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RCP London Safe Medical Staffing

The RCP's Guidance on safe medical staffing working party report aims to help those planning and organising core hospital medical services to answer the question: ‘How many doctors or their alternatives, with what capabilities, do we need to provide safe, timely and effective care for patients with medical problems?'.

Within the medical profession there is widespread concern that levels of medical staffing have fallen dangerously low. From 2013 to 2018, more than one in five census respondents reported that gaps in trainees’ rotas occurred so frequently as to cause significant problems in patient safety. Half of all advertised consultant appointments in acute internal medicine and geriatric medicine went unfilled due to a shortage of suitable applicants.

Key points

  • The results of the RCP Medical Registrar Survey (Appendix 2) and feedback from RCP members and fellows suggest that the out-of-hours workload of the medical registrar on-call is inappropriately onerous, with implications for patient safety.
  • The practice of a single medical registrar both leading the medical intake and providing on-call medical cover for the hospital is unlikely to be successful and contributes to the heavy out-of-hours workload of the medical registrar on-call.
  • It is essential that as much patient care as possible is delivered during the normal working day, rather than out of hours. We think that this is a key issue for patient safety, and the daytime staffing of wards should be such as to minimise ‘legacy’ work.
  • Service must always support training and we have concerns that the significant increase in consultant-delivered care may limit the opportunities for trainees to acquire experience in decision making. We urge trusts to recognise trainees’ educational needs when implementing consultant-delivered services.
  • There must always be sufficient time available to speak with patients and their families and carers to ensure that all the relevant issues are known to the medical team who are caring for that patient. This is particularly important when a patient is unable to represent themselves adequately.

This report represents the start of an ongoing process to help hospitals ensure that they have sufficient medical staff to meet the needs of their patients and deliver safe patient care. The RCP will work with the NHS to refine the method in different hospitals.

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'We have to ensure that attitudes towards older people change'

Opinion piece by Professor Martin Green, Chief Executive, Care England, published by Nursing Times:  Whenever I hear an ageist remark, I always flip the categories of the Act, and ask myself what the response would be if I made that same comment about black people, gay people, disabled people or women.

It is my view that one of the biggest challenges is to move to a system that is age-neutral and where ageism is seen to be as unacceptable as racism, homophobia or any other form of discrimination.

The challenge for the system is to stand against ageism at a time when it is endemic in society. It manifests itself in so many ways, but you only have to see the casual way that ageist remarks are thrown around to realise what a Herculean task we have in trying to eradicate ageist attitudes.

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King's Fund: The NHS 10-year plan: how should the extra funding be spent?

Prof Sir Chris Ham and Richard Murray writing for The King's Fund 12 July 2018: The government has announced increases in NHS funding over five years, beginning in 2019/20, and has asked the NHS to come up with a 10-year plan for how this funding will be used. After eight years of austerity, growing financial and service pressures within the NHS and the damaging and distracting changes brought about by the Health and Social Care Act 2012, there is now an opportunity to tackle the issues that matter most to patients and communities and to improve health and care.

In our view, the centrepiece of the new plan should be a commitment to bring about measurable improvements in population health and to reduce health inequalities. Health outcomes in the UK are not as good as those in many comparable countries despite recent progress in some areas such as cancer survival rates (Dayan et al 2018). Action is required across government as well as in the NHS in order to give greater priority to prevention and to tackle the wider determinants of health and wellbeing. Goals for improving health should be set following widespread consultation with the public and stakeholders.

Improving health and reducing health inequalities depends on making further progress in integrating health and social care, building on the development of new care models, sustainability and transformation partnerships (STPs) and integrated care systems (ICSs). An immediate priority is to communicate more effectively about why integrated care matters and about the benefits it will bring to people and communities. Some of the additional funding that has been announced should be earmarked to support the further development of integrated care with a focus on the needs of older people with frailty, people with complex needs and children.

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Pen pal scheme seeks to partner children and care home residents

Reported in Care Home Professionals (12 July 2018): A new initiative aiming to be the UK’s biggest pen pal scheme is to partner nursery and primary school children with care home residents of the same name.

The initiative, dubbed ‘Letters from a Namesake’, aims to bring together two different generations to share experiences and life stories.

Launched by the nations’ biggest supplier of name tags and labels for schools and care homes, My Nametags, the educational scheme aims to help develop children’s letter writing skills, while tackling loneliness among care home residents.

My Nametags are appealing for care homes in all parts of the UK to come forward and sign up if they are interested in taking part.

Lars B Andersen, Managing Director at My Nametags, said: “The way the scheme will work is we will match people and children with the same names.

“For example, a ‘Mary’ from a local nursery will be given the opportunity to write to ‘Mary’ in a residential care home and vice versa.

“No personal details will be shared as all the letters, pictures and drawings will be sent to us and passed on directly. We’re excited to be launching the scheme, and hope that it will help the local community enormously by bringing these two very different generations together.”

Care homes wishing to take part can register their interest by contacting or calling 01993 823 011.

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An economic analysis of flu vaccination - ILC report

The International Longevity Centre - UK has published a report which presents findings from a new economic model on cost-benefit analyses for differing uptake and efficacy scenarios for the English flu vaccination programme.

Given the rapidly ageing population of the UK and growing pressures on the National Health Service, tackling influenza is an important challenge, especially during the winter months when flu and other related health conditions are most prevalent. Vaccinations are recognised as a crucial defence against flu outbreaks, helping to protect individuals directly and by creating herd immunity. However, all health systems face financial constraints, and understanding the costs and benefits of vaccination comes into consideration by those implementing health policy.

Key findings include:

  • Vaccination averts between 180,000 and 626,000 cases of influenza per year in England
  • Flu vaccination helps avert between 5,678 and 8,800 premature deaths per year
  • The vast majority of hospital cases caused by influenza are among older adults. Over 1,800 individuals hospitalised in 2016-2017 were aged between 80 and 84 - higher than any other age group
  • The human capital costs of influenza range from £90 million to £270 million
  • The NHS flu vaccination programme costs £50,610 per death averted

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