bluuebunny/crossref_metadata_2025 huggingface dataset:
Health impact of smoking and smoking cessation strategies: current evidence
Authors: Duaso Maria J , Duncan Debbie
Published: May 2014

Smoking continues to be the main preventable cause of death in the UK. Tobacco consumption causes a wide range of diseases and other adverse effects, including multiple types of cancer, chronic obstructive pulmonary disease, cardiovascular disease, pregnancy complications, cataracts and osteoporosis. The Government's vision to ‘make every contact count’ emphasises community nurses' responsibility and key potential to promote healthier living and behaviour. This article reviews the latest evidence on supporting smokers in practice and argues that nurses working in the community are ideally placed to record smoking status, give advice, encouragement and support, refer people to local smoking cessation services and offer pharmacological treatment.
Faecal incontinence in the elderly: issues and interventions in the home
Authors: Gillibrand Warren
Published: May 2014

This paper discusses current evidence-based guidelines for the management of faecal incontinence in the elderly. The key aspects of maintaining dignity, quality of life and self-esteem are addressed within a presentation of good assessment, prevention, management and treatment principles. Particular focus is given to the added problems that faecal incontinence may bring to the elderly person suffering with this debilitating, and often embarrassing condition. The increased risk to skin integrity is discussed, with reference to available guidance to help nurses manage the risk of skin breakdown associated with persistent faecal incontinence.
Intermittent self-catheterisation: past, present and future
Authors: Nazarko Linda
Published: May 2014

In the past, the only way to drain a bladder was to use intermittent catheterisation. For four millennia, intermittent self-catheterisation (ISC) was used to treat bladder dysfunction. That changed in the 20th century when Foley redesigned and improved on 19th century designs for an indwelling urethral catheter. While some patients benefit from indwelling catheters, long- and short-term indwelling catheters can increase infection risks and contribute to bladder dysfunction. NICE guidance on infection control recommends that intermittent catheterisation should be used in preference to an indwelling catheter if it is a clinically appropriate and practical option for the patient. NICE also recommends that patients should be offered a choice of either single-use hydrophilic or gel reservoir catheters for intermittent self-catheterisation. Voiding problems increase the risks of infection, bladder and renal dysfunction, and can impair quality of life. Individuals who have reasonable bladder capacity and sufficient dexterity and motivation can regain bladder control using ISC, which can make a huge difference to their health and wellbeing.
Understanding residential home issues to meet health-care needs
Authors: Dudman Jenny , Meyer Julienne
Published: May 2014

The needs of individuals in residential care homes have risen over time. Residential care homes were originally set up to provide accommodation for those requiring limited support, but today residents often have high levels of both health and social care needs, which often go unmet. The suggestion often made is that more staff training and improved support are needed. This is an oversimplification, as a number of other factors have a significant impact on care provision. It is suggested that residents will continue to receive suboptimal care until the issues are acknowledged and tackled.
Understanding the inflammatory process in wound healing
Authors: Gethin Georgina
Published: May 2014

The basic elements of wound healing can be described using three sequential and overlapping phases: inflammation, proliferation and regeneration. These phases represent a highly organized, tightly regulated and complex sequence of events that are dependent on an exquisite balance between various cell types and mediators. Inflammation is a prerequisite to healing; however, chronic wounds in particular exhibit a prolonged inflammatory response, thus providing an ideal environment for bacterial infiltration and proliferation. Considering that approximately 70% of all wounds are chronic, with the majority of wound care being delivered in the community, this paper aims to support nurses in their understanding of inflammation in order to enhance clinical practice.
Preventing and managing heel pressure ulceration: an overview
Authors: Morton Nicky
Published: May 2014

Heel pressure ulcers are the second most common site for pressure ulceration; although their assessment and treatment can be complex, and they often require additional consideration over and above core principles of pressure ulcer prevention and management. Recent international pressure ulcer prevention and treatment guidelines developed jointly in Europe and the USA have provided greater clarity by achieving international consensus on how to care for patients at risk of heel pressure ulceration, and also on the management of such patients if a pressure ulcer develops. Health professionals should embrace these guidelines and embed them in their everyday clinical practice and within local guidance and protocols to ensure that patients are provided with evidence-based care supported by international collaboration and agreement.
Hepatitis B: raising awareness in the South Asian community in Preston
Authors: Landon Christine , Maru Alka
Published: May 2014

