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Introduction: Psychological services are typically offered via specialized mental health services, which are often overwhelmed with long waitlists. To address this need and provide patients with a service characterized by shorter waiting times and increased accessibility, online Eye Movement Desensitization and Reprocessing (EMDR) was established in the North Norfolk 4 Primary Care Network. Methods: This article presents this service's collaborative funding, development and outcomes within local GP surgeries. It constitutes a mixed-method service evaluation encompassing the future of EMDR in primary care services. Additionally, it includes the assessment of anxiety, depression, and PTSD symptoms as well as work and social adjustment in a cohort of 83 patients alongside a Thematic Analysis involving eighteen patients and six GPs. Results: The evaluation showed high completion and attendance among service users. Quantitative scores combined with qualitative feedback from patients and practitioners highlight the potential impact of EMDR therapy on General Practice and its broader provision of trauma-focused therapies. The most significant improvements were observed in anxiety and depression scores. Thematic Analysis indicated that the patients found the service helpful, labeling it as a "life-saver." They also discussed why they found the service effective; some also wished the service had been available earlier. Discussion: Findings underscore the potential of EMDR and online EMDR as an accessible and effective approach within primary care settings. The assessments showed an elevated level of access and attendance among service users. Therefore, it is recommended that timely EMDR services be extended through primary care networks. [ABSTRACT FROM AUTHOR]

Background and method: A cohort study using secondary data assessed associations between baseline characteristics and psychological sessions attended in young persons discharged from a Children and Young People's Mental Health Service in 2019. Results: There were 584 persons who attended a median of seven sessions. On multivariable regression analysis, males attended fewer sessions than females, young people from more affluent communities attended more sessions than those from poorer communities and those presenting with eating disorders and self‐harm in particular attended more sessions than those with anxiety. Conclusions: Addressing why these associations occur may improve mental health care in young persons. [ABSTRACT FROM AUTHOR]

The rising prevalence of dementia in the UK presents a public health and economic challenge. People over the age of 60 are the fastest growing age group in prison and the number of people in prison who experience dementia is rising. There is a lack of research focused on improving management and support for people in prison who may experience dementia, but growing awareness of the need for staff training in prisons to identify and support people showing symptoms of dementia. This paper reports the development of a theory and evidence-based training package for prison staff and peer carers to identify and support people in prison with mild cognitive impairment or dementia. Training content and format was informed by the literature on dementia training in prisons and analysis of qualitative and quantitative data from semi-structured interviews with prison staff and a survey administered to prison governors and healthcare managers, both of which explored current provision of dementia training and training needs. A stakeholder working group reviewed and revised the training during two interactive meetings. Future research to evaluate the effectiveness of the training in practice is required. [ABSTRACT FROM AUTHOR]

Background: Children and young people's (CYP) mental health is a major public health concern internationally and the recent Covid-19 pandemic has amplified these concerns. However, only a minority of CYP receive support from mental health services due to the attitudinal and structural barriers they and their families encounter. For over 20 years, report after report has consistently highlighted the shortcomings of mental health services for CYP in the United Kingdom and attempts to improve services have been largely unsuccessful. The findings reported in this paper are from a multi-stage study that aimed to develop a model of effective, high-quality service design for CYP experiencing common mental health problems. The aim of the stage reported here was to identify CYP's, parents' and service providers' perceptions of the effectiveness, acceptability and accessibility of services. Methods: Case studies were conducted of nine different services for CYP with common mental health problems in England and Wales. Data were collected using semi-structured interviews with 41 young people, 26 parents and 41 practitioners and were analysed using the Framework approach. Patient and Public Involvement was integrated throughout the study with a group of young co-researchers participating in data collection and analysis. Results: Four key themes defined participants' perceptions of service effectiveness, acceptability and accessibility. Firstly, open access to support with participants highlighting the importance of self-referral, support at the point of need and service availability to CYP/parents. Secondly, the development of therapeutic relationships to promote service engagement which was based on assessment of practitioner's personal qualities, interpersonal skills and mental health expertise and underpinned by relational continuity. Thirdly, personalisation was viewed as promoting service appropriateness and effectiveness by ensuring support was tailored to the individual. Fourthly, the development of self-care skills and mental health literacy helped CYP/parents manage and improve their/their child's mental health problems. Conclusions: This study contributes to knowledge by identifying four components that are perceived to be central to providing effective, acceptable and accessible mental health services for CYP with common mental health problems irrespective of service model or provider. These components could be used as the foundations for designing and improving services. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a complex chronic health condition that can have a significant impact on physical health and psychological wellbeing. Diabetes management can be particularly difficult for young people (YP) with a diagnosis, and complications arising from poor diabetes self-care can be personally and economically costly. There are ongoing local and national priorities to improve diabetes care management (NHS England, 2016/2017) and streamline resources. A service evaluation was commissioned to understand YP's experiences of living with diabetes. Methods: A qualitative approach was used to elicit YP's (16-25) experiences of living with diabetes. Eight YP were interviewed using a semi-structured format. Results: Five themes were identified from the data: 1) Experience of diagnosis, 2) Day-to-day management, 3) Self-identity, 4) Interactions with staff and 5) Peer support. Conclusions: Overall, the findings of this evaluation indicated that YP found navigating and balancing the demands of diabetes and engagement in typical developmental activities a challenging process. These were sometimes at odds with the priorities of healthcare professionals (HCPs), and lead to differences in the perception of optimal diabetes management. This in turn often had a major impact on engagement and diabetes self-care. The evaluation identified that there is an important role for a psychology service to support the psychological wellbeing of YP with diabetes and to create a shared understanding between YP and HCPs to help increase engagement, collaboration and self-management. [ABSTRACT FROM AUTHOR]

