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Focuses on Great Britain's White Paper on Public Health document entitled "Choosing Health White Paper," led by Health Secretary for England John Reid. Focus of the document; Opinion of the mental health organizations on the subject of the document; Statement of Angela Greatley, chief executive at the Sainsbury Center for Mental health on the prevalence of the document.

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, small-scale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2·4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose. [ABSTRACT FROM AUTHOR]

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this Health Policy paper, we look at the economic impact of the COVID-19 pandemic and historical spending in the UK and comparable countries, assess the role of private spending, and review spending projections to estimate future needs. Public spending on health has increased by 3·7% a year on average since the National Health Service (NHS) was founded in 1948 and, since then, has continued to assume a larger share of both the economy and government expenditure. In the decade before the ongoing pandemic started, the rate of growth of government spending for the health and care sector slowed. We argue that without average growth in public spending on health of at least 4% per year in real terms, there is a real risk of degradation of the NHS, reductions in coverage of benefits, increased inequalities, and increased reliance on private financing. A similar, if not higher, level of growth in public spending on social care is needed to provide high standards of care and decent terms and conditions for social care staff, alongside an immediate uplift in public spending to implement long-overdue reforms recommended by the Dilnot Commission to improve financial protection. COVID-19 has highlighted major issues in the capacity and resilience of the health and care system. We recommend an independent review to examine the precise amount of additional funds that are required to better equip the UK to withstand further acute shocks and major threats to health. [ABSTRACT FROM AUTHOR]

Background: Research nurses, midwives and allied health professionals are members of an important emergent profession delivering clinical research and, in the United Kingdom, have been the focus of considerable investment by the National Institute for Health Research (NIHR). This paper considers the experiences of research nurses, midwives and allied health professionals in relation to professional identity work, recognizing these are coproduced alongside others that they interact with (including patients, clinical staff and other research staff).Methods: Semi-structured interviews were conducted with 45 nurses, midwives and allied health professionals in the UK about their experiences of working in research delivery. Interviews were transcribed verbatim and thematically coded and analysed.Results: Our analysis highlights how research nurses, midwives and allied health professionals adjust to new roles, shift their professional identities and undertake identity work using uniforms, name badges and job titles as they negotiate complex identities.Conclusions: Research nurses, midwives and allied health professionals experience considerable challenges as they enter and transition to a research delivery role, with implications for their sense of professional identities. A change in the work that they undertake and how they are (or perceive they are) viewed by others (including clinical non-research colleagues and patients) has implications for their sense of professional and individual identity. The tensions involved extend to their views on symbols of professional identity, such as uniforms, and as they seek to articulate and demonstrate the value of their conjoined role in research and as a healthcare professional, within the unfolding landscape of health research. We embed our study findings in the context of the newly emerging clinical research practitioner workforce, which further exacerbates and complicates the role and identity complexity for nurses, midwives and allied health professionals in research delivery. [ABSTRACT FROM AUTHOR]

Background: Work stress and compassion fatigue are prevalent among healthcare staff and their negative effects on staff well-being and patient care are well-known. This paper reports on the implementation and evaluation of Schwartz Rounds® (Rounds) in UK healthcare organizations, predominantly part of the National Health Service (NHS). Rounds are one-hour, typically monthly, multidisciplinary forums during which clinical and nonclinical healthcare staff discuss the emotional and social demands of delivering patient care. The purpose of this research was to evaluate the effectiveness of Rounds attendance on the psychological distress, work engagement, compassion and self-reflection of healthcare staff.Methods: We used a pre-post control design to assess the effect of Rounds attendance across 10 UK healthcare organizations. This design was most appropriate given the voluntary nature of Rounds and ensured the study had ecological validity. Self-reported data were collected from attenders and non-attenders at baseline and at eight-months follow-up. The outcomes were psychological distress, work engagement, compassion and self-reflection.Results: During the 8 months' study duration, regular attenders (N = 51) attended Rounds on average 4 times (2-8). Attenders showed a significantly greater decrease in psychological distress (as measured with the General Health Questionnaire (GHQ)) than non-attenders (N = 233; odds ratio of 0.197; 95% confidence interval (0.047-0.823)). However, Rounds attendance had no significant effect on work engagement, compassion and self-reflection.Conclusions: Rounds attendance was linked to a 19% reduction in psychological distress adjusting for covariates. As an organization-wide intervention, Rounds thus constitute an effective, relatively low-cost intervention to assist staff in dealing with the demands of their work and to improve their well-being. [ABSTRACT FROM AUTHOR]

