A formative service evaluation exploring the experience and levels of satisfaction of patients attending a nurse led bone marrow clinic in one Health and Social Care Trust in Northern Ireland.

Within this article we reflect on the Belfast Health and Social Care Trust (BHSCT) Workforce Learning Development Improvement Service’s response to Covid19, and the need to support social work students commencing their Practice Learning Opportunity/placement (PLO) within Adult Services in August 2020. It was recognised that the global response to the Covid19 pandemic generated a landscape of significant change and innovation for both the Workforce Learning Development and Improvement Service within the Belfast Health and Social Care Trust (BHSCT) and students who were due to commence their PLOs within BHSCT for a period of practice learning from August – December 2020. The article explores how the Workforce Learning Development Improvement Service across in Adult Services within the BHSCT responded to meet changing need for social work students, BHSCT practice teachers (practice educators) and the operational context within which social workers practiced. The initiative, now consolidated within the student experience of their Practice Learning Opportunity (PLO) within BHSCT, is audited annually, and this article explores the learning from the initial audits in December 2020 and June 2021, as well as the ongoing changes embedded within the teams as we emerge from the Covid19 pandemic. Within this article we reflect on the Belfast Health and Social Care Trust (BHSCT) Workforce Learning Development Improvement Service’s response to Covid19, and the need to support social work students commencing their Practice Learning Opportunity/placement (PLO) within Adult Services in August 2020. It was recognised that the global response to the Covid19 pandemic generated a landscape of significant change and innovation for both the Workforce Learning Development and Improvement Service within the Belfast Health and Social Care Trust (BHSCT) and students who were due to commence their PLOs within BHSCT for a period of practice learning from August – December 2020. The article explores how the Workforce Learning Development Improvement Service across in Adult Services within the BHSCT responded to meet changing need for social work students, BHSCT practice teachers (practice educators) and the operational context within which social workers practiced. The initiative, now consolidated within the student experience of their Practice Learning Opportunity (PLO) within BHSCT, is audited annually, and this article explores the learning from the initial audits in December 2020 and June 2021, as well as the ongoing changes embedded within the teams as we emerge from the Covid19 pandemic.

<h3>Introduction</h3> Lynch syndrome is estimated to cause over 1,000 cases of colorectal cancer in the UK every year. Individuals that have Lynch syndrome have a lifetime risk of developing colorectal cancer or other Lynch associated cancers of &gt;35%. Yet fewer than 5% of individuals with the condition have been diagnosed in the UK. The Royal College of Pathologists (RCPath) cancer dataset (July 2014) mandates the use of immunohistochemistry or other testing for molecular features of Lynch syndrome in colorectal cancer or Lynch associated cancer patients under the age of 50, at the time of diagnosis. Performing this type of screening test for Lynch syndrome identifies those at greater risk of recurrence as well as family members at extended risk through early cascade testing. <h3>Method</h3> The strategy was developed by Bowel Cancer UK with advice from the Medical Advisory Board of the charity. We identified all NHS hospital trusts in England, health boards in Scotland and Wales and health and social care trusts in Northern Ireland. A freedom of information (FOI) request was submitted to each of these bodies in which a number of questions were asked to establish whether they were implementing the RCPath core dataset requirement, with regard to mismatch repair (MMR) testing for Lynch syndrome. As this was an FOI request respondents were required to respond within 20 working days. <h3>Results</h3> In England, 78% of trusts responded, 100% responded in Scotland and Northern Ireland; one health board in Wales did not respond. In England and Scotland 50% of hospital trusts and health boards currently do not follow the RCPath cancer dataset. 4 health boards in Wales do not, and all health and social care trusts in Northern Ireland stated they perform MMR testing to identify suspected Lynch syndrome patients. In England only 28 of those that did not perform testing stated they were intending to implement the dataset and two in Wales. Scotland is in the process of developing a nationally agreed protocol for implementation of the dataset. We found that among trusts and health boards that do test for Lynch syndrome many do not yet have in place a systematic reflex service, as mandated by RCPath. <h3>Conclusion</h3> Our findings show that the RCPath dataset may have already had some impact on the application of MMR testing for Lynch syndrome in patients diagnosed under the age of 50. However there is considerable variation in approach. We recommend that: England and Wales carry out a nationwide initiative to look at ways of delivering a consistent approach to reflex testing for Lynch syndrome; that all CCGs commission to reflect the RCPath cancer dataset thus ensuring providers are compliant with the dataset. <h3>Disclosure of interest</h3> None Declared.

