‘Sometimes you just need someone to guide you through the maze’ – Improving cardiac care services in the North of England: suggestions from a patient-led project

2020 ◽  
Vol 15 (2) ◽  
pp. 1-12
Author(s):  
Julie Goodfellow ◽  
Cathy Stark ◽  
Ian Mackersie ◽  
Vera Mackersie

Cardiomyopathy is a disease of the heart muscle, thought to affect around 160 000 people in the UK. It is often inherited and can be life-changing, with symptoms including tiredness, breathlessness and palpitations. The role of the patient in NHS care is no longer that of a passive recipient of care. There is an expectation that patients will be engaged in their own health, care and treatment. Initiatives exist where patients are encouraged to become involved in the design, planning and delivery of services. A patient-led service improvement project was designed and carried out by members of a local Cardiomyopathy UK support group, in order to capture the experiences of people affected by cardiomyopathy as they journeyed through the healthcare system in the North of England. This has enabled an evaluation of service provision, highlighting examples of good practice and areas for improvement. A total of 21 people, both patients and family members, shared their story through in-depth interviews. The overall picture that emerged was of a group of people deeply affected by a diagnosis of cardiomyopathy, who had experienced both positive and negative aspects of a healthcare system that does not appear to fully understand cardiomyopathy or the impact the condition has on the lives of patients and carers. The project highlighted a need for information and support at key times on a patient's journey through cardiomyopathy—at diagnosis, on discharge from hospital, when dealing with a device, when issues around family screening arise, or when the condition changes in some way. Many respondents had experienced a lack of information and support at these key times and communication between patients and health professionals was sometimes inadequate.

2021 ◽  
pp. 088626052110079
Author(s):  
Alison Gregory ◽  
Emma Johnson ◽  
Gene Feder ◽  
John Campbell ◽  
Judit Konya ◽  
...  

Experiences of sexual violence, childhood sexual abuse, and sexual assault are common across all societies. These experiences damage physical and mental health, coping ability, and relationships with others. Given the breadth and magnitude of impacts, it is imperative that there are effective, accessible services to support victim-survivors, ease suffering, and empower people to cope, recover and thrive. Service provision for this population in the United Kingdom is complex and has been hit substantially by austerity. Since positive social support can buffer against negative impacts, peer support may be an effective approach. The aim of this exploratory study was to capture the views and perspectives of professional stakeholders concerning service provision for victim-survivors, particularly perceptions of peer support. In-depth semistructured interviews were conducted in the UK during 2018 with six professional stakeholders, highly experienced in the field of service provision for victim-survivors of sexual violence and abuse. An abductive approach to analysis was used, applying principles from thematic analysis. Our sample comprised four females and two males, and their roles included psychiatrist, general practitioner, service improvement facilitator, and senior positions within victim-survivor organizations. Interviews highlighted models of peer support for this population, good practice and safety considerations, and a lack of uniformity regarding quality and governance standards across the sector. Findings indicated that current funding models impact negatively on victim-survivor services, and that provision is fragmented and insufficient across statutory and not-for-profit sectors. The influence of the medical model upon service provision was evident, which resulted in apprehension around support delivered in less-usual forms—including peer support. Further research is needed to explore the potential of peer support for victim-survivors of sexual violence and abuse.


2008 ◽  
Vol 65 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Tom L. Catchpole ◽  
Andrew S. Revill ◽  
James Innes ◽  
Sean Pascoe

Abstract Catchpole, T. L., Revill, A. S., Innes, J., and Pascoe, S. 2008. Evaluating the efficacy of technical measures: a case study of selection device legislation in the UK Crangon crangon (brown shrimp) fishery. – ICES Journal of Marine Science, 65: 267–275. Bycatch reduction devices are being introduced into a wide range of fisheries, with shrimp and prawn fisheries particularly targeted owing to the heavy discarding common in these fisheries. Although studies are often undertaken to estimate the impact of a technical measure on the fishery before implementation, rarely have the impacts been assessed ex post. Here, the efficacy of the UK legislation pertaining to the use of sievenets in the North Sea Crangon crangon fishery is assessed. Three impacts were evaluated: on fisher behaviour (social), on the level of bycatch (biological), and on vessel profitability (economic). An apparent high level of compliance by skippers was identified despite a low level of enforcement. The estimated reduction in fleet productivity following the introduction of the legislation was 14%, equalling the mean loss of Crangon landings when using sievenets calculated from catch comparison trawls. Sievenets did reduce the unnecessary capture of unwanted marine organisms, but were least effective at reducing 0-group plaice, which make up the largest component of the bycatch. Clearly the legislation has had an effect in the desired direction, but it does not address sufficiently the bycatch issue in the Crangon fishery.


