bluuebunny/crossref_metadata_2025 huggingface dataset:
Two cheers and a question
Authors: Cowper Andy
Published: May 2014

Observing the NHS reform agenda over the past eighteen months has been like watching a demolition derby. The fascinating, almost tragically inevitable procession of car crashes and wanton destruction - from ‘Commissioning A Patient-Led NHS’ to Baron Crisp of Eaglescliff to tariff to PCT and SHA redisorganisations - has managed to make the end sequence of The Blues Brothers movie look like a road safety advertisement.
Mister In-Between
Authors: Cowper Andy
Published: May 2014

Congratulations to David Nicholson on his selection to be the next chief executive of the NHS. Sir Ian Carruthers’ note to chief executives describes him as “someone who is passionate about the NHS and tireless in his drive to improve health and patient care. He leads by example, inspiring his colleagues and helping people give their best. I know he will be an excellent and inspiring leader of the NHS through the next period of delivery and reform”.
Can Patricia Hewitt copy John Reid's ‘mea culpa’?
Authors: Roth Andrew
Published: May 2014

Should Health Secretary Patricia Hewitt emulate the example of her Cabinet colleague Home Secretary John Reid's lengthy, unveiling of his department's failures and his drastic culling and replacement of top mandarins?
Will the Blair reforms of the NHS work?
Authors: Maynard Alan
Published: May 2014

After pumping billions into the NHS, access times and other process aspects of health care have improved, particularly in England where change has been managed with central targets and performance management. But many of the fundamental problems of the NHS remain in all four parts of the United Kingdom.
Are we ready for homegrown terror threats?
Authors: Ainsworth Steve
Published: May 2014

Human attention span sometimes seems extraordinarily short. Today the focus of anti-terrorism is on the skies;last year it was underground trains. The most recent terrorist acts have been associated with conventional explosives. As a result many people seem to have temporarily forgotten the potential danger posed by biological weapons.
Summertime blues
Authors: Cowper Andy
Published: May 2014

So I hope August was good to and for you, as we go back for what promises to be a memorable term. All sort of things are coming up in the next few months, but I thought I'd focus briefly on PCTs and commissioning.
Management resolutions in 2007: happy new year?
Authors: Cowper Andy
Published: May 2014

I want to see a target set and enforced by the Department on every NHS body to cut by 50% its use of external consultants. Pour encourager les autres, the Department itself should have a stretch target of 66%!
Just say no to health juries
Authors: Roth Andrew
Published: May 2014

I was just trying to decide how I felt about Gordon Brown's proposal of ‘citizens' juries’ to decide on health matters when a crucial letter came.
The future of cancer care in the NHS and beyond
Authors: Cowper Andy , Sikora Karol
Published: May 2014

Does the NHS currently deliver its cancer services clinically effectively and cost-effectively?
Putting cancer care into perspective
Authors: Harvey Trevor
Published: May 2014

Former nursing teacher and freelance writer Trevor Harvey gives an overview of cancer and cancer care today. Cancer is often perceived in the public imagination as a singular disease, but is more accurately regarded as a cluster of disease processes which may affect any and every organ and body system. There are over 200 different types of cancer, ranging from the common (such as breast cancer, with over 37,000 cases presenting annually) to the rare ones (such as lip cancer, with only 200 new cases per year)
The real democratic deficits to worry us
Authors: Maynard Alan
Published: May 2014

What a sad lot ministers are! Instead of getting on with challenging inappropriate and inefficient clinical practice variations and persuading doctors and managers that it might be useful to determine with outcome measurement whether patients are getting better as a result of NHS care, they are twittering about the democratic deficit!
Inspectors general needed
Authors: Roth Andrew
Published: May 2014

Their lordships were happy to give much more than their usual polite welcome to Lord Darzi at his first appearance before them in October as the DH's No. 2 and main progenitor of Gordon Brown's latest NHS ‘reconfiguration’.
Why clinical quality must come first
Authors: Moyes Bill
Published: May 2014

There is a media industry cliché that suggests good news doesn't make good headlines. In the NHS, it is an often-heard complaint that the media ignore good news to report on negative stories.
Challenges of stronger commissioning
Authors: Woodin Juliet , MacDonald John
Published: May 2014

If the Government's current policy to strengthen commissioning is successful, healthcare providers should notice a difference. This article considers the potential impact of stronger commissioning on NHS trusts, and identifies six strands of development activity that may arise for them as a result.
Commercial considerations in the new market place
Authors: Timmins Nicholas
Published: May 2014

