bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary care reforms: an American perspective
Authors: Halpern Stephen
Published: May 2014

In theory, the arguments for putting General Practitioners into the driving seat of the NHS look unassailable. In practice, the realities of the change agenda implied by such a move need careful consideration.
Unlocking the memory: investigating incidents
Authors: Barney Dave , Coughlin Geoff
Published: May 2014

This article covers a useful process for helping managers to get to the bottom of untoward incidents that may give rise to complaints or legal/disciplinary action . The importance of good practice in interviews is considered with reference to the techniques of cognitive interviewing, or ‘unlocking the memory’.
‘De-gonging’ those for whom the bell tolls
Authors: Maynard Alan
Published: May 2014

‘What about dealing with the regulators who sat around twiddling their thumbs?’
Managing NHS change more slowly but surely
Authors: Cowper Andy
Published: May 2014

As the signals strengthen that a General Election may be imminent, our series of interviews with the representatives on health policy for the major parties at Westminister continues.

This month, we speak to Dr Liam Fox MP, Shadow Health Secretary for the Conservative Party.
Bringing service users on board: the charity model
Authors: Loader Sarah
Published: May 2014

What can managers learn from the charity sector about involving service users? As CHCs go out the door and PALS are on the way in, there may be some useful lessons.
Democracy blues
Authors: Cowper Andy
Published: May 2014

Modern political discourse suggests that elections are about one major thing: a theme or message that is the main focus for the government or opposition. For some time, it has seemed that the impending general election would be about one of two things: the economy or public services.
Modernising the NHS: work in progress
Authors: Cowper Andy
Published: May 2014

As the signals emerge that a General Election may be imminent, we have run a series of interviews with the representatives on health policy for the major parties at Westminister.

Concluding the series is John Denham MP for the Labour Party Government, Minister of State for Health.
“So, David, who would want to eat in a place like this?”
Authors: Bell Andy
Published: May 2014

In the past few weeks, Outside In has been ‘on the inside’; not as a prisoner, nor even a patient, but a frequent visitor to one of the NHS’ fine hospitals. And what a splendid place it is! All (well, almost all) of the staff have been incredibly polite and helpful. The quality of medical and personal care given has been a testament to the benefits of the Welfare State to pretty much everyone in our society.
Improving PC communication for integration
Authors: Subramaniam Kannan
Published: May 2014

Greater use of information technology in the front-line of primary care brings potential for improved multidisciplinary and management communication.
Wound management protocols of care
Authors: Harding Keith , Cutting Keith , Price Patricia
Published: May 2014

The cost-effectiveness series continues with a review of the protocols of care in wound management, as applying to leg ulcers and pressure sores.
Computing the best anti-cancer drugs
Authors: Harvey Trevor
Published: May 2014

‘The idea relies on the wasted power of your desktop PC when you are working on an assignment or even surfing the net.’
Cost-effective migraine treatment: Almogran
Authors: Siddall Rhonda
Published: May 2014

The latest in our cost-effectiveness series presents a review of a drug treatment for migraine, and considers the potential cost-benefits that it may offer.
Medical spectre at The Queen's beanfeast
Authors: Roth Andrew
Published: May 2014

It was lucky that Tony Blair could borrow the bored Queen, before she rushed off enthusiastically to Royal Ascot, to lend her heritage brand of pomp and ceremony to the Government's announcement of how it hopes to improve the delivery of public services, particularly in health, education and policing.
‘The overthrow of a tyrant?’ The rural future in Scotland.
Authors: Woods Kevin J
Published: May 2014

‘… the country doctor, who has not a specialist nor a crack consultant at the end of his telephone, often has to tackle without hesitation cases which no sane practitioner in town would take in hand without assistance. No doubt this develops the resourcefulness of the country doctor, and makes him a more capable man than his suburban colleague.’ Bernard Shaw, The Doctor's Dilemma.
Impact of the Race Relations (Amendment) Act
Authors: Exten-Wright Jonathan , Hannon Jane
Published: May 2014

Recent discussions and reports about racism in the NHS are thrown into relief by this article, which looks at the breadth of implications of the Race Relations (Amendment) Act 2000.
Matron's in charge: the palliative power of myth
Authors: Harvey Trevor
Published: May 2014

Mary, the current NHS careers campaign proclaims, has lost the will to live. Alongside the picture of a bewildered woman of a certain age heading their latest advertising, we read that ten people, apparently, are helping her to find it. Which is, as the saying goes, nice.
Reading challenges for managers
Authors: Maynard Alan
Published: May 2014

Whilst many dozed on the beach this summer, two very different reports emerged from Whitehall village. One was from the Department of Stealth, entitled Shifting the balance of power within the NHS: securing delivery. The other was by the National Audit Office (for the Department of Stealth) and was called Inpatient and outpatient waiting in the NHS.
An AIDS test for young Dr Harris
Authors: Roth Andrew
Published: May 2014

