Tuesday, 25 August 2015

£150K to provide online GP consultations?

Pulse Today reported yesterday that a private health insurer is claiming that GPs could earn up to £150,000 per year working from home, by delivering an online consultation service.

Vitality – formerly PruHealth – is seeking 10 UK-based GPs to staff the online GP service offered to all of its health insurance customers.

The GPs would have to undertake 20 hours of training, within a fortnight, after which the health insurer is promising pay GPs £60 per hour.

Other insurance firms are also offering an online consultation service that is provided by private GPs, although they have been criticised as ‘Martini medicine’ by GP leaders.

GPs will provide 15-minute GP consultations via webcam and authorise electronic private prescriptions.

Following the completion of the desired training course, which includes online modules as well as a face-to-face IT system training session, GPs can book in for ‘flexible’ shifts during Monday to Friday 8am-7pm and 9am to 1pm on Saturdays when the service is available.
The news comes as Pulse reported last month on a new online service offering patients 10-minute online GP consultations via video link for £25 per session. The new service – called Push Doctor – has a network of more than 7,000 GPs who are available from 6am to 10pm for appointments, and works via a downloadable app.

Review to look at the care of new born babies that need extra support

A review of the care of new born babies that need additional support is being carried out to look at how infants with deteriorating health are cared for by hospitals and by community services.

Neonatal services are provided for new born babies who need extra care, for example, because they are born prematurely or need treatment in hospital after birth.

This thematic review of about 20 services in England will look at how well staff in fetal medicine, obstetrics, neonatal and community services work together to care for new born babies with declining health problems; particularly those with hypertension (high blood pressure) and tracheostomies.
The CQC are going to use this review to look at variation in the care management and how one service hands over to another service so the care is continuous.

The review – which starts in September 2015 – will also report on how well the services work together to identify and follow up on any complications during pregnancy.

Commenting on the review, Professor Edward Baker, Deputy Chief Inspector of Hospitals at the Care Quality Commission, said: “Our review aims to look at how services are managing new born infants with severe health complications, and how each of the respective services involved in the care work together.

“Everyone has the right to care which is safe and effective, but we know from our inspections of maternity services there is a marked difference in the quality of the care provided. We want to highlight good practice so that it can be shared, but also to identify what is stopping hospitals from providing good or outstanding care.

“While this review will not give us a national picture of the quality of care, we hope that it will lead to the development of clinical guidelines where required, so there is consistency in care across England.”

Advisory group

The regulator will work closely with an expert advisory group made up of members from professional bodies to look at variability and gaps in the quality and safety of care found in the areas in the focus of the inspection, as well as identifying any barriers that are preventing good or outstanding care.

The members of the advisory group include: the Royal College of Nursing, the British Association of Perinatal Medicine and the Royal College of Obstetrics and Gynaecology.


When the work is complete, the CQC will publish a report describing their key findings. The report will set out:
  • Barriers to good-quality care.
  • If required, recommendations about clinical areas that may benefit from additional clinical guidance or best practice guidelines.
  • Good practice examples that others can learn from.
  • How they will improve the way they inspect services that provide obstetric, neonatal and paediatric care.
The CQC expect to publish their findings next Spring (2016)

This review draws on the experiences of the Dixon family. Elizabeth Dixon died in 2001 as a result of failures in the tracheostomy care she received at home, while under the care of a newly qualified agency nurse.

Chief Inspector of Hospitals inspects core services at South West London and St George’s Mental Health NHS Trust

The Care Quality Commission (CQC) has completed focused inspections of wards for older people with mental health problems, acute wards for adults of working age and psychiatric intensive care units at the South West London and St George’s Mental Health NHS Trust during May 2015.

During previous inspections carried out by the Care Quality Commission in March 2014, a number of areas for concern across wards for older people were identified including inconsistent risk management and assessment of patients, incident reporting not always being undertaken and patient care plans not being detailed or personalised.

Across acute wards for adults of working age and psychiatric intensive care units, previously identified concerns included management of medicines and risk management.

During the most recent inspection, CQC found that improvements had been made on individual wards and requirements had been met. However, further areas for concern were identified. CQC issued five requirement notices requiring South West London and St George’s Mental Health NHS Trust to take action to improve the delivery of safe care and treatment for acute adult and older patients, dignity and respect for older patients, and person centred care and understanding of patient consent on particular wards for adults of working age.

