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

Cataracts, hips, knees and tonsils: NHS begins rationing operations

O. Wright

The Independent, July 28th 2011, p. 1

Data obtained through the Freedom of Information Act reveals that two-thirds of health trusts in England are rationing treatments for 'non-urgent' conditions. These include: hip and knee replacements, cataract operations, and varicose vein.

Does hospital competition save lives? Evidence from the English NHS patient choice reform

Z. Cooper and others

Economic Journal, vol.121, 2011, p.F228-F260

This research looks at the effects of competition between NHS hospitals on 30-day mortality rates for heart attack patients. Data for 433,325 patients who had suffered heart attacks between 2002 and 2008 and been treated at 227 English hospitals were analysed. This covers the period before and after fixed-price competition was introduced. The research found that death rates dropped by about 7% under the new regime, and fell quicker in more competitive markets. The authors estimate that the reforms saved the lives of about 300 heart attack patients per year. However, since heart attacks account for just 0.5% of hospital admissions, the lives saved due to the reforms when estimated across the NHS are likely to be significantly higher. On the other hand, the authors warn that competition based solely on price would lead to lower quality services.

Heart tsar attacks Health Secretary

J. Laurance

The Independent, July 26th 2011, p. 1, 10

The article reports on an attack on Andrew Lansley's proposed NHS reform by Sir Roger Boyle, who has just retired as the government's National Director of Heart Disease. Sir Roger accused the health secretary of squandering past gains in treatment because of his obsession with opening up the NHS to private providers. According to Sir Roger, the allegiances of private providers will be to their shareholders, rather than the public. He went on to say that Mr Lansley is acting without a democratic mandate from the electorate and that he's ejecting the old and bringing in the new without even looking at what has worked well in the past. Sir Roger says that Mr Lansley had not even bothered to visit him until recently. In his role, Sir Roger has been very successful; in his eleven-year-tenure, deaths from heart disease have halved.

The high price of justice

T. Care

Health Service Journal, July 7th 2011, p. 20-21

The increasing willingness of the courts to challenge decisions made by public bodies and the government via judicial reviews could represent a huge cost to the NHS. This article offers advice on what NHS organisations can do to limit their exposure to judicial review and manage the threat of it.

Hospital bed occupancy demystified

R. Jones

British Journal of Healthcare Management, vol.17, 2011, p. 242-248

This article uses queuing theory to explore issues surrounding the correct level of hospital bed occupancy required to deliver effective and safe healthcare. An absolute maximum occupancy of 82-85% is required to keep hospital-acquired infections at the minimum possible level. Average occupancy of 87% in the UK is the result of a policy to build smaller hospitals, but has very undesirable implications for staff and patients in the shape of queues for admission and hospital-acquired infections.

In charge of the not-so-light any more brigade

C. Santry

Health Service Journal, July 28th 2011, p. 16-17

This article reports an interview with Cynthia Bower, chief executive of the Care Quality Commission, in which she explains why the regulator is abandoning its light touch approach and planning to inspect all health and adult social care providers annually. The policy change has come about because of a series of high profile abuse scandals involving NHS and private providers and because of the disappointing results of the regulator's reviews of dignity and nutrition in hospital trusts. It has now been realised that unannounced personal visits by inspectors are required to identify poor care standards.

Is patient safety still in the right hands?

A. Moore

Health Service Journal, July 7th 2011, p. 22-23

In the next two years many organisations charged with ensuring and improving patient safety will be swept away and replaced by a new structure made up of Clinical Commissioning Groups and an NHS Commissioning Board with myriad responsibilities. Management costs will have been cut, budgets tightened and more services will be provided by private firms and social enterprises. There is concern that these reforms will adversely affect patient safety. In particular, there are growing fears that the abolition of the National Patient Safety Agency will leave a void that will be hard to fill.

