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

ACUTE HOSPITAL PROFILE : CATERING

Audit Commission

Audit Commission Publications, 2001

Report found that one third of hospitals serve sub-standard food for patients or leave them hungry. Some dishes are served cold and some patients do not receive the meal they ordered because they are at the end of the "food run" and their choice has gone. Others are unable to eat because they cannot reach their meals, open them or use the cutlery. 23% of trusts fail to check new patients' dietary requirements, and one third of dieticians acknowledge that hospital menus are inadequate. The research uncovered wide variations in daily spending on meals, and estimated that the wastage from unserved meals could be cut by £8m per year.

ACUTE PROBLEMS

C. Wright

Community Practitioner, vol. 74, 2001, p. 374-375

The NHS in Scotland is being radically restructured, with health boards and acute trusts being merged to form 15 new unified NHS boards. There are concerns that when acute and primary care services come together, precedence will be given to hospitals over the community setting in the allocation of funding.

AUDIT IN THE NHS

R. Klein and P. Day

Nuffield Trust, 2001

Concludes that while the Audit Commission's national studies on broad topics such as care of the elderly are valuable, it succeeds neither in improving effectiveness in the NHS nor in making its workings at local level more transparent. Suggests that the Commission links up with local authorities and with the Commons Health Select Committee as a way of making the NHS more accountable.

A BED FOR ALL SEASONS

S. Ward

Public Finance, Sept. 21st - 27th 2001, p. 18-20

Discusses the prospects of the NHS avoiding a winter beds crisis in 2001/02. Pressure on beds is being relieved by:

  • joint planning and budgeting between health and social services which is reducing bed blocking by elderly patients;
  • purchase of elective work from private providers;
  • improved capacity planning at local level.

CAUSE AND EFFECT

K. Walshe and J. Smith

Health Service Journal, vol. 111, Oct. 11th 2001, p. 20-23

In a survey of 304 chief executives of NHS organisations in England, three-quarters felt that the latest reorganisation set our in the consultation paper "Shifting the Balance" would delay delivery of the NHS Plan over 2002/03. A total of 55% expressed negative views about the reorganisation. Almost half doubted Primary Care Trusts' ability to cope with the expanded responsibilities for commissioning that are envisaged. Some 59% of chief executives thought their job would change as a result of reorganisation. A quarter thought they were less likely to be working in the NHS.

A DROP OF THE HARD STUFF

P. Smith

Health Service Journal, vol. 111, Oct. 18th 2001, p. 12-13.

Reports on the NHS Chief Executive Nigel Crisp's speech to the Institute of Healthcare Management conference. He strongly defended the star rating system for hospital trusts and warned that performance measures in 2002 would be even tougher, as patient satisfaction would be included.

ETHOS: MISSING IN ACTION

J. Shapiro

Health Service Journal, vol. 111, Sept. 27th 2001, p. 18

Argues that before more extensive private sector involvement in the delivery of public health care is introduced, government needs to work out what to do in the event of catastrophic failure by the private provider.

GENTLY DOES IT

N. Crisp

Health Service Journal, vol. 111, Sept. 27th 2001, p.16

The government's new rating system for hospitals is designed to help spread good practice and to measure performance against a balanced score card. Trust boards of poorly performing hospitals will bear the responsibility for ensuring improvements within a fixed time period, but with help from the performance fund and the Modernisation Agency. If targets are not met, changes will be made to the board and new managers will be brought in from elsewhere in the NHS. Top performing trusts will be rewarded with more autonomy and will be encouraged to bid for contracts to run failing hospitals.

THE GHOST OF A BOAST

J. Higgins

Health Service Journal, vol. 111, Oct. 18th 2001, p. 22-24

The NHS was introduced to enormous popular acclaim in 1948, but services always varied markedly and physical conditions were poor. At the birth of the NHS, two thirds of hospitals had been built before 1891. Even today, the NHS is providing care in accommodation built in the 1800s. It is now lagging behind comparable healthcare systems on several counts. It is unrealistic to expect it to become "the envy of the world", as promised by Tony Blair, in the lifetime of this government.

GOVERNMENTALITY AND RISK: SETTING PRIORITIES IN THE NEW NHS

P. Joyce

Sociology of Health and Illness, vol. 23, 2001, p. 594-614

Paper aims to explore priority setting issues in the NHS in the wake of the Conservative governments' reforms which separated the functions of purchasing and providing health care. It employs the conceptual framework of "governmentality", associated with the French social theorist Michel Foucault, to analyse this aspect of health policy. Governmentality analysis situates social and economic change as reflecting shifts in the "mentality" of government.

HOW TO IMPROVE NHS TREATMENT

H. D. Scott

Daily Telegraph, Oct. 4th 2001, p.24

Proposes solving the NHS's problems by:

  • increasing capacity through the recruitment of more consultants and GPs;
  • increasing funding through a hypothecated tax.

INCOMMENSURATE PARADIGMS? BRIDGING THE DIVIDE BETWEEN TECHNOCRATS AND THE LAY PUBLIC IN HEALTH CARE PLANNING: RECENT EXPERIENCE FROM WALES

M. Longley

International Journal of Consumer Studies, vol. 25, 2001, p. 255-264

Paper focuses on current attitudes towards public involvement in UK NHS planning. Politicians and others argue that "lay wisdom" has much to contribute, and that such involvement is essential if public confidence in the service is to be maintained. Many mangers and clinicians, however, operating within an essentially technocratic paradigm, remain unconvinced. Their views are often reinforced by lack of experience of methods for public involvement that can meet the many practical difficulties involved.

INVOLVING PATIENTS AND THE PUBLIC IN HEALTHCARE : A DISCUSSION DOCUMENT

Department of Health

London: 2001

Proposes abolishing Community Health Councils and replacing them with :

  • statutory Patients Forums run by lay representatives to inspect the work of each NHS Trust;
  • local statutory bodies to be called Voice agencies to report the concerns to the Forums and Patient Advisory and Liaison Services (PALS) to "a new tier of Strategic Health Authorities";
  • a new national body to be called Voice - the Commission for Public and Patient Involvement in Health, to oversee the arrangements and set standards.

IT'S THEIR SHOUT

J. Trueland

Health Service Journal, vol. 111, Oct. 18th 2001, p.16

Unlike the Commission for Health Improvement which looks at the performance of individual hospitals, the Clinical Standards Board for Scotland is setting standards in specific clinical areas across the health service as a whole. Initially it is focusing on heart disease, cancer and mental health.

KEEP IT LOCAL

A. Underdown and L. Thorpe

Community Practitioner, vol. 74, 2001, p. 368-369

Analysis of the 2000/01 Health Improvement Programmes (HIMPs) reveals the fragmented nature of services for young people across Health Authorities in England.

MANY HAPPY RETURNS

A. Gulland

Health Service Journal, vol. 111, Oct 11th 2001, p.12-13

Reports progress of trusts' efforts to recruit more nurses and to hit the government's target of getting 20,000 more nurses into the NHS by 2004. The government's expansion of training places has helped, and international recruitment has been a priority in the short term. However, the profession is ageing and a significant number of current nurses will be eligible to retire over the next five to ten years. The challenge of replacing them remains.

web linkMIND THE GAP: MANAGEMENT INFORMATION FOR OUTPATIENT SERVICES

Audit Scotland

Edinburgh: 2001

Report concludes that poor information gathering can have a knock-on effect for out patients. Findings show inadequacies in the type and quality of the data recorded both locally and nationally. Argues that a comprehensive review of the outpatient system is needed.

MOUTHING OFF

Anon.

Health Which, Oct. 2001, p.10-13

Researchers surveyed 730 dental surgeries around the UK in June and asked if they were taking NHS patients. Almost a quarter said they were taking only private patients, and the rest were not taking new patients at all. The researchers also rang NHS Direct, but of 20 calls made the service could only provide details of NHS dentists for seven callers.

