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

Can the NHS drive new ideas into circulation?

N. Edwards

Health Service Journal, Apr. 8th 2010, p. 8-9

This article presents an overview of major policy shifts in the NHS since the early 1990s, including the introduction of competition and patient choice, the recent emphasis on improving quality and patient safety, and expressed intentions to move power from the centre to the frontline. The process of change will not stop, although its future direction is uncertain.

Child health units prepare to move

E. Watson

Children and Young People Now, May 11th-17th 2010, p. 9

Maternity and paediatric units across England are to be merged into fewer and larger centres of provision covering wider areas and a greater number of patients. It is argued that such a consolidation will reduce costs and improve the quality of medical care. This article looks at the impact of the mergers on staff.

Conflict of interest for NHS regulator

N. Timmons

Financial Times, May 28th 2010, p. 2

Under the coalition's plans for the NHS, an independent board is to be created to oversee the commissioning of care. The current inspectorate, the Care Quality Commission, is expected to hand over its licensing of health organisations to Monitor which currently oversees foundation trusts. The head of the trusts' watchdog has conceded that there is potential for a conflict of interest for the new economic regulator between its duty to promote competition and oversee the financial health of foundation trusts.

Confronting the 'glass ceiling'

K. Ly

Community Practitioner, vol.83, May 2010, p. 10-11

Ten years after the amendment of the Race Relations Act in 2000 following the Stephen Lawrence Inquiry, institutional racism remains a problem in the NHS. Improvements still need to be made in tackling discrimination and ensuring that the workforce is racially diverse across all levels of the NHS. However some NHS senior managers from minority ethnic groups say that the 'glass ceiling' imposing restrictions on career development has been weakened.

Doctors must not ignore the right to die

K. Devlin

Daily Telegraph, May 20th 2010, p.1+2

Doctors could be struck off the General Medical Council register if they fail to respect the wishes of terminally ill patients who want to refuse treatment. They must allow the terminally ill to refuse food and water and must abide by advance directives stating that the patient does not wish to be resuscitated. Doctors must also follow the wishes of patients as communicated through a friend or relative who has been designated their 'legal proxy'. They must not let their own personal or religious objections interfere.

Fifth of patients on mixed wards

K. Devlin

Daily Telegraph, May 20th 2010, p. 2

A survey of almost 70,000 inpatients has shown that 18% are still being treated on mix sex wards, down from 25% in 2006. Almost one in four, 23%, said they were forced to share the same bathroom, down from 30% in 2008. The survey also showed that 18% of patients unable to feed themselves were not being helped by staff. Almost half the patients surveyed also complained that potential side-effects of medication had not been explained, and 40% said they had been prevented from sleeping at night by noise from other patients. However, the survey found significant improvements in hospital cleanliness and waiting times.

Foundation applications run into the ground

D. West

Health Service Journal, Apr. 22nd 2010, p. 4-5

The Health Service Journal compared NHS trusts' plans to apply for foundation status in early 2009 with current plans using submissions to the Department of Health. In 2009, 46 trusts said they hoped to have applied for foundation status by April 2010. Only 12 have done so and just five have been authorised. Advocates of provider reform are calling for radical change to reinvigorate the policy.

Head of NHS London resigns in protest at Tory health plans

R. Ramesh

The Guardian, May 27th 2010, p.23

Sir Richard Sykes, the Head of the NHS in London, has resigned over the government's decision to scrap a review of healthcare in the capital. The review was part of an exercise by the Labour government to cut costs in the NHS aimed at heading off a 5bn deficit in the capital's health budget.

Industrial tourism in health care

N. Moghal and C. Imison

British Journal of Healthcare Management, vol. 16, 2010, p. 172-177

In September 2009, a group of senior NHS leaders went on a week-long study tour of Seattle to visit and learn from some of the most forward-thinking providers of healthcare in the US and Microsoft. The tour highlighted the ingredients of successful healthcare improvement (shared vision, strong leadership, evidence-based methodologies to underpin continuous improvement and effective use of new technologies) and provided a vision of where the NHS could be going. Sustainable improvement requires effort over periods of up to 10 years, which presents a particular challenge to the NHS where improvement is needed more quickly due to the current financial crisis.

Investing in informatics

D. Carlisle (editor) Health Service Journal, Apr. 22nd 2010, supplement, 8p

Investment in IT is essential for delivering the cost savings that the NHS needs to make in a time of financial stringency. This supplement includes articles on business intelligence systems, the electronic patient record, and the recruitment of a skilled informatics workforce.

'It's another way of standing outside the door': supplementary prescribing and doctor-nurse partnerships

L. Hales, M. Lohan and J. Jordan

Social Theory and Health, vol.8, 2010, p. 210-228

In the UK, experienced nurses who undergo additional training can now become independent and supplementary prescribers. Supplementary prescribers are able to prescribe all drugs, including controlled drugs and unlicensed medicines. Supplementary prescribing (SP) requires a doctor (independent prescriber) to make the initial diagnosis. The nurse then works in partnership with the doctor and the patient to draw up a patient-specific clinical management plan. This allows the supplementary prescriber to review and prescribe for that patient for 12 months. This article reports a study of how nurses undertaking a course to become supplementary providers viewed the current and future working arrangements of SP. In particular, it focuses on nurses' views on how partnerships between nurses and doctors might work in SP practice. Results suggest that, although there were clearly some gains for nurses in terms of their functional autonomy, the overall balance of medical dominance remained intact.

Out of the mud and back on track

M. Goldman

Health Service Journal, May 6th 2010, p. 12-13

Good Hope Hospital trust had a significant historic deficit, a continuing income and expenditure imbalance, and serious operational issues. It had suffered for years from management inconsistency and planning blight, and a failed attempt at private sector management as a franchise. In 2007 Good Hope was returned to the public sector by way of its acquisition by Heart of England Foundation trust. This article draws some lessons for future NHS trust mergers and acquisitions.

Progress in improving stroke care

Committee of Public Accounts

London: TSO, 2010 (House of Commons papers, session 2009/10; HC 405)

Stroke is one of the top three causes of death and the largest cause of adult disability in England, costing the NHS at least 3 billion a year in direct care costs, with wider economic costs of around 8 billion. Since 2006 the Department of Health (the Department) and NHS have increased the priority given to stroke, particularly the speed of the acute hospital response. However, improvements have not been universal and too often the likelihood of receiving a timely brain scan or accessing specialist care is dependent on where and when you have a stroke. Similarly, the proportion of patients treated on a specialist stroke unit, although improving, is still well short of the Department's target of 90%, with some regions showing extremely wide variations. The improvements in hospital care are not yet matched by progress in delivering more effective support once stroke survivors leave hospital. Many patients discharged from hospital continue to struggle to obtain follow-up care and access to community rehabilitation services remains a post-code lottery. There is also a risk that the current level of services will not be sustained once the funding provided by the Department to help implement the strategy ends next year. There are a number of systemic problems restricting further development of stroke services, such as a lack of effective joint working between health and social care and limitations in out-of-hours hospital care. The report makes recommendations on how to sustain and improve still further the standards of services for all stroke patients across the whole stroke care pathway.

The right medicine?

R.Thorlby and J. Appleby Public Finance, Apr. 23rd-29th 2010, p. 20-23 Since the New Labour government came to power in 1997, a combination of policy levers have been constructed and used to improve the NHS, including targets, stringent performance management, financial incentives for individuals and organisations, and a modest degree of competition and patient choice. Successes for New Labour include reduced waiting times, the creation of national evidence-based clinical standards, and improved patient safety. On the other hand, health inequalities have widened and overall the challenge of prevention has not been successfully met.

Shaping our future today: why training is vital to recovery

H. Mooney (editor) Health Service Journal, Apr. 8th 2010, supplement, 8p It is essential to invest in staff training and development during the coming period of tighter budgets as the future of the NHS relies on building up skills and capability. Articles in this special supplement introduce the Department of Health's new Top Leaders programme, which invests in the development of senior managers and their potential successors, and discuss the role of HR and workforce development managers in organisational transformation.

Stick to the facts

D. Carlisle Health Service Journal, May 13th 2010, p. 26-31 Report of discussions at a roundtable of experts debating the use of research evidence to improve productivity and efficiency in the NHS, focusing on the role of the NHS Evidence portal. There are problems with the lack of outcome measures in the research literature which makes it difficult to identify best practice, with conflicting evidence and guidelines, and with identifying the most reliable evidence. There are also barriers to getting evidence applied in practice, including perceived lack of resources, fears about increased costs, managerial barriers and resistance from clinicians.

Trends in applications for higher surgical training

S. Sabanathan, M. Thomas and L.R. Jenkinson British Journal of Healthcare Management, vol.16, 2010, p. 218-223 Over the past five years there have been radical changes in doctors' working hours and selection processes for surgical training across the UK. However, there is still a growing demand and competition for surgical training, as evidenced by the increasing number of applications. There is a steady increase in the numbers of female applicants. Neither the European Working Time Directive nor the Medical Training Application Service have deterred applicants from seeking higher surgical training.

Up in the air: how political uncertainty will affect the NHS

Health Service Journal, May 13th 2010, p. 3-9 There are fears that the hung Parliament resulting from the 2010 UK general election will halt NHS reform and delay difficult decisions about cost savings and service reconfigurations. Specifically, plans for the reductions in hospital capacity in London could be put on hold, the move of acute hospitals to foundation status could be halted, and Tory promises to give the NHS real terms spending increases could be broken in the event of a coalition with the Liberal Democrats. The election has also returned a number of MPs committed to fighting local hospital reconfiguration plans. (For candidates' opposition to NHS service changes see also Health Service Journal, May 6th 2010, p. 6-7)

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