Thursday, 24 December 2015

NHS End of Life Care Documentation Project for London

The London End of Life Care (EOLC) Clinical Network has initiated a project to facilitate the adoption of standard forms across care settings in the city.  Facilitating the smooth transfer of patients between services, supporting patients, their carers and service providers in the process. 

50,000 patients in London experience EOLC each year and currently a variety of processes and forms are used to communicate important decisions relating to their care. These forms are not used universally, and only some are valid when moving patients across care settings.

The development of a set of documents and associated processes to facilitate transfer of care, including records of discussions and decisions taken in relation to EOLC, will ensure the provision of high quality, compassionate, integrated end of life care:
  • Empowering patients to be involved in decision making around their care
  • Strengthening communication between care providers
  • Reducing unnecessary duplication and the number of times a patient or their carer is asked the same questions.
  • Reducing unscheduled hospital attendances

The EOLC working group is made up of representatives from:
  • CCGs
  • Coordinate My Care
  • Critical/intensive care
  • GPs
  • London Ambulance Service
  • Paediatrics
  • Palliative care in acute trusts, community settings, the private sector and hospices
  • Patients/members of the public
  • Social services
  • Urgent and emergency care
The network’s work is aligned with, and builds on, the work of the Resuscitation Council (UK).

Wednesday, 23 December 2015

DoH NHS Mandate Published - With Clear Targets for NHS England

The Department of Health has published its annual mandate for NHS England, this time including objectives up to 2020. 
The Department of Health has told NHS England that it expects to see at least 50% of the English population being served by the new GP care model by 2020. The model will see single organisations providing primary and secondary care:
  • Ensuring that all patients have access to weekend and evening routine GP appointments.
  • Delivering ‘a measurable reduction’ in emergency admissions and emergency in-patient bed days by 2020.
  • Significantly reducing age-standardised emergency admission rates and emergency inpatient bed-day rates.
  • Making significant, measurable progress in health and social care integration, urgent and emergency care (including ensuring a single point of contact), and electronic health record sharing.
These plans are in line with NHS England’s Five Year Forward View, published in 2014.  The document covers primary and secondary care, step-down services, home care, counselling, dentistry and community services. 

In addition they expect to see:
  • All GP patients in England being given access to weekend and evening routine appointments.
  • The publication of practice-level metrics.  On access to, and the quality of, GP services.
  • No patient left waiting for more than 28 days for cancer diagnosis.
  • An increase in the number of patients diagnosed with dementia within 6 weeks of their initial referral.
  • 5,000 extra doctors in general practice.
  • A reduction in childhood obesity.
  • A new range of ‘Ofsted-style’ CCG level indicators, which include clinical outcomes.
  • Development of the new voluntary contract for GPs (Multidisciplinary Community Provider contract) for implementation in 2017-18.
Prior to publication a public consultation was held, with an unprecedented response rate of 127,400 responses compared to just over 150 in the previous year.
  • The public was mainly concerned with:
  • The extent of private sector involvement in NHS services.
  • The practicalities of plans to offer 7-day services safely.
The Department of Health sought to reassure the public, reiterating that it plans to increase the primary and community care workforce by 10,000 by 2020, ‘including an additional 5,000 doctors working in general practice’.

