STPs will need a change in law to succeed, says report

A report from London Southbank University argues that in order to deliver a better future for the NHS, all 44 STPs would need to be given legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role | NHS England

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Image source: LSBU

We commissioned this report as a reality check on the Sustainability and Transformation Plan process as a whole; to provide an opportunity for review; and to reconvene around the issues that need a sub-regional approach.

This report is a significant contribution to the myths and realities of the Sustainability and Transformation Plans and the process of their development. By starting from the actual situation in each STP footprint, this report grounds the plans in the reality of the local context, and provides a firm basis for any collective decision-making. Many of the STPs (the documents) are not clear about the full extent of the current situation (the baseline from which they are making their plans), which makes the collective STP leadership task extremely difficult.

 

Dementia training programmes for staff working in general hospital settings

Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes | Aging & Mental Health 

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Objectives: This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals.

Results: Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning were the most utilised. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients’ outcomes.

Conclusion: This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. It also highlights measures that could be used to develop and deliver training programmes in hospital settings.

Full reference: Scerri, A. et al. (2017) Dementia training programmes for staff working in general hospital settings – a systematic review of the literature. Aging & Mental Health. Vol. 21 (no. 8) pp.783-796

Improving the management of digital government

Improving the management of digital government argues that the digitisation of public services in the UK is happening too slowly | Institute for Government

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It says that appointing a minister responsible for digital government would help drive change and advance standards. Digital improvements would make government cheaper, more effective and more secure. The report points to the recent NHS cyberattack as an example of the fragility in some systems being used in the public sector.

The report warns that the Government Digital Service (GDS), the Cabinet Office unit responsible for leading digital transformation of government, faces resistance from many corners of Whitehall. Without a strong minister in charge, GDS is not able to drive digital improvements in a way that meets citizens’ expectations. It sets standards for digital government, but these need to be improved and extended throughout the civil service, and with IT contractors.

The report also makes several recommendations for both GDS and Whitehall departments on how they can work better together. The Government needs to organise services around people’s needs and to urgently clarify which system citizens should use to securely identify themselves online.

 

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

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

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Image source: The King’s Fund

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

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

Getting research into policy in health: The GRIP-Health project

For many, the idea that health policy should be informed by evidence is an obvious goal. And indeed, the global health community has widely called for increased use or uptake of research and evidence, in health policymaking | LSE Health and Social Care Blog

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However, a vast majority of these calls have been made without explicit recognition of the decidedly political nature of policymaking, and without consideration of how this may affect the use of evidence to inform decisions.

Indeed, calls for ‘evidence-based’ policymaking have become ubiquitous in recent years, applied in social sectors such as health, education, crime prevention and many others. Many have seen these calls deriving from the successes of the ‘evidence based medicine’ movement – a movement that has helped to ensure that clinical practice is informed by rigorous assessments of evidence of effects of different treatment options.

The GRIP-Health research programme was funded by the European Research Council to bring an explicitly political lens to the study of evidence use for health policymaking in low, middle and high income countries. It draws particularly on policy studies theories to consider how the nature of the policy process, the politicised features of health decisions, and the existing institutional arrangements for policymaking in different countries all can work to shape which evidence is utilised, and how it is utilised to inform or shape health policy decisions.

Winter warning: managing risk in health and care this winter

Leaders of NHS trusts in England are deeply concerned about the NHS’s ability to respond to mounting pressures next winter, according to a new report published today by NHS Providers.

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Winter Warning highlights the worries of many NHS trusts that extra funding for social care, partly allocated to ease winter pressure on the health service, is not consistently getting through to the NHS.

The report sets out in detail how the NHS responded earlier this year to what many consider to be the toughest winter on record. Despite extraordinary efforts from staff, the health and care systems struggled to cope under sustained pressure.

A key factor was the sharp rise in delayed transfers of care (DTOCs), for patients who were ready to be discharged, often because of difficulties in lining up suitable social care.

The government’s response in the spring budget was to use the £1 billion of extra social care funding for the current financial year to try to reduce social care-related NHS DTOCs, and so ease pressure on trusts.

The clear message in Winter Warning is that, in many places, this is not happening.

Government ‘reneging on promise to fund 10,000 extra nursing places’

Scrapping nursing bursaries was supposed to expand training places – but that pledge has been quietly dropped, universities say | The Guardian

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Universities are warning that the government is quietly reneging on its promise to provide 10,000 new nursing degree places, intended to relieve pressure on the NHS.

Student nurses must spend 50% of their degree working under supervision, usually in a hospital. But universities have told Education Guardian that not a single extra nursing training place has been funded or allocated for the future. It would cost £15m over five years to fund training placements for 10,000 new nurses, according to the Council of Deans of Health, the body that represents university faculties of nursing.

Applications to study nursing in the new 2017-18 academic year have slumped by 23% compared with last year, after the abolition of bursaries. The government said last year it would free up £800m and pay for an extra 10,000 places by ending bursaries and shifting student nurses to the standard system of £9,000-a-year tuition fees supported by loans. Angry academics now say this was a hollow promise.

Read the full news story here