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Morris, Rupert, and Jessica Clark-Jones. "I’ve got the power: Saunders v Vautier in the context of massively discretionary trusts." Trusts & Trustees 28, no. 1 (December 8, 2021): 19–28. http://dx.doi.org/10.1093/tandt/ttab098.
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Abstract In two judgments in 2019 and 2020, the Guernsey Court of Appeal upheld the judgment of the Guernsey Royal Court in Rusnano Capital AG (in liquidation) v Molard International (PTC) Limited and Pullborough International Corp [2019] GRC 011 in relation to the statutory “Saunders v Vautier” provisions under the Trusts (Guernsey) Law, 2007. The position, in Guernsey at least, remains therefore that beneficiaries of a discretionary trust can require trustees to terminate a trust and distribute the trust property, even in circumstances where a broad power to add further (unspecified) beneficiaries exists. This article considers the position, on any view unsettled, in England and Wales (as well as other jurisdictions which still rely on the common law interpretation) of the so-called rule in Saunders v Vautier in light of the somewhat contradictory case law and authorities, particularly in the context of trusts where the dispositive discretions effectively displace the beneficial interests.
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Harpum, Charles. "The Uses and Abuses of Constructive Trusts: The Experience of England and Wales." Edinburgh Law Review 1, no. 4 (September 1997): 437–63. http://dx.doi.org/10.3366/elr.1997.1.4.437.
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This paper, which was first given on 19 October 1996 at a seminar on constructive trusts organised by the Universities of Edinburgh and Strathclyde with the Scottish Law Commission, examines the role that constructive trusts play in English law. It explains the amorphous nature of such trusts, how they are rooted in concepts of equity and conscience, and how they are often imposed in accordance with equity's traditional grounds for intervention. The central thesis of the paper is that a constructive trust, when imposed, will cause the trustee to become subject to one or more fiduciary obligations or incidents. One situation in which this is not the case— where a constructive trust is employed to impose an encumbrance on a transferee of property—is criticised. There is also a critique of the recourse to equitable maxims as a reason for the imposition of constructive trusts. The paper concludes with some reflections on the likely path of development of constructive trusts in English law and whether they ought to be more widely received into Scots law.
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Dobson, R. "Hospital trusts in Wales halved." BMJ 316, no. 7137 (April 4, 1998): 1037. http://dx.doi.org/10.1136/bmj.316.7137.1037h.
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Dobson, R. "Call for fewer trusts in Wales." BMJ 313, no. 7055 (August 24, 1996): 443. http://dx.doi.org/10.1136/bmj.313.7055.443b.
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Shammas, Carole. "Tracking the growth of government securities investing in early modern England and Wales." Financial History Review 27, no. 1 (March 25, 2020): 95–114. http://dx.doi.org/10.1017/s096856501900026x.
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Interest in the growth of tradeable securities in early modern Britain, especially its relationship to economic development and the funding of government debt, has centered mainly on the borrower – whether it be trading company, industrial enterprise, or the state. This article directs attention to the investor, using Charity Commission Reports for England and Wales that document a dramatic mid-eighteenth-century shift by donors and trustees from investments in real estate and rent charges to perpetual government annuities, mainly 3 percent Consols. The heavy investment in this public debt product is what ultimately prompted the creation of the London Stock Exchange in 1801.In analyzing this shift, which occurred among the propertied in all regions of the nation, not just the metropolis or among corporate entities and the mercantile community, I consider both what made the annuities increasingly attractive for charitable trusts and the alternatives – real estate and private loans secured by mortgage or other means – more problematic. Legal changes, I argue, played a role in the transformation, especially the Charitable Uses Act of 1736, which made charitable devises of real estate very difficult and probably resulted in reduced investment in human capital and less wealth redistribution. Regions varied, however, in the degree to which they switched from real estate in the latter part of the eighteenth century; they also differed in the extent to which the switch resulted in more gifts of interest-bearing loans as well.Admittedly, the changes documented in this article concern only one type of depository for assets, charitable trusts. The appeal of these annuities, however, could extend to investments needed for other purposes such as postmortem payments to dependents. Moreover, the fall-off in demand for real estate in trusts correlates with GDP estimates showing a steady decline in income from real assets after 1755 and what some have noted in this period as a puzzle – the lack of an increased rate of return on rents and private loans at a time of robust investment in government debt. Most importantly, though, the transition demonstrates the ability of the government to induce a broad spectrum of the propertied population to invest in securities, if the vehicle they offered had the right characteristics, which were not necessarily highest yield or liquidity without loss in value.
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Morgan, Gareth G. "Charitable Incorporated Organisations: An Analysis of the Three UK Jurisdictions." Nonprofit Policy Forum 6, no. 1 (April 1, 2015): 25–44. http://dx.doi.org/10.1515/npf-2014-0035.
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AbstractThe specific legal forms available for charitable organisations have received much less attention by scholars as compared to work on the definition of charity, the boundaries of charitable status and the duties of charity trustees. Under each of the three UK jurisdictions, it could be argued that all charitable property is held on trust (in the sense that it is held for interests of the charity’s beneficiaries) but many charities are no longer formed using the structure of a trust. Charitable organisations can have many possible structures including charitable trusts, charitable associations, charitable companies and now charitable incorporated organisations (CIOs). Until recently the UK lacked any specific legal form for charities. The CIO was created to remedy this: a corporate body with limited liability, formed purely by registration with the appropriate charity regulator. Since 2008 it has been enshrined in statute in all three UK jurisdictions, though implementation dates only from 2011 in Scotland and from 2013 in England and Wales. The focus of this paper is a comparison of the CIO form in the three UK charity law jurisdictions. It analyses the frameworks for CIOs established in England and Wales, Scottish CIOs (SCIOs) and the (yet to be implemented) CIOs in Northern Ireland. It concludes that whilst the CIO concept is effectively reflected in all three jurisdictions, the differences between these three types of CIOs are much more than just those needed to comply with the different regimes of charity regulation – the differences raise important choices for those seeking to establish new charities operating UK-wide.
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Lupoi, Maurizio. "Trusts in mixed jurisdictions." Pravovedenie 67, no. 1 (2023): 21–55. http://dx.doi.org/10.21638/spbu25.2023.102.
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Closed legal systems are gone in modern world, “mixed” legal systems have become the norm. That has made so-called “transplants” easier but, contrary to a widely held view, legal institutions cannot be transplanted. English trust rules even less, for they are not a coherent set of rules. The British attempted to legislate on trusts for their colonies, for instance for Ceylon (the present-day Sri Lanka), and were thus obliged to be coherent. That made it necessary to introduce new legal concepts with unforeseeable consequences. A wave of legislation followed the adoption of the convention “On The Law Applicable To Trusts And On Their Recognition” by the 15th session of the Hague Conference on private international law (1985); it gave birth to the “international model” of trusts that quickly became the favourite setting of the rich and ultra-rich. Jersey in the Channel Islands was the leading jurisdiction, many others followed but it was not until the establishment of the International Finance Centres in the Gulf and later in Kazakhstan where “the laws of England and Wales” are taken as a source of law and local courts are staffed by former English judges or in any event by lawyers brought up in the common law that a proper transplant of the English trust took place. A totally different legal setting witnessed attempts to create imitations that had to run against well-established civil law conceptual attitudes that did not allow the existence of more than one patrimony per person or the segregation of assets within one person’s patrimony. In 2022 France decreed that each businessman is automatically the owner of two patrimonies; that open the way to a radical re-thinking of civil law notions. Québec and Louisiana are taken as examples of civil law legislation on trusts but Québec has followed its own idea that the assets that form the object of a fiducie belong to nobody, while Louisiana’s Trust Code is a deft admixture of civil law and common law elements based on the civilian notion of “fiduciary”. Luxembourg, France and other civil law countries are then examined: the focus then is on South Africa and Scotland, two countries which have a common past in a shared period of the European ius commune and a common present in being both orphaned from a cultural lineage that provided answers to current matters by drawing on Roman law. Now they both solve the problem of the patrimony by holding that a trustee has more than one patrimony, his own and then one for each trust of which he is the trustee.
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Fargas-Malet, Montserrat, and Dominic McSherry. "Regional variations in care planning in Northern Ireland: Proposing an ecological model of decision-making." Qualitative Social Work 19, no. 2 (November 5, 2018): 229–45. http://dx.doi.org/10.1177/1473325018811474.
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Care planning for children who enter care can be influenced by a range of factors. In Northern Ireland, there are differences in the proportions of children in different types of placements across the five Health and Social Care Trusts (equivalent to local authorities in England and Wales). The aim of the study was to identify the reasons for these differences. In order to do that, focus groups in each of the Trusts were conducted with social work professionals involved in care planning. Based on the study findings, an ecological model of decision-making in care planning is postulated. Differences among all of the Trusts were found within the model’s three levels, despite all of the Trusts operating under the same broad policy framework for care planning. For instance, different mindsets were evident, as participants in some of the Trusts clearly equated the notion that children should be provided with a permanent home with adoption, while in focus groups in other Trusts, this mindset did not prevail. In addition, the Trust structures and initiatives differed slightly and there were differences in the global context factors influencing decision-making. Based on these findings, we believe regional practical guidance and policies should be developed collectively by the five Trusts, so as to avoid the possibility of children facing a postcode lottery regarding the placements offered to them.
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Wallace, Louise M., Peter Spurgeon, Jonathan Benn, Maria Koutantji, and Charles Vincent. "Improving patient safety incident reporting systems by focusing upon feedback – lessons from English and Welsh trusts." Health Services Management Research 22, no. 3 (August 2009): 129–35. http://dx.doi.org/10.1258/hsmr.2008.008019.
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This paper describes practical implications and learning from a multi-method study of feedback from patient safety incident reporting systems. The study was performed using the Safety Action and Information Feedback from Incident Reporting model, a model of the requirements of the feedback element of a patient safety incident reporting and learning system, derived from a scoping review of research and expert advice from world leaders in safety in high-risk industries. We present the key findings of the studies conducted in the National Health Services (NHS) trusts in England and Wales in 2006. These were a survey completed by risk managers for 351 trusts in England and Wales, three case studies including interviews with staff concerning an example of good practice feedback and an audit of 90 trusts clinical risk staff newsletters. We draw on an Expert Workshop that included 71 experts from the NHS, from regulatory bodies in health care, Royal Colleges, Health and Safety Executive and safety agencies in health care and high-risk industries (commercial aviation, rail and maritime industries). We draw recommendations of enduring relevance to the UK NHS that can be used by trust staff to improve their systems. The recommendations will be of relevance in general terms to health services worldwide.
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Bailey, Nicola M., and Sally-Ann Cooper. "NHS beds for people with learning disabilities." Psychiatric Bulletin 22, no. 2 (February 1998): 69–72. http://dx.doi.org/10.1192/pb.22.2.69.
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A questionnaire was completed by 135 of the 161 (83.9%) National Health Service (NHS) trusts who provide specialist health services for people with learning disabilities in England and Wales. From these, cumulative frequencies were calculated to describe the current level of provision of NHS beds. Results vary in different parts of the country, but the majority of NHS trusts provide assessment and treatment admission beds, long-stay beds (including those NHS trusts who have completed their resettlement process) and respite care beds. A half of NHS trusts directly manage NHS day places. The high response to questionnaires indicates the current high level of interest in this issue.
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Cunliffe, Louise, Fiona Sanders, and Hilary Hall. "Regional NewsNORTH WEST WALES NHS TRUSTCONWY & DENBIGHSHIRE AND NORTH EAST WALES NHS TRUSTS." FPOP Bulletin: Psychology of Older People 1, no. 76 (April 2001): 12–14. http://dx.doi.org/10.53841/bpsfpop.2001.1.76.12.
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Davies, Sue, Tim Amos, and Louis Appleby. "How much risk training takes place in mental health services?" Psychiatric Bulletin 25, no. 6 (June 2001): 217–19. http://dx.doi.org/10.1192/pb.25.6.217.
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Aims and MethodThe main aim of the study was to establish the proportion of hospital trusts in England and Wales in which training in the assessment of suicide risk and risk of harm to others is available to mental health professionals. A questionnaire was sent to clinical directors covering training on these subjects and in mental health legislation, details of training and the existence of risk-related policies.ResultsSeventy-six per cent of trusts said they provided training in suicide risk assessment for junior psychiatrists; for hospital and community nurses, the figure was just over 50%. Between 50% and 60% of trusts said they provided training in the assessment of risk of harm to others. Provision of training in mental health legislation was said to occur in most trusts. In some key areas of risk management, hospital policies were uncommon.Clinical ImplicationsDespite the current importance of risk assessment in mental health services, many hospital trusts do not provide their staff with relevant training.
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Morgan, Alun, and Paul Ward. "A Surgical Care Practitioners’ Pilot Programme in Wales." British Journal of Perioperative Nursing (United Kingdom) 15, no. 4 (April 2005): 176–79. http://dx.doi.org/10.1177/175045890501500404.
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The Surgical Care Practitioner Pilot Programme, funded by the Welsh Assembly Government, commenced in October 2003. Preliminary evidence suggests that the pilot is making a significant difference to the care of surgical patients in those NHS trusts involved. The authors describe why the programme was initiated and what it was designed to deliver, together with the preliminary evaluation.
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Jenkins, Rachel, and Jan Scott. "Medical staffing crisis in psychiatry." Psychiatric Bulletin 22, no. 4 (April 1998): 239–41. http://dx.doi.org/10.1192/pb.22.4.239.
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This article summarises the findings of a National Health Service Executive, Royal College of Psychiatrists', National Association of Health Authorities and Trusts, and Trust Federation working group on medical staffing in mental health, which reported to ministers in summer 1996 and was launched at a conference in November 1996 jointly with the College. Although primarily focused on England and Wales, it is clear that similar problems exist in other parts of the United Kingdom and the Republic of Ireland.
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Sakhuja, Divya, and Jonathan I. Bisson. "Liaison psychiatry services in Wales." Psychiatric Bulletin 32, no. 4 (April 2008): 134–36. http://dx.doi.org/10.1192/pb.bp.107.018069.
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Aims and MethodTo determine the nature of current liaison psychiatry services in Wales, a structured telephone interview was conducted with representatives of all 11 National Health Service trusts.ResultsThree trusts (27%) had no dedicated liaison psychiatry service and only one of the eight (13%) with a service had a full-time consultant liaison psychiatrist. Only two services (25%) had a full-time junior doctor and three (37%) were not multidisciplinary, comprising nursing staff alone. No team had a clinical psychologist and only two (25%) provided a psychological treatment service.Clinical ImplicationsLiaison psychiatry services across Wales are fragmented, under-resourced and unlikely to meet patients' needs. They fall well short of the recommendations of the Royal Colleges of Physicians and Psychiatrists.
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Evans, Sherrill, Peter Huxley, Christine Baker, Jo White, Sally Madge, Steve Onyett, and Nick Gould. "The Social Care Component of Multidisciplinary Mental Health Teams: A Review and National Survey." Journal of Health Services Research & Policy 17, no. 2_suppl (April 2012): 23–29. http://dx.doi.org/10.1258/jhsrp.2012.011117.
