More New Guidance from NICE and the Importance of Healthcare Quality.

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Last month it was NG 97: Dementia, this month an equally important one NICE Guideline 100: Rheumatoid arthritis in adults: management

As with Dementia, the flowchart has also been updated making it easy to follow.

At the same time, they have also updated the Rheumatoid Arthritis Quality Standard (now Q33) which has 7 recommendations that it would be worth becoming aware of. Rheumatoid Arthritis affects over 400,000 people in the UK making it one of the most prevalent long-term conditions health professionals see. If you need to know more about rheumatoid arthritis its worth looking at the NHS Direct entry which you can see by Clicking Here

In the wake of the celebrations to mark #NHS70 and in the light of recent negative publicity about the health of the NHS, it’s probably a good time to mention this.  A new report from the Organisation for Economic Co-operation and Development (OECD), the World Health Organization (WHO) and the World Bank has claimed low-quality healthcare services are holding back progress on improving health in countries at all income levels. (i.e. the NHS is not alone in the problems its facing).

te report highlights that 1 in 10 patients is adversely affected during treatment in high-income countries. Adherence to clinical practice guidelines in eight low- and middle-income countries was below 50 per cent in several instances. Also, 10% of hospitalised patients in low- and middle-income can expect to acquire an infection during their stay, as compared to 7% in high-income countries. The report outlines the steps health services, health workers, governments, citizens and patients needed to take to improve healthcare quality. It would be a shame to let this important report slip under the radar because of #TrumpVisitUK and the Brexit mess. See:

OECD/WHO/World Bank Group (2018). Delivering Quality Health Services: A Global Imperative. World Health Organization. Geneva, Switzerland.

DOI:10.1787/9789264300309-en.

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All Healthcare Professionals Should Learn from the Gosport Inquiry Says British Geriatrics Society

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I chose not to Blog about this last week. However, that’s not an indication that I don’t think its important. Quite the reverse really, however, the events are so tragic its hard to know what to say other than I hope justice prevails.

For more about the story see: https://www.independent.co.uk/news/health/gosport-war-memorial-hospital-deaths-scandal-jane-barton-shipman-a8406456.html

below is the response of the British Geriatrics Society.

The British Geriatrics Society is calling all healthcare professionals to review the Gosport Independent Panel Report, and to learn from these shocking events which led to the deaths of over 450 patients who were given opiate painkillers “without medical justification” from 1989 to 2000 at Gosport War Memorial Hospital in Hampshire. The Inquiry found there was […]

via The British Geriatrics Society calls for all healthcare professionals to learn from the Gosport Inquiry to help prevent future tragedies — British Geriatrics Society

More sad stories to follow I suspect and I have no doubt I’ll be blogging some more about this in future!

Where Did That Green Paper Go? Plus NICE Dementia Guidance is Newly Updated

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An important announcement from the National Institute for Health and Care Excellence (NICE) this week regarding Dementia Care. NICE have revised updated the previous Dementia Guideline, (CG42) which had been in existence since 2006 (although parts of it were revised and updated during this period) and have replaced it with a new NICE Guideline called NG97: Dementia: assessment, management and support for people living with dementia and their carers

On their site NICE point out that the new guideline addresses how dementia should be assessed and diagnosed. It covers person-centred care and support, tailored to the specific needs of each person living with dementia. As part of this, it can help professionals involve people living with dementia and their carers in decision-making so they can get the care and support they need. It also addresses care coordination and staff training, and how dementia may impact on the care offered for other conditions.

They also mention what it does not do, which is also quite important that you are aware of. It does not cover every aspect of dementia care or support, or areas where recommendations would be the same for people with or without dementia. It focuses on areas where:

  • there is variation in practice, and enough evidence is available to identify what works best
  • people living with dementia need different care and support to people in the same situation who do not have dementia.

When I discuss using the NICE guidelines with my students I tend not to talk about the paper/online full written version but point them to the NICE Pathway. This has also been updated and is available here

Its been quite a disappointing week for Social Care in England as the UK government postponed the publication of the Adult Social Care Green Paper following the announcement of increased funding for the NHS. (Let’s not hold our breaths for too long to see if that’s true). The Green Paper was announced in November 2017 and is considered key to reforming social care in England which everyone knows is in dire straits. It was due for release before the end of the summer but now who knows?

There was some indication about what it ought to contain here and more about the delay here

Not Enough Publicity. This is All About Improving Older People’s Care!

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Two important documents that have been published this week. One from NHS Improvement and another from Public Health England.

Despite their importance though you’d be hard-pressed to know they were available.

So there is now a guide to reducing long hospital stays and further guidance on falls and falls prevention and you probably haven’t even noticed.

So first of all reducing long hospital stays. In NHS England, nearly 350,000 patients currently spend over three weeks in acute hospitals each year. Many are older people with a reduced functional ability (frailty) or who have a cognitive impairment. The benefits to the UK NHS and other healthcare systems of reducing hospital bed occupancy are clear. However, as everyone knows trying to achieve this is very difficult, particularly during the winter pressure for beds. So what can be done?

This week NHS Improvement released their “Guide to Reducing Long Hospital Stays”. Click the link and you’ll get to the page you can download it from.

Their guide is primarily aimed at acute and community trusts, but also makes reference to how system partners can play a supporting role.

