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.


Total transformation of care and support

The Social Care Institute for Excellence has published Creating the five year forward view for social care: how transformed and integrated health and care could improve outcomes and cost-effectiveness.

This updated paper explores the potential for scaling up the most promising examples of care, support and community health services, initially using data from Birmingham City Council, modelling their outcomes and costs.  Originally published in November 2016, it has been updated to include additional models.

The report contains the following chapters:

Vision for transformed care: Re-shaping services around the needs and strengths of individuals, families and communities.

Key messages and summary: Outcomes can be improved, and costs reduced, if the sector scales up promising practice.

Case studies: Six models of care and their potential impact on costs and outcomes.

Models of care: Overview of promising practice that support transformative change in health and social care.

Conclusions and next steps

The paper is available to download here

Transforming community care with digital technologies

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service explains how mobile solutions are transforming the work of community-based health teams | NHE


As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government.

The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service.

As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted:

  • A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used
  • Sufficient battery life to get through an entire working day
  • A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology
  • Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input

Read the full article here

Cost-effectiveness of Collaborative Care for Adolescents With Depression in Primary Care

Wright, D.R. et al. (2016) JAMA Pediatrics. 170(11) pp. 1048-1054


Question:  The Reaching Out to Adolescents in Distress (ROAD) collaborative care model has been found to be effective in treating adolescent major depressive disorder, but is it cost-effective?

Findings:  A randomized clinical trial conducted at 9 primary care clinics in Washington State suggests that collaborative care results in an increase of 0.04 quality-adjusted life-year over usual care at $883 above usual care, for a mean incremental cost-effectiveness ratio of $18 239 per quality-adjusted life-year gained.

Meaning:  Even by the most conservative standards, the ROAD collaborative care model is a cost-effective approach for treating adolescent depression.

Read the abstract here

Community triage for lower limb vascular concerns: reducing the burden on hospitals

NICE Quality and Productivity case study. Published online: October 2016

Image source: NICE
The Salford lower limb vascular assessment and triage service provides assessments, diagnosis and clinical management plans for patients with suspected non-acute peripheral arterial disease. Clinics are run 5 days a week with weekly evening clinics and monthly Saturday slots. Referrals are made by GPs using an e-referral system, and may also come from general podiatry, diabetes specialist nurses, district nurses, physiotherapy and the tissue viability service.

The service operates out of 3 gateway community centres, providing care closer to home. This is an improvement because previously patients were referred to the hospital vascular surgery team, but 80% did not need surgery and were subsequently referred to community exercise schemes. GPs now refer patients with symptoms of severe limb ischaemia straight to hospital, rather than to the community triage service. Those patients are seen quicker because the hospital appointments are freed up for serious cases.

The service is podiatry-led, working with patients to address their individual cardiovascular and limb risks and develops and agrees individual treatment plans. These may include referral to a community exercise and support scheme run by the local cardiac rehabilitation team, or the vascular surgery team at Central Manchester Foundation Trust hospital if appropriate.

Read the overview here

Read the full document here


Understanding quality in district nursing services

Understanding quality in district nursing services. Learning from patients, carers and staff. | Kings Fund

District nursing services play an important role in helping people to maintain their independence by supporting them to manage long-term conditions and treating acute illnesses – and demand for such services is increasing. These services will be key to the success of policies that aim to provide more care closer to home.

This report from The Kings Fund  investigates what ‘good’ district nursing care looks like from the perspective of people receiving this care, unpaid carers and district nursing staff and puts forward a framework for understanding the components involved. It also looks at the growing demand–capacity gap in district nursing and the worrying impact that this is having on services, the workforce and the quality and safety of patient care. The report makes recommendations to policy-makers, regulators, commissioners and provider organisations as to how to start to address these pressures.

How GPs in London are reducing hospital referrals

Thomas, K. The Guardian. Published online: 9 August 2016

New software enables GPs to confer with local hospital consultants to get advice on whether to refer a patient or not


Charlotte Levitt, a GP based in south London, faced a dilemma. One of her patients was taking a drug that had just come onto the market and his kidney function had started deteriorating. Should she refer the patient to a consultant, or take him off the drug?

Whereas many GPs might automatically make a referral, Levitt, referral management lead at Wandsworth clinical commissioning group (CCG), was able to resolve the question quickly. She logged on to Kinesis, web-based software from Cloud2 that enables GPs to confer with local hospital consultants. In this case, the consultant advised further blood tests: if they were abnormal, the patient should be referred. If not, the drug was likely to be the problem.

Last year, there were 13.6m GP referrals in England, a 5% rise on the previous year, representing an increasing cost burden on CCGs. A 2009 report from the NHS Institute for Innovation and Improvement found that up to 65% of patients referred to outpatient specialty clinics were discharged with “no significant pathology detected”, meaning many were unnecessary.

Read the full news article here