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

Confed is still 'looking out' for all its members

C. Santry

Health Service Journal, Aug. 19th 2010, p. 10-11

Report of an interview with Keith Pearson, chair of the NHS Confederation, in which he discusses the future of the organisation in the light of the abolition of primary care trusts which make up a significant proportion of its members from April 2013. It could become a pressure group dominated by foundation trusts, a commercial organisation selling management tools, or a forum bringing together GP consortia and providers. In the interim it will focus on relaying the concerns of its members to government.

Designing an integrated health care system: what are the key features?

S. Karakusevic

Journal of Integrated Care, vol.18, Aug. 2010, p. 36-42

This paper results from experience gained while developing the South Devon Integrated Care Network (ICN) and from more recent experience as an integrated care pilot organisation. It demonstrates that by taking an integrated approach, a hospital can develop and prosper, and that it is possible to reduce the number of beds and manage care in the community within the levels of funding currently available. The paper focuses on integration at organisation level and proposes a model of key system drivers and controls necessary to manage an integrated health and social care system.

The diabetes centre in a macroeconomic context

P. Grant

British Journal of Healthcare Management, vol.16, 2010, p. 382-389 Hospital-based diabetes centres are under pressure to move services into the community so that care can be delivered at below-tariff prices. Moreover, the Any Willing Provider scheme means that provision of community-based services is now open to competition, with few barriers to entry. This article applies Porter's five forces model to analyse the role of the diabetes centre in a macroeconomic context and to help diabetes teams plan for the future. It warns that caution needs to be exercised on the extent of service delivery change, as short-term savings may lead to decline in the quality of patient care, which will have long-term health and economic consequences.

Donors may get 1,000s in fertility plan

D. Campbell

The Guardian, Aug. 23rd 2010, p. 1

The Human Fertilisation and Embryology Authority, Britain's fertility regulator, is planning big changes to the strict rules governing egg and sperm donation in order to try and stop more childless couples from seeking treatment abroad.

'Equity and Excellence: Liberating the NHS': opportunities and challenges

Health Policy Committee

Bow Group, 2010

This report describes the 2010 NHS White Paper as courageous, but questions its vagueness about how savings will be made and where management costs will be cut in practice. It describes handing over commissioning to GP consortia as radical and bold, but warns that effective implementation of this will be dependent on the removal of a number of practical barriers, which it identifies as perceived problems of accountability, patient engagement, service quality and estate management. It also warns that successful implementation of the reforms will depend on strong leadership across the NHS.

Government ignored our advice on homeopathic remedies, say experts

S. Connor

The Independent, Aug. 3rd 2010, p. 10

Experts have accused the Coalition Government of ignoring scientific advice on the questionable nature of homeopathy by continuing to fund treatments despite there being next to no evidence of their effectiveness.

Harmed patients gaining voice: challenging dominant perspectives in the construction of medical harm and patient safety reforms

J.E. Ocloo

Social Science and Medicine, vol. 71, 2010, p.510-516

Looking at medical harm and patient safety from the perspective of patients harmed by NHS treatment, this paper argues that their experiences have acted as an important catalyst for the emergence of a patient safety movement in healthcare over the past ten years. Yet evidence suggests that these experiences have been largely excluded in the construction of patient safety reforms. Addressing this situation requires tackling the imbalance of power that exists between patients and healthcare providers in the UK. Harmed patients gaining voice and contributing their experiences to the development of patient safety reforms is seen as vital to breaking the dominance of the medical profession and to generating new forms of expertise and models of good practice that can help prevent the reoccurrence of the harm to others in the future.

Health reforms swell agenda of dissent for Lib Dem conference

G. Hurst

The Times, Aug. 23rd 2010, p. 9

Opposition to the coalition government's health plans are threatening to generate a new source of tension at the 2010 Liberal Democrat party conference. There is also considerable tension around the government's plans for free schools, changes to the university funding system and proposals for elected police commissioners. Ed Miliband has issued an open invitation to disillusioned Liberal Democrat members to defect to the Labour Party.

'Hotels' for patients and family

R. Winnett

Daily Telegraph, Aug.25th 2010, p. 1

The coalition government is considering setting up a network of 'patient hotels' where relatives could stay with the chronically ill and help with nursing care. It is believed that hotels could improve patients' prospects, speed recovery and cut costs as fewer nurses would be needed.

Implementing clinical governance policy: NICE

D. Spyridonidis and M. Calnan

British Journal of Healthcare Management, vol. 16, 2010, p. 394-401

NICE guidelines appear to be difficult to implement. While previous research has addressed clinicians' influence on guideline implementation, this paper focuses on the role of managers. The implementation process was explored retrospectively, prospectively and longitudinally, using a comparative case-study design involving four organisational settings in primary and secondary care and 74 interviews between 2007 and 2009. National policy requirements for performance management led senior managers to be more interested in financial accountability and in demonstrating that they had the appropriate documentation related to the implementation than in collecting evidence about the actual use of the guidelines in everyday practice. Further, NICE guidelines that required major financial investment for their implementation rarely reached the decision agendas.

