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Welfare Reform on the Web (April 2000): National Health Service - Reform - General

ABROAD MINDED

J. Buchan

Health Service Journal, vol. 110, Jan. 6th 2000, p.20-21

Overseas nurses make up 3% of the UK nursing workforce, but in inner London they make up 30%. Overseas nurses account for a quarter of new registrations with the UKCC. Overseas recruitment is liable to remain a feature of the NHS for the foreseeable future. Trusts should pay attention to recruitment costs and ensure that overseas recruits are given induction training which includes practical aspects of living in the UK, such as finding accommodation.

BLAIR ORDERS SHAKE-UP OF FAILING NHS

D. Brindle

Guardian, Jan. 6th 2000, p.1

Reports government plans to improve access to medical care by having all out-of-hours calls dealt with by NHS Direct, where nurses will decide whether a home visit is necessary. Government will also press ahead with opening more walk-in centres and developing more schemes where demarcations between health professionals are broken down.

THE BRITISH QUASI-MARKET IN HEALTH CASE: A BALANCE SHEET OF THE EVIDENCE

N. Mays, J.A. Mulligam and N. Goodwin

Journal of Health Services Research & Policy, vol. 5, no. 1, 2000, p.49-58

Paper sets out to assess the effects of 3 main elements of the quasi-market reforms of the NHS through a review of published studies:

  • General practices becoming fundholders
  • Health authorities becoming purchasers of emergency, unplanned and elective services
  • Conversion of providers of hospital and community health services into NHS trusts.

It concludes that little measurable change can be related unequivocally to the core mechanisms of the internal market.

CLINICAL EFFECTIVENESS. PART 5, EVALUATING CLINICAL CHANGE

C. Adams

Community Practitioner, vol. 73, 2000, p.435-436

Examines the methodologies required to determine quality of practice.

CLINICAL GOVERNANCE: AN ACUTE TRUST'S APPROACH

I. Haslock

British Journal of Health Cure Management, vol. 6, 2000, p.21-23

South Tees Acute Hospital Trust began its preparation for clinical governance with an analysis of its present operations to establish whether it has the right culture and organisational structures in place.

CLINICAL GOVERNANCE IN PRACTICE: A VIEW FROM THE SHOP FLOOR

J. Edwards

Journal of Clinical Excellence, vol. 1, 1999, p.163-166

Paper addresses the practical implementation of clinical governance. Proposes that quality initiatives should be spearheaded by the clinical directorate. Within each directorate special interest groups should be developed which would include lead clinicians, speciality managers, junior doctors and patient representatives. Similarly, special interest groups could be developed within primary care groups to facilitate quality programmes and improve the interface between primary and secondary care.

CLOSED TO ARGUMENT

M. Gould

Health Service Journal, vol. 110, Jan. 13th 2000, p.11-13

Gives an overview of proposed and on-going hospital trust mergers.

THE DEALS ON THE BUS GO ROUND AND ROUND

B. Duguid

Health Service Journal, vol. 110, Jan. 20th 2000, p.28-29

Fifteen trusts co-operated in an imaginative attempt to encourage former NHS nurses to return to work. A return-to-nursing roadshow based in a double-decker bus was successful when it toured the West country last summer. Nurses considering returning to work seemed to find the roadshow a relaxed way to discuss the options. The hospitals participating in the campaign have filled all 60 places on their return to practice courses.

DELAY, DENIAL AND DILUTION: THE IMPACT OF NHS RATIONING ON HEART DISEASE AND CANCER

D.G. Green and L. Casper

London: IEA Health and Welfare Unit, 2000 (Choice in welfare; no. 55)

A comparison of death rates from diseases of the circulatory system put the UK thirteenth out of 15 European countries studied. A 17-nation study found that the one-year survival rate for lung cancer in England was the worst of the 17. The five-year survival rate ranked twelfth out of 17. For breast cancer England's one-year survival rate ranked tenth out of 17. The five-year survival rate was eleventh. The primary cause of these failures is treatment rationing due to low expenditure but to raise expenditure to the levels of other developed countries, on the present NHS model, would require unacceptable increases in taxation. In order to improve health care in the UK it may be necessary to look at alternative sources of funding.