January 2007 was a month in which one of the many elephants in the room stirred.
Managing 2007's NHS: learning from Robinson in Rotherham?
Authors: Maynard Alan
Published: May 2014

Roy Griffiths, who was then chief executive of Sainsburys, was used by Margaret Thatcher to introduce general management into the NHS in 1983 with his infamous report.
Where did the extra NHS money really go?
Authors: Cowper Andy
Published: May 2014

Deficits are A Bad Thing. This is not because the NHS is intended to make a profit (such as its modest surplus of £13 million projected in the Q3 Financials (DH 2007). It's not. The NHS is there to deliver the maximum amount of health gain for the budget available.
Bye-bye to RAB, a rabbit from Brown
Authors: Timmins Nick
Published: May 2014

March 2007 was the month that ended appreciably brighter for the NHS than it started. Gordon Brown's Budget may have been dominated by his “tax con” (the Tories) or his “welcome simplification of the tax system” (the Financial Times and Institute for Fiscal Studies), and by his announcement of education's share of the comprehensive spending review.
Why doctors' selection process ended in tears
Authors: Caldwell Gordon
Published: May 2014

The announcement on 22nd March by the Department of Health Review Panel ( www.mmc.nhs.uk ) was an admission that the MTAS selection process had totally failed in selecting Junior Doctors to interview.
Don't let's forget, we're in it for the long-term
Authors: Sang Bob
Published: May 2014

Turbulence in NHS reform has been marked by leading commentators writing about the risks. Chris Ham (2007) reminds us that it is “questionable is whether the reforms will support the development of integrated care to reduce the use of hospital services. The continued separation between GPs and hospitals, and increasing diversity of provision to support patient choice, has brought further fragmentation, not closer integration.”
Small is beautiful except at Whitehall
Authors: Bell Andy
Published: May 2014

The relationship between the Department of Health and the NHS has always been fraught. Often the difficulties managers experience in gaining the confidence of clinicians and the public results from their awkward position between the two.
What has Blair ever done for the NHS?
Authors: Appleby John
Published: May 2014

A normal day at the King's Fund. Outside broadcast units parked on triple yellow lines, satellite dishes unfurling and men unravelling coaxial cables. Police with sniffer dogs. Police with cocked Heckler-Kochs. Wellturned out men and women queuing to get into the restaurant. At eight o'clock in the morning.
Blair dumps on Brown's NHS board
Authors: Timmins Nick
Published: May 2014

April 2007 was the month when almost everyone except the one person who really matters had a say over whether the NHS should have an independent board; when Tony Blair and Patricia Hewitt appeared wilfully to pour petrol on the fire of opposition to use of the private sector in the NHS; and when the private medical insurance market looked set to be reshaped by the proposed disposal by BUPA of its hospitals.
Junior doctors threaten a foreign diaspora
Authors: Roth Andrew
Published: May 2014

I was saddened that, just as I was celebrating my 88th birthday, shadow Health Secretary Andrew Lansley predicted that the government's gross mismanagement of junior doctors’ selection would create a “lost tribe” of some of the best of young doctors, fleeing abroad after their very expensive training because they had missed out on the ladder to lucrative consultant posts.
Gordon Brown's NHS hand grenade
Authors: Roth Andrew
Published: May 2014

When my generation went to war, we had a simple definition of a brave man: one who threw himself on an enemy grenade to save his comrades.
Health Advice for Gordon Brown
Authors: Dixon Jennifer , Dixon Michael , Edwards Nigel , Fisher David , Greatley Angela , Hodgetts Susan , Hunter David , Masters Adrian , Maynard Alan , Naylor Robert , Sang Bob , Smith Tom , Walker Anna , Walker David
Published: May 2014

To welcome the new Prime Minister Gordon Brown, British Journal of Healthcare Management asked a range of key figures in healthcare for their views on the top priorities for health under a new administration. Basically, we asked them for their health advice for Gordon Brown. We gave them no other brief than that of word length.
Prufrock, Pollyanna and Patricia
Authors: Cowper Andy
Published: May 2014

The narrator-hero of TS Eliot's modernist classic The Love Song Of J Alfred Prufrock laments that “I have measured out my life with coffee spoons”.
The two Davids and Gerry R: hurrah!
Authors: Cowper Andy
Published: May 2014

Last month, we cantered through the first part of the NHS Confederation's annual conference. We resume with Scottish lessons as delivered by Deputy First Minister Nicola Sturgeon. Sturgeon summarised the main themes for NHS Scotland.
The rise and fall of the Patient Forum
Authors: Warwick Philip
Published: May 2014

Last issue (Warwick 2007), we looked at the background to changes to public and patient involvement in health.
The shape of the future landscape
Authors: Moyes Bill
Published: May 2014

The future landscape of the health service has been placed under great scrutiny once again.
Stand there and do nothing except talk
Authors: Maynard Alan
Published: May 2014

There is to be no structural redisorganisation of the NHS but the Prime Minister's “listening exercise” has no limits as ministers seek to engage the public, patients and doctors in identifying how to improve the image and performance of the NHS.
Retreating from market reforms?
Authors: Timmins Nick
Published: May 2014

August 2007 was not, despite it being August, such a quiet month. Although it was also not one to give you the impression that the Blairite reform agenda is being driven remorsely onwards.
Knee-jerk leadership - who is leading NHS reform and where?
Authors: Sang Bob
Published: May 2014

Remember ‘Commissioning A Patient-Led NHS’ (DH 2005)? I do, principally because it had nothing to do with patients and leadership. It was, in effect, an overtly managerial agenda designed, inter alia, to deliver management cost savings, resulting in what many experienced commentators regard as the most damaging and dysfunctional restructuring to impact on the NHS in its entire history.
Invega: effective schizophrenia treatment
Authors: Millar Helen
Published: May 2014

Schizophrenia is one of the most devastating forms of mental illness affecting 1 in 100 and has an incidence of 1/10,000. It affects people in the prime of their lives with men and women being affected equally but males about 5 years on average earlier than women (Lehman 2004).
US patient choice: from Pong to Wii?
Authors: Appleby John
Published: May 2014

Speaking about the NHS (‘It’s wonderful!'… wild applause) at a recent conference of 600 American healthcare journalists in Washington, I heard the Secretary of Health and Human Services, Michael O Leavitt, describe a revamped patient choice website. He seemed somewhat apologetic about its contents, drawing an analogy with the entry-level 1970s arcade tennis game ‘Pong’. The aim, he said, was to eventually create a website equivalent to the Tiger Woods 3-D Wii pro-golf tournament game.
Financial risk in practice based commissioning
Authors: Jones Rod
Published: May 2014

Practice based commissioning (PBC) is central to Government reform of the NHS in England. The Department of Health (DH) states that, ‘PBC is central to world class commissioning and is our most powerful way of reaching in to local communities. It is a crucial method through which PCTs and practices can work together to improve health outcomes and reduce inequalities’ (DH, 2007).
Some good reasons to be cheerful
Authors: Timmins Nick
Published: May 2014

May 2008 was the month that for once contained far more good news than bad. Although the NHS being the NHS, whether some of it was good depends entirely on where you are standing when you look at the issue.
Ensuring work-related road safety
Authors: Griffith Richard
Published: May 2014

Travelling in the course of work is often a requirement for NHS staff. The mode of travel is largely by car, and concerns about the high rate of accidents involving people using vehicles for work has resulted in a concerted effort by the police and the Health and Safety Executive (HSE) to improve work-related road safety (The Work-Related Road Safety Task Group, 2001).
The NHS needs more doctors in management
Authors: Roberts Mark Vignesha
Published: May 2014

Spending a considerable time acquiring clinical skills, knowledge and experience for the benefit of patient care is a lengthy, life-long process familiar to all doctors. In the era of evidence-based medicine, this process is rightly encouraged more than ever before. Yet evidence-based medicine is only one contributor to effective clinical practice.
NICE guidance for healthy workplaces
Authors: Dillon Andrew
Published: May 2014

Public health and its role in preventing ill-health, has a vital role to play in tackling issues such as obesity, smoking and lack of physical activity. But preventing ill-health isn't a battle that can be won by the health service alone. Effective partnership working between health services, employers, local authorities, social services and other sectors is essential to help improve the health of individuals and the nation.
Health inequalities
Authors: Hill Rosalind
Published: May 2014

Last month, Alan Johnson and the Department of Health published Health Inequalities: Progress and Next Steps (Department of Health, 2008).
A manager's guide to dementia care
Authors: Nazarko Linda
Published: May 2014

Older people are the largest group of patients in acute settings, and the risk of dementia rises with age. People with dementia do not function to capacity outside their normal environment, and illness and injury can place further strains on them. Staff working in non-specialist units may have difficulty coping with the person with dementia. They may inadvertently make it more difficult for the person to cope in a bewildering and difficult situation. This article aims to provide managers with a brief overview of dementia, the problems people with dementia face in acute settings and how to enable staff to provide high quality care to meet patient needs.
A raw deal for GPs?
Authors: Hill Rosalind
Published: May 2014

