Evaluation of the Outpatients consultation in East Kent

CHSS undertook to support Kent and Medway Commissioning Support (KMCS: acting on behalf of East Kent Hospitals University NHS Foundation Trust and NHS Canterbury and Coastal Clinical Commissioning Group) in undertaking an independent analysis of a consultation on Outpatient services in East Kent. The aim of the consultation was to gain opinions from the public of a proposed Outpatient Clinical Strategy that intends to improve local access to, and facilities for, Outpatient services, and to offer a wider range of services on each site. CHSS advised on the survey, evaluated the consultation process, ran focus groups and carried out quantitative and qualitative analysis of the responses gathered during the consultation period (9th December 2013 to 17th March, 2014 - originally 9th March but period was extended). Ethical approval was not required for a consultation process, but ethical principles have been adhered to regarding data confidentiality and informed consent for the focus groups

Service Development Programme: Maximising Life Opportunities for Teenagers. Teenagers' Views and Experiences of Sex and Relationships Education, Sexual Health Services and Family Support Services in Kent - Survey findings for Year 2

This brief report provides findings from data collected in year 2 of a survey of teenagers' views and experiences of sex and relationships education and sexual health services in Kent. The data in year 2 was collected in Autumn 2005, a year after the data collected in year 1. The purpose of this report is to highlight the results in year 2 which differ from the year 1 survey data. It is to be used in conjunction with the report in year 1 entitled "Service Development Programme: Maximising Life Opportunies for Teenagers: Teenagers' Views and Experiences of Sex and Relationships Educatioon, Sexual Health Services and Family Suupport Services in Kent: Survey Findings July 2005". The final report on the survey will consist of findings from further analysis of the data from year 1 and year 2 merged together, available at the end of 2006

Older People Have Their Say! Survey of Older People’s Needs in Westgate Ward, Canterbury

Although a lot of effort in the last few years has been made to address the needs of people in old age, surprisingly not much is known about the views of this age group in the Canterbury City Council area. To address this lack of knowledge, the Canterbury and District Pensioners’ Forum was funded by the Canterbury City Council to explore the needs of older people living in this area. Our Forum decided to collaborate with the University of Kent to produce a survey on the needs of older people within the District of Canterbury. During the process of the project, we decided to base the survey on the Westgate Ward in Canterbury because we felt that older people living in this area represent a good example for highlighting needs that involve ‘ordinary’ older people. This ward is quite diverse in many ways; it spreads from a semi-rural area through to town dwelling. It is not seen as an area of deprivation, thereby has not generated any special money from the Government to help with social problems in the provision of social centres, community learning, social activities etc. Yet we know from our own experience that what may appear in many parts as fairly affluent is quite deprived of places for people to meet; and has large public housing areas with no amenities at all. The present Government put through legislation, which said that public services should be surveyed, and the part of that legislation that we are particularly interested in is “The National Service Framework for Older People”. That framework asks that older people are treated with dignity by NHS and Social Care organisations; and that Councils –County and District, examine existing services- housing, leisure and transport – to identify opportunities to promote health and well-being. We felt that Westgate Ward would be representative of many other areas within our District that had not received any special investment. The work that has been done in producing this survey has been done by members of the Canterbury & District Pensioners’ Forum with help from the University of Kent. It is a survey of older people, carried out by older people. It is our work. Information generated by this project will be assisting the Forum’s work to promote important issues related to older people’s quality of life and access to health and social care services. A comment from J.F. Kennedy we believe sums up the approach that we took at the start of this survey: “It is not enough for a nation to have added years of life. Our object must be to add new life to those years

Nurses’ experiences of transitions of older patients from hospitals to community care. A nation-wide survey in Norway

Moving older patients from hospitals to community services is a critical phase of integrated care. Yet there has been little large-scale research on the quality of these transitions. We investigated how Norwegian nurses working in community care services (N = 4,312) and at in-patient wards at hospitals (N = 2,421) experienced the quality of transitions of older patients from hospitals to community care. We tested hypotheses derived from qualitative research and consistent with predictions, we found that compared to hospital nurses, the nurses working in community care experienced lower quality of patient transitions and were less satisfied with information exchange on patients’ condition and needs. Further, when comparing groups of community nurses, we confirmed the hypothesis that nurses in home nursing were more dissatisfied with the quality of transitions and information exchange than nurses in nursing homes. We conclude that hospital nurses should have more face-to-face or telephone contact with community nurses, and specifically with home nurses. Further, we suggest that means are implemented to promote a mutual understanding of the older patients’ pathway from one service to the other, and to improve co-ordination across the services

Proof of concept evaluation of a project using ‘conversations inviting change’ methodology to support the development of in-place systems leadership in local care hubs

This evaluation took place between March and August 2018 and was commissioned by the NHS Leadership Academy on behalf of Kent and Medway Sustainability and Transformation Plan (STP) and delivered by East Kent Community Education Provider Network (EK CEPN). The programme consisted of three development sessions carried out over two sites, or multi-professional teams known as hubs, clusters or primary care networks by an experienced facilitator using the model ‘conversations inviting change’. This model embodies a narrative approach that recognises the domains identified by the National Leadership Academy of individual effectiveness, relationships and connectivity, innovation and improvement, learning and capacity building (NHS Leadership Academy, 2017)

Advancing integrated care evaluation in shifting contexts: blending implementation research with case study design in project SUSTAIN

Background: Despite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat ‘illusive’ impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015–2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators. Conclusions: Lessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analys

The Over 75 Service: Continuity of integrated care for older people in a United Kingdom primary care setting

Continuity of care is concerned with quality of care over a period of time. It describes a process by which service users and their families are co-operatively involved with health and social care professionals in managing their care needs. Continuity of care can be divided into informational, managerial and relational and has been associated with improved user- and service-related outcomes. To date, there have been few studies which examine how continuity of care is developed and maintained in integrated primary care systems. This paper explores continuity of care in an integrated Over 75 Service for people living at home with complex health and social care needs. Using a case study approach, qualitative data was collected from multiple sources including interviews with managers and professionals, users and carers, care plans, steering group minutes and field notes. Data was analysed thematically. A number of factors are identified which characterise continuity of care, namely: information sharing through direct communication between providers and the development of trusted relationships within the team; identified care co-ordinators who acted as a conduit for information and communication; the development of ongoing relationships with users and carers requiring dedicated time and accessible and flexible services delivered in the users’ own home

Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review

Objectives: To synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy. Design: A systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. Results: The search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature (LILACS). The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions; (2) composition of teams; (3) intervention effectiveness; and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines. Conclusions: The review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection

A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent

Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment