National Health Service Units Research Articles

Complications and Healthcare Costs Associated With the First Year Following Colostomy and Ileostomy Formation: A Retrospective Study.

The purpose of this study was to evaluate clinical and economic outcomes during the first year following ostomy formation. Single-center retrospective audit. The sample comprised 200 patients who underwent surgery leading to ileostomy or colostomy at a large English National Health Service (NHS) Trust. Clinical complications, medicine prescriptions, and interactions with healthcare services were reported over 12 months postsurgery, and interactions with the NHS were matched to the closest NHS unit cost to determine mean patient cost. The most common ostomy-related surgical site complications were high output (35.0%; n = 70), followed by moderate/severe peristomal skin complications (24.5%; n = 49) and bleeding (23.5%; n = 47). Ostomy management-related complications included general difficulties with ostomy management (50.0%; n = 100) and leakage-related mild peristomal skin issues (48.5%; n = 97). Clinical complication rates were highest in the first quarter following ostomy formation, except parastomal hernia, which increased in incidence over time. Ileostomy patients more frequently experienced high output, acute renal failure, and ostomy management-related complications and had increased length of inpatient admission. However, healthcare resource use was high in both groups, with a median of 13 inpatient admission days and 12 outpatient contacts overall within the first year. Mean cost per patient was £20,444.60 (US $26,018.41); 90.5% of these costs were attributed to ostomy-related factors. Patients are likely to experience at least one clinical complication following intestinal ostomy formation and have multiple interactions with the NHS. While a number of complications are more frequent in patients with ileostomies, both groups experienced considerable costs within the first year following surgery associated with ostomy management and recovery.

Early Chronic Pulmonary Diseases Prediction System

Smart breath analyzers are developed as sensing terminals of a telemedicine architecture devoted to remote monitoring of patients suffering from Chronic Obstructive Pulmonary Disease (COPD). The devices based on different sensors CO2, smoke sensor and Volatile Organic Compounds (VOCs), relative humidity and temperature (R.H. & T) and heart rate, respiration sensors) monitor the breath air exhaled into the expiratory line of the bi-tube patient breathing circuit. The sensor raw signals are transmitted to national health service units / Doctor by TCP/IP communication through a cloud remote platform using IoT module space.The work is a proof-of-concept of a sensors-based IoT system with the perspective to predict continuously the effectiveness of monitoring and/or any state of exacerbation of the disease requiring healthcare. By a gas-mixing bench towards gas, smoke in environment and acetone concentrations in exhaled breath collected in a sampling bag were carried out to test the realized prototypes. The paper reports on the longitudinal use of health tags among high- risk COPD patients in the indoor & outdoor environment using PIC16F877A microcontroller. Key Word: Chronic Obstructive Pulmonary Disease (COPD); exacerbation ; Buprenorphine; Nalbuphine; Postoperative.

Опыт организации системы здравоохранения Великобритании по фармацевтическому обеспечению лекарствами льготных категорий населения

Актуальность. Здоровье – найвысшая ценность не просто в контексте восприятия конкретным лицом, но и общества и государства в целом. Согласно содержания международных документов, утвержденных Генеральной Ассамблеей ООН, ВОЗ, Всемирной медицинской ассоциацией правительства несут ответственность за здоровье населения, обеспечивют реализацию права человека на жизнь и здоровье. Однако, для формирования мощной и действенной системы здравоохранения в Украине для фармацевтического обеспечения льготных категорий граждан полезным является опыт организации обеспечения здравоохранения в экономически развитых странах. Цель работы заключалась в изучении опыта Великобритании по организации организации системы здравоохранения для фармацевтического обеспечения лекарственными средствами льготных категорий населения. Материалы и методы. Для достижения поставленной цели были использованы общепринятые методы нормативно-правового, документального, ретроспективного и сравнительного анализа. Результаты. Система финансирования здравоохранения Великобритании предусматривает поступление преобладающей части средств из государственного бюджета, при этом распределение осуществляется по управленческой вертикали от высшего звена к низшему. Именно галоги, которые составляют около 90% бюджета здравоохранения, являются финансовым основанием национальной системы здравоохранения Великобритании. Для сравнения, только 7,5% средств поступают от работодателей. Поэтому можно утверждать, что система здравоохранения Великобритании фактически полностью обеспечивается за счет финансовых платежей со стороны плательщиков налогов и собственно государственного обеспечения. В мировой практике принято выделять три основные модели финансирования сферы здравоохранения: частная, бюджетная (модель Бевериджа), смешанная (модель Бисмарка). Частная модель финансирования существует за счет создания устойчивой конкуренции между заведениями здравоохранения. Частное страхование составляет около 40% от общих затрат, а остаток стоимости фармацевтического обеспечения покрывает сам пациент. Частная модель финансирования характерна для таких развитых стран как США и Япония. Бюджетная модель финансирования или модель Бевериджа предусматривает покрытие значительной части затрат на фармацевтическое обеспечение государственными учреждениями. Такая модель характерна и для Великобритании. Смешанная модель финансирования или модель Бисмарка базируется на «трех китах»: государство, предприятия и личные средства гражданина. Данная система финансирования на страховой основе характерна для Германии, Австрии и Франции. Частная медицина Великобритании — одна из наиболее передовых и наиболее дорогих в мире. В этой стране около 300 негосударственных госпиталей, каждый из которых получает лицензию в местном подразделении Национальной системы здравохранения и проходит проверку дважды в год. Здесь отсутствуют очереди, а медицинскую помошь предоставляют в полном и необходимом объеме. Платные услуги врачей и кабинетов оплачивают или страховые компании, или пациенты самостоятельно. В крупных компаниях Великобритании распространено медицинское страхование как дополнительный бонус к зарплате. Выводы. Опыт Великобритании по обязательному мединскому страхованию распространен в странах с преимущественным государственным финансированием. Модель Бевериджа распространена во многих странах, в которых государство обеспечивает компенсацию 80% и более затрат на здравоохранение (Канада, Австралия, Греция, Швеция, Испания). Значительные подвижки в системе здравоохранения Великобритании, возможность выбрать вид страхования и воспользоваться льготами на получение лекарственных средств позволила искусственно повысить конкуренцию между учреждениями здравоохранения, а соответственно – улучшить качество и скорость фармацевтического обеспечения пациентов. Таким образом, бюджетная медицина Великобритании – приоритет для многих стран мира и залог государственного финансирования фармацевтического обеспечения льготных категорий населения, независимо от уровня доходов и социального статуса.

PMD12 Budget IMPACT Analysis: First PASS Effect in Mechanical Thrombectomy from the Perspective of a Comprehensive Stroke Center in England

Mechanical thrombectomy (MT) is indicated for the treatment of acute ischemic stroke caused by large vessel occlusion. The first pass effect (FPE) is achieved when recanalization of the vessel is achieved after first pass. FPE has been associated with improved functional outcomes and we investigate the impact to the cost of care within English comprehensive stroke centers (CSCs). A budget impact model was created from the perspective of CSCs, covering one year and considering resource utilization during hospital stay and the hospital length of stay. Clinical outcomes and resource data were obtained from a post-hoc analysis of a large clinical multi-country study. To avoid selection bias, we only considered successfully recanalized patients, defined by a modified treatment in cerebral ischemia score (mTICI) of 2c-3. Current and future FPE rates were obtained from public literature. Cost data was also obtained from the literature and not from the National Health Service unit costs. Patients benefiting from FPE were associated with mean reductions of 29.2 minutes in Angio suite time, 0.39 thrombectomy devices per procedure and 3.4 days shorter hospital stay compared to patients recanalized with more passes. Estimated mean cost of an FPE patient was £5,393 compared to £7,476 for the others. In the current scenario of 80 MT procedures with an FPE rate of 23%, 18 patients benefit from FPE. If in the future FPE could be raised to 40%, 32 patients would benefit, and the CSC could potentially safe £29.162. Increasing the proportion of patients benefitting from FPE was associated with meaningful reductions in resource utilization and costs. Limiting the analysis to successfully recanalized patients was a conservative approach since patients who are not successfully recanalized present worse outcomes and higher cost.

Framework on strategic competence performance – a case study of a UK NHS organization

PurposeExtant literature on strategic environment analysis confirm broad evidence of studies on competences in the context of private sector organizations. Nevertheless, there is a growing interest and evidence of strategic competence in public sector organizations seeking to deliver improved performance. This paper attempts to determine the strategic competences of a National Health Service (NHS) unit for better organizational performance.Design/methodology/approachBased on the qualitative analysis of empirical evidence collected in a UK based NHS case study organization, we arrive at a strategic competence performance framework for the health unit using research carried out through interviews with employees and partner organization members.FindingsBy examining a UK-based qualitative case study, the proposed framework puts forward four strategic competence pillars vital for delivering organizational performance and effectively managing the environment of NHS unit's operations. The four strategic competences that are identified to foster NHS unit's performance are strategic leadership, staff engagement, knowledge transfer and partnership working.Originality/valueThe study examines the environment in which a UK based NHS health unit operates and identify the different strategic competences to deliver organizational performance.

