Welfare Reform on the Web (June 2001): National Health Service - Reform - General
54-HOUR WAIT TOPS CASUALTY SURVEY
J. Carvel
Guardian, Mar. 29th 2001, p. 10
A study of 200 hospital accident and emergency departments by a watchdog group found patients who had waited up to 54 hours before they were admitted to a ward. Victims included a 93-year-old woman with hypothermia and leg ulcers who was kept in the Accident and Emergency Department of Maidstone Hospital for over 30 hours.
(See also Independent, Mar. 29th 2001, p. 5; Times, Mar. 29th 2001, p. 15; Daily Telegraph, Mar. 29th 2001. 12)
ACCESS TO NHS DENTISTRY
Health Committee
London: TSO, 2001 (House of Commons papers. Session 2000/01; HC 247)
Argues that the General Dental Service remuneration is at the heart of the problems of public access to NHS dental services. It encourages the move of dentists out of the NHS, and discourages preventive care. Concludes that at present arrangements for accessing NHS dental services are inequitable, uncertain and getting worse; patients do not know where they stand. Unregistered patients find it hard to get any form of care and even registered patients can lose that status without redress or warning.
ADVERSE EVENTS IN BRITISH HOSPITALS: PRELIMINARY RETROSPECTIVE RECORD REVIEW
C. Vincent, G. Neale and M. Woloshynowych
British Medical Journal, vol. 322, 2001, p. 517-519
A retrospective review of 1014 medical and nursing records has shown that 110 patients experienced an adverse event. About half of these events were judged preventable within ordinary standards of care. A third of adverse events led to moderate or greater disability or death. Results suggest that medical errors are a serious source of harm to patients and a large drain on NHS resources.
ADVERSE EVENTS OR PATTERNS OF FAILURE?
J. Higgins
British Journal of Health Care Management, vol. 7, 2001, p. 145-147
Managers must understand why organisations designed to protect sick and vulnerable people sometimes do them harm. Evidence suggests that there may be consistent patterns of failure, when things go wrong in the NHS, not simply "adverse events". Six failures commonly occur (isolation, lack of leadership, no exposure to new ideas, inadequate adherence to systems and processes, poor communication, and disempowerment of users and staff).
ARE HOSPITALS' WAITING LISTS SELF-REGULATING?
D. P. Smethurst and H. C. Williams
Nature,vol. 410, Apr. 5th 2001, p. 652-653
The NHS system should be judged, "by measuring the overall quality of medical care, rather than by the length of hospital waiting lists". The self-regulation of healthcare systems reduces the impact of any intervention. Different levels of demand are absorbed using all the resources available suggesting that waiting lists are subject to the power laws of complexity theory.
BRINGING SERVICE USERS ON BOARD: THE CHARITY MODEL
S. Loader
British Journal of Health Care Management, vol. 7, 2001, p. 111-113
Article looks at lessons NHS managers can learn from the charity sector about user involvement. Explores the legal position of users of a charity's services who are involved in the running and management of their charity as trustees.
CARROT AND STICK
C. Wright
Community Practitioner, vol. 74, 2001, p. 131-132
'Our National Health - A Plan for Change', is aimed at overhauling the structure of the NHS in Scotland. Article discusses how acute and primary care trusts are to be merged with their respective health boards and what this means. It also looks at the wider roles to be played by pharmacists, nurses and health visitors and discusses the new skills and access to new support that are required to fill these roles.
CLEAN-UP CAMPAIGN NAMES WORST WARDS
D. Charter
Times, Apr. 11th 2001, p. 10-11
Reports that the 10 dirtiest hospitals in England have been named and placed under "special measures" by the government. They will be sent "hit squads" of experts from some of the cleanest hospitals, and will receive extra investment of £250,000 - £750,000.
(See also Daily Telegraph, 11th Apr. 2001; Independent, Apr. 11th 2001, p.6; Guardian, Apr. 11th 2001, p. 6)
CLINICAL GOVERNANCE: MAKING QUALITY COUNT
L. J. Donaldson
Journal of Clinical Excellence, vol. 2, 2001, p. 199-202
Clinical governance is being systematically implemented within the NHS at local level. It operates within a national framework of health quality in which new structures and mechanisms provide support. The emerging quality programme incorporates the key elements of patient-centred care: greatly reduced variations in process; quality assured services; the creation of a safety culture; the adoption of good practice and research evidence; and the provision of good information about service quality to patients and the public.