Wednesday, 16 December 2015

The Kings Fund Takes a Comprehensive Look at In-Patient Experiences Over 8 Years

The King’s Fund and Picker Institute Europe analysed inpatient survey data for acute trusts over a nine-year period (from 2005 to 2013). Assessing attitudes towards:
  • access and waiting
  • safety
  • care
  • information and choice
  • relationships and communication
  • cleanliness and comfort
Key findings:
  • Whilst patient experience over the period reviewed has improved in some areas, that improvement has been modest.
  • Improvements have typically been driven by national initiatives and policies to tackle widespread or high-profile problems.
  • On average, patients are less satisfied now with some aspects of care (such as length of wait from admission to hospital, to a bed on a ward, and timely discharge from hospital) than they were in 2005. These areas happen to be those where there are well-recognised pressures in the wider health and care system. 
  • There are still some aspects of patient care where performance is generally low and needs to improve, for example, noise levels at night and timely discharge.
  • Areas of care that patients were generally less satisfied with were also those that showed erratic annual changes and exhibited wider variations in performance between trusts.
  • Patients’ ratings relating to interactions with staff were generally more positive than for other aspects of care.
  • There are significant differences within and between trusts in how they approach patient experience work and how they use the data.  In general, specialist trusts performed well, whilst London trusts had some of the lowest scores.
Prof Sir Mike Richards, Chief Inspector of Hospitals, said: "We welcome the publication of the Kings Fund’s analysis of a decade’s worth of inpatient survey results."

"It is encouraging that patients are reporting improved care experiences in areas such as mixed sex accommodation and in cleanliness. While the results indicate that people’s experiences have been largely positive, overall there has not been much change over the last ten years and there have even been some areas of deterioration, such as with patient flow."

"We are clear that patient feedback should be a key driver for quality improvement in the NHS."
"How providers consider and act on patient feedback, including complaints and survey findings, is a core element of our inspections. Where a provider does not have systems in place to do this effectively, this would make us question the quality of its leadership and how ‘caring’ and ‘responsive’ its care can be."

"We encourage NHS trusts to reflect on their findings to understand what their patients really think about the care and treatment they provide, so that they can identify what is working well and what should change."

Will Room Be A Runaway Success At the Box Office?

With trailers for the film adaptation of Emma Donogue's bestselling book, Room, now running at your local multiplex, the buzz around this book and the forthcoming film is hotting up.

The book was short listed for the Booker prize in 2010 and tells the story of a young girl and her son, held captive in a garden shed for the whole of his life and much of hers.  At first you learn about the world she has created for her son in that one room, helping him to feel safe and secure in.  Then, when an opportunity arises for escape, you are taken on a journey of discovery.  The young boy has to come to terms with a world much bigger than the room he grew up in, all the terrible things that happened within the room and continue to happen outside its walls. His mother has to fight to keep him safe and secure as she herself adjusts to the outside world.

In the book the narrator is the 5 year old boy and translating his naïve sense of fear and wonder at the wider world to the big screen was seen as a major challenge, but the critics think they have pulled it off, creating a breath-taking, sometimes harrowing film that is ultimately uplifting.

As well as writing the book, Emma Donogue also wrote the screen play, the film was directed by Lenny Abrahamson under the StudioCanal banner.

The film has been a critical success, with the writer, actors and director all being tipped for success during the forthcoming awards season.

The film will be released in the UK on 15th January so expect to hear lots more about both the movie and book over the coming weeks.  

Tuesday, 15 December 2015

Independent Birmingham Hospital Placed into Special Measures by CQC

The Chief Inspector of Hospitals has placed Harriet Tubman Hospital, based in Handsworth Wood in Birmingham, into special measures following a CQC inspection.  All new admissions have been suspended.
The mental health rehabilitation unit, offering services to women with enduring mental illness, including patients who may be detained under the Mental Health Act, was deemed Inadequate by a team of CQC inspectors for safety, levels of care, effectiveness, responsiveness and leadership.
At the time of the inspection it was noted that:
·         4 out of 8 registered nurse posts were vacant, and being covered by agency staff.  Temporary staff did not receive a comprehensive induction to ensure they knew how to keep patients safe.
·         There was no evidence of discharge planning in any of the patients’ care. One patient had lived there for 15 years. Psychological therapies were not offered to patients to promote their recovery.
·         Training was not given in the use of restraint, and organisational guidance was not followed.
·         Patients who were not detained under the Mental Health Act were not free to leave when they wanted. The staff failed to recognise that these patients were being deprived of their liberty with no legal safeguards.
Areas for improvement highlighted in their report include:
·         Ensuring that the environment is kept safe for staff and patients at all times and promotes respect and dignity and the independence of patients.
·         Ensuring that staff receive appropriate training and supervision to ensure that there is always a sufficient number of skilled and experienced staff on duty.
·         Developing care plans that support and meet patient needs.
·         Staff must receive training in breakaway and de-escalation.
Deputy Chief Inspector of Hospitals (and lead for mental health), Dr Paul Lelliott, said:
"Although Harriet Tubman House is supposed to provide a rehabilitation service, we found that this hospital was failing to protect its patients from the risk of harm.
"Managers were not aware of the regulations they needed to meet to ensure the safety of their patients or to reduce the risks. Staff did not analyse incidents so they could learn from them. Care plans and risk assessments did not show staff how to support patients.
"The hospital environment did not promote patients’ recovery and some staff did not engage with patients in a way which would promote their wellbeing.
"At the time of our inspection we made sure that the provider Options for Care took action to address our immediate concerns. We have placed the hospital into special measures and we now expect Options for Care to meet all the legal requirements which are there to protect people in its care.
“We will return to inspect again within six months, and if we find that there has not been sufficient progress, we will take further action on behalf of the patients."

Friday, 11 December 2015

CQC Working with NSPCC to Encourage Young Carers to Share Their Experiences

The CQC has launched a six-month partnership with the NSPCC and its free, 24-hour counselling service, ChildLine, as part of its commitment and efforts to listen to and act on people's experiences of care, including young carers and patients, who can be hard to reach.

This latest 'tell us about your care' partnership is one of seven projects the CQC currently run in partnership with national organisations that are in a unique position to reach, and be reached, by people who may choose to discuss concerns about the way they are receiving health and adult social care or to identify examples of best practice.
The NSPCC will gather and submit regular feedback to the CQC.  This information will act as vital intelligence to help inform where, when and what the CQC inspect.
Chris Day, Director of Engagement at the Care Quality Commission, said:
"It is great to have ChildLine and the NSPCC working with us. Children and young people have a great deal of experience using care services and have opinions of how they have been cared for by in their general practices, dental surgeries, hospitals and other services, which need to be listened to and acted upon. NSPCC and ChildLine can assist us to reach out to young people who may have information that can help us take action against poor care and celebrate great services.
"Through our 'tell us about your care' partnerships, anyone can share their views and concerns about services. We use this information so we can make sure people get safe, effective, compassionate and high-quality health and adult social care they deserve and that we expect."

Thursday, 10 December 2015

The Guardian’s ‘Best Books of 2015’ Long List Now Available

The Guardian’s annual book review has now been published.  With over 60 books included in the reviewers list, there really is something for everyone.  This year’s reviewers included Hilary Mantel, Margaret Atwood, Anthony Horowitz, Lauren Child and Mark Lawson and now the Guardian wants to know what you think, with the readers nominations for their Book of 2015 now being accepted.
Whether you already have an opinion, are choosing a gift for a friend, or are looking for your next read, this list is worthy of a look.
Books that made the reviewers list include:
A Brief History of Seven Killings by Marlon James
Spanning three decades and crossing continents, A Brief History of Seven Killings chronicles the lives of a host of unforgettable characters – slum kids, drug lords, journalists, prostitutes, gunmen and even the CIA. 
Get It Together by Zoe Williams
Zoe Williams brings together all the arguments that occupy the current political landscape and argues that on all levels, it’s lunacy to be anything other than left-wing unless you’re actually already an oligarch. She offers us the debate in a truly entertaining way - she’s pacey, conversational and funny.
Grief is the Thing with Feathers by Max Porter
In a London flat, two young boys face the unbearable sadness of their mother's sudden death. Their father, a Ted Hughes scholar and scruffy romantic, imagines a future of well-meaning visitors and emptiness.  In this moment of despair they are visited by a crow - antagonist, trickster, healer, babysitter. This sentimental bird is drawn to the grieving family and threatens to stay until they no longer need him.
Invisible by Philip Ball
This is a history of humanity's turbulent relationship with the invisible. It takes on the myths and morals of Plato, the occult obsessions of the Middle Ages, the trickeries and illusions of stage magic, the auras and ethers of Victorian physics, military strategies to camouflage armies and ships and the discovery of invisibly small worlds.
Jihad Academy by Nicolas Hénin
Framed by Hénin s personal experience as a hostage of ISIS alongside James Foley, Jihad Academy debunks the myths surrounding Islamic extremism and provides a clear and revealing insight into the sect’s strange and distorted world. 
Margaret Thatcher: Everything She Wants by Charles Moore
