Search results

A distinction must be drawn between a dismissal on the one hand, and on the other a repudiation of a contract of employment as a result of a breach of a fundamental term of that contract. When such a repudiation has been accepted by the innocent party then a termination of employment takes place. Such termination does not constitute dismissal (see London v. James Laidlaw & Sons Ltd (1974) IRLR 136 and Gannon v. J. C. Firth (1976) IRLR 415 EAT).

One of the key initiatives of the National Institute of Mental Health in England National Workforce Programme (NIMHE NWP) has been to explore the development and sustainability of the non‐professionally qualified workforce (NPQW). Both the National Service Framework (NSF) for Mental Health (Department of Health, 1999) and the wider Department of Health Changing Workforce Programme (Department of Health, 2001) provided a unique opportunity to start this process off.

This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of “upstreamist”, health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.

Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of “upstreamist” system leadership to advance the integration of health care.

Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with “upstreamist” system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.

At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.

This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps.

To the best of the authors’ knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop “Esther” patient-centred approaches in the design of integrated health and care services.

The Equal Pay Act 1970 (which came into operation on 29 December 1975) provides for an “equality clause” to be written into all contracts of employment. S.1(2) (a) of the 1970 Act (which has been amended by the Sex Discrimination Act 1975) provides:

The various authorities concerned with food safety and the arrangements for detection and withdrawal of food which is hazardous to health are discussed. Suspect food can be removed from sale and from catering establishments rapidly thanks to the warning system organised by the Department of Health.

This annotated listing of 125 United States Government bibliographies is the first annual supplement to BIBLIOGRAPHY OF UNITED STATES GOVERNMENT BIBLIOGRAPHIES 1968–1973 (Pierian Press). Most publications included bear a 1974 imprint, though there are some with earlier imprints which are not included in the 1968–1973 BIBLIOGRAPHY.

Knight's Industrial Law Reports goes into a new style and format as Managerial Law This issue of KILR is restyled Managerial Law and it now appears on a continuous updating basis rather than as a monthly routine affair.

The European Union‐supported Child and Adolescent Mental Health in an Enlarged Europe (CAMHEE) project aimed to provide an overview of the challenges, current practice and guidelines for developing effective mental health promotion and mental illness prevention policy and practice across Europe. As part of this work, an analysis was undertaken of the situation in England, making use of a bespoke data collection instrument and protocol.Our analysis suggests that there has been significant effort and investment in research, needs assessment, policy, human resource and service developments in CAMHS over the last 20 years, leading to a more detailed understanding and availability of services. Much of the emphasis has been on assessment and management of difficulties, however in recent years attention has begun to focus on mental health promotion. National standards and programmes such as Every Child Matters (Department for Education and Skills, 2004) have acted as catalysts for a number of national initiatives.

New Horizons (Department of Health, 2009a) is the government's cross‐departmental strategy building on the perceived successes of the National Service Framework for Mental Health (Department of Health, 1999) and addressing those areas where there are still service shortfalls. It aims to improve both the mental health and well‐being of the population, and the quality and accessibility of services for people with poor mental health. The strategy will face a number of challenges, not least the tight resource restrictions across public services expected in the next few years. However if New Horizons continues to receive political backing, it does offer a framework to underpin a radical programme of change.