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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.

This paper examines strategies for improving recycling behaviour within the Cornwall National Health Service (NHS). Using quantitative (questionnaires and waste bin analyses) and qualitative (ethnography and interviews) methodologies, the study examined the waste management practices of staff from the Cornwall NHS. It was found that employee participation in waste recycling at work was low due to a range of factors including NHS focus and policies, group norms, and individual attitudes and beliefs about sustainable waste management. Recommendations for improving the sustainability of NHS, employee waste management practices, with a specific focus on recycling are included in the paper. These recommendations include measures focused towards both the NHS organization and individual staff members. [ABSTRACT FROM AUTHOR]

In the National Health Service in England there are many sources of information pertaining to patient safety. This paper sets out to describe the challenge of measuring patient safety and describes the key data sources that underpin the national understanding of the area. The paper will describe how utilizing all of the available patient safety data, irrespective of the variability inherent, can ensure that practising clinicians have a better understanding of the current picture of patient safety and can fully evidence the efficacy of their improvement actions. Examples of effective triangulation of these data sources are given with acknowledgement of the challenges this can present in terms of engagement and understanding, particularly in the clinical context. Recommendations for the effective use of information in the assessment of patient safety are also provided. [ABSTRACT FROM AUTHOR]

Commentators have argued that we have entered a new era of migration described by Vertovec as a ‘transformative diversification of diversity’. Multiple variables of difference in the ethnicity, immigration status, rights and entitlements, age and gender profiles and patterns of distribution, of new migrants mean that the UK, and many other EU countries, are now home to the most diverse population ever experienced. The onset of super-diversity challenges traditional multicultural models of welfare provision originally based upon an understanding of migrants as large and geographically contained clusters of predominantly postcolonial migrants. These changes are occurring at a time when migration has become highly politicized, multiculturalism is being questioned, a shift is under way towards assimilation and welfare provision has become re-racialized. This paper argues that models of welfare provision need to be rethought to take into account the new reality of super-diversity in a way that is affordable, politically acceptable and meets the needs of all. Using data from research undertaken from studies of health service provision in the West Midlands the paper explores the challenges of meeting the needs of new migrants under existing provision, the costs of failing to adapt to super-diversity and the reasons why provision has failed to adapt. The paper concludes by arguing the need for different approaches to provision, and suggesting some new ways forward. [ABSTRACT FROM PUBLISHER]

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]

While trust is seen as central to most social relations, most writers, including sociologists of science, assume that modern trust relations – especially those in regulatory relationships – tend towards the impersonal. Drawing on ethnographic material from one kind of scientific oversight body – research ethics committees based in the UK NHS – this paper argues that interpersonal trust is crucial to regulatory decision-making and intimately bound up with the way in which these oversight bodies work, and that as such they build on, rather than challenge, the trust-based nature of the scientific community. [ABSTRACT FROM PUBLISHER]

Abstract: 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. [ABSTRACT FROM AUTHOR]

This paper concerns the use of photo-elicitation interviews in constructing migrant narratives of health and well-being. It argues that photo-elicitation can be particularly effective in producing nuanced understandings about relationships among culture, place and health. It explores how, through this method, subject-centred understandings of health and well-being are able to challenge dominant discursive constructions that tend to ‘other’ and potentially stereotype minority groups in explanations of health behaviour. The paper includes discussion of issues of power and representation in research with marginalized populations, which further elaborates the value of photo-elicitation in developing a non-essentializing view of minority groups. The paper concludes with comment on the potential value of this method in the formulation of health and social policies aiming to incorporate the views and needs of marginalized or minority groups. [ABSTRACT FROM PUBLISHER]

Pressure ulcer prevention is core to nursing practice and as such is often overlooked as a safety risk. A multifaceted quality improvement initiative guided by both Felgen’s Model and the Model for Improvement delivered implemented in a systematic way led to significant improvements in the prevalence and incidence of pressure ulcers. Prevalence of all ulcers was reduced from 21% to 7% and to 3.1% when grade 1 ulcers are removed from analysis. Incidence (i.e. ulcers acquired in hospital) was reduced from 6.6% to 2.4% and 1.4% when grade 1 ulcers are removed from the analysis. Furthermore, improvements have been sustained for more than 2 years. This paper presents a case study of framework for change developed across a healthcare region NHS Tayside in Scotland. [ABSTRACT FROM PUBLISHER]

