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

30,000 patients are left waiting as target is missed

M. Beckford

Daily Telegraph, Apr. 15th 2011, p. 10

In Winter 2010 92% of hospital in-patients were being treated with 18 weeks of referral by their GPs, and the median wait was eight weeks. However, by February 2011 the proportion had fallen to 89.8%, the first drop below Labour's 90% target since it was set. The average wait had risen to nine weeks, with some patients waiting 22.8 weeks. Waiting times are expected to rise further as health trusts begin to make savings of 20bn over the next four years.

(See also Independent, Apr. 29th 2011, p. 18)

A&E chief: casualty units 'not coping'

D. Campbell and J. Bell

The Guardian, Apr. 13th 2011, p. 1

Hospital casualty departments are struggling to cope within growing demand for emergency care because they have too few staff and not enough beds, Britain's top emergency doctor John Heyworth has warned. New figures show a steep rise in A&E waiting times and the loss of 890 ambulance jobs.

(See also The Guardian, Apr. 13th 2011, p. 4)

Britain's maternity wards in crisis

J. Laurance

The Independent, Apr. 4th 2011, p. 1

This article reports that, due to staff shortages, infant mortality has risen at fourteen unnamed NHS trusts. The president of the Royal College of Obstetricians has said that, to ensure the safety of mothers and their babies, maternity care must be concentrated in fewer, larger units which can provide 24-hour consultant cover. The article points out that this would mean the loss of local, smaller maternity units, resulting in some mothers having to travel more to receive care. The article also points out that, before the election, David Cameron promised an extra 3,000 midwives but the pledge has yet to be honoured. The Royal College of Midwives says that there is a need of an extra 4,500 midwives if a high quality, safe service is to be delivered. Higher birth rates in the country, especially in London, have meant that many services are overstretched, with not enough staff to assist women. Over the past decade perinatal deaths have fallen, but there is disparity among the regions. A study of such deaths in the West Midlands for the period 2008-09 concludes 35 had received sub-standard care and their deaths might have been avoided. The Care Quality Commission (CQC) has found that one in five women were left on their own during labour and sent home without support or advice on feeding their babies. Fewer were offered antenatal classes. Both the Royal College of Midwives and the Royal College of Obstetricians say there is a shortage of both midwives and obstetricians. According to the Department of Health, since May 2010 the number of midwives has increased by 254. Last year, a record 2,493 midwives were in training. For 2011-12 there will be a total of 2,490 planned places available.

Cameron forced to lead NHS reform

M. Beckford and C. Hope

Daily Telegraph, Apr. 4th 2011, p. 1 + 2

This article reports that Prime Minister Cameron will take personal charge of the government's NHS reform plans in the face of mounting criticism. He intends to unveil a 'listening exercise' to reassure the public, doctors and coalition government MPs that the NHS is not being covertly privatised under the reforms.

Cameron set to announce delay of key NHS reforms

P. Wintour and D. Campbell

The Guardian, Apr. 4th 2011, p. 1

The Prime Minister David Cameron is preparing to bow to insurmountable political opposition by putting the coalition's flagship NHS reform bill on hold beyond Easter. In a sign of the political difficulties facing Cameron, the leader of the Liberal Democrat revolt against the reform is expected to release a list of 23 detailed demands for sweeping changes to the bill while the Labour leader Ed Milliband is expected to call on Cameron to hold all-party talks to see what can be salvaged from what he has described as 'a disgraceful way to treat the NHS'. Meanwhile, the NHS Confederation acting chief executive Nigel Edwards pointed out that some of the 1,500 NHS and Primary Care Trust managers who had been let go on Friday 1 April may have to be rehired.

The centre is learning to let go

R. Whiteman

Health Service Journal, Apr. 7th 2011, p. 16-17

This article discusses the extent to which the Health and Social Care Bill will transfer control of the NHS from central government to local authorities and GP commissioning consortia. It covers the role of the new local authority health and wellbeing boards, threats to the independence of Directors of Public Health, constraints of the health secretary's power to intervene in the day to day running of the NHS, and the transfer of responsibility for public health from PCTs to councils.

Children's care hit by shortage of trained NHS staff

S. Boseley

The Guardian, Apr. 21st 2011, p. 11

The Royal College of Pediatrics and Child Health has flagged up a shortage of consultants and the need to amalgamate smaller children's units around the country in order to deliver safe care. The college's data show that a third of the country's 220 children's units are not compliant with the EU Working Time Directive, with doctors forced to work longer than 48 hours per week, trainees left in charge and consultants having to stay at the hospital overnight because of lack of medical staff available.

