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

Assistant or substitute: exploring the fit between national policy vision and local practice realities of assistant practitioner job descriptions

A. Wakefield and others

Health Policy, vol. 90, 2009, p. 286-295

Over the past decade the NHS has sought to tackle staff shortages by introducing assistant practitioner roles into nursing and the allied health professions. These assistant practitioner roles were designed to deliver protocol-based clinical care under the direction and support of a state registered professional. At present the assistant practitioner role sits uneasily between two occupational spaces; it is seen neither as a professional role (due to its non-registered status and lack of professional regulation) nor as a traditional support role (assistant practitioners are expected to do more than traditional health care assistants). It is therefore essential for post-holders to be furnished with accurate and unambiguous job descriptions.

Caring approach to peace of mind

J. Taylor

Health Service Journal, May 7th 2009, p. 16-17

Advance planning involves patients expressing their wishes about their future care, such as a choice to die at home or to refuse further treatment. The Department of Health will be publishing a guide on advance planning for patients in July 2009. Clinicians and managers need to have systems in place to identify people approaching the end of their lives, discuss their preferences for care with them, and document their wishes.

The case that puts a stop to big pay-off cheques

A. Moore

Health Service Journal, May 7th 2009, p. 10-11

Ms Rose Gibb left Maidstone and Tunbridge Wells trust days before the publication of a critical Healthcare Commission report, on the promise of a 250,000 pay-off. The High Court has now decided that the pay-out cannot be enforced. Consequently, NHS chief executives facing accusations of incompetence are now more likely to be suspended or sacked following disciplinary proceedings. This could mean the end of managers' careers.

Choice rising but quality link missing

H. Crump

Health Service Journal, May 7th 2009, p.4-5

An analysis of hospital episode statistics from 66 primary care trusts for 2006/07 and the first three quarters of 2008/09 suggests that some patients are beginning to choose not to be treated at their local hospital. However, they are not yet choosing to travel in sufficient numbers to drive up quality or create competition.

Devolution in the UK: how each country went its own way

G. Clews

Health Service Journal, May 7th 2009, p. 21-23

This article examines the impact of devolution on health services in Scotland, Wales and Northern Ireland. The devolved health systems all have unique features, but managers are reluctant to comment on how well they think they are doing. The Scottish system has consciously moved away from market oriented models. Reorganisations in Wales and Northern Ireland have cut the numbers of health bodies. The remaining health organisations are working more closely with local authorities and social services.

A diagnosis of the NHS - by its patients

J. Laurance

The Independent, May 14th 2009, p. 8

The National Inpatient Survey by the Care Quality Commission (CQC), the health and social care inspectorate, is one of the largest of its kind, covering 72,000 patients who spent at least one night in hospital in 2008. The survey showed that despite record investment over the past decade, problems persist with mixed-sex wards, hospital food and answering call buttons. While more patients rated their ward as clean and said doctors and nurses are washing their hands, they are falling short on giving help with eating, involving patients in decisions and communicating with GPs. (See also The Guardian, May 14th 2009, p. 10)

Divergence or convergence? Health inequalities and policy in a devolved Britain

K.E. Smith and others

Critical Social Policy, vol. 29, 2009, p. 216-242

Since devolution in 1999, it has been widely reported that markedly different health policies have emerged. However, most of these analyses are based on a comparison of health care policies. This study takes a different approach and analyses public health policies aimed at reducing health inequalities through an analysis of national policy documents produced in England, Scotland and Wales. Results show a surprising degree of convergence across the three countries, as well as some continuity with the past. It is argued that the similar ways in which health inequalities have been conceptualised and framed as a policy problem in the three countries, combined with the dominance of the medical model of health, are likely to have played an important part in constraining policy responses.

DIY doctors: patients can boost NHS's value

P. Corrigan

Health Service Journal, Apr. 30th 2009, p. 12-13

The NHS has enjoyed a significant growth in resources since 2002. The 2009 national budget has shown that this year on year increase in investment will cease. This article argues that for the NHS to thrive in the new age of austerity it must get patients with chronic illnesses to manage more of their own care.

