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

500,000 medical records go online in public health database

I. Sample

The Guardian, Mar. 30th 2012, p. 19

An enormous online database of medical and lifestyle records from half a million middle-aged Britons was published in March 2012, giving scientists a powerful new tool to study diseases such as cancer, dementia and heart disorders. Public health researchers anywhere in the world can access anonymised records in the UK Biobank to help unravel the genetic and environmental factors that lead some people to develop diseases while others do not. They will be able to highlight groups of people who have been diagnosed with a specific condition and then look back through their records to see what common factors might have contributed to their illness.

Acute sector faces unprecedented shake-up

B. Clover

Health Service Journal, Mar. 29th 2012, p. 6-7

Sixty-five of England's 166 acute and specialist trust chief executives responded to the first of a series of quarterly surveys. Only 25 of the respondents were not involved in or considering acquisitions, mergers, or the gain or loss of services. A third of hospital leaders were considering acquiring services from another trust. At the same time, 15% could cede some of their services to another NHS body. One in eight anticipated transferring part of their work to a private or third sector body or social enterprise.

After the fury, the cold reality: NHS bill passes the final hurdle

J. Jowit

The Guardian, Mar. 21st 2012, p. 1, 6-7

The final vote for the Health and Social Care Bill ended more than a year of debate and several last-minute bids to overturn or delay the legislation. Labour used the final day's debate to declare it would repeal the reforms "at the first opportunity". After a year in Parliament, more scrutiny than any bill in living memory, and more than 1,000 amendments in the House of Commons and the House of Lords, MPs cast their final vote for the bill, with a government majority of 88. The bill will be sent to the Queen for royal assent, and is expected to become law.

Beyond rhetorical differences: a cohesive account of post-devolution developments in UK health policy

K. Smith and M. Hellowell

Social Policy and Administration, vol.46, 2012, p. 178-198

Since devolution in 1999, the Welsh Assembly government, the Scottish government and the Northern Ireland executive have each produced a wealth of documents setting out distinct approaches to health policy. Research analyses to date have suggested that the devolved administrations have developed distinct approaches to health care, but approaches to public health issues have remained consistent. The story presented in this article contrasts with these accounts, suggesting that, for both health care and public health policy, there remains a remarkable degree of consistency across the UK. Looking to the future, the article concludes that the common economic challenges, combined with a tight fiscal policy, means that the similarities in health care provision across the UK are likely to remain more pronounced than the differences.

Clegg backs fight to dilute changes to the NHS

R. Winnett

Daily Telegraph, Feb. 28th 2012, p. 2

The Deputy Prime Minister Nick Clegg sent a letter to all Liberal Democrat politicians urging them to back new amendments to the Health and Social Care Bill. The changes were designed to reduce competition, or the impact of the use of private firms, on the NHS. The Prime Minister was reported to be prepared to accept the amendments if they provided 'reassurance'.

Devolution and patient choice: policy rhetoric versus experience in practice

S. Peckham and others

Social Policy and Administration, vol.46, 2012, p. 199-218

This article explores the impact of political devolution in the UK on healthcare policy by exploring policy on patient choice. Market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved administrations in Scotland, Wales and Northern Ireland. Patient choice of healthcare provider has been a key policy in England and was the main demand side mechanism of the market reforms of the English NHS. The devolved administrations specifically rejected market style coordination and patient choice of provider. However, this study found that in practice choice was a limited concept in all four countries. Thus while at the national policy level there appeared to be a substantial difference between countries, at an operational level and in the way choices were experienced by patients there was much less difference, with substantial similarities in the way patient choices of provider and appointment times were managed.

Doctors give up fight with Government over NHS reform

O. Wright

The Independent, Mar. 13th 2012, p. 1, 8

In a personal letter to the Prime Minister, Dr Clare Gerada - who heads the Royal College of GPs - has launched an appeal to co-operation between the Government and GPs on NHS reforms. The appeal signals a change in tone from previous harsh attacks on the proposed reforms.

