Stephanie Tierney, Debra Westlake, Geoffrey Wong, Amadea Turk, Steven Markham, Jordan Gorenberg, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Anthony Meacock, Catherine Pope, Kamal R Mahtani
<p><strong>Background: </strong>Social prescribing addresses non-medical factors affecting health and well-being. Link workers are key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise sector. Funding from the National Health Service means that link workers are becoming a common part of primary care in England.</p><p><strong>Objective: </strong>To explore and understand the implementation of link workers in primary care in England.</p><p><strong>Design: </strong>A realist evaluation addressed the question - <i>When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances?</i></p><p><strong>Setting: </strong>Link workers and staff associated with seven primary care sites across England.</p><p><strong>Methods: </strong>Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition, interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients and with link workers 9-12 months later. Data were coded and developed into statements to identify how context around the link worker triggers mechanisms that lead to intended and unintended outcomes.</p><p><strong>Results: </strong>We found that link workers exercise micro-discretions in their role - actions and advice-giving based on personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could place link workers at risk of overstepping their remit.</p><p><strong>Limitations: </strong>Our research focused on link workers attached to primary care; findings may not be applicable to those working in other settings. Data were collected around seven link worker cases, who were selected purposively for variation in terms of geographical spread and how/by whom link workers were employed. However, these link workers were predominately white females.</p><p><strong>Conclusions: </strong>Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient needs but can result in uncertainty and to link workers feeling overstretched.</p><p><strong>Future work: </strong>Poor link worker retention may, in part, be associated with a lack of clarity around their role. Research to explore how this shapes intention to leave their job is being conducted by authors of th
{"title":"The consequences of micro-discretions and boundaries in the social prescribing link worker role in England: a realist evaluation.","authors":"Stephanie Tierney, Debra Westlake, Geoffrey Wong, Amadea Turk, Steven Markham, Jordan Gorenberg, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Anthony Meacock, Catherine Pope, Kamal R Mahtani","doi":"10.3310/JSQY9840","DOIUrl":"https://doi.org/10.3310/JSQY9840","url":null,"abstract":"<p><strong>Background: </strong>Social prescribing addresses non-medical factors affecting health and well-being. Link workers are key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise sector. Funding from the National Health Service means that link workers are becoming a common part of primary care in England.</p><p><strong>Objective: </strong>To explore and understand the implementation of link workers in primary care in England.</p><p><strong>Design: </strong>A realist evaluation addressed the question - <i>When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances?</i></p><p><strong>Setting: </strong>Link workers and staff associated with seven primary care sites across England.</p><p><strong>Methods: </strong>Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition, interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients and with link workers 9-12 months later. Data were coded and developed into statements to identify how context around the link worker triggers mechanisms that lead to intended and unintended outcomes.</p><p><strong>Results: </strong>We found that link workers exercise micro-discretions in their role - actions and advice-giving based on personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could place link workers at risk of overstepping their remit.</p><p><strong>Limitations: </strong>Our research focused on link workers attached to primary care; findings may not be applicable to those working in other settings. Data were collected around seven link worker cases, who were selected purposively for variation in terms of geographical spread and how/by whom link workers were employed. However, these link workers were predominately white females.</p><p><strong>Conclusions: </strong>Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient needs but can result in uncertainty and to link workers feeling overstretched.</p><p><strong>Future work: </strong>Poor link worker retention may, in part, be associated with a lack of clarity around their role. Research to explore how this shapes intention to leave their job is being conducted by authors of th","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris Sherlaw-Johnson, Theo Georghiou, Sarah Reed, Rachel Hutchings, John Appleby, Stuti Bagri, Nadia Crellin, Stephanie Kumpunen, Cyril Lobont, Jenny Negus, Pei Li Ng, Camille Oung, Jonathan Spencer, Angus Ramsay
<p><strong>Background: </strong>Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule.</p><p><strong>Objectives: </strong>To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England. To carry out a rapid mixed-methods evaluation of the implementation and impact of Patient-Initiated Follow-Up.</p><p><strong>Methods: </strong>The project was carried out in four sequential workstreams: (1) a rapid scoping review of outpatient innovations; (2) the application of indicator saturation methodology for scanning national patient-level data to identify potentially successful local interventions; (3) interviews with hospitals identified in workstream 2; and (4) a rapid mixed-methods evaluation of Patient-Initiated Follow-Up. The evaluation of Patient-Initiated Follow-Up comprised an evidence review, interviews with 36 clinical and operational staff at 5 National Health Service acute trusts, a workshop with staff from 13 National Health Service acute trusts, interviews with four patients, analysis of national and local data, and development of an evaluation guide.