NICE has published, in September 2016, a guideline which covers optimising care for adults with multimorbidity (multiple long-term conditions) by reducing treatment burden (polypharmacy and multiple appointments) and unplanned care. It aims to improve quality of life by promoting shared decisions based on what is important to each person in terms of treatments, health priorities, lifestyle and goals. The guideline sets out which people are most likely to benefit from an approach to care that takes account of multimorbidity, how they can be identified and what the care involves.
The guideline includes recommendations on:
- taking account of multimorbidity in tailoring an approach to care
- how to identify people who may benefit
- how to assess frailty
- principles of an approach to care that takes account of multimorbidity
- delivering the approach to care
The guideline is intended for healthcare professionals as well as people with multimorbidity, their families and carers.
Reported in The Guardian (14 October): Theresa May has told the head of the NHS that it will get no extra money despite rapidly escalating problems that led to warnings this week that hospitals are close to breaking point.
The prime minister dashed any hopes of a cash boost in next month’s autumn statement when she met Simon Stevens, the chief executive of NHS England, senior NHS sources have told the Guardian. Instead she told him last month that the NHS should urgently focus on making efficiencies to fill the £22bn hole in its finances and not publicly seek more than the “£10bn extra” that ministers insist they have already pledged to provide during this parliament.
She told him the NHS could learn from the painful cuts to the Home Office and Ministry of Defence budgets that she and Philip Hammond, the chancellor, had overseen when they were in charge of those departments, according to senior figures in the NHS who were given an account of the discussion.
Senior Whitehall sources have confirmed that Hammond’s statement on 23 November will contain no new money for the NHS, despite increasingly vocal pleas from key NHS organisations and the public’s expectation of extra health spending if Britain voted to leave the EU.
Reported in The Telegraph (16 October): A third of elderly patients may be being prescribed unnecessary medication, putting them at needless risk of side-effects and costing the NHS millions, a study has shown.
A review of 1,800 over 75s at NHS Croydon found that the average patient had been prescribed six different drugs. But after a reassessment hundreds of prescriptions were cancelled, with up to one third of patients taken off at least one drug. Hundreds of prescriptions were stopped because they were no longer effective and dozens because the patients were experiencing side effects or drug reactions.A further 121 patients were sent to their GP for further review, and 89 patients had their dose reduced.
The most common drugs which were stopped were the blood-thinning drugs warfarin and clopidogrel, aspirin, alendronic acid for osteoposrosis, cetirizine for hay fever and allergies, laxido for constipation, omeprazole for gastric reflux and adcal-d3, a drug to boost calcium and vitamin levels.
The research, carried out by pharmaceutical consultants Interface Clinical Services, predicted that the changes would save the NHS around £192,000 a year.
See also: Research finds ‘chemical cosh’ patients are more likely to suffer strokes (Islington Tribune)
Reported in the Nursing Times (17 October): Student affairs editor, Alan, questions whether the nursing profession is evolving into the leadership role that the health service needs. The word “nurse” has somewhat lost its meaning to me. Hours of lectures surrounding professional identity have yet to alter my opinion, because the nurses I see rarely give it a thought. Not knowing how to define their profession beyond their day to day tasks does not affect their work. They look after the patients in front of them and that is enough. We are entering a workforce that appears less and less sure what it wants to be.
Reported in the Guardian (6 October): Life expectancy has increased by 10 years across the globe in the past 35 years, thanks in part to efforts to treat infectious diseases such as Aids and malaria, but diet, obesity and drug use are now major causes of death and disability while too many women still die in childbirth, data reveals.
The Global Burden of Disease study, which regularly reviews the causes of illness, disability and death in every country in the world, shows health is improving but not to the same extent or in the same ways in every country. And as people live longer, they are suffering from more ill health and disability in their old age.
“Development drives, but does not determine health,” said Dr Christopher Murray, director of the Institute. “We see countries that have improved far faster than can be explained by income, education or fertility. And we also continue to see countries – including the United States – that are far less healthy than they should be given their resources.”
Life expectancy from 1980 to 2015 has risen globally by more than a decade to 69 years in men and 74.8 years in women. The cause of 70% of deaths is non-infectious diseases that often have lifestyle origins, such as heart disease, stroke and diabetes, but also include dementia. HIV/Aids, which was a major killer, accounted for 1.2 million deaths in 2015, which is a reduction of a third from 2005.
