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Welfare Reform on the Web (January 2011): National Health Service - Reform - General

Delivering the cancer reform strategy

National Audit Office

London: TSO, 2010 (House of Commons papers, session 2010/11; HC 568)

The report indicates that improvements have been made in key areas of cancer care and the efficiency of their delivery since the Cancer Reform Strategy was published in 2007. The NAO estimates that cancer cost the National Health Service (NHS) approximately 6.3 billion in 2008-09, but suggests that it is not clear if the implementation of the Strategy is achieving value for money. Reported spending on cancer care varied between Primary Care Trusts (PCTs) in 2008-09 - from 55 to 154 per head - which is consistent with the unexplained variation in spending from year to year. However, significant reductions have been made in the number of days cancer patients spend in hospital - largely as a result of increasingly treating patients as day cases. The Strategy aimed to minimise emergency admissions for cancer patients, but these are still increasing, with wide variations between PCTs and poor understanding of the reasons for those variations. This report suggests that there are opportunities to achieve better outcomes and free up resources:

  • Reducing the average length of stay in hospital to the level of the best performing PCTs could produce efficiencies worth some 113 million a year.
  • If the number of inpatient admissions per new cancer diagnosis was reduced to the level of the best performing PCT, bed days equivalent to around 106 million each year could be saved.
  • Radiotherapy machines could be used more productively to help the NHS meet increasing demand.

High quality information is essential to be able to commission services successfully and to monitor performance. Some information on cancer has improved, but significant gaps still remain.

Doctors' chief wants to see consultants on call

J. Laurance

The Independent, Dec. 2nd 2010, p. 22

Hospital consultants should work more evenings and week ends to ensure the safety of patients according to the Royal College of Physicians. Evidence of poor care provided by junior doctors out of hours means that consultants' hours have to change, said Richard Thompson, the president of the college.

(See also The Guardian, Dec. 2nd 2010, p. 17)

Give the kids a shot at the title

A. Parsa

Health Service Journal, Dec. 2nd 2010, p. 14-15

Over the past 20 years, the NHS has begun to undergo a transition from the monopoly provider of healthcare to financer and commissioner. In order to achieve value for money, it needs to encourage new innovative providers which can offer innovative solutions and high quality services at competitive prices. In the past, commissioners have selected the cheapest option regardless of quality, leading to massive waste of public money.

How will the reforms be judged?

A. Jones

Health Service Journal, Dec. 9th 2010, p. 16-17

This article looks at the criteria by which the success of the coalition government's health policy reforms could be judged. Success criteria should: 1) be outcomes-based; 2) be partly based on the views and choices of informed consumers; 3) include the emergence of a provider market for public health programmes; and 4) take account of the shift of health policy from the edge to the centre of politics.

Lansley vows to press on with controversial NHS reforms

R. Ramesh

The Guardian, Dec. 16th 2010, p. 16

Andrew Lansley, the health secretary, vowed to push ahead with radical plans to reform the NHS that will hand 80bn of taxpayers' money to GP consortia and offer managers the chance to join private companies in return for making the reforms work. The British Medical Associations (BMA), however, said its concerns had been disregarded, with Hamish Meldrum, the chair of the BMA, claiming that there is little evidence that the government is genuinely prepared to engage with constructive criticism of its plans for the NHS.

Liberating the NHS: legislative framework and next steps

Department of Health

London: TSO, 2010 (Cm7993)

This paper presents key details of the government's plans for NHS reform. The proposals state that the government will set out its requirements and expectations for the NHS in an annual mandate, which could only be changed outside the planning cycle in exceptional circumstances. The NHS chief executive will lead the commissioning board, which will be launched in shadow form in April 2011. The Board will be given extensive powers to subsidise GP commissioning consortia to make sure that they break even. The Board is also likely to run an insurance scheme where poorly performing consortia would be required to pay more into a pooled risk fund than better performers. The fund would be used by the Board to intervene where a consortium was at risk of financial failure. The Commissioning Board will begin to establish consortia from April 2012. Consortia will be statutory bodies, but they will be given significant flexibility to shrink or grow and to collaborate closely. There is no requirement for consortia to be made up of GP practices that are all adjacent to each other. As regards providers, the document confirms that any acute trust that has not attained foundation status by April 2013 will be merged, taken over or have its management franchised. Monitor will be given powers to create a risk pool to fund providers placed in 'special administration'. Where commissioners deem services essential so that they cannot be closed down, any additional subsidies will need to be set according to a transparent 'higher maximum price'. GP consortia would have to consult with local authorities on which services should be deemed essential. Finally, statutory health and well-being boards will be established with members drawn from commissioning consortia, local councillors, and representatives of HealthWatch.

Merger plans announced as FT deadline looms

B. Clover and D. West

Health Service Journal, Dec. 9th 2010, p. 4-5

The Department of Health had set a deadline on November 30th 2010 for acute hospitals to detail their plans to attain foundation status by April 2014. As the deadline approached, some challenged acute trusts began looking at plans for mergers or takeovers to create new organisations more likely to be authorised as foundation trusts.

