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

Bed occupancy: the impact on hospital planning

R. Jones

British Journal of Healthcare Management, vol. 17, 2011, p. 307-313

The ongoing rise in emergency hospital admissions around the world over the past few decades has never been fully explained. Long-term trends in hospital bed occupancy in England, Canada and Australia are examined to show that a recurring pattern of time specific increases appears to apply. The possibility of a common infectious source is discussed. Whatever the cause, the need to prepare acute hospitals for unexpected increases in bed demand has been shown to be more important than commonly appreciated.

Far from an open and shut case

S. Slipman

Health Service Journal, Aug. 4th 2011, p. 16-17

It is likely that all foundation trusts will be under an obligation to hold their board meetings in public in future. The author argues against this approach, on the grounds that trusts’ primary mode of public accountability is through their governors. A foundation trust’s membership, which is representative of the local population, elects governors in the ‘public’ category and they form a majority on boards of governors.

Get to the heart of the problem

V. Harrison

Health Service Journal, Aug. 18th 2011, p. 16-17

Statutory advocacy was introduced into the NHS in England in 2003. It is available to all patients whose complaints have not been resolved in a day, but awareness of this right and the existing services is low. This article discusses professional advocacy’s role and value.

Getting things in the open

R. Royce

Health Service Journal, Aug. 4th 2011, p. 24-25

This article gives the author’s personal views on how complaints handling within the NHS has changed in the past twenty-five years. Most trusts now have a dedicated department to handle the growing number of complaints, but are still unable to deliver timely replies in clear English that deal with the issues. They still generally do not tackle the root causes of the complaints. The author calls for all executive directors to review complaints and how they are dealt with as a stimulus for more attention being given to tackling underlying problems.

Healthcare identities at the crossroads of service modernisation: the transfer of NHS clinicians to the independent sector?

J. Waring and S. Bishop

Sociology of Health and Illness, vol. 33, 2011, p. 661-676

UK health policy increasingly supports delivery of NHS services by a range of private firms and voluntary organisations. For the English NHS, this is exemplified by the introduction of independent treatment centres (ISTCs). This study explores how clinicians experience the involuntary transfer of work to the independent sector. Drawing on Giddens, it is suggested that this transition presents dilemmas for professional identities that have been anchored within the values and working practices of the NHS. Three emergent new identities are highlighted: the ‘pioneers’, the ‘guardians’ and the ‘marooned’. The pioneers regarded the move to ISTCs as an opportunity to re-invigorate their clinical practices free of the constraints of working in the public sector. In contrast, the guardians interpreted the change as eroding the principles and values of the NHS and endeavoured to replicate the established ethos, hierarchies and relationships of the NHS in this new setting. Finally the marooned group struggled to come to terms with the changes in their work and longed to return to the NHS.

HealthWatch proposals risk ignoring the voice of child patients

L. Higgs

Children and Young People Now, July 26th-Aug. 8th 2011, p. 12-13

The Health and Social Care Bill sets out plans to establish local and national HealthWatch organisations from April 2012 to gather the views of patients and use their feedback to promote better outcomes in health for children and adults, and social care for adults. Local HealthWatch organisations will be funded through councils and will replace existing Local Involvement Networks. Professionals are concerned that child health could be treated as an ‘add-on’ in these arrangements.

‘Inert’ or improving: the state of medical regulation

N. Dickson and A. Maynard

Health Service Journal, Aug. 25th 2011, p. 16-17

Maynard argues that the General Medical Council (GMC) is ineffective in protecting patients from incompetent doctors. It has failed to put a reaccreditation process in place or to monitor and audit clinical performance. Dickson replies that the GMC is in the process of introducing significant reforms. It is rolling out medical revalidation from 2012, revising its core guide Good Medical Practice, and setting up a team of advisers to support medical directors on revalidation and dealing with under-performing doctors.

Labour ridicules David Cameron's NHS structure

P. Wintour and S. Boseley

The Guardian, Aug. 5th 2011, p. 12

Labour sought to ridicule David Cameron's claims to cut bureaucracy in the National Health Service, by publishing a diagram of the future shape of the NHS that makes Spaghetti Junction look like a Roman road. The party said the complex organogram of the new NHS would leave managers, patients and doctors bewildered as to where responsibility lay. It added that the changes already proposed had been made worse by the government's listening exercise, which led to a fresh layer of organisations being added to an already involved structure.

