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Welfare Reform on the Web - January 2001: National Health Service - reform - general

APPRAISING NICE APPRAISALS

J. Appleby

Health Care UK, Autumn 2000, p.24-26

Problems faced by the National Institute for Clinical Excellence in appraising new treatments include:

  • likelihood of appeals against its decisions;
  • rapid change leading to the need for constant re-evaluation;
  • lack of reliable evidence;
  • difficulty of evaluating an intervention in isolation from other technologies and staff expertise.

BEAM ME UP, BOURNEMOUTH

L. Whitfield

Health Service Journal, vol. 110, Oct. 12th 2000, p. 16-17.

Party leaders at the Conservative conference have committed themselves to the expansion of private healthcare provision.

THE CONSULTANTS' CONTRACT: DOES IT MATTER?

J. Keen

Health Care UK, Autumn 2000, p.22-33

The controversy surrounding government proposals to reform the consultants' contract could lead to a general debate about the role of private healthcare in the UK.

CONSULTANTS' NHS THREAT

R. Watson and N. Hawkes

Times, Oct. 18th 2000, p. 1+3

Hospital consultants are threatening a mass walkout from the health service in protest at government plans to curb their private practice. One proposal would see groups of consultants forming independent consortia and striking their own deals with both the private and the public sectors.

THE ELECTRONIC FUTURE FOR THE NHS

J. Hocksma

British Journal of Health Care Management, vol. 6, 2000, p. 472-474

One of the most important elements in the delivery of the NHS plan will be the imaginative harnessing of information technology through implementation of the Electronic Patient Record, electronic booking of appointments, electronic prescriptions emailed between GPs and pharmacists, and electronic procurement.

HANDS ON

M. Clarke

Health Service Journal, vol. 110, Oct. 19th 2000, p.32

Nurses at University Hospitals of Leicester Trust have been performing operations on patients with carpal tunnel syndrome and have secured a major reduction in overall treatment time to the satisfaction of all.

HOSPITAL READY TO WELCOME SPANISH NURSES

H. Carter and J. Carvel

Guardian, Nov. 8th 2000, p.13

The government has signed an agreement with Spain to recruit up to 5,000 Spanish nurses to fill vacancies in NHS hospitals.

(See also Times, Nov. 9th 2000, p.10; Times, Nov. 8th 2000, p.7)

HOWEVER HARD THEY TRY, THE TORIES CAN'T GET HEALTH RIGHT

A. McElvoy

Independent. Review Supplement, Nov. 1st 2000, p.3

Argues that the future NHS may become a key funder of health care services rather than a provider, commissioning them from diverse private and voluntary sector organisations. There will be an expanded role for private medical insurance, and a possible role for private sector managers to take over failing NHS hospitals.

Department of Health

2000

Sets targets for improving staff working conditions in the NHS, improving human resource management, and staff training and development.

IN SICKNESS AND IN WEALTH

J. Keen

Guardian, Nov. 6th 2000, p.17

Article points out that health care in the UK is far from free at the point of delivery and is already heavily penetrated by the private sector. All citizens pay for prescription drugs, and for dental and ophthalmic services. Many pay for private health insurance. Additionally, the hospitals are increasingly built and maintained with private sector involvement through the PFI.

INSIDER APPOINTED TO NEW COMBINED NHS JOB

N. Timmins

Financial Times, Oct. 11th 2000, p.3

Announces the appointment of Nigel Crisp, Director of the NHS Executive's London Regional Office, to the new combined post of NHS chief executive and permanent secretary at the Department of Health. Government may be disappointed not to have attracted a high profile figure from private industry.

(See also Independent, Oct. 12th 2000, p.2; Guardian, Oct. 12th 2000, p.12)

IT UPDATE

Health Service Journal, vol. 110; Oct. 26th 2000, Supplement. 20p.

The creation of networked systems enabling electronic transfer of information is key to the implementation of the NHS Plan. The update reports on progress in developing electronic patient records and on the savings that could be realised through the introduction of e-procurement.

MAKING PLANS FOR NIGEL

A. McGauran and L. Donnelly

Health Service Journal, vol. 110, Oct. 19th 2000, p.11-12

Reports positive response to the appointment of Nigel Crisp an NHS insider, to the joint post of NHS chief executive and permanent secretary at the Department of Health. Crisp has laid out a vision of a patient-centred service through links with key stakeholders. His priorities are implementing the NHS Plan, emergency care and getting staffing right.

MANAGEMENT, MUTUALITY AND RISK: BETTER WAYS TO RUN THE NATIONAL HEALTH SERVICE

G. Day

London: Director Publications, 2000

Argues that the NHS Plan will result in the creation of a bureaucratic nightmare. Suggests that some NHS organisations, particularly primary care trusts, should be self-governing and run on the lines of mutual societies in Europe and the US. This would make them more answerable to their users.

MIDWIFE CRISIS OVER HOURS AND WORKLOAD

S. Boseley

Guardian, Oct. 9th 2000, p.8

Reports that a serious shortage of midwives is depriving women of one-to-one care and pushing up the rate of caesarean sections. Long hours, low morale and intense pressure in understaffed NHS maternity units is causing more midwives to consider leaving, creating a vicious circle and worsening the situation.

MPS ANGRY AT PRIVATE HEALTH-CARE AGREEMENT

A. Grice

Independent, Nov. 1st 2000, p.10

Labour MPs and health unions have attacked the government's new concordat between the NHS and the private sector as backdoor privatisation.

