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Found 51 results
  1. Content Article
  2. Content Article
    Who we are The Quality Network for Inpatient Working Age Mental Health Services (QNWA) was first established in 2006 as AIMS (Accreditation for Inpatient Mental Health Services), which later specialised to AIMS-WA (Working Age), before becoming a quality network in the summer of 2020. The Network was founded to promote better standards of care within mental health inpatient wards following the publication of findings from the National Audit of Violence 2003-2005, which highlighted the concerning high prevalence of violence on acute wards, but also concluded that examples of good practice were going unrecognised. The Network is one of around 30 quality networks, accreditation, national clinical audit, and research and evaluation projects organised by the Royal College of Psychiatrists (RCP) Centre for Quality Improvement (CCQI). The CCQI works with more than 90% of mental health service providers in the UK to assess and improve the quality of care they provide. Since the first set of QNWA standards were published in September 2006, the Network has grown to include over 140 member wards. A full list of member wards and their current accreditation status is available to view on the RCP's website. What we do QNWA is a not-for-profit, run by quality improvement staff and steered by clinicians and patient and carer representatives. The purpose is to support and engage wards in a process of quality improvement whereby they are reviewed against a set of specialist standards for acute inpatient wards for working age adults. The accreditation process provides recognition for wards who meet a set threshold of standards and who are deemed to be operating at a level that achieves accreditation. Upon becoming a quality network in 2020, the developmental membership option was introduced. Unlike accreditation membership which works on a three-year cycle and results in an accreditation decision, the developmental membership works on an annual basis and there is no threshold of standards for services to meet. This allows services to familiarise themselves with the standards and review process before attempting to gain accreditation and to concentrate on any areas of improvement. The eighth edition standards were published in May 2022 and aim to reflect the changes in working practices and legislation over the last two years in addition to placing greater emphasis on equality, diversity and inclusion, as well as sustainability in mental health services. Standards for Acute Inpatient Services for Working Age Adults - 8th Edition (1).pdf QNWA promotes the sharing and learning of best practice through peer-led review visits and helps wards to action plan against areas of future improvement. The Network serves to identify areas of achievement and areas for improvement in individual services, through a culture of openness and enquiry. The model is based on engagement rather than inspection and this is achieved by facilitating and encouraging quality improvement through a supportive network of members and rigorous peer-review process. Membership benefits QNWA members benefit from having their service reviewed by expert acute inpatient colleagues and are also invited to attend tailored training events, special interest days and conferences. Some of the key benefits of being a QNWA member are listed below: The QNWA discussion group currently has over 400 members, who can ask questions and share knowledge and examples of best practice. This is the mailing list which is used to keep members up to date about upcoming training, peer reviews, special interest days and events, etc. Members also have exclusive access to Knowledge Hub – an online group to connect, network and share knowledge. One of the main benefits of being a QNWA member is being able to visit and peer-review other member wards. If staff wish to attend peer-review visits, they must first attend a peer-reviewer training session. These are free to attend and take place online every two months. Once trained, staff will have the opportunity to visit acute inpatient mental health wards across the UK; this is an excellent opportunity for professional development, to contribute to the peer-review process, and to facilitate networking and the sharing of best practice. The Network aims to hold 1–2 special interest days per year on a range of topics suggested by our members. Additionally, the Network holds an annual forum, with speakers, workshops and poster presentations. All QNWA members receive up to two free places to attend online events; face-to-face events are offered at a subsidised rate. Contact us If you are interested in becoming a member or would like to know more, please contact the QNWA team at QNWA@rcpsych.ac.uk
  3. Content Article
    Dr Jake Suett: My experience of suspected 'Long COVID' I have been unwell for 109 days now, and the entire illness has been incredibly frightening, with episodes of severe shortness of breath, cardiac-type chest pains and palpitations to name a few. I think I am slowly improving but am left with residual symptoms that have never gone away entirely but regularly return strongly in waves. In March, I was working as a staff grade intensive care doctor. I was working closely with patients with COVID-19 and had an illness that began with fever, dry cough and shortness of breath. I had braced myself for the coming wave of COVID-19 and was helping my hospital to prepare. I had studied the mortality data from a paper in The New England Journal of Medicine1 and had concluded that, as a young, healthy and active 31-year old doctor I would likely survive (very likely) or die (really quite unlikely) if I became exposed to the virus. I had not anticipated the existence of this strange third possibility of still feeling extremely ill nearly 16 weeks later. I realised that I was not alone with my symptoms when I read Professor Paul Garner’s blog in the BMJ2 about six weeks into my illness. I joined some of the support groups on Facebook including 'Long Covid Support Group' and was suddenly faced with the realisation that there were thousands of us in the same position. It was a bittersweet moment as it helped me to feel less alone, but on the other hand confronted me with a tremendous volume of genuine human suffering that was going unrecorded and unnoticed due to the circumstances of the crisis. People are experiencing incredibly frightening symptoms but some have found it hard to access healthcare as the NHS was being protected from being overwhelmed. Most have remained at home and have not been admitted to hospital. Many were unable to access testing in the first month of their illness, and most were never admitted to hospital. I wrote a letter (attached at the bottom of this blog) that other people could send to their MPs in an attempt to raise awareness of the situation of people suffering persistent symptoms. Here are my current thoughts on the issue of 'Long COVID' and what the next practical steps should be in addressing the problem for sufferers and society in general. 'Long COVID' In some people, there are prolonged symptoms of COVID-19, which have been called 'Long COVID' or 'Post-acute COVID-19'. There is a growing body of evidence that a significant minority of patients are suffering persisting and distressing symptoms that in ordinary times would represent 'red-flag' symptoms requiring urgent investigation. Data from the COVID-19 symptom tracker app shows that 1 in 10 patients are having symptoms for longer than three weeks3. The British Lung Foundation and Asthma UK’s post-COVID survey4 of over 1000 patients, of which over 800 had not been admitted to hospital, found that: “…many people who had mild – moderate COVID are now on a long road to recovery, affecting both their physical and mental health” and “When asked what symptoms most affect them, the top five were: breathing problems (90%), extreme tiredness (64%), sleep problems (22%), cough (22%) and changes in mood, or anxiety or depression (22%). The majority of people had not experienced these symptoms before having COVID.” The symptoms experienced by these patients are frightening and are consistent with other serious differential diagnoses that would usually warrant urgent investigation to rule out serious causes. These symptoms include shortness of breath, chest pain and various neurological symptoms (numbness, weakness, visual disturbances etc). Many people report emergence of new symptoms late in the course of their illness, a relapsing-remitting pattern to their symptoms, and many have reported a mild initial illness, all of which adds to the distress and uncertainty of the condition. Tim Spector writes, “There is a whole other side to the virus which has not had attention because of the idea that ‘if you are not dead you are fine”3. Some patients have reported requiring treatment for con-current bacterial pneumonia, urinary tract infections and pulmonary emboli. Some have reported other serious outcomes such as strokes and cholecystitis. Some that have had investigations have reported serious abnormalities on blood tests, echocardiograms and CTs. Most of these patients have not required hospital admission and many have not been able to access PCR testing at the early stage of their illness. At the moment, this data is not being collected in a scientific fashion, which is an impairment to building up an evidence base around the topic. This data urgently needs to be moved from anecdote into scientific studies and then applied clinically to help people. Some high-profile figures have spoken out about their experiences with a prolonged illness including two Professors of Infectious Diseases and an MP5,6,7. There are many examples of people remaining unwell for three months and longer8 (see letter for more). Articles in the BMJ address the issue from the perspective of a GP9, and from the perspective of occupational health10. We already have emerging evidence of longer-term complications affecting the respiratory11, cardiovascular12, endocrine13, neurological14,15 and gastrointestinal16 systems in at least some patients after COVID-19 and a new Kawasaki disease type illness has been identified in children following infection17. There are also plenty of historical warnings about long-term effects from the SARS outbreak in 200318,19 as well as well documented complications of other viral illnesses. On the basis of this, it is important for us to keep an open mind about what the underlying pathophysiology is in 'Long COVID' patients and encourage further epidemiological, mechanistic and treatment studies by those with expertise in the field. It would be dangerous to assume that pathology that has been detected in hospital patients with COVID-19 can not also affect those who may have managed to avoid admission. Dealing with this issue will require research and collaboration between multiple different medical specialties. Perhaps collaboration and joint guidelines should be considered early on as well as urgently starting studies that capture this cohort. (The PHOSP-COVID study unfortunately only captures follow up in patients after hospitalisation, although of course is a welcome step in the right direction.) The issue has started to be talked about more widely this week. Andrew Gwynne MP asked the Leader of the House of Commons for a debate or statement on 'Long