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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]

This paper examines the development of electronic health records within the National Health Service (NHS) by an analysis of a series of pilot projects funded by the Electronic Record Development and Implementation Project (ERDIP), one aspect of the work of the NHS Information Authority (NHSIA) (As of 1 April 2005, the NHSIA ceased to operate. Much of its work is continued by Connecting for Health and the Health and Social Care Information Centre.) The focus of the analysis is on the extent to which identifying and correcting error within health records was explored through these projects. The inherent potential for error and resultant impact on patient safety is highlighted, by considering the context of the record, the content of the record and the process of change from paper-based or piecemeal electronic health records to integrated electronic health records. While the process of change highlights issues of data security and access, it is the variability in starting points for different organizations that possibly poses most risk to patient safety. Issues relating to the content of the record can to some extent be minimized by the effective use of technology, but the tension between coding and qualitative data requires further consideration in terms of its impact on patient safety. This paper concludes that the development of electronic health records has to be viewed within the context of governance and patient safety, and the implications articulated. [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]

In this article the author comments on the various aspects of the National Health Service (NHS) reforms proposed by the government of Great Britain. It mentions that the government intends to reform the NHS in England based on the White Paper "Equity and Excellence: Liberating the NHS." It mentions the Challenge Committee, headed by the British cabinet's policy guru Oliver Letwin, formed in order to oversee developments. It also discusses the various objectives of the proposed reforms.

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]

There are substantial inequities within the current National Health Service (NHS), with people in lower socioeconomic groups (SEGs) using a wide range of services less relative to their needs than people in higher SEGs. These inequities are likely to arise due to factors on both the demand and the supply side of the system. On the demand side, they could arise from differences in patients' beliefs, knowledge, costs, resources and capabilities. On the supply side, professional beliefs and attitudes, and risk selection or cream-skimming by providers may result in inequities. This paper discusses whether these factors are at play within the English NHS and analyses whether current policy to extend patient choice of provider is likely to reduce or increase these inequities. It shows that extending patient choice may leave unchanged inequity due to differences in health beliefs (because choice does not affect these directly), increase inequity due to unequal resources (because patients may have to travel further), and decrease inequity due to unequal capabilities (because the poor will have access to a new and, for them a more effective, source of leverage over health service professionals). On the supply side, there will be little change. The paper then discusses policy options for dealing with factors that contribute to greater inequity on the demand side. It proposes a package of supported choice whereby individuals from lower SEGs would receive assistance in making choices, including an identified key worker to act as patient care adviser and help with transport costs. The paper concludes that policies for extending patient choice can enhance equity – so long as they are properly designed. [ABSTRACT FROM AUTHOR]

This paper focuses on one global aspect of the current health sector workforce policy agenda – the international recruitment and migration of health workers. It does so primarily by using a case study of the recruitment of nurses to the UK, as a means of exploring the policy challenges and associated research questions. The paper highlights the limitations in comparing national data on the nursing workforce, illustrating the extent to which currently collated national data can present a misleading picture of staff:population ratios in different countries. It then reports on the significant growth in the numbers of nurses entering the UK from other countries, using registration data. In 2001/02, more than 16 000 nurses entered the UK nursing register from non-UK sources. In this year, for the first time, the number exceeded the number of home-trained nurses. An analysis of postcode data highlights that these non-UK nurses have a younger age profile than home-based registered nurses and are more likely to report a postcode in London and south-east England. The paper also examines the push and pull factors that contribute to the international mobility of health workers. The paper concludes by examining the policy implications of this growing reliance on international recruitment, including the effect of the ethical guidelines on international recruitment introduced by the Department of Health in England. [ABSTRACT FROM AUTHOR]

NHS research governance makes it almost impossible to collect certain kinds of data on the everyday life of hospitals and the experience of patients. Fortunately, those of us who get sick enough to be admitted can write about the experience without fear of regulation. This paper presents some observations on clinical ethics, ward organization and infection control that would have been difficult to obtain in any other way, but which illustrate the policy and information costs of the present system. While not personally recommending this as a research strategy, the paper identifies a growing evidence gap and comments on its implications for the delivery of humane and well-organized care. [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]