In the wake of the Mid Staffordshire Public Inquiry, this paper considers the arguments for and against the imposition of a statutory duty of candour on individuals, examining the validity of claims that such a duty would result in greater secrecy among healthcare professionals and lead to defensive practice. Examination of arguments for imposing an individual duty, highlights the pre-existing moral obligation on healthcare professionals to inform patients who have suffered harm, has not yet been sufficiently embedded throughout the NHS by professional codes of conduct, and the need to establish systematic formalised error reporting in order to continue to minimise clinical error. [ABSTRACT FROM AUTHOR]

The disclosure of adverse events to patients or their families who have been affected is considered to be a central feature of high quality and safer patient care, but despite this, as few as 30% of harmful errors may currently be disclosed to patients. Advocates of open disclosure propose that failing to communicate effectively with patients following adverse events may have negative repercussions for all stakeholders. The disclosure of adverse events and errors to patients and their families is partly fulfilling the duty of candour advocated in the numerous recent reports into the quality and safety within the NHS. This paper considers why disclosure remains challenging for organisations and professionals alike, despite guidance and in a clear moral imperative and commitment from stakeholders to transparency in healthcare. [ABSTRACT FROM AUTHOR]

Healthcare is a highly regulated environment. This has driven what could be characterized as a papersafe approach, whereby organizations are required to demonstrate to a multiplicity of regulators, inspectorates and accrediting bodies that they are paper safe. However, for many organizations, this has not produced a system which is actually patient safe; rather it has in practice operated as a parallel system that does not reflect the true state of safety. This project looks at a quality improvement and patient safety programme and critically asks the question of whether it is flawed because of failure to address issues surrounding Doctors and cultural change. We used Johnson & Schole's cultural web framework to explore the attitudes of junior doctors towards a patient safety and quality improvement programme. Data collection was through the use of focus groups backed up with quantitative data from a web based questionnaire survey. It has been demonstrated that Doctors represent a dominant sub-culture within the NHS and their beliefs, attitudes and value are often at odds or unrecognized by senior healthcare managers. Unless the cultural differences are adequately addressed then transformational change projects such as 'Best and Safest Care' are unlikely to succeed. A better understanding of the organizational context allows for more appropriate change interventions to be developed. [ABSTRACT FROM AUTHOR]

In July 2010, the Government published the White Paper Equity and Excellence: Liberating the NHS, which places a strong emphasis on patient safety, sets the long-term vision for the NHS and describes a coherent framework of reform to deliver health care amongst the best in the world. Good nutritional care is a prerequisite of safe care and hence fundamental to the achievement of this vision, especially for vulnerable individuals. This article outlines the prevalence and costs associated with malnutrition and the impact of malnutrition on patient safety within the context of the current NHS reforms. It concludes with guidance for clinicians and senior managers which, where fully implemented, will facilitate good nutritional care and ensure compliance to nutritional guidelines, standards and legislation including the regulations relating to nutrition as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 and the Care Quality Commission (Registration) Regulations 2009. [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]

Using data from the UK National Reporting and Learning System and the National Health Service Litigation Authority, this paper assesses trends in patient safety incidents and litigation in relation to ophthalmic surgery generally and vitreoretinal (VR) surgery in particular. Examples of human error and equipment-related incidents in VR surgery are discussed. Data from incident reporting and litigation should be interpreted with care as these are influenced by many factors. An open culture, improved reporting and prioritisation of patient safety will help provide further insight into the prevalence and causes of patient safety incidents in VR surgery. [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 compares the development of genetic testing for breast cancer (BRCA testing) in the USA and the UK. It argues that national political cultures played an important role in how these genetic testing technologies were shaped, and that the shapes of these technologies had important implications for the users of these systems. In order to demonstrate the roles of national social and political elements in the development of new genetic testing technologies, I introduce the concept of a technology's architecture, which is made up of component and the specific ways in which these components are assembled to fulfill particular functions. In the USA, four very different BRCA testing systems initially emerged. However, one biotechnology company, Myriad Genetics, eventually used its legal and economic position to become the sole provider of testing. It offered BRCA testing the way many other laboratory tests were provided in the USA, available to anyone through any physician. The shape of this testing service had important implications for its participants, defining the client as a consumer who could demand access to any of Myriad's laboratory services, but could not choose among testing systems. In the UK, the government-run National Health Service provided testing through regional genetics clinics, using family history information to assess risks and triage care. Clients in the UK were defined as citizens and patients, who had the right to equal access to the testing system but could not demand any specific services. [ABSTRACT FROM AUTHOR]

