The discrepancy between actual and unreported incidents of violence in a learning disability nursing service

This article is not available through ChesterRep. It can be accessed at http://www2.hud.ac.uk/hhs/mhrg/journal/discrepancy.pdfThis study reports on research carried out within the Learning Disability Division of a major Mental Health NHS Trust in the North of England, and relates to the discrepancy between the actual number of incidents of violence and aggression and those reported. The literature review demonstrated that violence is a particular issue for nurses, particularly those working in the areas of mental health and learning disability where studies have indicated that as many as one in five may be affected. A questionnaire was distributed to all learning disability nurses currently employed in the Trust, a total of 411, with a response rate in excess of 40%. The study revealed that a discrepancy does exist between actual and reported incidents of violence within the Trust. It confirmed previous claims that the predominant difficulty is cultural, violence being regarded as part of the job and non-reporting primarily revolving around perceptions of incidents being considered 'minor', not worth the time to complete the paperwork. The paper concludes that more work is needed to achieve a united, consistent approach across the NHS, in order that a high quality, accessible service for people with learning disabilities and complex needs can be delivered without violence being considered an acceptable part of the job

Does competition between hospitals improve clinical quality?: a review of evidence from two eras of competition in the English NHS

Gwyn Bevan and Matthew Skellern review evidence on the effects of hospital competition on quality of care within the English NHS and question whether they support government proposals to extend competition

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The hospital as a multi-product firm: The effect of hospital competition on value-added indicators of clinical quality

There is increasing international interest in using Patient Reported Outcome Measures (PROMs) to assess health care provider performance. PROMs are a fundamental advance on existing indicators of health care quality in two respects: they equate outcomes with value added (i.e. health gain) from treatment rather than post-treatment health status, and they allow clinical quality to be measured at the level of the individual medical intervention to a far greater extent than existing failure-based indicators of quality such as mortality or readmissions. Most existing econometric studies of hospital competition and quality equate outcomes with post-treatment health status, and use mortality rates of various kinds as indicators of overall hospital performance, in spite of the fact that mortality is a relatively uncommon outcome in the spheres of hospital activity - such as elective surgery - in which competition for patients does occur. This paper contributes to the development of a value-added, multi-product conception of hospital quality by studying the impact of a major competition-promoting reform to the English NHS in 2006, in which patients were allowed to choose which hospital they attended for elective surgery, on PROMs of health gain from hip and knee replacement, groin hernia repair, and varicose vein surgery. In contrast to the existing literature, I find that the competition brought about by the introduction of patient choice of hospital may have had a negative effect on clinical quality. I put forward a theoretical framework that explains these findings, and conclude by arguing that future research should model the hospital as a multi-product firm, and capture clinical quality using value-added outcome measures

Guest editorial

This document is the Accepted Manuscript version of a published work that appeared in final form in Journal of Intellectual Disabilities and Offending Behaviour. To access the final edited and published work seehttp://dx.doi.org/10.1108/JIDOB-01-2016-0002 .This is the editorial for a special edition entitled 'Intellectual Disabilities: Nursing' of the Journal of Intellectual Disabilities and Offending Behaviour

Minimising bias in the forensic evaluation of suspicious paediatric injury

In the rules of evidence in all legal jurisdictions, medical experts are required to maintain objectivity when providing opinions. When interpreting medical evidence, doctors must recognise, acknowledge and manage uncertainties to ensure their evidence is reliable to legal decision-makers. Even in the forensic sciences such as DNA analysis, implicit bias has been shown to influence how results are interpreted from cognitive and contextual biases unconsciously operating. In cases involving allegations of child abuse there has been significant exposure in the media, popular magazines, legal journals and in the published medical literature debating the reliability of medical evidence given in these proceedings. In these cases judges have historically been critical of experts they perceived had sacrificed objectivity for advocacy by having an investment in a 'side'. This paper firstly discusses the issue of bias then describes types of cognitive biases identified from psychological research applied to forensic evidence including adversarial bias, context bias, confirmation bias and explains how terminology can influence the communication of opinion. It follows with previously published guidelines of how to reduce the risk of bias compromising objectivity in forensic practices then concludes with my own recommendations of practices that can be used by child protection paediatricians and within an organisation when conducting forensic evaluations of suspicious childhood injury to improve objectivity in formulation of opinion evidence

The relevance of the Goudge inquiry to the practice of child protection/forensic paediatrics

In 2008 Ontario, Canada the Goudge Inquiry arose following increasing concerns about practices surrounding forensic pathology and the investigation of paediatric deaths. Some of the considerations and recommendations have relevance to child protection/forensic paediatricians, particularly in relation to their responsibilities in opinion formulation and as expert witnesses. By examining the Inquiry recommendations, this paper applies them in relation to child protection/forensic paediatrics by discussing forensic medicine and its legal context, how interpretation of published reports and data should be used in opinion formulation; issues of 'diagnosis' versus 'opinion'; issues specific to child protection paediatrics; quality control; aspects of report writing and terminological considerations. It concludes with an adaptation of key recommendations directly from those of Goudge, applied to the context of paediatric forensic medicine undertaken in child protection assessments

