National Health Service Research Articles

A Qualitative evaluation in community settings in England exploring the experiences of coaches delivering the NHS Low Calorie Diet programme pilot to ethnically diverse participants

BackgroundThe management of type 2 diabetes (T2D) within diverse ethnic populations requires a culturally tailored approach. However, little is known about the experiences of coaches delivering interventions for T2D, such...

Ward-based in situ simulation: lessons learnt from a UK District General Hospital

IntroductionIn situ simulation (ISS) enables multiprofessional healthcare teams to train for real emergencies in their own working environment and identify latent patient safety threats. This study aimed to determine ISS...

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners’ and people living with Long COVID: a qualitative study

ObjectivesTo explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).DesignQualitative descriptive study employing one-to-one semistructured virtual interviews analysed...

Perspectives of people experiencing homelessness with recent non-fatal street drug overdose on the Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx (PHOENIx) intervention.

In Scotland, a third of all deaths of people experiencing homelessness (PExH) are street-drug-related, and less than half of their multiple physical- and mental health conditions are treated. New, holistic interventions are required to address these health inequalities. PHOENIx (Pharmacist Homeless Outreach Engagement and Non-medical Independent prescribing Rx) is delivered on outreach by National Health Service (NHS) pharmacist independent prescribers in partnership with third sector homelessness charity workers. We describe participant's perspectives of PHOENIx. This study aims to understand experiences of the PHOENIx intervention by participants recruited into the active arm of a pilot randomised controlled trial (RCT). Semi-structured in-person interviews explored participants' evaluation of the intervention. In this study, the four components (coherence, cognitive participation, collective action, reflexive monitoring) of the Normalisation Process Theory (NPT) framework underpinned data collection and analyses. We identified four themes that were interpreted within the NPT framework that describe participant evaluation of the PHOENIx intervention: differentiating the intervention from usual care (coherence), embedding connection and consistency in practice (cognitive participation), implementation of practical and emotional operational work (collective action), and lack of power and a commitment to long-term support (reflexive monitoring). Participants successfully engaged with the intervention. Facilitators for participant motivation included the relationship-based work created by the PHOENIx team. This included operational work to fulfil both the practical and emotional needs of participants. Barriers included concern regarding power imbalances within the sector, a lack of long-term support and the impact of the intervention concluding. Findings identify and describe participants' evaluations of the PHOENIx intervention. NPT is a theoretical framework facilitating understanding of experiences, highlighting both facilitators and barriers to sustained engagement and investment. Our findings inform future developments regarding a subsequent definitive RCT of PHOENIx, despite challenges brought about by challenging micro and macro-economic and political landscapes.

Predicting patients with dementia most at risk of needing psychiatric in-patient or enhanced community care using routinely collected clinical data: retrospective multi-site cohort study.

Dementia is a common and progressive condition whose prevalence is growing worldwide. It is challenging for healthcare systems to provide continuity in clinical services for all patients from diagnosis to death. To test whether individuals who are most likely to need enhanced care later in the disease course can be identified at the point of diagnosis, thus allowing the targeted intervention. We used clinical information collected routinely in de-identified electronic patient records from two UK National Health Service (NHS) trusts to identify at diagnosis which individuals were at increased risk of needing enhanced care (psychiatric in-patient or intensive (crisis) community care). We examined the records of a total of 25 326 patients with dementia. A minority (16% in the Cambridgeshire trust and 2.4% in the London trust) needed enhanced care. Patients who needed enhanced care differed from those who did not in age, cognitive test scores and Health of the Nation Outcome Scale scores. Logistic regression discriminated risk, with an area under the receiver operating characteristic curve (AUROC) of up to 0.78 after 1 year and 0.74 after 4 years. We were able to confirm the validity of the approach in two trusts that differed widely in the populations they serve. It is possible to identify, at the time of diagnosis of dementia, individuals most likely to need enhanced care later in the disease course. This permits the development of targeted clinical interventions for this high-risk group.

Stability of Willingness to Pay: Does Time and Treatment Allocation in a Randomized Controlled Trial Influence Willingness to Pay?

