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Background: The health-care community has a responsibility to address the environmental impact of delivering health-care services. Educational programmes present ideal fora to confer 'environmental competencies' to future health system leaders, managers, practitioners and researchers. The aim of this review is to synthesise the literature on health-care competencies, education and training of relevance to issues of environmental sustainability and climate change in the health sector. Methods: We conducted a systematic review of English language articles on environmental competencies in healthcare in the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ProQuest databases published from inception to April 2019. Thematic analysis and descriptive statistics were used to synthesise the findings and develop a typology of environmental competencies. Results: Of the 902 unique citations, we identified 23 articles that met our inclusion criteria. Environmental competencies that align with general management skills were most frequent (40%), followed by research skills (37%). Three competencies specific to the environment (22%) were identified: resource stewardship (n = 16), systems thinking (n = 14) and social and environmental justice (n = 7). The majority of work was identified in nursing, medicine and public health. Competencies were most commonly embedded in existing curricula or offered as new courses or workshops. Conclusion: Incorporating environmental competencies into education programmes will serve to raise awareness of, and advance the significance of, the health sector's impact on climate change and environmental sustainability. Our findings that environmental competencies align with previously validated health-care competencies support the perspective that these competencies represent essential knowledge and skills for the health-care workforce.

Carers of people with dementia can experience reduced health and well‐being, but little is known about how best to support them. There is some evidence to suggest that case management may improve outcomes for carers but less evidence about the features of case management services that can effectively support carers of people with dementia. Admiral Nursing operates a case management approach staffed by specialist nurses and is the only service of its kind in the United Kingdom dedicated to helping people with dementia and their carers. This paper reports qualitative findings from a mixed methods study of Admiral Nursing. For the qualitative strand of the project, data were collected in focus groups and in‐depth interviews with carers of people with dementia (n = 35) and analysed thematically using the framework approach. The aim of this analysis was to understand differences between the experiences of the carers in our sample with and without Admiral Nursing, applying Freeman's model of continuity of care (Freeman et al., Continuity of care, 2000). Participants who had received Admiral Nursing were recruited from two geographical locations and carers without experience of this service were recruited from two different areas. We found that carers in our sample felt 'supported' in circumstances where they received an ongoing service from an Admiral Nurse or other professional with expertise in dementia who was able to develop a meaningful relationship with them over time. We conclude that ongoing support, expertise in dementia and a meaningful relationship are key features of relationship continuity common in carers' reports of feeling supported. Specialist nurses are well placed to provide this continuity. [ABSTRACT FROM AUTHOR]

Objective: To update a 2010 meta-review of systematic reviews of effective interventions to support carers of ill, disabled, or older adults. In this article, we report the most promising interventions based on the best available evidence. Methods: Rapid meta-review of systematic reviews published from January 2009 to 2016. Results: Sixty-one systematic reviews were included (27 high quality, 25 medium quality, and nine low quality). The quality of reviews has improved since the original review, but primary studies remain limited in quality and quantity. Fourteen high quality reviews focused on carers of people with dementia, four on carers of those with cancer, four on carers of people with stroke, three on carers of those at the end of life with various conditions, and two on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasizing psychosocial or psychoeducational content, education and training. Improved outcomes for carers were reported for mental health, burden and stress, and wellbeing or quality of life. Negative effects were reported in reviews of respite care. As with earlier work, we found little robust evidence on the cost-effectiveness of reviewed interventions. Conclusions: There is no 'one size fits all' intervention to support carers. There is potential for effective support in specific groups of carers, such as shared learning, cognitive reframing, meditation, and computer-delivered psychosocial support for carers of people with dementia. For carers of people with cancer, effective support may include psychosocial interventions, art therapy, and counselling. Carers of people with stroke may also benefit from counselling. More good quality, theory-based, primary research is needed. [ABSTRACT FROM AUTHOR]

Background: Personal budgets are a key policy priority in adult social care in England and are expected to become increasingly important in the care of adults with mental health problems. Aims: This article systematically reviews evidence for the effectiveness of personal budgets for people with mental health problems across diverse outcomes. Methods: The review, conducted in 2013, used the EPPI-Centre methodology for conducting a systematic review informed by Social Care Institute for Excellence guidelines. Data were extracted from studies and combined using meta-synthesis. Results: Fifteen studies were included in the review which found mostly positive outcomes in terms of choice and control, quality of life, service use and cost-effectiveness. However, methodological limitations make these findings rather unreliable and insufficient to inform personal budgets policy and practice for mental health service users. Conclusions: Further high quality studies are required to inform policy and practice for mental health service users, which lags behind other adult social care groups in the use of personal budgets. [ABSTRACT FROM AUTHOR]

