National Health Service Plan Research Articles

Noninvasive ventilation in New Zealand: a national prevalence survey.

Home-based noninvasive ventilation (NIV) is an effective treatment for a range of conditions that cause respiratory failure which reduces hospitalisationand mortality and improves quality of life. To collect NIV prevalence, disease burden and equity data needed foreffective national NIV health service planning. The authors collected demographics and the primary diagnosis of patients receiving publicly funded NIV in New Zealand in 2018 by surveying all providers. National and regional prevalence rates were calculated using adult population data (aged ≥20 years) for each District Health Board region compared with a 2011 study. A subanalysis of individual-level data was used to calculate age-standardised rates by diagnostic category. A total of 1197 adults were receiving NIV giving a national rate of 32.9 per 100 000; almost twice the 2011 rate (16.7 per 100 000). Significant regional variations in NIV provision (4.5-84.2 per 100 000) were observed. The most frequent indications were obesity hypoventilation syndrome (OHS) (562, 47%), obstructive pathologies (335, 28%) and neuromuscular disorders (175, 15%); all have significantly increased in prevalence since 2011. Māori and Pacific peoples were significantly overrepresented among NIV users (2.24 [95% confidence interval (CI), 1.72-2.93]and 7.03 [95% CI, 5.52-8.94], respectively). The prevalence of NIV-dependent use (>15 h/day) was 4%. Home-based NIV provision has doubled since the previous survey, reflecting increased burden from OHS and obstructive pathologies and a disproportionate disease burden among Māori and Pacific populations. The large regional variations are concerning and highlight the urgent requirement for national service specifications, education and equipment provision. Further research is needed to address access equity.

Access block to psychiatric inpatient admission: Implications for national mental health service planning.

Access block to psychiatric inpatient admission: Implications for national mental health service planning.

Crisis resolution/home treatment and in-patient care

With the development of crisis resolution/home treatment (CR/HT) teams according to the National Health Service (NHS) Plan and Policy Implementation Guidance (Department of Health, 2000), it is important to anticipate the issues involved in their collaboration with acute in-patient units. What are the implications for in-patient care (IC) of CR/HT availability? How can we realise the opportunities that full integration can offer towards an improved acute service?

Evidence-based practice development project: private physiotherapy cancer care practice

Purpose: The National Health Service (NHS) plan has contributed to the growing entrepreneurial culture of the NHS, providing more autonomy and accountability with expectations of quality and efficiency underpinning best practice. A successful enterprise improvement must have a framework of robust processes designed and applied to meet patient demand. Practice development (PD) plays a key role in transforming healthcare culture and services, which complements the changes occurring in cancer care. The purpose of this study was to develop a unique private physiotherapy practice for cancer patients, promoting patient-centred care, within which care decisions reflect the needs, values and beliefs of the cancer patients and those providing the care.

The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial.

BackgroundAs an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users’ experiences of care, service use, staff well-being, and team model fidelity.Methods/designTwenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services’ electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study’s primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme.DiscussionOur trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams.Trial registrationCurrent Controlled Trials ISRCTN47185233Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1283-7) contains supplementary material, which is available to authorized users.

How many paediatric referrals to an allergist could be managed by a general practitioner with special interest?

The concept of a general practitioner with special interest (GPwSI) was first proposed in the 2000 National Health Service Plan, as a way of providing specialized treatment closer to the patient's home and reducing hospital waiting times. Given the patchy and inadequate provision of paediatric allergy services in the UK, the introduction of GPwSIs might reduce pressure on existing specialist services. A total of 100 consecutive referrals to a specialist paediatric allergy clinic were reviewed to assess what proportion could be managed by a GPwSI allergy service with a predefined range of facilities and expertise (accurate diagnosis and management of allergy; skin prick testing; provision of allergen avoidance advice; ability to assess suitability for desensitization). Each referral was reviewed independently by three allergy specialists. Cases were initially judged on the referral letter and then, to determine whether appropriate triage decisions could be made prospectively, cases were re-assessed with information summarized in the clinic letter. The proportion of referrals suitable for a GPwSI was calculated and their characteristics identified. At least 42% and up to 75% were suitable for management by a GPwSI in allergy based on unanimous and majority agreement, respectively. The appropriateness of 79% referrals could be identified based on the information in the referral letter. A total of 19% referrals were unsuitable for a GPwSI service because of complex or multisystem disease, need for specialist knowledge or facilities or patient's young age. At least two-fifths of paediatric allergy referrals to our hospital-based service could be dealt with in a GPwSI clinic, thereby diversifying the patient pathway, allowing specialist services to focus on complex cases and reducing waiting times for appointments.

What proportion of adult allergy referrals to secondary care could be dealt with in primary care by a GP with special interest?