Objective: Parental mental illness can affect the well-being of parents and their children; various initiatives have been developed to support professionals to be family focused. The Champions’ Model was introduced in Health and Social Care Trusts in Northern Ireland to promote professionals’ capacity to engage in Family Focused Practice, however there has been limited research into this initiative. This article aims to explore the activities undertaken by Champions in one Health and Social Care Trust, with a focus on making recommendations for service development. Method: A brief questionnaire was used to collect quantitative and qualitative data. The questionnaire contained five, tick box questions relating to activities of Champions and a sixth open ended question seeking examples of good practice. The questionnaire was distributed to all individuals (N = 65) who were listed as Champions in one Health and Social Care Trust. Results: Of 65 questionnaires distributed 29 were returned. Participants described carrying out some activities of the Champions’ role. Twenty six respondents provided examples of how the Initiative positively influenced their own and other colleagues’ practice, including promoting communication and collaboration between Adult Mental Health and Children's Services. Lack of time and organisational support to carry out the role emerged as barriers. Discussion: Results suggest the Champions’ Initiative has a positive influence on promoting Family Focused Practice across the Adult Mental Health and Children's services interface and contributes to addressing barriers identified in the literature. Views of Line Managers, colleagues and service users on the effectiveness of the Initiative require exploration.

Introduction: In 2012 the Western Health and Social care Trust (WHSCT) and the Northern Health and Social Care Trust (NHSCT) developed two new consultant pharmacist-led medicines optimisation case management models of care in both the intermediate care and care home settings. These two models have been refined and reproduced in each of the two trusts. The older people charity ‘Age NI’ has designed and developed a unique programme where older people are recruited and trained in facilitation, listening skills, and report delivery. Once trained, facilitators are engaged in carrying out bespoke, facilitated sessions with older people on key issues including health and social care so that their voices can be heard, and their views and experiences can be used to influence and shape policy and practice on ageing issues. Aims: To engage with older service users in both Trusts under the care of the consultant pharmacist led pharmacy teams, so as to: gain insight into their experience of this approach; add value to ongoing evaluations being carried out by the project team; and reflect the patient journey in the process of medicines optimisation. Target Population: In 2016 the Medicines Optimisation in Older People project team leads engaged with Age NI to conduct an independent evaluation from the patient perspective of these new pharmacy services. Peer facilitators interviewed patients, carers and nursing staff in intermediate care and care homes to gain an insight into their experiences. Project Timeline: A Project initiation meeting was held in January 2016 with service users interviewed by Age NI peer facilitators February/March 2016 and a final report produced in May 2016. Highlights: Age NI reported that this project highlighted the importance of person centred care, and the impact of it on the individual. Each respondent spoke very positively about their personal interaction with the pharmacist, and how this made them feel. The fact that the pharmacist spent time talking to people, getting to know them and their families/carers created an excellent basis on which to open up dialogue and discussion about medication and health. Accessibility to a pharmacist created a profound sense of reassurance for carers. Having a consultant pharmacist led pharmacy team on hand to look at the individual medicine requirements of each older person ensured more time for the nursing teams to focus on caring for the older person in both the care homes and intermediate care settings. Conclusion: Age NI made several recommendations based on their engagement with older people, carers and nursing staff in this project including: ‘Age NI supports the person centred approach demonstrated by the consultant pharmacist led pharmacy teams in the medicines optimisation project, and believes this to be a fundamental aspect in the delivery of excellent care to older people. The role of the specialist pharmacist in care homes and community hospitals should be adequately funded and provided in healthcare settings throughout Northern Ireland.’ The Department of Health in Northern Ireland has since provided permanent funding to roll out this medicines optimisation service from April 2017.

