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Mind the gaps: understanding and improving out-of-hours care for people with advanced illness and their informal carers
- Authors:
- PASK Sophie, et al
- Publisher:
- Marie Curie
- Publication year:
- 2022
- Pagination:
- 33
- Place of publication:
- London
This report sets out new evidence on out-of-hours care for people approaching the end of their lives, and their informal carers, derived from UK data on out-of-hours emergency department attendance among people who are in the last year of life; interviews with health professionals about out-of-hours services across the UK; and a patient and public involvement (PPI) workshop. We found that out-of-hours emergency department attendance increases in frequency as death approaches, and is more common among people living in the most socioeconomically deprived areas; that although all areas have access to telephone lines for general NHS services out-of-hours (e.g. NHS 111 in England and Wales), not all areas have a designated telephone line for out-of-hours palliative care support; that access to medicines out-of-hours can be complicated and time consuming; that there are gaps between what is theoretically in place and what is actually experienced by patients and informal carers; that equipment is hard to access; that care packages are often delayed or unavailable; and that much out-of-hours care relies on stretched community nursing services. The report makes a number of recommendations, calling on Integrated Care Systems, Health Boards and NHS Trusts, Integration Joint Boards and NHS Health Boards, and Health and Social Care (HSC) Trusts across the UK to strategically develop, enable and support greater integration and coordination of out-of-hours services. (Edited publisher abstract)
The elective care backlog and ethnicity
- Authors:
- GEORGHIOU Theo, et al
- Publisher:
- Nuffield Trust
- Publication year:
- 2022
- Pagination:
- 88
- Place of publication:
- London
This report examines, for all procedures, and for groups of common elective procedures, how rates of NHS-funded treatment varied between ethnic groups before the pandemic, and whether there were subsequent ethnic differences in the levels of ‘lost’ activity during the pandemic. The focus of our analysis is ethnicity, but deprivation, region and Covid-19 are confounders in interpreting ethnic differences, and so these are also examined to inform our interpretation of the results. The report is based on a detailed analysis of hospital data from March 2019 to February 2022. The analysis reveals that, before the pandemic, the White group had higher rates of elective procedures overall than the Black, Mixed and Asian groups, with the White group having almost a fifth more procedures than the Asian group per head of population. Cardiac and cataract procedure rates were highest in the Asian group and dental procedure rates were highest in the Black group. Procedure rates during the first year of the pandemic fell in all groups, with the NHS carrying out around 2.7 million fewer operations and tests in that year compared with the year before. However, the falls in activity were not uniform across the different ethnic groups, with the Asian group experiencing the largest overall fall in the first year of the pandemic compared with the other groups (a fall of 49% for all procedures compared with 44% for the White and Black groups). This means that if the proportional fall in activity was the same for the Asian group as it was for the White group, we would have expected to see just over 17,000 more procedures for the Asian group. Although the gap narrowed in the second year of the pandemic, there was still a larger deficit of care among the Asian group, with the fall remaining 2% larger for the Asian group than for the White group - an estimated deficit of 6,640 procedures. Apart from the Asian group, consistent differences were not found across procedures for other ethnic minority groups. The Black group did have larger rate falls than the White group for cardiac and cataract procedures (the fall was 19% larger for cataract procedures) but otherwise saw similar changes to the White group, including for all procedures taken together. The most deprived groups in the population experienced larger rate falls overall and for most specific procedure groups. For hip and knee replacements, there was a 13% larger fall in the most deprived group compared with the national change, and a 7% lower fall in the least deprived group. There was no relationship between the fall in elective hospital activity and the local impact of Covid-19 by region (as measured by reported Covid-19 cases and Covid-19 admissions). (Edited publisher abstract)
Systems research: 4,000 voices. Findings from a survey with people aged 65 years and older conducted on behalf of CQC
- Authors:
- LAMBERT Claire, et al
- Publisher:
- Ipsos MORI
- Publication year:
- 2022
- Pagination:
- 52
- Place of publication:
- London
This report presents the findings from a survey conducted by Ipsos on behalf of the Care Quality Commission (CQC). The survey was undertaken via telephone with 4,013 people aged 65 and over living in England in May and June 2022 who have used health and social care services in the last six months. In addition to demographics, the questionnaire covered use of health and social care services, experience when accessing these, waiting lists for health services or a care assessment, as well as social networks. Overall, people aged 65 and over who have used health and social care services in the last six months tend to describe the care and support they have received as good and feel they have received the care and support they thought they needed, at least to some extent. Although positive at an overall level, the findings highlight that there are risks to health inequalities. some groups of people consistently report poorer experiences of care and support than others (for example of being listened to or treated fairly): women, disabled people and those with multiple long-term conditions, people living in more deprived areas, people in social grades D and E, and people with caring responsibilities. Overall, people aged 65 and over who have used health or social care services in the last six months find it easy to get help from a close family member or friends / neighbours if it is needed, demonstrating strong social networks. However, those most likely to need help (for example, due to old age, a disability, being on a waiting list) find it comparatively harder to get help from family, friends and neighbours when they need it. Those who are currently waiting, either for health services or for a care assessment, are consistently more negative about health and social care services, in relation to access, the quality of care and the coordination of care. Significant minorities do not currently feel well supported, and/or find that their ability to carry out day-to-day activities is getting worse in comparison with when they were first referred to health services or requested a care assessment (Edited publisher abstract)
Support for care leavers
- Authors:
- FOLEY Niamh, et al
- Publisher:
- Great Britain. Parliament. House of Commons Library
- Publication year:
- 2022
- Pagination:
- 71
- Place of publication:
- London
This briefing covers the UK Government's policies to support care leavers in key areas. Care leavers are young people aged over 16 leaving local authority care. According to the Department for Education, in 2020/21 there were 44,590 care leavers in England now aged 17 to 21. The briefing primarily focuses on England but includes some information on devolved policies. It covers: strategies and funding; social services; housing; education and training; health services; social security benefits. Support for younger children moving into and out of care, or leaving care through adoption or other routes, is not considered in detail in this briefing. (Edited publisher abstract)
COVID-19 and older people: impact on their lives, support and care
- Authors:
- DUBOIS Hans, et al
- Publisher:
- European Foundation for the Improvement of Living and Working Conditions
- Publication year:
- 2022
- Pagination:
- 92
- Place of publication:
- Luxembourg
This report captures the impact of the COVID-19 crisis on the quality of life of older citizens, including the impact on their well-being, finances, employment and social inclusion. It explores the effects on the use of care services and older people's reliance on other support. The report presents policy measures that have been implemented in EU Member States to support older people along all of the above-mentioned dimensions. These include measures to support independent living and schemes to support the labour market integration of older people or to prevent unemployment, all of which play a role in the quality of life of older citizens. During the COVID-19 pandemic, social contacts decreased in all age groups in the EU; mental health deteriorated for people of all ages during the pandemic, but affected young people and the 80+ age group most severely; both decreases and increases in income were less common among older people, for whom pensions proved to be a stable source of income - however, pandemic-related expenditure, such as spending on private transport and care services, caused financial difficulties, especially for low-income groups; during the pandemic, the likelihood of reduced physical activity increased with age; low-tech e-healthcare (by phone) facilitated access to healthcare during COVID-19, however, many older people still preferred face-to-face consultations and almost half of users aged 50+ who opted to use e-healthcare reported that it did not fully meet their needs. (Edited publisher abstract)
National audit of dementia memory: assessment services spotlight audit 2021
- Authors:
- CORRADO Oliver, et al
- Publisher:
- Healthcare Quality Improvement Partnership
- Publication year:
- 2022
- Pagination:
- 85
- Place of publication:
- London
Based on data from 5970 case notes of patients seen for initial assessment between January and August 2021, this report looks at community-based memory assessment services in England and Wales. The report found that the average waiting time from referral to diagnosis has increased to 17.7 weeks since 2019, up from 13 weeks. It also found that over 70% of services experienced periods of closure, and over 80% had staff redeployed during 2020. Other key findings include: 35% of patients had an appointment via phone or video call, while 45% took place at their usual place of residence; as part of their initial assessment, 61% of patients had a discussion recorded about their eyesight, 58% had a discussion recorded about hearing, and 76% had a falls history discussed and recorded; CT/MRI scans were requested for 47% of patients, with variation in requests of 0-97.4% of patients per service. This range implies that variation is at service/protocol level, rather than assessed as appropriate in each case. The report goes on to make a number of recommendations, including a call for services to use quality improvement methods to actively monitor waiting times from referral to diagnosis, and identify problem areas and barriers to access, including demographic and other factors (e.g. care home residents), as services continue to recover from the impact of the COVID-19 pandemic and associated service closures and staff redeployment. (Edited publisher abstract)
Improving children and young people's mental health services: local data insights from England, Scotland and Wales
- Authors:
- GRIMM Fiona, et al
- Publisher:
- Health Foundation
- Publication year:
- 2022
- Pagination:
- 38
- Place of publication:
- London
This briefing presents analysis from the Health Foundation's Networked Data Lab (NDL) about children and young people's mental health. The analysis from local teams across England, Scotland and Wales has highlighted three key areas for urgent investigation, to help ensure children and young people get the care they need. These are: rapid increases in mental health prescribing and support provided by GPs; the prevalence of mental health problems among adolescent girls and young women; stark socioeconomic inequalities across the UK. In Part 1, we provide some background on the trends in mental health disorders among children and young people and existing pressures on services, as well as an overview of the main policies in place in England, Scotland and Wales to improve children and young people's mental health. In Part 2, we present findings from NDL partners: we examine trends and patterns of service use, including the use of general practice, specialist mental health care and acute services, along with differences by demographic and socioeconomic characteristics. In Part 3, we show how local NDL teams used linked data to improve services in their area. Local NDL teams found the use of GPs and medication for