A Low-Cost Breath Analyzer Module in Domiciliary Non-Invasive Mechanical Ventilation for Remote COPD Patient Monitoring.

Smart Breath Analyzers were developed as sensing terminals of a telemedicine architecture devoted to remote monitoring of patients suffering from Chronic Obstructive Pulmonary Disease (COPD) and home-assisted by non-invasive mechanical ventilation via respiratory face mask. The devices based on different sensors (CO2/O2 and Volatile Organic Compounds (VOCs), relative humidity and temperature (R.H. & T) sensors) monitor the breath air exhaled into the expiratory line of the bi-tube patient breathing circuit during a noninvasive ventilo-therapy session; the sensor raw signals are transmitted pseudonymized to National Health Service units by TCP/IP communication through a cloud remote platform. The work is a proof-of-concept of a sensors-based IoT system with the perspective to check continuously the effectiveness of therapy and/or any state of exacerbation of the disease requiring healthcare. Lab tests in controlled experimental conditions by a gas-mixing bench towards CO2/O2 concentrations and exhaled breath collected in a sampling bag were carried out to test the realized prototypes. The Smart Breath Analyzers were also tested in real conditions both on a healthy volunteer subject and a COPD suffering patient.

Chronic fatigue syndrome and quality of life.

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a challenging long-term condition (LTC) with complex and fluctuating symptoms. It is heterogeneous in presentation without diagnostic indicators; therefore, in health care encounters, insight must be gained from the patient’s perspective. One indicator of impact can be gained by measuring quality of life (QoL). By applying a patient-reported outcome measure (PROM), professionals can gather insights with direct relevance to the patient questioned. Such a tool can act therapeutically tool to promote holistic and individualized professional interventions and interval measurement can inform commissioning of specialist services. Standard practice appears not fully to capture the experience of CFS, while a search of the literature turned up QoL patient-reported outcome tools, but failed to reveal a CFS/ME-specific measure. The author explores a valid and reliable PROM that can monitor change and evaluate the UK National Institute of Clinical Excellence rehabilitation program, as delivered by specialist National Health Service units. An alternative, the World Health Organization’s quality-of life instrument (WHOQoL)-Bref26, is reviewed for relevance to the condition, measuring treatment outcomes and the wider debate of measuring QoL in LTCs.

Cataract surgery refractive outcomes: representative standards in a National Health Service setting.

To report refractive outcomes from an National Health Service (NHS) cataract surgery service and assess if results meet suggested benchmark standard. Details of all patients undergoing cataract surgery in the Southern General and New Victoria hospitals in Glasgow, UK, between November 2006 and December 2016 were prospectively entered into an electronic database. Patients were reviewed 4 weeks postoperatively in the eye clinic and underwent refraction at their local optometrist prior to this appointment. Surgically uncomplicated cases with in the bag' non-toric intraocular lens implantation were included. Patients with previous laser refractive procedures or failing to achieve 6/12 acuity or better postoperatively were excluded. Proximity to targeted postoperative refraction was documented. Over this 10-year period, 11 083 eyes underwent cataract surgery. Of these, 8943 eyes of 6936 patients (80.69%) met the inclusion criteria and had both target and postoperative outcome refraction recorded. The mean difference between the targeted and outcome refraction was -0.07D (SD 0.67). The mean absolute error was 0.50D. Postoperative refraction was within 1 D of target refraction for 7938 eyes (88.76%) and within 0.50 D for 5577 eyes (62.36%). Refractive outcomes following routine cataract surgery reported here are well within the targets recommended by the Royal College of Ophthalmologists and European guidelines, but suggest that higher cataract refractive outcome benchmark standards may not yet be a realistic expectation for all NHS units with current biometry practice.

