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Purpose: This paper aims to outline the initial pilot use of the client complexity matrix (CCM), an outcome measure developed for an NHS Adult Intellectual Disabilities Intensive Support Team (IST) in the West Midlands of England. Design/methodology/approach: A mixed method approach was used to report the results and evaluate the use of the CCM within this IST. The CCM was trialled for six months between January 2022 and June 2022. CCM scores pre and post IST intervention were analysed via t-test, and qualitative feedback from clinicians is detailed. Findings: Analysis suggests the CCM captures service success showing a significant decrease in complexity and risk post-intervention. Qualitative comments from clinicians were generally positive; however, there were requested changes regarding specific presentations, use of labels/language and for a digital version. Research limitations/implications: The tool is not co-constructed with the client. Because of this IST's caseload, the sample size was small. Only one clinician was asked to complete the CCM pre and post intervention. Future use of the measure will encourage two clinicians to complete the measure to evidence its inter-rater reliability. Each client's specific presentation was not explicitly analysed here. Practical implications: The CCM will be updated using the feedback from clinicians and from the peer review process. Research that examines the generalisability of this measure to other IST services would be beneficial. Originality/value: The CCM appears to fill a gap in outcome measurements for this IST service which looks at breadth and depth of client complexity and risk. [ABSTRACT FROM AUTHOR]

This paper builds on a previous article describing an innovative approach to enhance the service user and practitioner's experience of novel collaborative approach to service improvement. It aims to explore the impact of this through the voices of service users as collaborators and co-authors. The Recovery and Collaborative Care Planning Café (RCCPC) designed with World Café principles, created a safe space to foster inquiry and learning about recovery between service users, carers, and practitioners in an NHS Trust. An important part of the method was in changing conversations towards recovery and living well with conditions applying CHIME concepts (Connectedness, Hope, Identity, Meaning, and Empowerment). Story is a qualitative method known as a well-established effective means of engaging others in sharing experiences and perspectives. Through the stories of service users' experiences participating in the RCCP Cafe, it was clear that they felt that CHIME concepts had a positive impact on the way that their conversations evolved. Accounts of how these conversations had resulted in personal growth and increased connectedness emerged. [ABSTRACT FROM AUTHOR]

Background: The National Health Service (NHS) and general practice are increasingly adopting digital services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. Within a wider project examining digital facilitation (the Di-Facto study) our team conducted a patient survey amongst English primary care practices aiming to investigate patient views of what supports uptake and use of web-based services. This paper reports on the analysis of the free-text responses from the patient survey. Methods: The Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021–2022. We examined free-text responses to two questions relating to access to primary care web-based and support for web-based services. We used qualitative reflexive thematic analysis based on a six-stage process to analyse responses. Results: Of the 3051 patients who responded to the Di-Facto survey, 2246 provided a free-text response. We present our findings in two major themes: systems and structures and their impact on use of web-based services, and 'what works for me', a description of how respondents described what worked, or did not work in terms of their interactions with web-based services. Respondents described how the technology, such as poor practice website design, confusion over multiple digital apps, data security and concerns about eConsultation offerings impacted on use of web-based services. Respondents described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. Respondents described personal and technical barriers that impacted on their use of digital services, and described which web-based services worked well for them. Respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor. Conclusions: This analysis of free-text responses from a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. With an increasing push towards digital solutions in NHS primary care, practices should consider the design, rollout and communication of their web-based services to support patient access. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to critically examine the effects of COVID-19 social discourses and policy decisions specifically on older adult volunteers in the UK, comparing the responses and their effects in England, Scotland, Wales and Northern Ireland, providing perspectives on effects of policy changes designed to reduce risk of infection as a result of COVID-19, specifically on volunteer involvement of and for older adults, and understand, from the perspectives of volunteer managers, how COVID-19 restrictions had impacted older people's volunteering and situating this within statutory public health policies. Design/methodology/approach: The study uses a critical discourse approach to explore, compare and contrast accounts of volunteering of and for older people in policy, and then compare the discourses within policy documents with the discourses in personal accounts of volunteering in health and social care settings in the four nations of the UK. This paper is co-produced in collaboration with co-authors who have direct experience with volunteer involvement responses and their impact on older people. Findings: The prevailing overall policy approach during the pandemic was that risk of morbidity and mortality to older people was too high to permit them to participate in volunteering activities. Disenfranchising of older people, as exemplified in volunteer involvement, was remarkably uniform across the four nations of the UK. However, the authors find that despite, rather than because of policy changes, older volunteers, as part of, or with the help of, volunteer involving organisations, are taking time to think and to reconsider their involvement and are renewing their volunteer involvement with associated health benefits. Research limitations/implications: Working with participants as co-authors helps to ensure the credibility of results in that there was agreement in the themes identified and the conclusions. A limitation of this study lies in the sampling method, as a convenience sample was used and there is only representation from one organisation in each of the four nations. Originality/value: The paper combines existing knowledge about volunteer involvement of and for older adults. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses work in mental health services around the world, constituting the largest professional group.Nurses have been identified as being potentially able to carry out a much wider range of functions than are typically allowed in practice, when provided with suitable training.There are long‐term concerns regarding shortages of mental health nurses in England and many other countries.Workforce data is rarely subject to analysis in peer‐reviewed journals. What the paper adds to existing knowledge?: This paper provides a case study of the workforce patterns of a national mental health nurse (MHN) workforce overtime allowing comparison with other countries and specialities.MHN numbers reduced from 2011 to 2017, then increased to near the 2011 level by 2021, not meeting ambitious national plans for increasing numbers.The mental health nursing proportion of the total NHS nursing workforce decreased through this period.Advanced practice roles and skills are widely, but unevenly, distributed and are provided by a small proportion of nurses.The proportion of nurses working in community settings has increased to constitute more than half of all nurses for the first time.The ratio of support workers to nurses increased in inpatient settings and will continue to change. What are the implications for practice?: Historical challenges in recruiting MHNs suggest that future plans to expand the profession are overly optimistic.To support the development of advanced practice roles and new skill sets, clearer research evidence of impact is required and clearer national guidance regarding best practice models.Good workforce data are essential to inform good workforce planning. Introduction: Data regarding changes in characteristics of the MHN workforce is commonly cited in governmental publications, but is rarely analysed in peer‐reviewed journals, despite ongoing concerns regarding high vacancy rates within mental health services. Aim: The aim of the study was to characterize changes in the MHN workforce, implementation of new nursing roles/skills and alignment with national policy. Method: Analysis of nationally published workforce data, peer‐reviewed publications and governmental policy/planning documents. Results: Nurse numbers declined from 2011 to 2017, subsequently returning to near 2011 levels, but remaining below national targets. Nurses in community settings increased to constitute more than half of all nurses, whilst inpatient numbers declined, although more slowly than bed numbers. The ratio between nurses and support workers changed due to more support workers in inpatient settings. New advanced skills and roles for nurses have increased, but are unevenly distributed, constituting a small proportion of the total workforce. Implications for Practice: This paper provides a case study against which comparisons may be made with the nursing workforce in other countries and specialities. Even clear policy commitment to nursing growth may not deliver planned changes in numbers and introducing new roles may have uneven impact, especially in the absence of a robust evidence base. [ABSTRACT FROM AUTHOR]

