NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin for PCTs in North Staffordshire

Issue No: 53 June 2011

About this Bulletin: It aims to draw attention to some of the key documents and reviews on clinical effectiveness that have been published in the previous month. Where possible, links to the full text documents are included. If the article is in a journal, you can contact the Health Library for a copy. Link to request form: http://www.keele.ac.uk/healthlibrary/usingthehealthlibrary/interlibraryloans/#d.en.27437 [Please note - a charge of 2 per request is payable for most copies] If you need further assistance, please contact the Health Library or the NHS Outreach Librarians, details below. The bulletin can be e-mailed to colleagues who may also find it useful. A list of websites that are checked in the production of this bulletin are listed on the first page. Please suggest further useful sites. Feedback is always welcomed to inform future issues of the bulletin.

Contact information

Bulletin produced by NHS Outreach Librarians Tel: FeatureNet 8429 (External calls 0300 123 1535 ext 8429) E-mail: lindsay.snell@northstaffs.nhs.uk clareh.powell@northstaffs.nhs.uk

North Staffs Health Library Tel: 01782 679500 Fax: 01782 556582 E-mail: health.library@keele.ac.uk

NHS Library and Information Service North Staffordshire Contents in this issue
Alcohol Cancer Cardiovascular Diseases Children and Young People Commissioning Dementia Diabetes Emergency Care Evidence and Information Gastroenterology General Practice Guidance Health Reforms IVF Learning Disabilities Maternal and Infant Health Mental Health Nursing Neurology Obesity Older People Patient Care and Safety Pharmacy Prescribing Public Health Research Respiratory Safeguarding Children and Vulnerable Adults Service Management Sexual and Reproductive Health Substance Misuse Vaccination and Immunisation Workforce

Sources for Clinical Effectiveness Bulletin

Please suggest further sites that should be monitored in the production of this bulletin

Websites
Cochrane Library http://www.thecochranelibrary.com/ CRD Centre for Reviews and Dissemination http://www.crd.york.ac.uk/crdweb/ - DARE (Database of Abstracts of Reviews of Effects) - NHS Economic Evaluation Database Health Technology Assessment (HTA) Database http://www.hta.ac.uk Daily Health Bulletin http://www.sheffield.nhs.uk/healthbulletin/ Department of Health http://www.dh.gov.uk/en/index.htm Kings Fund http://www.kingsfund.org.uk/ NeLM (National Electronic Library for Medicines) news bulletin http://www.nelm.nhs.uk/en/ NICE http://www.nice.org.uk/ SIGN http://www.sign.ac.uk/new.html

NHS Library and Information Service North Staffordshire Alcohol

Drinking patterns and alcohol service provision for different ethnic groups in the UK: a review of the literature Bayley, M Some ethnic groups have higher than national average alcohol-related deaths. People from black and minority ethnic backgrounds have similar rates of alcohol dependency as the white population; however minority ethnic groups are under-represented in seeking treatment and advice. Help-seeking preferences vary between and within groups suggesting that drinking problems need to be addressed within both mainstream and specialist services. Greater understanding of cultural issues is needed in the development of alcohol services. http://www.pierprofessional.com/eihscflyer/downloads/EIHSC-3.4.pdf Improving accuracy in recording alcohol consumption: a survey in Greater Manchester Centre for Public Health (Liverpool John Moores University) in partnership with Greater Manchester Public Health Practice Unit This survey uses a new methodology which reveals consumption quantities 33% higher than equivalent regional/national surveys. This is particularly evident in higher level drinkers. The survey provides a baseline for more accurate monitoring of drinking at the population level. Further, it highlights how surveys can be developed to more accurately capture data around sensitive subjects, and provides more accurate data for needs assessments and service commissioning. http://www.cph.org.uk/showPublication.aspx?pubid=726 Statistics on Alcohol: England, 2011 NHS Information Centre http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/alcohol/statistics-onalcohol-england-2011-%5Bns%5D
Items in the Children and Young People sections may also be of interest. [back to topics]

Cancer
Anticoagulation for the long-term treatment of venous thromboembolism (VTE) in patients with cancer Akl, E et al. For the long-term treatment of VTE in patients with cancer, low molecular weight heparin compared to vitamin K antagonist reduces venous thromboembolic events but not death. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006650/frame.html Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis Biagi, J et al The authors concluded that a longer time to adjuvant chemotherapy was associated with worse survival among patients with resected colorectal cancer. JAMA. 2011; v.305(22) p.2335-2342. doi: 10.1001/jama.2011.749 3

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National Bowel Cancer Audit Annual Report 2010 NHS Information Centre This report contains data collected on patients with a diagnosis date between 1 August 2008 and 31 July 2009 - the reporting period 2008/09. http://www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/auditreports/bowel-cancer Cancer survival in the 'Spearhead' Primary Care Trusts of England Office for National Statistics This report presents cancer survival for adult patients resident in the 62 'Spearhead' primary care trusts in England, compared with those resident in the rest of England. It gives the oneand five-year age-standardised relative survival for patients diagnosed with one of the following ten cancers: bladder, breast (women), cervix, colon, lung, oesophagus, ovary, prostate, rectum and stomach. http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=14821 Funding Cancer Drugs: An evaluation of the impact of policies to improve access to cancer treatments Rarer Cancers Foundation This is the first detailed evaluation of the impact of recent changes to cancer treatment. It is intended to inform the development and implementation of policy on access to treatments, including: The implementation of the Cancer Drugs Fund in 2011/12. The development of detailed proposals to introduce a system of value-based pricing. How GP consortia develop local systems for determining access to treatments not routinely available on the NHS. http://www.rarercancers.org/images/stories/news/pdf/0611/funding_cancer_drugs_final.pdf How to improve cancer survival: explaining Englands relatively poor rates Kings Fund This report considers the existing differences in cancer survival rates between countries and discusses the reasons for these variations including: stage at diagnosis and diagnostic delay; treatment factors; patient factors; and physiological/biological factors. http://www.kingsfund.org.uk/publications/cancer_survival.html Improving outcomes: A strategy for cancer National Cancer Intelligence Network (NCIN) This supplement summarises some of the information and evidence that has been used to inform the development of Improving Outcomes: A strategy for cancer and highlights the extent to which variations in the quality of cancer services and outcomes continue to vary. http://www.ncin.org.uk/view.aspx?rid=663 The strategy is available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_123371 Promoting earlier diagnosis of cancer Department of Health Letter about the Department of Health's desire to invest in local pilot campaigns in order to promote cancer symptom awareness and encourage earlier presentation to primary care for a 4

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number of cancers and target groups. Bids of up to 100,000 are being invited. Deadline for submissions: Thursday, 4 August. http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/D H_127937 Revised Chemotherapy Measures for the Manual for Cancer Services Department of Health These measures are the outcome of a 3 month consultation period. http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_127744 The second all breast cancer report: focussing on inequalities - variation in breast cancer outcomes with age and deprivation. National Cancer Intelligence Network (NCIN) http://www.ncin.org.uk/view.aspx?rid=612
Items in the Children and Young People sections may also be of interest. [back to topics]

Cardiovascular Diseases
Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis Priess, D et al. In an analysis of data from 5 trials, intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy. JAMA. 2011;305(24) p.2556-2564. doi: 10.1001/jama.2011.860 Naftidrofuryl for intermittent claudication de Backer, T et al. The authors of this Cochrane Review concluded that naftidrofuryl has a statistically significant and clinically meaningful effect of improving walking distance in the six months after initiation of therapy for people with intermittent claudication. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001368/frame.html Structured telephone support or telemonitoring programmes for patients with chronic heart failure (CHF) Inglis, S et al. The authors of this Cochrane review concluded that structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; and that they improve quality of life, reduce costs, and evidence-based prescribing. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007228/frame.html
Items in the Cancer and Diabetes sections may also be of interest. [back to topics]

NHS Library and Information Service North Staffordshire Children and Young People
Adolescent health in the UK today: where next? Association for Young People's Health This report looks at why adolescent health matters. It also covers key trends in adolescent health and issues for service delivery. The report makes recommendations and gives supporting data about young people's health and well-being. http://www.chimat.org.uk/youngpeople/AHUK Grommets (ventilation tubes) for recurrent acute otitis media in children McDonald, S et al. The authors of this Cochrane Review concluded that grommets have a significant role in maintaining a 'disease-free' state in the first six months after insertion, but that clinicians should consider the possible adverse effects of grommet insertion before surgery is undertaken. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004741/frame.html Place of Death for Children, Teenagers and Young Adults with Cancer in England National Cancer Intelligence Network (NCIN) This briefing explores patterns of place of death among children, teenagers and young adults with cancer in England who died during 2000-2009. http://www.ncin.org.uk/publications/data_briefings/place_of_death_for_ctya_with_cancer.aspx PREview Planning Resources Child and Maternal Health Observatory PREview is intended to help commissioners, managers and professionals to target preventive resources, in particular around the Healthy Child Programme, where they are most needed. PREview is based on evidence for the factors in pregnancy and infancy that are associated with outcomes for children at five years. http://www.chimat.org.uk/preview You are not on your own: A booklet to help children and adults talk about a parents drinking Childrens Commissioner This booklet helps children to have frank discussions with teachers, professionals or an adult who they trust. http://www.childrenscommissioner.gov.uk/force_download.php?fp=%2Fclient_assets%2Fcp %2Fpublication%2F498%2FYou_are_not_on_your_own__A_booklet_to_help_children_and_adults_talk_about_a_parents_drinking.pdf
Items in the Maternal and Infant Health, Mental Health and Obesity sections may also be of interest. [back to topics]

NHS Library and Information Service North Staffordshire Commissioning

Changes to QOF 2011/12 NHS Employers This page gives an outline summary of the changes. http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages /ChangestoQOF2011-12.aspx GP commissioning in the NHS in England: Ten suggestions from the United States Nuffield Trust As the NHS prepares to transfer responsibility for around 60 per cent of its budgets to clinical commissioning groups, the degree of financial risk that will be faced by these groups is much wider in scope than anything seen before in the NHS. It is closer to the risk that has been held by some doctor-led groups and networks in the US. This Viewpoint provides a brief history of risk contracting in the US; describes the different models of physicians contracting with health insurance plans; and sets out ten suggestions for GP-led commissioning in England. http://www.nuffieldtrust.org.uk/publications/gp-commissioning-insights-medical-groups-unitedstates Thanks for the Petunias: A guide to developing and commissioning non-traditional providers to support the self management of people with long term conditions NHS Networks This guide is a product of the national Year of Care Programme. The Programme aims to ensure local services are available via commissioning, to support people in the actions they want to take to improve their health and well being outcomes. http://www.diabetes.nhs.uk/document.php?o=2328
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Dementia
A call to action on the use of antipsychotic drugs for people with dementia Dementia Action Alliance This call aims to improve the quality of life of people with dementia and their carers by reducing the inappropriate use of antipsychotics. http://www.institute.nhs.uk/qipp/calls_to_action/Dementia_and_antipsychotic_drugs.html Common core principles for supporting people with dementia: a guide to training the social care and health workforce Department of Health These principles can be used to support workforce development for any member of staff, in any health or social care setting, working with people at any stage of dementia. They can also be used to inform the content of curricula and training courses. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127442

