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Tian, Shulun. "A Comparative Analysis of the Fiduciary Duties of Loyalty of Trustees in English Common Law and Chinese Law." Trusts & Trustees 27, no. 10 (November 19, 2021): 974–88. http://dx.doi.org/10.1093/tandt/ttab088.
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Abstract England is the cradle of trusts and China introduced this flexible institution for its own needs and promulgated its trust law in 2001. Different to England, China does not have unified fiduciary doctrines and the Chinese trust has a strong contractarian nature. This article compares Chinese law and English law in terms of the rules about trustees’ duties of loyalty. The apparent differences reflected on micro rules may find their explanation in the macro trust structures and legislative backgrounds.
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Cope, Rowan. "Polygamous settlors: When is a wife not a wife?" Trusts & Trustees 28, no. 2 (December 29, 2021): 64–69. http://dx.doi.org/10.1093/tandt/ttab112.
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Abstract Wealthy nationals of countries outside of Europe, including in the Middle East, are beginning to discover the wealth preservation and succession planning advantages that discretionary trusts can afford them. Whilst this is positive for practitioners, the clash of cultures can cause difficulties for trustees (and their advisers) who are used to administering trusts for western traditional families. Not infrequently, settlors in this new cohort are nationals of countries which either expressly permit or tacitly tolerate polygamy. This article draws attention to the ambiguity around the recognition of such marriages in England and related jurisdictions, and the potential problems this may pose for trustees.
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Stępkowski, Aleksander. "ROZWÓJ INSTYTUCJI TRUSTU W PRAWIE SZKOCKIM." Zeszyty Prawnicze 4, no. 1 (May 30, 2017): 91. http://dx.doi.org/10.21697/zp.2004.4.1.06.
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Development of the Law of Trusts in ScotlandSummaryThe earliest indisputable traces of trusts law in Scotland may be found in reports from the first half of the XVH‘h century. There are several examples of even earlier dispositions to which a fiduciary character might be ascribed, coming from the XV,h and XVTh centuries. Nevertheless, we are not able to state categorically that these represent examples of trusts, since there is nothing about priority of beneficiary's rights in respect to trust property, before trustee’s personal creditors, whereas it seems to be today differentiam specificam discerning trust from contractual relations.According to the aforementioned case law, the main subject of trust dispositions was land (immoveable property, called in Scotland “heritable”). The main issue giving rise to legal controversies was the question of the manner in which the existence of a trust in land was allowed to be proved. The rules of evidence adopted by the Court of Session differed substantially from those of Scottish land law which were usually applied when proving titles in land. According to Scottish institutional writers, it seems to be most probable that the reason for such a favourable standing of land being subject to trust was that the Court of Session proceeded on the ground of its’ nobile officium, extraordinary equitable jurisdiction performed by this court, most probably since the very early stages of it’s activity, on the basis of a statutory provision from 1540.During the XVIIth century the first statutory regulations concerning trusts appeared, but more substantial progress in this respect took place in the XIXth century. Most often, it was statutory implementation of earlier common law principles and, in relation to trustees’ competences, of standards relating to the professional drafting of trust deeds. XIXth century legislation was consolidated in 1921 as the Trusts (Scotland) Act 1921 which was subsequently amended in 1961 and, together with the British Trustee Investments Act 1961 (which is still in force in Scotland although will be repealed soon, as it was already done in England in 2001), is partial codification of Scottish trusts law. Nevertheless it should be emphasised that Scottish trust law is still principally based on case law.As regards the influence of English Equity on the development of the Scottish law of trusts, it seems to be negligible in the early stage of the latter’s development. A considerable influence of the Chancery Court’s cases upon Scots law in respect of trusts only began in the fourth decade of the XIXth century, with a book by Charles Forsyth ( The Principles and Practice o f the Law o f Trusts and Trustees in Scotland (1844)), who had used intensively English case law as an illustration, he claimed, of Scottish law principles. Since this publication, nevertheless, English case law, as exposed in English textbooks, though not necessarily in the Chancery Reports, became an important source of inspiration for Scottish lawyers writing books on this subject and, subsequently, it was also used in the Court of Session as an important source of authority. Notwithstanding the above, Scottish judges were always more critical and generally have applied English principles in a less willing manner than has been seen from Scottish advocates and solicitors. Generally speaking, the English influence, although considerable, has not changed the very construction of Scottish trusts law. A beneficiary’s claim in respect of trust property is still considered to be a personal right, as opposed to a sui generis right in real estate.Contemporary Scottish jurisprudence considers trust property as a trustee’s special patrimony, distinct from his general patrimony and, as such, not accessible by his personal creditors. In this way, the Scots have worked out a civil law approach to trust, which was long considered to be hardly possible. This is also a reason why Scottish trusts law, as well as the whole of Scottish law, attracts so much attention from lawyers from Continental Europe.
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Reid, Kenneth G. C. "Patrimony Not Equity: the trust in Scotland." European Review of Private Law 8, Issue 3 (September 1, 2000): 427–37. http://dx.doi.org/10.54648/273249.
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While the distinction between legal and equitable ownership is of central importance to the historical development of the trust in England, the idea of trust does not depend on such a distinction. In the mixed legal systems, of which Scotland is an example, there is a fully developed doctrine of trust, but no corresponding doctrine of equity. This suggests that equity is not, after all, the main organising feature of the law of trusts. The argument of this paper is that the fundamental characteristic of the trust is not dual ownership, but dual patrimony. In the normal case a single person has only a single patrimony. But in a trust there are two patrimonies, for, in addition to his private patrimony, the trustee holds a trust patrimony consisting of all the assets and liabilities of the trust. The patrimonies are distinct in law, so that the assets of the trust patrimony cannot be used to meet the liabilities of the personal patrimony. This idea of dual patrimony explains much in the law of trusts that is otherwise puzzling. In particular it explains the substitution of assets when trust property is bought and sold, the protection given to the trust beneficiary against the personal insolvency of the trustee, and the identity of the trust in a manner distinct from those who, for the time being, are its trustees and beneficiaries.
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Morris, Rupert, and Jessica Clark-Jones. "I’ve got the power: Saunders v Vautier in the context of massively discretionary trusts." Trusts & Trustees 28, no. 1 (December 8, 2021): 19–28. http://dx.doi.org/10.1093/tandt/ttab098.
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Abstract In two judgments in 2019 and 2020, the Guernsey Court of Appeal upheld the judgment of the Guernsey Royal Court in Rusnano Capital AG (in liquidation) v Molard International (PTC) Limited and Pullborough International Corp [2019] GRC 011 in relation to the statutory “Saunders v Vautier” provisions under the Trusts (Guernsey) Law, 2007. The position, in Guernsey at least, remains therefore that beneficiaries of a discretionary trust can require trustees to terminate a trust and distribute the trust property, even in circumstances where a broad power to add further (unspecified) beneficiaries exists. This article considers the position, on any view unsettled, in England and Wales (as well as other jurisdictions which still rely on the common law interpretation) of the so-called rule in Saunders v Vautier in light of the somewhat contradictory case law and authorities, particularly in the context of trusts where the dispositive discretions effectively displace the beneficial interests.
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Harpum, Charles. "The Uses and Abuses of Constructive Trusts: The Experience of England and Wales." Edinburgh Law Review 1, no. 4 (September 1997): 437–63. http://dx.doi.org/10.3366/elr.1997.1.4.437.
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This paper, which was first given on 19 October 1996 at a seminar on constructive trusts organised by the Universities of Edinburgh and Strathclyde with the Scottish Law Commission, examines the role that constructive trusts play in English law. It explains the amorphous nature of such trusts, how they are rooted in concepts of equity and conscience, and how they are often imposed in accordance with equity's traditional grounds for intervention. The central thesis of the paper is that a constructive trust, when imposed, will cause the trustee to become subject to one or more fiduciary obligations or incidents. One situation in which this is not the case— where a constructive trust is employed to impose an encumbrance on a transferee of property—is criticised. There is also a critique of the recourse to equitable maxims as a reason for the imposition of constructive trusts. The paper concludes with some reflections on the likely path of development of constructive trusts in English law and whether they ought to be more widely received into Scots law.
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Fletcher, Thomas. "From Harrods to billionaires’ row: unexplained wealth orders after Hajiyeva and Baker." Trusts & Trustees 26, no. 7 (September 2020): 663–71. http://dx.doi.org/10.1093/tandt/ttaa063.
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Abstract This article considers the jurisdiction in England to grant unexplained wealth orders which are contained in the Proceeds of Crime Act 2002. It particularly focuses on the implications of the recent judgments in Hajiyeva v National Crime Agency [2020] EWCA Civ 108 and Baker v National Crime Agency [2020] EWHC 822 (Admin) for trusts and trustees. It concludes by identifying and commenting on the key issues in this context which may well fall to be considered in future cases.
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Ozieranski, Piotr, Eszter Saghy, and Shai Mulinari. "Pharmaceutical industry payments to NHS trusts in England: A four-year analysis of the Disclosure UK database." PLOS ONE 18, no. 11 (November 1, 2023): e0290022. http://dx.doi.org/10.1371/journal.pone.0290022.
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Introduction Although hospitals are key health service providers, their financial ties to drug companies are little understood. We examine non-research pharmaceutical industry payments to English National Health Service (NHS) trusts—hospital groupings providing secondary and tertiary care. Methods We extracted data from the industry-run Disclosure UK database, analysing it descriptively and using the Jonckheere-Terpstra test to establish whether a statistically significant time trend existed in the median values of individual payments. We explained payment value and number per trust with random effects models, using selected trust characteristics as predictors. Results Drug companies reported paying £60,253,421 to 234 trusts, representing between 90.0% and 92.0% of all trusts in England between 2015 and 2018. As a share of payments to all healthcare organisations, the number of payments rose from 38.6% to 39.5%, but their value dropped from 33.0% to 23.6%. The number of payments for fees for service and consultancy and contributions to costs of events increased by 61.5% and 29.4%. The median payment value decreased significantly for trusts overall (from £2,250.8 to £1,758.5), including those with lower autonomy from central government; providing acute services; and from half of England’s regions. The random effects model showed that acute trusts received significantly more money on average than trusts with all other service profiles; and trusts from East England received significantly less than those from London. However, trusts enjoying greater autonomy from government did not receive significantly more money than others. Trusts also received significantly less money in 2018 than in 2015. Conclusion NHS trusts had extensive pharmaceutical industry ties but were losing importance as payment targets relative to other healthcare organisations. Industry payment strategies shifted towards events sponsorship, consultancies, and smaller payments. Trusts with specific service and geographical profiles were prioritised. Understanding corporate payments across the health system requires more granular disclosure data.
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Engstrom, John H., and Randolph A. Shockley. "FINANCIAL REPORTING FOR THE GEORGIA COLONY." Accounting Historians Journal 12, no. 2 (September 1, 1985): 43–58. http://dx.doi.org/10.2308/0148-4184.12.2.43.
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Stewardship reporting was an important tool in the establishment and development of the American Colonies. In 1732 the King of England created the Colony of Georgia as a haven for England's “worthy poor.” A corporate trust was established to implement this purpose, and it was necessary for the trustees to account for the many private contributions to the cause as well as the grants from the crown. This article discusses the early history of the Georgia colony, presents a thumbnail sketch of Harman Verelst, the Trust's accountant, and illustrates by example the financial reporting he developed for the Georgia Colony.
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Thompson, Charles DR, Arun Mahay, David Stuckler, and Sarah Steele. "Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts." JRSM Open 8, no. 9 (September 2017): 205427041772040. http://dx.doi.org/10.1177/2054270417720408.
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Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.
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Grigoroglou, Christos, Kieran Walshe, Evangelos Kontopantelis, Jane Ferguson, Gemma Stringer, Darren Ashcroft, and Thomas Allen. "Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019–2021." BMJ Open 13, no. 6 (May 25, 2023): e065803. http://dx.doi.org/10.1136/bmjopen-2022-065803.
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ObjectivesTemporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019–2021.SettingDescriptive analyses of data on locum shifts from all NHS trusts in England in 2019–2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics.ResultsIn 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th–75th centile=2.2%–6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts’ staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019–2021, the mean number of weekly shifts per trust increased by 19% (175.2–208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts.ConclusionsThere were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts.
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Mateen, Bilal Akhter, Harrison Wilde, John M. Dennis, Andrew Duncan, Nick Thomas, Andrew McGovern, Spiros Denaxas, Matt Keeling, and Sebastian Vollmer. "Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: a descriptive analysis." BMJ Open 11, no. 1 (January 2021): e042945. http://dx.doi.org/10.1136/bmjopen-2020-042945.
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ObjectiveIn this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic.DesignDescriptive survey.SettingAll non-specialist secondary care providers in England from 27 March27to 5 June 2020.ParticipantsAcute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195).Main outcome measuresTwo thresholds for ‘safe occupancy’ were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement.ResultsAt peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1–17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds.ConclusionsThroughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above ‘safe-occupancy’ thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.
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Mears, Ruth, Sofia Leadbetter, Toby Candler, Hannah Sutton, Deborah Sharp, and Julian P. H. Shield. "Cross-sectional survey of child weight management service provision by acute NHS trusts across England in 2020/2021." BMJ Open 12, no. 11 (November 2022): e061971. http://dx.doi.org/10.1136/bmjopen-2022-061971.
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ObjectiveWith one in five children in England living with obesity, we mapped the geographical distribution and format of child weight management services provided by acute National Health Service (NHS) trusts across England, to identify breadth of service provision.DesignA cross-sectional survey.SettingThe survey was sent to acute NHS trusts (n=148) in England in 2020, via a freedom of information request.ParticipantsResponses were received from 139 of 148 (94%) acute NHS trusts, between March 2020 to March 2021.Outcome measuresThe survey asked each acute NHS trust whether they provide a weight management service for children living with obesity. For those trusts providing a service, data were collected on eligibility criteria, funding source, personnel involved, number of new patients seen per year, intervention duration, follow-up length and outcome measures. Service characteristics were reported using descriptive statistics. Service provision was analysed in the context of ethnicity and Index of Multiple Deprivation score of the trust catchment area.ResultsFrom the 139 survey respondents, 23% stated that they provided a weight management service for children living with obesity. There were inequalities in the proportion of acute NHS trusts providing a service across the different regions of England, ranging from 4% (Midlands) to 36% (London). For trusts providing a service, there was variability in the number of new cases seen per year, eligibility criteria, funding source, intervention format and outcome measures collected. A multidisciplinary approach was not routinely provided, with only 41% of services reporting ≥3 different staff disciplines.ConclusionIn 2020/2021, there were geographical inequalities in weight management service provision by acute NHS trusts for children living with obesity. Services provided lacked standardisation, did not routinely offer children multidisciplinary care and were insufficient in size to meet need.
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Walsh, Denis, Helen Spiby, Christine McCourt, Celia Grigg, Dawn Coleby, Simon Bishop, Miranda Scanlon, et al. "Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study." BMJ Open 10, no. 2 (February 2020): e033895. http://dx.doi.org/10.1136/bmjopen-2019-033895.
