bluuebunny/crossref_metadata_2025 huggingface dataset:
What is the future for Spearhead PCTs?
Authors: Pears Robert
Published: May 2014

Spearhead primary care trusts and councils have the worst health and deprivation in England, but their health services are often less well placed to tackle them. They are expected to reduce England's life expectancy gap by 10% by 2010, but in 2005 only 11% were on track. What does spearhead status really mean for public services, and how is the definition likely to affect future health inequalities?
Teamwork in action for diabetes
Authors: Siddall Rhonda
Published: May 2014

One definition of a good team is ‘a group of people organised to work together for a common goal’. The Carmarthenshire Diabetes Network team, led by consultant physician and diabetologist Dr Meurig Williams, can claim with well-deserved pride to be an effective, multidisciplinary team of health professionals that has delivered patient-centred care for its community of around 8000 diabetes patients. ‘The strength of our team is that it represents each major strand of the diabetes service and works effectively together. As a result, we punch above our weight,’ says the quietly spoken Dr Williams.
Sheila Paul
Authors: Paul Sheila
Published: May 2014

My first management role was to implement a computerised PAS in 1986. This really brought home to me at a very early stage in my career how nervous people can be about change, more so when the change involves new technology. We all take computers for granted now, but people were really apprehensive about using them 20 years ago. We need our staff to adapt and change all the time—our job is to understand how staff may feel and work with them to be comfortable with the change.
Long live the NHS
Authors: Hill Rosalind
Published: May 2014

Autumn has well and truly arrived, but the end of British summertime brought with it a new debate on whose healthcare system is ‘best’: that of the US, or the UK?
Are MSAs effective for cost-containment?
Authors: Ali Adam M
Published: May 2014

As the cost of health care continues to escalate, systems around the world are coming under increasing pressure to improve the efficiency with which they operate. However, in the drive to reduce the unnecessary use of services, the safety net that guarantees a decent minimum standard of care for the most vulnerable groups risks being compromised, as does patient choice and quality of care. Medical savings accounts (MSAs) offer an attractive solution to this dilemma, combining the efficiency of the marketplace with the protection of government control, and Singapore provides an example of a modern, efficient healthcare system based on compulsory MSAs. Have MSAs been effective at containing costs? Have they maintained the safety net? And are they an appropriate policy approach for a national health service?
Innovative organisational design for surgeries
Authors: Collinge William H
Published: May 2014

This article presents an innovative organisational model for the provision of routine operational surgeries in the UK. The focus is on the organisational structures and infrastructural fundamentals, which any innovative service provider entering the health sector should possess. The negative features of current routine operational surgery provision in the UK (e.g. long waiting lists, expensive private sector alternatives) are addressed through an examination of each critically-important organisational management issue. It is envisaged that the proposed organisational design could become the basis of a private sector enterprise, or be adopted by the NHS itself, following a systematic organisational review and realignment of routine operational surgery structures.
Unplanned paediatric care pathways
Authors: Snelson Edward , Gilchrist Judith , Wright Neil
Published: May 2014

Introduction: There are a variety of routes in which individuals can access out-of-hours care. In addition to traditional services, NHS Direct is increasingly involved in out-of-hours services. Evidence suggests that attendance at accident and emergency (A&E) departments is increasing. Anecdotal comments suggest that some patients perceive it as the quickest way to access out-of-hours care. Objective: To examine access times for different out-of-hours services by examining the time elapsed between families deciding to seek medical advice and seeing a doctor, in order to improve understanding of how this may influence the use of unplanned paediatric services. Method: Data was gathered on the time elapsed between deciding to seek medical advice and seeing a doctor for different patient pathways, including attending A&E directly; attending a GP out-of-hours collaborative; and telephoning NHS Direct. Data was collected over two weekends from automated call records from primary care patients and by questionnaire from 530 emergency department patients. This work was carried out as part of a service evaluation. It was registered with the Audit Office at Sheffield Children's Hospital, who agreed that no ethical approval was needed. Results: Attending A&E directly was on average 30 minutes quicker than seeing an out-of-hours GP. Those who initially telephoned NHS Direct experienced the greatest delays. It took 20 minutes longer for families who accessed the GP collaborative via NHS Direct to be seen compared with those who accessed it directly. Conclusions: Even when taking journey times into account, direct attendance at A&E provided the most rapid access to out-of-hours care. The involvement of NHS Direct has introduced additional delays in being seen by a doctor. Further work is required to examine the impact of this on the ways in which patients access out-of-hours care.
Regulating failure
Authors: Timmins Nick
Published: May 2014

November 2009 was a thoroughly bad month for healthcare regulation. Basildon followed Maidstone and Tunbridge Wells and Mid-Staffordshire into the catalogue of major interventions by the regulators rather later in the day than anyone would ideally like.
The ten essentials of large-scale change
Authors: Kennedy Ruth , Lawless Melanie , Slater Beverley
Published: May 2014

