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

1,500 lung cancer deaths 'unnecessary'

D. Campbell

The Guardian, Nov. 3rd 2011, p. 13

About 1,500 lung cancer patients die unnecessarily every year because they are not offered an operation and too few NHS surgeons are skilled in removing tumours, a report warns. Most hospitals offer surgery to far fewer patients than the 30% of people with the disease who doctors believe would benefit from treatment, according to an audit of 400,000 lung cancer operations since 1980 by the Society for Cardiothoracic Surgery.

Are foundation trusts able and willing to exercise autonomy? 'You can take a horse to water ...'

M. Exworthy, F. Frosini and L. Jones

Journal of Health Services Research and Policy, vol.16, 2011, p. 232-237

Foundation trusts (FTs) have been a central feature of NHS reforms in England since 2004. They illustrate recent policy emphasis on decentralisation of decision-making to more local levels. This article explores the ways in which FTs have exercised their autonomy from central government. It argues that while the ability of FTs to exercise autonomy is in place, they have shown no great willingness to exercise it. Such unwillingness may be because of continued centralisation, unclear policy and financial regimes, fear of negative impacts on relations with other local organisations, and awareness of greater risks to the FT, among others.

Are we there yet?: a review of organisational and clinical aspects of children's surgery

D.G. Mason and others

National Confidential Enquiry into Patient Outcome and Death, 2011

The report found that less than half of NHS hospitals are part of a paediatric surgery network. Such networks are crucial to ensure comprehensive and integrated delivery of high quality care for children who undergo surgery. The research noted that 71% of patients received good care and significant progress had been made since previous reports in 1989 and 1999, but found a number of areas requiring improvement. For example, it highlighted delays in transferring sick children with complex needs to a specialist centre for surgery, and revealed that nearly one in five hospitals did not have a comprehensive policy for identifying and managing sick children. Cases were also found where a hospital had insufficient nurses trained to provide immediate care for sick children when admitted.

Assessments show increasing risks to patients in NHS reform

R. Ramesh and J. Ball

The Guardian, Nov. 25th 2011, p. 15

The government's shakeup of the NHS has led to a decline in public confidence, 'may destabilise existing services' and has raised risks to patient safety and safeguarding children to disturbing levels. The risk assessments, which are publicly available, were prepared for the September board meetings of regional strategic health authorities and detail the scale of uncertainties and the chances that they will substantially affect the running of the health service for patients. They come as the NHS published its 'operating framework' in which 1.2bn will be set aside to pay for the government's reforms. Two controversial changes also come into force this year. First is that patient 'choice' will be measured by an increasing 'number of patients being treated at non-NHS hospitals', which critics say amounts to backdoor privatisation. Second is that GPs will no longer get extra cash for having needy patients. Instead family doctors will receive a 25 a head 'running allowance'. That means GPs in poor areas will lose about 12,500.

Caesareans for all as midwife shortages 'leave women in fear'

S. Adams

Daily Telegraph, Nov. 23rd 2011, p. 6

The National Institute for Health and Clinical Excellence recommended in November 2011 that women should always have the right to a Caesarean delivery, even if they had no physical or mental health need. The new guidelines were prompted by concerns that some mothers were afraid to give birth naturally on Britain's understaffed labour wards.

Coalition forced into U-turn on NHS waiting time targets

D. Campbell and J. Ball

The Guardian, Nov. 18th 2011, p. 1

The government was forced to abandon its opposition to NHS waiting time targets and introduce a new rule to halt the growing number of patients not being treated within the promised 18 weeks. The U-turn was a surprise because the health secretary, Andrew Lansley, had previously criticised waiting times measures introduced by Labour to speed up patient care as 'arbitrary Whitehall targets'. But fresh evidence that waiting times were creeping up, despite David Cameron's pledge to keep them low, forced Lansley to change tack and impose an extra treatment directive on the NHS. He had previously castigated targets as unnecessary, likely to distort NHS staff's clinical priorities and part of a bureaucratic 'top-down' system he intended to overhaul.

Cut out the last of the long waiters

A. McKeever and R. Findlay

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

Eliminating excessive waiting times for treatment is challenging for the NHS. However, the 1991 Patient's Charter made treating patients who had waited over two years a top priority. A backlog of some 42,000 two year waiters was then cleared in 80 working days thanks to use of production engineering, invocation of shared values, and determined leadership. If these principles were applied again in 2011, the NHS could achieve a guaranteed one-year maximum wait from referral to treatment in England.

