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Welfare Reform on the Web (March 2010): National Health Service - reform - general

Consumerism and the provision of health care

M. Calnan

British Journal of Health Care Management, vol. 16, 2010, p. 37-39

Government health policy in England has introduced market principles, competition and consumer choice into the NHS. Unfortunately most patients lack the knowledge and expertise to make informed choices about different treatments and rely on doctors for advice. It is therefore vital that patients continue to have trust and confidence in their doctors. Evidence suggests that individual doctors have to earn that trust through their professional performance and the ongoing relationship they develop with their patients.

Could the Tories give PCTs bite?

A. Maynard

Health Service Journal, Feb. 18th 2010, p. 16-17

Primary Care Trusts (PCTs) have been ineffective in holding hospitals to account and negotiating contracts which deliver value for money. However, they now have a new weapon in the shape of Commissioning for Quality Improvement (CQUIN). Under this initiative, PCTs are requiring hospitals to collect data on key performance indicators and from April 2010 will be able to financially penalise providers who perform poorly. Wise providers should respond by using staff performance measurement under the consultants' contract and Agenda for Change to drive up quality and productivity.

Culture of fear puts targets before patients, advisers tell NHS

R. Smith

Daily Telegraph, Feb. 18th 2010, p. 15

Reports by international organisations released under the Freedom of Information Act show that a culture of fear in the NHS meant that targets and politically driven policies were put before patients. The documents estimated that there were 43,000 deaths a year in the NHS that could have been avoided with better treatment.

DH takes hold of death ratio debate

D. West

Health Service Journal, Feb. 18th 2010, p. 4-5

The Department of Health is taking steps to ensure that the NHS agrees a standard approach to measuring hospital death rates. This is in response to a public row in November 2009 which followed a report on hospital safety by Dr Foster. Figures on death rates used in this report have been disputed by several hospitals labelled as poor.

Fines for hospitals if patients are sent home too quickly

R. Smith

Daily Telegraph, Feb. 18th 2010, p. 2

Around 500,000 patients are re-admitted to hospital every year within a month of discharge. The Conservatives claim that this shows that patients are either not getting proper follow-up care or are being sent home too early in order to release beds for new cases. Under a Conservative government, hospitals would have to fund home care for patients after discharge, and would not be paid if a patient was re-admitted as an emergency case for a problem related to their initial stay within a month of returning home.

Foundations firm despite scandals, argues Moyes

D. Williams

Public Finance, Feb. 5th-11th 2010, p. 14-15

Report of an interview with Bill Moyes, former executive chair of foundation trusts' regulator Monitor, in which he argues that care standards are rising across NHS hospitals in spite of recent high profile scandals. He maintains that having Monitor oversee finance and governance in foundation trusts while the Care Quality Commission oversees patient care is a strength of the system and not a hindrance.

Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005-March 2009

Chair: R. Francis

London: TSO, 2010 (House of Commons papers, session 2009/10; HC375)

This independent report on care standards at Staffordshire NHS Foundation Trust between 2005 and 2009 found that patients were abused and neglected by hostile staff and were left in humiliating and undignified conditions. Families of patients had to clean lavatories and public areas themselves, while food and drinks were left out of reach. It is alleged that some patients were reduced to drinking out of flower vases. Managers were indifferent to the problems as they focused on cutting costs and hitting targets to achieve foundation status. There was said to be a culture of fear and bullying, with staff concerned they would lose their jobs if targets were not hit. The report also found that 18 of the 22 board members who ran the trust over the period under investigation had left their roles, with none facing disciplinary action.

(For comment see Daily Telegraph, Feb. 25th 2010, p. 1+2)

Interpreting personalization in England's National Health Service: a textual analysis

C. Needham

Critical Policy Studies, vol. 3, 2009, p. 204-220

Personalization is an important theme in New Labour's account of public service reform. The concept emerged in documents and speeches from the middle of New Labour's second term (around 2003). In the personalization discourse service users are expected to be willing to take more responsibility for commissioning and managing their care, and supportive of the NHS as a public good, while actively shopping around for the best package of provision for their needs. Staff are also positioned ambiguously, as key partners in relationships of care, but also as barriers to reform, needing the goad of patient exit and voice.

Involving local people to improve services

K. Nicholson-Banks

British Journal of Healthcare Management, vol. 16, 2010, p. 10-15

As well as being a legislative requirement under the Health Act 2006, and the Local Government and Public Involvement Act 2007, and an essential competency for world class commissioning, there is a strong belief that involving patients and carers in decisions about healthcare is fundamental to service improvement. In order to ensure that patients' needs and preferences are met, NHS organisations must ensure that they are involved in all aspects of redesigning care. NHS Bournemouth and Poole have responded by setting up a Public Involvement Network where local people can sign up to one of five levels of involvement. The model aims to create more opportunities for people to participate, which will encourage them to share responsibility for their own health, for the health of others, and for the provision of more efficient and effective health services.

