PhysioUpdate 26th October 2021

Some patients' home situation was disregarded as NHS hospitals discharged them, CQC survey finds

One person in five (21 per cent) who took part in a national survey last year said their family or home situation was not taken into account when NHS staff planned their discharge, a Care Quality Commission (CQC) survey has found.

The finding is one of many appearing in a report on the latest national survey of hospital inpatients in England that was published by the CQC today (19 October).

Some people did not know who to contact if their condition caused concern after discharge (stock image)

The CQC voices concern that three in 10 respondents (30 per cent) were not given any written information about what they should – or should not do – after leaving hospital.

On a brighter note, most respondents (75 per cent) gave a rating of eight (or even higher) when asked about their overall experience – with more than a third of people giving a rating of 10 out of 10.

More than 73,000 people who stayed in one of the 137 acute and specialist NHS trusts in England for at least one night during November last year took part in the survey.

Most respondents said they had confidence in the staff treating them, and said their questions received clear responses. The cleanliness of hospital wards and room was generally appreciated but respondents were less pleased about the information provided they were given at the point of discharge – particularly in relation to medication and how to manage their condition or access further support once home.

Younger people and Black and minority ethnic groups' representation improves

The adult inpatient survey has been conducted annually since 2002 and in 2020 respondents were able to complete questionnaire online as well as by post for the first time. This innovation may have increased response rates from younger people (under 35) and those from Black and minority ethnic groups – both underrepresented groups in previous years.

Most respondents (85 per cent) said they had ‘always’ been treated with dignity and respect during their hospital stay. This was the case for those who had Covid-19 and those who did not (84 and 85 per cent respectively).

A minority of respondents (13 per cent) said that they had been asked to give their views on the quality of care received during their stay – with those with Covid-19 being less likely to say they had been asked to provide feedback.

Lack of support at home

Almost a third (30 per cent) of respondents said they were not given any written information about what they should or should not do after leaving hospital.

About a quarter of respondents (24 per cent) said they were not told whom to contact if they were worried about their condition or treatment after leaving hospital. A similar proportion (21 per cent) said they did not get enough support to help them recover or manage their condition once they were back at home.

As well its report on the national findings, the CQC also published the results for each of the 137 individual trusts that took part, and issued a report identifying those trusts that have performed better or worse across the survey overall.

'Tremendous effort' of staff lauded

The high levels of satisfaction reported by so many people reflect the tremendous efforts of healthcare professionals on the front line and their dedication and resilience is to be commended [Ted Baker, CQC]

Ted Baker, the CQC’s chief inspector of hospitals pointed out that the survey was undertaken at a time when a second wave of Covid infections began to take hold. 'Given this context and the unprecedented pressure on staff it is excellent to see such positive feedback in a number of areas.'

Professor Baker added: ‘The high levels of satisfaction reported by so many people reflect the tremendous efforts of healthcare professionals on the front line and their dedication and resilience is to be commended.

‘Patient feedback is incredibly important in helping shape how care is delivered and the survey results provide an incredibly useful guide to where improvements can be made.’

NHS leaders 'should be proud'

Matthew Taylor, chief executive of the NHS Confederation, said: ‘We owe a great deal of gratitude to the NHS after everything it has done for patients over the last 18 months, particularly as its workforce could come up against similar challenges again this year as cases of coronavirus continue to rise, alongside the threat of flu, increased demand for mental health services, and tackling the elective care backlog.

‘Health leaders and their teams should be very proud of the results and where improvements have been identified, they will be committed to examining their individual scores in detail.’

For more information, visit: https://www.cqc.org.uk/publications/surveys/adult-inpatient-survey-2020

Improving older people's diets in care settings led to fewer falls and fractures, study shows

Supplementing the diets of older people with items such milk, yoghurt, and cheese helped to reduce the number of falls and fractures occurring in a number of care settings, according to a study published in the latest edition of The BMJ.

The finding is important because, as the paper notes, almost one third (30 per cent) of hip fractures are estimated to occur among older adults in care settings. Those in such settings often have low intakes of calcium and protein – a factor linked to weak bones and an increased risk of falls and fractures.

The findings could also have implications for the 'wider community', the team suggests.

Boosting people's intake of dairy products had an important knock-on effect

Randomised control trial

A research team led by Sandra Iuliano, a senior research fellow at the departments of medicine and endocrinology, Austin Health, University of Melbourne, conducted a two-year trial among more than 7,000 residents (72 per cent of them women; average age 86) in 60 Australian care facilities.

The study is something of a rarity, in that it examines whether obtaining certain nutrients from foods – rather than supplements – is safe and effective. The researchers say their approach has ‘widespread implications as a public health measure for fracture prevention’.

An earlier study, cited in the paper, showed that giving pharmacological doses of calcium and vitamin D to women living in nursing homes – and who had histories of low calcium intakes and vitamin D deficiency – cut the rate of hip fractures.

