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

Approaches to health provision in the age of super-diversity: accessing the NHS in Britain's most diverse city

J. Phillimore

Critical Social Policy, vol. 31, 2011, p. 5-29

The past ten years have seen a huge influx of economic migrants from many different countries into the UK. These new migrants vary widely in ethnicity, immigration status, rights and entitlements, age and gender profiles, and patterns of distribution. This transformation of the population challenges the traditional multicultural models of health and welfare provision based on an understanding of migrants as coming in from Commonwealth countries and settling large clusters in defined geographic areas. This paper argues that models of health and welfare provision need to be rethought to take account of the reality of this new extremely diverse population in a way that is affordable, politically acceptable, and meets the needs of all. Using data from studies of health service provision in Birmingham, it explores the challenges of meeting the needs of new migrants under existing provision, the costs of failing to adapt to the new reality, and the reasons why provision has failed to adapt.

Doctors threaten to strike over NHS reforms

J. Laurance

The Independent, Feb. 3rd 2011, p. 16

The article reports that opposition to the proposed NHS reforms is mounting among the medical profession. Doctors are now considering strike action. Next month, the British Medical Association (BMA) is to hold an emergency meeting after its members expressed anger at the BMA's policy of 'critical engagement' with the Government over the reforms. The author of the article reports that the mood among clinicians is low following the Government's response to the consultation on the White Paper in December 2010. The response largely dismissed doctors' criticisms. In February 2011 the results of a poll of 2,000 members of the Royal College of GPs was published and showed that almost two thirds opposed the reforms. Doctors fear both the scale and the pace of the reforms, especially because they are untested. Another fear concerns the privatisation of the health market which, clinicians believe, might lead to fragmentation and even a break-up of the NHS. Furthermore, there are fears that allowing NHS hospitals to cut prices to attract business will trigger a 'race to the bottom'.

Embracing the era of the outcome

S. Patel and others

Health Service Journal, Feb. 24th 2011, p. 24-25

The Health Bill has placed greater emphasis on patient outcomes than on meeting targets, setting a new challenge for NHS organisations in improving quality. A clinical audit comprises a cycle of activities intended to lead to improvements in clinical practice and service provision. This article demonstrates how clinical audits can be used to inform and support trusts' business planning and marketing strategy.

A friend in need

B. Gates and M. Waight

Learning Disability Today, Dec. 2010, p. 26-27

The Valued People Project was launched in 2008 to consider the future of the specialist learning disability health workforce. This article reports on some aspects of focus groups that were conducted with 23 people with learning disabilities and 16 parents and relatives in 2009. Both parents and people with learning disabilities showed strong support for a specialist NHS learning disability workforce. Learning disability nurses were specifically identified as central to this.

Give patients choice over how they die, say health chiefs

T. Ross

Daily Telegraph, Feb. 24th 2011, p. 5

The West Midlands Strategic Health Authority argues that the current law, which makes it illegal to help someone to commit suicide, is no longer fit for purpose. It is not opposed to assisted suicide being legalised to give patients more 'choice' over how they die.

GPs hold the key as the NHS shake-up looms

J. Laurance

The Independent, Feb. 7th 2011, p. 18

The article reports that the success of the NHS reforms, put forward in the White Paper in July 2010, depends on GPs rising up to the challenge. For the reforms to be successful, the cooperation of GPs is essential. The British Medical Association, the Royal College of GPs and other medical associations have expressed reservations on the reforms. Crucially, it is still unclear what grassroots GPs think of them. The article reports that this may be revealed in March, when the BMA holds an emergency meeting that will allow all GPs to publicly air their views. Ministers claim that most GPs support the reforms, citing GPs' signing up to 140 pathfinder consortia covering half the population. Critics claim most GPs have done so believing it was a 'done deal'. The PM has said that if it is to survive, the NHS needs to change and adapt, becoming leaner and more efficient. However, it is an acknowledged possibility that GPs and other key players might fail to co-operate. This would mean that, after all the disruption and expense, we would be left with a system that would essentially be the same as the one we have at present.