COVID' during business questions on 2 July 2020 and First Minister of Scotland Nicola Sturgeon discussed the issue at Wednesday 1 July’s daily briefing saying, “One of the things it took us longer to learn, and we are still learning, is that even for people who don’t become very seriously unwell and don’t die from it, it can still do really long-term damage.”20 On Sunday 5 July, it was announced that NHS England would be launching a tool to aid long-term recovery21 and a statement from NHS England said, “…evidence shows that many of those survivors are likely to have significant on-going health problems, including breathing difficulties, enduring tiredness, reduced muscle function, impaired ability to perform vital everyday tasks and mental health problems such as post traumatic stress disorder (PTSD), anxiety and depression.”22 This is a welcome step and provides recognition to those who have been left struggling with persisting symptoms. However, it is important that these services do not exclude those who did not require hospital admission nor those whose clinical features suggest COVID-19 but who may have had trouble accessing testing or have suspected false negative results for a variety of reasons23,24,25,26. Clinicians need to be able to access these services for their patients if they feel they would benefit from them. What is the danger? Of course, the pandemic is a crisis and resources have been stretched to the limits. There is no cure for COVID-19 and there is still little evidence to suggest what the pathophysiology of the prolonged symptoms are. It’s been a challenging time for politicians, healthcare professionals and patients alike. However, there are risks with the current situation for those with 'Long COVID' that can be solved now as we move away from the peak of the first wave of the pandemic. The risks are: That serious but treatable complications of COVID-19 may not be detected and managed, such as thromboses, secondary infections, or cardiovascular, endocrine or neurological sequelae etc. That serious but treatable pathology may go undetected if misattributed to COVID-19 and not investigated. There is a third danger from a public health perspective, which is to mistakenly consider outcomes in terms of death vs survival, and to not consider the possibility of long-term morbidity and delayed mortality in survivors of COVID-19, and therefore miscalculate the risk vs benefit calculations of easing lock-down and other public health measures. There is the danger that we miss this opportunity to have robust epidemiological studies to capture the entire spectrum of COVID-19 disease, and therefore any potential morbidity and mortality associated with “Long-COVID” symptoms will go undetected, along with any clues that may be gained regarding the pathophysiology of COVID-19 and treatment options. What needs to be done? I believe that dealing with the problem of 'Long-COVID' will require a response from government, public health bodies, healthcare systems, scientists and society. Collectively, we will need to: Establish a scientific approach to the study of patients undergoing prolonged COVID-19 symptoms (ensuring the cohort that was not hospitalised and has persisting symptoms is also captured in this data). This needs to include epidemiological, mechanistic and treatment studies. (The Long-term Impact of Infection with Novel Coronavirus (LIINC) study27 being carried out at University of California San Francisco is a good example of the type of study required for capturing objective data on the full spectrum of COVID-19 disease, including in those individuals with a prolonged illness. Maintain an open-minded approach to the underlying pathophysiology of the condition28,29, and avoid classifying it with existing names for diseases until there is sufficient evidence to make these statements. Include Long COVID patients in the study design stages. Raise awareness amongst health professionals and make arrangements so that treatable pathology is investigated and ruled out. Provide information and guidelines on how to manage long-term COVID19. Raise awareness amongst employers. Consider the medical, psychological and financial support that may be required by these patients. When considering measures to ease the lock-down, include a consideration of the risk of exposing additional people to prolonged COVID-19 symptoms and long-term health consequences. Ensure and clarify that the plans announced on 5 July 2020 for research and rehabilitation by NHS England do not inappropriately exclude those who have not required hospital admission and do not exclude those who have been unable to access testing early on, or in whom a false negative test is suspected. It is important that similar services are available throughout the UK. I have encouraged people with these persisting symptoms to write to their MPs to make clear the needs of this group. I have included a letter to explain the situation here in case they would find it helpful. Conclusion The Socratic paradox, "I know that I know nothing" must remind us to keep an open mind at this stage when dealing with a new disease. In his novel The Plague, Albert Camus wrote, “Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.” We have already been taken by surprise by this virus in many ways. It’s important that creating a huge pool of long-term suffering, of unclear aetiology and with unclear outcome, in up to 5-10% of the population does not become an additional surprise. Even if these patients are uncommon, given the number of SARS-CoV2 infections the country has now seen we must arm ourselves with robust studies and evidence to inform healthcare practices and government policy moving forwards. Unless we