Gender Identity Services services specifications

Gender Dysphoria Clinical Programme

• Service specification: Gender Identity Services for Adults (Non-Surgical Interventions) NHS England 3 July 2019
• Service specification: Gender Identity Services for Adults (Surgical Interventions) NHS England 3 July 2019

Which cancers would benefit most from earlier diagnosis?

Which cancers would benefit most from earlier diagnosis?
ONS 18 June 2019

• While all cancers would benefit from earlier diagnosis, there are some cancers where earlier diagnosis would have a greater impact on survival. Colorectal and kidney cancer patients would see the greatest increase in their chances of survival if they were diagnosed at an earlier stage, data shows.
• The report includes proportion of people diagnosed at each stage, and overall net-survival for prostate, breast, kidney, colorectal, ovary and lung cancers.

Healthcare Standards for Children and Young People in Secure Settings

Healthcare Standards for Children and Young People in Secure Settings
Royal College Paediatrics and Child Health, updated June 2019

• The standards are intended to be a tool and resource for healthcare professionals, service planners and providers, governors/directors/managers and regulators to help plan, deliver and quality assure children’s health services in secure settings.

Why do patients with a curative treatment plan for oesophago-gastric cancer not go on to receive surgery?

Why do patients with a curative treatment plan for oesophago-gastric cancer not go on to receive surgery? Oesophago-Gastric Cancer: Short Report
HQIP 13 June 2019

• This report examines the potential reason for the difference between planned and actual surgical resection treatments in patients with oesophago-gastric cancer. Initial examinations point to differences in specialists' opinions, patient preferences, patient fitness and tumour characteristics.

Robotic assisted knee replacement surgery

Surgeons in North East first to use robotic arm in knee replacements
Newcastle Hospitals NHS Foundation Trust 13 June 2019

• Newcastle Hospitals NHS Foundation Trust surgeons are among the first in the country to use robotic assisted knee replacement surgery.
• Currently, between 10-20% of patients who undergo knee surgery are disappointed with the outcome and often need revision surgery. According to Professor Deehan, consultant orthopaedic surgeon, part of the solution to such is tailoring implant position in the joint to match the patient’s soft tissues. Robotic assisted surgery offers the promise of improving the surgeons’ ability to achieve this.”

NHS waiting times for elective and cancer treatment

NHS waiting times for elective and cancer treatment
Public Accounts Committee 12 June 2019

• The PAC report highlights waiting time standards, the DHSC review of waiting times, the impact for patients of longer waits, bottlenecks in hospital capacity, factors which could affect plans to better manage elective care. 

The PAC findings:
1. The NHS is failing to meet key waiting times standards for cancer and elective care, and its performance continues to decline.
Recommendation: NHS England should set out, by December 2019, how, and by when, it will ensure that waiting times standards for elective and cancer care will be delivered again.

2. The Department of Health & Social Care has allowed NHS England to be selective about which standards it focuses on, reducing accountability
Recommendation: The Department of Health & Social Care and NHS England should clarify to the Committee by December 2019:
• how NHS England will be held accountable for achieving waiting times standards now and in the future; and
• what additional support NHS England and NHS Improvement will put in place to help local NHS bodies to meet waiting times standards.

3. We are concerned that NHS England’s review of waiting times will not be enough to ensure a clear understanding of, and strong accountability over, the performance of the NHS.
Recommendation: The Department of Health & Social Care should ensure that any changes to current waiting times standards:
• help to improve patient outcomes and patient experiences;
• do not water down current standards to make them easier to meet; and
• are communicated clearly to the public, so that patients understand what they can expect of the NHS.

4. The national health bodies lack curiosity about the impact for patients of longer waits and how often this leads to patient harm.
Recommendation: The Department of Health & Social Care, together with NHS England and NHS Improvement, should write to us by December 2019 on how they are going to ensure that the data on patient harm due to long waiting times are going to be routinely collected, reported and acted upon.

