bluuebunny/crossref_metadata_2025 huggingface dataset:
A lucid interval? Whatever next!
Authors: Baker Mark R
Published: May 2014

It is hard to believe, but there are hints that Ministers are beginning to understand the consequences of their recent folly. Whatever intangible, illusory and elusive benefits there might be from delegating resources and responsibility to scarcely-formed and staggeringly ill-prepared Primary Care Tr usts, the negative consequences of such action are starting to register with our Lords and masters.
Foundation hospitals may fall into Labour's natural fault line
Authors: Roth Andrew
Published: May 2014

Health Secretary Alan Milburn's much-touted ‘foundation hospitals’, approved of both by T o ny Blair and the Tories’ Thatcherite health spokesman Dr Liam Fox, may require severe redesigning if they are to survive. This is not only because their underlying concept of allowing excellent hospitals to outstrip others is under severe challenge.
Pathology (net)working in practice
Authors: Mitchell-Jones Patrick
Published: May 2014

This article considers how managed networks and new technologies can help the modernisation and effective deployment of pathology.
Modelling the demand for same-day appointments
Authors: Jiwa Moyez
Published: May 2014

Providers are encouraged to increase access to primary care services. This directive comes at a time when the demand for services is rising, as are patient expectations (Salisbury 1997).

In this climate, managers must ensure that their teams are comfortable with their workload. We consider the possibility of a ‘Spring cleaning’ effect.
Universal, free, comprehensive?
Authors: Cowper Andy
Published: May 2014

One thing you can say about our second New Labour Government: they've got their mid-term unpopularity in early. The current political flashpoints may be transport and unpopular plans for a ground war on Iraq, but their ‘untouchable’ aura has worn off. Is this now likely to affect the NHS, and alter health policy?
Who turned out the lights? The need for learning
Authors: Price Andrew
Published: May 2014

The ‘Provocations’ series continues with a personal reflection on the need for learning organisations to become more than just a slogan.
Higher professional education: CPD for new GPs
Authors: Rughani Amar
Published: May 2014

As appraisal and revalidation plans are announced and the new contract for general practice goes out to GPs for their judgment, we look at a system with which newly-qualified GPs can be supported in their continuous professional development.
Zero tolerance for violence?
Authors: Harvey Trevor
Published: May 2014

Societies like ours, with their many layers of cultural complexity, are never quite what they seem. The stereotypes that inform our beliefs, attitudes and prejudices operate mostly subconsciously. We tend to assume that however different we may all look, at some fundamental level we have much in common with the mass of the people we pass in the street. This presumption may, however, be unfounded.
Adapting to a complex NHS
Authors: Halpern Stephen
Published: May 2014

Why doesn't the NHS work? Why have successive governments failed to achieve desired change? Why do so many policy interventions fail to achieve the intended consequences? Why is the ‘target culture’ of the NHS doomed to failure?
Milburn KO'd (again) by semi-globalised consultants
Authors: Roth Andrew
Published: May 2014

I note that the Health Secretary has elevated himself to the pantheon occupied by his predecessor, Aneurin Bevan, by being forced to compromise again with the consultants. As in October 2000, it was the heart surgeons who gave him the knockout punch.
Health care modelling: opening the ‘black box'
Authors: Ivatts Simone , Millard Peter
Published: May 2014

In the second of two articles, based on Professor Millard's recent lecture course, we explore the concept of “flow”, i.e. how patients actually move through hospital beds. The use of mathematical models to describe flow is outlined, and examples are given of practical applications in health care management.
Are salaried GPs the same as GP principals?
Authors: Reeves Diane , Rolfe Andrea
Published: May 2014

In the UK, there are increasing numbers of fixed-term salaried GP schemes designed to improve recruitment to general practice. This represents a move away from the traditional model of GP principals, providing care from the same practice for many years. We ask whether the new-style salaried GPs are carrying the same caseload as GP principals, and what patients’ views are on this development.
Milburn gets it right? 'Tis surely a miracle!
Authors: Maynard Alan
Published: May 2014

Like most drunken sailors, Comrade Milburn is spending like there is no tomorrow. He has concluded a deal with the consultants, which he describes as ‘something for something’. Without doubt, the consultants have succeeded in getting their mouths stuffed with gold yet again. But what will the NHS, let alone patients get in exchange?
Mental health policy: made in Bedlam?
Authors: Bell Andy
Published: May 2014

The wonderful great British summer: Wimbledon, Glastonbury, sunshine and showers, long school holidays (save for the poor souls with private tutors) and Department of Health consultation papers.
A NICE little earner, but what's the gain?
Authors: Harvey Trevor
Published: May 2014

We live in exciting times, don't we? NICE, the government-sponsored initiative spawned to be as nice as possible to everyone, while avoiding any offence to anyone who could possibly be differentiated from anyone else on the basis of, well, anything really, has improved on even its own nice nature. If that were possible.
The law of inverse relevance
Authors: Maynard Alan
Published: May 2014