Full reports for the focused inspections carried out across the provider’s core services, are available at: www.cqc.org.uk/provider/RQY.

Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals for mental health, said:

"Our recent focused inspection has found that South West London and St George’s Mental Health NHS Trust has taken steps to address a number of areas of concern that were previously identified on wards for older people with mental health problems, acute wards for adults of working age and a psychiatric intensive care unit in March 2014.

“Although we have found improvements in risk management, incident reporting and medicines management, further areas requiring improvement were identified. We have concerns about the delivery of safe care and treatment for acute adult patients of working age and older people, and the maintenance of dignity and respect for older patients.

“It is essential that the trust takes prompt and appropriate action to address these areas for concern and I look forward to improvements being implemented upon our next comprehensive inspection of South West London and St George’s Mental Health NHS Trust to ensure that service provision meets all the required standards.”

The trust must submit a report to CQC detailing the action that will be taken to ensure required standards are met and areas requiring improvement are addressed across the core services inspected.

South London care home rated as Outstanding by the Care Quality Commission

The Care Quality Commission (CQC) has rated the Marlborough Court care home in Thamesmead, South London as Outstanding following an inspection in June 2015.

During the recent inspection, CQC inspectors found that the provider was delivering services that are safe, effective, caring, well-led and responsive to people’s needs.

Under CQC’s programme of inspections, all adult social care services are being given a rating to help people make informed choices about their care. Overall, the Marlborough Court care home has been rated as Outstanding.

A full report from the inspection has been published on the CQC website: www.cqc.org.uk/location/1-304037140.

CQC found that the provider had strong leadership in place, with a strong ethos communicated to all staff on providing person centred care and ensuring a good quality of life for all service users. Staff had received additional specialised training in dementia as part of an organisational accreditation process and said that they felt valued and appreciated for their work. Both staff and management had also won a number of regional and national care awards.

A specially designed sensory garden was provided for residents with water features, wall chimes, plants and seating areas. Rails and raised beds helped ensure that all residents could use and interact with the garden, with sensors triggering different noises according to movements nearby.

The provider actively promoted residents’ involvement with their local community through the annual ‘Flame of Forgiveness Fortnight’ project. Started in 2014 and set to continue in 2015, the project commemorates World War One with an emphasis on the importance of forgiveness. Events take place involving local schools and culminate in the lighting of a beacon at the Marlborough Court care home.

Sally Warren, CQC's Deputy Chief Inspector for Adult Social Care, said:

"We found that the Marlborough Court care home is providing an Outstanding service, particularly for residents whose circumstances may make them vulnerable.

“We were particularly impressed with the provider’s work to ensure meaningful and positive experiences for residents and the commitment of all staff to continuously seek improved outcomes for service users, as well as enabling engagement between residents and the local community.

“Staff demonstrated a sound understanding of the differing needs of the people in their care and reflected these needs when planning and delivering services. This is a great example of what outstanding care looks like.”

CQC seek opinion on the regulation of independent doctor services

The Care Quality Commission (CQC) is seeking views on the regulation of independent doctor services via a consultation published today.

Services in this sector include remote consultation and  provision of treatment, travel vaccination clinics, slimming clinics, private GP services and family planning services (but not in vitro fertilisation or termination of pregnancy services).

The CQC have worked closely with providers and stakeholders to develop the consultation document and welcome public responses to their questions.

The organisation is interested in whether – and how – you think the CQC should regulate this sector and whether these services should be rated. Other questions include how the CQC can identify and share notable practice.

The planned approach builds on the 2013 consultation A New Start, which set out how the CQC will inspect and regulate all services. When the CQC regulates care they ask five key questions about services; whether they are safe, effective, caring, responsive and well-led.

Wednesday, 19 August 2015

A Compendium of Graduate Programs in Creative Writing - USA

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Why are so many doctors choosing to work overseas?

There is a national recruitment crisis in general practice and some other specialties. At the same time, many doctors are choosing to work abroad - interesting article on what exactly is happening in the medical profession, written by the BMJ:


New Jane Austen film based on Carolyn V Murray book

The life of Jane Austen is set to be the subject of a new film called "Jane by the Sea", based on the novel by Carolyn V Murray (Sandcastle Press).

