National evaluation of Diplomas: cohort 1 - the second year

The introduction of Diplomas for 14-19 year olds represented a major innovation in educational opportunity for young people in England. The Diplomas are being offered at three levels and across 14 subjects and have been implemented in three phases (from September 2008, 2009 and 2010). Following the establishment of the Coalition government in May 2010, a number of changes to the implementation and delivery of the Diploma qualification were introduced. The Minister of State for Schools announced that development of new Diplomas in science, humanities and languages, which were due to be introduced from September 2011, would be discontinued. Additionally the Diploma entitlement, whereby all young people within an area would be able to access any of the Diploma subjects, would be removed and that the decision about which Diploma subjects would be available to students would in future be made by schools and colleges. Moreover, it was decided that the Gateway application process whereby consortia (of schools, colleges, training providers, employers and Higher Education Institutes (HEIs)) had previously submitted an application to the Department for Education (DfE) for each Diploma subject they wanted to offer would no longer be required for provision commencing from 2012. Other changes included the freedom for institutions to decide whether or not they wanted to work collaboratively to provide Diploma provision

Prosodic awareness and children’s multisyllabic word reading

Prosody awareness (the rhythmic patterning of speech) accounts for unique variance in reading development. However, studies have thus far focused on early-readers and utilised literacy measures which fail to distinguish between monosyllabic and multisyllabic words. The current study investigated the factors that are specifically associated with multisyllabic word reading in a sample of fifty children aged between 7- and 8-years. Prosodic awareness was the strongest predictor of multisyllabic word reading accuracy, after controlling for phoneme awareness, morphological awareness, vocabulary, and short-term memory. Children also made surprisingly few phonemic errors while, in contrast, errors of stress assignment were commonplace. Prosodic awareness was also the strongest predictor of stress placement errors, although this finding was not significant. Prosodic skills may play an increasingly important role in literacy performance as children encounter more complex reading materials. Once phoneme-level skills are mastered, prosodic awareness is arguably the strongest predictor of single word reading

Introduction of a Physiotherapy Associate Practitioner role on Critical Care: an innovative service improvement to enhance seven-day services and improve efficiency and quality of care

Introduction: Rehabilitation after Critical Illness (RaCI) and Enhanced Recovery after Surgery (ERAS) have been areas of increasing focus over the last decade. Physiotherapy is integral to the optimal delivery of both pathways. Historically, physiotherapy staffing on our ICU limited the ability to best deliver these services. To address this, we developed a non-qualified Physiotherapy Associate Practitioner (PAP) role within ICU to carry a caseload of elective surgical patients. This increased the mobilisation of ERAS patients, and also released a specialist critical care physiotherapist to coordinate a multi-disciplinary RaCI service. Aims: • Improve outcomes for surgical patients. • More therapeutic time to patients with complex needs. • More consistent physiotherapy service on the ICU, seven days a week. • A multidisciplinary team (MDT) RaCI service; weekly outreach rounds and monthly outpatient clinic. Method: 1.8 WTE Band 4 PAPs were recruited on a pilot basis. They both completed a comprehensive training and competency framework. Functional mobility outcome scores at discharge from ICU and weekend productivity statistics were collected for six months. This was compared with data from 6 months prior to the pilot commencing. The senior physiotherapist co-ordinated the RACI pathway, as per NICE CG83. This included involvement in each RaCI patient’s rehabilitation on ITU, ward follow up, and outpatient review. Data was also collected to evaluate RaCI Pathway delivery. Results: Table View larger version Conclusion: We have described an innovative service change within the ICU physiotherapy team. This has allowed implementation of an enhanced mobility service 7 days a week. It has also facilitated the development of a RaCI service, to address the complex needs of long-term ICU patients. The recruitment of PAPs represents a relatively small financial investment, but one that has facilitated a restructure of the physiotherapy team, allowing optimisation of resource allocation to different ICU patient groups. Given the current financial constraints on NHS services, this project represents a unique and practical approach to achieving NHS England’s recommendation for safe, sustainable staffing with “the right staff, with the right skills, in the right place, at the right time” (National Quality Board 2016)

Specialist community teams for adults with learning disabilities: referrals to a countywide service in England

Purpose – While “generic” community teams for adults with learning disabilities (CTs) are well-established in the UK, very little recent evidence is available about any aspect of their work. As part of a larger project about the role, structure and functioning of CTs, the purpose of this paper is to provide data about referrals. Design/methodology/approach – Over threemonths, the authors obtained data about 270 consecutive new referrals to five CTs in a countywide integrated health (NHS) and care management (local authority) service. Findings – The 270 referrals related to 255 individuals, mainly already service users, with almost a third (30 per cent, n=204) described as people with severe or profound disabilities. Consistent with the reported living arrangements (residential accommodation or with one or more family members (87 per cent, n=270)), referrals were most often made by social care staff, General Practitioners or carers. The referrals related to a wide range of issues including mental health and/or behavioural needs, physical health and skills, and independence. The major group, however, were requests about a person’s entitlement to specialist learning disability services and/or reviews of an existing social care package. Research limitations/implications – The focus on new referrals and the exclusion of intra-team referrals mean that the data are not representative of a CT’s caseload and cannot be used as a basis for resourcing. Nevertheless, the findings emphasise the heterogeneity of the population, and the long-term and varied nature of their needs, meaning that CTs require access to a range of expertise and, often, an inter-agency approach. The implications for service design are considered. Originality/value – This is the first empirical study of referrals to specialist integrated (health and care management) community learning disabilities teams in England

'What vision?': experiences of Team members in a community service for adults with intellectual disabilities.

BACKGROUND: In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected. METHODS: Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture. RESULTS: Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. DISCUSSION: The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.We are grateful to all our participants in the IDP, without whom the study could not have taken place, to Professor Eivor Oborn (Warwick Business School) for her insights in the development of the study. Funding was provided by the NIHR’s Collaboration for Health Research & Care (CLAHRC) for Cambridgeshire & Peterborough. The preparation of the paper was funded by the NIHR’s CLAHRC East of England (ICHC, KAW, AJH, AL, EJ, APW). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the author accepted manuscript. The final version is available from Wiley via https://doi.org/10.1111/jir.1231