Campaigns against the privatisation of healthcare in the UK have often focused on saving, or preserving, the post-war National Health Service (NHS) of the 1950s. They talk of it as a 'national treasure', which has long given the UK some moral high ground over countries such as the United States. I argue that seductively simplified campaign slogans can also be blunt – they can carry with them more opaque messages such as those that encourage the maintenance of a patriarchal healthcare system. As a result, campaigns to save the NHS of the 1950s also preserve the nationalism, as well as the class and gendered staffing hierarchies, which (as I illustrate) come to reproduce inequalities in the care that is delivered. Through a multi-cited ethnography focused on the delivery of hip replacements in the NHS, I argue that a more complex form of political activism is needed to bring about the equality in healthcare that the NHS promises. In this paper, I flatten assumed hierarchies of power, to highlight some ethnographic examples of how everyday actions can come to reshape antiquated power structures. I conclude by suggesting we look to how power is pieced together across networks – and how we can re-locate collective agency to within and amongst ourselves to bring about a more equal, and less nationalistic, healthcare service. [ABSTRACT FROM AUTHOR]

The role of lifestyle on mental health in the ambulance worker population is unclear. The aim of this paper is to explore the role and impact of lifestyle on the mental health of ambulance workers within the United Kingdom (UK). Participants (N = 160) were recruited from 4 NHS ambulance trusts in England. Data were collected on lifestyle factors (sleep, physical activity and alcohol use) and mental health outcomes (trauma, anxiety, depression and stress); these were assessed by use of various questionnaires including validated measures. Sleep was shown to be the single biggest unique and significant predictor to all mental health outcomes. Suggestions for future research and intervention are considered. [ABSTRACT FROM AUTHOR]

The article suggests that the efforts of the British government to reform the National Health Service (NHS) are under threat from other factors that aim to hasten competition in the health service, according to the British Medical Association (BMA) in October 2010. As mentioned in the government's White Paper "Equity and Excellence: Liberating the NHS," reform efforts will allow more control to patients and frontline clinicians and promote stronger attention on public health. The other arguments of BMA are further explained by chairman Hamish Meldrum.

The article presents blogs from health care professionals on the 80 billion British pound National Health Service (NHS) commissioning budget and the white paper "Equity and Excellence: Liberating NHS."

Reports on the statement issued by practice nurses to express support to the government's white paper on public health in Great Britain. List of policies that would reinforce health promotion; Role of nurses in providing sexual health programs in primary care; Advantage of the creation of a national taskforce to increase the effectiveness of the British National Health Service Stop Smoking Services.

Provides information on the strategy of the National Health Service of Great Britain to manage its paperworks. Role of nurse managers in paperwork management; Practices that contributed to paper load in the agency.

This dissertation study investigates the ways that NHS libraries are currently marketing their services within their organisation and was submitted as part of the MA Library and Information Management at the University of Sheffield in 2019. This paper presents the findings from twelve semi‐structured interviews carried out with NHS library managers in the East of England to identify the most and least successful methods, and in comparison with that which is currently in the general marketing literature. The study found that outreach marketing was the most effective and that librarians are currently conducting marketing to the best of their ability, but they lack time and funding to be able to make the most of their promotional campaigns. F.J. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas' NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic. Methods: A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus. Results: Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths. Conclusion: Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes. [ABSTRACT FROM AUTHOR]

The article reports on a legal challenge launched by the British public service union Unison to the healthcare reforms proposed by the coalition government. The basis for the legal challenge was the failure of Health Secretary David Nicholson to consult the public on the plans. The union warned that the proposals would entail fundamental changes to the operation of the National Health Service (NHS) and that the public should be given an opportunity to comment on them. In response, the Department of Health claimed it is engaging fully on the issue.

