D2 Digital by Design: service delivery innovation award runner-up

Service users are sent personalised messages of support by the Response Prevention Project team. Photograph: Jason Lock/Jason Lock Photography

Text messages that support people recovering from alcohol misuse has significantly cut the number of people who relapse and have to be referred back to services.

Daily personalised support messages – which prompt a service user who has recently completed an alcohol misuse programme to reflect on their recovery – are delivered automatically as part of the Bolton Response Prevention Project called Shine.

The questions take into account the user's triggers to drink, such as the time of day they are likely to crave alcohol and also what motivates them to stop drinking such as their relationships with their family.

Service users are also asked whether they feel OK, or are struggling and need more support, and are sent appropriate messages.

Project manager Renate Kalnina at digital technology company D2 Digital by Design in Manchester, which is behind the initiative, says: "If they respond 'OK' we send them back a congratulatory message; if they are 'struggling' then the personalised intervention messages come into play.

"If they say that they need more support then the services get notified within 15 minutes and they get in touch with the client."

Service users are also sent a reminder via text message for appointments as part of the project, which ran from April 2010 to December 2012 in partnership with alcohol misuse services in Bolton.

Only 2.2% of Shine service users had to be re-referred for treatment, compared to 9.5% of non-Shine service users; a significant" reduction according to an analysis of the project.

Clients' attendance rates for relapse prevention programmes improved – rising from 42% to 72% in tier three services (medical intervention and psychosocial support) and from 17% to 72% in tier two services, which offer less intensive support and aftercare, the analysis revealed.

It is estimated the initiative has saved between £68,260 and £399,150, depending on individual client need.

D2 Digital by Design is in discussion with Public Health England about using the same model to support opiate users.

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Department of primary care health sciences, University of Oxford: winner, service delivery innovation award

Daniel Lasserson, senior clinical researcher, and Maggie Webb, unit manager, in the emergency multidisciplinary unit.

An emergency unit designed exclusively for old and frail patients is keeping them out of acute hospital and helping to prevent bed-blocking.

The emergency multidisciplinary unit (EMU) established at Abingdon community hospital in Oxfordshire is hoped to become the national model for the future of emergency care for older people.

Patients can be referred to the EMU, which is seen as an alternative to an acute hospital A&E, by either their own GP, a community nurse or ambulance paramedic.

The unit, which is open seven days a week from 8am-8pm on weekdays and 10am-4pm on weekends, is not available for patients who have suffered a stroke or a heart attack, who would still be taken to the local acute hospital's A&E. The majority of the 5,500 patients it has seen arrive with chest or bladder infection or heart failure. The average patient age is 89.

Staffed by elderly care physicians, GPs, nurses, healthcare assistants, therapists and social workers, the unit can quickly assess a patient. It has point of care blood testing with rapid results and X-ray facilities so the unit can guarantee speedy diagnosis.

The EMU has five hospital beds available for patients who may need to be kept in for a maximum 72 hours. A "hospital at home" nursing team is also available to provide support to patients who are sent home to recover.

"I would say that the EMU is more than just a casualty for older frail patients – it's more intensive because we aim to provide care for the episode at the time or for a number of days," says Dr Daniel Lasserson, a GP and senior clinical researcher at the department of primary care health sciences, University of Oxford, who helped design this new model of care.

Lasserson adds: "Its aims to deliver an acute care pathway for frail older patients that does not rely on bed-based care, yet can still provide appropriate medical, nursing and therapist treatments within an individually tailored care plan as close to the patient's home as possible.

"It was designed to challenge the existing urgent care pathway of admission to an acute hospital with its associated harms of unfamiliar and physically challenging environment and loss of independence."

The EMU, he says, addresses the dilemmas of how to best care for a growing elderly population with complex needs and multiple chronic conditions and to provide an alternative to "office hours" general practice or acute hospital bed-based care.

According to the EMU audit, 65% of patients who are assessed by the unit are able to stay in their own home – only 17% of patients need acute hospital care.

Lasserson says this new way of working, known as "interface medicine", is challenging the traditional medical training and care. Oxford has created an Interface Medicines Fellowship and is in discussions with Health Education England about how it can be developed nationally.

