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

Auditors' local evaluation and use of resources 2008/09: summary results for NHS trusts and primary care trusts

Audit Commission


Report shows that, in the new use of resources test, 70% of primary care trusts (PCTs) met only minimum standards for governance and management. Seven failed the management of resources test overall. However, 53% scored above minimum standards for financial management. PCTs also have real work to do in their workforce planning and development, with 119 meeting only minimum requirements. There was also a real weakness in data and knowledge about what community services were being provided and at what cost. However, all other trusts have continued to improve, with 93% meeting or exceeding minimum standards and 69% performing 'well' or 'strongly' compared with 49% in 2007/08.

Better outcomes in diverse groups

M. Gould

Health Service Journal, Sept. 24th 2009, p. 20-21

Evidence shows that morbidity and mortality in minority ethnic groups is worse than for the indigenous population. One factor in this is said to be the under-representation of BME groups in NHS senior management. There also needs to be a focus on improving outcomes through innovation to increase cultural competence among all staff and to develop appropriate services. However, targeting funding on particular groups can also foster resentment and adversely impact on community cohesion, which the NHS also has a duty to promote.

Can the Conservatives mix cutting and caring?

R. Vize

Health Service Journal, Oct. 1st 2009, p. 12-13

Conservative Party health policies consist of reducing the numbers of NHS managers and administrators, giving more commissioning power to GPs, abolishing targets and ending 'ministerial meddling' in the service. These are unlikely to have the desired effect of improving quality while driving down costs. For example, many GPs do not wish to become commissioners and would simply contract out their powers to private companies or their Primary Care Trust. Patient choice is unlikely to be as effective as targets in driving up standards, and cutting the number of managers would only produce about 5% of the savings the Conservatives need to find.


S. Shepherd (editor)

Health Service Journal, Oct. 1st 2009, Supplement, 10p.

Introduces the Yorkshire and Humber PCT Collaborative which aims to improve services by sharing learning and expertise. Articles cover the work of the Collaborative in market management, data sharing to improve understanding of local populations, partnership with local government in defining a high level integrated care pathway for mental health, ending the postcode lottery for treatments made available on the NHS through a joint approach to clinical decisions, and establishing a training programme to nurture the next generation of board level leaders.

Embrace new era of redesign to take NHS from good to great

A. Burnham

Health Service Journal, Oct. 29th 2009, p. 12-13

The Health Secretary argues that the NHS needs to:

  1. develop more preventative and people-centred services
  2. radically redesign services
  3. empower patients and engage staff in leading reform efforts from the bottom up. In this context he makes the case for regarding the NHS as the preferred service provider where it is working well.

However, if existing NHS providers are failing, and cannot or will not meet required standards, they should be replaced.

(For comment see Health Service Journal, Oct. 29th 2009, p. 14-15)

Face the facts of changing needs

H. Mooney

Health Service Journal, Oct. 29th 2009, p. 20-21

Primary care trusts should be decommissioning services which are no longer needed in their present form. They may retender for existing services or radically redesign them to ensure they are fit for purpose. This article considers how services can be successfully decommissioned.

Has Labour decentralised the NHS? Terminological obfuscation and analytical confusion

I. Greener and others

Policy Studies, vol. 30, 2009, p. 439-454

This article examines the decentralisation debate in the public sector, with special reference to the National Health Service. It aims to make three contributions:

  1. to explain how decentralisation became the organisational solution of choice in the public sector
  2. to assess claims from the New Labour government that decentralisation is taking place in the NHS
  3. to clarify the meaning of decentralisation. This analysis is then applied to the specific case of the introduction of primary care trusts into the NHS.

LINks begin to make connections

M. Hunter

Community Care Oct. 8th 2009, p. 26-27

Piloted in 2007, LINks (Local Involvement Networks) are intended to involve local communities in the commissioning, provision and scrutiny of local health and social care services. After a shaky start, some LINks are now emerging from the transitional bureaucracy and beginning to make an impact on service delivery. However progress is patchy and much of the best work focuses on the delivery of health rather than social care. Frontline social care professionals are becoming frustrated at the slow rate of progress in many areas.