Aims Recent UK legislation allows dental therapists or jointly-qualified dental hygienist-therapists to work in the general dental service. This study aimed to investigate the extent of dentists' knowledge of the clinical remit of jointly qualified hygienist-therapists, their willingness to consider employing such a professional, and factors associated with these two measures.Materials and methods A postal questionnaire was sent to 616 NHS-registered dentists in South-East Scotland. Analysis and classification of responses to open-ended questions used standard non-parametric statistical tests and quantitative techniques.Results Following two mailings, a 50% (n = 310) response rate was obtained. A total of 65% of dentists worked in a practice employing a dental hygienist, while only 2% employed a dental therapist. Hygienists tended to work in larger practices. Dentists' knowledge of the clinical remit of the dually-qualified hygienist-therapist was found to be limited, reflecting a restricted and inaccurate view of the professional remit of a hygienist-therapist. The majority (64%) said they would consider employing a hygienist-therapist in their practice, rising to 72% amongst dentists already working with a hygienist. Reasons given by dentists who were negative about this prospect were sought. Those who worked with a hygienist tended to refer to lack of physical space, whilst those who did not tended to cite reservations on clinical skills, competence and responsibilities, or on the costs involved.Conclusions This study identified considerable ignorance and negativity among dentists about the nature and clinical remit of this group of professionals. Dually-qualified hygienist-therapists will be in a position to treat much of the routine disease that exists within the population, and dentists may benefit from education in relation to the substantial contribution these individuals could potentially make to patient care. [ABSTRACT FROM AUTHOR]

After 13 years as editor of the British Medical Journal, Richard Smith is leaving to become head of the European arm of a U.S.-based health care company. Smith will link up with Simon Stevens, who is stepping down as British Prime Minister Tony Blair's senior health policy adviser, to run the new subsidiary of the UnitedHealth Group Inc. The company will help Great Britain's National Health Service (NHS) in providing patient care by commissioning at-home care for elderly patients and improving data management for clinicians and health care managers. Smith says the new company aims to strengthen the NHS by helping it coordinate health care services, although critics see Blair's reforms as a step toward privatizing British health care.

Focuses on the campaign against the white paper related to patient care in the National Health Service in Great Britain. Debate on the proposals by the British Medical Association council; Discussions on the letter from the chief medical officer; Implications of the white paper to professional awareness.

Focuses on the publication of the working papers of the National Health Service (NHS) in Great Britain. Renegotatiation of the contracts of general practitioners; Implementation of the NHS review; Role of the Department of Health in the distribution of the working papers to general practitioners.

The UK National Health Service (NHS) is changing. Consecutive UK industrial strategies have supported the shift from an NHS that provides free‐at‐point‐of‐delivery healthcare to one that also facilitates research. Said to promote healthcare's triple aim of 'better health, better healthcare, and lower cost' (Wachter, 2016, 3), the digitisation of patient records is a core part in opening routine aspects of the health system to potential research. In this paper, we thematically analyse 11 policy documents and ask, how does the NHS discuss its decision to digitise patient records and what are the implications of such practices on the citizen? We document how (1) digitisation is presented as a collective endeavour for patients and NHS professionals, offering new possibilities for patients to participate in their own health and that of the population through research and, (2) digitisation contributes to the building of an efficient health system. Through this analysis we reflect on how discussions of digitisation present uncritically the potential of Electronic Health Records and big data analytics to improve care and generate wealth through research, and reconfigure patienthood, by placing research participation as a routine part of accessing NHS healthcare. [ABSTRACT FROM AUTHOR]

Reports on the plans of the restructuring of the National Health Service (NHS) in Great Britain. Effects of the plans on health authorities, hospital managers and family doctors; Speculations of the changes on the NHS Management Board; Uncertainty of the decisions of NHS Chief Executive Duncan Nichol.

Presents the response related to the government's white paper proposals for the National Health Services in Great Britain. Scrutiny on the composition of self-governing hospitals and general practitioners' budgets; Interrelations of the program with two-tier system in the medical field; Need to prioritize primary care for elderly and the sick.

Focuses on the white paper negotiations of the General Medical Service Committee in Great Britain. Completion of the Health and Medicine Bill committee stage; Review of the long term funding of the National Health Service (NHS); Reference term of the prime minister on the internal review of the NHS.

Reports on professional organizations' welcoming of proposals in the December 1997 white paper on the National Health Service (NHS) in England. Promotion of clinical and cost effectiveness of treatments by the National Institute for Clinical Excellence; Support for the dismantling of the internal market; Need for more capital investments if services were to be improved.

