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

Board will step in if consortia falter

B. Clover and S. Calkin

Health Service Journal, Jan. 20th 2011, p. 4-5

Report of an interview with Sir David Nicholson, newly appointed chief executive of the NHS Commissioning Board, in which he presents his ideas about its relationship with GP Consortia and foundation trusts. He warns that failing consortia could be directly managed by the Board or broken up.

Cameron's reforms ill-thought out and short on detail, say doctors and MPs

S. Lister and S. Coates

The Times, Jan. 18th 2011, p.6

The battle over the Government's plans to reform the NHS continues on the eve of the publication of the Health and Social Care Bill. In a review published today the House of Commons Health Committee warns of the uncertainty that has been created by the 'surprise' change in policy, which transfers the management of most NHS funds to GPs. Over 300 doctors have written to The Times raising further doubts about the 'wholesale re-engineering of the NHS'. They warn that the abolition of the trusts is 'very expensive and totally unnecessary'. David Cameron, however, insists that ministers could not afford to delay essential modernization of Britain's public services.


Health Committee

London: TSO, 2011 (House of Commons papers, session 2010/11; HC513)

Taking previous findings as staring point, the paper looks at how to improve commissioning in the NHS in the most cost-effective way. The report highlights the risks and difficulties of implementing the proposed commissioning reforms at a time when the NHS is trying to achieve savings of four percent a year, for each of the next four years. According to the MPs, the proposed reforms fail to plan for the consequences of such dramatic changes in the way commissioning in the NHS is achieved. Furthermore, the report by the Health Committee also draws attention to the potential conflict between two principles: patient choice and the prerogative of GPs to identify priorities according to the availability of funds. The Committee also asked the Government to clarify to what extent private companies might be able to take legal action against GPs, should they feel the commissioning process was unfair to them. Finally, the Committee believes that, although GPs' involvement is a desirable outcome, it cannot be just the GPs; GPs ought to act as a catalyst for the involvement of the wider community.

Developing an innovation ecosystem: a framework for accelerating knowledge transfer

S. Hamer

Journal of Management and Marketing in Healthcare, vol. 3, 2010, p. 248-255

NHS organisations are being expected to change rapidly in response to external pressures, including a global recession, high levels of government debt, and changes in public expectations. There is a temptation to look for externally promoted solutions rather than making better use of existing organisational talent, avoiding disruptive change programmes and encouraging cross-organisational networks. This paper describes the development and subsequent use of a knowledge transfer framework which can enable decision-makers to take a systems approach to innovation development and adoption.

Feeling better? Improving patient experience in hospital

NHS Confederation


Report argues that hospital trusts should not neglect efforts to improve the patient experience as this can lead to savings and also improve quality. Well informed patients who feel they are listened to and are comfortable in their surroundings are less likely to develop complications or be readmitted. Unfortunately patient experience has been consistently relegated by trust boards which have focused instead on areas such as delivering efficient systems.


Fighting for life: IVF regulator aims to show its worth

A. Gentleman

The Guardian, Jan. 11th 2011, p. 12-13

Amelia Gentleman reports from her visit to the Human Fertilisation and Embryology Authority, one of the 192 quangos listed for abolition, and finds staff bemused but dedicated to continuing its work.

GP commissioning spells end of NHS, warns Lancet

D. Campbell

The Guardian, Jan. 28th 2011, p. 20

The government's health shake-up 'spells the end of the NHS' the Lancet warns today in a scathing critique of proposed reforms of the service in England. Its editorial adds that letting GPs commission 80bn of health care for patients from 2013 will lead to a 'catastrophic break-up of the NHS'.

Health and Social Care Bill

London: TSO, 2011 (Bill 132, session 2010/11)

The Bill includes proposals to: 1) bring commissioning closer to patients by giving responsibility to GP consortia; 2) increase accountability to patients and the public by establishing Healthwatch and local health and well-being boards within councils; 3) improve public health by creating Public Health England; 4) reduce bureaucracy by streamlining arms-length bodies; and 5) liberate the NHS from political micromanagement by supporting all NHS trusts to become foundation trusts and establishing independent regulation.

