bluuebunny/crossref_metadata_2025 huggingface dataset:
Redundancy and changes to terms and conditions
Authors: Hall Stephen
Published: May 2014

With redundancies and changes to terms and conditions on the cards, healthcare assistants and assistant practitioners should familiarise themselves with their employment rights. What does it mean to be ‘at risk’ of redundancy? What is suitable alternative employment and what is the response to being unfairly selected for redundancy? What happens if an employer attempts to unilaterally change terms and conditions?
Falls: environmental risk factors
Authors: Nazarko Linda
Published: May 2014

Falls occur because of factors relating to individuals, the environment and the care and support available. As people age the risk of falls increases. That risk is increased when a person is unwell and when the person moves to a new environment. The environment where the older person is cared for can reduce or increase the risk of falls and injury. This article, the third in a series, explains how staff can minimise the risk of falls in hospitals, care homes and also the person's own home.
What to do when someone asks for your assistance to die
Authors: Curry Tim
Published: May 2014

Support workers are the group of staff that spends the most quality time with clients. As a result, healthcare assistants (HCAs) and assistant practitioners (APs) can find themselves in the position of being asked by patients and/or their families to discuss one of the most complex issues in healthcare—assisted suicide. Although there are slight variations between the different countries of the UK, assisted suicide remains illegal and so HCAs and APs have to tread a fine line between listening to their clients’ concerns, but staying completely neutral where their own opinion is at stake.
Essentials of stroke for healthcare assistants
Authors: Hayes Catherine
Published: May 2014

Within the context of medicine and healthcare, ‘stroke’ is a term applied to an array of diverse manifestations of neurovascular illness. While the role of the healthcare assistant (HCA) does not entail engaging with the specific pathological processes of the condition, it is useful for them to familiarise themselves with core concepts in the field of stroke rehabilitation, so they might best provide a high level of care, underpinned by a thorough basic knowledge of the stage of illness and its likely prognosis or outcome. Professions allied to medicine are often challenged to understand the pathology, classification and symptoms of stroke, which are pivotal to the accurate diagnosis and subsequent management of the condition.

The role HCAs play in the ancillary care surrounding this process is invaluable. Their ability to work with patients who have suffered any form of stroke is significant, but arguably most beneficial in facilitating interaction with patients who might themselves be struggling to understand and come to terms with their newly diagnosed condition.

This article is a brief guideline to stroke for HCAs who might wish to develop or refresh their knowledge of stroke. The overall aim of the article is to provide a quick reference system for HCAs to understand the nature of the condition with which their patient is presenting, in order to equip them to work knowledgeably within the context of stroke care.
‘Essence of care’ on mental health wards: the HCA's role
Authors: Padfield Ben
Published: May 2014

This article explores and argues for the value of the HCA role in benchmarking and actioning recommendations using the essence of care tool in mental health units. By drawing attention to three benchmarks, it demonstrates the benefits of, and for, HCAs involving themselves in practice-development planning, reporting and implementation.
One foot on the ladder: getting started in vocational training
Authors: Orr Maggie , Stewart Warren
Published: May 2014

This paper outlines a small training pilot which was designed to promote learning activities among a group of health workers with personal histories of limited contact with formal education. The aim of the training was to provide intensive group training and practice based support with the aim of encouraging the participants to both continue their studies and to improve their clinical practice. The pilot was evaluated and showed some success in terms completion of the objectives and motivation to engage with more in depth formal training. This paper makes recommendations for future interventions.
Jam today: the law and ethics of covert medication
Authors: Yeomans Paul
Published: May 2014

Covert administration of medication has always been controversial and has not always been specified in care plans, it should be limited to incapacitated patients where the treatment is necessary and in best interests, or else authorised by mental health legislation or an appropriate court declaration. A lot of nursing and HCA practice that involves putting medication in food or drink may not actually be disguising it from the patient at all. The NMC guidelines do not refer to the Mental Capacity Act and are due for review, meanwhile the Maudsley Prescribing Guidelines are recommended. It is vital that HCAs and APs who administer or assist with medication understand their legal and ethical authority for hiding it, and reviewing the reasons with the wider team.
Building capacity: leadership and HCAs/APs
Authors: Megson Denise
Published: May 2014

Definitions of leadership are related in relation to present context and need for leaders in health and social care sectors. The article introduces the Factor 8 framework, which identifies the leadership characteristics of diverse leaders. The framework was developed by consultancy, Diversity Practice, and it is different from some other leadership frameworks. This framework considers bi-cultural competence and cultural capital and is a better fit with the current diversity agenda. Personal experiences were utilised to illustrate usage of the framework. Three different tools have been described to help HCA develop their capacity in leadership skills. The Ladder of Influence, devised by Maxwell, can help HCAs identify and understand where power to influence comes from. Stakeholder mapping can be used to identify where and at whom energies should be directed at for the most effective results and Life stories can help HCAs to have a clearer understanding of their heritage, values and passions thereby giving them leverage for developing leadership skills and qualities.
The role of HCAs in a children's hospice and their L&D needs
Authors: Crighton Liz
Published: May 2014

