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

400 health experts say reforms will cause 'irreparable harm' to the NHS

M. Beckford

Daily Telegraph, Oct. 4th 2011, p. 2

In an open letter to peers published in the Daily Telegraph, 400 public health specialists argued that the reforms enshrined in the Health and Social Care Bill would weaken the ability of the authorities to fight disease outbreaks and tackle health emergencies. They called on peers to reject the passage of the Bill. The intervention looked set to dismay ministers , who had hoped that opponents of the NHS reforms had been won over by the watering down of proposals in an unprecedented 'listening exercise' in the Spring of 2011.

Burnham: kill NHS bill and we will co-operate

P. Wintour and M. Taylor

The Guardian, Oct. 10th 2011, p. 4

Labour has changed tack on health policy, saying it would be willing to co-operate with the government on giving GPs greater commissioning powers, but only if ministers drop the Health and Social Care Bill, due to be debated in the Lords in October 2011. In his first act as shadow health secretary since his appointment, Labour's Andy Burnham said he was happy to see GPs given greater power to commission services, describing his appointment as a fresh start for Labour on the NHS. He said: "It's quite clear that the health secretary has failed to establish a consensus in the country behind his reforms. My message to him is please, stop digging in. The more he digs in, the more he is putting our National Health Service in the danger zone. This is a genuine offer that I am making to him - drop your bill and we will work with you constructively to reform NHS commissioning".

Call for inquiries at 36 NHS hospital trusts with high death rates

S. Boseley

The Guardian, Oct. 28th 2011, p. 13

Death rates in 36 hospital trusts in England are higher than expected, according to the Department of Health, which wants management and doctors to investigate why. Out of 148 trusts, the George Eliot hospital NHS Trust in Nuneaton, Warwickshire, was the worst performer last year, Next came the Isle of Wight, East and North Hertfordshire, Blackpool, Tameside, Medway, York and Basildon and Thurrock. George Eliot immediately ordered a review of its death rates. Its chief executive, Kevin McGee, said: 'We have instructed external experts to undertake a robust review to understand what is causing a consistently high rate'.

Clean bill of health?

R. Lewis

Public Finance, Oct. 2011, p. 28-31

Under the amended version of the Health and Social Care Bill before Parliament price competition is dead for the foreseeable future. This article looks at research on whether or not competition on quality in a fixed price market raises standards. Research on the impact of fixed price competition under payment by results in the NHS found that increased competition was associated with better quality care. However, the validity of the research has been subject to criticism. It has been argued that the measure of quality used - death from heart attack within 30 days of hospitalisation - is not a good proxy for overall quality of care because it relates to emergency and not elective treatment.

Doctors from overseas must speak English or be banned

R. Winnett and A. Porter

Daily Telegraph, Oct. 4th 2011, p. 1

Following a series of scandals in which patients died or suffered poor care as a result of foreign doctors speaking sub-standard English, the health secretary announced plans to amend the Medical Act to lay a duty on local NHS trusts to check the language skills of overseas trained doctors before they could be employed. He also stated that the General Medical Council would be given powers to take action against doctors when there were concerns about their ability to speak English.

Emergency staff to be told if you want to live or die

R. Winnett

Daily Telegraph, Oct. 12th 2011, p. 1 + 2

Seriously ill patients will be encouraged to record their wishes about end-of-life care on their electronic health records. This information will be available to NHS staff including paramedics and out-of-hours doctors. It is intended to ensure that the patient's wishes, typically to die at home rather than being taken to hospital, are respected.

Emerging clinical leadership development in the NHS

S. Moll and others

British Journal of Healthcare Management, vol. 17, 2011, p. 481-485

There is an appetite for engaging junior doctors in clinical leadership development in the NHS, as well as senior colleagues. Most previous initiatives have been aimed primarily at leadership development among senior doctors. However, opportunities to engage more junior colleagues in clinical leadership and medical management within the NHS have started to appear. In the NHS Next Stage Review in 2008, Lord Darzi called for the establishment of clinical leadership fellows to support clinicians with a particular interest in leadership. Within the North-West 14 such posts were piloted in 2009/10, identifying and recruiting emerging clinical leaders from multidisciplinary backgrounds. This article highlights some of their experiences and lessons learnt.