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ObjectiveTo identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England.DesignCase studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England.Setting and participantsNHS maternity services in different geographical areas of England Maternity care staff and service users from six NHS Trusts: two Trusts where more than 20% of all women gave birth in MUs, two Trusts where less than 10% of all women gave birth in MUs and two Trusts without MUs. Obstetric, midwifery and neonatal clinical leaders, managers, service user representatives and commissioners were individually interviewed (n=57). Twenty-six focus groups were undertaken with midwives (n=60) and service users (n=52).Main outcome measuresFactors influencing MU use.FindingsThe study findings identify several barriers to the uptake of MUs. Within a context of a history of obstetric-led provision and lack of decision-maker awareness of the clinical and economic evidence, most Trust managers and clinicians do not regard their MU provision as being as important as their obstetric unit (OU) provision. Therefore, it does not get embedded as an equal and parallel component in the Trust’s overall maternity package of care. The analysis illuminates how implementation of complex interventions in health services is influenced by a range of factors including the medicalisation of childbirth, perceived financial constraints, adequate leadership and institutional norms protecting the status quo.ConclusionsThere are significant obstacles to MUs reaching their full potential, especially free-standing midwifery units. These include the lack of commitment by providers to embed MUs as an essential service provision alongside their OUs, an absence of leadership to drive through these changes and the capacity and willingness of providers to address women’s information needs. If these remain unaddressed, childbearing women’s access to MUs will continue to be restricted.
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Hamnett, Nathan, Naomi Patel, Kathryn Nelson, Tom Harrison, and Nicholas White. "How do explicitly stated hospital trust values relate to their CQC ratings?" BMJ Leader 2, no. 2 (March 26, 2018): 68–70. http://dx.doi.org/10.1136/leader-2017-000062.
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IntroductionFor National Health Service(NHS) Trusts in the process of setting internal organisational values, it would be useful to see if there was a correlation between certain organisational values and Care Quality Commission (CQC) ratings to enable quality improvement.MethodsTo examine this, we identified the CQC ratings of the NHS England provider trusts and identified and listed the trust’s values. These values were then categorised and a comparison made of well-performing and underperforming trusts.ResultsA total of 43 different values were identified, with a total of 800 values being used across all 188 trusts. In the reviewed hospitals, a broad range of values were found with some not meeting common definitions of what a value is. All trusts included some aspect of behaviour in their values.ConclusionWell-performing hospitals are more likely to be open and honest with aspirational values, whereas those which are not are more likely to be focused on day to day service delivery with operational or proscriptive values. There was considerable variation from the published NHS constitution values with outstanding and good trusts having more variance from the values in the NHS constitution than trusts rated requiring improvement or inadequate.
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Mowbray, J. "Asset Protection Trusts in England." Trusts & Trustees 1, no. 6 (May 1, 1995): 12–13. http://dx.doi.org/10.1093/tandt/1.6.12.
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Harrop, Chris, John Read, Jim Geekie, and Julia Renton. "An Independent Audit of Pharma Influence in Public Mental Health Trusts in England." Ethical Human Psychology and Psychiatry 20, no. 3 (December 1, 2018): 156–68. http://dx.doi.org/10.1891/1559-4343.20.3.156.
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Without data, many people may think pharmaceutical companies' influence over mental health services is negligible. We audited the marketing activities of, and payments to, drug companies in relation to public mental health services in England. Forty-three of 53 Trusts responded to Freedom-of-Information-Act requests. Trusts' policies varied in covering seven activities: from 86% (gifts) to 37% (leaflets). In practice, industry-sponsored training events (51%) and direct talks (40%) were common (averaging 36 events or talks per Trust annually). Only 22% of Trusts produced legally required Conflicts-of-Interests registers; and 14% had none. All 22 Trusts that reported which company received the largest share of their drug expenditure named the same company. On average, Trusts spent 44% of their drugs budget on long-acting injectable antipsychotics (13% to 77%) and 32% on brand name drugs (5%–74%). Five Trusts ban the Pharma marketing activities investigated. Independent post-qualification medical education, and marketing-bans, are needed to avoid over-medicalized practice.
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Robertson, Ava, and Sarah Steele. "A cross-sectional survey of English NHS Trusts on their uptake and provision of active bystander training including to address sexual harassment." JRSM Open 14, no. 4 (April 2023): 205427042311666. http://dx.doi.org/10.1177/20542704231166619.
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Objective Reports identify that sexual harassment is troublingly pervasive in the NHS. Active bystander training (ABT) has been promoted to address sexual harassment, alongside other forms of poor behaviour, discrimination, and harassment. We explore ABT across all English NHS Trusts and determine whether the programmes address sexual misconduct in the training content. Design Freedom of Information requests asking whether Trusts offer ABT, and if so, about the programme content and delivery, and to NHS England on centrally commissioned ABT. Setting 213 NHS Trusts in England, and NHS England. Participants Not applicable. Main Outcome Measure Provision of ABT, and presence of sexual harassment content in the training. Results 199 Trusts responded by August 2022. Of these, 35 Trusts provide ABT, the majority of which deliver content that is not specific to sexual misconduct, are in London, outsource training using private providers, and only provide workshops on an opt-in basis. One Trust offers a standalone ABT module on sexual harassment. Private providers prohibit Trusts from sharing training material, inhibiting content analysis and evaluation. Among the 163 Trusts without ABT programmes, only 23 (13%) have plans to implement training. Conclusions ABT is underutilised in the NHS, despite being identified as an effective intervention in other settings like the military, higher education, and government workplaces. Studies should explore whether wider NHS adoption is warranted. Robust monitoring and evaluation processes are critical to strengthening the available literature regarding the effectiveness of ABT in the healthcare context and engaging in global knowledge sharing across health systems.
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Pinfold, Vanessa, Jonathan Bindman, Karin Friedli, Andrew Beck, and Graham Thornicroft. "Supervised discharge orders in England." Psychiatric Bulletin 23, no. 4 (April 1999): 199–203. http://dx.doi.org/10.1192/pb.23.4.199.
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Aims and methodSupervised discharge orders were introduced in April 1996. This paper describes two national surveys of their use in all mental health provider trusts in England. Data were collected from key informants in mental health provider trusts using a postal survey in 1997, and a follow-up telephone survey in 1998.ResultsThe total number of patients subject to supervised discharge in 1997 was 160, a mean of one per trust. In 1998, there were 378 cases, a mean of two cases per trust. The annual period prevalence in 1998 can be estimated as 510 cases, approximately one per 100000 total population per year. Seventeen applications of the ‘power to convey’ were identified.Clinical implicationsSupervised discharge is regarded as suitable for very few patients, though its use is growing. The controversial power to convey is seldom used in practice and barriers to its use are described.
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MILLS, Grant R. W., Lipika DEKA, Andrew D. F. PRICE, Sameedha RICH-MAHADKAR, Efthimia PANTZARTZIS, and Peter SELLARS. "CRITICAL INFRASTRUCTURE RISK IN NHS ENGLAND: PREDICTING THE IMPACT OF BUILDING PORTFOLIO AGE." International Journal of Strategic Property Management 19, no. 2 (June 19, 2015): 159–72. http://dx.doi.org/10.3846/1648715x.2015.1029562.
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NHS Trusts in England must adopt appropriate levels of continued investment in routine and backlog maintenance if they are to ensure critical backlog does not accumulate. This paper presents the current state of critical backlog maintenance within the National Health Service (NHS) in England through the statistical analyses of 115 Acute NHS Trusts. It aims to find empirical support for a causal relationship between building portfolio age and year-on-year increases in critical backlog. It makes recommendations for the use of building portfolio age in strategic asset management. The current trend across this sample of NHS Trusts may be typical of the whole NHS built asset portfolio and suggests that most Trusts need to invest between 0.5 and 1.5 per cent of income (depending upon current critical backlog levels and Trust age profile) to simply maintain critical backlog levels. More robust analytics for building age, condition and risk-adjusted backlog maintenance are required.
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Traest, Michael. "Jonathan Harris, The Hague Trust Convention. Scope, Application and Preliminary Issues, Oxford – Portland Oregon, Hart Publishing, 2002, 529 pp." European Review of Private Law 11, Issue 2 (April 1, 2003): 264–66. http://dx.doi.org/10.54648/erpl2003017.
