NHS Care Research Articles

A framework to guide the commissioning of healthcare services for people seeking asylum in England

Abstract The increasing number of people seeking asylum (PSA) in England, compounded by delays in processing their cases, has led to an urgent need for tailored practices to overcome barriers to healthcare access. While local examples of excellence in healthcare provision for PSA exist, a national framework to guide healthcare for these groups is lacking, leading to fragmentation and inconsistency in service provision. This collaborative research project with the British Red Cross took a co-production approach, involving three peer researchers with lived experience from the outset. From a literature review of case studies on improving access to healthcare for PSA, a preliminary framework of good practice was developed and explored with participants with lived experience of seeking asylum during three in-person workshops refined this. Finally, two focus groups with policymakers and healthcare professionals (HCPs) explored challenges in commissioning services, ensuring final framework relevance to the policy context. In total, 60 participants with lived experience attended three workshops and 19 policymakers and HCPs attended focus groups. Workshop participants emphasised the critical role of improving communication in healthcare settings and educating HCPs and PSA on entitlements and the NHS system. Policymakers highlighted the importance of robust leadership and a standardised national approach that can be adapted locally. Capacity constraints within the NHS and primary care system were highlighted as barriers to good quality care provision. Findings were collated into a practical framework, describing five pillars of good practice; 1)Working in partnership; 2) Upskilling the healthcare workforce; 3) Including lived experience voices; 4) Improving data on local needs; and 5) Strengthening pathways into healthcare. The framework provides guidance to enhance the accessibility, consistency and quality of healthcare services for PSA, addressing critical gaps in the current system. Key messages • A novel framework to guide commissioning and provision of healthcare for people seeking asylum has been developed, drawing from existing pockets of excellence to aid a consistent national approach. • The framework presents five pillars of systemic good practice, highlighting the importance of strategic partnerships, workforce training and data collection in providing good quality care.

A person-centred consultation intervention to improve shared decision-making about, and uptake of, osteoporosis medicines (iFraP): a pragmatic, parallel-group, individual randomised controlled trial protocol

Background Good quality shared decision-making (SDM) conversations involve people with, or at risk of osteoporosis and clinicians collaborating to decide, where appropriate, which evidence-based medicines best fit the person’s life, beliefs, and values. We developed the improving uptake of Fracture Prevention drug treatments (iFraP) intervention comprising a computerised Decision Support Tool (DST), clinician training package and information resources, for use in UK Fracture Liaison Service consultations. Two primary objectives to determine (1) the effect of the iFraP intervention on patient-reported ease in decision-making about osteoporosis medicines, and (2) cost-effectiveness of iFraP intervention compared to usual NHS care. Secondary objectives are to determine the iFraP intervention effect on patient reported outcome and experience measures, clinical effectiveness (osteoporosis medicine adherence), and to explore intervention acceptability, mechanisms, and processes underlying observed effects, and intervention implementation. Methods The iFraP trial is a pragmatic, parallel-group, individual randomised controlled trial in patients referred to a Fracture Liaison Service, with nested mixed methods process evaluation and health economic analysis. Participants aged ≥50 years (n=380) are randomised (1:1 ratio) to one of two arms: (1) iFraP intervention (iFraP-i) or (2) comparator usual NHS care (iFraP-u) and are followed up at 2-weeks and 3-months. The primary outcome is ease of decision-making assessed 2 weeks after the consultation using the Decisional Conflict Scale (DCS). The primary objectives will be addressed by comparing the mean DCS score in each trial arm (using analysis of covariance) for patients given an osteoporosis medicine recommendation, alongside a within-trial cost-effectiveness and value of information (VoI) analysis. Process evaluation data collection includes consultation recordings, semi-structured interviews, and DST analytics. Discussion The iFraP trial will answer important questions about the effectiveness of the new ‘iFraP’ osteoporosis DST, coupled with clinician training, on SDM and informed initiation of osteoporosis medicines. Trial registration ISRCTN 10606407, 21/11/2022 https://doi.org/10.1186/ISRCTN10606407

Post-rehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: a mixed methods cluster-feasibility controlled trial

BackgroundLess than 50% of stroke survivors regain their pre-stroke level of upper limb function, compounded with a lack of long-term rehabilitation options available. The Graded Repetitive Arm Supplementary Programme (GRASP)...

