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At least 55 records · Page 3Linked to original sources
PubMed2001

The provision of dental implants in the National Health Service Hospital dental services--a national questionnaire.

OBJECTIVE: To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment. DESIGN/SETTING: Anonymous postal questionnaire in the United Kingdom. SUBJECTS: Consultants in restorative dentistry. RESULTS: Out of the sample of 145, 109 consultants (75%) completed the questionnaire in 1999. 54 of the 109 consultants (49.5%) are involved in the provision of osseointegrated implant treatment, treating an average of 29 cases/year (range 2-150). However, over one third of the respondents treated 10 or less cases/year. 89% worked with oral surgeons as an implant team. 68% used Branemark (Nobel Biocare) implants as their main system. The majority of consultants felt that smoking, psychoses and previous irradiation were the most important medical factors that contra-indicated implant retained restorations whilst untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important oral contra-indications. Many centres were experiencing significant problems with the funding of implant treatment with one centre receiving no funding. The implications for patient care and specialist training are discussed. CONCLUSIONS: There is a marked variation in the number of patients treated with endosseous dental implants within the United Kingdom National Health Service hospitals. Many consultants treat 10 or fewer patients each year. In the main, there is agreement about the factors that contra-indicate implant treatment; these are in line with national guidelines.

Contraindications↗
PubMed1999

Bed-blocking in the National Health Service in Scotland: a study of bed-blocking in Scottish National Health Service trusts; its nature and extent.

OBJECTIVE: To determine the perceptions of managers in Scottish NHS trusts concerning bed-blocking. To help determine the causes of bed-blocking and suggest possible solutions to the problem. DESIGN: The first part of the study consisted of qualitative research interviews with key figures in NHS trusts and an examination of the existing literature on bed-blocking. This informed the second stage which was based on a questionnaire survey of senior managers in 35 trusts. SETTING: Interviews were carried out in three trusts in Forth Valley Health Board and Grampian Health Board areas. Questionnaires were sent out to 44 trusts throughout Scotland. The three trusts that were excluded from this study did not contain bed-blocking patients. SUBJECTS: Questionnaires were sent to chief executives of 44 NHS trusts in Scotland. Respondents were nominated by chief executives on the basis of their experience and understanding of bed-blocking problems within their own trust. RESULTS: Of the 44 questionnaires sent to trusts in Scotland, there were 35 responses (80%) which identified a total of 1845 beds as being blocked. The NHS secondary care-based respondents indicated that social services were responsible for 1406 bed-blocking patients in 35 trusts, an average of 40 patients per trust between August and September 1997. Some 600 of these "social services responsible" bed-blocking patients, an average of 21 patients per trust, were reported as awaiting comprehensive assessment by a social worker. In addition, 710 of these "social services responsible" bed-blocking patients, an average of 24 patients per trust, were awaiting funding authorization for a nursing home or residential home placement. NHS trusts were responsible for 237 bed-blocking patients, an average of seven patients per trust. In a further 202 cases bed-blocking was deemed to be neither the responsibility of the trust nor of social services as patients were awaiting vacancies in the patient's or carer's specific choice of residential or nursing home. CONCLUSION: Results from this study show that there would appear to be a significant number of blocked beds in NHS trust hospitals throughout Scotland. Trust staff, whilst acknowledging the complex nature of bed-blocking, perceive social services, who are responsible for the assessment, placement and financing of patients being transferred from hospitals to residential care in the community, as being responsible for the majority of these beds being blocked. It is, however, acknowledged that social services are under-funded and under-resourced. If the situation is to be improved, consideration should be given to changing service delivery processes in the context of the implementation of Designed to Care.

Bed Occupancy↗
PubMed1994

Survey of clinical pharmacy services in United Kingdom National Health Service hospitals.

The extent to which clinical pharmacy services are provided in National Health Service (NHS) hospitals in the United Kingdom was studied by means of a questionnaire. Questionnaires inquiring whether and to what extent certain clinical pharmacy services were provided were mailed to all NHS hospital pharmacies in 1992. The questionnaires also requested information about the hospital and the number and qualifications of pharmacists employed. The results were compared with those of a survey of pharmaceutical services in the United States. Of 508 questionnaires mailed, 416 usable responses were returned. Services commonly provided were inpatient drug therapy monitoring (96%), clinical trials support (92%), formulary management (89%), participation in drug and therapeutic committees (97%), and an on-site drug information center (60%). Services infrequently provided were therapeutic drug monitoring (21%), medication history-taking (16%), and a 24-hour on-site pharmacist (10%). Several services were associated with pharmacies that employed many pharmacists, pharmacists with advanced education, or specialist clinical pharmacists and pharmacies located in medical school teaching hospitals. U.K. hospital pharmacies provided fewer patient-oriented services and more drug information, therapy monitoring, and pharmacist education services than U.S. hospital pharmacies. Provision of clinical pharmacy services in the United Kingdom was associated with employment of many pharmacists, pharmacy clinical specialists, and pharmacists with advanced education.