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Background The study reviewed the disciplinary composition of community mental health teams (CMHTs) and conducted a national survey of mental health providers in England and Wales to explore the determinants of the social care component of CMHTs. Methods A comprehensive literature review and a national survey of NHS mental health Trusts in England and Wales. Results The literature review showed that team composition was rarely well justified with regard to effectiveness, despite some evidence that greater professional diversity (i.e. inclusion of social workers) was associated with higher effectiveness. Forty-two mental health Trusts responded (53.2%) to the survey. There were no staffing differences between responding and non-responding Trusts. Social workers accounted for 19.3% of the staffing total. Nurses formed a third of the workforce and social support workers made up a further 10%. We found that there continues to be a shortage (compared to policy targets and previous research) of psychiatrists, psychologists and occupational therapists, whereas the numbers of nurses employed far exceeds their target numbers. Total staffing numbers appeared to be slightly higher in Trusts citing ‘financial resources’ as a determining factor of team composition. Despite being statistically non-significant, the ‘financial resource’ effect was of medium magnitude. Similarly, there was a non-significant but approaching medium-sized effect of higher numbers of social care support staff when guidance was cited as a rationale for CMHT composition. There was a non-significant (P = 0.076) medium magnitude (η2p 5 0.067) trend towards higher staff numbers in more integrated trusts that did not cite financial resources as a driver of team composition. Conclusions If service recipients are to gain equal access to appropriately staffed services, further attention needs to be paid to supporting an adequately skilled multidisciplinary workforce. The workforce needs to be organised in a way that best provides for local needs rather than a service based largely on the existing supply of different professionals and disjointed workforce planning.
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Airey, Nick, and Stuart McLaren. "Drug services in England and Wales: a survey of treatment providers and their medical leads." Psychiatric Bulletin 30, no. 4 (April 2006): 140–42. http://dx.doi.org/10.1192/pb.30.4.140.
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Aims and MethodWe undertook a postal questionnaire survey of drug action teams in England and Wales with the aim of clarifying the nature of statutory specialist drug services.ResultsOf 159 drug action teams, 110 (69%) responded; 64 (58%) reported that mental health trusts exclusively provided their specialist drug services. Other providers were primary care and acute trusts, the non-statutory sector and social services. The majority of medical leads were psychiatrists (123 senior posts with 20% vacant/occupied by a locum), then general practitioners (GPs) (42) and other specialists (4).Clinical ImplicationsSpecialist drug services are offered by a range of treatment providers, with the medical lead being taken by GPs and other specialists in some areas. In view of the current difficulty in recruiting psychiatrists, we propose that alternative training pathways are considered for addiction specialists.
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Chockalingam, Nachiappan, Nicola Eddison, and Aoife Healy. "Cross-sectional survey of orthotic service provision in the UK: does where you live affect the service you receive?" BMJ Open 9, no. 10 (October 2019): e028186. http://dx.doi.org/10.1136/bmjopen-2018-028186.
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ObjectiveTo investigate the quantity and quality of orthotic service provision within the UK.DesignCross-sectional survey obtained through freedom of information request in 2017.SettingNational Health Service (NHS) Trusts/Health Boards (HBs) across the UK.Main outcome measuresDescriptive statistics of survey results, including information related to finance, volume of appointments, patients and orthotic products, waiting times, staffing, complaints, outcome measures and key performance indicators.ResultsResponses were received from 61% (119/196) of contacted Trusts/HBs; 86% response rate from Scotland (12/14) and Wales (6/7), 60% (3/5) from Northern Ireland and 58% (98/170) from England. An inhouse service was provided by 32% (35/110) of responses and 68% (74/110) were funded by a block contract. Long waiting times for appointments and lead times for footwear/orthoses, and large variations in patient entitlements for orthotic products across Trusts/HBs were evident. Variations in the length of appointment times were also evident between regions of the UK and between contracted and inhouse services, with all appointment times relatively short. There was evidence of improvements in service provision; ability for direct general practitioner referral and orthotic services included within multidisciplinary clinics. However, this was not found in all Trusts/HBs.ConclusionsThe aim to provide a complete UK picture of orthotic service provision was hindered by the low response rate and limited information provided in some responses, with greater ability of Trusts/HBs to answer questions related to quantity of service than those that reflect quality. However, results highlight the large discrepancies in service provision between Trusts/HBs, the gaps in data capture and the need for the UK NHS to establish appropriate processes to record the quantity and quality of orthotic service provision. In addition to standardising appointment times across the NHS, guidelines on product entitlements for patients and their lead times should be prescribed to promote equity.
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McGill, Gill, Gemma Wilson, Michael Hill, and Matthew D. Kiernan. "Utilisation of the principles of the Armed Forces Covenant in NHS Trusts and Clinical Commissioning Groups across England: a freedom of information investigation." BMJ Open 9, no. 1 (January 2019): e022053. http://dx.doi.org/10.1136/bmjopen-2018-022053.
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ObjectivesTo determine the extent to which National Health Service (NHS) service providers appoint a named Armed Forces veteran lead or champion, and to explore the commissioning of veteran-specific services by Clinical Commissioning Groups.DesignA convergent mixed method design was used to improve understanding obtained from the information provided by respondents on their practice. The study comprised two parts: phase 1 involved NHS Trusts, and phase 2 involved Clinical Commissioning Groups.SettingAll NHS Trusts and Clinical Commissioning Groups in England were contacted using a freedom of information request.ParticipantsAll NHS trusts and Clinical Commissioning Groups across England.InterventionsInitially, existing national websites were searched to gather information within the public domain. An audit was carried out, using the Freedom of Information Act (FOIA) 2000 to gather further information.Primary and secondary outcome measuresThe FOIA 2000 applies to UK Government departments and public authorities, including NHS Trusts in England, Wales and Northern Ireland.ResultsResponses from the freedom of information requests illustrate inconsistencies in relation to adopting the principles of the Armed Forces Covenant. The inconsistencies extend to the practice of appointing an Armed Forces Veteran Lead or an Armed Forces Veteran Champion. There is also evidence to suggest a lack of commitment to and understanding of policy guidance in relation to Clinical Commissioning Group responsibility for commissioning veteran-specific services.ConclusionsFindings from this study support the case for making improvements to, and improving the consistency of, commissioning practices for veterans.
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Courtenay, Molly, Riyad Khanfer, Gail Harries-Huntly, Rhain Deslandes, David Gillespie, Karen Hodson, Gary Morris, Anthony Pritchard, and Elizabeth Williams. "Overview of the uptake and implementation of non-medical prescribing in Wales: a national survey." BMJ Open 7, no. 9 (September 2017): e015313. http://dx.doi.org/10.1136/bmjopen-2016-015313.
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ObjectivesTo identify (1) the non-medical healthcare professionals in Wales qualified to prescribe medicines (including job title, employer, where the prescribing qualification is used, care setting and service provided); (2) the mode of prescribing used by these healthcare professionals, the frequency with which medicines are prescribed and the different ways in which the prescribing qualification is used; and (3) the safety and clinical governance systems within which these healthcare professionals practise.DesignNational questionnaire survey.SettingAll three National Health Service (NHS) Trusts and seven Health Boards (HB) in Wales.ParticipantsNon-medical prescribers.Results379 (63%) participants responded to the survey. Most of these prescribers (41.1%) were specialist nurses who work in a variety of healthcare settings (primarily in secondary care) within each HB/NHS Trust, and regularly use independent prescribing to prescribe for a broad range of conditions. Nearly a quarter of the sample (22%) reported that prior to undertaking the prescribing programme, they had completed master’s level specialist training and 65.5% had 5 years qualified experience. Over half (55.8%) reported that there were plans to increase non-medical prescriber numbers within the team in which they worked. Only 7.1% reported they did not prescribe and the median number of items prescribed per week was between 21 and 30. Nearly all (87.8%) of the sample reported that they perceived prescribing to have ensured better use of their skills and 91.5% indicated that they believed it had improved the quality of care they were able to provide.ConclusionNon-medical prescribing has been implemented across the whole of Wales; however, its uptake within HBs and NHS Trusts has been inconsistent, and it has not been considered across all services, particularly those in primary care. Opportunities therefore exist to share learning across organisations.
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Brown, Marcy L. "Clinical Librarian Programs May Lead to Information Behaviour Change." Evidence Based Library and Information Practice 2, no. 4 (December 7, 2007): 77. http://dx.doi.org/10.18438/b8wk5k.
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Objective – Assess whether the North Wales Clinical Librarian service changed the information behaviour of team clinicians. Specific objectives were to:
Assess which services were used.
Estimate the effects of training on clinician search patterns and search times.
Examine the benefits of services regarding clinical governance.
Examine the effects of training on clinician confidence.
Explore factors affecting librarian-clinician collaboration.
Design – Observational, longitudinal evaluation through:
1. Librarian reflective diaries
2. Baseline and final questionnaire surveys
3. In-person and telephone interviews between surveys
Setting – Three National Health Service (NHS) Hospital Trusts in North Wales, UK. These included North West Wales, Conwy & Denbighshire, and North East Wales.
Subjects – Physicians, nurses, and allied clinical staff working with clinical librarians in one of the above three NHS Trusts.
Methods – The evaluation period ran from November 2003 through January 2005. Data collected varied between Trusts, since program activities varied across locations. Questionnaire data was analyzed with Excel; interview data was analyzed with QSR N6.
North East Wales/Conwy & Denbighshire: In these two Trusts, baseline questionnaires were distributed in April 2004; interviews were conducted between July and October 2004, and final questionnaires were distributed in December 2004. Sixty-nine baseline questionnaires were returned from the April distribution, and 57 final questionnaires were returned in December. Additionally, 33 face-to-face and telephone interviews were conducted between July and October.
North West Wales: Immediate post-training feedback was collected from 90 participants; questionnaires sent one month after training had only a 32% response rate (24 of 75 questionnaires). Twelve interviews were conducted.
Results – Interviews at all sites demonstrated a conflict between wanting the librarian to perform searches for the clinical teams, and the clinicians needing or wanting more independence through greater search skills. The librarian reflective diaries showed a change in practice over the evaluation period. Administrative duties lessened and more time was spent on searching or teaching.
North East Wales/Conwy & Denbighshire: Although a greater percentage of medical staff reported using NHS and library Web sites by the end of the evaluation period (70.7% versus 59.4%), a larger percentage felt overwhelmed by the amount of information retrieved (68.3% versus 60.9%). At baseline, more than 50% wished to spend less than 10 minutes on a search of “general importance but not of personal interest” (18), but follow up indicated that the number of physicians expecting to spend that small amount of time had dropped to 36%. Among nurses and allied professionals, changes in information behaviour were fewer. The interviews confirmed that information provided by a clinical librarian affected patient management and/or therapy; patient diagnosis was not affected. One interview indicated that cost savings had resulted from information provided by a clinical librarian. Forty-five percent of interviewees felt that their search skills had improved.
North West Wales: Ninety-nine percent of session attendees rated training programs highly. Although feedback indicated a desire for more training, 88.9% did feel more confident about their search abilities immediately following a program. The one-month-post-training questionnaire had a very low response rate (32%), but over 54% of those responding did believe that their skills had improved. But one month later, 12 interviews reported that “initial enthusiasm had usually tapered off” (20), and those interviewed weren’t sure if they really had better skills.
Conclusions – While findings weren’t conclusive, they suggest that having a librarian participate on a clinical team does lead to changes in information behaviour. Staff members were more confident searchers, more willing to search for information, and more willing to delegate that task to a librarian. The study also suggests that library services may be effectively targeted to specific groups of clinicians, and may have an impact on patient care.
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Fenton, Clare. "Is consent causing confusion for clinicians? A survey of child and adolescent Mental health professional’s confidence in using Parental Consent, Gillick Competence and the Mental Capacity Act." Clinical Child Psychology and Psychiatry 25, no. 4 (June 6, 2020): 922–31. http://dx.doi.org/10.1177/1359104520931586.
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All professionals engaged in clinical work should be competent to assess consent for the interventions they provide. This study assesses CAMHS clinicians confidence and knowledge in the various forms of consent and the number of minors admitted to mental health units in England under parental consent alone. An online questionnaire using vignettes of possible scenarios was sent to child and adolescent mental health practitioners in Tees Esk and Wear Valleys Trust. A freedom of information request was used to determine the number of young people admitted through parental consent. Thirteen of the 20 trusts contacted had no knowledge of the number of young people admitted under parental consent. A total of 93 participants completed the survey. Out of six vignettes, there were two where the majority of responses were discordant with current legal advice. Both of these vignettes considered the use of parental consent for admission to a mental health unit. This study provides further evidence to indicate that the current consent processes in CAMHS causes confusion for clinicians. There continues to be very few safeguards for children admitted under parental consent, with most trusts in England and Wales having no centralised knowledge of whether this is occurring and the numbers involved if it is.
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Bristow, M. F. "Usage of clozapine and the new neuroleptics." Psychiatric Bulletin 23, no. 8 (August 1999): 478–80. http://dx.doi.org/10.1192/pb.23.8.478.
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Aims and methodTo explore clozapine and atypical antipsychotic usage in England and Wales, particularly availability, restrictions on use and shifting of prescribing to general practitioners. To examine the hypothesis that respondents in acute trusts would encounter more restrictions. Method used – postal questionnaire sent to general psychiatrists derived from the 1996 Medical Directory.ResultsThere was an 80% response rate and over 90% of respondents used clozapine, with only 9% reporting any difficulty in obtaining it. Difficulty was not associated with any particular type of trust. Only about 4% of respondents suggested that general practitioners regularly took over the prescribing costs of the drug.Clinical implicationsOptimistic, with widespread usage and few difficulties in obtaining clozapine. General practitioner prescribing is still very low and needs to increase.
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Cooper, Sally-Ann, and Nicola M. Bailey. "Psychiatrists and the learning disabilities health service." Psychiatric Bulletin 22, no. 1 (January 1998): 25–28. http://dx.doi.org/10.1192/pb.22.1.25.
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A study of all trusts in England and Wales providing specialist health services for people with learning disabilities attracted an 83.9% response rate. Considerable variation exists with regard to the quantity of services. The relationship between the learning disabilities psychiatrist and National Health Service learning disabilities bed-numbers and learning disabilities health professionals from other disciplines is explored. An appropriate balance needs to be kept in these ratios to reduce stress and burnout.
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Ochieng, Cynthia A., Hollie Richards, Jesmond Zahra, Sian Cousins, Daisy Elliott, Nicholas Wilson, Sangeetha Paramasivan, et al. "Qualitative documentary analysis of guidance on information provision and consent for the introduction of innovative invasive procedures including surgeries within NHS organisations’ policies in England and Wales." BMJ Open 12, no. 9 (September 2022): e059228. http://dx.doi.org/10.1136/bmjopen-2021-059228.
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ObjectiveTo review guidance, included in written local UK National Health Service (NHS) organisation policies, on information provision and consent for the introduction of new invasive procedures- including surgeries, and devices (IPs/Ds).DesignA qualitative documentary analysis of data on patient information provision and consent extracted from policies for the introduction of IP/Ds from NHS organisations in England and Wales.SettingNHS trusts in England and health boards in Wales, UK.ParticipantsBetween December 2017 and July 2018, 150 acute trusts in England and 7 health boards in Wales were approached for their policies for the introduction of new IP/Ds. In total, 123 policies were received, 11 did not fit the inclusion criteria and a further policy was included from a trust website resulting in 113 policies included for review.ResultsFrom the 113 policies, 22 did not include any statements on informed consent/information provision or lacked guidance on the information to be provided to patients and were hence excluded. Consequently, 91 written local NHS policies were included in the final dataset. Within the guidance obtained, variation existed on disclosure of the procedure’s novelty, potential risks, benefits, uncertainties, alternative treatments and surgeon’s experience. Few policies stated that clinicians should discuss the existing evidence associated with a procedure. Additionally, while the majority of policies referred to patients needing written information, this was often not mandated and few policies specified the information to be included.ConclusionsNearly a fifth of all the policies lacked guidance on information to be provided to patients. There was variability in the policy documents regarding what patients should be told about innovative procedures. Further research is needed to ascertain the information and level of detail appropriate for patients when considering innovative procedures. A core information set including patients’ and clinicians’ views is required to address variability around information provision/consent for innovative procedures.
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Morgan, MA, M. Goodson, X. Escofet, GWB Clark, and WG Lewis. "Workload and Resource Implications of Upper Gastrointestinal Cancer Surgical Centralisation in South East Wales." Annals of The Royal College of Surgeons of England 90, no. 6 (September 2008): 467–71. http://dx.doi.org/10.1308/003588408x301127.
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INTRODUCTION The aim of this study was to determine whether one specialist unit could manage all patients diagnosed with oesophagogastric cancer in Gwent and Cardiff and Vale NHS Trusts over a 6-month period with regard to workload, resource and training opportunities. PATIENTS AND METHODS All patients diagnosed with oesophagogastric (OG) cancer in Gwent and Cardiff and Vale NHS Trusts and referred to the regional South East Wales Upper GI multidisciplinary team over the 6-month period from 1 July to 31 December 2005 were studied prospectively and compared with the previous 6-month caseload at Cardiff and Vale. RESULTS Out-patient workload increased from 160 new (33 OG cancers) and 533 follow-up patients (161 OG cancers) between 1 January and 30 June 2005, to 290 new (68 OG cancers, 106% increase) and 865 follow-up patients (230 OG cancers, 43% increase) between 1 July, and 31 December 2005. The number of patients undergoing radical surgery increased from 14 to 23 (D2 gastrectomy 8 versus 13; oesophagectomy 6 versus 10). Cancer-related workload in the latter period generated 118 intermediate equivalents (IEs) of operative work for two specialist surgeons and one SpR occupying 38% of the total time available on 104 scheduled operating lists, compared with 64 IEs in the previous 6 months, representing an 84% increase in cancer-related operative training opportunities. CONCLUSIONS Centralisation of oesophagogastric cancer surgery is feasible and desirable if national guidelines are to be satisfied, and this strategy has significant positive implications for surgical training and audit.
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Ashmore, Russell, and Neil Carver. "Section 5(4) of the Mental Health Act 1983: a review of local policy and guidance in England and Wales." Mental Health Review Journal 21, no. 1 (March 14, 2016): 37–47. http://dx.doi.org/10.1108/mhrj-05-2015-0017.
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Purpose – The purpose of this paper is to review policy or guidance on the implementation of Section 5(4) written by NHS mental health trusts in England and health boards in Wales. Design/methodology/approach – A Freedom of Information request was submitted to all trusts in England (n=57) and health boards in Wales (n=7) asking them to provide a copy of any policy or guidance on the implementation of Section 5(4). Documents were analysed using content analysis. Specific attention was given to any deviations from the national Mental Health Act Codes of Practice. Findings – In total, 41 (67.2 per cent) organisations had a policy on the implementation of Section 5(4). There was a high level of consistency between local guidance and the Mental Health Act Codes of Practice. There were however; different interpretations of the guidance and errors that could lead to misuse of the section. Some policies contained useful guidance that could be adopted by future versions of the national Codes of Practice. Research limitations/implications – The research has demonstrated the value of examining the relationship between national and local guidance. Further research should be undertaken on the frequency and reasons for any reuse of the section. Practical implications – Greater attention should be given to considering the necessity of local policy, given the existence of national Codes of Practice. Originality/value – This is the only research examining the policy framework for the implementation of Section 5(4).
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Al Rajeh, Ahmed, Michael C. Steiner, Yousef Aldabayan, Abdulelah Aldhahir, Elisha Pickett, Shumonta Quaderi, and John R. Hurst. "Use, utility and methods of telehealth for patients with COPD in England and Wales: a healthcare provider survey." BMJ Open Respiratory Research 6, no. 1 (February 2019): e000345. http://dx.doi.org/10.1136/bmjresp-2018-000345.
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IntroductionAlthough the effectiveness of domiciliary monitoring (telehealth) to improve outcomes in chronic obstructive pulmonary disease (COPD) is controversial, it is being used in the National Health Service (NHS).AimTo explore the use of teleheath for COPD across England and Wales, to assess the perceptions of clinicians employing telehealth in COPD and to summarise the techniques that have been used by healthcare providers to personalise alarm limits for patients with COPD enrolled in telehealth programmes.MethodsA cross-sectional survey consisting of 14 questions was sent to 230 COPD community services in England and Wales. Questions were designed to cover five aspects of telehealth in COPD: purpose of use, equipment type, clinician perceptions, variables monitored and personalisation of alarm limits.Results65 participants completed the survey from 52 different NHS Trusts. 46% of Trusts had used telehealth for COPD, and currently, 31% still provided telehealth services to patients with COPD. Telehealth is most commonly used for baseline monitoring and to allow early detection of exacerbations, with 54% believing it to be effective. The three most commonly monitored variables were oxygen saturation, heart rate and breathlessness. A variety of methods were used to set alarm limits with the majority of respondents believing that at least 40% of alarms were false.ConclusionAround one-third of responded community COPD services are using telehealth, believing it to be effective without robust evidence, with a variety of variables monitored, a variety of hardware and varying techniques to set alarm limits with high false alarm frequencies.
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Jones, Aled, Jill Maben, Mary Adams, Russell Mannion, Carys Banks, Joanne Blake, Kathleen Job, and Daniel Kelly. "Implementation of ‘Freedom to Speak Up Guardians’ in NHS acute and mental health trusts in England: the FTSUG mixed-methods study." Health and Social Care Delivery Research 10, no. 23 (August 2022): 1–124. http://dx.doi.org/10.3310/guws9067.
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Background The introduction of ‘Freedom to Speak Up Guardians’ into every NHS trust in England was intended to support workers and trusts to better raise, respond to and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England. Objectives The overall aim of this study was to better understand the implementation of Guardians in acute trusts and mental health trusts. Design The Freedom to Speak Up Guardian role was conceptualised as a complex intervention consisting of several interacting and interlocking components spanning the macro level (national organisations), the meso level (individual trusts) and the micro level (employees, teams and wards/units). A mixed-methods study was designed, which consisted of three work packages: (1) a systematic narrative review of the international literature regarding interventions promoting ‘speaking up’ by health-care employees; (2) semistructured telephone interviews with Guardians working in acute hospital trusts and mental health trusts; and (3) qualitative case studies of Freedom to Speak Up Guardian implementation, consisting of observations and interviews undertaken in four acute trusts and two mental health trusts. Interviews were also undertaken with national stakeholders. Setting Acute trusts and mental health NHS trusts in England. Participants Work package 2: Freedom to Speak Up Guardians (n = 87) were interviewed. Work package 3: 116 interviews with key stakeholders involved in pre-implementation and early implementation decision-making, workers who had spoken up to the Guardian, and national stakeholders. Results Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS trusts. ‘Freedom to Speak Up Guardian’ is best considered an umbrella term, and multiple versions of the role exist simultaneously across England. Any comparisons of Guardians’ effectiveness are likely to be possible or meaningful only when this variability is properly accounted for. Many Freedom to Speak Up Guardians identified how a lack of available resources, especially time scarcity, negatively and significantly affected their ability to effectively respond to concerns; their opportunities to collect, analyse and learn from speaking-up data; and, more generally, the extent to which they developed their role and speak-up culture. Limitations It is possible that those whom we interviewed were more receptive of Freedom to Speak Up Guardians or may have been biased by ‘socially desirability’, and their answers may not always have represented respondents’ true perceptions. Conclusions Optimal implementation of the Guardian role has five components: (1) establishing an early, collaborative and coherent strategy congruent with the values of Freedom to Speak Up fosters the implementation of (2) policies and robust, yet supportive, practices (3) informed by frequent and reflexive monitoring of Freedom to Speak Up implementation that is (4) underpinned by sufficient time and resource allocation that leads to (5) a positive implementation climate that is congruent with Freedom to Speak Up values and is well placed to engender positive and sustainable Freedom to Speak Up culture and the well-being of a Guardian. Future work The following recommendations for future research are considered to be of equal priority. Studies of the speaking-up experiences of minority communities and ‘seldom-heard’ workforce groups are a priority requirement. There is also value in undertaking a similar study in non-hospital settings and where peripatetic working is commonplace, such as in ambulance services and in primary care settings. The role of human resources and ‘middle managers’ in the management of concerns is an area requiring further research, especially regarding concerns relating to unprofessional and transgressive behaviours. Devolved administrations in Scotland and Wales have adopted different approaches to speaking up; research undertaken in these contexts would offer valuable comparative insights. Researching the Guardian role ≥ 5 years post implementation is recommended to understand the medium-term impact and the longer-term sustainability of the role and well-being of Guardians. Study registration This study is registered as ISRCTN38163690 and has the study registration CRD42018106311. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 23. See the NIHR Journals Library website for further project information.
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Annison, Jill, Lol Burke, and Paul Senior. "Transforming Rehabilitation: Another example of English ‘exceptionalism’ or a blueprint for the rest of Europe?" European Journal of Probation 6, no. 1 (April 2014): 6–23. http://dx.doi.org/10.1177/2066220314529053.
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The Transforming Rehabilitation agenda represents a radical departure in the way that rehabilitative services are delivered in England and Wales. Under the proposed changes, the existing Probation Trusts will be replaced by a significantly smaller National Probation Service dealing with the rump of high-risk public protection cases. The supervision and delivery of services to those offenders assessed as low and medium risk will be contracted to a range of providers on a payment by results basis. In this introduction to the special edition of the European Journal of Probation, the authors trace the policy developments that have extended the scope of the privatisation of state services in England and Wales. They then consider the values underpinning these developments and the potential impact on probation work before finally exploring the ways in which the current debate over the future of the probation service in England and Wales are being constructed and responses to this crisis shaped. This is organised into four interrelated arguments – the evidence response; the implementation response; the media response and the reclaim response.
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Grace, John. "Who do I sue? Liability for the treatment of NHS patients by outside providers." Clinical Risk 13, no. 5 (September 1, 2007): 193–95. http://dx.doi.org/10.1258/135626207781572710.
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The following paper was presented by John Grace QC at the AVMA conference in Glasgow on 29 June 2007. Many practitioners have expressed concern at the difficulties they have encountered in locating the correct Defendant when their client has received NHS treatment in a private hospital or a foreign country or when treated by overseas medical teams flown in. This article examines the different situations which may arise and considers a practical solution to claims which arise in England where the CNST (Clinical Negligence Scheme for Trusts) apply. It should be noted that the CNST does not apply in Wales or Scotland.
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Tadd, Win, Alex Hillman, Michael Calnan, Sian Calnan, Simon Read, and Antony Bayer. "From Right Place - Wrong Person, to Right Place - Right Person: Dignified Care for Older People." Journal of Health Services Research & Policy 17, no. 2_suppl (April 2012): 30–36. http://dx.doi.org/10.1258/jhsrp.2011.011118.
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Objectives To examine: older people's and their relatives' views of dignified care; health care practitioners' behaviours and practices in relation to dignified care; the occupational, organizational and cultural factors that impact on care; and develop evidence-based recommendations for dignified care. Methods An ethnography of four acute trusts in England and Wales involving semi-structured interviews with recently discharged older people (n = 40), their relatives (n = 25), frontline staff (n = 79) and Trust managers (n = 32), complemented by 617 hours of non-participant observation in 16 wards in NHS trusts. Results ‘Right Place - Wrong Person’ refers to the staffs' belief that acute wards are not the ‘right place’ for older people. Wards were poorly-designed, confusing and inaccessible for older people; older people were bored through lack of communal spaces and activities and they expressed concern about the close proximity of patients of the opposite sex; staff were demoralised and ill-equipped with skills and knowledge to care for older people, and organizational priorities caused patients to be frequently moved within the system. In none of the wards studied was care either totally dignified or totally undignified. Variations occurred from ward to ward, in the same ward when different staff were on-duty and at different times of the day. Conclusions The failure to provide dignified care is often a result of systemic and organizational factors rather than a failure of individual staff and it is these that must be addressed if dignified care is to be ensured.
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Henley, Josie, Lucy Brookes-Howell, Joanne Euden, Philip Pallmann, Martin Llewelyn, Philip Howard, Neil Powell, et al. "Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study)." BMJ Open 13, no. 12 (December 2023): e077117. http://dx.doi.org/10.1136/bmjopen-2023-077117.
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ObjectiveTo explore and model factors affecting antibiotic prescribing decision-making early in the pandemic.DesignSemistructured qualitative interview study.SettingNational Health Service (NHS) trusts/health boards in England and Wales.ParticipantsClinicians from NHS trusts/health boards in England and Wales.MethodIndividual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions.ResultsDuring the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed.ConclusionThis study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic.Trial registration numberISRCTN66682918.
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Withers, Kathleen, Sarah Puntoni, Robert Palmer, Susan O'Connell, and Grace Carolan-Rees. "OP96 Standardizing Collection Of Patient-Reported Experience Measures To Drive Service Improvement In Wales." International Journal of Technology Assessment in Health Care 34, S1 (2018): 35. http://dx.doi.org/10.1017/s0266462318001289.
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Introduction:Co-production relates to patients and health professionals working in equal partnership with shared decision-making. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly being used to involve patients and measure healthcare quality. We set out to develop a set of universal experience questions for use across Wales. These will be used in various settings, including the national electronic PROMs and PREMs platform, which is already collecting outcome data across Wales and has received over 7,000 responses to date.Methods:Patient experience leads and clinical leads were invited to a workshop to discuss standardized PREMs collection in Wales, with all health boards and trusts represented. It was agreed that quantitative patient experience data collection, while limited, would be a pragmatic way to collect responses from a large cohort. It was agreed that a previously developed set of PREMs questions could be adapted for use in all healthcare settings. Patient focus groups reduced the number of questions to a shortlist of those considered most important by patients. Wording was improved and an additional question was added.Results:In partnership with stakeholders we developed and agreed on a set of universal PREMs questions. These have been added to the national electronic platform, with collection commencing imminently. This will allow patients accessing secondary care in Wales to provide PREMs and PROMs responses.Conclusions:Development of a standardized set of PREMs has allowed us to initiate collection on a national basis. Addition of PREMs to the national electronic platform provides a unique means of collecting large volumes of data consistently, allowing us to benchmark across and within organizations. It will also allow experience teams to target improvement initiatives and identify good practice. Together with outcomes responses, the data will be used to measure experience of care in Wales.
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Kemp, Donna, Michael Doyle, Mary Turner, and Steve Hemingway. "Care Plan Templates in Adult Community Mental Health Teams in England and Wales: An Evaluation." Nursing Reports 14, no. 1 (February 1, 2024): 340–52. http://dx.doi.org/10.3390/nursrep14010026.
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Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A ‘high/low’ typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person’s care. This study was not registered.
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Verow, P., and I. Blair. "Audit of immunization policy and practice of health care workers within National Health Service Trusts in England and Wales." Occupational Medicine 49, no. 4 (1999): 211–16. http://dx.doi.org/10.1093/occmed/49.4.211.
