Deliveries In England Research Articles

Heatwaves, Hospitals, and Health System Resilience in England: A Qualitative Assessment (Summer 2019)

Abstract Background Frequent heatwaves challenge healthcare delivery in England, affecting patient safety and staff welfare. This study addresses the observational gap in how healthcare settings adapt to extreme weather. Methods We utilised a qualitative approach, conducting semi-structured interviews with fourteen NHS staff across England to explore experiences during the 2019 summer heatwave. Participants included clinical and non-clinical personnel, providing broad insights into operational challenges and adaptive strategies. Results The 2019 heatwave significantly disrupted service delivery, with variable staff awareness of the Heatwave Plan for England affecting responses. Key issues included managing infection control versus electric fan usage, impacting patient and staff comfort and safety. These conditions also led to an increase in hospital admissions. Conclusions The findings highlight the need for improved workforce training and strategic planning to enhance resilience to heat-related risks. Further research is essential to develop a comprehensive evidence base on the impacts and costs of heatwaves and to assess the effectiveness of adaptation strategies. This will support national health adaptation planning and emergency response. Key messages • Enhanced planning and training are crucial for health system resilience to heatwaves. • More research is needed to understand heatwave impacts and effective responses.

Visualising Carrier Consolidation and Alternative Delivery Locations: A Digital Model of Last-Mile Delivery in England and Wales

Visualising Carrier Consolidation and Alternative Delivery Locations: A Digital Model of Last-Mile Delivery in England and Wales

Sociodemographic Disparities in HER2+ Breast Cancer Trastuzumab Receipt: An English Population-Based Study.

Sociodemographic disparities in traditional breast cancer treatment receipt in nonpublicly funded healthcare systems are well documented. This study investigated trastuzumab receipt by sociodemographic factors within a female, HER2+ breast cancer population in England's publicly funded National Health Service. The English national population-based cancer registry and linked Systemic Anti-Cancer Therapy database identified 36,985 women with HER2+ invasive breast cancer diagnosed between January 1, 2012 and December 31, 2017. Multivariable logistic regression determined the likelihood of trastuzumab receipt in early and metastatic disease by the deprivation category of area of residence and other sociodemographic characteristics. Early-stage trastuzumab receipt followed a socioeconomic gradient. Women residing in the most deprived areas were 10% less likely to receive trastuzumab [multivariable OR 0.90; 95% confidence interval (CI), 0.83-0.98] compared with women residing in the least deprived areas. In both early and metastatic disease, trastuzumab receipt was less likely in older women with more comorbidities, estrogen receptor-positive disease, and who were not discussed at a multidisciplinary team meeting. Despite the provision of free care at the point of delivery in England, sociodemographic disparities in early-stage HER2+ trastuzumab receipt occur. Further research determining how inequities contribute to disparities in outcomes is warranted to ensure optimized trastuzumab use for all. Fair access to novel cancer treatments regardless of place of residence, sociodemographic characteristics, and/or cancer stage requires prioritization in future cancer improvement policies. See related In the Spotlight, p. 1259.

Linkage of administrative family court care proceedings and hospital records for mothers in England: linkage accuracy and cumulative incidence of family court care proceedings after a first live birth

IntroductionLinkage of public law family court care proceedings (CP) data to all women giving birth in NHS hospitals in England allows calculation of the cumulative incidence of CP involvement for mothers with first children born. ObjectivesTo assess linkage accuracy and determine the 10-year cumulative incidence of CP after a first live birth (FLB) for population subgroups. MethodNHS England linked records for mothers in Cafcass (Children and Family Court Advisory and Support Service) involved in CP (2007-2021) to all mothers with a delivery in England using Hospital Episode Statistics (HES: 1997-21). We calculated match rates and assessed indirect evidence of potential false positive and missed links. We used survival analyses to estimate cumulative incidence of CP within 10 years overall and for five-year maternal age groups at first live birth. ResultsOf 120,937 mothers involved in CP, 6.6% (n = 8,010) were excluded due to missing postcode or date of birth, or age < 15 or > 50. Of the remaining 112,927 mothers, 92,891 (82.8%) were linked to a HES delivery record. Match rates were lowest for mothers with an ethnic minority background, older at first case, or residing in Greater London, but improved over time. Of 3,572,737 mothers with a FLB, 38,462 had CP involvement. The cumulative incidence of CP at 10 years from FLB was 1.31% (95% Confidence Interval [CI]; 1.29-1.32) overall and highest in mothers aged 15--19 years (6.79%, 95% CI: 6.69-6.89) and those living in the most deprived areas (2.47%, 95% CI: 2.43-2.51). ConclusionOne in 77 of all mothers and one in 15 aged less than 20 at first live birth were involved in CP within 10 years. Linkage error may underestimate the incidence of CP for mothers in London or with an ethnic minority background.

