Timetable for implementation of the workforce disability equality standard

NHS England has published an indicative timetable for implementation of the workforce disability equality standard (WDES).

The WDES will be mandated via the NHS Standard Contract for 2017-19. The NHS Standard Contract for 2017-19 sets out that NHS trusts and foundation trusts will have to implement the WDES in the first year.

Five safe, sustainable and productive staffing improvement resources

NHS Improvement has published five safe, sustainable and productive staffing improvement resources in the areas of maternity services, adult inpatients in acute care, district nursing services, learning disability services and mental health.

Temporary suspension of undetected oesophageal intubation category of Never Event

The new ‘undetected oesophageal intubation’ category of Never Event has been temporarily suspended from the 2018 Never Events list while a query about it is being resolved.

You will not need to report this category of incident as a Never Event until the suspension has been lifted. We will let you know when this category of Never Event has been reinstated.

Learning from the vanguards. Briefings from NHS Clinical Commissioners

Supporting people and communities to stay well
This briefing explores how the vanguards have sought to design health and care services around the needs of people who use them, focusing on the outcomes that matter to people and tailoring care to their needs and goals.

Staff at the heart of new care models

This briefing looks at how the vanguards have broken down traditional organisational barriers across whole systems, how they have engaged staff in the programmes, communicated change and supported staff to work differently.

Spreading and scaling up change
This briefing explores the ten key factors that the vanguards have identified are crucial to encourage the spread of initiatives.

PPA study day: Physio professor outlines new model of pain

Physiotherapists need a new model of pain that takes account of a ‘predictive’ sensory and cognitive interaction, and the influence of people’s emotions and expectations. T

his was the message from CSP fellow Mick Thacker, associate professor at London South Bank University at the Physiotherapy Pain Association (PPA) event on 26 January.

Against the odds: successfully scaling innovation in the NHS

This report from the Innovation Unit and the Health Foundation explores the findings of a research project about how to scale innovation in the NHS. It examines 10 innovations that have spread over the past 20 years and lists a set of provocations to consider how these insights build on, and challenge, existing wisdom on how to scale innovation in the NHS.

2017 survey of women's experiences of maternity care

This CQC report finds that overall women reported positive experiences of maternity care over 2017 and  there were small incremental improvements in results across almost every question. Whilst there have been general improvements overall, the results highlight the need for better communication and greater patient choice.

5 years on: responses to Francis: changes in board leadership and governance in acute hospitals in England since 2013

This report, written by the Health Services Management Centre, University of Birmingham in partnership with the University of Manchester and the Nuffield Trust, reveals that hospital boards report that they are placing a high priority on care quality and safety, and many invested significantly in nurse and medical staffing in the wake of the Francis Report. However, some hospital boards reported feeling that quality assurance as a pressure, as the demands of multiple external regulators was reported to sometimes feel burdensome, threatening to distract from a focus on the actual work of service improvements.

NIHR Signal Study raises questions about NHS “weekend effect”

The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness.

Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data.

Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate within 30 days was slightly higher for these admissions, it is likely that this was due to more severe illness. There was no difference in mortality for people who attended A&E but were not admitted.
NHS Trusts have been told by NHS England to reorganise services in line with “seven day working” to eliminate the weekend effect. These studies raise doubts as to whether such a reorganisation will achieve a reduction in mortality overall.

From the NIHR Dissemination Centre

NIHR Signal Early use of tranexamic acid reduces bleeding more effectively

In people bleeding after trauma or giving birth, tranexamic acid within an hour of the start of bleeding increases the chances of survival by 72% compared with a placebo. Overall the trial data showed that at least six deaths from bleeding complications were prevented for every 1,000 people treated and potentially more if treatment is started early.




Tranexamic acid is an antifibrinolytic drug which reduces the breakdown of blood clots and is known to reduce serious bleeding. The researchers wanted to see if the benefits of tranexamic acid were greater if given as early as possible.




The current guidance recommends giving tranexamic acid for bleeding after trauma and in women with bleeding after giving birth. It is now clearer that every 15-minute delay after the first hour can reduce survival by about 10%.


From the NIHR Dissemination Centre

EpiFix for chronic wounds [MIB 139]

New:  EpiFix for chronic wounds


EpiFix (MiMedx) amniotic membrane allograft is made of dehydrated human amnion/chorion membrane tissue (dHACM). The tissue is derived from amniotic membranes donated with informed consent in the US. EpiFix is terminally sterilised to reduce virus transmission. It is promoted to enhance wound healing, reduce scar tissue formation and modulate inflammation.
EpiFix is indicated for a wide range of wounds; the scope of this briefing is chronic difficult-to-heal wounds including diabetic foot ulcers, venous leg ulcers, arterial ulcers and pressure ulcers.
The company's instructions for use recommend weekly administration. After wound cleaning and debridement in a non-infected wound, EpiFix is removed from the packaging and cut to fit the size of the wound. After EpiFix is applied, a non-adherent contact layer should be placed on top and the wound dressed as usual. EpiFix can be used alongside compression, offloading, negative pressure and hyperbaric oxygen therapy.


The innovative aspect of EpiFix is that it is an allograft of human amniotic membrane that has been processed and purified for use (using the MiMedx proprietary PURION process). This is designed to preserve bioactive components and deliver non-viable cells, multiple extracellular matrix (ECM) proteins, active growth factors, cytokines, chemokines and other specialty proteins present in amniotic tissue with the aim of helping to regenerate soft tissue.

Senior leadership: humility, transparency and knowing when to step back

How investment in staff training, an open culture and peer learning helped senior leaders at Rotherham to transform children’s services performance. Read CommunityCare article here

Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer [TA 503]

New:  Technology appraisal guidance


Fulvestrant is indicated for 'the treatment of oestrogen receptor positive, locally advanced or metastatic breast cancer in postmenopausal women:

• not previously treated with endocrine therapy (licence extension under appraisal) or
• with disease relapse on or after adjuvant antioestrogen therapy, or disease progression on antioestrogen therapy' (appraised in NICE technology appraisal guidance on fulvestrant for the treatment of locally advanced or metastatic breast cancer).

The recommended dosage is 500 mg intramuscularly into the buttocks as 2×5‑ml injections (1 in each buttock) on days 1, 15 and 29, and then once monthly (until disease progression).

Ibrutinib for treating relapsed or refractory mantle cell lymphoma [TA 502]

New:  Technology appraisal guidance


Ibrutinib (Imbruvica, Janssen) inhibits a protein called Bruton's tyrosine kinase, stopping B-cell (lymphocyte) proliferation and promoting cell death.


Ibrutinib has a marketing authorisation in the UK for the treatment of adults 'with relapsed or refractory mantle cell lymphoma'.


The most common adverse reactions associated with ibrutinib include diarrhoea, musculoskeletal pain, upper respiratory tract infection, haemorrhage, bruising, rash, and nausea. For full details of adverse reactions and contraindications, see the summary of product characteristics.

