Sunday 30 December 2012

Failings in diabetes care 'cost thousands of lives'


'Diabetes care depressingly poor, say MPs', is the headline on the BBC News website. This is the damning verdict of a parliamentary report into standards of diabetes care in the NHS. The Public Accounts Committee reported that (in the words of the Daily Mail), "24,000 with diabetes 'are dying needlessly'".

The report was published by the Public Accounts Committee (PAC) – an influential group of MPs who have been given an oversight role to help ensure that taxpayers get value for money.

Based on official figures and spoken and written evidence from independent diabetes experts and officials, the PAC has set out recommendations for improved diabetes care in the NHS.

The report indicates that the NHS spent an estimated £3.9 billion on diabetes services in 2009/10. However, 80% of the costs are estimated to come from the management and treatment of avoidable diabetes-related complications, such as kidney disease and foot ulcers.

The report highlights that the number of people with diagnosed and undiagnosed diabetes is 3.1 million, set to rise to 3.8 million by 2020. This projected increase is likely to have a significant impact on NHS resources, the committee says.

The report accepts that there is consensus about what needs to be done for people with diabetes. However, progress in actually delivering the recommended standards and achieving treatment targets has been 'depressingly poor', it says.

 

Who produced the report?

The report, 'Department of Health: The management of adult diabetes services in the NHS' has been published by the PAC.

The PAC is made up of MPs appointed by the House of Commons, and is responsible for overseeing government expenditures to ensure transparency, value for money, and accountability in government financial operations.

 

What are the main findings?

The main findings of the report are:

  • an estimated 80% of the costs of diabetes come from the management and treatment of avoidable diabetes-related complications (such as diabetic eye disease and kidney disease)
  • the Department of Health estimates that up to 24,000 people with diabetes are dying each year from causes that could be avoided through better management of their condition
  • only half of people with diabetes receive all the basic tests to monitor their condition, and failure to carry out these simple checks heightens the risk of developing complications
  • less than one in five people with diabetes have achieved the recommended levels for blood glucose, blood pressure and cholesterol
  • despite the Department of Health improving information on diabetes, this information is not being used effectively to assess and improve the quality of care
  • many people with diabetes develop avoidable complications because they are not effectively supported to manage their condition and do not always receive care from appropriately trained professionals across primary and secondary care
  • the projected increase in the diabetic population could have a significant impact on NHS resources

The report states that the reasons these problems have arisen include:

  • the fact there is no strong national leadership – each Primary Care Trust is largely 'left to their own devices' when it comes to how they decide to tackle diabetes
  • there are no effective accountability arrangements for commissioners (those in charge of allocating funds to particular services)
  • there are no appropriate performance incentives (rewards, usually financial, designed to encourage best practice) for the providers of diabetes care

£5 million for veterans in need of new prosthetics

The Department of Health has £5 million available to spend on new prosthetics centres for veterans in 2013. The money is part of a £22 million package to support veterans' physical and mental health from 2010 to 2015.

So far this year, 32 veterans applied to get high specification prosthetic equipment, such as computer controlled knee units and specialist feet. The Department of Health has committed to funding clinically appropriate prosthetics for any veteran in England who has lost a limb in the service of their country.

There are currently an estimated 1,335 veteran amputees in the United Kingdom with the majority living in England. The Government wants to raise awareness of this funding so that all veterans who have lost a limb in the service of their country can benefit from the extraordinary, life-changing work the NHS can do with prosthetics. Find out more

Friday 28 December 2012

NHS Pension Scheme contributions calculator for 2013-14 published

An NHS Pension Scheme contributions calculator for 2013-14 employee contributions has been published today. The employee contributions calculator enables NHS Pension Scheme members to calculate how much their contributions will increase, if at all, on a monthly basis, on both a gross and net of tax relief basis.

View the NHS Pension Scheme contributions calculator for 2013-14

Thursday 20 December 2012

NHS Mandate published

The first Mandate between the Government and the NHS Commissioning Board, setting out the ambitions for the health service for the next two years, was published on 13 November 2013.

The Mandate reaffirms the Government's commitment to an NHS that remains comprehensive and universal – available to all, based on clinical need and not ability to pay – and that is able to meet patients' needs and expectations now and in the future.

The NHS Mandate is structured around five key areas where the Government expects the NHS Commissioning Board to make improvements:

  • preventing people from dying prematurely
  • enhancing quality of life for people with long-term conditions
  • helping people to recover from episodes of ill health or following injury
  • ensuring that people have a positive experience of care
  • treating and caring for people in a safe environment and protecting them from avoidable harm.

