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

ALL THE EVIDENCE POINTS TO TRAGEDY

D. Hunter

Health Service Journal, vol.111, Aug. 23rd 2001, p.18

Government plans to improve health care in England are based on massive structural reform of the NHS and the imposition of a raft of targets and performance indicators. It resolutely ignores evidence based on past failures that suggests that such approaches will be ineffective.

BACK TO KNEES IN NEASDEN?

M. Rigge

Health Service Journal, vol.111, Aug. 30th 2001, p.18

Discusses the pros and cons of moves to send NHS patients abroad for treatment in the face of long delays at home.

BRIEF ENCOUNTERS: GETTING THE BEST FROM TEMPORARY NURSING STAFF

Audit Commission

2001

Reports that the NHS spent £800m on temporary nursing staff in England and Wales in 1999/2000, a rise of over 20% on the previous year. The cost of staff supplied through commercial agencies rose by about a third to £360m in England and £8m in Wales. The cost of staff supplied by in-house reserves (bank staff) rose by about 15% to £430m in England and £10m in Wales. The £810m spent on temporary staff is about 10% of the cost of the total nursing pay bill. Trusts need to reduce demand for temporary staff by recruiting, retraining and deploying the right mix of permanent staff. Costs of temporary staff are increased by poor management and financial controls. Value for money is also poor as staff are often inexperienced and ill-prepared for the tasks in hand.

CELEBRITY MENU GOES ON THE WAITING LIST

D. Charter

Times, Aug. 21st 2001, p.1

Hospitals were due to introduce at least one recipe a day from a 43-dish list drawn up by celebrity chef Loyd Grossman during August 2001. Introduction of the new menu has now been postponed until December due to its high cost.

CLINICAL NEGLIGENCE: WHAT ARE THE ISSUES AND OPTIONS FOR REFORM?

Department of Health

[Leeds]: 2001

Sets out plans to make the clinical negligence compensation system faster and fairer while reducing costs by cutting bureaucracy. Ideas under discussion include a no-fault system, a scheme of structured settlements that would see payments adjusted to take account of changing needs, fixed tariffs for specific injuries, and greater use of mediation instead of financial compensation. Comments are to be fed to a newly convened advisory committte charged with reforming the system.

http://www.doh.gov.uk/clinical/negligencereform/

THE CURE AT HAND

A. Benjamin

Guardian, Sept. 5th 2001, p.10-11

Article discusses the number of shifts covered by temporary nurses and the number of nurses being recruited from overseas. It looks at the measures being taken to try and recruit and retain staff in the UK in the long-term. Plans include things like school visits, work placement and mentors. It examines the impact of the Fit for Work initiative in Newham, giving an example of someone who has worked through the scheme. A spokesman for the Department of Health emphasised the need to attract former nurses back to the profession by offering them £1,000, more flexible working arrangements and childcare places.

DEAD WEIGHT

P. Smith

Health Service Journal, vol.111, Sept. 13th 2001, p.12-13

Reports results of the Commission for Health Improvement's investigation of heart and lung transplants at St George's Hospital, London, following a disturbing number of patient fatalities. National recommendations arising from the report include: 1) a review of funding for all heart and lung transplantation programmes, based on the principle of levelling up; 2) heart and lung transplantation programmes should ensure a "solid and transparent" approach to selecting candidates for operations; 3) external experts should be called in to determine if rises in death rates are statistically significant; and 4) information on outcomes given to patients should be based on the most recent evidence available.

(See also Guardian, Sept. 13th 2001, p.17; Independent, Sept. 13th 2001, p.16; Times, Sept. 13th 2001, p.7).

DOCTOR'S ABUSE LEADS TO CALLS FOR REGISTER OF COMPLAINTS

J. Carvel

Guardian, Aug. 31st 2001, p.8

Following a scandal involving long term sexual abuse of patients by a GP, the Commission for Health Improvement has recommended: 1) a national complaints system for the NHS to log and track all concerns; 2) closer supervision of GPs by primary care trusts and health authorities; and 3) a more open and honest system for appointing GPs.

(See also Times, Aug. 31st 2001, p.8; Independent, Aug. 31st 2001, p.8; Daily Telegraph, Aug. 31st 2001, p.9).

DOWN IN THE DUMPS

A. McGauran

Health Service Journal, vol.111, Sept. 20th 2001, p.14-15

Government is proposing a form of secondment from the NHS for support staff where services are taken over by a private contractor. However legal advice suggests that this approach may break the European Acquired Rights Directive. Some private contractors have proposed a beefed-up TUPE (Transfer of Undertakings Protection of Employment) as an alternative if the secondment model proves unworkable.

