Inpatient care for people with diabetes: the economic case for change

This report from NHS Diabetes calls for more investment in specialist diabetes care to reduce the estimated £600 million excess spend on treating diabetes in hospitals.

First guideline on colorectal cancer care launched to promote best practice

In this new guideline, NICE sets out its recommendations for the treatment of colorectal cancer from diagnosis through to management, on-going care and support.

Hospital episode statistics: emergency readmissions within 28 days of discharge

These emergency readmission indicators provide information to help the NHS monitor success in avoiding (or reducing to a minimum) readmission following discharge from hospital.

Improving picture of bowel cancer care

A new audit shows that the overall care for bowel cancer patients in England in Wales is improving. However the report notes that urgent and emergency surgery continues to carry a much greater risk of death compared to elective and scheduled procedures.

National Voices develop Principles for Integrated Care

National Voices has developed, with its members, a set of principles for integrated care. agreed by 130 member organisations from health and social care.

What Experiences of Health Care Delivery Matter to Service Users and Why? A Critical Interpetive Synthesis and Conceptual Map

The aim of this recently published research by the Social Dimensions of Health Institute at the University of Dundee was to identify the range of experiences of health delivery that matter to patients and to produce a conceptual map to facilitate consideration of why they matter.

One plan to reduce four harms

The QIPP Safe Care programme aims to deliver care that is defined by the absence of pressure ulcers, falls, venous thromboembolism and catheter line infections by December 2012. It does this with one plan which can be implemented at a local level and integrated easily with existing workflow and routines.

Patient-level Information and Costing System (PLICS)

PLICS is a method of recording all significant activities (clinical interactions, processes, and procedures) related to an individual patient from the time of admission until the time of discharge. It calculates the resources consumed by using actual costs incurred by the organisation in providing the service or activity related directly to that patient’s care.

Case Management: What it is and how it can best be implemented

Case management is a way of integrating services around the complex needs of people with long-term conditions. This new report from the King’s Fund Case examines how this key strategy can improve delivery of integrated care for people these conditions.

An audit of physiotherapy services in England

This audit shows clear evidence that early access to physiotherapy services is highly cost effective and clinically effective for a wide range of patients including stroke survivors, those with musculoskeletal disorders and patients with long term conditions.

The public wants more choice of NHS care

A new survey commissioned by the Department of Health reports that of 5,000 respondents, 80% want more choice over how and where they are treated in the NHS and nearly ¾ want more choice in who provides their hospital care.

Guidance on choice of named consultant led team

This document provides guidance to providers and commissioners on implementation of the Government commitment to introduce choice of named consultant-led team for a first outpatient appointment for elective care where clinically appropriate.

When a Person Dies: Guidance for Professionals on Developing Bereavement Services

This new publication from the National End of Life Care covers the principles of bereavement services, along with bereavement care in the days preceding death, at the time of death and in the days following death. It also includes guidance on workforce and education, and the commissioning and quality outcomes of bereavement care.

King’s Fund reports on NHS performance

Many NHS hospitals will struggle to deliver productivity improvements essential to maintaining quality and avoiding significant cuts to services, according to the latest quarterly monitoring report from the King’s Fund.

Significant variation in numbers of women in England undergoing uterine fibroid

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 in the numbers of women undergoing UFE, and a lack of patient involvement in commissioning fibroid treatments.

Greater management of hyperglycaemia in patients with acute coronary syndromes needed

NICE recommends that patients with acute coronary syndromes (ACS) should have their blood glucose levels actively controlled if it is raised on admission to hospital. Currently, hyperglycaemia is not being considered as a risk factor for ACS and frequently remains untreated.

Improving support for older people looking after someone with advanced cancer

This briefing paper is about the findings and recommendations from a research project The whose aim was to study the experiences and main support needs of older carers* looking after someone with advanced cancer. The support services most important to older carers include: Regular health checks and prompt health care; practical help and equipment; a 24hour ‘manned’ helpline; regular visits by a palliative care specialist; reliable written information.

Study highlights benefits of radiotherapy after breast cancer surgery

This study, published in the Lancet says that radiotherapy following breast-conserving surgery "not only substantially reduces the risk of recurrence but also moderately reduces the risk of death from breast cancer".

Developing clinical senates and networks

The role of clinical networks and the new clinical senates is being reviewed. The work is expected to lead to a suggested operating model for networks and proposals for the operation of senates. Clinical senates are expected to bring together clinical leaders across broad areas of the country to give clinical leadership and expert advice for commissioning.

Guidelines for design of in-patient prescription charts

A study commissioned by the General Medical Council showed an unacceptable rate of prescribing error amongst all grades of doctor in hospitals. The researchers considered that the design of in-patient prescription charts was one factor contributing to errors.

Two new quick reference guides published to help you support patients with asthma and COPD

These guides provide a brief summary of the conditions and their causes, and explain how pharmacists can support patients to improve the management of symptoms and medicines adherence.

The Higher Risk General Surgical Patient: Towards Improved Care for a Forgotten Group

This RCS report says that the NHS must address the significant variations in care experienced by the 170,000 patients who have major emergency abdominal surgery each year. It makes nine recommendations, which if implemented within two years, will reduce complications and deaths, as well as reduce the cost of treating a group of patients who account for almost 90 per cent of post-operative general surgical deaths.

Following NICE guidelines for diabetes treatment 'could save NHS £625m'

NICE's guideline on type 2 diabetes recommends that human NPH insulin should be the first-line treatment offered to people with the condition. However, a study published in BMJ Open, has found that NHS spending on the more expensive insulin analogues rose from £18.2 million to £305 million between 2000 and 2009.

Women giving birth to twins or triplets should be offered specialist care

NICE's says that women with multiple pregnancy should be referred to a team of doctors, midwives and ultrasonographers once their scan is confirmed. The team should offer women information and emotional support specific to such births at first contact, and that on-going opportunities for further discussion should be given.

Better emergency care could save 500 lives a year in London

The evidence put forward by leading clinicians in this report suggests that increasing the number of hours hospital consultants are available at weekends and improving access to diagnostic scans could save more than 500 lives every year in London.

Radical changes needed to hospital services to ensure quality and safety of NHS care

This briefing from the King’s Fund calls for radical changes to streamline the process for reorganising hospital services and prevent politicians from blocking essential changes that would improve the quality and safety of NHS care.

Integrated care summary: What is it? Does it work? What does it mean for the NHS?

Chris Ham summarises the different forms of integrated care and their impact so far on the NHS. It has been prepared in the light of the increased interest in integrated care arising out of the work of the NHS Future Forum and the government’s response.

Issues facing commissioners of end-of-life care

This paper highlights the current barriers to commissioning personalised, integrated services for end-of-life care and outlines the opportunities commissioners have to improve services in the future.

NICE recommended risk assessments 'help prevent falls in elderly'

NICE recommends that older people who are in contact with healthcare professionals should be identified and risk assessed for the likelihood that they will suffer a fall. This BMJ clinical review says that, despite evidence showing risk assessments can prevent falls, they are not being regularly carried out.

National kidney care audit vascular access report 2011

This report presents the findings from the 2010 data collection period for patients starting dialysis between the 1st January and 30th June 2010. The central aims of this audit were to determine the performance of renal centres across England, Wales and Northern Ireland in the use of optimal vascular access for haemodialysis, to measure the burden of vascular access and to explore operational issues in providing access.

Implementing radiographer reporting

The DoH is encouraging the training of radiographers to report on straightforward x-rays, freeing time for consultant radiologists to assess more complicated images. This suggestion could lead to an estimated saving of £7.9m per year.

Interim report on children's congenital heart services in England

This report states that concentrating surgical expertise in fewer sites and bringing non-surgical care closer to home will benefit patients.

NCPC and Dying Matters report calls for new deal for the dying

No Dress Rehearsals looks at how end of life care is measuring up three years on from the publication of the government’s end of life care strategy. The report finds that, despite many examples of excellent care, there remain serious cases of neglect and ill-treatment, and many people are not getting their end of life wishes met.

Environments for care at the end of life

This publication describes projects in 19 NHS trusts that took part in schemes to improve the environment of care at the end of life. The projects show that, even in the most uninspiring environment, it is possible to create welcoming and comfortable spaces that are fit for purpose, good value for money and can improve the quality of care and the patient experience.

NICE calls for 24-hour blood pressure monitoring in radical update to guidelines

Patients suspected of having hypertension should be sent home and told to wear a monitor for 24 hours, rather than having their blood pressure checked in clinic.