There is concern that the UK general practitioner (GP) workforce has declined relative to the expanding needs of a primary care-led NHS. Much of the debate about possible solutions within the profession and amongst medical workforce planners has focused on the need to raise medical school intakes and recruit more new GPs. However, other evidence shows that, as with medicine in general, a differential relation ship exists in the GP labour market based upon socially ascribed characteristics. It follows that many already qualified GPs (e.g. women, ethnic minority and older doctors) are under-used in the context of generally accepted career structures. Hence, we would argue, part of the solution to workforce shortages lies in better retention and management of existing human resources. This paper first suggests a simple re-conceptualisation, which will help to frame a more sophisticated analysis than so far used for workforce planning of the nature of GP demand and supply. The framework is then used to explore the findings of the first ever national survey (n = 621) and follow-up interviews (n = 32) with a cohort of GP principal leavers. These showed that a variety of more flexible employment arrangements are needed in order to improve both GP recruitment and retention. In taking this approach, the paper also explores the potential implications of changing social trends for the structure of the GP profession. [ABSTRACT FROM AUTHOR]

Comments on information issues underpinning the problems of two public sectors in Great Britain, as well as on two articles on e-government initiatives. Information issues in the police and in the National Health Service; Challenges of e-government; Knowledge management in the public sector.

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]

Hadley and Hadfield (2006)1 discussed the steps being undertaken to launch a managed learning environment (MLE) in a large acute NHS Trust. The MLE was formally launched to a range of Trust staff in the spring of 2007. This paper considers the development of a formally classroom-based programme into one offering a blended approach. The Beacon Leadership programme chosen for this mode of learning is a high-profile course for clinical inter professional managers and aims to meet one of the key Trust objectives, to 'relentlessly improve patient experience and safety'. The programme has been developed in house and is only delivered to North Bristol Trust staff. This paper explores the development, instigation and evaluation of MLE use during the Beacon programme. [ABSTRACT FROM AUTHOR]

This article explores what role lawyers can play in contributing to learning from those incidents that result in a litigation claim. Specifically the authors consider what role the NHSLA has played and should be playing in improving patient safety. [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.

An introduction is presented in which the editor discusses articles in the issue related to patient safety regulation and technology in healthcare delivery, including Adam Darkin's article on practical implications of implementing telehealth services and Gordon Caldwell's paper on clinical leadership value.

This article reports on a study of local implementation in the UK Troubled Families Programme (TFP). Exploring the experiences of 12 families, the policies of local bureaucrats, and a critical reading of the literature, we argue that the local case represented an attempt to partially renegotiate disciplinary elements of the national programme and to recognise that the families were affected by structural poverty and inequality. Locating the TFP in the literature on disciplinary social policy, multi-scale 'Fast Policy' and the potential for local subversion through the agency of frontline workers, we suggest that the local attempts to renegotiate programme priorities were partially successful. These attempts were characteristic of 'contingent coping' in terms of both institutional processes and outcomes for the families involved. The evidence reported is significant and timely in the context of the expanded and relaunched TFP and this shapes our commentary on the recently published Improving Lives strategy. [ABSTRACT FROM AUTHOR]

Government reforms and restructuring of the NHS are hitting the headlines. But its policy on voluntary registration over statutory regulation has been largely overlooked -- and in the case of clinical physiology is a tragedy waiting to happen, according to Anne Burge, Chair of the Registration Council for Clinical Physiologists. [ABSTRACT FROM AUTHOR]

This article (written in April 2013) considers the observations and recommendations made in the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry as to a duty of candour and, in particular, the recommendation that there should be a statutory duty of candour imposed on healthcare providers, as well as on registered medical practitioners, nurses and other registered professionals, who believe or suspect that patient treatment or care has caused death or serious injury. The article details the Government's initial response to such recommendations, in which it indicated an intention to introduce a statutory duty for health and care providers, and sets out the contractual duty of candour that is currently included in the NHS Standard Contract for 2013/14 (SC35). There is then an analysis of the terms of the contractual duty contrasted with those of the proposed statutory duty; a look at the limitations of the contractual duty; a discussion of some of the issues that may arise in relation to when the relevant duty (either contractual or statutory) will be triggered; a consideration of the apparent novelty of a statutory duty of candour in English law; and a brief discussion in relation to the potential remedies, penalties and offences that may be adopted if such a statutory duty comes into force. In conclusion, on any basis the imposition of the contractual duty of candour and the intention to introduce some form of statutory duty heralds a new era in relation to candour in healthcare. [ABSTRACT FROM AUTHOR]

