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Welfare Reform on the Web (August 2000): National Heath Service - Reform - General

ACTION TEAMS TO UNVEIL FIRST IDEAS

D. Carlisle

Health Service Journal, vol.110, June 15th 2000, p.4

Potentially radical ideas for NHS reform under discussion by the governments action teams include: supernumerary status for junior doctors; a single registration body for all health professions, the development of multi-skilled health workers and joint training for all NHS staff; further development of NHS Direct so that it becomes the gateway to the NHS; new elective centres to carry out planned operations; an increased role for primary care services; merging local authority community plans with health improvement programmes; and performance assessment frameworks for all NHS staff and new incentive schemes to replace salary-based schemes.

AFTER MATRON, THERE'S AN NHS TO SAVE

M. Marrin

Daily Telegraph, June 2nd 2000, p.28

Proposes a series of measures for NHS reform, including; 1) introduction of mixed public-private funding for healthcare; 2) making more use of private sector facilities for NHS patients; 3) abolition of health authorities; 4) reinstatement of tax relief on private health insurance for older people; and 5) introduction of charges for GP visits.

BACK-TO-WORK BASIS

C. Grout

Health Service Journal, vol.110, June 15th 2000, p.32-33

A recruitment and retention group covering all trusts in Oxfordshire has identified opportunities for flexible working as the most important issue for staff considering a return to practice. The group's activities have included roadshows, the setting up of a telephone helpline and refresher courses. More than 300 potential returners and new recruits have been identified.

BARK VERSUS BITE

S. Ward

Health Service Journal, vol.110, June 22nd 2000, p.18

The Commission for Health Improvement has offered reassurances that its aim is to improve the quality of patient care in partnership with the NHS rather than simply to "name and shame" incompetent medical staff.

BLAIR ACTS TO ABOLISH NHS WAITING LISTS

P. Toynbee and D. Brindle

Guardian, May 31st 2000, p.1

Reports a possible revoluntionary strategy to abolish NHS waiting lists. This would involve the creation of elective surgery centres dealing with routine operations such as hip and knee replacements. These would operate round the clock seven days a week and would employ nurse anesthetists, operating assistants, etc.

(See also Guardian, May 31st 2000, p.22).

BLAIR GETS TOUGH WITH DOCTORS

L. Ward

Guardian, June 5th 2000, p.1

Reports ideas for NHS reform currently under discussion by the government. These include curbing the power of consultants, ending professional self-regulation, and creation of a new class of specialist geriatric nurses.

(See also Daily Telegraph, June 5th 2000, p.9; Daily Telegraph, June 6th 2000, p.15; Financial Times, June 6th 2000, p.2).

THE COMMONS TOUCH

K. McIntosh

Health Service Journal, vol.110, May 25th 2000, p.14-15

Reports on the progress of staff consultation on NHS reform in advance of the publication of the new national plan in July 2000.

CONFIDENT ABOUT EFFICIENCY MEASUREMENT IN THE NHS?

A. Street

Health Care UK, Spring 2000, p.47-52

The new performance indicators for the NHS published as part of the Performance Assessment Framework include a set of cost indices that attempt to shed light on the cost of service provision. Article begins by describing these indices. This is followed by a discussion of whether it is possible to interpret these indices as indicating poor performance. It is concluded that we cannot be confident that the indices have successfully identified differences in efficiency.

CONSUMING PASSIONS

J. Rogers

Health Service Journal, vol.110, 2000 p.31

Calls for a revolution to turn the NHS into a customer service orientated organisation.

CURING THE NHS

P. Lilley

Guardian, June 19th 2000, p.18

The article gives details of the authors' alternative blueprint for NHS reform and in particular giving the individuals the right to choose their hospital and consultant. To achieve genuine patients' choice P Lilley proposes: 1) restoring GP's right to refer patients to the hospital of their choice; 2) making information on waiting times, success rates, etc. for every hospital available on the internet and in doctors' surgeries; 3) making taxpayers' money follow the patient simply and speedily.

THE DEVIL IS IN THE DETAIL

J. Davies

Health Service Journal, vol.110, June 1st 2000, p.18-21

Workforce planning in the NHS has always lacked cohesion and been dominated by sectional interests. Government proposals for reform require an integrated approach guided by NHS managers at local, regional and national level.