Draw battle lines over local need

E. Harding and M. Kane

Health Service Journal, Nov. 3rd 2011, p. 26-27

The government has made it clear that joint strategic needs assessment, and the new joint health and wellbeing strategy it is meant to drive, will form the cornerstone of local priority setting and decision-making. Introduced in 2007, the joint strategic needs assessment is a process to identify current and future health needs of a local population, build stronger partnerships and lead to agreed commissioning priorities to improve outcomes and reduce health inequalities. This article offers advice on reviewing and improving the process.

First rise in patients on mixed wards since ban

R. Smith

Daily Telegraph, Nov. 18th 2011, p. 1

The number of patients being treated on mixed-sex wards increased in October 2011 for the first time after the practice was banned in 2010. At that point hospitals were warned that they would be fined for each breach. The October 2011 rise in breaches was blamed on public spending cuts by the Patients Association.

Greater risk of dying in hospital at the weekend

M. Beckford and C. Quilty-Harper

Daily Telegraph, Nov. 28th 2011, p. 1 + 2

The 2011 annual Dr Foster hospital guide used official figures to show that one in eight hospital trusts had higher than expected death rates at the weekend. In a handful of trusts the mortality rate rose by 20% or more at weekends. Many hospitals had far fewer senior consultants on site outside of normal office hours. They relied on junior doctors and nurses to treat critically ill patients. The 2011 edition of the guide used a new mortality rate which included all deaths within 30 days of discharge from hospital. It also considered deaths after complications from surgery and deaths among patients thought to be low risk. The analysis of all 147 NHS acute trusts identified 19 where death rates were higher than expected on both ratios.

(See also The Guardian, Nov. 28th 2011, p. 5)

Health watchdog faces investigation as concerns mount

R. Ramesh, D. Campbell and A. Bawdein

The Guardian, Nov. 15th 2011. p. 1

The watchdog responsible for overseeing NHS hospitals and care homes was urgently investigated in 2011by the Department of Health (DoH) over a series of alleged failures that could have risked patient care. DoH officials and NHS bosses acted after mounting concerns about the Care Quality Commission (CQC). The CQC's chief executive, Cynthia Bower, was questioned by Una O'Brien, the health department's permanent secretary, before a team of Whitehall officials descended on the watchdog's headquarters in the City. The inquiry coincided with investigations by the National Audit Office and the Commons Public Accounts Committee.

(See also The Guardian, Nov. 25th 2011, p. 10)

It's a matter of clear principles

D. Redding

Health Service Journal, Nov. 24th 2011, p. 28-29

This article describes the principles that should guide commissioners, regulators and professional groups in planning and delivering integrated care services. Integrated care must be organised around the needs of individuals, be focused on benefiting service users, be evaluated on the basis of its outcomes, be inclusive of voluntary sector contributions, be designed to work with carers, and be genuinely sensitive to the needs of minority ethnic groups.

Lansley: 'I have no plans to change CQC'

D. West

Health Service Journal, Nov. 17th 2011, p. 4-5

In this exclusive interview, health secretary Andrew Lansley confirmed that, apart from asking it to carry out more inspections, he had no plans to reform the Care Quality Commission. He also advocated the model of accountable care organisations, which are most commonly associated with the US healthcare sector, to drive integration. These are networks of providers which are given a pooled budget for patient care and are monitored on their performance.

Leadership and workforce

H. Mooney (editor)

Health Service Journal, Nov. 10th 2011, p. 19-22

In a time of unprecedented change and financial austerity, the NHS needs to incentivise, engage and train its entire staff to maximise performance through innovative and collaborative working. The jobs of managers and clinicians especially will change under the coalition government's NHS reforms. In order to support the emergence of leaders across the NHS, the government has announced the launch of a new Leadership Academy to help develop them. The academy will be charged with setting national standards for leadership development, preparing 'aspiring leaders' and challenging 'poor and inappropriate leadership behaviour'.

Lesbian and bisexual women's human rights, sexual rights and sexual citizenship: negotiating sexual health in England

E. Formby

Culture, Health and Sexuality, vol. 13, 2011, p. 1165-1169

Lesbian and bisexual women's sexual health and access to services have been little researched and are sidelined in government policy. This paper presents findings from a study conducted in the North of England which explored how heteronormative social contexts shape and impede lesbian/bisexual women's sexual decision-making and their access to appropriate sexual health information/services. It examines the relative invisibility of lesbian/bisexual women in sexual health policy in England and Wales and their experiences of services provided by the NHS. It presents and discusses empirical findings in the light of sociological literature on sexual rights and sexuality more broadly.

