Dementia ‘not being diagnosed’

Fewer than half of people with dementia ever receive a formal diagnosis, according to a new parliamentary report.

Around 800,000 people in the country currently have dementia, with numbers expected to rise to more than a million by 2021.

However, a report published this week by the parliamentary group on dementia has found a “shocking” variation in the number of people with dementia who are diagnosed.

In England, just 41% of people receive a diagnosis, and in parts of Wales diagnostic rates are as low as 32%.



Health visitor implementation plan quarterly progress report: April – June 2012

Department of Health

This report outlines progress made by the health visitor implementation programme and finds that the Department of Health is on track to meet its committment to increase the number of health visitors by an extra 4,200 by April 2015.

It sets out key achievements during April to June 2012 in the areas of: professional mobilisation; growing the workforce; early implementer sites support & development programme year 2; communications and marketing; the delivery partnership group; and the school nursing programme.

Securing the future financial sustainability of the NHS – National Audit Office

Health and social care

Securing the future financial sustainability of the NHS

This report found that, although in 2011-12 there was a surplus of £2.1 billion across the NHS as a whole, there is also some financial distress, particularly in some hospital trusts. It concludes that it is hard to see how continuing to give financial support to organisations in difficulty will be a sustainable way of reconciling growing demand for healthcare with the size of efficiency gains required within the NHS and that without major change for some providers, the financial pressure on them will only get more severe.

via Securing the future financial sustainability of the NHS – National Audit Office.

Nursing and midwives’ regulator ‘letting down’ patients

By Jane Dreaper, Health correspondent, Extract from BBC News

Failings “at every level” of the Nursing and Midwifery Council (NMC) mean it is letting down patients in its prime duty to protect them, says a report.

The UK’s 670,000 nurses and midwives have to register with the troubled regulator to enable them to work.

The independent review gives details of the NMC’s backlog of complaints against nurses and midwives.

via BBC News – Nursing and midwives’ regulator ‘letting down’ patients.

The Year 2011/12 – NHS Chief Executive’s annual report published

The year 2011/12 launched today at the annual NHS Confederation Conference and Exhibition. This is the annual report for 2011/12, in which Sir David Nicholson reviews the NHS achievements of the previous 12 months and considers the challenges to come.

This edition includes the quarter, which provides the definitive account of how the NHS is performing at national level against the requirements and indicators set out in the NHS Operating Framework 2011/12.

In his introduction to the year (PDF, 3.9MB), Sir David acknowledges the hard work and diligence of NHS colleagues, with the service now fully committed to delivering the Quality, Innovation, Productivity and Prevention (QIPP) efficiency savings.

Against a backdrop of massive organisational change, Sir David praises, ‘the heroic efforts made by the 1.2 million staff who work for our patients in the NHS.’ Together, they have delivered key successes, including the lowest infection rates since the introduction of mandatory surveillance, lower waiting times for A&E, cancer care and dentistry, and the delivery of £5.8 billion efficiency savings.

Sir David acknowledges the efforts of GPs to begin driving clinically-led commissioning and the wider NHS engagement with the new public health agenda and the creation of the Health and Wellbeing Boards.

Although the Health and Social Care Bill has now passed through Parliament, Sir David reminds NHS colleagues of the hard work to come ‘to implement the transition from the old system to the new’. While acknowledging this ‘daunting challenge,’ he believes the annual report demonstrates strong foundations are in place to deliver further change for staff and patients.

Watch the video of Sir David Nicholson, Chief Executive of the NHS, discussing the challenges facing the NHS and the huge progress being made across health services.

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Staying safe with medication

Keeping patients safe when they transfer between care providers – getting the medicines right
This report calls for improvements to the transfer of information about medicines when patients move between care settings. It outlines the results of a six-month project involving over 30 healthcare organisations which volunteered to implement RPS guidance on transfer of medicines information.

