Changes In Service Provision Research Articles

The remarkable invisibility of NHS 111 online.

In 2017, the NHS 111 telephone service was augmented by an online service. This is an exemplar of 'digital-first', the push to enrol digital technologies to deliver services, and is viewed by policymakers as an important vehicle for managing demand for overburdened health services. This article reports the qualitative component of a larger multi-method study of NHS 111 online. Qualitative telephone interviews with 80 staff and stakeholders implicated in primary, urgent and emergency care service delivery explored the impact of NHS 111 online on health-care work. The analysis presented here draws on Susie Scott's work on the 'sociology of nothing' and theories of the marked and unmarked, which we reached for when confronted by the remarkable invisibility of this seemingly core NHS service in the wider landscape of health care. Despite the apparently high use by patients and the public (30 million visits over 6months in the 2020 pandemic), we were surprised to find very low awareness among our interviewees. Confusion about nomenclature, an exceedingly crowded digital field (littered with alternative technologies and ways of accessing care) and constant change in service provision provide some cogent reasons for this invisibility, and sociology helps explain our data about this digital technology.

Impact of covid-19 on subspecialty training in obstetrics and gynaecology

The Covid-19 pandemic brought substantial changes in clinical practice in Obstetrics and Gynaecology (O and G). Redeployment of staff and restrictions in elective services raised training concerns. We sought to assess the impact on subspecialty training, to identify issues to help mitigate the impact. We conducted cross-sectional anonymous electronic surveys of UK subspecialty trainees at three time points: June 2020, February 2021, September 2021. Surveys were analysed by descriptive statistics and thematic analysis of free-text responses. Response rates ranged from 30% to 40%, with higher response rates from urogynaecology trainees. Up to 72% reported an impact on training, most notable in gynaecological subspecialties, and particularly urogynaecology, which persisted over time. More than a third anticipated needing extra time to complete training. This raises serious future workforce and patient care concerns. Clinical recovery should consider training needs as essential when re-establishing services. Subspecialty trainees may need additional time to achieve competencies required of future consultants. IMPACT STATEMENT What is already known on the subject? Covid-19 led to dramatic changes in clinical practice in Obstetrics and Gynaecology. Previous studies on training in O and G during the pandemic in the UK and internationally highlighted issues from redeployment, trainee absence, and changes in service provision, that had potential to severely impact training. What do the results of this study add? Subspecialty training in Obstetrics and Gynaecology has been affected by the pandemic. Urogynaecology was worst affected and continues to be affected over the course of the pandemic. What are the implications of these findings for clinical practice and/or further research? Covid-19 recovery plans need to incorporate training requirements. Extended training due to the pandemic may affect consultant workforce numbers and thus service provision in tertiary care.

Efficiency of the EmERGE Pathway of Care in Five European HIV Centres.

We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$ 2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services formedically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. There were 2251 participants: 87-93% were male, mean age at entry was 41-47 years. Medically stable people living with HIVhad outpatient visits in four sites whichdecreased by 9-31% and costs by 5-33%; visits andcosts increased by 8% in one site, which had to revert back to face-to-face visits. Antiretroviral drugs comprised 83-91% of annual costs: the Portuguese site had the highest antiretroviral drug costs in US$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensivein the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision.

Management of tuberculosis infection in Victorian children: A retrospective clinical audit of factors affecting treatment completion.

