Hospital Car Parking: The Impact of Access Costs

NHS Trusts have statutory powers to raise income, which allow them to decide whether to charge, and how much to charge, for hospital car parking. Trusts are not obliged to provide parking facilities on their premises, but provision will inevitably incur costs in the form of maintenance, security and staffing. If Trusts choose not to charge for parking, then these costs must be covered from other sources of revenue, potentially diverting resources from patient care. Charges typically account for around 0.25% of a hospital?s income, but can be as high as 1%. The government offers financial support to people on low incomes who incur travel expenses when accessing health care.

Community care in Scotland

This ethnological perspective of Community Care in Scotland will focus on historical, political, and social contexts and their influences on the community care arrangements for individuals within various types of communities in Scotland today

Topical preparations for the treatment of psoriasis in primary care: a systematic review

Context: There is clinical uncertainty about the appropriate use of first-line topical treatments for psoriasis. Objective To assess the relative effectiveness and tolerability of topical treatments for psoriasis in primary care. Data sources: All major medical databases of published literature were searched electronically; references of trial reports and recent reviews were searched; authors and companies were contacted for missing data from published reports. Study selection: (1) Randomised placebo-controlled trials of topical treatments for psoriasis and (2) randomised head-to-head studies of the new vitamin D3 derivative treatments for psoriasis, that reported clinical outcome using a Total Severity Score (TSS), Psoriasis Area Sensitivity Index or Investigator Assessment of Global Improvement. Data extraction: Eligibility and validity were assessed and data extracted independently by two authors. Data synthesis: Clinical outcomes were pooled using a random effect standardised weighted mean difference (SWMD) metric, including 3,380 patients randomised in 41 placebo (vehicle) controlled trials and 4,898 patients randomised in 28 head-to-head studies. There was a significant benefit in favour of active treatments against vehicle, SWMD: -1.06 (95%Cl: -1.26 to -0.86), approximately a 2-point improvement on a 12-point TSS after 6 to 8 weeks of treatment. The only significantly different benefit was for very potent corticosteroids; SWMD: -1.51 (95%Cl: -1.76 to -1.25), approximately a 3-point improvement on a 12-point TSS. Head-to-head studies support these findings, except that calcipotriol was estimated to be more effective than dithranol, coal tar and other vitamin D3 derivatives. Polytherapy, using a potent steroid and calcipotriol, was more effective than calcipotriol alone: SWMD 0.42 (95%Cl: 0.12 to 0.72) approximately a 0.8 point improvement on a 12-point TSS> No important differences in withdrawal or reporting of adverse events were identified. Conclusions Trials of short duration neither adequately inform the management of chronic disease nor describe the sequelae of treatment. The evidence base for long-term care, reflecting the disease pathway, should be improved. Combination therapy with topical vitamin D analogues and steroids, and maintenance therapy following treatment response merit further investigation.psoriasis, treatment, chronic disease management

Establishing a Fair Playing Field for Payment by Results

The English government has encouraged private providers – known as Independent Sector Treatment Centres (ISTCs) – to treat publicly funded (NHS) patients. Providers are paid a fixed price per patient treated, adjusted to reflect geographical differences in input costs. But there may be other legitimate cost variations between providers. This report considers the regulatory and production-process constraints that could cause public and private providers costs to differ. Most of these exogenous cost differentials can be rectified by adjustments to the regulatory system or to the payment method. We find evidence that ISTCs are treating different types of patients than NHS hospitals. If these differences drive costs, payments for treatment might need to be differentiated by setting.

Older People Have Their Say! Survey of Older People’s Needs in Westgate Ward, Canterbury

Although a lot of effort in the last few years has been made to address the needs of people in old age, surprisingly not much is known about the views of this age group in the Canterbury City Council area. To address this lack of knowledge, the Canterbury and District Pensioners’ Forum was funded by the Canterbury City Council to explore the needs of older people living in this area. Our Forum decided to collaborate with the University of Kent to produce a survey on the needs of older people within the District of Canterbury. During the process of the project, we decided to base the survey on the Westgate Ward in Canterbury because we felt that older people living in this area represent a good example for highlighting needs that involve ‘ordinary’ older people. This ward is quite diverse in many ways; it spreads from a semi-rural area through to town dwelling. It is not seen as an area of deprivation, thereby has not generated any special money from the Government to help with social problems in the provision of social centres, community learning, social activities etc. Yet we know from our own experience that what may appear in many parts as fairly affluent is quite deprived of places for people to meet; and has large public housing areas with no amenities at all. The present Government put through legislation, which said that public services should be surveyed, and the part of that legislation that we are particularly interested in is “The National Service Framework for Older People”. That framework asks that older people are treated with dignity by NHS and Social Care organisations; and that Councils –County and District, examine existing services- housing, leisure and transport – to identify opportunities to promote health and well-being. We felt that Westgate Ward would be representative of many other areas within our District that had not received any special investment. The work that has been done in producing this survey has been done by members of the Canterbury & District Pensioners’ Forum with help from the University of Kent. It is a survey of older people, carried out by older people. It is our work. Information generated by this project will be assisting the Forum’s work to promote important issues related to older people’s quality of life and access to health and social care services. A comment from J.F. Kennedy we believe sums up the approach that we took at the start of this survey: “It is not enough for a nation to have added years of life. Our object must be to add new life to those years

Integrated Care : A Pill for All Ills?

There is an increasing policy emphasis on the integration of care, both within the healthcare sector and also between the health and social care sectors, with the simple aim of ensuring that individuals get the right care, in the right place, at the right time. However, implementing this simple aim is rather more complex. In this editorial, we seek to make sense of this complexity and ask: what does integrated care mean in practice? What are the mechanisms by which it is expected to achieve its aim? And what is the nature of the evidence base around the outcomes delivered

How well do DRGs for appendectomy explain variations in resource use? : An analysis of patient-level data from 10 European countries

Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in ten European countries. In stage one, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length-of-stay (three countries). The first model used only the Diagnosis Related Groups (DRGs) to which patients were coded; the second used a core set of general patient-level and appendectomy-specific variables; and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities, but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patient’s age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy