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Several letters to the editor are presented in response to article "The White Paper: A Framework for Survival?," by Roger Jones in the September 2010 issue.

The article reports on the likelihood for the government of Great Britain to publish a white paper on the future of the National Health Services (NHS) and community services.

The role of medical journal publishing has both an academic function, to inform and communicate research, while for the profession it provides a structured area for debating changes in practice in order to establish suitable protocols for treatment. In addition, such publication is part and parcel of the academic reward system, effecting rank, prestige and salaries and is reflected in the structure of research assessment exercises. Within the postgraduate education of doctors the publication of papers provides a means to distinguish levels of participation in research and experience within specialities. In April 2003 the number of serial titles indexed by NLM stood at 3799 within Index Medicus, 4498 titles in Medline and almost 10000 titles in the list of serials indexed for online users. By March 2003 these figures had increased to 3923, 4579 and 10192 respectively. Apart from the output of learned societies, professional bodies and universities a large proportion of titles are commercially produced.

The UK government has stated within its plan of reform for the National Health Service that a secure system for the Electronic Transfer of Prescriptions will be available by 2004. The objectives of this paper are to highlight the significant barriers faced in securing an ETP system, to provide a critical analysis of the security mechanisms in the models currently being piloted and to suggest an alternative revised model which overcomes the identified deficiencies and security hurdles. To identify the significant security issues relevant to the adoption of ETP, the authors have combined their analysis of present prescription processing practice with their knowledge of computer security. The authors identify and describe how the issues of patient confidentiality, authorization, identity authentication, audit, scalability, availability and reliability are significant barriers to the adoption of ETP, particularly if they effect ease of use. The paper's contribution to the field of ETP is to suggest solutions to each of the identified security issues and to combine the solutions together in a revised and developed model. [ABSTRACT FROM AUTHOR]

Following the decision to establish an Advanced Biomedical Scientist Practitioner grade for senior biomedical scientists in the NHS Cervical Screening Programme, a conjoint examination board has been appointed by the Royal College of Pathologists and Institute of Biomedical Science to oversee the Certificate in Advanced Practice in Cervical Cytology examination. The examination consists of a multiple-choice paper, short-answer written questions and practical microscopy sections covering screening of unmarked slides, and more complex discussion cases. In the first year there were 58 entries with 29 successful candidates, a pass rate of 50%. The standard of performance in the examination showed a wide range, and some candidates appear to have underestimated the degree of preparation, knowledge or level of microscopy skill required. [ABSTRACT FROM AUTHOR]

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]

The transboundary dynamics of COVID-19 present an unprecedented test of organisational resilience. In the UK, the National Health Service (NHS), a talisman of collective fortitude against disease and illness, has struggled to cope with inadequate provision of virus tests, ventilators, and personal protective equipment needed to fight the pandemic. In this paper, we reflect on the historic dynamics and strategic priorities that have undermined the NHS's attempts to navigate these troubled times. We invoke the organisational resilience literature to address 'the good, the bad and the ugly' of preparedness in readiness and response to the current pandemic. In particular, we draw on Meyer's (1982) seminal work on 'adaptation to jolts', excavating current preparedness failings. We argue an overreliance on perceived efficiency benefits of 'lean production' and 'just in time' continuity planning superseded strategic redundancy and slack in the system. This strategic focus was not simply the result of a failure in foresight, but rather a failure to act adaptively on knowledge of the known threats and weaknesses spotlighted by earlier projections of an inevitable pandemic threat. In conclusion, we consider how the UK Government and NHS must now undergo a phase of 'readjustment' in Meyer's terms, in light of these failings. We suggest that independent responsibility for national future preparedness should be handed to the NHS free from political interference. This would operate under the umbrella of a national emergency preparedness, resilience and response public body, enshrined in law, and similar in governance to the current Bank of England. This will help ensure that foresight is accompanied by durability and fortitude in safeguarding the UK against future pandemic threats. [ABSTRACT FROM AUTHOR]

The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels – as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers. [ABSTRACT FROM PUBLISHER]

Purpose - The purpose of this paper is to explore how the next government could develop a better deal in relation to work, pensions and poverty. The paper argues that given the changing face of poverty, the next government should focus on creating better jobs if it is really to encourage people to work longer and save more for retirement. Furthermore, it could do more to support those who are currently under-saving for retirement. Design/methodology/approach - The paper draws on evidence from a number of recent qualitative and quantitative JRF research reports and government statistical data. Findings - The paper suggests policy recommendations for the next government focused on creating better jobs and helping those on lower incomes increase their pension pots. This includes: ensuring that the minimum wages is set with regard to the changing price of essentials and changing average earnings; raising awareness of the Living Wage and playing a leadership role; industrial strategies for low paid sectors; mid-life career reviews and increased rights for those aged 60 and over; the redistribution of tax relief on pension contributions and the auto-escalation of workplace pensions. Originality/value - This paper looks at the issue of an ageing society, work and pensions through a poverty lens. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the literature related to a large-scale quality improvement initiative, the 'Productive Ward: Releasing Time to Care', providing a bibliometric profile that tracks the level of interest and scale of roll-out and adoption, discussing the implications for sustainability. Background Productive Ward: Releasing Time to Care (aka Productive Ward) is probably one of the most ambitious quality improvement efforts engaged by the UK- NHS. Politically and financially supported, its main driver was the NHS Institute for Innovation and Improvement. The NHS institute closed in early 2013 leaving a void of resources, knowledge and expertise. UK roll-out of the initiative is well established and has arguably peaked. International interest in the initiative however continues to develop. Methods A comprehensive literature review was undertaken to identify the literature related to the Productive Ward and its implementation (January 2006-June 2013). A bibliometric analysis examined/reviewed the trends and identified/measured interest, spread and uptake. Results Overall distribution patterns identify a declining trend of interest, with reduced numbers of grey literature and evaluation publications. However, detailed examination of the data shows no reduction in peer-reviewed outputs. There is some evidence that international uptake of the initiative continues to generate publications and create interest. Conclusions Sustaining this initiative in the UK will require re-energising, a new focus and financing. The transition period created by the closure of its creator may well contribute to further reduced levels of interest and publication outputs in the UK. However, international implementation, evaluation and associated publications could serve to attract professional/academic interest in this well-established, positively reported, quality improvement initiative. Relevance to clinical practice This paper provides nurses and ward teams involved in quality improvement programmes with a detailed, current-state, examination and analysis of the Productive Ward literature, highlighting the bibliometric patterns of this large-scale, international, quality improvement programme. It serves to disseminate updated publication information to those in clinical practice who are involved in Productive Ward or a similar quality improvement initiative. [ABSTRACT FROM AUTHOR]

Purpose: As the evidence base in relation to open dialogue continues to grow and develop, this paper contributes to the growing evidence base within the UK. The purpose of this paper is to focus on the experiences of those who have received the service and reports a qualitative evaluation of an open dialogue service operating within the National Health Service of the UK. Design/methodology/approach: The opportunity to participate was offered to all those who had received open dialogue within this particular National Health Service (NHS) trust. In total, seven participants, from four different social networks, participated in the research and attended semi-structured focus groups. The audio recordings of all focus groups were transcribed and the data as subjected to inductive thematic analysis. Findings: The results provide an insight into the lived experience of the individuals who received open dialogue. The analysis of the data gathered in the focus groups revealed three major themes: relational mutuality, dichotomy with other mental health services and dialogical freedom. Practical implications: The results suggest that individuals and networks positively experienced receiving open dialogue, particularly in relation to the way in which they were able to relate to, and work with practitioners. However, the results did also raise some issues in relation to the complications of introducing the open dialogue model into existing NHS structures. Originality/value: This research contributes to the emerging evidence base in relation to open dialogue, especially considering the current lack of existing research undertaken within the UK. [ABSTRACT FROM AUTHOR]

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.

Provides information on the initiatives included in the National Programme for Information Technology of the British National Health Service (NHS). Features of the NHS care records service; Aim of the electronic transmission of prescriptions; Opportunities provided by the N3 network.

