An NHS foundation trust is a semi-autonomous organisational unit within the National Health Service in England . They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local strategic health authority ). As of March 2019 there were 151 foundation trusts.
106-545: Wirral University Teaching Hospital NHS Foundation Trust ( WUTH ) is an NHS Foundation Trust . It provides healthcare for people of the Wirral Peninsula and the surrounding areas of North West England and North Wales . The trust is responsible for Arrowe Park Hospital , Clatterbridge Hospital , and Wirral Women and Children's Hospital . It also provides some services at St Catherine's Health Centre, Tranmere and Victoria Central Health Centre, Wallasey . The Trust
212-605: A British colony in 1928, Kenya started training a select group of natives to practice medicine and care for the local population who were increasingly accepting and seeking western medicine. After independence from Britain in 1963, medical training in Kenya initially adopted the four-year medical school system used in the US rather than the six-year UK model. This was heavily influenced by the Kennedy Airlift which followed initial funding by
318-411: A hospitalist and one who has specialized in a clinical field provides advanced medical and surgical care and treatment such as administering anesthesia, performing general or specialised surgery, supervising other health workers and other administrative duties. A clinical officer's scope of practice depends on one's training and experience, jurisdiction and workplace policies. In Malawi, for instance,
424-703: A trainer . Clinical Officer (CO) is a protected professional title and its use by unregistered persons is prohibited by law and punishable by up to five years in jail with or without a fine. Globally, the title may not have legal restrictions and can refer to a job grade rather than a medical qualification such as junior assistive clinical staff (e.g. in Zambia and Tanzania ), licensed medical professionals (e.g. in Kenya and Malawi ) or high-level corporate officers, directors , and managers (e.g. Chief Clinical Officers in Europe and
530-502: A Foundation Trust status in 2007, the trust was known as Wirral Hospital NHS Trust. The Wirral Women and Children's Hospital was founded in 2011 following redevelopment of the maternity annexe on the Arrowe Park campus. In March 2012, the UK health sector regulator, Monitor , found the trust was "persistently failing" the 18-week waiting time target. It also had concerns about the way the board
636-402: A cap on the proportion of their income that can come from non-NHS treatments. It did not only apply to income derived from individual patients, it covered income from all non-NHS sources. This could include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas. The Health and Social Care Act 2012 abolished
742-429: A clinical officer (6) have a medical practice licence (7) complete a three-year period of clinical supervision under a senior clinical officer or a senior medical officer (8) have a practising certificate if they have a private practice which allows one to provide general medical services on their own directly to the public (9) undergo one or two additional years of specialized training (optional) and (10) become
848-541: A clinical officer is the officer in-charge of a health center or a district hospital and is part of the medical team in bigger hospitals where one may head a department or work under a senior clinical officer or a physician. Clinical officers are direct healthcare providers who manage and administer health institutions, medical schemes and projects in primary healthcare (PHC) settings and are frontline stakeholders in Universal Health Coverage in Kenya which
954-534: A clinical officer one requires at least four years of full-time medical training, supervised clinical practice and internship at an accredited medical training institution and hospitals and registration with the relevant medical board in their country. After a prescribed number of years in active practice, one may complete a further one or two-year residency programme in order to specialize in any approved branch of clinical medicine and surgery such as anesthesia or pediatrics , or get an advanced medical qualification from
1060-448: A clinical officer performs all routine surgical and obstetric operations such as exploratory laparatomy, emergency orthopaedics and Caesarean section . However, in Kenya, Tanzania and Mozambique one has to undergo further specialized training in order to perform such major operations safely. In rural and small urban health facilities a clinical officer is usually the highest medical care provider and works with minimal resources, relying on
1166-466: A comprehensive nine trimester programme of full-time study, practicals and examinations which are covered over three years leading to a fourth mandatory year of internship in a teaching hospital. A fifth and sixth residency specialisation years are undertaken after registration by the Clinical Officers Council and three years of work experience in general medicine which leads to the award of
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#17328631616041272-491: A compulsory one-year hospital internship programme and completion of a further three-year period of clinical supervision .. Required for registration and licensing by the Clinical Officers Council and membership of the Kenya Clinical Officers Association . Required for private practice or specialization Required for registration and licensing by the Clinical Officers Council and membership of
1378-476: A demotivated and low quality workforce and resulting poor health indicators. The United States' Centers for Disease Control and Prevention and other international health and research institutions make extensive use of COs in their projects in Africa and clinical officers have been the backbone of HIV care and treatment enabling the rollout of ARVS to even the most rural hard to reach areas in Africa. Research done by
1484-458: A general degree in clinical medicine or a specialist diploma in pediatrics , orthopedics , psychiatry , anaesthesia , reproductive health and other specialties. A clinical officer is therefore able to graduate and join the workforce in a minimum of four calendar years and provides medical services within the full scope of family and emergency medicine or within a narrower scope depending on their area of specialisation. Registration by
