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Welfare Reform on the Web (June 1999): National Health Service - Reform - General

ANOTHER WORTHY, BUT FATED ATTEMPT AT A PUBLIC HEALTH PRESCRIPTION

B. Blatt
British Journal of Health Care Management, vol. 5, 1999, p. 10-12.

Analyses the Labour government's plans for improving public health. These involve each Health Authority drawing up a Health Improvement Programme which will set targets for improvements to health. Each Primary Care Group will have its own action plan designed to reach those targets. A proposed incentive scheme will offer cash bonuses to individual practices for doing extra work to achieve the targets, while the Commission for Health Improvement will discipline the recalcitrant. Suggests that the whole programme is bureaucratic and will waste time and scarce resources.

BACK IN THE BLACK?

D. Allen
Community Practitioner, vol. 72, no. 2, 1999, p. 11-12.

Summaries the content of the Acheson report on health inequalities. Reports that it has been received favourably by professional organisations and the government. However its socialist tune and its wide-ranging and costly recommendations may frighten off those with the power to implement it.

BEYOND THE PRIMARY CARE LED NHS: REFLECTING ON AN ISLAND OF STABILITY?

J. Keep and J. Smith
British Journal of Health Care Management, vol. 5, 1999, p. 16-19.

Article suggests that times of NHS 'policy hiatus' or waiting for central guidance can provide valuable time for reflection and review. These 'islands of stability' should be sought out and valued by managers rather than resented as frustrations or unnecessary delays.

CARRY THAT WEIGHT

B. Millar
Health Service Journal, vol. 109, Feb. 18th 1999, p. 22-27.

Clinical governance can be briefly defined as meaning corporate accountability for clinical performance. A trawl of managers' and clinicians' views reveals widespread approval of the concept.

'DELIVER CLINICAL GOVERNANCE OR LEAVE'

K. McIntosh
Health Service Journal, vol. 109, March 18th 1999, p. 2-3.

Reports launch of guidance setting out a timetable for health authorities, trusts and PCGs to put clinical governance into place. A baseline assessment to identify problem areas is to be completed by September. NHS organisations will then have to draw up development plans for bringing services up to standard, and publish annual reports on clinical governance beginning next year. The Commission for Health Improvement will visit each local health system every three years to check on clinical governance systems.

FINAL CHECK-UP

W. Moore
Guardian. Society, Feb. 17th 1999, p. 8-9.

Describes case studies showing how clinical governance can be implemented in practice. At Glenfield Hospital in Leicester staff are encouraged to report all clinical mistakes so that faults in the system can be identified. At Leicester Royal Infirmary, 90% of consultants volunteer for an annual appraisal of their work. In the South Tees Acute Hospitals trust, doctors sit down with nurses, secretaries, receptionists and cleaners to redesign the services they provide by following a typical patient's journey through the system.

FLU - WHAT A SCORCHER!

S. Halpern
British Journal of Health Care Management, vol. 5, 1999, p. 13-14.

Examines the impact of the extra £250 million made available to help fend off a winter crisis. Points out that:

  • the NHS is a large and complex organisation that will respond unpredictably to tinkering;
  • money cannot be immediately turned into resources;
  • because the NHS operates constantly on the verge of crisis, it is difficult to achieve change quickly in one area without destabilising another;
  • that the NHS is vastly under-resourced and under-managed relative to the society which it serves.

INDEPENDENT INQUIRY INTO INEQUALITIES IN HEALTH

Report
London: TSO, 1998.

Major recommendations of the Acheson report include:

  • raising of benefits for women, children and older people;
  • additional resources for schools in deprived areas;
  • more social housing, and improved housing provision and access to health care for the homeless;
  • more affordable, high quality day-care for parents who want to work;
  • increased employment and training opportunities for the young and long-term unemployed;
  • further development of the role of health visitors;
  • more equitable access to NHS care.

INEQUALITIES IN HEALTH: PATTERNS, PATHWAYS AND POLICY

H. Graham
Community Practitioner, vol. 72, no. 2, 1999, p. 13-14.

Considers the latest evidence on health inequalities in Britain and looks at the policy messages which flow from an understanding of the links between disadvantage and poor health. Tackling health inequalities requires interventions targeted not only at disadvantaged individuals but also at the distribution of income, the pathways of disadvantage and the everyday environments in which poor people live.

THE LATE SHOW

L. Wallace and B. Stoten
Health Service Journal, vol. 109, March 4th 1999, p. 24-25.

A survey of 30 trusts in the West Midlands, conducted in the Summer of 1998, found only four ready to implement a plan for clinical governance and evidence - based medicine. Most chief executives had no plans to implement clinical quality systems. Shortage of clinicians' time and poor IT systems were seen as the main barriers to implementation.

