Tackling the growing crisis in the NHS: an agenda for action

The Kings Fund

This briefing identifies three big challenges for the NHS in England: sustaining existing services and standards of care; developing new and better models of care; and tackling these challenges by reforming the NHS from within. It aims to offer some practical solutions to help the NHS address one of the biggest crises in its history.

Success in NHS push to reduce avoidable antibiotic prescribing

Overall in 2015, antibiotic prescribing reduced by 5.3% compared to 2014


Action to prevent a future health crisis caused by antimicrobial resistance has seen the number of antibiotics prescribed in primary care fall substantially last year.

The progress follows the introduction of financial incentives in April 2015 by NHS England working with Public Health England (PHE). Between April and December 2015, two million fewer prescriptions were dispensed compared to the same period in 2014 – a 7.9% reduction.

Guidelines for reporting of health interventions using mobile phones

Agarwal, S. et al. BMJ. 2016. 352:i1174

Image source: poppy // CC BY-NC-ND 2.0

To improve the completeness of reporting of mobile health (mHealth) interventions, the WHO mHealth Technical Evidence Review Group developed the mHealth evidence reporting and assessment (mERA) checklist.

The development process for mERA consisted of convening an expert group to recommend an appropriate approach, convening a global expert review panel for checklist development, and pilot testing the checklist. The guiding principle for the development of these criteria was to identify a minimum set of information needed to define what the mHealth intervention is (content), where it is being implemented (context), and how it was implemented (technical features), to support replication of the intervention. This paper presents the resulting 16 item checklist and a detailed explanation and elaboration for each item, with illustrative reporting examples. Through widespread adoption, we expect that the use of these guidelines will standardise the quality of mHealth evidence reporting, and indirectly improve the quality of mHealth evidence.

Read the full article here

Disagreement between cardiac output measurement devices: which device is the gold standard?

Y. Le Manach & G. S. Collins. British Journal of Anaesthesia (2016) 116 (4):451-453.

Image source: Neil Leslie – Wellcome Images // CC BY-NC-ND 4.0

A common research question in perioperative haemodynamics research concerns the assessment of whether a new measurement device can replace an existing device (often referred to as method comparison studies). Typically, a new measurement method is being compared with an established reference method (unfortunately often referred to as the ‘gold standard’).

In a recent issue of the journal, Biais and colleagues reported the comparison of two cardiac output measurement devices, one based on pulse wave transit time (i.e. the new devices) and the other one based on transthoracic echocardiography (i.e. the reference method ‘gold standard’). The study concluded that devices were not interchangeable and that the new device cannot guide haemodynamic interventions in critically ill patients. Their conclusion was based on observing percentage errors exceeding the limits of 30%, suggested by Critchley and Critchley.

Read the abstract here

Implementation of a pilot telehealth programme in community palliative care

Collier, A. et al. Palliative Medicine. April 2016 vol. 30 no. 4409-417

Image source: Esther Vargas // CC BY-SA 2.0

Background: Telehealth technologies are an emerging resource opening up the possibility of greater support if they have utility for patients, carers and clinicians. They may also help to meet health systems’ imperatives for improved service delivery within current budgets. Clinicians’ experiences and attitudes play a key role in the implementation of any innovation in service delivery.

Aim: To explore clinicians’ perspectives on and experiences of the utilisation of a pilot telehealth model and its integration into a specialist community palliative care programme.

Design: Focus groups and interviews generated data that were analysed through the lens of a realistic evaluation theoretical framework.

Setting/participants: The study was conducted in a metropolitan specialist palliative care service in South Australia. Participants (n = 10) were clinicians involved in the delivery of community specialist palliative care and the piloting of a telehealth programme.

Results: Service providers consider telehealth resources as a means to augment current service provision in a complementary way rather than as a replacement for face-to-face assessments. Introducing this technology, however, challenged the team to critically explore aspects of current service provision. The introduction of technologies also has the potential to alter the dynamic of relationships between patients and families and community palliative care clinicians.

Conclusion: Implementation of a pilot telehealth programme in a specialist palliative community team needs to involve clinical staff in service redesign from the outset. Reliable IT infrastructure and technical support is critical for telehealth models to be effective and will aid uptake.

Read the abstract here