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

The annual health check 2007/2008

Healthcare Commission

2008

This study reports an in-depth investigation of the state of the NHS. Each acute trust, primary care trust, mental health trust and ambulance trust was measured on waiting times, hygiene, confidentiality, management of records, reducing deaths from cancer and heart disease, cutting hospital-acquired infections and treating patients with dignity and respect. While there were improvements in many areas, infection control remained a serious problem, with lapses in almost every trust. However, spectacular improvements were found in waiting times and cancer treatment at acute trusts. On the other hand, primary care trusts (PCTs) are failing to improve, with two-thirds rated fair or weak. PCT performance is being pulled down by issues around GP access, convenience and patient choice.

(For summary and comment see Health Service Journal, Oct. 16th 2008, p. 6-8)

Britain's health care improves but London is getting worse

J. Laurance

The Independent, Oct. 16th 2008, p. 4

The annual NHS performance ratings show that London, which historically has had the lion's share of NHS resources, is the only area of the country where the quality of services declined in 2007-08. Fewer than half its NHS trusts (48 per cent) scored 'excellent' or 'good' compared to 55 per cent in 2006-07.

(See also The Guardian, Oct. 16th 2008, p. 11 and The Times, Oct. 16th 2008, p. 5)

Burning ambitions at the end of the beginning

B. Crump

Health Service Journal, Oct. 2nd 2008, p. 16-17

Describes the role and future direction of the NHS Institute for Innovation and Improvement. The Institute works to find ideas that can be developed, adapted and adopted to help the NHS tackle its biggest challenges. It works on leadership development, on helping people to learn to improve and innovate, on the identification of creative new approaches to healthcare, and on supporting innovators to implement their ideas.

A clean bill of health

A. Moore

Health Service Journal, Oct. 9th 2008, p. 22-24

In 2007 Maidstone and Tunbridge Wells trust was the subject of a damning report by the Healthcare Commission. It detailed the failings that contributed to two significant outbreaks of C difficile and arguably to the deaths of up to 90 patients. This article describes how a new chief executive and board have transformed it, empowering staff and raising morale.

Drug firms bankroll attacks on NHS

J. Laurance

The Independent, Oct. 1st 2008, p. 1 & 2

Investigations have revealed that the rising tide of protest over the NHS's refusal to provide expensive drugs for cancer and other conditions is being funded by the pharmaceutical industry. Patient groups that have been among the most vocal in spearheading attacks on the National Institute for Clinical Excellence (Nice) over decisions to restrict access to drugs on the NHS depend for up to half their income of drug companies but these details are often undisclosed.

Data network

R. Allmark (editor)

Health Service Journal, Oct. 2nd 2008, supplement, 13p

This special supplement showcases the work of the NHS Information Centre in supplying accurate and up to date statistical data to support service commissioning and healthcare improvement.

Eat all that and you'll be sick

E. Dent

Health Service Journal, Oct. 2nd 2008, p. 20-22

Numbers of people diagnosed with Type 2 diabetes are growing due to the prevalence of obesity. In addition, up to 500,000 people in England could have undiagnosed diabetes. This article explores why GPs are failing to detect the condition. It goes on to discuss incidences of poor care of patients with diabetes in hospital, the impact of diabetes on pregnancy, and the importance for patients of education on managing the condition.

'Fair system' to allow private payment for cancer drugs

N. Timmins

Financial Times, Oct. 25th 2008, p. 2

A review by Professor Mike Richardson, the Government's 'cancer tsar', reportedly proposes that patients should be able to buy cancer drugs and other end-of-life treatments without having to meet the full cost of all their NHS care. If it goes ahead, NICE, the National Institute for Clinical Excellence, is expected to introduce a big increase in the acceptance threshold when it assesses whether these treatments for relatively rare conditions are effective, and guidance for patients. Any decision is expected to be announced in November.

Good cop Walker looks back on a turbulent era

C. Santry

Health Service Journal, Oct. 16th 2008, p. 12-13

The Healthcare Commission will be merged into the new Care Quality Commission in April 2009. In this interview chief executive Anna Walker reflects on her relationships with Commission Chair Sir Ian Kennedy, senior civil servants at the Department of Health, and other regulators such as Monitor and the Audit Commission.

Ministers to allow NHS drug top-up payments

A. Jamieson

Daily Telegraph, Oct. 20th 2008, p.10

Reports that the health secretary is expected to announce that patients can pay for treatments not available on the NHS privately while still receiving some care free from the health service. The Government has been under pressure to clarify the rules after some NHS trusts told cancer patients that they could not buy drugs privately while receiving free public care while others said the opposite.

The NHS after 60: for patients or profits

J. Lister

London: Middlesex University Press, 2008

Sixty years ago, in 1948, Aneurin Bevan's bold nationalisation of private, voluntary and municipal hospitals swept away a failed market system, and created the most popular of all the public services, the NHS. New Labour reforms are reversing this historic modernisation, and spending more money to create an artificial 'market' in health care which could never exist without government subsidy. The book takes a fresh look at the origins and evolution of the NHS, emphasising the 'reforms' which, in its sixth decade, have begun to transform the NHS into a European-style social health insurance fund, purchasing services from a variety of private- and public-sector providers. It also examines the NHS in an international context and discusses recent tendencies of Scottish, Welsh and Northern Irish governments to follow alternative lines of policy. The conclusion looks at the alternatives for the future development of the NHS. Will ministers roll the wheel of history further back towards a more radical market system? Or will they move forward to a public service based on greater accountability and responsiveness to the needs and wishes of local people and those with greatest health needs?