NATIONAL STOKE AUDIT: A TOOL FOR CHANGE?

A. G. Rudd et al

Quality in Health Care, vol. 10, 2001, p.141-151

A nationally conducted audit linked to a comprehensive dissemination programme was effective in stimulating improvements in the quality of care for patients with stroke. More patients are now being managed on stroke units and multidisciplinary care is becoming more widespread. There remain, however, many areas where standards of care are low, indicating a need for investment of skills and resources to achieve acceptable levels.

NEW NHS LEAGUE TABLE REWARDS TOP PERFORMERS

N. Timmins

Financial Times, Sept. 26th 2001 p.10

The new league table of NHS trusts gives hospitals 0 to three stars using 21 indicators that range from cleanliness and trolley waits to emergency re-admissions and deaths within 30 days of surgery. Top performing, hospitals will receive less frequent monitoring and inspection and be free to spend their share of a £155m performance fund as they wish. They will receive cash for centrally funded initiatives without having to bid for it, and can create spin-off business ventures. Hospitals that gained no stars will get a share of the performance fund, but will have to produce an action plan overseen by the NHS Modernisation Agency to spend it. Failure to improve within three months or a year will result in the sacking of the chairman and chief executive, with managers of better performing hospitals being invited to bid for a "franchise" to run them.

(See also Times, Sept. 26th 2001, p.14; Daily Telegraph, Sept. 26th 2001, p 14; Guardian, Sept. 26th 2001, p. 12, Independent, Sept. 26th 2001, p.10)

NHS IS URGED TO HIRE ASYLUM-SEEKERS AND STOP "POACHING" FROM THIRD WORLD

B. Russell

Independent, Sept. 28th 2001, p.12

Reports Liberal Democrats' proposals that medically qualified asylum seekers should be recruited to the NHS to ease staff shortages.

(See also Financial Times, Sept. 28th 2001, p.10)

NHS PLAN TARGETS LOOKING REMOTE

P. Stephenson

Health Service Journal, vol. 111, Oct. 4th 2001, p. 2-3

It is becoming clear that the targets for service improvement set out in the NHS plan are unlikely to be met despite increased funding. This is due to the extra money being used up on increased costs of drugs, pay inflation and increased pension payments.

NHS TO PAY FOR OPERATION IN GERMANY

Anon

Daily Telegraph, Oct. 4th 2001, p.15

The NHS has agreed to pay £6,000 for a woman to have an urgent knee operation in Germany because her local hospital has a long waiting list.

OBSTACLE COURSE

L. Warner, A. Hoadley and R. Ford

Health Service Journal, vol. 111, Oct. 4th 2001, p. 28-29

Focus groups of mental health practitioners, service users, and carers designed to test the competence of staff to deliver modern services, revealed wide discrepancies in perceptions. Staff saw the persistence of the medical model, and the risk-averse culture of trusts, as obstacles to delivering effective care. Users and carers felt generally uninvolved in care planning.

OF ONE MIND

J. Wood, F. Margison and D. Allen

Health Service Journal, vol. 111, Oct. 4th 2001, p.26-27

The NHS is heavily reliant on locum doctors, many of whom trained overseas. It is important they are appropriately trained so they can be integrated into the workforce. A pilot nine-session course for consultant locum psychiatrists was well received by participants. Medical directors have expressed willingness to pay for locums to attend such courses.

OVER THE BORDER

Anon

Health Which? Oct. 2001, p.18-19

Discusses the impact of devolved government on the NHS as policies diverge across the UK.

PATIENT EMPOWERMENT AND PUBLIC PARTICIPATION

[British Medical Association et al]

[London]: [2001]

Supports the principle of a patient focused NHS, with patients empowered to use services effectively and to get the care they deserve. Comments on various proposals in the NHS Plan which are aimed at helping to achieve this goal.