address this issue we will be left with a huge healthcare burden of chronic disease, and miss the opportunity to save lives and better understand this disease. Clinicians will face patients with these symptoms and have no access to evidence to help manage them. This will lead to bad health outcomes for both individual patients as well as causing significant impacts on society and public health in general. Additional reading: How will NHS staff with Long Covid be supported? Promises of Long Covid support have not materialised (a blog by Clare Rayner) Long Covid Minister needed to respond to growing crisis Post COVID-19 syndrome: What support can patients expect from their GP? Patient safety concerns for Long COVID patients (6 July 2020) Press release: Patient Safety Learning calls for urgent action to ensure Long COVID patients are heard and supported (6 July 2020) Dismissed, unsupported and misdiagnosed: Interview with a COVID-19 ‘long-hauler’ References Wei-jie Guan, Ph.D., Zheng-yi Ni, M.D., Yu Hu, M.D., Wen-hua Liang, Ph.D., Chun-quan Ou, Ph.D., Jian-xing He, M.D., Lei Liu, M.D., Hong Shan, M.D., Chun-liang Lei, M.D., David S.C. Hui, M.D., Bin Du, M.D., Lan-juan Li, M.D., et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382:1708-1720. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 https://blogs.bmj.com/bmj/2020/05/05/paul-garner-people-who-have-a-more-protracted-illness-need-help-to-understand-and-cope-with-the-constantly-shifting-bizarre-symptoms/ https://covid19.joinzoe.com/post/covid-long-term https://www.blf.org.uk/media-centre/press-releases/%E2%80%9Cwe-have-been-totally-abandoned%E2%80%9D-people-left-struggling-for-weeks-as https://blogs.bmj.com/bmj/2020/06/23/paul-garner-covid-19-at-14-weeks-phantom-speed-cameras-unknown-limits-and-harsh-penalties/ https://www.theguardian.com/commentisfree/2020/jun/28/coronavirus-long-haulers-infectious-disease-testing https://andrewgwynne.co.uk/long-termer-my-struggle-with-post-covid-sickness-my-weekly-article-for-the-tameside-reporter/ https://www.bbc.co.uk/news/uk-wales-53169736 Helen Salisbury: When will we be well again? BMJ 2020;369:m2490 https://www.bmj.com/content/369/bmj.m2490 https://blogs.bmj.com/bmj/2020/06/23/covid-19-prolonged-and-relapsing-course-of-illness-has-implications-for-returning-workers/ Xiaoneng Mo, Wenhua Jian, Zhuquan Su, Mu Chen, Hui Peng, Ping Peng, Chunliang Lei, Shiyue Li, Ruchong Chen, Nanshan Zhong. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. European Respiratory Journal Jan 2020. https://erj.ersjournals.com/content/early/2020/05/07/13993003.01217-2020 Tomasz J Guzik, Saidi A Mohiddin, Anthony Dimarco, Vimal Patel, Kostas Savvatis, Federica M Marelli-Berg, Meena S Madhur, Maciej Tomaszewski, Pasquale Maffia, Fulvio D’Acquisto, Stuart A Nicklin, Ali J Marian, Ryszard Nosalski, Eleanor C Murray, Bartlomiej Guzik, Colin Berry, Rhian M Touyz, Reinhold Kreutz, Dao Wen Wang, David Bhella, Orlando Sagliocco, Filippo Crea, Emma C Thomson, Iain B McInnes. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options, Cardiovascular Research, cvaa106, https://doi.org/10.1093/cvr/cvaa106https://academic.oup.com/cardiovascres/article/doi/10.1093/cvr/cvaa106/5826160 Agarwal S, Agarwal SK. Endocrine changes in SARS-CoV-2 patients and lessons from SARS-CoV. Postgraduate Medical Journal 2020;96:412-416. https://pmj.bmj.com/content/96/1137/412 Antonino Giordano, Ghil Schwarz, Laura Cacciaguerra, Federica Esposito, Massimo Filippi. COVID-19: can we learn from encephalitis lethargica? The Lancet Neurology, 2020;19(7):570 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30189-7/fulltext#articleInformation Mark A Ellul, Laura Benjamin, Bhagteshwar Singh, Suzannah Lant, Benedict Daniel Michael, Ava Easton, Rachel Kneen, Sylviane Defres, Jim Sejvar, Tom Solomon. Neurological associations of COVID-19, Lancet Neurol 2020, https://doi.org/10.1016/S1474-4422(20)30221-0 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30221-0/fulltext Lijing Yang, Lei Tu. Implications of gastrointestinal manifestations of COVID-19. Lancet Gastroenterol Hepatol 2020; May 12, 2020. https://doi.org/10.1016/S2468-1253(20)30132-1https://www.thelancet.com/pdfs/journals/langas/PIIS2468-1253(20)30132-1.pdf Galeotti, C., Bayry, J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol (2020). https://doi.org/10.1038/s41584-020-0448-7https://www.nature.com/articles/s41584-020-0448-7 Ngai, J.C., Ko, F.W., Ng, S.S., To, K.‐W., Tong, M. and Hui, D.S. The long‐term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology, 2010, 15: 543-550. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1843.2010.01720.x Ong, Kian-Chung et al. 1-Year Pulmonary Function and Health Status in Survivors of Severe Acute Respiratory Syndrome. CHEST, 2005, Volume 128, Issue 3, 1393 - 1400 https://journal.chestnet.org/article/S0012-3692(15)52164-8/fulltext https://www.thecourier.co.uk/fp/news/politics/scottish-politics/1414976/100-days-ill-health-secretary-pledges-support-for-long-haul-covid-19-patients-who-never-got-better/ https://www.bbc.co.uk/news/health-53291925 https://www.england.nhs.uk/2020/07/nhs-to-launch-ground-breaking-online-covid-19-rehab-service/ Watson Jessica, Whiting Penny F, Brush John E. Interpreting a covid-19 test result. BMJ 2020; 369: m1808https://www.bmj.com/content/369/bmj.m1808 Fan Wu, Aojie Wang, Mei Liu, Qimin Wang, Jun Chen, Shuai Xia, Yun Ling, Yuling Zhang, Jingna Xun, Lu Lu, Shibo Jiang, Hongzhou Lu, Yumei Wen, Jinghe Huang. Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications. medRxiv 2020.03.30.20047365; doi: https://doi.org/10.1101/2020.03.30.20047365 https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v2 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/890566/Evaluation_of_Abbott_SARS_CoV_2_IgG_PHE.pdf https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/891598/Evaluation_of_Roche_Elecsys_anti_SARS_CoV_2_PHE_200610_v8.1_FINAL.pdf https://www.liincstudy.org/en/study-information Dominique Batisse MD Assistance, Nicolas Benech MD, Elisabeth Botelho-Nevers MD, Kevin Bouiller MD, Rocco Collarino MD, Anne Conrad MD, Laure Gallay MD, Francois Goehringer MD, Marie Gousseff MD, Dr Cedric Joseph MD, Adrien Lemaignen MD, PhD, Franc¸ois-Xavier Lescure MD, Bruno Levy MD, PhD, Matthieu Mahevas MD, PhD, Pauline Penot MD, Bruno Pozzetto MD, PhD, Dominique Salmon MD, PhD, Dorsaf SLAMA , Nicolas Vignier MD, PhD, Benjamin Wyplosz. Clinical recurrences of COVID-19 symptoms after recovery: viral relapse, reinfection or inflammatory rebound? Journal of Infection (2020), doi: https://doi.org/10.1016/j.jinf.2020.06.073 https://www.sciencedirect.com/science/article/pii/S0163445320304540?fbclid=IwAR0WEEf9dNtmXmFuU-m67g-Fs5SLdckb1f-FnNzSnX1tT4dw3uGWmsfnS60 Ding, H., Yin, S., Cheng, Y., Cai, Y., Huang, W. and Deng, W. Neurologic manifestations of nonhospitalized patients with COVID‐19 in Wuhan, China. MedComm, 2020. doi:10.1002/mco2.13 https://onlinelibrary.wiley.com/doi/full/10.1002/mco2.13?fbclid=IwAR1yQ8DkVOCsIdonjuzl8tx7LlBp0_Lt6KgVUW79SrFwo-_9nyZmWiz7rsQ
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    Report findings Prevention campaigns are badly targeted and referral rates for those who do develop a health condition are inconsistent. At every stage marginalised communities face barriers to accessing high-quality recovery and rehabilitation services, including through societal discrimination, lack of cultural competence or communication barriers. A lack of consistent data is damaging the ability of health services to provide rehabilitation that meets needs. Without high-quality rehabilitation a patient experiences a downward spiral, and the prevalence of one LTC can often lead to multiple conditions.
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    Millions of people in the UK are suffering poor health because they miss out on vital rehabilitation after strokes, heart attacks and cancer, which in turn is also heaping further pressure on the NHS, a damning report warns. Physiotherapists say some groups of patients are particularly badly affected. Without access to these services, many patients desperately trying to recover from illness became “stuck in a downward spiral”, they said, with some developing other health conditions as a result. The new report by the Chartered Society of Physiotherapy (CSP) says millions of people in marginalised communities, including those from ethnic minorities, are not only more likely to live shorter lives, but also spend a greater proportion of their lives struggling with health difficulties. Vital services that could tackle those inequities are either unavailable or poorly equipped to meet their needs, the report warns, adding that “some communities face particular barriers”. Prof Karen Middleton, the chief executive of the CSP, said: “Rehabilitation services have been under-resourced for decades and were not designed coherently in the first place. This has exacerbated poor health outcomes, particularly for people from marginalised groups. “It’s not only the individual who suffers. Without adequate access to rehabilitation, health conditions worsen to the point where more and more pressure is eventually piled on struggling local health systems and other public services. “We desperately need a modernised recovery and rehabilitation service that adequately supports patients following a health crisis and prevents other conditions developing.” Read full story Source: The Guardian, 21 September 2022
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    Findings: 28% of people living with a SCI experience suicidal ‘ideation’ – frequent thoughts or ideas about committing suicide 47% of people living with a SCI reported experiencing mental health problems in one or more of the assessed mental health conditions 68% of people living with a SCI who accessed NHS psychological support have stopped because it was either “not appropriate for their condition” or “making their condition worse” It’s really not just physical. The findings of this seminal research is a wake-up call for the NHS, healthcare planners and policymakers to provide better mental health support services for SCI people - and their unpaid carers - as a matter of urgency.
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    The manifesto calls for equal access to high-quality, person centred community rehabilitation. It highlights current gaps in services, discusses the impact of the Covid-19 pandemic and states that failing to provide equal access to community rehabilitation falls short of the NHS constitution. It identifies the negative impact of inadequate community rehabilitation services, including: reduced quality of life and independence for people with long term conditions. increased risk of death for cardiovascular disease patients. increased emergency hospital admissions for falls. increased overall costs for the NHS (for example, in treating traumatic brain injury). increased healthcare inequalities. The manifesto argues that community rehabilitation must be radically reformed to: be fully accessible, helping people overcome any barriers they face. be truly person-centred, tailored to meet individuals’ multiple physical and psychological needs. be seen as an equal priority to domiciliary care, nursing and residential care in local authority adult social care planning and provision. embrace social prescribing. harness new technology and innovation seen in the response to the pandemic to provide a wider menu of options.
