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

Beginning of the end

D. Carlisle

Health Service Journal, June 18th 2009, p. 22-24

Improvement of end of life care is becoming an NHS priority. Measures are being developed to allow more people to die in their own homes instead of in hospital. However, since many people will still die in hospital, delivery of high quality end of life care needs to become a generic, rather than a specialist skill for health professionals. A public debate is needed to challenge the taboo around death and dying for the benefit of those nearing the end of their lives.

Co-optation, commodification and the medical model: governing UK medicine since 1991

S. Harrison

Public Administration, vol. 87, 2009, p. 184-197

'Self-regulation' and 'autonomy' are traditionally treated as distinctive elements of how professions such as medicine are governed in contrast to other occupations. For medicine, these elements are reinforced by the intellectual dominance of the biomedical model of health and illness. However in the UK the biomedical model has been co-opted for managerial purposes to support the commodification of medical care and the transformation of doctors into technicians subject to control from outside the profession. Health care has been redefined as a product created, sold and exchanged by an organisation subject to managerial control.

Doctors to trial hygiene checklist prior to surgery

J. Laurance

The Independent, June 1st 2009, p. 2

Safety experts have launched a new drive to improve hygiene in the NHS based on a simple checklist. The scheme called 'Matching Michigan' is modelled on one pioneered in the US state where it is estimated to have saved 1,500 lives in the first 18 months. Launched in the UK on 1 May, it is being piloted in eight NHS trusts in the north east and, if successful, will be rolled out across the country. Under the plan, medical staff will be asked to run through a series of checks each time they insert a catheter into the main artery in the chest, in the same way pilots check their aircraft before take-off.

Future of public health: burdens, challenges and opportunities

S. Dawson and Z. Morris (editors)

Basingstoke: Palgrave Macmillan, 2009

Situating public health within its social, environmental and political context, this book provides a realistic analysis of policy frameworks, effective interventions and measurement and evaluation. Viewed through psychology, sociology, and political science as well as public health, it creates a compelling vision for public health policy founded on choosing targets and sustaining evaluation in order to improve health status and lessen health inequalities. It examines the idea that public health needs to emancipate itself from three outmoded attitudes. The first is to be overly paternalistic without sufficient emphasis on shared responsibility for health. The second is to fail to sufficiently acknowledge the profound impact of social context on individual behaviour and motivation; and the third is to see public health outcomes as largely the results of externalities or the bad behaviour of others.

The future's bright

J. Taylor

Health Service Journal, May 28th 2009, p. 20-25

From 2012/13, NHS spending will be reined in sharply. The health service will need to respond by finding innovative ways of raising quality without increasing costs. This article reports expert views delivered at a roundtable.


R. Allmark (editor)

Health Service Journal, June 18th 2009, supplement, 8p

This issue of the quarterly supplement dedicated to innovation, information and technology in the NHS covers the new NHS Evidence portal aimed at helping staff keep up with the latest research, the role of the ContactPoint database in facilitating involvement of health professionals in child protection, and the quality of primary care trust websites.

Is evidence-based organizational innovation in the NHS a Chimaera - or just elusive?

R. Sheaff, S. Pickard and B. Dowling

Social Policy and Administration, vol. 43, 2009, p. 290-310

In many policy domains, including education and health, government expects public sector managers to base innovation on research evidence of 'what works'. Besides the extensively reported methodological and practical obstacles to doing so, this article proposes one more: the frequently 'politicised' character of organisational innovation. An organisational innovation is 'politicised' when different actors' interests conflict about whether or how it should be implemented and policymakers or managers face powerful incentives to implement the innovation successfully. Analysis of 61 organisational innovations in nine English primary care trusts suggests that while the majority of organisational innovations were not politicised in this way, a substantial minority were.

The long and winding road

D. Carlisle

Health Service Journal, June 25th 2009, p. 24-26

This article reviews progress with implementation of Lord Darzi's next stage review of the NHS one year after its publication. A number of the initiatives it proposed are under way or in preparation, including quality accounts. It is still unclear how far middle managers and clinicians have taken the quality improvement vision promoted by Darzi on board. The sudden economic downturn has set off a new debate over whether the cash savings now required will be compatible with Darzi's quality vision.

(For an interview with Lord Darzi, see Health Service Journal, June 25th 2009, p. 17)

Long term conditions

H. Mooney (editor)

Health Service Journal, June 4th 2009, p. 27-31

The Department of Health has been promoting self care for people with long term conditions since 2005 and regards requiring people to take responsibility for their own health as crucial to transforming the NHS. Government plans for management of long term conditions include promotion of healthy lifestyle choices, use of assistive technology, and provision of information, support and training to patients.

Personalisation's progress: performance patchy

J. Smith

Caring Times, June 2009, p. 14-15

Service personalisation, an idea which has been pioneered in the social services, is now being taken up as a flagship policy for the NHS. The Health Bill published in January 2009 contains proposals to pilot direct payments and possibly other forms of personal budgets, with the aim of giving patients greater choice and control over their healthcare. The author concludes that seriously ill patients may be reluctant to take responsibility for procuring their own treatment.

The power and the glory

P. Davies

Health Service Journal, June 4th 2009, p. 24-26

The Griffiths Report published in October 1983 recommended the introduction of general managers into the NHS to improve efficiency. These recommendations were accepted by government and the consensus management teams which had run the NHS were dissolved. Unfortunately the new management regime alienated staff and set managers and professionals at odds. This article reports the reaction of nurses and clinicians to the changes.

Professionals in power: the czars' first ten years

D. West

Health Service Journal, June 4th 2009, p. 12-13

National clinical directors were introduced into the NHS in 1999 and have been hailed as a success in improving service quality nationwide through the imposition of national standards. It is now envisaged that they will engage clinicians in coping with anticipated deep spending cuts and developing programmes that save cash while improving care.

Public values and public trust: responses to welfare state reform in the UK

P. Taylor-Gooby and A. Wallace

Social Policy Journal, vol. 38, 2009, p. 401-419

Reforms in the UK have significantly improved the delivery of public services. However, these improvements are not accompanied by enhanced public optimism about the future of the public sector. Exploration of the public response to NHS reforms shows that people regard them as promoting knavish and obstructing knightly behaviour by providers. Service users show little interest in empowerment or in being redefined as demanding consumers. They regard the reforms as undermining the core values of the health service, which include universal access to care and the caring commitment of staff to meeting the needs of users.

Regions to look again at plans as recession eats into visions

C. Santry

Health Service Journal, June 25th 2009, p. 4-5

NHS chief executive David Nicholson has warned that every strategic health authority will need to re-examine its strategy for implementing Lord Darzi's next stage review in the light of budget cuts expected after 2011. The 2010 NHS Operating Framework will call for a properly resourced implementation plan for each regional strategy.

(For an overview of progress with regional plans, see Health Service Journal, June 25th 2009, p. 12-13)

Report finds 70 children died after lapses in medical care

J. Laurance

The Independent, June 18th 2009, p. 7

A review of the safety of NHS care for children found more than 60,000 incidents reported to the National Patient Safety Agency (NPSA) in which they were put at risk. In 2007-08, more than 70 children died and 20,000 suffered injury or harm following lapses in medical care. The commonest problem was 'medication error' in which the amount of a drug was wrongly calculated, resulting in an overdose to the child. In 237 cases, the child suffered 'abuse', either from a member of staff or someone else.

(See also: The Guardian, June 18th 2009, p. 14)

Six new rights for every NHS patient

A. Grice

The Independent, June 29th 2009, p. 1 & 6

Patients are to be promised six new rights to NHS treatment as the Government attempts to push through a new raft of public service reforms. The new entitlement for patients will include the right to: an operation within 18 weeks of patients first seeing their GP; a free health check-up at the age of 40; the option of dying at home if they suffer from a terminal condition; an appointment with a cancer specialist within two weeks; treatment from an NHS dentist; and treatment in accident and emergency departments within four hours. Although patients will not be able to sue the NHS for not providing these guaranteed services, Primary Care Trusts would be forced to send people to a hospital in another area or, in extreme cases, for private treatment if they are not able to deliver it in NHS facilities. The reforms form part of the Government's 'Building Britain's Future' document designed to extend a consumer-driven approach to public services.

(See also The Guardian, June 29th 2009, p. 4 which focuses on social housing reforms as part of the same government initiative)

Skills for Health

S. Shepherd (editor)

Health Service Journal, June 11th 2009, Supplement, 9p

This special supplement looks at the work of Skills for Health in supporting NHS employers in ensuring that staff development can be used as an effective tool to improve quality and productivity. It covers the work of the Skills Academy for Health, the role of apprenticeships, the impact of the Working Time Directive on junior doctors' training, and the creation of extended roles for non-medical staff.

Trainee doctors being told to lie about long working hours

C. Santry

Health Service Journal, May 28th 2009, p. 4-5

Hospital trusts are under intense pressure to ensure that junior doctors comply with the EU Working Time Directive by limiting their hours to 48 per week by August 2009. Survey responses seen by HSJ suggest that staff are being asked to lie about their hours to make trusts appear to be compliant with the Directive.

(See also Daily Telegraph, June 1st 2009, p. 8)

What the doctor ordered

A. McKeon

Public Finance, May 15th-21st 2009, p. 24-25

The new Comprehensive Area Assessments focus on local partnerships working together to produce improved outcomes that matter to the community. They will address the quality of life of local people, how local statutory bodies are working together to bring about improvements, and what the prospects are for success. Area assessments will not be scored, but there will be a narrative report and a system of flags. Red flags will signal an area of concern and green flags will identify good practice. Under the new regime, the NHS will need to look beyond its own narrow objectives and consider how it can benefit the community more generally, for example through carbon emission reductions and boosting the local economy.

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