Cost-effectiveness of umeclidinium compared with tiotropium and glycopyrronium as monotherapy for chronic obstructive pulmonary disease: a UK perspective

BackgroundCost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective.MethodsA linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George’s Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model.ResultsOver a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (− 0.053; 95% CI: − 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: − £645, − £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (− 0.033; 95% CI: − 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses.ConclusionsFor treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost.Trial registration 201316, NCT02207829; 201315, NCT02236611

Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins

ObjectivesTo analyze the cost-effectiveness of current technologies (conservative care [CONS], high-ligation surgery [HL/S], ultrasound-guided foam sclerotherapy [UGFS], endovenous laser ablation [EVLA], and radiofrequency ablation [RFA]) and emerging technologies (mechanochemical ablation [MOCA] and cyanoacrylate glue occlusion [CAE]) for treatment of varicose veins over 5 years. MethodsA Markov decision model was constructed. Effectiveness was measured by re-intervention on the truncal vein, re-treatment of residual varicosities, and quality-adjusted life-years (QALYs) over 5 years. Model inputs were estimated from systematic review, the UK National Health Service unit costs, and manufacturers’ list prices. Univariate and probabilistic sensitivity analyses were undertaken. ResultsCONS has the lowest overall cost and quality of life per person over 5 years; HL/S, EVLA, RFA, and MOCA have on average similar costs and effectiveness; and CAE has the highest overall cost but is no more effective than other therapies. The incremental cost per QALY of RFA versus CONS was £5,148/QALY. Time to return to work or normal activities was significantly longer after HL/S than after other procedures. ConclusionsAt a threshold of £20,000/QALY, RFA was the treatment with highest median rank for net benefit, with MOCA second, EVLA third, HL/S fourth, CAE fifth, and CONS and UGFS sixth. Further evidence on effectiveness and health-related quality of life for MOCA and CAE is needed. At current prices, CAE is not a cost-effective option because it is costlier but has not been shown to be more effective than other options.

The successful implementation of Scotland's Hepatitis C Action Plan: what can other European stakeholders learn from the experience? A Scottish voluntary sector perspective.

The successful implementation of Scotland's Hepatitis C Action Plan: what can other European stakeholders learn from the experience? A Scottish voluntary sector perspective.

What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise

BackgroundChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), in its most severe clinical presentation, can result in patients becoming housebound and bedbound so unable to access most available specialist services. This presents particular...

Organizational Culture in an Academic Health Center

Implementing cultural change and aligning organizational cultures could enhance innovation, quality, safety, and job satisfaction. The authors conducted this mixed-methods study to assess academic physician-scientists' perceptions of the current and preferred future organizational culture at a university medical school and its partner health system. In October 2010, the authors surveyed academic physicians and scientists jointly employed by the University of Oxford and its local, major partner health system. The survey included the U.S. Veterans Affairs Administration's 14-item Competing Values Framework instrument and two extra items prompting respondents to identify their substantive employer and to provide any additional open-ended comments. Of 436 academic physicians and scientists, 170 (39%) responded. Of these, 69 (41%) provided open-ended comments. Dominant hierarchical culture, moderate rational and team cultures, and underdeveloped entrepreneurial culture characterized the health system culture profile. The university profile was more balanced, with strong rational and entrepreneurial cultures, and moderate-to-strong hierarchical and team cultures. The preferred future culture (within five years) would emphasize team and entrepreneurial cultures and-to a lesser degree-rational culture, and would deemphasize hierarchical culture. Whereas the university and the health system currently have distinct organizational cultures, academic physicians and scientists would prefer the same type of culture across the two organizations so that both could more successfully pursue the shared mission of academic medicine. Further research should explore strengthening the validity and reliability of the organizational culture instrument for academic medicine and building an evidence base of effective culture change strategies and interventions.

Single measures of performance do not reflect overall institutional quality in colorectal cancer surgery

ObjectiveTo evaluate overall performance of English colorectal cancer surgical units identified as outliers for a single quality measure—30 day inhospital mortality.Design144 542 patients that underwent primary major colorectal cancer resection...