The Viral Hepatitis Nursing Team from Lancashire Care Foundation Trust implemented a project raising awareness on Hepatitis B (HBV), offering detailed risk assessments and diagnostic testing to the south Asian community in Preston using local mosques. Post questionnaires were given to the participants to evaluate the effectiveness of the intervention. Results: In total 156 participants, all offered HBV testing and HBV vaccinations. 2 HBV surface antigen positive (HBsAg) positives, 10 past infection (HBsAg negative, antiHBC positive), 11 contacts followed up for testing and vaccinations. In conclusion, the initiative endeavours to increase the awareness of HBV amongst the population profile in order to improve the health of the South Asian community in the wider population as a direct result.
Older people: how do they find out about their health? A pilot study
Authors: Hurst Gill , Wilson Patricia , Dickinson Angela
Published: May 2014

Information about health is gained from various sources but little is known about the health information-seeking behaviours of older people and what factors affect this. This pilot study aimed to explore older people's experiences and views on their health information-seeking behaviours and to gain a better understanding of these. A qualitative study with nine older people was undertaken, using diaries and semi-structured interviews to gather data. Three key themes emerged relating to why they sought information, what shaped this and where health information was accessed. This study is generating new knowledge of older people's experiences and views on their health information-seeking behaviour. By understanding these, community nurses will be better placed to promote strategies that improve older people's access to appropriate health information and support its effective use.
A ‘good death’ at home: community nurses helping to make it possible
Authors: Adamson Elizabeth , Cruickshank Susanne
Published: May 2014

The number of people dying at home rather than in a hospital is increasing, albeit slowly. This coincides with a growing emphasis across the UK to increase choice and enable individuals to both live and die well, and in the preferred setting of their choice. While most health professionals would support this approach, it is clear that providing end of life care in the community to all, irrespective of where they live, is complex. Communities face different challenges to hospital based care settings, one of these being geographical distances. This article discusses current end of life policies and how the community nurse is central to their implementation. It draws on some recent research which has identified the important steps that enable a community nurse to facilitate a good death and a particular research study which illustrated the unique role of the Community Nurse in providing end of life care in a rural setting, but also the challenges.
Maintaining professional boundaries: keep your distance
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Maintaining professional boundaries is essential to an effective nurse-patient relation whose sole focus must be on the care and treatment needs of the patient. Complaints about failures to maintain professional boundaries are increasing, with the Nursing and Midwifery Council reporting some 247 new cases in the year 2011-12.

This article outlines the scope of the nurse-patient relationship, what activity is considered to be outside the professional relationship and considers the consequences for community nurses if they are found to have breached a professional boundary.
Practitioner and patient experiences of giving and receiving healthy eating advice
Authors: McClinchy Jane , Dickinson Angela , Barron Duncan , Thomas Hilary
Published: May 2014

This article explores the content of discussion by patients and practitioners where they were invited to talk about food and diet. A qualitative methodology using focus groups was employed within one Primary Care Trust in the east of England. Patients described their desire for access to nutritional guidance in primary care and their feelings of powerlessness when following dietary advice. Primary care practitioners discussed their experiences of giving information alongside their scepticism about patients' adherence to dietary advice. Without prompting from the interviewer, patients and practitioners independently chose weight management to illustrate their experiences. Frustrations were expressed by patients and practitioners groups who felt unmotivated to seek or give information respectively on weight management.
Implementing the ‘verification of expected death’ policy in clinical practice
Authors: Byron Shirley , Hoskins Robert
Published: May 2014

This article discusses research carried out with district nurses on their experiences of implementing the verification of expected death (VOED) policy in clinical practice in Scotland. Individual interviews were carried out with a purposeful sample of community nurses to seek their views on the VOED policy. Interviewees reported that implementing VOED documentation was not difficult if the community nurse knew the patient and family well. This made end-of-life discussions easier because of the therapeutic relationship that was already established. Although nurses were sometimes anxious about discussing death, their professional responsibility to the patient and relatives at this time took precedence over any personal feelings. The nurses highlighted that good communication skills were critical when initiating discussions around VOED.
Assessing parenteral diuretic treatment of decompensated heart failure in the community
Authors: Austin Jackie , Hockey Denise , Williams W Robert , Hutchison Stephen
Published: May 2014

Referrals of 46 patients with decompensated end-stage heart failure were reviewed by a community heart-failure specialist nurse as part of a pilot study to determine patient numbers suitable for parenteral diuretic treatment at home, and the appropriateness of the Mini Nutritional Assessment (MNA), Edmonton Symptom Assessment System (ESAS) and Carer's Stress Scales. Triage of patients resulted in the following care pathways: 14 (30%) received intravenous therapy, 11 (24%) received subcutaneous therapy, 9 (20%) required adjustment of medication, 8 (17%) could not be treated because of limited staffing resource, 4 (9%) met study exemption criteria. There were no adverse events following furosemide infusion. The majority of intravenous and subcutaneous treatments took 1–7 days (total 187 days). Parenteral diuretic therapy prevented admissions and reduced the severity heart failure symptoms in particular oedema. Patients and carers appreciated the service, which had a positive effect on carers' stress. Of the nursing tools, the ESAS and the Carer's Stress Scales proved useful in the management of patients.
Community nurses' participation in palliative care research: The Dignity Care Pathway
Authors: Andrew Jane , Johnston Bridget , Papadopoulou Constantina
Published: May 2014

