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

Analysing the clinical directorate system

R. Gupta, A. Vaidya and R. Campbell

British Journal of Healthcare Management, vol. 14, 2008, p. 382-389

Consultants were involved in the management of clinical services with the introduction of an internal market into the NHS in the early 1990s. The role of the clinical director was to bring clinicians and managers together to optimise resources and patient care. This research used a postal survey to ascertain the views of consultants regarding the clinical directorate system and their perceptions of their managers. It is hoped that the findings will provide a basis on which to build recommendations for effective consultant engagement in the management of the NHS.

Bedside manner earns Lansley strong support

R. Evans

Health Service Journal, Sept. 25th 2008, p. 14-15

Report of an interview with Conservative shadow health secretary Andrew Lansley in which he says that his party attaches the utmost importance to the NHS. They are also committed to creating an independent NHS board and to replacing the Department of Health with a public health department. He envisages Strategic Health Authorities performance managing primary care trusts and the latter performance managing GPs. Primary care trusts would commission but not provide services with GPs being given a more central role.

Can you hatch a new breed of executive?

M. Marshall

Health Service Journal, Sept. 25th 2008, p. 18-19

It is reported that 80m will be invested in leadership development in the NHS. Strategic Health Authorities have been tasked with nurturing leaders, but appear to see no need for a single framework to guide their work. Most see themselves as commissioners, contracting with established providers from the university, private and voluntary sectors to deliver the training.

Continuing professional development: rhetoric and practice in the NHS

A. Morgan, J. Cullinane and M. Pye

Journal of Education and Work, vol. 21, 2008, p. 233-248

This article aims to discuss Continuing Professional Development (CPD) in the NHS. CPD as a process is seen as a major mechanism of the agenda for reform in the NHS and therefore exploring the question of how CPD is perceived by staff can provide insights into the changing dynamics of the employment relationship, in particular staffing and professionalism. Relevant results are drawn from a wider study of frontline clinical supervisors in NHS Wales. The study found that, although CPD is intended to play a key role in NHS reform, there is a mismatch between provision of and for CPD activities leading to a perceived, and actual, failure of current systems to meet the expectations of the organisation, individuals and professional bodies. Secondly, there is a clear reluctance among this group of staff to take on managerial roles against the alternative option of investing in the development of their clinical skills. This has led to some of them falling into managerial roles without the necessary training.

Corporate manslaughter - act now

J. Topping

National Health Executive, vol. 2, July/Aug. 2008, p. 34-35

The Corporate Manslaughter and Corporate Homicide Act 2007 makes it easier to prosecute organisations, including NHS bodies, where gross failures in the management of health and safety lead to a death. Trusts need to follow the wide range of advice and guidance that has been made available by the Department of Health, NHS Employers, professional bodies and the Health and Safety Executive.

The Darzi Review

National Health Executive, vol. 2, July/Aug. 2008, p. 19-24

Presents a summary of the main recommendations of the Darzi Review of the NHS, followed by commentary from a number of experts in the field.

Denial of life-saving drugs is not NICE

S. Ainsworth

British Journal of Healthcare Management, vol. 14, 2008, p. 408-409

The National Institute for Clinical Excellence has come in for criticism for denying cancer patients expensive new treatments that might extend their lives by a few months. The author responds by pointing out that resources are finite and the money might be better spent on treating other, less vocal, groups of patients who can be cured or whose conditions can be controlled. He also argues that cancer patients should also be discouraged by government from impoverishing their families by squandering their own money on expensive treatments.

Experts get snagged on health's thorniest issue

H. Crump

Health Service Journal, Sept. 4th 2008, p.12-13

Government has been consulting on the thorny issue of whether patients should be allowed to top up their care by paying privately for expensive drugs not available on the NHS. Expert opinion is divided. Public health staff responding to the consultation say that allowing co-payments would create a two tier NHS and should be resisted. The insurance industry sees a business opportunity if top-up payments are allowed. Patients' groups are clear that those who choose to pay privately for additional drugs should not be denied NHS treatment and forced to pay for all their care.

(For views of Professor Karol Sikora see Daily Telegraph, Sept 12th 2008, p. 10)

HCAIs: challenging the assumptions

M. Cole

British Journal of Healthcare Management, vol. 14, 2008, p. 376-381

Healthcare-associated infections (HCAIs) have always been a problem for hospitals, but are currently the subject of great public concern, possibly due to media attention. Politicians have called for their eradication, but current strategies are simplistic and will not work. HCAIs are commonly associated with elderly patients with severe comorbidities and it is unlikely that it will be possible to reduce them by more than about 15%.

Healthcare for all: report of the Independent Inquiry into Access to Healthcare for People with Learning Disabilities

J. Michael


The inquiry found that people with learning disabilities are 'invisible' to the NHS in England, which is widely failing to meet their needs and deliver their legal right to equal treatment. The report recommends that:

  • the Department of Health should immediately amend core standards against which trusts are judged to include requirements to make reasonable adjustments to provision to meet the needs of vulnerable groups
  • undergraduate and postgraduate clinical training must cover learning disabilities
  • inspectorates should improve their monitoring of general health services provided for people with learning disabilities
  • the Department of Health should establish a learning disabilities public health observatory to raise awareness of the risk of premature avoidable death.
  • better data should be collected to allow people with learning disabilities to be identified by the health service.

