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Welfare Reform on the Web (January 2012): National Health Service - Reform - General

Cameron prescribes NHS reform in bid for economic upturn

A. Sparrow

The Guardian, Dec. 5th 2011, p. 14

David Cameron unveiled plans to allow patients' records and other NHS data to be shared with private life science companies. In his speech, the prime minister argued that giving researchers from private sector companies access to NHS information would make it easier for them to develop and test new drugs and treatments. He argued that cutting the regulation that restricts collaboration of this kind could boost the life science industry, which already employed 160,000 people in the UK, with an annual turnover of 50bn. Andy Burnham, the shadow health secretary, said he was not opposed to the idea in principle, but that the government would have to 'tread carefully' because of privacy concerns.

Clinical governance and attention to human resources

C. V. Som

British Journal of Healthcare Management, vol.17, 2011, p. 531-540

The role of human resources management in clinical governance implementation has been largely unexplored. This article aims to fill the research gap through an analysis of 35 case studies and documents published by key agencies It is concluded that human resources management has a crucial role to play in developing open organisational cultures in which clinical governance can flourish. Conversely, implementation of clinical governance influences human resources management, giving it a more strategic role in healthcare organisations.

Coming of age or over the hill?

A. McKeon

Health Service Journal, Dec. 8th 2011, p. 18-19

If commissioning is to prosper, it needs to play a decisive role in dealing with the three major issues facing the NHS: 1) development of integrated care for people with long-term conditions; 2) achievement of 20bn savings by 2015; and 3) acute sector reconfiguration. It is argued that meeting these challenges will depend on action by providers, with commissioners being marginal.

Deliberating Tarceva: a case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance

D. Hughes and S. Doheny

Social Science and Medicine, vol. 73, 2011, p. 1460-1468

The establishment of NICE in 1999 was justified partly by the need to reduce variations in the geographical availability of treatments arising from different policies of local commissioners. NICE undertakes technology appraisals of drugs and treatments, which lead to recommendations that commissioners in England and Wales are legally obliged to follow. Yet in practice significant variations in local approaches to the provision of high cost drugs continue to be reported. This study suggests that deliberations in the shadow of NICE guidance, far from involving a standardised application of agreed decision rules, frequently raise complex issues for local NHS managers and yield different local outcomes. Observational case study data are used to illustrate the nature of discussions surrounding one high-cost drug, Tarceva, and the changing construction of decision rules over time. The research suggests that social organisational factors, such as the case-based framing of local panel discussions, will make it difficult to achieve greater standardisation of outcomes.

Families not told of patients on 'death pathway'

R. Smith

Daily Telegraph, Dec. 2nd 2011, p. 1

The Liverpool Care Pathway aims to ensure that patients die without undue medical interference. Doctors may withdraw food, fluids and medication from dying patients placed on the Pathway and sedate them until the pass away. Health service guidance states that doctors should discuss with relations whether or not a patient is placed on the scheme. An audit by the Royal College of Physicians in 2011 found that doctors discussed plans with relatives in 94% of cases, but as many as 2,500 families were not informed. The study looked at a snapshot of data from 7,000 patients who were on the Liverpool Care Pathway in 127 hospital trusts between April and the end of June 2011.

Health care and adult safeguarding: an audit informing the relationship of the UK vetting and barring scheme with the NHS

L. Phair and J. Manthorpe

Journal of Adult Protection, vol. 13, 2011, p. 251-258

From October 2009, the Safeguarding Vulnerable Groups Act requires regulated activity providers to refer any worker to the Independent Safeguarding Authority (ISA) if they have removed the worker from regulated activity because they had harmed or there was risk of harm to a child or vulnerable adult. Typically, these include NHS trusts as well as social care providers. In 2010 the Department of Health sought to learn more about the potential impact of the Act on the NHS. In order to learn more about the potential number of referrals to the enhanced vetting and barring scheme established under the Act and the links of these referrals to NHS disciplinary outcomes and NHS systems that collect data about adverse events, a small audit was undertaken in 2010/11. This paper presents some of the key findings and discusses these in the context of NHS human resources practice and that of other employers.

IVF duties to pass to health watchdog despite warning

I. Sample

The Guardian, Dec. 8th 2011, p. 8

The Care Quality Commission (CQC) was told to press on with plans to take over the policing of IVF clinics, despite warnings that it could not cope with the extra workload. The troubled NHS healthcare watchdog was due to absorb the Human Fertilisation and Embryology Authority (HFEA), in addition to its main role of inspecting hospitals and care homes. The head of the CQC, Dame Jo Williams, in a letter sent at the end of October 2011 to the health minister Simon Burns, said that going ahead with the move threatened the commission's ability to handle the tough duties it already had. Williams wrote that the CQC had identified small efficiency savings that could be made by absorbing the HFEA, but said much of the regulator's work fell outside the CQC's remit and could 'compromise the CQCs ability to deliver its core business'.

