Welfare Reform on the Web (June 2000): National Health Service - Reform - General

BROWN 'MISLED' MPS OVER BUDGET PLEDGE TO RECRUIT NURSES

J. Hibbs and T. Womersley

Daily Telegraph, Mar. 27^th 2000, p. 8

Reports disclosure by a Cabinet colleague of Gordon Brown's that the 10,000 new nurses promised in the budget were in fact already in the pipeline and financed by a previous comprehensive spending review.

CLINCIAL INDIATORS (LEAGUE TABLES): A DISCUSSION PAPER

British Medical Association Board of Science and Education

London: 2000

Paper examines the six clinical indicators published in June 1999 to compare individual trusts and health authorities. Argues that the data are too complicated for the public and insufficiently specific to be of much use to individual doctors. They are also statistically flawed for the purposes of comparing trusts.

DELUSIONS OF GRANDEUR

A. Maynard

Health Service Journal, vol. 110, Mar. 30^th 2000, p. 22-23

Argues that the role of the royal medical colleges in the training and governance of doctors should be independently reviewed. The colleges have extensive influence on the NHS which may not be used to benefit the patient.

GETTING EVIDENCE INTO PRACTICE: AN ORGANISATIONAL BEHAVIOUR PERSPECTIVE

E. Ferlie, L. Fitzgerald and M. Wood

Journal of Health Services Research and Policy, vol. 5, 2000, p. 96-102

Studied the relationship between research evidence and clinical behaviour change in the NHS in the period 1995-1997 by examining the "careers" of change issues designed to reshape clinical practice, the impact of such change efforts, and the factors shaping change outcomes. Results showed a weak relationship between the evidence base and its diffusion. The diffusion and take-up of scientific evidence was shown to be socially constructed. Different forms of evidence were differentially accepted by individuals and groups. Specific organisational and social factors affected this pattern of impact. The general management hierarchy of the NHS played a very limited role in enabling evidence-based clinical change.

A GOOD PROGNOSIS

P. Toynbee

Guardian, Mar. 24^th 2000, p. 21

Argues that NHS modernisation depends on getting a grip on doctors, and changing the way that they work.

INADMISSABLE EVIDENCE

K. McPherson and A. Metcalfe

Health Service Journal, vol. 110, Mar. 30^th 2000, p. 26-27

Little research has been done on the number of intensive care beds the UK needs, and provision varies widely across the country. There is no indication of systematic under-provision, but there is confusion about appropriate referrals and admissions. Research suggests that with present levels of provision there are 2,100 - 2,500 avoidable deaths a year, but is unclear how many of these would have been prevented by increasing bed numbers.

MATRON REALLY DID KNOW BEST

M. Marrin

Daily Telegraph, Mar. 24^th 2000, p. 28

Argues that care standards in the NHS could be dramatically improved if nurse training was made less academic and more practical, with emphasis on hygiene and high standards.

MILBURN CALLS FOR A NEW 'BEVERIDGE PLAN FOR THE NHS'

A. Grice

Independent, Apr. 10^th 2000, p. 2

Announces the appointment of seven review teams, each headed by a minister, to produce plans for sweeping reforms of the NHS. The teams will look into: partnership, performance and productivity, the professions, patient care and prevention.

MILBURN ORDERS CLEAN-UP TO END WARD INFECTIONS

T. Womersley

Daily Telegraph, Apr. 6^th 2000, p. 17

National standards are to be introduced to clean up dirty hospital wards in an attempt to cut the number of nosocomial infections. The level of cleanliness has deteriorated following the contracting out of domestic services.

(See also Daily Telegraph, Apr. 7^th 2000, p. 28)

MODERNISING MEDICAL REGULATION

Department of Health

2000

Consultation document proposes a radical shake-up of disciplinary procedures for doctors. It recommends that the General Medical Council should have power to:

• strike doctors off the register permanently in severe cases;
• stop doctors applying to go back on the register after two unsuccessful attempts;
• suspend doctors immediately if they are accused of serious crimes.