Lean in healthcare

National Health Executive, vol. 2, July/Aug. 2008, supplement, 22p

The use of lean methodology derived from systems that have transformed manufacturing worldwide is attracting growing interest in the NHS. This supplement demonstrates how lean and six sigma tools, including statistical analysis, are being applied to improve service quality in general practice, pathology services, and hospitals.

Lib Dems back 'top-up' payments for cancer drugs by NHS patients

S. Coates and D. Rose

The Times, Sept. 9th 2008, p. 9

The Liberal Democrats are seeking to outflank Labour and Conservatives by backing calls for patients being allowed to pay privately to 'top-up' cancer care drugs available from the NHS. Current guidelines mean patients risk forfeiting their right to NHS treatment if they pay privately for drugs not yet approved by the National Institute for Health and Clinical excellence (NICE).

(See also The Independent, Sept. 12th 2008, p. 18 and The Guardian, Sept. 12th 2008, p. 11)

MRSA superbug cases fall by half in four years

S. Boseley

The Guardian, Sept. 19th 2008, p. 15

The government has revealed that the number of reported cases of patients being diagnosed with the hospital infection MRSA has halved between 2004 and 2008. The figures, collected by the Health Protection Agency, only cover MRSA infections and not Clostridium difficile infections, a fact which has prompted the Conservatives to accuse the government of moving the goalposts by not yet revealing the results of infection with the harder to deal with virus.

(See also The Times, Sept. 19th 2008, p. 15)

NHS emergency services risk failing up to 20 million patients, says health watchdog

J. Carvel

The Guardian, Sept. 26th 2008, p. 4

The Healthcare Commission has found that NHS emergency services responsible for 20 million patients across two thirds of the country are failing to provide the joint-up care patients expect. The report described 33% of the areas investigated as 'fair' while 18% of the areas were described as 'least well performing'.

(See also The Independent, Sept. 26th 2008, p.4)

NICE chiefs confronted by cancer patients

K. Devlin

Health Service Journal, Sept. 18th 2008, p. 8

Cancer patients have accused the National Institute for Health and Clinical Excellence of condemning sufferers to an early death by denying them new drugs on cost effectiveness grounds. They confronted the organisation's senior staff at a public meeting in Plymouth and demanded that they reconsider their decision not to fund four expensive new drugs for kidney cancer on the NHS.

Patients to get veto on access as NHS database expands across England

J. Carvel

The Guardian, Sept. 18th 2008, p. 14

New tougher rules, designed to protect patient confidentiality in the NHS, have been unveiled by the government. Before reading patients' electronic medical records, soon to be uploaded to a national database known as Spine, staff will be required to seek patients' specific consent.

'Pointless' NHS complaints system to become less rigid

D. Rose

The Times, Sep. 22nd 2008, p. 13

The Department of Health has promised to overhaul the system for making complaints about NHS care after a survey found that more than two thirds of patients think that the process is pointless. The report by the Patients Association has described the NHS complaints system as being cumbersome, variable and taking too long. Of nearly 500 patients polled, 69 per cent said that they had wanted to complain about the healthcare they had received in the past five years.

Safe birth: at last it's everyone's business

D. Gould

British Journal of Healthcare Management, vol. 14, 2008, p. 390-395

Delivering high quality and safe maternity services requires a team approach. Training needs to create teams that learn, rehearse and work together with the shared aim of improving the mother's experience of childbirth. There need to be clear protocols and guidelines developed by and shared with the whole team. Strong maternity teams will also need leadership to break down territorial boundaries between midwifery, obstetric and neonatal care. In developing such teams, health services can learn from the positive psychology movement and from high performing, multifactorial sporting teams where every role is valued and co-ordinated.

Self-managed citizens: the new paradigm in healthcare?

M. Frewin

National Health Executive, vol.2, July/Aug. 2008, p. 40-41

To ensure its own survival, the NHS needs to embrace new ways of working supported by information technologies such as Web 2.0. New information technologies are creating innovative ways for citizens and practitioners to interact and share their knowledge. They are enabling more integrated delivery of health and social care services; the deployment of telehealth solutions that move care into communities and homes; and the emergence of a new breed of citizen-consumers who are empowered to take control of the services they require and are better able to manage their own health.

Smells like teen spirit

C. Laurent

Health Service Journal, Sept. 4th 2008, p. 20-22

Adolescents are vulnerable to many harms and their health can suffer significantly from inappropriate risk-taking behaviour. However, they are less likely than other age groups to visit their GP. The chief medical officer of health, Sir Liam Donaldson, has called for new approaches to make healthcare more teen centred, recommended more research and development of teaching provision to understand their needs, and asked for young people to be included in the design of teen-friendly services.

Top-up fees for drugs herald two-tier NHS

F. Elliott & D. Rose

The Times, Sept. 23rd 2008, p. 1

Ministers are preparing to allow public patients to pay for some top-up drugs in a decision that opponents claim will spell the end of the National Health Service. The Health Secretary, Alan Johnson, is poised to relax the ban on patients paying privately for life-extending treatments while receiving NHS care.

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