Delayed hospital discharges have been identified as a problem for the English National Health Service and have prompted several policy and service development responses in the last decade. However, bedblocking is an issue surrounded by rival interpretations on how and why hospital delays occur and the way in which they are measured. To better understand this contested concept, this paper provides a brief description of the historical accounts that framed the emergence of delayed hospital discharges as a phenomenon. Three key features of the bed-blocking concept are also analysed: the reduction of patients' length of stay to improve efficiency, the intrinsic methodological difficulties of measuring hospital delays and the most common reasons for delayed discharges. A description of the characteristics of the patients frequently labelled as delayed discharge, their common traits and how these have been examined by previous research is also provided. Finally, this paper argues that the presence of hospital delays in a health system tends to be considered as an indicator of two possible system inefficiencies: a failure in the discharge planning process, which generally blames social services departments for not ensuring timely services, or a shortage of alternative forms of care for this group of patients. [ABSTRACT FROM AUTHOR]

Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organizing genetics provision increasingly inappropriate. In common with a number of developed world countries the UK has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organizational boundaries and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into 'mainstream' clinical provision in the National Health Service. Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted. Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding. Conclusions: More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized. [ABSTRACT FROM AUTHOR]

Objective: To review systematically randomized trials (RCTs) on the effectiveness and costs of paediatric home care. Methods: National Health Service (NHS) Centre for Reviews and Dissemination guidelines were followed. In all, 20 electronic and other sources were searched, using specially designed strategies. Economic studies and other selected designs were included, but only RCT findings – on service use, clinical outcomes, costs, and impact on the family – are reported here. Analysis is descriptive, with pooled standard mean differences used where meta-analysis was possible. Results: About 1730 identified records up to August 2001 were potentially relevant. In all, 10 RCTs (24 papers) were finally included, covering five types of paediatric home care – for very low birth weight or medically 'fragile' infants, for asthma or diabetes, for technology-dependent children, for mental health, and generic home care. Paediatric home care may enhance physical and mental development for very low birth weight infants and may be cheaper but the evidence is not strong. Home care for diabetes or asthma may reduce parents' costs with some clinical but no social differences noticeable. No randomized trials for technologically dependent children were found. Home care for mental health may increase parental satisfaction with services and reduce some health service and residential care costs. Generic home care showed no clinical effects at early follow-up. Partial follow-up after five years suggested improved psychological adjustment. No cost data were available for this care model. Conclusions: Despite recent expansion, research evidence from randomized trials for paediatric home care is slight, and methods used are weak in places. Paediatric home care poses practical and ethical questions that cannot be addressed by RCTs. [ABSTRACT FROM AUTHOR]

Government reform of the NHS in the UK has sought to increase the involvement of doctors (clinicians) in hospital management. Using frameworks from the psychological contract and organisational misbehaviour literatures, this paper examines the processes involved when clinicians assume management roles. This literature seeks to explain breaches to expectations regarding prior agreements with management and subsequent actions of 'getting even' as a result of breaches to the employment relationship. A qualitative methodology using interviews was undertaken, which identified two distinct groups of clinician–manager. Investors actively pursued a management opportunity as an alternative to clinical medicine, whilst reluctants tended to assume a management role to protect particular specialities from outside influence or from those they thought would be inappropriate clinician–managers. Investors and reluctants often had very little prior experience of management and managers and had problems reconciling their dual clinician–management role. Poor relationships with hospital managers who often had no understanding of their dual responsibilities led to tensions and conflict, which questions continued developments in this important area of UK health policy. Suggestions for improving this process are outlined. [ABSTRACT FROM AUTHOR]

The British NHS faces major challenges recruiting, motivating and retaining staff in a period of sustained growth and change. This paper examines the prevalence of skill shortages and organisations' coping strategies, as well the factors that motivate staff in the workplace and in the NHS in particular. It argues that the evidence base for informed policy-making needs radical improvement. It then considers a number of approaches to pay that are being used or suggested to attract, motivate and retain staff. These include performance pay, team pay and local pay determination, as well as considering broader factors such as morale and staff development. The paper then draws together some conclusions for policy-makers. These argue that better evidence is needed as to what is happening in the public sector labour market in order to frame appropriate responses and that thorough evaluation of policy initiatives is necessary to establish their utility before their widespread implementation. [ABSTRACT FROM AUTHOR]