Implementation of a peer support intervention for family members of involuntarily hospitalised patients

IntroductionPeer support has been identified as successful in improving patient wellbeing and empowerment and there is evidence that peer support can also help their family members (FMs). A peer support programme for FMs, developed in Germany, significantly improved FMs’ quality of life. We have worked to adapt this support programme for delivery in England. We will report the results of this adaptation process and of the implementation of peer support for FMs.ObjectivesTo examine the feasibility of the peer support programme developed and assess whether it can be delivered using a “train-the-trainer” approach.MethodsThe peer support programme is being implemented in two stages. In stage one, FMs with experience of supporting an involuntarily hospitalised patient (family peer supporters (FPSs)) receive an online training programme consisting of four sessions. These sessions, provided by the research team and FMs with lived experience of caring for an involuntarily hospitalised patient, teach FPSs skills in communication, reflection, coping and trialogue (promotion of equal communication between FMs, professionals and patients). FPSs then use these skills to deliver support to FMs of patients who are currently involuntarily hospitalised. This support is delivered for up to three months. The impact of this programme is assessed through one-to-one interviews with FPSs and FMs. Questionnaires are also provided to FMs measuring their quality of life, caregiving burden and psychological wellbeing before and after receiving support from FPSs.In stage two, a modified version of the training programme (based on FPS feedback) is provided to a new group of FPSs. This training will be delivered by FPSs from stage one. After receiving the training programme, stage two FPSs will deliver support to other FMs as described for stage one. Assessment of the modified programme will mirror stage one.ResultsProvision of the stage one training programme is complete, and delivery of support is in progress with modifications being made for stage two. Eight FPSs and six out of a target of 12 FMs have been recruited for stage one. FPSs reported the training programme to be a positive experience, highlighting that it was engaging, easy to understand and gave them the confidence to support other FMs. Technical difficulties and an overload of information were cited as areas to improve for the next stage.ConclusionsFPSs described the peer support training programme as a positive experience overall. However, improvements need to be made for stage two which is in progress. A more comprehensive report of our findings, including the impact of this peer support programme and the feasibility of implementing it in England, will be provided as the programme progresses.Disclosure of InterestNone Declared

Centre variation in home dialysis uptake: A survey of kidney centre practice in relation to home dialysis organisation and delivery in England.

Disparities in home dialysis uptake across England suggest inequity and unexplained variation in access. We surveyed staff at all English kidney centres to identify patterns in service organisation/delivery and explore correlations with home therapy uptake, as part of a larger study ('Inter-CEPt'), which aims to identify potentially modifiable factors to address observed variations. Between June and September 2022, staff working at English kidney centres were surveyed and individual responses combined into one centre-level response per question using predetermined data aggregation rules. Descriptive analysis described centre practices and their correlation with home dialysis uptake (proportion of new home dialysis starters) using 2019 UK Renal Registry 12-month home dialysis incidence data. In total, 180 responses were received (50/51 centres, 98.0%). Despite varied organisation of home dialysis services, most components of service delivery and practice had minimal or weak correlations with home dialysis uptake apart from offering assisted peritoneal dialysis and 'promoting flexible decision-making about dialysis modality'. Moderate to strong correlations were identified between home dialysis uptake and centres reporting supportive clinical leadership (correlation 0.32, 95% Confidence Interval (CI): 0.05-0.55), an organisational culture that values trying new initiatives (0.57, 95% CI: 0.34-0.73); support for reflective practice (0.38, 95% CI: 0.11-0.60), facilitating research engagement (0.39, 95% CI: 0.13-0.61) and promoting continuous quality improvement (0.29, 95% CI: 0.01-0.53). Uptake of home dialysis is likely to be driven by organisational culture, leadership and staff attitudes, which provide a supportive clinical environment within which specific components of service organisation and delivery can be effective.

