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

Battle of the sexes: the mixed ward row that won't lie down

C. Santry

Health Service Journal, Jan. 10th 2008, p. 12-13

Early Labour government promises to abolish mixed-sex wards in NHS hospitals have turned into vague aspirations, while the definition of single-sex accommodation has changed to include single-sex bays in mixed wards. This is described as cheating by patients' rights groups.

Brown unveils vision for 21st century health

R. Evans

Health Service Journal, Jan. 10th 2008, p. 4-5

In his first major speech on health policy, and subsequent interview, Gordon Brown promised that:

  • The NHS would focus on prevention as well as cure
  • Access to primary care would be improved
  • National screening for vulnerability to heart disease would be introduced
  • A Patients' Prospectus would be available with options for people with long-term conditions to receive care at home
  • Three million members of the public would be Foundation Trust members by 2012
  • Decisive action would be taken against failing services
  • An NHS constitution enshrining patients' rights and responsibilities would be produced
  • Introduction of personal healthcare budgets would receive serious consideration
  • Primary and secondary care would be seamlessly integrated

Caring for vulnerable babies: the reorganisation of neonatal services in England

National Audit Office

London: TSO, 2007 (House of Commons papers, session 2007/08; HC101)

In England there are 180 neonatal units based in NHS and foundation trusts and currently structured into 23 regional networks. The reorganisation of care into neonatal networks has improved the coordination and consistency of services, pointing to increased effectiveness. There are, however, still serious capacity and staffing problems, and a lack of clear data on outcomes. In addition, the variable state of financial management makes it difficult to judge the economy and efficiency of the service. It is therefore not possible to say whether or not networks have improved the overall value for money offered by the service. Nonetheless, the majority of parents are grateful for the care their babies receive. Given the rising demand for the service and the constraints within the system, parents' views are an important indicator of achievement, but the lack of robust evidence on outcomes makes it difficult to reach an objective view of the quality of the service.

Future patients? Telehealthcare, roles and responsibilities

T.L. Finch and others

Health and Social Care in the Community, vol. 16, 2008, p. 86-95

Increasing use of information and communication technologies is said to be revolutionising healthcare delivery by changing relationships between patients and professionals. This paper presents various accounts of the roles and responsibilities of the patient in the context of telehealthcare, as held by different policy and practice constituencies in the field. These accounts vary from patients as 'educated self-managers' embracing technology as a tool for empowerment, to service users with wide-ranging priorities and preferences for provision of their healthcare.

Governing the NHS: alternatives to an independent board

A. Dixon and A. Alvarez-Rosete

London: King's Fund, 2008

This report dismisses the idea of an independent NHS board as misguided, and calls instead for a constitution that would spell out lines of accountability and ensure appropriate legal checks on ministerial decisions. It could also enshrine the principle of subsidiarity, so that action could be taken locally whenever this would lead to better outcomes. It argues that a board would fail to remove the NHS from political interference because it would be unable to insulate itself from the high level of public interest in healthcare. It suggests other ways of depoliticising the NHS, including strengthening the independent reconfiguration panel and expanding the powers of the Commons Health Select Committee.

Heart death rates show a nation of inequalities

S. Gainsbury

Health Service Journal, Jan. 17th 2008, p. 4-5

Research by the Health Service Journal has revealed huge inequalities between healthcare need and NHS spending across England. Analysis of the latest data on coronary heart disease premature death rates and primary care trust heart disease spending shows that some of the trusts with the greatest needs spend the least. GPs in some of the poorest areas of the country are also failing to identify patients with coronary heart disease and treat them effectively.

Medical self-regulation: crisis and change

M. Davies

Aldershot: Ashgate, 2007

Self-regulation constitutes an important aspect of the regulatory and oversight process governing professionals. This book focuses directly on medical self-regulation in the context of both the wider regulatory framework and that of other regulatory models. Through a critical consideration of recent events, including high-profile and controversial cases, it is demonstrated that the self-regulatory process has failed and that only fundamental restructuring and a radical change in attitudes on the part of members of the profession can repair the damage. Attention is also given to the recent changes, current proposals for change and to alternative regulatory models.

