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

Access to health care services: an English policy perspective

M. Goddard

Health Economics, Policy and Law, vol. 4, 2009, p. 195-208

The English government is committed to improving access to health care services for particular groups perceived as being under-served, or inappropriately served, by existing services. In this article, four examples of policies aimed at improving access are considered and the evidence for their success is examined. These are: enhancing the supply of services to under-served areas; changing the organisation of services; setting targets to improve access; and empowering people to make choices. It is argued that the reason why some may be less successful than policymakers hoped is due to an imperfect understanding of the barriers to access that exist for different population groups and in different contexts.

Birth of a new age in maternity care

D. Carlisle

Health Service Journal, Apr. 16th 2009, p. 16-17

NHS maternity services are under pressure from a range of stakeholders to improve safety. Much of this pressure is top-down and critical and risks disempowering staff. In contrast, the King's Fund is launching a programme of long-term support for maternity units aimed at engaging staff in developing solutions through a series of regional workshops.

Breaking free

H. Mooney

Health Service Journal, Apr. 2nd 2009, p. 22-24

Advocates and critics of foundation trusts give their views on how these have fared and made used of their increased autonomy five years after their launch. Opponents maintain that government should have focused on strengthening commissioners, not on giving hospitals more freedom to innovate.

The changing nature of prescribing: pharmacists as prescribers and challenges to medical dominance

M.C. Weiss and J. Sutton

Sociology of Health and Illness, vol. 31, 2009, p. 406-421

In 2003, legislative changes were introduced in the UK which permitted prescribing by healthcare professionals other than doctors, including pharmacists and nurses. This article explores the potential threat to medical dominance posed by the advent of pharmacists as prescribers. Drawing on 23 interviews with pharmacist supplementary prescribers, it argues that the acceptance of pharmacists as prescribers, as experienced in the workplace, has been aided by: 1) blurred or fragmented definitions of prescribing; 2) the emphasis on new prescribers' competence, urging pharmacist prescribers to limit their areas of clinical practice; and 3) a team approach to patient management.

Corporate flair to the fore in brave new world

A. Moore

Health Service Journal, Apr. 2nd 2009, p. 12-13

Foundation trusts launched in 2004 are adapting their management structures to make best use of the freedoms they enjoy. Their boards need skills such as horizon scanning which are not normally required in an NHS trust but which are essential in a large private firm. Foundation trusts are also engaging clinicians through service line management. This approach effectively divides the foundation into separate cost centres, allowing the organisation to look at costs and income down to individual patient level. Such units can develop expansion plans and present them to the board.

Deliver dignity or pay for mixed sex wards

D. Carlisle

Health Service Journal, Apr. 2nd 2009, p. 20-21

In January 2009 the Health Secretary Alan Johnson announced that from 2010/11 hospitals would not be paid for care delivered in mixed sex wards unless there was an overriding clinical justification. Eliminating mixed sex wards has proved one of the most intractable problems facing the NHS, but there is now extensive guidance on how to tackle it.

Health inequalities

Health Committee

London: TSO, 2009 (House of Commons papers, session 2008/09: HC 286)

Whilst health of all groups in England is improving, over the last ten years health inequalities between the social classes have widened-the gap has increased by 4% amongst men and by 11% amongst women-because the health of the rich is improving more quickly than that of the poor. Health inequalities are not only apparent between people of different socio-economic groups-they exist between different genders, different ethnic groups. The elderly and people suffering from mental health problems or learning disabilities also have worse health than the rest of the population. The causes of health inequalities are complex, and include lifestyle factors such as smoking, nutrition, exercise, as well as wider determinants such as poverty, housing and education. The Government has introduced specific policies to tackle health inequalities; two of particular importance were establishing health inequalities targets and establishing Sure Start. In this report The Health Committee makes recommendations about measures to change lifestyles and lists a number of areas where improvement is required as a matter of priority:

  • Nutrition: the Government should legislate to introduce a statutory traffic light labelling system.
  • Health promotion in schools: targets need to be set for the Healthy Schools programme
  • The built environment: health must be a primary consideration in planning decisions
  • Tobacco control: tougher measures against tobacco smuggling should be introduced

HSJ Intelligence

R. Allmark (editor)

Health Service Journal, Apr. 16th 2009, Supplement, 8p.

This issue of HSJ's quarterly supplement dedicated to technological innovation looks at how a new online recruitment system has improved the experience of junior hospital doctors applying for specialist training posts. The improvement is due not only to new software but also to a change in the way the whole project has been handled following the chaos in 2007. The supplement also explores how Health 2.0 and mHealth (use of mobile devices to manage personal health) are promoting the power of the individual to share, learn and engage with fellow patients and healthcare professionals.

Hospitals will face regular 'risk summits' to vet standards

J.Carvel

The Guardian, Apr. 27th 2009, p.6

The Healthcare Commission report in March which indicated 'appalling' standards of emergency care at Stafford general hospital has led to the proposal that every hospital in England and Wales be regularly vetted at 'risk summits'. These will enable inspectors, health watchdogs and regional NHS chiefs to share information in order to identify signs which suggest sub-standard care.

Introducing academic health science centres

S.M. Davies

British Journal of Healthcare Management, vol. 15, 2009, p. 176-180

In March 2009 the UK government formally designated five university-NHS partnerships in England as academic health science centres (AHSCs). AHSCs are recognised internationally as distinctive forms of organisation required for the delivery of clinical care, education and research. Much of the international literature on AHSCs comes from the USA and it is important to understand the complexity and diversity of models in that country. Other countries, such as the Netherlands, may offer useful lessons for AHSC development, but there is limited documentation available in English.

