Welfare Reform on the Web (January 2008): National Health Service - reform - general

Building healthcare strategy, cradle to grave

A. Darzi, E. Oborn and P. Howitt

British Journal of Healthcare Management, vol. 13, 2007, p. 468-472

The authors examine the process and products of the recent review of healthcare in London in which they were involved, and point out its lessons for the development of regional strategy in general. The strategic health authority for London sought to inform its strategic thinking by commissioning A Framework for Action, a clinical review of projected needs and directions of change in greater London over the next 10 years. The Framework is built on seven care pathways and seeks to integrate a cradle to grave perspective. Developing it has involved extensive consultation with clinical and frontline staff and the public. The strategic health authority now faces the challenge of producing appropriate community level translation of the city-wide vision.

Challenges of stronger commissioning

J. Woodin and J. MacDonald

British Journal of Healthcare Management, vol. 13, 2007, p. 478-482

This article considers the potential impact of stronger commissioning on NHS trusts, and identifies six strands of development activity that may arise for them as a result. Providers will need to cope with:

• A move to legally binding contracts
• A requirement for accurate, relevant and timely information about activity to enable the contracts to be managed
• A need for monitoring and ensuring compliance with clinical guidelines covering issues such as referral thresholds and treatment appropriateness. Failure to comply could have real financial consequences for provider trusts
• Implementation of private sector customer care practices to ensure that patient expectations are met in the context of the choice agenda
• Collaboration with commissioners in the development of local strategies for healthcare delivery
• Changed responsibilities for the trust board in leading the development of the organisation in a commissioning driven environment.

Earlier, faster, shorter - and a lot more data

C. Laurent

Health Service Journal, vol. 117, Dec. 13th 2007, p. 16-17

The government’s new Cancer Reform Strategy focuses on prevention through improved education, further reductions in smoking and increased access to screening. The preferred treatments are surgery and radiotherapy, rather than expensive new drugs. The strategy also calls for a reduction in the time between a decision to treat being made and treatment starting. By 2010, no patient should be waiting more than 31 days for treatment to start. Government will invest £270m up to 2010 to implement the strategy. It sets out two central approaches to improve prevention and achieve earlier diagnosis: an emphasis on good data collection and a concerted effort to address health inequalities prevalent in cancer, including age, gender, deprivation and ethnicity.

Early runners set to be first past 18-week post

A. Moore

Health Service Journal, vol.117, Dec. 6th 2007, p.16-17

The 13 'early achiever' trusts hope to be either hitting or to be very close to the target of treating 90% of patients admitted to hospital and 95% of those treated as outpatients within 18 weeks of referral by December 31st 2007. They are reaching the target a year ahead of the rest of the NHS. This article reports on the challenges involved in eliminating waiting list backlogs. It is important: 1) to set up systems to track 'referral to treatment' times; 2) to avoid inappropriate hospital referrals; and 3) to clear the backlogs of those who have already been waiting more than 18 weeks.

Gender and access to healthcare in the UK: a critical interpretive synthesis of the literature

E. Annandale and others

Evidence and Policy, vol. 3, 2007, p. 463-486

This critical interpretive synthesis of the literature on gender and access to healthcare identified that research in this area has proceeded in a piecemeal manner. Genuinely comparative research that takes into account the experiences of both men and women is rare. An answer to the question of whether access to healthcare is characterised by gendered patterns of advantage and disadvantage is not possible given the current research base. However, this analysis suggests that access to services by men and women cannot be defined as either easy or difficult in any straightforward way, but that accessibility appears to be relative, variable and contingent on many other factors and circumstances, one of which is gender. It is concluded that gender equality in healthcare is best fostered through what the authors term 'critical gender awareness'.

The 'how' of changing culture and minds

A. Halligan

British Journal of Healthcare Management, vol. 13, 2007, p. 465-467

A patient-centred NHS can only come with the transformation of attitudes and behaviours among frontline staff. People cannot be persuaded to change through a command and control approach. They need to be made to understand that it is time to change their behaviour, using techniques such as simulation, storytelling, after action reviews and coaching, underpinned by information, communication and networking.

