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Welfare Reform on the Web (February 2001): National Health Service - Reform - General

ANTI-FLU DRUG GIVEN APPROVAL FOR GROUPS AT RISK

N. Timmins

Financial Times, Nov 22nd 2000, p.4

The National Institute for Clinical Excellence has reversed its previous stance in the face of new evidence and has approved the use of the anti-flu drug Relenza by the NHS for the elderly and other groups at risk of complications from the disease.

(See also Times, Nov. 22nd, 2000, p.6; Daily Telegraph, Nov 22nd 2000, p.8; Independent, Nov 22nd 2000, p.10; Guardian, Nov 22nd 2000, p.9).

BAN ON MS DRUG MAY BE REVERSED

D. Charter

Times, Nov 9th 2000, p.6

The National Institute for Clinical Excellence (NICE) Appeal Panel has found that when banning beta interferon, NICE failed to spell out why the drug was not cost-effective and failed to consider its long term benefits. The ban on this expensive multiple sclerosis drug may therefore be reversed.

BLEATING UP THE WRONG TREE

A. Maynard

Health Service Journal, vol.110, Dec 7th 2000, p.18-19

Improving staffing levels and job characteristics would probably be more effective in recruiting and retaining nurses in the NHS than pay hikes.

BODY POLITICS

W. Moore

Community Practitioner, vol.73, 2000, p.826-827

Compares Conservative, Labour and Liberal Democrat health policies. There is general consensus on NHS priorities, but key differences on how the health service should be funded. The Conservatives favour expansion of private insurance, while the other two parties remain committed to funding out of general taxation.

BOOKING PATIENTS FOR HOSPITAL CARE: A PROGRESS REPORT: SECOND INTERIM REPORT FROM THE EVALUATION OF THE NATIONAL BOOKED ADMISSIONS PROGRAMME FIRST WAVE PILOTS

R. Kipping et al

Birmingham: University of Birmingham Health Services Management Centre, 2000

Report finds real progress in day case bookings made easier by the existence of dedicated resources and waiting times shorter than six months. Inpatient booking has proved much more difficult to implement because of the lack of ring-fenced facilities for elective services, the lack of spare capacity and the risk of emergency cases making use of facilities needed to honour the booked date. Fourteen pilots have introduced electronic booking from general practice to secondary care, but progress was slowed by technical difficulties which have now been addressed. Booked appointments have proved popular with patients, but although there was a small reduction in waiting lists, waiting times deteriorated slightly.

COMING ON STRONG

C. Williamson

Health Service Journal, vol.110, Nov 16th 2000, p.26-27

Training for the increasing numbers of lay representatives on NHS bodies is limited. Patient representatives need a broad understanding of the concerns of a variety of patient groups and the values of health professionals and managers. Lay representatives should read professional journals in order to take an informed part in debate and challenge professional practice. Patient representatives need to be able to show how NHS practice relates to policy.

CROWD PULLER

T. Shifrin

Health Service Journal, vol.110, Nov 23rd 2000, p.16

Results of a survey of English and Welsh local authorities show that 93% of education authorities, 86% of housing departments, 67% of environmental services and 57% of cultural services are working in partnership with health. Hindrances to partnership working cited by respondents included funding problems and lack of understanding of each other's systems, roles and cultures.

DAMNING REPORTS EXPOSE HOSPITAL FAILINGS

J. Meikle, G. Gibbs and D. Ward

Guardian, Nov 16th 2000, p.6

Summarises reports from the Commission for Health Improvement on abuse of elderly patients with mental health problems in Garlands Hospital, Carlisle, staff conflicts and

administrative chaos at the Oxford Heart Centre and failure to implement planned changes after a bungled kidney operation at Llanelli.

(See also Times, Nov 16th 2000, p.4; Daily Telegraph, 16th Nov 2000, p.4; Independent, Nov 15th 2000, p.1 + 10; Health Service Journal, vol.110, Nov 16th 2000, p.13-15).

DISSATISFACTION WITH THE NHS KEEPS GROWING

N. Hawkes

Times, Dec 8th 2000, p.12

A survey carried out for the British Medical Association has shown that the number of people very satisfied with the NHS has fallen from 24% in 1998 to 13%, while the number very or fairly dissatisfied has risen from 18% to 28% . When asked who was responsible, 20% said the previous Conservative government, 11% the present Labour government and 44% simply "the Government". When prompted over which government, 51% said the Conservatives and 48% Labour. The BMA said that doctors, especially GPs, were falling into a state of "clinical depression" as they struggled to provide a service in an overstretched NHS where problems of overwork and under-capacity continued all the year round.

(See also Guardian, Dec 8th 2000, p.4; Financial Times, Dec 8th 2000, p.8; Independent, Dec 8th 2000, p.11; Daily Telegraph, Dec 8th 2000, p.17).

DOCTORS CLASH WITH MILBURN ON NHS PLAN

N. Hawkes, T. Baldwin and M. Kite

Times, Nov 20th 2000, p.1

The British Medical Association has argued that there will not be enough GPs to guarantee every patient an appointment within 48 hours by 2004 as required by the NHS Plan. About 10,000 extra GPs would be needed to make it possible to reach the target, while the NHS Plan promises an extra 2000 by 2004. The BMA is also uneasy about the government's intention to make NHS Direct the single point of access to the emergency system out-of-hours by 2004, on the grounds that this nurse-based system may lack the skills needed to determine whether a patient needs to be seen or not.

(See also Daily Telegraph, Nov 20th 2000, p.8; Financial Times, Nov 21st 2000, p.5).

FEELING A BIT PEAKY

R. Jones

Health Service Journal, vol.110, Nov 23rd 2000, p.28-31

Alarm at the apparent rise in the number of outpatients waiting longer than 13 weeks for an appointment in the Autumn of 2000 was unjustified. The number of people waiting for an outpatient appointment always rises to a peak in September. Differences between the pattern of GP referrals and the availability of consultant appointments partly explain the fluctuations. There are always more opportunities for GP referral during the first half of the year than there are available outpatient appointments at hospital clinics. In the second half of the year the pattern is reversed.

FINDERS, KEEPERS

J. Davies

Health Service Journal, vol.110, Nov 30th 2000, p.24-29

Outlines attempts to improve staff recruitment and retention in the NHS through a range of initiatives such as introduction of flexible working, overseas recruitment, stemming the tide of early retirements, and the national job evaluation project.

GREEN WITH ENVY

C. Deeming and J. Appleby

Health Service Journal, vol.110, Dec 7th 2000, p.22-25

The traffic light system for grading hospitals proposed in the NHS Plan attempts to measure performance both in absolute and relative terms. Using methodology likely to be employed by the Department of Health, researchers have drawn up a league table of health authorities. The results show a North-South divide, with the bulk of poorly performing health authorities situated in the North. There is an argument for adjusting the crude rankings to reflect the relative difficulties HAs face.

HAVE A NICE DAY

A. Clarke

Community Practitioner, vol.73, 2000, p.861-862

Looks at government plans to improve the morale of NHS frontline staff through the introduction of flexible working patterns.

HOSPITALS: THE HIDDEN DANGER

S. Brown

Public Finance, Nov 24th-30th 2000, p.16-18

Discusses measures being put in place to reduce the level of hospital-acquired infection in the NHS, including compulsory monitoring and renewed emphasis on hand washing.

HOSPITALS "IN BETTER SHAPE TO COPE WITH WINTER LOAD"

J. Burns and N. Timmins

Financial Times, Dec 5th 2000, p.3

Hospitals are now better resourced to deal with winter pressures thanks to wider provision of flu vaccination for at-risk groups; 1,350 more general and acute beds, and 445 more critical care beds; availability of 6,000 more nurses; increases in local authority placements in nursing homes; and new intermediate care services. However these improvements may not be enough to avert a winter crisis this year.

(See also Daily Telegraph, Dec 5th 2000, p.2; Independent, Dec 5th 2000, p.8; Times, Dec 5th 2000, p.11; Guardian, Dec 5th 2000, p.13).

THE HUMAN RIGHTS ACT 1998

D. Stone

British Journal of Health Care Management, vol.6, 2000, p.515-517

The Human Rights Act 1998 will impact on the NHS in the areas of treatment provision, patient privacy and patient autonomy. Particularly, inability to provide treatment due to lack of resources may not be accepted as a valid defence by the courts.

IN WITH THE NEW

D. Hunter and N. Bosanquet

Health Service Journal, vol.110, Aug 3rd 2000, p.16-17

Authors evaluate the government's NHS reform plans. Hunter points out a tension in the plan between central control and uniformity on the one hand and local autonomy and diversity on the other. Bosanquet welcomes the focus on more private sector involvement in the NHS.

INFORMATION AT THE BESIDE

F. Harvey

Financial Times, Nov 28th 2000, p.19

In the UK, the Labour government has been working to improve the IT infrastructure of the NHS since 1997. Barriers to progress include problems of compatibility between disparate systems within the NHS and concerns over the security of electronic patients' records.

LAW SPECIAL REPORT

Health Service Journal, vol.110, Nov 16th 2000, Supplement, 12p

Comments on legal implications for the NHS of paying the private sector to treat its patients, of new proposals for disciplinary procedures for doctors, and of failure to meet national performance targets.

LESS JAW, MORE TROUSERS

B. Jacobson

Health Service Journal, vol.110, Nov 9th 2000, p.22-23

Argues that clinical governance should both protect individual patients from dangerously incompetent medical practitioners and improve the performance of all practitioners for the benefit of the whole population.