An easy mistake to make

I. Torjeson

Health Service Journal, May 14th 2009,p. 25-27

Although misdiagnosis is the biggest fear of three out of five patients when consulting their GP, little or no research has been done on the problem in either primary care or hospital settings. Evidence suggests that delays in GPs identifying and referring suspected cancer patients is one reason why the UK has poorer cancer outcomes than elsewhere in Europe and North America. Computerised diagnostic aids are now available to prompt GPs to consider conditions they may not have thought of. Calling in specialist advice earlier and training patients to describe all their symptoms succinctly when consulting their GP could also help.

The evidence base for vertical integration in health care

A. Ramsay, N. Fulop and N. Edwards

Journal of Integrated Care, vol.17, Apr. 2009, p. 3-12

Vertical integration describes a situation where different components of a supply chain are brought together in a single organisation. In healthcare there are two main types of vertical integration:

  • Where agencies involved at different stages of the care pathway are part of a single organisation
  • Where payer and provider agencies are part of a single organisation.

The Department of Health has outlined plans to support the piloting of new models of integrated care. This article presents research evidence related to the impact of relevant models of integration on organisation structures, the process of providing care, and outcomes such as cost and patient experience.

Experiences in the UK National Health Service: the overseas nurses' workforce

O. Alexis and V. Vydelingum

Health Policy, vol. 90, 2009, p. 320-328

This study investigated how black and minority ethnic nurses recruited from overseas to work in the NHS view their opportunities for skill development and training and NHS equal opportunities policies generally. 900 questionnaires were distributed and 188 were returned, giving a success rate of 21%. Overseas nurses from Africa perceived their opportunities for advancement, training and development to be different from those of their counterparts in other immigrant groups. African nurses were also less likely to view their experiences positively, especially if they were working in hospitals outside of London. NHS hospitals need to review their equal opportunities and training policies in the light of these findings.

A fitting end

J. Taylor

Health Service Journal, Apr.30th 2009, p. 22-24

Public opinion favours making assisted suicide by severely ill people legal in Britain. Doctors, particularly specialists in palliative medicine, are at odds with public opinion on assisted suicide, with only 35% being in favour. They are concerned about vulnerable people being made to feel a burden and being coerced into ending their lives prematurely. Degenerative disease charities and think tanks prefer to focus on improving inadequate end of life and palliative care services.

Gendered nature of managerialism? Case of the National Health Service

K. Miller

International Journal of Public Sector Management, vol. 22, 2009, p. 104-113

This paper argues that managerialism, as applied in the UK public sector, contributes to a masculine organisational culture that inhibits female career progression. The example of the NHS shows how, in an effort to achieve efficiency, quality and performance gains, the majority of employees (women) are marginalised by a masculine organisational culture that has implications for managerial career progression and succession planning.

Health policy: a critical perspective

I. Crinson

London: Sage, 2009

This book provides a critical assessment of developments in health and healthcare policy. Primarily focusing on the UK, the chapters cover issues such as the policy-making process; the development of the NHS; health care governance; health promotion; and the comparative analysis of health care systems within the EU and US. Each chapter brings together social and political themes to offer a unique combination of theory, historical detail and wider social commentary. Case studies illustrate how policy has evolved and developed in recent years, and the implications these changes have for practice.

Hospital safety whistle-blowers 'being ignored'

K. Devlin

Daily Telegraph, May 11th 2009, p. 14

A survey for the Royal College of Nursing found that two-thirds of respondents had raised concerns about patient safety with managers. One in three of those who had complained said that no action had been taken as a result and concerns had been swept under the carpet. Moreover, 78% of respondents said they feared they would be victimised if they spoke out. More than one in five said they had been persuaded not to report concerns.

How long can Southend remain off the Agenda?

A. Moore

Health Service Journal, May 21st 2009, p. 12-13

Southend University Hospital foundation trust has opted out of Agenda for Change. Instead of employing the majority of its staff on national terms and conditions, it has been operating its own scheme for the last three years. Around 95% of eligible staff are on its package negotiated with unions and differing in many respects from Agenda for Change.