Clinical Trials as Topic↗
PubMed1996

Factors influencing the provision of clinical pharmacy services in United Kingdom National Health Service hospitals.

There is much variation in the provision of clinical pharmacy services in U.K. National Health Service hospitals. Some services are provided in groups and there are differences in the extent to which barriers exist to the provision of services. Factors that linked services included efficient use of resources; barriers involved a requirement for pharmacists to participate in multidisciplinary teams. The strong resemblances between service uptake by hospital pharmacies and the technology diffusion model provides insight into the future development of services in this era of evidence-based care.

Pharmacy Service, Hospital↗
PubMed1997

Who decides which pharmacy services are provided in UK National Health Service hospitals?

An interview survey of 129 UK National Health Service doctors, nurses, pharmacists and managers at eight acute care hospitals was conducted in 1994. The survey examined several topics including whether the introduction of the internal market had affected hospital pharmacy services and what those effects had been. An internal market has been introduced and it has had significant effects on the nature and structure of hospital pharmacy services. Directorate pharmacy services were available at six sites. Contracts for specific, usually novel, services had been implemented at one site and contracts had been introduced widely at another hospital. However, all the features of a market were not present at any site. Market orientation also has implications for the equity of service provision, primarily because decision-making regarding service provision is increasingly in the hands of the clinical directors, rather than pharmacy managers. The effects of this change are not yet clear.

Contract Services↗
PubMed2003

Treatment of anaemia in cancer patients: implications for supportive care in the National Health Service Cancer Plan.

The National Health Service (NHS) Cancer Plan published in 2000 has a short-term focus on the most pressing problems of improving survival rates and replacing equipment. It also mentioned as a target 'improved quality of life for those affected by cancer'. Continuity of care for longer-term care programmes was seen predominantly in terms of palliative care. Recent National Institute for Clinical Excellence (NICE) reports may have reinforced this approach by focussing on the clinical and cost effectiveness of chemotherapy for late-stage cancer. The impact on local decision-makers has been that drug funds have been prioritised for use on survival-enhancing interventions, with few resources left for short and longer-term supportive care targeted primarily on improving quality of life. Within supportive care, resources are particularly limited for funding treatments such as erythropoietin for the management of cancer-related anaemia, a common and very debilitating side-effect of intensive therapy. The need for a re-focusing on supportive care is associated with cancer becoming, in many instances, a longer-term illness. The prevalence of cancer is rising markedly due to increased survival rates. However, this creates a new challenge of reducing disability and improving quality of life. In surveys, patients have rated fatigue associated with anaemia as one of the most debilitating effects of their cancer and its treatment with chemotherapy. This paper reviews the evidence demonstrating the quality of life benefits of erythropoietin, and then considers the policy constraints that have limited the adoption of this treatment within the NHS. Through co-ordinated planning there are opportunities for cancer networks and primary care trusts (PCTs) working with cancer centres to develop more support in ways which are feasible and fundable. The case is argued that PCTs and cancer networks, in implementing the Cancer Plan locally, need to integrate short- and longer-term supportive care into their cancer service development plans, and recognise the importance of anaemia management as an integral part of this. Lessons can be learnt from UK renal services where anaemia management with erythropoietin is standard practice.

Anemia↗
PubMed2003

An investigation into the level and impact of merger activity amongst hospitals in the UK's National Health Service.

Since 1990 the National Health Service (NHS) has undergone a sustained period of change. This change has been necessary to prepare the NHS for the task of meeting a demand for services that continues to rise more rapidly than the availability of resources. Anecdotal evidence suggests that one of the most popular ways for trusts to improve their ability to meet demand is through mergers with other trusts. However, little rigorous research has been conducted to assess the extent or effectiveness of this strategy. A research project was, therefore, initiated to better understand the extent and impact of merger activity within the NHS. A questionnaire was developed and distributed to the chief executive, finance director, medical director and human resources director in all the 460 trusts that are currently members of the NHS confederation. In total the survey generated 459 responses out of a possible total of 1,840; an encouraging response rate of 25 per cent. The results of this research provide significant new evidence that "merger mania" has taken hold within the NHS. While 46 per cent of all responding trusts indicated that they had already merged, are actively involved in a merger, proposing to merge or are talking to prospective partners, a further 18.7 per cent of all trusts are forming strategic alliances rather than opting for a full merger. The dominant justification for merging are the beliefs that it will facilitate the reconfiguration of services and ultimately improve patient care. The paper concludes with a discussion of the significance of these results, before making recommendations with regard to their implications for future merger activity within the NHS.

Efficiency, Organizational↗
PubMed2005

From patients to providers: prospects for self-care skills trainers in the National Health Service.

Changes in the National Health Service (NHS) workforce and user involvement have been key areas of contemporary health care policy. Potentially, the current separation of the agendas for patient participation and reconfiguration of the workforce are being brought closer together in the NHS through the Expert Patients Programme (EPP), and its potential to create a new community health 'workforce' of self-management and self-care skills trainers and tutors. The aim of the present paper is to assess the establishment and prospects of these trainers as a new workforce role in the EPP and the NHS. This is done through policy analysis and process evaluation recording the development and implementation of the EPP in the NHS. Telephone interviews with individual trainers were undertaken in order to identify the way in which they are being introduced into the NHS. A representative sample of 19 trainers from the 26 teams covering all the primary care trusts (PCTs) in England were interviewed. The EPP trainers are employed and appointed by the Department of Health and assist PCTs to run EPP courses. The analysis of trainer perspectives illuminated some of the tensions inherent in this new role, which emerge from the consequences of having a long-term condition, their relationship to other occupations operating within primary care and their structural position within the NHS. Prospects for the future development of self-management trainers remain uncertain. Two likely outcomes are examined. The first is that trainers and volunteer tutors will become increasingly integrated as a semi-professionalised group within the primary care workforce. The other option is for trainers to become freelance consultants commissioned by PCTs to run local self-management, self-care support or EPP programmes with the consequence of establishing a more distant relationship with mainstream NHS provision.

Female↗
PubMed2004

Transfer of hospitals and "additional premises" to the state: questionable morality in the implementation of the National Health Service Act (1946).

The National Health Service Act of 1946, pioneered by Aneurin Bevan, came into being on the "appointed day", 5 July 1948. Hospitals with their "additional premises" throughout Britain were "seized" by the state and incorporated into this vast socialist enterprise. While the majority of the population welcomed this new initiative in the creation of a welfare state, associated with medical care from cradle to grave, not all (especially members of various Hospital Boards of Management) were so enthusiastic. The hospitals for "incurables" (long stay patients) were unhappy and lost a vast proportion of their income owing to a great deal of procrastination; but most of them ultimately managed to escape nationalisation after a prolonged period of negotiation, by a claim that they were "homes" rather than "hospitals". The confiscation of property which had been built as a result of voluntary subscription was another huge and highly contentious matter, which has been highlighted in recent years. The future of the Seamen's Hospital Society's properties represents a good example of this.

History, 20th Century↗
PubMed2005

Changes in age-adjusted mortality rates and disparities for rural physician shortage areas staffed by the National Health Service Corps: 1984-1998.

OBJECTIVE: This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality. METHODS: In a descriptive study using a pre-post design with comparison groups, the authors calculated age-adjusted mortality rates at baseline (1981-1983) and follow-up (1996-1998) for the populations of 448 rural whole-county health professional shortage areas arrayed into 3 groups based on the number of study years they were staffed by National Health Service Corps physicians, physician assistants, and nurse practitioners (terms of 1 to 7, 8 to 11, and 12 to 15 years). The authors compared changes over time in age-adjusted mortality rates in the 3 county groups that had National Health Service Corps staffing with rate changes in 172 whole-county rural health professional shortage areas and 772 non-health professional shortage area rural counties that had no National Health Service Corps. RESULTS: At baseline age-adjusted mortality was higher in all 4 health professional shortage area county groups than in the non-health professional shortage area county group. Age-adjusted mortality rates improved with time in all groups, including health professional shortage area counties both with and without National Health Service Corps support, and non-health professional shortage area counties. Essentially, baseline differences in age-adjusted mortality rates between health professional shortage areas and non-health professional shortage area counties did not diminish with time, whether or not there was National Health Service Corps support. CONCLUSIONS: From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed.

Adult↗
PubMed2001

Development and implementation of a new rapid aneuploidy diagnostic service within the UK National Health Service and implications for the future of prenatal diagnosis.