Background Post colonoscopy colorectal cancer (PCCRC) is defined as colorectal cancer found within 48 months of a colonoscopy in which no cancer was found. The British Society of Gastroenterology (BSG) proposes PCCRC rates as a key quality indicator of colonoscopy. Rates documented vary between 2-8%, with higher rates shown in Inflammatory Bowel disease (IBD). The English National Post Colonoscopy Colorectal Audit was established after recommendations from the World Endoscopy Organisation (WEO). We aim to establish the rates of PCCRC within this Health and Social Care Trust (HSCT). Method All CRCs diagnosed in our HSCT between January 2021 to December 2022 were retrospectively reviewed. Our definition for a PCCRC was one diagnosed between 0-48months after a colonoscopy. Information included whether the colonoscopy was complete, quality of bowel preparation, lesions detected, if resection of lesion was complete and if IBD was present. Results In this timeframe 524 CRCs were diagnosed in this HSCT, with 33(6.3%) having had a colonoscopy within the previous 48 months. Of the 33 PCCRCs, 21(63.6%) had a complete colonoscopy, 22(66.6%) had at least fair/satisfactory bowel preparation, 24(72.7%) had a lesion detected and 3(9%) had a prior diagnosis of IBD. Of those who had a lesion detected (n=24), 13(54%) had a complete resection and 10(41.6%) had a biopsy only or incomplete resection. Conclusions Our PCCRC detection rate is in keeping with previous published literature. Further analysis of the 33 cases should provide information on how we can reduce future PCCRCs.

Background Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those with a lower rather than a higher socioeconomic position, are also the most inactive. Peer-led physical activity interventions may offer a model to increase physical activity in these older adults and thus help reduce associated health inequalities. This study aims to develop and test the feasibility of a peer-led, multicomponent physical activity intervention in socioeconomically disadvantaged community-dwelling older adults. Objectives The study aimed to develop a peer-led intervention through a rapid review of previous peer-led interventions and interviews with members of the target population. A proposed protocol to evaluate its effectiveness was tested in a pilot randomised controlled trial (RCT). Design A rapid review of the literature and the pilot study informed the intervention design; a pilot RCT included a process evaluation of intervention delivery. Setting Socioeconomically disadvantaged communities in the South Eastern Health and Social Care Trust and the Northern Health and Social Care Trust in Northern Ireland. Participants Fifty adults aged 60–70 years, with low levels of physical activity, living in socioeconomically disadvantaged communities, recruited though community organisations and general practices. Interventions ‘Walk with Me’ is a 12-week peer-led walking intervention based on social cognitive theory. Participants met weekly with peer mentors. During the initial period (weeks 1–4), each intervention group participant wore a pedometer and set weekly step goals with their mentor’s support. During weeks 5–8 participants and mentors met regularly to walk and discuss step goals and barriers to increasing physical activity. In the final phase (weeks 9–12), participants and mentors continued to set step goals and planned activities to maintain their activity levels beyond the intervention period. The control group received only an information booklet on active ageing. Main outcome measures Rates of recruitment, retention of participants and completeness of the primary outcome [moderate- and vigorous-intensity physical activity measured using an ActiGraph GT3X+ accelerometer (ActiGraph, LLC, Pensacola, FL, USA) at baseline, 12 weeks (post intervention) and 6 months]; acceptability assessed through interviews with participants and mentors. Results The study planned to recruit 60 participants. In fact, 50 eligible individuals participated, of whom 66% (33/50) were female and 80% (40/50) were recruited from general practices. At 6 months, 86% (43/50) attended for review, 93% (40/43) of whom returned valid accelerometer data. Intervention fidelity was assessed by using weekly step diaries, which were completed by both mentors and participants for all 12 weeks, and checklists for the level of delivery of intervention components, which was high for the first 3 weeks (range 49–83%). However, the rate of return of checklists by both mentors and participants diminished thereafter. Outcome data indicate that a sample size of 214 is required for a definitive trial. Limitations The sample was predominantly female and somewhat active. Conclusions The ‘Walk with Me’ intervention is acceptable to a socioeconomically disadvantaged community of older adults and a definitive RCT to evaluate its effectiveness is feasible. Some modifications are required to ensure fidelity of intervention delivery is optimised. Future research needs to identify methods to recruit males and less active older adults into physical activity interventions. Trial registration Current Controlled Trials ISRCTN23051918. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 10. See the NIHR Journals Library website for further project information. Funding for the intervention was gratefully received from the Health Improvement Division of the Public Health Agency.

