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

Any future for the non-foundations?

J. Eastaugh and J. Shapiro

Health Service Journal, Nov. 4th 2010, p. 18-19

There is a clear commitment from the coalition government for all hospitals to achieve foundation status by 2013. Many hospitals which have not yet become foundation trusts need to renew outdated buildings. To finance redevelopment, they would in the past have entered into partnerships with the private sector. Unfortunately the foundation trusts regulator Monitor now requires applicants to meet highly restrictive ratios between amount of money borrowed and trusts' assured income, insisting that they show significant financial surpluses despite the long-term financial burdens of a partnership. This article looks at alternative options available for hospital trusts unable to meet Monitor's financial criteria for foundation status.

Cuts will turn back clock on quality of care, says Unison

R. Ramesh

The Guardian, Nov. 8th 2010, p. 13

Staff shortages, recruitment freezes and redundancies will 'turn back the clock on patient care', a survey of 8,000 NHS staff backed by Unison has found, with 59% of respondents reporting reductions in the number of staff employed, 80% reporting increased workload and 77% increased stress over the last 12 months.

Death rate data helps NHS heart surgeons lead way in Europe

S. Boseley

The Guardian, Nov. 25th 2010, p. 13

Heart surgeons in the NHS in England and Wales lead the rest of Europe, with death rates 25% lower than the average and faster recovery rates for patients, a comprehensive audit by the National College of Surgeons has revealed. Experts say the success is attributable to the collection and publication of death rates and outcomes data in the UK.

(See also Daily Telegraph, Nov. 25th 2010, p. 8)

Deaths to be monitored after patients leave hospital

S. Lister

The Times, Nov. 4th 2010, p. 29

Following the Mid Staffordshire NHS Foundation Trust scandal, Ian Dalton, chief executive of NHS North East, chaired a national review of use of hospital mortality data, leading the Government to announce new measures. From April 2011 onwards all deaths that occur in NHS hospitals and up to a month after discharge are to be monitored providing the most comprehensive picture of hospital mortality rates. The new Summary Hospital-level Mortality Indicators (SHMI) will act as a 'smoke alarm' to detect potential problems. The SHMI will also take into account risk profiles of patients and be available to NHS users through the NHS Choices website. A high mortality rate in the SHMI on its own would not be an indicator of low quality of care or poor performance, but should always be a 'trigger to ask hard questions'.

DH speeds up abolition of PCTs and SHAs

D. West and S. Calkin

Health Service Journal, Nov. 11th 2010, p. 4-5

A new timetable for NHS structural reform published by the Department of Health states that primary care trusts will be abolished by April 2013 and strategic health authorities during April 2012. Previous plans had said that primary care trusts would go from April 2013 and strategic health authorities by April 2013. This accelerated timetable has removed flexibility from the government's plans.

Emergency patients let down by targets, say surgeons

R. Smith

Daily Telegraph, Nov. 12th 2010, p. 1 + 2

In a letter to the Daily Telegraph, senior doctors say that they are deeply concerned about the low priority given to Accident and Emergency. Targets related to waiting times and cancelled operations, introduced by Labour, result in managers pushing doctors to operate on elective patients in order to avoid financial penalties. This can mean that patients admitted as emergencies are stabilised and then left to wait for surgery.

Evaluation of international recruitment of health professionals in England

R. Young and others

Journal of Health Services Research and Policy, vol. 15, 2010, p.195-203

In its plan to modernise the NHS in 2000, the New Labour government set ambitious workforce expansion targets. International recruitment was seen by policymakers as the key to meeting those targets until other measures boosting numbers could contribute. This study explored whether the international recruitment drive achieved its objective of boosting workforce numbers and to set this against the wider costs, longer-term challenges and questions arising. Results of a postal survey of NHS organisations and eight case studies showed that the main achievement of the international recruitment drive was that it was seen through without major disruption of NHS services. The wider costs and challenges, however, meant that large-scale international recruitment was not sustainable as a solution to workforce shortages.

