Government response to ACMD Report Commissioning impact on drug treatment services – Department of Health and Social Care

Details the government’s response to ACMD’s report on commissioning structures within treatment service.

Government response to ACMD Report Commissioning impact on drug treatment services
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Commissioning impact on drug treatment: The extent to which commissioning structures, the financial environment and wider changes to health and social welfare impact on drug misuse treatment and recovery – Advisory Council on the Misuse of Drugs

Report from the Advisory Council on the Misuse of Drugs that finds that drug and alcohol treatment appears to be facing a disproportionate decrease in resources, likely to reduce treatment penetration and the quality of treatment in England. This situation is compounded by frequent re-procurement of services that is using vital resources, creating unnecessary ‘churn’ and disruption and resulting in poorer recovery outcomes – at least in the short term. In this complex and changing context it is difficult to see how the levels of substance misuse (particularly drug treatment) coverage and quality will be maintained without significant effort to protect investment and quality.

Commissioning impact on drug treatment: The extent to which commissioning structures, the financial environment and wider changes to health and social welfare impact on drug misuse treatment and recovery
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Safeguarding Adults Review: Mendip House – Somerset Safeguarding Adults Board

Report identifying critical learning arising from practices which did not identify or act on evidence of bullying at Mendip House, a dwelling for six adults with autism with a staff team of 26 (excluding those on zero hours contracts). Mendip House
was one of seven separately registered dwellings based at the National Autistic Society’s Somerset Court campus comprising 26 acres of land. There are also outreach and day service facilities at the campus. Mendip House was closed on 31 October 2016.

Safeguarding Adults Review: Mendip House
Safeguarding Adults Review: Mendip House
20180206_Mendip-House_SAR_FOR_PUBLICATION.pdf
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Guidance on menopause and the workplace – Faculty of Occupational Medicine of the Royal College of Physicians

Offers employers practical guidance on how to improve workplace environments for women undergoing the menopause and latest information on how menopause affects some women at work.  It is also aimed at women who are experiencing the menopause for information.
Guidance on menopause and the workplace
Guidance on menopause and the workplace
Guidance-on-menopause-and-the-workplace-v6.pdf
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Report of the Task and Finish Working Group on Brain Tumour Research – Task and Finish Working Group on Brain Tumour Research

Report that identifies that additional research is needed and funders stand ready to invest more in brain tumour research.  It finds:

  • An effective way of growing research capacity and capability at all career stages, including senior research leadership, is to establish dedicated brain tumour research centres
  • Calls on funders to state explicitly to the research community that research applications in this area are particularly welcome.
  • Identified that current sample collections are not optimal, in terms of their size and nature, for the latest research needs.
  • While the UK has great strengths in neuroscience research, the current link-up to the brain tumour agenda is limited.
  • Identifies that certain drugs that have been developed for indications other than brain tumours but may have some effectiveness against brain tumours. There are a range of issues in developing such ‘repurposing’ of drugs.
  • A top 10 of research priorities established through extensive consultation with the research community should be embraced by researchers and research funders.
  • Dedicated training for doctors involved in the diagnosis and treatment of brain tumours needs to exist and in addition time is provided in consultant posts to allow research to be undertaken.
  • Recognises that more co-ordination and co-operation within the research community is essential to accelerate progress in brain tumour research.
  • People with brain tumours have made it clear that they want their health data to be used for research to accelerate the development of new treatments. Regulators should respect the wishes of patients for their data to be used in research. NHS Trusts and arms-length bodies should collaborate with medical research charities to enable them to meet the
    wishes of patient groups whom they represent in issues related to wider access to data.
Report of the Task and Finish Working Group on Brain Tumour Research
Report of the Task and Finish Working Group on Brain Tumour Research
Brain_tumour_research_-_task_and_finish_working_group_report.pdf
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Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C: Technology appraisal guidance [TA507] – NICE

Evidence-based recommendations on sofosbuvir–velpatasvir–voxilaprevir (Vosevi) for treating chronic hepatitis C in adults.

Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C: Technology appraisal guidance [TA507]
Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C: Technology appraisal guidance [TA507]
sofosbuvirvelpatasvirvoxilaprevir-for-treating-chronic-hepatitis-c-pdf-82606724580805.pdf
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Poverty in Northern Ireland 2018: Briefing – Joseph Rowntree Foundation

Joseph Rowntree Foundation briefing on poverty in Northern Ireland it finds:

  • Poverty in Northern Ireland is slightly lower than in England or Wales, but it is higher than in Scotland.
  • Poverty among pensioners has fallen considerably over the last decade. Families with children have seen steady or falling poverty rates, but working-age adults without children are now at higher risk of poverty than 10 years ago.
  • Higher worklessness and lower employment than elsewhere, and the proportion of people in poverty in workless households has increased slightly over time, in contrast with the UK as a whole.
  • Suggests that the employment rate continues to be a major factor affecting poverty rates in Northern Ireland, and that raising the employment rate could lead to falls in poverty.
  • The gap in educational attainment among richer and poorer children has narrowed slightly but remains very large.
  • More people with no qualifications and fewer people with higher level qualifications are found in Northern Ireland than in the rest of the UK.
  • One in 10 households in the poorest fifth in Northern Ireland are facing problem debt.
  • Nearly two thirds of people in the poorest fifth are not paying into a pension, increasing their risk of future poverty.
Poverty in Northern Ireland 2018: Briefing
Poverty in Northern Ireland 2018: Briefing
02_poverty_in_ni_briefing.pdf
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Home from home?: A case study of first year settlement experiences of EU nurses working in one NHS Trust – University of Wolverhampton Faculty of Education, Health and Wellbeing

Report that finds that EU nurses are initially unable to use their advanced skills and unprepared for the social environment in the UK. It calls for the scope of their practice and anticipated duties to be made transparently clear to them. Induction programmes should be ‘bite sized’ and supported by English classes. There isa suggestion that retention could be improved by early access to allow this group of nurses to re-engage with their advanced skills. The study also identifies and need to prepare the wards that they are due to work on in terms of the details of the skills that this group of nurses can bring to bear.

Home from home?: A case study of first year settlement experiences of EU nurses working in one NHS Trust
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Mapping of specialist primary health care services in England for people who are homeless – King’s College London Social Care Workforce Research Unit and The Policy Institute at King’s

Findings of a systematic mapping exercise across England of specialist primary health care services for single people who are homeless. The mapping exercise was part of a larger study that is in progress which is examining the integration, effectiveness and cost-effectiveness of different models of delivering primary health care to people who are homeless (HEARTH study).

Mapping of specialist primary health care services in England for people who are homeless
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Supporting older people with hearing loss in care settings: A guide for managers and staff – Action on Hearing Loss

Action on Hearing Loss guide to help staff working in longer-term care settings provide high-quality care and support to older people with hearing loss. It is written for care home managers, and the accompanying information sheets are for both managers and their staff. The guide uses the term ‘care home’ to cover all types of care settings for older people, including nursing, residential, dementia and extra care.

Supporting older people with hearing loss in care settings: A guide for managers and staff
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Heavy menstrual bleeding: assessment and management: Clinical guideline [CG44] – NICE

Updated clinical guideline from 2007 covers assessing and treating heavy menstrual bleeding. It aims to help healthcare professionals offer the right treatments to women with heavy periods (menorrhagia) that affect their quality of life, taking into account the woman’s individual preferences.  it is updated in the light of the EMA review of ulipristal acetate (Esmya) and temporary safety measures.

In February 2018, the European Medicines Agency (EMA) introduced a number of temporary safety measures as part of an ongoing review of ulipristal acetate (Esmya) for uterine fibroids. Further information is available from the EMA website. The temporary safety measures are:

  • Do not start new treatment courses of Esmya, including in women who have completed 1 or more treatment courses previously.
  • Perform liver function tests at least once a month in all women currently taking Esmya. Stop Esmya treatment in any woman who develops transaminase levels more than 2 times the upper limit of normal, closely monitor and refer for specialist hepatology evaluation as clinically indicated. Liver function tests should be repeated in all women 2 to 4 weeks after stopping treatment.
  • Check transaminase levels immediately in current or recent users of Esmya who present with signs or symptoms suggestive of liver injury (such as nausea, vomiting, malaise, right hypochondrial pain, anorexia, asthenia, jaundice). If transaminase levels are more than 2 times the upper limit of normal, stop treatment, closely monitor and refer for specialist hepatology evaluation as clinically indicated.
  • Advise women using Esmya on the signs and symptoms of liver injury.

