bluuebunny/crossref_metadata_2025 huggingface dataset:
Can district nurses and care home staff improve bowel care for older people using a clinical benchmarking tool?
Authors: Goodman Claire , Davies Sue L , Norton Christine , Fader Mandy , Morris Jackie , Wells Mandy , Gage Heather
Published: May 2014

A quasi-experimental study tested a clinical benchmarking tool (Essence of Care) to improve bowel-related care for older people living in six care homes. In the intervention care homes, district nurses and care home staff used the clinical benchmarking tool to discuss and plan how to improve bowel care for residents. In the control care homes, staff were provided with detailed information about the residents and continence services contact details. The intervention was acceptable to care home and district nursing staff, and possible to incorporate into existing working patterns. The study did not demonstrate a significant reduction in bowel-related problems, although there was evidence in one care home of reduction in episodes of avoidable faecal incontinence. At an individual level of care, there were observable benefits, and examples of person-centred care were prompted through participating in the intervention and improved staff awareness. Clinical benchmarking tools can be used to structure discussion between district nurses and care home staff to review and plan care for residents. However, it takes time to achieve change and embedding this kind of approach requires either robust pre-existing working relationships or the involvement of a facilitator.
When to allow or deny adult access to children's health records
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The Data Protection Act 1998, section 7, has long granted patients the right of access to their health records. The right is exercised by a subject access request and a person with parental responsibility may exercise this right on behalf of a child. However, once the child is considered Gillick competent then a subject access request to a child's records must only be granted with the consent of the child.

In this article the author sets out the requirements for a subject access request and why community nurses and specialist practitioners must proceed with caution when a request is received in respect of a child from the age of 12 years.
Technology, health and the home: eHealth and the community nurse
Authors: Peate Ian
Published: May 2014

Twenty-first century methods of communication are changing. Technology and the way it is used has the potential to revolutionise health care. In the same way information technology (IT) has had a massive impact on commerce and industry, it is also having a substantial impact on the practice of community nurses and the ways in which care is delivered. In order for the impact of IT to be a positive one, community nurses and other health professionals will have to learn and develop a range of new skills. Nurses can and should be directing and becoming involved in the ways in which the IT revolution unfolds. Nurses working with systems development teams also need to make known their needs making clear what information the various IT systems have to contain and how these will fit in with their nursing practice.
Group reminiscence therapy for adults with dementia: a review
Authors: Blake Marianne
Published: May 2014

Dementia is an increasingly prevalent and costly condition in the UK. This review aims to explore the potential effectiveness of reminiscence group therapy as a non-pharmacological tool for reducing depressive symptoms commonly associated with dementia.

The aim of this review is to explore existing literature regarding adults diagnosed with dementia, who are experiencing depressive symptoms, and the effect of reminiscence group therapy on their experience.

A limited systematic search of four databases and hand search of titles, abstracts and reference lists revealed scarce evidence. A total of four original research articles, which met the inclusion and exclusion criteria, were accepted for critical appraisal.

The overall quality of the studies was poor and use of multiple data collection tools made comparison difficult. All studies obtained some significant findings in favour of the effect of reminiscence group therapy.

The primary recommendation of this review is for further high-quality research.
Interventions to promote treatment adherence in type 2 diabetes mellitus
Authors: Asante Ernest
Published: May 2014

Type 2 diabetes mellitus (T2DM) is associated with increasing levels of morbidity and mortality. Full adherence to treatment recommendations such as pharmacological agents, dietary changes, physical activity and regular self-monitoring of blood glucose is essential to achieve good metabolic control. Cost-effective interventions such as individualised self-management education, cue-dose training and use of adherence aids have a positive impact on adherence to treatment recommendations, resulting in better glycaemic control. The application of these interventions could improve clinical outcomes within the NHS.
Understanding the palliative care needs of heart failure patients
Authors: Ivany Elena , While Alison
Published: May 2014

It is increasingly recognised that end-of-life care is suboptimal, especially for those with advanced non-malignant diseases. This study shows that individuals living with heart failure have a number of palliative care needs, including education, communication, symptom management and psychosocial needs. Clinicians struggled to discuss palliation with heart failure patients due to the unclear disease trajectory and cardiac-specific barriers to identifying palliation needs. Carers reported a need for greater social support and better guidance on best practice care. Furthermore, patients struggled to cope physically and psychologically with their reduced physical capabilities and were fearful of being a burden to their carers. Both patients and clinicians recognised a discontinuity between secondary and primary care, which has particular resonance in the context of the intention to relocate care nearer home.
The case for renewed investment in the district nursing specialist practitioner qualification
Authors: Longstaff Fiona
Published: May 2014