Tuberculosis preventive treatment (TPT) is strongly recommended for children following infection with Mycobacterium tuberculosis because of their high risk of progression to active tuberculosis, including severe disseminated disease. We describe the implementation of TPT for children and adolescents with evidence of tuberculosis infection (TBI) at Victoria's largest children's hospital and examine factors affecting treatment completion. We conducted a retrospective clinical audit of all children and adolescents aged <18 years diagnosed with latent TBI at the Royal Children's Hospital, Melbourne, between 2010 and 2016 inclusive. The primary outcome was treatment completion, defined as completing TPT to within one month of a target duration for the specified regimen (for instance, at least five months of a six-month isoniazid course), confirmed by the treating clinician. Factors associated with treatment adherence were evaluated by univariate and multivariate analysis. Of 402 participants with TBI, 296 (74%) met the criteria for treatment "complete". The most common TPT regimen was six months of daily isoniazid (377, 94%). On multivariate logistic regression analysis, treatment completion was more likely among children and adolescents who had refugee health screening performed (OR 2.31, 95%CI 1.34-4.00) or who were also treated for other medical conditions (OR 1.67 95%CI 1.0-2.85), and less likely among those who experienced side-effects (OR 0.32, 95%CI 0.11-0.94). However, TPT was generally well tolerated with side-effects reported in 15 participants (3.7%). Identification of factors associated with TPT completion and deficiencies in the existing care pathway have informed service provision changes to further improve outcomes for Victorian children and adolescents with TBI.

Stable pollination service in a generalist high Arctic community despite the warming climate.

Insects provide key pollination services in most terrestrial biomes, but this service depends on a multistep interaction between insect and plant. An insect needs to visit a flower, receive pollen from the anthers, move to another conspecific flower, and finally deposit the pollen on a receptive stigma. Each of these steps may be affected by climate change, and focusing on only one of them (e.g., flower visitation) may miss important signals of change in service provision. In this study, we combine data on visitation, pollen transport, and single-visit pollen deposition to estimate functional outcomes in the high Arctic plant-pollinator network of Zackenberg, Northeast Greenland, a model system for global warming-associated impacts in pollination services. Over two decades of rapid climate warming, we sampled the network repeatedly: in 1996, 1997, 2010, 2011, and 2016. Although the flowering plant and insect communities and their interactions varied substantially between years, as expected based on highly variable Arctic weather, there was no detectable directional change in either the structure of flower-visitor networks or estimated pollen deposition. For flower-visitor networks compiled over a single week, species phenologies caused major within-year variation in network structure despite consistency across years. Weekly networks for the middle of the flowering season emerged as especially important because most pollination service can be expected to be provided by these large, highly nested networks. Our findings suggest that pollination ecosystem service in the high Arctic is remarkably resilient. This resilience may reflect the plasticity of Arctic biota as an adaptation to extreme and unpredictable weather. However, most pollination service was contributed by relatively few fly taxa (Diptera: Spilogona sanctipauli and Drymeia segnis [Muscidae] and species of Rhamphomyia [Empididae]). If these key pollinators are negatively affected by climate change, network structure and the pollination service that depends on it would be seriously compromised.

Experiences of Social Participation for Canadian Wheelchair Users with Spinal Cord Injury during the First Wave of the COVID-19 Pandemic

The COVID-19 pandemic caused drastic life changes for people with spinal cord injury (SCI). The objective of the study is to explore the social participation of Canadian wheelchair users with SCI during the first wave of COVID-19. Methods: Fourteen participants from Quebec and British Columbia participated in a multi methods cross-sectional study. Three themes were identified, including (1) perceived participation restrictions for people with SCI and their loved ones, which revealed interruptions and changes in service provision during COVID-19, barriers and inconveniences to maintaining life habits and strategies developed during the pandemic to continue participating in meaningful activities; (2) There was no change in life habits (but some subjects found new ways to perform some activities), which highlights that life simply continued as usual and the participants developed new pastimes and interests; and (3) future hopes and concerns, which explained participants’ concerns about changes in interpersonal relationships after the pandemic. This study highlights daily participation challenges for people with SCI during the pandemic. Even though the use of technologies, delivery services and social support seemed to facilitate engagement in meaningful activities, mental health challenges and concerns for future relationships persisted for some.

"We figured it out as we went along": Staff perspectives of COVID-19 response efforts at a large North American syringe services programme.