The article highlights the recommendations on how to restart spirometry testing to ensure safety of patients and health care personnel. Topics mentioned include a description of spirometry, the risks of using spirometry, the challenges caused by COVID-19 to spirometry testing, and some devices and service delivery models that could help in performing spirometry testing.

Purpose: The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic. Design/methodology/approach: A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews. Findings: Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy. Originality/value: This is the only study to the authors' knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy. Design/methodology/approach: A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores. Findings: Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size. Originality/value: This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic. [ABSTRACT FROM AUTHOR]

The article discusses research on the early implementation of the Enhanced Health in Care Homes (EHCH) model due to COVID-19. Challenges with implementation of the EHCH model include time taken by staff to fulfill contract obligations, use of technology in care homes and primary care, effectiveness of data sharing and frequency of care home rounds and multidisciplinary team meetings. Also noted are the benefits of EHCH model and its potential expansion to include vulnerable and frail people.

The article discusses research on the role of non-medical prescribers (NMP) in treating patients with opiate analgesia dependence in primary care. The study describes the approach of a Benzodiazepine and Opiate Withdrawal Service (BOWS) to illustrate the role of NMPs in treating patients and the advantages of using NMPs. It outlines treatment and management options including stabilising medication, switching to and reducing dosage of diazepam and cognitive behavioural therapy.

Background: A significant proportion of forensic patients in England are long-stayers. This can be problematic as individuals are kept in restrictive environments at potentially inappropriate levels of security for many years, sometimes decades. Improvements to the current English forensic mental health system to meet the needs of long-stay forensic patients more effectively might be informed by the Dutch service for long-stay forensic patients. Aims: To compare the characteristics of representative samples of long-stay patients in England and in the Netherlands in an attempt to draw conclusions on the degree to which the Dutch service model might be relevant to England. Method: This cross-sectional study explores the relevance of the Dutch service model by comparing the characteristics of representative samples of long-stay patients in England (n = 401) and the Netherlands (n = 102). Descriptive statistics and analyses of differences between groups are presented. The Risk-Need-Responsivity model was used to guide the selection of the study variables and structure the interpretation of the findings. Results: Compared to their English counterparts, the long-stay Dutch patients were less likely to be diagnosed with schizophrenia, but more likely to have personality disorder and have committed sex offences. The English group were younger at first conviction and at first custodial sentence. The total number of offences and the proportion of violent offenders were similar, but the Dutch HCR-20 scores indicated a significantly higher risk of violence. Conclusions: Whilst there may be barriers to adopting the Dutch service model in England, the differences in the characteristics of the two groups studied here do not necessarily preclude this approach. [ABSTRACT FROM AUTHOR]

Purpose: Mental health service improvement initiatives often involve the setting of targets and monitoring of performance. The purpose of this paper is to describe the application of appreciative enquiry (AE), a radically different but complementary approach to quality assurance and improvement, to specialist mental health services across a health region.Design/methodology/approach: This case study describes a regional quality improvement (QI) project involving 12 early intervention in psychosis (EIP) services in South West England. In total, 40 people were trained in AE interviewing skills and in non-reciprocal peer review visits 59 interviews were conducted involving 103 interviewees including service users, carers, clinicians, managers and commissioners. Immediate verbal feedback was provided and main themes summarised in individual reports to host teams using the following headings: team values, strengths, dreams and development plans. A thematic analysis was conducted on team reports and a project report produced which summarised the stages and results of this regional initiative.Findings: All participants rated the experience as positive; it enhanced staff motivation and led to service development and improvement.Research Limitations/implications: The experiences of these 12 EIP teams may not necessarily be generalisable to other services/regions but this positive approach to service improvement could be widely applied.Practical Implications: AE is applicable in large-scale QI initiatives.Originality/value: To the authors knowledge this is the first time that AE has been applied to large-scale mental health service improvement and innovation. [ABSTRACT FROM AUTHOR]