</p><p><strong>Results: </strong>Using indicator saturation, we identified nine services with notable changes in follow-up to first attendance ratios. Of three sites interviewed, two queried the data findings and one attributed the change to a clinical assessment service. Models of Patient-Initiated Follow-Up varied widely between hospital and clinical specialty, with a significant degree of variation in the approach to patient selection, patient monitoring and discharge. The success of implementation was dependent on several factors, for example, clinical condition, staff capacity and information technology systems. From the analysis of national data, we found evidence of an association between greater use of Patient-Initiated Follow-Up and a lower frequency of outpatient attendance within 15 out of 29 specialties and higher frequency of outpatient attendance within 7 specialties. Four specialties had less frequent emergency department visits associated with increasing Patient-Initiated Follow-Up rates. Patient-Initiated Follow-Up was viewed by staff and the few patients we interviewed as a positive intervention, although there was varied impact on individual staff roles and workload. It is important that sites and services undertake their own evaluations of Patient-Initiated Follow-Up. To this end we have developed an evaluation guide to support trusts with data collection and methods.</p><p><strong>Limitations: </strong>The Patient-Initiated Follow-Up evaluation was affected by a lack of patient-level data showing who is on a Patient-Initiated
背景：在门诊服务中，为了更好地管理医疗服务和减少不必要的预约，正在进行一系列广泛的创新。其中一项研究最少的创新是 "患者主动随访"（Patient-Initiated Follow-Up），它允许患者在需要时预约，而不是按照标准时间表预约：利用全国医院的常规数据，确定近年来在英格兰国民健康服务中实施的门诊服务创新。对 "患者主动随访 "的实施情况和影响进行快速混合方法评估：该项目分四个工作流依次进行：(1) 对门诊创新进行快速范围审查；(2) 应用指标饱和方法扫描全国患者层面的数据，以确定当地可能成功的干预措施；(3) 对工作流 2 中确定的医院进行访谈；(4) 对患者主动随访进行快速混合方法评估。对患者主动随访的评估包括证据审查、与 5 家国民健康服务急症信托机构的 36 名临床和业务人员的访谈、与来自 13 家国民健康服务急症信托机构的工作人员的研讨会、与 4 名患者的访谈、对国家和地方数据的分析，以及制定评估指南：利用指标饱和度，我们确定了九家在随访与首次就诊比率方面有显著变化的服务机构。在接受访谈的三家机构中，两家对数据结果提出质疑，一家将变化归因于临床评估服务。患者主动随访的模式因医院和临床专科的不同而有很大差异，在患者选择、患者监测和出院的方法上也有很大程度的不同。实施的成功与否取决于多种因素，例如临床条件、员工能力和信息技术系统。通过对全国数据的分析，我们发现有证据表明，在 29 个专科中的 15 个专科中，更多地使用患者主动随访与门诊就诊频率较低、7 个专科的门诊就诊频率较高之间存在关联。有四个专科的急诊就诊频率较低与患者主动随访率的增加有关。我们采访的员工和少数患者认为患者主动随访是一项积极的干预措施，尽管对员工的角色和工作量有不同的影响。重要的是，医疗点和服务机构应自行对患者主动随访进行评估。为此，我们制定了一份评估指南，以支持信托机构收集数据和使用方法：患者主动随访评估因缺乏患者层面的数据而受到影响，这些数据显示了哪些患者正在接受患者主动随访。考虑到医疗机构和工作人员面临的压力，与当地服务机构的合作也具有挑战性。患者招募率较低，这影响了直接了解患者经历的能力：这项研究为不断发展的国家门诊转型政策和地方实践提供了有益的启示。患者主动随访通常被员工和患者视为一种积极的干预措施，但其对个人结果、健康不平等、更广泛的患者体验、工作量和能力的影响仍不确定：进一步的研究应包括患者层面的分析，以确定患者主动随访的个人临床结果和健康不平等问题，并对患者体验进行更广泛的调查：本研究已在研究注册中心注册（UIN：researchregistry8864）：该奖项由英国国家健康与护理研究所（NIHR）的健康与社会护理服务研究项目（NIHR奖项编号：16/138/17）资助，全文发表于《健康与社会护理服务研究》（Health and Social Care Delivery Research）第12卷第38期。如需了解更多奖项信息，请访问 NIHR Funding and Awards 网站。
{"title":"Investigating innovations in outpatient services: a mixed-methods rapid evaluation.","authors":"Chris Sherlaw-Johnson, Theo Georghiou, Sarah Reed, Rachel Hutchings, John Appleby, Stuti Bagri, Nadia Crellin, Stephanie Kumpunen, Cyril Lobont, Jenny Negus, Pei Li Ng, Camille Oung, Jonathan Spencer, Angus Ramsay","doi":"10.3310/VGQD4611","DOIUrl":"https://doi.org/10.3310/VGQD4611","url":null,"abstract":"<p><strong>Background: </strong>Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule.</p><p><strong>Objectives: </strong>To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England. To carry out a rapid mixed-methods evaluation of the implementation and impact of Patient-Initiated Follow-Up.</p><p><strong>Methods: </strong>The project was carried out in four sequential workstreams: (1) a rapid scoping review of outpatient innovations; (2) the application of indicator saturation methodology for scanning national patient-level data to identify potentially successful local interventions; (3) interviews with hospitals identified in workstream 2; and (4) a rapid mixed-methods evaluation of Patient-Initiated Follow-Up. The evaluation of Patient-Initiated Follow-Up comprised an evidence review, interviews with 36 clinical and operational staff at 5 National Health Service acute trusts, a workshop with staff from 13 National Health Service acute trusts, interviews with four patients, analysis of national and local data, and development of an evaluation guide.</p><p><strong>Results: </strong>Using indicator saturation, we identified nine services with notable changes in follow-up to first attendance ratios. Of three sites interviewed, two queried the data findings and one attributed the change to a clinical assessment service. Models of Patient-Initiated Follow-Up varied widely between hospital and clinical specialty, with a significant degree of variation in the approach to patient selection, patient monitoring and discharge. The success of implementation was dependent on several factors, for example, clinical condition, staff capacity and information technology systems. From the analysis of national data, we found evidence of an association between greater use of Patient-Initiated Follow-Up and a lower frequency of outpatient attendance within 15 out of 29 specialties and higher frequency of outpatient attendance within 7 specialties. Four specialties had less frequent emergency department visits associated with increasing Patient-Initiated Follow-Up rates. Patient-Initiated Follow-Up was viewed by staff and the few patients we interviewed as a positive intervention, although there was varied impact on individual staff roles and workload. It is important that sites and services undertake their own evaluations of Patient-Initiated Follow-Up. To this end we have developed an evaluation guide to support trusts with data collection and methods.</p><p><strong>Limitations: </strong>The Patient-Initiated Follow-Up evaluation was affected by a lack of patient-level data showing who is on a Patient-Initiated","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 38","pages":"1-162"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Cardiovascular disease is the most common cause of death worldwide, highlighting the need for studies to determine options for palliative care within the management of patients with heart failure. Although there are promising examples of integrated palliative care and heart failure interventions, there is heterogeneity in terms of countries, healthcare settings, multidisciplinary team delivery, modes of delivery and intervention components. Hence, this review is vital to identify what works, for whom and in what circumstances when integrating palliative care and heart failure.</p><p><strong>Objectives: </strong>To (1) develop a programme theory of why, for whom and in what contexts desired outcomes occur; and (2) use the programme theory to co-produce with stakeholders key implications to inform best practice and future research.</p><p><strong>Design: </strong>A realist review of the literature underpinned by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.</p><p><strong>Data sources: </strong>Searches of bibliographic databases were conducted in November 2021 using the following databases: EMBASE, MEDLINE, PsycInfo, AMED, HMIC and CINAHL. Further relevant documents were identified via alerts and the stakeholder group.</p><p><strong>Review methods: </strong>Realist review is a theory-orientated and explanatory approach to the synthesis of evidence. A realist synthesis was used to synthesise the evidence as successful implementation of integrated palliative care and heart failure depends on the context and people involved. The realist synthesis followed Pawson's five iterative stages: (1) locating existing theories; (2) searching for evidence; (3) document selection; (4) extracting and organising data; and (5) synthesising the evidence and drawing conclusions. We recruited an international stakeholder group (<i>n</i> = 32), including National Health Service management, healthcare professionals involved in the delivery of palliative care and heart failure, policy and community groups, plus members of the public and patients, to advise and give us feedback throughout the project, along with Health Education England to disseminate findings.</p><p><strong>Results: </strong>In total, 1768 documents were identified, of which 1076 met the inclusion criteria. This was narrowed down to 130 included documents based on the programme theory and discussions with stakeholders. Our realist analysis developed and refined 6 overarching context-mechanism-outcome configurations and 30 sub context-mechanism-outcome configurations. The realist synthesis of the literature and stakeholder feedback helped uncover key intervention strategies most likely to support integration of palliative care into heart failure management. These included protected time for evidence-based palliative care education and choice of educational setting (e.g. online, face to face or hybrid), and the importanc
{"title":"Integrating Palliative Care and Heart Failure: the PalliatHeartSynthesis realist synthesis.","authors":"Tracey McConnell, Carolyn Blair, Geoff Wong, Claire Duddy, Clare Howie, Loreena Hill, Joanne Reid","doi":"10.3310/FTRG5628","DOIUrl":"10.3310/FTRG5628","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is the most common cause of death worldwide, highlighting the need for studies to determine options for palliative care within the management of patients with heart failure. Although there are promising examples of integrated palliative care and heart failure interventions, there is heterogeneity in terms of countries, healthcare settings, multidisciplinary team delivery, modes of delivery and intervention components. Hence, this review is vital to identify what works, for whom and in what circumstances when integrating palliative care and heart failure.</p><p><strong>Objectives: </strong>To (1) develop a programme theory of why, for whom and in what contexts desired outcomes occur; and (2) use the programme theory to co-produce with stakeholders key implications to inform best practice and future research.</p><p><strong>Design: </strong>A realist review of the literature underpinned by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.</p><p><strong>Data sources: </strong>Searches of bibliographic databases were conducted in November 2021 using the following databases: EMBASE, MEDLINE, PsycInfo, AMED, HMIC and CINAHL. Further relevant documents were identified via alerts and the stakeholder group.</p><p><strong>Review methods: </strong>Realist review is a theory-orientated and explanatory approach to the synthesis of evidence. A realist synthesis was used to synthesise the evidence as successful implementation of integrated palliative care and heart failure depends on the context and people involved. The realist synthesis followed Pawson's five iterative stages: (1) locating existing theories; (2) searching for evidence; (3) document selection; (4) extracting and organising data; and (5) synthesising the evidence and drawing conclusions. We recruited an international stakeholder group (<i>n</i> = 32), including National Health Service management, healthcare professionals involved in the delivery of palliative care and heart failure, policy and community groups, plus members of the public and patients, to advise and give us feedback throughout the project, along with Health Education England to disseminate findings.</p><p><strong>Results: </strong>In total, 1768 documents were identified, of which 1076 met the inclusion criteria. This was narrowed down to 130 included documents based on the programme theory and discussions with stakeholders. Our realist analysis developed and refined 6 overarching context-mechanism-outcome configurations and 30 sub context-mechanism-outcome configurations. The realist synthesis of the literature and stakeholder feedback helped uncover key intervention strategies most likely to support integration of palliative care into heart failure management. These included protected time for evidence-based palliative care education and choice of educational setting (e.g. online, face to face or hybrid), and the importanc","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 34","pages":"1-128"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas Allen, Darren Ashcroft, Jane Ferguson, Christos Grigoroglou, Evan Kontopantelis, Gemma Stringer, Kieran Walshe
<p><strong>Background: </strong>The use of locum doctors in the National Health Service is widely believed to have increased, and there have been widespread and sustained concerns among policy-makers, healthcare providers, professional associations and professional regulators about the quality/safety, cost and effective use of locum doctors.</p><p><strong>Objectives: </strong>To provide evidence on the extent, quality and safety of medical locum practice and the implications of medical locum working for health service organisation and delivery in primary and secondary care in the English National Health Service, to support policy and practice.</p><p><strong>Design: </strong>Four interlinked work packages involving surveys of National Health Service trusts and of general practices in England; semistructured interviews and focus groups across 11 healthcare organisations in England; analysis of existing routine data sets on the medical workforce in primary care and in National Health Service trusts in England from National Health Service Digital and National Health Service Improvement; and analysis of data from the Clinical Practice Research Datalink in primary care and of electronic patient record data from two National Health Service hospitals in secondary care.</p><p><strong>Results: </strong>In primary care, about 6% of general practice medical consultations were undertaken by locums in 2010 and this had risen slightly to about 7.1% in 2021. In National Health Service trusts (mostly secondary care and mental health), about 4.4% of medical staff full-time equivalent was provided by locum doctors. But those overall national rates of locum use hide a great deal of variation. In primary care, we found the National Health Service Digital workforce returns showed the rate of locum use by Clinical Commissioning Group varied from 1% to almost 31%. Among National Health Service trusts, the reported rate of locum use varied from < 1% to almost 16%. We found that there was poor awareness of and adherence to national guidance on locum working arrangements produced by National Health Service England. Our research showed that locum working can have adverse consequences for the quality and safety of care, but that such consequences were probably more likely to result from the organisational setting and the working arrangements than they were from the locum doctors themselves and their competence, clinical practice or behaviours.</p><p><strong>Limitations: </strong>Our research was hampered in some respects by the COVID pandemic which both resulted in some delays and other challenges. Our efforts to use electronic patient record data in secondary care to explore locum doctor working were stymied by the problems of data access and quality.</p><p><strong>Conclusions: </strong>Locum doctors are a key component of the medical workforce in the National Health Service, and provide necessary flexibility and additional capacity for healthcare organisations and services
{"title":"The use of locum doctors in the NHS: understanding and improving the quality and safety of care.","authors":"Thomas Allen, Darren Ashcroft, Jane Ferguson, Christos Grigoroglou, Evan Kontopantelis, Gemma Stringer, Kieran Walshe","doi":"10.3310/CXMK4017","DOIUrl":"https://doi.org/10.3310/CXMK4017","url":null,"abstract":"<p><strong>Background: </strong>The use of locum doctors in the National Health Service is widely believed to have increased, and there have been widespread and sustained concerns among policy-makers, healthcare providers, professional associations and professional regulators about the quality/safety, cost and effective use of locum doctors.</p><p><strong>Objectives: </strong>To provide evidence on the extent, quality and safety of medical locum practice and the implications of medical locum working for health service organisation and delivery in primary and secondary care in the English National Health Service, to support policy and practice.</p><p><strong>Design: </strong>Four interlinked work packages involving surveys of National Health Service trusts and of general practices in England; semistructured interviews and focus groups across 11 healthcare organisations in England; analysis of existing routine data sets on the medical workforce in primary care and in National Health Service trusts in England from National Health Service Digital and National Health Service Improvement; and analysis of data from the Clinical Practice Research Datalink in primary care and of electronic patient record data from two National Health Service hospitals in secondary care.</p><p><strong>Results: </strong>In primary care, about 6% of general practice medical consultations were undertaken by locums in 2010 and this had risen slightly to about 7.1% in 2021. In National Health Service trusts (mostly secondary care and mental health), about 4.4% of medical staff full-time equivalent was provided by locum doctors. But those overall national rates of locum use hide a great deal of variation. In primary care, we found the National Health Service Digital workforce returns showed the rate of locum use by Clinical Commissioning Group varied from 1% to almost 31%. Among National Health Service trusts, the reported rate of locum use varied from < 1% to almost 16%. We found that there was poor awareness of and adherence to national guidance on locum working arrangements produced by National Health Service England. Our research showed that locum working can have adverse consequences for the quality and safety of care, but that such consequences were probably more likely to result from the organisational setting and the working arrangements than they were from the locum doctors themselves and their competence, clinical practice or behaviours.</p><p><strong>Limitations: </strong>Our research was hampered in some respects by the COVID pandemic which both resulted in some delays and other challenges. Our efforts to use electronic patient record data in secondary care to explore locum doctor working were stymied by the problems of data access and quality.</p><p><strong>Conclusions: </strong>Locum doctors are a key component of the medical workforce in the National Health Service, and provide necessary flexibility and additional capacity for healthcare organisations and services","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 37","pages":"1-266"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Winter pressures are a familiar phenomenon within the National Health Service and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review focuses on interventions or initiatives in relation to hospital winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care.</p><p><strong>Methods: </strong>We conducted a mapping review of United Kingdom evidence published 2018-22. Initially, we searched MEDLINE, Health Management Information Consortium, Social Care Online, Social Sciences Citation Index and the King's Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and a draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar (Google Inc., Mountain View, CA, USA). For each taxonomy heading, we produced a table with definitions, findings from research studies, local initiatives and systematic reviews and evidence gaps.</p><p><strong>Results: </strong>The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These headings were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified.</p><p><strong>Conclusions: </strong>Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and hospital at home interventions are heavily used and well supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole-system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting.</p><p><strong>Limit
{"title":"Interventions to minimise hospital winter pressures related to discharge planning and integrated care: a rapid mapping review of UK evidence.","authors":"Anna Cantrell, Duncan Chambers, Andrew Booth","doi":"10.3310/KRWH4301","DOIUrl":"https://doi.org/10.3310/KRWH4301","url":null,"abstract":"<p><strong>Background: </strong>Winter pressures are a familiar phenomenon within the National Health Service and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review focuses on interventions or initiatives in relation to hospital winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care.</p><p><strong>Methods: </strong>We conducted a mapping review of United Kingdom evidence published 2018-22. Initially, we searched MEDLINE, Health Management Information Consortium, Social Care Online, Social Sciences Citation Index and the King's Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and a draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar (Google Inc., Mountain View, CA, USA). For each taxonomy heading, we produced a table with definitions, findings from research studies, local initiatives and systematic reviews and evidence gaps.</p><p><strong>Results: </strong>The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These headings were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified.</p><p><strong>Conclusions: </strong>Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and hospital at home interventions are heavily used and well supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole-system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting.</p><p><strong>Limit","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 31","pages":"1-116"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Filippo Varese, Kate Allsopp, Lesley-Anne Carter, Gemma Shields, Daniel Hind, Linda Davies, Alan Barrett, Gita Bhutani, Katherine McGuirk, Fay Huntley, Joanne Jordan, Aleix Rowlandson, May Sarsam, Hein Ten Cate, Holly Walker, Ruth Watson, Jack Wilkinson, Jenni Willbourn, Paul French
<p><strong>Background: </strong>Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic.</p><p><strong>Aim: </strong>To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic.</p><p><strong>Design: </strong>Mixed-methods evaluation.</p><p><strong>Setting: </strong>Four Resilience Hubs.</p><p><strong>Methods: </strong>Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (<i>N</i> = 1973); follow-up questionnaire data (<i>N</i> = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs.</p><p><strong>Results: </strong>Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and
{"title":"The Resilience Hub approach for addressing mental health of health and social care workers during the COVID-19 pandemic: a mixed-methods evaluation.","authors":"Filippo Varese, Kate Allsopp, Lesley-Anne Carter, Gemma Shields, Daniel Hind, Linda Davies, Alan Barrett, Gita Bhutani, Katherine McGuirk, Fay Huntley, Joanne Jordan, Aleix Rowlandson, May Sarsam, Hein Ten Cate, Holly Walker, Ruth Watson, Jack Wilkinson, Jenni Willbourn, Paul French","doi":"10.3310/HGQR5133","DOIUrl":"https://doi.org/10.3310/HGQR5133","url":null,"abstract":"<p><strong>Background: </strong>Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic.</p><p><strong>Aim: </strong>To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic.</p><p><strong>Design: </strong>Mixed-methods evaluation.</p><p><strong>Setting: </strong>Four Resilience Hubs.</p><p><strong>Methods: </strong>Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (<i>N</i> = 1973); follow-up questionnaire data (<i>N</i> = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs.</p><p><strong>Results: </strong>Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 29","pages":"1-164"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catrin S Rhys, Bethan Benwell, Maria Erofeeva, Richard Simmons
<p><strong>Background: </strong>Good communication is consistently recognised as essential for effective complaint handling, while failures in communication correlate with risk of escalation. Nonetheless, communication in National Health Service complaint handling remains underexamined.</p><p><strong>Objectives: </strong>To examine complainants' lived experience of the complaints journey through (1) micro-analysis of their communication with National Health Service representatives; (2) their self-reported expectations and experiences throughout the complaints journey; to survey patient perceptions of the culture of the National Health Service; to develop 'Real Complaints' - an evidence-based communication training resource.</p><p><strong>Design: </strong>The project triangulates microlevel conversation analysis and discourse analysis of spoken and written complaints encounters with complainants' appraisals of those encounters in longitudinal case studies. This is underpinned by an audit of patient views of the cultural-institutional context of the National Health Service.</p><p><strong>Setting and participants: </strong>Data were gathered in the complaints-handling services of two National Health Service trusts and a Patient Advocacy Service in Northern Ireland. Twenty-three complainants consented to longitudinal data collection and 58 to initial encounter recording; 115 members of the Patient Advocacy Service mailing list completed the cultural audit; 3 trust complaint handlers, 1 Patient Advocacy Service complaint handler and 2 trust complaints managers were interviewed.</p><p><strong>Data sources: </strong>This yielded 1155 minutes of recorded calls, 113 written encounters, 36 diaries, 6 meetings, 23 interviews and 115 cultural audit responses collected over a period of 24 months.</p><p><strong>Results: </strong>Our analysis illuminates the dual nature of complaints: as personal expressions of dissatisfaction and as systemic critiques. The complaint experience is a dynamic journey with evolving narratives reflecting complainants' shifting perceptions, expectations and experiences of the 'system', both moment-by-moment and encounter-by-encounter in the overall journey. Key interpersonal priorities for complainants significantly affected complaint outcomes, most important of which was the need to be respected as a 'reasonable complainant'. Also key is the conversation analytic concept of affiliation, which involves taking a stance towards the event(s) being described that matches the complainant's stance. Use of affiliation by call handlers supported effective and efficient person-centred complaints handling, while absence of affiliation typically led to escalation of the scope, scale and emotional intensity of the complaint, sometimes to the point of an expressed intention to litigate (particularly in the case of written responses). Viewed holistically, successful complaints communication requires person-centredness, and affiliative interaction
{"title":"Harnessing the power of language to enhance patient experience of the NHS complaint journey in Northern Ireland: a mixed-methods study.","authors":"Catrin S Rhys, Bethan Benwell, Maria Erofeeva, Richard Simmons","doi":"10.3310/NRGA3207","DOIUrl":"https://doi.org/10.3310/NRGA3207","url":null,"abstract":"<p><strong>Background: </strong>Good communication is consistently recognised as essential for effective complaint handling, while failures in communication correlate with risk of escalation. Nonetheless, communication in National Health Service complaint handling remains underexamined.</p><p><strong>Objectives: </strong>To examine complainants' lived experience of the complaints journey through (1) micro-analysis of their communication with National Health Service representatives; (2) their self-reported expectations and experiences throughout the complaints journey; to survey patient perceptions of the culture of the National Health Service; to develop 'Real Complaints' - an evidence-based communication training resource.</p><p><strong>Design: </strong>The project triangulates microlevel conversation analysis and discourse analysis of spoken and written complaints encounters with complainants' appraisals of those encounters in longitudinal case studies. This is underpinned by an audit of patient views of the cultural-institutional context of the National Health Service.</p><p><strong>Setting and participants: </strong>Data were gathered in the complaints-handling services of two National Health Service trusts and a Patient Advocacy Service in Northern Ireland. Twenty-three complainants consented to longitudinal data collection and 58 to initial encounter recording; 115 members of the Patient Advocacy Service mailing list completed the cultural audit; 3 trust complaint handlers, 1 Patient Advocacy Service complaint handler and 2 trust complaints managers were interviewed.</p><p><strong>Data sources: </strong>This yielded 1155 minutes of recorded calls, 113 written encounters, 36 diaries, 6 meetings, 23 interviews and 115 cultural audit responses collected over a period of 24 months.</p><p><strong>Results: </strong>Our analysis illuminates the dual nature of complaints: as personal expressions of dissatisfaction and as systemic critiques. The complaint experience is a dynamic journey with evolving narratives reflecting complainants' shifting perceptions, expectations and experiences of the 'system', both moment-by-moment and encounter-by-encounter in the overall journey. Key interpersonal priorities for complainants significantly affected complaint outcomes, most important of which was the need to be respected as a 'reasonable complainant'. Also key is the conversation analytic concept of affiliation, which involves taking a stance towards the event(s) being described that matches the complainant's stance. Use of affiliation by call handlers supported effective and efficient person-centred complaints handling, while absence of affiliation typically led to escalation of the scope, scale and emotional intensity of the complaint, sometimes to the point of an expressed intention to litigate (particularly in the case of written responses). Viewed holistically, successful complaints communication requires person-centredness, and affiliative interaction","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 33","pages":"1-129"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gary Abel, Helen Atherton, Jon Sussex, Nurunnahar Akter, Abodunrin Q Aminu, Wiktoria Bak, Carol Bryce, Christopher E Clark, Emma Cockcroft, Hamish Evans, Evangelos Gkousis, Georgia Jenkins, Caroline Jenkinson, Nada Khan, Jeffrey Lambert, Brandi Leach, Christine Marriott, Jennifer Newbould, Sarah Parkinson, Jo Parsons, Emma Pitchforth, Laura Sheard, Stephanie Stockwell, Chloe Thomas, Bethan Treadgold, Rachel Winder, John L Campbell
<p><strong>Background: </strong>Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services.</p><p><strong>Objectives: </strong>Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support.</p><p><strong>Design: </strong>Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings.</p><p><strong>Setting: </strong>General practice in four regions of England.</p><p><strong>Participants: </strong>Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants.</p><p><strong>Intervention: </strong>Digital facilitation as undertaken in general practice.</p><p><strong>Main outcome measures: </strong>Patient and practice staff reported use of, and views of, digital facilitation.</p><p><strong>Data sources: </strong>Surveys, qualitative research; national General Practitioner Patient Survey (2019-22).</p><p><strong>Review methods: </strong>Scoping-review methodology applied to academic and grey literature published 2015-20.</p><p><strong>Results: </strong>While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients.</p><p><strong>Limitations: </strong>The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork.</p><p><strong>Conclusio
{"title":"Current experience and future potential of facilitating access to digital NHS primary care services in England: the Di-Facto mixed-methods study.","authors":"Gary Abel, Helen Atherton, Jon Sussex, Nurunnahar Akter, Abodunrin Q Aminu, Wiktoria Bak, Carol Bryce, Christopher E Clark, Emma Cockcroft, Hamish Evans, Evangelos Gkousis, Georgia Jenkins, Caroline Jenkinson, Nada Khan, Jeffrey Lambert, Brandi Leach, Christine Marriott, Jennifer Newbould, Sarah Parkinson, Jo Parsons, Emma Pitchforth, Laura Sheard, Stephanie Stockwell, Chloe Thomas, Bethan Treadgold, Rachel Winder, John L Campbell","doi":"10.3310/JKYT5803","DOIUrl":"10.3310/JKYT5803","url":null,"abstract":"<p><strong>Background: </strong>Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services.</p><p><strong>Objectives: </strong>Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support.</p><p><strong>Design: </strong>Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings.</p><p><strong>Setting: </strong>General practice in four regions of England.</p><p><strong>Participants: </strong>Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants.</p><p><strong>Intervention: </strong>Digital facilitation as undertaken in general practice.</p><p><strong>Main outcome measures: </strong>Patient and practice staff reported use of, and views of, digital facilitation.</p><p><strong>Data sources: </strong>Surveys, qualitative research; national General Practitioner Patient Survey (2019-22).</p><p><strong>Review methods: </strong>Scoping-review methodology applied to academic and grey literature published 2015-20.</p><p><strong>Results: </strong>While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients.</p><p><strong>Limitations: </strong>The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork.</p><p><strong>Conclusio","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 32","pages":"1-197"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicola Brimblecombe, Madeleine Stevens, Sara Gowen, Jo Moriarty, Robin Skyer, Annette Bauer, Camille Bou
<p><strong>Background: </strong>Many children and young people in England provide support to family members who are disabled, have mental or physical ill health, or misuse drugs or alcohol. Providing care can negatively impact children and young people's education, employment, health and social participation, with associated costs. Support is needed to prevent and reduce these negative impacts. The study sought to provide new knowledge and address prior research gaps regarding how best to support young carers from their perspective and that of the people they care for.</p><p><strong>Objectives: </strong>To address the following questions: What types, components or features of services and other support are seen as helpful, valued, and acceptable to young people who look after someone at home and the people they support? Conversely, what is found to be less or unhelpful? What additional support is perceived as needed? What are the barriers experienced by young and young adult carers in seeking and accessing services for themselves or the person they support? What are the barriers and facilitators for practitioners in providing support and services perceived as valued, helpful and needed by young and young adult carers and the people they support?</p><p><strong>Design and setting: </strong>In-depth qualitative methodology using focus groups, in-depth semistructured interviews and workshops in four localities in England.</p><p><strong>Participants: </strong>One hundred and thirty-three carers aged 9-25 years with a range of caring and life circumstances and sociodemographic characteristics. Seventeen adult care recipients (parents) with a range of physical and/or mental healthcare and support needs. Nineteen practitioners from schools, colleges, young carers organisations, voluntary sector services, mental health services, the National Health Service, adult social care and local authority adult and children's social care commissioners.</p><p><strong>Results: </strong>The types and aspects of support that young carers and their families need, and value when received, include: support that reduces or removes their practical and emotional caring responsibilities; support to mitigate the negative impacts of care and help with other life issues; information and advice about services and wider resources and support; someone trusted available to talk to; greater awareness, recognition and understanding; and choice, flexibility, and co-development of plans and solutions. We found a great deal of unmet need for support, and variation in type and quality of support received, including geographically.</p><p><strong>Limitations: </strong>Potential limitations are that we were not able to engage with, or recruit, young carers from some intended subgroups, meaning some perspectives are missing. Partly because of COVID-19 measures during the study, we mainly recruited through young carers organisations and their family projects, although this was balanced by recru
{"title":"Types and aspects of support that young carers need and value, and barriers and enablers to access: the REBIAS-YC qualitative study.","authors":"Nicola Brimblecombe, Madeleine Stevens, Sara Gowen, Jo Moriarty, Robin Skyer, Annette Bauer, Camille Bou","doi":"10.3310/ABAT6761","DOIUrl":"https://doi.org/10.3310/ABAT6761","url":null,"abstract":"<p><strong>Background: </strong>Many children and young people in England provide support to family members who are disabled, have mental or physical ill health, or misuse drugs or alcohol. Providing care can negatively impact children and young people's education, employment, health and social participation, with associated costs. Support is needed to prevent and reduce these negative impacts. The study sought to provide new knowledge and address prior research gaps regarding how best to support young carers from their perspective and that of the people they care for.</p><p><strong>Objectives: </strong>To address the following questions: What types, components or features of services and other support are seen as helpful, valued, and acceptable to young people who look after someone at home and the people they support? Conversely, what is found to be less or unhelpful? What additional support is perceived as needed? What are the barriers experienced by young and young adult carers in seeking and accessing services for themselves or the person they support? What are the barriers and facilitators for practitioners in providing support and services perceived as valued, helpful and needed by young and young adult carers and the people they support?</p><p><strong>Design and setting: </strong>In-depth qualitative methodology using focus groups, in-depth semistructured interviews and workshops in four localities in England.</p><p><strong>Participants: </strong>One hundred and thirty-three carers aged 9-25 years with a range of caring and life circumstances and sociodemographic characteristics. Seventeen adult care recipients (parents) with a range of physical and/or mental healthcare and support needs. Nineteen practitioners from schools, colleges, young carers organisations, voluntary sector services, mental health services, the National Health Service, adult social care and local authority adult and children's social care commissioners.</p><p><strong>Results: </strong>The types and aspects of support that young carers and their families need, and value when received, include: support that reduces or removes their practical and emotional caring responsibilities; support to mitigate the negative impacts of care and help with other life issues; information and advice about services and wider resources and support; someone trusted available to talk to; greater awareness, recognition and understanding; and choice, flexibility, and co-development of plans and solutions. We found a great deal of unmet need for support, and variation in type and quality of support received, including geographically.</p><p><strong>Limitations: </strong>Potential limitations are that we were not able to engage with, or recruit, young carers from some intended subgroups, meaning some perspectives are missing. Partly because of COVID-19 measures during the study, we mainly recruited through young carers organisations and their family projects, although this was balanced by recru","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 36","pages":"1-108"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kelly Daniel, Jennifer Bousfield, Lucy Hocking, Louise Jackson, Beck Taylor