'Living wills' may be reviewed after poison suicide

J. Bingham

Daily Telegraph, Oct. 5th 2009, p. 12

Kerrie Wooltorton tragically poisoned herself after making an advance directive under the Mental Capacity Act 2005 to the effect that doctors should not try to save her. It was unlawful for doctors to intervene because she had full knowledge of what she was doing. The health secretary has indicated that the law on advance directives could be reviewed in the light of this case.

NHS trusts still missing basic care targets

S. Lister

The Times, Oct. 15th 2009, p.3

The Care Quality Commission has warned that more than 40 health care trusts are at a risk of being refused new licences to operate. It publishes report is an annual assessment of the performance of NHS organisations. It found that the number of organisations achieving 'excellent' ratings in the report had fallen. Despite this, treatment waiting times have reduced as has the percentage of A&E patients being treated in under 4 hours.

No country for old men: the rise of managerialism and the new cultural vacuum

D. Zigmond

Public Policy Research, vol. 16, 2009, p. 133-137

The National Health Service has been changed massively by the expansion of complex, hierarchical 'cascading' forms of management. These culminate in the standardised micromanagement of clinical care. Much of this derives from models from competitive corporate industry. While such intense and rigid management may eliminate some of the worst clinical practice, it may unintentionally inhibit the best by stifling creativity.

The politics of difference? Providing a cancer genetics service in a culturally and linguistically diverse society

K. Atkin, N. Ali and C.E. Chu

Diversity in Health and Care, vol.6, 2009, p. 149-157

The UK struggles to provide appropriate and accessible healthcare to culturally diverse populations. This paper explores possible ways of engaging with these difficulties by discussing the policy and practice relevance of a research project designed to evaluate a cancer genetics service whose purpose was to make up for shortfalls in previous provision. The service aimed to offer non-directive, trans-cultural genetic counselling as a means of facilitating informed choice among minority ethnic groups. The empirical case study is used to introduce a broader theoretical discussion of how healthcare can respond to the needs of an ethnically diverse population.

ProState of the nation report: a call to action: delivering more effective care for BHP patients in the UK

Health Service Journal, Oct. 22nd 2009, supplement, 16p

In the UK about 3.2 million men suffer from the symptoms of benign prostatic hyperplasia. This special supplement offers an explanation of disease impact and treatment options, a summary of current UK guidance contrasted with the reality of management of the condition for GPs, specialists and patients, and a summary of the cost burden for the NHS and opportunities to improve care.

Renal services

J. Taylor (editor)

Health Service Journal, Oct. 29th 2009, supplement, 9p

A centralised model of renal services is no longer fit for purpose in a kidney disease population that is ageing and has increasing co-morbidities. Autonomous local renal units offer a better patient experience, delivered in a more convenient location by highly skilled professionals. NHS Kidney Care has produced a toolkit detailing how to set up an autonomous renal unit. The supplement finally presents case studies from Doncaster and Surrey showing how autonomous units have been set up in practice.

'Structural interests' in health care: evidence from the contemporary National Health Service

K. Checkland, S. Harrison and A. Coleman

Journal of Social Policy, vol. 38, 2009, p. 607-625

The authors argue that their study of the early stages of Practice Based Commissioning in England has confirmed Alford's contention that health service structures (in this case Payment by Results) systematically privilege certain interests above others. In this specific context, the dominant structural interest comprised by the hospitals can be labelled as 'corporate' monopoly. Hospitals enjoy a local monopoly because of their ability to define their workload and income, combined with the reluctance of patients to travel and of commissioners to destabilise local services. The challenging structural interest is made up of Practice Based Commissioning consortia led by GPs. These are challenging hospitals in terms of (non)adherence to guidelines and are seeking to govern their relationship with hospitals through formal rules such as patient pathways.

Tories need clear vision and a stronger message

A. Haldenby

Health Service Journal, Oct. 22nd 2009, p. 12-13

The Conservatives are strongly wedded to maintaining the status quo in the NHS in spite of the urgent need to modernise it. They have so far opposed the service reconfigurations needed to release funds tied up in hospital care for the development of primary care, integrated care and preventative services. They remain committed to a moratorium on hospital closures, and to GP commissioning, although GPs, even acting collectively, will never be able to force a redesign of services.

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