A lot on your plate

M. Stroud

Health Service Journal, Aug. 25th 2011, p. 26-27

Malnutrition is common in all UK healthcare settings. It is both a cause and a consequence of disease and is associated with poor clinical outcomes and vastly increased costs. The British Association for Parenteral and Enteral Nutrition is proposing a national framework for embedding best practice in nutritional care into the NHS. The new guide for acute trusts will help them meet Care Quality Commission nutrition standards and deliver continuous improvements in nutritional care.

NHS waiting times rise, as Labour blames the cuts

R. Ramesh

The Guardian, Aug. 19th 2011, p. 8

The number of people waiting for NHS care has risen sharply, with hundreds waiting more than a year to be offered treatment, official data shows. With the NHS expected to slash £20bn from its budgets over the next four years, managers have been struggling to ensure that patient care will not be affected by public spending cuts. Despite those efforts, the number of people forced to wait six months has leapt by 61% in a year. The Department of Health released figures showing 11,857 people in June had waited half a year to receive treatment, up from 7,360 in June 2010. The issue has seen Labour and the government trade blows over statistics. John Healey, Labour's shadow health secretary, said: "The NHS is starting to go backwards again under the Tories. Instead of concentrating efforts on improving services for patients, ministers have spent a wasted year forcing through their reckless and damaging NHS reorganisation."

Now lawyers move in to make a killing off Lansley’s NHS reforms

O. Wright

The Independent, Aug. 30th 2011, p. 2

The campaign group 38 Degrees has commissioned an opinion from top lawyers on the Health Secretary’s promise to prevent price competition in the NHS. The opinion, which will be passed on to MPs debating the Health and Social Care Bill, says that, because of EU competition legislation, the Secretary’s promise is meaningless and could be challenged in the courts

Plans for engagement are ‘insulting’

S. Calkin and D. West

Health Service Journal, Aug. 4th 2011, p. 4-5

HealthWatch is due to replace local involvement networks (LINks) in 2012. Its brief includes scrutinising health and wellbeing boards, councils and clinical commissioning groups as well as influencing service development and monitoring quality. There are serious concerns that local HealthWatch groups, which will be run by volunteers, will be unable to fulfil their role of consumer champions due to lack of funding. There is no start-up funding for local HealthWatch pathfinders, no ringfenced money and a potentially minimal uplift to the LINks’ budget.

Professionalization and its discontents

S. Timmons

Health, vol. 15, 2011, p. 337-352

Operating department practitioners in the NHS assist surgeons and anaesthetists in the operating theatre, though their roles overlap extensively with operating theatre nurses. This article shows how the process of professionalization for this occupational group turned out not to offer the benefits and privileges usually assumed (by both aspirant professions and sociologists) to accrue from becoming a profession recognised by the state. The analysis is based on a review of documentation from both within and outside the aspirant profession.

Revolution in genetics exposes NHS flaws

M. Henderson

The Times, August 3rd 2011, p.1, 11

British patients are missing out on a revolution in personally tailored medicine because the NHS is not ready to deliver it. Britain could miss out on the benefits not only for patients but also for the growth of a vibrant new life sciences industry. The warning comes as doctors in Oxford have found the cause of a four-year-old girl’s genetic condition by reading her entire DNA code and those of her parents, in the first case of its kind in Britain. Wider use of genetics is key to achieving the NHS efficiency savings demanded by the Government, by preventing disease and reducing the use of ineffective drugs and unnecessary diagnostic procedures. The Chief Medical Officer has stated that the new NHS Commissioning Board would guide investment in new genetic technologies as they become ready for clinical use.

Talking about a devolution

T. Care

Health Service Journal, Aug. 18th 2011, p. 24-25

Under the coalition government’s plans, control of the NHS will be decentralised and power to shape it will be devolved to local communities. This will be achieved by placing £80bn of funding in the hands of GP-led clinical commissioning groups, by establishing NHS Commissioning Board regional offices to support these groups, by setting up local clinical senates and by strengthening statutory health and wellbeing boards. However the localism agenda may be challenged by large foundation trusts, set up to operate as profit-making businesses.

The use of standard contracts in the English National Health Service: a case study analysis

C. Petsoulas and others

Social Science and Medicine, vol. 73, 2011, p. 185-192

Central to the new public management techniques introduced into public sector organisations in the 1990s is the process of contracting for services. This paper presents findings from a study on health care contracting in the context of the internal market in the NHS in England. It uses economic and socio-legal theories to examine the extent to which implementation of a new, detailed ‘complete’ contract introduced in 2007 conformed to policy intentions and theoretical predictions. Results showed that, despite efforts by the Department of Health to introduce a detailed national standard contract, local relationships remained central to effective contracting. The ‘complete’ contract remained a chimera because of the inherently complex nature of healthcare services and a lack of robust data required for proper forecasting and monitoring of activity.

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