A critical review of neonatal parent support programme in United Kingdom: the effect of kangaroo mother care in NHS.

It has become critically important to provide a thorough understanding of the effects of the Kangaroo mother care (KMC) phenomenon on infants in the neonatal stage within the United Kingdom (UK). The current body of knowledge suggests numerous research publications globally, but the UK has yet to scale up its KMC practice. This study provides a critical review of the subject for a more nuanced understanding of the subject effect and to identify the current stage of KMC research in the UK. The findings were consistent with the body of knowledge on KMC with slight variations. Specifically, the UK has limited primary study in KMC. Randomized clinical trials (RCT) in KMC are minimal hence the UK is dependent on MedTech like an infant incubator which is a potential threat to KMC scale-up. Breastfeeding figures in the UK suggest depleting practice of KMC. The National and local policies captured KMC components but have impacted morbidity and mortality indices. It also showed three areas of divergence in practice and standardization. To enhance UK national and local policies uniformized guidelines and standardization of postnatal follow-up and community-based supervision are necessary.

EP232 - Delayed Discharges – How do we compare post pandemic?

Abstract Aims A delayed discharge is when a patient is declared medically fit for discharge (MFFD), yet still requiring an inpatient bed as other circumstances prevent leaving the hospital. This 2nd cycle audit was to assess the proportion of inpatients that are MFFD in comparison to the previous data collected in 2019, assessing level of improvement, implications of cost on the NHS and reasons for delayed discharge. Methodology The data was collected on the 27th of February 2023 encompassing 17 different wards in the hospital, compared to the 1st cycle on 26th February 2019. Analysis covered; Specialty, Age, Reason for the delay, Gender and Number of Days delayed. The number of inpatients on the day (n=432), of which 78 were MFFD (18%). The procurement team provided a figure of £392 for cost per bed per night. Results Findings showed approximately 1 in 5.5 patients had a delayed discharged in 2023 in comparison to that of 1 in 4 patients as seen in 2019. With estimated costs incurred being approximately £31,000 on the day cost in the 2nd cycle in comparison to £27,000 in the 1st cycle. The Audit highlighted the most common reason for delay in discharge was Completion of Assessment (Occupational Therapy/Physiotherapy/Social Worker) and Further Non-Acute NHS Care. Conclusion Even though there was considerable improvement in the number of people experiencing a delayed discharge, the estimated costing was still appreciably higher. To improve financial sustainability taking advantage of Government funding would see £200milion put towards the safe discharge of patients.

Using Normalisation Process Theory to explore the contribution of stakeholder workshops to the development and refinement of a complex behavioural intervention: the STAMINA lifestyle intervention

BackgroundThe National Institute for Health and Care Excellence (NICE) recommend that men with prostate cancer on androgen deprivation therapy (ADT) are offered twice weekly supervised aerobic and resistance exercise to address side effects of treatment. However, supervised exercise is not routinely offered in standard clinical practice. The STAMINA programme grant for applied research (PGfAR) has been designed to evaluate whether this recommendation can be delivered within standard NHS care. This paper describes how future implementation of NICE recommendations within the NHS was explored during complex intervention development to enable evaluation of a lifestyle intervention.MethodsTwo stakeholder workshops were conducted to explore factors pertinent to future implementation of the STAMINA Lifestyle intervention (SLI). Normalisation Process Theory (NPT) provided the theoretical framework for discussion and analysis. Stakeholder workshop 1 focussed on intervention coherence and buy-in. Stakeholder workshop 2 explored barriers and facilitators for embedding SLI into the context of the NHS, with delivery partner Nuffield Health, in the future.ResultsWorkshops were attended by healthcare professionals (n = 16), exercise professionals (n = 17), members of public involved in PPI including patients (n = 12), health psychologists (n = 2), clinical commissioners (n = 4), cancer charities (n = 3), a cancer alliance (n = 1) and health economist (n = 1). Stakeholders agreed that professional training packages should emphasise the uniqueness of the SLI and underpinning theory and evidence (Coherence). To further engagement, the use of STAMINA champions and information about the delivery partner were recommended to enhance confidence and knowledge (Cognitive participation). Furthermore, a simple communication (Collective Action) and progress reporting system (Reflexive Monitoring) was suggested to fit into existing infrastructure within the NHS and community partner.ConclusionsApplication of NPT within two stakeholder workshops enhanced complex intervention development. Context-specific strategies to support implementation of SLI within the context of a trial were proposed, sensed-checked, and considered acceptable. The organisational implications of embedding and sustaining the intervention in preparation for wider NHS roll-out were considered (if proven to be effective) and will be explored in the qualitative component of a process evaluation underpinned by NPT.Trial registration(ISRCTN: 46385239). Registered on July 30, 2020.

