bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal basis for standards of driving with diabetes
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The tragic case of a district nurse killed when a car driven by a man in a hypoglycaemic state struck her while she took her regular evening walk highlights the dangers that can occur when a person with diabetes drives without regard to their condition. The man was later jailed for four and a half years for causing death by dangerous driving having been found criminally responsible for his actions because he failed to control his blood sugar levels during the journey ( Valek, 2007 ). This article considers the legal basis for the medical standards for driving imposed on individuals with diabetes and sets out the likely consequences of failing to comply with those standards.
Preventing infection with long-term indwelling urinary catheters
Authors: Slater Rebecca
Published: May 2014

This article sets out to inform readers on the care and management of indwelling catheters. The reason for urinary catheter insertion is discussed and the decision to use a long-term indwelling urinary catheter is explained. This article focuses on the risk of urinary tract infections (UTI) associated with the use of long-term indwelling catheters and how these may be avoided. Examples of current products are detailed and how the selection of the right product may be achieved is also outlined.
A vision for the future: defining nursing services and strategy
Authors: Cook Rosemary
Published: May 2014

A new consultation document on the future of nursing services in Northern Ireland will make interesting reading for nurses throughout the UK. Rosemary Cook reports.
Nutritional status of older patients admitted to hospital for surgery
Authors: Stewart James
Published: May 2014

This article summarizes the nutrition-related findings of an NCEPOD review into the care received by patients aged 80 years and over who died in hospital within 30 days of surgery.

Method: Data were collected on 1758 elderly patients (aged >80) who underwent surgery and died during the same hospital admission during April to June 2008. Questionnaires were sent to the surgeon and anaesthetist responsible for the patient and photocopied case note extracts were requested. Cases returned were reviewed by a group of specialists and assessment made of a number of aspects of care provided. The assessment of patient nutrition was one area. Results: From the surgical questionnaire, and where the question was answered (n=967), 93 patients had malnutrition on admission and only 55/93 were given nutritional support. From the case notes (n=902) only 118 patients had height recorded and 212 weight recorded. Formal nutritional assessment was made in only a minority of patients. Conclusion: Nutritional assessment in hospital is poor in an elderly surgical population. However, it must also be recognised that 93 patients were malnourished on admission and this may have been missed in the community.
Chairside assessment of peripheral arterial disease in diabetes patients
Authors: Turns Martin
Published: May 2014

The risk of peripheral arterial disease (PAD) is markedly increased among individuals with diabetes, and ischaemic event rates are higher in individuals with diabetes and PAD than in comparable non-diabetic populations. Consequently, early diagnosis and management of PAD is critically important to reduce the risk of cardiovascular events, minimize the risk of long-term disability and improve quality of life. There is no accepted single diagnostic tool used in chairside vascular assessment, and therefore a review of the literature is required to gain an understanding of the various investigations used to diagnose PAD in the diabetic population. First-line vascular investigation should be palpation of dorsalis pedis and posterior tibial pulses in both feet. If both pulses are not palpable in a foot, then audible doppler waveforms or ankle brachial index (ABI) should be performed. If the doppler waveforms are biphasic/triphasic, or there is an ABI of >0.9, then PAD is unlikely. If the doppler waveforms are monophasic, or the ABI is <0.9, then a decision is made to refer patients for formal vascular investigations. Health professionals must also consider the presence of foot lesions, pain and medical history in the assessment and management of their patients.
Pressure ulceration and the current government agenda in the UK
Authors: Stephen-Haynes Jackie
Published: May 2014

This article identifies the increasing importance of pressure ulceration in health care in the UK and the important role of pressure, shear, friction and moisture. The categoriZation of pressure ulcers is highlighted including images as categorised by the EPUAP (2009) . The impact of pressure ulcers on quality of life is highlighted. The current government agenda and the importance of serious incident reporting and the value of skin care bundles and assurance are discussed. The importance of the implementation of high impact actions in clinical practice is discussed and a conclusion made that the current agenda regarding pressure ulcers has an impact on all clinicians who need to engage fully in the prevention of pressure ulceration in all care settings.
Reflect for success: use of mentor recommendations to help failing students
Authors: Carr Jacqui , Walker Wendy , Carr Marcia , Fulwood Deb
Published: May 2014

Mentoring student nurses (STN) who fail to achieve can be distressing for all those involved in the process. A group of community nurse mentors (CNMs) and practice learning team teachers (PLTs) made recommendations to manage failing students. This paper reflects on the use of the recommendations in practice and discusses the impact on practice for the PLT and CNMs.
The role of the pharmacy technician in the skill-mixed district nursing team
Authors: McGraw Caroline , Coleman Bridget , Ashman Lea , Hayes Sarah
Published: May 2014

