NHS 111 to have more paediatric experts to reduce urgent care pressure

31st January 2023

NHS 111 will be expanded offering greater access to specialist paediatric advice and urgent mental health support

The UK Government said that urgent care provided in the community will be expanded to ensure ‘people can get the care they need at home,’ without the need for a hospital admission and that the measures will be ‘aligned with priorities for primary care,’ including the forthcoming GP access recovery plan and the implementation of the Fuller stocktake report.

The two-year delivery plan for recovery announced today comes amid ‘record demand for NHS services’ and promises ‘boosted frontline capacity’, with 800 new ambulances, including 100 mental health vehicles and 5,000 more hospital beds, backed by a £1bn fund.

The new plans will see an increased number of clinicians – including retired staff and returners – working in NHS 111.

The services will run for at least 12 hours a day – responding to calls normally requiring an ambulance crew – and will mean people who have fallen or are injured can get care and treatment at home within two hours.

Parents and carers seeking health advice for children and young people using NHS 111 will have increased access to specialist advice, including support from paediatric clinicians who can help them manage illness at home or decide the best route for their care.

This will see some children referred directly to a same-day appointment with a specialist rather than attending A&E, which NHS England said would avoid unnecessary hospital admissions.

Direct access to urgent mental health support using NHS 111 is also being rolled out with people being able to select the mental health option when they call up for help.

NHS 111 will also be integrated into the NHS app to make it even easier for people to use, the plan said.

Same day emergency care units, staffed by consultants and nurses, will be open in every hospital with a major A&E, allowing thousands of people to avoid an overnight hospital stay.

The plans will also see a new scheme embedding family support workers across selected A&E sites – with at least one in every region – to provide support to children with non-urgent issues.

Amanda Pritchard, the NHS chief executive, said: ‘The NHS has experienced the start of a winter like no other – the threat of the flu and covid ‘twindemic’ became a reality and that was alongside huge demand for all services – from ambulance and A&E services to mental health and GP appointments.

Health secretary Steve Barclay said: ‘Every day of every week, tens of thousands of people receive safe, high-quality urgent and emergency care. However, with the NHS under unprecedented pressure from high Covid and flu cases and the backlog from the pandemic, too many people are waiting too long in A&E or for ambulances. ‘Today’s plan which is backed by record investment aims to rapidly cut waiting times, helping to deliver on one of the Government’s five priorities, while giving patients the confidence that health and social care services will be there for them when they need them.

This article first appeared in our sister publication Pulse.

ENO Breathe programme for long COVID improves mental wellbeing and some aspects of breathlessness

19th May 2022

Use of the ENO Breathe programme led to improvements in mental health wellbeing and elements of breathlessness in patients with long COVID

The ENO Breathe programme used by patients experiencing long COVID symptoms has been found to improve mental health scores and elements of breathlessness compared to usual care. This was the conclusion from the first randomised trial to evaluate interventions for patients with long COVID by a UK team of researchers from London.

A recognised consequence for some patients after an acute infection with COVID-19 is long COVID and which has been defined as new or ongoing symptoms 4 weeks or more after the start of acute COVID-19. A wide range of symptoms experienced by those with long COVID have been documented with the most frequently reported including breathing problems, fatigue, muscle weakness or joint stiffness, sleep disturbances, problems with mental abilities, and mood changes such as anxiety or depression. Furthermore, a review of studies has suggested in both acute and long COVID, the impact of infection on health-related quality of life is substantial. In a systematic review, researchers identified how music interventions were associated with clinically meaningful improvements in health-related quality of life.

The English National Opera has created the ENO Breathe programme, to help patients recovering from the effects of COVID-19 an,d for the present study, the UK researchers set out to determine whether the programme could improve both mental and physical aspects of health-related quality of life, as well as breathlessness, in patients with long COVID. They conducted a parallel-group, single-blinded, randomised trial to compare the ENO programme with usual care. Eligible patients were adults (> 18 years of age) and who were recovering from COVID-19 with ongoing breathlessness with or without anxiety for at least 4 weeks after their acute onset of symptoms. Individuals were randomised 1:1 to the ENO Breathe programme or usual care. The programme was individualised and designed to support people with breathlessness and/or anxiety by focusing on breathing, retraining through singing techniques and delivered online. It consisted of an introductory session followed by 6, once weekly sessions.

The primary outcome of interest was a change in health-related quality of life (HRQoL) from baseline to the end of the 6-week programme and which was assessed using the RAND 36-item short form survey instrument and in particular two summary measures, the mental health (MHC) and physical health components (PHC). A number of secondary outcomes were used including a visual analogue scale (VAS) for breathlessness on rest, walking, climbing stairs and running.

ENO Breathe programme and HRQoL

A total of 150 participants with a mean age of 49 (81% female) were randomised to either the ENO programme or usual care. Across the two groups, there was a mean of 320 days since the onset of their initial COVID-19 symptoms.

Compared to usual care, those allocated to the ENO Breathe programme had a greater improvement in the MHC (regression coefficient = 2.42, 95% CI 0.03 – 4.80, p = 0.047). However, there was no significant difference between groups for the PHC component (p = 0.54).

With respect to breathlessness, the only self-reported measure to significantly reduce was based on running (p = 0.0026).

The authors concluded that the ENO Breathe intervention could improve mental health wellbeing and one aspect of breathlessness and suggested that the programme might have a role in supporting patients with persisting long COVID symptoms.

Citation
Philip KEJ et al. An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19: a parallel-group, single-blind, randomised controlled trial Lancet Respir Med 2022