How NICE guidelines are transforming services for brain cancer patients

NICE guidance aimed at improving outcomes for people with brain and other central nervous system tumours has resulted in a “significant increase”, from 66 to 87 per cent, in the number of patients being reviewed before surgery by a consultant-led team of healthcare professionals.

Reality lags behind the rhetoric of creating the ‘largest social enterprise sector in the world’

This report from the King’s Fund has found early evidence to suggest that health care providers that have adopted the social enterprise model have benefited by reducing bureaucracy, speeding up decision-making and by allowing the reinvestment of surpluses, an effective motivator for staff. It recommends that NHS commissioners offer longer-term contracts to enable social enterprise providers to establish themselves in a more competitive environment.

Maps show where patients feel they have benefited the most from their NHS treatment

A series of maps published by The NHS Information Centre highlight clear geographical variation in the extent to which patients feel they have benefited from their care. The maps are based on 2009/10 PROMS based on the results of questionnaires completed by patients before and after they undergo surgery.

Acute care toolkit for handover

This toolkit aims to provide a framework for standardisation of clinical handover practice, audit and monitoring of the process, and defining accountability and responsibilities in the process

RCN guidance on theatre transfers for children

Royal College of Nursing publishes briefing on assessment and management of children transferred between hospital departments.

Commissioning pathway for long-term conditions

Developed with the help of various experts and supported by NAPC, NHS Alliance, NICE and the DH, this pathway supports health and social care teams participating on the QIPP LTC workstream to implement a generic LTC care model and tackle the increasing demand in care needs. You will need to register for NHS Networks to view this document.

National strategy to transform respiratory disease care

A new strategy from the DoH sets out six shared objectives to improve outcomes for COPD and asthma through high-quality prevention, detection and treatment and care services.

New COPD quality standard published

NICE quality standard defines clinical best practice for specific topic areas. This standard for COPD includes 13 statements that aim to define high quality care for patients.

Drug therapy should come before surgery for people with stable angina

NICE in its new clinical guideline on the management of stable angina sets out recommendations on what treatment and care the NHS should offer to people with a diagnosis of stable angina, including the use of anti-anginal drug treatment and surgery

New quality standards for dermatology

The standards are intended for use in any service that provides care for people with skin conditions. They bring together best practice and existing guidance, and aim to meet the needs of commissioners.

More choice for NHS patients across the country

NHS patients will have more freedom to choose where they go for their healthcare from April 2012. Following advice from patient groups, clinicians and voluntary organisations, there are eight services that have been recommended as the most suitable, including: Services for back and neck pain; Continence services (adults and children); Wheelchair services (children); Podiatry (feet) services; Leg ulcer and wound healing;

Doctors demand radical shake-up of women’s health services promoting prevention rather than intervention

High Quality Women’s Health Care: A Proposal for Change by RCOG concludes that the combined force of the NHS reforms, workforce and financial pressures against a backdrop of rising demand, increasing complexity and changes in demographics means that the delivery of women’s health care in the current configuration cannot be sustained

Doctors demand radical shake-up of women’s health services promoting prevention rather than intervention

High Quality Women’s Health Care: A Proposal for Change by RCOG concludes that the combined force of the NHS reforms, workforce and financial pressures against a backdrop of rising demand, increasing complexity and changes in demographics means that the delivery of women’s health care in the current configuration cannot be sustained

Clinical commissioning and integrated care

In the wake of the NHS Future Forum report, Reform held two lunches to discuss how clinical commissioning will deliver integrated care. This is a transcript of those discussions between key individuals, including GPs, NHS leaders, patient representatives, policy makers and journalists.

Getting our of hospital?

This Health Foundation report says that community-based services have the potential to reduce NHS costs by promoting early discharge from hospital for patients who no longer need intensive acute care, but are not yet ready to fend for themselves at home. However, for significant cost savings to be realised moving care into the community needs to be associated with active reductions or decommissioning of hospital-based services.

Earlier operations and better care can improve the lives of thousands of hip fracture patients

In its first clinical guideline on hip fracture, NICE recommends that early surgery can help speed up recovery time for patients, lower the number of follow-up procedures necessary, and reduce the length of hospital stays.