Foundation for excellence: an evaluation of the foundation programme

J. Collins

NHS Medical Education England, 2010

This study analysed the two-year foundation programme for junior doctors, which they join after graduating from medical school. The programme, which was introduced in 2005 to give trainees broad experience before specialising, has many strengths, such as being a national, standardised course, but the research found that some trainees are expected to practise outside their level of competence and without appropriate supervision. This places patients at unnecessary risk. Problems are exacerbated by the European Working Time Directive, which limits doctors to a 48-hour week. Trainees are used to fill gaps in duty rosters.

Gaming of performance measurement in health care: parallels with tax compliance

A. Mears and P. Webley

Journal of Health Services Research and Policy, vol.15, 2010, p.236-242

The performance of NHS organisations is measured in a number of ways and the publication of these measures creates an incentive to perform well, be it direct (financial uplift) or indirect (greater market share or increased kudos). Where a measure is linked to an incentive, there will always be a temptation to manipulate either the situation or the data to portray performance as better than it actually is. This 'gaming' behaviour can mask poor practice and may put patients' lives at risk. Research has investigated and categorised this behaviour but has offered little in the way of solutions as the drivers are not well understood. In this article, insights from the study of the psychology of tax avoidance and evasion are used to explore the underlying causes.

Healey will 'get stuck into' broken promises on health

C. Santry

Health Service Journal, Nov. 11th 2010, p. 9

Report of an interview with Labour shadow health secretary John Healey, in which he undertakes to hold the coalition government to account for broken promises on health, without making any alternative constructive suggestions. He is opposed to staff pay freezes, GP commissioning and the 'any willing provider' policy.

Lansley aims to tackle health of vulnerable with better NHS care

D. Campbell

The Guardian, Nov. 30th 2010, p. 16

The coalition government will today pledge to improve the health of vulnerable groups, including the homeless, sex workers and prisoners, by providing them with better NHS care. The health secretary Andrew Lansley will set up a health inclusion board to tackle chronic health problems among marginalised groups. The body will be led by Prof. Steve Field, former chair of the Royal College of GPs.

Listening and learning: the Ombudsman's review of complaint handling by the NHS in England 2009-10

Parliamentary and Health Service Ombudsman

London: TSO, 2010 (House of Commons papers, session 2010/11; HC 482)

People who are not satisfied with the way their complaint has been dealt with by the NHS have the right to bring it to the Health Service Ombudsman. This report covers the first full year of the new complaint handling system for the NHS. The report's scope includes previously unpublished data about the number and type of complaints received by the Ombudsman in 2009-10 for every trust and strategic health authority region in England. It shows how many complaints were received and the outcomes of the complaints investigated. Poor complaint handling can make a difficult situation worse for patients and their families, and create unnecessary demands on NHS resources. In conclusion, NHS needs to listen harder and learn more from patients'complaints.

Millions at risk as hospitals miss out blood clot checks

R. Smith

Daily Telegraph, Nov. 24th 2010, p. 10

Almost all patients admitted to hospital should be assessed to establish if they are at risk of developing a blood clot. However, research by the All-Party Parliamentary Thrombosis Group found that only 14 hospital trusts in England were even close to meeting the guidelines.

New hospital death rates to be published in April

D. West

Health Service Journal, Nov. 4th 2010, p. 4-5 Hospital performance against a new official Summary Hospital-Level Mortality Indicator (SHMI) will be published by the NHS Information Centre and on the NHS Choices website from April 2011. Trust boards, clinicians and commissioners will be expected to take account of the new measure and use it as a warning of possible problems. However, the expert group which created the SHMI has strongly warned against using it to compare hospitals or as a reliable measure of their quality.

NHS tops survey of 11 nations for fair access to healthcare

R. Ramesh

The Guardian, Nov. 19th 2010, p. 12

Britain is the only one of 11 leading industrialised nations where wealth does not determine access to care. The NHS provides the most widely accessible treatments at low cost among rich nations, a survey by the American health think-tank The Commonwealth Fund has found.

