This document summarizes an audit of the Crisis Assessment and Home Treatment (CAHT) service in Sheffield, England. Some key findings include:
- CAHT provides 24/7 crisis assessment and home-based treatment as an alternative to hospitalization. The majority of referrals come from A&E departments.
- Over half of episodes (56.4%) were for patients receiving repeated treatment. No significant differences were found in repeat episodes based on ethnicity.
- The population served by CAHT has a higher proportion of individuals who are single, unemployed, and from Black and Ethnic Minority groups compared to Sheffield's general population.
- Significant differences were found in the ethnic distributions of patients across different
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Cheshire and Wirral Best Practice event - 8 NovemberInnovation Agency
The document outlines plans for developing integrated care communities across South Cheshire and Vale Royal. Key points include:
- The formation of 5 care community teams to provide coordinated, patient-centered care across the region.
- Initial priority projects include developing the care community teams, improving GP out-of-hours care, and musculoskeletal physiotherapy.
- Achievements so far include aligning staff to the 5 communities, implementing rapid response services, and beginning multidisciplinary team meetings.
- Future goals involve strengthening primary care partnerships, expanding social care support, and using data to better manage patient risk levels.
Valuing the health and wellbeing aspects of Community Empowerment (CE) in an ...cheweb1
Valuing the health and wellbeing aspects of Community Empowerment (CE) in an Urban Regeneration context using economic evaluation techniques. Economic evaluation seminar presented by Camilla Baba, PhD candidate, University of Glasgow 12 May 2016
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
- Acute liaison services provide mental health support to patients in acute hospital settings like emergency departments and inpatient wards. They address the high rates of undiagnosed and untreated mental illness in these physical health settings.
- Mental and physical health are closely linked, and acute liaison services help integrate treatment by detecting and treating co-occurring conditions. This can improve outcomes, reduce costs from shorter hospital stays, and support the quality and productivity goals of the NHS.
- Current provision of acute liaison services varies greatly across the country. Services are often commissioned separately from acute hospital care despite the benefits they provide within physical health settings. Most services provide assessment, brief intervention, and referral but capacity is
Investing in specialised services - the prioritisation framework, pop up uni,...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
This document provides an overview of implementing Payment by Results (PBR) in mental health services in the UK. It discusses clustering patients into groups with similar needs and treatments to develop care pathways and set prices. It outlines challenges including developing consistent classifications and collecting sufficient activity data. It also describes priorities like integrating care clusters into processes and continuing work on clusters for patients with learning disabilities.
The document discusses barriers and facilitators to implementing evidence-based supported employment (EBSE) in the UK. It summarizes the evidence showing EBSE is effective for people with severe mental illness. While government policy now supports EBSE, barriers remain like separate mental health and employment services and a lack of provider training. The Sainsbury Centre is working to establish "Centres of Excellence" through partnerships, training, outcome measurement, and learning networks to systematically implement high-quality EBSE across England. Successful implementation requires factors like organizational commitment, ongoing supervision, and measuring both process and outcome indicators.
Risk profiling, multiple long term conditions & complex patients, integrated ...Dr Bruce Pollington
Dr Bruce Pollington web-ex presentation to LTC QIPP programme
Utilising risk profiling, and risk stratification to identify patients with multiple long term conditions requiring complex care through integrated care teams.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Cheshire and Wirral Best Practice event - 8 NovemberInnovation Agency
The document outlines plans for developing integrated care communities across South Cheshire and Vale Royal. Key points include:
- The formation of 5 care community teams to provide coordinated, patient-centered care across the region.
- Initial priority projects include developing the care community teams, improving GP out-of-hours care, and musculoskeletal physiotherapy.
- Achievements so far include aligning staff to the 5 communities, implementing rapid response services, and beginning multidisciplinary team meetings.
- Future goals involve strengthening primary care partnerships, expanding social care support, and using data to better manage patient risk levels.
Valuing the health and wellbeing aspects of Community Empowerment (CE) in an ...cheweb1
Valuing the health and wellbeing aspects of Community Empowerment (CE) in an Urban Regeneration context using economic evaluation techniques. Economic evaluation seminar presented by Camilla Baba, PhD candidate, University of Glasgow 12 May 2016
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
- Acute liaison services provide mental health support to patients in acute hospital settings like emergency departments and inpatient wards. They address the high rates of undiagnosed and untreated mental illness in these physical health settings.
- Mental and physical health are closely linked, and acute liaison services help integrate treatment by detecting and treating co-occurring conditions. This can improve outcomes, reduce costs from shorter hospital stays, and support the quality and productivity goals of the NHS.
- Current provision of acute liaison services varies greatly across the country. Services are often commissioned separately from acute hospital care despite the benefits they provide within physical health settings. Most services provide assessment, brief intervention, and referral but capacity is
Investing in specialised services - the prioritisation framework, pop up uni,...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
This document provides an overview of implementing Payment by Results (PBR) in mental health services in the UK. It discusses clustering patients into groups with similar needs and treatments to develop care pathways and set prices. It outlines challenges including developing consistent classifications and collecting sufficient activity data. It also describes priorities like integrating care clusters into processes and continuing work on clusters for patients with learning disabilities.
The document discusses barriers and facilitators to implementing evidence-based supported employment (EBSE) in the UK. It summarizes the evidence showing EBSE is effective for people with severe mental illness. While government policy now supports EBSE, barriers remain like separate mental health and employment services and a lack of provider training. The Sainsbury Centre is working to establish "Centres of Excellence" through partnerships, training, outcome measurement, and learning networks to systematically implement high-quality EBSE across England. Successful implementation requires factors like organizational commitment, ongoing supervision, and measuring both process and outcome indicators.