Stroke prevention surgery 'not performed in time'

This report from The Vascular Society says that the majority of patients (60%) with symptoms of TIA or stroke are not receiving carotid endarterectomy surgery within the two-week timescale recommended by NICE.

New NICE quality standard published on chronic heart failure

NICE has published quality standards for the assessment, diagnosis and clinical management of chronic heart failure1 in adults, adding to the bank of quality standards already completed.

Integrated care for older people: examining workforce and implementation challenges

This report is the first in a series investigating the workforce implications of moving towards an integrated health and social care system. This report considers eight different ‘point’ models of care, describing the service provided and assessing economic, quality of care and workforce implications.

Largest ever diabetes audit shows people still not receiving all their basic health checks

The National Diabetes Audit 2010 shows that 2/3 of people with Type 1 diabetes and almost 1/2 of Type 2 patients do not receive all nine annual health checks to manage their diabetes effectively and that children and young people are less likely to receive all the recommended checks, such as blood pressure, blood glucose and foot checks. It also identified substantial regional variations in both the prevalence and treatment of complications such as kidney failure and dialysis.

Local adult neurology services for the next decade

This report from the Royal College of Physicians and the Association of British Neurologists evaluates local adult neurology services and finds that overall they are poorly organised and do not meet patients’ needs.

Eyecare commissioning guidance launched

This guide from the UK Vision Strategy supports clinical commissioning groups through all stages of the eye care commissioning process in a straightforward and comprehensive format.

Lincolnshire Research Observatory publishes health profiles

Health Profiles provide an overview of health and health inequalities. The LRO has published eight profiles, one for each district and one for Lincolnshire. The profiles provide a consistent and comparable view of the population’s health by means of some useful key indicators. They also highlight some key messages for Lincolnshire and each of the districts.

No marked improvement in transport service for kidney patients, national audit shows

The second major survey into kidney patient transport across England, Wales and Northern Ireland shows that while most patients are happy with the service they receive, there has been no marked improvement since the first survey's results were published two years ago.

Issue 3: June 2011

‘New model’ of care needed says The King’s Fund
The King’s Fund in its response to the government’s listening exercise on the Health and Social Care Bill, calls for the NHS to be re-orientated to deliver a new model of ‘integrated’ care, based on stronger collaboration between health professionals and more effective co-ordination of services.

New competence framework launched to help deliver quality, patient-centred respiratory care
Skills for Health have launched a new competence framework to help commission, manage and deliver improved patient-centred respiratory care. This will support the delivery of the forthcoming National Outcomes Strategy for COPD.

Guide on palliative care commissioning for children and young people
This document from ACT s designed to assist commissioners in identifying the types of services they should consider when commissioning provision for children and young people with life-limiting and / or life-threatening conditions.

Transforming our health care system: ten priorities for commissioners
This publication from the King’s Fund sets out ten priorities to help commissioners transform the health care system.

National Sentinel Stroke Audit 2010
The final report of the National Sentinel Stroke Audit shows that care for patients with stroke is still improving. It also says that patients on stroke units have better outcomes than those admitted to and treated on general wards.

Self-review tool for young people’s health services
Quality Criteria for Young People-friendly Health Services (2011) has been designed by the DoH for providers of health services to help them improve NHS health services. The quality criteria provide good practice guidance based on local practice and evidence of what will improve patient experience and health outcomes for young people.

Care coordination model: better care at lower cost for people with multiple health and social needs
This report from the Institute of Healthcare Improvement outlines methods and opportunities to better co-ordinate care for people with multiple health needs, and ways that organisations have allocated resources to better meet the range of needs in this population. Although targeted at US healthcare, may provide models of care co-ordination that could be applied to care in the UK.

Helping people help themselves
This literature review from The Health Foundation shows that proactive, behaviourally focused self-management support designed to increase self-efficacy can have a positive impact on people’s clinical symptoms, attitudes and behaviours, quality of life and patterns of healthcare resource use.

Evaluation of nurse and pharmacist independent prescribing
The DoH document concludes that nurse and pharmacist independent reports that nurse and pharmacist independent prescribers are operating safely and prescribing appropriately and that there are high levels of satisfaction among patients being treated by them.


This bulletin is brought to you by Library and Knowledge Services. It aims to keep you up-to-date with clinical governance issues. At the beginning of each month, a librarian will update the bulletin with relevant information published in the preceding month. If there are areas you think we also need to cover, please let us know.

