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

40pc rise in patients waiting a year

M. Beckford

Daily Telegraph, Sept. 16th 2011, p. 18

Reports that the number of patients waiting to be seen at hospital more than a year after being referred for treatment had risen by 40% from January 2011. Official figures showed that there were 19, 939 people still on an NHS waiting list in July 2011 after being referred for treatment more than 52 weeks earlier. The figures prompted new claims that the NHS was struggling to maintain levels of care while also facing a massive reorganisation and demands to realise £20bn of efficiency savings by 2015.

£12bn NHS IT system is scrapped

C. Smyth

The Times, September 22nd 2011, p. 8

An NHS computer project to create electronic records for 40 million patients in England that has cost £11.4 billion is to be abandoned and local trusts will be left to develop their own IT systems.

Army of NHS carers 'a disaster in waiting'

C. Smyth

The Times, Sept. 27th 2011, p. 1, 13

The nursing watchdog says that patients risk a 'ghastly national disaster' in the NHS unless ministers get a grip on the growing army of unregulated healthcare assistants. There are thought to be about 300,000 healthcare assistants working in the NHS, but there is no register, and although many have qualifications, including NVQs, there is no compulsory training. The Department of Health said that statutory regulation of healthcare assistants would not be 'proportional and targeted' and is working on a voluntary register.

Claims of cover-up as hospitals fail to disclose complaints

S. Adams

Daily Telegraph, Aug. 26th 2011, p. 12

Foundation trusts have been accused of covering up poor standards and neglect after a large rise in the numbers failing to disclose how many complaints they receive. The annual report by the NHS Information Centre is meant to offer a comprehensive picture of complaints about staff and services. However, the number of foundation trusts failing to submit data on complaints has risen by more than 50% from 18 to 29.

Clegg calls for 'probing questions' on NHS bill

N. Watt and R. Ramesh

The Guardian, Sept. 6th 2011, p. 4

The Tories and Liberal Democrats are facing a fresh clash over the government's NHS reforms after Nick Clegg encouraged his MPs to put 'probing questions' to ministers when the bill returns to the Commons. In a two-hour meeting with his parliamentary party , the deputy prime minister held out the possibility that he would accept amendments to the heath and social care bill when it moved to the House of Lords. Clegg's move means that Lady Williams could be backed by Liberal Democrat ministers if she attempts to amend the bill to guarantee that the health secretary has a legal duty to deliver a comprehensive health service free at the point of need. But a source at the Department of Health indicated last night that Andrew Lansley, the health secretary - who has already amended the bill after the government's 'listening exercise' - would not accept fresh amendments on this point.

Distributing leadership in health and social care: concertive, conjoint or collective?

G. Currie and A. Lockett

International Journal of Management Reviews, vol.13, 2011, p.286-300

This paper integrates literature in the areas of distributed leadership, sociology of professions and public administration, to examine the interaction of distributed leadership with institutional context, as it is enacted in practice. It focuses specifically on the enactment of distributed leadership in the UK health and social care context, and in doing so attends to how the institutional context influences the distribution of leadership. The review is framed around three research questions: 1) what is distributed leadership?; 2) why and how have governments promoted distributed leadership in the public sector?; and 3) does the health and social care context promote distributed leadership?

Drug companies will help plan treatment of patients in NHS

C. Smyth

The Times, Sept. 2nd 2011, p. 8

Drug companies will increasingly plan how patients are treated in the NHS as part of a 'fundamental' overhaul of their relationship with the health service. Ministers and pharmaceutical companies have drawn up a method of how to plan services as the industry adopts a 'different mindset about what's in the best interest of patients'. The British Medical Association said that 'It is essential that stringent firewalls and protocols are in place to ensure that there is no pressure on health professionals to use specific drugs or treatment'.

'Footprint' that counts cost of NHS care

S. Lister

The Times, Aug. 12th 2011, p. 21

'Patients urged to use services more responsibly' The new chief executive of the NHS Confederation said that people must be confronted with their 'care footprint' to persuade them to make better use of limited NHS resources, just as environmentalists have used carbon footprints to shame people into consuming less. The care footprint should differentiate between 'discretionary use' - which can be controlled by lifestyle choices- and 'non-discretionary' requirements such as for accidents and inherited disease.

Foundation trusts: are your governors ready?

