Search

Long covid (persistent COVID‐19) is a new disease with contested aetiology and variable prognosis. We report a 2‐year ethnography of UK long covid clinics. Using a preformative lens, we show that multidisciplinary teams (MDTs) built working knowledge based on shared practices, mutual trust, distributed cognition (e.g. emails, record entries), relational knowledge of what was at stake for the patient, and harnessing uncertainty to open new discursive spaces. Most long covid MDTs performed the working knowledge of 'rehabilitation', a linked set of practices oriented to ensuring that the patient understood and strove to 'correct' maladaptive physiological responses (e.g. through breathing exercises) and pursued recovery goals, supported by physiotherapists, psychologists and generalist clinicians. Some MDTs with a higher proportion of doctors (e.g. cardiologists, neurologists, immunologists) enacted the working knowledge of 'microscopic damage', seeking to elucidate and rectify long covid's underlying molecular and cellular pathology. They justified non‐standard investigations and medication in selected patients by co‐constructing an evidentiary narrative based on biological mechanisms. Working knowledge was ontologically concordant within MDTs but sometimes discordant between MDTs. Overt ontological conflict occurred mostly when patients attending 'rehabilitation' clinics invoked the working knowledge of microscopic damage that had been generated and circulated in online support communities. [ABSTRACT FROM AUTHOR]

The UK has a growing ageing population with increased prevalence of long-term conditions. It has the potential to overwhelm the country's healthcare system. The COVID-19 pandemic and its risk of transmission provided an opportunity for people with long-term conditions to focus on self-care and for district nurses to promote self-management. Self-management strategies, such as digital technology, motivational interviewing, social prescribing and shared decision-making can assist them in planning a whole-population approach towards managing physical and mental wellbeing. For this to become a reality, investment is needed to educate the patients, their carers, district nurses, multidisciplinary teams and to ensure the sustainability of self-care methods for future practice. [ABSTRACT FROM AUTHOR]

Multidisciplinary teams are increasingly advocated for in healthcare policy consequent to their capacity to develop innovative solutions to seemingly intractable service and care challenges. Recent arguments that inspirational leadership styles may foster innovation in multidisciplinary teams point to their potential value in this effort. However, inconsistency in the capacity of such leaders to engender innovation highlights the need to understand the mechanisms and boundary conditions that determine when such leadership generates positive effects. We argue that follower positive mood acts to mediate the path between inspirational leadership and innovation and may account for its variable effects. By increasing positive team mood, inspirational leaders can potentially bring about more flexible thinking and enhance innovation but can also increase reliance on less effortful information processing, undermining innovative potential. In an effort to address the dilemma posed by these contrasting effects, we propose that professional salience acts as an important boundary condition of this relationship such that only when profession is salient do inspirational leaders enhance multidisciplinary team innovation through positive mood. An analysis of survey data from 60 UK‐based multidisciplinary healthcare teams, investigating the inspirational leadership of practice‐based innovation, supports our moderated mediation model. Finally, the implications for HRM are considered, specifically for leader development and work team design. [ABSTRACT FROM AUTHOR]

Background: It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID‐19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on decision‐making, communication, or participation in the context of MDT meetings specifically. Methods: This was a mixed method, prospective cross‐sectional survey study taking place in the United Kingdom between September 2020 and August 2021. Results: The participants were 423 MDT members. Qualitative findings revealed hybrid working and possibility of virtual attendance as the change introduced because of COVID‐19 that MDTs would like to maintain. However, IT‐related issues, slower meetings, longer lists and delays were identified as common with improving of the IT infrastructure necessary going forward. In contrast, virtual meetings and increased attendance/availability of clinicians were highlighted as the positive outcomes resulting from the change. Quantitative findings showed significant improvement from before COVID‐19 for MDT meeting organisation and logistics (M = 45, SD = 20) compared to the access (M = 50, SD = 12, t(390) = 5.028, p = 0.001), case discussions (M = 50, SD = 14, t(373) = −5.104, p = 0.001), and patient representation (M = 50, SD = 12, t(382) = −4.537, p = 0.001) at MDT meetings. Discussion: Our study explored the perception of change since COVID‐19 among cancer MDTs using mixed methods. While hybrid working was preferred, challenges exist. Significant improvements in the meeting organisation and logistics were reported. Although we found no significant perceived worsening across the four domains investigated, there was an indication in this direction for the case discussions warranting further 'live' assessments of MDT meetings. [ABSTRACT FROM AUTHOR]