Achieving change and improvement on a large scale continues to be a challenge for health service leaders, given the inherent complexity and variation in healthcare delivery. Academic interest in quality improvement approaches has been significant over the past decade, but the knowledge generated is not always easy to apply in practical situations. Ten elements essential to the delivery of large-scale change are identified from practical experience of delivering change in a range of public sector contexts. It is suggested that these constitute pragmatic organising principles that naturally enable organisations to address the complex challenges of large-scale change identified in the research literature.
A combined haematology and surgery clinic
Authors: Lewis Christopher J , Carson Iona , Wilson Jonathan , Patel Ketan , Kelley Christopher , Babu Ed
Published: May 2014

A recent Government White Paper recommends that patients exhibiting lymphadenopathy should be assessed in rapid access diagnostic clinics, combining the skills of a multidisciplinary team. In this article, the authors highlight the benefits of a newly implemented lymph node clinic comprising the combined expertise of a haematologist and general surgeon.
When accepting a gift can be theft
Authors: Griffith Richard
Published: May 2014

At this time of year, gifts are often given as tokens of gratitude by grateful patients, past and present, to the healthcare staff who provide their care and treatment. Accepting a gift appears to be an entirely innocent way of acknowledging a patient's gratitude, and certainly boosts the morale of the staff concerned. However, there are circumstances in which the courts have held that accepting gifts, large or small, from vulnerable people is dishonest and amounts to theft. It is essential, therefore, that healthcare managers are aware of these circumstances and have a policy in place that clearly spells out the appropriateness of accepting a gift from patients. This article examines the cases in health and social care that illustrate when accepting a gift can amount to theft.
The need for fairer funding
Authors: Appleby John
Published: May 2014

For just over 30 years the NHS has used an ever-evolving formula to allocate the bulk of its budget in an unequal way across the country, with the intention of ensuring equal opportunity of access to health care for people at equal risk.
NHS values of data management
Authors: Grace Jamie
Published: May 2014

The NHS is thinking smart: NHS information technology systems are being improved on a widespread basis, and the almost unimaginable amount of personal data the NHS controls–and generates–on patients and families is being marshalled to provide NHS researchers and research affiliates with all-new levels of complexity in the raw data available to them.
Risk-based regulation in the new world order
Authors: Moyes Bill
Published: May 2014

The Better Regulation Executive defines good regulation as: transparent, accountable, proportionate, consistent and targeted. To these I would add: risk-based. Regulation exists to make sure that risks are understood, identified and managed (or mitigated). Not to take on that responsibility, but to ensure it happens.
The patient experience
Authors: Redding Don
Published: May 2014

Which patients, and which of their experiences, did Lord Darzi have in mind when he concluded, in the NHS Next Stage Review, that patient experience should become one of the three core elements of the new drive for ‘quality’?
Diabesity
Authors: Hill Rosalind
Published: May 2014

Last month it was reported that the number of people living with diabetes in Britain had increased by 63% over the past decade (Rose, 2009). This is largely a result of increasing waistlines, giving rise to more cases of type 2 diabetes (caused by lifestyle factors), not least in children.
Introducing Academic Health Science Centres
Authors: Davies Stephen M
Published: May 2014

The Government recently designated five University–NHS partnerships in England as Academic Health Sciences Centres (AHSCs), having stated its intention to foster this new form of organisation in the final report of the NHS Next Stage Review. What does the experience of the USA tell us about AHSCs, and to what extent is this relevant to policy implementation in England?
Steve Barnett
Authors: Barnett Steve
Published: May 2014

As a young human resources manager, I had to address 1000 school caretakers and cleaners to inform them that many were to lose their job as a result of compulsory competitive tendering in a local authority. This taught me, early in my career, the importance of seeing the ‘person’ behind the ‘decision’– particularly in such difficult circumstances, where it really is vital to treat people with a sense of compassion.
MOT your healthcare estate
Authors: Hensel Helen
Published: May 2014

The NHS Carbon Reduction Strategy for England has introduced a target for the NHS to reduce its 2007 carbon footprint by 10% by 2015, while healthcare organisations that meet the qualification criteria will be required to participate in the Carbon Reduction Commitment (Department of Energy and Climate Change, 2009). Key to cutting carbon consumption will be improving the sustainability performance of the NHS estate, by integrating policy directly into estates strategies so that these issues are considered at each stage of the property life cycle.
On the wane or waxing lyrical?
Authors: Johnson Helen
Published: May 2014

It is impossible to read any recent Department of Health (DH) publication without being reminded of the current policy emphasis on disease prevention and the promotion of wellbeing. The NHS Constitution makes it clear that the NHS exists ‘to improve our health and well-being, supporting us to keep mentally and physically well’ (DH, 2009a).
Getting through the maze
Authors: Duman Mark
Published: May 2014

