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NHS

David Oliver: Discharging patients from overcrowded hospitals—fewer “progress chasers” and more “doers” please

7 Jan, 15 | by BMJ

david_oliverThis year, urgent activity in English NHS hospitals has reportedly hit a record high. Officially reported “delayed transfers of care” (inpatients medically fit to leave, but awaiting community health and care services) have also peaked. These figures routinely underestimate the real number of people in beds whose needs no longer require the full facilities of the general hospital.

Hospitals are routinely declaring “Red” and “Black” status alerts and their executives are coming under increasing pressure from politicians, regulators, and NHS England over declining performance against the four hour standard for emergency department assessment and treatment (a target almost unique to the NHS). Emergency readmissions to hospital within 30 days are running at around 15% for patients aged 65 or over. more…

Billy Boland: Some New Year’s resolutions

2 Jan, 15 | by BMJ

billy_bolandEarlier this week, I saw someone put up their New Year’s resolutions from last year (NYE 2013) on social media to evaluate what they had achieved. It was, in fact, rather a lot, and got me wondering how successful I am at staying committed to change. Now I’m as blindly optimistic as the next person when it comes to estimating my capacity for reinvention, and can set resolutions with gusto. But right now, I can barely recall any that I’ve made.

If I’ve learnt anything about change management, it’s that in order to see outcomes you need to set goals and measure progress. So, in an effort to improve my paltry record, I’m sharing with you my leadership resolutions for 2015: more…

Ted Willis: Can the NHS meet the challenges of the next 20 years?

2 Jan, 15 | by BMJ

Ted WillisExpenditure on our health services in the UK has been rising consistently at around 4% per year in real terms for the last 30 years. It has doubled in real terms in just over 10 years. If this trend continues, this would mean us spending the real term equivalent of £230 billion in 2030, which would be 18% of current gross domestic product (GDP) and over double our present expenditure. Most developed countries follow a remarkably similar trend, with the United States well ahead, and Canada, France, and Germany also consistently above the UK. more…

Samir Dawlatly: How GP practices are funded—between a rock and a hard place

23 Dec, 14 | by BMJ

There are many uncertainties about the future of healthcare in the United Kingdom. This is largely because health is inherently political and, unfortunately, appears to be used by politicians to garner votes in forthcoming elections or gain points in opinion polls, without a great deal of thought being given to the consequences and feasibility of promises and plans. One of the major areas of concern is the funding of primary care. more…

Emma Spencelayh: To FT or not to FT—that is the question. Or is it?

16 Dec, 14 | by BMJ

Emma Spencelayh_2As part of the Health Foundation’s work on analysing the controversial decision to prohibit the proposed merger of Poole Hospital NHS Foundation Trust and the Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, we’ve been grappling with what the role of foundation trusts really is in an ever changing system. more…

Samir Dawlatly: The ills of general practice

10 Dec, 14 | by BMJ

“Have a seat; sorry to keep you waiting. I’m Dr Dawlatly. What brings you here today Mrs, err, Practice?”

“General,” she replied grumpily.

“I’m sorry, what?”

“General. That’s my title. I’ve risen through the ranks to General, so I would be grateful if you would address me properly, doctor,” she answered curtly. more…

Bev Fitzsimons: Supporting community providers to improve quality

9 Dec, 14 | by BMJ

bev_fitzsimonsIf you look at how the NHS is represented in the media, healthcare dramas tend to equal hospital dramas: Casualty, Holby City, even the marvellous Getting on. Community services often feature as slightly misty eyed nostalgia of district nurses and midwives on bicycles—a bit of a blast from the past.

Hospitals can sometimes be busy, confusing places, to be avoided unless absolutely necessary—especially by people who are already vulnerable, frightened, or confused. Care provided closer to (or in) people’s own homes is often preferable in many circumstances. more…

Jeffrey Aronson: Happy 50th birthday, Yellow Cards

8 Dec, 14 | by BMJ

jeffrey_aronsonTo London, to celebrate 50 years of the Yellow Card scheme. The scheme, which was started by the erstwhile Committee on Safety of Drugs (CSD), and is now run by the Medicines and Healthcare products Regulatory Agency (MHRA), allows health professionals and patients to report suspected adverse drug reactions to medicines, either manually, on a yellow coloured card, or online. more…

Ben Gibbison: “Well, it’s the NHS . . . what do you expect?”

5 Dec, 14 | by BMJ

ben_gibbisonA few years ago, I was climbing in the Indian Himalaya. After driving to the road head, we walked for four days to our base camp. There, one of our group suffered with high altitude cerebral oedema. We carried her back down the valley for 12 hours until we reached the road head and found a car to take us to the nearest hospital.

Once inside the hospital, I asked, “Have you got any oxygen?”

“I don’t know Sir, I’ll go and see,” came the reply from the nurse.

He appeared with a rusty oxygen concentrator, which he wheeled along the ground. We couldn’t start it and so, while I made attempts to fix the concentrator, the nurse wiped down the yellowing pair of nasal speculae with a rag. more…

Nancy Devlin, John Appleby, David Parkin: Why has the PROMs programme stalled?

3 Dec, 14 | by BMJ Group

In 2009, the English NHS introduced a world leading initiative in the pursuit of quality healthcare: the measurement of patients’ views about their own health became a routine part of the delivery of NHS funded services. In an initiative led by the Department of Health, robust and reliable condition specific and generic (EQ-5D) patient reported outcome measures (PROMs) are now completed by patients both before and after four elective surgical procedures. more…

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