NHS to expand nursing associate training places in England
The NHS has pledged to expand the number of training places for nursing associates to 10 500 by 2031/32, as part of wider plans for expansion across the nursing professions.
Since joining the Nursing and Midwifery Council (NMC) register in 2019, 5500 nursing associates have started working in the NHS. NHS England says that ‘the nursing associate role provides a career pathway for healthcare support workers and is a potential progression route into graduate level nursing. Over the last 5 years, thousands of healthcare support workers from NHS Trusts have enrolled on training nursing associate programmes’. It says there are plans to increase the number of nursing associates to 64 000 full-time equivalents by 2036/37.
The nursing associate role in England was introduced in response to the Shape of Caring review to ‘help build the capacity of nursing teams and support the delivery of high-quality care’. The role was formally announced by the UK government in 2016 and developed by Health Education England (HEE), with the NMC becoming the legal regulator in January 2018. As part of their training, nursing associates are educated in medicines management and, within the confines of local employer policies, administer prescribed medicines safely and appropriately. Alongside the regulatory standards for the role, HEE has published guidance to provide clarity to all NHS organisations about how nursing associates can be deployed to administer medicines safely and effectively: https://www.hee.nhs.uk/our-work/nursing-associates.
NICE recommends targeting of antibiotics to those at the highest risk of sepsis
The National Institute for Health and Care Excellence (NICE) has recommended better targeting of antibiotics for suspected sepsis to ‘ensure the right people receive treatment as soon as possible’ but that the medicines are not overused, which can lead to resistance.
The National Early Warning Score (NEWS2) is the NHS England endorsed system to identify acutely ill patients, including those with sepsis.
NICE guidance recommends using NEWS2 to help assess people with suspected sepsis who are aged 16 or over, are not and have not recently been pregnant, and are in an acute hospital setting, acute mental health setting or ambulance.
This recommendation is included in a partial update of NICE's recognition, diagnosis, and early management of suspected sepsis guideline, alongside further advice on assessing patients most at risk, when to give antibiotics and identifying the source of infection.
The guideline states people graded by NEWS2 as being the most severely ill should be prioritised and continue to receive broad-spectrum antibiotics within an hour.
As a result of the updated NEWS2 warning scores, NICE says it is expected that more people will be graded at a lower risk level where treatment should begin within 1–3 hours and the diagnosis clarified before antibiotics are given, targeted at a specific infection if possible.
This will help to reduce the risk of antibiotic resistance and give health professionals more time to investigate those who are less severely ill, so they receive the right treatment.
There are at least 245 000 sepsis cases diagnosed in the UK every year. An analysis of data by the UK Sepsis Trust in 2017 showed that there were 200 000 admissions to hospitals in England where sepsis was diagnosed.
Professor Jonathan Benger, NICE Chief Medical Officer, said: ‘This useful and useable guidance will help ensure antibiotics are targeted to those at the greatest risk of severe sepsis, so they get rapid and effective treatment. It also supports clinicians to make informed, balanced decisions when prescribing antibiotics. We know that sepsis can be difficult to diagnose so it is vital there is clear guidance on the updated NEWS2 so it can be used to identify illness, ensure people receive the right treatment in the right clinical setting and save lives.
‘This update is the latest part of the process to ensure NICE guidance is as current as possible. We recognise this is a vital and rapidly evolving area, so this is the latest in a series of planned updates to our guidance.’
The updated guidance aligns with the Academy of Medical Royal Colleges (AoMRC) statement on the initial antimicrobial treatment of sepsis.
It also includes recommendations on identifying the source of infection and involving surgical teams, which have been broadened to cover the risk of sepsis in all parts of the body and a wider range of interventions.
For more information on the suspected sepsis guidance visit: https://www.nice.org.uk/guidance/indevelopment/gid-ng10310.
Updated guidance for risk assessment and infection prevention for measles
NHS England has published guidance intended to support preparedness for and management of suspected or confirmed measles cases in healthcare settings.
The new guidance sets out some key recommendations, including that immunisation status/records are available for all staff (clinical and non-clinical) who may be exposed to a suspected or confirmed case of measles and staff are supported to ensure they are fully immunised; patient screening, triaging and testing protocols should be in place for all relevant care settings to ensure prompt isolation of suspected or confirmed cases of measles; a respiratory season or winter plan should be in place to ensure, for example, appropriate segregation of patient cases depending on the pathogen and management of increasing case numbers where they occur; and FFP3 respirator fit testing is completed for staff who may be required to assess or clinically care for a suspected or confirmed measles case. Training in IPC measures should be provided to all staff, including the correct use of PPE and the correct technique for donning and doffing (putting on and removing) PPE safely.