In the UK mental health and associated NHS services face considerable challenges. This paper aims to form an understanding both of the complexity of context in which services operate and the means by which services have sought to meet these challenges. Systemic principles as have been applied to public service organisations with reference to interpersonal relations, the wider social culture and its manifestation in service provision. The analysis suggests that the wider culture has shaped service demand and the approaches adopted by services resulting in a number of unintended consequences, reinforcing loops, increased workload demands and the limited value of services. The systemic modelling of this situation provides a necessary overview prior to future policy development. The paper concludes that mental health and attendant services requires a systemic understanding and a whole system approach to reform. [ABSTRACT FROM AUTHOR]

The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to address the serious problems that people with intellectual disability face in getting their healthcare needs met in general hospitals by improving the training of general hospital staff. Design/methodology/approach - Review of recent developments in models of service provision including the development of intellectual disability liaison nurses and the RAID model in liaison psychiatry. Findings - There is much scope for intellectual disability liaison nurses and liaison psychiatry services to work together in staff training in general hospitals. There is a clear strategic role for both services in convincing the management of general hospitals to implement such training using economic and quality arguments. Originality/value - The authors suggest a new model of working to improve the healthcare outcomes of people with intellectual disabilities through effective training of staff in general hospitals. [ABSTRACT FROM AUTHOR]

Presents a letter for Health Secretary Frank Dobson pertaining to ideas on how to improve the National Health Service (NHS) in Great Britain. View on the machinery of the health authority; Suggestion on how to change the culture within the NHS.

Discusses the British government's ten year plan for the National Health Service on the . Focus of the programme; Key feature of the programme; Aim of the plan. INSET: Key components of the ten year plan....

Focuses on the medical issues presented at the meeting of the Association of Community Health Councils in Great Britain. Emphasis of John Patter, health minister on the services of physician to patients; Arguments related to pay awards initiated by the National Health Services; Controversies concerning termination of pregnancy practices.

In 2012 the UK media reported the results of a paper in the British Medical Journal Open, including the finding that hypnotics increase the risk of ‘premature death’. Taking this media coverage as a case study, the paper explores UK people's responses and assesses the implications for the debate about the (de)pharmaceuticalisation of sleep. Two hundred and fifty one posts to the websites of 6 UK newspapers were analysed thematically, along with 12 focus group discussions (n = 51) of newspaper coverage from one UK newspaper. Four thematic responses were identified: bad science/journalism, Hobson's choice, risk assessment and challenging pharmaceuticalisation. We found that most people claimed that the story did not worry them, even if they stated that they were using sleeping pills, and that focus group members generally appeared to respond in terms of their pre-existing views of hypnotics. The way in which lay expertise was drawn on in responding to the coverage was one of the most striking findings of the study. People referred to their own or others' experience of taking hypnotics to recognise the legitimacy of taking them or to weigh up the risks and benefits, as reflexive users. Overall, our case study cautions against making strong claims about the power of the media to legitimate de-pharmaceuticalisation. While the media may have such a role, this is in the main only for those who are receptive to such a message already. [ABSTRACT FROM AUTHOR]

How do we make a difference? This paper traces the connections made between quantified knowledge, population health, and social justice by examining the efforts of population scientists to assess sexuality as a point of difference within population-based data systems, including on national health and social surveys, electronic medical records, and the Census. Population scientists emphasize the importance of measuring social difference in order to identify and remedy structural disadvantage. This evaluation requires the assessment of difference and the comparison of distinct groups across standardized outcome measures. In quantifying social difference, however, population scientists obscure or minimize several difficulties in creating comparable populations. I explore some of these challenges by highlighting three central tensions: the separation of difference from other aspects and categories of social experience, the reduction of difference through the use of one over several possible measures, and the enactment of difference as quantified knowledge loops back into society. As a theoretical inquiry into the form of social difference as it is conceptualized, operationalized, and materialized across the science-society nexus, this paper identifies the various commitments made during processes of scientific evaluation. By attending to the values and priorities that exist within and through practices of quantification, I aim to address the problem of measuring social difference as it pertains to the issues of social justice and health equity. [ABSTRACT FROM AUTHOR]

