National Health Service Trusts In England Research Articles

Review of National Health Service England's Emergency Preparedness, Resilience and Response Annual Assurance for 2021-2022.

National Health Service (NHS) England conducts annual assurance of NHS bodies in England's readiness to respond to emergencies using its Core Standards for emergency preparedness, resilience, and response (EPRR). This review assessed whether the first complete EPRR assurance after England's coronavirus disease (COVID-19) pandemic national response was performed successfully. The primary outcome of interest was the quantity of information regarding applicable Core Standards held by NHS England at the end of that assurance. Secondary outcomes were variations between the number of applicable Core Standards and information held by NHS bodies about the number of applicable Core Standards. NHS England recorded the correct number of applicable Core Standards for 88 of the 124 NHS trusts in England which provided general hospital accommodation and services in relation to accidents or emergencies. It recorded an incorrect number of standards for 13 trusts and did not record the number of standards for 23 trusts. NHS England's EPRR assurance resulted in correct data not being recorded for over a quarter of the above NHS trusts. This review may also be of interest to other state-level bodies that rely on the high-level assurance of their ability to provide health care during emergencies.

Pharmaceutical industry payments to NHS trusts in England: A four-year analysis of the Disclosure UK database.

Although hospitals are key health service providers, their financial ties to drug companies are little understood. We examine non-research pharmaceutical industry payments to English National Health Service (NHS) trusts-hospital groupings providing secondary and tertiary care. We extracted data from the industry-run Disclosure UK database, analysing it descriptively and using the Jonckheere-Terpstra test to establish whether a statistically significant time trend existed in the median values of individual payments. We explained payment value and number per trust with random effects models, using selected trust characteristics as predictors. Drug companies reported paying £60,253,421 to 234 trusts, representing between 90.0% and 92.0% of all trusts in England between 2015 and 2018. As a share of payments to all healthcare organisations, the number of payments rose from 38.6% to 39.5%, but their value dropped from 33.0% to 23.6%. The number of payments for fees for service and consultancy and contributions to costs of events increased by 61.5% and 29.4%. The median payment value decreased significantly for trusts overall (from £2,250.8 to £1,758.5), including those with lower autonomy from central government; providing acute services; and from half of England's regions. The random effects model showed that acute trusts received significantly more money on average than trusts with all other service profiles; and trusts from East England received significantly less than those from London. However, trusts enjoying greater autonomy from government did not receive significantly more money than others. Trusts also received significantly less money in 2018 than in 2015. NHS trusts had extensive pharmaceutical industry ties but were losing importance as payment targets relative to other healthcare organisations. Industry payment strategies shifted towards events sponsorship, consultancies, and smaller payments. Trusts with specific service and geographical profiles were prioritised. Understanding corporate payments across the health system requires more granular disclosure data.

How can NHS trusts in England optimise strategies to improve the mental health and well-being of hospital doctors? The Care Under Pressure 3 (CUP3) realist evaluation study protocol

IntroductionThe growing incidence of mental ill health in doctors was a major issue in the UK and internationally, even prior to the COVID-19 pandemic. It has significant and far-reaching implications,...

Challenges and successes in implementing an integrated electronic patient record (HIVE) at the Manchester University National Health Service Foundation Trust, England: 1000+ legacy systems, 10 hospitals, one electronic patient record.

The Manchester University National Health Service (NHS) Foundation Trust (MFT) is one of the largest NHS Trusts in England. Historically, the Trust has had very mixed clinical record keeping, including over 1000 individual information systems. None of these health information technology systems had the full functionality of an integrated electronic patient record (EPR). MFT evolved to its current size and complexity with a vision to improve patient care in Greater Manchester by adopting a Trust-wide EPR. The EPR "Go Live" occurred in September 2022. To describe the process of EPR integration as it reflected and impacted upon MFT's health information management (HIM) teams. MFT worked through a 2-year readiness program of work. This included technical readiness, software development and migration planning. Migration of data from the approximately 1000 systems was a major undertaking, during which access to the clinical history and ongoing operational reporting needed to be maintained. Pre-implementation requirements were outlined, a change management program was implemented, and the overall implementation was managed to tight timelines. "Go Live" was achieved for the EPIC EPR product (HIVE) within MFT. Legacy systems are still in the process of being decommissioned and staff are transacting within HIVE. Significant changes in processes and reporting continue to be made, despite some challenges. The Trust delivered the single largest EPIC European "Go live." Lessons learnt continue to be identified. The impact of what the EPR means for the HIM function is described.

Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019–2021

ObjectivesTemporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum...