I'm beginning to feel that GPs have been getting a bit of a raw deal over the past few weeks.
Clarity in regulation and care
Authors: Timmins Nick
Published: May 2014

July 2008 was the month in which the issue of top-ups within the NHS rumbled on; in which fresh moves were made to reassure the private sector that there is an expanding role for it within NHS care; and when everyone from the Department to the media to the NHS itself came up against the complexity of reporting on the quality of care.
Does the ICE scoring system improve practice?
Authors: Jones Michael H , Shailendra Archana , Lockwood Sue , Thompson Denise
Published: May 2014

The role of clinical audit in the NHS is continuously gaining momentum as an important tool for the maintainence of high standards in an ever-pressing environment of increasing expectations and restricted resources (Jamtvedt et al, 2006). Furthermore, the impact of clinical governance and a need to demonstrate hard evidence of good practice, as well as compliance with clinical guidelines, has highlighted the importance of the audit process.
A masterclass in patient level costing
Authors: Boyle Fiona , Beeson David
Published: May 2014

It will always be awkward, when one person has to account for the money that another spends. But it seems that no-one blinks an eye over exactly this state of affairs inside hospitals. Most spending decisions are taken by clinicians. Quite properly, they decide what care each patient needs, and their prime concern is health need, not cost implication. However, away from the clinical arena, management and finance staff have to account to the trust board for the financial consequences of those decisions.
Integrated care: an alchemist's dream?
Authors: Goodwin Nick
Published: May 2014

Alchemy once flourished as a respected profession. Nicolas Flamel, its most famous exponent, was even reputed to have succeeded in the ‘Great Work’—creating the Philosopherɇs Stone that turned lead to gold. In Darzi's ‘Great Work’, emphasis is placed on creating comprehensive wellbeing and prevention services, while integrating primary and community care with new ‘integrated care organisations’ (ICOs) (Department of Health, 2008).
Analysing the clinical directorate system
Authors: Gupta Romesh , Vaidya Abhay , Campbell Robert
Published: May 2014

Consultants were involved in the management of the clinical services with the introduction of an internal market in the NHS in the early 1990s. A clinical director was expected to bring clinicians and managers together to optimise resources and patient care. However, concerns have been expressed by Gupta (2005) and Braithwaite and Westbrook (2005) that such a system has failed to achieve this. This article considers consultants‘ views and suggests ways to address the issue.
Effective quality improvement: Lean thinking
Authors: Powell Alison , Rushmer Rosemary , Davies Huw
Published: May 2014

Lean thinking was developed by Toyota in the 1950s. It emphasises streamlining processes to provide what the customer wants with minimal wasted time, effort or cost. The approach uses a range of tools, such as ‘value stream mapping’ (identifying and removing any unnecessary steps in a process) and 5S (a series of five steps to enable workforce teams to look at the environment they work in and to start to identify the blocks in current processes). Lean thinking approaches have been applied in healthcare settings with some success in reducing waste. The approaches appear to be particularly useful in streamlining processes in support departments, rather than mainstream clinical services. Successful wholesale application has not yet been demonstrated in healthcare settings.
Effective quality improvement: Six Sigma
Authors: Powell Alison , Rushmer Rosemary , Davies Huw
Published: May 2014

Developed in industry in the 1980s, and applied in a limited way in health care from the 1990s, Six Sigma uses a range of statistical and other tools to reduce variations in processes. Although Six Sigma is a particularly challenging quality improvement approach to use in healthcare settings, some process improvements have been reported and there is growing interest in using a combination of lean thinking and Six Sigma approaches in the NHS.
Hyperacute stroke care: is the DGH underrated?
Authors: Paterson John , Volans Andrew
Published: May 2014

Aims: This article describes the development of a collaborative, multi-disciplinary approach to acute stroke care within a semi-rural district general hospital (DGH). The approach uses existing staff, equipment and resources from within the emergency department, the coronary care unit, the ambulance service, and the radiology department. Content and discussion: The programme is currently achieving a stroke thrombolysis rate of 11%, 1% above the Department of Health's target, and over 13 times higher than the national average. Patient outcomes compare favourably with that achieved by much larger specialist stroke centres. Over 50% of patientsshow a positive benefit by the seventh day post-stroke. Conclusions: The development of large hyperacute centres as envisaged in the national stroke strategy's ‘hub and spoke’ model may help combat the significant mortality and morbidity associated with stroke in the UK. However, the success of this model suggests that all hospitals, regardless of their size or location, should be able to offer state-of-the-art hyperacute stroke care.
Consumerism and the provision of health care
Authors: Calnan Michael
Published: May 2014

Forty years ago Richard Titmuss suggested that there are a range of limits (he identified at least 13) to the idea of consumerism (voice, choice and exit by patients) in relation to health care. For example, most patients enter the doctor-patient relationship on an uanequal basis in terms of status, knowledge and access to resources (such as drug prescribing and referral to other experts). And many patients do not know in advance exactly what medical procedures and drugs they will need-they rely on doctors for advice.
Open all hours?
Authors: Housden Philip
Published: May 2014

What's striking about the headlines from the Government's Comprehensive Spending Review is how the impact of the cuts are almost exclusively expressed in terms of job reductions. What was announced on 20 October were the settlements in terms of cash and percentage reductions for each Department of State. What was missing was much of the detail about which programmes will be reduced or withdrawn. And yet despite the lack of detail, there have been major assumptions made about the impact on jobs, with the aggregate impact ranging from 480000 to nearly a million-depending on who you listen to.
Trends in programme budget expenditure
Authors: Jones Rod
Published: May 2014

Each year primary care trusts (PCTs) in England provide a breakdown of their expenditure intoprogramme budgets covering 23 different categories of disease such as cancer, mental health and circulatory disease. Analysis of changes in these costs over the past 6 years confirms that at anational level the costs follow a pattern over time consistent with that seen in the components of health care cost in the USA. A key event appears to have occurred across England in 2007 which affected specific programme categories to a different extent. Categories most affected appear to be related to mental health, neonates, particular cancers, respiratory and social care costs. A regional pattern is also associated with this event. Possible causes are discussed.
Patient information delivery: clinical protocol (part 2)
Authors: Brocklesby Sarah
Published: May 2014

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

And so the NHS settlement for the next 4 years has arrived. It is, you might say, exactly as expected. The coalition government has honoured to the letter, though in the smallest way possible, its commitment to real terms spending growth −0.1% a year. But £1bn a year by 2014-15, or getting on for 1% of the budget, is to be diverted to spending on social care in an attempt to stop NHS beds overflowing as local government copes with its biggest real term cuts ever: a reduction of more than a quarter in its central government grant.
Cost awareness when prescribing treatment
Authors: Magnezi Racheli , Elzam Lilach , Kliker Yaniv , Kedem Ron , Fire Gil , Wilf-Miron Rachel
Published: May 2014

Aim: Healthcare organisations are constantly faced with the need to contain medical costs. Healthcare institutions expect practitioners to keep costs low, while providing patients with the best possible medical care. This study examines the attitudes of doctors to considering costs, while prescribing medical tests and treatment. Methods: Investigators submitted a 55-item questionnaire to 200 primary care practitioners in health maintenance organisations in Israel, in which14 questions addressed practitioners' attitudes to cost considerations. Results: Attitudes to cost containment depended on practitioners' awareness of costs, whether they were internists or family practitioners, and whether they participated in seminars on healthcare costs. Seniority had no bearing on attitude. Practitioners born in the former USSR knew more about the costs of inpatient hospital stay, whereas Israeli-born physicians were more aware of the costs of emergency room visits. Family practitioners, interns, and gynaecologists were equally aware ofthe costs of medications. Practitioners in administrative roles, unlike those who were not, thought that financial considerations are detrimental to a patient's health. Conclusions: Further education by the healthcare organisation would keep practitioners updated on medical advances, and familiarise them with unique contracts and costs. This would enable practitioners to feel more involved, and to understand the necessary economic considerations relevant to treating illnesses.
Performance evaluation of tertiary care
Authors: Njoku Jerome , Ugwoke Eze Charles , Chigozie Nwobi Ivor
Published: May 2014