Evidence-based practice is a cornerstone of modern health care. Ongoing challenges have been identified in the strength of the evidence base in community palliative care nursing ( Walshe and Luker, 2010 ). This paper discusses the participation of community nurses in a palliative care research project. The Dignity Care Pathway (DCP) is an evidence-based framework developed using a collaborative research approach with community nurses in Scotland. Collaborative research has been advocated as one way to facilitate integrated knowledge transfer and to address the research–practice gap. The aim of this paper is to discuss the participation of community nurses in a collaborative research project to implement a palliative care intervention in practice. The discussion will draw on findings from the third phase of the DCP multiphase research project.
Mobile technology: streamlining practice and improving care
Authors: Blake Holly
Published: May 2014

The use of mobile phones in care delivery has the potential to improve the way in which care is delivered. When implemented effectively, mobile technologies can empower patients and enhance communication between patients and their health-care providers. When barriers are recognised and addressed, mobile technologies can change working lives, facilitating rapid access to information and supporting efficiency in practice.
Catheter-related infections in patients on home parenteral nutrition
Authors: Magambo Winnie
Published: May 2014

Long-term parenteral nutrition in the community is a practice that is growing steadily in the UK. Catheter-related bloodstream infections (CRBSI) in these patients is one of the major causes of morbidity and re-hospitalisation. The prevention of CRBSI impacts the quality of life and outcomes of these patients.
Improving nutrition and care for people with dementia
Authors: Williams Kathryn , Weatherhead Ian
Published: May 2014

As the number of people diagnosed with dementia rises, care services are facing a significant increase in people accessing services, be it community, hospital or long-term residential care.

Maintaining wellbeing is an essential aspect of quality of life, and appropriate nutrition and hydration are essential to wellbeing.

Care staff require knowledge and understanding of dementia, the impact dementia has on the individual and the challenges and issues it presents for formal and informal carers.

The National Dementia Strategy and the Prime Minister's Challenge have placed emphasis on improved quality of care and education on dementia for care professionals.

Nutrition is a constant need to be met, especially as the illness progresses and the person may require considerable support to meet this need. Physiological changes through the journey of the illness present many challenges and considerations, especially towards end of life.

This article aims to raise awareness of dementia, diagnosis and issues faced on meeting the nutritional needs of people with dementia
Acute stroke, dysphagia and nutritional support
Authors: Hutchinson Emma , Wilson Neil
Published: May 2014

Annually, an estimated 152 000 people in the UK have a stroke, accounting for 11% of all deaths in England and Wales, but for those that survive, nutrition is key to the body's recovery. Consequences of malnutrition can include increased susceptibility to infection, delayed healing, impaired cardiovascular function, decreased muscle strength and depression.

Given the complex nature of post-stroke dysphagia, it may not be possible that simple screening tools sufficiently identify those at risk of aspiration. If a patient is deemed unsafe or unable to meet their nutrition and hydration needs orally, guidelines recommend they should be considered for nasogastric feeding within 24 hours and a referral for dietetic/nutrition team input should be made accordingly.

Speech and language therapists can predict early in a patient's journey whether or not prolonged dysphagia is likely. In turn, the need for long term artificial feeding can then also be anticipated.
Protecting children from smoking in the home: an ethics of care perspective
Authors: Rowa-Dewar Neneh , Ritchie Deborah
Published: May 2014

Community nurses are uniquely placed to help protect child health by facilitating the creation of smoke-free homes. However, there are a number of perceived barriers that may concern community nurses in their role of supporting parents in the creation of smoke-free homes, particularly those faced by disadvantaged parents. Arguments against intervening within the private domain of the home focus on concerns about protecting parents' autonomy to smoke within their own home and the potential for stigmatising parents who smoke, particularly mothers. Drawing on an ethics of care perspective, the authors propose an alternative perspective to the intervention in private settings. An ethics of care perspective may help to justify and encourage parents and community nurses to work in partnership to create a healthy environment for children and decrease the likelihood of children becoming smokers in the future.
Understanding dementia: developing person-centred communication
Authors: Hobson Pat
Published: May 2014

Dementia is a disorder that affects the person's ability to communicate with you and the world around them. As a healthcare assistant one of your unique roles is to maintain the quality of life for the person and enable the individual to maximize their potential. To enable you to meet the needs of the person with dementia, you must understand how the disorder affects the person's communication abilities. This article will focus on how we can adapt our ways in an attempt to communicate with the person through developing person-centred communication skills.
What is multiple sclerosis?
Authors: Swann Julie
Published: May 2014

This article is the first in a series on multiple sclerosis. It describes how this neurological disease affects a person's level of abilities.