Background: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. Aims: To compare the impact of standard parent‐based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. Methods and Procedures: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent‐based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20‐week period. Participants received one of two interventions: (1) Standard Care – indirect group PBI – (PBI) (2) Enhanced Care: indirect group enhanced PBI – (EPBI). Both standardised and non‐standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure – Speech & Language Therapy (PAM‐SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well‐being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. Outcomes and Results: One hundred fifty‐five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur‐Bates Communicative Development Inventories Sentence Length, from pre‐intervention to post‐intervention and 6 months post‐intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval –0.02 to 0.76), although wide variation was found. Conclusions and Implications: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject: Speech, language and communication needs (SLCN) have a knock‐on effect on emotional well‐being, school readiness, literacy and school attainment, putting children at increased risk of long‐term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge: Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work?: This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the complexity of the needs of people with delirium superimposed on dementia • To enhance your knowledge of second-generation activity theory • To recognise the consequences of the separation of physical health and mental healthcare. Background: Delirium superimposed on dementia (DSD) affects the physical, mental and cognitive well-being of the person. The separation of physical health and mental health means that the care of people with DSD is at odds with the multifaceted aetiology and presentation of the condition. There is a lack of research on DSD from a mental health perspective. Aim: To explore UK mental health nurses’ experiences of providing care for people with DSD. Method: Individual semi-structured interviews were conducted with seven mental health nurses from one NHS trust in England. Participants’ experiences were considered through the lens of second-generation activity theory. Data were analysed using framework analysis. Findings: Six themes were identified: awareness of guidance and tools; guidance or tools as ‘paper exercises’; knowing the patient; the multidisciplinary team; care burden; and mental health versus physical health. Conclusion: When providing care for people with DSD, mental health nurses use their skills in knowing patients as individuals. However, this aspect of ‘knowing’ cannot be readily translated into the use of a numerical scoring tool. An integrated approach is required to support the care of people with DSD. [ABSTRACT FROM AUTHOR]

Purpose: Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances? Design/methodology/approach: Development of initial programme theories and associated context–mechanism–outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013). Findings: The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system. Research limitations/implications: Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context. Originality/value: This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems. [ABSTRACT FROM AUTHOR]

Purpose: It is over 20 years since the publication of the Wanless Report, "Securing our Future Health: Taking a Long-Term View". The Wanless Report argued that the National Health Service (NHS) would survive in its current form only if the population became "fully engaged" with it. Design/methodology/approach: In this discussion paper, the authors explored what "fully engaged" meant to Wanless, what it might mean now (allowing for the impact of the anti-vaxxer movement) and what policymakers could do to enhance public engagement. Findings: Although the Wanless Report neatly fitted into other long-term thinking about the NHS, it was unique in that it built economic models to predict the costs and impact of different patterns of NHS performance. Wanless predicted that people's poor levels of health would put considerable pressure on the NHS. This pressure could swamp efforts to meet healthcare targets and improve health outcomes, despite its sizeable investment of money. Wanless set out three possible scenarios for public engagement with the NHS: solid progress, slow uptake and fully engaged. Practical implications: The authors pose questions for policymakers and practitioners. Would a reboot of the Wanless approach be worth the effort for policymakers? If yes, how would it differ from the original? The NHS faces the whole of society; could it be the vehicle for engaging the anti-vaxxer public with the truthfulness of medical science, and will it be this, that is, Wanless' enduring legacy? Originality/value: The exploration of the Wanless Report is complicated (at least for the time being) by the rise of the anti-vaxxer movement's resistance to health promotion and mistrust of part of the NHS. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities face health disparities, including in high‐income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010 (https://www.legislation.gov.uk/ukpga/2010/15/contents), the Mental Capacity Act 2005 (https://www.legislation.gov.uk/ukpga/2005/9/contents), and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally, the recent changes to healthcare organization in the UK, the COVID‐19 pandemic, and the implementation of the Valuing People white paper are discussed. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic impacted on the provision of care and routine activity of all National Health Service (NHS) services. While General Practitioner referrals to memory services in England have returned to pre‐pandemic levels, the estimated dementia diagnosis rate (DDR) fell by 5.4% between March 2020 and February 2023. Methods: In this paper we explore whether this reduction is accurate or is an artefact of the way the NHS collects data. Results: We explore the processes that may have affected national dementia diagnosis rates during and following the COVID‐19 pandemic. Conclusions: We discuss what action could be taken to improve the DDR in the future. Key points: Despite General Practitioner (GP) referrals to memory services in England returning to levels seen before the pandemic, there was a decline of 5.4% in the estimated dementia diagnosis rate (DDR) from March 2020 to February 2023.This paper explores the factors which may have affected the national DDR reduction. These include a backlog in dementia referrals, a reduction in coding of diagnoses, or a decrease in true dementia prevalence secondary to excess COVID‐19 deaths which has yet to be reflected in the DDR denominator.Further work is suggested to accurately capture dementia prevalence in the United Kingdom (UK). These include an up‐to‐date multicentre population‐based cohort study and adjusting the DDR denominator for factors known to affect dementia susceptibility such as deprivation, rurality, and ethnicity. [ABSTRACT FROM AUTHOR]

The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. This study of a Barts Health NHS Trust cohort from 2008 to 2022 aims to elucidate the incidence, clinical outcomes, and complications associated with paediatric T2D. A retrospective analysis utilising electronic and paper records identified 40 patients with T2D. The incidence doubled from 2.6/year in 2008–2013 to 5.4/year in 2014–2018. Sixty-eight percent exhibited co-morbidities, notably learning disabilities. At diagnosis, the mean BMI was 32.4 ± 6.71 kg/m2, with no gender-based disparity and no significant change over a two-year follow-up. The initial HbA1c was 75.2 ± 21.0 mmol/mol, decreasing to 55.0 ± 17.4 mmol/mol after three months (p = 0.001) and then rising to 63.0 ± 25.5 mmol/mol at one year (p = 0.07). While 22/37 patients achieved HbA1c < 48 mmol/mol, only 9 maintained this for a year. Several metabolic and cardiovascular complications were observed at diagnosis and follow-up, with no significant change in frequency. In 2022, 15 patients transitioned to adult services. HbA1c at transition was 74.7 ± 27.6 mmol/mol, showing no change one year post-transition (71.9 ± 26.9 mmol/mol, p = 0.34). This study highlights substantial therapeutic failure, with current management falling short in achieving a sustained reduction in BMI or HbA1c. Novel treatment approaches are needed to improve clinical outcomes and address the high burden of co-morbidities and complications. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the use and content of written guidance produced by mental health services in England and Wales describing hospital leave for informally admitted patients. Design/methodology/approach: Guidance on leave was requested from National Health Service (NHS) mental health trusts in England and health boards in Wales (n = 61) using a Freedom of Information submission. Data were analysed using content analysis. Findings: In total, 32 organisations had a leave policy for informal patients. Policies varied considerably in content and quality. The content of policies was not supported by research evidence. Organisations appeared to have developed their policies by either adapting or copying the guidance on section 17 leave outlined in the Mental Health Act Codes of Practice for England and Wales (Department of Health, 2016; Welsh Government, 2016). Definitions of important terms, for example, leave and hospital premises, were either absent or poorly defined. Finally, some organisations appeared to be operating pseudo-legal coercive contracts to prevent informal patients from leaving hospital wards. Research limitations/implications: Research should be undertaken to explore the impact of local policies on the informal patient's right to life and liberty. Practical implications: All NHS organisations need to develop an evidence-based policy to facilitate the informal patient's right to take leave. A set of national standards that organisations are required to comply with would help to standardise the content of leave policies. Originality/value: To the best of the author's knowledge, this is the first study to examine the use and content of local policies describing how informal patients can take leave from hospital. [ABSTRACT FROM AUTHOR]

Historically, information such as protocols and treatment pathways from specialist teams were shared with ward staff in paper format which proved cumbersome and difficult to update. Improvements were made with the addition of an intranet site, where protocols could be stored and accessed by clinical staff, however it was recognised that navigating the intranet site was not always straightforward and took up precious nursing time. The tissue viability team at the Royal United Hospitals NHS Foundation Trust (RUH) considered how such information might be made more readily available to clinicians. Inspired by widespread increased use of QR codes in public places during the COVID-19 pandemic, the team produced a poster containing multiple QR codes, enabling clinical staff to have instant access to wound care protocols as soon as the information was needed. [ABSTRACT FROM AUTHOR]

Background The term 'long COVID' describes ongoing symptoms and conditions experienced by people infected with SARS-CoV-2. This paper illustrates how a public health approach was used to influence and inform the development of post-COVID services across two Integrated Care Systems (ICSs). Methods A literature review was conducted between October and December 2020 to identify prevalence estimates for long COVID. The prevalence estimates were applied to locally available data on the susceptible population to estimate the number of people with long COVID. They were also used to develop a dashboard to predict fluctuations in the number of people experiencing persistent symptoms over time. Results A substantial number of people in each ICS may have experienced persistent symptoms or complications as a result of COVID-19. In Lancashire and South Cumbria, it is estimated that 33 000 people may have experienced post-COVID-19 syndrome since the beginning of the pandemic, which will include respiratory or cardiovascular complications. Conclusions The findings have been valuable in informing early service developments, engaging with managers and clinicians, and supporting applications for funding at a local level. Continued attention to emergent evidence on this topic will be vital in refining estimates and supporting service planning in the longer term. [ABSTRACT FROM AUTHOR]

In 2016, England's National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients' needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service.In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR's progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes.The NIHR's overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO's recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions. [ABSTRACT FROM AUTHOR]

In April 2013 the local public health function in England was returned from the National Health Service (NHS) to local government, reversing the transfer to the NHS made in 1974 with the abolition of the medical officer of health. Although many in the field had long felt that local government was the appropriate home for public health given its wide-ranging responsibilities for the social determinants of health, the timing was poor. Local government was in the third year of what continued to be an unprecedented ten-year period of austerity imposed by central government with cumulative cuts of the order of 40% for many local authorities. And despite an initial commitment to a ring-fenced public health grant, this grant has been cut each year since 2015–2016 in addition to the wider local authority funding cuts which have had inevitable knock-on effects on the public health function. Crucial public health services such as early years, smoking cessation and sexual health services have all been cut. Despite these cuts the UK government continues to claim a commitment to improving public health and tackling inequalities in health. This study examines the government's discourse on funding local public health services, and the ways in which it has responded to critics through a detailed documentary analysis of key government white papers, ministerial statements and its responses to criticisms, particularly from parliamentary select committees and professional bodies. The paper concludes by considering the implications for effective local public health action in a national regime of austerity. [ABSTRACT FROM AUTHOR]

Purpose: Policies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity. Design/methodology/approach: The analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities. Findings: The place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities. Originality/value: This study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to explore the influence of a talent management scheme in an English National Health Service (NHS) Trust on registered nurses' retention intentions. Background: The retention of nurses is a global challenge, and talent management initiatives can play a role in improving retention. Talent management in its broadest sense is a way in which an organization recruits and retains the workforce that it needs to optimize the services it delivers. Methods: In this qualitative study, eight in‐depth semi‐structured interviews were conducted with registered nurses who had participated in a talent management initiative, at an English acute NHS Trust. Data were collected in July 2019. Results: The talent management initiative influenced positive retention intentions. Retention of nurses was facilitated by the creation of networks and networking. Conclusion: Networks and networking can be viewed as a form of social capital, which was a facilitating factor for positive retention intentions for nurses. Implications for Nursing Management: Talent management initiatives for nurses should be developed and directed to include the building of networks and networking to enable development of social capital. Although this talent management scheme is within the NHS, the issue of nursing retention is global. Application of learning from this paper to other health care systems is possible. [ABSTRACT FROM AUTHOR]

This paper explores public sentiment towards strike action among healthcare workers, as a result of their perceived inadequate pay. By analysing survey data collected in England between 2022 and 2023, the study focuses on NHS nurses and junior doctors, due to their critical role in delivering essential public services. Results indicate higher public support for strikes by nurses and junior doctors compared to other professions such as postal workers, teachers, rail workers, airport workers, civil servants and university lecturers. However, variation in support for strikes by healthcare workers is observed across societal segments. Significant disparities in support are linked to individual political affiliations, left–right ideological positions and trust in the NHS. In short, nonconservative voters, individuals leaning towards left‐wing politics and those with greater trust in the NHS demonstrate higher likelihoods of supporting strikes by health workers. These findings carry implications for future strike decisions and highlight specific target groups for enhanced communication efforts to garner increased public support. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the impact of the Health and Social Care Act, 2012 on London’s rough sleepers as seen from the perspective of one former homeless service user (currently working as a support worker in a day centre providing outreach and “drop in” facilities for people who are street homeless and other vulnerable adults including female sex workers). The discussion centres on some of the unintended impacts of changes to healthcare commissioning; the new arrangements for patient, public representation; and the enhanced role of local councils.Design/methodology/approach This paper is grounded in front line practitioner reflection/opinion and draws on practical experience and observation at Spires, as well as research and government papers published by other service providers. The aspirations of the Health and Social Care Act, 2012 are set out before its practical application are examined from the rough sleeper’s dimension.Findings Putting clinicians and GPs centre stage in the commissioning and purchasing of healthcare may have some benefits for individual patient choice, but it can also dilute patient public involvement in health and social care with negative effects for vulnerable and excluded groups, including rough sleepers. The terms of reference ascribed to Local Healthwatch Organisations, the official representatives of the people, are narrower than previously and limit their ability to influence official policy. The Act centralises control whilst devolving operational responsibility, especially for public health provision on which rough sleepers often rely. It is suggested that local voluntary organisations and specialist “inclusion” health groups are increasingly being expected to take over responsibility for delivering health and social care and that mainstream collaboration is much reduced rather than enhanced by this fragmentation.Research limitations/implications This review is based on the opinion of an “expert by experience” which may not be representative.Originality/value This is one of few papers which present a front line service user/practitioner perspective on the impact of clinical commissioning on services for marginalised groups. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: 'Leave' is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods at home prior to discharge.Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective.While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. What the paper adds to existing knowledge?: The leave policies of NHS mental health services in England and Wales are highly inconsistent.The extent to which policies are consistent with guidance differs depending on which service is providing care. What are the implications for practice?: It is very likely that, because of inconsistencies between services and policies, practice also differs.Clinicians need to understand their responsibilities in the leave process to ensure that patients are supported in their recovery journey.Policymakers need to revisit leave policies in light of evidence from this study. Introduction: Considerable guidance is available about the implementation of leave for detained patients, but individual mental health services are free to determine their own policies. Aim: To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation. Method: A national audit of NHS mental health services leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave and nursing). Definitions of leave‐related terms were extracted and analysed. Results: Fifty‐seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain‐level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave) and 41.9% (nursing). Definitions varied widely and commonly differed from those in relevant guidance. Discussion: Mental health professionals are inconsistently supported by the policy in their leave‐related practice. This could potentially contribute to inconsistent practice and leave‐related patient outcomes. Implications for Practice: To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services, they will need to go beyond their organization's stated policy to ensure this occurs. [ABSTRACT FROM AUTHOR]

Smoking tobacco is both a pharmacological addiction and a serious social and public health issue. Smoking cessation services for pregnant women save babies' lives and have the potential to improve the health of families and communities. Engaging with pregnant smokers and their households towards quitting smoking requires a whole-team approach. Protected time for the specialist smoking in pregnancy team and freedom to develop the service improvement approach has been key in the setting described in this paper. The approach to smoking cessation described in this paper is of the quality improvement arm within the 'Saving babies' lives' bundle of interventions in Poole Hospital NHS Foundation Trust. The 'plan, study, do, act' model is described with a description of its implementation using sequential learning, enquiry, testing and being open to new ideas and approaches. The main driver questions have been: 'how do we reach pregnant smokers who are not motivated to quit?' and 'what approaches will potentiate success for this group?' [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the outcomes identified by the evaluation of the national programme of integrated care pilots (ICPs) in England in the context of wider policies designed to deliver integrated care and to consider the challenges presented to policy makers and evaluators in distilling usable insights to promote effective policy. Design/methodology/approach: This is a review of the ICP evaluation findings and the findings of a number of systematic reviews into aspects of integrated care. This paper shows the contextual analysis of these findings in relation to health policy in England. Findings: The evaluation of ICPs in 2012 produced mixed results with some potentially useful findings for policy makers. However, numerous integrated care initiatives succeeded the ICPs suggesting that insights from evaluation are of limited usefulness to policy makers or are difficult to implement. A shift in macro policy within the English NHS may support integrated care by aligning objectives of clinical teams with those of the wider systems within which they operate. Research limitations/implications: This review has not been based on a systematic review of the evidence on integrated care and reflects the personal experiences and views of the authors who have been active in this field of research for many years. Originality/value: This paper considers why evaluation findings appear limited in their impact on policy in the field of integrated care. Views as to how evaluation might be undertaken so that it generates actionable insights are advanced. [ABSTRACT FROM AUTHOR]

In the British NHS the principle of exceptionality involves assessing whether a patient is sufficiently different from the generality of patients to justify providing a treatment, such as an expensive cancer drug, not approved for routine funding. In England, individual requests for certain high‐cost treatments are considered by local panels that examine exceptionality alongside treatment efficacy and cost as the main criteria for funding. This was also the case in Wales until September 2017. Our paper draws on audio recordings of panel meetings and interviews in a Welsh Health Board to investigate how exceptionality was constructed in discussions. It focuses on the problematic combination of different decision criteria in meeting talk, particularly regarding the discourses associated with efficacy and exceptionality. Exceptionality is a fluid category that raised questions about the evidence‐based nature of panel decision making. In particular, the paper discusses the use of subgroup data from RCTs and the difficulty of deciding how small a subgroup of patients should be before it is deemed exceptional. Determining exceptionality has been an important mechanism for deciding that a minority of NHS patients can still receive high‐cost treatments not routinely provided for all. As a neglected rationing mechanism it warrants sociological examination. [ABSTRACT FROM AUTHOR]

Purpose Current debates surrounding the NHS contract in England are suggesting that it is in need of change to support an integrated health and social care transformation agenda that meets the needs of an ageing chronically ill population. The purpose of this paper is to describe a three-phase project in England that sought to develop and validate a whole systems contracting model for integrated health and social care focusing on older people with long-term conditions, and based on joint outcomes.Design/methodology/approach A participative mixed-method approach for the development of the contracting model was used; this consisted of a literature review, a design phase drawing on consensus method through stakeholder discussions and an international validation phase.Findings The final contracting model consists of four overarching and interrelated core elements: outcomes; partnership, collaboration and leadership; financial: incentives and risk; and legal criteria. Each core element has a series of more detailed contracting criteria, followed by further specifications attached to each criteria.Research limitations/implications While the policy environment appears to be conducive to change and encourages the adoption of new ways of thinking, there are difficulties with the implementation of new innovative models that challenge the status quo, and this is discussed.Practical implications The paper concludes with reflections on the way forward for local development and implementation.Originality/value There is currently much discussion for the need to realign contracting for integrated care that has a better fit for the transformation agenda, but until now, there have been no attempts to develop a whole systems approach that focusses on joint outcomes. This research bridges the gap but recognizes the challenges to implementation. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC. [ABSTRACT FROM AUTHOR]

Purpose: The Cameos of Care Homes project is an opportunity to use the medium of film to showcase the experiences and reflections of frontline care home staff whose employers participated in the National Health Service (NHS) England Vanguard programme. Reflecting on their involvement in one of the Enhanced Health in Care Homes Vanguards, 12 staff describe, in front of the camera, the impact on themselves and their colleagues, on their care for their older residents, and on the wider culture of the care home. The paper aims to discuss this initiative. Design/methodology/approach: The paper reports the experiences of care home staff that were purposefully recorded on film about their participation in a care home Vanguard. The recruitment of the care homes and staff is described, as are the development of interview questions and approaches needed when filming is considered as a research method. Findings: Participating care home staff reported that their involvement in the Vanguard programme had improved knowledge, confidence, morale, communication skills and the homes' learning cultures. They were enthusiastic about reporting their experiences on film. Examples were given of proactive early support from local NHS staff leading to improvements in care, thereby reducing demand on the NHS. However, participation was resource intensive for care homes. Care home staff hoped the support that accompanied the Vanguard programme would continue but were uncertain to what degree this would happen once the Vanguard programme ceased. Research limitations/implications: The interviews were undertaken with a self-selecting group of care home staff from two care homes operating in one of the six Vanguard sites in England. By their very nature, interviews for a public film cannot provide anonymity. Practical implications: Researchers seeking the views of care home staff may wish to consider filming interviews and presenting the film as a research output that is engaging and informative for care home and wider audiences. Originality/value: The paper presents an analysis of filmed interviews with care home managers and care workers working with older people. Their views on the Vanguard initiative have not been widely considered, in contrast to the sizeable literature relating to NHS activity and expenditure. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities.Studies of nurse consultants in the United Kingdom have largely been non‐empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. What this paper adds to existing knowledge?: The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change.A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. What are the implications for practice?: Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors.The continued absence of robust evidence as to the clinical/cost‐effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint.Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. Introduction: The nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders. Aims: The main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts. Method: We used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross‐sectional survey of post holder characteristics and semi‐structured interviews with directors of nursing. Results: Of 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0–12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work. Discussion: Nurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers. Implications for practice: Developing and sustaining nurse consultant roles requires role clarity and active support from nurse leaders. Roles need to demonstrate their value to the clinical systems in which they work. [ABSTRACT FROM AUTHOR]