Improving management of chronic illness in the National Health Service: better incentives are the key

J. Dixon

Chronic Illness, vol. 3, 2007, p. 181-193

People with chronic diseases tend to be old and frail, to have other co-morbidities, and to use a lot of services (thereby incurring high costs). Effective care for this group aims to avoid emergency hospital admissions through improved management of the condition(s) in the community. This paper examines reforms introduced into the NHS in England with a view to improving care for people with chronic illness. There is mixed and weak evidence for the effectiveness of interventions used in England to reduce the risk of emergency hospital admission for people with chronic illnesses. This is because they do not accurately identify a target population of individuals at highest risk and because NHS institutions are not offered sufficient financial and other incentives to work together to improve care continuously.

Intelligence: special report

R. Allmark (editor)

Health Service Journal, vol. 117, Dec. 20th 2007, p. 27-34

This special report includes:

• A review of the relaunched NHS Choices web site, which includes sections on patient choice, health promotion advice and an A-Z health encyclopaedia
• A report on a strategy for streamlining NHS procurement processes and promotion of interoperability through use of common coding and standards, rather than through imposition of a national system.
• An opinion piece on the continuing tendency of politicians to introduce new policies and initiatives with no supporting evidence for their effectiveness.

Keep your eye on the Kremlin, comrades …

S. Gainsbury

Health Service Journal, vol. 117, Dec. 20th 2007, p. 16-17

This article comments on the NHS Operating Framework for 2008/09. The framework introduces 60 new or extended centrally imposed targets, excluding the full list of indicators (vital signs) against which NHS organisations will be judged. These vital signs will be published by the Department of Health in due course. A further set of pre-existing national targets remain in place. Additionally, primary care trusts will be expected to develop local targets based on community needs. There is also concern that primary care trusts have only been informed of their funding allocations for 2008/09, instead of for the full three years to 2010/11, because the distribution formula is still under review. However, there are hints that the minority of trusts in real financial difficulties may be bailed out by their strategic health authorities.

Northern NHS trusts outperform those in the South

M. Conrad

Public Finance, Oct. 26th- Nov. 1st 2007, p. 12-13

People in the North of England are in poorer health than those in the South in almost all cases. However, performance assessments by the Healthcare Commission show that Northern patients receive better NHS services than their counterparts in the South. This appears to be due to superior use of resources and better financial management in Northern trusts.

Personal best: put the customer in control

A. Coulter and D. Redding

Health Service Journal, vol. 117, Dec. 6th 2007, p. 20-21

There is research evidence that health services tailored to individual patient needs are more effective. Examples of improved outcomes can be found in patient-centred telecare for those with chronic conditions, use of patient decision aids, patient education for self-care, and patient involvement in safety campaigns. Policies to promote personalised healthcare include improving patients’ health literacy, shared decision making between patients and professionals, and patient and public involvement in service development.

Plunging waiting times reopen dispute over clinical benefits

S. Gainsbury

Health Service Journal, vol.117, Dec. 6th 2007, p. 5

The government’s focus on cutting waiting times may now be diverting resources away from treatments for those in greatest clinical need. For example, the waiting lists for cataract surgery are now so short that patients are having the operation while they can still see to drive a car. Research indicates that current policy on waiting list reduction is bringing limited added value to patients.

Reducing infection

A. Nolan (editor)

Health Service Journal, vol.117, Dec. 20th 2007, Supplement, 13p

Many trusts are failing to meet the Hygiene Code standards for cutting infections. While MRSA infection rates are falling, those for Clostridium difficile are rising. Over the past year, the government has introduced numerous policies and programmes to try to force trusts to reduce infection rates. The supplement presents a case study of how Royal Wolverhampton Hospitals trust has successfully tackled these infections, followed by guidance on how using a balanced scorecard and root cause analysis could help reduce them.