Registered nurses in the district nursing service delegate a broad range of medication administration activities to healthcare assistants. Although healthcare assistants have provided extra capacity, not all activities are suitable for delegation to unregulated practitioners. At the same time, their competency assessment is often patient-specific and demands significant registered nursing input. The purpose of this 6-month pilot programme was to test the premise that the employment of a pharmacy technician in the district nursing service would enhance productivity levels and deliver cost savings. Activities delegated included the administration of oral tablets and subcutaneous insulin and low molecular weight heparin injections. The evaluation found that the introduction of the pharmacy technician was associated with neither enhanced productivity nor more than modest cost savings. However, role redesign is a long-term activity and their role could be built on with further competency analysis.
Effective patient outcomes using a gelling fibre dressing
Authors: Greenwood Michelle , Grothier Lorraine
Published: May 2014

Exudate has an important function within the process of wound healing; however, maintaining the wound bed at the optimum moisture level is a key factor in the wound's progression ( Moore, 2005 ). A patient's experience of living with a wound is often tarnished when leakage caused by the fluid discharged is unmanageable, which can subsequently have a negative effect on daily living and quality of life ( Edwards, 2003 ). Such wounds can cause substantial pain, suffering, loss of self-esteem, family distress, and a considerable financial cost to the NHS ( Dowsett, 2011 ). It is estimated that 2–3% of the local healthcare budget will be spent on chronic wound management ( Posnett et al. 2009 ). This article will present three case studies demonstrating the effective use of a gelling fibre dressing (Durafiber, Smith & Nephew) used on different wound aetiologies, including the clinical benefits and patient outcomes.
Supervised self-management of lower limb swelling using FarrowWrap
Authors: Wigg Jane
Published: May 2014

The use of FarrowWrap™ as an alternative to multilayer lymphoedema bandaging (MLLB) can provide an efficient, cost-effective treatment for patients with all types of chronic and lymphoedema oedema. In addition, used within supervised self-management, it allows for the patient to gain control and confidence of their long-term condition, giving greater independence. This article discusses the theory of MLLB and introduces FarrowWrap, an alternative wrapping system offering flexible compression treatment for a range of oedemas. Case studies are included to illustrate varied uses of FarrowWrap and how it can be implemented into clinical practice.
Mind the Hunger Gap: a review of malnutrition in the community
Authors: Blaikley Catherine
Published: May 2014

Malnutrition is known to affect over three million people in the UK, with 93% of these people living in the community setting. This is leading to escalating costs of over £13 billion to the NHS annually, which could simply be reduced by ensuring adequate nutritional screening followed by the provision of good nutrition and diet. As well as reducing costs this will improve quality of life for such patients. The British Dietetic Association has launched a campaign entitled ‘Mind the Hunger Gap’ to highlight the growing issue of malnutrition and to help address the problem. Community nurses have an important role to play in the prevention and treatment of malnutrition, and this article sets out some of the tools and strategies at their disposal.
Case study: treating an infected-wound of unknown aetiology
Authors: Lloyd-Jones Menna
Published: May 2014

There are occasions when patients present with wounds where the aetiology is unknown. Planning care for these patients is dependent on the wound assessment and treating the clinical symptoms for example infection. Wound infection is often regarded as a challenging problem for clinicians and a considerable financial burden for the NHS ( Patel, 2009 ). From a patient perspective, wound infection presents with unpleasant symptoms such as increased exudate, pain, swelling and malodour ( Barrett et al, 2010 ). The introduction of antibiotics in the late 1940s and 1950s had a huge impact on the control of bacterial infections, however recently due to bacterial resistance, topical antimicrobials such as honey are starting to regain their appeal in the treatment of wound infection ( Van der Weyden, 2003 ; Moffatt, 2006 ). The aim of this case study is to demonstrate how a honey dressing was used to treat an infected wound of unknown aetiology.
Court-ordered immunisations: a review of the issues
Authors: Griffith Richard
Published: May 2014

Following an outbreak of measles in Swansea in 2013, the UK courts were asked to order the immunisation of children after an unresolved dispute over the merits of the vaccination between the parents of two children. This article reviews the involvement and approach of the courts in cases of hotly disputed immunisation and argues that going to litigation and obtaining a court order is no guarantee that the vaccination will be given to the child.
Lawfully withdrawing life-sustaining treatment
Authors: Griffith Richard
Published: May 2014

The UK Supreme Court recently delivered its first judgement based on the application of the 2005 Mental Capacity Act. The plurality judgement given by Lady Hale clarified the law on medical futility and the circumstances under which a district nurse is lawfully able to withdraw life-sustaining treatment. It is essential that district nurses know when care and treatment becomes futile to ensure they are acting lawfully if a decision is taken to withdraw that care and treatment. This article considers the impact of the Supreme Court ruling on district nurse practice.
UrgoClean: a new dressing for desloughing exuding wounds
Authors: Kelly Jennifer , McGrath Alison , Wildman Sue
Published: May 2014