COMPLAINTS AS ACCOUNTABILITY? THE CASE OF HEALTH CARE UK AND THE NEW NHS
S. Kerrison and A. Pollack
Public Law, Spring 2001, p. 115-133
The NHS used to be a state-funded organisation with a highly centralised structure where care was provided by state owned and managed institutions. In the NHS Plan the intention is for power and authority to be devolved to a maze of primary care trusts, public-private partnerships and private providers. Providers will be within a web of accountability involving the National Care Standards Commission, the Commission for Health Improvement, NHS regional offices, the Audit Commission, and the National Audit Office, etc. However, within this framework complaints systems have been neglected and devalued. Patients will have no rights of appeal to these agencies, so the potential to use complaints as the eyes and ears of the agency in what is now a fragmented and diverse system is lost.
CROSSING THE BOUNDARIES
A. Clarke
Community Practitioner, vol. 74, 2001, p. 133-134
Discusses the consultant posts for nurses which give nurses the same status that doctors have in their profession. Article discusses two posts which have been filled and examines the requirement to show that a post-holder can provide expert nursing, midwifery or health care advice. Consultants need to show advanced knowledge and specialist skills, acquired after lengthy training, supervision and practice. Consultants are expected to take on a leadership function and to contribute to education, training and development of nurses, midwives, health visitors and others.
THE CRUELLEST MONTH
A. Moore
Health Service Journal, vol. 111, Mar. 15th 2001, p. 13-14
April 1st 2001 sees a massive expansion in the numbers of primary care trusts, a further concentration of NHS acute trusts and the conversion of many GPs to personal medical services contracts.
DEFINING MOMENTS
J. Belcher
Health Service Journal, vol. 111, Apr. 5th 2001, p. 32
Argues that the government's definition of intermediate care may lose credibility because it ignores the role of housing in promoting good health.
"DIRTY DOZEN" HOSPITAL TO BE SHAMED
D. Charter
Times, Apr. 10th 2001, p. 1
Reports that 42 hospitals have failed at the second attempt to meet basic standards of hygiene. A small number of incorrigibly filthy hospitals will be given extra cash to fund improvements and advice from experts from the cleanest hospitals.
(See also Daily Telegraph, Apr. 10th 2001, p. 4; Guardian, Apr. 10th 2001, p. 12; Health Service Journal, vol. 111, Apr. 12th 2001, p. 4)
ELECTION 'PRESSURE' ON PATIENT WAITING LISTS
D. Charter
Times, Mar. 16th 2001, p. 2
The NHS is under pressure to cut this month's waiting list to meet "manifesto commitments" in time for a possible May election. The pressure is on to reduce the 13-week out-patient lists in order for a big improvement in official waiting list figures to show through.
GET THEM WHILE THEY'RE YOUNG
S. Smith
Health Service Journal, vol. 111, Apr. 5th 2001, p. 28-29
Morecambe Bay Hospitals Trust's programme to promote NHS careers to school pupils has met with an enthusiastic response. Staff and managers have given talks on their work at a careers conference for the under-16s. Forty students have undertaken two-week work experience placements and it is hoped to extend the programme. Trust staff also plan to give talks in primary schools.
HEALTH ACTION ZONES: THE "THIRD WAY" OF A NEW AREA-BASED POLICY?
M. Powell and G. Moon
Health and Social Care in the Community, vol. 9, 2001, p. 43-50
The notion of the action zone has emerged as a key feature of New Labour's approach to social policy. There is some debate about whether Labour's area-based policies reflect the Old Left, the New Right or the "Third Way". Paper critically examines these issues for Health Action Zones (HAZs). It first outlines the development of HAZs and their main features. It then examines the themes that may have underpinned the HAZ strategy. Finally it examines critiques of HAZs in the light of wider debates about area-based strategies. It is concluded that HAZs fit well with some of New Labour's key themes, and may have some characteristics of a Third Way in that they incorporate features of both the Old Left of the Black Report and the New Right of competitive, bidding exercises.
