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

'After the stroke': patients' and carers' experiences of healthcare after stroke in Scotland

L. Salisbury and others

Health and Social Care in the Community, vol.18, 2010, p. 424-432

This study explored in detail patients' and carers' perceptions and views of lived experiences of the healthcare system and services received after stroke in Scotland. Data were collected using face-to-face semi-structured interviews with 13 stroke patients and nine carers. The data highlighted issues surrounding recognition of stroke symptoms by both participants and professionals; expeditious admission to hospital and stroke unit; and consultation during the discharge process and access to support and community follow up. Results suggest that the experiences of stroke patients and carers do not always concur with the recommendations of current clinical guidelines. Such recommendations do not always transfer into clinical practice.

Equity and excellence: liberating the NHS

Department of Health

London: TSO, 2010 (Cm 7881)

This paper announces coalition government plans for radical reform of the NHS. Consortia of GPs will take over from primary care trusts responsibility for commissioning care from hospitals, charities and other providers. The consortia will also be responsible for commissioning out-of-hours services. They will be regulated by an independent commissioning board, which will set objectives, monitor performance, and guide doctors. Primary care trusts and strategic health authorities will be abolished by 2013. All hospitals will become foundation trusts and will be allowed to earn more money from treating private patients. Hospitals and doctors will be judged on their clinical effectiveness, with time targets being abolished. Data on hospital performance and patient satisfaction will be published, making it easier for people to choose where to be treated. Patients will have greater control over their medical records and will decide who can see them. The aim is for them to be able to download their records to share with healthcare organisations, and to be able to communicate with doctors by email. A National Public Health Service will be set up and run jointly by the NHS and local authorities, with a ringfenced budget and responsibility for tackling smoking, alcohol abuse and obesity, as well as organising vaccination and screening programmes. Regions with high numbers of unhealthy people will receive extra cash.

(For comment advocating mandatory health insurance see Daily Telegraph, July 13th 2010, p. 19; for pre-publication wrangling see Health Service Journal, July 8th 2010, p. 4; for analysis see Children and Young People Now, July 20th-26th 2010, p. 11; Health Service Journal, July 15th 2010, p. 4-8; Health Service Journal, July 22nd 2010, p. 12-13)

Ethnicity, health and health inequalities

K.L. Saunders and J.N. Rao (guest editors)

Ethnicity and Inequalities in Health and Social Care, vol.3, June 2010, p.2-48

By nearly all measures, the health of Britain's minority ethnic populations is poorer than that of the majority White population. Focusing on initiatives in the West Midlands, the papers in this special issue describe a range of strategies and approaches for improving minority health and developing culturally competent systems of health provision. The collection addresses issues such as the link between prevalence of cousin marriages and high levels of infant mortality, child protection issues in religious communities, ways of counting numbers of newly arrived immigrants in a local community, the impact of government health promotion initiatives on minority groups, and strategies for involving lay community members in health service design.

Following NICE 2008: a practical guide for professionals on community engagement with local black and minority ethnic (BME) community groups

P. Lane and R. Tribe

Diversity in Health and Care, vol.7, 2010, p. 105-114

This paper provides a practical guide for health professionals on community engagement with under-represented groups, based on the 2008 NICE guidelines on the subject. It offers a four-stage process model of community engagement and consultation. It also encourages the representation of marginalised groups in local health and social service planning.

Has Lansley called time on falling waiting lists?

A. Moore

Health Service Journal, July 1st 2010, p. 12-13

Two views are emerging of health secretary Andrew Lansley's announcement of the abolition of central performance management of the 18 weeks referral to treatment target. One is that it is a misjudgement which will lead to waiting times rising as mangers decide the pressure is off. The other more favourable interpretation is that he is replacing a blunt target with a much more sophisticated system of levers and pressures, which will largely maintain performance but will remove some perverse incentives.

Improving NHS productivity: more with the same not more of the same

J. Appleby and others

Kings Fund, 2010

This new analysis shows that the NHS will face a productivity gap of up to 14bn a year by 2014. Finding 14bn means achieving annual productivity improvements of around 4% per year. The review shows that the most significant opportunities for improving productivity lie in reducing variations in clinical practice. The Department of Health's quality, innovation, productivity and prevention programme (QIPP) should therefore focus on action within clinical microsystems, the frontline teams that deliver care to patients. Productivity can also be improved if organisations work together in local systems of care to explore ways of sharing services and costs. For this agenda to succeed, the NHS needs to retain its experienced leaders at a time of organisational instability.

(For summary see Health Service Journal, July 22nd 2010, p. 14-15)

Is there an unsuitable doctor in the house?

C. Isles

The Independent, June 30th 2010, p. 22

Prof. Chris Isles presents a first hand account of trying - and failing - to recruit middle ranking and junior doctors at the Dumfries and Galloway Royal Infirmary which, like many other district hospitals around the country, faces severe shortages of clinicians.