Intrabeam radiotherapy system for adjuvant treatment of early breast cancer [TA 501]

New: Technology appraisal guidance


The Intrabeam radiotherapy system (Carl Zeiss UK) is a mobile irradiation system. It is designed to deliver a single dose of targeted low-energy radiation (X‑rays) directly to the tumour bed, while limiting the exposure of healthy tissue to radiation. Because it delivers low energy radiation, it can be used in an ordinary operating theatre at the time of surgery. The Intrabeam radiotherapy system provides a source of 50 kV energy from a spherical applicator of between 1.5 cm and 5.0 cm diameter. The applicator is sutured to the tumour bed so that breast tissue at risk of local recurrence receives the prescribed dose while skin and deeper structures are protected. Radiation is delivered over 20 to 30 minutes.




The Intrabeam radiotherapy system was granted a CE (Conformité Européene) mark in 1999 for use in radiotherapy.
Intrabeam can be used as an intraoperative radiotherapy system given as the sole treatment or as a boost treatment followed by external beam radiotherapy (EBRT). When intraoperative radiotherapy is given as a boost treatment with Intrabeam and followed by EBRT, there is no need for further external boost treatment. Six NHS centres in the UK have used Intrabeam for adjuvant treatment of early breast cancer.

Minimally invasive percutaneous nephrolitholapaxy medium (MIP-M) for removing kidney stones [MIB 138]

New:  Medtech innovation briefing


MIP‑M (Karl Storz, Germany) is a device used to remove kidney stones. MIP‑M is a miniaturised version of percutaneous nephrolithotomy (PCNL) and is suitable for people with kidney stones 12 to 24 mm in diameter in any renal calyx or in the renal pelvis. This device can be used on larger stones but this could increase the operative time and chances of complications. The MIP‑M device comprises a 12 Fr nephroscope, a 16.5/17.5 Fr operating nephrostomy or Amplatz sheath, a single-step dilator and grasping forceps.


The procedure is done by making a small incision, usually in the patient's back, and a needle is inserted into the renal pelvis. The position of the needle is confirmed by X‑ray or ultrasound. A guide wire is placed through the needle into the renal pelvis. It is then withdrawn, leaving the guide wire in place. A single-step dilator is passed over the guide wire to widen the access channel and a 16.5/17.5 Fr sheath is introduced. A miniaturised 12 Fr nephroscope is then passed inside the sheath; it allows the surgeon to see the kidney stones. The nephroscope has a channel through which grasping forceps are introduced to remove small stones. Bigger stones may have to be broken up using ballistic lithotripsy or laser treatments before removal. Ultrasound and laser instruments are also passed through the nephroscope channel.

Tell us how Occupational Therapy Week has impacted your local services or practice

The Royal College had a huge response to Occupational Therapy Week in November 2017 with so many of you, our members, really getting stuck in - organising local events and activities, engaging with your local community and health providers. Click here for article

5 Years On: Responses To Francis: Changes In Board Leadership And Governance In Acute Hospitals In England Since 2013

This report, written in partnership with the University of Manchester and the Nuffield Trust, reveals that hospital boards report that they are placing a high priority on care quality and safety, and many invested significantly in nurse and medical staffing in the wake of the Francis Report. However, some hospital boards reported feeling that quality assurance as a pressure, as the demands of multiple external regulators was reported to sometimes feel burdensome, threatening to distract from a focus on the actual work of service improvement. Click here for Kings Fund blog

Frail Older Adults More Likely to Develop Delirium After Surgery

Frailty in older adults may double the risk of developing delirium following elective surgery compared to old age alone, according to a new Canadian study by St. Michael’s Hospital in Toronto. Frailty is defined as the condition of feeling weak, fragile, and having low energy. Read PsychCentral article here

NIHR Signal Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate

It seems safer to reduce the dose of biological drugs, rather than to stop them if people with rheumatoid arthritis and their doctors want to avoid relapse. Stopping these powerful drugs caused the disease to recur in 58% of people compared with 29% who continued them. Reducing the dose also led to more relapses for people in remission, but did not cause those with low-grade disease activity to worsen.




Rheumatoid arthritis is a chronic disease which causes pain, swelling and stiffness in the small joints of the hands and feet. It can cause more widespread inflammation. The disease has episodes of improvement and deterioration so judging the effects of treatment can be difficult. Drug treatments suppress the immune system, putting people at higher risk of infection.




From the NIHR Dissemination Centre

Sore throat (acute): antimicrobial prescribing [NG 84]

New:  NICE guideline


acute sore throat (including pharyngitis and tonsillitis) is self‑limiting and often triggered by a viral infection of the upper respiratory tract

symptoms can last for around 1 week, but most people will get better within this time without antibiotics, regardless of cause (bacteria or virus).

Assess and manage children under 5 who present with fever as outlined in the NICE guideline on fever in under 5s.

Use FeverPAIN or Centor criteria to identify people who are more likely to benefit from an antibiotic and manage in line with recommendations 1.1.4 to 1.1.13.

Interventional radiology leaders release guidance to help speed up rollout of vital life-changing stroke treatment

The Supplementary Guidance to Facilitate the Training of Interventional Radiology Consultants to Undertake Stroke Thrombectomy has been produced by The Royal College of Radiologists, the British Society of Interventional Radiology, the British Society of Neuroradiologists and the UK Neurointerventional Group, to help hospitals train more specialist radiologists to perform life-changing stroke thrombectomy treatment.

The nursing workforce

The Health Select Committee has published its nursing workforce inquiry.  This report highlights the importance of improving staff wellbeing and development to allow the NHS to retain the valuable experience and skills of its current nursing workforce.

Updated guidance on the fit and proper person requirement

The CQC has updated its guidance on Regulation 5 - the fit and proper persons requirement for directors.

This is to reflect the changes outlined in our recent ‘next phase of regulation’ consultation. The guidance provides a more detailed explanation of what CQC interprets as serious mismanagement and serious misconduct. It also offers greater clarity about the obligations and responsibilities of those holding director roles.

Developing People - Improving Care: one year on

One year on from the launch of the Developing People- Improving Care, NHS Improvement highlights how leaders across health and social care have implemented the framework.

High impact change model Managing transfers of care

This resource supports the High Impact Change model for managing transfers of care. It contains examples for the eight system changes where there is evidence of impact, examples of emerging practice that are starting to make a difference and includes links to guidance and further information.

Nutrition and hydration

These resources from NHS Improvement on using nutrition and hydration to reduce the incidence of pressure ulcers and promote good wound healing, include evidence and recommendations for assessment and action when assessing an individual’s risk of developing a pressure ulcer; five top tips to prevent pressure ulcers; and three case studies.

Transferring apprenticeship levy funds

From April 2018, levy-paying employers will be able to transfer funds to other employers, through their apprenticeship service account.

The Education and Skills Funding Agency (ESFA) has confirmed that employers will be able to transfer up to 10 per cent of the annual value of fund to any employer, including smaller employers in their supply chain, and apprenticeship training agencies.

Employers receiving transferred funds will only be able to use them to pay for training and assessment for apprenticeship standards. They will not be able to use them to pay for training and assessment delivered against apprenticeship frameworks.

PFI and PF2

This briefing from the National Audit Office looks at the rationale, costs and benefits of the Private Finance Initiative; the use of and impact of PFI, and ability to make savings from operational contracts; and the introduction of PF2.

Fewer hospital appointments missed thanks to one simple idea

Going to the hospital for an appointment should be a simple process. But if you have an impairment and services aren’t set up to meet your needs, that’s not always the case.

