scholarly journals Knights and Knaves in the English Medical Profession: the Case of Clinical Excellence Awards

2015 ◽  
Vol 45 (1) ◽  
pp. 83-99 ◽  
Author(s):  
MARK EXWORTHY ◽  
PAULA HYDE ◽  
PAMELA MCDONALD-KUHNE
Keyword(s):  
Health Policy ◽  
National Health Service ◽  
Health Service ◽  
Medical Profession ◽  
Clinical Excellence ◽  
Medical Professional ◽  
Policy Makers ◽  
Written Responses ◽  
Private Interests ◽  
The Uk

AbstractWe elaborate Le Grand's thesis of ‘knights and knaves’ in terms of clinical excellence awards (CEAs), the ‘financial bonuses’ which are paid to over half of all English hospital specialists and which can be as much as £75,000 (€92,000) per year in addition to an NHS (National Health Service) salary. Knights are ‘individuals who are motivated to help others for no private reward’ while knaves are ‘self-interested individuals who are motivated to help others only if by doing so they will serve their private interests.’ Doctors (individually and collectively) exhibit both traits but the work of explanation of the inter-relationship between them has remained neglected. Through a textual analysis of written responses to a recent review of CEAs, we examine the ‘knightly’ and ‘knavish’ arguments used by medical professional stakeholders in defending these CEAs. While doctors promote their knightly claims, they are also knavish in shaping the preferences of, and options for, policy-makers. Policy-makers continue to support CEAs but have introduced revised criteria for CEAs, putting pressure on the medical profession to accept reforms. CEAs illustrate the enduring and flexible power of the medical profession in the UK in colonising reforms to their pay, and also the subtle inter-relationship between knights and knaves in health policy.

scholarly journals Pre-habilitation for patients awaiting total knee replacement in the United Kingdom National Health Service: A review of publicly facing information

2021 ◽  
pp. 1-7
Author(s):  
Gareth Stephens ◽  
Ahmed Maarabouni ◽  
Gemma Mansell ◽  
Chris Littlewood
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
National Health ◽  
Controlled Trial ◽  
Clinical Excellence ◽  
Future Research ◽  
Total Knee ◽  
The Uk

INTRODUCTION: Approximately 14,000 –21,500 individuals per year are dissatisfied with the outcome of their Total Knee Replacement (TKR) in the UK National Health Service (NHS). National Institute of Clinical Excellence (NICE) guidelines recommend that future research should evaluate whether a ‘full programme of pre-habilitation’ can improve outcomes for patients awaiting TKR. The aim of this review was to describe current pre-habilitation practice for patients awaiting TKR in the UK NHS, to inform future research. METHODS: Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of UK NHS Trusts that included detail about pre-habilitation for patients awaiting TKR. One reviewer extracted data, and a second reviewer verified this. RESULTS: Fifty PIS, nine information videos and one web page from 59 NHS Trusts were identified. NHS Trusts most commonly provide patients with advice on pre-operative rehabilitation via a single appointment, combined with a PIS (36/59; 61.0%). NHS Trusts use appointments, PIS and video to provide patients awaiting TKR with information regarding pain control (46/58; 79.3%), exercise therapy (46/58; 79.3%), what to expect on the day of surgery and in-patient stay (58/58; 100%), lifestyle interventions (27/58; 46.6%), and adverse events (44/58; 75.9%). CONCLUSION: NHS Trusts commonly provided patients awaiting TKR with ‘advice on pre-operative rehabilitation’, however no NHS Trust provided a comprehensive programme of pre-habilitation. The results of this study will inform the development of a comprehensive, multi-modal pre-habilitation programme, to be tested in a future high-quality randomised controlled trial.

Medical Sociology in the UK: building a research tradition in the shadow of a Public National Health Service

2012 ◽  
pp. 21-38
Author(s):  
David Hughes
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Sociological Theory ◽  
Medical Sociology ◽  
Medical Profession ◽  
Division Of Labour ◽  
Research Division ◽  
Social Scientific ◽  
The Uk

British medical sociology emerged in the shadow of a publicly-funded National Health Service, and the need for evidence to support the development of policy and services. Although the initial focus was on applied problems, largely defined by the medical profession, a combination of permissive leadership in the early research centres and the desire of research administrators to widen research agendas, gave medical sociologists considerable latitude to developed distinctive research programmes. By the 1970s British medical sociologists were turning their attention to focused studies of interaction in health care settings, on the one hand, and professional power, structural interests, social disadvantage and gender, on the other. But this shift from applied empirical research to studies that drew more explicitly on sociological theory was halted and even reversed as the research funding climate changed, and the emphasis shifted to large multi-site, multi-disciplinary studies. While the ESRC still supports some basic social scientific research and medical sociologists also find work in multidisciplinary projects examining contemporary problems, sociological concepts are increasingly likely to be blended with concepts from other disciplines in final reports. British medical sociology is no longer an infant sub-discipline, but it still remains in many ways a marginal enterprise, uncertain of its identity and its place in the health research division of labour.