DOCTORS CONDEMN 'DOGMA-DRIVEN' NHS INITIATIVES

J. Laurance

Independent, June 27th 2000, p.10

Doctors at the British Medical Association annual conference have condemned as populist reforms such the expansion of NHS Direct and the establishment of "assessment and support centres" for under-performing medics. They call for money to be spent instead on improving care services.

(See also Guardian, June 27th 2000, p.9; Financial Times, June 27th 2000, p.2).

DOCTORS' PRIVATE WORK HITS NHS WAITING LISTS

L. Ward

Guardian, June 8th 2000, p.7

More than 75% of hospital trust chief executives believe there is a conflict of interest when NHS consultants also work in the private sector. About 40% say that consultants' private work leads to longer waiting lists for operations. They also acknowledge that the mechanisms for checking that consultants meet their contractual commitments to the NHS do not work. The government should introduce a new contract setting out the specific obligations that consultants have to the NHS and stating the maximum number of hours consultants may work beyond their NHS commitments.

DOCTORS SNUB BLAIR 'BIG IDEA'

D. Brindle

Guardian, June 1st 2000, p.1

Reports that NHS consultants are likely to reject government plans for the introduction of flexible working patterns and for the breakdown of lines of demarcation between medical professions that are central to its goal of cutting waiting times.

(Times, June 2nd 2000, p.7; Financial Times, June 2nd 2000, p.5).

'EXPLOITED' DOCTORS WIN HOSPITAL PAY DEAL

T. Womersley

Daily Telegraph, May 26th 2000, p.13

Under the newly agreed deal, Britain's junior hospital doctors will be put into pay bands according to their actual post, reflecting the length and intensity of the hours they work. Hospital trusts will therefore have an incentive to reduce the hours of the most overworked doctors.

(See also Times, May 26th 2000, p.9; Independent, May 26th 2000, p.13)

FEARS OVER CENTRES TO CUT WAITING LISTS

C. Hall

Daily Telegraph, June 1st 2000, p.4

Questions the viability of dedicated elective surgery centres on the grounds of lack of appropriately qualified specialists to staff them and likely inability to cope with comorbidity and complications.

GETTING BACK ON ITS FEET

L. Eaton

Health Service Journal, vol.110, June 1st 2000, p.7-8

Ideas being debated by Tony Blair's modernisation action team looking at performance in the NHS include: use of care pathways as a measurement tool; tightening up on consultants' contracts so that they spend less time on private work; giving Health Authorities power to suspend GPs; and introducing imaginative new incentive schemes for staff.

HEADING FOR A CHANGE

P. Butler

Health Service Journal, vol.110, June 22nd 2000, p.13-14

Reports reaction to the NHS Confederation's proposals for modernising the NHS workforce. These include transferring more of doctors' work to nurse practitioners, creation of a new grade of "assistants" to provide a range of support services, redesigning of the consultant role, with more career stages between newly qualified and senior consultant, and the replacement of the current system of merit awards for consultants with more accountable incentive payments.

HEALTH CARE IN UK RANKED 18TH IN WORLD

D. Derbyshire

Daily Telegraph, June 21st 2000, p.14

According to the league tables published by World Health Organisation, Britain's health system has been ranked 18th in the world. The tables are based on five indicators: overall level of health, the distribution of health, responsiveness to patients' needs, fairness of financial contribution and distribution of health services, to give an overall picture of health performance. The UK emerges as a middle ranking country spending relatively little on health but spreading the costs and benefits equitably among the population.

(See also Times, June 21st 2000, p.8; Independent June 21st 2000; p.1; Guardian, June 21st 2000, p.3).

HOW TO FIX THE CONSULTANTS: GIVE THEM ALL A SOCKING RISE

P. Toynbee

Guardian, June 7th 2000, p.20

Proposes giving all NHS consultants a large salary increase of £20,000 - £30,000 provided that they give up their private patients. This would remove the consultants' perverse incentive to keep their waiting lists long in order to fuel demand for their private practice.

INVOLVING THE PUBLIC: IT'S NOT JUST FOR CHRISTMAS

A. Bell

British Journal of Health Care Management, vol.6, 2000, p.272-273

Looks at the public consultation exercise on the future of the NHS which took place in May/June 2000, and considers what its results could actually mean.

IT'S THE NHS, STUPID

P. Gosling

Public Finance, June 2nd-8th 2000, p.16-18

Summarises the views of a range of think tanks on greater use of the private sector in delivering health care in the UK.

LEAK REVEALS DRIVE TO CUT NHS WAITING

J. Carvel

Guardian, June 23rd 2000, p.1 and 2

Targets for a drastic shrinking of hospital waiting times have been drawn up by government action team preparing for a radical review of the NHS. They include a maximum of two weeks for cancer patients to get an outpatient appointment, four hours for a patient in an accident and emergency department to be admitted or discharged; and one minute for responses to calls to the 999 emergency number or NHS Direct.

MILBURN CALLS IN 'PATIENT POWER' TO HELP MODERNISE NHS

J Carvel

Guardian, July 4th 2000, p.11

Government plans to give patients' representatives a third of the seats on the "modernisation board" that will oversee NHS reform. Another third will be allocated to representatives of NHS staff and the final third to the managers of the best hospitals.

(See also Independent, July 4th 2000, p.7).

MILBURN LINES UP PRIVATE OPERATIONS TO CUT NHS LISTS

J. Carvel

Guardian, June 16th 2000, p.12

The government is negotiating a concordat with the Independent Healthcare Association for the NHS in England to rent operating theatres and beds to cut waiting lists. The intention is to expand the throughput of the NHS by using existing private capacity. The NHS will provide its own surgeons, anaesthetists and theatre assistants to carry out treatment. The concordat will cover elective surgery, critical care and intermediary care, but will exclude accident and emergency services.

(See also Daily Telegraph, June 15th 2000, p.1; Financial Times, June 16th 2000, p.4).

MILBURN OFFERS 'EARNED AUTONOMY' TO BEST HOSPITALS

R. Watson and J. Sherman

Times, May 31st 2000, p.14

Hospital trusts and primary care groups/trusts that succeed in meeting government performance targets will be subject to less external monitoring and direction. On the other hand, outside managers and clinicians will be brought in to raise standards among poor performers.

MILBURN PRIVATE PRACTICE WARNING

N. Timmins

Financial Times, May 19th 2000, p.3

In the war on NHS waiting lists, hospital consultants may face tighter controls on their private work. The lure of lucrative private work could provide a perverse incentive to keep waiting lists long.

(See also Financial Times, May 22nd 2000, p.31; Times, May 22nd 2000, p.4).

MILBURN SIDELINES PRIVATE SECTOR IN NHS PLAN

R. Bennett

Financial Times, June 28th 2000, p.4

The Health Secretary has indicated that there is only a minor role for the private sector in his national plan for the reform of the NHS, and no room for medical insurance.

MILBURN TO APPOINT SOLE CHIEF FOR HEALTH ROLES

N. Timmins

Financial Times, June 8th 2000, p.2

In an attempt to break down the barriers between health and social care, the Health Secretary is planning to appoint one person as both Chief Executive of the National Health Service and the Permanent Secretary at the Department of Health.

(See also Times, June 9th 2000, p.9; Guardian, June 9th 2000, p.13).

NEW LIB-LAB PACT OVER NHS REFORM

P. Webster

Times, July 5th 2000, p.1

Labour has secured Liberal Democrat support for its NHS reform plans. Both parties will co-operate to oppose Conservative plans to allow taxpayer funding of private health insurance schemes.

(See also Guardian, July 5th 2000, p.4)

NHS CAN MANAGE ON ITS OWN

D. Hunter

Health Service Journal, vol.110, May 25th 2000, p.18-19

Argues that reform of the NHS based on a welter of centrally imposed targets and performance measures is unlikely to succeed. These will be resisted by staff if they run counter to professional values. Lasting reform may be better achieved if local initiatives are allowed to develop that respect the culture of professional groups such as doctors, nurses and managers.

NHS CHIEF EXECUTIVE SAYS CENTRALISATION IS DETERRING LOCAL INITIATIVE

J. Carvel

Guardian, June 29th 2000, p.7

The outgoing Chief Executive of the NHS has warned government that the drift towards excessive centralisation of the health service was in danger of squeezing out the local initiative essential for meeting patients' needs.