People who are deaf in Dudley told their local Healthwatch that going for medical appointments was sometimes difficult for them. They talked about their fear of missing appointments because they couldn’t hear their names being called in busy clinics, and their struggles to communicate with staff.

Healthwatch Dudley brought a group of deaf people together to find out more about their experiences and what could be done to make things better. The group shared how the risk of missing appointments was making deaf people feel extremely anxious. It was suggested that they could be given vibrating and flashing pagers to let them know when the doctor was ready to see them. The Trust embraced the idea and pagers have now been introduced to hospital waiting areas across Dudley borough and are being used not only for deaf patients, but also for those with other sensory and physical impairments.

Sponsorship guidance for migrants updated (Tiers 2 and 5)

The Tier 2 and Tier 5 guidance for sponsors has been updated following the publication of the UK immigration rule changes. 

This guidance is to be used for all Tier 2 and Tier 5 sponsor licence applications made and certificates of sponsorship (CoS) assigned, on or after 11 January 2018.

Workload and wellbeing quarterly survey

The BMA keeps track of doctors' workload and wellbeing with the BMA quarterly survey (formerly known as the omnibus or tracker survey).

Each quarter the survey focuses on topical issues as well covering questions on workload, morale and work-life balance, which are repeated every quarter.

Key findings from our most recent survey:

• 71% of hospital-based respondents reported rota gaps in the departments in which they work. This figures remains consistent.
• 65% of hospital speciality respondents reported that there are medical doctor vacancies in their departments, while 47% of GPs had GP vacancies in the practice where they work.
• 89% of respondents believe their contribution to the NHS was valued by patients and 62% believed it was valued by managers, but only 17% felt valued by the government and politicians.

CQC and guardians of safe working

Information on guardians of safe working and exception reporting will now be collated by The Care Quality Commission (CQC) as part of its well led domain of inspections.

The CQC has begun a soft rollout for this process, and some interviews on inspection have already been carried out. In the future, employers can expect to be asked for some of the following things in advance of their inspections:

• quarterly GoSW reports
• the trust’s quality account, including the annual report on rota gaps and the plan for improvement to reduce these gaps
• exception reports issued to the board by the GoSW regarding escalation of and serious issues unresolved.

Lung cancer patients living for longer than ever

A new report published by the Royal College of Physicians (RCP) finds that more lung cancer patients are living for longer than ever, with 37% of patients alive at least 1 year after diagnosis compared to a rate of 31% in 2010.

The National Lung Cancer Audit (NLCA) 2017 annual report finds more cancers are being diagnosed at an earlier stage, with one in eight lung cancers found at the very earliest stage.

There has been a rise in diagnosis in patients aged over 70, the age group in which most lung cancer is present. There has been a rise of 5% more diagnoses in this age group since 2007.

National Audit of Cardiac Rehabilitation Annual Statistical Report 2017

A national audit of cardiac rehabilitation shows that about 68,000 people who had heart attacks missed out on cardiac rehabilitation in 2015/16, nearly half (49 per cent) of those who were eligible.

Data security and protection for health and care organisations

Document outlining action expected from health and care organisations in 2017 to 2018, to implement recommendations by the National Data Guardian.   It has been updated.

Making sense of accountable care

Briefing from the King's Fund - making sense of accountable care:

Constraints on NHS funding over the past seven years, combined with rising demand from a growing and ageing population, have put the NHS under enormous pressure. It has been clear for some time that simply working our current hospital-based model of care harder to meet rising demand is not the answer. Rather, the NHS needs to work differently by providing more care in people’s homes and the community and breaking down barriers between services.

Also see the King's Fund briefing: acccountable care explained

NICE consults on updated recommendations for the treatment and care of people with early breast cancer

NICE’s draft updated guideline on early and locally advanced breast cancer calls for extended hormonal therapy for some women after they’ve taken tamoxifen in order to reduce the risk of their breast cancer coming back.

The new recommendation is for women who have been through the menopause who have a type of breast cancer called ER-positive invasive breast cancer and who have been taking tamoxifen for 2 to 5 years. It reflects research showing that switching to an aromatase inhibitor after taking tamoxifen for 5 years improved disease-free survival compared with women who had only received tamoxifen for 5 years.

NHS winter pressures in England 2017/18

This briefing from the House of Commons Library  summarises the current data and trends on winter pressures in the NHS, including ambulance handover delays, bed occupancy, norovirus bed closures, and accident and emergency diverts.

Safeguarding adults protocol: pressure ulcers and the interface with a safeguarding enquiry

This guidance from the Chief Social Worker helps practitioners and managers across health and care organisations to provide caring and quick responses to people at risk of developing pressure ulcers.

Changes to the DHSC group accounting manual 2018 to 2019

This DHSC consultation seeks views on the guidance for financial reporting and preparing annual reports and accounts for the department and related bodies (non-Foundation Trusts). The consultation document outlines the proposed changes for the next financial year and feedback will be accepted until 23 February 2018.

Hidden hunger and malnutrition in the elderly

This report from the All Party Parliamentary Group on Hunger calls on the government to look more closely at malnutrition in older people which is estimated to cost the NHS and social care £15.7 billion a year by 2030. It argues that targeted investment in services which protect older people from malnutrition would deliver significant annual savings to the NHS, not least by reducing the number of hospital admissions and limiting the number of days older people spend in hospital.

State of child health: one year on

This report from the RCPCH warns that the current fragmented approach to child health poses risks to the long-term health of the nation.

Whilst the report acknowledges progress in some areas, such as the digital child health strategy and the implementation of the sugar tax, it argues that there has been a lack of improvement in several fundamental areas. It highlights the public health cuts as a particular area for concern and argues that the cuts are disproportionately affecting children's services.

Sustainability and transformation in the NHS

This report from the National Audit Office finds that additional funding, aimed to help the NHS get on a financially sustainable footing, has instead been spent on coping with existing pressures.

The report makes a number of recommendations to the Department of Health and Social Care, NHS England and NHS Improvement, which includes moving further and faster towards aligning nationwide incentives, regulation and processes, as well as reassessing how best to allocate the sustainability and transformation funding.

NHS Digital publishes guidance on data off-shoring and cloud computing for health and social care

National guidance has been published, setting clear expectations for health and care organisations who want to use cloud services or data offshoring to store patient information.

The guidance will ensure that organisations know how to use these solutions safely and securely, especially in the light of the fact that tighter restrictions on the processing and transfer of personal data are being brought in through the launch of the General Data Protection Regulation (GDPR) in May.

Pneumococcal: the green book, chapter 25

Chapter 25 of the Green Book on pneumococcal has been updated.

Management of Infants born to Mothers who have used Opioids during Pregnancy

The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment.

This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency.

Office of Health economics briefing on agency staff in the NHS

NHS Agency Staffing and the Impact of Recent Interventions, by Chris Mullin. OHE Seminar Briefing 22, January 2018


This seminar focuses on the NHS staffing markets and the use of temporary staff, specifically in the NHS provider sector, i.e. foundation trusts1 and NHS trust. (which include hospitals). To provide background and context, the discussion begins with an overview of the NHS labour market and the role of staffing agencies in providing temporary staff. The core of the seminar is an examination of previous strong growth in expenditure on such staffing, particularly during the early part of this decade; the effects to date of government intervention to address that spending; and possible lessons for other sectors from the limited evidence now available.


