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

Are our shiny new hospitals up to the job?

V. Lambert

Daily Telegraph, Mar. 10th 2010, p. 14-15

This article assesses the merits of the 118 new hospitals build under the Private Finance Initiative. These were built by a consortium of private investors and then leased back by the NHS. The building consortium generally continued to manage the building under contract. Critics argue that that have saddled the NHS with debt and with buildings which cannot easily be adapted to meet changing needs because they belong to the contractor.

Continuing professional development: policy and practice in the National Health Service (NHS)

J. Waterfield

21st Century Society, vol. 5, 2010, p. 103-115

Continuing professional development (CPD) is an important part of post-qualifying education in professional disciplines and as such is subject to policy initiatives at both the professional and governmental levels. This paper explores the changing relationship between a particular health profession, physiotherapy, and management and government, particularly in the areas of CPD and employability.

Decade of doing nothing on hospital death rates

R. Smith

Daily Telegraph, Mar. 26th 2010, p. 16

Prof. Sir Brian Jarman, a former British Medical Association president, has devised a method for calculating what a 'normal' mortality rate at a given hospital should be, based on the number of deaths that would be expected to occur given the general health of the local population and the types of treatment carried out. Based on this calculation, 25 hospital trusts in England have higher than expected mortality rates and should be investigated.

The desirability of being open about health care rationing decisions: findings from a qualitative study of patients and clinical professionals

A. Owen-Smith, J. Coast and J. Donovan

Journal of Health Services Research and Policy, vol. 15, 2010, p. 14-20

There is a growing consensus among clinicians and academics that healthcare rationing should be carried out explicitly and as systematically as possible. However there has been little research on the impact of explicit rationing decisions at the level of the individual patient. This paper reports on a study that explored both patients' and professionals' experiences of explicit and open rationing at the consultation level. The results suggest that moves in the UK to undertake rationing more explicitly are in line with the stated preferences of most patients and clinicians. However, the potential for distress caused through rationing openly means that further research is needed to understand whether explicitness is always the best approach at the consultation level.

The English Patient Safety Research Programme

Journal of Health Services Research and Policy, vol.15, 2010, Supplement 1, p. 91

The English Department of Health's Patient Safety Research Programme was launched in 2001. This supplement reports on a selection of completed research projects undertaken as part of the programme which attempted to answer three broad questions:

  • How common are safety incidents and antecedent errors?
  • What causes error?
  • What interventions are effective in reducing error?

Fair society, healthy lives: the Marmot Review: strategic review of health inequalities in England post-2010

Chair: Sir Michael Marmot


This independent review of health inequalities recommends action on six policy objectives: 1) giving every child the best start in life; 2) enabling all children, young people and adults to maximise their capabilities and have control over their lives; 3) create fair employment and good work for all; 4) ensuring a healthy standard of living for all; 5) creating and developing healthy and sustainable places and communities; and 6) strengthening the role and impact of ill health prevention. The report concludes that the government cannot afford to do nothing as inequality in illness accounts for annual productivity losses of 31-33bn, and lost taxes and higher welfare payments in the region of 20bn-32bn per year. Additional NHS healthcare costs associated with inequality are in excess of 5.5bn per year. There is an emphasis on investing over a long period to realise even longer term gains and on the need for cross-department working at all levels.

(For comment see Health Service Journal, Mar.4th 2010, p. 12-13)

Front-line Care: the future of nursing and midwifery in England'

Prime Minister's Commission on the Future of Nursing and Midwifery in England


This review of nursing and midwifery claims that high profile scandals in the health service have damaged the reputation of the nursing profession. It calls on nurses to restate their commitment to delivering high-quality and compassionate care to patients, and for their efforts in this direction to be better supported by employers.


Ministers failed to act on medical records warning

R. Smith

Daily Telegraph, Mar. 11th 2010, p. 12

The national summary care record which includes brief medical details is being rolled out and the database is set to cover 50 million people by 2012. Patients will be notified by letter that their details will be added to the database unless they opt out. There is evidence of lack of public understanding of the database and critics say that the government is making it too difficult for patients to opt out. Doctors are also claiming that patients' records have been added to the database before they have had a chance to object.