PATIENTS SET FOR SURGERY IN GERMANY AND FRANCE

N. Timmins

Financial Times, Oct. 16th 2001, p.12

The government is to run a pilot scheme for sending patients who face lengthy waits for NHS treatment to hospitals in other EU countries.

(See also Guardian, Oct. 16th 2001, p.12)

PLUGGING THE DEMOCRATIC DEFICIT

J. Williams

Public Finance, Sept. 14th - 20th 2001, p.30

The NHS and local government are moving towards a closer partnership in health care delivery. Argues that local government could develop an enhanced role in scrutinizing local health services, helping to restore accountability to local communities.

PRAGMATIC RANDOMISED TRIAL TO EVALUATE THE USE OF PATIENT HELD RECORDS FOR THE CONTINUING CARE OF PATIENTS WITH CANCER

J. G. Williams et al

Quality in Healthcare, vol. 10, 2001, p.159-165

A total of 501 patients under the care of the Department of Oncology, Singleton Hospital, Swansea took part in a pragmatic randomised controlled trial to evaluate the use of a multidisciplinary patient held record. The patient held record was valued by some patients and professionals but had no significant impact on the quality of life of patients or on NHS resource use. It had a positive impact on quality by helping patients feel more in control and prepare for meetings with healthcare staff. Patients who found it useful tended to be younger and to have more professionals involved in their care.

THE PROBLEMS WITH CENTRALISATION

R. Bullock

Journal of Clinical Excellence, vol. 3, 2001, p. 111-112

There is currently a tendency within the NHS to favour mergers to form large units that then try to centralise their operations in order to govern and overcome the complexity of health care. This is contrary to recent moves towards improving services by delegating responsibility. Delegation fosters local innovation and pride in working methods, leading to the emergence of learning within organisations and a developmental culture.

PUBLIC-PRIVATE PARTNERSHIPS : AN INDEPENDENT SECTOR GUIDE

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

Discusses private sector involvement in delivery of NHS acute and mental healthcare services. Also considers the role that private providers of long-term care could play in intermediate care delivery, and how the construction industry is gearing up to meet the demand for health service private finance initiatives.

SEQUEL OPPORTUNITIES

P. Stephenson

Health Service Journal, vol. 111, Oct. 18th 2001, p.11-12

Reports that one Adair Turner is leading a review of NHS structures to see how high performing acute trusts could be given greater freedom to pursue their earned autonomy. The review will examine the concept of contestability, which implies a diversity of providers and a contest for work. This review is running in parallel with a Treasury review of NHS funding which is expected to conclude that if the service is to remain free at the point of need, much more money will need to be invested in it.

STARLIGHT EXPRESS

A. Moore

Health Service Journal, vol. 111, Oct. 4th 2001, p. 11-12

Discusses reasons why some trusts have failed to gain any stars in the new rating system in the NHS. "No-star" trusts share difficulties in staff recruitment and problems with bed blocking. Some trusts have also faced organisational upheavals such as mergers.

STATE OF NHS IS MEDIEVAL, SAYS FRENCH MINISTER

P. Foster

Daily Telegraph, Oct. 5th 2001, p.19

The French Minister of Health has claimed that the NHS is in an intolerable state and is failing its citizens. He attributes the problems to a shortage of funding and the erosion of belief in the merits of the public sector following the privatisation ethic of the Thatcher years.

SWEEPING THE BOARD

J. Trueland

Health Service Journal, vol. 111, Sept. 27th 2001, p. 12-13

Discusses the implications of NHS Scotland's return to a more centralised structure based on unified health boards.

THREE STARS FOR A BIT OF STABILITY

N. Timmins

Financial Times, Sept. 28th 2001, p.16

Points out that well run hospitals tend to have benefited from stable and competent management at chief executive level.

WHAT MAKES A DECENT HOSPITAL?

J. Laurance

Independent, Sept. 29th 2001. Review Supplement, p.8

Hospital league tables do not measure clinical performance but do exert pressure on managers to improve administration.

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