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Welfare Reform on the Web (October 2010): National Health Service - Reform - General

Achieving equity and excellence for children: how liberating the NHS will help us meet the needs of children and young people

Department of Health

London: 2010

This paper sets out what the NHS White Paper will mean for children, young people and families and seeks views on how we can make the most of these important opportunities. It includes proposals for listening to the voice of children and families, personalising healthcare for children, shared decision-making and ensuring that age-specific information is routinely made available. It also asks for suggestions on development of appropriate outcomes measures and quality standards for children, and on incentives for quality improvement.

URL: @dh/@en/@ps/documents/digitalasset/dh_119490.pdf

Addressing performance concerns

G. Morrow and others

British Journal of Healthcare Management, vol.16, 2010, p. 436-442

There has been increasing awareness of the risk to patient care from poorly performing doctors, and of the need for structure and transparency in recognising underperformance and providing effective remediation. In the UK, the National Clinical Assessment Service (NCAS) was established in 2001 to provide advice and support to employers tackling performance concerns which are insufficiently serious to refer to a regulatory body. This article provides insight, based on the experience of referrers to NCAS in Northern Ireland, into the value of such a non-regulatory body for providing specialist advice and support.

Crisis in maternity after Brussels rules cut doctors' hours

R. Smith

Daily Telegraph, Sept. 9th 2010, p. 12

The cut in junior doctors' hours required by the EU Working Time Directive has combined with rising birth rates to cause a crisis in maternity units. Junior doctors in obstetrics and gynaecology have to sacrifice daytime training in order to cover wards at night and ensure patient safety.

EU law harming doctors' training

R. Smith and R. Winnett

Daily Telegraph, Sept. 8th 2010, p.1

The health secretary, Andrew Lansley, has signalled that he will seek to renegotiate the EU Working Time Directive so that junior doctors can work longer hours. There is concern that the cut in working hours required by the Directive has reduced the time available for training. According to a British Medical Association report, junior doctors starting to work on their chosen specialism spend 14% of their time on administration and only 13% on formal clinical training.

(See also The Times, Sept. 8th 2010, p.3)

Evidence based public health: a review of the experience of the National Institute of Health and Clinical Excellence (NICE) of developing public health guidance in England

M. Kelly and others

Social Science and Medicine, vol.71, 2010, p. 1056-1062

This paper discusses the challenges that have arisen in applying the principles of evidence-based medicine to the development of public health guidance in the National Institute of Health and Clinical Excellence (NICE). The challenge of applying these methods to an evidence base which is social and psychological as well as biomedical is considered. Key problems are identified, including the breadth of the evidence base, different analytic levels of explanation, and the length of the causal chain between interventions and outcomes in public health.

The future of pathology services

I. Torjesen

Health Service Journal, Sept. 16th 2010, supplement, 7p

Pathology is a frequently overlooked area in the NHS but has the potential to unlock up to 500m per year in efficiency savings. Experts in the field recommend that: 1) the profile of pathology is raised among the public and clinicians; 2) pathology should be focused on services rather than traditional disciplines; 3) the private sector should be involved in re-engineering services and managing change; 4) the self-interest of specific disciplines within pathology should be eliminated; and 5) interaction of pathologists with commissioners and patients should be increased.

Junior doctors desert the NHS

D. Rose

The Times, Sept. 6th 2010, p. 1& 8

Figures from the Medical Programme Board show that 23 per cent of the 6,000 junior doctors who completed their foundation training in England last year did not continue their work in the NHS. Many have suggested that the European Working Time Directive, combined with other factors, have had a negative impact on training and morale.

(See also The Times, Sept. 7th 2010, p.12 -13)

Minister denies U-turn on NHS Direct closure

R. Ramesh

The Guardian, Sept. 10th 2010, p. 5

The health secretary, Andrew Lansley, has announced that NHS Direct would remain, but its telephone number change so that from 2013, people could ring 111 for non emergencies and 999 for emergencies. The announcement appears to contradict a statement by the Department of Health in August that the service would be scrapped.