Multiple sclerosis (MS) is a progressive neurological disease. MS is generally diagnosed between the ages of 20 and 50years but can appear later and, in rare cases, children can be affected. The Multiple Sclerosis Society (2007) states ‘MS is the most common disabling neurological condition affecting young adults’. Around 85000 people in the UK have MS.
The interview
Authors: Peate Ian
Published: May 2014

While the interview is an important aspect of the application process it is not the only one. Preparing for an interview and undertaking some research about your prospective employer can help you when you arrive for interview. Preparation has been a central theme in this series and this is just as important when it comes to the interview.
Meeting the personal hygiene needs of a hospitalized child
Authors: Roberts Sheila
Published: May 2014

Children who are clean and well cared for will benefit from a healthier lifestyle and also have a greater self-esteem. Children in hospital need their personal hygiene needs cared for in the same way as they would at home. Healthcare assistants are often in the position to ensure these vital needs are met in a safe environment. This article discusses some of the issues surrounding personal hygiene in the hospital setting.
Healthcare assistants: improving end-of-life care
Authors: Edge Paula , Paule Anna , Smith Debbie
Published: May 2014

This article describes the conception, development and importance of healthcare assistant (HCA) role in providing end-of-life care to residents in a care home environment. Joining the Gold Standard Framework (GSF) has provided an opportunity for Risedale Estate Limited to realize the training style needed to uplift the role of the HCA. Having an HCA at the beginning of the GSF project made the company aware that training as a team regardless of designation, grade and discipline improved the provision of care. Team-based training made a difference in the HCAs’ confidence, communication and quality of support to the nursing staff. HCAs expressed their thoughts and feelings as part of a team in providing the end-of-life care. End-of-life care is now viewed by the HCA as a positive experience and an opportunity to be a part of their residents’ life.
Raising concerns of abuse
Authors: Grainger Angela
Published: May 2014

Statistical reports form the Department of Health and the Public Health Statistical Office indicate an increase in the reported incidence of the various forms of abuse. The media reports the tragic consequences of the worst forms. The view of professionals involved in abuse care is that abuse is still under-reported. HCAs and APs are in a unique position to notice potential or actual abuse, and this article outlines what to do in these situations.
Hearing impairment: environmental considerations
Authors: Swann Julie
Published: May 2014

The ability to hear can be substantially reduced if there are background noises or poor acoustics. If the environment is suitably designed from the outset, this can help to minimize hearing loss and enable people to communicate more effectively. This article aims to increase awareness in healthcare staff of environmental considerations and the impact of hearing problems within a workplace.
Mental Capacity Act 2005
Authors: Hughes Rhidian
Published: May 2014

The Mental Capacity Act (MCA) 2005 for England and Wales is a significant piece of legislation for health and social care. In Scotland arrangements are covered by the Adults with Incapacity (Scotland) Act 2000. Northern Ireland is governed by common law.
On your wavelength: Radiography assistant practitioner training in Scotland
Authors: Colthart Iain , McBride Margot , Murray Maria
Published: May 2014

NHS Scotland has recognized the need to develop the skills of its support workers within radiology and oncology departments. This article charts the experience of 31 trainees who successfully undertook a two-year programme to become radiography assistant practitioners. It gives an insight into the challenges and successes they encountered on their development journey, and discusses areas for improvement.
NHS modernization and the role of HCAs
Authors: Kessler Ian , Heron Paul
Published: May 2014

Over recent years, the healthcare assistant (HCA) role has become central to acute healthcare delivery (Wanless, 2002). While a nurse support role has been a longstanding feature of the healthcare workforce (Stokes and Warden, 2004), a range of developments re-calibrating the distribution of nursing and clinical tasks and responsibilities has broadened the space within which HCAs perform their role.
Assessment of critically ill patients: the ABCDE approach
Authors: Jevon Phil
Published: May 2014

Most in-hospital cardiopulmonary arrests are predictable, as patients usually display adverse signs before collapse. Early recognition and appropriate management of the deteriorating patient is therefore paramount. The Resuscitation Council UK recommends that clinical staff should follow the airway, breathing, circulation, disability and exposure (ABCDE) approach to assess and treat these patients. Local early warning scoring systems should be used and escalation protocols followed where indicated.
Silent epidemic: helping patients live with osteoporosis
Authors: Nazarko Linda
Published: May 2014

