National Health Service Scotland

NHS Lanarkshire (NHSL) Physiotherapy Musculoskeletal (MSK) service receives approximately 30,000 referrals annually, facing long waiting times and workforce pressures. To address these challenges, NHSL piloted Community Appointment Days (CADs)-a patient-centred model offering same-day assessment, advice, and community support in non-medical settings. A mixed-methods service evaluation was conducted using retrospective analysis of data from ten CADs delivered across three leisure centres in 2024-2025. Quantitative data from the Patient Management System included attendance, outcomes, and re-access rates. Qualitative data were collected via patient passports, surveys, and interviews. Objectives were to assess impact on waiting times, patient experience, cost avoidance, and sustainability. Of 2,287 patients booked, 1,866 attended. Outcomes included discharge (10%), patient-initiated review (PIR) (53%), and return appointment (37%). Average time per CAD was 69 minutes. PIR return rate was 8%, with 0% ED attendances for the same condition. CADs enabled a 3.7-fold increase in new patient capacity on the day, reducing waiting times in targeted waiting lists by 5 weeks in 2024 and 9 weeks in 2025. Initial setup costs were £16,388; subsequent CADs projected cost avoidance of £4,132 each. Patient feedback was highly positive, with strong Care CollaboRATE scores, though some reported environmental challenges. Staff reported CADs as less stressful or similar to routine work. CADs are a scalable, patient-centred model that improves access, reduces waiting times, and supports self-management while maintaining safety. Future work should refine triage, enhance booking systems, and evaluate long-term outcomes to ensure sustainability.

Objective: The paper aims to model Health-and-Social-Care (H&Sc) services as Cause–Effect (CE) groups within a Bayesian framework, using cross- and self-causation dynamics. The contribution is that the data used are open and never studied before and are posted online by National Health Services Scotland (NHSS). Method and Material: The paper contributes to the ongoing discourse on how Machine Learning(ML), and Bayesian inference, can inform the purposes of policymaking. Cause–effect relationships and Bayesian methods can associate public services as causes-effects, through suitable likelihood functions and priors that binomial and normal distributions can imlplement. The study identified the optimal predictive distribution using the Maximum-a-Posteriori (MAP) estimation method. Moreover, the CE-matrix approach, enables the representation of multiple causes linked to a single effect-target in a tabular format, that facilitates interpretability and prediction. Results: The findings indicate that services related to 'Alcohol' can be predictors of other effect-services, while home-based services were identified as causes of subsequent hospital admissions. Moreover, low-demand services were observed in earlier years, particularly those with no records after 1997, whereas higher-demand services were newly introduced in later years. These findings may offer insights into latent inter-service relationships, and inform policy development. The cross- and self-causation in a Bayesian framework, determined that the posterior can be predicted by 5 to 10 previous observations and this is significantly affected by the level of zero-padding (percentage of past no-records). In later years, the CE models yield more probable demand patterns. Cause–effect relationships were identified between smoking-related services, mental-health support, and the epidemiological index of Primary-1-Education children's Body-Mass-Index (BMI). Conclusions: The conclusions drawn from this analysis may be particularly relevant for insurance providers and public policymakers, who can leverage Bayesian CE-linked service models for long-term care planning, especially for elderly and low-income populations. The validation of ser-vice interlinkages further enhances the potential for precise and efficient resource allocation.

Abstract Aim In 2024 bariatric surgery services in our trust were expanded to a surgical hub, a hospital with short-stay surgical beds, 24/7 anaesthetic and medical cover, but no critical care. Criteria for the surgical hub are BMI <45, gastric sleeves, no revisional surgeries, no significant pain issues and no post-operative critical care requirement. The aim of this study was to compare post-operative complications of patients operated on at the hub with those with BMI >45 operated on at the tertiary centre, with the aim of guiding future patient selection. Method Post-operative complications following laparoscopic sleeve gastrectomy were reviewed for 11 patients with BMI <45 at the surgical hub and compared with 16 patients with BMI >45 at the tertiary centre. Results There were no post-operative complications in the surgical hub patients. Three patients at the tertiary centre had planned HDU stays due to pre-existing medical co-morbidities. There was 1 unplanned HDU admission due to difficulty weaning from high flow nasal oxygen in recovery. One patient returned to theatre due to hypotension secondary to haemorrhage. This patient (BMI 39) had a planned HDU bed due to obstructive sleep apnoea but was subsequently admitted to ICU. Conclusions There is a low rate of post-operative complications in patients with BMI >45, without significant comorbidities, undergoing laparoscopic sleeve gastrectomy. With careful patient preselection, consideration could be given to increasing the BMI limit at the surgical hub, reducing waiting list times and freeing up surgical space at the tertiary centre.

