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

Bradshaw warns PCTs: make the right choice

R. Evans

Health Service Journal, Apr. 17th 2008, p. 12-13

On April 1st 2008, 'free choice' came into force in the NHS, allowing patients to decide where they want to be treated. Much of the information on which they will base their choices is found on the NHS Choices web site. Health Minister Ben Bradshaw is keen to extend choice to patients with long term conditions, who may be empowered through the allocation of personal budgets to commission their own care. He acknowledges that the introduction of patient choice may lead to the closure of unpopular services and may thus destabilise local health economies.

Breaking away: Wales maps out its own future

A. Moore

Health Service Journal, Apr. 24th 2008, p. 12-13

Welsh Assembly proposals for NHS structure in the principality would see the abolition of the internal market and local health boards stripped of their commissioning role. Instead, a central NHS board for Wales would allocate funds to both hospital trusts and local boards; local boards would be cut from 22 to eight; and some community services could move from trusts to local boards. The overall aim is to follow a third way between an internal market and a command and control structure.

Chronic pain management

I. Torjesen (editor)

Health Service Journal, Apr. 24th 2008, supplement, 13p.

Ensuring that patients are referred quickly to a multidisciplinary pain management clinic can help prevent pain from becoming chronic through effective treatment and rehabilitation. This reduces dependence on state benefits, the prescribing of unnecessary painkillers, and the costs of other ongoing treatment. By redesigning pain services, commissioners have the opportunity to make savings and improve patients' experiences. This supplement looks at how some trusts have made improvements by changing referral pathways and moving services into the community.

Communication breaks down as staff feel left in dark by leaders

C. Santry

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

The fifth annual NHS staff survey shows that communication between staff and senior managers has broken down. In addition:

• 35% of staff said they felt undervalued
• 71% found their line manager supportive and said that he/she encouraged team working
• 8% said they had been harassed, bullied or abused by managers and 26% by patients or their relatives
• Less than half of respondents agreed that patient care was their Trust's top priority

Death's new dominion

L. Hunt

Health Service Journal, Apr. 24th 2008, p. 28-30

This article explores the implications of the Corporate Manslaughter and Corporate Homicide Act 2007 for the NHS. To secure a conviction under the new Act, it will be necessary to demonstrate that a given death was caused by poor management by the organisation as a whole, rather than by the shortcomings of any individual. Responsibility for health and safety rests with the trust board as a body corporate. However, organisations that meet health and safety obligations and manage risk appropriately will have nothing to fear from the new Act.

Decision making in a time of significant reform: managing in the NHS

I. Greener

Administration and Society, vol. 40, 2008, p. 194-210

This article draws on three empirical studies to explore the organisational and policy context within which NHS managers currently operate, looking for common themes in the challenges they face and the strategies they use for dealing with them. In a period when the pace and scope of reform are intense, the research explored three questions:

• What strategies do NHS managers use to ensure they stay up to date with what is required of them?
• How do they deal with the fact that much of what they are accountable for is out of their control?
• How does the introduction of a demanding performance measurement system affect them?

Enhancing quality: promoting consultant expansion across the NHS

British Medical Association

London: 2008

There is now increasing clinical evidence that in many areas of medical practice there is a need to increase the number of consultants available to treat patients. This is over and above the expansion in consultant numbers which has taken place previously. The financial pressures of the recent past have produced an artificial freeze on necessary consultant expansion in many areas and this is now beginning to impede improvements in the quality of patient care. This document launches a campaign from the Central Consultants and Specialists Committee (CCSC) for an immediate, focussed and planned expansion of consultant numbers where the need is clearly indicated. In this document, and in further releases over the coming weeks, we highlight clear evidence of where appointing new consultants will enhance the quality, speed and safety of care for patients.

Evidence-based medicine and patient choice: the case of heart failure care

T. Sanders, S. Harrison and K. Checkland

Journal of Health Services Research and Policy, vol. 13, 2008, p. 103-108

There is tension between evidence-based medicine and patient participation in decision-making. On the one hand, there is a view that chronic heart failure patients ought not to be treated too aggressively, so that it is legitimate to accept concerns about side effects as grounds for declining treatment. On the other hand, there is a view that the evidence in favour of treatment is so compelling that patient participation in decision-making can only occur at the margins. In the consulting room this tension is resolved in favour of evidence-based medicine, with the doctors using a variety of techniques to persuade patients to accept treatment.

Fingers on buzzers - how did you score?

B. Page

Health Service Journal, Apr. 24th 2008, p. 16-17

What patients think of health services has very little to do with objective performance measures such as standardised mortality ratios. Public satisfaction with health services has far more to do with the nature of local communities. Services in areas with ethnically diverse populations, high levels of deprivation, and large numbers of young people nearly always receive lower satisfaction ratings than those serving wealthier, older or less diverse populations.

Free regular 'health MoT' for over-40s to be unveiled

G. Rayner

Daily Telegraph, Apr. 1st 2008, p. 1

Reports the Health Secretary's announcement of three new measures: 1) free health screening for heart disease, kidney problems and diabetes for people over 40; 2) introduction of personal budgets for patients with long term conditions that will increase choice; and 3) a pledge to give each hospital a deep clean to eradicate superbugs.

(See also The Independent, Apr. 2nd 2008, p. 4; Daily Telegraph, Apr. 2nd 2008, p. 4, The Guardian, Apr. 2nd 2008, p. 5)

Intelligence

R. Allmark (editor)

Health Service Journal, Apr. 17th 2008, supplement, 12p.

