Hidden in plain sight: the unmet mental health needs of older people

Age UK, October 2016

According to this report, the current availability of mental health services does not meet the increasingly high demand from an ageing population. It also found that over a third of mental health trusts in England have no policies for providing integrated care for people over 65 with both mental and physical health needs.  Age UK makes a number of recommendations to build on progress already made and ensure that older people’s mental health gains not only parity of esteem with physical health concerns but parity with other age.

Key recommendations

  •  Implementation of Mental Health Taskforce recommendations should include a
    work stream dedicated to meeting older people’s mental health needs. This should
    include ensuring wide use of the new CQUIN for depression in older patients.
  • Local health and care commissioners should fully understand the prevalence of
    common mental health conditions among the over 65s in their areas.
  • Each clinical commissioning group and local authority should consider appointing
    “older people’s mental health champions”
  • All services should be appropriately funded and equipped to deliver fully integrated
    care that addresses mental and physical health and comorbidity

Access the full document here

New care models: Emerging innovations in governance and organisational form

The King’s Fund | Published online: 11 October 2016

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Image source: The King’s Fund

The 23 vanguard sites chosen to develop the multispecialty community provider (MCP) and primary and acute care system (PACS) new care models have been working to pool budgets and integrate services more closely. Some are continuing to use informal partnerships, but others are opting for more formal governance arrangements. Commissioners are grappling with how to contract for the new systems, while providers are exploring how to work together within emerging partnerships, how to allocate funding, and how to share risk and rewards.

Key findings

  • Many of the vanguard sites would like to bring together the budgets for core primary care services and other local services, but it seems unlikely that GPs will give up their core General Medical Services or Personal Medical Services contracts in the immediate future.
  • Many of the sites would like to bring together the budgets and contracting for some health and social care services, but only a small number have made substantial progress in incorporating social care.
  • Many commissioners plan to contract with a single provider or entity to hold the budget and oversee or deliver a broad range of services, although most are still deciding which organisation or partnership should do this.
  • Commissioning and developing new care models involves risks as well as opportunities, underlining the importance of how these models are governed, their organisational form and how risks are shared.
  • Building and strengthening collaborative relationships is just as important as focusing on the technical elements of integrated care.

Read the full summary here

Read the full report here

Enhanced Health in Care Homes model

One in seven people aged 85 or over is living permanently in a care home. The evidence suggests that many of these people are not having their needs properly assessed and addressed. As a result, they often experience unnecessary, unplanned and avoidable admissions to hospital, and sub-optimal medication.

The enhanced health care homes model  lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of services.

Seven key components and eighteen sub-components which define the care homes model are put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

These plans can help transform the way care is delivered, with staff from across health and social care organisations working together as part of multidisciplinary teams  to deliver high quality and financially sustainable care.

The enhanced health in care homes (EHCH) care model is one of a number of new care models that are delivering whole population healthcare. It will become a core element of the multispecialty community provider (MCP) and primary and acute care system (PACS) models.

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Image source: http://www.england.nhs.uk

Supporting patients to get online

NHS England has published further information to support GP practices, CCGs and NHS trusts with the effective promotion of online services to patients, including ordering of repeat prescriptions, booking of appointments and viewing of GP records.

The packs consist of templates for web copy, press releases, social media and newsletters as well as instructions on how to order the new range of promotional materials. The name of the programme has been changed from Patient Online to GP Online.

 

Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study

Scheer, S. et al. Critical Care Medicine. Published online: September 22 2016

Objective: To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated.

Design: Prospective observational before-after cohort study.

Setting: Tertiary university hospital in Germany.

Patients: All adult medical and surgical ICU patients with severe sepsis and septic shock.

Intervention: Implementation of a quality improvement program over 7.5 years.

Measurements: The primary endpoint was 90-day mortality. Secondary endpoints included ICU and hospital mortality rates and length of stay, time to broad-spectrum antiinfective therapy, and compliance with resuscitation bundle elements.

