Care Quality Commission

Youth Mental Health First Aid Training was offered to school nurses across a large community NHS Trust to support school nurses' understanding of children and young people's mental health needs. School nurses' levels of knowledge and confidence were audited pre- and post-training as part of a Quality Improvement Project. The results from this audit demonstrate that that the 2-day training course significantly improved school nurses' understanding of young people's mental health needs in relation to suicidal ideation, self-harming behaviour, psychosis, and common mental health disorders. The findings also demonstrated that the nurses who had completed the training felt more confident in supporting this cohort of children and empowered to use the newly acquired skills as part of their school nursing role.

Background Women often face the challenge of balancing professional growth with societal expectations around family and household responsibilities. Conversely, men encounter limitations due to restrictive paternity leave policies, often receiving undue praise for basic parenting duties. Through the lens of the Chief Pharmaceutical Officer’s clinical fellows 2023/24, we explore the question: ‘Can you have it all?’ Methods We explore stereotypical gender norms alongside the challenges and expectations faced by individuals of all genders on their leadership journeys. Through personal reflections, literature review and informal conversations with senior leaders, we explore how societal expectations and gendered norms shape the professional and personal lives of women in leadership roles. Results Commitment to reflection provides opportunities to pause and assess our journeys. Peer support networks are invaluable for professional development, helping to break down barriers and hierarchies. Coaching and mentoring offer significant support and guidance to aspiring leaders from underrepresented backgrounds providing new perspectives. Conclusion Balancing leadership and family responsibilities is challenging but achievable with the right support systems and a shift in workplace culture. However, we recognise, through all of this, self-care and prioritisation of mental well-being must be at the forefront to sustain a healthy balance. As clinical fellows, we have had the unique opportunity to share the complexities faced in the workplace. Through collective effort, we aim to foster environments that empower individuals on their leadership journeys, illustrating that, with the right support and conditions, it is possible to truly ‘have it all’.

The Humberside Enhanced Resettlement Service (HERS) was a psychologically informed, supported accommodation service for people on probation whose presentation is consistent with personality disorder. An evaluation, utilising semi-structured interviews, identified four themes of experience for people on probation and their probation practitioners who worked with HERS: (1) relationships; (2) practical support; (3) expectations, and (4) risk. This suggested that providing psychologically led supported accommodation enhances therapeutic relationships between professionals and people on probation, which may assist in reducing reoffending. Conclusions are tentative due to methodological limitations and future research should employ more robust methods to assess the impact of similar psychologically informed supported accommodation projects.

Objectives Safety culture surveys have been widely used in healthcare for more than two decades predominantly as a tool for measuring the level of safety culture (as defined as the beliefs and attitudes that staff express about how their organisation ought to work and how it does in fact work). However, there is the potential for the survey process itself to influence the safety culture and working practices in departments and organisations. The objective of this study was to identify the mechanism by which these changes might occur. Design, setting and participants Mixed methods combining qualitative semi-structured interviews and quantitative scores from patient safety surveys. This evaluation was conducted across general practice, community and acute hospitals in two NHS regions in England; South West and Greater Manchester. The study was undertaken between 2015 and 2018 during the implementation of a series of Patient Safety Collaboratives. Safety, Communication, Operational Reliability, and Engagement (SCORE) surveys were administered in 15 units, followed by a staff debriefing and a second SCORE survey. Semi-structured interviews were conducted with clinicians (n=61). Results from the first and second surveys were compared in order to test for differences in responses. Sixty-one semi-structured interviews were conducted across participating units and thematically analysed. Analysis and results Results from the first and second surveys were compared using chi-squared and Fisher’s exact tests. Sixty-one semi-structured interviews were conducted across participating units and thematically analysed. There was little change in responses between the first and second SCORE surveys. Within general practice there was some improvement in responses in three survey domains; however, these differences were not conclusive. The qualitative interview data demonstrated a beneficial effect on safety culture. Staff stated that the survey debriefings created a new safe space where problems could be discussed and improvement plans created. Conclusions Safety culture surveys can improve safety culture within departments if they are followed by a process that includes debriefing the staff and working with them to develop improvement plans.

The COVID-19 pandemic has had high mortality rates in the elderly and frail worldwide, particularly in care homes. This is driven by the difficulty of isolating care homes from the wider community, the large population sizes within care facilities (relative to typical households), and the age/frailty of the residents. To quantify the mortality risk posed by disease, the case fatality risk (CFR) is an important tool. This quantifies the proportion of cases that result in death. Throughout the pandemic, CFR amongst care home residents in England has been monitored closely. To estimate CFR, we apply both novel and existing methods to data on deaths in care homes, collected by Public Health England and the Care Quality Commission. We compare these different methods, evaluating their relative strengths and weaknesses. Using these methods, we estimate temporal trends in the instantaneous CFR (at both daily and weekly resolutions) and the overall CFR across the whole of England, and dis-aggregated at regional level. We also investigate how the CFR varies based on age and on the type of care required, dis-aggregating by whether care homes include nursing staff and by age of residents. This work has contributed to the summary of measures used for monitoring the UK epidemic.

