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

Backers turn against Lansley's NHS plan

D. Campbell

The Guardian, Feb. 7th 2012, p. 17

Two prominent backers of the coalition's NHS shake-up have joined the growing chorus of critics by claiming that GPs will be 'suffocated rather than liberated' by the planned changes. Dr Charles Alessi and Dr Michael Dixon have helped Andrew Lansley claim credibility for his plans among doctors over the past 18 months by strongly supporting his radical restructuring. They are leading lights in the NHS Alliance and the National Association of Primary Care, two key pro-reform organisations. But they now fear that the new consortiums of local doctors, which will start commissioning healthcare for patients in England from 2013, will not have the freedom that the health secretary has repeatedly pledged. Lansley has attempted to persuade sceptics that his reorganisation will put family doctors in charge of healthcare.

Boost staffing at weekends, win a cash bonus, hospitals told

J. Kirkup

Daily Telegraph, Jan. 30th 2012, p. 12

The health secretary expressed concern that death rates were higher at some NHS hospitals outside of normal working hours. Government was considering offering hospitals financial incentives to improve the care offered at weekends. Ministers were also looking at using transparency rules to push hospitals into changing their staffing patterns. Data about different trusts' medical results, cross-referenced to their weekend staffing levels, could be made available to patients in the expectation that they would choose to be treated at hospitals with better weekend cover.

Colleges split over Health Bill

C. Santry

Health Service Journal, Feb. 2nd 2012, p. 6

This article reports on the split that had developed in the position taken by the medical royal colleges towards the controversial Health Bill. In January 2012 one declared outright opposition, four expressed significant concerns, and two agreed to work to improve the legislation. The split occurred after talks to build a united front failed.

Competition is critical to reform

A. Lansley

Health Service Journal, Feb. 16th 2012, p. 18-19

In the light of criticism of the clauses in the Health Bill which seek to increase competition in the NHS, the health secretary defends the concept. He argues that governments worldwide are examining how to cope with rising demand for healthcare in times of fiscal austerity. His chosen instrument is to stimulate innovation and use of new technologies through competition.

Doctors' radical plan to tackle organ shortage

D. Campbell

The Guardian, Feb. 13th 2012, p. 1

Patients could be kept alive solely so they can become organ donors, hearts could be retrieved from newborn babies for the first time, and body parts could be taken from high-risk donors as part of an urgent medical and ethical revolution to ease Britain's chronic shortage of organs, doctors' leaders say. Hearts could also be taken from recently deceased patients and restarted in those needing a cardiac transplant, under controversial proposals from the British Medical Association intended to stop up to 1,000 people a year dying because of the country's chronic shortage of organs.

Does competition improve public hospitals' efficiency?: evidence from a quasi-experiment in the English National Health Service

Z. Cooper and others

London School of Economics Centre for Economic Performance, 2012

This study showed that competition from private hospitals did not spur public providers to improve their performance but instead left them with a more costly case-mix of patients. This led to increases in post-surgical stay in 2008, 2009 and 2010. The finding highlighted the need for policymakers to risk adjust payments as they introduced competition in markets with regulated prices, particularly where there were both public and private providers with different objectives and functions. The analysis also showed that competition between NHS providers introduced in 2006 led to moderate but statistically significant reductions in presurgery, postsurgery and overall lengths of stay.

Don't fight the future

S. Chisholm

Health Service Journal, Feb. 2nd 2012, p. 26-27

This article discusses some of the barriers to adoption of new technologies in the NHS, including high costs, complex service redesign, and insistence on piloting. It calls for a coordinated national approach to adopting, measuring the effectiveness of, and spreading innovations across the NHS to help overcome these barriers.

Going private: clinicians' experiences of working in UK independent sector treatment centres

J. Waring and S. Bishop

Health Policy, vol.104, 2012, p.172-178

Independent Sector Treatment Centres (ISTCs) were introduced into the NHS to reduce waiting times, increase service capacity and expand patient choice. Given the Coalition Government's commitment to further diversification of healthcare providers within the NHS, this study investigated how clinicians working in independent treatment centres perceived the differences between the public and private sectors. Interviews with 35 clinicians working at two ISTCS revealed that although the private sector had the capacity to offer improved work environment and patient experience, there were concerns about management priorities and the reconfiguration of work.

Health Bill changed to win over peers

S. Adams

Daily Telegraph, Feb. 3rd 2012, p. 2

The coalition government made 137 late amendments to the Health and Social Care Bill in an effort to address concerns raised by peers. Key changes included confirming the health secretary's ultimate responsibility and accountability for the NHS, and requiring health bodies to involve patients more in decision making, to actively support integration and to promote research. Many changes appeared to be intended to clarify and strengthen the language of the Bill.