THE MANAGEMENT AND CONTROL OF HOSPITAL ACQUIRED INFECTION IN ACUTE NHS TRUSTS IN ENGLAND

Public Accounts Committee

London: TSO, 2000 (House of Commons papers. Session 1999/2000; HC 306)

Report finds that there are at least 100,000 cases of nosocomial infection in NHS acute hospitals in England each year, leading up to 5,000 deaths and costing the NHS £1bn. Estimates that cases could be reduced by 15% by better application of infection control practices, saving around £150m a year.

MODERNISING NHS DENTISTRY: IMPLEMENTING THE NHS PLAN

Department of Health

London: 2000

Proposals for improving access to NHS dentistry include:

  • making NHS Direct a gateway to dental services;
  • establishing Dental Access Centres in areas with the worst access problems;
  • rewarding dentists' commitment to the NHS with payments of around £18m a year;
  • maximising the contribution of dental therapists and hygienists;
  • implementing clinical governance in NHS dentistry.

NHS KEEPS PATIENTS "WAITING FOR LONGER"

N. Hawkes

Times, Nov 14th 2000, p.12

Analysis of Department of Health figures by a private company, Health Care Navigator, purports to show that patients are waiting longer for treatment by the NHS in England than at any point since records began in 1998.

NHS "MUST DOUBLE ITS NURSES FROM ABROAD"

N. Hawkes

Times, Dec 11th 2000, p.2

An analysis of the nursing labour market carried out for the Royal College of Nursing has found that there is already a shortfall of 22,000 nurses countrywide and that 70,000 more can be expected to retire over the next few years. If retirement and other losses stay at their present rates, the NHS will need to recruit 110,000 new nurses to meet the government's target of increasing the workforce by 20,000 by 2004. The RCN estimates that 39,000 of these will have to come from overseas. The Department of Health has said that the RCN's conclusions were based on a misinterpretation of the 20,000 target as meaning full time nurses, when the government had intended it to include part-timers.

(See also Daily Telegraph, Dec 11th 2000, p.6; Guardian, Dec 11th 2000, p.15).

THE NICE WAY TO BRING LIFE TO THE NHS

N. Timmins

Financial Times, Nov 20th 2000, p.29

The pharmaceutical industry has portrayed the National Institute for Clinical Excellence (NICE) as a rationing body designed to deny patients in a cash-strapped NHS the drugs they need. NICE assessments do create new burdens for the industry as more research has to be done to prove that new drugs are cost-effective, but they also facilitate the rapid spread of good treatments through the NHS.

PRESSURE IS ON

J. Buchan

Health Service Journal, vol.110, Dec 7th 2000, p.26-27

The NHS is very reliant on physiotherapists who trained overseas and who now represent almost a third of new entrants. Australia is the main source of overseas-trained physiotherapists. If the UK is to increase recruitment of physiotherapists from abroad to increase staffing levels as envisaged in the NHS Plan, ethical considerations mean it should focus on the EU, the US and Australasia and not on developing countries.

SHARE OPTION

A. McGauran

Health Service Journal, Dec 7th 2000, p.11-13

Describes the work of the Cancer Services Collaborative in improving patient access to, and flow through, services for bowel, prostate, breast and ovarian cancer.

TALKING POINT

L. Donnelly

Health Service Journal, vol.110, Nov 23rd 2000, p.13-14

Outlines new management structure for the NHS envisaged by Chief Executive Nigel Crisp. An operational board will bring together Regional Directors with colleagues in social care, public health, central management and the Modernisation Agency. Implementation of the NHS Plan will be overseen by a project board meeting monthly. A strategy board will bring together all directors and some senior managers. Joint working with social care will be facilitated by the creation of eight social care regions coterminous with NHS regional offices.

UNDER THE INFLUENCE

K. Jones, R. Baggett and J. Allsop

Health Service Journal, vol.110, Nov 16th 2000, p.28-29

A survey of more than 100 health consumer groups found they considered providing advice and support as more important than influencing national policy. Almost two-thirds thought opportunities for participation had increased, but more than three-quarters felt their input was hampered by lack of resources.

WAITING TIMES IN WALES: A STRATEGY FOR THE FUTURE

Health and Social Services Committee, National Assembly of Wales

Cardiff: 2000 (HSSC-16-00)

Report on the management of waiting times in the NHS in Wales proposes a move towards a system of prioritising patients on grounds of clinical need. It also calls for action to produce additional capacity, encourage innovation and improve the management of information.

WATCHING THE MONITORS OF HEALTH CARE REFORM

A. Cowper

British Journal of Health Care Management, vol.6, 2000, p.524-529

Interviews with the heads of the Commission for Health Improvement, the National Institute for Clinical Excellence and the Health Development Agency. These agencies have a crucial role in bringing about the reform of the NHS and improving standards of health care.