Clegg adviser in threat to quit over NHS bill

N. Watt and D. Campbell

The Guardian, Apr. 11th 2011, p. 1

David Cameron was warned that he would have to endorse sweeping changes to the government's planned NHS reform when Norman Lamb, a senior adviser to Nick Clegg threatened to resign unless a series of demands were met. Lamb's warning came as the British Medical Association claimed the tight NHS settlement, which has raised the budget in line with inflation, would lead to an accelerated withdrawal of services.

(See also The Guardian, Apr. 11th 2011, p. 8-9, The Times, Apr. 12th 2011, p. 16, Daily Telegraph, Apr. 11th 2011, p. 11 and The Independent, Apr. 11th 2011, p. 2)

Commissioning: further issues

Health Committee

London: TSO, 2011 (House of Commons papers, session 2010/11; HC 796)

The report calls for significant changes to plans to give GPs control of the 80bn NHS commissioning budget from 2013. It recommends that GP consortia should have a board chaired by an independent person as well as a chief executive and a finance director. The boards should be forced to engage with the public and ensure that no conflicts of interest exist as a result of doctors commissioning services from private firms in which they have a stake.

Commissioning with confidence

M. Boyd

Health Service Journal, Apr. 28th 2011, p. 26-27

In the context of health service reform and fiscal austerity, GPs, senior nurses and other healthcare managers need to be trained to commission and manage complex health and social care programmes. This article describes an innovative training programme developed by NHS Derby County with Derby University for this purpose. The programme aims to equip participants with skills in: commissioning cycle and processes, health service finance and planning, governance and assurance, change leadership skills, contracting and procurement, complex decision-making and quality improvement.

Exploring the influence of service user involvement on health and social care services for cancer

P. Attree and others

Health Expectations, vol. 14, 2011, p. 48-58

Cancer network partnership groups in the UK are regional organisations set up to enable joint working between service users and health professionals, with the aim of developing more patient-centred care. Their remit is to promote collaborative working, shared decision-making, and shared ownership of service developments. This study examined the influence of their service user involvement activities on cancer care through documentary analysis and in-depth case studies of a sample of partnership groups. The results suggest that service user involvement in cancer network partnership groups is currently at its most effective at an operational level, in improving patient information, access to services and care environments. At a strategic level, however, in terms of planning and commissioning cancer care, the evidence of their influence is less compelling. There is no evidence of NHS professionals ceding control of the decision-making process to service users.

Fight to save the NHS begins


Labour Research, Apr. 2011, p. 16-18

NHS unions and health specialists have voiced concerns that the coalition government's plans for health service reform set out in the Health and Social Care Bill will cause irreversible and irreparable damage. The reforms would change the NHS from a publicly run and accountable service into a conglomerate of competing private companies bidding for patients. The TUC is co-ordinating a joint union campaign, All Together for the NHS, to oppose the changes.

GPs 'may exploit health reforms to boost pay

O. Wright

The Independent, Apr. 27th 2011, p. 15

NHS employers have warned that GPs may demand more money, before they agree to participate in the proposed reforms that would see the creation of GP consortia. The proposed legislation states that all GPs have to be in these consortia. The British Medical Association denied that GPs would try to get more money.

Health Bill in peril as MPs tell ministers to make big changes

A. Porter Daily Telegraph, Apr. 5th 2011, p. 4

Faced with a barrage of criticism of NHS reforms embodied in the Health and Social Care Bill, the health secretary Andrew Lansley announced in a Commons statement that there would now be 'a natural break in the passage of the Bill to pause, to listen, and to engage with all those who want the NHS to succeed and subsequently bring forward amendments to improve the plans further in the normal way'. This meant that the passage of the Bill would almost certainly be delayed, with the Lords committee stage put back.

(See also Health Service Journal, Apr. 7th 2011, p. 5)

Health reforms are ripe for exploitation, says think-tank

J. Laurance and A. Grice

The Independent, Apr. 14th 2011, p. 4

The article reports that, according to independent policy experts from the King's Fund - a health policy think-tank - legal loopholes in the bill to reform the NHS could leave it open to exploitation by profiteering outsiders. The same loopholes might be exploited by politicians and interest groups who would capitalise on the uncertainties. According to the King's Fund, the bill is permissive and not prescriptive, allowing for a number of interpretations by people and groups with differing interests and agendas. The controversy has led to a war of words between the Government and the Opposition.

Hospitals face checks on treatment for older breast cancer patients

M. Beckford

Daily Telegraph, Apr. 6th 2011, p. 2

The National Institute for Health and Clinical Excellence is developing a series of quality standards that will allow patients and the medical profession to see objective guidance that defines good care, enabling them to rate providers. One of these quality standards relates to treatment of breast cancer and will require women over 70 to be offered surgery and hormone therapy irrespective of age. Research has shown that only 60% of older women have been given surgery for breast cancer in eastern England in recent years, compared with 96% of middle-aged women.