HSD17 Key Features and Preferences for New High-Volume Low-Complexity Outpatient Care: Using Discrete Choice Experiments in Ophthalmology to Improve Diagnostic Service Delivery in England

HSD17 Key Features and Preferences for New High-Volume Low-Complexity Outpatient Care: Using Discrete Choice Experiments in Ophthalmology to Improve Diagnostic Service Delivery in England

The impact of maternity service restrictions related to COVID-19 on women's experiences of giving birth in England: A qualitative study

BackgroundThe COVID-19 pandemic led to significant changes in maternity service delivery in England, including: antenatal appointments being cancelled or held by phone; women having to attend antenatal scans alone; partners not being allowed to accompany women during labor; visitor restrictions on postnatal wards; and limited postnatal support. MethodsWe conducted semi-structured interviews with 46 women aged 18–45 who had low-risk pregnancies and gave birth to their babies using NHS services in England between 1st March 2020 and 1st March 2021. ResultsOur thematic analysis of interview data generated key themes: profound negative impacts of birth partners not being allowed to accompany women (including on emotional wellbeing, birth preferences and care-seeking choices); deep frustration about policy variation between trusts and inconsistent implementation of guidance; women being more concerned about the risk of giving birth alone than of COVID-19 infection; and women turning towards private care or delaying seeking NHS care so that they could have the birth experience they desired. The latter two results are, to the best of our knowledge, unique to this paper. ConclusionOur participants reported significant negative affects to their emotional and physical wellbeing because of maternity service restrictions. Going forward, efforts are required by policymakers and health service providers to re-establish trust in NHS maternity care and ensure capacity to provide for potential shifts in birthplace preferences. Health systems strengthening efforts should prioritise protecting the rights of women to access high quality, person-centred care in the event of future health emergencies that strain NHS capacity.

Healthcare apprenticeships: assessing the potential benefits to an acute care provider NHS organization.

The introduction of healthcare-based apprenticeships to become both a physician associate and a doctor has been approved for delivery in England. This will revolutionize medical training and it is hoped that medical training would be more accessible. This has generated a mixture of reactions, some enthusiastic and others concerned. This paper gauges interest among staff at Barking, Havering, and Redbridge University Hospitals NHS Trust in pursuing training as a doctor and/or physician associate through the apprenticeship route. Applicants were interviewed to discover their motivations for interest, and the potential benefit to the Trust of these new opportunities was also assessed. This revealed that applicants were primarily driven through intrinsic motivations, such as a lifelong dream to be a doctor and a desire to fulfil a patient-facing role. Many expressed financial and social situations were a barrier to prior application, making the apprenticeship role more attractive. Healthcare professionals should accurately represent the population that they serve, which is currently not the case. The prospective applicants, with diverse backgrounds and existing healthcare experience, can help to improve patient care through their diverse perspective and understanding of multidisciplinary team working. This article highlights the potential of medical-based apprenticeships to help address longstanding challenges in medical education and workforce diversity. Furthermore, there could be significant financial and practical benefits to the trust of upskilling enthusiastic staff. However, there is currently a lack of clarity regarding selection processes and entry criteria, which must be addressed.

Covid-19 and Technological Disruption in Health Care Delivery in England

Covid-19 and Technological Disruption in Health Care Delivery in England

Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders’ perspectives and strategies

ProblemCOVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans. BackgroundBefore the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic. AimTo explore community postnatal care provision during and since the pandemic across a large diverse UK region. MethodsA descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate. Findings11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women’s experiences); and Drivers of postnatal care changes (COVID-19, workforce issues). DiscussionChanges to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response. ConclusionChanges to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.

Understanding the impact of Covid-19 on the delivery and receipt of prison healthcare: an international scoping review

BackgroundPeople being held in prison are particularly vulnerable to Covid-19 infection, as places of detention are high-risk environments for spread of infection. Due to this risk, many prisons across the globe introduced measures to reduce the risk of Covid-19 transmission. The pandemic changed almost all aspects of prison life, including prison healthcare provision. We undertook a scoping review to understand what is known about the impact of the Covid-19 pandemic on the receipt and delivery of prison healthcare. This scoping review is part of a wider mixed-methods study focusing more specifically on the impact that Covid-19 had on prison healthcare delivery in England.MethodsWe conducted an international scoping review of peer-reviewed articles published between December 2019 and January 2022, across six electronic databases. We also conducted a hand search of key journals and the reference lists of included articles.ResultsTwelve articles met our inclusion criteria. The articles focused primarily on prisons in high-income countries and mostly explored the impact that the pandemic had on the provision of drug treatment services. Some aspects of drug treatment services were more impacted than others, with those delivered by external providers and preparations for release particularly hindered. Whilst prison mental health services were purportedly available, there were changes regarding how these were delivered, with group therapies suspended and most consultations taking place using telehealth. The articles reported both digital and non-digital adaptations or innovations to prison healthcare services to ensure continued delivery. Collaboration between different agencies, such as the prison itself, healthcare providers, and non-governmental organisations, was key to facilitating ongoing provision of healthcare to people in prison.ConclusionsCovid-19 impacted on prison healthcare internationally, but different treatment services were affected in disparate ways, both within and between countries. The published literature concentrates on the impact on drug treatment services. Prison healthcare providers rapidly adapted their processes to attempt to maintain service provision.