BackgroundThe concept of a General Practitioner with Special Interest (GPwSI) was first proposed in the 2000 National Health Service Plan, as a way of providing specialised treatment closer to the patient’s home and reducing hospital waiting times. Given the patchy and inadequate provision of allergy services in the UK the introduction of GPwSIs might reduce the pressure on existing specialist services.ObjectivesThis study assessed what proportion of referrals to a specialist allergy clinic could be managed in a GPwSI allergy service with a predefined range of facilities and expertise (accurate diagnosis and management of allergy; skin prick testing; provision of advice on allergen avoidance; ability to assess suitability for desensitisation).Methods100 consecutive GP referrals to a hospital allergy clinic were reviewed to determine whether patients could be seen in a community-based clinic led by a general practitioner with special interest (GPwSI) allergy. The documentation relating to each referral was independently assessed by three allergy specialists. The referrals were judged initially on the referral letter alone and then re-assessed with the benefit of information summarised in the clinic letter, to determine whether appropriate triage decisions could be made prospectively. The proportion of referrals suitable for a GPwSI was calculated and their referral characteristics identified.Results29 % referrals were judged unanimously appropriate for management by a GPwSI and an additional 30 % by 2 of the 3 reviewers. 18 % referrals were unsuitable for a GPwSI service because of the complexity of the presenting problem, patient co-morbidity or the need for specialist knowledge or facilities.Conclusions and clinical relevanceAt least a quarter, and possibly half, of allergy referrals to our hospital-based service could be dealt with in a GPwSI clinic, thereby diversifying the patient pathway, allowing specialist services to focus on more complex cases and reducing the waiting time for first appointments.

Risk for chronic kidney disease increases with obesity: Health Survey for England 2010.

Studies of the relationship between obesity and chronic kidney disease (CKD) in nationally representative population samples are limited. Our study aimed to determine if overweight and obesity were independently associated with the risk for CKD in the 2010 Health Survey for England (HSE). The HSE is an annually conducted cross-sectional study. In 2010 serum creatinine was included to determine the incidence of CKD in the population. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Multivariable logistic regression models were developed to calculate odds ratios and 95% confidence intervals for CKD risk by BMI (reference category: BMI=18.5-24.9 kg/m2) and adjusted for age, gender, ethnicity, smoking, diabetes and hypertension. A random sample of nationally representative households in England. Adults (n 3463) with calculable eGFR and BMI were included. The prevalence of CKD was 5.9%. The risk of CKD was over 2.5 times higher in obese participants compared with normal-weight participants in the fully adjusted model (BMI=30.0-39.9 kg/m2: adjusted OR=2.78 (95% CI 1.75, 4.43); BMI ≥ 40.0 kg/m2: adjusted OR=2.68 (95% CI 1.05, 6.85)). Obesity is associated with an increased risk of CKD in a national sample of the UK population, even after adjustment for known CKD risk factors, which may have implications for CKD screening and future national health service planning and delivery.

Effect of UK policy on medical migration: a time series analysis of physician registration data.

BackgroundEconomically developed countries have recruited large numbers of overseas health workers to fill domestic shortages. Recognition of the negative impact this can have on health care in developing countries led the United Kingdom Department of Health to issue a Code of Practice for National Health Service (NHS) employers in 1999 providing ethical guidance on international recruitment. Case reports suggest this guidance had limited influence in the context of other NHS policy priorities.MethodsThe temporal association between trends in new professional registrations from doctors qualifying overseas and relevant United Kingdom government policy is reported. Government policy documents were identified by a literature review; further information was obtained, when appropriate, through requests made under the Freedom of Information Act. Data on new professional registration of doctors were obtained from the General Medical Council (GMC).ResultsNew United Kingdom professional registrations by doctors trained in Africa and south Asia more than doubled from 3105 in 2001 to 7343 in 2003, as NHS Trusts sought to achieve recruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance to avoid active recruitment of doctors from resource-poor countries. Registration of such doctors declined subsequently, but in response to other government policy initiatives. A fall in registration of South African-trained doctors from 3206 in 2003 to 4 in 2004 followed a Memorandum of Understanding with South Africa signed in 2003. Registrations from India and Pakistan fell from a peak of 4626 in 2004 to 1169 in 2007 following changes in United Kingdom immigration law in 2005 and 2006. Since 2007, registration of new doctors trained outside the European Economic Area has remained relatively stable, but in 2010 the United Kingdom still registered 722 new doctors trained in Africa and 1207 trained in India and Pakistan.ConclusionsEthical guidance was ineffective in preventing mass registration by doctors trained in resource-poor countries between 2001 and 2004 because of competing NHS policy priorities. Changes in United Kingdom immigration laws and bilateral agreements have subsequently reduced new registrations, but about 4000 new doctors a year continue to register who trained in Africa, Asia and less economically developed European countries.

