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

17 years ago closure was needed urgently. Today Chase Farm stays open

S. Lister

The Times, June 17th 2011, p. 8

The urgent need to close Chase Farm's Accident & Emergency Department, on safety and financial grounds was first raised 17 years ago. However Chase Farm is a case study in how lack of political will, and extreme public pressure can block advances in care. The service is 'clinically unsustainable and unaffordable', but remains open.

All that glisters: are NHS reforms good for local government?

B. Hudson

Journal of Integrated Care, vol. 19, Apr. 2011, p. 4-12

The NHS White Paper seems to herald a greater role for local government in running health services in England than at any time since 1948. Partnership working between the NHS and local authorities is to be elevated to a higher level, and a greater role for elected members is to be introduced to address the democratic deficit in the centralised NHS. For these new arrangements to work in practice, the NHS needs to realise that it must collaborate with local government to achieve efficiency savings, for example in the management of patients with long term conditions.

The baby lottery

J. Laurance

The Independent, June 7th 2011, p.1

This article reports on cases in England and Wales where women who are unable to conceive naturally are being denied IVF on the NHS, for a number of reasons. The article quotes the results of research carried out by the All Party Parliamentary Group on Infertility, which sent out Freedom of Information requests to all 177 Primary Care Trusts (PCTs) in England and Wales in March 2011 and received 171 replies. These show great variation in the way in which guidelines set out by NICE are applied. Gareth Johnson, Tory MP for Dartford and chairman of the group, said that the NICE guidelines had been taken out of context and used to place arbitrary restrictions on infertile couples. The article also quotes Claret Lewis-Jones, chief executive of the patient group Infertility Network UK, who says that some PCTs are still failing to fund fertility treatments, despite NICE guidelines. This has led to a situation in which a couple might be denied IVF treatment, whilst a similar couple residing within the borders of an adjoining PCT might be granted it. PCTs which are strapped for cash might be trying to save money, but according to the article, the difference in the behaviour of PCTs might be adding to the stress experienced by infertile couples.

(See also The Times, June 7th 2011, p.13)

Back me or sack me over NHS reform, Cameron tells voters

A. Grice

The Independent, June 7th 2011, p.20

The Prime Minister will invite the public to vote against him at the next general election if he fails to keep his promise to protect the NHS. In a plea for confidence, the PM will reiterate his commitment to a publicly funded NHS notwithstanding reforms which, David Cameron believes, are needed to promote efficiency and reduce waste. The article explains that Mr Cameron is trying to bridge the divide between Nick Clegg, the deputy Prime Minister, and Andrew Lansley, the Health Secretary, and to allay fears that the Tory government is trying to introduce a US-style privatisation of the NHS through the backdoor. The PM will offer five personal guarantees: that the Government will not endanger universal coverage; that it will not break up or hinder efficient and integrated care; that it will keep waiting times low; that it will increase spending on the NHS; that it will not 'sell out' the NHS, but that the amount of competition introduced will benefit patients.

(See also The Times, June 6th 2011, p. 5; The Times, June 7th 2011, p. 13)

Embedding economic relationships through social learning? The limits of patient and public involvement in healthcare governance in England

P. Vincent-Jones

Journal of Law and Society, vol. 38, 2011, p. 215-244

This paper shows how the strategy of NHS modernisation adopted by successive governments since the 1970s has involved the privileging of individual choice over democratic voice in the reform of healthcare in England. The critique of this trend builds on the Polanyian insight that the market should not be permitted to dominate society, and that the potentially negative consequences of increasing commercialisation imply the need for the rebalancing of economic and democratic elements in the modernisation process. It shows how social learning theory might help in this task by focusing attention on the combination of economic, deliberative and experimentalist practices that may serve to promote reflexive governance in the public interest and thereby contribute to the embedding of economic relationships in social relations in this context.

Emergency surgery: standards for unscheduled care

Royal College of Surgeons of England


Available data suggest that outcomes for patients undergoing emergency surgery give cause for concern, with great variability between comparable units and mortality rates of over 50% for the over-80 age group. These standards are aimed at commissioners, service planners and providers to help them define and deliver safe and high quality emergency surgical care. It provides practical guidance on assessing whether an organisation meets the requisite standards and on routes to improvement if it does not. The standards cover timeliness of surgery, auditing outcomes and the patient experience, pr- and post-operative care, networking, training and education, clinical interdependencies, and communication with patients and their supporters.

