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

Anxiety on the up as managers react to 'Stalinist' SHA tactics

C. Santry

Health Service Journal, Feb. 12th 2009, p. 6-7

Reports that NHS London is taking a hard line with chief executives of trusts that miss targets or fail to follow procedures. Many trusts in London are performing badly against targets and managers fear that NHS London is forcing out chief executives in response to pressure from the Department of Health, creating a climate of fear.

(See also Health Service Journal, Feb. 5th 2009, p. 4-5)

Are patients choosing?

S. Henderson, R. Robertson and A. Dixon

British Journal of Healthcare Management, vol. 15, 2009, p. 77-80

Since April 2008 NHS patients should have been able to choose elective treatment from any hospital on a nationally approved list. Only half of 18 patients interviewed for this study had in fact been offered a choice of hospital. Patients had not discussed options with their GP or consulted the Internet for advice. To attract new patients, hospitals need to break historical referral patterns and loyalties and ensure that GPs offer choice.

Eastern promise

I. Torjesen (editor)

Health Service Journal, Feb. 26th 2009, Supplement, 13p

This supplement looks at how NHS East of England hopes to achieve its ambition of delivering the best health service in England over the next decade. It outlines the strategic health authority's plans for reducing health inequalities, improving access to treatment for people with mild to moderate mental health difficulties, investing in staff development, improving patient safety, and promoting patient choice.

Easy does it as NHS steps up to quality bat

D. West

Health Service Journal, Feb. 26th 2009, p. 12-13

Lord Darzi's review of the future of the NHS prioritised demonstration of improvements in care quality. This article reports progress on developing metrics. At the end of financial year 2009/10 all acute trusts will be required to publish a quality account and will be forced to answer for any failure to improve.

Effective quality improvement: some necessary conditions

A. Powell, R. Rushmer and H. Davies

British Journal of Healthcare Management, vol. 15, 2009, p. 62-68

Studies of quality improvement and other organisational change initiatives in healthcare show that there is a set of core conditions that are necessary, no matter what approach is used. These core conditions include: tailoring the approach to the local context; taking a whole organisation approach; engaging key personnel and groups; providing resources to support the programme directly and indirectly; and taking a sustained multifaceted approach to quality improvement. Paying attention to these core conditions as they apply in the local circumstances will substantially increase the likelihood that quality improvement initiatives will result in sustained improvements in the quality of patient care.

Free and single

A. Moore

Health Service Journal, Feb. 26th 2009, p.20-22

The percentage of single rooms in hospitals is rising dramatically throughout the UK. Single rooms can increase dignity and privacy, and allow care to be delivered closer to the patient. Downsides include costs and possibly increased demands on nurses.

Healthcare across EU borders: a safe framework

European Union Committee

London: TSO, 2009 (House of Lords papers, session 2008/09: HL 30)

In a report on cross-border healthcare, the Committee calls for patients to be given greater rights to travel to other EU member states for medical treatment at NHS expense. It recommends that the NHS should pay fees directly to foreign hospitals, rather than requiring the patient to pay upfront and then claim a reimbursement. However, they say that more should be done to ensure that British hospitals can refuse to accept patients from abroad if it would increase waiting times for local people.


R. Allmark (editor)

Health Service Journal, Feb. 5th 2009, supplement, 12p.

This issue of the quarterly supplement focuses on how software tools are working to provide holistic solutions in healthcare. Groundbreaking digital maps will support healthcare planning, analysis and activity of all kinds from identifying 'fresh food deserts' to deciding where to locate polyclinics. The social care charity Turning Point is pioneering a single electronic client record that allows services from health to housing to co-ordinate support for a patient. There are also articles on the future of health informatics in the US and on how wireless technology is transforming a foundation trust's admissions process.

Modernising nursing careers

C. Doherty

British Journal of Healthcare Management, vol. 15, 2009, p. 81-86

Career prospects, both hierarchical and developmental, are important factors for the retention of nursing staff. Specialist nurse posts offer nurses a career path that provides them with the opportunity to develop new knowledge and skills. The majority of nurses participating in this study who expressed a future job choice aspired towards specialisation. Specialist nurses said they were content to remain in their current posts because of the autonomy and developmental opportunities that they offer. Any reduction in opportunities for specialisation may therefore have negative consequences for retention.

More than 20 trusts are set to miss application deadlines

S. Gainsbury

Health Service Journal, Feb. 12th 2009, p. 4-5

More than 20 hospital and mental health trusts will not be ready for foundation status by the government's deadline of December 2010. They face either radical restructuring or becoming part of a 'shopping list' for existing foundation trusts looking for takeover opportunities.

The national programme for IT in the NHS: progress since 2006

Public Accounts Committee

London: TSO, 2009 (House of Commons papers, session 2008/09: HC 153)

This report examines the Department of Health on the progress being made in delivering the National Programme for IT, which is designed to reform the way the NHS in England uses information, and hence to improve services and the quality of patient care. The Programme requires substantial organisational and cultural change to be successful and it is dependent on the deployment of systems in an increasingly devolved NHS. It started with four Local Service Providers-the main suppliers responsible for implementing systems at local level-covering the whole of England, but two have left the Programme. The Programme's high dependence on just two major suppliers has implications for its capacity and capability, and for the Department's leverage. The estimated cost of the Programme is 12.7 billion, including 3.6 billion of local costs, although this figure remains uncertain. In the event that Trusts decide not to deploy the Programme's systems, the Department is nonetheless obliged to make payments to the suppliers concerned. The Programme is intended to generate substantial benefits for patients and the NHS. The aim is for the care records software to be delivered in a series of releases with increasing functionality. Delivering the clinical functionality will be key to convincing NHS staff of the benefits of the Programme because what has been provided to date has not met their expectations.

