The business of recovery: embedding health in economies after COVID-19

As the UK rebuilds and recovers after the COVID-19 pandemic, tackling socioeconomic inequalities will become increasingly pertinent. The link between health and wealth has been long established, with those at the highest risk of illness also being less likely to access healthcare. The pandemic has highlighted these disparities, with higher morbidity and mortality rates seen in deprived areas, as well as among ethnic minority communities. Leaders and clinicians across the NHS and social care have called for a ‘reset’ in the way healthcare is planned, commissioned and delivered in the UK. There is a growing need for a holistic approach to disease prevention, and it is crucial that government agencies take a strong role in addressing the wider determinants of health.

ENACT Study: What has helped health and social care workers maintain their mental wellbeing during the COVID-19 pandemic? Adaptive coping, team resilience, help-seeking behaviour and work based supports

Rapid studies have highlighted the adverse mental health impact of COVID-19 on health and social care workers (HSCWs). Complementing this work, we report on the psychosocial factors that have helped HSCWs adapt to the adversities associated with COVID-19 and protect staff wellbeing in Scotland. The ENACT study collected data from HSCWs (n= 1364) in Scotland during the third national lockdown. Using a cross-sectional design, participants completed an online survey providing quantitative data and free responses. A multi-method approach to analysis was used. The majority of HSCWs were found to have low wellbeing scores, high levels of COVID-19 stress, worry, burnout and risk perception scores and almost half of HSCWs met the clinical cut off for acute stress. Adaptive coping strategies and increased perceived team resilience helped mitigate against the adverse impact that COVID-19 stressors have on HSCWs’ mental wellbeing. HSCWs were significantly more likely to seek informal support for dealing with personal or emotional problems. Barriers to formal help-seeking were identified including stigma and fears of consequence of disclosure. HSCWs most valued peer support, workplace supports, visible leadership and teamwork. Our findings illuminate the complexity of the effects of the COVID-19 pandemic on HSCWs’ wellbeing and will inform future intervention development to increase positive adaptation amongst staff. Addressing barriers to mental health help-seeking among HSCWs is essential. The implications emphasise the importance of lessons learned across health and social care contexts, planning and preparedness for future pandemics.

Integrated Care for Seniors as a Challenge for Slovakia

Older age can be accompanied by a lot of changes in the field of health, which influence the social functioning of seniors.One of the factors influencing the quality of life of seniors is the connection of healthcare and social care, built on the interdepartmental cooperation. This approach is still absent in Slovakia.The aim of the paper is therefore to emphasize the importance and need of integrated care and to describe the barriers that prevent its implementation in Slovakia. In search of answers to the questions: “When and why was the healthcare and social care department of seniors established in Slovakia? What are the reasons persisting in this condition? What are the consequences of this divided care for the seniors in practice? What strategies use facilities for seniors to overcome this situation during the COVID-19 pandemic?” the authors used the method of the case study (Yin, 2003) focused on the Trnava self-governing region. Persistent structural, procedural, legislative and political factors have been identified as the main barriers. Specific for Slovakia is the existence of a barrier of the profession, which is caused by the low interest of social workers in the issue. The authors state that the situation in Slovakia is caused mainly by the reflection of integrated care as a political problem. In the end, the authors make several suggestions for solving the situation.

The health professional's duty to warn of preconception risks

Richard Griffith, Head of Health Law and Ethics in the School of Health and Social Care at Swansea University, looks at the law around negligence for disabilities in a child caused by a failure to warn of preconception risks

Fast-track hospital end-of-life discharge pathway: is it actually fast? National clinical audit

ObjectivesTo determine adherence to Department of Health and Social Care target of fast-track pathway discharge for end-of-life care within 48 hours.MethodsMulticentre audit in England using retrospective analysis of patient records for fast-track pathway tools submitted between 1 March 2019 and 31 March 2019.ResultsMost patients (72%) were not discharged within the 48-hour target. There was significant variability in success between hospital sites. Delays in discharge were most frequently considered to be secondary to delays in sourcing packages of care and 24-hour care facility placements. Involvement of specialist discharge nurses in paperwork submission improved rates by Commissioning Care Groups. Patients who died in hospital had significantly longer admissions than those who were discharged (discharged 19 days (IQR 11–28) vs died 28 days (IQR 18–42); p=0.039). This was entirely accounted for by increased numbers of days between admission and first suggestion of fast-track pathway discharge in those who died in hospital (discharged 9 days (IQR 5–19), died 15 days (IQR 9–33); p=0.003).ConclusionsWe demonstrated a delay in the fast-track pathway discharge process with significant variation in success of the discharge process at different geographical locations.

Reducing the Risk of Cognitive Decline and Dementia: WHO Recommendations

With population ageing worldwide, dementia poses one of the greatest global challenges for health and social care in the 21st century. In 2019, around 55 million people were affected by dementia, with the majority living in low- and middle-income countries. Dementia leads to increased costs for governments, communities, families and individuals. Dementia is overwhelming for the family and caregivers of the person with dementia, who are the cornerstone of care and support systems throughout the world. To assist countries in addressing the global burden of dementia, the World Health Organisation (WHO) developed the Global Action Plan on the Public Health Response to Dementia 2017–2025. It proposes actions to be taken by governments, civil society, and other global and regional partners across seven action areas, one of which is dementia risk reduction. This paper is based on WHO Guidelines on risk reduction of cognitive decline and dementia and presents recommendations on evidence-based, multisectoral interventions for reducing dementia risks, considerations for their implementation and policy actions. These global evidence-informed recommendations were developed by WHO, following a rigorous guideline development methodology and involved a panel of academicians and clinicians with multidisciplinary expertise and representing geographical diversity. The recommendations are considered under three broad headings: lifestyle and behaviour interventions, interventions for physical health conditions and specific interventions. By supporting health and social care professionals, particularly by improving their capacity to provide gender and culturally appropriate interventions to the general population, the risk of developing dementia can be potentially reduced, or its progression delayed.