This article will review the role of healthcare assistants (HCAs) working in a children's hospice service. It aims to identify and evaluate the benefits and the challenges associated with working in this demanding and specialist area and make recommendations that will help support and develop HCAs working in children's hospice settings. Areas for focus in this paper include: clinical skills and competency, delegation and supervision, access to learning opportunities, professional development and career progression.

With this in mind, a specific work-based education programme has been developed to meet the unique needs of HCAs working in children's hospices.

It is paramount that HCAs work within their sphere of competence to protect the public and ensure patients get the highest standard of care. By developing an education programme suited to their needs, it is hoped the quality of care will improve and that errors, complaints and the potential for litigation will be reduced.
Deprivation of Liberty Safeguards: Living DOLS
Authors: Yeomans Paul
Published: May 2014

The Deprivation of Liberty Safeguards (DOLS) for patients in hospitals and care homes have now had their first full two-year review. The Care Quality Commission (CQC) (2012) found variations in staff training, and the Mental Health Alliance (2010) said care home staff in particular needed more. DOLS inhabit a grey area between the mental health and mental capacity legislation, and the Alliance wonders why there aren't more referrals to independent advocates. As there is no legal definition of DOL, lawyers aren't necessarily better placed than HCAs to decide. Another wrinkle is that the supervisory body authorising DOLS is often the same authority that arranged placement.
Interprofessional awareness of learning disabilities for HCAs
Authors: Hayes Catherine , Batey Glenn
Published: May 2014

This article has been developed for healthcare assistants (HCAs), for whom working with people with learning disabilities may pose significant barriers to high-quality healthcare provision, due to a straightforward lack of awareness of current policies and initiatives in health. It raises the fundamental issues to be addressed within the context of healthcare provision. These are of direct relevance to the improvement of services for people with learning disabilities, aiming for the empowerment and facilitation of care for these people. Emphasis is placed upon the need for equity in healthcare for all and the need to avoid the tendency of society to homogenise all individual people with learning disabilities into one group.
Welsh university and health boards’ HCSW collaboration
Authors: Williams Julie , Ledsam Robert , Suffin Majella , Jolly Sara , Bennet Elizabeth
Published: May 2014

The UK Government's ‘Widening Participation’ agenda ( Public Accounts Committee, 2009 ) aims to ensure those who are able to benefit from higher education have the opportunity to do so.

In 2008, in response to this and other Welsh Assembly Government (WAG) publications, the National Leadership and Innovation Agency for Healthcare (NLIAH) in Wales lodged monies with local health boards (LHBs) to develop accredited education at level 4, Credit Qualification Framework Wales (CQFW). This was to be aimed at developing the nursing support roles within Agenda for Change (A4C) pay bands 1-4 and providing evidence-based, patient-responsive care.

Four LHBs in South Wales approached the University of Glamorgan and collaborated in the development of a higher education certificate, with the intention of providing education that would benefit the care patients received from support staff.
Wound care checklists—role and wound assessment
Authors: Andrews Hilary
Published: May 2014

This article provides two quick reference checklists that the healthcare assistant (HCA) and assistant practitioner (AP) undertaking wound care can use in order to clarify this area of their role and to provide safe and effective wound care.

The first checklist specifies step-by-step questions to ask when carrying out wound care.

The second provides a list of wound assessment signs that the HCA/AP must be observant for while undertaking wound care that should be reported to the registered nurse.

This article is based on a workshop given by the author at the 6th National HCA Conference in Birmingham on 15 November 2012.
Safety and quality of services: at the heart of all we do
Authors: Pond Christina
Published: May 2014

In February 2011, the Government published the Command Paper, Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers, in part as a response to prevent poor quality of care ( Department of Health (DH), 2011a ).

There is a recognition in the paper that ‘a more flexible system is needed to enable employers to assure themselves that prospective employees have met adequate standards of training and competence and to enable individual members of the public who seek care directly from unregulated, self-employed workers to assure themselves about their standards’.

In February 2012, the Department of Health commissioned Skills for Health and Skills for Care to jointly convene a project to develop a code of conduct and minimum training standards with a view that these could be used by a body (or bodies) establishing a voluntary register or registers for healthcare support workers who reported to registered nurses and midwives in England, including assistant practitioners (APs) but not those working in support of other registered healthcare professionals, for example, allied health professionals.

