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The article examines the issues surrounding White Paper's uncovering of the proposal to reforming the health professionals' Trust, Assurance and Safety regulation in Great Britain. The White Paper expressed that to reform, the importance of perceptions must be rightly emphasized as public needs to perceive that the regulatory system is operating in the interests of patients. It also stresses that the General Medical Council's (GMC) four functions must be integrated in the regulatory framework.

Since the creation of the National Health Service (NHS) in the United Kingdom in 1948 there have been significant changes in the way waste materials produced by healthcare facilities have been managed due to a number of environmental, legal and social drivers. This paper reviews the key changes in legislation and healthcare waste management that have occurred in the UK between 1948 and the present time. It investigates reasons for the changes and how the problems associated with healthcare wastes have been addressed. The reaction of the public to offensive disposal practices taking place locally required political action by the UK government and subsequently by the European legislature. The relatively new UK industry of hazardous healthcare waste management has developed rapidly over the past 25 years in response to significant changes in healthcare practices. The growth in knowledge and appreciation of environmental issues has also been fundamental to the development of this industry. Legislation emanating from Europe is now responsible for driving change to UK healthcare waste management. This paper examines the drivers that have caused the healthcare waste management to move forward in the 60 years since the NHS was formed. It demonstrates that the situation has moved from a position where there was no overall strategy to the current situation where there is a strong regulatory framework but still no national strategy. The reasons for this situation are examined and based upon the experience gained; suggestions are made for the benefit of countries with systems for healthcare waste management still in the early stages of development or without any provisions at all. [ABSTRACT FROM AUTHOR]

This paper reviews the current generation and management of healthcare waste in the United Kingdom, with a focus on that produced from healthcare provision in the National Health Service. While the current capacities of large-scale off-site treatment systems are adequate, there are a number of logistical factors that must be considered in future. These include variations in arisings from each country and from various regions within each country, the age and location of treatment/disposal facilities, the quantities, types and sources of healthcare waste, and the impact of waste minimization and recycling strategies. Managing UK healthcare waste is a complex issue that requires the correct technologies and capacities to be available. With increasing quantities and costs there is urgent need for future planning, and healthcare waste issues need to be addressed from a UK-wide perspective. Holistic strategies need to incorporate both minimization and segregation, with treatment using a combination of incineration and alternatives treatment technologies. The need for more research and accurate data to provide an evidence-base for future decision-making is highlighted. [ABSTRACT FROM AUTHOR]

Introduction There is an increasing expectation for the NHS to deliver a constantly up-to-date health service that is both safe and patient-oriented. This paper outlines the findings of a new risk assessment tool implemented across the organization targeted specifically to medical devices. Method The process employs a new medical devices risk assessment tool (MeDRa) to collect quantitative data relating to the contributory factors and control measures associated with medical devices used in the clinical setting. The tool utilises the responses from healthcare professionals as the 'real experts' in assessing risk to compute risk ratings for each device. Consequently the risk assessments are validated through the professional judgement of the clinical staff. Results As the data is inputted, the software tool computes the individual risk profiles for device categories in the particular clinical setting. A macro perspective of medical device risk is produced through statistical analysis and mathematical modelling using cross-tabulations. Risk perceptions are influenced by the differences in professional roles of nursing and medical staff. The outcome of the analysis is a report on medical device risks across the organization and an associated action plan, which identifies ways of mitigating those risks. Conclusions This approach efficiently produced risk assessments for each clinical area across the whole Trust in a matter of weeks. The MeDRa tool collated evidence to satisfy many of the criteria necessary for the external assurance framework. The subsequent statistical analysis and mathematical modelling highlighted a number of issues across the Trust that required interventions. [ABSTRACT FROM AUTHOR]

The 'Modern Matron' is one of the prominent nursing roles to emerge from the NHS Plan. The underpinning principle is to have a professional leader who is accountable for co-ordinating safe, high-quality care to improve patients' NHS experience. This paper discusses findings from a study of the implementation of the Modern Matron role in an acute NHS Trust in the East of England. The theoretical framework of 'limiting harm' was used to assess the extent to which the Modern Matron could contribute towards safe effective care and the reduction of harm. The study found that error-prone situations were clearly identified and that the Matrons were perceived to have a positive impact on a range of clinical issues. The evidence from this small study suggests that the Modern Matron role has the potential to make a positive contribution to patient safety. [ABSTRACT FROM AUTHOR]

This paper examines some fundamental issues pertaining to the use of, as well as to the distinctive characteristics of, information technology in relation to the development of information systems within the UK National Health Service (NHS). The paper refers to the current Resource Management initiative in the NHS, which involves the fabrication of information systems to connect medical activity to resource usage, and thus to costs. Examining the features of some of the rival inscriptions undergoing development of make this connection visible, the paper highlights the properties of information technology in enhancing their mobilization. It also addresses the immutability and combinability of these inscriptions, and discusses some of the implications, in terms of medical practice and knowledge, which may follow from their use. [ABSTRACT FROM AUTHOR]

The article presents information on restructuring in the NHS, through the impact of the 1990 Reforms on the Management of Labour. Government policy in the 1980s and 1990s has substantially changed the way in which health care is delivered and organised. As a labour intensive sector, there are particular repercussions for the management of work. This paper examines the initial impact on hospitals of the 1990 National Health Service (NHS) reforms, in terms of the introduction of internal com- petition and trusts, and the continued restrictions on hospital budgets. The NHS is a particularly important part of the public services, employing nearly 1.2 million people, nearly 22 per cent of all public sector employees (CSO: 1994), and having a very high political profile. Initial Conservative policies in the NHS focused on tighter cash limits, the erosion of pay comparability and the encouragement of private health care. In the mid 1980s, attention then moved to the reform of local management structures and practices.

