Productivity growth in the English National Health Service from 1998/1999 to 2013/2014

Productivity growth is a key measure against which National Health Service (NHS) achievements are judged. We measure NHS productivity growth as a set of paired year-on-year comparisons from 1998/1999–1999/2000 through 2012/2013– 2013/2014, which are converted into a chained index that summarises productivity growth over the entire period. Our measure is as comprehensive as data permit and accounts for the multitude of diverse outputs and inputs involved in the production process and for regular revisions to the data used to quantify outputs and inputs. Over the full-time period, NHS output increased by 88:96% and inputs by 81:58%, delivering overall total factor productivity growth of 4:07%. Productivity growth was negative during the first two terms of Blair’s government, with average yearly growth rate of 1:01% per annum (pa) during the first term (to 2000/2001) and 1:49% pa during the second term (2000/2001– 2004/2005). Productivity growth was positive under Blair’s third term (2004/2005–2007/2008) at 1:41% pa and under the Brown government (2007/2008–2010/2011), averaging 1:13% pa. Productivity growth remained positive under the Coalition (2010/2011–2013/2014), averaging 1:56% pa

London 2012: changing delivery patterns in response to the impact of the Games on traffic flows

The paper addresses road freight transport operations during the London Olympic and Paralympic Games in 2012. It presents work carried out prior to the Games to understand pre-Games patterns of freight deliveries in London (for both light and heavy goods vehicles) and the results of modelling work carried out to assess the likely impacts of the Games road restrictions on freight operations. The modelling results indicated that increases in total hours travelled carrying out collection and delivery work would range from 1.4% to 11.4% in the six sectors considered. The results suggested increases in hours travelled in excess of 3.5% in four of the six sectors modelled. The possible actions that could be taken by organizations to reduce these negative impacts were also modelled and the results indicated that such actions would help to mitigate the impact of the road restrictions imposed on operators during the Games. The actual impacts of the 2012 Games on transport both in general terms and specifically in terms of freight transport are also discussed, together with the success of the actions taken by Transport for London (TfL) to help the road freight industry. The potential freight transport legacy of the London 2012 Games in terms of achieving more sustainable urban freight transport is considered and the steps being taken by TfL to help ensure that such a legacy can be realized are discussed. Such steps include policy-makers continuing to collaborate closely with the freight industry through the ‘London Freight Forum’, and TfL's efforts to encourage and support companies revising their delivery and collection times to the off-peak; improving freight planning in the design and management of TfL-funded road schemes; electronic provision of traffic information by TfL to the freight industry, and the further development of freight journey planning tools

‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on

PROBLEM: Midwifery practice is emotional and, at times, traumatic work. Cumulative exposure to this, in an unsupportive environment can result in the development of psychological and behavioural symptoms of distress. BACKGROUND: As there is a clear link between the wellbeing of staff and the quality of patient care, the issue of midwife wellbeing is gathering significant attention. Despite this, it can be rare to find a midwife who will publically admit to how much they are struggling. They soldier on, often in silence. AIM: This paper aims to present a narrative review of the literature in relation to work-related psychological distress in midwifery populations. Opportunities for change are presented with the intention of generating further conversations within the academic and healthcare communities. METHODS: A narrative literature review was conducted. FINDINGS: Internationally, midwives experience various types of work-related psychological distress. These include both organisational and occupational sources of stress. DISCUSSION: Dysfunctional working cultures and inadequate support are not conducive to safe patient care or the sustained progressive development of the midwifery profession. New research, revised international strategies and new evidence based interventions of support are required to support midwives in psychological distress. This will in turn maximise patient, public and staff safety. CONCLUSIONS: Ethically, midwives are entitled to a psychologically safe professional journey. This paper offers the principal conclusion that when maternity services invest in the mental health and wellbeing of midwives, they may reap the rewards of improved patient care, improved staff experience and safer maternity services

Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist.

The opioid epidemic in the USA continues to worsen. Medical providers are faced with the challenge of addressing complications from opioid use disorders and associated injection drug use. Unsafe injection practices among people who inject drugs (PWID) can lead to several complications requiring acute care encounters in the emergency department and inpatient hospital. Our objective is to provide a narrative review to help medical providers recognise and address key health issues in PWID, who are being released from the emergency department and inpatient hospital. In the midst of rises in overdose deaths and infections such as hepatitis C, we highlight several health issues for PWID, including overdose and infection prevention. We provide a clinical checklist of actions to help guide providers in the care of these complex patients. The clinical checklist includes strategies also applicable to low-resource settings, which may lack addiction treatment options. Our review and clinical checklist highlight key aspects of optimising the health and safety of PWID