NHS System Research Articles

The Wages of Continuity: Health Policy Under the SNP

In government, the SNP has accentuated stability, public provision, and integration in health care and focused energy and patience in neglected ‘Cinderella’ policy areas such as mental health, public health, and health inequalities. This approach is not dissimilar to the policies of previous devolved Scottish governments. It makes Scotland an unusual kind of NHS system- one with stability and long-term focus on issues that are not obvious political winners. The SNP's successes in health come from building on, holding firm to, and developing this distinctively Scottish style of health policy.

Clinical leadership and prevention in practice: is a needs led preventive approach to the delivery of care to improve quality, outcomes and value in primary dental care practice a realistic concept?

BackgroundThere is a need to improve access to, and the quality of, service delivery in NHS primary dental care. Building public health thinking and leadership capacity in clinicians from primary care teams was seen as an underpinning component to achieving this goal. Clinical teams contributed to service redesign concepts and were contractually supported to embrace a preventive approach.MethodsImprovement in quality and preventive focus of dental practice care delivery was explored through determining the impact of several projects, to share how evidence, skill mix and clinical leadership could be utilised in design, implementation and measurement of care outcomes in general dental practice in order to champion and advocate change, during a period of substantial change within the NHS system.The projects were:1. A needs-led, evidence informed preventive care pathway approach to primary dental care delivery with a focus on quality and outcomes.2. Building clinical leadership to influence and advocate for improved quality of care; and spread of learning through local professional networks. This comprised two separate projects: improved access for very young children called “Baby Teeth DO Matter” and the production of a clinically led, evidence-based guidance for periodontyal treatment in primary care called “Healthy Gums DO Matter”.ResultsWhat worked and what hindered progress, is described. The projects developed understanding of how working with ‘local majorities’ of clinicians influenced, adoption and spread of learning, and the impact in prompting wider policy and contract reform in England.ConclusionsThe projects identified issues that required change to meet population need. Clinicians were allowed to innovate in an evironment working together with commissioners, patients and public health colleagues. Communication and the development of clinical leadership led to the development of an infrastructure to define care pathways and decision points in the patient's journey.

PWE-243 Narcotic bowel syndrome: a local experience of the hidden burden

Introduction The use of prescribed narcotic drugs has escalated throughout UK. There are 220,000 people within the Luton CCG catchment area and between June–November 2014, 32,956 prescriptions had been provided for strong opioid therapy. Not only is this a costly unchecked market, but much of this is taken for abdominal pain. Narcotic Bowel Syndrome (NBS) is under recognised and believed to be increasing in prevalence worldwide. NBS is a subset of opioid bowel dysfunction that is characterised by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. We attempted to assess the demand placed on the NHS system by NBS patients. Method In 2014 we started to collect the names of patients seen in gastroenterology clinics or during hospital admission where the clinician felt the patient was suffering from NBS. This was either thought to be the main cause or contributing factor to their symptomatology. A 12 year retrospective review was then made using the hospital coding system to assess the demand made by these patients on the Luton and Dunstable University Hospital through either outpatient clinic visits and/or hospital admissions. Results A database collated the names of 41 patients with NBS. Between January 2000 and December 2014 this cohort of patients have had a total of 660 hospital admissions and 1407 outpatient appointments. In that 15 year time period, the patients had an average of 16 hospital admissions (1.1 per year) each, and 34.3 outpatient clinic appointments each (2.3 per year). During this review period 2 patients died; one 46y old male died from a definite overdose, and one 33y old died from a probable overdose. Conclusion NBS is a poorly recognised condition that places a huge demand on the NHS system with regards to time, resources and finances. Early recognition could prevent a costly and potentially fatal pathway of deterioration. Disclosure of interest None Declared.