BACKGROUND: Prenatal diagnosis for chromosome abnormality is routinely undertaken by full karyotype analysis of chromosomes from cultured cells; pregnant women must wait on average 13-14 days for their results. Autosomal trisomies, which account for around 80% of significant abnormalities, can be detected by quantitative fluorescence (QF) PCR. We report on the development and implementation of this technique as the first such routine service within a diagnostic department of the UK National Health Service (NHS). METHODS: We designed a "one-tube test" comprising four primer pairs for polymorphic tetranucleotide repeat sequences on chromosome 21, four primer pairs for sequences on chromosome 18, three primer pairs for sequences on chromosome 13, and one primer pair to identify the sex chromosomes. All prenatal samples received by our NHS diagnostic department between April, 2000, and April, 2001, were tested. After DNA extraction, PCR amplification was done and the products separated on a capillary-based genetic analyser; the results were interpreted with dedicated software. Follow-up karyotype analysis was done on all samples. FINDINGS: 1148 amniotic fluid samples, 188 chorionic villus samples, and 37 fetal tissue samples were tested; the amplification failure rate was zero with our current protocol. QF-PCR results were obtained and reported on 1314 (98%) of the prenatal samples; the remaining 22 (2%) were uninformative because of maternal-cell contamination. One case of mosaicism in a chorionic villus sample, and two cases indicating somatic expansion of a tetranucleotide repeat were found. No false positive or false negative results were obtained. The mean reporting time for the last 4 months of data collection was 1.25 working days. INTERPRETATION: QF-PCR aneuploidy testing is an efficient and accurate technique for the detection of autosomal trisomies in prenatal samples. Implementation of this service has led to the rapid diagnosis of abnormalities and early reassurance for women with normal results.

Amniocentesis↗
PubMed2003

Public opinion on systems for feeding back views to the National Health Service.

OBJECTIVES: To explore public opinions about different systems for feeding back views about health services to the National Health Service. DESIGN: Questionnaire survey. SETTING: NHS Grampian, Scotland, UK. PARTICIPANTS: A random sample of 10 000 adults registered with a general practitioner in Grampian was invited to opt in to the study; 2449 were sent questionnaires. OUTCOME MEASURES: Opinions about different feedback mechanisms and their likely effectiveness in three scenarios; reasons for preferring particular mechanisms. RESULTS: Of 1951 respondents, over 80% thought patient representatives would be a good way for people to pass on their ideas about the NHS and would help to improve it. Patient representatives were the most widely preferred course of action for two out of three scenarios. People explained their preferences for particular feedback systems mainly in terms of their ease of use, the perception that they would be listened to, and the likelihood of anything being done about what they said. However, people varied in their judgements about the likely effectiveness of different feedback systems. Preferences for particular systems varied according to the types of situation considered. Some people are reluctant to approach clinical staff with concerns about healthcare quality. A substantial minority have no confidence that their concerns would be listened to or acted upon, however they were expressed. CONCLUSION: The "patient representative" function has substantial popular support and could facilitate local learning and action to improve the quality of health services from users' perspectives. Feedback systems must demonstrate their effectiveness if they are to gain and retain public confidence.

Adult↗
PubMed1994

A comparative study of internal customer management practices within service sector firms and the National Health Service.

In responding to the UK government's market forces model, some National Health Service (NHS) managers have introduced private sector concepts such as 'customer care' and 'total quality management' (TQM). Private sector firms find that success of these techniques is dependent upon creating an internal marketing orientation across the entire organization. To determine how internal marketing is being applied, a comparative survey of UK service sector firms and NHS units was undertaken using a modified version of Parasuraman's SERVQUAL model. All respondents indicated existence of type 1, 2, 3 and 4 gaps in the internal customer management process within their organizations. Major influencers of service gaps include departments placing internal efficiency ahead of internal customers and insufficient understanding of internal customer requirements. The survey indicated that, in certain areas of managing service quality, the NHS is performing better than its private sector counterparts. Nevertheless, opportunity for enhancing service quality in the NHS is possible through improving the flow of information between departments, stronger orientation towards meeting customer needs, upgrading provision systems and changing intradepartmental culture. The constraint facing the NHS manager is the limited availability of resources. One solution is to allocate resources in relation to service priorities. A directional planning matrix is presented as a tool for developing an optimum internal customer management strategy within an NHS unit.

Data Collection↗
PubMed1991

"Working for Patients": the National Health Service in the 1990s.

The National Health Service in England is on the verge of sweeping changes that would apply free-market methods to the state-financed health care system. The government proposal, WORKING FOR PATIENTS, would bring about the most far-reaching changes in the NHS since it was founded following World War II. This paper examines a number of important issues and questions raised by the White Paper on the NHS. One cannot understand the proposed changes in the NHS in abstraction from the broader context of the basic principles upon which the NHS was originally established: universalism, equality, accessibility, and continuity of care. The so-called reforms contained in the White Paper potentially threaten an internationally unique national health care system.

Economic Competition↗