District nursing as a profession has been under significant threat over the last few years due to a lack of foresight and funding, resulting in an undervalued and underinvested workforce. The once-heralded specialist practitioner programme was slowly decommissioned in all but a handful of universities, leaving no alternative but for community trusts to employ staff nurses in team leader roles without the development the added qualification gave them. In light of the renewed focus on the fundamental advancement of district nurses and recent Government publications clearly reinforcing the district nurse's role, this article argues for the need for educational commissioners and workforce planners to commit to continued investment in this vital profession.
Juxta CURES: compression for healing venous leg ulcers
Authors: Nugent Lisa
Published: May 2014

Clinicians are expected to show improved healing rates, reduction in recurrence rates and to demonstrate greater patient satisfaction. All patients should rightly expect a high standard of holistic care that supports both their physical and emotional needs. Keeping the patient engaged in the ‘healing process’ has many beneficial outcomes, not least to their emotional wellbeing. Managing to heal the wounds within a realistic timeframe is the required outcome for all parties.

This article demonstrates how a new compression device, Juxta CURES, has a positive impact on patients' quality of life, also benefiting the clinician while maintaining cost-saving efficiencies.
Mental health part 1: an overview
Authors: Simpson Clive
Published: May 2014

For many people, the whole issue of mental health is shrouded in myth and misrepresentation. This introductory article provides some facts and figures about mental health and illness. Health care support workers are likely to be involved in the care of patients with mental health problems from day to day and so it is important that they have a good understanding of what ‘mental health’ actually means. Attitude is also important and this article explores the oigin of negative attitudes and dispells some of the myths surrounding mental health.
Do HCAs deskill nurses?
Authors: Green Louise
Published: May 2014

It could be argued, with HCAs taking over some routine clinical tasks formerly performed exclusively by nurses, that this frees nurse up for higher level skills. However, whose higher level skills are being taken over? Doctors’ skills are being encroached upon and the result is a ‘zero-sum game’ for doctors and nurses, where everyone loses skills, except HCAs. This is not an empty protest; the British Gastroenterological Society, for example, is now worried that gastroenterology house officers are missing opportunities to conduct endoscopies with the advent of nurse endoscopists.
Bathing patients with care and dignity
Authors: Nazarko Linda
Published: May 2014

Enabling a person to maintain personal hygiene can help to maintain health and wellbeing. Healthcare assistants and assistant practitioners play an important role in this and helping a person to bathe must at all times be carried out with patience and sensitivity. Health and safety measures must also be observed at all times. This article explains which bathing products are the most suitable and gives advice to healthcare assistants and assistant practitioners on key areas such as safety and privacy and assisted washes.
Pressure ulcers part 1: aetiology and identification
Authors: Morris Clare
Published: May 2014

This article is the first in a series looking at pressure ulcers. Before we can understand how a pressure ulcer develops it is important to be able to understand the anatomy and physiology of the skin. The factors that make a person more likely to develop a pressure ulcer are explained. The important role of the healthcare assistant in early identification of pressure ulcers is described, as is the European Pressure Ulcer Advisory Panel classification system.
Raising your profile as support workers
Authors: Grainger Angela
Published: May 2014

Menna and I have just had an enjoyable evening at the British Journal of Nursing Achievement Awards. It is good to see nurses who are doing high-quality work which makes such a positive difference to patient care being nationally recognized. It was exactly one year ago at the previous BJN Awards that Menna and I discussed the possibility of a journal for healthcare assistants and assistant practitioners with Mark Allen, and here we are on our third issue!
Behaviour that challenges: types and treatment
Authors: Nazarko Linda
Published: May 2014

Healthcare assistants caring for people in hospitals and care homes may need to care for people who do not readily accept it and who display behaviours that are harmful or distressing to the person and others. This behaviour is known as ‘challenging behaviour’. This article aims to enable you to understand why challenging behaviour occurs and to help you to care for the person sensitively so that it is minimized.
The importance of good oral hygiene
Authors: Grainger Angela
Published: May 2014

Patients who are unable to eat and drink normally, and those who are immuno-suppressed, are at risk of suffering the ill effects of poor oral hygiene. Mouth care is an important aspect of nursing, and one which if neglected, can lead to inflammation of the mouth, oral thrush, and bad breath. Lack of mouth care provision is a feature of patient care complaints. Maintaining oral hygiene is a nursing duty that healthcare assistants are expected to perform.
Juggling work, life and an NVQ
Authors: Robinson Samantha
Published: May 2014

I have had the pleasure of managing the S/NVQ Department at The Medway NHS Foundation Trust for 5years and it is a role that gives me great satisfaction. Never a week goes past when I am not impressed and amazed by an individual’s achievement. Embarking on new challenges can be daunting and thrilling at the same time, however, there is no doubt that for most it is life-changing. The largest challenge is having to juggle work, study and home commitments so I have written this article to reflect on those challenges and discuss simple techniques to overcome them.
Wound care: a brief history
Authors: Lloyd Jones Menna
Published: May 2014