Doctors risk their careers by ignoring poor care on wards

J.-P. Ford Rojas

Daily Telegraph, Mar. 13th 2012, p. 13

Under General Medical Council guidelines that came into force in March 2012, doctors could face disciplinary action if they ignored poor patient care by colleagues or other health professionals. They could be held to account for failing to raise concerns about poor treatment even if they were not personally involved.

Evaluating Labour's market reforms, 2002-10

Journal of Health Services Research and Policy, vol. 17, 2012, Supplement 1, 71p

Starting in 2002, the Labour government in power introduced a series of NHS reforms in England designed to increase patient choice and encourage competition among public and private providers of elective services. In 2006, the Department of Health initiated the Health Reform Evaluation Programme to assess the impact of the changes. The changes broadly had the effects predicted by supporters but these were modest. Most of the negative impacts feared by critics had failed to materialise by early in 2010. However this high level conclusion conceals a far more nuanced and complex picture of both the process of implementation and the impact of the changes, as demonstrated by the papers in this special supplement.

Framing health inequalities for local intervention: comparative case studies

T. Blackman and others

Sociology of Health and Illness, vol. 34, 2012, p. 49-63

Towards the end of the 1990s reducing health inequalities rose up the agenda of governments in the UK, reflecting a growing awareness of their existence and preventability, as well as the financial cost of treatment if they were not addressed. This article explores how health inequalities are constructed as an object for policy intervention by considering four framings: politics, audit, evidence and treatment. A thematic analysis of 197 interviews with local managers in England, Scotland and Wales is used to explore how these framings emerge from local narratives following devolution. The power of politics emerged clearly from the analysis. In England it ran through how audit was perceived in practice and shaped the policy stream that to 2008 was more attentive to waiting times and budgets than health inequality and that after 2008 delivered medicalisation of health inequalities as a way of meeting short term targets. In Wales politics moved away from tackling health inequalities under pressure from a media-led campaign to reduce waiting times to match those in England. In Scotland, tackling health inequalities was seen as the object of joined-up working facilitated by a political stream that engendered stability and partnership working. No clear link emerged in any of the localities between what was being done and the evidence for doing it, beyond broad generalisations. There was also little systematic learning from the interventions that were being pursued.

Government response to the House of Commons Health Committee Report on Public Expenditure

HM Government

London: TSO, 2012 (Cm 8283)

On 24 January 2012, the Health Committee published Public Expenditure: Thirteenth Report of Session 2010-12 (HC 1499). The report followed an inquiry by the Health Committee which sought evidence from the Secretary of State for Health along with other witnesses, including the NHS Confederation, the Local Government Group and the King's Fund. The Government has considered the Committee's report and the issues that it raises, and this paper sets out the Government's response. The Government agrees that the challenges facing the NHS, and the opportunities available to improve the quality and productivity of services, will mean that how and where care is delivered will change. The Government recognises that the NHS and social care have different accountability and funding systems but it agrees that every opportunity should be taken to promote the development of integrated approaches resulting in services which are 'joined up' from the patients' perspective. The Health and Social Care Bill requires the NHS Commissioning Board to encourage clinical commissioning groups (CCGs) to use joint budget arrangements with local authorities where it would benefit patients, service users and carers. In addition, the creation of health and wellbeing boards will facilitate further joint working and integration between local authorities and CCGs.

Health bill 'will damage the NHS irreversibly'

D. Campbell

The Guardian, Mar. 1st 2012, p. 1

Profit-driven firms could oust GPs from their key role in deciding what treatments patients need because of creeping privatisation in primary care caused by the coalition's NHS shakeup, doctors' leaders warned. The British Medical Association (BMA) said that the relationship between family doctors and patients would suffer irreparable damage and that the reforms would be "irreversibly damaging to the NHS", in its most strongly worded criticism yet of Andrew Lansley's radical reorganisation of the NHS in England. The BMA denounced the Health and Social Care Bill as "complex, incoherent and not fit for purpose, and almost impossible to implement successfully, given widespread opposition across the NHS workforce".

