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

40% rise in patients who wait 18 weeks to be seen

S. Adams

Daily Telegraph, Jan. 20th 2012, p. 13

In May 2010, 20,662 patients referred by their GPs for hospital treatment had to wait more than the target time of 18 weeks to be seen. By November 2011, the figure had risen to 29, 508, an increase of 42.8%. A third of hospital trusts in England were failing to meet the deadline, almost four times the failure rate in mid-2010. The shadow health secretary leapt on the figures as proof that the coalition government could not be trusted with the NHS.

(See also Guardian, Jan. 20th 2012, p. 15)

Change and the NHS

T. Thornell

Training Journal, Jan. 2012, p. 16-19

Maintaining staff productivity in the face of the NHS reforms and spending cuts imposed by the coalition government presents managers with a huge challenge. In this situation, the NHS must prioritise and invest in the development of frontline staff at all levels. Implementation of a talent management strategy and leadership development programme for staff will give organisations a better chance of achieving a successful transition. Leadership that is developed and encouraged throughout the organisation will help the service rise to its challenges.

Competitive tendering 'as important' as AQP

C. Dowler

Health Service Journal, Jan. 19th 2012, p. 4-5

In competitive tendering, commissioners typically run contests for the sole rights to provide a service for a set period, with providers bidding on quality and price. With use of any qualified provider (AQP), patients are able to choose from a list of accredited providers that are paid a common unit price. HSJ understands that the Office of Health Economics (OHE) commission on NHS competition is expected to conclude that for some services AQP's use of multiple providers would offer poor value for money and that competitive tendering would be more efficient. Guidance on competition is likely to be heavily influenced by the OHE's recommendations.

Corporate social responsibility: a potential lifesaver?

F. Martin

British Journal of Healthcare Management, vol. 18, 2012, p. 14-15

Most patients choose to be treated at their local NHS hospital, regardless of its performance. There is evidence that patients who have faith in their local hospital are more likely to have a good outcome. There is a role for the public relations department in creating a positive image of, and building up trust in, the hospital in the local community.

Design of the NHS Commissioning Board

NHS Commissioning Board


This document sets out detailed proposals for the Board's design, structure and functions. Forty-four local offices will cover the same areas as the primary care trust clusters outside London. Regional offices for the South, North and Midlands, East and London will match strategic health authority clusters. A single national director in the operations directorate will manage contracts for specialist services commissioned by the Board at national level. The paper also sets out 11 key risks to the Board's success, including loss of senior leaders during the transitional period and a shortage of staff to commission specialist and primary care.

Education and training: the next stage

NHS Future Forum


People have welcomed the second opportunity to contribute to the development of the NHS's education and training system. Respondents have acknowledged that there have been some positive developments since our first report, including the moves to establish Health Education England (HEE) and the plans to further develop the role of the Centre for Workforce Intelligence (CfWI), though this is taking longer than expected. People were curious about how HEE would operate and the relationships it will develop, firstly with the NHS Commissioning Board, to ensure production of the appropriate health care workforce to meet planned health care provision; secondly with the CfWI, as accurate workforce data is essential to its planning; and thirdly with Public Health England to develop the public health workforce. There has been great interest in the plans for local education and training boards (LETBs), in particular in their relationship to HEE and how to make the views of all stakeholder groups, irrespective of size or influence, integral to decision-making. Of the possible operational models, we have heard most support for direct accountability to HEE, a view we support. There was also recognition that the key to success will be through strong partnerships between service delivery and academia with LETBs focusing on delivery rather than just representing views. The interest in local structures was matched by recognition that greater local responsibility is an opportunity to strengthen these partnerships between education, service and academia to deliver new practices and innovation. There was agreement that developing LETBs should align with the recent conclusions of the NHS Chief Executive's Review of Innovation.


Elderly bearing brunt of NHS bed cuts in drive to save money

D. Bowater and S. Rainey

Daily Telegraph, Jan. 9th 2012, p. 4

Research by the newspaper showed that more than half of hospital beds closed in 2011 were designated for elderly patients. This may be because geriatric beds were more expensive to run and hospitals were keen to cut costs.

Gagging orders placed on NHS watchdog staff

R. Sayal

The Guardian, Jan. 25th 2012, p. 5

A health watchdog with responsibility for protecting NHS whistleblowers asked at least six employees to sign confidentiality agreements that stop them from criticising the organisation publicly. The Care Quality Commission (CQC) asked the six, who had received 'special severance payments' since 2009, to sign a contract. The contracts contained a promise that they would not 'make or repeat any statement which disparages or is intended to disparage the goodwill or reputation of the CQC or any Specified Person'. The disclosure alarmed one member of the House of Commons' Public Accounts Committee, which was due to question Cynthia Bower, the CQC boss on Wednesday.