PWE-244 The financial burden of narcotic bowel syndrome: a local experience

<h3>Introduction</h3> Narcotic drugs are widely prescribed by both GPs and hospital physicians, but little consideration is afforded to the potential longterm issues when starting patients off on these addictive therapies. has escalated throughout UK. Between June–November 2014, 32,956 prescriptions had been provided for strong opioid therapy in the Luton CCG catchment area. Not only is this a costly unchecked market, but much of this is taken for abdominal pain. Narcotic Bowel Syndrome (NBS) is under recognised and believed to be increasing in prevalence worldwide. NBS is a subset of opioid bowel dysfunction, characterised by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. We attempted to assess some of the financial cost implications of this condition on our local district general hospital in 2014. <h3>Method</h3> In 2014 we started to collect the names of patients seen in gastroenterology clinics or during hospital admission where the clinician felt the patient was suffering from NBS. This was either thought to be the main cause or contributing factor to their symptomatology. During that year a retrospective analysis was performed reviewing the burden and cost of outpatient appointments and inpatient hospital admissions, using the hospital coding system and financial analysis. <h3>Results</h3> A database collated the names of 41 patients with NBS. From the 1st of January to the 31st of December 2014, this cohort of patients made 78 hospital admissions (1.9 per patient) with an average length of stay (LOS) of 4.1 days. This was costed at £91,310, or an average of £2,227 per patient per year. In addition to that the same 41 patients made 159 outpatient appointments (3.9 per patient), costing £15,639, or an average of £381 per patient per year. This small group of 41 patients cost a total of £106,949 in 2014 or an average of £2,608 per patient per year, in hospital inpatients admissions and outpatient appointments alone, before adding in their prescription costs. <h3>Conclusion</h3> NBS is a poorly recognised condition that places a huge demand on the NHS system with regards to time, resources and finances. The prevalence of this condition is thought to be increasing. Early recognition could prevent a costly and potentially fatal pathway of deterioration. On average the annual financial cost of hospital base care for each NBS patients is £2,608. <h3>Disclosure of interest</h3> None Declared.

The NHS oil tanker: heading towards a new horizon for urgent and emergency care

Paramedics have a key role to play in reducing current pressures on NHS services and providing patients with better care within a more sustainable NHS system. Hilary Pillin looks at some of the current transformations in urgent and emergency care delivery and illustrates how these new initiatives highlight a slowly changing culture in the NHS.

G182 Implementation of a neonatal Transitional Care Ward

<h3>Context</h3> According to the British Association of Perinatal Medicine Categories of Care 2011, a baby receiving transitional care (TC) must be resident with the mother. <h3>Problem</h3> TC admissions and neonatal intravenous antibiotic administration (n-IVAB) on the neonatal unit (NNU), which was geographically remote from the postnatal ward, resulted in mother-baby separation soon after birth and suboptimal documentation. <h3>Assessment of problem and analysis of its causes</h3> Three audits over four months in 2012 showed that: 3–10% of admissions to NNU represented between 23–62 TC bed days per month There were 905 episodes of n-IVAB administration Only 30% of TC babies had complete/accurate documentation, 59% had an incomplete/inaccurate record and 11% were not recorded at all <h3>Engaging staff</h3> Audit results were presented to the stakeholders in a combined meeting across Maternity, Neonatal, Divisional Management, Pharmacy and Estates Departments <h3>Strategy for change</h3> Agreed criteria for admission to the TCW Introduced a proforma to allow accurate documentation for each TC admission, management and discharge plan <h3>Intervention</h3> Delineated a transitional care ward (TCW) within the postnatal ward Provided 24 h TCW cover with allocated neonatal nurses administering n-IVAB and undertaking neonatal observations Adopted the Neonatal National Early Warning Score (nNEWS) for recording observations on TC babies Initiated midwifery training in checking neonatal drugs and providing opportunities for practice development in neonatal care <h3>Measurement of improvement</h3> Following implementation, a 4 week pilot showed 34 TCW admissions and 183 episodes of n-IVAB administration on TC, matching previous TC activity and now no longer required to be undertaken on NNU. <h3>Effects of change</h3> All TC babies are now managed on TCW, preventing mother-baby separation and allowing improved quality of care via a new neonatal/maternity working partnership. <h3>Lessons</h3> learnt Service improvement to an inefficient but established NHS system has proved challenging because of changes required to the physical working environment and the impact on staff of new working patterns and documentation. <h3>Message for others</h3> The implementation of a neonatal TCW has been achieved by motivating buy in from diverse stakeholders, excellent interpersonal skills and a solution-based approach focussed on keeping TC babies together with their mothers to improve quality of care.

