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The aim of the NHS England Vanguards of new care models was to improve healthcare provision and integration through the coordination of services, seeking to deliver the Five Year Forward View. The purpose of this paper is to report on an extensive analysis of one of the Vanguard programmes, exploring whether the implemented integrated response service (IRS) based in Harrogate, England, resulted in any meaningful change in secondary healthcare activity.

The authors used an interrupted time series framework applied to aggregate secondary care data, specifically emergency attendances for patients 65+, emergency bed days for all adults and non-elective admissions for 65+. Synthetic and geographic comparator data were employed to inform additional scenario analyses.

The majority of the analyses conducted found no statistically significant effect of the IRS team in either direction, suggesting that there was no change in the metrics that could be separated from natural variation. The data correlated with the findings of a qualitative analysis and challenges faced in staffing the team towards the end of the analysis period and the eventual disbanding of the IRS.

The analysis was partially hampered by data access challenges, limited to poorly specified aggregate secondary care data, and a poorly specified intervention. Furthermore, the follow-up period was limited by the disbanding of the service.

This analysis indicates that the Harrogate-based IRS team is unlikely to have delivered any sustained quantifiable impact on the intended secondary care outcomes. While this does not necessarily demonstrate a failure of the core principle behind the drive for integrated care, it is an important exploration of the challenges of evaluating such a service.

The purpose of this paper is to observe and analyse the effects of the use of telemedicine in care homes on the use of acute hospital resources.

The study was an uncontrolled retrospective observational review of data on emergency hospital admissions and Emergency Department (ED) visits for care home residents in Airedale, Wharfedale and Craven. Acute hospital activity for residents was observed before and after the installation of telemedicine in 27 care homes. Data from a further 21 care homes that did not use telemedicine were used as a control group, using the median date of telemedicine installation for the “before and after” period. Patient outcomes were not considered.

Care homes with telemedicine showed a 39 per cent reduction in the costs of emergency admissions and a 45 per cent reduction in ED attendances after telemedicine installation. In the control group reductions were 31 and 31 per cent, respectively. The incremental difference in costs between the two groups of care homes was almost £1.2 million. The cost of telemedicine to care commissioners was £177,000, giving a return on investment over a 20-month period of £6.74 per £1 spent.

The results should be interpreted carefully. There is inherent bias as telemedicine was deployed in care homes with the highest use of acute hospital resources and there were some methodological limitations due to poor data. Nevertheless, controlling the data as much as possible and adopting a cautious approach to interpretation, it can be concluded that the use of telemedicine in these care homes was cost-effective.

There are very few telemedicine studies focused on care homes.

Examines the development of DSP [digital signal processing] technology which has led to the increasing use of speech synthesis applications in the home, office and factory. Describes how the latest speech synthesizer chip works and outlines the product development cycle from the initial idea through the recording and encoding of the message to the end product: a speech synthesis device which can be used in a wide variety of man‐machine interface applications to warn, inform, instruct or to entertain.

In the 1970s, the United States Congress enacted two statutes that have had dramatic and far‐reaching effects on the education of handicapped children by public schools. These two laws, Section 504 of the Rehabilitation Act of 1973 and the Education For All Handicapped Children Act of 1975 (known as Public Law 94–142), have required local public school agencies to provide new eductional programs for thousands of handicapped children not previously served by the public schools. Counselors, principals, and teachers were quickly informed of the law's requirements and willingly began the task of main‐streaming and assimilating these children into various curricula. Their physical needs were attended to rapidly; their societal and emotional needs, unfortunately, lagged behind. Within the past seven years, there has been an increase in books, articles, and films specifically addressed to counseling the handicapped. Unlike past literature which focused only on the vocational aspect of rehabilitation counseling, current writing emphasizes personal counseling meant to assist a disabled child to participate fully in the problems and joys of daily living.

Presents over sixty abstracts summarising the 1999 Employment Research Unit annual conference held at the University of Cardiff. Explores the multiple impacts of globalization on work and employment in contemporary organizations. Covers the human resource management implications of organizational responses to globalization. Examines the theoretical, methodological, empirical and comparative issues pertaining to competitiveness and the management of human resources, the impact of organisational strategies and international production on the workplace, the organization of labour markets, human resource development, cultural change in organisations, trade union responses, and trans‐national corporations. Cites many case studies showing how globalization has brought a lot of opportunities together with much change both to the employee and the employer. Considers the threats to existing cultures, structures and systems.