Risk profiling, multiple long term conditions & complex patients, integrated ...Dr Bruce Pollington
Dr Bruce Pollington web-ex presentation to LTC QIPP programme
Utilising risk profiling, and risk stratification to identify patients with multiple long term conditions requiring complex care through integrated care teams.
Priority setting in healthcare is necessary to allocate limited resources to maximize health benefits. It involves ranking diseases, health conditions, and interventions based on criteria like burden of disease, cost-effectiveness, equity, and existing delivery capacity. While controversial, priority setting can be made legitimate through transparent processes that consider community needs and engage stakeholders. Frameworks provide structures to conduct priority setting exercises and address ethical challenges through criteria like accountability, participation, and appeals mechanisms. Identifying who loses out in the system through analyses like benefit incidence assessments is also important.
Using simulation to drive changes in health and care - long term conditions Year of Care model
Bev Matthews and Claire Cordeaux
Presentation from Day 1 of the Health and Care Innovation Expo 2014, Manchester Central
This document provides an overview of Ontario's Chronic Disease Prevention and Management Framework. It aims to provide a common policy framework to guide efforts in effectively preventing and managing chronic diseases. It also aims to guide various ministry transformation initiatives, such as primary health care renewal and public health renewal, with a focus on chronic disease prevention and management. The framework outlines eight components that need to be addressed through a systematic approach: health care organizations, delivery system design, provider decision support, information systems, personal skills/self-management support, healthy public policy, community action, and supportive environments. It emphasizes the importance of taking a population health approach focused on prevention to reduce the burden of chronic diseases.
Dr. Barry White, former HSE National Director, Clinical Strategy and ProgrammesInvestnet
The document discusses issues with the modern healthcare system including a reductionist approach, unrealistic expectations of health, and the failure to address behavioral factors. It argues that defining health as complete well-being has medicalized society and generated unnecessary demand. Bloodletting was the dominant medical practice for over 2000 years based on the ancient humoral theory but provided no improvement in life expectancy. While reductionism led to advances in the 20th century, a holistic approach is also needed. The key is developing self-awareness among both patients and clinicians to reconcile physical, psychological and social well-being.
The document proposes a microfinance health insurance scheme to improve access to quality primary healthcare in rural communities. It would establish a nodal center at community health centers to provide minimum premiums, cashless benefits, and reimbursement for out-of-pocket medical expenses. Profits would be reinvested in self-help groups and cooperatives to generate revenue and develop local infrastructure. This aims to increase utilization of existing healthcare services, strengthen referrals, empower communities, and boost the local economy through a sustainable community-level solution.
Mr Grant Brand: Lessons Learned in the First Nine Years of the Glasgow ARBD TeamAlcoholForum.org
The document summarizes lessons learned from the first nine years of the Glasgow Alcohol Related Brain Damage (ARBD) Team. It discusses how the team was set up, missed opportunities at the beginning, and what they have learned over time. Key points include broadening the referral criteria, conducting thorough multidisciplinary assessments, using legislation to help with harm reduction, providing rehabilitation services, and training other services on ARBD. It emphasizes the need for a public health approach, clear strategy, and person-centered flexible services for those with ARBD.
GPs' view of integration in North West London Nuffield Trust
GPs in North West London reported that patients experience fragmented care and that providers do not work together effectively. Improving relationships across sectors like mental health, community services, and social care was seen as important. However, GPs identified high workloads and lack of support for new ways of working as barriers. Protected time for multi-disciplinary meetings and shared IT systems were suggested to help overcome barriers and allow GPs to better coordinate care. While the Whole Systems Integrated Care program was known, perceptions varied and less than half of GPs thought its goals of improving quality and financial sustainability could be achieved through integration.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
This document discusses the promise of population health management (PHM) to improve healthcare in the United States. It outlines some of the key challenges with the current system, including a declining primary care workforce, fragmentation of care, and a lack of focus on prevention. The document then defines PHM and some of its core aspects, such as organized systems of care, care teams, and a focus on both medical and lifestyle factors that influence health. It also discusses some of the obstacles to implementing PHM, including the fee-for-service payment system and lack of health IT use. The document argues that new models like accountable care organizations and the patient-centered medical home show promise for enabling PHM and overcoming some of the current
Professor Liam Smeeth: Big Data, 30 June 2014Nuffield Trust
- The Farr Institute was established in 2012 with £19 million in funding to conduct health informatics research using large electronic health databases. It includes centers in London, Scotland, Wales, and Manchester.
- Examples are given of research using big data that would not otherwise be possible, such as studies of MMR vaccination and autism and the relationship between BMI and cancer risk.
- Challenges of randomized trials include recruitment, generalizability, and costs, and electronic health records may help address these challenges through trials like one testing text message reminders for flu vaccines.
Primary care mental health integration initiatives aim to meet full spectrum of patient needs through supported primary care services connected to other levels of care. Evidence shows countries with strong primary care have lower costs and healthier populations. Areas with higher primary care physician availability also have healthier populations and reduced social inequality effects. Successful primary care mental health integration requires addressing workforce shortages, training primary care workers, and collaborating across sectors to expand treatment to underserved communities.
We’re always ready to take on board the views of the people who matter most: it’s what helps us focus on providing products and services that people really need. This is the tenth year in which we’ve conducted our Health of the Nation study, canvassing the opinions of GPs right across the UK. This year we’ve extended our research to include the views of 1,000 patients to understand their experiences of healthcare in the UK.
Population Health Management PresentationCANorfolk
The document discusses population health management (PHM) and its role in supporting integrated care systems (ICS) in the UK. Key points:
- ICSs will be established everywhere by 2021 to integrate primary/specialist care, physical/mental health, and health/social care.