(For comment see Health Service Journal, Jan. 27th 2011, p. 4-9)

Horizontal and vertical integration in the UK: lessons from history

B. Rumbold and S.E. Shaw

Journal of Integrated Care, vol. 18, Dec. 2010, p. 45-52

This article reviews historical (published and grey) literature over the past 100 years, considering both the drivers for, and impediments to, various UK policy initiatives aimed at integrating health and social care. It aims to shed light on how the policy of integrated care has developed in the UK, and draw out lessons for modern policymakers.

How do quality accounts measure up?

C. Foot and others

King's Fund, 2011

In June 2010, all acute and mental health NHS trusts published their first set of quality accounts describing their services during 2009/10. This report analysed accounts from 64 trusts and found that they were extremely varied in the number and choice of measures, statistical rigour, and format and quality of presentation. Coupled with lack of benchmarking information, this means that it is not practically possible to differentiate quality of care between providers on the basis of quality accounts. The variation is attributed to the fact that the aims of quality accounts and their intended audience are too vague.


If cuts are dropped cash chaos will be instant, warns Chancellor

A. Asthana

The Times, Jan. 31st 2011, p.7

The Health and Social Care Bill has its second reading in Parliament. The Prime Minister claims that the debate around the plans has been littered with 'myths'. He says that failure to implement his Government's controversial health reforms will leave the NHS 'heading for crisis'.

Improving outcomes: a strategy for cancer

Department of Health


Under plans to improve cancer survival rates in England, the government will give GPs powers to order a range of cancer tests direct from hospitals, without having to refer the patient to a consultant first. This should speed up diagnosis. A 10m awareness programme will be launched to encourage people to visit their doctor as soon as they develop symptoms, and funding will be provided for 1,200 extra cancer specialists and new screening technologies to improve detection. The strategy also pledges 50m funding for additional cancer drugs, the expansion of radiotherapy services, and the introduction of a new bowel cancer screening technology. However, cancer networks will lose guaranteed funding and the government will rely on investment from charities to provide its promised one-to-one care by nurse specialists as no ring-fenced funding is being offered. The strategy also confirms that the government will keep all the existing cancer waiting time targets.


In search of a new leadership currency

O. Ojo

British Journal of Healthcare Management, vol. 16, 2010, p. 563-568

The radical proposals contained in the coalition government's 2010 healthcare white paper are the most significant shift in the tectonic plates of NHS top down management structures ever to be contemplated. Some of the government's intentions for health and social care delivery have transformative consequences for managerial and clinical leadership requirements. This article reviews relevant leadership literature with a view to exploring what existing leadership models tell us and how they can inform the strategic leadership thinking required to deliver the government's ambitions.

Lansley accused of secrecy over NHS plan

D. Campbell

The Guardian, Jan. 14th 2011, p. 19

Labour has accused health secretary Andrew Lansley of 'disgraceful secrecy' for refusing to reveal risks that his officials believe the NHS shake-up poses for the health service. The Department of Health, having identified things that could go wrong as a result of the radical restructuring of the NHS in England, rejected the opposition's request for details to be released under the Freedom of Information Act, arguing such disclosure would impede ministers.

Lansley unveils his health bill as chorus of concerns grows

R. Ramesh

The Guardian, Jan. 20th 2011, p. 12

The Health and Social Care Bill will abolish all of England's 152 Primary Care Trusts (PCTs), cutting more than 24,000 managerial staff, transferring spending powers to commission health services from public and private providers to GP consortia and allowing hospitals to chase private patients if the money is demonstrably ploughed back into the health service. The cost of implementing the changes is estimated to be 1.4bn, with projected savings to the NHS of 5bn by 2014 and 1.7bn every year thereafter. Dr Clare Gerada, chair of the Royal College of General Practitioners, expressed concerns that the 'any willing provider' measure allowed taxpayers' cash to be used to pay for private companies, competing to provide services at NHS prices. The shadow health secretary John Healey attacked the plans saying the government was pushing ahead with reforms despite warnings from health experts, professional bodies and patients' groups. The reforms will also see the abolition of the ten Strategic Health Authorities and make it easier for hospitals to merge or take over another nearby. The health secretary shied away from capping the amount of money GPs can earn. With one in eight family doctors already earning more than 150,000, there are worries that they will be paid even more to manage the NHS.

Leading medics challenge GPs to fight reform

D. Campbell

The Guardian, Jan. 6th 2011, p. 14

Doctors' leaders are facing a challenge from senior medics who claim they have accepted the government's NHS shake-up and should instead mobilise to thwart it. More than 100 doctors, including 20 professors, have signed an open letter in the British Medical Journal criticising the leadership of the British Medical Association, the doctors' union.

