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Welfare Reform on the Web - March 1999

NATIONAL HEALTH SERVICE - REFORM - GENERAL

[BMA Conference]

I. Murray
Times, 7th July 1998, p. 6

Reports condemnation by doctors' leaders of politically expedient promises to cut waiting times for cancer treatment. With funding limited, cancer patients should not be treated ahead of those with other serious conditions. Overall, the NHS needed a cash injection of £6 billion at once to repair crumbling equipment and buildings, followed by a real terms increase year on year over the next five years. More consultants were desperately needed to cut waiting lists, and lack of a government wide strategy on public health was perpetuating social injustice.

(See also Guardian, 7 July 1998, p. 8; Independent, 7 July 1998, p. 10; Daily Telegraph, 7 July 1998, p. 10).

COMPETITION AND PLANNING IN THE NHS

2nd ed.

C. Paton
Cheltenham: Thornes, 1998

Evaluates the Conservative governments' reforms of the NHS by considering their political origin, content and consequences. Analyses the key elements including the internal market, the purchaser/provider split, contracting and new approaches to the financing of services. Explores the tensions between markets and planning, and the politics and incentives involved in contracting and commissioning of services.

DESPERATELY SEEKING SOLUTIONS : RATIONING HEALTH CARE

D. Hunter
Harlow: Longman, 1998

Challenges assumption that all health services are inherently subject to rationing as demand invariably outstrips supply, and examines this within a comparative framework. Critically evaluates the extent to which rationing has always existed within the NHS. Until the introduction of managerialism and the internal market, rationing operated on an implicit rather than an explicit basis and was bound up with clinical judgements rather than purely financial considerations. The author questions whether explicit rationing is desirable or feasible.

DOBSON GETS TOUGH ON QUALITY OF HEALTH CARE

D. Brindle
Guardian, 2nd July 1998, p.2

Announces setting up a National Institute for Clinical Excellence which will provide guidance on new treatments and drugs, introduce national service frameworks and lay down what treatments and care should be given for particular conditions. A Commission for Health Improvement will be established to monitor performance and recommend remedial action where necessary. Health managers believe the plans contain inherent tension between regulation and clinical freedom.

(See also Independent, 2nd July 1998, p. 6; Daily Telegraph, 2nd July 1998, p. 16; Times, 1st July 1998; Financial times, 1st July 1998)

A FIRST CLASS SERVICE : QUALITY IN THE NEW NHS

Department of Health
Wetherby: Department of Health Publications, 1998

Main elements are clear, national standards for services and treatments through national service frameworks and a National Institute for Clinical Excellence; local delivery of high quality health care through clinical governance underpinned by modernised professional self-regulation and lifelong learning; monitoring progress through a Commission for Health Improvement; a framework for assessing performance and a national survey of patient and service user experience.

(For comment see Health Service Journal vol. 108, No. 5612, 9th July 1998, p. 8-9, 18-19).

IN THE PUBLIC INTEREST : DEVELOPING A STRATEGY FOR PUBLIC PARTICIPATION IN THE NHS

NHS Executive, Institute of Health Services Management and NHS Confederation
Wetherby: Department of Health Publications, 1998

Report endorses criticism of Community Health Councils' (CHCs) lack of democratic legitimacy, and acknowledges that the quality of their work is variable, with a lack of clarity about their role. Calls for a revitalisation of CHCs, linked to proposed reform of local government. CHCs could reform their membership, becoming more professional scrutineers, auditing policies to assess their impact on health and inspecting health facilities. Their remit could be extended to include primary care. Alongside this, scrutiny of the NHS by elected representatives could be achieved by other means, such as locally elected panels.

INTERNATIONAL HEALTH CARE

Financial Times, 2nd July 1998, p. 13-15

Gives an overview of the planned NHS reforms (introduction of Primary Care Groups, implementation of clinical governance, benchmarking of hospital costs, establishment of a National Institute of Clinical Excellence to produce guidelines for effective treatment, and of a Commission for Health Improvement to act as NHS Inspectorate). Then briefly surveys the state of managed care in the US, and the debate about internal markets in health care in New Zealand, Sweden and the Netherlands.

LEADING LIGHTS

L. Whitfield
Health Service Journal, vol. 108, no. 5611, 2 July 1998, p. 19

Reports on a conference on the future of Health Authorities. Concerns raised included tight timetable for implementation of the NHS reforms and inevitable tensions between Health Authorities and Primary Care Groups. Doubts were expressed about the practicality of primary care commissioning and the need to reassess relationships with the trusts and local authorities was emphasised.

NICE WORK IF YOU CAN FUND IT

P. Healy
Health Service Journal, vol. 108, no. 5613, 16 July 1998, p. 12-13

Details of the government's drive for quality in the NHS are emerging, but managers are concerned at the lack of new funds for the initiatives. Existing resources are to be switched around to pay for them. There is also concern that health authorities and trusts may not be able to afford to introduce treatments approved by the new National Institute for Clinical Excellence (NICE). The troubleshooting Commission for Health Improvement (CHI) will check on the implementation of standards, working closely with the Audit Commission and other bodies with a role in the quality field. The agenda is huge and complex, and there is a risk that the drive for quality may be lost among other competing demands.

OTHER VOICES FROM 50 YEARS OF THE NHS 1948-98

P. Butler and J. Dépont
London: Unison, 1998

Book is a series of snapshots of the experiences of 21 Unison members working in the NHS, and of their hopes and fears for its future. It offers personal glimpses of NHS changes as seen by staff such as a cleaner, a chef, a psychiatric nurse and a payroll administrator.

POINT OF DELIVERY

J. Neuberger
Volunteering, no. 38, May 1998, p. 12-14

Argues that extending the role of volunteers is critical to the future of the NHS. Volunteers could be involved in support of the dying, in spiritual care, in childcare support of families of sick children and as befrienders of the frail elderly.

PROVISION OF ACUTE GENERAL HOSPITAL SERVICES : HOW BIG SHOULD A GENERAL HOSPITAL BE?

British Medical Association, Royal College of Physicians and Royal College of Surgeons
London: Royal College of Surgeons, 1998

Report recommends the formation of a network of large elite hospitals each serving about 500,000 people to provide quality healthcare for the future. Small casualty units would close and district hospitals would be downgraded to provide only day care surgery and beds for rehabilitation.

A QUACK CURE THAT WILL DO NO-ONE ANY GOOD

J. A. Lee
Financial Times, 25th June 1998, p. 15

Argues that plans to publish league tables measuring doctors' performance in the wake of the baby deaths at Bristol Royal Infirmary are the flawed product of a mediocre public debate.

RATIONAL ARGUMENT

A. Ferriman and S. Ward
Public Finance, June 5-11 1998, p. 12-16

Presents the arguments for and against rationing of treatment within the NHS. Against rationing, it is urged that if the NHS eliminated ineffective treatments, doctors would never have to deny anyone an effective treatment. For rationing, it is urgued that, because resources are not infinite, some people will always be denied some treatments, and that doctors, managers and the public have to learn how to choose between more effective and less effective treatments.

VOTERS FEAR AN UNHEALTHY DECLINE

A. King
Daily Telegraph, 3rd July 1998, p. 10

Reports results of a Gallup survey showing that while use of and satisfaction with the NHS remain high, few voters think it has improved since Labour came to power and a majority do not look forward to any significant improvement in future. Fifty-nine per cent of respondents agree that the NHS needs more money.

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