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. [ABSTRACT FROM AUTHOR]

This article examines the effects of role redesign on the work and professional boundaries of midwives employed in the National Health Service. It outlines midwives' views and experiences of attempts to change their skills and professional boundaries and, using the concept of closure, considers the implications for the midwifery profession. The findings show that role redesign is changing midwives' work and that the traditional emotional, social and caring skills associated with a midwife are being undermined by the growth in technical work. Importantly, midwives' attempts to use closure have met with limited success and aspects of their work which they enjoy are being delegated to maternity support workers, while midwives' roles expand to include work traditionally performed by doctors. Midwives' concerns about the implications of work redesign for maternity care and their professional boundaries reflect the uncertainty surrounding the profession about the future role and skills of a midwife. [ABSTRACT FROM AUTHOR]

The article explores some of the potential risk areas that exist at the interface between hospital care and general practice care in Great Britain. The work done in general practice and work done in hospitals during the early decades of the National Health Service is described. Commentators said that adverse clinical events result from poor communication. Suggestions that might reduce adverse outcomes are provided.

The article presents an interview with Liam Donaldson, chief medical officer of the British Department of Health, about patient safety. The interview begins with an assessment of the report "An Organisation With a Memory" which stimulated a lot of awareness about patient safety. Donaldson then discusses the approach to cover ups or failure to comply with the being open policy. In addition, Donaldson talks about the role of the National Health Service Litigation Authority.

The New Labour government would have appeared to have demonstrated a strong commitment to the state health care sector since coming to power in 1997. It has more than doubled spending on the National Health Service, and this investment is projected to rise over the next four years. However, whether this 'modernization strategy' will be able to deliver a more equitable health care service in New Labour's third term in office is open to question. In addition, the expanding role of the private health care sector in a revived 'internal market' in health care raises serious concerns about the future direction of state health care provision. [ABSTRACT FROM AUTHOR]

The article focuses on litigation in the healthcare field in Great Britain. It presents the reasons the British National Health Service (NHS) Legal Aid seeks to avoid litigation unless it is essential to establish or protect precedent in the interest of the NHS. It explains the reason the costs of litigation on the individual case are increasing. It compares the case Chester v. Afshar with Donoghue v. Stevenson.

The article describes the early experience of an information officer appointed within a newly formed primary health care team in the new township of Cambourne, west of Cambridge. The post was jointly defined and funded through a partnership between Cambridge shire Libraries, the Primary Care Trust and Monkfield Medical Practice. It further describes the establishment of the post, it's positioning within the core clinical team and some of the activities undertaken, including the use of information prescriptions. Significant issues highlighted include the diversity of routes to information which emerged, the importance of information to National Health Service policy of Great Britain on patient choice and the role of the information officer as an accessible source of information on healthy lifestyles. The concept of an information officer post of this nature was based in part on the experience of the Gaiter Health Learning Center at Chicago's Northwestern Memorial Hospital. The Manager and her team in the Health Learning Center provide consumer health information not only for hospital patients and their families but also for the wider community.

NHS Direct, the 24-hour telephone helpline, uses modern communications technology to offer easier and faster access to advice about health, illness and the NHS so that people are better able to care for themselves and their families. In-depth interviews with callers to the service show that they bring with them discourses of the 'deserving' and 'undeserving' familiar in the provision of other welfare services. The figure of the 'time-waster' is the NHS equivalent of the welfare 'scrounger', acting as a mechanism to problematize entitlement. NHS Direct dispels such fears and legitimizes demand. At the same time, ever-rising levels of service use constitute a threat to what callers value most about it. [ABSTRACT FROM AUTHOR]

Will healthcare be drowned by the grey Tsunami or sunk by the demographic iceberg? Or will new and radical, economic, medical, nutritional, exercise and life style developments, produce a better economic model for future healthcare. A properly funded Health Service rather than an over Politicised Failing Sickness service. [ABSTRACT FROM AUTHOR]

The article describes a practical method of rapidly developing a corporate risk register by adopting an organizational learning approach. Risk register is defined. Risks associated with the health care business is discussed. Factors that influence risk rating are cited. The notion of the British National Health Service as a learning organization is considered.

The article presents a speech by John Swales, a professor of medicine at the University of Leicester, England, delivered at the National Health Service (NHS) at the Royal Society of Medicine (RSM) Reflections: Past, Present and Future on July 8, 1998. He talks about the influence of clinical trials on health services in Great Britain, the changes in patient treatment with the use of drugs since 1948 and the budget for healthcare and new technologies.

The article presents a speech by David Innes Williams, former president of Royal Society of Medicine (RSM), delivered at the National Health Service (NHS) at the RSM Reflections: Past, Present and Future on July 8, 1998. He discusses the changes that took place within NHS, the three parts of the health services in 1948 including the general practitioners and Medical Officers of Health and the consultants.

The article presents information on the systems of accountability in the context of the National Health Service (NHS) of Great Britain. The NHS has introduced initiatives in response to pressures of accountability. General practitioners play an important role in the nation's health care system. A number of NHS trusts are run by boards of directors. There are several methods of accountability practiced in Great Britain.

The article discusses an application with the court for an order that the care and accommodation issues involving a cerebral palsy patient should be stayed until such time as the Claimant had submitted to an assessment under Section 47 of the National Health Services and Community Care Act in Great Britain. In order to avoid a stay the Claimant's representatives agreed to an order for assessment, but limited to one person visiting for a period of around 2.5 hours.