Failing hospitals may be allowed to close as bail-outs are scrapped

M. Beckford

Daily Telegraph, June 21st 2011, p. 8

Failing hospitals will no longer be secretly 'bailed out' using taxpayers' money, the Government has claimed in the latest details of its controversial NHS reforms. The Department of Health said 'poor quality' organisations would not be 'propped up with subsidies' any more, as it highlighted the importance of competition and choice in improving public services. Ministers have scrapped plans to protect certain health services deemed essential from going bust, raising the prospect that some hospitals or units may be allowed to go to the wall.

Fighting talk for a year of living dangerously

C. Santry

Health Service Journal, June 23rd 2011, p. 16-17

NHS Confederation chief executive Mike Farrar warns that the reduction in manager numbers is bringing the NHS close to being unable to deliver reform. If the reduction continues, he argues that quality of care will decline. Mr Farrar also discusses the role of the NHS Confederation in influencing and lobbying the coalition government.

For the public, it's apocalypse now

P. Corrigan

Health Service Journal, June 9th 2011, p. 16-17

The coalition government failed to explain its proposed NHS reforms to the public. The idea then took root in the public mind that the government was planning to privatise the health service. It now has to spend every day proving that it is not about to privatise the NHS. Unfortunately, it will find proving a negative very difficult.

Foundation trusts face the future of boom and bust

T. Care

Health Service Journal, June 23rd 2011, p. 24-25

Foundation trusts are promised greater autonomy and freedom under the Health and Social Care Bill. However, trusts in financial difficulty will no longer be protected by the state, and those which are not offering essential services will be subject to the same insolvency rules as private companies.

Government response to the NHS Future Forum report

Department of Health

London: TSO, 2011 (Cm 8113)

The government has accepted almost all of the recommendations of the NHS Future Forum report and will amend the Health and Social Care Bill accordingly. The secretary of state for health will retain overall responsibility for delivery of health services. Regulator Monitor has lost its duty to promote competition, and will receive guidance from the Commissioning Board on how choice and competition should be applied to the NHS. It will continue to closely supervise foundation trusts. The NHS Commissioning Board and its local arms (reflecting primary care trust clusters) will discharge the duties of GP Consortia (renamed clinical commissioning groups) which are not deemed ready to take responsibility for services, will host existing and new clinical networks, and will produce guidance on competition and choice in the NHS. GP Consortia will be renamed clinical commissioning groups and will have a nurse, a hospital doctor and two lay members on their governing boards. Clinical senates, hosted by the Commissioning Board, will produce advice which clinical commissioning groups will be expected to follow. Local authority health and wellbeing boards will also monitor the activities of clinical commissioning groups and will be able to refer their commissioning plans to the Commissioning Board if they disapprove. On the provider side, an increasing number of NHS trusts will gain foundation status, but the deadline of 2014 for all to achieve this has been removed.

(For comment see Health Service Journal, June 17th 2011, p. 6-9; for summary see Health Service Journal, June 17th 2011, p. 4-5)


Government urged to clarify child health remits

L. Higgs

Children and Young People Now, May 17th-31st 2011, p. 14-15

Current proposals in the Health and Social Care Bill see responsibility for commissioning children and young people's health split between local authority-led health and well-being boards, the National Commissioning Board and GP consortia. The government should use the 'pause' in the passage of the Bill to clarify once and for all where responsibility lies and end the confusion.

Health trusts failing on referrals

J. Paige

The Guardian, June 17th 2011, p. 6

About a third of hospital trusts are failing to reach their targets for treating 90% of patients within 18 weeks of referral by their GP, it has been reported. Data for April shows 51 trusts breaching waiting time limits - compared with 26 trusts a year ago, according to the BBC. Despite this rise, overall the NHS is still meeting its target because many hospitals are performing better than required. On average across England, 90.5% of patients are seen within the limit.

Hospitals will be forced to admit medical errors, says government

A. Stratton

The Guardian, June 21st 2011, p. 13

The Department of Health has published its full response to last week's NHS Future Forum report, accepting many of the forum's recommendations and introducing a drive for transparency that will require hospitals to admit errors. A written ministerial statement said hospitals would have a new 'duty of candour', requiring them to tell patients when they had made mistakes - a key demand from the 'listening exercise'. Providers of NHS services would have the duty written into their contracts in a drive to increase transparency.