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Jauhari, Yasmin, Carmen Tsang, Jibby Medina, David Dodwell, Kieran Horgan, and David Cromwell. "Organisation of services for the management of breast cancer in older patients in NHS Trusts in England and Wales." European Journal of Surgical Oncology (EJSO) 43, no. 5 (May 2017): S60. http://dx.doi.org/10.1016/j.ejso.2017.01.225.
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Maggs-Rapport, Treasure, and Chadwick. "Community dental officers’ use and knowledge of restorative techniques for primary molars: an audit of two Trusts in Wales." International Journal of Paediatric Dentistry 10, no. 2 (October 9, 2008): 133–39. http://dx.doi.org/10.1046/j.1365-263x.2000.00182.x.
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Naser, Abdallah, and Hassan Al-shehri. "Postprocedural Complications Hospitalization Pattern Among Paediatric Patients at National Health Service Trusts: An Ecological Study in England and Wales." Journal of Multidisciplinary Healthcare Volume 16 (November 2023): 3545–54. http://dx.doi.org/10.2147/jmdh.s441247.
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Farrukh, Affifa, and John F. Mayberry. "Evidence of On-Going Disparate Levels of Care for South Asian Patients with Inflammatory Bowel Disease in the United Kingdom during the Quinquennium 2015–2019." Gastrointestinal Disorders 4, no. 1 (January 14, 2022): 8–14. http://dx.doi.org/10.3390/gidisord4010002.
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Over the last decade, there have been a number of studies which have documented disparate levels of care in the management of inflammatory bowel disease amongst various minority communities in the UK. Similar findings had previously been described in the USA, where access to biologics has been an issue. In this study, data on admissions to hospital of South Asian and White British patients with inflammatory bowel disease between 2015 and 2019 were collected from 12 National Health Service (NHS) trusts in England, three Health Boards in Wales and two Scottish health organizations using Freedom of Information requests. The analyses of data were based on the assumption that inflammatory bowel disease (IBD) has the same prevalence in the South Asian community and the White British community in the UK. Comparisons were made between the proportion of hospitalised patients who were South Asian and the proportion who were White British in the local community using a z statistic. In Leicester, Bradford, Croydon and Lothian, the proportion of patients from the South Asian community admitted to hospital was significantly greater than the proportion from the local White British community, which is consistent with the greater frequency and severity of the disease in the South Asian community in the UK. However, in Coventry, Wolverhampton, Walsall, Acute Pennine Trust in the north-west of England, Barking, Havering and Redbridge and Glasgow, South Asian patients were significantly under-represented, indicating significant issues with access to hospital-based healthcare for inflammatory bowel disease. This study provides evidence of on-going evidence of disparate levels of care for patients from a South Asian background, with inflammatory bowel disease being underserved by a number of NHS Trusts, Health Boards and comparable organisations. When there is on-going failure to achieve the objectives of the NHS of achieving equality in the delivery of care, it is critical to introduce effective policies which will alter the in-built inertia to change within such organisations.
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CALNAN, M., W. TADD, S. CALNAN, A. HILLMAN, S. READ, and A. BAYER. "‘I often worry about the older person being in that system’: exploring the key influences on the provision of dignified care for older people in acute hospitals." Ageing and Society 33, no. 3 (February 27, 2012): 465–85. http://dx.doi.org/10.1017/s0144686x12000025.
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ABSTRACTOlder age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusionas well asacute clinical needs.
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Batchelor, Paul. "The Historical and Political Background to the Proposals for Local Commissioning of Primary Dental Care by Primary Care Trusts." Primary Dental Care os12, no. 1 (January 2005): 11–14. http://dx.doi.org/10.1308/1355761052894158.
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This paper provides a background to the changes that are about to occur in the system for primary oral healthcare delivery in the NHS. This is part of a far wider reform programme involving all public sector services. The challenges that the Government faces are not unique: all countries are striving to alter their care systems to address the changing expectations of the electorate while attempting to control both the costs and inequalities. What is unique to the United Kingdom is the historical legacy of the NHS and its political importance, which should not be underestimated. An overview of the agenda for change in all parts of the health sector is presented. This is followed by a more detailed analysis of the proposals for future delivery of primary oral care in the NHS and the subsequent issues arising. A consistent theme running throughout the Government's agenda is devolution. Indeed, the detailed programme discussed in this paper applies only to England and Wales. The fact that Scotland has different plans highlights the importance of the political and cultural setting to any reform programme.
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Ashmore, Russell. "Engagement and observation: a review of local policies in England and Wales." Mental Health Review Journal 25, no. 2 (May 8, 2020): 169–83. http://dx.doi.org/10.1108/mhrj-01-2020-0007.
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Purpose The purpose of this paper is to report on the content of local policies on engagement and observation written by National Health Service (NHS) organisations in England and Wales. Design/methodology/approach Engagement and observation policies were obtained from all (n = 61) NHS mental health trusts in England and health boards in Wales via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings All organisations had a specific policy referring to either “observation and engagement” or “observation”. The policies varied considerably in quality, length, breadth and depth of the information provided. Significant variations existed in the terminology used to describe the different types of enhanced observation. Inconsistencies were also noted between organisations regarding: which members of the clinical team could initiate, increase, decrease and terminate observation; who could undertake the intervention (for example students); and the reasons for using it. Finally, despite rhetoric to the contrary, the emphasis of policies was on observation and not engagement. Research limitations/implications This research has demonstrated the value of examining local policies for identifying inconsistencies in guidance given to practitioners on the implementation of engagement and observation. Further research should be undertaken to explore the impact of local policies on practice. Practical implications Local policies remain variable in content and quality and do not reflect contemporary research. There is a need to produce evidence-based national standards that organisations are required to comply with. Originality/value To the best of the author’s knowledge, this is the first research in 20 years examining the local policy framework for the implementation of engagement and observation.
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Al Shoaraa, Oudai Amjad, Sami Qadus, and Abdallah Y. Naser. "Medication prescription profile and hospital admission related to medication administration errors in England and Wales: an ecological study." BMJ Open 13, no. 11 (November 2023): e079932. http://dx.doi.org/10.1136/bmjopen-2023-079932.
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ObjectiveTo explore the correlation between prescribing rate of medications and hospital admissions related to medications administration errors in England and Wales during the time from 1999 to 2020.DesignAn ecological study.SettingA population-based study using hospital admission data that are publicly available in the UK. Data in this study were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales from Wales. The Prescription Cost Analysis database was used to extract the prescription data.ParticipantsPatients who were hospitalised all National Health Service (NHS) trusts and any independent sector funded by NHS trusts.Primary outcome measureHospitalisation rates related to medication administration errors and its associated prescriptions.ResultsThe annual rate of hospital admissions related to medication administration errors increased by 32.0% (from 184.21 (95% CI 183.0 to 185.4) in 1999 to 243.18 (95% CI 241.9 to 244.4) in 2020 per 100 000 persons. The most common three indications of hospital admissions were T39 (non-opioid analgesics, antipyretics and antirheumatics), T43 (psychotropic drugs), T42 (antiepileptic, sedative-hypnotic and antiparkinsonism drugs). The age group 15–59 years had the highest number of hospital admissions (83.4%). Women contributed to 59.1% of the total number of hospital admissions. Admission rate among men increased by 16.7%. Among women, the admission rate increased by 44.6%.ConclusionAdmission rates due to medication administration errors increased markedly in the past decade. This increase was correlated with an increase in the prescription rate of several therapeutic classes. Patients taking non-opioid analgesics, antipyretics and antirheumatics, psychiatric medications, antiepileptic, sedative-hypnotic and antiparkinsonism drugs should have their recommended (and administered) doses closely monitored. They should be followed up on a regular basis to ensure that they are taking their medications as prescribed.
