 2017

NHS Digital latest figures show that NHS staff sickness absence has consistently reduced from the first quarter of 2015, which was showing at 4.44 per cent to the first quarter of 2017 sickness absence was down to 4.29 per cent.

Nursing associate case studies published

Health Education England (HEE) has now published a range of case studies on the pilot nursing associate role programme, featuring the new trainees.

There are 2,000 nurse associates currently in training at 35 pilot sites across England.  The case studies document how the trainees feel about the pilot, what they are learning from the experience and the opportunities the role will offer them.

Recommended Musculoskeletal Indicator Set launched

A standard set of indicators for musculoskeletal health services, from Arthritis Research UK relevant to people with arthritis and commissioners.

The indicators describe the value, quality and cost of musculoskeletal services, aimed at those who are responsible for shaping services (commissioners and providers) and also relevant and meaningful to clinicians and patients.

NHS England launches action plan to drive out wasteful and ineffective drug prescriptions, saving NHS over £190 million a year

NHS England has published detailed plans – drawn up with family doctors and pharmacists – to cut out prescriptions for ineffective, over-priced and low value treatments. Helping to trim hundreds of millions from the nation’s rapidly growing drugs bill will create headroom to reinvest all savings in newer and more effective NHS medicines and treatments.

A formal public consultation is being launched on new national guidelines which state that 18 treatments – including homeopathy and herbal treatments – which together cost taxpayers £141 million a year should generally not be prescribed.

National survey shows cancer patients feel increasingly positive about their NHS care

The National Cancer Patient Experience Survey 2016 asked people with cancer across England for their views on their care, with 72,788 responding.

Asked to rate their care on a scale of zero (very poor) to 10 (very good), respondents gave an average rating of 8.74 (ie 87.4% favourable) a statistically significant increase on last year’s score.

NICE approves more tolerable treatment for blood cancer

Around 2,200 patients a year with multiple myeloma are to benefit from a new, tolerable treatment on the NHS following approval by NICE.

Carfilzomib does not cause serious side effects, such as chronic pain from damaged tissue, to the same extent as current treatments, the independent committee at NICE found.

The drug, also called Kyprolis and manufactured by Amgen, treats patients with multiple myeloma whose cancer has come back after one round of treatment. Previous treatment must not include a drug called bortezomib.

Using reward to support financial wellbeing

Take a look at NHS Employers' new resource which introduces the importance of financial wellbeing and explores how employers can use reward to support staff and benefit their organisation.

There are many ways employers can help staff to improve their financial wellbeing, particularly if used strategically as part of their reward offer. Find out more about using reward to support financial wellbeing to see:

• how to define and measure financial wellbeing
• the evidence highlighting the impact of financial stress on individuals and organisations
• examples of the kinds of rewards and benefits that may help staff
• useful resources and publications on this topic.

Diversity and inclusion conference 2017

The NHS Employers annual diversity and inclusion conference is being held on 21 September at the Business Design Centre, Islington.

This year we have a fantastic programme planned for delegates and are lucky to welcome global experts and inspirational key note speakers including Peter Cheese, Chief Executive, CIPD, Michael Bach, Founder and CEO, Canadian Centre for Diversity and Inclusion, Belinda Parmar, Chief Geek, Empathy Business and Dr Manuela Barreto from the University of Exeter.

Ways of working flexibly

Derbyshire Community Health Services NHS Foundation Trust has maximised flexible working opportunities in its speech and language therapy (SLT) service to reduce agency spend, improve the working lives of staff and to support wider work taking place across the trust.

Freedom to Speak Up awards and new inspection guidance for guardians

The National Guardian's Office has launched new Freedom to Speak Up (FTSU) 2017 awards to recognise and celebrate the fantastic work being done in NHS trusts to improve the culture of speaking up.

The five FTSU award categories are as follows:

• Freedom to Speak Up Guardian or Network of the Year
• Speaking Up – the Freedom to Speak Up communication award 
• Speaking Up Together – the Freedom to Speak Up partnership award
• Learning from speaking up – the Freedom to Speak Up learning award
• Leading the change to speaking up becoming business as usual

Health and wellbeing of staff

The health and wellbeing of NHS staff is extremely important.

One Trust has considerably improved management information to improve understanding of issues surrounding stress.

Staff have 24/7 access to a staff support service, supplied by colleagues in Merseycare NHS Trust.
They also have a comprehensive range of training opportunities for all staff to assist in appraising stressors in their life and providing solutions to improving their lives including: Weight loss service, using our dieticians to manage a weight loss programme.

Consultation on guidance to ensure a safe and effective pharmacy team

The General Pharmaceutical Council has launched a consultation on new guidance for pharmacy owners which outlines what they are expected to do to ensure everyone in the pharmacy team can provide safe and effective services to patients and the public.

The proposed guidance for pharmacy owners covers both registered and unregistered staff, including managers who are not registered pharmacy professionals. This is the first time the GPhC has set out in guidance what pharmacy owners should do to make sure that non-registrant managers, who can play a critical role in the pharmacy, understand their responsibilities and the responsibilities of the rest of the pharmacy team, including pharmacy professionals.

Inpatient provision for children and young people with mental health problems

This report examines the state of child and adolescent mental health inpatient services in England. It explores the latest evidence and NHS data on admissions, quality of care, staffing and capacity. It highlights five challenges to raising standards in young people’s mental health provision.

• Report

Focus on physicians: census of consultant physicians and higher specialty trainees 2016-17

A survey by the Royal College of Physicians has found that only one in four substantive consultant physicians in the UK feel valued by the hospital in which they work.

The key findings from the wellbeing survey include that, more than 50% of the time, 78% of consultants felt valued by patients and 70% by colleagues/staff, but only 26% felt valued by the hospital. Only 35% of consultants felt fulfilled more than 50% of the time.

When asked what their dream job plan would be, 52% of respondents said it would entail more research, 41% said more teaching, and 47% said more time with patients.

Cardiac rehab patients should receive one-to-one exercise assessments and exercise programmes that take account of their individual choices

Cardiac rehab patients should receive one-to-one exercise assessments and exercise programmes that take account of their individual choices. This is one of the recommendations in an updated Scottish Intercollegiate Guidelines Network (SIGN) guideline on cardiac rehabilitation published recently.

The incidence and costs of inpatient falls in hospitals

This review from NHS Improvement is based on existing evidence and data, and provides an overview of the scale of inpatient falls and the benefits to the NHS if the rate of falls was reduced in hospitals.

Implementing the Learning from Deaths framework: key requirements for trust boards

NHS Improvement has published a resource for non-executive directors and non-clinical executive directors explaining how to meet the requirements set out in the National Guidance on Learning from Deaths.

It's also published preventable incidents, survival and mortality (PRISM) materials to help you develop your approach to case record reviews.

Effects of a hops (Humulus lupulus L.) dry extract supplement on self-reported depression, anxiety and stress levels in apparently healthy young adults: a randomized, placebo-controlled, double-blind, crossover pilot study

Hormones (Athens). 2017 Apr;16(2):171-180. doi: 10.14310/horm.2002.1738.

In otherwise healthy young adults reporting at least mild depression, anxietyand stress symptoms, daily supplementation with a hops dry extract can significantly improve all these symptoms over a 4-week period. These beneficial effects agree with the indication of hops for anxiety/mood disorders and restlessness, as approved by the German Commission E.