Keep all eyes on the quality ball

J. Taylor

Health Service Journal, July 14th 2011, p. 21-23

The ambition of making quality the central organising principle of the NHS is well known. This article reports the results of an online survey of NHS staff which sought to understand how quality is viewed on the ground as the service goes through radical reform. The respondents said that: 1) the Health Bill fails to reflect the importance of delivering quality in the NHS; 2) providers have the biggest impact on quality; 3) patients are best placed to define quality; 4) the facets of quality (clinical quality, patient experience, operational effectiveness and financial management) are prioritised differently by managers and other staff groups; 5) the largest barrier to quality is lack of time among influential people to drive a successful quality improvement programme; 6) more than a third of managers do not receive quality training; and 7) financial outcomes and operational effectiveness are the elements of quality taking precedence in the QIPP agenda.

King's Fund claims NHS is affordable

J. Laurance

The Independent, July 13th 2011, p. 21

John Appleby, chief economist at the King's Fund, has said that, contrary to what the Health Secretary has been arguing, growth in health spending is affordable. In his view, this is more a matter of choice than affordability.

Lansley heralds change in size and role of acutes

N. Golding and A. McLellan

Health Service Journal, July 14th 2011, p. 6-7

In an interview with the Health Service Journal, health secretary Andrew Lansley signalled significant changes in the size and role of acute hospitals, although he insisted that there was no certainty that hospitals would close. He also used the interview to exempt the acute sector from his general criticism that the NHS is over-managed.

Lansley opens 1bn of NHS services to private companies and charities

R. Ramesh

The Guardian, July 20th 2011, p. 15

The government will open up more than 1bn of NHS services to competition from private companies and charities. The health secretary has announced that on Tuesday, raising fears it will lead to the privatization of the health service. In the first wave, beginning in April 2012, eight NHS areas - including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children, and primary care psychological therapies for adults - will be open for 'competition on quality not price'. If successful, the 'any qualified provider' policy would from 2013 see non-NHS bodies allowed to deliver more complicated clinical services in maternity and 'home chemotherapy'.

(See also Times, July 20th 2011, p. 17)

Leaked document throws doubt on Lansley's goal of streamlining NHS

N. Watt and D. Campbell

The Guardian, July 6th 2011, p. 2

A new NHS commissioning board employing 3,500 staff and with a commissioning budget of 20bn will oversee the government's reform of the health service, according to a leaked Department of Health document. Labour said the document showed the government was planning to create a new layer of bureaucracy, raising questions over the health secretary's claim to be streamlining the management of the health service.

Maternity units struggle as birth rates soar

G. Roberts

The Independent, July 25th 2011, p. 5

Research carried out for the BBC's Panorama programme reveals that maternity units in England are struggling to cope with increasing birth rates, currently at their highest in 20 years. Last year, maternity units were forced to close to new admissions 1,055 times, nearly always because of understaffing or lack of beds. The research also reveals that in some London trusts, one in five midwifery posts lies vacant.

NHS 'creaking at the seams' as waiting lists grow

M. Beckford

Daily Telegraph, July 15th 2011, p. 12

Statistics from the Department of Health show that the proportion of inpatients waiting more than 18 weeks for treatment has risen by 29% since the 2010 general election. In a further sign of strain on the NHS, a King's Fund survey has found that one in four hospital managers fear that tough productivity targets may damage patient care. The President of the Royal College of Physicians has also reported that doctors are struggling to cope with rising demand, especially among the elderly, with tests and operations being delayed as a result.

NHS figures show system is ailing under pressure of cuts, warns medical chief

J. Laurance

The Independent, July15th 2011, p. 2

Sir Richard Thompson, the president of the Royal College of Physicians, has said that the NHS has started to show signs of ailing under the mounting pressure of cuts. He made the allegations while commenting on figures showing that waiting time for inpatient operations are on the rise. The health secretary has responded by saying that most people's waiting times are still under the maximum of 18 weeks set by the government

NHS rivals go to court over closure of child heart centre

C. Smyth

The Times, July 15th 2011, p. 5

For the first time one NHS organization has taken another to court as the Royal Brompton Hospital in Chelsea has asked for a judicial review of a consultation on closing several children's heart units around the country.

