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

Book an appointment with your GP online

T. Ross

Daily Telegraph, May 21st 2012, p. 1

Under a new NHS information strategy, patients will be able to book GP appointments and receive repeat prescriptions and test results online. By 2015, all patients will be able to access their medical records online. A new website will be created covering NHS hospitals, community services and social care, as well as information on charities and voluntary groups, to help patients choose the best care for them.

(See also Health Service Journal, May 24th 2012, p. 6-7)

Can you afford to ignore research and development?

A. Knight Jackson

Health Service Journal, May 3rd 2012, p. 26-27

In the context of current NHS reforms, it is important for trusts to capture the power of research and development as a tool to bolster the quality, innovation, productivity and prevention drive. In 2008 the Heart of Birmingham Teaching Primary Care Trust launched an ambitious R&D programme which was successful in promoting a research culture in the organisation. This article looks at the strengths of the programme and suggests a winning formula which can be adopted by any provider or commissioning organisation intent on championing R&D.

Care quality upheaval sparks fears on safety

D. West

Health Service Journal, May 10th 2012, p. 4-5

The government's health reforms have sparked a tripling of turnover among primary care trust staff responsible for monitoring hospital care quality. The massive upheaval has fuelled concern about the potential for serious quality and patient safety failings to be overlooked as NHS restructuring is implemented.

Choosing voices: the Department of Health's online interpretation of what patients want

S. Tunney and J. Thomas

Public Management Review, vol. 14, 2012, p. 311-329

Prior to 2010, the Labour government introduced reforms to the English NHS aimed at creating a market by increasing the number of providers, encouraging patient choice of provider, causing money to follow the patient, and arranging for private and NHS contractors to compete 'on a level playing field'. On a webpage entitled 'Why more change?', the Department of Health sought to justify these reforms on the grounds that patients and the public desired more choice of provider. The webpage did not offer any research evidence to support this claim, but the Department supplied the authors with 12 references to publications corroborating the webpage statements in response to a Freedom of Information request. An analysis of these publications showed that they included opinions unsupportive of the policy of patient choice which the Department did not publicise.

Confessions of a health worker

P. Walsh

Health Service Journal, May 3rd 2012, p. 28

The Department of Health has decided to introduce a contractual duty of candour - a requirement for NHS staff to be open and honest with patients and their families about patient safety incidents which cause harm. This article presents some suggestions on how trusts and clinical commissioning groups can prepare for the change.

Condition still critical

P. Collins

Public Finance, May 2012, p. 22-26

The original Health and Social Care Bill aimed to improve the NHS by giving control to clinicians, choice to patients, and freedom from central interference to organisations. These aims were to be achieved by granting commissioning rights to GP consortia, replacing regional NHS administrative bodies with independent entities such as the NHS Commissioning Board, and establishing Monitor as a regulator with a brief to promote competition among all willing providers. The Act that has emerged from the Parliamentary process is much less bold. The GP consortia have been replaced with clinical commissioning groups, which will be subject to more scrutiny from local health and wellbeing boards. Although primary care trusts and strategic health authorities will be abolished, there are plans for their place to be taken by NHS Commissioning Board regional and local offices. Monitor's functions have been downgraded, and it will confine itself to looking at anti-competitive behaviour where it is clear that this is to the detriment of the patient. It is unclear how this will work in practice.

Equality and diversity in the health service: an evidence-led culture change

S. Ali, C. Burns and L. Grant

Journal of Psychological Issues in Organizational Culture, vol.3, 2012, p. 41-60

Equality campaigners in the UK argue that public services continue to ignore the needs of minority communities, leading to poor outcomes. The authors describe a powerful toolkit in use in NHS North West to bring about cultural change so that staff serve diverse communities effectively. This evidence-based strategy applies cultural change management, defines requisite leadership competencies, and introduces a consistent, objective framework for measuring outcomes. Three years into the strategy, there has been a measurable improvement in the cultural competence of NHS bodies in the region.

