Yes / Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. According to the Commercial Medicines Unit (Department of Health, 2013), NHS hospitals in England currently spend around £3.6 billion annually on pharmaceuticals, having risen from £2.2. billion in 2005. The NHS continuously strives to promote excellence in what it does and justify how it does it. In undertaking this preliminary analysis 45 pharmacy staff members contributed to an online survey. The results presented a broad mix of views on how smart technology (e.g. iPhone, iPad) could be used and if it should be used at all in this setting. The outcome of this small scale study demonstrates the lack of knowledge as to if and how such technologies could be used in hospital pharmacy and therefore present grounds for testing out the broader application of smart technology via academic and practitioner consultations.

Yes / The National Health Service (NHS) Five Year Forward View in 2014 issued a grave warning that if healthcare demand in the UK continued to grow as its current rate, and efficiency or funding changes were not instigated there could be a mismatch between the service (in terms of resource provision) and patients of up to £30 billion a year by 2020/21. The report asserted that in order to “sustain a comprehensive high-quality NHS; action will be needed on all three fronts – demand, efficiency and funding” (2014:5). Based on this escalating issue, and with a focus on the expanded and value-added role of Community Pharmacists, this study chooses to focus on this service operation in light of the pressures as highlighted above by examining what Sustainability means and how it is applied in Community Pharmacy as a service provider in the NHS (UK).

No / NHS maternity services in England must increase productivity if the NHS is to make efficiency savings by 2014. At the same time, it is expected to maintain or improve patient outcomes such as safety and quality. Given staff costs are 60% of the budget; it is likely that either the number or composition of the workforce will need to be changed to meet these targets. In this article, the authors argue that very little is known about the impact of altering the skill mix on either productivity or patient outcomes. Furthermore, it is unclear whether output and outcomes are themselves trade-offs between increased workload, increased number of deliveries and the increased complexity of demand.

No / Postnatal care is an area for serious concern, with readmission of women and infants following discharge having increased significantly over the past decade. A reduction in average postnatal stays together with care delivered by many members of a fragmented multidisciplinary team disallowing full timely assessments of health needs, are reasons cited for this. There is a disjuncture between process, policy and health outcomes in maternity and neonatal outcomes. While there is evidence indicating what needs to be done to reduce mortality and morbidity and improve outcomes, more is required in relation to how this is done; central to this is innovation. Currently, the NHS does not have sufficient useful data on the extent to which frontline workers are delivering needed interventions, or their short and long-term impacts. Unscheduled maternity and neonatal admissions are supposedly a key indicator of the quality of maternity care. An understanding of why these incidents occur could generate significant cost reductions at a time of severe austerity and enhance the quality of care and safety for women and their infants.

No / The recently commissioned review of international healthcare systems by the Centre for Workforce Intelligence has a profound significance for healthcare management and the delivery of nursing and medicine within the UK (Cookson, 2012). This review will analyse and compare contrasting international healthcare systems of different providers across the UK—identifying the key factors affecting the delivery of healthcare. This commission must be viewed in relation to the ‘Nicholson Challenge’ (Hawkes, 2012), which requires savings of £21 billion to fund increased demand over the next four years. These efficiency savings are required to be found through better ways of working within current NHS law and regulation (Department of Health (DoH), 2010a; DoH, 2010b; Hawkes, 2012). The main agenda will be staff substitution —substitution of a higher graded practitioner by a lower graded practitioner. However, the greater opportunity is for healthcare assistants (HCAs) to become more professionally empowered.

No / The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.

No / Clinical and corporate governance have been an area of ongoing concerns in the NHS. Since the Bristol Royal Infirmary scandal of the 1990s and the events concerning Sir Jimmy Savile there has been a dilemma of its true nature and relationship. Clinical and corporate governance are closely related as the two of them share similar processes such as openness, performance review, striving for effective end results, and accountability in the use of resources and power within healthcare management.

No / The National Health Service (NHS) has historically undertaken initiatives to promote equality in employment as well programmes to develop and promote Black and Minority Ethnic (BME) staff. However, discrimination remains a feature of NHS employment practices and may help to explain the lack of BME staff at senior levels in the service. Despite having many initiatives BME staff are underrepresented in NHS senior management and at the top of each organisation, the management is almost always white. This paper will present findings from a case study on the experiences of corrective action by BME staff in senior/middle management positions. The paper will outline key messages and good practice to inform policy and practice.

Yes / In October 2014, Simon Stevens, the chief executive of NHS England, committed the service to plugging £22 billion of the expected £30 billion gap in its finances by 2020 through productivity gains of 2–3% a year by 2020. Since that announcement, the Government promised to provide £8 billion by 2020. This may notionally have been received, but it has not alleviated the severity of these financial constraints (Barnes and Dunhill, 2015). With austerity measures biting even deeper into the budgets of NHS organisations, all staff are under pressure to make cost efficiencies and at the same time improve operational standards and patient outcomes. In this pressured change environment, there are hospitals and departments that have embraced the demand for change, creating innovative skills mix platforms from which to deliver services. But there are also those who have remained entrenched in operational protocols. In both scenarios, the overarching driver for service re-design has been operational efficiency guided by government targets.

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing 'outcome' data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of 'feminine carer' offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders' stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a 'space' for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the 'other', offenders were able to re-author a more 'moral' and 'worthy' self. Moreover, the ATR has been found to be successful in enabling the offenders' hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.