Medical authorities have historically either been silent or circumspect about the role of candour in clinical relationships. Hippocrates told doctors to abstain from doing harm, not entertaining the possibility that they might be negligent, while in 1847 the American Medical Association declared that doctors have: ‘a sacred duty … to avoid all things which have a tendency to discourage the patient and depress his spirits’. Being candid about an injurious mistake in the course of treatment would no doubt discourage even the worldliest of 19th century patients. However, in recent years, the focus has shifted: doctors in 21st century have an obligation to disclose even the most depressing of mistakes. This modern ‘duty of candour’ is found in a mish-mash of moral principles, regulatory guidelines and contractual agreements but following the Francis Report it will be buttressed by statute. [ABSTRACT FROM AUTHOR]

The article presents several case studies related to maternity claims. It states that in one of the cases a sonographer wasn't able to identify fetal bladder and later the baby was born with bladder exstrophy. It mentions that in another case a woman claimed disabling fecal incontinence due to a third-degree tear during delivery. It highlights that in another case a woman claimed that she was not advised properly by a hospital about uterine rupture due to labor induction.

Allegations of poorly performed circumcisions may arise as negligence claims, civil claims or a professional (General Medical Council [GMC]) matter. This article explains the various types of circumcision, including those done for religious purposes, and attempts to provide an understanding of the issues relating to claims. The writer is a medicolegal expert (Accident & Emergency Consultant) who trained in surgery and for over 25 years has performed neonatal circumcision for religious purposes (usually in the home), child circumcision and adult circumcision. He has provided reports for both claimant and defendants, in negligence claims, civil claims and GMC proceedings. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses approaches to improve patient care such as continuing education and training for clinicians, competence-based training programmes, and inter-organizational learning.

The article discusses a case involving negligent aesthetic surgery. The surgery took place in a Belgian clinic and was performed by an Italian surgeon. [ABSTRACT FROM AUTHOR]

This piece has been written in response to a recent article published in the Times Higher Education Supplement (THES) which exposed the red tape restricting health research in the UK's National Health Service (NHS). Whilst the THES article was critical of NHS ethical review and research governance, it still views a streamlined version of the process as necessary for the protection of researchers and respondents. Drawing on the recent experience of applying for ethical approval and research governance for a qualitative study on gender and genetics, this paper examines the review process and the restrictive paperwork and procedures that surround it, focusing in particular on the impact this has on social science research. The argument will be put forward that while all research, whether clinical or social, is hampered by the bureaucracy surrounding the review process, social research is further alienated by it. This is because the paperwork and processes involved are set up to evaluate clinical, not social, research. Furthermore, the process is caught up in a culture of fear that breeds mistrust towards ‘outsiders’ wishing to conduct research in the NHS. The revision of NHS ethical review has to go further than mere bureaucratic streamlining - it needs to be made more relevant and accessible to health researchers working across a range of disciplines. [ABSTRACT FROM AUTHOR]

Despite the growing body of medical literature and numerous case reports relating to NHS liability for failing to prevent cauda equine syndrome, Claimant Clinical Negligence Solicitors are still being instructed in relation to numerous cases arising from the same mistakes being made by clinicians. This article contains a digest of case reports concerning cauda equina syndrome together with medical literature and a summary of learning points. [ABSTRACT FROM AUTHOR]

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]

Objectives To evaluate the effects on clinical outcome of dictating correspondence in front of patients and sending them copies of letters. Design Observational study of the practices of two consultants, one of whom (RDS) routinely dictated letters in front of his patients and almost always sent them a copy while the other (AM) did neither. Questionnaires were completed anonymously by patients at the end of their consultation. Setting Neurology department of a teaching hospital. Participants Patients attending neurology outpatient clinics. Results Seventy-two percent and 62% of the two consultants' patients were audited, and the demographic features of the two groups were similar. Eighty-six percent and 25% of RDS's and AM's patients, respectively, said that they wished to be present during dictation (p< 0.001). Within AM's group, those who had had some experience of the practice (with other consultants) were more likely to express a desire to be present during dictation (p = 0.023). Ninety-two percent and 77% of RDS's and AM's patients, respectively, felt that having a copy of their letter would be 'very useful' or 'useful' (p < 0.001). The perceived usefulness of receiving a copy letter and the desire to be present during dictation were associated for the total group and for RDS's patients. The two groups of patients were asked to express their degree of understanding at the end of the consultation, and 81% and 93% of RDS's and AM's patients, respectively, thought that their understanding was 'excellent' or 'good'. No trends emerged with regard to patients' preferences (to be present or absent during dictation and to receive or not receive a copy of their letter) and their level of understanding. Conclusions Patients appear to like being present when their letters are dictated, and appreciate receiving copies of these, but their overall understanding is seemingly independent of these variables. The success of the clinical consultation is probably influenced by numerous factors, and the elevation of patients' presence during dictation of correspondence and receipt of copy letters above all others seems unjustified. [ABSTRACT FROM AUTHOR]