5. Bottlenecks in hospital capacity are having a detrimental impact on how long patients wait for treatment.
Recommendation: NHS England and NHS Improvement should evaluate and report back to the Committee on how the NHS plans to ensure that it has the required diagnostic and bed capacity to meet patient demand in the medium to long term. They should also set out, in the short term, how they will support local bodies to improve their patient flow through the health system and reduce unwarranted variation

6. The NHS still does not understand sufficiently what is driving demand for referrals for elective treatment.
Recommendation: As we recommended in March 2019, NHS England and NHS Improvement should, by September 2019, write to us to set out how they will help local bodies to better understand the demand for care, and to plan their services accordingly to better meet the needs of their local patients

7. NHS England has not yet identified how it will manage the variety of factors that could affect the success of its plans to better manage elective care.
Recommendation: The Department, NHS Improvement and NHS England should, by December 2019, clarify to us: • How they are going to develop a fit-for-purpose workforce to ensure that the ambition to reduce face-to-face appointment by one-third is going to be achieved. • How they are going to ensure access to care is maintained if the number of outpatient appointments is not reduced as planned.

Summary

Access to Orkambi and other drugs for people with cystic fibrosis

Access to Orkambi and other drugs for people with cystic fibrosis
House of Commons Library 7 June 2019

• A debate pack has been prepared ahead of the debate to be held in Westminster Hall at 4.30pm on 10 June 2019 on access to Orkambi and other drugs for people with cystic fibrosis.

An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13.

An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13.
J R Soc Med. 2019 Jun 6:141076819851701

• Analysis of data around hip arthroplasties in England found that private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% compared to an increase of 186% among patients from the least affluent areas between 2007/2008 and 2012/2013. Private provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. 
• Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England.

Abstract

Frailty Cost: Economic Impact of Frailty in the Elective Surgical Patient.

Frailty Cost: Economic Impact of Frailty in the Elective Surgical Patient.
J Am Coll Surg. 2019 Jun;228(6):861-870

• A validated frailty index derived from a database of elective surgery at a US academic medical centre (n=10,257, years 2016-2017) found that frailty continued to be associated with increased direct cost, indirect cost, total cost, and decreased hospital income.

Abstract

Man vs. machine: Comparison of a machine learning algorithm to clinician intuition for predicting ICU readmission

Man vs. machine: Comparison of a machine learning algorithm to clinician intuition for predicting intensive care unit readmission [Midwest Clinical & Translational Research Meeting Conference Abstract A09]
Journal of Investigative Medicine; Jun 2019; vol. 67 (no. 5); p. 929

• A prospective study of 937 ICU discharges (University of Chicago, IL, USA) found that a machine learning model was more accurate than clinician intuition for predicting ICU readmission, suggesting that a machine learning model using real-time patient data could provide clinicians with additional information to guide decision-making regarding the timing of ICU discharge.

Abstract 

A new era: AI and machine learning in prostate cancer

A new era: artificial intelligence and machine learning in prostate cancer
Nature Reviews Urology 15 May 2019

• Machine learning methods are used to identify genes or groups of genes for which expression specificity to predict outcomes of prostate cancer is high and could be used for screening, developing diagnostic tools, determining optimal individualized treatment and producing targeted drug regimens.

Key points

Robot-assisted surgery in thoracic and visceral indications.

Robot-assisted surgery in thoracic and visceral indications. Collaborative assessment.
EUnetHTA; 6 May 2019. Report No.: OTCA14.

• The diverse range of surgeries included in this review, combined with the lack of reliable evidence for almost all indications, poses difficulties for the analysis and reporting of results. 
• Statements relating to effect can be made for Oesophagectomy, Gastrectomy, Rectal resection and Cholecystectomy.
• Oesophagectomy: robot-assisted surgery probably improves post-operative morbidity/QoL and reduces post-operative complications compared to open surgery (evidence quality: moderate). Intra-operative complications may be reduced with robot-assisted surgery vs. open surgery but here the evidence quality is low.
• Gastrectomy: robot-assisted surgery may reduce postoperative complications vs conventional laparoscopy (evidence quality: low)
• Rectal resection: robot-assisted surgery may improve sexual functioning but worsen sleep disturbances compared with conventional laparoscopy (evidence quality: low); robot-assisted surgery may decrease postoperative complications between 30 days and 6 months, but increase intraoperative complications (evidence quality: low)
• Cholecystectomy: robot-assisted surgery may reduce intraoperative complications and postoperative complications at 30 days compared to laparoscopy (evidence quality: low)