The second volume of Charles Moore's bestselling authorized biography of the Iron Lady.
My Brilliant Friend by Elena Ferrante
Through the lives of two women, Ferrante tells the story of an Italian neighbourhood, a city and a country as it is transformed in ways that, in turn, also transform the relationship between her two protagonists.
Neurotribes by Steve Silberman
A sprawling and fascinating dissection of the role autism has played in shaping human history.
One of Us by Åsne Seierstad
On 22 July 2011 Anders Behring Breivik killed 77 of his fellow Norwegians in a terrorist atrocity that shocked the world. In the devastating aftermath, the inevitable questions began. How could this happen? Why did it happen? And who was Anders Breivik?
Our Souls at Night by Kent Haruf
An exquisitely written story of aging, loneliness, empathy and the cruelties inflicted by those who should have our best interests at heart.
Sentenced to Life by Clive James
In his new collection of poems Clive James looks back over an extraordinarily rich life with a clear-eyed and unflinching honesty.
The Blue Touch Paper by David Hare
David Hare describes his childhood, his Anglo-Catholic education and his painful apprenticeship to the trade of dramatist. He sets the progress of his own life against the history of a time in which faith in hierarchy, deference, religion, the empire and finally politics all withered away. Only belief in private virtue remains.
The Bone Clocks by David Mitchell
Run away with Holly Sykes: wayward teenager, broken-hearted rebel and unwitting pawn in a titanic, hidden conflict.
The Festival of Insignificance by Milan Kundera
This novella follows four characters and their struggles in life. Sometimes funny, often thought provoking.
The Healing Station by Michael McCarthy
A wonderfully sensitive and insightful small book of poetry from someone who sees many deeper questions behind even the most bleak of human situations.
The Heart Goes Last by Margaret Atwood
A sinister, wickedly funny novel about a near-future in which the lawful are locked up and the lawless roam free.
The Illuminations by Andrew O'Hagan
How much do we keep from the people we love? Why is the truth so often buried in secrets? Can we learn from the past or must we forget it? Standing one evening at the window of her house by the sea, Anne Quirk sees a rabbit disappearing in the snow. Nobody remembers her now, but this elderly woman was in her youth a pioneer of British documentary photography. When her grandson Luke returns home to Scotland Anne's secret story begins to emerge, along with his, and they set out for an old guest house in Blackpool where she once kept a room.
The Little Red Chairs by Edna O'Brien
When a wanted war criminal from the Balkans, masquerading as a faith healer, settles in a small west coast Irish village, the community are in thrall. One woman falls under his spell and in this astonishing novel, Edna O'Brien charts the consequences of that fatal attraction.
The New Wild by Fred Pearce
In The New Wild, Fred Pearce goes on a journey to rediscover what conservation should really be about
The Visitors by Simon Sylvester
A tale of blossoming love, myth and dark mystery on a remote Scottish island.

To view the full list and find out how to nominate your book of 2015 visit

Tuesday, 8 December 2015

Hundreds of schools to benefit from £3 million investment in mental health

NHS England and the Department of Education have joined forces to launch a £3 million pound joint mental health pilot scheme for schools. 

The Mental Health Services and Schools Link Pilot is part of the vision set out in the Future in Mind report, which made a number of proposals on how mental health services for children and young people could be improved.  It will see the provision of single named points of contact for mental health service support in 255 schools, across 22 pilot areas.  Promoting more joined up working between schools and health services and providing better access to local, specialist mental health services for young people.