Every expectant mother to get her own midwife before and after birth

J. Kirkup

Daily Telegraph, May 16th 2012, p. 8

The health secretary announced a package of measures aimed at improving care in pregnancy and the early stages of motherhood. These included: 1) assigning pregnant women a named midwife to focus on their care; 2) provision of additional support to deal with post-natal depression; 3) provision of one-to-one midwife care during labour; and 4) more choice for women about where and when they give birth.

'Friends and family' test for hospitals

J. Kirkup

Daily Telegraph, May 25th 2012, p. 1

In response to concern about poor standards of care in NHS hospitals, especially of elderly patients, the government announced that patients would be asked if they would recommend their hospital to family members and friends. Results would be published to put pressure on the worst performing institutions to improve.

Gay couples and women over 40 to get free IVF treatment on NHS

S. Adams

Daily Telegraph, May 22nd 2012, p. 1 + 2 New guidance from the National Institute for Health and Clinical Excellence (NICE) recommended that same-sex couples and women aged between 40 and 42 should be entitled to free fertility treatment on the NHS for the first time. Fertility experts questioned whether health authorities could afford to widen eligibility criteria.

How Lansley's big vision got shredded

N. Edwards

Health Service Journal, Apr. 26th 2012, p. 22-23

The new Health and Social Care Act consists of layers of amendments laid on top of what was already a complex web of modifications to earlier legislation. Major elements of the original reform programme have been changed, but it is unclear how much this will really affect the way that the reforms play out in practice. There has been a softening of some competition measures, a significant shift to encouraging integration rather than promoting competition, and some tightening of accountability arrangements for clinical commissioning groups. However none of these really seem to alter the original thrust of the bill. Moreover many of the most significant reforms are already taking place independent of the legislation.

Innovation through technology

D. Carlisle (editor)

Health Service Journal, Apr. 26th 2012, supplement, 29p

The articles and case studies in this supplement on the role of new technology in innovation cover:

  • The role of innovation hubs in helping clinicians develop and bring to market new diagnostic tools and medical devices, negotiating hurdles such as intellectual property protection and partnerships with industry
  • Exploitation of the Electronic Staff Record (ESR) as a tool for managing staff absence and training
  • Use of electronic clinical correspondence to reduce the delays and bureaucracy involved in paper correspondence
  • Exploitation of the Electronic Health Record, with potential uses including early warning systems for patients at risk; semantic 'smart' searches for information retrieval; workforce management; and research support
  • Use of shared care records to give different parts of the NHS a full picture of each patient's history and health status.
  • Successes achieved by two new competitions launched by the Department of Health under the small business research initiative for firms to develop innovative technological solutions to the problems of the NHS

Is older people's care in crisis?

I. Philp

Health Service Journal, May 10th 2012, p. 24

This article offers four key principles for improving services for older patients: 1) admit to hospital only those frail older people who have evidence of underlying life threatening illness or who need surgery; 2) provide early access to an old age acute care specialist, ideally within the first 24 hours, to set up the right management plan; 3) discharge to assess as soon as the acute episode is complete, in order to plan post-acute care in the person's own home; and 4) provide comprehensive assessment and reablement during post-acute care to determine and reduce long-term care needs.

Modernising stroke care in England

D. Jenkinson

Health Service Journal, May 17th 2012, p. 25

The national stroke strategy was published in 2007 to address criticisms in a National Audit Office report published in 2005. It contained 20 quality markers along the care pathway, against which local services could secure improvements and address health inequalities over 10 years. A range of performance indicators show significant progress in implementing the strategy.

New shambles over NHS risk register

J. Jowit

The Guardian, May 8th 2012, p. 13

The cabinet was to decide whether the government wanted to veto a ruling that it should publish a full and frank assessment of the impacts of its Health and Social Care Act, which was passed in March 2012. Ministers planned to discuss a possible appeal or veto amid confusion over whether they might have missed the deadline for both, following a ruling by the information tribunal that the risk register must be made public. The disagreement over dates - which related to whether the 20-day deadline for a veto and 28 days for an appeal included weekends and bank holidays - was awkward for a government already embarrassed by confusion over another deadline in the Home Office's continuing efforts to deport the radical cleric Abu Qatada. That dispute had become part of the litany of criticisms rolled into claims that the coalition had become an "omnishambles" - a tag it appears to be finding it hard to shake off. The information tribunal announced in March 2012 that it rejected an initial government appeal against the information commissioner, and published its full ruling on 5 April, setting out that the Department of Health should publish the risk register.

