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Practice examples and case studies Guardian: New holistic approach to treat child obesity. "Mary Haddow is a specialist nurse working on a new scheme that forges links between healthcare professionals and community services to tackle obesity ...The new scheme brings together a range of healthcare professionals and services to offer personalised care and support for children with obesity problems. It is based on a local, holistic and sustainable approach and brings together a multi-disciplinary 'paediatric healthy weight team' – consisting of doctors, nurses, a dietician, psychologist and physical instructor". HQIP: Case study: Integrating Measurement for Improvement support for the All Wales 1000 Lives+ Programme. “Through measurement the Initiative was able to demonstrate improved outcomes, such as reduced central line infections, reduced ventilator associated pneumonia and reduced MRSA infections". NHS Clinical Commissioners (NHSCC): Clinical commissioning in action. NHS Clinical Commissioners is a coalition of the National Association of Primary Care (NAPC) and the NHS Alliance. This publication shares learning from CCGs around England in the form of case studies. Each case study illustrates an example of successful outcomes and service provision. Clinical commissioning in action (PDF 1.7MB). Social Care Institute for Excellence (SCIE): Defining excellence – four new Social Care TV films. Four new films have been launched which highlight excellence in social care. They focus on three key features that help to define excellence. These are: providing voice, choice and control; creating and maintaining good relationships; spending time purposefully and enjoyably. Services that combine these features can help to produce the best possible outcomes for people. Reports, commentary, statistics Beat: Costs of eating disorders in England: economic impact of anorexia nervosa, bulimia nervosa and other disorders focussing on young people. A newly released report carried out for Beat by a volunteer economist from the charity Pro Bono Economics (PBE) has found an overall estimated cost of £1.26billion per year to the English economy from eating disorders – and could be much higher. BMC Health Services Research: Assessing methods for measurement of clinical outcomes and quality of care in primary care practices. “Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results.” Commonwealth Fund: Quality Matters newsletter June / July 2012. The latest newsletter contains an item on quality of care at the end of life. The piece covers some of the efforts that a number of providers have been undertaking (many of which feature communication) and provides links to some resources. DH: Report of the Children and Young People’s Health Outcomes Forum. The Children and Young People’s Health Outcomes Forum has published its proposals on how health-related care for children and young people can be improved. The Forum has identified several themes that it says are key to making the improvements needed: putting children, young people and their families at the heart of what happens; acting early and intervening at the right time; integration and partnership; safe and sustainable services; workforce, education and training; knowledge and evidence; leadership, accountability and assurance; incentives. Children and Young People’s Health Outcomes Forum heads speak about their work. The joint chairs of the Forum, Professor Ian Lewis, Medical Director at the Alder Hey Children’s NHS Foundation Trust, and Christine Lenehan, Director at the Council for Disabled Children, speak about the work of the Forum and what they hope its recommendations will achieve. DH: Investment in mental health: working age adult and older adult reports. These two reports provide details of investment in mental health services for those aged 18 to 64 and for people aged 65 and above with some comparison of previous years. DHSSPS: Emergency Care Waiting Time Statistics (April – June 2012). The DHSSPS has published statistics on the time spent waiting in emergency care departments within Northern Ireland during the months of April, May and June 2012. Health and Social Care Information Centre (HSCIC): Smoking, drinking and drug use among young people in England – 2011. This is an annual survey carried out in participating schools across England to provide information on pupils' smoking, drinking and drug use behaviours. The survey focuses on different behaviours in different years, alternating between smoking and drinking one year, to drug use the next. Press release: Proportion of schoolchildren taking drugs fell over the past decade. HSCIC: Prescriptions dispensed in the community, England - statistics for 2001 to 2011. This report provides data relating to prescriptions dispensed in community by community pharmacists, appliance contractors and dispensing doctors. The bulletin highlights recent changes and the main trends between 2001 and 2011. HSCIC: Data quality. The new Health and