Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service

2017 ◽  
Vol 33 (2) ◽  
pp. 84-88 ◽  
Author(s):  
Huw OB Davies ◽  
Matthew Popplewell ◽  
Gareth Bate ◽  
Lisa Kelly ◽  
Katy Darvall ◽  
...  
Keyword(s):  
Fold Increase ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Below The Knee ◽  
Health And Social Care ◽  
The Uk ◽  
The Impact ◽  
Change In Mean ◽  
Mean Time ◽  
Significant Health

Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012–June 2013) and an 18-month period commencing six months after (January 2014–June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in chronically underfunded leg ulcer services.

scholarly journals The value of psychiatrists in leadership and management

2016 ◽  
Vol 22 (4) ◽  
pp. 263-268 ◽  
Author(s):  
Jennifer Perry ◽  
Fiona L. Mason
Keyword(s):  
Social Care ◽  
Self Awareness ◽  
Management Styles ◽  
Leadership And Management ◽  
Health And Social Care ◽  
The Uk ◽  
Medical Leadership ◽  
The Impact ◽  
Organisational Level

SummaryThe health and social care landscape in the UK is changing, and there is now, more than ever, a real need for doctors to embrace leadership and management. Evidence shows that medical leadership is associated with better outcomes for patients. Psychiatrists are particularly well suited to such roles, given the interpersonal skills and self-awareness that they develop in their training. In this article, we examine the role of the psychiatrist in leading at a patient, team and organisational level and the impact this has. We also discuss different leadership and management styles.

scholarly journals Understanding the needs and experiences of people with young onset dementia: a qualitative study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021166 ◽  
Author(s):  
Luisa I Rabanal ◽  
John Chatwin ◽  
Andy Walker ◽  
Maria O’Sullivan ◽  
Tracey Williamson
Keyword(s):  
Interpretative Phenomenological Analysis ◽  
Help Seeking ◽  
Late Onset ◽  
Psychological Impact ◽  
Young Onset ◽  
People With Dementia ◽  
Health And Social Care ◽  
Young Onset Dementia ◽  
The Uk ◽  
The Impact

AimDespite an estimated 40 000 people diagnosed with young onset dementia (YOD) in the UK, there is a general lack of awareness of the condition when compared with late onset dementia. The aim of this study was to explore the experiences and needs of people living with YOD (younger than 65 years) and gain an understanding of the issues that impact on them.SettingParticipants’ homes, support group premises or university rooms.Participants14 people with a diagnosis of YOD from a northern UK city.DesignSemistructured, in-depth interviews were audio recorded, transcribed and analysed cross-sectionally following principles of interpretative phenomenological analysis.ResultsFour superordinate themes are reported on ‘process of diagnosis’, ‘the impact of living YOD’, ‘needs of people with YOD’ and ‘living well with YOD’. Nine subordinate themes captured participant experiences of developing cognitive difficulties, after being diagnosed with YOD, and subsequently living with the condition. Key issues that emerging included a lack of general awareness of YOD; how this can delay help seeking; commonalities in prediagnosis trajectories; retrospective understanding of prediagnosis symptom patterns; the difficulties of obtaining a firm diagnosis; the importance of face-to-face support and difficulties associated with daily living. Participants also described the emotional and psychological impact of the condition and the importance of formal and informal support networks.ConclusionsPeople who have a diagnosis of YOD regard themselves as distinct from older people with dementia. Despite similar symptoms, the context in which they experience the condition creates a range of distinct psychosocial concerns not commonly well addressed by health and social care services. As awareness of YOD continues to grow, the development (or adaptation) of services that take into account the idiosyncratic needs of people with YOD should be addressed.

scholarly journals Service user and carers perspectives of joint and integrated working between health and social care

2014 ◽  
Vol 22 (2) ◽  
pp. 62-70 ◽  
Author(s):  
Ailsa Cameron ◽  
Lisa Bostock ◽  
Rachel Lart
Keyword(s):  
Mental Health ◽  
Design Methodology ◽  
Social Care ◽  
Mental Health Problems ◽  
Integrated Services ◽  
Content Type ◽  
Policy Debates ◽  
Health And Social Care ◽  
The Uk ◽  
The Impact

Purpose – The purpose of this paper is to provide an update to a review of the joint working literature in the field of health and social care for adults, with particular emphasis given to the experiences of users and carers. Design/methodology/approach – The aims of the literature review remained largely the same as those of the original, they were to identify: models of joint working, evidence of effectiveness and cost-effectiveness and the factors promoting or hindering the models. However, to reflect the growing interest in the experiences of users and carers a fourth aim was added to map these experiences. Given their prominence in terms of policy debates about integration, the review focused on jointly organised services for older people and people with mental health problems in the UK only. Findings – The review demonstrates tentative signs that some initiatives designed to join-up or integrate services can deliver outcomes desired by government. Importantly some studies that report the experiences of users of services and carers suggest that they perceive benefits from efforts to join-up or integrate services. However it is our contention that the evidence is less than compelling and does not justify the faith invested in the strategy by current or previous governments. Originality/value – The study updates our knowledge of the impact of joint working in the field of health and social care for adults. Importantly the paper highlights what is known about the experiences of users and carers of joint/integrated services.

