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 66
November 2019

This month in Evidence insights: 

New Tools

National Reports Library
This, tool, by the Healthwatch, has been designed to enable healthcare organisations to search nearly 3000 local Healthwatch publications for patient experience information. Across the country, Healthwatch speak to people about their experiences of services, and how care could be improved. From mental health, to care homes, to people's experiences of leaving hospital, a whole host of subjects are covered in the reports library. There's a local Healthwatch in every area of the country and each one focuses on the issues that matter most to the people in their communities.

Reduce length of stay - new e-learning resource
This new e-learning tool, developed by Health Education England, is designed to help health and care staff prevent delayed transfers of care. The tool can be used by nurses, allied health professionals and care staff to ensure patients have the best outcomes possible following care received in hospital. It includes resources to help staff take prompt practical actions and use every opportunity to ensure patients are cared for in the best place. 

New Guidance

Mental and physical health- practical ideas for improving care

This practical guide, developed by Q Improvement Lab and Mind is designed to improve services, for and with, people living with both mental and physical health problems. The guide identifies six high level problems and corresponding solutions that need action to improve care in this area. These relate to:
  1. Local knowledge
  2. Skills and training
  3. Environment and processes
  4. Patient expectations and understanding
  5. Coordination and collaboration
  6. Evidence base and business case                                                                    
In practice: Guidance for pharmacist prescribers
This guidance, by the General Pharmaceutical Council, covers five key areas that pharmacist prescribers should consider in order to prescribe safe and effectively. These include taking responsibility for prescribing safely; keeping up to date and prescribing within their level of competence; working in partnership with other health care professionals and persons seeking care; prescribing considerations and clinical judgement; and raising concerns.

Achieving integrated care 15 best practice actions
This guidance, by Local Government Association and in partnership with the Social Care Institute for Excellence, aims to support local systems in fulfilling their ambition of integration. The 15 actions prioritised in this resource draw on evidence about what works from international research, emerging best practices, and engagement with stakeholders and partners. The actions try to align with national policy, legal frameworks and regulatory guidance.

Hospice and palliative care funding allocations: 2019 to 2020
This guidance, from the Department of Health and Social Care, sets out the amount of funding received by clinical commissioning groups for hospice and palliative care services in the 2019 to 2020 financial year. 

National Workforce Plan for Approved Mental Health Professionals (AMHPs)
This document, by the Department of Social Care, contains a summary of recent guidance and explains the role of AMHPs in mental health services, which is designed to make it easier to recruit to the role. It is aimed at local authorities, directors of adult and children’s social care, NHS mental health trusts, and integrated care system workforce leads.

Patient access to records online: Prospective record access
This guidance, developed by NHS England and BMA General Practitioners Committee (GPC) in England aims to support GP practices in meeting the commitment to give new registrants with full online access to prospective data, subject to existing safeguards for vulnerable groups and third party and system functionality.

Guide to the 2018/19 data collection process and to improving ESR data quality
This guide, by NHS Improvement, aims to support trusts with the 2018/19 data collection process and help improve electronic staff record (ESR) data quality. It states Trust 2018/19 data will now be automatically extracted from ESR, with no manual data collection using Excel spreadsheets. The guide proposes these changes will impact on acute specialist, community and mental health trusts.
Implementation - New 'know-how'

Improving mental health services in systems of integrated and accountable care: emerging lessons and priorities
This report, by the Royal College of Psychiatrists, sets out recommendations for local and national health and care leaders to support the prioritisation of mental health as local areas develop into integrated care systems. 

The Multiple Conditions Guidebook
This guide, from the Taskforce, on multiple conditions, showcases ten examples of improving care to 15 million people in England with multiple long term conditions. It tries to build on earlier learning from people living with multiple conditions and highlights a selection of different practical approaches that support them.

Getting It Right First Time (GIRFT)
The GIRFT review, is an NHS improvement programme delivered in partnership with the Royal National Orthopaedic Hospital NHS Trust. The GIRFT review of ear, nose and throat (ENT) surgery services visited 126 units across the country. It provides a series of recommendations and shares good practice of units with higher than average day-case rates. 