Social Care Act 2012 gives the HSCIC responsibility for assuring the quality of national data submitted by hospitals, GPs and other care providers. This report highlights the importance of high-quality data and providing a starting point from which to measure improvements in accurate recording of data. House of Commons Library: Social care reform: funding care for the future – Commons Library Standard Note. This note provides a brief history of the proposals to reform the system of adult social care in England including information on the Coalition Government’s Caring for our future white paper and the accompanying progress report on funding reform published on 11 July 2012. House of Lords Science and Technology Committee: Sports and exercise science and medicine: building on the Olympic legacy to improve the nation’s health. The report states that there is a lack of awareness and appropriate training for health professionals of the benefits of exercise based treatments. A recent survey of 48 London GP practices found that none were aware of the latest Physical Activity Guidelines. The Committee call on the NHS to consider adding physical activity to the Quality and Outcomes Framework (QOF), which rewards GPs for how well they care for patients. They recommend that NICE and the NHS update chronic disease guidelines with detailed information about exercise, and evaluate the best way to deliver exercise treatments through the NHS. King’s Fund: Social care reform – where next? Presentations, including the keynote address made by Paul Burstow, Minister of State for Care Services, and debate and papers from this event held on 18 July 2012. King’s Fund: The next 50 years: is the NHS financially sustainable? "With the NHS facing a virtual freeze in its spending to 2014/15 and prospects for little or no real funding increases for some years after, what does the long-term future hold for the NHS?" Videos of main sessions and speakers slides from this seminar are available. King's Fund blog: Integrated care north and south of the border. "The challenges faced in Scotland in making a reality of partnership working are a timely reminder that structural simplicity and organisational integration do not in themselves ensure the delivery of integrated care". CCG's and PCTs - not so different after all. “There will be important differences between clinical commissioning groups (CCGs) and primary care trusts (PCTs) – it could hardly be otherwise, given the radically different context in which CCGs will be operating. But in terms of the population size they cover – a hugely significant issue for any commissioning body – CCGs and PCTs look increasingly similar”. Neurological Alliance: Intelligent outcomes: applying the health and social care reforms to improve outcomes for people with neurological conditions. The report identifies a range of neurology outcomes and warns that, "without their inclusion in the quality and accountability architecture of the reformed NHS, the new system will not be capable of delivering urgent improvements in neurology services and outcomes". It makes a series of recommendations to promote the active engagement of all levels of the health and social care service in enhancing neurological outcomes. Guardian: NHS is failing patients with neurological conditions, claims report. NHS Commissioning Board: Commissioning fact sheet for clinical commissioning groups (PDF 140KB). This fact sheet sets out the services to be commissioned by clinical commissioning groups (CCGs) from April 2013. It also sets out the complementary services to be commissioned by the NHS Commissioning Board (NHS CB), local authorities and Public Health England (PHE). NHS Commissioning Board: Videos of the Board meeting held on 19 July 2012. The board meeting was broadcast live as part of the NHS Commissioning Board’s commitment to make information as accessible as possible. You can view a recording of the board meeting on Ustream, or separate recordings of each agenda item. Nuffield Trust: The new NHS in England: structure and accountabilities. This slideshow details the main changes to management, accountability and funding structures resulting from the Health and Social Care Act 2012. The first slides show the old and new structure in overview, together with a slide detailing the current transitional arrangements. Further slides compare the earlier arrangements that were in place for funding, regulation and monitoring, advice and performance management, and patient and public participation, with the new system at both the national and local level. Nuffield Trust: The history of NHS reform. This interactive timeline covers 70 years of reform to the National Health Service charting the evolution of this public institution from its inception in the post-war years through to the present day. Office for National Statistics (ONS): Progress in measuring national well-being. Three articles are available reporting progress in the Measuring National Well-being programme: Where we live; Health; and Subjective