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NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin


for PCTs in North Staffordshire
Issue No: 42 – July 2010

About this Bulletin:

 It aims to draw attention to some of the key documents and reviews on clinical
effectiveness that have been published in the previous month.

 Where possible, links to the full text documents are included. If the article is in a
journal, you can contact the Health Library for a copy.
Link to request form: http://www.keele.ac.uk/depts/li/hl/illjournal.htm
[Please note - a charge of £2 per request is payable for most copies]

 If you need further assistance, please contact the Health Library or the NHS
Outreach Librarians, details below.

 The bulletin can be e-mailed to colleagues who may also find it useful.

 A list of websites that are checked in the production of this bulletin are listed on
the first page. Please suggest further useful sites.

 Feedback is always welcomed to inform future issues of the bulletin.

Contact information

Contents in this issue


Cancer Bulletin produced by NHS Outreach Librarians
Commissioning Tel: 07834 115958 [please leave a message]
Guidance E-mail: jayne.hickton@northstaffs.nhs.uk
Musculoskeletal
Service Management
Swine Flu
Workforce North Staffs Health Library
Tel: 01782 556565
Fax: 01782 556582
E-mail: health.library@keele.ac.uk

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Sources for Clinical Effectiveness Bulletin


Please suggest further sites that should be monitored in the production of this bulletin

Websites
Bandolier http://www.medicine.ox.ac.uk/bandolier/
Clinical Knowledge Summaries [NLH] http://cks.library.nhs.uk/
Cochrane Library http://www.library.nhs.uk/
CRD Centre for Reviews and Dissemination http://www.crd.york.ac.uk/crdweb/
- DARE – (Database of Abstracts of Reviews of Effects)
- NHS Economic Evaluation Database
Department of Health http://www.dh.gov.uk/en/index.htm
Health Technology Assessment (HTA) Database http://www.ncchta.org/
NICE http://www.nice.org.uk/
NHS Evidence Specialist Collections http://www.library.nhs.uk/specialistcollections/
SIGN http://www.sign.ac.uk/new.html

Cancer
Living with and beyond cancer: the improvement story so far
NHS Improvement
The purpose of this document is to give 'the story so far' and includes the work that NHS
Improvement, through the cancer adult survivorship improvement team, has been undertaking on
behalf of the National Cancer Survivorship Initiative (NCSI). The main focus is to present
improvement stories from the test communities who are piloting elements of care and support to
inform potential new models of care. The learning and improvement stories from the assessment
and care planning test sites will be included in the final report of the pilot phase of testing in the
winter.
http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=hXOKkpqRJE4%3d&tabid=56

Interim cancer drugs funding


Department of Health
This letter details arrangements for the interim cancer drug fund announced on 27th July.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
17996

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Commissioning
Building high-quality commissioning: what role can external organisations play?
King's Fund
This report examines how external support is being used by primary care trusts and strategic
health authorities and whether it is helping them to develop more effective commissioning. This
research shows that the use of external support is now standard practice in the NHS. There was
evidence that in many cases external organisations had succeeded in improving commissioning
processes and could provide support in key areas such as data analysis and commercial skills.
However, it was also clear that external support is not always used effectively. The report
provides guidance for commissioners, policy-makers and providers of support on how to avoid
those pitfalls and ensure best value from external support. The recommendations made will be
relevant to GP commissioning consortia as well as to PCTs.
http://www.kingsfund.org.uk/publications/building.html

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Guidance
NICE Clinical Guidelines

Delirium: diagnosis, prevention and management


Clinical guideline: (CG103)
http://guidance.nice.org.uk/CG103

Diagnosis and management of metastatic malignant disease of unknown primary origin


Clinical guideline: (CG104)
http://guidance.nice.org.uk/CG104

The use of non-invasive ventilation in the management of motor neurone disease


Clinical guideline: (CG105)
http://guidance.nice.org.uk/CG105

NICE Technology Appraisals

Capecitabine for the treatment of advanced gastric cancer


Technology appraisal: (TA191)
http://guidance.nice.org.uk/TA191

Gefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung
cancer
Technology appraisal: (TA192)
http://guidance.nice.org.uk/TA192

