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

A&E alternatives 'confuse' the public

D. West

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

Department of Health advisers have warned that many of the health centres presented as alternatives to hospital accident and emergency (A&E) departments under different names offer unreliable services and confuse the public. Many services are underused and they have failed to reduce pressure on hospital A&E departments. It is recommended that names of these urgent care centres be standardised and that primary care trusts must provide minimum services and standards.

Benefits of the two-week rule in lower GI patients

G. Lloyd and others

British Journal of Healthcare Management, vol.16, 2010, p. 134-139

It has been suggested that all patients referred to hospital outpatient departments with lower gastrointestinal symptoms should be seen within two weeks of referral. This would replace the current practice of scheduling appointments within two weeks for patients referred under the two-week wait scheme, and sorting the rest into urgent or routine categories, a system which means that many patients wait several weeks to be investigated. This study aimed to determine the benefit of seeing all patients with symptoms associated with colorectal cancer within two weeks, and in particular to discover how many cancers would have been diagnosed earlier, in the context of a tertiary referral centre in Leicester. Results showed that six patients with colorectal cancer over one month would have been diagnosed sooner if a policy of seeing all patients with lower gastrointestinal symptoms within two weeks of referral had been adopted. In order to accommodate the extra workload, it was calculated that each colorectal surgeon would need to hold an extra 0.5-1 clinics per week for a number of months, while 'mopping up' the backlog.

(See also: The Independent, Apr. 12th 2010, p.1-2)

Cancer survivorship

I. Torjeson (editor)

Health Service Journal, Mar. 25th 2010, Supplement, 9p

Cancer is becoming a long term condition, and two million people are living with it in the UK. Many of these patients have unaddressed physical and psychological needs. The National Cancer Survivorship Initiative (NCSI) is setting out to improve the quality and quantity of services for survivors of the disease in a very cost-effective way. It envisages all patients receiving a needs assessment and a personal care plan, with resources identified to deliver it, and information and support about what to expect in the future. Instead of routine, regular hospital follow-up appointments, NCSI is investigating new models, including telephone and self-triggered follow-up, where the patient's care plan outlines when to seek help and from whom.

CQC gets to grips with registration challenges

D. Williams

Public Finance, Mar. 25th-Apr. 8th 2010, p. 16-17

The Care Quality Commission (CQC) is in the process of registering the 381 NHS trusts in England that provide healthcare services. Registration will depend on trusts' ability to show that they meet minimum standards, and can be cancelled by the regulator if patient safety is at risk. Those trusts which cannot demonstrate compliance with minimum standards will have conditions placed on their registration, and will retain their licence to provide services only if the CQC is convinced of their capacity to improve.

Easing the journey through prostate cancer

H. Payne, M. Sobanja and J. Troup

British Journal of Healthcare Management, vol. 16, 2010, p. 129-133

National directives continue to encourage greater involvement of primary care in prostate cancer management. However, the complexity of the disease cannot accommodate absolute definitions of role responsibilities across primary and specialist care. This article reviews an initiative led by the British Uro-Oncology Group (BUG) to improve the management pathway for prostate cancer patients by improving communication between commissioners and clinicians within secondary, primary and intermediate care. It is concluded that demonstrable improvements in service delivery can be achieved by increased understanding of the commissioning process among specialist health professionals, and by greater understanding of prostate cancer clinical issues among commissioning and primary care professionals.

Hospitals escape fines after rethink on mixed sex wards

K. Devlin

Daily Telegraph, Apr. 1st 2010, p. 6

From April 1st 2010, hospitals were to be fined if they continued to treat patients in mixed sex wards. However, the government has announced that trusts will escape the fines if they have an action plan in place to eradicate the wards. Figures show that one in seven hospitals were still treating patients in mixed sex wards in 2009.

Hospitals must be forced to improve quality of their food, says expert

K. Devlin

Daily Telegraph, Mar. 31st 2010, p. 2

The government has been warned that voluntary attempts to improve the standard of hospital food have failed. The Good Food for Our Money Campaign is calling for legislation to establish clear food standards.