Integrating community pharmacy with NHS Direct: evaluation of a pilot scheme

Abstract Focal points

Professional integration within health centre pharmacies

Abstract Focal points

Health information needs of families attending the paediatric emergency department

BackgroundThe National Health Service Plan (July 2000) aimed to empower patients with more influence upon their own treatment. Provision of additional educational health information (AEHI) serves to inform families about...

Anne Mills—nurturing a generation of health economists

Anne Mills—nurturing a generation of health economists

Day case surgery training for surgical trainees: A disappearing act?

Introduction Over the past decade there has been considerable change to surgical training such as modernising medical careers which have raised concerns over exposure to operative experience. With the National Health Service (NHS) plan aiming for the majority of elective surgical cases to be performed as day cases we sought to assess the level of exposure modern day surgical trainees obtain in day case surgery. Methods An anonymous electronic questionnaire survey was completed by 100 surgical trainees in surgical training across the United Kingdom (UK) from a variety of sub-specialities. 16 questions pertinent to day case surgery exposure were answered. Results The majority of the trainees who completed the survey felt day case surgery is a vital part of their training as a surgeon. Only less than one-third of all the trainees had formal timetabled day case surgery lists. Of the 31 trainees who had scheduled day lists only 58% ( n = 18) were consistently able to attend. The most common reasons for being unable to attend were rota issues and lack of encouragement from seniors. 90 trainees (90%) were not satisfied with their overall Day Case Surgery training. Conclusions The survey reveals that the modern surgical trainee is gaining a low and inconsistent level of exposure to day case surgery despite being aware of the importance of this modality of training. An urgent review is required to ensure trainees become actively involved in day case surgery and are not missing on this vital training opportunity.

Readability of out-patient letters copied to patients: can patients understand what is written about them?

The National Health Service Plan of 2000 proposed that patients should receive a copy of all correspondence regarding their care. There is concern that the readability of patients' letters may not be appropriate for many patients. This study determined readability scores for sequential letters written to general practitioners and copied to patients, following ENT consultations at the Royal United Hospital in Bath. Intervention involved educating clinicians in techniques to improve readability. A total of 295 letters from eight clinicians were assessed in the pre-intervention phase. The mean Flesch reading ease score was 61.8 (standard deviation 8.7) and the mean Flesch-Kincaid reading grade was 9.0 (standard deviation 1.7). Re-audit analysed a further 301 letters. There was no significant change in the readability of the letters post-intervention. It may not be feasible to present medical information intended for general practitioners in a way that is readable to most of the UK adult population.

An Audit of an Integrated Care Pathway for a Crisis Resolution/Home Treatment Team

The development of crisis resolution/home treatment (CRHT) teams was outlined as a requirement in the National Health Service Plan (Department of Health 2000) and reiterated in the recent guidelines to have an impact on the provision of mental health care (Care Services Improvement Partnership [CSIP] 2006). The Home Option Service in Central Manchester, one of the first CRHT teams in the United Kingdom, provides support and a range of interventions, 24 hours a day, 7 days a week, for those service users experiencing a crisis in their mental health, as an alternative to hospital admission. The need for team working is explicit in the guidance statement to ensure fidelity and best practice for crisis services and it urges teams to provide clarity regarding their roles and responsibilities within the team approach (CSIP 2006). This paper illustrates a model for occupational therapists working within a crisis team in order to ensure that service users have access to occupational therapy when admitted to crisis care. Specific standards, in accordance with those outlined in the research and development strategic vision for occupational therapists in mental health (Association of Occupational Therapists in Mental Health 2006), have been identified to instigate a clear pathway for the stakeholders of crisis teams. A description of the development, implementation and evaluation of an integrated care pathway is provided, alongside a subsequent audit to measure the effectiveness of this model.

Copying Letters to Patients: Views of Professionals Working with People with Learning Disability

The National Health Service Plan (DoH, 2000) requires that patients receive copies of correspondence between health professionals about them, as of right. Patients with learning disabilities are not exempt from this rule. Copying letters to patients with learning disabilities is undoubtedly going to be challenging and complex for professionals working with them and, because of the heterogeneous nature of this group, specific guidelines need to be in place to support professionals in this task. The aim of the study was to ascertain the views of various professionals working in learning disability teams, on the copying of clinical letters to patients and their carers. The majority of respondents commented that, if letters are copied to patients with learning disabilities, then the persons may find it difficult to understand them, and a separate ‘simpler’ letter may need to be sent. Despite expressing concerns about this policy, the majority stated that they will be sending copies of letters regularly in their clinical practice in the future.

