Immunosuppressive therapy for kidney transplant in children and young people [TA482]

New:  Technology Appraisal Guidance

Evidence-based recommendations  on immunosuppressive therapies for preventing kidney rejection in children and young people. The therapies are basiliximab (Simulect), immediate-release tacrolimus (Adoport, Capexion, Modigraf, Prograf, Tacni, Vivadex), mycophenolate mofetil (Cellcept and non-branded versions), rabbit anti-human thymocyte immunoglobulin (Thymoglobuline), prolonged-release tacrolimus (Advagraf, Envarsus), mycophenolate sodium (Myfortic, Ceptava), sirolimus (Rapamune), everolimus (Certican) and belatacept (Nulojix).

This guidance makes recommendations on using basiliximab, rabbit anti-human thymocyte immunoglobulin, tacrolimus (immediate-release and prolonged-release), mycophenolate mofetil, mycophenolate sodium, sirolimus, everolimus and belatacept after kidney transplant in children and young people. The recommendations apply only to the initial immunosuppressive therapy (induction and maintenance therapy) started around the time of kidney transplant.

It was outside the scope of the appraisal to make recommendations on using azathioprine or corticosteroids after kidney transplant in children and young people.
Under an exceptional directive from the Department of Health, the appraisal committee was allowed to make recommendations about using drugs outside the terms of their marketing authorisations if there was compelling evidence of their safety and effectiveness.

Radiation dose monitoring software for medical imaging with ionising radiation [MIB127]

New:  Medtech Innovation Briefing from NICE:

The technologies described in this briefing are 8 radiation dose monitoring software technologies that automatically gather and analyse information on patients' exposure to ionising radiation from medical imaging and X‑ray-guided procedures.

The innovative aspects are that dose-related data from medical imaging with ionising radiation can be systematically collected, monitored and analysed in a largely automated way. The technologies are designed to improve image quality while minimising radiation exposure to the patient.

Table 1 Summary of included technologies

Innovations

Current guidelines and arrangements

Population, setting and intended user

Costs

Resource consequences

NIHR Signal Wider stakeholder involvement could overcome resistance to modernising healthcare services

Among principles that can help when decommissioning out-dated, unsafe or poor value services are clear leadership and transparency about the reason for change with patients, clinicians and local communities.

Modernising healthcare often involves reducing, replacing and removing services. This is called decommissioning and the task varies with the local context.

Sinusitis (acute): antimicrobial prescribing [NG 79]

New Guidance from NICE:

This guideline sets out an antimicrobial prescribing strategy for acute sinusitis.  It aims to limit antibiotic use and reduce antimicrobial resistance. Acute sinusitis is usually caused by a virus, lasts for about 2 to 3 weeks, and most people get better without antibiotics. Withholding antibiotics rarely leads to complications.

This guideline includes recommendations on:

• managing symptoms, including advice when an antibiotic is not needed and the use of corticosteroids and nasal sprays
• choice of antibiotic when a back-up or immediate prescription is needed
• self-care

Cystic fibrosis: diagnosis and management [NG78]

New Guidance from NICE:

This guideline covers diagnosing and managing cystic fibrosis.  It specifies how to monitor the condition and manage the symptoms to improve quality of life. There are also detailed recommendations on treating the most common infections in people with cystic fibrosis.

This guideline includes recommendations on:

• diagnosis
• service delivery, including how to organise services and multidisciplinary teams
• annual and routine reviews
• monitoring, assessment and management, including for lung disease, pulmonary infection, distal intestinal obstruction syndrome, liver disease and cystic-fibrosis-related diabetes
• preventing cross-infection

Cataracts in adults: management [NG 77]

New Guidance from NICE:

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

1.1 Patient information

1.2 Referral for cataract surgery

1.3 Preoperative assessment and biometry

1.4 Intraocular lens selection

1.5 Preventing wrong lens implant errors

1.6 Surgical timing and technique

1.7 Anaesthesia

1.8 Preventing and managing complications

1.9 Postoperative assessment

Promonitor for monitoring response to biologics in rheumatoid arthritis [MB126]

New Medtech innovation Briefing from NICE:

The technology described in this briefing is Promonitor. It is used to monitor response to biologic therapies.

The innovative aspect is that each sample only needs to be run once, potentially allowing for a higher throughput of tests.

The intended place in therapy would be in addition to current methods of monitoring drug response in people with rheumatoid arthritis.

Promonitor (Grifols–Progenika) is a portfolio of assays, run on an enzyme-linked immunosorbent assay (ELISA) technology platform, that measure drug levels (etanercept, infliximab, infliximab biosimilars, adalimumab, rituximab, golimumab) and their correlating anti‑drug antibodies (anti‑etanercept, anti‑infliximab, anti‑adalimumab, anti‑rituximab, anti‑golimumab). The focus of this briefing is the use of Promonitor tests to monitor response to biologic treatments for rheumatoid arthritis. Monitoring drug response can help determine which drug works best for the patient.

Acknowledging Teens’ Perspectives Leads to Stronger Self-Worth, Less Depression

A new study has found that when parents acknowledge the perspectives of their adolescent children and encourage them to express themselves, the kids have a stronger sense of self-worth, intrinsic motivation, and engagement, and also have less depression. Click here for PsychCentral article

Mindfulness meditation app works -- but acceptance training component is crucial

A new study found that one component of mindfulness interventions is particularly important for impacting stress biology. Acceptance, or learning how to be open and accepting of the way things are in each moment, is critical for the training's stress reduction effects. The researchers offer the first scientific evidence that a brief mindfulness meditation mobile app that incorporates acceptance training reduces cortisol and systolic blood pressure in response to stress. Click here for full story

Changes in Daylight Savings Time Influence Aggression

While many people greatly anticipate gaining an extra hour sleep when Daylight Saving Time officially ends, new research finds that time changes may be accompanied by increased acts of aggression.Click here for PsychCentral article

NHS told to 'get serious' as full impact of cyberattack revealed

NAO investigation finds at least 139 urgent cancer referrals cancelled after WannaCry cyberattack

Investigation criticises NHS England and DH response, and “absence of timely central direction”

Central bodies were ignorant of NHS’s cybersecurity arrangements and had not rehearsed national response

Nearly 600 GP practices shut down after infection

An investigation into the unprecedented WannaCry cyberattack on the NHS has revealed more than 130 urgent cancer referrals were cancelled and more than 1,000 medical devices were infected.
To obtain this article please contact libraryw@uhcw.nhs.uk

Broad support for revalidation proposals highlighted in consultation report

The General Pharmaceutical Council has published a report which highlights that there was overall support for the proposals for revalidation for pharmacy professionals among respondents to a consultation we held earlier this year.

The evidence base for circulating tumour DNA blood-based biomarkers for the early detection of cancer: a systematic mapping review

BMC Cancer. 2017 Oct 23;17(1):697. doi: 10.1186/s12885-017-3693-7

The presence of circulating cell-free DNA from tumours in blood (ctDNA) is of major importance to those interested in early cancer detection, as well as to those wishing to monitor tumour progression or diagnose the presence of activating mutations to guide treatment. In 2014, the UK Early Cancer Detection Consortium undertook a systematic mapping review of the literature to identify blood-based biomarkers with potential for the development of a non-invasive blood test for cancer screening, and which identified this as a major area of interest. This review builds on the mapping review to expand the ctDNA dataset to examine the best options for the detection of multiple cancer types.

UHCW Research: Kikuchi H

The non-executive director’s guide to NHS data – Part one: Hospital activity, data sets and performance

A ‘data revolution’ across health and care services in England is vital if local areas are to transform the way care is delivered, the NHS Confederation has said.

Encouraging organisations to ‘get to the heart of their data’, the NHS Confederation has launched a new series of guides to help board members to better understand data across the healthcare system and its role in transforming care.