How modern medicine could save the NHS 600m

J. Laurance

The Independent, Apr. 13th 2010, pp. 22-23

The National Institute for Clinical Excellence (NICE) has found that the NHS could save as much as 600m if it takes up its recommendations, according to this interview with Sir Andrew Dillon, its chief executive.

The maternity lottery - women less likely to die in childbirth in Albania than in UK

S. Boseley

The Guardian, Apr. 13th 2010, p. 3

An investigation by the Institute of Health Metrics and Evaluation in the USA has revealed that as many women are dying in childbirth in the UK as they were 20 years ago. Currently the UK is 23rd in the global league table behind countries such as Albania, Hungary and Ireland. A spokeswoman for the Royal College of Obstetricians and Gynaecologists pointed out that the death rate in the UK was still very low.

NHS is yet to capture the wealth of the net

D. West

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

The NHS lags behind leading industries in realising the potential of information technologies for improving communication with patients. Improving self-care for patients with long term conditions and therefore reducing demand relies on development of online services such as remote health checks and monitoring.

Night shift doctors left to care for 400 patients

R. Smith

Daily Telegraph, Apr. 21st 2010, p. 8

Research into the impact of the European Working Time Directive on staffing levels at British hospitals found wide variations in the number of doctors covering wards at night, with an average of one doctor for every 61 patients. The research also found that in some cases the most senior hospital doctor on duty at night was still in their first two years of training. Levels of cover at night are the same now as they were in 2001, despite a 50% increase in the number of junior doctors working for the NHS. The study suggests that the implementation of the Working Time Directive, which cut junior doctors' hours from 56 per week to 48, has cancelled out the expansion in doctor numbers and left many wards understaffed.

Nurses warn of 'dangerous' NHS staff cuts

J. Laurance

The Independent, Apr. 26th 2010, p.15

The Royal College of Nursing has warned that over 5,000 NHS jobs have been marked for redundancy, including hundreds of doctors and thousands of nurses. In addition, the RCN has found that more than nine out of 10 ward sisters covering 180 hospitals have said that they are already short-staffed on many shifts by nearly one-third. The RCN says that there is a clear link between the number of nursing staff and patient safety and has called for real protection of front-line services.

(See also: The Guardian, Apr. 26th 2010, p. 4)

Towards a community engagement strategy

K. Sheridan and P. Tobi

British Journal of Healthcare Management, vol. 16, 2010, p. 123-128

Strategic health authorities, primary care trusts, NHS trusts and foundation trusts now have a legal obligation to embed community engagement in their decision-making processes and to demonstrate that this engagement has had an influence. NHS bodies will therefore need to be systematic in ensuring that the public is involved at every stage. This article outlines a framework that will help them to approach engagement more strategically.

Trusts issue 'wake up call' to medics

C. Santry

Health Serviced Journal, Apr. 15th 2010, p. 4-5

Freedom of Information responses from 99 hospital trusts show that a fifth have reduced or plan to cut the time consultants spend on 'supporting professional activities' (SPAs), including training, research, audits, teaching and clinical governance. A further 15% plan to look more closely at the value provided by SPAs, which typically take up just under 25% of consultants' time.

Why the talk is opening up on hospital closures

R. Vize

Health Service Journal, Apr. 15th 2010, p. 12-13

Driven by looming budget cuts, the issue of hospital closures is now being openly debated. It is argued that up to 30,000 more hospital beds could be closed if more treatment was delivered in community settings, ineffective treatments were withdrawn, long term conditions were better managed, and patients were given better information, which has been shown to reduce demand. Hospital closures are being strongly opposed by the British Medical Association.

Young at heart: getting services right for children and adolescents

H. Mooney (editor)

Health Service Journal, Mar. 18th 2010, supplement, 17p.

This supplement highlights the challenges confronting the NHS in developing children's services and demonstrates how innovative solutions are leading to improved outcomes for children, young people and their families. The supplement covers: the Healthy Child Programme which offers universal services to all children and families from pregnancy to adulthood; the Family Nurse Partnership which offers support to young first-time parents through home visits; innovations in neonatal services; specialist services for adolescents; and support for children with long-term conditions.

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