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

Are LINks and HOSTS fit for PPI purposes?

B. Sang and C. Drinkwater

British Journal of Healthcare Management, vol. 14, 2008, p.161-163

In recent years there have been a number of attempts to legislate for a system of public and patient involvement in NHS decision-making. The authors discuss whether the latest plans to establish Local Involvement Networks (LINks) in each of the 150 Primary Care Trusts and unitary local authorities will work when previous attempts have failed.

Bold Sturgeon shows she has a softer side

J. Trueland

Health Service Journal, May 22nd 2008, p. 14-15

Report of an interview with Scottish Health Secretary Nicola Sturgeon covering the phased abolition of prescription charges in Scotland, her reversal of decisions to close accident and emergency departments in Ayr and Monklands hospitals, her philosophy of highlighting positive NHS achievements, the core policy of 'presumption against centralisation' and her opposition to marketisation of NHS Scotland.

Building a world-class NHS

I. Smith

Basingstoke: Palgrave Macmillan, 2007

The Labour government is committed to reforming a badly underperforming National Health Service. It has made a determined effort to solve two of the three problems that afflict the NHS - insufficient money and no policy to drive effective resource allocation. But the Government has failed to tackle the remaining problem - dysfunctional organization and poor management of the NHS. This book looks at the problems the NHS is facing, and provides new ideas for radical reform. Its objective is to offer the government recommendations as to how the reform process can be save d from failure.

Care pathways: legal sword or legal shield?

R. Griffith

British Journal of Healthcare Management, vol. 14, 2008, p. 156-160

Care pathways are a tool to manage the delivery of healthcare by setting out standards for evidence-based best practice in patient care and recording deviations from planned care in the form of variances. They are used in a number of areas to ensure that the care delivered to patients is consistent and efficient. This article considers the legal implications of care pathways and explores whether they can be used by patients to drive compensation claims or by healthcare managers to protect themselves from litigation by demonstrating that care is being delivered in accordance with a respected body of professional opinion.

Conciliation in healthcare: managing and resolving complaints and conflict

A. W. Platt

Oxford: Radcliffe, 2008

'Conciliation' is the term used in the National Health Service to describe a particular form of dispute resolution that is used in relation to the complaints process. Conciliation also has uses beyond the resolution of complaints. It can be of value in any situation where the clinical relationship has broken down. Equally, it may be used in an attempt to restore relationships as part of conflict management, either within the NHS or in other organisations where conflict or disagreement exists. The book is a comprehensive guide to the use of conciliation in the context of healthcare complaints and other situations of conflict or dispute. It explores the rationale for its use, and the situations in which it can be helpful. Practical advice is also given about the conduct of the conciliation process, highlighting the importance of appropriate support for both complainants and staff, and considering its relationship with other aspects of clinical and organisational governance.

Deaths from MRSA and C difficile in individual hospitals are revealed

S. Boseley

The Guardian. May 23rd 2008, p. 11

The Office for National Statistics has published figures revealing the numbers of deaths from MRSA and Clostridium difficile at individual hospitals in England and Wales. The figures show that 217 hospitals account for more than 80% of the total number of deaths from the diseases.

Glimpses into the future as first regional Darzi visions emerge

H. Crump and I. Torjeson

Health Service Journal, May 15th 2008, p.4-5

The first two regional plans spelling out what the Darzi review of the NHS will mean for patients were published in mid-May 2008. Key themes to emerge from NHS Yorkshire and Humber and NHS East of England's reports include a focus on tackling health inequalities, reducing waiting times and safeguarding popular services. A framework document published by Lord Darzi provides best practice on implementing reform, and highlights five key principles on which primary care trusts will be instructed to focus when delivering change. These are that change should benefit patients, that it will be clinically driven, locally led, involve patients, carers and the public, and that existing services will not be withdrawn until new ones are in place.

