Click here to skip to content

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

ACUTE HOSPITAL PORTFOLIO - DAY SURGERY

Audit Commission

Audit Commission Publications, 2001

Report examines a basket of 25 day surgery procedures. The best trusts were found to be carrying out 86% of breast lump excision surgery as day cases. This compared to a day case rate of 47% among the worst trusts. For inguinal hernia operations, the worst trust did not carry out any day surgery at all, while the best carried out 80% of its operations as day cases. Three reasons for performance disparities are identified:

  • in appropriate and insufficient use of day units;
  • poor management and organisation of day units;
  • clinicians' preference for inpatient surgery.

ALL CHANGE FOR THE 21ST CENTURY: NHS TRUSTS TRANSFORMED

K. Truss and J. Ely

British Journal of Health Care Management, vol. 7, 2001, p. 440-445 The Labour government has initiated fundamental reforms in healthcare provision, to which Trusts are having to respond in innovative ways. Change management literature has highlighted eight areas that it is of particular importance to address for change to be successful, including analysis of the context, focus on individual as well as systemic change and allowing for the interactive nature of change. Analysing the context for change in one NHS trust brought to light a series of strengths and weaknesses that needed to be taken into account in developing a change plan. Strengths included:

  • awareness of the need for change;
  • high levels of change management expertise, belief in the leadership of the Trust;
  • a strong team work ethic.

Problems identified included:

  • poor communication;
  • too much bureaucracy;
  • low morale.

Based on the findings of the study, several key actions were taken in designing and implementing the change programme, including:

  • the establishment of a change action team;
  • service re-engineering;
  • regular meetings with primary care colleagues;
  • a management restructure.

BILL GATES TO HELP MODERNISE NHS

J. Carvel

Guardian, Dec. 3rd 2001, p.9

Article reports on the enlistment of Bill Gates to talk to chief executives of NHS trusts on how to develop integrated systems to produce improvements in speed and quality of patient care. Article goes on to discuss the government's commitment of £1bn by 2005 to create an electronic patient records system.

BLAIR BID TO CONTRACT REFORM OF THE NHS

N. Timmins

Financial Times, Dec. 10rd 2001, p.1

The Health Secretary has been presented with a "contract" from the new Delivery Unit set up by Tony Blair after the election. It contains more than 100 targets and milestones that Downing Street expects to be hit in 2002/03. Unfortunately these conflict in some cases with the public service agreements signed with the Treasury at the time of the last Comprehensive Spending Review. Civil servants are alarmed that the Prime Minister appears to be trying to "micro-manage" the NHS from the centre, thwarting attempts at devolution.

BLAIR, BROWN AND MILBURN ARE A MENACE TO THE NHS

P. Toynbee

Guardian, Dec. 5rd 2001, p.18

The NHS has suffered over time from chronic underfunding and disruptive reorganisation. It is currently subject to a battle over its control between the Health Secretary, the Prime Minster and the Chancellor of the Exchequer.

BLAIR'S GAMBLE ON HEALTH

A. Maynard

Financial Times, Dec. 4rd 2001, p.21

Increased investment in the NHS is being used to repair buildings, replace equipment, cover rising costs of drugs and fund pay rises for staff. None of these measures will increase the capacity of the NHS to treat patients, so waiting times for treatment will not fall. In order to increase capacity more doctors and nurses are needed, and these are not available.

BREAKING THROUGH THE HEALTHCARE CLASS BARRIER

N. Timmins

Financial Times, Dec. 3rd 2001, p.23

Article discusses how the rising cost of heatlhcare makes the search for a system that stands the test of quality equality all the more arduous. It looks at some of the key areas that need to be tackled and the myths that surround them.

BUPA TO RUN CENTRE FOR NHS DAY CARE SURGERY.

N. Timmins

Financial Times, Dec 4th 2001, p.1

Under the terms of a deal with the government, BUPA will turn its Redhill Hospital in Surrey into a fast-track elective surgery centre. It will continue to employ its own nurses and will treat some 8000 NHS cases a year on a long term contract.

(See also Guardina, Dec. 4rd 2001, p.1; Dailty Telegraph, Dec. 4rd 2001, p.1)

BUSINESS PROCESS RE-ENGINEERING: LOST HOPE OR LEARNING OPPORTUNITY?

A. E. Powell and H. T. O. Davies

British Journal of Health Care Management, vol. 7, 2001, p. 446-449

In the 1990s business process re-engineering came to prominence as a means of transforming health services. Although many of the BPR implementation projects produced only modest improvements, there remains much to learn from the approach. Argues that lessons learned from previous BPR experiments in the NHS should be applied to the current modernisation agenda.