Aim: To evaluate the performance of tertiary healthcare institutions in Lagos State, Western Nigeria, with regard to their corporate goal of providing excellent tertiary healthcare servicesfor the community. Methods: One hundred and ten structured questionnaires were distributed by stratified random sampling on healthcare workers in three tertiary healthcare institutions. The survey was first piloted on a separate hospital of equal status in Lagos State, whichwas not included in the study, after which minor changes were made with regard to presentation and wording. Surveys were completed and returned by 90 healthcare workers, giving a response rate of 82%. Thequestionnaires were analysed using percentages, frequencies and the chi-square (X2)test. Results: The hospitals studied did not translate their mission statements into specific performance objectives and goals; there appeared to be no framework to evaluate performance. Service delivery was generally hindered by poor staff training, poor funding (especially in government-run hospitals), lack of participative management, demotivation, work stoppages, and inadequate technology/obsolete equipment. Conclusions: Employee performance, and therefore productivity in the health sector, could improve if adequate attention is paid to the continuing professional development (CPD) of employees to match the trends in technology and meet the ever-changing needs of the patient. Public tertiary healthcare institutions have no system in place to improve performance. They seem not to bother about productivity as long as their funding is not dependent on performance. The risk is that these hospitals may not be self-sustaining should the government withdraw funding.
The Human Rights Act 1998 and health care
Authors: Griffith Richard
Published: May 2014

In the decade since its introduction in October 2000, the Human Rights Act 1998 has had a profound effect on the policy development and delivery of health care. The almost continuous introduction of laws to ensure compliance with the principles and obligations of human rights law haveseen a gradual legalisation of health care and a reigning in of the discretionary powers of health professionals. This article reflects on the influence of the Human Rights Act 1998 on health care.
Funding the crisis of 2011
Authors: Bosanquet Nick
Published: May 2014

What can the NHS do to mitigate the finding crisis to come? Never were the words of the wise Senator so relevant: ‘There is no such thing as an unmitigated disaster-so get out there and mitigate.’
Competition and accreditation
Authors: Timmins Nick
Published: May 2014

February 2010 was the month in which the debate about social care funding-the outcome of which will have a large impact on the NHS-descended into the most unedifying demonstration of party political squabbling; one in which the prospect of managers becoming, in some way or other, a regulated profession rose; and one in which the evidence got a little stronger that competition in the supply of health care does indeed work.
Opportunities and threats in mental health: part 1
Authors: William R , Breakey F , Ghedia Reshma , Soo Ha Joon , Patel Nitisha , Sinha Khushboo , Smith James A
Published: May 2014

Mental health is a pressing issue with one in four adults in Britain experiencing at least one diagnosable mental health problem in their lifetime. Recent changes in the mental healthcare market have led to an increase in the variety of providers of care and a diverse supply base. Themain market forces in the mental health sector are NHS trusts, foundation trusts, the private sector, and the voluntary sector. This article analyses the providers and their services, with an evaluation of their overall effectiveness. The authors aim to analyse what services are on offeror are required by the range of organisations, in order to make a set of possible recommendations for a foundation trust looking to improve and expand on their current provisions. Conclusions will be drawn with regard to the opportunities and threats in the mental health sector.
Improving efficiency and quality with IT
Authors: Hill Rosalind
Published: May 2014

We see that iSOFT offers solutions which follow the patient's journey through the continuum of care. Can you give an overview of these solutions?
Developing pathology IT
Authors: Lee-Potter Emma
Published: May 2014

From digital pathology to disease screening algorithms, the iSOFT Laboratory User Convention 2010 showcased some of the most cuttingedge healthcare technology available today.
Managing medication compliance
Authors: Griffith Richard
Published: May 2014

The World Health Organization describes patient non-compliance with prescribed medication as a worldwide problem of striking magnitude. Healthcare managers will know that in the United Kingdom, 50% of older people do not take medicines as prescribed. This, in turn, leads to drug wastage, mismanagement of medical conditions and readmission to hospital. In this article, the reasons for non-compliance are considered, and the way managers might help improve concordance rates among patients are discussed.
The nature of healthcare costs and financial risk in commissioning
Authors: Jones Rod
Published: May 2014

The health insurance industry in the USA has noted a cycle of underwriting gains and losses which appeared to commence in the early to mid 1960s. After adjusting for inflation, unexplained step-like increases in total cost of approximately 6% appear to have occurred somewhere around 1962, 1966, 1974, 1979, 1986, 1990, 1998 and 2002. A similar pattern relating to medical emergency admissions has operated in the UK for at least 20 years. The implications of this behaviour tothe financial risk inherent in commissioning in England are discussed in this article. Data fromthe USA and Canada is used to complement the previous studies from the UK to explore causes for this behaviour.
Impact of the A&E targets in England
Authors: Jones Rod
Published: May 2014

