Responses

I am writing to you under the freedom of information act to request the following:

How many patients under your care for eating disorders were put on the not recovered pathway in the last five calendar years 2016-17, 2017-18, 2018-19, 2020-21, 2022-23.? Please can you break this information down by gender male/ female. and age -18/+18.

I am writing to you under the Freedom of Information Act 2000 to request information regarding intensive community and day patient treatment programmes for patients with eating disorders. Please provide a reference number for this request in your acknowledgement email. [If this request is forwarded internally, please do not cut out the introductory wording before the questions].

A note for clinicians/services involved in responding to this request
We are conducting this survey to help us understand how widely available these forms of treatment are across the UK. The top-level findings will be published in a report, in which individual services/providers will not be named. Instead, we will report the findings in terms of the proportion of providers or areas that offer intensive community and/or day patient treatment programmes for people with eating disorders.

We recognise that eating disorder services are under extreme pressure and are facing major challenges in recruiting and retaining the staff they need. This request will form part of a wider Beat project that will aim to understand and help overcome the barriers that the NHS faces in expanding access to these innovative service models. This will include challenging policy makers and commissioners to provide the required resources.

Background
Intensive community and day patient treatment programmes offer increased contact hours for the patient compared to traditional outpatient treatment. The patient returns home at night and therefore is not an inpatient. Such treatment programmes can help minimise inpatient admissions and reduce length of stay when admission is necessary.

Day patient treatment programmes sometimes called ‘day care’. tend to be run as a group programme, with patients attending the service during the day and returning home for evenings and weekends. Such programmes could potentially be delivered partially or wholly online/virtually. Some intensive community treatment programmes include home treatment, whereby a clinician visits the patient’s home to support meals and snacks and offer psychosocial intervention. There are other models of intensive community treatment aside from home treatment and we are very interested in hearing about these approaches too.

Questions
1. Does the Trust provide any intensive community and/or day patient treatment for eating disorders or refer patients on to receive such treatment from another NHS or non-NHS provider.? This may include day patient treatment, home treatment, or other innovative model/s. We are interested in programmes for children and young people, and/or adults.
£ Yes
£ No, and the Trust has never provided such a service
£ No, but the Trust did provide such a service in the past [Please provide more information below, including what led to the closure of this service/s]

If you answered “No” to question 1 either of the two options., that is all that is required, thank you for your response.
If you answered “Yes” to question 1, please answer the remaining questions below. If the Trust provides more than one model of intensive community or day patient treatment and/or has separate programmes based on age or any other criteria, please provide separate answers for each treatment programme and specify which programme is being referred to. If the Trust refers patients on to receive intensive community or day patient treatment from another NHS or non-NHS provider, please state the name of this provider, and cover this treatment programme within the answers you give to questions 2-8.

2. What model/s of intensive community or day patient treatment for eating disorders does the Trust provide or refer patients onto.? Examples include day treatment or home treatment, but we are keen to hear about any other forms of intensive treatment too aside from inpatient care.. In your answer, please specify whether these are provided in-person or online/virtually.

3. What is the intensity of this/these model/s of intensive community or day patient treatment for eating disorders?
a. Please provide the information requested below. If the Trust provides, or refers patients onto, more than one intensive community or day patient treatment programme please provide separate answers for each.:
Number of hours per day if applicable to model.
Number of days per week if applicable to model.
Number of contacts per week and minimum duration of those contacts if applicable to model.
Is supervised meal support provided? If so, for how many meals per day?.
b. Please provide any more information that we should know about regarding the intensity of treatment provided by this/these programme/s.

4. Are families or other carers engaged with when appropriate. in the treatment provided by this/these intensive community and/or day patient treatment programme/s for eating disorders? If so, please describe or attach further information outlining this engagement.

5. Is/are the intensive community and/or day patient treatment programme/s for eating disorders time limited, or is the length of this treatment based on clinical need? If it is time limited, what is the maximum length of treatment?

6. What are the referral criteria for patients to access the intensive community and/or day patient treatment programme/s for eating disorders? In your answer, please detail any exclusion criteria e.g., age, type of eating disorder/diagnosis, BMI, comorbidity, or otherwise..

7. What is/are the geographic catchment area/s for referrals to the intensive community and/or day patient treatment programme/s for eating disorders including any such programmes provided outside the Trust’s usual geographic area, potentially as part of an NHS-led Provider Collaborative.?
8. Please state the size of the caseload number of accepted referrals. at the Trust’s intensive community and/or day patient treatment programme/s for eating disorders on the dates below:
31 March 2023
30 September 2023
If the Trust provides more than one intensive community or day patient treatment programme, please provide the size of the caseload separately for each and specify whether the programme is for over 18s or under 18s..

