Welfare Reform on the Web (October 2000): National Health Service - Reform - General

80,000 CANCER PATIENTS DENIED DRUGS BY NHS

H. Rumbelow

Times, July 13 2000, p. 8

Reports that an additional £207 million is needed to enable the NHS to fund advanced anti-cancer drugs. £80 million is needed to fund modern drugs for colo-rectal cancer alone, and £24 million for breast cancer.

CAN WE WIN THE WAITING GAME?

A. Harrison

Public Finance, Aug. 11^th - 14^th 2000, p. 20-21

The government has committed itself to new hospital waiting list targets in the NHS National Plan. Article argues that, without access thresholds or other demand management measures, the NHS may well fail to meet the targets, and that meeting the targets does not guarantee proper and timely access for everyone.

CANCER RESEARCH: A FRESH LOOK

Science and Technology Committee

London: TSO, 2000 (House of Commons papers. Session 1999/2000; HC 332)

Recommends the creation of a new National Cancer Research Institute to set national research priorities and to co-ordinate and fund cancer research in the UK.

CASTING A VERDICT ON HISTORY

K. McIntosh

Health Service Journal, vol. 110, July 27^th 2000, p. 11-13

The great and the good give their assessment of the Labour governments new national plan for NHS reform.

CHANGE OF TUNE

J. Garnett

Health Service Journal, vol. 110, July 13^th 2000, p. 16-17

Reports proposals for the establishment of emergency care trusts, which would co-ordinate accident and emergency services, ambulance services, emergency dental and mental health services, and minor injury units.

CLEAN SWEEP

L. Whitfield

Health Service Journal, vol. 110, Aug. 10^th 2000, p. 12-13

The NHS plan promises immediate measures to clean up hospitals. Each NHS trust must nominate a board member to take personal responsibility for cleanliness, and all hospitals will undergo unannounced inspections in the next six months, with results released to the local media. There is concern that many of the problems with dirt in hospitals arise from contracting out and demands for efficiency savings. They will not be solved without investment in staff training and improved pay.

CLINICAL SUPERVISION AND CLINICAL GOVERNANCE: THE ART AND SCIENCE OF BRIDGE BUILDING

A. Lipp and P. Osborne

Journal of Clinical Excellence, vol. 2, 2000, p. 3-8

Paper argues that the strategy for health care management encompasses the scientifically rational approach most commonly used in health care today. This is likely to conflict with the more intuitive philosophy underpinning clinical supervision, which also contributes to the same health care strategy. Article suggests how these systems can harmonise and positively influence each other.

A. Bell

British Journal of Health Care Management, vol. 6, 2000, p. 323-324

Articles discusses the issue of lack of trust in the NHS services. To restore the public's trust, first, public expectations need to be tackled. The message that medicine is an inexact science and that mistakes will always be made should be heard clearly. Secondly, robust and transparent systems for raising the quality of care need to be established. The aim is for people using the NHS to understand how it works, where its limits lie, and how they can be used if need be.

CONSULTANTS' CONTRACTS

Health Committee

London: TSO, 2000, (House of Commons papers session 1999/2000; HC 586)

Report raises suspicions that consultants are maintaining long NHS waiting lists in order to increase demand for private practice. Recommends that government should make it a long term aim that consultants in the NHS should not undertake private practice.

CONSULTANTS' CONTRACTS TO SPECIFY NHS TIME

R. Bennett and N. Timmins

Financial Times, July 12^th 2000, p. 2

As part of NHS reform, consultants may be required to commit a fixed number of hours to dealing directly with patients under new national standardised contracts designed to boost productivity. The reform plan may also require hospitals to publish their performance details on the internet.

CONSULTING ROOM

S. McIver

Health Service Journal, vol. 110, July 6^th 2000, p. 28-29

The recent consultation exercise on NHS reform attempted to elicit public priorities for spending the extra £20bn over four years which the government has promised to allocate to the NHS. Its "consumer is king", approach may have raised public expectations too high, especially if the exercise has to be repeated in the context of rationing.

CURE OR CURSE?

C. Webster

Guardian. Society, July 26^th 2000, p. 3

The NHS since its inception has been cursed by resource starvation and repeated botched modernisation plans. If the present governments reform plans are to succeed, their promise of a massive injection of resources must be fulfilled.

DIRTY WORK

P. Butler

Guardian. Society, Aug. 2^nd 2000, p. 10-11

Argues that the relentless drive towards cost cutting in the NHS through contracting out and privatisation of support services has had a disastrous effect on quality.