Growing pains: high immigration renders old picture obsolete

J. Rutter

Health Service Journal, May 15th 2008, p. 18-19

The Institute for Public Policy Research is undertaking a two-year study of the impact of migrants on healthcare in the UK. The research has highlighted the complexity of calculating this impact due to: 1) the extreme diversity of the migrant groups; 2) the presence of irregular migrants (failed asylum seekers and visa overstayers) with no entitlement to free healthcare; and 3) the rise of residential mobility within the UK and circular or short-term migration, leading to undercounting migrant populations. The article concludes that high levels of migration are set to continue, and plans need to be laid now to meet the needs of increasingly diverse communities.

Hospital services face axe in NHS shake-up

R. Smith

Daily Telegraph, May 9th 2008, p.1

In an interview with the Daily Telegraph, Lord Darzai has indicated that his review of the NHS will recommend transferring specialist services to large regional centres in the interests of patient safety. This means that patients may have to travel up to 60 miles for treatment. On the other hand, where care need not be provided in hospital, it could be moved to health centres and GP clinics closer to patients' homes.

Hospital surgery death rates to be made public

J. Carvel

The Guardian, May 29th 2008, p. 1

The death rates of NHS patients who have undergone major surgery will be published on the NHS Choices website from this summer. The statistics are expected to reveal that hospitals which undertake fewer operations have disproportionately high rates of death during surgery – linked to the minimal experience of the surgeons performing the operations. It is hoped that the publication of these statistics will improve standards by forcing trusts only to undertake those forms of surgery for which they demonstrate a high success rate.

New approaches to physician power

K. Harmond

British Journal of Healthcare Management, vol. 14, 2008, p. 143-146

The idea of a health service safe in the hands of skilled clinicians is attractive to the public, which believes that patient care rather than political priorities would shape services, that tough decisions would be taken on scientific rather than financial grounds, and that care systems would rely on evidence rather than custom and practice. This article looks at the lessons the NHS can learn from America's Institute for Healthcare Improvement when engaging physicians in healthcare management.

NHS reforms rule out closure of hospitals before election

J. Carvel

The Guardian, May 9th 2008, p. 10

The government has pledged that potential hospital closures, planned as part of a mass reform of the NHS, will not take place until well after the next general election. Details of the reforms are also set to promise that no services will be withdrawn until improved facilities are already in place.

NHS set to meet target of reducing waiting times to 18 weeks

J. Laurance

The Independent, May 30th 2008, p. 4

The NHS looks set to achieve its target of reducing waiting times to a maximum of 18 weeks between referral and treatment. 87% of patients are currently treated within the 18-week time limit, which is three points short of the Department of Health's target. Barring a flu pandemic or similar, targets should be fully met by next Christmas.

No holds barred in management battle

P. Castro, S. Dorgan and B. Richardson

Health Service Journal, May 22nd 2008, p. 18-19

New analysis indicates a clear link between certain management practices on the one hand and better healthcare and higher hospital productivity on the other. The research shows that NHS management practices lag well behind those of their private sector counterparts and of UK industry. However, the 104 NHS hospitals assessed performed much better in some areas than others. They scored almost as well as small manufacturers for lean operations, but less well on performance management and significantly below both private hospitals and all manufacturers for talent management. Hospitals with the best management had the shortest average length of stay, the lowest readmission rates and the best record for controlling hospital acquired infections. These hospitals also had the best Healthcare Commission service quality and resource usage ratings, the highest levels of patient satisfaction and medical staff productivity and by far the strongest financial performance.

On top of the world

C. Ham and J. Deffenbaugh

Health Service Journal, May 29th 2008, p. 22-24

Two healthcare management experts debate whether the drive to raise the standard of service commissioning really can transform quality of care. Ham argues that strengthening commissioning will not deliver quality improvements because in reality information and power in the NHS reside with providers, making it difficult for commissioners to negotiate on equal terms. Deffenbaugh replies that, despite previous failures, commissioning may succeed because it is now seen as critical to the reform of the NHS and has access to resources, tools to leverage change, and strong organisational support.