Syringe services programmes face operational challenges to provide life‐sustaining services to people who use substances and those who have substance use disorders. COVID‐19 has disrupted operations at these programmes and is a threat to people with substance use disorder because of severe poverty, de‐prioritisation of COVID‐19 safety and high prevalence of comorbidities. This phenomenological qualitative study describes 16 in‐depth interviews with staff of one of the largest syringe services programme in North America—Prevention Point Philadelphia, located in the Kensington neighbourhood of Philadelphia, Pennsylvania. Interviews were conducted from December 2020 to February 2021, audio‐recorded, transcribed and coded to develop a thematic framework. Participants were mostly white (71.4%) and female (68.8%) with a median age of 31.5. Three main and four sub‐themes related to the impact of COVID‐19 on the syringe services programme were identified: (1) COVID‐19 altered services provision (sub‐theme: select service changes should be retained); (2) unclear or absent COVID‐19 response guidance which compromised mitigation (sub‐themes: COVID‐19 messaging was difficult to translate to practice, learn‐as‐we‐go); and (3) staff and clients experienced elevated mental anguish during the pandemic (sub‐theme: already limited resources were further strained). COVID‐19 presented complex challenges to an organisation normally strained in pre‐pandemic times. A staff culture of resourcefulness and resiliency aided the syringe services programme to balance client needs and staff safety. However, staff experienced a serious psychological impact, largely attributable to being unable to find reprieve from the stressors of COVID‐19 and the difficulties associated with navigating and acting‐on contradictory public health messaging. Staff also shared a belief that the relaxing of some pre‐pandemic barriers allowed staff to link clients more readily with services. Syringe services programmes should embrace the potential for lasting changes to health services delivery brought about by wide‐scale changes in service provisions because of COVID‐19.

Understanding the Psychological Impact of Lockdown: Combining Quantitative and Qualitative Analysis of Emergency Presentations

AimsThe pandemic of the COVID-19 variant caused a near-global lockdown, and the psychological impact of the direct effects of the virus, along with the resulting lockdown periods cannot be overestimated. Referrals made to the Liaison Psychiatry service at Derriford hospital during the 2020 lockdown were audited to better understand effects on patients’ mental health and resulting emergency presentations to services. These data were then used to identify areas for improvement, in order to tailor services to better support the population during recovery from the current lockdown, and for planning for future similar events.MethodsReferrals to the Derriford Liaison Psychiatry service between the 1st and 12th of May 202 were audited, totalling 106 referrals and a subsequent 87 assessments. Quantitative data on patient demographics, presentation, and outcomes was extracted from assessments along with qualitative data on patients’ subjective experiences from the initial lockdown period for thematic analysis. Routine data were used for comparator time periods from 2019, and during the second 2021 lockdown.ResultsDespite a lower number of presentations to ED during the first lockdown, the data demonstrate a higher acuity in presentations with more referrals for admission under section. The lockdown is shown to have particularly affected those with pre-existing psychiatric and physical comorbidity, along with specific patient groups. Thematic analysis confirms this, showing the diverse factors contributing to emergency presentations and demonstrating the increased stress of life in the home under lockdown. Comparisons between the qualitative and quantitative data confirm that patient experiences directly match both the routinely collected data and prior research. The project also revealed a reliance on private and third sector organisations for signposting on from assessments, and highlighted frequent changes to services during lockdown as a source of confusion for both patients and staff.ConclusionThe scale of impact identified affirms that exploration of the lockdown's contribution to presentation should be routine, particularly for identified at-risk patient groups. Areas frequently highlighted by patients can be used to fully explore the impact of lockdown on presentation during assessment. Patient information for self-referral needs to be regularly updated given frequent changes in service provision. Staff also need to be kept up to date on changing service structure at handover meetings.