Wound care is an incredibly common aspect of healthcare which many healthcare assistants and assistant practitioners will be involved in at some point in their careers. This article outlines a portion of the history of wound care - exploring how and why it has progressed to the advanced level it is at today.
Research: support workers play vital role in dementia care
Authors: Schneider Justine
Published: May 2014

An in-depth observational study of healthcare assistants (HCAs) in dementia wards set out to identify the workforce issues. The study found that healthcare assistants generally worked with compassion and found the caring role immensely satisfying. HCAs took responsibility for the ward atmosphere-emotional, social and environmental. HCAs thought their workplaces were understaffed on the whole and felt largely ignored and undervalued by members of the multidisciplinary team apart from the other direct-care staff. They coped with these problems by forming a close-knit team and supporting each other both on and off the ward. Looking beyond patient-centred care, employers should take into account other dynamics on the ward, notably those between staff members and between staff and relatives, as well as the patient-focused behaviours. ‘Relationshipcentred care’ might be a better description of the aim of the caring process.
The social model of disability
Authors: Hughes Rhidian
Published: May 2014

Ensuring disabled people are treated fairly and equally is a key component of health and social care practice. This article provides an introduction to the social model of disability, which recognizes the barriers people often faced are caused by negative attitudes, lack of access to services and failing to think about care and support from the perspective of services users. The article provides an overview of the social model and relevant disability legislation, before going on to illustrate how some key principles can be applied to practice.
Book Reviews
Authors: Evans Adrian
Published: May 2014

The textbook introduces the reader in a clear and concise way, commencing on the ‘how to understand the language’ that would be used in the book and what “jargon” a reader would evidence in the day to day care settings.
Understanding acute coronary syndrome
Authors: Mulryan Chris
Published: May 2014

Cardiovascular disease is a leading cause of death and disability in the UK. Patients with the disease often present with an acute episode of chest pain. When such chest pain is thought to be cardiac in origin, the person is said to be suffering from acute coronary syndrome (ACS) until a more specific diagnosis can be made. In this article ACS will be explained so that healthcare assistants and assistant practitioners can make a positive contribution to the care of a person who is suspected to be suffering with this important condition.
Patient observations: a guide for support workers
Authors: McMillen Rachel , Pitcher Ben
Published: May 2014

The clinical skill of taking and recording patient observations is fundamental to patient care and safety. Healthcare support workers regularly undertake these measurements and need to be equipped with the relevant knowledge and skills to ensure accurate readings. This article provides an overview of pulse, blood pressure, respirations, oxygen saturations and temperature measurements, with the normal and abnormal values given. Both the background and rationale for the use of early warning scoring systems are also provided.
Learning disabilities, spirituality and personal beliefs
Authors: Barber Chris
Published: May 2014

Those with learning disabilities are as likely as anyone else to experience and express a sense of spirituality and personal belief. The concept is deeply subjective and every individual is likely to have his or her own unique perspective. In addition, those with learning disabilities are likely to have their experiences and the way in which they express their sense spirituality and belief affected by their condition. This article will help support workers understand the concept of personal belief and its role within holistic nursing support and care for those with a learning disability.
Discrimination Against Learning Disabilities in Health Services
Authors: Barber Chris
Published: May 2014

Discrimination against those with learning disabilities within health services is widespread and has lead to considerable distress, ill health and even death in some circumstances. This article seeks to discuss what is meant by discrimination and its effects on those with a learning disability. A short description of current UK anti-discrimination law is also provided.
Continence series, part 2: long-term conditions
Authors: Nazarko Linda
Published: May 2014

Age-related changes make it more difficult for older people to maintain continence, because the urinary system is more finely balanced than in youth. Long-term conditions become more common as people age and these also increase the risk of a person developing continence problems. Understanding how these changes affect people can enable staff to work with individuals to enable them to remain continent.
Mental health: depression
Authors: McRory Barry
Published: May 2014

Depression is a common illness in society today; assistant practitioners (APs) and healthcare assistants (HCAs) may work with clients who are suffering from depression, either as a standalone illness or as the result of a reaction to their current circumstances. It is the aim of this article to provide an overview of depression, taking into consideration the causes and symptoms of the illness. It will also look at the most common types of depression and possible treatments for the client.
Developing practical reflective skills (1/2): personal learning
Authors: Oelofsen Natius
Published: May 2014

Reflective practice is about practitioners making sense of their experiences at work with the aim of improving practice. Part one of this article provides an overview of what reflection is, and the three types of learning involved in effective reflective practice. The concluding section of this part of the article focuses on personal learning as a component of reflective practice. A variation on Johari's window is introduced as a structured method for capturing personal learning and an example of how this might work in practice is offered.
Communication: making sense of what people with dementia say
Authors: Hobson Pat
Published: May 2014

Dementia is a disorder that affects the person's ability to process language and information in such a way that will enable them to communicate their physical needs, feelings and emotions. This can lead to frustration for both the healthcare assistants (HCAs) and, most importantly, the person with dementia. The main focus should be on the HCAs developing the ability to enter the world of the person with dementia and adapt their ways to enable them to make sense of what the person is attempting to communicate ( Hobson 2008 ). What should be avoided is an attempt to continuously bring the person back to a reality that at best no longer makes sense to the person and at worst can be a frightening and distressing experience.

