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

Achieving the 48-hour week for junior doctors

D. Kendall and others

British Journal of Healthcare Management, vol. 15, 2009, p. 127-131

NHS North West planned to implement a 48-hour working week for all junior doctors in training as required by the EU Working Time Directive one year ahead of the national deadline of August 2009. A team of six junior doctors was recruited to implement the project. This article describes the management tools and techniques they used.

Brand strategy for acute NHS trusts

R. Hudson

Journal of Communication in Healthcare, vol. 2, 2009, p. 20-33

Since NHS patients have been given the right to choose their treatment provider at the point of referral, hospitals need to market their services. This paper illustrates how the principles of branding and brand strategy can be used by NHS acute trusts, based on examples from the NHS and the commercial sector. It also shows how branding can be used to help build stakeholder loyalty and a unique relationship with stakeholders.

Data reveals wide variation in rates of reporting

C. Santry

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

The HSJ has analysed figures from the National Patient Safety Agency (NPSA) organisational reports to reveal trusts where patient safety incidents are most likely to cause deaths, and those with the highest and lowest reporting rates. Of 422 NHS organisations in England and Wales, 45 did not admit to any patient safety incidents or reported too few to be included in the NPSA data. The highest reporting rates were at Leicester City Primary Care Trust, which reported 158 incidents per 1,000 bed days. The analysis also reveals that it takes some trusts many months to report incidents, including patient accidents and medication errors.

Deprivation of Liberty Safeguards

R. Griffith

British Journal of Healthcare Management, vol. 15, 2009, p. 132-140

Deprivation of liberty safeguards for hospital patients and care home residents come into force on April 1st 2009. Following assessment, a standard authorisation will allow a supervisory body to authorise deprivation of liberty for up to 12 months for hospital patients and care home residents who lack decision-making capacity. A system of review and appeal against the authorisation will be available to the person or their representatives. Healthcare managers need to be aware of the new system, which is introduced in this article.

Diabetes Year of Care

A. Cowper (editor)

Health Service Journal, Mar. 12th 2009, supplement, 13p.

The Year of Care Programme sets out to discover how to deliver patient-centred and personalised care to people with long term conditions, using the opportunities and mechanisms provided by the health reform agenda. Effective care for people with long-term conditions requires a partnership between the patient and the health professional, where decision making is shared and self-care supported.

Doctors outcry over plans to sell patient records

R. Smith

Daily Telegraph, Mar. 3rd 2009, p. 1

Government plans outlined in the Coroners and Justice Bill would allow access to the medical records of named individuals by insurance companies or research organisations without their consent. The data could also be given to other government departments and agencies such as the Department for Work and Pensions, which could use it to check if benefits claimants were able to work. Medical organisations have written to justice secretary Jack Straw to express their grave concerns.

Drugs will get NHS go-ahead within six months, ministers say

R. Smith

Daily Telegraph, Mar. 4th 2009, p.14

Patients will get approved drugs on the NHS within six months instead of waiting up to two years under plans to speed up decisions by the National Institute for Health and Clinical Excellence (NICE). Measures announced include adding another committee of experts to consider the drugs and identifying medicines that need to be referred to NICE earlier. Guidance is also being issued to primary care trusts on criteria for funding drugs not approved by NICE.

Effective quality improvement: TQM and CQI approaches

A. Powell, R. Rushmer and H. Davies

British Journal of Healthcare Management, vol. 15, 2009, p. 114-120

The terms TQM (Total Quality Management) and CQI (Continuous Quality Improvement) are used fairly loosely by healthcare organisations to describe a general approach to quality improvement. Key features of these approaches include a strong emphasis on continuous quality improvement as an integral part of everyday work, on data driven improvement, on the active involvement of senior managers and on systems and teams rather than on individuals. They have been widely used in healthcare with mixed results. Particular challenges in applying these approaches in healthcare include the struggle to involve medical staff, and the conflict between many of the underlying assumptions of TQM/CQI and the cultural, political and financial context of the NHS.

Fast thinking

J. Taylor

Health Service Journal, Mar. 12th 2009, p. 18-20

Despite it being one of the England's biggest killers, and the largest cause of disability, stroke only gained a national strategy in 2007. Publication of the strategy has triggered a range of initiatives to improve services, including:

  1. training more specialist clinicians
  2. the introduction of performance measures
  3. the publication of two sets of new clinical guidelines in 2008
  4. the establishment of stroke networks across England.

