What is the state of mental health care? 22 September 2017 Are mental health services getting better or worse? The government repeatedly claims it is pumping money into rapid improvements, while a number of stories in recent days reinforces the impression that services are unravelling in the face of unparalleled demand. The Education Policy Institute has revealed that more than a quarter of children referred to specialist mental health services in 2016-17 – tens of thousands – were turned away (pdf). According to figures obtained by Labour MP and mental health campaigner Luciana Berger, for the third year running more than half of clinical commissioning groups (CCGs) are planning to either cut or freeze their mental health budgets, despite government pledges that funding will increase. Researchers from the University College London (UCL) Institute of Education and the University of Liverpool have shown that 24% of 14-year-old girls and 9% of boys reported experiencing depression. The numbers indicate that mental health problems among girls rise sharply as they enter adolescence, and parents underestimate the problem. A review of almost 300 case files by children’s charity Barnardo’s has shown that two-thirds of care leavers with mental health needs were not receiving any help from public services. It estimates that one in four care leavers suffer a mental health crisis. Read the full article at the Guardian Healthcare Network __________________________________________________ Private sector outrunning NHS on digital 8 September 2017 The irresistible entrepreneurial spirit of Silicon Valley is slamming into the immovable object of UK healthcare regulation, with the Care Quality Commission (CQC) exposing significant concerns with at least 10 online clinical services. Online services range from tiny startups to enterprises contracting thousands of doctors. High-profile respected players include Lloyds Pharmacy’s Online Doctor and Babylon, led by technology evangelist Ali Parsa. They typically offer GP consultations, pharmacy and advice. At least two providers inspected by the CQC have been criticised for prescribing large quantities of asthma inhalers, with Frosts Pharmacy’s Oxford Online Pharmacy accused of “putting patients at risk of life-threatening exacerbation”. (A subsequent inspection [pdf] confirmed the service was now safe and effective.) White Pharmacy was “prescribing a high volume of opioid- based medicines with no system in place to confirm patients’ medical or prescribing histories”. Health regulators are having to move fast to keep pace with the proliferation of online services. In March the CQC, General Medical Council, General Pharmaceutical Council and Medicines and Healthcare Products Regulatory Agency warned online services that they had to follow the same professional guidelines as any other provider. Read the full article at the Guardian Healthcare Network __________________________________________________ What NHS can learn from New Zealand 25 August 2017 As the NHS begins to grapple with the concept of accountable care systems, the experiences of the Canterbury region on New Zealand’s South Island offer important lessons on how – and how not – to do this. The King’s Fund has been studying the Canterbury transformation for some time, and has just published its latest report [pdf]. The key finding is that it has coped with growing demand without expanding hospital capacity – but neither has it cut it. Canterbury’s performance against the rest of the country is impressive; its 600,000 population has lower acute medical admission and readmission rates, shorter length of stay, fewer emergency department attendances, and lower spending on emergency hospital care. It is supporting more people in their homes and communities. There is an appealing simplicity about what the Canterbury health service has done. The starting place was talking with the staff. Mock-ups of healthcare settings were built in a warehouse and groups of staff walked through them to stimulate thinking on solutions for the many challenges they faced in an under-performing system. It was supposed to last a fortnight and involve about 400 people; it eventually ran for six weeks and more than 2,000 people turned up. Read the full article at the Guardian Healthcare Network __________________________________________________ Virtual reality is changing healthcare 14 August 2017 The immersive experience of virtual reality is poised to transform the way clinicians and patients experience healthcare. But hard evidence of its effectiveness and value for money is required before the NHS and medical schools can justify investment. Virtual reality uses software to generate realistic images, sounds and other sensations to replicate real environments or create imaginary ones, and simulates the user’s presence there, enabling them to look around, explore and interact. The technology can be as cheap as a few pounds, with a smartphone inserted into a basic headset such as Google Cardboard. More sophisticated smartphone headsets cost around £80, while elaborate virtual reality headsets might cost £500. Pain management GP and virtual reality enthusiast Keith Grimes described the clinical potential of virtual reality to the DigitalHealth.London Summit. Early work includes controlling pain and reducing anxiety by distracting the patient through immersion in another environment. It has been shown to work on everything from dentistry to changing wound dressings. “It can be a very low cost intervention to improve the quality of care and the experience of a patient, and it can reduce pain in a consistent fashion – it’s not just once with the wow factor,” he said. Read the full article at DigitalHealth.London __________________________________________________ Doctors’ shifting professional autonomy 11 August 2017 NHS