Pharmacogenomics in the UK National Health Service: opportunities and challenges

There is increasing interest in pharmacogenomics. However, it is also widely acknowledged that implementation of pharmacogenomics into clinical practice has been slow. Implementation is being undertaken in many centres in the US, but this is not nationwide and often focused on highly specialised academic centres, driven by champions. To date, there has been no implementation on a whole country basis. The UK National Health Service (NHS) is a single integrated healthcare system, which provides free care to all patients at the point of need. Recently, there has been a drive to implement genomic medicine into the NHS, largely spurred on by the success of the 100,000 genomes project. This represents an unprecedented opportunity to implement pharmacogenomics for over 60 million people. In order to discuss the potential for implementing pharmacogenomics into the NHS, the UK Pharmacogenetics and Stratified Medicine Network, NHS England and Genomics England invited experts from academia, the healthcare sector, industry and patient representatives to come together to discuss the opportunities and challenges1. This report highlights the discussions of the workshop with the aim of providing an overview of the issues that need to be considered to enable pharmacogenomic medicine to become mainstream within the NHS

Organisational uptake of NICE guidance in promoting employees’ psychological health

Background: Annual costs to organisations of poor mental health are estimated to be between £33bn-£42bn. The UK’s National Institute for Clinical Excellence (NICE) has produced evidence-based guidance on improving employees’ psychological health, designed to encourage organisations to take preventative steps in tackling this high toll. However, the extent of implementation is not known outside the National Health Service. Aims: To assess the awareness and implementation of NICE guidance on workplace psychological health Methods: 163 organisations participated in a survey of UK-based private, public and third sector organisations employing an accumulated minimum of 322,033 workers. Results: 77% of organisations were aware of the NICE guidance for improving mental well-being in the workplace, but only 37% were familiar with its recommendations. Less than half were aware of systems in place for monitoring employees’ mental well-being and only 12% confirmed that this NICE guidance had been implemented in their workplace. Where employee health and well-being featured as a regular board agenda item, awareness and implementation of NICE guidance were more likely. Significant associations were found between organisational sector and size and uptake of many specific features of NICE guidance. Conclusions: The majority of organisations are aware of NICE guidance in general, but there is a wide gap between this and possession of detailed knowledge and implementation. The role of sector and size of organisation is relevant to uptake of some features of NICE guidance, although organisational leadership is important where raised awareness and implementation are concerned

Evaluating the implementation and delivery of a social prescribing intervention: a research protocol

Background: In response to the increasing numbers of people with (multiple) chronic conditions, the need for integrated care is increasing too. Social prescribing is a new approach that aims to integrate the social and healthcare sector to improve the quality of care and user experience. Understanding main stakeholders’ perceptions and experiences is key to the implementation of social prescription and for informing future initiatives.  Objectives: This paper presents the protocol of a qualitative research study to explore factors that (i) facilitate and hinder the implementation of a social prescribing pilot in the East of England, and (ii) affect the uptake, adherence, and completion rates by service users.  Methods: A qualitative study including semi-structured interviews with managers, health professionals, service providers, navigators, and service users. Iterative thematic analysis will be used to analyse the data.  Conclusion: This study will produce evidence on factors that hinder and facilitate the implementation of a social prescribing programme, as well as factors affecting the engagement, and non-engagement, of service users. Findings can contribute to the development of an evidence base for social prescription programmes in the UK, and inform practice, policy, and future research in the field

Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study.

OBJECTIVES: To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice. DESIGN: Semi-structured qualitative interviews. SETTING: National Health Service, regulatory and third-sector organisations in England. PARTICIPANTS: Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13). MAIN OUTCOME MEASURES: Not applicable. RESULTS: Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional 'cultural engineering' to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of 'blacklisting' of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour. CONCLUSIONS: Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.GPM acknowledges the support of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM). MDW and GPM are supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. THIS Institute is supported by the Health Foundation—an independent charity committed to bringing about better health and health care for people in the UK. MDW is a Wellcome Trust Investigator (award WT09789) and a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care

Providing direction and management for health library and information services

The rapidly changing technology, coupled with clinical users with current needs that bear little resemblance to those of five years ago, means health LIS managers must develop new services and incorporate new technology. At the same time the health LIS are functioning within the turbulent health environment described in Chapter 1 where change is occurring in all areas. Two key areas on which the health LIS manager must focus to ensure that services ‘fit’ are strat egic direction and managing staff. This chapter is therefore divided into two sections: strategic and human resource management. The intention is not to convey that one is more important than the other, but that they involve different approaches and skills. Strategic and people management are intertwined: an effective health LIS strategy will be damaged by ineffective staff management and vice versa. The role of strategic management, informed by recent developments in the directions taken by health information services in UK NHS trusts, is discussed. The strategic process is outlined including strategic analysis, internal analysis, strategic options, evaluation of options and strategic implementation. This section is completed by discussions on the importance of different stakeholders to the strategy. Various business models, already applied within the library sector (Walton and Edwards, 1997), are used to develop the ideas within the health LIS context. The section looking at staff management discusses managing change, staff skills, teamwork and staff development

Cross sector policy and practice at the department for international development (DFID) in the UK and Nepal

Within international development, global agreement around the goals of poverty elimination and the Millennium Development Goals (MDGs) has led to renewed emphasis on ‘joined-up working’, partnership, and cross-sectoral approaches. This emphasis has been motivated by concerns to ensure coherent policy and practice between the plurality of actors in an increasingly complex global arena. The realisation that previous sectoral approaches to development have often failed to impact beneficially on poor people, has added to the calls for more cross-sectoral approaches that better reflect poor people’s crosssectoral lives. This paper is based on research into cross-sector policy and practice at the UK Government Department for International Development (DFID), in the UK and Nepal. Definitions and concepts of cross-sector policy and practice are explored including a ‘cross-sector continuum’ model representing different levels of collaboration. Visual diagramming and other participatory methods were utilised as techniques for exploring and representing cross-sectoral processes and relationships. DFID have made some significant structural changes and have engaged in discussion to improve cross-sectorality. There are examples of varying levels of cross-sectoral engagement throughout the organisation, but these were strongest at country and project levels. Gender, sustainable livelihoods and HIV, along with individuals that have a particular commitment to collaborative approaches, can act as catalysts for institutional change in cross-sector policy and practice. Other factors that facilitate cross-sectoral approaches were also identified. However, the research found that collaborative rhetoric within DFID documentation is not matched by the same level of commitment to operationalising cross-sectoral approaches. DFID face some major barriers to adopting cross-sectoral approaches including: a disjuncture between its role as a government bureaucracy and its role as a development organisation; a primary focus on product rather than processes; and the current pursuit of central level and sectoral approaches thought by some to be incompatible with cross-sectorality. The challenge is exacerbated by ‘disciplinarity’ and ‘territoriality’ within DFID, particularly involving the health sector. Although this study focused on DFID, the findings and some of the participatory methods used in this research offer lessons about cross-sectoral and broader collaborative working to a much wider audience