Willingness-to-pay (WTP) estimates are useful to policy makers only if they are generalizable beyond the moment when they are collected. To understand the "shelf life" of preference estimates, preference stability needs be tested over substantial periods of time. We tested the stability of WTP for preventative dental care (scale and polish) using a payment-card contingent valuation question administered to 909 randomized controlled trial participants at 4 time points: baseline (prerandomization) and at annual intervals for 3 years. Trial participants were regular attenders at National Health Service dental practices. Participants were randomly offered different frequencies (intensities) of scale polish (no scale and polish, 1 scale and polish per year, 2 scale and polishes per year). We also examined whether treatment allocation to these different treatment intensities influenced the stability of WTP. Interval regression methods were used to test for changes in WTP over time while controlling for changes in 2 determinants of WTP. Individual-level changes were also examined as well as the WTP function over time. We found that at the aggregate level, mean WTP values were stable over time. The results were similar by trial arm. Individuals allocated to the arm with the highest scale and polish intensity (2 per year) had a slight increase in WTP toward the latter part of the trial. There was considerable variation at the individual level. The WTP function was stable over time. The payment-card contingent valuation method can produce stable WTP values in health over time. Future research should explore the generalizability of these results in other populations, for less familiar health care services, and using alternative elicitation methods. Stated preferences are commonly used to value health care.Willingness-to-pay (WTP) estimates are useful only if they have a "shelf life."Little is known about the stability of WTP for health care.We test the stability of WTP for dental care over 3 y.Our results show that the contingent valuation method can produce stable WTP values.

OILVEQ: an Italian external quality control scheme for cannabinoids analysis in galenic preparations of cannabis oil.

Italy legalized cannabis oil for specific medical conditions (neuropathic pain, refractory epilepsy and other established pathologies) in 2015, but mandates titration of principal cannabinoids before marketing each batch using iphenated techniques coupled with mass spectrometry. To assess reliability of laboratories from the Italian National Health Service in charge of titrating the batches, the Italian National Institute of Health set up an quality control program on determination of Δ9-tetrahydrocannabinol l (THC), cannabidiol (CBD), Δ9-tetrahydrocannabinolic acid A (THCA-A) and cannabidiolic acid (CBDA) in cannabis oil preparations. Two rounds of exercises have been carried out since 2019, involving sixteen Italian laboratories. Five different cannabis oil samples (19-1A and 19-1B for the first round and 22-1A, 22-1B and 22-1C for the second one were prepared and 1 mL amount of each sample was sent to the laboratories. The quantitative performance of each laboratory was assessed calculating the z-score value, a statistical measurement for value's relationship to the mean of a group of values. In the first round, eight out of fourteen laboratories employed an LC-MS while the remaining six used GC-MS. Differently, in the second round, six out of eleven laboratories employed a GC-MS while the remaining five used LC-MS. In the first round, only 28.6 % laboratories achieved an acceptable performance (z-score±2), and all of them used LC-MS as analytical method. In the second round, none of the laboratories achieved an acceptable performance. Satisfactory results, based on z-scores, were generally low (0.0-75.0 %), with only one exception of 100 % for THCA-A determination in sample 22-1B. In the second round, three false negatives (two THC and one CBD by GC-MS determination) were reported while no false positives were described in the blank sample. The two rounds yielded a mean ERR% of 42 % approximately and a mean CV% around 70 % in GC-MS determination. When applying LC-MS determination, the two rounds yielded a mean ERR% of 36 % approximately and a mean CV% around 33 %. The obtained results underline the need for a clear and consistent protocol to be adopted by all laboratories intending to include the titration of oily cannabis-based products into their routinely analytical techniques. This emphasis on methodology standardization and participation to quality control schemes is essential for ensuring reliable and accurate measurements, ultimately enhancing the overall effectiveness and reliability of medical cannabis treatments.

Efficiency and productivity gains of robotic surgery: The case of the English National Health Service.

This paper examines the effect of new medical technology (robotic surgery) on efficiency gains and productivity changes for surgical treatment in patients with prostate cancer from the perspective of a public health sector organization. In particular, we consider three interrelated surgical technologies within the English National Health System: robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar clinical benefits. While the clinical benefits in adopting robotic surgery over laparoscopic intervention are unproven, it requires a high initial investment cost and carries high on-going maintenance costs. Using data from Hospital Episode Statistics for the period 2000-2018, we observe growing volumes of prostatectomies over time, mostly driven by an increase in robotic-assisted surgeries, and further analyze whether hospital providers that adopted a robot see improved measures of throughput. We then quantify changes in total factor and labor productivity arising from the use of this technology. We examine the impact of robotic adoption on efficiency gains employing a staggered difference-in-difference estimator and find evidence of a 50% reduction in length of stay (LoS), 49% decrease in post-LoS and 44% and 46% decrease in postoperative visits after 1year and 2years, respectively. Productivity analysis shows the growth in radical prostatectomy volume is sustained with a relatively stable number of urology surgeons. The robotic technique increases total production at the hospital level between 21% and 26%, coupled with a 29% improvement in labor productivity. These benefits lend some, but not overwhelming support for the large-scale hospital investments in such costly technology.