Health and social care should be merged - PM

D. Campbell

The Guardian, Jan. 5th 2012, p. 8-9

David Cameron ordered health and social care services to be brought together in order to benefit patients in a move which government advisers called the NHS's most urgent overhaul. The changes would lead to some hospitals closing, warned the pro-integration NHS Confederation, which represented hospitals and other major NHS employers. The prime minister had been persuaded by senior doctors and Downing Street health advisers that, without integration, the NHS could become unsustainable due to rises in the number of patients with long-term health conditions such as obesity, diabetes and breathing problems. The first move towards creating joined-up services was likely to see Lansley tell the NHS that it had to give integration the same priority that keeping waiting lists under control had had for the previous decade.

High risk healthcare 'will suffer if medical cover is privatised'

R. Ramesh

The Guardian, Jan. 13th 2012, p. 2

Potentially life-saving procedures could disappear from the health service because the high risks involved would force doctors to take out unaffordably expensive medical insurance, the British Medical Association warned after it emerged that the NHS compensation fund might be privatised to curb the burgeoning cost of medical litigation. Documents obtained under the Freedom of Information Act showed that in October 2011 officials in the Cabinet Office drew up a 'business assessment' for the NHS Ligation Authority (NHSLA), which paid out legal fees and compensation claims in medical negligence cases, for a 'credible business plan' that would be an 'alternative to [the] existing service delivery model'.

Hospitals to be ranked by 'family test' of care

J. Kirkup

Daily Telegraph, Jan. 6th 2012, p. 12

Following a series of scandals, the prime minister announced measures to drive up standards of nursing care in NHS hospitals. These included regular satisfaction surveys of staff, patients and families, patient and public involvement in inspections of wards, institution of hourly ward rounds by nurses, and the encouragement of the appointment of a staff member on each ward to take responsibility for care standards. In return, he promised a reduction in paperwork and the creation of a Nursing and Care Quality Forum to promote best practice among staff.

Lansley-BMA relations hit new low after 'poisonous' jibe

D. Campbell, R. Ramesh and N. Watt

The Guardian, Jan. 27th 2012, p. 17

Relations between the health secretary, Andrew Lansley, and Britain's doctors hit a new low after he accused the British Medical Association of being 'politically poisoned' in its opposition to his NHS shakeup. Lansley infuriated the doctors' union by repeating a description first used by Aneurin Bevan, the founding father of the NHS, at the time the service was created in 1948. The putdown came in a pre-prepared speech in Liverpool at the launch of a new children's health initiative, rather than in an off-the-cuff remark or interview. He criticised the growing chorus of concern from senior health professionals about his controversial health and social care bill. However, later in the day, Lansley performed his most significant U-turn yet on the bill over the highly charged issue of the health secretary's 'constitutional responsibilities' to the NHS, which a House of Lords committee had warned would be 'diluted' by the proposals.

Lansley backing plans to question patients' lifestyle

D. Campbell

The Guardian, Jan. 10th 2012, p. 2

Ministers were pressing ahead with proposals that would see NHS staff ask patients about their lifestyles during appointments, despite concerns that patients might resent such 'intrusive' questioning. The health secretary, Andrew Lansley, decided to back the NHS Future Forum's controversial idea, which called on midwives, surgeons and health visitors, as well as doctors and nurses, to ask patients about their smoking, drinking, diet and physical activity every time they see them.

A lot to learn

A. Moore

Health Service Journal, Jan. 26th 2012, p.21-26

This roundtable brought together leading figures in healthcare education to debate the government's reforms. Proposals include setting up a new body, Health Education England, greater involvement of employers through local NHS education and training boards, and potential new methods of funding the service.

'Myth' that Britain cannot ban EU doctors

R. Winnett

Daily Telegraph, Jan. 20th 2012, p. 16

Only doctors from outside Europe were routinely scrutinised for their English language ability before being registered by the General Medical Council. It had been alleged that European rules on free movement of labour meant that the NHS had to employ doctors from other member states with appropriate qualifications regardless of their ability to communicate in English. The internal market commissioner Michel Barnier dismissed this view and stated that language tests were not outlawed by EU law.

National company to take over PCT estate

D. Williams

Health Service Journal, Jan. 19th 2012, p. 10-11

A new national property company is to be set up to manage the primary care trust estate following their abolition. It will take the form of an asset holding company wholly owned by the Department of Health.

'No clarity' over future of thousands of jobs

D. Williams

Health Service Journal, Jan. 12th 2012, p. 4-5

A leaked Department of Health paper revealed the full breadth of functions to be taken over by the NHS Commissioning Board and showed how the process of transferring commissioning roles to new organisations was progressing. The document showed where each commissioning function was likely to be relocated from primary care trusts, strategic health authorities, the Department of Health and arm's length bodies. The destination of many core functions, particularly those in primary care trusts, remained unknown.