Listening and learning: the Ombudsman's review of complaint handling by the NHS in England 2010-11

Parliamentary and Health Service Ombudsman

London: TSO, 2011 (House of Commons papers, session 2010/12; HC 1522)

The Health Ombudsman resolved a total of 15,186 complaints about the NHS in England in 2010-11. This report finds that at a local level, the NHS is still not dealing adequately with the most straightforward matters. As the case studies included illustrate, minor disputes over unanswered telephones or mix-ups over appointments can end up with the Ombudsman because of inadequate responses by NHS staff and poor complaint handling. While these matters may seem insignificant alongside complex clinical judgments and treatment, they contribute to a patient's overall experience of NHS care. The escalation of such small, everyday incidents represents a hidden cost, adding to the burden on clinical practitioners and taking up time for health service managers, while causing added difficulty for people struggling with illness or caring responsibilities. Two particular themes stand out this year:

  • Poor communication can have a serious, direct impact on patients' care and can unnecessarily exclude their families from a full awareness of the patient's condition or prognosis.
  • Secondly, a failure to resolve disagreements between patients and their GP can lead to their removal from the GP's patient list - often without the required warning or the opportunity for both sides to talk about what happened.

Midwife shortage linked to rise in Caesarean births

J Laurance

The Independent, Nov. 23rd 2011, p. 13

A report from the Royal College of Midwives said that the maternity services faced a crisis, as there had been a 22 per cent rise in the birth rate since 2001 and there was a shortfall of almost 5,000 midwives in England. Lack of support by midwives during birth was said to be the reason for a high Caesarean rate. Caesarean births cost more than vaginal ones and require longer recovery periods.

Making the most of evaluation: a mixed methods study in the English NHS

C. Salisbury and others

Journal of Health Services Research and Policy, vol. 16, 2011, p. 218-225

The 2006 White Paper Our Health, Our Care Our Say proposed a range of policy initiatives aimed at promoting patient choice, improving access to services, providing greater support to people with long-term conditions and improving prevention and early intervention. It also included an unusually strong commitment to evaluate these initiatives using a range of pilot projects, demonstration sites and formal evaluations. All of these evaluations were mapped and subjected to critical appraisal. Twenty-one were purposively selected as case studies to increase understanding of how evaluations of health policy initiatives are commissioned, conducted and used. It is concluded that considerable public resources are committed to evaluation, but this investment is less productive than it could be. In order to improve the usefulness of evaluations it is important to provide greater clarity about the intended benefits of the initiative, to ensure that a means of evaluation is built into the policy-making process from the outset, to have a clearly defined purpose for the evaluation, ensuring that the methods chosen reflect that purpose, and to make clear how the findings will be used in setting future policy.


A. Moore

Health Service Journal, Nov. 3rd. 2011, Supplement, 7p

Pathology services are under pressure to change. They are faced with rising demand, need to contribute to savings, and face continued pressure to maintain quality. This supplement presents a debate among nine prominent figures in pathology about the future development of the service. Key points that emerged from the discussion included:

  • Is pathology an end-to-end service or simply a diagnostic testing operation?
  • There is a distinction between the data processing side of pathology services and the pathologist service
  • Services were likely to be centralised into 20-30 'hubs' distributed across England
  • The role of the private sector in delivering services would be important
  • Key performance indicators would be important for the service, as would regulation/accreditation

Private company to take over 'failing' NHS hospital

A. Porter

Daily Telegraph, Nov. 10th 2011, p. 1 + 2

In a landmark decision, the running of the heavily indebted Hinchingbrooke Hospital in Cambridgeshire was handed over to Circle, one of Britain's most prominent private healthcare providers. The move opened the way for other financially challenged hospitals to be run by private firms. Around 20 were thought to be candidates for takeover.

Prospects for knowledge exchange in health policy and management: institutional and epistemic boundaries

G. Martin, G. Currie and A. Lockett

Journal of Health Services Research and Policy, vol. 16, 2011, p. 211-217

There have been calls for greater exchange between research and practice in healthcare policy and management, but little investigation of what research commissioners and researchers themselves consider to be good quality research knowledge. This paper seeks to begin to remedy this gap in the literature. It focuses on the commissioning of research relating to the organisation and management of healthcare and other public services in Britain. It draws on interviews with government- and NHS-based commissioners of research, and producers of research (academics and independent consultants).The study identified divergent views on the nature of research (a product or a mindset), the value of research (academic versus practical utility), and originality of research (academic versus policy currency). These perspectives seem entrenched by different performance management pressures on each side of the divide. These strong performance management measures and wider institutional pressures on both sides of the divide mean that increasing the quantity and quality of exchange between research and practice will be profoundly challenging.