DESIGNING HEALTH SERVICE ORGANIZATION IN THE UK 1968 TO 1998: FROM BLUEPRINT TO BRIGHT IDEA AND MANIPULATED EMERGENCE

S. Harrison and B. Wood

Public Administration, vol. 77, 1999, p.751-768

Article shows that from 1968 to 1998 government policy making related to NHS organization progressively changed away from the production of a blueprint of what to be implemented and towards the promulgation of a 'bright idea' which local actors were given incentives to develop in accordance with government philosophy. Authors term this partial dissolution of the policy/action distinction 'manipulated emergency'. Argue that the approach adopted by the 1997 Labour government is largely, though not wholly, consistent with this, and it remains to be seen whether the high water mark of 'manipulated emergence' has passed.

EXPERTS WARN OF COLLAPSE AS CLINICAL GOVERNANCE STALLS

T. Agnew

Health Service Journal, vol. 110, Jan. 27th 2000, p.4

Lack of guidance and leadership from the Department of Health, coupled with inadequate funding, has stalled clinical governance and could lead to its collapse.

GETTING THE HUMP WITH HIMPS

A. Underdown and C. Sexty

Health Service Journal, vol. 110, Jan. 27th 2000, p.22-24

A survey of health improvement programmes found that only 16% identified children's needs as a priority. Only a quarter of HImPs had strategies for addressing teenage pregnancy. The results suggest patchy provision, and a failure to address issues strategically. Government guidance is needed to ensure that children and young people are made a priority in future HImPs.

GOOD MEDICAL PRACTICE FOR GENERAL PRACTITIONERS: DRAFT DOCUMENT FOR CONSULTATION

Royal College of General Practitioners

London: 1999

Proposes criteria against which a GP's fitness to practice could be assessed. These include accurate record keeping; keeping up to date with new developments; providing good information about services available; maintenance of good relationships with patients; avoidance of discrimination and prejudice; and appropriate referral.

HEALTH CARE UK 1999/2000

J. Appleby and A. Harrison (editors)

London: King's Fund, 1999

Comprehensive review of health care and policy issues covering the future of primary care organisations NHS networks, self-regulation of health care professionals, the health care rationing debate, the Modernisation Fund, and reducing variations and raising standards.

THE HEALTH SERVICE IS SICK FROM THE NECK UP

M. Marrin

Daily Telegraph, Jan. 21st 2000, p.28

Argues that lack of personal accountability in the NHS has fostered a culture of staff indifference, rudeness, slovenliness, lack of respect for individuals and lack of compassion.

IMPROVING LIVES: PROPOSALS FOR CHANGE

Long-Term Medical Conditions Alliance

London: 1999

Publishes nine recommendations to improve the quality of the life for people with long term medical conditions. These include improved access to specialist services, the development of nurse prescribing, extension of prescription season tickets to spread the cost of medication, inclusion of long term conditions in a ministerial portfolio, and more involvement of patient and user groups.

IN A TERMINAL STATE

W. Rees-Mogg

Times, Jan. 17th 2000, p.16

Argues that the NHS cannot continue as an underfunded state monopoly, and calls for the expansion of independent not-for-profit private medical institutions and private-public partnership to increase capacity.

IN SICKNESS AND IN PERPERTUITY?

J. Studd

Daily Telegraph, Jan. 13th 2000, p.24

Argues that chronic staff shortages in the NHS are putting intolerable pressures on doctors who are made scapegoats when disaster strikes. Calls for more use of the private sector to support health needs and to fund an increase in the numbers of doctors.