1590-482: A licence to practice medicine, a situation that has resulted to major strikes by clinical officers in the past leading to operation standstills in public hospitals when these strikes occur. On passing the final qualifying examination, they take the hippocratic oath then apply for provisional registration by the Clinical Officers Council, the statutory body that regulates the practice of clinical officers in
1696-580: A licence to practice under his own name as a private medical practitioner. The BSc. Clinical Medicine and Surgery degree was later introduced in 2006. Clinical officers play a central role in Kenya's medical sector today. There were 8,600 clinical officers on the register in 2010 compared to 7,100 medical officers. They are trained by the universities, the Kenya Medical Training College (KMTC), St. Mary's School of Clinical Medicine and other private institutions. The Ministry of Health, through
1802-487: A link between the community and the board of directors. The size of the council of governors and its exact composition are determined by the constitution of the particular trust. Each trust adopts its own constitution subject to certain restrictions in legislation. These restrictions include that a majority of the council of governors must be elected governors and governors must be unpaid volunteers. Some trusts are more committed to co-operative principles and have even written
1908-491: A medical doctor. However, due to the shorter training period when compared to medical officers (i.e. 4 years instead of 6 years), a clinical officer joins the public service at a lower grade and gains seniority through experience, additional training or further education. Like the term medical officer , the term clinical officer is a protected title whose use without the authority of the Clinical Officers Council
2014-651: A national WHO -recommended database at the Ministry of Health which receives and tracks health workload, performance and disease surveillance data from all public and private health facilities in the 47 counties . Clinical officers also run private practices using a license issued to them by the Kenya Medical Practitioners and Dentists Council . Career options for clinical officers include general practice , specialty practice , health administration , community health and postgraduate training and research in
2120-497: A new investigation into the trust's financial performance. That investigation was concluded in 2014, with the report from March of that year noting that "the trust is working hard to address our concerns about its finances and these improvements are already happening". In December 2013, the Care Quality Commission published a report into satisfaction of maternity services across England. Wirral Women and Children's Hospital
2226-819: A new organisation – the NHS Trust Development Authority – was established by the Health and Social Care Act 2012 to supervise trusts which have not reached foundation status, of which there were 99 in April 2013, 47 of which were never expected to reach foundation status. The Health and Social Care Bill 2011 , overseen by Lansley, proposed that all NHS trusts become foundation trusts or part of an existing foundation trust by April 2014. The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to
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#17328631616042332-787: A senior clinical, administrative or teaching position within their organisation or establishes and manages his/her own private practice. One who holds the Diploma in Clinical Medicine and Surgery can upgrade his/her qualification to the BSc. Clinical Medicine and Surgery or undertake postgraduate training at the university. One may also enroll for the Higher Diploma programme at the Kenya Medical Training College. The Higher Diploma in Clinical Medicine and Surgery requires at least three years of working experience and lasts twelve to eighteen months leading to
2438-488: A separate board (in the eastern countries such as Kenya and Uganda ). The broad nature of medical training prepares one to work at all levels of the health care system . Most work in primary care health centres and clinics, and casualty departments in hospitals where one will diagnose and treat all common diseases, including serious and life-threatening ones, in all age groups; and stabilise then admit, discharge or refer emergency cases. In smaller hospitals one may work as
2544-570: A shared services solution". By the end of 2013–14, foundation trusts collectively had built up cash reserves of £4.3 billion and it was suggested in the NHS Five Year Forward View that the government would "support" foundation trusts to spend this money "to help local service transformation". In response, the chief executive of the Foundation Trust Network, Chris Hopson, said: "The responsibility for these surpluses lies with
2650-582: A similar level by becoming Assistant Medical Officers (AMOs) or Medical Licentiates (MLs)."medical assistants/Sub Assistant Community Medical Officer" in Bangladesh , a Four Year medical diploma course conducting state medical faculty of Bangladesh under ministry of Health and family welfare. A clinician can specialize in any other field that is deemed appropriate by them and not just clinical medicine. China also has masters of clinical medicine. In countries like Tanzania, UK, and other countries, clinical medicine
2756-455: A supervising clinician. There is special emphasis on primary care with modules on community health taught throughout the course. Before starting their internship after the third year, clinical officers spend at least one month in a Provincial Rural Health Training Centre where they immunize children, examine pregnant women and offer family planning services in mother and child health clinics. They also treat in-patients and out-patients under
