Background: Wider communication about death and dying for those with intellectual disabilities has been highlighted as being of key importance. Objective: To gain the perspective of paid carers based in residential homes about meaningfully supporting individuals with intellectual disabilities in the bereavement process. Methods: Semi-structured interviews were conducted with paid carers working across two residential homes. Results: Four themes were identified: (a) challenges in having conversations about death and dying; (b) meaningful involvement of residents in the bereavement process; (c) the relationship between paid carers and residents (including the impact of a resident's death on paid carers); and (d) the support needs of paid carers. Conclusions: The recommendations from previous research of meaningfully involving people with intellectual disabilities in the bereavement process have not filtered fully into practice. Paid carers still highlight the need for specialist support and advice to help them discuss and increase involvement in death and dying.

BACKGROUND: Currently we are experiencing record numbers of visits to Emergency Departments (EDs) in England with an increase of 4.1% from last year. This is also alongside the worst performance for treating patients within 4 hours of arriving at an Emergency Department (Gardner, 2019). A new Frequent Service User Manager (FSUM) service was set up in West Kent to address the issue of those frequently attending EDs and support the well being of these patients. AIM: To evaluate a new service to address Frequent Service Use of Urgent Care Services. METHODS: Service data on demographics, loneliness, anxiety, quality of life, and urgent health care usage was obtained for those most frequently attending (n=22) a West Kent Emergency Department. Interviews were carried out with a sample of these patients (n=4) to capture their experiences of using the service. RESULTS: The main presenting symptoms for attending the Emergency Department were pain and alcohol related conditions. After 12 months, loneliness, anxiety and use of urgent care services had reduced. Quality of Life improved from baseline to 4 months but then stabilised at 12 months. The results highlight the important role FSUMs can play in supporting those that frequently attend Emergency Departments.

We aimed to evaluate a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care. Patients with stable long-term mental health conditions are often not discharged from secondary mental health services when no longer needed due to insufficient systems and processes to enable safe, effective, recovery-focussed treatment and support. The Primary Care Mental Health Specialist (PCMHS) Service was developed to address this gap; new PCMHS posts were introduced to act as a conduit for patients being discharged from secondary care and a single point of referral back into secondary care, should it be required. The two-year pilot, across six Clinical Commissioning Groups in South East England, began in March 2013. Interviews were conducted with all PCMHS employed in the pilot service (n=13) and a sample of service users (n=12). The views of professionals working alongside the service, including GPs, Psychiatrists and Mental Health Nurses, were captured using a brief online questionnaire (n=50). Time and Activity Recording Sheets were used to capture data required for economic analysis. Our findings indicate that the service is working well from the perspective of patients; staff employed within the service and professionals working alongside the service. Patients described the service as a 'safety net' they could fall back on in case of difficulties, whereas staff used the analogy of a 'bridge' to describe the way the service improved communication and collaboration between the various professionals and organisations involved in the patient's care. Improvements in well-being were seen to result from increased support for those transitioning from secondary to primary care, a more pro-active approach to relapse prevention and increased engagement in daily activities. Each PCMHS covered 36 patients in a one-month period, with a unit cost of £73.01 per patient.

The Kent, Surrey and Sussex Health Psychology Network (KSSHPN) was established in 2008 to provide a forum for local health psychologists, students and trainees to network and share experiences and knowledge. The KSSHPN represents members from different areas of health psychology working in a range of settings. It aims to: increase awareness of health psychology as a profession; demonstrate the diversity of skills and roles health psychologists can have; improve links between academia, the NHS and industry; emphasise local resources for research support and funding; and develop training and continuing professional development opportunities. Organising a one-day conference appeared to be a promising way to support these aims.

Background Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged. Methods This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge. Results A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support. Conclusions The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to support the cost effectiveness of providing peer support, but neither was it proven a costly intervention to deliver. The findings support an argument for a larger scale trial of peer support as an adjunct to existing services.

Active self-management of diabetes is essential for reducing the risk of serious complications. However, research indicates that many people with diabetes struggle to adhere to complex self-management regimens. Here, the authors describe the development of an intervention – a "concordance therapy" – to support diabetes self-management. The approach uses techniques from cognitive behavioural therapy and motivational interviewing to help people with diabetes and healthcare professionals work together to develop self-management regimens that are realistic and that work for the individual. Following development work, the intervention was piloted with a sample of older adults who had inadequately controlled type 2 diabetes. The authors' findings are presented, along with their considerations for future work in the area.

This report details an evaluation to assess the impact of the new primary care mental health specialist (PCMHS) role in Kent and Medway. The evaluation was undertaken by the Centre for Health Services Studies (CHSS) at the University of Kent and was conducted June 2013 to December 2014. The evaluation was commissioned by NHS Kent and Medway and supported by Kent and Medway Commissioning Support. The evaluation encompasses six CCG areas across Kent and Medway, with 13 PCMHS employed in these areas (see Table 1-1 for breakdown). The number of posts per CCG is dependent on the amount CCGs invest (roughly equating to population size), rather than prevalence of illness. The PCMHS have been seconded from Kent and Medway NHS and Social Care Partnership Trust (KMPT) for the duration of the pilot, and are either community psychiatric nurses (CPN) or occupational therapists (OT) by profession. The majority of PCMHS are hosted by a voluntary organisation (mcch); three are hosted by GP practices and two by a community Interest Company, Invicta CIC. The main objectives of the evaluation are: 1. To assess the impact on patients by capturing their experience of the service; 2. To assess the impact by capturing experiences of those delivering the service (i.e., PCMHS); 3. To assess the impact by capturing experiences of other professions who work alongside the service (i.e., mental health professionals in secondary care, GPs); 4. To assess the economic cost of the new service via a unit cost analysis.

The purpose of this research is to help patients to control their diabetes more effectively, by allowing them to develop a greater understanding of their condition and increase their confidence to keep to necessary behaviour changes such as appropriate diet and regular exercise. The method used here is based on an 'adherence therapy' manual originally developed to help older people comply with their antidepressant medication. We think that this approach can be adapted to improve the extent to which people with diabetes stick to their treatment plans. We have selected this group of patients because diabetes presents a significant challenge, both to the patient and healthcare system. Diabetes is also increasingly common in the ageing population and can increase the risk of other serious conditions such as heart disease and stroke. If people can control their diabetes effectively, the risk of complications and further health problems can be reduced. In this study we compare patients' ability to control their diabetes before and after therapy by looking at blood test results and rating-scale scores. If the treatment is effective, we plan to conduct a larger study in which patients receiving adherence therapy will be compared with patients having usual treatment only. The larger study would also allow us to see if any changes are maintained over the long-term.