LABOUR PAIN AND DIFFICULT DELIVERY
N. Timmins
Financial Times, Apr. 3rd 2001, p. 6
Presents an overview of the Labour government's attempts to reform the NHS between 1997 and 2001.
MANAGED COMPETITION, GOVERNMENTALITY AND INSTITUTIONAL RESPONSE IN THE UNITED KINGDOM
D. W. Light
Social Science and Medicine, vol. 52, 2001, p. 1167-1181
Article traces the use of managed competition to transform the NHS from an administered public service to a set of interlocking markets and contracts. Describes how the Thatcher government structured health care markets, with strong sellers (hospitals) and weak, muddled purchasing. Then summarises institutional responses to the purchaser-provider split by health authorities, hospital trusts and GP fundholders. Implementation, however, led to resistance, opposition and eventual abandonment of managed competition as too disruptive and costly. Yet it has left an enduring legacy of accountability to purchasers in economic terms such as efficiency, transaction costs and cost effectiveness.
MANAGING TEMPORARY STAFF IN THE NHS
S. Morgan
British Journal of Health Care Management, vol. 7, 2001, p. 142-144
Dependence on external nursing agency cover for non-emergency cover drains vital resources from the NHS. Trust run staff banks can optimise the use of existing nursing staff resources. Nurses on the system would be known to the trust, ensuring high quality staff and continuity of care.
MODERN MATRONS 'WILL RULE NHS WARDS'
C. Hall
Daily Telegraph, Apr. 5th 2001, p. 6
Matrons are to make a come back into our hospital wards 30 years after they disappeared. Matrons will be identifiable by their distinctive uniform. They will have the authority to put things right for patients with responsibility for making sure wards are cleaned, the food is good and the care is there. The Department of Health plans to have 500 matrons in place at the end of the year, and a total of 2000 by 2004.
(See also Guardian, Apr. 5th 2001, p. 7; Times, Apr. 5th 2001, p. 4; Independent, Apr. 5th 2001, p. 10; Health Service Journal, Apr. 12th 2001, p. 8)
MODERNISING OUTPATIENTS: DEVELOPING EFFECTIVE SERVICES
NHS Confederation
London: 2001
Proposes a model that would blur the distinction between primary and secondary care with specialists in primary care as well as in hospitals. Promotes the concept of specialist GPs, nurses and therapists and shared training, so that in some cases the idea of a referral could be dispensed with altogether. Such a shift would mean a transfer of resources and staff from traditional outpatient services to primary care, with sessions currently taking place in hospitals relocated into "primary care networks".
(For summary and comment see Health Service Journal, vol. 111, Apr. 19th 2001, p. 10-11)
MOVING THE GOALPOSTS
K. Craig and B. Thomas
Health Service Journal, vol. 111, Mar. 29th 2001, p. 32-33
The surgical directorate at Sheffield University Hospitals Trust introduced a system of target setting for consultants in 1994. The system includes the number of outpatient clinics to be provided, use of theatres, and record-keeping and audit. Each consultant's performance is reviewed quarterly. The initiative has increased the number of inpatients treated and is considered a robust framework for the introduction of a new consultant contract.
NHS: TOO SOON TO SAY IF PATIENT WILL RECOVER
A. Miles and R. Watson
Times, Mar. 22nd 2001, p. 12
In the Winter of 2000, three years after Labour came into power, the NHS was in crisis due to a flu epidemic. Labour's subsequent strategy for improving the situation has amounted to a massive injection of cash.
RE-EDUCATING THE HEALTH SERVICE
F. Field
Financial Times, Mar. 20th 2001, p. 23
Argues that in order to improve health care, the government should decentralise decision-making within the NHS. Funding should be raised through a mixture of local voluntary contributions and National Insurance.
RECRUITING DRIVE FAILS TO FILL 10,000 NURSE VACANCIES
N. Morris
Independent, Apr. 11th 2001, p. 6
Reports that, in spite of highly publicised recruitment campaigns, 9870 nursing posts had been vacant for at least three months in 1999/2000, up 2,720 from the previous year. Vacancies for consultants totalled 760, compared with 530 the previous year. The number of vacancies in other professions allied to medicine went up from 860 to 1,510.