The COVID‐19 pandemic and Brexit were separate yet inter‐related developments which affected the British National Health Service (NHS). The UK's state‐funded health sector had historically relied on migrant labour and depended on a migration infrastructure designed to solve its nursing labour shortages. The analysis of primary qualitative and secondary quantitative data shows that the NHS migration infrastructure increased its orientation towards Asia to compensate for the effects of Brexit. The paper reveals how the persistent use of temporary visas along with conditional contractual arrangements has led to various exclusions for migrant nurses and midwives. These data also demonstrate how international travel restrictions associated with COVID‐19 created temporary obstacles for nurses' inflows. Alongside Brexit, this has also resulted in an increase in outflows amongst EU health workers. The article identifies the development of migrant support infrastructure amongst Filipino and Indian nurses as a major COVID‐19 linked innovation. [ABSTRACT FROM AUTHOR]

The NHS accounts for 5.4% of the UK's total carbon footprint, with the perioperative environment being the most resource hungry aspect of the hospital. The aim of this systematic review was to assimilate the published studies concerning the sustainability of the perioperative environment, focussing on the impact of implemented interventions. A systematic review was performed using Pubmed, OVID, Embase, Cochrane database of systematic reviews and Medline. Original manuscripts describing interventions aimed at improving operating theatre environmental sustainability were included. 675 abstracts were screened with 34 manuscripts included. Studies were divided into broad themes; recycling and waste management, waste reduction, reuse, reprocessing or life cycle analysis, energy and resource reduction and anaesthetic gases. This review summarises the interventions identified and their resulting effects on theatre sustainability. This systematic review has identified simple, yet highly effective interventions across a variety of themes that can lead to improved environmental sustainability of surgical operating theatres. Combining these interventions will likely result in a synergistic improvement to the environmental impact of surgery. • Perioperative environments use 3–6 times more energy than the hospital in general. • Paper/cardboard recycling bins in operating areas led to a 50–67% recycling rate. • Reusable items can lead to 70% reduction in waste generation. • Alcohol scrub solutions vs handwashing saves ∼930,000 L/year/hospital of water. • Dispensing propofol in 20 mL bottles instead of 50/100 mL reduces drug wastage by 90%. [ABSTRACT FROM AUTHOR]

Introduction: Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority.Aim: The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally.Methods: Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes.Results: Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care.Conclusion: The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This paper argues that the terms on which GPs entered the NHS, as self-employed contractors, have proved remarkably resistant to the managerial pressures which have come to dominate other sections of the National Health Service. However, this traditional mode of financing and organizing the delivery of a key element of the National Health Service has become increasingly incompatible with wider health policy objectives — the development of an integrated network of good-quality, equitable and well-coordinated primary and community health services which are responsive to local needs. Furthermore, primary health services have themselves come to play a crucially important role in securing other strategic changes in the wider health policy arena, such as securing and sustaining a shift in the traditional balance between hospital and community-based health services and controlling expenditure in a needs-led service. The paper argues that, notwithstanding the change of government, the 1997. NHS (Primary Care) Act and the White Paper "The New NHS" are both integral to the achievement of wider strategic health policy objectives, such as improving the quality and coherence of services, and increasing professional accountability for the financial consequences of clinical decisions. However, the greatest significance of these and other related measures is that they shift the emphasis of health policy from commissioning and purchasing by primary care to commissioning and contracting for primary care. They thereby extend the exposure of GP-based services to managerialist scrutiny and control. [ABSTRACT FROM AUTHOR]

