Welfare Reform on the Web (November 2007): National Health Service - reform - general

Acute trust boards still failing in bug battle, watchdog claims

C. Santry

Health Service Journal, vol.117, Oct. 4th 2007, p. 5

Spot checks on 43 hospitals by the Healthcare Commission have revealed concerns that boards are not regularly discussing opportunities for improving infection control or ensuring that data are analysed effectively. In an interim report on hygiene code compliance, the Commission said that most boards needed to do more to outline their collective responsibility for minimising risk of infection or to incorporate the code fully into the trust's governance and performance frameworks.

Aspiring to excellence: findings and recommendations of the Independent Inquiry into Modernising Medical Careers

J. Tooke (Chair)

2007

This is the interim report of an independent inquiry into the failure of the Medical Training Application Service (MTAS) launched in 2007. MTAS was launched to match junior doctors to specialist training posts, but was scrapped after critics said it left thousands of excellent candidates without jobs. The report is deeply critical of the decision to devolve responsibility for workforce planning to strategic health authorities, but says that changing this after only 18 months would be too disruptive. Instead it recommends that regional workforce plans should be overseen and scrutinised by a national committee with service, professional and employer representatives. The report also says that:

1. the Department of Health should appoint a suitably qualified person at director level to lead medical education policy
2. the two training regulators, the General Medical Council and the Postgraduate Medical Education and Training Board, should be merged
3. there should be an end to the 'open door' policy for immigrant doctors
4. there should be a guaranteed postgraduate training place for all those at UK medical schools.

Behind closed doors: is Kent scandal a one-off?

A. Moore

Health Service Journal, vol.117, Oct. 25th 2007, p. 16-17

Patient deaths from Clostridium difficile at Maidstone and Tunbridge Wells hospital trust were the subject of a damning Healthcare Commission report. Problems with hygiene and cleanliness arose in old buildings which were not fit for purpose and from incompetence among some nursing staff. The trust board, under pressure from its strategic health authority, was focused on meeting government waiting time targets and achieving financial balance. It also claims to have been fed misleading information by the chief executive.

Cancer care

British Journal of Healthcare Management, vol. 13, 2007, p. 377-388

This special supplement looks at the future of cancer care in the NHS as the disease becomes a long term condition rather than a terminal one. It covers costs of new cancer drugs, increasing efficiency through competition between services, the impact of a new vaccine to protect against cancers caused by HPV, disease incidence, public perceptions of cancer, improvements in screening and drug treatments, and workforce development.

Commissioning: challenging providers

J. Woodin and J. MacDonald

British Journal of Healthcare Management, vol. 13, 2007, p. 371-376

Commissioning in the NHS is to be strengthened through the creation of a market environment in which commissioners will use the tools of competition, choice and payment by results to achieve results. This article considers the impact of stronger commissioning on healthcare service providers, focusing on:

• The move to legally binding contracts
• The need for accurate and timely information about activity
• Stricter adherence to clinical guidelines covering issues such as referral thresholds
• Greater focus on customer care as patients begin to exercise choice
• Relationships between commissioners and providers
• The role of the trust board, particularly in developing strategy

Foreign affairs

A. Moore

Health Service Journal, vol.117, Oct. 18th 2007, p. 26-28

Many in the NHS are unwilling to discuss the impact of the influx of migrant workers from Eastern Europe since 2004 on services, either for fear of accusations of racism or because they do not have accurate data. Uncertainty about numbers means that planning for demand on NHS services will be challenging, and funding allocations to primary care trusts may be inadequate in areas of rapid population growth. The arrival of a cohort of young people in an area will increase demand for sexual health, maternity and abortion services, and they are likely to have higher rates of communicable diseases such as tuberculosis. The NHS also needs to face up to the challenge of overcoming language barriers.

How can we stop the rush to quit with a golden handshake?

N. Edwards

Health Service Journal, vol.117, Oct. 25th 2007, p. 18-19

Some talented new chief executives have been appointed to take charge of failing trusts as their first job, have experienced serious difficulties, and been summarily removed, suffering severe reputational damage in the process. In other cases, incompetent chief executives receive lavish compensation payments when they move on. Neither of these scenarios is acceptable, and the NHS needs to take more care of its managerial talent.

Intelligent design is origin of good services

N. Edwards and W. Dunlop

Health Service Journal, vol. 117, Oct. 4th 2007, p. 22-23

The NHS Confederation and the Joint Medical Consultative Council interviewed a sample of doctors about their vision for practising in a reformed health service. Doctors said that they wanted to work in a well coordinated system based on reliable data and not in a set of disorganised services. They wanted to see the barrier between primary and secondary care broken down, and a system that provided an early diagnosis and treatment plan. They also felt the need to be valued by their organisations, the NHS hierarchy and the Department of Health.

Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS trust

Healthcare Commission

2007

This report of an investigation into Clostridium difficile outbreaks at Maidstone and Tunbridge Wells trust in which 90 patients died over two and a half years details a catalogue of failings:

• There was no recognition in the trust or the local health community of its relatively high rate of infection over several years.
• Trust policy in responding to outbreaks was 'not fit for purpose'. Some infected patients were nursed on open wards and other patients then caught C. difficile.
• It took four months to set up an isolation ward for patients with C. difficile, partly because of pressure on beds and a drive to meet targets.
• Patients and families complained about a low standard of care and the lack of dignity
• Wards, bathrooms and commodes were filthy and equipment was contaminated. Shared equipment was not cleaned between patients
• The then director of infection prevention and control had no real understanding of his role at the outset and in the 2005 outbreak failed in his duty to ensure that adequate surveillance systems were in place
• The trust's board was dominated by issues of finance, meeting government targets and reconfiguration, and paid insufficient attention to its responsibility for protecting patients against infection.

Johnson signals end of NHS reforms

A. Barker and N. Timmins

Financial Times, Sept. 26th, 2007, p.2

At the Labour Party conference, Health Secretary Alan Johnson promised an end to 'permanent revolution' in the health service. Although government sources stressed that structural changes will still be made when clinical need demands them, Johnson's statement has been interpreted as signalling an end to market-style reforms of the NHS. The Health Secretary emphasised that he wanted reform to be 'clinically-led, locally-driven'

(See also The Independent, Sept 26th, 2007, p.40)

More than half of trusts languish in bottom performance grades

C. Santry

Health Service Journal, vol.117, Oct. 18th 2007, p. 5, 6-7

The Healthcare Commission's annual health check 2006/07 shows an overall improvement in performance over the previous year, but more than half of trusts are still rated fair or weak for financial management and quality of services. Hospital trusts have also failed to hit targets for reducing MRSA, and many are not meeting basic hygiene and cleanliness standards. Primary care trusts are struggling to improve as quickly as other sectors and have seen a decline in the quality of their services. However, waiting times for operations and treatment have improved since 2005/06.

Our NHS, our future: NHS next stage review: interim report

A. Darzi

Deoartment of Health, 2007

This interim report on Darzi's review of the NHS focuses on improving access and infection control. To improve access it calls for:

1. the opening of at least 100 new GP practices, run by traditional independent contractors or private companies, in under-doctored communities, beginning with the 25% of primary care trusts with the worst services
2. provision of walk-in health centres in easy-to-reach locations such as shopping centres, which can be used without registration with a GP
3. pressure on existing GP surgeries to extend their opening hours and offer evening and Saturday appointments.

On infection control, the report calls for all patients coming into hospital to be screened for MRSA as soon as possible. Other recommendations include setting up a Health Innovation Council to promote the take up of new technologies and techniques, and better alignment between training and service delivery. This would avoid scandals such occurred in 2006, when large numbers of NHS trained physiotherapists were unable to find posts.

Shape up or ship out

H. Mooney

Health Service Journal, vol.117, Oct. 25th 2007, p. 28-30

A target for all NHS hospital trusts to be ready to apply for foundation status by December 2008 has proved unrealistic. The future of the 140-odd trusts which have not made the grade is uncertain. The regulator has said that some trusts will never be financially viable. This may include specialist trusts. Options for those left behind include closure or merger.

The utility of culture in healthcare reform

A. Halligan

British Journal of Healthcare Management, vol. 13, 2007, p. 390-392

Argues that hitting centrally imposed performance targets such as improved waiting times can cause a loss of focus on other aspects of healthcare services, such as patient safety. The imposition of targets, which often measure the wrong things, has also led to apathy among clinical staff. The article calls on doctors to re-engage and find a stronger political voice. Morale could also be improved by a system of awards to NHS staff for exceptional service.

Working jointly to scrutinise health?

A. Coleman

Journal of Integrated Care, vol. 15, Oct. 2007, p. 26-33

When NHS bodies consult on proposals which affect people from more than one local authority area, councils may form a joint health oversight and scrutiny committee to consider them. This article describes how a group of local authorities operated a specific joint health scrutiny committee. It highlights some of the benefits of health scrutiny, but suggests that engaging more fully with patients and the public in such reviews could result in a more influential and inclusive process.