27 Clinical Commissioning Groups will be involved in the trial, chosen from more than 80 applications to receive a boost of up to £85,000 per area.

The single point of contact in the schools will be responsible for developing closer relationships with a counterpart in local NHS CAMHS services to improve knowledge and understanding of mental health issues, and to help ensure any referrals are timely and appropriate.

The pilot will be supported from the centre and evaluated nationally to understand its impact.
Dr Jackie Cornish, National Clinical Director for Children and Young People at NHS England, said: “This is an opportunity for CCGs and schools to work together more closely, trial a new way of thinking and a new model. Our aim is to significantly improve the care and experience we can offer to children and young people with mental health problems.

“We know that if we can help young people effectively at the earliest possible age we can gain the best possible outcome for them in the long run and that is why we are focusing our attention to improve joint working with schools.”

Education Secretary, Nicky Morgan, said: “Mental health is a key priority for this government and for me personally.  The development of character, resilience and good mental health is vital alongside academic success in equipping young people with the skills needed to fulfil their potential.
“That’s why I’m delighted to see these schools engaging in joined up approaches with mental health services  to ensure that children, parents and teachers know where to turn and how to access the best support for young people with mental health concerns.”

Minister for Mental Health, Alistair Burt said: “When a young person is brave enough to ask for help from their school or doctor, we should never let them fall through the gap because services aren’t in touch with each other. That is why this initiative is so important.

“Children and young people’s mental health is one of my personal priorities and these pilots are part of the biggest transformation to young people’s mental health that the sector has seen.”

The lead CCGs which received funding are: East and North Hertfordshire, South Cheshire, Bedfordshire, Salford, East Riding of Yorkshire, Tameside and Glossop, Walsall, Halton, Birmingham, Camden, West Hampshire, Brighton and Hove, Sunderland, Gloucestershire, Somerset, Hammersmith and Fulham, Waltham Forest, Tower Hamlets, Chiltern, Wigan, Haringey, Sheffield.

Friday, 27 November 2015

NICE Guidance Calls for Better Integration of Social and Medical Care for Older People

A more person-centred approach to the provision of care for older people with complex social and medical needs has been called for by NICE.
The number of people with long-term conditions, such as dementia, diabetes, heart disease, and cancer, is set to rise by around 1 million in the next 3-5 years (in line with a rise in the number of older people in the population) and pressure on existing services is set to grow.
There has been much debate within the NHS, social care and the wider public, over how best to serve both the social and medical needs of this group and now NICE has joined the debate, publishing new guidance on the management of older people with multiple chronic condition and social care needs.
The guidance is aimed at social care providers as well as health practitioners, managers and commissioners and aims to improve quality of life, increase independence, choice, dignity and control, through a more person-centred approach
Key recommendations include:
·         Ensuring that each patient is treated as whole, rather than on a symptom by symptom basis, and that they are treated with dignity and respect at all times.
·         Having a single, named care coordinator for each patient, who acts as their first point of contact.  Leading the assessment process, liaising and working with all health and social care services (public, private and voluntary services).  Ensuring referrals are made and actioned appropriately.
·         Ensuring that care plans are updated regularly, to recognise the changing needs of the patient, recognising the progressive nature of many conditions.
·         Ensuring that patients are given choice and control over decisions made about their care.
·         Bringing together specialist teams to review and manage care, including community pharmacists, physiotherapists or occupational therapists,  mental health social workers or psychiatrists, and  community-based services liaison workers as appropriate.
Bernard Walker, Independent Consultant in social care, health and management, and Chair of the guideline development group, said: “When social care and health practitioners work together well, it helps both people using services and their carers to have choice and control over their care. It also avoids unnecessary duplication of services.
“As a committee, which brought together a knowledgeable group of experts including practitioners, carers and people who use services, we recognised how critically important this issue is. Better integration of health and social care services is best practice to which everyone involved in the care of older people with complex care needs and multiple long-term conditions should aspire.” 
Professor Gillian Leng, Deputy Chief Executive for NICE, added: “An estimated 6 million people in England aged 60 and over are living with more than one long-term health condition.