- PHM solutions will help ICSs understand health needs and match NHS services accordingly through data analysis.
- PHM aims to improve population health through proactive, data-driven care that prevents illness and reduces health inequalities.
Health Works: Supporting Health in the Working AgeNHSScotlandEvent
Hear about the innovative practice being developed in Scotland to allow people rapid access to case managed support to help them back to work, using a person‐centred, biopsychosocial model.
What Does Commissioning and Quality Improvement Mean to Me?Sarah Amani
This was a good question which got me thinking: there are so many buzz words in healthcare sometimes its good to unpack what we mean. As one of the areas I cover, Cornwall and the Isles of Scilly are of huge importantance and interest to me so I was really happy to be invited to meet with their impressive commissioning and quality improvement team to discuss this topic
Evaluating the priority setting processes used across the Cochrane Collaborationmonalisa2n
This document discusses various methods that Cochrane entities use to prioritize topics for future Cochrane reviews. It identifies 17 entities that do not have a priority setting process and 27 that do or plan to. Common criteria for priority setting include clinical relevance, importance of the topic, impact on outcomes, and importance to specific populations. The document evaluates different approaches like the "Accountability for Reasonableness" framework and compares criteria like inclusiveness and equity. It poses discussion questions about selecting and applying criteria, evidence mapping, and integrating priority setting into the Collaboration's entities and strategies.
Quantifying the added societal value of public health interventions in reduci...cheweb1
This document discusses two projects conducted by NICE to estimate the health inequality impacts of public health interventions:
1. Plotting 134 NICE public health guideline interventions on a "health equity impact plane" based on their incremental population health benefits and reduction in health inequality. 71 interventions improved total health and reduced inequality.
2. A pilot study estimating the distributional cost-effectiveness of smoking cessation interventions. This involved adapting an existing model to incorporate evidence on how inputs like baseline risk, quit rates, and uptake vary by socioeconomic status.
The aggregate approach provides a simple feasible way to consider health inequality, but may miss differential effects. A bespoke approach can better capture differences but requires more data. Overall
1) The document describes an herb garden containing several different herbs, including misai kucing, lidah buaya, spinach, Thai pepper, miracle fruit, ulam raja, semun, and various ferns.
2) It provides details on the botanical information and common uses of each herb, such as their medicinal properties or culinary uses.
3) Many of the herbs are used for traditional medicine or as food in Southeast Asian cuisines.
Priority setting in healthcare is necessary to allocate limited resources to maximize health benefits. It involves ranking diseases, health conditions, and interventions based on criteria like burden of disease, cost-effectiveness, equity, and existing delivery capacity. While controversial, priority setting can be made legitimate through transparent processes that consider community needs and engage stakeholders. Frameworks provide structures to conduct priority setting exercises and address ethical challenges through criteria like accountability, participation, and appeals mechanisms. Identifying who loses out in the system through analyses like benefit incidence assessments is also important.
Using simulation to drive changes in health and care - long term conditions Year of Care model
Bev Matthews and Claire Cordeaux
Presentation from Day 1 of the Health and Care Innovation Expo 2014, Manchester Central
This document provides an overview of Ontario's Chronic Disease Prevention and Management Framework. It aims to provide a common policy framework to guide efforts in effectively preventing and managing chronic diseases. It also aims to guide various ministry transformation initiatives, such as primary health care renewal and public health renewal, with a focus on chronic disease prevention and management. The framework outlines eight components that need to be addressed through a systematic approach: health care organizations, delivery system design, provider decision support, information systems, personal skills/self-management support, healthy public policy, community action, and supportive environments. It emphasizes the importance of taking a population health approach focused on prevention to reduce the burden of chronic diseases.
Dr. Barry White, former HSE National Director, Clinical Strategy and ProgrammesInvestnet
The document discusses issues with the modern healthcare system including a reductionist approach, unrealistic expectations of health, and the failure to address behavioral factors. It argues that defining health as complete well-being has medicalized society and generated unnecessary demand. Bloodletting was the dominant medical practice for over 2000 years based on the ancient humoral theory but provided no improvement in life expectancy. While reductionism led to advances in the 20th century, a holistic approach is also needed. The key is developing self-awareness among both patients and clinicians to reconcile physical, psychological and social well-being.
The document proposes a microfinance health insurance scheme to improve access to quality primary healthcare in rural communities. It would establish a nodal center at community health centers to provide minimum premiums, cashless benefits, and reimbursement for out-of-pocket medical expenses. Profits would be reinvested in self-help groups and cooperatives to generate revenue and develop local infrastructure. This aims to increase utilization of existing healthcare services, strengthen referrals, empower communities, and boost the local economy through a sustainable community-level solution.
Mr Grant Brand: Lessons Learned in the First Nine Years of the Glasgow ARBD TeamAlcoholForum.org
The document summarizes lessons learned from the first nine years of the Glasgow Alcohol Related Brain Damage (ARBD) Team. It discusses how the team was set up, missed opportunities at the beginning, and what they have learned over time. Key points include broadening the referral criteria, conducting thorough multidisciplinary assessments, using legislation to help with harm reduction, providing rehabilitation services, and training other services on ARBD. It emphasizes the need for a public health approach, clear strategy, and person-centered flexible services for those with ARBD.