UHCW Research: Kyrou I

People with co-occurring conditions: commission and provide services

This guidance from Public Health England supports local areas to commission timely and effective responses for people with co-occurring mental health and alcohol or drug use conditions.

Patient Flow – managing expectations and improving throughput

Here is a real-time patient journey assessment and visualisation tool created by Central Manchester University Hospital NHS Foundation Trust.

Online Speech Therapy Can Be as Effective as In-Person Treatment

Rehabilitation services delivered over the Internet and through other telecommunication networks allow health care professionals to reach more patients in need, but there has been some concern that so-called telerehabilitation doesn’t offer the same quality of care as in-person treatment.

Now a new study by Canadian researchers at Baycrest Centre for Geriatric Care shows there is no need to worry.

The findings, published in the journal Aphasiology, show that stroke patients who received speech language therapy over the Internet saw significant improvements in their communication skills, similar to those of patients receiving in-person treatment.

Causes of severe antisocial behavior may differ for boys and girls

The causes of severe antisocial behaviour may differ between boys and girls, which could pave the way for new sex-specific treatments, according to a major new study published today (Friday 21 July).

Using magnetic resonance imaging (MRI)-techniques to map the brains of over 200 teenagers aged 14 -- 18 years, researchers from the University of Bath (UK) and several other European universities conducted the most comprehensive study ever to analyse differences in brain development between children with conduct disorder (CD) and a group of typically-developing children (the control group).

A Third of Dementia Cases Are Preventable

A profound new study suggests managing lifestyle factors such as hearing loss, smoking, hypertension, and depression could prevent one-third of the world’s dementia cases.

Moreover, researchers discovered nonpharmacologic interventions such as social contact and exercise can mitigate symptoms associated with dementia.

Antidepressant use in pregnancy linked to autism in children

Children exposed to antidepressants during pregnancy seem to be at a slightly higher risk of autism than children of mothers with psychiatric disorders who were not treated with antidepressants during pregnancy, finds a study published in The BMJ.

Case studies: Improving Patiient Flow

This series of case studies explains how selected providers are delivering effectively against good practice priorities. These stories accompany our Good practice guide: Focus on improving patient flow and explain how providers have sought to localise and practically implement the principles of good patient flow.

The case studies are from the Trusts listed below, the link to the case studies is on the NHS Improvement website

• Ambulance handovers (Barts Health NHS Trust)
• Primary care streaming (Luton and Dunstable University NHS Foundation Trust)
• Emergency departments (Royal Berkshire NHS Foundation Trust)
• Mental health (Cambridgeshire and Peterborough NHS Foundation Trust)
• Clinical decision units (University Hospitals Bristol NHS Foundation Trust)
• Ambulatory emergency care (Mid Cheshire NHS Foundation Trust)
• Acute medical units (Salford Royal NHS Foundation Trust)
• Frailty (Poole Hospital NHS Foundation Trust)
• Specialties (Western Sussex Hospitals NHS Foundation Trust)
• Discharge (South Warwickshire NHS Foundation Trust)

GMC publishes action plan to improve revalidation

The General Medical Council (GMC) has unveiled a plan to implement the recommendations in Sir Keith Pearson’s report –Taking Revalidation Forward – published earlier this year.

The plan details work the GMC and others will do to improve medical revalidation, making it a more positive and meaningful experience for doctors, responsible officers, patients and everyone involved.

Measuring and monitoring of safety framework e-guide: better questions, safer care

This guide has been produced in conjunction with Advancing Quality Alliance, UK Improvement Alliance, Health Improvement Scotland and the Improvement Academy.

It contains a range of useful resources to help health and care professionals to take a more holistic approach when looking at the safety of care. It also offers detailed case studies and practical templates spanning roles from board to ward, and across ambulance, acute, mental health and primary care settings.

Guidance on overseas visitors hospital charging regulations

Updated guidance on making and recovering charges for NHS hospital treatment from overseas visitors not exempt from charge.

Physio self-referral website proves a hit in South Worcestershire

Up to 50 people a day have been self-referring to physiotherapy in South Worcestershire since a new website launched in June.

The Move to Improve website allows people to self-refer to physiotherapy

Developed by Worcestershire Health and Care NHS Trust, the Move to Improve website aims to give patients an easy, efficient way to access an appropriate level of physio care and support.

The state of care in mental health services 2014 to 2017

This report details the findings from CQC inspections of specialist mental health services over the last three years. It describes how our inspectors found that the clear majority of services are caring and compassionate towards their patients, with 88 per cent of NHS and 93 per cent of independent services being rated as good in this key question. However, the report also identifies several areas of concern: difficulties around accessing services, physical environments not designed to keep people safe, care that is over-restrictive and institutional in nature, and poor recording and sharing of information that undermines the efforts of staff to work together to make sure that people get the right care at the right time.

• Report

How bosses can help with mental health

Not everyone has a boss that understands mental health, that appreciates the importance of it, and who’ll praise staff for taking time off for mental health related reasons rather than dismissing their issues.

Plus, even workplaces that consider the impact of stress and wellbeing on productivity can improve, right? Even the most positive, supportive workplace can bring in new initiatives and ideas to make people feel happier and healthier.

So with that in mind, here are some simple ways bosses can make their workplaces more mental health friendly

Hyper-Stain Inspector: A Framework for Robust Registration and Localised Co-Expression Analysis of Multiple Whole-Slide Images of Serial Histology Sections

Sci Rep. 2017 Jul 17;7(1):5641. doi: 10.1038/s41598-017-05511-w.

In this paper, we present a fast method for registration of multiple large, digitised whole-slide images (WSIs) of serial histology sections. Through cross-slide WSI registration, it becomes possible to select and analyse a common visual field across images of several serial section stained with different protein markers. It is, therefore, a critical first step for any downstream co-localised cross-slide analysis. The proposed registration method uses a two-stage approach, first estimating a fast initial alignment using the tissue sections' external boundaries, followed by an efficient refinement process guided by key biological structures within the visual field. We show that this method is able to produce a high quality alignment in a variety of circumstances, and demonstrate that the refinement is able to quantitatively improve registration quality. In addition, we provide a case study that demonstrates how the proposed method for cross-slide WSI registration could be used as part of a specific co-expression analysis framework.

UHCW Research: D. Snead and N. Raipoot

Vulnerable adults let down on Mental Capacity Act

Vulnerable adults are too often being let down by social workers and care providers failing to follow the Mental Capacity Act properly, a report has warned.

The Local Government and Social Care Ombudsman’s review found one in five social care complaints made to the service last year concerned mental capacity or deprivation of liberty cases. More than two-thirds of these complaints were upheld, compared to 53% of all complaints across social care.

Monthly data on patient safety incident reports

Rolling data updated monthly, to show the number of patient safety incidents reported to the National Reporting and Learning System (NRLS) in the last 12 months.

The data is based on the date each incident report was submitted to the NRLS and not the date the incident was said to have occurred. It represents the current position at the time data was extracted from the NRLS and is subject to change, should any reports be updated as further information becomes available.

The data is broken down by each month reported and degree of harm, and is refreshed and updated on a monthly basis.