Produced by Voltage Pictures, the romantic comedy will examine the evolution of Austen’s novels and explore the relationships and experiences that served as inspiration for her work. According to "Hollywood Insider" website The Tracking Board, the film will combine scenes from the author’s life and her books.

Austen’s works have been frequently adapted in television and film. In 2007, Anne Hathaway played Austen in "Becoming Jane", which centred on Austen’s development as an author.

According to the Guardian, author Murray will also write the script for the film. Actors and directors of the project have yet to be announced.

HSJ report that "Community healthcare needs more prominence"

Gill Morgan writes that community healthcare needs more prominence as the NHS moves forward. This article is taken directly from her piece for the HSJ online (19th Aug 15). 

There is no doubt hospital care is essential but community services must also be made an important part of the system. A new vision to recognise and expand its role in commissioning and governance is needed, writes Gill Morgan.
Community health services used to be most people’s experience of healthcare. But one of the aspects of modern medicine’s wondrous advance has been that its technical and scientific achievements were concentrated in institutions.

Let us be in no doubt that the, at times, quite breathtaking quality and complexity of care that can only be provided by hospitals is an essential part of the healthcare system. But we must also recognise the breadth and sophistication of what can be accomplished by community and primary care services.

Recognise community care

Healthcare in the latter part of the 20th century became so dominated by hospitals, bricks and mortar that we now struggle to explain to people the virtues of providing care outside of hospital. In fact, we now have a phrase for it – out of hospital or OOH – as the notion is so remarkable to some.
I think we should change OOH to out of home. Healthcare at home, in clinics, surgeries and pharmacies should be seen as the default and desirable place for most people’s healthcare with only intense need, high risk and specialist intervention requiring the unique abilities of a hospital.  

Community health services lack the high public profile of other NHS services, and yet they often reach the deepest into our lives. They are part of our neighbourhoods, they come into our homes, and are with us for the long term.

We live longer now than ever before, but are more subject to frailty and long term conditions as a result. Community health services partner with colleagues across the NHS and in social care, education, charities and local government to personalise care packages which support people to maintain their independence for as long as possible.

Their personal, community based approach means they take many different forms, and are often organised to meet local patients’ and service users’ particular needs. Their underpinning philosophy is to help people live as independent and fulfilling a life as possible, for as long as possible.

Yet their role has never been well defined or as widely recognised as other parts of the NHS. Partly, this is due to the various forms they take: working so closely with GP services, they are often assumed to be part of the surgery. They are also rarely in the spotlight, lacking the propensity to make headlines, impact elections or generate national controversy.

Consequently, their potential to provide the sustainable core of the NHS and drive new models of care can be under-recognised. In effect they are usually described in the context of other services, rather than in their own.

To deliver better and new models of care it is essential that we unleash the community health sector’s potential. This needs a new vision which explicitly recognises and encourages its role; new currencies to describe, measure and fund their work; and a language to explain, promote, measure and expand it.
Self-sufficiency, self-awareness and self-care (with the right knowledge, technology and local backup) will have a massive impact on keeping people healthier and helping them live with manageable conditions.

This will need commitment, leadership, and an NHS freed to develop and move to new models of community based, person centred care and provide the services that can only be delivered in a hospital at the same time. As part of this commitment we will publish Community Health Services – A Way of Life, a narrative to support and drive the conversations and plans for new models of care and sustainable NHS services.

We need to talk the language of community health so that we can benefit from its current and future potential.

A new language and context

Community services need to be described in their own language. The NHS must see its mission as being about people, not patients.

People live with increasing health needs and frailty, but we too often see patients for whom a health transaction is the necessary fix. Until the NHS is oriented around people and their needs, rather than episodes of care, it won’t be able to address challenges of quality or cost.

Currencies and timescales need to be fit for sustaining long term relationships in neighbourhoods, and across health and social care. Integration should be an outcome benefit experienced by the person; not simply an organisational design principle or administrative convenience.

A community approach

Commissioners will need to offer consistency and a long and integrated view in their commissioning and tendering behaviour.

Trust boards and commissioners will need to pioneer and use different forms of information to assure themselves that services provided in the home, away from a hospital, are safe and provide service users with a positive experience of their care.

Regulators should seek to change their working models, to gain assurance that trusts providing community health services are well led and that agreed standards of care are met in different ways to the traditional hospital setting they are used to. This will require a new, sensitive approach to evaluating patient and service user feedback.

