Using supervision: Support or surveillance?

This is the author's pdf version of an book chapter published by SAGE© 2007.This chapter will analyse supervision of staff in relation to developmental and managerial functions; argue that pressures on social services organisations have ensured that the need for agency accountability far outweighs its developmental function; suggest that the need for professional supervision is greatly enhanced given the development of inter-professional working arrangements; and propose that approaches to supervision can be applied to social work that have first been developed in the health service

Book review : Ward, A. (2014). Leadership in residential child care: A relationship–based approach. Norwich: The Smokehouse Press. 184pp. ISBN 9780957633537

This delightfully candid book, drawing upon the full length of the author's extensive experience over five decades of working with, researching, and writing about children and young people in residential group care settings, exemplifies the value of understanding our historic present. As Olive Stevenson (1998, p. 154) so aptly observed: 'British child welfare has suffered from a lack of historical reflection: to acknowledge the distinctive and unique problems that we face today does not invalidate comparisons with the past'. If you are looking for an incisive, insightful, restorative text to begin to address this perceived deficit in your understanding of how practice wisdom can be accrued through time, then you can do no better than starting with Adrian Ward's considered reflections

Developing a Programme Theory of Integrated Care: the effectiveness of Lincolnshire’s multidisciplinary Neighbourhood Teams in supporting older people with multi-morbidity’ (ProTICare) [summary report]

It is a well-rehearsed conversation that an ageing population places a significant ‘burden’ on the healthcare system where this narrative has become arguably more prevalent during a time of unprecedented economic restraint. A key approach to ensuring cost-effective service delivery through the integration of health and social care services aims to ensure a ‘seamless’ care pathway from early preventative interventions, planned care for complex needs, and a reduction in unscheduled hospital admissions and inappropriate service use. Ultimately it is acknowledged that integrated care will lead to the improvement of older people’s quality of life (Curry and Ham, 2010). An innovative concept developed from this discourse is the ‘Neighbourhood Teams’, a multidisciplinary team, comprising healthcare professionals and voluntary sector services with the underlying focus of providing streamlined case managing of care for individuals with multiple long term conditions. It is evident that multimorbidity is an increasing concern for the healthcare system, recognisable amongst individuals over 65 years of age, especially those defined as the 'oldest old'. Echoing current policy, an additional but essential role of the Neighbourhood Teams is encouraging individuals to self-manage their conditions. This research will report on the effectiveness of four Lincolnshire Neighbourhood Teams in supporting older people with multimorbidities. Furthermore drawing upon existing literature and qualitative interviews with healthcare and voluntary sector staff, the development of a programme theory of integrated care derived from various elements of the project will reflect upon the perceived outcomes of the Neighbourhood Teams and their successes in achieving their stated aims

Developing a programme Theory of Integrated Care: the effectiveness of Lincolnshire’s multidisciplinary Neighbourhood Teams in supporting older people with multi-morbidity (ProTICare) [full report]

It is a well-rehearsed conversation that an ageing population places a significant ‘burden’ on the healthcare system where this narrative has become arguably more prevalent during a time of unprecedented economic restraint. A key approach to ensuring cost-effective service delivery through the integration of health and social care services aims to ensure a ‘seamless’ care pathway from early preventative interventions, planned care for complex needs, and a reduction in unscheduled hospital admissions and inappropriate service use. Ultimately it is acknowledged that integrated care will lead to the improvement of older people’s quality of life (Curry and Ham, 2010). An innovative concept developed from this discourse is the ‘Neighbourhood Teams’, a multidisciplinary team, comprising healthcare professionals and voluntary sector services with the underlying focus of providing streamlined case managing of care for individuals with multiple long term conditions. It is evident that multimorbidity is an increasing concern for the healthcare system, recognisable amongst individuals over 65 years of age, especially those defined as the 'oldest old'. Echoing current policy, an additional but essential role of the Neighbourhood Teams is encouraging individuals to self-manage their conditions. This research will report on the effectiveness of four Lincolnshire Neighbourhood Teams in supporting older people with multimorbidities. Furthermore drawing upon existing literature and qualitative interviews with healthcare and voluntary sector staff, the development of a programme theory of integrated care derived from various elements of the project will reflect upon the perceived outcomes of the Neighbourhood Teams and their successes in achieving their stated aims

Evolutionary and functional history of the Escherichia coli K1 capsule

Escherichia coli is a leading cause of invasive bacterial infections in humans. Capsule polysaccharide has an important role in bacterial pathogenesis, and the K1 capsule has been firmly established as one of the most potent capsule types in E. coli through its association with severe infections. However, little is known about its distribution, evolution and functions across the E. coli phylogeny, which is fundamental to elucidating its role in the expansion of successful lineages. Using systematic surveys of invasive E. coli isolates, we show that the K1-cps locus is present in a quarter of bloodstream infection isolates and has emerged in at least four different extraintestinal pathogenic E. coli (ExPEC) phylogroups independently in the last 500 years. Phenotypic assessment demonstrates that K1 capsule synthesis enhances E. coli survival in human serum independent of genetic background, and that therapeutic targeting of the K1 capsule re-sensitizes E. coli from distinct genetic backgrounds to human serum. Our study highlights that assessing the evolutionary and functional properties of bacterial virulence factors at population levels is important to better monitor and predict the emergence of virulent clones, and to also inform therapies and preventive medicine to effectively control bacterial infections whilst significantly lowering antibiotic usage

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden