Trent Regional Health Authority Research Articles

The Trent Regional Day Case Commission. An initiative to investigate the constraints to the extension of the use of day surgery.

In 1989, Trent Regional Health Authority set up a Commission to enquire into the organization of day case surgery and encourage its use. Improved methods for measuring and comparing day surgical activity were developed using routine data sources. These revealed even greater variation between hospitals and specialties in the amount of day surgery performed than did the usual analyses. Arrangements for day surgery differed considerably between specialties. Few theatres, beds, or surgeons' sessions were dedicated to day surgery, but general surgery and gynaecology used dedicated facilities more than other specialties such as ENT and ophthalmology. The Commission visited each hospital and found that day case facilities, organization and resources were poor in many of them. It was able to make specific recommendations for improvements. Day case surgery increased substantially over the period that the Commission operated, most hospitals reported that it had influenced changes in day surgery and that it had been useful, especially for local managers. Schemes to increase day surgery were funded. Highlights two elements for managing change: the need for good information about a problem, and the need to extend ownership of the issue throughout the organization.

THE QUASI‐MARKET, THE ENTREPRENEUR AND THE EFFECTIVENESS OF THE NHS BUSINESS MANAGER

The recent changes in the UK National Health Service were heralded by the publication of the Griffiths report in 1983 which highlighted the need for a business‐like’approach to management. The policy makers’generic strategy of the late 1980s and early 1990s centred around the concept of‘quasi‐markets’. These were artificial internal markets encompassing the purchasers and providers of public services.Little research has been undertaken into this new phenomenon of the‘quasi‐market’but entrepreneurship economic theory would suggest that for markets to be efficient would require a supply of alert and aware entrepreneurs. Within the restructured NHS, the mantle for entrepreneurial management seems to have been placed firmly on the shoulders of the newly created‘business managers’.A 1993 survey amongst NHS business managers in first and second wave trust hospitals in the Trent Regional Health Authority indicated that whilst business managers were knowledgable of what entrepreneurial activity is, they currently feel constrained in their new roles for a variety of reasons. The authors suggest that rational economic analysis is insufficient to explain this lack of innovatory endeavour. Instead policy makers’attention should be devoted to liberating health managers from their current constraints to encourage their entrepreneurial development.

The Role of Physiotherapy Helpers in Out-patient Physiotherapy Services

Summary The role of physiotherapy helpers was surveyed at ten sites in Trent Regional Health Authority, where the Regional physiotherapist: helper ratio was the lowest in the United Kingdom in 1992/93. Managers at the sites were interviewed and questionnaires left for both physiotherapists and helpers. The object of the survey was to find out what tasks helpers were carrying out, and to establish the attitudes of physiotherapists and managers to enlarging the helpers' role. The response rate was good at 94%. There was a large variation in the tasks being carried out by helpers at the different sites. Some were carrying out all electrotherapy techniques, while others were helping with clerical and housekeeping tasks only. The majority of physiotherapists expressed concerns about enlarging the role of helpers and felt that training should be “on the job” with some formal lectures from physiotherapists. Managers were unlikely to employ more helpers to meet increasing demands on their service. A scientific approach to task delegation and supervision is called for to formalise task allocation between physiotherapists and helpers.

GPs in principle but not in practice: a study of vocationally trained doctors not currently working as principals.

To identify doctors who are vocationally trained but not currently practising as principals in general practice; their reasons for not practising as principals; and whether the prospect of a re-entry course would appear to this group. Postal questionnaire survey based on semistructured interviews. Doctors who had been vocationally trained but were not currently practising as principals: 351 possible subjects identified by a process of "networking." Trent Regional Health Authority. 166 of the doctors who replied fitted the criteria (100 women; 66 men). The out of hours commitment was ranked as the most important factor for not practising as a principal--95 women and 50 men rated it important--followed by difficulty in combining work with family commitments--84 women, 31 men. 82 respondents (49%) said they would be interested in a re-entry course if one were available. There is a pool of vocationally trained doctors in Trent region who are not practising as principals in general practice. More flexible working patterns and the availability of a re-entry course could make the post of principal in general practice a more attractive proposition to these doctors.