Lay perceptions of the desired role and type of user involvement in clinical governance

A. Litva and others

Health Expectations, vol. 12, 2009, p. 81-91

The English NHS has sought to build a modern, dependable health service through enhanced effectiveness, responsiveness and consistency. Clinical governance, a policy for improving service quality, is a key pillar of these reforms. Primary care organisations have a statutory duty to ensure that patients and the public are involved in all service planning and decision making, including clinical governance. However, surveys indicate that user involvement in clinical governance is underdeveloped. In this research, focus groups were conducted with different types of lay people to explore their perceptions of public involvement in different aspects of clinical governance. Findings suggest that to facilitate user involvement, it would be necessary to use different strategies to accommodate the differing role perspectives and types of involvement desired by different groups of lay people.

One in four stroke patients 'not getting specialist care'

K. Devlin

Daily Telegraph, Apr. 23rd 2009, p. 10

A survey by the Royal College of Physicians shows that 26% of stroke patients never receive treatment on a specialist ward, despite evidence that this can dramatically increase their chances of survival. Only 17% are admitted to specialist units within four hours of arriving at hospital.

Personal responsibility in the NHS Constitution and the social determinants of health approach: competitive or complementary?

H. Schmidt

Health Economics, Policy and Law, vol. 4, 2009, p. 129-138

There is extensive evidence that the conditions in which people are born, live and work are the single most important determinant of good or ill health. In 2009 the Department of Health promulgated the new NHS Constitution which introduces explicit health related responsibilities for individuals. This editorial explores whether the two approaches are complementary or contradictory. The author argues that there are certain health related behaviours, such as hand washing and brushing teeth, for which individuals, however deprived, must take personal responsibility. He also aims to show that the responsibilities set out in the NHS Constitution should be seen as complementary to the social determinants of health approach, as they can pinpoint areas where social and structural determinants have an especially strong effect, underline the need for policies that build on promoting the co-production of health, and help make the healthcare system as efficient as possible.

Safer care

S. Shepherd (editor)

Health Service Journal, Apr. 23rd 2009, p. 25-29

This special report provides a window on the work of the NHS Institute for Improvement and Innovation in the field of patient safety. It describes:

  • The Leading Improvement in Patient Safety Programme which is enabling acute trusts to develop their safety strategies
  • A global trigger tool designed to help GPs identify, measure and act on patient safety warning signs more quickly and systematically
  • The safer care faculty, a group of clinicians who act as facilitators on the Leading Improvement in Patient Safety Programme

Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce

G.P. Martin, G. Currie and R. Finn

Social Science and Medicine, vol. 68, 2009, p. 1191-1198

Since 1997 the New Labour governments of the UK have sought to reconfigure the responsibilities of professional groups in the English NHS in pursuit of more effective, joined-up service provision. One of the new roles introduced has been that of general practitioner with special interests which aims to bridge the boundary between hospital specialists and primary care. This article explores how the division of labour between hospital geneticists and newly introduced GPs with a special interest in genetics was negotiated. GPSIs themselves wished to extend their expertise upwards into the realm of clinical genetics, with a view to practice. Geneticists were not keen on this idea, seeing clinical genetics as a field ill-suited to the autonomous practice of GPSIs, preferring instead roles which drew on GPSIs' role and status as GPs, and their commonalty with other GPs. Across the four case study sites, it was the geneticists' interpretation of the new role which won the day, through negotiation or coercion.

Working in partnership with service users

L. Maher and H. Baxter

British Journal of Healthcare Management, vol. 15, 2009, p. 172-175

This article introduces the experience-based design model, which involves patients, carers and staff working together to redesign services on the basis of their lived experience. An experience-based design approach can lead to improvements in safety, efficiency, dignity and reliability of health services. The approach can be used widely and adapted to fit with local need.

Working lives marred by culture of bullying

C. Santry

Health Service Journal, Apr. 23rd 2009, p. 12-13

The annual survey of NHS staff published in March 2009 showed that bullying is endemic in the organisation. Twelve per cent of staff surveyed claimed to have suffered bullying in the previous year and 8% said this was by managers. Staff from ethnic minorities and staff with disabilities were more likely to report bullying than White British workers. PENSIONS - UK

Aon cuts pension payments

N. Cohen

The Financial Times, Apr. 8th 2009, p.1

The UK arm of Aon Limited, one of the world's biggest insurance brokers, is to cut its contributions to staff defined contribution schemes by up to half. Aon is the first UK firm to do this, and it is suggested that other companies may follow.

New limit of 10,000 for pension credits

R. Murray-West

Daily Telegraph Budget 2009 special report, Apr. 23rd 2009, B10

Half a million or Britain's poorest pensioners will benefit from the increase in the savings limit for pension credits announced in this year's budget. However, Neil Duncan-Jordan of the National Pensioners Convention is among experts who feel that raising the state pension would be a better solution. For the full Budget Report, please see the Treasury Budget 2009 website at http://www.hm-treasury.gov.uk/bud_bud09_index.htm

Occupational hazards

N. Keogh

Public Finance, Apr. 3rd-9th 2009, p. 24-25

This article considers the implications of the decline in occupational pension provision for the public finances. It concludes that the state will be called upon to provide increased financial support through social security benefits to private sector workers whose income in retirement falls short of the government's minimum income guarantee.

Promises broken on pensions, say industry bodies

Y. Essen

Daily Telegraph Budget 2009 special report, Apr. 23rd 2009, B8

The Association of British Insurers is among those critical of the Government's changes to tax relief on pensions, which mean that from April 2011 people earning more than 180,000 will not get higher rate tax relief on pensions contributions. They will get the basic rate instead. The move will raise 3bn a year for the Government, according to pension consultants Watson Wyatt.

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