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

Coalition may backtrack on NHS reform plans

O. Wright

The Independent, Mar. 14th 2011, p. 20

Oliver Wright reports that, following opposition from campaign group 38 Degrees, members of the BMA, and members of the coalition, Andrew Lansley - the health secretary - has signalled that he is prepared to make concessions on the controversial NHS reform programme. Lib Dem activists have been making their concerns heard at the Liberal Democrat Spring Conference. At the conference, Lib Dem members voted to demand rules to prevent the NHS from being privatised. At the British Medical Association conference on 15/03/11, members will debate a vote of no confidence in the health secretary.

(See also The Guardian, March 14th 2011, p. 12)

Commissioners halt soaring referrals

C. Santry and S. Calkin

Health Service Journal, Mar. 24th 2011, p. 4-5

Figures revealing that outpatient appointments are set to rise by only 1% in 2010/11 are being hailed as proof that referral management systems introduced by primary care trusts have been successful in diverting patients away from secondary care. In comparison, outpatient attendances rose by an average of 8% per year between 2005/06 and 2009/10.

Delivering the cancer reform strategy

Committee of Public Accounts

London: TSO, 2011 (House of Commons papers, session 2010-11; HC 667)

Over the last ten years, the NHS has made significant progress in delivering important aspects of cancer services, with falling mortality rates and consistent achievement of the cancer waiting times targets. Since publication of the Strategy in 2007, improvements have also been made in reducing the average length of stay and numbers of patients treated as day cases. A significant increase in resources has contributed to these improvements, but the progress has also been achieved through clear direction and high profile leadership underpinned by strong performance management linked to waiting times and mortality targets. The committee welcomes the Department of Health's and NHS's commitment to improving the outcomes for cancer patients. The committee is concerned, however, that early diagnosis does not happen often enough; whilst cancer survival rates have improved and mortality rates have fallen, the gap in survival rates between England and the best European countries has not been closed. There remain wide, unexplained variations in the performance of cancer services and in the types of treatment available across the country.

Doctors join calls for ministers to ditch 'rushed' NHS reform

M. Beckford

Daily Telegraph, Mar. 16th 2011, p. 8

At the first special representative meeting of the British Medical Association for almost 20 years, doctors called on the government to halt the proposed radical reform of the NHS. They warned that the introduction of greater competition into the NHS would damage patient care, and claimed the proposals were rushed and not backed by evidence.

Doctors seek no confidence vote on Lansley health bill

D. Campbell

The Guardian, March 11th 2011, p. 9

The British Medical Association (BMA) is preparing to debate a series of motions which are highly critical of Lansley's reform of the NHS at an emergency general meeting. One motion from the BMA London region, the union's biggest, seeks a vote of no confidence. Another, from Buckinghamshire, says Lansley has reneged on a pre-election promise not to re-organise the NHS, and demonstrates the desire to destroy public trust in GPs and pursues policies despite the lack of evidence that they will improve either patient care or the NHS's finances.

Foreign GPs language alert

M. Beckford

Daily Telegraph, Mar. 30th 2011, p. 1 + 2

In a submission to the European Commission, which is reviewing rules on the free movement of medical staff across the EU, the General Medical Council has raised concerns that it is not allowed to check the qualifications or language skills of doctors from the European Economic Area.

Heart surgeons call for more transparency on death data

S. Boseley

The Guardian, Mar. 21st 2011, p. 15

Cardiovascular surgeons, backed by the Royal College of Surgeons, have taken the unusual step of criticising other specialists for failing to collect the data on deaths and other treatment outcomes that will give patients a clearer picture of where to go for the best results.


J. Taylor

Health Service Journal, Mar. 3rd 2011, p. 29-34

This special report on innovation in the NHS features:

  1. a quality observatory in Sussex that evaluates new interventions
  2. use of new technologies to increase the efficiency of procurement
  3. trials of the home use of telehealth technologies
  4. a crackdown on four key threats to patient safety ( pressure ulcers, falls, blood clots and catheter-associated urinary tract infections)

Lansley ready to review NHS plans after Lib Dems revolt

C. Hope

Daily Telegraph, Mar. 14th 2011, p. 9

Health minister Andrew Lansley has offered in a BBC interview to clarify and amend the Health Bill currently before Parliament in order to reassure critics. This retreat comes after the government's plans to reform the NHS were condemned as damaging and unjustified at the Liberal Democrat Spring Conference.

(See also Times, Mar. 14th 2011, p. 15)

Lib Dems may change stance on NHS reform

P. Wintour and A. Strutton

The Guardian, March 10th 2011, p. 2

The Liberal Democrat leadership signalled a willingness to rethink its stance on some NHS changes - such as the extension of competition and the accountability of GP commissioning - if the party's Spring Conference votes to rein in the shake-up.

Midwife led units threatened by falling births

A. Moore

Health Service Journal, Mar. 10th 2011, p. 4-5

Standalone midwife-led centres are under threat from high costs and falling numbers of deliveries. Seventeen out of 32 standalone centres - those not on the same site as a consultant-led unit - have seen falls in the number of women giving birth over the last three years. In some cases the falls in births can lead to the closure of units. Four units closed between 2008/09 and 2010/11, and there are question marks over the long term future of two more.

More patients get Alzheimer's drugs that help quality of life

R. Alleyne

Daily Telegraph, Mar. 23rd 2011, p. 8

Three drugs that the National Institute for Health and Clinical Excellence (NICE) had previously authorised for use with patients with moderate of severe symptoms of Alzheimer's disease only have now been approved for patients with milder forms of the condition. A fourth drug currently given only late in the development of the disease can now be prescribed for those with more moderate symptoms. This U-turn by NICE follows a campaign against the guidance issued in 2007 that blocked the use of the treatments.

National Health Service landscape review

National Audit Office

London: TSO, 2011 (House of Commons papers, session 2010-11; HC 708)

The July 2010 NHS White Paper, Equity and excellence: liberating the NHS, set out the Department of Health's long-term vision for the future of the NHS, which is to:

  • put patients at the heart of everything the NHS does
  • focus on continuously improving those things that really matter to patients - the outcome of their healthcare
  • empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services
The Health and Social Care Bill creating the necessary legislative change was published on 19 January 2011. This report summarises the key changes proposed including the establishment of a new NHS Commissioning Board and of GP consortia. 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.

The new health service: what it looks like so far

K. Ly

Community Practitioner, vol. 84, Mar. 2011, p. 16-17

Question marks remain about the detail and potential impact of the Coalition government's Health and Social Care Bill. This article gives an overview of its provisions, covering commissioning, competition between service providers, the replacement of all NHS trusts with foundation trusts, and the role of Monitor as economic regulator.

NHS reform could see GP surgeries on stock market

R. Ramesh

The Guardian, March 2nd 2011, p. 4

The government's health reforms could lead to GP practices being partially floated on the stock exchange, documents obtained by Channel 4 have revealed. One private health firm, IHP, has proposed that commissioning services for patients be handed over to a private company in which family doctors would hold a 20% stake.

NHS staff to control 'mutual' drug clinics

S. Boseley and D. Cambell

The Guardian, Mar. 30th 2011, p. 14

Health secretary Andrew Lansley has invited doctors, nurses and other health care staff to take what will be seen as another step towards privatisation, by forming 'mutuals' which will contract with the NHS to provide care for patients.

Reform will see 'shut' signs going up on UK hospitals

D. Campbell

The Guardian, Mar. 17th 2011, p. 12

Sue Slipman, chief executive of the Foundation Trust Network, has told the Guardian that handing GPs control of 80bn of NHS funds, letting private healthcare firms provide treatment and giving patients more choice about where they are treated - key policies promoted by the health secretary Andrew Lansley - would increase existing pressures on hospitals so much that some will not survive.

(See also The Guardian, Mar. 17th 2011, p. 13)

Reporting national clinical audits in quality accounts

N. Black and J. Nossiter

British Journal of Healthcare Management, vol. 17, 2011, p. 75-79

A key component of the Labour government's quest to improve quality in the NHS was the introduction of quality accounts in 2010. As well as improving the public accountability of NHS trusts, it is anticipated that the quality accounts will prompt trust boards to engage more with the quality agenda and to encourage quality assessment and improvement among clinicians and managers. This article appraises one section of the quality accounts, the reporting of national clinical audits. Overall participation in national clinical audits was 69%, but varied between acute trusts from less than 40% to 100%. Although most trusts did not provide examples of local quality improvement projects stimulated by national clinical audits, those that did demonstrated some innovative ways of improving services.