A plea for protection

S. Shepherd

Health Service Journal, May 1st 2008, p. 22-24

The number of sexually transmitted infections (STIs) continues to grow, with syphilis cases up 375% from 2001, HIV up 56% and Chlamydia up 57%. The target of seeing anyone who contacts a clinic within 48 hours has boosted access, but there are fears that sexual health is no longer a government priority. Campaigners want renewed focus on STIs, more targets to improve access, and much better local, regional and national commissioning and planning. This article presents a case study of how GUM services in Nottingham have been modernised to increase efficiency and improve access.

Quality has to bind the Darzi recipe for reform

A. Masters

Health Service Journal, May 29th 2008, p. 16-17

The author argues that improving quality must be the next national priority for NHS reform. Effective commissioning is the best way to improve quality. This requires enhanced skills, provision of outcome-based information on performance based on comparative quality data, introduction of performance-related pay, sanctions on poorly performing organisations, and more effective boards.

Quantum leap

H. Mooney

Health Service Journal, May 15th 2008, p. 24-26

The Royal Marsden foundation trust, the most famous specialist cancer hospital in England, is pioneering a satellite chemotherapy unit on the site of Kingston Hospital in south west London. It is intended to be the first of a series of units operated locally under the Royal Marsden banner. The ground floor of the new unit at Kingston will house a clinic jointly staffed by consultants from Kingston and the Royal Marsden, but the rest will be run as a day unit of the Royal Marsden. The move is part of a trend by well-known hospitals to open franchises, led by Moorfields Eye Hospital, which has 11 satellite units, including one in Dubai.

Record numbers are treated in hospital for alcohol problems

N. Morris

The Independent, May 23rd 2008, p. 7

The number of alcohol-related admissions to NHS hospitals in England rose by 7 per cent between 2005-06 and 2006-07 and last year's total was more than double 1995-96 figures. The NHS has warned that it faced an increasing burden from the effects of alcohol.

(See also The Times, May 23rd 2008, p.1; The Guardian, May 23rd 2008, p. 7)

Regulating medical bodies? The consequences of the 'modernisation' of the NHS and the disembodiment of clinical knowledge

S. Nettleton, R. Burrows and I. Watt

Sociology of Health and Illness, vol.30, 2008, p. 333-348

A recent series of reforms have aimed to modernise health care provision by making practices and procedures more transparent. Professionals are under scrutiny and the language of reform is replete with terms such as 'audit', 'governance', 'accountability', 'information' and 'performance'. In concert with the rhetoric of the monitoring of medical work, there is a rhetoric of support in the form of on-going training and professional development, flexible working practices and the ubiquitous concern with 'work-life balance'. This paper explores the consequences of these modernisation processes for the everyday lives of doctors working in the NHS.

Relapse for IT record system

N. Timmins

Financial Times, May 30th 2008, p. 2

Analysis of the impact of Fujitsu's departure from the Connecting for Health IT programme to provide every NHS patient in England with an electronic record.

Statins to be given to million more over-40s

R. Smith

Daily Telegraph, May 28th 2008, p. 1

New guidance from the National Institute for Health and Clinical Excellence urges GPs to trawl their records to identify patients over 40 at high risk of heart attack and stroke and call them in for advice and prescription of cholesterol lowering drugs. Implementation of the guidance should put 1.5 million more adults on medication and should prevent 15,000 heart attacks, strokes and new cases of angina every year.

Survey of adult inpatients in the NHS 2007

Healthcare Commission

2008

The survey suggests there have been recent improvements in areas that matter to patients. For example:

• A higher percentage of patients said they waited less than four hours to be admitted to a bed from A&E (67 percent in 2002, to 72 percent in 2006, and 73 percent in 2007)
• A higher percentage of patients said the quality of food is 'very good' (18 percent in 2002 and 2006, 19 percent in 2007) although there is still room for improvement
• A higher percentage of patients said the way that doctors and nurses work together was 'excellent' (36 percent in 2006, 39 percent in 2007), while 92 percent of patients described teamwork as 'excellent', 'very good' or 'good'
• A lower percentage of patients coming into hospital for a planned admission said they had shared a mixed-sex sleeping area when first admitted (ten percent in 2007, 11 percent in 2006).

