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Kinds of National Health Service Terms modified by National Health Service Selected AbstractsA systematic review of the diagnostic classifications of traumatic dental injuriesDENTAL TRAUMATOLOGY, Issue 2 2006Karla Maria Pugliesi da Costa Feliciano Abstract,,, A systematic review of the literature was undertaken to evaluate the criteria used for the diagnostic classification of traumatic dental injuries from an epidemiological standpoint. The methodology used was that suggested by the Cochrane Collaboration and the National Health Service. A total of 12 electronic bibliographical databases (BBO, BioMed Central, Blackwell Synergy, Cochrane, DARE, EMBASE, HighWire, LILACS, MEDLINE, PubMed Central, SciELO, SciSearch) and the World Wide Web were searched. There was no attempt to specify the strategy in relation to date, study design, or language. The last search was performed in May 2003. Two reviewers screened each record independently for eligibility by examining titles, abstracts, keywords and using a standardized reference form. Disagreements were resolved through consensus. The final study collection consisted of 164 articles, from 1936 to 2003, and the population sample ranged from 38 to 210 500 patients. 54 distinct classification systems were identified. According to the literature, the most frequently used classification system was that of Andreasen (32%); as regards the type of injury, the uncomplicated crown fracture was the most mentioned lesion (88.5%). Evidence supports the fact that there is no suitable system for establishing the diagnosis of the studied injuries that could be applied to epidemiological surveys. [source] The elusive NHS consumer: 1948 to the NHS PlanECONOMIC AFFAIRS, Issue 4 2001Will Anderson Since the creation of the National Health Service in 1948, patients have never been fully-fledged consumers of healthcare; they have never held personal economic power with which to express their needs and preferences to service providers. Nonetheless, the history of the NHS has demonstrated an ever-increasing policy interest in the needs of individual patients and in the responsiveness of services to these needs. Following the collapse of the postwar consensus which gave birth to the welfare state, successive governments have pledged to give priority to consumer needs, but have struggled to realise this priority in practice.Professional and state paternalism in defining patient needs and choices have endured. current policy emphasis on ,patient and public involvement' and ,partnership working' sustains a top-down bureaucratic approach but tempers practice with input from all stakeholders in local health economies. There is much to do to make the culture of the NHS genuinely responsive to consumer needs. [source] Cost-effectiveness of pharmacy and group behavioural support smoking cessation services in GlasgowADDICTION, Issue 2 2009Kathleen A. Boyd ABSTRACT Aims Smokers attending group-based support for smoking cessation in Glasgow are significantly more likely to be successful than those attending pharmacy-based support. This study examined the cost-effectiveness of these two modes of support. Design Combination of observational study data and information from National Health Service (NHS) Greater Glasgow and Clyde smoking cessation services. Setting Glasgow, Scotland. Participants A total of 1979 smokers who accessed either of the cessation services between March and May 2007. Intervention Two smoking treatment services offering one-to-one support in pharmacies, and providing group counselling in the community. Measurements Routine monitoring data on resource use and smoking status (carbon monoxide-validated, self-reported, non-quitters and relapsers) at 4-week follow-up. Findings The incremental cost per 4-week quitter for pharmacy support was found to be approximately £772, and £1612 for group support, in comparison to self-quit cessation attempts. These findings compare favourably with previously published outcomes from cost-effectiveness smoking cessation studies. Assuming a relapse rate of 75% from 4 weeks to 1 year and a further 35% beyond 1 year, and combining this with an average of 1.98 quality adjusted life years (QALY) gained per permanent cessation, provides an estimated incremental cost per QALY of £4400 for the pharmacy service and £5400 for group support service. Conclusions Group support and pharmacy-based support for smoking cessation are both extremely cost-effective. [source] A case of late-onset dependence on cocaine and crackADDICTION, Issue 4 2007Christos Kouimtsidis ABSTRACT Aims To raise awareness among the professional clinical and research community of the risk of cocaine misuse among elderly patients. Methods Case report of a male patient, aged 72 years, who presented to a community substance misuse service with cocaine use disorder (hydrochloride and base form). Results The development of the disorder was marked by high levels of cocaine (and later crack cocaine use), repeated periods of abstinence followed by relapse in the past 4 years, with severe consequences to the patient and his family. Treatment involved a close collaboration between several specialist addictions and old-age psychiatry teams in National Health Service. Implications Although dependence on cocaine among the elderly is considered very rare, clinical management can be challenging and is likely to require the involvement of several specialist and general health services. [source] GP prescribing of nicotine replacement and bupropion to