Well-being. In addition, ONS has released an article setting out the domains and measures which will be henceforth used for assessing well-being, based on extensive consultation summarised in an associated report, which is also published. There is also an interactive tool for comparing subjective well-being of residents in specific areas in the UK. Rethink Mental Illness: Parliamentary mental health group voice concerns about new NHS. The All Party Parliamentary Group on Mental Health (APPG MH) has expressed its concerns about the future of mental health services in the reformed NHS. The report highlights four key areas of concern: commissioning; local decision making; integrated care; personalisation and patient choice. Health and social care reform: making it work for mental health (758.9KB). RCN Policy briefing 19/12 Clinical Commissioning Groups: an overview of the authorisation process (PDF 97.6KB) . The Health and Social Care Act 2012 includes radical reform of the way that health care is commissioned in England. This RCN factual briefing is intended as a user-friendly summary of the authorisation process for CCGs, focusing in particular on the nursing role in the new commissioning landscape. RCN Policy briefing 20/12 Social Care Reform (PDF 3481.KB) . This briefing examines the detail of the white paper, draft bill and funding progress report and reflects on the positives and negatives in relation to the RCN’s positions and how changes will impact on service users and patients, their families and carers, and care and support staff. Scottish Government: Social Work Complaints: Consultation Report. This is the report of the analysis of the responses received for the Social Work Complaints Procedures consultation exercise that took place between December 2011 and March 2012. Yorkshire and Humber Quality Observatory (YHPHO): End of Life quality report. This quality report supports the work of the NHS Yorkshire and the Humber End of Life Pathway Leadership Board. The report brings together data on end of life around key themes and uses benchmarking data to identify issues and good practice as well as providing recommendations. In addition to this report, a supporting benchmark tool is available with a wider range of charts and indicators including summary notes and recommendations. Patient safety 1000 Lives Plus: New App will help staff identify life-threatening illness. A new App developed by 1000 Lives Plus in conjunction with Cardiff Medical Apps, has been launched to help hospital staff use the National Early Warning Score (NEWS) to identify patients who are developing serious illnesses such as sepsis. NEWS is in use in hospitals across Wales after being launched nationally in April 2012. The NEWS App can be downloaded from the Apple’s App Store for free. Agency for Healthcare Research and Quality (AHRQ): Improving patient safety in long-term care facilities: Training modules. A set of training modules to help educate nursing home staff on key patient safety concepts critical to improving the safety of nursing home residents. Each of the modules has an instructor’s guide and a student workbook (American). BMJ Quality and Safety: Deaths due to medical error: jumbo jets or just small propeller planes? Editorial looking at medical errors and patient safety. DH: National Patient Safety Agency annual report and accounts 2011/12. The last full annual report of the National Patient Safety Agency was presented to Parliament on 12 July 2012.The Agency closed and effectively ceased operation on the 9 July 2012, prior to its final abolition in October 2012. The Agency’s functions transferred to the NHS Commissioning Board Authority on 1 June 2012. DH: Care Quality Commission (CQC) annual report on the safer management of controlled drugs published. The Chief Pharmaceutical Officer (CPhO), Dr Keith Ridge, has written to Chief executives and SHA pharmacy/prescribing leads highlighting the publication of the Care Quality Commission 2011 annual report on the safer management of controlled drugs, and the report’s recommendations. Care Quality Commission: The safer management of controlled drugs annual report 2011 (PDF 1.02MB). DH: Resource pack published for local health resilience partnerships. Local health resilience partnerships (LHRPs) are a key feature of the new arrangements for local health emergency preparedness, resilience and response (EPRR) which will start from 1 April 2013 as part of the changes brought in by the Health and Social Care Act 2012. DH: Advisory Committee on Dangerous Pathogens (ACDP): Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious diseases of high consequence. The ACDP has updated 1996 specialist guidance on the management of patients with viral haemorrhagic fever (VHF) or other infectious diseases of high consequence. It provides advice on how patients suspected of being infected with a VHF should be comprehensively assessed, rapidly diagnosed and safely managed within the NHS, to ensure the protection of public health. DH: National survey of hepatitis