The project, which was completed in January 2013, has delivered a Code of Conduct, National Minimum Training Standards and core competences mapped to National Occupational Standards and QCF units, for health and adult social care workers in scope of the project.

This paper describes the objectives and methodology which underpinned this work and the resultant outputs from the project which offer the potential to contribute to driving up standards of care now and in the future.
Resistance to change: the organisation dimension
Authors: Stonehouse David
Published: May 2014

The author will examine how change within an organisation can be faced with resistance from the organisation itself. By ‘the organisation’ we do not mean the physical building, hospital or even trust, but more the culture, policies and procedures—and the senior staff who facilitate the running of the business. When change is identified as necessary or desirable by those on the ground, it is hard to accept why it is not embraced further up the organisation. Understanding how and why resistance can build up will help support staff to understand the issues and solve the problems, thereby not giving up on delivering successful change.
Understanding head injuries
Authors: Swann Julie I
Published: May 2014

The term ‘head injury’ covers a multitude of injuries, from mild concussion to severe brain damage. This article provides an introduction to the anatomy of the brain and explains the different types of head injuries and initial treatment.
Article 6: spirituality and learning disability
Authors: Barber Chris
Published: May 2014

People with a learning disability are as much spiritual beings, have similar spiritual needs and have the same rights to have these needs met as the rest of society; the ways that these spiritual needs are experienced, expressed and met may be different, however. This article sets out to explain what learning disability is, the spirituality of those with a learning disability, barriers to how those needs are met and the role of the HCA/AP and the nurse in meeting those needs.
Older people: how do they find out about their health?
Authors: Hurst Gill , Wilson Patricia , Dickinson Angela
Published: May 2014

Information about health is gained from various sources, but little is known about the health information-seeking behaviours of older people and what factors affect this. This pilot study aimed to explore older people's experiences and views on their health information-seeking behaviours and to gain a better understanding of these.

A qualitative study with 9 older people was undertaken, using diaries and semi-structured interviews to gather data. Three key themes emerged relating to why they sought information, what shaped this and where health information was accessed.

This study is generating fresh knowledge of older people's experiences and views on health information-seeking behaviour. By understanding these, health professionals will be better placed to promote strategies that improve older people's access to appropriate health information and support its effective use.
Focus on the micro-relationship in the delivery of care
Authors: Gethin-Jones Stephen
Published: May 2014

Recent reports have expressed concerns over the quality of care delivery in care settings and the homes of older people. This study followed 30 older people who had recently been discharged from hospital and were in the transition from re-ablement services to home care. The study focused on the non-clinical elements of care delivery (interpersonal relationships) and what the older patient felt was important in the delivery of their care.

This was a qualitative study using semi-structured interviews to gather data on the interpersonal processes involved in the delivery of intimate care to vulnerable older patients. Three key themes were developed as to what the older patient felt was important for good-quality care. These were:

The need for social interaction beyond the delivery of clinical healthcare tasks The need for consistent care staff in order to develop a working relationship The need for the older patient to feel they had some control over how their care was delivered.

In sum, the patients needed to feel they were working with the care staff rather than purely having the care done to them.
The role of ACT in procuring safe, sound and supportive services
Authors: McFadyen John Alexander
Published: May 2014

This article is an attempt to demonstrate the fundamental nature of Assertive Community Treatment (ACT) and the role it has to play in assisting to deliver on the wider strategic aims of securing sound and supportive services.
In the competence framework: developing Primary Care Managers
Authors: Emmerson Melody , Thomas Paul , Williams Steffi
Published: May 2014

This paper explores recent initiatives in the use of a competence framework method regarding the training of managers in Primary Care. The learning outcomes and practical use-value of this way of working are examined, as are implications for future training programmes.
Modernising the NHS: a game of two halves:
Authors: Peck Edward
Published: May 2014

The ‘modernisation’ of the NHS is gathering pace. At the centre of this project, however, there seems to lurk a tension; which resides in the balance between central prescription and local discretion.

This paper draws on the work of Marquand, 6 and Towell to suggest ways in which local modernisation boards can work with this tension in the pursuance of ‘modernisation’.
Health care modelling - why should we try?
Authors: Ivatts Simone , Millard Peter
Published: May 2014

This is the first of two articles, which aim to take the reader through some basic concepts of health care modelling by discussing recent research in this field. The articles are based on the recent lecture course in health care modelling by Professor Millard.
Modelling demand - a rejoinder
Authors: Mark Annabelle
Published: May 2014

In response to two major articles published by this magazine last year (Ivatts and Millard 2002 A & B), this article contends that a modelling approach may not offer sufficient solutions for the complexity of health care systems.
Malnutrition in hospital: an indictment of the quality of care?
Authors: Holmes Sue
Published: May 2014

Here we go again. The clinical and financial costs of malnutrition in hospitals are back to haunt the agenda.

