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

100,000 operations cancelled after bed shortages

R. Winnett

Daily Telegraph, Aug. 21st 2008, p. 10

Data released under Freedom of Information legislation show that more than 100,000 operations were cancelled in 2007/08. More than 7,000 patients had their operation cancelled more than once. The number is almost twice as high as previously admitted by the government.

A&E units traumatised as Darzi plans develop

A. Moore

Health Service Journal, Aug. 21st 2008, p. 10-11

The regional 10-year plans produced as part of Lord Darzi's review of the future of the NHS envisage major trauma services being concentrated at just one or two centres per region. Stroke and primary angioplasty services will be on more sites than trauma, but not at every accident and emergency unit. Emergency surgery, consultant-led maternity and inpatient children's services are also likely to be concentrated at fewer sites. This leaves smaller accident and emergency units facing an uncertain future as they lose patients.

Academics cast doubt on link between death and standards

D. West

Health Service Journal, Aug. 21st 2008, p. 4-5

A study commissioned by NHS West Midlands has criticised the way in which hospital standardised mortality ratios produced by health information provider Dr Foster Intelligence were reported and published. The research found little or no evidence that a high standardised mortality ratio systematically reflects poor quality care or a failing hospital. The strategic health authority commissioned the research after five of its trusts were listed as 'poor performing' on mortality in Doctor Foster Intelligence's Hospital Guide 2007.

After the false dawns - a real chance for staff

W. Hutton

Health Service Journal, Aug. 21st 2008, p. 14-15

The obligation to deliver high quality patient care enshrined in the draft NHS constitution cannot be honoured without committed and well trained staff. The constitution and accompanying documents say that the NHS will strive to provide all staff with well designed and rewarding jobs that make a difference. It will provide all staff with personal development, training and management support to enable them to succeed. It will strive to ensure that staff are healthy and safe. Finally, it will try to engage staff in decisions that affect them, both individually and through their representatives. The author argues that the direct link between high quality care and trained and committed staff means that in this case the promises will be kept.

The assessment of doctors' performance: tools and techniques

A. Collett and I. Starke

Journal of Management and Marketing in Healthcare, vol. 1, 2008, p. 400-411

Following the implementation of revalidation and the changes in postgraduate training in the UK, regular assessment will become a routine part of the working life of all NHS doctors. This article describes some of the key steps in designing assessment systems, along with a more detailed discussion of selected assessment methods.

The dawn of the fan

S. Shepherd

Health Service Journal, Aug. 21st 2008, p. 20-22

The government and NHS are using websites such as YouTube and Facebook to communicate with the public. Trusts believe that such websites will help them keep in touch with younger people better than other methods. However, such sites are open to abuse with unofficial groups appearing in the name of NHS organisations.

Devolved power flows through Darzi's vision

D. Nicholson

Heath Service Journal, Aug. 7th 2008, p. 14-15

The NHS Chief Executive sets out his plans for implementing the recommendations of the Darzi review of the future of the health service. The implementation process must reflect the principles that informed the review, namely partnership between the NHS, local authorities and other key stakeholders, local decisions on detailed reforms, clinical ownership and leadership, and realignment of the whole system to focus on quality. Activity will proceed on three levels: 1) implementation of regional visions; 2) Department of Health ensuring that clear plans and accountability arrangements are in place; and 3) staff development and training to create a deep cultural change within the health system.

Drugs body 'bullied and patronised cancer patients'

K. Devlin

Daily Telegraph, Aug. 11th 2008, p. 6

The NHS's drug-rationing body, the National Institute for Clinical Excellence, has been accused of bullying, ignoring and patronising patients in consultations over whether expensive new treatments for advanced kidney cancer should be made available free through the health service. The attack comes after NICE ruled that drugs capable of prolonging the lives of kidney cancer patients by up to two years were too costly to be made available on the NHS. (See also Daily Telegraph, Aug. 7th 2008, p. 1)

Duty of confidence: sharing information

R. Griffith

British Journal of Healthcare Management, vo. 14, 2008, p. 335-340

A duty of confidence is owed to patients. The duty is drawn from legal, contractual and professional obligations and requires that as a general rule patient information is not divulged. However, information often needs to be shared with others to ensure the effective care and protection of patients, especially vulnerable adults or children. Disclosure of patient information without consent is allowed in the public interest or where sanctioned by law. It is essential that managers carefully balance the general need for confidentiality against the welfare of the patient that may require the information to be shared without their consent.

Frank or futile? Health gets the blog treatment

J. Stephenson

Health Service Journal, Aug. 28th 2008, p. 10-11

NHS professionals are increasingly venting their spleen against the service on the Internet in the form of blogs, which are usually written anonymously. These blogs can give managers insight into what staff are thinking. Blogs also offer managers the chance to communicate directly with staff and patients and show the human side of what they do. However, official blogs can be very dull.