This article considers how specialist hospital services in the UK fared under Conservative health policy, with its emphasis on market-like arrangements, and what looks likely under the New Labour era, where new shibboleths (cooperation, quality, etc.) supposedly are in place. There appeared inherent in the Conservative health policy threats to specialist services from local competition, and purchaser agendas for local health needs of equity and prioritization. Moreover, small providers grappled with costs and the bureaucracy engendered by market-like arrangements and with their inability to make economies of scale. From the policy rhetoric since the New Labour election victory of May 1997, one might expect such specialist services to be 'coming in from the cold', but the reality seems quite different. In particular, this paper will outline the policy context for specialist providers for the period in the 1990s when the Conservative government undertook to reform the NHS. We also, through the Unit that is the subject of the case study, examine the actual effects of those reforms on this specialist service. Finally, we reflect further upon the resonances for specialist services in the New Labour era that can be gleaned from the case study. [ABSTRACT FROM AUTHOR]

The article presents the comments and answers of Jennifer Dixon to the issues raised by Elizabeth Murray on her essay. Dixon reiterates that her paper was focused on reduced unavoidable emergency admissions for the policies of the National Health Service system in Great Britain. She agrees on Murray that there are similar arguments for public health initiatives but points out that the most practical reason in designing health reform is to present economic arguments focusing on raising incentives.

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]

The National Health Service Staff Survey is an annual, England-wide survey of staff employed by National Health Service organisations. It is administered using online and paper questionnaires. Response rates have fallen over time, while the proportion of staff receiving the online version – which historically has a lower response rate – has increased. Three interventions to increase online response were tested using an experimental design: more reminders; change of signatory to the invitation to participate and concise messaging in the invitation. Thirteen thousand staff members in five National Health Service trusts received the online survey. Results were analysed using contingency tables and logistic regression to determine the effect of interventions independently and in combination. More reminders improved response by six percentage points (odds ratio 1.33, 95% CI 1.23–1.43) and concise messaging by two percentage points (odds ratio 1.08, 95% CI 1.00–1.17). Change of signatory had no statistically significant effect and neither did any combination of the interventions. Given that costs for the successful interventions were minimal, more reminders in combination with concise messaging are recommended as a strategy to improve online response to the survey. [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]

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]

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]

The Corporate Manslaughter and Corporate Homicide Act 2007 establishes the statutory offence of corporate manslaughter, replacing the previous common law corporate liability for manslaughter. Health-care providers are potentially liable. This includes, but is not restricted to, National Health Service bodies. This paper considers the hypothetical liability of the various bodies involved in a well-known case of death arising from medical error, had the Act been in force when it occurred. The discussion illustrates the likelihood of difficulty in establishing liability. This difficulty arises not only from the requirements of the Act but also the involvement of several different bodies in the facts and circumstances of the fatal mistake. There are implications for a National Health Service whose future is likely to include greater fragmentation of service provision, with a greater number of corporate providers. Successful prosecutions for corporate manslaughter are expected to remain rare. [ABSTRACT FROM AUTHOR]

As Britain's population ages, health- and social-care systems face the challenge of continuing to provide high-quality care in the face of increased demand on services. Government policy has proposed meeting this challenge through integrated partnership working to enable people with complex, multiple needs to receive timely care closer to home. Co-morbid mental health needs, including dementia, are common in people with physical health issues, and must be addressed appropriately if systems are to provide the best possible all-round patient care. This paper describes how two senior clinical psychologists have developed an embedded living mental health resource within physical health care, and demonstrates how this has directly and positively impacted on both service performance indicators and patient experience. [ABSTRACT FROM AUTHOR]

In recent years, the English NHS has achieved substantial reductions in waiting times for hospital treatment. This paper considers first whether the data used by the Government provide an accurate description of changes in waiting times and identifies some of the limitations of the measures used. It then attempts to identify how reductions have been achieved. It argues that some features of central government policy have been important - such as the use of targets - others, such as the introduction of new private sector capacity have not. It also shows that changes at local level have been critical to achieving the recorded improvements, but the precise impact of these is hard to identify. [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]