Objectives To evaluate the awareness of the volunteer pharmacy workforce of medication use and their satisfaction with the pharmacy services of the Tokyo 2020 Olympic and Paralympic Games from a pharmacist’s perspective. Methods A questionnaire was developed from related articles in published peer-reviewed journals and modified prior to distribution to the whole population of pharmacists serving at the Tokyo 2020 Olympic and Paralympic Games. Validity tests were conducted based on expert opinions and Cronbach’s alpha (0.79). The questionnaire consisted of demographics (11 questions), knowledge of medication use in sports (8 questions) and satisfaction on the provision of the service (5 questions). Responses using a 5-point-Likert scale, from strongly agree (5) to strongly disagree (1), and two free text questions were analysed with descriptive statistics. Results The response rate was 86% (n=32/37). Overall, the pharmacists reported a high awareness of medication use. Specifically, questions on the prohibited list of medications (mean 4.0±SD 0.7), COVID-19 policy (3.8±0.9), use of alternative non-prohibited medications (3.6±1.0) and therapeutic use exemptions (3.5±0.9). Moreover, they rated high satisfaction with the pharmacy service they provided. However, rates were ≤3 for knowledge of the International Olympic Committee Needle Policy (2.6±1.0), Medication Importation Declaration (2.9±1.0) and communication skills (3.0±1.0). Conclusion Pharmacists were confident and satisfied with the pharmacy service at the games. The study confirms the importance of prior training and education. Game-specific policies and strategies to improve communication skills should be included in the pharmacy education for future Games.

Objectives: To determine the predictive value of the measurement of the diameter of the optic nerve sheath (ONSD) with ocular ultrasonography compared to invasive intracranial pressure (ICP) measurement for the detection of intracranial hypertension (ICH). Design: Prospective, observational study. Setting: Intensive Care Unit (ICU) of two tertiary university hospitals in Montevideo, Uruguay. Patients: We studied 56 adult patients of both sexes, over 18 years of age, who required sedation, mechanical ventilation, and invasive ICP monitoring (patients with severe, traumatic and non-traumatic AEI) with a Glascow Coma Score (GCS) equal to or less than 8 on admission to the ICU. Interventions: This was a study that utilized non-invasive (minimal risk) ultrasonography in patients admitted to the ICU. Measurements and main results: In our study, a logistic regression model was performed in which it was observed that the variable ONSD is statistically significant with a p value of 0.00803 (<0.05). This model estimates and predicts the probability that a patient will have an ICP greater than 20 mmHg. From the analysis of the cut-off points, it is observed that a value of 5.65 mm of ONSD maximizes the sensitivity (92.9%) of the method (a greater number of individuals with ICP > 20 mmHg are correctly identified). Conclusions: In sedated neurocritical patients, with structural Acute Brain Injury, the ONSD measurement strongly correlates with the ICP values measured invasively.

Background/aim The Care Quality Commissions’ (CQC) recent report into the impact and experience of CQC regulation for ethnic minority-led general practitioner (GP) practices found that ethnic minority-led practices are disproportionately situated in areas of deprivation, working single-handedly and without adequate systems of support. These challenges are not always accounted for in CQC’s processes or methodology (CQC, 2022). This study summarises a review of literature carried out as part of research by the CQC, which was published in January 2022. Methods Search terms included ‘GP’, ‘CQC’, ‘Black and Ethnic Minority GPs’ combined with Boolean operators. Grey literature was reviewed, and searches were undertaken of known authors in the field. Backwards and forwards reference harvesting was performed on identified literature. Limitations included the capacity and subjectivity of the reviewer, as well as the availability of studies with a focus on ethnic minority GPs as opposed to doctors whose place of primary medical qualification was outside of the UK. Results 20 evidence sources were identified and included. The literature review found that many ethnic minority-led GP practices are in complex cycle of inequality, which starts with recruitment and thereafter followed by deprivation, isolation, poor funding and low morale. The symptom of these factors is often poor regulatory outcomes and ratings. When these poor ratings are received, GP providers often struggle to recruit, which serves to perpetuate the cycle of inequality. Conclusion When CQC rates an ethnic minority-led practice as requires improvement or inadequate, this can perpetuate a cycle of inequality.