“Care process into a cash transaction”: medical neoliberalism, Afloat and graphic medicine

ABSTRACT Medical neoliberalism has precipitated a significant shift away from the patient-centric approach to a profit-driven paradigm that prioritises the interests of corporations and shareholders over the well-being of patients. Consequently, there is a shortage of funding for adult social care resulting in compromised service quality. Taking these cues, the article close-reads some sections of Nigel Baines’s Afloat: A Memoir about Mum, Dementia, and Trying Not to Drown (2019) in order to demonstrate how graphic medicine offers multifaceted critique of the NHS and social care arrangements in the UK through nuanced visualisations. Baines deploys a series of visual metaphors to concretise his challenges in quest of an appropriate care arrangement for his dementia-afflicted mother. In particular, Baines deploys thought-provoking board game metaphors (such as the snake and ladder board) and the Yeatsian symbol of gyre to introspect the fine-grained workings of medical neoliberalism and its impact on social care. The article concludes by discussing how Afloat operates as a critical lens exposing the intricacies emblematic of healthcare environments and the deeply rooted vulnerabilities enmeshed within the system.

Gynaecological pathology and assisted reproductive treatment: can we increase the chances of successful treatment by optimising the pelvis?

Key content: Pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts may have a negative impact on fertility and the success of assisted reproductive technology (ART). If pelvic pathologies are identified during the course of investigations for subfertility, information based on the latest available evidence should be provided so that individuals can make informed decisions about how they wish to proceed. In some situations, surgical intervention prior to ART is strongly recommended, but in others, the evidence is more limited/conflicting. Learning objectives: To learn more about how and why pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts affect fertility and outcomes following ART treatment. To understand when surgical intervention is (and equally is not) indicated in the management of different pelvic pathologies in women with subfertility who are contemplating ART. To appreciate the different options on how to manage women with different pelvic pathologies identified before and during an ART cycle. To smooth the transition between secondary/tertiary NHS care and ART providers so that women are given consistent advice and managed according to evidence based recommendations.

Prevalence of weakness and factors mediating discrepancy between reported and observed leg weakness in people with sciatica

PurposeTo establish the prevalence and agreement between reported and observed leg weakness in people with sciatica. To establish which factors mediate any identified difference between reported and observed leg weakness in people with sciatica.Methods68 people with a clinical diagnosis of sciatica, records from spinal service, secondary care NHS Hospital, England, UK reviewed. Primary outcome measures were the sciatica bothersome index for reported leg weakness and the Medical Research Council scale for observed weakness. Agreement was established with Cohen’s Kappa and intraclass correlation coefficient. Potential factors that may mediate a difference between reported and observed weakness included leg pain, sciatica bothersome index sensory subscale, age, hospital anxiety and depression subscale for anxiety.Results85% of patients reported weakness but only 34% had observed weakness. Cohen’s Kappa (0.066, 95% CI − 0.53, 0.186; p = 0.317)] and ICC 0.213 (95% CI − 0.26, 0.428, p = 0.040) both showed poor agreement between reported and observed weakness. The difference between reported and observed measures of weakness was mediated by the severity of leg pain (b = 0.281, p = 0.024) and age (b = 0.253, p = 0.042).ConclusionThere is a high prevalence of reported leg weakness in people with sciatica, which is not reflected in observed clinical measures of weakness. Differences between reported and observed weakness may be driven by the severity of leg pain and age. Further work needs to establish whether other objective measures can detect patient reported weakness.

