Understanding NHS financial pressures. How are they affecting patient care?

The Kings Fund has published ‘Understanding NHS financial pressures. How are they affecting patient care?’

Understnading NHS financial pressures

Image source: https://www.kingsfund.org.uk/

Financial pressures on the NHS are severe and show no sign of easing. However, we know relatively little about their impact on patient care.

This study sought to investigate the impact of financial pressures in four very different areas of the health service: genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal services. The research used data analysis and interviews to explore different experiences across the system.

The researchers found that GUM and district nursing services were under particular strain. Both access to services and quality of patient care have been affected in ways that are difficult to detect with currently available metrics.

Within elective hip replacement services, activity has increased in recent years and patients remain happy with the outcome of their operations, but the latest data shows that average waiting times for treatment are starting to rise. Neonatal services appear to have largely maintained quality and access despite a number of longstanding pressures, although there is variation between units.

The findings create a challenge to the direction of travel set out in the NHS five year forward view of strengthening community-based services and focusing on prevention.

Read more here

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Presenting patient-reported outcomes data to patients and clinicians to improve interpretability

Snyder, C.F. et al. Cancer. Published online: 13 January 2017

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Background: Patient-reported outcomes (PROs) (eg, symptoms, functioning) can inform patient management. However, patients and clinicians often have difficulty interpreting score meaning. The authors tested approaches for presenting PRO data to improve interpretability.

Conclusions: The current results support presenting PRO data with higher = better directionality and threshold lines indicating normal versus concerning scores.

Read the full abstract here

Lung Cancer Clinical Outcome Publication 2016

The clinical outcomes publication is an NHS England initiative to publish quality measures at unit level and the level of individual consultant doctor using national clinical audit and administrative data | RCoP

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Image source: RCoP

The aims of publishing these results are to:

  • reassure patients that the quality of clinical care is high
  • assist patients in having an informed conversation with their consultant or GP about the procedure or operation they may have
  • provide information to individuals, teams and organisations to allow them to monitor and improve the quality of the clinical care they provide locally and nationally.

Read the overview here

Read the full report here

Every Voice Matters: Annual Report to Parliament 2015-16

Heatlhwatch | Published online: 18 October 2016

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Image source: Healthwatch

In 2015/16, the 152 local Healthwatch across England engaged over 380,000 people to find out their views about health and social care, and helped to signpost a further 220,000 people to the right place for their needs.

Collectively they also visited more than 3,500 local hospitals, GP surgeries and care homes to find out if they are working for people, and published over 1,450 reports about what people want and need from health and care.

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Image source: Healthwatch

This demonstrates a substantial public appetite for involvement in shaping health and social care services. Local Healthwatch help to bring people and professionals together to put these views at the heart of changes to the NHS, resulting in services beginning to respond to local people

With big changes ahead, Healthwatch is committed to helping people voice what they expect from future health and care services and supporting those in charge of NHS reforms to act on these views.

Drawing on the wealth of evidence collected by the network, we have been able to bring local views to national attention, helping to inform ongoing changes to primary, secondary and social care services across the country.

Read the full report here

Using appreciative inquiry to implement person-centred dementia care in hospital wards

Scerri, A. et al. Dementia. Published online: October 6 2016

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The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards.

Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.

Read the abstract here

Primary and acute care system (PACS)

NHS England launches frameworks to increase integration of health and care services

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NHS England has published Integrated primary and acute care systems (PACS) – Describing the care model and the business model

A PACS can be defined as a population-based accountable care model, with general practice at its core. It is organised around patients’ needs and aims to improve the physical, mental and social health and wellbeing of its local population.

However, it will also include most hospital based care, as well as primary, community, mental health and social care services. By aligning the goals and incentives of hospitals with other health and care providers, it offers the potential for a radical new approach to population health.

The integrated (PACS) Framework outlines the next steps required to set up the model – including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services.

This puts clinicians in the driving seat by pooling and allocating resources to areas that will have the greatest impact on the health of their local community and creates a shared responsibility towards the most vulnerable patients.

Improving Health Care Through Better Conversation

Coalition for Collaborative Care| Published online: 19 September 2016

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Image source: HEE

Research shows that people often don’t take their medications or change their lifestyles after after visiting a doctor or a nurse, while only about 60 per cent of people feel they are sufficiently involved in decisions about their care.

A campaign is being launched to tackle this issue and improve the way in which health professionals and people talk.

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Image source: HEE

‘Better Conversations’ looks at how clinicians and commissioners can introduce health coaching and will provide  information, evidence and tips on how to have a more equal conversation with people and are treated as partners in their care, rather than passive recipients.

It has been described by NHS Medical Director Professor Sir Bruce Keogh as an essential part of the plan to transform the way health care services are provided, to make them sustainable.

A pilot programme of health coaching was rolled out to nearly 800 clinicians across the East of England and is now ready for national adoption. The work is driven by Dr Penny Newman and backed by the NHS Innovation Accelerator initiative to achieve the aims of NHS England’s Five Year Forward View.

View the summary here

View HEE resources here