Labour tries to recruit medical chiefs to derail Lansley bill

D. Campbell

The Guardian, Dec. 15th 2011, p. 14

Labour urged key medical leaders to back a plan B to shake up the NHS without using Andrew Lansley's controversial proposals, in a last-ditch attempt to scupper the Health and Social Care Bill. The party hoped to persuade leaders of Britain's doctors, nurses and midwives to join a campaign that would derail the health secretary's plan by persuading enough MPs and peers to back their alternative, which they called their 'stability plan'. Andy Burnham, Lansley's Labour party shadow, met about 40 presidents and chief executives of key organisations such as the British Medical Association, NHS Confederation and royal colleges representing nurses, surgeons and midwives as a first step to try to win their support. Burnham hoped to capitalise on the huge concerns about the bill, and tried to form a united front to argue for proceeding with some elements of Lansley's plans, but not the major changes that have led critics to predict 'the end of the NHS as we know it' in England

Making health policy: a critical introduction

A. Alaszewski and P. Brown

Cambridge: Polity, 2012

This book opens up the policy-making process for students, uncovering how government decisions around health are really made. Starting from more traditional insights into how ministers and civil servants develop policy with limited knowledge and money, the book goes on to challenge the conception of policy as a rational process, revealing it to be something quite different. Knee-jerk reactions to disasters, keeping voters satisfied, the powerful leverage of interest groups, and the skewing of debate through ideology and the media are each considered in turn. These processes render policy far from rational or at least require a much broader approach for considering policy 'logic', one that is open to different rationalities of values, norms and pragmatism. The book draws on historical and contemporary examples to highlight that though challenges to policy-makers may seem in some ways novel, in many senses key processes endure and indeed are rooted in historical contexts. Although the examples are drawn from UK health and social care, the book's theory-driven approach is applicable across national contexts especially for countries where uncertainty, risk and resource pressures create significant dilemmas for policy-makers.

A national health inequalities fund for Wales: concept, design and implementation

M. Longley and others

Health Policy, vol. 103, 2011, p. 141-148

Between 2001 and 2008 the Inequalities in Health Fund (IiHF) in Wales channelled over 30m into 67 local projects tackling different manifestations of health inequality. Using the IiFF as a case study, this research evaluated the potential of a national innovation fund to stimulate local action to tackle national priorities in the context of devolution. The paper highlights the theoretical advantages of the approach and also explores the more common pitfalls in concept, design and implementation which emerged from conflicting priorities, resource and logistical constraints, and a crowded public policy agenda. It is concluded that national funds can be a useful lever for change, if appropriately conceived, designed and implemented. However, in the context of competing priorities, good practice is often difficult to achieve, and somewhat simplistic incentives are often subverted locally, diluting the original purpose of the initiative.

NHS executives told to resign as part of plan to shrink service

R. Ramesh

The Guardian, Dec. 19th 2011, p. 2

Andrew Lansley's decision to shrink the number of NHS trusts saw health service directors told they would have to leave their jobs, distracting the NHS leadership when the service was undergoing the biggest shakeup in 60 years, internal documents revealed. In a letter to the NHS Confederation - which represented the health service's top managers - senior executives wrote that a decision to cut both the size and number of primary care trusts, which commissioned 90bn of healthcare on behalf of patients, had led to the threat of a mass clearout at board level earlier than expected.

The Operating framework for the NHS in England 2012/13

Department of Health

2011

The 2012/13 NHS operating framework is aimed at driving the 20bn savings required by the government further and faster than before and ensuring that clinical commissioning groups do not inherit financial problems when they take on their statutory responsibilities in 2013. The framework announces a cut of at least another 1.5% in the tariff paid for NHS services, directs commissioners to clear all debts by the end of the financial year, and holds the line on tough penalties for emergency admissions and readmissions. The framework also announces:

  • The move of ambulance services onto tariff payments and away from block contracts
  • A tight running cost allowance of 25.00 per head of population for clinical commissioning groups, although high performing groups could receive extra funding.
  • That providers will be paid less than the national tariff price for treating patients with straightforward conditions, in order to discourage 'cherry picking' of easy cases
  • A duty on commissioners to publicise a patient's right to an alternative provider if a trust is at risk of missing the 18-week referral to treatment time target.

NHS watchdog under fire for 'putting patient care at risk'

R. Ramesh

The Guardian, Dec. 2nd 2011, p. 1 and 4

The watchdog responsible for overseeing the NHS had come under fire on multiple fronts, with counsel for the public inquiry into the Mid Staffs hospital scandal calling into question its leadership and 'unhealthy organisational culture' while the National Audit Office said its failures had risked 'unsafe or poor quality (patient) care'. In a series of withering assessments of the Care Quality Commission, at the end of the 13-month public inquiry into Stafford hospital, where poor care led to hundreds of needless patient deaths between 2005 and 2008, Tom Kark QC said the final report should consider the question of 'the leadership of the CQC'. He added: 'The evidence could suggest that the CQC had an unhealthy organisational culture, and that culture goes to the top.' The inquiry also needed to see if the CQC's board was open to 'internal criticism' and whether that allowed it to improve as an organisation, Kark said.