Part one of this series demonstrated that assessment unit costs are approximately those of an ambulatory assessment although, as decided by the Department of Health, providers are being paid using a tariff that is far higher than the real cost. In this second part, it is demonstrated that the true average cost of the wider emergency department function can only be revealed when A&E and assessment unit costs are combined. The allocation of patients into treatment categories is shown to be subject to considerable ambiguity, which misrepresents local costs when a strict payment by results (PbR) framework is applied. Such a framework implicitly assumes that counting and coding is at the national norm. Issues around the application of standards for counting events and the perverse incentives arising from targets are discussed. Part three of the series will look at the specific situation regarding paediatric assessment costs.
The psychological contract and health policy reform
Authors: Ojo Tim
Published: May 2014

Equity and Excellence: Liberating the NHS ( Department of Health, 2010 ) contains objectives that are radically reforming in nature. The structural and cultural changes required to meet these objectives significantly disrupt established ‘employer-employee’ relations. Indeed, employee stakeholders and their representative bodies across the NHS continue to express very serious concerns about the pace, scale and underlying ethos of some of the main proposals in the new policy. In response to these concerns, the government undertook a ‘listening exercise’, with a view to understanding and addressing them—with the option to revise the policy if and as necessary. From a human resource management and employee engagement perspective, the policy threatens the existing psychological contract employees have with the NHS in many ways. This article will explore the extent and nature of these threats and attempt to predict potential consequences for the attainment of the government's desired outcomes.
Scenario planning: managing uncertain futures
Authors: Hervé Beverley
Published: May 2014

As a strategy tool, scenario planning is an important component of strategic workforce planning as evaluating the impact of future events is integral to ensuring that an organisation's human resources strategies align with the strategic plan. Used within an integrated health and social care team it was a valuable tool in fostering ‘strategic conversation’, providing an opportunity to transcend professional boundaries, challenge the embedded culture and promote change. Using scenario planning as a precursor to traditional methods enables key uncertainties to be identified. These can be used as sensitivity or ‘what if’ analyses that provide management with information that is useful for quantifying the financial risks or service deficiencies that could occur if any of the anticipated futures materialise. There is greater potential for its use at all levels within health and social care and in particular when planning the future workforce within primary care, where there will be a requirement to respond to a range of variables.
Personalisation, participation and care
Authors: Powell Jason
Published: May 2014

Personalisation services are developing in England as a social policy response to user demands for more tailored, effective and flexible forms of health and social care support. Across England and Wales, this process is being implemented under the personalization which is also seen as a vehicle for promoting service user rights through increasing participation, empowerment and control while also promoting self-restraint by having users manage the costs of their health and social care. This paper reviews the existing research evidence for personalization, albeit limited, and identifies themes for future research.
Follow-up rates: is there potential for reduction?
Authors: Mirza Showkat , Chetwood ASA
Published: May 2014

Unnecessary outpatient follow-up appointments need to be minimised to increase effciency in the NHS. Trainee surgeons tend to follow-up more patients than consultants. We aimed to identify the difference in follow-up rates between trainee specialist registrars (SpRs) and a consultant's opinion to see if there was potential to decrease trainee follow-up rates. We retrospectively reviewed the letters of four general ENT (ear, nose and throat) clinics performed by fiveSpRs and noted the follow-up outcomes. The letters were then reviewed by a consultant otolaryngologist and their opinion on what the follow-up decision could have been was noted. 260 consultations were reviewed. SpRs had signifiicantly higher follow-up rates than the consultant (67% vs 27%, p < 0.0001, Chi squared test). There is potential to significantly reduce the follow-up rates of trainees in ENT surgery through appropriate training and monitoring.
Waste and the NHS: lessons from Toyota
Authors: Caldwell Gordon
Published: May 2014

Many clinicians and managers struggle with the concept of waste in clinical processes. After hearing and reading about the transformation of healthcare at Virginia Mason Medical Center in Seattle, the author read Toyota Culture the Heart and Soul of the Toyota Way. This article discusses some of the concepts of waste in clinical processes, concentrating particularly on the waste and costs of over-investigation.
Perceptions of health information system
Authors: Sinha Rajesh Kumar , Saha Dola , Shetty Sriraksha
Published: May 2014

Health information system forms an integral part of the any healthcare system. Its works with an objective to provide reliable, relevant, up-to-date, adequate, timely, and reasonably complete information to healthcare professionals as well as health mangers at all level of healthcare system. This article describes the perceptions of 279 health sciences interns towards health information system where a prospective study was conducted. The selected samples were questioned by using a validated and pre-tested questionnaire and their responses were marked and evaluated using the 5-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. The results showed that respondents, with good knowledge, had positively perceived the benefits of health information system, whereas many with lack of knowledge about the subject perceived otherwise. The study has also been able to identify an emergent need for educating and training the health science interns about health information system, its need, and its importance for better acceptability.
Can mental health policy ever deliver its objectives?
Authors: White Jennifer , Johnson Helen
Published: May 2014

