bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying care actions to conserve dignity in end-of-life care
Authors: Brown Hilary , Johnston Bridget , Östlund Ulrika
Published: May 2014

Community nurses have a central role in the provision of palliative and end-of-life care; helping people to die with dignity is an important component of this care. To conserve dignity, care should comprise a broad range of actions addressing the distress that might impact on the patient's sense of dignity. These care actions need to be defined. This study aims to suggest care actions that conserve dignity at the end of life based on evidence from local experience and community nursing practice. Data were collected by focus group interviews and analysed by framework analysis using the Chochinov model of dignity as a predefined framework. Suggestions on care actions were given in relation to all themes. As part of a multi-phase project developing and testing a dignity care pathway, this study might help community nurses to conserve dying patients' dignity.
Taking hypoglycaemia seriously: diabetes, dementia and heart disease
Authors: Holt Paula
Published: May 2014

Hypoglycaemia is a common and potentially deadly problem for people with diabetes who are prescribed insulin secretagogues and/or insulin as part of their treatment regimen. This article focuses mainly on type 2 diabetes and considers the incidence, pharmacological causes and definition of hypoglycaemia. It discusses the recently defined relationships between hypoglycaemia and the onset and development of dementia and cardiovascular disease. Hypoglycaemia risk factors are identified and linked to specific characteristics found in the elderly, and information is offered on how to treat hypoglycaemia effectively and avoid repeated episodes.
Intravenous therapy: guidance on devices, management and care
Authors: Ogston-Tuck Sherri
Published: May 2014

This article aims to provide guidance for practitioners on intravenous therapy devices, their management and care. It explains the indications for their use and considerations when selecting devices for intravenous therapy and treatment.

Both PVADs and CVADs are discussed in detail to provide the practitioner with a clear understanding for each. Infection control and how to reduce infection risks are also addressed with recommendations for best practice guidance on flushing devices, minimising complications and documentation.

This article addresses the importance of safe practice and aims to help practitioners to improve their knowledge and clinical decision-making for patients undergoing intravenous therapy.
Community matron caseload numbers: a literature review
Authors: Auckland Samantha
Published: May 2014

In early 2005, the Department of Health published its strategy for addressing the health and social care needs of people with long-term conditions (2005a ; b ). Community matrons were recruited to deliver this strategy. Since this time, there has been some debate around the optimum caseload number for community matrons to function effectively ( Abell et al, 2010 ). One study by Sargent et al (2008 ) concluded that community matrons were struggling to achieve and maintain 50 patients on their caseload, due to nine areas that impact on caseload manageability. This literature review concluded there is a wide variation regarding the optimum caseload number ranging from 14 patients in intensive case management to 80-100 families per fulltime health visitor. A number of authors do not specify caseload numbers due to the complexity of the task. However, what clearly emerges is that the factors that impact on case management appear to correlate with the issues identified by Sargent et al (2008 ).
Self-management for people with long-term neurological conditions
Authors: Chaplin Hema , Hazan Jill , Wilson Patricia
Published: May 2014

Although English government policy has encouraged the implementation of self-management programmes in services for people with long-term conditions, the evidence for their efficacy has been limited. People with long-term neurological conditions use community-based health services including community nursing, and have particular needs in regards to self-management. This article provides an overview of the evidence for the effectiveness of self-management interventions for people with long-term neurological conditions, in particular those with stroke, Parkinson's disease and multiple sclerosis. The current need for better interventions is highlighted, particularly the importance of providing condition-specific information and deliverance of interventions in a group setting to improve self-management outcomes. In response to weaknesses of previous self-management interventions for this population, an innovative Hertfordshire Neurological Service self-management programme is discussed, and the implications for future research are described.
Managing exudate associated with venous leg ulceration
Authors: Menon Jane
Published: May 2014

This review highlights the challenges associated with highly exuding venous leg ulcers for both the patient and the clinician. The main focus of the author's article is the management of heavy exudate levels, and key to this is the assessment process, which is discussed. The wide range of products and treatments available for managing high exudate levels are also explored. Despite these options, patients continue to suffer distress and the indignities of soiling of clothes, social embarrassment and reduced quality of life. The definition and composition of exudate is given, with particular emphasis on the damaging effects of chronic wound exudate. Reasons for high exudate and the priority of treating the underlying cause are discussed. Common themes examined are the assessment process, treating the underlying aetiology, the use of dressings and skin care. Complications of poor exudate management include a negative effect on the patient's quality of life, wound bed and periwound damage, increased risk of infection, increased costs to the health service and a delay in healing ( Vowden and Vowden, 2003 ). Primary research and reviews are summarised, evaluating their significance to the various themes explored.
Older people, isolation and loneliness: implications for community nursing
Authors: Skingley Ann
Published: May 2014

