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

Aspiring to excellence

J. Tooke

London: MCC Inquiry, 2008

The independent inquiry into Modernising Medical Careers recommended that:

• The Postgraduate Medical Education and Training Board should merge with the General Medical Council
• Education and training should be integrated into the Healthcare Commission's performance management regime
• Devolved workforce commissioning should continue for the time being and compliance with service level agreements between the Department of Health and Strategic Health Authorities should be reviewed in 2008/09.
• The Department of Health should strengthen policy development, implementation and governance for medical education, training and workforce issues, with clearer roles for a single responsible officer Selection into higher specialist training should be informed by the royal colleges, working in partnership with the regulator
• All four UK health departments and chief medical officers must be involved in changes to medical career structures
• A scrutiny body, NHS Medical Education England, should be set up with a ring-fenced budget and should be accountable to the senior responsible officer for medical education
• Local delivery of postgraduate medical education should form part of the remit of trust medical directors.
• Cash for this education should reflect training requirements and the contributions of service and academia
• The Department of Health should strengthen its links with education, clinical service, research and other government departments

(For comment on the government response see Health Service Journal, Mar. 6th 2008, p. 12-13)

Census shows wide variation in numbers of clinical staff

C. Santry

Health Service Journal, Mar. 20th 2008, p. 4-5

The latest NHS annual workforce census shows an 0.9% increase in professionally qualified clinical staff and an 0.5% reduction in the overall workforce from 2006 to 2007. However, numbers of professionally qualified clinical staff dropped in four of the 10 strategic health authorities. The number of GPs rose by only five, from 30,931 to 30, 936, suggesting that the Department of Health is unlikely to meet projected demand, which it put at 32,000 GP s by 2010-11.

Chorus of doubts over new voice for patients

D. Carlisle

Health Service Journal, Mar. 13th 2008, p. 12-13

At the end of March 2008, Patient and Public Involvement Forums, and their national body, the Commission for Patient and Public Involvement in Health, will be abolished and replaced by new local involvement networks (LINks). The LINks will have a broader remit than the old forums, covering social care as well as health. However, there is concern that government has given the LINks no guidance about governance structures, that there are no plans to create a national body to replace the Commission, and that the LINks will not have access to privately run health and social care facilities to carry out inspections.

Citizen and staff involvement in health-service decision-making: have National Health Service foundation trusts in England given stakeholders a louder voice?

R. Lewis and L. Hinton

Journal of Health Services Research and Policy, vol. 13, 2008, p. 19-25

Foundation trusts are intended to replace state ownership of hospitals with 'social ownership' where citizens and staff can enjoy membership rights and a formal role in the governance of the organization. This paper reports on an evaluation of the early implementation of these new governance structures at Homerton Hospital, London and considers whether or not the objective of greater staff and public involvement in decision-making has been achieved. It explored the roles adopted by elected and appointed governors of the trust and the extent to which they shared power with trust directors and influenced management. It found that governors perceived that they had made little impact on the decisions of the Trust in the year under study. However, evidence was found of increased involvement of governors and the public in the activities of the trust.

Crime scene - and you're in the dock

I. Torjesen

Health Service Journal, Mar. 27th 2008, p. 12-13

The Corporate Manslaughter and Corporate Homicide Act came into force on April 6th 2008. Under the Act, NHS trusts will become criminally liable for deaths where there is a 'gross breach of the relevant duty of care' on account of the way that their activities are organised. The introduction of the Act is likely to lead to more police-led investigations into health and safety breaches, and more trusts and their senior managers prosecuted under existing health and safety legislation.

Efficiency and equity considerations in the employment of health care assistants and support workers

C. Thornley

Social Policy and Society, vol. 7, 2008, p. 147-158

In order to save on staff costs in health and social care services, there have been moves to substitute cheaper for more expensive labour. This practice first appeared in UK healthcare in 1990 when the Conservative government introduced the grade of Health Care Assistant/Support Worker and has continued under the New Labour governments to the present day. This study demonstrates that cost savings have indeed been achieved through the introduction of these new grades in the NHS. However, the relative pay of these workers has declined even as evidence has accumulated of the real skills they have attained , of the important tasks they undertake and of their de facto substitution for professional staff. A number of equity considerations flow from this situation.

Health policy and politics

A. Hann (editor)

Aldershot: Ashgate, 2007

Health policy is influenced by a wide variety of national and international sources, by interprofessional struggles, and by the activities of non-governmental groups such as patients, patient-user groups, the media and the pharmaceutical industry. The book offers an analysis of policy making in the National Health Service. It looks first at the 'macro' level of policy-making at governmental level, and then at the professional institutional relationships and struggles, and interpersonal decision-making and power relations within small organizations and departments. The volume is unique in the variety of perspectives and topics covered - from the challenges of developing a service culture in health care and the increasingly consumerist attitude to health provision, to the impact of the EU on British health policy.

Healthy weight, healthy lives: a cross-government strategy for England

Cross-Government Obesity Unit, Department of Health [and] Department for Children, Schools and Families

London: 2008

This new strategy is composed of five elements:

• For healthy child growth and development: early identification of 'at risk' families, making breastfeeding the 'default option' for mothers, increasing physical activity and making cookery lessons compulsory in schools
• Promoting healthier food choices: finalising a food industry code on issues including labelling, accelerating the Ofcom review of junk food advertising, and allowing local authorities to restrict fast food outlets near schools and parks
• Promoting physical activity: a £30m investment in the Healthy Towns initiative, and an entertainment technology working group to improve parents' control of their children's sedentary activities
• Incentivising better health in the workplace, including the piloting of financial inducements
• Providing more personalised advice and support, with increased funding for weight management services over the next three years

Independent sector CATS: a drive for change

R. Way and J. Mackness

British Journal of Healthcare Management, vol. 14, 2008, p. 113-118

In the context of increasing involvement of the independent sector in the NHS, this research looked at the suggested creation of independent sector-led Clinical Assessment and Treatment Support Services (CATS) and their effect on attitudes to organisational change. A range of opinions and perceptions were collected from interviews with G Ps, managers, clinicians, executives and representatives of the independent sector in the North West of England. Results suggests that the CATS were seen as a threat which caused the NHS to start thinking and behaving 'differently'.

Managers should lend a listening ear to patients

J. Hughes

Health Service Journal, Mar. 20th 2008, p. 16-17

This article introduces the work of Breakthrough Breast Cancer in promoting patient involvement in the development of health services. The work of Breakthrough Breast Cancer demonstrates that patients can be successfully involved where they are properly supported and there is willingness to listen.

Médecins sans frontières?

M. Gould

Health Service Journal, Mar. 20th 2008, p. 22-24

The charity Médecins du Monde has set up a relief centre in London to provide immediate basic medical care for illegal immigrants and failed asylum seekers, and to help them get access to mainstream NHS services. Since 2004, these groups have only been eligible for emergency hospital care, family planning, sexual health services and treatment for notifiable diseases such as TB. Access to primary care is currently at the discretion of GPs, but observers predict that a ban on all but emergency care will be introduced. An analysis of patients using Médecins du Monde's London service has revealed that patients only want basic GP care, which reduces later hospital admissions.

An NHS constitution: to be or not to be?

R. Hill

British Journal of Healthcare Management, vol. 14, 2008, p. 99-101

Reports on a debate on whether the NHS needs a constitution or an independent governing board held at the King's Fund on 6th February. Concerns were apparent over whether an independent board would be a sufficient tool to prevent government from continually reasserting its control over the health service.

NHS hospitals can advertise to attract patients

J. Carvel

The Guardian, March 20th 2008, p. 12

The government has announced that NHS hospitals will now be allowed to advertise to compete for business and attract patients. Hospitals will be allowed to use testimonials from celebrities and medical professionals if they have personal experience of a particular hospital and are willing to promote its services without payment. Commercial sponsorship from companies will also be permitted providing that association with those companies is not seen to be damaging the 'NHS brand'.

