Acute Respiratory Infection Hubs: A Service Model with Potential to Optimise Infection Management.

Patients with acute respiratory infections (ARI)-including those with upper and lower respiratory infections from both bacterial and viral pathogens-are one of the most common reasons for acute deterioration, with large numbers of potentially avoidable hospital admissions. The acute respiratory infection hubs model was developed to improve healthcare access and quality of care for these patients. This article outlines the implementation of this model and its potential impacts in a number of areas. Firstly, by improving healthcare access for patients with respiratory infections by increasing the capacity for assessment in community and non-emergency department settings and also by providing flexible response to surges in demand and reducing primary and secondary care demand. Secondly, by optimising infection management (including the use of point-of-care diagnostics and standardised best practise guidance to improve appropriate antimicrobial usage) and reducing nosocomial transmission by cohorting those with suspected ARI away from those with non-infective presentations. Thirdly, by addressing healthcare inequalities; in areas of greatest deprivation, acute respiratory infection is strongly linked with increased emergency department attendance. Fourthly, by reducing the National Health Service's (NHS) carbon footprint. Finally, by providing a wonderful opportunity to gather community infection management data to enable large-scale evaluation and research.

Evaluation of the NHS England evidence-based interventions programme: a difference-in-difference analysis.

BACKGROUND: The NHS England evidence-based interventions programme (EBI), launched in April 2019, is a novel nationally led initiative to encourage disinvestment in low value care. METHOD: We sought to evaluate the effectiveness of this policy by using a difference-in-difference approach to compare changes in volume between January 2016 and February 2020 in a treatment group of low value procedures against a control group unaffected by the EBI programme during our period of analysis but subsequently identified as candidates for disinvestment. RESULTS: We found only small differences between the treatment and control group after implementation, with reductions in volumes in the treatment group 0.10% (95% CI 0.09% to 0.11%) smaller than in the control group (equivalent to 16 low value procedures per month). During the month of implementation, reductions in volumes in the treatment group were 0.05% (95% CI 0.03% to 0.06%) smaller than in the control group (equivalent to 7 low value procedures). Using triple difference estimators, we found that reductions in volumes were 0.35% (95% CI 0.26% to 0.44%) larger in NHS hospitals than independent sector providers (equivalent to 47 low value procedures per month). We found no significant differences between clinical commissioning groups that did or did not volunteer to be part of a demonstrator community to trial EBI guidance, but found reductions in volume were 0.06% (95% CI 0.04% to 0.08%) larger in clinical commissioning groups that posted a deficit in the financial year 2018/19 before implementation (equivalent to 4 low value procedures per month). CONCLUSIONS: Our analysis shows that the EBI programme did not accelerate disinvestment for procedures under its remit during our period of analysis. However, we find that financial and organisational factors may have had some influence on the degree of responsiveness to the EBI programme.

Seeing and managing the icebergs

[...]they may not always have the priority they merit on every leadership agenda, both during the COVID-19 crisis and in normal times. [...]the leadership challenges of addressing the socially structured health disparities may not have received the research attention they deserve. [...]a black or Asian female leader can be judged negatively for behaviours that are acceptable or even valued in a white male leader.8 9 In response to these challenges, we will shine a light on diversity and inclusion and we will broaden and change ideas of leaders and leadership. In a recent article in BMJ Leader, Gilmartin et al focus on diversity and gender balance among leaders as an important organisational capacity, and offer tangible advice on how this capacity can be developed.10 Gender diversity in leadership can be enhanced through the combination of mentorship, talent management, training and network opportunities, improvements to advertising, interview panel diversity and succession planning.8 Talent needs to be nurtured, and organisations need policies for inclusion and talent management that embraces and promotes diversity. Leadership development programs for physicians: a systematic review.

This is different

Correspondence to Professor Amit Nigam, Cass Business School, City, University of London, London EC1Y 8TZ, UK;Amit.Nigam.1@city.ac.uk Martin Luther King Jr, in the midst of the civil rights movement, referred to the ongoing protests by noting, ‘It would be fatal for the nation to overlook the urgency of the moment’.1 Broaden the context to the entire world as it faces and responds to the COVID-19 pandemic, and his words resonate today. On 27th February 2020, the Johns Hopkins University Centre for Systems Sciences and Engineering reported 82 700 cases worldwide, most of these in China;just over 1 month later, on 1st April 2020, that number was exceeded by cases in Italy (105 792), Spain (102 136) and the USA (189 633), while the global figure stood at 873 767.2 On the same date and time, deaths worldwide numbered 43 288, with the Imperial College COVID-19 response team estimating that unmitigated, the pandemic could lead to 40 million deaths globally this year.3 Allied to the health impact there is the socio-economic one. On 25 March 2020 it was estimated that over a quarter of the world’s population were already living in some form of ‘lockdown’ with restricted mobility and civil liberties.5 The physical and mental health impacts of prolonged domestic confinement, limitations on activity and exercise, loss of income and employment, to say nothing of diversion of existing health resources to counter COVID-19, are as yet unquantified but will be significant.