EUROPEAN BEDS FOR NHS PATIENTS BY THE NEW YEAR

D. Charter and N. Hawkes

Times, Aug. 31st 2001, p.1 + 4

The Health Secretary has been advised that he does not need to pass a new law to enable NHS patients to be treated abroad. All that is required is the agreement of the Privy Council. Department of Health officials are preparing guidelines for Primary Care Trusts, but insist there will be no additional money for extra operations.

THE EXPERT PATIENT: A NEW APPROACH TO CHRONIC DISEASE MANAGEMENT FOR THE 21st CENTURY

Department of Health

London: 2001

Backed by a £2m investment, a series of pilot projects aimed at training chronically ill patients to manage their own condition will be run across primary care services.

URL: http://www.doh.gov.uk/health inequalities/index.htm

FIRST IMPRESSIONS

F. Johnson and K. Greenwood

Health Service Journal, vol.111, Sept. 20th 2001, p.26-27

International recruitment continues to be a significant factor in NHS staffing. Some nurses recruited from overseas require a period of adaptation to orient themselves to the UK healthcare system. The quality of these adaptation and induction programmes varies. The Greater Manchester Workforce Development Confederation, which covers 15 Trusts, is running a project to develop a standardised induction programme.

FIRST RISE IN NHS BEDS FOR 30 YEARS

J. Carvel

Guardian, Sept. 20th 2001, p.15

Bed numbers in the NHS have increased for the first time in 30 years. The average number of overnight beds available for patients in general and acute hospitals rose by 714 to 135,794 in 2000/01. This increase has taken the government a third of the way towards its target of 2,100 extra beds by 2004.

(See also Times, Sept. 20th 2001, p.16; Daily Telegraph, Sept. 20th 2001, p.16; Financial Times, Sept. 20th 2001, p.10).

FOREIGN DOCTORS TO BAIL OUT NHS

J. Sherman and J. Landale

Times, Aug. 20th 2001, p.1

The government is to launch a worldwide advertising campaign to recruit senior doctors from abroad to help meet its target of bringing 10,000 extra doctors into the NHS by 2004.

(See also Times, Aug. 21st 2001, p.6; Guardian, Aug. 21st 2001, p.8).

HIGH STREET LOWS

R. Lewis

Health Service Journal, vol.111, Aug. 23rd 2001, p.27

Discusses the potential impact of local pharmaceutical services (LPS) pilots on community pharmacy.

IF LOOKS COULD KILL

L. Whitfield

Health Service Journal, vol.111, Aug. 23rd 2001, p.9-11

There is an unhelpful proliferation of bodies with a remit to audit the workings of the NHS. Some rationalisation is required, and the various regulatory bodies are jockeying for position.

INVOLVING PATIENTS AND THE PUBLIC IN HEALTHCARE: A DISCUSSION DOCUMENT

Department of Health

London: 2001

Proposes at least five tiers of patient organisations to promote their involvement in the NHS: 1) Patient Advocacy and Liaison Services staffed by NHS employees to help patients resolve difficulties on the spot; patient forums run by lay representatives inspecting the services of each Trust; local Voice agencies covering each Strategic Health Authority area and staffed by specialists which would co-ordinate the views of patients and citizens and bring together the local Patient Forums; local authority scrutiny committees to call NHS managers to account; and a national Voice commission that would set standards for public and patient involvement

http://www.doh.gov.uk/involvingpatients/

THE LISTENING BLANK

J. Higgins

Health Service Journal, vol.111, Sept. 13th 2001, p.22-23

The major failures reported in the Bristol heart baby deaths inquiry have been highlighted in most hospital inquiry reports over the past 30 years. The tendency to victimise the whistleblower has characterised virtually all inquiries. Inadequate leadership, isolation, system failures, poor communication and disempowerment of staff and service users are common themes. While organisational reform is essential, the real challenge is to change behaviour. This depends on the example of senior staff.

MATRON'S IN CHARGE: THE PALLIATIVE POWER OF MYTH

T. Harvey

British Journal of Health Care Management, vol.7, 2001, p.370-371

The government has proposed the introduction of "modern matrons" in charge of groups of wards. Argues that the role is anachronistic, and was proposed as a sop to middle class clamour in advance of a general election.

MISSING INGREDIENTS

R. Gordon

Health Service Journal, vol.111, Sept. 13th 2001, p.26

Author relates his personal experiences of unappetising hospital food served without sick and elderly patients being given any help or encouragement to eat it. Points out that improvements would require more funding.

MORE HARD CHEESE FOR THE HEALTH SERVICE

M. Gove

Times, Aug. 21st 2001, p.12

Attributes the ills of the NHS to its being a centrally controlled state monopoly provider of health care.