How to improve cancer survival: explaining England's relatively poor rates

C. Foot and T. Harrison

The King's Fund, 2011

This report, published in partnership with Cancer Research UK, considers the existing differences in cancer survival rates between countries and discusses the reasons for these variations including: stage at diagnosis and diagnostic delay; treatment factors; patient factors; and tumour biology and physiological/biological factors. The authors suggest that the most plausible drivers for improved survival rates are:

  • diagnosis at an early stage, including through effective screening programmes
  • access to optimal treatment
  • improvements in the management of older people with cancer.
To achieve these improvements, the NHS and public health need to work together to diagnose more cancers at an early stage and GPs need to use information about their referral rates and use of diagnostics to understand how their performance compares with others. The authors also emphasise the need to reduce variation in access to major surgery and to radiotherapy treatment for cancer and the need to address inequalities in the management of older people with cancer.


Information technology

D. Carlisle (editor)

Health Service Journal, June 9th 2011, p. 24-27

This special report on IT applications offers articles on:

  • the advantages offered by laptops with wireless Internet connections to community healthcare workers
  • use of computerised records to allow the medical history of inmates to be shared across prison facilities, while also identifying healthcare trends across populations
  • predictive models that identify older people at risk of needing intensive social care, with a view to facilitating prevention.

Keeping the faith

I. McMillan

Learning Disability Today, July 2011, p. 14-15

A new learning disability nursing project, with a remit to modernise and enhance the profile of learning disability nursing throughout the UK, was launched in February 2011, The project is intended to maximise the future practice, roles, career pathways and image of learning disability nursing in a changing health and social care landscape. This article reflects on the contribution of learning disability nurses to the care of such people since the 1980s.

Labour NHS changes wasteful, admits Balls

M. Savage and R. Watson

The Times, June 17th 2011, p. 29

Ed Balls, Shadow Chancellor, used his first major speech to criticize Labour's repeated attempts to reform the NHS as 'destabilizing and wasteful' as he conceded that the party had much to do to win back public trust on the economy.

Lib Dem crowing over concessions will not be forgotten, Tories warn

R. Watson and A. Asthana

The Times, June 14th 2011, p. 6, 7

Liberal Democrat triumphalism over the final shape of the NHS reforms has infuriated many Conservatives and tested the trust at the top of the coalition.

Loud and clear: nine shouts for the Health Bill

D. Redding

Health Service Journal, June 23rd 2011, p. 26-27

This article summarises the charity National Voices' submission to the NHS Future Forum. The charity called for changes to the Health and Social Care Bill that would offer:1) integrated services and seamless care; 2) user friendly patient information; 3) an end to paternalism; 4) an end to post code lotteries and unequal access to treatment; 5) strengthening patient and public involvement; 6) a policy of openness and disclosure of mistakes; and 7) coordinated care for people with long term conditions.

Mixed reception for climbdown

O. Wright

The Independent, June 15th 2011, p.2

The proposed amendments to the Health Bill following the government's 'listening exercise' attracted generalised approval from members of the Coalition but criticism from Labour; they could still face opposition from the British Medical Council.

(See also The Times June 15th 2011, p.10 and 17)

National programme for IT in the NHS: an update on the delivery of detailed care records systems

National Audit Office

London: TSO, 2011 (House of Commons papers, session 2010/12; HC 888)

This update reports that the rate at which electronic care records systems are being put in place across the National Health Service under the National Programme for IT (the Programme) is falling far below expectations and the core aim that every patient should have an electronic care record under the Programme will not now be achieved. Even where systems have been delivered, they are not yet able to do everything that the Department of Health (the Department) intended, especially in acute trusts. Moreover, the number of systems to be delivered through the Programme has been significantly reduced, without a commensurate reduction in the cost. This report concludes that the 2.7 billion spent so far on care records systems does not represent value for money. And the NAO has no grounds for confidence that the remaining planned spending of 4.3 billion on care records systems will be any different. The systems the Department contracted its suppliers - British Telecom and Computer Sciences Corporation - to deliver by 2010 are now not all expected to be in place until 2015-16 and progress in delivering care records systems varies dramatically between regions. In acute trusts, the systems are mainly providing administrative benefits, rather than the expected clinical ones, such as prescribing and administering drugs in hospitals. The Department has now moved away from its intention to replace systems wholesale, instead, building on and using trusts' existing systems. To do this will cost at least 220 million to get the systems to work together.