JUST THE TICKET

P. Meredith, C. Ham and R. Kipping

Health Service Journal, vol. 110, Jan. 13th 2000, p.22-24

Pilot schemes for direct booking of hospital appointments have won support of the consultants involved and have improved services for patients. Skilled leadership has been crucial to managing changes that enable direct booking to be put into practice. The nursing role is central to the system, particularly in pre-operative assessment clinics. For direct booking to become widespread, management of all acute hospital resources will have to be reviewed.

LONG-TERM CONTRACTS IN THE NHS: A SOLUTION IN SEARCH OF A PROBLEM?

D. Dawson and M. Goddard

Health Economics, vol. 8, 1999, p.709-720

Purchasers and providers in the NHS are now required to move from annual contracting cycles to longer-term contracts. The benefits are expected to include more efficient investment and improved sharing of financial risks. Evidence collected from the analysis of the contracts of a sample of health authorities and interviews with individuals involved in the contracting process shows that, given the property rights and financial structure of the public sector, the move from short- to long-term contracts is unlikely to produce the improvements in performance expected by the government.

NEW PUBLIC MANAGEMENT: AN ASSESSMENT AND EVALUATION WITH SPECIAL REFERENCE TO UK HEALTH

S. Dawson and C. Dargie

Public Management, vol. I, 1999, p.459-481

Defines new public management in three ways: as a movement, as an academic commentary and as reformed organisational practice in the public sector. Developments in UK health care are used as a case study to explore some of the assumed relationships between ideology (private sector practices and markets can increase efficiency in the public sector), actions (introduction of market mechanisms and business-like practices) and consequences (operational performance, strategic direction, governance and values). New public management at the end of the 1980s is much diversified and expanded from original conceptions but its survival in the UK as a movement, as an academic commentary and as a reformed organisational practice seems assured despite the change of government in 1997.

NHS BEDS LYING EMPTY IN SHORTAGE OF NURSES

C. Brown

Independent, Jan. 20th 2000, p.2

Reports results of an enquiry which shows serious shortages of intensive-care and high dependency beds, leading to longer waiting lists and delayed operations. There are also numerous instances of beds lying empty because of lack of nurses to staff them.

NO NICE AND CHI: REDUCING VARIATIONS AND RAISING STANDARDS

A. Coulter

Health Care UK, 1999/2000, p.119-128

In distinguishing its approach from the previous government's attempts to promote diversity and competition as the drivers for quality improvement, the present government has laid greater stress on centrally controlled mechanisms for raising standards. The two newly established national institutions, NICE and CHI, can be seen as the embodiment of the shift towards a centralised approach to standard setting and quality improvement. Time will tell whether these organisations can command sufficient respect from the various stakeholders to successfully lead the drive to improve standards of clinical care and restore public confidence in the NHS.

A NURSING PERSPECTIVE ON CLINICAL GOVERNANCE: POLICY, PRINCIPLES AND PRIORITIES

G. Harvey

Journal of Clinical Excellence, vol. 1, 1999, p.167-174

Feedback from discussion groups organised by the Royal College of Nursing in 1998 showed participants to be positive about the concept of clinical governance. Clinical government offers a framework for continuous quality improvement in nursing care. To achieve clinical government, systems of clinical audit, evidence-based practice, continuing professional development, risk management, and clinical supervision need to be put in place. The culture needs to support patient involvement, sharing of best practice, multi-professional collaboration and a blame-free approach to dealing with mistakes.

PHYSICIAN HEAL THYSELF - OR ELSE

S. Baseley

Guardian, Jan. 6th 2000, p.17

Reports on rivalry between the medical establishment and the Department of Health over who will have control of planned mechanisms for appraising doctors' performance.

POTENTIATING EVIDENCE-BASED PRACTICE THROUGH THE COLLABORATION UTILITY OF CLINICAL EFFECTIVENESS AND CLINICAL SUPERVISION

Journal of Clinical Excellence, vol. 1, 1999, p.175-178

Authors were seconded to a local NHS trust for 1 year to equip practitioners with the concepts and skills necessary to move towards evidence- based practice. The aim was to equip practitioners with the concepts and skills necessary to access and utilise evidence appropriately, whilst enabling them to explore the processes of decision-making and formation of professional judgements which influence their professional practice. The study tested the hypothesis that a combination of clinical effectiveness and clinical supervision would create a gestalt for practitioners. Results show that a gestalt occurred, and therefore a more integrated approach to the development of evidence-based practice is recommended.