Evaluating integrated care: why are evaluations not producing the results we expect?
This briefing, by Nuffield Trust, aims to outline the reasons why a number of integrated care models may not reduce hospital admissions as expected. It includes advice for model design and implementation, for commissioners of evaluation, and for evaluators on how to address these issues. 

Improving the health and wellbeing of girls and women
This report, by the Royal College of Obstetricians and Gynaecologists, aims to identify simple and cost-effective solutions to prevent girls and women falling through the cracks of the health system. It considers a whole life course approach, provides responses from a RCOG commissioned survey of 3,021 women, explores the importance of access to accurate education and information, prevention and empowerment. It also explores fragmentation and access to services and sets out a number of recommendations throughout. 

Leading for integrated care: 'If you think competition is hard, you should try collaboration'
This report, by The Kings Fund, seeks to explore the progress, challenges and opportunities the move towards greater integration presents, through interviews with 16 people leading or chairing an integrated care system or sustainability and transformation partnership.  

Ethical care: a bold reform agenda for adult social care
This report, by the Institute for Public Policy Research, identifies the main drivers of quality in social care and highlights some examples of innovative and high quality care across England.  The report argues that ideas must be broadened about what high-quality care consists of, to include improving people's well-being as they age, and therefore activities designed to engender purpose, meaning and social connection.

Transforming imaging services in England — a national strategy for imaging networks
This strategy, by NHS Improvement, sets out a proposal for implementing collaborative imaging networks on a national basis across England, delivering better quality care, better value services for patients and providing NHS staff opportunities to develop their career and increase their productivity. The NHS Long Term plan commits, that by 2023,  new diagnostic imaging networks would be introduced to improve turnaround times for imaging tests, improve access to sub-specialist opinion and make best use of the workforce.

Urgent and emergency care survey 2018
This report, published by Care Quality Commission (CQC) examines the experiences of people using type 1 and type 3 urgent and emergency care services across England. It highlights their experiences around waiting times, standards of care, dignity, patient safety and quality of discharge arrangements. The data forms part of the inspection process as well as contributing to national measures of patient experience such as NHS England’s overall patient experience score. 

Primary care networks: A pre-mortem to identify potential risks
This paper, published by Nuffield Trust, presents  six anticipated risks and challenges PCNs are likely to face in the next five years. Nuffield Trust and event partners drew together 45 GPs, local commissioners and representatives from NHS England/ Improvement and the British Medical Association to undertake a pre-mortem exercise to consider the threats and weaknesses of the introduction of PCNs by imagining their hypothetical failure.

Artificial intelligence: how to get it right
This report, is informed by research conducted by NHSX, and other partners over the past year.  The aim is to outline where in the system AI technologies can be utilised and the policy work that is, and will need to be done, to ensure this utilisation is done in a safe, effective and ethically acceptable manner. The purpose is to give a considered and cohesive overview of the current state of play of data-driven technologies within the health and care system, covering everything from the local research environment to international frameworks in development.

Steps to increase physical activity levels in the UK
This briefing, published by the BMA, presents the benefits of physical activity, the current low levels of physical activity in the UK and the significant inequalities that exist in levels of physical activity within the population. The document includes recommendations to government on how best to promote greater activity.
New Research 

‘Hospital mergers increase death and harm’? Not so fast
This working paper, by the Health Foundation, examines the central conclusions of the Competition and Markets Authority (CMA) paper; which states that research provides further empirical evidence that competition ultimately benefits patients. This report by Health Foundation, argues that more rigorous well designed research is needed to measure the impact of competition on the quality of care. 

What is the evidence on the role of the arts in improving health and well-being?
This report, by the World Health Organisation (WHO), aims to synthesize the global evidence on the role of the arts in improving health and wellbeing, with a specific focus on the WHO European Region. 