The National Health Service in the United Kingdom categorises research and research-like activities in five ways, such as 'service evaluation', 'clinical audit', 'surveillance', 'usual practice' and 'research'. Only activities classified as 'research' require review by the Research Ethics Committees. It is argued, in this position paper, that the current governance of research and research-like activities does not provide sufficient ethical oversight for projects classified as 'service evaluation'. The distinction between the categories of 'research' and 'service evaluation' can be a grey area. A considerable percentage of studies are considered as non-research and therefore not eligible to be reviewed by the Research Ethics Committee, which scrutinises research proposals rigorously to ensure they conform to established ethical standards, protecting research participants from harm, preserving their rights and providing reassurance to the public. This article explores the ethical discomfort potentially inherent in the activity currently labelled as 'service evaluation'. [ABSTRACT FROM AUTHOR]

Ruth Smith's incisive and moving account of her experiences with orthodox psychiatry as delivered by the UK National Health Service sets the scene for this special section. She gives a detailed description of her own twelve years' experience as a Carer to her daughter, diagnosed with psychosis at age 24 years. She explains how they struggled to comply with the psychiatric services and cope with the, often traumatic, treatment provided to them. Clearly, we need to do better, but how? Smith explains how her study of critical texts and research papers on the subject helped to form her own critical viewpoint. [ABSTRACT FROM AUTHOR]

Background: The accessibility of services within community pharmacies provides an ideal opportunity to manage minor ailments, yet over £1.1 billion is spent by the National Health Service (NHS) in the United Kingdom (UK) in managing minor ailments in high cost settings. There is a need to review the evidence base around clinical effectiveness of pharmacy-based management of minor ailments since the absence of such may lead to under-utilisation of pharmacy services and non-implementation of available pharmacy service models. This study aimed to systematically review the methodological approaches used to assess clinical outcomes of pharmacy-based management of minor ailments in the research literature. Methods: A systematic review was conducted to identify relevant literature using the following databases: Medline, EMBASE, CINAHL, IPA, CRD, CDSR, and Google Scholar from publication year 2000 onwards. Studies were included if they evaluated clinical outcomes of pharmacy-based management of any minor ailments, with or without a comparator setting such as Emergency Departments (EDs) or general practices. Screening and selection of titles, abstracts and full texts followed by data extraction and quality assessment (QA) was conducted. Paired researchers, from the team, reviewed papers using a protocol based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). QA was undertaken using the Critical Appraisal Skills Programme (CASP). Reporting was conducted in accordance with PRISMA checklist and statements. Results: A total of 19 studies were included. The majority of studies were observational, conducted in community pharmacies, and did not use a comparator participant group nor a comparator setting. Interventions included counselling, medicines supply and provision of advice on the management of minor ailments. One study used the randomised controlled trial (RCT) design with majority of the study utilising observational design. A range of clinical outcomes including symptom severity, pattern, resolution, and quality of life were reported. Methods used for the assessment of clinical outcomes were, overall, poorly reported. This included a lack of information on the development and validation of the data collection tools and the timing of baseline and follow-up data collection. Adverse clinical outcomes data were collected by only seven studies. Conclusions: Currently, there are methodological limitations in the studies that have sought to assess clinical outcomes of pharmacy-based management of minor ailments. Such lack of high quality evidence may contribute to failings to shift care from high cost settings, such as EDs and general practices. Generation of high quality evidence is likely to influence public choices when seeking care for minor ailments. There is scope for development of a core outcomes set specific to minor ailments management and development of a validated methodology for measuring such outcomes in a research study. [ABSTRACT FROM AUTHOR]

This paper discusses the UK Government's public consultation into the NHS bursary and the response from the Nursing and Midwifery Council. A public consultation stipulated that the current arrangements for funding, by the State, were not to be considered for discussion. Instead, the consultation only appraised views that would lead to the successful introduction of student finance loans for NHS professional education. Testimonies from nurses, midwives and nursing students expressed concern that the new funding arrangements were unaffordable, dis-incentivising and biased towards the marketisation of student loans in the UK, yet the changes went ahead. The changes to NHS bursary funding resulted from the UK Government's desire for growth in student numbers (and ostensibly not growth in financial figures), and the fact that nursing (and other healthcare) students will become more fiscally indebted, despite society's moral obligation to them. [ABSTRACT FROM AUTHOR]

