Click here to skip to content

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

BABIES ARE 50% MORE LIKELY TO DIE IN BUSY INTENSIVE-CARE UNITS, STUDY SHOWS

C. Arthur

The Independent, Jan 11th 2002, p.9

Babies are 50% more likely to die in intensive care if the unit is full, according to a new study carried out by the University of Aberdeen. The findings dispel the standard thinking that "bigger is better" for the units, known as neonatal intensive care units. The workload, rather than the size of the unit, was the key factor determining survival rates.

BEHOLD, A SHINING LIGHT

A. Moore

Health Service Journal, Vol. 111, Dec. 20th 2001, p.14-15

Discusses how the 12 hospitals branded the worst in the country in the performance ratings published in September 2001 handled the subsequent local media interest.

BLANK CHECKS

J. Yates

Health Service Journal, Vol.112, Jan. 10th 2002, p.30-31

Argues that surgeons' private work is a factor in the reduction of NHS productivity.

COME BACK BR AND THE NHS - ALL IS FORGIVEN

S. Jenkins

Times, Jan. 16th 2002, p. 16

Argues that hospital services can best be improved by a relaxation of central control and greater accountability to local communities rather than through privatisation.

CUTTING THE CRASS RHETORIC ABOUT PARTNERSHIP

P. Sang

British Journal of Health Care Management, vol. 8, 2002, p. 29-31

Successful delivery of the current health care policy agenda depends on high levels of co-operation. Concepts such as "partnership" are metaphorical and must be used with care. Beneath the policy rhetoric lies a more meaningful set of concepts related to co-operation. These include identifying shared purpose, clarifying common values, sorting out roles and responsibilities, and acknowledging the need to learn and share the learning.

DOCTORS' CHIEFS CALL FOR SHAKE-UP IN INSPECTIONS IN NHS HOSPITALS

N. Timmins

Financial Times, Jan. 2nd 2002, p.7

Doctor's leaders have called for a simplification of the system for regulation and inspection of NHS hospitals to reduce duplication and overlap. This should cut the time spent in preparation for inspections which divert resources from patient care.

FORMAL CONSENSUS: THE DEVELOPMENT OF A NATIONAL CLINICAL GUIDELINE

J. Rycroft-Malone

Quality in Health Care, vol.10, 2001, p.238-244

Paper outlines a formal consensus method used for the development of a national clinical guideline in an area in which research evidence was weak and conflicting. The method proved to be a practical and systematic way of integrating three strands of evidence: research, clinical expertise and patient experience. The resultant guideline is a mixture of research-based and consensus-based recommendations.

HEALTH PROVIDERS TO BE INSPECTED BY SINGLE BODY

N. Timmins

Financial Times, Jan. 17th 2002, p.3

Government is planning a single inspectorate for public and private health care providers. Combined with plans to make more use of the private sector and to allow hospitals to become independent corporations, this could lead to the NHS becoming a funder and regulator of health care, not a provider. The single inspectorate will be formed by the integration of the Commission for Health Improvement, the National Care Standards Commission, the Social Services Inspectorate and parts of the Audit Commission.

(See also Health Service Journal, vol. 112, Jan. 17th 2002, p.4)

HOSPITAL TAKEOVER MAY BE ANNOUNCED

N. Timmins

Financial Times, Jan. 14th 2002, p.2 & 17

The first failing NHS hospital to have its management taken over by another may be announced this week when Alan Milburn, Health Secretary, spells out further details of his plans to let successful hospital managers "franchise" their management skills to others.

HOW WOULD WE TELL IF THE NHS WAS ON THE MEND?

N. Hawkes

Times, Jan. 4th 2002, p.16

Increased spending has failed to improve the NHS, and it is falling in public esteem. Government is now focusing on a range of key targets such as improved cleanliness, better services in accident and emergency departments and reduced waiting times. The author doubts that it can ever succeed in getting the NHS, as a state monopoly, to function efficiently and to put the patient first.

INAPPROPRIATE ADJUSTMENT TO NHS WAITING LISTS

National Audit Office

London: TSO, 2001 (House of Commons papers. Session 2001/02; HC452)

Report reveals large-scale manipulation of hospital waiting lists by NHS managers in order to meet government targets. About 6000 patients were affected by waiting list fiddles at nine hospital trusts investigated by the Audit Office. Hospitals that manipulated lists used a variety of methods including alteration of patients' records; taking names off of lists even though the patient had not been treated; and not adding names to the list.

INFLUENCE OF EVIDENCE-BASED GUIDANCE ON HEALTH POLICY AND CLINICAL PRACTICE IN ENGLAND.

P. Coleman and J. Nicholl

Quality in Health Care, vol.10, 2001, p.229-237

A postal survey was used to gather data from 46 health authorities, 162 hospital trusts, and 96 primary care groups in England. The evidence-based guidance specified was significantly more likely to be seen to have contributed to the decisions of public health specialists and commissioners than to those of hospital consultants or GPs. Appropriate information support and dissemination systems that increase awareness, access, and use of evidence-based guidance at the clinical interface should be developed.