International team

Dr Iuliano and her colleagues, some of whom were based in the Netherlands and the US, examined whether ensuring residents’ diets included daily intakes of calcium (1,300 mg) and protein (1 g/kg body weight) from food sources would reduce the risk of fragility fractures and falls.

The residents' original diets were replete in vitamin D, but their daily calcium and protein intakes were below recommended levels.

In the randomised control trial, 30 facilities provided residents with additional milk, yoghurt, and cheese – achieving intakes of 1,142 mg calcium/day and 1.1 g protein/kg body weight/day. The remaining 30 control facilities continued with their usual menu: 700 mg/day calcium and 0.9 g protein/kg body weight/day).

Data from 27 intervention facilities and 29 control facilities revealed that a total of 324 fractures (135 hip fractures), 4,302 falls and 1,974 deaths occurred during the study period.

The intervention was associated with risk reductions of:

33 per cent for all fractures (121 compared to 203)
46 per cent for hip fractures (42 compared to 93)
11 per cent for falls (1,879 compared to 2,423)

'Widespread implications'

This nutritional intervention has widespread implications as a public health measure for fracture prevention in the aged care setting and potentially in the wider community [Sandra Iuliano et al.]

An analysis showed that there were no group differences in mortality from all causes, and that the relative risk reduction for fractures was similar to that found in trials using potent drug therapy to increase bone strength in people with osteoporosis.

Acknowledging that their study has certain limitations, the researchers note that using dairy foods to improve calcium and protein intakes is a ‘readily accessible intervention that reduces risk of falls and fractures commonly occurring in institutionalised older adults’.

They add: 'This nutritional intervention has widespread implications as a public health measure for fracture prevention in the aged care setting and potentially in the wider community.'

To see the full version of the article, titled Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial, visit: https://www.bmj.com/content/375/bmj.n2364

Respiratory physiotherapist Pamela Vaughn is a finalist in the 2021 Scottish Health Awards

The 'incredible resolve and flexibility' of staff since the onset of the pandemic has won praise

Glasgow-based physiotherapist Pamela Vaughn has been named as one of the finalists vying to win the allied health professional (AHP) category in the 2021 Scottish Health Awards.

Pamela, an advanced respiratory physiotherapist with NHS Greater Glasgow and Clyde, was named as one of three finalists in a Daily Record article published earlier this week (16 October).

The newspaper is running the prestigious awards with the Scottish Government and NHS Scotland. The AHP category is one of 16 featured in the Scottish Health Awards, the final of which is scheduled to take place at the O2 Academy in Edinburgh on 4 November.

Collaboration is 'key'

On hearing the news, Pamela told PhysioUpdate: 'I am honoured and so grateful to have been nominated for this award. I feel very lucky to have had the support and opportunities to work in an incredible profession that allows me to feel a valued part of a wider team. Healthcare is a real team effort with the success of patient care rarely being down to solo efforts, but the combined and collaborative efforts of many.'

Pamela added: 'This has never been so important as during the pandemic and the last 18 months have seen us pull together like never before. I have never felt prouder of the work we do for our patients.'

Pamela and her colleague Lorraine Wishart helped to develop a pioneering digital resource for patients that features in an item appearing on NHS Greater Glasgow and Clyde’s website

She said: ‘Bronchiectasis is a condition which can be difficult for patients to understand and manage. These videos make it much easier for patients to visualise it, and more importantly, to manage it.

‘We find utilising videos to engage with patients is a valuable tool to empower people to manage their condition from the comfort of their homes and within their communities.

Pamela added: 'Delivering person-centred care is at the heart of every decision we take and the new resource plays well into to this approach. Feedback from patients so far has been overwhelmingly positive and we’ll certainly be exploring other ways to develop videos for other conditions which help us continue to deliver safe and effective care to patients.’

For more information, visit: https://www.nhsggc.org.uk/your-health/health-services/respiratory-services/respiratory-resources-bronchiectasis

The other two finalists in the AHP category are occupational therapist Gemma O’Neil, from NHS Ayrshire & Arran, and Jane Allison, a podiatrist with NHS Borders.

A statement on the awards’ website praises the ‘incredible resolve and flexibility’ that health and social care staff have displayed since the onset of the Covid-19 pandemic in March 2020.

It adds: ‘The NHS was put on an emergency footing – maintaining urgent care, flexing capacity from paused services to meet demand and developing innovative ways of working.’

The 16 categories are as follows

• Allied Health Professional Award

• Support Worker Award

• Innovation Award

• Volunteers Award

• Midwife Award

• Young Achiever Award

• Unsung Hero Award

• Care for Mental Health Award

• Integrated Care Award

• Tackling Health Inequalities Award

• Leader of the Year Award