“As the number of older people in society increases, this figure is expected to rise too. A recent report by Age UK warned that a further one million older people in England could be living with multiple long-term conditions by 2020. This will inevitably put pressure on health and social care services and our new guideline highlights ways to best address the growing needs of this group.”

Thursday, 26 November 2015

Evidence Suggests Patients Are Not Interested in Weekend Opening for GP Practices

7 day opening for the NHS is a key aim for the UK government, and it is not restrict to secondary care.  The government wants to see GP practices open 7 days a week to meet demand and provide a more flexible service.  
In October 2013 the Prime Minister’s Challenge Fund was established to help improve access to general practice and increase innovation in primary care.  Results from the first 20 pilot schemes, released this autumn, suggested that whilst non-urgent appointments on a Saturday were welcomed by some parts of the community, Sunday opening was not supported by the general public.
The British Journal of General Practice has now published a paper echoing this finding. 
John Ford and colleagues, from the Universities of East Anglia and Oxford, sought the views of over 880,000 patients from across England, through the GP patient survey in 2014.  80% of those who completed the survey did not report any problems with current opening times.  Of the 20% who would like to see changes, approximately three-quarters said that Saturday opening would make it easier for them to see someone, but only 36% (6% of the total sample) thought the same about Sunday opening. 

Younger people, those who work full-time, and those who could not get time off work were more likely to report that weekend opening would help.  Those with complex needs such as those with Alzheimer's disease, learning difficulties or significant mobility issues did not report week day only opening as an issue.

Wednesday, 18 November 2015

Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust under Investigation

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust is under investigation by the health sector regulator, Monitor, following a deterioration in its financial position.  

The Trust is responsible for services in Bournemouth, Christchurch, East Dorset and part of the New Forest, and looks after over half a million people.  It has forecast a deficit of over £10 million for the current financial year.
Monitor will be reviewing financial management at the Trust, examining the reasons for the deterioration in its financial position and considering what can be done to improve the situation.
Paul Streat, Regional Director at Monitor, said:
“Patients rely on the services provided by Royal Bournemouth and Christchurch and we want to make sure the trust gets to grips with its finances as quickly as possible.
“We will examine what has caused the deterioration and find out what needs to be done to improve things.
“No decision has been taken on whether further regulatory action is needed, but Monitor will announce the outcome of its investigation in due course.”
Monitor has also voiced concerns about A&E waiting times at the Trust, and managers have already been tasked with taking the necessary steps to improve its A&E performance.

Tuesday, 17 November 2015

Delayed Transfers of Care: Flexible National Frameworks Required

Delayed transfers are recognised as one of the main pressures on today’s NHS; reducing its ability to meet targets and patient expectations. Some patients are kept in hospital settings long after it is appropriate, distressing many patients and carers, and reducing capacity for new patients coming into the system. 

After a significant period of stagnation in delayed transfer days, the total number of days discharges were delayed by in 2014/15, increased by 15% on the previous year, to over 210,000.  In the first 5 months of 2015/16 this rise continued, with a further 11% increase.  In response to members concerns, NHS Providers set up a commission to look into the causes of delayed discharge and route out best practice. 
Over 4 months the commission, chaired by Paul Burstow, captured evidence from across transfer of care settings, and the final report draws on good practice in health, local government, social care and housing settings.
The report does not attribute the problem of delayed discharge to any one issue or party, or find a single ‘one size fits all’ solution.  It highlights a range of complex challenges within the patient journey that can result in delayed discharge, with issues around workforce capacity, skills mix, and the flow within and between organisations all identified. 
The report recognises that only by bringing all sectors together, from health to social care and housing, can this issue be resolved.  The report goes on to demonstrate how national frameworks, systems and processes can, unintentionally, undermine local progress, and calls for the introduction of flexible frameworks, that support both best practice and local differences.
The commission recommends that Trusts consider adopting process engineering and data analytics as valuable tools to help surface out the root causes of problems with transfers of care, and the sharing of data across sectors to support this work.
The report concluded that:
 “Simply adding initiatives to already complex pathways is likely to exacerbate problems of flow. In contrast, by making the process leaner, understanding it end to end, designing change in partnership with the frontline, and making sure the patient’s perspective is held at the centre of everyone’s practice we can reduce length of stay, speed up the process of discharge, ensure adequate ongoing support and most important, improve patient care and health outcomes.”