PDF of the complete briefing is available at https://www.ohe.org/system/files/private/publications/Mullins%20Seminar%20Briefing.pdf

Transition From Child And Adolescent Mental Health Services To Adult Mental Health Services

This bulletin relates to an investigation into the transition from Child and Adolescent Mental Health Services to Adult Mental Health Services. It looks at the impact the issue of safety has had, or is having, on people and services across the healthcare system. It also describes the way mental health services are commissioned and delivered. Click here to see Kings Fund blog

NIHR Signal New screening pathway could help to identify a rare, single-gene form of diabetes

A screening pathway using blood and urine tests followed by two genetic (DNA) tests identified all people with a rare subtype of diabetes called monogenic diabetes. The screening pathway performed better than current practice based on age at diagnosis and family history which misses 63%. It is, therefore, a useful approach for ruling out this form of diabetes and probably cheaper overall than offering every young person with diabetes DNA testing.


Monogenic diabetes, caused by a mutation in a single gene can be misdiagnosed as type 1 diabetes, leading to unnecessary insulin treatment. Those recruited for this study were 98% white and tested at an average of 14 years after diagnosis.


From the NIHR Dissemination Centre

NIHR Signal Biological therapies for psoriasis do not increase serious infection risk

People with psoriasis who take an immune-modulating treatment are no more likely to get serious infections than people taking standard therapies.inf




There are fears that these biological therapies raise the risk of serious infections and this has discouraged their use. They are recommended by NICE for moderate to severe psoriasis. Previous studies have reached conflicting conclusions, making it hard to advise on the true risk.




This study used a large database of people with psoriasis from the UK and Ireland. It compared serious infection risk of the biological therapies (etanercept, adalimumab or ustekinumab) with non-biological therapies, after accounting for factors such as other illnesses. It found none of the biological therapies studied had a higher risk of infection compared to non-biological therapies or compared to each other.




From the NIHR Dissemination Centre

NIHR Signal A surgical procedure for shoulder pain is less effective than previously thought

An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all.


This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. The main intervention, decompression, involved removing any bony outgrowths that could have been causing the tendons around the shoulder to be “pinched”. This was compared with an arthroscopy used for investigation only; this did not include removing any bone or tissue. Those in the third “no treatment” arm did not receive any physiotherapy or advice.


From the NIHR Dissemination Centre

Signal Single urine samples are just as good as 24-hour collections for diagnosing pre-eclampsia

The urine spot albumin-creatinine ratio (which is done on a single, on-the-spot sample) reliably identified 99% of pregnant women with high blood pressure who went on to develop severe pre-eclampsia. The spot protein-creatinine ratio, as currently recommended by NICE, was slightly less sensitive identifying over 90% of women. Both spot tests were good value for money.


Nearly 1,000 women, suspected of having pre-eclampsia, took part in this NIHR-funded study, in 36 UK obstetric units. They had high blood pressure and protein detected in their urine (by dipstick) beyond 20 weeks of pregnancy. The study compared the diagnostic accuracy of newer ways of ‘spot’ testing a single sample of urine for predicting severe pre-eclampsia with traditional tests on a urine sample taken over 24-hours.


From the NIHR Dissemination Centre

NIHR Signal National tobacco control policies linked to improvements in children’s health

National smoke-free legislation in advanced economies is linked to reduced rates of preterm birth, asthma hospitalisations and serious throat and chest infections in children. Comprehensive smoke-free policies appear to be more effective than policies with only partial or selective introduction.


Smoking increases health risks for the smoker and others through second-hand exposure. Although the number of people smoking in the UK is falling, eight million UK adults still smoke, and an estimated five million children are exposed to second-hand smoke. Children are vulnerable to smoke due to their small, developing lungs and immune systems.


From the NIHR Dissemination Centre

NIHR Signal Blood test reduces mortality and shortens antibiotic use among adults with chest infection

It may be feasible to use procalcitonin blood levels to guide antibiotic treatment for adults in hospital with a suspected chest infection. By measuring procalcitonin, an indicator of bacterial infection, clinicians could review their diagnosis earlier.


This reduced antibiotic exposure by 2.5 days with fewer adverse effects and also less mortality. About 14 extra people in every 1,000 who had their management guided by the blood test would be expected to survive the first month, compared with those receiving standard care without this test.


From the NIHR Dissemination Centre

Ceritinib for untreated ALK-positive non-small-cell lung cancer [TA 500]

New:  Technology appraisal guidance


Ceritinib is recommended, within its marketing authorisation, as an option for untreated anaplastic lymphoma kinase (ALK)‑positive advanced non-small-cell lung cancer in adults, only if the company provides it with the discount agreed in the patient access scheme.




Why the committee made this recommendation
Most people with untreated ALK‑positive advanced non-small-cell lung cancer are offered crizotinib. Chemotherapy may be offered if the person's ALK mutation status isn't known, and therefore is not a relevant comparator for ceritinib. There are no trials directly comparing ceritinib with crizotinib; the clinical trial compares ceritinib with chemotherapy.


Because the clinical trial has not finished, it is unable to show how much ceritinib prolongs life compared with chemotherapy. But it shows that ceritinib is more effective than chemotherapy at increasing the length of time people live without their disease progressing. An indirect comparison suggests that ceritinib is more effective than crizotinib. Clinical experts support using ceritinib instead of crizotinib.

Glecaprevir–pibrentasvir for treating chronic hepatitis C [TA 499]

New:  Technology appraisal guidance


Glecaprevir–pibrentasvir is recommended, within its marketing authorisation, as an option for treating chronic hepatitis C in adults, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.


It is recommended that the decision to treat and prescribing decisions are made by multidisciplinary teams in the operational delivery networks put in place by NHS England, to prioritise treatment for people with the highest unmet clinical need.




Why the committee made these recommendations
  
Current treatment options for chronic hepatitis C depend on genotype, cirrhosis status and treatment history. Glecaprevir–pibrentasvir is suitable for all genotypes and has a shorter treatment duration than most other direct-acting antiviral treatments.

Lenvatinib with everolimus for previously treated advanced renal cell carcinoma [TA 498]

New:  Technology appraisal guidance




Lenvatinib plus everolimus is recommended as an option for treating advanced renal cell carcinoma in adults who have had 1 previous vascular endothelial growth factor (VEGF)-targeted therapy, only if:

• their Eastern Cooperative Oncology Group (ECOG) performance status score is 0 or 1 and
• the company provides lenvatinib with the discount agreed in the patient access scheme.

1.2 This recommendation is not intended to affect treatment with lenvatinib plus everolimus that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Golimumab for treating non-radiographic axial spondyloarthritis [TA 297]

New: Technology appraisal guidance


Golimumab is recommended, within its marketing authorisation, as an option for treating severe non-radiographic axial spondyloarthritis in adults whose disease has responded inadequately to, or who cannot tolerate, nonsteroidal anti-inflammatory drugs.


If patients and their clinicians consider golimumab to be one of a range of suitable treatments, including adalimumab, etanercept and certolizumab pegol, the least expensive (taking into account administration costs and patient access schemes) should be chosen.




Assess the response to golimumab 12 weeks after the start of treatment. Continue treatment only if there is clear evidence of response, defined as:

• a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units and
• a reduction in the spinal pain visual analogue scale (VAS) score by 2 cm or more.

Oesophago-gastric cancer: assessment and management in adults [NG 83]

New:  NICE guideline

1.1 Information and support

1.2 Organisation of services

1.3 Assessment after diagnosis

1.4 Radical treatment

1.5 Palliative management

1.6 Nutritional support

1.7 Follow-up

Age-related macular degeneration [NG 82]

New:  NICE guideline

1.1 Classifying age-related macular degeneration

1.2 Information and support

1.3 Risk factors

1.4 Diagnosis and referral

1.5 Pharmacological management of AMD

1.6 Non-pharmacological management of AMD

1.7 Monitoring AMD

Terms used in this guideline

Plasma EGFR mutation tests for adults with locally advanced or metastatic non-small-cell lung cancer [MIB 137}

New:  Medtech innovation briefing


Epidermal growth factor receptor (EGFR) mutation tests are in vitro diagnostic (IVD) tests used to help identify adults with non-small-cell lung cancer (NSCLC) suitable for treatment with EGFR tyrosine kinase inhibitors (EGFR‑TKIs). The presence of specific EGFR mutations show how effective treatment with EGFR‑TKIs will be. As a result, the test is useful for oncologists for deciding personalised treatment options.


EGFR mutations occur in EGFR exons 18–21 and mutations in exons 18, 19 and 21 and indicate suitability for treatment with EGFR‑TKIs. Mutations in exon 20 (with the exception of a few mutations) show the tumours are EGFR‑TKI resistant and not suitable for treatment with EGFR‑TKIs.

Point-of-care creatinine tests before contrast-enhanced imaging [MIB 136]

New:  Medtech innovation briefing


POC creatinine tests allow rapid measurements of creatinine levels using very small samples of whole blood, serum, plasma or a combination of these. The devices used for these tests are either handheld or table-top and need blood from either finger-prick or venous/arterial samples. The method of analysis can vary with some devices using test cartridges and some using test strips.


The focus of this briefing is POC creatinine testing to assess kidney function in people who are scheduled to have contrast-enhanced imaging. Testing is important because contrast materials such as iodine or gadolinium can cause kidney injury, particularly in high-risk patients and those with known kidney dysfunction. If patients do not have a recent creatinine measurement, their imaging may be cancelled and rescheduled. Alternatively, they may have unenhanced imaging – which is less reliable – or the planned contrast agent may be given, risking kidney injury. Current practice varies; a recent UK survey estimated that up to 20% of hospitals only check creatinine levels before imaging in people known to be at high risk of kidney injury (Harris et al. 2016).

MammaTyper in vitro diagnostic test for determining breast cancer subtypes [MIB 135]

New:  Medtech innovation briefing


The MammaTyper (BioNTech Diagnostics GmbH) test is a molecular in vitro diagnostic test for the relative gene expression quantification of the genes ERBB2, ESR1, PGR and MKI67 in human breast cancer tissue. It is used as a diagnostic test on biopsy samples of invasive breast cancer tissue from surgical resection or pre-operative core needle biopsies. The test is based on reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). MammaTyper classifies breast cancer into 4 subtypes that have different treatments according to St Gallen (2017) guidelines:

• Luminal A-like (oestrogen receptor [ER]-positive and generally human epidermal growth receptor 2 [HER2]-negative); treated with endocrine therapy.
• Luminal B-like subdivided according to the ERBB2 expression into:
  
  • luminal B-like (ER-negative and HER2-positive); treated with anti-HER2 therapy and chemotherapy
  • luminal B-like (ER-positive and generally HER2-negative); treated with endocrine therapy.
  
  
• HER2-positive (non-luminal); treated with anti-HER2 therapy and chemotherapy.
• Triple-negative (generally ER, progesterone receptor [PR]- and HER2-negative); treated with chemotherapy.

Dementia: applying All Our Health

Evidence and guidance to help healthcare professionals maximise their contribution to supporting the health, wellbeing and independence of people with dementia.Click here to link to DOH site

Mental Health Act: The Rise In The Use Of The MHA To Detail People In England

This report outlines the findings of a review of patients, carers and staff views on the causes of the rise in rates of detention. It concludes that there is no one single cause for the rise in detention rates over the last decade but that the rise suggests a system under considerable pressure. It argues that action must be taken to address underlying problems and that reform of mental health legislation alone will be unlikely to reduce detention rates. Click here for Kings Fund blog

NICE says that online and mobile programme Deprexis could help adults with depression get faster access to care and it should be tested out in NHS services. Click here for NICE article

NICE draft guideline on rheumatoid arthritis - consultation open

NICE draft guidelines on rheumatoid arthritis in adults are open for consultation until 1st March 2018.


The proposals include giving adults with rheumatoid arthritis access to specialist physiotherapy to help manage their condition and improve their fitness, flexibility and strength.


See the draft guidelines and register to contribute to the consultation process at https://www.nice.org.uk/guidance/indevelopment/gid-ng10014/consultation/html-content-2

Revised Never Events policy and framework for the NHS

The Never Events policy and framework sets out the NHS’s policy on Never Events. It explains what they are and how staff providing and commissioning NHS-funded services should identify, investigate and manage the response to them. It is relevant to all NHS-funded care.
Read more at https://improvement.nhs.uk/resources/never-events-policy-and-framework/

Latest Avian influenza (bird flu) updates Winter 2017 to 2018

Avian influenza (bird flu), a disease of birds, has been identified in wild birds in England in 2018. All poultry keepers should review their biosecurity, sign up for disease alerts, and register their birds with APHA. Keepers must report any unexplained deaths or sickness to their vet.

Public Health England advises the risk to public health from H5N8 and H5N6 avian influenza is very low and the Food Standards Agency has said the disease poses no food safety risk for UK consumers.

Read the latest updates in full at https://www.gov.uk/government/news/avian-influenza-bird-flu-in-winter-2017-to-2018

No hospital is an island: Acute Care collaborations demonstrate new ways of working

A new report on lessons learnt from the acute care collaborations includes case studies highlighting how vanguards are finding new ways to:

· Standardise clinical practice, pooling expertise, sharing vital patient information and analysing patient care across hospitals.

· Make better use of clinical support services, such as imaging and pathology.

· More creatively and flexibly use the skills of their healthcare professionals, reducing reliance on agency staff.

· Build innovative external partnerships with, for example, the pharmaceutical industry.

· Support more integrated health systems that champion person-centred care.

· Consolidate corporate support functions to generate efficiencies.

The report is available in full here https://www.england.nhs.uk/publication/no-hospital-is-an-island-learning-from-the-acute-care-collaboratives/ 

Occupational Therapy May Aid Quality of Life for Younger Diabetics

Occupational therapy may significantly improve the health and quality of life of diabetic young people, according to a new study led by researchers at the University of Southern California (USC). Click here for PsychCentral article

Why It’s So Hard to Walk Away from Difficult People

Do you have a difficult person in your life? Do you feel like it’s hard to just “cut the cord” and move on? 

