Darzi Review Research Articles

Trends in available beds per death in England

British Journal of Healthcare ManagementVol. 24, No. 7 Money MattersTrends in available beds per death in EnglandRodney JonesRodney JonesSearch for more papers by this authorRodney JonesPublished Online:2 Jul 2018https://doi.org/10.12968/bjhc.2018.24.7.358AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Beeknoo N, Jones R. A simple method to forecast next years bed requirements: a pragmatic alternative to queuing theory. British Journal of Medicine and Medical Research 2016; 18(4): 1-20. https://doi.org/https://doi.org/10.9734/BJMMR/2016/29518 Crossref, Google ScholarBone A, Gomes B, Etkind S, et al.. What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliative Med 2018; 32(2): 329-336. https://doi.org/httpa://doi.org/10.1177/0269216317734435. Crossref, Google ScholarDepartment of Health. The National Beds Inquiry, 2001. http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/Browsable/DH_4989760 (accessed 25 June 2018) Google ScholarDepartment of Health. The Wanless report: Securing good health for the whole population, February 2004. http://webarchive.nationalarchives.gov.uk/+/ http://www.dh.gov.uk/en/Publichealth/Healthinequalities/Healthinequalitiesguidancepublications/DH_066213 (accessed 25 June 2018) Google ScholarEuropean Health Information Gateway. Bed occupancy rate (%), acute hospitals only. 2018. https://gateway.euro.who.int/en/indicators/hfa_542-6210-bed-occupancy-rate-acute-care-hospitals-only/ (accessed 25 June 2018) Google ScholarFransham M, Dorling D. Have mortality improvements stalled in England? BMJ 2017; 357: j1946. https://doi.org/https://doi.org/10.1136/bmj.j1946 Crossref, Google ScholarInstitute for Public Policy Research. The Lord Darzi review of Health and Care. Interim Report. April 2018; https://www.ippr.org/publications/darzi-review-interim-report (accessed 25 June 2018) Google ScholarJones R. Does hospital bed demand depend more on death than demography? BJHCM 2011a;17(5):190-197. https://doi.org/https://doi.org/10.12968/bjhc.2011.17.5.190 Google ScholarJones R. Bed days per death: a new performance measure. BJHCM 2011b;17(5): 212–213. https://doi.org/https://doi.org/10.12968/bjhc.2011.17.5.213 Google ScholarJones R. Demand for hospital beds in English Primary Care Organisations. BJHCM 2011c;17(8):360–367. https://doi.org/https://doi.org/10.12968/bjhc.2011.17.8.360 Google ScholarJones R. Deaths and the marginal changes in healthcare costs BJHCM 2016;22(10):503–509. https://doi.org/https://doi.org/10.12968/bjhc.2016.22.10.503 Google ScholarJones R. Deaths and acute hospital beds in the Sustainability and Transformation Plans. BJHCM 2017a; 23(10): 498–499. https://doi.org/https://doi.org/10.12968/bjhc.2017.23.10.498 Google ScholarJones R. Government data on death rates do not tell a full story. BJHCM 2017b;23(8): 572-573. https://doi.org/https://doi.org/10.12968/bjhc.2017.23.8.396 Google ScholarJones R. The link between seasonal death rates and workloads. BJHCM 2017c;23(9): 448–450. https://doi.org/https://doi.org/10.12968/bjhc.2017.23.9.448 Google ScholarJones R. Volatility in emergency admissions per death. BJHCM 2017d; 23(11): 554-556. https://doi.org/https://doi.org/10.12968/bjhc.2017.23.11.552 Google ScholarJones R. Periods of unexplained higher deaths and medical admissions have occurred previously – but were apparently ignored, misinterpreted or not investigated. Eur J Internal Medicine 2018a; 40: e18-e20. https://doi.org/https://doi.org/10.1016/j.ejim.2017.11.004 Crossref, Google ScholarJones R. Admissions for certain conditions show explosive growth in England following a sudden and unexpected increase in deaths. Eur J Internal Medicine 2018b/ https://doi.org/https://doi.org/10.1016/j.ejim.2018.03.005 Crossref, Google ScholarJones R. Do outbreaks of ‘Disease X’ regulate NHS beds and costs? BJHCM 2018c; 24(4): 204-205. https://doi.org/https://doi.org/10.12968/bjhc.2018.24.4.204 Google ScholarNHS England. Winter daily SITREP 2017-18 data. 2018b; https://www.england.nhs.uk/statistics/statistical-work-areas/winter-daily-sitreps/winter-daily-sitrep-2017-18-data/ (accessed 25 June 2018) Google ScholarOffice for National Statistics. Monthly figures on deaths registered by usual area of residence in England and Wales, 2018a; https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/monthlyfiguresondeathsregisteredbyareaofusualresidence (accessed 25 June 2018) Google ScholarOffice for National Statistics. Deaths by single year of age tables. 2018b; https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/ (accessed 25 June 2018) Google ScholarPayne G, Laporte A, Deber R, Coyte P. Counting backward to health care's future: Using time-to-death modelling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures. Milbank Quarterly 2007; 85(2):213–257. Crossref, Google ScholarRoyal College of Surgeons. Over 62,000 fewer operations performed this winter, following necessary cancellations. 8 March 2018. https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/more-patients-wait-longer-for-elective-surgery/ (accessed 25 June 2018) Google ScholarStearns S, Norton E. Time to include time to death? The future of health care expenditure predictions. Health Econ 2004;13(4):315–327. Crossref, Google ScholarStenholm S, Kivimaki M, Jylha M et al.. Trajectories of self-rated health in the last 15 years of life by cause of death. Eur J Epidemiol 2016; 31(2):177-185. https://doi.org/https://doi.org/10.1007/s10654-015-0071-0 Crossref, Google ScholarThorne J, Turner E, Hounsome L et al.. Validating the use of Hospital Episode Statistics data and comparison of costing methodologies for economic evaluation: an end-of-life case study from the Cluster randomised trial of PSA testing for Prostate cancer (CAP). BMJ Open 2016; 6: e011603.https://doi.org/https://doi.org/10.1136/bmjopen-2016-011063. Google Scholar FiguresReferencesRelatedDetails 2 July 2018Volume 24Issue 7ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 2 July 2018 Published in print 2 July 2018 Information© MA Healthcare LimitedPDF download

