British Health Care System Research Articles

Exploring the experiences and perceptions of trainees undertaking a critical incident debrief training programme: A qualitative study.

Critical incident debriefing is an occupational health tool for supporting healthcare workers following critical incidents. Demand for debriefing has increased following the Covid-19 pandemic. There is now a need for more trained debrief facilitators to meet demand, but there is a dearth of literature regarding how best to train facilitators. This study addressed this by exploring participant experiences of an online critical incident debrief training programme. We conducted semi-structured interviews with 14 individuals who received a 5-day training programme based on the Critical Incident Stress Management model. Participants were recruited from a range of professional disciplines including psychology, nursing and human resources within one British healthcare system. Data were analysed using thematic analysis. The analysis produced three themes. Managing trainee experiences and expectations suggested that disciplinary heterogeneity in training groups supported inter-participant knowledge exchange. However, this variation also meant that training materials did not meet the learning needs of all participants. Modality of training suggested that while online learning was acceptable for some, others experienced screen fatigue and found it hard to build rapport with other participants. Systematic and organisational obstacles to training access and delivery suggested that lack of managerial support and organisational mental health stigma may be barriers to accessing training. A 5-day online CISM-based training programme was acceptable to participants. Organisations implementing critical incident debrief training may benefit from (1) offering both in-person and online training options, and (2) tailoring course materials according to the disciplinary make-up of groups.

Resource utilisation and outcomes of people with heart failure in England: a descriptive analysis of linked primary and secondary care data – the PULSE study

BackgroundHeart failure (HF) is associated with high levels of resource use and mortality, but prior UK studies have not compared outcomes by HF subtype (HF with reduced ejection fraction (HFrEF)...

The UK's ''Shortage of Occupation Scheme'': Advanced Stage of Neo-Colonialism on the Health System of Less Developed Countries: The Case of Nigeria

Purpose: As of May 2023, there is a chance that every day, about 50 Nigerians are convinced to get ready to move into the British healthcare system to fill the gap created by the demanding and expensive labour force of other European countries during the Brexit referendum of 2016. It is evidential that the exodus of this group of persons leaves a big gap in the healthcare sector of Nigeria and other countries with similar impact. To make things visible, this article will be elaborating on the neo-colonial approach taken by the British state to overcome the deficit in the labour force created after Brexit and how this hugely affects the countries providing the labour force, with our focus on Nigeria. The key terms to explored in this article are Neo-colonialism, Brexit and labour force. The article explains how the involvement of the British state in the Brexit referendum created a lacune in the job market and British state through neo-colonialism is using the workforce of the less developed countries to fill the gaps and rendering these countries vulnerable.
 Methodology: In order to ascertain the role of the British state in the collapse of the Nigerian healthcare system, a mixed method of both qualitative and quantitative information is collected from primary and secondary sources via current events, government policies, and existing academic publications as well as a visible and existing facts in the society. This is possible from the fact that the author is African from Cameroon, a neighbouring country to Nigeria where similar impacts of a destroyed healthcare system is felt. This is also facilitated by the fact that the author who is a foreign registered solicitor and a healthcare worker (healthcare assistant) in the UK is able to gather data through phone from some desirous Nigerians aiming towards migrating to the UK and also from those who have migrated through the shortage of occupation scheme from Nigeria and analysing same for the purpose of coming out with the outcome of this research.
 Findings: The article came out with its' findings that the neo-colonial control of the British state on less developed countries especially in the health sector, weakens and impoverishes these countries and give room for the countries to continue in a state of underdevelopment. That this is done through brain drain, brainwashing and other forms of exploitation.
 Unique Contribution to Theory, Practice and Policy: Using Marxism to explain the concept of neo-colonialism in this publication further explores the concept and related concepts and would serve as an enhancement to the career of a legal practitioners and activists who practice in this fields. It would serve as an eye opener to the society which may not have seen this approach of Neo-colonialism as harmful. The research will also serve as a tool to Immigration Organizations, healthcare providers, Human Rights campaigners, and policy makers of Nigeria in the fight and restructuring instruments that are negatively affecting the lives of citizens and other vulnerable group of persons. Finally, the research may have a transferable impact, to countries with similar experiences.

Becoming active in the micro-politics of healthcare re-organisation: The identity work and political activation of doctors, nurses and managers

The changing organisation and governance of healthcare work represents a persistent focus of micro-politics. Whilst there is a developed literature describing the micro-political struggles that occur amongst healthcare occupations, there is little understanding about how, when and why actors become politically aware and active. Framed by research on political activation and the concept of identity work, this paper reports on a narrative interview study with 65 people, specifically doctors, nurses and managers, working in the English healthcare system. The narratives show that healthcare workers become increasingly aware of and engaged in micro-political activities through incremental stages based on their accumulating experiences. These stages are opportunities for identity work as actors make sense of their experiences of micro-politics, their occupational affiliations and their evolving sense of self. This identity work is shaped by actors' changing views about the morality of playing politics, the emotional implications of their engagement, and their deepening political commitments. The study shows that political socialisation and activation can vary between occupations and rather than assuming political affiliations are given or acquired the papers highlights the reflective agency of healthcare actors.

At the junctures of healthcare: a qualitative study of primary and specialist service use by Polish migrants in England

Background:Polish people are the biggest migrant group in the UK and the scholarship shows that they are attentive to their healthcare needs and seek to fulfil them by using various services both within and outside the British public healthcare system. This article explores the role of junctures within healthcare systems in the connections migrants realize between healthcare systems and sectors. The article argues that in a transnational context, migrants enact these junctures by joining different levels of care within the same sector, between sectors and across national borders. In particular, the article explores how Polish migrants’ healthcare seeking practices within and beyond national borders are enacted given the features, availability and relationship between primary and specialist care for how they are articulated between private and public sectors.Methods:This article is based on the second phase of a mixed-methods study on how Polish people in the UK manage their health transnationally. The participants were purposefully sampled from survey respondents (first phase) who identified as having a long-term health condition or caring in a non-professional capacity for someone who is chronically ill. Thirty-two semi-structured audio-call interviews were conducted with Polish migrants living in England between June and August 2020. Transcripts were analysed by applying thematic coding.Results:Key findings include a mix of dissatisfaction and satisfaction with primary care and general satisfaction with specialist care. Coping strategies consisting in reaching specialist private healthcare provided a way to access specialist care at all or additionally, or to partially complement primary care. When Polish private specialists are preferred, this is due to participants’ availability of time and financial resources, and to the specialists’ capacity to fulfil needs unmet within the public healthcare sector in the UK.ConclusionPolish migrants join with their practices systems which are not integrated, and their access is limited by the constraints implied in accessing paid services in Poland. This shapes transnational healthcare practices as relating mostly to routine and ad-hoc access to healthcare. These practices impact not only the wellbeing of migrants and the development of the private market but also the public health provision of services.

Cancer Experience of Care Improvement Collaboratives in the National Health Service in England

NHS England started the work described in this article with the ambition of using insight and feedback from the adult National Cancer Patient Experience Survey to grow coproduced service improvements leading to improved patient centred quality outcomes in experience for cancer patients. Based on the Institute for Healthcare Improvement’s Breakthrough Collaborative Series, the approach of the Cancer Experience of Care Improvement Collaboratives (CIC) in the English healthcare system was developed, initially with 19 NHS provider organisation teams in 2019 as a face-to-face model, then developing into two collaboratives with an additional 15 NHS provider organisation teams in Cohort 2 and 8 teams in Rare & Less Common Cancers in a virtual framework. Each cohort has reported improvements in patient experience, staff experience and team working, but more fundamentally, have been able to describe a cultural shift in the way they work, together with people, leaving a lasting impact and legacy of this work. Key learning has been recognised with the increasing emphasis on involving people with relevant lived experience as partners and colleagues in the collaborative, alongside flexibility, responsiveness and adaptability as key to enabling project teams to continue where COVID-19 pressures allowed to participate.

PROF. MUHAMMAD SHAFIQUE (1936-2022): PIONEER OF PSYCHIATRY IN KHYBER PAKHTUNKHWA, PAKISTAN

PROF. MUHAMMAD SHAFIQUE (1936-2022): PIONEER OF PSYCHIATRY IN KHYBER PAKHTUNKHWA, PAKISTAN

Observational retrospective study calculating health service costs of patients receiving surgery for chronic rhinosinusitis in England, using linked patient-level primary and secondary care electronic data

ObjectivesChronic rhinosinusitis (CRS) symptoms are experienced by an estimated 11% of UK adults, and symptoms have major impacts on quality of life. Data from UK and elsewhere suggest high economic...

POSB143 The Financial Burden of Surgically Managing Chronic Rhinosinusitis with Nasal Polyposis in England

Chronic rhinosinusitis with nasal polyposis (CRSwNP) characterised by type 2 inflammation imposes significant burden of illness. Many patients whose symptoms are uncontrolled by intranasal corticosteroids need repeated surgeries to alleviate rhinorrhea, nasal congestion, hyposmia and/or facial pressure. The objective of this study was to determine the financial burden due to surgically managed CRSwNP from an NHS perspective. Hospital Episode Statistics (HES) were used to capture the characteristics and costs for all CRSwNP patients with ≥1 sinus surgery in England between April 2010 and March 2020. Patients were stratified into subgroups based on the absence (NP-No Comorbidities (NC)) or presence of relevant comorbidities such as asthma only (NP-Asthma) or asthma with NSAID exacerbated respiratory disease, known as Samter’s triad (NP-ST). 101,054 patients were included in the study (64% (n=64,461) NP-NC, 31.7% (n=32,049) NP-Asthma, 4.5% (n=4,544) NP-ST). The total cost of treating these patients was £260 million, with surgery tariffs, inpatient tariffs and outpatient tariffs accounting for 66.8% (£173.8million), 11.3% (£29.3 million) and 21.9% (£57 million) respectively. The average surgery tariff for an NP-ST patient was £2,089, significantly higher than the tariff associated with the NP-Asthma (£1,755), and NP-NC (£1,676) subgroups (p<0.01). Both inpatient and outpatient average tariffs were numerically and statistically significantly higher for NP-ST and NP-Asthma patients compared to NP-NC patients. Combined inpatient and outpatient tariffs were £631 per NP-NC patient, rising to £1,103 and £2,253 for NP-Asthma and NP-ST patients respectively. Surgical management of CRSwNP constitutes a significant direct financial burden on the English healthcare system, particulary for patients with comorbidities. These patients, or those with a poor surgical prognosis, may benefit from the emerging novel biologic therapies which can reduce the clinical burden of disease. Such treatment strategies may also contribute to a reduction in the significant financial burden associated with surgical costs.

A collaborative genetic carrier screening model for the British Ashkenazi Jewish community.

We present a unique model of a British genetic carrier screening programme for individuals with Ashkenazi Jewish ancestry that exemplifies a partnership between a publicly funded healthcare service (the NHS) and a charity, Jnetics. This model provides affordable access to carrier screening for severe autosomal recessive diseases increased in this community. Prior to the development of this programme, the British healthcare system only provided Tay Sachs’ screening for this community, leaving them at higher risk of having a child with a serious autosomal recessive disease. The Jnetics screening programme is promoted through community and social media campaigns, involves educational outreach, a pre-test genetic counselling service by a dedicated NHS-based genetic counsellor, saliva-based DNA testing, comprehensive reporting and, where required, post-test genetic counselling. The charity raises funds to subsidise the screening. In 6 years, the model has been successfully implemented in hospital and community settings and in schools and universities, aiming to reach those pre-conception. In response to the COVID-19 pandemic, the programme adapted by offering genetic screening virtually and has subsequently expanded in its outreach. Furthermore, the screening panel is currently being expanded to include other conditions increased in the Ashkenazi and also the Sephardi and Mizrahi Jewish communities. An example of innovation and accessibility, providing free screening to all students and disadvantaged individuals, the programme aims to provide a model that can potentially be adopted by other genetically at-risk communities.

Integrity in Public Life: Reflections on a Duty of Candour

This article will evaluate whether a “duty of candour” on public employees including specifically health practitioners and police officers is an effective mechanism in terms for improving trust and openness. This is the context of the actions of the police in relation to the Hillsborough Stadium disaster in 1989 where 96 soccer fans died at the match due to ineffective policing. The formal identification of responsibility on the part of the police despite the attempt by the police to attribute blame elsewhere, was the starting point of a proposal for an explicit duty on officials in public bodies such as the police to tell the truth and be under a statutory “duty of candour.” The article provides an overview of the duty of candour, its subsequent development, legislatively and professionally in the context of the British health care system, where it currently exists, and the potential impact for the police. It is argued that engagement with the paradox between professional and organizational duty expressed through the language of culture and truth telling is necessary to reassert the importance of trust and integrity in a range of public bodies.

Knowledge of Nutritional Issues among Osteopaths in Austria: A Cross-Sectional Study

Introduction: Osteopaths are important actors in the Austrian healthcare system. High prevalence rates for diseases associated with nutrition, as well as studies from other countries, imply that os-teopaths are confronted with questions regarding nutrition in the course of their work. Aim: The purpose of this study was to survey osteopath's knowledge of nutritional issues in a cross-sectional study and analyze factors that influence nutrition knowledge. Furthermore, it will be investigated if osteopaths are confronted with problems or questions regarding nutrition. Material and Methods: With the help of schools of osteopathy all osteopaths, who could be found in Austria, were asked to participate in an online survey. As instruments of research, the General Nutrition Knowledge Questionnaire (GNKQ) and a second questionnaire were used. Results: The average rate of correctly answered questions was 74.4% for the GNKQ and 37.2% for the Temple Questionnaire (n=188). Discussion: Compared to other occupational groups in the American or British healthcare system, Austrian osteopaths' average nutritional knowledge is slightly higher. Only nutrition experts and people employed at centres specializing in eating disorders obtained more favourable results. Fur-ther surveys ought to develop valid instruments for Austria and attempt to define which amount of nutrition knowledge can be considered as adequate for certain occupational groups. Keywords: nutrition knowledge, knowledge of nutritional issues, osteopathy, General Nutrition Knowledge Questionnaire

Climate change and health: time for action!

IssueFor several weeks, prophylactic messages against the extension of Covid-19 have saturated the public space. To protect populations, efficient measures have been rapidly put to limit the movement of people and manufactured goods. These policies have reduced global greenhouse gas emissions as well as air pollution, especially in China.ProblemIf climate change were an epidemic, we would probably have already restored it. But it results directly from the thermo-industrial activities linked to the consumption society. For Friel (Lancet, 2020), the dramatic consequences of this disturbances have to be considered as an essential health issue. She advocates for 'climate change and health alliances'.ResultsWithin such alliances, health professionals have the responsibility (1) to describe the morbidity inherent in our thermo-industrial societies (2) to alert populations, and (3) to work with allies to tackle climate change and protect human populations, starting with the most vulnerable. This type of alliance is underway in the battle against air pollution, as it has been for years for fighting smoking. Alliances are intended to extend to all population health issues, with a complete decompartmentalization of minds and practices at large scale.LessonsHealth professionals have to be mindful not to cause any harm while practicing. The health system alone produces up to 8% of global greenhouse gas in developed countries (Pichler, 2019; HCWH, 2019). There is room for action. Since 2009, the British health care system (NHS) has adopted an efficient decarbonation policy, reducing global emission from 8 to 4%, but this outstanding initiative remains an exception worldwide.Key messages A review of public health strategies is necessary to meet the energy, environmental and health issues, both in terms of health risks due to climate change and of decarbonation of care activities.Health professionals have the responsibility to alert populations and to work with allies to tackle climate change and protect human populations.

The contingencies of medical restratification across inter-organisational care networks.

The contemporary social organisation of medical work is characterised by internal hierarchies and stratification in the form of professional elites and managerial hybrids. This paper examines the changes in medical restratification brought about by the introduction of inter-organisational care networks. The study focuses in particular on the social position of doctors and the contingencies that enable or constrain intra-professional hierarchies across inter-organisational boundaries. This ethnographic study of major system change within the English healthcare system finds that a relatively small group of 'multiplex' elites have significant influence in both national policy-making and regional service re-configuration based upon multiple sources of clinical and reputational capital. Subsequent forms of restratification at the regional level are found to mirror such status markers whilst also revealing important local contingencies, especially where professional markers of distinction are coupled with and dependent upon organisational markers of distinction.

HEALTH CARE FOR IMMIGRANTS IN THE UNITED KINGDOM: HOW IS THE BRITISH SYSTEM PREPARED FOR SERVICING PATIENTS WHO ARE FOREIGNERS?

The article presents solutions that enable access to British health care system by foreigners. The migration situation and health care system in the UK is presented. The actions that have been taken to ensure foreigners get access to medical care are described. According to the law, the Primary Care is free for all patients staying in the UK. Secondary Care is free for patients with ordinary residents status, people who have access to healthcare on the basis of international agreements or immigration health surcharge. In order to enable the use of medical care, for non-English speakers, telephone interpretation is commonly used. The Equality and Diversity Council is dealing with problems related to equal access to medical care. Actions taken in the UK can be a reference point in searching for solutions that can be introduced in Poland to ensure equal access to medical care for foreigners.

The costs of treating vaginal and vulval cancer in England (2009\u20132015)

BackgroundHuman papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide. A causal relationship also exists between HPV and cancer in other areas of the female reproductive system including the vagina and vulva. Whilst the incidence of vaginal cancer in the UK has remained relatively stable over the past 25 years, vulval cancer rates are increasing. A body of literature exists on the epidemiology and aetiology of vaginal and vulval cancer, but little is known about the economic burden. The objective of this study was to quantify the costs of treating these cancers on the National Health Service (NHS) in England.MethodsInpatient and outpatient episodes were derived from Hospital Episode Statistics (HES). Health Resource Group (HRG) tariffs and National Reference Costs were used to estimate the cost of treating pre-cancerous and invasive vaginal and vulval lesions in England.ResultsThe study showed that for the 5 years from 2009/2010 to 2014/2015 the total cost associated with pre-cancerous and invasive vaginal and vulval lesions was over £14 million per year on average (95% of which was attributed to inpatient costs). Vulval cancer accounted for the largest proportion; an estimated 60% of the total cost (£8.82 million). On average 4316 patients per year in England were admitted to hospital and 912 patients attended outpatient settings for pre-cancerous and invasive disease of the vagina and vulva.ConclusionThe results indicate that vaginal and vulval cancer cost the English health care system over £14 million per year. Given the causal role of HPV in a proportion of these cancers, preventative measures such as the national HPV immunisation programme have the potential to reduce the economic burden. To ensure optimal use of NHS resources, it is important that future economic evaluations of such preventative measures consider the full burden of HPV related disease.