Private homes should adopt NHS system

Private homes should adopt NHS system

Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is associated with increased use of health, social and education services. There is a lack of data to quantify the economic burden of ADHD in the UK. The aim of this study was to estimate additional education, health and social care costs amongst adolescents in the UK diagnosed with ADHD. Participants were 143, 12- to 18-year-olds from the Cardiff longitudinal ADHD study. Service use relating to mental health over the previous year was measured using the children's service interview. Individual resource use was combined with unit cost data, from national sources, to calculate costs per patient and subsequently the mean cost per patient. Mean costs, 95% confidence intervals and median use were calculated using nonparametric bootstrapping methods. The mean cost per adolescent for NHS, social care and education resources used in a 12-month period related to ADHD was £5,493 (£4,415.68, £6,678.61) in 2010 prices and the median was £2,327. Education and NHS resources accounted for approximately 76 and 24%, respectively. Estimated annual total UK costs are £670 million. The additional costs to the NHS and education system of treating adolescents remain substantial for several years after the initial ADHD diagnosis. There exists a need to develop and evaluate early interventions which have the potential to reduce the longer-term burden, particularly on education resource use.

P149 Evolution of the NCSP: Integrating chlamydia screening into community health services; policy and practice developments in England

BackgroundThe National Chlamydia Screening Programme is a major component of sexual health provision in England. Over 1.4 million tests were performed on asymptomatic under 25-year olds in 2010/2011, and over...

Optimizing secondary prevention: Statin prescribing across East and West London in accordance with NICE guidelines

ObjectivesStatins are a well-known primary and secondary prevention drug for cardiovascular disease and NICE guidelines have been issued to identify key indicators for their use. An audit looking into statin prescribing for medical inpatients was carried out in two geographically distinct London hospitals.DesignA prospective inpatient audit of medical prescription charts was performed. Blood results were reviewed for the inpatients during their admission to identify any contraindications for statin usage (rhabdomyolysis). The medical notes were also reviewed for patient refusal of statin therapy.SettingThe study was carried out at two distinct hospitals in London. Whipps Cross University Hospital (WCUH) and Chelsea & Westminster Hospital (CWH) are located in East London and West London, respectively. Acute medical, surgical, obstetrics and gynaecology, paediatric and palliative wards were excluded.ParticipantsA total of 309 inpatient medical notes and prescription chart data were collected from WCUH (n = 211) and CWH (n = 98).Main outcome measuresHigh percentage of hospitalized patients are not prescribed statins despite clear clinical indications for their use. Regardless of geographical and socioeconomic factors between hospitals, statin prescribing remains suboptimal.ResultsThe patient demographics in both hospitals were very similar; the mean age at WCUH was 78 ± 15 1SD while at CWH the mean age was 74 ± 15 1SD. The results showed that approximately one-third of patients (30% at WCUH and 33% at CWH) had at least one indication for statin therapy according to NICE guidelines and yet they were not prescribed a statin. Ten percent of patients at WCUH and 13% of patients at CWH had ischaemic heart disease (IHD) and yet were not prescribed statins.ConclusionStatin prescription is often overlooked in secondary care with patients being discharged without the appropriate assessment (NICE guidelines), which subsequently means repeat prescriptions are not provided by the GP. This study is the first to show that this problem is not due to resources or geography, but is inherent within the NHS system. Consequently, a revised prescription chart checking system has been suggested for pharmacists and junior doctors.

From evidence‐base to practice: implementation of the Nurse Family Partnership programme in England

The aims of this article are to highlight the issues that are relevant to the implementation of a rigorously evidence‐based programme of support, the Nurse Family Partnership programme, into a national system of care. Methods used are semi‐structured interviews with families in receipt of the programme in the first 10 sites, with the nursing staff, with members of the central team guiding the initiative and with other professionals. Analyses of data collected during programme delivery evaluate fidelity of delivery. The results indicate that the programme is perceived in a positive light and take‐up is high, with delivery close to the stated US objectives. Issues pertaining to sustainability are highlighted ‐ in particular, local concerns about cost set against long‐term rather than immediate gains. However, local investment is predominantly strong, with creative methods being planned for the future. Overall, the study shows that within an NHS system of care it is possible to deliver a targeted evidence‐based programme.

Commissioning diabetes care: possible futures

Commissioning diabetes care: possible futures

Practice-based commissioning: privatization or saviour?

Practice-based Commissioning (PBC) has been designed by the Department of Health as a simple toolkit that can be used to determine budgets at practice level and is a fair method of sharing resources throughout the NHS. It means that money can follow the patient, enabling them to obtain the best resources in order to address their individual health needs. These resources must be shown to be clinically-effective and cost-effective and will be selected on the basis of good outcomes and can be privately managed or organized within the NHS system. This means that PBC will offer the potential to redesign services while insisting that these services are evidence-based and regularly audited.

