Welfare Reform on the Web (October 2001): National Health Service - Reform - General
BEDS CRISIS THIS WINTER AS HOMES FOR ELDERLY SHUT
C. Hall
Daily Telegraph, Aug. 13th 2001, p.7
Reports that nursing home closures around the country are leading to bed blocking in NHS hospitals by elderly patients. Older patients are occupying expensive acute hospital beds because there is nowhere else to send them.
BETTER PREVENTION, BETTER SERVICES, BETTER SEXUAL HEALTH: THE NATIONAL STRATEGY FOR SEXUAL HEALTH AND HIV
Department of Health
London: 2001
Improved access and information will be the main weapons used to combat the spread of sexually transmitted diseases, with primary care, acute and community trusts working together through "managed service networks". Three levels of service provision are proposed involving GP surgeries, specialist sexual health teams in primary care and the development of specialist clinical teams working across more than one Primary Care Group/Trust. They will be linked together into networks based on those currently operating in cancer services. There will also be three pilot one-stop sexual health clinics and projects for primary care youth service in liaison with the teenage pregnancy unit.
BIG MOTHER'S NASTIEST CHILD
T. Evans
Health Service Journal, vol.111, Aug. 2nd 2001, p.18
The Health and Social Care Act 2001 allows government to open people's electronic medical records to any organisation it considers to be acting in the public interest. This may lead to the debasement of the official record of patients' health. People may be concerned about how medical information may be used by other bodies, and so falsify the official version.
CANCER IN SCOTLAND: ACTION FOR CHANGE
NHS Scotland
Edinburgh: Scottish Executive Health Department, 2001
Scottish unitary health boards will hold the budgets for cancer services, but will be expected to pay more attention to the views of clinicians, health workers and patient groups in deciding how they are to be spent. The strategy will be spearheaded by a beefed-up Scottish Cancer Group, which will be reconfigured to involve more patient and voluntary-sector representatives. Three strengthened regional cancer advisory groups will be created which will work with the unified health boards to decide how services should be run.
COMING TO A HOSPITAL NEAR YOU
A. Murray
Guardian, Aug. 10th 2001, p.12
Private contractors responsible for the chaos on Britain's railways are now moving into health and education, where they will doubtless wreak equal havoc in their search for a quick profit.
'CORPORATE' NHS TELLS HOSPITALS TO SCRAP THEIR LOGOS
P. Waugh
Independent, Aug. 6th 2001, p.5
The government has ordered some of Britain's most famous hospitals to scrap their distinctive logos to ensure "consistent branding" across the NHS. The move includes Great Ormond Street Hospital for Sick Children and the Whittington Hospital in London and Alder Hey Children's Hospital in Liverpool. They will have to amend stationery, reports, signs and even nurses uniforms to show the NHS logo. Only those hospitals with a logo that predates the foundation of the health service in 1948 will be allowed to retain their brand.
(See also Times, Aug. 6th 2001, p.7).
DON'T BLAME THE SURGEONS, IT'S OUR APPROACH TO HEALTH THAT IS AT FAULT
R. Baker
Independent, Jul 19th 2001, p.4
Looks at the recommendations of the final report on the Bristol heart babies scandal and its implications for the rest of the NHS. The report has called for greater openness about the success rates of individual surgeons, an end to a culture of arrogance and tribalism among doctors and improved regulation and monitoring of their work. Moves to improve on these points are already under way through the revalidation scheme for doctors. The article goes on to discuss why this has not been well received by NHS doctors.
DROWNING, NOT WAVING
K. Walshe and J. Smith
Health Service Journal, vol.111, Aug. 16th 2001, p.12-13
Expresses concern about the impact on the NHS of the massive reforms proposed by the government in the recent consultation document, "Shifting the Balance". The proposed reforms place unrealistic expectations on the fledgling primary care trusts, and are being introduced with unseemly haste and without any evidence that they will be beneficial.
GETTING WON OVER
A. Moore
Health Service Journal, vol.111, Aug. 2nd 2001, p.22-25
Discusses progress by acute trusts in setting up schemes for consultant appraisal, which will become mandatory in April 2002.
HAGUE 'LOST NERVE OVER NHS'
P. Wintour
Guardian, Aug. 6th 2001, p.8
Shadow Health Secretary Liam Fox has said that "the party has been left powerless because it failed to listen to the concerns of ordinary voters, and became trapped in Labour territory by promising to match health spending". The only way he sees to improve the National Health Service (NHS) would be to persuade people that they need to spend more of their income on private health care. He was prevented from taking this line during the general election campaign. Article goes on to discuss the challenges of the NHS for the next Conservative leader.