(See also Financial Times, June 29th 2000, p.6).

NHS CHIEF EXECUTIVES QUIT IN PROTEST AT 'CONTROL FREAKERY'

J. Laurance

Independent, May 30th 2000, p.1 and 6

Reports the NHS to be in danger of losing its top managers, who are being put under enormous pressure to deliver improvements while being subjected to rigid central control by government. This lethal combination is causing great frustration and leading to a haemorrhage of senior managers.

NHS CONTROLS ASSURANCE AND RISK MANAGEMENT

B. Gibbs

British Journal of Health Care Management, vol.6, 2000, p.253-256

The need for all NHS trusts and health authorities to manage risk as part of their governance, risk management and health and safety responsibilities led to the promulgation of new regulations last year. Article presents a case study of the experience of Bassetlaw NHS trust in implementing the new system.

NHS STAFF ANGERED BY 'TOKEN' SURVEY

H. Rumbelow

Times, May 30th 2000, p.10

Reports that the short time the government has allowed for staff and the public to respond to its consultation on the future of the NHS has provoked cynicism. 13 million forms were sent out during the week beginning May 29th, and had to be returned by June 6th. The rushed timescale created the impression that the government had no intention of acting on the results.

(See also Independent, June 1st 2000, p.2).

NHS SURVEY SHOWS STAFF AND PUBLIC SPLIT

A. McSmith

Daily Telegraph, June 16th 2000, p.6

Results of the government's consultation exercise on NHS reform show that the public want more and better paid doctors and nurses, shorter waiting times, an end to mixed sex wards and more local hospitals. Staff want pay rises for non-nursing staff, better training and improvements in non-acute services such as community care.

(See also Independent, June 16th 2000, p.2).

NHS TOLD TO WORK WITH PRIVATE SECTOR TO AVOID CRISIS

N. Timmins and J. Kelly

Financial Times, May 26th 2000, p.1

New guidance from the Department of Health requires health authorities and trusts to involve the private sector in planning for emergency and elective care and to enter into partnership agreements with independent healthcare providers where these offer value for money.

NO KIDDING

S. Smalley

Health Service Journal, vol.110, June 22nd 2000, p.24-25

A survey of district general hospitals in the North West region shows a considerable reduction in paediatric activity over the past seven years. This raises training and staffing issues as doctors in these hospitals will not be exposed to a variety of childhood conditions. At the same time, referrals to specialist centres have increased. There needs to be a public debate about the range of children's services to be provided locally.

NO TWO WAYS ABOUT IT

A. Towse

Health Service Journal, vol.110, June 22nd 2000, p.29

Argues that the government must balance improvement in the quality of treatment with the need to create a consumer-responsive public service in allocating funds for NHS modernisation.

NURSES FIGHT GPs TO BE THE FIRST IN LINE

J. Sherman

Times, June 28th 2000, p.10

GPs regard the NHS Direct telephone helpline as a waste of money and a threat to their role as NHS gatekeepers. Nurses, however, regard the service as complimentary and it is popular with the public.

ONCE BITTEN .....

L. Eaton

Health Service Journal, vol.110, June 15th 2000, p.15-16

The action team developing plans for the modernisation of health promotion is looking at the impact of transport, the environment and housing. Proposals under consideration include a separate community development fund for local health improvement initiatives and free nicotine patches to help smokers give up.

PERFORMANCE INDICATORS: MAKING INFORMATION OUT OF DATA

C. Deeming

Health Care UK, Spring 2000, p.33-41

If the NHS performance indicators are to be of use, they must be presented in a context that will allow comparisons to be made. There are a number of options for the analysis and presentation of the NHS performance indicator data, including: targets, time series, rank order, cross-section, national average and international performance. If the latest attempt to use performance indicators is not to fail, the information needs to be packaged and made available in a number of ways, making full use of the full range of reference points.

PERFORMANCE MEASURES: THE PUBLIC'S CHOICE

J. Appleby and J.A. Mulligan

Health Care UK, Spring 2000, p.59-63

Where resources are scarce, investing in improving performance in one area will mean that other areas will suffer. Using scarce resources to reduce deaths in hospital means not using them to, say, reduce waiting times for first out-patient appointments. Article proposes finding out from the public what weight or value they would attach to each performance indicator. How important is it for the NHS, say, to reduce waiting times compared to reducing deaths from cancer. The weights so elicited would then be applied to the performance data for all health authorities, so that the different indicators could be added together to produce a composite indicator for each.