Team case formulation on acute psychiatric wards aims to support staff to manage significant levels of challenging behaviour. However, there is limited research on staff experience of case formulation in this setting. This study aimed to investigate staff experience of team case formulation sessions on acute psychiatric wards and their impact on staff wellbeing. Eighteen multidisciplinary staff (nurses, doctors, occupational therapists, support workers, activities coordinators) from five acute wards at a South London psychiatric hospital completed a semi-structured interview and visual analogue scales on their experience of attending case formulation. Thematic analysis was employed to analyse qualitative data. Participants reported that case formulation supported staff to develop a holistic understanding of service users, provided a safe space for staff to discuss the impact of challenging behaviour and improved teamwork and communication. Participants reported that these benefits increased their ability to identify and support the needs of service users and improved therapeutic relationships. Challenges with establishing continuity of care were highlighted. Team case formulation is an important intervention to support ward staff and has significant benefits to staff wellbeing and quality of care. Greater integration with existing ward practices may benefit both staff and service users. [ABSTRACT FROM AUTHOR]

The transition of Negative Pressure Wound Therapy (NPWT) from hospitals to community care is a significant advancement in patient care, driven by increased practitioner competence and technological improvements. Modern, mobile NPWT systems, equipped with smaller pumps, have expanded treatment options and reduced hospital stays. However, discharging patients with NPWT systems introduces some logistical challenges, including staff training, supply management and effective communication between hospital staff and community teams. Practical challenges include achieving secure seals in difficult anatomical locations, managing patient mobility and adapting care practices to home environments. Despite these challenges, the benefits of community-based NPWT are well-documented, reducing hospital costs and improving patient outcomes. Collaboration with NPWT system providers is essential to ensure appropriate training for community nurses, especially given the variety of products used across different trusts. The successful integration of NPWT into community settings demands a collaborative and multidisciplinary approach, addressing logistical, training and operational barriers to maximise its potential in improving patient outcomes.

Offloading is an essential part of the treatment of diabetic foot ulceration. However, it is not always used, despite clear international and national guidelines. To address inconsistent levels of implementation in the UK, clinicians were invited to online discussion groups to identify potential barriers to effective offloading in their practice. Through the groups, clinicians were able to identify key barriers to effective offloading and exchange best practice with their colleagues. This was a valuable exercise in supporting them through the COVID-19 pandemic, which has been a period of unprecedented challenges to clinical practice, and provided them with ideas and support to make changes to improve patient care. [ABSTRACT FROM AUTHOR]

This article describes The Evidence of Impact Model that was recently developed to support the analysis of short- to medium-term impact arising from Participatory Action Research and Developmental Evaluation approaches that were used within the Evidence for Change initiative. Evidence for Change was a team capacity building initiative that supported rapid, bottom-up, evidence informed change in health and social care environments. To explain the need for The Evidence of Impact Model and outline how it was developed, a variety of similar models are explored and the challenges of capturing impact arising from Evidence for Change are discussed. The resulting new model based on the existing concept of micro, meso and macro levels of impact is outlined in detail with supporting qualitative evidence. The authors conclude that The Evidence of Impact Model provides an effective lens for exploring impact at a variety of levels within an emerging and complex environment. [ABSTRACT FROM AUTHOR]