Finisterra ◽  
2012 ◽  
Vol 31 (62) ◽  
Author(s):  
Andrew Pike ◽  
Mário Vale

The industrial policy in the UK and in Portugal, as in most EU countries, seeks to attract new investment capacity, to create jobs and to promote the impact of the so-called "demonstration efect" of "greenfield" development strategies pursued in the new plants of inward investors on existing or "brownfield" plants. This industrial policy focus is particularly evident in the automobile industry.This paper compares the industrial policy oriented towards the automobile industry in the UK and in Portugal. Two recent "greenfield" investments are analised: Nissan in the North-East region (UK) and Ford/VW in the Setúbal Peninsula (Portugal), as well as three "brownfield" plants: Ford Halewood and GM Vauxhall Ellesmere Port in the North-West region (UK) and Renault in Setúbal (Portugal). The first part starts with a discussion of industrial policy in the automobile sector, the role of "greenfield" development strategies and the "demonstration effect" on "brownfield" plants. Then, the limits of new inward investment are pointed out, basically their problems and restrictions. Afterwards, the structural barriers to the "demonstration effect" within "brownfield" plants are outlined and some possabilities for alternative "brownfield" development strategies are presented.


2020 ◽  
pp. bmjspcare-2020-002422
Author(s):  
Donna Wakefield ◽  
Elizabeth Fleming ◽  
Kate Howorth ◽  
Kerry Waterfield ◽  
Emily Kavanagh ◽  
...  

ObjectivesNational guidance recommends equality in access to bereavement services; despite this, awareness and availability appears inconsistent. The aim of this study was to explore availability and accessibility of bereavement services across the North-East of England and to highlight issues potentially applicable across the UK, at a time of unprecedented need due to the impact of COVID-19.MethodsPhase 1: an eight item, web-based survey was produced. A survey link was cascaded to all GP practices (General Practitioners) in the region. Phase 2: an email was sent to all services identified in phase 1, requesting details such as referral criteria and waiting times.ResultsAll 392 GP practices in the region were invited to participate. The response rate was 22% (85/392). Twenty-one per cent (18/85) of respondents reported that they do not refer patients, comments included ‘not aware of any services locally’. A total of 36 services were contacted with 72% responding with further information. Most bereavement specific support was reliant on charity-funded services including hospices, this sometimes required a pre-existing link with the hospice. Waiting times were up to 4 months.ConclusionsAlthough multiple different, usually charity-funded services were identified, awareness and accessibility were variable. This survey was conducted prior to the COVID-19 pandemic, where complex situations surrounding death is likely to impact on the usual grieving process and increase the need for bereavement support. Meanwhile, charities providing this support are under severe financial strain. There is an urgent need to bridge the gap between need and access to bereavement services.


2019 ◽  
Vol 8 (3) ◽  
pp. e000409 ◽  
Author(s):  
Julia Wood ◽  
Bob Brown ◽  
Annette Bartley ◽  
Andreia Margarida Batista Custódio Cavaco ◽  
Anthony Paul Roberts ◽  
...  

In the UK, over 700 000 patients are affected by pressure ulcers each year, and 180 000 of those are newly acquired each year. The occurrence of pressure ulcers costs the National Health Service (NHS) more than 3.8 million every day. In 2004, pressure ulcers were estimated to cost the NHS £1.4–£2.4 billion per year, which was 4% of the total NHS expenditure.The impact on patients can be considerable, due to increased pain, length of hospital stay and decreased quality of life. However, it is acknowledged that a significant number of these are avoidable.In early 2015, it was identified that for the North East and North Cumbria region the incidence of pressure ulcers was higher than the national average. Because of this, a 2-year Pressure Ulcer Collaborative was implemented, involving secondary care, community services, care homes and the ambulance service, with the aim of reducing the percentage of pressure ulcers developed by patients within their care.The Breakthrough Series Collaborative Model from the Institute for Healthcare Improvement provided the framework for this Collaborative.In year 1, pressure ulcers were reduced by 36%, and in year 2 by 33%, demonstrating an estimated cost saving during the lifespan of the Collaborative of £513 000, and a reduction in the number of bed days between 220 and 352.


