Elective care: model access policy

Elective care: model access policy NHS Improvement 18 August 2017 updated 24 January 2019  

• The purpose of this policy is to ensure all patients requiring access to outpatient appointments, diagnostics and elective inpatient or day-case treatment are managed in line with national waiting time standards and the NHS Constitution. 
• Includes general principles, pathway-specific principles referral to treatment and diagnostic pathways, and Cancer pathways.

Operating theatres: opportunities to reduce waiting lists

Operating theatres: opportunities to reduce waiting lists
NHS Improvement 4 February 2019

• This report looks at unwarranted variation in theatre productivity and ways to improve how care is delivered in England
• The work, by Deloitte, found that hospitals could carry out over 291,000 more routine operations, like hip replacements and cataract surgeries, a year by improving how they schedule their surgical lists. 

About the findings:

RT300 for spinal cord injury rehabilitation

RT300 for spinal cord injury rehabilitation [MIB169]
NICE Medtech innovation briefing January 2019

• The RT300 combines functional electrical stimulation (FES) with a motorised ergometer that allows repetitive cycling activity as part of a rehabilitation programme for people with a spinal cord injury.
• This briefing discusses patient and system impact.

Ex-situ machine perfusion for extracorporeal preservation of livers for transplantation

Ex-situ machine perfusion for extracorporeal preservation of livers for transplantation [IPG636]
NICE Interventional procedures guidance, January 2019

• Evidence-based recommendations on ex-situ machine perfusion for extracorporeal preservation of livers for transplantation in people of all ages. This involves using a machine to give an oxygenated solution to the donor liver until it is transplanted.

Spinal Services:; GIRFT Programme National Specialty Report

Spinal Services:; GIRFT Programme National Specialty Report
Getting It Right First Time, January 2019

• The report focuses on spinal emergency conditions such as spinal cord injury and spinal infection, in addition to the management of common conditions such as back and radicular pain (sciatica). 
• The report shows that in 2017/18 the NHS carried out 52,523 surgical procedures on the spine.
• Key recommendations include:
• Referral without delay to 24-hour MRI scanning in all hospitals for patients with suspected cauda equina syndrome (a spinal emergency which can lead to limb paralysis and permanent loss of bowel and bladder function if not treated quickly);
• All major trauma centres to have the ability 24/7 to stabilise and decompress the spine in patients with fractured and dislocated spines;
• Suggested changes to the referral pathway of paediatric spinal deformity patients to enable children to be treated close to home where appropriate but at a centre
• with the shortest waiting time; 
• Better recording of implants, their use and patient outcomes.
• It is estimated the recommendations could deliver cost efficiencies of up to £27m.

Airway clearance techniques for cystic fibrosis

Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews
Cochrane Systematic Review 24 January 2019

• A review of the the evidence from six Cochrane Reviews about the effect of airway clearance techniques in people with cystic fibrosis.
• The overview found moderate evidence that PEP therapy and vibrating (oscillating) devices have a similar effect on lung function (forced expiratory volume in one second (FEV1) after six months of treatment. 
• It was not possible to draw definitive conclusions for all other comparisons in terms of FEV1 because the quality of evidence is currently lacking. Likewise, it was not possible to draw any definitive conclusions for other outcome measures such as individual preference and quality of life. Harms, such as acid reflux, collapsed lungs, coughing up blood, or decreased oxygen, were rarely mentioned in the original trials. There is a lack of evidence to determine if any particular airway clearance therapy is riskier than the other therapies. 

Better managing excess treatment costs

Better managing excess treatment costs
NIHR January 2019

• The way in which excess treatment costs are met is changing and a trial period for the new arrangements will roll out from 1 October 2018, through to April 2019.
• Briefings including "Establishment of new arrangements for funding the reimbursement of excess treatment costs from 1 October 2018 " from NHS England (December 2018) provide more detailed information about the new arrangements. 
• The impact of this work will:
• Enable the 15 NIHR Local Clinical Research Networks (LCRNs) to help manage the excess treatment costs process on behalf of their local CCGs and in collaboration with NHS England Specialised Commissioning. This single point of access for all proposals for which excess treatment costs may be applicable is designed to make the process much simpler for researchers to navigate.
• Establish a more rapid, standardised and consistent process for the management of excess treatment costs to avoid delays during study set up and to maximise patient recruitment.
• Set a threshold under which excess treatment costs will need to be absorbed by non-primary care providers participating in studies.