2862-767: A variety of tests, which have changed over time. In 2003 only trusts with three stars from the Commission for Health Improvement were eligible for foundation status. In that year Aintree Hospitals, Essex Rivers Healthcare, Newcastle upon Tyne Hospitals and Walsall Hospitals were all downgraded to two stars and so did not make the first wave of foundation trusts. Formerly referred to as foundation trust equivalent (FTe) instead of Equivalent Foundation Trusts , this designation applies only to trusts providing high secure psychiatric services, of which there are three: Nottinghamshire Healthcare NHS Trust , West London Mental Health NHS Trust and Mersey Care NHS Trust . These trusts abide by
2968-432: Is a staff constituency, a patient constituency, and a "public member" constituency, consisting of members who are neither patients nor staff but live in a defined geographical area. In addition, there are governors appointed by bodies with whom the trust works in partnership. So, for example, appointments may be made by local councils, local medical schools, and local voluntary organisations. Governors are intended to act as
3074-535: Is any public officer who is entitled to be registered as a medical practitioner if he applied under any law in the country: Section 14(1) of the Medical Practitioners and Dentists Act and Section 7(4) of the Clinical Officers Act are the only two laws that can authorize one to practice medicine and render medical or dental services in the public sector if they hold a registration certificate or in
3180-411: Is available online on the Clinical Officers Council and Ministry of Health websites. The Clinical Officers (Training, Registration and Licensing) Act No.20 of 2017 is the law that governs the medical practice of a clinical Officer. It establishes the Clinical Officers Council whose functions are to: Although training programmes existed as early as 1928, the first university to train clinical officers
3286-476: Is completed in nine 15-week trimesters over three calendar years (or 135 weeks which, notably, exceeds the minimum 130 weeks of instruction required to complete US MD programs). The BSc. Clinical Medicine and Surgery is completed over 4 years. Students study the biomedical and clinical sciences such as anatomy , physiology and pathology in the first year followed by the clinical subjects ( medicine , surgery , pediatrics , obstetrics and gynecology ) in
Wirral University Teaching Hospital NHS Foundation Trust - Misplaced Pages Continue
3392-569: Is described in Schedule 7 of the National Health Service Act 2006 , with the formal corporate form being called a "public benefit corporation". Each foundation trust has a council of governors. This is made up of elected governors and appointed governors. Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public. The elections are usually held in separate constituencies. Typically there
3498-547: Is eligible for registration as a medical practitioner under Section 11(1) of the Medical Practitioners and Dentists Act in addition to being expressly authorized to practice medicine, surgery or dentistry by Section 7(4) of the Clinical Officers Act Criminal Appeal 198 of 2008 - Kenya Law Criminal Case 6 of 2004 - Kenya Law CAP. 249 From the Anatomy Act , the legal definition of a medical officer
3604-445: Is one of the key pillars of the government's 5-year development plan under President Uhuru Kenyatta . The four pillars of the 5-year development plan are 1. Manufacturing 2. Affordable housing 3. Universal Health Coverage and 4. Food security . In Kenya's public health system, a clinical officer is an alternative practitioner who is trained and authorized by law to perform any technical, administrative or legal duties that require
3710-400: Is prohibited and a punishable offense under Kenyan laws. Court rulings uphold that a registration certificate or a licence issued by the council automatically confers the status of a medical officer or a qualified medical practitioner to a clinician and the titles are used interchangeably in medico-legal documents because a qualified clinical officer has a recognized medical qualification and
3816-453: Is regarded as a medical course and graduates are allowed to apply to masters of medicine specialties. No significant difference has been demonstrated in studies comparing treatment decisions, patient outcomes, quality of care provided and level of knowledge about diseases between a clinical officer and a medical officer (a non-specialist physician) except in countries where nurses were mistakenly assessed as clinical officers. However, because of
3922-647: Is required for registration. After registration one is required to apply for a licence from the COC which allows them to practice medicine, surgery and dentistry legally in the country. This licence is renewable every two years. Renewal requires evidence of having attained 60 Continuous Professional Development (CPD) points in the CPD diary by further training, research and publications, attending conferences and Continuing Medical Education (CME) sessions or major ward rounds and outreach activities. An experienced clinical officer usually holds
4028-549: Is unprepared to make any efforts at reforming its own practices. Closures, sackings and loss of patient services has been its traditional negative stance. The CCG therefore has the near impossible task of winning reform in the face of these negotiating tactics." As a result of this complaint, NHS England launched a Capability and Governance review of the Wirral Clinical Commissioning Group. Published in August 2014;
4134-562: Is usually the lowest entry-level cadre in the medical hierarchy but with years of experience and/or further training one can rise to the same or a higher grade than a physician. In most countries, however, wages are usually low compared to training and responsibilities and career progression is usually restricted by awarding terminal degrees and diplomas, training students who have not attained the minimum university entry grade and, in some countries, not awarding any degree or recognition for advanced training. In such countries, this usually results in
4240-530: The African-American Students Foundation (AASF) in 1959 and led to hundreds of young Kenyan students getting scholarships to study in American institutions: These students came back to Kenya after their studies and joined the civil service in the early post-independence Kenya . It was also around this time that the first DOs were accepted as medical officers by the US civil service and by 1967
