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Sample records for nhs direct wales

  1. The direct cost of intravenous insulin infusions to the NHS in England and Wales.

    PubMed

    Rajendran, Rajesh; Scott, Anne; Rayman, Gerry

    2015-08-01

    The cost of intravenous insulin infusion to the NHS is unknown. The aim of this study was to estimate the direct cost of insulin infusions to the NHS in England and Wales in the first 24-hour period of infusion. Data from the National Inpatient Diabetes Audit 2013 in the UK were used to estimate the number of insulin infusions in use across England and Wales. Costs were calculated for six models for setting up and maintenance of insulin infusions, depending on the extent of involvement of different healthcare professionals in the UK. In this study, the direct costs of intravenous insulin infusions to the NHS in England and Wales have been estimated to vary from £6.4-8.5 million in the first 24-hour period on infusion. More appropriate use of these infusions could result in substantial cost savings. PMID:26407380

  2. National community pharmacy NHS influenza vaccination service in Wales: a primary care mixed methods study

    PubMed Central

    Evans, Andrew M; Wood, Fiona C; Carter, Ben

    2016-01-01

    Background Influenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs. Aim To explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations. Design and setting A mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales. Method Interviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013–2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model. Results The contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs’ views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk. Conclusion Before community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP–pharmacy relationships, and improving public awareness must be overcome. PMID:26965025

  3. Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales

    PubMed Central

    Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

    2015-01-01

    Introduction Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign (‘Campaign’) was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. Methods A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. Results The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Conclusion and recommendations Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a ‘communications bundle’ consisting of six core components. We

  4. Compliance of NHS dental practice websites in Wales before and after the introduction of the GDC document 'Principles of ethical advertising'.

    PubMed

    Budd, M L; Davies, M; Dewhurst, R; Atkin, P A

    2016-06-10

    Objectives To evaluate the compliance of NHS dental practice websites in Wales, UK, with the 2012 GDC document Principles of ethical advertising, before its introduction (2011) and again after its introduction (2014).Methods All practices in Wales with an NHS contract and dental practice website were identified. The content of the website was evaluated to determine if it complied with the principles outlined in the 2012 GDC document Principles of Ethical Advertising.Results Twenty-five percent of the 446 practices sampled in 2011 had a website, compared to 44% of the 436 practices sampled in 2014. The principles best complied with were; displaying the name, geographic address, and telephone number of the practice (100% for both years). None of the websites compared the qualifications or skills of its practitioners to others, therefore 100% complied with this principle. Displaying team members' professional qualification and the country from which this is obtained was fairly well represented; 92% and 61% respectively in 2014; an improvement from only 50% and 49% respectively in 2011. Principles worst complied with were displaying the GDC's address (3% 2011; 9% 2014) or link to the GDC website (11% 2011; 7% 2014) and details of the practice complaints procedure (1% 2011; 5% 2014). Overall, no practice complied with all of the compulsory principles.Conclusion In both 2011 and 2014 no practice website was compliant with all the principles outlined in the 2012 GDC document Principles of ethical advertising. Reflecting results from previous studies, this study showed that compliance is slowly improving, yet over 4 years after the introduction of the mandatory principles, it remains that no practice website is 100% compliant. PMID:27283565

  5. Telemedicine and Older Neurology Outpatients: Use of NHS Direct and of the Internet in the UK.

    PubMed

    Larner, Aj

    2011-12-01

    Telemedicine is one potential approach to address the under-serviced health needs of older people. This article presents data from a project investigating neurology patients' awareness and use of the NHS Direct telephone helpline and the Internet over a 10-year period (2001-2010). Older people's awareness and use of the NHS Direct telephone helpline was low compared to other age groups and did not change with time. Although Internet access and use was also low compared to other age groups, access did increase over time. Hence, future generations of older people may be amenable to health contacts and inputs via cyberspace. PMID:23251322

  6. Between less eligibility and the NHS: the changing place of poor law hospitals in England and Wales, 1929-39.

    PubMed

    Levene, Alysa

    2009-01-01

    In 1929, the Local Government Act broke up the apparatus of the Poor Law Guardians and Unions, and transferred responsibility for the care of the poor to local councils. In theory, the period between the passing of the Act and the formation of the National Health Service witnessed a large-scale reclassification of the sick poor as patients rather than paupers. In reality, as this investigation of contemporary judgements of hospital quality and bed and staff numbers in English and Welsh county boroughs shows, the national picture was very varied at the local level. Local and sometimes regional traditions of care, finance and council priorities had a large influence on the ongoing development of a unified medical service which included the poor. In the best case scenario, hospitals were classified by patient type, and the principle of 'less eligibility' was discarded. Elsewhere, economic status continued to direct medical treatment, but in almost all cases, the chronic and elderly poor were more likely to remain in low-quality and unmodernized buildings than the acutely sick. The investigation highlights the disjuncture between the changed vision for the sick poor and its patchy enforcement on the ground. PMID:20027911

  7. Treatments of low-priority and the Patient Mobility Directive 2011, an end to legal uncertainty for the English NHS?

    PubMed

    Sheppard, Maria K

    2013-06-01

    The patient mobility case law of the Court of Justice of the European Union created legal uncertainty for the healthcare systems of EU Member States. The Patient Mobility Directive setting out patients' cross-border rights was adopted to end this uncertainty. With the Directive to be transposed into national law by October 2013 this article discusses whether the Directive achieves this objective for the English NHS. It contrasts the legal position of the NHS patient under case law and under the Directive regarding the need for prior authorisation of cross-border treatment, the level of reimbursement and the ambit of the healthcare benefits basket. It is argued that the risk of legal challenge may persist under the Directive, specifically regarding treatments which are classified by health authorities as low priority, namely treatments which are either not 'generally' available or only available subject to certain clinical criteria or access thresholds. PMID:23984495

  8. Establishing a people-centered health service in Gwent, Wales.

    PubMed

    Wilson, B

    1992-01-01

    The Welsh Health Planning Forum has developed a "Strategic Intent and Direction for the NHS in Wales." The aim is "to take the people of Wales into the 21st Century with a level of health on course to compare with the best in Europe" (Welsh Office NHS Directorate, The Welsh Health Planning Forum, 1989). Gwent Health, one of the nine health authorities in Wales, provides a comprehensive health service to its population of 445,000 and was chosen to develop a prototype for the provision of cancer services. Gwent residents were invited to seminars to express their opinions of the health service that was provided and describe the type of service they would like to have in the future. The response was encouraging enough to engender the planning of future seminars. PMID:10119895

  9. Has NHS reorganisation saved lives? A CuSum study using 65 years of data

    PubMed Central

    Lale, Alice S

    2016-01-01

    Objectives To determine if NHS reforms affect population mortality. Design Retrospective study using routinely published data. Setting & participants Resident population of England and Wales 1948 to 2012 Main outcome measure All cause age sex directly standardised mortality England and Wales 1948 to 2012. Methods Using the CuSum technique and Change-Point Analysis to identify sustained changes in the improving age-standardised mortality rates for the period 1948-2012, and comparing the time of these changes with periods of NHS reform. Where observed changes did not fit with NHS reform, changes external to the NHS were sought as a possible explanation of changes observed. Results CuSum plotting and CPA showed no significant changes in female mortality trend between 1948 and 2012. However, this analysis identified a sustained improvement in the male mortality trend, occurring in the mid-1970s. A further change in the rate of male mortality decline was found around the Millennium. Conclusion The 1974 NHS reorganisation, changing service arrangements predominantly for women and children, is considered an unlikely explanation of the improved rate of male mortality decline. Thus, centrally led NHS reorganisation has never had any detectable effect on either male or female mortality and must be considered ineffective for this purpose. But some evidence supporting the view that increased funding improves outcomes is found. PMID:26432817

  10. NHS politics. Winging it.

    PubMed

    Dewar, Steve; Chantler, Cyril

    2002-03-14

    At present, NHS managers are highly constrained, suffering excessive regulation and central control. More autonomy for trusts would mean fewer directives and less performance management. Giving trusts a new organisational form, such as a public interest company or foundation hospital, might be reinvigorating and would not involve further reorganisation. These new freedoms should be accompanied by new accountabilities, not solely to politicians but to independent NHS regulators, local communities and patients. Devolved power and greater patient choice could produce a more responsive NHS. Its potential needs to be explored through experimentation and evaluation. PMID:11915404

  11. NHS Health Checks

    PubMed Central

    Abdalrahman, Bayad; Soljak, Michael

    2015-01-01

    Cardiovascular disease is the leading cause of mortality and morbidity worldwide. In England, the government has adopted a population-wide prevention program for cardiovascular disease, the NHS Health Check program. The program has sparked controversies over the evidence base and feasibility of implementation. We aim to provide an update on the debate and program implementation. In conclusion, the evidence base for the NHS Health Check program has a number of uncertainties and program delivery has been suboptimal. It is important to continue monitoring and evaluating the program to provide the evidence base for future policy direction. PMID:25340472

  12. Site-directed immobilization of antibody using EDC-NHS-activated protein A on a bimetallic-based surface plasmon resonance chip

    NASA Astrophysics Data System (ADS)

    Sohn, Young-Soo; Lee, Yeon Kyung

    2014-05-01

    The characteristics of a waveguide-coupled bimetallic surface plasmon resonance (WcBiM SPR) sensor using (3-dimethylaminopropyl)-3-ethylcarbodiimide(EDC)-N-hydroxysuccinimide(NHS)-activated protein A was investigated, and the detection of IgG using the EDC-NHS-activated protein A was studied in comparison with protein A and a self-assembled monolayer (SAM). The WcBiM sensor, which has a narrower full width at half maximum (FWHM) and a steeper slope, was selected since it leads to a larger change in the reflectance in the intensity detection mode. A preparation of the EDC-NHS-activated protein A for site-directed immobilization of antibodies was relative easily compared to the engineered protein G and A. In antigen-antibody interactions, the response to IgG at the concentrations of 50, 100, and 150 ng/ml was investigated. The results showed that the sensitivity of the WcBiM sensor using the EDC-NHS-activated protein A, protein A, and SAM was 0.0185 [%/(ng/ml)], 0.0065 [%/(ng/ml)], and 0.0101 [%/(ng/ml)], respectively. The lowest detectable concentrations of IgG with the EDC-NHS-activated protein A, protein A, and SAM were 4.27, 12.83, and 8.24 ng/ml, respectively. Therefore, the increased sensitivity and lower detection capability of the WcBiM SPR chip with the EDC-NHS-activated protein A suggests that it could be used in early diagnosis where the trace level concentrations of biomolecules should be detected.

  13. Young people's use of NHS Direct: a national study of symptoms and outcome of calls for children aged 0–15

    PubMed Central

    Cook, E J; Randhawa, G; Large, S; Guppy, A; Chater, A M; Pang, D

    2013-01-01

    Objectives National Health Service (NHS) Direct provides 24/7 expert telephone-based healthcare information and advice to the public in England. However, limited research has explored the reasons to why calls are made on behalf of young people, as such this study aimed to examine call rate (CR) patterns in younger people to enable a better understanding of the needs of this population in England. Setting NHS Direct, England, UK. Participants and methods CRs (expressed as calls/100 persons/annum) were calculated for all calls (N=358 503) made to NHS Direct by, or on behalf of, children aged 0–15 during the combined four ‘1-month’ periods within a year (July 2010, October 2010, January 2011 and April 2011). χ² Analysis was used to determine the differences between symptom, outcome and date/time of call. Results For infants aged <1, highest CRs were found for ‘crying’ for male (n=14, 440, CR=13.61) and female (n=13 654, CR=13.46) babies, which is used as a universal assessment applied to all babies. High CRs were also found for symptoms relating to ‘skin/hair/nails’ and ‘colds/flu/sickness’ for all age groups, whereby NHS Direct was able to support patients to self-manage and provide health information for these symptoms for 59.7% and 51.4% of all cases, respectively. Variations in CRs were found for time and age, with highest peaks found for children aged 4–15 in the 15:00–23:00 period and in children aged <1 in the 7:00–15:00 period. Conclusions This is the first study to examine the symptoms and outcome of calls made to NHS Direct for and on behalf of young children. The findings revealed how NHS Direct has supported a range of symptoms through the provision of health information and self-care support which provides important information about service planning and support for similar telephone-based services. PMID:24327365

  14. An assessment of the nonmarket benefits of the Water Framework Directive for households in England and Wales

    NASA Astrophysics Data System (ADS)

    Metcalfe, Paul J.; Baker, William; Andrews, Kevin; Atkinson, Giles; Bateman, Ian J.; Butler, Sarah; Carson, Richard T.; East, Jo; Gueron, Yves; Sheldon, Rob; Train, Kenneth

    2012-03-01

    Results are presented from a large-scale stated preference study designed to estimate the nonmarket benefits for households in England and Wales arising from the European Union Water Framework Directive (WFD). Multiple elicitation methods (a discrete choice experiment and two forms of contingent valuation) are employed, with the order in which they are asked randomly varied across respondents, to obtain a robust model for valuing specified WFD implementation programs applied to all of the lakes, reservoirs, rivers, canals, transitional, and coastal waters of England and Wales. The potential for subsequent policy incorporation and value transfer was enhanced by generating area-based values. These were found to vary from £2,263 to £39,168 per km2 depending on the population density around the location of the improvement, the ecological scope of that improvement, and the value elicitation method employed. While the former factors are consistent with expectations, the latter suggests that decision makers need to be aware of such methodological effects when employing derived values.

  15. A national syndromic surveillance system for England and Wales using calls to a telephone helpline.

    PubMed

    Smith, G E; Cooper, D L; Loveridge, P; Chinemana, F; Gerard, E; Verlander, N

    2006-01-01

    Routine primary care data provide the means to monitor a variety of syndromes which could give early warning of health protection issues. In the United Kingdom, a national syndromic surveillance system, operated jointly by the UK Health Protection Agency (HPA) and NHS Direct (a national telephone health helpline), examines symptoms reported to NHS Direct. The aim of the system is to identify an increase in syndromes indicative of common infections and diseases, or the early stages of illness caused by the deliberate release of a biological or chemical agent. Data relating to 11 key symptoms/syndromes are received electronically from all 22 NHS Direct call centres covering England and Wales and analysed by the HPA on a daily basis. Statistically significant excesses in calls are automatically highlighted and assessed by a multi-disciplinary team. Although the surveillance system has characterised many sudden rises in syndromes reported to NHS Direct, no evidence of a biological or chemical attack has been detected. Benefits of this work, however, are early warning and tracking of rises in community morbidity (e.g. influenza-like illness, heatstroke); providing reassurance during times of perceived high risk (e.g. after the 7 July 2005 London bombs and December 2005 Buncefield oil depot fire); and timely surveillance data for influenza pandemic planning and epidemic modeling. PMID:17370968

  16. United Kingdom (Wales): Health system review.

    PubMed

    Longley, Marcus; Riley, Neil; Davies, Paul; Hernandez-Quevedo, Cristina

    2012-01-01

    Wales is situated to the west of England, with a population of approximately 3 million (5% of the total for the United Kingdom), and a land mass of just over 20 000 km2. For several decades, Wales had a health system largely administered through the United Kingdom Governments Welsh Office, but responsibility for most aspects of health policy was devolved to Wales in a process beginning in 1999. Since then, differences between the policy approach and framework in England and Wales have widened. The internal market introduced in the United Kingdom National Health Service (NHS) has been abandoned in Wales, and seven local health boards (LHBs; supported by three specialist NHS trusts) now plan and provide all health services for their resident populations. Wales currently has more than 120 hospitals as part of an overall estate valued at 2.3 billion pounds. Total spending on health services increased in the first decade of the 21st century, but Wales now faces a period of financial retrenchment greater than in other parts of the United Kingdom as a result of the Welsh Governments decision not to afford the same degree of protection to health spending as that granted elsewhere. The health system in Wales continues to face some structural weaknesses that have proved resistant to reform for some time. However, there has been substantial improvement in service quality and outcomes since the end of the 1990s, in large part facilitated by substantial real growth in health spending. Life expectancy has continued to increase, but health inequalities have proved stubbornly resistant to improvement. PMID:23578967

  17. Rapid investigation of cases and clusters of Legionnaires' disease in England and Wales using direct molecular typing.

    PubMed

    Mentasti, Massimo; Afshar, Baharak; Collins, Samuel; Walker, Jimmy; Harrison, Timothy G; Chalker, Vicki

    2016-06-01

    Legionella pneumophila is the leading cause of Legionnaires' disease, a severe pneumonia that can occur as sporadic cases or point-source outbreaks affecting multiple patients. The infection is acquired by inhalation of aerosols from contaminated water systems. In order to identify the probable source and prevent further cases, clinical and environmental isolates are compared using phenotypic and genotypic methods. Typically up to 10 days are required to isolate L. pneumophila prior to the application of standard typing protocols. A rapid protocol using a real-time PCR specific for L. pneumophila and serogroup 1, combined with nested direct molecular typing, was adopted by Public Health England in 2012 to reduce reporting time for preliminary typing results. This rapid protocol was first used to investigate an outbreak that occurred in July/August 2012 and due to the positive feedback from that investigation, it was subsequently applied to other incidents in England and Wales where faster typing results would have aided incident investigation. We present here results from seven incidents that occurred between July 2012 and June 2015 where the use of this rapid approach provided preliminary characterization of the infecting strain in an average 1.58 days (SD 1.01) after sample receipt in contrast to 9.53 days (SD 3.73) when standard protocols were applied. PMID:27046155

  18. Competitive strategies in the NHS.

    PubMed

    Coad, H; Kennedy, B

    1992-04-01

    The NHS has, of necessity since implementation of the NHS and Community Care Act 1990, strengthened its skills in business, marketing and other functions borrowed from industry and commerce. One area where, however, the NHS is currently weak is in competitive intelligence. Hazel Coad and Barbara Kennedy explain what this strategically important function is and how it can help financial viability. PMID:10118487

  19. Use of the NHS Choices website for primary care consultations: results from online and general practice surveys

    PubMed Central

    Murray, Joanna; Majeed, Azeem; Khan, Muhammad Saleem; Lee, John Tayu; Nelson, Paul

    2011-01-01

    Objectives To determine the effect of using the NHS Choices website on primary care consultations in England and Wales. We examined the hypothesis that using NHS Choices may reduce the frequency of primary care consultations among young, healthy users. Design Two cross-sectional surveys of NHS Choices users. Setting Survey of NHS Choices users using an online pop-up questionnaire on the NHS Choices website and a snapshot survey of patients in six general practices in London. Participants NHS Choices website users and general practice patients. Main outcome measures For both surveys, we measured the proportion of people using NHS Choices when considering whether to consult their GP practice and on subsequent frequency of primary care consultations. Results Around 59% (n = 1559) of online and 8% (n = 125) of general practice survey respondents reported using NHS Choices in relation to their use of primary care services. Among these, 33% (n = 515) of online and 18% (n = 23) of general practice respondents reported reduced primary care consultations as a result of using NHS Choices. We estimated the equivalent capacity savings in primary care from reduced consultations as a result of using NHS Choices to be approximately £94 million per year. Conclusions NHS Choices has been shown to alter healthcare-seeking behaviour, attitudes and knowledge among its users. Using NHS Choices results in reduced demand for primary care consultations among young, healthy users for whom reduced health service use is likely to be appropriate. Reducing potentially avoidable consultations can result in considerable capacity savings in UK primary care. PMID:21847438

  20. Public spending and NHS finance.

    PubMed

    Jones, T

    1992-10-01

    Reliability, the Chancellor's Autumn Statement on the country's economic prospects, and the Government's public spending plans seldom go hand in hand. Last year's statement, however, offers an insight into this year's discussions and negotiations and their effect on NHS resources. Tom Jones sets the scene. PMID:10122088

  1. Customer care in the NHS.

    PubMed

    Ruddick, Fred

    2015-01-20

    Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction. PMID:25585766

  2. Cultural changes within the NHS.

    PubMed

    Oakley, P

    The NHS is in the throes of profound change. How much of it is cultural? Indeed, what do we mean when we talk about the culture of an organisation? And if we succeed in defining culture, how does an understanding of this concept help us to manage the service better? This article sets out to answer these questions and argues that an understanding of organisational culture is a necessary part of good human resource management. PMID:7551487

  3. What is the NHS Safety Thermometer?

    PubMed

    Power, Maxine; Stewart, Kevin; Brotherton, Ailsa

    2012-09-01

    The English National Health Service (NHS) announced a new programme to incentivize use of the NHS Safety Thermometer (NHS ST) in the NHS Operating Framework for 2012/13. For the first time, the NHS is using the Commissioning for Quality and Innovation (CQUIN) scheme, a contract lever, to incentivize ALL providers of NHS care to measure four common complications (harms) using the NHS ST in a proactive way on one day per month. This national CQUIN scheme provides financial reward for the collection of baseline data with a view to incentivizing the achievement of improvement goals in later years. In this paper, we describe the rationale for this large-scale data collection, the purpose of the instrument and its potential contribution to our current understanding of patient safety. It is not a comprehensive description of the method or preliminary data. This will be published separately. The focus of the NHS ST on pressure ulcers, falls, catheters and urine infection and venous thromboembolism is broadly applicable to patients across all healthcare settings, but is specifically pertinent to older people who, experiencing more healthcare intervention, are at risk of not one but multiple harms. In this paper, we also describe an innovative patient-level composite measure of the absence of harm from the four identified, termed as "harmfreecare" which is unique to the NHS ST and is under development to raise standards for patient safety. PMID:23136533

  4. NHS market liberalisation and the TTIP agreement.

    PubMed

    Regan, Paul; Ball, Elaine

    2016-07-01

    Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests. PMID:27401200

  5. Use staff wisely to save NHS money.

    PubMed

    Moore, Alison

    2015-12-01

    The NHS could save up to £ 2 billion a year by improving workflow and containing workforce costs, according to Labour peer Lord Carter's review of NHS efficiency. Changes in areas such as rostering and management of annual leave must avoid increasing the pressure on staff. PMID:26647680

  6. Role of the private sector in elective surgery in England and Wales, 1986.

    PubMed Central

    Nicholl, J. P.; Beeby, N. R.; Williams, B. T.

    1989-01-01

    From a sample of 19,000 treatment episodes at 183 of the 193 independent hospitals with operating facilities in England and Wales that were open in 1986 it is estimated that 287,000 residents of England and Wales had elective surgery as inpatients in 1986 (an increase of 77% since 1981) and 72,000 as day cases. From 1985 Hospital In-Patient Enquiry data it was estimated that a further 36,000 similar elective inpatient treatments were undertaken in NHS pay beds (a decrease of 38%) and 21,000 as day cases. Overall, an estimated 16.7% of all residents of England and Wales who had non-abortion elective surgery as inpatients were treated in the private sector, as were 10.5% of all day cases. An estimated 28% of all total hip joint replacements were done privately, and in both the North West and South West Thames regions the proportion of inpatients treated privately for elective surgery was 31%. It is concluded that mainly for reasons of available manpower private sector activity may not be able to grow much more without arresting or reversing the growth of the NHS, in which case some method of calculating NHS resource allocation which takes account of the local strength of the private sector will be needed. PMID:2493874

  7. Economics of a reduction in smoking: case study from Heartbeat Wales.

    PubMed Central

    Phillips, C J; Prowle, M J

    1993-01-01

    STUDY OBJECTIVE--This study aims to apply economic principles and techniques in evaluating a health promotion programme. DESIGN--This study is an economic appraisal of the Heartbeat Wales no smoking intervention programme. The costs incurred over the four year period 1985-89 have been identified and estimates have been made of the likely future impact of the reduced smoking prevalence within Wales in terms of reduced morbidity and displaced mortality in three disease groups--coronary heart disease, lung cancer, and chronic bronchitis. SETTING--Wales, UK. RESULTS--The net present value of benefits is considerably greater than costs in terms of both the NHS and the economy as a whole in Wales. In addition, the net costs per life year saved shows that the programme generates additional working life years at relatively low cost. Because not all the benefits can be fully attributed to the programme 'impact rates' ranging from 100 to 10% have been applied to the level of benefits. The evidence suggests that even if only 10% of the benefits could be attributed to the programme there is still a positive net present value of benefits. The relative efficiency of this programme has not been considered here. CONCLUSION--Large scale benefits to the NHS and the economy as a whole can be derived from reductions in smoking. PMID:8350035

  8. Employee engagement within the NHS: a cross-sectional study

    PubMed Central

    Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

    2015-01-01

    Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both). The score for absorption was significantly higher than comparison group (P< 0.0001). However, total score is not significantly different. Conclusion: The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

  9. Morality and values in support of universal healthcare must be enshrined in law. Comment on "Morality and Markets in the NHS".

    PubMed

    Pollock, Allyson M

    2015-06-01

    This is a commentary on Gilbert and colleagues' (1) paper on morality and markets in the National Health Service (NHS). Morality and values are not ephemeral qualities and universal healthcare is not simply an aspiration; it has to be enshrined in law. The creation of the UK NHS in 1948 was underpinned by core legal duties which required a system of public funding and delivery to follow. The moral values of the citizens in support of social solidarity were thus transformed into a political and legal contract for citizens. The NHS still survives in Scotland, Wales and Northern Ireland but the coalition government abolished it in England in 2012, reducing the NHS to a funding stream, a logo and a set of market regulators. This paper describes and explains the Health and Social Care (HSC) Act 2012 in England and how the NHS is withering away and health services are being remodeled along US Health Maintenance Organization (HMO) lines. There was nothing moral about this extraordinary act of savagery and violence against the public in England, and against common values and widely held beliefs in public ownership funding and provision of universal healthcare. The public health consequences will be catastrophic which is why after the election on May seventh a new Bill is required to Reinstate the NHS and the Secretary of State's legal duty to provide listed health services throughout England. PMID:26029901

  10. Cutting the cost of NHS procurement.

    PubMed

    2013-10-01

    With the NHS spending over 20 billion sterling pounds annually on goods and services--accounting, typically, for around 30 per cent of each hospital's operating costs--but, in the view of Health Minister, Dr Dan Poulter MP, still 'failing to harness its enormous purchasing power', the Minister recently unveiled a new Procurement Development Programme for the service, (HEJ - September 2013) the goal being to help NHS Trusts 'find' over 1.5 billion sterling pounds of 'procurement efficiencies' over the next three years. HEJ reports. PMID:24341107

  11. NHS at forefront of carbon modelling.

    PubMed

    Brockway, Paul

    2010-10-01

    Paul Brockway, senior sustainability consultant at Arup, reports on a carbon footprint study undertaken at the Barts and the London NHS Trust which set out to "understand carbon hotspots and identify actions that can save both money and carbon". The completion of the Barts study, believed to have been the first such initiative involving an NHS Trust, follows a national, Sustainability Development Unit-commissioned footprint study led by the author in 2008, and described in detail in the article, "Assessing the full carbon impacts of healthcare", in the IFHE Digest 2010. PMID:21058618

  12. Doctors with problems in an NHS workforce.

    PubMed Central

    Donaldson, L. J.

    1994-01-01

    OBJECTIVES--To describe the incidence, nature, and implications of serious disciplinary problems among the medical staff of a large NHS hospital workforce. DESIGN--Descriptive study with analysis of case records. SETTING--Northern Health Region, an administrative area within the NHS covering a population of three million. SUBJECTS--Forty nine hospital doctors: 46 consultants and three associate specialists. MAIN OUTCOME MEASURES--The nature of the problems encountered within the doctors' practice, and the types of action taken by the employing authority. RESULTS--Over a five year period concerns serious enough to warrant the consideration of disciplinary action were raised about 6% of all senior medical staff (49/850). Ninety six types of problem were encountered, and were categorised as poor attitude and disruptive or irresponsible behaviour (32), lack of commitment to duties (21), poor skills and inadequate knowledge (19), dishonesty (11), sexual matters (seven), disorganised practice and poor communication with colleagues (five), and other problems (one). Twenty five of the 49 doctors retired or left the employer's service, whereas 21 remained in employment after counselling or under supervision. CONCLUSIONS--Existing procedures for hospital doctors within the NHS are inadequate to deal with serious problems. Dealing with such problems requires experience, objectivity, and a willingness to tolerate unpleasantness and criticism. Because most consultants' contracts are now held by NHS trust hospitals, however, those who had developed skill over the years in handling these complex issues are now no longer involved. Images p1278-a p1282-a PMID:8205022

  13. Morality and markets in the NHS

    PubMed Central

    Gilbert, Barnabas J; Clarke, Emma; Leaver, Laurence

    2014-01-01

    Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care. PMID:25489594

  14. NHS failing its black and minority workforce.

    PubMed

    2016-06-01

    The findings are in and are far from surprising. The first report of the NHS Workforce Race Equality Standard (WRES) was published on June 2 and contains a highly predictable litany of woe: black and minority ethnic (BME) staff are more likely than white staff to be bullied or abused, wherever they work. PMID:27286582

  15. Processes for reducing NHS carbon footprint.

    PubMed

    2007-08-01

    NHS Trust boards face challenging targets for cutting carbon emissions from new and existing facilities. Spirax Sarco's Murdo Macdonald looks at the help available and some of the latest examples of good practice in steam systems for hospital heating and hot water. PMID:17847881

  16. The NHS reforms. Conditions for successful change.

    PubMed

    Forster, D P; Hadley, R

    1989-10-01

    The NHS Review has proposed the most radical organisational change in health care since the inception of the service itself in 1948. Yet, the problems entailed in gaining acceptance for reforms of such magnitude are scarcely touched on in the white paper. The scale and strength of opposition which the proposals have subsequently met within the NHS have shown clearly that the issue of the management of change is likely to be central in the acceptance or otherwise of the proposals and subsequently their success or failure. Donald Forster and Roger Hadley outline the framework within which the issues posed by change can be analysed and assessed. In keeping with the government's preference for a management perspective, they emphasise insights from the literature on the management of change rather than the detail of the white paper. PMID:10296172

  17. 'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

    PubMed

    Gorsky, Martin

    2013-01-01

    This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena. PMID:23393404

  18. Solution Versus Gas-Phase Modification of Peptide Cations with NHS-Ester Reagents

    NASA Astrophysics Data System (ADS)

    Mentinova, Marija; Barefoot, Nathan Z.; McLuckey, Scott A.

    2012-02-01

    A comparison between solution and gas phase modification of primary amine sites in model peptide cations with N-hydroxysuccinimide (NHS) ester reagents is presented. In all peptides, the site of modification in solution was directed to the N-terminus by conducting reactions at pH = 5, whereas for the same peptides, a lysine residue was preferentially modified in the gas phase. The difference in pKa values of the N-terminus and ɛ-amino group of the lysine allows for a degree of control over sites of protonation of the peptides in aqueous solution. With removal of the dielectric and multiple charging of the peptide ions in the gas phase, the accommodation of excess charge can affect the preferred sites of reaction. Interaction of the lone pair of the primary nitrogen with a proton reduces its nucleophilicity and, as a result, its reactivity towards NHS-esters. While no evidence for reaction of the N-terminus with sulfo-NHS-acetate was noted in the model peptide cations, a charge inversion experiment using bis[sulfosuccinimidyl] suberate, a cross-linking reagent with two sulfo-NHS-ester functionalities, showed modification of the N-terminus. Hence, an unprotonated N-terminus can serve as a nucleophile to displace NHS, which suggests that its lack of reactivity with the peptide cations is likely due to the participation of the N-terminus in solvating excess charge.

  19. Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales

    PubMed Central

    2013-01-01

    Background This paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties and incentives, while Wales was retreating from the 1990s internal market and emphasising cooperation and flexibility in the contracting process. But there were also cross-border spill-overs involving common contracting technologies and management cultures that meant that differences in on-the-ground contracting practices might be smaller than headline policy differences suggested. Methods The nature of real-world contracting behaviour was investigated by undertaking two qualitative case studies in England and two in Wales, each based on a local purchaser/provider network. The case studies involved ethnographic observations and interviews with staff in primary care trusts (PCTs) or local health boards (LHBs), NHS or Foundation trusts, and the overseeing Strategic Health Authority or NHS Wales regional office, as well as scrutiny of relevant documents. Results Wider policy differences between the two NHS systems were reflected in differing contracting frameworks, involving regional commissioning in Wales and commissioning by either a PCT, or co-operating pair of PCTs in our English case studies, and also in different oversight arrangements by higher tiers of the service. However, long-term relationships and trust between purchasers and providers had an important role in both systems when the financial viability of organisations was at risk. In England, the study found examples where both PCTs and trusts relaxed contractual requirements to assist partners faced with deficits. In Wales, news of plans to end the purchaser/provider split meant a return to less precisely-specified block contracts and a renewed concern to build cooperation between LHB and trust staff

  20. Career Guidance in Wales: Retrospect and Prospect

    ERIC Educational Resources Information Center

    Clark, Mike; Talbot, John

    2006-01-01

    Deregulation of the LEA Careers Service followed by the establishment of the National Assembly for Wales in 1999 led, through consultation, to the establishment of a bi-lingual all-age career guidance service under the banner of Careers Wales. The article traces the history of career guidance in Wales from 1974, showing how it has taken a very…

  1. Education in Wales and Welsh Language Teaching.

    ERIC Educational Resources Information Center

    Parker, Franklin; Parker, Betty J.

    Brief annotations are presented for 72 entries on education in Wales and on teaching the Welsh language in Wales. Entries include books, government reports, and journal articles. Several citations compare bilingual teaching in Wales, Canada, the USSR, the United States, Scotland, Ireland, and the Province of Brittany in France. The collection…

  2. The NHS: assessing new technologies, NICE and value for money.

    PubMed

    Stevens, A; Chalkidou, K; Littlejohns, P

    2011-06-01

    The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. In healthcare, most advanced countries favour the last of the three. This is for three reasons: distribution (not only are the poor less able to pay for sickness, but sickness exacerbates poverty), information (markets operate poorly when providers can easily outsmart customers) and externalities (it is in the interest of everyone that infectious diseases and the other knock-on consequences of ill health are ameliorated). So in the UK, the state, with a good deal of cross-party consensus, directs most of health service supply. This system has become more complex over the decades since the formation of the NHS in 1948. A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy. PMID:21902077

  3. The ManVan: a mobile cancer support service for men with prostate, testicular and penile cancer in Wales

    PubMed Central

    Iredale, Rachel; Skilton, Rhiannon; Pugh, Richard; Blake, Heather

    2015-01-01

    The ManVan commenced service delivery on 1st April 2014 and is the United Kingdom’s first dedicated mobile support service for men affected by prostate, testicular, and penile cancer. It is delivered in partnership with Prostate Cancer UK and Movember and fully funded by the Movember Foundation. It brings nursing care, counselling for individuals and couples, group support and welfare rights advice, directly to men living with prostate, testicular and penile cancer in communities across Wales. The ManVan has travelled extensively across Wales during its first year, visiting 94 different locations, across all seven Local Health Board areas. The first half of the year began with a Roadshow where we welcomed thousands of visitors on board, including men and women worried by all sorts of cancer symptoms; their family and friends; health and social care professionals and politicians. The variety of venues the ManVan has visited has included hospitals, supermarkets, social clubs, caravan fairs and rugby grounds to help raise awareness of the ManVan service and identify potential clients. As expected the greatest proportion of visitors are male, particularly older men. In the second half of the year, we focussed on our target audience – men diagnosed with prostate, testicular, or penile cancer and their families. Using a targeted approach to urology clinics across NHS Wales, as well as community-based activity encouraging men from ethnic minorities to visit, we have now taken on 161 clients, many of whom have received more than one ManVan service, and attended on more than one occasion. Most of our clients have prostate cancer, are over the age of 55 years, and are married. Analysis of the early data around the clinical and psychosocial benefits of the services offered on the ManVan is positive and the annualised value of the benefits obtained for ManVan clients equates to more than £300,000 in this first year. There were 3,319 visitors to the ManVan in total during

  4. The ManVan: a mobile cancer support service for men with prostate, testicular and penile cancer in Wales.

    PubMed

    Iredale, Rachel; Skilton, Rhiannon; Pugh, Richard; Blake, Heather

    2015-01-01

    The ManVan commenced service delivery on 1st April 2014 and is the United Kingdom's first dedicated mobile support service for men affected by prostate, testicular, and penile cancer. It is delivered in partnership with Prostate Cancer UK and Movember and fully funded by the Movember Foundation. It brings nursing care, counselling for individuals and couples, group support and welfare rights advice, directly to men living with prostate, testicular and penile cancer in communities across Wales. The ManVan has travelled extensively across Wales during its first year, visiting 94 different locations, across all seven Local Health Board areas. The first half of the year began with a Roadshow where we welcomed thousands of visitors on board, including men and women worried by all sorts of cancer symptoms; their family and friends; health and social care professionals and politicians. The variety of venues the ManVan has visited has included hospitals, supermarkets, social clubs, caravan fairs and rugby grounds to help raise awareness of the ManVan service and identify potential clients. As expected the greatest proportion of visitors are male, particularly older men. In the second half of the year, we focussed on our target audience - men diagnosed with prostate, testicular, or penile cancer and their families. Using a targeted approach to urology clinics across NHS Wales, as well as community-based activity encouraging men from ethnic minorities to visit, we have now taken on 161 clients, many of whom have received more than one ManVan service, and attended on more than one occasion. Most of our clients have prostate cancer, are over the age of 55 years, and are married. Analysis of the early data around the clinical and psychosocial benefits of the services offered on the ManVan is positive and the annualised value of the benefits obtained for ManVan clients equates to more than £300,000 in this first year. There were 3,319 visitors to the ManVan in total during the

  5. Sunshine, Sea, and Season of Birth: MS Incidence in Wales.

    PubMed

    Balbuena, Lloyd D; Middleton, Rod M; Tuite-Dalton, Katie; Pouliou, Theodora; Williams, Kate Elizabeth; Noble, Gareth J

    2016-01-01

    Maternal sun exposure in gestation and throughout the lifetime is necessary for vitamin D synthesis, and living near the sea is a population level index of seafood consumption. The aim of this study was to estimate the incidence rate of multiple sclerosis (MS) in Wales and examine its association with sun exposure, coastal living, and latitude. The study used a database of MS hospital visits and admissions in Wales between 2002 and 2013. For the 1,909 lower layer super output areas (LSOAs) in Wales, coastal status, population, longitude/latitude, and average sunshine hours per day were obtained. Age-specific and age-standardised MS incidence were calculated and modelled using Poisson regression. The distribution of births by month was compared between MS cases and the combined England and Wales population. There were 3,557 new MS cases between 2002 and 2013, with an average annual incidence of 8.14 (95% CI: 7.69-8.59) among males and 12.97 (95% CI: 12.44-13.50) among females per 100,000 population. The female-to-male ratio was 1.86:1. For both sexes combined, the average annual incidence rate was 9.10 (95% CI: 8.80-9.40). All figures are age-standardized to the 1976 European standard population. Compared to the combined England and Wales population, more people with MS were born in April, observed-to-expected ratio: 1.21 (95% CI: 1.08-1.36). MS incidence varied directly with latitude and inversely with sunshine hours. Proximity to the coast was associated with lower MS incidence only in easterly areas. This study shows that MS incidence rate in Wales is comparable to the rate in Scotland and is associated with environmental factors that probably represent levels of vitamin D. PMID:27182982

  6. Sunshine, Sea, and Season of Birth: MS Incidence in Wales

    PubMed Central

    Balbuena, Lloyd D.; Middleton, Rod M.; Tuite-Dalton, Katie; Pouliou, Theodora; Williams, Kate Elizabeth; Noble, Gareth J.

    2016-01-01

    Maternal sun exposure in gestation and throughout the lifetime is necessary for vitamin D synthesis, and living near the sea is a population level index of seafood consumption. The aim of this study was to estimate the incidence rate of multiple sclerosis (MS) in Wales and examine its association with sun exposure, coastal living, and latitude. The study used a database of MS hospital visits and admissions in Wales between 2002 and 2013. For the 1,909 lower layer super output areas (LSOAs) in Wales, coastal status, population, longitude/latitude, and average sunshine hours per day were obtained. Age-specific and age-standardised MS incidence were calculated and modelled using Poisson regression. The distribution of births by month was compared between MS cases and the combined England and Wales population. There were 3,557 new MS cases between 2002 and 2013, with an average annual incidence of 8.14 (95% CI: 7.69–8.59) among males and 12.97 (95% CI: 12.44–13.50) among females per 100,000 population. The female-to-male ratio was 1.86:1. For both sexes combined, the average annual incidence rate was 9.10 (95% CI: 8.80–9.40). All figures are age-standardized to the 1976 European standard population. Compared to the combined England and Wales population, more people with MS were born in April, observed-to-expected ratio: 1.21 (95% CI: 1.08–1.36). MS incidence varied directly with latitude and inversely with sunshine hours. Proximity to the coast was associated with lower MS incidence only in easterly areas. This study shows that MS incidence rate in Wales is comparable to the rate in Scotland and is associated with environmental factors that probably represent levels of vitamin D. PMID:27182982

  7. Managing the new NHS: breathing new life into the NHS reforms.

    PubMed

    Best, G; Knowles, D; Mathew, D

    1994-03-26

    The essence of the NHS reforms is that they bring market forces to bear on organisations providing public services, while allowing those organisations more freedom to respond in ways that will improve the efficiency, effectiveness, and appropriateness of their services. The new structural changes to the NHS--a leaner management executive and fewer, slimmer regions--could be used either to strengthen these features of the reforms or frustrate them by allowing ministers and top management to intervene even more at local level and "overmanage" the market. To ensure that the aims of the reforms are not frustrated ministers and the management executive must restrict themselves to laying down clear strategies and then allow purchasers and providers to meet those strategies in their own ways. They also need to ensure that the whole NHS can learn and benefit from local experimentation and devise ways of managing the crises that will inevitably arise; otherwise they might be tempted to become involved in managing the market at too local a level, and the NHS will suffer the worst of both worlds: stifling bureaucracy at the top and parochial self interest locally. PMID:8167495

  8. Improving haematology care in Wales.

    PubMed

    Perett, Shelagh

    2002-04-17

    Care for patients with a malignant haematological disorder in Wales has been revised significantly since the mid-1990s. Recommendations from expert groups stated that a uniformly high standard of care should be provided as close to the patient's home as possible and variations in practice that had been causing concern and distress to patients and their families be reduced. The All Wales Haematology Nurses Group was established to promote and disseminate standards and guidelines that would contribute to achieving these aims. The basis for the group's work was transformational leadership and collaborative practice. Work is ongoing and the group is planning to consolidate achievements to date through country-wide audit and professional education. PMID:11998241

  9. The NHS R&D Information Systems Strategy (ISS).

    PubMed

    Ennis, J; Cooper, A; Henshall, C; Jacques, J; Zaman, N

    1994-12-01

    Following a strategy study which reported in August 1992 the NHS R&D Information Systems Strategy (ISS), a strategic framework for information systems, has been developed to support research and development in the NHS. This paper summarizes its main features, illustrates the benefits which specific information systems will bring, and outlines how the products of the programme are disseminated and accessed. PMID:10141710

  10. Health research access to personal confidential data in England and Wales: assessing any gap in public attitude between preferable and acceptable models of consent.

    PubMed

    Taylor, Mark J; Taylor, Natasha

    2014-12-01

    England and Wales are moving toward a model of 'opt out' for use of personal confidential data in health research. Existing research does not make clear how acceptable this move is to the public. While people are typically supportive of health research, when asked to describe the ideal level of control there is a marked lack of consensus over the preferred model of consent (e.g. explicit consent, opt out etc.). This study sought to investigate a relatively unexplored difference between the consent model that people prefer and that which they are willing to accept. It also sought to explore any reasons for such acceptance.A mixed methods approach was used to gather data, incorporating a structured questionnaire and in-depth focus group discussions led by an external facilitator. The sampling strategy was designed to recruit people with different involvement in the NHS but typically with experience of NHS services. Three separate focus groups were carried out over three consecutive days.The central finding is that people are typically willing to accept models of consent other than that which they would prefer. Such acceptance is typically conditional upon a number of factors, including: security and confidentiality, no inappropriate commercialisation or detrimental use, transparency, independent overview, the ability to object to any processing considered to be inappropriate or particularly sensitive.This study suggests that most people would find research use without the possibility of objection to be unacceptable. However, the study also suggests that people who would prefer to be asked explicitly before data were used for purposes beyond direct care may be willing to accept an opt out model of consent if the reasons for not seeking explicit consent are accessible to them and they trust that data is only going to be used under conditions, and with safeguards, that they would consider to be acceptable even if not preferable. PMID:26085451

  11. Public Library Development in New South Wales

    ERIC Educational Resources Information Center

    Jones, David J.

    2005-01-01

    Today every citizen in New South Wales has access to public library services through a sophisticated network, a partnership between local and State Government. In fact, free public libraries in New South Wales only began to operate in any numbers after the end of World War II--not even sixty years ago. Why did it take so long here, bearing in mind…

  12. Educational Leadership and School Renewal in Wales

    ERIC Educational Resources Information Center

    Egan, David; Marshall, Steve

    2007-01-01

    The paper sets out the main characteristics of the school system in Wales since 1999 when responsibility for education was devolved to the newly-created National Assembly for Wales. It moves on to consider the advances made in student attainment during this period, some of which can be ascribed to progress in learning and teaching pedagogy,…

  13. Children's Perceptions of National Identity in Wales

    ERIC Educational Resources Information Center

    Murphy, Alison; Laugharne, Janet

    2013-01-01

    The project forms part of a larger doctoral study which examines children's perceptions of national identity and its construction and importance in the world of the child in Wales. The research took place in a primary school class in the South Wales valleys, in a class of 27 children aged 7-8 years. Following an introductory activity, children…

  14. Understanding the roles of NHS trust board members.

    PubMed

    Deffenbaugh, J

    1996-01-01

    The establishment of NHS trust boards on a business format was a recent innovation resulting from the NHS reforms. In order to realize benefits for patients, it is essential that boards operate effectively. Explores within the framework of corporate governance, the practical implications of board member roles. Drawing on experience of strategy formulation at board level, analyses and clarifies the roles, and presents recommendations to increase board effectiveness. PMID:10162758

  15. Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis.

    PubMed

    Dafydd, Derfel Ap; Baskaradas, Aroon; Bobdiwala, Shabnam; Anwar, Muhammad Saleem; Abrahams, Rachel; Jeremy, Levy

    2016-06-01

    Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective. PMID:27251912

  16. Defining the Pharmacodynamic Profile and Therapeutic Index of NHS-IL12 Immunocytokine in Dogs with Malignant Melanoma

    PubMed Central

    Paoloni, Melissa; Mazcko, Christina; Selting, Kimberly; Lana, Susan; Barber, Lisa; Phillips, Jeffrey; Skorupski, Katherine; Vail, David; Wilson, Heather; Biller, Barbara; Avery, Anne; Kiupel, Matti; LeBlanc, Amy; Bernhardt, Anna; Brunkhorst, Beatrice; Tighe, Robert; Khanna, Chand

    2015-01-01

    Background Interleukin (IL)-12 is a pro-inflammatory cytokine that mediates T-helper type 1 responses and cytotoxic T-cell activation, contributing to its utility as anti-cancer agent. Systemic administration of IL-12 often results in unacceptable toxicity; therefore, strategies to direct delivery of IL-12 to tumors are under investigation. The objective of this study was to assist the preclinical development of NHS-IL12, an immunocytokine consisting of an antibody, which targets necrotic tumor regions, linked to IL-12. Specifically this study sought to evaluate the safety, serum pharmacokinetics, anti-tumor activity, and immune modulation of NHS-IL12 in dogs with naturally occurring cancers. Methodology/Principal Findings A rapid dose-escalation study of NHS-IL12 administered subcutaneously to dogs with melanoma was conducted through the Comparative Oncology Trials Consortium (COTC). Eleven dogs were enrolled in four dose-escalation cohorts; thereafter, an additional seven dogs were treated at the defined tolerable dose of 0.8 mg/m2. The expanded cohort at this fixed dose (ten dogs in total) was accrued for further pharmacokinetics and pharmacodynamics assessment. NHS-IL12 levels, serum cytokine concentrations, and peripheral blood mononuclear cell characterization (post-treatment) and draining lymph node immune profiling, and tumor biopsies (pre- and post-treatment) were collected. Adverse events included thrombocytopenia, liver enzymopathies, fever, and vasculitis. Correlation between interferon (IFN)-γ induction, adverse events, and NHS-IL12 exposure (maximum concentration and area under the concentration-time curve) were dose-dependent. Serum IL-10 levels and intratumoral CD8+ populations increased after treatment. Partial responses, according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, were observed in two dogs treated with NHS-IL12 0.8 mg/m2 and 1.6 mg/m2. Conclusions/Significance NHS-IL12 was administered safely to dogs with melanoma

  17. Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

    PubMed Central

    Shaw, Alison; Thompson, Elizabeth A; Sharp, Debbie

    2006-01-01

    Background Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. Methods Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent), recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. Results A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors") and attractive aspects of complementary therapies ("pull factors"). While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. Conclusion Complementary therapy use reflects patients

  18. Providing guidance to the NHS: The Scottish Medicines Consortium and the National Institute for Clinical Excellence compared.

    PubMed

    Cairns, John

    2006-04-01

    There is wide acceptance that cost-effectiveness is a relevant consideration when deciding which treatments to make available in publicly funded health services. An unresolved issue concerns the timing and the extent of such evaluations. The United Kingdom provides examples of two distinct approaches. The Scottish Medicines Consortium (SMC) provides guidance to the NHS in Scotland based on a rapid early review of the evidence. The National Institute for Health and Clinical Excellence (NICE) provides guidance to the NHS in England and Wales based on a later, more extensive review of the evidence. This paper explores how the difference in approach affects the role of the pharmaceutical industry, clinical experts and other stakeholders. It compares the guidance produced when both bodies have evaluated the same medicines. It addresses the general question of when to assess the cost-effectiveness of medicines. It concludes that there are important differences between the approaches of SMC and NICE, relating primarily to the timing of the review of evidence on clinical and cost-effectiveness. The difference in timing means that the activities of the two bodies are to a large extent complementary. PMID:15982779

  19. Creating a patient-led NHS: some ethical and epistemological challenges.

    PubMed

    Owens, John

    2012-01-01

    This article responds to the Coalition government's recent Open Public Services White Paper and to proposals which call for the creation of a 'patient-led NHS' which will, wherever possible, seek to give patients direct control over the services they receive, through a greater degree of choice and participation. Its central contention is that affording patients greater influence over the consultation and commissioning processes will require the NHS to accommodate and respond to the beliefs, values and agendas of patients, as well as those of medical professionals and policy makers. Since it cannot be assumed that professionals and patients will share the same beliefs, values and agendas, the creation of a system of patient-led services has the potential to bring disagreement between professionals and patients to a head, particularly within the consultation and commissioning processes. Thus, a set of complex epistemic and ethical challenges accompanies the proposed creation of a 'patient-led NHS', greater awareness of which will be necessary for the successful implementation of such reforms. PMID:26265952

  20. Wales as a Setting for Children's Fantasy.

    ERIC Educational Resources Information Center

    Kiefer, Barbara Z.