How will regulation and inspection processes change when the care setting is increasingly an individual’s private home?

Right workforce, skills, recognition and rewards

Providing support to stay healthy (or live more comfortably with ill health) needs additional and adapted roles and skills.

Different skills are needed to work in homes and high streets. Healthcare professionals will increasingly work alongside other care, support and advice professionals, using new approaches to relationship building and collaborative working.

Being locally responsive, neighbourhood based and person focused does not happen automatically. It requires:
  • skilled professionals;
  • well managed and led organisations; and
  • strong and meaningful relationships between agencies and committed commissioners.
Community indicators that work for the NHS, but also are meaningful to its partners, will be a key element; as will core competencies of professionals and organisations.

The NHS seeks to be invited to be guests in the everyday lives of people, rather than only being there for when things go wrong. Community healthcare services excel at this.

It may seem odd that we are having to relearn an approach we were once good at, but this will become a way of life and a way of sustaining better, healthier, independent living for longer.

Gill Morgan is chair of NHS Providers

Sunday, 9 August 2015

Central London surgery rated as outstanding by the Care Quality Commission

The Care Quality Commission (CQC) has found the quality of care provided by the Victoria Medical Centre to be Outstanding.

Inspectors found that the surgery was providing a safe, caring, effective and well-led service that was particularly responsive to the needs of the local community.

Victoria Medical Centre provides a primary medical service to patients living in and around Victoria, Central London.

Ursula Gallagher, Deputy Chief Inspector of General Practice Inspection for London, said:

"We found that the Victoria Medical Centre is providing an Outstanding service for members of the local community with a variety of health needs.

“We were particularly impressed with the practice’s work to initiate positive service improvements for local patients and the commitment of all staff to ‘go the extra mile’ to seek improved outcomes for local people.

“Staff demonstrated a sound understanding of the differing needs of their patients and reflected these needs when planning and delivering services. This is a fantastic example of what outstanding care looks like.”

Under CQC’s new programme of inspections, all primary medical services in England are being given a rating according to whether they are safe, effective, caring, responsive and well led.

The report on the Victoria Medical Centre highlights a number of areas of outstanding practice, including:
  • The surgery hosts and supports a monthly 'Memory Café’ for patients with dementia and their carers and family members, and has received very high patient satisfaction reports since its introduction.
  • A ‘link worker’ has been employed by the surgery specifically to assist elderly patients. The dedicated worker identifies and where appropriate visits patients aged 75 and over to offer support and information about available health and social care services. In particular, signposting elderly patients to fall prevention, flu and shingles vaccinations programmes.
  • The surgery worked with a local university professor to trial an innovative approach to decreasing stress and improving the wellbeing of working men through high quality counselling and acupuncture. Trials took place with over 150 male patients over an 18 month period. Seventy eight percent of patients reported improved wellbeing and the trial was shortlisted for a British Medical Journal award.
  • The practice sees more than 350 pregnant women a year and delivers full antenatal services from an integrated team of GPs, practice nurses and health visitors. The team recognised that many women had not taken folate in early pregnancy and took action to address this through the production of a dedicated leaflet on pre-pregnancy care. The leaflet won a best practise award from the Primary Care Women’s Health Forum, with 10,000 copies circulated to local GP practices and hospitals.

Chief Inspector of Hospitals is satisfied with urgent improvements to Portsmouth Hospitals NHS Trust but further improvement is required

England’s Chief Inspector of Hospitals has said that he is satisfied that urgent improvements have been made at Portsmouth Hospitals NHS Trust Accident and Emergency wards after a follow up inspection by the Care Quality Commission. However, the trust still has more work to do.

The team of inspectors and specialists visited Queen Alexandra Hospital on 25 April 2015 to check that the trust had taken action to address the CQC’s most urgent concerns. Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/RHU.
Following the initial inspection in February, CQC issued two warning notices to the trust requiring immediate improvements to be made in the Emergency Department to the initial assessment of patients, the safe delivery of care and treatment, and the management of emergency care.

Inspectors returned on 25 April and recognised that improvements had been made and that the warning notices had been met.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"At our last inspection our most urgent concern at Portsmouth Hospitals NHS Trust was the risk to patients arriving by ambulance. We took proportionate action to protect patients and subsequently Portsmouth Hospitals NHS Trust has worked to address our most serious concerns.