Osteoporosis is a silent epidemic that causes bones to fracture. It can cause disability, ensure sufferers must live in a care home and even lead to death. This article explains how osteoporosis affects a person, discusses how it can be prevented and outlines treatments available.
Self-harm, suicidal feelings and compassionate care
Authors: Wright Karen M , Wright Caraline E
Published: May 2014

Self-harm is an expression of pain and distress, although the reasons for self-harm may vary. It is often used as a coping mechanism and does not necessarily imply suicidal intent. Each case should be treated individually. This article describes the difficulties that can arise when working with patients who self-harm or feel suicidal and outlines possible approaches to aid recovery. It aims to enable support workers to understand the difference between self-harm and suicide, how to respond to keep patients safe and the importance of support and supervision to provide encouragement, direction and guidance.
Morton's neuroma: causes, symptoms and treatment
Authors: Nazarko Linda
Published: May 2014

Foot pain is common in adults. Morton's neuroma, a condition in which nerves can become trapped, can cause severe debilitating pain and affect quality of life. Healthcare assistants who are aware of symptoms and treatments can provide physical and psychological support to people with this condition and provide information on treatment and outcomes. This article explains what is known about the causes of Morton's neuroma and explains how it affects the body. It discusses various treatments for the condition, including how to change behaviours to decrease pain, injections, surgery and other treatments. Pain relief is also explored.
Domestic violence: top tips for support worker practice in Wales
Authors: Shakesby Amy , Wallace Carolyn
Published: May 2014

This article reports on a placement project carried out in Wales by a graduating Health and Social Care student to identify information for improving key relationship factors when working with women and their children who have been involved in or suffered from domestic violence.

The student undertook a review of the literature synthesizing research, policy and guidance to inform health and social care worker practice. Ten key tips were identified, which could be used to improve the relationship between support workers, domestic violence victims and their family members. These key tips helped provide support to them and assisted in an improved response of health and social care agencies.
Role of the healthcare assistant in an acute care setting
Authors: Tardivel Jacqueline
Published: May 2014

This study examines the experience of Healthcare Assistants (HCAs) working on medical and surgical wards of a general hospital. The purpose of the research was to provide an insight into the organisation's nursing ‘culture’ and healthcare workers' perceptions as to what constitutes HCA work. Data was collected using a qualitative approach, in which in-depth interviews were conducted, transcribed and analysed. The emerging descriptions of the HCA role informed the development of four themes. These themes suggest that with due consideration the HCA role may be advanced through a process of regulation and a comprehensive programme of training and supervision.
The therapeutic alliance in healthcare assistant practice
Authors: Hayes Catherine
Published: May 2014

Patients who have been formally diagnosed with a mental illness are much less likely to access the same healthcare for general health problems as other people. As a direct result of this, patients with mental health problems are statistically much more likely to die earlier of conditions such as cancer and common minor ailments. Clinical symptoms of disease are much more likely to remain uninvestigated, with increasing numbers of mental health patients remaining undiagnosed with type 2 diabetes mellitus, for instance. Ultimately, this leads to a diminished quality of life and a markedly decreased age of death. This article identifies the role of the healthcare assistant (HCA) as one means of engaging with people for whom mental illness may be an issue. The settings in which healthcare assistants work lend themselves to conversations and communication with people which might indicate that a patient with mental illness might need additional support and help. This process can ultimately be termed the ‘therapeutic alliance’. This article highlights key aspects of the need to build capacity within and between all professional healthcare disciplines in order to provide equity of care for all. It uses two theoretical standpoints, along with worked examples, to demonstrate the relevance of basic psychosocial interventions in the context of healthcare practice.

The promotion of the concept of recovery is one that has the potential to aid in the removal of stigma for people with mental illness. Healthcare assistants are present during many patient assessment, diagnosis and management pathways and it is here that the concept of the therapeutic alliance could potentially be developed further so that patients with mental health problems might be better supported.
Spirituality and religion: a brief definition
Authors: Barber Chris
Published: May 2014

The first article set out the need for this series of articles on spirituality and health care. This second article sets out to discuss what spirituality actually means from a number of differing perspectives and how spirituality is similar to – and yet different from – religion.
Developing practical reflective skilIs (2/2): a 3-step framework
Authors: Oelofsen Natius
Published: May 2014

This article follows on from a previous paper on reflective practice by presenting a 3-step framework for practical, structured reflection. The steps are designated as: curiosity; looking closer; and transformation. Through following the cycle, practitioners traverse a reflective process that starts by defining pertinent questions, followed by attempts to foster understanding through finding answers, and the cycle culminates in transformed thinking and improved practice. A practical example of the cycle in action is provided.
LINCS in Lancs: clinical research at the grass roots
Authors: Loughlin Wendy
Published: May 2014

In this article, a healthcare assistant reports on her experience of clinical research, as part of a team at her hospital trust. With training and support from the team, and financial backing from the National Institute for Health Research (NIHR), she was able to gain secondment for 2 days a week and play a full part in research into oral hygiene following a stroke.

