Writing for the Wider Public - Readability of Publicly Available Board Reports

Objective: This work aims to evaluate the readability of publicly available board reports from the Local Health Networks (LHNs) in South Australia and the National Health Service (NHS) Trusts in England. Method: Publicly available board reports from the LHNs in South Australia and NHS Trusts in England were identified, screened, and evaluated from January 2020 to August 2020. Results: The average Flesch Reading Ease score for all LHNs reviewed ranged from 34 ± 10.2 to 57 ± 0.0 (Difficult to Fairly Difficult). In comparison, the average Flesch Reading Ease score for all the NHS Foundation Trusts ranged from 46 ± 1.7 to 60 ± 3.0 (Difficult to Standard). The average Reading Ease score for metropolitan and non-metropolitan LHNs was 43 ± 8.1 and 41 ± 6.0 (Difficult to read). In contrast, the average Reading Ease score for metropolitan and non-metropolitan NHS Trust was Fairly Difficult with 53 ± 4.2 and 50 ± 3.5 respectively. Conclusion: The evaluation results suggest that there is scope for improving the quality of publicly available board reports from the boards reviewed in terms of their readability by the public.

EP.TU.833The F2 Cohort of COVID19: The impact on Career development – a survey analysis

In March 2020 the coronavirus outbreak was announced as a global pandemic by WHO, in response to the pandemic the NHS underwent huge changes. This included recalling foundation doctors and cancelling the changeover into their final rotations. There have been studies into the impact of the pandemic on junior doctor training and wellbeing, however none looking specifically at their career development. An online survey was distributed to a cohort of Foundation Year 2 Doctors (F2s) in one NHS trust. This specifically asked about the impact of not rotating, specialty tasters, courses and the overall impact of the pandemic. The results of this study show that F2 doctors report weaker specialty applications alongside missed career development opportunities. However, the main influence of COVID-19 was reported to be on the cohort’s personal lives. This study concluded that the COVID-19 pandemic negatively affected both F2 doctor’s professional and personal lives, and it would be useful to follow up the cohort’s career development in the long-term as well as investigate the impacts in other NHS foundation trusts in the country.

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

BackgroundThe effects of COVID-19 on the shift to remote consultations remain to be properly investigated.ObjectiveTo quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak.MethodsWe used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python.FindingsMental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18–21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients.Conclusions and clinical implicationsThe rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.

375 Points Mean Prizes, The Impact of Portfolio Points and Clinical Specialty on The Engagement of Trainees in Research

Aim Research and scholarship are key outcomes for medical education in order to learn transferable skills outside of the core curriculum as highlighted in 2018 by the General Medical Council. We have provided a historical snapshot of the key factors influencing medical undergraduates and trainees engaging in research. We distributed an anonymous survey to all UK Foundation Trusts and medical schools, which covered simple demographic information, factors influencing involvement in research and intended clinical specialty. Descriptive statistics were calculated for the responses. Results There were 264 responses to the survey, 119 (45.1%) from women. The strongest motivating factor for respondents was points for future applications, which accounted for 138 (52.2%) of responses, and became increasingly important with seniority of respondent. Time accounted for the largest obstacle to engagement in research, with 151 (57.3%) votes. For the 83 responses from aspiring surgeons, the mean number of PubMed citable publications was 2.52 compared to 1.28 for the respondents who listed a non-surgical specialty as their intended career path. Conclusions The UK Foundation Programme recently decided to remove additional educational achievement points (including two points for publications) for the 2023 intake of Foundation doctors. Such a decision, combined with our finding of point-driven reasoning for engagement in research, could result in fewer juniors conducting research. However, given our results highlighting increased engagement in research of aspiring surgeons, it is hoped that this decision will not affect the field of surgical research, but further qualitative analysis is required to explore this.

Differentiating 'attachment difficulties' from autism spectrum disorders and attention deficit hyperactivity disorder: Qualitative interviews with experienced health care professionals

Objectives: Attachment difficulties is an umbrella term often used to describe various forms of non-secure attachment. Differentiating ‘attachment difficulties’ from autism spectrum disorder (hereafter autism) and attention deficit hyperactivity disorder (hereafter ADHD) has been characterised as challenging. Few studies have explored how this happens in practice, from the perspective of the professionals. Design: Qualitative study. Method: We conducted in-depth semi-structured interviews with (n=17) healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analysed using a thematic approach. Results: We identified six interrelated themes that might reflect difficulties with differential conceptualisation. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviours; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualisation. Conclusion: Our results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualisation. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD and ADHD.

Financial sustainability of NHS Foundation Trusts in England five years after the enactment of the Health and Social Care Act of 2012

Background/Aims The enactment of the Health and Social Care Act (2012) led to significant structural changes in how hospital services are commissioned and has introduced direct competition with the private sector. The aim of this study was to assess the impact of the act on the financial position of the Shelford Group of NHS Trusts, 5 years after the act's enactment. Methods The levels of clinical activity, annual accounts and statements of financial position produced by the 10 Trusts for the financial years 2010/2011 to 2017/2018 were examined. Findings The key financial indicators for each organisation were collected. Key financial indicators for the period just before the Act were compared with the corresponding values for the period of 5 years after the enactment of the Act. The Shelford group of NHS Trusts provided 15 047 304 patient care episodes in 2017/2018, which represented a rise of 6.34% over 5 years. This was a significant slowdown in clinical, which had grown by 18.57% in the 4 years immediately before the act. There were no significant differences in the mean operating surplus returned by the Shelford Group in the 5 years after the Act, compared to before its implementation. The median cost of finance for each organisation increased by 35.4% from £18 245 000 to £24 703 000. The total capital employed remained static over the 5 years following enactment of the Act. There were no significant differences in levels of liquidity and leverage of the Shelford Group in the 5 years after the Act compared to before. Conclusions The financial position of the Shelford Group of Trusts has not been adversely affected by the Health and Social Care Act (2012) , although there was some evidence that the operational finances of these NHS Trusts were less robust in the 5 years following the Act.