Database addiction, YoHa, 2015/17

UK doctors' anger over NHS cash crisis

A NICE adaptation

BackgroundObesity care services are often faced with the need to adapt their resources to rising levels of demand. The main focus of this study was to help prioritise planned investments...

Over the past few decades, the UK's National Health Service (NHS) has progressively moved away from a tethered domain thereby becoming diffused into an environment rich with remote and digital information systems components. In such an environment, the population need for healthcare information, at the point-of-care, is a prime factor in managing the NHS efficiently. However, information integrity is sometime derelict. To facilitate such tasks various strategic models have been implemented - the latest being primary service provision (PSP), a subset of the application service provision (ASP) business model. It is clear that strategic change approaches in the NHS are always going to involve internet (web services) technology, thus, there is a need to investigate certain pertinent issues regarding healthcare data quality and integrity. In this paper, the authors show how security presents serious challenges to the PSP initiative. It also explains, using the NHS case study, that the quality of health information could be affected by streamlining complex, multistage medical information processes and emphasising on cost/benefit analysis for implementation of a web services model. This paper is based mostly on secondary data from measures being taken, in this public - private collaboration initiative, involving the supporting of every aspect of patient care. The overall concern was ensuring strong attention is paid to the aspects of web services that can disengage the NHS's effort to maintain information quality and integrity, and that the traditional goal of the NHS - free for all at the point of delivery - is kept intact.

Characteristics of patients seeking national health service (NHS) care for Achilles tendinopathy: A service evaluation of 573 patients

While austerity is commonly presented as a necessary, although undesirable, reduction in public expenditure, this framing may disguise a re‐imagining of the state whereby governments seize the opportunity of economic difficulties to shrink the state. This paper offers a critical examination of the nature of austerity by exploring the case of the UK's National Health Service (NHS), which according to political rhetoric is protected from austerity cuts. However, in the context of eight years of historically low funding growth coupled with increasing demand pressures from a growing and ageing population, the NHS has for several consecutive years faced substantial overspending by NHS provider organizations. With the Government intent on continuing its deficit and debt reduction path within a framework of ‘austerity’ focused almost exclusively on the expenditure side, NHS organizations have begun to explore radical solutions for reducing their costs. Following reported savings obtained by the early termination of a PPP contract at the Hexham General Hospital, politicians and some NHS managers have considered whether this experience might be repeated elsewhere. Our aims in this paper are to examine the financial feasibility of responding to the pressures created by austerity in this particular way, and to challenge the notion that the NHS has been protected from austerity. We extend the evidence base on PPP contract termination and analyze statistical information and financial statements in the public domain to highlight the legal and financial realities of early PPP termination.

ObjectiveTo estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding...

ABSTRACTObjective: To estimate the cost effectiveness of cilostazol (Pletal) compared to naftidrofuryl and pentoxifylline (Trental) in the treatment of intermittent claudication in the UK.* Pletal is a registered trade name of Otsuka America Pharmaceutical, Inc. and marketed in the UK by Otsuka Pharmaceuticals UK, Ltd, London, UK† Trental is a registered trade name of Aventis Phrmaceuticals Inc and marketed in the UK by Aventis Pharma Ltd, Kent, UKDesign and setting: This was a modelling study on the management of patients with intermittent claudication who are 40 years of age or above and have at least six months history of symptomatic intermittent claudication, secondary to lower extremity arterial occlusive disease. The study was performed from the perspective of the UK's National Health Service (NHS).Methods: Clinical outcomes attributable to managing intermittent claudication were obtained from the published literature and resource utilisation estimates were derived from a panel of vascular surgeons. Using decision analytical techniques, a decision model was constructed depicting the management of intermittent claudication with cilostazol, naftidrofuryl and pentoxifylline over 24 weeks in the UK. The model was used to estimate the cost effectiveness (at 2002/2003 prices) of cilostazol relative to the other treatments.Main outcome measures and results: Starting treatment with cilostazol instead of naftidrofuryl is expected to increase the percentage improvement in maximal walking distance by 32% (from 57% to 75%) for a 12% increase in NHS costs (from £801 to £895). Treatment with cilostazol instead of pentoxifylline is expected to increase the percentage improvement in maximal walking distance by 67% (from 45% to 75%) and reduce NHS costs by 2% (from £917 to £895). Treatment with naftidrofuryl instead of pentoxifylline is expected to increase the percentage improvement in maximal walking distance by 27% (from 45% to 57%) and decrease NHS costs by 14% (from £917 to £801).Conclusion: Within the limitations of our model, starting treatment with cilostazol is expected to be a clinically more effective strategy for improving maximal walking distance at 24 weeks than starting treatment with naftidrofuryl or pentoxifylline and potentially the most cost effective strategy. Moreover, the acquisition cost of a drug should not be used as an indication of the cost effectiveness of a given method of care.