scholarly journals Cutting the Wait—at Least for a While

2019 ◽  
pp. 63-83
Author(s):  
Adrian Kay
Keyword(s):  
Health Policy ◽  
National Health Service ◽  
Health Service ◽  
Process Improvement ◽  
Waiting Times ◽  
Political Legitimacy ◽  
Significant Decline ◽  
Uk National Health Service ◽  
The Uk ◽  
Political Priority

Although health policy was not an original feature of the attempt by New Labour to break from ‘old’ Labour politics in the UK, the alignment of political priority and policy analysis in government produced a successful period in the UK National Health Service. This chapter investigates the case of the historically significant decline in waiting times for NHS services in the decade after 2000; queues which were often at least eighteen months dropped to no more than eighteen weeks by 2010. Unlike welfare state politics generally in the UK, the NHS has always enjoyed great political legitimacy. This chapter reveals how this anchored a notable process improvement in the reform of a well-entrenched, fifty-year-old NHS system in the early 2000s, where previously abandoned programmes were recombined in a strong emphasis on commissioning alongside a significant boost in public expenditure agreed by the initially reluctant Minister of Finance, Gordon Brown. The chapter investigates how this process improvement in turn resulted in significant improvements in access to NHS services over the subsequent decade and presented a sequenced pattern of governing success; from politics to process to programme.

Australian doctors are more engaged than UK doctors: why is this the case?

BMJ Leader ◽  
2021 ◽  
pp. leader-2020-000372
Author(s):  
Paul W Long ◽  
Peter Spurgeon ◽  
Erwin Loh ◽  
Patti Mazelan ◽  
Fred Barwell
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Interpersonal Relationships ◽  
Working Conditions ◽  
Medical Staff ◽  
Policy Makers ◽  
The Status ◽  
Uk National Health Service ◽  
The Uk ◽  
And Training

BackgroundDespite reports highlighting the need for greater medical engagement and the benefits of being widely understood, very little information is available on the status of medical engagement in Australia, and how this compares to the UK. Answering this question will no doubt assist training bodies, curriculum designers and policy makers better understand relevant issues.MethodsThe medical engagement questionnaire (MES) was emailed to all medical staff working at 159 UK National Health Service Trusts and 18 health service organisations in Australia. The questionnaire consists of 30 predetermined items seeking responses using a 5-point Likert scale.ResultsOverall, doctors in the Australian dataset are slightly more engaged, or more positive, than their UK colleagues. Good interpersonal relationships was the only variable that UK doctors scored more positively than their Australian counterparts. At the lower end of the responses, that is the least engaged, we found this even more apparent. Where doctors in Australia are less disengaged, that is still more positive than the UK colleagues.ConclusionWhile the profiles of medical engagement vary at the sites and also across the MES and subscales, the data illustrate that overall doctors in Australia feel valued and empowered, and they have purpose and direction and work in a collaborate culture. At the most disengaged end of the scale, Australian doctors are markedly less disengaged than their UK counterparts. There may be numerous factors that influence and change how engaged doctors are in both countries. The most prominent of these are appear to be working conditions and lifestyle, driven by funding and other economics issues. This research is likely to be of great interest to regulators and training bodies in both countries.

Digital Ophthalmology in the UK – Diabetic Retinopathy Screening and Virtual Glaucoma Clinics in the National Health Service

2020 ◽  
Vol 237 (12) ◽  
pp. 1400-1408
Author(s):  
Heinrich Heimann ◽  
Deborah Broadbent ◽  
Robert Cheeseman
Keyword(s):  
Diabetic Retinopathy ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Daily Practice ◽  
Diabetic Retinopathy Screening ◽  
Technological Advances ◽  
Imaging Results ◽  
The Uk ◽  
Retinopathy Screening

AbstractThe customary doctor and patient interactions are currently undergoing significant changes through technological advances in imaging and data processing and the need for reducing person-to person contacts during the COVID-19 crisis. There is a trend away from face-to-face examinations to virtual assessments and decision making. Ophthalmology is particularly amenable to such changes, as a high proportion of clinical decisions are based on routine tests and imaging results, which can be assessed remotely. The uptake of digital ophthalmology varies significantly between countries. Due to financial constraints within the National Health Service, specialized ophthalmology units in the UK have been early adopters of digital technology. For more than a decade, patients have been managed remotely in the diabetic retinopathy screening service and virtual glaucoma clinics. We describe the day-to-day running of such services and the doctor and patient experiences with digital ophthalmology in daily practice.

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