BAPO Conference 22-24 March 2013 Telford

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Critical Appraisal Skills BAPO Short Course 19 April 2013 Staffordshire University

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BAPO Short Course Kinesio Taping 21 & 22 June 2013

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Jeremy Hunt challenges NHS to go paperless by 2018

The NHS should go paperless by 2018 to save billions, improve services and help meet the challenges of an ageing population, Health Secretary Jeremy Hunt will say today. In a … Read more → - Jeremy Hunt challenges NHS to go paperless by 2018 

Outcomes

Responsiveness of the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery 

J. Dawson, I. Boller, H. Doll, G. Lavis, R. Sharp, P. Cooke, and C. Jenkinson J Bone Joint Surg Br 2012;94-B 215-221 

Quote: The responsiveness of the Manchester–Oxford Foot Questionnaire (MOXFQ) was compared with foot/ankle-specific and generic outcome measures used to assess all surgery of the foot and ankle. We recruited 671 consecutive adult patients awaiting foot or ankle surgery, of whom 427 (63.6%) were female, with a mean age of 52.8 years (18 to 89). They independently completed the MOXFQ, Short-Form 36 (SF-36) and EuroQol (EQ-5D) questionnaires pre-operatively and at a mean of nine months (3.8 to 14.4) post-operatively. Foot/ankle surgeons assessed American Orthopaedic Foot and Ankle Society (AOFAS) scores corresponding to four foot/ankle regions. A transition item measured perceived changes in foot/ankle problems post-surgery. Of 628 eligible patients proceeding to surgery, 491 (78%) completed questionnaires and 262 (42%) received clinical assessments both pre- and post-operatively. The regions receiving surgery were: multiple/whole foot in eight (1.3%), ankle/hindfoot in 292 (46.5%), mid-foot in 21 (3.3%), hallux in 196 (31.2%), and lesser toes in 111 (17.7%). Foot/ankle-specific MOXFQ, AOFAS and EQ-5D domains produced larger effect sizes (> 0.8) than any SF-36 domains, suggesting superior responsiveness. In analyses that anchored change in scores and effect sizes to patients' responses to a transition item about their foot/ankle problems, the MOXFQ performed well. The SF-36 and EQ-5D performed poorly. Similar analyses, conducted within foot-region based sub-groups of patients, found that the responsiveness of the MOXFQ was good compared with the AOFAS.

This evidence supports the MOXFQ's suitability for assessing all foot and ankle surgery.

Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and Achilles tendon

Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and Achilles tendon Murley 2013 Scandinavian Journal of Medicine & Science in Sports Wiley Online Library

G. S. Murley, J. M. Tan, R. M. Edwards, J. De Luca, S. E. Munteanu, J. L. Cook

Scandinavian Journal of Medicine & Science in Sports

Abstract

The aim of this study was to investigate the association between foot type and the morphometry of selected muscles and tendons of the lower limb. Sixty-one healthy participants (31 male, 30 female; aged 27.1 ± 8.8 years) underwent gray-scale musculoskeletal ultrasound examination to determine the anterior-posterior (AP) thickness of tibialis anterior, tibialis posterior, and peroneus longus muscles and tendons as well as the Achilles tendon. Foot type was classified based on arch height and footprint measurements. Potentially confounding variables (height, weight, hip and waist circumference, rearfoot and ankle joint range of motion, and levels of physical activity) were also measured. Multiple linear regression models were used to determine the association between foot type with muscle and tendon morphometry accounting for potentially confounding variables. Foot type was significantly and independently associated with AP thickness of the tibialis anterior tendon, peroneus longus muscle, and Achilles tendon, accounting for approximately 7% to 16% of the variation. Flat-arched feet were associated with a thicker tibialis anterior tendon, a thicker peroneus longus muscle, and a thinner Achilles tendon. Foot type is associated with morphometry of tendons that control sagittal plane motion of the rearfoot; and the peroneus longus muscle that controls frontal plane motion of the rearfoot. These findings may be related to differences in tendon loading during gait.

Adaptable prosthetics for amputees

Approximately one in every 1,000 people in the UK is an amputee. Many lose their limbs as the result of tragic accidents or due to active military combat and for some amputees losing a limb is a loss of freedom.

Bryce Dyer (pictured) is part of a team of design engineers and clinicians studying prosthetics at BU’s Design Simulation Research Centre: “Many prosthetic limbs remain unused simply because they can be so uncomfortable over time,” he says.

Fitting a false limb is currently “a bit of a black art” says Dyer. Prosthetists traditionally require decades of experience to do their job successfully and are dependent upon the subjective feedback of patients, with no other method of measuring fit. Additionally, current technology does not allow for changes in volume – patients’ stumps may swell and contract. “It’s like having your feet change size on a daily basis and expecting your shoes to still fit comfortably,” says Dyer.

Led by Professor Siamak Noroozi, the BU team are turning an academic concept into a practical product that could lessen the misery of thousands of amputees.

They are creating a ‘smart socket’ – a lower-limb prosthetic which can adjust itself to fit the changing shape of the limb stump it connects with. The design team say the fit will be so comfortable that amputee servicemen may even be able to return to active combat.

Calling on combined expertise, BU’s School of Design, Engineering and Computing is using artificial intelligence to create a self-learning system that will measure interactions between socket and limb stump during the fitting and wear.

“It is very much at a research and development stage,” says Dyer. Currently the team are also attempting to miniaturise the technology to make it light and portable as well as incorporating wireless technology.

BU scientists have teamed with commercial partners at prosthetics and orthotics supplier Chas A Blatchford & Sons, who work with the Ministry of Defence Medical Rehabilitation Centre in Surrey, where injured soldiers are sent following service in Afghanistan and Iraq.

“One of the great things about this industrial partnership is that we will be able to get feedback from the very kind of people we are trying to help,” says Dyer.

With better fitting false limbs, medical costs will fall, say BU designers. Prosthetists will be able to get it right first time and will require less experience to be able to do their job properly. Being agile enough to return to active service is a huge bonus for the rising numbers of amputee soldiers. “It will get them back in the field rather than being retired early or restricted in what they can do,” says Dyer.

Understanding how elite sprinters perform with artificial limbs or “blades” and how different types of prostheses compare is central to another strand of Dyer’s research. “Paralympic running world records are still being set on a near annual basis – the sport hasn’t settled down yet. I’m looking at how individuals should be grouped together or separated – how to give the fairest possible race.”

As well as informing future Paralympic Committees, the research will apply to disability in sport in general. Should someone who’s lost both limbs compete against a runner missing just one limb, for example? And how should technology be categorised, when variations in quality of false limbs may create substantial differences among international athletes?

“Some 30 years ago, it was all about enabling disabled people to take part in sport,” says Dyer. “But now the quality of performances and the sums of money involved are so great, there’s much more at stake. We don’t want to restrict technology but we need to find a way to measure it.”

Source: http://buresearchchronicle.org.uk/theme/technology/adaptable-prosthetics-for-amputees/

Triple Amputee takes on the Dakar Rally 2013

Ex-paratrooper Tom Neathway lost both legs and an arm in an explosion in Afghanistan but is tackling this grueling 5,000-mile race across South America.

This is the 34th edition of the race, which started in Lima on January 4 and ends in Chile on January 20.

There is the fund-raising side. Tom will be raising hopefully £1million for Help For Heroes and Tedworth House, one of the five recovery centres set up in partnership between the Ministry of Defence, Help for Heroes and the Royal British Legion.

Source: http://www.mirror.co.uk/sport/other-sports/dakar-rally-2013-preview-tom-1519172#comments

UK's first hand transplant operation

A former pub landlord from West Yorkshire has become the first person in the UK to have a hand transplant.

Mark Cahill, who is 51, had been unable to use his right hand after it was affected by gout.

This procedure allowed very accurate restoration of nerve structures and is believed to be the first time this approach has been used, surgeons said.

Consultant plastic surgeon Professor Simon Kay, who led the surgical team, said: "This operation is the culmination of a great deal of planning and preparation over the last two years by a team including plastic surgery, transplant medicine and surgery, immunology, psychology, rehabilitation medicine, pharmacy and many other disciplines.

"The team was on standby from the end of November awaiting a suitable donor limb, and the call came just after Christmas.

Doctors say he is making good progress after an eight-hour operation at Leeds General Infirmary.

It is still very early to assess how much control of the hand will be gained - so far he can wiggle his fingers, but has no sense of touch.

Source: http://www.bbc.co.uk/news/health-20898940

http://news.sky.com/story/1033091/hand-transplant-completed-for-first-time-in-uk

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

Source: http://www.nhs.uk/news/2012/11November/Pages/Failings-in-diabetes-care-cost-thousands-of-lives.aspx

£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

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

Disabled boy, 4, receives prosthetic blade for Christmas just like his hero Jonnie Peacock

Rio Woolf, from Bushy Heath in Hertfordshire, had to have his lower right leg amputated after being born without a tibia, knee or ankle joint.

Full Story: 
http://www.dailymail.co.uk/health/article-2253006/Disabled-boy-receives-prosthetic-blade-Christmas-just-like-hero-Jonnie-Peacock.html

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:

• The Mandate: A mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015
• The Government's response to the consultation on the draft mandate to the NHS Commissioning Board
• Equality Analysis
• Reference document for policy impact assessments
• Financial Directions to the NHS Commissioning Board

 

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.

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

BAPO CONFERENCE & EXHIBITION 2013 EARLY BIRD OFFER ENDS 31 DECEMBER 2012 Don't miss out on this fantastic Early Bird Discount!!  For further information go to www.bapo.com find us on Facebook http://www.facebook.com/BAPO.com BAPO Secretariat Sir James Clark Building , Abbey Mill Business Centre, Paisley, Renfrewshire, PA1 1TJ T: +44 (0) 0141 561 7217 F: +44 (0) 0141 561 7218 E: Enquiries@bapo.com W: http://www.bapo.com Find us on facebook:http://www.facebook.com/BAPO.com

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.

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.

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.