(See also The Guardian, May 9th 2012, p. 7)

NHS liberation 'will not be overnight'

D. West

Health Service Journal, Apr. 26th 2012, p. 4-5

In an interview with the HSJ, Prof. Malcolm Grant, Chair of the NHS Commissioning Board, has warned that the NHS will not change overnight into an autonomous and liberated system on April 1st 2013. It will employ many of the same people, whose habits will need to change over time. In the face of continuing fiscal austerity, transformational service redesign will involve 10 years of very hard work.

The perspective that counts most

N. Cook and K. Miller

Health Service Journal, May 24th 2012, p. 24-25

Looking at service quality from the patient's perspective to inform and direct development has become an integral part of NHS activity in recent years. The patient experience programme at Oxleas Foundation Trust in south east London has become a central component of its quality push. An innovative methodology has been developed to measure qualitative and quantitative aspects of the service user and carer experience in both mental health and community health services within the trust. This involves trained volunteers administering a questionnaire during a one-to-one interview with users and carers.

Six steps to achieve evidence-based care

A. Fraser and D. Cohen

Health Service Journal, May 17th 2012, p. 22-24

The national stroke strategy published in 2007 advocated more specialised acute and hyper-acute care for stroke patients. In the same year NHS London committed itself to deliver these changes. Five years later, London's performance has improved dramatically. This article explores transformational change at the hospital unit level, through a study of service redesign at Northwick Park Hospital. Six key factors were found to have influenced successful implementation of evidence-based stroke care: clinical leadership with sustained management support; increased funding and staffing; data transparency and an increased role for audit; education and multidisciplinary team working; excitement; and support from the strategic health authority, primary care trust, and the stroke and cardiac networks.

Top trust chief's plea for independents

B. Clover

Health Service Journal, May 24th 2012, p. 4-5

In this interview, Gareth Goodier, the chair of the Shelford Group, argued in favour of more competition between public and independent service providers in the NHS in order to drive quality and efficiency. He also discussed the adverse effects of cuts to local authority social care services on the NHS due to a rise in delayed discharges and expressed concern about the shift of services out of hospitals into a community sector not geared up to offer them.

Waiting times and socioeconomic status: evidence from England

M. Laudicella, L. Siciliani, and R. Cookson

Social Science and Medicine, vol. 74, 2012, p. 1331-1341

Waiting times for elective surgery such as hip replacements should on depend on the severity of the patient's condition, and not on whether the patient has a high or low income, or whether they are highly educated. There is some evidence that this may nor be the case in reality. A previous study found evidence of inequality in NHS waiting times favouring patients living in advantaged areas of England. This study investigates possible explanations of these variations in waiting times, showing that they are driven by both education and income. Poorer patients wait about 7% longer than wealthier patients and less educated patients wait 9-14% longer than the better educated. There is no evidence that differences in the severity of medical conditions explain the social gradient in waiting times.

We must revise the rules of engagement

D. Carlisle

Health Service Journal, May 10th 2012, p. 14-16

Report of an interview with King's Fund fellow Dr Richard Bohmer on how the NHS could deliver better value for money. The solution lies in how healthcare is organised. High value healthcare organisations specify decisions in advance and in detail, setting out specific pathways for highly defined groups of patients. They design microsystems to fit around these pathways, that include the staff, IT, physical space, business policies and processes and procedures that support patient care. They also measure and review what they do and are financially stable. The starting point for organisations seeking to be 'high value' is clinical leadership and financial engagement. The article concludes by discussing how to engage clinical leaders at a time of financial crisis.

The winds of change

R. Cheung

Health Service Journal, May 3rd 2012, p. 21-23

The NHS Right Care Programme has commissioned a suite of themed atlases of unwarranted variation in healthcare, starting with a collaboration with the child and Maternal Health Observatory on variation in healthcare for children and young people. This atlas illustrates the magnitudes of variation in quality, equity of access and outcomes across 27 indicators of child health and will allow clinicians, commissioners and service users to identify priority areas for improvement.

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