I have to admit that until a couple of years ago, I had no interest in mental health. I would see features, articles and supplements in the range of publications that land on my (virtual) desk, and gleefully skip over them.
Mental health policy developments
Authors: Greatley Angela
Published: May 2014

This year marks the end of the first of the National Service Frameworks (NSF) for health and social care. The NSF in question was for mental health for adults of working age in England. Published in 1999, it set out a 10-year vision of what the NHS was expected to offer in terms of mental health care, using seven standards ranging from the promotion of good mental health and primary care to specialist services and support for carers.
Patient literacy in health care
Authors: Duman Mark
Published: May 2014

COPD–another acronym! In fact, about the only thing I know is that it stands for chronic obstructive pulmonary disease, that a COPD strategy has been promised this year (see: http://tinyurl.com/lokrgm ), and that a communications strategy, developed by SHM for the Central Office of Information, is soon due out for consultation.
Battle lines drawn
Authors: Hill Rosalind
Published: May 2014

At the time of writing, it is only four days in to the new year (and decade), and already thebattle lines have been drawn for the forthcoming general election, and with it, the NHS.
New year, new gifts for health care
Authors: Timmins Nick
Published: May 2014

December 2009 was the month in which everyone–well, almost everyone–celebrated the New Year with early Christmas presents. Needlessto say, however, not all Christmas presents, once they are opened, are wanted by the recipients.
Clinical coding: are trusts being short-changed?
Authors: Thavarajah Dushan , Francis Tracy , Rees Lynda , Davies Andrew P
Published: May 2014

Introduction: Clinical coding is important for financial payment, financial planning, provision of healthcare services, monitoring of health trends, audit, research and clinical governance. Coding among NHS trusts is performed by non-clinicans. The authors carried out an audit at Morriston Hospital, Swansea, to compare the difference between the way in which the coders and a surgeon coded for orthopaedic procedures. Morriston Hospital also receives tertiary referrals for more complex procedures that standard district general hospitals are unable to perform. Therefore, it also functions as a specialist trust. Methods: The authors undertook a retrospective analysisof 45 patient case notes of orthopaedic patients who had both trauma and elective orthopaedic surgery. These were first coded by the coder and then independently coded by the surgeon. Results: Clinical coders vs surgeons: Different code and different healthcare resource group (HRG) = 18%. Same code and same HRG = 33%. Different code and same HRG = 49%. Lost renumeration as a result = £4663 (over 1 month). Conclusions: Coding is often subject to inaccuracies due, in part, to the clinical coders (non-medical staff) and this could be improved. The coding system is flawed and generates inaccurate HRGs. Financial loss or gain can be a result of these flaws and inaccuracies. This is unacceptable for such a large organisation like the NHS, and is detrimental to individual trusts - both financially and for the provisionof health care.
Future perfect?
Authors: Appleby John
Published: May 2014

The UK NHS now consumes close on 10% of gross domestic product (GDP). If it were a country, in terms of GDP it would rank 46th (in 2008) out of 191-greater than New Zealand, Luxembourg and Pakistan. Since 1948, health care spending has more than trebled as a proportion of GDP and consumes close on a fifth of all departmental spending-equivalent of defence and education combined. And across the UK, one person in every 18 is now employed by the NHS. How did this happen and what are the prospects for spending over the next 60 years?
Is routine rotavirus vaccination necessary?
Authors: English Peter MB
Published: May 2014

Health administrations around the world are trying to decide whether they should add rotavirus vaccine to their countries' routine vaccination schedules. Two vaccines are available in the UK: Rotarix, from Glaxo SmithKline; and RotaTeq, from Sanofi Pasteur MSD. As with all decisions of this sort, the questions they need to answer will be: Can we afford it? Is the disease it could prevent serious? Does it work? How well does it work? Is it safe? Is it cost-effective (or, better still, cost-saving)?
Patient information delivery: a clinical protocol (1)
Authors: Brocklesby Sarah
Published: May 2014

Patient information is an established part of clinical practice, with clear guidelines regarding the production of written patient information. However, no clear clinical protocols could be found regarding how to deliver information to patients most effectively. NHS South Gloucestershire wished to ensure cost effectiveness by maximising patient outcomes from information-giving within the constraints of limited clinical time. This article describes the research behind the construction of a multidisciplinary clinical protocol for the delivery of health information to patients. This was done using a mixed method evaluation-a self-administered questionnaire was constructed following a process of literature review, consultation between multidisciplinary colleagues, and piloting. It used convenience samples of primary care trust service users. Quantitative analysis and descriptive statistics were used, as well as qualitative analysis. A total of 323 questionnaires were collected from ten health professional disciplines. Components of information-delivery were identified in four sections: environment; practitioner characteristics; how to give information; completion of process. Logistic regression showed written information increased perceptions of ‘usefulness’ of the information (P=0.001). Nearly all respondents indicated they were ‘very likely to act’ on the information (99.66%, where applicable). As a result, a multidisciplinary evidenced-based protocol was constructed using items that were indicated by agreement between the literature, patients' views and quantitative analysis. This article is the first of two articles that introduces the background to the study including literature review, methodology and results.
Managing grievances in the workplace
Authors: Griffith Richard
Published: May 2014