Learning Outcomes: Links: QCF: Level 2 and 3 Shared Units: Dementia Pathway Level 2 DEM 201,202,204,205,210,211,301,308,312,313
Support workers as leaders: yes, you can …
Authors: Stonehouse David
Published: May 2014

This is an article written following a presentation given at a national conference on the ‘Progression and Development in the Role of Support Workers’ in November 2012. Within this article, the author will highlight the important leadership role that support workers can and need to embrace.

The article is aimed at three groups: first and most important, support workers themselves; second, managers; and third, educationalists in charge of developing and delivering both in-house and external training courses.

Two key areas will be discussed where leadership by support workers is vital: quality and the management of change. The article will finish by looking at how support workers can be supported and developed within this often new role by managers and educationalists.
Hearing loss in people with learning disabilities
Authors: McShea Lynzee
Published: May 2014

People with learning disabilities are more likely to have a hearing loss than the general population, but are less likely to have their hearing problem diagnosed or managed. Difficulties in access, misconceptions around assessment and a lack of aftercare are all factors in this.

Undiagnosed hearing loss can cause significant problems in the life of a PWLD. Without training and education, carers do not have the expertise to detect hearing loss and manage hearing aids adequately. Even basic training could make a difference and a simple checklist to identify possible hearing difficulties is presented. Further research is needed in this area.
Mentorship: excellence in the mundane
Authors: Fulton John
Published: May 2014

This article outlines the key concepts that underpin mentorship. In healthcare, the term mentorship can be used to describe a relationship in which the mentor formally monitors and assesses the skill development of the person being mentored. It can also be used to describe a less formal relationship in which an older and more experienced colleague acts as a guide to someone less experienced. Whatever the relationship, there are some underpinning principles that are explored in this paper. The roles of the mentor are considered, as are the ways in which the skill development is monitored. The emotional labour that is involved in healthcare work is explored and the ways in which the mentor can support the student are outlined. A large element in any healthcare situation is the ways in which an individual ‘fits into’ the workplace. The concept of ‘communities of practice’ is considered and the role of the mentor in this context is explored.
Clinical skills series/3: urinary catheterisation
Authors: Peate Ian , Gault Christine
Published: May 2014

Urinary catheterisation is a common procedure performed in the majority of healthcare environments; it is deemed an intimate healthcare activity. There are a variety of reasons why a person may need to be catheterised. The healthcare assistant and assistant practitioner (HCA and AP) must demonstrate competence and confidence if they are required to undertake catheterisation along with catheter care. HCAs and APs are undertaking a range of care aspects associated with catheters; the HCA and AP must, however, ensure that they have been deemed competent to undertake any task and that the employer has permitted him or her to undertake the activity. An overview of the urinary system is provided and the guidelines required to perform male urethral catheterisation are discussed.
Team working and effectiveness in health care
Authors: Borrill Carol , West Michael , Shapiro David , Rees Anne
Published: May 2014

With the arrival of the National Plan, this timely paper presents preliminary findings from a major survey of multidisciplinary team working and effectiveness. The three-year study covered primary, secondary and community health care teams.
The looming battle between takeover and catch-up
Authors: Roth Andrew
Published: May 2014

Whatever the rumble of foreign battles or the fascination of internal splits, the crucial looming dialectic is the interaction between ‘takeover’ and ‘catchup’. Because they can fuse like press-ganged Afghan armies, they warrant close observation.
Modernising patient and public involvement
Authors: Sang Bob
Published: May 2014

This article considers whether the new structures for patient and public involvement in the NHS can truly put local people at the centre of health care.
Keys to the housing
Authors: Bell Andy
Published: May 2014

The term ‘key worker’ has, over recent months, permeated the lexicon of public and political language. It is a phrase that, not so long ago, was used mainly by a small number of boffins and enthusiasts. Now it is heard constantly from the likes of Gordon Brown, Ken Livingstone and all sorts of news reporters on television and radio. The ‘key worker’ it would appear, has officially been discovered.
Slouching towards Jerusalem
Authors: Cowper Andy
Published: May 2014