Recently, the issues of loneliness and social isolation among older people living in the community have been highlighted through television programmes, publications and campaign groups. Prevalence is age-related and is of most concern in the ‘oldest old’ group, where numbers are set to rise in the coming years. There is evidence to link a number of environmental, psychosocial and biomedical factors to loneliness and social isolation; research suggests that many of these are amenable to intervention in order to improve older people's lives. Initiatives largely include one-to-one interventions; group activities; or community engagement approaches. Community nurses are in a position to effect some of these changes in their areas of work.
Physical activity among the elderly in China: a qualitative study
Authors: Li Yanling , Du Xiaojing , Zhang Chunfang , Wang Sibao
Published: May 2014

The benefits of physical activity are well known, but little is known about the views of elderly Chinese people regarding physical activity, and what factors affect this. This qualitative study aims to explore the experiences and perceptions of the elderly community regarding physical activity and to gain a better understanding of these. A qualitative study of 12 elderly Chinese people was undertaken using the Colaizzi phenomenological approach and using semi-structured interviews to gather data. Three key themes emerged relating to current physical activity status, beliefs about physical activity and factors influencing physical activity.

This study provides new knowledge about the elderly community's experiences and perceptions of physical activity. By understanding these, we may show that promoting active lifestyles and building physical activity into and around day-to-day activities are important strategies in increasing levels of activity. Furthermore, the need for appropriate activity facilities, available space, peer motivation and general social support could promote activity beliefs and subsequent adherence among the elderly community.
The missing link: district nurses as social connection for older people with type 2 diabetes mellitus
Authors: Lucas Sandra
Published: May 2014

The relationship between social connection and health is widely recognised. However, there is a paucity of literature regarding the impact of district nursing care on social connection for people with a chronic illness such as type 2 diabetes mellitus (T2DM). Using a mixed-method approach, an exploration of the perceptions of older people living in the community with T2DM regarding their health and social connections was carried out. Findings revealed a strong relationship between the clients and the district nurse. The district nurse is an important aspect of clients’ social connection. For some clients where their social connection is limited, the district nurse is a central element. When the district nurse is the major social connection, problems can arise for the client, especially when they are being discharged or changes are made to their care.
From guidelines to clinical practice: cardiovascular risk management in inflammatory arthritis patients
Authors: Palmer Deborah , Miedany Yasser El
Published: May 2014

There exists significant evidence of increased risk of cardiovascular (CV) disease in rheumatoid arthritis (RA) patients in comparison with the general population. This finding has been supported by a number of guidelines recommending screening for CV disease risk in patients with the disease. However, the opportunity to identify and manage those patients at risk has been missed in both primary and secondary care. The success of CV risk management in diabetes patients provides a clear incentive to identify and actively manage CV risk in all RA patients as part of routine practice. This article provides an approach that shows how to assess for CV risk in standard clinical practice.
Nutrition and cancer: issues related to treatment and survivorship
Authors: Witham Gary
Published: May 2014

This paper reviews nutritional issues related to cancer treatment and further explores nutritional needs pertinent to cancer survivorship. It examines the major problems with nutrition when patients undergo the main cancer treatment modalities of chemotherapy, radiotherapy and surgery. Particular attention is paid to long-term dietary advice in acknowledgement of the improved effectiveness of cancer treatment and the chronic nature of the condition.
Final year student nurses' experiences of wound care: an evaluation
Authors: Ousey Karen , Stephenson John , Cook Leanne , Kinsey Laura , Batt Sarah
Published: May 2014

This article reports on research to explore if pre-registration nursing students felt prepared to manage patients' skin integrity effectively on registration. Final year nursing students completing adult, child and mental health fields were invited to complete questionnaires to investigate the amount of teaching sessions delivered in university in relation to managing skin integrity during their 3-year training programme, discover if pre-registration nursing students received supplementary management of skin integrity teaching in the clinical areas, explore which member of staff in the clinical areas supported the students' learning in the area of skin integrity. Data was collected on 217 final year students (196 females and 21 males) at two higher education institutions in the north of England. The majority of respondents (n=146; 68%) reported receiving less than 10 hours formal teaching at university on the subject of skin integrity over their 3-year courses. Of those registered on degree courses, 134 students (71%) reported receiving less than 10 hours formal teaching over their 3-year courses, compared with only 12 students (46%) registered on diploma courses. Some 198 (99%) of respondents reported that their clinical teaching was undertaken by registered nurses all or some of the time. Other health professionals were reported to provide substantially less clinical teaching; with the next largest contribution reported to be provided by specialist nurses, who provided all clinical teaching to 36 respondents (19%) and some clinical teaching to 115 respondents (59%). Some 149 respondents (70%) reported that the teaching they received had developed their knowledge and skills to maintain skin integrity for all patients. Respondents claimed that teaching received had developed their knowledge and skills, reporting an average of 16.9 hours spent in directed study; whereas those who did not claim that teaching they had received had developed their knowledge and skills reported an average of 7.6 hours spent in directed study. The results of this study suggest that diplomate nurses are likely to feel more confident and competent than their graduate counterparts, despite spending the same amount of time with mentors and their peers.
Capturing district nursing through a knowledge-based electronic caseload analysis tool (eCAT)
Authors: Kane Kay
Published: May 2014

The Electronic Caseload Analysis Tool (eCAT) is a knowledge-based software tool to assist the caseload analysis process. The tool provides a wide range of graphical reports, along with an integrated clinical advisor, to assist district nurses, team leaders, operational and strategic managers with caseload analysis by describing, comparing and benchmarking district nursing practice in the context of population need, staff resources, and service structure. District nurses and clinical lead nurses in Northern Ireland developed the tool, along with academic colleagues from the University of Ulster, working in partnership with a leading software company. The aim was to use the eCAT tool to identify the nursing need of local populations, along with the variances in district nursing practice, and match the workforce accordingly. This article reviews the literature, describes the eCAT solution and discusses the impact of eCAT on nursing practice, staff allocation, service delivery and workforce planning, using fictitious exemplars and a post-implementation evaluation from the trusts.
Social isolation and loneliness in the elderly: an exploration of some of the issues
Authors: Dury Rona
Published: May 2014

Older people are more vulnerable to loneliness and social isolation, and are more at risk of a range of health and social issues which can be directly linked to loneliness. However, there are often complex problems which are unique to the older age group which can have a profound effect on the provision and budgets of both health and social care. Various schemes have been put in place across the country to try to reduce the effects of loneliness and there is some evidence to support the mentoring and befriending models, although more research would provide clarity regarding their effectiveness.
The impact of the enhanced recovery after surgery (ERAS) programme on community nursing
Authors: Bernard Helena , Foss Mark
Published: May 2014

Early discharge from hospital as a result of enhanced recovery after surgery (ERAS) programmes can be both positive and frightening experiences for surgical patients. In a recently published article by the authors in the British Journal of Nursing, participants described mixed reactions to the ERAS programme, highlighting the period of home convalescence as being particularly challenging. In this article the concept of ERAS is explained, followed by an overview of the research study which led to the authors highlighting the issue of home convalescence. The interventions that have already been established locally as a result of this research are explored, as is the potential impact that both these short hospital stays and further necessary interventions might have on community nursing. The article examines whether health professionals are sufficiently easing the pressures of self-recovery to fill the apparent ‘void’ that the study participants described as existing between hospital care and community follow-up.
The role of the sign-off mentor in the community setting
Authors: Cooper Karen
Published: May 2014

In an move to identify nursing as an all-graduate profession, the Nursing and Midwifery Council standards identified that future nurses need to be equipped with the skills and knowledge to lead and deliver high-quality care. In order to have these skills within the changing context of health care, students need to experience care delivery across a range of community, hospital and other settings. Students have to undertake a final clinical placement of 12 weeks at the end of their programme, commonly called a consolidation placement, and are allocated a sign-off mentor to confirm they meet the requirements for entry to the register. Placement capacity within primary care settings continues to be a challenge alongside the need for providing a sign-off mentor. This article discusses some of the challenges and opportunities of the role of the sign-off mentor and the potential impact for encouraging newly qualified recruitment in this area.
Regulation of healthcare assistants: an ongoing debate
Authors: Storey Les
Published: May 2014

The regulation of healthcare assistants (HCAs) is a topic which has caused widespread debate since the role has begun to develop. Although the general consensus is that HCAs should be regulated, the problem is deciding who should do the regulating. This article outlines the reasons why regulation is so important and examines the differences between various health care bodies which are preventing a decision from being made.
Care approaches to spirituality and dementia
Authors: Béphage Gaëtan
Published: May 2014

Healthcare literature suggests that spiritual care is as important as physical and psychological interventions (McSherry, 2006). Using this approach can help healthcare staff to address the issue of meeting patients’ holistic needs and enhancing spirituality to promote spiritual health. By identifying a person’s spiritual needs, healthcare staff are able to positively contribute to a person’s wellbeing while in care.
Diabetes: a registered nurse becomes a hospital patient
Authors: Sargeant Mark
Published: May 2014

I have been a registered general nurse since 1988 and prior to this I was an enrolled nurse working on surgical, orthopaedic and respiratory medical wards. After qualifying as a staff nurse I worked in general and vascular surgery for 2 years before going into the speciality of orthopaedic nursing.
NHS 2010-2015: from good to great
Authors: Hughes Rhidian
Published: May 2014