What to do with general practice? For a decades, politicians have proclaimed the mantra of a “primary care-led NHS”, praying all the while that no-one would ask them what they meant. Primary care is A Good Thing, like motherhood and apple pie.
The early lives and times of London PALS
Authors: Abbott Stephen , Bentley Jane , Lanceley Anne , Meyer Julienne
Published: May 2014

This article provides an interim update on the progress so far of some of the new Patient Advocacy and Liaison Services (PALS) in London.
Book Reviews
Authors: Sang Bob
Published: May 2014

‘Doctor’,‘Patients’ - what a strange way to describe human beings Prot, in the film K-PAX
Retiring gracefully
Authors: Harvey Trevor
Published: May 2014

Work till you drop? Draw a pension at the end of your life for, if you're lucky, four or five years? I am a Baby Boomer, born during that biologically-inevitable population bulge which followed the Second World War. Frankly, I have not been gobsmacked at the foreseeable, but belated, recognition that British pensions have become a disaster waiting to happen. Demographics have made this realisation a blinding flash of the bloody obvious for decades, but buck-passing ministers have opted to ignore the implications until now.
Testing the foundations
Authors: Bell Andy
Published: May 2014

As another winter begins, the NHS is already the focus of a rising tide of attention. Newspapers and televisions are buzzing with stories of NHS woes, from the painfully familiar tale of the the toddler forced to wait on a trolley for 16 hours to the rather more novel case of a patient suing the NHS to have treatment abroad.
Meeting a suburban matron in a bordello
Authors: Roth Andrew
Published: May 2014

As a long-time biographer of politicians, I find that meeting the changelings among them can be as embarrassing as walking into a bordello and finding the madame is someone you knew as a respectable suburban matron. It can be as embarrassing for the changeling politicians as well. On our frequent trips facing each other on London Underground's Jubilee Line, taking me to West Hampstead and him to his Brent constituency, I have never had so much as a nod of recognition from Paul Boateng, the first half-black Cabinet minister, because I have chronicled in my Parliamentary Profiles his early career as a Trotskyist, including his inflammatory speeches at fringe meetings of the semi-Trotskyist Labour Herald, allegedly partly financed by the Libyans. Recently, he has been seen noisily cheering on Tony Blair as the PM has been whooping it up for a war in Iraq.
Filling in the forms
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.
Institutionalised contempt for elderly people continues into 21st century
Authors: Halpern Stephen
Published: May 2014

Anyone who hoped that the dawning of a new century would mark the end of British society's appalling mistreatment of the elderly people will be bitterly disappointed. Whether in the formulation of central Government policy, local health and social care implementation, or media coverage, there still remains an overwhelming desensitisation to the plight of the elderly.
PFI pie in the sky
Authors: Halpern Stephen
Published: May 2014

For decades, the NHS has reduced its bed numbers on the basis of all kinds of weird and wonderful criteria. Most of these criteria have been either about reducing excess capacity or achieving higher utilisation rates.
Table manners at the health care feast in the USA
Authors: Maynard Alan
Published: May 2014

During the early 1990s, managed care organisations were relatively successful at herding US provider-beasts and controlling their appetites for USA health care resources. By dividing and conquering the providers, managed care companies were able to gain discounted fees from physicians, hospitals and the international drug barons in the pharmaceutical industry.
‘Making Amends’ - mediating medical matters
Authors: Allen Tony
Published: May 2014

With the mounting costs of court cases for clinical negligence in the NHS still a key issue, the Chief Medical Officer's report ‘Making Amends’ drafts the next chapter in this saga. This article explores how dispute resolution can help the health service.
The new ‘health check' for the NHS from 2006
Authors: Kennedy Ian
Published: May 2014

The Healthcare Commission's new system for assessing the performance of those organisations providing health care will be introduced in 2006.
A war on drugs or a war on addicts?
Authors: Greener Mark
Published: May 2014

There's no way to place a positive spin on this; no way to sugar the unpalatable pill. The NHS condemns some intravenous drug users (IDUs) to a premature death and many more to tragic lives of unremitting misery
Is there light at the end of the tunnel?
Authors: Maynard Alan
Published: May 2014

For those of a pessimistic demeanour, current NHS policy is a mad jumble of half-baked policies with no attempt to ensure consistency by ‘joining them up’. It seems as if the wonkers in Downing Street invent ideas by the week and the Great Leader responds, “right on boys!” that sounds a good wheeze!”
Whither dentistry? Wither dentistry? What lies ahead?
Authors: Wylie Ian
Published: May 2014

