Promoting high quality care for all adults at the end of life 'How people die remains in the memory of those who live on' Promoting high quality care for all adults at the end of life 'How people die remains in the memory of those who live on' Document Gateway reference 9840 title End of Life Care Strategy – promoting high quality care for all adults at the end of life Description The End of Life Care Strategy aims to improve the provision of care for all adults at the end of life, and their families and carers. The text of this document may be reproduced without formal permission or charge for personal or in-house use.

End of Life Care Strategy

Good medical leadership is vital in delivering high-quality healthcare, and yet medical career progression has traditionally seen leadership lack credence in comparison with technical and academic ability. Individual standards have varied, leading to variations in the quality of medical leadership between different organisations and, on occasions, catastrophic lapses in the standard of care provided to patients. These high-profile events, plus increasing evidence linking clinical leadership to performance of units, has led recently to more focus on leadership development for all doctors, starting earlier and continuing throughout their careers. There is also an increased drive to see doctors take on more significant leadership roles throughout the healthcare system. The achievement of these aims will require doctors to develop strong personal and professional values, a range of non-technical skills that allow them to lead across professional boundaries, and an understanding of the increasingly complex environment in which 21st century healthcare is delivered. Developing these attributes will require dedicated resources and the sophisticated application of a variety of different learning methodologies such as mentoring, coaching, action learning and networking.

https://pmj.bmj.com/content/postgradmedj/87/1023/27.full.pdf

Medical leadership: why it's important, what is required, and how we develop it

The Wanless review Securing our Future Health, published by the Treasury in 2002, concluded that the United Kingdom would need to spend substantially more on health care and that fundamental reform would be needed to enable those resources to be used effectively. Five years on, the King's Fund has commissioned Sir Derek to undertake a retrospective review of NHS spending. Real spending on the NHS has increased by nearly 50 per cent in that time. This report looks at where that money has been spent, what it has achieved, whether government policy has promoted effective use of the resources, and what needs to happen next.

Our Future Health Secured?: A Review of NHS Funding and Performance

Background:

High estimates of preventable death rates have renewed the impetus for national regionalization of trauma care. Institution of a specialist multidisciplinary trauma service and performance improvement programme was hypothesized to have resulted in improved outcomes for severely injured patients.



Methods:

This was a comparative analysis of data from the Royal London Hospital (RLH) trauma registry and Trauma Audit and Research Network (England and Wales), 2000–2005. Preventable mortality was evaluated by prospective analysis of the RLH performance improvement programme.



Results:

Mortality from critical injury at the RLH was 48 per cent lower in 2005 than 2000 (17·9 versus 34·2 per cent; P = 0·001). Overall mortality rates were unchanged for acute hospitals (4·3 versus 4·4 per cent) and other multispecialty hospitals (8·7 versus 7·3 per cent). Secondary transfer mortality in critically injured patients was 53 per cent lower in the regional network than the national average (5·2 versus 11·0 per cent; P = 0·001). Preventable death rates fell from 9 to 2 per cent (P = 0·040) and significant gains were made in critical care and ward bed utilization.



Conclusion:

Institution of a specialist trauma service and performance improvement programme was associated with significant improvements in outcomes that exceeded national variations. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

A major trauma centre is a specialty hospital not a hospital of specialties

The Editor-in-Chief of the BDJ has previously raised important questions about dental workforce planning and the implications for dental graduates of recent changes and pressures. It is now time to revisit this issue. Much has changed since the last workforce review in England and Wales, and the rate of change is in all probability set to increase. First, at the time of writing this paper the momentous step of including dental care professionals (DCPs) on General Dental Council (GDC) registers in the United Kingdom has recently been completed. Second, the Scope of Practice of all dental professionals has been under consultation by the General Dental Council, and research evidence suggests that greater use should be made of skill-mix in the dental team. Third, within England, Lord Darzi has just published the 'Final Report of the NHS Next Stage Review', which emphasises 'quality care' and 'team-working' as key features of healthcare; this report was accompanied by an important document entitled 'A High Quality Workforce', in which plans for local workforce planning within the NHS are outlined, placing responsibilities at national, local and regional levels. Fourth, policy makers across the UK are wrestling with addressing oral health needs, promoting health and facilitating access to dental care, all of which have implications for the nature and shape of the dental workforce. Fifth, with the impact of globalisation and European policies we are net gainers of dentists as well as having more in training. Sixth, although there have been reviews and policy initiatives by regulatory, professional and other bodies in support of shaping the dental workforce, there has been little serious consideration of skill-mix and funding mechanisms to encourage team-working. Together, these events demand that we enter a fresh debate on the future dental workforce which should extend beyond professional and national boundaries and inform workforce planning. This debate is of great importance to future generations of dental healthcare professionals, funders, commissioners and providers of both dental services and dental education and training, and most importantly our patients and the public whom we serve. Furthermore, workforce planning must be linked to a philosophy of care which promotes promotion of health and embraces quality care, rather than merely treatment of disease, and addresses oral health needs and demands.

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The future dental workforce

A Framework for Action details how Professor Ara Darzi believes London's healthcare needs to change over the next ten years. It also looks beyond the vision and identifies the key enablers that will turn the vision into reality. Download the full report and those of the working groups.

Sir Ara Darzi

Papers

Healthcare for London: a framework for action