What has changed?

What has been learned?
Are health inequalities really intractable?
Authors: Greener Mark
Published: May 2014

Breaking the link between deprivation and illness is a priority for health services across the developed world. The Public Service Agreement aims to reduce inequalities in infant mortality and life expectancy at birth by at least 10 per cent by 2010.
What is ‘quality of life’ for patients?
Authors: Wyke Alexandra , Barby Anne , Cowper Andy , Lilleystone Jo , Staniszewska Sophie , Williams Simon
Published: May 2014

Since 1998, the Department of Health (DH) has recognised that patients‘ needs are not always taken into account when care is planned and delivered (Standing Advisory Group on Consumer Involvement in the NHS Research and Development Programme, 1998). Patients’ needs and priorities can be complex and wide-ranging and may not be easily identified or measured. As well as therapeutic benefit, quality of life (QoL) outcomes associated with health care are often of importance to patients.
The potential for operational research
Authors: Pitt Martin , Dodds Simon , Bensley David , Royston Geoff , Stein Ken
Published: May 2014

Operational research embodies a wide range of techniques that can improve the way we plan and organise health services. So, why have these tools not been more widely adopted in the NHS? To answer this we need to understand the key structural barriers to implementation, only then can we address the key issues and begin to realise this untapped potential.
Leadership needs of medical and clinical directors
Authors: Giordano Richard
Published: May 2014

The National Health Service (NHS) is facing one of the toughest financial periods of its history, and clinical leadership will be critical to maintaining the quality of care. The King’s Fund drew on a wealth of experience in developing the skills of leaders in the NHS to conduct a survey of clinical and medical directors to find out what skills they believed they need to face these challenging times.
The data vacuum in emergency and urgent care
Authors: Hughes Thomas , Volans Andrew , Higginson Ian , Brayley Nigel , Benger Jonathan
Published: May 2014

Emergency departments in the UK have seen a marked increase in patient activity over the last few years. Until recently, this activity was paid for by block contracts between commissioners and providers. The management of this activity has now fallen under the ‘Payment by Results’ (PbR) system. In the past, the data collection system for this activity has been inaccurate and consequently payment has not followed the patient care and has lead to perverse incentives. This paper describes the current situation with respect to PbR, assesses the problems that currently exist and describes an initiative by the College of Emergency Medicine to improve data collection and accuracy to inform commissioners and clinicians of the clinical activity that is occurring within emergency departments.
Reward management in healthcare
Authors: Gunawardena Indunil
Published: May 2014

The current financial climate and spending cuts across the NHS paints a picture of doom and gloom, and does little to motivate staff and increase productivity. Reward management in healthcare organisations is challenging at the best of times. Reward systems traditionally used in profit-based organisations cannot be used without significant modification in healthcare organisations. A combination of intrinsic and extrinsic reward systems implemented in an equitable and perpetually evolving manner is required. NHS mangers need to appreciate the importance of having a motivated human resource and should deploy the appropriate reward systems if productivity is to be achieved.
Clinical governance and attention to human resources
Authors: Som Chandra Vanu
Published: May 2014

The role of human resource management in implementing clinical governance framework remains largely unexplored. This article aims to fill this gap in the literature. A qualitative approach has been adopted to develop an insight into the research topic by analysing 35 crucial case studies and documents published by different independent agencies in UK associated with monitoring and evaluating the progress of a major clinical governance framework in the NHS organisations. A human resource strategy designed to support the implementation of clinical governance framework would enable the organisation to achieve better clinical outcomes. Since the concept of ‘clinical governance’ is promoted by World Health Organization, the lessons learned from the analysis of these case studies in UK have a much wider international implications. Hence, the findings of this research study could be useful for the policy makers, healthcare managers, clinical practitioners and other stakeholders of health sector in many countries.
The costs and benefits of hospital MRSA screening
Authors: Guleri Achyut , Palmer Ruth , Kehoe Aidan , Jones Annie , Lunt Barrie , Harper Nick , Lickiss Joe , Mawdsley Sharon , Hartley Julian
Published: May 2014

