Welfare Reform on the Web (January 2009): National Health Service - reform - general

Battle of the binge

S. Shepherd

Health Service Journal, Dec. 11th 2008, p. 20-22

Around 3% of all deaths in England (15,000 a year) are related to alcohol misuse. The cost of alcohol abuse to the health service is estimated at £2.7bn. There are growing calls for a regulatory approach to reducing alcohol harm, as voluntary partnerships with the drinks industry have not worked.

Child safety is a double whammy for managers

C. Santry

Health Service Journal, Dec. 11th 2008, p. 12-13

This article discusses the implications for the NHS of the death of Baby P at the age of 17 months after a lifetime of brutal treatment in spite of being seen 60 times by social workers and health professionals. There is a need to ensure that frontline staff involved with child protection, such as health visitors and paediatricians, are properly trained and supported. Getting buy-in from clinicians is crucial to entrenching child protection systems across healthcare organisations.

The fetal tissue economy: from the abortion clinic to the stem cell economy

J. Kent

Social Science and Medicine, vol.67, 2008, p. 1747-1756

Stem cell science relies on the procurement of human tissue from a variety of sources, including aborted foetuses. This paper examines the exchange relationships between women undergoing abortion, the clinicians who procure fetal tissue and stem cell scientists in Britain. The author describes and analyses the ways in which women undergoing abortion are constructed as 'donors' and how this differs from understandings of women donating embryos created in the in vitro fertilisation clinic. These differences may be partly understood in terms of a woman's relationship to the 'dead' fetus. This in turn relates to the procedures for obtaining consent. The law and guidelines on the use of fetal tissue in research mobilise particular constructions of women donors and the aborted fetus and this influences practices in seeking consent and collecting the tissue.

Inequalities in child health up to five years: a supradistrict audit

C.A. Smith and D. Willmott

Community Practitioner, vol. 81, Dec. 2008, p. 26-29

Reducing health inequalities is a key national priority. This paper describes a unique retrospective multidisciplinary audit that was carried out across the Greater Manchester area. Health visitor and midwifery records were audited against service provision to identify the extent to which local health and local authority services were implementing evidence-based interventions to reduce health inequalities in children aged under five. Results showed that recommendations from the Acheson report on measures to reduce health inequalities were not being implemented universally and that areas of highest deprivation were not being targeted.

Informing debate or fuelling dispute? Media communication of reconfiguration in Scotland's rural maternity care

E. Thomson and others

Social Policy and Administration, vol. 42, 2008, p. 789-812

Public reaction to health sector reform in the UK often frustrates policymakers. Public participation in health service decision-making is advocated, but precisely how to do it in practice is unclear. Public opinion is formed through many influences, including media reporting. This article presents findings from a review of media reporting about service reconfiguration at a rural maternity unit at Caithness General Hospital, Wick, Scotland. Qualitative and quantitative approaches were employed to explore the content of newspaper articles. The study analysed what messages were conveyed in the press, in what depth, and the balance of reporting. Findings provide insights into how changing social policy is communicated to the public and suggest that media portrayal of the public role in change may promote an adversarial rather than a participative stance.

Reducing alcohol harm: health services in England for alcohol misuse

National Audit Office

London: TSO, 2008 (House of Commons papers, session 2007/08; HC 1049)

The report notes that primary care trusts are free to decide how much to spend on alcohol services and are not under any specific requirement to provide them. Main findings include:

• A quarter of primary care trusts lack accurate assessments of alcohol problems in their area Only 58% of PCTs have an alcohol strategy
• An average PCT spends £600,000 on commissioning alcohol services, a little over 0.1% of typical annual expenditure
• There are wide variations in the local provision of specialist services
• More than a third of PCTs have not included the new public service agreement performance indicator on alcohol related admissions in their operating plans or local area agreement.

Representativeness, legitimacy and power in public involvement in health service management

G.P. Martin

Social Science and Medicine, vol. 67, 2008, p. 1757-1765

The healthcare system in Britain has been subject to an increasing drive to engage on a collective level with its public. However, public participation is limited by various constraints, including a widely observed reluctance on the part of health professionals and managers to engage with the public and put into practice the outputs of public involvement processes. Keen to retain control over decision-making, the professionals undermine the legitimacy of involved members of the public, particularly by questioning their representativeness. This paper examines the negotiation of representative legitimacy between staff and involved users by drawing on a qualitative study of service user involvement in pilot cancer genetics services recently introduced in England. In contrast to much of the research evidence, health professionals identified some degree of representative legitimacy in the contributions made by users. However, the ways in which staff and users constructed representativeness diverged significantly. Where staff valued the identities of users as biomedical and lay subjects, users described the legitimacy of their contribution in terms of knowledge and citizenship.

State of healthcare 2008

Healthcare Commission

London: TSO, 2008 (House of Commons papers, session 2008-09: HC 11)

This is the Healthcare Commission's fifth and final report to Parliament on the state of healthcare in England and Wales. It looks at the progress made in healthcare since 2004 and the challenges ahead. The overall picture is positive, with targets relating to the health of the population either met or on the way to being met. Life expectancy is increasing and rates of premature death due to cancer and circulatory disease are falling. However, there are underlying concerns. Inequalities in health status are persistent and, in some cases, are widening, despite targets aimed at reducing inequality. The Commission also expressed continuing concerns about the ability of healthcare organisations to meet the needs of the more vulnerable in our society such as people with learning disabilities, children and older people.

Trusts must clean up in fear of harsh penalties

A. Moore

Health Service Journal, Dec. 4th 2008, p. 14-15

A Healthcare Commission report on hospital cleanliness published in November 2008 showed a general improvement in standards. However, there are two significant areas of concern: decontamination of surgical instruments and other patient equipment such as commodes, and generally having a clean and well maintained environment. The article concludes by warning that trusts not complying with the hygiene code could face harsh penalties when the new regulator, the Care Quality Commission, comes into being in April 2009. The new Commission has powers to temporarily close hospitals if there is a significant risk to patient safety.

Trusts waste effort chasing EU hours

C. Santry

Health Service Journal, Dec. 18th 2008, p. 4-5

The EU working time directive will come into effect for trainee doctors in August 2008, and will cut their maximum working week from 56 to 48 hours. There is confusion among hospital trusts about how doctors' working hours should be calculated. Instead of using the official EU method of measuring working hours, about half of trusts are thought to be calculating their compliance with the directive using pay banding data for junior doctors on the new deal contract.

Who's for the chop?

S. Gainsbury

Health Service Journal, Dec. 18th 2008, p. 22-24

Former Health Secretary Alan Milburn set a target for all hospital trusts to attain foundation status by the end of 2008. However sixty-eight hospital trusts have barely begun the process of moving to foundation status. Financial struggles are a major cause of failure to make progress. For some trusts, merger, takeover or franchise may be the final outcomes.