Situation Reports (SitReps) is an internal Department of Health performance data collecting system. Although intended primarily for internal use, the data are also used to answer parliamentary questions, brief ministers and to inform national performance indicators. This paper reviews the data collection system and data-set, and shows how it can be used to evaluate delays in hospital discharge under the Community Care (Delayed Discharges etc.) Act 2003. However, limitations in the data include the fact that the data have only recently been extended to National Health Service (NHS) non-acute settings and do not include NHS patients in the private acute sector. Further, as the data-set derives from a weekly aggregate return rather than from individualized person-based records, it cannot be used to evaluate length of delay, or to link to other relevant data such as emergency readmissions. The provision of individualized data to facilitate linkage and extending coverage would increase its potential future use. Categories of delay should be further refined to facilitate monitoring of delays due to disputes about eligibility. [ABSTRACT FROM AUTHOR]

The extent to which clinical and public health guidance developed by the National Institute for Health and Clinical Excellence (NICE) can effectively serve the public by improving quality and efficiency across the National Health Service (NHS) and the broader public sector depends largely on the quality and relevance of the available evidence which informs its decisions. There are well-established organizational and procedural links between NICE and academic and professional organizations that undertake evidence synthesis. However, there are fewer means for evidence gaps identified during the development of NICE guidance to lead to the commissioning of new prospective studies. In this paper, we discuss the importance of a publicly funded clinical and public health research agenda that includes new prospective studies aimed at addressing knowledge gaps identified by NICE. We describe the early experience of NICE and the National Institute for Health Research (NIHR) working together to articulate and commission research to inform best practice recommendations. We propose ways in which NICE can collaborate more effectively with research funders to improve the evidence base upon which it bases its recommendations. [ABSTRACT FROM AUTHOR]

Despite the criticality of nurse rostering practices, there is a surprising lack of attention paid to this managerial activity both in practice and in the health-service management literature. This paper reports the results of an inductive, empirical study of rostering practices in the UK National Health Service with a view to developing a shared understanding of roster planning processes and of what constitutes rostering effectiveness. A survey of rostering practices in 50 wards, followed by five in-depth, longitudinal case studies, revealed the complexity of rostering activities, and identified the main design parameters, which were used to specify rostering systems and to prepare periodic rosters. Rostering activities were perceived to directly impact upon service delivery, resource utilization and nurse retention. A number of poor rostering practices were identified, which could lead to dysfunctional behaviour. This analysis points to a clear managerial imperative to improve local competencies in roster planning and control, recognizing their strategic significance in contributing to hospital effectiveness. A 'Strategic Roster Planning and Control (SRPC)' model is proposed, which may provide a framework for evaluating rostering effectiveness, and a platform for the sharing of best practice, in order to stimulate organizational learning and achieve nationwide improvements in hospital performance. [ABSTRACT FROM AUTHOR]

Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere. [ABSTRACT FROM AUTHOR]

Labioplasty is a surgical procedure performed to alter the size and shape of the labia minora. The reasons for women requesting this procedure remain largely unknown and recently girls and young women under the age of 18 years have been requesting this type of surgery. This paper examines the ethical acceptability of performing this procedure on under 18s. We will first discuss whether labioplasty can be considered to be a therapeutic technique. We will claim that, while it is difficult to offer a definitive definition of what constitutes a therapeutic technique, in our view labioplasty cannot be considered as such. This conclusion has relevance for the ethical acceptability of the procedure, its legal status in regard to the Female Genital Mutilation Act and the debates over who can give consent for it. It will be concluded that in our current state of knowledge, the benefits of labioplasty are far from clear, whereas the harms are demonstrable and therefore this procedure should not be offered to those aged under 18 years. [ABSTRACT FROM AUTHOR]

Introduction: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and 'modernizing' project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. Methods: Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. Results: The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses. Conclusion: Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and 'sold' to the nursing profession as enhancing its status compared with medicine. [ABSTRACT FROM AUTHOR]