• NRLS monthly incident report England: July 2016 to June 2017

Nationally Contracted Products programme Customer webinar

NHS Improvement and NHS BSA delivered an NCP customer webinar on Friday 7 July to over 100 attendees. The aim of this webinar was to provide an update on the NCP programme.

Good practice guide: Focus on improving patient flow

Good patient flow is central to patient experience, clinical safety and reducing the pressure on staff. It is also essential to the delivery of national emergency care access standards. Experts consistently advocate focussing on patient flow as a key factor in providing effective health care.

The good practice guide from NHS Improvement is also accompanied by a series of case studies that offer examples of how providers have implemented some of the principles in the guide.

Arts-based groups benefit individuals with mental health conditions

A new study found that participation in arts-based groups -- such as those that involve choir singing and creative writing -- benefits the emotions of both healthy adults and those experiencing mental health conditions. Read more HERE.

Understanding of a negative bowel screening result and potential impact on future symptom appraisal and help-seeking behaviour: a focus group study

Health Expectations. Volume 20, Issue 4. August 2017. Pages 584–592

Colorectal cancer (CRC) screening using a faecal occult blood test (FOBt) has the potential to reduce cancer-related mortality. Symptom vigilance remains crucial as a proportion of cancers will be diagnosed between screening rounds. A negative FOBt has the potential to influence how participants respond to future symptoms of CRC.

Participants recognized that reassurance from a negative FOBt could lead to a short-term delay in help-seeking if symptoms developed. Screening programmes should seek to emphasize the importance of the temporal nature of FOBt results with key messages about symptom recognition and prompt help-seeking behaviour

UHCW Research: Steve Smith

Quality improvement in mental health

Quality improvement approaches – increasingly well-established in NHS acute hospitals – could play a key role in improving the quality of mental health care. 

 

A growing number of mental health providers (in the UK and beyond) are beginning to embed quality improvement across their organisations, with some encouraging results. The approach is based on the concept that sustained improvement is best achieved by empowering frontline teams, service users and carers to design, implement and test changes to services.

This report describes the quality improvement journey of three mental health organisations (two in England and one in Singapore). It provides key insights and lessons for others considering embarking on a similar journey.

NICE recommends specialist physio for early-stage Parkinson’s

This new NICE guideline covers diagnosing and managing Parkinson's disease in people aged 18 and over. It aims to improve care from the time of diagnosis, including monitoring and managing symptoms, providing information and support, and palliative care.  Its recommendations cover:

1.1 Communication with people with Parkinson's disease and their carers
1.2 Diagnosing Parkinson's disease
1.3 Pharmacological management of motor symptoms
1.4 Managing and monitoring impulse control disorders as an adverse effect of dopaminergic therapy
1.5 Pharmacological management of non-motor symptoms
1.6 Pharmacological neuroprotective therapy
1.7 Non-pharmacological management of motor and non-motor symptoms
1.8 Deep brain stimulation and levodopa–carbidopa intestinal gel
1.9 Palliative care

Outdated handovers putting East Midlands patient care at risk, GMC report finds

During its review of medical education and training in the region, the GMC spoke to doctors in training who told how handovers lacked continuity of care and could be unsafe for patients. The issue was raised by doctors at Sherwood Forest Hospitals NHS Trust and United Lincolnshire Hospitals NHS Trust.

But at University Hospitals of Leicester NHS Trust a 3am ‘pulse check’ handover is in place in some departments, which was praised for giving teams a chance to review work and to discuss any issues.

Patients to benefit from £325 million investment in NHS transformation projects

Fifteen sustainability and transformation partnerships (STPs) will share in £325m of capital investment to take forward transformation projects.  The funding, announced by health secretary Jeremy Hunt and NHS England chief Simon Stevens on 19 July, has been targeted at the “strongest and most advanced schemes in STPs.”

Rise in children seeking mental health support after terror attacks

The number of children and young people seeking help from mental health services has spiked in the wake of recent terrorist attacks in England, according to the Royal College of Psychiatrists (RCP).

Hospitals across the Manchester region have seen an estimated 10% increase in children seeking help since a bomb ripped through the Manchester Arena on 22 May, killing 22 people, according to the RCP. Mental health experts in Greater Manchester hospitals received hundreds more patients from June to July compared with previous months.

Different Bacteria Profile Found in Alzheimer’s Brains

The brains of people with Alzheimer’s disease appear to show both increased bacterial populations and different proportions of specific bacteria compared to healthy brains, according to a new U.K. study which used DNA sequencing to evaluate the postmortem brains of Alzheimer’s patients.

The new findings, published in the journal Frontiers in Aging Neuroscience, support growing evidence that bacterial infection and inflammation in the brain may play a role in Alzheimer’s disease, a severe neurodegenerative condition that leads to cognitive decline, and eventually death.

Depression among young teens linked to cannabis use at 18

A study looking at the cumulative effects of depression in youth, found that young people with chronic or severe forms of depression were at elevated risk for developing a problem with cannabis in later adolescence.

Being mindful of mental health - The role of local government in mental health and wellbeing

This report explores how councils influence the mental wellbeing of our communities and how council services, from social care to parks to open spaces to education to housing, help to make up the fabric of mental health support for the people in our communities.

Imaging Pinpoints Brain Circuits Changed by PTSD Therapy

Using brain imaging to track the effects of treatment of post-traumatic stress disorder (PTSD), scientists have identified a brain circuit on which a frequently used and effective psychotherapy (prolonged exposure) acts to quell symptoms. The findings help explain why the neural circuit identified is a promising target for additional treatment development, including brain stimulation therapies.

In an accompanying paper, the authors also report that they have identified hallmarks in brain activity of people with PTSD that predict who will benefit from treatment. Both papers appear online July 18 in the American Journal of Psychiatry.

Fizzyo wins top tech health award

A physiotherapy-inspired computer gaming project for people with cystic fibrosis was chosen out of about 200 entries as the winner of the AbilityNet Tech4Good digital health award.

The idea behind the Fizzyo project is simple: to make physiotherapy breathing exercises fun – and encourage people to do them. It puts a wireless sensor into the mouthpiece of a conventional airway clearance device. As the user exhales, the sensor sends electronic signals that control computer games.

The safer management of controlled drugs

The CQC report sets out key changes to legislation and gives an overview of prescribing data and prescribing trends for controlled drugs across England in the primary care sector. It also makes recommendations to strengthen existing arrangements.

The National Audit of Breast Cancer in Older Patients: annual report 2017

This report describes the various aspects of the care provided by NHS breast cancer units in England and in Wales, and contains information on: patterns of surgical treatment in England and Wales among women diagnosed with breast cancer; the organisation of breast cancer services in England and Wales, with a particular focus on policies for the management of older patients; and how patient characteristics influence which treatments were considered as options for older patients.

Comparator report on patient access to cancer medicines in Europe revisited - a UK perspective

This report from the Association of the British Pharmaceutical Industry (ABPI) shows that the UK is trailing behind the rest of Europe in the treatment of cancer. It finds that British patients have worse survival rates after five years - the international benchmark for measuring the quality of cancer care – compared to the European average in nine out of ten cancers – only exceeding the EU average in melanoma

Sustainability and Transformation Plans: five key questions for planners

This analysis from the Centre for Health and the Public Interest identifies five key questions to ask of each of England’s 44 Sustainability and Transformation Plans. It aims to set out a framework for assessing their potential impacts.