The ‘Lancashire Initiative for Nursing and Caring research in Stroke’ (LINCS) is a partnership between the University of Central Lancashire (UCLan) and the Lancashire Teaching Hospital Trust and the author found that her experience of research at LINCS fed back into better care for her patients. She describes the challenges of her project on oral flora, but says she would definitely recommend that anyone considering taking part in clinical research do so.
Wellbeing, compassion fatigue and burnout in APs
Authors: Durkin Mark , Smith Joanne , Powell Michelle , Howarth Jane , Carson Jerome
Published: May 2014

It is important that the mental wellbeing of the healthcare workforce is attended to by managers. While many research workers have looked at issues of occupational stress and burnout, fewer have considered the mental wellbeing of staff. In this paper, we report on the findings from a larger survey of mental wellbeing, compassion fatigue and burnout in health and social care professionals.

Here we focus on the findings for assistant practitioners (APs). Some 45 APs took part in our questionnaire survey. They were all completing their foundation degree at the University of Bolton. The group were all quite experienced and most worked full-time. The average score on the Warwick Edinburgh Mental Wellbeing Scale for our group was 22.96, which is significantly below the average for the general population in the North West of England of 27.70. Only 3 out of 45 APs had ‘high wellbeing’, while 7 out of 45 had ‘low wellbeing’. Scores for trust were also quite low. Burnout was more of a problem than compassion fatigue for this group of practitioners, with the highest score on the item: ‘I have frequently felt weak, tired or rundown as a result of my work.’

While this was only a small study, and as such needs to be treated with some caution, it does reinforce the need to think about the wellbeing of the workforce and the necessity for managers to provide support for APs in their roles.
Hidden in the home: supporting same-sex partnerships
Authors: Hutchins Thomas
Published: May 2014

By allowing a situation to continue where lesbian, gay and bisexual (LGB) older people and their partners to remain hidden in health and social care, healthcare professionals risk ignoring their specific needs, which encompass a variety of biological and psychosocial issues.

Awareness that 4–10% of residents could be LGB can prepare staff to tackle their care needs with sensitivity, as can practical measures to make sure the environment, human and physical, is welcoming to LGB people.
Evaluating personal medical services pilots
Authors: Jenkins Clare , Lewis Richard , Gillam Steve
Published: May 2014

Personal Medical Services pilots are using local contracts to tackle health inequalities, particularly in areas such as the inner city, where General Medical Services are seen to have failed. The King's Fund has been working with four London pilot sites on their local evaluations, and this paper presents early messages from the first year of data collection.
Health service culture and health care performance
Authors: Davies Huw T O
Published: May 2014

The Government asserts that transforming the NHS culture is an integral part of its Modernisation Programme.

But what is the health service ‘culture’? And is it amenable to managed change?
Managing The NHS Plan for investment and reform
Authors: Cowper Andy
Published: May 2014

Most people have heard a version of the venerable quip that if you want to hear God laugh, you should tell Him your plans. In such a light, it would be easy to be cynical about The NHS Plan (Department of Health, 2000). The facile response would go something like, ‘All politicians are bad, everything they do is full of lies and they will always get it wrong. Plans never work. Can't you hear that sound? That's God laughing.’
Improving Population Health in Industrialised Nations
Authors: Wall Andrew
Published: May 2014

The phrase ‘Health Gain’ is a snappy way of saying that our country should become healthier; and every few years the government of the day issues a White Paper, giving their version of how this should be done. This invaluable monograph helps us see the wood for the trees.
Across the great divide: discussing the undiscussable
Authors: Bosanquet Nick , Dixon Jennifer , Harvey Trevor , Hunter David , Sang Bob , Pollack Allyson , Wall Andrew , Webster Charles
Published: May 2014

Recently, the career changes and challenges facing managers have gained almost critical mass. From modernisation to The NHS Plan, from the Learning from Bristol report to Shifting The Balance Of Power, it seems the only constant is change. Change which will make or mar the NHS' future.

How well conceived are the new plans? Is there meaningful consultation? What will be the effects on the future career of managers? Is there a forum for dialogue and discussion, when new ideas are felt to be unwise, ill-founded or just plain wrong? Can managers feel free to speak out if they wish?