SAVING MONEY THROUGH GOOD NUTRITION
S. Holmes
British Journal of Healthcare Management, vol. 7, 2001, p. 104-107
Hospital catering in the NHS is often targeted for efficiency savings without consideration of its implications. Levels of food wastage are high, ranging from 16% to 67%, and contribute to significant nutritional deficits. Effective nutritional care and/or nutritional support can reduce complications and shorten patient stays, resulting in significant savings. Appropriate food and adequate nutrition are central to high quality patient care.
SHARE ALIKE
B. Powney, J. Wood and N. Robson
Health Service Journal, vol. 111, Mar. 29th 2001, p. 35
Describes how a nurse, a physiotherapist and an occupational therapist share the leadership of an outpatient rehabilitation unit for older people at Thurrock.
SIZE ISN'T EVERYTHING
A. McGauran
Health Service Journal, vol. 111, Mar. 15th 2001, p. 16-17
With the advent of primary care trusts, health authorities are giving up their commissioning role in favour of a strategic focus. This is likely to lead to a rush of health authority mergers.
STRONG WORDS
C. Newdick
Health Service Journal, vol. 111, 2001, p. 26-27
Argues that in law National Institute for Clinical Excellence (NICE) guidance should not overrule health authorities' discretion to allocate resources. This means that NICE will not eliminate rationing or postcode prescribing. Complete consistency between health authorities is not achievable. Moreover GPs are required to prescribe on the basis of need and NICE guidance cannot have any impact on this.
THEY WERE THE WEAKEST LINK
J. Higgins
Health Service Journal, vol. 111, Mar. 22nd 2001, p. 26-28
The role and autonomy of NHS regional chairs has been eroded since they were established in 1974. They became increasingly anomalous after the abolition of regional health authorities in 1996. In recent years they have been caught between the NHS and the civil service, following the replacement of Regional Health Authorities by Regional Offices, which are civil service outposts. Under the NHS Plan, Regional Chairs are to be abolished altogether and replaced by an NHS Appointment Commission.
THINKING OUT OF THE BOX
C. Foote and P. Plsek
Health Service Journal, vol. 111, Apr. 12th 2001, p. 32-33
A culture of charity at the heart of the NHS has reinforced the view of the patient as passive recipient of care. The success of the NHS plan will depend on a genuine partnership between patients and professionals and a broader approach to management. Attention must be given to understanding health care as a complex, adaptive system.
TOO ILL TO TALK? USER INVOLVEMENT AND PALLIATIVE CARE
N. Small and P. Rhodes
London: Routledge, 2001
Explores the practical, emotional and conceptual barriers to user involvement by the seriously ill. These include reluctance to anticipate future needs, reluctance to join local or national pressure groups, conflicts between the needs of patients and those of their carers, and lack of clear routes for consultation.
WHOSE INTERESTS DO LAY PEOPLE REPRESENT? TOWARDS AN UNDERSTANDING OF LAY PEOPLE AS MEMBERS OF COMMITTEE
SC. Hogg and C. Williamson
Health Expectations, vol. 4, 2001, p. 2-9
Article focuses on "lay involvement" in health service committees and regulatory boards. Suggests that lay members fall into three broad categories: supporters of dominant, professional interests, supporters of managerial interests and supporters of patients' interests. These alignments should be taken into account in appointments to NHS bodies.
EXPLORING NURSES' EXPERIENCE OF CLINICAL GOVERNANCE
J. A. R. Jones
Journal of Clinical Excellence, vol. 2, 2001, p. 243-248
Paper describes a series of UK-wide discussion groups held with members of the Royal College of Nursing in Autumn 1999. Participants were asked about their involvement in clinical governance (CG) activities, the skills they felt were needed to participate in CG and the type of support they would find helpful. A number of barriers to implementation were highlighted. These related to a lack of awareness among clinicians about CG and the role they have to play; a failure in some areas to engage the hearts and minds of staff; cultural issues; and a lack of resources to support CG.