Managing change in gastroenterology

Gastrointestinal NursingVol. 11, No. 8 Penny's PageManaging change in gastroenterologyPenny HarrisonPenny HarrisonSearch for more papers by this authorPenny HarrisonPublished Online:17 Sep 2014https://doi.org/10.12968/gasn.2013.11.8.49AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Boam S (2013) Implementing positive changes. Nurs Times 109(11): 29–30 Google ScholarDepartment of Health (2008) High Quality Care for All: NHS Next Stage Review Final Report (Lord Darzi's review). The Stationary Office, London Google ScholarGage W (2013) Using service improvement methodology to change practice. Nurs Stand 27(23): 51–7 Crossref, Google ScholarHewitt-Taylor J (2013) Planning successful change incorporating processes and people. Nurs Stand 27(38): 35–40 Crossref, Google ScholarKennedy C (2007) Guide to the Management Gurus. 5th edn. Random House Business Books, London Google ScholarLister J (2008) The NHS after 60. For Patients or Profit? Middlesex University Press, Middlesex Google ScholarNHS Institute for Innovation and Improvement (2007) Improvement Leaders’ Guides Introduction. http://bit.ly/16LbZCn (accessed 26 September 2013) Google ScholarNursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. Nursing and Midwifery Council, London Google ScholarOxford English Dictionary (2013). Managing change. http://www.oed.com (accessed 23 September 2013) Google ScholarPhillips J, Simmonds L (2013a) Using fishbone analysis to investigate problems. Nurs Times 109(15): 18–20 Google ScholarPhillips J, Simmonds L (2013b) Managing clinical improvement projects. Nurs Times 109(16): 20–2 Google ScholarPhillips J, Simmonds L (2013c) Use of process mapping in service improvement. Nurs Times 109(17–18): 24–6 Google ScholarWalshe K, Smith J, eds (2006) Healthcare Management. Open University Press, Milton Keynes Google Scholar FiguresReferencesRelatedDetails 2 October 2013Volume 11Issue 8ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 17 September 2014 Published in print 2 October 2013 Information© MA Healthcare LimitedPDF download