“While I note that there have been some significant improvements, some patients are still having to wait too long to be admitted and I expect the trust to address this as a priority. Our inspectors will return in due course to check progress in this area.”

On the latest inspection, CQC found that patients arriving by ambulance were being assessed within 15 minutes by a nurse. Staffing levels had improved taking into account the increase in the number of patients and the need for skilled and experienced staff to be present in the department overnight. Nurses were now allocated to the corridor areas in the Emergency Department organising activity to avoid the disorder that inspectors had previously seen.

But there were still delays for patients waiting to see specialist doctors and be admitted even at times when beds were available in the hospital. These delays in admissions meant that the department was often full and posed a risk to patients. Patients brought in by ambulance continued to wait in a corridor, some for over an hour.

Although there had been improvement in staffing levels, patients waiting in corridors were not always being observed and monitored when staff were on breaks. Nurse staffing levels had not been assessed for the ambulance area.

The inspection reports highlights four areas for improvement, including:
  • Patients must be appropriately monitored at all times by sufficient numbers of staff in the Emergency Department to ensure they receive appropriate care and treatment.
  • Patients in the ambulance streaming area must have access to sufficient essential equipment and have a means of calling for help when necessary.
  • There must be a risk assessment of the ambulance streaming area. The new referral and admission process must work effectively for the timely assessment and admission of patients and to prevent overcrowding in the ED.
CQC inspectors will continue to monitor the trust, returning unannounced in the future to check that the required improvements have been made.

Story source - press release, CQC

Chief Inspector of Hospitals finds some progress at Hillingdon hospital, but services still require improvement

England’s Chief Inspector of Hospitals has rated services at Hillingdon hospital as Requires Improvement following an inspection by the Care Quality Commission (CQC).

At a previous inspection, in October 2014, inspectors had told Hillingdon Hospitals NHS Foundation Trust that it must take urgent action to improve cleanliness, infection control and the assessment and monitoring of service quality. At this point, services for children and young people, and the urgent and emergency care, surgery and medical care departments were rated Inadequate for safety.
The report published today details a follow-up inspection conducted in May 2015, during which inspectors found that some progress had been made. The hospital has now been rated as 'requires improvement' for the delivery of safe, effective, responsive and well-led services. It has been rated ‘good’ for the provision of caring services.

Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/location/RAS01.

Overall, inspectors found that the hospital had made significant improvements in the assessment and monitoring of service quality, cleanliness and infection control. The hospital is now cleaning and auditing in line with national standards required across the NHS. Increased housekeeping staff have been allocated within the A&E department and senior staff felt this change had resulted in improved cleanliness.

The majority of staff have received mandatory training in safeguarding and infection control. Key staff have also been deployed to oversee service delivery and promote good practice.

Potential risks in the management of medicines are being identified through audit and appropriate preventative action being taken. However, inspectors found that best practice was not always followed by staff, with some daily medicine checks not taking place as necessary and some areas where medicines were stored being left unsecured.

Inspectors found that action had been taken to address the deficiencies in the hospital environment and estate that were highlighted during the previous inspection. Changes to operating theatres were a work in progress at the time of the most recent inspection. However, the works completed at the time of inspection, planned works and annual maintenance targets were in line with national standards to ensure patients would be protected from the risk of infection in future.

Inspectors visited nine medical wards during the recent follow-up inspection and found that the trust had responded appropriately to many of the key issues that had previously been identified. However, it was observed that in some areas practice had not changed, despite new systems and processes being implemented to deliver the required improvements.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"At the time of our previous inspection, we had told Hillingdon Hospitals NHS Foundation Trust that it must take urgent action to meet some serious matters of concern. I am pleased to report that our latest inspection has found that the hospital is now making significant headway in many areas.

‘Although we have found improvements in services for children and young people, and the urgent and emergency care, surgery and medical care departments there is still a way to go which is why Hillingdon hospital is still rated as ‘Requires Improvement’ overall.

‘We still have concerns that some staff in A&E and medical wards are not following best practice in relation to hygiene and the use of personal protective equipment.

“Whilst I am satisfied that the hospital is heading in the right direction, I look forward to further improvements being implemented and fully embedded upon our next inspection.”

Wednesday, 5 August 2015

Practices being given lower positive scores than they deserve under Friends and Family Test

An exclusive taken directly from Pulsetoday.co.uk:

GP practices’ positive ratings are being undervalued under the Friends and Family Test because of the way the data is being published by NHS Choices, it has emerged.