The NHS Health Check programme: a survey of programme delivery in England before and after the Covid-19 pandemic response.

This study investigated NHS Health Check programme delivery before and after the Covid-19 pandemic response, with a focus on support services and referral methods available to Health Check attendees. The NHS Health Check is an important part of England's Cardiovascular Disease (CVD) prevention programme. Public health commissioners from all 151 local authorities responsible for commissioning the NHS Health Check programme were surveyed in 2021, using an online questionnaire to capture detail about programme delivery, changes in delivery because of the pandemic response, and monitoring of programme outcomes. Four-point rating scales were used to obtain level of confidence in capacity, accessibility and usage of follow-on support services for Health Check attendees. A typology of programme delivery was developed, and associations between delivery categories and a range of relevant variables were assessed using one-way analysis of variance. Sixty-eight responses were received on behalf of 74 (of 151) local authorities (49%), across all geographical regions. Our findings suggest a basic typology of delivery, though with considerable variation in who is providing the Checks, where and how, and with continued changes prompted by the Covid-19 pandemic. Support for risk management is highly varied with notable gaps in some areas. Local authorities using a model of delivery that includes community venues tended to have a higher number of services to support behaviour change following the Check, and greater confidence in the accessibility and usage of these services. A minority of local authorities gather data on referrals for Health Check attendees, or on outcomes of referrals. The Covid-19 pandemic has prompted continued changes in delivery, which are likely to influence patient experience and outcomes; these need careful evaluation. The programme's delivery and commissioners' intentions to follow through risk communication with appropriate support is challenged by the complexity of the commissioning landscape.

The NHS Health Check programme: a survey of programme delivery in England before and after the Covid-19 pandemic response

Background: This study investigated NHS Health Check programme delivery before and after the Covid-19 pandemic response, with a focus on support services and referral methods available to Health Check attendees. The NHS Health Check is an important part of England’s Cardiovascular Disease (CVD) prevention programme. Methods: Public health commissioners from all 151 local authorities responsible for commissioning the NHS Health Check programme were surveyed in 2021, using an online questionnaire to capture detail about programme delivery, changes in delivery because of the pandemic response, and monitoring of programme outcomes. Four-point rating scales were used to obtain level of confidence in capacity, accessibility and usage of follow-on support services for Health Check attendees. A typology of programme delivery was developed, and associations between delivery categories and a range of relevant variables were assessed using one-way analysis of variance. Results: Sixty-eight responses were received on behalf of 74 local authorities (49%), across all geographical regions. Our findings suggest a basic typology of delivery, though with considerable variation in who is providing the Checks, where and how, and with continued changes prompted by the Covid-19 pandemic. Support for risk management is highly varied with notable gaps in some areas. Local authorities using a model of delivery that includes community venues tended to have a higher number of services to support behaviour change following the Check, and greater confidence in the accessibility and usage of these services. A minority of local authorities gather data on referrals for Health Check attendees, or on outcomes of referrals. Conclusions: The Covid-19 pandemic has prompted key innovations in delivery, which are likely to influence patient experience and outcomes; these need careful evaluation. The programme’s delivery and intention to follow through risk communication with appropriate support is challenged by the complexity of the commissioning landscape.

Adapting SARS-CoV-2 vaccination delivery in England to population needs: a thematic analysis of providers and commissioner’s perceptions

BackgroundA national SARS-CoV-2 vaccination programme was implemented in England from 8th December 2020, adopting a series of local level service delivery models to maximise rollout. The evidence base informing service design programme at inception was limited. We examined the real-world implementation of the programme through an assessment of sub-national providers’ and commissioners’ perspectives on the service delivery models used, to strengthen evidence on the acceptability, effectiveness and efficiency of the service delivery approaches used for SARS-CoV-2 vaccination in England or elsewhere.MethodsQualitative, cross-sectional analysis based on semi-structured interviews conducted with 87 stakeholders working in SARS-CoV-2 vaccination delivery across four regions in England. Localities were selected according to geography and population socio-economic status. Participants were purposively sampled from health service providers, commissioners and other relevant bodies. Interviews were conducted between February and October 2021, and transcripts were thematically analysed using inductive and deductive approaches.ResultsVarious service delivery models were implemented over the course of the programme, beginning with hospital hubs and mass vaccination sites, before expanding to incorporate primary care-led services, mobile and other outreach services. Each had advantages and drawbacks but primary care-led models, and to some extent pharmacies, were perceived to offer a better combination of efficiency and community reach for equitable delivery. Common factors for success included availability of a motivated workforce, predictability in vaccine supply chains and strong community engagement. However, interviewees noted a lack of coordination between service providers in the vaccination programme, linked to differing financial incentives and fragmentated information systems, among other factors.ConclusionA range of delivery models are needed to enable vaccine rollout at pace and scale, and to mitigate effects on routine care provision. However, primary care-led services offer a tried-and-trusted framework for vaccine delivery at scale and pace and should be central to planning for future pandemic responses. Mass vaccination sites can offer delivery at scale but may exacerbate inequalities in vaccination coverage and are unlikely to offer value for money. Policymakers in England should prioritise measures to improve collaboration between service providers, including better alignment of IT systems.