Objectives To describe the plans of English NHS hospitals to implement ePrescribing systems. Design and setting Questionnaire-based survey of attendees of the National ePrescribing Forum. Participants A piloted questionnaire was distributed to all NHS and non-NHS hospital-based attendees. The questionnaire enquired about any completed or planned implementation of ePrescribing systems, the specific systems of interest, and functionality they offered. Main outcome measures Estimate of the number of NHS Trusts planning to implement ePrescribing systems. Results Ninety-one of the 166 questionnaires distributed to NHS hospital-based staff were completed and returned. Of those, six were incomplete, resulting in a total usable response rate of 51% (n=85). Eightytwo percent (n=46) of the 56 Trusts represented at the Forum were either 'thinking of implementing' or 'currently implementing' an ePrescribing system, such as Ascribe (13%, n=7) and JAC (20%, n=11). Forty percent (n=22) of respondents specified other systems, including those procured by NHS Connecting for Health e.g. RiO, Lorenzo and Cerner. Knowledge support, decision support and computerized links to other elements of patients' individual care records were the functionalities of greatest interest. Conclusion There is considerable reported interest and activity in implementing ePrescribing systems in hospitals across England. Whether such developments have the desired impact on improving the safety of prescribing is however, yet to be determined. [ABSTRACT FROM AUTHOR]

Over five years, the Global Trigger Tool (GTT) has been used to measure harm events on random case-notes at the Luton & Dunstable Hospital. The GTT has been adapted to a District General Hospital governance setting within the National Health Service. Overall, serious harm levels have diminished, though increased instances of more minor harm indicate that further improvements need to be made. [ABSTRACT FROM AUTHOR]

The article presents a study on stillbirth claims caried out by Great Britain's National Health Service (NHS) Litigation Authority (NHSLA) and Det Norske Veritas (DNV) in 2009. It highlights the study's background, scope, and findings. Also included in the study is the findings related to stillbirth which include age of the mother, high-risk pregnancies, and mode of delivery.

During a Parliamentary debate on the NHS Redress Act, questions were raised about the supposed better success rates of specialist lawyers versus non-specialists in clinical negligence cases. As a result we decided to look at the statistical evidence, based on the case files of a large medico-legal practice of a consultant general surgeon. [ABSTRACT FROM AUTHOR]

The majority of women in the UK choose to be screened antenatally for the genetic condition Down's syndrome. However, the majority of these women are not given the test for Down's that has been recommended by the NHS. The recommended test is the most accurate and has other benefits, and should be readily available on the NHS to all women. Providing tests that are less accurate regrettably leads to more babies miscarrying and the risk of Down's being missed. This article aims to raise awareness of the problem and to consider the medicolegal issues. [ABSTRACT FROM AUTHOR]

Located within a debate about changing organizational forms and new workforce roles this article provides an analysis of policy attempts to modernize the healthcare workforce. Theoretically, the article draws upon sociology of professions literature to focus upon competition within and between professions that impacts upon new roles in the NHS for doctors, designed to combine specialist and generalist knowledge and cross organizational and professional boundaries. The article highlights that attempts by policy-makers to reconfigure the clinical workforce may be constrained due to attempts at occupational closure by more powerful professional groups and by associated concerns about professional identities. [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]

Within the last two and a half years, two cases have come before the High Court (and several others – Kingsberry v Greater Manchester Strategic Health Authority [2005] and Purver v Winchester & East Leigh Healthcare NHS Trust [2007] – have been settled) concerning the practice of 'trial of forceps'. Elsewhere in this issue, Martin Spencer QC discusses the legal aspects of those cases. The purpose of this article is to explore the origin and the rationale of the practice, and to set out details of the procedure. [ABSTRACT FROM AUTHOR]