NHS forum GP admits private patient doubts

N. Watt and D. Campbell

The Guardian, June 29th 2011, p. 12

The government is facing renewed pressure over its health bill after Steve Field, the GP who led its 'listening exercise', admitted he should have done more to flag up concerns about private patients in NHS hospitals. Labour warned that the health secretary, Andrew Lansley, was still planning to create a 'full-scale market' after Steve Field acknowledged that the government would leave hospitals vulnerable to European Union competition law due to the presence of private patients. Concerns about a backdoor privatisation of the NHS prompted David Cameron and Nick Clegg to appoint Field to lead the Future Forum review. As Field was addressing MPs, who are considering the bill again at committee stage, doctors in the British Medical Association defied their leadership to pass a motion at their annual conference criticising the 'respray' of the health and social care bill.

Planned GP consortia could lead to chaos - and top-down diktats

J. Laurance

The Independent, June 1st 2011, p.20

The article reports on warnings by the Kings Fund, the leading health think-tank, that the modernisation of the NHS is in danger of being halted by the very government plans aimed at reforming it. The Fund warned that the weaknesses in the governance arrangements for GPs consortia risk undermining ministers' aims to reduce top-down management. This is because the flaws in the governance plans could mean that the NHS Commissioning Board would still have to intervene if there were concerns about consortia performance. In addition, the Fund warned that scaling back the role of the regulator, Monitor, in overseeing NHS Foundation Trusts could also lead to a lessened quality of services offered by hospitals. There are now fears that the Bill might have to be abandoned altogether; this is because, during the Government's two-month pause to listen to concerns about the proposed reforms, too many demands have been advanced, making the implementation of the proposed reforms extremely challenging. Nick Clegg, the Lib-Dem leader and Deputy Prime Minister, has been trying to demonstrate greater influence on the reform plans following the Lib-Dem defeat in the referendum on alternative voting and in the local elections in order to appear less willing to accept Tory interference with the NHS. However, the article highlights the fact that the Prime Minister himself has shown a dramatic change in his thinking on the matter since personally launching the white paper last year. After his declaration that 'our NHS will be much like what we have today', many are asking why the need to implement a costly bureaucratic revolution.

The procurement of consumables by National Health Service acute and foundation trusts

Committee of Public Accounts

London: TSO, 2011 (House of Commons papers, session 2010/12; HC 875)

This report discusses how the 165 National Health Service (NHS) acute and foundation hospital trusts in England spend over 4.6 billion a year on the procurement of medical supplies and other types of consumable goods. Each trust controls its own purchasing and can purchase consumables in various ways:

  • dealing direct with suppliers
  • through the national suppliers' organisation, NHS Supply Chain
  • via the regional Collaborative Procurement Hubs.

They can also choose to join other trusts in collaborative purchasing arrangements for particular localities or types of supplies. The Department of Health sees the future of NHS procurement as a 'pyramid' structure with national, regional and local procurement of different types of goods, as appropriate to the products and the supplier markets. However, this theoretical model does not reflect the current complex reality, with a profusion of bodies involved in the procurement process. Its effectiveness is open to question in the emerging landscape where foundation trusts act independently with no explicit incentive to co-operate. The fragmented system of procurement has produced a great deal of waste, with trusts being charged different prices for the same goods, ordering in inefficient ways and failing to control the range of products which they purchase. The National Audit Office has estimated that trusts could save around 500 million annually, 10% of their consumables expenditure, by amalgamating small orders into larger, less frequent ones, rationalising and standardising product choices and striking committed volume deals across multiple trusts. A lack of data has limited progress towards more efficient procurement and there has not been sufficient control over procurement practices.

Raid the past for golden nuggets

N. Crisp

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

The NHS was designed to provide good care for one-off episodes of illness, but needs to change to meet the needs of people with long term conditions, who are now its biggest users. The health secretary has come under intense criticism for his proposals on making this change. His main mistake was his failure to consult with and engage managers and clinicians when developing his plans. This consultative approach was used to good effect by the Blair government when developing the NHS Plan.