Foundation trust performance: a quantitative study

G. Pollio and G. Simonyan

British Journal of Healthcare Management, vol. 17, 2011, p. 462-469

This study investigates how well foundation trusts - given their unprecedented degree of autonomy in both governance and financial management - balance the volume, quality and costs of medical services to achieve the best results in terms of their performance. It also examines whether actual foundation trust performance is in line with the assumption that implementation of clinical governance measures would lead to improved results. Results based on a sample of 55 trusts showed that better quality of care was associated with higher volumes of services and better financial performance.

Hospitals to face spot checks in drive to lift standards

R. Winnett

Daily Telegraph, Oct. 26th 2011, p. 1 + 2

The health secretary announced that hospitals and care homes would face more unannounced inspections because of growing fears of a deterioration in patient care. He also announced that about 50 NHS trusts in financial difficulty would be bailed out by the taxpayer.

How is the NHS performing? October 2011 quarterly monitoring report

The King's Fund, 2011

Many NHS hospitals will struggle to deliver productivity improvements essential to maintaining quality and avoiding significant cuts to services, according to the October quarterly monitoring report from the King's Fund. This is the third quarterly monitoring report produced by the Fund as it aims to provide a regular update on how the NHS is coping as it grapples with the evolving reform agenda as well as the more significant challenge of making radical improvements in productivity.


Liberal Democrat peers end war with Tories over reform of NHS

A. Stratton

The Guardian, Oct. 26th 2011, p. 16

Senior Liberal Democrat peers once critical of the government's NHS bill signalled an end to the parliamentary rebellion as the health secretary, Andrew Lansley, made a key concession on one of their remaining concerns. In a letter to the Guardian, 32 peers said the time "for declaratory statements is past", as the Department for Health announced it would be accepting a Lib Dem amendment that the secretary of state should remain responsible for health service provision across England. Previously, Malcolm Grant, the government's choice to run the powerful NHS commissioning board, had outlined "an extraordinary transformation of responsibility" in the Health and Social Care Bill, through the shift of responsibility for day-to-day running of the health service from ministers to the quango. But the government said it would accept the Lib Dem amendment. A government source said it felt the secretary of state's role had always been clear, but was happy to make the situation clearer to satisfy the Lib Dems.

A licence to manage?

A. Moore

Health Service Journal, Oct. 13th 2011, supplement, 7p

Following a series of high profile scandals, there have been increasing calls for NHS managers to be regulated, and the government is considering introducing national standards with accountability. In this supplement a panel of experts considers possible regulatory structures and mechanisms, including ideas such as a 'General Management Council', a contractual code of conduct, and licences to certify managers' skills.

Modernisation as a professionalising strategy: the case of critical care in England

J. Green and others

Sociology of Health and Illness, vol. 33, 2011, p. 819-836

This paper explores how critical care staff made sense of the 'modernisation' of the health service under the New Labour governments. Modernisation programmes in critical care were reported to have shifted both its organisation and content in ways that resonate with broader changes in the public sector. Critical care was described as increasingly standardised, and the organisation of Critical Care Units as characterised by more equal relationships between doctors and nurses, greater inclusion of allied health professionals, and an enhanced status for the emergent speciality. In contrast to other settings, modernisation processes were regarded positively. It is suggested that critical care staff utilised modernisation as a strategy for professional gain which brought them greater autonomy and authority. Their responses to change were neither resistant nor compliant, but sceptically strategic.

National Health Service boards of directors and governance models

G. Veronesi and K. Keasey

Public Management Review, vol. 13, 2011, p. 861-885

This study investigated how NHS boards have dealt with the introduction of network-governance principles by New Labour governments in light of the increased importance of non-bureaucratic and non-market models of co-ordination. The evidence gathered shows that the behavioural dynamics of boards effectively act as antecedents of the implementation of different governance models. Accordingly, the policy makers' design appears to have received mixed implementation in the sense that only a portion of the board population has effectively incorporated in its modus operandi post-New Public Management principles of governance.