This study explored students' use of clinical photographs within seven medical schools in England. The design used was cross-sectional survey research. The data collection method was a self-completion online survey. A total of 283 students participated in the study. The proportion of students using clinical photographs was 87%, p = .217. The medical subject discipline in which clinical photographs were considered by students as most useful were dermatology (71%). The proportion for those 'Very' or 'Quite' likely to access an image library made available through their medical school was 92%. The main barrier to using existing photographic resources was awareness. [ABSTRACT FROM AUTHOR]

Background: patient involvement in the design, planning and delivery of health services is acknowledged to be a local and national priority. Aims: to improve service quality through a quality improvement initiative to explore patient preferences for involvement in health services design, planning and delivery. Methods: a questionnaire was developed to: assess patient preferences for involvement in hospital service development; and explore differences in responses between patient subgroups. Findings: 162 patients were recruited. Most were positive about being engaged in all service developments, not just those used personally. Involvement through questionnaires with infrequent email communication was favoured over attendance at public meetings. Time was a greater barrier to being involved than distance or remuneration. Conclusion' Patients valued involvement in health service development, but finding free time during working hours was difficult. There were no differences in preferences for involvement between subgroups defined by gender, ethnicity, home situation or health. [ABSTRACT FROM AUTHOR]

Patients with secondary breast cancer (SBC) may live for many years, but they require continual treatment and monitoring to control the disease. There is less specialist support available for this patient group, therefore funding was secured to improve the health and well-being of patients with SBC and their carers through an information and support day in the company of other patients. This article describes how three information and support events were hosted at the Christie Hospital in Manchester between July 2015 and January 2016, and reports the evaluation results. [ABSTRACT FROM AUTHOR]

This study aimed to examine what specialist nursing contributes to HIV service delivery across England and how it could be optimised. A three part multi-method qualitative study was undertaken, involving (1) interviews with 19 stakeholders representing professional or service user groups; (2) interviews with nurse/physician pairs from 21 HIV services; and (3) case studies involving site visits to five services. A framework analysis approach was used to manage and analyse the data. There was substantial variability in specialist nursing roles and the extent of role development. Most hospital-based HIV nurses (13/19) were running nurse-led clinics, primarily for stable patients with almost half (6/13) also managing more complex patients. Role development was supported by non-medical prescribing, a robust governance framework and appropriate workload allocation. The availability and organisation of community HIV nursing provision determined how services supported vulnerable patients to keep them engaged in care. Four service models were identified. The study showed that there is scope for providing a greater proportion of routine care through nurse-led clinics. HIV community nursing can influence health outcomes for vulnerable patients, but provision is variable. With limited financial resources, services may need to decide how to deploy their specialist nurses for best effect. [ABSTRACT FROM AUTHOR]

Background: Innovative strategies are required to improve access to evidence-based tinnitus interventions. A guided Internet-based cognitive behavioural therapy (iCBT) intervention for tinnitus was therefore developed for a U.K.Population: Initial clinical trials indicated efficacy of iCBT at reducing tinnitus severity and associated comorbidities such as insomnia and depression. The aim of this phase III randomised controlled trial is to compare this new iCBT intervention with an established intervention, namely face-to-face clinical care for tinnitus.Methods/design: This will be a multi-centre study undertaken across three hospitals in the East of England. The design is a randomised, two-arm, parallel-group, non-inferiority trial with a 2-month follow-up. The experimental group will receive the guided iCBT intervention, whereas the active control group will receive the usual face-to-face clinical care. An independent researcher will randomly assign participants, using a computer-generated randomisation schedule, after stratification for tinnitus severity. There will be 46 participants in each group. The primary assessment measure will be the Tinnitus Functional Index. Data analysis will establish whether non-inferiority is achieved using a pre-defined non-inferiority margin.Discussion: This protocol outlines phase III of a clinical trial comparing a new iCBT with established face-to-face care for tinnitus. If guided iCBT for tinnitus proves to be as effective as the usual tinnitus care, it may be a viable additional management route for individuals with tinnitus. This could increase access to evidence-based effective tinnitus care and reduce the pressures on existing health care systems.Trial Registration: ClinicalTrials.gov identifier: NCT02665975 . Registered on 22 January 2016. [ABSTRACT FROM AUTHOR]

