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

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

Committee of Public Accounts

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

Neonatal services provide care to babies born prematurely or with an illness or condition that requires specialist care. Over the last 20 years, neonatal services have undergone substantial organisational and technological changes whilst remaining a challenging and innovative area of medicine. Following a 2003 review of neonatal services, the 180 neonatal units based in the English National Health Service and Foundation Trusts were organised into 23 geographical, managed clinical networks. Demand for neonatal care has risen year on year: in 2006-07 around 60,000 babies (roughly one in ten births) were admitted to neonatal units, at a cost to the NHS of some £420 million. This report examines the quality and effectiveness of neonatal services and looks at the ability of the system to meet increased demand. Conclusions and recommendations include:

  • The networks have developed at different rates and two areas have yet to establish a formal managed network.
  • Networks have helped improve communication and co-ordination between units and have made progress in reducing the number of times babies have to be transferred long distances to obtain the necessary level of care.
  • There has been less progress on a key review recommendation for networks to re-designate units to ensure that the supply of intensive, intermediate, and special care matches demand.
  • The NHS still has limited data on patient outcomes, other than mortality rates, which show unexplained variations between networks.
  • Constraints in capacity mean that the Department of Health is still struggling to meet the demand for neonatal services, and problems over recruiting, retaining and training the staff required to deliver the service remains a major challenge.
  • Financial management at the unit level needs to be improved. Neonatal units have a poor understanding of the costs of running their unit and there are differences in how units' determine their charge for a cot day with wide variations in charges between similar types of unit.

All doctors face annual test of their competence

D. Rose

The Times, July 23rd 2008, p. 1 & 11

The Chief Medical Officer, Sir Liam Donaldson, has published a report which recommends that all doctors should be required to apply to renew their licence to practice every five years and to undergo mandatory annual reviews. The recommendations are intended to identify doctors who repeatedly make poor clinical decisions and will replace the more informal peer led performance reviews that are currently used for assessment. A trial of the system will start in two years time.

Are we choosing health?

Healthcare Commission and Audit Commission

London: Healthcare Commission, 2008

This report reviews how well the NHS and local government are tackling the issues of health improvement and health inequalities at a local and national level. It focuses on the impact of several policies all of which have a remit to improve problems such as smoking cessation, obesity, alcohol misuse, sexual and mental health, and well-being among young children and older people. Where targets have been clear, they have been successful. Improving access to sexual health services has worked because there was a target for patients to be seen within 48 hours. However, rising levels of alcohol misuse and obesity risk reducing life expectancy and there has been too little action to tackle the problems, too late. Progress in improving public health has been slowed because money has been diverted to address deficits and pay for reorganisations.

Arthritis victims suffer in drug rationing

R. Smith and S. Adams

Daily Telegraph, July 21st 2008, p. 1

The National Institute for Health and Clinical Excellence has issued a final appraisal of anti-TNP drugs for patients with rheumatoid arthritis. Three anti-TNP drugs are available on the NHS and until now doctors have been able to switch patients between them. However, the new appraisal could put a stop to this practice, despite it being impossible to tell in advance which one will work on a given individual. Doctors and patient groups are critical of the new approach, calling it a prescription for pain.

Darzi drives doctors to scale the dizzy heights

A. Moore

Health Service Journal, July 10th 2008, p. 12-13

Lord Darzi's review of the future of the NHS calls for the development of clinical leadership to improve service quality. He has proposed establishing an NHS leadership council to be responsible for overseeing all matters of leadership across healthcare. However, the review focuses on leadership by doctors more than by nurses or other professions allied to medicine.

Drifting apart: why the gaps are getting bigger

J. Allen

Health Service Journal, July 17th 2008, p. 16-17

Government set a target in 2002 of reducing health inequalities by 10% by 2010. However, inequalities in life expectancy and infant mortality between socio-economic groups are widening. The author points out that the NHS itself may be contributing to widening health inequalities because those most in need of care have worse access. There are widespread socio-economic, ethnic and age-related differences in access to best quality services, information and treatments offered.

Free health treatment for all anywhere in EU by 2011

K. Devlin

Daily Telegraph, July 3rd 2008, p. 6

The European Commission is proposing new rules that would enable patients to elect to be treated in any member state at NHS expense without prior authorisation. The UK government stands opposed to this, and insists that only patients who have been given the go ahead by the NHS would have the cost of their treatment reimbursed.