D.J. Brown and L. Rippon

British Journal of Healthcare Management, vol. 17, 2011, p. 392-393

The Health and Social Care Bill significantly increases the rights and responsibilities of foundation trust boards of governors. Governors will be able to publish their views on the performance of individual directors and of the trust. They will also act as an advisory panel should the trust be failing. Governors are volunteers and it will be the responsibility of the trust to train them to fulfil their responsibilities adequately.

From awareness to involvement? A qualitative study of respiratory patients' awareness of health service change

T. Kielmann and others

Health Expectations, vol. 14, 2011, p. 321-333

Despite the policy rhetoric, patient involvement in health service decisions remains limited. Barriers include a concern that most patients are unable to see beyond personal aspects of their care and a perception that professionals do not welcome patient involvement. This research aimed to explore respiratory patients' awareness of changes in local health service provision and provide insight into health professionals' attitudes to engaging patients. Participants were not only aware of trends in health service provision but interpreted changes in the light of local and national events. Despite this awareness, none of the patients was formally involved in service development, though some contributed to local voluntary groups. Professionals generally accepted the need for patients' views to be heard.

Gendered forms of othering in UK hospital medicine: nostalgia as resistance against the modern doctor

M. Tsouroufli, M. ÷zbilgin and M. Smith

Equality, Diversity and Inclusion, vol. 30, 2011, p. 498-509

Attempts to modernise the UK National Health Service involve promoting flexible approaches to work and training, restructuring postgraduate training, and increasing control and scrutiny of doctor's work. The medical community has responded with expressed anxiety about the implications of these changes for medical professionalism and the quality of patient care. Drawing on literature on nostalgia, gender, identity and organisations, this paper explores the narratives of 20 senior NHS hospital doctors to identify ways in which they use nostalgia to react to organisational and professional challenges and resist modernisation and feminisation of medicine.

German firm lined up to take over NHS hospital

R. Ramesh

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

A German company has been in talks to take over NHS hospitals, the first tangible evidence that foreign multinationals will be able to run state-owned acute services, a market worth £8bn. On the eve of the last Commons vote on the government's Health and Social CareBill before it heads to the Lords, freedom of information requests revealed a series of meetings focused on 'potential opportunities in London' between officials from the Department of Health, the NHS, the management consultant McKinsey and one of the largest German private hospital chains, Helios. Once EU competition law applies to the health service there would be no barrier to handing over the running of NHS hospitals to non-British firms. Helios has a record of turning around failing hospitals, largely by cutting staff or wage levels. Local politicians have accused it of being motivated more by revenues than by patient care.

(See also The Guardian, Sept. 14th 2011, p. 2)

Good intentions, increased inequities: developing social care services in emergency departments in the UK

P. Bywaters and others

Health and Social Care in the Community, vol. 19, 2011, p. 460-467

Avoidance of emergency hospital admissions is an important issue in the NHS. One approach to admission avoidance is provision of improved social care at the time of an acute hospital presentation. Consequently hospital emergency departments have become the focus for a variety of service developments which combine the provision of acute medical and nursing assessment and care with a range of activities in which social care is a prominent feature. This study, carried out between September 2007 and April 2008, was the first national survey of social care initiatives based in hospital emergency departments and aimed to determine the objectives, organisation, extent, functions, funding and evidence on outcomes of such interventions. About one third of respondents had embedded social care teams, while two thirds relied on referrals to external social services. The unintended effect of these initiatives has been to increase inequities in access to social services through emergency departments.

Health, behaviour and society: clinical medicine in context

J. Cleland and P. Cotton (editors)

Exeter: LearningMatters, 2011

There is more to a person than a particular symptom or disease: patients are individuals but they are not isolated; they are part of a family, a community, an environment, and all these factors can affect in many different ways how they manage health and illness. This book provides an introduction to population, sociological and psychological influences on health and delivery of healthcare in the UK in order to prepare students for clinical practice.

Health service chief challenges Lansley's reforms

N. Watt

The Guardian, Sept. 28th 2011, p. 12

The government's health reforms have run into further trouble due to the chief executive of the NHS publicly challenging a key proposal. As peers prepared to table a series of amendments to the Health and Social Care Bill, Sir David Nicholson said the government was wrong to block failing foundation hospitals from returning to direct NHS control. Andrew Lansley, the health secretary, wants to repeal a provision in the 2006 National Health Service Act which allows for the 'de-authorisation' of failing foundation trusts, triggering their return to NHS control. The change is designed to strengthen foundation trusts which will eventually take over the running of all hospitals in England. In evidence to the public inquiry into failings at the Mid-Staffordshire NHS Trust, Nicholson called on the government to retain the renationalisation of a failing trust in its 'armoury'. Nicholson is understood to have voiced, in private, reservations about the Lansley plan, which was introduced as an amendment to the Bill after the government's 'listening exercise' on the NHS reforms.