aid smoking cessation in England and WalesADDICTION, Issue 11 2004Andy McEwen ABSTRACT Aims Prescribing nicotine replacement therapy (NRT) or bupropion for smoking cessation is of considerable importance to public health but little is known about prescribing practices. This paper examines general practitioners' (GPs') prescribing patterns in Britain where these drugs are reimbursed. The results have implications for other health-care systems considering introducing reimbursement. Design, participants and setting Postal survey conducted in 2002 of a random sample of 1088 GPs in England and Wales, of whom 642 (59%) responded. Measures Number of requests GPs reported having received from patients for NRT and bupropion over the past month, the number of prescriptions they reported issuing and ratings of attitudes to these medications. Findings GPs reported receiving an average of 4.3 requests for NRT and 1.9 for bupropion in the previous month. They reported issuing 3.5 prescriptions for NRT and 1.2 for bupropion. Almost all GPs accepted that NRT (95%) and bupropion (97%) should be reimbursable on National Health Service (NHS) prescription. However, a significant minority of those who received requests for prescriptions did not issue any (8% for NRT and 26% for bupropion). This was related to whether they thought these products should be available on NHS prescription for both NRT and bupropion (OR = 0.66, P < 0.05), which in turn was related to beliefs about whether smokers should have to pay for treatment themselves, the cost-effectiveness of NRT/bupropion and the low priority they would give NRT/bupropion in the drug budget. For bupropion, concern about side-effects independently predicted not prescribing [odds ratio (OR) = 1.46, P < 0.03]. Conclusion In the British health-care system, which has a well-established system for technology assessment and professionally endorsed guidelines, a significant minority of GPs decline all patient requests for stop-smoking medicines. [source] The epidemiology of depression in diabetesEUROPEAN DIABETES NURSING, Issue 3 2008K Winkley BSc, PhD Lecturer in Diabetes, Psychology Abstract Depression is characterised by a period of low mood and loss of interest in everyday activities, and its prevalence in people with diabetes is thought to be twice as high as for those without the condition. Depression in diabetes is associated with a number of adverse outcomes such as increased morbidity, mortality and poor quality of life. As diabetes is increasingly common amongst the economically active, this has serious implications for health services and in the UK, the National Health Service (NHS) has recognised that depression in people with diabetes is a significant problem and recommends screening for depression in this group. Risk factors for depression in diabetes are almost identical to those in people without diabetes, but less is known about its course when people have diabetes, although the available evidence suggests it is more chronic. Research into the mechanisms by which depression is bad for people with diabetes suggests that biological, psychological and social factors play a part but the inter-relationships between these factors are likely to be complex and are not yet fully understood. Depression in people with diabetes can be treated successfully with pharmacological and psychological treatments at least in the short-term, but we do not yet know which treatments are successful in the long-term. Further research into the pathological mechanisms of depression and its treatment are needed if we are to continue to improve the health and lives of people with diabetes. Copyright © 2008 FEND [source] Implementing the 2-week wait rule for cancer referral in the UK: general practitioners' views and practices.EUROPEAN JOURNAL OF CANCER CARE, Issue 1 2004W. DODDS rgn, mphil research associate The 2-week wait rule for cancer referrals became effective in December 2000 for all cancers treated by the National Health Service in the UK. Attainment of this target depends initially on appropriate and timely referral by general practitioners (GPs). General practitioners' views and referral practices under the 2-week wait rule were examined based on a postal survey of 508 GPs in an inner London area (65% response). Data on mode of referral indicated that 90% of GPs used the urgent suspected cancer form, although 38% also sent a letter with further information. General practitioners generally regarded the 2-week wait rule as working well in terms of improving patients' initial access, and 50% thought communication with the hospital had improved. However, 46% expressed some concerns, including problems arising from the different sets of forms required by local cancer networks, the lack of a dedicated referral form for breast cancer, and feelings of a loss of autonomy. General practitioners also acknowledged an element of over-referral under this rule due to the effects of clinical uncertainty and patient pressure and their concerns about increased waiting times for non-target referrals. The survey therefore indicates that GPs are generally positive about the 2-week wait rule but identified some problems of implementation including a need for standardized national cancer referral forms. [source] Feasibility and challenges of independent research on drugs: the Italian Medicines Agency (AIFA) experienceEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 1 2010Italian Medicines Agency (AIFA) Research & Development Working Group Eur J Clin Invest 2010; 40 (1): 69,86 Key points ,,National