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National blood service, Oxford University hospitals NHS trust: technology innovation award runner-up

Oxford University hospitals NHS trust uses handheld computers at the bedside to scan the identity barcode on a patient's wrist band.

Introducing an identity barcode on a patient's wrist band, using handheld computers at the bedside, electronically controlling the temperature of blood fridges and tracking stock have improved patient safety Oxford University hospitals NHS trust's national blood trust and saved £528,000.

The trust wanted to reorganise its bedside and laboratory transfusion service in order to reduce the number of deaths from "wrong transfusion" – the second most frequent cause of death from transfusion reported to the UK's serious hazards transfusions scheme. In the past 15 years, errors in the UK transfusion service were responsible for 27 deaths and 120 cases of major morbidity.

Oxford hoped that by using technology it would also reduce the amount of time staff spent checking blood, reduce blood wastage and the inappropriate use of supplies, as well as speed up the supply of blood in emergencies.

Consultant haematologist professor Michael Murphy says: "For many members of the public or patients to think a process that is so important is relying on bits of paper and people looking at long numbers, is just unbelievable."

Today transfusion patients are identified by a barcode on their wrist band, which is scanned by a nurse at the bedside using a handheld computer. The nurse also scans his or her own barcode before following the transfusion process written on the computer screen.

There is now a complete electronic audit trail of blood supplies after the blood bank IT system was linked to others in the trust, which has led to significant improvements in blood sample collection, the collection of supplies from fridges and the transfusion-related admin.

Paperwork has been cut by 52 minutes per patient and the bedside transfusion process now requires one nurse instead of two. The initiative is recognised as an exemplar NHS evidence, quality, innovation, prevention and productivity project. The Oxford team wrote a national specification for the electronic transfusion service for the former National Patient Safety Agency.

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Moorfields eye hospital: service delivery innovation award runner-up

Nurses at Moorfields administer a third of all eye injections. Photograph: Moorfields eye hospital

Nurses at Moorfields eye hospital NHS foundation trust in London have been trained to give eye injections to patients in a groundbreaking move, which is changing professional practice and benefiting patients.

The hospital decided to teach senior nurses how to administer the drug Lucentis as an injection in the eye because of increased patient demand, following new national clinical guidelines and a lack of ophthalmologists to carry out the procedure. New guidelines from the National Institute for Health and Care Excellence (Nice) recommended that Lucentis should be injected into the eye to treat patients with diabetic maculopathy.

The decision put more pressure on the hospital because its doctors were already busy administering 10,000 Lucentis eye injections every year to patients with the wet form of age-related macular degeneration.

Moorfields decided to train its senior nurse to give the eye injections, even though it was opposed by the Royal College of Ophthalmologists because Lucentis is only licensed in the UK to be administered by a doctor.

Hospital lawyers were consulted and a special patient consent form was drawn up. The NHS Litigation Authority also guaranteed the nurses the various liability cover they needed.

So far, 15 Moorfields nurses have given 3,000 eye injections, representing 33% of the hospital's eye injection workload. Moorfields has also been able to run 15 extra eye injection sessions a week because of the new skills mix.

Moorfields fellow Joanna DaCosta says: "This model of working is instrumental in removing professional barriers, increasing job satisfaction and providing a cost effective healthcare system."

The success of the initiative is illustrated by the decision in May taken by the Royal College of Ophthalmologists to issue new guidelines that non-medically trained professionals can administer eye injections, provided they have appropriate training and supervision.

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Strike out bureaucracy: barriers to choice in public service delivery

From GP appointments to school timetables, more flexible systems will give people more choices Photograph: Custom Medical Stock Photo / Ala/Alamy

At the start of this year, I finished my work for the UK government as an independent reviewer on barriers to choice.

Someone from outside government was needed to look dispassionately at the way people were using their choices in public services and decide what barriers there were to prevent them.

I listened to a dizzying number of roundtables and must have spoken to well over a 100 service users face to face, and almost as many professionals.

But one person in particular stands out. She had muscular dystrophy and had to see her consultant every six months, which meant a two-hour round trip plus 30 minutes or more in the waiting room. It meant going over a large river and paying a toll. And all she said to the doctor when he asked her how she she felt was: 'I'm fine'.

What this woman really wants is to check in occasionally by phone, and see him when she's not fine. But she can't, because his slots are full seeing people who are also fine.

