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Welfare Reform on the Web (January 2002): National Health Service - Reform - General

ACCIDENT AND EMERGENCY

Audit Commission

Audit Commission Publications: 2001 (Acute hospital portfolio, review of national findings: no. 2)

Despite the NHS plan pledge to reduce trolley waits in accident and emergency departments, the Commission found that the percentage of patients admitted within four hours had dropped from 89% in 1996 to 76% in 2000. Whereas 72% of patients saw a doctor within an hour in 1996, the figure in 2000 had fallen to 53%. There is no discernible cause for this deterioration, suggesting that waiting times are determined by organisational and managerial differences as much as by resources and staff levels. Longer waits were found in London and in larger A&E departments for reasons which were not clear. Staff workloads also varied very widely, but there was no evidence that departments which were short staffed had longer waiting times than those which were generously staffed. Proposes making more use of nurse practitioners to treat non-urgent cases.

ANOTHER BRICK IN THE WALL

P. Walsh

Health Service Journal, vol. 111, Nov. 1st 2001, p.26-27

The government's decision to abolish community health councils in England does not appear to be the result of public consultation. A survey of English councils for voluntary service suggests that most are in favour of strengthening and reforming CHCs. The government's handling of this issue does not bode well for future consultation in the NHS.

BAREFOOT DOCTORS

D. Carlisle

Health Service Journal, vol. 111, Nov. 8th 2001, p. 12-13

Little progress has been made on implementing the recommendations of the report of the working group on refugee doctors and dentists. Money earmarked to assist with the integration of the refugees into the medical profession in the UK remains unallocated.

BLOCKBUSTERS

L. Donnelly

Health Service Journal, vol. 111, Oct. 25th 2001, p. 9-10

Trolley waits in casualty departments and bed blocking are two of the most intractable problems to hit NHS trusts. Pressure on acute beds could be reduced by treating more patients within primary care and so cutting referrals. However this would not solve the basic problem of insufficient capacity in both acute trusts and residential care.

BREAKING THE BANK

A. Cole

Health Service Journal, vol. 111, Nov. 15th 2001, p.22-24

Expenditure on agency nurses in the NHS is at an all-time high and increasing numbers of nurses are working exclusively for agencies. Agency nursing offers flexible hours combined with reduced stress, good pay and work variety.

EASY COME, EASY GO

J. Hesketh

Health Service Journal, vol. 111, Nov. 15th 2001, p.24-27

Discusses why increasing numbers of nurses are leaving the NHS work exclusively for agencies. Reasons include: 1) overwork and stress experienced by NHS nurses; 2) their comparatively low pay; 3) their increasing case loads; and 4) their lack of influence on NHS policy.

ENTER THE DRAGON

A. Moore

Health Service Journal, vol. 111, Nov. 15th 2001, p. 12-13

Discusses the role of the Modernisation Agency's visits team in analysing the problems of failing hospitals and showing them how to improve.

GERMAN MEDICAL FIRM TO BUILD AND RUN NHS HOSPITAL

A. Grice

Independent, Nov. 19th 2001, p.8

The Department of Health has opened negotiations with an unnamed German company to build, staff and run a new hospital. It also intends to hold talks with health providers in other European countries, including Italy and Spain.

GETTING TOUGH ON HOSPITALS' FAILINGS

N. Timmins

Financial Times, Nov. 8th 2001, p.15 & 6

Report of an interview with Peter Homa, chief executive of the Commission for Health Improvement (CHI). Discusses how CHI's role has developed, with recent reports becoming more overtly critical. Explains why CHI's reports point out failings without explanation of their causes, and why they do not brand hospitals as straightforwardly good or bad. Hospitals are enormously complex organisations in which one department may be failing while another is excellent. Finally calls for the rationalisation of the plethora of bodies which are currently involved in auditing and regulating the NHS.

A HEALTHY OUTLOOK: LOCAL AUTHORITY OVERVIEW AND SCRUTINY OF HEALTH

Audit Commission

Audit Commission Publications, 2001

Calls on the local health community to work in partnership with council overview and scrutiny committees by identifying broad areas for investigation across service boundaries, providing advice and information and working together to produce "do-able" reports. Acknowledges that committees will require training, financial resources and support from government if they are to function effectively.