Health Service (NHS) is becoming increasingly aware of the need to support independent research to answer some important questions for patient care in areas of scant commercial interest. ,,This article reports the main features and strategies of the independent research programme on drugs launched by the Italian Medicines Agency (AIFA) in 2005. ,,In the three bids launched between 2005 and 2007, a total of 151 studies have been approved for funding for a total of about 78 million Euro. ,,In this article we describe the Italian legislative framework under which the programme was launched, the types of research funded and discuss how the supported studies could contribute, in an international framework, to the knowledge needed on drug efficacy, effectiveness and safety. [source] THE SEARCH FOR A PROPORTIONATE CARE LAW BY FORMULA FUNDING IN THE ENGLISH NHSFINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 4 2009Gwyn Bevan Although the National Health Service was created to achieve equity of access to health care in 1948, over twenty years later an ,inverse care law' was seen to operate. The 1976,Report of the Resource Allocation Working Party,laid the principles of formula funding to achieve an equitable distribution of resources, to move, over time, towards the operation of a proportionate care law. These principles have been applied ever since in England. This paper describes the context, governance and subsequent development of formulas and three persistent problems: accounting for populations, their needs and variations in the unavoidable costs of providers. The paper concludes by outlining continuing problems from the past and new challenges of formula funding in England to reduce ,avoidable' inequalities in health. [source] A cost evaluation of treatment alternatives for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in BrazilHAEMOPHILIA, Issue 5 2007M. C OZELO Summary., The first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil is currently activated prothrombin complex concentrate (aPCC), with recombinant activated factor VII (rFVIIa) used as second-line therapy or as a last resort. The aim of this study was to determine the cost and effectiveness of these treatments from the perspective of the Brazilian National Health Service. A decision analysis model was constructed to assess total direct medical costs (including drug costs, costs of outpatient or inpatient care, ambulance transportation and cost of concomitant medications) of first-line treatment with aPCC or rFVIIa. Clinical outcome and resource utilization data were obtained both retrospectively and prospectively and validated by the consensus of an expert panel of Brazilian haematologists. A total of 103 bleeds in 25 patients were included in the analysis. rFVIIa resolved bleeds more quickly (4.4 h) than aPCC (62.6 h) and was more effective (100% vs. 56.7% respectively). Mean total direct medical costs (from initiation to cessation of bleed) were estimated to be US$13 500 (aPCC) and US$7590 (rFVIIa). Extensive sensitivity analyses confirmed the cost-effectiveness of rFVIIa. Compared with aPCC, rFVIIa was more effective and less expensive when used as first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil. rFVIIa should be considered a first-line treatment for the management of these patients. [source] The epidemiology of inhibitors in haemophilia A: a systematic reviewHAEMOPHILIA, Issue 4 2003J. Wight Summary., This paper emphasizes the importance of distinguishing between the prevalence, incidence and cumulative incidence of inhibitors in haemophilia A. Incidence and cumulative incidence data will include patients with transient inhibitors or whose inhibitors have been eliminated by treatment. As these will not be included in prevalence data, prevalence studies will tend to give rise to lower figures than incidence studies. As a result, the most accurate estimates of the true risk of inhibitor development comes from prospective studies of newly diagnosed haemophiliacs who are tested regularly for the presence of inhibitors. This paper reports a systematic review of the best available evidence relating to the epidemiology of inhibitors in haemophilia A. Cohort studies, registry data reporting incidence or prevalence of inhibitors in patients with haemophilia A, and prospective studies of factor VIII (FVIII) in the treatment of previously untreated patients which reported the development of inhibitors as an outcome, were included in the review. The overall prevalence of inhibitors in unselected haemophiliac populations was found to be 5,7%. The cumulative risk of inhibitor development varied (0,39%). Incidence and prevalence were substantially higher in patients with severe haemophilia. Studies of patients using a single plasma-derived FVIII (pdFVIII) preparation reported lower inhibitor incidence than those using multiple pdFVIII preparations or single recombinant FVIII preparations. Incidence data should be used to estimate the likely demand for treatments aimed at eliminating inhibitors, whereas the best estimates of the overall burden to the National Health Service (NHS) of treating bleeding episodes in patients with continuing inhibitors will come from prevalence studies. [source] Developing indicators for measuring Research Capacity Development in primary care organizations: a consensus approach using a nominal group techniqueHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2009Gill Sarre LCST Abstract Research Capacity Development (RCD) in the National Health Service supports the production of evidence for