Health Bill in fresh trouble as first signs of cabinet dissent emerge

P. Wintour and J. Jowit

The Guardian, Feb. 10th 2012, p. 1

The government's beleaguered Health Bill has run into fresh trouble after it emerged that plans were being laid for a call for it to be scrapped at the Liberal Democrat spring conference. It was also expected that the influential Conservative Home website, seen as the voice of the party grassroots, would publish an editorial calling for the bill to be dropped altogether. It was understood that Conservative Home had been urged to make the call by three cabinet members who believed David Cameron was not listening on the issue. One source said: 'We have almost been instructed to write this.' It was extraordinary that cabinet members felt so frustrated at the political deadlock that they had resorted to urging Conservative Home to raise the flag of rebellion. (See also The Guardian, Feb. 28th 2012, p. 9, The Guardian, Feb. 28th 2012, p. 11)

Lansley wins backing not to reveal risk register

J. Jowit

The Guardian, Feb. 23rd 2012, p. 8

Health secretary Andrew Lansley looked more determined than ever not to reveal the findings of a risk assessment done on the government's NHS shakeup. Lansley won the support of MPs, who voted by a majority of 53 against a Labour motion that the Department of Health should make its document public. However, growing disquiet among some Conservative MPs and Liberal Democrats was voiced by Lib Dem MP John Pugh, who told the often bad-tempered debate that the bill was 'toxifying the Tories' and 'sadly detrimental' to his party.

Leadership development for junior doctors: what can we learn from 'Darzi' fellowships in clinical leadership?

L. Stoll and others

International Journal of Leadership in Public Services, vol. 7, 2011, p. 273-286

There are calls for doctors to move beyond the confines of one-to-one relationships with patients and lead the improvement of healthcare outcomes for entire communities and populations. 'Darzi' Fellowships in Clinical Leadership provide trainees doctors with a unique opportunity to develop the organisational and leadership capability for future roles as clinical leaders. The Fellowships comprise 12 months 'out of programme' from speciality training during which trainees work on projects related to service redesign, quality and safety improvement, and leadership capacity building. This paper reports an impact evaluation of the programme, highlighting transferable design principles.

Lords deal NHS reforms first defeat

R. Mason and J. Kirkup

Daily Telegraph, Feb. 9th 2012, p. 2

Peers voted by 244 to 240 to amend the Health and Social Care Bill to emphasise the importance of mental health on February 8th 2012, suggesting that its passage could be more of a battle than the Government thought. Despite growing opposition to the Bill from the medical profession, the prime minister defended both the reforms and the health secretary in the Commons.

Loser takes all

J. Taylor

Health Service Journal, Feb. 23rd 2012, p. 16-19

Report of an interview with economist and journalist Tim Harford, who argues that failure is a necessary stage on the road to success, and that experimentation, that can fail, is ultimately more effective than an overarching grand plan in delivering service improvement. He discusses how these ideas could be applied to the NHS, where public accountability makes managers risk averse. A range of experts comment on these ideas.

Macmillan boss tackles the big C: commissioning

N. Golding

Health Service Journal, Feb. 2nd 2012, p. 16-17

In this reported interview, the new non-executive director of the NHS Commissioning Board, Ciarán Devane, argues for a balance between localism and national co-ordination in the reformed NHS. He is optimistic about the role of voluntary sector organisations in health service provision and wants to use his new job to promote the influence of patients. The interview also covers Mr Devane's views on cancer services in depth, as he was formerly chief executive of Macmillan cancer support.

Miliband tells Lords to join forces and kill off Lansley's NHS reforms

A. Grice

The Independent, Feb. 6th 2012, p. 6

Labour urged its peers in the House of Lords to vote against the Health and Social Care Bill. The Labour leader, Ed Miliband, argued that the reforms would result in 6,000 fewer nurses and that at a cost of £748m these jobs could be saved. (See also The Independent, Feb. 8thst 2012, pp. 1,6,7; The Guardian, Feb. 8th 2012, p. 2; Feb. 9th 2012, p. 8; The Guardian, Feb. 24th 2012, p. 8)

Most GPs believe 'reforms are toxic'

S. Adams

Daily Telegraph, Feb. 1st 2012, p. 2

In a letter to the newspaper, 365 GPs, specialists and health academics called for the sweeping reforms to the NHS in the Health and Social Care Bill to be halted. They argued that the reforms threatened to derail and fragment the NHS into a collection of competing private providers. This would lead to chaos and damage the quality and availability of patient care.