Hospitals will face a wave of closures, minister admits

M. Beckford and J. Kirkup

Daily Telegraph, Sept. 21st 2011, p. 2

The Coalition government has recognised that hospital service closures are inevitable due to a virtual freeze in the NHS budget, while demand rises due to population ageing. At the same time, the NHS has been ordered to find £20bn in efficiency savings by 2015. However reconfiguration plans are often resisted by local MPs, councillors and voters.

Integration and the NHS reforms

G. Wistow

Journal of Integrated Care, vol.19, no.4, 2011, p. 5-13

This study considers whether the framework for the integration of the responsibilities of local councils and the health service proposed in the 2010 White Paper Liberating the NHS is likely to be more successful than previous attempts. It formulates ten principles of integration derived from a historical literature review, and makes a comparison with principal features of new proposals in the White Paper for promoting integration between the NHS and local government in England. It is concluded that there is a relatively good fit between the principles and the proposals, but gaps are identified and implementation difficulties are already becoming evident especially in respect of the tension between localism and national accountability.

Intelligent kindness: reforming the culture of healthcare

J. Ballatt and P. Campling

London: RCPsych Publications, 2011

The book presents a new approach to healthcare reform. It argues that the NHS is a system that invites society to value and attend to its deepest common interests; it is a vital expression of community and one that can improve if society, patients and staff can reconnect to these deeper values. To do so will improve quality and patient experience, as well as morale, effectiveness, efficiency and value for money. Relentless regulatory and structural NHS reforms have failed to avert scandals and left many health service staff feeling alienated. Industrial and market approaches to reform, whatever their merits, urgently need to be balanced by an applied understanding of what motivates and assures compassionate practice.

Lansley told to water down NHS reforms

O. Wright

The Independent, Sept. 21st 2011, p. 8

Liberal Democrat Baroness Williams has said Andrew Lansley, the Health Secretary, would have to make further concessions if the Government's NHS reform bill is to be given the go ahead in the Lords. LibDem campaigners want the bill to secure the Health Secretary's ultimate responsibility for the NHS as well as the retention of caps on how much income hospitals can get from treating private patients. Another worry regarding the current bill is how much work foundation trusts can do.

'Let best NHS trusts form hospital chains'

S. Lister

The Times, Aug. 18th 2011, p.5

'Call for lost causes to be taken over by the strong' The latest report by the accountants KPMG suggests that the best NHS hospitals should be encouraged to set up 'chains' by taking over poor performing trusts and making them clinically and financially sustainable.

Limited choice is sent packing

E. Zanon

Health Service Journal, Sept. 1st 2011, p. 22-23

The EU directive on cross-border healthcare will come into force in the UK in October 2013. The directive aims to make it as easy as possible for patients to access healthcare abroad, subject to the same conditions that apply to accessing it at home. In the case of the NHS, patients will be required to have their eligibility for healthcare abroad authorised by their GP. The directive also lays down that commissioners are not required to pay more than the cost of a patient's treatment if it were provided by the NHS.

Medics urge royal colleges to resist 'unpopular' NHS reform

R. Ramesh

The Guardian, Sept. 12th 2011, p. 6

More than 150 scientists, surgeons and doctors have written to NHS professional bodies calling on the medical establishment to demand that the government withdraws its controversial health bill. Co-ordinated by the NHS Consultants' Association, the medics have written to presidents of the royal medical colleges urging them to stop co-operating with the government's proposed NHS reforms. The move comes as the British Medical Association begins to mobilise a public campaign against the bill, and coincides with the suggestion of Clare Gerada, chair of the Royal College of General Practitioners, that family doctors hire lawyers to cope with the conflicts of interest they would face over the commissioning reforms.

MPS back health Bill but peers plan an ambush

S. Lister

The Times, Sept. 8th 2011, p. 5

The Government's controversial plan to overhaul the NHS survived an important vote in the Commons when it received the backing of MPs by 316 votes to 251. This was the third reading of the Health and Social Care Bill so it can now pass to the Lords. An attempt to alter the abortion law for the first time in a generation was overwhelmingly rejected by MPs.

New nurses lack caring skills, says RCN chief

C. Smyth

The Times, Sept. 22nd 2011, p.1 & 8

Peter Carter , the Chief Executive of the Royal College of Nursing, stated that many new nurses arrivd in hospital incapable of caring for patients because they had spent too much time in the classroom and not enough on the wards. Matters were made even worse because the NHS was becoming increasingly reliant on unregulated and untrained healthcare assistants to do the basic nursing. With no automatic way of striking off healthcare assistants, even those accused of severe abuses, they could be re-employed elsewhere.

NHS chiefs 'blocking access to disease tests'

M. Beckford

Daily Telegraph, Sept. 8th 2011, p. 2

Research found that a quarter of primary care trusts were investigating how many patients individual GP practices referred for diagnostic tests or were looking for ways to reduce demand. In addition, a handful were identifying excessive use of tests, setting upper limits or refusing to let GPs have direct access. There are concerns that these tactics could delay the diagnosis of patients with life threatening diseases such as cancer.

NHS leaders deny Cameron's claim they now support reform

N. Watt

The Guardian, Sept. 8th 2011, p. 7

David Cameron faced embarrassment when medical leaders rejected his claim that they supported the government's health reforms. The row came hours before the Health and Social Care Bill was approved by MPs, after Cameron hailed the profession's support at prime minister's questions. 'Now you've got the Royal College of GPs, the physicians, the nurses, people working in the health service, supporting the changes we're making,' he said. The bodies questioned the prime minister's claim. Peter Carter, general secretary of the Royal College of Nursing, told the BBC: 'While we acknowledge that the government has listened to our members in a number of areas, we still have very serious concerns about where these reforms leave a health service already facing an unprecedented financial challenge.'

NHS may give women right to caesarean

M. Beckford

Daily Telegraph, Sept. 7th 2011, p. 2

Draft guidance from the National Institute for Health and Clinical Excellence states that doctors should try and dissuade women from demanding costly elective caesarean sections. However, if a vaginal birth is not an acceptable option after counselling, a caesarean should be offered. The NICE guidance goes against attempts by many NHS managers to save money by reducing the number of women having caesareans.

Old 'neglected to meet NHS targets'

M. Beckford

Daily Telegraph, Sept. 29th 2011, p. 2

A report from the Royal College of Surgeons claimed that up to half of the oldest patients undergoing some types of operation died each year due to poor treatment. It warned that patients languished in general wards rather than being given critical care, were seen by junior doctors rather than consultants, and suffered delays in treatment. Many developed dangerous infections. It was claimed that part of the reason for this situation was that NHS hospitals put more effort into meeting waiting time targets and seriously under-prioritised the care of elderly patients.

Patient and public involvement in the restructured NHS

A. Coleman and others

Journal of Integrated Care, vol. 19, no.4, p. 2011, p. 30-36

The Coalition government's plans for health service reform set out in the 2010 White Paper Equity and Excellence and the Health and Social Care Bill include proposals which emphasise individual patient choice and the need for local NHS bodies to be responsive to be responsive to collective public and patient opinion as expressed through local councils and local HealthWatch. This article looks at the mechanisms which are being proposed for taking public and patient involvement forwards, examines their potential impact and sets out reservations. It is argued that the legislation contains nothing that will guarantee more effective engagement with either patients or the public.

Policy entrepreneurship in the development of public sector strategy: the case of London health reform

E. Oborn, M. Barrett and M. Exworthy

Public Administration, vol. 89, 2011, p. 307-324

John Kingdon's 1995 'policy windows' model considers the role of individual agency within the policy process as well as explaining why change occurs (or not). It is argued that the role of individual agency in Kingdon's model needs more conceptual and theoretical elaboration and to be supported by more empirical evidence. This paper seeks to address this gap and contributes insight into the key role of a policy entrepreneur, not only in opening policy windows but also in yoking together a network to make policy agendas happen. It draws on an in-depth study of health policy formulation which focuses on the role of celebrated surgeon Sir Ara Darzi as a policy entrepreneur, who actively sought to build a network of strong allies and enlist their support in opening policy windows.

