Efforts to assess and improve the quality of mental health services are often hampered by a lack of information on patient outcomes. Most mental health services in England have been routinely collecting Health of the Nation Outcome Scales (HoNOS) data for some time. In this article we illustrate how clinical teams have used HoNOS data to identify areas where performance could be improved. HoNOS data have the potential to give clinical teams the information they need to assess the quality of care they deliver, as well as develop and test initiatives aimed at improving the services they provide.

No abstract

The imminent payment‐by‐results system for mental health in England means that Trusts need to reorganise delivery of care taking into account the new care pathway clusters. In this article, Dr Whelan and colleagues discuss the potential dilemmas and problems faced by the introduction of this system based on their own experience, with a particular focus on old age services. Copyright © 2011 Wiley Interface Ltd

Fruit bagging is a newly developed technology, widely used by the farmers, easy practice, and environment friendly and useful for high quality mango production in Bangladesh Four treatments were included in this experiment namely non-bag (control); white polythene bag; single layered white paper bag and double layered brown paper bag. The fruits were bag at 35, 45 and 55 days after fruit set. The experiment was carried out in the Randomized Complete Block Design with three replications. Fruit bagging has direct effect on fruit length, diameter, fresh weight and pulp weight (9.49cm, 8.31cm, 295.8g and 267.4g, respectively) while minimum was recorded in non-bagged control fruits (7.75cm, 6.91cm, 211.1g and 182.0g, respectively) at 35 and 45 days. In addition, the total sugar, reducing sugars, total soluble solid, ascorbic acid, pH and β-carotene were improved over control fruits. Brown paper bags are competent to change the fruit color. Brown paper bag extended shelf life up to 9 days with premier sensory quality as against 5 days of non-bagged control fruits.Considering the results, double layered brown and single layered white paper bagged fruits performed the best in respect of quality parameters and extending shelf life in mango cv. Mishribhog.

IntroductionA history of missed healthcare appointments is a consistent finding in most of the serious case reviews of all children who have been seriously harmed through child abuse, particularly neglect.1Minimising missed clinic appointments is not only in the best interest of the child but also for the trust, financially. The National Audit Office found that missed first outpatient appointments cost the NHS up to £225 million in 2012/ 2013.Aims1. To classify the profile of children not brought to developmental clinic appointments.2. To investigate barriers to attendance.3. Identifying options to minimise such barriers and ways to support the family.MethodsData was collated from Trust records, the departmental databases, patient files and a questionnaire based telephone survey of parents/carers of children with missed developmental clinic appointments in August/September 2016.ResultsThe trust-wide, missed appointment rate (outpatient appointments) for 2015–2016 was14.2% vs 17.9% in Developmental paediatrics. There were 62 missed appointments in developmental paediatrics (24%). Of these, 61% were follow up appointments; 60% being morning appointments. Seventy three percent of children were male, 65% between 5–11 years, 40% had previously missed appointments and 11% attended special needs schools. Seventy three percent of children had multiple comorbidities. 24% had complicated social situations including inadequate housing and safeguarding concerns (13%). In total, 40 (65%) participated in the telephone survey. The most common reasons for missing were forgetting (46.5%). 40 percent want a ‘choose and book’ option. Only 12 percent preferred weekend appointment. All requested a reminder, preferably by text message [87%] a day or two days before [70%].ConclusionA majority of children not brought to the clinic had multiple comorbidity with some having additional safeguarding concerns. The major barrier to attendance is parents either for- getting or not able to change the date. Targeted interventions in the form of multiple reminders by text messages, an option of ‘choose and book’ and a venue closer to their address will be useful in supporting those families.ReferenceBrandon, M et al., 2009. Understanding Serious Case Reviews and their Impact: A biennial analysis of serious case reviews 2005–07.