Wound debridement plays a key role in wound bed preparation and the healing of chronic wounds. A variety of techniques can be used to achieve debridement and autolytic debridement is frequently the clinician's first choice. This is aided by dressings including hydrogelsand hydrocolloids, which provide the moist environment required for white blood cells to function. This product focus uses 12 case studies to examine the effectiveness of UrgoClean in wound debridement.
The national health-care agenda in relation to negative pressure wound therapy
Authors: Sinha Surajit , Mudge Elizabeth
Published: May 2014

The NHS was founded upon the principle of providing health care for all, regardless of financial status. However, it has reached a point where patient demands are outgrowing NHS resources, causing conflict. Chronic wound management represents a considerable financial burden on health services in terms of manpower requirement, equipment, specialist opinion and adjunct therapies, such as negative pressure wound therapy (NPWT). Although funding bodies often perceive NPWT to be expensive, there is evidence that if used appropriately it leads to faster healing, early discharge and better quality of life for patients with chronic wounds. However, it must be acknowledged that the type and quality of studies are mixed. Further evidence is required to justify the use of NPWT in chronic wounds in the primary and secondary health-care setting.
District nurses' crucial role in identifying unlawful deprivation of liberty
Authors: Griffith Richard
Published: May 2014

A recent judgement by the UK Supreme Court has widened the criteria for the type of care and treatment that amounts to a deprivation of liberty in hospitals and care homes. Very many more vulnerable residents in care homes should now benefit from the protection of the Mental Capacity Act 2005 deprivation of liberty safeguards. This protection will only happen if care-home staff, who are the gatekeepers of the system, recognise which of their residents are deprived of their liberty. District nurses have a crucial role to play in promoting the use of the deprivation of liberty safeguards. They are ideally placed to help identify care that amounts to a deprivation of liberty in the care homes that they visit. This article discusses how district nurses must inform their practice by making reference to the UK Supreme Court judgement on the use of the deprivation of liberty safeguards and the actions that district nurses must take if they suspect a care home is depriving a resident of their liberty without authorisation.
Tissue viability specialist module: venous leg ulcers
Authors: Trevena Linda
Published: May 2014

Linda is in her second year of the assistant practitioner foundation course. This article is an adapted version of her assignment for the tissue viability specialist module. It focuses on a patient with a venous leg ulcer. The original paper included appendices but these have been removed for editorial purposes.

Linda is awaiting her mark for the assignment and this will be published in the August issue of the Journal along with the marking criteria.
Safeguarding Vulnerable Groups Act 2006
Authors: Hughes Rhidian
Published: May 2014

Abuse can take many forms including physical, sexual, psychological, material, neglect or acts of omission and discrimination. It is a violation of people's human and civil rights.
The impact of assistant practitioners on acute NHS trusts
Authors: Spilsbury Karen
Published: May 2014

Nursing care is delivered by both registered nurses (RNs) and assistant staff, or healthcare support workers (HCSWs). To meet increasing and changing demands for care, the skills of these occupational groups need to be deployed appropriately and efficiently (Buchan et al, 2001; Buchan and Shocalski, 2004; Department of Health (DH), 2004; Oulton, 2006). More flexible working at all levels throughout the nursing workforce is being encouraged internationally. This has led to changes in occupational roles and structures for the entire nursing workforce through role expansion, role extension and role redesign (Buchan and Calman, 2004; Department of Health NHS Modernisation Agenda, 2002; 2003; 2004). These changes have important implications for patient care and outcomes, as well as the roles of registered nurses and non-registered assistant staff.
Car adaptations to facilitate driving
Authors: Julie I Swann , Ryder Kate
Published: May 2014

When considerable functional problems cause difficulties with driving, extensive modifications may be needed to an existing vehicle or a purpose-made car may be required. Most production vehicles can be adapted to cope with complex disabilities. This article examines the mobility allowance, some car adaptations and looks at additional sources of funding a vehicle.
Pharmacology- a systems approach: gastrointestinal tract
Authors: Hennefer Dawn , Lawson Elizabeth
Published: May 2014

In our every-day living the need to eat is essential to the preservation of life. Rarely do we consider, when consuming food, what actually happens to it once it enters our mouth, largely our concerns are about the food tasting good and whether it satisfies our hunger. If we can understand some of the functions of the gastrointestinal tract and the role it plays in relation to the breaking down of food it will help us understand what happens when gastrointestinal tract is dysfunctioning and how some of the more common drugs our patients take such as antacids, proton pump inhibitors, laxatives etc. work.
Pharmacology - a systems approach: renal system
Authors: Hennefer Dawn , Lawson Elizabeth
Published: May 2014

In relation to physiology and pharmacology there are two important considerations to note when administering medicines. Can the drug be effectively metabolized, and can it be effectively excreted?