Pulse has discovered that patients who answer ‘don’t know’ when asked whether they were likely to recommend a GP practice are being counted negatively, which is distorting the overall picture, GPs say.

NHS England has said that it will continue to publish the data in this way, but will update the explanatory text on NHS Choices to explain the methodology.

But the GPC has said that practices with newer patients are likely to lose out through no fault of their own, and this anomaly was a ‘good example’ of why ‘crude data’ was not a good way to compare GP practices against one another.

When published on NHS Choices, results are presented only as the percentage of all patients surveyed who said they would recommend the practice.

This means that people who answer ‘don’t know’ are lumped in with the people who actively said they were ‘unlikely’ to recommend the practice, giving the impression that they themselves had actively said they were unlikely to recommend the practice.

However, Dr Roger Neal, GP partner at the Surgery in Henlow, Bedfordshire, who first raised the issue, said that the publication for the month of May had indicated only 52% of patients would recommend his practice, despite only one out of 21 patients surveyed saying they were ‘unlikely’ to recommend the practice.

He said this was likely due to ‘extensive new house building’ within the practice’s catchment area, as well as covering a nearby airforce base with a lot of transient patients, who are more likely to say they did not know whether they would recommend the practice.

He told Pulse: ‘Such patients therefore have limited experience of using our practice and are more likely to respond as ‘don’t knows’ to such questioning.

‘But the rub is that NHS Choices appears, worryingly, to use the ‘don’t knows’ within their calculation of recommendation as a negative response. This is a grossly unfair simplification of the statistics. If you exclude the “don’t knows” we would get 68% recommendation.’

Before the FFT launch in practices last December NHS England said the publication of scores ‘should provide morale boosting feedback’, however Dr Neal said: ‘My staff and I are failing to have our “morale boosted” by the FFT.’

The GPC, which criticised the FFT before its rollout due to the added bureaucracy, said this showed the limitations in the Friends and Family Test approach.

GPC chair Dr Chaand Nagpaul said: ‘The FFT and similar surveys have to be looked at in context. One of the greater limitations is simply looking at crude data for comparison purposes is that it lacks context. This is a good example where clearly the results of the FFT is going to be influenced by the fact that a large number of patients have yet to be able to familiarise themselves with the practice, and be able to comment on whether they feel they would recommend it or not.’

In a statement, NHS England said GPs had the opportunity to contextualise their data on their own practice website but it had settled on this ‘simpler presentation’ because many people had found a net promoter score ‘unhelpful’.

However the statement also said NHS England is ‘aware that the explanatory text on NHS Choices needs to be updated to make it clear what the data means’ and that it is ‘working on putting that in place within the coming weeks’.

A spokesperson said: ‘We also show the number of responses that the percentage is based on so patients will get a sense of how representative the numbers are. The number of “don’t knows” is, in most cases, a very small percentage and would not normally make a big difference to the overall perception of a service’s FFT data.

‘By far the majority of patients across the NHS who complete an FFT questionnaire - around 9 out of 10 for GPs - tend to express a positive view. ‘

UAL leads unique design project to improve youth mental health

University of the Arts London (UAL) has led a ground-breaking new design project in partnership with Norfolk and Suffolk NHS Foundation Trust (NSFT), using art and design to explore young people’s experiences of mental health services and how they can be improved.

UAL Early Lab is a new initiative led by UAL Chair of Communication Design Nick Bell and Camberwell College of Arts BA 3D Design tutor Fabiane Lee-Perrella, giving UAL students the opportunity to collaborate across the University to use design to drive social change.

UAL Early Lab’s first project opportunity saw students and academics spend a week working closely alongside NSFT’s clinicians and members of its Youth Council, made up of young service-users in Norfolk and Suffolk, exploring issues around mental health using design techniques such as storyboarding and stop-frame animation.

The UAL team presented its findings to commissioners, stakeholders and voluntary sector groups from across Norfolk. Their recommendations include:

• decentralising and distributing the service across the sparsely populated region
• offering a mobile and pop-up service for the convenience of users – where they are
• connecting to users through a new online platform designed to speak in their voice
• providing information, access to services and youth provisions through the online platform
• creating a seamless, integrated service across health, social care, education and youth justice
• concentrating on prevention, awareness and early intervention, especially in schools
• normalising mental health in schools.