In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process. [ABSTRACT FROM AUTHOR]

The NHS Friends and Family Test (FFT) is the largest single source of patient feedback in the world, having collected over 75 million pieces of feedback since its introduction in 2013. It is traditionally collected using paper forms after a service encounter. COVID-19 caused enormous disruption and change to primary care services across the world, and also reduced the ability of patients to give feedback about their significantly altered services. This project looked at the introduction of virtual delivery of the FFT to patients in a primary care network. Feedback received by a primary care network from December 2019 to August 2020 was audited and compared to feedback received after the introduction of virtual FFT delivery via AccuRx software. Qualitative feedback from practice staff was collected regarding the implementation of the FFT. 61 pieces of feedback were collected per month on average prior to the introduction of virtual FFT collection across the network. Trial introduction of virtual FFT introduction in 3 practices which serve 54% of the network's patients also returned 61 pieces per month. Issues identified included patient accessibility, potential introduction of bias in feedback collection and unequal provision of FFT between centres within the network. Virtual FFT collection offers an effective and COVID-secure way for practices to improve their collection of FFT data, of particular relevance when performing distanced consultations. Virtual FFT collection will now be introduced across this network. Further development areas include improving language accessibility, and automation to reduce administrative burden of data collection and reduce bias. [ABSTRACT FROM AUTHOR]

The NHS is the most revered organisation in Britain: 'the proudest achievement of our modern society'.1 It is certainly the largest, although since its inception in 1948 it has operated in a government-funded environment of restricted resources. Nevertheless, it has also benefitted from a generally effective model of intervention centred on a hospital care system integrating specialist and emergency care and a primary care system which functions as both a source of treatment and a gatekeeper to specialist care. New circumstances, including environmentally-generated risk and a shifting disease reality, challenges the adequacy of this model. This paper argues that these new circumstances, some of which have seen a legislative response by government, mean that the NHS has to apply sustainable development thinking programmatically throughout its management and operations. It is also argued that the organisation needs to refocus towards prevention particularly in order to stem the rising tide of non-communicable disease. This paper sets out the thinking and actions of the Sustainable Development Unit, which has the task of developing and implanting sustainability concepts in the NHS. It is argued that the cause of sustainable development calls for a mix of cultural and technological shifts, new incentives and a rolling programme of innovative change. Some examples of success are presented. [ABSTRACT FROM AUTHOR]

The UK's publically available blood stem cell infrastructure has undergone significant transformation in recent years as umbilical cord blood has joined adult donors as a viable clinical stem cell source. This paper describes the development of a collaborative governance arrangement between the UK's two domestic providers of blood stem cells: a public body and a charity. The paper argues that the collaborators, who stand to benefit from the alignment, legitimize their work through appeals to public good. It suggests that appeals to buy British obscure an inevitable requirement to cultivate international, networked stem cell exchange; the paper also explores collaborators' reinforcement of a supposed connection between human leukocyte antigen tissue type and ethnicity through claiming that the UK's ethnic minorities face an “unmet need.” By way of this, the paper demonstrates the interconnection of collaborators' institutional interests with concerns for national health equity. [ABSTRACT FROM PUBLISHER]

The author argues that the National Health Service (NHS) in Great Britain needs general practitioners (GP) who are focused on patient-centered values. He emphasizes the role of GP in providing high quality care. He claims that the GP leaders needed by the NHS are those who are motivated to improve patient care and those who are committed to care for individual patients. The author also suggests ways in which GP can perform their commissioning responsibility under the British government's practice-based commissioning scheme.

The author examines the implications of the white paper "Transparency in Outcomes--A Framework for the NHS" for hospital consultants. He discusses four broad themes of the white paper released by the coalition government of Great Britain which are important in addressing issues concerning hospital consultants and their patients. He describes changes in the country's health system under the proposals from the white paper.

