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Welfare Reform on the Web (July 2000): National Health Service - Reform - General

A BITTER PILL OR A SPOONFUL OF SUGAR

S. Woolfrey and M. N. Ashgar

British Journal of Healthcare Management, vol. 6, 2000, p. 199-201

Pharmacy practice in the UK is in transition due to significant NHS changes by the current government. Traditional dispensing skills are declining, but pharmacists are recognised as having the potential to contribute significantly to the medicines management agenda.

BREATHE EASY

T. Agnew

Health Service Journal, vol. 110, May 4th 2000, p. 12-13

The confidential enquiries into the key areas of still-births and sudden infant deaths, maternal deaths, perioperative deaths and suicides and homicides by people with mental illness, are now under the control of NICE. This may lead to reform of the system following a recently completed review.

CAN PRIVATE HOMES SOLVE BED CRISIS?

R. Winchester

Community Care, no. 1321, 2000, p. 10-11

Government plans to use private nursing homes to care for older NHS patients recovering from treatment might alleviate the pressure on acute hospital beds and reduce costs. However, there is concern that private nursing homes are not geared to take patients in need of rehabilitation.

CANCER: DELIVERING QUALITY SERVICES

Health Service Journal. Managers and Medicine Supplement, vol. 110, Apr. 27th 2000, 12p

Looks at the effect of various initiatives on NHS cancer services, including government guidance and targets implementation of one-stop shops to speed patients through the system and hospice-at-home services. In a perverse effect, cancer patients are not benefiting from a number of new drugs available because purchasers are reluctant to fund them until they have the NICE seal of approval.

CAUGHT IN THE ACT

D. Carlisle

Health Service Journal, vol. 110, Apr. 27th 2000, p. 10-11

Considers the implications of the Human Rights Act 1998 for the NHS. Patients refused expensive treatment could argue that their right to life guaranteed under the Act has been breached. The right to privacy will impact on access to medical records, mixed sex wards and crowded waiting areas.

THE CHANGING NATURE OF RATIONING IN THE UK NATIONAL HEALTH SERVICE

L. Locock

Public Administration, vol. 78, 2000, p. 91-109

Presents findings from empirical research exploring developments in health care rationing in the UK, and how far these were influenced by the NHS internal market. Results suggest that explicit rationing has continued to spread, but that the focus has shifted from exclusions of whole treatments from NHS provision towards a reconciliation of implicit and explicit approaches. There is a growing interest in explicit criteria to guide decision-making, within which clinicians exercise discretion in individual cases.

CONSEQUENCES OF DISCHARGES FROM INTENSIVE CARE AT NIGHT

C. Goldfrad and K. Rowan

Lancet, vol. 355, Apr. 1st 2000, p. 1138-1142

Study reviewed over 30,000 admissions to ICUs in over 60 hospitals, comparing the period 1988 to 1990 with 1995 to 1998. Results showed that night discharges from ICU are increasing in the UK. This practice is of concern because patients discharged at night fare significantly worse than those discharged during the day. Night discharges are more likely to be premature in the view of the clinicians involved. The implication of these results is that many hospitals have too few intensive-care beds.

DEACON BLUES

C. Wright

Health Service Journal, vol. 110, May 11th 2000, p. 14-15

Scottish Health Minister Susan Deacon has moved to tighten central control over the health service and has signalled that those who fail to meet targets will be penalised. Firstly, £60m of the £175m announced for the NHS following the budget will be distributed to Scottish health boards "with strings attached". Secondly, pay for senior NHS managers will be performance related.

DOCTORS AND NURSES TO BE TRAINED TOGETHER TO RELAX ELITIST DIVIDE

S. Boseley

Guardian, May 15th 2000, p. 7

Reports proposals to modernise medical training through the introduction of a modular approach. Trainee doctors and nurses would take certain modules such as communication skills and ethics together. This would help to break down barriers between different health professionals.

DOUBLE OR QUITS?

M. Allison

Health Service Journal, vol. 110, May 4th 2000, p. 30

Argues that successive government initiatives have increased the training, audit, administrative and appraisal commitments of consultants to the point that they have hardly any time left for clinical work. The promised expansion of consultant posts has not happened, and quality of care is suffering.

ELDERLY NHS PATIENTS MAY BE SENT INTO PRIVATE CARE

S. Carrell

Independent, May 2nd 2000, p. 2

The NHS may purchase beds in private nursing homes for elderly people recuperating after operations or in need of rehabilitation in an attempt to reduce "bed blocking".

(See also Guardian, May 2nd 2000, p. 1; Daily Telegraph, May 2nd 2000, p. 9; Financial Times, May 2nd 2000, p. 2; Health Service Journal, vol. 110, May 11th 2000, p. 14-15)

GPS ADMIT ELDERLY GET SECOND-CLASS TREATMENT

J. Laurence

Independent, May 17th 2000, p. 10

Data collected through interviews with 200 GPs show that discrimination against the elderly is rife in the NHS. Some 75% of doctors said that patients are denied treatment because of age. About 33% said they knew of age limits for heart bypass surgery and kidney dialysis and one in seven said elderly people were denied admission to intensive care units. Forty per cent said they would be worried about a frail elderly relative going into an NHS hospital.

(See also Daily Telegraph, May 17th 2000, p. 11; Guardian Society, May 17th 2000, p. 6 + 7)

A HEALTH SERVICE OF ALL THE TALENTS: DEVELOPING THE NHS WORKFORCE

Department of Health

London: 2000

Recommends that health managers should be put in charge of workforce planning. Proposes a three-tier structure at local, regional and national level with: Trust and Health authority chief executives producing local workforce plans linked to health improvement plans; workforce development confederations involving NHS and other employers of healthcare staff replacing education consortia and local medical workforce advisory groups; care group development broads bringing together different professions involved in, for example, cancer care; and a national workforce development board chaired by the NHS Chief Executive.

(For comment see Health Service Journal, vol. 110, Apr. 20th 2000, p. 11-12)

HIP REPLACEMENTS: GETTING IT RIGHT FIRST TIME

National Audit Office

London: TSO, 2000 (House of Commons papers. Session 1999-2000; HC 417)

Expresses concern about the lack of evidence of the effectiveness of hip prostheses in use, and weaknesses in the process for introducing new prostheses. There is a lack of relevant management information on such matters as outcomes of hip surgery, infection rates, costs, delays and cancellations, and length of stay. Makes recommendations on improving control over hip prostheses, spreading good practice and improving patient care.

HOSPITALS LOOK TO CHINA TO EASE NURSES CRISIS

D. Brindle

Guardian, May 17th 2000, p. 7

In order to reduce staff shortages, the NHS is discussing the possibility of official secondment of Chinese nurses to British hospital trusts on short term contracts.

HOTEL 'ROOM SERVICE' FOR NHS WARDS

C. Hall

Daily Telegraph, May 11th 2000, p. 2

Reports that Department of Health officials are beginning talks with hotel chains to see how improvements can be made to NHS catering. One idea is to provide menus similar to room service offered in hotels and to make 24-hour hot drinks provision available. Care assistants may also be trained to assist patients unable to feed themselves.

(See also Times, May 11th 2000, p. 1)

MEASURE FOR MEASURE, OR HOW CAN WE JUDGE THE NHS

A. Bell

British Journal of Healthcare Management, vol. 6, 2000, p. 170-171

Article considers inherent problems of finding workable criteria by which NHS performance and improvement can be judged.

MEDICAL AUTONOMY AND THE UK STATE 1975 TO 2025

S. Harrison and W. I. U. Ahmad

Sociology, vol. 34, 2000, p. 129-146

Provides an account of the decline of medical professional dominance in Britain from the mid-1970s to the present day. Contemporary explanations for this have been cast in a variety of terms, including proletarianism as a result of the application of capitalist logic, the advent of the knowledgeable patient/ consumer, and the financial crisis of the welfare state. Article critically assesses the explanatory contribution of post-fordist theory, an approach to analysing the welfare state which incorporates elements of all of these.