Polypectomy at colonoscopy and sigmoidoscopy in England: a review of national data between 1997 and 2007

<h3>Introduction</h3> Currently, there is no national endoscopic database in England. Information regarding the volume of therapeutic endoscopic procedures such as polypectomy is obtained mainly from small prospective studies. This article examines the Hospital Episode Statistics (HES) database to assess the number of patients that have undergone a therapeutic polypectomy for a diagnosis of a benign colorectal polyp over a 10-year period. We also analyse 28-day re-admission and 30-day mortality rates post procedure across 174 English National Health Service (NHS) units. <h3>Methods</h3> All elective patients having undergone a therapeutic polypectomy for a benign colorectal polyp between 1 Jan 1997 and 31 December 2007 in English NHS units were identified from HES after cleaning and formatting the dataset. Trends in rates of colonoscopies and flexible sigmoidoscopies were evaluated as well as 28-day re-admission and mortality rates over time. The reliability of HES data has previously been demonstrated in general surgical and medical patient cohorts <h3>Results</h3> The HES dataset reports that, 334,753 polypectomy procedures were performed on 286,204 patients in English NHS Trusts over the 10-year period. Of these, 233,119 (69.6%) were colonoscopicand 101,634 (30.4%) were via flexible sigmoidoscopy. Over this period a 55.2% increase in the total number of endoscopic polypectomy procedures were performed (from 20,289 in 1997 to 31,503 in 2007). Over the study years, the unadjusted average readmission (range-2.08% &gt; 2.47%) and mortality rates (range −0.33% &gt; 0.63%) overall were not significantly different (p = 0.440, both). <h3>Conclusion</h3> This analysis is the first to report national lower GI polypectomy numbers. It appears to demonstrates that patients undergoing endoscopic polypectomy rose by 55% from 1997 to 2007. Improved coding and a genuine increase in polypectomy workload may underlie these findings. Given the volumes of polypectomies being undertaken, and that polypectomy accounts for most of the procedure related risk with lower GI endoscopy, this may strengthen the case for improved training and accreditation in polypectomy.

Examining Autonomy’s Boundaries: A Follow‐up Review of Perinatal Mortality Cases in UK Independent Midwifery

An earlier matched cohort study in the United Kingdom found a significantly higher perinatal mortality rate for births booked under an independent midwife compared with births in National Health Service units (1.7% [25/1,508] vs 0.6% [45/7,366]). This study examined independent midwives' management and decision making in the 15 instances of perinatal death that occurred at term. Thematic analysis of independent midwives' case notes was performed in instances of perinatal mortality. Semi-structured interviews were conducted with the midwives concerned. Home birth was attempted in 13 of the 15 cases. Significant (often multiple) antenatal risk factors were identified in 13 cases, including twin pregnancy, planned vaginal births after cesarean section, breech presentations, and maternal illness. Several women had declined some or all routine antenatal screening. Three deaths occurred before labor onset. Postmortem results were known in only four cases; many causes of death remained unexplained. Professional consensus was that seven deaths were unpreventable; elective cesarean section may have changed the outcome in eight cases. However, the pregnant women had declined this option; some were reported to be avoiding National Health Service care because of previous bad experiences. Transfer to hospital care, when it occurred, was often problematic. Care management was judged to be clinically acceptable within the parameters set by the mothers' choices. Information about clinical processes (and outcomes) is essential if informed decisions are to be made. The women in this review had reportedly accepted the potential consequences of their high-risk situations. If reality is to match rhetoric about "patient" autonomy, such decision making in high-risk situations must be accepted.

Health Service Inpatient Units for People with Intellectual Disabilities and Challenging Behaviour or Mental Health Problems

Background As institutions for people with intellectual disabilities have been replaced with community services, health care provision has developed to provide assessment and treatment, low and medium secure units for people with challenging behaviour or mental health problems. These include both public and private sector provision. Little is known about these services. The aim of this study was to describe the characteristics of the services studied and to compare the different types of service.Methods A survey was carried out of National Health Service (NHS) and independent sector (IH) health settings providing specialist inpatient services for people with intellectual disabilities. Data were collected on setting and patient characteristics, staffing and management and care processes and outcomes.Results Services were very unevenly distributed across England. There were differences between NHS and IH settings. IH assessment and treatment units were bigger, had higher occupancy and lower staff ratio. In all three types of unit, IH units had fewer visits to patients, used more seclusion, physical restraint and had more locked areas. They had more complaints in more services from users and (for assessment and treatment units and low secure units only) from relatives. In low secure units, they had more adult protection referrals. On the other hand, IH units used fewer agency staff in assessment and treatment units (though more in medium secure units) and provided more appraisals, more visits from commissioners, more consultations with GPs and dentists and more use of whistleblowing procedures by staff. A quarter of people in NHS assessment and treatment units had finished treatment but had no plan for discharge.Conclusions Further research is required to determine the reasons for differences observed between IH and NHS units. The large number of people who have finished treatment emphasizes the importance of developing housing in the community with sufficiently skilled support. The large number of patients in low secure services raises the question whether this type of service is recreating the intellectual disability institutions which government policy intends to close.

