bluuebunny/crossref_metadata_2025 huggingface dataset:
Writing a reflective assignment as a student HCA in Ireland
Authors: Duffy Anita , Noone Eileen
Published: May 2014

Over recent years in the Republic of Ireland, there has been a major transformation in the healthcare workforce, especially those caring for older people. With the prompt induction of healthcare assistants (HCAs) to residential care facilities and more specifically to home care organisations, there has been an increase in demand for HCAs in Ireland.

Consequently, the number of students undertaking Further Education and Training Awards Council (FETAC) Level 5 training programmes for these positions has increased and the Irish Government is providing free training programmes for jobseekers to retrain as HCAs. One such programme is the CPL Momentum project, retraining job seekers to qualify as HCAs.

Many students struggle with academic writing and, in particular, with writing reflective assignments. In this article, one CPL Momentum student HCA and her reflective critical friend and course co-ordinator attempt to demystify the reflective writing process to empower other HCA students to critically analyse their own practice through reflective writing.
Septic shock — and the role the HCA and AP can play
Authors: Peate Ian , Holmes Edward
Published: May 2014

This article provides information concerning septic shock. This condition is also known as septicaemia and bacteraemia and is potentially fatal. Key terms such as sepsis, bacteraemia and septicaemia are defined. A discussion concerning the pathophysiological changes occurring with septic shock is provided. The signs and symptoms are described and the management of the condition is highlighted. The role of the healthcare assistant and assistant practitioner (HCA and AP) is addressed. The article emphasises the need for all staff to act quickly if sepsis has been suspected. A glossary of terms is provided.
Multiple personality disorder: an introduction for HCAs
Authors: Hayes Catherine
Published: May 2014

The public perception of multiple personality disorder (MPD) is of a sudden, irreversible and severe change in mental health. In fact, MPD is usually slow of onset and, with the right care, people can go on to live fulfilling lives after an episode of MPD.

Diagnosis is a long and complex process and it is reasonable for HCAs to raise issues of concern about patient behaviour with a qualified healthcare practitioner.

A basic awareness of the 5 types of symptoms can improve how and why the HCA or AP interacts with people living with MPD; these signs and symptoms may differ significantly in intensity and pattern and vary over time.
Quality palliative care for the person with dementia
Authors: Nazarko Linda
Published: May 2014

Although every one of us will die, death remains a taboo subject. People rarely discuss death, or their wishes in the event of life-threatening illness. When a person has dementia, end-of-life care planning is doubly difficult, because the taboo of discussing death combines with lack of understanding about dementia ( Alzheimer's Society, 2012a ). This reticence means that people with dementia may be subject to burdensome interventions at end of life and do not always benefit from high-quality end-of-life care ( Goldfeld et al, 2012 ).

This article outlines the reasons why a palliative approach is required, the principles and benefits of palliative care, and how this should be discussed and provided.
Drug focus on warfarin — an anticoagulant medication
Authors: Price Rob
Published: May 2014

Warfarin is a commonly prescribed anticoagulant medication used for the treatment and prevention of venous and arterial blood clots. This update article about warfarin covers the following: how it works, what it is used for, the potential side effects, when it should be avoided and practical considerations of warfarin therapy.
Ward Stars—applauding HCAs working in mental health wards
Authors: Higham Nic
Published: May 2014

The healthcare assistant (HCA) role plays a major part in inpatient mental health settings. HCAs are nowadays the staff who are able to offer the most direct patient care. Yet despite the significance of the HCA, evidence shows that the majority of HCAs receive little or no training or professional development for their complex role.

Patients frequently comment that it is the foundational, human qualities and compassionate attitudes that matter most to them. Ward Stars is a new and free staff development scheme for mental health inpatient HCAs. The scheme aims to provide a helpful structure for professional development and validation and enhance the status and reputation of the role.
Understanding the debate on regulation of support workers
Authors: Vaughan Suzanne , Melling Karen , O'Reilly Lynn , Cooper Denise
Published: May 2014

While much is written about the regulation of healthcare support workers (HCSWs), many authors and policy-makers do not distinguish between assumption and evidence. As calls for compulsory regulation of HCSWs grow louder, it is crucial that the evidence underpinning the debate on both sides is considered carefully and critically.

The authors reviewed journal articles and policy documents with the specific aim of clarifying the arguments for and against further regulation from an evidence-based perspective.

The majority of material recommended HCSW regulation; however, the mechanisms by which regulation would deliver better patient care were often missing and were rarely evidence-based.

