Endgame

Over a fifth of people in England and Wales are dying at home, a study published in Palliative Care reports. The time series analysis, which covered 2004-2010, showed a steady rise, from 18.3% in 2004 to 20.8% in 2010. This increase was also more marked amongst people with cancer and in the older population: it is the first rise in home deaths since 1974 amongst people over 85 years old. Guidance from NICE on commissioning end of life care focuses on designing "high quality evidence based services" supporting the national End of Life Care Strategy and the NICE quality standard. It also includes a benchmarking tool that promises a 10% reduction in hospital admissions that end in death and a possible £52million cost saving. The National End of Life Care Programme has produced guidance for professionals on developing bereavement services.

Trying to be heard

A paper from the NHS Confederation and the Royal College of Paediatrics and Child Health considers options for involving children and young people in decisions about health and wellbeing services. Looking back at survey data since 2000, it seems that "the voice of under 16s is not included in most national surveys". A study based on experience at Sheffield Children's Foundation Trust assesses effective surveys to measure patient experience amongst children and young people. Meanwhile, Penny Woods from the Picker Institute explains in Pulse how this survey forms the basis for the Children's Patient Experience Questionnaire, from which the new Outcomes Framework indicator on young people's experience of care.

Data monitor

NHS Information Centre has launched a very useful indicator portal, bringing together in one handy place all those pesky health and social care indicators. The 20th annual Health Survey for England was released last month. Special focus for this issue is respiratory health.

An aspirin a day?

Widely reported in the press was a large-scale review that questioned the use of aspirin for primary prevention in cardiovascular disease. The meta-analysis published in the Archives of Internal Medicine looked at data from 9 RCTs each involving over 1000 participants. Researchers found reductions in non-fatal heart attacks in each trial, but also the chance of suffering serious internal bleeding increased by about 30%. The study's authors conclude that while the benefit for people who already had a history of heart attack or stroke was not in doubt, "routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis." An article in Pulse quoted several GPs who already advised against aspirin taken in this way and noted doctors should be aware that there was a tendency for patients to self-medicate.

Futurology

The rallying cry to "make every contact count" has formed the headlines about the NHS Future Forum's latest offering. However, it's by no means the only thing the Forum has to say. The other areas attended to are integration, information and education and training. Regarding information (as leaked just before Christmas), there's a stress on effective data sharing and interoperability rather than a national system, along with more explicit support systems to facilitate the roll-out of full patient access to health records by 2015 and a back-to-basics proposal of universal use of the NHS number at the point of data capture (again!). The proposals about integration focus on the principle of "integration around the patient" and the role of electronic accessible care records and patient reported experience measures. Along with the Future Forum's report on education, there is also a paper out from DH on the subject.

Primary Colours Issue 47

The latest monthly round up of primary care news, Issue 47 is available to download now

No incentive

The practice of offering financial inducements to encourage health behaviour change is put under the spotlight by a team from the University of Newcastle in Australia. In this review of reviews, the authors identify key principles for deciding on use of financial incentives to achieve public health aims. Another study looks at how the Locally Enhanced Service system has worked in relation to preventive services in primary care.