NHS computer records project grinds to a halt

N. Timmins

Financial Times, Oct. 28th 2008, p. 1

Progress with Connecting for Health, the 12bn computer programme which aims to give doctors instant access to patients' records across the country, has virtually stopped, with just one hospital having installed the underlying patient administration system. The hospital, the Royal Free NHS Trust in London, is having problems getting it to work properly.

(See also: Financial Times, Oct. 28th 2008, p. 4.

NHS hospitals are warned on core standards

N. Timmins

Financial Times, Oct. 16th 2008, p. 2

The Healthcare Commission has warned that up to a third of NHS hospitals risk being refused a licence to operate because they are not meeting core standards of cleanliness, safety, effectiveness and record-keeping.

NHS wait falls to eight weeks

N. Timmins

Financial Times, 24th Oct. 2008, p. 2

The average wait from seeing a GP to the start of hospital treatment is now 8 weeks, the shortest in the history of the NHS, according to figures released by the Government on 1 October.

(See also The Independent, Oct. 24th 2008, p. 10)

No dead certainties

D. Carlisle

Health Service Journal, Oct. 16th 2008, p. 18-20

In July 2008 the NHS published mortality rates for four operations on the NHS Choices web site, enabling users to compare success rates for hospitals in a given area. Supporters hope that this disclosure will lead to greater transparency, improve service quality and facilitate patient choice. However, it remains uncertain how the public will interpret and use the data.

No satisfaction: why a redesign hit the rocks

A. Moore

Health Service Journal, Oct. 23rd 2008, p. 12-13

Controversial health service reconfiguration plans in Sussex are being put on hold following intense public opposition to closure of local hospitals. This article considers the lessons to be learned. In the first place, the consultation process was very long, leading to some of the drivers for change disappearing. Secondly, the breadth of the review allowed opponents to gain public support and exploit a belief that the consultation was a fake. Finally, clinicians were not adequately engaged at the outset.

Plans for larger private role in NHS

N. Timmins

Financial Times, Oct. 31st 2008, p. 4

The Department of Health has concluded that the private sector will have access to a market worth 10bn a year as Primary Care Trusts (PCTs) are discouraged from trying to run community hospitals and services. PCTs have been told to create a clear division between their role as commissioners of care and service provision and are seen to be being pushed towards divesting some services.

The political is personal: Edwina Hart takes charge

D. West

Health Service Journal, Oct. 9th 2008, p. 12-13

Welsh Health Minister Edwina Hart has announced plans for a 'national advisory board' to plan, fund and hold services accountable with herself as chair. Twenty-two local health boards, which provide primary care and commission secondary care, and eight acute trusts will be merged into just seven new bodies. Ms Hart will appoint chairs and vice-chairs, who with chief executives will report annually and in public to her board. The internal market will be formally abolished.

The profession must nip rotten medics in the bud

R. Willis

Health Service Journal, Oct. 9th 2008, p. 16-17

The General Medical Council is the regulator of the medical profession in the UK. It has made a concerted effort to modernise and to counter criticisms of its work that flowed from the Shipman case and its handling of other examples of clinical incompetence. Over the next few years the Council will bring in licences to practise and all doctors will be required by law to hold one if they want to continue with their medical work. In addition to licensing, a new system of revalidation will require doctors to renew their licence every five years. The Council is also preparing to reconstitute its governing body, which from January 2009 will consist of 12 doctors and 12 lay people. The government has decided to merge the postgraduate medical education and training board into the GMC in April 2010. The council will then for the first time be responsible for all phases of a doctor's career, undergraduate, postgraduate and continuing practice.

Refuse 'last hope' cancer drug, says NICE

R. Smith

Daily Telegraph, Oct. 15th 2008, p.10

The National Institute for Health and Clinical Excellence (NICE) has ruled that the drug lapatinib, which can be used to prolong the lives of women with advanced breast cancer by about two months, cannot be provided free on the NHS. NICE says that the drug does not extend life by long enough to justify the extra cost, although the manufacturers have offered to pay for the first doses, with the NHS funding further courses only if it has been shown to work

Unite and conquer

A. McGauran

Health Service Journal, Oct. 23rd 2008, p. 18-20

Academic health science centres bring together world class research bodies and clinical centres in a single organisation, aiming to compete internationally. University College London, Imperial College and King's College London are forming partnerships to create such organisations to compete with the top American medical schools.

'Zagat-style' guide will rate hospitals

J. Laurance

The Independent, Oct. 27th 2008, p. 16

Ministers are planning the first 'Zagat-style' user's guide to the NHS which will rate hospitals and GP practices on the basis of comments from patients. Star ratings could be given to the most popular NHS establishments in the same way as guides to eating out rank restaurants on the number of positive responses they receive. The scheme is due to go live next year with a TV campaign and dedicated website that patients will be encouraged to use to rate the service they receive.

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