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This book is the first monograph published in England devoted to a detailed analysis of the Hague Convention on the Law Applicable to Trusts and on their Recognition, concluded in The Hague on 1 July 1985. It is divided into two parts. The first one deals with the private international law rules concerning the creation of transnational trusts. This part is also named “Launching the Rocket.” In doing so the author refers to the image of the rocket-launcher and the rocket regularly invoked in relation to transnational trusts. As indicated by the author, the former concerns those preliminary matters necessary for creation of the trust, such as the capacity of the settlor to dispose of his property on trust. The latter governs matters affecting the trust once it has come into existence, such as the role of the trustee, the administration of the trust and the relationship between the trustee and the beneficiary; those matters are essentially covered by the Hague Trust Convention. In using the image of the rocket-launcher and the rocket, it is made clear that the subject-matter dealt with by the Hague Convention does not have to be taken into consideration if the pre-conditions for the formation of a trust are not satisfied. In other words, the rocket is not considered if it is not correctly launched. Indeed, each contracting State bound by the Hague Trust Convention has to apply its own national conflict of law rules to determine whether the rocket was succesfully launched (p 3).
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Gretton, George L. "Trusts Without Equity." International and Comparative Law Quarterly 49, no. 3 (July 2000): 599–620. http://dx.doi.org/10.1017/s0020589300064381.
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“Perhaps the greatest difficulty the civilians have in accepting the trust is caused by what I have come to regard as an English peculiarity logically detachable from the trust, namely, the distinction between the legal and the equitable estate. In Scots law, which, even if it did not invent and develop the trust for itself but took it over from England—the point is doubtful—has accepted it without inhibitions or reservations, no such distinction has ever been known. There the trustee becomes owner and the beneficiary acquires a contractual right against him.”1
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McCartney, Margaret, Raphaella Bergeron Hartman, Harriet Feldman, Ronald MacDonald, Frank Sullivan, C. Heneghan, and Calum McCutcheon. "How are declarations of interest working? A cross-sectional study in declarations of interest in healthcare practice in Scotland and England in 2020/2021." BMJ Open 12, no. 11 (November 2022): e065365. http://dx.doi.org/10.1136/bmjopen-2022-065365.
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ObjectiveTo understand arrangements for healthcare organisations’ declarations of staff interest in Scotland and England in the context of current recommendations.DesignCross-sectional study of a random selection of National Health Service (NHS) hospital registers of interest by two independent observers in England, all NHS Boards in Scotland and a random selection of Clinical Commissioning Groups (CCGs) in England.SettingNHS Trusts in England (NHSE), NHS Boards in Scotland, CCGs in England, and private healthcare organisations.ParticipantsRegisters of declarations of interest published in a random sample of 67 of 217 NHS Trusts, a random sample of 15 CCGs of in England, registers held by all 14 NHS Scotland Boards and a purposeful selection of private hospitals/clinics in the UK.Main outcome measuresAdherence to NHSE guidelines on declarations of interests, and comparison in Scotland.Results76% of registers published by Trusts did not routinely include all declaration of interest categories recommended by NHS England. In NHS Scotland only 14% of Boards published staff registers of interest. Of these employee registers (most obtained under Freedom of Information), 27% contained substantial retractions. In England, 96% of CCGs published a Gifts and Hospitality register, with 67% of CCG staff declaration templates and 53% of governor registers containing full standard NHS England declaration categories. Single organisations often held multiple registers lacking enough information to interpret them. Only 35% of NHS Trust registers were organised to enable searching. None of the private sector organisations studied published a comparable declarations of interest register.ConclusionDespite efforts, the current system of declarations frequently lacks ability to meaningfully obtain complete healthcare professionals’ declaration of interests.
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Howe, Alison, Julie Hendry, and John Potokar. "A survey of liaison psychiatry services in the south-west of England." Psychiatric Bulletin 27, no. 03 (March 2003): 90–92. http://dx.doi.org/10.1192/s0955603600001598.
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Aims and Method A postal survey was conducted to establish an overview of liaison psychiatry services in the south-west of England. Questionnaires were sent to all clinical directors of medicine, accident and emergency, and mental health in trusts which provide acute medical services. Results Thirty-six questionnaires were returned (77%), covering 17 out of 18 trusts providing acute services. Five trusts (28%) have a comprehensive dedicated liaison psychiatry service. A further six trusts (33%) have a service for deliberate self-harm only. Many respondents were critical of what they perceived to be an inadequate service. Five trusts had introduced a service in the 12 months preceding the survey. Clinical Implications An unmet need for liaison psychiatry services is clearly perceived across the south-west of England.
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Howe, Alison, Julie Hendry, and John Potokar. "A survey of liaison psychiatry services in the south-west of England." Psychiatric Bulletin 27, no. 3 (March 2003): 90–92. http://dx.doi.org/10.1192/pb.27.3.90.
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Aims and MethodA postal survey was conducted to establish an overview of liaison psychiatry services in the south-west of England. Questionnaires were sent to all clinical directors of medicine, accident and emergency, and mental health in trusts which provide acute medical services.ResultsThirty-six questionnaires were returned (77%), covering 17 out of 18 trusts providing acute services. Five trusts (28%) have a comprehensive dedicated liaison psychiatry service. A further six trusts (33%) have a service for deliberate self-harm only. Many respondents were critical of what they perceived to be an inadequate service. Five trusts had introduced a service in the 12 months preceding the survey.Clinical ImplicationsAn unmet need for liaison psychiatry services is clearly perceived across the south-west of England.
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Zhong, Jim, Peter Atiiga, Des J. Alcorn, David Kay, Rowland Illing, David J. Breen, Nicholas Railton, Ian J. McCafferty, Philip J. Haslam, and Tze Min Wah. "Cross-sectional study of the provision of interventional oncology services in the UK." BMJ Open 7, no. 10 (October 2017): e016631. http://dx.doi.org/10.1136/bmjopen-2017-016631.
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ObjectiveTo map out the current provision of interventional oncology (IO) services in the UK.DesignCross-sectional multicentre study.SettingAll National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards.ParticipantsInterventional radiology (IR) departments in all NHS trusts/health boards in the UK.ResultsA total of 179 NHS trusts/health boards were contacted. We received a 100% response rate. Only 19 (11%) institutions had an IO lead. 144 trusts (80%) provided IO services or had a formal pathway of referral in place for patients to a recipient trust. 21 trusts (12%) had plans to provide an IO service or formal referral pathway in the next 12 months only. 14 trusts (8%) did not have a pathway of referral and no plans to implement one. 70 trusts (39%) offered supportive and disease-modifying procedures. One trust had a formal referral pathway for supportive procedures. 73 trusts (41%) provided only supportive procedures (diagnostic or therapeutic). Of these, 43 (59%) had a referral pathway for disease-modifying IO procedures, either from a regional cancer network or through IR networks and 30 trusts (41%) did not have a referral pathway for disease-modifying procedures.ConclusionThe provision of IO services in the UK is promising; however, collaborative networks are necessary to ensure disease-modifying IO procedures are made accessible to all patients and to facilitate larger registry data for research with commissioning of new services.
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Mitchell, Alex J., and John Gill. "Research productivity of staff in NHS mental health trusts: comparison using the Leiden method." Psychiatric Bulletin 38, no. 1 (February 2014): 19–23. http://dx.doi.org/10.1192/pb.bp.113.042630.
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Aims and methodTo examine research productivity of staff working across 57 National Health Service (NHS) mental health trusts in England. We examined research productivity between 2010 and 2012, including funded portfolio studies and all research (funded and unfunded).ResultsAcross 57 trusts there were 1297 National Institute for Health Research (NIHR) studies in 2011/2012, involving 46140 participants and in the same year staff in these trusts published 1334 articles (an average of only 23.4 per trust per annum). After correcting for trust size and budget, the South London and Maudsley NHS Foundation Trust was the most productive. In terms of funded portfolio studies, Manchester Mental Health and Social Care Trust as well as South London and Maudsley NHS Foundation Trust, Oxford Health NHS Foundation Trust and Cambridgeshire and Peterborough NHS Foundation Trust had the strongest performance in 2011/2012.Clinical implicationsTrusts should aim to capitalise on valuable staff resources and expertise and better support and encourage research in the NHS to help improve clinical services.
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Morgan, Gareth G. "Charitable Incorporated Organisations: An Analysis of the Three UK Jurisdictions." Nonprofit Policy Forum 6, no. 1 (April 1, 2015): 25–44. http://dx.doi.org/10.1515/npf-2014-0035.
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AbstractThe specific legal forms available for charitable organisations have received much less attention by scholars as compared to work on the definition of charity, the boundaries of charitable status and the duties of charity trustees. Under each of the three UK jurisdictions, it could be argued that all charitable property is held on trust (in the sense that it is held for interests of the charity’s beneficiaries) but many charities are no longer formed using the structure of a trust. Charitable organisations can have many possible structures including charitable trusts, charitable associations, charitable companies and now charitable incorporated organisations (CIOs). Until recently the UK lacked any specific legal form for charities. The CIO was created to remedy this: a corporate body with limited liability, formed purely by registration with the appropriate charity regulator. Since 2008 it has been enshrined in statute in all three UK jurisdictions, though implementation dates only from 2011 in Scotland and from 2013 in England and Wales. The focus of this paper is a comparison of the CIO form in the three UK charity law jurisdictions. It analyses the frameworks for CIOs established in England and Wales, Scottish CIOs (SCIOs) and the (yet to be implemented) CIOs in Northern Ireland. It concludes that whilst the CIO concept is effectively reflected in all three jurisdictions, the differences between these three types of CIOs are much more than just those needed to comply with the different regimes of charity regulation – the differences raise important choices for those seeking to establish new charities operating UK-wide.
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Feldman, Harriet Ruth, Nicholas J. DeVito, Jonathan Mendel, David E. Carroll, and Ben Goldacre. "A cross-sectional study of all clinicians’ conflict of interest disclosures to NHS hospital employers in England 2015-2016." BMJ Open 8, no. 3 (March 2018): e019952. http://dx.doi.org/10.1136/bmjopen-2017-019952.
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ObjectiveWe set out to document how NHS trusts in the UK record and share disclosures of conflict of interest by their employees.DesignCross-sectional study of responses to a Freedom of Information Act request for Gifts and Hospitality Registers.SettingNHS Trusts (secondary/tertiary care organisations) in England.Participants236 Trusts were contacted, of which 217 responded.Main outcome measuresWe assessed all disclosures for completeness and openness, scoring them for achieving each of five measures of transparency.Results185 Trusts (78%) provided a register. 71 Trusts did not respond within the 28 day time limit required by the FoIA. Most COI registers were incomplete by design, and did not contain the information necessary to assess conflicts of interest. 126/185 (68%) did not record the names of recipients. 47/185 (25%) did not record the cash value of the gift or hospitality. Only 31/185 registers (16%) contained the names of recipients, the names of donors, and the cash amounts received. 18/185 (10%) contained none of: recipient name, donor name, and cash amount. Only 15 Trusts had their disclosure register publicly available online (6%). We generated a transparency index assessing whether each Trust met the following criteria: responded on time; provided a register; had a register with fields identifying donor, recipient, and cash amount; provided a register in a format that allowed further analysis; and had their register publicly available online. Mean attainment was 1.9/5; no NHS trust met all five criteria.ConclusionOverall, recording of employees’ conflicts of interest by NHS trusts is poor. None of the NHS Trusts in England met all transparency criteria. 19 did not respond to our FoIA requests, 51 did not provide a Gifts and Hospitality Register and only 31 of the registers provided contained enough information to assess employees’ conflicts of interest. Despite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and tracking such disclosures is not functioning adequately. We propose a simple national template for reporting conflicts of interest, modelled on the US ‘Sunshine Act’.
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Oluwatayo, Olufemi, and Trevor Friedman. "A survey of specialist perinatal mental health services in England." Psychiatric Bulletin 29, no. 5 (May 2005): 177–79. http://dx.doi.org/10.1192/pb.29.5.177.
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Aims and MethodTo survey current specialist perinatal psychiatric provisions and opinion about these services in England. A brief semi-structured confidential questionnaire was circulated to the lead clinician or manager responsible for perinatal services of the 78 mental health trusts in England.ResultsFifty-seven trusts (73%) responded. In 26 trusts (46%), availability of either specialist in-patient facilities and/or intensive home treatment facilities were reported. In only 13 trusts (23%) was there evidence of provision of services covering both in-patient and community components. The number of mother and baby units or their equivalents has reduced in the past decade. The services were generally considered to be inadequate nationwide and opinion remains divided about the best approach for providing them.Clinical ImplicationsThere is a need for a recommendation of a national standard provision of perinatal services by mental health trusts.
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Shammas, Carole. "Tracking the growth of government securities investing in early modern England and Wales." Financial History Review 27, no. 1 (March 25, 2020): 95–114. http://dx.doi.org/10.1017/s096856501900026x.
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Interest in the growth of tradeable securities in early modern Britain, especially its relationship to economic development and the funding of government debt, has centered mainly on the borrower – whether it be trading company, industrial enterprise, or the state. This article directs attention to the investor, using Charity Commission Reports for England and Wales that document a dramatic mid-eighteenth-century shift by donors and trustees from investments in real estate and rent charges to perpetual government annuities, mainly 3 percent Consols. The heavy investment in this public debt product is what ultimately prompted the creation of the London Stock Exchange in 1801.In analyzing this shift, which occurred among the propertied in all regions of the nation, not just the metropolis or among corporate entities and the mercantile community, I consider both what made the annuities increasingly attractive for charitable trusts and the alternatives – real estate and private loans secured by mortgage or other means – more problematic. Legal changes, I argue, played a role in the transformation, especially the Charitable Uses Act of 1736, which made charitable devises of real estate very difficult and probably resulted in reduced investment in human capital and less wealth redistribution. Regions varied, however, in the degree to which they switched from real estate in the latter part of the eighteenth century; they also differed in the extent to which the switch resulted in more gifts of interest-bearing loans as well.Admittedly, the changes documented in this article concern only one type of depository for assets, charitable trusts. The appeal of these annuities, however, could extend to investments needed for other purposes such as postmortem payments to dependents. Moreover, the fall-off in demand for real estate in trusts correlates with GDP estimates showing a steady decline in income from real assets after 1755 and what some have noted in this period as a puzzle – the lack of an increased rate of return on rents and private loans at a time of robust investment in government debt. Most importantly, though, the transition demonstrates the ability of the government to induce a broad spectrum of the propertied population to invest in securities, if the vehicle they offered had the right characteristics, which were not necessarily highest yield or liquidity without loss in value.
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Short, Robert. "England approves first mental health foundation trusts." BMJ 332, no. 7549 (May 4, 2006): 1052.2. http://dx.doi.org/10.1136/bmj.332.7549.1052-b.
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Bosanquet, Nick. "NHS England: Get tougher with the trusts." British Journal of Healthcare Management 22, no. 8 (August 2, 2016): 390–91. http://dx.doi.org/10.12968/bjhc.2016.22.8.390.
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Harris, C. "England introduces star system for hospital trusts." BMJ 323, no. 7315 (September 29, 2001): 709. http://dx.doi.org/10.1136/bmj.323.7315.709.
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Lupoi, Maurizio. "Trusts in mixed jurisdictions." Pravovedenie 67, no. 1 (2023): 21–55. http://dx.doi.org/10.21638/spbu25.2023.102.