Methicillin-resistant Staphylococcus aureus (MRSA) infections represent a significant challenge. Rapid and accurate identification of MRSA in hospital admissions is essential for timely treatment decisions, isolation/bio-burden reduction and reducing potential cross-transmission/acquisition of these infections. Here we present the clinical benefits and cost-effectiveness of a rapid MRSA screening programme, which was implemented at Blackpool Victoria Hospital. The economic advantages of continuing the service despite a 15% cut in overall budget are also presented. In the pre-study period (2007–2008) 20 461 emergency and 21 461 elective admissions were screened and 40 cases of MRSA bacteraemia were reported. Glycopeptide unit days were 4145. During the 12-month pilot, approximately 4% of the PCR emergency screens were positive. Nine MRSA bacteraemias were reported during this period, representing a 78% reduction over the previous year. The cost of service over 12 months was £396 285. Estimated savings from the reduction in bed days and glycopeptide use ranged from 282 266 to 329 117. Hospital-acquired (post 48 hours) MRSA bacteraemias were reduced from 28 to 5. Annual glycopeptide spend was reduced by 50%, from £251 168 (2007–2008) to £124 060 (2008–2009). Rapidly available MRSA results were used to complement clinical decision making and optimize treatment. The cost-effectiveness of any screening programme is proportional to its success. The overall benefits and savings achieved in the current study more than justified the expenditure on rapid screening, and the Trust has since adopted PCR as a regular screening service for emergency admissions.
Encouraging a new kind of leadership
Authors: Gowan Isobel
Published: May 2014

There is increasing evidence that good management and leadership lead to better patient outcomes ( Mountford and Webb, 2009 ). In the UK there is an increasing demand that NHS leaders have a clinical background ( DoH, 2009a ), yet there is relatively little focus on leadership skills during clinical training. We describe here an innovative programme commissioned and designed to bridge that gap in the final year of postgraduate medical training. We explain the structure of the programme, and that the aim was, and still is, to use experiential and reflective learning to enable doctors on the cusp of becoming consultants to broaden their horizons and manage their circumstances (both personal and professional) more effectively. This means helping them to understand their own individual needs, strengths and development areas, and to grasp with greater insight the system in which they work. We found that a tailored, non-didactic leadership programme, coupled with leadership coaching, was critical to improving clarity of goals, self-management, self-perception, self-confidence, preparedness for leadership and NHS knowledge for Specialist Registrars, who have gone on to gain hospital posts.
A strategic approach to cost improvement
Authors: Nazarko Linda
Published: May 2014

The NHS faces unprecedented challenges. Our ageing population and rising expectations are increasing demand for healthcare. NHS organizations are in the midst of massive organizational change and must cut costs by 20% over the next four years. There are risks that organizations will fail and that quality will suffer. This article aims to examine the benefits of a strategic approach and offers practical advice on how managers and clinicians can work together to improve efficiency and maintain quality.
Hospital bed occupancy demystified
Authors: Jones Rod
Published: May 2014

Part one of this series investigated the adequacy of current models used to forecast bed demand. This part explores the issues surrounding the correct level of occupancy required to deliver effective and safe health care. Economy of scale as explained by queuing theory is a significant factor in understanding bed occupancy. However, irrespective of the occupancy specific to different size hospitals, an absolute maximum occupancy in the range 82 to 85% is required to keep the level of hospital-acquired infection at the minimum possible level.
Complexity and leader competencies in healthcare
Authors: Hanson William , Ford Randal
Published: May 2014

Healthcare in the USA has made significant moves to shape leader-manager competencies in line with changing organisational needs. To that end, a growing health-care management literature has introduced the concept of ‘complexity’. Overall, competencies continue to be largely based on traditional leadership and management practices that are counter to creating an embedded culture of adaptation. Emerging complexity concepts and research offer a way to examine leadership geared toward achieving this end. In this context, leadership encompasses a holistic focus on shared processes, structures, and culture, rather than one dominated by manager initiation and control. So far, corresponding complexity leader-manager competencies have not yet been developed. The authors provide topical areas from a complexity perspective to help further develop leadership competencies in this direction that are congruent with the organisational reality facing healthcare
Balanced scorecards: a quality improvement intervention
Authors: Gunawardena Indunil
Published: May 2014

The main objective of the geriatric day hospital (GDH) is to facilitate prolonged independent living for older people in the community. Despite their varied benefits, the GDH has in the past come under the spotlight for lack of a good evidence base on outcome measures and cost-effectiveness. The balanced scorecard as a quality improvement intervention or performance management system has been used in many circumstances. The Clinical Audit Scheme for Geriatric Day Hospitals published by the Royal College of Physicians in 1994 identified a number of performance measures which represent the varies stakeholder interests involved in the GDH. These and other such performance measures can be used in the form of a balanced scorecard to provide a more accurate picture of the GDH performance to commissioners.
Job plans for surgeons improve theatre use
Authors: Sharma Mitesh , Karandikar Sharad , Budhoo Misra
Published: May 2014