Results from a lifestyle survey: Trent health.

The objective of this work was to examine the efficiency of a postal survey in generating data relevant to Trent Regional Health Authority's need for baseline measures as indicators for health promotion, as specified in its strategy for health promotion. A representative sample, by District, was identified using Family Health Service Authority registers as the sampling frame, stratified by age (16-70 years) and gender. Data were collected from the resulting sample of 21,603 using a self-completion illustrated questionnaire. Delivery was postal with two reminders. Prepaid envelopes were supplied for returns. Questions about lifestyle, e.g. behaviour, attitudes and beliefs about smoking. The survey took place in each of the 12 Districts of Trent Region, the total population of which is over 4.5 million. The main outcome measures were behaviour, attitudes and beliefs about health by age and gender and by social class. The response was 61% after exclusions. Young males were under-represented in response. Sixty four per cent of respondents were non-smokers, 14% took optimal exercise on a monthly basis and 15% never drank alcohol. In the week prior to the study males were more likely to have drunk more than the recommended units of alcohol (24%) than women (9%). Over two-thirds of respondents (72%) had three key elements of social support. The postal survey generated data directly relevant to indicators embedded within Trent Health's health promotion strategy. Across the Region it was possible to examine patterns of response by age, gender and by social class. Data were adequate as baseline measures and repeat studies will monitor change. However, data are biased with sub-groups under-represented. In addition, non-responders are known to be different from responders. Data are therefore limited, but can be used to describe general patterns amongst responders. Other methods of data collection are required for the collection of more sensitive and/or qualitative data.

Hairy cell leukaemia: descriptive epidemiology and a case-control study.

The descriptive epidemiology of hairy cell leukaemia is reported from a specialized register of haematological malignancies covering approximately one-third of England and Wales. The overall incidence of hairy cell leukaemia at 2.9 per million persons per year is similar to that recorded in America. There is a marked male preponderance (4.0 compared with 1.7 per million per year for females). A case-control study on hairy cell leukaemia was conducted in the Yorkshire and Trent Regional Health Authority areas. 50 cases and 95 controls were identified, and interviewed using a structured questionnaire. Previous results on the aetiology of hairy cell leukaemia were not supported by this study, with the exception of an association between hairy cell leukaemia and exposure to organic solvents, petrochemicals and related products.

Providing a personal service in the Trent Region.

Reports evaluation of the Trent Regional Health Authority's "Providing a Personal Service" initiative, one of the first major quality management strategies in the NHS. The evaluation highlights the key elements which supported this initiative and suggests some ways in which its progress can be sustained. Many of the comments are applicable to other approaches to quality management.

The Sigma Project.

The Sigma Project, underway in a number of health care settings across Trent Regional Health Authority, is making dramatic productivity gains and improvements in the quality of care. The Project is being spearheaded by a number of Trust chief executives and unit general managers.

Providing a Personal Service in the Trent Region

Reports evaluation of the Trent Regional Health Authority′s “Providing a Personal Service” initiative, one of the first major quality management strategies in the NHS. The evaluation highlights the key elements which supported this initiative and suggests some ways in which its progress can be sustained. Many of the comments are applicable to other approaches to quality management.

Listings.

International April 24-25 A conference on education and employment opportunities, titled 'Health policies in transition', will be held at the F.ast Midland Conference Centre, University Park, Nottingham. It will be organised by Trent Regional Health Authority and the University of Nottingham. The fee is £250. Details from Angela Elliott, Trent Regional Health Authority, Fulwood House, Old Fulwood Road, Sheffield S10 3TH. Tel 0742 630300.