decision-making in policy and practice. This study aimed to establish a level of consensus on a range of indicators to measure research capacity in primary care organizations. Indicators were developed in a two-stage process using workshops and modified nominal group technique. In 2005, workshops were used to generate possible indicators from a wide range of research active and research-interested people. A theoretical framework of six principles of RCD was used to explore and identify indicators. Data were thematically coded, and a 129-item, 9-point Likert scale questionnaire was developed. A purposive sample of nine experts in developing research capacity in primary care agreed to take part in a nominal group in April 2006. The questionnaire was circulated prior to the meeting, and analysis of the responses formed the basis for structured discussion. Participants were then asked to rescore the questionnaire. Only seven participants were able to take part in the discussion and rescore stages. Data were analysed in two ways: level of relevance attributed to each indicator as a measure of organizational RCD, represented by median responses (medians of 7,9 defined strong support, 4,6 indicated moderate support and 1,3 indicated weak support), and level of consensus reached by the group. Consensus was reached if 85% of the group rated an indicator within the same band. Eighty-nine (68%) indicators were ranked as strongly relevant, and for seventy-three of these indicators, a consensus was reached. The study was successful in generating a set of agreed indicators considered relevant for measuring RCD in primary care organizations. These will form the basis of a pilot tool kit to assist primary care organizations to develop research capacity. Further work will explore the applicability of the indicators in practice. [source] A collaborative approach to embedding graduate primary care mental health workers in the UK National Health ServiceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2008Janine Fletcher MSc Abstract The UK National Health Service (NHS) workforce has recently seen the arrival of the Graduate Mental Health Worker (GMHW) in primary care. We established a Quality Improvement Collaborative to assist in embedding this new workforce in one Strategic Health Authority Area of England. The intervention utilised ,collaborative' technology which involves bringing together groups of practitioners from different organizations to work in a structured way to improve the quality of their service. The process was evaluated by an action research project in which all stakeholders participated. Data collection was primarily qualitative. During the project, there was an increase in throughput of new patients seen by the GMHWs and increased workforce satisfaction with a sense that the collaborative aided the change process within the organizations. Involvement of managers and commissioners from the Primary Care Trusts where the GMHWs were employed appeared to be important in achieving change. This was not, however, sufficient to combat significant attrition of the first cohort of workers. The project identified several barriers to the successful implementation of a new workforce for mental health problems in primary care, including widespread variation in the level and quality of supervision and in payment and terms of service of workers. A collaborative approach can be used to support the development of new roles in health care; however, full engagement from management is particularly necessary for success in implementation. The problems faced by GMHWs reflect those faced by other new workers in healthcare settings, yet in some ways are even more disturbing given the lack of governance arrangements put in place to oversee these developments and the apparent use of relatively unsupported and inexperienced novices as agents of change in the NHS. [source] Managing the entry of new medicines in the National Health Service: health authority experiences and prospects for primary care groups and trustsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2001Ruth McDonald BA MSc PhD Abstract For the most part, the management of new medicines in the NHS has hitherto been a matter for local discretion. The result is that access to medicines is often determined by where a patient lives, as opposed to some nationally agreed clinical criteria. This ,postcode prescribing' has led to widespread variations in access to medicines and concerns about the resulting inequalities. Primary care groups and trusts are expected to reduce variations in access to care, whilst at the same time balancing their finances, since any overspends on prescribing must be covered by disinvestment in hospital and community services. We interviewed 21 health authority (HA) prescribing advisers to ascertain how they viewed the managed entry of new medicines in order to identify lessons for PCGs. In addition, we report the views of local prescribing managers on the potential impact of recent government policy changes on the process and speculate on the likely implications of these for primary care groups and trusts. What is clear from the study is that HAs often have no explicit objective in relation to new medicines, but that their desire to act is prompted by fears of overspending on prescribing budgets. The danger of this approach is that patients may be denied cost-effective treatments since all new medicines are seen as a problem. It seems likely that PCG/Ts will face the same dilemmas with which the HA advisers in our study have been wrestling