This article provides clear definitions of the key terms and processes needed to engage in the debate, followed by a summary of the arguments for and against the regulation of support workers.
Pathophysiology series 2: acute myocardial infarction
Authors: Peate Ian , Jones Noleen
Published: May 2014

This article provides the healthcare assistant and assistant practitioner (HCA and AP) with an overview of acute myocardial infarction (MI). The anatomy and physiology (including cardiac condition) are described. The role of cardiac muscle and the coronary arteries is outlined. In order to reduce morbidity and mortality associated with MI, the HCA and AP must have an understanding of the anatomy and physiology of the heart, the signs and symptoms of MI and the immediate care required by the patient. As well as the important physiological issues and the administration of prescribed drugs, the HCA and AP have a role to play in relieving anxiety and providing reassurance to the person and, if appropriate, his or her family. A glossary of terms is provided.
Returning to work: nurses’ experiences surveyed
Authors: Blomfield Richard , Horne Carys
Published: May 2014

One of the major obstacles to the implementation of The NHS Plan and modernisation of health care is the shortage of available nurses.

This article considers the impact of the recent initiatives on the personal and professional circumstances of nurses who return to work.

Are they in reality coming ‘back to the future’? What support will ‘nurse returners’ require for this movement to grow?
What do we really think of the NHS and its managers?
Authors: Bell Andy
Published: May 2014

Andy Bell of The King's Fund looks behind the face values of a recent opinion poll.

How much do either health care managers or the public really know about the other's views? Can a clearer, more useful picture be formed?
From whom can the NHS learn useful lessons?
Authors: Cowper Andy
Published: May 2014

Professor Andrew Pettigrew of Warwick University, giving the inaugural NHS Confederation Christmas Lecture last month, chose as his title ‘Does leadership make a difference to organisational performance in the NHS?’
Double standards
Authors: Baker Mark R
Published: May 2014

Negotiations on the new consultant contract are clearly at a delicate stage. With the announcement in the summer of the launch of negotiations on a new contract for general practitioners, the Government could find itself fighting a war on two fronts. Analysts of twentieth-century military history will avow that this is not a desirable position to be in.
Xplaining XML and what it means for IT
Authors: Kumar Ravi
Published: May 2014

All of a sudden, everyone's talking about XML — or Extensible Mark-Up Language, to give it its full name. It's billed as the next great step forward in health care IT, but many are asking, ‘Why is it such a great step forward?’ ‘Does it really live up to the hype?’, ‘How will it improve the way I work?’ and ‘What do I need to know about it now?’
‘Tis the season to be jolly
Authors: Cowper Andy
Published: May 2014

That may be overstating it, of course. Yet for all the irritating sharp pains caused by the winter's seasonal problems (not the pine needles), there has also been some comfort. The interim report of Derek Wanless' review for HM Treasury has concluded that the NHS requires massive increases in funding. Congratulations are due to those who helped and advised this committee: you know who you are.
Milburn wounded in the gunfight at the OK Corral
Authors: Roth Andrew
Published: May 2014

My fellow political correspondents are often like lemmings, following each other over a cliff. This recurred in mid-November when, after the Financial Times featured a story on the impact of an alleged new Blair-Brown feud, the following weekend all the ‘heavies’ and some of the ‘red-tops’ followed suit.
Lammy hits the NHS with double whammy
Authors: Halpern Stephen
Published: May 2014

The plan to recover the costs of treating personal injury cases received little attention in the national media. The timing of the announcement at the end of the week of September 11th was not the only element of defensiveness in this shallow, ill-thought-out scheme.
Points of engagement: alternative and complementary therapy in primary care
Authors: Pinder Margot
Published: May 2014

This article examines the role played by alternative and complementary therapies in primary care. Can they be of real use to GPs?
Opening the doors on NICE: the next steps
Authors: Dillon Andrew
Published: May 2014

NICE Chief Executive, Andrew Dillon, considers the debate sparked by the Health Select Committee Inquiry into his organisation
So what would YOU do then, Michael Dixon?
Authors: Dixon Michael
Published: May 2014

Continuing our new series, Dr Michael Dixon puts forward the reforms that he believes would most suit the NHS for a real and reliable future.
Policy Developments
Authors: Halpern Stephen
Published: May 2014

The relationship between health professionals and the media has often been difficult. Although there are some obvious potential causes for this friction such as both groups having very different goals, the whole area is not really well understood.
The price of being nice to GPs
Authors: Maynard Alan
Published: May 2014

General practitioners are being offered pots of money and a contract that is full of fun! In addition to throwing hundreds of millions of taxpayers’ money into their pockets, the GPs are being asked if they want to work shorter hours, and will be paid fee-per-item of service to do those things that have been deemed good for patients. Being nice to GPs is a nice set of mixed costs and benefits for patients and the rest of the NHS.
What are the costs and benefits of patient choice?
Authors: Maynard Alan
Published: May 2014

In this article, Alan Maynard considers what patient choice will do to improve NHS efficiency.
Waiting times abolished by new commissioning?
Authors: Hynes Donal M
Published: May 2014

Why are we waiting?