CAREER VIEW MIRROR

R. Palmer, P. Spurgeon and J. Clark

Health Service Journal, vol. 111, Nov. 29rd 2001, p. 26-27

A survey of doctors and managers found agreement that management training should be given at various stages of a doctor's career. Managers felt strongly that doctors should receive training in groups with other staff. Doctors believed clinical budgets should be under their control, but managers were opposed to this. Results suggest that a "them and us" culture persists between doctors and managers in the NHS.

CHANGE THE RECORD

N. Pettinger

Health Service Journal, vol. 111, Nov. 22nd 2001, p.20-21

Emergency hospital admissions have been rising at the rate of 2-3% per year over the past 20 years, and the trend looks set to continue. Medical emergencies account for most of the increase. Analysis shows that the bulk of the increase in emergency admissions has been for short stay patients. Better understanding of the pattern of emergency admissions should enable hospitals to improve the configuration of their wards. Acute admission wards should in theory be able to deal with the influx of short stay patients, shielding the main inpatient wards.

CLINICAL GOVERNANCE: A GUIDE TO IMPLEMENTATION FOR HEALTHCARE PROFESSIONALS

R. McSherry and P. Pearce

Oxford: Blackwell Science Ltd., 2002

A precise and comprehensive text on what is meant by clinical governance. Focusing on the needs of staff, this text offers practical advice on applying clinical governance in daily practice to provide quality healthcare. It goes on to identify and explore the barriers to the implementation of clinical governance, the legal issues surrounding it and the future of clinical governance for healthcare professionals.

CONSULTANTS IN REVOLT AGAINST HOSPITAL CHIEF

L. Duckworth

Independent, Nov 27 2002nd, p.12

Article reports on a vote of no confidence by senior medical staff at Walsgrave Hospital, Coventry against the chief executive, David Laughton. The result comes following a damning report from the Commission for Health Improvement which showed Walsgrave as having the highest death rate in the country for heart bypass surgery. The report also described an atmosphere of intimidation, a breakdown in communication, a higher than average re-admission rate and cramped and unhygienic conditions.

A CONTRACTING HEALTH SERVICE

N. Timmins

Financial Times, Dec 5rd 2001, p. 21

The government's deal with BUPA for the provision of a fast-track surgery centre under contract to the NHS marks a sea change in UK health services. In the future, although medical care will be state funded, it will be delivered by a mix of public, private and voluntary sector providers. Article goes on to discuss the contractual issues this will raise.

ELECTRIC AVENUE

J. Solly

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

A pilot electronic booking project for outpatient appointments at King's College Hospital, London, has been well received by consultants. However, only 24 out of 160 local general practices are participating. A considerable culture change is needed to persuade practices to become involved. More day to day support might encourage GP involvement.

EUROPEAN HEALTH GROUPS INVITED TO SET UP IN UK

N. Timmins and R. Shrimsley

Financial Times, Dec. 3rd 2001, p.1

Alan Milburn has pledged greater use of the private sector to reduce NHS waiting times. European healthcare companies are being encouraged to set up in Britain to treat NHS patients. Ministers are to encourage them to look at a range of options from building new surgical units to taking over unused NHS wards and theatres. Article goes on to discuss the options available to patients who have had to wait longer than six months for treatment which include being treated at another hospital with shorter waiting times or being treated in Europe.

EXTENDING CHOICE FOR PATIENTS

Department of Health

London: 2001

Sets out next stages in the government's plans to increase the number of operations that the NHS can carry out to reduce waiting times and to give patients much more influence over the place and time of their treatment. Proposes that by 2005 all patients and their GPs will be able to book hospital appointments and arrange treatment at a range of facilities, including private hospitals in the UK and abroad. The new system will be piloted to extend patient choice and cut waiting times for heart bypasses and angioplasty.

FRUSTRATION AND FURY

P. Wheatcroft

Times 2 Supplement, Nov.26rd 2001, p.2-3

On the basis of her daughter's recent experience at Leeds General Infirmary, author describes NHS administration as chaotic. Medical staff carry out prescribed procedures as an end in themselves without any concern for patients as individuals, and the food remains appalling.

THE GENERATION AIM

M.Thompson

Health Service Journal, vol. 111, Dec. 13rd 2001, p.11-12

Reports an interview in which Health Secretary Alan Milburn sets out his vision for NHS reform. He envisages a locally managed system that will be responsive to local needs. The Department of Health will confine itself to setting national standards, distributing resources and measuring performance. He admits that the NHS has been historically starved of cash, and reaffirms his commitment to more investment.

GREAT BARRIER REACH

J. Faugier and H. Woolnough

Health Service Journal, vol. 111, Dec. 6rd 2001, p.24-29

A survey of nurse directors showed that only half of those who applied for chief executive posts had been short-listed. As many as 70% of respondents said that nurse directors are prevented from becoming chief executives because they are stigmatised. Gender was identified as a barrier by 43% of respondents.

HEALTH AUTHORITIES SET TO SUPPLY ALL DRUGS APPROVED BY ARBITER

S. Neville and R. Bennett

Financial Times, Dec. 5rd 2001, p.3

Health authorities will be required by law from 2002 to fund all drugs approved by the National Institute for Clinical Excellence. This will boost patients' rights, but will put enormous pressure on the NHS drugs budget.

(See also Times, Dec. 6th 2001, p. 8; Daily Telegraph, Dec. 6th 2001, p.4; Guardian, Dec. 6th 2001, p.3)

HEALTHCARE FAILINGS 'CONTRIBUTE TO £23BN SICKNESS BILL'

N. Timmins

Financial Times, Dec. 3rd 2001, p.2

The confederation of British Industry has said that sickness absence from work is costing the UK £23bn a year, in part because of the inadequacies of healthcare. It has called for wider use of the private sector, more private health care insurance and greater use of charges in the provision of NHS care. The £23bn figure includes sickness absence while patients wait for treatment and the cost of sickness benefit. Article goes on to discuss the reasons for delays in treatment which add to the total cost.

(See also Guardian, Dec. 3rd 2001, p.10)

HOSPITAL CONSULTANTS GUIDE. PARTS 1-5

Times, Nov. 19th - 23rd 2001

Guides compiled on the basis of data collected by the Department of Health and analysed by Dr. Foster, an independent company, show which hospitals have the best outcomes in heart surgery, heart disease treatment, neurology, orthopaedics and general surgery. Data show wide variations in outcomes between the best and worst performing hospitals.

IN A BAD WAY

N.Timmins

Financial Times, Nov. 29rd2001, p.22

Additional governmental investment in the crumbling NHS started in April 2001. It has not yet worked through to produce service improvements. The service is also faced with a chronic shortage of doctors and nurses which will take time to remedy through recruitment from abroad and the expansion of training.

INSIDE THE LABYRINTH

L. Donnelly

Health Service Journal, vol. 111, Nov. 29rd 2001, p.14-15

Discusses the complex structure of the NHS Modernisation Agency, which runs about sixty programmes in six key groupings: the National Patients' Access Team; the Clinical Governance Team; the National Primary Care Development Team; the Learning Network Team; the Orthopaedic Services Collaborative; and the Leadership Programme.

LABOUR HASN'T GO A CLUE WHAT TO DO ABOUT THE NHS

R. Harris

Daily Telegraph, Dec. 4th 2001, p.22

Claims that the Labour Party has radically changed its policies on the health service seven times in the past five years because it lacks any real insight into how to improve it.

MAKING THE RIGHT CONNECTIONS IN MODERNISATION

A. Harrison

British Journal of Health Care Management, vol. 7, 2001, p.486-489

Ideas emerging in recent years such as care pathways, National Service Frameworks, and clinical networks promise to improve service co-ordination within the NHS. However, the full implications of these initiatives have yet to be thought through. They undermine the basis on which trusts currently operate, and while they may remove some barriers, they will tend to create others. The current need is for a strategic look at the future structure of the NHS which is likely to emerge as the new policies come in.

MILBURN: PRIVATE SECTOR IS PART OF NHS FAMILY

A. Grice

Independent, Dec. 7rd 2001, p.9

Reports on interview with the Health Secretary in which he lays out his vision of the NHS as a consumer-oriented service offering patient choice. In order to offer choice, private sector investment is needed to create a plurality of providers.

"MIND THE GAP!": MANAGING ACROSS BOUNDARIES

D J Hunter

British Journal of Health Care Management, vol. 7, 2001, p. 482-484

Article examines the distance between the desirable theory and difficult realities of collaborative working. Barriers to partnership working include:

  • differences in professional language and culture;
  • lack of trust;
  • uneven distribution of power.

Although the government is in principle supportive of partnerships, many of the policy instruments it has introduced are likely to prove obstacles to effective cross-boundary working. These include: performance-related pay, reliance on short-term contracts, encouragement of a competitive bidding culture, and targets and inspections based on vertical silos.

NHS 'CAN NEVER WORK IN PRESENT FORM'

N. Hawkes

The Times, Dec. 3rd 2001, p.6

The independent think tank, Politeia, has produced a new pamphlet which calls for the abolition of the NHS. The author, Dr. Lowler, identifies two key failings and describes the NHS as 'a vast, bureaucratic organisation. expensive and strikingly inefficient.'

