Kent County Council

As populations age, the gap between care needs and available support systems is widening, leading to critical vulnerabilities in staffing, infrastructure, and funding. The need for accessible, human-centred, and ethically grounded care technologies is growing. However, the development of digital health tools often lacks inclusivity and practical guidance. Existing ethical frameworks tend to remain abstract, which limits their real-world application. This study examines how such frameworks support the responsible development and implementation of caring technologies in older adult care. To achieve this, in-depth interviews were conducted with care providers, technology developers, and policymakers from partner organisations of the EMPOWERCARE project in the four participating countries: the UK, the Netherlands, Belgium and France. A core challenge was the limited applicability of abstract ethical principles in daily care settings. While existing initiatives often define ethical domains, few offer a structured, actionable process to guide implementation in practice. The proposed guide responds with a step-by-step structure, practical examples, and participatory tools to support inclusive, value-driven technology adoption. It is envisioned both as an implementation aid and a quality label to align stakeholders. Future research should validate the guide's usability, explore its role across care contexts, and examine how ethics can be more firmly embedded in innovation governance.

Introduction:Cerebral visual impairment (CVI) is an umbrella term that describes a broad range of brain related visual problems and it is now the most common cause of visual impairment (VI) in children in the developed world. Early assessment, management and support are essential to minimise the risk of lifelong negative consequences. Currently there are no internationally agreed clinical guidelines for the investigation and diagnosis of CVI, with variation in existing models of care resulting in potential service health inequities for this population.Objective:The objective of this scoping review is to identify and describe the components of existing service delivery models of care in relation to the detection, care, and management of children with CVI.Methods:We will search multiple databases to include MEDLINE, CINAHL, Embase, APA PsycINFO, and The Cochrane Library for English language publications from OECD countries. Supplementary searches will also be conducted to locate grey literature. We will include any study that describes or assesses service delivery for children (0–17 years) with CVI in health and social care, and education settings.Stakeholder engagement:We consulted with a broad range of stakeholders including subject experts and patient and public representatives during the planning and will continue during the conduct, reporting and dissemination of this scoping review.

With major changes planned for the governance of the healthcare system, Joe Home, Sacha Wright and Joe Deegan underline the need for an overhaul of strategic decision making in the NHS, balancing data-driven direction with empathetic services that meet the needs of communities.

Fire and rescue services in England routinely carry out Home Fire Safety Visits which aim to reduce risk of fire, support independent living and improve quality of life. The visits include a person-centred assessment and providing general advice on health-related topics such as preventing falls. To assess the effectiveness and cost-effectiveness of Home Fire Safety Visits (also known as Safe and Well Visits) to reduce falls and improve quality of life in older adults living in the community. We designed a multicentre, randomised controlled trial with economic and qualitative evaluations, involving two fire and rescue services in England, to recruit 1156 community-dwelling adults aged 65 years and over. All participants could continue to access routine care from healthcare professionals and were provided with a falls prevention leaflet as part of the trial. The intervention group were additionally offered a Home Fire Safety Visit. The usual care group were offered a visit after they had completed the trial. Blinding was not possible. Participants were randomised 1 : 1 using a secure web-based system. The primary outcomes were (1) the number of falls per participant and (2) health-related quality of life (EuroQol-5 Dimensions, five-level version) over 12 months from randomisation. Secondary outcomes included fire risk-taking behaviours, loneliness, fear of falling and time to first fall. The planned economic evaluation comprised cost-utility and cost-effectiveness analyses. The qualitative study was designed to examine intervention fidelity and acceptability. It proved impossible to conduct the trial as planned in the current research landscape. We faced significant delays in setting up and starting recruitment, in large part due to this coinciding with the start of the COVID-19 pandemic. Obtaining regulatory approval took longer than anticipated. Additionally, we were unable to access general practitioner registration data to identify participants as planned and so we had to use Consumer Classification Platform data to identify potential households to send study invitations to. This resulted in a less targeted and non-personalised mail-out as this is not patient-level data so the householder names were unavailable. Ultimately, recruitment was much lower than expected. In total, 237 participants were assessed for eligibility and 63 randomised (intervention, n = 32; usual care, n = 31). The Home Fire Safety Visits were delivered as planned to both groups; however, the planned statistical and health economic analyses could not be conducted due to the limited data. Data from the qualitative evaluation indicated the intervention was largely acceptable to staff and service users. Conducting trials in this setting is currently extremely challenging. To facilitate future research, we recommend an urgent review of research governance issues related to the types of personal data that can be accessed and used for research. This review should aim to provide support and avoid creating additional obstacles to research in this area. The evidence for the effectiveness and cost-effectiveness of Home Fire Safety Visits remains inconclusive. Research governance in local authorities needs urgent review. This trial is registered as Current Controlled Trials NCT04717258. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128341) and is published in full in Public Health Research; Vol. 13, No. 7. See the NIHR Funding and Awards website for further award information.