The perceptions of first point of contact roles in primary care by pre-registration students of the allied health professions.

To develop a better understanding of the perceptions of first point of contact roles within primary care by pre-registration students of the Allied Health Professions (AHPs). General practice in the UK is under growing pressure from declining general practitioner (GP) numbers and increased service demand. The National Health Service (NHS) is attempting to mitigate this demand by making more effective use of its highly experienced workforce through the creation of first contact practitioners (FCPs). Working in primary care, FCPs are highly experienced AHPs with three or more years of relevant clinical experience. An abductive qualitative research approach underpinned by a descriptive phenomenological methodology was adopted. Thematic analysis was used to analyse the focus group transcripts. Twenty two final-year pre-registration AHP students participated in three focus groups. Two themes with sub-themes were identified: (1) Understanding of the role-pathway to the role; role clarity; and sources of knowledge. (2) Impact on service-positives and challenges. This study synthesised new findings from the previously unexplored FCP stakeholder of pre-registration AHP students. Participants generally understood the FCP's purpose of unburdening GPs and perceived the FCP model to contribute to the solution of rising clinical and financial pressures within the NHS, and primary care specifically. However, there was confusion regarding the scope of practice of an FCP. It is vital that the future workforce understand this role through effective education.

Understanding weight management in adult secure mental health services: findings from a mixed-methods study in Northern England

Purpose Obesity and associated morbidity and mortality are major challenges for people with severe mental illness, particularly in secure (forensic) mental health care (patients who have committed a crime or have threatening behaviour). This study aims to explore experiences of weight management in secure mental health settings. Design/methodology/approach This study used a mixed-methods approach, involving thematic analysis. A survey was delivered to secure mental health-care staff in a National Health Service (NHS) mental health trust in Northern England. Focus groups were conducted with current and former patients, carers and staff in the same trust and semi-structured interviews were undertaken with staff in a second NHS mental health trust. Findings The survey received 79 responses and nine focus groups and 11 interviews were undertaken. Two overarching topics were identified: the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. In addition, seven themes were highlighted, namely: medication, sedentary behaviour, patient motivation, catered food and alternatives, role of staff, and service delivery. Practical implications Secure care delivers a potentially “obesogenic environment", conducive to excessive weight gain. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact. Originality/value To the best of the authors’ knowledge, this is the first study to involve current patients, former patients, carers and multidisciplinary staff across two large NHS trusts, in a mixed-methods approach investigating weight management in secure mental health services. People with lived experience of secure services are under-represented in research and their contribution is therefore of particular importance.

Mhealth interventions to improve public knowledge of HPV-associated oral cancer in the UK

In the UK, the age-standardised incidence rates of cancers of the ‘oropharynx’and ‘lip and oral cavity’ are ‘2.6%’ and ‘4.9%’ respectively.These indicate a significant oral cancer burden. These are attributable tonumerous risk factors; the major risk factors include tobacco use, alcoholconsumption, and exposure to oral HPV infection. Though, significantsuccess in reducing the prevalence of most of the major risk factorshas been recorded, exposure to HPV infection still remains a majordriver of oral cancer prevalence in the UK. HPV-associated oropharyngealcancer prevalence in men and women is 6.29 and 2.04%, respectively,while prevalence for HPV-associated oral cavity cancer in menand women is 11.7 and 6.95%, respectively; and it is projected to overtakecervical cancer by the year 2025. This is mainly due to exposure tooral HPV infection through oral sex practice as over 63% of UK youngadults are found to have a history of oral sex practice. Only a minorityof the UK population is aware of HPV-associated oral cancer whichcalls for more public health efforts to increase knowledge on the role ofHPV in oral cancer. While the use of technology-based, clinic-based,and community-based interventions has been employed to improvepublic knowledge on the role of HPV in oral cancer development, technology-based interventions have not been adequately explored. Mhealthapplication-based interventions have been previously employed toimprove knowledge and behavioural change in diverse chronic diseases.Hence, our recommendation on the adoption of Mhealth application-based intervention strategy in the education of the UK’s populationon HPV-associated oral cancer is highly desirable as it closelyaligns with the country’s National Health Service (NHS) commitmenttowards the digital transformation of the healthcare system.

The Cass report, gender identity, and where to go next

Child and adolescent clinicians in the United States have to be paying attention to what has happened to gender medicine in the United Kingdom. The highly respected service at the Tavistock Clinic has come under intense criticism — confusing as that may be — and in April Hilary Cass released her report to the UK's National Health Service expressing concern for gender medicine, saying it is “built on shaky foundations.” Coupled with recent lawsuits against the American Academy of Pediatrics (AAP) and gender‐affirming care, the standard in the United States, clinicians are left pondering their next steps. An editorial in the British Medical Journal following the release of the Cass Report gives a balanced summation. (For the report, go to Download the Final Report). The editorial is subtitled “an opportunity to unite behind evidence informed care in gender medicine.”