I don'tquite know why Dr Evan Harris sets my teeth on edge. He is young, articulate, good-looking in a darkly Faustian way and is very clever at dramatising his special approaches. As an agnostic of Jewish origins, he not only belongs to the National Secular Society but also sports lapel tags urging ‘Buy British Pork’. As the most crusading supporter of gay rights among the Liberal Democrats he participates in every debate, often provoking Ann Widdecombe into fury.
Cost-effective wound care - tissue viability
Authors: Gray David , White Richard , Russell Fiona , Flett Alison , Cooper Pam
Published: May 2014

The UK health service has a large annual expenditure related to the purchase of wound management products. As the field of wound management has developed during that past three decades, so the value of this expenditure has increased. It is important that managers work with wound management specialists to obtain the best clinical and economic outcomes for the patient.
The tyranny of choice
Authors: Charny Mark
Published: May 2014

This series reflects on the gap between policy as it is made in the centre and policy as it is lived in the trenches.
‘Jumpers for goalposts ...'
Authors: Bell Andy
Published: May 2014

During its first term of office, New Labour was accused by one former Government member of running a ‘macho’ administration, dominated by male behaviour patterns. Policy, she said, was made predominantly by men, and it was communicated using ‘militaristic, macho and hierarchical language’ (BBC News Online, 8 March 1999) that alienated women voters. Three years on, little, apparently, has changed.
Stuck if struck by stroke
Authors: Halpern Stephen
Published: May 2014

The treatment of strokes is poorest of all the poor relations in the NHS. Every year, some 130,000 people have a stroke and it remains the fourth-commonest cause of death in the UK. Because of the historical lack of resources and relatively poor advocacy, treatment for stroke patients has further to go than most other areas of serious illness.
Prognosis for paperless practice in pathology
Authors: Pattinson Sarah
Published: May 2014

This article explores the ways in which Information Technology (IT) modernisation of pathology services can help to directly improve patient care.
Taking discipline and grievance to new heights
Authors: Exten-Wright Jonathan
Published: May 2014

This article considers the implications of the recent changes in employment law and implications for procedure and practice in managing staff.
The medium and the message: lecciones de Español
Authors: Cowper Andy
Published: May 2014

The American academic Marshall McLuhan gave great quote. As well as his classic “The medium is the message” there are three quotes which seem to bear on where the process of NHS reform is at present, to wit:
E-Booking referral system for general dental practice
Authors: Dyer Peter Vincent
Published: May 2014

NHSNet is a facility available to all general medical practitioners but not as yet to their dental colleagues in practice. This paper describes the first UK initiative to link general dental practices to their local Department of Oral and Maxillofacial Surgery using IT enabling patients to be given appointments at the hospital at the time of their choice on a new referral system for general dental practitioners in Morecambe Bay.
Swing Low, Sweet Chariot
Authors: Cowper Andy
Published: May 2014

Once upon a time, we used to have a national team who under-performed. The way this team used to operate and be administrated and managed was pretty old-fashioned. Other teams in the same game elsewhere in the world were doing things very differently, and often quite a lot better.
Choose life: why the NHS needs informed patients
Authors: Cayton Harry
Published: May 2014

In this article, Harry Cayton proposes the reasons why he believes that informed patients will be good for the NHS.
NICE: Yeah, but, see, we need it?
Authors: Appleby Professor John
Published: May 2014

…But rationing exists, always has and always will regardless of the size of the NHS budget; there's only so much money each year and this places a global limit on what ’ the NHS can provide.
The chimera of choice
Authors: Cowper Andy
Published: May 2014

Time may be a great healer, but it's a lousy beautician. All the same, if you're a fan of nostalgia, you may remember in the early days of Blairism, there was much philosophical talk of communitarianism - after Ezzioni - and of the ‘radical centre’.
Creating an NHS safety culture - where to begin?
Authors: Thomson Peter
Published: May 2014

Most health care professionals think that they act in a safe and appropriate manner on behalf of patients. However, the Chief Medical Officer for England says the NHS lacks a safety culture. A recent paper in the British Journal of General Practice (Kennedy et al 2002) supported this bald statement from the CMO. There is a need for all involved in health care to review not just clinical practice, but their working environment as well.
House of race cards?
Authors: Bell Andy
Published: May 2014

It is just under three short years since Sir William Macpherson's report into the police handling of the murder of Stephen Lawrence defined the term ‘institutional racism’, and created the critical mass for it to be addressed in public policy. in that time, a new Race Relations (Amendment) Act has placed a statutory duty on public services, the NHS included, to take positive measures to secure equal opportunity both for staff and for the people who use them.
On wheezes and Exocets
Authors: Maynard Alan
Published: May 2014

The NHS is characterised by an exhausted management cadre, continuously oppressed by wacky Whitehall ‘wheezes’ and redisorganisations that divert attention from the fundamentals of the efficient use of Blair's billions.
Focus on fiddling while NHS management burns
Authors: Halpern Stephen
Published: May 2014

If the future of the NHS is to depend on events between now and the next General Election, much of the management evidence indicates the situation is becoming increasingly parlous.
The new localism
Authors: Harvey Trevor
Published: May 2014