scholarly journals The impact of story: measuring the impact of story for organisational change

2017 ◽  
Vol 9 (2) ◽  
pp. 170-184 ◽  
Author(s):  
Lisa Rossetti ◽  
Tony Wall
Keyword(s):  
Organisational Change ◽  
Evaluation Framework ◽  
Service Improvement ◽  
Organisational Development ◽  
Structured Interviews ◽  
Content Type ◽  
Health And Social Care ◽  
The Uk ◽  
The Impact ◽  
New Evidence

Purpose The role of dialogue has recently been identified as being important in generating impact in organisations, but the purposeful use of narrative or story-based approaches to effect organisational change and service improvement is still relatively innovative. The purpose of this paper is to document and examine two projects in health and social care settings which aim to generate organisational development and service improvement. Design/methodology/approach The paper evaluates and compares two case studies of story-based organisational development and service improvement projects in the UK. This involved developing an appropriate evaluation framework and assessing the impacts in each case using semi-structured interviews and thematic content analysis. Findings This paper reports the diversity of impacts and outcomes that were generated by the projects. Specifically, it is argued that there is a strong indication that story-based projects best achieve their objectives when clearly linked to key organisational strategic drivers or pathways, as evidenced by robust evaluation. Practical implications This paper recommends that researchers and practitioners, working with story-based methods, design credible and robust evaluative practices, in order to evidence how their work supports organisations to meet current sector challenges. The paper recommends a flexible evaluation framework for evaluating story-based projects in the workplace. Originality/value This paper offers new evidence and insight into the impacts and outcomes of using story-based approaches, and a new evaluation framework for these sorts of projects.

scholarly journals Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056790
Author(s):  
Sean Urwin ◽  
Jo C Dumville ◽  
Matt Sutton ◽  
Nicky Cullum
Keyword(s):  
Resource Use ◽  
Wound Care ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Venous Leg Ulcers ◽  
Annual Prevalence ◽  
The Uk

ObjectivesTo estimate and examine the direct healthcare costs of treating people with open venous leg ulcers in the UK.DesignCost-of-illness study.SettingA cross-sectional survey of nine National Health Service community locales over 2-week periods in 2015/2016.MethodsWe examined the resource use and prevalence of venous leg ulcer treatment in the community. Examination of variation in these obtained costs was performed by ordinary least squares regression. We used additional resource use information from a randomised control trial and extrapolated costs to the UK for an annual period.ResultsThe average 2-week per person cost of treating patients where a venous leg ulceration was the primary (most severe) wound was estimated at £166.39 (95% CI £157.78 to £175.00) with community staff time making up over half of this amount. Costs were higher where antimicrobial dressings were used and where wound care was delivered in the home. Among those with any recorded venous leg ulcer (primary and non-primary), we derived a point prevalence of 3.2 per 10 000 population and estimated that the annual prevalence could be no greater than 82.4 per 10 000 population. We estimated that the national cost of treating a venous leg ulcer was £102 million with a per person annual cost at £4787.70.ConclusionOur point prevalence figures are in line with the literature. However, our annual prevalence estimations and costs are far lower than those reported in recent literature which suggests that the costs of treating venous leg ulcers are lower than previously thought. Movement towards routinely collected and useable community care activity would help provide a transparent and deeper understanding of the scale and cost of wound care in the UK.

scholarly journals The long-term effects of childhood neglect or abuse. Implications for child and family services in the UK

2019 ◽  
Vol 12 (2) ◽  
pp. 57-78
Author(s):  
ANTONIA BIFULCO
Keyword(s):  
Mental Health Problems ◽  
Social Deprivation ◽  
Public Health Issue ◽  
Child And Family Services ◽  
Family Services ◽  
Psychological Burden ◽  
Childhood Neglect ◽  
Health And Social Care ◽  
The Uk ◽  
The Impact

Childhood neglect or abuse is damaging, with lifelong impacts on functioning, clinical and physical health. It can also transmit risk to the next generation. Child abuse is related to social deprivation, a source of family breakup, common in families under stress and is associated with other social ills such as domestic violence, and parental mental health problems. It is therefore costly to society financially, emotionally and in terms of family wellbeing. It is increasingly seen as a major public health issue given its wide prevalence. Contemporary issues in the UK concern not only ongoing neglect or abuse of children, but also the impact of historical abuse, a psychological burden to a significant number of adults. Often untreated, and occurring before adequate child protection policies were in place, the impacts of historical abuse is an ongoing concern both for health and social care services. This paper will describe the Childhood Experience of Care and Abuse (CECA) interview research findings and application in child and family services. It enables an accurate assessment of historical abuse, and its scoring system can be used on ongoing case files for children for better classification. A social and attachment model are described as explaining how damage from neglect and abuse can extend into later life.

scholarly journals Health and social care access for adults with learning disabilities across the UK during the COVID-19 pandemic in 2020

2021 ◽  
Vol 26 (3) ◽  
pp. 174-179
Author(s):  
Samantha Flynn ◽  
Chris Hatton
Keyword(s):  
Learning Disabilities ◽  
Northern Ireland ◽  
Social Care ◽  
Family Carers ◽  
Content Type ◽  
Care Services ◽  
Health And Social Care ◽  
Adults With Learning Disabilities ◽  
The Uk ◽  
The Impact

Purpose This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study.