DOCTORS STRENGTHEN NHS PLAN OPPOSITION

A. McGauran

Health Service Journal, vol. 110, Aug. 24^th 2000, p. 9

GPs have declared that the NHS plan's commitment to a 48 hour target time for appointments is undeliverable, without an expansion in the number of doctors. Hospital doctors have rejected plans to limit consultant private practice and for a new specialist grade of doctor below the level of consultant.

A DOSE OF SCEPTICISM

L. Eaton

Health Service Journal, vol. 110, July 20^th 2000, p. 11-12

The National Institute for Clinical Excellence has been dogged by leaks, accusations that it is not taking patients' views seriously and questions about how much confidence patients, the pharmaceutical industry and government can have in the evaluation process.

EMPOWERMENT TO THE PEOPLE

K. McIntosh

Health Service Journal, vol. 110, July 20^th 2000, p. 12-13

Introduces the work of the clinical governance support team set up by the chief medical officer to show people how to improve the quality of their patient care.

EVERYONE WHO RETIRES TO GET FREE HEALTH 'MOT'

M. White

Guardian, July 12^th 2000, p. 2

As part of its NHS reforms, the government is planning to offer everyone who retires a free medical check-up to identify illnesses before they become serious.

FAITH HEALING

M. Bunting

Guardian, July 24^th 2000, p. 15

Argues that the morale and good-will of NHS staff is being eroded by:

• centralisation;
• the encouragement of a culture of complaint;
• the proliferation of performance indicators which generate paperwork and a culture of blame when targets are not met.

HAGUE PUTS CHOICE AT THE HEART OF NHS POLICY

G. Jones

Daily Telegraph, July 25^th 2000, p. 2 + 20

A future Conservative government would reform health care provision by:

• giving patients the right to be treated at the hospital of their choice;
• expanding the private and independent sector;
• introducing guaranteed maximum waiting times for treatment based on clinical need.

(See also Independent, July 25^th 2000, p. 2; Times, July 25^th 2000, p.2)

HAGUE WEAKENS HEALTH PLEDGE

A. Sparrow

Daily Telegraph, June 30^th 2000, p. 12

William Hague watered down the Patients' Guarantee, the Tories' flagship health policy, when he admitted that under a future conservative government many minor conditions would not be covered by the guarantee when it was first introduced. Mr. Hague said the policy was meant to apply at first only to patients with the most serious conditions.

(See also Guardian, June 30^th, 2000, p. 3)

HAPPY LANDINGS

J. Buchan

Health Service Journal, vol. 110, Aug. 24^th 2000, p. 24-27

The number of overseas nurses coming to the UK has risen 48% in the last 12 months. The bulk of the increase has come from non-EU countries such as South Africa, Australia, the Philippines, New Zealand and the West Indies. This trend flies in the face of Department of Health guidance that urged trusts not to recruit from developing countries that were experiencing shortages of their own. Overseas nurses now account for almost one third of those working in inner London and 3.5% of the nursing workforce in England.

HEALTH CHIEFS ATTACK HIT SQUAD MOVE

F. Ireason

Public Finance, Aug. 11^th - 24^th 2000, p. 6

Reports concern over the government's precipitate action in sending squads from the National Patient Action Team into seven NHS trusts which failed to meet a high profile target relating to outpatients' waiting times.

HOLD YOUR PRIVATES

K. McIntosh

Health Service Journal, vol. 110, Aug. 10^th 2000, p. 12-13

Doctor's vehemently oppose the government's plans to crack down on consultants whom it believes to be given to seeing private patients in NHS times. The new NHS plans requires existing consultants to work seven fixed sessions a week. Newly appointed consultants will be contracted to work exclusively for the NHS for a given number of years, providing eight fixed sessions.

(See also Financial Times, Aug. 18^th 2000, p. 3)

HOW WELL IS THE NHS PERFORMING?

J. Appleby and J. A. Mulligan

London: King's Fund, 2000

Concludes that variations in health authority performance cannot be explained away by variations in social and economic conditions.

INQUIRY INTO NHS WILL REVEAL THE CORE OF BLAIRISM

R. Sylvester

Daily Telegraph, July 27^th 2000, p. 8

Tony Blair is committed to state provision of essential services such as health and education. At the same time he wants the NHS to adopt a more private-sector ethos in the way it works. Patients are to be redefined as consumers and hospitals subjected to audits, with the best rewarded and the worst penalised.

IS AGEISM PREVALENT IN ADULT CLINICAL GUIDELINES?