There should also be a risk assessment(s) undertaken for staff who may be at high risk of infection and/or complications from infection with measles.
For more information visit: https://www.england.nhs.uk/publication/guidance-for-risk-assessment-and-infection-prevention-and-control-measures-for-measles-in-healthcare-settings.
Report finds ‘more focus needed to put children at the heart of new health system’
Inconsistency in addressing the needs of babies, children and young people in local health plans highlights the need for stronger guidance from national government, finds a new report by the Children and Young People's Health Policy Influencing Group (HPIG). The group comprises influential charities and Royal Colleges, that looks to ensure that the particular and unique health needs of babies, children and young people are a focus for the health system.
The report analysed strategies and plans produced by Integrated Care Systems (ICSs), and how well they reflected different aspects of children's health. It focuses on the first year of the new ICSs, introduced by the Health and Care Act 2022, and acknowledges the work being developed in the context of increased demand and stretched budgets. However, the group says that too few ICSs consider integration with other key services in children's lives such as education settings (32% of ICSs) and children's social care (42%) – a ‘critical component to improving children's health outcomes’.
It adds that, while ICSs did identify priorities for children's mental health, obesity, early development, special educational needs and disabilities (SEND) and inequalities, the rationale for these decisions was often not articulated. Furthermore, children with major and long-term conditions were absent in the majority (59%) of strategies and almost a third of JFPs (27%) did not set specific targets to address inequalities to improve health outcomes.
Clearly identified leadership and accountability for the health outcomes of babies, children and young people was also found to be lacking. Despite a requirement to identify named board members to lead work for children and young people's services, safeguarding, and SEND, over half (57%) of Joint Forward Plans failed to do so.
To meet children and young people's needs the report says, their voices must be central when planning and designing services, yet the report discovered that they were rarely consulted in strategic planning. Only 6% of strategies and 17% of JFPs stated how babies, children and young people had influenced their work.
Matthew Dodd and Amanda Allard, Co-Chairs of the Children and Young People's Health Policy Influencing Group, said: ‘Babies, children and young people are too often an afterthought in conversations about addressing inequalities and improving overall life expectancy and wellbeing.
‘The Health and Care Act 2022 was a step in the right direction, helping focus the attention of Integrated Care Systems on babies, children and young people.
‘But legislation is only part of the puzzle, and we must not become complacent about ensuring children's needs are met in practice. We know that integrated and co-produced services across health, children's social care and education can improve children's outcomes and prevent costlier interventions further down the line and we look forward to continuing our work with national government and local systems to ensure this becomes a reality.’
More Londoners using digital tools to interact with their GP surgery
Results from a new report from the Health Innovation Network (HIN) South London and NHS England (London) Digital First team indicate that up to three quarters of Londoners have used online consultation forms, the NHS App and GP surgery websites to access primary care services.
More than 3000 patients from across London contributed to the report by completing an online survey or participating in focus groups. The report indicated that most people found these digital tools beneficial as they allowed them to complete key tasks related to managing their healthcare more independently.
While most patients who responded found the three digital tools easy and convenient to use, the report also highlighted variation across London, with some patients reporting challenges with accessibility and availability of certain features. For example, 43% were not able to book a routine GP appointment online and almost a third did not have full access to their medical records via the NHS App.
The report also highlighted the importance of continuing to tackle the root causes of digital exclusion, acknowledging that some groups underserved by digital technologies may still be underrepresented in this type of research.
The most used digital tool was the NHS App, which had been used by 87% of people who completed the survey. Generally, patients felt the NHS App was a useful source of information and they valued the ability to manage their own health through ordering repeat medication and accessing their health records. According to some patients, the quality of GP websites had improved; although difficulties remained for others around navigation, requesting routine appointments, and out-of-date information being displayed on GP websites.
Discussing the launch of the report, Matt Nye, Director of Digital First Programme, NHS England (London) said: ‘This report has shown us how integral digital tools are for people using primary care services across London.
‘We've heard that patients find the most common digital tools really helpful for accessing support in ways that suit their needs, and this provides more evidence for continuing to invest in making these channels as good as they can be.
‘Optimising digital channels can often provide long-term efficiency savings for practices while improving patient choice. If we can save admin time for busy GP teams through increasing the use of digital tools where appropriate, that in turn frees up time to help people who need to use other routes to access advice or support.’