4346-531: The Clinical Officers Council (COC) regulates their training and practice, accredits training institutions, and approves the syllabi of the universities and colleges. The Kenya Medical Training College (KMTC), also under the Ministry of Health, has campuses in regional teaching hospitals and trains the majority of clinical officers. St. Mary's School of Clinical Medicine and St. Mary's Mission Hospital in Mumias , owned by
Wirral University Teaching Hospital NHS Foundation Trust - Misplaced Pages Continue
4452-403: The Clinical Officers Council in 1989 which had jurisdiction over clinical officers. Instead of residency for the clinical officer, the higher diploma in paediatrics, ophthalmology and other specializations was introduced in the late 1970s as a post-basic course for those who had worked for three or more years and, after ten years of service, one became a Senior Clinical Officer and qualified for
4558-696: The Clinical Officers Council in 1989. In 1990 the Kenya Medical Training College was established by the government with campuses in all major towns and in 1996 the Roman Catholic Diocese of Kakamega established St. Mary's School of Clinical Medicine at St. Mary's Hospital in Mumias which become the second and third institutions to offer the training in Kenya. By this time clinical officers had to complete an accredited four-year programme of study, practicals and internship in clinical medicine and surgery and have their names entered in
4664-473: The Clinical Officers Council (COC) entitles one to render medical services in any public or private medical institution or to practice medicine independently as a private practitioner. Registration also qualifies one to join and participate in the affairs of the Kenya Clinical Officers Association (KCOA) , including its annual KCOA Scientific Conference , and the Kenya Union of Clinical Officers (KUCO) . As per
4770-412: The Commission for University Education Act No. 42 of 2012 removed the accreditation role from all regulatory bodies such as the Clinical Officers Council (COC) and the Kenya Medical Practitioners and Dentists Council (KMPDC) making the Commission for University Education (CUE) the only authorized accrediting body for all university degrees in Kenya including the degree in clinical medicine. In 2017
4876-843: The Hospital Universitario Fundación Alcorcón in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the Spanish National Health System , but its operational management is contracted out to a private company, and exempt from many of the rules normally imposed on state-owned hospitals, and in particular, that hospital was allowed to negotiate its own contracts with workers. The governance of that hospital includes local government, trade unions, health workers and community groups. Foundation trusts were announced by Health Secretary Alan Milburn in 2002, and
4982-503: The Kenya Clinical Officers Association Required for private practice or specialization The training expanded after Kenya's independence in 1962 through to 1970 when the newly created University of Nairobi started its own medical school and also used Kenyatta National Hospital as its teaching hospital . Legislation to regulate medical practice by clinical officers was passed in 1988 thus creating
5088-611: The Kenya Clinical Officers Association and the Kenya Union of Clinical Officers . In June 2020 the Public Service Commission approved the Revised Scheme of Service for Clinical Personnel which was issued by the State Department for Public Service to define the clinical officer's career structure, job description, standards for recruitment, training and advancement, and career planning and succession management within
5194-664: The Rochdale Principles into their constitution; they aspire to work closely and in partnership with other mutual and local organisations. At first, foundation trusts were authorised and regulated by Monitor , a non-executive body under the Department of Health. Monitor was merged into NHS Improvement in 2016. The trade body for foundation trusts is NHS Providers , formerly known as the Foundation Trust Network, which has 95% of all acute, ambulance, community and mental health foundation trusts in its membership. A 2014 report by
5300-541: The Socialist Health Association said that on the whole after 10 years, "Foundation Trusts [had]... not deepened in terms of democratic practice and participation". The independence of Foundation Trust governors was challenged in 2021 when the governors of Queen Victoria Hospital , a small specialist trust, called for a pause to plans for it to merge with University Hospitals Sussex NHS Foundation Trust . NHS Improvement were said to have effectively ordered
5406-1378: The United States ). A clinical officer observes, interviews and examines sick and healthy individuals in all specialties to determine and document their health status and applies relevant pathological , radiological , psychiatric and community health techniques, procedures and findings needed to classify diseases and related health problems and to establish a provisional or final diagnosis upon which to prescribe, initiate, carry out or terminate treatment or therapy based on their specialized knowledge, skills and experience in clinical pharmacology , use of clinical guidelines , best practices and disease patterns as well as individual patient and community characteristics while being actively pharmacovigilant to prevent, identify, minimize and manage drug reactions , drug errors, side effects and poisoning , overdiagnosis , overscreening , overtreatment and futile care . A clinical officer performs general and specialized medical duties such as diagnosis and treatment of disease and injury, ordering and interpreting medical tests, performing routine medical and surgical procedures, referring patients to other practitioners and managing health departments, institutions, projects and systems. Clinical officers, medical officers and medical practitioners are
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#17328631616045512-517: The University of Birmingham and published in the British Medical Journal concluded that the effectiveness and safety of caeserian sections carried out by clinical officers did not differ significantly compared with doctors. Better health outcomes including lower maternal mortality rates were observed where COs had completed further specialised training particularly in anaesthesia. In