This article looks at ways to abolish of waiting times and new mechanisms for commissioning in primary care using Referral Management Centres.
A right to be concerned
Authors: Baker Mark R
Published: May 2014

Health Ministers, so I am reliably informed, are very concerned at present. They have every right to be so. It has apparently, and finally, dawned on them that the Brown billions are funding little more than deficits. Meanwhile, the epidemic of targets and the approach of some key milestones almost guarantee that some will be missed.
Conversational Conferences: from ideas to action
Authors: Pratt Julian , Plamping Diane , Gordon Pat
Published: May 2014

This article considers how a new approach to the design of conferences can actively assist and encourage the innovation and energy needed to change working practices.
“Schools-and-hospitals-first”, or how I learned to stop worrying and love The NHS Plan
Authors: Cowper Andy
Published: May 2014

When you have finished reading this, here's a little game to play. Close your eyes tightly. Really screw them up, and start saying to yourself aloud, “Schools-and-hospitals-first.” Keep repeating it like a mantra, hardly pausing for breath. (Oh, by the way, it's probably best that you don't do this in public. Shut the door and lock it.)
A dirty business
Authors: Harvey Trevor
Published: May 2014

A century ago, entering hospital was a dangerous event. If your illness didn't kill you, the treatment probably would. Puerperal fever was the scourge of midwifery. Those who survived surgery risked succumbing to one of the litany of postoperative complications. Bleeding and bedsores were rife, and wound sepsis, chest or urinary tract infection were often lethal.
Austerity measures and single use items in ENT surgery
Authors: Parmar Amit , Clark Matthew PA
Published: May 2014

A change in policy regarding the use of certain topical medications was recently introduced to ENT operating theatres. These medications had been traditionally used on multiple patients but became designated single-use items. We aimed to assess the evidence base behind this change and assess the resultant financial impact, including to the wider healthcare community. The evidence base for the policies was sought from managerial staff, the infection control department, drug manufacturers and a PubMed search. Of the items identified as affected by policy change, their use over one month was audited and the resultant costs calculated. Each medication identified had previously been used upon multiple patients in the operating theatre scenario, where the medications are used on post-operative wounds (with a ‘no-touch’ technique between patients). There had never been clinical concern about this practice with regards to wound infection rates. We were unable to identify any evidence to support this change in practice. Cost analysis revealed a potential 83% saving in costs by reverting to a multiple-patient use policy. While we applaud efforts to reduce infection rates, policy changes to help achieve this should be justified with an appropriate evidence base or at least be targeted towards areas where there is clinical concern. With increasing numbers of items used in hospitals becoming designated single use, the cost implications are potentially huge when considering the healthcare community worldwide.
Printing the legend
Authors: Cowper Andy
Published: May 2014

‘This is the West, sir. When the legend becomes fact, print the legend.’ John Ford, The Man Who Shot Liberty Valence (1962)
Laughing and crying about foreigners’ “health tourism”
Authors: Roth Andrew
Published: May 2014

I don't know whether to laugh or cry about Dr Liam Fox's re-resurrection of the Tories’ periodic crusade against health tourism by foreigners exploiting the NHS; this time with the additional gimmick of an uncosted entitlement card. Cunning Dr Fox does not want to disclose its cost, for fear of precipitating cardiac arrest on the part of any future Tory Chancellor.
Treating to target: using cost-effective statins
Authors: Cowie Martin
Published: May 2014

There is overwhelming evidence that cholesterol-lowering with a statin is a key component of a global approach to risk reduction in cardiovascular disease.

However, spiralling costs have made some question the cost-effectiveness of these compounds.

This article reviews the evidence and suggests how to maximise health gain.
Health tourists and fellow travellers
Authors: Bell Andy
Published: May 2014

We've had single parents, benefit cheats, and ‘bogus’ asylum seekers. Now we have ‘health tourists’. The latest in a long line of public enemies has emerged from a series of political speeches, press releases and television documentaries during the summer ‘silly season’ this year.
Improving access with the ‘Three Minute Surgery’
Authors: Gordon Michael , Cliff Dominic
Published: May 2014

‘Mrs Grant first noticed the little lump on her wrist about 8 weeks before. Although it was painless, she wondered what it was.
Is Blair's horse more schizophrenic than he is?
Authors: Roth Andrew
Published: May 2014

Recently, I have had to modify the image conjured up by a famous Canadian humourist: about the man who jumped on his horse and galloped off in all directions. I was watching Tony Blair as he was listening with approval approaching adoration to the Budget speech of his deadly rival Chancellor Gordon Brown.
Acute problems persist for mental health
Authors: Bell Andy
Published: May 2014

Earlier this year the Sainsbury Centre for Mental Health and the Healthcare Commission both published reports looking into acute inpatient psychiatric wards. Both produced gloomy findings. The former, Acute Care 2004, was based on a survey of chief executives and ward managers across England (SCMH 2005).
Beyond comprehensive critical care - to quality
Authors: Harper S Jane , Shepherd Sue , Brookfield Sarah
Published: May 2014

Acute hospitals cannot function without critical care units and people to run them. Despite injection of money into critical care in 2000 and a subsequent increase in capacity, transfers of critically ill patients for non-clinical reasons still occur, and elective surgery is frequently cancelled for lack of a critical care bed. This article describes the state of critical care in 2006, based on a survey of hospitals in England.
The unannounced big announcement
Authors: Timmins Nick
Published: May 2014

