Bromley College of Further and Higher Education

The vision presented by OECD’s Forum on Tax Administration proposes a digital transformation of tax administration by embedding tax collecting process into the everyday activities that taxpayers use to service their needs rather than being an add-on process. The ATTACC project demonstrates how this could be achieved through Generic Radio Access Network (GRAN)-IoT-enabled cross-border trading. This project seeks to reduce frictions in international trade that stem from data duplication and complex administrative processes to deliver an automated cross-border tax and customs compliance capability and apply AI to analyze large datasets to spot discrepancies between declared income and actual financial activity.

Family and Group Conferencing (FGC) is a relatively new strengths-based approach applied to adults needing social care and mental health support in the UK. Although the approach is well established in children's services in the UK, few services currently offer FGCs to adults; therefore, there is limited evidence regarding FGCs in the adult services context in the UK. This study aims to fill this gap by examining how FGCs work and what differences they can make in people's lives. This paper (Part 1) addresses the first of two related research questions, aiming to characterize the practice model(s) that pertain to the context of adults' FGCs as currently offered. We employed a mixed methods research design drawing on data from both, previous literature as well as current practice by undertaking a comprehensive literature review, national survey and stakeholder interviews with current services and a deliberative forum involving a range of stakeholders pertaining to adult FGCs. Although there is some variation in the practice model(s) offered by services, the overall approach is underpinned by a relatively consistent set of values and principles, although these are often implicit. The FGC offers a staged approach that enables people and their networks to take greater control over their support arrangements. It is seen as an appropriate service offer across all adults and mental health services with the potential to result in a range of positive outcomes (as will be discussed in Part 2). Central to achieving this is flexibility within the service offer to accommodate the social and cultural needs of the individual and their network, the independence of the FGC coordinator, the necessity of sufficient preparation for all participants, and rapport building in advance of the Conference.

BackgroundThe national agenda to increase care outside the acute setting through virtual wards offers key opportunities for palliative care services to give intensive, timely support to enable patients to die at home, where otherwise they would need care in hospital/hospice setting. Coordinated, integrated services across professional groups/settings is essential to achieve this.AimTo evaluate a new model of working to expedite hospital discharges and avoid hospital admissions for patients requiring enhanced support to die at home.MethodHospital at Home accepts patients to: Frailty, Respiratory, IVs, Palliative pathways with joint working across pathways. We evaluated outcomes for patients under palliative pathway. Referrals were from: hospital, GPs, Rapid Response and hospice. Two clinicians (nurse/paramedic), with access to medical support, led the service with in-reach to the hospital and Hospital at Home team.ResultsOver 22 weeks, 106 patients accepted, 26% from hospital, 74% in home/care homes. 42% known to community palliative care (CPCT) but required urgent/intensive support. 66% were seen within 4 hours and 85% within 24 hours. 85% had 1–3 visits before either death (12%) or discharge to other services (50% to CPCT, 25% to GP). Three patients were admitted to hospice, one didn’t get out of hospital. Patient care focused on symptom control, support at end-of-life, complex discussions between patient, family and health care professionals to establish ceilings of treatment and hold risk, with urgent procurement of equipment and medications. Hospital admission avoided in 15% and hospital discharge expedited in 30%. Family and care home staff support were key. Challenges included development of coordinated IT systems, facilitating cross-organizational working and development of shared ethos and education.ConclusionThis is a flexible and responsive service seeking to join up care across organizations and settings. Learning and ongoing evaluation are shaping its development to establish its role within the wider system.

The most frequent hyperglycemic emergency and the leading cause of death in people with diabetes mellitus is diabetic ketoacidosis (DKA). DKA is common in people with type 1 diabetes, while type 2 diabetes accounts for roughly one-third of occurrences. Although DKA mortality rates have generally decreased to low levels, they are still significant in many underdeveloped nations. In industrialized countries, its mortality rate ranges from 2 to 5%, but in underdeveloped nations, it ranges from 6 to 24%. Therefore, it is always lethal if misdiagnosed or improperly treated. According to specific research, DKA can be present at the time of type 1 diabetes onset in 25 to 30% of cases and in 4 to 29% of young people with type 2 diabetes mellitus, and its features include hyperglycemia, metabolic acidosis, and ketosis with its triggering factors commonly being infections, newly discovered diabetes, and failure to start insulin therapy. Less than 20% of DKA patients present comatose, and patients with different levels of consciousness can present at other times. A close association between abnormalities found during a mental status evaluation and osmolality seems to exist. Hospital admission is necessary for vigorous intravenous fluid therapy, insulin therapy, electrolyte replacement, diagnosis and treatment of the underlying triggers, and routine monitoring of the patient’s clinical and laboratory conditions to manage DKA properly. Appropriate discharge plans should include actions to prevent a DKA recurrence and the proper selection and administration of insulin regimens.

Children’s health can be affected by the interrelated characteristics of the physical and social environment where they live, including housing quality, neighbourhood characteristics and the local community. Following a systems-based approach, this exploratory project sought to understand how the needs and aspirations associated with the home environment can work in synergy with, or be exacerbated by, other aspects of the local area. The study recruited parents of children aged 2–12 years old from two local authorities in England with high levels of child poverty: Tower Hamlets in East London, and Bradford District in West Yorkshire. Thematic analysis of participant interviews highlighted ten themes and opportunities for improvements. The evidence presented in this research emphasises how environmental quality issues within and outside the home, compounded further by delays in repairs and reduction in service standards, as well as affordability issues, are likely to deeply affect the wellbeing of an entire generation of disadvantaged children whose parents can feel disempowered, neglected and often isolated when attempting to tackle various dimensions of inequalities. Interventions which can improve the quality of housing, and access to space and services, are urgently needed, including initiatives to support and empower families and local communities, especially those prioritising opportunities for action.

Various actions and policies of governmental agencies and the General Dental Council (GDC) have crushed the compassion out of many dental professionals. Compassion is not the same as sympathy or empathy; compassion involves doing something practical to overcome a patient's problems. However, many compassionate dental professionals now think of the GDC as a bit like being trapped in a lift with a wasp. The statistical probability is that nothing really terrible is going to happen to you for trying to solve a patient's problems pragmatically, but the tension and the worry that it might is always present. One effective way to reduce the chances of a painful experience is not to undertake slightly risky procedures. It is far, far safer to make copious notes but then to refer on anything potentially problematic, especially under the flawed NHS Units of Dental Activity system, 'just to be on the safe side', while bowing low to the GDC and claiming it is 'outside of one's competence'. The net result is a lack of clinical engagement in solving patients' problems practically, coupled with an ongoing lack of experience and confidence in solving similar patients' problems, as well as shifting some problems unnecessarily on to overloaded hospital departments. Who benefits from those perverse outcomes?

Community-based support for autistic children and their families can prevent individuals from reaching crisis point and reduce inpatient admissions.1 Lauren Wallace-Thompson and Jason Rose describe how they set up a joint initiative with Bromley Council and the parents and carers of children and young people with autism, and what changes this has introduced.