The second-term Blair Government's failure to sort out NHS dentistry was a small but irritating black mark on the former Secretary of State Dr John Reid's end-of-tenure report.
Divergent staff responses to change in primary care
Authors: Hockly Anthea , Caan Woody , DeBell Diane
Published: May 2014

A research questionnaire was developed in an area that had previously identified a shortage of general practitioners. This questionnaire was completed at multiple sites by 43 staff - a mix of doctors and nurses in two primary care trusts.
Involving the patients and public in health
Authors: Shapiro Janet , Taket Ann
Published: May 2014

The Department of Health for England and Wales (DH) has indicated a commitment to consulting and listening topatients. Their aim is to increase involvement of patients and public in all areas of health care: how the individual patient is treated, how local services are delivered; and how decisions for overall planning are made.
Suitable pressing concerns for the DH?
Authors: Bell Andy
Published: May 2014

To mark the middle of the ‘silly season’ for news, last month the Department of Health published a new survey (DH 2005). Not another of its usual surveys, for example of public attitudes towards the NHS or of GPs’ views about Payment by Results, but of press coverage about health.
What's going on?
Authors: Cowper Andy
Published: May 2014

The contradictions in system reform have become like VPL (Visible Panty Line) with a party dress: they're showing, and they don't look good.
What the Mental Health Bill should look like
Authors: Bell Andy
Published: May 2014

In the middle of November, the long-awaited Mental Heath Bill was finally published. The Bill, which we now learn will amend the 1983 Mental Health Act rather than replacing it, has been widely criticised.
Leadership and learning from failure
Authors: Goodwin Neil
Published: May 2014

Leadership is a dynamic, interpersonalbased process. As such, it is subject to the human foibles that we all possess. Leadership demands respect for people's basic need for direction and protection, and it requires compassion and support at times when change is distressing.
The crisis in services that never was?
Authors: Bell Andy
Published: May 2014

While NHS managers across the country struggle with a bulging intray of reorganisations, financial crises and changes of policy, the outside observer of the system must wonder what on earth is going on in our unprecedentedly well-funded health service.
Predicting the next Maidstone disaster
Authors: Appleby John
Published: May 2014

2008 is the 40th anniversary of a regional health authority independent inquiry into patient care problems at Normansfield mental handicap hospital (as such hospitals were then called) in Teddington. The inquiry was sparked by a strike by nursing staff on 5 May 1976 over their grievances concerning Dr Terence Lawlor, a consultant psychiatrist in mental subnormality (again, the nomenclature has moved on).
Your individual healthcare menu
Authors: Bell Andy
Published: May 2014

Last month, David Nicholson told a King's Fund conference that individual budgets for health services were likely to be on their way within a few years. At first only for those with long-term conditions, Mr Nicholson anticipated people would work in groups through a system of brokerage to commission services for themselves from a range of providers (quoted in HSJ, 22 Nov 2007).
The first casualty of reform - lost NHS values
Authors: Halligan Aidan
Published: May 2014

Waiting lists have disappeared, winter crises are a thing of the past and there are significantly more doctors and nurses. By every orthodox and conventional measure, the substantive additional investment in our National Health Service since 2000 has made a real difference. The NHS is better than ever before.
Bare-knuckle fight? Own goal, more like.
Authors: Cowper Andy
Published: May 2014

Cowper's 19th Law states that ‘for every opinion poll, there is an equal and opposite opinion poll’. Nevertheless, there are slowly-firming signals that PM Gordon Brown may be starting to give a snap autumn general election more than cursory consideration. Polls have suggested a significant and sustained lead for Brown over David Cameron in public opinion as to who would make the best prime minister. This is in addition to a range of polls showing that Labour has sustained a lead over the Conservatives for several weeks.
Mental healthcare in prisons - and on release
Authors: Cowper Andy , Duggan Sean
Published: May 2014

In general, there's been significant improvement over the last four to five years, particularly when the responsibility for commissioning services was taken over by the NHS from the prison service.
Improving primary care and mental healthcare
Authors: Wesson Michael
Published: May 2014

Most people who have mental health problems initially seek help from their General Practitioner, and continue to be treated wholly in primary care.
Building smaller hospitals
Authors: Jones Rod
Published: May 2014

Earlier articles in this series investigated the capacity margin dictated by the 18-week referral to treatment guarantee (Jones, 2009a; 2009b), i.e. all targets have implicit capacity implications. This article will examine the application of a capacity margin into understanding bed occupancy and bed numbers
Limitations of the HRG tariff: local adjustments
Authors: Jones Rod
Published: May 2014

The market forces factor (MFF) is a local adjustment to the tariff, which takes ‘cost of living’ factors for staff, buildings and land into account for all NHS organisations (Wilson et al, 1996). If the MFF is so important to provider costs, then why does it have an insignificant effect on the observed variation between providers at healthcare resource group (HRG) level?
Trends in emergency admissions
Authors: Jones Rod
Published: May 2014