Poor foreign doctors put patients at risk in NHS

R. Winnett

Daily Telegraph, Jan. 12th 2012, p. 1, 2 + 23

In a letter to the newspaper, the heads of the Royal Colleges of Surgeons and Physicians said that EU laws were damaging medical care. Doctors with poor command of English could not be prevented from working in the NHS, and regulators were not informed when a doctor had been struck off in another member state. They added that the European Working Time Directive, which limited the hours that doctors could work, meant that trainees were not getting enough experience.

Services for people with neurological conditions

National Audit Office

London: TSO, 2011 (House of Commons papers, session 2010/12; HC 1586)

Since 2005, when the Department of Health introduced its National Service Framework for Long-term Conditions, people with neurological conditions have had better access to health services; but key indicators of quality - such as the rate of emergency hospital readmissions - have worsened. The Department does not know what the Framework and additional spending of nearly 40% over four years have achieved. The Framework was designed to improve care for people with neurological conditions, but progress in implementing it has been poor. Access to health services for people with long-term neurological conditions, such as Parkinson's disease, multiple sclerosis and motor neurone disease, has improved and waiting times for inpatient and outpatient neurology have decreased since 2007. However, although the number of elective neurological operations performed has increased, the rate of emergency admissions to hospital has also increased significantly and there is large variation in emergency admission rates between Primary Care Trusts. The availability of services for patients varies significantly depending on where they live. Many patients, following their diagnosis, are not given information on their condition, about local services or on available support. Ongoing care is fragmented and poorly coordinated and there is a pattern of patients being referred to hospital for treatment, then discharged and then referred to hospital again.

Thousands more are stuck in A&E for longer than four hours

S. Adams

Daily Telegraph, Jan. 27th 2012, p. 8

Data for England from the NHS Information Centre showed that the percentage of patients spending more than four hours in Accident and Emergency (A&E) departments rose from 4% of all attendances in 2009/10 to 5.6% in 2010/11. The rise took place before the coalition government scrapped the four hour target for time spent in A&E introduced by the previous Labour government and replaced it with new quality indicators. Doctors warned that they were 'firefighting' growing numbers of patients presenting at A&E departments.

Time to integrate words with action

C. Ham and J. Dixon

Health Service Journal, Jan. 5th 2012, p. 16-17

It is argued that developing integrated care must assume the same priority over the next decade as reducing waiting times was given during the last. Government policy should be founded on a clear, ambitious and measurable goal to improve the experience of patients to be delivered by a defined date. This goal would set a specific objective around which the NHS and local government could coordinate their activities. This goal should be reinforced by guarantees that patients with complex conditions would be entitled to an agreed care plan, a named case manager, and access to a personal health budget where appropriate.

Unions use NHS reforms to 'have a go at Government', says Lansley

A. Grice

The Independent, Jan. 20th 2012, p. 12

Andrew Lansley, the health secretary, accused health professionals' unions of using the proposed health service reforms as an excuse to attack the Government on cuts to their pay and pensions. He accused them of not addressing the reforms on their merits. The Royal College of Nursing replied by saying that they only had patients' interests at heart.

Upheaval, distraction and confusion - fear for future of the NHS

D. Campbell and R. Ramesh

The Guardian, Jan. 19th 2012, p. 8-9

The fact that growing numbers of patients had been waiting longer than they should - for treatment, in A&E or for a diagnostic test - during the coalition's time in power was one of the many issues facing Andrew Lansley, the health secretary. At the last count almost 250,000 patients in England had been waiting more than 18 weeks, including 100,000 who had to wait at least a year and 20,000 who had been waiting for more than a year. But waiting times were only one part of the coalition's gathering troubles over the NHS. With the Health and Social Care Bill marooned in parliament for 12 months, there were signs of government panic over a health service too busy reorganising itself, while trying to save 20bn, to focus on patient care.

Voice and choice in health care in England: understanding citizen responses to dissatisfaction

K. Dowding and P. John

Public Administration, vol.89, 2011, p. 1403-1418

Albert Hirschman suggested that increasing choice might drive out other means of improving services, notably through public action or voice. This study used Hirschman's core ideas to examine whether choice in healthcare in England might drive out voice as he suggests. Voice is considered in three parts: individual voice (complaints), collective voice (voting) and participation (collective action). Exercising choice is seen in terms of complete exit (not using healthcare), internal exit (using another NHS provider), and private exit (using private healthcare). The interaction of satisfaction and forms of voice and choice are analysed over time. Results suggest that Hirschman may be right in some respects. Those who are unhappy with the NHS are more likely to privately complain and plan to take up private health care. Those unable to choose private provision are likely to use private voice.

We must wake up, not shake up

A. McKeon

Health Service Journal, Jan. 26th 2012, p.18-19

The author argues that reconfiguration is not a silver bullet that will deliver efficiency gains and good quality services. In the first place, closing down hospitals is costly. Secondly, there are no successful models of transferring services to the community on a scale that enables hospitals to close. Thirdly, reconfiguration will be viewed by the public as leading to cuts in services and will be extremely unpopular.

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