for some time. Recent policy changes in relation to prescribing budgets and new medicines are likely to exacerbate these problems. The tensions between local priority setting, which may mean saying no to new medicines, whilst at the same time eradicating postcode prescribing and balancing budgets means that PCG/Ts face difficult policy choices. [source] Explaining trends in concentration of healthcare commissioning in the English NHSHEALTH ECONOMICS, Issue 8 2008Mark Dusheiko Abstract In recent years there have been marked changes in organisational structures and budgetary arrangements in the English National Health Service, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and hospitals. We show that elective admissions from PCOs and practices became significantly more concentrated across hospitals between 1997/98 and 2002/03. There was a reduction in the average number of hospitals used by PCOs (16.7,14.2), an increase in the average share of admissions accounted for by the main hospital (49,69%), and an increase in the average Herfindahl index (0.35,0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations as 100 health authorities were replaced by 303 primary care trusts. Most of the remainder was probably due to hospital mergers. Fundholding general practices that held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their PCO. Around 1/10th of the increase in concentration at practice level was due to the abolition of fundholding in April 1999. Our results have implications for the effects of the recent reintroduction of fundholding and the halving of the number of PCOs. Copyright © 2007 John Wiley & Sons, Ltd. [source] The effects of expanding patient choice of provider on waiting times: evidence from a policy experimentHEALTH ECONOMICS, Issue 2 2007Diane Dawson Abstract Long waiting times for inpatient treatment in the UK National Health Service have been a source of popular and political concern, and therefore a target for policy initiatives. In the London Patient Choice Project, patients at risk of breaching inpatient waiting time targets were offered the choice of an alternative hospital with a guaranteed shorter wait. This paper develops a simple theoretical model of the effect of greater patient choice on waiting times. It then uses a difference in difference econometric methodology to estimate the impact of the London choice project on ophthalmology waiting times. In line with the model predictions, the project led to shorter average waiting times in the London region and a convergence in waiting times amongst London hospitals. Copyright © 2006 John Wiley & Sons, Ltd. [source] The UCLan community engagement and service user support (Comensus) project: valuing authenticity, making space for emergenceHEALTH EXPECTATIONS, Issue 4 2007Soo Downe BA (Hons) RM MSc PhD Abstract Objective, To develop and evaluate service user, carer and community involvement in health and social care education. Background, Despite the high policy profile of involvement issues, there appear to be no published accounts of schemes that have used a systematic whole-faculty approach to community engagement in health and social care higher education. Focus of this paper, The set up and early development of a faculty-wide community engagement project. Setting and participants, Staff from the faculty of health in one University, local service users and carers and community group project workers and local National Health Service (NHS) and public sector staff. Design, Participatory action research including document review, field notes, questionnaires and interviews. Analysis, Thematic analysis. The emerging themes were tested by seeking disconfirming data, and through verification with stake-holders. Results, Prior to the study, there were examples of community engagement in the participating faculty, but they occurred in specific departments, and scored low on the ,ladder of involvement'. Some previous attempts at engagement were perceived to have failed, resulting in resistance from staff and the community. Despite this, an advisory group was successfully formed, and project framing and development evolved with all stake-holders over the subsequent year. The four themes identified in this phase were: building accessibility; being ,proper' service users/carers;moving from suspicion to trust: mutually respectful partnerships as a basis for sustainable change; and responses to challenge and emergence. Conclusions, Successful and sustainable engagement requires authenticity. Many problems and solutions arising from authentic engagement are emergent, and potentially challenging to organizations. [source] The education and training needs of health librarians,the generalist versus specialist dilemmaHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 3 2007Tatjana Petrinic Aims and objectives:, The aims of the study were to examine whether and how librarians with a generalist background can transfer to roles demanding more expert knowledge in the health sector. The objectives were (i) to compare the education and training needs of health librarians with science degrees with the education and training needs of health librarians with arts and humanities degrees; (ii) to compare the education and training needs of librarians working in the National Health Service (NHS) sector with the education and training needs of librarians working for the health sector but within higher education. Methods:, Face-to-face interviews with 16 librarians, a convenience sample of librarians working in the Thames Valley NHS region. Results:, The