Examination of the individual's liver and renal function, and the presence of any co-existing disease, will determine the answers. Having discussed the liver in the first part of the series, this article will look at the renal system, common disorders and the pharmacological interventions used to treat some of those.
Diabetes, ageing and bladder function
Authors: Nazarko Linda
Published: May 2014

Older people are more likely to develop diabetes and bladder problems. This article explains what is known about diabetes and bladder problems as well as exploring what treatments are available.
Personal development plans and workplace learning
Authors: Jackson Carolyn , Thurgate Claire
Published: May 2014

This article provides advice on how to write a personal development plan by presenting guidance on structure, goal setting, the collection of evidence and evaluation. The role of the mentor or course tutor in supporting your ability to reflect in and on practice and ensure your personal development plan is well constructed and evaluated is also explored.
The fundamentals of skin care
Authors: Andrews Hilary
Published: May 2014

With skin being the largest organ in the body and the skin playing such an enormous role in not only the physical but also the psycho-social health and wellbeing of an individual it is vital that all those who care for individuals are knowledgeable and competent in aspects of skin care.

Healthcare assistants (HCAs) and Assistant Practitioners (APs) are often well placed to be able to observe and assess the skin of the people that they care for in whatever setting. This article explores the fundamental aspects of skin care including skin cleansing, maintenance of skin integrity and skin assessment.
A genuine partnership to raise the status of support workers
Authors: Griffin Richard
Published: May 2014

In response to the Francis Report, the Government commissioned Camilla Cavendish to undertake a wide-ranging review of support worker development. Cavendish recommended a compulsory certificate of fundamental care be obtained by all support workers before they can give care.

This article focuses on one question, ‘How do we effectively develop healthcare support workers in a way that improves the quality of care?’ There are 6 critical things to consider: workforce planning, clarity about role boundaries, awareness of support worker roles, good-quality education and training that promotes employee self-efficacy (confidence to learn), team working, more research and, finally, quality assurance.
The impact of living with a chronic skin condition
Authors: Andrews Hilary
Published: May 2014

The aim of this article is to help create healthcare assistants (HCAs) and assistant practitioners (APs) who work with compassion, recognising that patients with skin disease are often affected in many dimensions of their lives—physically, socially and psychologically.

The impact of living with a chronic skin condition is explored, along with the impact on the lives of those who care for them. Complex relationships exist between the skin and the mind and this aspect of dermatological care is discussed.

The role that the HCA and AP can play in caring for individuals and their families with a skin condition is described by using a framework based on the 6 Cs - the six core values and behaviours recently described by the NHS Commissioning Board Chief Nursing Officer and Department of Health Chief Nursing Adviser as those that underpin good care ( Hollis, 2012 ).
Sex and the single dilemma: do you have a right to intervene?
Authors: Yeomans Paul
Published: May 2014

Are care staff under any obligations to facilitate or prevent sexual contact between patients? A sexual dilemma is given as an example of where the law does not require intervention in the absence of risk or criminal complaint. The means of ethical decision-making and sources of best practice are challenged, and an overview of where legal concerns dominate but don't necessarily fit a care plan or provide assistance to practitioners. Finally there is a consideration of clinical matters that could affec capacity in the future.
Spirituality 7: spiritual support in a ward or in a care home
Authors: Barber Chris
Published: May 2014

Interest regarding the impact of a person's spiritual and religious beliefs and practices within a variety of health care settings has increased over recent years. This article seeks to highlight a number of ways that these beliefs and practices can be met within a general medical or surgical ward of a general hospital and within a care or nursing home environment.
Northern soul: Manchester's part in creating the AP role
Authors: Mullen Chris
Published: May 2014

The article provides the reader with an historical overview—by the project director who led the development for the first 10 years—of how, when and where the assistant practitioner (AP) role was first developed, beginning in 2001. The project was called ‘Delivering the Workforce’ and became a long-term workforce modernisation strategy for the North West region.

The AP role was the major role that emerged and is still in place today. The key principles that underpinned the development of the AP role are described, alongside some of the resources and processes that were used. The aim of the article is to provide readers with the background to the origins of the AP role and also to help provide an understanding of the context and risks that the original ‘pioneers’ took particularly the first students, the two universities, the ‘practice trainers, and the organisations. A short reflection on the AP role today and the original ‘AP design’ is briefly discussed.
Dispelling myths about ageing for healthcare assistants
Authors: Hayes Catherine
Published: May 2014

This article provides healthcare assistants with some clear definitions of concepts in ageing that they can consider in their everyday practice. By defining ageing and its obvious link to the process of biological senescence (the normal process of biological ageing, which all living organisms experience from the moment their lives begin), HCAs are introduced to the characteristic signs of functional decline—which often epitomises the view we have of older people—and the normal physical degenerative trajectory towards death.