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Closed legal systems are gone in modern world, “mixed” legal systems have become the norm. That has made so-called “transplants” easier but, contrary to a widely held view, legal institutions cannot be transplanted. English trust rules even less, for they are not a coherent set of rules. The British attempted to legislate on trusts for their colonies, for instance for Ceylon (the present-day Sri Lanka), and were thus obliged to be coherent. That made it necessary to introduce new legal concepts with unforeseeable consequences. A wave of legislation followed the adoption of the convention “On The Law Applicable To Trusts And On Their Recognition” by the 15th session of the Hague Conference on private international law (1985); it gave birth to the “international model” of trusts that quickly became the favourite setting of the rich and ultra-rich. Jersey in the Channel Islands was the leading jurisdiction, many others followed but it was not until the establishment of the International Finance Centres in the Gulf and later in Kazakhstan where “the laws of England and Wales” are taken as a source of law and local courts are staffed by former English judges or in any event by lawyers brought up in the common law that a proper transplant of the English trust took place. A totally different legal setting witnessed attempts to create imitations that had to run against well-established civil law conceptual attitudes that did not allow the existence of more than one patrimony per person or the segregation of assets within one person’s patrimony. In 2022 France decreed that each businessman is automatically the owner of two patrimonies; that open the way to a radical re-thinking of civil law notions. Québec and Louisiana are taken as examples of civil law legislation on trusts but Québec has followed its own idea that the assets that form the object of a fiducie belong to nobody, while Louisiana’s Trust Code is a deft admixture of civil law and common law elements based on the civilian notion of “fiduciary”. Luxembourg, France and other civil law countries are then examined: the focus then is on South Africa and Scotland, two countries which have a common past in a shared period of the European ius commune and a common present in being both orphaned from a cultural lineage that provided answers to current matters by drawing on Roman law. Now they both solve the problem of the patrimony by holding that a trustee has more than one patrimony, his own and then one for each trust of which he is the trustee.
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Okonjo, Benedict, Parul Kaithwas, Jing Miao, Mark Mackay, and Vanessa North. "Writing for the Wider Public - Readability of Publicly Available Board Reports." Asia Pacific Journal of Health Management 16, no. 4 (December 13, 2021): 45–53. http://dx.doi.org/10.24083/apjhm.v16i4.797.
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Objective: This work aims to evaluate the readability of publicly available board reports from the Local Health Networks (LHNs) in South Australia and the National Health Service (NHS) Trusts in England. Method: Publicly available board reports from the LHNs in South Australia and NHS Trusts in England were identified, screened, and evaluated from January 2020 to August 2020. Results: The average Flesch Reading Ease score for all LHNs reviewed ranged from 34 ± 10.2 to 57 ± 0.0 (Difficult to Fairly Difficult). In comparison, the average Flesch Reading Ease score for all the NHS Foundation Trusts ranged from 46 ± 1.7 to 60 ± 3.0 (Difficult to Standard). The average Reading Ease score for metropolitan and non-metropolitan LHNs was 43 ± 8.1 and 41 ± 6.0 (Difficult to read). In contrast, the average Reading Ease score for metropolitan and non-metropolitan NHS Trust was Fairly Difficult with 53 ± 4.2 and 50 ± 3.5 respectively. Conclusion: The evaluation results suggest that there is scope for improving the quality of publicly available board reports from the boards reviewed in terms of their readability by the public.
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Mawdsley, Sharon. "What are acute NHS trusts in England doing to prevent the cross-border spread of carbapenem-resistant Enterobacteriaceae?" Journal of Infection Prevention 21, no. 5 (July 21, 2020): 196–201. http://dx.doi.org/10.1177/1757177420935633.
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Background: Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat to global public health as these organisms have the potential to cause infections which are easily spread and are associated with high mortality rates. Aim/Objective: The aim of this study was to establish which screening strategies acute NHS trusts in England have chosen to adopt and whether or not that strategy has prevented or is likely to prevent the cross-border spread of CRE. Methods: All acute NHS trusts in England were invited to participate in a multicentre quantitative study. Participants were asked to complete a questionnaire relating to their local CRE screening protocol. Findings/Results: Of the 91 participating trusts, 83 (91.2%) adhere to Public Health England (2013) guidance. However, only 22 (24.2%) trusts have adopted the European Centre for Disease Prevention and Control (2016) recommendations. In total, 31 (34.1%) trusts reported incidences of person-to-person transmission, of which 45.2% were related to foreign travel. Furthermore, 31 (34.1%) trusts reported that patients who have had an admission to a hospital in the UK not known to have a high prevalence of healthcare-associated CRE in the last 12 months had screened positive. Discussion: This study has demonstrated that inter-hospital transmission is as much of a concern as cross-border spread. Mandatory participation in enhanced surveillance could provide PHE with the epidemiological evidence required to support this stance and help to develop new national guidance.
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Valentine, Althea Z., Kapil Sayal, Beverley Jane Brown, and Charlotte L. Hall. "A national survey of current provision of waiting list initiatives offered by child and adolescent mental health services in England." British Journal of Child Health 4, no. 2 (April 2, 2023): 78–83. http://dx.doi.org/10.12968/chhe.2023.4.2.78.
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Background: Children and young people accessing child and adolescent mental health services (CAMHS) often report delays in receiving an assessment and commencing treatment. In 2018, the James Lind Alliance acknowledged developing CAMHS waiting-list interventions (WLI) as a top 10 priority. Aims: This study aimed to examine the current provision of WLI in CAMHS. Methods: During 2021, an online survey was sent to each National Health Service (NHS) trust providing CAMHS in England, to explore provision of WLI within their trust. Findings: Of the 57 CAMHS trusts identified as meeting inclusion criteria, survey responses were received from 16 trusts, 12 of which had implemented WLI, a large proportion of these were digital interventions. Barriers and facilitators to WLIs were identified, particularly availability of staff. Conclusions: WLIs are being used in some trusts but with limited evidence of evaluation, further research on the acceptability and effectiveness of WLI is warranted.
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White, Edward, and Julie Winstanley. "Clinical supervision provided to mental health nurses in England." British Journal of Mental Health Nursing 10, no. 2 (May 2, 2021): 1–11. http://dx.doi.org/10.12968/bjmh.2020.0052.
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Background/Aims Clinical supervision has become widely regarded as a central tenet of professional practice. However, little is known about the basis for claims to the benefits. This study described the features of clinical supervision provision to mental health nurses in England. Methods A Freedom of Information Act request was submitted to 52 mental health NHS trusts in England regarding clinical supervision that is available to ∼42 000 mental health nurses. These data underwent content analysis. Each submitted document was read several times and meaningful pieces of content were assigned to one of the 10 major themes that emerged (clinical supervision definitions, discriminated clinical supervision definitions, roles duties and responsibilities, confidentiality, training, evaluations, reporting, templates, references/bibliographies, document size). Results All 52 mental health NHS trusts responded. Multiple operational definitions of clinical supervision were reported. For 29 out of the 31 trusts (94%) the length of each clinical supervision session was reportedly 60 minutes, of which nearly 80% (23/29) were held at a frequency of between four and eight sessions a year. Overall, 33 trusts (64%) reported that the supervisors were specifically trained to provide clinical supervision to mental health nurses. Of the 52 trusts, 48 (92%) had a dedicated clinical supervision policy document. Most trusts reported brief in-house evaluations, which were narrowly contained to comply with local clinical supervision policy positions. Conclusions Early professional objectives for clinical supervision have since morphed into a de facto managerial staff performance monitoring exercise which may, or may not, have other advantages.
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Griffin, Kathryn Jane, Simon Cousins, Marc Aaron Bailey, David Berridge, and David Julian Ashbridge Scott. "Primary care trust commissioning of varicose vein intervention – New guidance needed?" Phlebology: The Journal of Venous Disease 29, no. 8 (June 10, 2013): 505–10. http://dx.doi.org/10.1177/0268355513492314.