Inpatient hospital care compared to outpatient or day care for people with eating disorders

Inpatient versus outpatient care, partial hospitalisation and waiting list for people with eating disorders
Cochrane Systematic Review 21 January 2019

• There was not enough evidence from trials (n=4, 511 people) to support any one setting for people with anorexia nervosa, bulimia nervosa, or other eating disorders. There was no clear difference in weight gain for people with anorexia nervosa who were treated in different settings, but they seemed more likely to complete treatment when some or all of it was offered in settings outside the hospital. 
• The evidence was low or very low‐quality, so we are uncertain about these results.

NHS financial sustainability
National Audit Office 18 January 2019

• This report 
• summarises the financial position of NHS England, CCGs and trusts 2017/18
• examines the financial flows and incentives in the NHS and whether these encourage long-term financial sustainability
• examines how local partnerships of health and care organisations are progressing, and what the Department of Health & Social Care, NHS England and NHS Improvement are doing to support them
• Figure 17 - National initiatives to help bodies to reduce demand, manage costs and improve efficiency

13-24 year olds with cancer in England: Incidence, mortality and survival

13-24 year olds with cancer in England: Incidence, mortality and survival
National Cancer Registration and Analysis Service, Teenage Cancer Trust 17 January 2019

• A detailed analysis of the latest trends in the incidence, mortality and five-year survival rates for cancer amongst young people (13 to 24-years).
• Key findings include: 
• Mortality rates of all cancers combined in 13 to 24 year olds have decreased from 42.9 per million in 2001 to 32.3 per million in 2015. 
• The largest reduction in mortality by diagnostic group in England between 2001 and 2015 has been in Leukaemias. There were also reductions seen in mortality from Central Nervous System tumours, bone cancer and in lymphoma.
• Five-year survival rates for cancer in 13 to 24 year olds have risen from 83% females / 80% males in (2001-05) to 87% in females / 84 % males (2007-11). 
• There are statistically significant variations in incidence and survival rates of cancer in 13 to 24 year olds based on geography and deprivation.  
• The incidence of cancer in 13 to 24 years olds in England has increased from a crude rate of 233.1 per million in 2001, to 299.7 per million in 2015.  

A Long Term Plan for children’s critical care [blogpost]

A Long Term Plan for children’s critical care [blogpost]
Harriet Ward 16 January 2019

• A manager of the South East England Paediatric Networks looks at the Long Term Plan and what it means for critical care and specialised surgery for children.

Rehabilitation for people with multiple sclerosis

Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews
Cochrane Systematic Review 14 January 2019

• Review of 15 Cochrane reviews (168 clinical trials) showed some benefits for people with MS who participated in exercise and physical activity programmes or multidisciplinary rehabilitation programmes (where the intervention is provided by a team of health professionals from different professions). They found improvements in everyday activities, function, and health‐related quality of life, compared with those who were not offered rehabilitation. 
• Evidence for other rehabilitation modalities was limited, due to lack of good‐quality studies. 

A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic.

A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic. [PubMed]

Ann R Coll Surg Engl. 2019 Jan;101(1):30-34.

• Clinical, financial and environmental benefits of  virtual urology clinic at Charing Cross Hospital, London.

Abstract

Translating cancer care innovation into practice - The Christie@model

Translating cancer care innovation into practice
HSJ 10 January 2019

• Professor Christopher J Harrison, medical director of The Christie Hospital, explains how he and his colleagues made use of a network model to improve the experiences of cancer patients in the region.
• The strategy was to establish a devolved network of Christie branded and run cancer services in partnership with hospitals and primary care teams across the city-region. Known as “The Christie @ model”, this network enables high-quality specialist care to be provided to reliable uniform standards.
• The full model is a partnership between The Christie and host organisations, in which The Christie takes responsibility for employing professional staff and the associated care delivery and governance, while the host provides, under a service agreement, access to support staff and services.

Extract from Christie Operational Plan 2018/19
Capacity Planning

• Growth in Chemotherapy delivery will be delivered through increased utilisation of the ‘Christie@’ model and other outreach sites. This includes commencing clinical trials to the Christie@Wigan’ site, expansion of services into new facilities at Tameside Hospital, improvement in capacity at Royal Bolton Hospital, and the development of services at Pennine Acute Hospitals. We will also be exploring the expansion of the Trust’s ‘Christie@Home’ service.