Managing disputes at work is a key role of managers, who must ensure that they are resolved quickly and fairly to avoid long-term strain on the relationship between manager and staff. The law governing workplace grievances and the claims arising from these changed in April 2009. The new framework focuses on resolving grievances by managers and staff working together and abiding by a revised statutory Code of Practice from the Advisory, Conciliation and Arbitration Service. It is therefore essential that healthcare managers are aware of the revised law, the Code and the rights of staff in the event of a grievance at work.
Forecasting emergency depatment attendances
Authors: Jones Rod
Published: May 2014

Given the central role which demand plays in the cost of health care, Money Matters has recently been exploring the issues around forecasting demand (Jones, 2010e-f). Having been involved in health care planning for over 18 years, I have serious reservations about the central assumption in NHS planning that demographic change or the ageing population is driving demand (Jones, 2010k). In this respect, increases in accident and emergency (A&E) attendances, which are far above that suggested by demography, are a common international feature (Santos-Eggimann, 2002; Zaragoza Fernandez et al, 2009; Chu et al, 2009).
360 appraisal of the practising NHS clinician
Authors: Maharajan Pushpakala Ajaya , B-Lynch Christopher
Published: May 2014

This study aimed to appraise the performance of a consultant as he worked in various sectors-NHS, private, and among the general practioners (GPs) in the district. By looking at the range of his work, the study aimed to replicate a 360° appraisal. The study involved a retrospective observational study, and was based at Milton Keynes General Hospital. Participants were those patients treated in the NHS sector, private sector and by GPs in the entire district. A formalisedquestionnaire was sent to patients anonymously. Data from responses were collected and analysed. The impact of other services on the performance of the consultant who worked in various sectors and their contribution to his general appraisal were measured. It was found that all the GPs (100%) in the district referred patients to him, and all of them were satisfied with his clinical judgement, diagnostic and surgical skills. Seventy-nine percent of the GPs rated his surgical skills between 80% and 100%. Analysing the responses from patients in the private sector revealed that all of them were happy with his surgical skills and expertise, with 96.6% feeling that he isa good communicator and 100% feeling that he was trustworthy. Analysing the responses from the NHS sector revealed that 91.8% of patients felt they were happy with his surgical expertise and 83.7% felt he was a good communicator. Ninety-one percent of patients felt he was trust worthy and 78.3% felt he was good at follow up appointments. It is concluded that although the consultant's contribution in the various sectors are varied, the responses received as part of the 360° assessment showed that other factors (like on call services, secretarial services etc) did not impact much on this overall. This study reveals the information that can be gained from a 360° appraisal, and provides a structure for others wishing to replicate such an appraisal at consultant level.
Are we just playing with DOLS?
Authors: Troke Ben , Ward Neil
Published: May 2014

This article will summarise the development of the Deprivation of Liberty Safeguards (DOLS), review relevant case law, and identify technical and practical problems and solutions. It is an issue which should concern all providers of health and social care, whether public or private bodies. DOLs will be a key focal point in the delicate balancing act which must be undertaken intrying to protect the many vulnerable members of society on the one hand with infringement of their civil liberties on the other.
Gender ratio and hospital admissions
Authors: Jones Rod
Published: May 2014

A series of articles in BJHCM has suggested that the patterns in medical andmental health admissions and A&E attendances can be best understood in the context of repeating outbreaks of a new kind of infectious disease (Jones, 2009a, b; 2010a-j). It has also been suggested that an increase in the proportion of female admissions is a characteristic signature associated with theseoutbreaks (Jones, 2010a, d, e).
The productive use of carbon
Authors: Appleby John
Published: May 2014

Amid the gloom of the impending freeze in NHS funding, there is a glimmer of light. As spending increases grind to a halt one likely outcome is that the 21 billion tonne carbon footprint the NHS makes each year could stabilise, or even decrease.
Appreciative inquiry: more than just a fad?
Authors: Jones Robert SP
Published: May 2014

Articles attesting to the positive effects of using a performance management technique known as appreciative inquiry are increasingly appearing in management literature. More detailed analysis reveals that little, if any, unambiguous evidence exists to support the claims of the proponents of appreciative inquiry and that the movement has many of the characteristics of a management fad. Despite this, the amount of anecdotal data on the benefits of appreciative inquiry suggest that future empirical investigation is warranted. Without such data gathering, appreciative inquiry risks becoming another management fad that promises much, but ultimately fails to deliver.
Towards a community engagement strategy
Authors: Sheridan Kevin , Tobi Patrick
Published: May 2014