The Mental Health Act 2007: a review of its implementation

This report examines key issues in the operation of the Mental Health Act five years on. It finds that while there have been some improvements in the treatment of people detained under the Act there remain major concerns about the use of compulsory powers and the availability of advocacy and support for the most vulnerable people. It argues that CCGs and local authorities must ensure that they uphold the rights of people detained under the Mental Health Act as they take up their new responsibilities.


Health Protection Report | Infection Reports | Healthcare Associated Infections

Last updated 15 June 2012 Volume 6, No 24 (PDF file, xxx kB) 

Trends in mandatory Staphylococcus aureus (MRSA and MSSA) and E. coli bacteraemia, andClostridium difficile infection data for England up to January-March 2012

The eleventh publication of the quarterly epidemiological commentary describes recent trends for mandatory surveillance of  (MRSA) and Clostridium difficile infections (CDI) reported by NHS acute Trust hospitals in England up to March 2012 [1,2]. The publication also contains analyses of the first 15 months of meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia data and a summary of the first 10 months of Escherichia coli bacteraemia surveillance (June 2011 to March 2012). This is the second quarterly epidemiological commentary to include mandatory surveillance data on E. coli bacteraemia.

The complete epidemiological commentary with additional information on the rates of MRSA, MSSA and E. coli bacteraemia, and CDI, is available on the HPA website [3].


MRSA bacteraemia

The total count of MRSA bacteraemia during the previous 10 years is shown in figure 1, and is divided into Trust apportioned episodes (this category includes patients presumed to have been infected while admitted to the Trust*) and non-Trust apportioned episodes (‘all other episodes’).

  • in 2011 there were 1,185 MRSA bacteraemia reports made. This is an 83.7% reduction compared to the number of reports in 2002 (7,274) (figure 1);
  • there were 504 Trust apportioned reports in 2011; representing an 83.7% reduction compared to 2006 (6,776 reports);
  • there were 681 non-Trust apportioned reports (all other reports) in 2011 compared to 2,244 in 2006 representing a 69.7% reduction in non-Trust apportioned reports compared to 2006 (figure 1).
  • there were 262 MRSA bacteraemia reports in the quarter January-March 2012 of which 118 and 144 were Trust apportioned and non-Trust apportioned, respectively. This represents an 86.4% decrease in reports relative to the baseline of 1,925 quarterly reports in financial year 2003/04.

Figure 1. Overview of MRSA bacteraemia reports, 2002 to 2011

MSSA bacteraemia

  • there were a total of 10,903 reports between January 2011 and March 2012. 3,569 of these reports were Trust apportioned ¥ and 7,334 were non-Trust apportioned (all other reports). An overview of reports by month is presented in figure 2.
  • there were 2,157 MSSA bacteraemia reports in the quarter January-March 2012 of which 33.3% and 66.7% were Trust apportioned and non-Trust apportioned, respectively.
  • Figure 2. Monthly counts of Trust apportioned and all other reports of MSSA bacteraemia, January 2011 to March 2012

E. coli bacteraemia

  • of all bacteraemia covered by mandatory surveillance, E. coli is currently the most common bacteraemia with monthly reports being about 28-fold and 4-fold higher than those for MRSA and MSSA bacteraemia, respectively.
  • there were a total of 26,619 E. coli bacteraemia reports between June 2011 and March 2012 (table 1). E. coli bacteraemia data is not currently being apportioned.

Clostridium difficile infection

in 2011 there were 19,130 CDI reports made. This is a 53.0% reduction compared to the number of reports in 2008 (40,705 [figure 3]);

  • there were 8,418 Trust apportioned † reports in 2011 representing a 64.0% reduction in Trust apportioned reports compared to 2008 (23,085 reports [figure 3]).
  • in 2011 there were 10,712 non-Trust apportioned (all other reports) CDI reports made, representing a 39.2% reduction from the number reported in 2008 (17,620). In 2010 the ratio of non-Trust apportioned reports to Trust apportioned reports was approximately 1:1 whilst in 2011 the ratio had increased to 1.3.
  • data for the most recent quarter (January-March 2012) showed a total of 3,708 reports, which corresponds to a 73.3% reduction on the baseline year’s quarterly average (13,875 reports for financial year 2007/08). Of the 3,708 reports, 1,610 (43.4%) were Trust apportioned while 2,098 (56.6%) were non-Trust apportioned.