Through the Mandate, the NHS will be measured, for the first time, by how well it achieves the things that really matter to people.

The key objectives contained within the Mandate include:

  • improving standards of care and not just treatment, especially for the elderly
  • better diagnosis, treatment and care for people with dementia
  • better care for women during pregnancy, including a named midwife responsible for ensuring personalised, one-to-one care throughout pregnancy, childbirth and the postnatal period
  • every patient will be able to give feedback on the quality of their care through the Friends and Family Test starting from next April – so patients will be able to tell which wards, A&E departments, maternity units and hospitals are providing the best care
  • by 2015 everyone will be able to book their GP appointments online, order a repeat prescription online and talk to their GP online
  • putting mental health on an equal footing with physical health – this means everyone who needs mental health services having timely access to the best available treatment
  • preventing premature deaths from the biggest killers
  • by 2015, everyone should be able to find out how well their local NHS is providing the care they need, with the publication of the results it achieves for all major services.

See NHS Mandate site

Health Secretary, Jeremy Hunt said:

"Never in its long history has the NHS faced such rapid change in our healthcare needs, from caring for an older population, to managing the cost of better treatments, to seizing the opportunities of new technology.

"This Mandate is about giving the NHS the right priorities to deal with those challenges. By focusing on what matters to patients, and giving doctors and other professionals the freedom to deliver, we will make sure the NHS stays relevant to our needs and continues providing the best possible care for us all."

The Mandate has been drawn up following consultation with the public, health professionals and key organisations across the health system between July and September 2012.

Read the following documents:

 

National Clinical Director Posts

AHPs are being encouraged to apply for National Clinical Director (NCD) posts.  The post holders will take the clinical lead in driving improvement in quality across all relevant domains of the NHS Outcomes Framework.  As part of that the NCD will be the architect of and responsible for successful design and delivery of a suite of commissioning tools to support system, professional and care pathway changes at a national and local level.  The NCD will work collaboratively with other NCDs to ensure there is coherent commissioning guidance across CCG and specialised commissioned services.   This is a great opportunity for Prosthetists and Orthotists to get involved in key roles that can influence services.   Roles are by secondment and include:

Informatics

Maternity and Children
Mental Health
Urgent Care
Stroke

Rehab and Recovery in the community
Trauma
Spinal
MSK

Integration and Frail elderly
Dementia
CVD
Diagnostics and Imaging
Obesity and Diabetes
Renal
Heart disease
Enhanced recovery and critical care

 

Application is through the NHS Jobs site.

Friday 14 December 2012

BAPO Conference & Exhibition 2013 - Early Bird Ends 31 December 2012


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Thursday 13 December 2012

Review of NHS critical infrastructure risk initiated

A review of critical infrastructure risk (CIR) has been initiated to support the commitments under the NHS Constitution for the NHS 'to provide services from a clean and safe environment that is fit for purpose based on national best practice'.  It may be risking regulatory requirements to ensure service users are protected against risks associated with 'unsafe and unsuitable premises'.

The review will build on existing practices, such as how backlog maintenance is currently determined, and ensure a system is put in place for the future that gets to the heart of the investment required to address risks that are critical.

NHS organisations are invited to participate in the Review of the NHS' recurrent reporting of a need for significant investment in maintenance of its facilities. This is to eliminate 'critical risks' to the safety of patients, visitors and staff; and the resilience of its services.

Monday 10 December 2012

Creating change: Innovation health and wealth one year on

The report, "Creating change: Innovation health and wealth one year on" provides an update on the implementation of the NHS Chief Executive's report "Innovation health and wealth, accelerating adoption and diffusion in the NHS" published in December 2011.

The first report  set out delivery for spreading innovation quickly and at a scale throughout the NHS. 'Creating change' demonstrates the progress that is being made at a time of great change in the NHS. It highlights what more should be done to deliver the improvements needed to fully embrace and embed innovation in the NHS and improve outcomes and quality for patients and the NHS and drive growth for the UK.

Read Creating change: Innovation health and wealth one year on


New national model to tackle variation in specialist healthcare services

For the first time patients requiring specialised treatment can look forward to the same level and standards of care. The NHS Commissioning Board has published the new Operating Model for commissioning specialised services setting out how a single, national system will ensure patients are offered consistent, high quality services across the country.

