The emphasis on primary care in health service development requires both academics and professionals involved in research to apply the highest standards in qualitative and quantitative methodology. This book provides accurate and up to date information in an easy to follow and clear way. Guidance is given on appropriate methods specialist advice and where to find it. All chapters include exercises to relate the reader's own experiences and review understanding. Primary Care Research series is aimed at developing the knowledge expertise and skills of all practitioners in primary care. Each book is based on contributions from experts in their field and is supported by practical facts personal insight support and advice. They enable all primary care practitioners to realise the potential of exploring information used in everyday working practice.
The National Programme for IT is dependent on the deployment of systems in an increasingly devolved NHS. This report examines the progress being made in delivering the Programme, including the termination of Fujitsu's contract as the Local Service Provider for the South. Some systems are being deployed across the NHS. The Care Records Service, however, is at least four years behind schedule, with the Department's latest forecasts putting completion at 2014-15. At 31 August 2008, new care records systems had been deployed in 133 of the 380 Trusts. Trusts in the North, Midlands and East have been receiving an interim system and will have to go through a further deployment in due course to implement Lorenzo, the care records software for the North, Midlands and East, which has suffered major delays. By the end of 2008, Lorenzo had not been deployed throughout any Acute Trust and in only one Primary Care Trust. Fujitsu's contract covering the South of England was terminated in May 2008. Negotiations to reset the contract had failed because the two sides were unable to agree on the price and commercial terms. The future arrangements for the South remain under discussion, but Trusts which have not yet implemented a new care records system will be allowed to choose between those offered by the two remaining Local Service Providers, BT and CSC. The estimated cost of the Programme is £12.7 billion, including £3.6 billion of local costs, although this figure remains uncertain. Keeping patient data secure is crucial to the reputation and success of the Programme, and the Department is confident that the mechanisms it is putting in place will provide a high level of security.
The National Programme for Information Technology in the NHS (the Programme) is a ten year programme to use information technology (IT) to reform the way the NHS in England uses information, and hence to improve services and the quality of patient care. The core of the Programme will be the NHS Care Records Service, but other elements include x-rays accessible by computer, electronic transmission of prescriptions, and booking of first outpatient appointments. The Programme was launched in 2002, and is now run by an agency, NHS Connecting for Health. This report examines: the progress made in delivering the systems against the original plans and costs (part 1); steps taken by the Department of Health, the agency and the NHS to deliver the Programme (part 2); how the IT systems have been procured (part 3); how the NHS is preparing to use the systems (part 4). The NAO estimates the gross cost of the Programme will be £12.4 billion to 2013-14. Although the pilot NHS Care Records Service will not be in place until late 2006, almost two years late, and other milestones have been deferred, the NAO reports substantial progress with the Programme. Management systems are in place, contracts were placed quickly and achieved large reductions in prices from bidders, and contract terms include important safeguards to secure value for money. Deployments of operational systems have begun, and several additional tasks have been delivered that were outside the original brief. Three key areas are identified which present significant challenges to the successful implementation of the Programme: ensuring IT suppliers continue to deliver systems that meet the needs of the NHS, to agreed timescales without further slippage; ensuring NHS organizations play a full part in implementing the systems; winning the support of NHS staff and the public in making the best use of the systems to improve services. The NAO report makes a number of recommendations for future management of the Programme.
The National Programme for IT in the NHS is an ambitious £11.4 billion programme of investment. This report is concerned with a central part of the Programme, where the aim was to create a fully integrated electronic care records system, which is expected to cost around £7 billion in total The Department has failed to demonstrate the benefits achieved for the £2.7 billion spent to date on care records systems and has accepted it is unable to deliver its original vision. It is now relying on individual NHS trusts to develop systems compatible with those in the Programme. Furthermore the Department could not explain how potential inconsistencies would be dealt with or what it will cost local NHS organisations to connect up. The Department has not got the best out of its suppliers, despite having paid them some £1.8 billion so far. One supplier, CSC, has yet to deliver the bulk of the systems it is contracted to supply and has instead implemented a large number of interim systems as a stopgap. The Department has been in negotiations with CSC for over a year, but conceded that it may be more expensive to terminate the contract than to complete it. The Department has also revised its contract with BT reducing the number of systems and increasing the price for each system delivered. This has resulted in BT being paid £9 million to implement systems at each NHS site, even though the same systems have been purchased for under £2 million by NHS organisations outside the Programme. The Committee is further concerned about the problems in getting timely and reliable information from the Department. Information provided has frequently been late, has contained inconsistencies and has contradicted other evidence.
