Evidence insights is a regular bulletin connecting you with the latest evidence in commissioning and service transformation.  We search a range of sources, selecting the highlights and presenting them to you in this concise bulletin.

Issue 67

This month in Evidence insights: 

New Tools

RightCare: Headache & Migraine Toolkit optimising a headache and migraine system
This toolkit, by RightCare, is designed to help health systems and commissioners understand priorities in headache and migraine care and the key actions to consider. It gives guidance on how to assess and benchmark current systems to find opportunities for improvement. It is produced with reference to an expert group of stakeholders and is supported by NICE. When putting together this toolkit, wider consultation took place with patient representatives, clinicians, social care organisation, professional bodies and other key stakeholders.

Paediatric Intensive Care Audit Network
This report, by the Paediatric Intensive Care Audit Network (PICANet), intends to summarise the paediatric critical care that took place in the United Kingdom and Republic of Ireland between 2016 and 2018. This report provides data on five key metrics for Paediatric Intensive Care services: case ascertainment, retrieval mobilisation times, number of qualified nurses per bed, emergency readmissions within 48 hours and mortality in PICU.

New Guidance
Community- centred public health: taking a whole system approach 

This guidance, by Public Health England, is designed to enable local systems to implement and embed community- centred approaches to health and wellbeing at scale. It builds on previous guidance on community- centred approaches to health and wellbeing. Community- centred approach are described as those that mobilise assets within communities, encourage equity and social connectedness and increase people control over their health and lives.

The older adults’ NHS and social care return on investment tool
This report, by Public Health England, aims to address the gaps in evidence on return on investment and economic benefit for interventions and services that support older people’s healthy ageing. It is designed to help local commissioners in designing and implementing services and it can be adapted to local conditions.

Immunisation: applying all our health 
This guide, by Public Health England, is designed to help health and care professionals prevent ill health and promote well being as part of their everyday practice. The information is aimed to help front line health and care staff use their trusted re;relationships with patients, families and communities to promote the benefits of immunisation. 

Health matters: physical activity - prevention and management of long-term conditions
This guidance, by Pubic Health England, intends to focus on the benefits of physical activity for the prevention and management of long- term conditions in adults.    


Implementation - New 'know-how'

Achieving Integrated Care: 15 best practice actions
This guidance, produced in partnership with Social Care Institute for Excellence, intends to support local systems in fulfilling their ambition of integration. There are 15 actions presented in this resource which aims to draw on evidence about what works from international research, emerging best practice and engagement with stakeholders and partners. The actions are aligned with national policy, legal frameworks and regulatory guidance to allow local variety in system design and service delivery.

How to build effective teams in general practice
This guide, by Kings Fund, aims to bring insight from research, policy analysis and leadership practice to address how General Practices are coming together to form Primary Care Networks (PCNs) and the new roles that are being introduced to create multidisciplinary and multi-agency teams. The need for collaboration and communication underpins much of this guide and further reading and case studies support each section.
This report, by Kings Fund, looks at five organisations who are trying to think differently about how to support patient and service users and considers what can be learnt from unconventional approaches.It asks whether these organisations’ approaches, or aspects of them, might be spread more broadly in the health and care system, and if so how?

Connecting Communities
This report, by Hanover Scotland, aims to outline the findings of an action research project to understand how housing associations, staff and residents can work together and with local communities to help people live the lives they want. A series of case studies are presented with the intention to portray it's affect on isolation and loneliness, well being and broader health outcomes for people, communities and health and care systems. 

Improving mental health services in systems of integrated and accountable care: emerging lessons and priorities 
This report, by Royal College of Psychiatrists, aims to understand the priorities and lessons for improving mental health services in established and emerging ICSs and makes recommendations that reflect the opportunities and challenges for areas in doing so. It’s focus is on multi-specialty community providers and primary and acute care systems. It also draws on the findings from a seminar with national and local leaders involved in the formation of ICSs. It draws on other integrated models of healthcare from the United States, Scotland and Wales.

A place to work: system approaches to workforce challenges in the NHS
This report, by NHS providers intends to examine how trusts are working with their staff and local partners to enable the workforce to adapt to new ways of collaborative working in systems and to support integrated and joined up care. It contains a number of case studies based on interviews with trusts, STPs and ICSs and local authorities. These explore new, devolved ways of organising and planning workforce needs, and of deploying, recruiting and retaining staff in a system context.

Opportunities to embed sexual and reproductive healthcare services into new models of care: a practical guide for commissioners and service providers
This report, by the Faculty of Sexual and Reproductive Healthcare (FSRH), sets out case studies to demonstrate the potential for new models of care to embed Sexual and Reproductive Health services. It is based on an audit to assess the extent to which Sexual and Reproductive Health is being factored into new models of care. 51 strategies and operational plans were reviewed from Sustainability and Transformation Partnerships, NHS England Vanguards and large-scale general practice organisations.

Shifting the mindset: a closer look at hospital complaints
This review, by Healthwatch England, aims to investigate how well NHS hospital trusts across England communicate about their work on complaints and whether current efforts are sufficient to build public trust. Under regulations, every hospital is required to collect and report on the number and subject of complaints, how many of them were upheld, and what action was taken as a result. This review presents findings and sets out recommendations for improvement in the complaints handling and management system at a national and local level.