Human psychology can encompass apparently opposed weltanshaungs. I was thinking this as I waited with what I must nowadays refer to as my “animal companion” in the local vet's surgery recently. It was very busy, and undoubtedly lucrative, but I have seen no move to develop anything like the District General Hospital for animals in every town.
The Kidderminster Effect
Authors: Maynard Alan
Published: May 2014

What is the explanation of the Government's desire to replicate and elaborate the Thatcher proposal for “autonomous” trusts? The inevitable challenge in answering this question is the perennial problem of divining the explicit and implicit goals of government.
Project-managing a change to electric hospital beds
Authors: Hignett Sue , Lang Richard
Published: May 2014

This article presents the lessons learnt from implementing electric beds in an acute NHS Trust.
Fixing it when it ain't broke
Authors: Halpern Stephen
Published: May 2014

Since Hippocrates’ time, one of the fundamental principles of medical practice has been to ‘first, do no harm’ to patients. An astonishing 100,000 people pick up infections in NHS hospitals annually, and the annual cost of hospital acquired infection has been estimated to be around one billion pounds.
“Are you a violent patient?”
Authors: Walshe Kieran
Published: May 2014

The ‘Provocations’ series returns with a funny and thoughtful anecdote about the relationships between industry ‘insiders’, and the consequences for patients.
Foundering foundation trust undermined through payment by results?
Authors: Timmins Nicholas
Published: May 2014

It's over. But before we bid it farewell with fireworks, October 2004 will be remembered as the one in which the theory around two of the more controversial parts of the Government's great NHS reforms – foundation hospitals and payments by results – started to become reality.
The season to be jolly
Authors: Cowper Andy
Published: May 2014

The season of mists and mellow fruitfulness is making its inexorable way into the season of respiratory disease, hypothermia and - oh joy -Christmas shopping.
Lib Dems reports grate expectations for NHS Plan
Authors: Halpern Stephen
Published: May 2014

The general practitioner service has always been seen as the jewel in the crown of the NHS. British primary care provided free to all at a consistently high standard was often proffered as one of the main advantages of living in this country. The same sentiment is rarely expressed these days and, if the gloomier predictions are to be believed, will soon not be made at all.
Dancing to the National Tariffs Tango
Authors: Maynard Alan
Published: May 2014

For reasons best known to some ‘Blair babe’ in some policy unit in Whitehall Village, the NHS in England is to be blessed with the creation of a system of national tariffs, which will determine the price of all procedures.
Excitable Sundays disclose terrible NHS scandals!
Authors: Roth Andrew
Published: May 2014

As an old hack, I eagerly read my five Sunday papers to find what ‘scandals’ the poor bastards on the Sundays have been able to unearth. When I was a full-time Lobby correspondent I always pitied Sunday political correspondents who were left with the fag-end of political stories even when Parliament normally sat on Fridays. I did not begrudge them the special briefings with which Number 10 began to spoon-feed them to have something to fill their end-of-week news hunger.
Dr John Reid snarls against a change of job
Authors: Roth Andrew
Published: May 2014

When you are a top executive, there is nothing worse than having the rug pulled out from under you just as you have mastered your job. This looks like happening to Dr John Reid, the Secretary of State for Health.
Where public health needs to go next
Authors: Cowper Andy
Published: May 2014

Professor David Hunter, Chair of the UK Public Health Association, outlines his thoughts about the present state of public health and its future direction.
Beware the precautionary principle?
Authors: Greener Mark
Published: May 2014

When it comes to health, the advice to be “better safe than sorry” seems sensible. After all, at one time or another, many scientists doubted whether humans could contract mad cow disease; whether asbestos could cause certain cancers; and whether blood products could transmit HIV.
French lessons on funding the future
Authors: Harvey Trevor
Published: May 2014

Comparisons, whilst odious, can be revealing. The cost of health care in a number of countries, roughly comparable to our own, shows an awareness of a looming crisis. This has been building as the demographic contour of age, and expectation of professional intervention, has evolved. Britain shares the problem of mainland Europe's social costs, which also afflicts the Netherlands, Germany, Scandinavia, Italy and France. Like us, these countries grew health systems in more socialist, less populated times, when we died younger, had fewer care options and lower expectations.
To choose the Right of ‘The Right To Choose'?
Authors: Cowper Andy
Published: May 2014

As a leader, Iain Duncan Smith didn't leave the Conservative Party much of a legacy. OK, they knew where they stood on Europe – firmly outside, thank you very much. There was a brief concern, launched on the Easterhouse council estate in Scotland, for the poor and the dispossessed. In health terms, Duncan Smith and his health spokesman Dr Liam Fox gave us the Patient's Passport: a subsidy to those who use private health surgery of 50% of the NHS cost of their operation.
Extra time and penalties: Birmingham 2004
Authors: Cowper Andy
Published: May 2014

The NHS Confederation conference is the major event of the NHS management calendar, where networking and learning co-incide and managers can hear about best practice from the great and the good.
A temporary solution or a long-term obligation?
Authors: Hodgkiss Kate
Published: May 2014

Many organisations will at some time have relied upon employment agencies to supply them with temporary workers, either to provide cover for absent employees or to supplement their permanent workforce.
Reid all about it
Authors: Cowper Andy
Published: May 2014