The paper reports the results of a study on benchmarking activities undertaken by the procurement organization within the National Health Service (NHS) in Scotland, namely National Procurement (previously Scottish Healthcare Supplies Contracts Branch). NHS performance is of course politically important, and benchmarking is increasingly seen as a means to improve performance, so the study was carried out to determine if the current benchmarking approaches could be enhanced. A review of the benchmarking activities used by the private sector, local government and NHS organizations was carried out to establish a framework of the motivations, benefits, problems and costs associated with benchmarking. This framework was used to carry out the research through case studies and a questionnaire survey of NHS procurement organizations both in Scotland and other parts of the UK. Nine of the 16 Scottish Health Boards surveyed reported carrying out benchmarking during the last three years. The findings of the research were that there were similarities in approaches between local government and NHS Scotland Health, but differences between NHS Scotland and other UK NHS procurement organizations. Benefits were seen as significant and it was recommended that National Procurement should pursue the formation of a benchmarking group with members drawn from NHS Scotland and external benchmarking bodies to establish measures to be used in benchmarking across the whole of NHS Scotland. [ABSTRACT FROM AUTHOR]

The recent acute budgetary pressures within the English National Health Service (NHS) have accentuated calls for targeted disinvestment thereby eliminating ineffective or low-value services to provide resources that can be reallocated toward more cost-effective purposes. This challenge extends beyond allocating new resources wisely, a goal that has been, since its inception, the primary focus of the National Institute for Health and Clinical Excellence (NICE). But on 6 September 2006, the Department of Health announced a new mandate for NICE to help the NHS identify interventions that are not effective. This paper discusses current NICE efforts to support value in the NHS and then explores the policy options available to the Institute as it prepares to launch a programme to meet the NHS request for guidance on disinvestment. All of the possible options present challenges. NICE will need to collaborate in new ways with partners inside, and perhaps outside, the NHS. However, the Institute has an established reputation for rigour, transparency and political durability that makes it well qualified to sustain public support in the face of difficult decisions. Disinvestment will provide a stern test of these qualities. [ABSTRACT FROM AUTHOR]

The importance of collaborative practice between those who provide services to children with special educational needs is now regarded as essential and is supported strongly by the UK government. However, joint working is often difficult to implement, despite the goodwill of all involved. This paper describes a pilot study aimed at developing collaboration between a local education authority and a National Health Service (NHS) Trust. It reports on the results of the evaluation and discusses aspects of the project that facilitated collaborative working between the various parties involved. [ABSTRACT FROM AUTHOR]

The UK National Health Service (NHS) is facing recruitment challenges that mean it will need to become an 'employer of choice' if it is to continue to attract high-quality employees. This paper reports the findings from a study focusing on allied health professional staff (n = 67), aimed at establishing the expectations of the NHS inherent in their current psychological contract and to consider whether the government's drive to make the NHS a model employer meets those expectations. The findings show that the most important aspects of the psychological contract were relational and based on the investment made in the employment relationship by both parties. The employment relationship was one of high involvement but also one where transactional contract items, such as pay, were still of some importance. Although the degree of employee satisfaction with the relational content of the psychological contract was relatively positive, there was, nevertheless, a mismatch between levels of importance placed on such aspects of the contract and levels of satisfaction, with employees increasingly placing greater emphasis on those items the NHS is having the greatest difficulty providing. Despite this apparent disparity between employee expectation and the fulfilment of those expectations, the overall health of the psychological contract was still high. [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]

Objective: Delayed hospital discharges are a key concern in a number of industrialized nations and are the subject of a range of government initiatives in the English National Health Service. The aim of this paper was to review the UK literature on delayed hospital discharges and older people in order to identify and explore the rate and causes of delayed hospital discharges, together with policies and practices that may reduce delayed discharges and improve the experiences of older people. Methods: Literature review based on searches of major health/social-care databases. Sources which explore the rate and cause of delayed discharges in the UK were included. Relevant documents were categorized using the research hierarchy set out in the National Service Framework for Older People and analysed according to criteria for appraising the quality of qualitative research proposed by Mays et al. Results: The review identified 21 studies, which suggest very different rates and causes of delayed discharge in different settings. The studies reveal the importance of rehabilitation services to reduce the rate of delayed discharge, the prevalence of delayed discharges caused by internal hospital factors, and the complex and multi-faceted nature of the factors contributing to delayed discharge. Despite this, the studies have a number of methodological flaws and often fail to include a patient perspective or to consider detailed policies and approaches to reduce the number of delayed discharges. There is also a failure to consider the needs of older people with mental health problems or people from minority ethnic communities. Conclusion: The evidence, as it currently stands, raises a number of issues about current hospital discharge policy, supporting some aspects of the current government agenda in England, but questioning other aspects. [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]