PUBLIC INVOLVEMENT IN HEALTH CARE PRIORITY SETTING: AN ECONOMIC PERSPECTIVE

T. Roberts et al

Health Expectations, vol. 2, 1999, p.235-244

Study used an interview based survey of 91 members of the public to explore whether the traditional QALY maximization is a good predictor of public responses to health care rationing decisions. Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for programmes that provided a prognostic improvement but left patients in a relatively poor states of health.

RATIONING ACCESS TO ELECTIVE CARE: THE WAY FORWARD

A. Harrison and B. New

Health Care UK 1999/2000, p.129-138

Proposes that certain illnesses should be made national priorities and treated within a timescale. This would apply to life-threatening diseases such as cancer. On the other hand, people requiring elective surgery, such as hernias and hip replacements, would be placed on the waiting list for operations only when their pain became acute.

REVALIDATION FOR CLINICAL GENERAL PRACTICE: DRAFT DOCUMENT FOR CONSULTATION

Royal College of General Practitioners

London: 1999

Proposes a process for the periodic appraisal of performance of general practitioners. GPs would submit evidence of their fitness to practice for assessment by a local revalidation group which would pass on recommendations to the General Medical Council.

THE SICKNESS LIES IN THE NHS ITSELF

J. Daley

Daily Telegraph, Jan. 11th 2000, p.18

The recent flu outbreak has put the NHS under severe pressure, evident in the shortage of intensive care beds and cancelling of operations. This inability of the NHS to cope with urgent cases at the same time as non-urgent ones is a result of the government's failure to get to grips with the questions of how the health service should be planned and funded.

(See also Independent, Jan. 11th 2000, p.4 and Times, Jan. 11th 2000, p.18)

STATISTICAL ANALYSIS OF THE UKCC'S PROFESSIONAL REGISTER 1 APRIL 1998 TO 31 MARCH 1999

United Kingdom Central Council for Nursing, Midwifery and Health Visiting

London

Despite recent recruitment drives, figures show that the numbers of Nursing, Midwives and health visitors are still falling, that the professions are ageing, and that there is an increasing dependency on overseas nurses.

TAKE THREE WOMEN .

L. Purves

Times, Jan. 18th 2000, p.18

Argues that the NHS should prioritise treatment of life-threatening illness and those which jeopardise independence. Cosmetic surgery, IVF and impotence treatments which are designed to raise life to some theoretical happiness, rather than saving it or making it bearable, should not be a priority at all. Funding should also be boosted by charging patients for services.

THE VERY ROUGH GUIDE

P. Butler

Health Service Journal, vol. 110, Jan. 13th 2000, p.14-19

Summarises the draft NHS planning and priorities guidance for 2000-02. Priority areas are:

  • health improvement by the development of local anti-smoking, drugs and teenage pregnancy action plans;
  • implementation of national standards for cancer services and development of local heart diseases and stroke prevention policies;
  • joint working by HAs and local authorities to improve care for older people, mental health service users and vulnerable children;
  • improvement of access through initiatives such as NHS Direct, review of accident and emergency services, etc;
  • service modernisation through implementation of NICE guidance, a new national pay scale, staff recruitment etc.

WATCHING THE DETECTIVES

J. Mottram and S. Pickens

Health Service Journal, vol. 110, Jan. 27th 2000, p.26-27

An audit of a Trust's audit department first established eight years ago, showed that most managers and clinicians viewed it positively. However, it was not seen as capable, on its own, of producing changes in practice. Some departments were unsure about the services offered by the audit department. A standard form for audit reports is now to be adopted in the Trust. The evaluation will be repeated in a year's time.

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