'Not quite Jericho, but more doors than there used to be'. Staff views on the impact of 'modernization' on boundaries around adult critical care services in England

M. Durand and others

Journal of Health Services Research and Policy, vol.15, 2010, p. 229-235

In 2000, the Department of Health funded a 35% increase in the number of critical care beds in England and published a strategy to 'modernise' adult critical care by creating a speciality based on severity of illness and level of care required, rather than on a patient's location in a hospital. The strategy had several componentsincluding, the integration of critical care with other acute hospital services through the introduction of outreach teams and NHS trust-wide Critical Care Delivery Groups and the establishment of 29 clinical networks involving all NHS trusts providing critical care; and encouragement of local service improvement projects. These policies aimed to alter the boundaries around critical care and create a comprehensive, seamless service. This study, involving in-depth interviews with a purposive sample of 45 critical care staff, explored staff perceptions of the impact of the changes. Policies to remove boundaries around adult critical care were perceived to have had a dramatic impact on the organisation of the service. Considerable progress was reported towards developing comprehensive critical care services both within and between hospitals.

Our mutual friends: better care or the end of the NHS?

P. Butler

The Guardian, Nov. 19th 2010, p. 21

The Department of Health is yet to complete an evaluation of the 29 employee led organisations that have spun off from the NHS since 2008, but the coalition government is determined to push Labour's idea further and faster. This week Andrew Lansley, the health secretary, has announced a further 32 NHS spin off projects, while the cabinet minister, Francis Maude, unveiled plans to encourage public sector staff to take over the services they provide.

The rising pressure for reform

J. Dixon

Health Service Journal, Nov. 4th 2010, p. 14-15

The NHS is facing the unprecedented challenge of radical reforms to patient care, rising demand and a real-terms reduction in funding from 2011/12-2014/15. In order to achieve the efficiency savings needed to balance its budget, it will need to reduce dependence on hospital care by patients and clinical staff in the community and focus on population health improvement and illness prevention.

Services set free

J. Lepper

Children and Young People Now, Oct. 19th-24th 2010, p. 32-33

The coalition government has given NHS staff in primary care trusts the right to request to leave the health service and set up not-for-profit companies which can bid for NHS contracts. It is keen to see more social enterprises set up by NHS staff to handle contracts. However, there are concerns that these small social enterprises will be unsustainable and will be replaced by large multinationals which can do the work more cheaply.

Short circuit: reprogramming the IT culture of the NHS

L. Whitfield (editor)

Health Service Journal, Nov. 4th 2010, Supplement, 8p

This supplement on IT in the NHS covers: the abandonment of the vision of a national standardised IT system for the NHS, and its replacement by a return to local procurement and modular developments; electronic hospital discharge summaries for GPs; improved presentation of management information based on existing data; and improving the interoperability of IT systems within NHS trusts.

The three Ps in the NHS White Paper: partnership, privatisation and predation: which way will it go and does it matter?

B. Hudson

Journal of Integrated Care, vol.18, Oct. 2010, p. 15-24

This article traces three conflicting themes in the coalition government's NHS white paper. There are proposals around new partnering opportunities that could transform the relationship between the NHS, local government and social care. However, it also envisages a larger role for the private sector and competition among providers, as well as turning over the bulk of the NHS commissioning budget to GPs, who are independent businessmen and not employees. The author suggests that social care is in danger of becoming a handmaiden to healthcare in an increasingly privatised market that could move towards an insurance-based model of funding.

Training and development

A. Moore (editor) Health Service Journal, Nov. 11th 2010, p. 25-31

This special report begins by exploring the negative impact of government funding cuts on NHS staff training and development. Surveys show that staff are now struggling to access the training they need. Other articles discuss:

  1. the new skills that managers will require to take the NHS through a period of radical change
  2. how new roles of assistant or associate practitioner should help to maximise the capacity of clinical staff
  3. recruitment of long-term unemployed people to entry level jobs in the NHS following pre-employment training.

User involvement in health care

T. Greenhalgh, C. Humphrey and F. Woodard (editors)

Chichester: Wiley, 2011

Health organizations are focusing more and more on patients - and requiring their employees to practise patient focused care. This book draws on the collective experience of The Modernisation Initiative of the Guy's and St Thomas' Charity and explores how patients' and carers' involvement may inform and shape quality improvement work. This initiative proved a key catalyst in transforming the quality of care in local kidney, stroke and sexual health services.

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