English Surveillance Programme for Antimicrobial Utilisation and Resistance’ (ESPAUR)

The 'English Surveillance Programme for Antimicrobial Utilisation and Resistance’ (ESPAUR) report says more than one million UTI samples were analysed in NHS laboratories across England last year (2016), and that resistance was a “common” observation.

One in three (34%) of the samples analysed were found to be resistant to an antibiotic called trimethoprim, compared to 29.1% in 2015.

Public Health England has also launched a major new campaign to help ‘Keep Antibiotics Working’.

The campaign warns people that taking antibiotics when they are not needed puts them at risk of a more severe or longer infection, and urges people to take their doctor’s advice on antibiotics.

NICE approves gene therapy for rare ‘bubble baby syndrome’

Strimvelis, a treatment for an ultra-rare inherited immune deficiency condition that has been dubbed ‘bubble baby syndrome’ has been approved by NICE in draft guidance.

Abstract ID: 139 Monte Carlo simulations for imaging in proton therapy

Physica Medica, Volume 42, Supplement 1, October 2017, Page 30

Proton therapy is rapidly gaining importance in the field of radiotherapy, because of its potential to deliver the planned dose over a small depth range and sparing dose to healthy tissue, when compared to conventional radiotherapy. Proton therapy, however, makes the need of new imaging modalities for treatment planning, based on direct measurements of tissue stopping power and eliminating the need to convert tissue density – as measured in conventional X-ray Computed Tomography) – to stopping power, upon which treatment planning is based[1]. The expected benefits of proton CT (pCT) for treatment planning in Proton Radiotherapy are producing great interest worldwide to develop instruments for clinical-quality pCT.

UHCW Research: SpyrosManolopoulos

Males with prolactinoma are at increased risk of incident cardiovascular disease

Clin Endocrinol. Accepted Author Manuscript. doi:10.1111/cen.13498

The aim of this study was to investigate whether the risk of incident cardiovascular disease (CVD) is increased in patients with prolactinoma.

UHCW Research: Tim Robbins

Adiponectin circulating levels and 10-year (2002–2012) cardiovascular disease incidence: the ATTICA Study

Endocrine (2017). https://doi.org/10.1007/s12020-017-1434-y

Adiponectin is an adipokine with anti-inflammatory and cardiovascular-protective properties. Existing epidemiological evidence is conflicting on the exact relationship between adiponectin and long-term cardiovascular disease (CVD) risk. Our aim was to prospectively assess whether circulating adiponectin is associated with long-term incident CVD.

UHCW Research: Ioannis Kyrou

Abstract ID: 248 A validated MC model of the University of Birmingham MC40 medical beam line

Physica Medica: European Journal of Medical Physics , Volume 42, Sup 1, p. 48 

The University of Birmingham MC40 Cyclotron is capable of delivering up to 40 MeV protons and 53 MeV He ions at a huge range of currents varying from fA to μA. A switching magnet allows the beam to be transported to one of twelve experimental areas. One of these is the medical beam line, which, in recent years has been used for the development of a novel proton CT device, radiobiological experiments, and proton range verification. We will present a validated MC model (using Geant4.10) of the medical beam line, demonstrating the excellent agreement between energy measurements and simulations, beam divergences, and scattering profiles through various materials. These three points are essential for all experiments conducted on the beam line. If time permits, we will also highlight some of the improvements made to the beam line where simulations formed an essential part of the design work such as a beam flattering system.

UHCW Research: Stuart Green

Heart failure: a story of damage, fatigue and injury?

Open Heart 2017;4:e000684. doi: 10.1136/openhrt-2017-000684

 

Heart failure has been recognised for years but the complete picture has been difficult to clearly understand. This article aims to try and put forward a proposed mechanistic explanation to encompass all that we see within the clinical heart failure syndrome using supporting published evidence. The aim of the article is to link, using published evidence, all the known varieties of heart failure into a spectrum that is explained by simple interlinked processes. In addition, the concept of routinely looking for reversibility of left ventricular dysfunction is introduced.

UHCW Research: Prithwish Banerjee

The provision of surgical tracheostomies by maxillofacial surgeons in the UK: time for a dedicated tracheostomy team?

The Annals of The Royal College of Surgeons of England 0 0:0, 1-4                     

Surgical tracheostomy is a commonly provided service by surgical teams for patients in intensive care where percutaneous dilatational tracheostomy is contraindicated. A number of factors may interfere with its provision on shared emergency operating lists, potentially prolonging the stay in intensive care. We undertook a two-part project to examine the factors that might delay provision of surgical tracheostomy in the intensive care unit. The first part was a prospective audit of practice within the University Hospital Coventry. This was followed by a telephone survey of oral and maxillofacial surgery units throughout the UK.

UHCW Research: P Chohan, Elledge R, Virdi MK and GM Walton

Literature review: the economic costs of lung disease and the cost effectiveness of policy and service interventions

This report, conducted by York Health Economics Consortium on behalf of the British Lung Foundation and British Thoracic Society, identifies published evidence on the economic costs of lung disease and the cost-effectiveness of different NHS activities, programmes and campaigns to combat lung problems.

Transforming Urgent and Emergency Care and the Vanguard Initiative: Learning from Evaluation of the Southern Cluster

Urgent and Emergency Care (UEC) vanguards aim to improve the quality, efficiency and effectiveness of UEC services so that patients receive the most appropriate care at the right time and in the right place, and so that unnecessary admissions to accident and emergency (A&E) and hospitals are reduced. The Southern Cluster comprises three such UEC vanguards. RAND Europe's evaluation examined the impacts of the vanguards, the processes underpinning delivery (and associated enablers and challenges), and implications for future policy and practice.

The evaluation used a multi-method approach, including theories of change, document review, workshops, interviews, surveys and data dashboards. Rand's report makes recommendations concerning: (i) UEC health and care workforce capacity-building, (ii) local-national coordination around UEC transformation, (iii) collaboration across localities and professions, (iv) support for an end-to-end UEC pathway with mutually reinforcing activities, (v) cost and outcome data, (vi) an interoperable data infrastructure, and (vii) capacity for evaluation and learning.

Latest NHS sickness absence statistics - June 2017

The latest figures released by NHS Digital shows that for quarter one 2017 (April to June) NHS staff sickness absence was 3.80 per cent. This is the lowest it has been since quarter one 2011 (April to June) when it was 3.77 per cent.

Response to second consultation on the next phase of regulation

The CQC has published its response to its second set of proposals that aim to simplify and strengthen the way we regulate health and social care in England.

Reward as part of an effective recruitment strategy

This new case study from NHS Employers highlights how Northern Devon Healthcare NHS Trust used reward, within a clear recruitment strategy to attract employees, increase applications for roles, reduce agency spend and nursing vacancies.

Monitoring noncommunicable disease commitments in Europe: progress monitor indicators

This report from Macmillan argues that the health and care system is failing to support recovering cancer patients with the physical and emotional trauma following treatment. It argues that the lack of appropriate aftercare is also placing pressure on the NHS with as cancer patients have 60 per cent more A&E attendances and 50 per cent more contact with GPs, 15 months after diagnosis.

Personalised Health and Care 2020: Patient Carers and Service User Vision

This DH paper outlines how the government and national health and care organisations aim to use information technology within current programmes, to improve health and social care services in England.

Falling number of nurses in the NHS paints a worrying picture

Pressures on nursing staff and the potential impact on patients are again in the news just as Jeremy Hunt promises more nursing training places – for good reason as the latest NHS workforce statistics show.

The number of nurses employed in the NHS follows a stable seasonal pattern. Numbers rise in the autumn as newly qualified staff complete their training and then decline again until the following summer as some staff resign or retire, before beginning the cycle once more as another year’s newly qualified staff arrive.