Was that the summer? Ah well. As the Parliamentary Circus drags itself back into some form of life via the cardiopulmonary resuscitation of the party conference season, health policy junkies gird what passes for their loins to cope with the latest instalments of the long, slow ‘odernisation’ of the NHS.
Beginning to reinvigorate the workforce
Authors: Benson Lawrence , Venning Pamela , Young Ruth , Walshe Kieran , Mullen Chris
Published: May 2014

This article examines the ‘Delivering the Workforce’ project in Greater Manchester, which aims to provide over 2000 assistant practitioners in a major attempt to contribute to the redesign of the health and social care workforce. target groups it is intended to benefit.
Hiding a tree in a forest: information set free (part two)
Authors: Cowper Andy
Published: May 2014

Nearly 20% of Freedom Of Information requests to the Department of Health relate to the National Programme for IT (NPfIT) - and not a single answer has been published to any of these.
Fatigue: the forgotten cancer outcome
Authors: Greener Mark
Published: May 2014

Fatigue among people suffering from cancer is often insidious, invasive and incessant. It is a pervasive physical, mental and emotional infirmity that dramatically undermines health related quality of life (HRQoL) and patients’ abilities to perform activities of daily living. It's a “complete lack of energy and severe mental exhaustion” (Curt 2001).
Another structural reorganisation - just what the NHS needs
Authors: Timmins Nicholas
Published: May 2014

August 2005 set an agenda that it is not clear that anyone with any sanity would want: yet another structural reorganisation stretching out from this autumn and over the next eighteen months, just at a time when almost everything else in the NHS is also changing.
The vultures gather to do the Oliver Twist
Authors: Maynard Alan
Published: May 2014

An increase in the size of the stock of game or fish generally leads to an increase in the number of predators: supply creates its own demand, as the economists remark. As in nature so it is in the NHS, although as ever ministers seem nicely naïve in asserting continually that the service has lots of dosh to fund everything that can be possible done, even though they have no idea of the full cost of the NHS modernisation’ - sorry, ‘system reform’.
What shall we do with the drunken sailor?
Authors: Cowper Andy
Published: May 2014

It's a rich man's world: just ask Bill Gates. Yes, I have just had a look at the Taxpayers'Alliance top 10 salaries in NHS list www.taxpayersalliance.com ). And laughed. And swore. And so this editorial is going to propose the Lister Hypothesis.
Low pay awards, complex quailty measures and ‘renationalising’ FTs: it's reforeform, Jim, but not as we know it.
Authors: Timmins Nicholas
Published: May 2014

October 2006 was the month in which it became clear that the Government is increasingly serious about restraining pay in the NHS next year.
On equilibrium, or why managers need choice too
Authors: Hardacre Jeanne , Keep Jane
Published: May 2014

In July 2005, ‘Commissioning A Patient Led NHS’ shook the boughs of the NHS and many NHS managers had experienced destablised summer holidays, having had the news about the changes to PCTs, primary care and SHAs.
The NHS Alliance Conference 2006
Authors: Cowper Andy
Published: May 2014

So what's the context for the NHS Alliance 2006 conference? Money is a key: the DH's own figures suggest that the NHS as a whole is due to be 1 billion pounds off budget by the end of the financial year. And Health Secretary Patricia Hewitt had just announced to the Commons Health Select Committee that she would “take personal responsibility”for seeing that the NHS as a whole ended the year in financial balance.
Budgeting for the costs of ‘Agenda For Change’
Authors: Burrows Emma
Published: May 2014

Agenda For Change (AFC) is hailed as the most radical overhaul of the NHS pay system since its foundation in 1948. So what will this new dawn for NHS pay usher in? It is evident in the short term that the programme will not be without its costs to care providers.
Tomorrow's commissioners and providers
Authors: Cowper Alan
Published: May 2014

This month, the NHS Alliance publishes its new document ‘Getting Better All The Time: what sort of commissioners and providers will deliver the best patient care?’ (2006).
The terms and conditions of conditional benefits
Authors: Bell Andy
Published: May 2014

The volume of paper emanating from Whitehall in recent weeks has been considerable. Hot on the heels of the health and social care white paper came, from its neighbour in Richmond House, the green paper on benefit reform (DWP 2006).
After Sir Nigel Crisp, the ‘blame game’ and a three-way role split?
Authors: Timmins Nicholas
Published: May 2014

Even though ‘mad March’ is over, it will be a long time before anyone can let it go. “Leroi est mort”. But no-one right now can say “vive le roi” - not least because no-one has a clue who it will be.
Next steps for reform: where do we go from here?
Authors: Cowper Andy
Published: May 2014

Kensington and Chelsea PCT, which I formerly chaired, got into trouble because the parlous state of its finances was neither known to the board nor recognised by the auditors until over £7 million of invoices, unpaid for over a year, emerged from the woodwork. The fact that creditors had not been banging on the door was a rude awakening to the chaotic reality of NHS finance, in which things are never quite what they seem.
When Tony Met Nigel
Authors: Cowper Andy
Published: May 2014