COVID 19\u2014impact on substance use treatment utilization and provision in South Africa

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide. The aim of this study was to explore, changes in the number of SUD treatment episodes provided during the height of the pandemic and, SUD treatment providers’ perceptions of the impact of COVID-19-related restrictions on people with SUDs and the delivery of SUD treatment services in South Africa.MethodsWe used administrative data collected as part of the South African Community Epidemiology Network on Drug Use (SACENDU) project to assess whether the number of treatment episodes changed during the height of COVID-19 restrictions. We used data from an online survey of SUD treatment providers to assess providers’ perceptions of the impact of COVID-19 on SUD treatment delivery. Eight seven SUD facilities were recruited to participate in the online survey.ResultsSixty-three organisations (out of a total of 86) participated in the survey, yielding a 73.2% response rate. About half (n = 30; 47.6%) of the sample thought the need for SUD treatment had remained the same or had increased during the COVID-19 lockdown. Half the sample (n = 32; 50.7%) reported decreased availability of SUD services during COVID-19 lockdowns. Participants believed that the lack of services during COVID-19 lockdown impacted negatively on patients that were enrolled in their programmes and on individuals who wished to access the service. Furthermore, changes in service provision seemed to increase patients’ anxiety, exacerbate pre-existing mental health problems and in some cases were thought to precipitate relapse. In addition, patient disengagement and attrition from treatment were thought to have increased during this period. Whilst 47.6% (n = 30) of providers agreed with the value of the alcohol ban, 23.8% (n = 15) of providers thought it had unintended negative consequences.ConclusionBased on the findings it is evident that SUD treatment services in South Africa have been significantly affected during the COVID-19 pandemic and more severely during the onset of the pandemic. Together with service providers, more effective ways should be sought on how to feasibly expand access to SUD treatment for all South Africans and enhance the country’s preparedness for future health emergencies.

The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users' needs and recommendations for the future.

Background: The aim of this study was to document employees’ experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users’ needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users’ emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users’ emerging needs. This was particularly so when users’ concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users’ needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users’ needs. We discuss practical and research implications of our findings with a focus on the users’ physical and mental health, use of telehealth, MAT, and overall service reorganisation.

A Service Evaluation of Adherence with Antimicrobial Guidelines in the Treatment of Community-Acquired Pneumonia Before and During the SARS-CoV-2 Outbreak.

Antimicrobial stewardship is essential to reducing antimicrobial resistance, reducing costs, and, crucially, ensuring good patient care. Community-acquired pneumonia (CAP) is a common medical condition, the symptoms of which show a significant overlap with those of COVID-19. Following the COVID-19 outbreak in Ireland, patients presenting to our hospital with features of a respiratory infection were more commonly reviewed within 24 hours (24h) of admission by an infectious disease (ID) or respiratory specialist. We aimed to assess how the change in service provision, involving frequent specialist reviews of patients admitted with features of CAP during the first wave of the COVID-19 pandemic, affected antimicrobial stewardship and prescribing practices. Patients admitted under general medical teams treated for CAP from March–April 2020 were included. Retrospective data including demographics, CURB-65 score, and antimicrobial therapy were collected, as well as information on whether the patient had undergone specialist review by an ID or respiratory physician. Data were compared to a similar cohort treated for CAP between November 2019 and January 2020, though in this cohort, before the era of COVID-19, none of the patients had undergone specialist review. Seventy-six patients were included from the March–April 2020 cohort, with 77 from November 2019–January 2020 for comparison. An ID or respiratory specialist reviewed 35 patients from the March–April cohort within 24 h of admission. There was a higher rate of appropriate escalation, de-escalation, and continuation of antibiotics among those reviewed. Less than 20% of patients were started on antibiotics in accordance with CAP guidelines on admission, though the antibiotics initiated were frequently deemed appropriate in the clinical setting. Specialist review increases rates of appropriate antimicrobial prescribing and adherence with hospital guidelines in patients with CAP.

