Digital Technology and health

Patient Carers and Service User Vision | National Information Board | Department of Health

This policy paper examines how changes in digital technology can be used to improve patient, carer and service user experiences of health services. The document will allow people to understand why and how changes are being introduced and to see whether the planned improvements are really happening.

New collaborative to support the physical health of people with a mental illness

Equally Well: A new collaborative to support the physical health of people with a mental illness | via Centre for Mental Health

In October 2016, the Academy of Medical Royal Colleges published the report ‘Improving the physical health of adults with severe mental illness: essential actions’  The report outlined the changes that were needed to make a sustained impact on the physical health of people living with a mental illness. It highlighted that coordinated national effort would be needed to bring good practice to scale and support further innovation and improvement across the country.

Equally Well  is an initiative from New Zealand which seeks to promote and support such collaborative action to improve physical health among people with a mental illness.

Now in the UK, the Centre for Mental Health, Kaleidoscope and Rethink Mental Illness are working together with support from the Royal College of GPs and the Royal College of Psychiatrists to create an Equally Well collaborative in this country.

Dementia assessment and improvement framework

An evidence-based framework to support and enable directors of nursing and medical directors to achieve ‘outstanding’ care standards for those living with dementia during their stay in hospital | NHS Improvement

This framework has eight standards, and draws on learning from organisations that have achieved an ‘outstanding’ rating from the Care Quality Commission. The document integrates policy guidance and best practice with opinion from patients and carers.

Engaging staff to drive quality improvement

NHS Employers has published Making it better: staff engagement for quality improvement. This case study highlights work that the Sheffield Teaching Hospital has undertaken on staff engagement as part of its programme of quality improvement, such as the collaborative development of the Sheffield Microsystems Coaching Academy, Listening into Action groups and the creation of trust values. The case study also highlights the benefits the organisation has seen as part of its ‘Making it Better’ transformation programme.

New £15 million grant scheme to improve mental healthcare

The Beyond Places of Safety fund will focus on improving urgent mental healthcare in local areas | Department of Health 

The Department of Health has launched a £15 million fund to better support people at risk of experiencing a mental health crisis.

The Beyond Places of Safety scheme aims to improve support services for those needing urgent and emergency mental healthcare. This includes conditions such as psychosis, bipolar disorder, and personality disorders that could cause people to be a risk to themselves or others.

The Beyond Places of Safety scheme will focus on:

  • preventing people from reaching crisis point in the first place
  • helping to develop new approaches to support people who experience a mental health crisis

Full story at Department of Health

Electronic Prescription Service saves NHS £130 million over three years

The transformative electronic prescription service (EPS) has managed to save the NHS £130 million over three years | NHS Digital

By allowing GP surgeries to send prescriptions directly to pharmacies, the EPS system, which has been developed by NHS Digital, has helped to save patients time and money when collecting their medications.

An audit of patients using the system found that 72 per cent said their medicines were ready and waiting for them when they arrived at their pharmacy, with the average prescription collection around 20 minutes quicker under the EPS system.

Over the past three years the system has saved patients almost £75 million and has meant patients need to make fewer return trips to pharmacies as a result of their medications being out of stock.

The time savings that EPS offers the average GP practice, allows staff to have more time to care for patients, particularly during the winter months when there is more demand for their services.

Additionally with more people falling ill over the winter period, EPS can help patients get their medication quickly and reduce the need for pharmacists to ring the GP about prescription queries.

The biggest savings were recorded by prescribers who saved around £327 million between 2013 and 2016, while dispensers saved nearly £60 million.

GP practices on average also saved an hour and 20 minutes each day by signing electronic repeat prescriptions compared to paper versions and an average of an hour and 13 minute a day by producing electronic repeat prescriptions compared to paper ones.

Other time savings for prescribers include:

  • Practices save an average of 43 minutes per day by not having to locate paper prescriptions within the practice.
  • Practices save an average of 31 minutes every day by not having to re-print lost paper prescriptions.
  • Practice staff save an average of 39 minutes every day by not having to wait for GPs to sign urgent paper prescriptions.
  • Practices save an average of 27 minutes every day by cancelling prescriptions electronically versus paper.

Full story at NHS Digital

Mental Health Service Models for Young People

In 2015, the government committed five years of extra funding for children and young people’s mental health services (CYPMHS). All areas of England were required to submit plans outlining how they will improve their services by 2020.

This POSTnote describes some of the new models of CYPMHS and examines the challenges to their effective implementation.

Overview

  • The Office for National Statistics estimates that nearly one in four Children and Young People (CYP) show some evidence of mental ill health.
  • It is estimated that between £70-100 billion is lost each year in the UK due to poor
    mental health.
  • New models of CYP mental health services are currently being developed across the
    country to suit the unique needs of local areas. They include whole-system, schoolsbased, community-based and other models, and involve integrating services from across the statutory and voluntary sectors.
  • Issues with implementing new service models include data monitoring, recruiting
    and retaining staff and funding.

Full document available here

NIHR Signal Early discharge ‘hospital-at-home’ gives similar outcomes to in-patient care

Gonçalves-Bradley DC, Iliffe S, Doll HA, et al. Early discharge hospital at home. Cochrane Database Syst Rev. 2017;6:CD000356.

Supported early discharge, where patients receive on-going hospital-level treatment in their own home, had no effect on mortality compared with standard in-patient care. Patients had shorter hospital stays, were more likely to be satisfied and less likely to end up in residential care.

This updated Cochrane review identified 32 international trials comparing early discharge hospital-at-home with hospital in-patient care. Most evidence related to people recovering from a stroke, where NICE already recommends supported discharge if this is appropriate. Other patient groups included those recovering from orthopaedic surgery and older people with various conditions. Trials were relatively small and the overall evidence quality was moderate to low.

The review aimed to see whether early discharge has an effect on NHS costs, but found insufficient evidence. Training, staffing and equipment costs need to be measured against patient outcomes in different therapy areas. Early supported discharge needs to be driven in areas where it can make the most difference and give the greatest benefit.

 

Effectiveness of UK provider financial incentives on quality of care: a systematic review

Rishi Mandavia, Nishchay Mehta, Anne Schilder and Elias Mossialos. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract 9 October 2017; bjgp17X693149. DOI: https://doi.org/10.3399/bjgp17X693149

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.

Aim To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.

Design and setting Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Method MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.

Results Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.

Conclusion The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.