Shut failing hospitals, says nurses' union chief

S. Lister

The Times, June 17th 2011, p. 1, 8

'Ministers must make brave decisions for NHS' Peter Carter of the Royal College of Nursing said that ministers must make brave decisions and stop the political self- interest that is hampering essential change to the way that healthcare is delivered. The worst-performing hospitals must be dismantled, merged and even closed if the NHS is to improve care and address the way that the health budget is spent. It is time to end the political taboo of hospital closures and have proper public debate about why the NHS is geared too much around hospital care.

Step up and meet the challenge health chief tells doctors

S. Lister

The Times, June 17th 2011, p., 9

Sir David Nicholson, chief executive of the NHS, spoke publicly for the first time since the Government set out its new plans for the health service. He sought to reassure doctors about health service reform and said that they needed to 'step up to their changing responsibilities at a time of unprecedented pressure.'

Summary report on the proposed changes to the NHS

NHS Future Forum

Department of Health, 2011

Following a two-month consultation on the controversial reforms to the NHS set out in the Health and Social Care Bill, this report recommends the following changes to the draft legislation:

  • Scrapping the timetable for GPs to take responsibility for commissioning services by forming consortia. Some commissioning boards will begin in 2013, but others may be delayed
  • Forcing all hospitals, even those run privately, to hold their meetings in public and publish minutes
  • Re-asserting the role of the Secretary of State for Health as holding ultimate responsibility for the NHS
  • Giving an obligation on commissioning bodies to set up 'clinical senates', to provide expert advice. On such bodies, however, there will be no guaranteed places for nurses, hospital doctors, and other healthcare professionals
  • Ensuring that private companies operating within the NHS will not be able to cherry-pick only profitable activities
  • Scrapping plans to give the Department of Health direct control over public-health policy; Establishing a new citizens' panel which will report every year to Parliament on how the new structures are working. Patients will also be given the 'right to challenge' poor services.

(See also The Guardian, June 14th 2011, p. 1 and 6-7; Times, June 14th 2011, p.6; The Independent, June 14th 2011, p.6-7)


Terminally ill can register death choices

D. Sanderson,

The Times, June 1st 2011, p. 5

The patient charter on end-of-life care created by the Royal College of Nursing (RCN) and the Royal College of General Practitioners (RCGP), will enable doctors to ask dying patients to record how and where they want to die, and if they want to be resuscitated. The charter contains seven pledges to make the last days and weeks of a person's life as comfortable as possible.

(See also Health Service Journal, June 17th 2011, p. 26-27)

Testing times: the future of skills development in the NHS

A. Moore (editor)

Health Service Journal, June 17th 2011, supplement, 8p

NHS organisations face tremendous challenges in delivering reforms and productivity gains, and to succeed they must invest in the continuing professional development of their staff. This special supplement on the future of skills development in the NHS offers articles on the role of healthcare providers in commissioning training for their staff, on the role of universities in provision of courses for the continuing professional development of NHS staff, and on the views of new entrants from the NHS graduate management scheme in relation to their career prospects. A case study of how provision of additional training and improved career paths to staff facilitated the restructuring of the pathology department at East Kent Hospitals University foundation trust is also included.

Time running out for reform in child heart care, says NHS chief

S. Lister

The Times, June 23rd 2011, p. 19

Local interest groups appear to be trying to derail attempts to raise standards in child cardiac services. An independent review found that a network based around fewer, larger centres would be safer and more sustainable, avoiding the problems at smaller units such as the risk of too few surgeons being available to operate and the cancellation of operations. The best outcomes are realised when surgical teams pool their expertise with a minimum of 4 surgeons a unit. Hospitals that stop carrying out surgery would become cardiology centres where children who do not need operations will go for diagnosis and management of their heart conditions. The jury is still out on what the final decision will be.

Shut failing hospitals, says nurses union chief

S. Lister

The Times, June 17th 2011, p. 1, 8

Peter Carter of the Royal College of Nursing said that ministers must make brave decisions and stop the political self-interest that is hampering essential change to the way that healthcare is delivered. The worst-performing hospitals must be dismantled, merged and even closed if the NHS is to improve care and address the way that the health budget is spent. It is time to end the political taboo on hospital closures and have proper public debate about why the NHS is geared too much around hospital care.

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