It isn't easy to sum up 2002 for a health care manager. You could call it the year of Shifting The Balance Of Power, particularly if your experience has been of shifting the job. You might call it the first year of the five-year, £40 billion Budget plan. As ever, the money is the real NHS Plan. We'll come back to the question of money: managers always do.
Journal of a vague year: 2002 in health care
Authors: Harvey Trevor
Published: May 2014

An end-of-year report on the themes and developments in the NHS across the past twelve months.
First patient singular
Authors: Harvey Trevor
Published: May 2014

I recently left the real world to spend a couple of days as a patient in one of our newest, shiniest and most expensive NHS hospitals. Struck by the apparently immaculate nature of my surroundings, I felt a bit out of place in my gardening clothes.
Whatever happened to quality?
Authors: Maynard Alan
Published: May 2014

Acentral ingredient of the Reverend Blur's agenda to reform the NHS was the emphasis not only on improving access by reducing waiting times, but also the pledge to improve quality. For instance the National Patient Safety Agency is now fully operational, but what has it done to improve the quality of patient care?
Star Wars
Authors: Cowper Andy
Published: May 2014

Words change their meaning over time. Centuries ago, ‘franchise’ meant the right to vote (from the French franchir - to set free); today it is mainly used to denote the licensing rights of a brand or product. It seems a linguistic irony that its sense has changed from concerning the will of the majority to its modern pertenance to commercial matters.
Rhetoric and reality, lions and donkeys
Authors: Charny Mark
Published: May 2014

This is the first in a new series reflecting on the gap between policy as it is made in the centre and policy as it is lived in the trenches.
The pursuit of better performance
Authors: Cowper Andy
Published: May 2014

Lord Hunt of Kings Heath OBE is Parliamentary Under-Secretary of State in the Lords for the Department of Health.

His remit includes performance and clinical quality (including the performance and quality taskforces); medicines and medical devices; genetics and biotechnology; R&D, statistics, IT; executive Agency Management; departmental management; and the Eastern and North West Regions.

Prior to his ennoblement, Philip Hunt was Director of National Association of Health Authorities and Trusts (the predecessor to the NHS Confederation).
So what would YOU do then, Andrew Wall?
Authors: Wall Andrew
Published: May 2014

In the first of a new series, former Chief Executive Andrew Wall puts forward the reforms that he believes would most suit the NHS for a real and reliable future.
Lies, damned lies and the SAFF settlements
Authors: Maynard Alan
Published: May 2014

The Service Agreement and Financial Framework (SAFF) settlements for 2002-2003 are occupying NHS managers throughout the land.
More pursuit of better performance
Authors: Cowper Andy
Published: May 2014

We resume our interview with Lord Hunt of Kings Heath OBE, Parliamentary Under-Secretary of State in the Lords for the Department of Health.

Prior to his ennoblement, Philip Hunt was Director of National Association of Health Authorities and Trusts (the predecessor to the NHS Confederation).
The National Care Standards Commission
Authors: Easterbrook Joanne , Rees Rebecca
Published: May 2014

This article looks at the National Care Standards Commission to regulate both private and voluntary sector homes and hospitals.
Divided effort to reach the dividend
Authors: Halpern Stephen
Published: May 2014

The NHS could save millions of pounds a year and improve thousands of people's lives by investing in local communities and more sustainable practices, claims this latest study from the King's Fund.
Managing for the future and sustainable NHS
Authors: Jochelson Karen
Published: May 2014

This article considers various management options to make the NHS a more environmentally friendly system.
The cancer NSF: a suitable case for treatment
Authors: Baker Mark R
Published: May 2014

Improving cancer outcomes has been a public health and service development priority for many years. This paper summarises the background to the case for change and the strategy for achieving success.
On defining ambulatory care in practice
Authors: Bowers John , Jeffrey Susanne , Mould Gillian
Published: May 2014

This article explores definitions of ambulatory care in practice, and considers how they will fit in to health care modernisation.
Money or your life
Authors: Maynard Alan
Published: May 2014

The rhetoric of governments worldwide is that they wish to ensure “value for money” in their health care systems. Yet in most countries there are examples of where this mantra is being violated, as governments trade efficiency for votes, committing highway robbery which gives them electoral benefits but damages patients’ health.
Disappointed not to be disappointed
Authors: Charny Mark
Published: May 2014

This series reflects on the gap between policy as it is made in the centre and policy as it is lived in the trenches.
Intermediate care for older people - an implementation
Authors: Young John , Robinson Michael , Chell Sue , Burns Eileen , Fear Jon , Sanderson Diane
Published: May 2014

Intermediate care services are being developed in England and elsewhere to provide an integrated health and social care model for older people with sub-acute illness and/or needing rehabilitation. A more rapid implementation of these services might be achieved if the practical service development issues were better understood.
Where the NHS meets education: a future workforce
Authors: Gillow Judy , Sheldon Lesley , Humphris Debra
Published: May 2014