NHS Standard Contract 2017/18 and 2018/19 Technical Guidance

This is the draft version of the NHS Standard Contract 2017-19 Technical Guidance, published to accompany NHS England’s statutory consultation in October 2017.

NHS England has also published for consultation, proposals for in-year National Variations to the NHS Standard Contract 2017/18 and 2018/19 (Full Length) and to the NHS Standard Contract 2017/18 and 2018/19 (Shorter Form). We have also published the associated Technical Guidance in draft form.

Towards an effective NHS payment system: eight principles

This report from the Health Foundation sets out eight principles for a future payment system, primarily arguing that clarity of purpose is required to refocus the system’s many objectives. It argues that that now is the ideal time to review the system, with vanguards and STPs already changing the way that care is delivered, while a two-year fixed payment by results tariff offers space for reform.

CQC reports on radiation incidents

The CQC's annual report on activity relating to our enforcement of The Ionising Radiation (Medical Exposure) Regulations 2000 in England has been published.

The report gives a breakdown of the number and type of notifications we received from healthcare providers when patients received exposures of radiation that were ‘much greater than intended’ during 2016.

Radiation risk with digital mammography in breast screening

This review estimates the risks and benefits of breast screening in terms of number of deaths due to radiation-induced cancers and the number of lives saved due to digital breast screening in the NHS Breast Screening Programme (NHSBSP) in England.

Preventing and managing stroke: NHS RightCare Pathway

As part of the ongoing commitment by NHS England to prevent stroke and improve treatment and outcomes, NHS RightCare has published the latest Pathway for Stroke. 

Developed with the Stroke Association, the pathway details interlocking components for an optimal system for prevention and management of stroke and the priority higher value interventions that local health economies should focus on to address variation, improve outcomes, reduce cost and contribute toward a sustainable NHS.      

Performance Tracker: Autumn 2017

This report from the Institute for Government is the first in a series of data-driven analyses on the performance of government. The report uses government data to examine five key public services: hospitals, adult social care, police, prisons and schools. It finds that until recently the government managed to maintain the quality of public services while controlling spending however it warns that now the UK faces a combination of failing public services and breached spending controls.

See Spring's Performance Tracker Report

Shrewsbury and Telford hospital

My pledge was to identify a more rmeaningful way of commending wards and individual staff members who have been identified as providing excellent End of Life care to our patients in the trust bereavement survey feedback Click here for webpage

Donald Trump's 'downward mental health spiral' could lead US to war, clinical psychologist says

Health professional argues there is a possibility President Trump's mental health could leave America vulnerable to terror attacks or war. Read news article here

Plants May Help Maintain Mental Health of Astronauts

Research has shown that gardening or even just the presence of plants has a positive psychological effect on people, making them happier and more social. Now, in a new review published in the journal Open Agriculture, researchers at the University of Florida assert that plants may play a key role in maintaining the mental well-being of space crews. To read article click here

Audit uncovers concerns about the use of electroconvulsive therapy in England

Electroconvulsive therapy (ECT) continues to be used in England without comprehensive national auditing. In a new Psychology and Psychotherapy: Theory, Research and Practice study, experts recommend that national audits of ECT be reinstated, and they call for an investigation into why ECT is still excessively administered to older people and women. Click here for article

Sustainable staffing in our emergency departments

NHS Improvement has developed a plan with the Royal College of Emergency Medicine (RCEM), NHS England and Health Education England to grow the workforce, reduce attrition in medical training and ensure emergency departments are attractive places to work.

Learning from others: good practice when prescribing opioids in chronic pain

Long-term opioid prescribing for chronic non-cancer pain is becoming an increasing issue in England.

Faye's story puts these potential dangers into reality by describing, from her parents' perspective, the sequence of events that ultimately led to her untimely death from respiratory depression. They also outline the lessons learned by the GP practice involved in the case that they want to share with all healthcare professionals.

Please share these resources with those in your team involved in managing patients with long term pain, and encourage them to reflect on their own, and their teams, practice.

Emergency department (ED) patient safety checklist

This checklist has been proven to improve clinical processes and reduce serious incidents from unrecognised patient deterioration in crowded emergency departments.

Dementia assessment and improvement framework

An evidence-based framework from NHS Improvement to support and enable directors of nursing and medical directors to achieve ‘outstanding’ care standards for those living with dementia during their stay in hospital.

New materials on prevention and diagnosis of FASD

The National Organisation for Foetal Alcohol Syndrome-UK (NOFAS-UK) has launched new materials designed to increase awareness about the risk of prenatal exposure to alcohol. The new materials include posters and a pre-release version of a booklet, which explains how to identify possible cases of fetal alcohol spectrum disorders (FASD).

NMC to amend English language requirements for applicants trained outside the UK

The Nursing and Midwifery Council (NMC) is making alternative options available for nurses and midwives, trained outside the UK, to demonstrate their English language capability.

Emergency department survey 2016

The CQC asked people about their experiences of emergency departments. This report contains the analysis of the results.

New technology, earlier diagnosis and better coordination of care in cancer

“Achieving World-Class Cancer Outcomes – Progress Report 2016-17” describes the significant advances the National Cancer Programme has made over the past year as it moves towards the full delivery of the NHS five-year national cancer strategy. The strategy was developed in 2015 by an Independent Cancer Taskforce that was asked to deliver the vision set out in the NHS Five Year Forward View.

The report describes progress across the field including:

• Modernisation of radiotherapy equipment throughout the country.
• New models of care introduced to ensure cancer is diagnosed earlier and improve survival.
• Establishment of Cancer Alliances across the country to bring together clinical leaders, healthcare workers, patients and charities for better coordination of care.

Exclusive: Airbnb style company bids to place NHS patients in spare rooms

NHS pilots Airbnb style company that sources rooms in private homes for patients post-discharge

Company says “hosts” need no care experience and can help both NHS and patients

Campaigners and ADASS raise safeguarding concerns about “abuse of vulnerable people”

Members of the public with no care experience are being offered up to £1,000 a month to rent spare rooms to patients after they are discharged from hospital, under an Airbnb style model to be piloted by the NHS.


to obtain this article please contact: libraryw@uhcw.nhs.uk

Protecting our most vulnerable patients

Analysts at NHS England have looked at the approaches taken by five new care model vanguards (Tower Hamlets, Sunderland, North East Hants and Farnham, Erewash and Morecambe Bay) to identify patients at risk in their communities. They found that they have introduced the ‘building blocks’ of an effective risk stratification process and most are using predictive models and implementation is clinically-led. Click here for link to NHS England blog

Schizophrenia Interferes With All Brain Communication Networks

New research finds the effects of schizophrenia are widespread with the disease affecting neural wiring in all areas of the brain. The finding overturns the theory that schizophrenia manifests due to communication issues in only the prefrontal and temporal lobes. Click here for news from PsychCentral

Specific Brain Training Approach Can Aid Memory and Attention

New research suggests a specific method of brain-training is significantly better in improving memory and attention than other training protocols. Johns Hopkins University researchers discovered the method that helps the most also demonstrates more significant changes in brain activity.
Researchers explain that while the brain exercise didn’t make anyone smarter, it greatly improved skills people need to excel at school and at work. Investigators believe these results suggest it’s possible to train the brain like other body parts — with targeted workouts. Click here for news piece

Midday Light Therapy May Be Best for Bipolar Disorder

A new study suggests that six weeks of midday light therapy can help people with bipolar disorder improve mood and enhance functional abilities.
Bright light therapy has been used for years to reduce symptoms of depression in patients with Seasonal Affective Disorder (SAD). The therapy is typically delivered in the morning to theoretically reset circadian rhythms. Click here for news item

Lifestyle Choices Key to a Longer Life

A new study has found that people who are overweight cut their life expectancy by two months for every extra kilogram (or about two pounds) of weight they carry.
The study, from researchers at the University of Edinburgh, also found that education leads to a longer life, with almost a year added for each year spent studying beyond school. Click here for news link

'Magic mushrooms' may help 'reset' depressive brains, study claims

"Magic mushrooms can 'reboot' brain to treat depression," reports the Daily Telegraph.
The news is based on a small UK study that looked at the effects of psilocybin, a chemical found in magic mushrooms, on patients with severe depression. Click here for behind the headlines link

New £15 million grant scheme to improve mental healthcare

The Department of Health has launched a £15 million fund to better support people at risk of experiencing a mental health crisis.Click here for news story

PleuraFlow Active Clearance Technology for maintaining chest tube patency [MIB125]

New: Medtech innovation briefing


The technology described in this briefing is PleuraFlow Active Clearance Technology (ACT). It is a chest drain that incorporates a tube clearance system.

