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

Altogether now? Policy options for integrating care

C. Ham and others

University of Birmingham, Health Services Management Centre, 2008

Report explores models for the integrated care available to the NHS, covering integrated health and social care commissioning, primary healthcare integration, and primary and secondary care integration. These models would offer patients co-ordinated care, avoiding problems caused by the divide between GPs, hospitals and social care. However, there is a risk that the new integrated care organisations would evolve into huge, slow-moving, unresponsive monopoly providers.


'Anyone here a doctor who speaks nurse?'

M. Gould

Health Service Journal, June 26th 2008, p. 22-23

Medical errors in the NHS are often caused by communication problems among staff. As services become more specialist, they also become more fragmented, giving rise to serious communication problems. Managers, doctors, nurses, pharmacists, etc form separate tribes with their own terminology and slang. Such staff tribes often focus on their own agendas, rather than on the health of their patients. The National Patient Safety Campaign is aiming to make communication a priority for staff, patients and carers.

Cameron would scrap NHS targets in power

N. Watt and C. Higgins

The Guardian, June 24th 2008, p. 13

David Cameron has revealed that the Conservatives would scrap all central NHS targets if they were in government. The Conservatives would aim to save more than 100,000 lives a year by adopting a system focused on measuring 'health outcomes' and raising NHS standards.

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

Public Accounts Committee

London: TSO, 2008 (House of Commons papers, session 2007/08; HC390)

The Committee examined the quality and effectiveness of neonatal services in caring for these most vulnerable members of our society. It looked at the ability of the system to meet increased demand for neonatal services, the benefits of networking neonatal units, recruitment and training of staff and the impact on health inequalities. It found that premature babies born at neonatal units across England are being put at unnecessary risk due to hospital understaffing. Babies born prematurely are often at risk of infection and death as around half the neonatal networks in England do not have access to a 24-hour specialist transport service and only 24% have enough qualified staff to achieve the British Association of Perinatal Medicine is recommended ratio of one nurse to every baby.

A checklist that could prevent thousands of deaths

J. Laurence

The Independent, June 25th 2008, p. 2

An aircraft-style safety test is to be implemented in all British hospitals to reduce the risk of surgery, using a simple check-list that has been proved to save thousands of lives. More than eight million operations were carried out in the UK last year and there were 129,000 reported incidents in which patients were put at risk.

Computing for the NHS: 45 years of support

J. Roberts

British Journal of Healthcare Management, vol. 14, 2008, p. 228-232

The author tracks the development of healthcare computing from its inception almost 50 years ago to the present day. It examines the key phases of development from unconnected unidisciplinary solutions to the complex multi-agency solutions that underpin effective modern healthcare. She concludes that health informatics can have a strong positive impact on patient safety and health status, as well as improving effectiveness in care delivery and management.

The Corporate Manslaughter Act: are you prepared?

J. Harwood

National Health Executive, vol.1, Mar./Apr. 2008, p. 60-61

Under the Corporate Manslaughter and Homicide Act 2007 an organisation can be convicted of manslaughter where a death is caused by the way it manages its affairs and this amounts to a 'gross breach of a duty of care' owed by that organisation to the deceased. This article explores the implications of the Act for the NHS and warns managers to ensure that key risks to patients, staff and third parties are regularly assessed and responded to.

(See also Journal of Management and Marketing in Healthcare, vol.1, 2008, p. 297-305)

Developing the NHS performance regime

Department of Health 2008

This document is designed to afford greater transparency and consistency across the NHS in relation to identification of underperformance, interventions to address turnaround, and managing failure. Initially, underperforming trusts will be given three months to improve. If failing trusts cannot demonstrate sufficient improvement after three months, they will be classed as 'seriously underperforming'. After six months, the strategic health authority (SHA) will give the NHS chief executive a progress report. Evidence of insufficient progress may lead to the organisation being labelled 'challenged'. The SHA will then agree a turnaround plan and will be able to impose interim managers and remove board members. If there is no improvement after a further year, primary care trusts may be taken over by another PCT or have their functions outsourced. Hospitals may be closed or merged with a foundation trust.

(For comment see Health Service Journal, June 12th 2008, p. 14-15)

Electronic patient records: finding the right solution

K. Middlehurst

British Journal of Healthcare Management, vol. 14, 2008, p. 233-235

This article outlines the criteria that foundation trusts should use when selecting an electronic patient record system: ? A good electronic patient record system should have robust security features to protect confidential information and to make staff more accountable ? Thorough staff training and involvement are critical to success ? The system needs to be flexible and to have continuous supplier support throughout its lifetime.

Failing hospitals to get private sector bosses

J. Carvel

The Guardian, June 4th 2008, p. 2

In an attempt to improve services to patients, failing NHS hospitals may be put under private sector management. Private hospitals do not yet have experience of running emergency services in Britain, so the proposed plans would be a radical departure from current practice. The government's plans will also give the NHS chief executive, David Nicholson, the power to sack entire boards of hospitals unable to meet targets for improvement.