Commitment to reality: services for early intervention in psychosis in England

This paper is no doubt as accurate a reflection as we can get of the progress made with the development of early intervention services in England. Concerning the history – in 2000 there was much pressure from Ministers to develop new services as there had been so much criticism of the new Labour Governments first term in office and poor progress on health generally. The Government had pledged to bring the level of health investment up to the level of the European average, which would result in a significant increase in resources. The key document for National Health Service (NHS) investment and reform was the NHS Plan (2000), which set out new plans for service investment and development across the whole of the NHS. Concerning early intervention (EI) it was agreed that 50 million UK pounds would be invested in early intervention services and the key target (in my opinion) was that all young people who develop a first episode of psychosis would be in receipt of early intervention services by 2005, and that they would continue to be supported for 3 years. Ministers realized the importance of these services to young people. The target number of teams and caseloads was the result of standardized system of recording delivery against targets and was very unsophisticated and based on the only model available at the time, which was the EI service in Birmingham with some reductions for non-urban areas. In my opinion the key targets were – number of teams, meeting the criteria for teams contained in the ‘planning and implementation guidance’ (so called fidelity) and meeting the stated aim that – all young people would be in receipt of such services, who needed it, by 2005’. We did not know the numbers at the time; we had to make a best but unsophisticated guess! The paper does not mention whether all young people needing such services are getting them. Also we knew in 2000 the teams would not function properly or be successful if they did not meet the fidelity to the model and 50% are still reporting they do not meet the criteria! Finally the NHS Plan was funded but, as usual, the NHS did more than was required with investment in other lower priority areas. Also the new general practitioner contract cost substantially more than planned and the new system for rewarding staff (Agenda for Change) led to largely significant but unplanned pay rises. This led the NHS into a significant overspend last year even with massive and unprecedented levels of new investment! All in all, in my opinion the reforms were not properly managed and implemented by senior managers, with the highest priority given, as usual, to waiting lists and general hospital services. The most crucial question is whether or not the Government is still committed to meeting its targets on early intervention that it set 6 years ago and whether the new Department of Health’s planning and strategic frameworks are still requiring this. A substantial start has been made, however, as the authors conclude. But if we are ever going to stop ‘bailing out the bath’ in psychiatry we have to make a real effort to turn off the tap!

The National Programme for Information Technology – An Overview

The National Health Service (NHS) in England is in the middle of an Information and Communications (ICT) revolution. The NHS National Programme for IT (NPfIT) has been described as one of the world’s biggest IT projects, costing £6.2bn. ‘Over the next ten years, state‐of‐the‐art computer systems will be installed across the NHS. Once the work is complete, those systems will, for the first time, connect more than 117,000 doctors, 397,000 nurses and 128,900 other healthcare professions in England.’ The improvement of services through the application of ICT surrounds our everyday life, whether at the bank, in supermarkets or in the entertainment industry. Whilst major technological advances have taken place in medical imaging, diagnosis, treatment and surgery, the same level of advancement in information and communication management, across the whole organization, has proved far more elusive.The concept of the Electronic Patient Record (EPR) in the NHS was first introduced to readers of this journal in 2000. The idea of using information management and technology to ease the burden on NHS staff had been developing for years, with some success in what Brennan described as ‘pockets of excellence’, but on the whole these initiatives had not achieved the revolutionary change sought and were regarded as a ‘frustrating failure’. The Department of Health (DH) therefore seconded Frank Burns from one of the successful EPR sites, Wirral NHS Trust, to develop a strategy to take the NHS towards the vision of an integrated, computer‐savvy health service.Three years later, Brennan was back in these pages with an update. The vision of Information for Health and its spin‐offs had led to disappointment, missed targets and, ultimately a major re‐think. Apart from the failings of Information for Health, the DH was also having to respond to a number of other influential publications; Building the Information Core: Implementing the NHS Plan, Jan 2001; Delivering the NHS Plan;6 and Securing Our Future Health: Taking a Long‐Term View, April 2002 (commonly known as the Wanless Report).

New roles to support practice learning – Can they facilitate expansion of placement capacity?

The National Health Service (NHS) Plan [Department of Health, 2000. The NHS Plan: A Plan for Investment, a Plan for Reform, The Stationery Office, London] set out an ambitious programme of growth for the number of students undertaking health professional education programmes. To meet this demand there is a growing and widely acknowledged need to increase the number of clinical placements needed by these students. This paper outlines the findings from a regional project that aimed to map the current pattern and availability of clinical placements for healthcare students by the collection of quantitative placement data (such as location, specialty, and number of mentors) as well as in-depth interviews with Clinical Placement Managers (CPMs). This article will focus on the findings from interviews with CPMs and their views and experiences of what role they can play in increasing placement capacity. The study revealed that the introduction of this role had facilitated the development and expansion of placement capacity, as the CPMs filled a gap in the form of up-to-date local knowledge about the clinical areas. The CPMs provided a much needed 'bridge' between the Higher Education Institution (HEI), the student and the clinical area. Recommendations are made in relation to future introduction of similar roles that aim to support student learning in practice. Furthermore, useful insights for ongoing policy implementation and development are highlighted.