Falling short: the NHS workforce challenge
This report, by the Health Foundation, aims to analyse the changes in the size and composition of the NHS workforce in England in the context of long-term trends, policy priorities and future projected needs. It seeks to build on previous years, provide analysis of longer-term trends and insights into the changing NHS staff profile.  It focuses specifically on the critical NHS workforce issues that have been repeatedly identified in recent years: nursing shortages, and shortages of staff in general practice and primary care.
The report also explores key pressure points:
  • student nurses
  • the international context and international recruitment 
  • retention                                                                                                                          
Estimating need in older people Findings for England
This report, by Age UK, outlines how ill health, poverty, unmet needs for care and support, poor housing, loneliness and social isolation are profound challenges for many older people. It estimates the numbers and percentages of people aged 65 and over in England with these disadvantages and collates insights from older people’s own voices about the experience of living with them.

Will I care? The likelihood of being a carer in adult life
This report, from Carers UK, aims to review the impact of caring and the likelihood of becoming an unpaid carer. It makes the case that understanding the impact of caring is included in workplace support and that caring must be centre stage in public policy and decision making.

The nation's health: priorities for the next government
This report, by the Health Foundation, aims to look at how long-term improvements in life expectancy and mortality in the UK have stalled and are falling behind other high income countries. At the same time, the difference between the health of people living in the best- and worst-off communities is widening. It calls for action across the whole government to address these trends and asks that investment be directed towards areas of public spending that create the right conditions for people to lead healthy lives.

Fit for the future: how should the incoming government help the NHS in England?
This report, by the NHS Confederation has surveyed its members in England to gauge what they feel are their most critical priorities for an incoming government. This report aims to summarise their most pressing issues: workforce, social care and capital investment.

Universal approaches to improving children and young people’s mental health and wellbeing
This report, published by Public Health contains a short description of interventions identified from the synthesis of systematic reviews which are used to improve children and young people’s mental health and wellbeing. 

Establishing the evidence base for ‘multiple site single service’ (MSSS) models of care
This systematic review, by Public Health England, aims to describe the evidence base for multiple site, single service (MSSS) models of care and highlight the current limitations of available research. The report seeks to set out a universal framework to categorise different MSSS models that may be employed in the reorganisation of secondary care services, and a suggested set of outcome measures to guide the planning, implementation and evaluation of future clinical service reconfiguration to better understand the population impact of service change.

Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme
This qualitative study, published by the BMJ, aims to examine the lessons learnt from the implementation of five vanguards initiatives in the North East of England. The study took place across six local authority areas and within six clinical commissioning groups responsible for the delivery of each vanguard’s aims and objectives.

The measurement maze
This report, by The Health Foundation, aims to take a snapshot of quality measures in three clinical areas: breast cancer care, renal care, and young people’s mental health care. It seeks to be a useful resource for clinicians and managers in those areas. It suggests there is a case for streamlining and simplifying national quality measurement so that data is used as effectively as possible. It highlights how multiple sources and numerous national bodies preside over data collection and explores whether there is a case for rationalisation and simplification in order to ensure that data are being used most effectively to bring benefits to patients and clinical teams.

New Guidance from NICE

The following guidance was published in November which may be of value to commissioners.

Clinical guidelines
Fever in under 5s: assessment and initial management [NG143]  |  Cannabis-based medicinal products [NG144]  |  Thyroid disease: assessment and management [NG145]  |  Workplace health: long-term sickness absence and capability to work [NG146]  |  Diverticular disease: diagnosis and management [NG147]

Technology Appraisals
Pentosan polysulfate sodium for treating bladder pain syndrome [TA610
]  |  Rucaparib for maintenance treatment of relapsed platinum-sensitive ovarian, fallopian tube or peritoneal cancer [TA611]  |   Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy  [TA613]  
|  Neratinib for extended adjuvant treatment of hormone receptor-positive, HER2-positive early stage breast cancer after adjuvant trastuzumab [TA612]


New work from the Strategy Unit

Exploring Mental Health Inpatient Capacity
This report, by the Strategy Unit,  aims to explore the pressures on inpatient mental health services across Sustainability and Transformation Partnerships in England, drawing on a wide range of datasets, published research and interviews with staff working on mental health services. The report was commissioned by and includes a response from the Royal College of Psychiatrists.
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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