Audit of coronary angiography and bypass surgery

The appropriateness of coronary angiography and coronary artery bypass surgery in the Trent regional health authority was assessed by comparison with predetermined consensus criteria. 49% of coronary angiographies were considered to be entirely appropriate in relation to the patient's clinical condition, but 21% were deemed inappropriate. Coronary artery bypass surgery was considered appropriate in 55% of patients, but inappropriate in 16%. Audit by "appropriateness" scores may help to determine which patients should first be investigated and treated when resources are limited and waiting lists are long.

The demand for neonatal intensive care.

In a one year prospective study within the Trent Regional Health Authority the demand for neonatal intensive care was estimated to be 1.1 cots per 1000 births. Intensive care level 1 (as defined by the British Paediatric Association and British Association for Perinatal Paediatrics) was determined by two separate techniques, which showed close agreement. Intensive care level 2 could not be measured directly, as the definition was too subjective. This aspect of demand was therefore estimated by using data derived from the treatment of babies transferred for intensive care. These findings represent a minimum estimate of need, as the data were obtained from a service constrained by having facilities well below the estimated level (roughly 60% of estimated demand). In the future other factors such as increased survival of extremely preterm infants will be likely to increase demand still further.

Post-transfusion hepatitis in Trent Regional Health Authority, 1988.

Post-transfusion hepatitis in Trent Regional Health Authority, 1988.

“Return to Go”: Renewal Process in an Internal Organisation Development Unit

The National Health Service is increasingly aware that the development of organisations and management is crucial to the pursuit of “excellence”. In light of this, the experience of one internal grouping, the Trent Regional Health Authority Organisation Development Unit, is reviewed as a guide to senior managers considering the creation of similar cadres for management development purposes. The article examines the history of the unit from the point of view of the author and traces the roots of the Organisation Development approach from its origins in the 1960s.

SERVING THE HEALTH SERVICE

Tight budgets are forcing the UK's regional health authorities to examine ways of improving efficiency. One of the most forward‐looking is the Trent authority, which has adopted industry practices in procurement, stock management, storage and distribution, and which in 1986 opened a regional distribution centre. Ian Bradshaw, regional supplies officer for Trent Regional Health Authority, describes the impact of computer systems and the implementation issues behind these initiatives.

Hydrogeochemical studies for Al, F and Fe in waters supplying haemodialysis units in the Trent region, U.K.

Geographical and seasonal variations in the concentrations of Al, F and Fe in tap water supplying home haemodialysis units within the administrative area of the Trent Regional Health Authority, have been examined. Aluminium and fluoride were considered for their implications in bone disorders and iron for its competitive binding with aluminium to transferrin in serum. Four different water treatment systems are currently used and the extractive performance of these have been assessed. In general, the current Department of Health and Social Security's (DHSS) guidelines for aluminium in water used to prepare dialysate are met (30 μg/l), but the proposed European Economic Community's (EEC) levels of 10 μg/l, are not. The removal of fluoride and iron from water by the different treatments was comparable to the removal of aluminium. A comparison between old and new equipment highlights the importance of regular monitoring and maintenance.

Cooperation between the prison medical service and the NHS: a conversation.