Patient power needs a turbo boost

S. Thornton

Health Service Journal, July 7th 2011, p. 16-17 The report of the NHS Future Forum on the coalition government's reforms set out in the Health Bill supported increased patient involvement in NHS decision-making. The prime minister has also advocated for real patient power in the NHS. However implementation of a policy of greater patient involvement will require incentives and accountability in the form of performance measures.

Policy and strategy for improving health and wellbeing

E. Porter and L. Coles (editors)

Exeter: Learning Matters, 2011

As health policy at a national level has an ever increasing impact on local health services, it is important to understand how the development and implementation of policy and strategy provide the framework for improving quality, innovation, productivity and prevention in the delivery of healthcare. The book is divided into two sections, with section one a strategic overview of national policies, and section two giving specific local implementation of policy to support section one. Case studies and examples will help the reader to understand the policy and strategy and to apply them to their local setting.

Quango's shadow could cast a chill

D. Stout

Health Service Journal, July 21st 2011, p. 16-17

The absence of a national body with a focus on commissioning has been a past weakness of the NHS. The new NHS Commissioning Board has the opportunity to significantly improve the way that commissioning is delivered. However, if it fails, it could undermine the chances of clinical commissioning groups (CCGs) working well. The Board will need to maintain a delicate balance between supporting CCGs to deliver innovation and holding them to account through a clear performance framework. This article suggests some simple steps that the board could take to avoid some of the pitfalls it faces.

Rising NHS waiting times may cost lives

D. Campbell and J. Bell

The Guardian, July 11th 2011, p. 1

Dr Mark Porter, chairman of the British Medical Association consultants committee, has warned that patients could die as a result of rising NHS waiting times for tests and treatments. His remark will add to the pressure on David Cameron who has offered several personal reassurances that patients will not have to endure long waits to be treated. A Guardian analysis of official NHS data on England's six main waiting time targets shows that five are increasingly being breached. (See also The Guardian, July 11th 2011, p. 12)

Safeguarding adults at risk in the NHS through inter-agency working

S. Williams

Journal of Adult Protection, vol. 13, no.2, 2011, p.100-113

This article appraises professional practice in safeguarding vulnerable adults in the English and Welsh NHS . It examines the mechanisms in place and discusses how future policy will affect multi-agency working in this field. It concludes that safeguarding systems need to be timely, rigorous and transparent to increase levels of public confidence and to ensure that vulnerable people are safe when accessing public services. The concept of safeguarding adults is increasingly being integrated into government policy and there are many successful examples of partnership working in England and Wales. However, there are also substantial barriers that hinder organisations from working together effectively, such as different cultures, practices and ideologies.

Service user involvement in cancer care: the impact on service users

P. Cotterell and others

Health Expectations, vol.14, 2011, p. 159-169

The development of involvement initiatives in the NHS has been mirrored in cancer care for over a decade, with cancer policy initiatives influential in the area. However, knowledge about the impact of such involvement on service users is scant. This research aimed to address this gap by exploring the personal impact of involvement on the lives of cancer patients based on data gathered a eight focus groups and through nine in-depth interviews with service users active at local, regional and national level. Results show that in order to have a positive impact on involved individuals the role and remit of user groups needs to be clear. Involvement in user groups can have a very positive impact by fostering collective support and a sense of solidarity, as well as enabling members to grasp new opportunities. Feeling positive about being involved is also connected to a sense that people are actually influencing service or research development.

Spending cuts will mean longer waiting times, say NHS managers

O. Wright

The Independent, July 6th 2011, p. 14

A survey of NHS chairmen and chief executives revealed that the squeeze on health spending will result in longer waiting times and more limited access to treatments. 75% of respondents agreed that cuts in local authority spending will impact upon their service in the coming 12 months.

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