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

12bn NHS computer system brought to halt by glitches

K. Devlin

Daily Telegraph, Oct. 29th 2008, p. 6

Reports that the implementation of the national electronic patient records system has ground to a halt in some parts of the country due to technical hitches. NHS leaders in London have decided to halt implementation indefinitely in order to iron out technical problems, while in the South the NHS is struggling to find a replacement for Fujitsu which pulled out of a contract in May 2008.

Arthritis patients win battle for review of drug restriction

R. Smith

Daily Telegraph, Nov. 24th 2008, p. 1 + 2

National Institute for Clinical Excellence guidance on the use of three drugs that combat rheumatoid arthritis said that patients could not switch to a different medicine in the group if the first did not work for them. Following an appeal by campaigners on the grounds that the organisation had not followed its own procedures properly, NICE has agreed to review its decision.

A bit of give and take

D. Carlisle

Health Service Journal, Nov. 13th 2008, p.21-23

The UK is short of organs for transplant. 90 per cent of people support the idea of transplants but have not signed a donor card and opted into the current system of voluntary donation. This article rehearses the arguments for and against moving to a system of presumed consent, where a deceased person's organs could be taken unless he/she had explicitly stated that he/she did not wish to donate them after death.

Brown may still change organ donation law

J. Kirkup and K. Devlin

Daily Telegraph, Nov. 18th 2008, p. 12

A review by the Organ Donation Task Force has concluded that there is no evidence that presumed consent would increase transplant numbers or save lives. However Gordon Brown has indicated that the law could still be changed so that people would have to opt out of having their organs harvested after death, in spite of the Task Force's recommendations.

Do patients justice

J. Taylor

Health Service Journal, Nov. 20th 2008, p. 20-22

In 2007/08 it took an average of 1.5 years to reach a settlement on claims handled under the NHS clinical negligence scheme for trusts, a voluntary risk-pooling scheme launched in 1995. This timescale for dealing with claims compares favourably with the insurance industry. Delays in settling claims often result from the complexity of the cases, which nearly always involve brain-damaged babies. However trusts could sometimes avoid litigation by offering an apology and an explanation

Donor reforms speed delivery of gift of life

S. Shepherd

Health Service Journal, Nov. 6th 2008, p. 12-13

This article reports progress on implementation of the first report of the organ donation taskforce which aims to increase organ donation by 50% over five years. The changes will require the installation of clinical champions and donor transplant co-ordinators in almost every acute trust in the UK. These will work closely with intensive care and emergency department staff, as well as the families of potential donors. Trust donation committees will help these experts monitor organisational performance and maximise opportunities for donation, while dedicated retrieval teams will be available around the clock, reducing the burden placed on the donor hospital.

Foundation trusts and Monitor

Health Committee

London: TSO, 2008 (House of Commons papers, session 2007/08: HC 833)

Before foundation trusts (FTs) were established, there was considerable debate about whether the supposed benefits of these new trusts would materialise and about what the impact of these trusts would be on the wider NHS. Since little systematic and objective evaluation of FTs' performance has been carried out, the Health Committee decided to hold a one-off evidence session on FTs and Monitor, their regulator, and to publish a short report on its findings. Key aims of FTs were the promotion of innovation and greater public involvement; however, the Committee found there was a lack of objective evidence on FTs' performance. It recommends that the Government commission research to assess all aspects of FTs' performance objectively so that best practice can be shared with other FTs, and with the NHS more widely. While FTs do not appear to have yet exploited the full potential of their autonomy, their ability to make decisions more quickly was important and made a 'tangible' difference to the dynamic of their organisations. Concerns persist about what level of Government intervention in FTs' affairs is legitimate, and the report recommends that the Government must clarify what the appropriate levels of intervention are. Finally, Monitor's application process and regulatory regime are well regarded. However, there is potential duplication between the Healthcare Commission and Monitor both of which evaluate the quality of FTs' services.

How are top-ups going to affect your services?

H. Crump

Health Service Journal, Nov. 13th 2008, p.12-13

Patients' right to access NHS treatment while paying for additional drugs has been spelled out in the Richards review. This decision shifts the foundations on which the NHS stands. According to Professor Richards, we need to redefine what constitutes an 'episode of care'. Under the old system, PCTs were applying different definitions - some patients were expected to pay for a small proportion of NHS treatment where others were facing massive bills as a result of strict interpretations of the rules. To avoid confusion Richards recommended that 'private care should be carried out at a different time and place' from NHS care. Guidance has been produced to address the practical difficulties of this recommendation.

Improving access to medicines for NHS patients: a report for the Secretary of State for Health by Professor Mike Richards CBE

Department of Health, 2008

This landmark review of co-payments will allow patients to top up NHS treatment with privately purchased drugs. It calls a halt to the practice employed by some primary care trusts of withdrawing treatment from patients who choose to top up. It also sets out measures to streamline the drug approval process and make more drugs available on the NHS. Strategic health authorities will encourage collaborative working among primary care trusts, which will be expected to set policies about drugs in advance of NICE guidance.