The number of patients requiring specialised services is small with services located in specialist centres in major towns and cities across England. Concentrating services to provide the same national standards of quality will ensure that specialist staff can be more easily recruited and the necessary levels of training maintained.

The new Operating Model and associated Commissioning Intentions mark a clear move away from regional commissioning to a single national approach to both commissioning and contracting. By bringing together the current ten different systems for commissioning specialised services, it provides the opportunity to innovate and introduce new technologies to benefit patients and improve health outcomes in a systematic way.

Underpinning the Operating Model are the Commissioning Intentions for 2013/14 ensuring for the first time that the delivery, quality and access for all prescribed specialised services is standard across the country.

Ian Dalton, Chief Operating Officer and Deputy Chief Executive at the NHS Commissioning Board said,

"This improved system will ensure national consistency in accessing services, reduce variation, and set clear quality standards leading to better health outcomes for patients. It will also allow us to start developing an outcomes framework for rare and specialised conditions, thus starting to move the focus of our discussions with providers from contract inputs to health outcomes.

"This is a real opportunity to dramatically improve the way we provide services for people with rare and specialised conditions through having clearly articulated standards for services.

"Our next step will be to shortly launch a public consultation on the first ever set of national service specifications and clinical policies for specialised services.  This will be the first time we have had clear national policy and sets our clear intention for the future"

The new system will provide a clear focus on a range of rare conditions and low volume treatments ranging from medical genetics, kidney disorders and uncommon cancers to complex cardiac interventions, burn care and some specialised services for children.

James Palmer, the new Clinical Director for Specialised Services at the NHS Commissioning Board said,

"Strong clinical involvement has been central to the development of this approach. We are working closely in partnership with Clinical Commissioning Groups and colleagues on the frontline to ensure the whole patient pathway is as seamless and locally responsive as possible in meeting patients' needs."

Specialised services accounts for approximately 10% of the total NHS budget and accounts for approximately £11.8 billion per annum.

More information is available in the specialised commissioning resources area.

Friday 7 December 2012

Latest NHS Commissioning Board CCG bulletin 27 November 2012

Latest CCG bulletin published by the NHS Commissioning Board.

The NHS Commissioning Board has published its latest bulletin for CCGs from Dame Barbara Hakin, national director for commissioning development. 


Tuesday 4 December 2012

Contractual ‘duty of candour’ to drive a more open NHS culture

New rules to toughen transparency in NHS organisations and increase patient confidence have been announced by Health Minister Dr Dan Poulter following a public consultation. The government will create regulations that require the NHS Commissioning Board to include a contractual duty of openness in all commissioning contracts from April 2013.

This means that NHS organisations will be required to tell patients if their safety has been compromised, apologise, and ensure that lessons are learned to prevent them from being repeated. Although all NHS organisations are currently expected to be open about mistakes, there is no contractual duty to hold them to account when this does not happen.

Dr Dan Poulter said:

"The importance of an open culture cannot be underestimated. We expect that Robert Francis will make further recommendations on duty of candour when the Mid Staffordshire Inquiry has been published, and we are committed to taking whatever further action we think is needed as a result. But we cannot simply wait when there are things we can already do – creating this contractual duty of candour now ensures that NHS contracts for the next financial year will champion patients' rights to always have basic honesty from our NHS, as well as safe care."

The responses to the public consultation and the government's analysis of them have now been published, alongside the impact assessment and equalities analysis of the proposed contractual duty of candour.

Sunday 2 December 2012

Relationship Between Tightness of the Posterior Muscles of the Lower Limb and Plantar Fasciitis

Yolanda Aranda Bolívar, Pedro V. Munuera Martínez, and Juan Polo Padillo

Abstract

Background: The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity
was associated with plantar fasciitis.

Methods: A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited.
Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion
(knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves,
sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive
powers.

Results: Differences between the 2 groups for the tests used to assess muscular shortening were significant (P < .001) in
all cases. The straight leg elevation test and ankle dorsiflexion with the knee extended presented respective sensitivities of
94% and 100% and specificities of 82% and 96% as diagnostic tests for the participants in this study.

Conclusion: Tightness of the posterior muscles of the lower limb was present in the plantar fasciitis patients, but not in
the unaffected participants.

Clinical Relevance: The results of this study suggest that therapists who are going to employ a stretching protocol for
treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs
could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from
an adequate tissue-specific plantar fascia-stretching protocol.

Level of Evidence: Level III, case control study.




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Jonathan