5618-627: The civil service . The scheme is administered by the Ministry of Health through the Cabinet Secretary and the Principal Secretary in conjunction with the Public Service Commission and the County Chief Officer for Health in each of the 47 Counties of Kenya . Clinical officer is a professional designation established by the government through the Clinical Officers Council (COC) which has jurisdiction and responsibility for
5724-589: The government or the private sector . Many clinical officers in the private sector are government contractors and subcontractors who provide primary care and hospital services to the public in their own private clinics or in public hospitals through contracts with the national government, county governments or other government entities such as the National Health Insurance Fund (NHIF). Kenya has approximately 25,000 registered clinical officers for its 55 million people. In her books, "Beyond
5830-551: The Department of Health definition of a foundation trust, but the Secretary of State for Health maintains a direct line of communication and accountability with them because he or she has the responsibility to provide healthcare to patients who have been detained under the Mental Health Act , and have been judged to pose a grave and immediate danger to the public. Unlike full foundation trusts, governors have no statutory role, and
5936-410: The Department of Health was promoting "A new type of NHS hospital". In 2011, the 116 trusts then in the pipeline to make applications were required to sign a formal agreement, with a deadline for the application to be made. Board members at a number of trusts which missed the deadline were sacked. It was accepted by Andrew Lansley that a number of trusts would never reach foundation trust status, and
6042-479: The Department of Health, was established to process loans for capital developments, but during 2014 applications were made by trusts which had trouble paying utility bills or replacing medical equipment. Guidance issued under the tenure of Jeremy Hunt in October 2014 said that conditions could be set which could include: reductions in the use of temporary staff, "use of collaborative procurement routes" or "the adoption of
6148-458: The FTs; any attempt by the statutory bodies to make a grab for them will be furiously resisted". By 2016, the distinction between foundation trusts and other NHS trusts was widely regarded as eroded, and in that year the two regulators were combined into a new body, NHS Improvement . The notion that every trust should become a foundation trust was abandoned, and the widespread financial crisis undermined
6254-489: The Foundation Trust Network it was raised to 1.5%. These caps disappeared on 1 October 2012. Collective earnings from private patients increased 14%, from £346.1 million in 2012–13 to £395.9 million for 2014–15. Private earning is concentrated on specialist hospitals in London who see many patients from other countries. Most trusts have negligible private income. In order to achieve foundation trust status, NHS trusts have to pass
6360-573: The NHS to reconsider "whether the model of foundation trusts is sensible", arguing "If one-third of the hospital system is permanently not demonstrating good viability and good governance, is that telling you something about actually how the system should run as opposed to how we thought it should run?". In January 2022 Sajid Javid , writing in The Times said he was planning a “revolution” that would allow “well-run hospitals more freedom”. Foundation trusts had
6466-702: The National Assembly as follows: The dual diploma in clinical medicine and surgery plus an internship year is the standard qualification for clinical officers which is awarded on completion of a four-year training programme which started as various programmes that were used to train medical practitioners in the East Africa Protectorate in the 1920s and which now resembles the North American four-year MD and DO medical school programmes (including being structured in 9 trimesters over 3 years to meet
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#17328631616046572-512: The Roman Catholic diocese of Kakamega , was the first private institution to train clinical officers. It admits students who got the minimum university entry grade in high school and have passed a written examination and oral interview. The students sit the same examination as their counterparts at the KMTC and are examined by consultants from the public service. On 28 October 1981 lawmakers addressed
6678-744: The State: The Colonial Medical Service in British Africa" and "Indian Doctors in Kenya, 1895 - 1940: The Forgotten History", the author Anna Greenwood notes that before 1923 there were twice as many Indian doctors as there were European doctors working in the Colonial Medical Service . The Indian doctors had migrated to British Africa along with the coolies who came to work on the Uganda Railway . The Indian doctors faced discrimination and were not appointed to nor paid at
6784-546: The Trust consistently achieving the standard for referring patients for treatment within 18 weeks. Monitor also recognised the "important improvements" made by the Board of Directors in the way the Trust is run and engages with clinical staff. As a result of this Monitor concluded in February 2013 that the Trust was longer in breach of its terms of authorisation. In November 2013, Monitor opened
6890-434: The basic training for clinical officers starts after high school and takes four or five years ending on successful completion of a one-year internship in a teaching hospital and registration at the Clinical Officers Council where annual practice licenses are issued. This is followed by a three-year clinical apprenticeship under a senior clinical officer or a senior medical officer which must be completed and documented in
6996-454: The board of directors have no statutory duty towards the governors. The governors cannot, without the board of directors' permission, have any control over the direction of the trust, and cannot appoint or remove trust auditors. The chair and directors are not appointed by their board of governors. Chief Clinical Officer A clinical officer ( CO ) is a gazetted officer who is qualified and licensed to practice medicine . In Kenya