main findings confirmed that structured continuing professional development (CPD) is required to meet the rapidly changing needs in the health sector. The emphasis ought to be on teaching skills, outreach work, marketing and promotion, research skills and methods, subject knowledge and terminology, and management skills. Library school curricula do not appear to meet the demands of medical library posts. A first degree in scientific subjects is advantageous in the early stages of a career but diminishes with continuing training and experience. There is no evidence of a significant difference in training needs and provision between the librarians in NHS posts as opposed to those in higher education (HE) posts. Conclusions:, The conclusions suggest that library schools need to update their programmes to include teaching skills, advanced search skills, project management skills, research methods, with more practical exercises. Particular attention should be given to librarians with a first degree in non-scientific subjects in terms of time allocated for CPD, quality of training and access to reliable mentorship. [source] Electronic journal provision in a health-care library: insights from a consultation with NHS workersHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 2 2006Sarah E. Crudge Objective:, This study determines the current awareness journal reading requirements of the users of Stockport National Health Service (NHS) Trust's library. The overlap between requirements and the provision of the NHS Core Content resources, four major electronic journal bundles, and the holdings of North West health libraries is also investigated. Methods:, A survey of both hospital and Primary Care Trust staff was conducted, and respondents were required to provide a list of their favourite journal titles. Each requested title was assigned a subject code, and the impact factor was noted. Results:, From 135 survey responses, 217 journal titles were identified and 33 category codes were utilized. There was little overlap between the request list and the NHS Core Content titles, but substantial correspondence existed between the request list and the print holdings of North West health libraries. Conclusions:, Current awareness journal reading requirements will not be met by the Core Content provision alone. Bundles of titles offer value-for-money solutions, but may be at the expense of popular titles. Furthermore, the success of regional document supply schemes may be compromised if large numbers of health-care libraries replace print holdings with similar electronic journal bundles. [source] Embedding knowledge management in the NHS south-west: pragmatic first steps for a practical conceptHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 2 2003Caroline Plaice Knowledge management, like clinical governance, is a practical science. Clinical governance, with its emphasis on creating an environment where clinical quality is monitored and acted upon, is one of the foundation stones of the new National Health Service (NHS). Both knowledge management and clinical governance need to share the same criteria in order to operate. Using these two pragmatic concepts and the premise of a practical approach, this article seeks to identify the drivers for knowledge management in the NHS, highlight national initiatives and focus on the steps libraries in the south-west of England have taken to make knowledge management a reality. In so doing, the central role of the library and information service has been reinforced and embedded and librarians have been recognized for their real worth to their organizations. [source] Modernising pay in the UK public services: trends and implicationsHUMAN RESOURCE MANAGEMENT JOURNAL, Issue 3 2010Stephen J. Perkins The emerging character of the UK government's public sector pay reforms during the second and third (New) Labour terms of office is reviewed and contextualised. Three settings are examined where pay reform has been actively employed , with the accent on harmonisation, simplification and devolution of practice, with the express intention of restoring public service workforce morale, while improving services to clients , namely, local government, the National Health Service and the Higher Education sector. The evidence is interpreted as illustrating undoubted change, but also significant areas where progress has been less than intended, measured against the government's original programme goals. Equal pay considerations appear to have dominated all three projects reviewed: the failure to date of public sector managements to capitalise on opportunities the new pay architecture affords them to change local working practices may be attributed to a combination of factors discussed in the article. These have given rise to tensions as efforts have been pursued to transplant private sector pay techniques, somewhat hastily in some cases, without due consideration of the institutional context within which public services and proximal institutions function. [source] Employee participation and union voice in the National Health ServiceHUMAN RESOURCE MANAGEMENT JOURNAL, Issue 2 2004Stephen Bach This article examines the role of trade unions in the health service at workplace level under the Labour government's modernisation agenda, and focuses on the shifting balance between forms of direct and indirect participation drawing on case studies of three acute hospital trusts. There has been a strong growth in forms of direct communication within the case study trusts and some increase in