Accessible summary The governments in the UK want people with learning disabilities to have a voice about what happens in their own life and also in policy., One way of doing this is through research. This paper looks at two inclusive research projects, which were about people using direct payments and personal assistants. The projects both employed people with learning disabilities., Each of these projects made a training pack from the research, so that they would help people with learning disabilities and their supporters. They also had some effects in ways that were not planned, because the government wanted to learn from them about inclusive research., All research seems to have most effect when there are many voices seeking change, including those of policy makers themselves., Inclusive research is a way of achieving 'choice and control'. But just like with direct payments and personal budgets, the best way in these projects was to have good support from other people who will listen to you, and help you decide things for yourself., Summary Participation, voice and control have long been central concerns in the research at Norah Fry. This paper focuses on inclusive research relating to choice and control, as experienced by people with learning disabilities who use personal budgets and direct payments, and aims to question how the process of inclusive research can be linked to wider outcomes. The paper gives a brief overview of two studies carried out by Norah Fry Research Centre, which were in partnership with self-advocacy groups and employed people with learning disabilities, between 1999 and 2007. Both in research and in everyday life, we question individual notions of 'choice and control', showing how relational autonomy was at the heart, both of the process of the inclusive research and also of the outcomes and findings. However, all social research seems to have greatest impact when there is a 'bandwagon effect' of policy and practice initiatives. The discussion considers how the impact of inclusive research designs can be at policy, practice and 'direct' user level and is often achieved by people with learning disabilities having a voice at the dissemination stage. [ABSTRACT FROM AUTHOR]

Background: Accounting-that is, standardized measurement, public reporting, performance evaluation and managerial control-is commonly seen to provide the core infrastructure for quality improvement in healthcare. Yet, accounting successfully for quality has been a problematic endeavor, often producing dysfunctional effects. This has raised questions about the appropriate role for accounting in achieving quality improvement. This paper contributes to this debate by contrasting the specific way in which accounting is understood and operationalized for quality improvement in the UK National Health Service (NHS) with findings from the broadly defined 'social studies of accounting' literature and illustrative examples. Discussion: This paper highlights three significant differences between the way that accounting is understood to operate in the dominant health policy discourse and recent healthcare reforms, and in the social studies of accounting literature. It shows that accounting does not just find things out, but makes them up. It shows that accounting is not simply a matter of substance, but of style. And it shows that accounting does not just facilitate, but displaces, control. Summary: The illumination of these differences in the way that accounting is conceptualized helps to diagnose why accounting interventions often fail to produce the quality improvements that were envisioned. This paper concludes that accounting is not necessarily incompatible with the ambition of quality improvement, but that it would need to be understood and operationalized in new ways in order to contribute to this end. Proposals for this new way of advancing accounting are discussed. They include the cultivation of overlapping and even conflicting measures of quality, the evaluation of accounting regimes in terms of what they do to practice, and the development of distinctively skeptical calculative cultures. [ABSTRACT FROM AUTHOR]

Purpose -- Improvements in organisational culture are a common recommendation of enquiries into system failure and an aspiration of policy. The purpose of this paper is to explore an initiative to change culture in a low-secure service through the introduction of a self-advocacy group. Design/methodology/approach -- An independent evaluation was carried out by a university research team. A theory-based methodology was deployed with qualitative data gathered through observations, interviews and focus groups. Findings -- Culture change was reported by senior managers and clinicians in relation to the transparency of the service, decision making regarding resources, and engagement of patients in redesign. Self-advocacy group members reported a different relationship with senior management which in turn enabled greater influence in the organisation. Achieving these impacts relied on independent and skilled external facilitation, support from senior managers, and a calm and democratic atmosphere in the meetings. Ward staff were kept at an arms-length from the group and were less certain that it had made any difference to the way in which the ward operated. Research limitations/implications -- The research was only based in one organisation and the impacts of the initiative may vary with a different local context. Research in a wider sample of organisations and culture change initiatives will provide greater insights. Practical implications -- Self-advocacy groups can lead to organisation culture change alongside benefits for individual group members but require funding, external and independent facilitation, and organisational endorsement and support. Originality/value -- This paper adds to the limited literature regarding culture change in secure services and services for people with a learning disability in general and also to the understanding of the impact of self-advocacy groups. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to provide an overview of the evidence surrounding the design and delivery of adolescent-specific health services for young people aged 14-25. This aims to make recommendations for National Health Service (NHS) senior management teams on the available literature relating to service design for children's and young people's services within the UK. Design/methodology/approach -- This paper presents a mini-review carried out in Spring 2013 using EMBASE, BNI, PSYCHinfo, MEDLINE and Google Scholar to systematically search available published and unpublished research papers. Systematic reviews, meta-analyses and evaluations of service models were included within this review. Adapted "GRADE" criteria were used to appraise the evidence. Findings -- Of 70 papers found, 22 met the inclusion criteria. There were five main service designs found within the literature: hospital-based; school-linked or school-based; community based; combination and integrative; and other methods which did not fit into the four other categories. Research limitations/implications -- This review is limited to the literature available within the inclusion criteria and search strategy used. It intends to inform management decisions in combination with other parameters and available evidence. Originality/value -- There is range of research and evidence syntheses relating to adolescent services, but none of these have been conducted with a focus on the UK NHS and the information needs of managers re-designing services in the current climate within England. [ABSTRACT FROM AUTHOR]