Intelligence supplement

R. Allmark (editor)

Health Service Journal, Nov. 27th 2008, Supplement, 12p.

This issue looks at: 1) the impact of patient response websites on the NHS; 2) the development by NHS Connecting for Health of a standardised system for medical record keeping; 3) a new online game, Virtual PCT, which allows players to act as chief executive of a primary care trust with debts and poor community health; and 4) use by NHS trusts of snapshot videos and photographs on websites as marketing tools.

Johnson keeps the faith on inequalities

R. Evans

Health Service Journal, Oct. 30th 2008, p. 12-13

Report of an interview with health secretary Alan Johnson, in which he expresses confidence that the government's target of reducing health inequalities and differences in life expectancy at birth by 10% by 2010 will be met. He is also confident that the 113 new GP practices being set up in the 20% of primary care trusts with the lowest numbers of family doctors per head will end the scandal of under-doctored areas, and expresses firm opposition to age discrimination in the NHS.

Life-giving cancer drug is not cost-effective, says NICE

R. Smith

Daily Telegraph, Oct. 28th 2008, p. 2

Lenalidomide can halt the progress of an aggressive bone marrow cancer for up to three years, according to its manufacturer, Celgene. Draft guidance from the National Institute for Health and Clinical Excellence disputes the claim. It says that, at 36,000 per patient per year, the drug breaches its cost-effectiveness threshold more than twice over.

NICE to speed up NHS drug funding decisions

K. Devlin

Daily Telegraph, Nov. 5th 2008, p. 14

Reports that the National Institute for Health and Clinical Excellence (NICE) will be more flexible in deciding whether drugs for terminally ill patients are cost effective. Patients who wish to top-up their NHS care by buying expensive drugs privately will be allowed to do so without forfeiting the free element of their treatment, provided that they can separate out all of the associated costs and cover them. NICE will also reduce the time it takes to make decisions on the cost-effectiveness of expensive new drugs.

(See also Daily Telegraph, Nov. 4th 2008, p.1)

NICE told to release Alzheimer's figures

R. Smith

Daily Telegraph, Oct. 30th 2008, p. 2

The National Institute for Health and Clinical Excellence will now release details of how it reached a controversial decision to restrict the use of certain Alzheimer's drugs following a decision by the House of Lords not to hear their appeal.

(For comment on NICE methodology, see Daily Telegraph, Oct. 24th 2008, p. 14)

Nine out of 10 health trusts fail hygiene test


Daily Telegraph, Nov. 24th 2008, p. 10

The Healthcare Commission performed unannounced spot checks on 51 hospitals and found that only five adhered to government hygiene standards put in place to reduce hospital infections. While most of the failures did not pose an immediate risk to patient safety, the Commission found that almost all acute trusts had more work to do to control the spread of hospital infections.

Pressure on to pick a winning combination

D. West

Health Service Journal, Nov. 27th 2008, p. 12-13

Legislation will dictate that all healthcare providers produce their first quality account - carrying a pre-selected set of measures for public consumption - at the end of 2009/10. This means deciding what measures will be included, and making sure solid data collection is in place to report them, before March 2009. Many trusts lack capacity to decipher the data they hold into meaningful indicators and are far from settling on a preferred set.

(See also Health Service Journal, Nov. 20th 2008, p.4-5)

Productive series

S. Shepherd (editor)

Health Service Journal, Nov. 6th 2008, Supplement, 13p

The Productive Ward, developed by the NHS Institute for Innovation and Improvement, empowers ward teams to redesign work processes and enables them to deliver better care. It offers practical tools which enable staff to find ways of reducing time spent on activities such as paperwork, handovers and searching for equipment and of increasing time available for patient care. The principles on which the Productive Ward programme is based are now being extended into other areas of the NHS, such as mental health and community services and the operations of trust boards.

Shunned NHS hospitals face closure

A. Porter

The Daily Telegraph, Nov.17th 2008, p. 1 + 14

Market forces introduced by Labour's health care reforms mean some hospital units are no longer attracting enough patients to survive. NHS hospital units face closure as patients choose to be treated in more successful medical centres. The figures show how NHS hospitals are also competing with privately run, independent sector treatment centres, which are becoming popular with patients and their GPs.

Survey shows 'racism alive in NHS'

C. Santry

Health Service Journal, Nov. 6th 2008, p. 4-5

A survey of 231 acute and primary care trusts has shown that black and minority ethnic workers are grossly under-represented among senior management but disproportionately involved in disciplinary hearings, bullying and harassment cases, and capability reviews. BME staff make up around 16% of the workforce, but are involved in more than twice as many bullying and harassment cases and capability reviews.

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