New ambulance service standards

NHS England has announced a new set of performance targets for the ambulance service which will apply to all 999 calls for the first time.

  • National response targets to apply to every single 999 patient for the first time
  • Faster treatment for those needing it to save 250 lives a year
  • An end to “hidden waits” for millions of patients
  • Up to 750,000 more calls a year to get an immediate response
  • New standards to drive improved care for stroke and heart attack
  • World’s largest clinical ambulance trial updates decades-old system

The new targetsnew targets will save lives and remove “hidden” and long waits suffered by millions of patients, including reducing lengthy waits for the frail and elderly. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation amongst others.

Call handlers will change the way they assess cases and will have slightly more time to decide the most appropriate clinical response. As a result cardiac arrest patients can be identified quicker than ever before, with evidence showing this could save up to 250 lives every year.

Full story via NHS England

 

How ward staff engage with the implementation of a patient safety intervention

A patient safety intervention was tested in a 33-ward randomised controlled trial | BMJ Open

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Objectives: No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the trial and our aim in this paper is to understand staff engagement across the 17 intervention wards.

Findings: First, there were palpable differences in the ways that the 17 ward teams engaged with the key components of the intervention. Five main engagement typologies were evident across the life course of the study: consistent, partial, increasing, decreasing and disengaged. Second, the intensity of support for the intervention at the level of the organisation does not predict the strength of engagement at the level of the individual ward team. Third, the standardisation of facilitative processes provided by the research team does not ensure that implementation standardisation of the intervention occurs by ward staff.

Conclusions: A dilution of the intervention occurred during the trial because wards engaged with Patient Reporting and Action for a Safe Environment (PRASE) in divergent ways, despite the standardisation of key components. Facilitative processes were not sufficiently adequate to enable intervention wards to successfully engage with PRASE components.

Full reference: Sheard, L. et al (2017) Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation. BMJ Open. 7:e014558

Adult Social Care: Quality Matters

Department of Health, 2017

 

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Source: Department of Health 

The Quality Matters initiative  is co-led by partners from across adult social care sector. This publication sets out a single view of quality and a commitment to improvement. The summary action plan sets out 6 priority areas to make progress on improving quality in first year.  These initial priorities have been identified by people who use services, their families and carers, providers, commissioners, and organisations that support and oversee adult social care services.

This action plan summarises, for each of our priorities:

 

  • What this priority means in practice
  • Who is responsible for making it happen
  • Where we will focus in the first year.

Tobacco Control Playbook

World Health Organization

Tobacco Control
Source: World Health Organization

The Tobacco Control Playbook has been developed by collecting numerous evidence-based arguments from different thematic areas, reflecting the challenges that tobacco control leaders have faced while implementing various articles of the WHO FCTC and highlighting arguments they have developed in order to counter and succeed against the tobacco industry.This is the start of what is intended to be a living document, which will be updated and extended with further arguments and on the basis of feedback, as well as any developments in tobacco industry approaches. Everyone concerned with tobacco control is invited to contribute to its success by continuing to offer arguments and responses, and sharing their experiences through a dedicated website.

Roll out of NHS Wi-Fi to GP surgeries begins

NHS Digital has begun roll out of NHS WiFi to GP surgeries in England and it should be completed by the end of the year.

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Using NHS WiFi, patients will be able to access the internet free of charge in their GP’s waiting room, via their smart phone or tablet. It will enable patients to link in with local health clinics and services and is paving the way for future developments in digital patient care.

NHS WiFi will provide a secure, stable, and reliable WiFi capability, consistent across all NHS settings. It will allow patients and the public to download health apps, browse the internet and access health and care information.

Local Clinical Commissioning Groups (CCGs) are responsible for choosing a supplier that can provide an NHS WiFi compliant system which suits their needs, and working with them to implement it across their local NHS sites. The chosen system must be based on a set of policies and guidance defined by NHS Digital.

Guidance available via NHS Digital relates to implementing NHS WiFi in GP practices. Hospitals and secondary care will follow in 2018.

Further details available here

Entrepreneur scheme for innovative doctors extended to healthcare scientists and dentists

A unique training scheme for clinicians whose innovative ideas could lead to big patient benefits has been opened up to healthcare scientists and dentists | NHS England

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Over the last year 103 junior doctors have developed their ideas and their business skills through the Clinical Entrepreneur programme. Now applications are opening up to healthcare scientists and dentists.

The programme offers a range of support and education, including mentoring by leading medical technology innovators, to give the budding entrepreneurs the business skills and industry knowhow they need to make their ideas a reality.

Competition policy in five European countries

This working paper explores how policies affecting competition have been implemented and promoted in health systems in five countries: France, Germany, the Netherlands, Norway and Portugal | Health Foundation

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  • In conventional markets, customers are attracted to particular suppliers by a more appealing combination of price and quality. But in health care, patients are usually insulated from costs and may find it difficult to judge quality due to information asymmetries and their infrequent use of services.
  • This means that the question – what do we expect or want of competition? – is not so easily answered in health care settings, and lessons from other sectors might not apply.

Key points:

  • Proximity to the health care provider, rather than quality, remains the key driver of patient choice.
  • There is potential tension between stimulating quality competition and controlling expenditure because restrictions on hospital treatments imply that money does not follow the patient, and hospitals may react by making access more difficult or letting their waiting times increase.
  • Information for assessing proposed hospital mergers requires improvement, particularly information on quality.
  • There is limited scope for further expansion in the use of private providers to treat NHS patients given the current focus on controlling expenditure.
  • The economic rationale for controlling entry of providers into general practice is unclear.
  • Selective contracting for patients with chronic and multiple conditions to reduce fragmentation of care raises concerns for competition and regulation. This is because of the long-term nature of the implied contracts and the restricted pool of potential providers willing to bid for these contracts.

Read the working paper here

A Multifaceted Intervention to Improve Outcomes in Intensive Care

This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU | Critical Care Medicine

Interventions: Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.

Measurements and Main Results: Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.

Conclusions: Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.

Full reference: Dykes, P. et al. (2017) Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine. Published online: 3rd May 2017

Investigation into NHS continuing healthcare funding

National Audit Office

National Audit Office has published findings of investigation into NHS continuing healthcare.

NHS continuing healthcare (CHC) is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing health care needs.  Funding for ongoing health care is a complex and highly sensitive area, which can affect some of the most vulnerable people in society and those that care for them. The number of people assessed as eligible for CHC funding has been growing by an average of 6.4% a year over the last four years.  In 2015-16, almost 160,000 people received, or were assessed as eligible for, CHC funding in the year, at a cost of £3.1 billion.