NHS pressures – future trends

British Medical Association

BMA warns that unless urgent action is taken, millions more patients will be waiting for longer than 4-hours for treatment in A&E, and there will be dramatic rises in number of people waiting on trolleys for treatment, or at home for non-emergency elective procedures.

NIHR Signal Multiple illnesses and end-of-life care drive high healthcare costs in old age

Hazra N C, Rudisill C, Gulliford M C. Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death? Eur J Health Econ. 2017. [Epub ahead of print].

Ageing on its own does not drive healthcare costs. Instead, this research found that the increasing number of health conditions and age-related impairments along with the proximity to death are more strongly linked to healthcare costs than age alone.

This UK study investigated healthcare costs in people over 80 years old. Costs increased to the mid-90s before declining again. Proximity to death was the strongest predictor of cost, which was higher for people aged 80-84: £10,027 per year versus £7,021 per year for those over 100. Multiple illnesses also had a strong influence, with each additional health complaint progressively increasing costs.

This suggests that to provide person-centred and efficient healthcare services for all, planning should take account of the number and types of conditions rather than age alone.

Reducing delayed transfers of care over winter

NHS Improvement has written to the chief executives of all trusts providing community services setting out actions they must implement to reduce delayed transfers of care over winter. | NHS Improvement | HSJ

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NHS Improvement  chief executive Jim Mackey has said trusts must help improve delayed discharges over winter and listed six actions they need to carry out in the next six months:

  1. Facilitate the sharing of patient data with acute and social care partners and from 7 November ensure daily situation reports are completed “to enable better understanding of community services at a national level”.
  2. Jointly assess discharge pathways with local partners including “being an active participant in the local acute provider’s discharge and hosting operational discussions daily where necessary to discharge patients in community settings”.
  3. Develop “discharges hubs” over the next six months and beyond, designed to be a single point of access for patients moving between acute and community services.
  4. Ensure a “robust patient choice policy” is implemented.
  5. Clarify to partner organisations what services the trust offers to patients.
  6. Ensure collection of patient flow data and data on plans to improve patient flow.

Full detail is given by NHS Improvement who have produced the following  report to help improve flow into and out of community health services:

Flow in providers of community health services: good practice guidance

Related HSJ article: Trust chiefs given new instructions to tackle winter DTOCs

Improving the care of people living with dementia admitted to hospitals

This review seeks to identify primary research and use its findings to develop explanations of what characteristics of dementia-friendly initiatives in hospitals make them work, in what circumstances, and why | BMJ 

Abstract

Objectives To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.

Design A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.

Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.

Eligibility criteria Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.

Results Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.

Conclusions This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.

Full reference: Handley M, Bunn F, Goodman C. | Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review | BMJ Open 2017; 7:e015257

See also: Dementia care in hospital: training, leadership and culture change needed | The Mental Elf

Improving healthcare access for people with learning disabilities

Guidance for social care staff on how to help people with learning disabilities get better access to medical services to improve their health | Public Health England

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The health charter for social care and accompanying guidance provide information about the steps organisations and providers can take to improve the health and wellbeing of the people they support. There are practical tips as well as links to further information and useful resources.

There is also a self-assessment tool to enable organisations signed up to the health charter to measure progress and develop an action plan for improvements.

The series of short information sheets show social care staff how they can help people with learning disabilities to get better access to health services.

The documents can be accessed via Public Health England

‘Data revolution’ crucial to transformation

A ‘data revolution’ across health and care services in England is vital if local areas are to transform the way care is delivered | NHS Confederation

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The NHS Confederation has launched a new series of guides to help board members to better understand data across the healthcare system and its role in transforming care.

Produced in association with healthcare intelligence provider CHKS, the guides for non-executive directors (NEDs) aim to kick start a ‘data revolution’ by looking at how data can be used to drive improvement, provide effective oversight and support the transformation of care. The first guide is aimed at NEDs in acute care, and examines activity in both primary and secondary care settings and considers the role of data sharing in bringing about efficiency savings.

Full document: The non-executive director’s guide to NHS data. Part one: Hospital activity, data sets and performance