The place of charity in a public health service: Inequality and persistence in charitable support for NHS trusts in england

The British National Health Service (NHS) relies for the great bulk of its funding on direct taxation, but the contribution of charitable sources of income to the NHS is not well-understood. The few studies of charitable giving to the NHS to date have concentrated on aggregate levels of income and expenditure. However, to date there has been limited collective understanding about the extent to which different kinds of NHS Trusts benefit from charitable funding and about the persistence of inequalities between trusts in their access to these resources. This paper presents novel analyses of the distribution of NHS Trusts in terms of the proportion of their income that comes from charitable sources. We build a unique linked longitudinal dataset which follows through time the population of NHS Trusts, and the population of associated NHS charities, in England since 2000. The analysis illustrates intermediate levels of charitable support for acute hospital trusts compared with the much lower levels of charitable support for ambulance, community and mental health Trusts and, conversely, much higher levels of charitable support for Trusts providing specialist care. These results represent rare quantitative evidence relevant to theoretical discussions about the uneven nature of the voluntary sector's response to healthcare need. They provide important evidence for a key feature (and arguably weakness) of voluntary initiative, namely philanthropic particularism - the tendency for charitable support to focus on a restricted range of causes. We also show that this ‘philanthropic particularism’ – reflected in the very sizeable differences in charitable income between different sectors of NHS trusts - is becoming more marked over time, while spatial disparities, notably between elite institutions in London and other locations, are also substantial. The paper reflects on the implications of these inequalities for policy and planning within a public health care system.

'You get looked at like you're failing': A reflexive thematic analysis of experiences of mental health and wellbeing support for NHS staff.

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages.

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure.

Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a "burning platform" for scaling up such services. As health care organizations look to expand and maintain the use of video in the "new normal," it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al's 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an "organizing vision" for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.

Cross-sectional survey of child weight management service provision by acute NHS trusts across England in 2020/2021

ObjectiveWith one in five children in England living with obesity, we mapped the geographical distribution and format of child weight management services provided by acute National Health Service (NHS) trusts...

Does registered nurse involvement in improving healthcare services, influence registered nurse retention?

Registered nurses are 'critical' to population health, international responses to emergencies, epidemics and disasters. Retention of registered nurses (RNs) is an international nursing priority. In England, RNs are encouraged to be involved in improving healthcare services. This benefits quality of care, operational and financial performance. However, RN involvement in improvement may reduce RN retention. It is important to understand this relationship when developing effective RN retention strategies. The purpose of this research is to describe possible relationships between RN involvement in improving healthcare services and RN retention, using published 2018 data for National Health Service (NHS) Trusts in England. The relationship between RN involvement in improving healthcare services and RN retention was explored using a correlational design, involving secondary data from the annual NHS Staff Survey and Model Hospital. In mental health NHS Trusts in England, a statistically significant, positive correlation of 0.24 was found between RN 'ab(ility) to make suggestions for improvement' and RN retention. In mental health NHS Trusts, a statistically significant correlation of 0.278 was found between RNs 'making improvements happen' and RN retention. In acute NHS Trusts in England, a statistically significant, negative correlation of -0.15 was identified between RNs 'mak(ing) improvements happen' and RN retention. The findings suggest that RN retention factors in mental health and acute NHS Trusts differ from community and specialist NHS Trusts in England. This is an important consideration for national RN retention programmes as a single approach to RN retention may not be effective across all healthcare settings.

Scaling up Quality Improvement for Surgical Teams (QIST)\u2014avoiding surgical site infection and anaemia at the time of surgery: a cluster randomised controlled trial of the effectiveness of quality improvement collaboratives to introduce change in the NHS

BackgroundThe aim of this trial was to assess the effectiveness of quality improvement collaboratives to implement large-scale change in the National Health Service (NHS) in the UK, specifically for improving outcomes in patients undergoing primary, elective total hip or knee replacement.MethodsWe undertook a two-arm, cluster randomised controlled trial comparing the roll-out of two preoperative pathways: methicillin-sensitive Staphylococcus aureus (MSSA) decolonisation (infection arm) and anaemia screening and treatment (anaemia arm). NHS Trusts are public sector organisations that provide healthcare within a geographical area. NHS Trusts (n = 41) in England providing primary, elective total hip and knee replacements, but that did not have a preoperative anaemia screening or MSSA decolonisation pathway in place, were randomised to one of the two parallel collaboratives. Collaboratives took place from May 2018 to November 2019. Twenty-seven Trusts completed the trial (11 anaemia, 16 infection). Outcome data were collected for procedures performed between November 2018 and November 2019.Co-primary outcomes were perioperative blood transfusion (within 7 days of surgery) and deep surgical site infection (SSI) caused by MSSA (within 90 days post-surgery) for the anaemia and infection trial arms, respectively. Secondary outcomes were deep and superficial SSIs (any organism), length of hospital stay, critical care admissions and unplanned readmissions. Process measures included the proportion of eligible patients receiving each preoperative initiative.ResultsThere were 19,254 procedures from 27 NHS Trusts included in the results (6324 from 11 Trusts in the anaemia arm, 12,930 from 16 Trusts in the infection arm). There were no improvements observed for blood transfusion (anaemia arm 183 (2.9%); infection arm 302 (2.3%) transfusions; adjusted odds ratio 1.20, 95% CI 0.52–2.75, p = 0.67) or MSSA deep SSI (anaemia arm 8 (0.13%); infection arm 18 (0.14%); adjusted odds ratio 1.01, 95% CI 0.42–2.46, p = 0.98). There were no significant improvements in any secondary outcome. This is despite process measures showing the preoperative pathways were implemented for 73.7% and 61.1% of eligible procedures in the infection and anaemia arms, respectively.ConclusionsQuality improvement collaboratives did not result in improved patient outcomes in this trial; however, there was some evidence they may support successful implementation of new preoperative pathways in the NHS.Trial registrationProspectively registered on 15 February 2018, ISRCTN11085475

