bluuebunny/crossref_metadata_2025 huggingface dataset:
National minimum standards for community equipment services
Authors: Donnelly Brian
Published: May 2014

There are approximately 10 million pieces of community equipment delivered to 3.5 million clients every year in England and Wales. The service is key for moving people safely around the whole health and social care system, and is used by almost every clinical professional working in the community. It is an absolute essential part of the early intervention and prevention agenda.

Unfortunately, the service currently has no standards in place nor is it regulated or inspected in its own right by any of the regulators. Recently enacted legislation impacts significantly on this service area, which has serious penalties for failure. There are some concerning aspects of service delivery, particularly regarding quality and patient safety issues. Widespread failings in service delivery are resulting in a significant number of unnecessary fatalities and incidents, and avoidable costs being incurred. Undue care in this area is resulting in health and social care organizations not fully realizing their strategic and policy objectives. Unless community equipment is addressed appropriately, these issues are likely to be intensified, especially with recent and proposed changes for community equipment services, such as ‘choice and control’.

It is proposed that national minimum standards will reduce risks and improve quality and safety, while saving public funds through a reduction in secondary episodes of care.
Will nursing be prioritized?
Authors: While Alison
Published: May 2014

The long-awaited Commission’s Report (Department of Health, 2010) emerged to much fanfare with the claim that in the future, nurses and midwives will be central to all aspects of health care and their practice will be rooted in compassion. Reference to compassion was an admission that on occasions nursing and midwifery has fallen below par challenging public trust in the professions. Indeed, two things were particularly remarkable about the report; the fact that it is the first major report to look at nursing and midwifery since the 1972 Briggs Report, and an honesty that registered nurses must take responsibility for their own high standards as well as not tolerating poor standards of clinical practice from their peers.
A practice-based survey of mortality revisited – what trends in end-of-life care are emerging?
Authors: Lakasing Edin , Sparkes Carly
Published: May 2014

The gathering of mortality data in general practice is useful and important; it provides a vital insight into local health needs, highlights gaps in service provision and educates those working in general practice. This article considers the mortality rates in Chorley Wood Health Centre between 2008 and 2009. The survey results provide an interesting insight into local trends, one key factor being the rate of people being enabled to die at home.
Tackling undernutrition in older people from a regional perspective
Authors: Masters Rachael
Published: May 2014

The aim of this article is to outline the issues of malnutrition in older peopleand national initiatives to effectively identify and treat undernutrition, concluding with a local example of how County Durham and Darlington is tackling undernutrition from a regional perspective through a service called Focus on Undernutrition.
Developing the community environmental health role of the nurse
Authors: Carnegie Elaine , Kiger Alice
Published: May 2014

This paper is a report from one phase of an exploratory case study. It investigated the environmental health concerns of members of communities within one city in the North East of Scotland. Individual interviews with stakeholders (n=21) and four focus groups were conducted with a convenience sample of community nurses (n=19). Community nurse participants believed that their environmental health role remains underdeveloped. They indicated that they do not view the NHS as a resource for environmental health information. An environmental role is constrained by the NHS not being perceived as a source of information or expert in environmental health. They described limited contact between community nurses and public health medicine and uncertainty and conflict of interest between clinical groups regarding the scope of an environmental health role. Policy makers could support the development of an environmental advocacy role – a pilot of this is required.
Infection control and intravenous therapy in patients in the community
Authors: Higginson Ray
Published: May 2014

Recent efforts to reduce infections have been focused within the hospital setting. Early hospital discharge, shorter inpatient stays, day surgery and the movement of patients between acute and long-stay care facilities is likely to make community-acquired infection an increasing problem. There are, or course, universal precautions and general infection control issues to consider when undertaking any clinical procedure, both in hospital and the community, but when administering intravenous therapy (medicines and/or maintenance fluids) specific measures need to be considered. This is especially important if a patient is receiving intravenous therapy at home. There are many reasons why patients may need to receive intravenous therapy in the community and these will all present with specific problems. This paper will discuss some of the infection control procedures one must undertake when administering intravenous therapy to patients in the community.
IA (the ileostomy and internal pouch Support Group)
Authors: Demick Anne , Stammers Carolyn
Published: May 2014

These are the words of the late Professor Bryan Brooke who perfected the procedure of stoma formation with the eversion technique in the early 1950s. Bryan Brooke also had the foresight to know that if the psychological needs of his patients were addressed, they would make a better recovery and in April 1956, with his encouragement, a group of patients met together to establish The Ileostomy Association.
Treating shingles (herpes zoster) in the older person
Authors: Watkins Jean
Published: May 2014