Health 2.0 empowers plugged in patients

D. Carlisle

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

Patients are exchanging experiences of NHS treatment through social networking web sites. This article presents arguments for and against the NHS engaging the public in online dialogue via health 2.0 facilities.

HealthSpace site lets patients manage medical records online

D. Batty

The Guardian, July 4th 2008, p. 4

The government is piloting a new website, HealthSpace, which allows patients to manage their own health records online in an attempt to give people more control over their health care. Records on the website are intended to be in addition to patients' medical records and users will not be able to change their records through the site.

The heat is on

D. Carlisle

Health Service Journal, July 3rd 2008, p. 28-31

Outlines the challenges that the NHS will face in the future due to population ageing, global warming, the emergence of Web 2.0 facilities such as online patient controlled health records and personal health monitoring systems, and the development of clinical genetics.

Hello, goodbye

A. Moore

Health Service Journal, July 10th 2008, p. 22-24

The NHS is moving towards a situation where sufficient numbers of healthcare professionals are trained in the UK to meet demand. The number of new recruits from overseas has slumped as vacancies have dried up. There is an increasing perception that the UK no longer welcomes overseas staff.

High quality care for all: NHS next stage review final report

Department of Health

London: TSO, 2008 (Cm7432)

The final report of the Darzi review of the future of the NHS recommends:

  • The creation of an NHS constitution clearly stating patients' rights and entitlements, including the right to be treated with dignity and respect in a clean environment.
  • Giving patients a legal right to choose where to be treated and which GP to register with for routine care
  • Publishing high-quality comparative information about a range of services to help patients make informed choices about their care
  • Bonus payments to GPs and hospitals providing high-quality care in clean premises that are praised by patients. However, providers would be fined if they fell short of the new standards. For example, hospitals would not be paid for botched operations or catastrophic medical errors. GPs would be rewarded for maintaining their patients in good health as well as providing good care. Hospitals would be judged on a set of measures to include infection rates, cleanliness and success of treatments.
  • Requiring primary care trusts to fund all drugs that have been approved by the National Institute for Health and Clinical Excellence (NICE), which would be expanded to complete its assessments of new treatments more quickly.
  • Providing patients with long-term conditions with individual budgets to purchase their own care. Proposes that personalised budgets should be piloted with 5,000 patients in 2009. There would be safeguards to ensure that patients who had spent their budgets were not denied care.
  • Free tests to detect heart disease, diabetes and kidney disease to be offered to everyone between 40 and 74 from 2009.

(For comment see Health Service Journal, July 3rd 2008, p. 4-9; for an interview with Gordon Brown and Lord Darzi see Health Service Journal, July 3rd 2008, p. 24-27))

Hospitals where risk of dying in surgery is tripled

K. Devlin

Daily Telegraph, July 11th 2008, p. 8

The Department of Health has published statistics showing wide variations in death rates from operations across England. The risk of dying from a major operation in some hospitals is more than three times the expected rates. However, the Department of Health said the figures were not statistically significant because of the low numbers of patients involved.

(See also The Independent, July 11th 2008, p. 6)

Life savers in deep water

R. Norris

Health Service Journal, July 17th 2008, p. 22-24

Three confidential inquiries into why people die currently cover maternal and child health, patient outcomes and death, and homicide by people with mental illnesses. Cuts in death rates can be directly linked to the inquiries' findings and they have influenced national policy and targets. Funding is proving an ongoing challenge, with one inquiry able to follow up only two of the thirty topics suggested each year.

The limits of knowledge management for UK public services modernization: the case of patient safety and service quality

G. Currie, J. Waring and R. Finn

Public Administration, vol. 86, 2008, p. 363-385

In the ongoing drive to improve public services in the UK, there is interest in the contribution that the effective management of knowledge across organisational and professional boundaries can make. In this article the authors empirically investigate the potential for knowledge sharing within the NHS modernisation agenda, focusing on patient safety. Current policy seeks to improve patient safety in the UK through the introduction of the National Reporting and Learning System (NRLS), which aims to facilitate the sharing of knowledge across occupational and organisational boundaries. This study evaluates the impact of the introduction of the National Reporting and Learning System on operating theatres within a university teaching hospital.

Marking the end of an era?


Labour Research, July 2008, p. 9-11

Health service unions say that the outlook for the NHS in England is gloomy, as increasing levels of privatisation will mean that it can no longer conform to its founding principles of providing equal access to free care. They regard the use of private funding for new hospital buildings, patient choice and personal budgets as particular threats.

The nation fears for the future of the mismanaged, wasteful NHS

A. King

Daily Telegraph, June 30th 2008, p. 1 + 8

A YouGov opinion poll shows that a large majority believes that much of the money invested in the NHS by New Labour has been wasted. Most people are still satisfied with the treatment they receive, but the proportion satisfied has fallen from 91% in 1998 to 81%. Most people also say that they detect no recent improvement in the health service, and only 21% look forward to any real improvement in the future. Almost no respondents believe that the NHS is efficiently managed, and 82% say that it wastes either a great deal or a fair amount of money. People nevertheless are resistant to change, remaining opposed to local decision-making and to the idea of concentrating services in large specialist hospitals.

The National Programme for IT in the NHS: progress since 2006

National Audit Office

London: TSO, 2008 (House of Commons papers, session 2007/08; HC484)

The National Programme for IT in the NHS was launched in 2002 to reform the way in which the NHS in England uses information. This report examines progress in delivering the Programme in respect of:

  • Progress against time - finds that it is likely to take some four years more than planned to fully deploy the electronic care records system. Good progress is being made with other elements of the Programme.
  • Progress against cost - the estimated total cost of the Programme remains unchanged at £12.7bn, but it is difficult to produce a reliable estimate of local costs
  • Progress in realising benefits - some benefits, including financial savings, are starting to emerge.
  • Technical performance of the systems - suppliers have largely met targets for service availability and performance deductions have been applied where there have been service failures. Trusts have experienced technical problems in using the new care records systems, especially in the period following a deployment.

The report also identifies five challenges to be managed for the successful delivery of the programme:

  1. achieving strong leadership and governance
  2. maintaining the confidence of patients in the security of their records
  3. securing the support of clinicians and other NHS staff
  4. managing suppliers effectively
  5. using the systems effectively at the local level.

NHS urged to shed market systems


Financial Times, July 8th 2008, p.2

The British Medical Association is calling for the NHS in England to abandon choice, competition and market-like mechanisms and use integrated care, like Scotland's health service.

Novelty of treatment for the masses

N. Timmins

Financial Times, July 4th 2008 p. 4

This article is one of a series looking at the development of the National Health Service since its creation sixty years' ago. It focuses on universal access to care, the quality of patient treatment, and working conditions for doctors and other medical staff, from the early years of the NHS to date. It uses contemporary sources from 1948 as well as recollections from GPs and other health workers.

Patient choice: friend or foe?

S. Bojakowski

Journal of Management and Marketing in Healthcare, vol.1, 2008, p. 252-261

In the NHS patient choice will always be limited by resource constraints. At present patients can choose where they want to be treated, but cannot choose expensive treatments which are beyond the means of the NHS. The choice agenda appears to be evolving into personalisation, which focuses on empowering patients to comment directly to hospitals on the sort of care they require. There may be an opportunity for the private healthcare sector to compete with the NHS by making available treatments to which NHS patients are denied access.

The patient movement as an emancipation movement

C. Williamson

Health Expectations, vol. 11, 2008, p. 102-112

The many and diverse patient groups, individual patients and patient representatives, activists or advocates who want to improve healthcare can be said to constitute the patient movement. It is a new social movement based on its supporters' values rather than on their socio-economic disadvantages, but lacks an explicit ideology. This article analyses the key features of patient activism and finds parallels between it and recognised emancipation movements in respect of its radicalisation of activists, creation of new knowledge, identification of guiding principles, recruitment of allies, proneness to schism, unmasking of new issues, and the gradual social acceptance of some of its key ideas.

Private hospitals to follow NHS in publishing patient outcomes and death rates

N. Timmins

Financial Times, July 29th 2008, p. 3

David Nicholson, NHS chief executive, has told the Commons Health Committee that from 2009, when the private and NHS sectors will come under the same regulatory umbrella, private hospitals will have to publish an annual quality report showing how many patients they treat, outcomes and death rates. This means that for the first time, direct comparison with NHS hospitals will be possible.