Physical characteristics of the ageing process are discussed in relation to the physiological signs of ageing as a gradual deterioration in function and capacity to respond to environmental stress. This is interlinked with the complex medical histories with which elderly people often present in healthcare practice. Specific considerations of working with older patients such as polypharmacy (the use of multiple medications), and general health problems, are then discussed and the notion of ageism as a discriminatory practice is briefly explored.
Best Practice Guidelines: Protocols and procedures
Authors: Wilson Jo
Published: May 2014

This article discusses Best Practice Guidelines, in particular, how to draft and deploy them correctly.
Cost savings to general practice from a PPI switch
Authors: Crispin Rupert
Published: May 2014

Our series on cost-effectiveness continues with an appraisal of the potential savings to be made from switching to a different proton pump inhibitor (rabeprazole) for treatment of acid-related upper gastrointestinal disorders.
Logistics - a catalyst for change in the NHS
Authors: Kidd Paul
Published: May 2014

Hospital supply chains have traditionally relied heavily on their nursing staff to order and replenish stocks – an activity which, though important is not the most effective use of finite nursing resource.

This article looks at how the Central Middlesex Hospital has developed a Public-Private Partnership (P-PP) with a leading logistics company which has not only streamlined the hospital's supply chain, but has also achieved significant cost savings.
Commissioning the future of primary care
Authors: Cowper Andy
Published: May 2014

This is a great opportunity, and a good time for debate on commissioning. We need to examine the role of strategic health authorities (SHAs) in supporting or potentially being a barrier to this agenda.
Yvonne Coghill
Authors: Coghill Yvonne
Published: May 2014

I remember my first management post; I was so pleased with myself. I was responsible for a team of ten people and made the assumption that they had the same motivations and aspirations that I did. I was shocked to find that this was absolutely not the case. I learned pretty quickly that everyone had different motivations for being at work. My job as manager and leader was to learn how to motivate members of my team who were from disparate backgrounds (all of whom had different priorities) and get them to meet corporate objectives.
Rationing health care
Authors: Maynard Alan
Published: May 2014

What is the role of the National Institute for Health and Clinical Excellence (NICE) in the rationing process and how can the issue of rationing be better managed?
Management of infertility in primary care
Authors: Wilkes Scott
Published: May 2014

It has only been 30 years since the birth of Louise Brown, the first in vitro fertilisation (IVF) success. Since then, there has been a rapid rise in assisted reproductive technologies and the routine use of IVF in clinical practice. However, the ‘whole patient’ journey from presentation to final outcome has largely been ignored or served by outdated commissioning arrangements. This article reviews the role of primary care in investigation, diagnosis, obesity management, ovulation induction and referral, concluding that there is an urgent need for NHS commissioners to reappraise their fertility pathways.
QIPP, quality indicators and metrics
Authors: White Richard , Bosanquet Nick
Published: May 2014

Quality, Innovation, Productivity, and Prevention, or QIPP (Department of Health (DH), 2008; Nicholson, 2009), is the new landscape in which we operate (Farrar, 2009). These four tenets will be familiar to all involved in health care; both from the perspective of planning and the delivery of clinical services in the NHS. The implications for the delivery of a quality service have been considered for nursing in general and tissue viability in particular (Hinchcliffe, 2009; Ousey and White, 2009a, 2009b).
Emergency admissions and hospital beds
Authors: Jones Rod
Published: May 2014

Parts one and two of this series discussed the components of a variety of trends and longer-term cycles leading to increasing emergency admissions. This article discusses the issues of bed planning for emergency admissions in light of the annual summer/winter and long-term cycles. The impact of changing to single sex wards and the provision for zero day stay admissions is also discussed.
Sian Thomas
Authors: Thomas Sian
Published: May 2014

I work in the public sector because the opportunity to change lives is so great. I once managed a project to relocate 100 people with learning difficulties from their hospital institution into their own homes in the community. The move had a hugely positive impact on their lives and, as if to poetically represent this in physical form, their vacated home itself was demolished and replaced with a fantastic new community building project. It drove home just how much most of us take for granted in our daily lives.
Creeping towards the abyss
Authors: Maynard Alan
Published: May 2014

In the heady days of Prime Minister Blair ‘spraying’ extra cash into the NHS, he used to talk about the unavoidable ‘hard choices’ that NHS managers would have to make as they used increasing flows of new, real resources.
Time to rise to the challenge
Authors: Barnett Steve
Published: May 2014

There were many issues and themes debated and discussed at the NHS Confederation conference in June, but one in particular spanned the three days of the event.
Major trauma: a Lean approach to process design
Authors: Silvester Lucy A
Published: May 2014