Bowel cancer is the fourth most common cancer in the UK. Early diagnosis has a significant effect on survival rates. Referral guidelines for suspected bowel cancer state that symptomatic patients should be referred by a GP for an appointment with a specialist within two weeks. Once referred, the primary aim of secondary care clinics is early diagnosis. This article describes a nurse-led service development to respond to the increasing numbers of people with suspected bowel cancer referred under the two-week guideline. The reconfigured service has streamlined care, reduced waiting times and has been received positively by patients. The innovation resulted in the award of an international travel scholarship for the team. As a result, the first transanal total mesorectal excision has been performed in the trust and the team's knowledge of malignant and benign conditions in the bowel has improved. The service has further responded to increased demand by providing telephone assessments. Audits are being conducted to assess and compare patient satisfaction with face-to-face versus telephone assessments, and any differences in cancer detection, number or type of investigation. [ABSTRACT FROM AUTHOR]

Background Innovations Project ( IP) was a new multidisciplinary team based within an inner city, walk-in health centre, North East England (throughout 2011). The aim was to describe the social and mental disorders of the hard to reach young people ( HTRYP) from the IP and compare with a matched sample who attended a Community Mental Health Team ( CMHT) and follow-up both samples 24 months after discharge. Methods A retrospective review of clinical case notes of YP who attended the IP and CMHT. A 24-month (postdischarge) follow-up evaluation of the mental state and social function of the YP in both groups using Health of the Nation Outcome Scales for Child and Adolescent Mental Health (Ho NOSCA) and Children's Global Assessment Scale ( CGAS). Results Thirty-six referrals were accepted over a one-year period by the IP, 31 met criteria for the HTRYP, 15 were offered individually tailored therapy. The HTRYP who were more deprived compared to the CMHT matched sample ( n = 115), experienced a higher median number of mental disorders ( n = 3 compared to CMHT n = 1), higher severity scores and lower levels of social function ( HTRYP Ho NOSCA mean: 19.1 (95% CI 15.9-22.2) and CMHT mean: 11.2 (95% CI 2.0-23.0) p = <.001, and HTRYP CGAS mean: 51.0 (95% CI 46.0-56.2) and CMHT mean: 58.9 (95% CI 52.9-64.8), p = .05). The HTRYP made significantly greater improvement compared to CMHTYP; (Ho NOSCA p = <.001 and CGAS p = <.002) at discharge. A total of 13 HTRYP and 9 CMHT YP attended the follow-up review at 24 months. There was substantial variability in terms of social function between the YP within each sample. Conclusions The term ' HTR' describes a state that may be often temporary, as opposed to lifelong. A bespoke service offering a developmental theoretical framework, regular reviews and an individualised care plan, was able to engage and had the potential to reduce morbidity suffered by HTRYP. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore how social housing providers could respond to residents living with dementia in non-specialist housing.Design/methodology/approach A research framework was developed from published material and used to assess how dementia friendly a national housing provider was, and what could be different. Electronic surveys were completed by 209 members of staff; semi-structured interviews with 18 senior managers and an external contractor; a customer focus group with five residents. A literature review and telephone interviews with housing providers identified current areas of innovation and good practice which informed the research recommendations.Findings There are ways a non-specialist social housing provider can develop dementia friendly services through developing a customer focused approach, staff awareness raising and training, and through working collaboratively with specialist statutory and non-statutory services across health and social care. These have the potential to impact positively on the quality of life of residents with dementia or caring for people with dementia.Practical implications Social housing providers should be considering their older residents, and how they can design and develop services to respond to specific needs.Originality/value There is limited understanding of how mainstream housing providers could and should develop an offer for their residents living with dementia. This research provides an assessment approach and has developed ideas about what this offer could look like. [ABSTRACT FROM AUTHOR]

A significant proportion of men suffer side effects and are acknowledged to have unmet physical, functional and psychological needs after prostate cancer treatment. A nurse-led survivorship programme was implemented at Newcastle upon Tyne Hospitals NHS Foundation Trust for men with prostate cancer. This article describes implementation of the model and presents the results of an early evaluation to assess its impact. In the first 6 months 169 men (90% of those invited) engaged in the survivorship programme. Holistic needs assessments in particular were found to be invaluable for addressing individual men's needs and signposting them to relevant services. Collaboration between existing organisations and initiatives across primary and secondary care resulted in the establishment of a comprehensive network of services available to men on the programme. The nurse-led Newcastle survivorship model has been able to deliver individualised survivorship care with a high satisfaction rating within routine NHS practice. [ABSTRACT FROM AUTHOR]

