Provision of community care: who, what, how much?

This briefing from the Health Foundation analyses information on the community care contracts held by 78 per cent of CCGs in England to enable better understanding of the provision of these services. It finds that NHS providers hold more than half of the total annual value of contracts in the sample, while private providers held 5 per cent of the total annual value, but 39 per cent of the total number of contracts issued.

Full briefing available here

Transforming community care with digital technologies

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service explains how mobile solutions are transforming the work of community-based health teams | NHE

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As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government.

The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service.

As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted:

  • A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used
  • Sufficient battery life to get through an entire working day
  • A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology
  • Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input

Read the full article here

Unmet need for health and social care: a growing problem?

There is a great deal of focus in the health and care system on measuring the quality of care being provided. But what about care that isn’t provided at all? | The King’s Fund Blog

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We have published several reports this year highlighting pressures in community-based services, including social care and district nursing. These pieces of research raised concerns about changes to the availability and quality of services as a result of rising demand and insufficient funding and staff numbers. The reports also raised concerns that these pressures might be leading to rising levels of unmet need.

Unmet need is difficult to define, and harder still to measure. This would be true in any setting, but particularly for services like district nursing that are delivered in people’s own homes. People who are not receiving district nursing care but would benefit from it, or those who are receiving some care but require more than they are currently getting, are often out of sight. There are no overcrowded waiting rooms or queues to bring this unmet need to light.

Read the full blog post here

Community based end of life care commissioning

Public Health England has published Public perceptions and experiences of community-based end of life care initiatives: a qualitative research report.

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This report is aimed at commissioners of end of life care services to support new ways of commissioning through using public health approaches to build compassionate communities. The key objectives of the research were to understand the awareness and knowledge of community end of life care across a number of key audiences; their perceptions of community end of life care; their experiences of end of life care and any community initiatives; and any improvements that could be made to community end of life care.

Evaluation of the Rotherham Mental Health Social Prescribing Pilot

Sheffield Hallam University Centre for Regional Economic and Social Research | Published online: 3 November 2016

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Image source: SHU

The Rotherham Social Prescribing Mental Health Pilot was developed to help people with mental health conditions overcome the barriers which prevent discharge from secondary mental health care services. The 12-month pilot – which has now been extended to March 2017 – helps service users build and direct their own packages of support by encouraging them to access personalised services provided by local voluntary and community groups. The pilot was delivered in partnership by Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) and a group of local voluntary sector organisations led by Voluntary Action Rotherham on behalf of NHS Rotherham Clinical Commissioning Group (CCG).

The evaluation of the pilot, carried out by Sheffield Hallam University’s Centre for Regional Economic and Social Research (CRESR), found that it had helped increase the number of discharges from mental health services and improved social and emotional wellbeing of the service users. 156 service users were referred to the pilot, with 136 (87 per cent) taking up one of the voluntary and community services available, such as sports groups, craft classes, cookery courses, swimming, learning programmes, employment skills, yoga, and therapeutic art groups. The research, which was measured against eight different wellbeing outcomes, showed that:

  • 93 per cent of service users made progress against at least one outcome
  • 64 per cent made progress against four or more of the outcomes
  • 39 service users were discharged from mental health services (out of 72 discharge review meetings)

Read the full overview here

Read the full report here

Views from the NHS frontline: Health Visitors

Amid drastic cuts to health visiting services, I’m struggling to help the vulnerable families I see every day | The Guardian Healthcare Network

112-2Health visitors don’t always get good press at the school gates or toddler groups. Among my fellow nursing friends, the standing joke is that I spend my day simply weighing babies. I guess as a result it’s not hard to see why in some areas the value placed on health visiting has fallen so far that the service will be cut completely.

At the moment most councils are reviewing the funding for health visiting amid drastic cuts to public health budgets. Cumbria and Staffordshire are planning on cutting health visiting posts and a number of other NHS trusts have job freezes and have discussed redundancies. NHS Digital reported this year that the number of health visitors dropped in UK by 433 posts.

While perhaps there may be some truth in the comments I so often hear, the reality of health visiting feels very different.

Read the full article here

Increasing the uptake of long-acting reversible contraception in general practice

Mazza, D. et al. (2016) BMJOpen. 6:e012491

Introduction: The increased use of long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormonal implants, has the potential to reduce unintended pregnancy and abortion rates. However, use of LARCs in Australia is very low, despite clinical practice guidance and statements by national and international peak bodies advocating their increased use. This protocol paper describes the Australian Contraceptive ChOice pRojet (ACCORd), a cluster randomised control trial that aims to test whether an educational intervention targeting general practitioners (GPs) and establishing a rapid referral service are a cost-effective means of increasing LARC uptake.

Methods and analysis: The ACCORd intervention is adapted from the successful US Contraceptive CHOICE study and involves training GPs to provide ‘LARC First’ structured contraceptive counselling to women seeking contraception, and implementing rapid referral pathways for LARC insertion. Letters of invitation will be sent to 600 GPs in South-Eastern Melbourne. Using randomisation stratified by whether the GP inserts LARCs or not, a total of 54 groups will be allocated to the intervention (online ‘LARC First’ training and rapid referral pathways) or control arm (usual care). We aim to recruit 729 women from each arm. The primary outcome will be the number of LARCs inserted; secondary outcomes include the women’s choice of contraceptive method and quality of life (Short Form Health Survey, SF-36). The costs and outcomes of the intervention and control will be compared in a cost-effectiveness analysis.

Ethics and dissemination: The ACCORd study has been approved by the Monash University Human Research Ethics Committee: CF14/3990-2014002066 and CF16/188-2016000080. Any protocol modifications will be communicated to Ethics Committee and Trial Registration registry. The authors plan to disseminate trial outcomes through formal academic pathways comprising journal articles, nation and international conferences and reports, as well as using more ‘popular’ strategies including seminars, workshops and media engagements.

Read the article here