MILBURN ASKS PUBLIC HOW TO SPEND EXTRA £16.5BN

J. Laurance

Independent, May 10th 2000, p. 12

Reports that opinion will be canvassed from patients on May 31st on how to spend the £16.5bn allocated to the NHS in the budget. Leaflets will be distributed for patients to make suggestions, open meetings will be held in Leeds and London and a website has been set up to receive suggestions.

NEW 'LEAVE TO DIE' CASES CAST DOUBT ON NHS METHODS

C. Hall and T. Womersley

Daily Telegraph, Apr. 14th 2000, p. 8

Reports anecdotal evidence that the practice of writing 'do not resuscitate' instructions on the notes of elderly patients without their consent is widespread in the NHS. This practice breaches British Medical Association guidelines which say that patients or their relatives should be consulted about any decision not to resuscitate.

(See also Times, Apr. 14th 2000, p. 6)

NEW LIFE FOR HEALTH

Commission on the NHS

Vintage Press, 2000-07-05

Recommends that the NHS should be made more accountable by being removed from the control of the Department of Health and made an independent institution. Attacks government's strategy for improving health care through central control, but praises initiatives such as the Commission for Health Improvement, NHS Direct and walk-in treatment centres as being responses to calls for greater professional regulation and to patients needs.

NEW NHS STAFF TO PERFORM MINOR SURGERY

C. Hall

Daily Telegraph, Apr. 18th 2000, p. 15

Reports proposal from the Royal College of Physicians to train 'health care practitioners' in specific tasks such as cataract surgery and endoscopy examinations. The plan is designed to address the shortage of doctors and nurses in the NHS and break down barriers between professions.

NHS 'SMART CARD' MAY HOLD PATIENT'S RECORDS

R. Sylvester

Daily Telegraph, Apr. 17th 2000, p. 1

Reports that a "smart card" that would carry a patient's medial records may be introduced as part of NHS modernisation. The cards would allow people to access a central database to order repeat prescriptions or consult their medical records, and would be used in kiosks at supermarkets, in libraries or in post offices.

NO KEN DO

P. Butler

Health Service Journal, vol. 110 May 11th 2000, p. 12-13

While the newly elected mayor of London has no formal responsibility for health policy and no jurisdiction over funding or health service reconfiguration the NHS may find itself caught in the crossfire if Mr Livingstone uses his position to attack New Labour.

NO MONKEY BUSINESS

S. Ward

Public Finance, Apr. 14th - 20th 2000, p. 18-20

Describes the role of the new Commission for Health Improvement (CHIMP) which has been set up with sweeping powers to review health authorities, trusts and commissioning groups in England and Wales to help them improve their performance.

OVER TO YOU

L. Whitfield

Health Service Journal, vol. 110, May 4th 2000, p. 11-12

Reports how the government's 'national consultation' of staff and public on the future of the NHS is being organised.

PRESCRIBING OF COSTLY MEDICINES

Royal College of Physicians

London: 2000-07-05

Recommends that the government and the public should acknowledge that there are limitations on NHS resources. NICE should evaluate the cost-effectiveness of any expensive new medicine before it is prescribed anywhere in the NHS. Separate funding should be set aside for the most expensive medicines. Doctors should openly discuss with patients why some drugs are not available.

PRESENTING A PICTURE OF HEALTH

N. Timmins

Financial Times, Apr. 18th 2000, p. 17

Presents Homerton Hospital as a model for the whole NHS. It offers booked appointments for waiting list operations. It has broken down traditional barriers between nurses and doctors, with nurse practitioners able to dispense drugs and discharge patients from the Accident and Emergency Department and senior nurses managing services round the clock. Children's services are organised so that no child stays more than one night. After that, care is provided by nurses and other therapists in the child's own home.

RATIONING WILL BE LIFTED ON CANCER DRUGS

N. Hawkes and T. Baldwin

Times, Apr. 12 2000, p. 10

Reports that ministers are expected to agree that the drugs taxol and taxotere used for treatment of breast and ovarian cancer should no longer be rationed on grounds of cost.