MOVERS AND SHAKERS

A. Cole

Health Service Journal, vol.111, Aug. 30th 2001, p.24-27

Discusses the emergence of radical patient action groups in the UK. These groups tend to form in response to a particular medical scandal and use the threat of litigation and the power of the media to achieve their ends.

NEW UNIT PROMOTES PRIVATE SECTOR IN NHS

N. Timmins and A. Pike

Financial Times, Sept. 19th 2001, p.9

Reports that the government has set up a new unit in the Department of Health that will create "a proper strategic relationship" between the NHS and the private sector. The unit will also oversee private involvement in some of the 29 fast track surgery centres the government is planning and provide the framework for UK patients to be treated abroad.

NHS COMPLAINTS PROCEDURE: NATIONAL EVALUATION

System Three Social Research and York Health Economics Consortium

London: Department of Health, 2001

Provides a summary of the current NHS complaints procedure and highlights the ways in which it differs between the four countries of the UK. Then presents the views of service users (complainants, staff complained against, health councils and patient interest groups) and of those operating the system (chief executives, complaints managers, convenors, lay chairs, and regional/national complaints leads). Discusses the main findings and policy implications in relation to local resolution and independent review respectively.

NO LEGAL AID FOR PATIENTS HAVING NHS SURGERY ABROAD

R. Verkaik

Independent, Sept. 12th 2001, p.15

The Legal Services Commission has confirmed that NHS patients sent abroad for treatment under government plans to cut waiting lists will not be entitled to legal aid to pursue medical negligence claims.

NO QUICK FIX

R. Klein

Health Service Journal, vol.111, Aug. 30th 2001, p.28-30

The inquiry into childrens heart surgery at the Bristol Royal Infirmary highlights the disjunction between ends and means in the NHS. It draws attention to the "make do and mend" culture in the service and sees the ethos of "getting by" as the enemy of excellence. Its most radical and challenging theme is to argue for the separation of management and regulation in the NHS.

NURSE'S CHOICE: JOB SECURITY OR AGENCY FREEDOM

E. Judge

Times, Sept. 5th 2001, p.2

Article looks at the benefits of being agency or NHS staff. It looks at two cases which both come down to a matter of personal choice. Time, money, stress levels and patient care are all considered.

(See also Independent, 5th Sep. 2001, p.11).

NURSES CAN HIDE DRUGS IN THE FOOD OF PATIENTS

J. Laurance

Independent, Sept. 6th 2001, p.7

The UK Council for Nursing and Midwifery has issued guidance stating that, where a patient is refusing medication and is judged incapable of giving consent, drugs can be administered by mixing them with food and drink.

(See also Daily Telegraph, Sept. 6th 2001, p.13; Guardian, Sept. 6th 2001, p.11).

ORGANISATIONAL BEHAVIOUR AND ORGANISATIONAL STUDIES IN HEALTH CARE: REFLECTIONS ON THE FUTURE

L. Ashburner

Palgrave, 2001

By looking at current and future health care organisation this book puts forward ideas for new ways of working and of understanding the health sector. It explores key developments such as: the impact of information technology on professional culture; the use of overseas nurses; clinical governance; telemedicine; development of new organisational forms within primary care and increased partnership working.

OVERSEAS COMPANIES MAY RUN NHS UNITS

N. Timmins

Financial Times, Aug. 21st 2001, p.3

Reports that the government is considering inviting continental European healthcare companies to staff and run hospital units under contract to the NHS in an attempt to hit its targets for waiting times and treatments. These providers would compete with UK private hospitals, using staff from their continental home bases to combat NHS shortages.

THE OVERSEAS TREATMENT

P. Gosling

Public Finance, Aug. 24th - Sept. 6th 2001, p.18-20

Evidence from the US, France and Germany does not suggest that private sector involvement in health care delivery will per se raise standards. Much care in those countries, however, is successfully delivered by non-profit organisations, and the NHS might usefully reconsider its relationship with these.

PATIENTS MUST WAIT FOR EU HELP

T. Reid

Times, Aug. 28th 2001, p.2

Under the plan recently announced by the Health Secretary, regulations blocking overseas treatment for NHS patients will be overturned, opening the way for people to be sent abroad for treatment when they face long delays. However the plans will take a significant amount of time to implement.

(See also Financial Times, Aug. 28th 2001, p.3).

PATIENTS WAIT LONGER FOR NHS SURGERY IN THE SOUTH

D. Charter

Times, Sept. 4th 2001, p.1 + 4

Analysis shows that patients in the South East are not benefiting from the reduction in surgery waiting times elsewhere. The gap between the best and worst regions in England for most types of operations is 61/2 weeks. Continuing high demand, chronic staff shortages and bed blocking are blamed for delays in London and the South East. The Department of Health has rejected the figures, claiming they are based on unsound mathematics.