Part one of this series discusses how the more widely recognised factors, such as an ageing population, re-admissions and increasing expectations of medicine, only contribute to a baseline increase in emergency admissions. Seasonal variation is discussed in the context of the predictability, or otherwise of emergency admissions, in response to changes in the weather and the wider environment. However, these are unable to explain the observed cyclical events occurring in medicine every 4-6 years, and even longer cycles in surgical and trauma admissions. These cycles are discussed in part two, while part three investigates the implications on bed planning. The current methods for estimating the size of hospitals and bed pools within hospitals are shown to be inappropriate to the real needs of emergency care.
Shaping PCT provider services
Authors: Imison Candace
Published: May 2014

The Government wants the commissioning and provider functions of primary care trusts (PCTs) in England to be separated. By October 2009, PCTs must have outlined their plans to reconfigure their services. This article is a summary of a Kings Fund report (Imison, 2009) written to help PCTs as commissioners, and their community providers, to consider the future configuration options.
Organisational leadership development for less
Authors: Ojo Olurotimi
Published: May 2014

This article presents an outline argument for the strategic development of internal coaching capacity within NHS trust and social care contexts. This is in anticipation of the likely impactof reduced public sector spending on health and social care budgets, and the consequences of this on organisational leadership development activity in the future.
Giving oral evidence in the courtroom
Authors: Griffith Richard
Published: May 2014

With increased regulation and litigation in the healthcare sector, appearing in court is becoming an almost routine part of a manager's role. The prospect of appearing in court or giving evidence at a fitness to practice hearing remains daunting. The process is still largely adversarial, and cross-examination is a hostile experience. This article discusses why giving oralevidence requires effective communication and an understanding of the trial process.
The Equality Act 2010: strengthening legislation
Authors: Griffith Richard
Published: May 2014

This article outlines the key provisions of the Equality Act 2010, which aims to simplify andextend discrimination law to include socio-economic factors, discrimination by association, anddual discrimination. Significantly for healthcare managers, it will extend discrimination with regard to age and to the provision of services-and this includes health care.
Opportunities and threats in mental health: part 2
Authors: Breakey R William F , Ghedia Reshma , Ha Joon Soo , Sinha Khushboo , Smith James A
Published: May 2014

With mental health being a prominent issue for the NHS, it is necessary to consider improvements for patient care packages. Having conducted research into the mental health sector and the external providers of care, an analysis must be undertaken of the various external providers. In this article, we look at key questions that have arisen from our research regarding threats and opportunities in the mental health sector for foundation trusts. In order to answer these questions, it is necessary to choose relevant documents to analyse. Criteria were drawn up, and a methodology is outlined. Thematic analysis is used to understand the relevant data from organisations in the private, voluntary and social service sectors. This is then related back to foundation trusts, to recognise where there is room for improvement. Significant areas of interest are services developments, understanding the environment within which one operates and understanding theuser of such services. By analysing various organisations, we will go on to draw substantial conclusions regarding improvements that can be made for foundation trusts within the mental healthsector.
Addressing performance concerns
Authors: Morrow Gill , Burford Bryan , Kergon Charlotte , Illing Jan
Published: May 2014

Aim: To assess the impact of the National Clinical Assessment Service (NCAS) on governance activity for medical and dental practitioners in Northern Ireland. Method: Telephone interviews were conducted with a purposive sample of referrers to NCAS in Northern Ireland. Results: Twenty-two referrers agreed to take part and nineteen were interviewed. Respondents held a range of positions, including senior human resources personnel, but the majority were Medical Directors or Clinical Directors. The majority of referrals were for issues related to clinical competence, although this frequently overlapped with behavioural, health and probity issues. As well as automatically-triggered referral as part of disciplinary cases, reasons for seeking input from NCAS included seeking reassurance, expertise and objective advice. In some cases, employers reached their limits with a case, and NCAS filled the ‘governance gap‘ between local and regulatory responsibility. All respondents expressed satisfaction with the service and found NCAS to be approachable, accessible and neutral. Some challenges remained in handling performance concerns. These included: achieving a balance between patient safety, service delivery and responsibility to the practitioner in question; initial contact with the practitioner; and challenges in identifying and managing performance concerns indoctors who were not located with a long-term employer (i.e. trainees and locums). Conclusion: NCAS has value as an independent non-regulatory body in addressing performance concerns, and could have a positive future role in supporting the regulatory process of revalidation
Foundation trust performance: a quantitative study
Authors: Pollio Gerald , Simonyan Gayane
Published: May 2014