Writing for the Wider Public - Readability of Publicly Available Board Reports

Objective: This work aims to evaluate the readability of publicly available board reports from the Local Health Networks (LHNs) in South Australia and the National Health Service (NHS) Trusts in England. Method: Publicly available board reports from the LHNs in South Australia and NHS Trusts in England were identified, screened, and evaluated from January 2020 to August 2020. Results: The average Flesch Reading Ease score for all LHNs reviewed ranged from 34 ± 10.2 to 57 ± 0.0 (Difficult to Fairly Difficult). In comparison, the average Flesch Reading Ease score for all the NHS Foundation Trusts ranged from 46 ± 1.7 to 60 ± 3.0 (Difficult to Standard). The average Reading Ease score for metropolitan and non-metropolitan LHNs was 43 ± 8.1 and 41 ± 6.0 (Difficult to read). In contrast, the average Reading Ease score for metropolitan and non-metropolitan NHS Trust was Fairly Difficult with 53 ± 4.2 and 50 ± 3.5 respectively. Conclusion: The evaluation results suggest that there is scope for improving the quality of publicly available board reports from the boards reviewed in terms of their readability by the public.

NHS CHECK: protocol for a cohort study investigating the psychosocial impact of the COVID-19 pandemic on healthcare workers

IntroductionThe COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear....

Pharmacy professionals\u2019 views regarding the future of NHS patient medicines helpline services: a multimethod qualitative study

BackgroundPatient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals, to provide patients with post-discharge medicines-related support. However, findings suggest that many PMHS are provided sub-optimally due to a lack of resources. This study sought to examine pharmacy professionals’ perceptions of the future of PMHS.Methods Participants comprised pharmacy professionals from NHS Trusts in England that provided a PMHS. Invitations to participate in a qualitative survey and then an interview were sent to pharmacy services at all NHS Trusts that provided a PMHS. This resulted in 100 survey participants and 34 interview participants. Data were analysed using Braun and Clarke’s inductive reflexive thematic analysis.ResultsTwo themes were generated: Enhancing value for service users and Improving efficiency. Enhancing value for service users identifies pharmacy professionals’ suggestions for improving the value of PMHS for service users. These include providing access methods extending beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist to offer medicines-related support. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings.ConclusionsPMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally/nationally). However, such change is dependent upon the sharing of patients’ information between hospitals and the centralised hub/s or pharmacies. To enhance the value of PMHS for service users, providers should consider establishing other methods of access, such as email and video consultation. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.

Recommendations for improving follow-up care for patients with mesothelioma: a qualitative study comprising documentary analysis, interviews and consultation meetings

ObjectivesThe study aim was to explore experiences of patients with pleural mesothelioma of follow-up care in three National Health Service (NHS) Trusts to develop recommendations for practice.DesignThe study design was...

Charging of overseas visitors in England and universal health coverage: a cross-sectional analysis of NHS trusts.

In 2017, new regulations in England introduced upfront charging for non-urgent care within the National Health Service (NHS). Individuals from outside the European Economic Area who have not paid the immigration surcharge are chargeable for NHS care at 150% of cost. A freedom of information (FOI) request was sent to 135 acute non-specialist NHS trusts in England to create a database of overseas visitors charges. This was analysed using multiple linear regression to explore the relationship between sex, age, nationality, ethnicity, urgency and the cost of healthcare. Of 135 acute non-specialist trusts in England 64 replied, providing a data set of 13484 patients. Women were found to be invoiced higher amounts than men (P=0.002). Patients were more likely to be women (63 versus 37% men), and within this group, almost half of patients were of reproductive age, with 47.9% (3165) aged 16-40years old. Only seven trusts supplied data on urgency, and within these trusts the urgency of treatment was significantly related to cost, with the most urgent (immediately necessary) treatment costing the most (P<0.001). This research reflects that that migrant women, and particularly undocumented women, are disproportionately impacted by the NHS charging policies in England.

