Personalised letters and a “taster session” help double attendance at NHS stop smoking services

Gilbert H, Sutton S, Morris R, et al. Start2quit: a randomised clinical controlled trial to evaluate the effectiveness and cost-effectiveness of using personal tailored risk information and taster sessions to increase the uptake of the Unstop Smoking Services. Health Technol Assess. 2017;21(3):1-206.

Attendance at NHS stop smoking services (SSS) almost doubled after smokers were sent letters showing their personalised risk of serious illness if they continued to smoke alongside invitations to try the service.

Less than 5% of smokers attend these services in England and numbers are on the decline, although this is one of the most effective ways of stopping smoking.

A personalised risk letter was sent to 2,636 smokers alongside an invitation to a local taster session. 17.4% attended, compared to 9.0% of 1,748 smokers who received a standard letter advertising the service. The letter and invitation to a taster session also increased the number who had quit smoking by six months (9% vs. 5.6%).

This proactive recruitment looked likely to be cost effective over a person’s lifetime compared to the usual non-specific invitation.

Those recruited represented only a small proportion of smokers wishing to quit and who may be more motivated than most. There remains a need across all of society to increase accessibility to stop smoking services.

Nurses and pharmacists can prescribe as effectively as doctors

Weeks G, George J, Maclure K, Stewart D. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev. 2016;(11):CD011227

Prescribing by suitably-trained pharmacists and nurses offers similar outcomes to prescribing by doctors, at least in the management of chronic conditions.

This Cochrane review pooled clinical outcomes and patient satisfaction across 45 studies of nurse or pharmacist prescribing compared with doctor prescribing.

Most studies were of chronic disease management in primary care settings in high income countries (25 from the US and six from the UK).

Independent and supplementary prescribers in the NHS include not only the nurses and pharmacists, as covered in this review, but also other professions such as podiatrists, optometrists, and physiotherapists. At a time of high demand for NHS resources, with shortages of doctors in some specialties, prescribing by other professionals may help ease the workload, but safety, time and costs of training need to be considered.

Self-care: everybody’s talking about it

Self-care everybody’s talking about it
A discussion paper by Self Help UK on behalf of Regional Voices

This paper highlights the need to support patients to better manage their own health and the need for greater recognition of the potential for voluntary and community services contribution towards this. The discussion paper outlines the benefits of promoting self-care approaches and the briefing for the voluntary and community sector contains case studies.

How healthcare is funded

Kings Fund, March 2017

The NHS is experiencing the longest and most severe slowdown in funding in its history. This has raised questions about the sustainability of its funding model. This article explains the main models used to finance health care: taxation, private health insurance and social health insurance. It outlines how each model works in its purest form, while recognising that most countries typically pay for health care using a combination of methods.

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.

NHS efficiency map: updates

The HFMA and NHS Improvement have worked in partnership to update and revise the NHS efficiency map.

efficiency-map-jan-17
Image source: HFMA

The map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency.

The national focus on improving efficiency and productivity will mean taking local action to deliver savings remains a priority for all NHS organisations. Aimed at NHS finance directors and their teams and other NHS staff with an interest in the delivery of CIPs, the purpose of the NHS efficiency map is to highlight existing resources on eliminating waste, increasing efficiency and at the same time improving quality and safety.

The map is split into three sections: enablers for efficiency, provider efficiency and system efficiency. The map highlights the successes some NHS providers have had in delivering specific efficiency schemes and provides sign-posts to existing tools and reference materials. It also includes updated definitions for different types of efficiency.

The map will be updated as new tools and case studies are produced.

The case studies produced to date are:

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

Tackling culture change to transform mental health services

Mandip Kaur for the King’s Fund Blog | 16th March 2017

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Traditionally, mental health services are delivered by Children and Adolescent Mental Health Services (CAMHS) up until the age of 16 or 18 – or when a young person leaves school or college – at which point they’re expected to transition to adult mental health services. It’s long been recognised that this is a poor boundary for service transition, often having a further detrimental effect on mental health.

Forward Thinking Birmingham delivers mental health services for children and young people aged up to 25, combining the expertise of Birmingham Children’s Hospital, Worcester Health and Care Trust, Beacon UK, The Children’s Society and The Priory Group. The partnership’s vision is that Birmingham should be the first city where mental health problems are not a barrier to young people achieving their dreams. The transformational changes to the service were driven by the need to address disjointed and fragmented care provision, complicated service models, long waiting lists and rising demand. The service operates a ‘no wrong door’ policy and aims to provide joined-up care, focusing on individual needs, with improved access and choice for young people.

Read the full blog post here

How big data is being mobilised in the fight against leukaemia

In a project funded by Bloodwise and the Scottish Cancer Foundation, we have created LEUKomics. This online data portal brings together a wealth of CML gene expression data from specialised laboratories across the globe | Lorna Jackson & Lisa Hopcroft for The Conversation

Leucemia mieloide cronica (LMC)
Image source: Paulo Henrique Orlandi Mourao – Wikimedia // CC BY-SA 3.0

Our intention is to eliminate the bottleneck surrounding big data analysis in CML. Each dataset is subjected to manual quality checks, and all the necessary computational processing to extract information on gene expression. This enables immediate access to and interpretation of data that previously would not have been easily accessible to academics or clinicians without training in specialised computational approaches.

Consolidating these data into a single resource also allows large-scale, computationally-intensive research efforts by bioinformaticians (specialists in the analysis of big data in biology). From a computational perspective, the fact that CML is caused by a single mutation makes it an attractive disease model for cancer stem cells. However, existing datasets tend to have small sample numbers, which can limit their potential.

Read the full blog post here

Best practice in Memory Services: Learning from across England

This report summarises the findings from a series of visits carried out by NHS England’s National Clinical Director for Dementia

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The visits were to a number of memory services which were experiencing longer waiting times from referral to assessment. The audit found that there had been significant successes in a number of clinics in improving access times over the past year, often in challenging circumstances.

Common features of the services which were reducing waiting times were:

  • Reviewing the assessment pathway and reconfiguring workforce to match demand. Some achieved this through upskilling existing staff, using vacancy funding creatively or investing in new staff.
  • Developing joint clinical protocols for referral and diagnosis, follow-up care, access to and reporting of scans and care home management
  • Supporting memory services in primary care 3,4.

Based on the findings the top ten tips to service improvement are:

  1. Involve service users and carers at every step
  2. Understand current and future demand and map against available capacity
  3. Review referral protocols
  4. Review brain scan (CT/MRI) protocols
  5. Examine DNA rates
  6. Ensure correspondence clearly states diagnosis and accompanying ‘Read Codes’
  7. Identify education and training opportunities
  8. Consider protocol for diagnosis in primary care including care homes
  9. Review with commissioners the role of specialist nurses
  10. Become MSNAP accredited and share best practice examples

Read the full report here