C services in prisons in England. The first dedicated survey of hepatitis C services in prisons in England shows that diagnosis and treatment for chronic hepatitis C infection is available to prisoners in most prisons in England, but that care models available vary between in-reach service and out-reach based services. DH: Flu vaccination programme extended to all children. The flu vaccination programme is to be extended to all children in the UK free of charge. DH: £8 million invested to tackle HIV and improve sexual health. Almost £8 million is being invested in driving down HIV infections and providing information to improve people’s sexual health. The money will go to the Terrence Higgins Trust and FPA (Family Planning Association) over three years and builds on previous work funded by the Department. Guardian: "Will patients really die this week because of new NHS hospital doctors?”. August 1 is 'black Wednesday', “day one of the killing season, when hospital death rates spike by 6%. But is it really true?" FoNS Centre for Nursing Innovation: Evaluation of the LSHA Programme - Developing and Sustaining a Practice Based Strategy for Reducing Healthcare Associated Infections. In this programme 16 project teams started the programme, 13 completed and provided a final report (11 reports as some teams combined reporting). Through the collection of multiple forms of evidence this evaluation found that nine teams reported reductions in healthcare associated infections and/or improvements in practice that would contribute to reducing risks of healthcare associated infections. Of significance in achieving this was the: Clinical leadership roles held by project leaders (e.g. ward managers); Effective strategic support; Use of a wide range of practice development methods; Involvement of the clinical teams. Health and Social Care Information Centre (HSCIC): Summary Hospital-level Mortality Indicator (SHMI) - Deaths associated with hospitalisation: England, January 2011 - December 2011, Experimental Statistics'. Some key facts are that 10 trusts had a SHMI value categorised as ‘higher than expected', 16 trusts had a SHMI value categorised as ‘lower than expected', 117 trusts had a SHMI value categorised as ‘as expected' and the percentage of patient admissions with palliative care coded at either diagnosis or specialty level is approximately 1.0 per cent. Health-EU Newsletter: Injury prevention: better data needed for EU-wide benchmarking and effective action. Issue 94, 19 July 2012. Health Protection Agency (HPA): Hepatitis C in the UK. The future burden of hepatitis C-related infections and national progress in tackling the infection is set out in this report, indicating that the number of people chronically infected with hepatitis C in the UK is estimated at 216,000; hospital admissions for hepatitis C-related End Stage Liver Disease (ESLD) and liver cancer are increasing, from 612 in 1998 to 1,979 in 2010; and deaths have risen from 98 in 1996 to 323 in 2010. An overall increase in registrations for liver transplants with post-hepatitis C cirrhosis has also been observed from 45 in 1996 to 101 in 2011. Press release. HPA: Quality criteria for an effective immunisation programme. This document defines the key elements for the implementation and delivery of a safe, equitable, high quality, efficient immunisation service which is responsive to the needs of vaccine recipients and/or their carers. It is intended for all those involved in immunisation programmes including commissioners, providers and advisors. The document includes the following sections-vaccine accessibility, assessment prior to immunisation, effective communication about vaccines, transport, storage and handling, documentation, adverse event/incident reporting, training and co-ordination. HPA: Whooping cough outbreak continues with 675 new cases reported in June. Confirmed cases of whooping cough in England and Wales reported to the Health Protection Agency (HPA) are continuing to rise, with a further 675 cases reported in June, bringing the total so far this year to 2,466, more than double the total for 2011 when 1,118 cases were reported for the whole year. HPA: Update 31 July: Legionnaires' disease in Stoke-on-Trent. Public and environmental health experts continue to investigate the Legionnaires’ disease outbreak at Stoke-on-Trent after identifying a probable source, in order to eliminate all potential sources from the investigation. HPA: Risk of infection from caesareans at nearly 10 per cent. Research from the Health Protection Agency (HPA) identified 394 surgical site infections among 4,107 women followed up after a caesarean section operation (9.6 per cent). The majority of these infections were minor (88 per cent) and the risk was found to be higher in overweight or obese women, according to findings published in the British Journal of Obstetrics & Gynaecology. HPA: MRSA, C.difficile, MSSA surveillance. Results for Mandatory Surveillance Data. The importance of healthcare associated infections (HCAIs) as