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In 2016, England's National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients' needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service.In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR's progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes.The NIHR's overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO's recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions. [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.

Context This paper presents a critique of current knowledge on the engagement of patients and the public, referred to here as patient and public involvement ( PPI), and calls for the development of robust and theoretically informed strategies across the continuum of medical education. Methods The study draws on a range of relevant literatures and presents PPI as a response process in relation to patient-centred learning agendas. Through reference to original research it discusses three key priorities for medical educators developing early PPI pedagogies, including: (i) the integration of evidence on PPI relevant to medical education, via a unifying corpus of literature; (ii) conceptual clarity through shared definitions of PPI in medical education, and (iii) an academically rigorous approach to managing complexity in the evaluation of PPI initiatives. Results As a response to these challenges, the authors demonstrate how activity modelling may be used as an analytical heuristic to provide an understanding of a number of PPI systems that may interact within complex and dynamic educational contexts. Conclusion The authors highlight the need for a range of patient voices to be evident within such work, from its generation through to dissemination, in order that patients and the public are partners and not merely objects of this endeavour. To this end, this paper has been discussed with and reviewed by our own patient and public research partners throughout the writing process. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine relationships between internationally educated nurses’ (IENs’) performance in a registered nurse competency assessment process and the outcomes of their nursing registration applications. Assessments of nursing practice competencies, IEN applicant characteristics and registration outcomes were explored.Design/methodology/approach This is a secondary statistical analysis of a subset of IEN application data from a previous study in combination with assessment data from an additional database. Application data between 2008 and 2011 were analyzed using univariate/bivariate analyses and regression models to explore the relationship of performance in the assessment process and outcomes of the registration process.Findings Competency categories IEN applicants had difficulties with (from least to most) were Professional Responsibility and Accountability, Ethical Practice, Self-Regulation, Service to the Public, Knowledge-Based Practice: Specialized Body of Knowledge and Knowledge-Based Practice: Competent Application of Knowledge. IENs educated in the UK and USA had the highest scores and odds of meeting competencies. Applicants educated in India and Asia had lower scores and odds ratios. All national entry-to-practice examination and registration eligibility competencies were significantly related to registration outcomes. Applicants passing the exam had higher competency scores while applicants ineligible for registration had lower competency scores.Research limitations/implications Limitations include integrity of data extracted from active databases, IEN motivation to complete the RN registration process and conversion of assessment scales for research analysis.Originality/value Results inform regulation policies that improve IEN registration processes and may be informative to regulators, assessment centers, educational institutions and IENs. [ABSTRACT FROM AUTHOR]

Patient charges are increasingly advocated by government as a policy tool to raise revenue and regulate the utilization of primary health care. Since the Conservative government came to power in 1979, the charge for NHS prescriptions has risen sharply from 20 pence per item in 1979 to £3.05 in April 1990. Charges for sight testing were introduced in April 1989. An introduction, or increase, in patient charges often provokes fierce political and medical debate about likely effects on patients. Such debate can be informed by empirical evidence from the growing number of economic studies in the US and UK which quantify the statistical relationship between patient charges and health care utilization. This paper reviews the evidence on drug prescriptions and patient charges and presents data for the UK. The implications of patient charges for the efficiency and equity of primary health care provision are considered. [ABSTRACT FROM AUTHOR]

Aims This paper describes the process of validating the Readiness for Interprofessional Learning Scale (RIPLS) for use with postgraduate health care professionals. Context The RIPLS questionnaire has proved useful in the undergraduate context, enabling tutors to assess the readiness of students to engage in interprofessional learning (IPL). With the drive in the National Health Service (NHS) to deliver health care in interprofessional teams, it seems logical to ask whether postgraduate education should, or could, be delivered successfully in interprofessional contexts. As a preliminary to undertaking an extended IPL project, the researchers tested the validity of the RIPLS tool in the postgraduate health care context. Method A modified version of the RIPLS questionnaire was administered to all general practitioners, nurses, pharmacists and allied health professionals in the Dundee Local Health Care Cooperative (LHCC) ( n = 799). A total of 546 staff responded (68%). Results Three factors, comprising 23 statements, emerged from the statistical analysis of the survey data, namely, teamwork and collaboration, sense of professional identity and patient-centredness. The internal consistency measure was 0.76. Analysis of variance suggested some key differences between the different professions in respect of the factors. Conclusions The RIPLS questionnaire was validated for use in the postgraduate context, thus providing researchers with a tool for assessing health professionals' attitudes towards interprofessional learning at practice level, community health partnership level or at a national level of education and training. Significant differences between professional groups should be taken into account in designing any interprofessional learning programme. [ABSTRACT FROM AUTHOR]