Improving behavioural health care in the emergency department and upstream
This paper, by the Institute for Healthcare Improvement, intends to provide actionable guidance for hospital emergency departments and their community partners to create compassionate, seamless and effective system of care that respects and works with patients with mental health conditions and substance use disorders who present to the emergency departments. The paper includes framework for a better system of care that comprises four key components: 1) Processes, provider culture, patients, and partnerships 2) High- leverage changes and specific change idea 3) Suggested measures 4) Practical tips, examples and resources and tools. Access to the paper requires free registration. 
New Research 

Quality and inequality: digging deeper
This report, by Nuffield Trust, aims to explore the inequalities in the quality of care between the most and least deprived groups.  This report builds on quality indicators to investigate whether inequalities in the quality of care between socioeconomic groups have changed over the last 10 years. 

Juggling work and unpaid care
This report, by Carers UK, intends to look at the impact the ageing population is having among those who are juggling work while providing unpaid care, how the world of work needs to adapt and the consequences if it does not. This report also looks at the interventions that can be undertaken to meet these challenges and improve productivity.

Quality improvement in general practice: what do GPs and practice managers think?
This report, by Health Foundation, explores the level of quality improvement awareness, appetite and activity in general practice across the UK, through a survey of over 2,300 GPs and 1,400 practice managers, alongside qualitative interviews. The report finds a high level of agreement from GPs and practice managers about what helps or hinders their work to improve quality. It aims to set out how national and local system leaders can support those working in general practice to improve quality of services they provide.

Social care 360
This review, by Kings Fund outlines and analyses 20 key trends in adult social care in England over recent years. It intends to take a broad perspective, including indicators that relate closely to health, housing, benefits and carers, as well as services provided by local authorities and aims to provide a ‘360 degree’ view of the sector. The review is structured into six sections 1) Access 2) Expenditure 3) Providers 4) Workforce and carers 5) Quality 6) Integration with other service.

Measuring progress: commitments to support and expand the mental health workforce in England
This report, by British Medical Association, analyses workforce data and survey of health care professionals working in the sector with the aim of assessing progress against commitments and identifying where further action is required.

Improving care by using patient feedback
This review by National Institute for Health Research, aims to bring together nine recent NIHR studies which look at how NHS organisations use patient feedback to make improvement to services. The evidence in the review ranges from online ratings to real-time feedback in different settings, from hospital wards to general practice and mental health. The research intends to help health providers to make best use of patient survey and other data from patients on their care.

The economic influence of the NHS at the local level
This report, by the Kings Fund, aims to look at the NHS’s role within the wider economy from several perspectives – the level of influence the NHS holds through employment and spending; the relative level of earnings in the NHS compared to the wider local economy; and the provision of training, skills and opportunity. It draws on data on economic activity within the wider economy together with data on employment and wages in the NHS at sustainability and transformational partnership (STP) area.

The determinants of mental health
This report, by Centre of Mental Health, aims to examine the financial and investment challenges facing mental health providers. It intends to focus on the unequal determinants of mental health that influence mental health throughout our lives. A range of suggestions have been identified from previous research and it draws on specific actions and approaches that could help to prevent, reduce or mitigate inequalities in the determinants of mental health.
Gender and Nursing as a Profession
This report, by Royal College of Nursing, intends to explore and critique the gendered construction of value within the nursing profession and evaluates how value is attributed to nursing, the value placed on individual and the status of the profession. The data collected to address these questions were drawn from quantitative data and in- depth interviews with senior stakeholders from the nursing profession.

New Guidance from NICE

The following guidance was published in December and January which may be of value to commissioners.

Clinical guidelines

Menopause: diagnosis and management [NG23] |  Acute kidney injury: prevention, detection and management [NG148] | Colorectal cancer [NG151]

Technology Appraisals
Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome [TA615] Cannabidiol with clobazam for treating seizures associated with Dravet syndrome [TA614] | Cladribine for treating relapsing–remitting multiple sclerosis [TA616] | Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure [TA617] |  Olaparib for maintenance treatment of relapsed platinum-sensitive ovarian, fallopian tube or peritoneal cancer [TA620] | Palbociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer [TA619] |  Atezolizumab with carboplatin and nab-paclitaxel for untreated advanced non-squamous non-small-cell lung cancer (terminated appraisal) [TA618] | Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer [TA621]

Quality Standards 

Lung cancer in adults [QS17] | Rheumatoid arthritis in over 16s [QS33] | Flu vaccination: increasing uptake [QS190] | Colorectal cancer [QS20] | Cerebral palsy in adulta [QS191]

New work from the Strategy Unit

Person-centred intelligence: our guide to implementation and our offer of support
This guidance, produced in partnership with Ipsos Mori, describes an approach to implementing person- centred intelligence. It brings together the views of national policy experts, clinicians, researchers and those who have implemented person- reported measures; findings from a detailed review of the current evidence; and insight from the expertise and experience drawn from the Strategy Unit and Ipsos Mori.

How will we know if Integrated Care Systems reduce demand for urgent care?
This paper, by the Strategy Unit, explores potential outcomes of a new blended payment system for Urgent Care. The paper has three objectives 1) To illustrate the workings of the blended payment system 2) To demonstrate that inappropriate modelling of “planned” activity levels could divert tens of millions of pounds away from the emergency care system. 3) To pinpoint the reasons why conventional forecasting approaches are unsuitable in this context, and to suggest alternatives.

Opening the ‘black box’ of scenario planning through realist synthesis
This paper, by the Strategy Unit offers a 'programme theory' for scenario planning. The researchers identified and synthesised evidence about the 'black box' of scenario planning to understand: what contexual factors enable or disable the success of a scenario intervention and what are the mechanisms through which scenario planning activities provoke new thinking. 
We want to hear from you!

We welcome your feedback about this update, or if there is a specific area of evidence you would like covered that would benefit commissioning decision making and/or service transformation. E: or T: 0121 612 1538. 
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