direct participation among professional groups. Despite this ,dualism' in employment relations, however, the target culture of the NHS has precluded the development of effective voice mechanisms. The policy implications for trade unions and the implications for the implementation of NHS pay modernisation are considered. [source] Services for erectile dysfunction in the UK , a 12-month review of referrals to a west Midlands NHS clinicINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2010G. Hackett Summary Introduction:, Few studies have addressed the health economics of the provision of services for sexual dysfunction within the National Health Service. Aim:, To evaluate the referral patterns, workload and prescribing costs in secondary care resulting from government guidance on erectile dysfunction (ED). Method:, A review of 324 consecutive referral letters to the Good Hope Hospital Erectile Dysfunction Clinic was conducted to assess the purpose of referral. Prescribing data and costs were assessed over the same 2-year period. Results:, Severe distress was the main reason for referral in 54% of referrals. Long term prescribing according to government guidance doubled the cost of care and created an unsustainable increase in clinic and pharmacy workload. Conclusions:, Existing regulations designed to control costs of ED therapy have created health inequalities, waste of resources and have increased the overall cost of care. [source] Reclaiming the National Health Service from political controlINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2007Graham Jackson Editor No abstract is available for this article. [source] Modernizing times: UK hearing-impaired consumers at the policy crossroadsINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 2 2008Liz Ross Abstract Although there is now a long-standing belief in the UK that free consumer choice improves market efficiency, the supply of some consumer products and services remained controlled by the state. In the interests of consumers, it regards as vulnerable to misdirection and malpractice or unlikely to have the technical expertise to make informed decisions. Historically, the supply of hearings aids has been restricted to the National Health Service and specific licensed practitioners in the independent sector. Recent changes to both product and service provision have brought about a radical alteration to this situation, and to the framework of control. This case study of a changing healthcare system demonstrates more generally the difficulties experienced by people trying to improve or maintain auditory functions for speech communication. Access to appropriate technological solutions may be precluded by cost, distribution arrangements or lack of knowledge. Overarching these difficulties, regional health policy variations within the UK mean that consumer experiences vary according to where they live. Consumer influence over the direction and scope of changes to the hearing aid market is limited despite the rhetoric of choice. This article examines the emerging ,liberalized' market and its contradictions. [source] The challenges of commissioning healthcare: a discussion paperINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2009Article first published online: 5 JUN 200, Sheila Peskett Abstract The UK's Department of Health Independent Sector Programme to procure healthcare for National Health Service (NHS) patients from the independent sector revealed many of the challenges of commissioning, particularly assessing governance arrangements and identifying the organisational attributes of high quality healthcare providers. These issues were first discussed in a workshop at the British Association of Medical Managers (BAMM) Medical Directors Conference in Dublin in November 2007 (Dale, et al., 2009). The more difficult challenges of achieving effective clinical engagement, including motivational factors, organisational environment and systems and partnership working, in the complex field of commissioning healthcare in the UK are also explored here with particular reference to systems in other countries. Copyright © 2009 John Wiley & Sons, Ltd. [source] Follow-up of serious offender patients in the community: multiple methods of tracingINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2002Elizabeth Jamieson Lecturer Abstract Longitudinal studies of people with mental disorder are important in understanding outcome and intervention effects but attrition rates can be high. This study aimed to evaluate use of multiple record sources to trace, over 12 years, a one-year discharge cohort of high-security hospital patients. Everyone leaving such a hospital in 1984 was traced until a census date of 31 December 1995. Data were collected from several national databases (Office for National Statistics (ONS), Home Office (HO) Offenders' Index, Police National Computer Records, the Electoral Roll) and by hand-searching responsible agency records (HO, National Health Service). Using all methods, only three of the 204 patients had no follow-up information. Home Office Mental Health Unit data were an excellent source, but only for people still under discharge restrictions (<50% after eight years). Sequential tracing of hospital placements for people never or no longer under such restrictions was laborious and also produced only group-specific yield. The best indicator of community residence was ONS information on general practitioner (GP/primary care) registration. The electoral roll was useful when other sources were exhausted. Follow-up of