7102-594: The clinical officer can be traced back to around 1888 when Sir William Mackinnon, 1st Baronet founded the Imperial British East Africa Company . The company was granted royal charter by Queen Victoria and was used by the Government of the United Kingdom to establish its influence in the East Africa Protectorate (present day Kenya ). As the influence grew a healthcare system developed to meet
7208-572: The clinical officer is one way of attaining the Millennium Development Goals 4 (reducing child mortality) and 5 (improving maternal health). Worldwide, patients are seen by many other practitioners other than the traditional doctor such as: A clinical officer takes the Hippocratic oath and, depending on jurisdiction, may be registered by the same statutory board as physicians (in the southern countries such as Zambia and Malawi ) or
7314-400: The clinical officer's training , registration and licensing and each officer must (1) study clinical medicine and surgery or clinical medicine and community health for three or four years (2) graduate from a government-accredited medical training college (3) sit and pass a government licensing examination (4) complete an internship year at a teaching hospital (5) be registered as
7420-464: The clinical officers register which was cleaned annually and taken to the government printer to be published in the Kenya Gazette . Private practice by clinical officers who had left government service after working for a minimum of 10 years was now allowed. Professional degrees in clinical medicine and surgery were first offered by Egerton University and other universities as from 2006 and in 2012
7526-452: The colonial service as they were not deemed to be the proper face of the imperial services in Africa. The Indian Assistant and Sub-Assistant Surgeons were thus replaced with similarly qualified Africans who came to be known as clinical officers when the authorizing legislation was passed in 1988 abolishing the Assistant and Sub-Assistant Surgeon and similar positions. In Kenya , the origin of
7632-537: The council of governors to work towards a merger. A study undertaken in 2005 by the King's Fund of Homerton University Hospital NHS Foundation Trust found some governors disappointed and disillusioned. Another report in 2005, funded by the Nuffield Foundation , found that it was too easy to invite members to sit on sub-committees, where they quickly became bogged down in the minutiae of operational planning, whilst
7738-401: The country. The internship involves supervised rotations in the major clinical departments namely casualty , medicine , paediatrics , surgery , obstetrics and gynecology . They are supervised by consultants in the respective fields. The consultants ensure that they can practice clinical medicine safely before signing them off for registration. An internship booklet signed by the consultants
7844-658: The establishment of the first formal training programme for clinical officers at Kenyatta National Hospital in 1928. The programme initially admitted experienced nurses and took them through a one-year certificate course which prepared them for advanced practice. The nursing pathway was discontinued and new students had to study clinical medicine and surgery and sit and pass continuous assessment tests and final qualifying examinations for three years which covered basic medical sciences , medicine , surgery , paediatrics , obstetrics and gynecology , community health , rural health and health service management before admission into
7950-589: The form of employment, resignation and recommendation letters before approval of practising certificates and Master Facility List numbers for their own private practices or before promotion from the entry-level training grade for those who remain employed. A further two-year higher diploma training which is equivalent to a bachelor's degree in a medical specialty is undertaken by those who wish to leave general practice and specialize in one branch of medicine such as paediatrics , orthopaedics or psychiatry . Unique Master Facility List numbers are generated from
8056-480: The government's Revised Scheme of Service for Clinical Personnel (2014) a clinical officer works at any of 8 grades depending on ones seniority. As gazetted officers all registered clinical officers are legally authorized to prepare, sign, issue and keep safe custody of official state documents such as medical examination reports, sick notes , postmortem examination reports and death certificates and to appear in courts of law as expert witnesses. For this reason,
8162-540: The guidance of qualified Clinical officers and organise outreach services where they venture into remote rural villages, seeing patients and immunising children. During this time they complete a project in community diagnosis. They also learn Health Service Management which prepares them for their management and leadership roles in health centers and other institutions. All clinical officers must work as full-time interns for one year without pay or any form of motivation at an approved public or mission hospital before getting
8268-529: The legislative basis was the Health and Social Care (Community Health and Standards) Act 2003 . The first ten NHS hospitals to become foundation trusts were announced in 2004. Gordon Brown prevented plans by Alan Milburn that they should be financially autonomous in 2002. By 2012, the Monitor website listed 145 foundation trusts. Successive governments set target dates by which all NHS trusts were supposed to have reached foundation status. For example, by 2009
8374-679: The main A&;E seen within 4 hours. In May 2014 Frank Field MP alleged that close relationships between senior members of the Wirral Clinical Commissioning Group (CCG) and the Trust may have dented the "independence" and "integrity" of local health services. Writing to the Secretary of State that "Arrowe Park [ sic ] has a long history of not being able properly to manage its budget. It regularly looks around for further funds to which it demands almost immediate access but
