Derek Ward

Primary exclusions: evidence for action

Summary This short report presents the interim findings of an ESRC‐supported study of primary school exclusions. The research to date has involved a questionnaire survey of LEAs nationally and in‐depth case studies, involving schools, parents/carers and children, in two contrasting LEAs. It is first argued that the exclusion from mainstream education of very young children is, in itself, a cause for alarm. Evidence is then presented of rising numbers of exclusions, as well as high levels of unmet educational and/or social need in the majority of cases studied. It is concluded that urgent government action to support children, many of whom were found to be ‘in need’, is not only required under the Children Act 1989, but would actually prove more cost‐effective.

Pilot cluster randomised controlled trial of flooring to reduce injuries from falls in elderly care units: study protocol

Falls are an issue disproportionately affecting older people who are at increased risk of falls and injury. This protocol describes a pilot study investigating shock-absorbing flooring for fall-related injuries in wards for older people. Objectives To inform future research by evaluating fall-related injuries on the intervention and existing flooring, assessing the sustainability of the flooring in ward environments, estimating the cost-effectiveness of the floor and assessing how the floor affects patients and other users. Design This study uses mixed methods: a pilot cluster randomised controlled trial, observation via mechanical testing and interviews. Eight participating wards (clusters) are randomised using a computer-generated list. No blinding is incorporated into the study. Each site has a baseline period of approximately 6 months. Then, four sites receive the intervention floor, while four continue using standard floors. Sites are then followed up for approximately 1 year. Participants Any person admitted to a bed in the ‘study area’ of a participating ward can be entered into the trial. Orientated patients, visitors and any hospital staff who use the floor in a study area are eligible for inclusion in an interview. Intervention An 8.3 mm thick vinyl floor covering with polyvinyl chloride foam backing (Tarkett Omnisports EXCEL). Outcomes The primary outcome is fall-related injuries. Severity of injuries, falls, cost-effectiveness, user views and mechanical performance (shock absorbency and slip resistance) are also being assessed. Trial registration ClinicalTrials.gov: NCT00817869; UKCRN ID: 5735.

Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery

BACKGROUND Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful. Distraction techniques may reduce the associated pain and anxiety. OBJECTIVE To investigate an audiovisual distraction (Bedscapes) on pain and anxiety during minor surgery for the correction of ingrown toenail. METHOD In a randomised controlled trial, patients (N=152) with ingrown toenails requiring surgical correction under local anaesthesia were allocated to receive Bedscapes+standard care or standard care alone. Pain levels due to local anaesthetic injection were assessed post-procedure, and anxiety levels were assessed pre- and post-procedure in both groups. Follow-up focus groups were conducted with 14 patients allocated to the Bedscapes group, and one-to-one interviews were held with four podiatrists. RESULTS Participants with high pre-procedure anxiety scores experienced greater pain on injection, and older patients reported lower pain than younger patients, regardless of group allocation. Bedscapes did not reduce pain or anxiety, and was apparently no more effective than interpersonal interaction between podiatry staff and the patient. CONCLUSIONS Pain of injected anaesthesia correlates closely with pre-operative anxiety. Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery.

Care Home Rehabilitation Schemes: Further Findings from a National Survey

The continued expansion of the intermediate care initiative has resulted in the use of alternative care settings, such as nursing and care homes, for the delivery of rehabilitative interventions for older people. In this paper, we report on the findings from the second stage of a national survey of rehabilitation schemes that use care home settings. The survey reveals a wide range of approaches and standards, leading us to ask whether there is a gap between policy goals, good practice and actual service provision. The care home rehabilitation schemes were selected on the basis that they offered, as a minimum, rehabilitation to improve an older persons physical status.

Care Home Environments, Rehabilitation and Older Persons: A Survey of Current Service Provision in England

The emergence of the intermediate care agenda has added momentum to the debate on the use of alternative care settings for the delivery of rehabilitative interventions for older persons. This paper reports on the findings of the first stage of a research programme to investigate the extent of the use of care home environments for the rehabilitation of older people in England. Stage two of the project will explore in more depth the characteristics of the rehabilitation provision identified in stage one.

The Digital House of Care: information solutions for integrated care

The purpose of this paper is to describe the development of a digital tool in an English county striving towards a vision of integrated information that is used to underpin an increasingly integrated future of health and social care delivery.,It discusses the policy context nationally, the origins and implementation of the initiative, the authors’ experiences and viewpoint highlighting key challenges and learning, as well as examples of new work undertaken.,In all, 12 health and care organisations have participated in this project. The ability for local commissioners and providers of services to now understand “flow” both between and within services at a granular level is unique. Costs are modest, and the opportunities for refining and better targeting as well as validating services are significant, thus demonstrating a return on investment. Key learning includes how organisational development was equally as important as the implementation of innovative new software, that change management from grass roots to strategic leaders is vital, and that the whole system is greater than the sum of its otherwise in-silo parts.,Data linkage initiatives, whether local, regional or national in scale, need to be programme managed. A robust governance and accountability framework must be in place to realise the benefits of such as a solution, and IT infrastructure is paramount.,Organisational development, collaborative as well as distributed leadership, and managing a change in culture towards health and care information is critical in order to create a supportive environment that fosters learning across organisational boundaries.,This paper draws on the recent experience of achieving large-scale data integration across the boundaries of health and social care, to help plan and commission services more effectively. This rich, multi-agency intelligence has already begun to change the way in which the system considers service planning, and learning from this county’s approach may assist others considering similar initiatives.