(See also Independent, Apr. 12th 2000, p. 6; Guardian, Apr. 12th 2000, p. 8; Daily Telegraph, Apr. 12th 2000, p. 8)

SIT UP, TAKE NOTICE

P. Straw et al

Health Service Journal, May 11th 2000, p. 24-26

A survey of 5000 in patients in a Scottish Trust has revealed concerns about privacy, information giving, pain control and discharge arrangements. Patients became anxious when hospital staff appeared to contradict each other, and found it depressing to be asked the same questions by stream of different staff.

TALKING CONTRACTS AND TAKING CARE: MANAGERS AND PROFESSIONALS IN THE BRITISH NATIONAL HEALTH SERVICE INTERNAL MARKET

L. Griffiths and D. Hughes

Social Science and Medicine, vol. 51, 2000, p. 209-222

Paper draws on audio-recordings of a Health Authority's contract meetings with hospital providers to examine the nature of interactions between managers and clinicians in the NHS internal market. Concludes that the depending of managers on clinicians to make the contracting system work, taken together with the continued social and cultural authority of senior medical consultants, limits' managers' ability to control professionals.

TARGET PRACTICE

P. Bulter

Health Service Journal, vol. 110, Apr. 27th 2000, p. 8-9

Explains Conservative Party proposals on maximum waiting times for NHS treatment based on medical need, with the most serious conditions getting priority. People would be encouraged to take out insurance to pay for treatment of minor ailments, although eventual treatment by the NHS would still be guaranteed. The danger is that this approach would create a gap between those who could pay for fast access to treatment and those who could not, and that the expanded private sector would syphon off NHS staff.

TESTING TIMES

Audit Commission

Audit Commission Publications, 2000

Report highlights unacceptable variations in the quality of diabetes services. In some areas patients are not properly taught how to manage their condition, and GPs and hospitals are failing to carry out routine checks that can stave off complications such as eye disease and kidney failure.

THREAT TO 80 MATERNITY UNITS OVER STAFF CRISIS

R. Eden

Daily Telegraph, Apr. 10th 2000, p. 5

Study by three medical Royal Colleges shows that up to 80 hospital maternity units could close or be merged due to a shortage of specialist doctors and midwives.

THREE PRESCRIPTIONS FOR A HEALTHIER NATIONAL SERVICE

R. Sylvester and T. Womersley

Daily Telegraph, Apr. 25th 2000, p. 4

As the government begins a national consultation exercise as part of its campaign to modernise the NHS, authors reveal the main proposals being examined by the action teams it has appointed to look into prevention, partnerships and performance standards.

(See also Guardian, Apr. 25th 2000, p. 4)

TRUSTING TO LUCK

S. Abbott and S. Gillam

Health Service Journal, vol. 110, May 18th 2000, p. 24-25

An analysis of 36 Health Authorities' health improvement programmes found they reflected national priorities well. The average number of priorities was 13, with coronary heart disease/stroke, mental health and cancer being the most common. One plan set no priorities. Most programmes included some consultation with the public, but only seven had measurable targets. Many plans were written in a way that would make them difficult for the public to understand. Only 13 provided a glossary.

WAITING LIST TARGET HAS BEEN MET, LABOUR WILL CLAIM

A. McSmith

Daily Telegraph, May 17th 2000, p. 2

Statistics show that in March 2000 there were around 1,050,000 people waiting to be treated in NHS hospitals, compared with 1,158,004 three years earlier. This means that Labour can claim to have kept its promise to cut waiting lists by 100,000, although success may be short-lived due to seasonal fluctuations.

(See also Guardian, May 17th 2000, p. 11; Times, May 17th 2000, p. 15); Financial Times, May 18th 2000, p. 7)

WE WANT A BETTER NHS: THEY PLAN A NEW LOGO

M. Marrin

Daily Telegraph, May 12th 2000, p. 24

Argues that nursing standards within the NHS have collapsed and need to be improved by

  • a radical reform of training;
  • reinstatement of state enrolled nurses;
  • acceptance of a degree of hierarchy among nurses;
  • a substantial pay rise.
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