The government response to the House of Commons Health Select Committee report on winter pressure in accident and emergency departments

The report from the Department of Health responds to each of the 27 conclusions and recommendations in the Health Select Committee’s report. It highlights how the NHS prepares for winter, as part of its year-round operational resilience planning, to ensure the health and social care system in England is fully prepared for the increased pressures at that time of year.

See also the Parliamentary Health Committee's report.

Have your say on support for doctors' who return to training

Health Education England (HEE) are developing a programme of activities to support doctors who are returning to training after a period out of programme (OOP) activity.

They are keen to learn about the challenges trainee doctors face, identify effective support already in place and further interventions that might help, plus other support services and signposting they might find useful. To inform this programme, HEE have published a call for ideas, seeking the views of junior doctors, medical royal colleges, educators, associated professions and employers.

You can submit your ideas and views via an online survey which will close on 4 August at 23:59.

Boards required to designate executive with data security responsibility

Every NHS board in England will be required to designate an executive board member responsible for data and cyber security, under government plans to bolster data security and increase cyber resilience across the health and care sector. 

The move forms part of a new requirement for chief executives to issue an annual ‘statement of resilience’ detailing the action their organisation is taking to meet the ten data security standards recommended in Dame Fiona Caldicott’s review into data security, consent and opt-outs.

National Paediatric Diabetes Audit Part 2: Hospital Admissions and Complications

This is the National Paediatric Diabetes Audit Report: Hospital Admissions, the second analysis of admissions data published by the Royal College of Paediatrics and Child Health. For the first time, data submitted by healthcare professionals working in paediatric diabetes units has been combined with Hospital Episode Statistics (HES) and data from the Patient Episode Database for Wales (PEDW) to provide a robust picture of diabetes-related admissions in England and Wales.

National Audit of Dementia Care in General Hospitals 2016-2017: Third Round of Audit Report

This report from the Healthcare Quality Improvement Partnership (HQIP) presents the results of the third round of the National Audit of Dementia (NAD) with collected data between April and November 2016.

The National Audit of Dementia (care in general hospitals) measures the performance of general hospitals against criteria relating to care delivery which are known to impact upon people with dementia while in hospital.

Model service specification for wheelchair and posture services

The model service specification, produced by NHS England sets out the ambitions for excellent wheelchair service and provides CCGs with a framework for them to use with their service users, providers and suppliers to commission services that meet the needs of wheelchair users and their families.

2017-18 education & training placement tariffs: tariff guidance and prices from 1st April 2017

This document from the Department of Health sets out the national tariffs for healthcare education and training placements in the academic year 2017 to 2018; how the tariffs will be implemented; and in what circumstances the national tariffs may be varied and how to do this. The tariffs cover non-medical placements and medical undergraduate and postgraduate placements in secondary care.

Emergency Care Data Set supplementary guidance

The purpose of this document from NHS Digital  is to outline the manner by which the CDS Type 011 – EmergencyCare Data Set (ECDS) should be used and interpreted by users, system suppliers and other stakeholders by providing information on each individual data group and its constituent data items.

Arctic Sun 5000 for therapeutic hypothermia after cardiac arrest

New Medtech Innovation briefing from NICE on using Arctic Sun 5000 for therapeutic hypothermia after cardiac arrest.

The innovative aspects are that it is less invasive than endovascular systems and is designed to cool more efficiently than conventional external methods because of the adhesive, repositionable gel pads it uses. It works by adjusting the water temperature in the gel pads every 2 minutes in response to the patient's body temperature, which is constantly monitored using a probe.

The intended place in therapy would be instead of standard surface cooling systems to induce mild hypothermia in people who are comatose after having a cardiac arrest in or out of hospital, and for subsequent rewarming.

Memory Impairment Begins Early in Schizophrenia and May Worsen

People with schizophrenia often experience debilitating cognitive problems, including difficulties with episodic memory, a key factor in social functioning.

Episodic memory involves recalling personal events such as what you did yesterday, what you had for lunch an hour ago, or the the details of social interactions. Poor episodic memory, a common feature of schizophrenia, limits the ability to form relationships with others.

Researchers at the University of California, Los Angeles (UCLA) have discovered that early-stage schizophrenia patients have better recall regarding social events if they are given hints about context. The new findings suggest a potential strategy for memory training for people with this debilitating disease.

PTSD may be physical and not only psychological

The part of the brain that helps control emotion may be larger in people who develop post-traumatic stress disorder (PTSD) after brain injury compared to those with a brain injury without PTSD, according to a new study.

Musculoskeletal ultrasound for diagnosis to confirm or rule out a diagnosis of rheumatoid arthritis

In patients with suspected rheumatoid arthritis, does the use ofmusculoskeletal ultrasound increase the ability ofrheumatologists to confirm or rule out a diagnosis ofrheumatoid arthritis at an earlier stage compared to routinediagnostic assessment? 

Evidence note from Healthcare Improvement Scotland:
There is evidence from two overlapping systematic reviews to support the clinical effectiveness of adding musculoskeletal ultrasound to clinical assessment and laboratory testing to diagnose rheumatoid arthritis at an earlier stage of the disease. Results from three primary studies with methodological weaknesses suggest that musculoskeletal ultrasound can increase rheumatologists’ diagnostic certainty, predict progression to inflammatory arthritis and decrease the time to diagnosis or initiation of DMARD therapy in patients with suspected rheumatoid arthritis.

Constipation in children and young people: diagnosis and management

Updated NICE clinical guidance on constipation in children. This guideline covers diagnosing and managing constipation in children and young people up to 18. It provides strategies to support the early identification and timely, effective treatment of constipation which will help improve outcomes for patients. It does not cover constipation caused by a specific condition.

This guideline includes recommendations on:

• history-taking and physical examination
• digital rectal examination
• clinical investigations and management
• diet and lifestyle
• psychological interventions
• antegrade colonic enema procedure
• information and support

Absorb Bioresorbable Vascular Scaffold system for coronary artery disease

Updated medtech innovation briefing from NICE on using the Absorb Bioresorbable Vascular Scaffold system for coronary artery disease.

The innovative aspect is that over time it is resorbed in the artery, unlike metal stents.

The intended place in therapy would be for use in place of a metallic drug-eluting stent in people with coronary artery disease who are having angioplasty.

New generation cardiac CT scanners (Aquilion ONE, Brilliance iCT, Discovery CT750 HD and Somatom Definition Flash) for cardiac imaging in people with suspected or known coronary artery disease in whom imaging is difficult with earlier generation CT scanners

Updated diagnostics guidance on using new generation cardiac CT scanners.

New generation cardiac CT scanners (Aquilion ONE, Brilliance iCT, Discovery CT750 HD and Somatom Definition Flash) are recommended as an option for first-line imaging of the coronary arteries in people with suspected stable coronary artery disease (with an estimated likelihood of coronary artery disease of 10–29%) in whom imaging with earlier generation CT scanners is difficult.