There are more than one million people living with chronic obstructive pulmonary disease (COPD) in the UK. COPD does not follow a predictable course and differs from person to person. It is often difficult to determine the stage that a person has reached in the condition: while some patients will present with a gradual decline, others may remain stable for years, and some will require hospital admission for respiratory support. The uncertainties around the nature and progression of COPD make decisions about end-of-life (EOL) and starting EOL care challenging. This article explores some of the indicators of decline in a person with COPD, including exacerbations, cognitive dysfunction, sarcopenia, depression and anxiety. It also discusses the importance of starting appropriate EOL discussion with patients, as well as the many benefits of multidisciplinary team working when it comes to recognising care needs and enhancing patients' quality of life. [ABSTRACT FROM AUTHOR]

Effective communication within nursing and multiprofessional healthcare teams is essential to promote patient safety. However, communication is a complex concept comprising various elements and variables that affect how messages are delivered, received and interpreted. In this article, the author explores communication within healthcare teams and provides some insight into the factors that affect team communication, such as interpersonal relationships. The author also explores organisational culture and cultural sensitivity, and discusses some evidence-based approaches to enhancing communication within healthcare teams., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

This study investigates a moderated mediation model of professional commitment and team effectiveness through cognitive diversity moderated by task conflict. Data were collected from 70 UK healthcare teams and their leaders using two questionnaires. We find that teams comprised of members who have, on average, high professional commitment are more effective than teams of members who are less committed and that this path is mediated by cognitive diversity and contingent on task conflict. Team composed of members who are strongly committed to their profession may be more effective consequent to their advocacy of different perspectives and expertise, reflecting cognitive diversity. However, this positive effect of professional commitment is not universal but contingent on the level of disagreement between members on task-related issues. This is one of the first studies to demonstrate that professional commitment can increase team effectiveness and does so through a complex contingent path. While few studies have investigated professional commitment, our results suggest that such commitment can be of great value to multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Purpose – Previous research has identified a need for greater clarity regarding the functions of multidisciplinary team (MDT) meetings in UK community mental health services. The purpose of this paper is to identify the functions of these meetings by systematically reviewing both primary research and academic discussion papers. Design/methodology/approach – Papers relating to adult community mental health teams (CMHTs) in the UK and published between September 1999 and February 2014 were reviewed and appraised using NICE quality checklists. The search was broad in scope to include both general CMHTs and specialist CMHTs such as early intervention psychosis services and forensic mental health teams. A thematic synthesis of the findings was performed to develop an overarching thematic framework of the reported functions of MDT meetings. Findings – None of the 4,046 studies identified directly investigated the functions of MDT meetings. However, 49 mentioned functions in passing. These functions were categorised into four thematic domains: discussing the care of individual patients, teamwork, team management and learning and development. Several papers reported a lack of clarity about the purpose of MDT meetings and the roles of different team members which hindered effective collaboration. Practical implications – Without clearly agreed objectives for MDT meetings, monitoring their effectiveness is problematic. Unwarranted variation in their functioning may undermine the quality of care. Originality/value – This is the first systematic review to investigate the functions of CMHT MDT meetings in the UK. The findings highlight a need for empirical research to establish how MDT meetings are being used so that their effectiveness can be understood, monitored and evaluated. [ABSTRACT FROM AUTHOR]

This article gives a reflective overview on cancer management from a urological perspective. It is based on anecdotal evidence and observations of local practice, and highlights some of the inherent difficulties of delivering a robust service in a target-driven healthcare system. Cancer is a complex disease. It is crucial that stringent measures are used to ensure those affected by it receive care that is of the highest quality, delivered in a timely manner, and tailored to meet the individual's needs. In 2000, the Government's attempt to increase competition among healthcare providers in the delivery of care, and thereby healthcare quality and efficiency, resulted in a number of healthcare reforms being introduced in the UK. Central to these were the NHS Cancer Waiting Time standards, which were designed to fast-track care delivery in the management of cancer patients. The multidisciplinary teams play a pivotal role in this process and their contribution is imperative to achieving the desired outcomes. It is acknowledged that targets can be beneficial, but there are clear unintended consequences as well. Increases in urgent referrals result in significant screening demands and, consequently, newly diagnosed cancers. This, combined with factors such as patient choice and costs, put added pressure on NHS establishments and health professionals to deliver care within the target specifications. [ABSTRACT FROM AUTHOR]