Nicholson steps up reform with radical savings move

S. Gainsbury and C. Santry

Health Service Journal, Sept. 16th 2010, p. 4-5

In his second letter on managing the transition, NHS chief executive David Nicholson has paved the way for primary care trusts to merge to cut costs in advance of their abolition in April 2013. The letter also confirms government plans for GP commissioning consortia to be made statutory bodies and announces the appointment of strategic health authority level transition leads.

Patient groups and the construction of the patient consumer in Britain: an historical overview

A. Mold

Journal of Social Policy, vol. 39, 2010, p. 505-521

Drawing on the papers and publications produced by patient-consumer groups, as well as government documents, this article presents an historical overview of the shifting meaning of the patient-consumer in Britain, and attempts to unravel the extent to which patients themselves were involved in driving such change. It argues that the patient-consumer was constructed both by patient-consumer groups and by government, a process which produced competing ideas about what it meant to be a patient-consumer. Patient organisations played a key role in building up the patient-consumer in the late 1960s and 1970s, but towards the end of the 1980s they lost control of this figure as patient consumerism was reformulated by the Conservative government. The increasing marketisation of public services during the 1990s resulted in greater emphasis being placed on the individual patient-consumer. This led to a fragmentation of collective attempts to represent patient-consumers, forcing patient-consumer groups to adopt a reactive rather than a proactive stance.

A review of the evidence of third sector performance in its relevance for a universal comprehensive health system

E. Heins and others

Social Policy and Society, vol. 9, 2010, p. 515-526

UK policy promotes third sector organisations as providers of NHS funded healthcare in a competitive environment. This systematic review of the international research literature investigates the evidence for this policy. It shows that there is no consistent evidence that non-profits perform better than the private sector in either non-universal or universal health systems. In a competitive environment non-profit providers behave much like for-profit providers. The evidence does not support a policy of using non-profits in a switch from an integrated publicly owned and provided system to a provider-based system with market incentives and principles.

Shedding the pounds: obesity management, NICE guidance and bariatric surgery in England

Office of Health Economics, Sept. 2010

This report details the results of an exercise undertaken by the Office of Health Economics (OHE) looking at trends in obesity, current provision of bariatric surgery in England with particular reference to the NICE clinical guideline for obesity, and potential economic benefits that could be achieved through adherence to the NICE guideline.

Tens of thousands are denied new cancer treatments


Daily Telegraph, Sept. 14th 2010, p. 2

A survey of 58 NHS centres providing 89% of the country's radiotherapy treatment for cancer shows that only 9,775 patients out of 41,421 who would have benefited from intensity-modulated radiotherapy actually received it. This treatment is more effective because it homes in on the tumour and does not damage surrounding healthy tissue. Many centres have machines that can deliver the latest treatments but are using them for conventional old fashioned radiotherapy due to lack of trained staff and other issues such as the machine not being equipped with the correct software.

Towards the emancipation of patients: patients' experiences and the patient movement

C. Williamson

Bristol: Policy, 2010

The patient movement works to improve the quality of healthcare. Some of the work entails trying to get standards of care that put patients at institutionalised disadvantage replaced by standards that free (emancipate) patients from that disadvantage. Combining new academic theory with rich empirical evidence, the book explains how looking at healthcare from an emancipatory perspective could improve its quality as patients experience it.

Under doctors' orders

D. Williams

Public Finance, Aug. 13th-Sept. 2nd 2010, p. 16-19

In the 2010 health white paper, the coalition government proposes transferring responsibility for service commissioning from primary care trusts to GP consortia supervised by a new quango, the NHS Commissioning Board. The consortia will be free to commission services from any willing public or private healthcare provider. It is unclear whether the consortia will take on experts made redundant by primary care trusts to commission services, or contract out the work to large private companies. It is estimated that the upheaval will cost the NHS 2-3bn, with no prospect of real savings.

Why many hands make IT work

T. Greenhalgh and T. Bowden

Health Service Journal, Sept. 16th 2010, p. 12-13

This article draws lessons for the NHS IT programme from the much cheaper implementation of electronic patient records in New Zealand. It recommends that:

  1. central government should support but not manage the change
  2. the change model should be revisited
  3. the NHS should stop equated organisational learning with codified knowledge
  4. small scale low risk incremental change should be allowed in parallel with large scale efforts.
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