HEALTH TOURISM DISMISSED AS UNLAWFUL
N. Hawkes
Times, July 31st 2001, p.8
The Department of Health has dismissed the idea of systematically sending NHS patients abroad for treatment which was floated by Frank Field MP. It is illegal under the NHS Act 1997 for health authorities to commission operations abroad "en masse".
HELP OUR HOSPITALS: GO HOME
C. Doyle
Daily Telegraph, July 24th 2001, p.20
Argues that pressure on hospital beds could be reduced by extension of day surgery provision.
HONOUR BOUND
A. Well
Health Service Journal, vol.111, Aug. 9th 2001, p.30-31
Argues that the government needs to sort out the many inconsistencies in its health policies. NHS managers have a good record on implementing government policy, but the Health Secretary needs to clarify his attitude to them and address the loss of top people.
HUGE RISE IN FOREIGN NHS NURSES
L. Duckworth
Independent, Aug. 15th 2001, p.1
The number of foreign nurses registered to work in Britain rose by 4% in 2000/01, as the NHS increased its reliance on staff from overseas.
(See also Times, Aug. 15th 2001, p.6).
IMPROVING CHILDREN'S HEALTH (2): AN ANALYSIS OF HEALTH IMPROVEMENT PROGRAMMES (2000-2003)
Children's Society et al
London: NSPCC, 2001
Report expresses concern that the HImPs demonstrate the fragmentation of children's services. Faced with a plethora of plans and initiatives, some addressing children and young people specifically, others including them within generic provision, and many lacking targets and milestones, it becomes very difficult to determine whether children's health needs are being met. Major weakness in the HImPs include the limited attention given to the health needs of minority ethnic children and the limited recognition of the potential impact on children of adult behaviours and health conditions. Local activity seems to be strongly determined by issues being accorded national priority, and levels of activity increase where extra funding is made available.
INPATIENT AND OUTPATIENT WAITING IN THE NHS
National Audit Office
London: TSO, 2001 (House of Commons Papers Session 2001-02; HC 221)
Reports that one in five consultants questioned had frequently treated patients in a different order to their clinical priority simply to meet government targets to reduce waiting lists or to ensure patients waited less than 18 months. Also names a number of trusts which manipulated their waiting lists inappropriately by taking names off them. Highlights major inconsistencies between trusts on which patients they include on waiting lists, which means the lists cannot be verified. Identifies key areas where action is needed to improve the management of waiting lists and times: appropriate GP referrals; outpatient clinics to be operated at optimal capacity; and use of operating theatres during evenings and weekends, etc..
THE LAST CHANCE (AGAIN): HOW TO GET THE NHS RIGHT
A. Wall
British Journal of Health Care Management vol.7, 2001, p.321-322
Article looks at Alan Milburn's task of overseeing real improvements in the NHS. It discusses the problems he faces, what motivation is needed, the type of discipline required and possible solutions.
LEARNING FROM BRISTOL: THE
REPORT OF THE PUBLIC INQUIRY INTO CHILDREN'S HEART SURGERY AT THE BRISTOL ROYAL
INFIRMARY, 1984-95
Department of Health
London: TSO, 2001 (Cm 5207)
Key recommendations for the future include:
- partnership with patients (increased involvement in decision-making, quality of information and communications around consent);
- improved support and counselling services;
- a duty of candour placed on healthcare professionals to tell patients when things have gone wrong;
- the creation of a council for the regulation of healthcare professionals to oversee the regulatory bodies for separate staff groups;
- a review of consultants contracts and distinction awards; improved education in the non-clinical aspects of care;
- investment in multi-professional training and pilot schemes on joint undergraduate education for those wishing to become health care professionals;
- periodic appraisal for all healthcare professionals;
- improved supervision of clinicians trying out new procedures;
- 48-hour immunity from disciplinary action for "whistle blowers";
- abolition of the current system for dealing with clinical negligence claims;
- expanded roles for the Commission for Health Improvement (CHI) and National Institute for Clinical Excellence (NICE) in validating hospital performance and setting national clinical standards respectively;
- the creation of a new body, independent of the Department of Health, to oversee NICE and CHI.
(For comment see Health Service Journal, vol.111, July 26th 2001, p.11-17).
LEFT HOLDING THE BABY
A. Moore
Health Service Journal, vol.111, July 26th 2001, p.14-15
In the wake of the Bristol inquiry, it is probable that services for children needing hospital treatment will become focused on a small number of highly specialised centres.
LIMIT ON NEW DRUGS FOR ARTHRITIS SUFFERERS
M. Durham
Independent, July 27th 2001, p.11
Reports that the National Institute for Clinical Excellence has recommended only a limited extension of the use of the new COX-2 inhibitors for arthritis patients. The drugs are effective painkillers but are expensive and the NICE guidance limits their use to patients at high risk of stomach bleeding.