'Never heard of it': understanding the public's lack of awareness of a new electronic health record

T. Bratan, K. Stramer and T. Greenhaigh

Health Expectations, vol.13, 2010, p. 369-378

The introduction of electronic patient records that are accessible by multiple providers raises security issues and requires informed consent, or at the very least an opportunity to opt out. Introduction of the Summary Care Record (SCR) (a centrally stored electronic summary of a patient's medical record) in pilot sites in the UK was associated with low awareness, despite an intensive public information programme that included leaflets, posters, letters and road shows. This study explored why the public information campaign had limited impact and sought to learn lessons for future programmes.

NHS is close to breaking point as cuts take their toll, say doctors

R. Smith

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

A study by the Royal College of Physicians has concluded that the NHS could soon reach breaking point due to increasing demand, a reduction in doctors' hours under the European Working Time Directive, and financial cuts. Financial pressures could mean training posts for junior doctors being cut, and a drop in the number of places at medical school.

(See also The Guardian, Dec. 9th 2010, p. 22)

NHS is facing 'toughest year in its history'

O. Wright

The Independent, Dec. 29th 2010, p. 17

2011 could be the 'toughest' the NHS has faced in its 62 year history, hospital managers have warned the government. Patient care could suffer and hospitals close unless ministers can successfully manage their ambitious 15-20bn efficiency drive alongside the wholesale re-organisation of the NHS structure.

One junior doctor caring for 400 patients

R. Smith

Daily Telegraph, Dec. 2nd, 2010, p. 14

A Royal College of Physicians survey of 126 hospitals examined working patterns and patient care in acute admissions units. Few hospitals had sufficient cover from consultants specialising in acute medicine to staff these units around the clock. The survey found that: 1) almost three quarters of acute physicians did not work at week-ends and only two-thirds contributed to the on-call rota; 2) almost half of hospitals did not have the recommended three consultants specialising in acute medicine; 3) in just over half of hospitals the on-call consultant had other routine clinics and tasks to complete and did not cancel them in line with guidance; 4) many patients were seen only once a day in a formal ward round in the acute phase of their illness; and 5) nearly three quarters of hospitals had no cover from consultants specialising in acute medicine over the week-end.

Protests by patients and GPs slow health service shake-up

S. Lister and C. Smyth

The Times, Dec. 16th 2010, p. 14-15

Despite being warned that the pace and scale of change risk breaking up the health service, the Government remains committed to a programme that would transform the delivery of healthcare by handing spending powers to GPs and stripping out bureaucracy. Concerns raised have however managed to achieve a slowing down of the pace of change. This article includes useful tables and charts.

Rapid Spread

D. Carlisle (editor)

Health Service Journal, Dec. 9th 2010, Supplement, 12p

Rapid Spread takes the learning from work to reduce healthcare associated infections in the NHS and applies it to other areas in need of improvement. This supplement describes how Rapid Spread was developed, the theory that underpins it, the lessons learned from early tests, and case studies of sites that have applied it.

Risk to patients forces review of EU laws limiting doctors' hours

S. Lister

The Times, Dec. 22nd 2010, p. 19

The European Commission acknowledges that laws limiting working hours need to be changed to address problems that they are causing for sectors such as healthcare.

A risky business: the White Paper and the NHS

J. Gubb

Civitas, 2010

Under plans announced in the 2010 NHS White Paper, primary care trusts will be replaced by GP consortia which will assume responsibility for commissioning services. The report warns that such radical structural change risks distracting managers from the important tasks of driving up productivity and improving patient care. Instead, the government should seek to build on the best of current NHS commissioning, while permitting entrepreneurial GPs to take over in areas where primary care trust led commissioning is failing.

URL: http://www.civitas.org.uk/pdf/Riskybusiness2010.pdf

Sick children face delays or long journeys for ops

D. Campbell

The Guardian, Dec. 16th 2010, p. 16

Sick children who need surgery face delays or long journeys to specialist medical centres because too many of England's hospitals cannot perform operations on them, a study by the Royal College of Surgeons has found.

'A train crash': the NHS verdict on the Coalition's health reform

O. Wright and J. Laurance

The Independent, Dec. 15th 2010, p. 12

Senior figures from across the health service have warned ministers that that the NHS faces a 'train crash' and could 'implode' over the pace of the government's reform plans. Doctors, health economists and a former Conservative health secretary have warned that proposals, including the abolition of primary care trusts and the transfer of the 70bn commissioning budget to GP consortia, go too far, too fast.

Young lives at risk from poor healthcare

C. Smyth

The Times, Dec. 16th 2010, p. 15

More than half of hospitals are failing to provide emergency services and routine operations for children which is putting young lives at risk and 'significant pressure' on the specialized teams who are forced to carry out the routine work. There is no training for the next generation of children's surgeons and many hospitals are unable to anaesthetise children under the age of 5.

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