Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study.

Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study.
Health Serv Deliv Res March 2021;9(4)

• Generalist models of care appeared a more natural fit for smaller organisations, but there was no evidence that any of the models identified produced better outcomes for patients.

Mortality due to cancer treatment delay: systematic review and meta-analysis

Mortality due to cancer treatment delay: systematic review and meta-analysis
BMJ 2020; 371 :m4087 16 October 2020

• Analysis of 34 studies of the association of cancer treatment delay and mortality concludes that "even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers." 

Abstract

How to provide specialist services: how do we know when centralisation is a good idea?

How to provide specialist services: how do we know when centralisation is a good idea?
Postgraduate Medical Journal 02 October 2020. doi: 10.1136/postgradmedj-2020-138151

• A discussion of the pros and cons of centralisation by Stuart Michael Crawford, Clinical Lead for Research,  Airedale NHS Foundation Trust.

Senate Council Adopt, Adapt, Abandon: What have we learned about how health care can be delivered during the last twelve weeks?

Senate Council Adopt, Adapt, Abandon: What have we learned about how health care can be delivered during the last twelve weeks? East of England Clinical Senate Council July 2020

• This short paper summarises the discussion of East of England Clinical Senate Council on 24 June 2020 and presents its key findings and recommendations Members brought their own experiences and perspectives to the discussion with a view to summarising whether the changes made in the course of responding to the COVID-19 incident, could be adopted, adapted or abandoned as the health and care services look to restore services for patients.

The management of emergency spinal surgery duringthe COVID-19 pandemic in Italy. A preliminary report

The management of emergency spinal surgery during the COVID-19 pandemic in Italy. A preliminary report
Bone Joint J 2020;102-B(6):1–6. 23 Apr 2020 https://doi.org/10.1302/0301-620X.102B6.BJJ-2020-0537

• “The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation.”

Cancer services profiles: 2019 annual update

Cancer services profiles: 2019 annual update
PHE 3 December 2019

• Annual update of data in the cancer services profiles for the financial year 2018 to 2019.
• These profiles present data at GP, CCG and national level on:
• cancer incidence and screening
• Two Week Wait (TWW) referrals
• diagnostic services
• emergency presentations and admissions

Multi site single service: improving outcomes, reconfiguring services - systematic review

Multi site single service: improving outcomes, reconfiguring services - systematic review
PHE 4 November 2019

• ‘Multiple site single service’ (MSSS) models of care describe a method of delivering care across more than one clinical site or location, often across a regional geography, through a single clinical service or team. This systematic review examines the published evidence around MSSS models.
• It also sets out a universal framework to categorise different MSSS models which may be employed in the reorganisation of secondary care services, and a suggested set of outcome measures to guide planning, implementation and evaluation of future clinical service reconfigurations to better understand the population impact of service change.

Provision of Interventional Radiology Services, 2 ed

Provision of Interventional Radiology Services, 2 ed
Royal College of Radiologists September 2019

• This document demonstrates the range of services offered by interventional radiologists and sets out the core requirements for the provision of an IR service both in district general hospitals and tertiary or teaching hospitals, advising on how services may be set up collaboratively within regions to offer the highest quality of care to patients.

Impact of cancer service centralisation on the treatment of men with prostate cancer:

Impact of cancer service centralisation on the radical treatment of men with high‐risk and locally advanced prostate cancer: A national cross‐sectional analysis in England
Int J Cancer. 2019 Jul 1; 145(1): 40–48. 17 January 2019. doi: 10.1002/ijc.32068

Analysis of data from the National Prostate Cancer Audit database indicates that centralisation of specialist cancer services does not affect whether men receive radical treatment, but it does affect treatment modality.

Abstract

Mental health Spec Comm budget to be devolved to "provider collaboratives"

Providers offered control of NHSE budgets worth billions
HSJ 3 May 2019

• "HSJ can reveal." NHS England has invited providers to take on specialised commissioning powers across the country, in a major expansion of its mental health new care models programme. The organisation has set a new target for setting up “provider collaboratives” - which are expected to take on the responsibilities and budgets - across the whole of England by 2022, and in 75 per cent of areas by 2020.
• Services included are: children and adolescent mental health inpatient services, adult secure mental health services, and adult eating disorder services.