A new study published in the journal American Sociological Review may shed some light on why this happens. The findings are clear cut: Difficult people are often the people you are stuck with, either because you need them or because you can’t ignore them. In other words, they are usually members of your family or your coworkers. Click here for PsychCentral article

Does Threat of Climate Change Affect Mental Health

Many people believe climate change is the driving force behind extreme weather events, be it unprecedented flooding, wildfires, or hurricanes. Historically, the threat of being directly impacted by these events has been small but times may have changed as reports of such incidents continue to rise. Click here to read PsychCentral article

Research highlights ‘patient-centred care’ needs to be more than an NHS buzzword

Read our response to National Voices research, which found that only 3% of people with one or more long term condition reported having a written plan for their care and support. Read Healthwatch article here

Revealed: NHS Improvement abandons consultancy turnaround programme

A financial turnaround project where management consultants are sent to work with NHS trusts has been shelved by NHS Improvement, HSJ has learned.

The third wave of the financial improvement programme was due to start in early 2018 but sources involved told HSJ an “in-house” team will now work with the most troubled providers instead.


To obtain this article please copy abd paste the post into an email and send to libraryw@uhcw.nhs.uk

Eight artworks inspired by mental health problems

The Perspective Project hosts art, poetry and writing with the aim of ending stigma and providing an outlet for those with mental health problems. The 24-year-old founder, Mark Anscombe, is already sharing the work of over 30 artists from around the UK, US and Canada, all of whom have various mental health issues. The project accepts submissions in any form, and people can submit anonymously Click here to see newspaper article

NHS Providers STP and accountable care background briefing

As part of the new programme on sustainability and transformation partnerships (STPs) and accountable care, this briefing brings together an overview of how national policy has evolved to promote system-based collaboration, including the development of STPs, accountable care systems (ACSs) and accountable care organisations (ACOs).
http://nhsproviders.org/resource-library/briefings/stps-and-accountable-care-background-briefing

Bird flu prevention zone extended to cover whole of England

A bird flu prevention zone has been declared across the whole of England, Chief Veterinary Officer Nigel Gibbens has confirmed today.
This means it is a legal requirement for all bird keepers to follow strict biosecurity measures. It comes as 13 dead wild birds were confirmed to have the virus in Warwickshire.
https://www.gov.uk/government/news/bird-flu-prevention-zone-extended-to-cover-whole-of-england

RCOT announces revised guidelines for occupational therapy and total hip replacement

The Royal College of Occupational Therapists (RCOT) is delighted to announce the publication of the second edition of the practice guidelines for working with people undergoing total hip replacement. Endorsed by the British Hip Society, the new guidelines recognise in particular the changes in length of recommended stay for patients as well as the fact that this surgery is increasingly being performed on younger patients.
https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines/hip

Artificial intelligence could help NHS physios with exercise compliance

New research published by the think tank Reform, Thinking on its own, suggests that Artificial intelligence (AI) can analyse data collected on wearable technology and help NHS clinicians support changes in patients’ behaviour.

• Chartered Society of Physiotherapy news item
• Thinking on its own: AI in the NHS

Public Health England: Teenage Pregnancy Prevention Framework

Public Health England has published guidance for local teenage pregnancy prevention programmes designed to help young people avoid unplanned pregnancies and develop healthy relationships.
https://www.gov.uk/government/publications/teenage-pregnancy-prevention-framework

World leading cancer dataset shows improvements in diagnosis

Routes to Diagnosis now includes 10 years’ worth of data, covering more than 3 million cancer cases, making it the most comprehensive diagnosis of its kind in the world.
The data shows a dramatic improvement in the way some cancers are being diagnosed across England, but also pinpoints areas where improvements could still be made.http://www.ncin.org.uk/publications/routes_to_diagnosis

NIHR Signal Blood test reduces mortality and shortens antibiotic use among adults with chest infection

It may be feasible to use procalcitonin blood levels to guide antibiotic treatment for adults in hospital with a suspected chest infection. By measuring procalcitonin, an indicator of bacterial infection, clinicians could review their diagnosis earlier.


This reduced antibiotic exposure by 2.5 days with fewer adverse effects and also less mortality. About 14 extra people in every 1,000 who had their management guided by the blood test would be expected to survive the first month, compared with those receiving standard care without this test.


From the NIHR Dissemination Centre

NIHR Signal Starting antiretroviral therapy immediately after HIV diagnosis reduces transmission of the virus

Giving antiretroviral therapy to people newly diagnosed with HIV may be an effective and cost-effective way of reducing new infections. Increased HIV testing in at-risk populations may identify more people for treatment and also reduce infection rates.


Using data from a number of sources including NIHR funded projects, researchers developed a computer simulation model. The model looked at the relationship between HIV infections, sexual risk behaviours and antiretroviral therapy over a 30 year period. Introduction of antiretroviral therapies and increased condom use were associated with lower rates of new cases. Most new HIV infections arose due to people not yet being aware of their HIV status. Modelling projections suggested that increasing the rate of HIV testing, and initiating antiretroviral therapy from diagnosis could both reduce the rates of new infections.


From the NIHR Dissemination Centre

NIHR Signal Two common operations to fix a broken tibia have similar outcomes

In people who had broken the lower part of their tibia (shin bone), fixation using a metal rod nailed to the inside the bone was compared with a locking plate screwed onto the surface of the bone. There was no difference in the quality of life, disability or pain at 12 months for people who had fractures of the lower tibia fixed using either technique.






NICE guidance recommends that surgery takes place within 24 hours of injury but does not mandate which type of surgery to perform. This NIHR UK-based trial was funded to find which treatment was better for lower tibial fractures.




From the NIHR Dissemination Centre

NHS England vaccine advice 'increased risk of flu admissions'

More patients may have been admitted to hospital with flu this winter after NHS England asked GPs to order a less expensive flu vaccine, a senior doctor has warned.


To obtain this article copy and paste the post into an email and send to libraryw@uhcw.nhs.uk

Funding And Staffing Of NHS Mental Health Providers

Our new report finds that the spending gap between NHS acute hospitals and NHS mental health providers widened further last year. It argues that the squeeze on mental health providers' funding, coupled with a staff shortage, has put huge pressure on the workforce and left mental health trusts struggling to staff services safely. Click here to read Kings Fund blog

PM commits to government-wide drive to tackle loneliness

Theresa May will host a reception and set out the government's plans to tackle loneliness. Click here to read press release

Adoption and spread of innovation in the NHS

Briefing from the King's Fund:

The first large-scale clinical trials of statins were held in the mid-1980s and statins became available on prescription from the NHS in the 1990s. By the early 2000s, the English NHS was prescribing around 8 billion daily doses of statins each year, contributing to dramatic reductions in rates of mortality from cardiovascular disease.

Meanwhile, despite considerable progress, the NHS, like other health systems, is still struggling to implement basic hygiene protocols such as handwashing in hospitals, 150 years after Joseph Lister published his observations in the Lancet on antiseptic methods. Some innovations are incendiary, spreading with a spark from funders, regulators, professionals or the public. Others seem stubbornly immobile, no matter how easy they appear to implement or how persuasive the evidence.

Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

J Bodyw Mov Ther. 2018 Jan;22(1):13-17. doi: 10.1016/j.jbmt.2016.10.001. Epub 2016 Oct 21.

OBJECTIVE: To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.
METHODS:

CONCLUSION: This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

UHCW Research: A Pritchard

NHS standard contract 2017-19 (January 2018 edition) – eContract system

The eContract system has been updated in line with the NHS standard contract 2017-19 (January 2018 edition – both full length and shorter).

The eContract system reduces the time taken to draft the contract. NHS England strongly recommends that commissioners and providers use the eContract system. 

High impact change model: managing transfers of care

This change model, developed by the Local Government Association with the Association of Directors of Adult Social Services, outlines a practical approach to managing patient flow and hospital discharge. It identifies eight system changes that will have the greatest impact on reducing delayed discharge. The resource supplements the model by bringing together examples of work being undertaken across the country, for each of the eight system changes.

Why Can’t Mental Health Patients Make Decisions About Their Own Treatment?

The law in England and Wales currently allows for mental health patients to be treated against their consent, even if they are able to give it. Is this consistent with their human rights? Click here to read article from RightsInfo

Transcendental Meditation Shown to Ease Veterans’ PTSD

A new study shows that veterans suffering from post-traumatic stress disorder (PTSD) found significant relief from their symptoms as a result of practicing Transcendental Meditation (TM). Please click here for Psych Central news article

New Health Foundation programme selects 12 projects to improve analytical capability in health and care services

The Health Foundation has selected 12 projects from across the UK to take part in the first round of its new £1.2 million Advancing Applied Analytics programme.

The programme aims to improve analytical capability in support of health and care services. It supports analysts who are working on local innovative and ambitious projects, to help them demonstrate improvements to analytical capability in health and care services and provide lessons for the wider care system.

Cranio-Cervical Trauma Eidemiology, Classification, Diagnosis and Management

J Spine Neurosurg 2017, 6:5. DOI: 10.4172/2325-9701.1000284

Objective: To provide an overview of current knowledge of the management of Cranio-Cervical (Occipito-cervical) injuries.

Conclusion: Cranio-cervical injuries constitute a significant proportion of high velocity trauma and can be missed. There is a need for high index of suspicion in such patients. Recent trends seem to favour surgical management of these injuries even in the elderly. Aim should be early surgical fixation wherever possible even in elderly patients, if there is no significant co-morbidity or contraindication for surgery.

UHCW Research: Amar Saxena

Hepatic amyloidosis: a cause of rapidly progressive jaundice

BMJ Case Reports 2018; doi:10.1136/bcr-2017-222942

An 83-year-old man presented with an acute history of weight loss and jaundice. He had a history of type 2 diabetes mellitus and hypertension. He consumed 30 units of alcohol per week. 

UHCW Research: Benjamin Disney and Veena Shinde

Updated: David Behan steps down as CQC chief

Sir David Behan has announced he will step down as chief executive of the Care Quality Commission in the summer.

Sir David joined in 2012, at a time of huge controversy about the behaviour of and standards at the regulator. It has made substantial changes to how it works under his leadership, many in response to the Francis inquiry into events at Mid Staffordshire Foundation Trust.

To obtain this article copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk

TYM smartphone otoscope for imaging and videoing the external ear canal and eardrum [MIB134]

New:  Medtech innovation briefing

The TYM smartphone otoscope (Cupris) uses an iOS smartphone to let users capture images and videos of the external ear canal and eardrum. These can then be reviewed and shared securely with other healthcare professionals through the Cupris app.

The TYM smartphone otoscope package consists of 5 specula (4.25 mm), a proprietary smartphone case and an otoscope attachment.

Next-generation sequencing panel for solid tumour cancers in children [MIB133]

New:  Medtech innovation briefing

The next-generation sequencing (NGS)-based panel for solid tumour cancers in children is an in-house laboratory test, not a commercial product. It was developed at the Centre for Molecular Pathology at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust and validated in-house for clinical application, following the standardised framework published by Mattocks et al. (2010).

Medicines optimisation dashboard quarterly refresh

Medicines optimisation leads are encouraged to visit the MO Dashboard following the latest quarterly refresh of the data.

NHS Performance Statistics - January 2018

Combined Performance Summary

• Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care 
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures 
• Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates 
• Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies

Standard for physiotherapy degree apprenticeship gets seal of approval

The CSP has received confirmation that the Institute for Apprenticeships has approved the standard for the physiotherapy degree apprenticeship.

The standard sets out the knowledge, skills and behaviours that individuals will need to demonstrate as they progress through the new apprenticeship route to qualify as a physiotherapist.

It makes clear that the apprenticeship will be at honours degree level and that all apprentices will need to follow a degree programme, for which Health and Care Professions Council approval and CSP accreditation have been secured.

SaBTO microbiological safety guidelines 2017

Guidance from the Department of Health and Social Care on the microbiological safety of human organs, tissues and cells used in transplantation.

HEE launches supported return to training strategy

Health Education England has launched a strategy and investment plan which details ten commitments to ensure that trainees are supported on their return to training pathway.

There are more than 50,000 doctors undertaking postgraduate training in England. At least 10 per cent of these will need to take time out of their programme for a variety of reasons such as parental leave, sickness or bereavement, to gain additional experience or training outside of the postgraduate training programme, to conduct academic research, or to take a career break.

Growing innovative models of health, care and support for adults

This briefing from SCIE explains that innovative, often small-scale models of health, social care and support for adults could be scaled up to benefit as many people as possible. It makes a number of recommendations for the Government and national partners

Chronic Obstructive Pulmonary Disease (COPD) Pathway

The Chronic Obstructive Pulmonary Disease (COPD) Pathway defines the core components of an optimal service for people with COPD.

The NHS RightCare Pathway for COPD provides a national case for change and a set of resources to support local health economies to concentrate their improvement efforts where there is greatest opportunity to address variation and improve population health.

UK flu levels continue to increase according to PHE statistics

Seasonal flu levels have continued to increase in the last week across the UK, with flu hospitalisations up 50% according to Public Health England figures.  

The statistics show over the last week there has been a 78% increase in the GP consultation rate with flu like illness, a 50% increase in the flu hospitalisation rate, and a 65% increase in the flu intensive care admission rate. The main strains circulating continue to be flu A(H3N2), A(H1N1) and Flu B.

Drugs and pharmaceutical electronic market information tool (eMIT)

This tool gives background information on the pharmaceuticals that hospitals might buy.

The data provided includes an estimate of NHS hospital-sector annual usage from English trusts for the product selected, the average price paid for that product over the last 4 months of the period, and a measure of how much that average changed.

Faculty of Pain/British Pain Society consensus statement on the use of Corticosteroids for Neuraxial Procedures in the UK

The Faculty of Pain Medicine and the British Pain Society have released a joint statement on this important topic.

Thinking on its own: AI in the NHS

This report illustrates the areas where artificial intelligence (AI) could help the NHS become more efficient and deliver better outcomes for patients. It also highlights the main barriers to the implementation of this technology and suggests some potential solutions.

Fatigue and sleep deprivation – the impact of different working patterns on doctors

This briefing from the British Medical Association highlights why doctors are at risk of fatigue and the acute and long-term impacts this can have. It also presents a framework for how Government, organisations and doctors themselves can manage this risk.

Latest NHS sickness absence statistics - August 2017

The latest figures released by NHS Digital show that NHS staff sickness absence remained the same at 3.92 per cent in August 2016, compared to 3.92 per cent in August 2015.