It's always the small things. Malcolm Gladwell's contemporary classic The Tippping Point (2002) is subtitled ‘how little things can make a big difference’. Al Capone was busted for tax evasion. And George Bush got to the White House thanks to a badly-designed ballot paper and worn hole-punchers.
Auditing key lessons on contracts and commissioning
Authors: Timmins Nicholas
Published: May 2014

May 2006 was the month in which hundreds of managers were at last told the shape of the SHAs and PCTs they may, or may not, be working for in future. Now they can stop worrying about their jobs, and start really worrying about them.
How does policy learn from pilots?
Authors: Meyrick Jane , Granville Gillian
Published: May 2014

In November 2004, the Department of Health (DH) published its public health white paper ‘Choosing Health: Making Healthier Choices Easier’ (DH 2004) following an extensive consultation to generate ideas for policy on how best to improve the health of the population and reduce inequalities in health.
Come the NHS revolution: impact or knee-jerk?
Authors: Hardacre Jeanne , Keep Jane
Published: May 2014

For a number of years, the NHS has been expanding and growing. The growth has arisen from extra funding, and with that funding has come the expectation of change, and a more subtle expectation of becoming more ‘productive’.
Beware of gurus bearing ‘solutions’
Authors: Maynard Alan
Published: May 2014

The American health care systems are poor and expensive. Most employees are insured by their employers, although few have choice of carrier and all face considerable co-payments or user charges as private entrepreneurs try to control access and utilisation with price barriers.
Nicholson's NHS, RAB reprieved and iterating IT to the service locally
Authors: Timmins Nicholas
Published: May 2014

December 2006 saw David Nicholson's first big outing — a Downing Street press conference aside — as NHS chief executive. The operating framework for next year was his attempt to stamp what he clearly hopes will be his style of operation on the NHS.
A half-century's celebration
Authors: Roth Andrew
Published: May 2014

Ispent the first part of the Christmas recess raising a glass to an important medical-political event which had occurred exactly fifty years before. The event in question was the resignation of Sir Anthony Eden as Prime Minister.
A 3-dimensional balanced scorecard model for R&D
Authors: Jones Kerina
Published: May 2014

The Balanced Scorecard (BSC) was initially described by Kaplan and Norton (1992). It is a measurement-based strategic management and learning system, applicable in all organisations.
A local NHS for local people?
Authors: Bell Andy
Published: May 2014

It is now a mantra in the NHS that local is good and national is bad. After years of central direction, under the heavy burden of targets and dropped bedpans in Whitehall (or Waterloo Road if you work in mental health), PCTs and trusts are, it is said, being freed to go their own way, make their own decisions and be more responsive to local people.
Commissioning - challenging providers
Authors: Woodin Juliet , MacDonald John
Published: May 2014

If the Government's current policy to strengthen commissioning is successful, healthcare providers should notice a difference. This article considers the potential impact of stronger commissioning on NHS trusts, and identifies six strands of development activity that may arise for them as a result.
Cally Palmer
Authors: Palmer Cally
Published: May 2014

The main difference with foundation trust status has been operating as a business, with local accountability. Foundation status suits the fact that The Royal Marsden has a different contribution to make to the NHS as a specialist provider. We have a powerful bench to bedside agenda for translating basic science from the Institute into improved care for patients in the Hospital. Before we became an NHS foundation trust, I was often asked why we did things differently. Now, no one asks why we trial new models of care or innovate technically.
Is it more money but less reform?
Authors: Timmins Nick
Published: May 2014

October 2007 brought us the money; further evidence about ministers' schizophrenic view of whether choice, competition and use of the private sector should drive reform; and a hint that the government may be about to address social care seriously, a la Wanless.
Where primary care is going - 2008 and beyond
Authors: Cowper Andy
Published: May 2014

Are clinicians making a real difference as decision-makers and influencers in the new, bigger PCTs, or is it tokenism all over again?
Open culture will help patient safety
Authors: Davis Alan Maryon
Published: May 2014

Healthcare managers will scarcely need reminding that patient safety — particularly when it comes to hospital-acquired infections like MRSA and Clostridium Difficile - is big news at the moment.
New economics - from bust to boom?
Authors: Appleby John
Published: May 2014

The headlines write themselves. From the scandal of overspending at a time when the NHS had never had it so good to a time of underspending just as belts are tightening. From the outside it looks like very poor planning. But maybe from the inside there's a certain logic if not inevitability about the super-caution over finances: ministerial reaction to headlines only a year ago of overspending were, after all, felt keenly in the NHS.
The ‘how’ of changing culture and minds
Authors: Halligan Aidan
Published: May 2014

There is no task more difficult than that of changing people's behaviour. I believe there has been a failure to put as much energy into improving our healthcare culture as we put into tackling access, and that this has led to a fundamental imbalance within our healthcare institutions.
Why Gerry ain't a pacemaker
Authors: Halpern Stephen
Published: May 2014

Successful businessmen have held a fascination (or should that be fetish?) for managing the NHS ever since the 1983 NHS Management Inquiry, headed by then Sainsbury's boss Roy Griffiths.
Is NHS reform policy better in practice than in theory?
Authors: Foster Andrew
Published: May 2014

