Search

The National Service Framework (NSF) for Mental Health in 1999 was central to the modernisation of mental health services under the New Labour government of 1997. It placed an emphasis on universal clinical standards and set out a vision for service developments over the next 10 years. One such proposal was the development of crisis resolution teams, aimed at reducing the psychiatric admissions rate by providing care at home. This article provides a critical analysis of policies relating to the provision of 24-hour access to mental health services, focusing on the specifications for creating crisis resolution teams, as laid out in the NSF for Mental Health and the NHS Plan. First, it looks at the historical context surrounding the policy, examining the content of the NSF and NHS plan and how policy was disseminated and implemented nationally and locally. Then it examines the effects and changes this policy brought about and, specifically, whether it has achieved its aims of reducing the nationwide acute psychiatric inpatient admission rate. [ABSTRACT FROM AUTHOR]

Aspinal F., Gridley K., Bernard S. & Parker G. (2012) Promoting continuity of care for people with long-term neurological conditions: the role of the neurology nurse specialist. Journal of Advanced Nursing 68(10), 2309-2319. Abstract Aims. To identify service models that provided care co-ordination for people with long-term neurological conditions in the UK. Background. The successful management of long-term neurological conditions needs sophisticated management across several health, social care and other service boundaries, as well as involvement of people with long-term neurological conditions and their support network. Yet, fragmentation of, and limited access to, support has been evident for over 20 years. Design. This study employed a mixed-method approach, including a systematic review, qualitative case studies and a quantitative national survey. This paper reports findings from the qualitative case study element of the research. Methods. In-depth (qualitative) case studies were conducted in six neurology 'service systems' in the UK representing geographic and demographic diversity. The research took place between November 2007-May 2008. The concept of 'continuity of care' was used as a framework for our case studies. Qualitative methods, including telephone and face-to-face interviews, were used to explore people's experience of continuity of care. Data were managed and analyzed using the Framework technique. Findings. Neurology nurse specialists were able to contribute to all elements of continuity of care for people with long-term neurological conditions. Conclusion. Their specialist knowledge about the condition and local services, flexibility, co-ordinating role, and their holistic and collaborative approach to practice, are key factors in nurse specialists promoting continuity of care. Nurse specialists exist in many different clinical areas and in many countries. Findings about the importance of their role in promoting continuity of care have important implications for UK and international policy and practice. [ABSTRACT FROM AUTHOR]

Leg ulcers are common and costly to treat, and the quality of care provided to patients with this condition varies widely across the UK. The introduction of specialized community-based leg ulcer clinics in Gloucestershire has been associated with increased ulcer healing rates and decreased rates of ulcer recurrence, but this model of care has not been widely replicated. One way of ending this 'postcode lottery' is to produce a National Service Framework for leg ulcers, with the aim of delivering high-quality evidence-based care via such clinics under the supervision of local consultant vascular surgeons. Existing National Service Frameworks cover a range of common conditions that are, like leg ulceration, associated with significant morbidity, disability and resource use. These documents aim to raise quality and decrease regional variations in health care across the National Health Service, and leg ulceration fulfils all the necessary criteria for inclusion in a National Service Framework. Centrally defined standards of care for patients with leg ulceration, and the reorganization and restructuring of local services to allow the accurate assessment and treatment of such patients are required. Without a National Service Framework to drive up the quality of care across the country, the treatment of patients with leg ulcers will remain suboptimal for the majority of those who suffer from this common and debilitating condition. [ABSTRACT FROM AUTHOR]

