Implementing an Integrated Acute Response Service: Professional Perceptions of Intermediate Care

Purpose: The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital. Design/methodology/approach: A qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically. Findings: The key to successful implementation was that the service was co-created from the “ground-up” with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique in intermediate care settings. Referrals into the ART service were dependent on awareness of the service at the interface with mainstream services. Transitions out were sometimes delayed due lack of availability of social care packages. To ensure sustainability of the ART and other integrated intermediate care services, continued resources, especially skilled staff members, are necessary. Originality/value: This study adds to the intermediate care and acute response service literature by offering insights into “what works” from a professional perspective in terms of service implementation, care processes and sustainability, in an integrated care system

PCT commissioning: how community nurse involvement can be encouraged

Commissioning is the process by which PCTs identify the health needs of their population and make prioritized decisions to secure care to meet those needs within available resources. It includes longer term strategic planning, medium term planning (three year Local delivery Plans) and the shorter term agreement and performance management of service level agreements. The process should involve the public, engage clinicians, and be conducted on a whole system basis, informed by health equity audits, and carried through with the full participation of other stakeholders including NHS Trusts, local authority(s) and the voluntary sector (NHS Modernization Agency, 2004)

UK policy on social networking sites and online health: from informed patient to informed consumer?

Background: Social networking sites offer new opportunities for communication between and amongst health care professionals, patients and members of the public. In doing so, they have the potential to facilitate public access to health care information, peer-support networks, health policy fora and online consultations. Government policies and guidance from professional organisations have begun to address the potential of these technologies in the domain of health care and the responsibilities they entail for their users. Objective: Adapting a discourse analytic framework for the analysis of policy documents, this review paper critically examines discussions of social networking sites in recent government and professional policy documents. It focuses particularly on who these organisations claim should use social media, for what purposes, and what the anticipated outcomes of use will be for patients and the organisations themselves. Conclusion: Recent policy documents have configured social media as a new means with which to harvest patient feedback on health care encounters and communicate health care service information with which patients and the general public can be ‘empowered’ to make responsible decisions. In orienting to social media as a vehicle for enabling consumer choice, these policies encourage the marketization of health information through a greater role for non-profit and commercial organisations in the eHealth domain. At the same time, current policy largely overlooks the role of social media in mediating ongoing support and self-management for patients with long-term conditions

Service user involvement in an undergraduate nursing programme

This article highlights the impacts that service user involvement can have on the education of UK undergraduate student mental health nurses both personally and professionally. It reports the findings from a short module evaluation of a collaboratively delivered theory unit using a qualitative approach. It reports the findings from a short module evaluation of a collaboratively delivered theory unit using a qualitative approach embracing two focus groups. The findings from the two focus groups highlight that the service user input (‘expert by experience’) offered a positive learning experience for the students, enabled them to appreciate the meaning of recovery and hope, facilitated the identification as to the importance of their role in terms of connecting meaningfully with those they are supporting plus reconsidering key priorities for practice. They suggest also that there is theory/practice gap reduction as students were able to connect the service user narratives to the evidence base for deeper understanding and application. Although only a brief evaluation of a short theory module within a wider mental health programme including a limited number of students, the findings echo the wider literature and offer further rationale to support direct service user involvement in mental health education across other professions, perhaps interesting at this time as increasingly, learning/teaching programmes implement blended learning with significant online teaching and less face to face facilitation of learning. This article highlights the positive impact not only of service user input into healthcare education but also the benevolent influence skilled narratives can have as a pedagogical approach for learning. Although there is much in the literature as to the benefits for student learning in involving service users within HEI education, there is limited information as to ‘how’ and ‘why’ this is the case, this article seeks to bridge that ga

Urgent care centre redirection: evaluation of a nurse led intervention

Aim: Patient redirection can help reduce service demand by providing information about more appropriate services. There is, however, no evidence about the effect of nurse-led patient redirection in urgent care centre settings. The aim of this project was to develop and evaluate a nurse-led patient ‘self-care and redirection first’ intervention in an urgent care centre (UCC). Method: Adopting a prospective observational design, the intervention was delivered to an opportunity sample of patients who attended a south London hospital UCC, between June and July 2014, and evaluated through patient interviews five to ten days after initial attendance. Findings: 118 of the 1,710 people who attended the UCC participated in the intervention, of whom 81 (69%) were redirected to other services or home to self-care, and 37 were transferred to an emergency department. Of the 110 (93.2%) participants who completed the questionnaire, 97.2% were satisfied with the service. Only two accessed different services to those recommended, 72.2% (n=85) said they would not reattend a UCC for a similar condition. Conclusion: Treating minor ailments in a UCC is an inefficient use of resources. A nurse-led self-care and redirection intervention can help divert patients with minor ailments to more appropriate services. Further evaluation of the effect of the intervention on service demand and costs is required

Moving upstream in health promoting policies for older people with early frailty in England? A policy analysis.