New generation cardiac CT scanners are recommended as an option for first-line evaluation of disease progression, to establish the need for revascularisation, in people with known coronary artery disease in whom imaging with earlier generation CT scanners is difficult. CT scanning might not be necessary in situations in which immediate revascularisation is being considered.

Aquilion PRIME CT scanner for imaging coronary artery disease in adults in whom imaging is difficult

Updated Medtech innovation briefing on using the Aquilion PRIME CT scanner for imaging coronary artery disease in adults in whom imaging is difficult.

The Aquilion PRIME is a CT scanner that can be used for computed tomography coronary angiography (CTCA), to diagnose or evaluate coronary artery disease non‑invasively in people with conditions that make it difficult to obtain good‑quality CTCA images. The Aquilion PRIME has technical features that are recognised to address clinical challenges in patients who have coronary artery disease that is difficult to image, but there is no published evidence on the safety or effectiveness for this indication. It can also be used for other clinical imaging applications in adults and children. The Aquilion PRIME typically costs between £350,000 and £500,000, excluding VAT, depending on the configuration.

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people - guidance (TA455)

New NICE technology appraisal guidance on using adalimumab (Humira), etanercept (Enbrel) and ustekinumab (Stelara) for plaque psoriasis in children and young people.

Adalimumab is recommended as an option for treating plaque psoriasis in children and young people aged 4 years or older, only if the disease:

• is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and
• has not responded to standard systemic therapy, such as ciclosporin, methotrexate or phototherapy, or these options are contraindicated or not tolerated.

Etanercept is recommended as an option for treating plaque psoriasis in children and young people aged 6 years or older, only if the disease:

• is severe, as defined by a total PASI of 10 or more and
• has not responded to standard systemic therapy, such as ciclosporin, methotrexate or phototherapy, or these options are contraindicated or not tolerated.

Ustekinumab is recommended as an option for treating plaque psoriasis in children and young people aged 12 years or older, only if the disease:

• is severe, as defined by a total PASI of 10 or more
• has not responded to standard systemic therapy, such as ciclosporin, methotrexate or phototherapy, or these options are contraindicated or not tolerated.

Ustekinumab for moderately to severely active Crohn’s disease after previous treatment - guidance (TA456)

New NICE technology appraisal guidance on using ustekinumab (Stelara) for previously treated moderately to severely active Crohn’s disease in adults.

Ustekinumab is recommended, within its marketing authorisation, as an option for treating moderately to severely active Crohn's disease, that is, for adults who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a TNF‑alpha inhibitor or have medical contraindications to such therapies.

The choice of treatment between ustekinumab or another biological therapy should be made on an individual basis after discussion between the patient and their clinician about the advantages and disadvantages of the treatments available. If more than 1 treatment is suitable, the least expensive should be chosen (taking into account administration costs, dosage and price per dose).

Ustekinumab should be given until treatment failure (including the need for surgery) or until 12 months after the start of treatment, whichever is shorter.

Somatom Definition Edge CT scanner for imaging coronary artery disease in adults in whom imaging is difficult

Updated NICE medtech innovation briefing on using the Somatom Definition Edge CT scanner for imaging coronary artery disease in adults in whom imaging is difficult.

The Somatom Definition Edge is a CT scanner that can be used for computed tomography coronary angiography (CTCA), to diagnose or evaluate coronary artery disease non-invasively in people with conditions that make it difficult to obtain good-quality CTCA images. The Somatom Definition Edge has technical features that are recognised to address clinical challenges in patients who have coronary artery disease that is difficult to image, but there is no published evidence on the safety or effectiveness for this indication. It can also be used for other clinical imaging applications in adults and children.

L-Dex U400 for lymphoedema after breast cancer treatment

New Medtech innovation briefing from NICE on using the L-Dex U400 for lymphoedema after breast cancer treatment.

The innovative aspects are that it uses bioimpedance spectroscopy to measure fluid status, aiming to detect lymphoedema earlier.

The intended place in therapy would be in diagnosing or monitoring lymphoedema related to breast cancer treatment. It could be used as an alternative to current detection or measurement techniques, such as simple tape measurement of limb circumference.

FreeStyle Libre for glucose monitoring

NICE has developed a medtech innovation briefing (MIB) on FreeStyle Libre for glucose monitoring.

The innovative aspect is that FreeStyle Libre measures glucose levels from a sensor applied to the skin as an alternative to routine finger-prick blood glucose testing, and can produce a near-continuous record of measurements which can be accessed on demand. It can also indicate glucose level trends over time.

The intended place in therapy is as an alternative to routine blood glucose monitoring in people with type 1 and 2 diabetes who use insulin injections. Finger-prick blood glucose measurements are sometimes still needed, such as when a person is ill or when they are driving.

Bortezomib for treating multiple myeloma after second or subsequent relapse (terminated appraisal) - guidance (TA453)

New NICE Technology Appraisal Guidance:

NICE is unable to make a recommendation about the use in the NHS of bortezomib for treating multiple myeloma after second or subsequent relapse because no evidence submission was received from Janssen-Cilag. We will review this decision if the company decides to make a submission.

Ibrutinib for untreated chronic lymphocytic leukaemia without a 17p deletion or TP53 mutation (terminated appraisal) - guidance (TA452)

New NICE Technology Appraisal

NICE is unable to make a recommendation about the use in the NHS of ibrutinib for untreated chronic lymphocytic leukaemia without a 17p deletion or TP53 mutation because no evidence submission was received from Janssen–Cilag. We will review this decision if the company decides to make a submission.

Daratumumab with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma (terminated appraisal) - guidance (TA454)

New NICE Technology Appraisal 

NICE is unable to make a recommendation about the use in the NHS of daratumumab, with lenalidomide and dexamethasone, for treating relapsed or refractory multiple myeloma because no evidence submission was received from Janssen-Cilag. We will review this decision if the company decides to make a submission.

New improved BNF and BNFC app launched

Following the recent launch by the publishers of the British National Formulary (BNF) and British National Formulary for children (BNFC) of a new, faster, easier to use and access app, NICE has confirmed that its BNF app will be withdrawn later this year.

The new app has been purpose built for iOS and Android platforms. This has enabled an intuitive design and enhanced features around search and interactions checking and updating mechanisms.

For the first time adult and child BNF content is available through a single app, providing ease of use and saving space on users’ devices.

UK health system comes out on top in new report

The UK was rated first out of 11 countries in a report on international healthcare systems published by the Commonwealth Fund.

The report compared the UK to healthcare systems in the US, Switzerland, Sweden, France, Germany, the Netherlands, Canada, New Zealand, Norway and Australia.

The Commonwealth Fund’s report ranks the UK first overall and first for care process (prevention, safe care, coordination, and patient engagement) and equity (comparison of performance for higher- and lower-income individuals). The UK also scores highly in terms of getting value out of the money the tax payer puts in.

NHS bursary scheme rules 2017

This guidance from NHS Business Services Authority contains information about the NHS bursary scheme, with new rules applicable for the academic year 2017 to 2018.

£86 million funding announced for new medicine and technology

The government has announced new funding of up to £86 million for UK firms to develop medical breakthroughs.

The package will allow small and medium sized enterprises (SMEs) to develop and test new technologies in the NHS. This could include innovations such as digital technologies to help patients manage their conditions from home instead of a hospital, or to develop new medicines.