The National Service Framework (NSF) for Diabetes was developed by the UK government to tackle variations in care for patients with diabetes. This article critically analyses the impact of this policy and its effect on health care, focusing specifically on Standard 3 of the NSF. This standard discusses patient empowerment and involving patients in their own care. A number of education programmes have been set up to empower patients to better manage their diabetes, and two of these are explored in detail: Dose Adjustment for Normal Eating (DAFNE) and Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND). Research has shown however, that many people are not aware of these initiatives, suggesting that more needs The National Service Framework (NSF) for Diabetes was developed by the UK government to tackle variations in care for patients with diabetes. This article critically analyses the impact of this policy and its effect on health care, focusing specifically on Standard 3 of the NSF. This standard discusses patient empowerment and involving patients in their own care. A number of education programmes have been set up to empower patients to better manage their diabetes, and two of these are explored in detail: Dose Adjustment for Normal Eating (DAFNE) and Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND). Research has shown however, that many people are not aware of these initiatives, suggesting that more needs to be done to ensure that patients, nurses and other health professionals are aware of the services available for people with diabetes in the community. Furthermore, research suggests that there is a lack of emotional and psychological support for patients living with this chronic condition. It is suggested here that nurses can provide patients with this support, as well as with information to help them access services to manage their diabetes. This, together with education about diet and exercise, and appropriate referrals, will enable the nurse to ensure that all patients receive high-quality care. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is common, harmful and treatable but has, until recently not been recognised in its early stages. The British National Health Service (NHS) provides a unique opportunity to study CKD because it is in effect a closed-managed care system. This single healthcare system for the United Kingdom is funded by the Government and paid for by general taxation. All UK citizens are registered with primary care physicians who control access to secondary care services. As a managed care system it should be able to offer integrated care across the whole patient pathway—allowing early identification of CKD, interventions to reduce risk and prompt management of complications. In reality, there are professional, organisational and institutional barriers to coordination and delivery of care in the NHS. The establishment of general-practice-based disease registers linked to a quality and outcomes framework in 2004 provides a basis for implementing the chronic disease model of care. The publication of the National Service Framework for renal services complemented by these changes in primary care has resulted in a paradigm shift from kidney disease being viewed as a secondary care condition to being a primary care priority as part of vascular control and management. In the first two years of the initiative, over 40% of the expected CKD stage 3 to 5 population has been registered in primary care. Kidney disease is now recognised as a public health problem in the United Kingdom, preventative strategies are being integrated into comprehensive vascular risk assessments and management programmes and kidney disease has become an NHS priority area. [ABSTRACT FROM AUTHOR]

Patients with long-term neurological conditions are highly dependent on registered nurses and healthcare assistants for care. This article highlights some of the issues nurses face in providing care to patients with long-term neurological conditions. A synopsis is given of a study currently underway, which is considering these issues. The study aims to explore the education and training requirements of registered nurses and health care assistants in providing care for adults with complex neurological conditions. During the 3-year study, data are being obtained from registered nurses, health-care assistants, and allied health professionals working with adults affected by complex neurological conditions, and from their relatives and families. The results of this study will be the subject of a future paper. It is anticipated that by addressing nursing education requirements in this speciality area, future nursing practice will be improved for this patient group, thus contributing to improved quality of life. [ABSTRACT FROM AUTHOR]

The great majority of patients starting renal replacement therapy (RRT) have progressed from earlier stages of chronic kidney disease (CKD): most could therefore have been identified earlier, with possible improvements in outcome. Although end-stage renal disease (ESRD) is relatively rare, treatment with dialysis or transplantation is very expensive, currently costing over 2 % of the total National Health Service (NHS) budget. Any improvement in the early identification and management of CKD is therefore highly desirable. Recent years have seen kidney disease move up the health-political agenda in the United Kingdom (UK). This process began with the publication of the National Service Framework (NSF) for Renal Services, which was underpinned by UK guidelines for the identification, management and referral of CKD in adults. Implementation of these strategies was encouraged by a national roll-out of estimated glomerular filtration rate (eGFR) reporting and by paying primary care physicians an incentive to identify CKD through the inclusion of a renal domain in the Quality and Outcomes Framework (QOF). National variation in eGFR reporting was addressed through a UK National External Quality Assessment Scheme (UKNEQAS) 'harmonization' process. In autumn 2008, it is anticipated that the National Institute for Health and Clinical Excellence (NICE) will publish its clinical guidelines on CKD. [ABSTRACT FROM AUTHOR]