Re-engaging with arts and cultural activities at the Life Rooms: ‘It’s given me spring’

BackgroundMersey Care NHS Foundation Trust’s Life Rooms initiative is an established and successful model of integrating arts and culture within NHS provision. In the face of COVID-19, the Life Rooms was restructured to provide a full suite of online resources. Following the lifting of restrictions, in-person arts provision returned to the Life Rooms sites. Additional evidence in respect of the impact on mental health and wellbeing of the return to in-person arts and cultural activities provided by the Life Rooms, as well as the relative merits of online and in-person arts and cultural activities, is needed to inform future planning around in-person, online, and/or hybrid provision.MethodsInterviews with practitioners delivering cultural and creative courses at the Life Rooms (n = 8) and users of the Life Rooms (n = 5) were conducted to explore the impact of the return to in-person arts provision at the Life Rooms, as well as the merits of online and in-person arts provision. Data were analysed using thematic analysis.ResultsThree overarching themes were identified: ‘Provision, access, and reach’; ‘Value of arts and creativity’; and ‘Challenges with the Life Rooms model in the new normal’. The findings demonstrate the critical role of arts and cultural provision in providing stigma-free environments to reconnect the vulnerable and isolated. As re-engagement remained slow, there is a need to be responsive to hesitation around re-engaging in-person. The Life Rooms online learning offer remained vital for those who are vulnerable or otherwise unable to access in-person activities.ConclusionsAs our findings show a demand for maintaining online provision that enables accessibility together with in-person provision that boosts community connectedness, ensuring continued online access alongside in-person delivery should be prioritised. As mental health demands could continue to grow in coming years as the pandemic evolves, in-person arts engagement could have an important role in meeting mental health needs.

Addressing an Identified Need: Training in Serious Incidents Investigations and Coroner's Inquests for Psychiatric Trainees in Kent and Medway NHS and Social Care Partnership Trust (KMPT)

Addressing an Identified Need: Training in Serious Incidents Investigations and Coroner's Inquests for Psychiatric Trainees in Kent and Medway NHS and Social Care Partnership Trust (KMPT)

An Evaluation of the Prevalence of Use of High Dose Antipsychotic Therapy Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust

An Evaluation of the Prevalence of Use of High Dose Antipsychotic Therapy Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust

An Audit of Whether Patients on the General Adult Inpatient Wards and the PICU in Mersey Care NHS Foundation Trust Who Are Prescribed High Dose Antipsychotic Therapy Are Being Monitored as per Trust Policy

An Audit of Whether Patients on the General Adult Inpatient Wards and the PICU in Mersey Care NHS Foundation Trust Who Are Prescribed High Dose Antipsychotic Therapy Are Being Monitored as per Trust Policy

A Re-Audit of the Assessment of the Nutritional Status of Patients Admitted to the General Adult Inpatient Wards in Mersey Care NHS Foundation Trust

A Re-Audit of the Assessment of the Nutritional Status of Patients Admitted to the General Adult Inpatient Wards in Mersey Care NHS Foundation Trust

An Audit to Assess Nicotine Management on a Mental Health Rehabilitation Unit in Mersey Care NHS Foundation Trust

An Audit to Assess Nicotine Management on a Mental Health Rehabilitation Unit in Mersey Care NHS Foundation Trust

An Audit of Baseline Physical Health Monitoring in Patients Under the Care of Mersey Care NHS Foundation Trust Who Are Commenced on Lithium

An Audit of Baseline Physical Health Monitoring in Patients Under the Care of Mersey Care NHS Foundation Trust Who Are Commenced on Lithium

‘Sustainable Minds’: Examining Clinician Engagement in Sustainable Mental Health Care Practices at Bradford District Care NHS Foundation Trust

‘Sustainable Minds’: Examining Clinician Engagement in Sustainable Mental Health Care Practices at Bradford District Care NHS Foundation Trust

An Audit of Physical Health and Blood Test Monitoring in Patients Under the Care of Mersey Care NHS Foundation Trust Who Are Prescribed Lithium

An Audit of Physical Health and Blood Test Monitoring in Patients Under the Care of Mersey Care NHS Foundation Trust Who Are Prescribed Lithium

Audit of Compliance With Stopping the Overprescribing of People With Autism Spectrum Condition (ASC) and Intellectual Disability (STOMP) Within the Child and Adolescent Mental Health Services (CAMHS) in Warrington, Mersey Care NHS

Audit of Compliance With Stopping the Overprescribing of People With Autism Spectrum Condition (ASC) and Intellectual Disability (STOMP) Within the Child and Adolescent Mental Health Services (CAMHS) in Warrington, Mersey Care NHS

An Evaluation of High Dose Antipsychotic Therapy Prescribing Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust

An Evaluation of High Dose Antipsychotic Therapy Prescribing Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust