Care Organisations In England Research Articles

Binaries and Blurred Lines: The Ethical Stress of Child Protection Social Work in the Grey of Extra-Familial Harm

ABSTRACT Social care responses to extra-familial harm require social workers to work across the binaries of welfare and justice, victim and perpetrator, parent and professional, risk and protection. This paper examines the ethical consequences of working in this manner, through qualitative data (focus groups, interviews, observations, case file analysis and documentary review) from three children's social care organisations in England who trialled new child protection pathways for significant harm outside of family homes/relationships. The extent to which these pathways created five conditions for a welfare response to extra-familial harm are considered, before these results are brought into conversation with Bourdieu’s meta theory of capital, habitus and doxa, and Fenton's practice theory of ethical stress. The challenges identified evidence of the importance foregrounding social work values in the pursuit of welfare-based response to extra-familial harm. They also offer a rationale for studying theories of care ethics in social work in the context of interagency practice.

Uptake of advanced clinical practice roles in the health service in England: Perspectives at the micro level

Health care organisations in many countries are developing advanced clinical practitioner roles to address workforce shortages and growing demand for services. Even in countries where advanced practice roles are more established there are low numbers, clustered in a limited range of professions, mostly nursing specialities. Successful implementation of national policies encouraging increased advanced practice roles and from a broader range of professions, requires attention to all levels of the health system. There is a lack of evidence as to the motivation to take-up these roles at the micro, individual actor level. This study explored the motivations important at the micro level in influencing a range of health professionals to undertake advanced practice roles. The study used an interpretive methodology with thematic analysis and was framed by theories of motivational domains in the work environment. Semi-structured interviews were undertaken with eighteen advanced clinical practitioners working in health care organisations in England. The motivators for role take-up were found to be predominantly intrinsic reflecting participants’ desires for advancement, both personal and for their profession, and improved efficiency of patient care. Participants described experiencing limited organisational support and sometimes discouragement from other professionals. There is potential for health organisations at the meso level of health care systems to support national growth of advanced practice roles by giving attention to the motivations of diverse health professionals. We propose a new theoretical framework of motivators for advanced clinical practice role uptake at the micro level.

How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland?

To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.

Child sexual exploitation

Purpose The purpose of this paper is to offer an overview of the research to date, including how some findings have informed practice within child care organisations in England and Wales. The challenges of applying this research are considered, along with some of its key limitations. Avenues for future research are proposed, but understanding will only progress further if research is underpinned by appropriate theory. This paper suggests promising theory that could be applied to CSE. There is also a need to consider CSE risk more holistically and not just in relation to the presence or absence of discrete vulnerability factors. Design/methodology/approach This is a brief overview of the literature to date, with a focus on how it has been applied by child care professionals. Findings Discusses how some findings have informed practice within child care organisations in England and Wales. Originality/value This is a viewpoint piece.

Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial

SummaryBackgroundMany countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. We aimed to assess the effectiveness of giving the programme to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth.MethodsWe did a pragmatic, non-blinded, randomised controlled, parallel-group trial in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organisations in England. Eligible participants were nulliparous and aged 19 years or younger, and were recruited at less than 25 weeks' gestation. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimised by gestation (<16 weeks vs ≥16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Mothers and assessors (local researchers at baseline and 24 months' follow-up) were not masked to group allocation, but telephone interviewers were blinded. Primary endpoints were biomarker-calibrated self-reported tobacco use by the mother at late pregnancy, birthweight of the baby, the proportion of women with a second pregnancy within 24 months post-partum, and emergency attendances and hospital admissions for the child within 24 months post-partum. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN23019866.FindingsBetween June 16, 2009, and July 28, 2010, we screened 3251 women. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. All follow-up data were retrieved by April 25, 2014. 304 (56%) of 547 women assigned to FNP and 306 (56%) of 545 assigned to usual care smoked at late pregnancy (adjusted odds ratio [AOR] 0·90, 97·5% CI 0·64–1·28). Mean birthweight of 742 babies with mothers assigned to FNP was 3217·4 g (SD 618·0), whereas birthweight of 768 babies assigned to usual care was 3197·5 g (SD 581·5; adjusted mean difference 20·75 g, 97·5% CI −47·73 to 89·23. 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (AOR 1·32, 97·5% CI 0·99–1·76). 426 (66%) of 643 assessed women assigned to FNP and 427 (66%) 646 assigned to usual care had a second pregnancy within 2 years (AOR 1·01, 0·77–1·33). At least one serious adverse event (mainly clinical events associated with pregnancy and infancy period) was reported for 310 (38%) of 808 participants (mother–child) in the usual care group and 357 (44%) of 810 in the FNP group, none of which were considered related to the intervention.InterpretationAdding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. Programme continuation is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge.FundingDepartment of Health Policy Research Programme.

Managers’ Identification with and Adoption of Telehealthcare

This paper presents managerial attempts at implementing telehealthcare. Our longitudinal, ethnographic case studies document both successful and failed implementations across five health and social care organisations in England. We draw on theories of organisational identity, sensemaking and sensegiving to highlight how managerial organisational identities can inhibit the uptake of digital health technologies. Managers who strongly identified with their current role at work felt threatened by the intended change; a telehealthcare mode of care delivery. When a strongly identified workforce agrees with this assessment, managerial and employee sensemaking and sensegiving coalesce, forming a united front of resistance that prevents further adoption of the innovation.

Constructing the gendered body? A critical discourse analysis of gender equality schemes in the health sector in England

This article examines gender discourses embedded in gender equality policies in the health sector. Gender mainstreaming was first adopted by a number of international and intergovernmental, regional and national actors some time ago, yet there is limited evidence of progress in addressing gender justice in health. Failures in gender equality policies have often been attributed to the lack of gender-disaggregated data, combined with a lack of resources, training and skills. In addition, studies have identified problems originating in the shift from participatory approaches to technocratic solutions, and the persistence of underlying gender relations of power. However, gender equality policies may also contribute to gender discourse in ways which reinforce and perpetuate inequalities between men and women. This article draws on Bacchi’s ‘what is the problem represented to be’ (WPR) approach to policy analysis, to explore responses of primary care organisations in England to legislation requiring public sector organisations to tackle gender discrimination and promote equality of opportunity between men and women. The article adopts a critical discourse approach to gender equality documents and suggests that such texts construct women and men as essentially different, reinforcing specific forms of masculinity and male performance and notions of male disadvantage in health systems.

Cash for student placements will help promote primary care jobs

Primary care organisations in England could be given cash for providing practice placements to nursing students as part of plans to boost nurse numbers in community settings. Health Education England is exploring the idea of standardised payments to primary care organisations that offer placements. Its director of nursing Lisa Bayliss-Pratt said that if more trainee nurses completed community placements they might seek jobs in primary care after qualifying, instead of taking the traditional route into secondary care. Traditionally, acute trusts have received payments but there have been wide regional variations, resulting in an uneven distribution of students and a lack of opportunities for nurses to gain experience of the community sector, said Dr Bayliss-Pratt. She made the comments at a Queen’s Nursing Institute (QNI) conference in London last week on providing health care in patients’ homes. The comments followed a question from the audience asking what was being done to attract more nurses into community settings. The audience member told Dr Bayliss-Pratt that some university courses for community

An evaluation of staff engagement programmes in four National Health Service Acute Trusts

The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision-making, and the related literature. A mixed-methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used. The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were "championed" by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation. The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations. Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done.

Demand for hospital beds in primary care organisations

This paper demonstrates that the ratio of bed days per death reflects the contribution from factors which increase demand for hospital admission and bed use. Data covering primary care organisations was extracted from a variety of sources and the relationships affecting higher bed days per death were explored. The capitation formula used to fund primary care organisations in England shows no correlation with bed days per death and may be inadvertently creating financial pressures. Healthcare policy needs to foster greater integration in healthcare. Bed days per death is introduced as a new performance measure which can be used to track the success of a variety of admission avoidance and other schemes for care in the community and to support international comparisons of bed utilisation.

P1-21 Cluster randomised trials in a healthcare database: utilising electronic patient records for intervention research

IntroductionCluster randomised trials (CRTs) may have limited power because of the correlation of individual responses within clusters and the allocation of only small numbers of clusters. This ongoing study evaluates...

Medicines Use Review: adoption and spread of a service innovation

Abstract Background Research has shown that implementation of community pharmacy Medicines Use Review and Prescription Intervention (MUR) in the first year of the service in England and Wales was less extensive than anticipated. Several barriers to MUR becoming accepted and embedded in the National Health Service (NHS) were identified. Objective To evaluate progress in the provision of the MUR service in England and Wales in its second year (April 1, 2006-March 31, 2007) compared with the first year; and to analyse trends from available national data from the third year of provision in 2007–2008. Methods The analysis drew on the following data sources: routine data on provision of MURs for community pharmacies in a stratified random sample of 31 primary care organisations in England and Wales, and national datasets on MUR provision from the Pharmaceutical Services Negotiating Committee and NHS Information Centre. Outcome measures The percentage of community pharmacies providing the MUR service, the numbers of MURs provided in 2006–2007 at pharmacy and primary care organisation level, and the extent of, and variation in, provision. Key findings The percentage of community pharmacies providing the MUR service increased from 38 to 67.2%. Overall, 62 559 MURs were provided (a more than four-fold increase on the previous year), representing 13.8% of the possible maximum. The mean number of MURs provided (per provider) increased from 36 to 85. For existing providers the mean number increased from 36 to 111 (median 78, range 0–423). For new providers the mean number was 52 (median 17, range 1–401). More than half (52%) of the pharmacies in the sample claimed for fewer than 50 MURs. Overall, 82% of MURs were provided by multiples and this percentage was lower among new providers (62%) than existing providers (89%). Thirty-three (8.1%) existing MUR providers had no recorded MURs in the second year: almost two-thirds of these (64%) were independents. Eleven pharmacies (1.5%) provided the maximum number of 400 MURs per year: all but one were branches of multiples. Of the pharmacies not yet providing MURs, 78% were independent. Conclusions Both numbers of MURs and numbers of providers of MUR services increased markedly during the service's second year. Those newly providing the service in the second year claimed for more than twice as many MURs as did those who had been ‘new providers' the previous year. Overall just over half of all providing pharmacies claimed for the equivalent of one MUR a week or fewer. Therefore the extent of ‘successful adoption’ of MURs is debatable. Differences in the level of provision continued between independent and multiple pharmacies in terms of both adoption of the service and the number of reviews conducted. As in the previous year, independent pharmacies were less likely to provide the MUR service and when they did the numbers conducted were lower than those provided by multiples.