    1982-01-01

    Examines three works of fantasy that have been awarded the Newbery or Carnegie Medal during the last 15 years ("The High King,""The Owl Service," and "The Grey King") and that have used Wales as their setting. (HOD)

  1. Patient characteristics and clinical caseload of short stay independent hospitals in England and Wales, 1992-3.

    PubMed Central

    Williams, B. T.; Nicholl, J. P.

    1994-01-01

    OBJECTIVE--To describe and quantify the patients and clinical activities of independent short stay hospitals. DESIGN--Retrospective survey of hospital records for sampled periods of one financial year and comparison with data from 1981 to 1986. SETTING--217 independent hospitals in England and Wales, 1992-3. MAIN OUTCOME MEASURES--Distributions of sex, age groups, and areas of residence of patients, clinical procedures, financial provision. RESULTS--Data were obtained from 201 (93%) hospitals. An estimated 429,172 inpatients (7% more than 1986) and 249,531 day cases (an increase of 154%) from 1986 were treated in the year. The number of overseas patients was half that in 1986. Clinical case mix remained similar to 1986. Abortion remained the commonest procedure (13% v 19% in 1986). Lens operations, heart operations, endoscopies, and non-surgical cases showed the largest increases from 1986. Proportionately more overseas patients had abortions (30% v 12% for England and Wales residents) and they received 41% of coronary artery bypass grafting. Three quarters of the patients were aged 15-64. The proportion of patients aged over 65 had changed little (19% v 17% in 1986). Estimated average bed occupancy was only 48%. Only one in 20 patients was treated under NHS contract; 90% of episodes were funded through private health insurance. CONCLUSIONS--The demand for treatment in private hospitals continues to increase despite additional investment in the NHS, but the overseas market is falling. Overall, the range of clinical activity has changed little. PMID:8025470

  2. The Lightening Veil: Language Revitalization in Wales

    ERIC Educational Resources Information Center

    Williams, Colin H.

    2014-01-01

    The Welsh language, which is indigenous to Wales, is one of six Celtic languages. It is spoken by 562,000 speakers, 19% of the population of Wales, according to the 2011 U.K. Census, and it is estimated that it is spoken by a further 200,000 residents elsewhere in the United Kingdom. No exact figures exist for the undoubted thousands of other…

  3. Going private? Exploring the drift away from the NHS.

    PubMed

    Silvester, S; Calnan, M; Manley, G; Taylor-Gooby, P

    2000-04-01

    The perception that dentistry is being privatised is widespread. A two-phase study was undertaken to investigate the factors influencing dentists' decisions to practise in the public and or private sectors. In phase I a national postal survey of general dental practitioners (n = 1011) explored differences in working practices and experience of NHS and non-NHS work. Survey data were supplemented in phase II by in-depth interviews with four subsamples of dentists in two regions. The survey found that although the majority of dentists continued to treat the majority of their patients within the NHS since the introduction of the 1990 contract patterns of practice have changed. Where private dentistry was increasing, it was regionally variable and arose mainly from concerns with financial security, maintaining quality of work and autonomy. Ideological differences were apparent in relation to differences in practice mix. Those who continued to work in the NHS, because of insufficient demand for private dentistry, did so in order to provide access to treatment and to maintain a reliable source of income and pension rights. Dentists interviewed expressed reluctance in withdrawing from NHS practice. Disillusionment with government policy and recognition of the marginal nature of dental health issues suggests that current trends will continue. PMID:11404966

  4. Can learning organizations survive in the newer NHS?

    PubMed Central

    Sheaff, Rod; Pilgrim, David

    2006-01-01

    Background This paper outlines the principal characteristics of a learning organisation and the organisational features that define it. It then compares these features with the organisational conditions that currently obtain, or are being created, within the British NHS. The contradictory development of recent British health policy, resulting in the NHS becoming both more marketised and more bureaucratised has correspondingly ambiguous implications for attempts to implement a 'learning organisation' model. Methods Texts that define and debate the characteristics of a learning organisation were found by snowballing references from the founding learning organisation books and published papers, and then by searching a database specifically devised for a literature review on organisational structures and processes in health care. COPAC and ABI-Info databases for subsequent peer-reviewed publications that also appeared relevant to the present study were searched. Results The outcomes of the above search are summarised and mapped onto the current constituent organisations of the NHS to identify the extent to which they achieve or approximate to a learning organisation status. Conclusion Because of the complexity of the NHS and the contradictory processes of marketisation and bureaucratisation characterising it, it cannot, as a whole system, become a learning organisation. However, it is possible that its constituent organisations may achieve this status to varying degrees. Constraints upon NHS managers to speak their minds freely place an ultimate limit on learning organisation development. This limitation suggests that current British health service policy encourages organisational learning-but not too openly and not too much. PMID:17074083

  5. Lifestyle treatments in cystic fibrosis: The NHS should pay.

    PubMed

    Ketchell, Robert Ian

    2016-08-01

    With the NHS under increasing financial pressure and healthcare costs soaring year on year, it is perhaps not surprising that assessment agencies focus on cost-effectiveness analysis when assessing new therapies. Such an approach does not however, always take sufficient account of treatment burden, lifestyle and patient choice and therefore new equally effective but perhaps "easier to take" formulations and faster delivery systems for current therapies do not always take precedence in current treatment guidelines. In arguing that the NHS should pay for so-called lifestyle treatments in cystic fibrosis the counterintuitive nature of some of the current decision making is discussed and a more holistic approach to improve NHS efficiency is presented. PMID:27373763

  6. From plough to plate--an NHS first?

    PubMed

    Baillie, Jonathan

    2011-10-01

    A recent Soil Association survey saw nearly a third of the 1,000 patients questioned about the food they had received during a recent hospital stay report that it was so bad that, at times, they could not recognise what was on their plate (HEJ - September 2011). The resulting report, however, also commended a number of healthcare organisations which had put considerable time, effort, and commitment, into providing first-class patient meals, often at negligible extra cost, and using high quality, locally sourced produce. One NHS Trust pioneering such an approach, while simultaneously boosting the fortunes of local farmers and other food producers, is Sussex Partnership NHS Foundation Trust, which, HEJ editor Jonathan Baillie discovered, is now not only being held up as a national exemplar of good NHS catering practice, but has also recently had the go-ahead for a new pound 2.2 million catering facility. PMID:22053361

  7. People's Collection Wales: Online Access to the Heritage of Wales from Museums, Archives and Libraries

    ERIC Educational Resources Information Center

    Tedd, Lucy A.

    2011-01-01

    Purpose: The People's Collection Wales aims to collect, interpret, distribute and discuss Wales' cultural heritage in an online environment. Individual users or local history societies are able to create their own digital collections, contribute relevant content, as well as access digital resources from heritage institutions. This paper aims to…

  8. Medical Tourism: A Cost or Benefit to the NHS?

    PubMed Central

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    ‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

  9. The problem with rational approaches to reforming the NHS.

    PubMed

    Smith, Tom

    2002-12-01

    Several papers with a common theme published between May and August 2002 are drawn together to present a research-informed critique of economic logic present within recent NHS reform. They attempt to persuade the reader that excessive faith in predictive systems of thought that are underpinned by theories of rational behaviour is misplaced within the NHS. They suggest rational economic theory makes some problematic assumptions about human and individual behaviour. The problem is that there are many modes of thought at work within the NHS, and not all of these cogs are turned by economic rationality. Increasingly, over the last 10 years or so, economic concepts have become more and more prominent in the NHS. Their influence has gone beyond finance becoming a dominant issue. In addition to budgets, contracts and cost itemisation, theoretical relationships of supply and demand are now called upon to change professional behaviour. A new framework for the NHS has been built which is developing market forces. The papers provide some insight into whether the systems set in place to produce a patient-centred service do so in a meaningful way. The first paper examines an emerging primary care group (PCG). Now part of primary care trusts, PCGs were a lynchpin of new economic relationships in the new NHS. Community based, in theory PCGs take decisions made about healthcare resources closer to the patient for whom they are a proxy demander and shaper of services. To what extent do PCGs fulfil this role? The first paper is based on data collected during an in-depth 2 year observation study to test the applicability of health economics to healthcare organisations. It examines the early experience of commissioning services for coronary heart disease (CHD). PMID:12468703

  10. Medical tourism: a cost or benefit to the NHS?

    PubMed

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems. PMID

  11. Lifestyle treatments in cystic fibrosis: The NHS should not pay.

    PubMed

    Hull, Jeremy

    2016-08-01

    Lifestyle treatments can be defined as those which may have in impact on quality of life but do not affect health outcomes. Particular treatment options may be preferred by patients because they are for example, easier to use, take up less time or taste better. The impact on adherence needs to be considered. Treatment options that promote greater adherence to therapy are likely to be more efficacious and so are not, by definition, lifestyle treatments. The NHS is facing unprecedented financial pressure and resources are limited. When lifestyle treatments are more expensive than standard therapy, they should not be funded by the NHS. PMID:27349724

  12. Leadership in the NHS: does the Emperor have any clothes?

    PubMed

    Checkland, Kath

    2014-10-01

    In this essay, I explore the rise of the concept of 'leadership' in the English NHS, highlighting the similarity with a previous shift from (bad, old) 'administration' to (good, new) 'management'. I take a critical look at this discursive shift and highlight some of the overblown claims made for the value of 'clinical leadership'. I argue that, rather than turning all NHS staff into leaders, we should perhaps tone down the level of our rhetoric and instead emphasize the need for a service full of good followers who will maintain a relentless focus on care, quality and efficiency. PMID:24756135

  13. Effect of increasing active travel in urban England and Wales on costs to the National Health Service.

    PubMed

    Jarrett, James; Woodcock, James; Griffiths, Ulla K; Chalabi, Zaid; Edwards, Phil; Roberts, Ian; Haines, Andy

    2012-06-01

    Increased walking and cycling in urban areas and reduced use of private cars could have positive effects on many health outcomes. We estimated the potential effect of increased walking and cycling in urban England and Wales on costs to the National Health Service (NHS) for seven diseases--namely, type 2 diabetes, dementia, cerebrovascular disease, breast cancer, colorectal cancer, depression, and ischaemic heart disease--that are associated with physical inactivity. Within 20 years, reductions in the prevalences of type 2 diabetes, dementia, ischaemic heart disease, cerebrovascular disease, and cancer because of increased physical activity would lead to savings of roughly UK£17 billion (in 2010 prices) for the NHS, after adjustment for an increased risk of road traffic injuries. Further costs would be averted after 20 years. Sensitivity analyses show that results are invariably positive but sensitive to assumptions about time lag between the increase in active travel and changes in health outcomes. Increasing the amount of walking and cycling in urban settings could reduce costs to the NHS, permitting decreased government expenditure on health or releasing resources to fund additional health care. PMID:22682466

  14. Enterovirus infections in England and Wales, 2000-2011: the impact of increased molecular diagnostics.

    PubMed

    Kadambari, S; Bukasa, A; Okike, I O; Pebody, R; Brown, D; Gallimore, C; Xerry, J; Sharland, M; Ladhani, S N

    2014-12-01

    There have recently been significant changes in diagnostic practices for detecting enterovirus (EV) infections across England and Wales. Reports of laboratory-confirmed EV infections submitted by National Health Service (NHS) hospital laboratories to Public Health England (PHE) over a 12-year period (2000-2011) were analysed. Additionally, the PHE Virus Reference Department (VRD) electronic database containing molecular typing data from 2004 onwards was interrogated. Of the 13,901 reports, there was a decline from a peak of 2254 in 2001 to 589 in 2006, and then an increase year-on-year to 1634 in 2011. This increase coincided with increasing PCR-based laboratory diagnosis, which accounted for 36% of reported cases in 2000 and 92% in 2011. The estimated annual incidence in 2011 was 3.9/100,000 overall and 238/100,000 in those aged <3 months, who accounted for almost one-quarter of reported cases (n = 2993, 23%). During 2004-2011, 2770 strains were submitted for molecular typing to the VRD, who found no evidence for a predominance of any particular strain. Thus, the recent increase in reported cases closely reflects the increase in PCR testing by NHS hospitals, but is associated with a lower proportion of samples being submitted for molecular typing. The high EV rate in young infants merits further investigation to inform evidence-based management guidance. PMID:25039903

  15. Principles and indicators of successful consumer involvement in NHS research: results of a Delphi study and subgroup analysis.

    PubMed

    Boote, Jonathan; Barber, Rosemary; Cooper, Cindy

    2006-02-01

    Consumer involvement in NHS research is Department of Health policy within the UK. Despite the existence of policy directives and guidance, until recently there has been no consensus among consumers and researchers about what it means to involve consumers successfully in NHS research. This paper discusses the value of consensus research in this policy area, and presents the detailed findings of a Delphi study carried out to reach consensus on principles and indicators of successful consumer involvement in NHS research. Study participants, comprising consumers, researchers and consumer-researchers, were identified using a purposive sampling strategy. Consensus was reached on eight clear and valid principles of successful consumer involvement in NHS research, with each principle having at least one clear and valid indicator. Subgroup analysis revealed few significant differences in how consumers, researchers and consumer-researchers rated the principles and indicators. The implications and limitations of the study are discussed. Further research is needed to assess: (1) the usefulness of the principles and indicators for differing models of consumer involvement, health research methodologies, and subject areas within health research; and (2) the impact of 'successful' consumer involvement on health research processes and outcomes. PMID:15899535

  16. Stressors, moderators and stress outcomes: findings from the All-Wales Community Mental Health Nurse Study.

    PubMed

    Edwards, D; Burnard, P; Coyle, D; Fothergill, A; Hannigan, B

    2000-12-01

    The All-Wales Community Mental Health Nurse Stress Study was the largest study undertaken in the UK to date to investigate stress, burnout and coping amongst the CMHN workforce. The aim of the study was to examine the variety, frequency and severity of stressors, to describe coping strategies used to reduce work-based stress, and to determine stress outcomes. Questionnaires were sent out to 614 CMHNs from ten NHS Trusts throughout Wales. The response rate was 49% (n = 301). The measures used included the Maslach Human Services Survey, the CPN Stress Questionnaire, the Psychnurse Methods of Coping Questionnaire, the Rosenberg Self-Esteem Scale and the General Health Questionnaire GHQ-12. Community mental health nurses indicated that trying to maintain a good quality service in the midst of long waiting lists, poor resources, and having too many interruptions while trying to work in the office were particularly stressful items. The coping strategies that CMHNs utilized the most were having a stable home life and looking forward to going home at the end of the day, having outside interests and hobbies and talking to people that they got on well with. Forty per cent of CMHNs tended to view themselves negatively, feeling that others did not hold much respect for them. The GHQ-12 measure indicated that 35% of CMHNs had crossed a threshold of psychiatric caseness. Measured against a normative sample of mental health workers, 51% of CMHNs were experiencing high levels of long-term emotional exhaustion. Twenty-four per cent were suffering from high levels of depersonalization burnout and were not relating well to clients, whilst 14% were experiencing severe long-term feelings of lack of personal accomplishment. The results from the study provided us with a picture of stress and coping in CMHNs in Wales. Addressing these factors may help to reduce levels of experienced stress and burnout. PMID:11933511

  17. Where should health services go: local authorities versus the NHS?

    PubMed

    Pollock, A M

    1995-06-17

    The Association of Metropolitan Authorities has recently proposed that responsibility for the NHS should pass from health authorities to local authorities. One of the fiercest debates at the outset of the NHS was whether the hospitals should be run by local authorities. In the end the minister for health, Aneurin Bevan, decided against local democracy and in favour of a national health service. His arguments included the fact that equality of treatment could not be guaranteed if facilities varied with local finances and that even the largest authorities were not big enough to pool risks and expertise. All these arguments still apply today, and the recent changes in community care provide an insight into how a market model of local authority control might work. The changes have been accompanied by a shift from public to private sector provision and the introduction of charges for services that the NHS once provided free. As important, the willingness and ability of local authorities to raise extra revenue from local taxes and charges affect the service they can provide, so leading to inequalities of provision. Local authorities have yet to make the case that they can preserve the fundamental principles and benefits of the NHS, including its reliance on central taxation and unified funding formulas. PMID:7787651

  18. Changing cultures--determining domains in the NHS.

    PubMed

    Mark, A; Scott, H

    1991-11-01

    This article explores changes in the National Health Service (NHS) as an organisation, in the context of the emerging managerial culture. This new culture is also seeking to influence the other forms of organisational culture which have co-existed until now in the NHS; its success in doing so is limited by the lack of a shared value system within the new management culture. The issue is explored with reference to domain theory as suggested by Kouze and Mico (1979), and subsequently amended by others, to fit the developments occurring in the NHS. Consideration is given to the following issues with reference to the three domains of politics, management and professions. Can we establish: the continued existence of each domain; the changing location of groups between each domain; the interrelationship between the domains: the location of issues within or between the domains. The theory is then located within the broader discipline of organizational behaviour to provide a revised model for thinking about and acting upon the cultural change in the new NHS; the organizational learning now required is shown to require the following activities by each domain; identification, interpretation and communication. PMID:10118701

  19. NHS values. I want to tell you a story.

    PubMed

    Pattison, S; Manning, S; Malby, B

    1999-02-25

    Many NHS staff feel that they are unable to put their values into action because of the constraints on the service. They want a working environment where trust is possible and mistakes can be made without retribution. The reality is often bullying and attempts at innovation being met with reproach. PMID:10387429

  20. The clinical director in the NHS: utilizing a role-theory perspective.

    PubMed

    Willcocks, S

    1994-01-01

    Reviews the role of the clinical director in the NHS, based on data collected in a qualitative research study. Utilizes role theory to invite insight into a relatively new but important managerial role. Suggests that effectiveness in the role may be measured by the extent to which managers are able to meet the expectations of their role set, and also that the overall effectiveness of the clinical direction may be the extent to which he or she is able to influence, adapt, modify or change these role expectations. PMID:10161168

  1. Health needs of detainees in police custody in England and Wales. Literature review.

    PubMed

    Rekrut-Lapa, Tatyana; Lapa, Alexander

    2014-10-01

    The aim of this systematic is to review and analyse the literature concerned with the health needs of detainees in police custody in England and Wales. The healthcare of detainees in police custody is regulated by the England and Wales Police and Criminal Evidence Act 1984. The Faculty of Forensic and Legal Medicine of the Royal College of Physicians also sets quality standards for the provision of custodial healthcare. The provision of healthcare in custody presents a number of challenges including the patient group, the setting and the overlap between the legal and medical concerns that are addressed by the medical team. Currently, care to the detainees in custody is delivered by a mixture of private organisations, police-led forensic medical services and the NHS. A search of the PUBMED, EMBASE and PsycINFO databases undertaken using the search terms: (police custody) OR (detainees) OR (police detainees) yielded 830 publications. All of the titles were screened to identify potentially relevant publications concerned with the health needs of detainees in police custodies in England and Wales. There were no design specific criteria set for inclusion of the studies in this literature review. 77 articles were initially identified as relevant and obtained in full. After further analysis 28 publications were included in this literature review. A total sample of over 12,000 detainees was examined in this literature review. Approximately 20% of detainees seen by health care teams suffer from psychiatric conditions. On average, 50% of patients claim that they have problems with drugs and alcohol. Physical health conditions are also highly prevalent with up to 74% of detainees requiring regular medication. Forensic medical issues included the management of detainees who were restrained using handcuffs, irritant sprays and TASER. Detainees who are suspected of internal drug concealment also require intensive medical input. Injury documentation in custody is often requested

  2. Our Vision for a Sustainable Wales

    ERIC Educational Resources Information Center

    Davidson, Jane

    2010-01-01

    The Welsh Assembly Government is committed to putting sustainable development at the heart of all it does. In May 2009, the Assembly launched its latest scheme, "One Wales: One Planet," which sets out a clear definition of sustainable development as enhancing the economic, social and environmental wellbeing of people and communities, achieving a…

  3. New South Wales School Design Projects.

    ERIC Educational Resources Information Center

    Wilson, Cecilia

    2003-01-01

    Australia's New South Wales Education Facilities Research Group, a joint initiative between the Department of Education and Training and the Department of Public Works and Services, provides action research into issues which impact on school design. This article describes a few of the initiatives which have resulted, such as an educational video…

  4. A View from England and Wales

    ERIC Educational Resources Information Center

    Ingham, Roger

    2016-01-01

    This commentary outlines developments regarding Sex and Relationships Education (SRE, akin to Comprehensive Sex Education) in England and Wales over the past 15 years or so. BZgA has been a WHO/Europe collaborating centre for sexual and reproductive health since 2003. In this capacity, BZgA contributes to the development and dissemination of WHO…

  5. A new fetal RHD genotyping test: Costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales

    PubMed Central

    2011-01-01

    Background Postnatal and antenatal anti-D prophylaxis have dramatically reduced maternal sensitisations and cases of rhesus disease in babies born to women with RhD negative blood group. Recent scientific advances mean that non-invasive prenatal diagnosis (NIPD), based on the presence of cell-free fetal DNA in maternal plasma, could be used to target prophylaxis on "at risk" pregnancies where the fetus is RhD positive. This paper provides the first assessment of cost-effectiveness of NIPD-targeted prophylaxis compared to current policies. Methods We conducted an economic analysis of NIPD implementation in England and Wales. Two scenarios were considered. Scenario 1 assumed that NIPD will be only used to target antenatal prophylaxis with serology tests continuing to direct post-delivery prophylaxis. In Scenario 2, NIPD would also displace postnatal serology testing if an RhD negative fetus was identified. Costs were estimated from the provider's perspective for both scenarios together with a threshold royalty fee per test. Incremental costs were compared with clinical implications. Results The basic cost of an NIPD in-house test is £16.25 per sample (excluding royalty fee). The two-dose antenatal prophylaxis policy recommended by NICE is estimated to cost the NHS £3.37 million each year. The estimated threshold royalty fee is £2.18 and £8.83 for Scenarios 1 and 2 respectively. At a £2.00 royalty fee, mass NIPD testing would produce no saving for Scenario 1 and £507,154 per annum for Scenario 2. Incremental cost-effectiveness analysis indicates that, at a test sensitivity of 99.7% and this royalty fee, NIPD testing in Scenario 2 will generate one additional sensitisation for every £9,190 saved. If a single-dose prophylaxis policy were implemented nationally, as recently recommended by NICE, Scenario 2 savings would fall. Conclusions Currently, NIPD testing to target anti-D prophylaxis is unlikely to be sufficiently cost-effective to warrant its large scale

  6. Is compassion possible in a market-led NHS?

    PubMed

    Flynn, Maria; Mercer, Dave

    The principle of compassionate care is increasingly seen as the core element of good nursing practice. However, recent media reports have focused on the "compassion deficit". We carried out a review of national and international evidence on core professional values, which showed that caring and compassion are inherent nursing values. While the development of these values is influenced by training and role modelling, the main influence is the organisation and culture in which nurses work. This article discusses the findings of the review in relation to the national debate around compassionate care within an NHS that is being fundamentally changed. We suggest any failure in compassion is more likely to be due to government health policy and NHS organisational culture than to any shortcomings of nurses or nursing practice. PMID:23513933

  7. Complications of facial fillers: resource implications for NHS hospitals

    PubMed Central

    Hachach-Haram, Nadine; Gregori, Marco; Kirkpatrick, Niall; Young, Richard; Collier, Jonathan

    2013-01-01

    Facial rejuvenation seeks to reverse the negative sequelae of multiple factors but most importantly of genetic predisposition, sun damage and smoking. With the advent of the so-called ‘non-surgical’ techniques, and perhaps fuelled by these austere times, volumetric facial augmentation using dermal fillers has soared in popularity among both patients and practitioners. However, legislation has yet to keep pace with the change in clinical practices leaving patients poorly informed and with no protection against unscrupulous suppliers and unregulated practitioners. When things go wrong, patients often turn to the National Health Service (NHS) to rectify both the acute and chronic sequelae resulting in potentially difficult ethical and resource implications. Here, we report one of an increasing number of cases presenting to our NHS craniofacial service with acute filler-related complications. PMID:23362071

  8. Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

    PubMed

    Crawford, Louise

    2016-02-01

    This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested. PMID:26806451

  9. Healthcare Assistants: distributional losses as a consequence of NHS modernisation?

    PubMed Central

    Clark, Ian; Thompson, Amanda

    2015-01-01

    This paper examines the labour process of Healthcare Assistants (HCAs) at a National Health Service (NHS) hospital trust (TUH) in the context of the NHS modernisation agenda. It determines whether application of the modernisation agenda is formalised at TUH and considers how HCAs are affected. The paper is based upon 60 interviews with HCAs, structured questionnaires completed by all interview respondents, observation of HCAs and interviews with non‐clinical managers. The findings show that elements of the modernisation agenda are informally implemented at TUH to the detriment of HCAs. HCAs experience distributional losses in the form of intensification as nurses deflect duties to HCAs and insulate themselves from adverse effects. HCAs resist, using selective absence when pressures mount. They ameliorate losses by re‐internalising their work as a job with caring elements not a genuine caring role. They rationalise their altered behaviour towards patients by blaming the regime's treatment of them as a subordinated group. PMID:27570359

  10. Hypnobirth within the NHS: time to ditch the parent craft?

    PubMed

    Gavin-Jones, Teri

    2016-05-01

    Antenatal education within the National Health Service (NHS) is a service in decline within some hospital trusts. Classes on offer are being moved into online formats or discontinued completely. Whilst research into antenatal education remains limited, what is known is that good birth preparation is of value. "Participative preparation for childbirth can enhance women's overall satisfaction with the childbirth experience" (Schrader McMillan et al 2009: 49). There are pockets of excellent antenatal education within the NHS, but no system for regulating the quality and content. Traditional 'parent craft' classes can be oversubscribed, turning what should be a participative group into an audience. Offering good quality antenatal education has the potential to increase normality, improve the birth outcome and the experience of both woman and her birth partner. Is it time to ditch the parent craft and implement dynamic woman-focused education? PMID:27295754

  11. Is follow-up capacity the current NHS bottleneck?

    PubMed

    Allder, Steven; Walley, Paul; Silvester, Kate

    2011-02-01

    Capacity and demand theory suggests that the presence of a queue is not necessarily an indication of a shortage of capacity in a system. It is much more likely that either there is a demand and capacity variation that creates queues or there is a delay designed into the system. A shortage of capacity is only really indicated where a backlog is not stable and continues to grow. In this article, data are taken from one NHS trust that provides evidence for a continually growing backlog for follow-up outpatient services. It is believed that these data are representative of most locations within the NHS in England and therefore suggest an immediate shortage in effective follow-up capacity. To avoid compromise to patient care, the problem will have to be addressed before the situation becomes unmanageable. The paper highlights options to reduce or deflect demand or to increase effective capacity. PMID:21404781

  12. What have NHS managers ever done for us?

    PubMed Central

    2010-01-01

    The image of the UK National Health Service manager has not always been positive. Like others in the public sector, NHS managers are sometimes associated in the media with waste and inefficiency, in contrast to those in ‘front line roles’. Thus healthcare professionals and members of the public might ask, in the tradition of Monty Python's Life of Brian, what NHS managers have ever done for us. In this short article, we outline some of the evidence from the literature on attitudes to, and role of, healthcare managers, before drawing on our own interview and observation based fieldwork with managers themselves. We argue that the role of the healthcare manager is not always well understood, and that in a sector facing ever more intense and large scale organisational challenges, managers should be seen as important partners in a health service focused on clinical outcomes. PMID:25949629

  13. Influenza vaccination for NHS staff: attitudes and uptake

    PubMed Central

    Shrikrishna, Dinesh; Williams, Siân; Restrick, Louise

    2015-01-01

    Objectives Annual vaccination against influenza (flu) is recommended for all UK National Health Service (NHS) staff to help reduce the risk of contracting the virus and transmitting it to patients. However, despite flu campaigns and vaccination promotion, uptake remains low. The aim of this study was to investigate staff attitudes to flu vaccination to see how this may influence their decision to be vaccinated. Methods An online survey was sent to staff members across 6 NHS trusts, asking if staff had been vaccinated in the preceding flu season (2013–2014); the survey included questions about beliefs and attitudes to the vaccination, scored on a 5-point Likert scale. Results 3059 NHS staff members responded to the survey (86% in the 26–59 age group, 77% female and 84% hospital based). 68% of respondents reported being vaccinated in the preceding year. Using a stepwise regression model, the survey response retained as a positive predictor of having been vaccinated was ‘people working in healthcare should have the flu vaccination every year’ (p<0.001), and the responses retained as negative predictors were ‘the flu vaccination will make me unwell’ (p<0.001) and ‘the flu vaccination was too much trouble for me’ (p<0.001). Analysis by staff group showed a significant difference in the response to ‘the flu vaccination will make me unwell’ between groups (p=0.01), with doctors having a greater tendency to disagree with this statement than other staff members. Conclusions These results suggest that addressing NHS staff beliefs around the need for vaccination, while ensuring that practical barriers to having the vaccination are removed, may help to increase uptake. An emphasis on alleviating the concerns of particular staff groups regarding adverse effects of the vaccine may also be of benefit in improving uptake, to protect patients as well as staff. PMID:26019875

  14. An analysis of catering options within NHS acute hospitals.

    PubMed

    Hwang, J L; Desombre, T; Eves, A; Kipps, M

    1999-01-01

    Reforms of the NHS's healthcare structure have placed additional pressure on all aspects of hospital management. Evaluation of the effects of these reforms is difficult without more information on current conditions. Hospital catering in acute care trusts has little contemporary background research available. With this in mind, a survey of all the acute care NHS trusts within the eight regions in England was undertaken to investigate the hospital meal service process. A mailed questionnaire asked for the meal production system, food service method and food delivery personnel used by each trust, and a copy of a weekly menu. Results, from an 80.7 per cent response rate, indicate that most trusts use batch cooking to prepare their meals, and plated meal service to deliver the food to the wards. Almost 75 per cent of the trusts use nurses, at least in part, to serve food. English foodstuffs dominate the menus. Most of the trusts have moved towards meeting the goals set by the Patients' Charter and other NHS recommendations. PMID:10724573

  15. Cancer incidence in England and Wales and New Zealand and in migrants between the two countries.

    PubMed Central

    Swerdlow, A. J.; Cooke, K. R.; Skegg, D. C.; Wilkinson, J.

    1995-01-01

    Risks of cancer incidence in people born in England and Wales and New Zealand (non-Maoris) living in their home countries, and after migration between the two countries, were analysed using data from their national cancer registries. Since these populations are of similar genetic origin, any real differences in cancer incidence between them are likely to reflect the action of environmental or behavioural risk factors. The greatest differences in risk between the countries were for cutaneous melanoma and lip cancer. In each sex, relative risks of these malignancies were 4 or greater for the New Zealand-born in New Zealand compared with English and Welsh natives in their home country, and risks for migrants in each direction were generally intermediate between those born in the home country in the two countries. Sizeable significantly raised risks in the New Zealand-born in New Zealand compared with English and Welsh natives in England and Wales also occurred for cancers of the mouth, small intestine, colon, thymus, eye and thyroid, and non-Hodgkin's lymphoma in each sex, and for cancer of the prostate. For all of these sites except mouth, small intestine and colon there were also risks around or above New Zealand-born levels for English and Welsh migrants to New Zealand; for colon cancer these migrants had risks close to those in England and Wales. New Zealand migrants to England and Wales had risks of cancers of the colon and prostate that were similar to or above New Zealand levels. Risks of cancers of the stomach, lung, pleura and bladder, and Hodgkin's disease in each sex, and cancers of the cervix, ovary and scrotum and penis, were substantially and significantly lower in the New Zealand-born living in New Zealand than in English and Welsh natives in England and Wales. In English and Welsh migrants to New Zealand risks of bladder cancer in each sex, and of scrotal and penile and pleural cancer in males, approximated to England and Wales risks; cervical cancer

  16. Re-organisation of oesophago-gastric cancer services in England and Wales: a follow-up assessment of progress and remaining challenges

    PubMed Central

    2014-01-01

    Background This study is an update on an earlier article in 2007 to assess the implementation of the Cancer Plan reform strategy in England and Wales. Findings A national online survey to upper gastro-intestinal leads at network and trust level. The questionnaire was designed based on existing clinical practice guidelines and addressed governing principles and operational procedures related to the delivery of cancer care. It was sent in January 2012 to upper gastro-intestinal network and trusts leads at all cancer networks and acute NHS organisations in England and Wales. Responses were received from 100% of Cancer Networks and 91% of NHS organisations. Centralisation of surgery has improved with all but two trusts (5.4%) now meeting the minimum staffing level for oesophago-gastric cancer surgery. This is a substantial improvement since the 2007 survey when 21 trusts (46.7%) did not meet this requirement. The use of formal assessment for nutritional needs has improved, too. In 2007, the involvement of the palliative care team in multi-disciplinary teams was poor. While this has improved, 27 trusts (19.7%) still report that none of the palliative care team members routinely attend the multi-disciplinary team discussion. Conclusions The survey demonstrates improved compliance with organisational recommendations since the last assessment in 2007. Centralisation of surgery has improved and is nearly fully compliant with the reform strategy. Areas that require further improvement are nutritional support and inclusion of palliative care in multi-disciplinary team meetings. PMID:24406032

  17. Orientations of linear stone arrangements in New South Wales

    NASA Astrophysics Data System (ADS)

    Hamacher, Duane W.; Fuller, Robert S.; Norris, Ray P.

    2012-12-01

    We test the hypothesis that Aboriginal linear stone arrangements in New South Wales (NSW) are oriented to cardinal directions. We accomplish this by measuring the azimuths of stone arrangements described in site cards from the NSW Aboriginal Heritage Information Management System. We then survey a subset of these sites to test the accuracy of information recorded on the site cards. We find a preference recorded in the site cards for cardinal orientations among azimuths. The field surveys show that the site cards are reasonably accurate, but the surveyors probably did not correct for magnetic declinations. Using Monte Carlo statistics, we show that these preferred orientations did not occur by chance and that Aboriginal people deliberately aligned these arrangements to the approximate cardinal directions. We briefly explore possible reasons for these preferred orientations and highlight the need for future work.

  18. Making the economic case for prevention – a view from Wales

    PubMed Central

    2012-01-01

    Background It is widely acknowledged that adverse lifestyle behaviours in the population now will place an unsustainable burden on health service resources in the future. It has been estimated that the combined cost to the NHS in Wales of overweight and obesity, alcohol and tobacco is in excess of £540 million. In the current climate of financial austerity, there can be a tendency for the case for prevention efforts to be judged on the basis of their scope for cost savings. This paper was prompted by discussion in Wales about the evidence for the cost savings from prevention and early intervention and a resulting concern that these programmes were thus being evaluated in policy terms using an incorrect metric. Following a review of the literature, this paper contributes to the discussion of the potential role that economics can play in informing decisions in this area. Discussion This paper argues that whilst studies of the economic burden of diseases provide information about the magnitude of the problem faced, they should not be used as a means of priority setting. Similarly, studies discussing the likelihood of savings as a result of prevention programmes may be distorting the arguments for public health. Prevention spend needs to be considered purposefully, resulting in a strategic commitment to spending. The role of economics in this process is to provide evidence demonstrating that information and support can be provided cost effectively to individuals to change their lifestyles thus avoiding lifestyle related morbidity and mortality. There is growing evidence that prevention programmes represent value for money using the currently accepted techniques and decision making metrics such as those advocated by NICE. Summary The issue here is not one of arguing that the economic evaluation of prevention and early intervention should be treated differently, although in some instances that may be appropriate, rather it is about making the case for these

  19. Slow Poisoning? Interests, Emotions, and the Strength of the English NHS

    PubMed Central

    Greer, Scott L.

    2015-01-01

    Martin Powell makes the point that the death of the National Health Service (NHS) is constantly asserted without criteria. This article suggests that the NHS is many things, which makes criteria unstable. The alignment of interests in the structure of the NHS enables both overheated rhetoric and political strength, and that pluralization of provision might actually undermine that alignment over time10.15171/ijhpm.2015.72 PMID:26673183

  20. A co-productive health leadership model to support the liberation of the NHS.

    PubMed

    Nicol, Edward; Sang, Bob

    2011-02-01

    Following the recent white paper - Equity and Excellence: Liberating the NHS - we need a 21st-century model of leadership in the NHS that re-focuses on the centrality of the relationship between clinicians and patients. This paper argues the case for co-productive 'Health Leadership' that can meet the challenges set by the current Big Society agenda, Darzi and Wanless, so that we achieve a sustainable, high quality NHS, fit for the 21st century. PMID:21282796

  1. Wasting your assets--how to make better use of the NHS estate.

    PubMed

    Locke, J

    1994-05-01

    The impact of the health reforms together with other developments will mean that the 24 billion pounds NHS estate will undergo the most fundamental change since the days of Florence Nightingale. Against this background it is more important than ever that the utilisation of the estate is improved and that the NHS learns how to make the best use of private sector investment, says John Locke, Chief Executive of NHS Estates. PMID:10134705

  2. NHS reforms reduce length of waiting lists but create widespread unease.

    PubMed Central

    Gray, C

    1996-01-01

    Reforms involving the National Health Service (NHS) have greatly reduced the length of waiting lists in the United Kingdom. The key to the reductions was additional funding from the government, the chief executive of the NHS said during a recent visit to Ottawa. Decreasing the size of the waiting lists created intense stress for NHS personnel, who had to work longer hours, and it also lowered demand for private-sector care. PMID:8943941

  3. Illness prevention in the NHS five year forward view.

    PubMed

    Fuller, Sabrina

    2015-06-01

    Illness prevention is a priority for the NHS Mandate and the Five Year Forward View, and offers a means to maintain sustainable health and social care services in the context of an ageing population and the growth of behaviour-related illness. The National Institute for Health and Care Excellence guidance recommends a structured approach to embedding behaviour change interventions into clinical care, and effective implementation requires organisational support. This article describes how nurse leaders, managers and commissioners can ensure this implementation through setting objectives for staff, training and development, as well as supporting staff to adopt healthier lifestyles. PMID:26014792

  4. The rationing agenda in the NHS. Rationing Agenda Group.

    PubMed Central

    New, B.

    1996-01-01

    The Rationing Agenda Group has been founded to deepen the British debate on rationing health care. It believes that rationing in health care is inevitable and that the public must be involved in the debate about issues relating to rationing. The group comprises people from all parts of health care, none of whom represent either their group or their institutions. RAG has begun by producing this document, which attempts to set an agenda of all the issues that need to be considered when debating the rationing of health care. We hope for responses to the document. The next stage will be to incorporate the responses into the agenda. Then RAG will divide the agenda into manageable chunks and commission expert, detailed commentaries. From this material a final paper will be published and used to prompt public debate. This stage should be reached early in 1997. While these papers are being prepared RAG is developing ways to involve the public in the debate and evaluate the whole process. We present as neutrally as possible all the issues related to rationing and priority setting in the NHS. We focus on the NHS for two reasons. Firstly, for those of us resident in the United Kingdom the NHS is the health care system with which we are most familiar and most concerned. Secondly, focusing on one system alone allows more coherent analysis than would be possible if issues in other systems were included as well. Our concern is with the delivery of health care, not its finance, though we discuss the possible effects of changing the financing system of the NHS. Finally, though our position is neutral, we hold two substantive views--namely, that rationing is unavoidable and that there should be more explicit debate about the principles and issues concerned. We consider the issues under four headings: preliminaries, ethics, democracy, and empirical questions. Preliminaries deal with the semantics of rationing, whether rationing is necessary, and with the range of services to which

  5. The rationing agenda in the NHS. Rationing Agenda Group.

    PubMed

    New, B

    1996-06-22

    The Rationing Agenda Group has been founded to deepen the British debate on rationing health care. It believes that rationing in health care is inevitable and that the public must be involved in the debate about issues relating to rationing. The group comprises people from all parts of health care, none of whom represent either their group or their institutions. RAG has begun by producing this document, which attempts to set an agenda of all the issues that need to be considered when debating the rationing of health care. We hope for responses to the document. The next stage will be to incorporate the responses into the agenda. Then RAG will divide the agenda into manageable chunks and commission expert, detailed commentaries. From this material a final paper will be published and used to prompt public debate. This stage should be reached early in 1997. While these papers are being prepared RAG is developing ways to involve the public in the debate and evaluate the whole process. We present as neutrally as possible all the issues related to rationing and priority setting in the NHS. We focus on the NHS for two reasons. Firstly, for those of us resident in the United Kingdom the NHS is the health care system with which we are most familiar and most concerned. Secondly, focusing on one system alone allows more coherent analysis than would be possible if issues in other systems were included as well. Our concern is with the delivery of health care, not its finance, though we discuss the possible effects of changing the financing system of the NHS. Finally, though our position is neutral, we hold two substantive views--namely, that rationing is unavoidable and that there should be more explicit debate about the principles and issues concerned. We consider the issues under four headings: preliminaries, ethics, democracy, and empirical questions. Preliminaries deal with the semantics of rationing, whether rationing is necessary, and with the range of services to which

  6. Maintaining standards of aesthetic practice in trainees subject to NHS restrictions.

    PubMed

    Paterson, P; Allison, K

    2006-01-01

    The Specialist Advisory Committee (SAC) in plastic surgery within the United Kingdom (UK) recommends a modular training programme to include aesthetic surgery. The intercollegiate board examinations test candidates on all aspects of aesthetic practice yet there is no formal, national aesthetic training in the UK. Closure of National Health Service (NHS) private patient facilities has reduced training opportunity [Nicolle FV. Sir Harold Gillies Memorial Lecture; Aesthetic plastic surgery and the future plastic surgeon. Br J Plast Surg 1998;51:419-24.] Calmanisation [Hospital doctors: training for the future. The Report of the Working Group on Specialist Medical Training (The Calman Report). London: HMSO; 1993.], the European Working Time Directive (EWTD) [; Phillips H, Fleet Z, Bowman K. The European Working time Directive-interim report and guidance from The Royal College of Surgeons of England working party chaired by Mr Hugh Phillips; 2003 []; Chesser S, Bowman K, Phillips H. The European Working Time Directive and the training of surgeons. BMJ Careers Focus 2002;s69-7.], and more importantly the implementation of "local" aesthetic guidelines have placed further pressures on training. Reductions of NHS case mix will ultimately lead to a reduction in trainee experience. With increasing regulatory pressure from the Commission for Healthcare Improvement, standards of aesthetic practice can only be maintained by increasing private/independent sector involvement. At present a disparity exists between the demand and provision of aesthetic surgery training in the UK. Aesthetic surgery forms part of the training curriculum for plastic surgery and as such remains a training issue. A review of aesthetic surgery training is needed in the UK through consultation with trainers and trainee representatives. PMID:16876084

  7. Feedback from reporting patient safety incidents--are NHS trusts learning lessons?

    PubMed

    Wallace, Louise

    2010-01-01

    For the study, first published in 2006, the researchers examined how well NHS organisations had attempted to use the information they gathered from adverse clinical incidents and whether they were learning from it. By looking at existing relevant research worldwide, interviewing experts, surveying NHS organizations (acute, community and ambulance), consulting health care and other high-risk industry safety experts and NHS risk managers, and investigating case studies of good practice, they developed a model to assess how ready NHS systems were to learn from incidents. This is known as Safety Action and Information Feedback from Incident Reporting (SAIFIR). PMID:20075136

  8. Organizational Failure in an NHS Hospital Trust: A Qualitative Study.

    PubMed

    Ravaghi, Hamid; Mannion, Russell; Sajadi, Haniye Sadat

    2015-01-01

    The objective was to explore the key factors associated with organizational failure in an NHS Hospital Trust. This case study adopted a qualitative design. Fifty-seven semistructured interviews and document analyses were conducted as well. Data were analyzed using a framework analysis method. A range of symptoms of organizational performance failure was identified. These relate to a financial deficit, lack of good external relationships, inability to meet core targets, a lack of clear management systems, and low staff morale. These markers had not been taken seriously by the previous senior management team. Symptoms of failure were the reflection of presence of secondary and primary causes of failure. Poor managerial leadership, poor financial control and performance management, lack of open culture, distraction by 2 large projects, and the lack of clinician engagement were perceived as internal causes of failure and the high level of policy changes within the NHS as the key external cause. The level of deprivation in the area was also thought to have had a negative impact on performance. The findings reinforce and expand on those of recent studies across the public sector. Tracking an organization's performance and early diagnosis of performance problems, focusing on performance management systems, and taking into account contextual factors are issues that should be considered. PMID:26506299

  9. NHS dental professionals' evaluation of a child protection learning resource.

    PubMed

    Harris, J C; Bradbury, J; Porritt, J; Nilchian, F; Franklin, C D

    2011-01-22

    The aim of this survey was to evaluate the impact of an educational child protection resource which had been developed and made available, free of charge, to all NHS dental practices and salaried primary dental care services in England and concurrently published online. A postal questionnaire was sent to a random sample of 1000 NHS dental practices to assess whether the learning objectives of the educational resource had been met. A total of 467 questionnaires were completed (46.7% response rate). Almost two thirds of participants (63.4%) remembered receiving the Child Protection and Dental Team (CPDT) handbook or seeing the website and almost all of them had used (looked at or read) it and felt able to access it if needed. Of the 265 users, 76.2% felt it had improved their knowledge of child protection, 60.5% had adopted a child protection policy, 53.7% had identified a child protection lead and 25.8% had arranged further training as a result of using the educational resource. The findings from the evaluation indicated that the learning objectives of the CPDT educational resource had been met and highlighted ways in which the resource could be further improved to effectively meet the needs of dental professionals. PMID:21252889

  10. Causes for concern: is NICE failing to uphold its responsibilities to all NHS patients?

    PubMed

    Claxton, Karl; Sculpher, Mark; Palmer, Stephen; Culyer, Anthony J

    2015-01-01

    Organisations across diverse health care systems making decisions about the funding of new medical technologies face extensive stakeholder and political pressures. As a consequence, there is quite understandable pressure to take account of other attributes of benefit and to fund technologies, even when the opportunity costs are likely exceed the benefits they offer. Recent evidence suggests that NICE technology appraisal is already approving drugs where more health is likely to be lost than gained. Also, NICE recently proposed increasing the upper bound of the cost-effectiveness threshold to reflect other attributes of benefit but without a proper assessment of the type of benefits that are expected to be displaced. It appears that NICE has taken a direction of travel, which means that more harm than good is being, and will continue to be, done, but it is unidentified NHS patients who bear the real opportunity costs. PMID:25488707

  11. General surgical workload in England and Wales.

    PubMed Central

    Allen-Mersh, T G; Earlam, R J

    1983-01-01

    An attempt was made to measure the workload of a typical general surgical firm (two part time consultants and their junior staff) serving a population of 100 000 in England and Wales. This provides a background against which to plan curricula for undergraduate and postgraduate teaching, as well as being a guide to the experience that a surgical trainee should get in a suitable training post. The effect of changes in surgical staffing on the number of operations done by a surgeon may also be estimated. PMID:6414594

  12. New Labour, Education and Wales: The Devolution Decade

    ERIC Educational Resources Information Center

    Reynolds, David

    2008-01-01

    An account is given of the development of a distinctive set of education policies in Wales after devolution of power in 1999. In contrast to policies in England that emphasised consumer choice concerning accountability, and central state "support" of the profession, Wales chose a more "producerist" paradigm that emphasised collaboration between…

  13. Workplace bullying in NHS community trust: staff questionnaire survey

    PubMed Central

    Quine, Lyn

    1999-01-01

    Objectives To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying. Design Questionnaire survey. Setting NHS community trust in the south east of England. Subjects Trust employees. Main outcome measures Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job satisfaction scale, the support at work scale, and the propensity to leave scale. Results 1100 employees returned questionnaires—a response rate of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the victims of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2.7) v 12.2 (2.3), P<0.001) and higher levels of job induced stress (mean 22.5 (SD 6.1) v 16.9 (5.8), P<0.001), depression (8% (33) v 1% (7), P<0.001), anxiety (30% (125) v 9% (60), P<0.001), and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P<0.001). Support at work seemed to protect people from some of the damaging effects of bullying. Conclusions Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff. Key messages38% of staff in a community NHS trust reported being subjected to bullying behaviours in the workplace in the previous year and 42% had witnessed the bullying of othersStaff who had been bullied had lower levels of job satisfaction and higher levels of job induced stress, depression, anxiety, and intention to leaveSupport at work

  14. Trade unions and local bargaining in the NHS.

    PubMed

    Corby, S; Blundell, B

    1997-01-01

    Examines some effects of NHS Trusts moving away at varying speeds from complex national arrangements for determining terms and conditions towards local bargaining. Notes that while there has been some research into the extent and nature of this decentralization, the impact on trade unions has largely been ignored. This research suggests that, far from marginalizing stewards, senior managers have involved them in joint discussions. Although there has not been a renewal of local trade unionism, there has not been a decline, as membership has held up. Moreover, stewards have coped remarkably well with their enhanced roles, even though faced with the increasing and conflicting demands of their work and their union duties, compounded by problems in obtaining time off work because of lack of cover. PMID:10167874

  15. Options for change in the NHS consultant contract.

    PubMed Central

    Clarke, R. W.; Gray, C.

    1994-01-01

    The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers. PMID:8086915

  16. Controlling healthcare-associated infections in the NHS.

    PubMed

    Duerden, Brian

    2008-04-01

    The prevention and control of healthcare-associated infection (HCAI) is a priority for the NHS. The delivery of national targets for reducing methicillin resistant Staphylococcus aureus bacteraemias and Clostridium difficile infection are supported by enhanced mandatory surveillance through the Health Protection Agency and a Department of Health improvement programme that promotes policies and protocols for enhancing clinical procedures and places infection prevention and control at the centre of clinical and corporate governance. The Health Act 2006 Code of Practice makes such policies and protocols a legal requirement and compliance will be assessed by the Healthcare Commission. Clinicians must recognise their responsibilities for patient safety and take a lead role in ensuring good practice to reduce HCAI. PMID:18478854

  17. Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers

    PubMed Central

    Nikolentzos, Athanasios; Kontodimopoulos, Nick; Polyzos, Nikolaos; Thireos, Eleftherios; Tountas, Yannis

    2015-01-01

    The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for “reshuffling” clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy. PMID:26156925

  18. The mutuality metaphor: understanding healthcare provision in NHS Scotland.

    PubMed

    Howieson, Brian

    2016-06-20

    Purpose - Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated. Design/methodology/approach - The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered. Findings - It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland. Research limitations/implications - The existence of paradox and ambiguity does not, however, negate the usefulness of the term "mutuality". Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated. Practical implications - There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help. Originality/value - Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding. PMID:27296885

  19. Cancer incidence in migrants to New South Wales from England, Wales, Scotland and Ireland.

    PubMed Central

    McCredie, M.; Coates, M. S.; Ford, J. M.