mental health problems is growing in their areas. In North West London, the monthly number of those aged 0-25 years with a mental-health related prescription or GP event (diagnosis, observation or referral) grew threefold between 2015 and 2021. In Grampian (Scotland), the proportion of those aged 0-24 years with mental health-related prescriptions increased from 4.7% in 2012 to 6.4% in 2019. Around 25% of older adolescent girls and young women aged 17-22 years have a probable mental health disorder, a higher share than for any other group of children and young people. There is a stark contrast between areas of differing socioeconomic deprivation. In the 20% most deprived areas, compared to the 20% least deprived, crisis referrals were 60% higher among children and young people in touch with services in Leeds; there were twice as many prescriptions and 1.7 times as many referrals in Grampian; and there were close to twice as many crisis presentations to acute services in Wales. (Edited publisher abstract)
Attitudes, experiences and expectations on long-term care in Spain
- Authors:
- ILINCA Stefania, et al
- Publisher:
- InCARE
- Publication year:
- 2022
- Pagination:
- 8
- Place of publication:
- Vienna
This factsheet provides an accessible summary of the key findings from the data collected by the InCARE survey in Spain and across Europe. The results are based on unweighted data consisting of 375 responses from Spain and 2373 responses from across EU-27 countries, collected through an online survey between September 2021 and February 2022. Our results indicate that limited availability and high costs are commonly cited as barriers in access to care in Spain, suggesting a need for increasing financial protection and improved planning of care delivery. Spanish respondents have very low trust that the long-term care system will be able to respond to their future care needs, especially regarding the capacity and accessibility of community-based care solutions. Attitudes and preferences for care arrangements are shifting away from the traditional familialistic grounding of the Spanish care system, and towards a stronger role of the State and of professional services in long-term care provision. (Edited publisher abstract)
Understanding service provision for children in need in England
- Authors:
- COLLYER Hannah, et al
- Publisher:
- What Works Centre for Children's Social Care
- Publication year:
- 2022
- Pagination:
- 69
- Place of publication:
- London
This report presents the findings of a research study which explored the support offered to children and their families who have a Child in Need plan across four local authorities. Little is known about the needs of children who are on Child in Need plans and this research aimed to add to the existing knowledge base. We carried out a manual review of 82 case files of children with a Child in Need plan and supplemented this with in-depth case discussions with practitioners. We held seven focus groups with 29 social work staff, along with 11 interviews with parents of children with a Child in Need plan. To inform the study, we also held four roundtables with attendees from a wider range of LA's (separate from included in the study). The study found that there was considerable variation in the use of and the reasons why children were placed on Child in Need plans, and subsequently the length and types of interventions provided. a range of factors, such as parental engagement with children's services, family support and historical concerns influenced the decision-making to recommend a Child in Need plan. Whilst collaboration with parents was heavily emphasised in social worker's accounts of their work, parents often did not feel involved in the development of Child in Need plans, and were not always aware of goals they were working towards. There is little understanding of the characteristics of children who have a Child in Need plan. A wide range of support services and interventions were provided by social workers, family support workers and specialist teams within LAs, in addition to external services to which families were referred. A large proportion of the social worker's role was providing advice and guidance to parents, along with co-ordinating multi agency support. There are gaps in service provision despite the wide range of internal and external services offered to children and families. In particular, this involves difficulties accessing timely specialist support, particularly for child and parent mental health. (Edited publisher abstract)
Early childhood inequalities
- Authors:
- CATTAN Sarah, et al
- Publisher:
- Institute for Fiscal Studies
- Publication year:
- 2022
- Pagination:
- 76
- Place of publication:
- London
This chapter focuses on inequalities in early childhood cognitive and socio-emotional development, and in the environments in which children are raised. These emerge very early in life and shape individuals' outcomes and experiences, both as children and as adults. This chapter reviews existing evidence and provides new evidence from the UK on the nature, magnitude and long-term implications of these inequalities. It examines how such inequalities have changed over time and provides a critical appraisal of current UK policies aimed at supporting children and their families in the early years. The report finds that a substantial fraction of the inequalities in children's early development at age 3 can be traced back to inequalities in their home, educational, emotional and material environments at the same age: inequalities in these environments explain over 20% of the overall inequalities in cognitive development and 45% of the inequalities in socio-emotional development at age 3. The quality of relationships between parents and children, and other aspects of the emotional environments provided in the home, are an important source of variation explaining differences in child emotional and behavioural difficulties. Based on the evidence provided in this chapter, we recommend an early years policy that includes three pillars: a welfare state supporting sufficient income and a housing policy that ensures secure housing and reduces social segregation; high-quality mental healthcare, with a stronger focus on detection and treatment among mothers and fathers in this period of infancy; and strong support for families including in early parenting to foster the development of strong attachment and parent-child relationships. (Edited publisher abstract)