Resisting the urge to undervalue the future

J. Mackenzie

British Journal of Healthcare Management, vol. 17, 2011, p. 400-405

The NHS faces a significant gap between the resources needed to maintain clinical quality and the resources available in 2020. Addressing this gap requires a transformational change in how the NHS configures and delivers its services. It does not currently consider future sustainability with a suitable degree of strategic weight when making decisions about service configurations. Including sustainability as a core domain of how the NHS measures and assesses quality can provide a longer term strategic focus. Sustainability can act as a moderator of the other domains of quality (i.e. by examining how the system uses finite resources whether financial, natural or human capital) and can help close the resource gap.

Rewrite the admissions rules

S. Rowe

Health Service Journal, Sept. 1st 2011, p. 18-20

Reductions in emergency admissions will feature heavily in primary care trusts' plans to save money, yet they are an area in which the total level of paid activity per financial year has increased. Efforts to cut emergency hospital admissions typically focus on reducing use by 'frequent flyers', but an approach akin to health screening could be more fruitful. The entire population of a practice could be contacted to ask about their general health, with a view to early identification of problems.

Should the NHS look to the USA for a new paradigm?

D. Bowden

British Journal of Healthcare Management, vol.17, 2011, p. 406-410

The UK government is flirting with moving towards a more market-driven healthcare system. Based on his experience in the USA, the author discusses the hidden dangers of such an approach. A market-based healthcare delivery system will come into conflict with the ethical mandate to provide equal access to medical care. It will also be at the mercy of well-funded special interest groups and the media, which will work to mould public opinion. A market-driven system would put large sums of public money into the hands of private firms to buy care, and would effectively be putting the thieves in charge of the jewellery shop.

The state of health care and adult social care in England: an overview of key themes in care in 2010/11

Care Quality Commission

London: TSO, 2011 (House of Commons papers, session 2010/12; HC 1487)

The Commission's third annual report on the state of health and social care in England reports that only 51% of NHS hospitals met standards that ensure patients receive effective, safe and appropriate care. The Commission had moderate concerns about 26% and major concerns about 7%. It also found that a third of hospitals were failing to meet standards on handling medicines safely and a fifth were not treating elderly patients with dignity or ensuring that they had enough to eat and drink. In addition, only 51% of nursing homes were meeting standards. Councils were found to be restricting support to elderly and disabled people with the most severe difficulties, and mental health trusts were cutting jobs to save money.

Surgery delayed 'to lower expectations'

M. Beckford and K. Little

Daily Telegraph, Sept. 5th 2011, p. 2

An investigation has shown that at least 10 primary care trusts have told hospitals to increase the length of time before they see patients in order to save money. In some areas patients faced delays of 12-15 weeks after GP referral, even though the hospital could have seen them sooner. The disclosures have been seized on by government as more evidence of the need for health service reforms.

The tender trap: back to the future?

J. Edmonstone

British Journal of Healthcare Management, vol. 17, 2011, p. 371-374

External consultancy has a bad name in the NHS, and is associated with waste of money. Before consultants are appointed they are required to bid or tender for the work. This bidding process has many disadvantages for consultants including unclear project briefs, short closing dates for tender submission, plagiarism by competitors, and the transitory relationship between the client and the consultancy. The author suggests an alternative approach involving a partnership team made up of senior managers from the client organisation and consultants working together over a long period to steer the work.

This marriage is going to take work

M. Britnell

Health Service Journal, Sept. 22nd 2011, p. 18-19

The NHS currently operates using two business models that are no longer fit for purpose: the general hospital and the primary care practice. This has resulted in sub-optimal care and costs. The challenge is to move towards a new model of integrated care services. The NHS reforms proposed by the Coalition government offer an opportunity for the introduction of integrated care organisations run from hospitals or clinical commissioning groups.

Time to stand up and be counted

K. Walshe

Health Service Journal, Sept. 1st 2011, p. 14-15

The Department of Health has talked for many years of devolving power and responsibility to the frontline of the NHS. However, the reforms being implemented by the Coalition government will reinforce central control through the creation of a new quango, the NHS Commissioning Board. On the other hand the reforms do present an opportunity for real change. NHS foundation trusts could use their freedoms to demonstrate their independence from government. The new health and wellbeing boards could become bastions of democratic legitimacy at the local level, prepared to stand up to the Department of Health, Monitor and the Commissioning Board. Managers and GPs could put aside their differences and work together to make clinical commissioning groups forces for local change.

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