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The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment reviews should be offered to people with an intellectual disability and/or autism who are at risk of admission into a mental health hospital.

Admission and discharge data was collected across two assessment and treatment units between January 2019 and December 2022. Adherence to the care and treatment review policy was also reviewed as was length of inpatient stay. A retrospective evaluation was conducted. Triangulation of data was collected via the trusts’ electronic patient record system and NHS analytics team. Descriptive statistics, Mann–Whitney U test and a one-way ANOVA with post hoc tests were used in the analysis.

An increase in behaviours of challenge and deterioration of mental health were the main reasons for admission. Forty-nine percent (30) of those admitted to the assessment and treatment units accessed a care and treatment review. Care and treatment reviews were more frequently provided for individuals experiencing longer inpatient stays.

There is limited evidence relating to outcomes and impact of care and treatment reviews. Further research is required to explore effectiveness of care and treatment reviews to understand benefits and appropriately prioritise resource.

Parental satisfaction with paediatric home care has previously been found to be high and the results presented here confirm this finding. This study is unique in that a well defined population from one geographical area was studied before and after the introduction of the new home care service. Referrers included general practitioners, doctors in emergency care and out‐patient clinics, referring children for a wide range of acute conditions. Compared with hospital admission only half the number of adverse effects on children and families were reported by parents. Interest has been increasing in alternative service provision to prevent or reduce paediatric hospital admissions to avoid adverse effects on children and families. This study examined the views of parents experiencing hospital at home compared with hospital referral between 1999 and 2001 across the whole spectrum of acute clinical conditions. Hospital at home was the preferred service for a wide range of illnesses. Parents and carers identified extension of hospital at home to 24‐hour cover as a future preference. Parental preference for paediatric hospital at home for acute illness was confirmed.

This paper aims to identify reverse flows and exchanges that support public service provision. Reverse flow literature has focused on manufacturing based supply chains using the lens of exchange (recovery, reuse, repair and recycle) to gain performance improvement in product flows. Limited research is available to support an understanding of customer-derived reverse exchange (RE) service processes. The authors contribute to the service literature through the development of RE antecedents and derive new and revised definitions with the supporting constructs of RE service processes.

This paper synthesises literature creating a framework of antecedents for RE. Antecedents reflect differences of service flow (level of service inseparability and ‘acting upon’). These antecedents are empirically tested within an illustrative pre-existing UK healthcare case study against the synthesised antecedents and existing RE definitions. Two teams of researchers reviewed the data generated from public service supply chain processes. Definitions of RE were either revised or derived from the empirical data by each team.

The service concept of ‘acting upon’ for inseparable public service supply chain flows provides a basis for examining the existence of reverse flows and exchanges. Revised and new classifications to the RE model are proposed to stimulate contextual performance improvement and innovation in public service provision. Psychological utility is an additional feature to economic, environmental and social utility in public service RE. RE offers practitioners and academics a strategic operational competence to achieve improvement and innovation in public services and further advance this concept.

Extending the literature beyond the manufacturing derived RE concept to develop an understanding of the customer’s role in preserving and co-creating value in RE and flows in public service. New RE antecedents for public services, including the potential of psychological utility, are presented.

A new tier of intermediate care services for older people is being introduced in England and one function of these services will be district general hospital (DGH) admission avoidance. Concern has been expressed that this situation might compromise a prompt medical assessment. Reports recent experience with the medical assessment of directly admitted patients to a community hospital. The records of 81 of 87 patients admitted directly to the community hospital were available. The expected contributions to the medical assessment were not achieved by general practitioners in 27 patients (33 per cent); by hospital practitioners in 56 patients (69 per cent); and by consultants in 18 patients (22 per cent). Eight patients (10 per cent) had illnesses of greater complexity than initially considered and required transfer to the DGH. Concludes that, it can be difficult to ensure a timely medical assessment for patients admitted directly to an intermediate care service and critical incident reporting of patients who require transfer to a DGH should become a routine clinical governance activity for these services.