NICE will review its guidance on heavy menstrual bleeding when the EMA review has concluded. In the meantime, the guidance must be read in conjunction with the temporary safety measures above.

Heavy menstrual bleeding: assessment and management: Clinical guideline [CG44]
Heavy menstrual bleeding: assessment and management: Clinical guideline [CG44]
heavy-menstrual-bleeding-assessment-and-management-pdf-975447024325.pdf
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PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites: Medical technologies guidance [MTG9] – NICE

Updated evidence-based recommendations on PleurX for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites.

This guidance has been updated to include a review of the cost model using more recent values. New evidence and updated costs identified during the guidance review are denoted as [2018].

NICE has developed tools, in association with relevant stakeholders, to help organisations put this guidance into practice.

PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites: Medical technologies guidance [MTG9
PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites: Medical technologies guidance [MTG9
pleurx-peritoneal-catheter-drainage-system-for-vacuumassisted-drainage-of-treatmentresistant-recurrent-malignant-ascites-pdf-1788120827845.pdf
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MiraQ for assessing graft flow during coronary artery bypass graft surgery: Medical technologies guidance [MTG8] – NICE

Evidence-based recommendations on MiraQ for assessing graft flow during coronary artery bypass graft surgery.

Having originally been developed to make recommendations on the use of VeriQ, this guidance has been updated to make recommendations on the use of a follow-on technology, MeriQ. The recommendations, committee considerations and evidence for VeriQ apply to the new technology. The technology name has been changed where relevant from VeriQ to MiraQ. New evidence and updated costs identified during the guidance review are denoted as [2018].

MiraQ for assessing graft flow during coronary artery bypass graft surgery: Medical technologies guidance [MTG8]
MiraQ for assessing graft flow during coronary artery bypass graft surgery: Medical technologies guidance [MTG8]
miraq-for-assessing-graft-flow-during-coronary-artery-bypass-graft-surgery-pdf-1788119148229.pdf
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Aortic valve reconstruction with processed bovine pericardium: Interventional procedures guidance [IPG604] – NICE

Evidence-based recommendations on aortic valve reconstruction with processed bovine pericardium. This involves replacing a damaged aortic valve with a new valve made from chemically treated cow pericardium.

Aortic valve reconstruction with processed bovine pericardium: Interventional procedures guidance [IPG604]
Aortic valve reconstruction with processed bovine pericardium: Interventional procedures guidance [IPG604]
aortic-valve-reconstruction-with-processed-bovine-pericardium-pdf-1899873861710533.pdf
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Reveal LINQ insertable cardiac monitor to detect atrial fibrillation after cryptogenic stroke: Medtech innovation briefing [MIB141] – NICE

The technology described in this briefing is Reveal LINQ insertable cardiac monitor (ICM) with CareLink service for detecting suspected asymptomatic atrial fibrillation (AF) after cryptogenic stroke.