The fat of the land

E. Dent

Health Service Journal, Mar. 26th 2009, p. 18-20

It is predicted that, if no action is taken, 60% of men, 50% of women and 25% of children will be obese by 2050. There will be corresponding increases in obesity related diseases such as heart disease, diabetes, stroke and some cancers. Government is responding with a raft of initiatives aimed at preventing people from becoming overweight. However, obesity management is far less embedded in general healthcare than smoking cessation.

Fit for recovery

N. Bosanquet, A. Haldenby and H. Rainbow

Reform, 2009

Report accuses the NHS of having a 'dinosaur' attitude to staff well-being. It could save 1bn a year in staff absence costs if it followed the example of private firms and encouraged workers to take more exercise and eat healthily. Incentivising individuals to get fit is said to be more effective than relying on costly public health campaigns. The report also claims that introducing bonus schemes for healthy living also leads to a reduction in sickness absence.

Improving services for children in hospital: report of the follow-up to the 2005/06 review

Healthcare Commission

2009

The Commission carried out a review of 154 hospital trusts where children are treated to check on progress made since an earlier investigation in 2005/06. Key findings are:

  • Three in ten trusts do not meet the basic minimum level of child protection training for key staff
  • Four in ten trusts do not have the equivalent of one nurse per shift trained to assess and treat pain in children
  • Three quarters of trusts did not meet guidelines on life support training and more than one in ten had deteriorated on this score since 2005/06
  • More than seven out of ten trusts have got worse or been consistently poor at ensuring that surgeons and anaesthetists treat enough children to maintain their skills.

Investigation into Mid Staffordshire NHS Foundation Trust

Healthcare Commission

2009

Report reveals a litany of failings at Mid Staffordshire hospitals trust that led to mortality rates in emergency care that were between 27% and 45% higher than would be expected. Failures included:

  • Shortage of doctors and lack of supervision of juniors
  • Failures in nursing training
  • Outbreak of Clostridium difficile not reported
  • 150 posts cut to save 10m despite understaffing
  • Lack of basic equipment in Accident and Emergency including thermometers, trolleys and cardiac monitors
  • Receptionists in A&E expected to judge the seriousness of cases
  • Patients left covered in blood and in pain on soiled sheets
  • Wards, beds, commodes and bathrooms not clean

The report concludes that the trust was more concerned with hitting government targets, gaining foundation status and improving its image than with caring for its patients.

(For comment see Daily Telegraph, Mar. 18th 2009, p.1+2, 8)

Leadership development: does it make a difference?

S. Prosser

British Journal of Healthcare Management, vol. 15, 2009, p. 121-126

When millions of pounds are being spent on leadership development in the NHS, there is need for concrete evidence that it is having a positive effect on patient care. This article is the summary of a report that set out to find such evidence. The evidence it limited, but is sufficient to show that effective leadership does make a positive difference to the patient experience.

NHS management growing four times faster than nurses

R. Smith

Daily Telegraph, Mar. 26th 2009, p. 10

Official figures show that the NHS is now employing 1.36 million people, but the number of managers is rising four times faster than the number of nurses. The report also shows that the number of people working in the NHS rose by 27% in a decade. The number of midwives rose by 2.3%, the number of consultants by 3.7%, and the number of doctors in training by 5.1%. However, the number of nurses in GP surgeries dropped by 3.6% and practice staff excluding nurses fell by 2.2%.

NHS review website under fire

N. Timmins

Financial Times, Mar. 11th 2009, p. 4

An NHS Choices website which has cost millions of pounds of government money has been criticised as a waste because independent websites run by not-for-profit entities like Patient Organisation perform much the same functions.

Organ donors may nominate family

C. Hope

Daily Telegraph, Mar. 18th 2009, p. 2

Currently organs for transplant are donated into a national pool where they are used to help those most in need. The Government has signalled that it will change the rules to allow donors to specify who should receive their organs if there is no critical need for them nationally

The patient is always right

K. McIntosh

Health Service Journal, Mar. 5th 2009, p. 20-22

The Department of Health is selecting personal health budget pilot sites to launch this summer. The King's Fund has warned that the scheme could be exploited by the middle classes and so increase health inequalities, but In Control, which developed the idea of personal budgets, is convinced they will offer real benefits. Issues are emerging, including the possibility of people spending the money on things other than healthcare or purchasing treatments not approved by the NHS or their doctor. Experience also suggests that the budgets will not cover the full cost of care, but the Department of Health has ruled out top-ups.

What let standards fall so low at Mid Staffordshire?

D. West

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

Following a damning report on standards of emergency care at Mid Staffordshire foundation trust by the Healthcare Commission, this article investigates the root of the problems. It is alleged that standards began to slip in 2005, when a new chief executive introduced radical cost saving measures and a drive for foundation status at the expense of patient care.

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