(See also Times, Nov. 1st 2000, p.2; Daily Telegraph, Nov. 1st 2000, p.13)

NATIONAL SERVICE FRAMEWORKS: OVERVIEW

A. Harrison

Health Care UK, Autumn 2000, p.30-33

Although National Service Frameworks (NSFS) are a significant attempt to design and deliver effective health services, doubts remain about the way they are being developed. NSFS do not link their proposals to the achievement of national targets, nor are the changes of emphasis they suggest based on any research evidence. The Frameworks are unclear about the relationship between the national guidelines and the local NHS, and neglect the organisational and financial infrastructure. Finally, no account is taken of how initiatives taken in one particular service will impinge on others.

NHS DRIVE FOR MORE ETHNIC MINORITY STAFF

S. Boseley

Guardian, Oct. 25th 2000, p.5

Reports a government drive to attract more people from ethnic minorities into the NHS and into nursing in particular. The initiative will include setting recruitment targets in areas where they are under-represented.

NHS HAILS NEW DEAL FOR PRIVATE SECTOR BEDS

T. Baldwin

Times, Oct. 31st 2000, p.14

Reports signing of an agreement between the government and the Independent Health Care Association to facilitate NHS Trusts taking up spare capacity in the private and voluntary sector at commercial rates. The agreement covers:

  • renting spare operating theatres from the private sector for elective surgery by NHS staff;
  • commissioning private hospitals to provide elective care;
  • transfer of critical care patients between sectors to reduce the number of cancelled operations;
  • joint work to develop intermediate care;
  • information exchange.

(See also Guardian, Nov. 1st 2000, p.9; Financial Times, Nov. 1st 2000, p. 1 + 8; Daily Telegraph, Oct. 31st 2000, p.2)

NURSES 'ON THE CHEAP THREATEN NHS REFORM'

C. Hall

Daily Telegraph, Oct. 24th 2000, p.13

Hospitals are cutting costs by downgrading senior nursing posts by stealth. A survey of 6,000 registered nurses has shown that the number of nurses in the top grades has shrunk by more than 13% in eight years, with senior ward sister numbers falling by 9,000.

(See also Guardian, Oct. 24th 2000, p.7)

OPEN WIDE

J. Gorham and J. Galloway

Health Service Journal, vol. 110, Oct. 26th 2000, p.26-29

The government's plan to invest 18m to encourage dentists to do more NHS work is not likely to arrest the move towards private practice. Although health authorities are to be made accountable for delivering a dental strategy they will have no control over the work of dentists in their area. Dentistry remains out of line with the NHS's founding principle of providing free care at the point of access. The government has not addressed the problem of shortage of dentists in some areas. Dental hygienists and therapists should be allowed to undertake some more routine work.

OUT-OF-HOURS CALLS TO DOCTORS TO BE PUT ON SINGLE NUBMER

J. Carvel

Guardian, Oct. 31st 2000, p.7

Reports plans to establish a single national help-line for medical assistance. The national service would aim to provide an assessment of the patient's needs, leading to advice over the phone for minor ailments, an out-of-hours visit by a doctor for more serious conditions, or a rapid response from an ambulance to emergencies.

(See also Times, Nov. 1st 2000, p.4)

PRIORITY RESPONSE?

Anon

Health Which? Oct. 2000, p. 22-26

Radical reforms of the ambulance service were implemented in 1997, including call prioritisation and performance targets. Statistics show that ambulance response times are poor in many areas and actually deteriorating in some. Poor performance persists even in some areas where call prioritisation has been introduced.

PRIVATE WINGS, RUFFLED FEATHERS

T. Shifrin

Health Service Journal, vol. 110, Nov. 2nd 2000, p.12-13

Reports comment on the new Concordat between the NHS and the independent sector. There is concern that the independent sector may expand its services by poaching NHS staff and then sell them back at a profit.

SCOPE TO IMPROVE

K. Walshe et al

Health Service Journal, vol. 110, Oct. 26th 2000, p.30-32

A survey of all 47 NHS trusts in the West Midlands found that clinical governance had not been advanced beyond the production of strategies, establishing committees and appointing leads. There was little evidence of the cultural change clinical governance requires, and it has yet to make a real difference at the clinical workface.

WE MISJUDGED SIZE OF NHS PROBLEMS, BLAIR TELLS DOCTORS

C. Hall

Daily Telegraph, Oct. 18th 2000, p.12

The prime minister has admitted that improvements in the NHS will take years to achieve. The government will invest in the NHS but in return will expect reform, including breaking down of demarcations between professions.

(See also Guardian, Oct. 18th 2000, p.10; Independent, Oct. 18th 2000, p.11)

WHAT BUSINESS IS THE NHS IN? ESTABLISHING THE BOUNDARY OF A HEALTH CARE SYSTEM'S RESPONSIBILITY

B. New

London: Institute for Public Policy Research, 2000

Paper argues that not everything the NHS is capable of providing is necessarily relevant to a universal publicly funded service. Policymakers should be concerned not only with which treatments are effective and cost-effective but with those that offer appropriate types of benefit. We need to decide which treatments should lie within the remit of the NHS and which should be the responsibility of the individual. The appropriate balance between considerations of need, personal responsibility, affordability and public support in making such decisions should be debated. In order to avoid public disillusionment and disappointment, we need to set out clearly what is relevant and reasonable for the health service to provide.

WOMEN 'AT RISK' FROM SHORTFALL IN CANCER CARE

C. Norton

Independent, Oct. 26th 2000, p. 11

An audit of 75% of Britain's health authorities and boards has shown that one in three has not adequately funded taxanes for treating advanced breast cancer and one in six has not provided the treatment for ovarian cancer recommended by NICE. Around one in nine authorities has reduced budgets for treating other tumour types in order to fund taxanes.

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