Reported by ITV (7 October): The NHS "would not cope" without workers from abroad, nursing leaders have warned.
New figures suggest the number of EU nationals joining NHS hospitals has soared - around one in five nurses recruited in England 2015/16 were non-British EU nationals, up from one in 14 in 2011/12. During the same period, the proportion of British nurses joining hospitals dropped from roughly 78% to 70%. The figures show foreign nurses make a "critical contribution" to the NHS, the Royal College of Nursing (RCN) said.
The Department of Health said overseas workers "form a crucial part of our NHS and we value their contribution immensely". The new figures are based on analysis by the Press Association and showed that of the 33,000 nurses recorded as joining hospitals in 2015/16, just over 6,000 held an EU nationality other than British.
See also: Immigration crackdown could lead to staff shortages, say recruiters (Guardian)
Reported in Care Management Matters (5 October): The National Institute for Health and Care Excellence (NICE) has published, for public consultation, its draft updated clinical guideline on Parkinson’s disease.
The guideline covers diagnosing and managing Parkinson’s disease in adults. It aims to improve care from the time of diagnosis, including monitoring and managing symptoms, providing information and support, and palliative care.
The draft guideline for consultation updates some aspects of NICE’s previous guideline on the treatment of Parkinson’s disease published in 2006. It includes new recommendations about managing Parkinson’s disease dementia and nutritional support for people with Parkinson’s disease. It also includes the addition of a section on managing and monitoring impulse control disorders that are sometimes the result of dopaminergic therapy, a common treatment for Parkinson’s disease.
NICE is looking for input into the consultation from:
- Healthcare professionals.
- Commissioners and providers.
- People with Parkinson’s disease, their families and carers.
Reported in The Nursing Times (4 October): NHS Improvement has launched an investigation into the cost and prevalence of inpatient falls across the health service in a bid to better understand the problem and help trusts tackle it.
Alongside the research, NHS Improvement will set up “falls collaboratives” and highlight examples of good practice that could be replicated across the NHS.
The work fits into efforts by the regulator to focus attention on the four most prevalent harms in hospitals – pressure ulcers, falls, urinary tract infections, and problems linked to blood clots or venous thromboembolism.
The regulator said that tackling these could release resources equivalent to 3,900 extra nurses being employed in the health service.
Reported on the Government website: The number of medical training places available to students each year will be expanded to ensure the NHS has enough doctors to continue to provide safe, compassionate care in the future, Health Secretary Jeremy Hunt announced today (4 October 2016).
From September 2018, the government will fund up to 1,500 additional student places through medical school each year. Students will be able to apply for the extra places from next year in order to take them up from the academic year 2018/19.
The Health Secretary also pledged to reform the current cap on the total number of places that medical schools can offer, which is set at just over 6,000 a year. Currently, universities can only offer places to half of those who apply to study medicine, but this new measure will allow all domestic students with the academic grades, skills and capability to train as a doctor to have the chance to do so.
The government will consult on how these proposals can be implemented. We will also also explore ways to ensure graduates provide a return on taxpayer investment to the NHS through, for example, a minimum period of NHS service.
Reported by Community Care (4 October 2016): Councils are set to use desktop assessments to complete deprivation of liberty cases in a bid to clear a backlog of more than 100,000 referrals.
An advice note issued by the Association of Directors of Adult Social Services (ADASS), seen by Community Care, said this approach should only be used for cases triaged as ‘low priority’ or renewals of existing Deprivation of Liberty Safeguards (DoLS) authorisations of at least six months.
All such cases should be screened against nine criteria, including whether relatives object or there are any safeguarding concerns, ADASS said. If none are present “the more proportionate approach” should be used, with a best interests assessment carried out on papers alone or with a “shorter” visit than would normally be expected.
One council keen to implement ADASS’s approach said it was taking legal advice before doing so. ADASS said the approach was “compliant” with the DoLS legislation.
Official figures released last week by NHS Digital revealed the DoLS case backlog hit 101,750 in April 2016, up from 75,000 the previous year. This is a result of the Supreme Court’s ‘Cheshire West’ ruling in March 2014, which effectively lowered the threshold for cases requiring DoLS authorisations and triggered a ten-fold rise in applications.