Healthcare reform's new dawn

N. Seddon

Health Service Journal, Mar. 1st 2012, p. 18-19

In the future health services will be expected to do more with less resources. This means that patients will be expected to take more responsibility for managing and monitoring their own conditions in the community, using personal budgets and telehealth technologies. Consequently fewer hospitals will be needed. Finally, in order to avoid waste, transparency will be required to reveal which services and approaches work best.

Is it too late to stop the Bill?

C. Harries

Community Practitioner, vol. 85, Mar. 2012, p. 15-17

The controversial proposals for NHS reform in the Health and Social Care Bill have been vehemently opposed by professional organisations and trade unions in the health sector. This article offers a handy timeline of the bill's passage through Parliament and summarises the arguments of the opposition.

(See also Children and Young People Now, Mar. 6th-9th 2012, p. 8-9)

Lean management in the NHS: fad or panacea?

B. McIntosh and G. Cookson

British Journal of Healthcare Management, vol.18, 2012, p. 130-135

Lean management focuses on improving product quality while eliminating waste, primarily through process redesign and the integration of employees, management, suppliers, and customers into the quality management process. The NHS is required to make significant cost savings while maintaining service quality. While there are many differences between manufacturing and healthcare which make the direct transfer of lean management techniques problematic, it does offer a way of improving clearly-defined and specialised clinical procedures. Applicability to wider NHS organisation would require a paradigm shift in management philosophy.

Looking back, moving forward

Health Service Journal, Mar. 15th 2012, supplement, 54p

The National Programme for Information Technology (NPfIT) was an ambitious programme that aimed to move the NHS in England towards a single, central electronic care record for patients and to provide authorised professionals with access to them. The programme was widely and wrongly regarded as an unmitigated disaster. This supplement presents the results of an evaluation of aspects of the programme, including the impact of the electronic health record on the quality and safety of care, the electronic blood tracking pilot at Croydon University Hospital, the electronic prescription service in primary care, and the impact of IT on interactions between patients and health professionals.

Nursing a grievance? The role of healthcare assistants in a modernized National Health Service

S. Bach, I. Kessler and P. Heron

Gender, Work and Organization, vol. 19, 2012, p. 205-224

Nursing has long sought to establish its distinctive contribution to the hospital division of labour and to differentiate its contribution from that of other staff who undertake nursing work. In the context of intense healthcare workforce reform, there has been a growth in lower status occupations, including healthcare assistants. This article explores the relations between nurses and healthcare assistants. Using data from two NHS hospital trusts, it examines the boundaries between the roles of healthcare assistants and nurses from the perspectives of both. The analysis suggests that overlaps between the work of healthcare assistants and nurses jeopardise the mandate of registered nurses and the discourse of 'holistic care', creating tensions between the two groups. Healthcare assistants provided a substantial proportion of direct care on the case study wards. This was reflected in the skill mix in which there were usually three healthcare assistants and four nurses on duty on each day shift. These staffing patterns, in combination with the administrative and technical workload of registered nurses, led healthcare assistants to claim that they were more responsive to the physical and emotional needs of patients, challenging the distinctive patient-centred ideology of nurses.

Quality accounts monitoring by acute trust boards

B. Ritchie and N. Mays

British Journal of Healthcare Management, vol. 18, 2012, p. 87-94

A Quality Account is a publicly available annual report on the quality of an organisation's NHS healthcare services. Acute trusts were required to publish them starting in 2010. One of their objectives is to encourage trust boards to assess quality across the totality of services they offer, with an eye to continuous improvement. This study analysed the minutes of acute trust boards of directors' meetings to assess how they monitored quality issues in the period 2008-10, before and after the requirement for all acute sector providers to produce Quality Accounts. Results showed that Quality Accounts had a positive effect on board quality monitoring arrangements at 5 of the 15 acute trusts examined. Modest increases were found between 2008 and 2010 in regular reports to the board on quality and safety, patient experience and complaints. However, board attention to monitoring the clinical effectiveness of specific services was low overall throughout 2008-10.