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Objectives In light of evidence of national variability in service commissioning of varicose vein intervention, our aim was to evaluate the current state of primary care trust commissioning for all forms of varicose vein intervention in England. We also sought to clarify the extent to which access to endovenous and surgical varicose vein services is being restricted. Methods Under the Freedom of Information Act (2001), a structured email survey was sent to 108 primary care trusts in England. Trusts were asked how many elective endovenous laser therapy and open procedures were commissioned from 2008 to 2011 and they were asked to submit their commissioning policy for analysis. The ‘qualifying criteria’ expressed in each policy were analysed by theme and geographical region. Results Of 108 surveys, 95 (88%) were completed and returned. Of these, 91 (96%) stated that varicose vein interventions were actively commissioned. Eighty-eight (97%) of primary care trusts that commissioned varicose vein interventions stated that access was restricted. Qualifying criteria varied considerably between regions. Conclusions Access to varicose vein intervention appears to be restricted, with national variation in commissioning across England. This might have an impact on patient care and surgical training. We propose that a national decision be made about which varicose vein patients should be offered funding for treatment on the National Health Service.
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Muijs, Daniel. "Quality in School Trusts: A Comparative Study in Four Countries." Education Sciences 14, no. 7 (July 10, 2024): 752. http://dx.doi.org/10.3390/educsci14070752.
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Recent decades have seen the emergence of new forms of governance in education. Market-oriented education policies have seen schools removed from local government oversight, and instead sees them run by independent school trusts. This begs the question of what effectiveness and quality in a trust framework mean. In this paper, we review the literature from four countries with relatively comparable trust structures: England, the Netherlands, Sweden, and the US, to look at the evidence base on trust quality, leadership, and effectiveness. We find that the evidence base itself is relatively limited in scope. It is strongest in relation to impact on the organisation, especially with regards to the importance of HR, relationships within the trust, and quality assurance mechanisms. There is evidence at the network level on the importance of knowledge and skills of governors, effective forms of collaboration, and a shared vision across the trust. Trusts can improve the quality of education through professional development of teachers, developing consistent approaches, and sharing knowledge. Evidence of how trusts can enhance their impact in the community is limited.
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Walsh, A., J. Olivier, and O. Old. "Emergency general surgery: a ‘state of the nation’ survey." Bulletin of the Royal College of Surgeons of England 106, no. 4 (June 2024): 228–33. http://dx.doi.org/10.1308/rcsbull.2024.75.
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INTRODUCTION Many projects seek to improve emergency general surgery (EGS) care across England. However, no study to date has examined how EGS is currently organised or how this is evolving. The aim of this study was to determine the current status of EGS organisation in England, whether this correlates with measures of hospital activity and changes proposed in the future. METHODS Surveys were sent to all NHS trusts in England via freedom of information requests. Trusts were given eight weeks to reply. Trust characteristics were ascertained by asking their organisational structure as well as acute bed numbers, number of admissions under general surgery, number of cases submitted to the National Emergency Laparotomy Audit in 2021 and whether they planned to start an EGS service within the next five years. Organisational structures were categorised as: a) mixed general surgical take; b) daily allocation to a subspecialty; c) dedicated EGS consultants/service covering weekdays; d) dedicated EGS consultants/service covering weekdays and weekends; or e) other. RESULTS A total of 101 organisations responded. There were 36 organisations in group A, 16 in group B, 10 in group C, 30 in group D and 5 in group E. Four organisations declined to supply information on organisational structure. No trust characteristic was significantly different between organisational structures. Two-fifths (41%) of the organisations reported having an EGS service in place (groups C and D). Almost a quarter (23%) of those without an EGS service reported plans to implement one within the next five years. CONCLUSIONS Our results indicate a growing trend towards implementing EGS services in England, with over 50% of trusts expected to offer such a service in five years’ time. It is important to pursue a collaborative definition of best practice for EGS to ensure high quality care for patients.
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Blackwell, Anna K. M., Daina Kosīte, Theresa M. Marteau, and Marcus R. Munafò. "Policies for Tobacco and E-Cigarette Use: A Survey of All Higher Education Institutions and NHS Trusts in England." Nicotine & Tobacco Research 22, no. 7 (October 5, 2019): 1235–38. http://dx.doi.org/10.1093/ntr/ntz192.
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Abstract Introduction There is an absence of evidence regarding the impact of treating tobacco smoking and vaping equivalently in workplace policies. We aimed to describe and compare smoking and vaping policies in acute nonspecialist NHS Trusts (n = 131) and Higher Education Institutions (HEIs) (n = 131) in England. Methods We conducted a census of smoking and vaping policies through organizational websites searches and direct requests for information. We recorded whether and where smoking and vaping were permitted. Results Smoking was prohibited indoors in all organizations. No NHS Trust permitted smoking freely outdoors, in contrast with 60% of HEIs. In 27% of NHS Trusts and 33% of HEIs smoking was permitted in designated areas, while in 73% of NHS Trusts and 8% of HEIs smoking was prohibited anywhere on site. Vaping was prohibited indoors in all NHS Trusts and all but one HEI, but permitted freely outdoors in 18% of NHS Trusts and 75% of HEIs. Vaping was permitted in designated outdoor spaces in 23% of NHS Trusts: 21% had areas shared with smokers; 2% had separate vaping areas. Vaping was permitted in designated outdoor areas in 18% of HEIs, all of which were shared with smokers. Vaping was prohibited anywhere on site in 54% of NHS Trusts and 6% of HEIs. Conclusions Policies vary considerably in whether vaping and smoking are treated equivalently. Smoking policies in most HEIs should be reviewed to include more effective tobacco control approaches. Evidence is needed on the impact of imposing shared or separate spaces on vapers and smokers. Implications This report provides a comprehensive review of smoking and vaping policies in two types of organization across England. It highlights key discrepancies between current public health recommendations for vaping and existing workplace policies, which often lead to smokers and vapers sharing spaces. The report identifies the need for evidence on the impact of imposing shared spaces on smokers and vapers to inform workplace policies that maximize public health benefit.
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Simpson, Joanna C., Hannah Sutton, and Michael PW Grocott. "Cardiopulmonary Exercise Testing — A Survey of Current Use in England." Journal of the Intensive Care Society 10, no. 4 (October 2009): 275–78. http://dx.doi.org/10.1177/175114370901000412.
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Cardiopulmonary exercise testing (CPET) is an objective method of evaluating integrated cardiopulmonary function. Increasingly, it is being used for perioperative risk assessment. This survey was performed between October and December 2008 to identify where and how CPET is being used for perioperative risk assessment in England. Direct telephone contact was made with the Department of Anaesthesia in 154/173 (89%) of NHS Trusts in England in order to ascertain the availability of a CPET service. One hundred and fifteen (66%) Trusts confirmed whether or not they have a CPET service −30 (17%) Trusts have a CPET service and 12 (7%) are in the process of setting one up. These Trusts were sent a nine-question survey, which was completed by 15 Trusts. Criteria for selecting patients for CPET testing included type of surgery, age and co-morbidities. All trusts use anaerobic threshold (AT) values to identify patients at risk of adverse outcome, though many also used additional variables including peak oxygen consumption, ventilatory equivalents for carbon dioxide, ventilatory equivalents for oxygen, oxygen pulse, oxygen consumption/power slope and breathing reserve. Different numerical threshold values were used in different centres. Patients identified as high risk were managed in a variety of ways, including referral for specialist advice, modifying or cancelling surgery, modified perioperative care and augmented postoperative care (in a level 2 or 3 environment). This survey clearly highlights significant inconsistency in the use of CPET for perioperative risk assessment and suggests that some standardisation of practice may be of value.
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Warren, Leigh R., Jonathan Clarke, Sonal Arora, and Ara Darzi. "Improving data sharing between acute hospitals in England: an overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care." BMJ Open 9, no. 12 (December 2019): e031637. http://dx.doi.org/10.1136/bmjopen-2019-031637.