Main Results: A total of 14,115 patients were screened. The incidence of severe sepsis and septic shock was 9.7%. Ninety-day mortality decreased from 64.2% to 45.0% (p < 0.001). Hospital length of stay decreased from 44 to 36 days (p < 0.05). Compliance with resuscitation bundle elements was significantly improved. Antibiotic therapy within the first hour after sepsis onset increased from 48.5% to 74.3% (p < 0.001). Multivariate analysis revealed blood cultures before antibiotic therapy (hazard ratio, 0.60-0.84; p < 0.001), adequate calculated antibiotic therapy (hazard ratio, 0.53-0.75; p < 0.001), 1-2 L crystalloids within the first 6 hours (hazard ratio 0.67-0.97; p = 0.025), and greater than or equal to 6 L during the first 24 hours (hazard ratio, 0.64-0.95; p = 0.012) as predictors for improved survival.

Conclusions: The continuous quality improvement initiative focused on the resuscitation bundle was associated with increased compliance and a persistent reduction in 90-day mortality over a 7.5-year period. Based on the observational study design, a causal relationship cannot be proven, and respective limitations need to be considered.

Read the abstract here

Investment in new units for mums with mental ill health

NHS England is preparing to invest in three new inpatient units for mums with serious mental ill health to help them to stay with their babies.

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The new Mother and Baby Units (MBUs) will be in East Anglia: Cambridgeshire, Norfolk and Suffolk; the North West: Cumbria and Lancashire; and the South West: Cornwall, Devon and Somerset.

The services will provide in-patient support for women and their babies with the most complex and severe needs who require hospital care who are experiencing severe mental health crisis including very serious conditions like post-partum psychosis.

Expanding capacity in mother and baby units is a key element of NHS England’s transformation programme for perinatal mental health services as part of integrated pathways of care. This covers both the creation of new units in areas with the most severe access issues, as well as reviewing capacity in existing units, with funding across the five-year period – estimated £10m in 2017/18 and £15m in 2018/19 as outlined in the Implementation Plan.

The perinatal mental health programme also supports the ambitions of the widerMaternity Transformation Programme, which seeks to deliver the vision set out in Better Births, the report of the National Maternity Review to improve maternity outcomes for women and their babies.

Read more via NHS England

Long term conditions

NHS England has published The Long Term Conditions Year of Care Commissioning Programme Implementation Handbook.

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Image source: http://www.nhsiq.nhs.uk/

The handbook is the main output of the Year of Care Commissioning Programme. It describes the experiences of five care economies working as part of the programme as they work towards developing capitated budgets for some patients and services.

A range of new posters are available showing how early implementer sites from the Long Term Conditions Year of Care Commissioning Programme are using their outputs from the programme to proactively support local service change decision making:

Sort film: Revolutionising person centred care for people with complex care needs

 

Dementia Nursing

The Department of Health has published Making a difference in dementia: nursing vision and strategy: refreshed edition.

This strategy sets out how nurses can provide high quality compassionate care and support for people with dementia, so they can live well with dementia within all care settings, including a person’s own home.

It aims to support all nurses to be responsive to the needs of people with dementia, continue to develop their skills and expertise, and achieve the best outcomes for people with dementia, their carers and families.

This refreshed strategy builds on the original strategy, published in March 2013.

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Image source: http://www.gov.uk/

Help for people with learning disabilities to live independently

Local authorities are being invited to apply for a share of the £25 million housing and technology fund for people with learning disabilities.

The funding will allow the creation of a range of housing and technology options which could include floor sensors to monitor for falls or finger-print technology to make access as easy as possible for residents. This £25 million fund builds on £20 million already earmarked by NHS England as part of its Transforming Care programme.

The main aims of the fund are to:

  • use new technologies to improve and adapt existing accommodation, enabling people to remain living independently
  • prevent unnecessary in-patient admissions
  • provide solutions for people who require urgent housing and are at risk of entering inappropriate services like hospital or residential care
  • encourage community-based solutions that promote independence and choice over housing
  • save money and resources – specially adapted housing reduces the need for costly hands-on care