November 21, 2014

The NHS must improve evaluation if it is to lead the country on healthy staff

The NHS needs to better evaluate its internal health and wellbeing programmes if it is to secure itself as a national leader on healthy staff.

‘Evaluating Health & Wellbeing Interventions For Healthcare Staff: Key Findings’, published today (21 November), has warned that financial pressure on the NHS will make it increasingly difficult for NHS boards to justify its own staff health and wellbeing programmes – unless more evidence and rigor is developed to assess their value.

NHS Employers, which published the report, said this would be a significant loss because effective programmes need to expand and are known to benefit staff, the health service and patients.

It comes after the announcement in October 2014 by Simon Stevens, chief executive of NHS England, in which he outlined his vision of an NHS that encourages the public to become healthier by strongly supporting its own staff to do likewise.

The report provides evidence and describes ten key principles to help enhance evaluation of these programmes:

  • Ensure the purpose of the evaluation is determined
  • Establish your evaluation criteria
  • Plan, prepare and where possible document the evaluation design
  • Look for change
  • Consider the long-term impacts of an intervention
  • Consider the bigger picture
  • Senior management engagement
  • Build a capacity and capability for evaluation
  • Ensure there is focus on process as well as on the outcome
  • Effective communication and understanding of evaluation findings

It also recommends that NHS organisations increasingly share and develop a detailed evidence base – helping to explore what works and what doesn’t.

The report is the result of a year of research in partnership with Zeal Solutions Ltd, including substantial cooperation from the Sheffield Teaching Hospitals NHS Foundation Trust to support and analyse improvements in its PhysioPlus staff physiotherapy service.

Danny Mortimer, chief executive of the NHS Employers organisation, said:

“The NHS has over many years expanded its staff wellbeing policies and programmes, supporting the well-being of our people, to help them to deliver high quality patient care. However we are concerned that financial pressure on NHS organisations will reduce the funding for such projects unless managers can better demonstrate their value.

“Developing more systematic, evidence-based approaches will drive improvement in these projects. This research can be used to demonstrate the impact of quality health and wellbeing programmes to Boards throughout the NHS. I also have no doubt that NHS organisations can provide a great example to others about how staff can become healthier and more engaged in their roles.”

Sir Andrew Cash, chief executive of Sheffield Teaching Hospitals NHS Foundation Trust, said:

“It is a challenging time for the health system as a whole. So it’s absolutely right that these important staff wellbeing programmes need to grow, to ensure staff and the service have the resilience to deliver care when patients need it most.

“I’m very pleased that Sheffield Teaching Hospital’s self-referral PhysioPlus service is a big part of this report. Working closely with NHS Employers and Zeal helped PhysioPlus to use good practice. We found that open relationships and robust evaluation are key, especially when evaluation is targeted, and also that a good system helps get more people interested in the benefits.”

Professor Karen Middleton, chief executive of The Chartered Society of Physiotherapy, said:

“Given the cost of sickness absence in the NHS, the squeeze on budgets and the need to deliver high quality care to patients, it is vital that the NHS invests in the health of its own staff.

“Sickness absence amongst NHS workers can mean missed appointments and longer waits for treatment for patients.

“The Boorman review in 2009 found that provision of health and wellbeing schemes could save the NHS £555m nationally and today’s report shows that fast access to physiotherapy can greatly reduce absence rates and increase productivity amongst staff.

“The research highlights a strong commitment to reducing sickness absence in the NHS and presents a compelling case for this being adopted throughout the NHS.”

Then report is available here (publicly from 21 November and under embargo from 20 November):

Sick leave in the NHS has gradually improved and at least 300,000 more staff are covered by comprehensive health and wellbeing policies compared to three years ago. Dozens of strong and engaging health and wellbeing programmes within the NHS examples are available here:

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November 19, 2014


Responding to cancer waiting times statistics for July to September 2014 released today by NHS England1, Lynda Thomas, Chief Executive at Macmillan Cancer Support, says:

“This is the third quarter in a row where the cancer waiting time target for patients to begin treatment following an urgent referral has been breached in England.  As the situation worsens and more trusts miss their targets we can no longer ignore what has become a fundamental problem within the NHS.