Guilty by emission as carbon cuts loom large

H. Crump

Health Service Journal, Aug. 14th 2008, p. 10-11

Trusts have less than 20 months to meet an ambitious target to cut NHS carbon emissions by 15%. The NHS spends around £400m on energy and emits one million tonnes of carbon each year. It must shave off 150,000 tonnes of carbon emissions. This can be done by cutting car use through local provision of services in the community, less use of disposable goods, and local procurement of food. The article highlights some innovative ideas being pioneered by trusts.

Healthcare for all

J. Michael


This review of NHS care for people with learning disabilities finds that frontline staff are in many cases unaware of their particular needs. They can also fail to consult with or respect the knowledge of carers. Inspectors do nor focus specifically on services for the group, while managers fail to monitor performance adequately. The report recommends that:

  • The Department of Health should immediately amend core standards against which trusts are judged to include a requirement to make reasonable adjustments to the service to meet the needs of vulnerable groups
  • Clinical training at undergraduate and postgraduate levels should cover learning disabilities
  • Inspectorates should focus more on monitoring general health services provided to people with learning disabilities
  • The Department of Health should develop a learning disabilities Public Health Observatory to raise awareness of the risk of premature avoidable death
  • Data collection should be improved to allow the NHS to identify people with learning disabilities.
(For comment see Community Care, Aug. 17th 2008, p. 10-11)

Hospital pest problems fuel hygiene concerns

R. Smith

Daily Telegraph, Aug. 6th 2008, p. 1 + 2

Figures released under the Freedom of Information Act show that there have been almost 20,000 reports of pest problems in NHS hospitals in England since January 2006. Outbreaks have included rats in maternity wards, wasps and fleas in neo-natal units, bed bug infestations and flies in operating theatres. The figures raise questions about standards of cleanliness in NHS hospitals.

Huge contrasts found between UK nations

S. Gainsbury

Health Service Journal, Aug. 28th 2008, p. 4-5

A comparison of health services in England, Scotland, Wales and Northern Ireland shows marked differences in the likelihood of emergency admission to hospital, staying overnight or being operated on. Healthcare information providers CHKS analysed statistics from the four nations and found significant differences in the patient experience. The figures suggest differences in the organisation and efficiency of services, but also point to diverging clinical standards.

Impact of critical care outreach services on the delivery and organization of hospital care

D. Baker-McClearn and S. Carmel

Journal of Health Services Research and Policy, vol. 13, 2008, p. 152-157

Outreach services are usually composed of teams of nurses trained in critical care who are available to provide clinical support or advice on hospital wards when the health of a patient is deteriorating. They were established in the NHS in England and Wales in 2001. Data on their impact were collected through semi-structured interviews with hospital staff who were either members of, or came into contact with, the outreach service in eight hospitals in England. The study demonstrated that outreach services had a positive impact on service delivery and the organisation of hospital care.

Managers losing sleep as 48-hour week nears

A. Moore

Health Service Journal, Aug. 7th 2008, p. 10-11

By August 1st 2009 junior hospital doctors should be working no more than 48 hours per week to comply with the European Working Time Directive. Currently they should work no more than 56 hours. Implementing the eight hour reduction in working time will be a challenge and trusts will need to make significant changes to comply. Cutting hours will be most difficult for small departments and will add to the pressure for centralisation of services.

National service

A. Moore

Health Service Journal, Aug. 28th 2008, p. 20-22

Emergency hospital admissions have rocketed in England since the four-hour accident & emergency waiting target was introduced in 2004. More people may be going to A&E because they know they will be seen promptly. Better access may be increasing demand. Emergency admissions for long term conditions are highest in Wales. In Northern Ireland the readmission rate is down.

NHS hospitals to forge £2bn research link-up with university

J. Carvel

The Guardian, Aug. 7th 2008, p. 10

Four NHS hospitals have disclosed plans to form a business partnership with University College London (UCL) to create the largest biomedical research organisation in Europe. The £2bn venture, to be called UCL Partners, will seek to establish London as an intellectual leader for the invention of new drugs and treatments.

NHS trusts face fines for poor hygiene

J. Laurance

The Independent, Aug. 12th 2008, p. 2

Fines of up to £50,000 will be imposed on NHS trusts which breach hygiene regulations in a crackdown on hospital infections. The measures are part of the Government's drive to protect patients against superbugs, which means inspectors will have powers to prosecute dirty hospitals and clinics and impose sanctions ranging from fixed penalty fines to closure of wards, clinics or services.

A perfect 10 from patients is the number one target

J. Sussex and A. Towse

Health Service Journal, Aug. 14th 2008, p. 14-15

Better quality care is currently the dominant theme of NHS reform in England. The authors suggest that care quality could be measured by asking patients whether care has left them feeling better or worse using a number of questionnaires already in existence.

Poor suffer as the health gap gets wider

R. Smith

Daily Telegraph, Aug. 26th 2008, p. 6

The gap between the health of the rich and poor has grown under the Labour government despite policies aimed at reducing it. Department of Health officials have been told that a target of reducing health inequalities by 10% by 2010 may not be hit.

The provision of cross-border health services for Wales: interim report

Welsh Affairs Committee

London: TSO, 2008 (House of Commons papers, session 2007/08; HC870)

The report begins by summarising cross-border health issues highlighted in an inquiry launched in November 2007. It outlines the services that are currently used by Welsh patients on a cross-border basis. It then describes the policy divergence that has occurred between the English and Welsh NHS. The commissioning and funding of cross-border health services are then considered, as are the current arrangements for co-ordination. Each of these areas impact on patients who receive their treatment on a cross-border basis; consideration is therefore given to the confusion and concern expressed by patients during the Inquiry. The report aims to contribute to discussions surrounding:

  • The proposed protocol between the Department of Health and the Welsh Assembly Government on cross-border provision
  • The proposed restructuring of the NHS in Wales and its impact on cross-border health services
  • Mr James Steers's review of neurosciences services for Welsh patients

The Race Equality Service Review

South East Coast BME Network


Figures extracted from every NHS trust in the this region show the difficulties black and minority ethnic (BME) people face in getting jobs, and the disproportionate number involved in grievances once they are employed. Data reveal that BME people account for 31% of those short listed for jobs in acute trusts, but only 16% of appointees. BME workers in acute trusts are 70% more likely to lodge an employment tribunal claim than would be expected from their proportion of the workforce, but 63% less likely to be made redundant.

(For summary see Health Service Journal, Aug. 7th 2008, p. 4-5)

Resolving the care crisis: technology in action

U. Fröderberg and T. Harvey

British Journal of Healthcare Management, vol. 14, 2008, p. 345-349

Technology can play a vital role in enabling health service managers to deliver 'more for less' and adapt more easily to evolving care models. Digital pen and paper (DPP) reduces administration time by electronically capturing and recording handwritten patient information. Data can be transferred to a back-end server in real time, allowing reports and test results to be validated and action to be taken immediately if necessary.

Saving carbon, improving health: A draft carbon reduction strategy for the NHS in England

NHS Sustainable Development Unit


This consultation presents the NHS with challenges including:

  • Creating an 'NHS carbon model' to measure progress
  • Having a carbon management strategy in place for all NHS organisations by 2009
  • Extending the Department of Health's £100m energy fund to help trusts
  • All new buildings to be low carbon by 2015 and zero carbon by 2018
  • All NHS bodies to have a sustainable travel plan by 2010
  • All NHS organisations to report annually on a metric as part of a performance scorecard

Super patients should use their powers wisely

A. Dixon and R. Ashton

Health Service Journal, Aug. 28th 2008, p. 14-15

Lord Darzi's final report on the future of the NHS set out the government's intention to launch a pilot programme in 2009 to evaluate the feasibility of personal budgets in healthcare. Use of personal budgets poses some challenging questions, including:

  • The fact that it is impossible to accurately predict the medical care needs even of patients with relatively stable long term conditions
  • What happens if patients choose to squander taxpayers' money on ineffective treatments?
  • What happens when a patient has exhausted their personal budget but still needs care? The NHS may end up paying to rescue patients from the consequences of their own poor decisions.
  • Will patients be able to carry over unspent budget to the following financial year?
  • How will commissioners stimulate the local market so that patients have a choice where to spend their budget?

Towards a theory of care transition: from medical dominance to managed consumerism

M. Bury and D. Taylor

Social Theory and Health, vol. 6, 2008, p. 201-219

This paper sees health care in England being transformed from a system characterised by medical dominance to one characterised by managed consumerism in an ageing society, involving significant changes in the nature of professionalism and professional practice. An emphasis on professional regulation and evidence-based practice, combined with partnership and shared decision-making is found in a range of policies aimed at altering social relations in health care. Choice, self-management and active engagement in health become features of a restructured patient role.

Watchdog chair to get tough on obeying NICE rules

C. Santry

Health Service Journal, Aug. 14th 2008, p. 4-5

Report of an interview with Baroness Young, chair of the new Care Quality Commission, in which she pledges that the it will crack down on NHS organisations that fail to follow National Institute for Clinical Excellence guidelines. Ignoring guidelines could result in marked-down annual assessment ratings and lower staff pay.

What is 'quality of life' for patients?

A. Wyke and others

British Journal of Healthcare Management, vol. 14, 2008, p. 280-287

Current instruments used to measure patient quality of life (QoL) largely fail to include the patient perspective. Failure to measure QoL adequately can lead to an under-estimation of the cost effectiveness of medicines, medical devices and other clinical interventions. A new alliance of patient organisations, academics and other experts, tentatively called the QALYity Project, has sought to address these shortcomings. The Project has devised a two-stage methodology where patients are able to define their QoL agenda in a new instrument, while taking into account the variation of patient opinion on the topic of QoL. The new patient-devised instrument has succeeded in highlighting QoL factors of importance to patients.

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