NURSES TO PRESCRIBE DRUGS

H. Rumbelow

Times, March 13^th 2000, p. 9

Many nurses are to be given powers to prescribe drugs without a doctor's consent. It will allow nurses to treat minor injuries and chronic illnesses such as diabetes and asthma. The changes mark a breakdown of barriers between doctors and nurses and will allow doctors to deal with more serious cases.

ON THE SLIDE

T. Agnew

Health Service Journal, vol. 110, Mar. 23^rd 2000, p. 16-17

Expert opinion on NHS cancer services is divided into those who are impressed by the government's attempts to tackle years of under-investment and neglect, and those who want much more done faster. All agree that extra cash and manpower are needed.

PEOPLE AS PARTNERS: ADOPTING THE 'CRABMATIC VISION' APPROACH

E. Buggins

Community Practitioner, vol. 73, 2000, p. 525-526

Explores the idea of developing health services by looking at the needs of both providers and users through partnership.

RATING SYSTEM WILL NAME BAD HOSPITALS

S. Schaefer

Independent, Mar. 27^th 2000, p. 8

Announces plans to introduce a hotel-style star rating system for hospitals as part of the drive to raise NHS standards. Hospitals would be awarded up to 5 stars on 20 different criteria, including cleanliness, waiting lists and the proportion of patients successfully treated. Failing hospitals would be starved of cash unless standards improved.

(See also Financial Times, Mar. 27^th 2000, p. 2)

STAFF SHORTAGES WORRY NURSES MORE THAN PAY

H. Rumbelow

Times, 3^rd Apr. 2000, p. 8

Reports results of a survey showing that staff shortages have overtaken pay as the main concern of nurses. Despite government attempts to lure more people into nursing there are still 15,000 vacancies in English hospitals. Any gains in recruitment are being wiped out by the fact that nurses are still leaving the NHS in droves.

(See also Daily Telegraph, Apr. 3^rd 2000, p. 5; Independent, Apr. 3^rd 2000, p. 9; Guardian, Apr. 3^rd 2000, p. 6)

A TABOO THAT WON'T DISAPPEAR OVERNIGHT

N. Timmins

Financial Times, March 13^th 2000, p. 21

While Labour's attitude to private healthcare provision is shifting, serious practical constraints remain. The issue of quality of private healthcare is being addressed by the introduction of a new private sector inspectorate. But there are to even larger constraints on a big expansion in private provision paid for by the NHS. The first is the limited number of doctors and consultants in Britain and the second is the fact that most consultants work both for the NHS and privately which complicates the issues of future payments for private healthcare provision.

VIRTUAL LIBRARIES

C. Adams, S. de Lusignan and S. Hoult

Community Practitioners, vol. 73, 2000, p. 553-554

Describes the national electronic library for health that will go online in the summer of 2000. The library will offer clinical information, methodologies for its utilisation, tools for auditing and evaluating practice, and access to clinical guidelines such as NICE.

WANTED: FEET TO FILL BIG SHOES

S. Thornton

Health Service Journal, vol. 110, Mar. 31^st 2000, p. 31

Any structural reform of the NHS following chief executive Sir Alan Langland's departure will need to address the tension between central control and the need of local service providers for sufficient freedom of movement to develop a local community leadership role.

WEIGHTS FOR WAITS: LESSONS FROM SALISBURY

A. Lack, A. T. Edwards, A. Boland

Journal of Health Services Research and Policy, vol. 5, 2000, p. 83-95

Paper describes a waiting list patients' points scheme under development in Salisbury, Wilts., for the fair management of elective inpatient and day case waiting lists. Paper illustrates how points can be assigned to patients on a waiting list to indicate their relative unmet need, and shows the impact on case mix and resource use of the implementation of the points system versus "first come, first served".