Quality measures set to usurp mortality rates

D. West and S. Calkin

Health Service Journal, Nov. 3rd 2011, p. 4-5

The NHS medical director has predicted that interest in hospital mortality indicators will wane as clinicians begin to produce more service-specific mortality measures. The comments follow first results from the government-backed whole hospital mortality measure. The new Summary Hospital-Level Mortality measure singled out 14 trusts with unexpectedly high death rates and another 14 outliers with low rates.


J. Taylor (editor)

Health Service Journal, Nov. 17th 2011, supplement, 10p

Medical revalidation will be introduced from the end of 2012 and will usher in the most significant reform of medical regulation for 150 years. The General Medical Council has issued guidance on appraisal and the supporting information doctors will have to collect with the help of their organisation's clinical governance systems. This will then be discussed with their appraisers. Doctors will also have to bring feedback from patients and colleagues at least once in every five-year revalidation cycle. This supplement offers articles on: what makes an appraisal system effective; pilot programmes implemented by some organisation to help smooth the introduction of revalidation; and the role of the Revalidation Support Team

A statistical breakdown of complaints about primary care trusts and relevant care trusts 2010-11

Parliamentary and Health Service Ombudsman

London: TSO, 2011 (House of Commons papers, session 2010/12; HC 1523)

This is a supplement to the main report 'Listening and learning: the Ombudsman's review of complaint handling by the NHS in England in 2010-11 which displays the Ombudsman's more detailed data on complaints about primary care trusts and relevant care trusts. For each trust the data shows how many complaints:

  • were received
  • resolved through intervention
  • accepted for investigation
  • reported on (with the percentage upheld, partly upheld and not upheld)

Study contradicts government's criticism of NHS over cancer deaths

D. Campbell

The Guardian, Nov. 8th 2011

David Cameron and Andrew Lansley's repeated criticisms of the NHS's record on cancer have been contradicted by new research that shows the health service to be an international leader in tackling the disease. The findings challenge the government's claims that NHS failings on cancer contribute to 5,000-10,000 unnecessary deaths a year, which ministers have used as a key reason for pushing through their radical shakeup of the service. In fact, the NHS in England and Wales has helped achieve the biggest drop in cancer deaths and displayed the most efficient use of resources among 10 leading countries worldwide, according to the study published in the British Journal of Cancer.

The Third Sector, user involvement and public service reform: a case study in the co-governance of health service provision

G.P. Martin

Public Administration, vol.89, 2011, p. 909-932

Successive British governments have pursued an evolving programme of public service modernisation. Two mechanisms for modernisation of public services have been increased public participation and service user involvement and an enhanced role for the Third Sector in the design, management and delivery of public services. The Third Sector and service users are seen as having important roles in refashioning provision and making it more user centred. However, tensions arise from the often contradictory demands placed on third sector organisations in their roles in public service governance, and the risks of co-optation, deradicalisation and conflicting interests that result from opportunities to increase influence for both third sector organisations and involved service users. This study explores these tensions by examining data from a longitudinal qualitative study of service-user involvement in a programme of pilot cancer-genetics services located in the NHS but facilitated by the non-profit organisation Mcmillan Cancer Support. The analysis highlights limits in the extent to which lateral governance networks pluralise stakeholder involvement. Rather than prioritising wider stakeholder views in the design and delivery of public services, placing third sector organisations at the centre of governance networks may simply co-opt these organisations into reproducing predominant principles.

Thousands left for a year on 'hidden' NHS waiting lists

R. Smith

Daily Telegraph, Nov. 18th 2011,p. 6

Ministers admitted in November 2011 that a quarter of a million NHS patients had been waiting longer than the 18 weeks for treatment. Once the government's target, which required that treatment should start within 18 weeks of referral by a GP, had been breached, there was no incentive for hospitals to see them. These patients were then forgotten and languished on hidden waiting lists.

(See also Health Service Journal, Nov.17th 2011, p. 5)

Training and development

A. Moore (editor)

Health Service Journal, Nov. 10th 2011, supplement, 8p

This special supplement addresses: 1) the training needed by GPs to enable them to fulfil their new commissioning role from 2013; 2) the advantages and disadvantages of basing degree-level nursing training in a hospital instead of at an academic institution; 3) the impact of plans to give employers more of a say in the training of doctors and other clinical staff; and 4) systems required for students and organisations to make the most of work experience placements.

We've been listening, have you been learning?

Patients Association, 2011

As with our previous two reports, 'Patients Not Numbers, People Not Statistics' (2009) and 'Listen to Patients, Speak up For Change' (2010), this report contains firsthand accounts of some of the very worst stories of poor care in hospitals that have come to the attention of the Patients Association Helpline. This year's report includes previous accounts of unsatisfactory care at the same hospital experienced by the families involved.


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