“Delays in diagnosis and waiting for treatment can leave a dark cloud hanging over people with cancer and their families. As they face the unknown, thousands of cancer patients will be left scared, anxious and distressed.

“No one should be forced to suffer like this. Yet today’s statistics show the current system isn’t working and people with cancer are being badly let down. With UK cancer survival rates far behind the rest of Europe we must urgently look to fix this.

“Ahead of the next general election Macmillan Cancer Support is calling on all the political parties to commit in their manifestos to improving cancer survival rates and making cancer a top priority.”

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November 13, 2014

Sight loss support for blind and vision impaired ex-Service men and women

Learning to live with sight loss can be extremely difficult, making the support available from organisations such as Blind Veterans UK absolutely vital.

Blind Veterans UK, the national organisation for vision impaired ex-Service men and women, believes that no one who has served our country should battle blindness alone and offers free, lifelong services and support to help veterans discover a life after sight loss.

It doesn’t matter how long ago they served, or even how a veteran lost their sight – it could be due to old age, illness or an incident while in Service – if they are now battling severe sight loss, Blind Veterans UK can help.

The charity provides rehabilitation and training, along with emotional support and a wide range of equipment and social activities. This is delivered through its UK-wide network of welfare officers and community services and three service centres in Brighton, Sheffield and Llandudno, North Wales.

Independent research estimates that there are 68,000 plus blind veterans who are eligible for the charity’s services but are not currently aware of the opportunities and support available.

Blind Veteran UK’s No One Alone campaign is calling for more to be done by NHS healthcare professionals to improve referral pathways to the charity so that veterans are signposted to support as a matter of course once they are diagnosed with severe sight loss.



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November 11, 2014

New drug could make vaccines more effective in the elderly

Scientists have developed a new method of boosting the ageing immune system using a naturally occurring chemical compound. Early tests in mice, published today in the journal eLife, show that the compound restores the immune system’s inbuilt ‘memory’ enabling it to mount a more powerful protective response following vaccination.


The compound, called spermidine, is now being developed by the researchers as a potential drug to make vaccines more effective in the elderly, which in future could help protect this vulnerable population from seasonal flu and other infections.

Professor Katja Simon, senior author of the study, from the Medical Research Council (MRC) Human Immunology Unit at Oxford University, said:


“Viral infections like flu are unpleasant for most people, but can be very serious for the over-65s and vaccines, like the free annual flu jab, are the best form of protection. Our aim is to make that protection even better, by adding immune boosting compounds to routine vaccinations.”

The elderly population, in particular people over 65, don’t always get adequate protection from the flu jab.This is because as we age, our immune system becomes less effective at responding to new infections, and even to ones we’ve had in the past.


The reasons for this decline in immunity are complex, but a key factor is that the white blood cells that coordinate the response to an infection – called T cells – lose the ability to form a ‘memory’ of the infection. Therefore when elderly people encounter a virus, even if it’s one they’ve had before or have been vaccinated against, they are unable to mount a strong immune response and can develop a serious, even fatal, infection.


Researchers have now identified a key cellular process that is essential for the formation of immune memory and show that this process becomes defective in immune cells with age, helping to explain why immunity diminishes over time. By targeting this process with spermidine, the scientists managed to improve the ageing immune system’s ability to respond to the flu vaccine.  


First author of the study Daniel Puleston, a PhD student from the MRC Human Immunology Unit at Oxford University, said:


“We already know that the over 65s have a problem forming an immune memory and as a consequence infection causes proportionally more deaths in this age group. We’ve now identified a key process involved in this memory formation, and by enhancing this process in aged mice we’ve been able to boost their immune response to vaccination.


“The effect was so powerful that the treated mice mounted an even stronger T cell response to the vaccine than young mice. It’s the equivalent of a 90 year old responding to a vaccine better than a 20 year old, which makes this a very exciting pathway to target as a potential way of boosting vaccine protection in the elderly.”


Spermidine works by enhancing a normal cellular process called autophagy, where parts of the cell that have become defective or damaged are broken down and destroyed within cell.


The researchers found that mice lacking a gene important for autophagy couldn’t make memory T cells when given the flu vaccine. They also saw that levels of autophagy were lowered in T cells from aged mice, suggesting that autophagy is a vital part of forming the immune memory into old age.