Access to this funding will also speed up the time it takes to get new technologies from the lab to patients in the NHS.

The announcement is the first step in taking forward the Accelerated Access Review (AAR) – an independently chaired review, which made recommendations to government on speeding up patient access to new technologies.

Combined Performance Summary - May 2017

This publication from NHS England summarises the data around NHS performance for May 2017.

It contains a summary of the monthly performance statistics on:

• 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

Involving your staff with quality improvement initiatives

NHS Employers' new briefing on staff involvement in quality improvement activities will help you to identify:

• staff involvement is an essential ingredient of a sustainable approach to quality improvement
• a range of ways in which staff can be involved in quality improvement activity
• staff involvement is an integral part of your approach
• staff need protected time and training in quality improvement techniques
• greater staff involvement will help to deliver sustainable improvements.

Diabetes pathway

This diabetes pathway from NHS RightCare defines the core components of an optimal diabetes service for people with or at risk of developing Type 1 and Type 2 diabetes that delivers the better value in terms of outcomes and cost.

The pathway shows the core components of an optimal diabetes service, evidence of the opportunity to reduce variation and improve outcomes and the key evidence-based interventions which the system should focus on for greatest improvement, supported by practice examples from across the NHS.

The UK National Registry of ABO and HLA Antibody Incompatible Renal Transplantation: Pretransplant Factors Associated With Outcome in 879 Transplants

Transplant Direct. 2017 Jun 26;3(7):e181. doi: 10.1097/TXD.0000000000000695. eCollection 2017 Jul.

ABO and HLA antibody incompatible (HLAi) renal transplants (AIT) now comprise around 10% of living donor kidney transplants. However, the relationship between pretransplant factors and medium-term outcomes are not fully understood, especially in relation to factors that may vary between centers.

Results of AIT were acceptable, certainly in the context of a choice between living donor AIT and an antibody compatible deceased donor transplant. Several factors were associated with increased chance of transplant loss, and these can lead to testable hypotheses for further improving therapy.

UHCW Research: Fuggle SV and Higgins RM

Decisions regarding admission to the ICU and international initiatives to improve the decision-making process

Critical care (London, England) 21.1: 174. (July 4, 2017)

Whether a critically ill patient should or should not be offered life-supporting treatment in the intensive care unit (ICU) is arguably the most important decision that is regularly made on behalf of a patient; deciding not to admit somebody may mean that their death is inevitable. Yet these decisions are often made in the face of uncertain information, time constraints and without the patient being able to participate in discussions. In this context it is perhaps surprising that more research and guidance has not addressed this area of practice.

There are three overarching considerations that must influence the decision not to admit a patient to ICU. Firstly, that an individual patient’s preference may be to decline intensive care treatments. Secondly, that the burden of invasive and distressing treatments on the ICU may outweigh any potential benefit. Thirdly, that the ICU is a labour and resource-intensive endeavour: resources are not available for every patient to be admitted. Intensivists are provided with a limited amount of resources and are, usually implicitly, charged with doing as much good as possible with what is available. This means that at times of high demand or limited resource availability, patients who have less clear-cut potential to benefit from the ICU may not be admitted [1, 2]. Managing resources is an unavoidable part of the intensivist’s job.

In this issue Nicolas Chin-Yee and colleagues shine more light on the interaction of these three issues by studying the impact of admission to the ICU for older patients.

UHCW Research: Bassford, Christopher

Digital Pioneers Pave the Way for Future NHS

A series of projects to improve the use of digital technology in the NHS has been launched. The Digital Pioneers programme is one of a number of co-produced innovation programmes being driven
by the Eastern Academic Health Science Network (Eastern AHSN), one of 15 AHSNs in England.

An initial eight projects running across the East of England will reach over 500,000 patients, providing new, more efficient ways to treat, monitor and keep clinicians connected to patients. The projects aim to improve support for patients in key areas such as cardiac rehabilitation, e-prescribing, and assessment of stroke patients.

Parenteral nutrition: indications and safe management

British Journal of Community Nursing 2017 22:Sup7, S22-S28
                     
The aim of this article is to provide an overview of what parenteral nutrition (PN) is and when its use is required. It will describe the process of nutritional assessment, and considerations when choosing venous access. The different approaches to provision of PN solutions in hospital will be discussed. Catheter-related and metabolic complications can occur during delivery of PN; there will be a discussion of the different types of complications and how these can be avoided or minimised. Finally, the pivotal role of the nurse in the assessment and ongoing care of patients who require PN will be highlighted, including skills required to administer PN safely.

UHCW Research: Nicky Wyer

Influence of lung CT changes in chronic obstructive pulmonary disease (COPD) on the human lung microbiome

PLoS One. 2017 Jul 13;12(7):e0180859. doi: 10.1371/journal.pone.0180859. eCollection 2017.

Our findings indicate that CT detectable structural changes in the lung of COPD patients, which we termed severe subtypes, are associated with alterations in bacterial communities, which may induce further changes in the interaction between microbes and host cells. This might result in a changed interplay with the host immune system.

UHCW Research: Subramanian, D and Parr D.

Inspiring change: a review of the quality of care provided to patient receiving acute non-invasive ventilation

This NCEPOD report focuses on the quality of acute non-invasive ventilation clinical care, for patients aged 16 years or older who are admitted to hospital.  It takes a critical look at areas where the care of patients might have been improved. Remediable factors have also been identified in the clinical and organisational care of these patients

College-funded research shows Minor Eye Conditions Services reduced volume of patients referred to hospitals by GPs

New research funded by the College of Optometrists has found that introducing an intermediate-tier service (ITS) for eye care services could reduce the volume of patients referred to hospitals by GPs and provide replacement services at lower costs.

The research, published by BMJ Open, although not applicable across all parts of the UK, investigated the changes in volume of hospital ophthalmology patients and the related costs, before and after minor eye conditions services (MECS) were introduced in two London boroughs.

NICE issue consultation on draft guideline on macular degeneration

The National Institute for Health and Care Excellence has opened a consultation for their draft guideline on macular degeneration, closing 24 August 2017.

The draft guideline provides advice on the management of people with AMD, including pharmacological and non-pharmacological treatments. It also provides guidance on tools available to diagnose and monitor AMD, and what information and support should be provided for people with AMD.

The first prospective annual report of the National Ophthalmology Database Audit

The first prospective National Ophthalmology Database (NOD) Audit report on cataract surgery in England and Wales looked at 120,722 cataract operations undertaken between 1 September 2015 and 31 August 2016 by 55 English and 1 Welsh NHS cataract surgical centres.

The report shows that cataract surgery centres are delivering high quality care to their patients. This is one of the most frequently performed surgeries in the UK with approximately 390,000 cataract operations performed in England and 16,000 performed in Wales each year, restoring sight for patients and enabling them to retain independent living.

Regulations on medical exposure to ionising radiation

This consultation from the Department of Health seeks views on proposed regulations on safety standards for protection against the dangers from medical exposure to ionising radiation.  This consultation closes on 31 July 2017.

Your data: better security, better choice, better care

This DH report outlines the government's response to the Caldicott Review and the Care Quality Commission's review on data protection in the NHS. The response accepts the recommendations in both reviews and it makes commitments to the safeguarding of information with the creation of the National Data Guardian's position as a statutory position and the introduction of stronger sanctions to protect anonymised data.

