A critical commentary on policy and practice over time in English health and social care. The paper aims to discuss these issues.
Abstract
Purpose
A critical commentary on policy and practice over time in English health and social care. The paper aims to discuss these issues.
Design/methodology/approach
Personal reflections based on prior experience as a senior leader in the English health and care system, combined with insights and relevant evidence from other senior leaders and health and care “think-tanks”.
Findings
Shifting the balance of care from a hospital to a community setting can potentially be cost-effective as well as improving quality for service users. However, it will require a change in the approach to planning and implementation, by focussing on service users and communities, rather than on statutory organisations. It will also require a greater level of integration between primary care, community health services, social care and the voluntary sector, and greater levels of “co-production” with service users and the public.
Research limitations/implications
Front-line health and care leaders are generally unaware of the evidence base in this field. Emergent findings in this field need to be rapidly evaluated and then communicated to front-line leaders and practitioners.
Originality/value
Incorporates direct experience of senior leaders in the field together with the existing and emerging evidence base.
Details
Keywords
The purpose of the paper is to provide an overview of issues being faced, and likely to have to be faced, in establishing effective health and wellbeing boards.
Abstract
Purpose
The purpose of the paper is to provide an overview of issues being faced, and likely to have to be faced, in establishing effective health and wellbeing boards.
Design/methodology/approach
The paper is based the perspective of the Department of Health's lead for implementation of these boards. Set in the context of national policy expectation, it draws on the early experiences of board development all over the country; and on discussions and seminars held to test their practical implications.
Findings
Transformation of the current pattern of services is needed to meet the preferred needs of the public. This is a major challenge at local level, and the leadership capacity and style of the new boards, and their communication skill, will be vital to the creation of responsive integrated services.
Originality/value
The paper draws together current thinking on a key policy initiative of the current government, and links it directly to integrated health and social care.
Details
Keywords
The action taken by the Council of the British Medical Association in promoting a Bill to reconstitute the Local Government Board will, it is to be hoped, receive the strong…
Abstract
The action taken by the Council of the British Medical Association in promoting a Bill to reconstitute the Local Government Board will, it is to be hoped, receive the strong support of public authorities and of all who are in any way interested in the efficient administration of the laws which, directly or indirectly, have a bearing on the health and general well‐being of the people. In the memorandum which precedes the draft of the Bill in question it is pointed out that the present “Board” is not, and probably never was, intended to be a working body for the despatch of business, that it is believed never to have met that the work of this department of State is growing in variety and importance, and that such work can only be satisfactorily transacted with the aid of persons possessing high professional qualifications, who, instead of being, as at present, merely the servants of the “Board” tendering advice only on invitation, would be able to initiate action in any direction deemed desirable. The British Medical Association have approached the matter from a medical point of view—as might naturally have been expected—and this course of action makes a somewhat weak plank in the platform of the reformers. The fourth clause of the draft of the Bill proposes that there should be four “additional” members of the Board, and that, of such additional members, one should be a barrister or solicitor, one a qualified medical officer of health, one a member of the Institution of Civil Engineers, and one a person experienced in the administration of the Poor‐law Acts. The work of the Local Government Board, however, is not confined to dealing with medical, engineering, and Poor‐law questions, and the presence of one or more fully‐qualified scientific experts would be absolutely necessary to secure the efficient administration of the food laws and the proper and adequate consideration of matters relating to water supply and sewage disposal. The popular notion still exists that the “doctor” is a universal scientific genius, and that, as the possessor of scientific knowledge and acumen, the next best article is the proprietor of the shop in the window of which are exhibited some three or four bottles of brilliantly‐coloured liquids inscribed with mysterious symbols. The influence of these popular ideas is to be seen in the tendency often exhibited by public authorities and even occasionally by the legislature and by Government departments to expect and call upon medical men to perform duties which neither by training nor by experience they are qualified to undertake. Medical Officers of Health of standing, and medical men of intelligence and repute are the last persons to wish to arrogate to themselves the possession of universal knowledge and capacity, and it is unfair and ridiculous to thrust work upon them which can only be properly carried out by specialists. If the Local Government Board is to be reconstituted and made a thing of life—and in the public interest it is urgently necessary that this should be done—the new department should comprise experts of the first rank in all the branches of science from which the knowledge essential for efficient administration can be drawn.
Shamsuddin Ahmed and Addas F. Mohammed
Accident emergency hospital (AEH) services require cohesive, collective, uninterrupted streamlined medical diagnostic and satisfactory patient care. Medical service efficiency in…
Abstract
Purpose
Accident emergency hospital (AEH) services require cohesive, collective, uninterrupted streamlined medical diagnostic and satisfactory patient care. Medical service efficiency in AEHs is difficult to quantify due to the clinical complexity involved in treatment involving various units, patient conditions, changes in contemporary medical practices and technological developments. This paper aims to show how to measure efficiency by eliminating waste in AEH system, identify service failure points, identify benchmark medical services, identify patient throughput time and measure treatment time when AEH services are nonstandard. The applications shown in this paper are distinct in particular; we the authors use nontraditional and systems engineering approach to collect data as the traditional data collection is difficult in real-time AEHs.
Design/methodology/approach
The authors show in this study how to measure overall patient treatment time from admission to discharge. Project evaluation and review technique (PERT) captures the inconsistencies involved in measuring treatment time, including measures of variability. The irregular treatment time and complexity involved in the emergency health-care services are usual. The research methodology illustrates how the time function map and service blueprint can improve value-added time in AEHs and benchmark services between similar AEHs.
Findings
The inconsistency in treatment time between AEH in public and private hospital is found to be in ratio of 1:20. The private hospital suggests variety of treatments and long stays for recovery. The PERT computations show that the average time a patient remains in a government AEH is about 10 days. The standard deviation of the AEH treatment time is about 0.043 per cent of the expected patient care time. The inconsistency is not significant as compared to the expected value. In 89.64 per cent of the cases, a patient may be discharged in less than 10 days’ time. The patient on average is discharged in 13 days in a private hospital.
Originality/value
The patient treatment time of an AEH is evaluated with PERT project management approach to account for inconsistencies in treatment time. This research makes new contributions in benchmarking AEH throughput time, identify medical service failure points with service blueprint, measure the efficiency with time function map and collect patient data with nontraditional methods. The inherent inconsistencies in a clinical process are identified by PERT analysis with the variance as a characteristic of the treatment time. Improvement of variability implies cost reduction in AEH system.