The five year plan, NHS 2010-2015: from good to great, sets out Government's intentions for improving the NHS (Department of Health, 2009a). Crucially, it does so at a time when public sector finances will become increasingly tight in the context of the economic downturn.
Reducing the risk of ulcers and amputations in type 2 diabetes
Authors: Nazarko Linda
Published: May 2014

Although type 2 diabetes is often considered to be ‘mild’ diabetes, it can lead to major complications, such as ulcers and amputations. The number of people with type 2 diabetes who undergo limb amputations has doubled in a decade. Every week 100 people have a limb amputated because of diabetic complications. Simple interventions such as stopping smoking and wearing suitable footwear dramatically reduce the risk of ulcers and amputations and improve quality of life. This article aims to educate the healthcare assistant (HCA) on the reasons why people with diabetes develop foot ulcers, which will enable the HCA to provide appropriate care and support to people with diabetes.
Tackling ‘Sundowning’ in Dementia Care
Authors: Nazarko Linda
Published: May 2014

Disturbed sleep patterns and increased levels of confusion, agitation and behavioural problems in the evening (‘sundowning’) can cause the person with dementia and his or her caregivers great distress. Sometimes, clinicians respond to such problems by prescribing sedatives that can make problems worse. It is important that staff are able to understand why people with dementia develop such problems. Staff should use non-drug treatments whenever possible to improve quality of life ( Ballard et al, 2008 ). This paper explains how disturbed sleep patterns and sundowning affect the person with dementia and how to reduce the incidence of sleep disturbance and distressing behaviours.
Higher apprenticeships: a way into nursing for HCAs?
Authors: Glasper Alan
Published: May 2014

The creation of an all-graduate nursing profession, coupled with the abolition of the practice-based state enrolled nurse (SEN) role, has left a vacuum for the rest of the caring professions in the health sector.

Following the reports of Robert Francis and Camilla Cavendish in 2013, the Government has asked the sector to come up with a ‘higher apprenticeship’ route into nursing for unregulated staff, such as healthcare assistants.

This article discusses this government initiative to introduce higher apprenticeship schemes leading to nurse registration for those who have proven they can deliver health care.
All change for the 21st century: NHS Trusts transformed
Authors: Truss Katie , Ely Jane
Published: May 2014

NHS Trusts are under enormous pressure to change the way they deliver health care to patients, but there is often little information or guidance available to help Trusts achieve these changes successfully. Based on broader research in change management, we present the findings of a study into the context for change within one NHS Trust, and discuss the way in which the challenges identified in the study have been met.
The NHS Plan from an American perspective
Authors: Enthoven Alain
Published: May 2014

Will the Government's NHS Plan (Department of Health, 2000) succeed in staving off a winter crisis? Or even future crises?

Stanford University Professor Alain Enthoven, creator of the Internal Market, assesses the future prospects.
Seasonal greetings
Authors: Baker Mark R
Published: May 2014

Confusion reigns in the NHS. The political structure appears to be in chaos as the Chancellor seems to have taken over from Mr. Milburn. The decision-making structure in the service itself is imploding as health authorities close up shop.
Policy and political fads: the rhetoric and reality of managerialism
Authors: Marmor Ted
Published: May 2014

Based on the Nuffield Trust's 2001 Rock Carling Lecture, this piece considers the past generation of changes in approach to the management of health care. Lessons from America are considered, and this article examines how transient fashions of approach and coercive rhetoric can do serious harm.
Lip service and the cost of the nursing workforce
Authors: Harvey Trevor
Published: May 2014

The Government's annual across-the-board pay award for nurses, a 3.2 per cent increase, was predictable but disappointing, and cannot fuel the increase in recruitment the Government has anticipated. Nurses in Britain continue to receive salaries that make it increasingly difficult for Trusts to persuade the cream of recent qualifiers to take up posts, while increasingly our brightest nurses look elsewhere for career development within a thriving international marketplace for their skills.
Sooth or dare?
Authors: Cowper Andy
Published: May 2014

A soothsayer is a seer or prophet: a person able to predict the future. This definition is odd, since the linguistic root of the word ‘sooth’ means truth or reality. Hmmm. Most soothsayers, whether astrologers, meteorologists or other less useful types such as editorial writers, tell us anything but the truth.
The accidental manager
Authors: Halpern Stephen
Published: May 2014

After almost five years in or around the Department of Health, Alan Milburn has finally discovered the secret of success. Health Secretaries will not solve the problems of the NHS because Health Secretaries are the problem of the NHS.
Cardiovascular disease: treating high-risk patients
Authors: Siddall Rhonda
Published: May 2014

This article reviews data on the cost-effectiveness of trating patients at high risk of cardiovascular disease with the drug ramipril.
Will the Retention of Employment Model work?
Authors: Davies Lynn
Published: May 2014