Shingles is a common problem and will affect a fifth of the population at some time in their lives (Opstelten, 2005). It may occur at any age but the incidence and severity of the condition increases with age (Johnson et al, 2008). It is therefore likely that community nurses, in their day-to-day work with older people, will encounter the problem. If they are able to recognize it and arrange treatment in the earlier stages of its development, they will be in the position of helping to speed the resolution of the rash and reduce the debilitating consequences that may follow, in particular in the form of post-herpetic pain, which may affect the patient for weeks, months or even years after the active stage is over, visual complications following ophthalmic herpes zoster or zoster encephalitis that may be fatal. Apart from pain and future of the patient, the condition may require the disruptive and expensive option of hospital admission. The possibility of the introduction of a new vaccine, that would reduce the incidence of shingles, will also be discussed.
Challenging times for skin diseases and the elderly
Authors: Man Bevis
Published: May 2014

Over the past three years the British Skin foundation has awarded over £2.2 million to research projects looking at a huge/multitude of different skin diseases in the UK. It is a lot of money but research is expensive and there remains a long way to go before many of these skin diseases are fully understood.
The Long Term Conditions Delivery Support (LTC DS) Team
Authors: Loader Tom
Published: May 2014

The LTC DS Team is a small, NHS-funded organization with one team member based in each of the ten Strategic Health Authority regions around the country. Over the past few years, the direction and focus of our work has had a few twists and turns, not least of all owing to the recent change in government. Our remit is, broadly speaking, to support the implementation of government policy, and we do this by supporting service improvement and innovation for people with long-term conditions, with an emphasis on neurology.
Regulation of herbal medicines
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Complementary and alternative medicine is an increasingly popular form of health intervention used by millions of people in the UK each year. The demand for such therapies has seen their use grow and many have been adopted by district nurses as a supplement to the treatment and care they provide their patients. The use of complementary and alternative medicine is largely unregulated and this has led to increasing call for more effective regulation to ensure patient safety. Of particular concern recently has been the need to regulate the use of herbal medicines. This article considers the proposals for the reform of herbal medicines and professional and legal implications for district nurses who use complementary and alternative medicine in their practice.
Drug use variations
Authors: While Alison
Published: May 2014

Medications play a large part in today’s health-care delivery. Indeed, it is this centrality to health care that has fuelled various debates about the cost and benefits of different drugs, especially expensive medicines associated with cancer treatments and multiple sclerosis (MS). Undoubtedly, medications have been responsible for improved patient outcomes for treatable conditions, however, funding of medications can impact upon the available resources for other health services.
WCA: looking ahead
Authors: Toner Louise
Published: May 2014

The past 18 months have been challenging for the Wound Care Alliance UK. However, we are now moving forward and we sincerely hope you will move forward with us. Those of you who are or have been members of either the Wound Care Society or the Tissue Viability Nurses Association may be wondering what we have been doing and what you have been getting for your membership fees. We are pleased to tell you that we will shortly be sending you two educational booklets, one related to pre-tibial lacerations and the other to infection control. These will be the last hard copy publications we will send as thereafter we will post things on our website; a further two educational booklets will be posted via the website in April.
Intermittent pressures in compression bandaging for oedema management
Authors: Muldoon Jeanette
Published: May 2014

Chronic oedema is an increasing problem requiring higher levels of knowledge and research. With improvements in education and specialist products, management of patients with uncomplicated oedema can be undertaken by non specialist practitioners. Despite recent advances there remains a paucity of research that provides information to link science and theory to clinical practice. This article seeks to review studies that challenge older beliefs and focus on new theories that underpin management with compression to improve clinical effectiveness and patient comfort.
An interview with Fran Worboys and Caitriona O’Neill
Authors: Worboys Fran , O’Neill Caitriona
Published: May 2014

CO: Having worked in palliative care I regularly encountered people with cancer-related or palliative oedema. However, there were also a significant number of patients with non-cancer-related conditions that presented with swelling. For all these people lymphoedema was having a negative impact upon their quality of life. The hospice-based lymphoedema clinic that I helped run, accepted patients only known to hospice services which meant that many more were not able to access this resource. The fragmentation of services for the management of this long-term condition appeared widespread and patients were falling through the many gaps.
District nurses' and aseptic technique: where did it all go wrong?
Authors: Unsworth John
Published: May 2014

Concerns have been raised about whether it is possible to perform aseptic procedures within a community setting. Hallett (2000) has described how community nurses often have a fatalistic view about whether such procedures can really be performed at home. At the same time there has been an increase in the number of patients being cared for at home who need interventions which must adhere to the principles of asepsis. While it has been acknowledged for some time that community nurses must be resourceful and adapt the procedure, the view that community nurses cannot really perform aseptic procedures is a fairly new phenomenon. This article explores the reasons why concerns about the performance of aseptic procedures in the community may have arisen and what steps can be taken to address these concerns to ensure that care at home is both safe and effective.
Catheterization in the community: converting to the Foley catheter tray
Authors: Yates Ann
Published: May 2014