A great deal has happened with prison health care since we began publishing our series two years ago. ' Dr John Kilgour had then just taken over as director of the prison medical service, and he has now had a chance to make his presence felt. Twenty six new doctors have been recruited, and the service is almost up to full strength.2 A plan has been launched to increase the number of fully trained nurses. The Chief Inspector of Prisons has published a report on preventing suicide in prisons and been trumped by a more radical one from Scotland.34 The physical state of Holloway Prison's psychiatric wing has been described by the Home Secretary as wholly unsatisfactory, and plans have been made to resite and reorganise it.5 Plans have been produced for improving the service offered by Grendon, the psychiatric prison.6 And, perhaps most important of all, Mrs Ren?e Short's House of Commons Select Committee for Social Services has begun an investigation into the prison medical service: huge amounts of written evidence have been received, and the committee is now visiting prisons and taking oral evidence. All of these developments might be seen as steps forward but might be stymied by the continuing problem of overcrowding. Since our articles were published the number of people has risen by 4000?to 48000. Two years ago the Home Office was predicting that this figure would not be reached until the end of the decade. The 16 new prisons that are being built will help but not solve the problem. To make a further contribution to this continuing debate and throw a little more grist into Mrs Short's mill we organised a small meeting in October to discuss cooperation between the prison medical service and the National Health Service, and the rest of this article is a report on the conversation. Undoubtedly the select committee will discuss the possibilities that the prison medical service might either be absorbed into the NHS or that a special health authority directly responsible to the Department of Health and Social Security might be created to oversee the medical services in all secure institutions (including the special hospitals), but the arguments for and against these schemes have been well rehearsed,1 and we did not want to repeat them. Present at the meeting were: Mr Brian Edwards, the general manager of Trent Regional Health Authority; Professor John Gunn, professor of forensic psychiatry at the Institute of Psychiatry; Dr John Kilgour, director of the prison medical service; and Dr Richard Smith, assistant editor of the BMJ and author of our series on prison health care. The article has been written by Dr Smith and approved by the other three. Aptly and ironically we held our discussions at the Caf? Royal, a regular haunt of Oscar Wilde, a man who did not enjoy his stay in either Pen ton ville or Reading prisons.

Supernumerary senior house offices in anaesthesia: a review of a regional training scheme, 1962-1972.

The Sheffield Regional Hospital Board, which became the Trent Regional Health Authority in 1974, initiated a scheme for training of Senior House Officers in anaesthesia in 1962; between 1962 and 1972, 73 graduates passed through the scheme of whom 29 (40%)* held consultant posts at the time of the review (mid 1979), another 8 (11%)* were senior registrars and on the way to consultant status. None of the 16 overseas graduates had achieved consultant status although one was a senior registrar. Twenty-six (35-6%)* of the 73 doctors (15(20-5%)* United Kingdom or Republic of Ireland graduates and 11 (15-1%)* from overseas) are thought to have left the practice of anaesthesia although some of these were not traced and may indeed be practising, and some of the females have indicated an intention to return to the specialty when their children are older.

The ante-natal detection of Down's syndrome: some demographic aspects.

The numbers of Down's syndrome live births in the area covered by the Sheffield Regional Hospital Board (Trent Regional Health Authority) were estimated using age specific incidence data from a recent detailed Swedish study. The estimated number and proportion of Down's syndrome live births, which could have been detected by prenatal screening of elderly mothers at high risk, fell substantially in recent years. In the maternal age group forty to forty-four the estimated number of Down's syndrome livebirths decreased from thirty-three (24.6 per cent) in 1963 to thirteen (15.7 per cent) in 1973. Over the same period there was a fall in estimated numbers in the thirty-five to thirty-nine age group from twenty-seven (20.2 per cent) to twelve (14.5 per cent). This trend has been due predominantly to a rapid decline in the fertility rates of women aged thirty-five and over. However, projections based on the best available evidence suggest that about 11.4 per cent to 13.8 per cent of all Down's livebirths up to 1991 could be detected by screening all pregnancies in the forty to forty-four age group. A further 11.7 per cent to 14.4 per cent of Down's livebirths could be detected by screening pregnancies in the thirty-five to thirty-nine age group.

A survey of obstetric practice in the trent region in relation to the prevention of down's syndrome

A survey was carried out of the practice and opinions of consultant obstetricians in the Trent Regional Health Authority regarding amniocentesis in the prevention of Down's Syndrome. The survey suggests that if current practice continues, an insufficient proportion of pregnancies to women aged 35+ will be screened in order to reduce substantialy the incidence of Down's syndrome. Important factors are the maternal age used in selection by consultants, the latest gestational age at which an amniocentesis might be considered, and the necessity in some cases for the patient to initiate the request for amniocentesis. Amniocentesis is predominantly considered to be the responsibility of individual consultant firms, and sub-regional units for this procedure are not recommended.