National Institute for Health and Clinical Excellence

Health Committee

London: TSO, 2007 (House of Commons papers, session 2007/08; HC27)

Patient and professional groups and the pharmaceutical industry have highlighted the failings of the National Institute for Health and Clinical Excellence (NICE), such as the slow release of guidance and the perceived unfairness of some of its recommendations. The committee examined three main areas of concern: the evaluation process, the affordability of guidance and its implementation. Following the Office of Fair Trading's report on the Pharmaceutical Price Regulation Scheme, the committee also looked at the potential role of NICE in such a new system.

NPfIT for purpose?

M. Thomas

National Health Executive, vol.1, Nov./Dec. 2007, p. 41-43

In the UK, the introduction of electronic patient records is at the heart of the NHS National Programme for IT (NPfIT), which is the largest civilian IT project in the world. However, it now seems to be at risk of joining the list of unnecessary IT project failures.

Prevention is better than cure, but by how much?

J. Le Grand and R. Sherriff

Health Service Journal, Jan. 31st 2008, p. 16-17

There is general agreement that prevention of ill health is better than cure. Policymakers now need advice on which preventive interventions should receive government support. To this end the government has set up Health England, an independent body with the twin tasks of prioritising preventive interventions and identifying ways of encouraging commissioners to support them. Health England believes that interventions should be prioritised on the basis of population health impact and cost effectiveness.

Service transformation

A. Nolan (editor)

Health Service Journal, Jan. 31st 2008, p. 27-33

The NHS Integrated Service Improvement Programme (ISIP) was launched in 2005. This special report explores how ISIP guidance and toolsets have been used to:

  • Improve services for people with schizophrenia in Liverpool through a partnership between the city council and the primary care trust
  • Tackle high rates of mortality from coronary heart disease in Hull by integrating existing work on prevention and treatment
  • Simplify complex emergency health and social care processes in Kent

Sixty not out

Anon

Health Service Journal, Jan. 10th 2008, p. 28-30

Responses to a survey of 1606 NHS managers showed that:

  • 80% do not believe that the NHS will remain free at the point of use
  • They believe that people with long term conditions benefit most from the service and that people with mental health problems benefit least
  • 59% intended to stay in the NHS until they retire, the main reason being the prospect of a good pension
  • 54% were not optimistic about the future of the NHS because of poor staff morale, wasted money, cuts and a target-driven culture

State of healthcare 2007: improvements and challenges in services in England and Wales

Healthcare Commission

London: TSO, 2007 (House of Commons papers session 2007-2008; HC 97)

The Commission's fourth report on the state of healthcare in England and Wales sets out the main improvements during 2006/2007, and includes the following six key challenges for service providers:

  • Primary care trusts need to work with their partners to gain a better understanding of the health needs of the populations they serve, in order to target preventative measures more effectively and purchase the healthcare services their populations need.
  • Healthcare providers and commissioners need to identify where there are gaps in access and work with partners to find ways of closing these gaps.
  • Healthcare providers and commissioners need to focus more on learning from information already available to them, in particular data on clinical outcomes and complaints, errors and near misses. Trust boards and senior staff must take the lead in establishing a culture of learning from mistakes and putting patients at the centre of the decision making process.
  • NHS trusts need to do more to ensure that they have effective systems for protecting children, and ensure that staff who work with children have comprehensive, up-to-date training. Particular attention should be given to the needs of adolescents.
  • Healthcare organisations need to place more emphasis on listening to patients, providing them with accessible information, and understanding and addressing their individual needs.
    • Healthcare providers in both the independent sector and NHS need to do more to assess the quality of their services against other similar organisations through benchmarking and audit.
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