Managing medication compliance

R. Griffith

British Journal of Healthcare Management, vol.16, 2010, p. 402-408

It is estimated that 50% of medicines prescribed for older people in the UK are not taken as directed, leading to drug wastage, mismanagement of medical conditions and hospital readmission. The most common reasons for non-compliance are adverse drug reactions and practical difficulties taking tablets. Healthcare managers must ensure that policies are in place addressing any barriers that may affect patient compliance. Policies must be informed by the law and best practice advice from regulatory bodies, so that strategies to combat non-compliance are safe and evidence-based.

Ministers fight EU curbs on surgeons' hours

A. Porter

Daily Telegraph, Aug. 2nd 2010, p.1

A survey by the Royal College of Surgeons has shown that the European Working Time Directive, which restricts the number of hours that junior doctors can work to 48 per week, has adversely affected the quality of patient care. The Department of Health has indicated that it will attempt to negotiate an opt-out for some NHS workers.

(See also Daily Telegraph, Aug. 4th 2010, p.1 + 2)

NHS shiftwork agency 'for sale'

R. Ramesh

The Guardian, Aug. 6th 2010, p. 15

A surprise move to sell off an agency that provides tens of thousands of nurses and other health workers to hospitals has led to claims by Unison and other unions that the government is 'promoting privatisation'.

(See also Financial Times, Aug. 6th 2010 p.2)

NHS should be included in cuts, say citizens' jury

A. Stratton

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

Just over 90% of a citizens' jury of 24 people who spent 3.5 days debating money-saving ideas as part of research by PricewaterhouseCoopers felt the NHS should not be protected from cuts. PwC also polled 1,780 adults, the majority of whom suggested that as well as healthcare, funds for international development should also be considered for cuts.

Out with the old, in with the new

A. Parsa

Health Service Journal, Aug. 26th 2010, p. 12-13

This comment piece argues that, in order to increase productivity and improve services, the coalition government needs to encourage innovative new providers to enter the healthcare market place. It is from new entrants, not established incumbents, that innovation will come.

Patient safety: a casualty of target success?

M.D. Williams and A. Smart

International Journal of Public Sector Management, vol. 23, 2010, p. 416-430

The NHS in England is confronted with a range of competing priorities. This research aims to develop a conceptual resilience-based model that takes account of the competing success factors of patient safety, finance, service delivery targets, and staff workload in NHS hospitals. Content analysis of risk management documents in four hospitals shows that the need to succeed on finance and service targets received greater attention than patient safety and staff workload.

Patients on their best behaviour

S. Martin and R. Cialdini

Health Service Journal, Aug. 19th 2010, p. 12-13

This article describes how the new science of social influencing can reduce waste in the NHS by cutting non-attendance at appointments, increasing treatment compliance, and persuading people to take more responsibility for their health.

Pledge to abolish mixed-sex wards by year's end

R. Prince

Daily Telegraph, Aug. 16th 2010, p.1 + 2

Reports that the health secretary is to pledge to end the indignity of mixed sex hospital wards in all but accident and emergency and intensive care units by the end of 2010. However, provision of single sex wards across the NHS has been deemed impossible by experts.

(See also Daily Telegraph, Aug. 17th 2010, p. 8)

Systems man

D. Williams

Public Finance, July 16th-29th 2010, p. 18-19

Report of an interview with Chris Ham, chief executive of the King's Fund, in which he comments on the coalition government's NHS reforms. Prof. Ham argues that the top priority should be to improve NHS productivity, not to embark on a massive reform of commissioning. If GP consortia are to be made responsible for commissioning, they must be made accountable. There needs to be oversight of the whole healthcare system in a local area. The government plans that local authorities should assume this role, but they lack expertise in NHS issues.

Tests for foreign nurses scrapped

R. Alleyne

Daily Telegraph, Aug. 23rd 2010, p. 6

Under the current system, all overseas nurses wishing to work in Britain have to prove that their clinical skills are up to date. Either they have to show that they have carried out a minimum of 450 hours nursing in their own country in the past three years, or they must attend an intensive three-month refresher course. These requirements have been dropped for nurses from EU countries on the grounds that they may break EU laws on freedom of movement of labour. Nurses from EU countries will now only need to produce a diploma from their country showing they are qualified.

Union tries to block NHS reforms in court over 'sham consultation'

A. Sparrow

The Guardian, Aug. 25th 2010, p. 12

The public services union Unison has announced it would go to court to block the government's plans for radical re-organisation of the NHS on the grounds that the consultation process conducted by the Department of Health is a 'sham'. In a statement released on Tuesday 24 August, Karen Jennings, Unison Head of Health, has accused the department of ignoring a legal duty to consult patients.

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