How is the NHS performing? Quarterly monitoring report

The King's Fund


This monitoring report is the first of a regular quarterly review, which will combine publicly available data on selected NHS performance measures with views from a panel of finance directors on the key issues their organisations are facing. It complements the King's Fund's monthly waiting times tracker and is a continuation of work that it has done historically to assess, analyse and report on the performance of the NHS. It highlights significant concerns among those responsible for delivering the 20bn efficiency savings, with waiting times at their highest for three years, A&E departments overstretched and surgeons warning that patients are being denied treatments.


Identifying clinical leadership functions

S. Willcocks

British Journal of Healthcare Management, vol. 17, 2011, p. 96-100

Clinical leadership will be crucial for the successful implementation of the Coalition government's radical NHS reforms. Clinical leaders will need support and guidance on fulfilling their role in implementing the transformational changes planned. It is suggested that the revised functional leadership model may be useful as a practical guide to developing clinical leadership effectiveness, particularly if it is subsumed within a systems model. It may be used in the NHS in conjunction with a competency framework as a tool for developing clinical leaders.

The introduction of new interventional procedures in the British National Health Service: a qualitative study

T. Lourenco and others

Health Policy, vol. 100, 2011, p. 35-42

Interventional procedures (IPs) are health technologies used for diagnosis or treatment that involve an incision, puncture, entry into the body cavity or use of electromagnetic radiation. Decisions regarding their introduction into the NHS lie with individual trusts (England and Wales) and boards (Scotland). Currently, there is no prescribed way to do this. This exploratory qualitative study was undertaken to describe the current processes of introduction of IPs into clinical practice based on semi-structured interviews with 14 decision-makers. Results showed significant variation in how new IPs are introduced across different provider centres. Some have very structured and transparent processes, including committees and the development of business cases. Others use a less structured approach in which the clinician wanting to introduce the procedure makes the decision. At commissioner organisations, the variation identified across centres was less. Although most had a process, new IPs were not considered a priority.

Lansley says he's sorry, sort of, as nurses give him big thumbs down

M. White

The Guardian, Apr. 14th 2011, p. 1

The health secretary Andrew Lansley faced the humiliation of a 99% no-confidence vote at the Royal College of Nursing's annual conference in May 2011. In a meeting with 60 nurses away from the main conference hall, Lansley had to apologise repeatedly for his failure to communicate his vision for the NHS to them.

(See also The Times, Apr. 13th 2011, p. 16 and Apr. 14th 2011, p. 5; The Times, Apr. 20th 2011, p. 8; Daily Telegraph, Apr. 13th 2011, p.12 +Apr. 14th 2011, p. 10 and the Independent, Apr. 13th 2011, p. 2 and Apr. 14th 2011, p. 4)

National Health Service landscape review

Public Accounts Committee

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

The Health and Social Care Bill, published on 19 January 2011, proposes a new model for the NHS focusing on patient outcomes. The proposals are intended to transform the NHS in England into a highly devolved, market-based model in which local commissioners and providers of health services are freed from central control, with an increased say for local authorities, patients and the public. The two significant structural changes proposed in the Bill are the abolition of the current structure of commissioners of health services and the regional organisations that oversee them (Primary Care Trusts and Strategic Health Authorities), and the creation of the NHS Commissioning Board and GP commissioning consortia to make commissioning more clinically led. The Government also expects all health service provider trusts to become Foundation Trusts by 2014. The reform programme will need to be managed alongside the imperative, set in 2009, to secure challenging efficiency gains across the NHS of up to 20 billion by the end of the financial year 2014-15 and the requirement to reduce administrative costs in non front-line organisations by 33% over the same period. Establishing strong, effective systems of governance and clear lines of assurance and accountability supported by robust flows of information will be key to ensuring that public money is safeguarded. There is a continuing need to provide accountability to Parliament and for information and assurance to be aligned with new funding channels The Government requires all hospitals to become Foundation Trusts by 2014 or cease to exist as independent entities. They will compete with non-NHS providers. Competition law puts the focus on protecting services rather than providers. This has serious implications for the less competitive NHS hospitals, particularly those with expensive PFI contracts. It is imperative that the Department of Health puts in place clear and transparent policies for dealing with failure of commissioners or providers to ensure patients are protected and value for money is assured. High quality risk management will be crucial if the change programme is to be delivered to time and budget and to realise its intended benefits, especially during the transition stage. The cost implications of the programme to deliver the reforms are clearly set out. The Department of Health estimates the initial cost of the reforms will be a total of 1.4 billion, mainly redundancy costs, to be offset by a 33% (1.7 billion) reduction in administrative spending by 2014-15. At this stage there is scope for these cost and savings estimates to change, for example, if GP consortia are reluctant to employ staff from existing NHS commissioning bodies. This report provides an overview of aspects of the reforms where Parliament requires clarification and draws out a number of risks associated with the transition to the new model that need to be managed.