December 2008 was the month that featured not so much the good, the bad and the ugly, but the exceptional, the dire and the decidedly mixed bag.
Moving healthcare closer to home
Authors: Samuels Martin
Published: May 2014

In December, the Department of Health launched the NHS Operating Framework for 2008/09, which requires trusts to develop local plans for services they provide. It expects PCTs to take steps toward providing care close to patient's homes as possible.
Michael Dixon
Authors: Dixon Michael
Published: May 2014

Values are essential to the NHS: they are the NHS. Two GPs whose values inspired me are Anthony Barker, a visionary doctor who practiced in Ngudu, South Africa during the apartheid era – a very poor area. Working in very hard conditions, Barker's only thoughts were how he could best help his patients. His altruism, heroism and courage against apartheid are inspiring.
The right to die
Authors: Hill Rosalind
Published: May 2014

Health news this month (courtesy of the BBC, of course) began with a woman's dilemma in the High Court over her right to die and the possibility that her husband, if he assists, could beprosecuted (BBC, 2008).
Two reports, two responses
Authors: Rogers Rosalind
Published: May 2014

In Northern Ireland, in the week before its traditional July holidays, a commissioned report quietly slipped into the public domain. It was recommending changes in current service provision for children with speech, language and communication needs (Northern Ireland Speech and Language Therapy Task Force, 2008).
Costing orthdopaedic interventions
Authors: Jones Rod
Published: May 2014

Under payment by results (PbR) hospitals receive the bulk of their income from the healthcare resource group (HRG) tariff. The tariff in each HRG is the weighted average cost for all English hospitals. A key assumption within the national tariff is that all procedures or admissions with the same clinical codes must cost the same, irrespective of the specialty in which the activity occurs. It has always been stated that the groups of codes that make up a HRG are iso-resources, i.e. cost roughly the same (Jones, 2001; The NHS Information Centre (NHS IC), 2007).
No surprises over the foie gras
Authors: Cowper Andy
Published: May 2014

The old Lancashire proverb ‘don't piss on your own front doorstep’ springs to mind about the row over increasing the hours of access to GP services.
Predicting a sickly constitution?
Authors: Timmins Nick
Published: May 2014

January 2008 was the month where almost everyone, it appears, requires a constitution when they would be far better off taking a constitutional. Labour looks increasingly
Monitor and the Care Quality Commission
Authors: Moyes Bill
Published: May 2014

The NHS doesn't stand still for long. This year the service marks its 60th anniversary, but during a year of retrospective celebration there will also be new developments of fundamental importance, and for many the most pertinent of these is the emergence of a new regulatory body, the Care Quality Commission (CQC).
Prevention is better than cure
Authors: Bell Andy
Published: May 2014

No sooner than the fireworks stopped for New Year, both Government and Opposition began setting out their visions for health policy in England. All have focused not just on the traditional health policy territories of the way the NHS is managed, but on the future of social care and the prevention agenda.
Provision of bariatric surgery in Norfolk
Authors: Sivagnanam Piriyah , Rhodes Michael
Published: May 2014

Morbid obesity is defined as having a body mass index (BMI) of more than 40kg/m2 or a BMI between 35kg/m2 and 40kg/m2 with associated comorbidities (National Institute for Health and Clinical Excellence (NICE), 2002). Obesity is fast becoming a pandemic that is spiralling out of control. In the UK, between 1993 and 2005 obesity rates increased from 13% to 23% in men and from 16% to 25% in women (The Information Centre, 2006). The potential annual economic burden of this condition has been estimated at £6.6-7.4 billion (House of Commons Health Select Committee, 2004).
Validating colonoscopy waiting lists
Authors: Marden PF , Newton A , Williamson M , Douglas S , House W , Farnham K , Robertson D
Published: May 2014

The advent of colorectal screening has highlighted the need for accurate and manageable colonoscopy waiting lists. Under recent Department of Health (DH) targets, by December 2008 all patients in the NHS will require effective treatment within 18weeks of original referral (DH, 2004; NHS, 2008). This has obvious implications for the organisation of diagnostic and therapeutic endoscopy services throughout the NHS, and adds further impetus to the need for reduction of endoscopy waiting lists.
No room at the inn: maternity units closed
Authors: Phipps Belinda
Published: May 2014

Figures released in March 2008 highlighted the fact that more than 40% of trusts had to shut the doors of their maternity units or divert women to other sites at least once during 2007, with one trust reporting that it had to close its doors 28 times.
Accident and emergency: no tailor-made solutions
Authors: Ainsworth Steve
Published: May 2014

Those who have read Kipling will readily recall his tale of the mongoose Rikkitikki-tavi, and of his war with the great cobra Nag. Few, however, will recall the role played in the conflict by Darzee, the tailor-bird
Agfa HealthCare
Authors: Middlehurst Karen
Published: May 2014

Every clinician needs the right tools to save lives. Critical to making a speedy diagnosis is the rapid collection, retrieval and interpretation of high quality images and other important data. As the market leader for state-of-the-art imaging and imaging informatics, Agfa HealthCare is committed to bringing benefits to busy hospitals and healthcare facilities of all sizes and their patients.
Electronic patient records: finding the right solution
Authors: Middlehurst Karen
Published: May 2014

Foundation trusts should innovate by definition. The Department of Health (2007) describes the purpose of foundation trusts as ‘bringing about improved access to higher quality services for NHS patients by incentivising innovation and entrepreneurialism.’ Although innovating continuously is not essential, seizing the initiative is important when the consequences of getting it slightly wrong are great. Larger IT projects, such as commissioning an integrated electronic patient record (EPR) system, are occasions when foundation trusts have to be well informed. Trusts should think carefully about how the system will meet patient needs, and ensure their system does just that.
Diamond days: the NHS at 60 years
Authors: Ainsworth Steve
Published: May 2014

On its 60th birthday the NHS, and those who work in it, have much to celebrate.
Improving the care of heart attack patients
Authors: Kendall Jason , Berry Sunita
Published: May 2014

The emergency treatment of heart attacks in the UK, or what is known as ST elevation myocardial infarction (STEMI), has undergone substantial change in recent years, with the use of both pharmacological treatment administered before the patient is admitted to hospital (pre-hospital thrombolysis (PHT)), mechanical intervention and primary percutaneous coronary intervention (PPCI), increasing rapidly.
Tom Moloney
Authors: Moloney Tom
Published: May 2014

Throughout my career I've been lucky enough to work across a wide range of industries and business sectors, from motorcycling to fashion, construction to computing. Over the years I have come to believe that the performance of individuals and teams can be greatly improved through effective performance measurement. Gone are the days, in my opinion, of patronage.
Limitations of the HRG tariff: excess bed days
Authors: Jones Rod
Published: May 2014

Every year hospitals submit an analysis of their costs for a variety of health resource groups (HRGs). These are called ‘reference costs’ and the Department of Health (DH) uses these reference costs to devise the national HRG tariff. Local reference costs are first adjusted for the local cost of labour and buildings via the market forces factor, and the adjusted costs are then averaged to give the national price for each HRG.
Patient and public engagement in WCC
Authors: Redding Don
Published: May 2014

When English primary care trust managers return from their holidays they will be pressing to get ready, by October, their first full strategies under the World Class Commissioning framework.
What can foundation trusts add to the NHS?
Authors: Maynard Alan
Published: May 2014

There are now over 100 Foundation Trusts. They are the ‘cream’ of the stock of acute, mental health and community hospitals in the English NHS, having been carefully vetted by the regulator, Monitor. But are these organisations adding exceptional value to the NHS, or are they rutted in NHS grooves and failing to exploit their freedoms?
Safe birth: at last, it's everyone's business
Authors: Gould Debby
Published: May 2014

In February this year, the King's Fund published an independent enquiry into the safety of maternity services in England (2008). Initially it seems that it contains nothing new.
Denial of life-saving drugs is not NICE
Authors: Ainsworth Steve
Published: May 2014

The National Institute for Health and Clinical Excellence (NICE) seems to have been getting nothing but bad press lately. And having such a benign sounding acronym for a name is just asking for trouble.
What does 2009 hold for the NHS?
Authors: Dillon Andrew , Dixon Michael , Crump Bernard , Imison Candace
Published: May 2014

A lot can happen in a year. And a lot happened in 2008. The beginning of last year saw a row over the proposals to increase hours of access to GP services and belligerence on the part of the BMA.
The future of health care is ours to imagine
Authors: Harmond Kate
Published: May 2014

The Institute for Healthcare Improvement (IHI) is a not-for-profit organisation aiming to improve worldwide health care. It was founded in 1991 and works to accelerate change by cultivating better quality patient care. A significant role is to put ideas into action, and demonstrate their effectiveness.
The NHS in 2009-10: a time of reckoning
Authors: Maynard Alan
Published: May 2014

The prudence of Whitehall Village and all NHS managers during seven years of plenty is now to be tested by seven years of want. An indication of the testing times ahead has been heralded by the small uplift in hospital tariffs for 2009–10.
Malnutrition in hospitals: unrecognised and ignored
Authors: Abayomi Julie , Judd Shirley , Hackett Allan
Published: May 2014

Malnutrition in hospitals has been acknowledged since Florence Nightingale's time. Despite a range of policies and campaigns to deal with the problem, little appears to have changed. This article argues that preventing malnutrition among hospital patients is not just a question of providing quality hospital food. Tackling malnutrition needs to be a priority for all health professionals, managers and politicians. There needs to be a substantial change in culture within the NHS, acknowledging nutrition as an integral component of clinical care, with budgets for food provision held within ‘clinical services’, rather than ‘hotel services’. Health professionals need increased nutritional knowledge and should undertake undergraduate and postgraduate nutritional training, with an emphasis on malnutrition. With reduced hospital stays, the window of opportunity for identifying and treating malnutrition will diminish without the involvement of primary care staff. Screening will help identify those at risk, but adequate funding to ensure appropriate resources to deal with malnutrition are also needed.
Cervical cancer immunisation: 1 year on
Authors: Bedford Simone
Published: May 2014