a cause of preventable illness and death has been recognised increasingly in recent years, and the prevention and control of these infections has become a priority. Joint Commission Journal on Quality and Patient Safety: The Henry Ford Health System No Harm Campaign: A Comprehensive Model to Reduce Harm and Save Lives (PDF 1.7MB). The No Harm Campaign aims to “decrease harm events by reporting and studying harm events, researching causality, identifying priorities and redesigning care to eliminate harm. Substantial cost savings have also been made. Key actions for ongoing success are a focus on leadership, disseminating performance and stealing ideas through national and local collaborations.” (American). Institute for Safe Medication Practices (ISMP): Just Culture and its critical link to patient safety. The Institute for Safe Medication Practices has devoted two issues of its Medication Safety Alert to the issue of a ‘just culture’ and its links to patient safety. Medicines and Healthcare products Regulatory Agency (MHRA): MHRA asks for views about giving patients earlier access to medicines. This consultation is a key part of the Government’s commitment to growing the UK’s life sciences sector and economy. Under the scheme, the MHRA would provide a scientific opinion on the benefits and risks of medicines. This would assist the NHS in making decisions about making medicines available for patients with life threatening, chronic or debilitating conditions. The consultation closes on 5 October 2012. MHRA: MHRA warns public of potentially dangerous sports supplements. The MHRA has warned people to be wary of buying illegal sports supplements because they might contain dangerous ingredients that could cause kidney failure, seizures and heart problems. An MHRA investigation found that 84 illegal products such as energy and muscle gain products are being sold that contain dangerous ingredients such as steroids, stimulants and hormones. NHS Education for Scotland (NES): Significant Event Analysis: Community Pharmacy and GPs working together to develop safer practices. Currently GPs and pharmacy teams use the same NES documentation to analyse significant events. This guidance will enable teams to conduct an effective Significant Event Analysis (SEA) with the aim of improving and developing their practice to ensure that they provide patients with high quality, safe and effective services. RCN: National Early Warning Score (NEWS). The Royal College of Nursing has joined forces with the Royal College of Physicians (RCP) to launch a new universal patient safety system. NEWS consists of a standardised bedside chart and uses universally recognised terminology to make it easier for clinical staff to recognise and respond to a patient whose condition is deteriorating. The system can be used in both acute and community care settings. The RCN led on the development of a key part of the work, an e-learning portal, for use by all staff groups, from health care assistants to hospital consultants. A film about NEWS is also available. The benefits of a single national early warning scoring system include giving a simple, standardised set of parameters to be scored when a patient’s vital signs are initially assessed, and which remain consistent if a patient is moved between wards, departments and even hospitals, standardising the training and data by hospitals and other health care settings. National Early Warning Score (NEWS) online training resource. Royal College of Physicians: National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. NICE: NICE calls for standardised model of bedside monitoring. Royal College of Physicians (RCP): Falls prevention resource pack. As part of the Fallsafe project, the Royal College of Physicians has produced a Falls Prevention Resources pack. The pack comprises a collection of quality improvement best practice measures for assessing the impact of the number of falls in clinical hospital wards as well as preventing and managing falls. FallSafe project. The Final Check. The College of American Pathologists estimates that 1 in 1,000 blood specimens ends up being labelled with the wrong patient identifiers. That type of error can potentially harm two patients—the patient whose blood was mislabelled as well as the patient who was incorrectly linked to that specimen. Both patients may end up with incorrect diagnoses, missed treatment, or treatment that they do not need. Hospitals can use this simple intervention to dramatically reduce the rate of mislabelled blood specimens. The intervention was used for the first time at Palmetto Health in 2011, resulting in a 90 percent decrease in mislabelled specimens in the first month it was used. World Health Organisation (WHO): Guidance on prevention of viral hepatitis B and C among people who inject drugs. This guidance is the first step in the provision of comprehensive guidance on viral hepatitis surveillance, prevention and treatment by the World Health Organization. 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