Social workers have worked with older people with mental ill health in multidisciplinary teams for many years. Research regarding their contribution is nevertheless sparse. This article addresses this gap. Qualitative data from semi-structured staff interviews were drawn from a multiple case study of community mental health teams (CMHTs) for older people, some with and others without social worker members. Interviews included questions about team roles and the impact of the presence or absence of social workers on team functioning. A grounded theory approach was adopted to analyse the data, enabling issues of importance to interviewees to emerge. Non-social work CMHT staff were found to place a high value on social worker team membership due to their specific skills, knowledge and values, and with regard to communication pathways. Social workers and other team members' views were found to differ regarding whether social workers within CMHTs should operate as generalists or specialists. The findings suggest the need for formal structures extending beyond the co-location of multidisciplinary staff; appropriate and sufficient supervision for social work team members; and the development of more workable and direct referral systems between CMHTs and social services adult social work teams. [ABSTRACT FROM AUTHOR]

Aim: Sacrococcygeal teratoma (SCT) is a rare paediatric germ cell tumour (1:40,000). Long-term data regarding urinary tract and bowel function after SCT resection is limited to few studies. A UK Children's Cancer and Leukaemia Group (CCLG) Surgeons multicentre study aimed to critically analyse long-term functional outcomes in patients following resection of SCT., Methods: Nationwide study of UK paediatric surgical oncology centres using a standardised data collection form. All index cases of newborn infants and children <16 years with SCT diagnosis during 2005-2015 were included., Results: 165 SCT patients treated at 14 UK paediatric surgical oncology centres were included. Median age at presentation was 1 day [interquartile range, IQR: 0-25]; median age at surgery was 10 days [IQR: 4-150]. One hundred seventeen (70%) were female and 48 (30%) male. Antenatal diagnosis was made in 44% index cases. Total 59% of patients were Altman Stage I or II lesions. Follow-up data were available in 83% cases. Tumour recurrence occurred in 13 (7%) patients at median age 13 months [IQR: 8.75-30 months]. Fifty-nine (36%) of 165 patients had documented adverse bladder or bowel dysfunction. Twenty-two (37%) cases required urinary clean intermittent catheterisation (CIC) urology health care, with eight patients (14%) needing operative intervention to control management of bowel dysfunction., Conclusion: This UK CCLG study showed 36% of SCT patients develop bladder or bowel dysfunction after primary tumour resection. Functional assessment of bladder and bowel function is mandatory during after-care follow-up of all SCT patients. A multidisciplinary care pathway, with surgeon speciality groups including surgical oncology, paediatric urology and paediatric colorectal specialists, is strongly advised to facilitate 'best practice' monitoring of long-term health and improve patient quality of life (QoL) into adulthood., (© 2022 Wiley Periodicals LLC.)

Abstract: Sarcomas are a rare group of tumours with many differing behaviours and histologies. The generally poor outcomes for patients with sarcoma have not significantly improved over recent years in the United Kingdom. The reasons for this are multi-factorial but delayed diagnosis plays an important role. Developing patient pathways and clinical guidelines is critical to improving patient outcomes as well as raising awareness of sarcoma in primary and secondary care. Expert centres play a key role in diagnosis and the complex multimodality treatment of sarcoma; furthermore centralising of care is critical to improving outcomes as this where multidisciplinary expertise is concentrated. In this review we explore the current role of the expert centre from a United Kingdom (UK) perspective and compare and contrast this with practice elsewhere. [Copyright &y& Elsevier]

