Welfare Reform on the Web (May 2000): National Health Service - Reform - General
A&E SERVICES UNAFFECTED BY DOUBLING OF CALLS TO NHS DIRECT
M. Gould
Health Service Journal, vol. 110, Mar. 2nd 2000, p. 7
Analysis of calls rates at three pilot NHS Direct sites showed that use of the helpline doubled between its first and second years of operation, but there was no evidence of it fuelling demand for emergency services.
ACCESS TO DENTAL SERVICES AND RECRUITMENT OF SALARIED GDPS: A SURVEY OF HEALTH AUTHORITIES
British Dental Association London: 1999
Results show that a third of the health authorities reported an increase in calls about problems with access to a dentist and that two-thirds were short of dentists, up from a half in 1998. The BDA estimates that another 570 dentists are needed to improve the situation.
ACCESS TO ELECTIVE CARE: WHAT SHOULD REALLY BE DONE ABOUT WAITING LISTS
A. Harrison and B. New
London: Kings Fund, 2000
Favours a system of access to non-urgent or "elective" care used in New Zealand. Using a points system, hospital specialists decide who should be treated in the next six months. Patients become eligible for treatment as their condition becomes troublesome. Everyone else is returned to GP care.
ALL THINGS TO ALL MEN
L. Donnelly
Health Service Journal, vol. 110, Feb. 17th 2000, p. 13-15
Reports reaction to the National Beds Inquiry. Consensus appears to be that the most likely outcome is a reduction in acute beds combined with an improvement in home care brought about by increased numbers of district nurses and GPs.
AS NOT SEEN ON TV
M. Cross
Health Service Journal, vol. 110, Mar. 9th 2000, p. 26-28
Telemedicine is crucial to the future of the NHS and has the potential for delivering massive cost savings. It is developing strongly in the areas of accident and emergency services, minor injuries units, outreach clinics and linking GP practices to hospital care.
BLAIR IN POLICY SHIFT ON PRIVATE HOSPITALS
N. Timmins
Financial Times, Mar. 1st 2000, p. 2
Reports that Tony Blair stated in a TV debate that there was no objection to the NHS paying private hospitals to treat patients provided that funds were available.
(See also Health Service Journal, vol. 110, Mar. 9th 2000, p. 6-7)
BLAIR THREATENS THOSE "WHO WILL NOT CHANGE"
Anon.
Health Service Journal, vol. 110, Mar. 2nd 2000, p. 5
In a speech delivered at St Thomas' Hospital, Tony Blair toughened his stance on poorly performing managers who resist change and signalled that they could lose their jobs. At the same meeting he resisted pressure to abandon the waiting list initiative, which was alleged to be disturbing clinical priorities. He also spelled out a five point plan for the reform of accident and emergency services which will involve giving trained A&E nurses increased powers to order tests and prescribe drugs; fast tracking patients to the appropriate speciality; and cutting waiting times by separating treatment of major and minor conditions.
(See also Guardian, Mar. 1st 2000, p. 1; Independent, Mar. 1st 2000, p. 3; Health Service Journal, vol. 110, Mar. 9th 2000, p. 18)
CARING FOR PROFIT
S. Ward
Public Finance, Jan. 28th - Feb. 3rd 2000, p. 16-18
Explores the controversy over the role of the private sector in health care provision. Depending on your perspective, a growth in private provision would relieve the pressure on the NHS or begin to reduce it to a rump service for the most deprived.
DOCTORS AND DENTISTS TOLD TO 'OPEN ALL HOURS'
A. Frean
Times, Mar. 10th 2000, p. 8
Doctors and dentists will be required to open their surgeries in the evenings and at weekends under government plans to ensure that public services are able to meet consumer demand in the 24 hour economy.
(See also Independent, Mar. 10th 2000, p. 5)
DOCTORS AND NURSES DRAFTED IN TO MANAGE THE NHS
J. Sherman
Times, Feb. 23rd, 2000, p. 1
Alan Milburn, the Health Secretary, is planning a fundamental reorganisation of health service management to bring doctors, nurses and hospital chiefs into top NHS jobs. He plans to enlist 15 top professionals to advise on raising standards and modernising hospitals and GP services.