8480-509: The main decisions were taken at meetings that they only heard about after they took place. The public's perception of foundation trust status implying a high standard of clinical care was changed by the Mid Staffordshire NHS Foundation Trust scandal of the late 2000s ( Stafford Hospital Scandal ) and the ensuing Francis inquiry , published in 2013. At the outset, some critics claimed that foundation trusts went against
8586-799: The medical needs of the colony . In 1901 Kenyatta National Hospital was established as the Native Civil Hospital and later renamed the King George VI Hospital after King George VI of the United Kingdom . In 1958 the European Hospital (present-day Nairobi Hospital ) was established in the same area to serve the European settlers . The need for qualified medical staff who would provide preventive , promotive , curative and rehabilitative services in hospitals and communities led to
8692-499: The medical practice of medical officers and clinical officers. The supreme health policy and medical authorities in the republic are the cabinet secretary of health and the director of medical services who oversee the registration and licensing of medical institutions and the training, registration and licensing of medical practitioners through the Medical Practitioners and Dentists Board and the Clinical Officers Council . As
8798-498: The minimum 130 weeks of instruction recommended by the Liaison Committee on Medical Education ) instead of the more recent six-year MBChB programme that was introduced in the 1970s and is more common in European and Commonwealth countries: Medical Officers training: Clinical Officers training: The current training follows international guidelines and the two qualifications are awarded jointly on successful completion of
8904-511: The misrepresentation of executives’ views to governors and a culture of staff not speaking up because they believed the trust chair Michael Carr was unwilling to act. A subsequent NHSI investigation was carried out which identified governance issues and a breakdown of communication between all elements of the Board. Palaniappan Saravanan, a consultant cardiologist was dismissed for gross misconduct in November 2017. In February 2018 Dr John Coakley, who
9010-464: The multi-country study, poor outcomes were observed in Burkina Faso and Zaire - the only countries where the procedure was performed by trained nurses. Higher rates of wound infection and Wound dehiscence in these countries was thought to be due to the nurses' poor surgical technique and need for enhanced training. ≠ Kenya has a comprehensive framework of parallel laws and regulations that govern
9116-480: The nature of practice, populations served and resources at ones disposal, a clinical officer is less likely to administer expensive treatment, prescribe expensive (but not necessarily better) drugs or engage in futile care . The success of HIV/AIDS prevention and treatment initiatives in Africa is mostly attributed to use of clinical officers to diagnose the disease and provide comprehensive medical care. Access to emergency obstetric care through greater deployment of
9222-739: The old legislation was repealed and the Clinical Officers Council reconstituted by the Clinical Officers (Training, Registration and Licensing) Act No. 20 of 2017 which requires each clinical officer, clinic or medical centre to be registered by the council and to maintain a current practice license and a current practising certificate in order to operate legally within the scope of medicine , dentistry , orthopedics or health work. A clinical officer may, with respect to patients - examine, diagnose, order laboratory and imaging investigations, prescribe treatment and perform procedures as per their scope of training. Clinical officers are members of
9328-621: The only officers who are gazetted and licensed to practice medicine in Kenya . They work under oath and generate credible health data and information within communities and health institutions and cascade the same to the county and national governments, government agencies and third parties through standard recording and reporting tools from the Ministry of Health which are used to capture data on disease outbreaks, physical injuries and deformities, mental illness, drug resistance, disability, nutritional disorders, births and deaths among others. To practice medicine and surgery or dentistry as
9434-533: The private patient income cap but FTs have to do the majority of their work for the NHS. This restriction was kept to reassure those concerned about future developments that FTs would continue to have NHS work as their central concern. Previously each FT had its own cap, set at the level of its private activity when the first FTs were established in 2003/4. About three-quarters of all FTs had a cap of 1.5% or less. Until 2010 all mental health trusts were completely barred from undertaking non-NHS work, but after lobbying from
9540-451: The private sector if they hold a current licence as well. The Public Health Act further defines a medical officer of health as a public officer who is responsible for health nationally (the Director of Medical Services and the Director clinical services) or regionally (the county or sub-county Medical Officer of Health and the county or sub-county Clinical Officer). Like his counterparts in
9646-412: The public sector and less autonomous than was originally expected. By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and three were ambulance trusts. They included acute trusts, mental health, community and ambulance trusts. By March 2019, the number of foundation trusts had shown a small increase to 151. The basic governance structure and form of foundation trusts
9752-522: The public service, a clinical officer in the private sector has the same practice rights and privileges as a medical officer and both are authorized to work independently and specialize in any approved branch of general or specialised medicine. The Competition Act No.12 of 2010 directly prohibits and addresses multi-sectoral abuse of dominance, consumer welfare, exemptions, cartels and unwarranted concentration of economic power among practitioners. A register of active clinical officers and medical institutions