In the light of the ongoing debate about the transfer of NHS staff and their terms and conditions to private sector companies, this article considers the potential effects of transferring ‘soft staff’ and the resulting implications for managers.
Enjoy your Fox-hunting while you still can
Authors: Roth Andrew
Published: May 2014

One of the problems about Parliamentary blood-sports like forced resignations, it that you cannot predict the throat-slicing precisely. Mrs Thatcher sometimes delayed sackings for as much as a year to ensure they were unconnected with the events. She would not permit the resignation of Defence Secretary John Nott, who opposed sending a fleet to recapture the Falklands, until the victory there was in the bag. She similarly delayed dropping two other Tory Ministers who were disasters.
Big is beautiful
Authors: Bell Andy
Published: May 2014

Eagle-eyed media commentators have noticed that the NHS is a very big organisation. It is, they say, second only to the Chinese army in its magnitude, and run (they believe) in similar fashion. While many such commentators sing the praises of large business corporations (such as those which own many of our major media outlets), this newly-spotted ‘size thing’ about the NHS has upset many people. It has also led to accusations that many of the service's faults are because it is a monopolistic monolith, impossible to reform and incapable of responding to what people really want.
Is it real ... or is it Alitalia?
Authors: Cowper Andy
Published: May 2014

Simple. It remains the belief of this journal that its readers are not stupid, and will have formed their own opinions about the usevalue of the simplistic ratings system. This view does not seem to be shared by some in Whitehall Village, who, despite some improvements in the system (and its communication) this year, are still tending to measure the wrong things in the wrong way without robust data.
When a healer harms
Authors: Harvey Trevor
Published: May 2014

I have no doubt that we will all continue to attempt to first digest, and then rationalise with a universal bewilderment, the many hundreds of deaths now credited to the lethal ministrations of Dr. Harold Shipman. in comparison, considering crude statistics, the crimes of child maiming and murder carried out by Nurse Beverly Allitt in the spring of 1991 ago may seem small in scale.
A Foundation for the unthinkable
Authors: Baker Mark R
Published: May 2014

The former Soviet Union's efforts at rewriting history are now, it would appear, being eclipsed by the studied forgetfulness of To ny Blair's so-called New Labour Government.
The Browning of public health
Authors: Halpern Stephen
Published: May 2014

Trying to meet higher NHS staffing targets is bit like trying to fill a bucket with hole in the bottom. The vast proportion of new staff that are simply replacing those who have left the service makes it hideously difficult to achieve real increases.
Round objections to critics of the choice agenda
Authors: Cowper Andy
Published: May 2014

Lord Hunt OBE, formerly Parliamentary Under-Secretary of State in the Lords for the Department of Health, looks back on his time in office and forward to the next wave of NHS reforms.

Prior to his ennoblement, Philip Hunt was Director of the National Association of Health Authorities and Trusts (the predecessor to the NHS Confederation).
A plague on projects
Authors: Ainsworth Steve
Published: May 2014

If there is one thing which makes my heart sink, it's the expression ‘special project’. Whenever I hear those two doom-laden words I wince, not just because I suspect that someone is almost certainly about to waste a great deal of time and effort, but also from embarrassment. I too bear the scars of being dragged into other folks’ fantasies.
Challenging how we think about management
Authors: Learmonth Mark
Published: May 2014

Can Critical Management Studies help us to fresh thinking about health care management? A former NHS manager outlines the background.
How health, politics and politicians interact
Authors: Roth Andrew
Published: May 2014

The battering that National Health Service professionals have received makes them hyper-sensitive to interference from politicians. At the height of Thatcherism, my cousin's husband, a renal consultant at Jimmy's in Leeds, said Tories were akin to “Trotskyists” in their pursuit of “permanent revolution” in the NHS.
Developing the health and social care workforce
Authors: Drennan Vari , Levenson Ros , Goodman Claire , Evans Catherine
Published: May 2014

This article looks at developing the workforce in health and social care services for older people, and considers the relevant perceptions and transferrable learning.
Policy Developments
Authors: Halpern Stephen
Published: May 2014

Equity in the provision of health care has long persisted as the holy grail of both Old and New Labour. Yet despite devoting an enormous amount of energy and resources to its pursuit, there is little evidence so far that this Government is getting anywhere nearer to understanding the problem, let alone producing solutions.
Varying views on the value of patient choice
Authors: Sang Bob , Dixon Mike , Wall Andrew
Published: May 2014

As part of our choice special issue, we present three professionals’ varying views about the meaning and value of choice.
Being daft Down Under - will Michael Howard learn from John Howard?
Authors: Maynard Alan
Published: May 2014

Australian Prime Minister John Howard (the cheery-looking soul who handed Martin Johnson the Rugby World Cup) is pursuing with vigour and stealth a policy of privatising the public health care system. Could there be lessons here for an incoming Conservative Prime Minister in the UK, called Michael Howard?
The measurement of management
Authors: Bell Andy
Published: May 2014