The World Health Organization (2009a) has acknowledged the importance of cervical cancer and other HPV-related diseases as global health problems, and recommended national immunisation programmes to combat these. In September, 2008 the UK Government set out to immunise school girls against cervical cancer. This article examines the UK's immunisation programme one year after its inauguration, including an overview of the choice of vaccine, suspected adverse reactions, uptake rates across the UK, and potential barriers.
Productive, efficient cost savings
Authors: Appleby John
Published: May 2014

As the financial pinch draws nearer for the NHS, it has begun to (re)discover the need to grapple with the basic economic problem of resource allocation in the face of scarcity. It is also discovering the economic words to go with it– but not always the right meanings.
Simplified one-stop clinic
Authors: CY Tang Vincent , WY Lee Elaine
Published: May 2014

Objective: The Government initiative to reduce patient waiting times for new referrals to specialist clinics has put a great amount of pressure on outpatient clinics. The objectives of this study were to identify which patients referred to the urology clinics at St Helier Hospital would be suitable for the simplified one-stop clinic model-a model which allows patients to receive appropriate investigation, consultation and treatment plans in one sitting, with care then either discharged back to the GP for follow-up, or put on the elective surgery waiting list-and to estimate the potential number of follow-up appointments that could be saved through the use of the simplified one-stop clinic model. Method: Three months of GP referrals to the general urology clinics were identified retrospectively. The simplified one-stop clinic criteria were then hypothetically applied to these referrals. The group that was suitable for the one-stop clinic was further analysed for the purpose and outcome of the first and the follow-up appointments. Results: Out of 330 referrals, 48.8% were suitable for the simplified one-stop clinic. Further analysis of this group showed that 38.5% were discharged and 27.3% were put on the elective surgery waiting list following the initial consultation. The remaining 34.2% required follow-up, because 14.3% were awaiting renal tract ultrasound, 12.4% were awaiting uroflow rate study, and 7.5% for other reasons. Conclusions: There is a potentially significant number of follow-up appointments in the general urology clinic that are wasted owing to patients waiting for simple investigations. The authors believe the simplified one-stop clinic model has the potential to provide a safe solution to reduce the burden of follow-up appointments within urology.
Cost-effectiveness in blood glucose testing
Authors: Martin Melanie
Published: May 2014

To help improve patient outcomes, primary care organisations should encourage the use of blood glucose self-monitoring (both pre- and post-meal) where indicated, but only as part of a structured education programme. In this way, patients can better understand when to test, how to act on test results and learn how to minimise wasted resources. Primary care organisations should also consider the use of simple meters of the highest performance, including coding, haematocrit and interference, which are discussed in this article. This article aims to highlight aspects for primary care organisations to consider in order to maximise effectiveness and cost-benefits in blood glucose monitoring.
Deprivation of liberty safeguards
Authors: Griffith Richard
Published: May 2014

The Mental Health Act 2007 introduced an amendment to the Mental Capacity Act 2005 that authorises the deprivation of liberty of a person who lacks decision-making capacity in a care home or hospital, where this is necessary to protect him/her from harm. Healthcare managers in hospital trusts will be required to identify patients being deprived of their liberty and request authorisation from their supervisory body for this to continue in the patient's best interests. The safeguards are come into force on the 1 April 2009.
Experience and good management for IT
Authors: Sanderson John
Published: May 2014

The NHS is the third largest employer of any single organisation globally and understandably, has relatively complex and unique recruitment requirements accordingly. Yet, historically, the large-scale computing systems needed for such an organisation have always been farmed out to major generic systems suppliers in the belief that this represents a lower risk.
Rise of the robots
Authors: Hill Rosalind
Published: May 2014

Sending this May issue of BJHCM to press has possibly been one of the most difficult. Reading on, I'm sure you will be able to tell that one reason for this is writer's block–I have absolutely no idea what to write about. Appleby's got flu covered, and Timmins the Budget.
Emergency admissions and financial risk
Authors: Jones Rod
Published: May 2014

Parts one and two of this series looked at the long-term trends and cycles in emergency admissions, while part three investigated the implications to acute bed planning. This article discusses the erratic changes in emergency admission rates as a result of external forces, such as weather and environment, in relation to the financial risk experienced by capitation-funded commissioning groups.
Commissioning for public engagement
Authors: Redding Don
Published: May 2014

Last year I worked with a PCT that had experienced the worst of the last NHS financial clampdown, during a ‘turnaround’ process in 2006. The cuts and withdrawals of service deeply damaged its stakeholder and community relationships.
The need for scepticaemia
Authors: Maynard Alan
Published: May 2014