This issue of the quarterly supplement focuses on data security. Late in 2007 HM Revenue and Customs admitted that it had lost the confidential details of every child benefit claimant. The supplement argues that a culture change is needed in the NHS to ensure that procedures for safeguarding confidential patient data are understood and followed by staff. It also describes a new risk assessment tool for cardiovascular disease and considers its implications for the health inequalities agenda and reports on an experiment that put cancer statistics on the Internet in an accessible form for patients for the first time.

Most NHS staff say patients are not top priority

J. Carvel

The Guardian, Apr. 9th 2008, p. 11

Only 46% of NHS staff in England think caring for patients is the top priority at their workplace. More than 150,000 nurses, doctors and ancillary staff were surveyed by the Healthcare Commission. Unison has stated that NHS trusts are placing too much emphasis on marketing and financial targets.

Operations halted by unfit equipment

R. Smith

Daily Telegraph, Apr. 25th 2008, p. 6

Hospitals used to sterilise surgical instruments on site, but are being encouraged by the Department of Health to contract the work out to private companies. Now a survey by the Royal College of Surgeons has found that two-thirds of respondents are unhappy with the condition of instruments sent away for sterilisation. This is leading to operations being cancelled at the last minute.

Patient satisfaction levels still in critical condition

N. Hawkes

The Times, Apr. 24th 2008, p. 26

The National Patient Survey Programme has produced data which indicates that levels of patient satisfaction with the NHS have failed to demonstrate any clear improvement between 2005-2006 and 2006-2007. Improvements have however been recorded on some other indicators such as quality of care.

The politics of healthcare in Britain

S. Harrison and R. McDonald

London: Sage, 2008

The book provides a considered overview of the politics of health care in Britain. Bringing together a wide range of material on both past events and recent developments, the chapters cover issues such as the politics of health professionalism, rationing, clinical knowledge, and organization and management. Each chapter offers a unique combination of theory, historical detail and analysis of contemporary events. It features case studies to illustrate how health care policy has evolved and developed in recent years, and the implications these changes have for practice. The final chapter is based on three detailed case studies that illuminate the tensions and debates discussed throughout the book.

Room for manoeuvre? Explaining local autonomy in the English National Health Service

M. Exworthy and F. Frontini

Health Policy, vol. 86, 2008, p. 204-212

Decentralisation has returned as a key theme in English health policy in recent years. Most research emphasis has been on investigating the transfer of power from central government to local organisations such as primary care trusts and foundation trusts. However, this paper examines the way in which local organisations exercise their varying degrees of autonomy from higher authorities within the network of statutory and independent agencies that make up the local health economy. It draws on different strands of the literature to discuss the room for manoeuvre of local organisations within health economies, with special reference to primary care trusts.

Something to hide? Get the facts before you hire

I. Torjesen

Health Service Journal, Apr. 10th 2008, p. 14-15

In the light of new guidance issued by NHS Employers, this article gives advice on best practice in recruiting NHS staff. It is important to check the applicant's identity, their right to work in the UK, and possible criminal record. The paper goes on to describe the role of the new Independent Safeguarding Authority, which will draw on a wide range of sources to decide if someone should be barred from working with children and vulnerable adults.

Spotlight on complaints: a report on second-stage complaints about the NHS in England

Healthcare Commission

London: 2008

The Healthcare Commission investigated 10,000 complaints in 2007, including cases of patients being left in soiled bedding and allegations of rude nurses. In some cases call bells were left out of reach and elderly patients were nor given help with eating. Complaints about GPs included claims that they were too busy to spend sufficient time with patients and consequently misdiagnosed illnesses. Other complaints were that accident and emergency departments withheld pain relief and women were left alone during labour. In 23% of cases looked at, the Commission's main recommendation was that trusts should apologise.

Thousands will keep their sight after U-turn on drug rules

R. Smith

Daily Telegraph, Apr. 2nd 2008, p. 4

The National Institute for Health and Clinical Excellence had ruled that people with age-related macular degeneration had to lose the sight of one eye before receiving the drug Lucentis on the NHS. This decision has been reversed in the latest draft guidance after a public outcry.

UK doctors lose out as foreigners get backing for jobs

R. Smith

Daily Telegraph, May 1st 2008, p. 2

The Department of Health tried to implement guidance that doctors qualifying in British or EU medical schools should be given priority over doctors from outside Europe in the allocation of training posts. This guidance was challenged by the British Association of Physicians of Indian Origin and has now been declared illegal by the law Lords.

United for growth

A. McGauran

Health Service Journal, Apr. 24th 2008, p. 24-26

Imperial College Healthcare Trust plans to become a world leader in academic health science research by 2012. It controls five hospitals, offering a unique partnership between a university and the NHS which should dissolve the barriers between research and healthcare delivery. To this end, it has launched a leadership model that does away with directorates and instead puts doctors in charge of clinical programme groups.

Vital year of reform for healthy-looking NHS

N. Timmins

Financial Times, Apr.3rd 2008, p. 3

Interview with David Nicholson, chief executive of the NHS, looking at the challenges facing the NHS over the next year.

World class commissioning: a health policy chimera?

C. Ham

Journal of Health Services Research and Policy, vol. 13, 2008, p. 116-121

In the next phase of NHS reform, greater emphasis is being placed on the introduction of market-like mechanisms such as patient choice, payment by results, and introduction of competition among providers. Of critical importance in this phase will be the ability of healthcare commissioners of care to negotiate on equal terms with providers. This paper reviews the evidence on commissioning outside the UK to establish what lessons can be learned from the experience of other countries, particularly New Zealand, Europe and the USA. It argues that there are formidable obstacles to the development of world class commissioning, and a danger that rhetoric will outstrip reality.