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ObjectivesTo determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability.DesignRetrospective observational study using Hospital Episode Statistics.SettingAcute hospital trusts in the NHS in England.ParticipantsAll adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018.Primary and secondary outcome measuresFrequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems.Results21 286 873 patients were involved in 121 351 837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11 017 767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15 736 863 (73.9%) patients had two or more encounters with the included trusts and 3 931 255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system.ConclusionsEach year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
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Wake, Mark, and William Green. "Relationship between employee engagement scores and service quality ratings: analysis of the National Health Service staff survey across 97 acute NHS Trusts in England and concurrent Care Quality Commission outcomes (2012–2016)." BMJ Open 9, no. 7 (July 2019): e026472. http://dx.doi.org/10.1136/bmjopen-2018-026472.
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ObjectiveThis research explores measures of employee engagement in the National Health Service (NHS) acute Trusts in England and examines the association between organisation-level engagement scores and quality ratings by the Care Quality Commission (CQC).DesignCross-sectional.Setting97 acute NHS Trusts in England.Participants97 NHS acute Trusts in England (2012–2016). Data include provider details, staff survey results and CQC reports. Hybrid Trusts or organisations affected by recent mergers are excluded.Outcome measuresAnalysis uses organisation-level employee engagement and CQC quality ratings.ResultsEmployee engagement is affected by organisational factors, including patient bed numbers (β=−0.46, p<0.05) and financial revenue (β=0.38, p<0.05). CQC ratings are predicted by overall employee engagement score (β=0.57, p<0.001) and financial deficit (β=−0.19, p<0.05). The most influential employee engagement dimension on provider ratings is ‘advocacy’ (λ=0.54, p<0.001). Analysis supports the notion that employee engagement can be predicted from advocacy scores alone (eigenvalue=4.03). Better still, combining advocacy scores from the previous year’s survey or adding in motivation scores is a highly reliable indication of overall employee engagement (95.4% of total variance).ConclusionsNHS acute Trusts with high employee engagement scores tend to have better CQC ratings. Trusts with a high financial deficit tend to have lower ratings. Employee engagement subdimensions have different associations with CQC ratings, the most influential dimension being advocacy score. A two subdimension model of engagement efficiently predicts overall employee engagement in NHS acute Trusts in England. Healthcare leaders should pay close attention to the proportion of employees who would recommend their organisation as a place to work or receive treatment, because this is a proxy for the level of engagement, and it predicts CQC ratings.
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Fargas-Malet, Montserrat, and Dominic McSherry. "Regional variations in care planning in Northern Ireland: Proposing an ecological model of decision-making." Qualitative Social Work 19, no. 2 (November 5, 2018): 229–45. http://dx.doi.org/10.1177/1473325018811474.
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Care planning for children who enter care can be influenced by a range of factors. In Northern Ireland, there are differences in the proportions of children in different types of placements across the five Health and Social Care Trusts (equivalent to local authorities in England and Wales). The aim of the study was to identify the reasons for these differences. In order to do that, focus groups in each of the Trusts were conducted with social work professionals involved in care planning. Based on the study findings, an ecological model of decision-making in care planning is postulated. Differences among all of the Trusts were found within the model’s three levels, despite all of the Trusts operating under the same broad policy framework for care planning. For instance, different mindsets were evident, as participants in some of the Trusts clearly equated the notion that children should be provided with a permanent home with adoption, while in focus groups in other Trusts, this mindset did not prevail. In addition, the Trust structures and initiatives differed slightly and there were differences in the global context factors influencing decision-making. Based on these findings, we believe regional practical guidance and policies should be developed collectively by the five Trusts, so as to avoid the possibility of children facing a postcode lottery regarding the placements offered to them.
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Gillespie, Sharon, Fiona Cowell, Candy McCabe, and Andreas Goebel. "Complex regional pain syndrome acute care pathways in England: Do they exist and what do they look like?" Hand Therapy 23, no. 3 (March 14, 2018): 95–99. http://dx.doi.org/10.1177/1758998318764182.
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Introduction Complex Regional Pain Syndrome is a condition with a high degree of morbidity and health costs to the National Health Service (NHS), characterised by persistent pain, sensory, motor, trophic and autonomic signs and symptoms. The British Orthopaedic Association (BOA) and the Royal College of Physicians (RCP) have recommended treatment guidelines and care pathways for the management of acute Complex Regional Pain Syndrome. The objective of this scoping exercise was to use Freedom of Information (FOI) requests to ascertain whether NHS Trusts in England had such pathways and what they looked like. Methods FOI requests were sent to 126 English NHS Trusts on 9 March 2017 on behalf of the Complex Regional Pain Syndrome Clinical and Research Network UK, asking: “What does your acute Complex Regional Pain Care Syndrome pathway look like?” Results Replies were received by 95 NHS Trusts and of these 84 had relevant services but (82%) had no pathway or agreed initial management. Conclusions It appears to be common for no acute care pathway to exist for CRPS in NHS Trusts in England despite it being a domain in BOA national guidelines. The Royal College of Physicians guidelines also recommend integrated MDT care. Consequentially, BOA and Royal College of Physicians standards in acute CRPS management are not yet being followed in most acute NHS Trusts in England providing trauma care. Where there is a pathway agreed, it is rarely integrated and truly multidisciplinary.
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Veale, David. "Choice of provider for out-patient treatment is not working." BJPsych Bulletin 42, no. 2 (March 16, 2018): 82–85. http://dx.doi.org/10.1192/bjb.2017.25.
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SummaryIn 2012, the coalition government introduced the legal right for National Health Service (NHS) patients in England to choose their mental healthcare provider for out-patient treatment. This was a significant step towards parity of care between mental and physical ill health, and NHS Improvement and NHS England have provided sensible guidance on its implementation. However, several factors prevent the system from working as it was intended: lack of awareness of the principle of patient choice for out-patient treatment; complacency from some trusts and commissioners; mental health trusts operating outside the e-referrals system; misuse of care pathways; lack of direct access by many general practitioners for out-of-area referrals; and delays in authorisation for funding. I describe how I have come to this conclusion and suggest some solutions.Declaration of interestThe author is employed by a trust that potentially benefits from ‘patient choice’.
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Allen, Thomas, Kieran Walshe, Nathan Proudlove, and Matt Sutton. "Do performance indicators predict regulator ratings of healthcare providers? Cross-sectional study of acute hospitals in England." International Journal for Quality in Health Care 32, no. 2 (November 14, 2019): 113–19. http://dx.doi.org/10.1093/intqhc/mzz101.
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Abstract Objective To determine whether a large set of care performance indicators (‘Intelligent Monitoring (IM)’) can be used to predict the Care Quality Commission’s (CQC) acute hospital trust provider ratings. Design The IM dataset and first-inspection ratings were used to build linear and ordered logistic regression models for the whole dataset (all trusts). This was repeated for subsets of the trusts, with these models then applied to predict the inspection ratings of the remaining trusts. Setting The United Kingdom Department of Health and Social Care’s Care Quality Commission is the regulator for all health and social care services in England. We consider their first-inspection cycle of acute hospital trusts (2013–2016). Participants All 156 English NHS acute hospital trusts. Intervention(s) None. Main Outcome Measure(s) Percentage of correct predictions and weighted kappa. Results Only 24% of the predicted overall ratings for the test sample were correct and the weighted kappa of 0.01 indicates very poor agreement between predicted and actual ratings. This lack of predictive power is also found for each of the rating domains. Conclusion While hospital inspections draw on a much wider set of information, the poor power of performance indicators to predict subsequent inspection ratings may call into question the validity of indicators, ratings or both. We conclude that a number of changes to the way performance indicators are collected and used could improve their predictive value, and suggest that assessing predictive power should be undertaken prospectively when the sets of indicators are being designed and selected by regulators.