Purpose – National treatment guidelines regarding Borderline Personality Disorder (BPD) (National Institute for Health and Clinical Excellence, 2009) make a number of recommendations relating to system and cultural treatment variables including: access to services, autonomy and choice, developing an optimistic and trusting relationship and managing endings and transitions. The purpose of this paper is to look at a model which could help organisational effectiveness across a range of service settings in relation to personality disorder. Design/methodology/approach – Explanation of why the McKinsey 7S organisational model (Waterman et al., 1980) may be useful in assessing organisational effectiveness in relation to personality disorder. Findings – Cultural and organisational factors across a range of levels need to be aligned to allow for effective service delivery. This is particularly important in working with this client group where strong emotional reactions and subsequent organisational splits are common. Practical implications – The application of this tool within clinical leadership and service development would be particularly important for coherence within generalist (as opposed to specialist) settings. Originality/value – To the authors’ knowledge this analysis is unique as a review of NHS culture across a range of settings and discussion of the implications for service delivery for patients with BPD. [ABSTRACT FROM AUTHOR]

Objective: To examine the epidemiology of referrals to a specialist neurotrauma clinic and explore and highlight implications for clinical practice and service development for persons with head injury/traumatic brain injury (HI/TBI). Design and methods: A retrospective population-based cohort study of all referrals to a specialist neurotrauma clinic over a 9-year period. Data from a specialist head injury database (which included all persons presenting to hospital with traumatic brain injury) were analysed. Results: In total, 1235 new patients of all ages, severities of injury, both admitted and non-admitted were referred. Referrals have increased due to successful integration with new service developments and resulting optimization of resources. Conclusions: Data gathered from the cohort gives increased understanding of the characteristics and numbers of patients requiring rehabilitation and adds to the evidence-base. Integration with new and complementary service developments has optimized the function/aims of the clinic and enhanced its role in terms of patient service and outcome and as a research resource. The model provides principles which may be applied to planning, organizing and providing follow-up/rehabilitation services for HI/TBI. [ABSTRACT FROM AUTHOR]

Background: The Supported Discharge Service (SDS) is a model of enhanced care in the community for adolescents after inpatient discharge. Methods: This study comprised the first 20 patients referred to SDS, largely those with delayed discharges. Service use and clinical outcomes were collected and predictors of total contact time were investigated. Results: Significant improvements had been made with SDS. Higher baseline Strengths and Difficulties Questionnaire (SDQ) conduct scores were associated with less contact time. Conclusions: SDS is a feasible model of care. Adolescents with conduct problems may benefit from engagement strategies. Further rigorous evaluation of the model is required. [ABSTRACT FROM AUTHOR]

Background The 2012 Health and Social Care Act in England replaced primary care trusts with clinical commissioning groups (CCGs) as the main purchasing organisations. These new organisations are GP-led, and it was claimed that this increased clinical input would significantly improve commissioning practice. Aim To explore some of the key assumptions underpinning CCGs, and to examine the claim that GPs bring 'added value' to commissioning. Design and setting In-depth interviews with clinicians and managers across seven CCGs in England between April and September 2013. Method A total of 40 clinicians and managers were interviewed. Interviews focused on the perceived 'added value' that GPs bring to commissioning. Results Claims to GP 'added value' centred on their intimate knowledge of their patients. It was argued that this detailed and concrete knowledge improves service design and that a close working relationship between GPs and managers strengthens the ability of managers to negotiate. However, responders also expressed concerns about the large workload that they face and about the difficulty in engaging with the wider body of GPs. Conclusion GPs have been involved in commissioning in many ways since fundholding in the 1990s, and claims such as these are not new. The key question is whether these new organisations better support and enable the effective use of this knowledge. Furthermore, emphasis on experiential knowledge brings with it concerns about representativeness and the extent to which other voices are heard. Finally, the implicit privileging of GPs' personal knowledge ahead of systematic public health intelligence also requires exploration. [ABSTRACT FROM AUTHOR]