Following the success of the presentation and overall collaboration, NSFT commissioners are planning to use the findings in the imminent transformation of services for young people, and also to influence practice further afield.

Consultant Psychiatrist and Deputy Medical Director (Research) at NSFT Dr Jon Wilson said:
“I’m very excited by this project. I think it will give us the ammunition to drive change forward in Norfolk mental health services for young people. And because of links nationally, I think we can use that to articulate this around the whole of the country and start to give people the confidence that things can be different.”

UAL Chair of Communication Design and co-founder of UAL Early Lab Nick Bell said:
“I wanted to find an opportunity for students to use design much earlier than usual, right at the start of something. At the start it is possible to address the root causes of social issues and that increases chances of contributing to outcomes that are resilient and sustainable.

“I told Dr Jon Wilson I wanted to take UAL Early Lab to a place where an issue is active and to work responsively with people who endure those issues every day in that place. Jon invited UAL Early Lab to Norfolk to work with NSFT’s Youth Council. Having a group of young, talented UAL students collaborating with his bright, young service users very much appealed to him.”

NSFT Youth Council member and service user Katie-Louise Davis said of the experience:

“This was such a new and different concept to work with. I feel that the fact we worked together so well is amazing and shows that two passions; mental health and art and design, can collide to form something beneficial and inspiring.”

London College of Fashion MA Fashion Futures graduate Kat Thiel said:

“For us it was amazing to actually have hands-on experience where you are really grasping what it is to socially interact and to socially design.”

Camberwell College of Arts BA 3D Design tutor and co-founder of UAL Early Lab Fabiane Lee-Perrella said:

“So called ‘Design Thinking’ removes making from the design process – the supposedly intimidating bit. UAL Early Lab places making at the centre of our connection with people. We use processes of making to unlock personal capacities.

“We collected information from the bottom to the top and we wove all this information through with the perspective of the outsider, from the perspective of the maker. We made things and we brought this back to them as a set of proposals and findings they can take forward.”

Members of the Youth Council and UAL Early Lab team will present the findings from the project at the International Association for Youth Mental Health (IAYMH) conference in Montreal, Canada in October.

CQC starts new strategy development

In 2013, the Care Quality Commission (CQC) launched Raising Standards, Putting People First – a three year strategy introducing its new approach to regulation including the appointment of three chief inspectors.

It is now developing a new strategy to be launched in spring 2016. This will be a five year strategy that will set out CQC’s vision for health and social care quality regulation in the future.

The development of the new strategy is taking place within an ever-changing environment in which people are living longer lives, expectations on the quality of health and social care are changing, the population is growing and technology is advancing.

The CQC will be consulting with all its audiences on its future strategy in an open and collaborative way to ensure it is making the right decisions.

It has set up a web survey to help it develop its new strategy. This is an informal opportunity to feed into the strategy as it develops. In early 2016, the CQC will run a formal consultation on its proposed approach, before publishing a finalised strategy later in the year.

Circa 10% patients on a GP list are carers

The responsibilities of carers mean they are more likely to suffer from ill health; through stress and depression, poor self-care or physical injuries due to incorrect moving and handling. Despite this, fewer than 10% of carers are identified by their GP practice and offered appropriate support.
In this article, published by the CQC, there is an explanation of what is meant by the term ‘carer’ and examples are given of good and outstanding care for carers in general practice.

Who are carers?

One of the reasons many carers are not identified by their GP practice is confusion around how to define term ‘carer’.
A carer is a person of any age (including children) who provides unpaid support to a partner, relative, friend or neighbour who couldn’t get by without their help. This could be due to old age, frailty, disability, a serious health condition, mental ill health or substance misuse. Parents of children who are disabled or who have a serious health condition are also considered to be carers.
There is a difference between a carer and a care worker or care assistant who is paid to provide care. This can be confusing, as some carers receive statutory payments (for example Carer’s Allowance) or a direct payment for their caring role. However, even when carers are in receipt of such payments, they are still considered to be carers.
As many practice teams know, carers may not readily identify with the label ‘carer’. Instead, they see themselves as someone’s partner, relative or friend who is simply “doing their best” to help someone they care about. For this reason, the question “Do you look after someone?” can be a more effective opening question than “Are you a carer?”