Factors associated with wide variation in clinical litigation rates across acute NHS trusts in England: a cross-sectional analysis.

Identify organizational factors associated with high clinical litigation rates among acute National Health Service (NHS) trusts in England. Cross-sectional analysis using routine data. NHS trusts in England. A total of 235 NHS trusts used the NHS Clinical Negligence Scheme in 2016-17. Ninety-seven trusts (41.3%) with no maternity services, 2 (0.9%) providing specialized services and 3 (1.2%) without clinical negligence claims were excluded. Hence, the remaining 133 trusts (56.6%) were included. None. Rate of clinical litigation by trust per 100 000 occupied bed days. The mean rate of clinical litigation was 25.4 per 100 000 occupied bed days. In univariable analyses, higher values of summary hospital-level mortality indictor, staff sickness, written complaints, patient safety incidents and being in the North of England led to increased clinical litigation rates. Conversely, higher patient admissions, NHS Staff Survey overall engagement score and occupied bed days led to decreased clinical litigation rates. In the multivariable model, factors associated with increased clinical litigation rates were as follows: summary mortality hospital-level indicator (SHMI) (0.9 increase in litigation rate per 0.05 increase in SHMI; P = 0.012); new written complaints (0.62 increase per 50 complaints higher; P < 0.001); located in the North of England compared to London (5.22 higher; P < 0.001). Conversely, a higher number of occupied bed days (-0.64 change per 50 000 days higher; P = 0.007) was associated with lower clinical litigation rates. This study identified organizational factors associated with clinical litigation, which will be of interest to clinicians and the NHS. This research also highlights areas for further investigation.

The Clinical Need for New Diagnostics in the Identification and Management of Patients with Suspected Sepsis in UK NHS Hospitals: A Survey of Healthcare Professionals.

Development of a new diagnostic is ideally driven by an understanding of the clinical need that the test addresses and the optimal role the test will have within a care pathway. This survey aimed to understand the clinical need for new sepsis diagnostics and to identify specific clinical scenarios that could be improved by testing. An electronic, cross-sectional survey was circulated to UK National Health Service (NHS) doctors and nurses who care for patients with suspected sepsis in hospitals. Two hundred and sixty-five participants completed the survey, representing 64 NHS Trusts in England. Sixty-seven percent of respondents suggested that the major cause of delay was during the initial identification of sepsis and the subsequent recognition of patients who were deteriorating. Existing blood tests did not enhance the confidence of consultants making their diagnoses. Those surveyed identified a role for a near-patient test to “rule out” suspected sepsis and, thereby, stop or postpone use of antibiotics. Current diagnostic tests are slow, non-specific, and do not reliably identify patients with a high suspicion of sepsis. As a result, they have a limited use in patient management and antibiotic stewardship. Future development of sepsis diagnostics should focus on overcoming these limitations.

Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts

BackgroundInformation overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession.ObjectiveThis study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom.MethodsThis study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics.ResultsThe vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment.ConclusionsThere is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care.

Modifiable healthcare factors affecting 28-day survival in bloodstream infection: a prospective cohort study

BackgroundBloodstream infection is common in the UK and has significant mortality depending on the pathogen involved, site of infection and other patient factors. Healthcare staffing and ward activity may also impact on outcomes in a range of conditions, however there is little specific National Health Service (NHS) data on the impact for patients with bloodstream infection. Bloodstream Infections – Focus on Outcomes is a multicentre cohort study with the primary aim of identifying modifiable risk factors for 28-day mortality in patients with bloodstream infection due to one of six key pathogens.MethodsAdults under the care of five NHS Trusts in England and Wales between November 2010 and May 2012 were included. Multivariable Cox regression was used to quantify the association between modifiable risk factors, including staffing levels and timing of appropriate therapy, and 28-day mortality, after adjusting for non-modifiable risk factors such as patient demographics and long-term comorbidities.ResultsA total of 1676 patients were included in the analysis population. Overall, 348/1676 (20.8%) died within 28 days. Modifiable factors associated with 28-day mortality were ward speciality, ward activity (admissions and discharges), movement within ward speciality, movement from critical care, and time to receipt of appropriate antimicrobial therapy in the first 7 days. For each additional admission or discharge per 10 beds, the hazard increased by 4% (95% CI 1 to 6%) in medical wards and 11% (95% CI 4 to 19%) in critical care. Patients who had moved wards within speciality or who had moved out of a critical care ward had a reduction in hazard of mortality. In the first 7 days, hazard of death increased with increasing time to receipt of appropriate antimicrobial therapy.ConclusionThis study underlines the importance of appropriate antimicrobials within the first 7 days, and the potential for ward activity and ward movements to impact on survival in bloodstream infection.