NHS hits most of its waiting list targets

N. Timmins

Financial Times, Feb 27th, p. 4

The median waiting time patients have to wait for hospital treatment can begin after seeing a GP is down to 7.6 weeks for in-patients treatment and 4.1 weeks for out-patient treatment. Not all hospitals have reached the target in all specialisms, but on average across the NHS as a whole, the targets are being met.

NHS next stage review

Health Committee

London: TSO, 2009 (House of Commons papers, session 2008/09: HC 53)

High Quality Care for All: Next Stage Review Final Report (NSR), which was led by Lord Darzi and published on 30 June 2008, is the latest of many reviews of the NHS. The main difference from its predecessors lies in the extensive consultation undertaken with clinicians and patients. Its main focus is improving the quality of care provided by the NHS. However, the Health Committee have concerns about the implementation of the report, which will be the responsibility of Primary Care Trusts (PCTs), because they doubt that most PCTs are currently capable of doing the task successfully as many of them lack analytical and planning skills and the quality of their management is very variable. The Committee are also concerned that the NSR provides little detail about costs and contains many priorities without ranking them. The NSR reiterates the Department of Health's plans to create 150 GP-led health centres, one for each PCT in England. However, this expansion in supply needs careful management and evaluation to determine whether it leads to better evidence-based medical interventions for patients and whether it reduces disparities in health care access and utilisation between different social classes. Finally, the Committee think it is unfortunate that the NSR does not place more emphasis on the importance of recruiting and developing better managers. One means of improving management would be through more effective use of the NHS Graduate Management Scheme which has attracted graduates of great ability, but too often not made the best use of them.

NHS pay modernisation in England: agenda for change

National Audit Office

London: TSO, 2009 (House of Commons papers, session 2008/09: HC 125)

Agenda for Change is the name given to the project for reforming pay in the NHS. The Department of Health and NHS, in partnership with the trade unions, successfully implemented Agenda for Change for some 1.1 million employees, doing so within a short timescale. The new system gives the NHS a single and transparent system for employing staff, and simplifies significantly the administration of pay within the NHS. This report examines the implementation and costs of Agenda for Change and the Knowledge and Skills Framework in England. This report also reviews the extent to which the benefits of the new reward system have been realised and examines some of the barriers to fully realising these. It recommends that the Department and NHS Employers should disseminate and share best practice on the use of the Knowledge and Skills Framework and how Agenda for Change can be used to improve efficiency and patient care.

NHS values of data management

J. Grace

British Journal of Healthcare Management, vol.15, 2009, p. 73-76

The implementation of the Connecting for Health IT programme will introduce national-level electronic patient records to the NHS. This information, when anonymised, will be available for research. This article considers the steps that the NHS will need to take to comply with the Data protection Act 1998 in handling this data and making it available for research.

Patients' choice hit by booking system

K. Devlin

Daily Telegraph, Jan. 28th 2009, p. 8

Reports that patients are being prevented from choosing to wait longer to see popular consultants. They are being denied appointments by the Choose and Book computer system which fail to meet government targets to treat all patients within 18 weeks of referral.

Regulator takes fight for foundation freedoms to the House of Lords

D. West

Health Service Journal, Feb. 19th 2009, p. 4-5

Foundation trusts regulator Monitor believes that proposals in the Health Bill compromise their independence by requiring them to send quality accounts to the health secretary. Baroness Murphy, a non-executive director of Monitor, has tabled an amendment that would instead have the quality accounts reported to foundation trust governors, Parliament and Monitor itself.

Religion of belief? A practical guide for the NHS

Department of Health


This guidance warns that any attempts by NHS staff to preach or witness to other staff or patients will be treated as harassment under disciplinary procedures and could lead to dismissal. However, it does not make clear the limits of acceptable discussion about religion.

(For comment and an account of the case of Mrs Caroline Petrie, a community nurse threatened with dismissal for offering to pray for a patient, see Daily Telegraph, Feb. 6th 2009, p. 1 + 2)

Rethink on kidney cancer drug ban

K. Devlin

Daily Telegraph, Feb. 4th 2009, p. 1

In response to public pressure, the National Institute for Health and Clinical Excellence (NICE) has reversed its decision to ban the expensive kidney cancer drug Sutent from being offered by the NHS. NICE revised its guidance after taking into account new rules requiring greater funding for expensive drugs than can help terminally ill patients, and after the manufacturer offered to cover some of the costs. Under the deal, the manufacturer will pay for the first six-week cycle of the drug, costing 3,139, with the NHS picking up the rest of the bill.

Top-up rules set for rewrite as fear of litigation mounts

H. Crump

Health Service Journal, Feb. 19th 2009, p. 6

The government is expected to rewrite its guidance on implementation of the Richards review recommendations on top-up payments. The guidance says that all NHS routes should be exhausted before patients can make top-up payments without losing their entitlement to receive the rest of their treatment free. This means that clinicians are having to increase the number of applications they send to Primary Care Trusts for exceptional funding to include clinically non-exceptional cases.

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