The aerodynamism of honey bees may not, at first glance, seem germane to NHS reform in theory and practice.
Gateway to mental heath services
Authors: Marsden Debbie , Wesson Michael
Published: May 2014

A redesign of existing local services in Southport and Formby has created an innovative and simple gateway to mental health services and transformed the experience for service users, carers, and referrers.
What will Brown's new brooms bring?
Authors: Timmins Nick
Published: May 2014

June 2007 brought a change of administration that, for the Department of Health, might as well have brought a change of government. For in his search for “change”, Gordon Brown has cleared out almost the entire ministerial team — something that rarely happens without the government changing.
Andrew Horne
Authors: Horne Andrew
Published: May 2014

On my first appointment as a CEO, I was overconfident about my own abilities — I didn't know what I didn't know! This was a very useful learning experience, giving me the valuable lesson of making mistakes, learning from them and moving on.
The direction of travel in reform
Authors: Cowper Andy
Published: May 2014

The direction of travel for most people in August is away, on a well-earned holiday. Don't forget the suncream. So far, however, there has not been too much in the way of clear signals about the new Government's direction of travel for health reform.
Julian Hartley
Authors: Hartley Julian
Published: May 2014

My biggest challenge was coming to Blackpool and turning around a £24 million deficit to balanced position in one year. This was a white-knuckle ride, but a fantastic learning experience which taught me the importance of having the best possible team in place and clear and consistent communication.
Better - a surgeon's notes on performance
Authors: Cowper Andy
Published: May 2014

Better is a book you need to own and read, sooner rather than later. I suspect it may be a classic. It is one of those truly good books that will make you want to give copies away to people. (And no, I have not bought shares in the publisher.)
Can medicine be globalised?
Authors: Roth Andrew
Published: May 2014

We are all aware of the globalisation of manufactured products. Last month we bought for our cottage in Brittany a new washing machine from France's biggest supermarket chain, Carrefour. Although it bore the English tradename Bluesky, almost all such electrical goods are manufactured in China.
Appraisal time for the Department
Authors: Appleby John
Published: May 2014

The Department of Health's Annual Performance Report came out just before Christmas–to nil public fanfare. But then again it is not the sort of report designed for public consumption. Alan Johnson's second introductory sentence reads:
Risk factors for oral cancer
Authors: Warnakulasuriya Saman
Published: May 2014

November 2009 is Mouth Cancer Action Month in the UK. This campaign is run by the British Dental Health Foundation, supported by the Department of Health and the British Dental Association. The incidence of mouth cancer has risen by 41% in just 10 years to 5350 new cases annually. The 5-year survival rate of mouth cancer patients is just 50%, but early detection and diagnosis gives patients a 90% chance of survival. Major risk factors for oral cancer are cigarette smoking and alcohol misuse. Among Asian populations, regular use of betel quid (with or without added tobacco) increases oral cancer risks. Dentists and other health professionals should be aware of the emerging risk factors for oral cancer such, as the role of human papillomavirus (HPV), decreases in risk that could be achieved by encouraging high fruit and vegetable consumption, as well as some controversies related to the aetiology of this disease that need clarification. The aim of this article is to provide an opinion on these debated controversies.
Length of stay efficiency
Authors: Jones Rod
Published: May 2014

The previous article in this series examined the evidence to support the generally smaller size of hospitals built in recent years. Bed demand was roughly the same as 10 years ago (Jones, 2009a). This observation may conflict with the generally perceived notion that average length of stay (LOS) is declining and therefore hospitals need to be smaller. The issues involved in this apparent conflict of ‘reality’ must be understood, although it must also be pointed out that genuine ‘inpatient’ LOS reduction has been minimal in the USA over the past 10 years (Nataraja et al, 2009).
Jenny Saunders
Authors: Saunders Jenny
Published: May 2014

I have worked at National Energy Action (NEA) for 23 years–joining when the charity had just been established and with a grand total of 10 staff in a shared office in Newcastle's notorious Bigg Market. I was a general Information Officer, and had to get involved in preparing publications, media work, handling general enquiries, and organising events–often involving members of the health sector who were busy people and didn't always see the connection between poor housing and health.
Can get some satisfaction?
Authors: Appleby John
Published: May 2014

Over the last ten years, assessing the performance of the NHS has become something of an industry. The Healthcare Commission, Monitor, the Audit Commission and a plethora of Department of Health reports now routinely provide league tables, check lists and composite scores.
Stimulus and effect: rationing
Authors: Terheyden Nick van
Published: May 2014

In recent months a lot of attention has been focused on the US Stimulus Package that came in at $787 billion (about £554 billion at current exchange rates), and the resultant cries of ‘What's in it for me?’
Reforming commissioning
Authors: Maynard Alan
Published: May 2014

The aim of the purchaser–provider reforms introduced by the Thatcher administration in 1989 was that commissioning would lead to more careful contracting and improved efficiency in the use of society's scarce resources. Twenty years later, this is still the hope of reformers as epitomised by the World Class Commissioning policies of 2008.
If the cap no longer fits
Authors: Housden Philip
Published: May 2014