offenders/offender-patients has generally focused on event data, such as re-offending. People untraced by that method alone, however, are unlikely to be lost to follow-up on casting a wider records net. Using multiple records, attrition at the census was 38%, but, after certain assumptions, reduced further to 5%. Copyright © 2002 Whurr Publishers Ltd. [source] Junior doctors' working hours: Perspectives on the reformsINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2008Carol Wilkinson MSc BA(Hons) RGN Teacher's Cert Fellow Higher Education AcademyArticle first published online: 5 MAY 200 The European Working Time Directive for junior doctors came into force in Britain in August 2004. The reforms themselves have been a long time in development and implementation since the inception and debates regarding the New Deal, to the current formations under health and safety legislation. This study, undertaken within a hospital trust setting in England, provides an insight into the perspectives of doctors, nurses and human resources managers in relation to the European Working Time Directive. Critical consideration is given to the impact of the reforms upon the National Health Service and more specifically to daily working relationships at the point of implementation. The results demonstrate some ambivalence towards the reforms because of the major shift in culture for the professions per se, but also for the future of health-care delivery where there are considerable tensions. [source] Developing Clinical Terms for Health Visiting in the United KingdomINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003June Clark BACKGROUND The UK health visiting service provides a universalist preventive health service that focuses mainly on families with young children and the elderly or vulnerable, but anyone who wishes can access the services. The principles of health visiting have been formally defined as the search for health needs, the stimulation of awareness of health needs, influencing policies that affect health, and the facilitation of health-enhancing activities. The project is currently in its fourth phase. In phase 1, 17 health visitors recorded their encounters with families with new babies over a period of 3 months; in phase 2, 27 health visitors recorded their encounters with a wider range of clients (769 encounters with 205 families) over a period of 9 months; in phase 3, the system is being used by a variety of healthcare professionals in a specialist program that provides intensive parenting support; phase 4 is developing a prototype of an automated version for point-of-contact recording. UK nursing has no tradition of standardized language and the concept of nursing diagnosis is almost unknown. Over the past decade, however, the government has initiated the development of a standardized terminology (Read codes) to cover all disciplines and all aspects of health care, and it is likely that the emerging SNOMED-CT terminology (a merger of the Read codes with the SNOMED terminology) will be mandated for use throughout the National Health Service (NHS). MAIN CONTENT POINTS The structure and key elements of the Omaha System were retained but the terminology was modified to take account of the particular field of practice and emerging UK needs. Modifications made were carefully tracked. The Problem Classification Scheme was modified as follows: ,All terms were anglicized. ,Some areas , notably relating to antepartum/postpartum, neonatal care, child protection, and growth and development,were expanded. ,The qualifiers "actual,""potential," and "health promotion" were changed to "problem,""risk," and "no problem." ,Risk factors were included as modifiers of "risk" alongside the "signs and symptoms" that qualify problems. The Intervention Classification was modified by substituting synonymous terms for "case management" and "surveillance" and dividing "health teaching, guidance, and counseling" into two categories. The Omaha System "targets" were renamed "focus" and a new axis of "recipient" was introduced in line with SNOMED-CT. The revised terminologies were tested in use and also sent for review to 3 nursing language experts and 12 practitioners, who were asked to review them for domain completeness, appropriate granularity, parsimony, synonymy, nonambiguity, nonredundancy, context independence, and compatibility with emerging multiaxial and combinatorial nomenclatures. Review comments were generally very favourable and modifications suggested are being incorporated. CONCLUSIONS The newly published government strategy for information management and technology in the NHS in Wales requires the rapid development of an electronic patient record, for which the two prerequisites are structured documentation and the use of standardized language. The terminology developed in this project will enable nursing concepts to be incorporated into the new systems. The experiences of the project team also offer many lessons that will be useful for developing the necessary educational infrastructure. [source] A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisorsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2005M. N. KOSTOPOULOU Summary. Objective., The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. Design., A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. Methods., The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results., Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. Conclusion., Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated. [source] | |||||||||||||||||||||||||||||||||||||