Does competition from private surgical centres improve public hospitals’ performance? Evidence from the English National Health Service

This paper examines the impact of competition from government-facilitated entry of private, specialty surgical centres on the efficiency and case mix of incumbent public hospitals within the English NHS. We exploit the fact that the government chose the location of these surgical centres (Independent Sector Treatment Centres or ISTCs) based on nearby public hospitals’ waiting times – not length of stay or clinical quality – to construct treatment and control groups that are comparable with respect to key outcome variables of interest. Using a difference-in-difference estimation strategy, we find that ISTC entry led to greater efficiency – measured by presurgery length of stay for hip and knee replacements – at nearby public hospitals. However, these new entrants took on healthier patients and left incumbent hospitals treating patients who were sicker, and who stayed in hospital longer after surgery

Substitution of Recycled Plastic Aggregates (RPA) in concrete and its influence on pullout capacity of mechanical and chemical anchors

There is a lot of plastic going to land fill or entering environmentally sensitive systems, that could ideally be converted into a form or material that would be considered as a resource. Much of this plastic waste is not suitable for re-cycling or use, where exposed to sun light or weathering elements. Some of these materials have been converted to granular materials and used in sub-soil drainage systems as free draining materials and as substitute for aggregates in concrete pavements. There is significant enthusiasm for utilising ‘environmentally friendly’ construction systems and materials. Unfortunately, that enthusiasm can result in them being utilised in in-appropriate situations that can have a negative result to the reputation of the material or system. The aim of this project was to determine if anchors and fixings inserted into Recycled Plastic Aggregates (RPA) concrete elements will perform as expected and required. Proprietary RPAs were procured from a commercial supplier to substitute for natural concrete aggregates in various proportions. Normal and RPA concrete cylindrical samples were manufactured in a controlled environment at USQ lab and subsequently cured for 28 days. The purpose of manufacturing and testing normal concrete samples, involving standard concrete blends, was to provide a reference point when comparing the performance of the RPA concrete systems. Compression tests were performed on both normal and RPA concrete samples using the universal load test machine. On the other larger samples, holes were drilled in the normal and RPA concrete samples to install proprietary mechanical and chemical anchors so pull-out tests could be performed to simulate real life scenario. These pull-out tests were also performed on universal load test machine. The 50% RPA concrete demonstrated significant capacity reduction and to the extent that these rates cannot be sustainable. The 20% RPA concrete has demonstrated reduction in capacities that could conceivably be tolerated in the construction industries. The mechanical anchors were noticeably more affected by the RPA substitution than the chemical anchors. The substitution of recycled plastic provides a sustainable option for offsetting waste plastic going to landfill, thereby reducing environmental pollution. This study develops confidence in the performance of post fixed anchors inserted into low percentage RPA concrete, creates awareness in the industry and supports recycling through buying products which include recycled content in line with Australian Government National Plastic Plan 2021

Essays on public services, markets, and intrinsic motivation

This thesis comprises three essays examining the roles of markets and intrinsic motivation in public organisations. Chapter 1 examines the impact of establishing Independent Sector Treatment Centres in the English National Health Service (NHS) during the 2000s on the performance of neighbouring NHS (public) hospitals. It finds that NHS hospitals that had an ISTC placed nearby became more efficient (measured using pre-surgical length of stay for orthopaedic surgery), but also received sicker patients on average, as ISTCs avoided treating the sickest patients. Average cost per patient at ISTC-exposed NHS hospitals increased, suggesting that any efficiency gains were swamped by the negative effect on costs of worsened patient casemix. Chapter 2 examines the 2006 introduction of patient choice of hospital for elective surgery within the English NHS, using Patient Reported Outcome Measures (PROMs) of health gain from surgery as a measure of hospital quality. The hospital competition brought about by this reform appears to have led to lower varicose vein surgery quality, but no change in groin hernia surgery quality. For orthopaedic surgery quality, the evidence in support of a negative effect of competition outweighs the evidence to the contrary. We explain these findings by explicitly modelling the hospital as a multi-product firm. Chapter 3 examines the rationale for the 2011 Busan Declaration, which states that foreign aid should be given in line with the priorities of recipients, by constructing a model of the interaction between donors and charitable entrepreneurs, where occupational choice is endogenous, donors can choose whether to give, and donors and entrepreneurs are paired in a stable matching. We show that mission conflict in the charitable sector can arise when mission preferences and income earnings ability in the private sector are correlated, and examine policy options to encourage the charitable sector to give greater weight to recipients’ objectives