With the aim of minimizing clinical incidents and improving clinical practice, the Cardiff and Vale University Health Board carried out a trial of a Foley catheter tray to be carried by district nurses as emergency boot stock. As part of the trial all nurses had to undergo training on the Foley catheter tray prior to use. The district nurses using the tray reported improvement in confidence, efficiency, convenience and patient experience. Owing to the success of the initiative, use of the Foley catheter tray as emergency boot stock is now standard practice for District Nursing/Acute Response and out-of-hours care in the Cardiff and Vale area.
Nutrition for older people: building immunity over the winter season
Authors: van der Kramer Vanessa
Published: May 2014

Maintaining adequate levels of nutrition is particularly important over the winter months when older people can be particularly vulnerable. This article discusses ways of encouraging healthy eating among elderly people and suggests tips for a balanced and nutritious diet.
Reducing admissions for long-term conditions: is telehealth the answer?
Authors: Phillips Jim
Published: May 2014

The Department of Health has released early findings from its telehealth trial, which seem to promise significant benefits for community-based care. Jim Phillips reports.
Vulnerable adults and the abolition of powers to remove a person in need of care
Authors: Griffith Richard
Published: May 2014

The coalition Government is urging parliament to repeal the power of local authorities in England to remove a vulnerable adult who retains decision-making capacity from their home if they are in need of care and attention. The move is justified on the grounds that the power is little used, might contravene the person's human rights and does not reflect the government's person-centred and community-focused reforms of adult social care and support. This article reviews the power to remove a person to a suitable place under the National Assistance Act 1948 and argues that reforming, not repealing, the law is what is required if vulnerable adults are to be protected from abuse and neglect.
Care assistants in Japan: differences and similarities
Authors: Storey Les
Published: May 2014

In 2003, I was involved in a series of conferences which were held in Kobe, Japan. The visit to Japan was partly funded by the Vocational Qualification Forum and International Departments of the Royal College of Nursing. During my visit, I had the opportunity to meet with many nurses and other health professionals working in a number of different cities and towns in Japan including Kobe, Kyoto, Tokyo and Osaka.
Maternity care assistants under the spotlight
Authors: Smith Julie
Published: May 2014

Maternity care assistants (MCAs) (also known as maternity support workers (MSWs)) have been in the news recently following allegations that some have been performing tasks beyond their remit. These allegations confirm many health professionals’ worst opinions about the rise of the healthcare assistant (HCA), but also shine a critical light on registered health professionals themselves. The official role of the MCA is broad but its main focus is to act as an assistant on the maternity ward or in the community. Duties include data entry, meeting and greeting and maintaining a safe environment (NHS Jobs, 2007). However MCAs, like HCAs, are not regulated, and if not properly managed, the boundaries of their role can often become blurred.
Care of the skin in the elderly person
Authors: Pritchard Barbara
Published: May 2014

The skin is the largest organ in the body, and provides a protective barrier between the environment and ourselves (Cameron, 1997). It also mirrors the health status of the person, giving greater insight into the client's physical, social and psychological status. Therefore, those who give skin care and help with personal hygiene are in the perfect position to assess the skin status (Lawley, 1991). This article will provide information and advice on how to care for the skin of elderly patients.
An HCA working on a bank basis
Authors: Harris Staurt
Published: May 2014

The role of a healthcare assistant (HCA) or care support worker, as they are now known where I currently work, is a role like no other. Challenging to many but rewarding to all, working as part of a hospital team can really open your eyes to the world around you. The duty of an HCA is to provide support and assistance to the professional nursing workforce, as part of a varied and multidisciplinary team. In many cases the HCA will provide the first line of care for hospitalized patients. The role is vital as it helps senior nurses and team members to perform more specialized tasks. It is also an excellent opportunity for many nursing students working as HCAs to increase their patient care and basic nursing skills.
Who's doing what?
Authors: Vaughan Paul
Published: May 2014

Hello again! I sent my first opinion piece to the editor, Julie Smith, last month and she got back to me saying they would like to call the column, ‘Vaughan's Views’. It made me think what an honour it is to have a piece in this Journal that allows me space to offer my views to the world. Julie doesn't know what a monster she has unleashed! So, I've been telling anyone who'll listen that I have a regular column in the journal — well at least until the masses rise up and ask for me to be removed!
Healthcare assistants unite!
Authors: Barber Chris
Published: May 2014

Welcome to this, the fourth edition of the BJHCA. Included in this particular edition you will find articles covering such diverse issues as, mental health, autism and Asperger's syndrome, stroke care and tissue viability. At first glance there may not be much that unites these diverse issues, yet it is its very diversity that forms the connection. Nursing and care are, by their nature, diverse. The articles in this edition reflect this as something to be grasped, welcomed and valued, not feared. As the smoking ban is now in place, you may see more people coming into your workplace asking for help on giving up. As healthcare assistants are becoming more involved in the process of smoking cessation, Andy Thornett's article on lifestyle modification will be very useful if this happens.
Autism: an overview of the condition
Authors: Megson Denise Y
Published: May 2014

