Category Archives: Hot topics

Adult social care: quality matters

A Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

Library and Knowledge Services already make an important contribution to safe, high-quality care in the NHS. However, an absence of funding currently prevents library services extending their service and knowledge resources to most social care staff, and the number of providers in the social care sector make it difficult to negotiate service level agreements at a local level. This may change in areas where accountable care organisations are created, bringing health and social care together.

Commissioners of social care in local authorities could be approached to discuss the potential contribution of LKS to quality in the social care sector, and see if any SLAs can be created. This may be something that should be done at a national level, to avoid duplication of effort and ensure equitable funding and access.

Source: Department of Health and Care Quality Commission

Link to main document

Publication format: Webpage, with links to the main document and action plan

Date of publication: July 2017

Summary of driver:

The Quality Matters initiative is co-led by partners from across the adult social care sector, and this document sets out the agreed principles that support high-quality, person centred adult social care. The principles reflect those of the NHS National Quality Board.

There is no change to statutory responsibilities.

Key features of driver:

  • There are around 12,000 adult social-care providers in the UK
  • They provide care in around 25,000 different locations – excluding people’s homes
  • The sector contributes around £20bn to the economy
  • It enables families of people being cared for to continue working
  • It employs about 1.43m people doing 1.55m jobs
  • Challenges include:
    • Rising needs from an ageing population with increasingly complex conditions
    • Rising costs to providers of adult social care
    • Restricted public funds
    • Challenges in recruiting and retaining good-quality staff
  • Quality can vary – some is unacceptable and unreliable
  • Quality Matters is a shared commitment for everyone who uses works in and supports adult social care. It aims to achieve:
    • A shared understanding of what high-quality care is
    • More effective and aligned support for quality in adult social care
    • Improved quality in adult social care
  • Single, shared view of quality including:
    • Equity and equality
    • Person-centre care
  • Principles are:
    • Promoting quality through everything that we do
    • Coordinate action
  • Priorities to improve quality
    • Acting on feedback, concerns and compliments
    • Measuring, collecting and using data more effectively
    • Commissioning for better outcomes
    • Better support for improvement
    • Shared focus areas for improvement
    • Improving the profile of adult social care
  • Seven steps to improve quality:
    • Setting clear direction and priorities
    • Bringing clarity to quality
    • Measuring and publishing quality
    • Recognising and rewarding quality
    • Maintaining and safeguarding quality
    • Building capability
    • Staying ahead

Primary audience: Commissioners, managers and staff in the adult social care sector, users of adult social care, regulators and improvement agencies

Date last updated: September 2017

Due for review: September 2017

Group member responsible: JC


Hot Topics: Neighbourhood Care Teams

A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations.  Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice: 

  • LKS may need to consider how to provide clinical librarian services to what in effect are ‘virtual wards’
  • Integrated care teams may contain members from social care, housing, and the voluntary sector that have not traditionally been served by NHS LKS, and consideration may need to be given the potential needs of these users so we can provide as seamless a service as possible to all members of the team. At a national or regional level, it would be useful to negotiate funding for NHS LKS to provide services to these groups so that this doesn’t have to be negotiated on an individual LKS basis
  • LKS may need to look at information resources to support social care staff in particular
  • There could be a role for LKS in providing information to service users covered by the care team, as one of the objectives is to support them to manage their own health
  • As with Accountable Care Organisations, as organisational boundaries blur, LKS may be required to adapt their service delivery models accordingly, particularly as care moves increasingly into the community

What are neighbourhood care teams?

Neighbourhood care teams are a specific example of integrated care.

These are usually local teams comprising health and social care professionals, sometimes supported by housing professionals or the voluntary sector, that work with people with long-term or multiple conditions or the frail elderly. The service user usually has access to a case worker or navigator for a single point of access, medical records are usually shared between the members of the team, and members of the team may be drawn from different organisations. Their aim is to support people to remain in their own homes and live as independently as possible, and to avoid unnecessary hospital admissions.

They may also be known as integrated local care teams, locality care teams, virtual wards, neighbourhood teams or similar. Neighbourhood care teams or similar models are a feature of many local Sustainability and Transformation Plans (STPs).

What examples are there of neighbourhood care teams in practice?

The document from NHS England on new care models (1) provides examples of a couple of schemes similar to neighbourhood care teams, namely Fylde Coast Local Health Economy and Stockport Together.

Other examples include:

What’s the evidence for neighbourhood care teams?

A Nuffield Trust report (2) looking at different community interventions including integrated health and social care teams found no evidence of a reduction in hospital admissions, but this may be due to ‘case finding’ identifying previous unmet needs, and any reduction in admissions may only happen in the long-term.

However, there is evidence (3) that co-ordination of care through integrated teams improves patient experience and quality of life, and some evidence that chronic care management models are associated with lower costs.

Further reading

  1. NHS England (2016). New care models: Vanguards – developing a blueprint for the future of NHS and care services
  2. Nuffield Trust (2011). An evaluation of the impact of community-based interventions on hospital use
  3. King’s Fund (2015). Care co-ordination through integrated health and social care teams

Hot Topic: Social Prescribing

A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations.  Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice: 

  • LKS teams may be asked to try to locate or synthsise evidence to support the commissioning of specific social prescribing initiatives
  • LKS teams, in collaboration with public library services may be involved in the provision of some social prescribing initiatives (such as service-user or staff reading groups, digital literacy training, books on prescription schemes or similar – see the KfH PPI group’s Ideas Bank for more ideas) or in working with social prescribing co-ordinators to signpost to suitable opportunities (many public library services will have directories of community organisations)
  • LKS could work with occupational health teams to have staff referred to particular initiatives run by the library
  • Social prescribing, along with other initiatives in local STPs, may represent a shift away from secondary care and this may have implications for our user base which may become more community-based

What is social prescribing?