Presents a model designed to explore the stochastic nature of non‐elective admissions. Using historic data taken from the patient administration system of a large district general hospital situated in Plymouth, England, the model shows the importance of understanding the profile of risk behind non‐elective planning. This understanding may lead to more robust waiting times planning, promoting open dialogue between the trust and its commissioners on how such risk is managed. It also allows for the setting of clear goals for admission avoidance and early discharge schemes. At a strategic level, an understanding of the stochastic nature of non‐elective admissions raises questions about the potential cost of entirely ring‐fencing elective workload, disallowing the sharing of beds in times of peak demand. As a specific policy manifestation of this proposed ring‐fencing, the development of “diagnostic and treatment centres” may need to be more pragmatic than the “purist” view being expressed in the NHS Plan if overall efficiency is not to be significantly reduced.

This paper aims to describe the development and evaluation of integrated intensive support service (ISS) for adults with learning disabilities who have complex needs and are at risk of admission to an inpatient unit.

Existing services were remodelled. The service explored external service models and established an integrated ISS comprising intensive community support and intensive support beds.

Data indicates that the majority of people referred to the service avoid both admission to an inpatient unit and placement breakdown. Most people admitted to the inpatient unit are not known to community services. Length of stay has significantly reduced.

Other services can use the information to remodel how to provide intensive support and avoid admission to an inpatient unit.

It demonstrates how remodelling can drive improvements to reduce placement breakdown and risk of admission.

The dynamic support database (DSD) clinical support tool structures the risk of admission rating for individuals with intellectual disabilities. This study aims to investigate inter-rater reliability between multi-disciplinary health care professionals within the North West of England.

A small-scale quantitative study investigated reliability between raters on the DSD clinical support tool. A data set of 60 rating tools for 30 individuals was used. Descriptive statistics and Kappa coefficient explored agreement.

The DSD clinical support tool was found to have strong inter-rater reliability between individual items and the differences between individual scores were spread suggesting variance found could not be attributed to specific questions. Strong inter-rater reliability was found in the overall ratings.

Results suggest the DSD clinical support tool provides stratification for risk of admission ratings independent of who completes it. Future studies could investigate inter-rater reliability between organisations, i.e. health and social care professionals, and use a larger data sample to ensure generalisability. Replication of the study within child and adolescent services using the children’s DSD clinical support tool is also recommended.

The DSD clinical support tool has been implemented within the child and adult intellectual disability services across the North West. As more teams across England consider its implementation, the study provides reassurance that coding agreement is high, allowing for stratification for risk of admission independent of the rater.

Health-care systems currently face great challenges, including an increasing elderly population. To respond to this problem, a hospital emergency department, three municipalities, and self-employed general practitioners in Denmark decided to collaborate with the aim of reorganizing treatment of elderly acute ill patients. By establishing a small-scale collaborative community and through an action research process, we show, how to jointly explore and develop a new organization design for in-home hospital treatment that enables the health professionals to collaborate in new ways, and at the same time to investigate and improve this cocreation process and codesign of knowledge among multiple different stakeholders.

This study of 216 congestive heart failure (CHF) patients at a large teaching hospital in south‐central Ontario was undertaken to determine whether the patients managed in an outpatient heart failure clinic used fewer hospital resources (as expressed in number of admissions, complexity of admission, and length of stay (LOS)) than a matched cohort who were not managed in an outpatient clinic. Statistical significance of LOS opportunities could not be demonstrated (owing to sample size), however, the heart failure clinic is making a positive impact on all types of admissions (CHF and non‐CHF) in terms of LOS and suggests that management in an outpatient setting for chronic disease states is important for acute care hospitals to consider.

A three‐year in‐depth study has examined three models to improvecare in residential homes for older people in England. The study showed that each aimed to provide a ‘home for life’ for residents. Using multi‐source data gained from a range of qualitative and quantitative methods involving residential home managers, care staff and extensive review of documentation related to key care functions, inhibitors and enhancers to the achievement of this aim were identified. Inhibitors were lack of available top‐up funding to meet increased care needs, care staff's inadequate knowledge of behaviour‐disordered residents, workload, cross‐sector barriers and environmental problems. Among the enhancers were flexible regulation, up‐skilling of care staff, care staff's achievement in palliative care, perceived avoidance of hospital admission, and sound practice‐led relationships with nurses. The implications for practice are of relevance to policy makers, educators, community health and social care professionals, and older residents, their relatives and representative organisations.