7 research outputs found
Support workers in intermediate care
Despite the proliferation of support worker roles in the UK, little is known
about their actual numbers, employment conditions or levels of training.
Intermediate care services appear to be an important employer of support
workers, but the diversity of intermediate care services makes the task
of understanding support worker roles even more complex. This paper
presents data from 33 services which were involved in an NHS Modernisation
Agency’s Changing Workforce Programme project, the Accelerated
Development Programme for Support Workers in Intermediate Care in
England. Within this project, the main employers of support workers were
primary care trusts and/or social services. Participating intermediate care
teams were involved in admission avoidance, assisted discharge and
re-ablement, or combinations of these services, and the majority of care
was provided in the patient’s own home. The 33 services employed 794
support workers and 368 professionally qualified staff. The mean ratio of
professionally qualified staff to support workers was 0.95 (range = 0–4.9,
SD = 1.05). Support worker roles included multidisciplinary working,
meeting rehabilitation needs, providing personal care and enablement.
Team leaders included nurses, social workers, physiotherapists, professional
managers, home carers and support workers. The most commonly reported
sources of support worker training were National Vocational Qualifications
and in-house training. In 80% of the services, at least half of the support
workers had a qualification. Three models of supervision emerged across
the services: the allocation of a mentor; team supervision; and formal
and informal line management. These findings illustrate the diversity of
employment of support workers in intermediate care. The variations in
training, supervision and skill mix have implications for clinical governance
and support worker regulation. The employment of support worker staff
jointly across health and social care raises cross-boundary issues around
employment contracts and pay
Multi-center evaluation of baseline neutrophil-to-lymphocyte (NLR) ratio as an independent predictor of mortality and clinical risk stratifier in idiopathic pulmonary fibrosisResearch in context
Summary: Background: Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder with a variable disease trajectory. The aim of this study was to assess the potential of neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in IPF. Methods: We adopted a two-stage discovery (n = 71) and validation (n = 134) design using patients from the UCL partners (UCLp) cohort. We then combined discovery and validation cohorts and included an additional 794 people with IPF, using real-life data from 5 other UK centers, to give a combined cohort of 999 patients. Data were collected from patients presenting over a 13-year period (2006–2019) with mean follow up of 3.7 years (censoring: 2018–2020). Findings: In the discovery analysis, we showed that high values of NLR (>/ = 2.9 vs < 2.9) were associated with increased risk of mortality in IPF (HR 2.04, 95% CI 1.09–3.81, n = 71, p = 0.025). This was confirmed in the validation (HR 1.91, 95% CI 1.15–3.18, n = 134, p = 0.0114) and combined cohorts (HR 1.65, n = 999, 95% CI 1.39–1.95; p < 0·0001). NLR correlated with GAP stage and GAP index (p < 0.0001). Stratifying patients by NLR category (low/high) showed significant differences in survival for GAP stage 2 (p < 0.0001), however not for GAP stage 1 or 3. In a multivariate analysis, a high NLR was an independent predictor of mortality/progression after adjustment for individual GAP components and steroid/anti-fibrotic use (p < 0·03). Furthermore, incorporation of baseline NLR in a modified GAP-stage/index, GAP–index/stage-plus, refined prognostic ability as measured by concordance (C)-index. Interpretation: We have identified NLR as a widely available test that significantly correlates with lung function, can predict outcomes in IPF and refines cohort staging with GAP. NLR may allow timely prioritisation of at-risk patients, even in the absence of lung function. Funding: Breathing Matters, GSK, CF Trust, BLF-Asthma, MRC, NIHR Alpha-1 Foundation
Dynamic professional boundaries in the healthcare workforce
The healthcare professions have never been static in terms of their
own disciplinary boundaries, nor in their role or status in society.
Healthcare provision has been defined by changing societal
expectations and beliefs, new ways of perceiving health and illness,
the introduction of a range of technologies and, more recently, the
formal recognition of particular groups through the introduction
of education and regulation. It has also been shaped by both interprofessional
and profession-state relationships forged over time.
A number of factors have converged that place new pressures on
workforce boundaries, including an unmet demand for some
healthcare services; neo-liberal management philosophies and a
greater emphasis on consumer preferences than professional-led
services. To date, however, there has been little analysis of the
evolution of the workforce as a whole. The discussion of workforce
change that has taken place has largely been from the perspective
of individual disciplines. Yet the dynamic boundaries of each
discipline mean that there is an interrelationship between the
components of the workforce that cannot be ignored. The purpose
of this paper is to describe four directions in which the existing
workforce can change: diversification; specialisation and vertical
and horizontal substitution, and to discuss the implications of
these changes for the workforce