<p><strong>Background: </strong>Women's sexual and reproductive health needs are complex and vary across the life course. They are met by a range of providers, professionals and venues. Provision is not well integrated, with inequalities in access. In some areas of the United Kingdom Women's Health Hubs have been established to improve provision, experience and outcomes for women, and to address inequalities and reduce costs. These models were established prior to the national implementation of Women's Health Hubs announced in the English 2022 Women's Health Strategy.</p><p><strong>Objective: </strong>To explore the 'current state of the art', mapping the United Kingdom landscape, and studying experiences of delivering and using Women's Health Hubs across England, defining key features and early markers of success to inform policy and practice.</p><p><strong>Design: </strong>A mixed-methods evaluation, comprising three work packages: Mapping the Women's Health Hub landscape and context and developing a definition of Women's Health Hubs, informed by an online national survey of Women's Health Hub leaders, and interviews with regional stakeholders. In-depth evaluation in four hub sites, including interviews with staff and women, focus groups in local communities and documentary analysis. Interviews with national stakeholders and consolidation of findings from work packages 1 and 2. Fieldwork was undertaken from May 2022 to March 2023. The evaluation was initiated prior to the national scale-up of Women's Health Hubs announced in the 2022 Women's Health Strategy.</p><p><strong>Results: </strong>Most areas of the United Kingdom did not have a Women's Health Hub. Seventeen active services were identified, established between 2001 and 2022. Women's Health Hubs were diverse, predominantly GP-led, with different perspectives of the role and definition of a hub. Women using hubs reported positive experiences, finding services caring and convenient. Implementation facilitators included committed, collaborative leaders working across boundaries, sufficient workforce capacity and a supportive policy context. Challenges included access to funding, commissioning, workforce issues, facilities and equipment, stakeholder engagement and wider system integration, priorities and pressures. Leaders were committed to addressing inequalities, but evidence of impact was still emerging.</p><p><strong>Limitations: </strong>It was challenging to locate models; therefore, some may have been missed. Data availability limited assessment of impact, including inequalities. Some population groups were not represented in the data, and the evaluation was more provider-oriented. It was not possible to develop a typology of Women's Health Hubs as planned due to heterogeneity in models.</p><p><strong>Conclusions: </strong>Existing Women's Health Hub models were providing integrated approaches to meet local needs. Many were at an early stage of development. Evidence of system-level im
{"title":"Women's Health Hubs: a rapid mixed-methods evaluation.","authors":"Kelly Daniel, Jennifer Bousfield, Lucy Hocking, Louise Jackson, Beck Taylor","doi":"10.3310/JYFT5036","DOIUrl":"https://doi.org/10.3310/JYFT5036","url":null,"abstract":"<p><strong>Background: </strong>Women's sexual and reproductive health needs are complex and vary across the life course. They are met by a range of providers, professionals and venues. Provision is not well integrated, with inequalities in access. In some areas of the United Kingdom Women's Health Hubs have been established to improve provision, experience and outcomes for women, and to address inequalities and reduce costs. These models were established prior to the national implementation of Women's Health Hubs announced in the English 2022 Women's Health Strategy.</p><p><strong>Objective: </strong>To explore the 'current state of the art', mapping the United Kingdom landscape, and studying experiences of delivering and using Women's Health Hubs across England, defining key features and early markers of success to inform policy and practice.</p><p><strong>Design: </strong>A mixed-methods evaluation, comprising three work packages: Mapping the Women's Health Hub landscape and context and developing a definition of Women's Health Hubs, informed by an online national survey of Women's Health Hub leaders, and interviews with regional stakeholders. In-depth evaluation in four hub sites, including interviews with staff and women, focus groups in local communities and documentary analysis. Interviews with national stakeholders and consolidation of findings from work packages 1 and 2. Fieldwork was undertaken from May 2022 to March 2023. The evaluation was initiated prior to the national scale-up of Women's Health Hubs announced in the 2022 Women's Health Strategy.</p><p><strong>Results: </strong>Most areas of the United Kingdom did not have a Women's Health Hub. Seventeen active services were identified, established between 2001 and 2022. Women's Health Hubs were diverse, predominantly GP-led, with different perspectives of the role and definition of a hub. Women using hubs reported positive experiences, finding services caring and convenient. Implementation facilitators included committed, collaborative leaders working across boundaries, sufficient workforce capacity and a supportive policy context. Challenges included access to funding, commissioning, workforce issues, facilities and equipment, stakeholder engagement and wider system integration, priorities and pressures. Leaders were committed to addressing inequalities, but evidence of impact was still emerging.</p><p><strong>Limitations: </strong>It was challenging to locate models; therefore, some may have been missed. Data availability limited assessment of impact, including inequalities. Some population groups were not represented in the data, and the evaluation was more provider-oriented. It was not possible to develop a typology of Women's Health Hubs as planned due to heterogeneity in models.</p><p><strong>Conclusions: </strong>Existing Women's Health Hub models were providing integrated approaches to meet local needs. Many were at an early stage of development. Evidence of system-level im","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"12 30","pages":"1-138"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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