Aims To identify the views and working practices of consultant diabetologists in the UK in 2006–2007, the current provision of specialist services, and to examine changes since 2000. Methods All 592 UK consultant diabetologists were invited to participate in an on-line survey. Quantitative and qualitative analyses of responses were undertaken. A composite ‘well-resourced service score’ was calculated. In addition to an analysis of all respondents, a sub-analysis was undertaken, comparing localities represented both in 2006/2007 and in 2000. Results In 2006/2007, a 49% response rate was achieved, representing 50% of acute National Health Service Trusts. Staffing levels had improved, but remained below recommendations made in 2000. Ten percent of specialist services were still provided by single-handed consultants, especially in Northern Ireland (in 50% of responses, P = 0.001 vs. other nations). Antenatal, joint adult–paediatric and ophthalmology sub-specialist diabetes services and availability of biochemical tests had improved since 2000, but access to psychology services had declined. Almost 90% of consultants had no clinical engagement in providing community diabetes services. The ‘well-resourced service score’ had not improved since 2000. There was continued evidence of disparity in resources between the nations (lowest in Wales and Northern Ireland, P = 0.007), between regions in England (lowest in the East Midlands and the Eastern regions, P = 0.028), and in centres with a single-handed consultant service ( P = 0.001). Job satisfaction correlated with well-resourced service score ( P = 0.001). The main concerns and threats to specialist services were deficiencies in psychology access, inadequate staffing, lack of progress in commissioning, and the detrimental impact of central policy on specialist services. Conclusions There are continued disparities in specialist service provision. Without effective commissioning and adequate specialist team staffing, integrated diabetes care will remain unattainable in many regions, regardless of reconfigurations and alternative service models. [ABSTRACT FROM AUTHOR]

This paper explores developments in the risk management of coronary heart disease (CHD) that have followed the implementation of the Coronary Heart Disease National Service Framework (NSF) guidelines from the patient's perspective. The CHD NSF introduced in 2000 set national threshold targets for blood pressure and cholesterol levels for primary care managed patients, it also laid down guidelines for the clinical management of those patients deemed to be at 'high cardiac risk.' Additionally, following the implementation of the revised General Medical Services contract in 2003, financial incentives were introduced to encourage general practitioners to meet these national regulatory guidelines. This paper draws upon the outcomes of a series of focus group discussions with patients with current prescriptions for both hypercholesterolaemia and hypertension carried out in Scotland and South-East England. The findings suggest that many of the patients perceived the regular monitoring of their total serum cholesterol level and subsequent titration of statin therapy as being the primary method by which their heart disease was now to be clinically managed. Patient perceptions of their role in the self-management of their condition were frequently confined to compliance with their monitoring and medication regime. The paper concludes by arguing that, for many of the patients in the study, the implementation of this national cardiac risk management guidance has had the consequence, whether intended or not, of reinforcing a position of medical dependency. [ABSTRACT FROM AUTHOR]

This paper reviews local and national changes and progress in the care of head injuries over the past decade in the Eastern Region. [ABSTRACT FROM AUTHOR]

Practice development can be a local initiative, or it can be shaped by `top-down' policy agendas. Following the launch of a National Service Framework for Older People (NSF-OP) in England, a study was commissioned to examine the development of specialist services and staff for older people, one of the key recommendations of this policy. A two stage study was conducted, the first stage being a questionnaire in three parts to identify practice developments across a range of agencies, and the second to carry out case studies to identify processes in more detail. This paper reports on some of the findings from the first stage of the study, focusing on the data from National Health Services. This suggested that definitions of specialism are unclear and roles are ambiguous, which has implications for training and practice development. Other data, however, suggested that the development of services for older people was not simply a response to the NSF-OP, but had been in progress for variable lengths of time before this. [ABSTRACT FROM AUTHOR]