Stakeholder consultation practices within healthcare infrastructure planning

PurposeWith the advent of the Darzi review in 2008, and more recently the White Paper “Equity and Excellence: Liberating the NHS” (2010), the NHS in England is being redesigned to provide high quality, person‐centred services with improved capacity and performance. In this change oriented scenario, stakeholder consultation has a critical role to play given the widespread advocacy in government policy and healthcare literature. In order to support informed decision making, the purpose of this paper is to: explore healthcare infrastructure planning through various approaches to stakeholder consultation within English Primary Care Trusts (PCTs); and develop a conceptual approach to strategic asset management (SAM) based on the findings of stakeholder consultation and engagement exercises.Design/methodology/approachA multi‐method triangulation approach including action research has been adopted to evaluate current stakeholder consultation practices with a local PCT and to explore their approach to healthcare infrastructure planning through: a literature review of stakeholder engagement and theory; evaluation of a local consultation exercise; and a web based document review of consultation practices within 149 English PCTs.FindingsPCT estate managers and healthcare planners have to operate within constantly changing dynamic healthcare environments and need to reduce uncertainty and indecision that often surrounds the debate of reconfiguration of healthcare facilities and services. Consultations by the PCTs vary in: the level of detail provided to the public; sample sizes; detail and transparency of the consultation; distribution and analyses of the consultation; and techniques and approaches.Practical implicationsThe findings of this study can be used by healthcare policy makers to: inform how clinical commissioning groups (CCGs) could be better involved during patient and public engagement; and determine practical ways of putting patients at the heart of General Practitioners (GP) commissioning.Originality/valueThe research identifies gaps within current stakeholder consultation practices in English PCTs and develops a conceptual approach to SAM that accounts for stakeholder consultation; decision making levels within healthcare infrastructure planning within a wider competency based organisational view, which currently does not exist.

Meeting the needs of the older patient in GI nursing

Gastrointestinal NursingVol. 10, No. 3 penny's pageMeeting the needs of the older patient in GI nursingPenny HarrisonPenny HarrisonSearch for more papers by this authorPenny HarrisonPublished Online:16 Aug 2013https://doi.org/10.12968/gasn.2012.10.3.50AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Baughan J, Smith A (2009) Caring in nursing practice. Pearson Education, Harlow Google ScholarBorland S (2011) Shameful neglect of the elderly in one fifth of our hospitals breaks the law. Daily Mail. 13/10/11. Google ScholarCare Quality Commission (CQC) (2011) The State of Healthcare and Adult Social Care in England: an overview of key themes in care 2010/11. The Stationary Office, London Google ScholarDepartment of Health (2008) High Quality Care for All: NHS Next Stage Review final report. (Lord Darzi's review). The Stationary Office, London Google ScholarDepartment of Health (2010) Excellence and Equality: Liberating the NHS. DH, London. www.dh.gov. (accessed 10/4/12) Google ScholarDuffin C (2012a) New recruits tested for compassion. Nurs Stand 26(27): 5 Crossref, Google ScholarDuffin C (2012b) One nurse to seven older patients: RCN recommends a safe staff ratio. Nurs Stand 26(29): 12–3 Crossref, Google ScholarNational Nursing Research Unit (NNRU) (2008) Nurses in society: starting the debate. Kings College, London Google ScholarOxford English Dictionary (OED) (2012) www.oed.co.uk (accessed 10/4/12) Google ScholarWallace C et al. (2012) Caring for frail patients: best practice. Nurs Stand 26(28): 50–6 Crossref, Google ScholarWild D et al. (2012) A new model of care for the older person. Nurs Times 108(12) 12–5 Google Scholar FiguresReferencesRelatedDetails 1 April 2012Volume 10Issue 3ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 16 August 2013 Published in print 1 April 2012 Information© MA Healthcare LimitedPDF download

A NICE influence on GI nurses?