GPs' view of integration in North West London Nuffield Trust
GPs in North West London reported that patients experience fragmented care and that providers do not work together effectively. Improving relationships across sectors like mental health, community services, and social care was seen as important. However, GPs identified high workloads and lack of support for new ways of working as barriers. Protected time for multi-disciplinary meetings and shared IT systems were suggested to help overcome barriers and allow GPs to better coordinate care. While the Whole Systems Integrated Care program was known, perceptions varied and less than half of GPs thought its goals of improving quality and financial sustainability could be achieved through integration.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
This document discusses the promise of population health management (PHM) to improve healthcare in the United States. It outlines some of the key challenges with the current system, including a declining primary care workforce, fragmentation of care, and a lack of focus on prevention. The document then defines PHM and some of its core aspects, such as organized systems of care, care teams, and a focus on both medical and lifestyle factors that influence health. It also discusses some of the obstacles to implementing PHM, including the fee-for-service payment system and lack of health IT use. The document argues that new models like accountable care organizations and the patient-centered medical home show promise for enabling PHM and overcoming some of the current
Professor Liam Smeeth: Big Data, 30 June 2014Nuffield Trust
- The Farr Institute was established in 2012 with £19 million in funding to conduct health informatics research using large electronic health databases. It includes centers in London, Scotland, Wales, and Manchester.
- Examples are given of research using big data that would not otherwise be possible, such as studies of MMR vaccination and autism and the relationship between BMI and cancer risk.
- Challenges of randomized trials include recruitment, generalizability, and costs, and electronic health records may help address these challenges through trials like one testing text message reminders for flu vaccines.
Primary care mental health integration initiatives aim to meet full spectrum of patient needs through supported primary care services connected to other levels of care. Evidence shows countries with strong primary care have lower costs and healthier populations. Areas with higher primary care physician availability also have healthier populations and reduced social inequality effects. Successful primary care mental health integration requires addressing workforce shortages, training primary care workers, and collaborating across sectors to expand treatment to underserved communities.
We’re always ready to take on board the views of the people who matter most: it’s what helps us focus on providing products and services that people really need. This is the tenth year in which we’ve conducted our Health of the Nation study, canvassing the opinions of GPs right across the UK. This year we’ve extended our research to include the views of 1,000 patients to understand their experiences of healthcare in the UK.
Population Health Management PresentationCANorfolk
The document discusses population health management (PHM) and its role in supporting integrated care systems (ICS) in the UK. Key points:
- ICSs will be established everywhere by 2021 to integrate primary/specialist care, physical/mental health, and health/social care.
- PHM solutions will help ICSs understand health needs and match NHS services accordingly through data analysis.
- PHM aims to improve population health through proactive, data-driven care that prevents illness and reduces health inequalities.
Health Works: Supporting Health in the Working AgeNHSScotlandEvent
Hear about the innovative practice being developed in Scotland to allow people rapid access to case managed support to help them back to work, using a person‐centred, biopsychosocial model.
What Does Commissioning and Quality Improvement Mean to Me?Sarah Amani
This was a good question which got me thinking: there are so many buzz words in healthcare sometimes its good to unpack what we mean. As one of the areas I cover, Cornwall and the Isles of Scilly are of huge importantance and interest to me so I was really happy to be invited to meet with their impressive commissioning and quality improvement team to discuss this topic
Evaluating the priority setting processes used across the Cochrane Collaborationmonalisa2n
This document discusses various methods that Cochrane entities use to prioritize topics for future Cochrane reviews. It identifies 17 entities that do not have a priority setting process and 27 that do or plan to. Common criteria for priority setting include clinical relevance, importance of the topic, impact on outcomes, and importance to specific populations. The document evaluates different approaches like the "Accountability for Reasonableness" framework and compares criteria like inclusiveness and equity. It poses discussion questions about selecting and applying criteria, evidence mapping, and integrating priority setting into the Collaboration's entities and strategies.
Quantifying the added societal value of public health interventions in reduci...cheweb1
This document discusses two projects conducted by NICE to estimate the health inequality impacts of public health interventions:
1. Plotting 134 NICE public health guideline interventions on a "health equity impact plane" based on their incremental population health benefits and reduction in health inequality. 71 interventions improved total health and reduced inequality.
2. A pilot study estimating the distributional cost-effectiveness of smoking cessation interventions. This involved adapting an existing model to incorporate evidence on how inputs like baseline risk, quit rates, and uptake vary by socioeconomic status.
The aggregate approach provides a simple feasible way to consider health inequality, but may miss differential effects. A bespoke approach can better capture differences but requires more data. Overall
1) The document describes an herb garden containing several different herbs, including misai kucing, lidah buaya, spinach, Thai pepper, miracle fruit, ulam raja, semun, and various ferns.
2) It provides details on the botanical information and common uses of each herb, such as their medicinal properties or culinary uses.
3) Many of the herbs are used for traditional medicine or as food in Southeast Asian cuisines.
The document is an overview of the Audit Booklet published in August 2003 by the FFIEC IT Examination Handbook. It summarizes changes made to the booklet, including reorganizing it to follow the examination process flow. New contents were added to address legislation like Sarbanes-Oxley and Gramm-Leach-Bliley Acts. It also specifically addresses outsourcing IT audits and third-party reviews. The booklet is organized into sections on audit roles and responsibilities, independence of internal audits, developing an internal audit program, risk assessment, audit plans, and additional topics like outsourcing. Appendices include examination procedures and resources.
During the Devonian period, plants began spreading from wetlands onto dry land. Toward the end of the period, the first forests arose as trees evolved woody structures capable of supporting branches and leaves. Some trees during this time grew to be 100 feet tall. The first ferns, horsetails, and seed plants also appeared. Prototaxites were large terrestrial organisms from this time that were possibly fungi or lichen. Archaeopteris was an extinct tree-like plant with fern-like leaves.