A comparison of NHS and private psychiatric intensive care units: Unit and patient characteristics

Background: Both the National Health Service (NHS) and the private sector provide psychiatric intensive care. To date little is known about the differences between the two sectors regarding the unit functioning and characteristics of patients who are accommodated in psychiatric intensive care units (PICUs).Aim: To compare the unit and patient characteristics of NHS and private PICUs.Method: A cross sectional census day postal design was employed.Results: A total of 170 PICUs (154 NHS, 16 private) were identified. NHS PICUs accommodated 1038 patients and the private PICUs housed 200 patients. Analysis of the data showed that some differences existed between the two sectors related to unit characteristics. Private units reported having higher number of beds, more nursing staff, more unit facilities and more out of area referrals than the NHS Units. Regarding the patient characteristics, private PICUs had significantly more patients with personality disorders and forensic history than the NHS PICUs. NHS patients had a shorter length of stay compared to those in the private sector. The demographic profiles of NHS and private PICU patients were similar. The majority of the patients were white, male, unemployed and single.Conclusion: The NHS and the private sector PICUs share many characteristics in terms of unit functioning and patient characteristics, however, some significant differences between the two sectors have also emerged.

The cost of wound care for a local population in England

The objective of this study is to estimate the cost of wound care in a local population of approximately 590 000 using results from a wound care audit carried out in Hull and the East Riding of Yorkshire as a basis. Full results of the audit will be published separately. An audit in June 2005 provided information on patients with wounds and on their treatment. This was combined with representative National Health Service unit costs to produce an estimate of the total cost of wound care in 2005-2006. In all, 1644 patients had a total of 2300 wounds (1.44 per patient). Most (74.1%) were treated in the community by district nurses, 21.2% were treated in hospital and 4.8% were treated in residential or hospice care. More than one in four hospital inpatients (26.8%) had a wound. Median duration was 6-12 weeks. Twenty-four per cent had their wound for 6 months or more, and almost 16% of patients had remained unhealed for a year or longer. One in eight wounds (12.8%) were reported as showing signs of infection. The estimated cost of wound care in 2005-2006 was pound15 million to pound18 million ( pound2.5 million to pound3.1 million per 100 000 population). Caring for patients with wounds required the equivalent of 88.5 full-time nurses and up to 87 hospital beds. Wounds are a significant source of cost to patients as well as the health care system. The most important determinant of cost appears to be wound complications which require hospitalisation or which delay hospital discharge. Reducing costs requires a systematic focus on effective and timely diagnosis, on ensuring treatment is appropriate to the cause and condition of the wound and on active measures to prevent complications and wound-related hospitalisation. These results should be generalisable to other similar populations in the UK and elsewhere.

The London Survey of Psychiatric Intensive Care Units: service provision and operational characteristics of National Health Service units

Background: Psychiatric Intensive Care Units (PICUs) and Low Secure Units (LSUs) provide care for the most disturbed inpatients in adult mental health services. Little is known about levels of provision or how these units operate within local services. In 2002 the Department of Health (DoH) published National Minimum Standards of Care for Psychiatric Intensive Care and Low Secure Environments, but there remains a paucity of service level data to inform the specialism. Aim: To offer the first large-scale systematic survey describing service structure and functioning of PICU and LSU. Method: A questionnaire was sent to ward managers of every PICU and LSU in London. Information was gathered on provision, physical structure, staffing and aspects of unit functioning. Results: 17 National Health Service (NHS) PICUs containing 193 beds, and 16 NHS LSUs containing 199 beds were identified in London. An additional one third of PICU provision was privately (non NHS) funded and managed. Bed occupancy was high (90%, PICUs; 95%, LSUs in the 8 weeks prior to census day) and waiting lists for LSU beds long (64 patients on waiting lists for LSU beds on the census day, mean waiting time for LSU bed, 93 days). The use of agency nursing staff was high (33% of staff per shift on PICUs, 28% of staff per shift on LSUs). Conclusions: All but two units failed to meet the National Minimum Standards for PICU and LSU Environments. Improvements need to be made in provision and staffing levels for permanent nursing staff, psychology and other therapies. Idiosyncrasies exist in admission criteria, particularly with regard to informal patients in LSUs and Personality Disordered patients across the board. Declaration of Interest: The project was part-funded by Department of Health.