    1990-01-01

    Cancer incidence in migrants to New South Wales (NSW) from individual countries within the British Isles has been compared with that in the Australian-born population using data from the NSW Central Cancer Registry for the period 1972-84. Indirectly age-standardised incidence ratios (SIR) showed that, for cancer at all sites combined, Scottish migrants had a significantly higher, and English migrants a lower, incidence than the native-born Australians. Melanoma of skin was less common in migrants from all four countries while lung cancer was more common. In all except the Irish migrants, stomach cancer was more frequent than in the Australian-born. Raised SIRs for bladder cancer were found in men from all the countries and for breast cancer in all except the Irish women but only in the English migrants were these ratios significant. English migrants differed from those from Wales, Scotland and Ireland in that, compared with the Australian-born, they had significantly lower SIRs for cancer of the colon (both sexes), head and neck, larynx and prostate (men), gallbladder and kidney (women), and a higher SIR for ovarian cancer. Bone cancer was relatively more common in men born in Wales. 'Other genital' cancers (penis and scrotum; vulva and vagina) tended to be more frequent in migrants from each country than in the Australian-born. PMID:2257232

  20. Lessons from 2012: What the NHS Can Learn from Britain's Olympic Success.

    PubMed

    Maile, Edward J; Blake, Alastair M

    2013-01-01

    The 2012 London Olympic and Paralympic Games were widely regarded as an organisational and sporting success for the United Kingdom. Therefore, it is prudent to consider what other large, public endeavours might learn from the Games' success. Team GB worked to develop a positive team culture based around shared values. This is something the National Health Service (NHS) could learn from, as an organisation which can appear to lack this culture. The NHS should also work harder to adopt evidence-based practices, and to adopt them quickly, as is often the case in sport. Sport is the ultimate example of transparent results reporting, and the NHS ought to consider systematic reporting of risk-adjusted performance data, which may drive improved performance. The NHS should pay attention to the experiences of successful Olympic sports with centralised centres of excellence, and to medical data which suggests that better outcomes result from centres of excellence. The NHS and wider government should look to Olympic athletes and place more emphasis on prevention of disease by encouraging positive lifestyle choices. Finally, the NHS should develop private sector partnerships carefully. We must look to gather knowledge and ideas from every area of life in pursuit of excellence in the NHS. Experience of the Olympics offers a number of instructive lessons. PMID:25737779

  1. Disease surveillance in England and Wales.

    PubMed

    2016-01-01

    This issue of Veterinary Record introduces a new look for the monthly disease surveillance report for England and Wales from the APHA. The format and content has been changed to provide a report that brings together data and information from different sources of government-funded and other veterinary scanning surveillance activity. This first report in the new format considers current issues, such as actions to prevent porcine epidemic diarrhea and what to do if it is suspected, and provides an update on international disease threats, such as bluetongue and avian influenza. It also discusses the seasonal impact of porcine reproductive and respiratory syndrome virus in pig herds, and guidance for laboratory investigation of ovine abortion/stillbirths. Highlights from the scanning surveillance network for November/December 2015 are reported and, on p 43, a separate article describes the work of the Veterinary Risk Group. PMID:26744008

  2. Clinical audit of core podiatry treatment in the NHS

    PubMed Central

    Farndon, Lisa; Barnes, Andrew; Littlewood, Keith; Harle, Justine; Beecroft, Craig; Burnside, Jaclyn; Wheeler, Tracey; Morris, Selwyn; Walters, Stephen J

    2009-01-01

    Background Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. Methods The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. Results 1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P < 0.001, though the confidence interval indicated that the improvement was relatively small. Conclusion Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the

  3. RCN wales reveals its first nursing education strategy.

    PubMed

    2016-03-23

    RCN Wales has published its first nursing education strategy to equip nurses with the skills and competencies required to work with increasingly complex patients in a variety of settings. PMID:27008115

  4. Topological anisotropy of stone-wales waves in graphenic fragments.

    PubMed

    Ori, Ottorino; Cataldo, Franco; Putz, Mihai V

    2011-01-01

    Stone-Wales operators interchange four adjacent hexagons with two pentagon-heptagon 5|7 pairs that, graphically, may be iteratively propagated in the graphene layer, originating a new interesting structural defect called here Stone-Wales wave. By minimization, the Wiener index topological invariant evidences a marked anisotropy of the Stone-Wales defects that, topologically, are in fact preferably generated and propagated along the diagonal of the graphenic fragments, including carbon nanotubes and graphene nanoribbons. This peculiar edge-effect is shown in this paper having a predominant topological origin, leaving to future experimental investigations the task of verifying the occurrence in nature of wave-like defects similar to the ones proposed here. Graph-theoretical tools used in this paper for the generation and the propagation of the Stone-Wales defects waves are applicable to investigate isomeric modifications of chemical structures with various dimensionality like fullerenes, nanotubes, graphenic layers, schwarzites, zeolites. PMID:22174641

  5. 'The Sister' in the early days of the NHS.

    PubMed

    Ellis, Harold

    2016-04-01

    All the readers of this journal will have read and heard about the ward and operating theatre sisters in 'the old days'. What were they really like, and what was it like to work with them in the hospitals of those far-off times? I entered the old Radcliffe Infirmary Oxford in the summer of 1945, just as World War II was drawing to a close, as a 19 year old student to start my clinical training. I then qualified in July 1948, the very month the NHS came into being, and started my surgical career as house surgeon. The Radcliffe was the only acute hospital in the town and dealt with all emergency admissions. In addition, we worked at the Churchill Hospital, then a hutted hospital, erected during the War to deal with Canadian military casualties and now handed over for civilian use. Elective orthopaedics was carried out at the Wingfield Morris Hospital, later the Nuffield Orthopaedic Centre. The patients here were mostly children with bone and joint tuberculosis or poliomyelitis. The Slade Isolation Hospital dealt with the infectious fevers; I was admitted there twice as a student, with first chicken pox and then measles, both caught from my patients! PMID:27290759

  6. Saving the NHS one blood test at a time

    PubMed Central

    Akhtar, Waqas; Chung, Yooyun

    2014-01-01

    As a team of junior doctors our aim has been to save costs in day to day work so that money can be reallocated to improving nursing staff levels on our wards. Stem cell units have regular blood collection schedules in order to monitor organ response to chemotherapy and to look for complications in immunocompromised patients. We set out to reduce the number of biochemical investigations to a minimum that would be clinically indicated. We designed a new blood collection proforma for nursing staff to follow and audited all blood tests taken during a 2 week period before and after its introduction. The number of inappropriate blood tests were recorded as those that were not clinically indicated or not present on the collection schedule. After the introduction of the change the number of inappropriate tests were reduced by 937 over the 2 week period, with a cost saving of £1,478.42. Similar strategies for reducing unnecessary investigations and focusing on tests that will change management could help the NHS cope with a difficult financial future and provide continued safe staffing levels and quality care. PMID:26734249

  7. Pyrrolizidine alkaloid poisoning of sheep in New South Wales.

    PubMed

    Seaman, J T

    1987-06-01

    Pyrrolizidine alkaloid poisoning of sheep in New South Wales was reviewed, based on the records of the New South Wales Department of Agriculture's Regional Veterinary Laboratories. The plant species causing significant mortalities were Echium plantagineum and Heliotropium europaeum. The syndrome of hepatogenous chronic copper poisoning was more frequently diagnosed than primary pyrrolizidine alkaloid poisoning, particularly when grazing E. plantagineum. The data indicated that adult crossbred ewes were the most commonly affected class of sheep. PMID:3632498

  8. Evaluation of NHS Carbamates as a Potent and Selective Class of Endocannabinoid Hydrolase Inhibitors

    PubMed Central

    2013-01-01

    Monoacylglycerol lipase (MAGL) is a principal metabolic enzyme responsible for hydrolyzing the endogenous cannabinoid (endocannabinoid) 2-arachidonoylglycerol (2-AG). Selective inhibitors of MAGL offer valuable probes to further understand the enzyme’s function in biological systems and may lead to drugs for treating a variety of diseases, including psychiatric disorders, neuroinflammation, and pain. N-Hydroxysuccinimidyl (NHS) carbamates have recently been identified as a promising class of serine hydrolase inhibitors that shows minimal cross-reactivity with other proteins in the proteome. Here, we explore NHS carbamates more broadly and demonstrate their potential as inhibitors of endocannabinoid hydrolases and additional enzymes from the serine hydrolase class. We extensively characterize an NHS carbamate 1a (MJN110) as a potent, selective, and in-vivo-active MAGL inhibitor. Finally, we demonstrate that MJN110 alleviates mechanical allodynia in a rat model of diabetic neuropathy, marking NHS carbamates as a promising class of MAGL inhibitors. PMID:23731016

  9. Can NHS politics, power and conflict ever be a good thing for nurses?

    PubMed

    Lees, Carolyn

    2016-07-14

    This article explores how organisational politics, power and conflict have a positive role to play for nurses in NHS organisational change and improvement, rather than always leading to disagreement and dispute. PMID:27409782

  10. Present dangers and future threats: some perverse incentives in the NHS reforms.

    PubMed Central

    Paton, C.

    1995-01-01

    The NHS reforms have come to mean all things to all men (and women). Identifying a market oriented purchaser-provider split as the conceptual heart of the reforms is still, however, useful. There are important perverse incentives in and around the NHS that are associated with the reforms; furthermore, many reactions to the resulting problems are paradoxical and often counterproductive. Hitherto most criticism of the reforms from the health policy and management community (as opposed to the professions and the public) has been tactical rather than fundamental. There are serious problems for the NHS associated both with the NHS market and with current, often tacit, strategies for the future of the service. Images p1247-a FIGURE 1 PMID:7767197

  11. GIS Applied to Landslide Hazard Mapping and Evaluation in North-East Wales

    NASA Astrophysics Data System (ADS)

    Miller, S. A.; Degg, M.

    2009-04-01

    regression) approach. The resulting models divide the landscape of North-East Wales into areas of ‘low', ‘moderate' and ‘high' landslide susceptibility using calculated probability values. These models indicate that 8% of the surface exposure of drift deposits and 12% of the area of solid geology are classified as being of high or very high susceptibility to slope instability. Validation of the models indicates that they have success rates of up to 80% in predicting the location of known (documented and mapped) landslides. This compares very favourably to models produced elsewhere. The usefulness of the models as a landslide management tool has also been explored by carrying out a landslide impact survey for built-up areas of Holywell and Greenfield Valley in the north of the study area, where there are a number of well defined (‘known') landslides. The landslide impact survey highlights that damage to the built environment extends beyond these known landslides into areas indicated by the models as being of high and very high susceptibility to slope instability. This emphasises the value of GIS techniques, incorporating direct and indirect landslide mapping, in landslide susceptibility modelling and associated landslide management.

  12. Analysis of consultants' NHS and private incomes in England in 2003/4

    PubMed Central

    Morris, Stephen; Elliott, Bob; Ma, Ada; McConnachie, Alex; Rice, Nigel; Skåtun, Diane; Sutton, Matt

    2008-01-01

    Summary Objective Consultants employed by the NHS in England are allowed to undertake private practice to supplement their NHS income. Until the introduction of a new contract from October 2003, those employed on full-time contracts were allowed to earn private incomes no greater than 10% of their NHS income. In this paper we investigate the magnitude and determinants of consultants' NHS and private incomes. Design Quantitative analysis of financial data. Setting A unique, anonymized, non-disclosive dataset derived from tax returns for a sample of 24,407 consultants (92.3% of the total) in England for the financial year 2003/4. Main outcome methods The conditional mean total, NHS and private incomes earned by age group, type of contract, specialty and region of place of work. Results The mean annual total, NHS and private incomes across all consultants in 2003/4 were £110,773, £76,628 and £34,144, respectively. Incomes varied by age, type of contract, specialty and region of place of work. The ratio of mean private to NHS income for consultants employed on a full-time contract was 0.26. The mean private income across specialties ranged from £5,144 (for paediatric neurology) to £142,723 (plastic surgery). There was a positive association between mean private income and NHS waiting lists across specialties. Conclusions Consultants employed on full-time contracts on average exceeded the limits on private income stipulated by the 10% rule. Specialty is a more important determinant of income than the region in which the consultant works. Further work is required to explore the association between mean private income and waiting lists. PMID:18591691

  13. New strategy for NHS procurement Manchester Conference Centre, 17 April 2012.

    PubMed

    Scott, Dawn

    2012-07-01

    Through the QIPP agenda, the NHS is expected to deliver procurement savings of pounds 1.2 bn by 2014/15. The question at the conference was--is that enough? The NHS as a whole is expected to deliver efficiencies of some pounds 20 bn, which implies that, if procurement was to take its fair share, savings of some pounds 3 bn-3.5 bn would be needed. PMID:22919770

  14. A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

    PubMed

    de Viggiani, Nick

    2013-08-01

    Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships. PMID:23910844

  15. Guidance for commissioning NHS England dental conscious sedation services: a framework tool.

    PubMed

    Howlett, Paul

    2014-01-01

    Conscious sedation is an integral part of modern day dental care and should be delivered through a high quality, effective and evidence-based approach. Commissioning of NHS dental services in England is currently under review by NHS England and the National Dental Commissioning Group. This group has identified the management of vulnerable people including anxious patients, as one of its priorities. The Society for the Advancement of Anaesthesia in Dentistry (SAAD) believes this provides an opportunity to influence the commissioning of NHS conscious sedation services. With this aim in mind,"Guidance for Commissioning NHS England Dental Conscious Sedation Services: A Framework Tool" was developed. This guidance proposes a common approach to the organisation of NHS dental conscious sedation services in England, advocating the provision of Tier 1 and Tier 2 services in all regions. Its ethos is a"hub and spoke" model of service delivery with patient assessment delivered by experienced and well trained dental sedationists at its core. In line with the recent Francis Report fundamental standards for all aspects of dental conscious sedation practice are outlined, supported by a robust and predictable quality assurance process. This work has been shared with key stakeholders in NHS England including the Chief Dental Officer and the Head of Primary Care Commissioning. PMID:24624524

  16. Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

    PubMed Central

    Narayanan, V.; Dickinson, A.; Victor, C.; Griffiths, C.; Humphrey, D.

    2016-01-01

    Objectives There is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. Methods All NHS mental health trusts in England (n = 56) and healthcare boards in Wales (n = 6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. Results Falls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. Conclusions Falls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health

  17. Juridification, medicalisation, and the impact of EU Law: patient mobility and the allocation of scarce NHS resources.

    PubMed

    Veitch, Kenneth

    2012-01-01

    This article explores the relationship between EU Law and the allocation of scarce NHS resources in the context of the EU's objective of facilitating access to health care for patients within the EU. Focusing on the Watts case and the recently adopted EU Patients' Rights Directive, the article addresses the political and economic aspects of the implications of EU Law for, inter alia, domestic law, medicine, and the NHS. It does so through developing an analytical framework comprising the notions of juridification and medicalisation. Those notions, which are drawn here from the work of Jürgen Habermas, Ivan Illich, and Sheila McLean, are not only helpful as means of thinking through the nature of the specific EU laws considered in the article; by virtue of their broader focus on, and critique of, the welfare state, they offer an opportunity to reflect more generally on the implications of these laws for the role of the welfare state and medical and legal professionals in the development of the EU's internal market in health care services. Having undertaken this analysis, the article argues that, in order to capture the developments and implications of EU Law on patient mobility, it is necessary to update and partially reformulate the notions of medicalisation and juridification. PMID:22535326

  18. Sending NHS Patients for Operations Abroad: Is the Holiday Over?

    PubMed Central

    Hanna, Sammy A; Saksena, Joyti; Legge, Stella; Ware, Howard E

    2009-01-01

    INTRODUCTION The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, and trusts could reach UK Government targets and avoid breaches. At our hospital, a significant number of patients, who had undergone a total joint replacement abroad, were discharged after only one postoperative review and often had very little physiotherapy. A few presented to our clinic with more serious problems. PATIENTS AND METHODS This is a retrospective review of two matched groups of patients (22 each), all of whom underwent a total knee replacement in 2003. The first group (abroad, Belgium) included 10 males and 12 females with a mean age of 74.5 years and a mean follow-up of 37 months. The second group (local institution) included 10 males and 12 females with a mean age of 71.4 years and a mean follow-up of 34 months. All patients were evaluated using the Oxford Knee Score (OKS), Knee Society Score (KSS), and SF-12 systems. RESULTS OKS and KSS were similar in the two groups. However, SF-12 figures revealed a statistically significant difference in both the physical (PCS) and mental components (MCS). Belgium group – mean PCS 40, mean MCS 48: local group – mean PCS 47, mean MCS 57; P < 0.05. CONCLUSIONS The results demonstrate that, although the majority of patients operated upon abroad got comparable functional results to patients operated locally, they often felt dissatisfied with the overall experience of travelling for their operation. Furthermore, the issues of ‘patient ownership’ and long-term follow-up need to be fully addressed in order to safeguard the high standard of care we should offer our patients. PMID:19102820

  19. Smoke Blankets New South Wales, Australia

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Australia's largest city of Sydney was clouded with smoke when more than 70 wildfires raged across the state of New South Wales. These images were captured on the morning of December 30, 2001, by the Multi-angle Imaging SpectroRadiometer (MISR) instrument aboard NASA's Terra spacecraft. The left-hand image is from the instrument's 26-degree forward-viewing camera, and the right-hand image is from the 60-degree forward-viewing camera. The vast extent of smoke from numerous fires is visible, particularly in the more oblique view. Sydney is located just above image center.

    Dubbed the 'black Christmas' fires, the blazes destroyed more than 150 homes and blackened over 5000 square kilometers (about 1.24 million acres) of farmland and wilderness between December 23, 2001 and January 3, 2002. Many of the fires are believed to have been caused by arsonists, with only one fire linked to natural causes. The fires were aggravated by gusty winds and hot dry weather conditions. Approximately 20,000 people have worked to contain the blazes. No people have lost their lives or been seriously injured. Nevertheless, the fires are considered to be the most prolonged and destructive of any in Australia since the Ash Wednesday conflagration of 1983 that claimed 72 lives.

    The images represent an area 322 kilometers x 374 kilometers and were captured during Terra orbit 10829.

  20. The diarrhoeal diseases in England and Wales

    PubMed Central

    Taylor, Joan

    1960-01-01

    The diarrhoeal diseases are now a minor cause of death in England and Wales, although they remain a major cause of acute illness in children and of absenteeism among adults. Since the Second World War there has been a general rise in the annual number of Salmonella infections, with, however, a drop in the years 1956 and 1957. Infection with Shigella sonnei—the only member of the dysentery group which causes disease at all commonly in England and Wales—has shown a steady increase. Escherichia coli infection has fallen considerably but continues to be a common cause of infantile diarrhoea. A number of environmental factors are discussed in connexion with these three main agents of diarrhoeal disease; and in a consideration of sources of infection the author suggests that while cases of clinical illness are the most important source of illness due to Sh. sonnei and E. coli, human foods, animal feeding stuffs and fertilizers are also responsible for much infection with the salmonellae. The different serotypes or Salmonella and E. coli are reviewed in relation to the epidemiology of the diseases they give rise to. PMID:13775612

  1. Flood Forecasting in Wales: Challenges and Solutions

    NASA Astrophysics Data System (ADS)

    How, Andrew; Williams, Christopher

    2015-04-01

    With steep, fast-responding river catchments, exposed coastal reaches with large tidal ranges and large population densities in some of the most at-risk areas; flood forecasting in Wales presents many varied challenges. Utilising advances in computing power and learning from best practice within the United Kingdom and abroad have seen significant improvements in recent years - however, many challenges still remain. Developments in computing and increased processing power comes with a significant price tag; greater numbers of data sources and ensemble feeds brings a better understanding of uncertainty but the wealth of data needs careful management to ensure a clear message of risk is disseminated; new modelling techniques utilise better and faster computation, but lack the history of record and experience gained from the continued use of more established forecasting models. As a flood forecasting team we work to develop coastal and fluvial forecasting models, set them up for operational use and manage the duty role that runs the models in real time. An overview of our current operational flood forecasting system will be presented, along with a discussion on some of the solutions we have in place to address the challenges we face. These include: • real-time updating of fluvial models • rainfall forecasting verification • ensemble forecast data • longer range forecast data • contingency models • offshore to nearshore wave transformation • calculation of wave overtopping

  2. Examining the role of Scotland's telephone advice service (NHS 24) for managing health in the community: analysis of routinely collected NHS 24 data

    PubMed Central

    Elliott, Alison M; McAteer, Anne; Heaney, David; Ritchie, Lewis D; Hannaford, Philip C

    2015-01-01

    Objectives To examine the type, duration and outcome of the symptoms and health problems Scotland's nurse-led telephone advice service (NHS 24) is contacted about and explore whether these vary by time of contact and patient characteristics. Design Analysis of routinely collected NHS 24 data. Setting Scotland, UK. Participants Users of NHS 24 during 2011. Main outcome measures Proportion of the type, duration and outcome of the symptoms and health problems NHS 24 is contacted about. Results 82.6% of the calls were made out-of-hours and 17.4% in-hours. Abdominal problems accounted for the largest proportion of calls (12.2%) followed by dental (6.8%) and rash/skin problems (6.0%). There were differences in the type of problems presented in-hours and out-of-hours. Most problems (62.9%) had lasted <24 h before people contacted NHS 24. Out-of-hours calls tended to be for problems of shorter duration. Problems reported out-of-hours most commonly resulted in advice to visit an out-of-hours centre and in-hours advice to contact a general practitioner. Most of the service users were female and from more affluent areas. Use of the service declined with age in those over 35 years. The characteristics of users varied according to when NHS 24 was contacted. The number of calls made by an individual in the year ranged from 1 to 866, although most users (69.2%) made only one call. The type of problem presented varied by age and deprivation, but was broadly similar by gender, rural/urban status and geographic area. Call outcomes also varied by user characteristics. Conclusions This is the first study to examine how the public uses NHS 24. It has identified the patterns of problems which the service must be equipped to deal with. It has also provided important information about who uses the service and when. This information will help future planning and development of the service. PMID:26310396

  3. Creating a patient-led NHS: some ethical and epistemological challenges

    PubMed Central

    2012-01-01

    This article responds to the Coalition government's recent Open Public Services White Paper and to proposals which call for the creation of a ‘patient-led NHS’ which will, wherever possible, seek to give patients direct control over the services they receive, through a greater degree of choice and participation. Its central contention is that affording patients greater influence over the consultation and commissioning processes will require the NHS to accommodate and respond to the beliefs, values and agendas of patients, as well as those of medical professionals and policy makers. Since it cannot be assumed that professionals and patients will share the same beliefs, values and agendas, the creation of a system of patient-led services has the potential to bring disagreement between professionals and patients to a head, particularly within the consultation and commissioning processes. Thus, a set of complex epistemic and ethical challenges accompanies the proposed creation of a ‘patient-led NHS’, greater awareness of which will be necessary for the successful implementation of such reforms. PMID:26265952

  4. Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente

    PubMed Central

    Feachem, Richard G A; Sekhri, Neelam K; White, Karen L

    2002-01-01

    Objective To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California. Methods The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators. Results The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS. Conclusions The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology. What is already known on this topicComparisons of healthcare systems in different countries have to be undertaken with great care but can be instructiveThe overall healthcare system in the United States is more expensive than the NHS and population health outcomes are no betterThe US healthcare system comprises many discrete and unique subsystems, including the health maintenance organisationsWhat this paper addsAn integrated, non-profit health maintenance organisation in California (Kaiser Permanente), with over six million members, costs about the same as the NHS but performs considerably betterKaiser's superior performance is mainly in prompt and appropriate diagnosis and treatmentThese findings challenge the widely held

  5. The Climate Change Consortium of Wales (C3W)

    NASA Astrophysics Data System (ADS)

    Hendry, K. R.; Reis, J.; Hall, I. R.

    2011-12-01

    In response to the complexity and multidisciplinary nature of climate change research, the Climate Change Consortium of Wales (C3W) was formed in 2009 by the Welsh universities of Aberystwyth, Bangor, Cardiff and Swansea. Initially funded by Welsh Government, through the Higher Education Funding Council for Wales, the Countryside Council for Wales and the universities, C3W aims to bring together climate change researchers from a wide range of disciplines to explore scientific and sociological drivers, impacts and implications at local, national and international scale. The specific aims are to i) improve our fundamental understanding of the causes, nature, timing and consequences of climate change on Planet Earth's environment and on humanity, and ii) to reconfigure climate research in Wales as a recognisable centre of excellence on the world stage. In addition to improving the infrastructure for climate change research, we aim to improve communication, networking, collaborative research, and multidisciplinary data assimilation within and between the Welsh universities, and other UK and international institutions. Furthermore, C3W aims to apply its research by actively contributing towards national policy development, business development and formal and informal education activities within and beyond Wales.

  6. Coproduction in commissioning decisions: is there an association with decision satisfaction for commissioners working in the NHS? A cross-sectional survey 2010/2011

    PubMed Central

    Taylor-Phillips, Sian; Clarke, Aileen; Grove, Amy; Swan, Jacky; Parsons, Helen; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry

    2014-01-01

    Objectives To undertake an assessment of the association between coproduction and satisfaction with decisions made for local healthcare communities. Design A coproduction scale was developed and tested to measure individual National Health Service (NHS) commissioners’ satisfaction with commissioning decisions. Setting 11 English Primary Care Trusts in 2010–2011. Participants Staff employed at NHS band 7 or above involved in commissioning decisions in the NHS. 345/440 (78%) of participants completed part of all of the survey. Main outcome measure Reliability and validity of a coproduction scale were assessed using a correlation-based principal component analysis model with direct oblimin rotation. Multilevel modelling was used to predict decision satisfaction. Results The analysis revealed that coproduction consisted of three principal components: productive discussion, information and dealing with uncertainty. Higher decision satisfaction was associated with smaller decisions, more productive discussion, decisions where information was readily available to use and those where decision-making tools were more often used. Conclusions The research indicated that coproduction may be an important factor for satisfaction with decision-making in the commissioning of healthcare services. PMID:24902728

  7. MISR Stereo Imagery of Blue Mountain Fires in New South Wales, Australia

    Atmospheric Science Data Center

    2013-12-17

    article title:  MISR Stereo Imagery of Blue Mountain Fires in New South Wales, Australia     ... October 24, 2013 - MISR Stereo Imagery of Blue Mountain Fires in New South Wales, Australia project:  MISR ...

  8. Current Practice in the Referral of Individuals with Suspected Dementia for Neuroimaging by General Practitioners in Ireland and Wales

    PubMed Central

    Ciblis, Aurelia S.; Butler, Marie-Louise; Quinn, Catherine; Clare, Linda; Bokde, Arun L. W.; Mullins, Paul G.; McNulty, Jonathan P.

    2016-01-01

    Objectives While early diagnosis of dementia is important, the question arises whether general practitioners (GPs) should engage in direct referrals. The current study investigated current referral practices for neuroimaging in dementia, access to imaging modalities and investigated related GP training in Ireland and North Wales. Methods A questionnaire was distributed to GPs in the programme regions which included approximately two thirds of all GPs in the Republic of Ireland and all general practitioners in North Wales. A total of 2,093 questionnaires were issued. Results 48.6% of Irish respondents and 24.3% of Welsh respondents directly referred patients with suspected dementia for neuroimaging. Irish GPs reported greater direct access to neuroimaging than their Welsh counterparts. A very small percentage of Irish and Welsh GPs (4.7% and 10% respectively) had received training in neuroimaging and the majority who referred patients for neuroimaging were not aware of any dementia-specific protocols for referrals (93.1% and 95% respectively). Conclusions The benefits of direct GP access to neuroimaging investigations for dementia have yet to be established. Our findings suggest that current GP speciality training in Ireland and Wales is deficient in dementia-specific and neuroimaging training with the concern being that inadequate training will lead to inadequate referrals. Further training would complement guidelines and provide a greater understanding of the role and appropriateness of neuroimaging techniques in the diagnosis of dementia. PMID:27007435

  9. The NHS and market forces in healthcare: the need for organisational ethics.

    PubMed

    Frith, Lucy

    2013-01-01

    The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. PMID:23087185

  10. New South Wales annual vaccine-preventable disease report, 2013

    PubMed Central

    Rosewell, Alexander; Spokes, Paula

    2015-01-01

    Aim To describe the epidemiology of selected vaccine-preventable diseases in New South Wales, Australia for 2013. Methods Data from the New South Wales Notifiable Conditions Information Management System were analysed by local health district of residence, age, Aboriginality, vaccination status and organism. Risk factor and vaccination status data were collected by public health units. Results Pertussis notification rates in infants were low, and no infant pertussis deaths were reported. Despite a high number of imported measles cases, there was limited secondary transmission. The invasive meningococcal disease notification rate declined, and disease due to serogroup C remained low and stable. Conclusion Vaccine-preventable diseases were relatively well controlled in New South Wales in 2013, with declining or stable notification rates in most diseases compared with the previous year. PMID:26306215

  11. Class, gender and insanity in nineteenth-century Wales.

    PubMed

    Michael, Pamela

    2004-01-01

    This chapter shows how class and gender defined the experiences of patients admitted to the North Wales Lunatic Asylum during the late-nineteenth and early-twentieth centuries. Although not lending support to the notion that the asylum was predominantly an instrument of class and gender oppression, it does illustrate how threats of banishment to the asylum could be utilised to reinforce norms of social behaviour outside the institution in far-flung communities across north Wales. It suggests that lay rather than professional encounters were critical in the social construction of madness and the enforcement of social control. PMID:15005914

  12. Assessment of facilities management process capability: a NHS facilities case study.

    PubMed

    Amaratunga, Dilanthi; Haigh, Richard; Sarshar, Marjan; Baldry, David

    2002-01-01

    Describes a process to assess facilities management (FM) process capabilities: the structured process improvement for construction environments--facilities management (SPICE FM) approach. The SPICE FM framework is a method that FM organizations can use to monitor continuously and subsequently improve their performance. The SPICE FM framework is being tested in a series of case studies to ensure that its outputs are appropriate to the FM sector and of value in the real world. Documents the outcomes of a study undertaken at a facilities directorate of a healthcare NHS trust, in searching its applicability within the NHS. Further describes the study methodology and the key activities undertaken and reviews the key communication and management processes that are in place to support the implementation of the strategic FM objectives within the specific NHS facilities directorate. PMID:12500653

  13. Annual appraisal and liege homage: why the British NHS is fundamentally a feudal organisation.

    PubMed

    Tyler, Len; Evans, Ann

    2003-01-01

    A study of the past can help us understand present-day management structures. Strong parallels can be seen between the present-day British National Health Service (NHS) and English feudal society in the early Middle Ages. Both systems are hierarchical, both show limited mobility between layers in the hierarchies and in both there is a strong element of central control coexisting with significant day-to-day delegation of responsibility. Ceremony plays a key role in relationships, such as through the swearing of liege homage in feudal society and through formal assessment and appraisal in the modern NHS. Although the NHS clearly does not show parallels for every element of feudal society, it is possible to draw practical lessons from the comparison, particularly relating to the ownership of problems, team-working and appraisal. PMID:12683435

  14. International patients within the NHS: a case of public sector entrepreneurialism.

    PubMed

    Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

    2015-01-01

    Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints

  15. The NHS Health Check in England: an evaluation of the first 4 years

    PubMed Central

    Robson, John; Dostal, Isabel; Sheikh, Aziz; Eldridge, Sandra; Madurasinghe, Vichithranie; Griffiths, Chris; Coupland, Carol; Hippisley-Cox, Julia

    2016-01-01

    Objectives To describe implementation of a new national preventive programme to reduce cardiovascular morbidity. Design Observational study over 4 years (April 2009—March 2013). Setting 655 general practices across England from the QResearch database. Participants Eligible adults aged 40–74 years including attendees at a National Health Service (NHS) Health Check. Intervention NHS Health Check: routine structured cardiovascular check with support for behavioural change and in those at highest risk, treatment of risk factors and newly identified comorbidity. Results Of 1.68 million people eligible for an NHS Health Check, 214 295 attended in the period 2009–12. Attendance quadrupled as the programme progressed; 5.8% in 2010 to 30.1% in 2012. Attendance was relatively higher among older people, of whom 19.6% of those eligible at age 60–74 years attended and 9.0% at age 40–59 years. Attendance by population groups at higher cardiovascular disease (CVD) risk, such as the more socially disadvantaged 14.9%, was higher than that of the more affluent 12.3%. Among attendees 7844 new cases of hypertension (38/1000 Checks), 1934 new cases of type 2 diabetes (9/1000 Checks) and 807 new cases of chronic kidney disease (4/1000 Checks) were identified. Of the 27 624 people found to be at high CVD risk (20% or more 10-year risk) when attending an NHS Health Check, 19.3% (5325) were newly prescribed statins and 8.8% (2438) were newly prescribed antihypertensive therapy. Conclusions NHS Health Check coverage was lower than expected but showed year-on-year improvement. Newly identified comorbidities were an important feature of the NHS Health Checks. Statin treatment at national scale for 1 in 5 attendees at highest CVD risk is likely to have contributed to important reductions in their CVD events. PMID:26762161

  16. Myxomatosis in farmland rabbit populations in England and Wales.

    PubMed Central

    Ross, J.; Tittensor, A. M.; Fox, A. P.; Sanders, M. F.

    1989-01-01

    The overall pattern and consequences of myxomatosis in wild rabbit populations were studied at three farmland sites in lowland southern England and upland central Wales between 1971 and 1978. When results from all years were combined, the disease showed a clear two-peaked annual cycle, with a main autumn peak between August and January, and a subsidiary spring peak during February to April. Rabbit fleas, the main vectors of myxomatosis in Britain, were present on full-grown rabbits in sufficient numbers for transmission to occur throughout the year, but the observed seasonal pattern of the disease appeared to be influenced by seasonal mass movements of these fleas. However other factors were also important including the timing and success of the main rabbit breeding season, the proportion of rabbits which had recovered from the disease and the timing and extent of autumn rabbit mortality from other causes. Significantly more males than females, and more adults and immatures than juveniles, were observed to be infected by myxomatosis. Only 25-27% of the total populations were seen to be infected during outbreaks. Using two independent methods of calculation, it was estimated that between 47 and 69% of infected rabbits died from the disease (much lower than the expected 90-95% for fully susceptible rabbits with the partly attenuated virus strains that predominated). Thus it was estimated that 12-19% of the total rabbit populations were known to have died directly or indirectly from myxomatosis. Although the effects of myxomatosis were much less than during the 1950s and 1960s, it continued to be an important mortality factor. It may still have a regulatory effect on rabbit numbers, with autumn/winter peaks of disease reducing the numbers of rabbits present at the start of the breeding season. PMID:2806418

  17. Reducing waste in the NHS: an overview of the literature and challenges for the nursing profession.

    PubMed

    Minogue, Virginia; Wells, Bill

    2016-07-01

    Waste in the NHS is estimated to account for 20% of health expenditure. This article examines the literature on reducing waste, analyses some approaches to waste reduction, and identifies the role that nurses and other health professionals can play in developing a sustainable NHS. For the purposes of the article, and to inform nursing practice, the definition of, and discussion about, waste is broader than that outlined by the Department for Environment, Food and Rural Affairs (Defra) controlled waste regulations, and the Royal College of Nursing classification. It includes clinical waste, waste arising out of clinical practice, service delivery and care, infrastructure, and carbon emissions. PMID:27369724

  18. Some Aspects of School Library Development in England and Wales.

    ERIC Educational Resources Information Center

    Pender, Kevin

    1987-01-01

    A history of school libraries in England and Wales shows progress to be inconsistent, with centers of excellence the exception rather than the rule. Only when high-quality school libraries are clearly linked to effective learning will the teaching profession become firmly committed to the resource center's role in the school. (EM)

  19. Survey of Public Opinions About Schools in New South Wales.

    ERIC Educational Resources Information Center

    Baumgart, Neil; And Others

    A questionnaire survey in New South Wales (Australia) provided the basis for this discussion of the implications of public opinion for future educational policy. The report supports the use of systematic surveys to contribute information to the blend of knowledge, experience, and awareness of future trends policy makers rely on to reach decisions.…

  20. Embracing the UNCRC in Wales (UK): Policy, Pedagogy and Prejudices

    ERIC Educational Resources Information Center

    Lyle, Sue

    2014-01-01

    Most countries are signatories to the United Nations Convention on the Rights of the Child (UNCRC). In 1999, the Government of Wales was devolved from the UK, and in 2011 the "Children and Young Persons Rights Measure" put the UNCRC as the basis of all its work. Any programme introduced in schools should therefore promote the UNCRC. To…

  1. Development of a Senior Physics Syllabus in New South Wales

    ERIC Educational Resources Information Center

    Binnie, Anna

    2004-01-01

    In 2000, the New South Wales Board of Studies introduced new syllabi for Junior Science (years 7-10) and Senior Science subjects (years 11 and 12), i.e. Physics, Chemistry, Biology, and Earth and Environmental Science (Geology). The structure of these courses is similar: it is based on a contextual perspective and is underpinned by a number of…

  2. Dental prescribing in Wales and associated public health issues.

    PubMed

    Karki, A J; Holyfield, G; Thomas, D

    2011-01-01

    Dental prescribing data in Wales have not been studied in detail previously. The analysis of national data available from Health Solutions Wales showed that dental prescribing in Wales accounted for 9% of total antibacterial prescribing in primary care in 2008. Penicillin and metronidazole constituted the bulk of antibiotics prescribed by dentists. Since the publication of National Institute for Health and Clinical Excellence (NICE) guidance (March 2008) on prophylaxis against infective endocarditis, dental prescriptions for amoxicillin 3g sachets and clindamycin capsules have decreased. Dental prescriptions for fluoride preparations increased in number from 2007 to 2008. Dental prescribing of controlled drugs raises no concern. The figure for antibiotic prescribing in Wales is similar to that of England. Nevertheless, the figure seems a little high, indicating potential inappropriate prescribing behaviour among dentists. Antibiotic resistance is a major public health issue and many patients each year die from infections from bacterial strains that are resistant to one or more antibiotics. Inappropriate use of antibiotics is a major cause of antibiotic resistance and every effort should be made to reduce the number of inappropriate antibiotic prescriptions in dental practice. PMID:21164522

  3. Education and Nationhood in Wales: An Historiographical Analysis

    ERIC Educational Resources Information Center

    Jones, Gareth Elwyn

    2006-01-01

    Throughout the centuries, a sense of national identity in Wales has manifested itself in a variety of ways--aspirations to statehood, a unique language, cultural distinctiveness, religious affiliation, sporting achievement and, most recently, political devolution. Educational institutions in myriad forms have reflected aspects of these…

  4. The Wales Region: Microelectronics Education to the Mid Eighties.

    ERIC Educational Resources Information Center

    Taylor, Lionel

    1982-01-01

    Discusses developments which should occur in the Wales region by the end of the Microelectronics Education Programme (1984). Indicates that a major curriculum project has been started to enable developments in information technology to be reflected in classrooms, focusing on the production of software and resource materials. (Author/JN)

  5. Training and Enterprise in England and Wales: A Critical Review.

    ERIC Educational Resources Information Center

    Ploszajska, Teresa

    1994-01-01

    Analyzes Training and Enterprise Councils (TECs) within the historical context of national and local training initiatives in England and Wales. Concludes that decreasing public financing means that the quality and availability of training will depend on where one lives. In less affluent areas, TECs will be unable to affect the local economy,…

  6. New Labour, Communitarianism and Citizenship Education in England and Wales

    ERIC Educational Resources Information Center

    Dunn, Andrew; Burton, Diana

    2011-01-01

    This article posits a connection between the influence of communitarianism on New Labour's ideology and the content of citizenship education in England and Wales. We first describe and problematize communitarianism, drawing on both UK and US thinkers, and then relate our findings to literature on citizenship education. We conclude by suggesting…

  7. Youth Justice in England and Wales: A Risky Business

    ERIC Educational Resources Information Center

    Paylor, Ian

    2011-01-01

    Risk factor research dominates explanatory models of youth offending and "evidence-based" policy and practice with young people in the youth justice system in England and Wales. Asset is the product of these actuarial ideas and has put the risk factor prevention paradigm into practice. This article evaluates the impact that an actuarial approach…

  8. Inclusive Policy and Exclusionary Practice in Secondary Education in Wales

    ERIC Educational Resources Information Center

    Selleck, Charlotte L. R.

    2013-01-01

    This article reports on a study of two contrasting secondary schools, serving the same "community" in south-west Wales; a bilingual school (Welsh and English) and an English-medium school (English only). Data were gathered using ethnographic methods, with this study focusing primarily on data elicited through "ethnographic chats". The analysis is…

  9. School-to-Work Transition in England and Wales.

    ERIC Educational Resources Information Center

    Attwell, Graham

    1997-01-01

    Discusses the government role in school-to-work (STW) in England and Wales, youth unemployment and the labor market, effects of deregulation, current research on STW, and the introduction of modern apprenticeship, in which formal training in further education colleges is combined with apprenticeship. (SK)

  10. Teacher Unionism and Collective Bargaining in England and Wales.

    ERIC Educational Resources Information Center

    Thornton, Robert J.

    1982-01-01

    This article analyzes the teacher union movement and the system of teacher bargaining in England and Wales. The author traces the postwar history of teacher negotiations and shows that the present system of negotiation has experienced increasing difficulties in the past decade, such as a rise in teacher militancy. (Author/CT)

  11. Wolves and Big Yellow Taxis: How Would Be Know If the NHS Is at Death’s Door?

    PubMed Central

    Greener, Ian

    2015-01-01

    Martin Powell suggests that the death of the English National Health Service (NHS) has been announced so many times we are at risk of not noticing should it actually happen. He is right. If we ‘cry wolf’ too many times, we risk losing sight of what is important about the NHS and why. PMID:26673181

  12. Why Do Speech and Language Therapists Stay in, Leave and (Sometimes) Return to the National Health Service (NHS)?

    ERIC Educational Resources Information Center

    Loan-Clarke, John; Arnold, John; Coombs, Crispin; Bosley, Sara; Martin, Caroline

    2009-01-01

    Background: Research into recruitment, retention and return of speech and language therapists in the National Health Service (NHS) is relatively limited, particularly in respect of understanding the factors that drive employment choice decisions. Aims: To identify what factors influence speech and language therapists working in the NHS to stay,…

  13. EDC/NHS cross-linked collagen foams as scaffolds for artificial corneal stroma.

    PubMed

    Vrana, N E; Builles, N; Kocak, H; Gulay, P; Justin, V; Malbouyres, M; Ruggiero, F; Damour, O; Hasirci, V

    2007-01-01

    In this study, a highly porous collagen-based biodegradable scaffold was developed as an alternative to synthetic, non-degradable corneal implants. The developed method involved lyophilization and subsequent stabilization through N-ethyl-N'-[3-dimethylaminopropyl] carbodiimide/N-hydroxy succinimide (EDC/NHS) cross-linking to yield longer lasting, porous scaffolds with a thickness similar to that of native cornea (500 microm). For collagen-based scaffolds, cross-linking is essential; however, it has direct effects on physical characteristics crucial for optimum cell behavior. Hence, the effect of cross-linking was studied by examining the influence of cross-linking on pore size distribution, bulk porosity and average pore size. After seeding the foam with human corneal keratocytes, cell proliferation, cell penetration into the scaffold and ECM production within the scaffold were studied. After a month of culture microscopical and immunohistochemical examinations showed that the foam structure did not undergo any significant loss of integrity, and the human corneal keratocytes populated the scaffold with cells migrating both longitudinally and laterally, and secreted some of the main constituents of the corneal ECM, namely collagen types I, V and VI. The foams had a layer of lower porosity (skin layer) both at the top and the bottom. Foams had an optimal porosity (93.6%), average pore size (67.7 microm), and chemistry for cell attachment and proliferation. They also had a sufficiently rapid degradation rate (73.6+/-1.1% in 4 weeks) and could be produced at a thickness close to that of the natural corneal stroma. Cells were seeded at the top surface of the foams and their numbers there was higher than the rest, basically due to the presence of the skin layer. This is considered to be an advantage when epithelial cells need to be seeded for the construction of hemi or full thickness cornea. PMID:17988518

  14. AJ Cronin and The Citadel: did a work of fiction contribute to the foundation of the NHS?

    PubMed

    O'Mahony, S

    2012-06-01

    AJ Cronin (1896-1981) was a Scottish-born doctor-turned-novelist whose most famous novel is The Citadel, published in 1937. The book describes the struggles of an idealistic young doctor working in Wales and London in the 1920s and 30s. The novel was a global bestseller and its portrayal of a largely ineffective, corruption-ridden system of healthcare is thought to have directly influenced the foundation of the National Health Service in 1948. The Citadel anticipates such phenomena as evidence-based medicine and continuing medical education. This paper argues that the novel was never intended as propaganda for a state-controlled national health service. On the contrary, Cronin was against state control. Analysis of the novel is informed by recent biographical revelations about Cronin and the blurring of the margin between fact and fiction in Cronin's life and work is examined. PMID:22693705

  15. School Councils in New South Wales: A Report to the New South Wales Department of Education and Training.

    ERIC Educational Resources Information Center

    Boylan, Colin; Bittar, Lex

    The aim of school councils in New South Wales (Australia) is to ensure that the whole community is involved in all important decisions made by the school. The impetus for school councils began in 1990, and in 1995 the Department of School Education placed their formation on its priority agenda in response to their slow rate of establishment. Two…

  16. Management Development in the NHS: Nurses and Managers, Discourses and Identities

    ERIC Educational Resources Information Center

    Sambrook, Sally

    2006-01-01

    Purpose: Aims to provide a brief discussion of discourses of HRD, then a brief review of HRD within the NHS, including stakeholders in HRD, and particularly management development. To explore some of the different discourses used by different managers, particularly those with a nursing background and those without, and the possible reasons for the…

  17. Control and accountability in the NHS market: a practical proposition or logical impossibility?

    PubMed

    Glynn, J J; Perkins, D

    1998-01-01

    Before the imposition of the NHS internal market, systems of accountability and control were far from adequate and could be criticized on a number of grounds. The market was offered as a panacea to address these inadequacies. However, in practice there have only been partial improvements which could have been achieved without the imposition of the market. The market also creates new problems and a number of crises and scandals seem to be addressed at the political level by pleas to utilize resources more effectively. These pleas mean that more and more the focus is turning back to central planning in the provision of care and further away from so-called market mechanisms. The NHS "managed" market has been imperfect and will continue to be so. Argues that there is no alternative but to return to the planned provision of health care in order to improve on accountability and control in the NHS. Hopefully the adverse impact of the market on clinicians and others will force a more rational reappraisal of the fundamental raison d'être of the NHS and the need for those involved in the delivery of services, at all levels, to be more openly accountable. PMID:10351254

  18. A Survey of Food Projects in the English NHS Regions and Health Action Zones in 2001

    ERIC Educational Resources Information Center

    Caraher, Martin; Cowburn, Gill

    2004-01-01

    Background and Objective: This article sets out the findings from an analysis of food projects, with a particular emphasis on fruit and vegetables, from the 26 Health Action Zones (HAZs) in England and those taking place within the former NHS regional areas in 2001. The objective was to gather information on the existing practice to inform future…

  19. Patient record access: making it work for you and the NHS

    PubMed Central

    2011-01-01

    Background Patient record access is NHS policy. It is now a reality in the UK, although it remains a rarity. Setting This article summarises the current state of patient record access in the UK, focusing on a particular system for which there is most data available. It also explores possibilities for expanded functionality in the near future. This will offer both patients and the NHS a more interactive approach that offers significant benefits to both. Results Patient record access not only appears safe, but also offers benefits to patients. These include improved safety; a more accurate record; better relationships between patients and clinicians; better data sharing and integration across the NHS; improved self-care and shared decision-making; and better compliance. Practices gain by saving time. In addition, they gain by having empowered patients who can do more for themselves. However, clinicians in general, and GPs in particular, are anxious about enabling record access, fearing loss of control, litigation and breaches of the daa protection act. Conclusions Patient record access with added transactional services is likely to benefit patients and practices across the NHS. It supports QIPP. It is likely to become routine, but cannot substitute for good traditional communication with and support for patients. PMID:25949647

  20. Giving night shift staff healthy food choices is a priority, says NHS chief.

    PubMed

    Kleebauer, Alistair

    2014-11-01

    Night shift staff will have access to healthy food options as part of a drive to improve the health of hospital staff in England, NHS chief executive Simon Stevens said as he announced his vision for the health service last week. PMID:25351052

  1. Partial progress: governing the pharmaceutical industry and the NHS, 1948-2008.

    PubMed

    Abraham, John

    2009-12-01

    Coinciding with sixty years of the U.K. National Health Service (NHS), this article reviews the neglected area of the governance of the pharmaceutical industry and the NHS. It traces the relationships between the pharmaceutical industry, the state, and the NHS from the creation of the health service to the present, as they have grappled with the overlapping challenges of pharmaceutical safety, efficacy, cost-effectiveness, pricing, promotion, and advertising. The article draws on the concepts of "corporate bias" and "regulatory capture" from political theory, and "counter-vailing powers" and "clinical autonomy" in medical sociology, while also introducing the new concepts of "assimilated allies" and "pharmaceuticalization" in order to synthesize a theoretical framework capable of longitudinal empirical analysis of pharmaceutical governance. The analysis identifies areas in which the governance of pharmaceuticals and the NHS has contributed to progress in health care since 1948. However, it is argued that that progress has been slow, restricted, and vulnerable to misdirection due to the enormous and unrivaled influence afforded to the pharmaceutical industry in policy developments. Countervailing influences against such corporate bias have often been limited and subject to destabilization by the industry's assimilated allies either within the state or in the embrace of pharmaceuticalization and consumerism. PMID:20018987

  2. Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

    PubMed

    Addicott, Rachael

    2016-01-01

    For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement. PMID:26328512

  3. Fiscal decentralization in the Italian NHS: what happens to interregional redistribution?

    PubMed

    Ferrario, Caterina; Zanardi, Alberto

    2011-04-01

    This paper explores how pressures for an increased decentralization of taxing powers to sub-national governments may affect the degree of income redistribution across regional territories accomplished by the Italian NHS. In Italy, political responsibilities for health care are decentralized to regional governments, but the central government retains a critical role in ensuring all citizens uniform access to health services. To this end the central government runs an expenditure needs equalizing system to top up regional governments own resources. However, this system is currently put under question by strong political pressures calling for a weakening of central government involvement. Applying a well developed econometric approach we find that the NHS currently reduces interregional differences in per-capita income by about 7% of GDP. A reform of the NHS in terms of a reduction of expenditure standards produces a weakening of redistribution across jurisdictions, the size of which crucially depends on the financing arrangements of health care that will be actually adopted. We conclude that the decentralization of the NHS would give rise to relevant policy issues concerning in particular the different health care spending possibilities across regions and the impact on the interregional mobility of patients. PMID:20864204

  4. Healthcare reform. Is the NHS ready for US business guru's strategy?

    PubMed

    Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

    2006-12-01

    The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there. PMID:17228622

  5. NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

    PubMed Central

    2012-01-01

    Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. Methods Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. Results Average population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group

  6. Assessing the impact of a new health sector pay system upon NHS staff in England

    PubMed Central

    Buchan, James; Evans, David

    2008-01-01

    Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS) in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions), and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact variations. Similarly, the lack of

  7. Attitudes and intentions of homeless people towards service provision in South Wales.

    PubMed

    Christian, Julie; Armitage, Christopher J

    2002-06-01

    The theory of planned behaviour (TPB: Ajzen, 1988, 1991) was used as a framework to investigate homeless people's participation in outreach service programmes. In total, 104 homeless people from South Wales were interviewed using a schedule based on the TPB. Congruent with previous research on the TPB, attitude was the dominant predictor of behavioural intentions, and intention and perceived behavioural control were predictive of behaviour. Contrary to predictions, subjective norms also exerted a direct effect on behaviour. The discussion focuses on two issues: first, the utility of social cognition models in explaining the relationship between demographic variables and behaviour in homelessness research; second, the direct effects of norms on behaviour and the extent to which work on social groups might usefully extend research on models such as the TPB to aid understanding of behaviour amongst stigmatized populations. PMID:12133225

  8. Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

    PubMed

    Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

    2011-09-01

    The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS. PMID:21371053

  9. Ordovician "sphinctozoan" sponges from Prince of Wales Island, southeastern Alaska

    USGS Publications Warehouse

    Rigby, J.K.; Karl, S.M.; Blodgett, R.B.; Baichtal, J.F.