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The Ministerial Group on Dementia Research: headline report Department of Health The Advisory Group has been working over the last 18 months on proposals to increase the volume, quality and impact of dementia research. Its final Headline Report includes a comprehensive set of agreed actions, with clear timelines. Progress against these actions will be assessed at a final meeting of the Advisory Group in 12 months time. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127750
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Diabetes
Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and Bayesian random-effects meta-analyses of randomized trials Bangalore, S et al. The authors concluded that the evidence suggests that in patients with type 2 diabetes mellitus/ impaired fasting glucose/ impaired glucose tolerance, a systolic BP treatment goal of 130 to 135 mm Hg is acceptable. With more aggressive goals (<130 mm Hg), the risk of stroke continued to fall, but there was no benefit regarding the risk of other macrovascular or microvascular (cardiac, renal and retinal) events, and the risk of serious adverse events increased. Circulation. Published online before print May 31, 2011, doi: 10.1161/CIRCULATIONAHA.110.016337 National Diabetes Audit: Key findings about the quality of care for people with diabetes in England and Wales 2009-10. Executive Summary NHS Information Centre The NDA includes data from both primary and secondary care participants. It currently covers four core care components of the National Service Framework (NSF) for Diabetes: Is everyone with diabetes recorded on a practice diabetes register? What percentage of people registered with diabetes received the nine key processes of diabetes care (Measure: Weight, Blood Pressure, HbA1c, Urine Albumin Creatinine Ratio (UACR), Serum Creatinine, Serum Cholesterol; Assess: Eyes, Feet, Smoking)? What percentage of registered diabetics achieved NICE defined treatment targets for glucose control, blood pressure and blood cholesterol? For people with registered diabetes what are the rates of acute and long term complications? http://www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/auditreports/diabetes Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus Hemmingsen, B et al. The authors of this Cochrane Review concluded trials did not show significant differences for all-cause mortality and cardiovascular mortality when targeting intensive glycaemic control compared with conventional glycaemic control. Targeting intensive glycaemic control reduced the risk of microvascular complications while increasing the risk of hypoglycaemia. Further, 8

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intensive glycaemic control might reduce the risk of non-fatal myocardial infarction in trials exclusively dealing with glycaemic control in usual care settings. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD008143/frame.html
Items in the cardiovascular diseases section may also be of interest. [back to topics]

Emergency Care
NHS 111 Minimum Data Set Department of Health The 111 number will provide a new easy to remember route into the NHS for all those who are unclear about which service is best placed to meet their needs. The 111 service was rolled out to four pilot sites in 2010. This publication supplies data to help assess the efficiency and effectiveness of the different 111 models. http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/NH S111MinimumDataSet/index.htm Transforming NHS ambulance services National Audit Office The report concludes that the Department of Health has until recently focused on speed of response as a measure of ambulance service performance, rather than clinical outcomes. The ambulance service achieves high levels of public satisfaction but there are wide variations in efficiency. The report identifies possible savings for the NHS of 165 million a year. Improving ambulance trusts performance has been hampered by a lack of comparative information to benchmark performance. The new clinical quality indicators introduced from April offer the potential for measurement of performance based on outcomes. http://www.nao.org.uk/publications/1012/nhs_ambulance_services.aspx
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Evidence and information

Public consultation on the new NHS Evidence Process and Methods Manual NHS Evidence NHS Evidence enables access to authoritative health and social care evidence and best practice through a web-based portal. NHS Evidence has produced a new Process and Methods Manual describing how new and important evidence is made available through NHS Evidence. NHS Evidence welcome comments from stakeholders, health and social care professionals and members of the public. Consultation closing date: 16th September 2011 http://www.evidence.nhs.uk/nhs-evidence-content/process-and-methods-manual
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NHS Library and Information Service North Staffordshire Gastroenterology

Prevention of NSAID-induced gastroduodenal ulcers Rostom, A et al. The authors of this Cochrane review concluded that various interventions prevent NSAIDinduced gastroduodenal ulcers in different patient groups. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD002296/frame.html
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General Practice
GP Patient Survey, April 2010 to March 2011 Department of Health Responses from around 5 million patients, providing timely and valuable information for Primary Care Trusts, GP practices and other patients about patients' experiences of local services. http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatientsurvey2007/ind ex.htm National survey of GP opinion 2011 BMA This interim analysis of some key questions in the National Survey of GP Opinion 2011 covers data from the first 10,000 UK postal respondents. It describes in more detail responses according to GP status where appropriate. http://www.bma.org.uk/images/gpopinionsurvey2011_tcm41-207092.pdf Promoting Continuity of Care in General Practice RCGP This paper outlines the evidence of the cost-effectiveness of general practice. It also makes the important link between access and continuity of care and suggests ways of helping patients achieve effective therapeutic relationships. The report identifies two specific types of Continuity of care: Relationship Continuity (the doctor-patient relationship in its most basic sense), and Management Continuity (co-ordination and co-operation between service providers to enable the patient to navigate the healthcare system). The report makes 30 recommendations to policy-makers, managers and commissioners, and practices. http://www.rcgp.org.uk//news/press_releases_and_statements/greater_continuity_of_care.as px
Items in the Commissioning sections may also be of interest. [back to topics]

Guidance
Annual Review 2010/2011 NICE http://review2010-2011.nice.org.uk/ 10

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NICE Clinical Guidelines BRAHMS Copeptin assay MTG4 http://guidance.nice.org.uk/MTG4 The management of hip fracture in adults CG124 http://guidance.nice.org.uk/CG124
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NICE Technology Appraisals Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs TA225 http://guidance.nice.org.uk/TA225 Lung cancer (non-small-cell, advanced or metastatic maintenance treatment): erlotinib (monotherapy) TA227 http://guidance.nice.org.uk/TA227 Rheumatoid arthritis (methotrexate-nave) - golimumab (terminated appraisal) TA224 http://guidance.nice.org.uk/TA224 Rituximab for the treatment of follicular non-Hodgkins lymphoma (maintenance treatment following response to first-line chemotherapy) TA226 http://guidance.nice.org.uk/TA226
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NICE Consultation Documents Acute coronary syndromes: ticagrelor Closing date for comments: 21 July 2011 http://guidance.nice.org.uk/TA/Wave20/70/Consultation/DraftGuidance Anaphylaxis To comment, contact the registered stakeholder organisation that most closely represents your interests. http://www.nice.org.uk/guidance/index.jsp?action=folder&o=55280 NICE advice on healthcare-associated infections To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 9 August 2011 http://www.nice.org.uk/guidance/phg/advicehealthcareassociatedinfectionsconsultation.jsp 11

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Diagnostics Assessment programme manual The manual has been developed with substantial input from a number of individuals and organisations in the NHS, the diagnostics industry, academia and the Department of Health. Development of the manual has also been informed by NICE's experience of running other evaluation programmes. Closing date for comments: 9 September 2011 http://www.nice.org.uk/aboutnice/whatwedo/aboutdiagnosticsassessment/DiagnosticsProgra mmeManual.jsp End of life care Closing date for comments: 22 July 2011 http://www.nice.org.uk/guidance/qualitystandards/indevelopment/endoflifecare.jsp Obesity: working with local communities Guidance to tackle obesity at a local level using a whole system approach was initiated by NICE in 2009. The work was put on hold in November 2010 and reviewed as part of the Governments obesity strategy work programme. The revised scope has a stronger focus on local, community-wide best practice. To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 22 July 2011 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=55088 Patient experience in generic terms: Guidance and Quality Standard This standard is for England, Wales and Northern Ireland. An associated quality standard is being developed for use in the NHS in England. To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments:19 July 2011 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=55048 Prophylaxis against infective endocarditis To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 25 July 2011 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=55269
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Other Guidance Evidence-based guideline: Treatment of painful diabetic neuropathy American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation Neurology May 17, 2011 v.76(20) p.1758-1765. Published online before print April 11, 2011, doi: 10.1212/WNL.0b013e3182166ebe Guidelines on oral anticoagulation with warfarin: 4th edition British Committee for Standards in Haematology http://www.bcshguidelines.com/documents/warfarin_4th_ed.pdf 12

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Other Health Technology Assessments Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS): two parallel randomised controlled trials Glazener C This Study found that providing one-to-one conservative physical therapy for men with urinary incontinence after prostate surgery is unlikely to be effective or cost-effective compared with standard care including the provision of information about conducting pelvic floor muscle training. Health Technol Assess 2011:15(24)
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Health Reforms
Accountability in the NHS: Implications of the government's reform programme Kings Fund The authors identify five types of accountability most relevant to health care by scrutiny, management, regulation, contract and election. Current accountability relationships, of both providers and commissioners, are considered, and compared and contrasted with the proposed new forms. The authors then assess whether the reforms will meet the governments policy aims and whether the new system is workable. http://www.kingsfund.org.uk/publications/nhs_accountability.html Establishing social enterprises under the Right to Request Programme National Audit Office This report highlights risks to value for money associated with the Department of Health's programme for enabling its staff to take the lead in leaving the NHS to set up health social enterprises. http://www.nao.org.uk/publications/1012/the_right_to_request_programme.aspx Government response to the NHS Future Forum report Department of Health This document sets out the Government's detailed response to the Forum's report. It explains how the government will make significant changes in line with the Forum's recommendations. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127444 Government's response to forum report: briefing NHS Confederation This briefing gives commentary and analysis on the governments response to the NHS Future Forum. http://www.nhsconfed.org/OurWork/latestnews/Pages/member-briefing-on-Governmentsresponse.aspx

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Ensuring transparency and probity: GPC guidance to ensure the honest and transparent operation of clinically led commissioning consortia. BMA This guidance sets out how consortia can ensure their governance arrangements have the confidence and trust of the public. It also calls on the government to scrap the proposal to pay consortia a performance-related payment if they perform well financially. http://www.bma.org.uk/images/whitepapergpcguide10transparancymay2011_tcm41-206907.p df NHS Future Forum recommendations to Government Department of Health Set up as an independent group to pause, listen and reflect on the content of the existing Health and Social Care Bill the Forum has made a series of recommendations in the following areas: Choice and Competition Clinical advice and leadership Education and training Patient involvement and public accountability The reports and supporting documents are available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127443 Reforming the NHS: Changes to the Health and Social Care Bill Kings Fund This simple comparison sets out the Bill's initial proposals, what has now changed, and some key questions that remain unanswered. http://www.kingsfund.org.uk/current_projects/the_health_and_social_care_bill/reforming_the_ health_bill/index.html Registration of primary medical services providers by the Care Quality Commission: a consultation on a proposed change in the date of registration Department of Health From April 2012, providers of primary medical services for the NHS are due to register with the CQC. This document describes proposals to change the start date for registration of GP practices to April 2013, while proposing that the registration of out of hours providers and NHS walk-in centres should still go ahead in April 2012. Consultation closing date: 29 July 2011 http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_127174 The voluntary and community sector in health: Implications of the proposed NHS reforms Kings Fund This report considers the main opportunities and challenges facing the voluntary and community sector. It discusses what needs to happen to ensure the sector can flourish in the new system and what it needs to do to grasp new opportunities. http://www.kingsfund.org.uk/publications/voluntary_sector.html
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NHS Library and Information Service North Staffordshire IVF

Holding back the British IVF revolution? A report into NHS IVF provision in the UK today All Party Parliamentary Group on Infertility Following a number of Freedom of Information questions to all PCTs in the UK, this report highlights the inconsistent availability of IVF provision. http://www.infertilitynetworkuk.com/News/?id=15620
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Learning Disabilities
Information for people with learning disability and their carers Royal College of Psychiatrists This is a new series of very accessible information for people with mental health problems who also have learning disabilities. All these materials have been written and tested with people with learning disabilities and their carers. http://www.rcpsych.ac.uk/mentalhealthinfo/problems/learningdisabilities.aspx
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Maternal and Infant Health

Bump to Baby NHS Local An NHS search engine for new and expectant mums, giving access to articles, videos, discussions and forums about birth and pregnancy. http://www.bumptobaby.info/ Infant Feeding Survey 2010: Early Results NHS Information Centre The survey provides estimates of the incidence, prevalence and duration of breastfeeding and other feeding practices adopted by mothers from the birth of their baby up to around ten months. It also collects information about mothers smoking and drinking behaviour before, during and after pregnancy. http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-relatedsurveys/infant-feeding-survey/infant-feeding-survey-2010-early-results Management of Women with Mental Health Issues during Pregnancy and the Postnatal Period Royal College of Obstetricians and Gynaecologists This document highlights the role of maternity services in the early identification of high-risk women and assessment of current illness, and describes principles of service organisation to meet these needs. http://www.rcog.org.uk/management-women-mental-health-issues-during-pregnancy-andpostnatal-period 15

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Maternity Finder (West Midlands) NHS Local Use this Maternity Finder to find information about maternity units and pregnancy services across the West Midlands, including details of services before, during and after birth, catering and parking facilities. http://nhslocal.nhs.uk/data-and-tools/maternity-finder-west-midlands Non-clinical interventions for reducing unnecessary caesarean section Khunpradit, S The authors of this Cochrane Review concluded that a number of measures may reduce unnecessary Caesarean sections. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005528/frame.html Self Assessment Tool - NICE Neonatal Standards Child and Maternal Health Observatory (ChiMat) This tool is for neonatal clinical and managerial leads to assess progress against the standard for specialist neonatal care. This is to help ensure that the physical, psychological and social needs of babies and their families are at the heart of all care given. Registration with the ChiMat website required to access this tool. Registration is free. http://www.chimat.org.uk/selfassessmenttools Thinking of getting pregnant? Make sure youre protected against German measles Department of Health This patient information leaflet outlines the risks of German measles and how mothers can protect themselves, friends and family from getting the disease. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127517
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Mental Health
Attitudes to Mental Illness: 2011 survey report NHS Information Centre This report presents the findings of a survey of attitudes towards mental illness among adults in England undertaken in 2011. Questions on this topic have been asked since 1994. http://www.ic.nhs.uk/statistics-and-data-collections/mental-health/mental-health-act/attitudesto-mental-illness--2011-survey-report-ns Clinical relevance of findings in trials of antipsychotics: systematic review Lepping, P et al. A systematic review identified studies of antipsychotics that used the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS). A published method of translating these into Clinical Global Impression Change scale (CGIC) scores was used to measure clinical relevance. The findings show improvements of limited clinical relevance. The British Journal of Psychiatry (2011) 198: 341-345. doi: 10.1192/bjp.bp.109.075366

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Haloperidol versus chlorpromazine for schizophrenia Leucht, C et al. The authors of this Cochrane Review concluded that given that haloperidol and chlorpromazine are global standard antipsychotic treatments for schizophrenia, it is surprising that incomplete reporting still makes it difficult for anyone to draw clear conclusions on the comparative effects of these drugs. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004278/frame.html Mental health and wellbeing of elders in black and minority ethnic communities Social Care Institute for Excellence (SCIE) Black and minority ethnic communities are often at greater risk of isolation and loneliness, which SCIE has found are two of the most significant factors linked to poor mental wellbeing. This series of 3 films looks at how social care professionals can work together to provide personalised services that help to alleviate problems with isolation and give people back their independence. http://www.scie.org.uk/socialcaretv/topic.asp?guid=588c2a0d-8307-4cd0-baa4-c8cd5feb6fcd Mindful Forum Mental Health Providers Forum This website aims to provide information to all mental health stakeholders from service users to professionals, focusing on practical solutions for the delivery of more responsive mental health services. It aims to be as accessible as possible and to engage individuals at all levels in the debates surrounding mental health, for effective development of policy and practice. http://mindfulforum-mhpf.org.uk/ QIPP and mental health: reducing the use of out of area services NHS Confederation This Briefing provides a guide to support local mental health communities, from both the NHS and local authorities, gain a better understanding of their use of out of area services and, where appropriate, come up with solutions to provide better value for money. It gives an overview of the issue and describes a seven step approach to reducing use of out of area services where appropriate. http://www.nhsconfed.org/Publications/briefings/Pages/QIPP-and-mental-health.aspx Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes Crowther, C et al. This Cochrane review shows that a repeat dose of prenatal corticosteroids, given to women who remain at risk of an early birth after an initial course of prenatal corticosteroids, helps the baby's lungs and reduces serious health problems in the first few weeks of life. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003935/frame.html

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Self Assessment Tool CAMHS Child and Maternal Health Observatory (ChiMat) This tool helps CAMHS partnerships to assess progress against mental health and psychological well-being standards. It can be used by individual organisations, partnerships and local areas to support improvement in their services. This is an adaptation of the tool originally provided by ChiMat and the Childrens Service Mapping (CSM) programme. Registration with the ChiMat website required to access this tool. Registration is free. http://www.chimat.org.uk/selfassessmenttoolshttp://www.chimat.org.uk/selfassessmenttools
Items in the Maternal and Infant Health, Prescribing and Safeguarding Children and Vulnerable Adults sections may also be of interest. [back to topics]

Nursing
Making nursing visible: valuing our contribution to high quality patient-centred care RCN This guidance covers the use of standardised terminologies in electronic patient records. It describes the value of ensuring that nursing concepts can be captured within electronic patient records to make nursing visible and valued. http://www.rcn.org.uk/__data/assets/pdf_file/0003/372990/003877.pdf
Items in the Research sections may also be of interest. [back to topics]

Neurology
Local adult neurology services for the next decade Royal College of Physicians This new report makes three proposals: expansion and improvement of local services with a shift in emphasis from scheduled to emergency care better organised care for patients with long-term neurological conditions, partly through an enhanced role for specialist nurses and GPs with a special interest in neurology better local planning with increased clinical involvement in a commissioner/ provider forum, creating a neurological network to improve clinical and financial outcomes. http://bookshop.rcplondon.ac.uk/details.aspx?e=354 (Scroll to the bottom of the page to download the report)
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Obesity
Obesity Epidemic, Paranoia or Evidence Based? The Bow Group This paper assesses current predictions indicating that 60% of the UK population will be classified as clinically obese by 2050 and recommends action to reduce this risk. http://www.bowgroup.org/content/target-paper-obesity-epidemic-paranoia-or-evidence-based 18

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A simple guide to classifying body mass index in children National Obesity Observatory http://www.noo.org.uk/uploads/doc/vid_11601_A_simple_guide_to_classifying_BMI_in_childr en.pdf Slide sets for adult and child obesity National Obesity Observatory Powerpoint slides presenting key data and information on adult and child obesity in clear, easy to understand charts and graphics. Adults: http://www.noo.org.uk/gsf.php5?f=10928&fv=11474 Children: http://www.noo.org.uk/gsf.php5?f=10929&fv=11475
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Older People
Dignity and nutrition for older people CQC This review is a targeted inspection programme of NHS hospitals. It looks at whether older people are treated with respect and whether they get food and drink that meets their needs. CQC is adding reports to these pages as they are published. http://www.cqc.org.uk/reviewsandstudies/inspectionprogrammedignityandnutritionforolderpeople.cfm
Items in the Mental Health, Substance Misuse and Workforce sections may also be of interest. [back to topics]

Patient Care and Safety

Complaints and Litigation House of Commons Health Select Committee The Health Committee has found that the role of the Health Service Ombudsman needs a complete overhaul if it is to provide an effective appeals process for the complaints system. The other key finding is that there continues to be unacceptably wide variation in operation of complaints procedures within the NHS. http://www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/786/78602.htm Social Impact Evaluation of five Carers' Centres using Social Return on Investment The Princess Royal Trust for Carers This analysis evaluates the impact of the support given by five Carers' Centres over a number of years. Looking across the whole network of 144 Carers Centres supported by The Princess Royal Trust for Carers, the independent analysis estimated the gain based on total funding of 57m to be in the region of 814m per year. http://www.carers.org/sites/default/files/prtc_draft_report_v7_final_version_3_with_edits.pdf
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NHS Library and Information Service North Staffordshire Pharmacy

NHS Community Pharmacy Contractual Framework: 2011/12 Service Developments: Update Pharmaceutical Services Negotiating Committee This update summarises changes to the Framework. http://www.psnc.org.uk/news.php/1067/update_on_changes_to_the_pharmacy_contract
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Prescribing
An organisational competency framework to ensure the effective delivery of medicines management functions and responsibilities: a guide for commissioning consortia boards. National Prescribing Centre The Framework and a supporting Self-assessment tool are available at: http://www.npc.nhs.uk/qipp/ PCT Prescribing for January to March 2011 NHS Information Centre The data includes PCT code and name; BNF section code; BNF section name; Items; Actual Cost and Net Ingredient Cost http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/prescriptions/pct-prescribingfor-january-to-march-2011 Scopolamine (hyoscine) for preventing and treating motion sickness Spinks, A et al. The authors of this Cochrane Review concluded that the use of scopolamine versus placebo in preventing motion sickness has been shown to be effective but no conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD002851/frame.html
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Public Health
Analysis of controls on the marketing and promotion of food and drink to children Department of Health This report is based on: A mapping exercise of marketing practices, regulations, policies, commitments and proposals relating to food marketing to children; Consultations with corporate stakeholders; Consultations with children, young people and parents; An analysis of the Marine Stewardship Council as a case study. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127778 20

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Healthier and more sustainable catering: toolkit and supporting nutrition principles Department of Health http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_125579 Local Health Profiles 2011 Association of Public Health Observatories The Profiles give a snapshot overview of health for each local authority in England, and are produced annually. http://www.apho.org.uk/default.aspx?QN=HP_FINDSEARCH2011
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Research
Informed consent in health and social care research RCN This document provides an overview of: the concept of informed consent for research; the ethical and legal framework; the process of gaining informed consent; the participants perspective; and obtaining informed consent in specific circumstances. http://www.rcn.org.uk/__data/assets/pdf_file/0010/78607/002267.pdf NIHR Research Support Services Framework National Institute for Health Research This framework of good practice and standard procedures is intended to facilitate consistent local research management and improve performance. http://www.nihr.ac.uk/systems/Pages/Research_Support_Services.aspx
Items in the Dementia section may also be of interest. [back to topics]

Respiratory
Epinephrine for bronchiolitis Hartling, L et al. This Cochrane review demonstrates the superiority of epinephrine compared to placebo for short-term outcomes for outpatients, particularly in the first 24 hours of care. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003123/frame.html Immunostimulants for preventing respiratory tract infection in children Del-Rio-Navarro, B This review shows immunostimulants reduce the incidence of Acute Respiratory Tract Infections by 40% on average in susceptible children, and considers possible safety concerns. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004974/frame.html

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Mortality associated with tiotropium mist inhaler in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis of randomised controlled trials Singh, S et al. The authors concluded that this meta-analysis indicates a 52% increased risk of mortality associated with tiotropium mist inhaler in patients with chronic obstructive pulmonary disease. BMJ 2011; 342:d3215 doi: 10.1136/bmj.d3215 (Published 14 June 2011) Respiratory disease competence framework Skills for Health This Framework describes the knowledge, skills and attitudes required to deliver patient centred respiratory care. Its purpose is to provide an underpinning framework of National Occupational Standards (NOS) and Units of Learning for the respiratory care workforce, so that people can plan and develop their services more effectively. The NOS and units of learning were identified with input from healthcare professionals as well as professional bodies and other national groups. The Standards, report and case studies are available at: http://www.skillsforhealth.org.uk/copd/
[back to topics]

Safeguarding Children and Vulnerable Adults

The role, function and future of designated safeguarding professionals in the NHS in England RCN, Royal College of Paediatrics and Child Health This document aims to provide clarity and guidance to support designated safeguarding professionals while carrying out their statutory functions during the current structural turbulence in the NHS; and to outline a long term model to ensure that children and young people in contact with the heath service are adequately protected. http://www.rcn.org.uk/__data/assets/pdf_file/0011/390584/Designated_Professionals__FINAL.PDF Messages for Munro Ofsted This report gives the views of children in care and care leavers at three separate events held for the review carried out by Professor Eileen Munro. Munro was present at all three events to hear the views of the children at first hand. http://www.ofsted.gov.uk/Ofsted-home/Publications-and-research/Browse-allby/Care/Children-s-rights/Messages-for-Munro Out of Mind, Out of Sight: Breaking down the barriers to understanding child sexual exploitation Child Exploitation and Online Protection Centre This report shows that while some areas of the UK have victim focused services with agencies effectively working together to identify victims of child sexual exploitation this is not the case in all areas. It highlights multi-agency work as essential to ensuring that the victims needs come first and tackling this crime. The assessment acknowledges the major challenges faced by agencies in identifying victims of child sexual exploitation and in gaining the trust of 22

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victims to build successful cases against offenders. It gives full details of best practice and advocates similar approaches be more widely adopted, based on needs and risks in local areas. Executive summary: http://www.ceop.police.uk/Documents/ceopdocs/ceop_thematic_assessment_executive_sum mary.pdf Full report http://www.ceop.police.uk/Documents/ceopdocs/ceop_thematic_assessment.zip Prevention in adult safeguarding: A review of the literature Social Care Institute for Excellence This report shares findings from research, policy and practice on prevention in adult safeguarding and presents a wide range of approaches that can help prevent abuse. http://www.scie.org.uk/publications/reports/report41/index.asp?dm_t=0,0,0,0,0 Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarter 4 2010/11 NHS Information Centre http://www.ic.nhs.uk/statistics-and-data-collections/mental-health/mental-health-act/quarterlyanalysis-of-mental-capacity-act-2005-deprivation-of-liberty-safeguards-assessments-englandquarter-4-2010-11
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Service Management
Implementing the Overseas Visitors Hospital Charging Regulations 2011 (Regulations come into force from 1 August 2011) Department of Health This guidance is for NHS bodies in carrying out their duties under the NHS (Charges to Overseas Visitors) Regulations 2011 to make and recover charges for NHS hospital treatment from overseas visitors not exempt from charge. It also includes guidance to safeguard the health of those not entitled to free hospital treatment. NB, the Regulations do not come into force until 1 August 2011 and aspects of this guidance that relate directly to those Regulations should not be implemented until then. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127393 Collaboration between local health and local government agencies for health improvement Hayes, S et al. The authors of this Cochrane Review concluded that when comparing local collaborative partnerships between health and government agencies with standard working arrangements there is no difference in health outcomes. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007825/frame.html

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NHS Chief Executive Innovation review: Call for evidence and ideas Department of Health The NHS Chief Executive has asked Sir Ian Carruthers to lead a review on his behalf on how the spread of innovations can be accelerated across the NHS, and to produce a report in November 2011 that will inform the strategic approach to innovation in the modernised NHS. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_127940 Review of Community Health Partnerships Audit Scotland This report looks at the impact of Community Health Partnerships in improving peoples health and quality of life by joining up health and social care services and moving more services from hospitals into the community. This is a challenging and important role but few CHPs have the authority to influence how resources are used in their area. The report also calls for a fundamental review of partnership arrangements to ensure they focus on meeting individuals needs. The report also highlights examples of good practice, but there is limited evidence of wide-spread sustained improvements. http://www.audit-scotland.gov.uk/media/article.php?id=168 Routes for social and health care: a simulation exercise Kings Fund This report focuses on Crafton a hypothetical metropolitan borough in central England and sets up a number of routes to managing change. During the simulation two contrasting viewpoints emerged. One group took a strongly managerial perspective that recognised the need for immediate decisions to reduce expenditure, while putting in place the conditions for a radical transformation in the way that people receive care and support in the longer term. The other group took a more devolutionist approach, arguing that the financial challenges across health, social care and housing could not be managed through a top-down approach; they proposed a radical acceleration of personalisation and community engagement. http://www.kingsfund.org.uk/publications/social_care_routes.html Specification for the planning, application and measurement of cleanliness services in hospitals British Standards Institution This Standard provides a framework for the planning, application and measurement of cleanliness in hospitals. This Standard is freely available to NHS staff. http://shop.bsigroup.com/en/ProductDetail/?pid=000000000030208877
Items in the Mental Health section may also be of interest. [back to topics]

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NHS Library and Information Service North Staffordshire Sexual and Reproductive Health
Antioxidants for male subfertility Showell, M et al. The authors of this Cochrane Review concluded that the evidence suggests that antioxidant supplementation in subfertile males may improve the outcomes of live birth and pregnancy rate for subfertile couples undergoing ART cycles. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007411/frame.html Provider training and experience for people living with HIV/AIDS Rackal, J et al. The authors of this Cochrane Review concluded that results demonstrate improved medical outcomes when treated by a provider with more training/expertise in HIV/AIDS care in the outpatient (clinic) setting. Practitioners who do not consider themselves 'experts' in HIV/AIDS care and care for few of these patients need to seriously consider this review which demonstrates a trend towards worse patient outcomes when receiving care by those with low caseloads/training in HIV/AIDS care. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003938/frame.html STI Annual Data Tables Health Protection Agency Data for England is available on: STI diagnoses from both GUM and community-based settings 2008-2010 Diagnoses in GUM clinics by gender, age and sexual orientation 2001-2010 HIV testing uptake 2010 Patient's area of residence, ethnicity and continent of birth 2010 Report and tables are available at http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1201094610372
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Substance Misuse
Heroin maintenance for chronic heroin-dependent individuals Ferri, M et al. The available evidence suggests an added value of heroin prescribed alongside flexible doses of methadone for long-term, treatment refractory, opioid users, to reach a decrease in the use of illicit substances, involvement in criminal activity and incarceration, a possible reduction in mortality; and an increase in retention in treatment. Due to the higher rate of serious adverse events, heroin prescription should remain a treatment for people who are currently or have in the past failed maintenance treatment, and it should be provided in clinical settings where proper follow-up is ensured. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003410/frame.html Our Invisible Addicts: First Report of the Older Persons Substance MisuseWorking Group Royal College of Psychiatrists The report warns that not enough is being done to tackle substance misuse in our aging population making them societys invisible addicts. It pulls together evidence to highlight 25

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the extent of the problem and makes a series of key recommendations covering screening, alcohol consumption guidelines, public health campaigns and training for health and social care professionals. http://www.rcpsych.ac.uk/files/pdfversion/CR165.pdf
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Vaccination and Immunisation

Items in the Maternal and Infant Health section may also be of interest. [back to topics]

Workforce
Integrated care for older people: Examining workforce and implementation challenges Centre for Workforce Intelligence This report is the first in a series investigating the workforce implications of moving towards an integrated health and social care system. It considers eight different models of care, describing the service provided and assessing economic, quality of care and workforce implications. http://www.cfwi.org.uk/intelligence/projects/integrated-care-for-older-people-examiningworkforce-and-implementation-challenges NHS staff attitudes tracking survey Department of Health This survey provides an overview of NHS staff morale and engagement plus awareness of attitudes towards a range of DH and NHS initiatives. It includes NHS staff working in a range of primary, secondary and community settings. http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/ListOfSurveySince1990/D H_127666 NHS Staff Earnings January - March 2011 NHS Information Centre This data gives present estimates of annual basic pay and total earnings for NHS staff groups (excluding GPs and high street dentists). Pay data is taken from all NHS organisations using the Electronic Staff Record (ESR) during the period. http://www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-earnings/nhs-staffearnings-january--march-2011 The support workforce in the NHS NHS Confederation This digest highlights recent research on support workers in health. This evidence can help managers understand the increasing importance of support staff and how they can best be used as part of a flexible modern workforce. http://www.nhsconfed.org/Publications/digests/Pages/SDO-Digest-1.aspx
Items in the Dementia and General Practice sections may also be of interest. [back to topics]

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