Rituximab for the treatment of relapsed chronic lymphocytic leukaemia


Technology appraisal: (TA193)
http://guidance.nice.org.uk/TA193

Denosumab for the treatment of therapy-induced bone loss in non-metastatic prostate


cancer Technology appraisal: (TA194)
http://guidance.nice.org.uk/TA194

NICE Public Health Guidance

Dietary interventions and physical activity interventions for weight management before,
during and after pregnancy
Public health guidance: (PH27)
http://guidance.nice.org.uk/PH27

NICE Interventional Procedure Guidance

Percutaneous mitral valve annuloplasty


Interventional procedure guidance: (IPG352)
http://guidance.nice.org.uk/IPG352

Percutaneous radiofrequency ablation of renal cancer


Interventional procedure guidance: (IPG353)
http://guidance.nice.org.uk/IPG353

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Shoulder resurfacing arthroplasty


Interventional procedure guidance: (IPG354)
http://guidance.nice.org.uk/IPG354

NICE Consultation Documents

Anxiety (partial update): draft guideline consultation


Closing date for comments 17 August 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=49808

Alcohol dependence and harmful alcohol use: guideline consultation


Closing date for comments 19 August 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=49435

Constipation (women) - prucalopride: appraisal consultation


Closing date for comments 24 August 2010
http://guidance.nice.org.uk/TA/Wave22/6/Consultation/Latest

Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent
paradoxical embolism: interventional procedures consultation
Closing date for comments 24 August 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=49939

Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent
paradoxical embolism in divers: interventional procedures consultation
Closing date for comments 24 August 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=49944

Percutaneous closure of patent foramen ovale for recurrent migraine: interventional


procedures consultation
Closing date for comments 24 August 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=49942

Percutaneous radiofrequency ablation for primary and secondary lung cancers:


interventional procedures consultation
Closing date for comments 24 August 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=49937

Low intensity pulsed ultrasound for promotion of fracture healing: interventional


procedures consultation
Closing date for comments 24 August 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=49932

Pain and bleeding in early pregnancy: scope consultation


Closing date for comments 31 August 2010
http://guidance.nice.org.uk/CG/Wave23/4/Scoping/ScopeConsultation

NICE Quality Standards

NICE quality standards on stroke, dementia and VTE


NICE has presented the Health Secretary with advice on new, national, evidence-based quality
standards on the care and treatment of stroke, dementia and venous thromboembolism (VTE)
patients in the NHS in England. The new quality standards are a set of concise statements that
show what high-quality care should look like for these conditions. The standards are sourced from
the best available evidence such as NICE guidance, or evidence accredited by NHS Evidence.
Produced in collaboration with the NHS and social care, as well as their partners or service users,

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they have been developed with the following audiences in mind: patients and the public;
clinicians; public health practitioners; commissioners; and health and social care professionals.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
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Clinical Knowledge Summaries updated in July 2010

 Polycythaemia/erythrocytosis (new)
 Post-traumatic stress disorder (new)

Other Guidance

Health Technology Assessments

Systematic review and cost effectiveness evaluation of ‘pill-in-the-pocket’ strategy for


paroxysmal atrial fibrillation compared to episodic in-hospital treatment or continuous
antiarrhythmic drug therapy (Saborido)
Health Technol Assess; 14.31

Chemoprevention of colorectal cancer: systematic review and economic evaluation


(Cooper)
Health Technol Assess; 14.32

Cross-trimester repeated measures testing for Down’s syndrome screening: an


assessment (Wright)
Health Technol Assess; 14.33

H1N1 influenza and pandemic flu themed issue 1 (NIHR)


Health Technol Assess; 14.34

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Musculoskeletal
Hip fracture annual evidence update
NHS Evidence
The scope of the literature search covers fractures affecting the proximal femur.
http://www.library.nhs.uk/trauma_orthopaedics/ViewResource.aspx?resID=381172&tabID=289&c
atID=11048

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Service Management
Equity and excellence: liberating the NHS
Department of Health
This White Paper outlines the Government's long-term vision for the future of the NHS which
involves GP Consortia being given responsibility for commissioning care for their local
communities and the phasing out of Primary Care Trusts and Strategic Health Authorities. It sets
out how the plans will: put patients at the heart of everything the NHS does; focus on
continuously improving the outcome of patients' healthcare; and empower clinicians to innovate,
with the freedom to focus on improving healthcare services. The Department is consulting on
elements of these proposals. Details on how to respond can be found in the White Paper. Also
available are an 'Analytical strategy for the White Paper and associated documents', an 'Initial