A review of London’s health needs highlighted deficiencies in the treatment and care of major trauma patients, including below optimum rehabilitation. Patients who sustain complex musculoskeletal injuries account for over half of hospital admissions following major trauma. Yet, the evidence suggests a lack of rehabilitation services and inequalities in access for this patient group. A particular area of concern is the transition from the acute setting to other health and social care providers. This study examined the current trauma pathway as experienced by patients with complex musculoskeletal injury and ascertained whether their care and rehabilitation needs were met.
Clinical commissioning groups in the new system
Authors: Hayden Jonathan
Published: May 2014

The Health and Social Care Bill (HL Bill 92) is continuing its progresses through the House of Lords. The position of—what are now known as—clinical commissioning groups (CCGs) has evolved as the legislation has moved through the parliamentary process—particularly as a result of the ‘pause’ in the legislative process and the listening exercise. CCGs were always going to inherit many of the statutory obligations that currently apply to primary care trusts but the nature and membership of CCGs also means that they will face some new challenges – particularly in relation to conflicts on interest. This article summarises some of the key statutory duties and challenges clinical commissioning groups (CCGs) will face.
The appropriate use of amiodarone
Authors: Siddall Rhonda , Howard-Baker Louise
Published: May 2014

Cardiologists at Wrexham Maelor Hospital drew to our attention the fact that amiodarone may not be used appropriately in the treatment of atrial fibrillation (AF). Though the All Wales Medicine Strategy Group had developed shared care guidelines in 2007, there was anecdotal evidence that these were not well known, and that patients and their carers were ill informed about the need for monitoring for adverse effects. All 251 patients were reviewed by Wrexham primary care practices, with the assistance of the prescribing support team and in partnership with the consultants. The review of amiodarone prescribing revealed that the drug was no longer indicated in 50 % of patients who were taking it and a subsequent audit of 50 % of patients in primary care practices revealed that monitoring guidelines were not being followed. Consequently, working in partnership with secondary care services, we devised a template for good practice that included a patient information leaflet, a virtual clinic, educational talks and an educational campaign to raise awareness of the existence and content of the shared care guidelines.
Specifying activity levels for alcohol services
Authors: Gandy Rob , Owens Lynn
Published: May 2014

This article describes the experience of developing a service specification for procuring an alcohol Lifestyles service and identifies the difficulties in specifying activity levels for procurement and contractual purposes. These difficulties arise because there are fundamental unknowns on service demands: first, the proportions of individuals with differing levels of complexity (patient mix), and second the numbers requiring care interventions of varying intensity. Given that patient care pathways will vary in their support and duration, and that the appropriate individual delivering the care will differ within and across treatment pathways, a ‘systems modelling’ approach was applied that controlled for this level of complexity. The service data used included the complexity of the alcohol-related problem, numbers in treatment and source/method of referral. The modelling approach compared what happens when the staffing is fixed, with when the number of referrals is fixed. Iterative variations to the assumed staff mix can enable commissioners to better understand the relationships between available resources and projected activity volumes. It was concluded that while the activity quoted in a service specification should reflect the ‘most likely’ scenario, contractual arrangements and monitoring should link activity levels to the patient mix. This approach is transferable to other services which have similar characteristics.
The tender trap: back to the future?
Authors: Edmonstone John
Published: May 2014

Consultancy has a bad press in the NHS and is the subject of allegations about wasted expenditure. External consultants cover many fields, range in size and focus and operate in a variety of ways. Central to the work of consultants is the tendering process—enshrined in the culture and never questioned. There are, however, a number of flaws and deficiencies associated with tendering and these reflect a series of underlying assumptions. An alternative ‘partnership team’ model which is outcome-based, relationship-focused and for the longer-term offers a better future by adopting pre-tendering approaches.
Establishing e-learning networks for managers
Authors: Robson Jean
Published: May 2014

This case study arose out of a Leonardo da Vinci Partnership Project (2010–12) as part of the EU Lifelong Learning Programme. Four educational providers in Turkey and UK trialled an open access learning module on the iVersity cloud-based virtual learning platform aimed at developing managerial competences in managing change in healthcare facilities and/or programmes in different countries. 25 managers from Africa, Asia, Australasia and Europe participated in the small trial conducted in early 2012. The trial showed, with minimal investment apart from time, that management learners could take a more proactive role in managing their own learning and negative perceptions about the feasibility and value of e-learning could be changed very quickly. The trial demonstrated that it is feasible to deliver managerial e-learning across international borders without new investment in technology, promote resource exchange between managers, empower learners to drive their own learning, and enhance e-learning skills. The learning environment was evidently enriched and enhanced with the more intelligent application of e-learning technology.
Science or art: risk and project management in healthcare
Authors: Sheppy Bruce , Zuliani Juan David , McIntosh Bryan
Published: May 2014