Role of a National Health Service Electronic Prescriptions Database in the Detection of Prescribing and Dispensing Issues and Adherence Evaluation of Direct Oral Anticoagulants

Background: Anticoagulation therapy plays a crucial role in the management of atrial fibrillation (AF) by significantly reducing the risk of stroke. Direct oral anticoagulants (DOAC) became preferred over warfarin due to their superior safety and efficacy profile. Assessing adherence to anticoagulation therapy is necessary in clinical practice for optimising patient outcomes and treatment efficacy, thus emphasising its significance. Methods: A retrospective study utilised the Latvian National Health Service reimbursement prescriptions database, covering prescriptions for AF and flutter from January 2012 to December 2022. The proportion of days covered method was selected for adherence assessment, categorising it into three groups: (1) below 80%, (2) between 80% and 90%, and (3) above 90%. Results: A total of 1,646,648 prescriptions were analysed. Dabigatran prescriptions started declining after 2020, coinciding with a decrease in warfarin prescriptions since 2018. The total adherence levels to DOAC therapy were 69.4%. Only 44.2% of users achieved an adherence level exceeding 80%. The rate of paper prescriptions decreased from 98.5% in 2017 to 1.3% in 2022. Additionally, the utilisation of international non-proprietary names reached 79.7% in 2022. Specifically, 16.7% of patients selected a single pharmacy, whereas 27.7% visited one or two pharmacies. Meanwhile, other patients obtained medicines from multiple pharmacies. Conclusions: The total adherence level to DOAC therapy is evaluated as low and there was no significant difference in age, gender, or “switcher” status among adherence groups. Physicians’ prescribing habits have changed over a decade.

Steady undermining of the UK National Health Service underlies industrial action by doctors and other staff

Erosion of standard of healthcare in the United Kingdom underlies the industrial action taken recently by staff in the publicly provided National Health Service. Underfunding and understaffing, largely as a consequence of neoliberal government “austerity” policies implemented following the 2007-08 banking crisis, together with lack of long-term planning and a drive towards outsourcing, have led to a deterioration in the quality of services. Reduction in bed numbers and neglect of community and social support have compounded problems by making it more difficult both to admit and to discharge patients in a timely fashion. Access to services has been compromised with negative consequences for the sick. Reduction of doctors’ real wages together with stress at work, moral injury caused by feelings of not being able to do the best for patients, burnout from the Covid-19 pandemic and uncertainty about the future have led to the longest ever strike action by junior doctors in England.

Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity.

Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. Nineteen adults with a history of obesity living in the United Kingdom were interviewed through video conferencing between May 2020 and March 2021. Semi-structured interviews and socio-demographic questionnaires were used, and data analysed through hermeneutic phenomenology informed reflexive thematic analysis. Three main themes were created: living with convenience and normalcy: the increased accessibility of unhealthy food, people interacting with digital media for positive practice change, and the need to prioritise prevention in schools, the National Health Service and the food industry. The food environment was the major barrier, while interactions with social media was the most important opportunity to adopt healthy practices. The National Health Service was considered an obesogenic environment, something relevant since it has been traditionally recognised as an obesity management system. The perceptions from individuals with a history of obesity provide new suggestions on the influence of previously overlooked environments to design more adequate and effective interventions and policies that consider, more than in the past, the environments where people spend their lives.

Strategic threat health response in Australia capital cities: Predicting the optimum locations for field hospitals through geospatial analysis

AbstractObjectiveThe advent of the COVID‐19 pandemic has accentuated the critical importance of epidemic preparedness within national healthcare systems. This study presents a geospatial analysis aimed at optimising the placement of field hospitals in Australia to ensure adequate healthcare access during pandemics.MethodsThe latest census data from the Australian Bureau of Statistics were integrated with the spatial locations of current emergency departments within Australian capitals. Buffer zones with a 7.5 km radius were created around the public emergency departments (EDs). Buffer zones outside the 7.5 km radius that exhibited high population densities were categorised into high‐density (red), moderate‐density (yellow) and low‐density (green) zones to prioritise and tailor healthcare responses during a pandemic. The identification of high‐density population areas outside the ED radius enabled the stratification of potential sites for ED facilities.ResultsNinety‐one potential field hospital sites were identified across Australia's capital cities. The findings indicate that the addition of these sites would place over 95% of the population within a 7.5 km radius of an ED facility. This network of proposed sites is designed to serve a spectrum of population densities, ensuring equitable healthcare access for both densely populated urban centres and less populated areas.ConclusionsThis study underscores the potential of field hospitals to strengthen Australia's public health system against emergencies. By advocating for the creation of 91 field hospitals within a 7.5 km reach for over 95% of urban dwellers across major cities, it demonstrates a strategic approach to ensure comprehensive ED coverage. Drawing on international examples, including China's Fangcang hospitals, the USA's post‐acute care (PAC) facilities and the United Kingdom's National Health Service (NHS) Nightingale Hospitals, it highlights the need for healthcare agility and scalability, especially during pandemic outbreaks. The research presents a blueprint for field hospital deployment, marking a significant advancement in public health logistics and protection across Australia's varied demographic and geographical landscapes.