(See also Daily Telegraph, Mar. 10th 2010, p. 1)

Network resilience in the face of health system reform

R. Sheaff and others

Social Science and Medicine, vol. 70, 2010, p. 779-786

Where direct control of individuals or organisations has been removed from a 'hollowed out' state, networks can serve as surrogate governance structures. Varieties of healthcare networks include professional (expertise) networks, clinical referral (care) networks, project networks, 'experience' networks of users and carers, and policy networks (including policy communities). Health system reform in many countries, including England, has re-introduced or extended healthcare markets, raising the question of how these changes impact on the operation of health networks and how managers can control or influence them. To explore these matters empirically, this article examines development of four clinical and professional networks in the English NHS from 2006 to 2008.

NHS database raises privacy fears, say doctors

J. Sturke and D. Campbell

The Guardian, Mar. 8th 2010, p. 10

The British Medical Association has written to the Government outlining concerns that creating a vast database of personal medical records will jeopardise the relationship of trust between patients and GPs.

NHS managers may be heroes of the moment

C. Santry

Health Service Journal, Feb. 29th 2010, p. 12-13

Recent research has demonstrated that NHS managers make a positive contribution to a range of outcomes as well as boosting trusts' financial performance. The study scored management practices at 61% of acute hospitals in England according to how well they monitored patient pathways, managed staff and met objectives. It found that hospitals with higher management scores benefited from a wide range of improved clinical outcomes. Management was also found to be better in areas with greater competition for services, including non-marginal constituencies where acute trusts are not protected by MPs' promises to retain district general hospitals. A second study has demonstrated that trusts run by boards with influential non-executive and clinical directors performed better than those led by very dominant chief executives.

NICE failing to give dying patients cancer drugs

K. Devlin

Daily Telegraph, Mar. 15th 2010, p. 12

In November 2008, the National Institute for Health and Clinical Excellence (NICE) was ordered by the government's adviser on cancer to look more favourably on expensive end-of-life drugs, particularly those used to treat less common cancers. However, figures uncovered by the Rarer Cancers Forum show that since then NICE has rejected treatments that could have helped 16,000 patients a year with rarer cancers. Moreover, little progress has been made on a pledge to speed up the assessment of drugs.

(See also The Independent, Mar. 15th 2010, p. 16) .

Patients in cupboards as hospitals fill up

R. Smith

Daily Telegraph, Mar. 9th 2010, p. 6

A survey of nurses has found that patients are routinely being treated in non-clinical areas of hospitals such as cupboards and kitchens because wards are full. Cramped conditions and a lack of equipment at temporary beds put patients at risk, but nurses' concerns are often ignored by managers.

'Preferred provider' policy unravels

S. Gainsbury

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

Health secretary Andy Burnham's policy that NHS organisations should be treated as 'preferred providers' of services is unravelling. The policy conflicts with the Labour Party's commitment to the promotion of mutualism, and is also in danger of breaching EU procurement law.

Rescue plan for ailing hospitals in doubt

D. West

Health Service Journal, Feb, 25th 2010, p.4-5

The government has encouraged high-performing foundation trusts to take over failing hospitals in the hope of raising standards. However, strategic health authorities and foundation trusts have expressed doubts about the approach, amid fears that the performance of the successful trust might be dragged down instead of that of the failing hospital being improved.

Services for people with rheumatoid arthritis

Committee of Public Accounts

London: TSO, 2009 (House of Commons papers, session 2009/10; HC 46)