NHS fails some critically ill children, experts say

S. Boseley

The Guardian, Oct. 27th 2011, p. 9

More than a quarter of the children who die after emergency NHS surgery in the UK have not received the best possible care, according to an authoritative study. The investigation, by experts in children's care, found that there were often delays in transferring very sick children from district to specialist hospitals where they would have the best chance. Many hospitals did not have appropriate systems for managing children's pain and families were not properly warned that their child might die during or after their operation. NCEPOD (the national confidential inquiry into patient outcome and death) wants to see all hospitals operating on children become part of clinical networks, where they can share resources and skills. Even though it is recognised as good practice, only half the hospitals in the review were part of such a network.

NHS patients waiting longer for scans

D. Campbell and J. Ball

The Guardian, Oct. 6th 2011, p. 16

A growing number of patients are not receiving a diagnostic test such as an x-ray or ultrasound scan within the NHS's recommended six-week waiting time, official figures show. The tests, which detect conditions such as cancer and heart problems, are regarded as vital by doctors, and are one of the most politically sensitive of the health service's waiting time targets. David Cameron and the health secretary, Andrew Lansley, have repeatedly pledged to keep all NHS waiting times low, despite the service facing rising demand and a financial squeeze. The numbers of patients waiting longer than recommended to be treated in hospital after referral by their GP has risen as well. Monthly performance data released by the Department of Health (DH) for August shows that more people in England are not receiving one or more of 15 key diagnostic tests undertaken by the NHS within six weeks. At the end of August, 11,400 patients had been waiting longer than six weeks. That was up by 700 from the previous month and by 5,500 on the same month last year.

NHS Reform Bill survives Lords vote

M. Beckford

Daily Telegraph, Oct. 13th 2011, p. 6

Amid deep concern in the medical profession and among many members of the public, some peers tried to have the controversial Health and Social Care Bill rejected or subjected to detailed scrutiny that would have ruined the government's timetable. However, following two days of debate in the upper house, and pressure applied by ministers and whips to Tory and Liberal Democrat peers, attempts to delay or throw out the Bill were rejected comfortably.

NHS urged to improve care after miscarriage

S. Boseley

The Guardian, Oct. 10th 2011, p. 9

A campaign has been launched to improve the care given to the thousands of vulnerable women who do not get the support and understanding they need from the NHS when they suffer a miscarriage. Some women, says the website Mumsnet - which is launching the campaign with the backing of doctors and other experts - have to wait several desperate days for the scan that will confirm their baby is dead, while many others are unthinkingly treated in hospital in the same wards and rooms as women who are pregnant or have new babies.

NHS's slowness to change 'killing people'

C. Smyth

The Times, Oct. 12th 2011, p. 11

'Surgeon says life-saving ideas are not taken up'. Professor Norman Williams, President of the Royal College of Surgeons, has said that patients are dying because the NHS is too slow to adopt better ways of doing surgery with Britain lagging decades behind other countries in using safer and less invasive techniques. He urged the health service to create a system that would ensure that the 4.5 million people who have operations each year receive the most up to date care.

Nurses say they are too busy to do a proper job


Daily Telegraph, Oct.3rd 2011, p.2

A 2011 survey of nurses and healthcare assistants working in the NHS revealed that 52% felt their workload was too heavy and 32% thought that the quality of patient care was falling. The poll also found that 5% of respondents thought they would be made redundant within a year. A further 6% expected reduced hours and 7% thought they would be downgraded. Four out of ten said they were seeing recruitment freezes, 19% reported job cuts and 13% were witnessing bed or ward closures. The survey provided evidence for an attempt to amend the Health and Social Care Bill during its passage through the Lords to require safe staffing levels.