Background: Melanoma incidence has quadrupled since 1970 and melanoma is now the second most common cancer in individuals under 50. Targeted immunotherapies for melanoma now potentially enable long-term remission even in advanced melanoma, but these melanoma survivors require ongoing surveillance, with implications for NHS resources and significant social and psychological consequences for patients. Total skin self-examination (TSSE) can detect recurrence earlier and improve clinical outcomes but is underperformed in the UK. To support survivors, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed to prompt and improve TSSE performance, with subsequent reporting of concerns and submission of skin photos to a Dermatology Nurse Practitioner (DNP). ASICA was delivered as a randomized pilot trial.Methods: This paper reports on process evaluation. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using Microsoft Excel and SPSS. We explored which participants used ASICA, and how frequently, to report any skin concerns. We also determined how the interactions had worked in terms of quality of skin photographs submitted, clinical assessments made by the DNP, and the assessments and decisions made for each concern. Finally, we explored significant events occurring during the trial. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using SPSS. A semi-structured interview was undertaken with the DNP to gain perspective on the range of concerns presented and how they were resolved.Results: Of 121 recruited melanoma patients receiving ASICA for 12 months, 69 participants submitted a total of 123 reports detailing 189 separate skin-related concerns and including 188 skin photographs. Where participants fully complied with follow-up by the DNP, concerns were usually resolved remotely, but 19 (10.1%) were seen at a secondary care clinic and 14 (7.4%) referred to their GP. 49 (25.9%) of concerns were not completely resolved due to partial non-compliance with DNP follow-up.Conclusion: Melanoma patients randomized to the ASICA intervention were able to report skin-related concerns that could be resolved remotely through interaction with a DNP. Feasibility issues highlighted by ASICA will support further development and optimization of this digital tool.Trial Registration: Clinical Trials.gov , NCT03328247 . Registered on 1 November 2017. [ABSTRACT FROM AUTHOR]

Discourse related to any political event is a portrayal of the views of the participants involved. These views in turn are based on the underlying ideologies, beliefs and, concepts. Intertextual connections, among other aspects of discourse, make a discourse more meaningful and understandable in a given context. This article is an attempt to bring to light the various shades of discourse of Brexit, in terms of its participants and characteristics that emerged on the canvass of British political scene in the wake of 2016 EU Referendum campaign. Moreover, it goes on to explore instances of intertextual connections in post referendum Brexit discourse. For this purpose, a number of placard images from the "People's Vote march", an anti-Brexit march organized on October 20, 2018, were selected. This paper brings to light the dichotomy of Britons into Leavers and Remainers during Brexit referendum and further bisects them into senders and receivers to elaborate the participants of Brexit discourse. A review of the literature reveals Leavers' discourse to be chiefly based on populism, Euroscepticism, British sovereignty, global Britain, anti-immigration, racism, misrepresentation of facts and discreet handling of language by the leaders of leave camp. On the contrary, it is found that Remainers' discourse mainly relied on regarding immigrants as strength of UK and EU membership as a source of imparting stability and productivity to the UK on the one hand and on highlighting the loss of healthcare benefits to the UK and NHS and prevalence of unemployment on the other hand. [ABSTRACT FROM AUTHOR]

Given the escalating healthcare costs around the world (more than 10% of the world's GDP) and increasing demand hospitals are under constant scrutiny in terms of managing services with limited resources and tighter budgets. Hospitals endeavour to find sustainable solutions for a variety of challenges ranging from productivity enhancements to resource allocation. For instance, in the UK, evidence suggests that hospitals are struggling due to increased delayed transfers of care, bed-occupancy rates well above the recommended levels of 85% and unmet A&E performance targets. In this paper, we present a hybrid forecasting-simulation-optimisation model for an NHS Foundation Trust in the UK. Using the Hospital Episode Statistics dataset for A&E, outpatient and inpatient services, we estimate the future patient demands for each speciality and model how it behaves with the forecasted activity in the future. Discrete event simulation is used to capture the entire hospital within a simulation environment, where the outputs is used as inputs into a multi-period integer linear programming (MILP) model to predict three vital resource requirements (on a monthly basis over a 1-year period), namely beds, physicians and nurses. We further carry out a sensitivity analysis to establish the robustness of solutions to changes in parameters, such as nurse-to-bed ratio. This type of modelling framework is developed for the first time to better plan the needs of hospitals now and into the future. [ABSTRACT FROM AUTHOR]

The author reflects on the implications of the National Health Services' proposed reforms in the mental health services in Great Britain. She cites the white paper entitled "Equity and Excellence: Liberating the NHS," which details the changes to the way in which health services are commissioned and managed in the country. However, the author argues the need for the NHS to consider the financial restraint of the mental health providers which might be affected in the said proposed reform.

The NHS White Paper Equity and Excellence: Liberating the NHS recognises that the current system is not sustainable. But the White Paper's proposals are not radical enough; only re-focusing the current system will actually make the NHS sustainable. This article proposes a wider, longer term political vision that includes sustainability as a core value. Whatever promotes sustainability is likely to be good for health as well, so healthcare workers have a never to be repeated opportunity to help shape a sustainable future. [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]

The author reflects on the dilemmas of general practitioners (GPs) in taking decisions for patient care in view of a new health care policy of the British National Health Service. The policy emphasizes both effectiveness and cost of patient care. However, it becomes difficult for GPs to decide what is best for patients and what is cost effective for the government. Physician Lord Horder's view on the training of general practitioners has also been considered as a solution to the problem.