How many NHS managers does it take to change a light bulb? The answer, according to a growing band of politicians, media observers and doctors, is far too many at present.
Markets and super-markets
Authors: Cowper Andy
Published: May 2014

“However selfish man may be supposed, there are evidently some principles in his nature which interest him in the fortune of others and render their happiness necessary to him, though he derives nothing from it except the pleasure of seeing it.”
Mathematical modelling: how and why
Authors: Harrison Gary , Ivatts Simone , Millard Peter
Published: May 2014

This article responds to Mark's (2003) recent commentary on Millard and Ivatts (2002 A and B) earlier articles on modelling health care demand and patient flows.
Will foundation hospitals build on the ‘Baghdad Bounce’?
Authors: Roth Andrew
Published: May 2014

By one of the greatest of political ironies, foundation hospitals and entry into the Euro have a much greater chance of being pushed through by an Iraqi-war-enhanced Tony Blair than if he had not joined in the invasion as a loyal lieutenant to President Bush.
Building better care in a public-private partnership
Authors: Bosanquet Nick , Catchpole Peter
Published: May 2014

This case study for clients with severe learning disabilities presents a successful example of inter-sector practice.
Is this The Real Thing?
Authors: Maynard Alan
Published: May 2014

There have been many ‘false dawns’ in the history of creating incentives for efficiency and equity in the NHS. Has the Government finally staggered on to the right path for ensuring value for money in the expenditure of nine per cent of our Gross Domestic Product?
Thoroughly Modernising Milly leaves the valley
Authors: Halpern Stephen
Published: May 2014

The verdict of history will be to earn Alan Milburn a place at the high table of ministers who have made most difference to the NHS, along from Bevan, Powell, Crossman and Clarke. If that seems to rate him too highly, then it is worth considering what he achieved.
Who will head the new Brownite Department of Health?
Authors: Roth Andrew
Published: May 2014

Under ordinary circumstances, I should now be trying to plot the differences between the policies of two Blairite Secretaries of State for Health: the new former Communist from Scotland against the old ex-Trotskyite from the north-east. I might have dilated on Dr Reid's apparent greater flexibility in negotiations with consultants, or his greater sensitivity to disparities in health treatment for under-privileged areas.
Managing doctors: a contradiction in terms?
Authors: Maynard Alan
Published: May 2014

The term ‘anagement’ and doctors do not rest easily together. Management is about control of process, costs and outcomes. Doctors are concerned with the maintenance of their clinical freedom and the rhetoric of their trade union, the British Medical Association in the recent debate over the consultant contract, demonstrates that this freedom is seen as essential as their high salaries.
Is the NHS racing towards equality?
Authors: Bell Andy
Published: May 2014

Last month, the Government published its official response to the independent inquiry report into the death of David ‘Rocky’ Bennett at a Norfolk psychiatric hospital in 1998.
Smoke and mirrors
Authors: Harvey Trevor
Published: May 2014

I will assume that you, dear reader, are a committed, altruistic and career-oriented actor in the National Health Service. Your email inbox is bulging, your in-tray is groaning under the weight of glossy documents from ‘the executive’, printed on art paper in subtle colours, with lots of pastel blue space around the thin columns of logo-laden text.
Election alert - some manifesto questions
Authors: Maynard Alan
Published: May 2014

It seems that we will have an election in May. Tweedledee and Tweedledum are already exchanging blows and often evidence free assertions and counterassertions about waiting times, competing programmes of cuts in ‘unnecessary’ bureaucracy and trust deficits.
Anti-TNF drugs for rheumatoid arthritis
Authors: Bosworth Ailsa
Published: May 2014

Rheumatoid arthritis (RA) has had more publicity since the advent of anti-TNF drugs than ever before in the history of the disease.
Polarising polls and eventual events
Authors: Timmins Nicholas
Published: May 2014

It's over, and four weeks of campaigning have given way to a general election result — one which everyone knows except the author. Not because I'm on another planet, but because this is written prior to the voting.
Outcome measures the next step for Payment By Results
Authors: Cowper Andy
Published: May 2014

So it's goodbye to cuddly, avuncular Dr John Reid, and it's hello to Matron Patricia Hewitt, the ‘listening’ new Health Secretary. Dr Reid's debating and public speaking skills were two key attributes, as was his unwillingness to embark on new structural reforms for the sake of it. We wish him well with the Ministry of Attack.
The double-edged sword of scientific research
Authors: Bell Andy
Published: May 2014