Also this week (yesterday June 14th.) Public Health England’s Guide on Falls was updated.  Called Falls: applying All Our Health the guide includes core principles for healthcare professionals to follow and a large number of resources and examples of good practice from some key national agencies. Click on the link and go and explore, and see if you can adopt some of the measures suggested or check if you are doing these already.

So if these are such an important phenomenon to tackle why did these document releases not get more publicity?

Can Scotland Help? @WeNurses #70nursebloggers

It came to my attention this week that Professor Jane Cummings,  The Chief Nursing Officer for England has called on nursing, midwifery and care staff to help mark the 70th anniversary of the NHS by encouraging more nurses and midwives to blog in order to showcase the fantastic contribution that the profession has made to healthcare over the years. Rather than looking backwards, I thought I’d say something about what is going in Scotland that might inspire our nursing and health and social care colleagues in England. So here goes!

Realistic Medicine was initially discussed as a way forward for the NHS in Scotland by the Cheif Medical Officer Dr Cath Calderwood in 2016. It has become an NHS’ vision for introducing the concept of “realistic medicine” concept and is designed to make sure that by 2025 anyone providing healthcare in Scotland will take a realistic medicine approach. NHS Inform states

 Realistic medicine puts the person receiving health and social care at the centre of decisions made about their care. It encourages health and care workers to find out what matters most to you so that the care of your condition fits your needs and situation. Realistic medicine recognises that a one size fits all approach to health and social care is not the most effective path for the patient or the NHS.

Realistic medicine is not just about doctors. It applies to all professionals who use their skills and knowledge to help people maintain their health and prevent and treat illness. This includes nurses of course, but also pharmacists, physios, OT’s, social work and everyone else. The Chief Medical Officer’s third annual report was published last week but if you want to know more about this approach and its impact you can read this and download the 2018 summary from here

One of the features that is really useful for all nurses and healthcare professionals is the idea of encouraging people to ask 5 questions about their treatment. The 5 questions are given in the image below.

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So a challenge to our nursing colleagues elsewhere spread the word and start encouraging your patients to use the 5 questions.

The second initiative is less uniquely Scottish but it has certainly been having an impact and that’s called “What Matters to You”  This Scotland-wide campaign encourages and supports meaningful conversations between people who provide health and social care and the people, families and carers who receive their care. ‘What Matters to You?’ day started in Norway in 2014 and has been growing internationally since. This year ‘What matters to you?’ day falls on the 6th June 2018, so there is still plenty of time to get involved. Of course, asking “What matters to you?” isn’t a question for just one day its a question that we should ask everyone. As Scotland’s Chief Nursing Officer, Fiona McQueen has said,

“The one thing I think that would transform the care that we deliver to people is to listen…… really listen; not just hear what suits us. We need to listen to staff who deliver care and make changes that support them to provide real excellence; but in particular, we need to listen to people who use our services. When we focus on what truly matters to the person and have that ‘what matters to you?’ conversation, that is what will make all the difference”

For a bit of inspiration about personalising healthcare to include what matters, see Why is it important to ask what matters? and  @PersonCntrdSco and if you are on Twitter look for #wmty18

Frailty Resources

age-2785015_960_720Apologies to my MSc in Gerontology students first; because a number of them have just finished their Frailty in Older People Module. So this is too late to help them with their assignment. However, it’s still useful to know its here.

The journal “Age and Ageing” have released a Virtual Edition called “Frailty” that covers many of the main issues in Frailty,  including describing the condition conceptually, reporting its epidemiology, contrasting different options for clinical assessment, detailing the adverse outcomes of frailty in older subjects and some insights into what interventions might improve outcomes for frail older people (and their carers). They have made them available on-line. To have a look at what you can access and to learn a bit more about this important topic CLICK HERE.

Looking forward to next Thursday when Atul Gwande is joining a QI Connect Webinar hosted by Healthcare Improvement Scotland. If you don’t know who Atul Gwande is the I would have a look and listen to these. The Reith Lectures 2014

If you want to join the webinar go to https://www.eventbrite.co.uk/e/qi-connect-atul-gawande-tickets-42419687427

So What Does “…to Live Well with Dementia” Mean?

Firstly, Happy Easter to you all and I hope you are enjoying a great weekend, even if it is somewhat chilly here in Scotland.

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Last month quite quietly I think Age Concern published a new report entitled “Promising Approaches to Living Well with Dementia” which sets out to illustrate what it might means to live well with dementia in the UK currently. It is full of examples of interesting approaches which are already in place in some parts of this country, but as the report makes clear up and down the country there is a need to reduce the current postcode lottery that exists when you go looking for the help and services highlighted here. Please take a look and be inspired. There is no clear reason why what is discussed here is not available to all.

Good news for nurses in England this week as the new pay deal got another step closer to happening. Will it make you feel more valued? Will it make up for the years of enforced pay restraint? Probably not but at least it’s in line with inflation rather than below inflation. For details of the deal see RCN Nursing Pay  Now, what about everyone else working for the NHS and beyond?

Finally don’t miss your chance to visit the Age and Ageing journal who are currently publishing a free online collection of 15 papers to provide an update on the advances of pharmacological and non-pharmacological interventions in dementia over the last 15 years.

So go and download something interesting to read in between the Hot Cross Buns, Prosecco and Chocolate! 🐣🐰🥂🍾