In a desire to see these questions given due attention, British Journal of Health Care Management has asked a range of experienced figures to voice their concerns. A commentary on these views is given by respected US health care academic Professor Ted Marmor (who will give December's Rock-Carling Lecture).
Patient involvement in clinical governance
Authors: Sang Bob , O'Neill Steve
Published: May 2014

Recently, the authors of this piece spent time exploring the implications of the clinical governance programme and its future development with colleagues from patients’ organisations. This piece reflects their contribution and, by drawing on the principles of Continuous Quality Improvement (CQI), offers some practical advice on taking forward patient involvement in clinical governance. Will the circle be completed?
The last chance (again): how to get the NHS right
Authors: Wall Andrew
Published: May 2014

Is your name Alan Milburn? Right, you've got a job ahead of you to oversee real improvements in the NHS. You have four-and-a-half years. It's delivery time, and we are not talking Consignia. So what are you going to do, and more importantly, what are you going to stop doing?
Exploring middle management in the NHS
Authors: Hewison Alistair
Published: May 2014

Middle management is essential to the effectiveness of the NHS, yet we still know very little about it. What do middle managers do and what do they think about their work? Drawing on recent research, a ‘snapshot’ of managing in the NHS is presented in order to provide some answers to these important questions.
“And all because the doctor prescribed an NSAID” - expenditure on PPIs and joined-up thinking in prescribing
Authors: Phillips Ceri
Published: May 2014

With 24 million prescriptions written each year for NSAIDs they are extremely important in pain management. However, they cause ulcers, some of which result in bleeding and death. Thus significant expenditure is incurred in co-prescribing to avoid these adverse events. This article advocates joined-up thinking in prescribing to ensure that decisions are made outside the context of specific budgets, to produce benefits for patients and the NHS overall.
Biogenerics: an act of faith?
Authors: Greener Mark
Published: May 2014

This article looks at the potential benefits and pitfalls for wider use of biogenerics.
What choice implies for primary care
Authors: Peckham Stephen
Published: May 2014

There is an increasing emphasis on developing choice in primary care. While the main emphasis is on NHS primary care and the increasingly important role of pharmacists, dentists and opticians there has also been a growth in the use of complementary and alternative medicine some of which is funded and provided by the NHS. Such developments blur traditional boundaries and create new management problems for primary care.
Clinical engagement: so why should you even bother?
Authors: Harmond Kate
Published: May 2014

Senior doctors in hospitals are probably the best educated and brightest public sector employees. They are among the most highly paid group of staff, and are responsible for both commissioning and consuming major capital and revenue streams. They lead, influence and manage significant departments and teams, and often represent the public face of the service. Patients generally trust and respect their opinion, and they enjoy a high personal and professional reputation.
Decentralisation? No evidence it works
Authors: Peckham Stephen
Published: May 2014

The English NHS continues to develop new structures and organisations which are part of the government's policy of decentralising health care services. The aim is to give local NHS organisations more freedom from central control as it is assumed that local, decentralised organisations will be more effective at meeting health care needs and more efficient than a centralised bureaucracy.
The rise and fall of the Patient Forum
Authors: Warwick Philip
Published: May 2014

The circular A Stronger Local Voice (Department of Health 2006) published in July announced that Patient Forums in England will be abolished to be replaced by local authority run Local Involvement Networks (LINks). What went wrong with Forums? What was wrong with Community Health Councils before them? Will LINks be judged to be more successful? Is there anything to be gained from another major reorganisation of public involvement arrangements?
Effective quality improvement: TQM and CQI approaches
Authors: Powell Alison , Rushmer Rosemary , Davies Huw
Published: May 2014

Developed in Japan in the 1950s, Total Quality Management/Continuous Quality Improvement (TQM/CQI) approaches have been taken up in a variety of forms by many healthcare organisations since the early 1990s. Although TQM/CQI has several strengths, including a strong customer focus and the use of data to analyse variations in quality, its use in health care has encountered a range of practical and cultural obstacles. In the first of five articles looking at major approaches to quality improvement that have been used in healthcare organisations in the past two decades, the authors review the potential of TQM/CQI and the challenges of using this approach to improve patient care.
Derek Campbell
Authors: Campbell Derek
Published: May 2014

Learning is a continuous process, and I have learned much from both my mistakes and my successes. One important difference now over the past is that I am less inclined to beat myself up over mistakes, and allow myself to celebrate success with those who really make it happen, the team I work with and for.
Display of leadership
Authors: Moyes Bill
Published: May 2014

Respected NHS commentators and analysts have been busy producing work on what the next financial settlement will mean for the health service. Some difference in opinion exists regarding the severity of the challenge ahead, but none of the forecasts make pleasant reading for trust boards. We have been telling foundation trust boards to start planning for the worst, and not wait for the worst elements of the financial crisis to start to bite–by which point it could be too late to take effective action.
Using a Delphi survey to identify priorities
Authors: Wilson Steven , Moffat Martin
Published: May 2014