This article reports findings from a scoping review of the literature on good practice in social care for disabled adults and older people with severe and complex needs. Scoping reviews differ from systematic reviews, in that they aim to rapidly map relevant literature across an area of interest. This review formed part of a larger study to identify social care service models with characteristics desired by people with severe and complex needs and scope the evidence of effectiveness. Systematic database searches were conducted for literature published between January 1997 and February 2011 on good practice in UK social care services for three exemplar groups: young adults with life-limiting conditions; adults who had suffered a brain injury or spinal injury and had severe or complex needs; and older people with dementia and complex needs. Five thousand and ninety-eight potentially relevant records were identified through electronic searching and 51 by hand. Eighty-six papers were selected for inclusion, from which 29 studies of specific services were identified. However, only four of these evaluated a service model against a comparison group and only six reported any evidence of costs. Thirty-five papers advocated person-centred support for people with complex needs, but no well-supported evaluation evidence was found in favour of any particular approach to delivering this. The strongest evaluation evidence indicated the effectiveness of a multidisciplinary specialist team for young adults; intensive case management for older people with advanced dementia; a specialist social worker with a budget for domiciliary care working with psycho-geriatric inpatients; and interprofessional training for community mental health professionals. The dearth of robust evaluation evidence identified through this review points to an urgent need for more rigorous evaluation of models of social care for disabled adults and older people with severe and complex needs. [ABSTRACT FROM AUTHOR]

People with diabetes have to make multiple daily choices about the management of their condition, often with minimal input from a their healthcare professional. The necessary lifestyle changes, the complexities of management and the side effects of therapy make education a central part of diabetes management and it is recommended that structured education is made available to all people with diabetes at the time of initial diagnosis and on an ongoing basis This article describes how a number of multidisciplinary teams, across three NHS trusts, collaborated to standardise education for people with newly diagnosed type 2 diabetes. A previously developed structured education programme, "Diabetes and You", was re-evaluated to the meet the needs of the local population. [ABSTRACT FROM AUTHOR]

We aim to compare the outcomes of patients undergoing R0 esophagectomy by a multidisciplinary team (MDT) with outcomes after surgery alone performed by surgeons working independently in a UK cancer unit. An historical control group of 77 consecutive patients diagnosed with esophageal cancer and undergoing surgery with curative intent by six general surgeons between 1991 and 1997 (54 R0 esophagectomies) were compared with a group of 67 consecutive patients managed by the MDT between 1998 and 2003 (53 R0 esophagectomies, 26 patients received multimodal therapy). The proportion of patients undergoing open and closed laparotomy and thoracotomy decreased from 21% and 5%, respectively, in control patients, to 13% and 0% in MDT patients (χ2 = 11.90, DF = 1, P = 0.001; χ2 = 5.45, DF = 1, P = 0.02 respectively). MDT patients had lower operative mortality (5.7% vs. 26%; χ2 = 8.22, DF = 1, P = 0.004) than control patients, and were more likely to survive 5 years (52% vs. 10%, χ2 = 15.05, P = 0.0001). In a multivariate analysis, MDT management (HR = 0.337, 95% CI = 0.201–0.564, P < 0.001), lymph node metastases (HR = 1.728, 95% CI = 1.070–2.792, P = 0.025), and American Society of Anesthesiologists grade (HR = 2.207, 95% CI = 1.412–3.450, P = 0.001) were independently associated with duration of survival. Multidisciplinary team management and surgical subspecialization improved outcomes after surgery significantly for patients diagnosed with esophageal cancer. [ABSTRACT FROM AUTHOR]