There has been a significant increase in the volume of referrals from general dentists to hospital oral surgery services over the last decade in England. The referral rate also varies between dentists and the referral systems need to become more sophisticated to understand demand and support needs led commissioning of services. Aim 1. Examine received referrals for hospital oral surgery and explore the reasons for selection to consultant led hospital-based care or specialist primary care. 2. Determine the minimum data set required for the triager to make decisions for selection. Materials and methods Central capture and clinical triage of all referral letters received by the Oral Surgery department of a University Hospital. Results One thousand eight hundred and eighty-five letters were triaged. Nineteen per cent were deflected to primary care including 2% for postgraduate training. Reasons for secondary care triage were anticipated surgical difficulty (43%), teaching and training (21%), need for general anaesthesia (16%), medical co-morbidities (8%), other indicators (8%) and psychosocial (4%). Conclusions The introduction of a central triage system produced a significant amount of data and highlighted several important issues around decision-making that need to be addressed for future development of the system. The study demonstrated that it is possible to direct a significant proportion of referrals to primary care that were destined for hospital consultant management. However, no account was taken of the quality of the care provided. Review of teaching and training systems in the future can and will be better informed by interrogation of intelligence from a more sophisticated and consistent needs assessment. [ABSTRACT FROM AUTHOR]

Aims and objectives To clarify by consensus the professional and patient views of expected treatment outcomes for chronic obstructive pulmonary disease and to compare the similarities and differences and identify the potential for adjusting service delivery. Background Chronic obstructive pulmonary disease is an under-researched topic necessary to illuminate health planning, and patient partnership needs in the UK clinical screening is low priority for this condition. Government policy expects that service users are involved in planning services for their condition, but few opportunities exist for this process. Design A feasibility study in two phases conducted three service user focus groups and one specialist professional group to provide statements of expected treatment outcomes from chronic obstructive pulmonary disease interventions. The statements then formed a further two-round Delphi structured survey to compare service users' and carers' views with those of specialist professionals to ascertain what differences could be developed in service delivery for people with chronic obstructive pulmonary disease. Methods Three rounds of Delphi survey were administered. Round 1: Specialist professionals and patients with chronic obstructive pulmonary disease ranked statements using nominal group technique. A nine-point scale Delphi consensus study used the statements in two further rounds. Results Twenty-four of 54 professionals contacted, and 52 of 152 patients and carers completed Delphi rounds 2 and 3. Consensus was found within and between both groups. The greatest difference was where professionals sought government targets and did not realise patient expectations, which were constrained by policy disincentives. The greatest agreement was for accurate record keeping and the need for revised chronic obstructive pulmonary disease services. Conclusions Patients consider that services should support them to retain their independence and enable their adaptation to the condition. Relevance to clinical practice Health professionals aim to provide patient focused care based on need. This helps improve outcomes of interventions. Patients are willing and able if supported to increase independence and maintain self-help. [ABSTRACT FROM AUTHOR]

Background: With recent changes in the economy and the drive for cost-effective health care, current practices in the NHS need to be reviewed and revised. In light of this, the aim of this study is to investigate the perceived benefits of routine follow-up of patients with prostate cancer and to examine perceptions of prostate cancer patients and health professionals about who should follow-up patients and where and when this should take place. Methods: A service evaluation was carried out on a sample of patients receiving follow-up assessment following radical treatment for prostate cancer and health professionals in a specialist cancer urology unit in an acute NHS trust in southeast England. Data were collected through patient (n=47) and health professional (n=17) questionnaires and through a group discussion with a sample of patients (n=52). Results: There was agreement between patients and professionals that the main purpose of followup consultation was to review the prostate-specific antigen (PSA) blood test and assess urinary symptoms. The majority of patients and professionals wanted follow-up in the hospital with face-to-face consultation. There was general agreement that assessments should be carried out every six months. An overwhelming majority of patients (95%) felt that it was important to have easy access to the urology cancer nurses and doctors. Conclusion: Patients want to maintain the traditional model of hospital based follow-up in specialist urology cancer clinics. However, this approach is not economically sustainable. If this is to change we need to work with our patients to develop a service that meets their needs. For a new approach to follow-up to meet the needs of patients, they need to be confident that they have access to expert advice and support, and are assured of referral back to the urology team if required. Nurses are ideally placed to play a key role in the development of such a service. [ABSTRACT FROM AUTHOR]

A National Deaf Child and Adolescent Mental Health Service (CAMHS) was launched in England in October 2009. This new service commissioned by the National Commissioning Group was centrally funded after a successful pilot between 2004 and 2009 that was evaluated positively by the Social Policy Research Unit at York University in England using both qualitative and quantitative research. The new service has four main centres in London, York, Dudley and Taunton. Staff from these centres work into six additional local CAMHS centres to give good geographical coverage. These are based in: Newcastle; Manchester; Cambridge; Maidstone; Oxford; and Nottingham. The service provides assessment and interventions for severe to profoundly deaf children and young people with serious child mental health problems. The service uses innovative communication technologies such as teleconferencing, texting and webcam as well as traditional provision of clinical services in clinics, home and school visits. Users and carers will have an ongoing say in service development. [ABSTRACT FROM AUTHOR]

Purpose -- The aim of this article is to critically review the Autism Strategy and to discuss its implications. Design/methodology/approach -- This is a and critical review of the Autism Strategy and its implementation. This includes discussion of the political context, reactions to the strategy by stakeholders, economic considerations, equity, integration across health and social care and the role of diagnostic services and specialist interventions. Findings -- The Autism Strategy Fulfilling and Rewarding Lives was published in 2010. It aimed to increase awareness of autism, establish clear pathways for diagnosis and needs assessment, promote independent living and access to work, and help the development of local services. It focuses on intended outcomes, is not prescriptive about how those aims are achieved, and relies on existing legislation such as the Disability Discrimination Act. The emphasis on accessing mainstream services may limit the development of appropriate specialist services, especially in the current economic climate. Specialist interventions that may follow diagnosis are not prioritised, even though the economic case for them has been well made by the Audit Commission. Although the Department of Health has produced "outcomes and ambitions" to measure implementation of the Strategy, local authorities are not required to measure themselves against these targets or publish their results. However , organisations such as the National Autistic Society have already developed training materials to help with implementation, and the NICE guidelines for adults with autism due in 2012 may help the development of better services. Originality/value -- This article provides new insights into the implications of the strategy for service users, service managers and healthcare professionals. Although the strategy applies to England only, the principles are of interest to stakeholders in other countries. [ABSTRACT FROM AUTHOR]

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Purpose - The purpose of this paper is to obtain an insight into how mental health and alcohol services are responding to people presenting with alcohol and mental health problems, as a part of a wider North West Alcohol and Mental Health Project commissioned by Drink Wise North West and Alcohol Improvement Programme (Department of Health).Design/methodology/approach - An electronic survey was sent to managers and clinical leads in mental health and alcohol services across the North West region of England.Findings - The paper found a variation in definitions of dual diagnosis and that not all areas had a strategy in place. NHS mental health and alcohol services seemed to offer a wider range of treatment options; but, this reflects the more complex nature of the service users. Workforce issues were identified as an important issue. Barriers to accessing effective care included lack of agreements between local agencies, and solutions included greater partnership working.Research limitations/implications - This was a small sample of respondents, accessed opportunistically and, therefore, unlikely to be a true representation of all services in the North West of England.Originality/value - Whilst limited in scope, this survey highlights that even after ten years of service development related to alcohol and mental health, there are still significant barriers to effective care and that more workforce development and multi-agency collaboration is required. [ABSTRACT FROM AUTHOR]

Introduction: This research has considered current developments in the provision of services for people with long-term conditions within the NHS of England. Community Matrons are being employed and by adopting a case management approach they are aiming to improve patient care and reduce their demands for acute hospital care. Description: Qualitative research was undertaken to explore experiences of community matrons and service leads on the development, implementation and provision of services for people with long-term conditions. Conclusions: This research provides evidence of what is being done to meet the challenge of long-term conditions and provides lessons for similar challenges and service development for different areas of care and in other countries. Continual system and role change has had effects on service delivery and on the whole care. These effects relate to; defining the role of community matron and structure of service, training staff, identifying patients, providing infrastructure, demonstrating benefits, identifying gaps in services, ability to reduce avoidable admissions and identifying the advantages and difficulties of the role. Discussion: All of these aspects should be used to inform future development. [ABSTRACT FROM AUTHOR]

This paper describes and discusses the evaluation of an innovative child and adolescent mental health project located in a large county in eastern England. The project was one of eight located in the voluntary sector and supported by the Mental Health Foundation as part of a national initiative aimed at responding in new, accessible ways to young people requiring help for emotional and mental health problems. Traditional specialist CAMH services are overwhelmed by demand while also failing to engage many young people. This study provides evidence of how new services can develop to meet the needs of troubled young people in appropriate and acceptable ways. [ABSTRACT FROM AUTHOR]

