BACKGROUND: Concerns have been expressed regarding the impact of Transforming Care (TC) an English deinstitutionalisation mandate, on forensic services. With nursing staff positioned as significant in delivering TC; this research explored nursing experiences.
METHODS: Nine face-to-face semi-structured interviews were completed with nursing staff working in either inpatient or community forensic teams. Multi-perspectival interpretive phenomenological analysis was used to explore participants\' experiences. Interviews were analysed independently, prior to a mini meta-synthesis.
RESULTS: Participants from the inpatient group experienced TC as a threat, which resulted in consistency of perspective and practice. Participants from the community group viewed TC as a worthwhile challenge, which presented opportunity. The community infrastructure was experienced as inadequate by both groups, with the needs of people in forensic services needing more consideration, leading to widespread frustration.
CONCLUSIONS: The blanket approach of TC may not be suitable for this population, with those leading TC perceived as naïve.

SummaryThe Transforming Care national plan for England to develop community services and close hospital beds for people with intellectual disabilities and/or autism was published in October 2015 and is due to finish in March 2019. In this editorial the key plan objectives are evaluated, with particular reference to people with intellectual disabilities and/or autism who offend or are at risk of offending. The conclusion is that, to date, the plan has failed to meet its targets to reduce the number of in-patients with intellectual disabilities and/or autism and to invest in community services, and the number of patients in independent sector beds is increasing.Declaration of interestThe author is employed by Northumberland, Tyne and Wear National Health Service Foundation Trust, however the opinions expressed in this article are the author\'s own and do not reflect the views of the Trust.

BACKGROUND: In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability.
OBJECTIVE: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England.
METHODS: File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported.
RESULTS: Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores.
CONCLUSIONS: In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.

BACKGROUND: Transforming Care is making mixed progress in supporting people with intellectual and developmental disabilities, and complex needs, move to more appropriate specialist accommodations closer to home. Community support staff often spend greatest amounts of time with service-users, yet are some of the least heard voices about why placements succeed and fail to varying extents.
METHODS: Managers and support staff (n = 13), working in ostensibly \"specialist\" community placements, were interviewed about perceived barriers and facilitators to implementing Transforming Care. Transcripts were subjected to thematic analysis.
RESULTS: Participants identified difficulties balancing people\'s rights, safety and quality of life needs, and felt the system\'s expectations of them are hard to deliver within the resources, legislation, values and support models provided them. Multidisciplinary expertise was highly valued for both emotional and practical support, but was least valued when perceived as overly blaming or inspectorial. Specialist health input was seen to withdraw prematurely for this particular client group.
CONCLUSIONS: Recommendations are provided for how staff perspectives should inform Transforming Care in interests of service-users.

Although the concept of \'Transforming care\' is promising for improving health care, there is no consensus in the field as to its definition. The aim of this concept analysis is to develop a deeper understanding of the term \'Transforming care\' within the nursing discipline, in order to facilitate its comprehension, implementation, and evaluation. We performed a comprehensive literature review on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Web of Science, Wiley-Blackwell, ScienceDirect, and SpringerLink and used Walker and Avant\'s approach to analyse the concept. From the 20 studies selected for this analysis, 3 main attributes of \'Transforming care\' were identified: patient-centredness, evidence-based change, and transformational leadership driven. We suggest an operational definition to facilitate the implementation of the concept in practice. Furthermore, we propose that implementation is guided by the following key ideas: (1) fostering a culture of continuous improvement; (2) encouraging bottom-up initiatives; (3) promoting patient-centred care; and (4) using transformational leadership. Lastly, the evaluation of \'Transforming care\' initiatives should assess care processes and professionals\' and patients\' outcomes.

OBJECTIVE: To examine the relationship between the implementation of a transforming care initiative and two patient outcomes, inpatient falls and hospital acquired pressure ulcers.
BACKGROUND: Patients continue to experience harm in hospitals from adverse events such as inpatient falls and hospital acquired pressure ulcers. These and other patient safety concerns led to transforming care initiatives.
METHODS: This cohort study used historical controls and a time series design. The setting was two surgical units of an acute care hospital; 7125 patients discharged from these units between July 2008-December 2010 were included. Those patients discharged during the initial 3 months of implementation were excluded. Several interventions were adopted as part of the transforming care initiative such as bedside handover and bedside whiteboards. Coded administrative data were accessed to identify patients who had experienced a fall or acquired a pressure ulcer during their hospital stay. Statistical process control was used to identify changes in outcomes over time.
RESULTS: The findings demonstrated variation in the proportion of patients experiencing a fall in both units and for the proportion of patients acquiring a pressure ulcer in one unit, following implementation.
CONCLUSIONS: These results demonstrate that implementing a transforming care initiative may have some influence on the quality and safety of patient care as measured by patient falls and pressure ulcers but findings varied. Further research is required to gain an understanding of the inconsistency of the impact of these initiatives across all clinical contexts.