Improvement’s drive to raise clinical standards is prising open the sensitive issue of doctors’ autonomy, and shows how the legal and professional boundaries of medicine are constantly shifting. The Get It Right First Time programme is uncovering massive and unacceptable differences in performance, such as a 25- fold variation in orthopaedic surgical site infection rates. Now colorectal surgeon John Abercrombie has used his report into general surgery performance to challenge the high degree of autonomy enjoyed by British surgeons. He contrasts the demanding training and assessments required to qualify with the laissez-faire approach to subsequent professional development. The rules are so lax that a surgeon could carry on practising unaware of new operating techniques, care pathways or developments in infection control. This goes some way to explaining why new approaches to care takes so many years to permeate every part of the NHS. Abercrombie calls for routine monitoring of performance measures such as infection and readmission rates, and for the surgical Royal Colleges to introduce tougher rules around continuing professional development. This could include visits to units which are delivering the best outcomes. Read the full article at the Guardian Healthcare Network __________________________________________________ From Prescott’s speechwriter to the NHS 2 August 2017 Jeremy Marlow had planned to join the NHS as a doctor. Twenty-five years later he finally works for the health service as executive director of operational productivity at NHS Improvement. “I always wanted to read medicine – I had places [to study it at university],” he says. “But my adolescence struck a bit late and when I left school I just didn’t want to do it. I didn’t want to be locked in – so you wonder why on earth I joined the civil service.” But the pull of science still proved strong, and after a year out he took a degree in environmental science followed by a PhD at Newcastle University in paleo-oceanography – “reconstructing the oceans and climate of the past” – which provides insights into climate change. He had been exploring postdoctoral opportunities, but chanced upon a booklet at a careers fair on the civil service Fast Stream. “I looked at some of the career descriptions of people who had gone in and thought ‘I like the look of that’,” Marlow says. After securing a place he told the civil service he was interested in working in the Department for Environment, Food and Rural Affairs, the Home Office or the Ministry of Defence. He was posted to Defra shortly before a major climate change conference in Johannesburg – and was mortified to find himself assigned to the litter and dog fouling team, part of an interdepartmental group looking at liveability and quality of life. Read the full article at Civil Service World __________________________________________________ NHS links with councils are fracturing 31 July 2017 The financial crisis engulfing health and social care risks driving the NHS and local government apart. Local Government Chronicle has revealed that ministers have instructed 47 of the 152 councils running social care to reduce delayed transfers of care from hospitals attributable to social services by 60% or more, based on their performance in February. The accompanying letter from the Department of Health and Department for Communities and Local Government made clear that councils that fail to hit their target risk being penalised in the allocation of the £2bn of additional social care funding announced in the budget. The Local Government Association has already withdrawn support for the Better Care Fund planning guidance (pdf) for this year, which compels councils to focus on reducing pressure on the NHS irrespective of their local priorities. There are two issues: whether this is a sensible way to tackle delays in transfers of care, and what this increasingly fractious debate says about relations between health and local government. According to the official statistics, there were 178,400 days lost through delays in May. Around 55% were attributable to the NHS, 37% to social care and the remainder had shared responsibility. Read the full article at the Guardian Healthcare Network __________________________________________________ Ambulance overhaul shows way forward 14 July 2017 NHS England’s gutsy move to overhaul the ambulance response system exemplifies how the NHS can push through controversial changes, and the perils of trying to do it. At first glance the new system appears counterintuitive – allowing 999 call handlers more time to decide the appropriate action, and classifying significantly fewer calls as needing the fastest response. But, crucially, the changes are based on an all-but-bulletproof body of evidence. NHS England claims the Ambulance Response Programme, commissioned in 2015, has been the world’s largest clinical ambulance trial, involving independent analysis of 14m emergency calls over 18 months. It says emphatically that no safety issues were identified with the new approach, and estimates that 250 lives will be saved across England annually. For the public launch, a small army of senior clinicians and other prominent figures was assembled covering everything from acute care to strokes, heart attacks, ambulance services and paramedics. Each explained why the new approach was best for their patients and the wider system. The ambulance improvements are central to the national drive to treat heart attacks and strokes quickly in specialist centres. Instead of the current fiasco of multiple ambulances being sent to the same call, and paramedics on motorbikes being dispatched when an ambulance is needed, the focus is shifting to the outcome for the patient. Read the full article at the Guardian Healthcare Network __________________________________________________