This article reports that as New Labour begins a third term in office, the National Health Service (NHS) looks likely to be dominated by an ongoing emphasis on personalization, on people with long-term conditions and on patient choice. At present, policy has tended to focus very much on choice of acute provider, on the expert patient and on professional case managers to reduce the number of emergency hospital admissions. In many ways, this is a new agenda for the NHS, and the jury is very much out on whether such a large, professionally dominated and acute care-focused organization can really deliver on these aspirations. Since 1997, disabled people have been able to receive cash sums in lieu of directly provided social services, using these to design their own care packages and to employ their own staff. With peer support from Centres of Independent Living, the evidence suggests that this way of working increases choice and control, improves satisfaction and leads to fewer unmet needs, greater continuity of care and a more cost-effective use of public resources.

This article examines the development and impact of a national knowledge translation project aimed at improving access to evidence and learning on community-centred approaches for health and wellbeing. Structural changes in the English health system meant that knowledge on community engagement was becoming lost and a fragmented evidence base was seen to impact negatively on policy and practice. A partnership started between Public Health England, NHS England and Leeds Beckett University in 2014 to address these issues. Following a literature review and stakeholder consultation, evidence was published in a national guide to community-centred approaches. This was followed by a programme of work to translate the evidence into national strategy and local practice. The article outlines the key features of the knowledge translation framework developed. Results include positive impacts on local practice and national policy, for example adoption within National Institute for Health and Care Evidence (NICE) guidance and Local Authority public health plans and utilization as a tool for local audit of practice and commissioning. The framework was successful in its non-linear approach to knowledge translation across a range of inter-connected activity, built on national leadership, knowledge brokerage, coalition building and a strong collaboration between research institute and government agency. [ABSTRACT FROM AUTHOR]

BackgroundOlder people from deprived areas, the oldest old and those from ethnic minorities engage less in health promotion interventions and related research, potentially generating inequities.AimTo explore and map the extent to which such ‘hard to reach’ groups of older people, are the focus of local health and well-being strategies in England.MethodsDocument analysis of current health and well-being promotion strategies in a purposive sample of 10 localities in England with high proportions of some or all of the three hard to reach groups. Documents were analysed using an interpretive approach.FindingsA total of 254 documents were retrieved and reviewed. Much of the content of the documents was descriptive and reported the implications for resources/services of population ageing rather than actual initiatives. All localities had an Older People’s Strategy. Strategies to counter deprivation included redistribution of winter fuel payments, income maximisation, debt reduction and social inclusion initiatives, a focus on older owner occupiers and recruitment of village ‘agents’ to counter rural deprivation. The needs of the oldest old were served by integrated services for older people, a community alarm service with total coverage of the 85+ population, and dietary advice. The needs of black and minority ethnic (BME) older people were discussed in all localities and responses included community work with BME groups, attention to housing needs and monitoring of service use by BME older people. Three other themes that emerged were: use of telecare technologies; a challenge to the idea of ‘hard to reach’ groups; and outreach services to those at most risk.ConclusionsDocument analysis revealed a range of policy statements that may indicate tailoring of policy and practice to local conditions, the salience of national priorities, some innovative local responses to policy challenges and even dissenting views that seek to redefine the policy problem. [ABSTRACT FROM PUBLISHER]