What struck me most forcibly was that she was asking for something quite simple, though important to her as a long-term patient. It was a 'choice' about her treatment, in a sense, but not one that is recognised currently by the system in the UK.

The new emphasis would be less about choosing between regulated options, and more about making services flexible enough to suit individuals better – closer to the 'personalisation' agenda in social care, where service users can get budgets they can (theoretically, at least) use in ways they believe are best suited to their needs.

The best approach may be to find ways to give service users the confidence to ask for something different, and perhaps provide duties on service providers to consider this. I imagine this would be like a 'right to request' flexible service delivery.

In each case, the provider would not be obliged to provide flexibility if it is impossible, but they would be obliged to explain why and make that explanation public.

This would help people cut through systems or bureaucratic arrangements. Perhaps they want a consultant who won't mind them asking lots of questions, or to study Spanish at A-level when all that prevents them is their school's time-tabling system, or to go to bed later than 5pm when their carer comes round. 

This is basic flexibility which articulate people can often get now by being assertive, but which others can't.

There are possible objections to this kind of approach. Patients may choose badly. They may fail to take responsibility for the wider system, by misusing the flexibility they are offered.

There may also be higher costs from treating people more individually, and the costs will come before the potential savings are available. Financial innovations that tie professionals too closely to narrow numerical outcomes, like the current experiments with payment by results, may also make flexibility more difficult to achieve.

More flexibility would require up-front investment and mean fewer set systems, but more human connection.

David Boyle is the author of The Human Element: Ten new rules to kickstart our failing organisations (Earthscan) and a range of other books. This article is based on a piece commissioned by the British Council for its Equality Exchange forum on public services

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View the original article here

Strike out bureaucracy: barriers to choice in public service delivery

From GP appointments to school timetables, more flexible systems will give people more choices Photograph: Custom Medical Stock Photo / Ala/Alamy

At the start of this year, I finished my work for the UK government as an independent reviewer on barriers to choice.

Someone from outside government was needed to look dispassionately at the way people were using their choices in public services and decide what barriers there were to prevent them.

I listened to a dizzying number of roundtables and must have spoken to well over a 100 service users face to face, and almost as many professionals.

But one person in particular stands out. She had muscular dystrophy and had to see her consultant every six months, which meant a two-hour round trip plus 30 minutes or more in the waiting room. It meant going over a large river and paying a toll. And all she said to the doctor when he asked her how she she felt was: 'I'm fine'.

What this woman really wants is to check in occasionally by phone, and see him when she's not fine. But she can't, because his slots are full seeing people who are also fine.

What struck me most forcibly was that she was asking for something quite simple, though important to her as a long-term patient. It was a 'choice' about her treatment, in a sense, but not one that is recognised currently by the system in the UK.

The new emphasis would be less about choosing between regulated options, and more about making services flexible enough to suit individuals better – closer to the 'personalisation' agenda in social care, where service users can get budgets they can (theoretically, at least) use in ways they believe are best suited to their needs.

The best approach may be to find ways to give service users the confidence to ask for something different, and perhaps provide duties on service providers to consider this. I imagine this would be like a 'right to request' flexible service delivery.

In each case, the provider would not be obliged to provide flexibility if it is impossible, but they would be obliged to explain why and make that explanation public.

This would help people cut through systems or bureaucratic arrangements. Perhaps they want a consultant who won't mind them asking lots of questions, or to study Spanish at A-level when all that prevents them is their school's time-tabling system, or to go to bed later than 5pm when their carer comes round. 

This is basic flexibility which articulate people can often get now by being assertive, but which others can't.

There are possible objections to this kind of approach. Patients may choose badly. They may fail to take responsibility for the wider system, by misusing the flexibility they are offered.

There may also be higher costs from treating people more individually, and the costs will come before the potential savings are available. Financial innovations that tie professionals too closely to narrow numerical outcomes, like the current experiments with payment by results, may also make flexibility more difficult to achieve.

More flexibility would require up-front investment and mean fewer set systems, but more human connection.

David Boyle is the author of The Human Element: Ten new rules to kickstart our failing organisations (Earthscan) and a range of other books. This article is based on a piece commissioned by the British Council for its Equality Exchange forum on public services

• Want your say? Email us at public.leaders@guardian.com.