(See also Financial Times, July 27th 2001, p.4).
MILBURN'S MEDICINE LEAVES A SICKLY TASTE
N. Hawkes
Times, July 26th 2001, p.18
Argues that the targets set in the NHS Plan for increasing NHS staff and reducing waiting lists and times appear to be unlikely to be met. The only thing the Plan is likely to achieve is yet another major structural reorganisation of the NHS, which will solve nothing.
MORE FAST-TRACK HOSPITALS TO CUT WAITING TIMES
D. Charter
Times, Aug. 13th 2001, p.9
Eight diagnostic and treatment centres dedicated to elective surgery were promised by 2004 in the NHS Plan. This has now risen to 12, with a further 29 promised by 2008. Ministers believe that these fast-track centres offer the best hope of reducing NHS waiting lists.
MS DRUGS LIKELY TO STAY OFF HEALTH SERVICE LIST
S. Boseley
Guardian, Aug. 7th 2001, p.7
Reports that the National Institute for Clinical Excellence is set to rule that beta interferons and glutiramer acetate are not cost effective and should not be prescribed for multiple sclerosis sufferers on the NHS. The drugs do not help all sufferers and cost £7,000 to £10,000 per patient per year.
(See also Independent, Aug. 7th 2001, p.7; Times, Aug. 7th 2001, p.7; Financial Times, Aug. 7th 2001, p.2).
THE NEW NHS: WILL COMPLEMENTARY THERAPIES FIT IN?
D. Peters and S. Gillam
British Journal of Health Care Management, vol.7, 2001, p.330-331
Looks at the integration of complementary therapies into the mainstream of the National Health Service (NHS) and discusses whether this is a sign of a more patient centred NHS.
NHS NURSES WILL LOSE JOB UNLESS THEY GO PRIVATE
C. Hall
Daily Telegraph Aug. 14th 2001, p.4
Staff at Kington Cottage Hospital in Herefordshire have been told that they must resign from the NHS to work for the private company that is to run Blanchworth Care Hospital. This is in direct contradiction to statements by the Health Secretary that NHS staff will not transfer to private companies brought in to take over the running of hospitals.
ON TARGET, OFF COURSE?
S. Ward
Public Finance, Jul. 20th-26th 2001, p.16-18
It looks increasingly likely that the government's recruitment targets for doctors and nurses are going to be met with the increased funds available. Article goes on to discuss the recruitment and retention issues that are being looked at in order to make sure targets are met. It also looks at the impact of the number of health care staff who are due to retire in an ageing profession.
OPEN AND SHUT CASE
P. Stephenson
Health Service Journal, vol.111, Aug. 16th 2001, p.14-15
Discusses the National Patient Safety Agency, whose key task will be to implement a national adverse incident reporting system for the NHS. Twenty-five pilot sites have been chosen to work through the practicalities of central reporting. Most have a couple of years experience of collating information. They agree that it is crucial that information on adverse incidents can be provided without fear of reprisal and that it is acted on.
OPTIMISING VALUE: THE MOTIVATION OF DOCTORS AND MANAGERS IN THE NHS
A. Graham and J. Steele
London: Public Management Foundation, 2001
Research provides evidence that doctors and managers in the NHS share the same goals and values. For both groups, the main motivation for doing their jobs is to improve the health of patients and the local community. However job satisfaction is being eroded by the problems encountered in the NHS, including a lack of resources, the amount of change in the system and the failure of NHS leaders to value staff and involve them in decision-making. Findings present a strong case for NHS leaders to do more to harness doctors' and managers' commitment to their local services and community, and to address the causes of their demotivation. They show that such an approach is more likely to be effective than financial rewards such as performance related pay.
OVER-60S WAIT LONGER IN CASUALTY, SURVEY SHOWS
M. Durham
Independent, Aug. 1st 2001, p.6
A snapshot survey of over 200 hospitals has shown that people over 60 wait more than 90 minutes longer in casualty that younger people. The longest delays are in the South East where older patients wait for up to 6½ hours.
(See also Times, Aug. 1st 2001, p.8).
'THE OVERTHROW OF A TYRANT?' THE RURAL FUTURE IN SCOTLAND
K.J. Woods
British Journal of Health Care Management 2001, vol.7, 2001, p.316-320
Article looks at health care needs in rural areas of Scotland. It examines how to meet community needs, dealing with issues of distance decay, strategic thinking, resource allocation, primary care, acute hospital services and managed clinical networks.
