BACKGROUND:The prevalence of children with life-limiting conditions is increasing. It is difficult to estimate palliative care needs in this population, and few studies have explored the characteristics or service use patterns of this group. The aim of this study was to estimate the number of children with palliative care needs in North West England, exploring associations between patient characteristics and service activity. METHODS:All services providing healthcare to children in North West England were surveyed to provide data on children (0-19 years) with palliative care needs within a census period (6-15 February 2023). Data collected included demographic information, diagnosis and care patterns. Point prevalence of need was calculated for all children by age group and ethnicity. Associations between patient characteristics (eg, age, ethnicity) and being actively seen by services were explored in logistic regression models. RESULTS:49 services provided data on 1694 children. Point prevalence of need was 10.1 per 10 000 0-19-year-olds (95% CI 9.6 to 10.6). Children of South Asian ethnicity were less likely to be actively seen (defined as seen or called within the census period) than those of White ethnicity (OR 0.45, 95% CI 0.32 to 0.64). CONCLUSIONS:Disparities in the use of children and young people's palliative care services were demonstrated. Future research should focus on developing measures of complex need for palliative care for children with life-limiting conditions, as well as inclusive and appropriate interventions to address disparities.

BACKGROUND:Since December 2022, the National Health Service (NHS) has experienced large-scale strikes by staff. The NHS cancels approximately 12 million elective care appointments each year, and around 1 million elective appointments were cancelled due to strikes between 2022 and 2024. During strikes, emergency care is prioritised, and it has been claimed that emergency departments (EDs) run 'better than usual'. The aim of this study was to investigate changes in patient flow into hospitals through the ED during the strike periods. METHODS:Cox proportional hazards modelling was applied to data from two different EDs in the north-west of England to model time between patient arrival at the ED and their subsequent admission. Systematic (linear temporal trend, yearly seasonality, daily seasonality, weekends, ED 'heat') and patient/presentation-level factors (urgency, service referred to, patient age, ethnicity and gender) were controlled for. The impact of different striking professions on patient time to admission was investigated using HRs, where a higher HR indicated faster admission. RESULTS:Over the analysis period, we observed 61 separate strike days: 40 junior doctor strike days, 11 nursing days, 10 consultant days and 7 ambulance days. Junior doctor and consultant strikes coincided on 4 days. For the type 1 ED, median time to see a clinician was similar on strike and non-strike days (median 2 hours 27 min on strike days (IQR: 1 hour 2 min to 4 hours 53 min), 2 hours 27 min on non-strike days (IQR: 1 hour 5 min to 5 hours 14 min)). Patients were admitted through the ED more quickly on both the junior doctor and consultant strike days compared with non-strike days (HRs: 1.12, 1.28, both p≤0.001). This increased flow was only seen while consultants were striking in the type 2 smaller ED. CONCLUSIONS:These findings suggest that the improved patient flow observed on strike days could be driven by the additional inpatient capacity created through the postponement of elective care. This result indicates that NHS hospital systems could potentially be adjusted to enhance turnaround times and reduce ED crowding.

Background A substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents' care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs.Methods A retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models.Findings Data from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6-15%], emergency admissions by 25% [20-39%] and length of stay by 11% [3-18%] (with an additional month-by-month decrease of 28% [24-34%]). The cost analysis found a cost reduction of 57 pound per resident in 2018, increasing to 113 pound in 2021.Interpretation The introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents.

Background The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area.Aims To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes.Method A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes.Results Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication.Discussion LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing.

Background Since December 2022, the NHS has experienced large-scale strikes over pay by staff. Strikes heavily impact elective care delivery. The NHS cancels approximately 12 million elective care appointments each year. One million appointments have been cancelled due to strikes between 2022 and 2024. During this time emergency care is prioritised, and in a recent opinion piece, the president of the Royal College of Emergency medicine claimed the Emergency Department ran 'better than usual'. The aim of this paper was to investigate changes in patient flow into hospitals through the ED during the strike periods. Methodology Data from two different emergency departments (EDs) in the North West of England is analysed using Cox-regression to model time between patient arrival at the ED, and subsequent admission. Various systematic and patient-level factors are controlled for. The impact of different striking groups (nurses, junior doctors etc.) on patient time to admission is analysed. Results For the Type 1 ED, hazard ratios indicate that patients are admitted through the ED more quickly on strike days where any single group of staff were striking compared to non-strike days (HRs: 1.16-1.39, all p < 0.003). This increased flow was only seen for consultant strikes in the smaller ED. Interpretation These findings for all strike types indicate that improved patient flow on strike days is likely due to the increased inpatient capacity from elective care postponement. This result may indicate that there is room for change in NHS hospital systems to improve turnaround time and reduce ED crowding. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement AG is funded by EPSRC Doctoral Training Partnership, grant number EP/R513076/1. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The project was approved by Lancaster University Faculty of Health and Medicine Research Ethics committee, reference FHM-2023-3868. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data supporting this study is not publicly available due to ethical considerations around accessing linked patient-level healthcare data. Please contact the main author for more information (a.garner2@lancaster.ac.uk).

