Morbidly obese patients face access restrictions under NEW Devon cost cutting plan – Health Service Journal 
A cash strapped clinical commissioning group plans to limit access to routine surgery for obese patients and suspend funding for some non-urgent procedures in a drastic bid to find £26m of in year savings.

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The parallel universes of integrated care: the process of change is as important as the content – King’s Fund Blog
Norman Lamb’s announcement of a second wave of 10 integrated care pioneers at our recent integrated care summit signalled the continuing commitment of ministers to joining up care around the needs of patients and populations. The palpable enthusiasm of health and social care leaders at the summit contrasted strongly with presentations by researchers who were much more cautious about the strength of the evidence to support integrated care. A rapid review of systematic reviews and meta-analyses found that evidence of economic impact was either mixed or uncertain, while also noting weaknesses in the design of many evaluations.

The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population-based, cross-sectional study. – Health Services and Delivery Research, Vol:2, Iss:38
The performance of maternity services is seen as a touchstone of whether or not we are delivering high-quality NHS care. Staffing has been identified in numerous reports as being a critical component of safe, effective, user-centred care. There is little evidence regarding the impact of maternity workforce staffing and skill mix on the safety, quality and cost of maternity care in the UK.

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Delivering High Value Care Pathways – a commissioning scenario – NHS Right Care
A typical Long-Term Conditions story and how the NHS Right Care approach can help to achieve better value. Describes how can the Right Care approach improve value for patients with Type 2 Diabetes and the value that commissioners get for their spend on Diabetes. Presents the Right Care approach in a more personalised fashion by using a use case which would speak to practitioners rather than managers, by modelling a scenario about the experience of a patient entering a long term condiiton pathway, in this case Type 2 Diabetes.

Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study – Health Services and Delivery Research
Multidisciplinary team (MDT) meetings have been endorsed by the Department of Health as the core model for managing chronic diseases. However, the evidence for their effectiveness is mixed and the degree to which they have been absorbed into clinical practice varies widely across conditions and settings. Aims to identify the key characteristics of chronic disease MDT meetings that are associated with decision implementation, a measure of effectiveness, and to derive a set of feasible modifications to MDT meetings to improve decision-making. Finds substantial diversity exists in the purpose, structure, processes and content of MDT meetings. Greater multidisciplinarity is not necessarily associated with more effective decision-making and MDT decisions (as measured by decision implementation). Decisions were less likely to be implemented for patients living in more deprived areas. We identified 21 indications of good practice for improving the effectiveness of MDT meetings, which expert stakeholders from a range of chronic disease specialties agree are both desirable and feasible. These are important because MDT meetings are resource-intensive and they should deliver value to the NHS and patients. Priorities for future work include research to examine whether or not the 21 indications of good practice identified in this study will lead to better decision-making; for example, incorporating the indications into a modified MDT and experimentally evaluating its effectiveness in a pragmatic randomised controlled trial.

Instruments to assess integrated care: a systematic review – International Journal Of Integrated Care
Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within
the instruments identified. Finds no measurement instrument covering all aspects of integrated care. Further, a lack of uniform use of the eight organisational elements across the studies was prevalent. It is uncertain whether development of a single ‘all-inclusive’ model for assessing integrated care is desirable.

A qualitative study of integrated care from the perspectives of patients with chronic obstructive pulmonary disease and their relatives – BMC Health Services Research
Disease management programmes have been developed for chronic obstructive pulmonary disease (COPD) to facilitate the integration of care across healthcare settings. The purpose of the present study was to examine the experiences of COPD patients and their relatives of integrated care after implementation of a COPD disease management programme. Finds participant suggestions for optimizing the integration of healthcare included assigning patients a care coordinator, telehealth solutions for housebound patients and better information technology to support interprofessional cooperation.