Like sand from the beach, medical research gets into all sorts of strange places. The recent furore over the legal status of cannabis is a case in point. What started out as a policing measure, designed to reduce the burden on officers of policing the consumption of a drug that, while still illegal, would no longer carry such severe sanctions for possession, ended up as a major health scare that could still lead to a very significant change in the direction of government policy.
Fear and loathing
Authors: Cowper Andy
Published: May 2014

I'm fine, thank you for asking. This locality (south-west London) feels a bit high-risk at present, but the psychopaths, sociopaths and pseudo-religious neanderthals behind the attacks on London's public transport didn't get me yet. See Catch 22.
The pharmaceutical industry, probity industry, probity and the NHS
Authors: Ley Richard
Published: May 2014

Probity is key in relationships between the NHS and its suppliers. It is vital for the NHS to work in productive partnership with many different groups, and these relationships must be demonstrably above board in every respect. Effective codes and guidelines have a major part to play in this.
The K.I.S.S. of death of the new GP contract
Authors: Ainsworth Steve
Published: May 2014

According to the 18th century economist Adam Smith, ‘The tax each individual is bound to pay ought to be certain, and not arbitrary. The time of payment, the manner of payment, and the quantity to be paid, ought all to be clear and plain to the contributor, and to every other person.’
Commissioning and managing palliative day care
Authors: Payne Malcolm
Published: May 2014

Palliative day care has increased from 30 units in 1985 probably providing fewer than 500 places in total to the point where nationally there are around 13,000 places.
Perceptions of the clinical director role
Authors: Cragg Robert , Marsden Nicola , Wall David
Published: May 2014

Two decades have elapsed since clinical directorates were first introduced into the NHS, yet evaluations of the clinical director (CD) role remain limited and lack practical application.
Quality improvement: theory and practice
Authors: Boaden Ruth
Published: May 2014

In October 2008, the NHS Institute for Innovation and Improvement published a report which focused on the many quality improvement approaches used in health care (Boaden et al, 2008). It reviewed the Plan-Do-Study-Act (PDSA) cycle, Statistical Process Control (SPC), Six Sigma, Lean thinking, Theory of Constraints (TOC) and Mass Customisation, and drew on academic and empirical sources of information to provide a series of challenges for healthcare managers and leaders. Quality improvement approaches from industry are increasingly applied in health care and this article considers what evidence exists of their effectiveness and applicability.
Working in partnership with service users
Authors: Maher Lynne , Baxter Helen
Published: May 2014

Creating a health service where we no longer do things ‘to and for’ patients, but work with them as equal partners in their own care, is at the centre of health strategy, policy and reform. The use of the experience based design approach will ensure that healthcare services truly reflect the needs of patients, carers and staff based on their actual experience. It provides a mechanism whereby patients’ experiences provide insights which identify opportunities and they contribute fully to the change process, leading to safer, more dignified, effective and reliable care.
The costs of pandemic flu
Authors: Appleby John
Published: May 2014

By the time you read this, we will either be in the grip of a full-blown WHO Phase 6 global pandemic outbreak of the H1N1 strain of flu... or, er, possibly not. If a pandemic does occur, the impact on people's health and economies could be significant.
Implementing Lean in primary care
Authors: Roberts Sally , Singh Suresh
Published: May 2014

There have been a variety of articles on how Lean thinking has been successfully implemented within the acute sector, but very few on how it can and should be implemented within provider services across primary care. This article discusses the journey undertaken for the successful implementation of Lean throughout an organisation, and how the development of a service improvement strategy-with Lean principles at its core-has promoted the provision of quality services and effective evidence-based outcomes to ensure the organisation is fit for the future.
Wellbeing in healthcare organisations: key issues
Authors: Robertson Ivan , Flint-Taylor Jill
Published: May 2014

There is a growing level of interest and activity in the wellbeing of staff in healthcare organisations in the UK. This interest is both stimulated and supported by a body of literature ranging from the NHS Health and Wellbeing Review (Boorman, 2009), to internationalscientific studies linking wellbeing with organisational performance. Also relevant is the practical experience of healthcare organisations that have begun to adopt a more strategic approach to staff wellbeing. By combining a study of these sources with the authors' own experiences of the practical application of wellbeing interventions, both within and outside the health sector, three main themes were identified: the importance of psychological wellbeing; the importance of identifying and tracking measurable benefits; and the role of management and leadership, and the need for a strategic approach. These themes are explained and discussed with reference to key research articles, the latest national reports, and examples of strategic work being carried out in this area by NHS trusts.
The middle manager's role in quality improvement
Authors: Wilson Steven
Published: May 2014