    2005-01-01

    A faunule of silicified hypercalcified "sphinctozoan" sponges has been recovered from a clast of Upper Ordovician limestone out of the Early Devonian Karheen Formation on Prince of Wales Island in southeastern Alaska. Included in the faunule are abundant examples of the new genus Girtyocoeliana, represented by Girtyocoeliana epiporata (Rigby and Potter), and Corymbospongia adnata Rigby and Potter, along with rare Corymbospongia amplia n. sp., and Girtyocoelia(?) sp., plus common Amblysiphonella sp. 1 and rare Amblysiphonella(?) sp. 2. The assemblage is similar to that from Ordovician clasts from the eastern Klamath Mountains of northern California. This indicates that the Alexander terrane of southeastern Alaska is related paleogeographically to the lithologically and paleontologically similar terrane of the eastern Klamath Mountains. This lithology and fossil assemblage of the clast cannot be tied to any currently known local rock units on Prince of Wales Island. Other clasts in the conglomerate appear to have been locally derived, so it is inferred that the limestone clasts were also locally derived, indicating the presence of a previously undocumented Ordovician limestone unit on northern Prince of Wales Island. 

  10. Nasal cancer in England and Wales: an occupational survey.

    PubMed Central

    Acheson, E D; Cowdell, R H; Rang, E H

    1981-01-01

    A national survey of the incidence of nasal cancer in England and Wales during the period 1963-7 with special reference to occupation confirmed the well-known increases in incidence of nasal cancer in cabinet makers and wood machinists, together with the absence of any significant increase in carpenters and joiners, and the increases in boot and shoe operatives and repairers, and in nickel smelters in South Wales. The significant excesses of cases found among coalminers, furnacemen in the gas, coke, and chemical industry, and furnacemen and labourers in foundries may be associated with exposure to coal and coke dust or may be spurious. No excess of nasal cancer was found among male textile workers. Excesses of uncertain significance were found among tailors and dressmakers, bakers and pastry cooks, and printers. Apart from the well-known relationships between adenocarcinoma and work in the furniture and footwear industries there is no definite indication in this survey of any association between a particular histological type of nasal tumour and occupation in England and Wales. PMID:7272233

  11. The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals

    PubMed Central

    Schofield, Behnaz; Cresswel, Kathrin; Westbrook, Johanna; Slee, Ann; Girling, Alan; Shah, Sonal; Coleman, Jamie; Sheikh, Aziz

    2015-01-01

    Introduction Electronic prescribing (ePrescribing) systems are rapidly being introduced into National Health Systems (NHS) hospitals in England following their widespread earlier adoption into primary care settings. Such systems require substantial changes in the way pharmacists organise their work and perform their roles. There is however as yet limited evidence on the extent to which these changes may support or compromise efficient and safe working practices by pharmacists. Identifying and quantifying these changes, and their effects, is central to informing system and work practice design, as well as informing training and implementation processes. This protocol describes a study to measure the impact of ePrescribing systems on pharmacists’ time and workflow. Methods and analysis A direct observational controlled pre–post implementation time-and-motion study will be conducted in six wards at one NHS Trust over two observational periods. Pharmacists will be shadowed and details of all work tasks performed will be collected and time-stamped. Task distribution, frequency and duration will be measured and changes in these measures preimplementation and postimplementation, and between control and intervention wards will be measured. Interviews with pharmacists will investigate their perceptions of the impact of the ePrescribing systems on their work and will be conducted in both periods. The extent to which pharmacists’ expectations of the impact of the ePrescribing systems on their work with postimplementation reports will be qualitatively explored, as will any differences between perceptions and results from the time-and-motion analysis. Ethics and dissemination Institutional research ethics approval has been obtained from The University of Edinburgh. Local approval from the participating NHS Trust and informed consent from participating pharmacists have been obtained, while also complying with local governance requirements. The results of the study will be

  12. Awareness and perceptions of the risks of exposure to indoor radon: a population-based approach to evaluate a radon awareness and testing campaign in England and Wales.

    PubMed

    Poortinga, Wouter; Bronstering, Karin; Lannon, Simon

    2011-11-01

    The current study aimed to evaluate the locally directed radon roll-out program that was conducted between 2001 and 2005 in England and Wales to increase radon awareness and testing rates. A representative sample of 1,578 residents aged 16 and older were interviewed who lived in radon-affected areas of 15 local authorities in England and Wales that were eligible for participation in the program. The study systematically sampled across participating and nonparticipating local authorities, "actionable" and "nonactionable" radon-affected areas, and geographic regions with different campaign histories (Wales, Southwest England, and the rest of England). As a multistage sampling strategy was used, the data were analyzed from a multilevel perspective. This study found that participants living in participating local authorities had higher levels of awareness and were more likely to have tested their home for radon than participants living in nonparticipating local authorities. Similar results were found for participants living in "actionable" areas as compared to those living in "nonactionable" radon-affected areas. The study further found that radon awareness and testing rates were the highest in Southwest England and the lowest in Wales. This study suggests that the radon roll-out program has been effective in raising awareness and testing rates, and that ongoing domestic radon campaigns in Southwest England may have raised radon awareness and testing in these areas, showing important reinforcement effects of multiple risk communication campaigns. PMID:21477087

  13. Patient choice for older people in english NHS primary care: theory and practice.

    PubMed

    Harding, Andrew J E; Sanders, Frances; Lara, Antonieta Medina; van Teijlingen, Edwin R; Wood, Cate; Galpin, Di; Baron, Sue; Crowe, Sam; Sharma, Sheetal

    2014-01-01

    In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whether making individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs-older people. This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care. PMID:24967329

  14. Tracing experiences of NHS change in England: a process philosophy perspective.

    PubMed

    McMurray, Robert

    2010-01-01

    For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration. PMID:20919431

  15. Systematic Investigation of EDC/sNHS-Mediated Bioconjugation Reactions for Carboxylated Peptide Substrates.

    PubMed

    Totaro, Kyle A; Liao, Xiaoli; Bhattacharya, Keshab; Finneman, Jari I; Sperry, Justin B; Massa, Mark A; Thorn, Jennifer; Ho, Sa V; Pentelute, Bradley L

    2016-04-20

    1-Ethyl-3-(3-(dimethylamino)propyl)carbodiimide (EDC) bioconjugations have been utilized in preparing variants for medical research. While there have been advances in optimizing the reaction for aqueous applications, there has been limited focus toward identifying conditions and side reactions that interfere with product formation. We present a systematic investigation of EDC/N-hydroxysulfosuccinimide (sNHS)-mediated bioconjugations on carboxylated peptides and small proteins. We identified yet-to-be-reported side products arising from both the reagents and substrates. Model peptides used in this study illustrate particular substrates are more susceptible to side reactions than others. From our studies, we found that bioconjugations are more efficient with high concentrations of amine nucleophile but not sNHS. Performing bioconjugations on a model affibody protein show that the trends established with model peptides hold for more complex systems. PMID:26974183

  16. Changing domains in the management process. Radiographers as managers in the NHS.

    PubMed

    Forbes, T; Prime, N

    1999-01-01

    Examines a group of radiographers developing management roles within the backdrop of a changing NHS. A comparative study of 25 Scottish and English radiographer managers were interviewed using semi-structured interviews. Interviews were based on a number of issues associated with moving from a clinical professional to a clinical manager and were analysed using domain theory. The interviews formed a number of emerging themes, which included management, professionalism, management style, conflicts between the role of both manager and professional, and role change. Radiographer managers are forming new "hybrid" manager roles, which have been developing within a changing NHS. A definite tension was seen in this role change. This transition was not easy for this group of radiographer managers. However, they have shown resilience in undertaking both operational and strategic management decisions, while using their clinical background to inform their decision making. PMID:10747440

  17. The changing context of employment in the NHS: some legal implications of changes to employment contracts.

    PubMed

    Desombre, T; Benny, R

    1998-01-01

    The NHS has undergone and continues to undergo rapid change. As a result of this, the duties and responsibilities of employees will also change. Managers within the NHS have a responsibility to ensure that appropriate contracts of employment are held by employees and that, where required, variations in these contracts are documented. This paper uses the example of the changing role of the Executive Nurse Director to highlight the importance of this need. It concludes by warning that failure to consider both the legal duties placed on employers when implementing contractual variations and the legal implications of adopting an unlawful method of variation, might lead to large legal bills and a demand on managerial time dealing with any legal claim against the employer. PMID:10346297

  18. Success factors for implementation of the balanced scorecard in a NHS multi-agency setting.

    PubMed

    Radnor, Zoe; Lovell, Bill

    2003-01-01

    Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for "successful" BSC implementation in a NHS multi-agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, "blind" BSC implementation without consideration of these factors may result in potential "failure". PMID:12870249

  19. Questions about the NHS Supply Chain's generic specifications project arise at TVS 2016.

    PubMed

    Fronzo, C

    2016-05-01

    The last session at this year's Tissue Viability Society (TVS) conference was a debate surrounding the Government's proposed NHS Supply Chain generics programme. In one corner explaining the full proposal, how it will work and who will be involved was Mandie Sunderland, and in the other was Richard White, who had a number of questions to ask. Here Camila Fronzo, JWC Chief Sub Editor, summarises the main points of the debate and the questions still to be addressed. PMID:27169336

  20. A Pilot Action Learning Set for NHS R&D Managers

    ERIC Educational Resources Information Center

    Boaden, Margaret

    2004-01-01

    A pilot action learning set was established in late September 2002, with the objective to develop a model of action learning appropriate for R&D managers. This initiative was one of a number of responses to a request for training and support by a small group of R&D managers who were based in non-teaching acute and primary care NHS trusts. The…

  1. Any qualified provider: a qualitative case study of one community NHS Trust's response

    PubMed Central

    Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

    2016-01-01

    Objective To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Design Intrinsic case study combining qualitative analysis of interviews and field notes. Setting An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013–2014. Participants NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Findings Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. Conclusions AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. PMID:26908521

  2. Making health care more sustainable: the case of the English NHS.

    PubMed

    Pencheon, David

    2015-10-01

    The NHS is the most revered organisation in Britain: 'the proudest achievement of our modern society'. It is certainly the largest, although since its inception in 1948 it has operated in a government-funded environment of restricted resources. Nevertheless, it has also benefitted from a generally effective model of intervention centred on a hospital care system integrating specialist and emergency care and a primary care system which functions as both a source of treatment and a gatekeeper to specialist care. New circumstances, including environmentally-generated risk and a shifting disease reality, challenges the adequacy of this model. This paper argues that these new circumstances, some of which have seen a legislative response by government, mean that the NHS has to apply sustainable development thinking programmatically throughout its management and operations. It is also argued that the organisation needs to refocus towards prevention particularly in order to stem the rising tide of non-communicable disease. This paper sets out the thinking and actions of the Sustainable Development Unit, which has the task of developing and implanting sustainability concepts in the NHS. It is argued that the cause of sustainable development calls for a mix of cultural and technological shifts, new incentives and a rolling programme of innovative change. Some examples of success are presented. PMID:26410181

  3. Healthcare financing reform in Latvia: switching from social health insurance to NHS and back?

    PubMed

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

    In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions. PMID:25445111

  4. Estimating the financial cost of chronic kidney disease to the NHS in England

    PubMed Central

    Kerr, Marion; Bray, Benjamin; Medcalf, James; O'Donoghue, Donal J.; Matthews, Beverley

    2012-01-01

    Background Chronic kidney disease (CKD) is a major challenge for health care systems around the world, and the prevalence rates appear to be increasing. We estimate the costs of CKD in a universal health care system. Methods Economic modelling was used to estimate the annual cost of Stages 3–5 CKD to the National Health Service (NHS) in England, including CKD-related prescribing and care, renal replacement therapy (RRT), and excess strokes, myocardial infarctions (MIs) and Methicillin-Resistant Staphylococcus Aureus (MRSA) infections in people with CKD. Results The cost of CKD to the English NHS in 2009–10 is estimated at £1.44 to £1.45 billion, which is ∼1.3% of all NHS spending in that year. More than half this sum was spent on RRT, which was provided for 2% of the CKD population. The economic model estimates that ∼7000 excess strokes and 12 000 excess MIs occurred in the CKD population in 2009–10, relative to an age- and gender-matched population without CKD. The cost of excess strokes and MIs is estimated at £174–£178 million. Conclusions The financial impact of CKD is large, with particularly high costs relating to RRT and cardiovascular complications. It is hoped that these detailed cost estimates will be useful in analysing the cost-effectiveness of treatments for CKD. PMID:22815543

  5. Nhs: Network-based Hierarchical Segmentation for Cryo-EM Density Maps

    PubMed Central

    Burger, Virginia; Chennubhotla, Chakra

    2012-01-01

    Electron cryo-microscopy (cryo-EM) experiments yield low-resolution (3–30Å) 3D-density maps of macromolecules. These density maps are segmented to identify structurally distinct proteins, protein domains, and sub-units. Such partitioning aids the inference of protein motions and guides fitting of high-resolution atomistic structures. Cryo-EM density map segmentation has traditionally required tedious and subjective manual partitioning or semi-supervised computational methods, while validation of resulting segmentations has remained an open problem in this field. Our network-based bias-free segmentation method for cryo-EM density map segmentation, Nhs (Network-based hierarchical segmentation), provides the user with a multi-scale partitioning, reflecting local and global clustering, while requiring no user input. This approach models each map as a graph, where map voxels constitute nodes and edges connect neighboring voxels. Nhs initiates Markov diffusion (or random walk) on the weighted graph. As Markov probabilities homogenize through diffusion, an intrinsic segmentation emerges. We validate the segmentations with ground-truth maps based on atomistic models. When implemented on density maps in the 2010 Cryo-EM Modeling Challenge, Nhs efficiently and objectively partitions macromolecules into structurally and functionally relevant sub-regions at multiple scales. PMID:22696408

  6. A Mid-Upper Palaeolithic human humerus from Eel Point, South Wales, UK.

    PubMed

    Schulting, Rick J; Trinkaus, Erik; Higham, Tom; Hedges, Robert; Richards, Michael; Cardy, Bernice

    2005-05-01

    We report here on a human humerus directly dated to 24,470 +/- 110 BP, placing it within the Gravettian, or Mid-Upper Palaeolithic. The partial humerus is an isolated find and can be attributed (with some caution) to the Pleistocene 'bone cave' of Eel Point on Caldey Island, Wales (UK). The humerus is probably male, similar in robusticity to other Gravettian right humeri. The apparent absence of stone tools and presence of hyaena bone and coprolites suggest that the element may not derive from an intentional burial. After a maxilla from Kent's Cavern and the Gravettian Paviland 1, Eel Point represents the third oldest anatomically modern human known from Britain. Stable carbon and nitrogen isotope measurements do not support certain use of marine foods but highlight the need for more research on contemporary faunal remains in order to better interpret human values from this period. PMID:15857652

  7. How many people in England and Wales are registered partially sighted or blind because of age-related macular degeneration?

    PubMed Central

    Rees, A; Zekite, A; Bunce, C; Patel, P J

    2014-01-01

    Purpose The purpose of the study was to determine what proportion of new certifications between 1 April 2007 and 31 March 2008 could be attributed to age-related macular degeneration (AMD) and to describe the AMD-certified population in England and Wales. Methods An electronic version of the Certificate of Vision Impairment form (CVI), the ECVI, was used at the certifications office to transfer information from the paper-based certificates into a database. The electronic certifications data set was queried for all certificates completed between 1 April 2007 and 31 March 2008 with the main cause of certifiable visual loss being AMD or with the main cause of certifiable visual loss being multiple pathology but a contributory cause being AMD. The electronic data set was adapted so that a distinction could be made between geographic atrophy (GA) and neovascular AMD (nAMD). Results The Certifications Office received 23 185 CVIs between April 2007 and March 2008, of whom 9823 (42%) were people registered severely sight impaired (SSI) and 12 607 (52%) were certified as sight impaired (SI). AMD contributed to 13 000 causes of registration on the CVI forms during this period and was the main cause in 11 015 people. In these 11 015 people, GA accounted for 49.3%, nAMD 35.1%, and AMD not specified 15.7%. Conclusions The data in this report provide detailed information on CVI registration due to AMD before the widespread adoption of ranibizumab therapy in NHS practice and provide an insight into the burden of vision loss due to AMD at a time of great change in the management of nAMD. PMID:24788009

  8. Assessing risk of non-compliance of phosphorus standards for lakes in England and Wales

    NASA Astrophysics Data System (ADS)

    Duethmann, D.; Anthony, S.; Carvalho, L.; Spears, B.

    2009-04-01

    High population densities, use of inorganic fertilizer and intensive livestock agriculture have increased phosphorus loads to lakes, and accelerated eutrophication is a major pressure for many lakes. The EC Water Framework Directive (WFD) requires that good chemical and ecological quality is restored in all surface water bodies by 2015. Total phosphorus (TP) standards for lakes in England and Wales have been agreed recently, and our aim was to estimate what percentage of lakes in England and Wales is at risk of failing these standards. With measured lake phosphorus concentrations only being available for a small number of lakes, such an assessment had to be model based. The study also makes a source apportionment of phosphorus inputs into lakes. Phosphorus loads were estimated from a range of sources including agricultural loads, sewage effluents, septic tanks, diffuse urban sources, atmospheric deposition, groundwater and bank erosion. Lake phosphorus concentrations were predicted using the Vollenweider model, and the model framework was satisfactorily tested against available observed lake concentration data. Even though predictions for individual lakes remain uncertain, results for a population of lakes are considered as sufficiently robust. A scenario analysis was carried out to investigate to what extent reductions in phosphorus loads would increase the number of lakes achieving good ecological status in terms of TP standards. Applying the model to all lakes in England and Wales greater than 1 ha, it was calculated that under current conditions roughly two thirds of the lakes would fail the good ecological status with respect to phosphorus. According to our estimates, agricultural phosphorus loads represent the most frequent dominant source for the majority of catchments, but diffuse urban runoff also is important in many lakes. Sewage effluents are the most frequent dominant source for large lake catchments greater than 100 km². The evaluation in terms of

  9. Identifying Probable Suicide Clusters in Wales Using National Mortality Data

    PubMed Central

    Jones, Phillip; Gunnell, David; Platt, Stephen; Scourfield, Jonathan; Lloyd, Keith; Huxley, Peter; John, Ann; Kamran, Babar; Wells, Claudia; Dennis, Michael

    2013-01-01

    Background Up to 2% of suicides in young people may occur in clusters i.e., close together in time and space. In early 2008 unprecedented attention was given by national and international news media to a suspected suicide cluster among young people living in Bridgend, Wales. This paper investigates the strength of statistical evidence for this apparent cluster, its size, and temporal and geographical limits. Methods and findings The analysis is based on official mortality statistics for Wales for 2000–2009 provided by the UK's Office for National Statistics (ONS). Temporo-spatial analysis was performed using Space Time Permutation Scan Statistics with SaTScan v9.1 for suicide deaths aged 15 and over, with a sub-group analysis focussing on cases aged 15–34 years. These analyses were conducted for deaths coded by ONS as: (i) suicide or of undetermined intent (probable suicides) and (ii) for a combination of suicide, undetermined, and accidental poisoning and hanging (possible suicides). The temporo-spatial analysis did not identify any clusters of suicide or undetermined intent deaths (probable suicides). However, analysis of all deaths by suicide, undetermined intent, accidental poisoning and accidental hanging (possible suicides) identified a temporo-spatial cluster (p = 0.029) involving 10 deaths amongst 15–34 year olds centred on the County Borough of Bridgend for the period 27th December 2007 to 19th February 2008. Less than 1% of possible suicides in younger people in Wales in the ten year period were identified as being cluster-related. Conclusions There was a possible suicide cluster in young people in Bridgend between December 2007 and February 2008. This cluster was smaller, shorter in duration, and predominantly later than the phenomenon that was reported in national and international print media. Further investigation of factors leading to the onset and termination of this series of deaths, in particular the role of the media, is required. PMID

  10. Aluminium projects boost New South Wales power plans

    SciTech Connect

    Scott, W.E.

    1980-11-01

    New South Wales is expanding its power-generating capacity to power new aluminum smelters and extensions to existing smelting facilities planned for the 1980s. Cheap coal-based electricity is vital to the program's success. Officials deny reports that other consumers will suffer power shortages during the development stages and are confident the State's energy policies to provide 7400 MW of new capacity and introduce 500-kV transmission will also supply new industry and community power needs. Only France has a comparable power expansion program. (DCK)

  11. HLA and multiple sclerosis in south east Wales.

    PubMed Central

    Swingler, R J; Kirk, P F; Darke, C; Compston, D A

    1987-01-01

    A stronger association has been found between multiple sclerosis and HLA-DR2 than -DQwl in south east Wales (prevalence c 113/10(5)) in contrast to recent observations in north east Scotland (prevalence 178/10(5). The complex relationship between the HLA system and multiple sclerosis, demonstrated in this and other studies, is explained more easily under a polygenic model of inheritance, in which environmental events and genes interact, than by the presence of a single susceptibility gene. PMID:3499485

  12. New 48-inch line gives Wales more gas supplies

    SciTech Connect

    Not Available

    1982-11-01

    A new 11-mile, 48-in pipeline will not only supply an even flow of gas from the British Gas national grid to towns in the Wales Gas district but also serve as a daily storage facility by means of nightime linepacking at 700 psi. The largest diameter gas line to be constructed in the UK, the pipeline is confined to a 165-ft wide corridor leading through wet and dry moorland, farms, reclaimed colliery tips, and bogs. Construction engineers took care to protect archeological features along the route and to restore the land to its original condition.

  13. Building the Capacity of Local Education Authorities in Wales: Context, Processes and Developments

    ERIC Educational Resources Information Center

    Avery, Graham; Colebourne, David; James, Chris; Florek, Anton

    2004-01-01

    Recent policy developments are requiring local education authorities (LEAs) in Wales to undertake a more significant role in improving the Welsh education service. This article reports some of the outcomes of a Welsh Assembly government-funded initiative that addressed aspects of the development of the capacity of LEAs in Wales to fulfil this…

  14. Sexual Difficulties for Persons with Multiple Sclerosis in New South Wales, Australia

    ERIC Educational Resources Information Center

    Redelman, Margaret Juliet

    2009-01-01

    This 1992 study was conducted to ascertain the incidence of sexual difficulties in individuals diagnosed with multiple sclerosis (MS) living in New South Wales, Australia. New South Wales is a state lying roughly 29-36 [degrees] south of the equator. This is currently the largest study conducted. The anonymous questionnaire completed by 283…

  15. Learning Welshness: Does the Curriculum Cymreig Positively Affect Pupils' Orientations to Wales and Welshness?

    ERIC Educational Resources Information Center

    Smith, Kevin

    2015-01-01

    This article explores the possible affect schooling has on pupils' orientations to cultural and national identity in Wales. The Curriculum Cymreig is a distinctive feature of the national curriculum of Wales that has important ramifications regarding the enactment of citizenship education in Welsh schools. Under this initiative, schools in Wales…

  16. The Origins and Growth of Ragged Schools in Wales, 1847-c. 1900.

    ERIC Educational Resources Information Center

    Grigg, Russell

    2002-01-01

    Investigates the establishment of ragged schools in nineteenth century Wales. States they dealt with the many shabbily clad, underprivileged youth found roaming the streets. Explains Wales focused on creating church and boarding schools. Concludes that other schools eventually provided welfare based services which caused ragged school's demise.…

  17. Trends in Examination Performance and Exposure to Standardised Tests in England and Wales

    ERIC Educational Resources Information Center

    Goldstein, Harvey; Leckie, George

    2016-01-01

    Schools in England and Wales since the late 1980s have been compared in terms of their performances in public examinations and standardised test scores in the form of "school league tables", with Wales ceasing to produce these after 2001. One of the factors related to performance in examinations is the choice of the examination board,…

  18. An Analysis of the Changing Shape of Initial Teacher Education and Training in Wales since Devolution

    ERIC Educational Resources Information Center

    Reid, Ken; Tanner, Howard

    2012-01-01

    After a sustained period of relative calm, initial teacher education and training (ITET) in Wales has seen much change in recent times since devolution and all the indications are that this change agenda is likely to escalate in both the short and long term. In order to understand what has been happening in the ITET field in Wales, our paper sets…

  19. Tackling Behaviour and Attendance Issues in Schools in Wales: Implications for Training and Professional Development

    ERIC Educational Resources Information Center

    Reid, Ken

    2011-01-01

    In 2009, the Welsh Assembly Government published its Report on the review of behaviour and attendance in schools in Wales. The National Behaviour and Attendance Review (NBAR) in Wales was chaired by the author of this paper. Both the Review and the Welsh Assembly Government's response contained recommendations related to the training and…

  20. Harbingers of Feminism? Gender, Cultural Capital and Education in Mid-Twentieth-Century Rural Wales

    ERIC Educational Resources Information Center

    Baker, Sally; Brown, Brian

    2009-01-01

    This paper reports the results of a small-scale narrative study of men and women who grew up in mid-twentieth-century rural Wales, and their reminiscences regarding women and education. Although the dominant image of Wales during that era is that of a male-dominated society, all of our participants remembered influential independent women and…

  1. Changing Policy, Legislation and Its Effects on Inclusive and Special Education: A Perspective from Wales

    ERIC Educational Resources Information Center

    Ware, Jean

    2014-01-01

    This article, by Jean Ware of Bangor University School of Education, examines policy developments in education in Wales since devolution, and their implications for inclusive and special education. This is set in the context of the demographics of Wales, which, it is argued, have a significant influence on policy and on the nature of educational…

  2. Former director of RCN Wales Liz Hewett began at Ty Maeth in 1998.

    PubMed

    Lenzy, Tracy

    2016-06-01

    Great story in Nursing Standard about the book Nursing Matters, which delves into the 50th anniversary of the RCN headquarters in Wales, Ty Maeth (features, May 18). However, Liz Hewett began working at the RCN in Wales in 1998 - not in 1988 as stated in the article. PMID:27275910

  3. An Integrated Library Platform: Wales' Approach to Delivering Digital Information and Resources Nationally

    ERIC Educational Resources Information Center

    Bevan, Paul; Tyler, Alyson

    2009-01-01

    Purpose: This paper aims to outline the developments and strategies employed to supply online library services in Wales through a national platform: library.wales.org These services include: the "Cat Cymru" cross-catalogue search, centrally procured subscription resources and local library microsites. Design/methodology/approach: The paper reviews…

  4. 78 FR 32367 - Approval of Subzone Status; Teva Pharmaceuticals USA, Inc.; North Wales, Chalfont, Kutztown and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-30

    ... Federal Register inviting public comment (78 FR 17634-17635, 3-22-2013). The FTZ staff examiner reviewed... Foreign-Trade Zones Board Approval of Subzone Status; Teva Pharmaceuticals USA, Inc.; North Wales... of Teva Pharmaceuticals USA, Inc., in North Wales, Chalfont, Kutztown and Sellersville,...

  5. The incidence of cancers among second-generation Irish living in England and Wales.

    PubMed Central

    Harding, S.

    1998-01-01

    The incidence of ovarian, cervical, lung and prostatic cancer was higher in second-generation Irish living in England and Wales than in all other persons in England and Wales. A higher incidence of ovarian cancer was not found in first-generation Irish. Differences in socioeconomic status did not explain these patterns. PMID:9764590

  6. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. 334.1330 Section 334.1330 Navigation and Navigable Waters CORPS OF....1330 Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. (a) The area. An area...

  7. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. 334.1330 Section 334.1330 Navigation and Navigable Waters CORPS OF....1330 Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. (a) The area. An area...

  8. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. 334.1330 Section 334.1330 Navigation and Navigable Waters CORPS OF....1330 Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. (a) The area. An area...

  9. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. 334.1330 Section 334.1330 Navigation and Navigable Waters CORPS OF....1330 Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. (a) The area. An area...

  10. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. 334.1330 Section 334.1330 Navigation and Navigable Waters CORPS OF....1330 Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. (a) The area. An area...

  11. Standardising the organisation of clinical equipment on surgical wards at North Bristol NHS Trust: a quality improvement initiative

    PubMed Central

    Ward, Joseph; Spencer, Robin; Soo, Eleanor; finucane, katherine

    2015-01-01

    Poorly organised clinical equipment can waste significant amounts of time otherwise available for direct patient care. As a group of foundation year one doctors, we identified the organisation of clinical equipment across surgical wards at North Bristol NHS Trust to be poor with stocks often low and items frequently difficult to locate. Time-motion studies (n=80) were confirmatory demonstrating that the mean time to collect equipment necessary for venepuncture, cannulation, arterial blood gases, or blood cultures ranged from 121 to 174 seconds between different areas. By applying a plan-do-study-act (PDSA) methodology, surveying peers as well as working with nursing staff and senior managers, we were able to purchase and implement clinical equipment trolleys on 10 surgical wards across the trust to reduce the time-taken to locate clinical equipment to between 38 to 45 seconds (p=0.01). We feel the key factors for the success of our initiative were strong multidisciplinary engagement and a simple uniform idea. Clinical equipment trolleys organised in a standardised manner have now been rolled out hospital-wide in the new Southmead Hospital Brunel building. PMID:26734373

  12. Occupational mortality among women in England and Wales.

    PubMed Central

    Roman, E; Beral, V; Inskip, H

    1985-01-01

    Occupational mortality in women who died in England and Wales from 1970 to 1972 was analysed. Many of the associations found were consistent with those that have been described for men, with high mortality ratios for cirrhosis in barmaids and publicans, for suicide in the medical and allied professions, and for respiratory disease in textile workers. Parity is a determinant of patterns of disease in working women, and the relative excess of cancer of the breast, ovary, and uterine body in professional and clerical workers probably reflected the high proportion of nulliparous women in these groups. Other associations may have reflected true occupational hazards; one observation requiring further attention was the high proportional mortality ratio for anaemia in textile and clothing workers. The description of the occupational mortality among women in England and Wales is hampered by the incomplete recording of information about women's occupations at registration of death. As women now constitute 40% of the workforce, often have their own specific occupations, and possibly also have their own diseases related to specific occupations it is time for the registrar's guidelines on the recording of women's occupation--last reviewed at the beginning of this century--to be revised. PMID:3926119

  13. Graphene nanoengineering and the inverse Stone-Thrower-Wales defect

    NASA Astrophysics Data System (ADS)

    Lusk, Mark T.; Wu, David T.; Carr, Lincoln D.

    2010-04-01

    We analyze a fundamental building block for monolithic nanoengineering on graphene: the Inverse-Stone-Thrower-Wales (ISTW) defect. The ISTW is formed from a pair of joined pentagonal carbon rings placed between a pair of heptagonal rings; the well-known Stone-Thrower-Wales defect is the same arrangement, but with the heptagonal rather than pentagonal rings joined. When removed and passivated with hydrogen, the structure constitutes a molecule, diazulene, which may be viewed as the result of an ad-dimer defect on anthracene. Embedding diazulene in the honeycomb lattice, we study the effect of ad-dimers on planar graphene. Because the ISTW defect has yet to be experimentally identified, we examine several synthesis routes and find one for which the barrier is only slightly higher than that associated with adatom hopping on graphene. ISTW and STW defects may be viewed as fundamental building blocks for monolithic structures on graphene. We show how to construct extended defect domains on the surface of graphene in the form of blisters, bubbles, and ridges on a length scale as small as 2Å×7Å . Our primary tool in these studies is density functional theory.

  14. Real world evaluation of three models of NHS smoking cessation service in England

    PubMed Central

    2012-01-01

    Background NHS Stop Smoking Services provide various options for support and counselling. Most services have evolved to suit local needs without any retrospective evaluation of their efficiency. Three local service evaluations were carried out at Bournemouth & Poole Teaching Primary Care Trust (PCT) (PCT1), NHS South East Essex (PCT2) and NHS Warwickshire (PCT3) to describe the structure and outcomes associated with different services. Result Standardised interviews with key personnel in addition to analysis of data from 400 clients accessing the service after 1st April 2008 in each PCT. The PCTs varied in geography, population size and quit rate (47%-63%). Services were delivered by PCT-led specialist teams (PCT1), community-based healthcare providers (PCT3) and a combination of the two (PCT2) with varying resources and interventions in each. Group support resulted in the highest quit rates (64.3% for closed groups v 42.6% for one-to-one support (PCT1)). Quit rates were higher for PCT (75.0%) v GP (62.0%) and pharmacist-delivered care (41.0%) where all existed in the same model (PCT2). The most-prescribed therapy was NRT (55.8%-65.0%), followed by varenicline (24.5%-34.3%), counselling alone (6.0%-7.8%) and bupropion (2.0%-4.0%). Conclusion The results suggest that service structure, method of support, healthcare professional involved and pharmacotherapy all play a role in a successful quit. Services must be tailored to support individual needs with patient choice and access to varied services being key factors. PMID:22226240

  15. The NHS Health Check programme: implementation in east London 2009–2011

    PubMed Central

    Robson, John; Dostal, Isabel; Madurasinghe, Vichithranie; Sheikh, Aziz; Hull, Sally; Boomla, Kambiz; Page, Helen; Griffiths, Chris; Eldridge, Sandra

    2015-01-01

    Objectives To describe implementation and results from the National Health Service (NHS) Health Check programme. Design Three-year observational open cohort study: 2009–2011. Participants People of age 40–74 years eligible for an NHS Health Check. Setting 139/143 general practices in three east London primary care trusts (PCTs) serving an ethnically diverse and socially disadvantaged population. Method Implementation was supported with education, IT support and performance reports. Tower Hamlets PCT additionally used managed practice networks and prior-stratification to call people at higher cardiovascular (CVD) risk first. Main outcomes measures Attendance, proportion of high-risk population on statins and comorbidities identified. Results Coverage 2009, 2010, 2011 was 33.9% (31 878/10 805), 60.6% (30 757/18 652) and 73.4% (21 194/28 890), respectively. Older people were more likely to attend than younger people. Attendance was similar across deprivation quintiles and was in accordance with population distributions of black African/Caribbean, South Asian and White ethnic groups. 1 in 10 attendees were at high-CVD risk (20% or more 10-year risk). In the two PCTs stratifying risk, 14.3% and 9.4% of attendees were at high-CVD risk compared to 8.6% in the PCT using an unselected invitation strategy. Statin prescription to people at high-CVD risk was higher in Tower Hamlets 48.9%, than in City and Hackney 23.1% or Newham 20.2%. In the 6 months following an NHS Health Check, 1349 new cases of hypertension, 638 new cases of diabetes and 89 new cases of chronic kidney disease (CKD) were diagnosed. This represents 1 new case of hypertension per 38 Checks, 1 new case of diabetes per 80 Checks and 1 new case of CKD per 568 Checks. Conclusions Implementation of the NHS Health Check programme in these localities demonstrates limited success. Coverage and treatment of those at high-CVD risk could be improved. Targeting invitations to people at high-CVD risk

  16. Interregional Patient Mobility in the Italian NHS: A Case of Badly-Managed Decentralization

    PubMed Central

    Neri, Stefano

    2015-01-01

    The article by Brenna and Spandonaro on interregional mobility for acute hospital care in Italy raises important issues concerning social and territorial equity in a healthcare system. Based on Regions and private providers’ strategic behavior, the hypothesis adopted to explain patient cross-border mobility (CBM), demonstrated by statistical analysis, may be further explored using qualitative methods. In order to reduce CBM, the central government needs to play a more active role in coordination, even in a highly decentralized National Health Service (NHS). PMID:26673474

  17. Assessing knowledge skills in the NHS: a training needs analysis approach.

    PubMed

    Hamilton, Seona

    2013-06-01

    This feature discusses the use of a training needs analysis exercise carried out by library staff at the NHS Greater Glasgow & Clyde (NHSGGC) Library Network to support the development of a fit for purpose programme of information skills training. A survey was designed based on a well-known information skills competency framework and used to gain an understanding of the knowledge skills needed by staff and how library training could best support these. The survey received a good response rate and led to the successful writing of a training plan for the Library Network for the delivery of information skills training. H.S. PMID:23692458

  18. An economic analysis of the limits of market based reforms in the English NHS

    PubMed Central

    2013-01-01

    Background Over the past three decades, a limited range of market like mechanisms have been introduced into the hierarchically structured English National Health Service (‘NHS’), which is a nationally tax funded, budget limited healthcare system, with access to care for all, producing structures known as a quasi market. Recently, the Health and Social Care Act 2012 (‘HSCA’) has been enacted, introducing further market elements. The paper examines the theory and effects of these market mechanisms. Methods Using neo-classical economics as a primary theoretical framework, as well as new institutional economics and socio-legal theory, the paper first examines the fundamental elements of markets, comparing these with the operation of authority and resource allocation employed in hierarchical structures. Second, the paper examines the application of market concepts to the delivery of healthcare, drawing out the problems which economic and socio-legal theories predict are likely to be encountered. Third, the paper discusses the research evidence concerning the operation of the quasi market in the English NHS. This evidence is provided by research conducted in the UK which uses economic and socio-legal logic to investigate the operation of the economic aspects of the NHS quasi market. Fourth, the paper provides an analysis of the salient elements of the quasi market regime amended by the HSCA 2012. Results It is not possible to construct a market conforming to classical economic principles in respect of healthcare. Moreover, it is not desirable to do so, as goals which markets cannot deliver (such as fairness of access) are crucial in England. Most of the evidence shows that the quasi market mechanisms used in the English NHS do not appear to be effective either. This finding should be seen in the light of the fact that the operation of these mechanisms has been significantly affected by the national political (i.e. continuingly hierarchical) and budgetary context

  19. Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.

    PubMed

    Newdick, Christopher; Danbury, Christopher

    2015-12-01

    Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions? PMID:23704781

  20. Cost-effectiveness of Collagen Crosslinking for Progressive Keratoconus in the UK NHS

    PubMed Central

    Salmon, Andrew; Chalk, Daniel; Stein, Ken; Frost, Andrew

    2015-01-01

    Background Keratoconus is a progressive degenerative corneal disorder of children and young adults that is traditionally managed by refractive error correction, with corneal transplantation reserved for the most severe cases. UVA collagen crosslinking is a novel procedure that aims to prevent disease progression, which is currently being considered for use in the UK NHS. We assess whether it might be a cost-effective alternative to standard management for patients with progressive keratoconus. Methods We constructed a Markov model in which we estimated disease progression from prospective follow-up studies, derived costs derived from the NHS National Tariff, and calculated utilities from linear regression models of visual acuity in the better-seeing eye. We performed deterministic and probabilistic sensitivity analyses to assess the impact of possible variations in the model parameters. Results Collagen crosslinking is cost-effective compared to standard management at an incremental cost of £3,174 per QALY in the base case. Deterministic sensitivity analysis shows that this could rise above £33,263 per QALY if the duration of treatment efficacy is limited to 5 years. Other model parameters are not decision significant. Collagen crosslinking is cost effective in 85% of simulations at a willingness to pay threshold of £30,000 per QALY. Conclusion UVA collagen crosslinking is very likely to be cost-effective, compared to standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond five years is desirable. PMID:26315704

  1. NHS values, compassion and quality indicators for relationship based person-centred healthcare

    PubMed Central

    Cox, John

    2015-01-01

    The paper by Gilbert et al. should be on the table of every politician and National Health Service (NHS) manager in the run up to the general election, when the NHS is at the hustings. They have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy – to which are added the preservation of personhood, the values of listening, the maintenance of altruism and the origins of compassion. It is asserted that the quality of healthcare is dependent on the quality of the caring relationship between healthcare staff members, and between staff and patients. The nature of Compassionate Resilience is outlined with respect to Health Visitor training – and the contribution of faith communities to public health is also considered. The four Quality Indicators of an enabling environment first proposed by Cox and Gray are summarised, and the need for increased conceptual clarity of these key values recognised. PMID:26029903

  2. Social richness, socio-technical tension and the virtual commissioning of NHS research

    PubMed Central

    Morgan, Philip A; McCourt, Christine A; Youll, Penny

    2007-01-01

    Background This paper draws on a recent study that evaluated the process of commissioning NHS funded research using virtual committees. Building on an earlier paper that reported our evaluation, here we focus on the effects of asynchronous computer mediated communication (CMC) when used to support group work. Methods To do this the discussion focuses on how CMC affected three key group factors, building relationships, group cohesion and group commitment. The notion of socio-technical tension is elaborated and the paper explores how social richness can act to counter the socially impoverishing and time extending effects of asynchronous CMC. Results We argue that social richness in this context results from the presence of five principal influences. These are: a dynamic range of participant aspirations and personal agendas; participant commitment to and identification with the work and ideals of the group; a rich diversity of social, professional and work-related backgrounds; a website designed to enhance participation and interaction and the mediating effects of an effective chairperson. Conclusion If virtual work groups are to be used by the NHS in the future, then there is a need for more research into the role of social context and its relationship to the effectiveness of newly formed virtual groups. Equally as important are studies that examine the effects of socio-technical interaction on groups undertaking tasks in the real world of work. PMID:17553135

  3. The medicalisation of health inequalities and the English NHS: the role of resource allocation.

    PubMed

    Asthana, Sheena; Gibson, Alex; Halliday, Joyce

    2013-04-01

    Tackling health inequalities (HI) has become a key policy objective in England in recent years. Yet, despite the wide-ranging policy response of the 1997-2010 Labour Government, socio-economic variations in health continued to widen. In this paper, we seek to explore why. We propose that a meta-narrative has emerged in which the health problems facing England's most deprived areas, and the solution to those problems, have increasingly come to be linked to levels of National Health Service (NHS) funding. This has been, in part, a response to key shortcomings in previous rounds of resource allocation. The very significant sums of money allocated with respect to 'health inequalities' reflects and reinforces the belief that the NHS can and should play a central role in promoting health equity. This medicalisation of HI focuses attention on the role of individual risk factors that lend themselves to medical management, but effectively sidelines the macroprocesses of social inequality, legitimising the kind of society that neo-liberal government has produced in the United Kingdom - one in which health (like other assets) has become a matter of individual and not collective responsibility. PMID:22947257

  4. Current cost of medical negligence in NHS hospitals: analysis of claims database

    PubMed Central

    Fenn, Paul; Diacon, Stephen; Gray, Alastair; Hodges, Ron; Rickman, Neil

    2000-01-01

    Objectives To identify trends in the incidence and cost of clinical negligence claims. To determine the current annual cost to the NHS as a whole in terms of cash paid out to patients and their solicitors and the defence costs incurred. Design Analysis of records on database. Setting A well defined group of hospitals within one health authority which collected information on a consistent basis over many years. Main outcome measures Data on individual claims. Trends in incidence of claims and costs identified independently from organisational reforms and changes in accounting practices. Results The rate of litigation increased from 0.46 to 0.81 closed claims per 1000 finished consultant episodes between 1990 and 1998. Overall expenditure on clinical negligence by the NHS in England in 1998 was estimated at £84 million (95% confidence interval £48 million to £130 million). Conclusions After adjustment for hospital activity, the rate of closed claims increased during the 1990s by about 7% per annum, a substantial rate of growth but not the uncontrolled explosion sometimes alluded to in the wider media. More coordination and openness are needed in data collection. PMID:10845963

  5. On the Efficiency of NHS Ester Cross-Linkers for Stabilizing Integral Membrane Protein Complexes

    NASA Astrophysics Data System (ADS)

    Chen, Fan; Gerber, Sabina; Korkhov, Volodymyr M.; Mireku, Samantha; Bucher, Monika; Locher, Kaspar P.; Zenobi, Renato

    2015-03-01

    We have previously presented a straightforward approach based on high-mass matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS) to study membrane proteins. In addition, the stoichiometry of integral membrane protein complexes could be determined by MALDI-MS, following chemical cross-linking via glutaraldehyde. However, glutaraldehyde polymerizes in solution and reacts nonspecifically with various functional groups of proteins, limiting its usefulness for structural studies of protein complexes. Here, we investigated the capability of N-hydroxysuccinimide (NHS) esters, which react much more specifically, to cross-link membrane protein complexes such as PglK and BtuC2D2. We present clear evidence that NHS esters are capable of stabilizing membrane protein complexes in situ, in the presence of detergents such as DDM, C12E8, and LDAO. The stabilization efficiency strongly depends on the membrane protein structure (i.e, the number of primary amine groups and the distances between primary amines). A minimum number of primary amine groups is required, and the distances between primary amines govern whether a cross-linker with a specific spacer arm length is able to bridge two amine groups.

  6. Evidence and values: paying for end-of-life drugs in the British NHS.

    PubMed

    Chalkidou, Kalipso

    2012-10-01

    In January 2009, Britain's National Institute for Health and Clinical Excellence (NICE), following a very public debate triggered by its decision, six months earlier, provisionally to rule against the adoption by the National Health Service (NHS) of an expensive drug for advanced renal cancer, introduced a new policy for evaluating pharmaceuticals for patients nearing the end of their lives. NICE's so-called end-of-life (EOL) guidance for its Committees effectively advises them to deviate from the Institute's threshold range and to value the lives of (mostly) dying cancer patients more than the lives of those suffering from other, potentially curable, chronic or acute conditions. This article tells the story of the EOL guidance. Through looking at specific EOL decisions between 2009 and 2011 and the reactions by stakeholders to these decisions and the policy itself, it discusses the triggers for NICE's EOL guidance, the challenges NICE faces in implementing it and the policy's putative implications for the future role of NICE in the NHS, especially in the context of value-based reforms in the pricing and evaluation of pharmaceuticals, currently under consideration. PMID:23079299

  7. Positron annihilation Doppler broadening spectroscopy study on Fe-ion irradiated NHS steel

    NASA Astrophysics Data System (ADS)

    Zhu, Huiping; Wang, Zhiguang; Gao, Xing; Cui, Minghuan; Li, Bingsheng; Sun, Jianrong; Yao, Cunfeng; Wei, Kongfang; Shen, Tielong; Pang, Lilong; Zhu, Yabin; Li, Yuanfei; Wang, Ji; Song, Peng; Zhang, Peng; Cao, Xingzhong

    2015-02-01

    In order to study the evolution of irradiation-induced vacancy-type defects at different irradiation fluences and temperatures, a new type of ferritic/martensitic (F/M) steel named NHS (Novel High Silicon) was irradiated by 3.25 MeV Fe-ion at room temperature and 723 K to fluences of 4.3 × 1015 and 1.7 × 1016 ions/cm2. After irradiation, vacancy-type defects were investigated with variable-energy positron beam Doppler broadening spectra. Energetic Fe-ions produced a large number of vacancy-type defects in the NHS steel, but one single main type of vacancy-type defect was observed in both unirradiated and irradiated samples. The concentration of vacancy-type defects decreased with increasing temperature. With the increase of irradiation fluence, the concentration of vacancy-type defects increased in the sample irradiated at RT, whereas for the sample irradiated at 723 K, it decreased. The enhanced recombination between vacancies and excess interstitial Fe atoms from deeper layers, and high diffusion rate of self-interstitial atoms further improved by diffusion via grain boundary and dislocations at high temperature, are thought to be the main reasons for the reversed trend of vacancy-type defects between the samples irradiated at RT and 723 K.

  8. Developing a market orientation in the Health Service: a survey of acute NHS Trusts in Scotland.

    PubMed

    Laing, A W; Galbraith, A

    1996-01-01

    Argues that the introduction of the quasi market mechanism into the Health Service has required that managers within NHS trusts acquire new managerial skills relating to market operations and, more importantly, reorientate their organizations towards the marketplace. Examines the pattern of development which has occurred within acute trusts across Scotland in the past three years, and argues that managers in the majority of trusts have developed a remarkably robust and relevant conceptualization of the nature and application of marketing within the NHS, reflecting the difficulties managers have faced in selling the concept of marketing to a generally sceptical body of clinicians. Notes, in part owing to such professional scepticism, that the development of marketing as an implementable approach to operations has lagged significantly behind the managerial conceptualization, although this cannot be attributed solely to resistance from clinicians and other health care professionals. Rather, suggests that such limited progress in implementing a market orientation reflects a range of "structural" barriers, both within individual trusts and the specific market environment faced by trusts. PMID:10162938

  9. Chemical cross-linking with NHS esters: a systematic study on amino acid reactivities.

    PubMed

    Mädler, Stefanie; Bich, Claudia; Touboul, David; Zenobi, Renato

    2009-05-01

    Structure elucidation of tertiary or quaternary protein structures by chemical cross-linking and mass spectrometry (MS) has recently gained importance. To locate the cross-linker modification, dedicated software is applied to analyze the mass or tandem mass spectra (MS/MS). Such software requires information on target amino acids to limit the data analysis time. The most commonly used homobifunctional N-hydroxy succinimide (NHS) esters are often described as reactive exclusively towards primary amines, although side reactions with tyrosine and serine have been reported. Our goal was to systematically study the reactivity of NHS esters and derive some general rules for their attack of nucleophilic amino acid side chains in peptides. We therefore studied the cross-linking reactions of synthesized and commercial model peptides with disuccinimidyl suberate (DSS). The first reaction site in all cases was expectedly the alpha-NH(2)-group of the N-terminus or the epsilon-NH(2)-group of lysine. As soon as additional cross-linkers were attached or loops were formed, other amino acids were also involved in the reaction. In addition to the primary amino groups, serine, threonine and tyrosine showed significant reactivity due to the effect of neighboring amino acids by intermediate or permanent Type-1 cross-link formation. The reactivity is highly dependent on the pH and on adjacent amino acids. PMID:19132714

  10. Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience.

    PubMed Central

    Gray, N; Womack, C; Jack, S J

    1999-01-01

    NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future. PMID:10474514

  11. A national framework for flood forecasting model assessment for use in operations and investment planning over England and Wales

    NASA Astrophysics Data System (ADS)

    Moore, Robert J.; Wells, Steven C.; Cole, Steven J.

    2016-04-01

    -wide coverage across the fluvial rivers of England and Wales, which can be assessed at gauged sites. Thus the performance of the national G2G model forecasts can be directly compared with that from the local models. The Performance Summary for each site model is complemented by a national spatial analysis of model performance stratified by model-type, geographical region and forecast lead-time. The map displays provide an extensive evidence-base that can be interrogated, through a Flood Forecasting Model Performance web portal, to reveal fresh insights into comparative performance across locations, lead-times and models. This work was commissioned by the Environment Agency in partnership with Natural Resources Wales and the Flood Forecasting Centre for England and Wales.