Two Irish public health physicians, Petr Skranbanek and James McCormick, argued that the purpose of their book was to induce scepticaemia in its readers (Skrabanek and McCormick, 1992). They defined scepticaemia as ‘a condition of low infectivity. Medical School education can give life long immunity’.
Swine flu: preparing for the second wave
Authors: Higginson Ray
Published: May 2014

Although the current swine flu pandemic shows signs of slowing, with reported weekly cases falling across the UK, health professionals need to prepare themselves for a possible second wave of pandemic swine flu this coming winter. The regional variations in swine flu management raise series concerns for future service delivery. If the H1N1 virus mutates and becomes more virulent, then there needs to be a single, coherent preparedness plan put in place across the whole country. Although a mild infection for the majority who catch it, swine flu has been shown to be fatal in a small number of cases. To help mitigate against the effects of any future pandemic, a truly unified national response is required.
Whatever happened to the NSF for COPD?
Authors: Johnson Helen
Published: May 2014

I had an interesting time researching material for this article. Current hot policy topics relating to chronic obstructive pulmonary disease (COPD)? Er, it was difficult to find any national policy relating to COPD at all, let alone policy that was hot and topical.
A guide to managing COPD
Authors: Barnett Margaret
Published: May 2014

Managing chronic obstructive pulmonary disease (COPD) in both primary and secondary care is both a difficult and challenging problem for healthcare providers. Although it is a preventable disease, it is one of the most common chronic diseases, which is increasingly causing considerable morbidity and mortality. For many years, COPD has been poorly understood or recognised, resulting in late presentation and therefore delayed diagnosis, which consequently has a significant impact on the progression of the disease and increased use of health resources. This article briefly describes the symptoms and treatment strategies of COPD, and discusses what constitutes ‘best practice’ in the management of this condition.
Delivering quality and High Impact Actions
Authors: Dowsett Caroline , White Richard
Published: May 2014

The vision for the NHS over the next five years is to go from ‘good to great‘ (Department of Health (DH), 2009). This five-year plan maps the journey for improving the NHS andfocuses on improving quality, while improving productivity, using innovation and prevention, to drive and connect them (the QUIPP model; Farrar, 2009).
Implementing clinical governance policy: NICE
Authors: Spyridonidis Dimitrios , Calnan Michael
Published: May 2014

Clinical governance, manifested in the form of the NICE guidelines, has become a core component of the English government's health policy directives for improving health care effectiveness. However, NICE guidelines appear to be difficult to implement. Previous research has addressed clinicians' influence on guidelines implementation, but little is known about the potential influence of NHS managers in this process. This paper aims to explore managerial influence in the implementation of two NICE guidelines-obesity and chronic heart failure guidelines. The implementation process was explored retrospectively, prospectively and longitudinally, using a comparative case-study design involving four organizational settings in primary and secondary care and 74 in-depth interviews between 2007 and 2009. National policy requirements for performance management led senior managers to be more interested in financial accountability and in demonstrating that they had the appropriate documentation related to the implementation, rather than collecting evidence about the actual use of the guidelines in everyday practice. Further, NICE guidelines that required major financial investment for their implementation rarely reached the decision agendas. Blurred lines of professional and organizational accountability between managers led to a lack of agreement on the perceived successful outcomes for NICE guidelines implementation. Implications for health care management and policy are discussed.
Diabetes: complications, prevention and treatment
Authors: Forth Rachel , Jude Edward
Published: May 2014

Managing patients with diabetes can be challenging; preventing complications and reducing morbidity and mortality are the main treatment goals. Complications of diabetes can be: acute such as diabetic ketoacidosis, hyperosmolar coma and hypoglycaemia; and chronic, including retinopathy, nephropathy, neuropathy and cardiovascular disease. This article will look at the complications, prevention and treatment of diabetes mellitus. The national service framework and Diabetes UK survey will be addressed.
The importance of early intervention in mental health
Authors: Bell Andy
Published: May 2014

This article discusses how cuts in NHS budget over the next five years will affect mental health services and the ways in which better value for money could be achieved. To improve people's experience of mental healthcare, services will have to shift toward prevention and early intervention, as services and staff cannot be added without the loss of existing provision.
Long-term management of hospital orthodontic services
Authors: Banks Phil
Published: May 2014

This study sought to monitor longitudinally the service provided in two district general hospital (DGH) units. Monthly data were collected from January 1989 to December 2009 for: patient referral, attendance and DNA rates, waiting lists, treatment completion rate, appliance types used, proportion of multidisciplinary work, level of treatment need and quality of outcomes. Variations in these parameters were analysed in the light of changes imposed by government, purchaser and provider policies. Departmental policies to improve treatment outcomes were evaluated.
Beyond the basics: designing robust junior doctor rotas
Authors: Moreton Adam
Published: May 2014

Rotas compliant with the junior doctor contract (the New Deal) were implemented many years ago, but problems still occur with more complex issues such as handover omitted from rotas, trainees working incomplete rota cycles, staggered start times, and the use of junior doctor rotamasters. This article discusses frequently encountered problems when implementing a new rota, issues that are more nuanced and ‘beyond the basics’.
Trends in outpatient follow-up rates in England
Authors: Jones Rod
Published: May 2014