When aged mice were given spermidine prior to flu vaccination, their T cell response was enhanced dramatically. The researchers have patented spermidine and will now see if they can use the compound, or other autophagy-enhancing drugs, to improve responses to already licensed vaccines in mice before hopefully moving on to early safety trials in humans.


Professor Katja Simon added:


“We think that spermidine could be particularly useful alongside many of the vaccines currently in development that protect against other viruses. However, we expect it to be at least 5 to 10 years before a drug reaches the clinic.”


Professor Paul Moss, Chair of the MRC’s Infections and Immunity Board, which co-funded the research, said:


“As people continue to live longer, there is an urgent need to develop new ways of protecting this group from potentially life-threatening infections. This work is a brilliant example of how cutting-edge immunology can be applied to this challenge and take us a step closer to our goal of making a vaccine that works just as well in the elderly as it does in the young.”


The research was funded by the MRC and the Wellcome Trust.

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November 11, 2014

Planning for the Better Care Fund

The National Audit Office recognizes that a government programme to integrate local health and social care services to improve care in the community and lessen pressures on health services is an innovative idea. However, according to today’s report, the quality of early preparation and planning did not match the scale of ambition.

The Better Care Fund aims to deliver better, more joined-up local services to older and disabled people to care for them in the community, keep them out of hospital and avoid long hospital stays. However, early local plans for the Fund, which will pool £5.3 billion of existing NHS and local authority funding in 2015-16, did not meet Ministers’ expectations or generate the level of savings the Government expected and all plans had to be resubmitted. Although the Government’s early planning assumption was that the Fund would save the NHS £1 billion in 2015-16, current plans forecast at least £314 million of savings for the NHS.
The Better Care Fund will run from April 2015. The Department of Health and the Department for Communities and Local Government developed the Fund’s policy, with NHS England and the Local Government Association responsible for the delivery and implementation of the Fund. It was agreed that local areas would develop plans for spending the Fund with minimal central prescription, in order to drive local innovation from the bottom up, and reflecting the fact that no savings target had been formally agreed for the Fund during Spending Round 2013. As a result, there was no central programme team, no programme director and limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support. In addition, the initial scheme guidance did not mention the scale of savings expected from the Fund.
All 151 local health and wellbeing boards submitted plans in April 2014 for how they would spend their Fund allocations in 2015-16. But NHS England concluded in May that the Fund plans would deliver only £55 million of financial savings, not the £1 billion the Department of Health and NHS England expected. The Departments concluded that the plans required further development and Ministers did not approve any plans in April, as originally intended. Planning for the Fund paused between April and July 2014 while the Government reviewed and revised the Fund’s scope and how the £1 billion pay-for-performance part of the Fund would work.
In July 2014, the Departments revised and improved the Fund’s governance and programme management, requiring local areas to submit new plans in September 2014 for expected approval in late October. However these changes to the Fund reduced from 11 months to five months the time available for local areas to prepare for the implementation of the Fund from April 2015. The Local Government Association does not agree with the changes in the Fund’s scope. It has said that the revisions undermine the Fund’s core purpose as promoting locally led integrated care and reduce the resources available to protect social care and prevention initiatives.
Under the Fund’s revised conditions, local areas were asked to aim for at least a 3.5% reduction in their total emergency admissions over 2014 levels. Expecting such reductions within one year is ambitious against a trend of rising emergency admissions and feedback from local areas suggesting that some areas will struggle to meet this target. Local areas have proposed reductions of 3.1%.
Independent assurance of the September Fund plans found them to be stronger and better supported than the April plans. Almost two-thirds of plans were either approved by Ministers or approved with support and only 5 plans were not approved. The biggest risk area identified is to the protection of social care services with 21 local areas assessed as having significant risks.
Amyas Morse, head of the National Audit Office, said today:
“The Better Care Fund is an innovative idea but the quality of early preparation and planning did not match the scale of the ambition.
“The £1 billion financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government’s confidence in the Fund’s value. Ministers were right to pause and redesign the scheme in April this year when they realized it would not meet their expectations. 
“The Fund still contains bold assumptions about the financial savings expected in 2015-16 from reductions in emergency admissions. To offer value for money, the Departments need to ensure more effective support to local areas, better joint working between health bodies and local government, and improved evidence on effectiveness.”
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