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    Suicidal thoughts are three times as common in those living with a spinal cord injury in the UK, according to new research And yet, it’s estimated that only one third of people living with a spinal cord injury (SCI) are getting access to mental health support, and of those, 68% do not feel that support services available are able to meet their needs. These alarming statistics are taken from a new report, ‘It’s not just physical’ which was presented to parliament yesterday (17 November). The report shines a light on the mental health problems faced by people with spinal cord injuries in the UK today. It's calling on the NHS, government and other health policy makers to provide better mental health support services for people with spinal cord injuries – and their unpaid carers – as a matter of urgency. Nik Hartley, Spinal Injuries Association CEO said: “We are at risk of failing thousands of people in the UK living with a spinal cord injury. Our new report highlights that psychological damage caused by a SCI is, at best, considered as an afterthought, and at worst, completely ignored by the medical profession. We need urgent action and for services to be sufficiently specialised to support the thousands of people living with this type of injury before it is too late.” Read full story Source: Spinal Injuries Association, 17 November 2021
  15. Content Article
    Researchers from the Faculty of Health at the University of Plymouth together with collaborators from NHS Trusts in Devon and Cornwall have been working on developing an online toolkit of resources – ‘The Telerehab Toolkit’. The toolkit is designed to support health and social care practitioners in the remote assessment and management of people with movement impairment and physical disability, including people recovering from COVID-19. This project has been funded by the UKRI Medical Research Council. The content of the toolkit is based on interviews and discussions with over 100 practitioners, patients and their family members, a survey of 247 UK practitioners and a review of the latest evidence. It contains sections for practitioners and for patients, with information and guidance on online and telephone appointments as well as links to other useful resources.
  16. News Article
    In the largest independent randomized controlled trial (RCT) of its type, a multimodal digital therapy program for patients with non-specific chronic low back pain has outperformed standard-of-care treatment across all medical outcomes. Results of the study, published in the Journal of Pain Research, show that patients using Kaia, the back pain management app developed by leading digital therapeutics company Kaia Health, reduced pain levels, anxiety, depression, stress, and improved wellbeing and body functionality significantly more compared to standard-of-care treatments, e.g. pain killers, surgeries, physical therapy. “This large-scale study demonstrates the significant benefits for people managing low back pain when using Kaia to deliver a multimodal treatment through a digital device, such as a smartphone,” says Thomas R. Toelle, M.D., Ph.D., Head of the Pain Center of the Technical University Munich, Germany. “These results add to the growing body of medical evidence that supports the use of digital multimodal treatments for chronic conditions, such as back pain.” Low back pain is one of the leading causes of global disability, with an enormous cost for healthcare systems worldwide. 1,2 According to a 2018 report on the impact of musculoskeletal pain on employers, chronic pain, including back pain, accounts for 188.7 million lost work days, and $62,4 billion in lost productivity cost.3 Kaia is an app-based, multimodal digital therapy program for chronic back pain, which focuses on Physical therapy, Relaxation exercises, and Medical education.
  17. Content Article
    Concerns about patient safety and support Patients living with Long Covid have been left ‘joining the dots’ to try to understand how they can access safe, quality care and what they can do to improve their health. Their physical and mental health, employment and economic circumstances have, in many cases, been affected by the barriers they have faced. Those living with Long Covid have highlighted a number of concerns, from which we have identified eight key themes: 1. Inconsistent care and contradicting advice Serious clinical symptoms are not being investigated consistently or referred on to the appropriate specialties. There are concerns that failure to investigate could have a negative impact on health outcomes. In July 2020, the National Institute of Clinical Excellence cautioned against the use of graded exercise therapy (GET) for patients recovering from Covid-19.[2] However, contradictory advice is still being given around GET as a safe rehabilitation approach, with many raising concerns that it could be deeply harmful. [3] [4] [5] [6] Inconsistencies of access to Long Covid assessment centre services, particularly in Wales, Northern Ireland and Scotland. Huge variations in the medical support and care given. There is a risk that existing health inequalities may be widened as a result of this. 2. Employment and welfare There is a lack of wider understanding about the debilitating impact of Long Covid and how it affects people’s lives and ability to work. [7] [8] This can lead to inadequate support from employers and an inconsistent approach to benefits. Government benefits do not address the devastating economic impact that Long Covid has had for many people. 3. Children with Long Covid More work needs to be done to understand how Long Covid is presenting in children and to raise awareness of the profound impact Long Covid can have on young people.[9] The assessment services, which were part of the five-point plan laid out by the NHS to address Long Covid, do not include services for children.[10] There needs to be better information available to schools on how they can support children living with the effects of Long Covid and any reasonable adjustments that may be necessary to support their educational and health needs. 4. NHS workforce and resource planning Service provision must accurately reflect the vast number of people living with Long Covid in the UK who were and were not hospitalised. This is necessary for the NHS to understand the scale of the challenge and to effectively mitigate against a pandemic of chronic ill health. There are concerns that the wide-ranging needs of these patients may not be adequately reflected in NHS workforce planning, service delivery and funding. A large number of NHS staff are living with Long Covid, unable to work at all, or to their previous capacity. 