This study aimed to develop gemcitabine-loaded nanocapsules for pancreatic cancer treatment, optimizing their formulation before evaluating them through in vivo studies. The researchers selected gemcitabine as the model drug because it has established clinical relevance and known pharmacokinetic shortfalls (short half-life and poor bioavailability) with toxic dose limits which suit the evaluation of nanoparticle drug delivery systems. The researchers conducted a 32 factorial design to optimize the formulation through adjustments of PLGA concentration and Tween 80 concentration. The optimal characteristics of F5 among nine formulations included particles of 160 ± 3nm with 87 ± 2% encapsulation efficiency and - 27.8 ± 1.2mV zeta potential. The in vitro drug release testing alongside pharmacokinetic results established that nanoparticle gemcitabine caused extended drug delivery and dramatically better bioavailability in addition to achieving longer systemic circulation than free gemcitabine alone. Evaluation of biodistribution revealed that the product displayed tumor-targeting property and had improved antitumor effect and less side effect compared with the other groups. The findings demonstrate that gemcitabine works as an ideal model chemotherapy drug to measure nanocarrier delivery platforms for treating pancreatic cancer solid tumors.

Summary: As a shift from 'smart' to 'caring' technologies is needed, which puts the end-user's care needs at the forefront, we developed the Caring Technology guideline which is an added value for caring technology implementation in healthcare organisations. Objectives: This study aimed to investigate the needs and expectations associated with the implementation of caring technologies in elderly care and use this information to inform the development of a Caring Technology guideline. The Caring Technology guideline (developed in the context of the Interreg 2Seas project ‘EMPOWERCARE’) provides an eight-step procedure, supported tools and best practices to support a care organisation in the implementation of technology, and takes the 8 ‘Caring Technology Principles’ (developed by the King Baudouin Foundation) as an ethical reference. Design: Questionnaires and online in-depth interviews were conducted with EMPOWERCARE partner organisations to investigate the current use and relevance of the Caring Technology Principles, important aspects to be considered for the Caring Technology guideline, the contribution of technology trials to the guideline and the influence of the region of technology implementation on the interpretation of the principles or technology implementation. To include perspectives on these topics from outside the EMPOWERCARE project, we organised an online EMPOWERCARE Annual Event workshop with both EMPOWERCARE partners and external organisations, and an online workshop with care organisations in Zeeland. Lastly, a focus group with EMPOWERCARE partner organisations was conducted to discuss the most relevant target group for the Caring Technology guideline and to collect feedback on the proposed process guidance. Results: The region of technology implementation did not influence the use of principles or the implementation of technology. Participants currently focus on centralising end-users in healthcare technologies and on increasing digital literacy and technology acceptance for both end-users and the workforce. Principles such as quality assurance, democratic and participatory governance, and responsible innovation were less represented by the participants. Participants struggle with the theoretical aspect of the Caring Technology Principles. The reported challenges can be translated into the following tools in the Caring Technology guideline: a process guide, good practices and workshop formats. To this end, the Caring Technology guideline is an added value compared to existing initiatives. Conclusion: The present study elucidates the needs and expectations associated with technology implementation in elderly care. This input was used to inform the development of a Caring Technology guideline, based on the Caring Technology Principles. As there is, to our knowledge, no current initiative that is both based on guiding principles and provides a process guide for the practical implementation, the Caring Technology guideline that we propose is an added value for caring technology implementation in healthcare. Next steps include further testing and dissemination of the Caring Technology guideline.

BackgroundLung cancer has the poorest survival due to late diagnosis and there is no universal screening. Hence, early detection is crucial. Our objective was to develop a lung cancer risk prediction tool at a population level.MethodsWe used a large place-based linked data set from a local health system in southeast England which contained extensive information covering demographic, socioeconomic, lifestyle, health, and care service utilisation. We exploited the power of Machine Learning to derive risk scores using linear regression modelling. Tens of thousands of model runs were undertaken to identify attributes which predicted the risk of lung cancer.ResultsInitially, 16 attributes were identified. A final combination of seven attributes was chosen based on the number of cancers detected which formed the Kent & Medway lung cancer risk prediction tool. This was then compared with the criteria used in the wider Targeted Lung Health Checks programme. The prediction tool outperformed by detecting 822 cases compared to 581 by the lung check programme currently in operation.ConclusionWe have demonstrated the useful application of Machine Learning in developing a risk score for lung cancer and discuss its clinical applicability.