In this paper, I aim to re-establish the meaning and importance of the concept of 'evidence-based policy making' (EBP) in health care. The term EBP is often misunderstood as being either vacuous (who thinks that public policy should not be based on evidence?), unrealistic (the naive product of ivory tower thinking) or conservative (an excuse permanently to delay reform). It need be none of these things. EBP should be thought of as a set of rules and institutional arrangements designed to encourage transparent and balanced use of evidence in public policy making. As well as controlled trials and observational studies, a broad range of theoretical and empirical evidence about human behaviour may be relevant to predicting policy outcomes - including stakeholder opinions and other sources of intelligence that might not qualify as scientific research. Gradual progress towards EBP, properly understood, has the potential to facilitate open democracy and to improve policy outcomes. The argument is illustrated using examples based on large-scale policies of health care reform in England, where progress towards EBP over the last decade has been real but modest. [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]

The NHS has experienced a significant amount of organisational change and restructuring, which has included numerous mergers and de-mergers, since the Labour party came to power in the UK in 1997. However, to date there has been little in the way of evaluation of such changes, particularly the impact of organisational restructuring on the staff involved. This paper examines the human aspect of a merger, and subsequent de-merger, within a primary care trust (PCT) in the North of England, using a focus group methodology. The findings demonstrate that leadership and management styles have a significant impact on staff experiencing such changes. In addition, the psychological contract can be damaged due to the impact of several factors, inducing exit or intention to leave. Employees experienced a constant cycle of change with little time for stabilisation or adjustment, leading to negativity and lowered motivation at times. [ABSTRACT FROM AUTHOR]

Explicit priority setting in healthcare, which often involves multiple criteria and value judgements, has come to prominence in a number of different healthcare systems over the past decade. Drawing on the results of a survey of priority setting in practice in the UK National Health Service, this paper analyses issues associated with quantification in priority setting, focusing on techniques for eliciting and aggregating values, the criteria and form of models used and their application in priority setting. The findings reveal a clear focus on equity, a strong concern to demonstrate openness, consistency and transparency in priority setting—leading to greater use of explicit multi-criteria models—and a notable focus on the quality of 'evidence'. However, reported difficulties in weighting over-long lists of non-commensurate and overlapping criteria, the inclusion of inappropriate criteria, and attributes of the form of models employed, lead to the conclusion that the implications of the methods are not always appreciated, the resulting priority 'scores' sometimes misunderstood and, in some cases, the concern for transparency and explicitness appears to outweigh concern for methodological understanding—leading to an illusion of transparency. [ABSTRACT FROM AUTHOR]

The tendering process has become the dominant and now traditional approach to the allocation of research and consultancy projects. This is largely built around the notion that it ensures accountability and probity within the allocative procedure, and that high quality of work and 'value for money' are the outcomes. It appears to have become an institutionalized and unchallengeable process. Yet it is rarely costed in terms of the true resource implications for all the organizations involved, nor is quality assessed in terms of alternative processes that might be employed. This paper explores the tendering process in terms of factors that may suggest that the quality of work produced via the tendering process is not always as good as it might be. Also in a hypothetical example involving the university sector and the National Health Service, data are presented indicating that the overall cost to the public sector is often actually greater than the value of the contract being allocated. An alternative preferred provider relationship-based allocative process is advocated as an improvement to the current established tendering procedure. [ABSTRACT FROM AUTHOR]

The problems associated with hospital-acquired infection have been causing increasing concern in England in recent years. This paper reports the results of a nationwide survey of hospital infection control professionals' views concerning the organizational structures used to manage and obtain funding for control of infection. A complex picture with significant variation between hospitals emerges. Although government policy dictates that specific funding for hospital infection control is formally made available, it is not always the case that infection control professionals have adequate resources to undertake their roles. In some cases this reflects the failure of hospitals' infection control budgetary mechanisms; in others it reflects the effects of decentralizing budgets to directorate or ward level. Some use was made of informal mechanisms either to supplement or to substitute for the formal ones. But almost all infection control professionals still believed they were constrained in their ability to protect the hospital population from the risk of infectious disease. It is clear that recent government announcements that increased effort will be made to support local structures and thereby improve the control of hospital acquired infection are to be welcomed. [ABSTRACT FROM AUTHOR]