What can the Experiences of Primary Care Organisations in England, Scotland and New Zealand Suggest About the Potential Role of Divisions of General Practice and Primary Care Networks/Partnerships in Addressing Australian Challenges?

This paper focuses on what can be learnt from the experiences of Primary Care Organisations (PCOs) in England, Scotland and New Zealand about the potential role of Divisions of General Practice (DGPs) and Primary Health Care Networks/Partnerships (PCN/Ps) in Australia, in addressing the challenges of ensuring access to a comprehensive range of primary health care services that are well coordinated and address population health needs. Responsibility for contracting and commissioning gives PCOs considerable leverage to influence the availability and range of primary health care services. A capitation-based funding system and associated patient enrolment enables a population focus and care over time, while aligned regional and local planning boundaries between PCOs and other health service planning boundaries also help with more coordinated approaches to planning, service development and service delivery. These elements are largely absent in the Australian health care system and set significant limitations on the role of DGPs and PCN/Ps. While DGPs can contribute to improving general practice quality and access to multidisciplinary care, and PCN/Ps can improve coordination, their scope of responsibilities and authority will need to be significantly strengthened to enable them to take a comprehensive approach to ensuring access to primary health care, service coordination and addressing population health needs.

Primary care.

Primary care sites are proliferating on the internet. For example, NHS Alliance, the chief representative organisation of primary care organisations in England, operates a site at www.nhsalliance.org/ that supports development in primary care organisations.

Efficiency and productivity change in the English National Health Service: can data envelopment analysis provide a robust and useful measure?

Several tools are available to health care organisations in England to measure efficiency, but these are widely reported to be unpopular and unusable. Moreover, they do not have a sound conceptual basis. This paper describes the development and evaluation of a user-friendly tool that organisations can use to measure their efficiency, based on the technique of data envelopment analysis (DEA), which has a firm basis in economic theory. Routine data from 57 providers and 14 purchasing organisations in one region of the English National Health Service (NHS) for 1994-1996 were used to create information on efficiency based on DEA. This was presented to them using guides that explained the information and how it was to be used. They were surveyed to elicit their views on current measures of efficiency and on the potential use of the DEA-based information. The DEA measure demonstrated considerable scope for improvements in health service efficiency. There was a very small improvement over time with larger changes in some hospitals than others. Overall, 80% of those surveyed gave high scores for the potential usefulness of the DEA-based measures compared with 9-45% for existing methods. The quality of presentation of the information was also consistently high. There is dissatisfaction with efficiency information currently available to the NHS. DEA produces potentially useful information, which is easy to use and can be easily explained to and understood by potential users. The next step would be the implementation, on a developmental basis, of a routine DEA-based information system.

The relationship between size and performance of primary care organisations in England

The relationship between size and performance of primary care organisations in England

The relationship between size and performance of primary care organisations in England.

To examine the relationship between the size and performance of primary care organisations, the effect of and the reasons for mergers. Data on size, proxy measures of performance and merger intentions for 71 organisations were extracted from telephone and mail surveys of primary care groups and trusts (PCG/Ts). Of the 22 performance measures examined, only two were significantly associated with size, and over half were not associated with any of the potential explanatory variables. Most organisations (70%) were planning mergers. If all planned mergers take place, the mean size of primary care organisations will double to nearly 200000. The main reasons for mergers were to make better use of resources and for PCGs to become PCTs. There is little evidence that the performance or efficiency of a primary care organisation is associated with its size. Optimal size may differ for different functions. Mergers are seen as a way of increasing management capacity and may reflect the desire of managers to manage large organisations. There is a risk that larger primary care organisations will recreate hierarchies and lose local ownership and participation.

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.