Objectives Globally, populations are rapidly ageing and countries have developed health promotion and wellbeing strategies to address increasing demand for health care and old-age support. The older population is not homogeneous however, and includes a large group in transition between being active and healthy to being frail, i.e. with early frailty. This review explores the extent to which policy in England has addressed this group with a view to supporting independence and preventing further progression towards frailty. Methods A narrative review was conducted of 157 health and social care policy documents current in 2014-2017 at three levels of the health and social care system in England. Findings We report the policy problem analysis, the shifts over time in language from health promotion to illness prevention, the shift in target populations to mid-life and those most at risk of adverse outcomes through frailty, and changes to delivery mechanisms to incentivize attention to the frailest rather than those with early frailty. We found that older people in general were not identified as a specific population in many of these policies. While this may reflect a welcome lack of age discrimination, it could equally represent omission through ageism. Only at local level did we identify some limited attention to preventative actions with people with early frailty. Conclusion The lack of policy attention to older people with early frailty is a missed opportunity to address some of the demands on health and social care services. Addressing the individual and societal consequences of adverse experiences of those with the greatest frailty should not distract from a more distinct public health perspective which argues for a refocusing upstream to health promotion and illness prevention for those with early frailty

Paying for the quantity and quality of hospital care : the foundations and evolution of payment policy in England

Prospective payment arrangements are now the main form of hospital funding in most developed countries. An essential component of such arrangements is the classification system used to differentiate patients according to their expected resource requirements. In this article we describe the evolution and structure of Healthcare Resource Groups (HRGs) in England and the way in which costs are calculated for patients allocated to each HRG. We then describe how payments are made, how policy has evolved to incentivise improvements in quality, and how prospective payment is being applied outside hospital settings

Learning from contract change in primary care dentistry: a qualitative study of stakeholders in the north of England

The aim of this research was to explore and synthesise learning from stakeholders (NHS dentists, commissioners and patients) approximately five years on from the introduction of a new NHS dental contract in England. The case study involved a purposive sample of stakeholders associated with a former NHS Primary Care Trust (PCT) in the north of England. Semi-structured interviews were conducted with 8 commissioners of NHS dental services and 5 NHS general dental practitioners. Three focus group meetings were held with 14 NHS dental patients. All focus groups and interviews were audio recorded and transcribed verbatim. The data were analysed using a framework approach. Four themes were identified: ‘commissioners’ views of managing local NHS dental services’; ‘the risks of commissioning for patient access’; ‘costs, contract currency and commissioning constraints’; and ‘local decision-making and future priorities’. Commissioners reported that much of their time was spent managing existing contracts rather than commissioning services. Patients were unclear about the NHS dental charge bands and dentists strongly criticised the contract's target-driven approach which was centred upon them generating ‘units of dental activity’. NHS commissioners remained relatively constrained in their abilities to reallocate dental resources amongst contracts. The national focus upon practitioners achieving their units of dental activity appeared to outweigh interest in the quality of dental care provided

Meeting the needs of older people living at home with dementia who have problems with continence

Purpose The purpose of this paper is to discuss the question of how to meet the needs of older people living at home with dementia who have problems with continence. The paper is focused on social care practice in community settings. Design/methodology/approach This paper is practice focused and draws on the authors' research and experiences in clinical care, workforce development and service improvement. Findings This paper summarises research on incontinence and its negative effects on quality of life and care relationships. It describes the impact of incontinence in terms of social embarrassment, restricted social activity, extra work (such as laundry) and costs, but also distress. It links research with care practice, with a focus on people with dementia who may be at particular risk of both continence problems and of assumptions that nothing can be done to assist them. Social implications This paper provides questions that could be addressed in commissioning and provision of services and argues that they need to be informed by care practitioners' experiences. It provides details of sources of support that are available at national and local levels. Originality/value This paper draws together research on continence and social care practice to provide a series of self-assessment questions for local services. It focuses on social care workers who are at the frontline of practice including personal assistants and carers

Hollowing out national agreements in the NHS? The case of "Improving Working Lives" under a "Turnaround" plan

Purpose: The purpose of this paper is to consider the resilience of a national-level initiative (Improving Working Lives (IWL)) in the face of local-level initiative (Turnaround) in an NHS hospital and compare to Bach and Kessler’s (2012) model of public service employment relations. Design/methodology/approach: Case study research consisting of 23 in-depth semi-structured interviews from a range of participants. Findings: The principles behind IWL were almost entirely sacrificed in order to meet the financial objectives of Turnaround. This indicates the primacy of localised upstream performance management initiatives over the national-level downstream employee relations initiatives that form the basis of the NHS’ claim to model employer aspiration. Research limitations/implications: The case study was conducted between 2007 and 2009. While the case study falls under previous government regime, the dualised system of national-level agreements combined with localised performance management – and the continued existence of both Turnaround and IWL – makes the results relevant at the time of writing. Originality/value: Some studies (e.g. Skinner et al., 2004) indicated a perception that IWL was not trusted by NHS staff. The present study offers reasons as to why this may be the case