In February 2011, the Coalition Government published its first mental health strategy No Health Without Mental Health. One year on, Jennifer White and Helen Johnson ask if this strategy was simply the latest in a series of well-meaning strategies in mental health that fall short of their objectives when implemented. The ambition of the latest strategy was to mainstream mental health provision and care and achieve ‘parity of esteem’ with physical health. These are difficult times for the public sector and this Government has set itself a challenge that would be difficult even in affluent times. After years of successive Government strategies purporting to prioritise mental health, are we nearly there yet?
A flaw in person-based funding?
Authors: Jones Rod
Published: May 2014

A long time series of surgical emergency admissions is used to demonstrate that bed occupancy (and costs) fluctuates in a manner which is far greater than expected from simple random variation. Periods of adverse environmental conditions can be discerned which presumably act to exacerbate existing conditions. Somewhere around 20% of cost variation between clinical commissioning groups (CCGs) may be explained by the wider environment (weather, air quality, infectious outbreaks). Future generations of the capitation formula will need to incorporate a greater proportion of environmental factors and at a local level some form of yearly risk payment (or risk equalisation via larger financial risk pools) may be needed to account for adverse events not experienced elsewhere.
Dissection and discoveries in Enlightenment Europe
Authors: Allan Kate
Published: May 2014

In this article, Kate Allan considers past approaches to human anatomy
Orthopaedic Litigation What is the Financial Burden Trend?
Authors: Thavarajah Dushan , Podger Hannah , 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.
Financial risk and volatile elderly diagnoses
Authors: Jones Rod
Published: May 2014

Rod Jones, statistical advisor, discusses volatile diagnoses in those aged 75 years and over
Skill maximisation: the future of healthcare
Authors: McIntosh Bryan , Sheppy Bruce
Published: May 2014

The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.
An introduction to wound healing and dressings
Authors: Newton Heather
Published: May 2014

The cost of managing patients with chronic wounds is rising and accounts for 3% of the total NHS budget. Despite significant advances in wound management over the last 35 years there remains little evidence of standardised practices across the country. The management of wounds is continually viewed as a challenging and costly area of practice. The challenges arise from the increasing complexity of acute and chronic wounds, which are affected by patients multiple comorbidities, resistant bacteria and an aging population. There is also a plethora of dressings available in the market place today which despite providing a wide choice can be confusing and costly if inappropriately used. This article will explore the principles of wound healing, highlighting key factors that can impact on outcomes. The main types of wound dressings will also be discussed.
Cutting costs without losing blood
Authors: Saxby Robert
Published: May 2014

The holy grail for the NHS is how to minimise costs without endangering service quality, particularly to patients. This mandate to cut—expressed as ‘save x%’ is passed down to the various departments within an organisation where the great horse trade begins. To protect patient-facing services this often means that disproportionate cuts are made in the back office, including IT. Unless done with great acumen, this can be akin to cutting off a hand to save the vital organs, with harmful consequences. This article looks at the issues involved in balancing the cost/quality equation in an area that crucial to the good health of virtually all health services—technology.
Polyprofessionalism: a shift in healthcare delivery
Authors: Deshpande Ashutosh
Published: May 2014

The delegation of clinical roles to non-medically trained healthcare workers is a globally phenomenon that is increasing due to a variety of epidemiological, economic and practical factors. This article summarises and reflects on these trends and their implications in terms of human resource planning, education and training, and legal accountability.
Reduced skin integrity: is what we have enough?
Authors: Bateman Sharon Dawn
Published: May 2014

Skin integrity, its assessment, management and prevention of deteriation truly is the responsibility of all healthcare workers from ward to board, from office to treatment room, and from Parliament to pharmacy. Maintenance of good skin integrity is everyone's business, and we all need to re-group and re-focus if harm to patients skin integrity is to be avoided ( Bateman, 2013 ). This article discusses reduced skin integrity pertaining to pressure ulcers and moisture lesions and the healthcare conundrum that we are currently experiencing with rising prevalence and incidence of skin damage alongside national and local drivers guiding change. There has never been a greater emphasis on patient safety and quality of care as there is currently, with healthcare clinicians, managers, procurement, industry and private service providers having to come together collaboratively to improve patient outcomes and provide safe, effective, financially sound pressure ulcer prevention and management strategies that are acceptable to patients and their carers. This article will explore the financial, clinical and management arena we currently practice within and asks the question: is this enough?