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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. 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

  13. 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

  14. 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

  15. 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

  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. 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.

  18. '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

  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. 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

  17. 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

  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. 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

  9. 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

  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. 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

  12. 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

  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. 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

  18. 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

  19. 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

  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. 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…

  3. 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…

  4. 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…

  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. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  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. 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.

  17. 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

  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. 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

  2. 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

  3. 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

  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. 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

  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. 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

  4. 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

  5. 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

  6. '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

  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. 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

  9. 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

  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. 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

  20. 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

  1. 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.

  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. 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

  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. 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

  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. 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)

  19. 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

  20. 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…

  1. 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)

  2. 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,…

  3. 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…

  4. 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)

  5. 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.…

  6. 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…

  7. 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…

  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. 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)

  10. 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…

  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. 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

  17. 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…

  18. 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

  19. 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…

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  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. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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…

  20. 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

  1. 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

  2. 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

  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. 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

  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. 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.

  12. 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

  13. 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…

  14. 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,...

  15. 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,…

  16. 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…

  17. 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…

  18. 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…

  19. 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…

  20. 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…

  1. 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…

  2. 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.…

  3. 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

  4. 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

  5. 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…

  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. 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

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  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