Learning in lockdown: exploring the impact of COVID-19 on interprofessional education

2021 ◽  
Vol 29 (11) ◽  
pp. 648-652
Author(s):  
Alison Power ◽  
Michael Palapal Sy ◽  
Maggie Hutchings ◽  
Tracy Coleman ◽  
Alla El-Awaisi ◽  
...  
Keyword(s):  
Interprofessional Education ◽  
Social Care ◽  
Lessons Learned ◽  
Global Perspective ◽  
Face To Face ◽  
Perceptions And Attitudes ◽  
Health And Social Care ◽  
Rich Data ◽  
The Uk ◽  
The Impact

The COVID-19 pandemic has had a significant impact on the learning experiences of students undertaking health and social care programmes across the globe. In the UK, the Nursing and Midwifery Council introduced emergency standards for undergraduate programmes in 2020, making significant short-term changes to programme delivery. However, the mandate for all students to undertake interprofessional education remained. Interprofessional education is key to preparing students on health and social care programmes, as it enables students to work as effective members of multi-agency/multi-professional teams on qualification. It is an important element of training, as it has a direct impact on quality of care and service user experience. This series of articles will explore the experiences of ‘lockdown learning’ from the perspective of academics, students and service users from a global perspective in relation to the delivery of interprofessional education during the pandemic, which necessitated a wholesale move from face-to-face, blended and online learning to include emergency remote teaching. The series was written by members of the Centre for the Advancement of Interprofessional Education Research Subgroup (Interprofessional Education Experiences) and aims to identify barriers and facilitators to successful shared learning and provide suggestions for how lessons learned can be taken forward to further enhance this important element of pre-registration education. The perceptions and attitudes of academics and students on such comprehensive changes are a unique and rich data source to explore and inform future provision.

The right to healthcare

2020 ◽  
pp. 195-208
Author(s):  
Ann Marie Gray
Keyword(s):  
Human Rights ◽  
Social Care ◽  
Health And Social Care ◽  
Human Rights Act ◽  
Human Rights Act 1998 ◽  
The Uk ◽  
The Right ◽  
The Impact ◽  
The Relationship

This chapter explores the relationship between human rights and health and social care. It begins by setting out the main international mechanisms, at UN, EU and ECHR levels, and the obligations they place on governments. It then discusses the impact of international and domestic human rights instruments through an examination of developments in social care policy, and with regard to reproductive health care rights in Northern Ireland. It also highlights issues relating to devolution and the implementation of human rights in the UK and in particular the role of the Human Rights Act (1998).

scholarly journals Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053185
Author(s):  
Megan Armstrong ◽  
Caroline Shulman ◽  
Briony Hudson ◽  
Patrick Stone ◽  
Nigel Hewett
Keyword(s):  
Social Care ◽  
Barriers And Facilitators ◽  
Complex Needs ◽  
Care Access ◽  
Care Services ◽  
Health And Social Care ◽  
Service Barriers ◽  
The Uk ◽  
The Impact ◽  
Care Support

IntroductionThe number of people living in homeless hostels in the UK has steadily increased over the past decade. Despite people experiencing homelessness often having considerable health problems and a range of complex needs frequently in association with addictions, the experiences of hostel staff and residents especially in relation to accessing health and social care support have seldom been explored. The aim of this paper is to identify the barriers and facilitators to accessing health and social care services for people living in homeless hostels.DesignExploratory qualitative baseline data were collected as part of an intervention to facilitate palliative care in-reach into hostels.Setting/participantsInterviews were conducted with 33 participants; 18 homeless hostel managers/support staff and 15 people experiencing homelessness, from six homeless hostels in London and Kent.ResultsThree themes were identified (1) internal and external service barriers to health and social care access due to stigma, lack of communication and information sharing from services and assumptions around capacity and the role of the hostel, (2) the impact of lack of health and social care support on hostel staff leading to burnout, staff going beyond their job role and continuous support given to residents, (3) potential facilitators to health and social care access such in-reach and support from those who understand this population and hostel staff training.DiscussionResidents have multiple complex needs yet both hostel staff and residents face stigma and barriers accessing support from external services. Positive relationships were described between hostel residents and staff, which can be an essential step in engaging with other services. People experiencing homelessness urgently need better access to person-centred, trauma-informed support ideally via in-reach from people who understand the needs of the population.

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