The innovative aspects are that it is designed to prevent the formation of blood clots within chest tubes and, if they do occur, to actively remove them.

Mepilex Border dressings for preventing pressure ulcers [MIB124]

New: Medtech innovation briefing


The technology described in this briefing are Mepilex Border dressings, specifically the 2 variants designed to prevent pressure ulcers (Mepilex Border Heel and Mepilex Border Sacrum).

The innovative aspects are that the dressing is designed to reduce pressure and friction caused by patient movements. It also uses the company's proprietary Safetac technology, which is intended to minimise pain when changing dressings or inspecting the skin.

Doctors threaten legal action against NHS over IR35 tax rules

Unions representing locum doctors have threatened to seek a judicial review against NHS Improvement claiming the NHS is continuing to wrongly apply new tax rules.

The IR35 tax rules came into force for NHS trusts in April and require trusts to pay the tax and National Insurance for temporary staff who supply their services through a personal service company.  In some cases, the extra tax can reduce their income by half.


NHS Improvement has said it is up to trusts to ensure they are compliant with the rules.
To obtain full article please contact: libraryw@uhcw.nhs.uk

This year's most important health strategy is the one you might not read

If it ignores the upcoming Industrial Strategy White Paper, the NHS will miss the opportunity to boost its future financing, provision and staffing through strategic local economic partnerships, notes Michael Wood


The Industrial Strategy White Paper is expected to be published around the same date as the Chancellor’s 22 November statement. The word “Industrial” in the title probably means that both NHS leaders think it’s not for them and industry leaders think it’s not for us. In fact, both would be wrong.
To obtain this full article please contact: libraryw@uhcw.nhs.uk

A&E survey: Best and worst performing trusts revealed

Five trusts performed worse than expected for overall patient experience, while six performed better than expected

Best and worst performers for ambulance A&E waiting times also revealed

Forty per cent of A&E attendees waited more than four hours to be seen

Five trusts have been identified as offering a poor overall experience to patients in their accident and emergency departments, based on a new Care Quality Commission patient survey.

To obtain this article please copy and paste the post into an email and send it to library@uhcw.nhs.uk with the subject line reading, Please obtain this article.

A&E survey: Two in five report waiting more than four hours

Forty per cent of patients waiting over four hours to be seen at large A&Es, compared to 15 per cent at urgent care centres

Sixteen per cent of ambulance attendees wait over 60 minutes to be transferred to A&E

Better patient experience at type three centres compared to type one

Two-fifths of accident and emergency attendees report waiting more than four hours to be seen, a new patient survey has revealed.

To obtain this article please copy and paste the post into an email and send it to library@uhcw.nhs.uk with the subject line reading, Please obtain this article.

The new chair of NHS Improvement has told MPs it is “obvious” the NHS is at “full stretch” and needs more money.

Baroness Dido Harding said she would be a “thorn in the side” of ministers in her new role.


In a pre-appointment hearing this afternoon at the Commons health committee, Baroness Harding, a Conservative peer, said she would be prepared to challenge the government on health issues. She is also married to Conservative MP John Penrose.
To obtain this full article please contact: libraryw@uhcw.nhs.uk

Consultation on nursing associate regulation now open

The Department of Health has launched a new consultation seeking views of employers about how nursing associates should be regulated.

Responses will feed in to changes of the Nursing and Midwifery Order 2001, which sets out the Nursing and Midwifery Council’s (NMC) powers and duties. The order needs to be amended for the NMC to effectively regulate the nursing associate profession.

The consultation, launched on Monday 16 October, is open until 26 December 2017. 

Seven new project teams selected to deliver better health care at scale across the UK

Seven health care project teams have each been awarded £0.5 million by the Health Foundation to take proven health care interventions and approaches and deliver them at scale across the UK.

Over the next two and a half years, as part of the Health Foundation’s Scaling Up Improvement programme, the project teams will scale their projects regionally or nationally and aim to deliver direct improvement to patient outcomes.

Accessible Information Standard – Overview 2017/2018

This document from NHS England provides an overview of the Accessible Information Standard for patients, service users, carers and parents.

Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty

Knee Surg Sports Traumatol Arthrosc (2017) 25: 3403. https://doi.org/10.1007/s00167-016-4314-8

Around 10–30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables.

UHCW Research: Daniel Wilson-Nunn

Engaging staff to improve quality case study

NHS Employers' latest staff engagement case study explores how Sheffield Teaching Hospitals NHS Foundation Trust has developed a number of ways to support its quality improvement programme.

Focusing primarily on staff engagement, the study looks at the development of the Sheffield Microsystems Coaching Academy, forming Listening into Action groups and the creation of trust values. The case study also highlights the benefits the organisation has seen as part of its 'Making it Better' transformation programme.

Changes to the National Patient Reported Outcomes Measures programme

NHS England undertook a consultation on the national Patient Reported Outcomes Measures (PROMs) programme in 2016. As a result of the findings of that consultation, NHS England has now taken the decision to discontinue the mandatory varicose vein surgery and groin-hernia surgery national PROM collections.

NHS England will continue with hip and knee surgery PROM collections and are working with NHS Digital to make the national data on them easier to use and to provide a range of automated outputs that are tailored to the needs of trusts, CCGs and other users.

Dementia-Friendly Dentistry

Dementia-Friendly Dentistry: Good Practice Guidelines, published by the FGDP, enables dental professionals to understand dementia and its implications for dental practice, and adapt their patient management and clinical decisions accordingly.

Commissioning for Quality and Innovation: Enhanced supportive care data tool

This updated version of the tool, from NHS England, should be used to collect baseline data and return data relevant to each quarter's payment trigger within the Enhanced supportive care (for advanced cancer patients) commissioning for quality and innovation national goal.

NHS targets super-sized chocolate bars in battle against obesity, diabetes and tooth-decay

Hospitals have been ordered to take super-size chocolate bars and “grab bags” of sugary snacks off the shelves in the latest step of the NHS plan to fight obesity, diabetes and tooth-decay.

NHS England chief executive Simon Stevens has announced a 250 calorie limit on confectionery sold in hospital canteens, stores, vending machines and other outlets.

Hospital chiefs will have to ensure that four out of five items purchased on their premises do not bust the limit, which is an eighth of a woman’s and a tenth of a man’s recommended daily intake, or lose out on funding ring-fenced for improving the health of staff, patients and their visitors.

Unhealthy sandwiches and drinks are also being targeted as the NHS, Europe’s largest employer, takes a lead in tackling the availability of unhealthy food and drinks that are fuelling an obesity crisis.

Maintaining reciprocal healthcare for patients after Brexit

Now that negotiations are underway between the UK and the European Union on the terms of the UK’s withdrawal from the EU, what will this mean for British people who need healthcare in another EU country, or EU citizens who need treatment while they’re in the UK?

This paper, produced by the Brexit Health Alliance, explains what is happening in the Brexit negotiations, and what the implications would be if the existing reciprocal arrangements were to be discontinued post Brexit.