9858-640: The review found evidence of a "poor relationship between the CCG and Wirral University Teaching Hospital Foundation Trust". As result, both the Chair of the CCG, and the CCG's Chief Clinical Officer resigned in December 2014; having already voluntarily stepped aside in the May of that year. In December 2017 David Allison, the chief executive, left with immediate effect after four executive directors had complained to NHS Improvement about
9964-576: The same rank as medical officers (European doctors). Instead, they were designated as Assistant or Sub- assistant surgeons despite having attended similar 3 - 4 year Indian medical schools that were recognized by the General Medical Council in the UK and performing clinical and administrative duties that were largely identical to those of the European doctors. From the mid-1920s the Indians were removed from
10070-422: The second year. The third and fourth year involves supervised clinical practice and internship in teaching hospitals where they rotate in all the departments, receive beside lectures, attend consultants' ward rounds, clerk patients and present medical histories, perform deliveries and first-assist in major surgery. They also attend clinical meetings and write prescriptions which at this stage must be counter-signed by
10176-607: The spirit of the principles laid out by Aneurin Bevan , the founder of the NHS. Others feared that it would lead to a two-tier system. Others doubted whether foundation trust members would succeed in having any effective influence over hospital management. In 2011, some argued in a report financed by the Nuffield Foundation that the success associated with foundation trusts had been due to other factors than governance. In June 2014, Bill Moyes, former Monitor executive chair, urged
10282-493: The structure and duration of medical training in Kenya was similar to the US MD training. When the University of Nairobi split from the University of East Africa and became the first university in Kenya in 1970, it continued to teach the six-year British degree which led to the creation of two statutory bodies: the Kenya Medical Practitioners and Dentists Board in 1978 which had jurisdiction over medical officers and physicians, and
10388-466: The supposed autonomy when almost all had to rely on money borrowed from the Department of Health, to which strings were attached. Foundation trusts have some managerial and financial freedom when compared to NHS trusts . The introduction of foundation trusts represented a change in the history of the National Health Service and the way in which hospital services are managed and provided. At
10494-542: The time of introduction, they were described "as a sort of halfway house between the public and private sectors". This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS with an internal market . The stated purpose is to devolve decision-making from a centralised NHS to local communities, in an effort to be more responsive to their needs and wishes. But after Gordon Brown prevented plans by Alan Milburn to make them financially autonomous they have been much more in
10600-478: The traditional medical history and physical examination , often with little or no laboratory facilities, to make a diagnosis and provide treatment. In bigger and better equipped facilities a clinical officer generally acquires superior knowledge, experience and skills and provides high quality and a wider range of services in district, provincial and national hospitals, universities and colleges, research institutions and private medical facilities. A clinical officer
10706-564: The university. There are no pathways (post-basic or post-graduate entry-level conversion programs) for nurses and other health workers hence it takes at least eight years of specialised medical training and experience for a clinical officer to graduate with a post-basic qualification. "Clinical officer" in some countries such as Tanzania and Zambia refers to a different cadre of health workers, comparable to "medical assistants" in Malawi , who have less than three years of training but who may upgrade to
10812-417: Was Egerton University in 1999. Programs also exist at Masinde Muliro University of Science and Technology (MMUST) , Uzima University , Jomo Kenyatta University of Agriculture and Technology , Kenya Methodist University (KEMU) Mt Kenya University . and Presbyterian university of East Africa (PUEA). , and Meru University of Science and Technology (MUST) . The diploma in Clinical Medicine and Surgery
10918-457: Was established by The Wirral Hospital National Health Service Trust (Establishment) Order 1990, coming into force on 21 December 1990. It received ownership of health assets from Wirral Health Authority, including sites at Arrowe Park and Clatterbridge, as a result of The Wirral Hospital National Health Service Trust (Transfer of Trust Property) Order 1992, coming into force on 5 June 1992. Prior to gaining teaching accreditation and authorisation as
11024-495: Was formerly medical director at Homerton University Hospital NHS Foundation Trust , resigned as a non-executive director, a position to which he was appointed in July 2017. It was reported that "There has been a total and complete breakdown of relationships and governance". In September 2016, the trust was selected by NHS England as one of twelve Global Digital Exemplars . NHS Foundation Trust Alan Milburn 's trip in 2001 to
11130-712: Was named in the Top 7 in England and the No 1 in North West England for patient care. In January 2014, the Care Quality Commission published a report into the standards of care at Arrowe Park Hospital. The report stated that the hospital had met all six measures for delivering 'standards you have a right to expect' in hospital care. In March 2018 it was the sixteenth worst performer in A&E in England, with only 63.2% of patients in
11236-543: Was run. Chief executive, Len Richards, had already left the trust in August 2011 following a vote of no confidence . His replacement, David Allison, joined the trust in April 2012. Since Mr Richards' departure, all of the previous Executive Board members have left. The last, Sue Green (director of human resources), was made redundant following a restructure of the senior management team. In February 2013, Monitor reported that "significant improvements" had been made in reducing waiting times for patients needing routine surgery with
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