Asthma self-management programmes can reduce unscheduled care

Pinnock H, Parke HL, Panagioti M, et al; PRISMS and RECURSIVE groups. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Medicine. 2017;15(1):64. | via National Institute for Health Research

People with asthma who receive supported self-management are less likely to attend A&E or be admitted to hospital. The interventions are unlikely to increase overall costs for healthcare services. Those who self-manage are also likely to have more controlled asthma and a better quality of life.

This extensive overview of systematic reviews included evidence from 270 randomised controlled trials exploring the effects of asthma self-management on healthcare utilisation and costs. Self-management programmes were slightly more expensive, but this cost was likely to be offset by reducing unplanned medical visits and improving patient quality of life.

Trials covered different self-care education programmes delivered in a range of contexts. However, programmes which included written action plans supported by regular professional review were found to be most beneficial.

These findings are in keeping with current guideline recommendations and emphasise that supported self-management programmes for asthma should be prioritised.

Sustainability and Transformation Plans: What, why and where next?

The Institute for Public Policy Research (IPPR) has published Sustainability and transformation plans (STPs): what, why and where next? 

The NHS is facing one of the most challenging periods in its history, with a funding gap of more than £22 billion over the coming years. And the pressure on the social care system is more acute than ever, with many councils raising eligibility thresholds and making cuts to social care budgets.

Image source: http://www.ippr.org

Sustainability and Transformation Plans (STPs) – which are local health and care reform plans, authored jointly by NHS and local government leaders to improve outcomes and drive greater efficiency in their local area – are one of the government’s main responses to this problem. These plans rightly focus on decentralising power within the NHS, investing in leadership and relationships to drive improvements, and on local health and care organisations coming together to overcome the silos created by the 2012 Health and Care Act.

This report looks at the most promising reform solutions that have been identified by STPs, and also sets out the range of challenges that stand in the way of them realising their vision for improved health and efficiency.

Download summary here or full report here

 

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

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.

• Report
• Overview

 

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

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.

• Report
• Blog post

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

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.

• Blog post
• Related systematic review
• GRIP website

Why UK hospital staff find it difficult to make improvements based on patient feedback

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services | Social Science and Medicine

This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.

A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback.

Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’.

• First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise.
• Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment.
• Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted.

Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

Full reference: Sheard, L. et al. (2017) The Patient Feedback Response Framework – understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Social Science & Medicine. 178. pp. 19-27.

 

NHS England has issued a call for the world’s best healthcare innovations

The NHS Innovation Accelerator has already improved the uptake of pioneering ideas, equipment and technology such as ventilation tubes that reduce cases of pneumonia and new approaches to mental health care | NHS England

The NHS Innovation Accelerator (NIA) has already successfully helped transform patient care across the NHS by fast-tracking the uptake of pioneering ideas, equipment and technology such as ventilation tubes that reduce cases of pneumonia and new approaches to mental health care.

NHS England Chief Executive Simon Stevens has now confirmed a further round of the programme which will focus on the clinical priorities outlined in the Next Steps Five Year Forward View plan including mental health, primary care and urgent and emergency care.

The initiative, supported by England’s 15 Academic Health Science Networks (AHSNs) and hosted at UCLPartners, has to date helped support the uptake of ground-breaking concepts in 469 NHS organisations. The aim is to provide innovators with a package of tailored support – including access to a 2017 bursary fund totalling £240,000 and mentoring from a team of experts – in order to help their ideas gain uptake across the NHS.

• News story
• NHS Innovation Accelerator (NIA)

Acting without delay – How the independent sector is working with the NHS to reduce delayed discharge

NHS Confederation, June 2017

This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care.  Reducing delayed discharge – where often frail and elderly patients are unable to leave hospital due to necessary care, support or accommodation in the community being unavailable – is arguably one of the biggest priorities for the NHS.

Delayed discharges and transfers of care (DTOCs) have a significant impact on the ability of NHS acute trusts to provide routine treatment such as elective surgery. It is vital, both for the patient and the trust, to be able to discharge patients speedily to avoid adverse effects to patient flow.

Sustainability and transformation plans: how serious are the proposals? A critical review

London South Bank University, School of Health and Social Care, May 2017

This report 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. It also recommends that STP leaders need to plan ahead based on the reality of their current situation, identify changes that are evidence-based, develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector. Alongside the main report, 44 sub-reports are available, each critically reviewing the plans for each STP locality.

Involving people in health and care guidance

The two sets of guidance, and a wealth of web based resources and best practice, together supersede the original ‘Transforming Participation in Health and Care’ guidance, which was published in 2013 | NHS England

In response to user feedback, elements of the original guidance have been retained and new features introduced, including a greater focus on people with the greatest health needs, and information on the practicalities of involvement.

The links between individual and collective involvement in health are clear; people who have advanced knowledge, skills and confidence to manage their own health are more likely to get involved at a group/community level in having a say about health and health services. Equally, those who have been involved in the commissioning process (planning, buying and monitoring) health services are more likely to be informed about health and health services; they will therefore be better placed to manage their own health and be involved about decisions relating to their care and treatment.

• Patient and public participation equality and health inequalities
• Involving people in their own health and care: statutory guidance for clinical commissioning groups and NHS England