(See also the Guardian, Dec. 12th 2011, p. 10)

Opening the black box: a study of the process of NICE guidelines implementation

D. Spyridonidis and M. Calnan

Health Policy, vol. 102, 2011, p.117-125

The use of clinical guidelines as a means of disseminating best practice is extensively recognised, yet their actual uptake is low and uneven. This paper offers a process analysis of guideline implementation as it unfolded over time. It aims to provide further understanding of the process of introducing and using scientific and technological developments in practice using NICE guidelines as exemplars. The study showed that the NICE guideline implementation process had both planned and emergent components. The implementation process might be characterised as strategic and planned to begin with but became uncontrolled and subject to negotiation as it moved from the planning phase to adoption in everyday practice. The variations in the implementation process could best be accounted for in terms of differences in the structure and nature of the local organisational context. The latter pointed to the importance of managers as well as clinicians in decision-making about implementation.

Peers demand pledge on NHS accountability in health bill

R. Ramesh

The Guardian, Dec. 20th 2011, p. 15

The coalition government's Health Bill would dilute accountability to Parliament and the courts and should be amended to address serious constitutional issues that remained, a Lords committee warned. The committee examining the constitutional implications of public bills, chaired by Lady Jay, said the House of Lords would have to alter the Health Bill so that 'ministerial responsibility' for the NHS was made 'explicitly' clear. In November 2011 the government was forced to hold up the part of its NHS bill dealing with the health secretary's new role to stave off an embarrassing rebellion from a coalition of Labour and Liberal Democrat peers over the issue.

The preparedness of UK graduates in acute care: a systematic literature review

V.R. Tallentire and others

Postgraduate Medical Journal, published online Dec. 13th 2011 A review of 10 studies on the perceptions of junior doctors found that those working in hospitals did not feel fully prepared to treat acutely sick patients. The researchers suggested that changes to the medical school curricula, which have put greater emphasis on communication and teamwork, may have been to the detriment of training in managing emergencies and acute clinical care. The problems appeared to have worsened since the introduction of new standards for medical training by the General Medical Council in 2003.

URL: http://pmj.bmj.com/content/early/2011/12/04/postgradmedj-2011-130232.full.pdf

Rationing in health care: the theory and practice of priority setting

I. Williams, S. Robinson and H. Dickinson

Bristol: Policy Press, 2012

The challenges faced by those rationing scarce health care resources have intensified following the economic downturn. This book tackles this issue by exploring the latest thinking and practice on priority setting methods. In an accessible style the book brings together theories, practice and evidence from a wide range of disciplines and provides practical, evidence-based prescriptions for decision makers.

Shaping health policy: case study methods and analysis

E. Exworthy and others (editors)

Bristol: Policy Press, 2012

This collection examines the role that case-studies play in understanding and explaining British health policy. Overall, the chapters cover the key health policy literatures in terms of the policy process, analytical frameworks and some of the seminal moments of the NHS. They have been written by leading health policy researchers in sociology, social policy, management and organisation studies. The collection explores and promotes the case-study as an under-used method and thereby encourages a more reflective approach to policy learning by practitioners and academics.

Sixty-step plan to restore faith in the NHS

R. Winnett

Daily Telegraph, Dec. 7th 2011, p. 1 + 2

The government has unveiled 60 new outcome-based targets for the NHS, based on the quality of care patients receive, not merely the speed at which they are treated. They include a commitment to preventing unnecessary early deaths, a pledge to enhance the quality of life of people with long-term conditions, and a drive to ensure that patients have a positive experience when using the health service. The benchmarks will be monitored partly through studying clinical data and partly through patient satisfaction surveys. The new NHS Commissioning Board and the Care Quality Commission will intervene directly to address problems highlighted by the data.

Why is UK medicine no longer a self-regulating profession? The role of scandals involving 'bad apple' doctors

M. Dixon-Woods, K. Yeung and C.L. Bosk

Social Science and Medicine, vol. 73, 2011, p. 1452-1459

The regulative bargain between the medical profession and the state in the UK has been fundamentally altered. The profession remains the intermediary social institution by which patients are assured that doctors will act as their fiduciary agents. However, the reliance of the system on trust-like relations has now fundamentally changed to reliance on formal regulatory policies and procedures that seek to control, monitor and enforce standards relating to the performance of doctors. It is argued that a susceptibility to unchecked doctor misconduct was a structural feature of the profession's collegial model from its foundation, and allowed the betrayal of the trust of patients and peers by 'bad apples'. Specific features of the scandals that occurred from the mid-1990s, combined with a contingent set of contexts, created momentum for reform. Reform was made possible by a political need to show firmness in the face of huge public anger; by the voice permitted to a coalition of critics; by shifts in broader social attitudes to authority; and by the opportunity presented to pro-interventionist managerialist and political agendas to pursue their interests.

Will integration help systems deal with health care reform effectively?

S. Karakusevic

Journal of Integrated Care, vol.19, no. 5, 2011, p. 41-46

Increasing life expectancy has pushed up health and social care costs due to increased demand for services. This article looks at the likely impact of these demographic pressures on local organisations. It is likely that between 4 and 8 per cent of existing budgets will need to be released to cope with rising demand over the next decade. Systems that work in an integrated way are more likely to achieve this.

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