Despite its rapid growth in recent literature, risks in project management have received limited critical attention when compared to Lean principles and total quality management. The aim of this article is to examine the ongoing dialogue within health services funders and providers concerning the relationship between project management and its relationship to hard and soft environmental risk factors. The failure of high profile projects and cost to the taxpayer is on the increase. This article argues that the lack of understanding in relation to a holistic assessment of project success factors contributes to increased risk of failure. It argues that greater emphasis is needed on placing risk relative to both operational and cultural factors, as opposed to the frequent use of prescriptive mechanistic methodologies. These changes have the potential not merely to improve the success rates of healthcare management projects, but health outcomes too.
Explaining the laws of unplanned care
Authors: Rowe Simon
Published: May 2014

Unplanned care (accident and emergency attendances and emergency admissions) may be defined as three separate, but connected laws. The need for local healthcare economies to reduce the total levels of unplanned care in a financial year means that they require an approach to determine where they should be focusing their efforts and why. The three laws offer this, as they can be used to explain unplanned care and to dispel any number of viewpoints that fall outside of them. They are based on a set way of collecting and analysing unplanned care data that distinguishes between the unique individuals that experience, for example an accident and emergency attendance and the number of subsequent repeat attendances by individual.
A research guide to CCG management
Authors: Meads Geoffrey , Chatting Donna , Burgess Abigail , Westmore Matthew
Published: May 2014

Recent and forthcoming studies relevant to the main performance requirements of clinical commissioning groups are highlighted. These are derived from the strategic commissioning approach to applied health management subjects adopted in National Institute for Health Research programmes. Their mid-term perspective helps to ensure sound empirical findings of utility over time across organisational and policy changes. A practical guide is offered to identifying sound evidence and transferable learning, with some exemplar illustrations from the past NIHR portfolio. This portfolio bears witness to the benefits of a ‘needs led science added’ approach, particularly for health managers seeking a fit between research findings and their particular contexts.
Heroes or villains: the PIP scandal and whistleblowing
Authors: McIntosh Bryan , Cohen Ivan , Sheppy Bruce
Published: May 2014

The article traces the history of the Poly Implant Prosthesis (PIP) scandal from an ethical perspective and explores the underpinning moral dilemmas inherent in the act of ‘whistleblowing.’ It goes on to consider the consequential stakeholder and broader societal reaction to whistleblowing which is discussed through deontological and teleological perspectives of ethically driven motives to act. It draws on the duty of care responsibility of healthcare professionals and the dilemma of personal consequence by the act of whistleblowing, whereby the objective of that act is the maintenance or improvement of patient standards and care. It argues that a cultural shift in organisational behaviour is urgently required to abrogate the needs for whistleblowing by means of internal systems and processes. Whistleblowing would thus become a supererogatory act of moral courage rather than carrying negative consequences in the interests of short-term saving face.
A re-assessment: forecasting unplanned care activity
Authors: Rowe Simon
Published: May 2014

A previously published article on the forecasting of unplanned care (accident and emergency attendances and emergency hospital admissions) detailed three approaches to forecast activity. One of these, a set numerical approach attempted to use the differences between the numbers of emergency admissions (EA) and non-admissions (NA) to forecast them. Further work has shown that the use of two variables, a and b cannot reduce the number of possible values from an infinite to a finite number, without at least one assumption being made on how limit them. The limitations of the approach are shown to link with weaknesses inherent with the available unplanned care data. A new and combined approach with the availability of hospital beds for emergency admissions is suggested.
A survey of quality of sonographic practice
Authors: Eze Charles Ugwoke , Asogwa Catherine C , Eze Cletus Uche
Published: May 2014

Sonography practice is operator dependent. The aim of this study was to determine the level of training of sonography practitioners and their participation in continuing professional development (CPD): performance of regular quality assurance tests on ultrasound equipment, type of sonographic services rendered and type of transducers used for such services. The survey was a prospective cross-sectional study done at Enugu and Abuja, Nigeria. Ethical approval was obtained while convenience sampling method was used to select 15 centres studied. Self-administered semi-structured questionnaire was used in data collection. Analysis was carried out with Epi Info computer software, version 3.5.1 whereas descriptive statistic was used to analyse the responses. Most ultrasound machines were over 10 years old; 30% and 32.5% of practitioners had only MBBS and BSc in medical radiography respectively; 20% of practitioners were not involved in CPD; 35% of ultrasound machines had regular quality assurance tests; 37.5% of repeat examinations were due to errors in sonographic reports; 25% were due to missed diagnosis. Majority (70%) of small body part/superficial examinations carried out either with sector array (22.5%) or convex array (50%) transducer of 3.5MHz frequency. Sonography practice was poor in the two cities. Improving the training and regular participation of practitioners in CPD programmes and also carrying out regular quality assurance checks on ultrasound machines will improve quality of sonographic practice in the two cities.
Financial risk and volatile childhood diagnoses
Authors: Jones Rod
Published: May 2014

