OBJECTIVE To determine whether the variation in unadjusted rates of caesarean section derived from routine data in NHS trusts in England can be explained by maternal characteristics and clinical risk factors. DESIGN A cross sectional analysis using routinely collected hospital episode statistics was performed. A multiple logistic regression model was used to estimate the likelihood of women h...

BACKGROUND National Health Service (NHS) trusts, which provide the majority of hospital and community health services to the English NHS, are increasingly adopting a 'public firm' model with a board consisting of executive directors who are trust employees and external non-executives chosen for their experience in a range of areas such as finance, health care and management. In this paper we co...

Unfettered by such restraining influences as a clear view of the end results, in 1991 the government of the UK made a fundamental change to the administration of its 43 year old NHS. Previous reorganisations had merely tinkered with the machinery for cascading funds from the chancellor of the exchequer to the NHS foot soldiers. This time there was a revolutionary idea at the core. Right down to...

In the past decade, quality of care and patient safety in British hospitals have become the focus of increasing public, professional, political, and regulatory concern. The 2001 inquiry into paediatric cardiac surgery at Bristol Royal Infirmary concluded that the Department of Health was unable to respond to an issue of quality of care, even though the Department of Health accepted that ultimat...

the paper by gilbert et al. should be on the table of every politician and national health service (nhs) manager in the run up to the general election, when the nhs is at the hustings. they have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy – to which are added the pres...

BACKGROUND Complication management appears to be of vital importance to differences in survival following surgery between surgical units. Failure-to-rescue (FTR) rates have not yet distinguished surgical from general medical complications. The aim of this study was to assess whether variability exists in FTR rates after reoperation for serious surgical complications following colorectal cancer ...

BACKGROUND Walkrounds, introduced as Leadership (or Executive) WalkRounds, are a widely advocated model for increasing leadership engagement in patient safety to improve safety culture, but evidence for their effectiveness is mixed. In the English National Health Service (NHS), hospitals have been strongly encouraged to make use of methods closely based on the walkrounds approach. A study was c...

OBJECTIVE (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. DESIGN...