Running towards a happier future

K. Hewitt

Health Service Journal, Mar. 17th 2011, p. 20-22

In 2007 NHS Bristol and NHS South Gloucestershire, with partnership organisations, launched what was then the largest ever tendering process for clinical services in the UK. The vision was to create integrated mental and community health services for children and young people. The result is the Community Children's Health Partnership, which is a formal partnership between North Bristol Trust and Barnardo's. This article sets out to explain the procurement process.

Seething cauldrons and fuming colleagues

B. Clover

Health Service Journal, Mar. 10th 2011, p. 16-17 This article is a report of an interview with Mark Porter, chair of the British Medical Association consultants and specialists committee. Concerns are raised about a split between GPs and consultants as the balance of power within the NHS shifts towards the GPs with the formation of GP led commissioning consortia. There is also anxiety about the introduction of more competition between NHS providers under Coalition government reforms. It is argued that there is no evidence that competition improves clinical services. Finally, there is a warning that forcing all trusts to achieve foundation status by April 2014 could lead in some cases to a catastrophic failure in patient care as the attention of boards is diverted..

A special case for development

A. Young and others

Health Service Journal, Mar. 24th 2011, p. 28-29

There are reports that clinical nurse specialist vacancies are being left unfilled in the context of cost cutting in the NHS. However these specialists can contribute to overall reductions in costs by, for example, helping patients self-manage their conditions. They can also earn money for their employing trusts by, for example, leading clinics. To gain maximum benefit from their deployment, trust managers must provide adequate administrative support.

Top doctors warn that creeping privatisation will erode expertise

R. Ramesh and D. Campbell

The Guardian, Mar. 18th 2011, p. 16

Medical leaders fear the controversial switch to allow 'any willing provider' to supply care services for the NHS will fragment the system, raising concerns that medical expertise will suffer as private companies cherry-pick profitable, but clinically less important work.

Tory health reforms are disruptive and untried, warns Lib Dem peer

C. Smyth and S. Coates

The Times, Feb 28th 2011, p. 4

Conservative plans to reform the NHS are 'untried and disruptive' and should be challenged by the Liberal Democrats says Baroness Williams of Crosby.

Wanted: one careful owner for failed hospital

R. Royce

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

It is anticipated that some hospital trusts will not attain foundation status by the deadline of April 1st 2011, will go into the failure regime, and will be taken over by the private sector. In order to rescue such organisations, the new private owners will need to install robust staff performance management, reduce the costs of, or close down, services running at a loss, suspend public consultation on service redesign, and recruit experienced and ruthless hospital managers,.

We're all in this together

C. Blount and others

Health Service Journal, Mar. 24th 2011, p. 17-22

This roundtable of experts debated the future of the relationship between the NHS and the pharmaceutical industry, looking at the best ways to marry positive health outcomes with profits.

Where next for NHS reform?

NHS Confederation, 2011

The NHS Confederation has supported the Coalition Government's objectives but has also expressed concerns about the significant risks involved with the reforms. It is concerned that the debate about the changes has become increasingly polarised and entrenched, with little movement on practical solutions for managing these risks. This is destabilising for the NHS, which is already making structural changes to meet the agenda set by the Government. This paper seeks to identify the broad areas of concern and then to suggest potential options in response. There is a recurring theme running through the analysis - that there has often been a reality gap between ideas that are good in principle and the details of practical delivery, which have looked opaque or too optimistic.

Why compel hospitals to compete with each other?

D. Campbell

The Guardian, Mar. 8th 2011, p. 10

Mark Porter, chairman of the British Medical Association, has warned that a healthcare system run on a deliberately competitive basis, as set out in the government's Health and Social Care Bill, cannot deliver care of a universally high standard as the NHS seeks to do. Porter accepts that the government does not intend the NHS to be damaged by its reform, but, as the NHS budget will remain largely flat in the next few years, if the private providers are to start winning contracts, it will be at the expenses of existing NHS providers. The new consortia of GPs which will decide how 80bn is spent on patient care will be obliged to choose whoever offers the best deal, not necessarily their local hospital, or indeed any NHS service at all.

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