The SAFER patient flow bundle and Red2Green days approach

NHS Improvement has provided resources that will help you implement the SAFER patient flow bundle and Red2Green days in your organisation. When followed consistently, these can reduce length of stay and improve patient flow and safety.

See also:

• SAFER patient flow bundle: board rounds
• SAFER patient flow bundle: ward rounds

Healthcare Informatics

New guidance from the Royal College of Ophthalmologists.

Healthcare involves the collection and generation of huge amounts of information which is subsequently managed, utilised and shared. Healthcare informatics is the science of ensuring that this processing of information is efficient and safe for the benefit of patients. With the current rapid improvements in information technology, it is the duty of healthcare providers to harness this technology to maximise efficiency, safety and quality of patient care, as well as to help drive healthcare innovation.

This document intends to provide a glossary and basic introduction to the multiple facets of healthcare informatics and provides references for further reading.

Diabetes UK Consensus Guideline for Flash Glucose Monitoring

Flash glucose monitoring (Flash GM) is a new technology that has recently been made available on the NHS Drugs Tariff. This means in principle it is available to people with diabetes in the UK on
NHS prescription. It is important that healthcare professionals and local health decision makers
are aware of the new technology so that they can make sure that people with diabetes have access
to Flash GM in their local area.

Seven Day Services Clinical Standards

This document from NHS England provides details of the seven day hospital services clinical standards.

Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries (IPG594)

New NICE Interventional Procedure guidance on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure in people with high spinal cord injuries. This involves implanting electrodes into the diaphragm to make it contract. This gradually strengthens the diaphragm and may eventually help the person to breathe without a ventilator.

Current evidence on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries shows that there are serious but well-recognised safety concerns. Evidence on efficacy is limited in quantity and quality. Therefore, this procedure should only be used in the context of research.

Choice in end of life care: government progress

How the National End of Life Care Programme Board is delivering personalisation and choice in care for people at or near the end of life.

Tissue pathway for histopathological examination of the placenta

This tissue pathway from the Royal College of Pathologists aims to provide guidance on the range of indications for referral of aplacenta for histopathological examination and minimum standards for pathologists undertaking placental examinations. Variations to the standard pathway for singleton placentas, relating to pregnancies from multiple gestations, are also included. Please note that products of conception (1st trimester) have been included in the tissue pathways for gynaecological pathology.

Prevent Training and Competencies Framework

This document is to support organisations in determining the level of Prevent training and the competencies that are required for staff in the health sector.

Reviewing ‘stranded’ patients in hospital – what are patients waiting for?

These resources will help NHS Organisations undertake a stranded patient review in any setting, from the acute trust to reablement services. These should be multi-agency in approach. The result should support the patient along their journey, providing data and evidence to inform system change discussions.

Intermediate care including reablement

This new NICE guideline covers referral and assessment for intermediate care and how to deliver the service. 

Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care.

Recommendations include:
1.1 Core principles of intermediate care, including reablement
1.2 Supporting infrastructure
1.3 Assessment of need for intermediate care
1.4 Referral into intermediate care
1.5 Entering intermediate care
1.6 Delivering intermediate care
1.7 Transition from intermediate care
1.8 Training and development

Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by motor neurone disease [IPG 593]

New Interventional Procedures guidance from NICE on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure in people with motor neurone disease. This involves implanting electrodes into the diaphragm to make it contract. This gradually strengthens the diaphragm and may eventually help the person to breathe without a ventilator.

Current evidence on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by motor neurone disease suggests that there are serious long-term safety concerns. Evidence on efficacy is limited and therefore, this procedure should not be used to treat this condition.

Faltering growth: recognition and management of faltering growth in children

New NICE Guidance covering the recognition, assessment and monitoring of faltering growth in infants and children. It includes a definition of growth thresholds for concern and identifying the risk factors for, and possible causes of, faltering growth. It also covers interventions, when to refer, service design, and information and support.

This guideline includes recommendations on:

• weight loss in the early days of life
• faltering growth after the early days of life
• organisation of care
• information and support for parents and carers

Lifelong learning and building teams using peer feedback

This document from the Royal College of Radiologists outlines the processes and benefits of using both peer review and peer feedback within radiology departments.

WHO Guidelines on Integrated Care for Older People (ICOPE)

The provision of integrated care is key for older people. The WHO Guidelines on Integrated Care for Older People (ICOPE) propose evidence-based recommendations for health care professionals to prevent, slow or reverse declines in the physical and mental capacities of older people.

List of prescribed specialised services directly commissioned by NHS England

A list of prescribed specialised services directly commissioned by NHS England as at April 2017.

WHO guideline on syphilis screening and treatment for pregnant women

Since the publication of the WHO Guidelines for the management of sexually transmitted infections in 2003, changes in the epidemiology of STIs and advancements in prevention, diagnosis and treatment necessitate changes in STI management.

This guideline provides updated recommendations for syphilis screening and treatment for pregnant women based on the most recent evidence and available serologic tests for syphilis

NHS staff health & wellbeing: Commissioning for Quality and Innovation (CQUIN) 2017-19 Indicator 1 Implementation Support

This supplementary guidance from NHS England provides clarification on the criteria set out in the indicator specifications for the 2017-19 Health and Wellbeing CQUIN and supports implementation of each CQUIN indicator by providing tools and resources.

Influenza: treatment and prophylaxis using anti-viral agents

Updated guidance from Public Health England on how to manage influenza (flu) using anti-viral agents.

When the price isn't right: how cuts in hospital payments added up to the NHS deficit

NHS hospitals and other services ended the financial year 2016/17 with an underlying deficit of £3.7 billion. That is to say: they had £3.7 billion less reliable cash coming in than they had going out.

The answer, in this briefing from the Nuffield Trust, is surprisingly simple: hospitals are paid for each patient they treat, and the price they receive is set by a national tariff listing thousands of common procedures or types of care. But the prices on this list have been cut in real terms every year since 2009/10, and most years in cash terms too.

This means that a hospital will be given just £937 in cash this year to treat a patient they would have received £1,000 in cash to care for in 2009/10 – the green line on our graph. Factor in eight years of inflation, and that £937 is more like £760 (the blue line).

New enhancements to DBS services

The Disclosure and Barring Service (DBS) is introducing a number of enhancements to improve their services.

The changes, which can help employers speed up their recruitment and referral process, will either be available immediately or will come into effect in 2018.

NHS leaders unveil action to boost flu vaccination and manage winter pressures

NHS England, Public Health England, the Department of Health and NHS Improvement have unveiled measures to boost the uptake of flu vaccinations along with package of new contingency actions to respond to pressures on frontline services this winter. 

Intensified preparations include:

• Providing free flu vaccines for hundreds of thousands of care home staff at a cost of up to £10m as well as increasing the number of jabs for young children in schools and vulnerable people
• Directing NHS trusts to ensure they make vaccines readily available to staff and record why those who choose to opt out of the programme do so
• Writing to doctors, nurses and other healthcare workers reminding them of their professional duty to protect patients by being vaccinated
• Setting up a new National Emergency Pressure Panel to provide independent clinical advice on system risk and an appropriate regional and national response
• The biggest expansion in training for A&E consultants ever with hundreds more doctors over the next four years and other healthcare staff

Advancing Healthcare Awards 2018

Entries are now open for the Advancing Healthcare Awards 2018.

In its 12th year the awards are open to allied health professionals, healthcare scientists and those who work alongside them in support roles, and aim to recognise and reward those projects and professionals that make a real difference to patients’ lives.

Nominations are welcomed from individuals, teams and patients, service users and carers. With four new awards, there are now 14 categories in total, with the overall winner announced at a ceremony held on 20 April 2018 in London.

The deadline for entries is 5pm on Friday 19 January 2018.

New rehab garden helps hospital patients return home with confidence

Leamington Spa Hospital has opened a garden to rehabilitate patients who have experienced brain injuries, strokes and amputations.