Presenting a climate-smart forestry evaluation framework based on national forest inventories

Climate-smart forestry (CSF) has gained increasing attention in recent years. Yet, a framework to assess the three pillars of CSF, in terms of mitigation and adaptation to climate change and ecosystem service (ES) provision based on national forest inventory (NFI) data is currently lacking. In this study, we present an assessment framework of CSF based on forest indicators derived from NFI. To quantify the three pillars of CSF we defined 1) mitigation based on the forest carbon stock, 2) adaptation using biodiversity and susceptibility to disturbances caused by storm and bark beetles and 3) ES provision with timber production and protection against avalanches and rockfall. We demonstrate the application of this framework using Swiss NFI data and projections of future forest development under four different management scenarios. Our results show that, in general, the carbon stock is increasing at the national scale when current management practices are maintained. Increases are especially pronounced in the Jura and Southern Alps regions. Trade-offs occur between enhancing mitigation and adaption, and the sustainable provision of ES such as timber production. Scenarios with increased harvesting intensities lead to a higher timber supply in the short-term, while decreasing the carbon stock, biodiversity-related old-growth indicators and the protective function of forests. The indicator framework presented in this study provides a first methodological approach that can support policy making to balance the different forest services in the context of CSF.

A qualitative study of the Scottish homeless service provisions through the production of reflexive mapping exercises

BackgroundThe Scottish oral health and psychosocial wellbeing programme, Smile4life, identified a scarce knowledge of the health and social services available for those going through homelessness or at risk of becoming homeless. The Public Bodies (Joint Working) (Scotland) Act 2014 aims to integrate health and social care in Scotland to meet the needs of vulnerable populations. The Reflexive Mapping Exercise aims to integrate care by providing a framework to map services that allows for analysis of the geographic distribution and types of support that has been offered. The reflexive component discusses joint strategies to integrate services, improve practices, and reduce unequal distribution that might marginalise individuals, limiting their access and engagement with services. MethodsThe reflexive mapping framework aims to maximise participation and development through co-designed participatory research, involving an advisory group composed of key stakeholders and individuals with lived experience. Policy makers and practitioners working in the homelessness sector collaborated to gather, review, and update the data collected about services through online searches, telephone calls, institutional visits, and event consultations. An analysis of the current service provision was made to identify deficits and areas to improve. FindingsThe mapping is a visual and descriptive publication that includes services from different areas of support and their referral pathways. The completed mappings and reflexive exercises have shown a scarcity of services allocated to the most deprived areas of Scotland, with the majority of services seeking to address crisis periods with little aim at prevention, early intervention, and sustainability. InterpretationThe mapping process identified the need to take a prophylactic approach and create a more equitable distribution of services. The Reflexive Mapping Exercise helps to provide a framework that promotes communication and integration of health and social care services among practitioners and vulnerable services users. A reflexive approach helps to plan the strategic delivery of homeless services in Scotland with the service user at the forefront of care. The limitations surrounding the dynamic nature of service provision changes have been identified and are planned to be addressed through the formation of an online interactive resource. FundingThis work was supported by Scottish Government (grant number 121.80.4497).

Maintaining Postgraduate Healthcare Education During COVID-19: Does a Virtual Format Allow Effective Engagement and Personal Development?

IntroductionThe COVID-19 pandemic has brought unprecedented challenges in health care, leading to a dramatic change in service provision and impacting surgical training. The availability of a virtual meeting platform allowed our team to develop a new educational programme aiming to maintain an ethos of education safely, focusing on providing an opportunity to develop non-technical skills and maintain reflective practice.Materials and MethodsMicrosoft Teams was used to conduct two streams of weekly education: a journal club focussing on developing critical evaluation skills, and case-based in-depth discussion forum to develop presentation skills and evidence-based management. A questionnaire after 10 weeks was used to evaluate the effectiveness and engagement of the two streams.ResultsFifty-three responses were received. Seventy-two percent felt that their engagement in teaching was increased on a virtual platform. There was 88% satisfaction with the platform. Reflective practice increased and 40% of respondents felt their non-technical skills improved. Sixty-eight percent stated that they would like to continue the virtual format going forward and 88% would recommend this to their peers. Ninety-two percent felt that the platform played a pivotal role in helping maintain team morale during this period.ConclusionOur experience of using a virtual tool to maintain education within our department is very positive. There has been good engagement with positive reflection and learning at a time of great change in the NHS. Both trainees and non-trainees have benefited. With ongoing COVID still influencing clinical practice, we recommend utilising virtual platforms to maintain education in surgical departments.

Changes in adult home parenteral nutrition practice over 25 years

Home Parenteral Nutrition (HPN) is the established treatment of intestinal failure. This study considers the changes in practice in a single UK centre over the past twenty-five years. Data was culled from a database used for clinical care and maintained prospectively. Two hundred and five patients were included from 1993 to 2018. Patient numbers increased from 22 during 1999-2003 to 158 during 2014-2018. The median age at discharge increased from 52 years during 1999-2003 to 59 years during 2014-2018. Thirty percent of patients discharged during 1999-2003 had Crohn's disease, reducing to 14% during 2014-2018. Fifteen percent of patients discharged during 1999-2003 had small bowel fistula or obstruction in comparison to 44% during 2014-2018. Only 18 patients were treated with palliative intent, the majority in recent years. An increasing number of patients required help with HPN care over the years. Survival in non-palliative patients was 85% at 1 year, 67% at 3 years, 53% at 5 years and 42% at 10 years. The majority of deaths were due to underlying disease and only 5 of 55 deaths were attributed to HPN alone. HPN dependence in non-palliative patients was 73% at 1 year, 59% at 3 years, 56% at 5 years and 43% at 10 years. Fifty eight patients stopped HPN after reconstructive surgery. Patients experienced 5.1 admissions/1000 HPN days (64.7 admission days/1000 HPN days). Admission rate did not change over the years though the percentage due to catheter problems fell from 52% to 40% while the percentage due to underlying disease or unrelated cause rose. The increase in numbers, age and dependency of HPN patients requires increasing resource and consideration of new models of service. Many patients with short bowel syndrome now survive to old age and the care needs of the HPN patient who has become elderly can be complex. A significant proportion of patients are being referred for HPN as a bridge to reconstructive surgery after surgical complication and this requires close involvement of gastrointestinal surgeons in HPN teams. The need for hospital admissions remains a burden for HPN patients and there is scope for changes in service provision to try to reduce hospital days.

A Healthier Future for Tissue Viability - An initiative to improve outcomes for patients with lower limb issues

Reducing unwarranted variation in clinical care and access to care was a central goal of the Five Year Forward View, and the later Long Term Plan. Variation in provision and access to lower limb services in one Sustainability and Transformation Partnership were apparent. Through networking and collaboration of STP wide tissue viability and related specialist services a programme of service development was accepted as part of wider Frailty service provision.This led to a public health needs assessment of the problem being commissioned; 6 clinical pathways being produced; and clear recommendations for improvement in service provision being made. The public health needs assessment is believed to be the first of its kind considering the issues of leg ulceration, cellulitis of the lower limb, lymphoedema of the lower limb (excluding cancer related), chronic oedema of the lower limb, diabetic foot ulceration and foot ulceration.Data from local hospital episode statistics, community services data and extrapolation from national data sources has been used to understand the local impact. This provided an idea of the numbers of the population affected, the costs to the local health economy and a baseline for improvement outcome measurement in the future. It also prompted widespread service provision changes to meet the needs of those living with lymphoedema and chronic oedema and pathways for skin tear and leg ulceration have been designed for implementation.The public health needs assessment is fully published and freely accessible elsewhere. This article describes the process followed to undertake the work.

2021/19 Employees’ contracts can be split so they transfer to multiple employers on a TUPE service provision change (UK)

2021/19 Employees’ contracts can be split so they transfer to multiple employers on a TUPE service provision change (UK)

COVID-19 Disrupted Provision and Utilization of Health and Nutrition Services in Uttar Pradesh, India: Insights from Service Providers, Household Phone Surveys, and Administrative Data.

