Articles for tag: change, health, NHS, policy, reform, transformation

September 15, 2024

Fast on the heels of Lord Darzi’s report, Sir Keir Starmer has set out sweeping plans for NHS reforms. The first component of Starmer’s reform blueprint focuses on the digitalisation of healthcare services. This involves leveraging technological advancements to enhance patient empowerment and streamline healthcare delivery. Key elements include the development of a comprehensive NHS ...

July 1, 2024

TheEditor

Management

You are the Boss – The Locum Psychiatrist’s Manual

This post is derived from a manual that I constructed some time ago. It summarises a book that I am publishing. The summary constitutes opinion on how a locum business ought to be run. It is not advice even though it may appear to be directive and refers to ‘you’. The author owes you no ...

June 15, 2024

TheEditor

Diagnosis Investigative Medicine Mental Health

The biopsychosocial assessment

The biopsychosocial model is a comprehensive approach to understanding mental health that integrates biological, psychological, and social factors. This model recognises that mental health and illness are the result of complex interactions between these domains, rather than being caused by a single factor. Biological aspects encompass genetic predispositions, neurochemical imbalances, and physical health conditions. Psychological ...

May 25, 2024

TheEditor

Law Mental Health

The Importance of the Nearest Relative in Mental Health Law

In mental health care (in England & Wales), the legal concept of the ‘nearest relative‘ (NR) holds significant weight. This pivotal role, enshrined in the Mental Health Act 1983, serves as a vital safeguard for patients who find themselves navigating the complexities of mental health treatment. The term should not simply be equated with ‘next ...

December 23, 2023

TheEditor

Investigative

Beyond Nuclear Shadows – Navigating Trust and Secrecy

I only found out today about this major cover up in the history of the world. I’m like “How on earth can one cover up a major nuclear disaster?!” But then my mind immediately drifted on to cover-ups in health services. If ‘they’ can cover-up a nuclear disaster in Russia, it shows the might of ...

August 23, 2023

TheEditor

Management Medicine Rights

Dream or reality?

In this article I focus mainly on public sector health care consultations. It is an open ‘secret’ that UK public health services are: short of staff, doctors are overworked, many groups of staff are suffering with burnout, clinic sessions are quite time-limited, follow-up visits are few and far between, patients are often not given sufficient ...

May 16, 2023

TheEditor

Mental Health

Dealing with burnout

Burnout is a psychological syndrome that results from chronic workplace stress that has not been successfully managed. One of the first issues is ‘stress’. Not everybody feels it in the same way. Not all stress is bad. People have difficulty being aware when they are under abnormal stress. This article was followed by Getting serious ...

Stage	Cost/Price (£)	Tax/Duty (£)	Tax/Duty Type	Calculation	Calculation
1. Manufacturer’s Cost	2	0	N/A	This is a hypothetical cost of production.
2. Specific Duty Added	2	5.89	Specific Duty	£294.72 per 1000 cigarettes / 1000 * 20	Fixed amount per pack.
3. Manufacturer’s Profit	7.89	0	N/A	(Assumed to bring the total to £7.89)	This is a hypothetical profit margin.
4. Ad Valorem Duty Included	9	1.11	Ad Valorem Duty	16.5% of £9.00 (approx. retail price before VAT)	Included within the retail price, not added separately.
5. Retailer’s Profit	10.11	0	N/A	(Assumed to bring the total to £10.11)	This is a hypothetical profit margin.
6. Final Retail Price (excl VAT)	13	0	N/A	(Includes specific duty and ad valorem duty)	This is the price displayed on the shelf, excluding VAT.
7. VAT Added	13	2.6	Value Added Tax (VAT)	20% of £13.00	Applied at the point of sale.
Total	15.6	9.6	Approximately 61.5% of the final price (£15.60) is tax – due to the simplified conservative assumptions about manufacturer and retailer costs and profit margins.

Documentation Issue	Critique
Vague Descriptors	Terms like “distressed state,” “emptiness,” and “intense anger” lack specific behavioural anchors. The descriptions are mere observations without any real substance. How was the intensity of the anger manifested? What did the patient say? How did she appear? Was she grimacing? Without concrete examples, these descriptors are open to interpretation and do not provide a clear picture of the patient’s presentation.
Generalised Interventions	Phrases like “explored coping mechanisms” and “discussed strategies” are so general that they amount to padding. No one will know what specific coping mechanisms were explored. How did this worker actually attempt to help the patient? What exact strategies were discussed? How were these tailored to the patient’s individual needs and the nature of their emotional instability?
Lack of Measurable Outcomes	The record mentions the patient feeling “slightly calmer” but lacks objective measures to assess the effectiveness of the interventions. How was this improvement gauged? Is it just ‘your’ word for saying so? Many services will accept such records as ‘standard’ because of cultural norms.
Ambiguous Plan	The plan to “continue to work on developing skills” and “encourage the patient to practice techniques” is vague and lacks specific, measurable goals. What specific skills will be targeted? What techniques were discussed ‘between sessions’? How will progress be monitored? What constitutes “practice” in this context, and how will adherence be assessed?
Omission of Risk Assessment	Given the nature of EUPD and the potential for self-harm, the record should include a formal risk assessment. What specific risk factors were considered? How was the risk of self-harm evaluated and managed?
Limited Patient-Specific Insight	While the record mentions EUPD, it does not provide specific insights into how this diagnosis informs the interventions or the plan. How were the chosen strategies tailored to the patient’s unique challenges related to their personality disorder?

Cognitive Activity	Description
1. Information synthesis	Gathering and integrating diverse information; evaluating reliability and relevance of each piece
2. Evidence evaluation	Critically assessing quality and strength of available evidence; identifying gaps
3. Principle balancing	Weighing competing ethical principles; reconciling guidelines with case-specific considerations
4. Stakeholder consideration	Analysing individual patient needs/rights; considering regulatory and societal requirements
5. Consequence projection	Anticipating potential outcomes; assessing short-term and long-term consequences
6. Risk-benefit analysis	Systematically evaluating risks; weighing risks against potential benefits
7. Legal framework integration	Incorporating relevant legal standards; ensuring compliance with statutory obligations
8. Ethical reasoning	Applying ethical frameworks; resolving ethical dilemmas in forensic psychiatric practice
9. Interdisciplinary integration	Synthesising perspectives from various disciplines; reconciling conflicting viewpoints
10. Decision refinement	Iteratively reviewing and adjusting decisions; fine-tuning to address all relevant factors
11. Uncertainty management	Acknowledging areas of uncertainty; developing mitigation strategies
12. Prioritisation	Determining relative importance of factors; focusing on critical elements
13. Cognitive bias recognition	Identifying potential biases; implementing strategies to minimise their impact
14. Justification formulation	Developing clear, logical rationale; ensuring transparent and defensible reasoning
15. Contextual adaptation	Tailoring approach to specific case factors; recognising unique case influences

Sir Keir Starmer’s Reforms of the NHS – referenced in part against Lord Darzi’s Report.

You are the Boss – The Locum Psychiatrist’s Manual

The biopsychosocial assessment

The Importance of the Nearest Relative in Mental Health Law

Beyond Nuclear Shadows – Navigating Trust and Secrecy

Dream or reality?

Dealing with burnout

Fires in Los Angeles compels review of tail risk

The Role and Duties of Expert Witnesses in the UK Legal System

The Genetic Basis of ADHD and its Impact on Brain Structure and Function

Articles for tag: change, health, NHS, policy, reform, transformation

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