Foundation trusts (FTs), as part of healthcare decentralisation reforms, enjoy considerable financial and governance autonomy. This study aimed to better understand how the trusts balanced the quality, volume and costs of medical services to achieve the best performance by examining the gross association between selected performance measures. It also examined whether actual FT performance was in line with the assumption that implementation of clinical governance measures would lead to improved results. From a sample of 55 trusts, we found a significant positive correlation between the quality and volume of care, as well as between quality and trust financial performance. Better quality of care was associated with higher volumes of services and better financial performance. However, the actual number of high performing trusts in the sample did not differ significantly from the chance predicted number.
Costs of paediatric assessment
Authors: Jones Rod
Published: May 2014

Part one of this series investigated the general costs for assessment activities, while part two investigated how the four-hour A&E target was skewing the costs of A&E attendances. In this part, the cost of specific paediatric assessment activities has been evaluated against the 2010/11 healthcare resource group (HRG) tariff and little linkage appears to exist between the actual cost and the tariff. It is concluded that the approach adopted for the development of HRGs (healthcare resource groups) covering inpatient admission is inappropriate to assess activities for which the key factor is the cost of achieving a diagnosis, rather than the cost associated with inpatient care due to a diagnosis. The current short stay tariff uses a set of assumptions based on length of stay that do not hold for assessment activities.
Efficiency savings: preparing for a bleak future?
Authors: Majumder Pallab
Published: May 2014

The NHS must make £20 billion pounds worth of efficiency savings over the next two years. Using the knowledge and experience of my own specialty in the historical as well as current context, I shall present my thoughts and propose a few ways to save money for NHS by trying to translate the facts from a single highly-specialised service into thinking about universal efficiency savings in NHS. I shall comment on the areas of waste and inefficiency that is being observed and commented on by clinicians working on the front line as well as by the strategic and operational leaders of different services across the regions, tiers and specialties. Finally, I shall reflect on how realistic these proposals are, and what challenges are to be expected in implementing these hypothetical cost improvement plans.
All together now: North West leadership schools
Authors: Holmes S , Ahmed-Little Y , Brown B , Moonan M , Collins S , Liggett H , Simpsonis K
Published: May 2014

Since 2008, medical trainees in the North West have been running a series of very successful North Western Medical Leadership Night Schools. These are open to all junior doctors with an interest in leadership and management. Feedback is consistently positive; attendees are taking learning back to their own organisations demonstrating a clear appetite for more. Against this backdrop, other health professions had also begun developing the leadership capacity of their own members to deliver a clinical workforce prepared to lead. Various initiatives struggled to attract truly multi-disciplinary participation from junior clinicians. The Medical Leadership School model was therefore extended to create a family of leadership schools. By creating different leadership schools for junior clinicians from different discipline, the specific needs of each group could be met. The overall aims of the leadership schools are to develop capacity and capability within the silos of the individual professions while also creating opportunities to then bring people together. Our leadership schools involve hundreds of junior clinicians across the region, allowing them to commit as much capacity as they can spare. We signpost opportunities for those who are keen to learn more and we work within a specific geographical area so our schools support the development of networks, building bridges at the front line.
Orthopaedic litigation what is the financial burden trend?
Authors: Thavarajah Dushan , Hobbs Nigel
Published: May 2014

The purpose of this study was to assess orthopaedic litigation in the NHS over 10 years (2000–2010) looking at the financial loss, injuries (negligence) sustained and causation that resulted in these successfully litigated cases. By doing this we analyse the financial burden, assessing whether the situation is improving, and also learn valuable lessons on improving care. The study included all cases that involved orthopaedic litigation within English NHS hospitals, for patients over the age of 16. Litigation is actually relatively uncommon within the NHS in England with 0.07% claims for the total number of consultant episodes over 10 years. However, it still remains costly at £251 million. Recent trends demonstrate promising results with a reduced number of claims, and more successfully defended closed claims which may be a reflection of subspecialisation within orthopaedics. However, spinal themes relating to delayed diagnosis and negligent surgery account for the 40 of the claims within the top 100 pay outs. Reducing litigation is vital in order to retain autonomy within the profession and can be helped by documenting what you did; the reasoning behind any decision you made; and what your notes say.
Referral letter content: can it affect patient outcomes?
Authors: Jiwa Moyez , Dadich Ann
Published: May 2014

This study aimed to identify the type and level of content within GP referral letters associated with favourable patient outcomes. Data was sourced from both PubMed and Embase, and 528 references were systematically reviewed: 30 articles were included. Information extracted included the influence of referral practices on patient outcomes. The study found that most articles reported on information flow from GPs, which was typically poor. Only two articles noted the direct effect of GP referral on patient outcomes. In conclusion, there is limited research on the type and level of content within GP referral letters to specialists that are associated with favourable patient outcomes. Researchers inferred that: the quality and quantity of information relayed at the interface between primary and secondary care is poor, and that this compromises patient outcomes.
An unexplained increase in deaths during 2012
Authors: Jones Rod
Published: May 2014