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:

Service specification Radiotherapy Operational Delivery Networks

Service specifications for radiotherapy services across England.
NHS England January 2019

• Service specifications include a new specification to establish 11 Radiotherapy Operational Delivery Networks across England which will be responsible for driving improvements in treatment and care through the adoption of best practice standards, improving access for patients to the most advanced and innovative techniques and reducing the variation in quality of services.

Therapy-led spasticity interface service - case study

Case study: Therapy-led spasticity interface service
NHS Improvement 10 December 2018

• A therapy-led spasticity interface service (SIS) run by Northern Devon Healthcare NHS Trust provides a one-stop shop approach to spasticity management, including assessment, pharmacological review, botulinum toxin therapy, rehabilitation, postural management, splinting and orthotics, and support for self-management.

National Vascular Registry: Annual Report 2018

National Vascular Registry: Annual Report 2018
HQIP  28 November 2018

• Comparative information on five major interventions for vascular disease plus the findings of an organisational audit which evaluated the current arrangement of hospital vascular services, which are in the process of being re-organised into vascular networks in England.
• Interventions are:
• Carotid endarterectomy
• Repair of aortic aneurysms, including elective infra-renal, ruptured infra-renal, and more complex aneurysms
• Lower limb bypass
• Lower limb angioplasty/stenting
• Major lower limb amputation

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report
Getting It Right First Time, 28 November 2018

• The GIRFT review into oral and maxillofacial surgery across England outlines the need to centralise services and build on existing hub and spoke networks for the specialty, especially in the treatment of patients with head and neck cancer and those needing corrective jaw surgery. This configuration will enable central hubs to focus on in-patient work, while outlying spoke hospitals take care of day cases and out-patients, which form a high proportion of oral and maxillofacial work.
• The report also urges providers to consider allocating dedicated oral and maxillofacial theatre time for emergency cases, which in turn will help prevent out-of-hours operations and the cancellation of planned procedures, and reduce pre and post-operative length of hospital stay.
• It further calls for a standard protocol to be introduced across the country to reduce unwarranted variations in the number of hospital follow-up appointments after surgery. In the most straight-forward of cases, eg; dental extractions, the report suggests a target of zero follow-up appointments.

Recommendations fall within four key themes:

An assessment of the national approach to improving cancer services in England 1995–2015

Unfinished business: An assessment of the national approach to improving cancer services in England 1995–2015
Health Foundation November 2018

• This report offers an account of what has changed since 1995 in cancer services in England and explores what factors might have contributed to success and failure in how cancer services developed
• It finds that while progress has been made on reducing mortality, and improving the chances of survival and the experience of care, for people in England diagnosed with cancer,  the gap in survival rates has not been closed. 
• The report sets out recommendations to help bring about radical improvements in early diagnosis and detection of cancer, such as increasing investment in diagnostic equipment, building public understanding of cancer symptoms, improving resourcing of primary care, greater support for GPs to refer more patients and supporting collaboration across primary and secondary care.

Key issues of neonatal service configuration in England: the NeoNet multimethods study

A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study
Health Serv Deliv Res 2018;6(35), October 2018

• Geographic analysis and computer models were used to investigate a range of alternative scenarios for neonatal care, looking at the impact of greater and lower levels of centralisation. The models suggest that having fewer units, especially for intensive care, could potentially improve infant survival rates. Costs and resource implications (e.g. the number of nurses required), as well as the impact on parental travel time, were also investigated using these models.

Open access programme for patients following breast cancer treatment

Breast cancer survivors control their follow-up care in Maidstone
NHS England Case study [no date]

• Open Access Programme at Maidstone hospital puts patients in control of their breast cancer recovery. The programme, supported by the Kent and Medway Cancer Alliance, is based on a similar model at the Royal Marsden Hospital. Patients have access to telephone support, advice and appropriate clinical follow-up, in addition to regular mammograms, for a period of five years following treatment for breast cancer.
• See also patient leaflet on Open Access Follow up service at Imperial College 
• See all NHS England Cancer case studies.

‘Top Tips’ for Reconfiguring Vascular Services

‘Top Tips’ for Reconfiguring Vascular Services
Vascular Society of Great Britain and Ireland July 2018

• These ‘top tips’ are aimed at anyone, and everyone, involved in the reconfiguration of local vascular services to produce a united network of partner hospitals.