This article examines the development of an educational package to contribute to the workforce demands of the future ‒ a partnership approach between service and education.
Monoglotia: the disease that makes ex-Trotskyists love Yanks
Authors: Roth Andrew
Published: May 2014

I snickered when I heard Ken Livingstone (at London's million-strong anti-war demonstration) attack fiercely the warlike Bushmen who have captured Washington before marching on Baghdad. Could this be the same man who himself has turned over Transport For London to a cabal of Yanks, including one whose rail industry experience involved transporting cattle around Pennsylvania?
Lord Hunt: having a nasty put-down on your political gravestone
Authors: Roth Andrew
Published: May 2014

There is nothing so unpleasant as having an honourable and distinguished political and professional career end in a thuggish put-down. And yet this has been the fate of Philip, Lord Hunt of Kings Heath, who resigned his post as Under-Secretary of State for Health in March rather than support participation in the invasion of Iraq without UN endorsement. Before becoming a Minister, he was a long-time director of the National Association of Health Authorities.
The price of knowledge is high but the cost of ignorance is greater!
Authors: Maynard Alan
Published: May 2014

The importance of measurement within the National Health Service should need no stating.

Unfortunately, it still does.

This article makes the case.
Contracts and social contracts / Ambulance blues
Authors: Cowper Andy
Published: May 2014

A contract is a curate's egg of a thing: good in places, and binding. Nobody said that negotiating new contracts for GPs and consultants would be easy. Nobody was right about that: and Agenda For Change's four-year gestation could start looking like a walk in the park if negotiations carry on as badly as they have done so far.
Foundation hospitals still a glint in Hutton's beady eye
Authors: Roth Andrew
Published: May 2014

I almost missed the revealing programme on Birmingham's top candidate for its first foundation hospital. I had not previously watched BBC2's pre-lunch politics programme because I object to its T o r y-partisan chairman, Andrew Neil. I had experience with him when he edited the Sunday Times, where he commissioned an article from me on Labour Party candidates for the 1987 general election. On receiving it, Neil converted all the Labour candidates I had assessed as soft-Left to looney-Left, to frighten off voters. He also sat, for eight months, on information from Harrods owner Mohammed al-Fayed that he had two Tory MPs, Neil Hamilton and Tim Smith, on his secret payroll.
Needs and priorities in dental care
Authors: Richards Wayne
Published: May 2014

This article argues that rationing is an inescapable part of the provision of publicly-funded dental care at two quite distinct levels, and is likely to remain so.

This rationing is based on a flawed model of service provision.

Present patterns of service provision create and sustain a double jeopardy for certain socio-economic groupings. An evolutionary model of service provision is suggested to facilitate equitable service delivery.
‘Fast Track' to lower ICU costs and better care
Authors: McGiness Julia , Singh Vinod , Park Gilbert
Published: May 2014

The Intensive Care Unit is among the most expensive places in any hospital. At Addenbrooke's, we have been investigating a number of ways in which the ICU could, in general, be made more effective and more cost-efficient.
The New World? NHS Alliance 2005 annual conference
Authors: Cowper Andy
Published: May 2014

O Harrogate! How do we love you? Let us count the ways ... beautiful architecture, Betty's tea room, good pubs, a working spa (whose opening hours always seem to fail to co-incide with conferences here).
Improving care for patients with Parkinson's Disease
Authors: Castleton B , Dunstan C , Nicholas V , Titheridge E , Bouckley S , Crawhurst P , Friggens W
Published: May 2014

Services to those suffering from Parkinson's Disease (PD) lack a co-ordinated multi-professional approach andoften include serious shortcomings.
Financial matters - really, really matters
Authors: Timmins Nicholas
Published: May 2014

It was the month of the money, of measurement, and a restatement of why the means that the NHS is being subjected to have been chosen.
From Machiavelli to NHS management
Authors: Cowper Andy
Published: May 2014

What could be better than a quote from the world's first masterpiece of management literature to introduce the launch of our new design? We hope you like it — and our new features. This issue features a policy special, as we interview secretary of state Patricia Hewitt about NHS finances and the future; while Conservative policy proposals are outlined by her opposite number Andrew Lansley; and Vincent Cable of the Liberal Democrats considers the role and responsibility of choice in healthcare.
Squeamish about MPs' visual aids
Authors: Roth Andrew
Published: May 2014

I am glad that they have long banned visual aids for MPs. I would have turned squeamish during frequent MPs' demands for newer and more expensive treatments for their constituents.
Priorities for healthcare in 2008
Authors: Smith Tom , Sobanja Michael , Dixon Niall , Hampton Chris , Hodgetts Susan , Morgan Gill
Published: May 2014

Like the 18-week target, New Year's Resolutions require a sensible degree of tolerance. Without that, resolutions will be more notable in the breach than in the observance.
Should patients be able to top-up their NHS care?
Authors: Bosanquet Nick , Appleby John , Maynard Alan , Bamford Terry , Redding Don , Furness David
Published: May 2014