The introduction of a market mechanism into the National Health service in the UK was underpinned by the belief that decentralised purchasing would both improve the quality of health care provision and restrain spiralling costs, through purchasers exercising their ability to choose between alternative providers. Focusing on budget holding General Practitioners, that is those practices responsible for purchasing hospital services for their practice populations, this paper explores the evolving purchasing behaviour of these professional intermediaries. Drawing on empirical evidence gathered as part of a broader study of the purchasing behaviour of GP Fundholders in Scotland, specifically it examines the key information sources and decisional criteria utilised by these professional intermediaries in selecting health care providers for their practice population. Utilising relational models of market behaviour, it addresses both the contextually specific issue of whether the market mechanism within the NHS is achieving the twin objectives of improving health care provision and restraining cost pressures, and the broader conceptual issue of the purchasing behaviour of professional intermediaries within a service sector environment. [ABSTRACT FROM AUTHOR]

An ageing population and increased longevity means that long term care will become progressively more expensive. In 2009 the Government published a Green Paper on future funding options and a White Paper in 2010. This article considers the role of private finance products under the 'Partnership' option. It finds that few households are able to pay for LTC based on income and savings but the number increases if housing assets are included. We show that products can be devised for a range of circumstances, although state support would need to continue. We propose a simplified means testing system based on a combination of income and assets. [ABSTRACT FROM AUTHOR]

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This paper presents the findings of original research into the competencies, or behavioural repertoires, of board-level communicators in the UK National Health Service (NHS). Eight core competencies specific to that group were discovered and these are presented along with the supporting behaviour sets. The paper compares and contrasts these competencies with those of communicators in other public sector organisations and with a group drawn from the private sector. While the research found that there are a large number of similarities between the NHS and these other sectors, there are a number of significant differences. The paper discusses these differences in depth. Communication practitioners aspiring to take on a board-level role in the NHS will need to learn these behaviours and enact them if they wish to be successful in their search for promotion. Similarly, board-level communicators who wish to equip their team with higher-level competencies in readiness for promotion to senior levels can use the research as a blueprint for coaching and training. The paper concludes with recommendations for further research. [ABSTRACT FROM AUTHOR]

BACKGROUND: Smoking is one of the biggest avoidable causes of morbidity and mortality in the United Kingdom. This paper quantifies the current health and economic burden of smoking in the UK. It provides comparisons with previous studies of the burden of smoking in the UK and with the costs for other chronic disease risk factors. METHODS: A systematic literature review to identify previous estimates of National Health Service costs attributable to smoking was undertaken. Information from the World Health Organization’s Global Burden of Disease Project and routinely collected mortality data were used to calculate mortality due to smoking in the UK. Population-attributable fractions for smoking-related diseases from the Global Burden of Disease Project were applied to NHS cost data to estimate direct financial costs. RESULTS: Previous studies estimated that smoking costs the NHS about £1.4 billion to £1.7 billion in 1991 and has been responsible for about 100 000 deaths per annum over the past 10 years. This paper estimates that the number of deaths attributable to smoking in 2005 was 109 164 (19% of all deaths, 27% deaths in men and 11% of deaths in women). Smoking was directly responsible for 12% of disability adjusted life years lost in 2002 (15.4% in men; 8.5% in women) and the direct cost to the NHS was £5.2 billion in 2005–6. CONCLUSION: Smoking is still a considerable public health burden in the UK. Accurately establishing the burden in terms of death, disability and financial costs is important for informing national public health policy. [ABSTRACT FROM AUTHOR]

The author weighs the possible impact of the proposal by the new British coalition government to restructure the National Health Service (NHS) in 2010. Particular focus was given by the author on the new NHS Outcomes Framework. He notes that such framework will center on three themes of quality, namely, the effectiveness of treatment and its effect on both clinical and patient-reported outcomes, the safety of the provided treatment and patients' broader experience of health care. He points out some loopholes in the proposals.