Middle management can be a difficult position to hold in the health service and their role in facilitating quality improvement can often be undervalued or misunderstood. However, there is increasing evidence demonstrating that middle managers are fundamental to implementing service improvements and other organisational changes that make a real difference to patients. As well as the top-down one-size-fts-all approach to quality improvement and the bottom-up professionally-led approach, there is a ‘middle out’ approach that can bring great benefits. This article identifies four key roles that middle managers can play in supporting quality improvement initiatives: communicator, coordinator, campaigner and conflict manager.
Attitudes to biomedical waste management
Authors: Reshmi Bhageerathy , Kumar Sinha Rajesh , Gopi Krishna
Published: May 2014

Context: Awareness of safe waste management practices among the health care community is crucial. Objective: To assess the knowledge and attitude of nurses and paramedical staff towards biomedical waste management. Materials and methods: A total of 819 respondents were interviewed in ratio of: nurses (514); operating theatre (OT) technicians (63); laboratory technicians (76); and housekeeping staff (166). The tool used was a semi-structured questionnaire with questions on awareness and attitude towards biomedical waste management. Statistical analysis: SPSS version 11.5 was used, Chi-square test was carried out, and p<0.05 was considered significant. Results: The respondents’ awareness on waste management being conducted in the hospital was 100%. This response was similar in terms of awareness of facilities present in hospital for segregation and removal of waste, but only 88% of housekeeping staff knew about it, compared with 100% in the other three groups. When asked whether safe management of health care waste is an extra burden on their usual work, 76% of the laboratory staff responded positively, followed by 71% of OT staff, 67% of housekeeping staff and 47% of nurses. The responses were found to be statistically significant (p<0.05). Conclusions: Nursing professionals had an edge over the other staff regarding awareness of waste management, which can be attributed to their accountability and commitment in ward management. The OT technicians, laboratory and housekeeping staff had comparatively less understanding of the subject, but had a more positive attitude.
Behavioural science in public health policy
Authors: Cheung Ronny , Ardolino Antonella
Published: May 2014

Governments have a natural interest in making sure that people look after themselves. The burden on society of a population which makes poor choices in their physical, financial, social and personal lives is ultimately borne by the state, to varying degrees. Nowhere is this more true than in health, and in the UK we feel this particularly acutely because we have a state-funded universal health care system which commits to bearing the cost of treating all of its citizens. If we can prevent people getting ill, the benefits for the NHS, as well as to society as a whole, are potentially immense. The estimated cost to the NHS of alcohol misuse is £2.7 billion per annum, smoking £2.7 billion, obesity £4.2 billion and inactivity £1–1.8 billion. The wider cost to society is estimated at £20 billion per annum for alcohol misuse, £5.2 billion for smoking, £15.8 billion for obesity and £8.3 billion for inactivity, in England alone ( DoH 2009 ). The current climate of financial austerity only makes the need to reduce the impact of these lifestyle conditions more urgent and pressing. The publication of the Public Health White Paper signals the intention of the Coalition Government to pursue ‘nudge’ principles of behavioural science to improve the health of the population. But what really is the science behind ‘nudge’, and why should clinicians and hospital managers be interested in it?
Measuring the impact of social enterprises
Authors: Bertotti Marcello , Sheridan Kevin , Tobi Patrick , Renton Adrian , Leahy George
Published: May 2014

The economic crisis and present government's strategy on spending cuts have put pressure on public bodies to do ‘more with less’. With their pursuit of a balance between social and economic objectives, social enterprises have the potential to minimise costs for public sector service delivery and fulfil a number of other policy priorities. The coalition government suggests identifying the best social enterprises and then rolling out their innovative services across the country. However, nowhere is the social, environmental and health value created by social enterprises captured systematically and there is not a level playing field that enables comparison across different types of social enterprises. In this article, the State of Social Enterprise Survey 2009—one of the the largest surveys on social enterprises ever conducted in the UK—is used to discuss the extent of the uptake of impact measurement tools. Results from the survey show a poor use of these tools in the social enterprise sector overall, although health and social care social enterprises fare slightly better. Some policy implications are considered, particularly around the need to create a more appropriate, easy to use impact assessment tool and make sure that organisations are appropriately funded and encouraged to make use of it.
Patient flow analysis: planning a new surgery unit
Authors: Karvonen Sauli , Lehto Matti , Elo Jussi
Published: May 2014

Patient flow analysis brings patients to the core of hospital design by formulating target models for care unit’s patient flow and layout. Each patient transfer is a potential source of deviations as well as waste in the treatment process. In the target model the functions creating the main patient flow can be placed next to each other. In this study, a patient flow analysis was conducted in an orthopaedic trauma unit. IA target model was designed for patient flow in which the operational management of the patient flow is the responsibility of one person. To implement the target model, the unit’s operating theatres, ward, x-ray, and outpatient clinic should be placed as close to each other as possible, with x-ray and a plaster cast/orthoses room located in the interface between the ward and outpatient clinic. This target model eliminates around 5000 patient transfers between organisation units, reducing the number into half seen in the current situation. The target model also improves informal interaction between professional teams.