The 2003 Health and Social Care Act, which established foundation trusts, introduced a cap on the percentage of total income they could gain from private patients. This was set at the earnings achieved in 2002/03 financial year, and designed to stop excess future profit generation at the expense of NHS patients. Since then Monitor, the FT regulator, has been accused of taking too light a touch to a range of approaches some trusts have taken to enable private patient earnings to grow.
Towards a new transatlantic zone
Authors: Cantle Florence
Published: May 2014

Transatlantic learning is something I always want to do. In order to know more about what transatlantic learning is and what the benefits are, the author conducted a first-hand investigation, the overall aim of which was to increase knowledge of the area. In addition, the author aims to apply the knowledge gained to current practice.
Employment references and the law
Authors: Griffith Richard
Published: May 2014

Job references are a crucial component of the process of employing competent, trustworthy staff, and healthcare managers are often required to write and take up references for staff that leave and join their workforce. Writing a job reference is not always a simple matter, however, and care must be taken to ensure they are reliable and truthful. This article looks at the legal requirements for a job reference.
Closing hospital beds
Authors: Maynard Alan
Published: May 2014

The demand for health care is growing as the number of elderly increases and public expectations of cure and care (if not immortality!) continues to rise. Funding over the next five years will be constrained acutely in many countries due to the economic recession and gross imbalances in public finances.
Standards for registration
Authors: Hutchinson Linda
Published: May 2014

The legal framework for the regulation of health and adult social care is changing.
Budget basics and the economic outlook
Authors: Spellman Ruth
Published: May 2014

A persistent theme of the G20 summit held at the beginning of April was that ‘the world has changed’. There will be no ‘return to normal’, we were told–where normal is deemed to be something like, say, 2006. But it is not at all clear exactly what this means. That is why debate over what was actually achieved at the summit will rumble on as the strengths and weaknesses of the measures agreed are revealed over time.
24 months to invest to save the NHS
Authors: Bell Andy
Published: May 2014

This year's NHS Confederation conference was overshadowed by talk of impending budget deficits. After so many years of generous funding increases for the NHS as a whole, the realisation that times will be hard for some years to come left a dark cloud hanging over the conference.
Effective quality improvement: conclusions
Authors: Powell Alison , Rushmer Rosemary , Davies Huw
Published: May 2014

In this series of articles, the authors have examined the research evidence on the use and impacts of five of the major organisation-level approaches to quality improvement in health care in the past two decades: Total Quality Management/Continuous Quality Improvement, Business Process Reengineering, practitioner-led rapid cycle change, Lean thinking and Six Sigma. But how much do the approaches differ, and does it matter which approach is used?
Opportunity knocks?
Authors: Housden Philip
Published: May 2014

The recent White Paper requires PCTs to divest of so-called provider arms by April 2011. The plan requires a move to an ‘any willing provider’ approach for community services reducing barriers to entry by new suppliers.
Leadership: a challenge for GPs?
Authors: Willcocks Stephen
Published: May 2014

Since High Quality Care for All (2008), the development of leadership has been seen as a priority, and this has prompted various initiatives, not least the development of a leadership competency framework for doctors. The Medical Leadership Competency Framework (2009) is the first strategic level attempt to develop the leadership competencies required by doctors at various stages in their careers. Leadership is all the more important given the recent change of government and the policy of retrenchment, major structural change, and the emergence of new organisations, for example, GP commissioning consortia. The success of these new organisations, particularly in budget holding, ‘will depend on the engagement of GPs and the leadership they provide’ (Ham, 2010). The question is: which leadership model or approach is best for GPs working in primary care? This short article will seek to address this question.
Time to pause and digest
Authors: Timmins Nick
Published: May 2014

It is a time of pregnant pause. Much digesting of the NHS White Paper and its accompanying documents. Much uncertainty among GPs, not to mention all those PCT and SHA staff whose future is clouded. Watching family doctors grapple with the idea that the government intends to hand over to them some £70bn or £80bn pounds' worth of NHS expenditure to them for commissioning-like it or not-is intriguing. And worthy of comparison with the last time a government gave them cash with which to buy patient care back in the late 1980s with the invention of fundholding.
Doctoring ethics
Authors: Hill Rosalind
Published: May 2014

In 1998, The Lancet published a study by Dr Andrew Wakefield, Dr Simon Murch and Professor John Walker-Smith, which linked the measles, mumps and rubella (MMR) vaccination to autism and bowel disease. The study had the effect of causing widespread alarm in parents and, consequently, uptake rates of the vaccination plummeted dramatically, even though the study only examined 12 case studies.
Vying for advantage on NHS spending
Authors: Timmins Nick
Published: May 2014

January 2010 was the month in which Andy Burnham's spending plans came under fire, a slightly clearer picture emerged of what life under the Conservatives may be like, and Bill Moyes departed-temporarily at least-with a broadside.
Beyond the fringe
Authors: Housden Philip
Published: May 2014