• Understanding adolescents’ experiences in secure care is important. • Effective care was linked to supportive, empathetic staff. • ’Peer solidarity,’ based on shared experiences, fostered trust and friendship. • Personalised care plans and a supportive, therapeutic environments was beneficial. • Our findings offer valuable insights for professionals involved in service design. There is a paucity of literature qualitatively exploring adolescents’ experiences in secure care, which is an essential consideration for future service design. We aimed to increase understanding of factors which contribute both positively and negatively to these young people’s experience. A systematic review was conducted following PRISMA guidelines. Studies were identified by searching five online databases in June 2024. The quality and risk of bias of each study meeting inclusion criteria was independently assessed by two authors using the Crowe Critical Appraisal Tool. 26 relevant studies were identified. Analysis revealed key themes: relationships/communication with others, rules and regulations, thoughts towards self and perspectives on treatment plans. Effective care appeared linked to supportive, empathetic staff and a balance between regulation and freedom. ’Peer solidarity,’ based on shared experiences, appeared important, fostering trust and friendship. Transition periods, especially to adult services, were identified as disruptive and anxiety-inducing. The importance of personalised care plans and supportive, therapeutic environments was emphasised, though findings varied across settings and age groups. Most papers were of moderate to high quality. Our findings offer valuable insights for professionals involved in design of supportive secure care environments tailored to the needs of involved young people. Future research should focus on directly exploring the lived experiences of less explored populations, such as the impact of neurodiversity or living in the developing world, on young people’s experience of secure care. This would ensure a more inclusive range of perspectives shape effective and compassionate care strategies.

In 2017, the WHO introduced the AWaRe (Access, Watch and Reserve) classification of antibiotics to support antibiotic stewardship (AMS) at local, national and global levels. We assessed the categorization of each of the antibiotics for systemic use for antimicrobial stewardship and quality improvement practice across primary and secondary care in the UK, proposing a nationally adapted UK-AWaRe classification. A four-stage modified Delphi survey was conducted to review the AWaRe classifications in light of antibiotic resistance profiles, antibiotic use and stewardship practice in the UK. Recommendations were iteratively discussed and consensus reached on how to adapt the WHO AWaRe list. Implications of the proposed new categorization for possible antibiotic usage targets were assessed using England national antibiotic consumption data as a case study. Sixty-one experts across the four UK nations participated in the modified Delphi process. Consensus was most easily reached, with least between-expert variation, for Access antibiotics. Seventeen antibiotics differed in categorization when comparing proposed adapted UK-AWaRe classification and the 2023 WHO AWaRe classification. Through the focus group discussions, the importance of clear messaging was highlighted for the proposed move of first-generation cephalosporins into the Access category, a step-change from the 2019 England AWaRe classification, where all cephalosporins were in the Watch category. From the case study analysis of national data in England, Access antibiotics accounted for >60% of human antibiotic use between 2018 and 2022, 69.7% when using the WHO 2023 classification and 63.7% with the proposed UK-adapted 2024 classification. An adapted UK-AWaRe list has been suggested through a consensus-reaching process. This will support national AMS and antibiotic usage targets of the UK antimicrobial resistance 2024-29 national action plan.

The Scottish Patients at Risk of Re-Admission and Admission (SPARRA) score predicts individual risk of emergency hospital admission for approximately 80% of the Scottish population. It was developed using routinely collected electronic health records, and is used by primary care practitioners to inform anticipatory care, particularly for individuals with high healthcare needs. We comprehensively assess the SPARRA score across population subgroups defined by age, sex, ethnicity, socioeconomic deprivation, and geographic location. For these subgroups, we consider differences in overall performance, score distribution, and false positive and negative rates, using causal methods to identify effects mediated through age, sex, and deprivation. We show that the score is well-calibrated across subgroups, but that rates of false positives and negatives vary widely, mediated by various causes including variability in demographic characteristics, admission reasons, and potentially differential data availability. Our work assists practitioners in the application and interpretation of the SPARRA score in population subgroups.

Abstract Background Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital. Method Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty. Conclusions Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.