In public health, the routine use of linear forecasting, which restricts our ability to understand the combined effects of different interventions, demographic changes and wider health determinants, and the lack of reliable estimates for intervention impacts have limited our ability to effectively model population needs. Hence, we adopted system dynamics modelling to forecast health and care needs, assuming no change in population behaviour or determinants, then generated a “Better Health” scenario to simulate the combined impact of thirteen interventions across cohorts defined by age groups and diagnosable conditions, including “no conditions”. Risk factors for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy is significant, adding 5.1 and 5.0 years, respectively. We demonstrate the feasibility, applicability and utility of using system dynamics modelling to develop a robust case for change to invest in prevention that is acceptable to wider partners.

Research QuestionCan caller satisfaction and trust in police be improved (or equalled), after police agree to send a police car to meet with a caller face-to-face, by the alternative of immediate transfer of the call to a police officer who speaks to the caller at length by telephone?DataA total of 1016 calls for police service to 999 or 101 assigned by call takers as falling into a “medium” priority category were checked for eligibility, including consent of the caller to speak immediately to a police officer by phone if possible. Eligible offence types excluded domestic abuse but included a variety of other matters. A majority (57.7%) of eligible cases were about threats made by neighbours, workplace colleagues or others known to the caller. A total of 450 cases were selected as eligible for the test sample out of a total of assessed as potentially eligible.MethodsEligible cases were randomly assigned to either a control group (N = 225) of business as usual (BAU) attempts to provide a face-to-face meeting with a police officer, or the experimental group (N = 225) receiving immediate telephone transfer to a police officer who talked with the caller for over an hour as the initial police response. Analyses were done by intention-to-treat. While 99.75% (N = 249/250) of the experimental cases were treated as assigned, only about half of the 225 control cases actually received a face-to-face meeting with a police officer. All 450 assigned callers who gave consent to enter the experiment were contacted for a satisfaction survey at least 14 days following random assignment of the cases, from which the completion rate was 72.5% (almost identical in the two treatment groups).FindingsEligible, consenting callers reported substantially higher levels of being “satisfied” or “very satisfied” with the experimental police response by telephone (92.6%) than with the BAU efforts to arrange a face-to-face meeting between a police officer and the caller (68.9%). Trust and confidence in Kent police declined among 21% of callers receiving BAU service, but only 9% of callers given immediate telephone service. The median time from the initial call to a conversation between police and caller was under 1 min for the experimental treatment vs. 2721 min for the 80% of BAU control treatments in which any conversation between an officer and a caller occurred within 96 h after the call.ConclusionThis first experiment in a research collaboration on FAST (Finding Alternative and Speedier Tactics) policing has opened the door to further tests of immediate response by remote communications (Rothwell, et al. Cambridge Journal of Evidence-Based Policing, 6, 1–24, 2022). For the kinds of cases included in this experiment, there is a clear preference by callers for the speedier service by a simple phone call over much slower attempts to provide a face-to-face meeting. If broadly adopted across many other high-volume, low-harm categories of requests for police service, fast policing by phone, video or silent live-chat online could improve public approval of policing while allowing more time for police to prevent more serious crimes.

Abstract Background: The needs of children in care are a government priority, yet the evidence-base for effective interventions to support the emotional wellbeing of children in care is still lacking. Research suggests that supporting the carer-child relationship, by promoting the carer’s reflective parenting, may be an effective approach to improving the well-being of these children.Methods: The study comprises a definitive, pragmatic, randomised control trial, with embedded process evaluation and economic evaluation, and an internal pilot, to evaluate the effectiveness, and cost effectiveness, of the Reflective Fostering Programme.The study is being conducted in local authority sites across England, and is targeted at foster carers (including kinship carers) looking after children aged four to 13. Consenting participants are randomly allocated to the Reflective Fostering Programme (intervention arm) in addition to usual support or usual support alone (control arm). The primary outcome is behavioural and emotional well-being of the child 12 months post-baseline, and secondary outcomes include: foster carer’s level of stress, quality of life, reflective capacity, compassion fatigue and burnout, placement stability, the quality of the child-carer relationship, child’s capacity for emotional regulation, and achievement of personalised goals set by the carer.Discussion: This study trials one of the first parenting programmes specifically targeting the reflective capacity of foster carers. A feasibility study has indicated effectiveness of the Programme in improving the child-carer relationship and emotional and behavioural wellbeing of children in care. This study will test the effectiveness and cost-effectiveness of implementing the Reflective Fostering Programme as an additional aid to the support already available to local authority foster carers.Trial Registration: ISRCTN 70832140