Peers and BMA attack Lansley's NHS reforms

N. Morris

The Independent, Oct. 1st 2011, p. 15

A cross-party group of peers called for the Health and Social Care Bill to undergo further changes. The Lords Constitution Committee warned that proposed reforms failed to enshrine in law the health secretary's ultimate responsibility for the NHS. Meanwhile, the British Medical Association (BMA) called for the Bill to be scrapped altogether. Critics of the Bill said they feared that incumbent and future health secretaries, if the Bill became law in its current form, might see their responsibilities with regards to the NHS diluted.

(See also The Guardian, Oct. 4th 2011, p. 6; the Independent, Oct. 11th 2011, p. 1, and Independent, Oct 12th 2011, p. 2)

Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring

F. MacFarlane and others

Sociology of Health and Illness, vol. 33, 2011, p. 914-929

This paper describes the findings of a study to explore how senior managers in the UK National Health Service coped with changes over a 40 year period as new management and governance structures were introduced at all levels within the service. Successful senior NHS managers appeared to share three important survival features. First, they drew eclectically and sometimes unconsciously on a wealth of practical, tacit knowledge gleaned over time from accumulated experience in diverse NHS settings. Secondly, their identities were strongly linked to what they interpreted as the values, ethos and culture of the NHS, a powerful brand which seemed to transcend the various structural transitions introduced by successive governments and policy initiatives, and which strengthened their identity and sense of purpose in the face of change. Thirdly, they had rich social networks comprising other NHS managers on whom they could call for information, support and ideas.

The psychological contract and health policy reforms

T. Ojo

British Journal of Healthcare Management, vol. 17, 2011, p. 452-456

From a human resource management and employee engagement perspective, the radical reforms proposed by the coalition government threaten the existing psychological contract employees have with the NHS in many ways. This article explores the extent and nature of these threats and attempts to predict potential consequences for the attainment of the government's desired outcomes.

Quango will hold NHS power, leak reveals

R. Ramesh

The Guardian, Oct. 24th 2011, p. 15

The health secretary will "franchise" the running of the NHS to a quango for up to three years at a time - a move that will result in an unelected academic and the nation's 38,000 family doctors, rather than ministers, being accountable for the day-to-day running of the health service, according to leaked documents obtained by the Guardian. In unpublished evidence to the health select committee, Malcolm Grant, the government's choice to run the powerful NHS commissioning board, outlined "an extraordinary transformation of responsibility" that appeared to undermine claims by ministers that the proposed legislation would not dilute the government's constitutional responsibilities to the health service.

Register of untrained health workers is still 'years away'

C. Smyth

The Times, Oct. 10th 2011, p. 18

Patients will have to wait years before the growing army of untrained healthcare assistants in the NHS is covered by the Government's promised voluntary register. It would be better copying the Scottish policy of imposing a binding code of conduct for healthcare assistants. The government says that failures of basic care will only be solved by better management, not regulation. A Department of Health spokesman said 'We expect to make progress on a voluntary register of social care workers by 2013 and hope to establish a voluntary register of healthcare support workers in parallel.'

Trust trains its own nurses to nurture better 'attitudes'

C. Smyth

The Times, October 4th 2011, p. 11

The Heart of England NHS Foundation Trust based in Birmingham is reverting to the in-house training that was standard before nursing was made a university qualification in the 1990s. It is setting up its own nurse training scheme believing that some nursing degrees are too academic, neglecting 'attitudes and behaviour - for people to get well you have to get the fundamentals right.' The Heart of England Trust feels that in some universities the balance between theory and practice is wrong. The course will be bound by national curriculum standards.

Wasting lives 2011: a statistical analysis of NHS performance since 1981

J. O'Connell

London: Taxpayers' Alliance, 2011

Analysis of mortality figures from the World Health Organisation suggested that there were almost 12,000 extra deaths from treatable diseases in Britain in 2008 compared with the average rates for other European countries, including the Netherlands, France and Spain. The report argues that the failure of the NHS to match standards achieved by other European health systems was not due to underfunding but to centralisation, political interference and insulation from competition.

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