Purpose The NHS needs to adapt as never before to maintain and plan for an integrated and sustainable multi-professional workforce, spanning all health and care sectors. This cannot happen without system leaders embracing workforce transformation at scale and enabling system-wide collaboration and support for multi-professional learning and role development. "By learning together, we learn how to work together". The paper aims to discuss these issues.Design/methodology/approach The case studies included in this paper provide evidence of the ability of NHS systems to adopt integrated workforce models at scale. The case studies were chosen to demonstrate how system-wide change is possible, but still requires a partnership approach to innovation, strategic workforce planning and commissioner support for new models of care.Findings With partnership working between arm's length bodies, commissioners, educators and workforce planners, the NHS is more than capable of generating a transformed workforce; a workforce able to continue providing safe, effective and joined-up person-centred care.Research limitations/implications The focus of this paper is integrated workforce development undertaken by Health Education England from 2017 to the date of drafting. The case studies within this paper relate to England only and are a cross-section chosen by the authors as a representative of Health Education England activity.Practical implications The NHS needs to find ways to use the wider health and care workforce to manage an ever-increasing and diverse patient population. Silo working, traditional models of workforce planning and commissioning no longer provide an appropriate response to increasing patient need and complexity.Social implications The evolution of the NHS into a joined-up, integrated health and social care workforce is essential to meet the aspirations of national policy and local workforce need – to centre care holistically on the needs of patients and populations and blur the boundaries between primary and secondary care; health and social care; physical and mental health.Originality/value This paper contains Health Education England project work and outcomes which are original and as yet unpublished. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a commentary on the paper "Specialist community teams for adults with learning disabilities: referrals to a countywide service in England" by Isabel Clare and colleagues. Design/methodology/approach: This paper reviews some themes presented in this paper relating to the practice and management of community teams for adults with learning disability within the context of recent national service initiatives. Findings: There is a limited literature on the practice, purpose and service caseload management of community teams. Taken in the context of recent national service initiatives, the paper by Clare et al. illustrates the gaps between the way community teams are currently processing demands and how these services will likely need to behave in future. Originality/value: There is little recent literature examining the purpose of, and management approaches in, community teams and this addition should stimulate some further consideration of how community teams need to adjust to meet changing demands. [ABSTRACT FROM AUTHOR]

Despite years of calls for adoption of a Just Culture, it is evident that taking this concept from paper to practice has been slower than expected. Many have cited the subpar application of the Just Culture framework and, recently, questions have been raised regarding how the Just Culture framework is perceived by those impacted by harm, including patients, family members, and staff. Though this framework is one tool that can be used to guide inquiry after harm events, its use, independent of active efforts toward restoration of relationships with patients, families, and staff, could compromise engagement and therefore learning. A lack of focus on restoring the trust of those affected by harm in parallel with the event investigation introduces a risk of further compounding the harm for all involved. Those involved in safety work at NHS England have recognized the need to apply a systems mindset within a concerted effort toward more compassionate engagement for optimal learning and improvement. In response, they have included compassionate engagement and involvement of those affected by patient safety incidents as a foundational pillar in the NHS England Patient Safety Incident Response Framework. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to demonstrate the approach taken in delivering the quality and impact elements of Knowledge for Healthcare, the strategic development framework for National Health Service (NHS) library and knowledge services in England. It examines the work undertaken to enhance quality and demonstrate the value and impact of health library and knowledge services. It describes the interventions developed and implemented over a five-year period 2015–2020 and the move towards an outcome rather than process approach to impact and quality. Design/methodology/approach: The case study illustrates a range of interventions that have been developed, including the outcomes of implementation to date. The methodology behind each intervention is informed by the evidence base and includes professional engagement. Findings: The outcomes approach to the development and implementation of quality and impact interventions and assets provides evidence to demonstrate the value of library and knowledge staff to the NHS in England to both high-level decision-makers and service users. Originality/value: The interventions are original concepts developed within the NHS to demonstrate system-wide impacts and change. The Evaluation Framework has been developed based on the impact planning and assessment (IPA) methodology. The interventions can be applied to other healthcare systems, and the generic learning is transferable to other library and knowledge sectors, such as higher education. [ABSTRACT FROM AUTHOR]

Since the introduction of the Improving Access to Psychological Therapies (IAPT) programme in NHS England, psychological therapy has gained traction as 'evidence-based' and 'effective' in both clinical and economic terms. In the process, psychotherapeutic care has been reconstituted as highly manualised, standardised, and quantifiable. Drawing on anthropological fieldwork with mental health practitioners, this paper examines some common tensions that practitioners experience in their daily work where psychotherapy is sought within the framework of evidence-based medicine (EBM). For therapists working within IAPT, extensive monitoring and practices of accountability have come to undermine psychotherapeutic efforts to care for patients as 'people'. As a result, many practitioners now feel that they are working in a 'factory of therapy' whereby psychological treatment is recast in the service of outcome measures, and by which critique of the IAPT service, as well as caring relations within it, have been precluded. [ABSTRACT FROM AUTHOR]

England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms. [ABSTRACT FROM AUTHOR]