MANAGING FOR HEALTH: IMPLEMENTING THE NEW HEALTH AGENDA

D. Hunter
London: Institute for Public Policy Research, 1999.

Argues that in the 1980s the NHS was subjected to new public management that involved on the one hand a crude hardline managerialism and on the other competition in the public sector. The present government has retained the essence of this approach, and has pushed some aspects, such as performance measurement, harder. This approach is inappropriate, and a new way is needed, focused on long term planning rather than markets and services. Management in the future NHS should no longer be about intra-organisational control along vertical lines, but about managing, largely through facilitation and nurture, complex horizontal networks of organisations.

ON PENALTIES AND THE PATIENT'S CHARTER: CENTRALISM V DE-CENTRALISED GOVERNANCE IN THE NHS

D. Hughes and L. Griffiths
Sociology of Health and Illness, vol. 21, 1999, p. 71-94.

Article draws on a recent qualitative study of the NHS in Wales to examine the use of penalty clauses to enforce Patient's Charter guarantees for waiting times. This mechanism, which appears to govern the purchaser/provider relationship from within, turns out to be significantly constrained by continuing central direction. Moreover, informal resistance strategies, similar to those used in the past to counter bureaucratic regulation, operate to limit the impact of decentralised contractual governance.

REGULATION ISSUE

P. Healy
Health Service Journal, vol. 109, Feb. 18th 1999, p. 10-11.

Reports that following a series of scandals, the way the health professions are regulated is about to undergo radical overhaul. A new and smaller Nursing, Midwifery and Health Visiting Council is to replace the UK Central Council and four national boards that govern nurse education. Proposals to change the rules governing professions allied to medicine are being picked up in the Health Bill now before Parliament, and the government has promised a study on whether healthcare assistants should be regulated. In an apparently successful attempt to head off ministerial intervention, the General Medical Council has decided that all doctors will have to prove regularly that they are fit to practice or risk being struck off.

THE SERVICIAN VISION

M. Davies
Health Service Journal, vol 109, March 18th 1999, p. 24.

Argues that the implementation of clinical governance will mean the merging of the management and clinical processes.

WHAT IMPACT WILL THE NEW QUALITY AGENDA HAVE ON TRUST EXECUTIVES?

N. Sewell
British Journal of Health Care Management, vol. 5, 1999, p. 6-8.

The new quality agenda represents a demanding programme of change and activity for board members and highlights the critical need for training and development. The growing emphasis on quality management techniques, more explicit national performance monitoring, the need to make clinical governance effective and to create better value within the NHS has created the feeling that managers are being asked to undertake roles for which they have not been trained.

WORKING TOGETHER

L. Eaton
Community Practitioner, vol. 72, no. 2, 1999, p. 7-8.

Reports on how the government's proposals for a closer working relationship between health and social services, including pooled budgets and joint strategic planning, have been greeted by community practitioners.

WORKS OUTING

L. Donnelly
Health Service Journal, vol. 109, March 18th 1999, p. 14.

Reports discussion of the role of evidence-based intervention in the proposed national service framework for mental health services. There was a sharp divide between those wanting action now and those pleading for time to build up a firm evidence base and for the flexibility to translate national strategy to meet local circumstances.

LEARNING FROM THE NHS INTERNAL MARKET: A REVIEW OF THE EVIDENCE

J. Le Grand, N. Mays and J. A. Mulligan (eds)
London: King's Fund, 1998.

Meta-analysis of nearly 200 published studies of the Conservative governments' health reforms, 1991-97. The review of evidence focuses on the three main components of reform: health authority purchasing, GP fundholding and trusts. Results are, in the main, inconclusive. Measurable changes were small and attributing change to the reforms themselves proved problematic in that some developments, such as increased activity levels, were already occurring before the reforms.

NURSING IN THE NEW NHS: MODERN, DEPENDABLE

A. Fatchett
Edinburgh: Baillière Tindall, 1998.

Emphasising the move towards primary care led services, and providing a commentary and critique of the 1997 White Paper "The New NHS: modern, dependable", book focuses on how these changes are going to affect practice and professional roles from now on.

RETHINKING HUMAN RESOURCES: AN AGENDA FOR THE MILLENNIUM

J. Martinez and T. Martineau
Health Policy and Planning, vol, 13, 1998, p. 345-358.

Health care reforms require fundamental changes to the way in which the health workforce is planned, managed and developed within national health systems. While issues involved in such transitions remain complex, their importance and the need to address them in a proactive manner are vital for reforms to achieve their key policy objectives.

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