'Did not attends' in children 0-10: a scoping review

Patients who do not attend (‘DNA’) health appointments have been identified as a service problem incurring significant costs to the NHS. In order to explore the causes, effects and costs of child DNAs, we carried out a scoping study to map the literature and identify gaps in the research. Given the breadth of issues underpinning DNAs, a scoping study, including research studies, audits, policy documents and conference abstracts, was the most useful way to map the field. To foster public and patient participation, we sought advice from parents participating in the National Children's Bureau's Family Research Advisory Group. From a pool of 1997 items, we found few UK studies with non-attendance of 0–10 year olds as a primary focus, though many more incidentally reported DNA rates. Overall, four topics predominated: the conceptualization of DNAs; the correlates of non-attendance; initiatives to reduce non-attendance; and the relationship between non-attendance and safeguarding. The Family Research Advisory Group identified broadly similar issues, but with a stronger emphasis on communication and practical matters. While there may be circumstances where failing to attend appointments makes little or no difference to a child (or even benefits them) it is likely that there are children whose health or well-being are compromised as a result of failing to attend appointments. Both ‘over’ and ‘under'-attendance can be a source of anxiety to health professionals. Areas where further work is needed include robust evaluation of the effectiveness, cost-effectiveness and maintenance of measures to reduce DNAs and a better understanding of the relationship of safeguarding to non-attendance

Managing the estate of the National Health Service in Wales

English/Welsh text on inverted pagesAvailable from British Library Document Supply Centre-DSC:m01/40670 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Implementing a National Policy Initiative to Support Normal Birth: Lessons From the All Wales Clinical Pathway for Normal Labour

Introduction This article discusses findings from an ethnographic study of a national policy initiative in Wales, United Kingdom. The policy aimed to decrease the caesarean section rate and increase the number of normal births by implementing a clinical pathway for normal labour. The aim of this study was to explore the real life experiences of those involved in the development and use of the policy. Methods A range of qualitative methods was used, including observation, semistructured interviews, focus groups, and documentary analysis. Data were collected from midwives, doctors, midwifery managers, and mothers. Field notes and transcripts were thematically analysed. Results The article discusses aspects of the findings related to the early stages of policy formation and development, including the initial phase of national implementation. It considers the challenges presented by creating national policies, discussing positive and negative aspects of the process. Discussion The key themes discussed are effective consultation and involvement, group processes, “ownership,” reaching consensus, and the need for ongoing support. Issues of relevance to maternity care providers in other cultural locations are discussed and recommendations are made

‘Layering’ peer enquiry as a system change strategy: some lessons from Wales

This chapter describes a peer enquiry process developed by headteachers in Wales. Peer enquiry was one of the key collaborative school improvement approaches used within a regional challenge that aimed to develop a more ‘self-improving system. The chapter discusses the potential of peer enquiry for bringing about system change by gradually replacing ‘vertical’ accountability structures by more collaborative and reciprocal ‘horizontal’ approaches. The key differences for those involved in undertaking a peer enquiry, rather than a peer review, arose as much from the context in which it took place as they did from any substantive differences in the processes used