Non-Trust apportioned reports (“all other reports”): These include all reports that are NOT apportioned to an acute Trust. The two categories are mutually exclusive.

The next commentary will be published in September 2012.

via Health Protection Report | Infection Reports | Healthcare Associated Infections.

CQC Review: Learning Disabilities

Care Quality Commission (CQC)

Review of services for people with learning disabilities
The CQC has published a further 10 reports from a targeted programme of 150 unannounced inspections of hospitals and care homes that care for people with learning disabilities. The programme is looking at whether people experience safe and appropriate care, treatment and support and whether they are protected from abuse. A national report into the findings of the programme will be published later this year.

King’s Fund: Palliative care articles

School for Social Care Research, London School of Economics and Political Science

End of life care: methods review
This review provides an overview of the range of research methods that have been commonly used in end of life care research and their relevance for social care. It provides a policy and service context for understanding end of life care research in social care and, using examples from relevant research, considers the advantages and disadvantages of different research methods and tools. The particular ethical challenges and practical issues that may arise are discussed along with some strategies and sources of support to address them.

Helen & Douglas House

A review of palliative care for children and young adults in the Thames Valley
Helen & Douglas House has commissioned and authored a collaborative review of palliative care need and provision in the region for patients up to the age of 40 years. The findings of the review are presented as a consultative report, with provisional recommendations at national, regional and organisational levels. It highlights a number of key findings, including that there is a lack of palliative care studies relating to young adults.

King’s Fund news:

Royal College of Nursing (RCN)

Mandatory nurse staffing levels
Despite older people often having the most complex needs, this report suggests they regularly suffer from a severe shortage of nurses and health care assistants (HCAs), coupled with an inappropriate skill mix of HCAs to nurses. It calls for a ‘patient guarantee’, setting out the number of nurses needed on older people’s wards.

NHS National End of Life Care Programme

Critical success factors that enable individuals to die in their preferred place of death

Highlighting good practice from seven PCTs across the country, this report identifies the critical success factors associated with improving end of life care and enabling a person to die in the place of their choice. The report is intended as a starting point to help those commissioning and planning services to see what has worked well in other areas although it does not suggest that one size fits all.

Transforming end of life care in acute hospitals: the route to success ‘how to’ guide
This guide builds upon the framework set out in ‘The route to success in end of life care – achieving quality in acute hospitals’, published in 2010. It highlighted best practice models developed by acute hospital trusts, providing a framework to enable hospitals to deliver high quality care to people at the end of life. This guide aims to help clinicians, managers and directors implement ‘The route to success’ more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement’s Productive Ward: Releasing time to care series.

News from The King’s Fund: Cardiac rehab needed

Heart UK

After the event: getting care right for patients after a heart attack

This report calls on all NHS trusts to offer cardiac rehabilitation services to heart attack patients after finding that 2,100 patients across England are not being offered rehabilitation despite the clear benefits of the service in improving patient experience and outcomes from the disease.

King’s Fund: Cancer framework

Department of Health

An intelligence framework for cancer
This document sets out plans to tackle deficiencies of collection and analysis in cancer intelligence.

Improving outcomes: a strategy for cancer – first annual report 2011
This report aims to help the reformed NHS deliver cancer outcomes that are amongst the best in the world and provides information on progress in 2011.