A recurring series of infectious-like outbreaks across the UK and in other Western countries has been associated with increased deaths, emergency medical admissions, GP referrals and emergency department attendances. Previous outbreaks in 2002 and 2007 suggested that an outbreak may be due again in 2012. As expected, deaths in England and Wales were observed to show a step-like increase of around 430 to 480 extra deaths per week commencing in the sixth week of the 2012 calendar year, but increasing to around 1000 excess deaths per week in early 2013. A parallel increase in emergency admissions also occurs at the same point in time. The impact at local authority level is highly granular and a genuine infectious outbreak is implicated where the method of transmission is probably by person to person contact. The ubiquitous herpes virus, cytomegalovirus, may be the causative agent but this requires validation.
Quality and patient safety in mental health
Authors: Woodthorpe Nicholas , Bakhsh Esam , Paton Calum
Published: May 2014

Fourteen psychiatrists were engaged in structured interviews on issues of quality and patient safety. Understanding of definitions, major critical incidents, local procedures and perceptions of a safety culture were analysed to develop recommendations for improving patient safety. There was limited understanding of the terms quality and patient safety. There was limited knowledge of major critical incident inquiries in the NHS and little awareness of findings and recommendations. There was a lack of recognition of potential patient safety incidents and, if they were acknowledged, a shortfall in reporting them. Factors inhibiting a safety culture were evident, such as a blame culture and fear of whistleblowing. Consistent and focused training needs to be given to psychiatrists to improve knowledge and awareness of concepts and lessons from incidents. Senior management initiatives need to be developed to promote an improved safety culture.
NHS Property Services: a strategy for the future
Authors: Holden Simon
Published: May 2014

This article describes the foundation of NHS Property Services in 2013 following the implementation of the Health and Social Care Act 2012. It provides an overview of the the role of NHS Property Services following the reforms of 2013, and the organisation's strategy for the future in delivering cost-effective estates and facilities management for the health service.
The Information Governance Review and the new legal framework for informaties
Authors: Grace Jamie
Published: May 2014

To an outside legal commentator, the NHS has recently undergone a distinct shift in the specific legalities that control and empower the sharing of patient information. A great many healthcare managers will be adapting their practices and reacting to these statutory adaptations. Public protection concerns, marketisation economics, health policy, and a push towards greater (appropriate) transparency are the driving forces in this particular context. But the journey is not over. The Code of Practice to be published by the National Health and Social Care Information Centre—the fulcrum of the newly-balanced framework for data sharing—will address the extent to which patients have autonomy and choice with regard to their own information, in a response to the views of researchers, ethicists and politicians alike.
Urological procedures coding: who should do it?
Authors: Hall Katherine , Tang Vincent , Srirangam Shalom
Published: May 2014

This study sought to determine if consultant urologists code better than the coding department, and whether this could save the trust money. This took the form of a prospective study, where consultant urological surgeons completed electronic discharge letters for 30 elective operations during a calendar month. A clinical audit coder then reviewed the case notes independently generating another code (audit coding). These were then compared to the ‘gold-standard’ episode codes that were created by a combined team of a urologist and an experienced senior clinical coder reviewing the notes together and applying local and national standards. Errors were identified with both urologist and coding department coding. The coding department out-performed the urologists in all areas of primary and secondary diagnoses, primary and secondary procedures and resulted in a potential net loss of income of £3456 compared with a potential loss of £8468 from urologist coding. Accurate urological coding is best performed by coders not urologists, since it is complicated and requires training. Clinicians can, however, make a vital contribution by ensuring clear documentation of procedures, primary procedures and ensuring recording of all co-morbid diagnoses. Formal agreement of common codes between urologists and coders will reduce inconsistency and improve efficiency.
Clinical Supervision in a High Secure Hospital
Authors: Carthy John , Noak James , Wadey Emma
Published: May 2014

Preparation and implementation plans are crucial to the successful introduction of clinical supervision. This paper identifies key elements in the implementation and improved uptake of clinical supervision for nurses in a high-secure setting and through the use of a descriptive quantitative survey using questionnaires, evaluates the quality and effectiveness of supervision received.
Developing The New Sign Schizophrenia Guideline
Authors: Cawthorne Patricia , Barron Derek T
Published: May 2014

This article describes the process of developing a national clinical mental health guideline. While describing this process, the authors suggest that the involvement of a mental health nurse in the development of this guideline is an example of the active and important role that nurses are making within mental healthcare in Scotland. The article concludes with the suggestion that mental health nurses should be taking an active interest in, and participating in similar important strategic clinical developments across the NHS in Scotland.
Acceptance and Commitment Therapy
Authors: Curran Joe , Darling Jennifer , Rogers Paul , Gournay Kevin
Published: May 2014

This article discusses acceptance and commitment therapy. It outlines the principles that underpin acceptance and commitment therapy practice, and how these principles can be applied. It encourages the reader to reflect upon their own use of the techniques, and to review their strengths and weaknesses.
Mental health problems in military personnel
Authors: Hayes Catherine
Published: May 2014

For some military personnel, the reality of a return to civilian life can be marred with issues of mental health. The incidence and prevalence rates of depression and substance misuse in currently serving personnel and veterans is striking. This article serves to highlight the need for increasing awareness of issues pertaining to mental health in military personnel and veterans, which can be used as predictors of risk in the likelihood of attempted suicide or longer-term mental illness.
The Open Doors network: dementia and self-growth
Authors: Howorth Mike , Keady John , Riley Cathy , Drummond Gillian
Published: May 2014

This article outlines the development of the Open Doors network facilitator post in Greater Manchester West Mental Health NHS Foundation Trust. The post is unique in the NHS in that it is led and facilitated by Mike Howorth, a person with Alzheimer’s disease. This article outlines the self-growth and wellbeing experiences of Mike as he re-entered the workforce in his early 80s after 15 years of retirement. Being the Open Doors network facilitator has provided Mike with new challenges and opportunities in his life, including facing up to, and overcoming, a life-long fear of public speaking. The achievements of the post are shared within Mike’s overall story of his own wellbeing, as well as his ambitions for the post in the future.
Delivering person-centred, safe and effective care
Authors: Moore Ros
Published: May 2014

Ros Moore says that mental health nursing is no longer the ‘Cinderella’ of the past, and that nurses are leading the profession
The mental health needs of black and minority ethnic men
Authors: Peate Ian
Published: May 2014

Little is known about black and minority ethnic (BME) men and their mental health needs, including how they experience and express their distress. Mental ill-health is often the result of a number of interacting factors—physical, biological, social, environmental, political and psychological. Men from BME communities can face specific disadvantages as a result of racism and discrimination. These disadvantages can often be seen through poverty, their housing, health, education and employment. This article aims to provide a better understanding of BME mental healthcare, inform awareness among mental healthcare providers and discuss the nursing response to ensure that men from BME communities are provided with care responsive to their unique needs.
The development of the Wellbeing Evaluation Scale
Authors: Kelly Angela , Papadopoulos Andrew , Oyebode Jan , Bäckmark Goodwill Helena , Halloran Elizabeth
Published: May 2014

Wellbeing is a complex construct and to date there has been great inconsistency across measures of wellbeing with respect to their theoretical foundations, dimensions, composition, and psychometric properties. The need for wellbeing measures that have robust epistemological and ontological frameworks and sound psychometric properties is evident as a basis for effective care planning, outcome evaluation and research. The following paper describes the development and psychometric evaluation of the Wellbeing Evaluation Scale (WES), long and short forms, from an analysis of data drawn from a representative population of 203 adults aged 55 years and over. Following an initial pilot study (n = 98), a repeated investigation involved a representative sample of 203 adults over the age of 55 who were recruited from the West Midlands for this study. The findings suggest that the WES is a reliable, valid, and representative measure of wellbeing in adults over 55. It is concluded that the WES can be considered as a reliable tool for the purposes of assessment, care planning and research.
NHS 24: The role of the nurse consultant
Authors: Johansen Ron
Published: May 2014

This is the second of two articles looking at the role of the nurse consultant in NHS 24. NHS 24 is Scotland's national provider of telehealth services. To set the context for the nurse consultant role, the first article explores the growth in telehealth and outlines its impact on mental health nursing. This article considers the network of teams the nurse consultant works within and between before reflecting on the scope of the role, 'nursing at a distance' and the preparation necessary for practice in a different and challenging care environment. The value of a joint appointment between NHS 24 and Glasgow Caledonian University in signalling organisational commitment is reflected on before concluding.
Bored to death: tackling lack of activity in care homes
Authors: Boyd Andrea , Payne Joanne , Hutcheson Catriona , Bell Sheena
Published: May 2014

Approximately two thirds of people in care homes have a form of dementia ( Alzheimer's Society, 2007 ). The majority of care home residents with dementia spend most of their time engaged in no activity at all, with unstructured time accounting for two thirds of their day ( Lucero et al, 2001 ). Engagement in meaningful activity can change mood, behaviour and even cognition for the duration of the activity ( Pulsford, 1997 ). Activities expand knowledge and provide a sense of meaning and accomplishment ( Tappen, 1997 ). They facilitate socialisation and communication and enhance self-esteem ( Wald, 1993 ). Finally, they provide physical, mental and emotional stimulation ( Whitcomb, 1993 ). Therefore, failure to provide opportunities for therapeutic activities for persons with dementia is tantamount to abuse ( Crump, 1991 ). The provision of training for care home staff facilitates grading of activities to ensure they are appropriate to each resident's ability and interests. It also reduces the risk of discouragement and hostility, experienced when activity breaks down ( Pulsford, 1997 ).
Embedding Safe to Say: supporting survivors of abuse
Authors: McNay Lisa , Marland Glenn , Martin Colin R , Duffy Tim , Hampson Sue
Published: May 2014