An annualised flexible job plan involving a rolling rota for consultants’ elective theatre work was planned to improve theatre efficiency and demand-capacity planning. It was introduced in 2006 to see if a maximum efficiency of theatre utilisation could be achieved with improved overall cost-effectiveness. The study is a comparison of outcomes between conventional practice and modern practice after implementation of the annualised job plan.
Joint replacement surgery: comparing hospitals
Authors: Wong Fabian , Charles Loren , Back Diane , Davies Andrew , Earnshaw Peter , Ajuied Adil
Published: May 2014

Statistics regarding aspects of hospital inpatient care are readily available in the public domain. This data is used by policy makers, healthcare commissioners and patients, to compare healthcare providers and inform decision-making. However, by convention these statistics are expressed in the form of the arithmetic mean, which is not an optimal tool for comparing healthcare providers. The authors propose that when comparing lengths of inpatient stay following hospital admissions of elective joint replacement surgery, the geometric mean and mode should be used. These measures are more meaningful to patients, and less sensitive to long stay outliers, which some specialist hospitals are predisposed to due to complexity of case mix, as well as for geographic and socioeconomic reasons. We conducted a comparative cohort study, reviewing prospectively collected length of stay data, for a central London teaching hospital and a Home Counties district general hospital. Our results support the use of the geometric mean and mode over the measures currently used.
The needs of informal carers for people with dementia
Authors: Egdell Valerie
Published: May 2014

There are approximately 800 000 people with dementia in the UK. Dementia is debilitating, not only for sufferers, but also for their informal carers. Drawing on qualitative research, this article considers issues that health and social care practitioners need to take in account so that they can appropriately provide and target their support for informal carers of people with dementia. Specifically, this article considers carer's experiences and expectations of social/informal support and the ways in which they engage with statutory and voluntary sector support. The article highlights that individual carers have different resources to draw upon and it should not be assumed that they will be supported by family and friends. Carers may also have negative experiences of support from formal service providers characterised by a poor provision of information regarding the support services. Health and social care practitioners should not assume that carers are able to discover this information themselves. In sum, practitioners need to be aware of the support needs of not only people with dementia but also their carers.
Supporting implementation of health service change
Authors: Shute Rebecca , Harrison Kay , Forsyth Kirsty , Melton Jane , Thompson Simon , Fear Chris
Published: May 2014

This article describes how health service transformation can be aided by using ‘practice development’ as a vehicle for change at times of economic uncertainty. It explores the importance of understanding the needs of individuals in the workforce when engaging in a process of development and emphasises the importance of equipping leaders with the tools to understand individual practitioner's capacity to engage in a process of development. A review of existing measurement tools summarised within the paper indicates a paucity of valid and reliable instruments to support leaders to identify individual support needs at time of transformation and change. The article therefore recommends the development of further tools to support leaders to understand and respond to the individual needs within the workforce at times of development and change.
Financial implications: ENT medical documentation
Authors: Lawrence Rachael J , Hinchliffe Paul
Published: May 2014

An audit was undertaken to evaluate the quality of documentation in our ENT outpatient department. It aimed to identify and subsequently improve any identified weakness in documentation and to optimise financial gain for our department. An audit of the number of procedures recorded for both newly-referred and follow-up patients for the financial year 2009/2010 was undertaken. Results were presented to all healthcare professionals, who were subsequently encouraged to accurately record every procedure undertaken. The total number of procedures performed in the following financial year was then audited to assess for improvement. Regarding follow up patients, an additional 3252 procedures were recorded in the financial year 2010/11 compared with 2009/10. An additional 403 procedures were recorded for newly referred patients. This equates to an additional income of £216 647 for our ENT outpatient department for the 2010/11 financial year compared with 2009/10. Accurate documentation of clinical procedures should be encouraged to maximise income, thereby allowing increased spending and a subsequent improvement in overall
Market power: a PCT acting as a monopsony
Authors: Bojakowski Steve
Published: May 2014

A monopsony (the opposite of a monopoly) situation occurs where demand comes from one buyer. A PCT is in a monopsony position as a sole purchaser of NHS services for a local area. Economic theory suggests two tests that can determine if a primary care trust (PCT) is abusing its monopsony position—is it driving down prices or is it restricting services to patients? Two reviews by the Cooperation and Competition panel has confirmed that economic theory can provide measures to indicate if a PCT is acting unfairly as an monopsony.
Surgical procedures, costs and patient satisfaction
Authors: Jade Andrews Lisa , El Alami Wathik , Davies Chi
Published: May 2014