Lead physiotherapist Lucy Gwynne described the garden as ‘unique’ and said its design aims to improve the balance, mobility and confidence of patients in dealing with everyday hazards on foot and in wheelchairs.

The features of the garden are a slalom course, stepping stone path, uneven surface, bridge, activity board, wire loop challenge and cognitive therapy facilities.

Care Quality Commission regulating health and social care

This report from the National Audit Office concludes that the Care Quality Commission has improved as an organisation, but now needs to overcome some persistent issues with the timeliness of some of its regulation activities if it is to sustain further improvement.

How mobile technology can reduce agency spend

Read this NHS Employers' case study looking at how Royal Surrey County Hospital NHS Foundation has used mobile technology and collaboration to increase the take up of its internal bank.

Find out about the trust's challenge, its approach to creating the app and how clinicians can now book gaps in medical rotas at the touch of a button.

Nivolumab is recommended for use within the Cancer Drugs Fund (CDF) for some patients with head and neck cancer.

The immunotherapy drug, nivolumab, also known as Opdivo made by Bristol-Myers Squibb, will be available for patients with head and neck cancer who have not responded to chemotherapy within 6 months, and the cancer has spread to other parts of the body.

When NICE first reviewed nivolumab, it was found that the evidence for its effectiveness in treating head and neck cancer was uncertain. NICE invited Bristol-Myers Squibb to submit a CDF proposal to show how they would strengthen the evidence for nivolumab.

Patients can now have access to the drug via the NHS whilst it is within the CDF. During this time, further data will be collected from how well patients do who access the drug through the CDF and from a clinical trial to help address uncertainties in the evidence.

New treatment option for people with gastrointestinal cancer

Regorafenib can be offered as an option to treat people who have gastrointestinal stromal tumours (GIST) that have spread to other parts of the body, cannot be treated by surgery, or if the person is unable to take other treatments.

The drug was previously only available to patients through the CDF but now, after NICE’s recommendation, it will be routinely available on the NHS.

Expanded version pedicled free-style perforator flaps in clinical practice: a need for a more comprehensive classification system

J. Eur J Plast Surg (2017). https://doi.org/10.1007/s00238-017-1365-0 

The evolution of the angiosome concept into the perforasome theory as we increasingly move towards the distal end of the microvascular tree for reconstructive options has allowed us to design ad hoc perforator flaps.

It is feasible to perform the many variations of perforator flaps provided; the microsurgical anatomy of the area is well defined, aided by imaging studies as necessary. Risk stratification also needs to be taken into account when planning these flaps. Based on our results and observations, an alternative pedicled perforator flap classification is put forward.

UHCW Research: J. Hardwicke

Educating and campaigning for pressure ulcer prevention

Wounds UK 13 (3)

This article highlights the successful efforts of the Tissue Viability team at the University Hospital Coventry and Warwickshire (UHCW) in reaching out to clinical staff in order to make progress in preventing pressure ulcers. The author describes how staff, with an interest in pressure ulcer prevention, are chosen to act as a link between the Tissue Viability Team and other clinical colleagues. After a short training, these link workers pass on brief 10-minute (power) training without having to leave their individual clinical setting, focussing on the key messages to: Assess, Surface, Keep moving, Incontinence and Nutrition (ASKIN). All of which helps to reduce in the incidence of hospital-acquired pressure ulcers.

UHCW Research: Rachel Reece

Sepsis [QS161]

New NICE quality standard covers the recognition, diagnosis and early management of sepsis for all populations. It describes high-quality care in priority areas for improvement.

Sere also Sepsis guidance implementation advice for adults and the Cross-system sepsis action plan 2017 from NHS England.

New guidance on managing conflicts of interest in the NHS

On 9 February 2017, NHS England issued new guidance on managing conflicts of interest in the NHS. This guidance:

• introduces common principles and rules for managing conflicts of interest
• provides simple advice to staff and organisations about what to do in common situations
• supports good judgement about how interests should be approached and managed.

See Conflicts of Interest in the NHS – Guidance for staff and organisations

The guidance came into force on 1 June 2017 and is applicable to the following NHS organisations:

• Clinical Commissioning Groups (‘CCGs’)
• NHS Trusts and NHS Foundation Trusts – which include secondary care trusts, mental health trusts, community trusts, and ambulance trusts
• NHS England (through our Standards of Business Conduct).

This guidance supersedes and extinguishes the Standards of Business Conduct for NHS staff (HSG(93)5).

To make implementation easier a model policy which includes the content of the guidance has been released. Organisations can adopt this policy or use parts of it to update their current policies and procedures.

See also Managing conflicts of interest in the NHS – questions and answers

Sickle cell and thalassaemia screening: care pathway

This document from Public Health England describes the sickle cell and thalassamia (SCT) screening pathways.

See also Sickle cell and thalassaemia screening: handbook for laboratories

Approved costing guidance

Updated 4th October

The Approved costing guidance forms a co-ordinated approach to patient-level costing (PLICS), the reference costs collection and the reference costs assurance programme.  It has recently been updated.

It comprises:

• costing standards to be used by providers of NHS services 
• PLICS collection guidance to be used by acute sector early implementers in submitting their 2016/17 cost data
• integrated reference costs and education and training collection guidance to be used for submitting 2016/17 cost data, which are mandatory for all providers of NHS services

'No systematic bullying' of NHS finance staff, says second professional body

A second body representing NHS finance staff has described reports of senior managers feeling bullied into reporting unachievable numbers “disturbing”, but does not believe there is a “systematic” problem.

Earlier this week, the Chartered Institute of Public Finance and Accountancy, a professional body for public sector accountants, voiced concerns that experienced NHS managers are having their professional ethics compromised, and that underlying financial performance is being misrepresented.


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Cerebral palsy in children and young people [QS 162]

New Quality standard

This quality standard covers diagnosing, assessing and managing cerebral palsy in children and young people under 25. It describes high-quality care in priority areas for improvement.

Keeping quality standards up to date

This quality standard is reviewed each year and updated if needed.
Next review: August 2018

Visceral adiposity index and 10-year cardiovascular disease incidence: The ATTICA study

Nutrition, Metabolism & Cardiovascular Diseases (NUTR METAB CARDIOVASC DIS), Oct2017; 27(10): 881-889

Visceral adiposity index (VAI) has been proposed as a marker of visceral adipose tissue accumulation/dysfunction. Our aim was to evaluate potential associations between the VAI and the 10-year cardiovascular disease (CVD) incidence.

UHCW Research: I Kyrou, 

Combined Performance Summary - August 2017

This publication from NHS England summarises the data around NHS performance for August 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

Each Baby Counts full 2015 report

The Royal College of Obstetricians and Gynecologists (RCOG) has published the first full Each Baby Counts report into all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015.

Children born prematurely have greater risk of cognitive, motor and behavioural difficulties

Babies born preterm – at any degree – have a greater risk of developing cognitive, motor and behavioural difficulties and these problems persist throughout school years, finds a new study published online in BJOG: An International Journal of Obstetrics and Gynaecologists.

The authors call for “organisations delivering healthcare, policy makers and educational institutions to take into account the additional academic, emotional and behavioural needs of children born preterm.”

In the UK, around 60,000 babies are born prematurely each year. Short term complications of preterm for the child include higher risk of respiratory complications, sepsis, and bleeding into brain. In addition, these children are at risk of cognitive, motor, and behavioural difficulties in the long-term.

However, there is little evidence on the effects of being born preterm at various points in subsequent years after birth. Therefore, UK based researchers carried out a systematic review to analyse the effect of preterm birth at various stages on the cognitive, motor, behavioural and academic performance of children born preterm versus those born at term.

Reconfiguration of NHS services (England)

House of Commons Library briefing on reconfiguration of NHS services, including recent policy developments, information on consultation and scrutiny powers, and drivers of major service changes.