What does good and outstanding care for carers look like?

Many organisations including the RCGP, Carers Trust, Carers UK and local commissioners have described initiatives practices can use to improve the care they give to carers. Some common themes include:

Improving carer identification:

There has been an increase in the number of people recorded as carers by their GP in the last year. Many practices have increased the number of people on their carers register by:
  • Nominating a lead person for carers
  • Asking patients with long term conditions to identify their carers
  • Running awareness-raising campaigns to get carers to self-identify

Improving healthcare for carers:

  • Flu vaccination:
    • Most carers are eligible for a free flu vaccination to protect themselves and the person they care for. The PHE Green Book defines those eligible as: “Those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Vaccination should be given on an individual basis at the GP’s discretion in the context of other clinical risk groups in their practice.”
    • Recent figures from Public Health England show that vaccine uptake for carers identified by GP practices this year was 45.1%. There is significant scope for practices to improve their rates of flu vaccination for carers, as this figure is the percentage of patients registered as a carer by their GP practice and not the percentage of all carers. Estimates show that only 3% of all eligible carers actually receive their flu vaccine. Given the importance of protecting both carers and the people they care for from the flu, GP practices are strongly encouraged to identify the one in ten patients who are carers so that they can be offered the vaccine.
  • Screening carers regularly for depression and other health problems
  • Offering flexible appointments for carers.

Improving support for carers:

  • Organising carer support groups or advice surgeries
  • Organising surveys to gather carers’ feedback about services and their satisfaction with them
  • Referrals to carers services for more specialised information, advice and support

What examples of outstanding care for carers have we already identified in our inspections?

CQC inspectors have seen compassionate approaches to supporting carers in general practice. See these examples:

An urban practice with 3,600 patients:

The practice was proactive in its support for carers. For example, the computer system alerted GPs if a patient was a carer. The practice provided written information for carers to ensure they understood the various avenues of support available to them. The practice had links with a carer support worker and ran a carers group, which provided access to advice and information. This had resulted in the practice winning a local carers award for the support provided to carers in 2006.

A semi-rural practice with 9,500 registered patients:

The practice had a register of carers and a member of staff carried out the role of 'carers coordinator'. This staff member made annual contact with every carer on the register to ensure they were receiving the care and support they required. The carers register was then updated based on this contact.

A practice in a small town serving 14,000 registered patients:

The practice developed a carers group and worked with the Carers' Association to ensure patients received the most up to date support and guidance. The practice arranged a weekly session with the Carers Association to see carers (who may not necessarily be registered patients themselves). The practice made the room freely available because they recognised the benefits of this contact to the carers of their patients. The Carers Association worked with the practice to deliver a carers awareness evening to provide additional support to patients.

Carers Trust examples

Carers Trust has a range of best practice examples of outstanding care for carers. A recent case study provided by Herefordshire Carers Support, who have established a network of GP practice Carers Leads across the county, is below. In addition to increasing the number of carers identified and referred to their local carers service, the network has also encouraged practices to work collaboratively to support carers in the community:
“During Carers Week this year the Carers Leads from three practices worked together to hold an information event. All three surgeries contacted their carers and invited them to the event which featured speakers, info stands and Q&A sessions throughout the morning, ending with a speech by Baroness Jill Pithkeatly, the Herefordshire Carers Support Patron. It was a big success and a great example of surgeries working together to provide a service for their carers.”

Somerset House to exhibit TINTIN: Hergé’s Masterpiece

Somerset House says it will channel some of Tintin creator Hergé’s adoration of architecture and design when it opens a major exhibition on the cartoon in November.

Curators believe the neoclassical qualities and nautical heritage of the house – which served as the home of the Navy Board and the office of Lord Nelson – will make it a “compelling” setting for TINTIN: Hergé’s Masterpiece, which will explore the evolving artwork of a strip launched as a weekly in Le Petit Vingtième, in Brussels, in 1929.

Models and installations of memorable locations, including Tintin’s apartment, will be showcased, with a particular emphasis on Marlinspike Hall – Captain Haddock’s country house, once owned by his maritime ancestor, Sir Francis Haddock.

The exhibition will drawing on the archives of the Hergé Museum in Belgium.

TINTIN: Hergé’s Masterpiece is at Somerset House from November 12 2015 – January 31 2016. Admission free.

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Image, copyright Hergé-Moulinsart 2015