Limited choices in NHS care

Last month the NHS came under scrutiny when Barak Obama announced plans to reform US health care. Republicans and other conservative campaigners have been reported making comparisons between the proposed reforms and the UK NHS system and in the process they have slammed the NHS for its long waiting lists and made accusations about it rationing the more expensive treatments. Examples of poor treatment have been paraded in the press to support these ideas. A number of hypothetical comments have been made about popular public figures with claims that they would not receive treatment because of age restrictions and would die if the USA followed a system similar to the NHS. It doesn't help when a report from the Patients Association highlights appalling standards in NHS care, mainly relating to basic nursing when caring for the elderly. Although the reports are not representative across the NHS, they give a very bad impression of our service.

Presidential election buries news of two-tier NHS system president-elect Barack Obama’s

President-elect Barack Obama’s healthcare Blueprint for Change pledges to make health insurance affordable and accessible to all Americans. So it is ironic that the UK government chooses American election day to try to bury the news that it is creating a two-tier NHS by introducing a system of regressive user fees for certain drugs.

Reactions to Comments on Great Britain

Back to table of contents Previous article Next article Letters to the EditorFull AccessReactions to Comments on Great BritainJoseph Berger, M.D.Joseph BergerSearch for more papers by this author, M.D.Published Online:7 Nov 2008https://doi.org/10.1176/pn.43.21.0024In the August 15 issue, APA President Nada Stotland, M.D., concluded her column by describing her visit to the Royal College of Psychiatrists' annual conference with the comment, “While there is some interest in privatization, most people are satisfied with the current system,” and she noted that “over the past 10 years, the NHS [National Health Service] has greatly reduced waiting times and introduced standards... and is moving in the direction of increased patient choice.”These comments combine a quite remarkable and very unfortunate distortion of the true situation with a failure to understand and realize why the positive elements are almost entirely a product of the element that Dr. Stotland chose to minimize.The real situation is that there is a very large private health care system in Great Britain, with leading private hospitals, clinics, and physicians providing care to large numbers of people who pay for that care through insurance offered by a few private companies. The enormous growth in the private alternative dates from the time when Margaret Thatcher was prime minister.It is the presence of this private alternative that has provoked the NHS to make whatever small improvements it has made in the past few years. It is a response to public demands and the comparisons that citizens were making between the quality of service and rapid access that the private alternatives offered and the huge deficiencies that were notorious and chronic in the NHS.The NHS or public system most definitely offers medical help to anyone. At times the standards may indeed be high, and no sensible voices are suggesting that it be abandoned. But in Great Britain many people know that in the private system they may receive care that they would not receive in the public system, and in the circles of my relatives and friends in Great Britain, all of them have private insurance and at times make crucial and vital use of the private system.Downsview, OntarioDr. Berger is a past president of APA's Ontario District Branch and its representative to the APA Assembly. ISSUES NewArchived

Summary of: Morale of vocational dental practitioners in the United Kingdom

Objective This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK. Design Postal questionnaire survey. Setting Dental vocational training schemes in the UK. Subjects Vocational dental practitioners. Method A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007. Results A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships. Conclusion The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS.

Morale of vocational dental practitioners in the United Kingdom

This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK. Postal questionnaire survey. Dental vocational training schemes in the UK. Vocational dental practitioners. A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007. A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships. The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS.

Editorial

Editorial

Comparative cost-minimisation of oral and intravenous chemotherapy for first-line treatment of non-small cell lung cancer in the UK NHS system

The National Institute for Health and Clinical Excellence recommends vinorelbine (VNB), paclitaxel, docetaxel, and gemcitabine in the treatment of non-small cell lung cancer. An economic model was prepared to determine the comparative cost of these agents, including the new oral formulation of VNB from a United Kingdom National Health System perspective. Clinical effectiveness was determined from published trials. Costs of drug acquisition, administration, toxicity management, and patient transportation costs were calculated from reference publications. A Markov model was used to estimate the cost per patient over 52 weeks. Intravenous VNB, gemcitabine, paclitaxel, and docetaxel incur annual follow-up costs of 3,746 pounds, 5,332 pounds, 5,977 pounds, and 6,766 pounds, respectively, while oral VNB with outpatient administration on d1, and self-administration at home on d8 every 21 days has a cost per patient per year of 2,888 pounds. Oral VNB allows further hospital resources savings.