(See also Independent, Sept. 4th 2001, p.2).

PUBLIC PAIN, PRIVATE GAIN

K. Bryson, E. Williams and C. Bell

Health Service Journal, vol.111, Sept. 6th 2001, p.24-26

Using private hospitals over 11 weeks in the Winter of 2001 enabled East Surrey Health Authority to remove more than 1000 patients from waiting lists. Prices were comparable to, and sometimes cheaper than, the NHS. The average cost was £1,120 per treatment. Patient satisfaction seemed high, and consultant productivity was higher in the private sector.

REFORMING THE NHS COMPLAINTS PROCEDURE: A LISTENING DOCUMENT

Department of Health

London: 2001

The current NHS complaints procedure has two stages. Local resolution encourages NHS trusts and primary care practitioners to deal with complaints locally and resolve them quickly. When matters are not resolved complainants have the right to request an independent review. Document summarises proposals for the reform of the current complaints procedure to make it more effective, fair and consistent.

RULES OF ENGAGEMENT

S. Marples

Health Service Journal, vol.111, Sept. 20th 2001, p.22-25

The Institute of Health Care Management believes that NHS managers should be subject to a regulatory body and a professional code of practice. This would improve patient safety and managers' credibility. Managers should be required to demonstrate competence in human resource management, finance and information management. A regulatory code should incorporate the values of integrity, honesty, openness and accountability. Removable offences should include improper conduct.

SECRET SERVICE

R. Winchester

Community Care, no.1386, 2001, p.20-21

The Health and Social Care Act 2001 makes provision for medical information on individuals held by GPs to be accessed by the Health Secretary and by any other organisation, he or she deems fit. These could include local authorities, the police and even private companies. Article discusses the implications of this for people with mental health problems and their carers.

A SHOTGUN MARRIAGE

A. McGauran

Health Service Journal, vol.111, Sept. 6th 2001, p.11-13

Investigates the impact of the Concordat on the relationship between the NHS and private health care providers. Finds some evidence that surgeons and private providers are colluding to fleece the NHS to make quick profits. Best results are obtained where Trusts agree with private providers to feed them a regular stream of cases over the year rather than using spot purchasing to cover crises.

STOP KIDDING AROUND

J. Griffiths

Health Service Journal, vol.111, Sept. 20th 2001, p.28

Argues that the NHS must learn to trust and appreciate its staff if it is ever to become truly effective.

THOUGHTS ON "SHIFTING THE BALANCE OF POWER"

T. Bamford et al

British Journal of Health Care Management, vol.7, 2001, p.355-357

A panel of experts considers the implications of the recent consultation paper on NHS restructuring "Shifting the Balance of Power".

THOUSAND NHS PATIENTS TREATED ABROAD

C. Hall

Daily Telegraph, Aug. 21st 2001, p.4

Reports that the Department of Health is investigating the implications of a recent ruling by the European Court of Justice that appears to give Britons the right to treatment in other EU countries where there is spare capacity if they are facing an excessively long wait for NHS treatment.

TODAY'S SPECIAL

J. Davis

Health Service Journal, vol.111, Sept. 13th 2001, p.27

Reports on the newly developed role of nutrition assistant at the Oxford Radcliffe Hospitals Trust. Nutrition assistants assist patients who need help with their meals, document patients' food and drink intake, determine patients' food preferences, and complete menus and offer choices of menus and snacks as appropriate.

TOO HOT TO HANDLE?

C. Laurent

Health Service Journal, vol.111, Aug. 23rd 2001, p.22-25

People who manage wards find that their accountability to a range of stakeholders is being increased while their control of resources is being diminished. Nurses at this level shoulder a heavy burden of responsibility with little support, and would benefit from leadership training to enable them to influence change.

WATCHDOG CONDEMNS "DEADLY, FILTHY" HOSPITALS

J. Laurance

Independent, Aug. 22nd 2001, p.8

A report by the Commission for Health Improvement has condemned Epson and St Helier NHS Trust for its high death rate, filthy hospitals, and defensive and closed style of management.

(See also Health Service Journal, vol.111, Aug. 23rd 2001, p.15; Guardian, Aug. 21st 2001, p.1).

WHO NEEDS MORE DOCTORS?

D. Walker

Guardian, Aug. 29th 2001, p.19

Points out that higher spending on healthcare does not correlate with improved public health or longevity. It can be argued that the NHS is doing a good job on slender resources.

WORKING WITH THE PHARMACEUTICAL INDUSTRY

A.J. Brzezicki

British Journal of Health Care Management, vol.7, 2001, p.374-376

Suggests that involvement of pharmaceutical industry support in the NHS should be seen as beneficial, and indeed as a way to maximise outcomes for patients.

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