NHS reforms 'will guarantee new overhaul within five years'

S. Adams

Daily Telegraph, Jan. 31st 2012, p. 10

The editors of the British Medical Journal, the Health Service Journal and the Nursing Times wrote in the BMJ that the government's Health and Social Care Bill was 'unnecessary, poorly conceived, badly communicated, and a distraction at a time when the NHS is required to make unprecedented savings'. They predicted that the NHS would need another major reorganisation within five years if the government pressed ahead with its reforms. The trio argued that the government should establish an independent commission to look into the future of the health service.

NHS staff told to heed patients' requests for food and drink

D. Campbell

The Guardian, Feb. 24th 2012, p. 8

NHS staff would have to give greater priority to patients' requests for food, drink, pain relief and the chance to have a wash under guidelines intended to improve hospital care. The National Institute for Health and Clinical Excellence (NICE) drew up its quality standard and guidance after care, especially regarding elderly patients' nutritional needs and privacy, was criticised in reports by the NHS Ombudsman, Care Quality Commission, Age UK and Patients' Association. The guidance was intended to help ensure patients were treated with compassion, dignity and respect and that they had more of a say about how they were treated. Patients should get the chance to 'discuss their health beliefs, concerns and preferences in order to individualise their care', said a NICE spokeswoman. It also specified that patients should have their physical needs - such as nutrition, hydration, personal hygiene and pain relief - and psychological concerns - such as fear and anxiety - assessed. They should also be reminded that they can choose, accept or decline treatment.

NHS will have to expand treatment rationing, warn GPs

D. Campbell

The Guardian, Feb. 27th 2012, p. 9

The NHS was facing such acute financial pressure that it would have to extend the rationing of treatments in order to cope, GPs warned. An overwhelming majority of family doctors believed that the NHS was under such strain that ministers would have to undertake the politically difficult task of redefining what it could, and could not, afford to provide. Rising demand for healthcare, the discovery of new treatments and flat NHS budgets had reopened the debate on whether it needed to set out clearly what services would be restricted to patients with certain ailments. A representative survey of 821 GPs in England, commissioned by the Nuffield Trust health thinktank, found that 85% predicted the financial challenge would ultimately force the government to spell out more clearly what care was and was not available to patients.

Nurses' chief regulator quits as minister orders inquiry

D. Brindle

The Guardian, Feb. 6th 2012, p. 8

Terms of an inquiry into the way nurses and midwives were regulated was to be announced after checks found 'significant weaknesses' in the handling of complaints about nursing and risks to the protection of the public. The profession's chief regulator, Roger Thompson - himself a nurse - resigned from his post at the Nursing and Midwifery Council (NMC), and the inquiry was expected to consider whether it was competent to run its own affairs.

(See also The Guardian, Feb. 24th 2012, p. 14)

Official papers expose risks of health reform

J. Jowit

The Guardian, Feb. 15th 2012, p. 1

The government's health reforms ran a high risk of reducing levels of safety and patient care while leading to overspending, internal NHS reports warned. The potential for conflict between NHS organisations in the new system and upheaval during the transition was high, according to risk assessments drawn up by the four English NHS regions. There was also a high chance the reforms would fail to achieve hoped-for management improvements and budget cuts, they said.

Old foes are fighting the same corner

D. Kerr

Health Service Journal, Feb. 9th 2012, p. 16-17

This article argues that both the proponents and opponents of the controversial Health Bill have failed to grasp the concept of value-driven healthcare. Faced with rising demand and flat funding, NHS organisations need to focus on achieving value for money by improving patient outcomes while reducing costs. Quality could also be improved by ranking healthcare providers in publicly available league tables. Such transparent performance measurement would incentivise clinicians to improve their service.

PM accused of divide and rule on Health Bill

P. Wintour

The Guardian, Feb. 20th 2012, p. 1

David Cameron was accused of deepening divisions in the health service by only inviting royal medical colleges and health practitioners that he believed would back his NHS reorganisation to a special summit at Downing Street. Strikingly both the BMA and the Royal College of General Practitioners were not asked to the summit, even though the transfer of greater powers to doctors was a centrepiece of the changes. Cameron, facing widening opposition to the reorganisation from across the health service, sections of the Liberal Democrats, crossbench peers and fellow Conservative cabinet members, believed he had no alternative but to plough on with the Health Bill, and show there was a viable support base for the changes within the health service.

(See also The Guardian, Feb. 21st 2012, p. 1; The Guardian, Feb. 22nd 2012, p. 9)

Report of the Office of Health Economics Commission on Competition in the NHS

London: Office for Health Economics, 2012

Current evidence suggests that price competition in healthcare may lead to lower quality care. For this reason the government has planned that competition among qualified providers would be on quality, with prices fixed by the regulator, Monitor. However, this report warns that using fixed prices to prevent competition from driving down quality could become increasingly problematic over time as providers' costs converged on the prices they knew would be paid, and the possibility of cost reduction became obscured by lack of benchmarks. There is a risk that prices fixed by a regulator could increasingly diverge from the costs of providing the service to the desired quality, especially when that quality cannot be fully observed. The report also warned that competing providers could 'cherry pick' easy and lucrative patients. As the NHS would need to spend time and money monitoring and managing competitive markets to protect quality, it needed to choose priority areas for introducing competition. A framework to help clinical commissioning groups identify where competition could be feasible and beneficial was needed and had been developed by the commission.

Rise in patients waiting more than 18 weeks for NHS treatment

J. Ball

The Guardian, Feb. 17th 2012, p. 13

The number of patients waiting more than 18 weeks for NHS treatment continued to increase year-on-year, with more than 22,600 patients facing long waits in December 2011. The NHS constitution gave all patients the right to treatment within 18 weeks of their first referral by a GP - a right reaffirmed by David Cameron at the end of the NHS 'listening' exercise in 2011. However, 8.4% of inpatients treated in December 2011 waited longer than this guaranteed period. This was still within the government's operational target of treating 90% of patients in the allotted time.

Scrapping NHS reforms could save 6,000 nursing jobs, Miliband claims

R. Syal

The Guardian, Feb. 6th 2012, p. 8

Ed Miliband claimed that the total number of nurses working within the NHS had been cut by 3,500 since the 2010 general election, and could fall by a further 2,500 by the end of this Parliament. The Labour leader said that official NHS statistics proved that the Tories' reorganisation of the health service was directly damaging frontline patient care. At the same time, Labour argued that the funds set aside to pay for the costs of the Health Bill's reorganisation would protect all 6,000 nursing jobs if Parliament chose in the coming weeks to abandon the reform.

Survey of patients' and families' experiences of rare diseases reinforces calls for a rare disease strategy

S. Nutt and L. Limb

Social Care and Neurodisability, vol. 2, 2011, p. 195-199

Over the summer of 2010, Rare Disease UK conducted a survey of the experiences of patients living with a rare disease and their families. Analysis of the results of this survey showed that, despite a great variation in the conditions reported, there was often a commonality in the experiences of rare disease patients with many reporting similar problems and issues with regard to obtaining a correct diagnosis and accessing necessary care, information and support. The research reinforced the need for a UK strategy for rare diseases in accordance with the EU's Recommendation on an Action in the Field of Rare Diseases adopted unanimously in June 2009.

Taking up the Dorrell challenge

J. Appleby

Health Service Journal, Feb. 23rd 2012, p. 20-21

The NHS plans to make the £20bn of savings required by the government by 2015 through a combination of a price squeeze through the tariff, a pay freeze, management cost cuts and cuts to national budgets. However, as the Commons Health Committee has argued in its 2010 and 2012 reports, the service actually needs to focus on radical redesign to deliver long term benefits and better integration of health and social care.

TripAdvisor hospital ratings show where you are likely to die

R. Mason

Daily Telegraph, Feb. 15th 2012, p. 8

The government funded NHS Choices website allows patients to give feedback on their hospital treatment in the same way as travellers review holiday destinations on the TripAdvisor site. A study by academics at Imperial College London found that hospitals with good patient ratings on the Internet site tended to have a 5% lower death rate and an 11% lower readmission rate. Health minister Simon Burns commented that the research suggested that patient feedback could be more valuable than previously thought.

Understanding strategy, change and leadership in UK health and social care

S. Willcocks

Journal of Integrated Care, vol. 19, no.6, 2011, p. 23-32

This article explores various approaches to strategy in the NHS, including the competitive advantage model and the emergent, political or negotiated, process. In particular, it applies strategy with a market-based, competitive orientation, given the continuing interest in competition and patient choice in the NHS. It also looks at strategy from an emergent, processual perspective, with particular emphasis on its context. The latter is important in health and social care, given the complex nature of the context and the potential for resistance. Finally, it explores the implications for strategic leadership.

Williams says Lansley should drop NHS competition clause

R. Ramesh

The Guardian, Feb. 14th 2012, p. 16

The government's health reforms were plunged into fresh doubt by a call from the Liberal Democrat peer Shirley Williams for Andrew Lansley to drop competition from the Health Bill - hours after the prime minister and his Lib Dem deputy defended the health secretary. Writing in the Guardian, Lady Williams called for the government to drop the chapter on competition, adding that the public had a fear of privatisation founded on the idea that GPs 'might become dependent on advice from powerful private health companies, and that the imposition of UK and European competition laws, addressed to markets and not to social goals, might destroy the public service principles of the NHS'.

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