The National Audit Office (NAO, 2005) has reported that the priority afforded to stroke care should be increased, given its impact on health and cost to the NHS. It recommends improvements in preventing, treating and managing stroke patients in line with recent evidence. Thrombolysis for acute ischaemic stroke is a proven treatment that produces good results in significant numbers of patients (Mar et al, 2005). However, owing to various barriers many hospitals in the UK have failed to implement effective systems to facilitate the delivery of this treatment to acute stroke patients. These barriers include a lack of skill, nursing knowledge, and 'fast-track' organization relating to thrombolysis as a treatment for acute stroke. Fears of intracranial bleeding and lack of appropriate stroke unit beds and issues of consent have also been identified as further problems (Innes and International Stroke Trial (IST-3), 2003). Taking these concerns into consideration, Scarborough District General Hospital has developed a multidisciplinary model with the Coronary Care Unit (CCU), integral to the delivery of treatment. Between 2003 and 2005, 24 stroke patients have received thrombolysis treatment and have been cared for in CCU. Outcome results have been positive, with 51% of patients demonstrating a significant benefit at 7 days post-stroke. This model has broken traditional professional and speciality boundaries to allow patients to receive treatments they otherwise would not have received. Moreover, it provides the potential for further exploration into the wider implementation of thrombolysis for acute stroke patients in the UK. [ABSTRACT FROM AUTHOR]

We report here the different roles undertaken by the members of 10 multidisciplinary cancer teams in conveying information to patients during their care. Team members completed an Informational Roles Questionnaire measuring an individual's perception of their major role and that of their colleagues in giving information to patients. They also completed two standard psychological health measures, the General Health Questionnaire and Maslach Burnout Inventory. The information giving roles of the surgeon, oncologist, radiologist and clinical nurse specialist were well recognised by their colleagues; however, other team members' roles were more ambiguous and less well understood. The clinical nurse specialist provided the broadest information coverage for patients. Few professional groups regularly informed patients about clinical trials and family history and the clinical nurse specialist was often the only person to deal with patients' sexual well being, consequently these areas are likely to receive poor coverage. Probable psychiatric morbidity (GHQ> or =4) in teams ranged from 5 to 27%. High levels of emotional exhaustion were particularly apparent in team leaders and nurses and feelings of low levels of personal accomplishment were prevalent in the histopathologists and radiologists. Putative benefits to patients and healthcare professionals from multidisciplinary team working may not be realised without investment in team training. [ABSTRACT FROM AUTHOR]

Over the past 30 years, there have been various trends in diabetes foot care, but the overall aims and outcomes remain fundamentally unchanged. Diabetes patient numbers are increasing, and many of the new methods and products that have been developed in recent years have not proved effective enough to change regimens of care to any great extent. While new technologies are also important, working in a multidisciplinary way is crucial and needs to be a priority for practitioners. Although some progress has been made, this needs to continue and increase to meet the old and new challenges being faced. [ABSTRACT FROM AUTHOR]

