Showing papers in "British Journal of Healthcare Management in 2014"
TL;DR: It is imperative that diabetes management aims to achieve optimal glucose control to minimise the risk of long-term complications and to enable the person with diabetes to lead a good quality of life.
Abstract: Diabetes mellitus (DM), a chronic metabolic disorder, has been recognised as a major public health problem with far-reaching consequences not just for its adverse impact on the health of people affected by this condition, but also for the economic burden it places on the healthcare system. To reduce cost, it is imperative that diabetes management aims to achieve optimal glucose control to minimise the risk of long-term complications and to enable the person with diabetes to lead a good quality of life. This is often achieved through the use of a vast array of lifestyle and pharmaceutical interventions designed to prevent and control hyperglycaemia. However, evidence asserts not maintaining blood glucose within a normal range can result in chronic hyperglycaemia. This in turn leads to the development of micro and macrovascular complications. Such complications incur additional indirect costs to patients, employers and society due to absence from work caused by sickness and early retirement.
23 citations
TL;DR: Poisson statistics are used to transform the difference between one year and the next into a common currency of standard deviations of difference to show the source of the increase in deaths is highly diagnosis specific and is largely Rod Jones' disease.
Abstract: British Journal of Healthcare Management 2014 Vol 20 No 1 45 © 2 01 4 M A H ea lth ca re L td diagnosis-age combinations showed a specific increase in 2012 compared to 2011. Since there are large differences in the number of deaths for different ages and diagnoses, this article has used Poisson statistics to transform the difference between one year and the next into a common currency of standard deviations of difference. Anything with more than a three standard deviation difference can be considered statistically significant. Figure 1 shows the pattern of statistically significant increases and decreases at International Classification of Diseases (ICD) chapter level following the 2012 event where there were 35 specific female age band-diagnosis increases but only 27 for males while Table 1 shows which ICD chapters were specifically associated with a high increase in deaths across all age bands. The increase is generally higher for females except for neoplasms. Since there are 19 ICD chapters describing cause of death it should be apparent that the source of the increase in deaths is highly diagnosis specific and is largely Rod Jones Increased deaths in 2012: which conditions?
18 citations
TL;DR: The slightly earlier increase in GP referral and consequent outpatient first attendance can be understood in terms of deteriorating health necessitating GP referral, eventual hospital admission and then death.
Abstract: 90 British Journal of Healthcare Management 2014 Vol 20 No 2 © 2 01 4 M A H ea lth ca re L td Figure 1 is illustrative of this clash of ideologies, where a 4.8% increase in outpatient first attendance (mostly GP referred) occurs in December of 2011. A 5.2% increase in admissions via AE 2013e; 2014). Therefore, the slightly earlier increase in GP referral and consequent outpatient first attendance can be understood in terms of deteriorating health necessitating GP referral, eventual hospital admission and then death. A similar time and spatial cascade involving outpatient first attendance has been documented following an event in 2007. On that occasion, the increase in outpatient demand was far higher than seen in 2012 and this could be the outcome of a different strain of the same infectious agent. This can be observed in the differential effects of influenza strains against morbidity and mortality. This Rod Jones Forecasting conundrum: a disease time cascade
14 citations
TL;DR: The most frequent invasive procedure performed by nurses in acute care is venous access with 80% of patients in the USA, 60% in the UK, and 33–67% in Australia requiring intravenous access.
Abstract: The most frequent invasive procedure performed by nurses in acute care is venous access with 80% of patients in the USA, 60% of patients in the UK, and 33–67% of patients in Australia requiring intravenous access (Lavery, 2005; Hadaway, 2012; Wallis, 2014). Not only are vascular access devices the primary avenue for treatment administration, but many patients receive multiple intravenous medications and have more than one vascular access device (VAD). High usage of VADs, both central and peripheral, is not without risk of infection or other complications. Concerns regarding catheter-associated bloodstream infections are common with a general focus on central venous access devices (CVAD). Prevention for central line associated bloodstream infections (CLABSI) is concentrated on compliance with the five components of the central line bundle with variable success (Pronovost, 2006; Blot, 2014; Hsu, 2014). Preventive efforts and the application of new safety devices have resulted in actual cost reductions in ad...
12 citations
TL;DR: The concept of a step-like alteration in case mix is explored further and it can be seen that diagnoses showing an above average increase in 2012/13 undergo a considerable jump in terms of the proportion of the total case-mix.
Abstract: 142 British Journal of Healthcare Management 2014 Vol 20 No 3 © 2 01 4 M A H ea lth ca re L td mainly arthropathies, are largely dealt with in rheumatology. The diagnosis for outpatient activity is reported by a number of consultants working at hospitals. This constitutes around a 3% sample of total outpatient activity. The concept of a step-like alteration in case mix is explored further in Figure 2 for dermatology. It can be seen that diagnoses showing an above average increase in 2012/13 undergo a considerable jump in terms of the proportion of the total case-mix. The bulk of this shift arises from four conditions showing statistically significant increases, in decreasing order: dermatitis, cellulitis, acne and rosacea. The high proportion in the number of attendances for diagnoses with a shift up in the period in Figure 2 suggests that a large proportion of the dermatological case-mix is immune-sensitive. The immunological basis for dermatological conditions has been previously discussed. It has been suggested that the herpes virus, cytomegalovirus (CMV), may be implicated. It is a good example of the type of immune modulating agent that may be the ultimate cause of these changes. At this point, it is crucial to understand that to the bulk of the population, CMV is a largely Rod Jones Unexpected changes in outpatient first attendance
10 citations
TL;DR: Healthcare decision makers should not base their decisions on cost of dressings alone, but take into account the costs mitigated by using an advanced wound therapy, to assess if these are indeed more cost-effective long-term.
Abstract: The current economic downturn in the UK and other countries has caused healthcare organisations
to justify the costs of more advanced technologies. This is seen especially within the wound care
discipline. The costs of healthcare account for a third of all UK government spend and with the
prevalence of chronic wounds increasing, the cost of modern wound care is becoming more
strained and open to scrutiny. Healthcare decision makers should not base their decisions on cost
of dressings alone, but take into account the costs mitigated by using an advanced wound therapy.
A clinical-economic assessment should be performed on a number of advanced therapies to assess
if these are indeed more cost-effective long-term.
8 citations
TL;DR: This article examines the growing importance of m-health over the past decade, and the ongoing contribution of this concept globally to key areas healthcare, such as disease management, wellbeing and diagnostics.
Abstract: Mobile health (m-health) was first introduced in 2003, and has now become one of the major pillars of modern ICT for healthcare. This article examines the growing importance of m-health over the past decade, and the ongoing contribution of this concept globally to key areas healthcare, such as disease management, wellbeing and diagnostics.
7 citations
TL;DR: The issue of peristomal skin complications such as sore skin and skin infections will be explored to aid commissioners and service providers to understand some of the issues faced by patients, their carers and the stoma specialist nurse.
Abstract: The many thousands of people in the UK with a stoma be it temporary or permanent, may encounter a number of issues that can affect them physically or mentally. This article will focus upon the issue of peristomal skin complications such as sore skin and skin infections. Within the public domain there is limited information that is evidence-based on the topic. The Association of Stoma Care Nurses UK (ASCN UK) has recently published national standards of care (Osborne, 2014), however, they do not guide on peristomal skin complication care. This article will discuss stomas, their generic care and then explore the issue of sore skin treatment to aid commissioners and service providers to understand some of the issues faced by patients, their carers and the stoma specialist nurse.
7 citations
TL;DR: Pharmaceutical companies specialising in pain who adopt a consultative, patient-centric approach will have an important role to play in addressing the challenge that chronic pain presents to society, through the development of innovative treatments, education of clinicians and support of patient organisations.
Abstract: Chronic pain is common and complex to manage because biological, psychological and social factors conspire to amplify and perpetuate symptoms and their impact on a patient's life. Pain exacts a large toll on individuals, their families, the healthcare system and the economy. Management of pain requires a holistic multidisciplinary approach, combining education, exercise, pharmacological therapy, psychological therapies and other interventions. Pharmaceutical companies specialising in pain who adopt a consultative, patient-centric approach will have an important role to play in addressing the challenge that chronic pain presents to our society, through the development of innovative treatments, education of clinicians and support of patient organisations.
7 citations
TL;DR: How improving hand hygiene compliance can improve patient care, prevents HCAIs and is fundamentality a patient safety prerequisite is highlighted.
Abstract: Published evidence suggests that healthcare associated infections (HCAIs) are avoidable and infection prevention and control (IPC) strategies provide cost-effective solutions. The NHS Outcomes Framework (Department of Health, 2010) Domain 5 recognises that patient safety is of paramount importance in terms of quality of care and to delivering better health outcomes. Preventing HCAIs is necessary in reducing the severity of harm and is a key performance indicator. It is vital that NHS organisations ask themselves how they can help to improve the safety of patients. The seven steps to patient safety (National Patient Safety Agency, 2004) is a guide to good practice, which covers building a safer culture and managing, reporting and learning from patient safety incidents. This article highlights how improving hand hygiene compliance can improve patient care, prevents HCAIs and is fundamentality a patient safety prerequisite.
6 citations
TL;DR: The advantages and disadvantages of different strategies that can be employed by commissioners and service providers in the evaluation of HTM services are discussed.
Abstract: As home telemonitoring (HTM) moves away from randomised controlled trials and towards the mainstreaming of services, a clear set of guidance on how to evaluate them is needed. Without appropriate and systematic evaluations, the healthcare sector and those who commission its services will not be able to learn important lessons about which aspects of HTM work best. This article will discuss the advantages and disadvantages of different strategies that can be employed by commissioners and service providers in the evaluation of HTM services.
TL;DR: In this article, the role and appropriateness of different research paradigms in exploring whether the enterprise culture (the NHS policy to produce resource utilisation, quality and efficiency improvements demonstrated by leading private organisations) has provided a framework for performance improvement in a rural district general hospital (DGH).
Abstract: This article examines the role and appropriateness of different research paradigms in exploring whether the enterprise culture (the NHS policy to produce resource utilisation, quality and efficiency improvements demonstrated by leading private organisations) has provided a framework for performance improvement in a rural district general hospital (DGH). The discussion and conclusions are intended to provide a broad understanding of different paradigms and methodologies in order to inform choice for a robust research protocol for a PhD study. The article is also intended to be used as a guide to other researchers in this area. The paper concludes that a stance between realism and idealism, positivism and interpretivism applied through a mixed-methodology is justified to design the research protocol.
TL;DR: Analysis of Hospital Episode Statistics data over the period 1998/99 to 2012/13 shows an increase in adult admissions for the dementia/ Alzheimer’s/Parkinson's group of diagnoses, but the changes are highly age-specific.
Abstract: 192 British Journal of Healthcare Management 2014 Vol 20 No 4 © 2 01 4 M A H ea lth ca re L td and Parkinson’s disease, all of which are neurodegenerative diseases (Jones and Goldeck, 2014). Changes in outpatient case mix have been demonstrated to occur in neurological conditions surrounding the 2012 event (Jones and Goldeck, 2014). In this respect it would be interesting to see if inpatient admissions for these conditions show evidence for cycles. Analysis of Hospital Episode Statistics (HES) data over the period 1998/99 to 2012/13 shows an increase in adult admissions for the dementia/ Alzheimer’s/Parkinson’s group of diagnoses from 65 350 in 1998/99 to 77 060 in 2012/13. However, as can be seen in Figure 1, the changes are highly age-specific. Hence, between 1998/99 and 2012/13 the proportion of age 15–59 admissions increase from 10% to 13% of the total while age 60–74 declines from 24% to 20% and 75 and over increases from 65% to 69% of the total. To understand the implication of what is happening requires further scrutiny of Figure 1. First, the cycles are centered around the last three outbreaks in 2002, 2007 and 2012 in which ages 75 and over appears to Rod Jones Long-term cycles in admissions for neurological conditions
TL;DR: The Surgical Quality and Safety Circle was formed, and was composed of hospital administrators and consultants from departments of surgery, anaesthesia and intensive care, and aimed to create a patient-centered culture.
Abstract: Hospital Authority (HA), a statutory body responsible for managing public healthcare in Hong Kong, provides 90% of inpatient hospital services. The Surgical Outcomes Monitoring and Improvement Program was launched to monitor and improve the surgical outcomes of patients managed under HA. Tuen Mun Hospital, the largest acute hospital in Hong Kong, was committed to implement quality improvement projects to improve patients' outcomes after reviewing the first report in 2010. Other than the possibility of surgical technique failure, there were multiple cultural and managerial problems recognised, which could have contributed to the suboptimal outcome. The Surgical Quality and Safety Circle was formed, and was composed of hospital administrators and consultants from departments of surgery, anaesthesia and intensive care, and aimed to create a patient-centered culture. It also aimed to improve the fundamental standards of services provided, promote inter-departmental co-ordination and communication, ensure cont...
TL;DR: While care data limps on, so does the government's proposal to introduce a new criminal offence of wilful neglect of patients in the wake of Mid-Staffs and the Francis and Berwick reports, and BJHCM Nick Timmins discusses the NHS’s proposal to use anonymised patient data.
Abstract: learning to make them better The arguments against are pretty much identical Those opposing the idea are pretty much the same people And the failure to sell the idea mirrors pretty much what happened with summary care record And that episode demonstrated spectacularly that once you are properly on the back foot and having to postpone or water down, it is incredibly difficult to recover It has to be hoped that the six-month delay will allow the argument to be one And it has sincerely to be hoped that the outcome is not an ‘opt-in’ model If it is, the value of the exercise will be hugely undermined Relatively small numbers of people oppose the idea of their organs being used for transplant But only around 30 per cent of the population finds the time to take the positive step of opting in to donor registers An opt out model is fine, so long as individuals know they have the right to do it and it is then easy for them so to do And while care data limps on, so does the government’s proposal to introduce a new criminal offence of wilful neglect of patients in the wake of Mid-Staffs and the Francis and Berwick reports The new offence will cover care in all settings, plugging what the department sees as a loophole in the law, given that such an offence already exists for the care of mentally ill or mentally incapacitated patients It does not apply to others, athough there are in fact common law and other offences that could be used Furthermore, in its latest consultation document, the government has moved beyond restricting the offence to care that causes serious harm or death, leaving it to the prosecuting authorities to decide when such a charge is appropriate Will this new piece of law raise standards of care? Well, just maybe But it is easy to be highly doubtful about that It feels like one more piece of regulation (or in this case criminal sanction) to deal with the failed regulation in Mid-Staffs, when the answer to failed regulation is not necessarily failed regulation How many prosecutions might there be? The department’s impact assessment heroically comes up with a figure of perhaps 240 a year, which sounds a lot, although a closer reading of the consultation’s impact assessment shows that it doesn’t really have much of a clue BJHCM Nick Timmins, senior fellow at the Institute for Government and the King’s Fund, discusses the NHS’s proposal to use anonymised patient data Avoiding the mistakes of the past
TL;DR: Attendances during the period up to December 2010 and the increased deaths during Rod Jones Untangling the A&E crisis are studied.
Abstract: 246 British Journal of Healthcare Management 2014 Vol 20 No 5 © 2 01 4 M A H ea lth ca re L td attendances during the period up to December 2010. It is during this time that there was a push to open Type 3 AE 2013b). The increased deaths during Rod Jones Untangling the A&E crisis
TL;DR: The results resonated with an earlier qualitative study, strengthening the findings that recruitment of frontline care workers remained the major difficulty facing many elderly care service providers, and that maintaining a stable frontline care workforce can be done only with an effective preparation of the workforce.
Abstract: The present survey study was conducted to examine the challenges facing the elderly care service industry in Hong Kong. The survey was designed based on a qualitative study conducted earlier and was aiming to examine the recruitment challenges facing Hong Kong's elderly care service providers and their perceptions of the latest elderly policy, ‘Ageing in Place’. The results resonated with an earlier qualitative study, strengthening the findings that recruitment of frontline care workers remained the major difficulty facing many elderly care service providers, and that maintaining a stable frontline care workforce can be done only with an effective preparation of the workforce through adequate education and training, along with a well-structured career prospect and reasonable competitive remuneration. Nevertheless, many elderly service providers supported the concept of ‘Ageing in Place’ and it can only be facilitated with an aged-friendly environment and by promoting the culture of intergenerational harmo...
TL;DR: It can be seen that cancelled operations during the day are a function of hospital size and medical bed pool occupancy at the end of the day (midnight) and how this related to cancelled surgical operations during that day.
Abstract: 594 British Journal of Healthcare Management 2014 Vol 20 No 12 © 2 01 4 M A H ea lth ca re L td service? Insight can be gained from a unique survey of daily (midnight) occupancy of the medical bed pool in Scottish hospitals and how this related to cancelled surgical operations during that day. Hence we are dealing with a daily occupancy figure and not a quarterly average. These data have been summarised in Figure 2 where it can be seen that cancelled operations during the day are a function of hospital size and medical bed pool occupancy at the end of the day (midnight). Hospital size ranged from 22 medical beds at the Gilbert Bain hospital in Shetland through to 424 medical beds at the Ninewells hospital in Dundee. Data were obtained by a series of Freedom of Information requests over the period 1 January 2013 to 1s March 2014 (Elison, 2014). In England, the average acute hospital has 66%, 29% and 5% of the general and acute bed pool as medical, surgical and paediatric beds respectively. Some 60 out of 190 acute Trusts have more than the maximum of 424 medical beds in the Scottish survey, and 57 English hospitals match the ‘>250’ group in Figure 2. Only 16% of hospitals have an average less than 80% occupancy, while 41% have an average over 90%, and 13% have an average over 95%. Recall that the weekly average occupancy in the general and acute bed pool is artificially lowered by low occupancy in the surgical bed pool over the weekend, and by the inclusion of low average occupancy specialties such as paediatrics. Also factor in that daily medical bed occupancy tends to rise throughout the day until around 2 pm and then begins to fall reaching a minimum around midnight. A typical medical/surgical assessment unit will see an 80% increase in occupied Rod Jones Medical bed occupancy and cancelled operations
TL;DR: How, in times of economic uncertainty and financial constraints, clinical nurse specialists within the field must articulate and demonstrate the value of their role and the service they provide is focused on.
Abstract: Clinical nurse specialists (CNSs) are valuable members of the multidisciplinary chronic pain team. This article will discuss the role of the CNS, who is required to undertake a range of activities and possess a wide portfolio of skills to support individuals to live with chronic pain. In addition, it will focus on how, in times of economic uncertainty and financial constraints, clinical nurse specialists within the field must articulate and demonstrate the value of their role and the service they provide.
TL;DR: Though the business model of outsourced NHS support services has been successful, subcontracted hourly paid, sessional and casual support workers will receive neither sharps safety training nor the support of an effective occupational health service.
Abstract: Engineered sharps safety devices have delivered a substantial reduction in sharps injuries to healthcare professionals but disposal-related errors and subsequent injury to ancillary and support staff have remained largely unchanged. Obligations placed on employers by existing health and safety legislation, and more recently by the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, are welcome developments for healthcare professionals though the protection for subcontracted support staff and agency workers may be less than adequate. Outsourcing ancillary services creates unforeseen problems. Remarkably, the sharps injury rate for support staff, when measured against employment statistics, greatly exceeds that for frontline healthcare professionals. Though the business model of outsourced NHS support services has been successful, subcontracted hourly paid, sessional and casual support workers will receive neither sharps safety training nor the support of an effective occupational health s...
TL;DR: This study examines the service for patients with hip or knee complaints in comparison with referral directly to secondary care through a musculoskeletal community assessment triage service (MCATS).
Abstract: It is important that the clinical effectiveness of referral pathways brought in to streamline patient care are critically evaluated. One such pathway for orthopaedic patients is a musculoskeletal community assessment triage service (MCATS). This study examines the service for patients with hip or knee complaints in comparison with referral directly to secondary care. A single general practice referred 432 patients with hip or knee complaints over a 5-year period: 226 through MCATS and 206 directly to secondary care. Time to initial consultation was 4 days longer, on average, in secondary care (p=0.05), but time from referral to achieving a working diagnosis was 11 days longer for MCATS patients (p<0.001), with more consultations required (p<0.001). Overall, the use of cross-sectional imaging was greater at MCATS than in secondary care (p=0.04). Patients referred directly to secondary care required surgical management more frequently (36% vs 16%; p<0.001). GPs can triage patients effectively who are likely...
TL;DR: The number of emergency admissions per death may be a useful way of gauging the number of admissions per person over a lifetime, i.e. at any point in time emergency admissions are occurring at all points of the population's life-cycle.
Abstract: 446 British Journal of Healthcare Management 2014 Vol 20 No 9 © 2 01 4 M A H ea lth ca re L td death may be a useful way of gauging the number of admissions per person over a lifetime, i.e. at any point in time emergency admissions are occurring at all points of the population’s life-cycle. In this respect, Figure 1 gives the monthly number of emergency admissions per death (both in and out of hospital) from February 2009 to February 2014. A seasonal profile is evident and this is shown in Figure 2. Deaths generally peak in January/ February; as do emergency admissions. However, deaths peak more strongly than emergency admissions and this leads to the summer peak in the ratio of emergency admissions per death. Since many emergency admissions are not directly linked to end of life, we can use this ratio as a rough snapshot of the average emergency admissions per person per lifetime. This assumption holds roughly true when births and deaths are matched. There were 1.43 births per death in England in 2013, so any ratio will be biased toward childhood emergency admissions. So how do we explain the very high figure of 11.5 (annual average) per death? First, we adjust for the current ratio of 1.43 births per death which brings the figure of 11.5 down to somewhere around 8 per death. Table 1 provides further useful insight. Admission to speciality accident and emergency (A&E) are mainly assessment unit admissions, and prior to 2002/03 was fairly constant at 2.2% of total emergency admissions. The A&E four-hour target changed all that, and by 2009/10, this had risen to 12.3% of emergency admissions. Rod Jones Trends in emergency admissions per death
TL;DR: Most GPs were aware of and used the Sexually Transmitted Infections (STI) Testing Tool; the Online STI Testing Tool GP training was perceived to improve GPs' ability to raise the topic of STIs with patients and order appropriate tests.
Abstract: Objective: Describe how different types of resources are received and perceived by primary care clinicians to improve sexual healthcare. Study design: Cross-sectional online survey of primary care clinicians in New South Wales, Australia, to evaluate the perceived impact of nine resources to promote sexual healthcare—seven were tailored to general practitioners (GPs) and two to practice nurses (PNs). Participants: 431 primary care clinicians (GPs=214; PNs=217). Main outcome measures: Awareness, use and perceived impact of the resources. Principal findings: Most GPs were aware of and used the Sexually Transmitted Infections (STI) Testing Tool; the Online STI Testing Tool GP training was perceived to improve GPs' ability to raise the topic of STIs with patients and order appropriate tests. Although the highest proportion of PNs were aware of the online STI PN training, most used the PN Postcard. The former helped to improve PNs' ability to identify at-risk patients and document sexual history. Conclusions: ...
TL;DR: Steve Jessop, Chief Nurse Information Officer of Hull and East Yorkshire NHS Trust, argues that the way forward is using mobile devices for managing clinical information.
Abstract: Steve Jessop, Chief Nurse Information Officer of Hull and East Yorkshire NHS Trust, argues that the way forward is using mobile devices for managing clinical information
TL;DR: A retrospective audit of 500 consecutive day case upper limb trauma cases that were managed in a hand unit between 1 May and 31 October 2011 to examine the effectiveness of mandatory screening for MRSA screening in a patient cohort.
