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Welfare Reform on the Web (August 1999): National Health Service - Reform - General

ARE PATIENTS REALLY CONSUMERS?

M. Keaney

International Journal of Social Economics, vol. 26, 1999, p. 695-706.

Argues that far from being passive consumers of pre-packed health care, patients ought to be considered as partners in a continuing process of enquiry, in accordance with John Dewey's philosophy of instrumentalism. As a result it is argued that the present commodification of health care in the UK should be halted in order to preserve and build on the achievements of the NHS.

DATA DAY

B. Cumbers and A. Donald

Health Service Journal, vol. 109, April 15th 1999, p. 30-31.

A project investigating the feasibility of using research data in routine clinical practice showed that most clinicians found it too time-consuming. Obtaining relevant research articles took an average of three days with an on-site library, and a week without one. The most serious barrier was the poor state of the information itself.

EXPLODING HEALTH CARE MYTHS: THE REAL THREATS TO PUBLIC HEALTH

M. Tremblay

British Journal of Health Care Management, vol. 5, 1999, p. 89-91.

Argues for the greater integration of private and public health care, and more local leadership balanced by less national action. Britain has sufficient doctors and nurses, but needs more physiotherapists, occupational therapists, dieticians and other health professionals. The emphasis should be on empowering the public to manage their own health and to enable them to seek out the knowledge to make their own health decisions.

THE INFLUENCE OF HEALTH NEEDS ASSESSMENTS ON HEALTH CARE DECISION-MAKING IN LONDON HEALTH AUTHORITIES

M. Hensher and N. Fulop

Journal of Health Services Research and Policy, vol. 4, 1999, p. 90-95.

Health needs assessment gained prominence under the model of health care purchasing developed to support the 1991 reforms of the NHS. Results of a survey of needs assessment activity in 14 London Health Authorities indicated that it directly supported decision-making and action in two-thirds of the studies identified, but up to 20% of assessments had no impact on service provision. Four key functions of health needs assessment were observed: identifying a problem; planning detailed changes to services; providing post hoc justification for earlier decisions; and using participation in needs assessment to build "ownership" of subsequent decisions.

IS IT A BIRD, IS IT A PLANE...?

P. Butler

Health Service Journal, vol. 109, April 15th 1999, p. 16.

Reports comments by senior NHS figures on the Health Secretary's ideas for improving management development in the Health Service so that the best managers were steered into the toughest jobs and properly rewarded.

A NEW ERA FOR HEALTH CARE

Labour Research, vol. 88, no. 4, 1999, p. 9-10.

Unions have welcomed the reformed, primary-care led NHS, but are concerned that it should not be dominated by GPs.

THE NHS IS NOT SAFE

A. Judd

Daily Telegraph, April 26th 1999, p. 20

Points out that technology just now coming on stream will offer 24-hour monitoring of medical conditions on a mass scale without requiring any patient's presence. For the NHS to make full use of these technologies, there will have to be changes in working practices, skills and professional demarcations beyond any that we have so far seen. The alternative approach that tries to fit the technology into existing health service structures will mean that the NHS will become increasingly second-rate as all who can afford it will be linked to monitoring stations owned by the big healthcare companies.

NHS PERFORMANCE ASSESSMENT FRAMEWORK

NHS Executive

Wetherby: Department of Health. 1999

Framework covers six areas: health improvement, fair access, effective delivery of appropriate health care, patient and carer experience, health outcomes and efficiency. It sets 41 performance indicators covering these areas, and the first results are to be published later this year.

(For comment see Health Service Journal, vol. 109, April 15th 1999, p. 2-3).

NICE: WISE MEN ON A MOUNTAIN OR AN ALLIANCE FOR CHANGE?

N. Bosanquet

British Journal of Health Care Management, vol. 5, 1999, p. 118.

Predicts problems for the National Institute for Clinical Excellence in fulfilling its brief of increasing take up of cost effective innovation. PCGs and Hospital Trusts will not follow NICE guidelines if so doing causes overspend. Deep knowledge is needed to make a definite judgement about the effectiveness of an innovation. NICE needs a permanent core group looking at each product area.

ORGANISATIONAL COSTS IN THE NEW NHS: AN INTRODUCTION TO THE TRANSACTION COSTS AND TRANSITION COSTS OF DELIVERING HEALTH CARE

B. Croxson

London: Office of Health Economics, 1999.

Report casts doubt on government claims that the current round of NHS reforms will lead to savings of £1 bn in administrative costs. Argues that costs could actually rise because, although the number of contracting parties is being reduced through merger of trusts and the creation of primary care groups, internal divisions will still exist and organisations will still need to negotiate with each other. Concludes that measured costs could fall, but this is likely to be achieved more by redefining "bureaucracy" than by reducing organisational costs.

PICT FOR PARLIAMENT

P. Butler

Health Service Journal, vol. 109, April 22nd 1999, p. 14-15.

On the eve of the election of members of the Scottish Parliament, article reports plans of candidates with a health service background for the future of the NHS in Scotland.

TOEING THE LINE

C. Harris

Health Service Journal, vol. 109, April 15th 1999, p. 24-25.

If the Health Bill is passed on time, the professions allied to medicine will be far more closely regulated. The Council for Professions Supplementary to Medicine will be replaced by a Health Professions Council initially covering up to 12 professions. There will be tighter controls on fitness to practise and more powers to discipline professionals guilty of misconduct. Finally, no-one will be able to offer services as chiropodist, dietician, orthoptist, etc. without being on the council's register.

VIRTUAL REALITY

K. McIntosh

Health Service Journal, vol. 109, April 15th 1999, p. 11-12.

Describes progress to date in setting up the National Institute of Clinical Excellence. At present the body has a chair and a chief executive but no office staff. Its first set of appraisals is due this autumn, although the appraisal process has not yet been decided.

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