Maximising the Health and Wellbeing of the Midwifery Workforce: With Wellness Recovery Action Planning

<h3>Introduction</h3> In Northern Ireland (NI) there are approximately 20,000 people living with heart failure (HF) and over 6,000 HF related hospital admissions each year. The National Heart Failure Audit (NHFA)...

Care planning for Looked After Children (LAC) is accepted as being critical in ensuring good outcomes for LAC, however, the available evidence base highlights that despite the introduction of key legislation across the UK, that care planning for LAC remains inconsistent. There is limited Northern Ireland (NI) specific research available that relates to care planning for LAC; with the care planning experience of LAC being referenced in the recent review of Children’s services in NI, (Jones, R. (2023). The report of the independent review of Northern Ireland’s children’s social care services. https://www.cscsreviewni.net/files/cscsreviewni/2023-06/The%20NI%20Review%20of%20Children%27s%20Social%20Care%20Services.pdf.) which highlighted the variance in policies and procedures across the five Health and Social Care Trusts in Northern Ireland (NI), resulting in continued disparity in service delivery for children and families. The current, restricted evidence base for social work decision making in care planning, highlights practitioner’s overreliance on practice wisdom rather than evidenced-based research, theory and/or service user knowledge. This mixed methods study focussed on increasing knowledge around decision making in care planning. A training package was developed and delivered to practitioners across children’s services in one Trust area. A pre and post survey was completed with 74 practitioners in addition to 20 post training semi-structured interviews. The significant response rates and sample size offer validity and strength to the findings which correlate with previous studies completed across the UK that also conclude that research, theory and service user knowledge is not prominent in social worker’s understanding of what informs their decision making in care planning for LAC. This information is valuable for practitioners and managers attached to social work in children’s services. Recommendations include further embedding of a culture of learning and reflection to support the development of practitioner knowledge, skills and confidence; and to assist in the development of governance processes to audit the impact of practitioner training.

Introduction: Unlike nursing homes, which have a qualified nurse on duty 24 hours, residential homes offer a social care model and are managed by a senior care assistant. This may increase the risk of admission to the emergency department (ED). The 45 bedded residential care home and associated GP medical practice in this pilot reported poorly communicated, inappropriate, and duplicate referrals to the practice, with nearly half of admissions to the emergency department occurring without professional assessment of any kind. Who is it for? The pilot aimed to enable care home staff to improve identification of residents at risk of deterioration and to make appropriate referrals to GP and other services, and reduce ED admission without professional assessment. Design, implementation and monitoring of the initiative: The need for change was identified by the selected residential care home and aligned GP practice, who noted several key shortcomings such as ineffectual assessment processes, inappropriate and duplicated GP referrals. The intervention was designed by a project implementation group which included residents, their families, care home managers and staff, GPs and their practice manager, and – from the Northern Health and Social Care Trust - nurses from the Responsive Support, Education, and Anticipatory Care with Care Homes (REACH Team) and a community nurse and Trust pharmacist. Intervention: A nursing team from the Northern Health and Social Care Trust – the Responsive Support, Education, and Anticipatory Care with Care Homes (REACH Team) – delivered and monitored an educational programme to home staff focused on early detection of decline. This included: Recording of vital signs. Recognition of ‘soft signs’ (1) of decline (such as change in diet, reduced mobility, and agitation) using the ‘RESTORE2 Mini’ tool. (2) Using the Situation, Background, Assessment, Recommendation, Decision (SBARD) structured communication tool when referring residents to the GP or other services. Results: Over a three-month period: 14 of 28 staff (50%) took part in the training. 43 of 45 residents (96%) were assessed for frailty and also referred to a Trust pharmacist for medication review. GP anticipatory care plans were completed with 38 of 45 residents. When residents were referred to their GP using SBARD, approximately 60 % were managed within the home. 63% of admissions to the emergency department (ED) occurred after professional assessment, although the overall attendance rate was not affected. The intervention was well-received by residents, their families, home staff, and GPs. Learning and next steps:A short, nurse-led, educational intervention can enable residential care home staff to effectively identify residents at risk of deterioration, improve communication, and make referrals to appropriate health services. This relatively straightforward intervention, using accepted assessment tools and existing resources, would be readily transferrable to many care home settings. Cooper G. Using Soft Signs to Identify Deterioration [Internet]. 2020 [cited 2023 Aug 30]. Available from: https://wessexahsn.org.uk/img/projects/Soft%20Signs%20White%20Paper%20GC%20WPSC%20Final%201.2.pdf RESTORE2 [Internet]. 2023 [cited 2023 Aug 30]. Available from: https://wessexahsn.org.uk/projects/329/restore2