A liberated NHS: but will it lead health and social care together or force them apart?

R. Miller and others

Journal of Integrated Care, vol. 18, Dec. 2010, p.41-44

The new Coalition government has promised a substantial scaling back of centrally driven policy and target setting. Instead, it expects local communities to find and develop their own solutions for health and social care. This new approach may provide a unique opportunity for greater integration, but the lack of co-ordination and strategic direction may also lead to fragmentation and single-agency responses. This article identifies four key elements in health and social care leadership that will be crucial to ensure that greater freedom leads to better integration.

A 'Liberated' NHS: intentions, impact and implications for local government

R. Jones

Journal of Integrated Care, vol. 18, Dec. 2010, p. 35-40

This article looks at the implications of the NHS restructuring proposed by the Coalition government in the 2010 White Paper for local government. The reforms will lead to a fragmentation of the NHS, with a plethora of GP commissioning consortia replacing primary care trusts and proliferation of service providers, and transfer of responsibility for public health to local authorities. It is concluded that, despite this increased fragmentation, there are new opportunities for local government to act as a positive partner for the NHS.

Liberating the NHS: legislative framework and next steps

Department of Health

London: TSO, 2010 (Cm 7993)

This paper sets out how the Government will legislate for and implement its reforms set out in the White Paper 'Equity and Excellence: Liberating the NHS'', drawing on the insights and experience contributed by those who responded to the consultation. It presents how the White Paper's reform programme will be taken forward to completion, answering questions and setting the framework for reform. It sets out further policy development based on substantial feedback and reaffirms the government's strong commitment to the reforms. The response to the consultation demonstrated support for the principles set out in the White Paper. The feedback has been carefully considered and the Government has decided on changes including:

  • commissioning of maternity services will now sit with GP consortia;
  • councils' formal scrutiny powers will be extended to cover all NHS-funded services;
  • local authorities will have greater freedom in how these are exercised

Management of NHS hospital productivity

National Audit Office

London: TSO, 2010 (House of Commons papers, session 2010/11; HC491)

Hospital productivity has fallen over the last ten years despite significant increases in hospital funding which were intended to deliver improvements in patient care, and were designed in part to increase productivity. Hospitals have used their increased resources to deliver against national priorities, but they need to provide more leadership, management and clinical engagement to optimise the use of additional resources and deliver value for money. The NHS announced in 2009 that, in response to the economic downturn and increasing demand for healthcare, it would need to deliver between 15 billion and 20 billion of efficiency savings by 2013-14. Around 40 per cent of these savings are expected to come from increasing efficiency in hospitals. Recent research indicates that the scale of these savings will require productivity gains of approximately six per cent per annum. The 'Payment by Results' system of setting national tariffs has promoted some efficient practice, such as reductions in the length of time patients spend in hospital and more operations taking place as day cases. If all hospitals performed at the level of the top 25 per cent in respect of staff costs, use of estate, control of emergency admissions and bed management, the NAO estimates that the NHS could save around 1.6 billion a year.

Milliband condemns 'arrogant' Cameron for railroading plans

O. Wright

The Independent, Jan. 20th 2011, p. 5

Labour's leader Ed Milliband has accused David Cameron of arrogance for pushing ahead with NHS reforms, despite opposition from health experts and NHS staff. At PMQs, Mr Milliband asked for guarantees that waiting times would not increase; the PM didn't offer them. The author of the article reports Dr Hamish Meldrum, chairman of the British Medical Association, as saying that the plans are risky.

National Health Service landscape review

National Audit Office

London: TSO, 2011 (House of Commons papers, session 2010/11; HC708)

This report summarises the key changes proposed in the White Paper on the reform of the National Health Service, although, given that they are at an early stage, it does not attempt to evaluate them or to draw conclusions on value for money. Translating the aspirations of the White Paper and the Bill into reality will involve a highly complex programme of linked activities, many of which are interdependent. Some pilot schemes, such as GP commissioning consortia 'pathfinders' are being introduced, but the detail of other aspects of the reform programme is yet to be determined. The full reforms will take several years to implement.