  • The innovative aspects are: a proprietary AF detection algorithm, which is designed to reduce false positive detections; small device size, which allows insertion outside a catheterisation lab; and memory capacity offering sufficient recording time to establish symptom–rhythm correlations.
  • The intended placein therapy is in addition to standard care for patients after cryptogenic stroke whose AF remains undiagnosed by standard stroke care. It could also be used to replace repeated longer-term external cardiac monitoring.
  • The main points from the evidence summarised in this briefing are from 5 studies (1 randomised controlled trial [RCT] and 4 observational studies) including 1,821 adults who have had cryptogenic stroke. The observational studies show that Reveal devices can detect AF and the RCT shows a significantly higher rate of AF detection and subsequent treatment compared with conventional electrocardiogram (ECG) monitoring.
  • Key uncertainties around the evidence are a lack of studies comparing Reveal LINQ with standard care and whether evidence generated using the predecessor device is generalisable to the current technology.
  • The cost of Reveal LINQ with MyCareLink patient monitor is £1,800 per unit (excluding VAT). The resource impact will be greater than standard care because of the device cost and adopting the device would require redesign of current pathways for cryptogenic stroke. These additional costs could be offset from using a less resource-intensive setting for device implantation compared with other continuous ECG monitors, and from the remote monitoring function. In addition, an increased rate of AF detection leading to effective treatment and a reduction in stroke risk would be expected to result in downstream savings.
Reveal LINQ insertable cardiac monitor to detect atrial fibrillation after cryptogenic stroke: Medtech innovation briefing [MIB141
Reveal LINQ insertable cardiac monitor to detect atrial fibrillation after cryptogenic stroke: Medtech innovation briefing [MIB141
reveal-linq-insertable-cardiac-monitor-to-detect-atrial-fibrillation-after-cryptogenic-stroke-pdf-2285963451125701.pdf
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Coban 2 for venous leg ulcers: Medtech innovation briefing [MIB140] – NICE

Medical innovation bulletin on Coban 2 compression bandage for venous leg ulcers.

  • The innovative aspect is that it is thinner than 4‑layer bandages. This aims to improve mobility and convenience.
  • The intended place in therapy would be as an alternative to current compression bandages in selected people with venous leg ulcers.
  • The main points from the evidence summarised in this briefing are from 3 studies (2 in UK, 1 in Italy; comprising 2 randomised controlled trials [RCTs] and 1 observational study) including a total of 1,456 adults with venous leg ulcers. The evidence is limited in quantity and quality. One randomised study showed that Coban 2 slipped significantly less than 4‑layer bandages. The studies showed Coban 2 is as effective for wound healing as other compression bandages.
  • Key uncertainties around the evidence or technology are that there are no studies showing better wound healing than 4‑layer bandages.
  • The cost of Coban 2 is £8.24 per unit (excluding VAT). The resource impact would likely be similar to standard care (£4 to £15 depending on size of bandage).
Coban 2 for venous leg ulcers: Medtech innovation briefing [MIB140]
Coban 2 for venous leg ulcers: Medtech innovation briefing [MIB140]
coban-2-for-venous-leg-ulcers-pdf-2285963449446085.pdf
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Sexual health, reproductive health and HIV in England: A guide to local and national data (Revised December 2017) – Public Health England

Updated guidance to help health professionals including local government, service providers and commissioners understand the sexual health data that is available across England and how the data can be accessed. It includes data collected by Public Health England and other organisations.

Sexual health, reproductive health and HIV in England: A guide to local and national data (Revised December 2017)
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A guide to support maternity safety champions – NHS Improvement

This guide for champions at the frontline, trust board and regional levels outlines broad role descriptions and responsibilities, and suggests activities to promote best practice – recognising that these will develop. It also signposts existing safety initiatives and improvements that can offer support.

A guide to support maternity safety champions
A guide to support maternity safety champions
Maternity_safety_champions_13feb.pdf
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Social care: care home market – structure, issues, and cross-subsidisation (England): (Briefing Paper Number 8003) – House of Commons Library

This House of Commons Library briefing paper considers the current structure of the care home market in England, as well as issues facing the sector and how private clients (“selffunders”) tend to pay more than local authority funded residents (known as “crosssubsidisation”).

Social care: care home market – structure, issues, and cross-subsidisation (England): (Briefing Paper Number 8003)
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Fit and proper persons regulations in the NHS: What do providers need to know? – NHS Providers

Briefing from NHS Providers detailing practical suggestions for how trusts can ensure their policies and procedures comply with the fit and proper persons regulations (FPPR), as well as meet the expectations of the Care Quality Commission’s regulatory approach. It also highlights what trusts should take into account when considering whether to undertake an investigation into FPPR concerns raised about a director, and what they should be mindful of at each stage of the process.

Fit and proper persons regulations in the NHS: What do providers need to know?
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