Reducing unplanned care: a new paradigm

S. Rowe

British Journal of Healthcare Management, vol. 18, 2012, p.104-108

Each local healthcare economy faces a challenge in controlling rising numbers of accident and emergency attendances and emergency hospital admissions, which are neither affordable nor desirable. Data analysis from NHS Wakefield District has been used to develop a new paradigm for viewing and understanding total levels of unplanned care. If they are to reduce them, this analysis suggests that they should work from the basis that totals for unplanned care in any financial year are driven by the number who experience them, rather than by the number who have more than one unplanned event in a year. Secondly, results suggest that those who experience an emergency admission in a given financial year are unlikely to have experienced one in those before it.

Reforms could damage NHS, warns draft risk register

N. Watt and R. Ramesh

The Guardian, Mar. 27th 2012, p. 1

Emergencies in the NHS could be less well managed under the government's controversial health reforms, according to a draft version of a risk register on the bill which had been leaked. Labour claimed the register served as a "damning indictment" of the health reforms which passed into law after a bruising parliamentary battle. The warnings about the threat posed by the bill were issued in a draft version of the risk register, dated 28 September 2010, which was leaked to the health writer Roy Lilley. The government was criticised for refusing to comply with a ruling by the information commissioner to publish the Transition Risk Register, drawn up on 10 November 2010, after an FOI request by the former shadow health secretary, John Healey.

Scrap NHS Bill, say doctors who will run reforms

T. Ross

Daily Telegraph, Feb. 29th 2012, p. 8

In a letter to David Cameron obtained by Pulse magazine, Dr Sam Everington, from Tower Hamlets Clinical Commissioning Group, called for the controversial Health and Social Care Bill to be scrapped. It was the first time that one of the clinical commissioning groups set up to implement the proposals formally expressed its opposition to the Bill.

Train doctors to help patients die at home, say experts

R. Smith

Daily Telegraph, Mar. 22nd 2012, p. 14

The Royal College of Physicians has argued that doctors should be trained to treat dying patients with dignity and help them pass away at home instead of in hospital. Doctors need to identify much earlier when patients are dying and discuss the care they wish to receive with them. It is proposed that all doctors involved in care of the dying should go on a training course every five years to update their knowledge.

Tribunal told of 'chilling effect' if NHS papers are released

H. Mulholland

The Guardian, Mar. 6th 2012, p. 18

The publication of documents outlining the risks relating to the government's health changes could lead to a "distorted and wildly speculative interpretation of risk", according to the permanent secretary of the Department of Health. Una O'Brien also warned that publishing the documents would have a "chilling effect" on the way civil servants tasked with outlining the potential pitfalls of a policy commit their views to paper, as the government fought to keep secret the contents of its risk assessments of the government's shakeup of the NHS. O'Brien was giving evidence to the information rights tribunal as the government sought to overturn a November 2011 ruling by the information commissioner, Christopher Graham, who ordered the health secretary, Andrew Lansley, to release his department's risk assessment of the potential dangers of his radical shakeup.

The wrong answer to the wrong question

H. Cayton

Health Service Journal, Mar. 15th 2012, p. 16-17

Lack of staff is often advanced as an excuse for poor care. The public inquiry into the Mid Staffordshire Foundation Trust is expected to recommend that minimum staffing ratios be set for doctors and nurses in accident and emergency departments and elderly care wards. The author argues that this input measure will not be effective and that instead local managers should be given discretion to identify the mix of skills and competencies that staff need to achieve desired outcomes. Organisations should be judged on whether or not they achieve these outcomes.

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