Gastrointestinal NursingVol. 9, No. 4 Professional IssuesA NICE influence on GI nurses?Penny HarrisonPenny HarrisonSearch for more papers by this authorPenny HarrisonPublished Online:16 Aug 2013https://doi.org/10.12968/gasn.2011.9.4.49AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health (2008) High Quality Care for All: NHS Next Stage Review final report. (Lord Darzi's review). The Stationery Office, London Google ScholarDepartment of Health (2010) Equality and excellence: Liberating the NHS. The Stationery Office, London Google ScholarEastham P (2006) Does NICE have to be cruel to be kind? Daily Telegraph. www.telegraph.co.uk/health/3344366 (Accessed 10 May 2011). Google ScholarHMT (2010) Public Spending Review. London, HMT. www.hm-treasury.gov.uk (Accessed 10 May 2011) Google ScholarHealth Service Journal (2008) (Editorial) NICE chairman hits back at critics. Health Service Journal 18 August Google ScholarKeogh B (2011) Clinical services and standards committee: state of the art lecture: measuring quality in the NHS. BSG Annual Meeting, Birmingham Google ScholarNHS Institute for Innovation and Improvement (2007) Going lean in the NHS www.institute.nhs.uk/lean (Accessed 10 May 2011) Google ScholarNHS (2009) The NHS Constitution. www.constitution.nhs.uk/downloads/nhs_constitution_document.pdf (Accessed 10 May 2011). Google ScholarNHS Institute for Innovation and Improvement (2009) The Productive series. www.institute.nhs.uk/productive (Accessed 10 May 2011) Google ScholarNHS Evidence (2011). Evidence for care. http://www.evidence.nhs.uk/ (Accessed 10 May 2011) Google ScholarNational Institute for Health and Clinical Excellence (2011) NICE services and information including pathways and cost saving support advice. www.nice.org.uk (Accessed 10 May 2011) Google ScholarRawlins M (2011) Clinical services and standards committee: using guidelines to develop quality standards. BSG Annual Meeting, Birmingham Google Scholar FiguresReferencesRelatedDetails 1 May 2011Volume 9Issue 4ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 16 August 2013 Published in print 1 May 2011 Information© MA Healthcare LimitedPDF download

Modelling catchment areas for secondary care providers: a case study

Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating the catchment area of a planned new hospital, the extra level of detail provided by the gravity model may prove necessary. However, in virtually all other applications, the Proportional Flow method produced the optimal model for catchment populations in Manchester, based on several criteria: it produced the smallest RMS error; it addressed cross-boundary flows; the data used to create the catchment was readily available to SCPs; and it was simpler to reproduce than the gravity model method. Further work is needed to address how the Proportional Flow method can be used to reflect service redesign and handle OAs with zero or low activity. A next step should be the rolling out of the method across England and looking at further drill downs of data such as catchment by Healthcare Resource Group (HRG) rather than specialty level.

Secondary care and changing the face of emergency care

The delivery of emergency care has changed significantly over the last decade, driven by several factors which include better disease understanding, improved access to diagnostics, emergency care access targets and...

Community nurses shall inform policy

The Queen's Nursing Institute plans to road-test the Department of Health's Transformational Guides by involving frontline practitioners to help shape future web-based versions.

Innovation yields improvements

Darzi's review NHS High Quality Care for All makes a number of courageous policy propositions that are associated with service improvements. What may be exercising some minds in the NHS is just how to make this a reality? There are no quick fixes to this challenge. Bevan et al (2008) however, note that on its own, across-the-board formal instruction in quality improvements and change management methods are not capable of delivering the results required to make change a reality.

Measuring health-related quality of life in cancer patients

The measurement of health-related quality of life (HRQoL) is being increasingly advocated in healthcare practice, particularly in relation to cancer care. The use of patient-reported health instruments has been recommended in Lord Darzi's review of the NHS. Consequently, nurses have to be aware of the most reliable and valid QoL measurement tools for given situations and conditions. The aim of this article is to review the most common HRQoL tools for use in the oncology setting, highlighting the specific properties of each instrument.

NHS Next Stage Review 2008

The NHS Next Stage Review aims to puts quality at the centre of improvements to health services (Department of Health (DH), 2008a). It is often referred to as the ‘Darzi review’ as Professor the Lord Darzi of Denham led the work. Darzi consulted widely with frontline staff and the public to help shape the report’s national priorities.

Ian Gilmore: President of the Royal College of Physicians

Ian Gilmore: President of the Royal College of Physicians

Rising to the challenge.

HEALTH MINISTER Lord Darzi's review of the NHS was co-designed by clinically led local groups, each of which developed its own vision for change along eight care pathways.

No more cooking the books

If there is one word that is driving current health policy it is ‘quality’. You can’t turn a page in the nursing press without being bombarded by new quality tools, quality audits, and other management ‘quality’ jargon. The Darzi review has stated that primary care services will have quality as their raison d’être. That’s an admirable aim as no one wants shoddy services, but how does one go about defining quality in district nursing services?

Deprivation, demography, and the distribution of general practice: challenging the conventional wisdom of inverse care.

It is generally believed that the most deprived populations have the worst access to primary care. Lord Darzi's review of the NHS responds to this conventional wisdom and makes a number of proposals for improving the supply of GP services in deprived communities. This paper argues that these proposals are based on an incomplete understanding of inverse care which underestimates the degree to which, relative to their healthcare needs, older populations experience low availability of primary care. Many deprived practices appear to have a better match between need and supply than practices serving affluent but ageing populations. However, practices serving the oldest and most deprived populations have the worst availability of all.