A youth-led approach to exploring mental health

From September 2016 to July 2017, Involve worked with Leaders Unlocked, to deliver a pilot project to engage young people in conversations about mental health in Oldman. It aimed to empower 14-25 year olds to identify the mental health issues that they viewed as most important; engage their peers in exploring these topics; and work with local decision-makers to make recommendations for change. The project report outlines the methodology of the the pilot project and the final evaluation report presents the impacts of the project.

• Evaluation report
• Project report

Health profile for England

This report from Public Health England draws on population health data to give an overall picture of the health of England. It finds that life expectancy has now reached 79.5 years for men and 83.1 years for women but that much of this extra time is spent in poor health. A major theme of the report is health inequalities as the data shows that in the wealthiest areas, people enjoy nearly 20 more years in good health than those in the poorest areas.

Suicide by children and young people: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.

This report, from the The University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) examines the findings from a range of investigations such as coroner inquests, into the deaths by suicide of people aged under 25 between January 2014 and December 2015 in England and Wales, extracting information about the stresses they were facing when they died.

Data was collected from 922 suicides by people aged under 25 in England and Wales during 2014 and 2015. The information came from investigations by official bodies, mainly from coroners, who take evidence from families and professionals.

ADHD medication tied to lower risk for alcohol, drug abuse in teens and adults

The use of medication to treat attention deficient hyperactivity disorder is linked to significantly lower risk for substance use problems in adolescents and adults with ADHD, according to a study led by researchers at Indiana University.

Is it still taboo to take a mental health sick day?

In the UK, there is no legal difference between taking a mental health sick day and a day off for a physical problem like a back problem.

Last year, Britons took 137 million sick days. Of these, 15.8 million days were for a stated mental health issue - whether that is stress, depression, anxiety or a more serious condition such as manic depression and schizophrenia - according to Office for National Statistics Labour Force Survey statistics. But is it frowned upon by bosses?

RCPSYCH Dementia report 2017

This report presents the results of the third round of the National Audit of Dementia, including recommendations and hospital scores.

A new treatment option for people with kidney cancer

People with advanced kidney cancer are set to benefit from a new treatment, after NICE has said cabozantinib should be available on the NHS.  It recommends cabozantinib as an option for people with advanced renal cell carcinoma (RCC).

Collecting outcomes to promote value-based healthcare

This case study describes how the University Hospital of Coventry and Warwickshire NHS Trust (UHCW) has started to collect, measure and use health outcomes for patients receiving prostate cancer care. The project is part of a wider programme of work currently underway in the trust to promote value-based healthcare.

UHCW Research: Rachel Mayman and Catherine Mitchell

Annual diabetes checks reduce mortality risk for people with diabetes

People with diabetes who have had annual diabetes checks regularly in the preceding seven years have a mortality rate which is half the rate of those who have not, according to the latest National Diabetes Audit 2015-16, published by NHS Digital

NHS England addresses concerns on gender services

NHS England’s new Senior Responsible Officer for Gender Identity Services introduces a 12-week consultation on proposed new service specifications:

This consultation covers both surgical and non-surgical interventions.

Apprenticeships in the NHS - Staff Council guidance

The NHS Staff Council has issued jointly agreed guidance on apprenticeships in the NHS.

It is designed to give general advice for those directly employing apprentices. It does not advise on any specific apprenticeship programmes, or cover those employed through Apprenticeship Training Agencies (ATAs).  The guidance gives some detail on:

• apprenticeship agreements 
• general requirements for apprenticeships
• approaches around the employment and pay of apprentices.

Government responds on cyber security and data

On 12 July 2017, the government announced that investment in data and cyber security will be boosted above £50 million - and include a new £21 million capital fund for major trauma centres - as part of its response to reviews and consultation feedback on these issues.

Your Data: Better Security, Better Choice, Better Care is the government’s response to the:

• National Data Guardian for Health and Care’s Review of Data Security, Consent and Opt-Outs
• public consultation on that review
• Care Quality Commission’s Review ‘Safe Data, Safe Care’

Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Screening – Membership Consultation

The Royal College of Ophthalmologists have produced a new clinical guideline titled Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Screening.

A draft version of this guideline and the associated patient information leaflet has now been released for consultation and the College would welcome any comments or observations on the content, format or recommendations, by 31 July 2017.

Have your say on Health Education England's draft volunteering strategy

HEE is asking for responses on its draft volunteering strategy, which explores the benefits for the NHS and highlights existing good practice.

e-referrals have halved DNAs

Electronic referrals have reduced the number of missed appointments or DNAs (did not attends) in England’s NHS by 50 per cent

Rob Shaw, the interim chief executive of NHS Digital, said this meant NHS organisations had 50 per cent more appointments available for other patients.

‘If secondary care starts to fully take up e-referrals we will end up saving over £50 million a year,’ he said. ‘That money can be put back into the NHS.’

Mr Shaw spoke about e-prescriptions, saying GPs and pharmacists could not believe how much time and effort they saved when compared to using the old FB10 prescription forms.

But he said it taken the health service too long to embed new technologies and called for far faster adoption.

Study compares switching meds vs. an additional med for patients unresponsive to an antidepressant

Among patients unresponsive to an antidepressant medication, adding the antipsychotic aripiprazole modestly increased the likelihood of remission from depression compared to switching to the antidepressant bupropion, according to a study published by JAMA.

How to manage mental health at work

In recent months, a number of high-profile figures have spoken frankly about their experiences of mental health. Prince Harry has disclosed the anxiety and panic attacks he experienced following the sudden death of his mother, while former England cricketer Freddie Flintoff and rapper Professor Green have also both opened up about their mental health.

Experts welcome such open discussions on mental health, which has been a taboo subject for far too long. “It’s great that more people feel able to talk about their mental health,” says Madeleine McGivern, head of workplace wellbeing programmes at the charity Mind. “There is still a long way to go – especially in many workplaces – but things are definitely moving in the right direction.”

Read more HERE

Councillors' perceptions of Sustainability and Transformation Partnerships

This LGA survey of local councillors finds that less than a quarter of respondents are confident that STPs will succeed and that the majority feel that they have not been involved with shaping, commenting on or approving of the plans. The report argues that STPs  should be more democratically accountable through local health and wellbeing boards, which should also be given a legal duty to sign off the plans.

Staff health and wellbeing CQUIN 2017-19 guidance

NHS England has published the Commissioning for Quality and Innovation (CQUIN) scheme for the staff health and wellbeing section  next two financial years.

For the 2018/19 season these are:

• 50 per cent uptake or less = no payment
• 50 to 60 per cent uptake = 25 per cent payment
• 60 to 65 per cent uptake = 50 per cent payment
• 65 to 75 per cent uptake = 75 per cent payment
• 75 per cent uptake or above = 100 per cent payment

Sir Peter Carr Award winners announced

Dr Rachel Pilling, a Consultant Ophthalmologist, and Daniel Wadsworth, Deputy Head of Access at Bradford Teaching Hospitals NHS Foundation Trust, impressed judges with their project idea “15 seconds – 30 minutes”. This encourages NHS staff to complete a small task today, that might take 15 seconds but may save colleagues 30 minutes by avoiding further tasks down the line. The initiative aims to reduce frustration at work, increase job satisfaction and as a result improving patient experience.

