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

Can the system do more to catch local 'failures'?

N. Edwards

Health Service Journal, Nov. 12th 2009, p. 12-13

It is argued that the present system of retrospective performance measures of day to day operations are not suitable for the early identification of NHS organisations with serious problems. It might be better to look systematically at an organisation's capability and leadership, while recognising that failure may be due to cultural problems or issues with the wider system rather than to poor management.

Choice at the point of referral: early results of a patient survey

R. Robertson and A. Dixon

King's Fund, 2009

A survey of 5,997 NHS patients has shown that 49% were actually offered a choice of hospital. Patients were most likely to be offered a choice by their GP (60%), in a letter outlining the options (21%) or by a telephone booking advisor (20%). Just 4% of patients accessed official hospital performance data on the NHS Choices web site when booking an appointment. Another 6% read a leaflet about their choices, while 9% asked the adviser on a telephone line while making a booking. By contrast, 41% relied on their own past experience of the hospital, and 36% asked their GP. An additional 18% relied on the experience of their friends and family when choosing a hospital. Patients said that cleanliness, quality of care and the standard of facilities were the three most important factors that had influenced their choice of hospital.

Degree-only rule 'will deter nurses'

K. Devlin

Daily Telegraph, Nov. 13th 2009, p. 6

Reports reactions from unions and experts to the government's announcement that from 2013 all new entrants to the profession will have to complete a three-year nursing degree. There are concerns from the unions that the new requirements will deter many talented candidates from entering the profession. However, experts say that nursing has become highly technical and nurses need to be educated to degree level to meet its new demands.

Failing hospital condemns hundreds to death

R. Smith

Daily Telegraph, Nov. 27th 2009, p. 1 +4

Unannounced inspections at Basildon Hospital in the Summer and Autumn of 2009 found that the management of the Accident and Emergency Department was poor, with problems including poor environment, lack of leadership and delays for patients. The Department was not kept clean, reusable equipment was not effectively decontaminated, and patients had little privacy. Complaints about nursing in the hospital generally included failure to monitor, feed and give drugs correctly, and twice as many patients suffering bed sores as the national average.

Hospitals warning is alarmist - watchdog

J. Meikle

The Guardian, Nov. 30th 2009, p, 12

The government's health and social care watchdog has criticised parts of a report identifying 12 'significantly underperforming' NHS hospital trusts as the row intensifies over standards of care. Lady Young, head of the Care Quality Commission, has told the BBC that while some of the data presented in Dr Foster's findings were legitimate, some were 'alarmist'.

(See also The Times, Nov. 30th 2009, p.3)

Improving care, reducing cost

A. Leaman

British Journal of Healthcare Management, vol. 15, 2009, p.504-507

Use of management consultants in the NHS has attracted criticism. This article presents case studies demonstrating how input from management consultants can lead to innovations that increase efficiency and reduce costs.

Innovative organisational design for surgeries

W.H. Collinge

British Journal of Healthcare Management, vol. 15, 2009, p. 496-503

Population ageing in the UK is likely to increase demand for routine orthopaedic operations. At the same time, patient expectations of a high quality medical service have also risen. This article explores the concept of a new medical establishment geared towards the provision of routine operational surgery services. Such an establishment should endeavour to provide quality, affordable services that are patient-centric. Services should also be decentralised and provided locally. This model could be adopted by the NHS or by private providers.

Investigation into deaths at NHS trust with blood-stained floors

O. Bowcott

The Guardian, Nov. 27th 2009, p. 13

An inspection of Basildon and Thurrock University Hospitals NHS foundation trust in October 2009 has found hygiene failures and raised concerns about high death rates. Action has been demanded.

(See also The Times, Nov. 27th 2009, p.17; The Independent, Nov. 27th 2009, p. 1 & 8)

Malnutrition in hospitals: unrecognised and ignored

J. Abayomi, S. Judd and A. Hackett

British Journal of Healthcare Management, vol. 15, 2009, p. 488-495

Malnutrition has been present in hospitals since the time of Florence Nightingale. Despite a range of policies and campaigns to deal with the problem, little appears to have changed. This article argues that preventing malnutrition among hospital patients is not just a question of providing better quality food. Tackling malnutrition needs to be a priority for all health professionals, managers and politicians. There needs to be a substantial change of culture within the NHS, with nutrition acknowledged as an integral component of clinical care and increased knowledge about it among professionals.

The NHS Constitution: a consultation on new patient rights

Department of Health


Plans for the expansion of patients' rights unveiled by the government include giving them a legal right to die at home, to cancer tests within seven days, to personal health budgets, and to evening and weekend GP appointments. From 2010, anyone forced to wait more than 18 weeks for NHS treatment for any illness would be legally entitled to free private care for the condition. All patients aged between 40 and 74 would be given the right to a 'health MOT' every five years from 2012.

Poor handovers and working time directive 'causing hospital deaths'

O. Bowcott

The Guardian, Nov. 5th 2009, p. 12

The report of the National Confidential Enquiry into Patient Outcome and Death has found that poor communication between doctors, poor handovers at night and delays in contacting consultants are causing unnecessary hospital deaths.

(See also The Independent, Nov. 5th 2009, p. 13)

The role of advocacy and interpretation services in the delivery of quality healthcare to diverse minority communities in London, United Kingdom

W. El Ansari and others

Health and Social Care in the Community, vol. 17, 2009, p. 636-646

Inequalities in access to appropriate and acceptable healthcare contribute to a pattern of poorer health status, reduced life expectancy and greater dissatisfaction with healthcare amongst people from Black and minority ethnic communities. Language acts as a further barrier to access. The development of bilingual advocacy fuses two services - interpretation and advocacy - to ensure that people from BME communities are able to have their healthcare needs met appropriately. This paper explores the development of bilingual advocacy services at a NHS University Hospital Trust in East London, which has a highly diverse population speaking over 100 languages.

Self care

H. Mooney (editor)

Health Service Journal, Nov. 12th 2009, p. 24-27

This special report looks at the role of the NHS in empowering patients to manage their chronic conditions and improve their quality of life by engaging them in self care. Support for self care is an integral part of personalised care planning, which involves a holistic discussion of the full range of the patient's needs and wishes. NHS staff will need training to work in the new ways required to support individual patient empowerment. The special report includes a case study of NHS East of England's vision for the implementation of self care and personal health planning.

Unplanned paediatric care pathways

E. Snelson, J. Gilchrist and N. Wright

British Journal of Healthcare Management, vol. 15, 2009, p. 549-556

In order to access NHS care, especially out-of-hours, the patient is required to navigate an increasingly complex system. NHS Direct provides an umbrella service for patients wishing to access out-of-hours medical care. However, this study suggests that the quickest route by which children can access an out-of-hours, face-to-face consultation with a clinician is through the hospital accident and emergency (A&E) department. Using NHS Direct appears to delay the child being attended to, compared with using either A&E or a GP out-of-hours collaborative. This is increasing the workload of hospital A&E services.

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