Profile of Hospital Admissions Due to Preterm Labor and Delivery in England.

Preterm labor and delivery are associated with various short- and long-term complications in neonates and infants. This research aimed to look at the trends in preterm labor and birth-related hospitalizations in England. The Hospital Episode Statistics database was used to extract hospital admission data for the ecological study of preterm labor and delivery between April 2012 and April 2020 in England. The overall admission rates decreased by 26.2%, from 14,210 in 2012 (CI: 99.18-102.49) to 10,490 in 2020 (CI: 73.02-75.87) per 100,000 individuals. Hospitalizations were frequently caused by spontaneous labor with preterm delivery, spontaneous labor without delivery, and preterm delivery without spontaneous labor (68.9%, 20.6%, and 9.6%, respectively). The rate of hospital admission due to preterm delivery without spontaneous labor, preterm labor without delivery, preterm spontaneous labor with preterm delivery, and preterm spontaneous labor with term delivery decreased by 32.0%, 26.9%, 24.4%, and 14.7%, respectively. Women aged 25-29 years accounted for most hospital admissions. Preterm labor and delivery-related hospital admissions rates have significantly decreased over the past decade. Women in the reproductive age range of 25-34 years were more prone to hospital admission followed by preterm labor due to various reasons.

‘They Made an Excellent Start…but After a While, It Started to Die Out’, Tensions in Combining Personalisation and Integration in English Adult Social Care

This article seeks to understand the challenges of combining the distinct aims of personalisation and integration in adult social care. Addressing the local context of service delivery in England through interviews with key stakeholders, we identify how personalisation and integration activities require different, and potentially conflicting, approaches. We observe direct tensions when structural integration with health systems distracts focus from achieving personalised delivery of care or where a focus on clinical outcomes takes precedence over broader wellbeing aspirations. Integration can entail the prioritisation of health over social care and a population rather than personal orientation. We suggest that personalisation and integration are in ‘policy conflict’ (Weible and Heikkila, 2017) and that policy-makers need to acknowledge and address this rather than promise the ‘best of both worlds’.

Localism and the will to housing: neighbourhood development plans and their role in local housing site delivery in England

ABSTRACT The planning system in England is regarded as a key mechanism for the delivery of housing but is also seen by some as a brake on its supply. In this context, the introduction of neighbourhood planning in 2011 has been promoted as a mechanism to reduce opposition to new housing and aid housing growth. This paper focuses on how this policy tool has been implemented with a view to mobilising communities to assist in the allocation of housing sites. The paper draws on empirical data to illustrate the role, motivations, and response to neighbourhood planning and its impact on the delivery of housing.

Study protocol: a mixed-methods study to evaluate which health visiting models in England are most promising for mitigating the harms of adverse childhood experiences

IntroductionExposure to adverse childhood experiences (ACEs) is associated with poorer health outcomes throughout life. In England, health visiting is a long-standing, nationally implemented service that aims to prevent and mitigate...

Powerful or Disempowering Knowledge? The Teaching of Sociology in English Schools and Colleges

While studying sociology can be empowering and transformative, fostering criticality and reflexivity, this capacity is not being sufficiently harnessed in school/college-based delivery in England. A large survey of sociology teachers revealed that they are required to teach outdated and sometimes discredited studies, which can reinforce rather than challenge stereotypes held by the privileged and which can be disempowering for those students who cannot recognise their own experiences. This article provides a unique insight into the ways that school/college curricula reinforce inequality and contributes to important debates within the sociology of education. Specifically, the article argues that the work being undertaken to decolonise the curriculum in universities, through challenging structural and discursive operations of power, should also inform the revision of school/college specifications. The lessons from this study can be usefully applied to the teaching of sociology beyond England and indeed to other subject disciplines.