5. Knowledge gaps among health professionals There is a poor understanding among some health professionals of Long Covid, how to diagnose it and how it can impact people’s lives. This can result in misdiagnosis or a disbelief that patients are still unwell. Some patients are finding they are unable to access further assessment or treatment due to their GPs not believing they have Long Covid, distance from clinics, not having been hospitalised or not having a confirmed positive test result (despite Royal College of GP’s guidance to the contrary).[11] Some GPs are unaware of the location of assessment clinics or how to refer patients to services (e.g. the ‘Your Covid Recovery’ tailored rehabilitation programme). There does not seem to be a clear strategy for training healthcare professionals on case recognition and referral pathways. 6. Data, research and insight gaps Including, but not limited to, the following: Currently there is insufficient understanding of the risk factors, mechanism or pathophysiology of Long Covid, appropriate diagnostic techniques as well as prevention or treatments. There is a lack of research into the debilitating impact Long Covid can have on children’s health, education and wellbeing.[12] 7. Public health messaging not reflective of Long Covid Public health messaging and reporting do not include the proportion of both adults and children who are experiencing Long Covid. Public health messaging (and the NHS website) does not reflect the range of initial acute symptoms of Covid-19 or those experienced by people living with Long Covid. Public health messaging does not reflect the severity and relapsing nature of Long Covid. 8. Communication and engagement gaps There is no patient and public involvement strategy for Long Covid. Assessment centres (previously referred to as Long Covid clinics) are being established but there is lack of information about the services they provide, where they are, how patients can access them and how clinicians can refer. It is unclear what treatments and support are available post-assessment, and what resources are needed to meet this growing need. There does not seem to be a clear strategy for providing health professionals with the necessary information to be able to support Long Covid patients. Currently there is no coordinating task group or Government body specifically working to understand the whole spectrum of issues relevant to Long Covid and how they intertwine. Long Covid Minister and cross-government task force We are calling on the Prime Minister to appoint a Minister for Long Covid. This role would be responsible for coordinating a UK Cross-government task force, accountable for broad oversight and action relating to the Long Covid crisis. This multi-stakeholder approach would go far beyond the remit of the current NHS England Task Force for Long Covid. Membership To respond to the broad spectrum of issues, we would anticipate that this Task Force would involve collaboration between officials from departments across the government, including: ● Department of Health and Social Care ● Department of Work and Pensions ● Public Health England ● HM Treasury ● Department for Education ● No 10/Cabinet Office C-19 Taskforce ● NHS England and NHS Improvement ● NHS England and NHS Improvement Long Covid Task Force ● Northern Ireland Executive ● Scottish Government ● Welsh Government Communication and engagement There is an urgent need for a Long Covid communication and engagement strategy, to include information and updates for patients, clinicians, relevant organisations and the public. This needs to be a genuine two-way process with proactive action to inform, support and educate, and to obtain feedback from all relevant parties. The effectiveness of these communications must be monitored to ensure that key stakeholders are receiving the information and guidance they need to support people living with Long Covid. Patient engagement is proven to be a key factor in designing effective services and improving clinical outcomes; it should never be viewed as ‘nice to have’ or applied in a tokenistic way. Those with lived experience of Long Covid must be seen as partners at every step of the response, with a clear involvement strategy to ensure that decisions ‘about them’ are not made ‘without them’. To undervalue this input would be incredibly short-sighted and would contravene NHS policy.[13] The task force should be responsible for delivering the communication and engagement strategy to help address the concerns we have outlined in the eight themes. Engaging with organisations outside of the cross-government task force will be essential and should include: ● Long Covid peer support groups and those with lived experience ● Patient information experts ● Occupational health experts ● Royal colleges ● Trade unions ● Citizens Advice Conclusion More must be done to ensure that people living with Long Covid are able to access safe, quality care and that every effort is made to empower those around them to support their recovery. We believe that a multi-stakeholder approach, led by a dedicated Minister, is key to responding to, and planning for, the growing challenges of Long Covid. The current absence of oversight and accountability poses a risk to patients and must be addressed urgently. References Office for National Statistics, The prevalence of long COVID symptoms and COVID-19 complications, 16 December 2020. Torjesen, Ingrid, NICE cautions against using graded exercise therapy for patients recovering from covid-19, BMJ 2020; 370:m2912. Health and Service Executive, Long Covid and the Workplace: What does the evidence support in terms of intervention, 13 January 2021. Torjesen, Ingrid, NICE backtracks on graded exercise therapy and CBT in draft revision to CFS guidance, BMJ 2020; 371:m4356. ME Action Network, Long COVID Patients Warned Of Damaging Exercise Programme, 3 November 2020. Tuller, David, Trial By Error: Professor Paul Garner’s BMJ Blog Post on His Powerful Cognitions, 28 January 2021. The Guardian, Many ‘long Covid’ sufferers unable to fully work six months later, 5 January 2021. People Management, Should HR be worried about long Covid? , 28 January 2021. University of Cambridge, Video: Long Covid Kids – 5 News, 24 November 2020. NHS England and NHS Improvement, NHS to offer ‘long covid’ sufferers help at specialist centres, 7 October 2020. Royal College of General Practitioners, Management of the long-term effects of COVID-19, 30 October 2020. The BMJ Opinion, Counting long covid in children, 16 October 2020. NHS England and NHS Improvement, NHS England Patient and Public Voice Partners Policy, July 2017.