Within the health and social care sector in the United Kingdom, the management of death and bereavement has become increasingly challenging. This service evaluation sought to explore the bereavement care offered to individuals living in one Health and Social Care Trust catchment area of Northern Ireland. Qualitative interviews were conducted with key government and voluntary agency staff. The findings indicated that much of the bereavement provision is based on the interest and initiative of individual staff members, with few processes to assess the level of bereavement care needed and those best skilled to provide it. Recommendations are made for a bereavement care strategy that outlines a bereavement needs assessment process, identifying the scope of interventions and protocols for practice.

<h3>Background</h3> The European Society of Cardiology (ESC) recommend that if reperfusion is delivered within 120 minutes (min) of diagnosis, a primary percutaneous coronary intervention (PPCI) strategy is preferable to fibrinolysis...

Attitudes to individuals presenting with alcohol-related issues are important in developing therapeutic relationships and applying alcohol-related interventions. This study explores staff attitudes to these individuals across a range of roles and departments. Data were gathered from 204 staff in the Southern Health and Social Care Trust in Northern Ireland. Regression models were used to predict attitudes as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Two hundred and four people participated in the study. The sample comprised doctors, nurses, allied health professionals and other staff who had face-to-face contact with patients. Staff worked in accident and emergency (A&E), medical, surgical, addiction or psychiatry departments. Staff working in addiction and psychiatry departments had significantly higher levels of role adequacy compared with those in A&E. Staff in addictions also demonstrated higher levels of role legitimacy, motivation and role satisfaction than those in A&E. Doctors had higher role adequacy and role legitimacy than nursing staff. There are critical differences in staff attitudes to patients presenting with alcohol-related issues in a range of hospital settings; training and working in a specialist setting have a significant positive influence on staff attitudes. This suggests that further training and support would positively enhance the attitudes of staff in a variety of professional roles and across a range of hospital settings in the management of patients presenting with alcohol-related difficulties. [Iqbal N, McCambridge O, Edgar L, Young C, Shorter GW. Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations. Drug Alcohol Rev 2015;34:487-94].

Bone Marrow Iron in CKD: Correlation With Functional Iron Deficiency

The Southern Health and Social Care Trust in Northern Ireland applied a modified version of the Objective Structured Clinical Examination (OSCE) to assess the skills of home care workers in assisting older people taking prescribed medications. In Northern Ireland, home care workers are care workers employed by health and social care trusts or private agencies. The application of the model has developed the skills of this staff group, improved the relationship between the commissioner and provider, significantly reduced the time spent by community nurses in individual training and assessment, and enhanced the patient experience for those taking medication. Overall, the application of this model has provided assurances to the Trust board, the executive director of nursing, and operational directors that home care workers are competent in assisting older people in this high-risk activity.