POWER STEERING

P. Butler

Health Service Journal, vol.110, June 29th 2000, p.14-15

The government's NHS modernisation teams looking at access and patient empowerment is investigating issues such as complaint-handling, patient-held medical records and staff communication skills.

PRIORITY SETTING AND THE PUBLIC

P. Mullen and P. Spurgeon

Abingdon: Radcliffe Medical Press, 2000

The book explores the reasons for the current pressure to set priorities in healthcare. It also focuses on the involvement of the public in decisions about healthcare provision. It examines techniques and approaches used in priority setting, drawing on work both inside and outside the health sector. A wide number of methods from a range of disciplines are described, reviewed and guidance is given on factors to consider for selection.

PRIVATE HEALTH CARE: TOUGH CHOICES AHEAD

J. Keen

Health Care UK, Spring 2000, p.27-29

The private sector competes with the NHS and cannot expand without stripping it of staff, resources and patients. Attempting to increase the use of the private sector is likely to exacerbate NHS staff shortages. Investing in the NHS could reduce demand for private care, undermining the government's pledge to increase total UK healthcare spending to the European average.

REFORMING MARKETS IN HEALTHCARE: AN ECONOMIC PERSPECTIVE

P.C. Smith (editor)

Buckingham: Open University Press, 2000

Book comprises a series of commentaries on NHS reforms introduced by the Labour government. It covers reform of primary care, performance indicators and the performance framework, clinical governance, contractual relationships, clinical practice guidelines and locally-based resource allocation.

REMOTE CONTROL

R. Elkeles and R. Thompson

Health Service Journal, vol.110, 2000, p.28-29

The current system of medical manpower planning fails to balance doctors' training requirements with the demands of the NHS. Specialist registrars regularly have to leave their hospitals for training sessions, forcing the cancellation of sessional work. Hospital medicine is heavily reliant on locums and doctors from abroad. Consultants need more junior support to provide a proper service. This could possibly be achieved by increasing the time spent at senior house officer level.

REVOLUTION IN THE NHS

J. Wilson and J. Hartley-Brewer

Guardian, June 1st 2000, p.4 and 5

Focuses on the way that consultants work and on ideas for the elimination of waiting lists. It is alleged that the way consultants are contracted to the NHS means that many spend more time on their private practices than on their public service commitments while still drawing a fat NHS salary. Ideas for cutting waiting times include introduction of dedicated elective surgery centres, breakdown of demarcation between NHS staff, better management of chronic conditions, better demand management and internal efficiency measures.

(See also Financial Times, June 1st 2000, p.6).

TORY'S PLEDGE TAX RELIEF ON FIRMS' MEDICAL COVER

A. Sparrow

Daily Telegraph, June 26th 2000, p.4

At present company medical insurance is taxed as a "benefit in kind" raising £100 million paid by employers in the form of National Insurance Contributions and £400 million paid by employees in tax. In order to encourage this kind of insurance, the Tories want to remove the charge to employers and halve the tax on employees.

WE WANT HEALTH QUALITY, NOT EQUALITY

J. Daley

Daily Telegraph, June 27th 2000, p.26

Argues that the NHS is an experiment in social engineering aimed at ensuring equal access to treatment rather than promoting quality or responsiveness to clinical need. This means that rationing is endemic in the system and that expensive new treatments have to be made available to all, or none.

THE WRONG MEDICINE

P. Toynbee

Guardian, June 16th 2000, p.23

Argues against the proposed concordat between the NHS and the private sector. There is a danger that the NHS will become so dependent on the private sector that it will lose control of costs. Independent hospitals, if put in a monopoly position, will be able to vastly increase their charges for doing NHS work.

YESTERDAY'S COSMETIC OPERATION

D. Green

Daily Telegraph, June 1st 2000, p.30

Argues that Britain should move to a European model of healthcare which would be based on mixed public-private provision, would permit consumer choice, encourage competition and require patients to pay towards the cost of their care.

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