Health and social care systems experience difficulty in delivering the continuity of care that service users want. Lack of clarity about what continuity means hinders service organisation and delivery. The NIHR Service Delivery and Organisation programme funded a series of research projects to tackle this conceptual confusion, and subsequently commissioned a review of the projects' outputs. The aim was to assess how the projects had progressed conceptualisation and measurement of continuity, and increased knowledge about what influenced it. This paper concentrates on two questions: what is continuity of care, and what influences it? We reviewed the projects' outputs and extracted data using techniques adapted from systematic reviewing methods. We treated the outputs as 'transcripts' and used the Framework approach to qualitative analysis to handle them. This maintained the coherence of individual projects while allowing cross-project themes to emerge. We then produced a narrative synthesis of findings. Service users and carers valued good relationships with professionals; this did not always mean seeing the same person and encompassed trust, the professional's style and communication skills, and the time made available. Service users and carers also valued understanding the patient's condition and treatment. This went beyond giving information, to include communication that recognised individuals' capacities and that was skilled, given sufficient time, and from a trusted source. Service users valued co-ordination between professionals and services; this covered communication, planning, and services' storage and use of information about them. Co-ordination with carers and others was also important. Experiences of continuity were influenced by service users' characteristics and circumstances, care trajectories, the structure and administration of services, professionals' characteristics, carer participation, the wider context of the 'whole person' and satisfaction. The review highlighted how service users, carers and professionals construct continuity dynamically between themselves. This has implications for both professional training and service users' expectations. [ABSTRACT FROM AUTHOR]

Current health policy in England regarding the management of childhood illness advocates for care to be delivered as close to home as possible. The aim of this article is to report findings from a qualitative component of a larger study evaluating models of care closer to home (CCTH) for children and young people who are ill. The focus is on parents' psychosocial experience of receiving CCTH for their ill child. A qualitative case study design was used, with four Primary Care Trusts in England as the case study sites. In-depth, semi-structured interviews were conducted with 27 parents and one extended family caregiver of children using CCTH services within the case study sites. Interviews were conducted face-to-face and audio-recorded with permission. Data were collected in 2009. There was an overall preference for CCTH over hospital-based care where possible. The parents in this study experienced differing levels of responsibility as part of this care, and responded to this in different ways. Being supported emotionally and socially by practitioners was an important part of receiving CCTH for parents, especially when they had increased responsibility as part of this care. Developing relationships with practitioners appeared to be a medium through which parents received support. If the provision of CCTH continues to expand in line with current policy, provision of support for parents should be considered a fundamental aspect of service development. [ABSTRACT FROM AUTHOR]

Introduction: Long-term neurological conditions are a major cause of disability in the UK and internationally. Their successful management, in order to enhance health and well-being, requires both sophisticated organisation across a number of health, social care and other service boundaries, and the real involvement of people with neurological conditions and members of their support networks. Policy development: This paper reports on part of the preliminary scoping phase of a study designed to evaluate the impact of the National Service Framework for long-term neurological conditions on integrated care. It describes current policies in England and reports on discussions with a range of people involved in the planning, provision or use of services, which took place during the scoping exercise. These interviews inform how policy affecting people with long-term neurological conditions has been received and implemented so far. Conclusion and discussion: Findings suggest that progress towards integrated service provision is patchy and slow. In the competing priorities within government policy, neurological conditions have tended to be marginalised, within healthcare policy generally and in initiatives to support people with long-term conditions in particular. The reasons for this are explored and will inform the next stages of the research. [ABSTRACT FROM AUTHOR]

Several studies have used secondary data sources in order to learn about outcomes for adults who have been in contact with the care system in childhood. This article discusses two of the large-scale longitudinal datasets in the UK that are available to researchers and which include information on adults who were looked after in childhood: The National Child Developmental Study (NCDS) and The British Cohort Study (BCS70). These databases are considered to be among the best sources available to investigate long-term outcomes for looked-after children in the UK. This article describes these databases and the use made of them by researchers exploring the life chances of looked-after children. It also identifies the advantages as well as the limitations of these datasets and presents implications for this field of research. [ABSTRACT FROM AUTHOR]

Objective: To review systematically randomized trials (RCTs) on the effectiveness and costs of paediatric home care. Methods: National Health Service (NHS) Centre for Reviews and Dissemination guidelines were followed. In all, 20 electronic and other sources were searched, using specially designed strategies. Economic studies and other selected designs were included, but only RCT findings – on service use, clinical outcomes, costs, and impact on the family – are reported here. Analysis is descriptive, with pooled standard mean differences used where meta-analysis was possible. Results: About 1730 identified records up to August 2001 were potentially relevant. In all, 10 RCTs (24 papers) were finally included, covering five types of paediatric home care – for very low birth weight or medically 'fragile' infants, for asthma or diabetes, for technology-dependent children, for mental health, and generic home care. Paediatric home care may enhance physical and mental development for very low birth weight infants and may be cheaper but the evidence is not strong. Home care for diabetes or asthma may reduce parents' costs with some clinical but no social differences noticeable. No randomized trials for technologically dependent children were found. Home care for mental health may increase parental satisfaction with services and reduce some health service and residential care costs. Generic home care showed no clinical effects at early follow-up. Partial follow-up after five years suggested improved psychological adjustment. No cost data were available for this care model. Conclusions: Despite recent expansion, research evidence from randomized trials for paediatric home care is slight, and methods used are weak in places. Paediatric home care poses practical and ethical questions that cannot be addressed by RCTs. [ABSTRACT FROM AUTHOR]

Focuses on the policy changes in community health and social care funding in Great Britain. Transfer of resources from the security budget to local authorities; Objectives for the changes; Impact of the issue on hospital admissions.