Introduction: International policy is encouraging a re-design of health and social care services, including the use of social prescribing. Torbay and South Devon NHS Foundation Trust, an Integrated Care Organisation in the UK, commissioned a voluntary sector 'Wellbeing Coordination' service as a key element of the wider care model. This case study seeks to understand how primary, acute, social, community and voluntary services are working together in a locality hub and the impact of wellbeing coordinators on service users' well-being, use and cost of health and social care services Methods: A before-and-after study, supplemented with qualitative case studies, practitioner interviews/surveys, observations of multidisciplinary team (MDT) meetings and service user/caregiver interactions. Applying an action-based participatory approach, findings were co-produced with stakeholders and members of the public by embedded researchers-inresidence. Quantitative service user data were collected on health and social well-being outcomes and frailty on referral and 12 weeks. Comprehensive activity and cost data were collected at 12 months pre- and post-referral. Results: Health outcomes and service activity data were collected on 49 participants receiving the wellbeing coordination programme. All person-reported outcomes showed statistically significant increases in mean change scores (Warwick-Edinburgh Mental Well-being Scale, Well-being Star?, Patient Activation Measure, Rockwood Clinical Frailty Scale, Living well goals met). Qualitative case studies and observations highlighted key mechanisms of the intervention and the hub working. The impact on health and social care use and cost was more nuanced, with mean activity and cost increasing overall. Referrals from the Enhanced Intermediate Care MDTs (20/49) showed higher levels of use and cost. At locality hub level, the practitioner survey, observations and interview findings show an increase in vertical and horizontal organisational integration and high levels of staff-reported person-centeredness while embodying a strengths-based approach. Discussion: The study shows a positive impact on outcomes and mixed patterns regarding activity and cost. The findings indicate potential for more 'down-stream' and preventative work. The close links with the wider voluntary sector add to the hub offer in holding more complexity, providing access and continuity of care, and delivering holistic and personalised care in the right place and at the right time. Conclusion: Key elements of how the hub works indicate the importance of leadership, coordination, communication, colocation, and contracting that allows the nourishing of trusting relationships and crossing of organisational and professional boundaries. Lessons learned: Challenges included pooling resources, record sharing, information governance and engaging all stakeholders in a shared vision for a strengths-based, personcentred culture. Ownership and bottom up dynamics and formal and informal relationships between practitioners at all levels, including the community they work with, were key features for overcoming these. Limitations: Case studies and participatory research approaches may be considered lesser to experimental study designs. However, context is crucial to integrated care and extrapolating generalizable findings. Co-production and triangulating varying data sources helps studying and implementing complex system wide transformation. Suggestions for future research: The Researcher-in-Residence model could be rolled out across systems to facilitate learning, and to increase robustness of insights. [ABSTRACT FROM AUTHOR]

This is the penultimate article developed from a series of masterclasses organised and funded by the Department of Health for community matrons during summer 2006. The articles synthesise the masterclass content in order to describe the areas of practice that are common to the community matron role and which have to be practiced with high levels of knowledge and skill if community matrons are to deliver the expected benefits to patients and to the NHS. It uses a case study to explore the fundamental concepts of accountability, teamwork; knowing the system; assertiveness; advocacy and empowerment which community matrons identified consistently as being significant in ensuring successful inter-professional and inter-agency working. [ABSTRACT FROM AUTHOR]

The article reports on the result of the large-scale, three-year study conducted by Sainsbury Centre for Mental Health to explore the impact of team leadership on implementing change in mental health service provision in the health service in Great Britain. The survey revealed that there is still more to be done to improve gatekeeping and referral processes. Only 68 percent of the ward managers who reported fully understanding of the functions and remits of all community teams.

Abstract: Aims: To evaluate current care and service provision for people with head and neck cancer in the UK. Materials and Methods: Self-report questionnaires for cancer networks, clinical leads of oncology units and leads for multidisciplinary teams (MDTs) were designed. These questionnaires were based on a previous survey. Questionnaires were sent out between 2009 and 2010. Results: Questionnaires were received from all networks (n = 37), most oncology units (48 of 53) and most MDTs (51 of 63). Care for people with head and neck cancer is increasingly being provided by a centralised MDT. The membership of these teams varies; facilities available for team meetings are fit for purpose in most cases. MDTs are meeting frequently (weekly meetings in 96%) and discussing on average 18 cases at each meeting (95% confidence interval 15–21 cases). Most oncologists have access to all common anti-cancer drugs and most have access to all forms of radiotherapy. Intensity-modulated radiotherapy is not yet available in some oncology units (28%). A small number of units have only one oncologist (13%). Despite audit and research being part of the rationale for MDT working, regular discussion of morbidity and mortality is unusual (40%) and use of a database to record decisions is not universal. Only seven centres record decisions into the Data for Head and Neck Oncology database. Reported recruitment to studies is generally low (<2% of cases enrolled in studies in 62%). Conclusions: Head and neck cancer care is increasingly provided through a centralised MDT. Increased resources and further changes in practice are required to implement current National Health Service cancer policy. Teams need to improve recording of their decision-making, discuss morbidity and mortality and support recruitment to clinical studies. [Copyright &y& Elsevier]