This is the second article relating to the embedding of Safe to Say into a BSc pre-registration course. The first article ( McNay et al, 2012 ) outlined the format of Safe to Say and its rationale and indicated the need for evaluative research. This article reports on the first two student cohorts that were evaluated. Improvement in the selfperceived confidence and competence of participants was apparent at end of the training and on three-month follow-up as compared to pre-workshop assessment. Qualitative data supports and elucidates the quantitative findings and four clear themes are identified.
The brilliance of resilience
Authors: Gillam Tony
Published: May 2014

Tony Gillam reflects on his past experiences of the concept of resilience
Is there a crisis in inpatient mental health care?
Authors: Rooks Jennifer , Mutsatsa Stanley
Published: May 2014

The standards of care in the NHS are the subject of debate. Frequently, members of the public have complained about poor staff attitudes towards patients and visitors alike and this has generated discussion as to the best way forward for the nursing profession. In mental health, poor standards have been reported on numerous occasions and the first author had firsthand experience of casual nursing attitudes when she visited a friend in an acute inpatient mental health ward. This article uses her anecdotal account to highlight poor standards in mental health. The paper then examines possible antecedents to this vexed issue before suggesting a way forward.
Recovering wellbeing: an integrative framework
Authors: Papadopoulos Andrew , Fox Andrew , Herriott Martin
Published: May 2014

The concept of recovery continues to be central in informing mental health policy and provision in the UK. Contemporary recovery frameworks often highlight the maximisation of individual potential and the achievement of identified recovery goals as key outcomes on which mental health services are designed, delivered and evaluated. Despite this, many people experiencing severe mental health difficulties continue to struggle to achieve their potential and to live meaningful lives within their local communities. This article considers recovery orientated approaches in terms of their relevance in addressing the experiences and needs of this population. The authors propose integrating a recovery focus within a wider wellbeing framework and needs-adapted care pathway that views wellbeing as contextualised within multiple dimensions of a person's environment and which views recovery as the journey through which people experience wellbeing. The implications for mental health services and nursing are discussed.
Keeping an open mind: treating alcohol misuse and depression
Authors: Fernandez Jeff
Published: May 2014

This article explores the concept of treating depression for problematic and dependent drinkers. It has been clinically stated that it is always best to treat depression for a patient with alcohol dependence when the person is able either to abstain from alcohol or maintain consumption of alcohol at minimal levels. This is the approach most clinicians in the area of alcohol dependence adopt, however, this article advocates an open approach to treating patients with this dual problem. In some cases, initiating treatment for depression, such as prescribing an antidepressant, can lift a patients’ mood and cut down on their alcohol consumption quickly. This can help often problematic patients to engage in their alcohol treatment. This article explores this concept through a detailed case study from an inner city London primary care clinic. It concludes that keeping an open mind on treating depression for alcohol problematic and dependent drinkers is the most effective way to treat this cohort of patients.
Verbal orders: are you up to date with current guidance?
Authors: Haw Camilla , Stubbs Jean , Dickens Geoff
Published: May 2014

Verbal orders are known to be associated with medication errors—especially in general hospitals—but there is an absence of research into them in psychiatry. Fifty inpatient nurses working in a large psychiatric hospital were asked if they would accept a verbal order from a doctor. 26% said they would not accept a verbal order, though only 12% were aware of the current guidance. A further 12% lacked confidence into taking a verbal or were unsure of the exact procedure, while 62% gave an incorrect account of how to take a verbal order. Recent attendees on a medicines management training course or those who said they were familiar with national guidance were no more likely to be aware of the correct procedure than the remaining nurses. The findings have implications for local training needs. This simple study could easily be repeated in other settings to check that nursing staff are up-to-date with current guidance and thereby minimising the risk of medication errors. Suggestions are made for further research into verbal orders in psychiatry.
The blood-brain barrier: Its implications in neurological disease and treatment
Authors: Khan Ehsan
Published: May 2014

The blood-brain barrier is the main structure that protects the brain from internal insult. The blood-brain barrier consists primarily of cerebral capillaries which, under the influence of neighbouring cells, present a restrictive barrier to potentially harmful blood-borne toxins. Although the blood-brain barrier has been discussed in the literature for nearly a century, awareness of its clinical and pharmaceutical importance is only now being realized. As knowledge of this structure improves, clinical interventions that modify the blood-brain barrier will become more common. It is therefore important that practitioners involved in the care of patients with neurological dysfunction have a basic understanding of how this structure works. This paper describes the physiological nature of the blood-brain barrier and provides an insight into the widespread impact it has on central nervous system disease and treatment.