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) states that emergency patients must have prompt access to theatres, critical care facilities and appropriately-trained staff at all times. Due to the increased number of trauma cases treated by our orthopaedic teams a dedicated Day Surgery Trauma List (DSTL) was introduced. This article is a retrospective study of operations, cost implications and patient satisfaction of this list. We reviewed 49 patients operated on by the first author in six months from October 2008 to March 2009. The type of operation, place of operative decision and the time taken from the decision to actual operation was recorded. The cost was analysed with the help of the finance department. Patient satisfaction was calculated from a questionnaire. Decision to operate was taken in accident and emergency in 60% cases and 40% in fracture clinic. The average time from the decision to operation was two days. Cost-benefit to the NHS was £300 per case. 28 patients answered the questionnaire with overall patient satisfaction of 8.57 out of 10. The day surgery trauma list may be used to perform various orthopaedic trauma procedures with significant cost containment (£14 400 in six months). Benefits to patients were specified operative time, reduced waiting times and good clinical care.
Implementing new radiotherapy techniques
Authors: Dahele Max , Slotman Ben
Published: May 2014

The implementation of medical innovations has often been something of an Achilles’ heel ( Berwick, 2003 , McGlynn et al, 2003 ). It is common for such implementation projects to end prematurely and unsuccessfully, and to deliver behind schedule and below expectation ( Kotter, 1995 ; Soumerai and Avery, 2010 ). Problems are frequently attributed to external barriers, outside the control of the project team, including a lack of time, money and human resources. Internal factors, for example department leadership or the performance of the project group and individuals within the department often receive less critical attention. This might be because these issues may be more challenging to confront. However by failing to do so, there is a real chance that those responsible for strategy, leadership and implementation may miss out on opportunities to improve their performance, leverage existing resources and increase the odds of future success. This article is not about whether it is better to be an early adopter or not, nor is it a systematic review of the evidence base for current technologies. Rather, it has a practical focus on the clinical implementation of advanced radiotherapy technologies for the purpose of trying to improve patient treatment, one of the major challenges in this field. Although much of the content of this article is generic, its emphasis is on the public sector. Inevitably selection has been necessary, and so some topics are not covered and in places the discussion is limited. It does not go into detail about the behaviour of organizations, or the theory of innovation diffusion ( Greenhalgh et al, 2004 ; Rogers 2004 ), concentrating instead on the current operating environment, implementation barriers, large-scale initiatives to aid technology diffusion, and some suggestions about what can be done in our own departments, to try and increase the chance of successful implementation.
Cancer commissioning doesn't have to be a black hole
Authors: Ward Colin , Clarke Christine
Published: May 2014

Cancer commissioning is complex. The East Midlands Cancer Network (EMCN) demonstrates best practice in commissioning chemotherapy drugs in the interest of patients by driving quality, productivity and equity of care through improved understanding of chemotherapy expenditure in the absence of network wide electronic prescribing systems. The EMCN programme used detailed expenditure data to facilitate a clinically led commissioner involved review of prescribing practices. This approach has reduced the rate of increase in expenditure on chemotherapy over the past three years. This has been achieved in parallel with enhanced patient care through the development of agreed funded care pathways and treatment algorithms. In turn this has enabled the management of patients in a more equitable and evidence-based manner which is translating into improved patient outcomes across the region. It also serves to emphasise the benefits of a single lead commissioner working with a single cancer network on behalf of the commissioning stakeholders in a defined area. It also provides a way in which a simple expenditure review process can result in benefits in quality and cost until the new mandatory chemotherapy dataset is established
A social audit of private hospital services in India
Authors: Saha Dola , Reshmi B , Sabu KM
Published: May 2014

There is a social responsibility in the healthcare sector to provide better healthcare services to all groups of society irrespective of their socioeconomic status. Social audit helps to ascertain the extent of the services being provided to the underprivileged. It was our objective to identify the extent of healthcare services being provided to the underprivileged by the private hospitals, and also to understand the barriers in providing them. A total of 17 hospitals were considered for the study. The medical directors and managers were interviewed for the study. An informal interview and a semi-structured questionnaire were used to ascertain the response from the respondents. The questions covered areas such as the percentage of outreach programs; frequencies of subsidized or free services given and barriers they face. Approximately 58% of hospitals stated that they considered the economic status of the patient when considering for free and subsidised services in the hospitals. Around 64% claimed that they provided free and subsidised services to the people. Barriers faced by these hospitals were mostly in finding sponsors. In conclusion, the healthcare sector understands its role in making healthcare affordable and finds ways to reach out to the needy. However, finding a sponsor was seen as a major hurdle for many hospitals.
Resuscitating Oracle Learning Management
Authors: Clarkson D McG , Radford Mark
Published: May 2014