Focuses on the rejection of the general practitioners of the government's National Health Service (NHS) in Great Britain. Rejection of the government's proposal for general practitioners; Views regarding the white paper of the NHS; Compatibility of the concepts of the white paper with the principles of the NHS.

The NHS Breast Screening Programme (NHSBSP) was started in 1988 and is a large, organised cancer screening programme. It is delivered by 80 services across England and screens over 2 million women each year. As a screening programme, it must balance the detection of cancers against possible harm to women who do not have cancer. The NHSBSP was therefore designed with detailed information gathering and performance metrics right from the start. In this review paper, we examine how performance metrics in screening mammography have improved the national screening programme and the further developments and challenges that are expected in the years to come. [ABSTRACT FROM AUTHOR]

Background: There are many challenges in delivering and evaluating knowledge for healthcare, but the lack of clear routes from knowledge to practice is a root cause of failures in safety within healthcare. Various types and sources of knowledge are relevant at different levels within the healthcare system. These need to be delivered in a timely way that is useful and actionable for those providing services or developing policies. How knowledge is taken up and used through networks and relationships, and the difficulties in attributing change to knowledge-based interventions, present challenges to understanding how knowledge into action (K2A) work influences healthcare outcomes. This makes it difficult to demonstrate the importance of K2A work, and harness support for its development and resourcing. This paper presents the results from a project commissioned by NHS Education for Scotland (NES) and Healthcare Improvement Scotland (HIS) to create an evaluation framework to help understand the NHS Scotland Knowledge into Action model.Methods: The team took a developmental approach to creating an evaluation framework that would be useful and practical. This included a literature review to ensure the evaluation was evidence-based; adaptation of contribution analysis for K2A project; action research with K2A project leads to refine the work and develop suitable measures.Results: Principles for evaluation and an evaluation framework based on contribution analysis were developed and implemented on a trial project. An outcomes chain was developed for the K2A programme and specific projects. This was used to design, collect and collate evidence of the K2A intervention. Data collected routinely by the intervention was supplemented with specific feedback measures from K2A project users.Conclusions: The evaluation approach allowed for scrutiny of both processes and outcomes and was adaptable to projects on different scales. This framework has proved useful as a planning, reflecting and evaluation tool for K2A, and could be more widely used to evidence the ways in which knowledge to action work helps improve healthcare outcomes. [ABSTRACT FROM AUTHOR]

Produced and published by the coalition government, the publication of the 2014 Special Educational Needs and Disability Code of Practice: 0-25 years (2014 SENCoP) sets out to overhaul the management of special educational needs (SEN) provision across England and Wales. This paper employs a critical discourse analysis (CDA) of the 2014 SENCoP to reveal the ideologies and aims that this policy is built upon. Following a Foucauldian framework of governmentality, this article focuses upon the way in which 'a successful transition to adulthood' is constructed within the policy, particularly in relation to the wider Conservative narrative of a 'Big Society.' Developing this analysis, the article draws upon the current political landscape of a Conservative government and the shift towards the creation of a 'shared society' in attempt to locate 'adulthood' within its wider political, economic, and cultural context. This analysis reveals the neoliberal values underpinning the 2014 SENCoP, whereby educational support is reduced to the practice of shaping and sculpting the future generation of citizens. By deconstructing notions of employment, independence, participation, and health, this article reveals the 2014 SENCoP as a tool of government, written to the demands of the economy rather than the unique needs, aspirations, and ambitions of children and young people labelled with SEN. [ABSTRACT FROM AUTHOR]