To get our articles on policy and leadership direct to your inbox, sign up to the Guardian Public Leaders Network now.

Looking for your next role? See our Guardian jobs site for senior executive jobs in government and politics.

• For the latest on public services leadership, follow us: @publicleaders

View the original article here

Strike out bureaucracy: barriers to choice in public service delivery

From GP appointments to school timetables, more flexible systems will give people more choices Photograph: Custom Medical Stock Photo / Ala/Alamy

At the start of this year, I finished my work for the UK government as an independent reviewer on barriers to choice.

Someone from outside government was needed to look dispassionately at the way people were using their choices in public services and decide what barriers there were to prevent them.

I listened to a dizzying number of roundtables and must have spoken to well over a 100 service users face to face, and almost as many professionals.

But one person in particular stands out. She had muscular dystrophy and had to see her consultant every six months, which meant a two-hour round trip plus 30 minutes or more in the waiting room. It meant going over a large river and paying a toll. And all she said to the doctor when he asked her how she she felt was: 'I'm fine'.

What this woman really wants is to check in occasionally by phone, and see him when she's not fine. But she can't, because his slots are full seeing people who are also fine.

What struck me most forcibly was that she was asking for something quite simple, though important to her as a long-term patient. It was a 'choice' about her treatment, in a sense, but not one that is recognised currently by the system in the UK.

The new emphasis would be less about choosing between regulated options, and more about making services flexible enough to suit individuals better – closer to the 'personalisation' agenda in social care, where service users can get budgets they can (theoretically, at least) use in ways they believe are best suited to their needs.

The best approach may be to find ways to give service users the confidence to ask for something different, and perhaps provide duties on service providers to consider this. I imagine this would be like a 'right to request' flexible service delivery.

In each case, the provider would not be obliged to provide flexibility if it is impossible, but they would be obliged to explain why and make that explanation public.

This would help people cut through systems or bureaucratic arrangements. Perhaps they want a consultant who won't mind them asking lots of questions, or to study Spanish at A-level when all that prevents them is their school's time-tabling system, or to go to bed later than 5pm when their carer comes round. 

This is basic flexibility which articulate people can often get now by being assertive, but which others can't.

There are possible objections to this kind of approach. Patients may choose badly. They may fail to take responsibility for the wider system, by misusing the flexibility they are offered.

There may also be higher costs from treating people more individually, and the costs will come before the potential savings are available. Financial innovations that tie professionals too closely to narrow numerical outcomes, like the current experiments with payment by results, may also make flexibility more difficult to achieve.

More flexibility would require up-front investment and mean fewer set systems, but more human connection.

David Boyle is the author of The Human Element: Ten new rules to kickstart our failing organisations (Earthscan) and a range of other books. This article is based on a piece commissioned by the British Council for its Equality Exchange forum on public services

• Want your say? Email us at public.leaders@guardian.com.

To get our articles on policy and leadership direct to your inbox, sign up to the Guardian Public Leaders Network now.

Looking for your next role? See our Guardian jobs site for senior executive jobs in government and politics.

• For the latest on public services leadership, follow us: @publicleaders

View the original article here

Honoring the nation's Health Service Durability of Disabled People

In the past the nation's Health Services are the crown jewelry from the welfare condition within the United kingdom. Its achievements have grown to be the envy around the globe since its beginning in 1948. The institution has enhanced and maintained the lives and health of the united states and it is people. This really is regardless of sex, gender, ethnicity, age and disabilities. Healthcare continues to be free at the purpose of shipped. Yet, the services are taken care of with National Insurance Contributions through the working population within the United kingdom.

Despite its accomplishments and achievements, disabled people (learning and physical disabilities) weren't viewed as individuals with equal privileges in comparison to non-disabled people. These were stigmatised and known as different names like the "mongos, cripples, loonies and handicapped". Besides their castrations, these were secured in "lengthy stay hospitals" coupled with hardly any accessibility community. Their existence-expectancy was short, in most cases this based on medical professionals within the hospitals/houses who called it at 40-years-old, even though many didn't have the privilege to meet that age. Their demands were poorly handled plus they didn't have selection of the helpOrtreatment apart from accepting that which was available. Most were ill-treated as well as their outcry rose the problems of "Moral Integrity, Human Privileges and Equal Possibilities" for those.