Julie Moore: NHS leader who walks the wards

PurposeThe purpose of this paper is to enquire into the role and skills of the action learning facilitator in the context of service improvement work in the UK's National Health Service (NHS). An earlier companion paper examined the concept of service improvement and the possible contribution of action learning as a means of bringing about both personal and organisational development.Design/methodology/approachThe paper takes the form of a case study. The research reports on the facilitation of action learning sets which formed part of a leadership development programme in the NHS. Data were collected via telephone interviews, focus groups, action learning sets and a World Café event.FindingsThe action learning facilitator's role is encircled by questions of method, approaches, skills and competencies, and crucially by complex contextual factors. Three role models are offered for the action learning facilitator – i.e. initiator, coach, and leader – and the paper concludes that any person fulfilling this role should develop the habits of reflection, critique and learning as part of developing their practice. Supervision and developmental support are also useful for people who are always asking themselves – “Am I doing it right?”Research limitations/implicationsThis case study on which these findings are based was developed at a time of great turmoil in the NHS. The dramatic specifics of the case serve to illustrate the critical variability and uniqueness of context. However, we believe that this does not greatly affect the efficacy of general conclusions drawn about action learning facilitation.Practical implicationsThe practice of action learning is developing rapidly in many different organisational and community settings, and there is a growing demand for its skilful facilitation.Originality/valueCurrently there is little literature on what constitutes appropriate development for action learning facilitators. The paper gives some clear choices and guidelines for the development of this role.

The COVID-19 response for vulnerable people in places affected by conflict and humanitarian crises

Public sector healthcare services are both large users and innovators of health technologies. In the UK's National Health Service (NHS) initiatives have been developed to manage the process of technological innovation more effectively. This has two main aims, to maximize potential commercial returns from innovations developed within the NHS; and to improve levels of patient care through appropriate diffusion of innovations. The initiatives have been devised using approaches and processes already used in other public sector organizations, in particular, universities. Central to the approach taken by many universities is the setting up of a university technology transfer office (UTTO) to provide innovation management services. This paper assesses the extent to which the UTTO-based approach to technology transfer matches the needs of the NHS. Several significant factors are identified that suggest that the two sectors merit different approaches to innovation management. An agenda for further research into health service innovation management processes is suggested that emphasises issues including: the relative roles of formal and informal innovation processes; contingent variables affecting design of innovation processes; limitations of technology-push approaches to managing practice-based innovation; and cultural fit of innovation management models.

50 years of the inverse care law

ABSTRACTObjective: This study estimated the health economic impact of olopatadine (Opatanol) compared to branded cromoglycate (Opticrom) and generic sodium cromoglycate in the treatment of seasonal allergic conjunctivitis (SAC) in the UK.* Opatanol is a registered trade name of Alcon Laboratories Ltd, Hemel Hempstead, UK† Opticrom is a registered trade name of Sanofi Aventis, Guildford, UKDesign and setting: This was a modelling study performed from the perspective of the UK's National Health Service (NHS).Methods: A decision model was constructed depicting the management of SAC sufferers who are 4 years of age or above over a typical allergy season of 4 months and considers the decision by a GP to initially treat a patient with olopatadine, branded or generic cromoglycate. The analysis assumed both drugs to be equally effective. Consequently, a cost-minimisation analysis was performed to identify the least costly alternative.Main outcome measures and results: Starting treatment with olopatadine is expected to lead to a healthcare cost of £92 (95% CI: £46; £150) over 4 months compared to £109 (95% CI: £65; £166) with branded cromoglycate and £95 (95% CI: £51; £152) with generic cromoglycate, resulting in a 16% and 3% reduction in healthcare costs respectively over 4 months of treatment. This cost-difference is primarily due to fewer GP visits among olopatadine-treated patients.Conclusion: Use of olopatadine instead of branded or generic cromoglycate affords an economic benefit to the NHS. Hence, within the limitations of the model, olopatadine is the preferred first-line treatment for use in SAC sufferers, since it is expected to lead to fewer GP visits, thereby releasing healthcare resources for alternative use.

ViEWS in the emergency department