Issue 2: May 2011

Urgent and emergency care clinical audit toolkit
The toolkit from the Royal College of General Practitioners and the College of Emergency Medicine is aimed at all providers of urgent and emergency care and is intended as a practical guide on checking the quality and care provided.

Fundamentals of commissioning health services for children
This paper from the Child Health and Maternity Partnership looks at how some PCTs have not only reduced admissions but commissioned services which deliver better outcomes for children and young people. It also looks at why the current provision of these services is unsatisfactory,

Facing the future: standards for paediatric services
This RCPCH report warns that regardless of the outcome of the current health bill, an extensive re-design of children’s health care is now necessary to safe-guard positive health outcomes for children.

RCN publishes new standards on care of children
The RCN has published new standards to promote the highest level of care and wellbeing for children. Sections 3, 4 and 5 are particularly relevant to service delivery.

Reducing expenditure on low clinical value treatments
This briefing from the Audit Commission suggests that the NHS could save up to £500 million a year by carrying out fewer ineffective or inefficient treatments. It considers some of the efforts to decommission treatments of low clinical value.

Quality indicators for TCS
This document introduces 43 quality improvement indicators for the “transforming community services” programme. They cover many aspects of community services that interface secondary care, and will be of interest to clinicians, providers, as well as commissioners of community services.

Variations in health care: the good, the bad and the inexplicable
This report from the King’s Fund illustrates differences in admission rates for many routine surgical procedures. The existence of these variations in health care directly affect equity of access to services, the health outcomes of the populations and the efficient use of resources.

Rural health economies and the health bill
The Health and Social Care Bill presents an opportunity to improve rural health services by tailoring services to meet the needs of their communities. However, it is important that the specific characteristics of rural areas are taken into account when reforms are being implemented.

Are efficiency and productivity improving in the NHS?
This review by the Audit Commission shows how and where primary care trusts (PCTs) spent their money, how trust income changed and how successful the NHS has been in moving care out of hospitals to more cost-effective settings.




This bulletin is brought to you by Library and Knowledge Services. It aims to keep you up-to-date with clinical governance issues. At the beginning of each month, a librarian will update the bulletin with relevant information published in the preceding month. If there are areas you think we also need to cover, please let us know.

Issue 1: April 2011

Interventional radiology: guidance for service delivery

The report from the National Imaging Board illustrates how the NHS can improve quality, safety and productivity while delivering comparable or better outcomes for patients with shorter hospital stays and fewer major complications.

NICE quality standard: chronic kidney disease

This new NICE quality standard for CKD also comes with a commissioning and benchmarking tool, covering service requirements, local service levels, service redesign and quality assurance.

Lincolnshire Public Health Annual Report 2010
This report recommends that patients with cancer receive input from a number of different services. Co-ordination of cancer services is essential. The role of Lincolnshire Cancer Partnership should be strengthened to ensure that cancer services in Lincolnshire are planned effectively.

NHS Institute take initiative to join up care

The NHS Institute’s joined up care initiative has case studies and a guide to delivering joined up care, whereby different organisations can work together to improve patient experiences, reduce duplication and waste and increase the quality of care.

Right to provide guidance published

The Department of Health has issued guidance on the ‘right to provide’ (R2P). This guide sets out a process for people working in NHS Trusts who wish to propose the development of a staff-led enterprise , i.e. to take over and run services themselves as an employee-led mutual.

QOF funding shifted to efficiency savings drive

NHS Employers has announced changes to the GP contract which will see QOF payments redistributed and used to fund the drive to keep patients out of hospital and reduce emergency admissions to hospital.

Reconfiguring hospital services: lessons from South East London

This report from the King’s Fund considers whether reconfiguration of hospital services is an appropriate response to the need to drive up quality and drive down costs.

Staffing in maternity units: getting the right people in the right place at the right time

The report, again from the King’s Fund considers the available evidence about the relationship between staffing levels and deployment practices and safety of care for mothers and babies, and includes models of care delivery in maternity units.

This bulletin is brought to you by Library and Knowledge Services. It aims to keep you up-to-date with clinical governance issues. At the beginning of each month, a librarian will update the bulletin with relevant information published in the preceding month. If there are areas you think we also need to cover, please let us know.