The plights of disabled people touched the minds and hearts of some people from the parliament and clergymen/women within the United kingdom. The advocates for change used this chance and known as for that abolition from the guidelines and legislation that supported segregation. It was broadly based on many pressure groups who lobbied their constituency people of parliament in the home of Commons. The protagonists searched for for change and reforms from the National Health Service and also the wider welfare services. This received "A Royal" shield and also the birth from the "NHS and Community Care Act (1990). Since that time reforms haven't stopped but has acquired momentum.

Thus, 1990 could be appreciated by a lot of like a year of liberation for disabled people. Additionally, it marked the start of a guide for reforms within the wider welfare systems and normalisation of disabled individuals the broader community. Normalising the lives of disabled people as well as their assimilation locally has elevated the overall public's attitudes and behaviors towards disabled people of various classifications. The reforms make significant changes and enhancements within the lives of the client groups as broadly observed used as well as in the towns they live.

Reflecting around the attainments and realisations from the reforms, many disabled people now lives over 65-years-old and comparatively in good condition. Credits are because of the large number of support systems for example advances in medical sciences, assistive technology, logos of services (Direct Obligations, Cash for Care) and independent living. These have given immerse possibilities and lifestyle for that client groups as well as their care providers. For instance, they can now connect to the community using their personal assistants and socialise with non-disabled people.

Similarly, health insurance and social care professionals are actually well educated used to know and react to challenging behaviors in youngsters and grown ups with multiple pathology of disability. Every single day, we have seen individuals with disabilities for example autism and a focus deficit and they're expected to deal with their functional activities of everyday living inside a world, which could frequently appear bewildering and irrational. The majority of the client groups (severe or mild disabilities) may require one type of support or another therefore, it's imperative their support systems aren't interrupted so as not to confuse their retinue.

This could cause high amounts of panic and anxiety, leading to behaviors that may be difficult for some individuals to cope with. This might offer significant tests to experts who take part in the supply of your practice, health insurance and welfare services. Analyzing the initial tasks facing children and grown ups with disabilities, their conditions may exacerbate because they are ageing. This could tentatively present some problems to experts who support these to attend their holistic needs. Thus, support plan or individual programme plans (IPP) for disabled people require continuous monitoring and evaluation of the needs in addition to sufficient financial and human assets.

The present reforms within health insurance and social care industries are threaten a few of the accomplishments already designed to safeguard the wellness of numerous service customers. The risk is the fact that as individuals with learning disabilities for example are becoming older, they might face exactly the same mental and physical problems of ageing people. Most would want growing support to make sure they get old inside a society where their safety and dignity might be maintained. However, parents who're the primary care providers for his or her kids with learning disabilities or individuals with physical infirmities might find it harder to deal as they age. A lot more than frequently, brothers and sisters along with other relatives taking about this role find it difficult to learn more they require simply because they haven't been a part of care giving.

Consequently, older persons with disabilities who don't have relatives risk the next of growing isolation hence social work has transformed of looking after management approach. They've little possibilities to rapport with service customers as it was once previously. They are accountable for care commission while service customers need to source and appoint their own individual assistants and this may be a problem for a lot of. Thus, the un-answered questions inside the current welfare systems are who'll safeguard the interests from the vulnerable if their parents are no more in a position to? Would the neighborhood authorities' social services departments perform dual roles of commissioning and care delivery therefore, what's the legal and financial implications for government bodies?

In anticipation, grown ups with profound, moderate or severe behaviors who're living individually using their personal assistants might find it difficult within the lengthy-run when they're aged. You will find still many potential issues around choice and control, controlling their personal budgets and finances in addition to maintaining safety and health around them. It's been observed used that supported or aided housing isn't necessarily right for older grown ups with disabilities, who may need help with activities for instance, mounting stairs or getting intoOrfrom the bath in addition to planning foods along with other domestic chores. On the other hand, generic houses for that seniors might not have assets or perhaps be appropriate for that specific needs of individuals with challenging behaviors.

Durability of disabled people must be celebrated because of the NHS and community care reforms and continuous re-organisations of the profession.

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