While the Oracle Learning Management® (OLM) system is widely used in the NHS in England to record medical device training, the reporting modes available restrict the use of the facility for the review of summary information of training status relating to specific clinical areas. In addition, where a range of training and evaluation processes can lead to ‘competency’ in respect of a specific individual and medical device, OLM cannot derive a single status from a series of such entries. The scientific programming language MATLAB® was used to develop a software tool to merge an Excel® extract from OLM with spreadsheets of locally identified competency requirements. The key field of an individual's electronic staff record (ESR) number was used to merge the two data sets together. It has been found necessary to develop a separate ‘data dictionary’ to describe characteristics of training elements referenced within OLM. The ability to create local spreadsheets of competency status of staff from the generic OLM system has proved of benefit in implementation of medical equipment training management processes. The maintaining of local spreadsheets of individuals and required medical equipment competencies provides also a practical mechanism to structure and maintain a medical device training programme.
Strategy and the strategic role of GPs in the NHS
Authors: Willcocks Steve
Published: May 2014

This article explores strategy and the strategic role of the GP in the new NHS. It highlights the importance of understanding the strategic context of the NHS, following the successful passage of the Health and Social Care Bill. It applies contrasting views on strategy: top-down, rational vs ‘bottom-up’ emergent approaches to characterise strategy in the NHS. It suggests that it may be possible to explore strategy using the integrated model of strategy devised by Johnson et al (2011) . In so doing, strategy is conceptualised in terms of: strategy as context; strategy as content or choice; and strategy in action, or as enacted by key actors. It highlights the practical implications for GPs as key actors involved in strategy, particularly those involved in clinical commissioning groups (CCGs).
The introduction of the 18-week wait initiative
Authors: Beech Thomas , Naylor Dawn
Published: May 2014

The 18-week wait initiative (18WWI) was introduced in December 2008 with the aim of reducing the waiting times of patients referred by their GPs and being seen and treated in secondary care. The aim of the study was to assess whether there had been a change in the way patients were managed in the outpatient clinic as a result of this and whether any service changes were necessary. This is a retrospective service evaluation comparing the outcome of new patients seen in otolaryngology clinics both before and after the introduction of the 18WWI. The wait in time between GP referral and outpatient visit is less following the introduction of the 18WWI. Following the 18-week wait introduction the number of new patients attending outpatient clinics increased, whereas the number of patients listed for an operation fell. There appears to be a shift in the need for more outpatient appointment slots with a possible reduction in the need for operating theatre time. If this trend continues and is translated across departments it will impact on the service that needs providing.
After Francis: has the shock been big enough?
Authors: Timmins Nick
Published: May 2014

Following Francis, Nick Timmins, senior fellow at the Institute for Government and the King's Fund, wonders what the long-term effects on the NHS will be
Average length of stay in hospitals in the USA
Authors: Jones Rod
Published: May 2014

In the pursuit of lower health care costs, measures of efficiency, such as length of stay (LOS) come under increased scrutiny. There is a general perception that the operation of a free market in the USA leads to higher efficiency. However, lower average LOS in US hospitals is shown to decrease in proportion to the number of beds per hospital. This is partly due to the role of hospital size and the truncating effect of Medicare diagnosis-related group (DRG) payments on costs and therefore upon average LOS. The USA should not be used as a so-called efficiency benchmark for LOS, and on a like-for-like basis seems to have an average LOS which is comparable to that in England.
Measuring the effectiveness of home telemonitoring
Authors: Goode Kevin M , Crundall-Goode Amanda , Barrett David I
Published: May 2014

As home telemonitoring (HTM) moves away from randomised controlled trials and towards the mainstreaming of services, a clear set of guidance on how to evaluate them is needed. Without appropriate and systematic evaluations, the healthcare sector and those who commission its services will not be able to learn important lessons about which aspects of HTM work best. This article will discuss the advantages and disadvantages of different strategies that can be employed by commissioners and service providers in the evaluation of HTM services.
Oral liquid antipsychotic formulation in the treatment of psychosis
Authors: Mutsatsa Stanley , Bressington Daniel
Published: May 2014

This article discusses oral liquid antipsychotics as a treatment option to either oral tablets or injection formulation. It discusses bioavailability, treatment in emergencies and the potential merits of using oral liquid preparations in terms of relevant practical issues.
Representations of mental health disorders in print media
Authors: Bowen Matt , Lovell Andy
Published: May 2014

This article reviews research findings into the portrayal of mental health disorders in print media, with particular attention to research that uses content analysis. The findings indicate that there is diversity in the representations of mental health disorders, and that in the UK the proportion of ‘good news’ stories increased between 1992 and 2008. However, there remains an over-association of mental health disorders with dangerousness, and this is emphasised through the use of sensationalistic language and highlighting violence in newspaper headlines. These results are explored as part of the process of stigmatisation and the impact that it has on the knowledge, attitudes and behaviours of the general public; and on the lives of service users.