Junior doctors' hours face review

R. Smith

Daily Telegraph, May 22nd 2009, p. 16

Junior hospital doctors' hours are due to be reduced to 48 per week in August 2009 in compliance with the EU Working Time Directive. However the government has announced a review of the impact of the cut in the light of concerns that it will adversely impact on the quality of their training.

Never say never?

M. Fletcher and T. Huehns

Health Service Journal, May 14th 2009, p. 20-21

There is a growing expectation that certain types of medical error should never occur. The term never events was coined by the National Quality Forum in the US in 2001to describe such avoidable errors. The National Patient Safety Agency has worked closely with the NHS to produce framework for action on never events in England. The framework identifies eight core never events and gives guidance on how they should be monitored and reported and how measures are to be put in place to prevent them.

Recertification in obstetrics and gynaecology: principles, problems and prospects

L. C. Edozien, T. Mahmood, and C. Dillon

Journal of Management and Marketing in Healthcare, vol. 2, 2009, 195-207

The 2007 White Paper Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century sets out proposals for ensuring that all statutorily regulated health professionals periodically revalidate their professional registration. Medical revalidation will have two components: relicensure and specialist recertification. For relicensure, all doctors will have a licence to practice that enables them to remain on the medical register, and this licence will have to be renewed every five years. This process will be managed by the General Medical Council. Recertification will apply to all specialist doctors, requiring g them to demonstrate that they meet the standards that apply to their medical speciality. These standards will be set and monitored by the Medical Royal Colleges. This paper sets out the approach taken by the Royal College of Obstetricians and Gynaecologists to setting standards for the recertification of obstetricians and gynaecologists.

Rose Gibb judgement ends era of pay-offs

A. Moore

Health Service Journal, Apr. 30th 2009, p. 4-5

Ms Gibb left her position as chief executive of Maidstone and Tunbridge Wells trust in disgrace in October 2007 following an outbreak of C. Difficile which killed at least 90 patients. She had negotiated severance terms under which the trust agreed to pay her 175,000 in addition the 75,000 she was entitled to in lieu of notice. The High Court has now turned down her bid to enforce the contract, saying that the trust had shown irrational generosity in agreeing the 175,000 compensation payment.

Sink or swim

A. Moore

Health Service Journal, May 21st 2009, p. 24-26

Small district general hospitals are often at the heart of their communities but are struggling to remain independent of large centralised facilities. They are employing imaginative solutions to retain key services in-house, and historical barriers to these solutions are diminishing.

Unneeded surgery may be costing millions

D. West

Health Service Journal, May 14th 2009, p. 4-5

In April 2009, NHS hospitals began asking patients undergoing groin hernia, varicose vein and hip and knee replacement operations to rate their health before and three months after surgery. The results, known as patient reported outcome measures, will be used to compare hospitals on the basis of how much patients' health improves. But they will also reveal how many patients with mild or no symptoms are being operated on unnecessarily.

We can't cope with sudden baby boom, hospitals say

D. Rose

The Times, May 22nd 2009, p.5

Figures obtained by The Times under the Freedom of Information Act suggest that two thirds of NHS trusts are unable to cover the cost of providing maternity services as the birthrate rises. The NHS has been asked to make 15 billion of 'efficiency savings' over the next three years, which, medical leaders warn, is only likely to exacerbate existing problems.

Working for better health information and technology across Wales

G. Thomas

Journal of Management and Marketing in Healthcare, vol.2, 2009, p. 125-134

Designed for Life is the Welsh Assembly Government strategy for the future of health and social care in Wales. Key components of this strategy include better use of information and technology and a commitment to a single electronic health record, currently being enabled through Informing Healthcare, the Welsh NHS IT programme. This paper highlights Wales as an exemplar of how to deliver better health information and technology across a country using an incremental, collaborative approach that will ultimately meet the objectives of Designed for Life.

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