N.R. Balcombe and W. Saweirs

Journal of Clinical Excellence, vol. 2, 2000, p. 43-48

Article explores the origins and current existence of rationing health care and of ageism in medical practice and discusses the use of age in adult clinical guidelines as a marker for such concepts.

MANAGER NUMBERS INCREASE DESPITE 'RED TAPE' PLEDGE

T. Shifrin

Health Service Journal, vol. 110, July 20^th 2000, p. 7

The number of managerial posts in the NHS increased by 7% between 1998 and 1999, from 21,850 to 23,380. The rise coincides with the launch of primary care groups in advance of the merger and downsizing of health authorities.

MINISTER TO TAKE POLITICS OUT OF NHS MERGERS

J. Carvel

Guardian, 30^th June 2000, p. 5

The government will set up an independent panel of doctors, nurses, managers and patient representatives to decide on hospital mergers and bed places. The panel will make recommendations on all proposals for hospital reorganisations. Although it will be expected to follow government health policies and work within budgets set by the Treasury, it will be told to act independently of ministers.

(See also Financial Times, June 30^th, 2000, p. 4)

NEW CONSULTANTS BANNED FROM PRIVATE WORK

R. Sylvester

Daily Telegraph, July 27^th 2000, p. 1

Predicts that under the governments national plan for the NHS, hospital consultants will be banned from doing private work when they first qualify, so paying back the state for their medical training.

THE NHS PLAN

Department of Health

London: TSO, 2000, (Cm 4818)

Promises to deliver:

• an extra 20,000 nurses, 7,500 consultants, 2000 GPs and 6,750 other health professionals by 2005;
• an extra 7,000 beds by 2004;
• a maximum waiting time of six months for an operation by 2005; a nationwide "clean-up" of hospital wards;
• patient's advocates in every hospital to take up complaints;
• a guarantee that by 2004 patients will be able to see a GP within two days;
• free health checks on retirement;
• free nursing care for the elderly;
• provision of intermediate care beds in cottage hospitals and community homes to prevent bed blocking by older people;
• increased powers and authority for nurses;
• tighter control on doctors;
• increased NHS use of the private sector to increase capacity to meet waiting time targets;
• closer integration of health and social services through the establishment of Care Trusts with pooled budgets;
• provision of all out of hours care through NHS Direct from 2004;
• extension of new-style contracts for GPs which pay by quality rather than volume of services;
• breast cancer screening for 65-70 year olds;
• free fruit for nursery and infant school pupils;
• nicotine replacement therapy on the NHS.

(For summary see Times, July 28^th 2000, p. 1 + 15 + 17; Daily Telegraph, July 28^th 2000, p. 1, 4-5; Independent, July 28^th 2000, p. 1, 6-7; Financial Times, July 28^th 2000, p. 1 + 4; Guardian, July 28^th 2000, p. 1 + 8-9)

NINE-MONTH LIMIT ON NHS WAITING LISTS

N. Timmins and B. Groom

financial Times, July 17^th 2000, p. 4

The government's NHS reform plan is likely to include a pledge that patients will not have to wait more than nine months for non-urgent treatment from GP referral to operation. Work by the Treasury and the Department of Health indicates that shortages of nurses and doctors would make a more ambitious target too risky.

NURSES FROM CHINA MAY JOIN NHS BY END OF YEAR

C. Hall

Daily Telegraph, Aug. 7^th 2000, p. 1 + 6

The NHS is planning to recruit nurses from China to ease staff shortages.

P

T. Shifrin

Health Service Journal, vol. 110, Aug. 3^rd 2000, p. 16-17

Case study of survey by Telco (The East London Communities Organisation) of conditions of Newham General Hospital.

THE PHONEY WAR BEING FOUGHT OVER THE NHS

A. McElvey

Independent, July 26^th 2000, p. 3

Argues that a purely tax-funded health care system will not survive. The likely alternative might combine a tax funded care service with means-tested top-ups through insurance or savings schemes. The role of government would be to regulate, rather than dominate health care.

PLEDGE TO END NHS DELAYS ON SURGERY

G. Jones

Daily Telegraph, July 24^th 2000, p. 1 + 2

Predicts that the Labour government's reform plans for the NHS will include: reduction of waiting times for surgery; swift rescheduling of cancelled operations; setting up Patient Advocacy and Liaison Service teams to handle complaints; breaking down the lines of demarcation between nurses' and doctors' roles; having GPs carry out minor operations at their surgeries; and action to improve cleanliness through wide-ranging inspections and spot checks.

(See also Guardian, July 24^th 2000, p. 4; Times, July 24^th 2000, p. 1)

THE POLITICS OF NHS REFORM 1988-1997

C. Ham

London: King's Fund, 2000

Book is based on interviews with four politicians who served as secretary of state for health between 1988 and 1997, and offers an important insight into the NHS reforms of this period. Explores the "world" in which the health secretaries worked, the people and groups they interacted with and how they confronted the issues they faced.

A PRIVATE REMEDY FOR PUBLIC ILLS

D. Lal

Financial Times, July 21^st 2000, p. 21

Proposes that the government should fund health insurance for all citizens through a range of private providers. Patients could then purchase health care as required.

A PUNISHING SCHEDULE

T. Shifrin

Health Service Journal, vol. 110, Aug. 17^th 2000, p. 14-15

Under the new NHS plan, the health service will be subject to a punishing regime of inspection and scrutiny by:

• the local authority;
• the Commission for Health Improvement and the Regional Office;
• patient environment action teams, checking on hospital cleanliness;
• the Appointments Commission, looking at board members;
• a national clinical assessment authority, examining individual doctors' performance;
• patients, through survey;
• the UK Council of Health Regulators covering the General Medical Council and other regulatory bodies.

QUALITY AND PERFORMANCE IN THE NHS: NHS PERFORMANCE INDICATORS

NHS Executive

London: Dept. of Health, 2000

Indicators reveal wide variations in standards of care in NHS trusts and health authorities in England. They show nearly five times more patients are waiting for treatment in the worst performing health authorities than in the best. Death rates within 30 days of surgery are at least three times higher in some hospitals than in others of the same type. Five-year survival rates for women diagnosed with breast cancer vary from 83.7% in east Surrey to 64.5% in north Staffordshire. For colon cancer the survival rate ranged from 52.4% in Hertfordshire to 24.9% in the Tees Health Authority.

(For comment see Guardian, 14^th July 200, p. 13; Times, July 14^th 2000, p. 1, 18 + 19; Daily Telegraph, July 14^th 2000, p. 14; Independent, July 14^th 2000, p. 10)

QUITE UNHEARD OF

E. Feather

Health Service Journal, vol. 110, July 6^th 2000, p. 30-31

Presents case study of how physiotherapists in an NHS trust were consulted about the national plan for the NHS. Therapists expressed the need for greater recognition, proposed the introduction of consultant therapist posts to allow them to take over some of the work of doctors, and they were stretched to capacity.

REMEDY OR RUIN FOR THE NHS

S. Ward

Public Finance, July 21^st - 27^th 2000, p. 16-18

Predicts that the new National Plan for the NHS will focus on reduction of waiting times for treatment, integration of health and social care, and more co-operation with the private sector.

RETRO CHIC RULES THE ROOST

D. Hunter

Health Service Journal, vol. 110, July 20^th 2000, p. 18-19

Comments adversely on government proposals to combine the posts of Department of Health permanent secretary and NHS chief executive. This is likely to lead to too much political interference in health service operational matters.

SHAPE UP OR SHIP OUT

S. Ward

Health Service Journal, vol. 110, July 20^th 2000, p. 24-26

At present patients wishing to be treated elsewhere in the EU at NHS expense need to get permission in advance from the Department of Health. Recent judgements by the European Court of Justice suggest that this approach interfered with the free movement of goods and services and so contravenes EU law. There are signs, however, that the Court may reverse its stance under political pressure, since free movement of patients across borders could put a severe strain on member states' health care budgets.

"SHOCKED" CHCs BITE BACK IN ROW OVER ABOLITION

K. McIntosh

Health Service Journal, vol. 110, Aug. 3^rd 2000, p. 4-5

Reports reaction to government plans to abolish community health councils. There is concern that this move will reduce public monitoring of the NHS despite its supposed "patient focus". CHCs will be replaced by Patient Advisory and Liaison Services, patient fora, and independent local advisory panels.

TALKING IT THROUGH

L. Donnelly

Health Service Journal, vol. 110, Aug. 10^th 2000, p. 11-12

Nurses welcome the new NHS plan's promises to extend their prescribing role, increase their autonomy and make their working conditions more flexible and family friendly.

UNFAIR TREATMENT

V. Grove

Times 2, July 26^th 2000, p. 3-5

Interviews with two hospital consultants reveal them to be dedicated but frustrated by bureaucracy, lack of support staff, and lack of beds.

WE'RE SICK OF MIRACLE CURES, MR BLAIR

S. Jenkins

Times, July 28^th 2000, p. 22

Argues that the government's NHS reforms are likely to fail because they rely on heavy centralisation, which will stifle local initiative and discretion.