J. Taylor (editor)

Health Service Journal, June 24th 2010, supplement, 13p This supplement explores ideas around transforming the NHS into a service that supports and enables patients (now redefined as customers) to manage their own health and that meets their psychological and emotional health needs as well as their physical ones, treating them with dignity and respect. The articles cover the concept of quality improvements driven by service users and providers working together, improved communication and interaction between doctors and patients, improved patient and public involvement in service design, community engagement in service design so as to ensure equitable access, supporting self-management for people living with long term conditions, and shared clinician-patient decision-making.

'National management system' to 'grip' transition

A. McLellan

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

The Department of Health is to establish a 'national management system' formed from senior management teams at the Department and the ten strategic health authorities to maintain tight control of NHS finances during the transition to the new structure set out in the 2010 White Paper, Equity and Excellence: Liberating the NHS. There will need to be a unified approach to workforce changes and a monitoring and reporting regime. The national management system will start to align with the future NHS leadership structure, which will consist of an independent commissioning board, the new department of public health and the economic regulator (Monitor). The new national structure should also supply centralised support to GP commissioners.

NHS losing 47 jobs a day due to 'efficiency' cuts, says union

R. Ramesh

The Guardian, July 7th 2010, p.8

The Royal College of Nursing 's survey of 100 NHS organisations has found that 9,973 jobs have been lost over the last 6 months due to recruitment freezes, redundancies and staff not being replaced when they retire.

The patient's heroic journey

P. Ramsden

British Journal of Healthcare Management, vol. 16, 2010, p. 328-331

For many years the physician was viewed as the focal point in medical decision-making, but the emphasis is now on the decisions the patient makes on the road to recovery. The patient's decision pathway may bring him into contact with numerous healthcare professionals at its various stages. This article shows how the patient's decision pathway is similar to the journey of the hero in a film, and that the healthcare professionals have key supporting roles in this story.

Position of trust

L. Phillips

Public Finance, June 11th-17th 2010, p. 18-19

In order to improve efficiency and outcomes, the coalition government will turn Monitor, the independent watchdog for NHS Foundation Trusts, into a full blown economic regulator, managing access, competition and price-setting across the service. This article reports an interview with Steve Bundred, newly appointed Monitor chief executive, about the implications of the reform.

Revision to the operating framework for the NHS in England 2010/11

Department of Health


The revised NHS operating framework has increased the savings in management costs that NHS organisations will be required to deliver by March 2012 by more than a third. By moving the baseline for cuts from 2009/10 to 2008/09, the Department of Health now requires organisations to remove the 23% increase in management costs between the two years. Performance management of the 18 weeks referral-to-treatment and primary care access targets will stop immediately, and the accident and emergency target has been relaxed to 95% of patients seen within four hours of arrival, down from 98%. Primary care trusts will also be allowed to 'park' their provider arms with other NHS bodies as an interim measure while they develop more ambitious models for the separation of provision from commissioning.

Tackling inequalities in life expectancy in areas with the worst health and deprivation

National Audit Office

London: TSO, 2010 (House of Commons papers, session 2010/11; HC186)

This report has found that differences in life expectancy between the 70 most deprived areas of England and more affluent parts of the country have widened in the last 10 years, by 7% for men and 14% for women.


Transparency in outcomes: a framework for the NHS

Department of Health


This consultation document contains 100 proposed new measures focusing on patient outcomes which will replace the performance targets abolished by the coalition government. Surveys of patient attitudes and how well they feel their treatment went will be a main feature of the new system.

Two-week cancer pledge at risk

J. Kirkup

Daily Telegraph, July 15th 2010, p. 1 + 2

A guarantee introduced by Labour that all patients thought to have cancer by their GP will be seen by a specialist within two weeks may be scrapped by the coalition government. The disclosure came in an answer to a Parliamentary question by David Cameron, who said that the target might be abandoned if doctors and health officials thought it was not improving cancer care.

Unhealthy? Then help yourself

A. Quigley

Health Service Journal, July 8th 2010, p. 14-15

There is opinion poll evidence that the public increasingly expects citizens to take responsibility for maintaining their own health. Around 50% of people questioned by Ipsos Mori said that the NHS should limit the treatment it offers free to people who choose unhealthy lifestyles, but only 22% supported giving less priority to treating them. The NHS needs to consider how to engage with the public on these issues.

Using human rights-based approaches to conceptualise lesbian and bisexual women's health inequalities

J. Fish and S. Bewley

Health and Social Care in the Community, vol. 18, 2010, p. 355-362

This article draws on principles embodied in the Yogyakarta agreement which foreground the principle of the right to the highest attainable standard of physical and mental health as a basis for any consideration of health and human rights. In particular, the article argues that the right to health does not only depend on good healthcare but includes access to health information, participation, equity, equality and non discrimination. The study on which it is based explored the experiences reported by lesbian and bisexual women in healthcare settings, and may help to inform a human rights based approach to LB women's health.

What are quality and safety at the point of care?

G. Caldwell

British Journal of Healthcare Management, vol. 16, 2010, p. 344-349

High quality and safe inpatient care depends on making the right diagnosis at the right time and providing the right treatments. The conditions required to enable frontline clinicians to deliver high quality, safe inpatient care can be described in simple, elegant and concrete terms. If clinicians, leaders, and managers can agree to work together to create these conditions, there is an opportunity to draw these interest groups together with a common purpose to the advantage of patients.

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