Although officially 'dismantled', the National Programme for IT in the NHS continues in the form of separate component programmes which are still racking up big costs. The original contracts with CSC totalled £3.1 billion for the setting up of the Lorenzo care records system in trusts in the North, Midlands and East. Despite the contractor's weak performance, the Department of Health is itself in a weak position in its attempts to renegotiate the contracts. It couldn't meet the contractual obligation to make enough trusts available to take the system. We still don't know what the full cost of the National Programme will be. The Department's latest estimate of £9.8 billion leaves out the future costs of Lorenzo or the potential large future costs arising from the Department's termination of Fujitsu's contract for care records systems in the South of England. Parliament needs to be kept informed not only of what additional costs are being incurred, but also of exactly what has been delivered so far. The Department estimates £3.7 billion of benefits to March 2012, just half of the costs incurred. There is still a long way to go before government departments can honestly say that they have learned and properly applied the lessons from previous contracting. Given the Department's track record with the National Programme, it is very hard to believe that the paperless NHS towards which the Department is working has much chance of being achieved by the target date of 2018
Screening programmes involve the systematic offer of testing for populations or groups of apparently healthy people to identify individuals who may be at future risk of a particular medical condition or disease, with the aim of offering intervention to reduce their risk. For many years, screening was practised without debate, and without evidence, but in the 1960s serious challenges were raised about many of the screening procedures then being practised. Benefits and harms of screening must be measured in high quality trials, and the benefits of screening must be weighed alongside the negative side-effects. Concerns were raised about potential and actual harm arising when people without a health problem received dangerous and unnecessary investigations and treatments as a result of routine screening tests. Controversy raged, and it took some 50 years to achieve widespread recognition that evidence-based and quality assured programme delivery was essential, coupled with provision of balanced informed to enable informed choice for potential participants. Commercially motivated provision of poor quality and non-evidence based screening tests is increasing and screening remains a highly contested topic that has relevance in all health systems including for the general public and media. This book serves as a practical and comprehensive guide to all aspects of screening. Following the international success of the first edition, this second edition brings extensive updates and new case study material. The first section deals with concepts, methods, and evidence, charts the story of screening back to 1861, and covers all aspects of a screening programme and how to research the full consequences. The second section is a practical guide to sound policy-making and to high quality delivery of best value screening. The controversies, paradoxes, uncertainties, and ethical dilemmas of screening are explained, and each chapter is packed with examples, real-life case histories, helpful summary points, and self-test questions. Reference is made to the NHS, a leader in screening, but the primary focus is on universal principles, making the book highly relevant across the globe.
The foundation of the National Health Service on 5 July 1948 was a momentous development in the history of the United Kingdom. Issues of health care touch the lives of everyone, and the NHS has come to be regarded as the cornerstone of the welfare state and as a model for state-organisedhealth care systems elsewhere. Yet throughout its history, the Service has existed in an atmosphere of crisis. Charles Webster's political history is an entirely new and original examination of the NHS from its inception through to its management under the first term of the current Labourgovernment, providing the necessary framewrork for assessing its future as we enter the new millennium.
What are public health services? Countries across Europe understand what they are or what they should include differently. This study describes the experiences of nine countries detailing the ways they have opted to organize and finance public health services and train and employ their public health workforce. It covers England France Germany Italy the Netherlands Slovenia Sweden Poland and the Republic of Moldova and aims to give insights into current practice that will support decision-makers in their efforts to strengthen public health capacities and services. Each country chapter captures the historical background of public health services and the context in which they operate; sets out the main organizational structures; assesses the sources of public health financing and how it is allocated; explains the training and employment of the public health workforce; and analyses existing frameworks for quality and performance assessment. The study reveals a wide range of experience and variation across Europe and clearly illustrates two fundamentally different approaches to public health services: integration with curative health services (as in Slovenia or Sweden) or organization and provision through a separate parallel structure (Republic of Moldova). The case studies explore the context that explain this divergence and its implications. This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe Division of Health Systems and Public Health. It accompanies two other Observatory publications Organization and financing of public health services in Europe and The role of public health organizations in addressing public health problems in Europe: the case of obesity alcohol and antimicrobial resistance (both forthcoming).
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