Legislative and policy drivers have propelled community engagement to the top echelon of priorities for public bodies. They must now not only embed community engagement into their decision-making cycles, but also be able to demonstrate that engagement has had an influence. This means that whereas in the past engagement activity was unstructured and tended to occur typically onlyin the final phases of service commissioning and delivery planning, public bodies will now need to be systematic in ensuring that patients and the public are involved at every stage of the process. This article outlines a framework that will help public bodies to approach engagement morestrategically. It draws on the authors' experiences of cross-sectoral community engagement work to unpack the issues, methods and resources needed at every stage of the process.
Easing the journey through prostate cancer
Authors: Payne Heather , Sobanja Michael , Troup Janis
Published: May 2014

This article reviews the project, Prostate Cancer-Improving Patient Journeys, led by the British Uro-oncology Group (BUG) in partnership with the NHS Alliance. In an environment where service design and redesign are of vital importance in improving patient care and meeting NHS targets, models of prostate cancer service delivery vary significantly across the UK. Inthe setting ofthree regional meetings, different models of service and key challenges in prostate cancer management were reviewed and debated. A total of 120 professionals (spanning specialis, primary and intermediate care and commissioning roles) participated in the initiative. The outcomes highlighted that prostate cancer services need to be individually tailored to local health populations according to burden of the disease and resources around specialist healthcare expertise in a specific locality. Demonstrable improvements in service delivery can be achieved throughincreased understanding among specialist health professionals of the commissioning process, and equally increased understanding about prostate cancer clinical issues among commissioning and primary careprofessionals.
Doing More With Less: managing costs
Authors: Brown D J
Published: May 2014

For anyone who has a genuine interest in improving patient care-and for anyone who has read Robert Francis' report on the long-term failings at Mid Staffs-comments like this, which I heard yesterday from a friend, should send shivers down the spine. The long-anticipated ‘funding gap’ in the NHS has arrived-whether through the slow strangulation of the private finance initiative PFI or simple budgetary tightening. Spending plans are making no sense to thepeople treating patients. And the good people are leaving.
Patient portals and health records in diabetes care
Authors: Paylor Michael
Published: May 2014

Greater patient empowerment is often described as an essential component to improving care for patients with diabetes. One way of supporting patient empowerment is through the use of web-based tools such as patient portals and personal health records, and this article describes the current and potential use of such tools for diabetes care.
Industrial tourism in health care
Authors: Moghal Nadeem , Imison Candace
Published: May 2014

The NHS is facing a significant financial challenge. If the financial crisis is to drive morethan a ‘slash and burn’ of current services, the NHS needs to go on an improvementjourney. This article shares the experience of an industry tour which highlighted the ingredients of successful healthcare improvement, and provided a vision of where health care could be going in the future. The experience confirmed some core foundations for successful change in health care, including the successful application of an evidence-based change methodology alongside a clear vision. It also suggested the need for sustained leadership and organisational effort over time periods of up to 10 years. This presents a significant challenge to the NHS where improvement is required over a much shorter time frame.
Minimum standards for equipment services
Authors: Donnelly Brian
Published: May 2014

There are approximately 10 million pieces of community equipment delivered to 3.5 million clients every year in England and Wales. The service is vital for moving people safely around the whole of the health and social care system, and is used by almost every clinical professional working in the community. It is an absolute essential part of the early intervention and preventionagenda. Unfortunately, the service currently has no standards in place, nor is it regulated or inspected in its own right by any of the regulators. Recently enacted legislation impacts significantly on this service area, which has serious penalties for failure. There are some very concerning aspects of service delivery, particularly with regard to quality and patient safety issue. Widespread failings in service delivery are resulting in a significant number of unnecessary fatalities and incidents, and avoidable costs being incurred. Undue care in this area is resulting in health and social care organisations not fully realising their strategic and policy objective. Unless community equipment is addressed appropriately, these issues are likely to be intensified, especially with recent and proposed changes for community equipment services (e.g. ‘choice and control'). It is proposed that National Minimum Standards will reduce risks, improve quality and safety, while saving public funds through a reduction in secondary episodes of care.
Do NHS cost pressures follow long-term patterns?
Authors: Jones Rod
Published: May 2014

The pressure to achieve targets and balance budgets leaves most within the NHS with little time to explore fundamental issues, such as the very long-term patterns behind demand and cost. For example, during 2009 most primary care trusts (PCTs) experienced huge and totally unexpected pressure on budgets. Did this really come from nowhere or could it be that our hidden/unarticulated assumptions with regard to the basis for movement in costs is flawed?
Substance and passion
Authors: Hill Rosalind
Published: May 2014