Background Healthcare in care homes during the COVID-19 pandemic required a balance, providing treatment while minimising exposure risk. Policy for how residents should receive care changed rapidly throughout the pandemic. A lack of accessible data on care home residents over this time meant policy decisions were difficult to make and verify. This study investigates common patterns of healthcare utilisation for care home residents in relation to COVID-19 testing events, and associations between utilisation patterns and resident characteristics.Methods Datasets from County Durham and Darlington NHS Foundation Trust including secondary care, community care and a care home telehealth app are linked by NHS number used to define daily healthcare utilisation sequences for care home residents. We derive four 10-day sets of sequences related to Pillar 1 COVID-19 testing; before [1] and after [2] a resident's first positive test and before [3] and after [4] a resident's first test. These sequences are clustered, grouping residents with similar healthcare patterns in each set. Association of individual characteristics (e.g. health conditions such as diabetes and dementia) with healthcare patterns are investigated.Results We demonstrate how routinely collected health data can be used to produce longitudinal descriptions of patient care. Clustered sequences [1,2,3,4] are produced for 3,471 care home residents tested between 01/03/2020-01/09/2021. Clusters characterised by higher levels of utilisation were significantly associated with higher prevalence of diabetes. Dementia is associated with higher levels of care after a testing event and appears to be correlated with a hospital discharge after a first test. Residents discharged from inpatient care within 10 days of their first test had the same mortality rate as those who stayed in hospital.Conclusion We provide longitudinal, resident-level data on care home resident healthcare during the COVID-19 pandemic. We find that vulnerable residents were associated with higher levels of healthcare usage despite the additional risks. Implications of findings are limited by the challenges of routinely collected data. However, this study demonstrates the potential for further research into healthcare pathways using linked, routinely collected datasets.

During 2020, the COVID-19 pandemic disrupted the delivery of HIV prevention and treatment services globally. To mitigate the negative consequences of the pandemic, service providers and communities adapted and accelerated an array of HIV interventions to meet the needs of people living with HIV and people at risk of acquiring HIV in diverse geographical and epidemiological settings. As a result of these adaptations, services such as HIV treatment showed programmatic resilience and remained relatively stable in 2020 and into the first half of 2021. To review lessons learned and suggest which novel approaches to sustain, UNAIDS convened a virtual consultation on Feb 1-2, 2022, which was attended by a range of stakeholders from different areas of global HIV response.

Aims, Objectives and BackgroundHealthCall is a digital health initiative that aims to reduce emergency department attendances by upskilling care home staff to use app-based technology whereby residents with new clinical presentations’ observations are recorded electronically using a structured SBAR approach. Information is fed to a Single Point of Access where clinical staff triage the referrals. This study evaluated the effectiveness of the HealthCall technology across the North East of England to safely reduce ED referrals and attendance.Method and DesignThe study included 122 care homes covering the study period 2018–2021. Routinely collected secondary care data from County Durham and Darlington NHS Foundation Trust was linked with clinical data from HealthCall. We describe the change in ED attendances over the period before, during and after the introduction of the technology to the care homes. We fitted Poisson generalised linear mixture models to monthly counts of emergency attendances. Covariates were included to adjust for seasonality and external factors such as COVID-19, and hierarchical random intercepts were included to account for both individual and care home variability. The impact of HealthCall technology usage on residents’ expected number of attendances is tested as a ‘step’ change at intervention and a ‘slope’ change post intervention.Results and ConclusionWe identified 8,702 care home residents through linkage between the secondary care and HealthCall datasets. Preliminary results suggest the use of HealthCall reduces expected monthly ED attendances for care home residents by 16% (95%CI 5 to 25, p-value<0.001). No significant change was observed in the impact of HealthCall during the post-intervention period.This study finds that the implementation of the HealthCall technology reduces the expected number of monthly emergency department attendances for residents. The technology allows for ongoing monitoring of resident health alongside providing more convenient and timely access to clinical advice that promotes more appropriate and resident-focussed decision leading to fewer unnecessary ED attendances.