Rheumatoid arthritis is a lifelong, progressive, musculoskeletal disease that causes severe pain, swelling and inflammation of the joints, and can lead to reduced joint function and disability. An estimated 580,000 people in England have the disease, with 26,000 new cases diagnosed each year. Annual healthcare costs to the NHS are 560 million, with costs to the economy of 1.8 billion in sick leave and work-related disability. Too many people with the disease are not diagnosed early enough and, once diagnosed; they do not always get the services they need to help them live as well as possible with the disease. Starting treatment within three months can stop the disease getting worse and yet the time between experiencing symptoms and receiving treatment is typically nine months, unchanged since 2003. The barriers to gaining early treatment arise from people's low awareness of the disease, causing them to delay seeking medical help, and from GPs failing to spot the early symptoms and refer quickly enough for diagnosis by a specialist. People with rheumatoid arthritis visit a GP on average four times before referral, and a fifth visit a GP eight or more times before referral. People don't always get the services they need once they have been diagnosed and, as for many long term conditions, there may be a postcode lottery of care. There are differences in the quality and breadth of services available, in particular significant gaps in access to psychological services. Not diagnosing the disease early enough makes it harder for people to remain in work. Three quarters of people with rheumatoid arthritis are diagnosed when of working age, and one third of people stop working within two years of being diagnosed. People with the disease often lack the right support mechanisms to help them maintain their independence and make an economic contribution to society. In November 2008 the Government accepted the finding of a Review of the health of Britain's working age population that steps were needed to help people with musculoskeletal conditions, but this has yet to filter through to action on the ground.

Should the NHS develop leaders collaboratively?

H. O'Meara and S. Slipman

Health Service Journal, Mar. 11th 2010, p. 18-19

The National Leadership Council is driving a transformation in leadership development across the NHS. In this article O'Meara and Slipman debate whether NHS organisations should collaborate in training leaders.

This may hurt a little: how the health service can get back on its feet

J. Gubb

Daily Telegraph, Mar. 9th 2010, p. 16-17

The NHS budget for England is 102.7bn for 2009/10, representing almost 9% of national income. Responsibility for spending the money is delegated to 152 Primary Care Trusts which commission services. In theory Primary Care Trusts act as social health insurers who purchase healthcare services needed by patients and hold providers to account for their performance. However the decisions that they can make are constrained by government targets and priorities, NICE guidelines, and public and staff resistance to change. They have, by and large, failed to stem the tide of hospital 'empire building' and to move services out into cheaper community settings.

Weak managers could be 'struck off'

C. Santry

Health Service Journal, Mar. 4th 2010, p. 4-5

A Department of Health advisory group has produced proposals for ensuring the quality of senior NHS managers on boards. These proposals include clearer standards, strengthened recruitment and vetting processes, better corporate governance and a consultation on whether a formal system of regulation should be established. The Prime Minister appears to have pre-empted the consultation by announcing in a Parliamentary exchange that underperforming managers would be struck off a list as being unfit for employment in the NHS.

Incompetent nurses allowed to continue treating patients

K. Rawlinson

The Independent, Mar. 3rd 2010, p. 20

An audit carried out for the Council for Healthcare Regulatory Excellence (CHRE) has found 'very poor file and case management' within the Nursing and Midwifery Council (NMC). The report states that incompetent nurses are continuing to treat patients because investigations into their fitness to practice are being closed early and without proper authority. The CHRE said it continues to receive more complaints about the NMC than about any of the eight other health regulatory bodies it oversees.

NHS cuts patient death rate

J. Laurance

The Independent, Mar. 25th 2010, p. 14

The National Patient Safety Agency (NPSA) has reported that the risks of dying or suffering serious harm at the hands of the NHS as a result of an accident or mistake have fallen sharply. Latest figures show that between 2008 and 2009 there was a 37 per cent fall in the number of deaths following accidents or mistakes and a 34 per cent fall in incidents causing serious harm. The NPSA believes this is largely due to hospitals and GP practices having become safer places to be treated in since a series of measures were adopted to protect patients.

Quarter of NHS trusts failing hygiene tests

R. Ramesh

The Guardian, Mar. 17th 2010, p. 1 & 2

The Care Quality Commission (CQC) used its powers last year to assess how well NHS trusts were coping with hospital infections which affect 300,000 patients a year. Of the 167 trusts inspected, 42 were found by the Commission to be in 'breach' of NHS registration requirements by not meeting standards. The CQC has been derided by critics as a 'toothless watchdog' but has now been granted the power to impose tough sanctions that could see failing hospitals warned, prosecuted, fined up to 50,000 and ultimately closed down if they fail to comply with the regulator's edicts.

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