Background and aims: Through the implementation of a Delphi consultation survey, the aim of the study was to identify the key priorities and opportunities for NHS Quality Improvement Scotland (QIS) to support NHS boards and community health partnerships (CHPs) to improve the quality of care in primary healthcare services in Scotland. Methods: A three-stage Delphi survey was undertaken involving a panel of clinicians, managers, academics, professional bodies and voluntary organisations working in community and primary healthcare services in Scotland. Results: Following three rounds of the Delphi survey, where the panel scored their level of agreement with suggested topic areas, a number of priority areas have now beenidentified where NHS QIS support could add the most value to community and primary healthcare services. Conclusions: The Delphi process has enabled NHS QIS to gather feedback quickly and efficiently from a wide range of geographically dispersed primary care clinicians, managers and academics across Scotland. The feedback received through the Delphi has been extremely valuable in informing the development of the future NHS QIS community and primary care work programme.
Infected wounds: improving outcomes and managing cost
Authors: Jhass Paul
Published: May 2014

Infected wounds can be debilitating and painful for our patients and frequently require costly, protracted management. While healthcare professionals always endeavour to offer care of the highest quality to their patients, in the current financial climate, it must also be affordable. Issues of cost are further compounded by a lack of clear guidance for the management of infected wounds in the community, with practice often dictated by personal experience. To address these issues, the Kent Community Health NHS Trust, in collaboration with academia and industry, plan to benchmark current costs and standards of care, and develop a clear strategy for the management of infected wounds in the community. Our aim is to define measurable parameters that, when improved, will both improve care and deliver cost savings of around 10–15%. These data will allow us to drive improvements in the quality of care, while realising the cost reductions, and also update the knowledge, competencies and capabilities of our staff.
Logging in and logging out: patient safety on ward rounds
Authors: Caldwell Gordon
Published: May 2014

In this commentary, Gordon Caldwell argues that tardy access to core clinical information systems may be close to paralysing clinical care processes for doctors, nurses and other health professionals to the detriment of safe high quality patient care. The number of logouts, logins and reboots required to use core clinical information systems must be reduced and simplified, if safe effective clinical care on ward rounds is to be delivered in a timely fashion. Undue emphasis on limiting ease of access to data, because of concerns about data confidentiality, may be endangering patient care. We need a new understanding of confidentiality within the clinical care teams, which will allow swifter access to essential clinical data.
The challenge of capability in leadership development
Authors: Edmonstone John
Published: May 2014

All NHS leadership development is currently based upon competence frameworks, which have evolved over the last decade. Underlying such frameworks is a set of assumptions concerning leadership, which is seldom examined. Examination of the assumptions leads to an emerging critique of the competence-based approach. While competence is appropriate for addressing ‘tame’ problems, tackling ‘wicked’ problems requires the development of capability—a form of questioning insight.
The impact of very old patients in the ED
Authors: Banerjee Ashis , Mbamalu David , Dehnadi Homa
Published: May 2014

The United Kingdom is facing up to the effects of an ageing society, with steadily increasing longevity. This is inevitably going to lead to an increase in health care costs in the short term. The number of nonagenarians and centenarians is rising as a result of widespread improvements in health care. The impact of attendances by this group of patients in the emergency department is leading to an increasing prevalence of complex medical illness, with potentially increased costs of care that may be incompletely reimbursed. We have attempted to quantify the extent of the problem in our department, and make some recommendations for the future.
Delivering NHS health checks to all
Authors: Martin Hayley
Published: May 2014

The NHS Health Check programme (formerly known as vascular checks) is an ambitious initiative that will offer preventative checks to men and women aged 40–74 years to assess their risk of vascular disease (heart disease, stroke, diabetes and kidney disease). The Department of Health public health White Paper, Healthy Lives, Healthy People, published on 30 November 2010, confirmed that NHS health checks are here to stay. For primary care trusts, NHS health checks are already a reality. Work began in April 2009, with all primary care trusts expected to offer some checks in 2009/10 and full implementation required by 2012/13. By this time, 20% of eligible people should be invited for an NHS health check once a year, i.e. the whole population will be reviewed over 5 years. However, primary care trusts have a real challenge ahead to successfully implement the programme by 2012. Such challenges include: finding funding; deciding who will be responsible for commissioning the service; finding capacity for this service (and its required follow-up) and reaching certain populations. This article offers a novel model to address these changes.
Bed occupancy: the impact on hospital planning
Authors: Jones Rod
Published: May 2014

The ongoing rise in medical emergency admissions seen around the world over the past few decades has never been fully explained. Long-term trends in hospital bed occupancy in England, Canada and Australia are examined to show that a recurring pattern of time-specific increases appears to apply. The possibility of a common infectious source is discussed. Whatever the cause the need to prepare acute hospitals for unexpected increases in bed demand has been demonstrated to be more important than commonly appreciated.