New drugs for sufferers in early stages of Alzheimer's

R. Smith

Daily Telegraph, Jan. 18th 2011, p. 2

New draft guidance from the National Institute for Health and Clinical Excellence extends the use of three drugs currently restricted to patients with moderate to severe symptoms to those in the early stages of the disease to slow its progress. This new draft guidance overturns a decision made in 2007 to restrict the drugs because of uncertainty over their cost effectiveness. New research has shown that the drugs work in patients with mild symptoms and offer a large enough benefit to justify the cost of 2.80 per patient per day.

NHS plans will penalise the poor, says BMA doctor

R. Ramesh

The Guardian, Jan 25th 2011, p, 12

Laurence Buckman, chair of the British Medical Association (BMA) GPs' Committee, has warned that the proposals for reform of the NHS will see the poor, elderly, infirm or terminally ill in large parts of the country lose out to richer patients who can 'shop around' and 'demand' the right to see a doctor.

NHS shake-up could set patients against GPs, warns report

D. Campbell

The Guardian, Jan. 19th 2011, p. 4

A report by the health think tank Nuffield Trust has raised concerns over potential tensions emerging in family doctors' relationships with patients once GP led consortia have been handed over 80bn to spend on treatment from 2013. The study states: 'in the case of GPs commissioning, the question of how incentives should be used has not been resolved.' The possibility of re-directing savings from efficient care to GPs' private incomes could be unacceptable for the public. Limiting the number of people sent to hospital for investigation or treatment could lead patients to ask whether they are denied treatment to earn doctors money.

NHS shake-up will damage cancer care, say charities

D. Campbell

The Guardian, Jan. 13th 2011, p. 4

Cancer charities have warned that patients could die earlier because of the government's NHS shake-up will lead to the disbandment of teams of experts who advise doctors in hospitals on how to improve care. Key staff at some of the 28 cancer networks across the UK have already been told that their jobs are at risk because of the government's re-organisation of the health service which will see the abolition of the primary care trusts in 2013.

NHS told to end culture of overprescribing

J. Laurance

The Independent, Jan. 4th 2011, p. 11

NHS patients are being prescribed too many drugs with detrimental effects on their health and the loss of millions of pounds from the health budget according to Professor Sir Alasdair Breckenridge, the chair of the Medicines and Healthcare Products Regulatory Agency.

Reforms to NHS 'run risk of disaster'

S. Lister and R. Watson

The Times, Jan. 17th 2011, p.1, 12

Six health unions including the British Medical Association and the Royal College of Nursing are extremely concerned about plans to create greater commercial competition within the health service. They warn that radical reforms to the NHS are 'potentially disastrous' and run unnecessary risks. They are fearful of the speed and scale of the reforms believing that the proposal to introduce price competition between the NHS and private companies risks undermining the care of patients by putting cost before quality

Seven in ten health managers will just shift jobs after shake up

M. Beckford

Daily Telegraph, Jan. 20th 2011, p. 14

Impact assessments published alongside the Health and Social Care Bill show that up to 70% of managerial staff in primary care trusts and strategic health authorities will move to jobs in the new GP consortia. This contradicts earlier claims by ministers that the reform would cut administrative costs as control of health commissioning budgets transferred to GPs. In effect, GP consortia will be primary care trusts under a different name. The impact assessments also warn that patient care could be put at risk by the scale of the reforms.

What does Cameron's 'massive gamble' with the NHS mean for us?

O. Wright

The Independent, Jan. 20th 2011, p. 4

Oliver Wright reports on the reform of the NHS, describing it as 'the most radical pro-market shake-up in its history.' Wright details the reform and opines that it is being implemented partly to save money, and partly for ideological reasons. The reform will eliminate middle management and give patients choice. The article points out that the biggest changes will be the suppression of the Strategic Health Authorities and of Primary Care Trusts, in a shift that will see the formation of consortiums of GPs which will acquire commissioning powers. All hospitals will become independent from Whitehall and become Foundation Trusts. They will run their own affairs but, if they lose money, they will be allowed to fail and be taken over. Private companies will be able to compete for NHS patients and could even take over NHS hospitals. The article reports criticism of the reform coming from different quarters. For the medical profession, the problem is mainly about timing and about the danger of abolishing the bodies that control spending. For the TUC, the reform breaks the Government's promise not to enact top-down reforms and to respect the founding principles of the NHS. For Unison, the Bill will only benefit private health companies.

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