Everyone would like the NHS to be able to provide everything they need for their health and wellbeing. When NHS care is denied, there is a strong sense of distaste among the public. It would seem then, that the issue of top-ups would be realtively straightforward. It would seem. However, views on the matter are remarkably polarised.
The economics of dementia
Authors: McCrone Paul
Published: May 2014

Dementia is a degenerative condition with a prevalence that increases dramatically with age. Alzheimer's disease accounts for more than half of all cases. Given the numbers involved, dementia is a key area of concern for policy makers, clinicians, patients and families, and generates much media attention. This article summarises what we know about the cost of dementia and what evidence there is regarding drug treatments and psychological therapies.
Places of safety, problems of safety
Authors: Bell Andy
Published: May 2014

Every year, some 11 500 people are being taken to police stations because officers think they need an urgent mental health assessment. That was the finding of a report published by the Independent Police Complaints Commission (IPCC) last month (IPCC, 2008). It means that two thirds of occasions when a person is put in a ‘place of safety’ under the Mental Health Act, they are taken to a police station rather than a health service facility.
A tight squeeze for the future
Authors: Timmins Nick
Published: May 2014

November 2008 was the month where, if confirmation were needed, it came. Between last month's column and this one, the Government's fiscal position has gone from bad to worse. Borrowing that most forecasters were projecting to be perhaps in the £90 billion range next year will be more like £120 billion. It will be 8% of GDP next year, worse than it was in the recessions of the 1990s, 1980s and 1970s. Net debt–the accumulated borrowing–will rise from less than 30% of national income at the start of this decade to a staggering 57% by 2014–15.
Yve Buckland
Authors: Buckland Yve
Published: May 2014

Healthcare management should always be grounded in operating experience. During the 1980s I worked on a project in Birmingham which was about involving users of community care services in the way these serviceswere developed and delivered. It was a humbling experience being brought face-to-face with the wisdom, expertise and innovative thinking that patients and the public can bring to public service delivery; as well as the frustrations and impact of poor services. This work gave me a passion for user involvement and customer focus in health and social care.
Security, quality and the sharing of data
Authors: van Terheyden Nick
Published: May 2014

George Clooney's suffered from it. Britney Spears has suffered from it. And Sir Bobby Robson has too. Patient confidentiality and the breach of patient records makes headlines on both sides of the pond and continues to affect all manner of healthcare delivery.
DH call for review into medical training
Authors: Goddard Andrew
Published: May 2014

The Secretary of State for Health has recently instructed Sir Christopher Edwards, Chair of Medical Education England (MEE) ‘to commission the Postgraduate Medical Education and Training Board (PMETB) to conduct a review of the quality of postgraduate medical training within a EWTD compliant working environment’. Such a review, albeit rather late in the day, should be welcomed for several reasons.
Emergency preparedness
Authors: Jones Rod
Published: May 2014

The Department of Health (DH) (2009) has recently released the operating framework for the NHS in England, which will apply to the 2010/11 financial year. The section dealing with emergencypreparedness talks about NHS organisations ‘putting in place plans and arrangements to deliver an effective response to threats and hazards’. The same document discusses an NHS with fewer acute beds, and deals with the recent unprecedented rise in medical emergency admissions without comment but introduces prices for 2010/11 which will only pay 30% of full tariff for emergency activity above a 2008/09 baseline.
What are quality and safety at the point of care?
Authors: Caldwell Gordon
Published: May 2014

Clinicians, leaders and managers must share the same values and beliefs about the nature of and priorities in quality and safety in patients' care. The medical profession seems to have lost its ability to present simple and elegant arguments about what it values as the essential foundations of safe, high quality, inpatient care. These concepts of quality and safety must be made concrete with indicators that can support the making of the right diagnosis at the right time and providing the right treatments. Through a process of structured observation of my team's working over 5 years, I have come to understand the indicators of quality and safety that I value in acute general medical care. If clinicians, leaders and managers could agree on these indicators, I believe we could make rapid progress in improvements in the quality and safety of inpatients' care.
Mandatory training: evaluating its effectiveness
Authors: Mythen Lynn , Janice Gidman
Published: May 2014

Mandatory and statutory training is an integral part of learning in the public health sector from both internal and legislative perspectives. Individual trusts usually set their own mandatory agenda-based training on the perceived learning needs of the workforce, with the staff not necessarily having the choice or motivation to learn. Considering this conflict with adult learning theory, how can the health service evaluate the effectiveness of mandatory training, not just in terms of costs, but also the impact it can have on behaviours and practice in the workplace?
Increasing engagement with clinical outcome data
Authors: Dharamshi Riaz , Hillman Toby , Shaw Rory
Published: May 2014

