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

Adding value to a 21st century health service: a review of the NHS public appointments process

NHS Appointments Commission


This review's recommendations provide the template for the Commission's work in the future. It covers issues of precision in recruiting candidates with the right skills as board members and chairs of NHS organisations. More women and disabled people and members of minority ethnic groups need to be appointed. It recommends that strategic health authorities should assume responsibility for on-going training of board members and chairs, while the Commission retains ownership of induction training. An active performance management system will be developed, and the Commission will seek powers to suspend board members when this is necessary to retain public confidence. A new fast track termination process for unsatisfactory board members will also be put in place. Finally the review suggests further consideration is needed of the remuneration of board members and of public participation in the appointment process.

Better care, better lives

Department of Health

London: DH Publications, 2008

This government strategy outlines plans for improved palliative care services for some of the country's sickest children. The strategy places a new expectation on trusts and strategic health authorities to establish local and regional children's palliative care networks, which bring together commissioners, clinicians and providers from all sectors. It also says that families should have access to round-the-clock advice and support from community teams to help cut unplanned hospital admissions.

Innovation under wraps

I. Torjesen

Health Service Journal, Feb. 14th 2008, p. 26-28

The introduction of new technologies into the NHS tends to increase demand and so raise costs. Action to adopt many technologies that have proved cost effective in the long term has been comparatively slow in the UK. The National Institute for Health and Clinical Excellence was set up in 1999 to assess emerging technologies. The Commons Health Select Committee has suggested that NICE should conduct less in-depth evaluations of new drugs soon after licensing to ensure that the most cost effective are made available quickly. In the meantime, some experts believe that primary care trusts should work together on decision-making about costly new interventions.

Log in to the future

R. Norris

Health Service Journal, Feb. 14th 2008, p. 29

Report of an interview with Sir Jonathan Michael of BT Health, in which he argues that investment in information and communications technology and electronic systems is the way forward for the NHS. He believes that security will be high and personalised care enhanced.

Monitor challenges DH on freedoms

S. Gainsbury

Health Service Journal, Feb. 21st 2008, p. 4-5

In an email sent to foundation trust chairs and chief executives, Monitor chair Bill Moyes has expressed his discomfort over the directive tone of recent letters from the Department of Health to foundation trusts, which he interprets as issuing instructions. This is contrary to the existing legislation as it implies that foundation trusts are in a line management accountability relationship with the Department.

New super-regulator begins to take shape

C. Santry

Health Service Journal, Feb. 28th 2008, p. 12-13

Under the Health and Social Care Bill at present before Parliament, three regulators (The Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission) will merge to form a new body, the Care Quality Commission. However details of how the new body will operate are sketchy, leaving NHS trusts in the dark about how the changes will affect them.

Nurse and pharmacist supplementary prescribing in the UK: a thematic review of the literature

R.J. Cooper and others

Health Policy, vol. 85, 2008, p. 277-292

Introduced in the UK in 2003, supplementary prescribing (SP) is a key part of the government's plans to revolutionise the delivery of healthcare and offers prescribing rights to members of several professions, including nurses and pharmacists. SP is a dependent model of prescribing, involving a tripartite arrangement between the supplementary prescriber, an independent prescribing doctor and the patient. Following an initial medical diagnosis, SP allows suitably trained healthcare professionals to take prescribing responsibility for patients in accordance with a specific clinical management plan. This paper reviews the extant literature relating to nurse and pharmacist SP.

Perceptions of the clinical director role

R. Cragg, N. Marsden and D. Wall

British Journal of Healthcare Management, vol. 14, 2008, p.58-65

Two decades have elapsed since clinical directorates were first introduced into the NHS, yet evaluations of the clinical director (CD) role remain limited and lack practical application. This study describes how Q-Sort methodology can be deployed to enhance our understanding of staff perceptions of the clinical director role. Research participants deem the CD role to be essential for effective directorate performance. Working relationships within the clinical directorate reviewed appeared to be constructive, with all staff rejecting the presence of antagonism between managers and CDs. The study reveals CD roles to be predominantly strategic in nature, with participants reporting that CDs have limited influence over the prioritisation of funds. Their line management responsibilities are confined to the medical staff.

Reducing MRSA: the knowns and the unknowns

A. Cowper

British Journal of Healthcare Management, vol. 14, 2008, p. 55-57

There are indications that, after years of effort, levels of hospital-acquired infections such as MRSA are reducing. This article assesses the impact of a range of factors on reducing incidence of MRSA, including central government targets, support from the Department of Health, and geographical location.

Representation and legitimacy in health policy formulation at a national level: perspectives from a study of health technology eligibility procedures in the United Kingdom

T. Milewa

Health Policy, vol. 85, 2008, p. 356-362

Decisions about the availability of publicly funded new drugs and medical devices are of fundamental concern to patients, health technology manufacturers, clinicians and tax payers. The issue of who can claim to speak for whom in decisions made on behalf of a significant proportion of the population may thus be central to the perceived legitimacy of the decision-making process. A focus on the UK rationing body, the National Institute for Health and Clinical Excellence, indicated the potentially fluid and imprecise reality of some dimensions of representation and legitimacy. Findings from interviews with a purposive sample of informants suggested that at least four factors contribute to this fluidity and imprecision. These encompassed an unpredictable and episodic selectivity in the identification of 'stakeholders', variable discursive reference by participants to real-world experiences of relevant 'constituencies', selective discursive collaboration between notionally distinct interests, and attempts to evoke shared objectives between such parties in the course of deliberation.

Tolerance of minor incidents needs major overhaul

I. Carruthers

Health Service Journal, Feb. 14th 2008, p. 18-19

Research shows that around one in ten of all patients admitted to hospital will experience some form of harm. The data show a rise in minor errors that could result in a few extra days in hospital, at substantial cost to the NHS. This article suggests six practical steps that boards, senior managers and clinical leaders can take to reduce these errors.

What a carve-up

H. Mooney

Health Service Journal, Feb. 28th 2008, p. 23-24

Eighteen months after their reconfiguration in 2006, the role of strategic health authorities (SHAs) in the health economy remains unclear. Government seems to be intent on modifying their role away from the day-to-day management of increasingly autonomous local NHS organisations and towards a strategic role that will take an overview of the development of regional health services.

Where NICE leads, can commissioners follow?

M. Dougherty

Health Service Journal, Feb. 21st 2008, p. 16-17

This article discusses cost and service design barriers to putting National Institute for Clinical Excellence clinical guidelines into practice, using long-acting reversible contraception as a case study. World class commissioning is an opportunity to strengthen the link between standards developed for healthcare and the way services are commissioned. Closer collaboration is needed in translating clinical and cost-effectiveness data from NICE into commissioning contract parameters.

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