But the survey also highlights variation in performance between trusts. The Commission said this was a particular issue in areas such as: waiting for hospital admission; mixed-sex sleeping areas and bathrooms; help from staff both with eating meals and in response to call buttons; cleanliness of wards and bathrooms; hand washing by staff; the quality of food; patient involvement in decisions; and arrangements for discharge.

Those in peril

C. Santry

Health Service Journal, May 22nd 2008, p. 30-32

A survey of 168 NHS professionals (middle managers, chief executives and clinicians) has shown that, although patient safety is a high priority for the NHS, national monitoring processes are not picking up failures and incidents are regularly going unreported. In total, a quarter of respondents said they were aware of a patient safety incident occurring in their trust over the past year that had not been reported. Overall, 71% of those surveyed agreed that national monitoring processes in patient safety were 'weak'.

(See also Health Service Journal, May 22nd 2008, p. 4-5)

Thousands of cancer beds 'could be lost' to save £500m

R. Alleyne

Daily Telegraph, May 12th 2008, p. 10

An analysis of figures published by the government in December 2007 as part of its Cancer Reform Strategy suggests that a massive closure of beds will be needed to release funding to pay for radiotherapy and drugs. Patients will receive chemotherapy and radiotherapy as day patients at local clinics without going into hospital. Cancer care will be centralised in large specialised hospitals where there is expertise to achieve the best results.

Trust and welfare state reform: the example of the NHS

P. Taylor-Gooby

Social Policy and Administration, vol. 42, 2008, p. 288-306

Empirical analysis of trust in public institutions suggests that it is best thought of as derived from two separate bases: cognitive, deliberative, rational consideration of track record, based on good information and a more affective acceptance that the trustee shares values and interests with the trustor. This article uses evidence from the British Social Attitudes survey to show that trust in the NHS is strongly influenced by perceptions that reflect these two approaches. The extent to which the service treats its users in ways that indicate it respects their interests is important alongside perceptions of more objective factors such as staffing levels and quality of treatment.

Trusting in the new NHS: instrumental versus communicative action

P.R. Brown

Sociology of Health and Illness, vol. 30, 2008, p. 349-363

Recent reforms within the NHS, particularly the introduction of clinical governance, have been enacted with the apparent aim of rebuilding patient trust following a series of high-profile scandals. Clinical governance is a tool by which the risks of negative consequences in healthcare outcomes are minimised through on-going monitoring of doctors' performance. It also marks a transition in knowledge management from 'embodied knowledge' held by the individual in tacit form, to 'encoded knowledge', where knowledge is disseminated across a community of doctors in the form of explicit guidelines, directives and standards. Individual autonomy is replaced by strong organisational control. This paper explores whether patient trust is a product of the system (instrumental rational efficiency of the institution) or the life world (qualitative interpersonal communication). It begins by examining the rationalisation of the NHS, extrapolating from this approach to a particular understanding of trust. The reforms are found to be consistent and coherent so long as patient trust functions in a highly instrumental way and is based on the perceived efficiency of the system. This approach neglects the importance of one-to-one communication between patient and medical professional in building trust.

The unspoken question over doctors' contract

D. Carlisle

Health Service Journal, May 1st 2008, p. 12-13

There are about 8,000 staff and associate specialist doctors in NHS hospitals who are in non-training jobs and will therefore not go on to become consultants. As many as 80% are non-white, mostly Asian. They signed a new contract in 2008, which will award them neither massive hikes in income like consultants nor reduced hours like junior hospital doctors. There is a suspicion that institutional racism may be to blame for the comparatively poor terms offered by the new contract.