Study objective: UK government policy mandates the introduction of 'intermediate care services' to reduce emergency admissions to hospital from the population aged 75 years or more. We evaluated one of these initiatives--the Keep Well At Home (KWAH)--Project in a West London Primary Care Trust. Design: KWAH involves a two-phase screening process, including a home visit by a community nurse. We employed cohort methods to determine whether KWAH resulted in fewer emergency attendances and admissions to hospital in the target population, from October 1999 to December 2002. Results: estimated levels of coverage in the two phases of screening were 61 and 32%, respectively. The project had not maintained records of which additional health and social care services had been delivered following screening. The rates of emergency admissions to hospital in the 9 months before screening were similar in practices that did and did not join the project (rate ratio (RR) = 1.05; 95% CI 0.95-1.17), suggesting absence of volunteer bias. Over the first 37 months of the project, there was no significant impact on either attendances at Accident & Emergency departments (RR = 1.02; 95% CI 0.97-1.06) or emergency admissions of elderly patients (RR = 0.98; 95% CI 0.93-1.05). Conclusion: the KWAH Project has been ineffective in reducing emergency admissions among the elderly. Significant questions arise in relation to selection of the screening instruments, practicality of achieving higher coverage of the eligible population, and creation of a new postcode lottery. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is a preventable disease, yet is kills over 100000 people a year in the UK. CHD was among the first conditions to be addressed by a national service framework (NSF), published in 2000. Five years on, this article discusses the key tenets of the NSF that apply to primary care and how they should be being implemented, and discusses what else the Government is doing to tackle this common and costly condition. INSET: KEY POINTS. [ABSTRACT FROM AUTHOR]

Background: Heart failure has a poor prognosis, yet drugs known to improve outcomes are either not prescribed, or prescribed at sub-therapeutic doses. The National Service Framework (NSF) for coronary heart disease recommended specialist heart failure clinics to address this problem but their efficacy has not been evaluated. Objectives: To determine the effectiveness of a protocol-driven heart failure clinic staffed by nurse and pharmacist specialists for improving symptoms and optimising treatment with key therapeutic agents, without adversely affecting renal function. Results: Of the 234 patients with at least one follow-up visit, 127 (57%) were receiving none or only one key therapeutic agent when first seen, this was reduced to 25 patients (11%) at most recent follow-up. The improvement in prescription rates was accompanied by significant up-titration of dose, the proportion of patients on "medium" or "high" doses rising from 43 (18%) to 134 (57%) for beta-blockers, and from 129 (55%) to 201 (86%) for ACE-inhibitors/angiotensin receptor blockers. Clinical improvement was reflected in reductions in patients with NYHA functional classes III and IV (93 (40%) to 53 (23%)), and in patients with moderate or severe symptoms. Significant reductions in alcohol consumption and cigarette smoking were recorded. Up-titration of treatment was associated with reductions in heart rate and systolic blood pressure; increases in serum potassium and creatinine concentrations were small. Conclusion: In a heart failure clinic staffed by nurse and pharmacist specialists, it is possible to achieve target doses of key therapeutic agents and improve symptoms without adversely affecting electrolytes or renal function. [ABSTRACT FROM AUTHOR]

It is estimated that 200 million prescriptions for children and adolescents were issued in the UK during 2002. Therefore, it is important for the National Service Framework for Children (NSFC) to include advice on managing medicines effectively for children. This literature review was performed at the request of the NSFC Medicines External Working Group in order to provide underpinning evidence in the development of advice on managing medicines.Detabases, websites and conference abstracts were searched systematically to identify information on managing medicines in children in 2003. This article reported the results on medication review, concordance, enhanced medicines access through community pharmacy services and the use of medicines in schools.Although there is little evidence specific to paediatrics, the objectives and rationale of medication review could be expected to apply to chronic diseases in children. Issues such as polypharmacy, wastage, repeat prescriptions and medication problems could be similar. The benefits seen in adults may also occur in children, and medication review may possibly have a role in the management of medicines in children. There is an obvious role for pharmacists in ensuring the safety of over-the-counter medications and provision of information and education to parents, carers and adolescents. Evaluation and provision of necessary education and training to community pharmacists is needed, even in the most basic paediatric issues such as sugar-free medications. The evidence suggests that treatment compliance and adherence are generally lower in children than in adults, particularly in adolescents as they approach independence. Those with learning disabilities and infants are likely to be at risk of non-compliance, although little work has been done in these populations. Children and adolescents need appropriate parental and professional support in taking control of their medication and treatment. The management of medicines in school would appear to be far from ideal. Further research into school-based medicines education and outreach clinics would also be beneficial. [ABSTRACT FROM AUTHOR]

