Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches.

Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

'When you have the adrenalin pumping, it kind of flushes out any negative emotions': a qualitative exploration of the benefits of playing football for people with mental health difficulties.

BACKGROUND: Physical activity is a factor by which mental health can be improved. However, the association between mental health and physical exercise, in a "team-based sport" setting within the community, remains unclear. AIMS: The current paper aims to provide an evaluation of a football programme, implemented by Time to Change Wales, funded by the Welsh Government, to improve mental health. METHODS: Participants attended weekly 90-120 minute football sessions, held in local community venues across Wales, UK, with no requirement on the number of sessions that participants had to attend. A qualitative method was employed to explore the experiences of those who took part. RESULTS: Individuals who participated in the programme reported psychosocial and physical benefits, such as improved physical and mental health, improved social confidence and having a sense of purpose added to their day-to-day living. Factors affecting participation were also identified within the data, such as environmental barriers. Conclusion: The findings provide both support and contextual extension to previous research in this area; demonstrating the positive effects of sport-based therapy for those with mental health difficulties. Implications and conclusions should be used to inform future research into developing community sport-based programmes to improve mental health.

Impact of eye clinic liaison officers: a qualitative study in UK ophthalmology clinics.

OBJECTIVES: To explore the impact of eye clinic liaison officers (ECLOs, also known as sight loss advisors) on the processes, functions and quality of ophthalmology clinics through the experiences of ophthalmology staff in the UK. DESIGN: Qualitative study. SETTING: UK hospital ophthalmology clinics. PARTICIPANTS: Health and social care professionals in the UK. RESULTS: ECLOs who had a presence in hospital ophthalmology clinics were seen as valuable in streamlining processes within the clinic, particularly in relation to the certification of visual impairment process, and providing continuity of care for patients when they were discharged from medical treatment. ECLOs also saved staff time in the clinic, as they were often responsible for providing emotional and practical support for patients living with sight loss. CONCLUSIONS: ECLOs are well placed in ophthalmology clinics. They can relieve pressure on clinical staff by taking on information giving and referring duties, allowing other staff to focus on their clinical responsibilities. The impact of ECLOs may depend on efficient communication with the clinical team, being trusted by other staff and having a good knowledge of local and national sight loss support services outside of the hospital setting. Further research could enhance our understanding of how much time and associated costs ECLOs substitute in the ophthalmology clinic.

Evaluating the role of Cardiac Genetics Nurses in inherited cardiac conditions services using a Maturity Matrix.

BACKGROUND: Cardiovascular disease is a leading cause of death worldwide and genetic risk factors play a role in nearly all such cases. In the UK, health service capacity to meet either current or future estimated needs of people affected by inherited cardiac conditions (ICCs) is inadequate. In 2008 the British Heart Foundation funded nine three-year Cardiac Genetics Nurse (CGN) posts across England and Wales to enhance ICC services. The CGNs were experienced cardiac nurses who had additional training in genetics and acted to coordinate cardiac and genetics service activities. AIM: To create and apply a framework against which progress in ICC service improvement could be measured over time following the CGN appointments. METHODS: A performance grid (Maturity Matrix, MM) articulating standards in five domains against stages of ICC service development was created by stakeholders through a consensus approach. The MM was used to guide staged self-assessments by the CGNs between 2009 and 2011. A six-point scale was used to locate progress from 'emerging' to 'established', represented graphically by spider diagrams. RESULTS: Progress in all domains was significant for new, emerging and established services. It was most notable for effective utilisation of care pathways and efficient running of clinics. Commitment to family-centred care was evident. CONCLUSION: The ICC-MM provided a comprehensive framework for assessing ICC services and has merit in providing guidance on development. CGNs can help integrate care across specialisms, facilitating the development of effective and sustainable ICC services at new, developing, and more established ICC service locations.

A national health inequalities fund for Wales: concept, design and implementation.

OBJECTIVES: To evaluate the potential for a national innovation fund, in the context of devolved health policy, to stimulate local action to deliver national priorities, using as a case study the conception, design and implementation of the £30m Welsh Assembly Government's (WAG) Inequalities in Health Fund (IiHF) 2001-08. METHODS: Multi-method evaluation of the national and local conception, design and implementation of the Fund, using analysis of documentary evidence, interviews and focus groups with national (Wales) officials and more than 170 local managers and professionals. The field work was carried out between October 2004 and June 2007. RESULTS: Different approaches at the three stages (concept, design, implementation) can reduce or enhance the effectiveness of funds like this one as a tool for achieving national objectives, and these are described. CONCLUSIONS: National funds can be a useful lever for change, if appropriately conceived, designed and implemented. However, in the context of competing healthcare and other policy priorities, 'good practice' is often difficult to achieve, and somewhat simplistic incentives are often subverted locally, diluting the original purpose of the initiative.

Floods and tsunamis.

Floods and tsunamis cause few severe injuries, but those injuries can overwhelm local areas, depending on the magnitude of the disaster. Most injuries are extremity fractures, lacerations, and sprains. Because of the mechanism of soft tissue and bone injuries, infection is a significant risk. Aspiration pneumonias are also associated with tsunamis. Appropriate precautionary interventions prevent communicable dis-ease outbreaks. Psychosocial health issues must be considered.

A comparison of the figure-of-eight method and water volumetry in measurement of hand and wrist size.

The purpose of this study was to develop a tape measure method to assess the size of the hand and wrist. This tape measure method was designed to be readily performed, easily administered, reliable, and valid compared with water volumetry. The study sample included 50 normal consenting volunteers. Two examiners measured each hand of each subject three times, alternating hands between measurements. In the second phase of the study, the same two examiners measured both hands of the subjects using the traditional water volumetry method. The intraclass correlation coefficients for intra- and interater reliability obtained were 0.99. Pearson product-moment correlation values between the figure-of-eight tape measure and the water volumetry method for the two examiners were 0.94 and 0.95, respectively. The figure-of-eight method demonstrated excellent reliability and concurrent validity compared with the water volumetry method. These results support the application of the figure-of-eight method as a reliable and valid evaluation tool for the assessment of hand and wrist size.