The role of the private sector in improving access to clinical services: a case study of trauma and orthopaedic services

J.A. Rafferty, G. Marchand and A. Reed

Journal of Management and Marketing in Healthcare, vol. 1, 2008, p. 273-285

This article reflects on the role of the independent sector in the NHS in England. The independent sector provides the extra capacity in the health system which enables the implementation of patient choice, and contributes to delivering the government's objective of promoting diversity in the supply of healthcare. It will also contribute to the delivery of the government's final access target, 18 weeks from referral to treatment.

SHAs and trusts lock horns over who leads on future shape of workforce

C. Santry

Health Service Journal, July 31st 2008, p. 4-5

Lord Darzi's next stage review of the NHS is being criticised for granting Strategic Health Authorities (SHAs) extra workforce planning powers. The section causing most alarm refers to primary care trusts submitting workforce plans to SHAs, to be merged into a single regional strategy. This seems to contradict a statement elsewhere in the report that “most workforce planning [will be] carried out at a local provider level”. There are concerns that trusts are being sidelined.

Shift in IT policy as trusts are told they can develop their own system

S. Gainsbury

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

The Department of Health has signalled a shift in the national programme for IT that will see it supporting organisations that want to develop their own systems. Trusts looking to develop local systems will be helped to ensure that these will be able to “talk to” a future national system.

Sign here, please …


Health Service Journal, July 3rd 2008, p. 32

Argues that the main challenge facing the NHS is to reduce spiralling demand for its services by investing in disease prevention. In future the NHS will have to build a contract with citizens which makes treatment for illness conditional on their living a healthy lifestyle. People who break the contract by making the 'wrong' lifestyle choices would find themselves excluded from treatment by a less paternal NHS. There will be an expanded role for employers and occupational health services in promoting the good health of the working age population.

Signed and delivered - the rules in writing

K. Walshe

Health Service Journal, July 24th 2008, p. 14-15

For 60 years since its establishment the NHS has existed in a legal vacuum. Its founding legislation gave the Secretary of State for Health almost unfettered power to run it like a medieval fiefdom. The author supports Lord Darzi's proposals for a NHS constitution. This should provide a simple and coherent statutory framework, set out in legislation and enforceable by the courts, which outlines the rights, powers and duties of five key actors: individual patients; communities and their representatives (including local authorities and patient groups); NHS organisations; private healthcare organisations working with the NHS; and the Department of Health and national agencies such as the Healthcare Commission and Monitor.

Sixty years of the National Health Service

E. Dent (editor)

Health Service Journal, July 3rd 2008, Supplement, 76p

This supplement charts the currents that have shaped the modern NHS, from management, politics, clinical practice, campaigns and public expectations to architecture, the media and popular culture. It includes reminiscences from those who were in post when the NHS was launched and frank recollections from former Health Secretaries. It discusses five days that shook the NHS and identifies the 60 people who have had the greatest influence on it. The stories and analyses reveal a service that has been transformed. Managers have changed from clerks into strategic leaders; clinicians have moved from rigid hierarchies into multidisciplinary teams; mental health services have moved out of asylums and into the community; and the focus on healing the sick is being replaced by an emphasis on disease prevention.

Towards better births: a review of maternity services in England

Healthcare Commission

London: 2008

This investigation into antenatal, birth, and postnatal care was ordered after high death rates were found amongst new mothers at a succession of hospitals. It found that some women are giving birth on a virtual conveyor belt because maternity wards are overcrowded and understaffed. Some are rushed through so quickly that more than one mother gives birth in each bed every day. Consultants are not present on the wards enough of the time, doctors and nurses do not get on with each other and severe staff shortages mean that women are left alone and distressed during labour. Women are often turned away from maternity units while in labour because they are full. Neonatal units are also overstretched and have to turn away babies needing intensive care, so that families have to travel hundreds of miles to get treatment.

Will the latest plans see a renaissance in maternity services?

D. Carlisle

Health Service Journal, July 3rd 2008, p. 14-15

In spite of many attempts at reform since 1993, the reality of maternity services falls far short of the ideal, which is to offer women a choice over where and how to give birth. Midwives are in short supply in many areas, and promised extra funding has not come through, having been subsumed into PCTs' general budgets. There are concerns about the cost effectiveness of home birth services and midwife-led units, which have not proved as popular with women as expected.

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