Long-term sustainability of NHS and Adult Social Care

The House of Lords Select Committee on the Long-term Sustainability of the NHS has published The Long-term Sustainability of the NHS and Adult Social Care.

The Committee highlights the ‘short sightedness’ of successive governments for failing to plan effectively for the long-term future of the health service and adult social care.  It makes a number of recommendations including the establishment of an independent Office for Health and Care Sustainability which will be able to identify clearly the healthcare needs of a changing population and the staffing and funding required to meet these needs.

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Patient experience of different regional models of urgent and emergency care

Foley, C. et al. (2017) BMJ Open. 7:e013339

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Objectives: To compare user experiences of 8 regional urgent and emergency care systems in the Republic of Ireland, and explore potential avenues for improvement.

Conclusions: No consistent relationship was found between the type of urgent and emergency care model in different regions and patient experience. Scale-level data may not offer a useful metric for exploring the impact of system-level service change.

Read the full article here

Eight elements of workplace wellbeing

A new poster and web section has launched to show the eight elements that are critical to delivering a robust and effective health and wellbeing offer for your staff | NHS Employers

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Image source: NHS Employers

All eight elements need to be in place in order to ensure your wellbeing strategy is as effective as possible. Communication and leadership are essential to create a healthy culture in your organisation, where staff are fully supported.

For more information on the featured points, view the vital signs: eight elements of workplace wellbeing web section.

Information and Digital Technologies: Clinical Requirements 2020

Breakthroughs in the use of data and technology are changing the way we live our lives. Adaptation of these changes has been relatively slow in healthcare, but there is now an increasing focus on learning how to use these technologies to improve the way we deliver care for our patients | Academy of Royal Medical Colleges

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Image source: AoMRC

Policy developments in the digital agenda at a national level have been supported by the Academy of Medical Royal Colleges setting out its vision for NHS information systems in 2013 and the National Information strategy for a digital NHS in 2014.

The aim of this document is to ensure that clinical priorities are met and reflected at a national level. It is the list of clinical requirements setting out what information and communication technologies clinicians would expect in 2020 in the work environment. These standards have been designed to establish a level of detail that will inform decision-making and enable accountability.

As 2020 approaches Clinicians should see the tangible areas of improvement in data and technology and use it to modernise and improve the quality of care we are able to deliver for our patients.

Read the full report here

Analysis of the time and workers needed to conduct systematic reviews of medical interventions

Borah R. et al. (2017) BMJ Open. 7:e012545

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Objectives: To summarise logistical aspects of recently completed systematic reviews that were registered in the International Prospective Register of Systematic Reviews (PROSPERO) registry to quantify the time and resources required to complete such projects.

Results: The mean estimated time to complete the project and publish the review was 67.3 weeks (IQR=42). The number of studies found in the literature searches ranged from 27 to 92 020; the mean yield rate of included studies was 2.94% (IQR=2.5); and the mean number of authors per review was 5, SD=3. Funded reviews took significantly longer to complete and publish (mean=42 vs 26 weeks) and involved more authors and team members (mean=6.8 vs 4.8 people) than those that did not report funding (both p<0.001).

Conclusions: Systematic reviews presently take much time and require large amounts of human resources. In the light of the ever-increasing volume of published studies, application of existing computing and informatics technology should be applied to decrease this time and resource burden. We discuss recently published guidelines that provide a framework to make finding and accessing relevant literature less burdensome.

Read the full article here

Financial sustainability of the NHS

The Committee’s evidence session began with the Head of NHS England speaking out against comments made in that day’s press by sources at No. 10 | House of Commons Committee of Public Accounts

The fact that key players running our NHS are bickering in public does little to inspire confidence that patients are at the heart of everyone’s priorities. As this report underlines, the NHS is facing huge challenges. This requires a united effort to resolve these for the long term.

Faced with these pressures, the Department of Health has resorted to raiding the separate capital budget earmarked for long-term investment and is using this to fund day-to-day spending. Reducing investment in the hospital estate and medical equipment risks making the NHS less sustainable in the longer-term and limits the funding for investing in new services in the community. Local sustainability and transformation plans are supposed to be a vehicle for creating a modern day NHS, but NHS England and NHS Improvement have much more to do before the public can feel confident that plans are achievable, especially when the Head of NHS Improvement acknowledges that the 4% efficiency savings required are so challenging. We recognise the unprecedented challenge of achieving financial sustainability when patient demand is rising, budgets are tight and pressures in social care are impacting on the NHS. But the Department, NHS England and NHS Improvement are asking local bodies to solve multiple problems and deliver a range of priorities, without a proper understanding of what they can realistically achieve. Transformation under such pressure is hard to achieve.

Read the full report here

Winter Insight: NHS 111

An analysis of how NHS 111 has fared, especially over the winter period | Nuffield Trust

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Image source: Nuffield Trust

Key Points:

  • The proportion of callers being dispatched from NHS 111 to emergency services over the last three years has risen. There has been a particular rise in the share of people who are passed to ambulances.
  • There is great variability between different areas in how likely NHS 111 is to send people to A&E or the ambulance service. This might suggest that some areas are too likely, or not likely enough, to send people to emergency services. NHS 111 is also more likely to dispatch an ambulance than to simply send people to A&E – which is the reverse of the usual pattern of NHS use. This lends credence to claims that the service is too risk-averse in some cases.
  • However, contrary to criticism that it adds to the pressure on A&E, the service overall seems to steer people away from emergency services. Patient surveys suggest as many as 8 million more people would have gone to A&E and the ambulance service over the last three years without 111. The call line also soaks up extra demand during winter, when it becomes less likely to refer people to urgent services.
  • NHS 111 still answers the vast majority of calls within a minute, and few people hang up after having to hold for more than 30 seconds. However, it has not met its target of answering 95 per cent of calls within 60 seconds for two-and-a-half years, and it seems prone to serious under-performance when calls spike after Christmas and the New Year.

Read the full report here