'Hoody' law to enforce discharges

C. Dowler

Health Service Journal, Feb. 17th 2011, p. 7

NHS Sefton board papers from February 2011 state that patients deemed fit for discharge but who refuse transitional care home placements will be given 48 hours written notice to make their own arrangements. If a patient still refuses to leave, the hospital could seek a court order for possession of their bed on grounds of trespass.

Monitor prepares for a new role as economic regulator

D. Williams

Public Finance, Jan. 2011, p. 8-9

Monitor which currently regulates foundation trusts, is to become an economic regulator, overseeing the new market in healthcare provision that health secretary Andrew Lansley hopes his reforms will usher in. The new Monitor will work with the Care Quality Commission to license all healthcare providers, be they public, private or third sector. At the same time it will promote competition between these same providers, and set rules for how the new market will operate.

NHS reforms raise prospect of Tesco-style hospital chains

C. Smyth

The Times, Feb. 25th 2011, p. 5

'Service will benefit from competition, says policy chief' . The National Health Service must be transformed along the lines of the deregulated gas and electricity markets. The NHS must change dramatically from a public sector organization to a more open market.

Patients on mixed-sex wards in half of hospitals

M. Beckford

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

Official ststistics show that 72 out of 144 acute trusts that provided figures treated men and women on the same wards in January 2011, up from 70 out of 147 in December 2010. These figures show that managers are still struggling to end the practice before the imposition of a tough new sanctions regime. From April 2011, hospitals in England will be fined 250.00 for each breach of the rules.

Patients' privacy threatened in NHS shake-up

M. Beckford and S. Swinford

Daily Telegraph, Feb. 24th 2011, p. 4

The British Medical Association has identified a number of bodies which will have rights to access sensitive medical information without patients' consent under the Health and Social Care Bill. These bodies would include the NHS Commissioning Board, the NHS Information Centre, and local authorities, which are taking over responsibility for public health. It fears that the change will lead to patients withholding information from doctors and is calling for the bill to be redrafted so that proper safeguards are in place.

Revalidation of doctors

Health Committee

London: TSO, 2011 (House of Commons papers, session 2010/11; HC557)

The Committee reports on the progress of plans first unveiled by the General Medical Council (GMC) in 2000 for the introduction revalidation for doctors to confirm their fitness to practise. Progress has been slow, and the Committee urges the GMC to ensure no further delays in the implementation of plans by 2012. It emphasises that the need to identify inadequate and potentially dangerous doctors must not be overlooked in the revalidation process and adds that it is unsatisfactory that so little attention has been paid to the issue of how to deal with doctors whose practice gives cause for concern. The Committee goes on to highlight concerns about the fitness to practise of doctors from other EU countries, especially with regard to their ability to communicate in English. It calls on the GMC to state publicly if it is not satisfied that it has the necessary powers to fulfil its role (whether as a result of EU legislation or for any other reason) and to report to Parliament what changes are necessary to enable it to function effectively.

Chair's 'Liberating the NHS' reforms survey

The Royal College of General Practitioners, 2011

The poll, conducted via the online tool SurveyMonkey, shows that GPs are yet to be convinced that the NHS reforms will improve patient care, enhance the relationship between GPs and consultants, or reduce bureaucracy. The College conducted the survey as part of its ongoing consultations with GPs about the health service reforms, and respondents were asked their views on four main areas:

  • GP commissioning
  • Any willing provider
  • NHS infrastructure
  • Direction of travel of reforms

The poll attracted more than 1,800 responses. Over 50% disagreed that the proposed model of GP commissioning would create a patient-led NHS. More than 70% of respondents said they disagreed, or strongly disagreed, that the concept of 'Any Willing Provider' would either achieve a patient-led NHS, or improve healthcare outcomes.

Why competition needs tactics

R. Smith

Health Service Journal, Feb. 17th 2011, p. 16-17

This article summarises a debate on 'Competition versus integration in the NHS' organised by the Cambridge Health Network and the King's Fund. The main conclusion was that evidence demonstrated that competition could drive up standards in general, but not in highly specialised, services. Competition could be beneficial in elective and primary care but not in emergency, specialist and chronic illness services. It was pointed out that the most intractable problem with introducing competition into the NHS was political, in that a true market system would have to allow some hospitals to fail and close down.

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