The repetitive stereotypical behaviours of people with autism may be linked to the way they perceive external stimuli and react to adapt to them. A simplified sequential model of cognitive processing has been used to illustrate how perception is linked to understanding and inferred in behaviour. The evidence used is from observations of people who have worked with children with autism, adults with autism, studies using advanced technological means and empirical studies. An insight into the difference in perception can assist us in understanding how some people with autism deal with and manage their perceived environment.
Should HCAs have to pay for their own training?
Authors: Thornett Andrew , Jones Jackie
Published: May 2014

Nationally accredited training for healthcare assistants (HCAs) makes an important contribution to ensuring quality of care. This has been provided through NVQs. Should HCAs be paid to attend these training courses? Most students in all disciplines receive some form of income, so perhaps the question is better phrased: should HCAs receive salaried income during their training?
A healthcare assistant working in a private hospital
Authors: Robson Jo-anna
Published: May 2014

I work as a healthcare assistant (HCA) in a private hospital in Washington, Tyne and Wear. I have worked within the hospital for 11 years.
Record keeping: the role of the healthcare assistant
Authors: Nazarko Linda
Published: May 2014

Healthcare assistants (HCAs) work in hospitals, primary care trusts, care homes and increasingly in general practice. Guidance from the Royal College of Nursing (RCN) states that HCAs should receive training in communication, confidentiality and record keeping in addition to training in clinical skills (RCN, 2007). This article aims to enable you to understand your responsibilities in relation to record keeping.
Work-based learning for healthcare support workers
Authors: Hackshall Leanne , Smith-Owens Marie
Published: May 2014

Papworth Hospital NHS Foundation Trust sought novel ways to prepare healthcare support workers for their current roles and new ways of working through the development of an integrated taught/work-based competency programme. This programme provides a structured developmental approach to education and training, facilitating attainment of competency and future learning.
Falls part 5: care and treatment following a fall
Authors: Nazarko Linda
Published: May 2014

The healthcare assistant (HCA) may be the first person to attend to an individual who has fallen. It is important that the HCA offers help and seeks assistance when appropriate. This article outlines what to do in such circumstances.
Parkinson's disease part 2: when rhythm is impaired
Authors: Swann Julie
Published: May 2014

Parkinson's Disease and Parkinsonism affect the execution of movement patterns. This causes many problem areas inside and outside a person's home environment. This second article on the condition outlines how healthcare assistants and assistant practitioners can assist people with Parkinsonian symptoms and help with mobility.
Career planning for the healthcare assistant
Authors: Nazarko Linda
Published: May 2014

The role of the healthcare assistant (HCA) has changed. They now work in many settings and undertake a huge variety of roles. They can choose to remain HCAs or use a HCA role as the opportunity to gain an insight into clinical practice. Development opportunities have expanded and HCAs are encouraged to gain national vocational qualifications if they wish and become assistant practitioners or registered practitioners. This article outlines some of the career opportunities available and how staff can develop their roles.
Benefits and barriers: NVQs in NHS South Central
Authors: Zolle Olga , Wilton Emma
Published: May 2014

National Vocational Qualifications (NVQs) in health and social care offer competence-based assessment and training in the workplace for healthcare assistants (HCAs). The competences are defined at a national level and are therefore standardized across the UK. They are accredited by a number of different awarding bodies and are offered by many providers across the UK. These standalone qualifications are also now found embedded as part of the training in apprenticeships. A recent study conducted in the NHS South Central region explored the benefits that the standalone qualifications have for employees and employers in the workplace as perceived by HCAs and their line managers. This article discusses the study.
How to talk to people with depression or anxiety
Authors: Carr Caroline
Published: May 2014

This article is the second in a short series on depression and anxiety. Many people want to talk about how they feel, and this article is about the way that HCAs can help patients who are depressed or highly anxious; the previous article looked at the impact of depression and anxiety on relationships. The third article in the series will look at how HCAs can prevent depression/anxiety and other influences at work from affecting them.
Taking a human rights-based approach to care
Authors: Hughes Rhidian
Published: May 2014

This article describes the key principles underpinning human rights legislation in relation to health and social care services. It illustrates how healthcare assistants (HCAs) and assistant practitioners (APs) can take a human rights-based approach in everyday practice.
Improving practice in patient observation for HCAs
Authors: Thomson Anne , Hogg George
Published: May 2014

This article describes the design, implementation and initial evaluation of a course for healthcare assistants within NHS Tayside, which is designed to prepare healthcare assistants for their role in the initial assessment and timely handover of acutely ill and deteriorating adult hospital patients.
Challenging behaviour and treatment for dementia
Authors: Nazarko Linda
Published: May 2014

Increasing numbers of people have dementia. Those with the condition often exhibit challenging behaviour and find interacting with their environment and other people difficult as a result of the physical changes that dementia causes. This article explains the common symptoms of dementia and what medication can be used to help those with the condition. It aims to enable support workers to understand why people with different types of dementia interpret the world in different ways. It also aims to enable support workers to understand what challenging behaviour is, how common it is and when it occurs.
Better care through better training—evaluation of an HCA development programme
Authors: Griffin Richard , Arbuthnot Robin , Fee Lynn , McElroy Linda
Published: May 2014

There is increasing recognition of the need to ensure NHS support workers have the appropriate knowledge and competences to provide care to patients. In the absence of statutory national guidelines for training, individual bodies are taking their own initiatives. In 2011, the Belfast Health and Social Care Trust introduced an innovative development programme for its ward-based nursing healthcare support workers. This article describes the results of an independent evaluation of the programme. The evaluation found a wide range of performance improvements, including reduced errors, improved safety, communication skills and discretionary effort. Reasons for its effectiveness, including building of staff confidence, are discussed.
The sTimul project: putting yourself in the patient's shoes
Authors: Harrison Denise
Published: May 2014

Two UK healthcare professionals went to Belgium this summer to take part in a two–day learning experience, where, instead of being carers, they became cared for, influencing their practice to ensure that residents' dignity is maintained. The Dignity in Care project aims to provide better insight into how experiential learning can improve care providers' ethical abilities.
Clinical observations 4/6: assessing blood pressure
Authors: Peate Ian , Wild Karen
Published: May 2014

This is the fourth article in the series of six focusing on clinical observations and here we will consider the assessment of a person's blood pressure. The healthcare assistant (HCA) and assistant practitioner (AP) are often required to carry out this important observation several times a day. This article will address the why, when, how, what and where of blood pressure assessment. An overview of how blood pressure is maintained will be provided, along with the appropriate pathophysiological changes that may impact on a person's blood pressure.

The HCA and AP must be aware of how they are to record and report blood pressure findings in line with local policy. Understanding the mechanics of blood pressure and how to perform this task effectively will enable the HCA and AP to provide high-quality, safe and effective care.
Mentorship in action for healthcare assistants
Authors: Hayes Catherine
Published: May 2014

There is increasing focus in the healthcare sector on mentoring, the process whereby one person gives special attention and support to another. Without care, the mentor-mentee relationship can be fraught and unhelpful. A shared and mutual understanding on behalf of mentor and mentee of what the process of mentorship involves often defines the facilitation of learning and determines the overall time that the professional relationship lasts. Both sides must sign up to a contract that defines the parameters of their work together.

This article looks at the elements that make for a good experience for both sides in mentoring. It discusses methods of improving communication and the importance of encouraging reflexivity.
Significance of clinical history-taking in healthcare provision
Authors: Hayes Catherine , Collins Michael
Published: May 2014

The process of clinical history-taking is an integral part of clinical practice for most healthcare practitioners registered with professional regulatory bodies. The adjunct role of the healthcare assistant within the context of clinical history-taking has been an invaluable addition to the holistic care and wellbeing of patients at their initial consultations with practitioners. Whether they assist in the reassurance of the patient, their families or carers, the healthcare assistant provides a presence, which necessitates their understanding of the clinical history-taking process, alongside a consideration of their holistic health and wellbeing. This article provides an insight into the clinical history-taking process, alongside the essential factors influencing holistic wellbeing.
Role of occupational therapy in reducing further falls
Authors: Price Sian
Published: May 2014

This article will outline the role of the Occupational Therapy Department in the development of a standardised screening assessment tool for use within the emergency department.
Multiple sclerosis: offering care tailored to the person's needs
Authors: Nazarko Linda
Published: May 2014

The number of people in the UK living with multiple sclerosis (MS) is growing by around 6000 a year. They experience significant physical and emotional difficulties because of the disease and social attitudes to it. This article looks at the different types of MS. It explains treatment options and how symptoms are managed.
Developing a code of conduct for support workers
Authors: Higgins Claire , Adams John
Published: May 2014

There has been an increased focus in recent years on the need to ensure high standards of care from all healthcare workers. Codes of conduct represent an important tool in establishing and maintaining high standards, but in the absence of national registration their adoption by support workers has been patchy. This article describes the development of a code of conduct in one English NHS Foundation Trust, Northamptonshire Healthcare NHS Foundation Trust (NHFT).

The elements of the NHFT Code are outlined. These include: professional development; respect, empathy and consideration; confidentiality and data protection; equality, diversity and inclusion; professionalism and accountability; you, your team and the organisation; and, finally, behaviours and attitudes.
Continence series 6: helping to resolve constipation
Authors: Nazarko Linda
Published: May 2014

Constipation is a common symptom that has many causes. This article explores normal bowel function and explains what factors can lead to constipation and how these can be identified and treated.
9/9 Spirituality and healthcare: past, present and future
Authors: Barber Chris
Published: May 2014

This final article in this series on spirituality and healthcare will, through a conversation between a small number of people, revisit the previous articles in this series, discuss the issues raised and present tentative suggestions for future spiritual care and support.
Delirium: a serious condition associated with poor outcomes
Authors: Nazarko Linda
Published: May 2014

Delirium, also known as acute confusional state, affects people who are unwell. Older people and people admitted to hospital are especially at risk of developing delirium. Diagnosis can be challenging and it may go unrecognised in busy hospital environments. This article uses a case study approach to explain the causes of delirium, clinical presentation and treatment and management.
Bribe and prejudice - NHS still fails mentally disabled
Authors: Shallcross Mike
Published: May 2014

Anticipating the government's National Learning Disability Strategy, this article questions whether people with learning difficulties are getting what they need from the NHS. Drawing on several recent surveys and the inquiry into surgical standards at the Royal Brompton, the author discovers scandalous evidence of thoughtless behaviour and discriminatory rationing.
Management in primary care groups and trusts
Authors: Dowling Bernard , Wilkin David , Coleman Anna
Published: May 2014

Primary Care Groups and Trusts (PCG/Ts) are central to the British Government's plans to modernise the NHS. To fulfil their functions they will require sufficient numbers of skilled managers supported by an adequately resourced staffing infrastructure. However, this paper indicates that managers believe there is a serious gap between the expectation that PCG/Ts will play a central role in NHS modernisation and the managerial capacity required for the accomplishment of their objectives.
Cutting the Crass Rhetoric About Partnership
Authors: Sang Bob
Published: May 2014

The ‘Provocations’ series returns for 2002, with a warning that when it comes to management-speak, careless talk costs lives.
The onanistic mass debate
Authors: Bell Andy
Published: May 2014

When the Chancellor of the Exchequer stood up to deliver his Pre-Budget Report at the end of November, he may have thought that he was, for once and for all, putting a lid on the fermenting debate about how the NHS is financed. Quoting at length from an interim report into NHS funding by Derek Wanless, the Chancellor spoke as if the matter was at an end and we could now just get on with life as it is.
Wanless In Wonderland
Authors: Halpern Stephen
Published: May 2014

The future of British health care is now verging on catastrophe. This is not a matter of being over-dramatic, but the conclusion reached after examining the elements that are currently likely to affect national policy.
Old habits die hard ...
Authors: Harvey Trevor
Published: May 2014

Dr. Richard Horton's piece (Lancet, 2002) concerning nurse prescribing, engendered a wide reaction. A number of Horton's reviewers interpreted his words as the casting of a sideways blow at nurses: a put-down from on high. Closer reading shows his argument to be more reasonable than a merely provocative goad. Horton argues that doctors are notoriously protective of their power and prestige. He's right.
Seeds of understanding clinical audit sown by CEPOD
Authors: Halpern Stephen
Published: May 2014

The National Confidential Inquiry into Perioperative Deaths (CEPOD) was set up over a decade ago by the late Brendan Devlin, a Teeside surgeon. At the time it was a unique pioneering initiative in clinical audit. Despite the waves of initiatives set up in its wake, CEPOD remains one of the most important and rigorous audits of clinical care in the UK.
A house in need of order
Authors: Baker Mark R
Published: May 2014

Readers of these columns might be forgiven for thinking that I attribute all the ills of the NHS to the vicissitudes of politicians in general and to the present gang in particular. However, this would be far from the truth. I would like to dedicate this article to the contribution to failure contrived by members of my own profession.
Shifting The Balance Of Power: managing change
Authors: Dixon Michael
Published: May 2014

Shifting The Balance Of Power hands the star role in the NHS to Primary Care Trusts (PCTs). This article looks at the following three major aspects:

The current plans of the Department of Health outlined in ‘Shifting the Balance - The Next Steps’, and how we might interpret them.

Relationships that PCTs will need to make with those around them.

The ways in which PCTs will deliver in their various roles.
Shipman shape and Bristol fashion
Authors: Maynard Alan
Published: May 2014

As Dr.Phil. Hammond remarked recently, the current state of the NHS is ‘Shipman shape and Bristol fashion’. Last year the British Medical Journal published a retrospective study of ‘adverse events’ by Vincent and his col-leagues. This showed that the error rate in their hospital was 10.8 per cent. Regional data about the reporting of adverse events shows that some Trusts are liars and others may have similar rates to those reported by Vincent.
The phoney fight over federalism
Authors: Roth Andrew
Published: May 2014

It is fairly rare that you can say that both sides are correct in a bitter partisan battle in which the participants seem to be at daggers-drawn. Tory Leader Iain Duncan-Smith backs his ultra-right-wing Health Spokesman Dr Liam Fox in proclaiming Labour as ‘centralising’ the National Health Service. in seeming contradiction, Health Secretary Alan Milburn takes great pride in the extent to which he is ‘devolving’ power to the best hospital trusts.
Outdated practices, involved patients
Authors: Harvey Trevor
Published: May 2014