HOME BOUNTIES

A. Moore

Health Service Journal, vol. 111, Oct. 25th 2001, p.12-13

Problems of bed blocking in the South East are so severe that they are jeopardising service delivery across the region. Long term solutions include development of intermediate care facilities, offering people more support at home, and encouraging private provision of care home places.

NEVER SAY DIE

A. Moore

Health Service Journal, vol. 111, Nov. 1st 2001, p. 14-15

Reports various proposals for ensuring that cancer research and services are kept up to date. These include introducing a National Cancer Act to ensure that cancer research and treatment budgets increase every year to meet National Cancer Research Institute priorities, negotiating with pharmaceutical companies to reduce the price of new drugs, and putting in place procedures to "fast track" promising treatments.

NHS LOOKS FOR 1,000 FOREIGN DOCTORS

C. Hall

Daily Telegraph, Nov. 7th 2001, p.15

The Health Secretary has admitted at the launch of a recruiting drive in Spain that the NHS will need to employ 1000 foreign doctors and 2000 nurses to meet government targets and ease the staffing shortages in English hospitals.

(See also Financial Times, Nov. 8th 2001, p.7)

NHS WATCHDOG TO BE GIVEN POWER TO CRITICISE POLICY

C. Hall

Daily Telegraph, Nov. 9th 2001, p.11

The NHS Reform Bill proposes that the Commission for Health Improvement (CHI) should be given the same status as the powerful schools inspectorate, Ofsted. It would appoint its own board and senior officers and would make an annual report to parliament on the state of the NHS. Also proposes that CHI should take over the controversial star rating system for hospital trusts, and should have the power to suspend a hospital department if its work is found to be dangerously poor.

(See also Financial Times, Nov. 9th 2001, p.5; Guardian, Nov. 9th 2001, p. 9; Times, Nov. 9th 2001, p. 12; Independent, Nov. 9th 2001, p.10)

ONLY CONNECT

A. Hague

Health Service Journal, vol. 111, Nov. 15th 2001, p. 28-29

The establishment of a network for critical care services in five hospitals has led to a decrease of transfers of patients for non-clinical reasons. There have been no transfers outside the network's area. The introduction of common admission policies has led to more openness about bed availability. Introduction of the network has standardised data collection.

PATIENTS ON WAITING LISTS CAN "SHOP AROUND"

L. Duckworth

Independent, Nov. 16th 2001, p.10

Patients waiting more than a year for a hospital admission will be given the right to NHS funded treatment in the private sector, abroad, or in another region under radical plans to extend choice in the NHS.

(See also Daily Telegraph. Nov. 16th 2001, p.4)

PATIENTS TO GET GREATER CHOICE ON TREATMENT

N. Timmins

Financial Times, Nov. 12th 2001, p.2

In order to hit its waiting time targets, government plans to allow patients to choose whether they wish to be treated by the NHS, in a private hospital or overseas. In a return to the internal market, competition between NHS hospitals will be encouraged. However, any radical change will require new funding mechanisms.

QUICK, QUICK SLOW

R. Jones

Health Service Journal, vol. 111, Oct. 25th 2001, p.20-23

In most hospitals, a two-week guaranteed maximum waiting time for cancer referrals will be a mathematical impossibility. Guaranteed waiting times require over-provision of appointments. Randomness makes it virtually impossible to allocate the correct number of urgent appointment slots. Current appointment systems are not able to cope with the operational demands arising out of randomness. Randomness dictates that only a proportion of appointments can be offered at a guaranteed time.

SURVIVING THE AFTERSHOCK

A. McGuaran

Health Service Journal, vol. 111, Nov. 1st 2001, p.11-12

Describes how a number of acute trusts are developing plans to improve performance in weak areas identified by Commission for Health Improvement reviews.

VIOLENT PATIENTS DENIED TREATMENT

J. Carvel

Guardian, Nov. 2nd 2001, p.11

For the protection of staff, persistently violent and abusive patients will be banned from NHS hospitals and denied treatment for minor illnesses and injuries for up to a year.

WHAT LIES WITHIN?

A. McGuaran

Health Service Journal, vol. 111, Nov. 15th 2001, p.11-12

Discusses the present and future role of the medical royal colleges in the education and training of doctors, political lobbying, and improving patient care.

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