Structured interactions between nurses and patients through intentional rounding: A scoping review.

To synthesize existing literature describing the impact of intentional rounding on patient outcomes among hospitalized adults. Intentional rounding has been described as purposeful therapeutic communication between nurses and patients during regular checks with patients using standardized protocols.Despite the widespread adoption of intentional rounding, the current understanding of the benefits of these structured interactions between nurses and patients is limited. The critical role of nurses in ensuring high-quality and safe care in acute hospitals is often noted only when things go wrong. This was highlighted by investigations into the reasons for the failures in patient care at the Mid Staffordshire National Health Services. A scoping review was performed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines. Sixteen studies were included in the final review. Various rounding models were noted among different clinical settings; four studies reported a significant reduction in falls, and a further three reported a decrease in pressure injuries. Two studies reported a reduction in call bell usage. Significant improvements in patients' satisfaction with intentional rounding were reported in three studies. Promoting intentional rounding without solid evidence of its acceptability, feasibility, and suitability in different clinical settings could compromise nurses' ability to provide safe care. There is weak evidence of the effectiveness of intentional rounding on patient outcomes because of the diversity of methods employed and methodological limitations in many studies. Our findings identify the need for robust studies to explore the acceptability and feasibility of a rounding protocol that can be implemented in different clinical settings.

Primary school attainment outcomes in children with neurodisability: Protocol for a population-based cohort study using linked education and hospital data from England

Background Neurodisability describes a broad range of heterogenous conditions affecting the brain and/or the neuromuscular system that result in functional limitations including cognitive, sensory, and motor impairments. Children with neurodisability have complex health and educational needs. They are likely to achieve below-expected levels in measures of school attainment and require special educational needs provision. While the educational outcomes of children with specific conditions under neurodisability have been investigated previously, there is little evidence on the collective outcomes of population or the progression of their attainment throughout primary school. This study aims to describe educational attainment and attainment trajectories by the end of primary school for children in England with neurodisability recorded in hospital records, compared to their peers. Methods We will use the Education and Child Health Insights from Linked Data (ECHILD) database, which links educational and health records across England. We will define a primary school cohort of children who were born in National Health Service funded hospitals in England between 1st September 2003 and 31st August 2008, who were enrolled in reception of a state-funded primary school at age 4/5 years. Children with neurodisability will be identified using diagnostic and procedure codes recorded from birth to the end of primary school (age 11) in hospital admission records. We will describe educational outcomes at reception (Early Years Foundation Stage Profile, age 4/5), year two (key stage one, age 6/7), and year six (key stage two, age 10/11) for three groups of children: those with an indicator of neurodisability first recorded before the beginning of primary school, those with an indicator of neurodisability first recorded during primary school, and those without a record of neurodisability before the end of primary school. We will additionally explore the variation in educational outcomes between these groups, accounting for socioeconomic and demographic characteristics.

The Cass report, gender identity, and where to go next

Child and adolescent clinicians in the United States have to be paying attention to what has happened to gender medicine in the United Kingdom. The highly respected service at the Tavistock Clinic has come under intense criticism — confusing as that may be — and in April Hilary Cass released her report to the UK's National Health Service expressing concern for gender medicine, saying it is “built on shaky foundations.” Coupled with recent lawsuits against the American Academy of Pediatrics (AAP) and gender‐affirming care, the standard in the United States, clinicians are left pondering their next steps. An editorial in the British Medical Journal following the release of the Cass Report gives a balanced summation. (For the report, go to Download the Final Report). The editorial is subtitled “an opportunity to unite behind evidence informed care in gender medicine.”

Well-being in newly qualified doctors: exploring the value of peer-led reflective sessions

IntroductionFollowing the COVID-19 pandemic and ongoing pressures within the National Health Service, there has been an increasing concern about the well-being of junior doctors in the UK. Newly qualified doctors...