It is a means for GPs and other primary care professionals to refer patients to non-medical interventions that can be used to improve their physical or mental well-being. The kinds of options available for prescribing could include walking groups, knit and natter groups, cookery classes, adult learning, volunteering, and self-help reading (the Books on Prescription scheme is an example of social prescribing).

Social prescribing is mentioned in the NHS England document ‘Next Steps on the Five Year Forward View’ and in the General Practice Forward View as a means of reducing avoidable demand, with an aim to work with the voluntary sector and primary care to ‘design a common approach to self-care and social prescribing’ (1). A national clinical champion for social prescribing was appointed by NHS England in 2016.

Social prescribing is a feature of many local Sustainability and Transformation Plans (STPs).

What examples are there of social prescribing in practice?

There are plenty of examples, some of which are listed in the evaluation carried out by the University of York on pages 5-7 (2). The Commissioning Handbook for Librarians provides suggestions for searching for material about social prescribing (3) which will help identify more.

The Rotherham social prescribing service is a very large scheme, and was mentioned in the NHS Five Year Forward View as an emerging model for the future.

What’s the evidence for social prescribing?

A systematic review carried out in 2016 and published in BMJ Open (4) found that there was there was little good quality systematic evidence to inform the commissioning of social prescribing programmes, as did a previous review of 2015 published by the University of York’s Centre for Reviews and Dissemination (2).

There is some evidence that social prescribing schemes can make a difference to outcomes such as quality of life, levels of depression, and reduction in use of health services, and social prescribing schemes show high levels of satisfaction from users and health care professionals. However, much of the evidence is qualitative, is from self-reported outcomes, and is from small-scale schemes. Most studies focus on a particular intervention rather than social prescribing generally(5). Evidence on the cost-effectiveness of social prescribing is limited.

Further reading

  1. NHS England (2017). Next steps on the NHS Five Year Forward View.
  2. University of York. Centre for Reviews and Dissemination (2015) Evidence to inform the commissioning of social prescribing.
  3. The Commissioning Handbook for Librarians (2017) Social Prescribing.
  4. Bickerdike L, Booth A, Wilson PM, et al. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017;7
  5. King’s Fund (2017) What is social prescribing?

Primary audience: LKS staff and their wider organisations

Date last updated: May 2017

Due for review: May 2018

Group member responsible: JC

Hot topic: Accountable Care Organisations

A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations.  Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice: 

  • LKS teams may be affected by changes to organisational structures as a result of the emergence of Accountable Care Organisations (ACOs).
  • There may be an opportunity to deliver evidence and knowledge to managers, commissioners and transformation teams as health care services undergo this change.
  • As organisational boundaries blur and take a ‘whole population’ approach, LKS may be required to adapt their service delivery models accordingly.
  • If healthcare moves away from a competitive structure and towards a collaborative one, there will be many opportunities relating to knowledge management that could support the sharing and dissemination of good practice, innovation and organisational knowledge.
  • LKS will have to consider how the negotiation and procurement of resources needs to adapt to reflect the changes in organisational structures.
  • There is a clear role for technology in supporting the emergence of ACOs and that presents an opportunity for digitally enabled LKS.

What is an Accountable Care Organisation?

An Accountable Care Organisation (ACO) or Accountable Care System (ACS) brings together a number of providers (e.g. acute hospital care, general practice, mental health, social care, ambulance services and pharmacies) to take responsibility for the cost and quality of care for a defined population within an agreed budget (1).

ACOs have been proposed as one way of overcoming fragmented responsibility for the commissioning and provision of care in the NHS.  They could in principle offer an organisational structure that draws together previously siloed or competing providers into a network with a shared sense of purpose and financial interest (3).

Next Steps on the Five Year Forward View (5) describes ACOs as “an evolved version of an STP” and states that ACOs “provide joined up, better coordinated care”.  It published the names of nine geographical areas that are likely to emerge as ACOs in 2017/18.

What can we learn about ACOs from elsewhere?

ACOs have evolved recently in the United States and they build on a much longer history of integrated care systems such as Kaiser Permanente and Intermountain Healthcare (1).

In the UK, three ‘Vanguard’ schemes stated their intention to explore the potential of the ACO as an organising structure in the NHS: Northumbria, Northamptonshire and Salford (3).

What are the challenges involved?

  • Relationships: Establishing strong relationships between the leaders of participating organisations and the clinicians who deliver care;
  • Technology: Accelerating the implementation of electronic care records to help predict avoidable hospital admissions and to coordinate discharge planning;
  • Finance: New ways of commissioning and paying for services need to be established across traditional organisational boundaries (1).

Further reading

  1. King’s Fund, 2016, Accountable Care Organisations explained
  2. King’s Fund, 2014, Accountable Care Organisations in the United States and England
  3. National Health Executive, 2016, Accountable care organisations: the future of the NHS?
  4. Nuffield Trust, 2016, Accountable Care Organisations: The winners and losers
  5. NHS England, 2017, Next Steps On The NHS Five Year Forward View

Primary audience: LKS staff and their wider organisations

Date last updated: May 2017

Due for review: May 2018

Group member responsible: VT