Commission chair and report author, Rt Hon Paul Burstow, said "Local collaboration is key to improving transfers of care. It is also vital that patients, carers and service users are at the centre of developing personalised care that works for them."

Thursday, 12 November 2015

Prime Minister’s Challenge Fund to Improve Access to Primary Care Gets Off to a Strong Start.

The £50 million Prime Minister’s Challenge Fund was established in October 2013 to help improve access to general practice and increase innovation in primary care.   Twenty pilot schemes started work in April 2014, and the first independent evaluation of their work has now been published.
Key Findings

·         The pilots have given over 7 million patients access to a new or enhanced primary care services.

·         During the week, outside core working hours, 4.9 million patients have had access to a new or enhanced GP appointment service, with approx. 400,000 appointments provided. 

·         Access to core hour appointments has also increased, with approx. 520,000 additional appointments made available within core hours across the pilot schemes.

·         At weekends 5.4 million patients have had access to new or enhanced GP appointment services.

·         As of May 2015, there had been a 15% reduction in minor self presentation at A&E in pilot scheme areas, compared with the same period in the previous year; representing 29,000 attendances.

·         It was noted that the take up of Sunday booked appointments was low, and it was suggested that these might best be reserved for urgent care.

·         Pilots that built on joint working with ANPs, pharmacists, the voluntary sector, care homes, physiotherapists and paramedics released local GP capacity and more appropriately matched the needs of patients with practitioners.

·         Based on the evidence from the pilots the report recommends that 41-51 total extended hours per week are required per 100,000 registered population in order to meet the levels of demand experienced, of which 30-37 hours should be GP hours.  

Notes of Caution

·         The report stresses the need to tailor solutions to local demand and demography, in order to provide relevant services and value for money service for patients.

·         The achievements that pilots have made have not been without challenges. Many of these challenges have been process related and have caused mobilisation delays and had cost implications. IT interoperability, information governance, securing indemnity insurance and CQC registration are the most commonly cited process barriers. Acknowledging these issues, NHS England has established support for wave two pilots to ease and expedite mobilisation of their programmes and minimise duplication of effort in resolving common problems.

·         Wave one pilots did experience some capacity issues, which often manifested as difficulties in recruiting or competing with OOH providers for GP time. There also remains some concerns around the availability of ANPs in particular, which are likely to be exacerbated as more local health economies press ahead with seven day services and introduce skills mix.

Further funding of £100m for a second wave of schemes was announced in September last year.  Thirty-seven schemes have been selected for 2015/16 involving over 1400 practices and 10.6m patients.

Wednesday, 11 November 2015

CQC Survey Reports ‘No notable improvement’ in people’s experiences of out-of-hospital mental health care

The annual CQC patient experience survey into people’s experience of using community mental health services has been published.  It shows no overall improvement in people’s experience of mental health services over the last year, and in some cases a reduction in the quality of service.
The regulator is now calling for NHS trusts to reflect on their findings and improve their care.

Over 13,000 patients in England were surveyed, with conditions ranging from mild depression to psychosis. The survey did not cover the care people had received for their general practice. The survey asks for views on aspects of their care, such as whether they felt they were treated with dignity and respect and on whether they felt involved in decisions about their care.