Colchester trust launches falls prevention film

Colchester Hospital University NHS Trust has created a 13-minute film to help patients recover from a fall and to minimise the risk of future falls.

The Regulation of Medical Associate Professions in the UK

This DH consultation seeks views on the regulation of medical associate professions in the UK, including physician associates, physicians’ assistants, surgical care practitioners and advanced critical care practitioners. The closing date for comments is 22 December 2017.

Sustainability and transformation partnerships: developing robust governance arrangements

This briefing from the HFMA includes a diagnostic tool to assess the status of governance arrangements arising from ‘at scale’ working. Completing the tool will provide a basis for discussion by the board/ governing body and/ or audit committee of an NHS body when seeking assurance about developing governance arrangements.

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

N Engl J Med. 2017 Oct 5;377(14):e20.

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism.

UHCW Research: M. O. Weickert

Clinical academic career: an alternative viewpoint

Clin Teach. 2017 Apr;14(2):141-142. doi: 10.1111/tct.12545. Epub 2016 Jun 15.

Clinical academic career: an alternative viewpoint.

UHCW Research: S. Tso

Study suggests epidural does not slow second stage of labour

A study published in the journal Obstetrics & Gynaecology, showed that the use of epidural analgesia in the second stage of labour made no difference to duration of labour, and suggests that the practise of minimising pain management in labour may be outdated.

The results show epidural also had no effect on normal vaginal delivery rate, incidence of episiotomy, the position of the fetus at birth or any other measures of fetal well-being. The study compared the effects of catheter-infused, low-concentration epidural anesthetic to a catheter-infused saline placebo in this double-blinded, randomized trial of 400 women.

Enabling providers to develop new care models

Commissioners will play an important role in empowering providers to work together to establish the collaborations that may evolve to become the accountable care systems of the future.  Find out more in these four articles, published by PCC:

• Getting GPs on board remains a big issue for accountable care organisations
• NHS England’s proposed contractual approaches for accountable care models
• Commissioners must drive but leave providers to steer new care models
• Accountable care organisations need support to get GPs’ pay right

NMC releases draft standards of proficiency for nursing associate role

The Nursing and Midwifery Council (NMC) has released draft standards of proficiency for nursing associates.

The standards are an early draft, and the NMC will launch a public consultation in Spring 2018 to help further develop the standards.

Clinical radiology UK workforce census 2016 report

Key findings of the Clinical radiology UK workforce census 2016 report include;

• Nearly one-in-ten UK radiologist posts (8.5%) were vacant during 2016, nearly two-thirds of which (61%) were unfilled for a year or more
• The need for scans continues to grow. In England from 2013-16 the number of computed tomography (CT) and magnetic resonance imaging (MRI) scans respectively rose by more than 30% - three times more than the rate of workforce growth. Technological advances mean that these scans are more complex than ever before and take longer to interpret
• The high proportion of retirements versus new consultant numbers means the UK’s radiologist workforce will expand by just 1% year-on-year
• Last year, only 3% of NHS imaging departments were able to report all their patient scans within normal working hours
• The NHS spent nearly £88 million in 2016 paying for backlogs of radiology examinations to be reported – the same amount could have paid for at least 1,028 full-time consultants

Making the case for quality improvement: lessons for NHS boards and leaders

This report by The King's Fund has been co-authored with The Health Foundation.

• The NHS is facing significant financial and operational pressures, with services struggling to maintain standards of care. Now, more than ever, local and national NHS leaders need to focus on improving quality and delivering better-value care. All NHS organisations should be focused on continually improving quality of care for people using their services. This includes improving the safety, effectiveness and experience of care.
• Quality improvement – the use of methods and tools to continuously improve quality of care and outcomes for patients – should be at the heart of local plans for redesigning NHS services. NHS leaders have a vital role to play in making this happen – leadership and management practices have a significant impact on quality. Studies have shown that board commitment to quality improvement is linked to higher-quality care, underlining the leadership role of boards in this area.
• Improving quality and reducing costs are sometimes seen as conflicting aims when they are in fact often two sides of the same coin. There are many opportunities in the NHS to deliver better outcomes at lower cost (improving value), for example by reducing unwarranted variations in care and addressing overuse, misuse and underuse of treatment. There are many examples across the NHS showing that even relatively small-scale quality improvement initiatives can lead to significant benefits for patients and staff, while also delivering better value.
• The potential benefit is even greater if quality improvement techniques are applied consistently and systematically across organisations and systems. However, this is not currently the case. To deliver the changes that are needed to sustain and improve care, the NHS needs to move from pockets of innovation and isolated examples of good practice to system-wide improvement.

In this briefing, we outline 10 lessons for NHS leaders. These provide a starting point for leaders seeking to embed quality improvement in their work.

Exclusive: Variation in surgery standards depending on time of day flagged

National Emergency Laparotomy Audit reveals widespread variation in standards of care for thousands of patients

Patients operated on at night and after midnight had higher chance of death than those treated during the day

Almost a quarter of hospitals missing key targets to get patients to operating theatres within two hours.

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The Commissioner: Winter, deaths and inequality

What NHS England isn’t telling you, and more indispensable insight for commissioners, by Dave West.

Covering unexpected wobbles in life expectancy a couple of years ago, it struck me that the phrase “life expectancy” is a bit misleading.

It is often treated as an unquestionable statistic based on some incredible insight into the future – perhaps from an algorithm so powerful it has developed the necessary foresight, or handed down from a mysterious external presence.
In fact, “period life expectancy” – the figure that is often discussed and was the basis of recent analysis by Sir Michael Marmot’s team – does not even involve any expert prediction or debate.

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Is it possible to self-diagnose depression?

In 2017, everything is just one click away, maybe even a mental illness. Google have partnered with the National Alliance on Mental Illness (NAMI) to create a self-assessment test that enables US users to see if they should seek help for depression. Click here to read newspaper article

Mental Health Service Models For Young People

Parliamentary Office of Science and Technology -
In 2015, the government committed five years of extra funding for children and young people’s mental health services (CYPMHS). All areas of England were required to submit plans outlining how they will improve their services by 2020. This POSTnote describes some of the new models of CYPMHS and examines the challenges to their effective implementation. Click here for Kings Fund blog

Mental Health In Prisons

This report looks at the provision of mental healthcare in prison, and efforts to maintain prisoner well-being. We also considered routes out of prison, including continuity of care into the community and transfer to secure hospital. Click here for link to Kings Fund blog

People with learning disabilities and behaviour that challenges should be better cared for in the community, says NICE

Local authorities and NHS bodies should provide specialist community care for people with learning disabilities who behave in a way that challenges to avoid admissions to psychiatric wards or residential homes, new draft guidance from NICE says. Click here for news piece

Immunosuppressive therapy for kidney transplant in children and young people [TA481]

New Guidance from NICE:

Evidence-based recommendations on immunosuppressive therapies for preventing kidney rejection in children and young people. The therapies are basiliximab (Simulect), immediate-release tacrolimus (Adoport, Capexion, Modigraf, Prograf, Tacni, Vivadex), mycophenolate mofetil (Cellcept and non-branded versions), rabbit anti-human thymocyte immunoglobulin (Thymoglobuline), prolonged-release tacrolimus (Advagraf, Envarsus), mycophenolate sodium (Myfortic, Ceptava), sirolimus (Rapamune), everolimus (Certican) and belatacept (Nulojix).

This guidance makes recommendations on using basiliximab, rabbit anti-human thymocyte immunoglobulin, tacrolimus (immediate-release and prolonged-release), mycophenolate mofetil, mycophenolate sodium, sirolimus, everolimus and belatacept after kidney transplant in children and young people. The recommendations apply only to the initial immunosuppressive therapy (induction and maintenance therapy) started around the time of kidney transplant.
It was outside the scope of the appraisal to make recommendations on using azathioprine or corticosteroids after kidney transplant in children and young people.
Under an exceptional directive from the Department of Health, the appraisal committee was allowed to make recommendations about using drugs outside the terms of their marketing authorisations if there was compelling evidence of their safety and effectiveness.