NHS market expansion set to decelerate

B. Clover and C. Dowler

Health Service Journal, Apr. 14th 2011, p. 4-5

Forthcoming government guidance on the 'any qualified provider' policy will see competition phased into the NHS more slowly than expected and the creation of a national register of private providers eligible to bid for NHS work. In order to enter the register providers will have to meet four criteria, including Monitor/Care Quality Commission registration, signing a standard NHS contract and a guarantee of adherence to NHS quality standards. The guidance is being drawn up amid widespread concerns over plans to significantly open up the NHS market.

No. 10 tries to buy off doctors over NHS reforms

N. Morris

The Independent, Apr. 18th 2011, p. 2

David Cameron signalled that the proposed reforms of the NHS could be temporarily halted, owing to the apparent and increasing opposition from health professionals. The PM promised 'proper and substantive' changes, which would see hospital doctors, as well as GPs, involved in the commissioning of services for patients. The PM insists that this 'listening exercise' is not a PR stunt and that reforms will go ahead.

Respecting patient autonomy: understanding the impact on NHS hospital in-patients of legislation and guidance relating to patient capacity and consent

M. Redley and others

Journal of Health Services Research and Policy, vol. 16, 2011, p. 13-20

It is now a firmly established legal and ethical principle that, before any medical treatment or act of personal care is carried out, adult patients must give consent. Hospital staff are required to observe the Reference Guide for Consent for Examination or Treatment, the provisions of the Mental Capacity Act 2005, and the requirements of the government's Dignity in Care campaign. This research explored the kinds of decisions patients are being routinely asked to make in the course of their care and treatment, the manner in which hospital staff approach patients about these routine acts of care and treatment, and the steps that are taken to ensure that patients are able to engage in informed decision-taking. Hospital staff working on a general medical ward for older people were observed for over 50 hours carrying out acts of medical and personal care. Results showed that, in contrast to personal care decisions, when medical staff approached patients in order to carry out routine treatment, they generally did so in a manner that did not acknowledge that the patients had a right to exercise choice.

Scramble to save coalition NHS reform

N. Watt, S. Boseley and P. Curtis

The Guardian, Apr. 5th 2011, p. 1

The health secretary Andrew Lansley is to launch a last ditch attempt to save his controversial NHS reform by accepting that the membership of the new GP-led consortia must be widened in line with proposals made by the Health Select Committee chaired by the former health secretary Stephen Dorrell.

Unravel the reasons for readmissions

N. Wilson

Health Service Journal, Apr. 21st 2011, p. 24-25

Unplanned hospital readmission rates have been rising year on year across England. The government has equated this with failing care and as part of its focus on outcomes is bringing in financial penalties. This article describes how West Suffolk Hospitals Trust's investigation of the causes of emergency readmissions should help it to avoid these penalties.

Variations in health care: the good, the bad and the inexplicable

J. Appleby and others

King's Fund, 2011

There is persistent and widespread variation in the proportion of NHS patients undergoing operations in different areas of England. The variation in procedure rates suggests that many patients are not being given the surgery they need while others may be undergoing operations they do not benefit from. More deprived patients are less likely to undergo procedures for which there is good evidence, such as hip and knee replacements, but more likely to undergo operations of little benefit, such as tonsil removal. The report also highlights variation in the uptake of cheaper surgery methods. For example, day surgery for varicose veins accounts for as many as 90% of such operations in some primary care trusts and as little as 30% in others. It recommends more collection and publication of data to identify problem areas. Once these have been identified, local health organisations should be required to explain their position publicly.


We are on the edge of calamity

R. Barker

Health Service Journal, Apr. 14th 2011, p. 16-17

Demand for healthcare is rising while new treatments are increasingly expensive. Therefore the gap between the care the NHS would like to provide and what it can afford is widening every year. The author calls for a radical rethink of roles, responsibilities and rewards in the healthcare system. Specifically, he argues: that healthcare should become a personal matter; that healthcare delivery systems should be redesigned to focus on management of chronic illnesses and the delivery of services in the community; and that professionals and organisations should be paid on the basis of performance.

We can build a better future

R. Greatorex

Health Service Journal, Apr. 7th 2011, p. 20-22

If the NHS is to provide high quality care in a climate of fiscal austerity, workforce planning cannot be an afterthought. Sound planning for the future surgical workforce requires: improved data about what surgeons actually do; adequate time for continuous professional development; and awareness of cultural changes that mean that younger clinicians are seeking a better work-life balance.

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