Accident and Emergency wait times seem to be constantly in the news. Less commonly but equally importantly are headlines that waiting lists for elective operations and procedures are on the rise. Although these topics hit our headlines regularly there is actually very little evidence and understanding behind the reasons for these changes in NHS services, and how the NHS can take positive action to cope with these issues.
From what we understand a lot of the currently held beliefs around the causes for pressure on NHS services come from very basic, non peer-reviewed, and potentially flawed analyses. It does not need too much explaining that making decisions based on these might be a bad idea.
I remember being asked in my interview for nursing why I wasn’t applying to be a doctor. There’s no simple answer to ‘what nursing is’ or ‘what it means to me’ but the answer I gave then is probably as close as I’ll ever get.
I’m not that interested in disease but I am interested in people. Nursing is about supporting and helping people, often through their most difficult times. While it’s hard to distinguish this from many other caring professions the key (to me) is that the focus is on the person comes first and the rest follows.
We know that nurses miss or delay taking patients’ vital signs (such as pulse, temperature and blood pressure) at night. Until now, no one knew why.
The NHS expects hospitals to use ‘Early Warning Scores’ to measure how ill someone is. These are based on the observation of ‘vital signs’ – measurements of things like pulse, temperature, blood pressure and breathing speed. The higher the score, the more often someone’s vital signs should be checked. This is so staff can spot the early danger signs of someone becoming very unwell, in time to help them.
Your local hospital will probably have an ‘early warning protocol’ that says how often people should be checked according to their early warning score. At higher levels observations will need to be done in the middle of the night. Despite this, we know that nurses are much less likely to do the observations that are expected to be done at night.
Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.
National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1). It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).
When people talk about managing mental health the most frequent thing to do is to recourse to self help or looking to services to help. There is less recognition of the power of social networks for help and support based on connections and reciprocity around us.
Separating out the individual from their need for other people and ability to mobilise resources in order to manage effectively, has meant that the notion of a personal community of support (the array of personal ties with which people are located and embedded) has not tended to be included in understanding or responding to mental health need.
Now there’s a nascent social movement about networks.
It’s common for academics to be found popping up at conferences and even music festivals these days, telling people what they have been finding out in an effort to spread the word and get the message heard. This was just the activity we were engaged in and one of the benefits for us as academics is that we also get to hear about others work and this gives us ideas.
The MWF takes place over 3 days in London . The first day takes place in the Houses of Parliament where Baroness Hollins hosts panel discussions on aspects of mental well-being and the next two days take place predominantly in City Lit, a further education college that serves London. Throughout these two days there is a plethora of wonderful sessions that can be accessed, free of charge, by those registered for the event. Attendees include those with lived experience of mental distress, both themselves and as carers; interested members of the public; policy makers; commissioners and professionals from every group with a role in helping those in mental distress.
It really is the most eclectic, informative and creative space to find yourself in. A place where many, sometimes opposing, worlds collide.
Our talk was full, so we had a great audience of interested people who asked questions all the way along and shared their own experiences of being pet owners. What stood out particularly, and resonated with the findings from our study, was the way in which pets give unconditional love which is consistently there regardless of how we are feeling.
Pets are trusted more than people many said and seem to have an intuitive understanding of their owners, knowing just when to demand to go out or to curl up for a cuddle.
For me most important was the knowledge, which we gained from the study, that for our cohort none of the participants had their pets considered as important network members as part of their care and yet all that had pets stated that they were essential.
The room completely agreed with this and the professionals in the room were clear that pets will be considered more seriously in future, in fact two of the attendees stated that they were relieved to have some research evidence to back up something they had wanted to attend to for a while but had felt reluctant to do so in case they were laughed at.
More and more of us are looking online for information to support our health (see Chris Allen’s work on support in Online Communities). In my research, I have found that the ability to get hold of that information and support, which is personal to you, can make a huge difference to how well you are.
I’m focusing on insulin pumps, which are an alternative means to deliver insulin to people with diabetes – compared to the more traditional multiple daily injections.
Insulin pumps have been developed to help people with Type 1 diabetes manage the condition better; both in terms of their quality of life and by more closely resembling a fully-functioning pancreas.
However, introducing a new health technology to an already difficult to manage condition is not necessarily simple, or easy.
It was palpable with research geekery excitement while travelling to Nottingham for the 2017 Health Services Research UK Conference. I needed this, I thought, an opportunity for positivity, to talk enthusiastically about how we as researchers can help sustain the future of the NHS and wider health services. The conference didn’t disappoint.
We are all too aware of the popular rhetoric that consumes newsfeeds and social media channels, with headlines like ‘The NHS is in Crisis’ and ‘too many people are pitching up to A&E’. All doom and gloom. The conference was a perfect antidote to this. While there are no panaceas to these ongoing issues, my fellow health services researchers offered positivity and direction against the troubling backdrop of public service austerity and Brexit uncertainty.
Article by Martin Simpson-Scott, PPI Coordinator NIHR CLAHRC Wessex
Mark Stafford-Watson is one of our NIHR CLAHRC Wessex public contributors. He’s also ‘PPI Champion’ for our Theme 1 research team (Integrated Respiratory Care) – of particular personal relevance to Mark, as he has a long-term respiratory condition.
As PPI Champion for the Fundamentals of Care theme within NIHR CLAHRC Wessex, I’ve a great experience and opportunity to be an equal member of a team developing the research priorities for this area of work. Crucially, these weren’t priorities that we developed together in a closed room, but rather they were co-produced at several stages.
This site promotes independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Funding Scheme. The views expressed in this blog are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health