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.

Aims and objectives. The aim of this paper is to reflect on how an acute hospital trust involved a youth council comprising 17 young people aged 11–18 years to improve children’s service delivery in one NHS trust in the UK. Background. Over the last decade, there has been an increased emphasis on the active involvement and participation of children and young people in the decision-making processes that affect them. However, one challenge in involving users in acute hospital trusts is how their views are used to develop services. For this reason, University Hospitals Coventry and Warwickshire NHS Trust, UK (University Hospitals Coventry and Warwickshire NHS Trust have given permission to have their name cited in the publication of this article) recognising the emerging national patient and public involvement agenda, planned and developed a youth council for the Trust in 2006. Process. The process of setting up the youth council is outlined. An evaluation workshop took place with 15 members of the youth council and their views are incorporated around three specific areas: • Evidence that their involvement has improved trust services; • Barriers to young people’s voices being heard in service delivery; • What could promote young people’s involvement in healthcare services. Conclusion/Relevance to clinical practice. This paper describes the setting up of a youth council but also discusses the potential barriers and how to overcome them to promote young people’s involvement in hospital trust service planning and development. Whilst the focus of the council was young people, the principles are of use to a wide range of clinical professionals faced with similar challenges. [ABSTRACT FROM AUTHOR]

This paper uses a queuing model to evaluate completion times in Accident and Emergency (A&E) departments in the light of the Government target of completing and discharging 98% of patients inside 4 h. It illustrates how flows though an A&E can be accurately represented as a queuing process, how outputs can be used to visualise and interpret the 4-h Government target in a simple way and how the model can be used to assess the practical achievability of A&E targets in the future. The paper finds that A&E targets have resulted in significant improvements in completion times and thus deal with a major source of complaint by users of the National Health Service in the UK. It suggests that whilst some of this improvement is attributable to better management, some is also due to the way some patients in A&E are designated and therefore counted through the system. It finds for example that the current target would not have been possible without some form of patient re-designation or re-labelling taking place. Further it finds that the current target is so demanding that the integrity of reported performance is open to question. Related incentives and demand management issues resulting from the target are also briefly discussed. [ABSTRACT FROM AUTHOR]

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]

The Health Trainer initiative was a public policy initiative designed to tackle health inequalities. Despite considerable improvements in the health of the population in the United Kingdom, there continues to be a gap between the rich and the poor in terms of deaths from cancer, stroke and coronary heart disease. There is a relationship between these health problems and lifestyle behaviours such as smoking, physical inactivity and poor diet. The Health Trainer initiative was created as part of the white paper Choosing Health. Following initial implementation across targeted Primary Care Trusts (The Spearhead Group), a rigorous evaluation of the initiative is taking place prior to a national roll out. This paper uses Whitehead's framework to examine the decision to implement health trainers as a stated aim of tackling health inequalities. The four purposes of health policy as identified by Whitehead (1995) and the categories of healthy living initiatives (Visram and Drinkwater 2005) are examined and applied to the health trainer initiative and its potential for reducing health inequality. [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]

Clinical governance has been acknowledged as the driving force behind National Health Service (NHS) reform since the government white paper outlined a new style of NHS in the UK in 1997. The framework of clinical governance ensures that NHS organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will develop. A major component of a clinical governance framework requires utilizing audit procedures, which assess the effectiveness of current systems and ultimately direct continual quality improvement. This paper describes the audit component of a local clinical governance framework designed for a unit based within an NHS trust, which has utilized a multidisciplinary approach to assess the effectiveness of a newly commissioned service and its impact on the residents and staff. The unit is a 12-bedded, low-secure-intensive rehabilitation unit for clients with severe and enduring mental illness. Using recognized and standardized psychometric outcome measures, information was collected on clinical symptoms, social functioning, social behaviour, quality of life, relationship quality with named nurses and medication side-effects. Additionally, confidential staff measures were included to assess levels of burnout, identify expressed emotion and assess staff perception of models of illness. The paper includes a comprehensive account of how managerial commitment, teaching processes and application of technology ensured prompt data collection and maintained the momentum through the audit timescale. Data analysis and presentation of data in both clinical reviews and in senior management meetings within the unit are discussed. Findings highlight the full integration of the audit system into the processes of the unit. Clinically, the paper highlights the enhancement of the knowledge base of the client group and the influence on clinical decision-making processes and care delivery as a result of the audit. Brief clinical examples are given. In conclusion, the impact of the audit on unit strategy and organizational efficiency are discussed to highlight the importance of closing the audit loop and completing the cycle of clinical governance. The audit system has positive implications for replication in other services. [ABSTRACT FROM AUTHOR]