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equality impact assessment', the Secretary of State's statement to the House of Commons and
the 'DH draft Structural Reform Plan'.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_117353

Liberating the NHS: managing the transition


Department of Health
The NHS Chief Executive has written a Dear Colleague letter to the chief executive community
setting out plans to lead the implementation of the White Paper. This first communication sets out
the initial steps that are being taken at a national level to ensure the NHS continues to deliver for
today whilst designing a new system for tomorrow. It provides a framework within which Strategic
Health Authorities can lead this process regionally, and sets out some initial actions that
commissioners and providers need to take as part of state of readiness for 2012. A timeline for
the process is also available.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
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NHS White Paper documents


The Department of Health (DH) has published two further documents relating to the
implementation of the NHS White Paper:
- Regulating healthcare providers - consultation
This document further outlines proposals on foundation trusts and the establishment of Monitor
as an independent economic regulator for health and adult social care. It seeks views on specific
consultation questions. Closing date for comments is 11 October 2010.
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117782
- Report of the arms-length bodies review
This report of the review sets out proposals for ALBs in the health and social care sector. These
proposals form part of the cross-Government strategy to increase accountability and
transparency, and to reduce the number and cost of quangos.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_117691

Improving NHS productivity: more with the same not more of the same
King's Fund
The report analyses how the NHS can meet the challenges it faces as it enters a more
constrained financial environment. It revisits assumptions about the cost and demand pressures
facing the NHS and identifies the contribution of different cost and demand drivers to the
projected growth in expenditure required, and illuminates the choices faced, nationally and
locally, to manage these pressures. It maps out some of the strategies that might be used to
release resources, and assesses their likely potential to deliver productivity improvements. It
highlights the need to focus on variations in clinical practice and to find ways of managing
demand for hospital care through a renewed emphasis on the needs of people with long-term
conditions. The Quality, Innovation, Productivity and Prevention (QIPP) programme must give
particular attention to these issues in the future. Finally it highlights the role that different parts of
the health system need to play which includes the opportunities for different agencies to work
together in local systems of care and to explore ways in which closer integration between primary
and secondary care and health and social care could contribute to meeting the productivity
challenge.
http://www.kingsfund.org.uk/publications/improving_nhs.html

Quality of general practice in England


King’s Fund
As part of an inquiry into the quality of care and services provided by GPs and other health
professionals working in general practice in England, the King's Fund has published two papers:
'Continuity of care and the patient experience', and 'The quality of GP diagnosis and referral' and
is inviting comments on these subjects. The Inquiry panel commissioned a research project to

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examine good practice in relation to continuity of care and to assess whether, and how, this might
be measured. The first paper explores patients’ and clinicians’ perspectives on good practice in
relation to continuity of care, and considers how GPs can stimulate and maintain continuity. The
second paper looks at variations in the quality of diagnosis and referral across general practice,
and identifies evidence-based ways to improve the quality of this aspect of GP care.
Continuity of care:
http://www.kingsfund.org.uk/current_projects/gp_inquiry/dimensions_of_care/continuity_of_care.h
tml
GP diagnosis and referral:
http://www.kingsfund.org.uk/current_projects/gp_inquiry/dimensions_of_care/diagnosis_and.html

The triumph of hope over experience


NHS Confederation
Reorganising and restructuring have been common activities in the NHS over the last 20 years
and are on the agenda again. Some savings can undoubtedly be made from restructuring or
merging management, back office and front line functions, but the inevitable loss of focus on
delivery and delays in service improvements are hard to ignore. This report looks at the available
evidence about the pattern of reorganisation, why there’s so much of it and why it often fails, and
outlines the important points to consider when reorganising services.
http://www.nhsconfed.org/Publications/reports/Pages/triumph-of-hope.aspx

Dealing with the downturn: using the evidence


NHS Confederation
This report looks at some of the issues that need to be thought about when considering how to
approach the financial challenges and the misunderstandings, pitfalls and problems with some of
the evidence. The report looks at the size and scale of the problem faced and explores a number
of areas for reducing costs: providing care closer to home; managing long-term conditions;
reducing variation; skill mix and substitution; improving quality; and integration and organisational
mergers. It also sets out some of the myths and misconceptions associated with cost savings and
reiterate the need for brave leadership.
http://www.nhsconfed.org/Publications/reports/Pages/Dealing-with-the-downturn.aspx

