Mapping maternity care facilities in England

Objective. To describe the organisation of maternity care at trust and unit level in England. Methods. All NHS trusts providing maternity care participated in a survey as part of the Healthcare Commission review of maternity care in England in 2007. Data on trusts and numbers of units were also collected in 2009 as part of the Birthplace in England programme. Results. Models of care provision are limited: in 2007 two-thirds of trusts provided choice between home birth and birth in an obstetric unit only. Geographical variation is substantial, with approximately 70% of trusts in the North-West, Yorkshire and Humberside and London Strategic Health Authority regions having only obstetric units, compared with 50% or less in the South-West and East Midlands. Availability and proximity of specialist facilities for women and babies within trusts varies and is linked with obstetric units. Changes in trust configuration, identified in 2009, have largely resulted from opening alongside midwifery units, then available in a quarter of trusts. Freestanding midwifery units continue to provide care for small numbers of women, commonly in more rural areas. Conclusions. In 2007, 66% of trusts had no midwifery-led units and this is likely to have limited the choices that women were able to make about their planned place of birth and the possibility of having midwife-led care in nonobstetric unit settings. Recent data suggest that women’s options for care may have increased, although capacity and staffing issues, reflected in closures to admissions, may affect these

At the margins of the medical? Educational psychology, child guidance and therapy in provincial England, c.1945-1974

This article mobilises archival material from local authorities in England to assess the shifting role of psychologists within local school health services from the 1930s through to the reorganisation of the National Health Service (NHS) in 1974. It argues that psychologists were increasingly positioned between therapist, diagnostician and social worker, that this was bound together with a local discourse of children’s emotional well-being and that the increasing fluidity of the psychologist’s role emerged from local policies designed to stress the ‘educational’ nature of their role. In so doing, it extends work by John Stewart on child guidance and more long-standing histories of local, ‘municipal’ medical services. It suggests ways in which the older, localised provision of public health services in Britain persisted after the creation of the NHS and argues the need for a more flexible understanding of what was ‘medical’ about the local welfare state in this period

The Control of Methicillin-Resistant Staphylococcus aureus Blood Stream infections in England

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) is a major healthcare burden in some but not all healthcare settings, and it is associated with 10%–20% mortality. The introduction of mandatory reporting in England of MRSA BSI in 2001 was followed in 2004 by the setting of target reductions for all National Health Service hospitals. The original national target of a 50% reduction in MRSA BSI was considered by many experts to be unattainable, and yet this goal has been far exceeded (∼80% reduction with rates still declining). The transformation from endemic to sporadic MRSA BSI involved the implementation of serial national infection prevention directives, and the deployment of expert improvement teams in organizations failed to meet their improvement trajectory targets. We describe and appraise the components of the major public health infection prevention campaign that yielded major reductions in MRSA infection. There are important lessons and opportunities for other healthcare systems where MRSA infection remains endemic

Can wage changes solve the labour crisis in the National Health Service?

This study aimed to examine the healthcare labour demand and supply elasticity regarding wage in the National Health Service (NHS) in England amid a labour crisis. A simultaneous error-correction regression analysis was conducted using secondary data from the NHS and Office for National Statistics from 2009 Q3 to 2022 Q1. Findings indicate both labour demand and supply of HCHS doctors in the NHS are highly inelastic with respect to real wages, with only a 0.1% decrease in NHS staff hiring and a 0.8% rise in NHS staff’s willingness to work as full-time equivalents per 10% wage increase. Approximately 22% of the wage disequilibrium adjusts quarterly, indicating moderate speed of wage adjustment. Our results suggest that wage setting is not a sufficient solution to the labour crisis. Innovative and sustainable solutions are needed to reduce the demand for skilled health labour and increase the supply of health labour

Creating new roles in healthcare: lessons from the literature

The NHS is faced with the urgent task of reshaping and enhancing its nursing workforce. Part of this reshape will be happening soon with the introduction of nursing associates – the first cohorts are currently undergoing training. However, introducing new roles in an established healthcare workforce is not an easy task. It needs to be well thought-out and planned, and conducted with the primary aim of meeting patient need. This article sums up the findings of a literature review on the introduction of new roles in healthcare, using lessons learned from the past to provide guidance to leaders and workforce planners

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs

AIDS Inside and Out: HIV/AIDS and Penal Policy in Ireland and England & Wales in the 1980s and 1990s.

As HIV/AIDS emerged in the 1980s as a new and seemingly overwhelming public health challenge, prisons were highlighted as an important location for the control of the epidemic. Yet, they often seemed unwilling or unable to adopt national guidelines. This article compares the policy decisions made by the prison services of the Republic of Ireland and England & Wales in response to HIV/AIDS in the 1980s and 1990s, bringing together the histories of penal policy and HIV/AIDS for the first time. It develops our understanding of contemporary policy history, and demonstrates the value of a comparative approach to both penal and health histories. Policy-making was shaped by both national and more localised traditions and trends, from attitudes to criminal justice and responses to HIV/AIDS at the national level, to the histories, structures, and staffing of prison services themselves

'She can't come here!' Ethics and the case of birth centre admission policy in the UK

Using ethnographic data lifted from an investigation into midwifery talk and practice in the South of England, this paper sets out to interrogate the ethics underpinning current admission policy for Free Standing (midwifery led) Birth Centres in the UK. The aim of this interrogation is to contest the grounds upon which birth centres admissions are managed, particularly the over-reliance on abstract calculations of risk—far removed from the material lived experience of the mother wishing to access these birth centre services

Community-based post-stroke service provision and challenges: a national survey of managers and inter-disciplinary healthcare staff in Ireland.

ABSTRACT: BACKGROUND: The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. Maximising rehabilitation input at this point can minimise the impact of disability. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement. METHODS: The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N=7) and disciplinary allied health professional and public health nurse managers (N=25) were interviewed (94% response rate). RESULTS: Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (\u3e65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients. CONCLUSIONS: This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for strategic planning; increased funding of healthcare staff; increased team resources and teamwork; and removal of service provision barriers based on age. There were notably many challenges beyond funding. Similar evaluations in other healthcare systems would serve to provide comparative lessons to serve to tackle this underserved aspect of care for patients with stroke and their families