Major trauma care in England

National Audit Office

London: TSO, 2010 (House of Commons papers, session 2009/10; HC 213)

The report is critical of the quality of care for trauma patients (those who have suffered falls, been shot or stabbed, or been victims of accidents). There are wide variations in treatment across the country, and a lack of government action to improve the situation. In some categories, such as road traffic accidents, treatment has not improved for 20 years. The report recommends that patients should be taken directly to specialist trauma centres instead of local accident and emergency departments. Regional trauma networks should be set up, and the National Institute for Health and Clinical Excellence should draw up standards for the care of patients. In the interim, NHS managers should take immediate action to identify the hospital within their area with the most experience in trauma care and divert patients there.

NHS 'should stop funding homeopathy'

H.Devlin

The Times, Feb. 23rd 2010, p.8

Phil Willis, the chairman of the Science and Technology Select Committee, has said that policies on homeopathy are not based on sound evidence and has suggested that the NHS should cut funding for homeopathic treatments. The NHS currently funds four alternative medicine clinics in England and Scotland and spends 152,000 per year (0.001 per cent of its total drug budget) on homeopathic prescriptions.

(See also The Guardian, Feb. 23rd 2010, p.7; The Independent, Feb. 26th 2010, p. 12 & 13)

Nutrition Action Plan Delivery Board end of year progress report

Department of Health, 2010

The report states that 239 patients in NHS hospitals died of malnutrition in 2007. A total of 2,656 people have died of malnutrition in hospitals and care homes since. However it warns that these figures are misleading, because malnutrition would have been a contributory cause of many more deaths.

Quality accounts

K. Fox (editor)

Health Service Journal, Feb. 18th 2010, Supplement, 19p

Quality accounts are short, readable documents in which NHS providers set out how good their services are, where improvement is needed, and how they intend to do it. All providers of NHS acute care must publish a quality account from April 2010. All quality accounts should cover six areas: 1) an overall statement of accountability from the board; 2) three to five priorities for improvement; 3) a review of performance covering safety, effectiveness and patient experience; 4) research and innovation; 5) what others say about the provider; and 6) data quality indicators. This special supplement includes articles on: the experience of providers who piloted the system in NHS East of England; the expectations of Monitor and the Care Quality Commission; support for providers from Quality Observatories and the NHS Information Centre; and the role of clinicians in improving data quality.

Quality is becoming an accountable business

D. West

Health Service Journal, Feb. 4th 2010, p. 12-13

In 2010 NHS trusts will be publishing the first tranche of quality accounts. Draft guidance from the Department of Health requires each trust to declare how many of its service lines it has reviewed for quality of care. This demand has worried some, as has the requirement for primary care trusts to 'endorse' and assure the accuracy of their providers' accounts. Monitor is proposing that foundation trusts will have to go beyond complying with Department of Health guidance by getting the Audit Commission to offer external assurance. The proposals reflect the view that quality accounts should eventually bring the strict, legal accountability of financial accounts into patient care.

Quality strongly linked to increases in managers

C. Santry

Health Service Journal, Feb. 11th 2010, p. 4-5

Analysis has revealed a strong link between quality scores and increases in manager numbers in NHS organisations. From 2004 to 2008 the number of senior managers grew by an average of 6% and all other managers by 5% in trusts rated weak in the annual health check, compared with 24% and 36% in those rated excellent. Therefore current targets of reducing management costs by 30% may have adverse consequences.

The regulatory state and the New Labour government's re-regulation of provision in the English National Health Service

J.S.F. Wright

Regulation and Governance, vol. 3, 2009, p. 334-359

Following its election in 1997, the New Labour government embarked upon a ten year programme of reform of the English National Health Service. The term 'regulatory state' denotes a coherent style of policy making under which markets and rule making displace public ownership and centralised administration of services. This article assesses the influence of the regulatory state on the New Labour Government's reform of provision in the English NHS. It builds an account of the regulatory state based on a discussion of five key themes: the Audit Society, Regulation Inside Government, the New Regulatory State, the British Regulatory State, and Regulatory Capitalism. It then unfolds Labour's reform programme across themes common to these accounts: the division of labour between state and society, the division of labour within the state, the formalisation of previously informal controls, and the development of meta-regulatory techniques of enforced self-regulation. It concludes that the key themes of the regulatory state are at work in Labour's transformation of NHS provision.

Why parking is driving the NHS to distraction

J. Farrington-Douglas

Health Service Journal, Feb. 18th 2010, p. 12-13

The question of charging for hospital parking has caused much debate in England. Patient groups such as Macmillan Cancer Support are campaigning against outpatients being charged, and the unions are objecting on behalf of staff, especially those who cannot access public transport. The government has launched a consultation which makes it clear that not all charges can be lifted, but asks whether the solution is better adherence to guidance, free parking for inpatients or their main visitor, or capping charges.

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