Tackling inequalities in life expectancy in areas with the worst health and deprivation
National Audit Office
The report concludes that the Department of Health has made a serious attempt to tackle health
inequalities across England but having set a target in 2000 to reduce health inequalities, it took
time to embed the issue in the policy and planning framework of the NHS and to develop an
evidence base of the most cost-effective interventions. Given the slowness in applying cost-
effective interventions on the scale required in the early and mid-2000s, the NAO was unable to
conclude that the Department’s approach provided value for money up to this time. More recently
the improved take-up of these interventions is likely to have improved value for money.
http://www.nao.org.uk/publications/1011/health_inequalities.aspx

What's next for health and social care integration?


NHS Confederation
Rising demand for health and social care, combined with increasingly scarce resources, is
leading to renewed interest in ‘integrated care’ as a potential solution. The NHS Confederation
and the Association of Directors of Adult Social Services (ADASS) have developed a joint
programme of work looking at the issues around the commissioning and provision of integrated
health and social care services. This discussion paper is one of the first outputs from a work plan
which will continue throughout the year.
http://www.nhsconfed.org/Publications/Pages/health-socialcare-integration.aspx

Information on the Quality of Services - Final Report


Quality Information Strategy Sub-Group of the National Quality Board

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This report, published on the Department of Health website, provides recommendations to


improve how information on service quality is created, used and communicated, and advice on
how the information system itself should be structured.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_117314

Health profiles
A snapshot of health for each local area comparing key statistics such as life expectancy,
deprivation and early deaths from stroke and heart disease has been published by the
Department of Health. The collated summaries show that there are clear variations in health
across the country. Key findings include, life expectancy for men and women continues to
increase, early deaths from heart disease, stroke and cancer continue to fall, the highest rates of
alcohol-related hospital admissions are found in urban areas of the North East and North West,
including Liverpool, Newcastle and Middlesborough and there are higher rates of malignant
melanoma skin cancer in the South West and South East, including Plymouth, Weymouth and
Portland, and Oxfordshire.
DH:
http://nds.coi.gov.uk/clientmicrosite/Content/Detail.aspx?ClientId=46&NewsAreaId=2&ReleaseID
=414270&SubjectId=36
APHO: http://www.apho.org.uk/default.aspx?QN=P_HEALTH_PROFILES

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Swine Flu
Swine flu pandemic review
The Cabinet Office has published an independent review into the UK’s strategic response to the
2009 swine flu pandemic. The review’s author, Dame Deirdre Hine, outlines 28 recommendations
that aim to enhance the proportionality of a future response, strengthen the development and
handling of scientific advice, and improve how government communicates with the public.
Independent review : http://www.cabinetoffice.gov.uk/ukresilience/ccs/news/100701-flu-
pandemic-review.aspx

In relation to this report, the NHS Chief Executive has issued a letter providing information on two
NHS operational reports which have been produced by the NHS Resilience team.
Letter :
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
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Learning the lessons from the H1N1 vaccination campaign for Health Care Workers :
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_117130

Report of the Swine Flu Critical Care Clinical Group and Key Learning Points for Future
Surge Planning :
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_117129

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Workforce
International and European nurse recruitment: RCN guidance for nurses, health care
assistants, health care employers and RCN officers
Royal College of Nursing

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In recent years, the UK has seen a significant increase in non-UK trained nurses working in
health and social care environments. This guidance sets out the key considerations and RCN
principles for ensuring the ethical recruitment and employment of nurses internationally and
across Europe. The publication includes advice on good recruitment and employment practice,
information on the regulation of nurses in the UK, support available for nurses and details of
useful contacts and resources.
http://www.rcn.org.uk/__data/assets/pdf_file/0019/326530/003816.pdf

The nature and consequences of support workers in a hospital setting


NHS National Institute for Health Research
This report finds that healthcare assistants are often under-utilised within the NHS. The authors
assessed the use and consequences of support worker roles in hospitals from the perspective of
different stakeholders and looked at whether these roles vary between and within hospitals,
between different departments, and by different supporting roles.
http://www.sdo.nihr.ac.uk/files/project/155-final-report.pdf

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