2018 ◽  
Vol 34 (S1) ◽  
pp. 55-55
Author(s):  
Fay McCracken ◽  
Carla Deakin

Introduction:Getting technologies adopted in the UK healthcare system can be time-consuming and complex. The National Institute for Health and Care Excellence Office for Market Access (NICE OMA) has developed a novel approach to enable greater and more coordinated dialogue between life sciences companies and healthcare system stakeholders on market access issues.Methods:When establishing NICE OMA, interactions were carried out with life sciences trade associations and key healthcare system stakeholders to explore challenges in market access landscape. Feedback highlighted that dialogue with NICE and other stakeholders is often limited and occurs in high-risk situations; indicating a need for greater and more coordinated dialogue between industry and multiple healthcare system stakeholders outside of formal processes.Results:The approach developed is a safe harbor engagement framework which enables NICE OMA to facilitate interaction between life sciences companies and key healthcare system stakeholders; this collaborative approach promotes shared understanding of aspects that will allow innovative technologies to reach patients faster. It brings together multiple organizations in a safe environment where ideas can be exchanged between participants, allowing organizations to think beyond their own area of interest and to work collaboratively. Companies have used the engagement framework flexibly to engage at different stages along the development to adoption journey. Feedback indicates that companies have benefitted from channeling discussions through NICE to bring together key leaders from different organizations, as well as the neutral facilitation of discussions. Healthcare system partners have gained insights/knowledge that hadn't been apparent beforehand. Patient and clinical representatives have appreciated the opportunity to provide views to a broad range of stakeholders often early in the development of the technology.Conclusions:The NICE OMA safe harbor engagement framework has been well-received to date. Further feedback will be sought to understand the impact in helping to optimize the market access journey.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract Integrated care is seen as a solution for addressing Europe’s changing demographics and dealing with the fragmented delivery of health and care services affecting numerous healthcare systems. The SCIROCCO tool is an online participatory tool which helps to facilitate multi-stakeholder dialogues on progress towards integrated care. It does so by: Defining maturity to adopt integrated care in terms of the Maturity Model developed by the European Innovation Partnership on Active and Healthy Ageing (B3 Action Group on Integrated Care).Assessing the maturity of healthcare systems.Assessing the maturity requirements of good practices.Supporting twinning and coaching for “knowledge transfer” to facilitate the adoption of integrated care and exchange of good practices. Knowledge transfer is seen as mutually beneficial for involved regions to access evidence and learn about integrated care. In SCIROCCO, there are two variants of twinning: the first has the aim of transferring a good practice to the healthcare system, while the second is about the improvement of a particular aspect of a healthcare system in order to improve integrated care maturity. Twinning is becoming ever more popular as an approach, and - in 2019/2020 - is being used in a number of European projects. The SCIROCCO tool was evaluated both quantitatively and qualitatively. Validity and reliability were evaluated using quantitative analyses while usability and perceptions on impact were assessed using questionnaires and focus groups. It was used by more than 60 healthcare organisations in Europe and beyond during 2016-2018. Most recently, it was tested in twinning and coaching activities, which resulted in the development of local Action Plans outlining steps forward on integrated care for the receiving regions. As part of the SCIROCCO Exchange project, an enhanced SCIROCCO tool is developed. This tool will improve existing knowledge transfer activities by allowing for the easy searching of assets on integrated care from a variety of sources, supporting improvement planning and checking evolution towards plans. The objectives of this workshop are: Presenting the main functionalities of the SCIROCCO toolOutlining the results of its overall evaluationDiscussing the experiences that 2 regions have had with using the SCIROCCO tool for knowledge transferPresenting progress and next steps during SCIROCCO Exchange for an enhanced SCIROCCO toolPresenting plans for evaluating the enhanced SCIROCCO toolGathering input from workshop participants on how the enhanced SCIROCCO tool could even better support knowledge transfer in different regions. Key messages The experience of regions and evaluation results demonstrate the benefits of the SCIROCCO tool for facilitating multi-stakeholder collaboration and learning towards improving integrated care. The progress and plans for the SCIROCCO Exchange tool, enhanced with the feedback and suggestions of workshop participants, offer promise for even better support for knowledge transfer.