PLAN TO CUT OFF DRUGS FOR MS PATIENTS CONDEMNED
C. Hall
Daily Telegraph, Aug. 8th 2001
The National Institute for Clinical Excellence (NICE) has recommended that drug companies manufacturing beta-interferons for the treatment of multiple sclerosis should negotiate with the Department of Health to cut the cost of the drugs to the National Health Service (NHS). NICE has recommended that the NHS stop using the drug once current patients have completed their treatment despite overwhelming evidence that it works. Article goes on to discuss the reasoning behind the recommendation and looks at patients' comments on the situation.
(See also Financial Times, Aug. 8th 2001, p.2).
PROTECTING PATIENT CONFIDENTIALITY: A CONSULTATION PAPER
Confidentiality and Security Advisory Group for Scotland
Edinburgh: Scottish Executive Health Department, 2001
Aims to ensure that NHS Scotland gives due recognition to the rights of individual patients to privacy while allowing the use of anonymised data to support research and inform public health policy. Recommends that NHS Scotland should ensure that patient identifying information is not processed without patient consent, while developing systems to make acceptably anonymised data available for indirect healthcare uses.
RECORDED DELIVERY
L. Whitfield
Health Service Journal, vol.111, Aug. 9th 2001, p.14-15
Discusses current proposals for the implementation of first generation emergency care electronic health records. It is envisaged that these will be held centrally, and that NHS staff, social workers and other "gateway" agencies should have access. Patients may have access to their own records via "Smartcards". It is likely that the system will be developed using a public-private partnership, and that the NHS will be charged for access.
ROW HITS PURCHASE OF PRIVATE HOSPITAL BY NHS
N. Timmins
Financial Times, Aug. 9th 2001, p.2
The government has bought a private Heart Hospital in London to increase capacity for cardiac operations within the National Health Service (NHS). The move will increase University College Hospital's cardiac capacity for NHS patients from 750 a year to 1,600 at the same time as freeing up space for other procedures at the Middlesex Hospital. The price of £27.5m was said to be an outstanding deal, given that the hospital was independently valued at £35m and that it would cost around £50m to build such a state of the art facility from scratch. However as Geoff Martin of Unison has said, "This is actually a bail-out for a failing private hospital and it nails the government's lie that the private sector has got all the answers to running this kind of service".
(See also Financial Times, Aug. 8th 2001, p.2; Daily Telegraph, Aug. 9th 2001, p.2; Independent, Aug. 9th 2001, p.6).
SHIFTING THE BALANCE OF POWER WITHIN THE NHS: SECURING DELIVERY
Department of Health
London: 2001
Document covers three organisational changes in the NHS: the development of primary care trusts to fulfil their potential, the creation of strategic health authorities and a refocusing of the work of the Department of Health. Primary Care Trusts (PCTs) will become the lead NHS organisations. Trusts will be expected to devolve greater responsibilities to clinical teams and to encourage the growth of clinical networks. High performing trusts will earn greater autonomy. Strategic Health Authorities (SHAs) will lead the strategic development of the local health service and manage the performance of PCTs. Four new regional offices of health and social care will be created, covering London, the South, the Midlands and the North. Document also develops proposals for NHS franchising, which will enable top managers to improve performance across the service.
TAKING THE AIR
C. Gallagher
Health Service Journal, vol.111, Aug. 2nd 2001, p.16
In an attempt to implement the clean hospitals programme, many trusts have installed automatic air fresheners to remove offensive odours. There is concern that these may be triggering respiratory problems.
THIN RED LINE OF NHS HEROES
B. Hudson
Health Service Journal, vol.111, Aug. 9th 2001, p.18
In health care, public private partnerships (PPPs) are likely to be extended into new areas (especially primary and intermediate care) and new roles, including clinical services. Article explores the dilemmas in regulation, accountability and service co-ordination and the ideological contradictions this policy will raise.
THIRD OF PATIENTS WILL COME FROM PRIVATE SECTOR
D. Charter
Times, Aug. 9th 2001, p.8
Article discusses the recent purchase by the National Health Service of a state of the art heart hospital. It examines how public and private patients will be treated alongside one another and looks at how the staff will be transferred from the private to the public sector.
THE TOMORROW PEOPLE
J. Davies
Health Service Journal, vol.111, July 26th 2001, p.26-29
Discusses moves by the new medical schools to encourage applications from minority ethnic and other disadvantaged groups and to promote graduate entry into the profession. Goes on to consider ways of tackling the shortage of teaching staff in medical schools.
VISION FROM AFAR
P. Streets
Health Service Journal, vol.111, Aug. 16th 2001, p.31
Experience in Africa suggests that many tasks done by doctors could be delegated.