9. Which organisation/s commission the intensive community and/or day patient treatment programme/s for eating disorders? If this is one or more NHS Integrated Care Board ICB. or NHS Trust as lead provider for an NHS-led Provider Collaborative., please specify their name/s in your answer to this question.
10. Please tell us what the Trust is proud of about its intensive community and/or day patient treatment programme/s for eating disorders and outline the challenges and opportunities the Trust has experienced in providing this/these programme/s.

How many cases of this have been reported each year?
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How many days did each patient stay?
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What were the reasons for their stay?
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How much did it cost to keep each patient?
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What was the reason for each patients’ discharge?
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I would like to make the following FOI request for Gloucestershire Health and Care NHS Foundation Trust:
What training has been delivered to staff within the Trust relating to religion and religious beliefs, within the period 1st August 2022 to 1st August 2023?
I would like a list of all the sessions delivered to staff. If a course has been delivered multiple times, please list each instance separately. For each one, I would like to know:
What was the session title or topic if known.?
Was the session delivered even if only partially. by someone external to the Trust?
o If so, who?
o How much was paid to them for this?
o If payment is made, please specify if VAT was applicable, and if VAT is included in your figures..

Re: Freedom of Information Request

I am writing to you from Leukaemia Care to request information under the Freedom of Information Act.

Leukaemia Care is the UK’s leading Leukaemia charity. We exist to improve the lives of everyone affected by Leukaemia, MDS and MPN. We provide information, advice and support for anyone affected, this includes patients and their friends and families too. We raise awareness of the issues impacting people affected by leukaemia, MDS and MPN, and campaign to fix them.
We are currently interested in finding out more information about the role of a Clinical Nurse Specialist CNS. within hospital trusts. We want to make sure that people with leukaemia are given the correct access to a CNS as we believe this role, and the support provided, is extremely valuable to those who have received a diagnosis and are being treated for leukaemia.

It would be greatly appreciated if you could provide as much detail as possible to the following requests in writing via email or post.

NB: All of the following requests are relating to the treatment of adults 16 years +. only.

The information we request is from your most recent data.

1, Which haematological cancers are treated at your trust?

2, How many blood cancer patients are under the care of your trust?

3, Total number of haematological Clinical Nurse Specialists are in the trust?

4, Total number of leukaemia specific CNS’s are in the trust?
– If you do have leukaemia specific CNS’s in the trust, how many leukaemia patients are there per leukaemia CNS’s?
– Do have myeloid and lymphoid specific CNS’s and if so, how many of each?

5, Are haematological/ blood cancer CNS’s required to undertake normal ward duties?

6, Have you measured patient access to CNS’s within the trust? If so, what was the outcome?

7, Do you have, or plan to have any funding in place for training more haematology or blood cancer specific CNS’s?

I appreciate that you may not be able to use the MS Forms link. I have a word version of the form which I append. I also include the data fields requested below.
NHS Pain Education
This information is being requested as a freedom of information request. We are trying to find out what education is taking place in the workplace for staff who work directly with patients. Although this form is several pages long it should take less than 10 minutes to complete. Section 1
1. Name of your organisation
2. Do you provide education for your healthcare staff about pain management? Delete as appropriate – if NO please do not continue with the form and return it to a.swift@bham.ac.uk.
Yes No
Section 2
3. Who do you deliver pain education to?
The following section is divided into staff groupings. Please add a cross in the relevant box to indicate who you provide pain management education to at least annually.
Mandatory Optional Mandatory for some but not all Not provided Not a staff group in this organisation
Band 3 support worker nursing or midwifery.
Nurses
Midwives
Health visitors
FY1/FY2
ST1/CT1
ST2/CT2
ST3-6
Consultant
Support worker therapy.
Physiotherapists
Occupational therapists
Speech and language therapists
Dieticians
Art therapists
Counselling team
Social workers
Dieticians
Chaplaincy
Psychologists
Pharmacists
Radiography and imaging team
Others please list.
4. What percentage of each of the following staff groups attending at least one pain education event in the last 12 months.
Support workers nursing and midwifery.
Nurses
Doctors
AHPs
Other please list.
5. Who delivers pain education in your organisation?
6. What methods do you use to deliver pain education to staff?
Face to face Online – asynchronous Online – synchronous Both F2F and online, participant chooses Method not used.
Classroom or lecture theatre LT. -lecture didactic.
Classroom or LT discussion/Q&A
Case study presentation and discussion
Video of past teaching sessions
Video of expert giving lecture or being interviewed
Simulation lab- management of a lifelike scenario
Skills demonstration e.g. injections
Supervised skills practice
Role play
Supervision in clinical area supervised practice.
Specialist embedded in the ward – work alongside
One to one coaching on request
Pain ward rounds include ward staff
Posters in the clinical area
Pocket guides
Dashboard messaging
Audit feedback
Intranet guidelines
Smartphone or app
Guidance pop-ups in electronic patient management or prescribing system
Ask the expert sessions
WhatsApp discussion groups
Pain meetings in clinical areas
Schwarz rounds
QI programmes
7. If you have a virtual learning environment as part of your pain management education please describe what methods are used e.g. case studies, narrated powerpoints, quizzes, reading materials.
8. Are there any other methods that you use?
9. Content of pain education.
The EFIC core curriculum contains seven domains. Please indicate which aspects of the curricula you include in your pain education all or some of the time.
Pain as a biopsychosocial phenomenon impact on the individual and their family/carers showing understanding of the cognitive, sensory and affective dimensions
The impact of pain on the patient and their family/carers
Pain as a multidimensional phenomenon with cognitive, sensory, and affective dimensions
The individual nature of pain and the factors contributing to the person’s understanding, experience and expression
Understand the importance of social roles, school/ work, occupational factors, finances, housing and recreational/leisure activities in relation to the patients’ pain
The importance of working in partnership with and advocating for patients and their families,
Promoting independence and self-management where appropriate
Prevalence of acute, chronic/persistent and cancer-related pain and the impact on healthcare and society
The characteristics and underlying mechanisms of nociceptive pain, inflammation, neuropathic pain, referred pain, phantom limb pain and explain nociplastic pain syndromes
The distinction between nociception and pain, including nociceptive, neuropathic and nociplastic pain
Mechanisms of transduction, transmission, perception and modulation in nociceptive pathways The relationship between peripheral/central sensitization and primary/secondary hyperalgesia
Mechanisms involved in the transition from acute to chronic/ persistent pain and how effective management can reduce this risk
The changes that occur in the brain during chronic/persistent pain and their possible impact including cognition, memory and mood. and cognitive-behavioural explanations such as fear-avoidance
The overlap between chronic/persistent pain and common co-morbidities, including stress, sleep, mood, depression and anxiety
The mechanisms underlying placebo and nocebo responses, and their relation to context, learning, genetics, expectations, beliefs and learning
The role of genetics and epigenetic mechanisms in relation to risk of developing chronic/persistent pain and pharmacotherapy
The importance of interprofessional working in pain management along with potential barriers and facilitators to team-based care
How to work respectfully and in partnership with patients, families/ carers, healthcare team members and agencies, to improve patient outcomes
Team working skills communication, negotiation, problem solving, decision-making, conflict management.
The professional perspectives, skills, goals and priorities of all team members
How to take a comprehensive pain history, an assessment of the patient across the lifespan and in care planning, consider social, psychological, and biological components of the pain condition
Person-centred care including how the following may influence the experience of illness, pain, pain assessment and treatment: Social factors, Cultural factors, Language, Psychological factors, Physical activity, Age, Health literacy, Values and beliefs, Traditional medical practices, Patients’ and families’ wishes, motivations, goals, and strengths
Patients’ and families’ different responses to the experience of pain and illness including affective, cognitive, and behavioural responses
The rationale for self-report of pain and the understand in which cases nurse-led ratings are necessary
At risk individuals for under-treatment of their pain e.g., individuals who are unable to self-report pain, neonates, cognitively impaired. and how to mitigate against this.
Using different assessment tools in different situations, using a person-centred approach
Valid, reliable and sensitive pain-assessment tools to assess pain at rest and on movement; tools that are appropriate to the needs of the patient and the demands of the care situation
Culturally sensitive and appropriate pain assessment for individuals who speak a different language to the language spoken by the healthcare professionals
Understand the rationale behind basic investigations in relation to serious pathology
What specialist assessment is, when it is needed, and how to refer.
Importance of accurate documentation
Assessment of pain coping skills and pain behaviours
Health promotion and self-management
Importance of non-pharmacological management
How to work with patients to develop goals for treatment
Evidence based complementary therapies for pain management e.g. acupuncture, reflexology.
Physical pain management strategies e.g. exercise, stretching, pacing, comfort, positioning, massage, manual therapies, heat/cold, hydrotherapy..
Psychological pain management strategies e.g. distraction, relaxation, stress management, patient and family education, counselling, health promotion and self-management..
Evidence based behavioural therapies e.g. CBT, mindfulness, acceptance and commitment, couple/family therapy, hypnosis/guided imagery, biofeedback.
Electrotherapies e.g. TENS, spinal cord stimulation.
Types of analgesics and potential combinations non-opioids, opioids, antidepressants, anticonvulsants, local anaesthetics.
Routes of delivery
Risks and benefits of various routes and methods of delivery PCA, Epidural, Nerve blocks, Plexus blocks..
Onset, peak effect, duration of effect.
Adverse events and management of these
Which drugs are appropriate to particular conditions and contexts
Side effects, detecting, limiting and managing these.
Long-term opioid use risks and benefits
Risk of addiction in different patient groups e.g. post-operative management, chronic pain management.
Addiction risk factors
Identification of aberrant drug use
Tapering opioid therapy
Preparation for discharge and ongoing pain management
10. Do you include anything else in your pain education that has not been captured so far?
11. Is there anything else that you would like to tell us about?