ABSTRACTBackgroundThe coronavirus (COVID-19) pandemic may substantially affect health systems, but little primary evidence is available on disruption of health and nutrition services.ObjectivesThis study aimed to 1) determine the extent of disruption in provision and utilization of health and nutrition services induced by the pandemic in Uttar Pradesh, India; and 2) identify how adaptations were made to restore service provision in response to the pandemic.MethodsWe conducted longitudinal surveys with frontline workers (FLWs, n = 313) and mothers of children <2 y old (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests.ResultsCompared with prepandemic, service provision reduced substantially during lockdown (83–98 percentage points, pp), except for home visits and take-home rations (∼30%). Most FLWs (68%–90%) restored service provision in July 2020, except for immunization and hot cooked meals (<10%). Administrative data showed similar patterns of disruption and restoration. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service provision. Key adaptations made to provide services were delivering services to beneficiary homes (∼40%–90%), social distancing (80%), and using PPE (40%–50%) and telephones for communication (∼20%). On the demand side, service utilization reduced substantially (40–80 pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing the challenges of limited travel (30%), nonavailability of services (26%), and fear of catching the virus when leaving the house (22%) or meeting service providers (14%).ConclusionsCOVID-19 disrupted the provision and use of health and nutrition services in Uttar Pradesh, India, despite adaptations to restore services. Strengthening logistical support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.

Impacts of COVID-19 on Provision and Utilization of Health and Nutrition Services in Uttar Pradesh, India: Insights From Phone Surveys and Administrative Data

ObjectivesThe COVID-19 pandemic has significant potential implications for health systems, but little primary evidence is available on effects on health and nutrition services. We aimed to examine changes in service provision and utilization during the pandemic in Uttar Pradesh, India and identify positive adaptations to service delivery. MethodsWe conducted longitudinal surveys with frontline workers (FLW, n = 313) and mothers of children < 2 years (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. ResultsCompared to pre-pandemic, service provision reduced substantially during lockdown (83–98 percentage points, pp), except for home visits and take-home-rations (∼30%). Most FLWs (68–90%) resumed service provision in July 2020, except for immunization and hot-cooked meals (< 10%). Administrative data showed similar patterns of disruption and resumption. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service delivery. Key adaptations made to provide services included: delivering services to beneficiary homes (∼40–90%), social distancing (80%), using PPE (40–50%), and telephones for communication (∼20%). On the demand side, service utilization also reduced substantially (40–80pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing challenges of limited travel (30%), non-availability of services (26%), fear of catching virus when leaving the house (22%) or meeting service providers (14%). ConclusionsCOVID-19 affected the provision and use of health and nutrition services despite efforts at service restoration and adaptations. Strengthening logistics support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19. Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute; and Alive & Thrive, led by FHI Solutions.

Beyond Traditional Social Work with Elderly: Reflections from Ukraine in Times of Social Distancing

The global COVID-19 pandemic envokes numerous challenges in many areas of societies, including social services. The idea of ‘social distancing’ contradicts the whole idea of social work and inevitably causes deepening social exclusion. This study is aimed to analyse peculiarities of Ukrainian social workers’ activities under severe quarantine restrictions or lockdown. Special attention is paid to local social services for the elderly as a group recognised as most vulnerable to COVID-19. A survey of representatives of territorial centres of social services in Ukraine, conducted in August 2020, revealed some problems caused by restrictive quarantine measures and positive changes in the centres. The study highlights some surprising contradictions in the impact of the pandemic on social work practice with the elderly. Social services providers in local communities (territorial centres of social services, social services centres for families, children, youth, etc.) received almost no additional support during the quarantine. Yet, they consider introducing new, distant forms of communication, adjusting the work schedule, etc., as positive changes in service provision. The study determines that the response to the challenges of a problematic situation depends on local characteristics and mostly on human resources – work organisation and professional adaptability. An important role belongs to the ability of social workers to act in emergencies, the availability of standard procedures, protocols, and resources for use in such situations, understanding the need to adhere to values of social solidarity. The specific applications from the study results are drawn for Ukrainian social work.