During the Carboniferous period, forests of tree-like lycopsids and ferns covered vast areas, eventually forming the coal deposits of today. Notable plant groups included ferns, seed
Pteridophyta or Pteridophytes are Vascular Plants (also known as "seedless plants") that reproduce and disperse via spores. They do not produce either seeds or flowers.
Additional info:
+ Division Equisetophyta (horsetails & scouring rushes)
+ Division Psilotophyta (whisk ferns)
(This is our report in Botany 2.)
Made by: Sharmine Ballesteros (BS Biology 2A2-1)
The document describes efforts to improve psychosis care through the Treatment and Recovery In PsycHosis (TRIumPH) program. The key points are:
1) A working group was established between Southern Health NHS Foundation Trust and Wessex Academic Health Science Network to improve assessment and treatment for people experiencing psychosis based on understanding gaps in existing care.
2) The program developed and implemented a standardized care pathway across four Early Intervention in Psychosis teams, improving access to assessment and treatment.
3) Feedback from service users, carers, and clinicians informed the work, which aimed to provide more compassionate, holistic, and recovery-focused care.
Long term conditions like diabetes place a large burden on healthcare systems. A study in Yorkshire examined experiences providing care for long term conditions. It found that telehealth interventions can reduce hospital admissions, bed days, and costs while improving patients' quality of life. The Whole System Demonstrator Programme trial of telehealth and telecare in various UK regions showed a 45% reduction in mortality rates and 20% fewer emergency admissions among other benefits. Telehealth represents an opportunity to deliver more specialized care while reducing strain on hospitals and caregivers.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Dr Eileen Pepler, Academic, Researcher and Consultant in the Canadian Healthcare will discuss how NHS England work in chronic disease is being translated into a Canadian context.
Can integration reduce hospital admissions 2RICHARD YOUNG
This document discusses the results of an integrated care programme in Enfield that aimed to reduce hospital admissions. It found that in the first quarter of full implementation, there was an 8% drop in unplanned admissions for over-65s and a 9% reduction in delayed transfers. However, unplanned admissions rose in other age groups. While clinical outcomes improved and patient satisfaction increased, the economic return has been marginal. The document argues that further transformation, such as harnessing innovation, continued integration of care budgets, and technologies to keep people well, will be needed to successfully reduce costs while improving care.
DR TIM LEIGHTON AND KATHERINE JENKINS - WHAT CAN THE PAST TEACH US ABOUT THE ...iCAADEvents
The presentation and workshop will be a participatory session discussing the future of addictions counselling, and how decades of experience can inform best practice whilst also combining cutting edge research and treatment methods. Addictions counselling with individuals, couples, families and groups has become more complex and challenging. How can we de ne and describe the training and quali cations needed to ensure the best practice and the most e ective interventions? What is the relationship between the quality framework and the therapeutic work? The workshop will explore tensions that arise in practice as experienced by the audience, and suggest ways to get the training, support and continuing professional development you need. Tim and Katherine will be encouraging the audience to share their own thoughts and ideas.
This document summarizes the key priorities and recommendations from the Five Year Forward View for Mental Health (5YFV MH) report in the UK. The 5YFV MH aims to transform mental health services by 2020 through four priorities: 1) Improving 24/7 crisis care, 2) Integrating physical and mental health care, 3) Promoting good mental health, and 4) Reforming the mental health system. Some recommendations include expanding 24/7 crisis services, increasing access to psychological therapies, and developing children's crisis models. The 5YFV MH dashboard will monitor progress through key metrics on areas like crisis care, perinatal services, and outcomes for people with mental health problems.
Reducing Readmissions and Length of Stay | VITAS HealthcareVITAS Healthcare
Hospice can help reduce hospital readmissions and lengths of stay for patients with serious illnesses like heart failure. By providing comprehensive care, including nursing support 24 hours a day, palliative care physician support, medications, equipment, and targeted programs for conditions like CHF, hospice can help meet patient goals of comfort and avoiding inappropriate hospitalizations. For the patient with heart failure described in the case study, hospice could help prevent readmissions and allow the patient to focus on quality of life rather than further medical interventions by providing end-of-life care in their home.
The document summarizes a social prescribing program in Rotherham that aims to reduce hospital admissions and support patients' non-medical needs through community services. Key points:
- The program refers patients identified as at high risk of hospitalization to voluntary community services through case management.
- An evaluation found the program achieved a 7-17% reduction in hospital admissions and emergency department visits among participants. Greater reductions were seen for those who engaged more and were under age 80.
- Participants also experienced improved mental health and well-being. The program provides an estimated return on investment of 43 pence to £1.98 for every £1 invested through reduced healthcare costs.
- Stakeholders see the program as
Anne Hendry: reshaping care pathways for older peopleThe King's Fund
Dr Anne Hendry, Consultant Geriatrician and National Clinical Lead for Quality, Scottish Government, talks about the Reshaping Care for Older People programme in Scotland, which is aimed at improving services for older people by shifting care towards anticipatory care and prevention.
The Joint Improvement Team supports the implementation of this 10 year programme, which began in 2011, and involves 32 integrated partnerships between the NHS, local authority, third and independent sectors. A £300 million change fund is available to the partnerships to 2015.
LTC Year of Care Commissioning Model
Lesley A Callow, Delivery Support Manager - Long Term Conditions Year of Care Commissioning Model
NHSIQ
Fionuala Bonnar, Year of Care Programme Manager
LTC Year of Care benefits:
Improved outcomes and wellbeing:
Patients receive care that is better managed, more seamless across different care services and more needs focused.
Reduction in acute admissions to hospital; and shorter lengths of stay when these are required.
Clinical professionals contribute to a more holistic service for patients by working within an integrated patient-centred care plan
Local health and Social Care economies:
Provide care that delivers value for money and is better managed by integrated teams.
