Glamorgan Research News

Publication of 'Best configuration of hospital services for Wales: A Review of the evidence'

Wed, 09 May 2012 09:27:56 +0100

An independent review of what clinical evidence says about hospital services in Wales, published today (Wednesday 9 May 2012), concludes that patients in Wales are not getting the best possible outcomes from their hospital care and there is a strong case for changing the way some hospital services are organised.

The report, by Professor Marcus Longley at the Welsh Institute for Health and Social Care (WIHSC) at the University of Glamorgan, was commissioned by the NHS in Wales.

The research paper represents the first time that the existing clinical evidence has been brought together in one place to present the overall picture of the issues that are driving change across the NHS.

Some of the main findings of the report show that:

The current configuration of hospital services does not deliver the best outcomes for patients uniformly across Wales;
Service quality needs to be improved if Wales is to have services comparable with the best healthcare systems in the world;
Unless action is taken quickly, the shortage of medical staff in some services is likely to lead to the unplanned closure, and possible collapse, of these services;
The increasing specialisation of some types of services mean that centralising expert clinical staff leads to better patient outcomes in these specialties;
The nature of healthcare means that many hospital services are interdependent and outcomes for patients could be improved if certain types of services are brought together onto one site;
The impact of longer travelling distances as a result of centralisation can be lessened by boosting pre-hospital care, using telemedicine more widely and effectively, and providing better transport links.

Professor Marcus Longley, Director of WIHSC, commented: “The performance of the NHS in Wales has improved significantly over the past decade, but challenges remain and difficult decisions now need to be taken. Acting as a neutral policy expert, the University is reviewing the evidence to inform a rational debate about how best to organise our NHS services to meet the changing needs of people in Wales.”

The NHS in Wales has welcomed the research paper. Helen Birtwhistle, Director of the Welsh NHS Confederation, which represents all Local Health Boards and Trusts in Wales, said:

“The report sends a strong message to the NHS in Wales, and the wider Welsh public, that there are aspects of our current health system that could, and should, be better. As the report says, there is an urgent need for us to change our hospital services if we are to provide a high-quality and safe health service, comparable to the best anywhere.

“There are some difficult and potentially unpopular decisions ahead so it is critical that the public have access to clear and independent information to help them examine Health Board plans. This independent research paper is an important step in that process.”

See below to download supporting documents:

Download a pdf summary of the independent review here also available in Welsh

Download the Access doucment here

Download The Workforce doucment here

Download the Quality & Safety document here

New Medicines for Serious Conditions

Fri, 13 Apr 2012 14:40:09 +0100

The findings of a citizens’ jury, tasked with deciding whether the benefits of new medications for serious conditions outweigh the side effects, are published today, Friday 13 April 2012.

Convened by the University of Glamorgan and supported by Genetic Alliance UK the national alliance of over 150 patient organisations supporting those affected by genetic conditions, the jurors analysed the risks and benefits of new medicines.

The 12 jurors, taken from across the UK, were either patients with serious and/or rare conditions, or family members of someone with a serious and/or rare condition and met for a total of five days between September and December 2011.

Professor Marcus Longley who conducted the work alongside Genetic Alliance UK, “The Jurors explored the risks and benefits of hypothetical case studies and heard from a number of expert and advocate witnesses about how the regulatory system currently works, its strengths, and its potential weaknesses. After considering the evidence and debating the issues amongst themselves, they presented their conclusions.”

Over the past ten years there have been several high profile cases which have clearly demonstrated the difficulties that regulators, as well as pharmaceutical and biotechnology companies, have in measuring and balancing the risks associated with new therapies against the potential benefits they may offer patients.

It might be inferred that public and media reaction to the cases has induced both an increasingly cautious approach to the approval of new products, and the prioritisation of risk avoidance over innovative research.

Prof Longley continued, “The analysis of the risks and benefits associated with new medicines is a complex subject. The Jury was designed as a structured and in-depth study into how patients with rare and/or serious conditions (and their families) perceive this balance, and how effectively current regulatory and other mechanisms reflect their preferences.”

The findings:

1. Regulators should include psychosocial factors in their decision making: Jurors would like to see regulators broadening the range of issues which they consider when deciding whether to approve a new medicine. Jurors have generated a list of 25 psychosocial factors that are important to them, to be included in the assessment of risks and benefits of new medicines.