In this paper we study queuing systems within the NHS. Recently imposed government performance targets lead NHS executives to investigate and instigate alternative management strategies, thereby imposing structural changes on the queues. Under such circumstances, it is most unlikely that such systems are in equilibrium. It is crucial, in our opinion, to recognise this state of affairs in order to make a balanced assessment of the role of queue management in the modern NHS. From a mathematical perspective it should be emphasised that measures of the state of a queue based upon the assumption of statistical equilibrium (a pervasive methodology in the study of queues) are simply wrong in the above scenario. To base strategic decisions around such ideas is therefore highly questionable and it is one of the purposes of this paper to offer alternatives: we present some (recent) research whose results generate performance measures and measures of risk, for example, of waiting-times growing unacceptably large; we emphasise that these results concern the transient behaviour of the queueing model-there is no asssumption of statistical equilibrium. We also demonstrate that our results are computationally tractable. [ABSTRACT FROM AUTHOR]

The article reports on the British government's white paper on health care outside hospital. According to the white paper entitled "Our Health, Our Care, Our Say," people with learning disabilities have not, historically, been treated well by the NHS. The overall aim of the white paper is to give people more choice about the care they receive in the community.

This paper evaluates the causes of excessive queuing in the NHS, which results in patient backlogs and long waiting times. There has been a general call to increase the over- all design capacity of many local health systems in the belief that there is insufficient capacity to meet patient demand. This paper suggests that lack of capacity is typically not the major issue. The primary cause of queuing in the NHS is the mismatch between demand and capacity, i.e. demand and capacity variation. Poor understanding of this variation, in particular variation in capacity, is compounded further by capacity loss through low yields of key resources and by increasing resources at parts of the process that are not bottlenecks. All this leads to ineffective capacity planning. As a result, some parts of the NHS are investing in additional capacity that will not increase the overall output from the service or may even make the situation worse. However, the knowledge exists to design health- care systems that deal with the variation in demand. Many hundreds of NHS teams are already using these principles with promising results. Given concerted leadership action, staff capability building and new systems to match demand and capacity on a daily basis, it would be possible to develop `low wait' or even `no wait' services across the NHS. [ABSTRACT FROM AUTHOR]

Background: Clinical research has been central to the global response to COVID-19, and the United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out globally for the scale and speed of its COVID-19 research response. This paper explores the impacts of COVID-19 on clinical research in an NHS Trust and how the embedded research system was adapted and repurposed to support the COVID-19 response. Methods and findings: Using a multi-method qualitative case study of a research-intensive NHS Trust in London UK, we collected data through a questionnaire (n = 170) and semi-structured interviews (n = 24) with research staff working in four areas: research governance; research leadership; research delivery; and patient and public involvement. We also observed key NHS Trust research prioritisation meetings (40 hours) and PPI activity (4.5 hours) and analysed documents produced by the Trust and national organisation relating to COVID-19 research. Data were analysed for a descriptive account of the Trust's COVID-19 research response and research staff's experiences. Data were then analysed thematically. Our analysis identifies three core themes: centralisation; pace of work; and new (temporary) work practices. By centralising research prioritisation at both national and Trust levels, halting non-COVID-19 research and redeploying research staff, an increased pace in the setup and delivery of COVID-19-related research was possible. National and Trust-level responses also led to widescale changes in working practices by adapting protocols and developing local processes to maintain and deliver research. These were effective practical solutions borne out of necessity and point to how the research system was able to adapt to the requirements of the pandemic. Conclusion: The Trust and national COVID-19 response entailed a rapid large-scale reorganisation of research staff, research infrastructures and research priorities. The Trust's local processes that enabled them to enact national policy prioritising COVID-19 research worked well, especially in managing finite resources, and also demonstrate the importance and adaptability of the research workforce. Such findings are useful as we consider how to adapt our healthcare delivery and research practices both at the national and global level for the future. However, as the pandemic continues, research leaders and policymakers must also take into account the short and long term impact of COVID-19 prioritisation on non-COVID-19 health research and the toll of the emergency response on research staff. [ABSTRACT FROM AUTHOR]

Purpose: As surgical specialties now begin the graduated return to elective activity and face-to-face clinics, this paper investigates the current head and neck outpatient practices across the United Kingdom. Methods: A cross-sectional study comprised of an online 20-item survey was distributed to members of the British Association of Head & Neck Oncologists (BAHNO). The survey was open on a web-based platform and covered topics including safety measures for patients, protective equipment for healthcare staff and protocols for the use of flexible nasendoscopy in the clinic. Results: The survey was completed by 117 participants covering 66 NHS Trusts across the UK. There was a significant reduction in face-to-face Otolaryngology, Maxillofacial and Speech and Language clinic patients when compared to pre-pandemic numbers (p < 0.0001). Risk assessments for flexible nasendoscopy were done for 69% of clinics and 58% had an established protocol. Room downtime after flexible nasendoscopy ranged from 0 to 6 h and there was a significant increase in allocated downtime after a patient had coughed/sneezed (p < 0.001). Natural ventilation existed in 36% of clinics and the majority of responders didn't know the Air Change Per Hour (ACPH) of the clinic room (77%). Where ACPH was known, it often did not match the allocated room downtime. Conclusion: There is a wide variation in outpatient activity across the United Kingdom, but adaptations are being made to try and maintain staff and patient safety. However, more can still be done by liaising with allied teams to clarify outpatient protocols. [ABSTRACT FROM AUTHOR]

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness. It is considered as an important public health issue, and prevalence of diagnosis has increased as awareness of the disease grew over the past years. Supply of specialist medical experts has not kept pace with the increasing demand for assessment, both due to financial pressures on health systems and the difficulty to train new experts, resulting in growing waiting lists. Patients are not being treated quickly enough causing problems in other areas of health systems (e.g. increased GP visits, increased risk of self-harm and accidents) and more broadly (e.g. time off work, relationship problems). Advances in machine learning make it possible to attempt to diagnose ADHD based on the analysis of relevant data, and this could inform clinical practice. This paper reports on findings related to the mental health services of a specialist Trust within the UK's National Health Service (NHS). The analysis studied data of adult patients who underwent diagnosis over the past few years, and developed a diagnostic model for ADHD in adults. The results demonstrate that it is indeed possible to correctly diagnose ADHD patients with promising statistical accuracy. [ABSTRACT FROM AUTHOR]

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]

Purpose – The purpose of this paper is to describe the delivery of a mainstreaming model within a public sector, mental health (National Health Service (NHS)) organisation. The model promotes the inclusivity of a spectrum of presentations from co-existing moderate anxiety and depression to severe mental disorder (psychosis) and problematic substance and alcohol use. Design/methodology/approach – This paper introduces the delivery of three collective approaches, termed the “three essential elements” to support a mainstreaming treatment model, facilitated by a “Dual Diagnosis Lead”. The model encompasses; a “direct access” referral pathway, joint collaboration with practitioners and the delivery of a “Dual Diagnosis” training programme. An independent evaluation was commissioned to explore eight mental health and substance misuse practitioners’ views and experiences in relation to the impact of the mainstreaming model. This paper also considers feedback from 230 course participants attending a one day “Dual Diagnosis” training programme. Findings – This paper suggests that practitioners may benefit from the implementation of the mainstreaming approach and the delivery of this approach could be moving “Dual Diagnosis” interventions closer to mainstream practice. Research limitations/implications – The limitations of the mainstreaming model are acknowledged in relation to the generalisation of practitioners’ views and reported experiences. Originality/value – This paper offers a description of the delivery of a mainstreaming model involving the “three essential elements”. The model provides a useful insight and demonstrates the possibilities which may be achieved when attempting to implement a mainstreaming treatment approach within mainstream mental health and drug and alcohol services. [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]

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]