Incentive to improve services for patients
Improved joint working and shared responsibility for outcomes
3.1 - Progress on implementing primary care homesNHS England
1) The Primary Care Home (PCH) model brings together health and social care professionals from various organizations to provide enhanced personalized care focused on the needs of the local community.
2) Core characteristics of the PCH include whole population health management, a multidisciplinary workforce based on community needs, and aligned financial and clinical drivers to improve population outcomes.
3) Evaluations of PCH sites found improvements in A&E attendance and admissions, GP referrals, prescribing costs, staff satisfaction, and population health indicators like flu vaccinations.
Professor Aine Carroll - IPPOSI Patient Reported Outcomes Measures conference...ipposi
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1. 1
Crisis Assessment and Home
Treatment – EPIC Audit
Dr Jo Nicholson
Clinical Psychologist
What is Crisis Assessment and
Home Treatment?
“People experiencing severe mental health difficulties should be
treated in the least restrictive environment with the minimum of
disruption to their lives. Crisis resolution/ home treatment (CRHT)
can be provided in a range of settings and offers an alternative to
inpatient care. The majority of service users and carers prefer
community-based treatment, and research in the UK and elsewhere
has shown that clinical and social outcomes achieved by
community-based treatment are at least as good as those achieved
in hospital.”
Mental Health Policy Implementation Guide 2001
2. 2
CRHT Service Development in
Sheffield
• Sheffield Crisis Assessment and Home Treatment (CAHT) is a new
service development, in line with the national demands for new core
mental health services.
• The Sheffield CAHT has developed the pre-existing ‘Out of Hours’
service, with a substantial increase in staffing and shift in focus and
philosophy of service to provide a fully operational service from
January 2005.
• Provides 24 hours a day, 365 days a year crisis assessment and
home based treatment to people experiencing mental health
difficulties, where the home treatment compnent is prioritised for
those people who would otherwise be admitted to hospital.
• It offers the least restrictive and most appropriate form of
assessment and home treatment with the minimum disruption to
their lives.
CAHT - Inclusion Criteria
The inclusion criteria are as follows:
• Where the person is potentially
experiencing a mental health crisis and
admission to hospital is being considered
• And, the person needs to be seen within
24 hours
• And, the person presents at an increased
level of risk to themselves or others
3. 3
Service Components
The CAHT service response to referrals has
four components:
• Triage
• Crisis Assessment
• Home Treatment
• ‘Gate keeping’.
What is Home Treatment?
• The Crisis Assessment and Home Treatment approach is to work to
maximise the person’s coping and resilience through a period of
crisis and/or acute exacerbation of mental health functioning. The
Home Treatment approach provides an appropriately intensive level
of psychiatric, social and psychological support based on the
individual’s needs. Home Treatment seeks to promote functional
coping and recovery in the least stigmatising and restrictive setting.
• As the needs of the patient are highly individual the period of care
and the intensity of support provided can vary greatly. Home
Treatment can be a very short intervention (i.e. no more than 1-3
days) providing a physical and psychological ‘safety net’ for the
individual. Overall, Home Treatment aims to contain and resolve the
‘crises’ within an 8 week period. However, there are some
individuals who need a longer spell of care either to resolve the
crisis or ensure that appropriate support services are in place so that
risk and needs are adequately managed.
4. 4
CAHT – Global Audit Strategy
• Comprehensive rolling programme of audit that
will run across a two year cycle.
• Led by two senior clinicians within the service.
• Supported by a service-dedicated psychology
assistant, specifically recruited for that purpose.
• Multi-professional steering group has been set-
up to guide the programme and this has user
and carer representation.
1st Quarter
6 months
1 year
2 years
InsightEquitable Service
Access and
Culturally Sensitive
Service Pathways
Demographics
1st Quarter
6 months
1 year
2 years
InsightStHA performance
indicators
Inpatient
6 months
1 year
2 years
CAHT databaseBenchmark to
comparable
published research
and audit data
Service User and Carer
Feedback
6 months
1 year
2 years
CAHT databasesBenchmark to
comparable
published research
and audit data
Clinical Outcomes
1st Quarter
6 months
1 year
2 years
Insight
CAHT database
StHA performance
indicators
Service Performance
ReportData SourceService
Standard
Programme Area
5. 5
Databases
• The data presented within this audit is based upon a
number of database sources; including CAHT databases
and Insight.
• Through collaboration with the SCT Information
Department, data from Insight data also uploaded into
Excel and merged with the existing CAHT databases.
• The Excel databases were imported into SPSS. This
provided more flexibility in data interrogation than could
be provided through routine Insight reports.
• The CAHT service is currently working towards
developing a ‘live’ electronic recording system that will
rationalise the number of data sources in use.
EPIC Audit
Additional audit procedures need to be in
place to monitor the impact of EPIC
1. Monitor/Describe Components of
‘standard care pathway’
2. Monitor/decsribe culturally senstive care
pathway
6. 6
Audit Standards
1. The CAHT is contracted by the StHA to provide 1200 episodes of
Home Treatment in a year period.
2. The CAHT service aims to provide an equitable service
3. The CAHT service should develop clear care pathways that are
responsive to the needs of the different client groups and the
referrers it serves
4. Ensure that individuals experiencing acute mental health
difficulties are treated in the least restrictive setting as close to
home as possible
5. To act as ‘gatekeeper’ to acute inpatient services, rapidly
assessing individuals with acute mental health problems and
referring them to the most appropriate service
Activity Results – Referral Rate
Crisis Assessment and Home
Treatment
Crisis Assessment OnlyConsultation Only
CAHT Categories
2,500
2,000
1,500
1,000
500
0
NumberofPatients
478
14.59%
2,187
66.74%
612
18.68%
7. 7
Missing Data
• White UK 52.3% (1713)
• BEMs 10.4% (340)
• Missing Data 37.4% (1235)
• For ethnicity – up to 40% missing data
• Varies by quarter, with more missing data
as year goes on
Results – Referral Rate
84.3%
(339)
15.7%
(63)
83.7%
(456)
16.3%
(89)
83.4%
(1713)
16.6%
(340)
Ethnicity
White UK
Black and
Ethnic
Minorities
Multiple
Episodes
Patients
with Single
Episode
All
Episodes,
including
repeats
Demograp
hic
Variable
8. 8
Activity Data – Repeat Patients
• In total, 1847 individual patients were seen in
the first year of operation, but a significant
proportion of these were seen at least twice.
There were 588 patients who received
multiple episodes of care, this means 32.1% of
patients were seen at least twice. Of the
3277episodes of care provided by CAHT, 56.4%
were repeat episodes.
• Initial differences by ethnicity diminished over
year period and no significant relationship
between ethnicity and likelihood of having a
repeat episode.
Results – CAHT and A&E
(based on 3 month sub-sample)
• A&E is the major referral source to CAHT accounting for
over half of all referrals (56%).
• 77% of A&E referrals are seen after 5pm and half (49%)
of all referrals to CAHT are seen after 5pm.
• Referrals from A&E are least likely and referrals from
CMHT’s are the most likely to result in Home Treatment
as a clinical outcome. Referrals from A&E are 3 times
less likely to result in Home Treatment as compared to
referrals from a CMHT.
9. 9
Referral Source
(based on 3 month sub-sample)
• In hours distribution of White UK (80%) to
BEMs (20%) by referral source fairly
consistent.
• There is one exception to this; number of
BEM’s accessing CAHT by GP Out-of-
Hours drops by half (White UK 90.9%
BEMs 9.1%)
Setting of First Direct Contact
(Full Year)
15.2% (16)84.8% (89)Other Location
14% (83)86% (510)A&E
15.5% (80)84.5% (435)Telephone
34.2% (13)65.8% (25)Police Station
18.8% (88)81.2% (381)Clients Home
BEMsWhite UK
10. 10
Results - Demographics
• Overall referrals to CAHT are equal proportions of male and female, are an
average age of 37, likely to be unemployed (68.1%) and not married
(73.1%).
• 78.5% are White UK and 16.6% Black and Ethnic Minorities.
• Distritbution of ethnicity did not vary across clinical categories (crisis
assessment only verusus crisis assessment and home treatment)
• There are significant demographic differences between the patients referred
to CAHT across the 4 PCT Sectors.
• Compared to the general population of Sheffield (2001 Sheffield Census),
CAHT service users are nearly twice as likely to be single or
divorced/separated. They are also six times more likely to be unemployed
and twice as likely to come from a Black and Ethnic Minority group.
Ethnicity by PCT Area
• There were statistically significant differences in the
distributions of ethnicity across the different PCT areas
(chi=13.6: p=0.003).
• The South West had the highest proportions of BEM’s
referred to the service (23%).
• The South East had the lowest proportion of BEM’s
referred to the service (13.8%).
• It is notable that the proportion of BEM’s from the North
is close to the proportional average (across all sectors)
and the South East has the lowest proportional rate
when those sectors actually have the highest proportion
of BEM’s of all the sectors.
11. 11
CAHT Ethnicity Distribution
Compared to Sheffield Census
89.2
83.8
10.8
16.2
0
10
20
30
40
50
60
70
80
90
British BEMs
Sheffield 2001
Census
CAHT Population
Detailed breakdown of ethnicity
OtherDual
Heritage
YeminiChineseAsianBlackWhite
Other
White
Collapsed Ethnicity Codes
2,000
1,500
1,000
500
0
NumberofPatients
32
1.56%
31
1.51%
20
0.97%
33
1.61%
97
4.72%78
3.8%
49
2.39%
1,713
83.44%
12. 12
Specific to EPIC Project
• In the 1 year period there were 54 patients
(2.4%) whose ethnicity was recorded as
‘Asian or Asian British Pakistani’
Clinical Outcomes by Ethnicity
9.3 (9.6)
12.8 (13.4)
5.9 (5.7)
7.8 (7.5)
Ethnicity
White UK
Black and Ethnic
Minorities
BPRS Difference Score
(Assessment –
Discharge)
Mean (StD)
HoNOS Difference
Score (Assessment –
Discharge)
Mean (StD)Demographic
13. 13
Proposed Audit of Clinical
Pathways
• Audit of Standard Care Pathway
• Audit Enhanced ‘culturally sensitive’ care
pathway
• Refer to EPIC Audit Presentation 2 page1
14. 14
• Refer to audit present 2 page2
• Refer to audit present 2 page3
15. 15
• Refer to audit present 2 page 4
Enhanced Pathways into Care
Audit Checklist V2.1
Culturally Appropriate Care
Basic Demographics
Insight number : Gender: Male (1) Female (2)
Date of Birth: ___ /___ /_______ Diagnosis: ______________ (ICD10: F______)
Date of Admission/Assessment: ___ /___ /_______ Date of Discharge:___ /___ /_______
Ethnic group:
Other (25)Mixed White and
Black Caribbean (20)
Mixed White and
Black Africa (21)
Mixed White and Asian (22)
Mixed White Other (23)
Yemeni (1)
Chinese (1)
Vietnamese (1)
Asian or Asian
British Indian (7)
Asian or Asian
British Pakistani (8)
Asian or Asian
British Bangladeshi (9)
Asian Other (12)
Black/Black British Africa (3)
Black/Black British Caribbean
(4)
Somali (5)
Black Other (6)
White (2)
White British
(17)
White Irish (18)
White Other
(19)
Not asked (1)
Refused to answer
Unable to answer
(16)
English as First Language: Yes (1) No (2)
Other Language(s): ________________________________________________
16. 16
Case Note Review:
Drugs offered are reviewed with consideration
of appropriateness to spiritual beliefs (i.e.