2. Regulators should be more permissive for those treatments for people with rare and/or serious conditions: Because of their often unique circumstances, patients with rare and/or serious conditions may well be willing to take greater risks than the system currently allows. They should be given that choice.

3. Patients should be more involved in all stages of the process, from setting the research agenda, to post-marketing authorisation decisions: Patients’ experiences and preferences should be included at all stages. Patient representatives (such as patient group members) should be supported to be joint decision makers, alongside clinical experts, throughout the process.

4. Patients should be better supported to make their own decisions: Decision-making about new medicines is challenging, but possible for most patients provided they are given adequate information and support? (or something like that). Jurors generated a list of questions to help guide patients when deciding on their own treatment options.

Notes:

The Citizens’ Jury is a participatory research method. Drawing upon aspects of a legal trial by Jury, a small group of individuals form a Jury over a few days, to learn about and deliberate a particular issue in depth. They weigh the evidence presented, discuss it amongst themselves, and reach a Verdict. They also often make other observations and recommendations relevant to the matter in
hand.

Peter Hain on building democracy in South Africa and Northern Ireland: 2012 Lord Merlyn Rees lecture

Wed, 21 Mar 2012 14:06:05 +0100

As democracy in South Africa comes of age and Northern Ireland continues on the path to peace, The University of Glamorgan invites you to The 2012 Lord Merlyn Rees Lecture.

Building democracy: lessons from South Africa and Northern Ireland
Rt. Hon. Peter Hain MP

Thursday 26 April 2012
at 6pm
Royal Welsh College of Music and Drama

On 26 April 1994, millions of people queued to vote for the first time in an poll that swept Nelson Mandela to power in South Africa’s first free election. Eighteen years later, as South Africa prepares to celebrate Freedom Day and Northern Ireland marks fourteen years since the Good Friday Agreement, anti-apartheid leader and former Northern Ireland secretary Peter Hain will tell the story of his own experiences and reflect on the lessons that we can take for democracy today from these momentous turning points.

The lecture will be chaired by the Chancellor of the University, Rt Hon Lord Morris of Aberavon KG QC
Refreshments will be served.

Please book your place by emailing rsvp@glam.ac.uk

Project to ‘clean up’ the use of coal

Mon, 12 Mar 2012 15:07:07 +0100

The University of Glamorgan, as coordinator of a collaborative consortium of 13 EU partners, has secured over €9 million from the European Commission for a research project which will investigate how coal can be burnt so as to facilitate Carbon Capture and Storage, thereby minimising CO2 emissions to the environment.

The Reliable and Efficient Combustion of Oxygen/Coal/Recycled Flue Gas Mixtures project, known as RELCOM, is designed to undertake a series of applied research, development and demonstration activities involving both experimental studies and modelling work to enable full-scale early demonstration oxyfuel plant to be designed and specified with greater confidence as well as providing improved assessment of the commercial risks and opportunities.

Currently around 28% of electricity in the UK is produced by burning coal so the need to find cleaner methods of burning the fuel is much needed.

Professor Steve Wilcox of the Faculty of Advanced Technology who is leading the project said, “Coal will remain a major fuel for electricity generation worldwide for at least several decades. To reduce the impact of climate change, the power generation industry will be increasingly required to reduce its CO2 emissions.

“Improvement of cycle efficiency and increased use of biomass help to reduce CO2 emissions in the near term, but the longer term need to move to near-zero emission power generation will require the deployment of carbon capture and storage (CCS) technologies for the fossil fuel generation of electricity.”

Oxyfuel combustion is a CCS technology where fossil fuel is fired with oxygen instead of air, the flue gases then largely consist of CO2 and water vapour so that CO2 purification is more easily achieved.

A major challenge exists to lower the resulting flame temperatures which can be achieved through recycle of the flue gases. This mitigates the flame temperature making oxyfuel combustion suitable for retrofit or new-build coal power plant. Other advantages include virtually zero emissions of the oxides of nitrogen and a significantly smaller carbon capture plant.

Oxyfuel combustion has been demonstrated at approximately 40MWt but commercial-scale demonstration is the next necessary step and there are significant barriers to this happening.

Led by the University of Glamorgan, the project will be undertaken by a consortium of higher education institutions, research centres and industrial partners, from across Europe, bringing together the best in research facilities and technology development expertise.