Writing about the outcome of a general election before it has even took place is a particularly challenging task to undertake, and I'm not going to try; but rather reflect on what each of the three main parties has to offer. At the time of writing, it is exactly one week beforethe polls open. And by the time this issue of BJHCM reaches your doormat, the decision will havebeen made: Conservatives, Labour, Liberal Democrats, or the hung parliament that everyone is nowexpecting?
A global perspective on healthcare innovation
Authors: Harmond Kate
Published: May 2014

This exploration of innovations in medical practice and healthcare delivery was a collaborative programme between the Oxford Centre for Entrepreneurship and Innovation at the Said Business School, the George Institute for International Health, and the Oxford Biomedical Research Centr.
Challenges for the next parliament
Authors: Timmins Nick
Published: May 2014

April 2010 was the month in which, at the time of writing and with a week to go until pollingday, the NHS had barely featured in the election campaign. Save that is, for the politicians making ever greater promises to protect the NHS, and the party leaders taking it in turns to pour syrup and saccharine all over the nurses at the Royal College of Nursing's annual bash in Bournemouth.
Fares fair
Authors: Housden Philip
Published: May 2014

The new coalition government has set out its plans to cut the huge UK structural deficit. The ‘emergency budget’ promises to make Britain a debt-free country in five years. this will be achieved with 23% of the deficit cleared with additional taxation, while 77% come from reduced public expenditure.
The Budget: going for broke
Authors: Appleby John
Published: May 2014

Liam Byrne's attempt at a jokey letter to his successor at the Treasury—‘I’m afraid to tell you there's no money left!'—now looks, post-emergency Budget, something of an understatement (not to say in somewhat poor taste). Of course, not only has the money gone, but so too has the new Chief Secretary, David Laws.
UK cancer funding: challenges for commissioning
Authors: Bojakowski Steve
Published: May 2014

Recessionary pressures, ageing populations and the availability of new technologies are increasing cost pressures on the NHS. To achieve world class cancer care, funding of cancer services needs to increase in the UK. Appropriate funding is an essential component of high quality cancer services, yet significant variations in spending on cancer persist within England. These cannot alone be explained by variations in need-or indeed outcome. A critical task for commissioners is therefore to assess their level of expenditure on cancer services, and identify areas where it may be inappropriately high or low and take action to address this.
Forecasting year-end activity
Authors: Jones Rod
Published: May 2014

We are at mid-year and someone from finance says we are over budget. Time to talk about the profile of activity across a year and methods for forecasting year-end. Do we use simple twelfthsor track relative to last years' activity. Neither of these approaches are the preferredoption.
The challenges of change
Authors: Timmins Nick
Published: May 2014

By the time you read this, you may or may not have read the NHS white paper. Even if you have, while many things will be clearer, a fair number will not.
Question time
Authors: Mongin-Bulewski Carole
Published: May 2014

The new Tory-Lib Dem coalition Government has now announced its plans for the NHS in the white paper: Equity and Excellence: Liberating the NHS. The main change in the organization of the NHS is that in the next few years, the responsibility for 80% (some £80 billion) of the budget-currently held by local managers working for PCTs-will be transferred to GP consortia. Since theannouncement, many questions have been on everybody's mind-health professionals and members of the general public alike.
Call screening by hospital switchboard operators
Authors: Ardolino Antonella , Chedgy Edmund , Hollingworth Tom , Savva Nicholas
Published: May 2014

This study aimed to determine whether screening of telephone calls occurs in hospitals acrossEngland. Eighteen hospitals were selected at random. The caller requested connection to a namedconsultant and to the on-call medical Senior House Officer (SHO). The results of this study highlight a variation in policies between hospitals. All calls were connected to the on-call SHO, with 39% of switchboard operators asking the caller to identify themselves. In the case of calls toconsultants, 67% of callers were asked for identification; 28% of callers were connected to the consultant's mobile telephone-12% of which had not been asked for identification. This study demonstrates the need for local trusts to protect their staff, either by implementing training sessions on how to manage inappropriate calls or by participating in the development of national guidelines to aid switchboard operators to screen calls effectively.
Forecasting demand
Authors: Jones Rod
Published: May 2014

Recent comments that commissioning in the NHS only rates about 3 out of 10 should lead to a consideration of why it is so hard to effectively commission, rather than why are ‘they’ so rubbish? A large part of the unacknowledged difficulty in commissioning lies in the inability to forecast demand accurately and, as a consequence, to fix budgets.
Could England end up going Dutch?
Authors: Timmins Nick
Published: May 2014

The NHS is reeling from the scale of Andrew Lansley's ambition and the speed with which he intends to deliver it. Staff in primary care trusts-whether they are on the provider side, the public health side or, most painfully, on the commissioning side-wonder where they will end up.
Storms on the horizon?
Authors: Bosanquet Nick
Published: May 2014

The White Paper has had a cordial reception-but storms to come could block the road to implementation. The Nicholson letter strikes a note of realism about the transition with its message of tough financial control. It is also a whistle to action. ‘In this change we must be on the pitch not in the commentary box(. But in the old and wise maxim, time spent on reconnaissance is rarely wasted.
Recruit with caution, manage with care
Authors: Vaithianathan Rhema , Hockey Peter , Lewis Geraint , Lees Peter
Published: May 2014

Managers in many healthcare systems are being compelled to increase productivity as a way of dealing with budgetary cutbacks and ageing populations. One approach to improving productivity may be to recognise more explicitly the high value of health professionals, and especially very expensive doctors. Considering doctors as assets allows the quantification of the health benefits that they generate for organisations and patients. Greater recognition of the magnitude of these benefits might encourage employers into recruiting, managing and maintaining doctors more carefully. Ultimately, this change of mindset might persuade healthcare managers to subject decisions regarding human capital to a similar degree of scrutiny as they currently apply to the purchase and maintenance of capital equipment. To increase productivity, the maxim for hospital managers should be to recruit doctors with caution and to manage them with care.
Care closer to home: aspirations and delivery
Authors: Nazarko Linda
Published: May 2014

Although successive governments have aspired to provide care closer to home there's still a gap between aspiration and delivery. In their report the Audit Commission produced a report that stated ‘PCTs made little or no in-road in 2008/09 to transferring care from hospitals into the community.’ ( Audit Commission, 2009 ).

This article analyses the reasons why intermediate care services are not being fully utilised and sets out the case for increased investment in intermediate care services.
Understanding risk within GP commissioning
Authors: Jones Tim , Lee Andy
Published: May 2014

Healthcare provision is a high risk business and appropriate risk-management strategies should be considered to ensure the commissioning of a ‘service’ operates within a consistent and stable financial environment to ensure the best outcomes. It is well known, and documented, that there is a high degree of risk involved with natural fluctuations in terms of the healthcare needs of a population (insurance risk), and also an additional component of controllable activity associated with things such as poor prescribing, inappropriate referrals, lack of implementation of best practice or poor signposting of patient pathways (service risk). In addition to this, cyclical patterns of medical emergency admissions have been noted in the UK during the past 20 years. Understanding these risks and variations, and minimising their effects, will support the commissioning and delivery of effective services and healthcare interventions. This paper discusses the implications of risk within the changing UK healthcare environment, and investigates an example of the insurance risk and service risk found within a health system which displays annual cyclical activity.
Discussing expensive anti-cancer drugs
Authors: Fallowfield Lesley , Jenkins Valerie , Langridge Carolyn , Solis-Trapala Ivonne , Jones Alison , Barrett Jane
Published: May 2014

Funding expensive new cancer therapies is increasingly problematic for healthcare systems worldwide. In this study wthe authors report UK clinicians' views and experiences when discussing expensive anti-cancer drugs with patients. A study-specific survey was emailed to members of relevant professional oncology organisations between April and August 2010: 368 clinicians responded. During the previous 12 months, 71% had made exceptional/individual funding requests; few were successful. Only 9% of clinicians discussed expensive drugs with all patients, 75% with ‘some’ and 16% with ‘none’. Among those who told ‘some’, 81% (224/276) did so only if convinced of clinical benefit, 72% only if patients initiated the subject, and 55%, if relatives did. Clinicians treating both privately funded and NHS patients (43%) were three times more likely to discuss expensive treatments (p<0.001) than those working only within the NHS. Clinicians' reporting of patients' and relatives' reactions to such discussions was ‘understanding’ (63%, 45%), ‘distress’ (40%, 41%) and ‘indignation’ (24%, 38%). A majority of clinicians (98%) had received no guidance on conducting such discussions and 76% wanted training. This survey clearly demonstrated that few clinicians discuss expensive anti-cancer treatments with their patients and welcome access to a training programme to assist them.
Promoting wellbeing in young people
Authors: Mistral Willm
Published: May 2014

It is crucial important to focus on improving the mental health of young people. A survey of children in the UK, for the Office for National Statistics, found a rate of 10% with mental disorders, and these increase the risk of lifetime problems. The social environment impacts upon risks for psychological difficulties, and working with schools and families is necessary not only to relieve current suffering but to reduce the likelihood of future problems and ever-increasing workloads for health services.
An evaluation of two health insurance schemes in India
Authors: Reshmi Bhageerathy , Sanah Noore , Nair N Sreekumaran , Unnikrishnan B
Published: May 2014

The study aimed to find out the functioning of two community-based health insurance schemes through patients enrolled in them, at a tertiary care hospital in Karnataka, South India. Methodology: It was a cross sectional study, total of 384 patients was randomly selected from the whole lot of patients who were enrolled in the two selected community-based health insurance schemes. The study was carried out using a pretested semi structured questionnaire. About. 98% of the respondents said that they availed services 1–3 times from the scheme in 1 year; 89% of the respondents said that discount provided by the scheme was useful. Satisfaction levels of the card users were analyzed and out of 384 patients, 54.9% patients said that their scheme was good and 51.8 felt that admission and claim process was good. About 49.2% said that quality of treatment was good. It can be concluded that many users are satisfied with the health insurance they have opted and utilisation rate of the card is high.
The National End of Life
Authors: Henry Claire , Hayes Anita
Published: May 2014

In 2008 the Department of Health published a national end of life care strategy for England, the first of its kind in the world ( Department of Health, 2008 ). The strategy acknowledged that despite examples of excellent care, many people do not die in their preferred setting or after being involved in planning their care. Despite surveys consistently indicating that most would prefer to die at home or in a community setting such as a hospice ( Cicely Saunders International, 2011 ), in 2005, 58% of deaths took place in hospital. The strategy also acknowledged that many people experience unnecessary pain and other symptoms and referred to ‘distressing reports of people not being treated with dignity and respect’. The low priority accorded end of life care (EoLC) by both the NHS and social care, partly due to a societal reluctance to discuss death and dying, has led to wide variations in standards. The absence of a co-ordinated, person-centred approach to EoLC also imposes avoidable costs on the NHS. This article examines the National End of Life Care Programme's key role in promoting and supporting the changes that can deliver the improvements in care and productivity outlined in the strategy. We have approached this by working with partners to achieve whole system transformational change. Both our approach and the resources we have developed complement the recently-published NHS Change Model.
Reducing unplanned care: a new paradigm
Authors: Rowe Simon
Published: May 2014

Each local healthcare economy faces a challenge. The rising numbers of accident and emergency (A&E) attendances and emergency hospital admissions (unplanned care) are neither affordable, nor desirable. The current financial climate has only increased this challenge. Local healthcare economies now not only need to reduce the total number of each from one financial year to the next, but to do this in an absence of ideas and approaches that work. Data analysis from NHS Wakefield District has been used to inform a new paradigm on how the total levels of unplanned care are viewed and understood. The analysis shows that local healthcare economies should embrace at least two main findings, if they are to reduce the totals. The first is to work from the basis that the totals for unplanned care in any financial year are driven by the number who experience them, rather than by the number who have more than one unplanned event in a year. The second specifically concerns emergency admissions. Individuals who experience an admission in a financial year are unlikely to have experienced one in those before it.
More time for patients: digital pens for clinicians
Authors: Cooper Stuart
Published: May 2014

In a move to improve the timeliness and accuracy of recording patient data, Wolverhampton City primary care trust (PCT) explored a range of mobile technologies within its community services departments. The goal was to eliminate the need to re-enter handwritten patient notes into its i.Patient Manager (iPM) patient record system—a process which tied up both clinical time and increased the risk of mistakes, as information had to be recorded twice.
Forecasting unplanned care activity
Authors: Rowe Simon
Published: May 2014

The need to forecast unplanned care activity is entwined with local healthcare economies need to reduce it. An analysis of the available data shows that it directly limits the type of approach that can be used to forecast this type of demand. It is proposed that local healthcare economies start with an approach that works by profiling individual-level data. The use of a pure numerical approach is considered to complement the other two, if there is the willingness among local healthcare economies to use it. Three laws for unplanned care demonstrate the need to question whether any of the approaches funded by local healthcare economies will reduce the levels of unplanned care, and contribute to financial savings.
Management information systems and the NHS
Authors: Kausar Rushdi Yusuf Ali , Kamal Asma
Published: May 2014

Management information systems refer to methods used to manage information collected during an organisation's daily activities and can be used to determine business strategies and support the decision-making process. Plans for modernisation and improvement of service delivery rely on improvements in quality, efficiency and capacity, which, in turn, require strong systems for information storage and handling. The NHS provides a comprehensive range of services including information services to patients to promote good health, prevent disease and reduce health inequalities. It has a strong system for clinical governance and aims to improve the quality of its services. It has become evident that healthcare services has seen a shift from the dominance of clinical professionals to the position where institutions are managed based on market values. The NHS will have to prioritise investment in the training of staff to develop analytical skills of current economical and market forces. Interoperable IT systems with strong security and features facilitating communication will help to improve accessibility to information and decision-making. Regular audit of costs and outcomes will also allow the NHS to set priorities for further development.
Lewisham Hospital and Francis: the big test
Authors: Timmins Nick
Published: May 2014

Nick Timmins, senior fellow at the Institute for Government and the King's Fund argues that Jeremy Hunt has faced his first ‘big test’ with Lewisham hospital