Six areas Healthwatch wants NHS England to focus on in 2018

Using the views you have shared, find out what six areas Healthwatch has told the Government that NHS England should focus on over the next year to improve health and social care for people.

1. Improving public involvement in changes to local services
2. Using people’s experiences of leaving hospital as a way of measuring how well services are working together
3. Demonstrating how learning from feedback is improving care
4. Increasing focus on the evaluation of mental health services
5. Shifting the focus of NHS targets to take greater account of people's experiences
6. Tackling access issues in NHS dentistry

Child vision screening guidance updated

Public Health England has updated its guidance on child vision screening. The resources for commissioners and providers include a service specification, competencies, leaflets and template letters.

NHS supports development of health innovations

The NHS has selected 138 entrepreneurs to design and deliver new technological solutions and innovations in healthcare. This includes the appointment of five healthcare scientists, tackling conditions including sickle cell disease and allergic reactions.

The Clinical Entrepreneurs Programme, run by NHS England, supports NHS workers to work with, and learn from, leading health and technology industry experts to develop their own innovative ideas.

2018 Clinical Excellence Awards

The 2017 Clinical Excellence Awards Round results were announced in late December 2017. ACCEA have now announced that the 2018 round will open on Tuesday 13 February 2018 and will close on Thursday 12 April 2018.

Service redesign training for finance professionals

NHS Improvement is offering a quality, service and redesign practitioner programme specifically for finance staff in collaboration with Healthcare Financial Management Association and Future Focused Finance.

This five day programme (over five months) is free of charge to NHS finance professionals attending with a clinical or service management colleague with whom they're working on an improvement project.

Demand and Capacity Trainer Programme

The Demand and Capacity Trainer Programme is a free, accredited, six-month programme designed to support organisations to develop internal capability and skills in demand and capacity modelling.

The approach will equip staff to train others in demand and capacity and thereby spread this knowledge more widely at a local level. As a result local areas are better equipped to develop credible activity plans that support the delivery of reduced waiting times for patients.

Getting the most from technology requires pathway redesign

The topic of technology led at September’s NHS Innovation Expo conference. NHS England used Expo as an opportunity to showcase the innovation test bed areas, publishing a ‘Story so far’ update. These seven areas test different technologies with the aim of demonstrating how to choose, implement and iterate technology to transform care pathways and the experience of care.

Travel with CPAP machines: how frequent and what are the problems?

Journal of Travel Medicine, Volume 25, Issue 1, 1 January 2018, tax085

 

Obstructive sleep apnoea syndrome is a common condition for which continuous positive airways pressure (CPAP) is the standard treatment. The condition affects a population of which a substantial proportion will be travelling. We use a questionnaire survey of CPAP users to gain understanding regarding the behaviours, attitudes and problems surrounding travel with CPAP machines during travel and while abroad.

UHCW Research: Richard Bodington

Are patients satisfied with the head and neck skin cancer service? An evaluation of outpatient services with a review of published reports

British Journal of Oral and Maxillofacial Surgery December 2017 Volume 55, Issue 10, Pages 1018–1023 

Scientific publications place much emphasis on postoperative outcomes such as recurrence, but little attention to patients’ satisfaction. The purpose of this evaluation was to find out patients’ reported outcomes after their initial consultation, treatment, and follow-up appointments for non-melanoma skin cancer of the head and neck.

UHCW Research: V. Petrosyan

Pathogenesis and Management of Adiposity and Insulin Resistance in Polycystic Ovary Syndrome (PCOS)

In: Freemark M. (eds) Pediatric Obesity. Contemporary Endocrinology. Humana Press, Cham
Polycystic ovary syndrome (PCOS) is a common condition that often presents during adolescence with characteristic reproductive and hyperandrogenic features. Activation of the hypothalamic-pituitary (HP)-adrenal and HP-ovarian axes during adolescence often coexists with weight gain and heightened insulin resistance; PCOS manifests in those girls who are genetically predisposed. The association of PCOS (the subgroup with both oligo-amenorrhoea and hyperandrogenic features) with metabolic dysfunction, although not contributory as a diagnostic feature, deserves particular focus in adolescent girls. Given the increased risks for development of type 2 diabetes mellitus and dyslipidaemia, it is important that screening for metabolic dysfunction is applied, that “metabo-vigilance” is maintained, and that any emergent metabolic risk factor is managed accordingly. Weight loss remains the most important strategy for both prevention and management of PCOS in obese adolescent girls. With the burgeoning obesity epidemic, it is incumbent upon all of us to promote a healthy lifestyle amongst our children, to avoid excessive weight gain and the associated obesity-related morbidities such as PCOS.

UHCW Research: Thomas M Barber

Exclusive: A&E doctors tell prime minister patients are dying in corridors

Clinical leads for emergency departments warn prime minister of premature deaths in corridors
A&E waiting time performance has dipped to between 45 per cent and 75 per cent at times
Doctors say winter preparations failed to deliver and call for significant funding boost

Senior doctors in charge of more than 60 hospital emergency departments have written to the prime minister warning of “very serious concerns” about patient safety amid the winter crisis, including a case of patients dying prematurely in corridors.

To obtain this article copy and paste the post into an email and send to libraryw@uhcw.nhs.uk

Exclusive: CQC suspends routine inspections over winter pressures

Routine inspections of some services cancelled by CQC due to winter pressures

Regulator says decision will allow staff to focus on caring for patients

Chief executives criticise decision as a “mockery” and counter to the policy of “minimum standards”

The Care Quality Commission is suspending routine inspections of some hospitals, GP practices and urgent care services during January due to winter pressures, HSJ can reveal.

To obtain this article copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk

Accountable care organisations

This House of Commons briefing paper looks at the introduction of Accountable Care Organisations (ACO) in the NHS in England, the development of the ACO policy, and comment on its potential impact.

Risk of death and severe harm from failure to obtain and continue flow from oxygen cylinders

Patient safety alert from NHS Improvement on the risk of death and severe harm from failure to obtain and continue flow from oxygen cylinders.

Lateral percutaneous nephrolithotomy: A safe and effective surgical approach

Indian Journal of Urology (INDIAN J UROL), Jan-Mar 2018; 34(1): 45-50

Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of the renal tract, a smaller window for percutaneous puncture, and a higher risk of anterior calyx puncture. This study aimed to demonstrate the feasibility and safety of lateral-PCNL in managing large renal calculi without the disadvantages of prone and supine positions.
UHCW Research: Jonathan Jian Wei Gan

What’s behind the ‘winter crisis’?

The NHS is once again hitting the headlines, with many hospitals on black alert and a large number of elective operations being postponed to reduce the extreme pressure on services over this winter period.

A King’s Fund briefing looks at the factors behind what the press refer to as a “winter crisis”.

NHS workforce statistics

NHS Digital has published provisional monthly numbers of NHS hospital and community health service staff working in trusts and CCGs in England.

The figures exclude primary care staff.

NHS efficiency map

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

The map is split into three sections: enablers for efficiency, provider efficiency and system efficiency. It highlights the successes some NHS providers have had in delivering specific efficiency schemes and provides sign-posts to existing tools and reference materials. It also includes updated definitions for different types of efficiency.

It has been updated with additional case studies.