(See also The Times, June 4th 2008, p. 8; Daily Telegraph, June 4th 2008, P. 1&2)

Heart patients dying due to poor hospital care, says report

S. Boseley

The Guardian, June 4th 2008, p. 5

A new report funded by the Department of Health has found that one in five patients who undergo heart bypass operations are not receiving the best care while in hospital. Delays in recognising a patient's deterioration following surgery or in referring problems onto more senior colleagues are often to blame for the deaths of some heart patients who might otherwise survive.

Is the treatment working? Progress with the NHS system reform programme

Healthcare Commission and Audit Commission

London: Audit Commission, 2008

The report looks at the ambitious programme of market-style reforms that aim to improve efficiency and effectiveness and were first set out in the NHS Plan of 2000. It evaluates the key elements: giving patients more choice; greater NHS use of the independent sector; the creation of foundation trusts; practice based commissioning; and Payment by Results. It also reviews the impact of major changes to employment contracts with NHS staff. The report concludes that almost 1bn spent on increasing choice and competition in the health service have not yet delivered any significant benefits to patients. About half of patients are still not being given a choice about where they are treated, and the changes have also failed to increase the numbers of patients being treated outside of hospital. Moreover, there is insufficient information available from the NHS to allow patients to make an informed choice.

Latest cure failed its first clinical trial

N. Timmins

Financial Times, June 5th 2008, p. 3

Argues that yesterday's announcement of a new regime to tackle failing NHS hospitals, including the possibility that the private sector might take over their management, is not really new but a continuation of the management initiative started in 2001 under Nigel Crisp. Includes a table of hospitals and PCTs that are seen as potential candidates for private sector intervention.

(See also The Guardian, June 5th 2008, p. 12; The Times, June 5th 2008, p. 21)

The LINks effect

M. Vivian

National Health Executive, vol.1, Mar./Apr. 2008, p. 68-69

The Local Government and Public Involvement in Health Act which came into force on 1st April 2008, enables Local Involvement Networks (LINks) to begin to be set up. Authorised LINks representatives will have the right to enter specific services and view the care provided. They can also ask for information and make recommendations, getting a response within a specific timescale, and refer matters of concern to the local overview and scrutiny committee.

Local inequalities mark map of wellbeing

S. Boseley and J. Carvel

The Guardian, June 24th 2008, p. 9

Research has been released by the Association of Public Health Observatories which reveals that there are big disparities between the health of people in different parts of England. Data on more than 30 key indicators were collected which revealed the inequalities in regional health standards in an attempt to allow health workers across all regions to address the particular health issues in their area.

Modernising medical careers

Health Committee

London: TSO, 2008 (House of Commons papers, session 2007/08; HC25)

For many years there have been concerns about the poor training and indifferent career prospects experienced by some hospital doctors. The Modernising Medical Careers (MMC) Programme was established in 2003 to address these difficulties. As a result of inadequate preparation during the implementation of the reforms, the MMC Programme was plunged into crisis in 2007. The new centralised recruitment system, the Medical Training Application Service (MTAS), proved highly unpopular with both candidates and assessors. The number of applicants was also much higher than expected, creating fierce competition for posts. The Committee's inquiry has exposed serious problems with the management of the MMC reforms, and particularly the introduction of MTAS, by the Department of Health and its partners. A divided and inappropriate governance structure, flawed project and risk management, and poor communication with junior doctors were the most serious failings. The Inquiry also uncovered wider problems with the policy development and leadership of MMC within the Department of Health.

Nurses to be rated on how compassionate and smiley they are

J. Carvel

The Guardian, June 18th 2008, p. 1

As part of a government plan to improve quality of care and to tie in with the upcoming 60th anniversary of the NHS, nurses are to be scored on how compassionate they are towards patients.

(See also Daily Telegraph, June 18th 2008, p. 14)

Nurses' clinics to compete with GP's surgeries

C. Brown

The Independent, June 27th 2008, p. 21

A report by Lord Darzi, the Health Minister, will propose that nurses run their own 'companies' inside the NHS to compete with traditional family doctor surgeries and provide more services to patients, offering physiotherapy, health checks for illnesses such as diabetes, and immunisation programmes.

(See also The Guardian, June 27th 2008, p. 2; The Guardian, June 30th 2008, p. 7)

On the long road to recovery

N. Timmins

Financial Times, June 30th 2008, p. 4

In the first of a five-part series, Nicholas Timmins examines the NHS and the main issues facing it now and in future. This first article looks at the foundation and history of the NHS, and its strengths. It includes charts comparing historic and latest available data for spending, staffing, waiting lists, numbers of practitioners and beds.

A patient must be allowed to top up their treatment

K. Sikora

Daily Telegraph, June 2nd 2008, p. 8

The NHS is unable to fund many of the expensive new treatments for cancer which are becoming available. At present patients who wish to supplement NHS care by paying for one of these new drugs personally, are told that they must pay for all their treatment privately. The author argues that patients have already paid for basic care through taxation, and should be allowed to help out the NHS by making top-up payments for extra treatments.