Background In April 2020, Covid-19 brought NHS elective procedures to a halt. The aim of this paper is to produce accurate forecasts on the building backlog, highlight the state of waiting lists currently and propose solutions required to prevent a public health crisis. Method Using data published by NHS digital and NHS England on previous years, we have analysed and used this to produce estimates of cancellations and missed cases. We also analyse government data on waiting lists and show compliance or lack of with these. Results We show that compliance with waiting list times pre pandemic was falling year on year (83.2% in 2020 down from 87% in 2019). Every month that passes we estimate that 400 000 cases are not being performed. This may include urgent cancer care work in some trusts. Conclusions Waiting lists have been governed by strict rules since 2004. Given falling compliance with 18-week intention to treat we believe the scale of the backlog combined with NHS capacity diminished due to Covid-19 precautions is a public health crisis waiting to occur. We identify difficulties in resuming elective work and suggest strategies that could be employed to avoid a public health crisis. [ABSTRACT FROM AUTHOR]

Purpose Comment on the contribution that housing can make to delivering better health and wellbeing outcomes. More specifically, the purpose of this paper is threefold: summarise recent evidence that makes the case for housing in helping to address health and social care issues; comment on the challenges and opportunities of partnership working; and describe examples of interesting and innovative local joint provision.Design/methodology/approach Draws on the author's briefing papers on housing, health and social care for housing quality network, which is a national housing consultancy organisation as well as the author's role as Chairperson of East Midlands Housing Care and Support, which is a regional housing association.Findings Collaboration between housing, health and social care is making slow progress at the national level in England. This is despite an ever-increasing evidence base highlighting that good housing can help to address issues, such as delayed discharges. Nevertheless, there are an increasing number of interesting examples of successful local initiatives on housing, health and adult social care. The way forward is to facilitate joint working at a local level.Originality/value Focusses on the success of examples of local joint working between housing, health and social care to achieve better outcomes for vulnerable people. [ABSTRACT FROM AUTHOR]

Increasing attention has focused on the role of joint commissioning in health and social care policy and practice in England. This paper provides an empirical examination of the three discourses of joint commissioning developed from an interpretative analysis of documents by Dickinson et al. (2013; BMC Health Services Research, 13) and applied to data from our study exploring the role of knowledge in commissioning in England. Based on interviews with 92 participants undertaken between 2011 and 2013, our analysis confirms that the three discourses of prevention or empowerment or efficiency are used by professionals from across health and social care organisations to frame their experiences of joint commissioning. However, contrary to Dickinson et al., we also demonstrate that commissioners and other stakeholders combine and trade off these different discourses in unexpected ways. Moreover, at sites where the service user experience was central to the commissioning process (joint commissioning as empowerment), a greater sense of agreement about commissioning decisions appeared to have been established even when the other discourses were also in play. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise some of the factors that can make it challenging for nurses to access training and maintain competence in using medical devices • To learn about development of an electronic medical device training passport that aims to better identify nurses' training needs • To understand the benefits of an electronic medical device training passport for nurses, nurse managers and clinical leaders Background: All nurses, particularly those working in critical care settings, are required to use medical devices when providing patient care. However, inconsistent practice and variations in documentation can make it challenging for nurses and nurse managers to identify what medical device training is required and when. Aim: To develop and evaluate the use of an electronic medical device training passport to identify the training needs of nurses in intensive care units (ICUs). Method: A pilot study was conducted in a multi-unit critical care department in London, England, to determine if the passport could make it easier to identify ICU nurses' medical device training needs compared with existing practice. Nine participants were first asked to identify their needs using existing spreadsheets or paper records, then asked to identify them using the passport. The participants were also interviewed to identify their training requirements before and after using the passport. The data were analysed quantitatively and qualitatively. Findings: The electronic passport significantly improved identification of medical device training needs compared with paperwork or spreadsheets for all device groups, except for medical devices used on high dependency units (P≤0.005). However, there may be issues related to nurses' behaviours and expectations, particularly that staff do not always recognise their need for training. Conclusion: The findings of this pilot study suggest that the use of an electronic medical device training passport has many benefits and could make it easier to identify ICU nurses' training needs in clinical practice. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomesTo date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment.There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices What this paper adds to existing knowledge?: This study provides unique insights into service and personalized non‐treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patientsIt reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice?: The need to apply findings for the development of best practice guidanceFactors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff. [ABSTRACT FROM AUTHOR]

Clinical academic career pathways for nurses, midwives and allied health professionals are a strategic priority for NHS England, and there has been significant investment in the National Institute of Health Research integrated clinical academic programme for non-medical healthcare professionals. Nurses, midwives and allied health professionals face numerous barriers to successfully building a clinical academic career. For those outside the integrated clinical academic programme, clinical academic career approaches are varied and often driven by individual practitioners rather than robust organisational processes or strategy. The vision of 'future midwife' is that midwives maximise opportunities in research and scholarship. However, there is little clarity about how these academic aspirations may be supported. This reflective lived experience discussion paper explores key issues around clinical academic midwifery careers, including how space for clinical academic midwives can be assured and the steps midwives can take to start to develop this rewarding and important career. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is designed to explore the relationship between information and clinical governance in the English NHS. Design/methodology/approach - The paper is a personal reflection based upon the interim report of the National Information Governance Committee (NIGC) of the Care Quality Commission. Findings - The contribution of the NIGC to clinical governance in England has been significant for a number of reasons. Most notably, it has been embedded at the heart of an organisation concerned with the whole spectrum of health and social care, with a role where information is seen predominately as a means to deliver better care rather than an end in itself. The recommendation to establish a specific and mandatory information governance (IG) element of the inspection regime reflects the fact that without validation of the evidence base, the whole inspection regime may be seen as resting on insecure foundations, and provides re-assurance in the integrity of the whole inspection process, well beyond the scope of IG. Originality/value - The paper provides an insight into policy making at the heart of clinical governance, and its relationship with IG. It highlights the fact that the work of the NIGC has placed validation of information at the heart of the new CQC inspection regime, providing increased confidence in the information on which the rest of the inspection process is based. [ABSTRACT FROM AUTHOR]

Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Changes in demographics and disease patterns are challenging health and care systems across the world. In England, national policies have reset the direction of travel for the NHS. Collaboration, integration and personalisation are intended to become prime principles and drivers for new models of care. Central to this is the concept of population health management. This has emerged, internationally, as a method to improve population health. Fundamental for population health management to succeed is the use of integrated data, analytics combined with professional insight and the adoption of a learning health system culture. This agenda reaches beyond the NHS in England and the public health profession to embrace a broad range of stakeholders. By drawing on international experience and early experience of implementation in the United Kingdom, the potential for health and care systems in England to become world leading in population health management is explored. Design/methodology/approach: A viewpoint paper. Findings: Population health management is a major change in the way health and care systems look at the challenges they are facing. It makes what is happening to individuals, across the continuum of care, the essence for insight and action. The NHS has the components for success and the potential to become world leading in delivery of population health management as part of its integrated care agenda. Originality/value: This is the first viewpoint paper to set out how population health management contributes to the integrated care agenda in the NHS. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report the findings of a study that explores the contribution volunteers make to social care for older adults, identifying lessons for the social care sector and policymakers. Design/methodology/approach: An exploratory multiple case study design was used to capture the perspectives and experiences of managers of services, volunteer co-ordinators, volunteers, paid care staff and older people. Seven diverse social care organisations took part in the study drawn from three locations in the South West of England. Findings: This study identified three distinct models of volunteer contribution to social care services for older people. Although the contributions made by volunteers to services are valued, the study drew attention to some of the challenges related to their involvement. Research limitations/implications: The organisations taking part in this small-scale study were all based in the South West of England, and the findings are therefore not generalisable but contribute to the growing evidence base related to this important field. Practical implications: This study demonstrates the importance of the volunteer co-ordinator role and suggests that it is properly funded and resourced. It also confirms the importance of volunteers receiving appropriate training and support. Originality/value: Given the increasing involvement of volunteers in the provision of social care, this paper provides lessons to ensure the role of volunteers in social care enhances rather than diminishes the quality of care provided. [ABSTRACT FROM AUTHOR]

Personal health budgets (PHBs) are being promoted in England as expanding the benefits of choice and control to individuals with healthcare needs. National Health Service (NHS) money is provided to eligible people to use as set out in approved care plans, including direct employment of personal assistants (PAs). The government plans to increase NHS‐funded PHBs and to further introduce integrated personal budgets (IPBs). This potentially creates more demand for directly employed or self‐employed PAs with health‐related skills. The objective of this paper is to report findings from interviews with PAs (n = 105) and key informants (n = 26) from across England, undertaken between October 2016 and August 2017, about the potential for the PA workforce to undertake 'health‐related' tasks as facilitated by the introduction of PHBs. PAs were purposefully recruited to ensure the sample included participants from different geographical locations. Key informants were purposefully selected based on their knowledge of policy and community services. Data were analysed quantitatively and qualitatively. This paper focuses on reporting qualitative findings, which are set within the theoretical framework of normalisation process theory to explore implementation challenges of PHBs. The majority (64%) of PAs confirmed that they saw their current roles as congruent with PHBs, were willing to engage with PHBs and undertake health‐related tasks. However, 74% of PAs said they would need additional training if enacting such roles. Key informant interviews appraised the development of PHBs as complex, noting incongruences arising from NHS and social care‐funded PAs carrying out similar roles within different organisational systems. We conclude the current PA workforce is willing to take on PHB work and is likely to interweave this with work funded by PBs and self‐funding care users. Implications include the need for careful consideration of training requirements and delivery for PHB‐funded PAs. [ABSTRACT FROM AUTHOR]

The difficulty of measuring public services outcome results in governments adopting some quality performance measurements to oversee the standards and characteristics of the presented services. The study empirically tests the theory of performance management and the extent the waiting time policy would result in higher quality service and better health outcomes in 161 trusts in England from 2010/2011 to 2013/2014. The results show that higher waiting admission share has significant adverse effect on quality standards in terms of mortality rate. Moreover, the findings show that shorter range of waiting time is statistically associated with higher patients' reported heath gains. However, the paper shows evidence of the presence of the output distortions effect of performance management strategy. The study shows that hospitals with lower mean waiting time have significantly higher readmission rate within 28 days of discharge. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England (2015/2016–2017/2018). It focuses on the perceived facilitators and barriers affecting the development and implementation of the NCM programme and offers some insight into the role of national level support in enabling local integration initiatives. Design/methodology/approach: A set of 29 interviews were carried out with a variety of respondents at the national level (including current and past programme leads, strategic account managers, advisors to the programme and external regulators) between October 2017 and March 2018, and analysed thematically. Findings: A set of facilitative elements of the programme were identified: the development of relationships and alliances, strong local and national leadership, the availability of expert knowledge and skills, and additional funding. Challenges to success included perceived expectations from the national Vanguard programme, oversight and performance monitoring, engagement with regulators, data availability and quality, as well as timetables and timescales. Crucially, the facilitators and challenges were found to interact in dynamic and complex ways, which resulted in significant tensions and ambiguities within the support programme. Research limitations/implications: While the sample was drawn from a range of different senior players and the authors ensured a diverse sample associated with the NCM support programme, it inevitably cannot be complete and there may have been valuable perspectives absent. Originality/value: The paper demonstrates that the analysis of facilitators and challenges with respect to the national support of implementation of integrated care initiatives should move beyond the focus on separate influencing factors and address the tensions that the complex interplay among these factors create. [ABSTRACT FROM AUTHOR]