This project aimed to create timely, relevant clinical dashboards for individual surgical consultants to support a number of processes. The project consisted of four stages: collection of data on the views of consultants to using performance data as part of their routine practice, design of a clinical dashboard that was secure, accessible and up to date, clinical engagement, and measuring the effects of the change. Prior to the study, 94% of consultants did not have access to routine, up-to-date clinical information, and 88% were interested in having it available. All indicators included in the dashboards produced by the project were considered useful by the majority of consultants, but no consultants felt that their practice had been changed by having the dashboards available for six months. 91% cited poor data quality as the reason for this. The study found that while there is high enthusiasm among consultant surgeons for access to timely clinical outcomes data, the use of such data is undermined by the perception among surgical consultants that the data is inaccurate.
Caries, change and the dental profession
Authors: Richards Wayne
Published: May 2014

Major changes in the epidemiology and management of dental caries will affect organizational aspects of care provided by general dental practitioners (GDPs). Caries are now far less common, and research is challenging long-held beliefs around their diagnosis and treatment. A move to preventive, evidence-based care will reduce intervention and avoid over-treatment. Dentists may see this as devaluing traditional restorative skills, so established practice must be questioned sensitively. As such, a move would mean less intervention and avoid over-treatment for current users, who are usually in high socioeconomic groups and at risk of over-treatment. It would allow resources to be redirected to people in deprived groups, who are more likely to have oral disease. Primary care organizations should ensure that satisfying patient desire does not happen at the expense of workforce allocation to perform basic care. They could also support models of care that embrace the current evidence base.
Leadership models for healthcare improvement
Authors: DaCosta Joanna
Published: May 2014

An ability to lead collaboratively across professional boundaries is a key aspect of successful introduction of quality improvement initiatives. In healthcare, excessive importance is attributed to the personal and positional qualities of leadership. The traditional hierarchal model of postgraduate medical training is not conducive to developing practical leadership skills among doctors and does not support change and innovation. Medical professionals should actively promote the development of leadership skills amongst their more junior colleagues with a particular emphasis on collaborative working across professional boundaries.
Innovation and the NHS: turning theory into practice
Authors: Chisholm Sally
Published: May 2014

The need for rapid, widespread and systematic adoption of innovation within the NHS has never been more acute. The global financial crisis and the drive for major NHS efficiency savings means the service must focus immediately on transforming its disappointing record in this area. There is no reason, however, why this cannot be achieved. Britain has an enviable record in biomedical science research. The NHS is also blessed with great expertise and a highly skilled workforce. With these resources at hand, it is essential for managers right across the service to embrace new and better ways of delivering healthcare. The NHS’s Technology Adoption Centre (NTAC) is well placed to drive this policy through, having built up a wide base of expertise since it was mandated to analyse the problems surrounding the implementation of innovation. Adopting new technologies and ways of working can often be complex and difficult—particularly so in large organisations. The NTAC, however, has developed an armoury of tools to help managers counter these issues so that innovation can become the NHS norm rather than the exception.
Volatile inpatient costs: CCG financial stability
Authors: Jones Rod
Published: May 2014

The introduction of GP commissioning almost assumes that there is a weak link between financial risk and size and that risk is independent of location-specific environmental factors—i.e. costs are entirely predicted by a capitation formula based on population demographic and socio-economic variables. This article seeks to investigate the volatility associated with different aspects of healthcare costs, namely, occupied beds as a proxy for inpatient costs. The observed volatility can give an estimate of the real world volatility in the total costs of a commissioning budget. This study extends the previous analysis of year-to-year volatility at national level down to local level using English primary care trust (PCT) populations mainly aligned to local authority boundaries. The difficulty of formulating equitable risk sharing instruments in the presence of significant environment or location-specific volatility is discussed along with the implications to population- or person-based funding formula.
Young carers and end of life services
Authors: Gandy Rob , Wilford Sara , Alexander Aileen
Published: May 2014

In 2009, the NHS National Centre for Involvement and Liverpool Primary Care Trust undertook a national pilot project to establish how best to undertake patient and public involvement in respect of end of life (EOL) services. This article describes the outcomes from its sub-project which focused on young carers. It is projected that there are substantial numbers of young carers in the UK, at any one point in time, supporting their (grand)parents, or other adult family members, during their terminal illness. Interviews with young carers were conducted to gain understanding of their experiences of EOL service delivery by carers and professionals, and what support they felt they needed themselves.

It was found that young carers were often inadvertently marginalised and at times felt ‘invisible’ to those providing care to the patient. Young carers require the same consistent, accurate and honest information as adult carers. Carers and professionals need to talk and listen to them, and to recognise the importance of the whole family, in the care of the patient. Local young carer's services can provide support and information, but there are many organisations that could also provide greater support including schools, social services, and health professionals.