The C word: how we react to cancer today

This report from Macmillan argues that with cancer diagnoses becoming more common than marriage in the UK, there is a greater need for the public to be better informed about the reality of cancer diagnosis and treatment. The report explores people's experiences when receiving a cancer diagnosis and how best to support patients following diagnosis.

The interface between primary and secondary care: Key messages for NHS clinicians and managers

Good organisation of care across the interface between general practice and secondary care providers is crucial in ensuring that patients receive high-quality care and in making the best use of clinical time and NHS resources in both settings. This briefing document describes the key national requirements which clinicians and managers across the NHS need to be aware of. These are set out in the new NHS Standard Contract for 2017-19, under which clinical commissioning groups (CCGs) commission health services from providers, which came into effect on 1 April 2017 and which will remain in place until 31 March 2019.

• The interface between primary and secondary care: Key messages for NHS clinicians and managers
• Joint letter from NHS England and NHS Improvement

Entrepreneur scheme for innovative doctors extended to healthcare scientists and dentists

A unique training scheme for clinicians whose innovative ideas could lead to big patient benefits has been opened up to healthcare scientists and dentists.

Over the last year 103 junior doctors have developed their ideas and their business skills through NHS England's Clinical Entrepreneur programme. Now applications are opening up to healthcare scientists and dentists.

The programme offers a range of support and education, including mentoring by leading medical technology innovators, to give the budding entrepreneurs the business skills and industry knowhow they need to make their ideas a reality.

How to support a depressed partner while maintaining your own mental health

There is no lightning-bolt moment when you realise you are losing your sense of  self; just an absence. When you are caring for someone you love, your wants and needs are supplanted by theirs, because what you want, more than anything, is for them to be well. Looking after a partner with mental health problems – in my case, my husband Rob, who had chronic depression – is complicated.

Antipsychotic combinations for schizophrenia

Many people with schizophrenia do not achieve a satisfactory treatment response with their initial antipsychotic drug treatment. Sometimes a second antipsychotic, in combination with the first, is used in these situations.

This Cochrane Review examines whether:
1. treatment with antipsychotic combinations is effective for schizophrenia; and
2. treatment with antipsychotic combinations is safe for the same illness.

Communication skills training for mental health professionals working with people with severe mental illness

Research evidence suggests that both mental health professionals and people with severe mental health illness such as schizophrenia or schizoaffective disorder find it difficult to communicate with each other effectively about symptoms, treatments and their side effects so that they reach a shared understanding about diagnosis, prognosis and treatment. Effective use of communication skills in mental health interactions could be associated with increased patient satisfaction and adherence to treatment.

This Cochrane Review looks at the effectiveness of communication skills training for mental health professionals who work with people with severe mental illness.

Depression, Anxiety Biggest Risks to Well-Being Later in Life

It’s called the “age paradox.” Why do some people report high levels of subjective well-being as they age in spite of age-related ailments and the social losses of aging?

“Aging itself is not inevitably associated with a decline in mood and quality of life,” said Professor Karl-Heinz Ladwig, the head of the Mental Health Research Group at the Institute of Epidemiology II, Helmholtz Zentrum München, and a professor of psychosomatic medicine at the TUM University Hospital.

“It is rather the case that psychosocial factors, such as depression or anxiety, impair subjective well-being. And in the case of women, living alone also plays an important role.”

Read more HERE.

Childhood psychiatric disorders increase risk for later adult addiction

Children's health and well-being while growing up can be indicators of the potential health issues they may encounter years later. A new study suggests that a childhood psychiatric disorder increases the risk of developing addiction later in life.

Locality Sensitive Deep Learning for Detection and Classification of Nuclei in Routine Colon Cancer Histology Images

IEEE Transactions on Medical Imaging ( Volume: 35, Issue: 5, May 2016 )

Detection and classification of cell nuclei in histopathology images of cancerous tissue stained with the standard hematoxylin and eosin stain is a challenging task due to cellular heterogeneity. Deep learning approaches have been shown to produce encouraging results on histopathology images in various studies. In this paper, we propose a Spatially Constrained Convolutional Neural Network (SC-CNN) to perform nucleus detection. SC-CNN regresses the likelihood of a pixel being the center of a nucleus, where high probability values are spatially constrained to locate in the vicinity of the centers of nuclei. For classification of nuclei, we propose a novel Neighboring Ensemble Predictor (NEP) coupled with CNN to more accurately predict the class label of detected cell nuclei. The proposed approaches for detection and classification do not require segmentation of nuclei. We have evaluated them on a large dataset of colorectal adenocarcinoma images, consisting of more than 20,000 annotated nuclei belonging to four different classes. Our results show that the joint detection and classification of the proposed SC-CNN and NEP produces the highest average F1 score as compared to other recently published approaches. Prospectively, the proposed methods could offer benefit to pathology practice in terms of quantitative analysis of tissue constituents in whole-slide images, and potentially lead to a better understanding of cancer.

UHCW Research: Yee-Wah Tsang, David R. J. Snead  and Ian A. Cree        

Psychodermatology: a historical perspective

British Journal of Dermatology Volume 177, Issue S1, July 2017, Pages: 190–198. Historical Abstracts Orals

Psychodermatology encompasses the grey boundary between psychiatry and dermatology. It covers cutaneous disease aggravated by mental health (e.g. psoriasis), psychiatric conditions that present to dermatology (e.g. delusional infestation) and psychiatric disease secondary to cutaneous disease (e.g.

depression). Through analysis of source material this poster explores the history and development of psychodermatology.

UHCW Research: D. Jackson, R. Jerrom and A. Sharma

Glucagon decreases IGF-1 bioactivity in humans, independently of insulin, by modulating its binding proteins

J Clin Endocrinol Metab jc.2017-00558. DOI: https://doi.org/10.1210/jc.2017-00558. 03 July 2017

Depending on its lipolytic activity, glucagon plays promising role in obesity treatment. Glucagon-induced growth hormone (GH) release may promote its impact on lipid metabolism, although the underlying mechanisms are not well-defined. The current work highlights the glucagon impact on GH/IGF-1/IGF-binding proteins (IGFBPs) axis in vivo and in vitro, taking insulin as confounding factor into consideration.

Our data point to the glucagon-induced decrease in bioactive IGF-1 levels as a novel mechanism through which glucagon induces GH secretion. This insulin-independent reduction is related to increased IGFBP-1 and IGFBP-2 levels that is most likely mediated via activation of the FOXO-/mTOR pathway.

UHCW Research: Martin O. Weickert

A case of dystrophic calci nosis cutis and ossification secondary to cutaneous nodular amyloidosis masquerading as a soft-tissue tumour

British Journal of Dermatology (2017) 177 (Suppl. 1), pp 25–77: Bristol Cup Posters

We present a rare case of nodular amyloidosis associated with secondary dystrophic calcinosis cutis and ossification in a patient who underwent a circuitous route to dermatology following wide excision of a suspected lower-leg sarcoma.

UHCW Research: A. Wernham, W. Anderson, E. Poblet, E. Blessing and T. Shim