News from the Kings Fund: Fraud costs/Leadership/Industrial action


The financial cost of healthcare fraud: what data from around the world shows
This report investigates the true financial cost of fraud to the NHS. It estimates that the NHS loses £3 billion per year in fraud and in light of financial pressures, minimising fraud has the potential to aid with efficiency savings.

also …


What makes a top hospital? Leadership
This is the third in a series of publications centred around quality in hospital services. This report looks at the features of leadership that are found in top performing acute organisations.

also ..

NHS Employers

Guidance on emergency cover during industrial action 
Unison and Unite have both produced guidance on emergency cover and exemptions from industrial action. It encourages their branches to engage with employers when they seek to discuss levels of cover.

The Kings Fund: Case management

The King’s Fund

Case management: what it is and how it can best be implemented
This report examines how case management can improve delivery of integrated care for people with long-term conditions. It outlines the principles of case management; what the core components are; what the benefits are; and the factors needed for successful implementation of case management.

News from NHS Networks: 3 November

Progress report from the Department of Health on the four year plan to improve training for health visitors.
Care Quality Commission will be inspecting a further 50 NHS hospitals and 500 adult social care services as part of its work on dignity and nutrition.
This report focuses on three Health Professions Council regulated professions – chiropodists / podiatrists, occupational therapists, and paramedics – and explores their understanding of what professionalism means and how it develops.   Read more »

News from NHS Networks: 3 November

Care Quality Commission will be inspecting a further 50 NHS hospitals and 500 adult social care services as part of its work on dignity and nutrition.
The cold weather plan for England, which aims to protect people’s health throughout the cold winter months, was launched today – the official start of winter.
Carers UK has published a briefing outlining a joint call with over 50 other members of the Care & Support Alliance for action to reform social care
Four new case studies outline how some NHS trusts have trialled a variety of solutions to reduce spend on agency staff.
The Department of Health’s National Institute for Health Research in partnership with Health and Medicines and Healthcare products Regulatory Agency has announced the creation of a new Clinical Practice Research Datalink service, which will be fully established by 1 April 2012
This report highlights the process of care of children less than 18 years of age, including neonates who died within 30 days of emergency or elective surgery on the same admission. A copy of the Executive Report is available in The Staff Library.
This quarterly report presents provisional results from the monitoring of the NHS stop smoking services in England during the period 1 April 2011 to 30 June 2011.
A major push forward in the implementation of a screening programme for abdominal aortic aneurysms (AAA), which will save the lives of thousands of older men, has been launched by health secretary Andrew Lansley.
A survey by the Medical Technology Group to explore the provision of and access to uterine fibroid embolisation (UFE) treatment for fibroids, found significant variation between PCTs and acute trusts in the numbers of women undergoing UFE, and a lack of patient involvment in commissioning fibroid treatments.
Many news sources have reported that a “major review” of the NHS breast screening programme is to take place. BBC News said “the evidence for breast cancer screening in the UK is being reviewed amid controversy about the measure’s effectiveness”.
GPs will be able to prescribe ticagrelor (Brilique), in combination with low-dose aspirin for up to 12 months, for patients with acute coronary syndromes (ACS), following final guidance from NICE.

News from The King’s Fund: 26 October

Action on Elder Abuse

Regulatory activity in hospital settings: a critical analysis of the Care Quality Commission’s Dignity and Nutrition Inspection of 100 English hospitals
These inspections were held between March and June 2011. This report identifies a number of key themes which regularly emerged from poorer performing wards. It also identifies problems with the inspections process and makes several recommendations as to how the process could be improved in the future.

NHS Kidney Care

Improving the standard of care of children with kidney disease through paediatric nephrology networks
This report focuses on the ‘patient experience’ in light of the health reforms taking place across England. It examines access to services, patient and carer involvement, quality indicators, audit and workforce planning. In particular, it draws out how paediatric nephrology networks will be setting out the core requirements for success and standards for commissioning and provision of services. It was created in collaboration with The Royal College of Paediatrics and Child Health and the British Association for Paediatric Nephrology.