Virtual recruitment at South Central Ambulance Service NHS Foundation Trust

Link to report here

Inclusive culture case study – North East London NHS Foundation Trust

Find out how North East London NHS Foundation Trust improved it’s culture by putting people first, engaging with staff and ensuring its recruitment process was inclusive.

Link to report here

Practical changes in cancer care could reduce fear and confusion among people with dementia – NIHR

People with dementia face unique challenges when they need cancer treatment. In a new study, researchers explored the difficulties faced by people with dementia, their carers and healthcare professionals.  They interviewed and spent time with these groups and came up with practical measures which could help.

Dementia causes problems with memory, communication and decision-making. Many people with dementia found hospital visits confusing and frightening; they had difficulty retaining information and in understanding what was happening. Staff working in cancer services (oncology) said they lacked training on dementia, and that dementia was often not flagged in medical records. People with dementia who had supportive family carers were more likely to receive appropriate cancer care and treatment. But it placed a burden on carers.

The researchers suggest several strategies which could make cancer care more accessible and individualised for people with dementia. Involving carers more would help, along with longer appointments and simpler written explanations, with pictures, for people to take home. Staff working in cancer services could benefit from training on dementia. And it needs to be easier for people to travel to hospitals, and to find their way around them.

Link to full article here

Evidence-based Interventions Across Boundaries: System Working

We have undertaken engagement to discover how Integrated Care Systems (ICSs) have collaborated across organisational boundaries to i

Aims and objectives

We have engaged with a wide range of exemplar ICSs to collate different approaches to system working in the implementation of EBI guidance. These experiences were compiled and summarised to help other systems efficiently implement best practice in the domains covered.  As such, the results are expressed in an advisory format, with an emphasis on practical advice, operational benefits to smooth the route to implementation.

The specific aims and objectives are:

1. To enable collaboration at scale within ICSs, centred around delivering the core features of EBI implementation.
2. To enhance the quality of decision making and the level of insight available to decision makers, by enabling a wider range of participants at key points. 
3. To promote efficiency and simplicity in EBI-related decision making, by enabling ICSs to consider where decisions are best made, how many times they are made, and who needs to be involved. 
4. To promote public and patient confidence in EBI-related decision making, through strategic involvement in and oversight of key decisions.
5. To optimise accountability for implementation, aligning power and influence with operational action to provide wide-ranging and senior backing – allowing key implementation agents at every level to act with confidence and system-wide authority.

The information included has both direct and indirect effects which support the uptake and implementation of NICE guidance:

1. The EBI guidance is substantially informed by NICE guidance, meaning that these proposals will support the translation of the recommendations made in NICE guidance into clinical practice. 
2. NICE guidance is pathway-oriented and spans different organisations.  By helping systems to develop and piece together the core building blocks of cross-system working, this guidance not only enables delivery of EBI guidance, but also allows for easier implementation of NICE guidance.

Key findings

The examples featured were self-reported by the systems involved on the basis of them leading to beneficial changes. The results and benefits of these actions can be summarised as follows:

Governance

• Building stronger relationships (e.g. through information sharing processes) with a wider range of system partners has enabled many of the benefits described above. For example, Sussex Health and Care Partnership have created a county-wide oversight committee covering EBI implementation. This includes local authorities (LAs). Issues are only escalated to this committee when they meet a set of escalation criteria, which ensures key decision makers from all organisations are used only at the most beneficial points.  
• Increased representation of alternative system actors has led to an infusion of expertise into their policy development and oversight processes, allowing for a greater understanding of technical issues (i.e. public health involvement) and adverse implementation impacts (i.e. Healthwatch identifying differential impact on specific patient populations).
• More extensive stakeholder engagement translates to higher public and patient confidence in the programme, which avoids challenge, and supports more frontline collaboration on specific implementation issues.
• Governance processes which situate EBI-related programmes at the STP/ICS-level may also unlock opportunities for inter-programme working. For example, linking EBI to mutually supportive transformation programmes irrespective of which individual organisation these are located in. 
• System-wide governance processes also increase decision-making speed and reduce duplication.

Compliance and performance monitoring

• Consistent, cross-system implementation models reduce the ICS administrative cost (doing things once rather than several times). It also reduces the administrative burden on providers who, in some systems, were needing to engage with multiple differing processes of administration.

Clinical Engagement and Policy Development

Clinical engagement approaches can also benefit from being harmonised at system level:

• As clinical priorities are often agreed at system level, a single approach to engagement aligns with clinical authority, sets a high evidence standard to support engagement and permits a wider benchmarking range.

Programme Management

• System-wide programme teams allow the STP/ICS to continually translate activities of senior management and clinical leadership to the frontline.

Our engagement shows that all systems have room for improvement in at least some of the above areas.

Link to full article here

Learning disability mortality review (LeDeR): Action from learning report 2020/21

This action from learning report highlights
some of the many activities and measures
health and social care services have put
in place since our last report in July 2020,
both locally and nationally. It also updates
the commitments that we made in both
that report and the COVID-19 action from
learning report, published in November
2020.

Link to report here

Collaborating for better care – NHS Providers report

In this report we set out 14 examples of a wide range of collaborations
taking place across the country to show the complexity of arrangements.

Link to full report here

Closed Incision Negative Pressure Wound Therapy (ciNPWT) reduces Surgical Site Infection following Emergency Laparotomy – NICE Case study

Organisation: The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Published date: June 2021

Surgical site infection (SSI) contributes to a significant proportion of post-operative morbidity in patients undergoing emergency laparotomy (EL). SSIs cause significant patient burden, increased length of stay and have economic implications.

We undertook a registry-based, prospective cohort study, using data from National Emergency Laparotomy Audit (NELA) database between January 2014 and December 2019. This study aims to compare rates of SSI between patients receiving ciNPT and standard surgical dressing following emergency laparotomy through a propensity matched analysis.

Prophylactic ciNPWT was applied to the midline laparotomy incision under sterile conditions. Negative pressure consisted of continuous -125 mmHg for 7 days. The control group consisted of patients undergoing a standard surgical dressing. In this patient population, prophylactic ciNPWT in emergency laparotomy patients was associated with a reduction in SSI rates.

Link to full case study here