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At the end of the year there is to be an upheaval at the headquarters of the Association of Teachers in Technical Institutions. Mr Edward Britton moves downstairs in Hamilton House to take up his appointment as general secretary designate of the NUT and is to be succeeded as ATTI Secretary by Mr Tom Driver; at the same time the ATTI acquires two new assistant secretaries, Mr William Boaden and Mr Peter Dawson. These changes will have important consequences for both the NUT and the ATTI.

The hip fracture “best practice tariff” (BPT) came into effect in April 2010. It advocated two key improvements: surgery within 36hrs of arrival in the emergency department; and multi-disciplinary care directed by ortho-geriatrician from admission to discharge. The aim of this paper is to look at the 36 hours to operation target and its implications for orthopaedic department trauma service staff in a busy district general hospital, and to evaluate the measures implemented to meet the target.

Trauma-list data, collected from a theatre management system, was compared with trauma patients placed on elective and emergency lists, before and after designated daily trauma lists were implemented.

After a designated daily trauma list was introduced, a significant rise (from 56 per cent to 85 per cent) became evident in the proportion of patients operated on within 36hrs, between November 2010 to February 2011, while hip fracture cases managed on the elective list fell from 24 per cent to 17 per cent.

Despite adding a half-day trauma list, the trauma service has insufficient capacity to achieve the new BPT for all hip fracture patients in the hospital. Therefore, there is a significant knock-on effect for managing patient overspill on elective services. Will the significant changes in service provision designed to achieve this BPT be cost effective?

This paper aims to answer how busy department staff address an issue that professionals in every English hospital are facing.

Coding clinical work should allow accurate and precise methods of assessing individual or department activity. The NHS financial reforms have increased correct diagnostic coding importance by introducing “payment by results” so that funding is directly linked to patient activity. The aim of this study is to assess the accuracy of procedure codes (OPCS 4.4), and its effect on Healthcare Resource Group tariff codes that directly affect revenue.

A total of ten procedures from ten consultants were randomly selected over one month. Each consultant coded his or her own procedures. From these codes, Healthcare Resource Group tariff codes were assigned to each patient. These were compared with procedure and Healthcare Resource Group tariff codes generated by coding department staff.

Of 100 procedures, four were un‐coded by coding department staff. There was concordance in 35 per cent of cases. Coders only gave one code for each procedure, whereas 35 per cent of procedures coded by consultants were assigned multiple codes. This resulted in 27 per cent of cases generating a different Healthcare Resource Group tariff code. Of the cases, five resulted in a difference of £4,000 or more; however, the overall difference was a £3,367 revenue loss if coder's codes were used.

Study numbers were limited to 100 with five cases showing excessive financial gain or loss significantly influencing the overall result.

Present procedure coding practice is inaccurate and results in Healthcare Resource Group tariff codes that do not accurately represent clinical activity and productivity. Under payment by results, this can result in a significant revenue loss and possibly ultimately future referrals. Therefore, coding practice needs to be improved as a matter of urgency. Arguably, this could be achieved by closer communication between coders and clinicians.

The paper identifies a flaw in the way clinical activity and productivity is assessed at present. This is fundamental to the process on which “payment by results” is based, and therefore must be addressed if trusts are to be financially successful.

In the third of a series of articles on the sacred cows of education Michael Pollard looks at the National Foundation for Educational Research.

A further contribution to the debate about ways of cutting costs in higher education was made last month by the Rev George Tolley, principal of Sheffield Polytechnic and vice‐chairman of the Committee of Directors of Polytechnics. The pressures for demanding ‘a reduced scale of increase in expenditure (which is not the same as a cut‐back)’ are inevitable, he said. Shorter courses, a reduced commitment to research a ‘shift’ system and a worsening of the staff‐student ratio were amongst the possibilities that would have to be considered.

It used to be said that the quickest way to empty the House of Commons was to start a debate on education. This is no longer so. Yet it is true that a teaching situation already serious, and becoming more so, has received little attention nationally. This is strange when the developing situation affects a substantial and growing part of the working population — the office workers.

The Department of Education and Science, with a nice sense of timing two weeks before the ATTI conference, has published yet another statement of contempt for the technical colleges and all who dwell therein. This is administrative memorandum 13/70 introducing the fourth ‘Pilkington’ report on the more effective use of technical college resources. Notwithstanding the fact that technical college buildings are more intensively used than any other educational buildings, that the further education sector has been the most savaged by the recent financial cuts and that the authorities refuse seriously to consider a national agreement on conditions of service for technical college teachers, you are urged, nay instructed, my technical college colleagues, to extend the college year.

After the weeks and months of waiting, the interim announcement from the Department of Education and Science on the conditional designation of 16 of the 30 proposed Polytechnics was greeted as something of a damp squib.

A new Education Act is now being actively prepared by the Department of Education and Science and will probably be tabled during the 1969–70 parliamentary session. Preparations for the Bill are being overseen by Mrs Shirley Williams, Minister of State at the Department.