2017 ◽  
Vol 9 (2) ◽  
pp. 170-184 ◽  
Author(s):  
Lisa Rossetti ◽  
Tony Wall

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.


2017 ◽  
Vol 200 ◽  
pp. 75-100 ◽  
Author(s):  
T. Sherwen ◽  
M. J. Evans ◽  
R. Sommariva ◽  
L. D. J. Hollis ◽  
S. M. Ball ◽  
...  

Halogens (Cl, Br) have a profound influence on stratospheric ozone (O3). They (Cl, Br and I) have recently also been shown to impact the troposphere, notably by reducing the mixing ratios of O3 and OH. Their potential for impacting regional air-quality is less well understood. We explore the impact of halogens on regional pollutants (focussing on O3) with the European grid of the GEOS-Chem model (0.25° × 0.3125°). It has recently been updated to include a representation of halogen chemistry. We focus on the summer of 2015 during the ICOZA campaign at the Weybourne Atmospheric Observatory on the North Sea coast of the UK. Comparisons between these observations together with those from the UK air-quality network show that the model has some skill in representing the mixing ratios/concentration of pollutants during this period. Although the model has some success in simulating the Weybourne ClNO2 observations, it significantly underestimates ClNO2 observations reported at inland locations. It also underestimates mixing ratios of IO, OIO, I2 and BrO, but this may reflect the coastal nature of these observations. Model simulations, with and without halogens, highlight the processes by which halogens can impact O3. Throughout the domain O3 mixing ratios are reduced by halogens. In northern Europe this is due to a change in the background O3 advected into the region, whereas in southern Europe this is due to local chemistry driven by Mediterranean emissions. The proportion of hourly O3 above 50 nmol mol−1 in Europe is reduced from 46% to 18% by halogens. ClNO2 from N2O5 uptake onto sea-salt leads to increases in O3 mixing ratio, but these are smaller than the decreases caused by the bromine and iodine. 12% of ethane and 16% of acetone within the boundary layer is oxidised by Cl. Aerosol response to halogens is complex with small (∼10%) reductions in PM2.5 in most locations. A lack of observational constraints coupled to large uncertainties in emissions and chemical processing of halogens make these conclusions tentative at best. However, the results here point to the potential for halogen chemistry to influence air quality policy in Europe and other parts of the world.


BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047995
Author(s):  
Rosamund Yu ◽  
Bec Hanley ◽  
Simon Denegri ◽  
Jaber Ahmed ◽  
Nicholas J McNally

ObjectivesTo design, deliver and evaluate a programme of training workshops for biomedical researchers aimed at building confidence and skills in actively involving patients and the public (PPI) in research.DesignA bespoke programme of training workshops in PPI aimed at researchers.SettingA large National Institute for Health Research Biomedical Research Centre in London and several partner organisations.Participants721 scientists, clinicians and research managers attending dedicated training in PPI at a major London NHS (National Health Service)–university partnership.InterventionsA programme of 72 training workshops, designed to build practical skills and confidence for researchers working with patients and the public in research, was delivered at a major research-active NHS:university partnership. An iterative approach was taken to the programme, with the content of the workshops continually reviewed and refreshed to respond to the needs of researchers. Surveys before, immediately following and 6 months after training investigated the impact on researchers’ confidence and skills in PPI work, and the kind of PPI they subsequently carried out.ResultsTraining brought about immediate marked increases in researchers’ self-reported confidence to carry out PPI activities within their research, and in their knowledge of good practice. The evaluation indicates that workshop attendees were more likely to involve patients in their research following training. Researchers tended to involve patients and the public in a range of areas, including input to study design and patient information, in particular.ConclusionsWhen positioned within a broader organisational strategy for PPI in research, such training has an important role to play in progressing PPI in a major research partnership. Training appeared to provide the confidence needed to carry out PPI which enabled further development of confidence and skills. Involving researchers who have attended the training in the ongoing development of the programme and bringing in patients to the training programme are key next steps.


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