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Crawford, Mike J., Daniel Huddart, Eleanor Craig, Krysia Zalewska, Alan Quirk, David Shiers, Geraldine Strathdee, and Stephen J. Cooper. "Impact of secondary care financial incentives on the quality of physical healthcare for people with psychosis: a longitudinal controlled study." British Journal of Psychiatry 215, no. 6 (July 5, 2019): 720–25. http://dx.doi.org/10.1192/bjp.2019.162.
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BackgroundConcerns have repeatedly been expressed about the quality of physical healthcare that people with psychosis receive.AimsTo examine whether the introduction of a financial incentive for secondary care services led to improvements in the quality of physical healthcare for people with psychosis.MethodLongitudinal data were collected over an 8-year period on the quality of physical healthcare that people with psychosis received from 56 trusts in England before and after the introduction of the financial incentive. Control data were also collected from six health boards in Wales where a financial incentive was not introduced. We calculated the proportion of patients whose clinical records indicated that they had been screened for seven key aspects of physical health and whether they were offered interventions for problems identified during screening.ResultsData from 17 947 people collected prior to (2011 and 2013) and following (2017) the introduction of the financial incentive in 2014 showed that the proportion of patients who received high-quality physical healthcare in England rose from 12.85% to 31.65% (difference 18.80, 95% CI 17.37–20.21). The proportion of patients who received high-quality physical healthcare in Wales during this period rose from 8.40% to 13.96% (difference 5.56, 95% CI 1.33–10.10).ConclusionsThe results of this study suggest that financial incentives for secondary care mental health services are associated with marked improvements in the quality of care that patients receive. Further research is needed to examine their impact on aspects of care that are not incentivised.
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de Brito, Marianne, Amy Johnson, Sue Schilling, Leila Asfour, and Nick J. Levell. "BH10 Unequal National Health Service wig provision: toupée or no toupée, that is the question?" British Journal of Dermatology 191, Supplement_1 (June 28, 2024): i77. http://dx.doi.org/10.1093/bjd/ljae090.157.
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Abstract The psychological impact of alopecia on patients’ quality of life can be significant. Patients may experience loss of confidence, discrimination, social anxiety and other mental health disorders as a result. In the absence of effective and well-tolerated treatments available in the National Health Service (NHS) to treat the underlying cause of the alopecia, wigs can provide an opportunity for patients to live confidently, free of stigma and visible differences. The Alopecia UK Charter for Best Practice for Wigs Provision aimed to support fair and equitable wig provision across the UK, work that was supported by NHS England and NHS Improvement. We investigated wig provision across nonprivate patients in the UK via an online survey. We circulated a three-question, 1-minute survey to dermatology doctors and healthcare professionals seeing nonprivate patients within NHS trusts (England), health boards (Wales and Scotland) or health and social care trusts (Northern Ireland). This was via the Alopecia UK stand at the British Association of Dermatologists (BAD) Annual Meeting 2023, to the circulation of the British Hair and Nail Society membership and events, and via the BAD newsletter. We received 73 responses. Overall, for nonprivate patients with severe alopecia, most reported that wig provision would be straightforward (52%), but a large minority reported variable difficulty, due to patient or other factors (33%), and 5% reported it would be impossible. The remaining 10% did not know. There were respondents from all regions of the UK, with most from England: 59 (Northern Ireland: 2, Scotland: 3, Wales: 7, not stated: 2). The best-represented regions in England were the Midlands (14), the North West (14), North East and Yorkshire (10) and London (9), but there were responses from all regions. There was widespread variation in access to wig provision by different regions. All respondents from Scotland (3 of 3) and the South West (2 of 2) reported wig provision was straightforward, while all respondents from Northern Ireland (2 of 2) reported variable difficulty. At least 50% of the respondents from the East of England, London, Midlands, South East and North West reported wig provision was not straightforward. The findings of this survey reveal widespread variation in ease of access to wig provision throughout different regions of the UK. This demonstrates a lack of equality between patients with alopecia in different regions of the UK and impacts on patient choice. This goes against the Alopecia UK Charter for Best Practice for Wigs Provision. We hope that these findings will have implications at health policy level to improve and standardize access for all patients with alopecia who want and need a wig.
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Passmore, Oliver. "Insolvent trusts—the Z Trusts litigation." Trusts & Trustees 25, no. 10 (November 29, 2019): 1033–40. http://dx.doi.org/10.1093/tandt/ttz106.
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Abstract The Z Trusts litigation in Jersey represents the first occasion on which a Court has considered what is to happen when a trust becomes “insolvent”. The Royal Court has given a series of judgments which deal with various aspects of such a situation, from the duties of trustees, to the procedure for creditor claims, to the question of priority between creditors. As such, it represents a case study in how a Court might approach such a situation and provides useful guidance to trustees and those who transact with them as to what might happen in such circumstances.
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Llewelyn, Martin J., Detelina Grozeva, Philip Howard, Joanne Euden, Sarah M. Gerver, Russell Hope, Margaret Heginbothom, et al. "Impact of introducing procalcitonin testing on antibiotic usage in acute NHS hospitals during the first wave of COVID-19 in the UK: a controlled interrupted time series analysis of organization-level data." Journal of Antimicrobial Chemotherapy 77, no. 4 (February 8, 2022): 1189–96. http://dx.doi.org/10.1093/jac/dkac017.
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Abstract Background Blood biomarkers have the potential to help identify COVID-19 patients with bacterial coinfection in whom antibiotics are indicated. During the COVID-19 pandemic, procalcitonin testing was widely introduced at hospitals in the UK to guide antibiotic prescribing. We have determined the impact of this on hospital-level antibiotic consumption. Methods We conducted a retrospective, controlled interrupted time series analysis of organization-level data describing antibiotic dispensing, hospital activity and procalcitonin testing for acute hospitals/hospital trusts in England and Wales during the first wave of COVID-19 (24 February to 5 July 2020). Results In the main analysis of 105 hospitals in England, introduction of procalcitonin testing in emergency departments/acute medical admission units was associated with a statistically significant decrease in total antibiotic use of −1.08 (95% CI: −1.81 to −0.36) DDDs of antibiotic per admission per week per trust. This effect was then lost at a rate of 0.05 (95% CI: 0.02–0.08) DDDs per admission per week. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions rather than all admissions. Introduction of procalcitonin in the ICU setting was not associated with any significant change in antibiotic use. Conclusions At hospitals where procalcitonin testing was introduced in emergency departments/acute medical units this was associated with an initial, but unsustained, reduction in antibiotic use. Further research should establish the patient-level impact of procalcitonin testing in this population and understand its potential for clinical effectiveness.
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Hobson, J. M. "Will our junior doctors be ready for the next major incident? A questionnaire audit on major incident awareness across three NHS Trusts in Wales." BMJ Open 1, no. 1 (July 4, 2011): e000061-e000061. http://dx.doi.org/10.1136/bmjopen-2011-000061.
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Mee, John. "Property rights and personal relationships: reflections on reform." Legal Studies 24, no. 3 (June 2004): 414–50. http://dx.doi.org/10.1111/j.1748-121x.2004.tb00256.x.
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This paper considers the possible reform of the law governing property rights upon the termination of a close personal relationship, taking as its point of departure the Law Commission's Discussion Paper on Home-Sharing (2002). Having considered the reasons for the inconclusive outcome of the Law Commission's project (and the Discussion Paper's comments on the law of trusts), the paper moves on to consider the possible shape of future reform. It examines first the preliminary question of whether possible legislation should focus on unmarried cohabitees or whether a wider range of relationships should be encompassed (with or without a cohabitation requirement), The paper then looks at the form which a legislative scheme might take, examining the possibility of focusing on contributions (along the lines of New South Wales’ legislation) and the Law Society's proposals for a regime based on‘economic advantage and disadvantage’. The experience of the courts in the matrimonial context is considered with a view to extracting relevant lessons. In general, rather defending one particular model for reform, the paper attempts to identify and explore key issues which will be of relevance across a variety of approaches to reform.