Trends in the follow-up rate for a variety of outpatient specialties are investigated over a 24 year period. In the majority of specialties the greatest reduction in the follow-up rate occurred prior to 2000/01. Many specialties exhibit a degree of cyclic behaviour in the follow-up rate which seems to arise out of non-linear behaviour over time in the rates of GP referral. Sudden increases in GP referral can arise from a congruence of adverse environmental conditions; i.e. sporadic ‘spike’ events, or due to longer term cycles in the wider environment (including infectious outbreaks). Such increases result in a higher proportion of false positive GP referrals leading to a dip in the follow-up rate. GP commissioners in England are advised to pay far greater attention to the undulating nature of outpatient activity and costs. Potential environmental factors contributing to such cycles are discussed along with the implications to activity and cost forecasting.
Completing discharge summaries reduces delays
Authors: Kermanshahi Mohammad Shebli , Zahoor Tosief , Jassar Patrick
Published: May 2014

Decreasing hospital length-of-stay is one of the most-tackled topics in hospital management in the NHS. This is important because, it reduces cost and increases the turnover of patients. In addition, it decreases the risk of nosocomial infections and improves patient satisfaction. The discharge summary is an important communication tool should be filled appropriately with regards to the medical information and content, because it essentially affects the management of the patient in the community. This is a descriptive paper that discusses how completing discharge summaries in the operating theatre can help decrease length-of-stay and improve patient satisfaction, without compromising patient care.
Shifting DVT identification into primary care
Authors: Ali Majid , Young Victoria
Published: May 2014

Deep vein thrombosis (DVT) can be very difficult to diagnose but early recognition and appropriate treatment can improve outcomes. Since May 2010, a DVT service has been available at Solihull Healthcare and Walk-In Centre, which enables uncomplicated DVT identification and management for all Solihull patients, speeding up patient care and avoiding referrals to hospital. In the first 11 months of the service, 355 patients were tested for DVT, saving over £220 000 from reduced hospital admissions.
Impact of centralisation on vascular surgical services
Authors: Beggs Andrew D , McGlone Emma-Rose , Thomas Paul RS
Published: May 2014

Studies showing a volume-outcome relationship in vascular surgery have led to a drive towards centralisation of vascular surgical services. This has led to these services being transferred from the district general hospital (DGH) to a central ‘network’ hospital. An unintended consequence of this is that the tariff funding stays with the operating hospital. Patients who are transferred back to the DGH for rehabilitation following treatment at the network hospital do not receive funding to cover their inpatient stay. We present data showing that since centralisation there has been a drop in overall income in a DGH along with sicker patients being repatriated. These patients also stay longer. This has implications for funding of rehabilitation tariffs and for the viability of district general vascular services.
A point of care electronic stroke data collection system
Authors: Teale Elizabeth , Young John , Sleigh Ian
Published: May 2014

Data reporting requirements in many areas of healthcare are considerable, and increasingly form the basis of remuneration. The solution to efficient capture and submission of large volumes of accurate data is therefore likely to be electronic. Using the example of stroke, this article describes the development and implementation of electronic data collection systems into NHS secondary care trusts across Yorkshire. We describe our strategy for engagement with the end-user including requirement gathering, scoping of existing systems, identification of gaps in data reporting and development of IT ‘glue’ to allow these gaps to be bridged. An operationalised framework for this strategy is provided. Through close attention to data structure, we have been able to develop systems which may facilitate the collection and submission of existing mandatory data reporting requirements, reducing the data collection burden and maximising efficiency and data quality.
Attitudes to causes of failure to report service errors
Authors: Salem Ahmad , Jones Colin , Elkharam Walid M
Published: May 2014

This article seeks to explore the attitudes and beliefs of healthcare staff relating to the causes and reporting of medication errors in UK hospitals. Exploratory descriptive qualitative design, a focus group of six senior nurses took part (with ICU nurses, medical assessment and senior nurses) was used as the method of data collection. A focus group discussion was digitally recorded and transcribed. Transcriptions of the interviews were analysed using the Framework Analysis ( Ritchie and Spencer, 1994 ). Five key themes emerged from the data, these were: poor quality of feedback; enduring culture of blame; fear factor (divided into: lack of knowledge, hierarchy and historical, power and confidence); need for protection (divided into: need protect myself, professional responsibility and from litigation); and professional culture. Participants indicated they would report medication errors frequently if they have timely feedback, reduce blame culture effect from organisation and if they have more open discussion between variant medical culture medics and nurses. The study reveals the attitudes and beliefs of healthcare staff relating to reporting medical errors which decrease their ability to report however, they still do report for different causes such as professional responsibility (senior nurses) and fear from litigation.
Scrapheap challenge
Authors: Ainsworth Steve
Published: May 2014

Steve Ainsworth discusses the difficulties of cancer screening resources in the UK