Key Findings
·         The number of people who rated their experience as poor increased by 3% (28% compared to 25% last year).
·         A slightly higher proportion of people felt they were not feel listened to by staff (7%, up from 5% in 2014).
·         11% of people felt they were not given enough time to discuss their needs and treatments (up from 9% in 2014).
·         7% felt they were not treated with dignity and respect (up from 6% in 2014).
·         70% reported that they ‘definitely’ felt listened to by the person or people they saw (down from 73% in 2014).
·         73% reported that they were ‘always’ treated with respect and dignity (down from 75% in 2014).

The survey also shows some variation in performance between NHS trusts, with a small group performing poorly across many of the questions. Those that scored ‘worse than expected’ for 10% or more of all of the questions are:
·         Coventry and Warwickshire Partnership NHS Trust (inspected by CQC in January 2014 – not rated)
·         Leicestershire Partnership NHS Trust (inspected by CQC in March 2015 and rated Requires Improvement)
·         Lincolnshire Partnership NHS Foundation Trust (to be inspected by CQC in November 2015)
·         North Essex Partnership University NHS Foundation Trust (inspected by CQC in August 2015 – awaiting rating)
·         The Isle of Wight NHS Trust (inspected by CQC in June 2014 and rated Requires Improvement)

Those that scored ‘better than expected’ for 10% or more of all of the questions are:
·         Bradford District Care NHS Foundation Trust (inspected by CQC in June 2014 and rated Good)
·         Cheshire and Wirral Partnership NHS Foundation Trust (inspected in June 2015 – awaiting rating)
·         Mersey Care NHS Trust  (inspected by CQC in June 2015 and rated Good)
·         NAVIGO Health and Social Care CIC (to be inspected by CQC in January 2016)
·         Tees, Esk and Wear Valleys NHS Foundation Trust  (inspected by CQC in January 2015 and rated Good)

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (lead for mental health) said: “Overall it is disappointing that there has been no notable improvement from last year’s survey. In particular, the fact that over a quarter of people reported a poor experience of their care is worrying and must be acted on.

“Community mental health services play a vital role in supporting people with their mental health problems without needing to stay in hospital.  It is imperative that the NHS gets this right.

“We urge all NHS trusts and in particular those that have performed poorly to reflect on what the survey tells them about what their patients think of their services act on the findings.

“We will consider the results of this survey in our inspections so that we can be confident that people receive the safe, high-quality and compassionate care they deserve.”

Tuesday, 10 November 2015

Lesbian Bond Girl – Just Needed ‘The Right Man’

Dr Gibson, a dedicated fan of 007 was in regular correspondence with the writer of the novels and in June of 1959 wrote to Ian Fleming complaining that he had changed Pussy Galore from “a criminal Lesbian into a clinging honey-bun (to be bottled by Bond) in the last chapter”.

Pussy Galore, an agent of Goldfinger, in Ian Fleming's 1959 007 novel, is a thoroughly modern, independent woman, equal, or superior, to most of the men around her.  She is the only woman in the USA known to be running an organised crime gang and is 'immune' to James Bond’s charms.  Bond describes her has as having black hair, pale skin, and the only violet eyes that he has ever seen. She is in her thirties, her voice is low and attractive and he is under her spell.

In the novel she tells Bond that she became a lesbian after she was sexually abused by her uncle at the age of 12.  But by the end of the novel Bond has helped Pussy Galore find her inner domestic goddess, as she turns her back on the world of crime and falls in love with a man.  Bond looks deep into her eyes and says, ‘They told me you only liked women’. He then promises her “a course of TLC”, before she looks up at his “passionate, rather cruel mouth” and it comes “ruthlessly down on hers”.

In response Dr Gibson’s letter, James Bond’s writer, Ian Fleming, wrote that Pussy Galore, Goldfinger’s lesbian love interest, only needed ‘the right man to come along and cure her psycho-pathological malady”.

The letter from Ian Fleming to Dr Gibson will be auctioned on the 11th November, by Bonhams for an estimated price of between £3,000 and £4,000.