FATAL LACK OF ACUTE CARE BEDS REVEALED
I. Murray
Times, Feb. 18th 2000, p. 10
According to a new scientific study in the Lancet patients in England and Wales are dying because there are fewer than half the required adult intensive care beds. The study looked at admission to the intensive care and high dependency beds in South Wales over a year. A spokesman for the Health Department said that a review of critical care provision was under way.
FINGER OF BLAME
K. McIntosh
Health Service Journal, vol. 110, Feb. 3rd 2000, p. 16-17
The image of GPs as kindly practitioners may never recover from the unmasking of Dr Harold Shipman as a serial killer. Doctors and managers are calling for the urgent reform of the system for monitoring unexpected deaths.
FLEET OF FOOT
J. Snell
Health Service Journal, vol. 110, Feb. 24th 2000, p. 26-28
Looks at the implications of an ageing workforce and an early retirement culture for NHS staffing.
'GRANNY WARDS' TO RELIEVE NHS BED SHORTAGE
G. John
Independent, 31st Jan. 2000, p. 6
Wards specifically for elderly patients recovering after treatment are to be created to relieve bed shortages in NHS hospitals. These will be run by consultant nurses. Convalescent homes are also set to re-emerge to enable elderly people to be moved out of costly hospital beds but looked after until they are ready to go home. More intensive domiciliary care will also allow some elderly patients to go home sooner than is now possible.
(See also Guardian, Feb. 3rd 2000, p. 9; Daily Telegraph, Feb. 3rd 2000, p. 19)
GREAT EXPECTATIONS
L. Eaton
Health Service Journal, vol. 110, Feb. 10th 2000, p. 13-15
Argues that the impact of new Labour reforms of the NHS such as the introduction of new technology and the establishment of Primary Care Groups, the National Institute for Clinical Excellence, and the Commission for Health Improvement will not be felt until after the next general election.
HEADACHE THAT WON'T GO AWAY
N. Timmins
Financial Times, Mar. 2nd 2000, p. 12
Sir Alan Langland's decision to quit as chief executive of the NHS has thrown open the question of how to manage the service. Ideas being floated include bringing in frontline doctors and nurses to run the NHS, the creation of a new strategy unit, and reshaping the top of the Health Department to bring public health, social care and the NHS together. There is concern that such changes may not achieve what is wanted. NHS staff are suspicious of modernisation initiatives imposed from above, and the emphasis on central control is stifling local initiative.
(See also Health Service Journal, vol. 110, Mar. 2nd 2000, p. 13-14)
HEALTHCARE IN THE UK: THE NEED FOR REFORM
R. Lea
London: Institute of Directors, 2000
Proposes the introduction of an "NHS Passport" which would entitle the citizen to free access to core health services. These ought to be restricted to treatment of serious or life-threatening diseases. All other services, including programmes such as cervical and breast cancer screening, would be shifted to the private sector. The NHS Passport would also act as a voucher towards the cost of funding private treatment for serious conditions. In addition, proposes that NHS trusts ought to convert to independent mutual organisations, although subject to strict regulation by health authorities. These measures would increase resources available for health care without an unacceptable rise in general taxation.
HOSPITAL WAITING LISTS LENGTHEN BY 36,000 IN MONTH
C. Hall and J. Hibbs
Daily Telegraph, Feb. 18th 2000, p. 13
Labour's manifesto pledge to cut hospital waiting lists ran into further trouble when it was revealed that the number of people waiting for admission rose by 36,000 to 1,108,000 in December 1999. The 3.4% increase was attributed to the flu crisis.
(See also Times, Feb. 16th 2000, p. 8)
IF I MAY BE SO BOLD.
R. Rowden
Health Service Journal, vol. 110, Mar. 2nd 2000, p. 29
Argues that the civil servants running the NHS Executive should be replaced by top clinicians and managers who have a grip on operational realities.