olanzapine velotabs) Yes (1) No (2)
Timing of administration is reviewed with
consideration of apporopriateness to cultural
practice (i.e. administration times during
Ramadan) Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
No (2)
Yes – indirect (1.1)
Yes – direct (1.2)
Prescribing:
Prescribing assumed by CAHT
Drug chart
Drug review
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Within 7 days:
Care plan
Risk Assessment form
Assessment summary
Medic review
Yes (1) No (2)CTRS scale
Interpreter Offered:
N/A English as first language (0)
No (2)
Yes – Family member (1)
Yes – staff member (1.1)
Yes – Independent (1.2)
Yes – Refused (1.3)
Ethnicity checked from pateint perspective:
Yes (1) No (2)
Assessed spiritual practice:
Yes (1) No (2)
Immediate Care plan identifies
cultural/spiritual needs:
Yes (1) No (2)
Yes (1) No (2)Assessment form
Ethnic origin identified:
Yes (1) No (2)
English as first language identified within
form:
Yes (1) No (2)
Yes (1) No (2)Triage form
Comments / VarianceCulturally Appropriate Care
Standard Care
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Children in household
Number of children
Ages identified
Child protection issues identified
Liaison to other agencies for
children’s needs
Referral to meet children’s needs
Appropriate chaperone offered
Yes (1) No
(2)
Appropriate gender offered
Yes (1) No
(2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Physical Health needs:
Physical Examination
Blood tests
ECG
Other
Culturally sensitive/validated tools have been
considered
Yes (1) No
(2)
Translated self administration tools (insert
here list of appropriate alternatives)
Yes (1) No
(2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Other Assessment Tools:
BDI
LUNSERS
Other
17. 17
Interpreter offered in core assessments with
patient:
N/A English as first language (0)
No (2)
Yes – Family member (1)
Yes – staff member (1.1)
Yes – Independent (1.2)
Yes – Refused (1.3)
Interpreter offered in core assessments with
carer:
N/A English as first language (0)
No (2)
Yes – Family member (1)
Yes – staff member (1.1)
Yes – Independent (1.2)
Yes – Refused (1.3)
Use of interpreter for follow-up visits:
N/A English as first language (0)
No (2)
Yes – Family member (1)
Yes – staff member (1.1)
Yes – Independent (1.2)
Yes – Refused (1.3)
Gender issues/mix
Yes (1) No (2)
Discuss issues of shoes, presence of family
members, hosting, seating
Yes (1) No (2)
Written materials translated
Yes (1) No (2) Not available (3)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
N/A (3)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Home visit:
Risk Assessment
Mental state
Carer needs
Adult protection issues
Psychoeducation to Patient:
Meds - verbal
Meds - written
Mental health – verbal
Mental Health - written
Psychoeducation to Carers:
Meds - verbal
Meds - written
Mental health – verbal
Mental Health - written
Seen by:
Consultant
SPR
SHO
Nursing
Social Worker
Occupational Therapy
Psychologist
STR
Referral to culturally appropriate day services
Yes – Accepted (1)
Yes – Refused (1.1)
No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
_________________
_
Yes (1) No (2)
Referral on:
CMHT sector
CMHT CNS
EIS
Statutory day services
Non-statutory services (please
specify)
Other specialist services
Brief new professionals on cultural and
spiritual needs prior to visit
Yes (1) No (2)
Yes (1) No (2)
N/A (3)
Yes (1) No (2)
N/A (3)
Yes (1) No (2)
N/A (3)
Joint working:
Liaison to existing care providers
Joint visit with existing care
providers
Joint visit for new assessment
Use of appropriate models in formulation and
direct working (i.e. gin possession, PTSD,
CBT, evidence base etc)
Yes (1) No (2)
Consultation within team for culturally
appropriate care planning
Yes (1) No (2)
Consultation external to team for culturally
appropriate care planning
Yes (1) No (2)
Liaison to culturally appropriate agencies (e.g.
PMC, transcultural team, Somali mental
health, Irish)
Yes (1) No (2)
Follow-up care planning consider cultural and
spiritual needs
Yes (1) No (2)
Care Plan Translated
N/A English as first language (0)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Care Plan Elements:
Diagnosis
Contact Plan
Risk assessment
Mental state
Medication
Physical
Psychological
Social
Occupational
Liaison to other agencies
Follow-up needs
Signposting and advocacy
Evidence discussed/shared with
Patient
Evidence of Review
18. 18
Brief new professionals on cultural and
spiritual needs
Yes (1) No (2)
Referral to culturally appropriate day services
Yes – Accepted (1)
Yes – Refused (1.1)
No (2)
Discharge summary refers specifically to
cultural and spiritual needs
Brief new professionals on cultural and
spiritual needs prior to visit
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
_________________
Yes (1) No (2)
Yes (1) No (2)
Yes (1) No (2)
Discharge:
Primary care only
CMHT – Sector
CMHT – CNS
Inpatient service – Informal
Inpatient service - Formal
Statutory day services
Non-statutory services (please
specify)
Other specialist services
Discharge Visit
Discharge Summary
Contact Details
Dr Jo Nicholson
07980 733148
jo.nicholson@sct.nhs.uk