Those of us who are of a certain age can recall with amusement the hushed, gummy tones of a busty Les Dawson in drag intoning, usually to an equally matronly Roy Barraclough, that a friend had been unwell. Self-consciously alluding to something vaguely embarrassing, Dawson would wheeze, ‘She's had it all taken away, poor dear.’
Targets, targets everywhere ...
Authors: Charny Mark
Published: May 2014

‘Targets place a premium on spin rather than on honesty’
Menus without prices: how not to reform GPs’ contracts
Authors: Maynard Alan
Published: May 2014

The comrades in the most powerful trade union in the country, the British Medical Association, are busy improving the wages and conditions of medical operatives across the NHS. Taxpayers and patients, who will be excluded from care if the contract settlements crowd out service improvements, should beware.
Pricing (again) in the NHS
Authors: Maynard Alan
Published: May 2014

Thatcher's attempt to introduce pricing into her internal market failed. The NHS was designed and operated for 50 years to measure and control expenditure, ignoring the cost of its services as well as activity levels and outcomes. With cash-limited budgets and single-source funding via taxation, this was successful in controlling macro-economic expenditure even if no one knew or even cared much about micro-economic efficiency.
Pugchat - a new word to learn and use
Authors: Cowper Andy
Published: May 2014

This magazine holds you, our readers, in high esteem. You do some of the toughest jobs in the land in terms of thanklessness, pressure and job insecurity, and you mostly do them very well. Whatever BJHCM can do to provide you with a monthly dose of analysis, comment, debate, insight and even entertainment remains both a pleasure and a privilege.
Dead on impact
Authors: Halpern Stephen
Published: May 2014

As if the NHS didn't have enough to deal with in the shape of unnecessary centralised meddling by the Department of Health, an additional layer of interference has been created by the Cabinet Office.
I'm worried about Alan
Authors: Roth Andrew
Published: May 2014

I'm worried about Alan Milburn. Perhaps this is an echo of my youthful aspiration about becoming a psychiatrist. Or the chapter I have been writing about the attraction of politics for crooked psychopathic liars who, when caught out, re-invent themselves as injured innocents or born-again Christians. But let's not dwell on the Aitkens or Hamiltons of the world. I worry about Milburn just as, when driving, I shrink when I see a tiny car confront a giant lorry. Why should a Cabinet middle-ranker dependent on the Chancellor's generosity square up to ‘The Iron’ Chancellor? Anyone with any sense scratched their head when Milburn again trailed his red cape with his (7th August) Times article not only trying to re-sell his controversial foundation hospital idea, but to make it a solution to Labour's re-election hopes.
Learning organisations: the triumph of visions over reality
Authors: Charny Mark
Published: May 2014

This series reflects on the gap between policy as it is made in the centre and policy as it is lived in the trenches.
Failure To Attend: a waste we can reduce
Authors: Jassar Patrick , Jose Jemmy , Coatsworth Andrew
Published: May 2014

The ‘Provocations’ series returns with an appraisal of ways to reduce instances of Failure To Attend (FTA).
Heart-rending cases make bad laws
Authors: Bell Andy
Published: May 2014

It is already well-known that moral panics and media crises have frequently been the starting points for sea-changes in government policy in Britain. in the NHS, for example, both the Tories’ internal market and Labour's pledge to raise spending to the European average came from Prime Ministers being bounced into showing they were taking decisive action to get things done in the health service following media scandals about failings in care.
Managing obesity and overweight patients
Authors: Holland Mike
Published: May 2014

This article considers treatment approaches to the management of obesity in primary care.
Milburn's New Year's resolutions
Authors: Maynard Alan
Published: May 2014

The new year of 2003 is likely to be of great significance for the National Health Service. Whilst most support the Government's ambitious agenda, it is clear that there are major difficulties which Whitehall Village treats with the Nelson touch - i.e. if you put your telescope to your blind eye, you will not see the danger signals.
Choice words … but will choice work?
Authors: Bell Andy
Published: May 2014

Choice, it appears, is now well and truly in fashion. In the NHS it is, anyway. With the evident popularity of the patient choice initiative in elective surgery, the Government has now announced its intention to extend the scheme to other areas of health care, from A&E and maternity services to services for chronic and mental illnesses.
Too much in ‘The Sun'
Authors: Bell Andy
Published: May 2014

Headlines in The Sun newspaper have a tendency to become infamous. A case in point happened in September when the newspaper took the unusual step of beginning the day with one headline and replacing it with another.
Silence is golden
Authors: Ainsworth Steve
Published: May 2014

I was at a meeting the other day and experienced a first. One of the managers who was assisting the committee was discreetly taken outside by a member and asked to pipe down and keep his opinions to himself.
Getting the bottle to ‘out’ clinical performance
Authors: Maynard Alan
Published: May 2014

One of the popular freebie newspapers, Hospital Doctor, recently ran a front-page article in which admiration was expressed of the GP pay negotiator, Dr Hamish Meldrum. The author of the piece asked “how did this man get such a good contract deal for GPs?”
A Minister replies to a few choice words
Authors: Hutton John
Published: May 2014

John Hutton MP, Minister for Health, responds to a recent BJHCM editorial with a defence of the Govenment policy on patient choice and the role for Foundation Trusts.
The quality of mercy
Authors: Harvey Trevor
Published: May 2014

Reginald Crew was a former soldier and car worker, a Liverpudlian and a family man. If his life was not extraordinary, its ending was. Mr. Crew was in the process of succumbing to a particularly ghastly fate.
The price of everything
Authors: Harvey Trevor
Published: May 2014

Every employer already knows, or finds out the hard way, that if you want commitment from your workforce, you must first show that commitment to them. The obvious paradigm is to be found in football. Pay up, or face the loss of your best players.
Employment law: staff with serious convictions
Authors: Craik David
Published: May 2014

This article considers what, as an employer, a manager can legally do if one of their employees is charged with or convicted of a serious crime.
Target practice
Authors: Charny Mark
Published: May 2014

This series reflects on the gap between policy as it is made in the centre and policy as it is lived in the trenches.
Little England just got smaller
Authors: Bell Andy
Published: May 2014

Wars do not provide the best of backdrops to discussions about health policy. With the constant stream of images of distant explosions in Baghdad, of tanks racing across the desert under road signs to various Iraqi cities and of captured soldiers looking terrified and bedraggled, the focus on domestic policy matters inevitably subsides for a time.
Riding the Foundation Trust hobby-horse
Authors: Wall Andrew
Published: May 2014

Secretaries of State come and go, but their policies linger.

As the debate on Foundation status for acute trusts continues inside and outside Parliament, Andrew Wall, former manager of Bath Health Authority and policy commentator puts forward this analysis.
Hard choices balancing rights and responsibilities
Authors: Bell Abdy
Published: May 2014

Rhetoric about balancing rights and responsibilities has been a hallmark of New Labour. Even more than the infamous combination of fiscal prudence and social inclusion, the communitarian ethos that rights and responsibilities must exist in equal measure is central to the beliefs propounded by Tony Blair's Government.
Policy Developments
Authors: Halpern Stephen
Published: May 2014

One small, faltering step towards taking account of citizens’ views has been taken by the National Institute for Clinical Excellence in setting up a Citizens Council.
Spotting the difference in health care reforms
Authors: Maynard Alan
Published: May 2014

Reforms in health care systems come in many varieties. It is often difficult to discern the intent, let alone the likely and actual effects. The American political scientist Professor Ted Marmor distinguishes between ‘refor m’ and ‘re-form’.
The NHS's collective heart failure
Authors: Greener Mark
Published: May 2014

Effectively and efficiently managing cardiovascular disease remains a high priority for the government, NHS executives and clinicians - with good reason.
The tsunami of reform: the fall and rise of the NHS
Authors: Hunter David J
Published: May 2014

The first major reorganisation of the NHS that I observed loomed in 1974: it is stunning how the same issues are still being wrestled with now as then. Just as stunning is the inability or unwillingness of governments to learn from past experience even when they insist they have done, as New Labour tried to do in 1997 on entering office.
A bribe, by any other name, is still as crass
Authors: Cowper Andy
Published: May 2014

It seems there is to be no choice for primary care practices who wish to commission services themselves, when it comes to Choose And Book. The Health Service Journal (27 January 2005) reports that the DoH's technical guidance on practice-based commissioning will tell PCTs that they must refuse to allow practices to move to practice-based commissioning if they do not adopt the NPfIT's Choose And Book software for the GPs’ desktops.
Is NHS reform policy more smart than wise?
Authors: Cowper Andy
Published: May 2014

Name-dropping is a terrible thing, as I was saying to Simon Stevens just the other evening. We had been discussing a recent piece in The Economist, which proposed that the financial woes of erstwhile private finance initiative giant Jarvis demonstrated that the PFI is, in fact, working.
Swallow hard and deal with dysphagia
Authors: Greener Mark
Published: May 2014

Swallowing is one of those biological actions that you don't think about, until something goes wrong. Yet dysphagia — difficulty swallowing — presents a relatively common clinical problem and raises several issues for health care managers
The costs of redisorganisation
Authors: Maynard Alan
Published: May 2014

Comrade Blur is energetically redisorganising the English NHS. Having been elected with no health care policy in 1997 and then having a vision on the road to Damascus in 1999, high levels of investment have subsequently been accompanied by policy reversals and ‘wheezes’ adopted as a result of policy tourism.