(See also Health Service Journal, vol. 110, Marc. 2nd 2000, p. 13-14)
IMPLEMENTING THE VISION: MAINTAINING THE VALUES
NHS Alliance
London: NHS Alliance, 2000
Proposes the removal of the NHS from direct political control and its establishment as a quango working to provide a range of services agreed by the government of the day. Also recommends scrapping half of all hospital outpatient clinics, allowing GPs to refer patients direct for routine procedures, and drawing up lists of treatments available on the NHS.
INPATIENT ADMISSIONS AND BED MANAGEMENT IN NHS ACUTE HOSPITALS
National Audit Office
London: TSO, 2000 (House of Commons papers, session 1999/2000; HC 254)
Reports that in 1998/99 57,000 patients had operations cancelled for non medical reasons on the day of, or following, admission. More than 9,000 of these patients were not treated within a month of their cancelled operations, up 29% on the previous year. Estimates that delayed discharges affect almost 6,000 elderly patients aged 75 and over each day, resulting in the loss of 2.2million bed days per year. Calls for greater investment in IT to improve bed management and better internal co-ordination and liaison with external agencies to prevent bed blocking.
MEDICAL COUNCIL MAY ANSWER TO PARLIAMENT
R. Bennett
Financial Times, Mar. 2nd 2000, p. 6
Plans are under consideration to make the General Medical Council accountable to the Health Select Committee in the wake of the Shipman scandal.
MILBURN PLEDGES TO END LOTTERY OF CARDIAC CARE
D. Derbyshire
Daily Telegraph, Mar. 7th 2000, p. 16
Reports government strategy for improving treatment for coronary heart disease. This includes: speeding up of ambulance response times; reduction of waiting lists for heart surgery to three months over the next ten years; provision of defibrillators in public places; 30 new training places for heart surgeons; establishment of a new register of patients at risk; and foundation of fastrack chest pain clinics. The strategy aims to speed up treatment, end regional in equalities in coronary care and stress the importance of prevention.
(See also Independent, Mar. 7th 2000, p. 9; Times, Mar. 7th 2000, p. 4; Guardian, Mar. 7th 2000, p. 9; Health Service Journal, vol. 110, Mar. 9th 2000, p. 4-5)
THE NHS: FACING THE FUTURE
J. Dixon and A. Harrison
London: King's Fund, 2000
Argues that demand for health care will always outstrip supply, regardless of the adequacy of funding. No health care system can provide every beneficial service, nor should it try to because this would result in some other area of public spending being starved of cash. The NHS needs to learn to manage demand and to control costs more closely.
NHS URGED TO EXPAND HEALTHCARE FOR WORKERS
N. Timmins
Financial Times, Mar. 9th 2000, p. 3
Reports proposals for the creation of a new agency NHS-Plus to market occupational health services to private companies.
(See also Guardian, Mar. 9th 2000, p. 9)
PUBLIC OPINION AND RATIONING IN THE UNITED KINGDOM
D. King and A. Maynard
Health Policy, vol. 50, 1999, p. 39-53
In the UK health care professionals ration access to diagnosis and treatment. Rationing is an avoidable fact of life in a world where the demand for care exceeds society's willingness and ability to finance it. Data taken from the 1998 Eurobarometer Survey are analysed to examine public opinion regarding rationing issues, such as funding for health care, the need to set limits in health coverage, the role of stakeholders in setting priorities, and the use of age, and other factors, as a criteria for setting priorities.
A QUALITATIVE STUDY OF THE EXTENT TO WHICH HEALTH GAIN MATTERS WHEN CHOOSING BETWEEN GROUPS OF PATIENTS
P. Dolan and R. Cookson
Health Policy, vol. 51, 2000, p. 19-30
There is considerable debate about the appropriateness of allocating health care resources on the basis of the size of the health improvements they generate. Study aimed to elicit the general public's views about the extent to which health gain matters vis-à-vis other considerations. The message that came through from group discussions was that equality of access should prevail over the maximisation of benefits, provided that treatments are sufficiently effective.