(See also Daily Telegraph, Mar. 20th 2008, p. 12)

'Nurse entrepreneurs': a case of government rhetoric?

M. Traynor and others

Journal of Health Services Research and Policy, vol. 13, 2008, p. 13-18

This paper examines the promotion of 'nurse entrepreneurs' by the government from approximately 2003. It analyses policy statements from 1997 and focuses particularly on a key ministerial speech from 2003, which promoted the concept of 'nurse entrepreneurs' to a nursing audience. Theoretically, it draws on aspects of structuralist and poststructuralist linguistics. From the government's point of view, expanding the role of nurses to include activities previously carried out by doctors cuts costs and increases efficiency, chiefly in terms of broader access to NHS services. Government also perceives nurses as being more amenable to external control than doctors. The expanded role is 'sold' to the nursing profession as enhancing its status compared with medicine.

Private hospitals retreat from NHS

N. Timmins

Financial Times, March 20th 2008, p.4

A drive to get patients to exercise their right to choose any accredited hospital, public or private, for routine treatments was launched yesterday by ministers; at the same time, some of Britain's biggest independent hospital groups announced that their desire to work in the National Health Service had diminished sharply.

(See also The Independent, Extra, March 20th 2008, p.2)

The same old faces

C. Santry

Health Service Journal, Mar. 6th 2008, p. 22-24

There is concern that few senior NHS managers come from black and minority ethnic groups, although there is a lack of reliable statistics on the matter. Current projects to improve the situation are have ambitious aims but are as yet limited in scale. Cultural attitudes, covert discrimination and trusts not publishing their race equality activities are all issues here.

Social pioneers feel their way

T. Shifrin

Society Guardian, March 5th 2008, p. 15

Since 2006 a wave of new health services are being introduced by social enterprises through 'pathfinder projects' supported by the Department of Health. Article discusses two such projects in Hampshire and Lincolnshire.

Tackling concerns: addressing regulation

J. Martin

British Journal of Healthcare Management, vol. 14, 2008, p. 102-104

The conference 'Tackling Concerns' aimed to provide practical guidance on tackling poor performance issues and supporting clinicians in difficulty in the light of changes to legislation that are planned in the Health and Social Care Bill. The author reports the changes to regulation and assessment of doctors that were discussed.

Tiers before teatime: taking targets á la carte

A. McKeon

Health Service Journal, Mar. 13th 2008, p. 16-17

In November 2007 the government issued 198 national indicators from which local authorities and their NHS and voluntary sector partners, working through local strategic partnerships, can select up to 35 priorities and agree their targets and plans with government offices. The Department of Health has complemented this approach through the publication of 'vital signs' in January 2008. These include national priorities that NHS Trusts must deal with, such as 18-week waits; a set of national priorities that will be subject to local targets, such as obesity among primary school children; and a raft of indicators for possible local priorities. The author argues that the regulatory and assessment system will also need to change.

Welsh hospitals to scrap car parking charges

J. Carvel

The Guardian, March 3rd 2008, p. 7

Following a campaign by cancer patients unable to afford frequent hospital visits due to parking costs at hospitals, the Welsh Assembly is expected to further break from NHS policy in England and introduce a programme of free hospital parking. Parking charges at most Welsh hospitals are likely to be abolished from April 1, the first anniversary of the abolition of prescription charges in Wales.

Who will stand up for rare conditions?

J. Murray

Health Service Journal, Mar. 27th 2008, p. 16-17

There has been concern that greater local control of health budgets may lead to services for people with rare conditions which are expensive to treat not being commissioned by primary care trusts. Government has taken steps to ensure that treatment is available for patients with rare conditions through the creation of specialised commissioning groups to take responsibility for the majority of services. A national commissioning group will fund services for the conditions that are rarest and most expensive to treat.