Polyclinics 'will mean longer trips to see your GP'

K. Devlin

Daily Telegraph, June 9th 2008, p.1+2

There are concerns that hundreds of GP surgeries will be closed and replaced by polyclinics and GP-led health centres. Patients could then be forced to travel up to three times as far as now to see their doctor. Patients living in rural areas will be worst hit.

(See also The Times, June 9th 2008, p. 6+7; Daily Telegraph, June 12th 2008, p. 1; The Guardian, June 11th 2008, p. 17; The Guardian, June 13th 2008, p. 12; Daily Telegraph, June 18th 2008, p.4)

Quarter of NHS trusts failing hygiene tests

J. Carvel

The Guardian, June 16th 2008, p. 3

The Healthcare Commission has released figures indicating that more than a quarter of NHS trusts in England are at risk of losing their licence to treat patients because of their failure to meet basic hygiene standards. Trusts will have 10 months to solve the hygiene problems before a tougher regime is introduced in April 2009 which could result in the closure of hospitals in failing trusts.

(See also The Independent, June 16th 2008, p. 13; Daily Telegraph, June 16th 2008, p.1)

Reconciling two conflicting tales of the English health policy process since 1997

A. Alvarez-Rosete and N. Mays

British Politics, vol. 3, 2008, p. 183-203

This article identifies and investigates two seemingly conflicting accounts of the development of the English health policy process at the national level since 1997. The first account points to a high degree of central political control over the initiation and development of policy, and the maintenance of a system of strong central government. The second account describes a system of 'network governance', suggesting a more complex health policy process in which central government (in particular the Department of Health) is weaker than before and no longer holds a monopoly over the health policy-making process. This paper reviews the empirical evidence on the English health policy process since 1997 to determine which of the two narratives more accurately captures its nature at the national level.

Reform of NHS dental service has left nearly one million patients worse off

D. Rose

The Times, June 6th 2008, p. 27

The NHS Information Centre has released information which indicates a significant fall in the numbers of people visiting NHS dentists since the Government's new dental contract was implemented in April 2006. The report has also indicated that there is wide variation across the country in terms of access to an NHS dentist, with the South of the country indicating lower access figures than the North.

(See also Daily Telegraph, June 6th 2008, p. 1; The Independent, June 6th 2008, p. 4; The Guardian, June 6th 2008, p. 7)

Regions braced for change as plans put Darzi's vision on map

A. Moore

Health Service Journal, June 19th 2008, p. 14-17

Presents an overview and analysis of the regional plans and proposals produced by Strategic Health Authorities under the Darzi Review, with comment from experts in the field.

Running out of steam

N. Plumridge

Public Finance, May 23rd-29th 2008, p. 20-23

Independent sector treatment centres (ISTCs) were introduced into the NHS to boost capacity and cut waiting times for elective surgery. The contracts offered to the first wave of providers were very generous in order to tempt private firms to enter the market. ISTCs were guaranteed payment whether or not the contracted levels of activity were delivered. This made them very unpopular with NHS hospitals, which were also concerned about having to fix the mistakes made by inexperienced surgeons employed by the centres. Contracts for second wave centres are currently being negotiated, with considerably tighter terms and much more NHS involvement.

Skills development

S. Shepherd (editor)

Health Service Journal, June 19th 2008, supplement, 9p

Healthcare providers across the UK face a serious challenge in developing their workforces to meet changing demands, including population ageing, the rise in numbers of patients with long term conditions, and policy drives to deliver care closer to home. This special supplement sets out what Skills for Health is doing to help providers meet these challenges, covering sector skills agreements, a new qualifications strategy, and the development of new staff roles to meet changing needs.

Thousands hit by maternity closures

R. Smith

Daily Telegraph, June 27th 2008, p. 1+2

The Conservative Party has discovered that:

  • 10 NHS maternity units have closed
  • Five units have been downgraded from obstetrician-led to midwife-led
  • 15 maternity units are under threat of closure and there are plans to downgrade a further 11

These changes are part of government plans to concentrate services at large specialist facilities where consultants can be on call around the clock.

Top-up treatment reviewed

N. Hawkes

The Times, June 18th 2008, p. 20

The Heath Secretary Alan Johnson has asked Mike Richards, the national director for cancer, to re-examine current Government policy which effectively penalises patients who pay towards their treatment with private funds.

(See also The Guardian, June 18th 2008, p. 6; Daily Telegraph, June 18th 2008, p. 4)

We'll scrap targets to save lives, Cameron pledges

R. Winnett

Daily Telegraph, June 24th 2008, p. 1+4

The Conservatives argue that, in spite of record investment in the NHS by New Labour, England has some of the worst health outcomes in Europe. They would, if elected, scrap all centrally imposed NHS targets and replace them with information on how likely patients are to survive or recover after treatment in individual hospitals. Patients and G Ps would then choose where to go for treatment and it is hoped that consumer power would drive up standards.

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