Rod Jones, statistical advisor discusses the volatility in admissions for children and the link with financial risk in commissioning
Implementing the MLCF in general practice: implications for development?
Authors: Willcocks Steve , Milne Paul , Milne Heather
Published: May 2014

Leadership has not been a core part of the undergraduate medical curriculum in UK medical schools, nor has it featured strongly in postgraduate medical training. Notwithstanding this, policy changes have encouraged doctors to become more involved in organisational leadership and clinical leadership. A medical leadership competency framework (MLCF) has been developed specifically for doctors. This has been piloted in secondary care but relatively less work has been carried out in primary care. This article sets out to explore the relevance of the MLCF framework as a structured approach to developing leadership and management for doctors in the context of primary care.
Early experiences of any qualified provider
Authors: Jones Lorelei , Mays Nicholas
Published: May 2014

This paper reports findings from a study of the early implementation of ‘any qualified provider’ (AQP) that was undertaken over the summer of 2012. The aim of the study was to provide an early indication of the progress of—and issues raised by—the first phase of implementation of the AQP process so as to inform future policy implementation. Semi-structured telephone interviews were held with 26 individuals from organisations involved in the implementation of AQP. The study found that there was some confusion regarding the degree of freedom available to local commissioners. This together with tight timescales for implementation meant that the choice of services for AQP was not always well matched to local needs. Providers felt that the tariff offered in some cases was not enough to provide the service without resulting in reductions in quality. Nonetheless, support for AQP was widespread, as a method of procurement, to be used when and if local commissioners decide that it would be suitable and would bring benefits.
Projecting numbers of falls related to visual impairment
Authors: Boyce Tammy , Stone Moira K , Johnson Stevie , Simkiss Philippa
Published: May 2014

A large body of evidence examines the causes of falls but understanding the role of visual impairment as a cause of falls is studied less and, as a result, is less well understood. Local areas require information at local levels to accurately assess the health needs of their populations, such as understanding the impact of falls on local health services. modification of published formula to calculate how a local area can estimate its fall numbers related to visual impairment. the modified formula makes it possible for local areas in england and Wales to project the number of falls related to visual impairment. this formula will help those commissioning falls and fracture pathways to factor in the effect of visual impairment.
Appraisal: a key tool to delivering quality care
Authors: Stonehouse David
Published: May 2014

In this article the author will examine the important role that the appraisal system, or performance review, plays in ensuring and improving quality care. As a manager it is your responsibility to support and develop your staff. Through appraisal you can identify good practice and support the achievement of organisational goals. It is also your opportunity to sit down with your staff on a one to one and discuss short falls and problems in performance. This article will start by highlighting the benefits and importance of appraisals, before examining why they have also generated such bad press in the past with both managers and staff? It will then identify the role and purpose that appraisal brings when performed correctly. Why difficulties may arise in performing appraisals will be highlighted. The importance of training for both managers and staff, in the appraisal process will be discussed as a key element to success.
Sustainable development in healthcare
Authors: Pencheon David
Published: May 2014

This article discusses the progress of the health service in reaping the benefits of carbon reduction and sustainable development. It looks at how the health service can move forward from delivering traditional healthcare more efficiently, to more radical approaches to health improvement in a difficult and unpredictable financial climate. The author argues that the health service can be transformed into truly modern, participative and sustainable sector that is fit for the future.
The consequential costs related to lifestyle
Authors: Greenshields Gordon
Published: May 2014

There are enormous consequential costs to the NHS in treating ill-health where lifestyle self-abuse behaviour regarding diet, exercise, smoking and alcohol consumption are key factors. The statistical trends of these risk factors, particularly in obesity/overweight and alcohol consumption, give cause for major concern particularly in regard to their growing impact on hospital admissions. To calculate the NHS consequential costs for each year from 2006/07 to 2011/12, a common costing methodology has been applied across poor diet, physical inactivity, obesity/overweight, smoking and alcohol consumption. Lifestyle self-abuse behaviour (excluding drug abuse) is costing the NHS £18.6 billion a year (15.3% of NHS UK expenditure). This is a rise of £4.1 billion (28.5%) from 2006/07 with obesity/overweight (30%) and alcohol consumption (35%) being the largest increases. Given the statistical trends, these costs will continue to rise and with constrained future financial growth, their proportion of total NHS expenditure will increase. With the NHS struggling with its financial sustainability in the medium and long-term, is this major consumption of resources acceptable, as this is an avoidable financial burden.