The Darzi Review (NHS Next Stage Review) – What it Means for NICE

In July this year, Lord Darzi, Junior Health Minister and practising surgeon, announcedthe findings of his wide ranging review of the NHS (the Next Stage Review, emphasising the fact that it is intended as the ‘next stage’ of existingstrategy for the NHS and not anew ‘re-organisation’). The review made many recommendations, several affecting NICE. Among the recommendationsare that NICE should take charge of a new ‘NHS Evidence’ service, be involved with setting the Quality and Outcomes Framework (QOF), increase the number of guidelines it produces, and work with the Department of Health to speed up the technology appraisal process (often relating to new drugs). A ‘NICE Fellowship’ programme will also be introduced among NHS professionals to encourage implementation of NICE guidance. The NHS Constitution, announced alongside the review, reinforced NICE'sposition within the NHS and gave patients alegal right to drugs and treatments that the Institute has approved. The review and accompanying constitution provide strong endorsements of NICE and the new responsibilities they confer fit well with our current work and our own vision of the future. One of the most important announcements was about ‘NHS Evidence’. Lord Darzi's report indicated that: ‘A national clinical evidence base will be created, housing what local, national and international clinicians believe to be the best available evidence about clinical practice, pathways and models of care and innovations. This will be available to commissioners, practitioners, patients and the public alike.’ NICE and the NHS Institute have been asked to develop the business model for an innovative and accessible evidence service setting out aclear vision, operating arrangements and costs which will demonstrate real additional benefits for NHS staff and patients. Currently, evidence for effective clinical and public health practice is widely available but it is often difficult to access and variably applied in the NHS. A large number of different enterprises, many funded and some operated by the NHS, generate, interpret and present evidence. Despite this, NHS decision-makers often find it difficult to gain access to what they need when they are at the point of making a decision. NHS Evidence will create aunified evidencebase for everyone in the NHS who makes decisions about treatments or the use of resources, and for patients who want to know more about their care. The evidence will be comprehensive, quality assured and made available both in its original form and through guidelines, pathways, tools and other resources. It will inform patient care, commissioning and service management. Although it will have its own web site, the new service will operate primarily as an integral part of the existing decision-support systems used across the NHS, providing user-and context-specific material. NHS Evidence will allow health professionals, commissioners and service managers to base their decisions on a shared, quality-assured evidence base. They will be able to offer and share their local experience of using evidence in designing and delivering services, and both individual users and NHS organisations will be able to create their own space within NHS Evidence to build their own evidence libraries. Patients will have the opportunity to be better informed about their conditions, the life-style options which might help, and the treatments available. NHS Evidence will provide a convenient central location for a host of information and make clinicians' lives easier by providing a single point of access for that knowledge. There will be the option to receive alerts highlighting significant new evidence about specific areas of interest, and clinicians will also be able to add to their existing journal sources with a free, targeted, immediately accessible route to the latest studies and reports. Trainees will also have access to educational modules.

Lord Darzi's review and what it means for NICE

Along with everyone throughout the NHS, we were very interested in the outcome of Lord Darzi's review earlier this summer, and in particular, what his findings would mean for NICE.

The surgical workforce: where next?

The surgical workforce is rapidly changing and it would appear that few have an accurate grasp of the current situation. Modernising Medical Careers (MMC) and the Medical Training Application Service wreaked havoc, leaving many trainees confused about their current situation and uncertain about their future career prospects; there is no clarity on staff grade numbers and a significant number of CCT [Certificate of Completion of Training]-holders are struggling to find a consultant post. Lord Darzi's review has called for integrated workforce planning, occurring at the local level with employers, regionally with oversight from the strategic health authorities and nationally with a newly established 'centre of excellence' for workforce planning, to be supported at each level by professional advisor y groups. What are the implications for the profession?

The QNI/BJCN survey will feed into a report on district nursing next year

The Queen's Nursing Institute and British Journal of Community Nursing survey hopes to give weight and shape to the role of district nursing, which was omitted from the Darzi Review.

College response to Darzi Review

No new targets and a focus on quality of care were the two main messages coming from Lord Darzi's Next Stage Review final report, published at the end of June to coincide with the celebration of the 60th anniversary of the NHS. The review provides a vision for the new foundations for the health service of empowered staff and patient choice but with little detail on the delivery frame work. This vision is the star t of the next stage of NHS reform for the coming ten years.