SHAKE-UP WILL GIVE NURSES A BIGGER ROLE
H. Rumbelow and T. Baldwin
Times, Feb. 29th 2000, p. 11
Reports announcement that the Department of Health will fund the training of 1,000 new nurses and midwives, offering them a more responsible role by breaking down boundaries between doctors and nurses.
(See also Guardian, Feb. 29th 2000, p. 4; Daily Telegraph, Feb. 29th 2000, p. 9; Financial Times, Feb. 29th 2000, p. 8)
SHAPING THE FUTURE NHS: LONG TERM PLANNING FOR HOSPITALS AND RELATED SERVICES
Department of Health
London: 2000
Report declares it to be impossible to meet growing health care needs by making greater use of existing wards. Sets out three options:
- to raise acute care beds by more than 25% or 35,000 over the next twenty years;
- to raise them by 6% or 8,000 beds;
- to expand community health and social care services and cut beds by 12,000 or 9%.
SHIPMAN CASE MAY CURB DOCTORS' POWERS
N. Timmins
Financial Times, Feb. 3rd 2000, p. 6
Reports that doctors may lose the right of self-regulation through the General Medical Council following the Shipman case. The GMC could be forced to accept a majority of lay members, or alternatively it could be made accountable to a Parliamentary select committee rather than the Privy Council.
SHORTAGES IN NHS 'DENYING ELDERLY PATIENTS DIALYSIS'
T. Womersley
Daily Telegraph, Mar. 10th 2000, p. 7
A confidential report claims that elderly kidney patients are being refused dialysis because the health service does not have the resource to treat them.
STREEP'S AHEAD
K. McIntosh
Health Service Journal, vol. 110, Feb. 10th 2000, p. 16-17
Argues that the Commission of Health Improvement will need to combine the roles of policeman and supportive friend in its inspection of hospitals.
TEAM OF OUTSIDERS TO DRIVE NHS REFORM
M. White
Guardian, Feb. 24th 2000, p. 12
The Health Secretary has created a strategy unit of outside professionals to work with the Department of Health to drive forward NHS modernisation.
TIGHTER CONTROLS PLANNED ON HOW DOCTORS PRESCRIBE
J. Laurance
Independent, Feb. 18th 2000, p. 4
Ministers are considering higher controls on the way doctors treat patients in order to help NHS meet the growing demands on its services. Doctors would be given detailed guidelines to ensure patients get the best care within limited resources. The National Institute of Clinical Excellence (Nice) set up by the Government last year is already developing guidelines on the use of expensive drugs and common treatments, such as the removal of wisdom teeth.
TRAINING AND DEVELOPMENT
Health Service Journal, vol. 110, Feb. 24th 2000, Special report 20p
Reports on the rise of web-based open and distance learning, how barriers can be broken down by joint learning sessions, a new leadership training programme for NHS chief executives, and quality assurance training for clinical governance.
VARIABLE INTEREST
L. Whitfield
Health Service Journal, vol. 110, Feb. 3rd 2000, p. 14-15
Describes the planned future role of the Audit Commission within the NHS. The Commission intends to tie its programme of national value for money (VFM) studies more tightly to national priorities and to give them more of a user focus. It will take a 'portfolio approach to local VFM work, sending auditors into a trust with a 'diagnostic' tool that benchmarks its performance in a number of areas. This will allow discussion over whether action is needed on the area covered by a national report. The Commission will also be adjusting its strategy to deal with the new risks thrown up by NHS reform such as the private finance initiative and PCGs, and will seek to agree an integrated approach with the Commission for Health Improvement.
(For full report see: The Audit Commission Health Strategy 2000-2003: a consultation document)
WHAT'S UP DOC?
K. McIntosh
Health Service Journal, vol. 110, Feb. 24th 2000, p. 16-17
Self-regulation of the medical profession by the General Medial Council must be modernised following the Shipman case and other scandals. Article considers the options.
WHEN ALL TRUST HAS GONE
V. MacDonald
Public Finance, Feb. 18th-24th 2000, p. 23
Argues that the Shipman case destroyed public confidence in the General Medical Council. Regulation of doctors should be placed in the hands of the Department of Health, and there needs to be a totally independent method of hearing complaints.