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners’ mental health problem on the couples’ communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER’s operational effectiveness.

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. As part of the intelligence-driven approach to regulation, the CQC works closely with national clinical audit bodies to identify key metrics which reflect quality of care and track the performance of providers against these metrics. Where outliers on national audits are identified that may reflect risks to patients, the CQC encourages the hospital to identify any learning points and implement changes to improve patient care.In this article, we describe the role of national audit outcomes in the regulatory process and how providers can use national audits to inform both quality assurance and quality improvement processes, with two illustrative case studies. We discuss the ongoing challenges with using audit data in the regulatory process and how these could be addressed.

Objective This study aimed to examine the long-term outcomes and health-related quality of life in patients with blunt thoracic injuries over 6 months from hospital discharge and develop models to predict long-term patient-reported outcomes. Design A prospective observational study using longitudinal survey design. Setting The study recruitment was undertaken at 12 UK hospitals which represented diverse geographical locations and covered urban, suburban and rural areas across England and Wales. Participants 337 patients admitted to hospital with blunt thoracic injuries were recruited between June 2018–October 2020. Methods Participants completed a bank of two quality of life surveys (Short Form-12 (SF-12) and EuroQol 5-Dimensions 5-Levels) and two pain questionnaires (Brief Pain Inventory and painDETECT Questionnaire) at four time points over the first 6 months after discharge from hospital. A total of 211 (63%) participants completed the outcomes data at 6 months after hospital discharge. Outcomes measures Three outcomes were measured using pre-existing and validated patient-reported outcome measures. Outcomes included: Poor physical function (SF-12 Physical Component Score); chronic pain (Brief Pain Inventory Pain Severity Score); and neuropathic pain (painDETECT Questionnaire). Results Despite a trend towards improving physical functional and pain at 6 months, outcomes did not return to participants perceived baseline level of function. At 6 months after hospital discharge, 37% (n=77) of participants reported poor physical function; 36.5% (n=77) reported a chronic pain state; and 22% (n=47) reported pain with a neuropathic component. Predictive models were developed for each outcome highlighting important data collection requirements for predicting long-term outcomes in this population. Model diagnostics including calibration and discrimination statistics suggested good model fit in this development cohort. Conclusions This study identified the recovery trajectories for patients with blunt thoracic injuries over the first 6 months after hospital discharge and present prognostic models for three important outcomes which after external validation could be used as clinical risk stratification scores.

Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community.

The Front Cover shows the structure of a novel iron intermediate species with an N‐heterocyclic carbene ligand containing a deprotonated amidate moiety. The presence of the amidate functionality is responsible for the excellent catalytic activity displayed by the iron complex in transfer hydrogenation of ketones to alcohols. The background image shows the iconic bridge of Lisbon to highlight that this paper is part of the International Symposium on Homogeneous Catalysis Special Collection. Oscar A. Lenis‐Rojas is acknowledged for the cover design artwork. More information can be found in the Full Paper by B. Royo and co‐workers.

The quest for active, yet “green” non-toxic catalysts is a continuous challenge. In this work, covalently linked hybrid porphyrin–nanodiamonds were prepared via ipso nitro substitution reaction and characterized by X-ray photoelectron spectroscopy (XPS), fluorescence spectroscopy, infrared spectroscopy (IR) and thermogravimetry-differential scanning calorimetry (TG-DSC). The amine-functionalized nanodiamonds (ND@NH2) and 2-nitro-5,10,15,20-tetra(4-trifluoromethylphenyl)porphyrin covalently linked to nanodiamonds (ND@βNH-TPPpCF3) were tested using Allium cepa as a plant model, and showed neither phytotoxicity nor cytotoxicity. The hybrid nanodiamond–copper(II)–porphyrin material ND@βNH-TPPpCF3-Cu(II) was also evaluated as a reusable catalyst in cyclohexene allylic oxidation, and displayed a remarkable turnover number (TON) value of ≈265,000, using O2 as green oxidant, in the total absence of sacrificial additives, which is the highest activity ever reported for said allylic oxidation. Additionally, ND@βNH-TPPpCF3-Cu(II) could be easily separated from the reaction mixture by centrifugation, and reused in three consecutive catalytic cycles without major loss of activity.

The Mental Health Units (Use of Force) Act 2018 is due to come into force, with the aim of increasing the management and oversight of the use of force in mental health hospitals. It does not, however, provide any powers for staff to lawfully restrain patients. Nursing staff must rely on a miscellany of legal provisions and authorities to justify the physical restraint of patients. This article sets out the circumstances when mental health nurses may lawfully use physical restraint on patients, with reference to domestic and European legislation and case law.