  12. UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender, ethnicity and disability

    PubMed Central

    Surman, Geraldine; Goldacre, Michael

    2014-01-01

    Objectives To seek doctors’ views about the NHS as an employer, our surveys about doctors’ career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good ‘equal opportunities’ employer for women doctors, doctors from ethnic minority groups and doctors with disabilities. Design and Setting Surveys undertaken in the UK by mail and Internet. Participants UK medical graduates in selected graduation years between 1993 and 2012. Main outcome measures Respondents were asked to rate their level of agreement with three statements starting ‘The NHS is a good equal opportunities employer for…’ and ending ‘women doctors’, ‘doctors from ethnic minorities’ and ‘doctors with disabilities’. Results Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000–2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities. Conclusions Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern. PMID:25271275

  13. Developing and implementing the community nursing research strategy for Wales.

    PubMed

    Kenkre, Joyce; Wallace, Carolyn; Davies, Robyn; Bale, Sue; Thomas, Sue

    2013-11-01

    In order to obtain the best patient outcomes in community nursing, practice needs to be underpinned by robust research-based evidence. This article describes a Community Nursing Research Strategy developed and implemented in Wales to provide the nursing profession with the evidence to support future organisational and professional change in achieving excellence in the community. This was developed in partnership with education, research, health services, workforce planning and Government using consensus methodology (specifically, a nominal group technique). Consequently, the process was inclusive and included three steps: escalating presentation of ideas, topic debate and topic rating. The result was a strategy with four implementation strands, including a virtual network, research portfolio, application to practice and leadership. PMID:24471230

  14. Multi-decadal climate variability, New South Wales, Australia.

    PubMed

    Franks, S W

    2004-01-01

    Traditional hydrological risk estimation has treated the observations of hydro-climatological extremes as being independent and identically distributed, implying a static climate risk. However, recent research has highlighted the persistence of multi-decadal epochs of distinct climate states across New South Wales (NSW), Australia. Climatological studies have also revealed multi-decadal variability in the magnitude and frequency of El Niño/Southern Oscillation (ENSO) impacts. In this paper, examples of multi-decadal variability are presented with regard to flood and drought risk. The causal mechanisms for the observed variability are then explored. Finally, it is argued that the insights into climate variability provide (a) useful lead time for forecasting seasonal hydrological risk, (b) a strong rationale for a new framework for hydrological design and (c) a strong example of natural climate variability for use in the testing of General Circulation Models of climate change. PMID:15195429

  15. Evaluating the Labour Government's English NHS health system reforms: the 2008 Darzi reforms.

    PubMed

    Mays, Nicholas

    2013-10-01

    Starting in 2002, the UK Labour Government of 1997-2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase patients' choices of the place of elective hospital care and encourage competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. In June 2008, the White Paper, High quality care for all, was published. It represented the government's desire to focus the next phase of health care system reform in England as much on the quality of care as on improving its responsiveness and efficiency. The 2008 White Paper led to the commissioning of a further wave of evaluative research under the auspices of HREP, as follows: an evaluation of the implementation and outcomes of care planning for people with long-term conditions; an evaluation of the personal health budget pilots; an evaluation of the implementation and outcomes of the Commissioning for Quality and Innovation (CQUIN) framework; and an evaluation of cultural and behavioural change in the NHS focused on ensuring high quality care for all. This Supplement includes papers from each project. The evaluations present a mixed picture of the impact and success of the 2008 reforms. All the studies identify some limitations of the policies in the White Paper. The introduction of personal health budgets appears to have been the least problematic and, depending on assumptions, likely to be cost-effective for the sorts of patients involved in the pilot. For the rest of the changes, impacts ranged from little or none (CQUIN and care planning for people with chronic conditions) to patchy and highly variable (instilling a culture of quality in acute hospitals) in the three years following the publication of the White Paper. On the other hand, each of the studies identifies important insights relevant to modifying

  16. Wolves and Big Yellow Taxis: How Would Be Know If the NHS Is at Death's Door?: Comment on "Who killed the English National Health Service?".

    PubMed

    Greener, Ian

    2015-10-01

    Martin Powell suggests that the death of the English National Health Service (NHS) has been announced so many times we are at risk of not noticing should it actually happen. He is right. If we 'cry wolf' too many times, we risk losing sight of what is important about the NHS and why. PMID:26673181

  17. Setting health care capitations through diagnosis-based risk adjustment: a suitable model for the English NHS?

    PubMed

    Asthana, Sheena; Gibson, Alex

    2011-07-01

    The English system of health resource allocation has been described as the apotheosis of the area-level approach to setting health care capitations. However, recent policy developments have changed the scale at which commissioning decisions are made (and budgets allocated) with important implications for resource allocation. Doubts concerning the legitimacy of applying area-based formulae used to distribute resources between Primary Care Trusts (PCTs) to the much smaller scale required by Practice Based Commissioning (PBC) led the English Department of Health (DH) to introduce a new approach to setting health care budgets. To this end, practice-level allocations for acute services are now calculated using a diagnosis-based capitation model of the kind used in the United States and several other systems of competitive social health insurance. The new Coalition Government has proposed that these budgets are directly allocated to GP 'consortia', the new commissioning bodies in the NHS. This paper questions whether this is an appropriate development for a health system in which the major objective of resource allocation is to promote equal opportunity of access for equal needs. The chief reservation raised is that of circularity and the perpetuation of resource bias, the concern being that an existing social, demographic and geographical bias in the use of health care resources will be reinforced through the use of historic utilisation data. Demonstrating that there are legitimate reasons to suspect that this will be the case, the paper poses the question whether health systems internationally should more openly address the key limitations of empirical methods that select risk adjusters on the basis of existing patterns of health service utilisation. PMID:21093953

  18. 75 FR 22832 - Lake Wales Ridge National Wildlife Refuge, Highlands and Polk Counties, FL

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-30

    ..., 2008 (73 FR 35149). For more about the refuge and our CCP process, please see that notice. Lake Wales... frequencies would be reduced to provide for the production of saw palmetto for use as forage by...

  19. Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

    PubMed

    Desombre, T; Eccles, G

    1998-01-01

    This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction. PMID:10177367

  20. Complexity in the new NHS: longitudinal case studies of CCGs in England

    PubMed Central

    Checkland, Katherine; Coleman, Anna; Perkins, Neil

    2016-01-01

    Objective The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be ‘bottom up’ with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged. Design Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures. Setting/participants In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings. Results Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs. Conclusions The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a ‘membership’ organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of ‘membership’ raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning. PMID:26743708

  1. Method of invitation and geographical proximity as predictors of NHS Health Check uptake

    PubMed Central

    Gidlow, Christopher; Ellis, Naomi; Randall, Jason; Cowap, Lisa; Smith, Graham; Iqbal, Zafar; Kumar, Jagdish

    2015-01-01

    Background Uptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities. Methods This observational cohort study used data from all 4855 individuals invited for an NHS Health Check (September 2010–February 2014) at five general practices in Stoke-on-Trent, UK. Attendance/non-attendance was the binary outcome variable. Predictor variables included the method of invitation, general practice, demographics, deprivation and distance to Health Check location. Results Mean attendance (61.6%) was above the city and national average, but varied by practice (47.5–83.3%; P < 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR = 2.87, 95% CI = 2.26–3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR = 1.04, 95% CI = 1.03–1.04), female gender (OR = 1.48, 95% CI = 1.30–1.68) and living in the least deprived areas (OR = 1.59, 95% CI = 1.23–2.05) were all independent positive predictors of attendance. Conclusions Using verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations. PMID:25427882

  2. A Safe Place to Stay Sharp: Action Learning Meets Cooperative Inquiry in the Service of NHS OD Capacity Building

    ERIC Educational Resources Information Center

    Traeger, James; Norgate, Carolyn

    2015-01-01

    This is an account of practice. It explores the meeting point between action learning and action research, as a way of doing capacity building in organisational development (OD) in the NHS in the UK. The authors were part of a short cooperative inquiry (Heron, J. 1996. "Co-operative Inquiry: Research into the Human Condition." London:…

  3. Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

    PubMed

    Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

    2013-11-01

    This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems. PMID:25595009

  4. Healthcare identities at the crossroads of service modernisation: the transfer of NHS clinicians to the independent sector?

    PubMed

    Waring, Justin; Bishop, Simon

    2011-07-01

    Health policies increasingly support private businesses to take an active role in the organisation and delivery of public healthcare services. For the English NHS, this is exemplified by the introduction of Independent Sector Treatment Centres. A number of these facilities involve the wholesale secondment of NHS clinicians to the private sector which, we suggest, raises important questions about the identities of healthcare professionals accustomed to working in the public sector. Our paper investigates this transition highlighting three prominent discontinuities in clinical work: the ethos of private sector ownership, new lines of authority and fragmented relationships. Drawing on Giddens, we examine how clinicians experience and interpret these changes and how they keep their biographical 'narrative going'. The 'pioneers' interpreted the independent sector as an opportunity to re-invigorate their practice through new roles, relationships and higher quality care; the 'guardians' as an opportunity to replicate and protect the customs and standards of the NHS in the private sector; whilst the 'marooned' longed to return to the NHS. Our study illustrates how the sectoral context can shape healthcare identities, and how contemporary reforms aimed at promoting partnerships across public and private sectors can have profound implications for clinicians. PMID:21314688

  5. Leadership development in UK companies at the beginning of the twenty-first century: lessons for the NHS?

    PubMed

    Alimo-Metcalfe, B; Lawler, J

    2001-01-01

    States that the development of leadership in the NHS is currently high on the agenda of the Department of Health, the government and local health sector organisations. Reports the findings of a study of public and private sector organisations, exploring the development of their in-house leadership skills. Outlines the findings in depth and discusses the implications for health organisations. PMID:11765321

  6. A systematic analysis of DMTMM vs EDC/NHS for ligation of amines to hyaluronan in water.

    PubMed

    D'Este, Matteo; Eglin, David; Alini, Mauro

    2014-08-01

    The activation of carboxyl groups with N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride and N-hydroxysuccinimide (EDC/NHS) for amide formation is the standard method for amine ligation to hyaluronan (HA), and a very well established wide-ranging bioconjugation method. In this paper we compare 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMTMM) to EDC/NHS activation chemistry for HA ligation using an array of substrates including small, large and functional molecules. For all the substrates tested DMTMM yields were superior at parity of feed ratio. DMTMM chemistry resulted effective also in absence of pH control, which is essential for EDC/NHS conjugation. Overall our results demonstrate that DMTMM is more efficient than EDC/NHS for ligation of amines to HA and does not require accurate pH control or pH shift during the reaction to be effective. DMTMM-mediated ligation is a new promising chemical tool to synthesize HA derivatives for biomedical and pharmaceutical applications. PMID:24751270

  7. Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales

    PubMed Central

    Dougan, S; Elford, J; Rice, B; Brown, A; Sinka, K; Evans, B; Gill, O; Fenton, K

    2005-01-01

    Objectives: To examine the epidemiology of HIV among black and minority ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W). Methods: Ethnicity data from two national HIV/AIDS surveillance systems were reviewed (1997–2002 inclusive), providing information on new HIV diagnoses and those accessing NHS HIV treatment and care services. In addition, undiagnosed HIV prevalence among MSM attending 14 genitourinary medicine (GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring Programme and having routine syphilis serology was examined by world region of birth. Results: Between 1997 and 2002, 1040 BME MSM were newly diagnosed with HIV in E&W, representing 12% of all new diagnoses reported among MSM. Of the 1040 BME MSM, 27% were black Caribbean, 12% black African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44% other/mixed. Where reported (n = 395), 58% of BME MSM were probably infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4% to 12.5%) of BME MSM aged 16–44 in E&W were living with diagnosed HIV in 2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM (p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and 2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11.7% to 20.8%), while among MSM born in other regions it remained below 6.0%. Conclusions: Between 1997–2002, BME MSM accounted for just over one in 10 new HIV diagnoses among MSM in E&W; more than half probably acquired their infection in the United Kingdom. In 2002, the proportion of BME MSM living with diagnosed HIV in E&W was significantly higher than white MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These data confirm the need to remain alert to the sexual health needs and evolving epidemiology of HIV among BME MSM in E&W. PMID:16061545

  8. A history of Soil Survey in England and Wales

    NASA Astrophysics Data System (ADS)

    Hallett, S.; Deeks, L.

    2012-04-01

    Early soil mapping in Britain was dominated, as in the USA, by soil texture with maps dating back to the early 1900's identifying surface texture and parent rock materials. Only in the 1920's did Dokuchaev's work in Russia involving soil morphology and the development of the soil profile start to gain popularity, drawing in the influence of climate and topography on pedogenesis. Intentions to create a formal body at this time responsible for soil survey were not implemented and progress remained slow. However, in 1939 definite steps were taken to address this and the soil survey was created. In 1947, its activities were transferred from Bangor to the research branch of the Rothamsted experimental station in Hertfordshire under Professor G.W. Robinson. Soon after, a number of regional offices were also established to act as a link with the National Agricultural Advisory Service. At this time a Pedology Department was established at Rothamsted, focussing on petrological, X-ray, spectrographic and chemical analyses. Although not a Rothamsted Department itself, the Survey did fall under the 'Lawes Agricultural Trust'. A Soil Survey Research Advisory Board was also formed to act as a liaison with the Agricultural Field Council. In Scotland by contrast, soil survey activities became centred on the Macaulay Institute in Aberdeen. Developments in the survey of British soils were accompanied in parallel by the development of soil classification systems. In 1930 a Soils Correlation Committee had been formed to ensure consistency in methods and naming of soil series and to ensure the classification was applied uniformly. In England and Wales the zonal system adopted was similar to that used in the USA, where soil series were named after the location where they were first described. American soil scientists such as Veitch and Lee provided stimulus to the development of mapping methods. In Scotland a differing classification was adopted, being similar to that used in Canada

  9. Corneal Stromal Cell Growth on Gelatin/Chondroitin Sulfate Scaffolds Modified at Different NHS/EDC Molar Ratios

    PubMed Central

    Lai, Jui-Yang

    2013-01-01

    A nanoscale modification strategy that can incorporate chondroitin sulfate (CS) into the cross-linked porous gelatin materials has previously been proposed to give superior performance for designed corneal keratocyte scaffolds. The purpose of this work was to further investigate the influence of carbodiimide chemistry on the characteristics and biofunctionalities of gelatin/CS scaffolds treated with varying N-hydroxysuccinimide (NHS)/1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide hydrochloride (EDC) molar ratios (0–1) at a constant EDC concentration of 10 mM. Results of Fourier transform infrared spectroscopy and dimethylmethylene blue assays consistently indicated that when the NHS to EDC molar ratio exceeds a critical level (i.e., 0.5), the efficiency of carbodiimide-mediated biomaterial modification is significantly reduced. With the optimum NHS/EDC molar ratio of 0.5, chemical treatment could achieve relatively high CS content in the gelatin scaffolds, thereby enhancing the water content, glucose permeation, and fibronectin adsorption. Live/Dead assays and interleukin-6 mRNA expression analyses demonstrated that all the test samples have good cytocompatibility without causing toxicity and inflammation. In the molar ratio range of NHS to EDC from 0 to 0.5, the cell adhesion ratio and proliferation activity on the chemically modified samples significantly increased, which is attributed to the increasing CS content. Additionally, the materials with highest CS content (0.143 ± 0.007 nmol/10 mg scaffold) showed the greatest stimulatory effect on the biosynthetic activity of cultivated keratocytes. These findings suggest that a positive correlation is noticed between the NHS to EDC molar ratio and the CS content in the biopolymer matrices, thereby greatly affecting the corneal stromal cell growth. PMID:23337203

  10. Neural tube defects in New South Wales, Australia

    PubMed Central

    Field, Barbara

    1978-01-01

    Cases of spina bifida cystica, encephalocele, and anencephaly occurring over a 9-year period, 1965 to 1973, in New South Wales, Australia, were identified. A low frequency of 1·1 for spina bifida and encephalocele (SB) and 0·9 for anencephaly (A) was found. Secular trends parallel to those observed in the northern hemisphere were noted. Detailed analysis of 1575 cases showed an excess of births in spring, corresponding with conception in the summer months, after correction for shorter gestation in anencephalus, which varies from the peak of spring conceptions observed in British studies. An excess of female cases for each abnormality and a social class effect with a deficit of cases in classes I and II and an excess in classes IV and V and ex-nuptial births were apparent. The first birth rank for younger mothers did not show a significantly increased risk; however, the effect of high birth rank and older maternal age was more significant. Migration studies showed that in migrating from areas of high incidence these parents maintain a higher risk than the Australian population. The highest risk group was that in which both parents were born in the UK, and the next highest that in which an English-born mother was married to an Australian father. Mothers from Malta, and either or both parents from Lebanon, Egypt, and Austria were also at high risk. Part-aboriginal children had a higher risk rate for ASB than white Australian children. The proportion of older sibs affected was 4·12% of sibs of both sexes of an index case of spina bifida, and 3·19% of an index case of anencephaly. The abnormalities alternate or recur in families. An increased perinatal mortality rate in sibs was shown. Twin studies showed a higher concordance rate for monochorionic pairs. A sequential interaction in an excess of opposite sex sib before an index case was apparent. The results of this study support a multifactorial aetiology for ASB resulting from genetic environmental interaction

  11. Designing a national soil erosion monitoring network for England and Wales

    NASA Astrophysics Data System (ADS)

    Lark, Murray; Rawlins, Barry; Anderson, Karen; Evans, Martin; Farrow, Luke; Glendell, Miriam; James, Mike; Rickson, Jane; Quine, Timothy; Quinton, John; Brazier, Richard

    2014-05-01

    Although soil erosion is recognised as a significant threat to sustainable land use and may be a priority for action in any forthcoming EU Soil Framework Directive, those responsible for setting national policy with respect to erosion are constrained by a lack of robust, representative, data at large spatial scales. This reflects the process-orientated nature of much soil erosion research. Recognising this limitation, The UK Department for Environment, Food and Rural Affairs (Defra) established a project to pilot a cost-effective framework for monitoring of soil erosion in England and Wales (E&W). The pilot will compare different soil erosion monitoring methods at a site scale and provide statistical information for the final design of the full national monitoring network that will: provide unbiased estimates of the spatial mean of soil erosion rate across E&W (tonnes ha-1 yr-1) for each of three land-use classes - arable and horticultural grassland upland and semi-natural habitats quantify the uncertainty of these estimates with confidence intervals. Probability (design-based) sampling provides most efficient unbiased estimates of spatial means. In this study, a 16 hectare area (a square of 400 x 400 m) positioned at the centre of a 1-km grid cell, selected at random from mapped land use across E&W, provided the sampling support for measurement of erosion rates, with at least 94% of the support area corresponding to the target land use classes. Very small or zero erosion rates likely to be encountered at many sites reduce the sampling efficiency and make it difficult to compare different methods of soil erosion monitoring. Therefore, to increase the proportion of samples with larger erosion rates without biasing our estimates, we increased the inclusion probability density in areas where the erosion rate is likely to be large by using stratified random sampling. First, each sampling domain (land use class in E&W) was divided into strata; e.g. two sub

  12. The Stone-Wales transformation: from fullerenes to graphite, from radiation damage to heat capacity.

    PubMed

    Heggie, M I; Haffenden, G L; Latham, C D; Trevethan, T

    2016-09-13

    The Stone-Wales (SW) transformation, or carbon-bond rotation, has been fundamental to understanding fullerene growth and stability, and ab initio calculations show it to be a high-energy process. The nature and topology of the fullerene energy landscape shows how the Ih-C60 must be the final product, if SW transformations are fast enough, and various mechanisms for their catalysis have been proposed. We review SW transformations in fullerenes and then discuss the analogous transformation in graphite, where they form the Dienes defect, originally posited to be a transition state in the direct exchange of a bonded atom pair. On the basis of density functional theory calculations in the local density approximation, we propose that non-equilibrium concentrations of the Dienes defect arising from displacing radiation are rapidly healed by point defects and that equilibrium concentrations of Dienes defects are responsible for the divergent ultra-high-temperature heat capacity of graphite.This article is part of the themed issue 'Fullerenes: past, present and future, celebrating the 30th anniversary of Buckminster Fullerene'. PMID:27501968

  13. Modeling chloride transport using travel time distributions at Plynlimon, Wales

    NASA Astrophysics Data System (ADS)

    Benettin, Paolo; Kirchner, James W.; Rinaldo, Andrea; Botter, Gianluca

    2015-05-01

    Here we present a theoretical interpretation of high-frequency, high-quality tracer time series from the Hafren catchment at Plynlimon in mid-Wales. We make use of the formulation of transport by travel time distributions to model chloride transport originating from atmospheric deposition and compute catchment-scale travel time distributions. The relevance of the approach lies in the explanatory power of the chosen tools, particularly to highlight hydrologic processes otherwise clouded by the integrated nature of the measured outflux signal. The analysis reveals the key role of residual storages that are poorly visible in the hydrological response, but are shown to strongly affect water quality dynamics. A significant accuracy in reproducing data is shown by our calibrated model. A detailed representation of catchment-scale travel time distributions has been derived, including the time evolution of the overall dispersion processes (which can be expressed in terms of time-varying storage sampling functions). Mean computed travel times span a broad range of values (from 80 to 800 days) depending on the catchment state. Results also suggest that, in the average, discharge waters are younger than storage water. The model proves able to capture high-frequency fluctuations in the measured chloride concentrations, which are broadly explained by the sharp transition between groundwaters and faster flows originating from topsoil layers. This article was corrected on 22 JUN 2015. See the end of the full text for details.

  14. New South Wales annual vaccine-preventable disease report, 2012

    PubMed Central

    Spokes, Paula; Gilmour, Robin

    2014-01-01

    We aim to describe the epidemiology of selected vaccine-preventable diseases in New South Wales (NSW) for 2012. Data from the NSW Notifiable Conditions Information Management System were analysed by: local health district of residence, age, Aboriginality, vaccination status and organism, where available. Risk factor and vaccination status data were collected by public health units for cases following notification under the NSW Public Health Act 2010. The largest outbreak of measles since 1998 was reported in 2012. Pacific Islander and Aboriginal people were at higher risk as were infants less than 12 months of age. Notifications of invasive pneumococcal disease (IPD) in children less than five years declined; however, the overall number of notifications for IPD increased. Mumps case notifications were also elevated. There were no Haemophilus influenzae type b case notifications in children less than five years of age for the first time since the vaccine was introduced. Invasive meningococcal disease case notifications were at their lowest rates since case notification began in 1991. Case notification rates for other selected vaccine-preventable diseases remained stable. Vaccine-preventable disease control is continually strengthening in NSW with notable successes in invasive bacterial infections. However, strengthening measles immunization in Pacific Islander and Aboriginal communities remains essential to maintain measles elimination. PMID:25077033

  15. Impacts of climate change on wheat in England and Wales

    PubMed Central

    Semenov, Mikhail A.

    2008-01-01

    The frequency and magnitude of extreme weather events are likely to increase with global warming. However, it is not clear how these events might affect agricultural crops and whether yield losses resulting from severe droughts or heat stress will increase in the future. The aim of this paper is to analyse changes in the magnitude and spatial patterns of two impact indices for wheat: the probability of heat stress around flowering and the severity of drought stress. To compute these indices, we used a wheat simulation model combined with high-resolution climate scenarios based on the output from the Hadley Centre regional climate model at 18 sites in England and Wales. Despite higher temperature and lower summer precipitation predicted in the UK for the 2050s, the impact of drought stress on simulated wheat yield is predicted to be smaller than that at present, because wheat will mature earlier in a warmer climate and avoid severe summer drought. However, the probability of heat stress around flowering that might result in considerable yield losses is predicted to increase significantly. Breeding strategies for the future climate might need to focus on wheat varieties tolerant to high temperature rather than to drought. PMID:18682360

  16. Specialization in and within sexual offending in England and Wales.

    PubMed

    Howard, Philip D; Barnett, Georgia D; Mann, Ruth E

    2014-06-01

    Existing evidence suggests that offenders tend not to specialize in sexual offending in general but that there is some specialization in particular types of sexual offending. This study examined the sexual histories and reoffending of a large, national data set of offenders convicted of a sexual offense and managed in England and Wales by the National Offender Management Service (N = 14,804). The study found that specialization in sexual offending compared to nonsexual offending was most evident for offenders with convictions for accessing indecent images. We also found considerable evidence of specialization within sexual offending, most notably for noncontact offenders, especially again indecent images offenders. Crossover between sexual offense types was very rare for those with contact adult offenses and for noncontact offenders although those with child contact offenses sometimes crossed over to indecent images reoffending. If specialization within sexual offending exists, the use of single risk assessment instruments to predict all types of sexual recidivism may be less effective than previously assumed. A comparison of different prediction models indicated that some items presently used in one-size-fits-all risk tools to predict any sexual reoffending only effectively predict certain subtypes of sexual offending. Statistically there appear to be some potential benefits to creating specialist risk predictors for different subtypes of offending, but further work is needed to justify the implementation demands that would be caused by abandoning one-size-fits-all tools. PMID:23835742

  17. A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

    PubMed

    Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

    2008-08-01

    Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

  18. Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis

    PubMed Central

    Fulop, Naomi; Protopsaltis, Gerasimos; Hutchings, Andrew; King, Annette; Allen, Pauline; Normand, Charles; Walters, Rhiannon

    2002-01-01

    Objective To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. Design Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. Setting Nine trusts (cross sectional study) and four trusts (case study) in London. Participants 96 interviews with trust board members, other senior managers, clinicians, service managers, and representatives of health authorities, regional office, community health councils, local authorities, other trusts in the area, and primary care groups and trusts. Main outcome measures Stated and unstated drivers, and impact of merger on delivery and development of services, management structures, and staff recruitment, retention, and morale. Effects of difference in trust size before and after the merger. Savings in management costs two years after merger. Results Some important drivers for merger are not publicly stated. Mergers had a negative effect on delivery of services because of a loss of managerial focus on services. Planned developments in services were delayed by at least 18 months. Trusts' larger sizes after mergers had unintended negative consequences, as well as predicted advantages. The tendency for one trust's management team to dominate over the other resulted in tension. No improvement in recruitment or retention of clinical and managerial staff was reported. Perceived differences in organisational culture were an important barrier to bringing together two or more organisations. Two years after merger, merged trusts had not achieved the objective of saving £500 000 a year in management costs. Conclusions Important unintended consequences need to be accounted for when mergers are planned. Mergers can cause considerable disruptions to services, and require greater management support than previously acknowledged. Other organisations undergoing restructuring

  19. Expanded newborn screening in New South Wales: missed cases.

    PubMed

    Estrella, Jane; Wilcken, Bridget; Carpenter, Kevin; Bhattacharya, Kaustuv; Tchan, Michel; Wiley, Veronica

    2014-11-01

    There have been few reports of cases missed by expanded newborn screening. Tandem mass spectrometry was introduced in New South Wales, Australia in 1998 to screen for selected disorders of amino acid, organic acid and fatty acid metabolism. Of 1,500,000 babies screened by 2012, 1:2700 were diagnosed with a target disorder. Fifteen affected babies were missed by testing, and presented clinically or in family studies. In three cases (cobalamin C defect, very-long-chain acyl-CoA dehydrogenase deficiency and glutaric aciduria type 1), this led to modification of analyte cut-off values or protocols during the first 3 years. Two patients with intermittent MSUD, two with β-ketothiolase deficiency, two with citrin deficiency, two siblings with arginosuccinic aciduria, two siblings with homocystinuria, and one with cobalamin C defect had analyte values and ratios below the action limits which could not have been detected without unacceptable false-positive rates. A laboratory interpretation error led to missing one case of cobalamin C defect. Reference ranges, regularly reviewed, were not altered. For citrin deficiency, while relevant metabolites are detectable by tandem mass spectrometry, our cut-off values do not specifically screen for that disorder. Most of the missed cases are doing well and with no acute presentations although eight of 15 are likely to have been somewhat adversely affected by a late diagnosis. Analyte ratio and cut-off value optimisations are important, but for some disorders occasional missed cases may have to be tolerated to maintain an acceptable specificity, and avoid harm from screening. PMID:24970580

  20. An investigation of the suitability of the EFQM Excellence Model for a pharmacy department within an NHS Trust.

    PubMed

    Stewart, Ann

    2003-01-01

    Explores whether the EFQM Excellence Model provides a suitable framework for quality management within the pharmacy department at Hope Hospital, Salford Royal Hospitals NHS Trust. Research involved a literature search of the work of authors in the field of quality, generically and in healthcare, the development of quality awards, and practical cases of implementation of the model in NHS Trusts. Common themes were identified from this search. Interviews with staff and customers showed high levels of customer awareness, customer satisfaction and generic training. This was compared with the data from the literature search and the researcher's observations. The Excellence Model was seen to be a suitable framework for quality management provision, although there was little knowledge of it in the pharmacy department. A quality service was still being provided in spite of this, but the model could build further on this good work and provide a more structured approach. PMID:12870245

  1. Artificial intelligence techniques to optimize the EDC/NHS-mediated immobilization of cellulase on Eudragit L-100.

    PubMed

    Zhang, Yu; Xu, Jing-Liang; Yuan, Zhen-Hong; Qi, Wei; Liu, Yun-Yun; He, Min-Chao

    2012-01-01

    Two artificial intelligence techniques, namely artificial neural network (ANN) and genetic algorithm (GA) were combined to be used as a tool for optimizing the covalent immobilization of cellulase on a smart polymer, Eudragit L-100. 1-Ethyl-3-(3-dimethyllaminopropyl) carbodiimide (EDC) concentration, N-hydroxysuccinimide (NHS) concentration and coupling time were taken as independent variables, and immobilization efficiency was taken as the response. The data of the central composite design were used to train ANN by back-propagation algorithm, and the result showed that the trained ANN fitted the data accurately (correlation coefficient R(2) = 0.99). Then a maximum immobilization efficiency of 88.76% was searched by genetic algorithm at a EDC concentration of 0.44%, NHS concentration of 0.37% and a coupling time of 2.22 h, where the experimental value was 87.97 ± 6.45%. The application of ANN based optimization by GA is quite successful. PMID:22942683

  2. The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust

    PubMed Central

    Peacock, M

    2013-01-01

    Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy. PMID:27433195

  3. Mentally abnormal prisoners on remand: I—Rejected or accepted by the NHS?

    PubMed Central

    Coid, Jeremy W

    1988-01-01

    Increasing numbers of mentally abnormal offenders are sentenced to prison. The decision to treat or imprison them is influenced by the attitudes of consultant psychiatrists and their staff. The process whereby those decisions were made and the willingness of consultants to offer treatment were investigated. A retrospective survey of all (362) mentally abnormal men remanded to Winchester prison for psychiatric reports over the five years 1979-83 showed that one in five were rejected for treatment by the NHS consultant psychiatrist responsible for their care. Those with mental handicaps, organic brain damage, or a chronic psychotic illness rendering them unable to cope independently in the community were the most likely to be rejected. They posed the least threat to the community in terms of their criminal behaviour yet were more likely to be sentenced to imprisonment. Such subjects were commonly described by consultants as too disturbed or potentially dangerous to be admitted to hospital or as criminals and unsuitable for treatment. Consultants in mental hospitals were most likely and those in district general hospitals and academic units least likely to accept prisoners. The fact that many mentally ill and mentally handicapped patients can receive adequate care and treatment only on reception into prison raises serious questions about the adequacy of current management policies and the range of facilities provided by regional health authorities. PMID:3136837

  4. Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

    PubMed

    Blake, Holly; Lloyd, Scott

    2008-01-01

    This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes. PMID:19094421

  5. Environmental aspects of health care in the Grampian NHS region and the place of telehealth

    PubMed Central

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact – although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579

  6. Environmental aspects of health care in the Grampian NHS region and the place of telehealth.

    PubMed

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO(2) per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO(2) per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact--although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579

  7. Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings

    PubMed Central

    Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

    2012-01-01

    The recent turmoil within the banking sector has led to the development of the most significant recession since the “great depression” of the 1930s. Although the coalition government has promised to “guarantee that health spending increases in real terms in each year of Parliament”, this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS. PMID:22167516

  8. Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings.

    PubMed

    Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

    2012-06-01

    The recent turmoil within the banking sector has led to the development of the most significant recession since the "great depression" of the 1930s. Although the coalition government has promised to "guarantee that health spending increases in real terms in each year of Parliament", this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS. PMID:22167516

  9. The effect of long-term migration dynamics on population structure in England & Wales and Scotland.

    PubMed

    Murphy, Michael

    2016-07-01

    We investigated the effect of migration on population dynamics in England & Wales and Scotland from the mid-nineteenth century to the present by comparing actual population size and structure with estimates based on zero net migration from a range of starting dates. In this period, Scotland had the largest net outflow among countries in Europe for which detailed information is available, whereas overall net migration in England & Wales was close to zero. In the absence of migration, population would have been over twice as large in Scotland in 2013 as the actual value, but similar to its actual value in England & Wales. Levels and pace of population ageing have been broadly similar in both countries, so the major impact of differential migration has been on population size rather than structure. We discuss these findings in relation to the debate on migration policy between political parties supporting and opposing independence in the 2014 Scottish referendum. PMID:27294474

  10. Gas-Phase Intramolecular Protein Crosslinking via Ion/Ion Reactions: Ubiquitin and a Homobifunctional sulfo-NHS Ester

    PubMed Central

    Webb, Ian K.; Mentinova, Marija; McGee, William M.; McLuckey, Scott A.

    2013-01-01

    Gas-phase intra-molecular crosslinking of protein ubiquitin cations has been demonstrated via ion/ion reactions with anions of a homobifunctional N-hydroxysulfosuccinimide (sulfo-NHS) ester reagent. The ion/ion reaction between multiply-protonated ubiquitin and crosslinker monoanions produces a stable, charge reduced complex. Covalent crosslinking is indicated by the consecutive loss of two molecules of sulfo-NHS under ion trap collisional activation conditions. Covalent modification is verified by the presence of covalently crosslinked sequence ions produced by ion-trap collision-induced dissociation of the ion generated from the losses of sulfo-NHS. Analysis of the crosslinked sequence fragments allows for the localization of crosslinked primary amines, enabling proximity mapping of the gas-phase 3-D structures. The presence of two unprotonated reactive sites within the distance constraint of the crosslinker is required for successful crosslinking. The ability to covalently crosslink is therefore sensitive to protein charge state. As the charge state increases, fewer reactive sites are available and protein structure is more likely to become extended due to intramolecular electrostatic repulsion. At high charge states, the reagent shows little evidence for covalent crosslinking but does show evidence for ‘electrostatic crosslinking’ in that the binding of the sulfonate groups to the protein is sufficiently strong that backbone cleavages are favored over reagent detachment under ion trap collisional activation conditions. PMID:23463545

  11. Gas-phase intramolecular protein crosslinking via ion/ion reactions: ubiquitin and a homobifunctional sulfo-NHS ester.

    PubMed

    Webb, Ian K; Mentinova, Marija; McGee, William M; McLuckey, Scott A

    2013-05-01

    Gas-phase intra-molecular crosslinking of protein ubiquitin cations has been demonstrated via ion/ion reactions with anions of a homobifunctional N-hydroxysulfosuccinimide (sulfo-NHS) ester reagent. The ion/ion reaction between multiply-protonated ubiquitin and crosslinker monoanions produces a stable, charge-reduced complex. Covalent crosslinking is indicated by the consecutive loss of 2 molecules of sulfo-NHS under ion trap collisional activation conditions. Covalent modification is verified by the presence of covalently crosslinked sequence ions produced by ion-trap collision-induced dissociation of the ion generated from the losses of sulfo-NHS. Analysis of the crosslinked sequence fragments allows for the localization of crosslinked primary amines, enabling proximity mapping of the gas-phase 3-D structures. The presence of two unprotonated reactive sites within the distance constraint of the crosslinker is required for successful crosslinking. The ability to covalently crosslink is, therefore, sensitive to protein charge state. As the charge state increases, fewer reactive sites are available and protein structure is more likely to become extended because of intramolecular electrostatic repulsion. At high charge states, the reagent shows little evidence for covalent crosslinking but does show evidence for 'electrostatic crosslinking' in that the binding of the sulfonate groups to the protein is sufficiently strong that backbone cleavages are favored over reagent detachment under ion trap collisional activation conditions. PMID:23463545

  12. Controlling coupling reaction of EDC and NHS for preparation of collagen gels using ethanol/water co-solvents.

    PubMed

    Nam, Kwangwoo; Kimura, Tsuyoshi; Kishida, Akio

    2008-01-01

    To control the crosslinking rate of the collagen gel, ethanol/water co-solvent was adopted for the reaction solvent for the collagen microfibril crosslinking. Collagen gel was prepared by using EDC and NHS as coupling agents. Ethanol did not denaturate the helical structure of the collagen and prevented the hydrolysis of EDC, but showed the protonation of carboxylate anions. In order to control the intra- and interhelical crosslink of the collagen triple helix, variations of the mole ratio of carboxyl group/EDC/NHS, and of the ethanol mole concentration were investigated. Increase in the EDC ratio against the carboxyl group increased the crosslinking rate. Furthermore, an increase in the ethanol mole concentration resulted in an increase of the crosslinking rate until ethanol mole concentration was 0.12, but showed gradual decrease as the ethanol mole concentration was further increased. This is because the adsorption of solvent by the collagen gel, protonation of carboxylate anion, and hydrolysis of EDC is at its most optimum condition for the coupling reaction when the ethanol mole concentration is 0.12. The re-crosslinking of the collagen gel showed an increase in the crosslinking rate, but did not show further increase when the coupling reaction was executed for the third time. This implied that the highest possible crosslinking rate for the intra- and interhelical is approximately 60% when EDC/NHS is used. PMID:18023082

  13. The National Behaviour and Attendance Review (NBAR) in Wales: Findings on School Behaviour from the Professional Perspective

    ERIC Educational Resources Information Center

    Reid, Ken

    2009-01-01

    This paper presents the methodology and some of the findings on school behaviour obtained for the National Behaviour and Attendance Review (NBAR) in Wales. This work was undertaken over two years between 2006 and 2008. The Report was widely circulated in Wales to schools, local authorities, health and social service departments, as well as a wide…

  14. Testing, Training and Tensions: The Expression of Health within Physical Education Curricula in Secondary Schools in England and Wales

    ERIC Educational Resources Information Center

    Harris, Jo; Leggett, Gemma

    2015-01-01

    This paper utilises critical discourse analysis to explore and discuss the expression of health within physical education (PE) curricula in secondary schools in England and Wales. The study adopted a case study approach, involving three state secondary schools in England and two in Wales. Data were drawn from interviews with PE teachers and…

  15. Seasonal variation and time trends in childhood asthma in England and Wales 1975-81.

    PubMed Central

    Khot, A; Burn, R; Evans, N; Lenney, C; Lenney, W

    1984-01-01

    In England and Wales hospital admissions for childhood asthma almost trebled over the period 1975-81. This may have reflected a true increase in the incidence of acute asthma, a swing from primary to hospital care, or both. The trend was not due to a change in diagnostic fashion. Monthly admissions showed a pronounced seasonal variation with fewest admissions in winter, rising in spring and early summer to peak in the autumn. A deep admission trough was present in August. The monthly admission profile was very similar throughout England and Wales, suggesting that major "trigger" factors were responsible. PMID:6430420

  16. International Study of Health Care Organization and Financing of renal services in England and Wales.

    PubMed

    Nicholson, Tricia; Roderick, Paul

    2007-12-01

    In England and Wales, the quantity and quality of renal services have improved significantly in the last decade. While acceptance rates for renal replacement therapy appear low by international standards, they are now commensurate with many other northern European countries. The major growth in renal services has been in hemodialysis, especially at satellite units. Health care is predominantly publicly funded through a tax-based National Health Service, and such funding has increased in the last 10 years. Improvements in health outcomes in England and Wales are expected to continue due to the recent implementation of standards, initiatives, and monitoring mechanisms for renal transplantation, vascular access, and patient transport. PMID:17653861

  17. Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

    PubMed

    Seaton, Andrew

    2015-01-01

    This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful. PMID:26502665

  18. The late devensian and holocene evolution of Barmouth Bay, Wales

    NASA Astrophysics Data System (ADS)

    Larcombe, Piers; Jago, Colin F.

    1994-03-01

    A marine seismic and sedimentological investigation of the Late-Devensian and Holocene sediments of Barmouth Bay, North Wales, was undertaken to reconstruct late-glacial and Holocene sedimentary environments, and to evaluate post-glacial sedimentation rates. In the last glacial, the Devensian, many Welsh estuaries were the sites of valley glaciers flowing from the Welsh Ice cap onto the modern inner-shelf. At Barmouth, the Mawddach valley glacier flowed into the present inner-shelf of Cardigan Bay. The modern courses of the Mawddach Estuary and the river Gwril were overdeepened by erosive sub-glacial flows, and are later infilled by a coarse-grained sub-glacial and pro-glacial infill sequence. With late-glacial relative sea-level rise and retreat of the Welsh Ice, the Mawddach valley tidewater glacier became grounded and confined to the valley. Re-equilibration of the ice profile occurred, and a morainal complex was formed at its toe. In the early Holocene, the morainal complex formed the seaward boundary of a sheltered nearshore basin where fine-grained, partly organic, sediments were deposited in a lagoonal or estuarine environment. Holocene reworking of the sediments by shallow-marine processes has formed a lag surface to the morainal complex, and has introduced gravel of Irish Sea Ice character from offshore. Wave action has formed a shingle coastal barrier, narrowing the mouth of the modern estuary. A shoreface-attached sand wedge, which attains a maximum thickness of 4 m beneath the modern ebb-tidal delta, overlies the lag surface and onlaps the coastal barrier. Since 8-9 ky BP, the mean sediment accumulation rate of estuarine and shallow-marine sediments has been 2.3-3.1 mm/yr, roughly equivalent to the long-term mean rate of sea-level rise for Cardigan Bay. This mean rate masks rapidly increasing accumulation rates in the Mawddach Estuary in the last 5-6 ky, which now may be 82 mm/yr, and which are due to reworking of shoreface and barrier sands into the

  19. Lost to the NHS: a mixed methods study of why GPs leave practice early in England

    PubMed Central

    Doran, Natasha; Fox, Fiona; Rodham, Karen; Taylor, Gordon; Harris, Michael

    2016-01-01

    Background The loss of GPs in the early stages of their careers is contributing to the GP workforce crisis. Recruitment in the UK remains below the numbers needed to support the demand for GP care. Aim To explore the reasons why GPs leave general practice early. Design and setting A mixed methods study using online survey data triangulated with qualitative interviews. Method Participants were GPs aged <50 years who had left the English Medical Performers List in the last 5 years (2009–2014). A total of 143 early GP leavers participated in an online survey, of which 21 took part in recorded telephone interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis techniques. Results Reasons for leaving were cumulative and multifactorial. Organisational changes to the NHS have led to an increase in administrative tasks and overall workload that is perceived by GP participants to have fundamentally changed the doctor–patient relationship. Lack of time with patients has compromised the ability to practise more patient-centred care, and, with it, GPs’ sense of professional autonomy and values, resulting in diminished job satisfaction. In this context, the additional pressures of increased patient demand and the negative media portrayal left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice. Conclusion To improve retention of young GPs, the pace of administrative change needs to be minimised and the time spent by GPs on work that is not face-to-face patient care reduced. PMID:26740606

  20. NHS funded fertility treatment--a national service in name only?

    PubMed

    O'Donnell, Claire; Manché, Marioth; Kingsland, Charles; Haddad, Nabil; Brickwood, Paul

    2005-12-01

    The variable nature of NHS provision of fertility services has again been highlighted by the response of commissioners to the recent guidance from the National Institute of Clinical Excellence. This paper describes an evidence-based model for policy aimed at minimising inequity across one Strategic Health Authority. The paper highlights the difficulties resulting from the current Department of Health guidance on targeting those in greatest need. A different way of describing this group is proposed, namely, defining childlessness in terms of parental status alone. This is clear to both patient and clinician at the outset, not subject to variable interpretation and because it is quantifiable for any given population, facilitates the commissioning of a level of service provision that reflects expressed need. A clinical audit suggests that the annual incidence of fertility problems prompting attendance at secondary care clinics is similar to levels observed nearly 20 years ago, at around 98 per 10,000 of the fertile population (proxy denominator, women aged 25 - 39). Our model further indicates that, for the more complex treatments, if both partners were required to be childless and treatments were to be delivered within 12 - 18 months of listing, commissioners would need to fund treatment for around 15 - 20 patients per 10,000 of the fertile population. If only one partner was required to be childless this figure would rise by 15 - 20%. We argue that despite the clinical guidelines, fertility treatments will remain a 'postcode lottery' unless central government addresses the priority to be given to fertility treatment on a national basis. PMID:16393821

  1. Simulating the effect of land use and climate change on upland soil carbon stock of Wales using ECOSSE

    NASA Astrophysics Data System (ADS)

    Rani Nayak, Dali; Gottschalk, Pia; Evans, Chris; Smith, Pete; Smith, Jo

    2010-05-01

    Within Wales soils hold between 400-500 MtC, over half of this carbon is stored in organic and organo-mineral soil which cover less than 20% of the land area of Wales. It has been predicted that climate change will increasingly have an impact on the C stock of soils in Wales. Higher temperatures will increase the rate of decomposition of organic matter, leading to increased C losses. However increased net primary production (NPP), leading to increased inputs of organic matter, may offset this. Land use plays a major role in determining the level of soil C and the direction of change in status (soil as a source or sink). We present here an assessment of the effect of land use change and climate change on the upland soil carbon stock of Wales in 3 different catchments i.e. Migneint, Plynlimon and Pontbren using a process-based model of soil carbon and nitrogen dynamics, ECOSSE. The uncertainties introduced in the simulations by using only the data available at national scale are determined. The ECOSSE model (1,2) has been developed to simulate greenhouse gas emissions from both organic and mineral soils. ECOSSE was derived from RothC (3) and SUNDIAL (4,5) and predicts the impacts of changes in land use and climate on emissions and soil carbon stock. Simulated changes in soil C are dependent on the type of land use change, the soil type where the land use change is occurring, and the C content of soil under the initial and final land uses. At Migneint and Plynlimon, the major part of the losses occurs due to the conversion of semi-natural land to grassland. Reducing the land use change from semi-natural to grassland is the main measure needed to mitigate losses of soil C. At Pontbren, the model predicts a net gain in soil C with the predicted land use change, so there is no need to mitigate. Simulations of future changes in soil C to 2050 showed very small changes in soil C due to climate compared to changes due to land use change. At the selected catchments, changes

  2. Mapping bare soil in South West Wales, UK, using high resolution colour infra-red aerial photography for water quality and flood risk management applications

    NASA Astrophysics Data System (ADS)

    Sykes, Helena; Neale, Simon; Coe, Sarah

    2016-04-01

    Natural Resources Wales is a UK government body responsible for environmental regulation, among other areas. River walks in Water Framework Directive (WFD) priority catchments in South West Wales, UK, identified soil entering water courses due to poaching and bank erosion, leading to deterioration in the water quality and jeopardising the water quality meeting legal minimum standards. Bare soil has also been shown to cause quicker and higher hydrograph peaks in rural catchments than if those areas were vegetated, which can lead to flooding of domestic properties during peak storm flows. The aim was to target farm visits by operational staff to advise on practices likely to improve water quality and to identify areas where soft engineering solutions such as revegetation could alleviate flood risk in rural areas. High resolution colour-infrared aerial photography, 25cm in the three colour bands and 50cm in the near infrared band, was used to map bare soil in seven catchments using supervised classification of a five band stack including the Normalised Difference Vegetation Index (NDVI). Mapping was combined with agricultural land use and field boundary data to filter out arable fields, which are supposed to bare soil for part of their cycle, and was very successful when compared to ground truthing, with the exception of silage fields which contained sparse, no or unproductive vegetation at the time the imagery was acquired leading to spectral similarity to bare soil. A raindrop trace model was used to show the path sediment from bare soil areas would take when moving through the catchment to a watercourse, with hedgerows inserted as barriers following our observations from ground truthing. The findings have been used to help farmers gain funding for improvements such as fencing to keep animals away from vulnerable river banks. These efficient and automated methods can be rolled out to more catchments in Wales and updated using aerial imagery acquired more recently to

  3. Missions Statements in Wales: The Impact of Markets and Policy on Congruence between Institutions

    ERIC Educational Resources Information Center

    James, Helen; Huisman, Jeroen

    2009-01-01

    This study seeks to compare the mission statements of higher education institutions in Wales as well as to compare these with regional level policy statements and demands from the market. The underlying idea is to reveal the extent to which mission statements actually differ and are (or are not) in line with such regional policies and market…

  4. When School Is Not Enough: New Initiatives in Intergenerational Language Transmission in Wales

    ERIC Educational Resources Information Center

    Edwards, Viv; Newcombe, Lynda Prichard

    2005-01-01

    This paper examines language reproduction in the family in the context of a highly innovative project in Wales, where the Welsh language has been in decline for over a century. Although Welsh-medium schooling has played a pivotal role in slowing and even reversing language shift in recent decades, there is mounting evidence of the dangers of …

  5. Policy, Politics, Parsimony and Pragmatism: The State and the Rural School in Colonial New South Wales.

    ERIC Educational Resources Information Center

    Kyle, Noeline

    1990-01-01

    Provides a case study on rural schooling in New South Wales. Focuses on the dimensions of class, race, and gender and their relationship to educational quality and equality. Elaborates on the effects of state educational policy on teachers, pupils, and communities. Maintains that educational policy was guided by a pragmatist philosophy. (RW)

  6. School Expenditure and School Performance: Evidence from New South Wales Schools Using a Dynamic Panel Analysis

    ERIC Educational Resources Information Center

    Pugh, G.; Mangan, J.; Blackburn, V.; Radicic, D.

    2015-01-01

    This article estimates the effects of school expenditure on school performance in government secondary schools in New South Wales, Australia over the period 2006-2010. It uses dynamic panel analysis to exploit time series data on individual schools that only recently has become available. We find a significant but small effect of expenditure on…

  7. Density and abundance of badger social groups in England and Wales in 2011-2013

    NASA Astrophysics Data System (ADS)

    Judge, Johanna; Wilson, Gavin J.; MacArthur, Roy; Delahay, Richard J.; McDonald, Robbie A.

    2014-01-01

    In the United Kingdom, European badgers Meles meles are a protected species and an important wildlife reservoir of bovine tuberculosis. We conducted a survey of badger dens (main setts) in 1614 1 km squares across England and Wales, between November 2011 and March 2013. Using main setts as a proxy for badger social groups, the estimated mean density of badger social groups in England and Wales was 0.485 km-2 (95% confidence interval 0.449-0.521) and the estimated abundance of social groups was 71,600 (66,400-76,900). In the 25 years since the first survey in 1985-88, the annual rate of increase in the estimated number of badger social groups was 2.6% (2.2-2.9%), equating to an 88% (70-105%) increase across England and Wales. In England, we estimate there has been an increase of 103% (83-123%) in badger social groups, while in Wales there has been little change (-25 to +49%).

  8. Leadership Succession in New South Wales Catholic Schools: Identifying Potential Principals.

    ERIC Educational Resources Information Center

    Dorman, Jeffrey P.; D'Arbon, Tony

    2003-01-01

    Reports on research conducted on leadership succession in New South Wales Catholic schools in order to identify potential principals using data collected from middle and senior management staff (n=943). Explains that short-term targeting of this population may be helpful, but impediments to leadership succession need to be addressed. (CMK)

  9. Diagnostic Trends in Autistic Spectrum Disorders in the South Wales Valleys

    ERIC Educational Resources Information Center

    Latif, A. H. A.; Williams, W. R.

    2007-01-01

    This study provides an analysis of the diagnostic trends in autistic spectrum disorder (ASD) for children aged under 17 years in the Rhondda and Taff Ely districts of South Wales. In the period 1988-2004, 336 children received a diagnosis of ASD and represent the case registry data of one community pediatric team. For the period 1994-2003, the…

  10. A Novel Whiteheadean Science Program for 14-16 Year Olds in England and Wales

    ERIC Educational Resources Information Center

    Akeroyd, Michael

    2007-01-01

    A novel "Whiteheadean" science program was initiated in England and Wales in September 2006. Following a critical House of Commons report in 2002, the government altered the National Curriculum targets and thus forced the Examination Boards to alter their specifications in order to come in line. Assessment at GCSE level (i.e., the 14-16 year…

  11. Women's Work or Creative Work? Embroidery in New South Wales High Schools

    ERIC Educational Resources Information Center

    Wood, Susan

    2009-01-01

    Embroidery is traditionally regarded as women's work and the teaching of embroidery as a means of preparing young women for domesticity, a view which has been reinforced by historians studying changes in the high school art curriculum that occurred with the introduction of the Wyndham Scheme in New South Wales in the early 1960s. This paper argues…

  12. The Social Context of School Bullying: Evidence from a Survey of Children in South Wales

    ERIC Educational Resources Information Center

    Lambert, Paul; Scourfield, Jonathan; Smalley, Nina; Jones, Raya

    2008-01-01

    The article presents a descriptive review of the various patterns of association with school bullying that were revealed in a survey of over 26,000 children aged 11-16 in South Wales. The survey examined risks and protective factors for young people and included a question about being a bully and another about being bullied. Following regression…

  13. The Effects of National Testing in Science at Key Stage 2 in England and Wales

    ERIC Educational Resources Information Center

    Collins, Sue; Reiss, Michael; Stobart, Gordon

    2009-01-01

    In this article, the authors describe a research project designed to explore the effects of science testing in Year 6 (age 11) in England and implications of the abolition of testing in Wales since 2004. The research was commissioned by the Welcome Trust in association with the ASE to inform representation to the House of Commons Select Committee…

  14. An Analysis of Misconceptions in Science Textbooks: Earth Science in England and Wales

    ERIC Educational Resources Information Center

    King, Chris John Henry

    2010-01-01

    Surveys of the earth science content of all secondary (high school) science textbooks and related publications used in England and Wales have revealed high levels of error/misconception. The 29 science textbooks or textbook series surveyed (51 texts in all) showed poor coverage of National Curriculum earth science and contained a mean level of one…

  15. An Alternative Reading of Modern Religious Education in England and Wales

    ERIC Educational Resources Information Center

    Barnes, L. Philip

    2009-01-01

    This paper challenges the overly positive image of the contribution made by religious education in England and Wales to the attainment of liberal educational aims that was recently presented in this journal, in the context of a review symposium on a "festschrift" celebrating the work and achievements of the influential British religious educator,…

  16. Passages to Literature: Essays on Teaching in Australia, Canada, England, the United States, and Wales.

    ERIC Educational Resources Information Center

    Milner, Joseph O'Beirne, Ed.; Milner, Lucy Floyd Morcock, Ed.

    Representing Australia, Canada, England, the United States, and Wales, this collection of essays focuses on ways in which teachers can adapt classroom activities and modify writing assignments to encourage personal response and exploration of texts. Essays, their authors, and nationalities are as follows: (1) "The River and Its Banks: Response and…

  17. Mortality among a Cohort of Persons with an Intellectual Disability in New South Wales, Australia

    ERIC Educational Resources Information Center

    Florio, Tony; Trollor, Julian

    2015-01-01

    Objectives: The main objective of the study was to compare mortality for people with an intellectual disability (ID) to the general population in New South Wales (NSW), Australia. A second objective was to provide mortality data for people with an intellectual disability from NSW in a standardized format, which allows for international comparisons…

  18. Central, Local and Individual Continuing Professional Development (CPD) Priorities: Changing Policies of CPD in Wales

    ERIC Educational Resources Information Center

    Jones, Ken

    2011-01-01

    Wales provides an interesting case study of the ways in which policies relating to continuing professional development (CPD) change over time. During the past three decades there has been a swing from central political influences on CPD policy to a focus on school priorities coupled with greater individual professional focus, then back again to…

  19. 76 FR 4129 - Lake Wales Ridge National Wildlife Refuge, Highlands and Polk Counties, FL; Final Comprehensive...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-24

    ... 20, 2008 (73 FR 35149). Lake Wales Ridge NWR is a unit of the Merritt Island National Wildlife Refuge... Unit contains the vast majority of the refuge's sand pine scrub habitat where rare, threatened, and... period via a Federal Register notice on April 30, 2010 (75 FR 22832). We received comments from...

  20. The Decline and Revival of Music Education in New South Wales Schools, 1920-1956

    ERIC Educational Resources Information Center

    Chaseling, Marilyn; Boyd, William E.

    2014-01-01

    This paper overviews the decline and revival of music education in New South Wales schools from 1920 to 1956. Commencing with a focus on vocal music during the period up to 1932, a time of decline in music teaching, the paper examines initiatives introduced in 1933 to address shortcomings in music education, and the subsequent changes in…

  1. Young Offenders in New South Wales, Australia and the Need for Remedial Sexual Health Education

    ERIC Educational Resources Information Center

    Mistler, Grant; Kirkwood, Kristie; Potter, Emily; Cashin, Andrew

    2008-01-01

    The 2005-2008 Australian National Sexually Transmissible Infections Strategy identifies young people as a key target group in need of sexual health education, screening and management. For young people who are in contact with the New South Wales (NSW) juvenile justice system, a dire need for remedial sexual health education exists. NSW young…

  2. Further Education and Industrial Training in England and Wales. Comparative Papers in Further Education, Number Twelve.

    ERIC Educational Resources Information Center

    Russell, Russ

    This report describes the nature and scope of further education and industrial training in England and Wales. Examined in a discussion of the United Kingdom educational system are funding, the relationship between school and government, school inspections, and curriculum and research bodies. The next section is devoted to changes that have…

  3. Changes in Academic Library Space: A Case Study at the University of New South Wales

    ERIC Educational Resources Information Center

    Bailin, Kylie

    2011-01-01

    As the digital environment continues to become more pervasive in our lives, academic libraries have had to adapt to ensure that services remain relevant to users' needs. Research was conducted to examine the 2009-2011 refurbishment at the University of New South Wales (UNSW) Library and evaluate its success in meeting users' needs in terms of…

  4. The Use of Audio-Visual Aids in Adult Education in Wales

    ERIC Educational Resources Information Center

    Powell, Anthony

    1974-01-01

    A survey of the provision of visual aids for use by tutors in Wales shows that the supply of equipment is not always adequately arranged by education authorities, and that tutors are often not sufficiently trained in the use of aids. (Author/AG)

  5. The Radical Reform of Administrative Policies in New South Wales School Education: Practical and Theoretical Implications.

    ERIC Educational Resources Information Center

    Macpherson, R. J. S.

    The government of New South Wales (Australia) is attempting to enhance the quality of public education by radically altering management structures and practices. Despite some popular objections, political intervention was mandated and warranted due to excessive centralization in administrative policy making, curriculum development, and resource…

  6. The Management of Professional Development of Staff in Secondary Schools in Wales

    ERIC Educational Resources Information Center

    Turner, Chris; Mitchell, Sue

    2004-01-01

    The purpose of this article is to present the findings from some empirical research carried out in 2002 among 200 staff working in 13 secondary schools in South Wales, concerning their views of the management of professional development. The findings indicated many of the significant differences between staff were gender-based. Female staff…

  7. The Changing Social and Demographic Profile of Nursing Students in New South Wales.

    ERIC Educational Resources Information Center

    Wright, Caroline M.; Sumar, Bashir H.

    1996-01-01

    A study compared characteristics of New South Wales (Australia) nursing students in 1986 (n=447) and 1995 (n=512). Results show no significant socioeconomic differences overall, only for females. Certain family characteristics also differed, including number of siblings and mother's income. It was also found that new public policy does not…

  8. Sustainability of Curriculum Development for Enterprise Education: Observations on Cases from Wales

    ERIC Educational Resources Information Center

    Roffe, Ian

    2010-01-01

    Purpose: This paper aims to examine the variety of approaches to curriculum development for enterprise education developed for schools, further, and higher education under an Entrepreneurship Action Plan in Wales and to consider the sustainability issues for delivery in these sectors. Design/methodology/approach: This investigation adopted a case…

  9. Improvements to Suicide Prevention Training for Prison Staff in England and Wales

    ERIC Educational Resources Information Center

    Hayes, Adrian J.; Shaw, Jenny J.; Lever-Green, Gillian; Parker, Dianne; Gask, Linda

    2008-01-01

    Suicide prevention training for the prison service in England and Wales has been criticized. STORM is a package emphasizing the practice and review of interactions with suicidal persons and was evaluated in a pilot study for use in prisons. Trainees completed questionnaires immediately before and after training and at 6 to 8 months follow-up.…

  10. Historical Child Sexual Abuse in England and Wales: The Role of Historians

    ERIC Educational Resources Information Center

    Bingham, Adrian; Delap, Lucy; Jackson, Louise; Settle, Louise

    2016-01-01

    This article reflects on methodological and ethical issues that have shaped a collaborative project which aims to chart social, legal and political responses to child sexual abuse in England and Wales across the twentieth century. The etymological problem of searching for child sexual abuse in the historical archive is discussed, given that the…

  11. Prison Education in England and Wales. (2nd Revised Edition). Mendip Papers MP 022.

    ERIC Educational Resources Information Center

    Ripley, Paul

    In response to prison disturbances in England and Wales in the late 1980s, the education program for prisoners was improved and more prisoners were given access to educational services. Although education is a relatively new phenomenon in the English and Welsh penal system, by the 20th century, education had become an integral part of prison life.…

  12. Implementing Curriculum Reform in Wales: The Case of the Foundation Phase

    ERIC Educational Resources Information Center

    Taylor, Chris; Rhys, Mirain; Waldron, Sam

    2016-01-01

    The Foundation Phase is a Welsh Government flagship policy of early years education (for 3-7 year-old children) in Wales. Marking a radical departure from the more formal, competency-based approach associated with the previous Key Stage 1 National Curriculum, it advocates a developmental, experiential, play-based approach to teaching and learning.…

  13. Rhetoric or Reality? Ethnic Monitoring in the "Threshold Assessment" of Teachers in England and Wales

    ERIC Educational Resources Information Center

    Menter, Ian; Hextall, Ian; Mahony, Pat

    2003-01-01

    Following the 1998 Green Paper on teachers' work, the UK government introduced Threshold Assessment of teachers in England and Wales in 2000. Teachers who met the Threshold standards were rewarded with a pay rise and access to an upper pay spine. At the time ministers gave assurances that equal opportunities would be taken very seriously in the…

  14. Changes to Educational Policy and Management in Wales: Facing the "Cuts" and New Strategic Challenges

    ERIC Educational Resources Information Center

    Reid, Ken

    2011-01-01

    Like the rest of the United Kingdom, Wales is facing a new challenge from the implementation of the Coalition Government's cuts. The Welsh Assembly Government [WAG, renamed Welsh Government (WG), in May 2011] budget was reduced by 1.8 billion British Pounds over the next four years. WAG responded by introducing its own revised austerity budget…

  15. The Communities Providing Religious Education and Catechesis to Polish Immigrants in England and Wales

    ERIC Educational Resources Information Center

    Makosa, Pawel

    2015-01-01

    Since Poland's accession to the European Union in 2004, hundreds of thousands of Polish citizens have arrived in the UK in search of work, of which the majority landed in England and Wales. This process, although not as fast now, is still ongoing. The majority of immigrants from Poland are young people who start families and have children. Many of…

  16. The Slow Process of Modernising Teacher Training in Music in New South Wales, 1920-1956

    ERIC Educational Resources Information Center

    Chaseling, Marilyn; Boyd, William E.

    2014-01-01

    The need for appropriately trained teachers to teach in its schools has been a priority for the Department of Education (hereafter referred to as the Department) since the beginning of public education in New South Wales in the 1850s. This paper presents an overview of the provisions made by the Department for the musical development of its…

  17. Foreign Language Study in New South Wales, State of the Art, 1973.

    ERIC Educational Resources Information Center

    Robinson, Gail L.

    This paper argues that an elitist concept regarding foreign language study and absolute criteria for such study have made foreign language study insensitive to the needs of an increasingly larger proportion of the student population in New South Wales, including even the most able students. In discussing this viewpoint, the paper examines: (1) the…

  18. The Significance of Contemporary Contradiction in Educational Assessment Policies in England and Wales.

    ERIC Educational Resources Information Center

    Broadfoot, Patricia

    Some of the assumptions underlying educational assessment policies in England and Wales are discussed in terms of contradictions in the aims of those policies. Two key initiatives--the national "bench-mark" testing and records of achievement--provide the focus for illustrating the potentially fundamental change of emphasis in the nature and role…

  19. Brief Report: Multilevel Analysis of School Smoking Policy and Pupil Smoking Behaviour in Wales

    ERIC Educational Resources Information Center

    Wiium, Nora; Burgess, Stephen; Moore, Laurence

    2011-01-01

    A multilevel analysis of cross-sectional data from a survey involving 1941 pupils (in grades 10 and 11) and policy indicators developed from interviews with staff from 45 secondary schools in Wales examined the hypotheses that pupil smoking prevalence would be associated with: restrictive staff and pupil smoking policies; dissemination of school…

  20. Learning Support Policy in Australia (New South Wales) and New Zealand; Discourses of Influence

    ERIC Educational Resources Information Center

    Tearle, Kerri; Spandagou, Ilektra

    2012-01-01

    This paper presents a comparative discourse analysis of the learning support policy in New South Wales, Australia and New Zealand. The dominant discourses in both policies are identified and analysed in terms of how they determine the manner in which students experiencing difficulties with learning are included in schools. It is argued that the…

  1. Morchella australiana sp. nov., an apparent Australian endemic from New South Wales and Victoria

    Technology Transfer Automated Retrieval System (TEKTRAN)

    An abundant fruiting of a black morel was encountered in temperate northwestern New South Wales (NSW), Australia, during a mycological survey in August 2010. The collection site was west of the Great Dividing Range in a young, dry sclerophyll woodland forest dominated by Eucalyptus and Callitris nor...

  2. The Dark Figure of Infanticide in England and Wales: Complexities of Diagnosis

    ERIC Educational Resources Information Center

    Brookman, Fiona; Nolan, Jane

    2006-01-01

    Infants aged younger than 12 months have the highest homicide victimization rate of any single age group in England and Wales. In addition, there are good grounds for believing that the official homicide statistics for this particular age group are an underestimate and subject to distortion. At the same time there is evidence mounting in the…

  3. Remove, Rehabilitate, Return? The Use and Effectiveness of Behaviour Schools in New South Wales, Australia

    ERIC Educational Resources Information Center

    Granite, Elizabeth; Graham, Linda J.

    2012-01-01

    Research indicates that enrolments in separate special educational settings for students with disruptive behaviour have increased in a number of educational jurisdictions internationally. Recent analysis of school enrolment data has identified a similar increase in the New South Wales (NSW) government school sector; however, questions have been…

  4. The Individual Inventor and the Implications for Innovation and Entrepreneurship: A View of Wales

    ERIC Educational Resources Information Center

    Thomas, Brychan; Gornall, Lynne; Packham, Gary; Miller, Christopher

    2009-01-01

    This paper investigates, through quantitative and qualitative analysis, inventive activity in the modern technological setting of Wales in the 21st century. The paper reports on the barriers, motivations and drivers to inventors becoming entrepreneurs in exploiting their ideas and taking them to market, and indicates the outcomes of a pilot phase…

  5. Counter-Geographies: The Campaign against Rationalisation of Agricultural Research Stations in New South Wales, Australia

    ERIC Educational Resources Information Center

    Gibson, Chris; Dufty, Rae; Phillips, Samantha; Smith, Heather

    2008-01-01

    This paper discusses an example of community action mounted in a rural region of New South Wales, Australia, in response to proposals by the State Government to rationalise agricultural research stations operated by the Department of Primary Industries. Informed by a Foucaultian understanding of power and the concept of governmentality,…

  6. Educational Enrolment of Students with a Disability in New South Wales and Victoria.

    ERIC Educational Resources Information Center

    Dempsey, Ian; Foreman, Phil; Jenkinson, Josephine

    2002-01-01

    This article discusses the impact of legislative and special education policy on the educational enrollment of students with a disability across Australia. Enrollment trends in New South Wales and Victoria are examined and discussed within the context of their respective special education policies, disability discrimination legislation, and…

  7. The Strange Death of the Comprehensive School in England and Wales, 1965-2002

    ERIC Educational Resources Information Center

    Haydn, Terry

    2004-01-01

    The past 25 years have seen an accelerating erosion of the comprehensive "ideal" in England and Wales. Parental choice has replaced centralized LEA allocation of pupils, systems for engineering a balanced social mix in schools have been largely abandoned, and the introduction of "league tables" to measure the comparative effectiveness of…

  8. Numbers Talk--Words Count: Language Policy and Adult Numeracy Education in Wales and New Zealand

    ERIC Educational Resources Information Center

    Coben, Diana; Miller-Reilly, Barbara

    2014-01-01

    In this paper we review and compare language policy in relation to adult numeracy education in Wales and New Zealand with respect to the Maori and Welsh languages in the latest stage of our international comparative study of adult numeracy education. While much has been written about the relationship between language and literacy, the relationship…

  9. Multiagency Protocols in Intellectual Disabilities Transition Partnerships: A Survey of Local Authorities in Wales

    ERIC Educational Resources Information Center

    Kaehne, Axel

    2010-01-01

    The paper presents the findings of a study of transition protocols (for adolescents leaving school and entering the general marketplace) in place for intellectual disability partnerships in 22 local authorities in Wales. The study consisted of a survey of existing protocols and a documentary analysis of the content of the obtained protocols. The…

  10. Serials Solutions and LinkFinderPlus at the University of Wales Swansea

    ERIC Educational Resources Information Center

    Brown, Andrew; Smyth, Neil

    2005-01-01

    Purpose: To provide practical information on two electronic journal-related products implemented in Library and Information Services at University of Wales Swansea. Design/methodology/approach: An overview is provided of the evaluation of electronic journal management products undertaken and subsequent implementation. Findings: Serials Solutions…

  11. University Patenting in Wales, Scotland and Northern Ireland: A Comparative Analysis

    ERIC Educational Resources Information Center

    Beale, Andrew; Blackaby, David; Mainwaring, Lynn

    2008-01-01

    Using data on the patent portfolios of UK universities, the paper compares the levels of patenting activity (filings), success (grants) and quality (patents with commercial co-assignees and patent citations) at Welsh, Scottish and Northern Irish institutions. Patent activity, per researcher, in Wales is on a par with that in Scotland and about…

  12. Vocational Rehabilitation in Wales: A Mixed Method Evaluation of Condition Management Programmes

    ERIC Educational Resources Information Center

    Reagon, Carly

    2011-01-01

    Condition management programmes (CMPs) are vocational rehabilitation schemes, which aim to address the needs of disability-related benefit claimants in the UK. The aim of this evaluation was to investigate the extent to which three CMPs in Wales enable individuals to manage health conditions and move closer towards work. Outcome measurements for…

  13. Advice and Educational Policy Making: Scotland and New South Wales 1942-1961.

    ERIC Educational Resources Information Center

    Duffield, Jill

    1995-01-01

    Compares the work of two advisory committees: the Sixth Scottish Advisory Council on Education which produced the 1947 report, "Secondary Education," and the Committee Appointed to Survey Secondary Education in New South Wales (Australia), which produced the "Wyndham Report" in 1957. Concludes that the committee's relationship to the government…

  14. Knowledge for What? Wales, Militarisation and the Endless Promotion of the Knowledge Economy

    ERIC Educational Resources Information Center

    Tannock, Stuart

    2009-01-01

    The "knowledge economy" has become the buzzword of development policy in the early twenty-first century. Nations and regions around the world are all told that they must transform themselves into knowledge economies to survive and prosper. This article uses the example of Wales and its recent embrace of a massive military privatisation project in…

  15. The Role of Trust in the Development of Connectivities amongst Rural Elders in England and Wales

    ERIC Educational Resources Information Center

    Curry, Nigel; Fisher, Rhiannon

    2012-01-01

    Using Simmel's notion of sociation, the way in which rural elders in England and Wales relate to, or connect with, each other and others within their community, can be seen to be conflictual as well as consensual. As a vehicle for exploiting this relationship, social capital also can be antithetic as well as convergent and an important element of…

  16. Technological Innovation, Entrepreneurship, Higher Education and Economic Regeneration in Wales: A Policy Study

    ERIC Educational Resources Information Center

    Thomas, Brychan; Packham, Gary; Miller, Christopher

    2006-01-01

    This paper presents the views of key policy makers concerning innovation and entrepreneurship in Wales. The development of innovation in SMEs and the policy implications for economic regeneration are also analysed. The role of a variety of actors (including users and suppliers) is considered, as is the impact of networks of SMEs linked together in…

  17. PICKUP Wales, U.K. Assurance of Quality Vocational Continuing Education and Training.

    ERIC Educational Resources Information Center

    Daniels, C. E. J.

    The Professional, Industrial, and Commercial Updating Programme (PICKUP) of the United Kingdom is aimed at improving the performance of British industry through the colleges. In Wales, PICKUP is part of the Welsh Office Education Department. Various factors have encouraged educational institutions to take on PICKUP work: the Education Reform Act…

  18. Implementation of an Integrated Information Management System at the National Library of Wales: A Case Study

    ERIC Educational Resources Information Center

    Evans, Manon Foster; Thomas, Sian

    2007-01-01

    Purpose: This paper aims to describe the experiences of the National Library of Wales in implementing an integrated information management system. Design/methodology/approach: Discusses the stages involved in the procurement process, data migration and general system implementation. Findings: Emphasises the need for a well-prepared yet flexible…

  19. Language Policy and Governmentality in Businesses in Wales: A Continuum of Empowerment and Regulation

    ERIC Educational Resources Information Center

    Barakos, Elisabeth

    2016-01-01

    In this paper, I examine how language policy acts as a means of both empowering the Welsh language and the minority language worker and as a means of exerting power over them. For this purpose, the study focuses on a particular site: private sector businesses in Wales. Therein, I trace two major discursive processes: first, the Welsh Government's…

  20. Cost-Effectiveness Analysis of the New South Wales Adult Drug Court Program

    ERIC Educational Resources Information Center

    Shanahan, Marian; Lancsar, Emily; Haas, Marion; Lind, Bronwyn; Weatherburn, Don; Chen, Shuling

    2004-01-01

    In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the…

  1. School Outcomes in New South Wales and Queensland: A Regression Discontinuity Approach

    ERIC Educational Resources Information Center

    Miller, Paul W.; Voon, Derby

    2014-01-01

    This paper examines the differences in school (NAPLAN) outcomes between New South Wales and Queensland. It shows that there are pronounced differences in Year 3 NAPLAN results between these states, though these dissipate when later class years are considered. The reasons for these state effects in school outcomes are explored using an empirical…

  2. The Beginnings Of Educational Psychology in the Universities of England and Wales.

    ERIC Educational Resources Information Center

    Thomas, J. B.

    1996-01-01

    Analyzes the contribution of the early departments of education in England and Wales to the development of educational psychology. Examines syllabi, textbooks, primary sources, and previous research to investigate the contributions of important pioneers in these departments. Concludes with a comment on the methodology of the research. (MJP)

  3. Indigenous Gambling Motivations, Behaviour and Consequences in Northern New South Wales, Australia

    ERIC Educational Resources Information Center

    Breen, Helen M.; Hing, Nerilee; Gordon, Ashley

    2011-01-01

    Against a background of public health, we sought to examine and explain gambling behaviours, motivations and consequences of Indigenous Australians in northern New South Wales. Adhering to national Aboriginal and ethical guidelines and using qualitative methods, 169 Indigenous Australians were interviewed individually and in small groups using…

  4. Managing the Performance of Staff in LEAs in Wales: Practice, Problems and Possibilities

    ERIC Educational Resources Information Center

    James, Chris; Colebourne, David

    2004-01-01

    Recent policy developments are changing the work of local education authorities (LEAs) in Wales requiring them to play a broader role in the community and a significant role in raising educational achievement. LEAs are obligated to set out their improvement targets in institutional plans and are called to account by external inspection, which…

  5. Water quality trends at an upland site in wales, UK, 1983-1993

    NASA Astrophysics Data System (ADS)

    Robson, A. J.; Neal, C.

    1996-02-01

    Ten years of detailed upland stream and bulk deposition water quality data from Plynlimon, mid-Wales, are examined for trend. A robust statistical test (the seasonal Kendall test) is applied and data are presented graphically. Smoothing techniques are used to highlight the patterns of change which underlie high data scatter. The graphs show long-term cycles within the data which violate the assumptions of common statistical tests for trend. These cycles relate to fluctuations in the weather patterns at Plynlimon. Even though the seasonal Kendall test is significant for some determinands, the evidence from the graphs suggests that many of these trends are unlikely to continue.For solutes in rainfall, there is no convincing long-term trend. There is a possible increase in ammonium concentrations, which may indicate an increasing atmospheric source generated by farming activities, but this will require a longer data series for confirmation. Several trace metal concentrations increased significantly part way through the study period, but later returned to the original levels. The bulk precipitation sea salt input has been uneven over the 10-year sampling period, with the highest inputs occurring during the wetter winters.For solutes in streamwaters, there are clear trends in dissolved organic carbon (DOC), iodine and bromide, which increase over time and may be attributed to an increase in organic decomposition in the catchment. Previous studies in Wales have shown similar behaviour for colour, which is related to DOC, but the corresponding changes for bromide and iodine are new. For most other streamwater determinands, any changes are masked by the effects of year to year variations in the quality and quantity of rainfall. For example, zinc and chromium variations parallel the corresponding rainfall quantity variations. The effect of rainfall quality variation is marked for marine-derived elements such as chloride. For sulphate, streamwater variations are inverted

  6. Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Design Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. Setting North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Participants Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. Interventions NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Main outcome measures Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. Results NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014–7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. Conclusions NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community

  7. Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting

    PubMed Central

    Carter, Madeline; Thompson, Neill; Crampton, Paul; Morrow, Gill; Burford, Bryan; Gray, Christopher; Illing, Jan

    2013-01-01

    Objectives To examine the prevalence and impact of bullying behaviours between staff in the National Health Service (NHS) workplace, and to explore the barriers to reporting bullying. Design Cross-sectional questionnaire and semi-structured interview. Setting 7 NHS trusts in the North East of England. Participants 2950 NHS staff, of whom 43 took part in a telephone interview. Main outcome measures Prevalence of bullying was measured by the revised Negative Acts Questionnaire (NAQ-R) and the impact of bullying was measured using indicators of psychological distress (General Health Questionnaire, GHQ-12), intentions to leave work, job satisfaction and self-reported sickness absence. Barriers to reporting bullying and sources of bullying were also examined. Results Overall, 20% of staff reported having been bullied by other staff to some degree and 43% reported having witnessed bullying in the last 6 months. Male staff and staff with disabilities reported higher levels of bullying. There were no overall differences due to ethnicity, but some differences were detected on several negative behaviours. Bullying and witnessing bullying were associated with lower levels of psychological health and job satisfaction, and higher levels of intention to leave work. Managers were the most common source of bullying. Main barriers to reporting bullying were the perception that nothing would change, not wanting to be seen as a trouble-maker, the seniority of the bully and uncertainty over how policies would be implemented and bullying cases managed. Data from qualitative interviews supported these findings and identified workload pressures and organisational culture as factors contributing to workplace bullying. Conclusions Bullying is a persistent problem in healthcare organisations which has significant negative outcomes for individuals and organisations.

  8. Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies. Setting Community pharmacies across the North East of England accredited to provide this service. Participants Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests. Intervention Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required. Primary outcomes Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction. Results A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload. Conclusions Community pharmacists were able to manage patients’ OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when

  9. Contribution of a government target to controlling Clostridium difficile in the NHS in England.

    PubMed

    Duerden, Brian I

    2011-08-01

    The introduction of mandatory surveillance of Clostridium difficile infection (CDI) in 2004 showed the scale of the challenge: cases in patients >64 years old reached 55,681 in 2006. The first type 027 outbreaks had been in 2005 and CDI was a headline issue. The prevention and control of CDI requires a tripartite partnership between clinicians, health service managers, and the government/Department of Health which needs to set standards, ensure that CDI is a priority, set targets and monitor outcome. Government can also legislate; the Health Act 2006 introduced a statutory Code of Practice for infection prevention and control for the NHS and extended to all independent health and care settings in 2010. In 2008, a national target was set for a 30% reduction in CDI by 2010-11 (baseline 2007-8). It was population-based and set a standard (ceiling) rate/10,000 in each area, within which acute hospitals had a target/1000 admissions (diagnosed after day 3). In the first year (2008-9), a 35% reduction was achieved from 55,499 to 36,079 cases in all ages and in 2009-10 the total was 25,604, a 54% reduction from 2007-8. However, in 2009, cases >64 years old were 29% down from 2008 but only 9% down in the 2-64 year old group; also, by this stage, cases in acute hospitals and in other settings were almost equal. Death certification showing CDI fell for the first time in 2008 and in 2009 there were 3550 total mentions (7816 in 2007) of which 1510 (42%) were as underlying cause (3875, 49%, in 2007). The reductions in CDI have been achieved by a raft of measures. Crucially, the targets focused management emphasis on infection prevention and control. This was supported by enhanced surveillance. Clinical practice protocols were implemented through the high impact interventions (care bundle) approach, and there was a major emphasis on cleanliness and hygiene (particularly hand washing for clinical staff and environmental cleaning and disinfection in patient areas). Achievement of

  10. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.

    PubMed

    Doyle, Cathal; Howe, Cathy; Woodcock, Thomas; Myron, Rowan; Phekoo, Karen; McNicholas, Chris; Saffer, Jessica; Bell, Derek

    2013-01-01

    The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This

  11. Linking NHS data for pediatric pharmacovigilance: Results of a Delphi survey

    PubMed Central

    Hopf, Y.M.; Francis, J.; Helms, P.J.; Haughney, J.; Bond, C.

    2016-01-01

    Background Adverse drug events are a major cause of patient safety incidents. Current systems of pharmacovigilance under-report adverse drug reactions (ADRs), especially in children, leading to delays in their identification. This is of particular concern, as children especially have an increased vulnerability to ADRs. Objectives The objective was to seek consensus among healthcare professionals (HCPs) about barriers and facilitators to the linkage of routinely collected health data for pediatric pharmacovigilance in Scotland. Methods A Delphi survey was conducted with a random sample of HCPs including nurses, pharmacists and doctors, working in primary or secondary care, in Scotland. Participants were identified from sampling frames of the target professionals such as an NHS workforce list for general practitioners and recruited by postal invitation. A total of 819 HCPs were invited to take part. Those agreeing to participate were given the option of completing the questionnaires online or as hard copy. Reminders were sent twice at a fortnightly interval. Questions content included description of professional role as well as testing for the willingness to support the proposed project and was informed by the Theoretical Domains Framework of Behavior Change (TDF) and earlier qualitative work. Three Delphi rounds were administered, including a first round for item generation. Results 121 of those invited agreed to take part (15%). The first round of the Delphi study included 21 open questions and generated over a 1000 individual statements from 61 participants that returned the questionnaires (50.4%). These were rationalized to 149 items for the second round in which participants rated their views on the importance (or not) of each item on a 9-point Likert scale (strongly disagree – strongly agree). After the third round, there was consensus on items that focused on professional standards, and practical requirements, overall there was support for data linkage and a

  12. Electronic structures of Stone-Wales defective chiral (6,2) silicon carbide nanotubes: First-principles calculations

    NASA Astrophysics Data System (ADS)

    Song, Jiuxu; Liu, Hongxia; Guo, Yingna; Zhu, Kairan

    2015-11-01

    By using first-principle calculations based on density functional theory, the geometries and electronic structures of the Stone-Wales defective chiral (6,2) silicon carbide nanotubes (SiCNTs) are investigated. Independent on their orientations, Stone-Wales defects form two asymmetric pentagons and heptagons coupled in pairs (5-7-7-5) and a defect energy level in the band gap of the SiCNT. By applying transverse electric fields, significant differences in the electronic structures of the defective (6,2) SiCNTs are achieved, which may provide the foundation of identifying the orientation of Stone-Wales defects in chiral SiCNTs.

  13. Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011

    PubMed Central

    Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

    2013-01-01

    Objectives To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (p<0.0005, commissioning and contracts OR   0.32, 95%CI   0.18 to 0.57, finance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical

  14. Addressing Library Anxiety (LA) in student nurses: a study in an NHS Foundation Trust Hospital library and information service.

    PubMed

    Still, Madeleine

    2015-12-01

    Library anxiety is a concept which has been recognised in academic library circles since the early 1990s. It can result in students actively avoiding the library for the duration of their studies. Madeleine Still is Trust Librarian at North Tees & Hartlepool NHS Foundation Trust and while studying for an MSc, recognised that some student nurses were exhibiting signs of library anxiety. She decided to make it the focus of her MSc dissertation, and this article discusses her research project as well as highlighting the measures she has taken to address the issues she uncovered. Madeleine graduated in July 2013 with an MSc in Information & Library Studies from Robert Gordon University. PMID:26768906

  15. Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking

    PubMed Central

    Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

    2015-01-01

    Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking. Design A cross-sectional survey. Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. Conclusions NHS professionals working in secondary care are in contact with potential

  16. Epidemiology and Pathogenesis of C. difficile and MRSA in the Light of Current NHS Control Policies: A Policy review

    PubMed Central

    Agha, Maliha

    2012-01-01

    Healthcare associated infections (HCAIs) cause significant morbidity and mortality, and are estimated to cost the United Kingdom National Health Service £1 billion annually. The current health care infection rates suggest that the level of performance to avoid HCAIs is not maintained consistently. Increasing screening, improving local accountability and performance management, careful use of antibiotics in the management of emergency patients, health economy wide approaches, and improved hand washing will be effective in lowering the rate of HCAIs. This paper reviews current NHS Control Policies in place for Methicillin Resistant Staphylococcus Aureus (MRSA) and C. difficile. PMID:26257907

  17. Comparison of Mortality Following Hospitalisation for Isolated Head Injury in England and Wales, and Victoria, Australia

    PubMed Central

    Gabbe, Belinda J.; Lyons, Ronan A.; Lecky, Fiona E.; Bouamra, Omar; Woodford, Maralyn; Coats, Timothy J.; Cameron, Peter A.

    2011-01-01

    Background Traumatic brain injury (TBI) remains a leading cause of death and disability. The National Institute for Health and Clinical Excellence (NICE) guidelines recommend transfer of severe TBI cases to neurosurgical centres, irrespective of the need for neurosurgery. This observational study investigated the risk-adjusted mortality of isolated TBI admissions in England/Wales, and Victoria, Australia, and the impact of neurosurgical centre management on outcomes. Methods Isolated TBI admissions (>15 years, July 2005–June 2006) were extracted from the hospital discharge datasets for both jurisdictions. Severe isolated TBI (AIS severity >3) admissions were provided by the Trauma Audit and Research Network (TARN) and Victorian State Trauma Registry (VSTR) for England/Wales, and Victoria, respectively. Multivariable logistic regression was used to compare risk-adjusted mortality between jurisdictions. Findings Mortality was 12% (749/6256) in England/Wales and 9% (91/1048) in Victoria for isolated TBI admissions. Adjusted odds of death in England/Wales were higher compared to Victoria overall (OR 2.0, 95% CI: 1.6, 2.5), and for cases <65 years (OR 2.36, 95% CI: 1.51, 3.69). For severe TBI, mortality was 23% (133/575) for TARN and 20% (68/346) for VSTR, with 72% of TARN and 86% of VSTR cases managed at a neurosurgical centre. The adjusted mortality odds for severe TBI cases in TARN were higher compared to the VSTR (OR 1.45, 95% CI: 0.96, 2.19), but particularly for cases <65 years (OR 2.04, 95% CI: 1.07, 3.90). Neurosurgical centre management modified the effect overall (OR 1.12, 95% CI: 0.73, 1.74) and for cases <65 years (OR 1.53, 95% CI: 0.77, 3.03). Conclusion The risk-adjusted odds of mortality for all isolated TBI admissions, and severe TBI cases, were higher in England/Wales when compared to Victoria. The lower percentage of cases managed at neurosurgical centres in England and Wales was an explanatory factor, supporting the changes made to the NICE

  18. Thyroid cancer epidemiology in England and Wales: time trends and geographical distribution.

    PubMed Central

    dos Santos Silva, I.; Swerdlow, A. J.

    1993-01-01

    Thyroid cancer incidence has been increasing in many countries, whereas mortality has been falling due to better survival. Radiation is the best-established risk factor and there has been concern that recent rises in incidence might be related to fallout radiation from atmospheric nuclear weapon tests. We examined thyroid cancer time trends and geographical distribution in England and Wales and possible interpretations of these. During 1962-84, there were significant increases in incidence (P < 0.001) in each sex at ages under 45. Cohort analysis by single year of birth showed an overall increase in incidence risks in women aged 0-44 born since 1920, with a sudden rise in risk for the birth years 1952-55 followed by a lower risk for the more recent cohorts. In men, there was an overall increase in risk at ages 0-44 in successive birth cohorts, but the pattern was irregular. In each sex, the risk in persons aged 45 and over decreased slightly in successive generations. Geographically, highest incidence risks were in countries in North and Mid Wales, in which the risk was almost twice that in the rest of the country. This pattern was present only at ages 45 and over and was most clear in rural areas. The peak of thyroid cancer risk in women born in 1952-55 is consistent with a carcinogenic effect of fallout radiation, since these women were children in the late 1950s and early 1960s when fallout radiation was greatest in England and Wales. The focus of high thyroid cancer risks in Wales was in areas with high levels of fallout radiation. However, thyroid cancer risks in Wales were not high for more recent cohorts (the ones who were exposed to fallout early in life), and a focus on high risk of benign thyroid diseases was present in Wales well before nuclear weapons existed. The distributions of these benign thyroid diseases, or of factors causing them, seem more likely than fallout to explain the high risk areas for thyroid cancer in the country. PMID:8431362

  19. Thyroid cancer epidemiology in England and Wales: time trends and geographical distribution.

    PubMed

    dos Santos Silva, I; Swerdlow, A J

    1993-02-01

    Thyroid cancer incidence has been increasing in many countries, whereas mortality has been falling due to better survival. Radiation is the best-established risk factor and there has been concern that recent rises in incidence might be related to fallout radiation from atmospheric nuclear weapon tests. We examined thyroid cancer time trends and geographical distribution in England and Wales and possible interpretations of these. During 1962-84, there were significant increases in incidence (P < 0.001) in each sex at ages under 45. Cohort analysis by single year of birth showed an overall increase in incidence risks in women aged 0-44 born since 1920, with a sudden rise in risk for the birth years 1952-55 followed by a lower risk for the more recent cohorts. In men, there was an overall increase in risk at ages 0-44 in successive birth cohorts, but the pattern was irregular. In each sex, the risk in persons aged 45 and over decreased slightly in successive generations. Geographically, highest incidence risks were in countries in North and Mid Wales, in which the risk was almost twice that in the rest of the country. This pattern was present only at ages 45 and over and was most clear in rural areas. The peak of thyroid cancer risk in women born in 1952-55 is consistent with a carcinogenic effect of fallout radiation, since these women were children in the late 1950s and early 1960s when fallout radiation was greatest in England and Wales. The focus of high thyroid cancer risks in Wales was in areas with high levels of fallout radiation. However, thyroid cancer risks in Wales were not high for more recent cohorts (the ones who were exposed to fallout early in life), and a focus on high risk of benign thyroid diseases was present in Wales well before nuclear weapons existed. The distributions of these benign thyroid diseases, or of factors causing them, seem more likely than fallout to explain the high risk areas for thyroid cancer in the country. PMID:8431362

  20. The index of orthognathic functional treatment need accurately prioritises those patients already selected for orthognathic surgery within the NHS.

    PubMed

    Shah, Rupal; Breeze, John; Chand, Mohit; Stockton, Peter

    2016-06-01

    The index of orthognathic functional treatment need (IOFTN) is a newly-proposed system to help to prioritise patients for orthognathic treatment. The five categories are similar to those used in orthodontics, but include additional parameters such as sleep apnoea and facial asymmetry. The aim of this audit was to validate the index and find out the potential future implications, should such a system ever be adopted by commissioners. We calculated the IOFTN category of 100 consecutive patients who had orthognathic surgery between 2010-14 using clinical notes, photographs, study models, and radiographs, and determined the number in categories 4 or 5, analogous to the current indications for orthodontic treatment within the NHS. Sufficient clinical information was available to categorise 59/100 patients, and 56 of the 59 (95%) were in either category 4 or 5. All three of the remaining patients (in categories 1-3) who were operated on were treated because of the anticipated favourable impact on their quality of life. The IOFTN has been proposed for use in future commissioning of orthognathic services within the NHS, and this study has confirmed its efficacy in prioritising treatment accurately, with 95% of patients being in categories 4 or 5. We recommend that the orthognathic treatment index be adapted to include additional psychosocial assessment so that patients who fall into the lower functional categories are not automatically excluded from this potentially life-changing treatment. PMID:26935212

  1. Management factors associated with impaired locomotion in dairy cows in England and Wales.

    PubMed

    Barker, Z E; Amory, J R; Wright, J L; Blowey, R W; Green, L E

    2007-07-01

    Forty-nine farms in England and Wales were visited on 4 occasions between February 2003 and March 2004. A total of 21,693 scores of locomotion were assigned to 7,722 cattle. Locomotion was assessed on a 3-point scale by observing the posture of a cow's back while standing and walking (1 = sound, 2 = not sound, 3 = lame). Data on measurable factors potentially associated with locomotion were collected from all farms using direct observations of the farm environment and a comprehensive farmer interview. The mean herd locomotion score was 1.77 +/- 0.02. There was no significant difference in mean herd locomotion scores between 5 herds housed in straw yards (1.72 +/- 0.02) and 44 herds housed in free stalls (1.78 +/- 0.02), possibly because of lack of power. A GLM was produced using data from the 44 herds housed in free stalls, with the mean farm locomotion score of all cows examined on all 4 visits as the outcome variable. Factors associated with an elevated locomotion score were dry cows kept in straw yards compared with free stalls (increase in locomotion score = 0.06 +/- 0.03), pregnant heifers kept with milking cows in winter compared with being kept with dry cows (increase in locomotion score = 0.09 +/- 0.03), aisle widths of < 3 m compared with widths of > or = 3 m (increase in locomotion score = 0.06 +/- 0.02), a curb height of < or = 15 cm compared with a height of > 15 cm (increase in locomotion score = 0.07 +/- 0.03), routine trimming of hooves of all cows by a hoof trimmer or by the farmer compared with no routine hoof trimming (increase in locomotion score = 0.18 +/- 0.04 and 0.13 +/- 0.03 respectively), feeding corn silage to milking cows compared with feeding other forage types (increase in locomotion score = 0.10 +/- 0.03), and the use of automatic scrapers in the free-stall barn compared with tractor scrapers (increase in locomotion score = 0.10 +/- 0.03). These variables were correlated with many other management variables. The use of automatic

  2. Developing a historical climatology of Wales from Welsh and English language sources

    NASA Astrophysics Data System (ADS)

    MacDonald, N.; Davies, S. J.; Jones, C. A.; Charnell-White, C.

    2009-04-01

    Historical documentary records are recognised as valuable in understanding long term climate variability. In the UK, the Central England Temperature Series (1772- ) and the Lamb weather catalogue (1861- ) provide a detailed climate record for England, but the value of these archives in Wales and Scotland is more limited, though some long term instrumental series exist, particularly for cities such as Cardiff. The spatial distance from the central England area and a lower density of instrumental stations in Wales has limited understanding of climate variability during the instrumental period (~1750- ). This paper illustrates that historical documentary records represent a considerable resource, that to date have been underutilised in developing a more complete understanding of past weather and climate within many parts of Western Europe.

  3. Stone-Wales-type transformations in carbon nanostructures driven by electron irradiation

    NASA Astrophysics Data System (ADS)

    Kotakoski, J.; Meyer, J. C.; Kurasch, S.; Santos-Cottin, D.; Kaiser, U.; Krasheninnikov, A. V.

    2011-06-01

    Observations of topological defects associated with Stone-Wales-type transformations (i.e., bond rotations) in high-resolution transmission electron microscopy (HRTEM) images of carbon nanostructures are at odds with the equilibrium thermodynamics of these systems. Here, by combining aberration-corrected HRTEM experiments and atomistic simulations, we show that such defects can be formed by single electron impacts and, remarkably, at electron energies below the threshold for atomic displacements. We further study the mechanisms of irradiation-driven bond rotations and explain why electron irradiation at moderate electron energies (~100 keV) tends to amorphize rather than perforate graphene. We also show via simulations that Stone-Wales defects can appear in curved graphitic structures due to incomplete recombination of irradiation-induced Frenkel defects, similar to formation of Wigner-type defects in silicon.

  4. Leprosy in England and Wales 1953–2012: surveillance and challenges in low incidence countries

    PubMed Central

    Fulton, Nicholas; Anderson, Laura F; Watson, John M; Abubakar, Ibrahim

    2016-01-01

    Objective To review all notified cases of leprosy in England and Wales between 1953 and 2012. Design National surveillance study of all reported cases. Setting England and Wales. Outcome Number and characteristics of reported cases. Results During this period, a total of 1449 leprosy cases were notified. The incidence fell from 356 new cases notified between 1953 and 1962 to 139 new cases between 2003 and 2012. Where data were available, leprosy was more common in men, 15–45 year olds and those from the Indian subcontinent. There was considerable undernotification in 2001–2012. Conclusions The high level of under-reporting indicates a need for improved surveillance in the UK. Public Health England, in collaboration with the UK Panel of Leprosy opinion, has revised the UK Memorandum on Leprosy in order to provide updated guidance on diagnostic procedures, treatment, case management, contact tracing and notification. PMID:27142858

  5. Impact of managed clinical networks on NHS specialist neonatal services in England: population based study

    PubMed Central

    Gale, C; Santhakumaran, S; Nagarajan, S; Statnikov, Y

    2012-01-01

    Objective To assess the impact of reorganisation of neonatal specialist care services in England after a UK Department of Health report in 2003. Design A population-wide observational comparison of outcomes over two epochs, before and after the establishment of managed clinical neonatal networks. Setting Epoch one: 294 maternity and neonatal units in England, Wales, and Northern Ireland, 1 September 1998 to 31 August 2000, as reported by the Confidential Enquiry into Stillbirths and Sudden Deaths in Infancy Project 27/28. Epoch two: 146 neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit, 1 January 2009 to 31 December 2010. Participants Babies born at a gestational age of 27+0-28+6 (weeks+days): 3522 live births in epoch one; 2919 babies admitted to a neonatal unit within 28 days of birth in epoch two. Intervention The national reorganisation of neonatal services into managed clinical networks. Main outcome measures The proportion of babies born at hospitals providing the highest volume of neonatal specialist care (≥2000 neonatal intensive care days annually), having an acute transfer (within the first 24 hours after birth) and/or a late transfer (between 24 hours and 28 days after birth) to another hospital, assessed by change in distribution of transfer category (“none,” “acute,” “late”), and babies from multiple births separated by transfer. For acute transfers in epoch two, the level of specialist neonatal care provided at the destination hospital (British Association of Perinatal Medicine criteria). Results After reorganisation, there were increases in the proportions of babies born at 27-28 weeks’ gestation in hospitals providing the highest volume of neonatal specialist care (18% (631/3495) v 49% (1325/2724); odds ratio 4.30, 95% confidence interval 3.83 to 4.82; P<0.001) and in acute and late postnatal transfers (7% (235) v 12% (360) and 18% (579) v 22% (640), respectively

  6. The contribution of infections to neonatal deaths in England and Wales.

    PubMed

    Depani, Sarita J; Ladhani, Shamez; Heath, Paul T; Lamagni, Theresa L; Johnson, Alan P; Pebody, Richard G; Ramsay, Mary E; Sharland, Mike

    2011-04-01

    This study used anonymized death certificate data to determine the contribution of specific infections to neonatal deaths in England and Wales between 2003 and 2005. Infection was recorded in 11% of deaths, with two-thirds occurring in premature neonates. Group B Streptococcus was indicated in 32% of death certificates that specified a bacterial infection and in 11% of all infection-related deaths. PMID:21317829

  7. Anthropogenic greenhouse gas contribution to flood risk in England and Wales in autumn 2000.

    PubMed

    Pall, Pardeep; Aina, Tolu; Stone, Dáithí A; Stott, Peter A; Nozawa, Toru; Hilberts, Arno G J; Lohmann, Dag; Allen, Myles R

    2011-02-17

    Interest in attributing the risk of damaging weather-related events to anthropogenic climate change is increasing. Yet climate models used to study the attribution problem typically do not resolve the weather systems associated with damaging events such as the UK floods of October and November 2000. Occurring during the wettest autumn in England and Wales since records began in 1766, these floods damaged nearly 10,000 properties across that region, disrupted services severely, and caused insured losses estimated at £1.3 billion (refs 5, 6). Although the flooding was deemed a 'wake-up call' to the impacts of climate change at the time, such claims are typically supported only by general thermodynamic arguments that suggest increased extreme precipitation under global warming, but fail to account fully for the complex hydrometeorology associated with flooding. Here we present a multi-step, physically based 'probabilistic event attribution' framework showing that it is very likely that global anthropogenic greenhouse gas emissions substantially increased the risk of flood occurrence in England and Wales in autumn 2000. Using publicly volunteered distributed computing, we generate several thousand seasonal-forecast-resolution climate model simulations of autumn 2000 weather, both under realistic conditions, and under conditions as they might have been had these greenhouse gas emissions and the resulting large-scale warming never occurred. Results are fed into a precipitation-runoff model that is used to simulate severe daily river runoff events in England and Wales (proxy indicators of flood events). The precise magnitude of the anthropogenic contribution remains uncertain, but in nine out of ten cases our model results indicate that twentieth-century anthropogenic greenhouse gas emissions increased the risk of floods occurring in England and Wales in autumn 2000 by more than 20%, and in two out of three cases by more than 90%. PMID:21331040

  8. Newborn bloodspot screening for Duchenne Muscular Dystrophy: 21 years experience in Wales (UK)

    PubMed Central

    Moat, Stuart J; Bradley, Donald M; Salmon, Rachel; Clarke, Angus; Hartley, Louise

    2013-01-01

    Duchenne muscular dystrophy (DMD), a progressive X-linked neuromuscular disorder, has an estimated worldwide incidence of 1:3500 male births. Currently, there are no curative treatments and the mean age of diagnosis is 5 years. In addition, subsequent pregnancies frequently occur before a diagnosis is made in an index case. An ‘opt in' screening programme was introduced in Wales in 1990 with the aim to: reduce the diagnostic delay, permit reproductive choice and allow planning of the care of the affected boy. Newborn bloodspots were collected routinely as part of the Wales newborn screening programme. Specific consent was obtained for this test separately from the other tests. During the 21-year period, 369 780 bloodspot cards were received from male infants, of these 343 170 (92.8%) were screened using a bloodspot creatine kinase (CK) assay following parental consent. A total of 145 cases had a raised CK activity (≥250 U/l) and at follow-up, at 6–8 weeks of age, 79 cases had a normal serum CK (false-positive rate 0.023%) and 66 cases had an elevated serum CK. DMD was confirmed in 56 cases by genotyping/muscle biopsy studies, Becker muscular dystrophy in 5 cases and other rarer forms of muscular dystrophy in 5 cases. This long-term study has so far identified 13 false-negative cases. The incidence of DMD in Wales of 1:5136 during this period is lower than that of 1:4046 before commencement of screening in Wales. Screening has reduced the diagnostic delay enabling reproductive choice for parents of affected boys and earlier administration of current therapies. PMID:23340516

  9. Short rotation willow coppice in Wales: High production under adverse environmental conditions?

    SciTech Connect

    Slater, F.M.; Hodson, R.W.; Randerson, P.F.

    1995-11-01

    The production of short rotation willow coppice in central Wales was once regarded as a vain hope rather than a distinct possibility. Research at the University of Wales, Cardiff, Field Station at Llysdinam in mid-Wales over the last four years has proven that it is possible to produce a commercially viable crop on very poor upland soils and at an altitude of almost 300m provided that lime and inorganic fertilizers are added. Because of the national need to find new routes for the disposal of sewage sludge, its addition to short rotation coppice serves the dual purpose of disposal and nutrient addition. Over the first two years of the sludging experiment, it was found that the addition of 300 m{sup 3}ha{sup -1} of digested sewage sludge significantly increased crop weight, at least in the first year. Unfortunately, the crop yields did not reach those obtained using inorganic fertilizers at the same site but it is suggested that a repeated application regime might improve overall crop yield.

  10. Association between incidence of non-Hodgkin's lymphoma and solar ultraviolet radiation in England and Wales.

    PubMed Central

    Bentham, G.

    1996-01-01

    OBJECTIVES--To examine whether the incidence of non-Hodgkin's lymphoma in different areas of England and Wales is associated with levels of solar ultraviolet radiation. DESIGN--Geographically based study examining the association between incidence of non-Hodgkin's lymphoma and estimated levels of solar ultraviolet radiation, controlling for social class and employment in agriculture. SETTING--59 counties in England and Wales. SUBJECTS--All registered cases of non-Hodgkin's lymphoma during the period 1968-85. MAIN OUTCOME MEASURE--Age and sex adjusted odds ratio for non-Hodgkin's lymphoma in each county. RESULTS--Incidence of non-Hodgkin's lymphoma was significantly associated with solar ultraviolet radiation levels (P < 0.001), even after social class and employment in agriculture were controlled for (P = 0.004). In a comparison of counties in the highest and lowest quarters of solar ultraviolet radiation, the relative risk of non-Hodgkin's lymphoma was 1.27 (95% confidence interval 1.24 to 1.29), rising to 1.34 (1.32 to 1.37) after adjustment for social class and employment in agriculture. CONCLUSIONS--The incidence of non-Hodgkin's lymphoma in different areas of England and Wales is positively associated with levels of solar ultraviolet radiation. These results are consistent with the hypothesis that exposure to solar ultraviolet radiation increases the risk of non-Hodgkin's lymphoma. PMID:8620128

  11. Dying younger in Scotland: Trends in mortality and deprivation relative to England and Wales, 1981-2011.

    PubMed

    Schofield, Lauren; Walsh, David; Munoz-Arroyo, Rosalia; McCartney, Gerry; Buchanan, Duncan; Lawder, Richard; Armstrong, Matthew; Dundas, Ruth; Leyland, Alastair H

    2016-07-01

    Given previous evidence that not all Scotland's higher mortality compared to England & Wales (E&W) can be explained by deprivation, the aim was to enhance understanding of this excess by analysing changes in deprivation and mortality in Scotland and E&W between 1981 and 2011. Mortality was compared by means of direct standardisation and log-linear Poisson regression models, adjusting for age, sex and deprivation. Different measures of deprivation were employed, calculated at different spatial scales. Results show that Scotland became less deprived compared to E&W between 1981 and 2011. However, the Scottish excess (the difference in mortality rates relative to E&W after adjustment for deprivation) increased from 4% higher (c.1981) to 10% higher in 2010-12. The latter figure equates to c. 5000 extra deaths per year. The increase was driven by higher mortality from cancer, suicide, alcohol related causes and drugs-related poisonings. The size and increase in Scottish excess mortality are major concerns. Investigations into its underlying causes continue, the findings of which will be relevant to other populations, given that similar excesses have been observed elsewhere in Britain. PMID:27235691

  12. The health status of mussels, Mytilus spp., in Ireland and Wales with the molecular identification of a previously undescribed haplosporidian.

    PubMed

    Lynch, S A; Morgan, E; Carlsson, J; Mackenzie, C; Wooton, E C; Rowley, A F; Malham, S; Culloty, S C

    2014-05-01

    Both wild and cultured mussels (Mytilus edulis, Mytilus galloprovincialis and hybrids), are found along most of the Irish coastline. M. edulis is widespread along all Irish coasts and is the only mussel species present on both the east coast of Ireland and the Welsh coast in the Irish Sea. M. galloprovincialis and hybrids are found along the Irish coastline except for the east coast. Samples of Mytilus spp. were collected from twenty-four sites, encompassing all coasts of Ireland and the Welsh coast, at different times of the year and over several years (2008-2011). In total, 841 mussels were examined histologically to assess their health status and the presence of any parasites or commensals. Mussels from 14 of the 24 sites were screened using polymerase chain reaction (PCR) to determine which mytilid species were present. A range of parasites were observed, generally at low levels. The most diverse community of parasites was observed at a sheltered site with poor water quality. Of significance, a previously undescribed haplosporidian was detected in a single mussel sample in the Menai Strait, Wales, by PCR and was confirmed by direct sequencing and is most closely related to Minchina chitonis and a haplosporidian of the Florida marsh clam Cyrenoida floridana. While M. edulis were infected by a variety of micro- and macro-parasites, only trematodes were observed in M. galloprovincialis and hybrids. Habitat description and the environmental factors influencing the study sites, including water quality and exposure, were recorded. PMID:24607665

  13. Palaeomagnetic data for Permian and Triassic rocks from drill holes in the Southern Sydney Basin, New South Wales

    NASA Astrophysics Data System (ADS)

    Facer, R. A.

    1981-04-01

    A section 300 m thick across the Permian—Triassic boundary has been sampled in the Southern Coalfield of the Sydney Basin, New South Wales. 55 samples, mainly grey to drab sandstones, were collected from 9 diamond drill holes which penetrated the entire Narrabeen Group and the upper part of the conformably underlying Illawarra Coal Measures, as well as a sill emplaced into the coal measures. The samples included fully oriented cores. Additional reconnaissance samples from two further drill holes were also studied. Partial alternating field demagnetization and petrography indicate the magnetic remanence to be a stable DRM. Partial thermal demagnetization above 300°C or 400°C caused large increases in magnetic susceptibility. Partial chemical demagnetization did not cause significant changes in remanence directions. For the Coal Cliff Sandstone (basal Narrabeen Group, Triassic) the palaeomagnetic pole position (Normal) was calculated to be at 59°N 322°E (dp = 27°, dm = 29°), which agrees with previously published data. For the uppermost coal measures (Permian) the pole position was calculated as 58°N 340°E (dp = 09°, dm = 10°). Data for samples from the lower to middle coal measures yield a pole position which is between the new Permian—Triassic pole position and that for the underlying Middle Permian igneous rocks. The top of the Reversed "Kiaman Magnetic Interval" (Permian) may be near the Tongarra coal and Appin Formation boundary — (early) Late Permian.

  14. Updating the Phase 1 habitat map of Wales, UK, using satellite sensor data

    NASA Astrophysics Data System (ADS)

    Lucas, Richard; Medcalf, Katie; Brown, Alan; Bunting, Peter; Breyer, Johanna; Clewley, Dan; Keyworth, Steve; Blackmore, Philippa

    The Phase 1 Survey is the most comprehensive and widely used national level map of semi-natural habitats in Wales. However, the survey was based largely on field survey and was conducted over several decades, before being completed in 1997. Given that resources for a repeat survey were limited, this study has used an object-orientated rule-based classification implemented within eCognition of multi-temporal satellite sensor data acquired between 2003 and 2006 to map semi-natural habitats and agricultural land across Wales, thereby allowing a progressive update of the Phase 1 Survey. The classification of objects to Phase 1 habitat classes was undertaken in two steps; firstly the landscape of Wales was divided into objects using orthorectified SPOT-5 High Resolution Geometric (HRG) reflectance data (10 m spatial resolution) and Land Parcel Information System (LPIS) boundaries. A rule-base was then developed to progressively discriminate and map the distribution of 105 sub-habitats across Wales based on time-series of SPOT HRG, Terra-1 Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) and Indian Remote Sensing Satellite (IRS) LISS-3 data, derived datasets (e.g., vegetation indices, fractional images) and ancillary information (e.g., topography). The rules coupled knowledge of ecology and the information content of these remote sensing data using a combination of thresholds, Boolean operations and fuzzy membership functions. A second rule-base was then developed to translate the more detailed sub-habitat classification to Phase 1 habitat classes. Indicative accuracies of the revised Phase 1 mapping, based on comparisons with the later Phase 2 survey (for selected habitats), were >80% overall and typically between 70% and 90% for many classes. Through this exercise, Wales has become the first country in Europe to produce a national map of habitats (as opposed to land cover) through object-orientated classification of satellite sensor data

  15. Climatic sensitivity of river temperature regimes within England and Wales (Invited)

    NASA Astrophysics Data System (ADS)

    Hannah, D. M.; Garner, G.; Sadler, J. P.; Orr, H.

    2013-12-01

    Water temperature is often referred to as the ';master water quality parameter' due to its critical importance for physical, chemical, and biological processes in rivers and streams. To better manage land and water resources for ecosystem and societal benefit, it is essential to improve knowledge of drivers of stream temperature dynamics across multiple scales. Most river temperature studies are conducted at the (sub-)basin scale. Hence, there is a paucity of wider perspectives on factors determining space-time variation: (1) to identify of the most sensitive hydrological regions/ basins to changing climate, and (2) to inform setting of thermal standards and development of assessment tools. To address these knowledge gaps, this observational study presents (for the first time) a quantitative assessment of spatial patterns, inter-annual variability and climatic sensitivity of the shape (form) and magnitude (size) of annual river temperature regimes across England and Wales. Classification of long-term average (1989-2006) annual river (air) temperature regime dynamics at 88 (39) temperature stations within England and Wales identifies spatially differentiable temperature regions. Emergent river temperature regions are used to structure detailed hydroclimatological analyses of a subset of 39 paired river and air temperature stations. The form and stability of air and water temperature regimes is classified for individual station-years; and a sensitivity index (SI, based on conditional probability) is used to quantify the strength of associations between water-air temperature regimes. Selected river basin properties are also employed in analyses to infer modification of air-river temperature links by catchment hydrological processes. The nature and strength of river and air temperature regime associations differ between regions across England and Wales. Physically meaningful catchment processes, namely groundwater contributions to river flow and water exposure time to

  16. Deploying a culture change programme management approach in support of information and communication technology developments in Greater Glasgow NHS Board.

    PubMed

    Frame, Joanne; Watson, Janice; Thomson, Katie

    2008-06-01

    This article reports on the project management and Culture Change Programme adopted by the NHS Greater Glasgow Health Board to deliver an electronic patient record (EPR) to support cardiology and stroke clinical services. To achieve its vision for the EPR (;to "really make a difference" to patient care by providing to the right person, the right information, under the right safeguards') the Board recognized that attending to social and organizational issues is at least of equal importance to addressing strictly technical concerns. Consequently, an ICT Culture Change Programme (ICT CCP) was devised and implemented to assist in the management of change, and in particular to facilitate a visionary clinical and cultural environment operating in conjunction with the evolving technical environment. In this article we describe the key components of this approach, outline the benefits we believe have accrued, and describe the steps being taken to build upon lessons learned. PMID:18477599

  17. The process of EDC-NHS cross-linking of reconstituted collagen fibres increases collagen fibrillar order and alignment

    SciTech Connect

    Shepherd, D. V. Shepherd, J. H.; Cameron, R. E.; Best, S. M.; Ghose, S.; Kew, S. J.

    2015-01-01

    We describe the production of collagen fibre bundles through a multi-strand, semi-continuous extrusion process. Cross-linking using an EDC (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide), NHS (N-hydroxysuccinimide) combination was considered. Atomic Force Microscopy and Raman spectroscopy focused on how cross-linking affected the collagen fibrillar structure. In the cross-linked fibres, a clear fibrillar structure comparable to native collagen was observed which was not observed in the non-cross-linked fibre. The amide III doublet in the Raman spectra provided additional evidence of alignment in the cross-linked fibres. Raman spectroscopy also indicated no residual polyethylene glycol (from the fibre forming buffer) or water in any of the fibres.

  18. Preparation of thin film nanofibrous composite NF membrane based on EDC/NHS modified PAN-AA nanofibrous substrate

    NASA Astrophysics Data System (ADS)

    Yang, Y.; Wang, X.; Hsiao, B. S.

    2016-07-01

    A novel kind of thin-film nanofibrous composite (TFNC) nanofiltration (NF) membranes consisting of a polyamide (PA) barrier layer were successfully fabricated by interfacial polymerization (IFP) based on electrospun double-layer nanofibrous substrates, which have an ultrathin poly (acrylonitrile-co-acrylic acid) (PAN-AA) nanofibrous layer as top layer and a thicker polyacrylonitrile (PAN) nanofiber layer as bottom porous support layer. Immersing PAN/PAN-AA nanofibrous substrates into 1-ethyl-(3-3-dimethylaminopropyl) carbodiimide hydrochloride/N-hydroxysuccinimide (EDC/NHS) aqueous solution and piperazine (PIP) aqueous solution (0.20 wt%) sequentially for a period of time, the carboxyl groups on PAN-AA nanofibers were activated by carbodiimide and then reacted with the amide groups. The as prepared composite membrane has an integrated structure with high rejection rate (98.0%); high permeate flux (40.4 L/m2h) for MgSO4 aqueous solution (2 g/L).

  19. Embedding Physical Activity in the Heart of the NHS: The Need for a Whole-System Approach.

    PubMed

    Speake, Helen; Copeland, Robert J; Till, Simon H; Breckon, Jeff D; Haake, Steve; Hart, Oliver

    2016-07-01

    Solutions to the global challenge of physical inactivity have tended to focus on interventions at an individual level, when evidence shows that wider factors, including the social and physical environment, play a major part in influencing health-related behaviour. A multidisciplinary perspective is needed to rewrite the research agenda on physical activity if population-level public health benefits are to be demonstrated. This article explores the questions that this raises regarding the particular role that the UK National Health Service (NHS) plays in the system. The National Centre for Sport and Exercise Medicine in Sheffield is put forward as a case study to discuss some of the ways in which health systems can work in collaboration with other partners to develop environments and systems that promote active lives for patients and staff. PMID:26942468

  20. Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS

    PubMed Central

    Checkland, Kath; Allen, Pauline; Coleman, Anna; Segar, Julia; McDermott, Imelda; Harrison, Stephen; Petsoulas, Christina; Peckham, Stephen

    2013-01-01

    Objective One of the key goals of the current reforms in the English National Health Service (NHS) under the Health and Social Care Act, 2012, is to increase the accountability of those responsible for commissioning care for patients (clinical commissioning groups (CCGs)), while at the same time allowing them a greater autonomy. This study was set out to explore CCG's developing accountability relationships. Design We carried out detailed case studies in eight CCGs, using interviews, observation and documentary analysis to explore their multiple accountabilities. Setting/participants We interviewed 91 people, including general practitioners, managers and governing body members in developing CCGs, and undertook 439 h of observation in a wide variety of meetings. Results CCGs are subject to a managerial, sanction-backed accountability to NHS England (the highest tier in the new organisational hierarchy), alongside a number of other external accountabilities to the public and to some of the other new organisations created by the reforms. In addition, unlike their predecessor commissioning organisations, they are subject to complex internal accountabilities to their members. Conclusions The accountability regime to which CCGs are subject to is considerably more complex than that which applied their predecessor organisations. It remains to be seen whether the twin aspirations of increased autonomy and increased accountability can be realised in practice. However, this early study raises some important issues and concerns, including the risk that the different bodies to whom CCGs are accountable will have differing (or conflicting) agendas, and the lack of clarity over the operation of sanction regimes. PMID:24327362

  1. The limits of market-based reforms in the NHS: the case of alternative providers in primary care

    PubMed Central

    2013-01-01

    Background Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Methods Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. Results and conclusions We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market

  2. The Role of the NHS in the Development of Revans' Action Learning: Correspondence and Contradiction in Action Learning Development and Practice

    ERIC Educational Resources Information Center

    Brook, Cheryl

    2010-01-01

    In adapting Bowles' and Gintis's correspondence principle of education, this paper suggests that there are ways in which the theory and practice of action learning developed "in correspondence" with the NHS. In doing so, the paper draws, in part, upon an historical assessment of Revans' Hospital Internal Communications Project of the 1960s,…

  3. A feasible approach to evaluate the relative reactivity of NHS-ester activated group with primary amine-derivatized DNA analogue and non-derivatized impurity.

    PubMed

    Dou, Shuping; Virostko, John; Greiner, Dale L; Powers, Alvin C; Liu, Guozheng

    2015-01-01

    Synthetic DNA analogues with improved stability are widely used in life science. The 3'and/or 5' equivalent terminuses are often derivatized by attaching an active group for further modification, but a certain amount of non-derivatized impurity often remains. It is important to know to what extent the impurity would influence further modification. The reaction of an NHS ester with primary amine is one of the most widely used options to modify DNA analogues. In this short communication, a 3'-(NH2-biotin)-derivatized morpholino DNA analogue (MORF) was utilized as the model derivatized DNA analogue. Inclusion of a biotin concomitant with the primary amine at the 3'-terminus allows for the use of streptavidin to discriminate between the products from the derivatized MORF and non-derivatized MORF impurity. To detect the MORF reaction with NHS ester, S-acetyl NHS-MAG3 was conjugated to the DNA analogue for labeling with (99m)Tc, a widely used nuclide in the clinic. It was found that the non-derivatized MORF also reacted with the S-acetyl NHS-MAG3. Radiolabeling of the product yielded an equally high labeling efficiency. Nevertheless, streptavidin binding indicated that under the conditions of this investigation, the non-derivatized MORF was five times less reactive than the amine-derivatized MORF. PMID:25621701

  4. Potential for advice from doctors to reduce the number of patients referred to emergency departments by NHS 111 call handlers: observational study

    PubMed Central

    Anderson, Andrew; Roland, Martin

    2015-01-01

    Objective To determine the effect of using experienced general practitioners (GPs) to review the advice given by call handlers in NHS 111, a national service giving telephone advice to people seeking medical care. Design Observational study following the introduction of GPs to review call handlers’ decisions which had been made using decision support software. Setting NHS 111 call centre covering Cambridgeshire and Peterborough. Intervention When a call handler using standard NHS 111 decision support software would have advised the caller to attend the hospital accident and emergency (A&E) department, the decision was reviewed by an experienced GP. Main outcome measures Percentage of calls where an outcome other than A&E attendance was recommended by the GP. Results Of 1474 cases reviewed, the GP recommended A&E attendance in 400 cases (27.1%). In the remainder of cases, the GP recommended attendance at a primary care out-of-hours centre or minor injury unit in 665 cases (45.2%) and self-management or some alternative strategy in 409 (27.8%). Conclusions Fewer callers to NHS 111 would be sent to emergency departments if the decision was reviewed by an experienced GP. Telephone triage services need to consider whether using relatively unskilled call handlers supported by computer software is the most cost-effective way to handle requests for medical care. PMID:26614624

  5. The role of the nurse lecturer in the supervision of students' essays, projects and assignments: results of an all Wales questionnaire survey.

    PubMed

    Mansell, Ian; Bennett, Glynis; Torrance, Colin; Fairbairn, Gavin

    2002-10-01

    This study explores the role of the lecturer in nursing and midwifery education in the supervision of students' essays, projects and assignments. Three methods were used within the study; semi-structured interviews, questionnaires and focus groups. The results from the semi-structured interviews were used to develop a questionnaire which was distributed to the population of lecturers in nursing and midwifery education (n=285) within Wales. This article reports some of the key findings of the questionnaire survey. Lecturers report a directive style of supervision with a considerable amount of time being invested in the supervision process. The production of guidelines for good supervision practice is recommended as a way of providing consistent and fair supervision for students. PMID:12384031

  6. [Efficiency versus quality in the NHS, in Portugal: methodologies for evaluation].

    PubMed

    Giraldes, Maria do Rosário

    2008-01-01

    To proceed to the evaluation of the efficiency and quality in the NHS, based in methodologies of evaluation of management, indicators of benchmarking and indicators of process and outcome. The 1980 and 1990 decades have seen the proliferation of all forms of process indicators as a way to control health services. It is not a coincidence that the increase in managed care has been accompanied by an explosion of process indicators, as it has happened in the health system of the USA. More recently the attention has turned away from measures of performance, which measure the process (what has been done) to those which measure outcomes (what was the result). Quality indicators have been developed in Europe, first to be used in hospitals, but also to be used in primary health care. Conceptually the justification for the introduction of process indicators comes from the principle that their use will reinforce a modification in the quality of the proceedings, which will give origin to better outcomes as well at population level, as resource saving. Outcome indicators compared with process indicators in health care shows that process indicators have the advantage of being more sensitive than outcome indicators to differences in the quality. Optimizing health care quality has the objective of establishing a quantitative relationship between the quality of the health services and cost-effectiveness. To identify quality indicators and benchmarking and to implement plans to measure the quality of health care. In a study made in a group of senior GP, in the UK, with the objective of determining which process indicators better reflect the quality of the services in primary health care services a Delphi method was used. Only seven indicators were chosen by 75% of the respondents: the percentage of eligible patients receiving cervical screening; the percentage of generic prescribing; the percentage of eligible patients receiving childhood immunization; the percentage of eligible

  7. Ten years of asthma admissions to adult critical care units in England and Wales

    PubMed Central

    Gibbison, Ben; Griggs, Kathryn; Mukherjee, Mome; Sheikh, Aziz

    2013-01-01

    Objectives To describe the patient demographics, outcomes and trends of admissions with acute severe asthma admitted to adult critical care units in England and Wales. Design 10-year, retrospective analysis of a national audit database. Setting Secondary care: adult, general critical care units in the UK. Participants 830 808 admissions to adult, general critical care units. Primary and secondary outcome measures Demographic data including age and sex, whether the patient was invasively ventilated or not, length of stay (LOS; both in the critical care unit and acute hospital), survival (both critical care unit and acute hospital) and time trends across the 10-year period. Results Over the 10-year period, there were 11 948 (1.4% of total) admissions with asthma to adult critical care units in England and Wales. Among them 67.5% were female and 32.5% were male (RR F:M 2.1; 95% CI 2.0 to 2.1). Median LOS in the critical care unit was 1.8 days (IQR 0.9–3.8). Median LOS in the acute hospital was 7 days (IQR 4–14). Critical care unit survival rate was 95.5%. Survival at discharge from hospital was 93.3%. There was an increase in admissions to adult critical care units by an average of 4.7% (95% CI 2.8 to 6.7)/year. Conclusions Acute asthma represents a modest burden of work for adult critical care units in England and Wales. Demographic patterns for admission to critical care unit mirror those of severe asthma in the general adult community. The number of critical care admissions with asthma are rising, although we were unable to discern whether this represents a true increase in the incidence of acute asthma or asthma severity. PMID:24056484

  8. Assessing options for the development of surface water flood warning in England and Wales.

    PubMed

    Priest, S J; Parker, D J; Hurford, A P; Walker, J; Evans, K

    2011-12-01

    This paper explores the technical options for warning of surface water flooding in England and Wales and presents the results of an Environment Agency funded project. Following the extensive surface water flooding experienced in summer 2007 a rainfall threshold-based Extreme Rainfall Alert (ERA) was piloted by the Met Office and Environment Agency providing initial steps towards the establishment of a warning for some types of surface water flooding. The findings of this paper are based primarily on feedback on technical options from a range of professionals involved in flood forecasting and warning and flood risk management, about the current alerts and about the potential options for developing a more targeted surface water flood warning service. Providing surface water flooding warnings presents a set of technical, forecasting and warning challenges related to the rapid onset of flooding, the localised nature of the flooding, and the linking of rainfall and flood forecasts to flood likelihood and impact on the ground. Some examples of rainfall alerting and surface water flood warning services from other countries are evaluated, as well as a small number of recently implemented local services in England and Wales. Various potential options for implementation of a service are then explored and assessed. The paper concludes that development of a surface water flood warning service for England and Wales is feasible and is likely to be useful to emergency responders and operational agencies, although developing such a service for the pluvial components of this type of flooding is likely to be feasible sooner than for other components of surface water flooding such as that caused by sewers. A targeted surface water flood warning service could be developed for professional emergency responders in the first instance rather than for the public for whom such a service without further operational testing and piloting would be premature. PMID:21862203

  9. Rehabilitation of refugee victims of torture and trauma: principles and service provision in New South Wales.

    PubMed

    Reid, J C; Strong, T

    1988-04-01

    A number of recently-arrived refugees who are suffering from psychological disturbances and physical injuries that have resulted from torture or severe trauma has come to the attention of welfare workers and health personnel in New South Wales. A tentative estimate of more than 2000 refugees in New South Wales who are so affected, and clear evidence of extensive human rights abuses in the countries from which they came, indicate an urgent need for specialized care for the victims. Organized violence, including detention, torture and severe deprivation, is a tool of governments in many countries of the world. The varied forms of torture are all designed to destroy the trust, personality and self-esteem of the victims and to foster dependency, debility and dread, both in the victims and in the societies in which they live. Those persons who survive torture and detention often are affected severely in body, mind and spirit. Many victims exhibit acute and chronic symptoms that are described commonly by the diagnostic categories "post-traumatic stress disorder" and "torture syndrome". Their kin, especially spouses and children, also suffer psychological and familial disturbances frequently, as a result of the arrest, detention and torture of the victim. Their suffering is compounded by the distress of fleeing their home country and the stresses of adjusting to a new country and way of life. In Europe and North America, services have been established to treat and to rehabilitate sufferers of these disorders. Treatment programmes differ in structure and size, but include commonly psychotherapy, physiotherapy, specialized medical care and parallel assistance with resettlement and social adjustment for both the patients and their families. This article cites illustrative case material from New South Wales and summarizes the recommendations for a community-based rehabilitation service for victims both of torture and of other forms of organized violence, such as detention in

  10. A generalised framework for large-scale evaluation of discharge uncertainties across England and Wales

    NASA Astrophysics Data System (ADS)

    Coxon, Gemma; Freer, Jim; Westerberg, Ida; Woods, Ross; Smith, Paul; Wagener, Thorsten

    2014-05-01

    Benchmarking the information content and quality of discharge data in England and Wales is essential for analyses of catchment behaviour and modelling results for research and water management. This is particularly pertinent for comparative hydrological analysis and modelling performance conducted over regional and national scales to ensure the information content of discharge data is effectively characterised. In this study, the first country-wide assessment of discharge uncertainty in England and Wales is undertaken. We analyse rating-curve data and stage-discharge measurements for over 700 gauging stations and present a novel, generalised framework for quantifying discharge uncertainty that is readily applicable to many gauging stations. Our methodology utilises a non-parametric regression technique for fitting the rating curve, specifically accounting for measurement error by bootstrap sampling from derived measurement uncertainties and for scatter in the stage-discharge relationship. Additionally, the framework incorporates techniques to account for different types of stage-discharge relationships, including time-variable rating curves, gauging station changes and outliers in the stage-discharge measurement data. Results for all gauging stations across England and Wales are presented demonstrating (1) how discharge uncertainty varies spatially for low, mean and high flows, (2) how the framework captures place-specific uncertainties for a number of case studies and (3) the links that can be drawn between catchment characteristics and discharge uncertainty. We also analyse changes in the official rating curves to deduce the stability of the stage-discharge relationship and find this is dependent on catchment dynamics. Finally, we discuss the significance of these results for national scale uncertainty analyses and comparative hydrological assessments. This methodology is applicable to any catchment with comparable stage-discharge information.

  11. Cancer mortality in small areas around nuclear facilities in England and Wales.

    PubMed Central

    Baron, J. A.

    1984-01-01

    Cancer mortality trends were examined for the small areas around fourteen nuclear and five non-nuclear facilities in England and Wales. Using routine OPCS mortality data, standardized mortality ratios (SMRs) for these areas were computed for selected causes of death. Changes in the SMRs were then sought by comparing the SMRs for the five years before the facility opened with the period 10 (in some cases 15) years after start-up, and by computing the weighted regression of the SMRs on calendar year. These analyses indicate no overall pattern of increasing cancer SMRs around nuclear facilities. PMID:6498079

  12. Low formation energy and kinetic barrier of Stone-Wales defect in infinite and finite silicene

    NASA Astrophysics Data System (ADS)

    Manjanath, Aaditya; Singh, Abhishek K.

    2014-01-01

    Stone-Wales (SW) defects in materials having hexagonal lattice are the most common topological defects that affect the electronic and mechanical properties. Using first principles density functional theory based calculations, we study the formation energy and kinetic barrier of SW-defect in infinite and finite sheets of silicene. The formation energies as well as the barriers in both the cases are significantly lower than those of graphene. Furthermore, compared with the infinite sheets, the energy barriers and formation energies are lower for finite sheets. However, due to low barriers these defects are expected to heal out of the finite sheets.

  13. Real wages, the economic cycle, and mortality in England and Wales, 1870-1914.

    PubMed

    Blane, D

    1990-01-01

    The mortality rates of the various age groups within the population of England and Wales fell dramatically between 1870 and 1914, and this period has been used to examine McKeown's thesis of an inverse relationship between a population's mortality rate and its standard of living. Using real wages as a measure of living standards, McKeown's thesis is found to hold for most age groups for most of the period. Several anomalies are identified, however, and it is argued that these can best be reconciled with the original thesis by taking account of the economic cycle. PMID:2407674

  14. [The sainsbury centre for mental health: forensic mental health services in England and wales].

    PubMed

    Rutherford, M; Duggan, S

    2008-06-01

    The Sainsbury Centre for Mental Health (SCMH) is a charity founded in 1985 by Gatsby Charitable Foundation. The SCMH works to improve the quality of life for people with mental health problems by influencing policy and practice in mental health and related services. Working to improve the quality of mental health care for people in prison is one of SCMH main work theme. This paper describes some epidemiological aspects of mental health situation of prisoners in England and Wales and the available forensic facilities to manage this kind of patients in prison. PMID:23128315

  15. Ophthalmic genetics: a genealogical guide to sources in England and Wales.

    PubMed Central

    Jay, M

    1995-01-01

    Large pedigrees are fundamental to seeking new genes; they can be constructed on the basis of a family history but can frequently be enlarged considerably from public records. Genealogical sources in England and Wales consist of public records such as civil registration of births, marriages, and deaths, census returns, wills, and church records. Details are given as to their use and where they are to be found. In addition, examples are given of how archival material and pathology reports may be used to compile extensive pedigrees which can span 10 generations. Images PMID:8825921

  16. Getting it Right? Lessons from the Interwar Years on Pulmonary Tuberculosis Control in England and Wales

    PubMed Central

    Bowden, Sue; Sadler, Alex

    2015-01-01

    This paper examines morbidity and mortality patterns in interwar England and Wales, using previously under-explored primary archival source materials. These materials help us understand not only what local authorities could and did do, but also the reasons for the marked variations in the ability of different authorities to manage the problem. We identify where and why there were problems and also how and why some authorities were more successful than others in dealing with the disease. Wealth was not an issue. We find a combination of pro-active preventative measures was significant. PMID:25498440

  17. Capacity withholding in wholesale electricity markets: The experience in England and Wales

    NASA Astrophysics Data System (ADS)

    Quinn, James Arnold

    This thesis examines the incentives wholesale electricity generators face to withhold generating capacity from centralized electricity spot markets. The first chapter includes a brief history of electricity industry regulation in England and Wales and in the United States, including a description of key institutional features of England and Wales' restructured electricity market. The first chapter also includes a review of the literature on both bid price manipulation and capacity bid manipulation in centralized electricity markets. The second chapter details a theoretical model of wholesale generator behavior in a single price electricity market. A duopoly model is specified under the assumption that demand is non-stochastic. This model assumes that duopoly generators offer to sell electricity at their marginal cost, but can withhold a continuous segment of their capacity from the market. The Nash equilibrium withholding strategy of this model involves each duopoly generator withholding so that it produces the Cournot equilibrium output. A monopoly model along the lines of the duopoly model is specified and simulated under the assumption that demand is stochastic. The optimal strategy depends on the degree of demand uncertainty. When there is a moderate degree of demand uncertainty, the optimal withholding strategy involves production inefficiencies. When there is a high degree of demand uncertainty, the optimal monopoly quantity is greater than the optimal output level when demand is non-stochastic. The third chapter contains an empirical examination of the behavior of generators in the wholesale electricity market in England and Wales in the early 1990's. The wholesale market in England and Wales is analyzed because the industry structure in the early 1990's created a natural experiment, which is described in this chapter, whereby one of the two dominant generators had no incentive to behave non-competitively. This chapter develops a classification methodology

  18. Consumer participation in service planning--the AWS (All Wales Strategy) experience.

    PubMed

    McGrath, M

    1989-01-01

    This paper provides a case study of the involvement of carers in planning services for mentally handicapped people under the All Wales Strategy (AWS). After describing the structure for consumer participation in the AWS in Gwynedd, reasons for the low level of participation found are examined before considering what can be learnt from these early experiences. Major changes in the planning structure implemented after a review of the system are outlined. The paper ends with a discussion of the major operational principles which might underlie an effective system of consumer participation. PMID:10292255

  19. Inter-annual rainfall variations and suicide in New South Wales, Australia, 1964-2001

    NASA Astrophysics Data System (ADS)

    Nicholls, Neville; Butler, Colin D.; Hanigan, Ivan

    2006-01-01

    The suicide rate in New South Wales is shown to be related to annual precipitation, supporting a widespread and long-held assumption that drought in Australia increases the likelihood of suicide. The relationship, although statistically significant, is not especially strong and is confounded by strong, long-term variations in the suicide rate not related to precipitation variations. A decrease in precipitation of about 300 mm would lead to an increase in the suicide rate of approximately 8% of the long-term mean suicide rate.

  20. Stone-Wales Defects Created by Low Energy Recoils in Single-walled Silicon Carbide Nanotubes

    SciTech Connect

    Wang, Zhiguo; Gao, Fei; Li, JINGBO; Zu, Xiaotao T.; Weber, William J.

    2009-10-15

    The defect creation at low energy events was studied using density functional theory molecular dynamics simulations in silicon carbide nanotubes, and the displacement threshold energies determined exhibit a dependence on sizes, which decrease with decreasing diameter of the nanotubes. The Stone-Wales (SW) defect, which is a common defect configurations induced through irradiation in nanotubes, has also been investigated, and the formation energies of the SW defects increase with increasing diameter of the nanotubes. The mean threshold energies were found to be 23 and 18 eV for Si and C in armchair (5,5) nanotubes.

  1. Bayesian conditional-independence modeling of the AIDS epidemic in England and Wales

    NASA Astrophysics Data System (ADS)

    Gilks, Walter R.; De Angelis, Daniela; Day, Nicholas E.

    We describe the use of conditional-independence modeling, Bayesian inference and Markov chain Monte Carlo, to model and project the HIV-AIDS epidemic in homosexual/bisexual males in England and Wales. Complexity in this analysis arises through selectively missing data, indirectly observed underlying processes, and measurement error. Our emphasis is on presentation and discussion of the concepts, not on the technicalities of this analysis, which can be found elsewhere [D. De Angelis, W.R. Gilks, N.E. Day, Bayesian projection of the the acquired immune deficiency syndrome epidemic (with discussion), Applied Statistics, in press].

  2. A review of outbreaks of infectious disease in schools in England and Wales 1979-88.

    PubMed Central

    Joseph, C.; Noah, N.; White, J.; Hoskins, T.

    1990-01-01

    In this review of 66 outbreaks of infectious disease in schools in England and Wales between 1979-88, 27 were reported from independent and 39 from maintained schools. Altogether, over 8000 children and nearly 500 adults were affected. Most of the outbreaks investigated were due to gastrointestinal infections which affected about 5000 children: respiratory infections affected a further 2000 children. Fifty-two children and seven adults were admitted to hospital and one child with measles died. Vaccination policies and use of immunoglobulin for control and prevention of outbreaks in schools have been discussed. PMID:2209745

  3. Pneumoconiosis: a study of its effect on miners' health in South Wales 1900-1980.

    PubMed

    Howells, G; Rees, C

    Since its discovery in the late 19th century, pneumoconiosis has shaped the lives of thousands of miners. In some ways it became inextricably linked to the South Wales coal field and was a major public health threat to the men who worked in those mines. The disease was caused by the conditions of work and worsened the situation of many who were already living in poverty. This historical research account traces the miners' plight and touches on some of the public health issues raised by the disease. PMID:10347463

  4. Rock art at the 'Mini-Yengo' site near Kulnura, New South Wales

    NASA Astrophysics Data System (ADS)

    Hamacher, Duane W.; Clegg, John K.; Pankhurst, Robert S.

    2012-11-01

    The "Mini-Yengo" rock art site is located in Mangrove Creek Dam Park on Kyola Road, near the corner of Kyola Road and George Downes Drive, approximately 1.8 km to the northwest of Kulnura, New South Wales, Australia. No records of this site were identified in the published literature (Sim 1966; Needham 1981; McCarthy 1983; Gordon 1993; McDonald 1993) but it was included in site card 45-3-0528 from the Aboriginal Heritage Information Management System (AHIMS). The site card contained unpublished surveys by V. Attenbrow in 1980 and I.M. Sim in 1976.

  5. Cancer mortality in Indian and British ethnic immigrants from the Indian subcontinent to England and Wales.

    PubMed Central

    Swerdlow, A. J.; Marmot, M. G.; Grulich, A. E.; Head, J.

    1995-01-01

    Risk of cancer mortality from 1973 to 1985 in persons born in the Indian subcontinent who migrated to England and Wales was analysed by ethnicity, and compared with cancer mortality in the England and Wales native population, using data from England and Wales death certificates. There were substantial highly significant raised risks in Indian ethnic migrants for cancers of the mouth and pharynx, gall bladder, and liver in each sex, larynx and thyroid in males, and oesophagus in females. There were also substantial raised risks in these migrants of each sex for non-Hodgkin's lymphoma and myeloma. For the mouth and pharynx, and liver in each sex, and gall bladder in females, there were also raised risks of lesser magnitude in British ethnic migrants. For colon and rectal cancer and cutaneous melanoma in each sex, ovarian cancer in women and bladder cancer in men, there were appreciable significantly reduced risks in the Indian ethnic migrants not shared by those of British ethnicity. Appreciable raised risks in British ethnic migrants not shared by those of Indian ethnicity occurred for nasopharyngeal cancer in males, soft tissue malignancy in both sexes and non-melanoma skin cancer in males. In migrants of both ethnicities there were appreciable significantly raised risks in each sex for leukaemia and decreased risks in each sex for gastric cancer, for lung cancer except in females of British ethnicity and in males for testicular cancer. The results suggest the need for public health measures to combat the high risks of oral and pharyngeal cancers and liver cancer in the Indian ethnic immigrant population of England and Wales, by prevention of betel quid chewing and hepatitis transmission respectively. The data also imply that early exposures or early acquired behaviours in India, or exposures during migration, may increase the risk of leukaemia and reduce the risks of gastric and testicular cancers in the migrants irrespective of their ethnicity. Aetiological

  6. The Contribution of the New South Wales Primary Schools Sports Association towards Developing Talent in Australian 12-Year-Old Female Swimmers

    ERIC Educational Resources Information Center

    Light, Richard

    2012-01-01

    This article reports on a case study that inquired into the influence of the New South Wales Primary Schools Sports Association competitive swimming structure on the development of talented 12-year old female swimmers. The study focused on ten 12-year old girls in the New South Wales team that contested the 2009 national swimming championships…

  7. Impacts of American Agricultural Education Student Teachers on Eleven Community Members in a New South Wales, Australia Community: A Qualitative Study

    ERIC Educational Resources Information Center

    Bunch, Tera; Stephens, Carrie; Hart, William

    2011-01-01

    The purpose of this study was to evaluate the influences of American agricultural education student teachers on a rural community in New South Wales, Australia. The study analyzed interviews with eleven participants of the American student teacher program in a rural New South Wales community. Results of the study were formulated by two…

  8. Modeling Water Utility Investments and Improving Regulatory Policies using Economic Optimisation in England and Wales

    NASA Astrophysics Data System (ADS)

    Padula, S.; Harou, J. J.

    2012-12-01

    Water utilities in England and Wales are regulated natural monopolies called 'water companies'. Water companies must obtain periodic regulatory approval for all investments (new supply infrastructure or demand management measures). Both water companies and their regulators use results from least economic cost capacity expansion optimisation models to develop or assess water supply investment plans. This presentation first describes the formulation of a flexible supply-demand planning capacity expansion model for water system planning. The model uses a mixed integer linear programming (MILP) formulation to choose the least-cost schedule of future supply schemes (reservoirs, desalination plants, etc.) and demand management (DM) measures (leakage reduction, water efficiency and metering options) and bulk transfers. Decisions include what schemes to implement, when to do so, how to size schemes and how much to use each scheme during each year of an n-year long planning horizon (typically 30 years). In addition to capital and operating (fixed and variable) costs, the estimated social and environmental costs of schemes are considered. Each proposed scheme is costed discretely at one or more capacities following regulatory guidelines. The model uses a node-link network structure: water demand nodes are connected to supply and demand management (DM) options (represented as nodes) or to other demand nodes (transfers). Yields from existing and proposed are estimated separately using detailed water resource system simulation models evaluated over the historical period. The model simultaneously considers multiple demand scenarios to ensure demands are met at required reliability levels; use levels of each scheme are evaluated for each demand scenario and weighted by scenario likelihood so that operating costs are accurately evaluated. Multiple interdependency relationships between schemes (pre-requisites, mutual exclusivity, start dates, etc.) can be accounted for by

  9. "Persons That Live Remote from London": Apothecaries and the Medical Marketplace in Seventeenth-and Eighteenth-Century Wales

    PubMed Central

    Withey, Alun

    2011-01-01

    Summary This article uses evidence from Welsh apothecary shops as a means to access the mechanisms of the "medical marketplace" in seventeenth- and eighteenth-century Wales. As a country physically remote from large urban medical centers, and with few large towns, Wales has often been overlooked in terms of medical commerce. Nevertheless, evidence suggests that Welsh apothecaries participated in broad and sophisticated networks of trade with London suppliers. Moreover, their shops contained a wide range of medicines from herbal simples to exotic ingredients and chemical preparations, highlighting the availability of such goods far from large urban centers. PMID:21804184

  10. "Persons that live remote from London": apothecaries and the medical marketplace in seventeenth-and eighteenth-century Wales.

    PubMed

    Withey, Alun

    2011-01-01

    This article uses evidence from Welsh apothecary shops as a means to access the mechanisms of the "medical marketplace" in seventeenth- and eighteenth-century Wales. As a country physically remote from large urban medical centers, and with few large towns, Wales has often been overlooked in terms of medical commerce. Nevertheless, evidence suggests that Welsh apothecaries participated in broad and sophisticated networks of trade with London suppliers. Moreover, their shops contained a wide range of medicines from herbal simples to exotic ingredients and chemical preparations, highlighting the availability of such goods far from large urban centers. PMID:21804184

  11. Preparation and properties of EDC/NHS mediated crosslinking poly (gamma-glutamic acid)/epsilon-polylysine hydrogels.

    PubMed

    Hua, Jiachuan; Li, Zheng; Xia, Wen; Yang, Ning; Gong, Jixian; Zhang, Jianfei; Qiao, Changsheng

    2016-04-01

    In this paper, a novel pH-sensitive poly (amino acid) hydrogel based on poly γ-glutamic acid (γ-PGA) and ε-polylysine (ε-PL) was prepared by carbodiimide (EDC) and N-hydroxysuccinimide (NHS) mediated polymerization. The influence of PGA/PL molar ratio and EDC/NHS concentration on the structure and properties was studied. Fourier transform infrared spectroscopy (FT-IR) and X-ray photoelectron spectroscopy (XPS) proved that hydrogels were crosslinked through amide bond linkage, and the conversion rate of a carboxyl group could reach 96%. Scanning electron microscopy (SEM) results showed a regularly porous structure with 20 μm pore size in average. The gelation time in the crosslink process of PGA/PL hydrogels was within less than 5 min. PGA/PL hydrogels had excellent optical performance that was evaluated by a novel optotype method. Furthermore, PGA/PL hydrogels were found to be pH-sensitive, which could be adjusted to the pH of swelling media intelligently. The terminal pH of swelling medium could be controlled at 5 ± 1 after equilibrium when the initial pH was within 3-11. The swelling kinetics was found to follow a Voigt model in deionized water but a pseudo-second-order model in normal saline and phosphate buffer solution, respectively. The differential swelling degrees were attributed to the swelling theory based on the different ratio of -COOH/-NH2 and pore size in hydrogels. The results of mechanical property indicated that PGA/PL hydrogels were soft and elastic. Moreover, PGA/PL hydrogels exhibited excellent biocompatibility by cell proliferation experiment. PGA/PL hydrogels could be degraded in PBS solution and the degradation rate was decreased with the increase of the molar ratio of PL. Considering the simple preparation process and pH-sensitive property, these PGA/PL hydrogels might have high potential for use in medical and clinical fields. PMID:26838920

  12. Impact of the 1991 NHS reforms on the availability and use of coronary revascularisation in the UK (1987–1995)

    PubMed Central

    Black, Nick; Langham, Susan; Coshall, Catherine; Parker, John

    1996-01-01

    Objective—To describe changes in the availability, utilisation, and waiting times for coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) between 1987/88 and 1994/95 and to review commissioning of these services. Design—A series of cross sectional surveys and interviews with purchasers and providers. Setting—Four health regions in the United Kingdom. Patients—All residents aged 25 years or more who underwent coronary revascularisation. Results—There has been little change in the availability of consultants in cardiology in specialist centres, while the number of non-consultant cardiologists has risen significantly. The availability of consultant surgeons more than doubled in some regions, while non-consultant surgical staff increased by 40–90%. The NHS rate of use of both CABG and PTCA has increased steadily since 1987/88. In 1994/95, only two districts had CABG rates of less than 300 per million population. The additional contribution of privately funded cases varied between 14–23% for CABG and 7–30% for PTCA. Regional rates varied 1·3-fold for CABG and threefold for PTCA in 1994/95, while district rates of CABG varied 3·6-fold and PTCA 18-fold. Revascularisation rates were higher in districts with least need in 1991/92 and this persisted over the following three years. The overall waiting time for CABG (214 days) was largely unchanged from 1992/93 (234 days). The overall waiting time for PTCA (138 days) was 25% shorter than in 1992/93 (185 days). Prioritisation of patients waiting over a year had not yet adversely affected the waiting time of more urgent patients. Commissioning has faced a complex web of interconnected problems which, in general, caused more problems for purchasers than providers initially but which appear to be of increasing concern to providers. Conclusions—The 1991 NHS reforms had had no observable impact on the availability and use of coronary revascularisation by 1995

  13. Differential and spatial aspects of suicide mortality in New South Wales and Sydney, 1980 to 1991.

    PubMed

    Burnley, I H

    1994-09-01

    Occupational and marital status dimensions of suicide mortality in New South Wales were examined for the periods 1980 to 1985 and 1986 to 1989-90 respectively, and marital status and birthplace group mortality profiles were examined in relation to grouped occupations, with a view to identifying the relative influence of these differentiating factors on suicide mortality. Spatial analysis was undertaken for different ages, in major regions of New South Wales and statistical local areas in Sydney for the period 1985 to 1991, and associations with socioeconomic characteristics of geographic areas were investigated. Despite residential revitalisation in inner city areas, higher mortality in several inner city localities has persisted over time while levels have risen in some outer areas. Never-married and divorced men in manual work were most at risk of committing suicide and never-married and divorced women had elevated suicide levels. Male suicide levels were elevated among farmers and related workers, and youth and adult male suicide levels were elevated in inland regions of the state. Possible explanations for the variations are discussed. PMID:7841260

  14. Shiga Toxin-Producing Escherichia coli O157, England and Wales, 1983-2012.

    PubMed

    Adams, Natalie L; Byrne, Lisa; Smith, Geraldine A; Elson, Richard; Harris, John P; Salmon, Roland; Smith, Robert; O'Brien, Sarah J; Adak, Goutam K; Jenkins, Claire

    2016-04-01

    We evaluated clinical Shiga toxin-producing Escherichia coli O157 infections in England and Wales during 1983-2012 to describe changes in microbiological and surveillance methods. A strain replacement event was captured; phage type (PT) 2 decreased to account for just 3% of cases by 2012, whereas PT8 and PT21/28 strains concurrently emerged, constituting almost two thirds of cases by 2012. Despite interventions to control and reduce transmission, incidence remained constant. However, sources of infection changed over time; outbreaks caused by contaminated meat and milk declined, suggesting that interventions aimed at reducing meat cross-contamination were effective. Petting farm and school and nursery outbreaks increased, suggesting the emergence of other modes of transmission and potentially contributing to the sustained incidence over time. Studies assessing interventions and consideration of policies and guidance should be undertaken to reduce Shiga toxin-producing E. coli O157 infections in England and Wales in line with the latest epidemiologic findings. PMID:26982243

  15. Shiga Toxin–Producing Escherichia coli O157, England and Wales, 1983–2012

    PubMed Central

    Byrne, Lisa; Smith, Geraldine A.; Elson, Richard; Harris, John P.; Salmon, Roland; Smith, Robert; O’Brien, Sarah J.; Adak, Goutam K.; Jenkins, Claire

    2016-01-01

    We evaluated clinical Shiga toxin–producing Escherichia coli O157 infections in England and Wales during 1983–2012 to describe changes in microbiological and surveillance methods. A strain replacement event was captured; phage type (PT) 2 decreased to account for just 3% of cases by 2012, whereas PT8 and PT21/28 strains concurrently emerged, constituting almost two thirds of cases by 2012. Despite interventions to control and reduce transmission, incidence remained constant. However, sources of infection changed over time; outbreaks caused by contaminated meat and milk declined, suggesting that interventions aimed at reducing meat cross-contamination were effective. Petting farm and school and nursery outbreaks increased, suggesting the emergence of other modes of transmission and potentially contributing to the sustained incidence over time. Studies assessing interventions and consideration of policies and guidance should be undertaken to reduce Shiga toxin–producing E. coli O157 infections in England and Wales in line with the latest epidemiologic findings. PMID:26982243

  16. The analysis and forecasting of male cycling time trial records established within England and Wales.

    PubMed

    Dyer, Bryce; Hassani, Hossein; Shadi, Mehran

    2016-01-01

    The format of cycling time trials in England, Wales and Northern Ireland, involves riders competing individually over several fixed race distances of 10-100 miles in length and using time constrained formats of 12 and 24 h in duration. Drawing on data provided by the national governing body that covers the regions of England and Wales, an analysis of six male competition record progressions was undertaken to illustrate its progression. Future forecasts are then projected through use of the Singular Spectrum Analysis technique. This method has not been applied to sport-based time series data before. All six records have seen a progressive improvement and are non-linear in nature. Five records saw their highest level of record change during the 1950-1969 period. Whilst new record frequency generally has reduced since this period, the magnitude of performance improvement has generally increased. The Singular Spectrum Analysis technique successfully provided forecasted projections in the short to medium term with a high level of fit to the time series data. PMID:26708927

  17. Origin of artificial radionuclides in soil and sediment from North Wales.

    PubMed

    Al-Qasmi, Hamza; Law, Gareth T W; Fifield, L Keith; Livens, Francis R

    2016-01-01

    During the operations at the Sellafield nuclear fuel reprocessing complex, artificial radionuclides are discharged to the Irish Sea under authorisation, where they are dispersed. In this study, the southern distribution and transport of Sellafield derived radionuclides have been investigated. Both natural and artificial radionuclides have been studied in a soil core from the riverbank of the Afon Goch in Anglesey, North Wales. Particulate input is dominant for all artificial radionuclides (including the more soluble (137)Cs and (236)U) with an estimated lag time of about a decade. The preferential northward seawater movement in the NE Irish Sea limits solution input of (137)Cs and (236)U to the areas south of Sellafield. The relatively long lag time reflects both the water circulation pattern and distance between the study site in north Wales and the source point in Cumbria. Two redox active zones are observed in the top and the bottom of this core, although there is no evidence for any redistribution of Pu and natural uranium by these redox processes. However, (236)U, derived from irradiated uranium, showed variable distribution in the core. This could be a potential response to the geochemical conditions, showing that (236)U may be a promising tracer for the environmental processes and a signature of the Sellafield historical discharges of irradiated uranium. PMID:26529492

  18. Cancer mortality among local authority pest control officers in England and Wales.

    PubMed Central

    Thomas, H F; Winter, P D; Donaldson, L J

    1996-01-01

    OBJECTIVE: To examine cancer mortality by tumour site among local authority pest control officers. METHODS: Prospective mortality study, and follow up to the end of 1994, of 1485 male pest control officers aged between 17 and 69 and employed in 296 local authorities in England and Wales for at least six months between January 1980 and April 1984. Observed numbers of deaths were compared with those expected on the basis of the rates for relevant calendar year, cause, sex, and age specific groups for England and Wales. RESULTS: 200 deaths occurred during the follow up period of which 65 were certified as due to malignant neoplasms. No tumour type showed significantly more deaths than expected. Total all cause, lung cancer, and respiratory disease mortality were significantly lower than expected. CONCLUSIONS: 15 year follow up of a group of men handling a wide range of pesticides did not show any significant risk of cancer. This may be partially explained by the healthy worker effect and also the limited power of the study to detect significant increases in the less common tumours. Further long term follow up of this cohort will continue. Chemical control of pests that can cause human disease and can contaminate food and water has been, and will continue to be, a major public health measure. It is important to ensure that the health of those applying pesticides is not at excess risk. Negative results are important. PMID:9038805

  19. High liver content of polybrominated diphenyl ether (PBDE) in otters (Lutra lutra) from England and Wales.

    PubMed

    Pountney, Angela; Filby, Amy L; Thomas, Gareth O; Simpson, Vic R; Chadwick, Elizabeth A; Stevens, Jamie R; Tyler, Charles R

    2015-01-01

    Polybrominated diphenyl ethers (PBDEs), used as flame retardants since the 1970s, are being phased out of use, but are persistent and widespread in the environment. Historical declines in Eurasian otter (Lutra lutra) populations have been associated with exposure to dieldrin and polychlorinated biphenyls (PCBs), but links with other persistent organic pollutants have not been explored. In this study, liver samples from 129 otters, collected across England and Wales from 1995-2006, were analysed for PBDEs, together with PCBs, DDT breakdown products, and hexachlorobenzene. Associations with geographical location and life history parameters were explored. Concentrations of PBDEs in otters (∑BDE 12-70000ngg(-1) lipid) paralleled those measured in marine mammals, with PBDE-47 the dominant congener and high levels of PBDE-99 and -100. Otter livers contained high concentrations of PBDE-153 and -209, typical of terrestrial top predators. Inter-individual variation in PBDE concentrations was high and correlated with geographical location. ∑PBDE was 25% of ∑PCB, and comparable with ∑DDT, identifying PBDEs as a major contaminant in otter populations in England and Wales. PMID:25014662

  20. Shared Web Information Systems for Heritage in Scotland and Wales - Flexibility in Partnership

    NASA Astrophysics Data System (ADS)

    Thomas, D.; McKeague, P.

    2013-07-01

    The Royal Commissions on the Ancient and Historical Monuments of Scotland and Wales were established in 1908 to investigate and record the archaeological and built heritage of their respective countries. The organisations have grown organically over the succeeding century, steadily developing their inventories and collections as card and paper indexes. Computerisation followed in the late 1980s and early 1990s, with RCAHMS releasing Canmore, an online searchable database, in 1998. Following a review of service provision in Wales, RCAHMW entered into partnership with RCAHMS in 2003 to deliver a database for their national inventories and collections. The resultant partnership enables both organisations to develop at their own pace whilst delivering efficiencies through a common experience and a shared IT infrastructure. Through innovative solutions the partnership has also delivered benefits to the wider historic environment community, providing online portals to a range of datasets, ultimately raising public awareness and appreciation of the heritage around them. Now celebrating its 10th year, Shared Web Information Systems for Heritage, or more simply SWISH, continues to underpin the work of both organisations in presenting information about the historic environment to the public.

  1. Population Accessibility to Radiotherapy Services in New South Wales Region of Australia: a methodological contribution

    NASA Astrophysics Data System (ADS)

    Shukla, Nagesh; Wickramasuriya, Rohan; Miller, Andrew; Perez, Pascal

    2015-05-01

    This paper proposes an integrated modelling process to assess the population accessibility to radiotherapy treatment services in future based on future cancer incidence and road network-based accessibility. Previous research efforts assessed travel distance/time barriers affecting access to cancer treatment services, as well as epidemiological studies that showed that cancer incidence rates vary with population demography. It is established that travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the demand for cancer radiotherapy (RT) services. However, an integrated service planning approach that combines spatially-explicit cancer incidence projections, and the RT services accessibility based on patient road network have never been attempted. This research work presents this novel methodology for the accessibility assessment of RT services and demonstrates its viability by modelling New South Wales (NSW) cancer incidence rates for different age-sex groups based on observed cancer incidence trends; estimating the road network-based access to current NSW treatment centres; and, projecting the demand for RT services in New South Wales, Australia from year 2011 to 2026.

  2. Transition mechanism of Stone-Wales defect in armchair edge (5,5) carbon nanotube

    NASA Astrophysics Data System (ADS)

    Setiadi, Agung; Suprijadi

    2015-04-01

    We performed first principles calculations of Stone-Wales (SW) defects in armchair edge (5,5) carbon nanotube (CNT) by the density functional theory (DFT). Stone Wales (SW) defect is one kind of topological defect on the CNT. There are two kind of SW defect on the armchair edge (5,5) CNT, such as longitudinal and circumference SW defect. Barrier energy in the formation of SW defects is a good consideration to become one of parameter in controlling SW defects on the CNT. Our calculation results that a longitudinal SW defect is more stable than circumference SW defect. However, the barrier energy of circumference SW defect is lower than another one. We applied Climbing Image Nudge Elastic Band (CI-NEB) method to find minimum energy path (MEP) and barrier energy for SW defect transitions. We also found that in the case of circumference SW defect, armchair edge (5,5) CNT become semiconductor with the band gap of 0.0544 eV.

  3. Rainbow channeling of protons in very short carbon nanotubes with aligned Stone-Wales defects

    NASA Astrophysics Data System (ADS)

    Ćosić, M.; Petrović, S.; Bellucci, S.

    2016-01-01

    In this paper proton channeling through armchair single-walled-carbon-nanotubes (SWCNTs) with aligned Stone-Wales defects has been investigated. The energy of the proton beam was 1 GeV, while the lengths of the SWCNTs have been varied from 200 nm up to 1000 nm. The linear density of aligned defects has been varied in the whole range, from minimally up to maximally possible values. Here are presented results of a detailed morphological analysis concerning: the formation, evolution and interaction of the nanotube rainbows. The potential of the SWCNT has been constructed from Molère's expression of the Thomas-Fermi's proton-carbon interaction-energy, using the approximation of the continuous atomic string. Trajectories of the channeled protons were obtained by solving the corresponding classical equations of motions. Distributions of the transmitted protons were obtained by the Monte-Carlo simulation. The shape of angular distributions has been explained in the framework of the theory of nanotube rainbows. The aim of this study is also to investigate the applicability of the proton rainbow channeling for the characterization of nanotubes with aligned Stone-Wales defects.

  4. Estimating the cost of improving service quality in water supply: A shadow price approach for England and wales.

    PubMed

    Molinos-Senante, María; Maziotis, Alexandros; Sala-Garrido, Ramón

    2016-01-01

    Service quality to customers is an aspect that cannot be ignored in the performance assessment of water companies. Nowadays water regulators introduce awards or penalties to incentivize companies to improve service quality to customers when setting prices. In this study, the directional distance function is employed to estimate the shadow prices of variables indicating the lack of service quality to customers in the water industry i.e., written complaints, unplanned interruptions and properties below the reference level. To calculate the shadow price of each undesirable output for each water company, it is needed to ascribe a reference price for the desirable output which is the volume of water delivered. An empirical application is carried out for water companies in England and Wales. Hence, the shadow price of each undesirable output is expressed both as a percentage of the price of the desirable output and in pence per cubic meter of water delivered The estimated results indicate that on average, each additional written complaint that needs to be dealt with by the water company includes a service quality cost of 0.399p/m(3). As expected, when looking at the other service quality variables which involve network repair or replacement, these values are considerably higher. On average, the water company must spend an extra 0.622p/m(3) to prevent one unplanned interruption and 0.702p/m(3) to avoid one water pressure below the reference level. The findings of this study are of great importance for regulated companies and regulators as it has been illustrated that improvements in the service quality in terms of customer service could be challenging and therefore ongoing investments will be required to address these issues. PMID:26379261

  5. All-Wales licensed premises intervention (AWLPI): a randomised controlled trial to reduce alcohol-related violence

    PubMed Central

    2014-01-01

    Background Alcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom’s (UK) health services. Robust interventions targeted at licensed premises are therefore required to reduce the costs of alcohol-related harm. Previous evaluations of interventions in licensed premises have a number of methodological limitations and none have been conducted in the UK. The aim of the trial was to determine the effectiveness of the Safety Management in Licensed Environments intervention designed to reduce alcohol-related violence in licensed premises, delivered by Environmental Health Officers, under their statutory authority to intervene in cases of violence in the workplace. Methods/Design A national randomised controlled trial, with licensed premises as the unit of allocation. Premises were identified from all 22 Local Authorities in Wales. Eligible premises were those with identifiable violent incidents on premises, using police recorded violence data. Premises were allocated to intervention or control by optimally balancing by Environmental Health Officer capacity in each Local Authority, number of violent incidents in the 12 months leading up to the start of the project and opening hours. The primary outcome measure is the difference in frequency of violence between intervention and control premises over a 12 month follow-up period, based on a recurrent event model. The trial incorporates an embedded process evaluation to assess intervention implementation, fidelity, reach and reception, and to interpret outcome effects, as well as investigate its economic impact. Discussion The results of the trial will be applicable to all statutory authorities directly involved with managing violence in the night time economy and will provide the first formal test of Health and Safety policy in this environment. If successful, opportunities for replication and generalisation will be considered. Trial registration

  6. Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia.

    PubMed

    Doran, Christopher M; Ling, Rod; Byrnes, Joshua; Crane, Melanie; Shakeshaft, Anthony P; Searles, Andrew; Perez, Donna

    2016-01-01

    Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006-2013. This analysis uses Australian dollars (AUD) and 2010-11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006-2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006-2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer. PMID:26824695

  7. Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia

    PubMed Central

    2016-01-01

    Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006–2013. This analysis uses Australian dollars (AUD) and 2010–11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006–2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006–2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer. PMID:26824695

  8. Giving greater financial independence to hospitals--does it make a difference? The case of English NHS Trusts.

    PubMed

    Marini, Giorgia; Miraldo, Marisa; Jacobs, Rowena; Goddard, Maria

    2008-06-01

    In 2003 a new type of provider organisation, the Foundation Trust (FT), was introduced in England, and the best performing NHS hospitals were able to apply for 'Foundation status'. FTs enjoy greater financial flexibility and are subject to less central monitoring and control. The phased introduction of FTs represents an opportunity to examine whether the new financial structures facing FTs have produced any differences in financial performance compared with non-FTs. We use difference in difference methods to examine whether Foundation status had a significant effect on financial management. We find that Foundation status has had a limited impact in terms of acting as an instrument to signal strong financial management of FTs. This result may reflect the relatively early stage of the FT process or may be due to the fact that all types of Trusts are experiencing a challenging financial environment, including the introduction of a prospective payment system. However, we explore the nature of the trends emerging over time and discuss the implications of our findings for policy. PMID:17910094

  9. Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS

    PubMed Central

    Beaussier, Anne-Laure; Demeritt, David; Griffiths, Alex; Rothstein, Henry

    2016-01-01

    In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes. PMID:27499677

  10. Negotiating competency, professionalism and risk: the integration of complementary and alternative medicine by nurses and midwives in NHS hospitals.

    PubMed

    Cant, Sarah; Watts, Peter; Ruston, Annmarie

    2011-02-01

    This qualitative interview study examined the use of complementary and alternative medicine (CAM) by nurses and midwives in NHS hospital settings in 2008 in the UK. It showed that the groundswell of interest in CAM in the 1990s had diminished by this time due to changes to policy and funding, and increasingly stringent clinical governance. Nevertheless, CAM provided an opportunity for committed and self-motivated practitioners to extend their therapeutic repertoire and develop affective dimensions of practice. However, the integration of CAM did not afford the autonomy, status and material gains traditionally associated with a collective professional project. In practice, occupational strategies were individualistic, and grounded in the assertion of competency through expressions of professionalism rather than the credentialism which underpins classic professionalisation. Central to these strategies was CAM related risk, which became a means by which to claim occupational space. However, the extent to which the adoption of CAM enhanced the nurses' and midwives' roles was limited by traditional medical authority; the uncertain status of CAM knowledge; and the absence of collective strategies - which together often left practitioners in a position of vulnerability. PMID:21208701

  11. Piloting the Impact of Three Interventions on Guaiac Faecal Occult Blood Test Uptake within the NHS Bowel Cancer Screening Programme.

    PubMed

    White, Becky; Power, Emily; Ciurej, Monika; Lo, Siu Hing; Nash, Katherine; Ormiston-Smith, Nick

    2015-01-01

    This study evaluated the impact of three interventions on uptake of the guaiac faecal occult blood test (gFOBT) in Greater London. The interventions were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme (BCSP) and assist stool sampling. Logistic regression analysis of BCSP London data (N = 205,541 invitees aged 60-74) compared uptake at 12 weeks between intervention groups and a control group, sent kits as usual between January-April 2013 and January-April 2014. An endorsement flyer, included with gFOBT kits, had no impact on uptake (P = 0.68). In 60-69-year-olds, there was a small but significant increase in modelled uptake amongst invitees sent both the flyer and a kit enhancement pack compared with controls (45.1% versus 43.4%, OR = 1.07, P = 0.047). In North East London, the flyer together with outdoor advertising was associated with a small but significant increase (45.6% versus 43.4%, OR = 1.09, P = 0.027). The largest increases were seen when all three interventions (flyer, pack, and advertising) were combined (49.5% versus 43.4%, OR = 1.28, P < 0.001). The increased uptake in the intervention groups was largest in "first-timers" and smaller amongst previous nonresponders and previously screened invitees. PMID:26525423

  12. Cross-sectional review of the response and treatment uptake from the NHS Health Checks programme in Stoke on Trent

    PubMed Central

    Cochrane, Thomas; Gidlow, Christopher J.; Kumar, Jagdish; Mawby, Yvonne; Iqbal, Zafar; Chambers, Ruth M.

    2013-01-01

    Background As part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service. Methods A cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes. Results Overall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%). Conclusions The attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation. PMID:23104892

  13. Sulfo-NHS-SS-biotin derivatization: a versatile tool for MALDI mass analysis of PTMs in lysine-rich proteins.

    PubMed

    Markoutsa, Stavroula; Bahr, Ute; Papasotiriou, Dimitrios G; Häfner, Ann-Kathrin; Karas, Michael; Sorg, Bernd L

    2014-03-01

    The discovery of PTMs in proteins by MS requires nearly complete sequence coverage of the detected proteolytic peptides. Unfortunately, mass spectrometric analysis of the desired sequence fragments is often impeded due to low ionization efficiency and/or signal suppression in complex samples. When several lysine residues are in close proximity tryptic peptides may be too short for mass analysis. Moreover, modified peptides often appear in low stoichiometry and need to be enriched before analysis. We present here how the use of sulfo-NHS-SS-biotin derivatization of lysine side chain can help to detect PTMs in lysine-rich proteins. This label leads to a mass shift which can be adjusted by reduction of the SS bridge and alkylation with different reagents. Low intensity peptides can be enriched by use of streptavidin beads. Using this method, the functionally relevant protein kinase A phosphorylation site in 5-lipoxygenase was detected for the first time by MS. Additionally, methylation and acetylation could be unambiguously determined in histones. PMID:24449390

  14. Piloting the Impact of Three Interventions on Guaiac Faecal Occult Blood Test Uptake within the NHS Bowel Cancer Screening Programme

    PubMed Central

    White, Becky; Power, Emily; Ciurej, Monika; Lo, Siu Hing; Nash, Katherine; Ormiston-Smith, Nick

    2015-01-01

    This study evaluated the impact of three interventions on uptake of the guaiac faecal occult blood test (gFOBT) in Greater London. The interventions were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme (BCSP) and assist stool sampling. Logistic regression analysis of BCSP London data (N = 205,541 invitees aged 60–74) compared uptake at 12 weeks between intervention groups and a control group, sent kits as usual between January-April 2013 and January-April 2014. An endorsement flyer, included with gFOBT kits, had no impact on uptake (P = 0.68). In 60–69-year-olds, there was a small but significant increase in modelled uptake amongst invitees sent both the flyer and a kit enhancement pack compared with controls (45.1% versus 43.4%, OR = 1.07, P = 0.047). In North East London, the flyer together with outdoor advertising was associated with a small but significant increase (45.6% versus 43.4%, OR = 1.09, P = 0.027). The largest increases were seen when all three interventions (flyer, pack, and advertising) were combined (49.5% versus 43.4%, OR = 1.28, P < 0.001). The increased uptake in the intervention groups was largest in “first-timers” and smaller amongst previous nonresponders and previously screened invitees. PMID:26525423

  15. Career progression of men and women doctors in the UK NHS: a questionnaire study of the UK medical qualifiers of 1993 in 2010/2011

    PubMed Central

    Svirko, Elena; Goldacre, Michael J

    2014-01-01

    Summary Objectives To report the career progression of a cohort of UK medical graduates in mid-career, comparing men and women. Design Postal and questionnaire survey conducted in 2010/2011, with comparisons with earlier surveys. Setting UK. Participants In total, 2507 responding UK medical graduates of 1993. Main outcome measures Doctors’ career specialties, grade, work location and working pattern in 2010/2011 and equivalent data in earlier years. Results The respondents represented 72% of the contactable cohort; 90% were working in UK medicine and 7% in medicine outside the UK; 87% were in the UK NHS (87% of men and 86% of women). Of doctors in the NHS, 70.6% of men and 52.0% of women were in the hospital specialties and the great majority of the others were in general practice. Within hospital specialties, a higher percentage of men than women were in surgery, and a higher percentage of women than men were in paediatrics, obstetrics and gynaecology, clinical oncology, pathology and psychiatry. In the NHS, 63% of women and 8% of men were working less-than-full-time (in general practice, 19% of men and 83% of women; and in hospital specialties, 3% of men and 46% of women). Among doctors who had always worked full-time, 94% of men and 87% of women GPs were GP principals; in hospital practice, 96% of men and 93% of women had reached consultant level. Conclusions The 1993 graduates show a continuing high level of commitment to the NHS. Gender differences in seniority lessened considerably when comparing doctors who had always worked full-time. PMID:25408921

  16. Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

    PubMed Central

    Osaro, Erhabor; Chima, Njemanze

    2014-01-01

    The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness. PMID:25182941

  17. GPs' perspectives on managing the NHS Health Check in primary care: a qualitative evaluation of implementation in one area of England

    PubMed Central

    Shaw, Rachel L; Lowe, Helen; Holland, Carol; Pattison, Helen; Cooke, Richard

    2016-01-01

    Objectives To evaluate the implementation of the National Health Service (NHS) Health Check programme in one area of England from the perspective of general practitioners (GPs). Design A qualitative exploratory study was conducted with GPs and other healthcare professionals involved in delivering the NHS Health Check and with patients. This paper reports the experience of GPs and focuses on the management of the Heath Check programme in primary care. Setting Primary care surgeries in the Heart of Birmingham region (now under the auspices of the Birmingham Cross City Clinical Commissioning Group) were invited to take part in the larger scale evaluation. This study focuses on a subset of those surgeries whose GPs were willing to participate. Participants 9 GPs from different practices volunteered. GPs served an ethnically diverse region with areas of socioeconomic deprivation. Ethnicities of participant GPs included South Asian, South Asian British, white, black British and Chinese. Methods Individual semistructured interviews were conducted with GPs face to face or via telephone. Thematic analysis was used to analyse verbatim transcripts. Results Themes were generated which represent GPs' experiences of managing the NHS Health Check: primary care as a commercial enterprise; ‘buy in’ to concordance in preventive healthcare; following protocol and support provision. These themes represent the key issues raised by GPs. They reveal variability in the implementation of NHS Health Checks. GPs also need support in allocating resources to the Health Check including training on how to conduct checks in a concordant (or collaborative) way. Conclusions The variability observed in this small-scale evaluation corroborates existing findings suggesting a need for more standardisation. Further large-scale research is needed to determine how that could be achieved. Work needs to be done to further develop a concordant approach to lifestyle advice which involves tailored

  18. A study and comparative analysis of managerial and leadership effectiveness in the National Health Service: an empirical factor analytic study within an NHS Trust hospital.

    PubMed

    Hamlin, R G

    2002-11-01

    The research described in this article was concerned primarily with identifying the criteria of managerial/leadership effectiveness applying at the middle and front line levels of management within an NHS Trust Hospital using critical incident technique and factor analysis methods. The findings suggest that the self-perceptions of managers and the perceptions of superiors and subordinates are very similar, and only differ on a limited number of criteria. This challenges the 'perspective-specific' models of managerial effectiveness advocated by some researchers. The results are compared against those from a near identical study carried out by the author within one part of the British Civil Service, and the results from a different but comparable factor analytic study carried out by other researchers elsewhere in the NHS. The results suggest the existence of generalized criteria of managerial effectiveness, which lend considerable support to the notion of the 'universally effective manager'. This challenges the 'contingent models' of managerial effectiveness advocated by various expert commentators. In addition, the research supports the new model of transformational leadership offered by Alimo-Metcalfe and Alban-Metcalfe for application within both the NHS and local government, and adds to the empirical base supporting the current drive towards evidence-based practice in management within the healthcare sector. PMID:12396550

  19. Part-Time Students at the University of New South Wales. Tertiary Education Research Centre Monograph No. 2.

    ERIC Educational Resources Information Center

    Barrett, Eve M.

    Information is presented on part-time male students entering the departments of commerce, engineering, and science of the University of New South Wales in 1969. The major puroose of the survey was to obtain infomration relevant to the general studies program. In addition to asking the student his views on general studies, information was obtained…

  20. The Management of Independent Secondary School Libraries in England and Wales: The Skills and Perceptions of Library Managers

    ERIC Educational Resources Information Center

    Turner, Richard; Matthews, Graham; Ashcroft, Linda; Farrow, Janet

    2007-01-01

    This paper investigates aspects of the management of independent secondary school libraries in England and Wales. It is based on a survey of 150 independent school library managers, with a response rate of 68.7 percent, which was carried out as part of an ongoing PhD research project. The paper considers a range of issues important to school…

  1. Miami and North Wales, So Far and Yet So Near: A Constructivist Account of Morphosyntactic Development in Bilingual Children

    ERIC Educational Resources Information Center

    Mueller Gathercole, Virginia C.

    2007-01-01

    This paper proposes a constructivist account of the development of morphosyntax in bilinguals, based on an examination of two populations--English-Spanish bilinguals in Miami and English-Welsh bilinguals in North Wales. Despite sociocultural and sociolinguistic differences across these groups, the development of bilinguals in the two groups…

  2. Societal Factors; An Analysis of Selected Factors of Dormitory Students and Commuting Students at Johnson and Wales College.

    ERIC Educational Resources Information Center

    Bukowski, Joseph E.

    Focusing on freshmen commuter students and freshmen dormitory students at Johnson and Wales College, general characteristics and academic achievement were measured. General entrance characteristics included student age, College Entrance Examination Board scores and high school rank. Academic achievement was measured in terms of student grades in…

  3. Children's Astronomy: Implications for Curriculum Developments at Key Stage 1 and the Future of Infant Science in England and Wales.

    ERIC Educational Resources Information Center

    Sharp, John

    1995-01-01

    Notes the remarkable success of the astronomy component of the National Curriculum in England and Wales. Presents findings of a survey of children's astronomical beliefs, which are consistent with constructivist theory, and proposes the value of children's astronomy learning. Argues that a 1995 revision in the National Curriculum, which would…

  4. The Pre-Incubator: A Longitudinal Study of 10 Years of University Pre-Incubation in Wales

    ERIC Educational Resources Information Center

    Voisey, Pamela; Jones, Paul; Thomas, Brychan

    2013-01-01

    This paper describes a longitudinal study of over 10 years of university pre-incubation in Wales, using case studies of incubated businesses to track their performance since 2001. Surviving "graduated" businesses were investigated and quantitative and qualitative data were gathered to profile the current status of these businesses and…

  5. An Audible Voice of the Past: The Rare Printed Collections of the State Library of New South Wales

    ERIC Educational Resources Information Center

    Patton, Maggie

    2009-01-01

    Since 2005 the State Library of New South Wales has provided staff with an opportunity to research aspects of the Library's services and collections through the State Librarian's Staff Fellowship Program. In January 2008, Maggie Patton commenced a project to rediscover and document the development of the rare printed collections at the State…

  6. What Makes the Digital "Special"? The Research Program in Digital Collections at the National Library of Wales

    ERIC Educational Resources Information Center

    Cusworth, Andrew; Hughes, Lorna M.; James, Rhian; Roberts, Owain; Roderick, Gareth Lloyd

    2015-01-01

    This article introduces some of the digital projects currently in development at the National Library of Wales as part of its Research Program in Digital Collections. These projects include the digital representation of the Library's Kyffin Willams art collection, musical collections, and probate collection, and of materials collected by the…

  7. Education and Training for 16-18 Year Olds in England and Wales. Individual Paths and National Trends.

    ERIC Educational Resources Information Center

    Payne, Joan; Cheng, Yuan; Witherspoon, Sharon

    This book describes the experiences of a series of five nationally representative cohorts of young people reaching school-leaving age between 1986 and 1993 who were surveyed as part of the continuing England and Wales Youth Cohort Study. The cohort study charts the path taken by young people over the first 3 years after compulsory education. Part…

  8. A Needs Assessment in South Wales Schools for a Novel Medical Student-Led Sex Education Programme

    ERIC Educational Resources Information Center

    Twine, C.; Robbe, I. J.; Forrest, S.; Davies, S.

    2005-01-01

    The rationale behind using medical students as sexual health educators in light of current UK governmental policy agenda and research on effective interventions is described in this paper, which also examines the results of a cross-sectional survey of the sexual health knowledge and attitude of 14-15 year-olds in some South Wales schools. Major…

  9. Approaches to In-Service Teacher Development in England and Wales Concerning the Use of Technology in Secondary Mathematics

    ERIC Educational Resources Information Center

    Clark-Wilson, Alison

    2009-01-01

    In England and Wales, there has been a significant investment in technology to support teaching and learning in all subjects and school phases since the mid-1990s and a number of training models and approaches have been used, which include the development of online materials to support face-to-face sessions with expert teacher educator support.…

  10. The Genesis of School Inspection in South East Wales 1839-1843: Issues of Social Control and Accountability

    ERIC Educational Resources Information Center

    James, David C.; Davies, Brian

    2009-01-01

    The article examines the genesis of school inspection in South East Wales during the period 1839-1843 through the writing of Hugh Seymour Tremenheere, one of the first school inspectors. It discusses the formation of the new inspectorate and provides a narrative analysis of educational provision and social, cultural and economic conditions…

  11. Functional versus Critical Literacy in the Rehabilitation of Offenders: A Survey of Probation Services in England and Wales.

    ERIC Educational Resources Information Center

    Webster, Alec; Caddick, Brian; Reed, Malcolm; Ford, Karen

    1999-01-01

    A survey of 53 probation services in England and Wales and visits to 13 revealed unsystematic provision of literacy services in correctional rehabilitation, conflicting perspectives on how literacy should be defined and taught, and ambivalence about the role of probation officers as punitive or preventive. (SK)

  12. A Census Chronicle--Reflections on the Campaign for a Religion Question in the 2001 Census for England and Wales

    ERIC Educational Resources Information Center

    Sherif, Jamil

    2011-01-01

    The campaign from 1996-2000 to include the religion question in the 2001 Census for England and Wales was a defining event for Muslim communities in Britain because it provided formal recognition of their collective identity as a faith group, rather than being subsumed in the "black", "Asian" or "Pakistani/Bangladeshi" ethnic categorisations of…

  13. Use of the Blind Learning Aptitude Test with Children in England and Wales and the United States.

    ERIC Educational Resources Information Center

    Mason, H. L.

    1991-01-01

    An 18-month study of the use of the Blind Learning Aptitude Test at schools for visually impaired children in England and Wales found the test to be culturally fair and appropriate for use with children for whom English is a second language. Scores are compared with standardization data for visually impaired children in the United States.…

  14. Incredible Years Parent Training Support for Nursery Staff Working within a Disadvantaged Flying Start Area in Wales: A Feasibility Study

    ERIC Educational Resources Information Center

    Bywater, Tracey Jane; Hutchings, Judith Mary; Gridley, Nicole; Jones, Karen

    2011-01-01

    Parenting programmes are effective interventions for preventing and treating conduct problems in young children. Up to 20% of children in disadvantaged areas have conduct disorder. Recent government initiatives such as targeting early years services to designated disadvantaged Flying Start areas in Wales have resulted in increased nursery-care…

  15. Quasi-Market Reforms and Vocational Schooling in England and Wales: An Economic Analysis. Division of Economics Working Paper.

    ERIC Educational Resources Information Center

    Davies, Peter; Adnett, Nick

    The creation of a quasi-market in England and Wales schooling has changed pupil, parent, and school behavior in a way that has reinforced the dominance of traditional, academic schooling. A study summarized results of research into this quasi-market behavior, with particular emphasis upon the upper secondary age group. The study found that while…

  16. Learning about Learning 2.0: Evaluating the "New South Wales Public Library Learning 2.0" Program

    ERIC Educational Resources Information Center

    Forsyth, Ellen; Joseph, Mylee; Perry, Leanne

    2009-01-01

    The "New South Wales Learning 2.0" training program is being made available to the entire NSW public library work force of over 2300 people in 2008-2009. This paper is a snapshot of the impact of the course as at September 2008, five months after it was launched. It explores how the training impacted on the staff skill levels, knowledge, and…

  17. Gender and Merit: Coeducation and the Construction of a Meritocratic Educational Ladder in New South Wales, 1880-1912

    ERIC Educational Resources Information Center

    Proctor, Helen

    2007-01-01

    Central to the assembling of the New South Wales public education system in the late nineteenth and early twentieth centuries was the setting of borders and boundaries between different categories of students. These boundaries were particularly decisive in the institution of the public high school, where entry and progress were regulated by tests…

  18. Learner Diversity: A Successful Blended Professional Learning Approach Promoting Quality Inclusion in the United Kingdom and New South Wales, Australia

    ERIC Educational Resources Information Center

    Clench, Hugh; King, Brian Smyth

    2014-01-01

    This paper describes the development of an online training model for teachers and teaching assistants working with students with special educational needs. Originally developed as part of a government funded initiative in the UK, the model has been successfully applied in other contexts, most notably in New South Wales, Australia where it has had…

  19. From Vision to Reality: Views of Primary School Principals on Inclusive Education in New South Wales, Australia

    ERIC Educational Resources Information Center

    Graham, Linda J.; Spandagou, Ilektra

    2011-01-01

    This paper discusses the findings of a research study that used semi-structured interviews to explore the views of primary school principals on inclusive education in New South Wales, Australia. Content analysis of the transcript data indicates that principals' attitudes towards inclusive education and their success in engineering inclusive…

  20. The Use of Sessional Teachers in Universities: Faculty of the Built Environment, University of New South Wales Australia

    ERIC Educational Resources Information Center

    Marshall, Nancy

    2012-01-01

    This paper discusses the issues and realities presented by the casualisation of higher education teaching staff. It uses a case study from the University of New South Wales [UNSW] in Sydney Australia. The research presents and analyses perspectives from two key stakeholders in a university [students and academic management] on the use of sessional…

  1. "Ars Poetica," Romanticism and English Education: Poetic Inheritances in the Senior Secondary English Curriculum in New South Wales, Australia

    ERIC Educational Resources Information Center

    Carter, Don

    2013-01-01

    Poetry, as a textual form for critical study and composition, continues to occupy a significant place in Australian senior secondary English syllabus documents and classrooms (cf. Carter, 2012). Indeed, within the senior secondary English syllabus in New South Wales (NSW), poetry remains one of the core mandatory types of texts for study by the…

  2. Influences on the Expression of Health within Physical Education Curricula in Secondary Schools in England and Wales

    ERIC Educational Resources Information Center

    Harris, Jo; Leggett, Gemma

    2015-01-01

    This paper presents selected findings from a wider study on the expression of health within physical education (PE) curricula in secondary schools in England and Wales. The study revealed that the expression of health in PE broadly reflected ideologies associated with promoting "fitness for life" and "fitness for performance"…

  3. The Gender Gap and Discriminating Power in the National Curriculum Key Stage Three Science Assessments in England and Wales.

    ERIC Educational Resources Information Center

    Preece, Peter F. W.; Skinner, Nigel G.; Riall, Robin A. H.

    1999-01-01

    Describes a study of gender differences in science achievement in England and Wales. Finds that the most pronounced gender differences in favor of males occurred in the higher-level papers taken by more able students, especially in physics. Also, more discriminating questions exhibited larger gender gaps in favor of males. Contains 21 references.…

  4. A Marathon Not a Sprint: Lessons Learnt from the First Decade of Digitisation at the National Library of Wales

    ERIC Educational Resources Information Center

    Jones, R. Arwel

    2008-01-01

    Purpose: This paper aims to provide an overview of developments in digitisation policy and practice at the National Library of Wales (NLW) from 1995 to 2007 and drawing out the lessons learnt. Design/methodology/approach: A chronological overview of developments focusing on the pilot phase, policy statements of 2001 and 2005 and on specific…

  5. International Colloquium on Education: British and American Perspectives (4th, Swansea, Wales, United Kingdom, May 22-24, 1995). Proceedings.

    ERIC Educational Resources Information Center

    Wales Univ., Swansea. Dept. of Education.

    This collection of studies represents collaboration between the Departments of Education of the University of Wales Swansea and the University of Wisconsin-La Crosse. The papers are as follows: (1) "Analysing the Social Climate of Schools and Classrooms" (Robert W. Bilby); (2) "Reading Whose World?" (Diane Cannon); (3) "The National Council of…

  6. Detaining the Usual Suspects: Charting the Use of Segregated Settings in New South Wales Government Schools, Australia

    ERIC Educational Resources Information Center

    Graham, Linda J.; Sweller, Naomi; Van Bergen, Penny

    2010-01-01

    This article examines the increase in segregated placements in the New South Wales government school sector. Using disaggregated enrolment data, it points to the growing over-representation of boys in special schools and classes, particularly those of a certain age in certain support categories. In the discussion that follows, the authors question…

  7. The Sterilisation of People with Intellectual Disabilities in England and Wales during the Period 1988 to 1999

    ERIC Educational Resources Information Center

    Stansfield, A. J.; Holland, A. J.; Clare, I. C. H.

    2007-01-01

    Background: In England and Wales, if a person is thought to lack capacity to make a decision to undergo a sterilisation operation, a specific process occurs. A Judge sitting in the Family Division of the High Court receives evidence from relevant parties including psychiatric and gynaecological experts and subsequently decides on the lawfulness of…

  8. Statements of Special Educational Needs and Tribunal Appeals in England and Wales 2003-2013--In Numbers

    ERIC Educational Resources Information Center

    Marsh, Alan J.

    2014-01-01

    The study presents a statistical analysis of statements of special educational needs and Special Educational Needs and Disability (SEND) tribunal appeal rates in England and Wales. It is set against the backcloth of the 2014 Children and Families Act which replaces statements with Education, Health and Care (EHC) plans. The numerical overview…

  9. Local Education Authorities' Approaches to Provision for Children with Specific Speech and Language Difficulties in England and Wales

    ERIC Educational Resources Information Center

    Lindsay, Geoff; Dockrell, Julie E.; Mackie, Clare; Letchford, Becky

    2005-01-01

    Children with specific speech and language difficulties (SSLD) pose a challenge to the education system as a result of their language needs and associated educational and social-behavioural difficulties. Local education authorities (LEAs) in England and Wales have developed language units to meet their needs but previous research has indicated…

  10. Progress through High School: A Study of Senior Secondary Schooling in New South Wales. ACER Research Monograph No. 43.

    ERIC Educational Resources Information Center

    Ainley, John; Sheret, Michael

    This book provides an overview of a 4-year longitudinal study of senior secondary schooling in the government high schools of New South Wales, Australia. The study followed the progress from year 9 to year 12 of 3,000 students from 22 government secondary schools in 2 metropolitan and 2 nonmetropolitan regions. The book is divided into 10…

  11. Expectations and Levels of Understanding When Using Mobile Phones among 9-11-Year Olds in Wales, UK

    ERIC Educational Resources Information Center

    Turley, Joanne; Baker, Sally-Ann; Lewis, Christopher Alan

    2014-01-01

    There is growing interest in examining the use of mobile technology among children. The present study extended this literature among a sample of 9-11-year olds in Wales, UK in three ways. First, to examine the level of mobile phone ownership; second, to consider how mobile phones are used, investigate timescales and expectations when communicating…

  12. Health Promotion Research and the Public Health Function: Prospects for the Future--A Perspective from Wales

    ERIC Educational Resources Information Center

    Tudor-Smith, Chris; Roberts, Chris

    2004-01-01

    With the advent of devolution, policies and programmes are being developed and delivered to meet the particular needs of the people of Wales. It is recognized that such policies and programmes need to be informed by the best available evidence to identify key issues, assess what has worked elsewhere to address them, and to have monitoring and…

  13. Amperometric determination of hydrogen peroxide by functionalized carbon nanotubes through EDC/NHS coupling chemistry.

    PubMed

    Jeykumari, D R Shobha; Narayanan, S Sriman

    2007-06-01

    The electrochemistry of the redox mediator Toluidine blue (TB) which was covalently linked to the carboxyl group of the multiwalled carbon nanotubes (MWNTs) by coupling reactions, in which N-hydroxysuccinimide was used to assist 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride catalyzed amidation reaction is described. The results from cyclic voltammetry (CV) and amperometry suggested that the redox mediator is linked to the surface of the MWNTs and the nanotubes showed an obvious promotion for the direct electron-transfer between the redox mediator and the electrode. A couple of well-defined redox peak of TB was observed in a phosphate buffer solution (pH 7.0). The redox mediator immobilized to MWNTs exhibits remarkable electrocatalytic activity for the reduction of hydrogen peroxide (H2O2). The analytical applicability of the modified electrode for the determination of hydrogen peroxide was examined. A linear response in the concentration range of 6.8 x 10(-7)-3.4 x 10(-2) M (r = 0.9958) was obtained with detection limit of 3.4 x 10(-7) M for the determination of hydrogen peroxide. The modified electrode has advantages of being highly stable, sensitive, ease of construction and use. PMID:17654948

  14. National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study

    PubMed Central

    2014-01-01

    relationships with their patients and colleagues. To improve the sustainability of such sudden changes in policy direction, it is important to address clinicians’ experience and satisfaction. PMID:24927819

  15. Identification and characterization of transmissible Pseudomonas aeruginosa strains in cystic fibrosis patients in England and Wales.

    PubMed

    Scott, Fiona W; Pitt, Tyrone L

    2004-07-01

    Most past studies of cross-infection with Pseudomonas aeruginosa among cystic fibrosis (CF) patients in the UK suggest that it is a rare occurrence. However, two recent reports of highly transmissible strains in patients in regional centres in England (Liverpool and Manchester) have raised questions as to the extent of the problem and prompted a nationwide survey to establish the distribution of P. aeruginosa strain genotypes among these patients. Isolates of P. aeruginosa were requested from over 120 hospitals in England and Wales and a sample size of approximately 20% of the CF patient population in each centre was recommended. In total, 1225 isolates were received from 31 centres (range 1 to 330). Single patient isolates were typed by SpeI macrorestriction and PFGE. A panel of strains of the common genotypes including representatives of reported transmissible strains was assembled and further characterized by fluorescent amplified fragment length polymorphism (FAFLP) genotyping. At least 72% of all patients harboured strains with unique genotypes. Small clusters of related strains were evident in some centres, presumably indicating limited transmission of local strains. The most prevalent strain was indistinguishable from that previously described as the 'Liverpool' genotype, and accounted for approximately 11% of patient isolates from 15 centres in England and Wales. The second most common genotype (termed Midlands 1) was recovered from 86 patients in nine centres and the third genotype, which matched closely the PFGE profile of Clone C, a genotype originally described in Germany, was found in eight centres and was isolated from 15 patients. A fourth genotype, identical to the published Manchester strain, was found in three centres. FAFLP analysis revealed some microheterogeneity among strains of the Liverpool genotype but all isolates of this genotype were positive by PCR for a strain-specific marker. These data suggest that cross-infection with P. aeruginosa

  16. National scale high-resolution mapping of coastal wave overtopping risk in England and Wales

    NASA Astrophysics Data System (ADS)

    Alexandre, Rebecca; Hird, Matthew

    2015-04-01

    The coastal flooding associated with the 2013-2014 UK winter storms caused widespread property damage and one fatality along the coastlines of south-west England and Wales. High spring tides and large waves combined to unexpectedly overtop coastal flood defences. The increasing risk of waves overtopping sea defences coupled with the rise in property development along the coast highlights the need for new and innovative tools for understanding coastal flood risk. Until now, broad-scale coastal hazard maps have overlooked coastal wave overtopping inundation, thereby underestimating flood risk. Recognising this gap has led to the development of the first nation-wide wave overtopping flood map for England and Wales, which we present here. Aimed primarily at the re/insurance sector, JBA has established a methodology for rapidly modelling large-scale wave overtopping flooding. An inception study investigated a range of modelling approaches for national scale modelling and the most suitable design computed general peak wave overtopping rates representative of four separate return period events. Hydrographs were calculated to reflect the changes in the overtopping rate as a result of changes to the water levels throughout the tidal cycle. Overtopping volumes were then computed from the overtopping rates and defence polylines digitised in ArcGIS. Finally, topographically controlled inundation was simulated across a high-resolution digital terrain model using a 2D hydrodynamic flood model. Results from the selected methodology compared well against test areas modelled in detail using additional data on bathymetry, beach profiles, and defence geometry. Sensibility checks were performed using extreme sea level value data to ensure that the model outputs were consistent with the sea level heights expected during a storm event of a particular return period. Moreover, model results corroborated well with media reports on flood extents experienced by communities during the 2013

  17. Molybdenum distributions and variability in drinking water from England and Wales.

    PubMed

    Smedley, P L; Cooper, D M; Lapworth, D J

    2014-10-01

    An investigation has been carried out of molybdenum in drinking water from a selection of public supply sources and domestic taps across England and Wales. This was to assess concentrations in relation to the World Health Organization (WHO) health-based value for Mo in drinking water of 70 μg/l and the decision to remove the element from the list of formal guideline values. Samples of treated drinking water from 12 water supply works were monitored up to four times over an 18-month period, and 24 domestic taps were sampled from three of their supply areas. Significant (p < 0.05) differences were apparent in Mo concentration between sources. Highest concentrations were derived from groundwater from a sulphide-mineralised catchment, although concentrations were only 1.5 μg/l. Temporal variability within sites was small, and no seasonal effects (p > 0.05) were detected. Tap water samples collected from three towns (North Wales, the English Midlands, and South East England) supplied uniquely by upland reservoir water, river water, and Chalk groundwater, respectively, also showed a remarkable uniformity in Mo concentrations at each location. Within each, the variability was very small between houses (old and new), between pre-flush and post-flush samples, and between the tap water and respective source water samples. The results indicate that water distribution pipework has a negligible effect on supplied tap water Mo concentrations. The findings contrast with those for Cu, Zn, Ni, Pb, and Cd, which showed significant differences (p < 0.05) in concentrations between pre-flush and post-flush tap water samples. In two pre-flush samples, concentrations of Ni or Pb were above drinking water limits, although in all cases, post-flush waters were compliant. The high concentrations, most likely derived from metal pipework in the domestic distribution system, accumulated during overnight stagnation. The concentrations of Mo observed in British drinking water, in

  18. Incidence and mortality of primary liver cancer in England and Wales: Changing patterns and ethnic variations

    PubMed Central

    Ladep, Nimzing G; Khan, Shahid A; Crossey, Mary ME; Thillainayagam, Andrew V; Taylor-Robinson, Simon D; Toledano, Mireille B

    2014-01-01

    AIM: To explore recent trends, modes of diagnosis, ethnic distribution and the mortality to incidence ratio of primary liver cancer by subtypes in England and Wales. METHODS: We obtained incidence (1979-2008) and mortality (1968-2008) data for primary liver cancer for England and Wales and calculated age-standardised incidence and mortality rates. Trends in age-standardised mortality (ASMR) and incidence (ASIR) rates and basis of diagnosis of primary liver cancer and subcategories: hepatocellular carcinoma, intrahepatic bile duct and unspecified liver tumours, were analysed over the study period. Changes in guidelines for the diagnosis of primary liver cancer (PLC) may impact changing trends in the rates that may be obtained. We thus explored changes in the mode of diagnosis as reported to cancer registries. Furthermore, we examined the distribution of these tumours by ethnicity. Most of the statistical manipulations of these data was carried out in Microsoft excel® (Seattle, Washington, United Sttaes). Additional epidemiological statistics were done in Epi Info software (Atlanta, GA, United Sttaes). To define patterns of change over time, we evaluated trends in ASMR and ASIR of PLC and intrahepatic bile duct carcinoma (IHBD) using a least squares regression line fitted to the natural logarithm of the mortality and incidence rates. We estimated the patterns of survival over subsequent 5 and 10 years using complement of mortality to incidence ratio (1-MIR). RESULTS: Age-standardised mortality rate of primary liver cancer increased in both sexes: from 2.56 and 1.29/100000 in 1968 to 5.10 and 2.63/100000 in 2008 for men and women respectively. The use of histology for diagnostic confirmation of primary liver cancer increased from 35.7% of registered cases in 1993 to plateau at about 50% during 2005 to 2008. Reliance on cytology as a basis of diagnosis has maintained a downward trend throughout the study period. Although approximately 30% of the PLC registrations had

  19. Changing an ingrained culture: Improving the safety of oxygen therapy at University Hospitals Bristol NHS Foundation Trust.

    PubMed

    Gatter, Michelle; Dixon, Giles; Wall, Josh; Mew, Ed

    2015-01-01

    Oxygen is one of the most commonly administered drugs in UK hospitals. Our quality improvement project aimed to increase the safety of oxygen therapy at University Hospitals Bristol NHS Foundation Trust. We aimed to increase the rate of oxygen prescribing and increase the percentage of nurses signing appropriately for oxygen titration and administration. We hypothesised this would result in a higher percentage of patients achieving their appropriate oxygen saturations. Our project ran on several acute medical and surgical wards. We tested several interventions with a plan, do, study, act method of continuous data collection. We firstly focussed on the education of junior doctors and then the wider multi-disciplinary team with a trust-wide "safety focus". We utilised patient safety systems already in place in the hospital, such as the clinical risk register and incident reporting system. We also trialled an intervention that was successfully implemented by another group in a different trust in the UK. Oxygen prescription increased from 44.4% to 76.9% over the duration of the project. Appropriate nursing signatures increased from 26.6% to 60%. The number of patients achieving appropriate target saturations rose from 61.8% to 76.7%. The most successful interventions were the trust safety briefing and oxygen safety hangers. Our project has showed the importance of integrating new projects within safety schemes already available. Persistence and careful intervention are key to changing strongly engrained cultures in large organisations. Interventions that have proved to be successful in other trusts can be implemented to enact change. PMID:26732123

  20. Can we afford screening for neural tube defects? The South Wales experience.

    PubMed Central

    Hibbard, B M; Roberts, C J; Elder, G H; Evans, K T; Laurence, K M

    1985-01-01

    Clinical and financial gains and losses accruing from five different options for screening for open neural tube defects were estimated, based principally on the results of detailed monitoring of inputs and outcomes and of process costs in the South Wales Anencephaly and Spina Bifida Study. As well as estimating the overall clinical costs of a screening service it was shown that if the prevalence, including terminations, of open neural tube defects is between 1.25 and five per 1000 births the financial cost of avoiding the birth of a seriously handicapped child who would survive for more than 24 hours is in the range 9000 pounds- 54000 pounds depending on the option adopted and the prevalence of the condition in the target population. Prevalence is the biggest determinant of cost. The data should provide a basis for assessment and discussion of resource priorities in the National Health Service. PMID:3917791