Introduction: The chest x-ray (CXR) is the most commonly performed x-ray examination in England, UK. Reporting radiographers provide a cost-effective and safe solution for managing CXR backlogs, but not all Trusts support this service development. This study aimed to establish the service enablers and challenges associated with training and employing radiographers to report CXR images in acute hospital sites in England, UK., Methods: Approval for this electronic survey was granted in 84 of 146 (58%) Trusts approached. The survey was open for 10 weeks during August to October 2020, comprising of qualitative and quantitative questions. Data was exported in to an Excel spreadsheet where manual thematic analysis was performed. Descriptive statistics were also generated., Results: Sample size was 75 (89% response rate). Thirty-three departments (44%) had at least one trainee. Most departments (n = 53, 71%) employ at least one CXR reporting radiographer. A total of 121/160 (76%) radiographers report CXRs. Number of reporting sessions shows progression. Factors enabling training and employment arise from service improvements, financial pressures, and developing the workforce. The main challenges relate to staffing issues with a number of associated sub-themes. A small faction indicated lack of radiographer interest to report CXRs due to litigation worries; possibly uncovering a new and emerging issue., Conclusion: Enablers and challenges associated with radiographers reporting CXRs are similar to previous studies. The growth of CXR reporting radiographers and reporting sessions indicates a continuing reliance on radiographers to contributing to managing CXR backlogs., Implications for Practice: It is recommended that potential trainees are explicitly informed of the legal protection that will be provided, to prevent accountability concerns impacting on the continuing progression in this area of advanced practice., Competing Interests: Conflict of interest statement None., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

This article describes and comments upon the process of developing the Sanctuary project in London, a project that will provide two community-based crisis support services for African and African-Caribbean women and men in mental crisis and distress. This initiative is informed by the extensive research documenting the ways in which mainstream, mental health services fail Black people, and by evidence suggesting that innovations in service provision for Black people are often vulnerable and limited in their impact. In an effort to avoid replicating these problems, considerable emphasis has been given to developing the project in partnership with the main stakeholders—in this instance statutory and Black voluntary sector agencies as well as Black users, caters and community members. Within this context, issues relating to inequalities can be proactively addressed, thereby reducing the risk that they undermine the effectiveness of service provision at a later stage. However, working in partnership can also hinder or delay service developments if discussions between stakeholders become protracted or conflicts unresolved. The author draws on experience gained from this project to identify the potential as well as the difficulties of using a partnership approach to developing effective Black mental health provision. The author's role in the development of these projects has been as representative of one of the partners, the King's Fund Centre for Development. [ABSTRACT FROM AUTHOR]

This paper describes the development of a new assessment service in Southampton for children with autism and related disorders. The evolution of the service is described and the multidisciplinary assessment process is outlined. The response of families to the service is evaluated and the current status of the service is examined critically. The importance of forging good working links with other local services for children is emphasised. [ABSTRACT FROM AUTHOR]

This paper presents an analysis of the first 81 cases seen in the recently established assessment service for children with autism and related disorders in Southampton. The children presenting for assessment are described in terms of a number of biographical, educational, behavioural, and medical features and the characteristics of our sample are compared with published findings. The future development of the service is considered in the light of current developments and common features and concerns of the families seen. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of computer-assisted interview compared with pen and paper on disclosure of sexual behaviour, diagnostic testing by clinicians, infections diagnosed and referral for counselling. Methods: Two-centre parallel three-arm randomised controlled open trial. Computer-generated randomisation with allocation concealment using sealed envelopes. Setting: Two London teaching hospital sexual health clinics. Participants: 2351 clinic attenders over the age of 16 years. Interventions: Computer-assisted self-interview (CASI). Computer-assisted personal interview (CAPI). Pen and paper interview (PAPI). Main Outcome Measures: Diagnostic tests ordered, sexually transmitted infections (STI). Secondary Outcomes: Disclosure of sexual risk, referral for counselling. Results: 801, 763 and 787 patients randomly allocated to receive CASI, CAPI and PAPI. 795, 744 and 779 were available for intention-to-treat analysis. Significantly more diagnostic testing for hepatitis B and C and rectal samples in the CAPI arm (odds for more testing relative to PAPI 1.32; 95% CI 1.09 to 1.59). This pattern was not seen among CASI patients. HIV testing was significantly lower among CASI patients (odds for less testing relative to PAPI 0.73; 95% CI 0.59 to 0.90). STI diagnoses were not significantly different by trial arm. A summary measure of seven prespecified sensitive behaviours found greater reporting with CASI (OR 1.4; 95% CI 1.2 to 1.6) and CAPI (OR 1.4; 95% CI 1.2 to 1.7) compared with PAPI. Conclusion: CASI and CAPI can generate greater recording of risky behaviour than traditional PAPI. Increased disclosure did not increase STI diagnoses. Safeguards may be needed to ensure that clinicians are prompted to act upon disclosures made during self-interview. [ABSTRACT FROM AUTHOR]