This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self-reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful. Sixteen London GPs were interviewed, eight ‘high implementers’ (having met five or more of six CHD NSF milestones) and eight ‘low implementers’ (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open-ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA). There were three main areas that differentiated high and low implementers: beliefs about evidence-based practice, control over professional practice and consequences of achieving the milestones. Low implementers: (i) expressed less belief in evidence-based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care. This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care. [ABSTRACT FROM AUTHOR]

This paper discusses the evolution of intermediate care (IC) and presents interim observations from a survey of providers in England being conducted as part of a national evaluation. Telephone interviews covering various issues concerning the level of provision and style of delivery have been conducted with 70 services to date. Data from these are used to discuss the progress, range and nature of IC in relation to clinician viewpoints and academic and official literature on the subject. IC ‘on the ground’ is a multiplicitous entity, with provision apparently evolving in accordance with the particularities of local need. While protocols for medical involvement in IC generally appear to be well established, there are some tensions concerning integration of services in a locality, care management processes and questions of flexibility and inclusiveness in relation to eligibility criteria. [ABSTRACT FROM AUTHOR]

Background Heart failure is common, causes considerable morbidity, and imposes a major financial burden on both society and the National Health Service. The National Service Framework (NSF) for Coronary Heart Disease (CHD) set national standards for the management of people with heart failure in England. We examined how patients with heart failure were investigated and treated compared with NSF standards, and explored the current constraints in improving the care of these patients. [ABSTRACT FROM PUBLISHER]

Over the last few years there has been a revolution in open access echocardiography services due to an increased demand from within secondary care and primary care. There have been some concerns expressed by specialists and open access echocardiography has not been universally welcomed as a means of offering healthcare. Suspected heart failure comprises the majority of primary care referrals for open access echocardiography. There is lack of rigorously controlled studies to support widespread establishment of open access echocardiography services. [Copyright &y& Elsevier]

Bipolar disorder (BD) is a severe mental illness that has been largely ignored by the National Service Framework (NSF) for Mental Health. This is particularly notable because it is associated with a higher suicide rate than schizophrenia and has a greater burden of disability. The NSF offers little guidance on service models that specifically consider BD. This is of concern because of the complexities that are inherent in the management of BD. These deficiencies in the NSF may have far-reaching implications for resource allocation, service organization, and patient management and well-being. Moreover, the standards and performance targets laid out in the NSF will be difficult to meet if this important and common mental illness is not specifically catered for in mental health services. Local Implementation Teams would be well advised to take note of the recently published British Association for Psychopharmacology guidelines for the management of BD. [ABSTRACT FROM AUTHOR]

Background Wide variation in rates of angiography and revascularization exist that are not explained by the level of need for these services. The National Service Framework for Coronary Heart Disease has set out a number of standards with the aim of increasing the number of revascularizations and reducing inequalities in access to care. In this study we aimed to investigate inequity in angiography and revascularization rates between the four Primary Care Group (PCG) areas in Camden and Islington Health Authority and to put in place measures to address the problems identified. [ABSTRACT FROM PUBLISHER]

Abstract The concepts of quality assurance (for which clinical audit is an essential part), evaluation and clinical governance each depend on the ability to derive and record measurements that describe clinical performance. Rapid IT developments have raised many new possibilities for managing health care. They have allowed for easier collection and processing of data in greater quantities. These developments have encouraged the growth of quality assurance as a key feature of health care delivery. In the past most of the emphasis has been on hospital information systems designed predominantly for the administration of patients and the management of fin-ancial performance. Large, hi-tech information system capacity does not guarantee quality information. The task of producing information that can be confidently used to monitor the quality of clinical care requires attention to key aspects of the design and operation of the audit. The Myocardial Infarction National Audit Project (MINAP) utilizes an IT-based system to collect and process data on large numbers of patients and make them readily available to contributing hospitals. The project shows that IT systems that employ rigorous health informatics methodologies can do much to improve the monitoring and provision of health care. [ABSTRACT FROM AUTHOR]