There is an increasing trend towards hospital consultants forming groups or ‘chambers’, still mainly in the big cities, but not exclusively so. These chambers have taken a variety of forms; limited liability partnerships (LLPs), private limited companies, or looser associations. A few of these structures have been set up to include private practice, but most are formed as a vehicle to enable increased supply of consultant services to the NHS market. This is avaluable contribution, but one that remains at the fringe of mainstream provision.
Bridging the divide
Authors: Hill Rosalind
Published: May 2014

The results of the 2009 NHS staff survey, published by the Care Quality Commission (CQC) last month, reveal some pretty disappointing opinions with regard to healthcare managers.
PROMs: not an election issue
Authors: Appleby John
Published: May 2014

So that was the general election—I presume some sort of Labservital type government has now been formed. Meanwhile, the NHS has combined two of the things it does best-statistics andhealth-by issuing the first set of pre-operative patient reported outcome measures (PROMs) data.
A new approach to project managing change
Authors: Edmonstone John
Published: May 2014

Project management based on the PRINCE 2 (Projects In Controlled Environments) methodology isthe default mode for managing organisational change in the NHS. While this approach to project management is suitable for ‘tame’ problems, it is not so for ‘wicked'problems, which are the focus of most organisational change activities in health care. The NHS organisation development function has adopted the PRINCE 2 approach to managing change, but thereis evidence that the function itself is not completely developmental. A new approach to project managing change is needed based on a search for ‘clumsy’ rather than ‘elegant’ solutions.
Epilepsy care in the over 60s: a comparative audit
Authors: Chappell Brian , Bagshaw Jan , Crawford Pamela
Published: May 2014

Aim: To ascertain the current UK management processes for epilepsy in older patients. Method:A comparison of two general practice audits (first cycle) of people being treated for epilepsy aged 60 years and over in two geographical areas. Results:The cohort of 213 of patients came from 12 different practices. Seizure frequency in older people with epilepsy appears to be lower than that in younger patients; 80% are seizure-free. This compares with 40-60% of people in othergeneral practice note reviews and audits, where age is not a factor. Monotherapy rates are similar to the population in general. There is evidence of new antiepileptic drug use. Geriatricians receive virtually no referrals for the diagnosis of epilepsy. General physicians and neurologists receive the most. Geriatricians and general physicians very rarely provide follow-up; GPs complete most of this work, except where patients are still having seizures, and neurologists and specialist nurses then have a greater role to play. Having a dedicated local neurology departmentappears to increase initial referral rates to relevant specialist services and improve some outcome measures. Conclusions: Seizure frequency in older peoplewith epilepsy is low. Management and care for this patient group differs greatly from that provided for children and young adults.
Is evidence-based management a myth?
Authors: Jones Robert SP
Published: May 2014

Although rigorous standards of evidence are demanded before a clinical intervention is approved and disseminated, evidence-based performance management is only beginning to be regarded as important. Unsubstantiated expert opinion is still too highly rated in evaluating management interventions, despite being regarded with appropriate skepticism in clinical management. This article questions this dichotomy and suggests that all management interventions are capable of independent evaluation. Some relevant research parameters are discussed. Using the example of appreciative inquiry, it is suggested that claims that a process is either not capable of independent verification, or does not need such verification, are not sustainable and are likely to lead to the premature abandonment of potentially useful interventions.
New tricks
Authors: Hill Rosalind
Published: May 2014

The new Tory-Lib Dem coalition Government has been in power for a little over a month now, and not surprisingly, the NHS has already featured highly on the political agenda.
Even the best laid plans...
Authors: Appleby John
Published: May 2014

Now that the Department of Health's website has now been rebooted-with virtually its entire history of policy pronouncements, forward plans and press releases shoved off to the National Archives-and a new Year Zero established, it can be hard to put current events in their historical context. Hard, but not impossible.
The patient's heroic journey
Authors: Ramsden Philip
Published: May 2014

The purpose of this study is to reinforce the notion that not only is the patient the focus of decisions on the pathway to recovery through the healthcare system, but this requires the support and cooperation of many healthcare professionals. By using a storytelling arc and character archetypes taken from the narrative theory of cinema, it shows how the patient's decisionpathway is similar to the journey of the hero in film, and that healthcare professionals have key and supporting roles in this story. It results in healthcare professionals matching specific archetypes encountered in film, and equates stages of the decisions pathway to events in film structure. The outcome emphasises the patient-centred approach and the necessity of interprofessional cooperation.
Audit and incentive pay: a match made in heaven?
Authors: Bhogal P , Bhogal M , Brereton A
Published: May 2014

As act two of the financial crisis begins to unfold, governments across the globe are findingit difficult to finance their debts and raise new money on the markets. The new buzzword is austerity and the UK is not exempt from the coming storm. Cuts in public spending, the likes of which have not been seen for decades, will soon be upon us. With this in mind, talk of financial incentives for public servants may seem ludicrous. However, perhaps there is a way in which departments can save money while still providing a financial reward for those workers interested in increasing efficiency. In this article, we present an idea linking the audit cycle to financial incentives and demonstrate how it could be effective to all parties involved.