This article examines the findings of a Royal College of Nursing (RCN) survey, The Value and Contribution of Nursing to Public Health in the UK: Final report, on the value of public health nursing and nurses' role in shaping the integration of health and social care. The prevention of ill health is important across all the UK's government health policies as they place an emphasis on improving health and supporting people not just to live longer, but to stay healthy. Integration of care means aligning health and social services and making sure that they are 'person-centred', designed to meet the needs of individuals across care pathways which are 'place-based' where people are living and working. To meet the unprecedented challenges of increasing population demands and financial pressures in health and care services, improving the public's health and better integration of services are fundamental. Nurses and midwives are in a unique position to support and drive this improvement because of the regular and frequent contact they have with people. The survey highlights the value of the contribution they can make to public health and the associated knowledge and skills required to undertake such work [ABSTRACT FROM AUTHOR]

The article discusses the use of syndromic surveillance in the Emergency Care Data Set (ECDS) project initiated by the Royal College of Emergency Medicine in England. Topics covered include the goal of improving the collection and quality of data in emergency departments, the mandated changes to national clinical emergency care data sets and the driving factors for implementation of ECDS.

Background. Recent interest has focused on reorganizing emergency medical services (EMS) for traumatic brain injury (TBI) patients, with bypass of nonspecialist hospitals and direct transportation to distant neuroscience centers. Although this could expedite neurosurgery and neurocritical care, deteriorating physiology could be deleterious. Methods. We performed a multicenter cohort study examining adult patients with significant TBI enrolled in the English National Trauma Registry. The distributions and correlation of first recorded prehospital and emergency department (ED) vital signs were compared, and the effect of time on changes in vital signs was examined in bivariate and multivariate analyses. Results. A total of 7149 eligible patients were studied. No clinically significant differences were apparent between distributions of prehospital and ED vital signs. Moderate linear correlation was observed for field and ED pulse rate ( r2 = 0.34) and GCS values (Spearman's rho = 0.76), with weak correlation apparent for systolic blood pressure ( r2 = 0.28) and respiratory rate ( r2 = 0.28). Eight percent of cases' vital signs deteriorated in the prehospital interval; however , odds of deterioration in vital sign status did not vary significantly with duration of EMS interval. Conclusion. The similarity between prehospital and ED vital signs, and lack of association between EMS interval and physiological deterioration, may support a strategy of direct transportation of TBI cases to specialist centers. Further research is necessary to identify patients at risk from deterioration during bypass and to investigate effects on mortality. [ABSTRACT FROM AUTHOR]

The article reports that Royal Liverpool and Broadgreen University Hospitals NHS Trust has successfully completed a proof of concept (PoC) evaluation of CSC's Clinical Information Portal. The portal has been developed as part of a pilot of the NHS Interoperability Toolkit. It is stated that the portal has enabled healthcare professionals to obtain a single-screen view of a patient's notes.

In England, numerous government policies and initiatives have been developed to encourage the active participation of patients in their care and to engage the public in the planning and development of health services. Despite an intense focus, progress in this area has been disappointingly slow. The concept of patient and public involvement (PPI) is often dismissed by critics as irrelevant and impractical and true patient engagement is still the exception rather than the rule. In order to move away from a tokenistic approach to PPI there is much work to be done. National patient surveys provide a valuable evidence base for monitoring levels of involvement. Examples from the Patients Accelerating Change programme show the positive difference that effective, well-executed involvement can achieve. Such demonstrations of the added value of partnership working are essential to help ensure that involvement becomes embedded within the culture of healthcare organisations. [ABSTRACT FROM AUTHOR]

The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. ‘Patient choice’ policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of ‘choice’ might not necessarily be the ‘local’ provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients’ access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio-economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients’ willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice. [ABSTRACT FROM AUTHOR]

When surgery was cancelled at his NHS Trust because of a lack of high dependency unit beds, Alexander Brown led a multidisciplinary approach in the redesign of services. Here, he explains the process. [ABSTRACT FROM AUTHOR]

Focuses on the implication of the NHS and Community Act 1990 and the consequent review and reform of the National Health Service for the healthy care industry in Great Britain. Aim of the reform to give patients better health care and greater choice of services available; Provision by the British government of financial grants for District Health Authorities and some general practitioners (GP) to act as purchaser for their patients from competing health care providers; Stipulation in the Patients Charter of the right of patients to have a second opinion and to an extra contractual referral if a specialized treatment is not available locally.