Abstract: Aims: Approximately 3% of the UK population are carriers for methicillin-resistant Staphylococcus aureus (MRSA). The NHS set a target of reducing MRSA nosocomial infections by 20% in 2012/13. The Department of Health instigated mandatory universal screening for elective and trauma surgery at significant cost and increased resource demand. Patients presenting to our service with simple upper limb trauma requiring day case surgical intervention are included in mandatory universal MRSA screening, despite being discharged post-operatively before any screening result is known. The aim of this study was to examine the effectiveness of mandatory screening in our patient cohort. Methods: We undertook a retrospective audit of 500 consecutive day case upper limb trauma cases that were managed in our hand unit between 1 May and 31 October 2011. Patient demographics, injury, operative intervention, pre-operative MRSA screening result and post-operative wound swab results were examined. Patients with frankly infective...
TL;DR: An analysis of the average year-to-year volatility in acute admissions for various specialty-age combinations calculated over a 15-year period for the whole of England, showing rapidly escalating average volatility as the activity diminishes.
Abstract: British Journal of Healthcare Management 2014 Vol 20 No 10 489 © 2 01 4 M A H ea lth ca re L td environment (weather and infectious outbreaks). Figure 1 presents an analysis of the average year-to-year volatility in acute admissions for various specialty-age combinations calculated over a 15-year period (1998/99 to 2012/13) for the whole of England. To simplify the analysis some high level specialty groups have been created covering medicine and surgery. The absolute difference between each year has been calculated and divided by the square root of the first year to convert the difference into a Poisson approximation to standard deviations worth of difference. The average of these has been calculated and turned back into a percentage difference using 2012/13 activity. This adjusts the time series for growth into present day activity. Age has been included to reflect the fact that different parts of the country have different age distributions. Elective and non-elective has been included to give an overall picture and because in more deprived locations the balance shifts toward non-elective admission. Between 2002/03 and 2010/11, there was additional growth due to ‘admissions’ into assessment units and HRG tariff-driven counting creep as outpatient procedures and tests were re-badged as a ‘day case’. The slope of the trend between these years has been calculated, as has the slope either side of these years, and subtracted from the calculation of volatility. To avoid any over-estimation of volatility the highest year-to-year volatility (usually arising when a counting change has occurred), has been deleted from the calculation of the average. Some 52 age-specialty combinations are shown in Figure 1, and all roughly cluster around a power-law (or loglog) relationship which is described by the equation shown. Note the rapidly escalating average volatility as the activity diminishes. This is driven by two components. First, simple statistical scatter around an average, shown in the dotted line, which represents 2.2 standard Rod Jones Financial volatility in NHS contracts
TL;DR: The article will discuss the rationale and outline plans for an example of a recent service development within a mental health service for refugee children and young people, in terms of opportunities and challenges presented, and explore the barriers and obstacles to the proposed new service.
Abstract: This article will outline a plan for a redesign of service structure and delivery in the current context of the equal importance of high-quality clinical care and economic efficiency. This will be drawn from the author's experience of developing proposals for funding and setting services in this new and perceivably challenging environment. The article will discuss the rationale and outline plans for an example of a recent service development within a mental health service for refugee children and young people, in terms of opportunities and challenges presented. It will go on to explore the barriers and obstacles to the proposed new service through an interview with the manager of the service. An explicit discussion of these issues could initiate the development of a realistic idea of the benefits and challenges involved in making these strategic and service changes.
TL;DR: This article outlines how Scotland's approach to improving chronic pain services has evolved over the last seven years and where it stands currently.
Abstract: This article outlines how Scotland's approach to improving chronic pain services has evolved over the last seven years and where it stands currently. Successive reports have highlighted patchy provision of chronic pain management services. The Scottish Service Model for Chronic Pain clearly sets out how services need to be organised and delivered across the whole patient pathway. Establishing a nationally resourced initiative has provided clear direction, support and drive to improve clinical services locally.