Economic Migration of Eastern Europeans in the UK after the UK Referendum Held in 2016

The economic status of Eastern European migrants has become a major issue in the UK, as it was one of the main arguments for leaving the European Union in the 2016 Referendum. The negative view on migrants from Eastern Europe in the UK relies on the fact that these migrants are a major burden for the British social and healthcare system. At the same time, however, the issue of modern slavery is discussed, based on the fact that Eastern Europeans in the UK are willing to work under undignified working conditions. The aim of the paper is to analyse and evaluate the economic status of Eastern Europeans on the UK labour market. The paper is based on the theoretical concept of the dual labour market, which is used in the analysis of real data. The dataset used was prepared by the UK Office for National Statistics (GB): As the conclusion, the expected changes in migration of the Eastern Europeans after the UK’s leaving the European Union, currently scheduled for 31 November 2020, are given.

Awareness of and attitudes towards cervical cancer prevention among migrant Eastern European women in England.

It has been hypothesized that, in England, the rise in incidence of cervical cancer and the fall in screening coverage might be attributable in part to the effect of migration of Eastern European born women. We explored the attitudes and behaviours of these women towards cervical cancer prevention strategies. A mixed methods study using quantitative surveys and in-depth semi-structured qualitative interviews was conducted between April 2015 and December 2016. In total, 331 surveys and 46 interviews were completed. Native English women had greater knowledge that a smear test is a screening test for pre-cancerous cervical cells (90% vs. 71% p≤0.01), whereas migrant Eastern European women believed that it was conducted as part of a full gynaecological examination (46% vs. 21% p≤0.01) and that the screen interval was annual (18% vs. 4% p≤0.01). Distrust of the English healthcare system resulted in some Eastern European women returning to their country of birth for screening. Poor awareness of cervical cancer prior to migration and lack of information at registration with a general practitioner in England were associated with failure to participate in screening. The views and attitudes expressed by the migrant Eastern European women in this study suggest that they are not fully participating in cervical screening in England. Targeted education at the point of contact with healthcare services in England is needed to increase cervical screening participation among these women.

How policy tools evolve in the healthcare sector. Five countries compared

ABSTRACT The aim of this work is to investigate which policy tools are used in the governance of the healthcare sector. In particular, we compare the healthcare systems of five OECD countries: Australia, Canada, Germany, England and the Netherlands. The analysis intends to reconstruct the healthcare governance methods implemented in these countries, and understand how they have evolved over the last thirty years. Throughout this work, policy tools are subdivided into four categories: direct provision, regulation, financing and information. Direct provision remains the prevailing mode of governance in the English healthcare system. All of the five countries studied in this work make extensive use of regulation. Insurer regulation is particularly stringent in Germany, the Netherlands and Australia. Of the countries examined, those that make the greatest use of financial leverage seem to be Australia and Canada. England and the Netherlands are the two countries that focus most on informative policy tools.

Coastal flooding and frontline health care services: challenges for flood risk resilience in the English health care system.

ObjectivesOur objective was to assess the health care system impacts associated with the December 2013 east coast flooding in Boston, Lincolnshire, in order to gain an insight into the capacity of the health care sector to respond to high-impact weather.MethodsSemistructured interviews were held with regional strategic decision makers and local service managers within 1 km of the recorded flood outline to ascertain their experiences, views and reflections concerning the event and its associated health impacts and disruption to health care services. A snowballing sampling technique was used to ensure the study had participants across a broad range of expertise. Interviews were recorded and transcribed verbatim, and data analysis was preformed using NVivo (v10) to apply a thematic coding and develop a framework of ideas.ResultsThe results of this case study provide a vital insight into the health care disruption caused by flooding. All sectors of the health care system suffered disruption, which placed a strain on the whole system and reduced the capacity of the sector to respond to the health consequences of flooding and delivering routine health care. The formal recovery phase in Lincolnshire was stood-down on 4th February 2014. The results of this work indicate limitations in preparedness of the health care system for the reasonable worse-case scenario for an east coast surge event.ConclusionsThe health care sector appears to have limited capacity to respond to weather-related impacts and is therefore unprepared for the risks associated with a future changing climate. Further work is required to ensure that the health care system continues to review and learn from such events to increase climate resilience.