Immunosuppressive therapy for kidney transplant in adults

New Guidance from NICE:

Evidence-based recommendations on immunosuppressive therapies for preventing kidney rejection in children and young people. The therapies are basiliximab (Simulect), immediate-release tacrolimus (Adoport, Capexion, Modigraf, Prograf, Tacni, Vivadex), mycophenolate mofetil (Cellcept and non-branded versions), rabbit anti-human thymocyte immunoglobulin (Thymoglobuline), prolonged-release tacrolimus (Advagraf, Envarsus), mycophenolate sodium (Myfortic, Ceptava), sirolimus (Rapamune), everolimus (Certican) and belatacept (Nulojix).

This guidance makes recommendations on using basiliximab, rabbit anti-human thymocyte immunoglobulin, tacrolimus (immediate-release and prolonged-release), mycophenolate mofetil, mycophenolate sodium, sirolimus, everolimus and belatacept after kidney transplant in children and young people. The recommendations apply only to the initial immunosuppressive therapy (induction and maintenance therapy) started around the time of kidney transplant.
It was outside the scope of the appraisal to make recommendations on using azathioprine or corticosteroids after kidney transplant in children and young people.
Under an exceptional directive from the Department of Health, the appraisal committee was allowed to make recommendations about using drugs outside the terms of their marketing authorisations if there was compelling evidence of their safety and effectiveness.

Tofacitinib for moderate to severe rheumatoid arthritis [TA480]

New Guidance from NICE:

Evidence-based recommendations on tofacitinib (Xeljanz) for treating moderate to severe rheumatoid arthritis in adults.

1 Recommendations

1.1 Tofacitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying anti-rheumatic drugs (DMARDs), only if:

• disease is severe (a disease activity score [DAS28] of more than 5.1) and
• the company provides tofacitinib with the discount agreed in the patient access scheme.

Changes to cancer waiting times system and dataset

NHS England is planning changes to the cancer waiting times (CWT) system and dataset, which will come into effect from April 2018.

The changes are part of a programme of work to implement the new 28 day faster diagnosis standard by 2020. The CWT system enables CCGs to monitor and manage pathways of care for cancer patients. An information standards notice published on 28 September sets out the forthcoming changes, and an updated guidance document for CWT standards will be published later this year.

Exclusive: CQC plans rules on 'safe workload' for junior doctors

The Care Quality Commission has asked the medical royal colleges to draw up new “safe workload” standards for junior doctors, amid concerns they are still being given a workload that is unsafe, HSJ can reveal.

The CQC’s new chief inspector of hospitals, Ted Baker, also told HSJ in a wide ranging interview that:

• Staff were leaving the NHS because of culture problems including bullying
• The CQC had shifted trust chief executives behaviour from performance management to staff engagement
• Dedicated staff would get the NHS through winter because NHS services and capacity had not kept pace with demand

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New CQC chief inspector: We want to be friendly

The new chief inspector of hospitals has told HSJ the Care Quality Commission “wants to be friendly”, and a “strong partner” in helping trusts improve. Professor Ted Baker told HSJ: “We want to be friendly. I’ve been in some meetings in my time where the regulator comes in and it has been very confrontational. I don’t want the CQC to be like that.”
Speaking in one of his first interviews since becoming chief inspector in August, he continued: “The CQC has to be rigorous and demand high standards. It has to be clear to everyone that we will intervene if we find something unsatisfactory.
“This is not a soft touch approach, but I don’t think regulation is about a big stick as much as it is about influencing and building positive cultures.”
Professor Baker, a former medical director and deputy chief executive in Oxford, does not want providers to ”see regulators as someone that comes in and causes trouble for them when things go wrong, but [instead] as a real strong partner in helping them make sure things are getting better”, he said.
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New chair of NHS Improvement revealed

The former chief executive of the broadband provider TalkTalk is the Department of Health’s preference to be the next chair of NHS Improvement, HSJ understands.

Baroness Dido Harding, a Conservative peer, will be named as the Department of Health’s preferred choice for the job subject to a pre-appointment hearing at the Commons health committee.


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NIHR Signal New evidence confirms three-yearly surveillance interval for people at intermediate risk of bowel cancer

From the NIHR Dissemination Centre

People with benign growths (adenomas), who are at intermediate risk of bowel cancer, benefit from follow-up colonoscopy .  However, some people at the lower end of risk in this intermediate category may not benefit from this further follow-up. At higher risk, a three-yearly colonoscopy is thought to be sufficient.

This NIHR-funded cohort study reviewed data for 11,944 intermediate-risk patients from UK hospitals and screening trials. Within this group, particular features were identified which placed them at higher risk, such as the presence of larger or highly abnormal adenomas or incomplete colonoscopy. These patients had half the risk of developing cancer if they attended one follow-up colonoscopy three years later, and two-thirds the risk if they attended a second after another three years. For people without these features, the benefits of ongoing surveillance were less clear.
This large-scale study showed that all intermediate-risk patients had increased chance of cancerous growths if the interval since initial screening exceeded three years. This supports the current UK screening schedule.

It may be possible to reduce the frequency of screening in a subgroup of patients at low-intermediate risk. A study of more recent data will be necessary to validate this finding.

Protocol for a systematic search and critical review of studies, in effective strategies to maintain quality of life in adult patients with postural orthostatic tachycardia syndrome utilizing an interpretive approach

EP Europace, Volume 19, Issue suppl_1, 1 October 2017, Pages i43

POTS is a rare condition which disproportionately affects young women (5:1). Diagnosis is by tilt table which confirms >30 beat per minute heart rate rise on standing. Symptoms for sufferers are variable, including palpitation, dizzyness, poor concentration, "brain fog", pains, anxiety and gastrointestinal disturbances. Current evidence base is limited. Treatment is salt, fluids, compression stockings, tilt exercises and medication. There is no systematic review published in POTS. Meta-analysis is not possible due to heterogeneity of studies.

UHCW Research: H Eftekhari, F Osman and S Hayat

Refining the diagnostic criteria of the postural orthostatic tachycardia syndrome (POTS) using power spectral indices

EP Europace, Volume 19, Issue suppl_1, 1 October 2017, Pages i12

Postural orthostatic tachycardia syndrome (POTS) is characterised by frequent symptoms and rise in heart rate of ≥ 30bpm within 10min of standing, in absence of significant orthostatic hypotension. Clinical evaluation of patients with suspected POTS includes detailed history and non-invasive investigations such as head-up tilt (HUT). The pathophysiology of POTS remains ill-understood, but increased sympathetic expression may cause the multitudinous symptoms. Heart rate (HR) and blood pressure (BP) variability characterise the sympathovagal balance. High frequency (HF) reflects vagal tone and low frequency (LF) and LF/HF ratio reflect sympathetic tone and sympathovagal balance. We investigated autonomic responses of POTS patients to HUT and compare them with negative controls (NEG) and vasovagal syncope (VVS) patients.

UHCW Research: S. Hayat, 

Prime Minister launches world-leading project on impact of ethnicity on everyday life

The ethnicity facts and figures website brings together information from across government about how ethnicity affects people's everyday lives.

Key findings include:

• employment rates are higher for white people than for ethnic minorities across the country, with a larger gap in the north than in the south (13.6% compared to 9%)
• education attainment data shows there are disparities in primary school which increase in secondary school, with Chinese and Asian pupils tending to perform well and White and Black pupils doing less well, particularly those eligible for free school meals
• ethnic minorities are under-represented at senior levels across the public sector