Defining ‘Dignity’ for Older People in Wales

Tue, 31 Jan 2012 11:48:47 +0100

A report on the findings of a study on what dignity means to older minority ethnic people in Wales has been launched to mark this year’s Dignity in Action Day, 1st February.

Over the decades research in the area of dignity and age has grown in both the UK and internationally.

Although the body of research evidence has helped significantly to refine the concept of dignity and to broaden our understanding of older people’s experience and expectations of care, few studies have sought to examine the concept of dignity and perceptions of dignified care as linked to social identity and racialisation, and to develop an understanding of the possible impact this has on enhancing or damaging a care encounter.

A report on the study, ‘In their own words’: Voices of African-Caribbean and Black Welsh men and women fifty years and older, led by University of Glamorgan academic Dr Roiyah Saltus seeks to address this gap in Wales.

Dr Saltus said, “This exploratory study is significant in that is seeks to address a present gap in the research evidence base. We hope that this study is of interest to anyone with a concern about older people’s care and with services, organisations and agencies who are seeking to shape positively the expectations older people have on the care and support options they have at their disposal. Further research on the concept and lived experiences of dignified care encounters that explore further the concepts of personal and social identities is needed. With this should come studies that explore the personal identities of older people as linked to other social markers such gender, ethnicity, migration histories, and as shaped by the accumulated impact of structural inequalities.”

Led by Dr Saltus who is a Principal Research Fellow based at the University of Glamorgan, the aim of the qualitative, exploratory study was to capture how dignity is understood, and how dignified care is viewed, with a focus on support or care expectations, preferences and experiences.

Interviews were conducted with 21 first and second generation Black Caribbean/ West Indian older people, and older men and women living in Wales who self-identify as being 3rd or 4th generation Black Welsh (that is of mixed ethnic groups, with ancestral links to Africa and the Caribbean).

The study revealed that, as aspects of their personal identity, social markers such as ethnicity and cultural identity shaped their understanding of what dignity means and also had an impact on how they felt they would be treated in care encounters. A key message is that attention to these elements is important, as is the need to develop an understanding of the possible impact such factors may have on enhancing or damaging a care encounter. The anxiety around external sources of support and care was voiced, by some, in terms linked to their personal identity, and not being treated with care and with dignity because of their ethnic or cultural background.

Care or support workers who assume that they know what an older person needs, who seek to provide care or support based on their presumptions of a older person’s cultural-specific needs, or who do not have the skills needed to work across ethnic groups, delivering person-centred care are other key concerns raised by the participants.

Martyn Jones from Age Cymru said, “Age Cymru is grateful to Dr. Saltus and the Wales Ethnicity Research Collaboration (WERC) at the University of Glamorgan for offering the opportunity for our Older Minority Ethnic Network (OMEN) to participate in this research. OMEN exists to provide a voice to the often marginalised minority ethnic section of the older population in Wales and to ensure that Age Cymru develops robust policy positions based on evidence obtained from the widest possible cross section of society. We feel that this groundbreaking research will do much to extend knowledge and understanding in this area and to influence the development of policy and implementation of services for older minority ethnic people across Wales.”

Notes to editors:
Further findings were:

• The almost unanimous view that mutual respect and reciprocity is vital to the fostering of dignity and the acknowledging of a person’s self worth. “You treat the person as you would like to be treated.” (002: African-Caribbean woman, aged 73) The key messages repeated most often by the participants were: the universal right to be respected, the significance of one’s self-worth, the links between self-respect and dignity in social encounters, and the impact of the social positioning of older age and societal discrimination.

• The study revealed that older people have strong views on what constituted care. Key responses to the question ‘what type of care would you like to expect to receive’ that were revealed were: basic personal care; acknowledgement of human dignity; acknowledged as an individual; acknowledgment of and attention to social markers linked to the personal and social identities of older people, as articulated by the person; care that prolonged autonomy and independence; care delivered by people who were not only aware of individual preferences and cultural differences (or similarities as the case may be), but who were responsive and made appropriate adjustments. These were considered key enhancers and indicators of dignified care.

The study was funded by the Welsh Government’s New Ideas Social Fund and is part of a series of studies being conducted under the auspices of the Wales Ethnicity Research Collaboration (WERC – www.werc.org.uk), an all-Wales research group with partners