Patient engagement has been a focus of patient-centered care in recent years, encouraging health care organizations to increase efforts to facilitate a patient's ability to participate in health care. At the same time, a growing body of research has examined the impact that social determinants of health (SDOH) have on patient health outcomes. Additionally, health care equity is increasingly becoming a focus of many organizations as they work to ensure that all patients receive equitable care. These three domains – patient engagement, SDOH, and health care equity – can intersect in the implementation of social needs screenings among health care organizations. We present a case study on a two-phase social needs screening implementation project and describe how this process focuses on equity. As health care organizations seek to increase patient engagement, address SDOH, and improve health equity, we highlight the need to move away from a siloed approach and view these efforts as interrelated. By approaching efforts to address these challenges and barriers as the duty of all those involved in the patient care process, there may be larger strides made toward equitable health care.

This paper aims to explore how making tabletop board games elicited adolescents’ design thinking during their participation in a summer game design camp at their local library.

This study leverages qualitative approaches to coding transcripts of participants’ talk. This study uses the design thinking framework from the Hasso-Plattner Institute of Design at Stanford University as provisional codes to identify and make sense of participants’ verbalized design activity.

This study found that the making context of designing tabletop board games elicited a high frequency of design talk in participants, evidenced by both quantitative and qualitative reports of the data. Additionally, participants in large measure obviated constraints on their design activity imposed by linear conceptions of the design thinking model this study introduces, instead of moving fluidly across design modes. Finally, participants’ prior experiences in both life and in regard to games significantly influenced their design study.

This study highlights the unique affordances of making-centric approaches to designing tabletop games in particular, such as participants’ quick and sustained engagement in the study of design. This study also highlights the need for conceptions of design thinking specific to designing games.

BP Chemicals Aerospace Composites has launched a JAR‐145 approved maintenance organization for aerospace composite components.

Short breaks enable unpaid carers to have a life alongside caring, supporting their physical and emotional well-being. In the UK, short breaks are usually explored during a Carers Assessment. The conversations underpinning these assessments require considerable skill and presently there are few tools to support the exploration of short break needs, desired outcomes and options. Images are used in other conversations to enhance communication, help people consider options and broaden thinking. This study aims to explore whether and how stakeholders thought images might support short break conversations.

To improve access to meaningful short breaks, we need to be guided by the insights of unpaid carers, those they support, practitioners, commissioners and policymakers. We hosted two online involvement events, designed to facilitate the exchange of perspectives and ideas amongst diverse stakeholders. The events explored the acceptability, facilitators and challenges of using images to enhance unpaid carer short break conversations.

The online events were attended by 47 short break stakeholders. These stakeholders saw merit in using images to support short break conversations. They identified several facilitators and challenges to introducing images into practice. The paper highlights how this learning can inform future research and practice development.

Supporting the well-being of older unpaid carers is a pertinent concern as the number of older unpaid carers continues to grow. This paper reports on how stakeholders have informed the earliest stages of practice and research development in a relevant area and provides a model of involvement that others can emulate.

The national tariff system for clinical processes and procedures aims to put a discrete unit cost on clinical activity. Calculating such costs can be subject to a great deal of local variation and interpretation. Given the rising costs of diabetes the purpose of this paper is to ask the question what does a diabetes outpatient appointment in the UK NHS actually cost? This is important in a time of financial austerity and healthcare rationing because it can be difficult to decipher the attribution of costs within the acute hospital setting.

Exploring this question, the author considers the present cost model and analyse in terms of the language of unit model cost; the basic tariff system and how it works in diabetes and looking at internal cost information the author attempts to unbundle the cost to provide a more accurate value for the cost object.

One major finding is that costs and overheads are divided arbitrarily as opposed to being distributed on the basis of measured relative consumption. Alternative costing methods are appraised to demonstrate that a patient level episodic costing approach such as patient level information and costing system (PLICS) which incorporates aspects of activity-based costing (ABC) would be far more appropriate. Using time driven ABC (TDABC), a new patient appointment costs £162 for 30 minutes and a follow-up appointment costs £81 for 15 minutes.

PLICS has the added benefit of greater financial and clinical transparency and this goes some way towards the holy grail of greater engagement with the doctors delivering clinical care.

It would appear that there are different purposes of different costing systems. One can argue that a costing system is there to both contain costs and divide overheads and demonstrate activity. Depending on how data are interpreted costing information can be an agent of enlightenment and behavioural modification for healthcare professionals to show them their direct and indirect costs, their capacity and productivity.

Clinicians and health service managers can see from this practical example how the distribution of costs and resources are unfair and can impede the delivery of a service. By using alternative costing methodologies such as ABC not only do the author gets a better reflection of the true cost of the finished consultant episode but is also able to engage clinicians in understanding how costs are generated.