  18. Content Article
    Key recommendations Data should be collected systematically on cases of Long COVID and presented alongside numbers of cases, hospitalisations and deaths from COVID-19. Building on the experience of the Post-Hospitalisation study, a national register of patients with Long COVID should be established, including those who have not required hospitalisation, to enable long-term follow-up and thus a better understanding of thenatural history of this condition. This should include specific codes for GPs to use so that patients can be followed up and tracked in research studies over the longer term. Further efforts should be undertaken to ensure that all health professionals likely to come into contact with patients who have Long COVID are fully aware of the existing NICE guidelines. Clinical commissioning groups and their equivalents in the devolved nations should ensure that there are appropriate models of care in place, including multi-disciplinary and multi-specialist teams, with clearly defined pathways through which patients can access them. Research studies funded so far will provide invaluable information, but there is a need for continuing review to identify emerging gaps in our knowledge, especially in relation to the impact of Long COVID on people’s lives and how they are overcomingthe challenges they face.Patients with Long COVID should be recognised as an extremely important resource in shaping research and policy in relation to this condition.
  19. Content Article
    The COGER study, designed by members of the Special Interest Group for Geriatric Rehabilitation of the European Geriatric Medical Society (EuGMS), study aims to: Explore the course of activities of daily living (ADL) recovery and influencing factors. Describe other outcomes after geriatric rehabilitation in post-COVID-19 patients. Describe geriatric rehabilitation services provided to post COVID-19 patients across Europe. The study group are presently looking for rehabilitation services to volunteer to support the work. By taking part you will help them to understand how older people recover from COVID-19, and the services that make a difference. It is possible that data collected will help further the understanding of long-term questions about the best configuration of rehabilitation for older people. This could help harmonise approaches across Europe in an evidence-based way. How to get involved: Firstly, please download and read the protocol document on the BGS website. If you are a centre in the UK, please email j.gough@bgs.org.uk indicating your interest in participating. Germany - If you are from Germany and wish to participate, please email Stefan Grund. Rest of Europe - If you are elsewhere in Europe, please email Miriam Haaksma.
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  22. News Article
    Demand for oxygen from COVID-19 patients recovering at home is set to place the NHS under strain, the health service has warned. NHS England has issued guidance to out-of-hospital health providers on the extra demands likely to be placed on them given the number of people recovering after a hospital stay with the coronavirus. It warns that the provision from its home oxygen services and community respiratory teams across the NHS is expected to be an issue as the scale of demand increases. Andrew Whittamore, a practising GP and clinical lead for the Asthma UK and British Lung Foundation partnership, said concerns about the potential for hospitals to be overwhelmed in the early part of the pandemic had led to community oxygen teams being primed to take on more patients – but he described that ramping up as “a short-term fix”. “We don’t know how long people are going to need oxygen or other services for,” he said. “There are definitely going to be extra patients added on to our community teams’ workloads.” The Taskforce for Lung Health – of which the British Lung Foundation is a member – has raised particular concerns about access to pulmonary rehabilitation. An education- and exercise-based treatment, which is proven to be more effective for lung patients than many drug-based treatments, and face-to-face classes have been suspended during the pandemic. It may be that such treatment would also be helpful for some patients recovering from COVID-19. Jackie Eagleton, policy officer at the British Lung Foundation, said there had been issues with access to pulmonary rehabilitation for a long time, but the need to offer this form of support to people with lung conditions “has never been more pressing than it is now”. Read full story Source: The Independent, 16 June 2020
  23. News Article
    The health service will face a “tsunami” of coronavirus survivors discharged from hospitals needing long-term physical and mental support that the NHS will struggle to provide, The Independent has been told. Coronavirus can leave patients with lasting physical damage and scarring to their lungs, meaning many could struggle to breathe and move around as well as they did before – in some cases permanently. Patients admitted to intensive care can also suffer physical effects of being paralysed weeks and almost half who are ventilated with a tube in their windpipe will experience a form of delirium that can include terrifying hallucinations and leave survivors with lasting mental problems including post-traumatic stress. Experts have warned a long-term lack of funding of NHS rehabilitation services and post-discharge care for ITU patients means the health service will struggle to help the thousands of patients who beat the virus but face a long road to recovery. Read full story Source: 3 May 2020
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    Documents include: COVID-19 guideline scope: management of the long-term effects of COVID-19 Equality impact assessment Management of the long-term effects of COVID-19 Management of the long-term effects of COVID-19: organisations that responded to targeted peer consultation on the draft scope Management of the long-term effects of COVID-19:Targeted peer consultation on draft scope comments table Summary of consultation comments and responses for COVID-19 guideline scope: management of the long-term effects of COVID-19. To find out more about the guideline and to register as a stakeholder, please follow the link below. For ease, the above documents are also attached below.
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