National Clinical Audit of Seizures and Epilepsies for Children and Young People (2018)

National Clinical Audit of Seizures and Epilepsies for Children and Young People (2018)
HQIP 10 January 2019

• This audit, known as Epilepsy12, shows incremental improvements in some areas of paediatric epilepsy service provision alongside a considerable need for improvement in others.
• The report includes the first ‘yearly snapshot’ of the organisation of paediatric epilepsy services for children and young people in England and Wales as well a case study of how paediatric epilepsy services have used their Epilepsy12 results to identify and undertake local quality improvement activities.

National Maternity and Perinatal Audit – Intensive Care Report

National Maternity and Perinatal Audit – Intensive Care Report
HQIP 10 January 2019

• The purpose of this report is to describe the feasibility of linking the NMPA’s maternity data to intensive care data and to evaluate the suitability of rates of maternal admission to intensive care as an indicator of care quality. It also describes the demographics of women admitted to intensive care and the reasons for admission.
• This report shows that the linkage of maternity data to intensive care data offers the potential to understand the demographic factors underlying admission to intensive care, and the timing of intensive care admission relative to birth. However, as NHS organisations differ in their configuration of care for women who are critically ill during pregnancy, birth or the postnatal period, criteria for admission to intensive care varies so admissions to intensive care do not reliably indicate severe maternal morbidity. In different hospitals women with the same clinical condition may be cared for in different settings.

High-performance medicine: the convergence of human and artificial intelligence

High-performance medicine: the convergence of human and artificial intelligence
Nature Medicine 25 p44–56, January 2019

• In this review article Eric J. Topol describes the impact Artificial Intelligence is having on medicine for physicians, health systems and patients.

Abstract

NHS Long Term Plan – highlights for commissioning of cancer services

NHS Long Term Plan – highlights for Specialised Commissioning of cancer services
NHS England 7 January 2019
Extracts from the NHS Long Term Plan relating to cancer services (paras 3.51-3.65)

• The plan highlights 
• A new ambition that, by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to three-quarters of cancer patients. 
• use of personalised and risk stratified screening and testing the family members of cancer patients where they are at increased risk of cancer. 
• bowel cancer screening, 
• HPV primary screening for cervical cancer, 
• an extension of lung health checks, 
• new cancer screening programmes and diagnostic capacity, 
• work by Primary care networks to ensure improvement in early diagnosis, 
• a faster diagnosis standard from 2020 and overhaul of diagnostic services 
• investment in equipment 
• investment to ensure roll out of new techniques and technologies 
• use of molecular diagnostics and rollout of routinely offer genomic testing over the next ten years 
• personalised care planning for those diagnosed with cancer and appropriate follow up after treatment. 

Milestones for cancer
• From 2019 we will start to roll out new Rapid Diagnostic Centres across the country.
• In 2020 a new faster diagnosis standard for cancer will begin to be introduced so that patients receive a definitive diagnosis or ruling out of cancer within 28 days.
• By 2020 HPV primary screening for cervical cancer will be in place across England.
• By 2021, where appropriate every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support.
• By 2022 the lung health check model will be extended.
• By 2023, stratified, follow-up pathways for people who are worried their cancer may have recurred. These will be in place for all clinically appropriate cancers.
• By 2028, the NHS will diagnose 75% of cancers at stage 1 or 2.

Watch the Health and Social Care committee 8 January 2019 discussing Early diagnosis and the cancer workforce in the NHS long-term plan 

Cerebral palsy in adults: NICE guidance

Cerebral palsy in adults [NG119]
NICE January 2019

• This guideline covers care and support for adults with cerebral palsy. It aims to improve health and wellbeing, promote access to services and support participation and independent living.

Follow‐up services for improving long‐term outcomes in ICU survivors

Follow‐up services for improving long‐term outcomes in intensive care unit (ICU) survivors
Cochrane Systematic Reviews 2 November 2018

• An assessment of the evidence around the effectiveness of follow‐up services for ICU survivors found insufficient evidence to determine whether existing ICU follow‐up services are effective in identifying and addressing the unmet health needs of ICU survivors.