(See also Daily Telegraph, Dec 3rd 2001, p.2)

NHS UNION DECLARES WAR OVER BUPA DEAL

A.Grice

Independent, Dec. 5rd 2001, p.11

Unions have reacted with hostility to government proposals for using the BUPA hospital at Redhill in Surrey to treat NHS patients. They regard it as a declaration of war that will set back their efforts to reach a peace deal with the government over public-private partnerships.

(See also Financial Times, Dec. 5rd 2001, p.3; Guardian, Dec 5rd 2001, p.3; Daily Telegraph, Dec. 5rd 2001, p.4; Times, Dec. 5 2001, p.6)

ON THE SIDE WALK

M. Pollard

Health Service Journal, Vol. 111, Nov. 29rd 2001, p.23-25

The latest NHS reorganisation proposes that doctors in trusts should be given more managerial responsibility. Attempts to involve doctors in NHS management over the last 10 years have not been wholly successful. The constant reorganisation of the NHS hinders the integration of clinicians in management.

PAPER CHASE

T. Shifrin

Health Service Journal, vol. 111, Nov. 22nd 2001, p. 12-13

Outlines and comments on the provisions of the NHS Reform Bill 2001. The Bill offers a dramatic extension of the Commission for Health Improvement's remit, turning it into a kind of Ofsted for the NHS. It provides for the establishment of a Council for the Regulation of Healthcare Professionals and the abolition of Community Health Councils. In their place it allows for the creation of trust level patient forums and a new national body, the Commission for Patient and Public Involvement in Healthcare. On the structural side, the Bill implements the proposals outlined in "Shifting the Balance of Power in the NHS". It legislates for the creation of Strategic Health Authorities and lays responsibility for commissioning healthcare on Primary Care Trusts.

PARLIAMENT MUST CHERISH ITS POWERS TO ENSURE THE HEALTH OF THE NATION

F. Field

Times, Nov. 22nd 2001, p.20

An amendment to the NHS Reform Bill has been tabled proposing the establishment of a joint select committee of both Houses of Parliament to which individual health regulators and institutional regulators such as the Commission for Health Improvement and the new Council for the Regulation of Health Care Professionals would be accountable. The committee would have the responsibility of making the regulators raise service quality and of protecting patients and the public interest via Parliament.

REACH FOR THE STARS

T. Travers

Public Finance, Nov. 16rd-22nd 2001, p. 21-22

Star rating systems are the latest in a long line of performance measurements for public services such as health and education. There is concern that the system is simplistic and will fail to deliver real improvements in services which are starved of funding.

SHIFTING THE BALANCE: THAT WAS THE YEAR 2001

C. Webster

British Journal of Health Care Management, vol. 7, 2001, p. 479-481

Article reviews the past year's major events in health care. Discusses the failings of the public health system, the role of the NHS Modernisation Agency, and the glaring shortcomings of the NHS in the light of international comparisons.

SHORT MEASURE

S. Boyle and J. Appleby

Health Service Journal, Vol. 111, Dec. 13rd 2001, p. 24-27

Despite a large increase in NHS funding, hospital activity rates have slowed and may be decreasing. Growth in elective activity has tended to be in planned admissions, which have no direct impact on waiting lists. There is some evidence that much of this new funding is being used to improve staff pay and conditions and the quality of NHS services, rather than to treat more patients. Unless money is redirected into activity-generating areas that impact on waiting times, the NHS will struggle to deliver its targets.

SOLE MATES

L. Whitfield

Health Service Journal, vol. 111, Dec. 13rd 2001, p.17

Introduces a collaboration of major IT firms, known as Lightbulb, aimed at developing a common integration architecture framework based on government-wide standards, to help achieve information sharing by NHS organisations.

SUITS YOU, SIR

L. Donnelly

Health Service Journal, Vol. 111, Nov 22nd 2001, p. 9-11

Commentators predict that the latest round of NHS reorganisation and restructuring set out in the NHS Reform Bill will bring no benefits to the service and will further erode staff morale.

SURGICAL TEAMS FROM THE CONTINENT MAY OPERATE ON NHS PATIENTS

N. Timmins

Financial Times, Dec. 4rd 2001, p.3

Reports sweeping changes to the NHS involving patients routinely being sent abroad for treatment, clinical teams from the continent operating on patients in the UK under contract, and floors of private hospitals being taken over for NHS use.

"WE NEED MORE TIME"

A. Miles

Times 2 Supplement, Nov. 26rd 2001, p.3-4

Argues that increased investment is bringing about improvements in NHS hospitals, but they are still facing problems of low staff morale, rising demand, and lack of community and social services, which leads to bed blocking.

Search Welfare Reform on the Web