AN INTERVENTION TOO FAR

F. Lawrence

Guardian, Jan. 17th 2002, p.18

Argues that the government is keeping the NHS in a state of continuous upheaval which is hindering improvement and demoralising staff. Giving top-performing hospitals greater autonomy and more funds may enable them to flourish, but may create failing hospitals around them, as happened with opt-out schools under the Tories in the 1980s.

LABOUR'S CONTROL FREAKS POSE A DANGER TO OUR HEALTH

T. Dalrymple

Daily Telegraph, Dec. 28th 2001, p.26

Argues that government suppressed the Prescribers' Journal because it was truly independent and might have given advice conflicting with official policy. Instead the Department of Health is producing the NHS Magazine, a purely propaganda publication which is projecting an image of the health service totally at variance with reality.

LEARNING FROM BRISTOL: THE DEPARTMENT OF HEALTH RESPONSE TO THE REPORT OF THE PUBLIC INQUIRY INTO CHILDREN'S HEART SURGERY AT THE BRISTOL ROYAL INFIRMARY 1984-1995

Department of Health

London: TSO, 2002 (Cm 5363)

In response to the Bristol Heart Surgery Inquiry, the government presents its plans to reform the way in which the NHS deals with cases of negligence. A National Patient Safety Agency will be created to log reports of medical errors and spot patterns of suspicious deaths. League tables of mortality rates for individual surgeons will be published, giving patients details of their doctor's success rates for the first time.

MANAGING THE ENTRY OF NEW MEDICINES IN THE NATIONAL HEALTH SERVICE: HEALTH AUTHORITY EXPERIENCES AND PROSPECTS FOR PRIMARY CARE GROUPS AND TRUSTS

R. McDonald, P. Burrill and T. Walley

Health and Social Care in the Community, vol.9, 2001, p.341-347

Reports results of interviews with 21 health authority (HA) prescribing advisers which aimed to ascertain how they viewed the managed entry of new medicines. Responses show that HAs often have no explicit objectives in relation to new medicines, but that their desire to act is prompted by fears about overspending their prescribing budget. The danger of this approach is that patients may be denied cost effective new treatments because all new medicines are seen as a problem. Recent policy changes with regard to new medicines and prescribing budgets are likely to exacerbate these problems for PCGs/Ts. Tensions between local priority setting, which may mean saying no to new medicines, and the objectives of eradicating postcode prescribing while balancing budgets mean that PCGs/Ts face difficult policy choices.

MANAGING THE PRESSURE: EMERGENCY HOSPITAL ADMISSIONS IN LONDON, 1997-2001

M. Damiani and J. Dixon

London: King's Fund, 2002

Report shows that there is no significant variation in emergency admissions other than for respiratory diseases. Most of the cases that result in long hospital stays are found among older people, most of whom have chronic illness. Emergency admissions for respiratory disease peak in early January. Suggests that this may be due to the Christmas and New Year bank holidays which limit the availability of primary care and social services. Older patients with chronic respiratory disease are identifiable in advance of winter by primary care staff. Report calls for pro-active management of these vulnerable patients by primary care teams during December and January.

MATERNITY UNITS COULD BE NEXT FOR THE 'LEAGUE TABLE' SPOTLIGHT, SAYS MINISTER

B. Russell

The Independent, Jan. 21st 2002, p.2

Detailed statistics on the performance of maternity units are to be published for the first time. Alan Milburn, Secretary of State for Health, is considering a full unit-by-unit guide to maternity hospitals.

MATTERS OF LIFE AND DEATH

D. Birkett

The Guardian, Jan. 22, 2002, p.16

The author maintains that while private hospitals, are idealised and the public health system derided, in maternity care the NHS is unrivalled.

MILBURN'S "RAILTRACK OF THE NHS"

J. Carvel and M. White

Guardian, Jan. 16th 2002, p.6

Reports hostile reaction from Labour MPs and unions to government plans to encourage top-performing hospitals to became not-for-profit companies with authority to vary national agreements on pay and conditions. Plans to allow private firms to take over the running of failing hospitals also went down like a lead balloon.

(See also Times, Jan. 16th 2002, p.8; Daily Telegraph, Jan. 16th 2002, p.6; Health Service Journal, vol.112, Jan. 17th 2002, p.4-5)

MORE PATIENTS WAITING LONGER THAN A YEAR FOR SURGERY THAN IN 1997

B. Russell

Independent, Dec 24th 2001, p.4.

Article discusses figures revealed in a parliamentary written answer by John Hutton, Minister of State for Health. The figures showed that numbers of patients waiting for more than 12 months for treatment had risen in 50 out of 95 health authorities since 1995.

(See also Times, Dec 24th 2001, p.6)

NATIONAL HEALTH SERVICE GOES UNDER KNIFE

N. Timmins

Financial Times, Dec. 17th 2001, p.12

Far-reaching reforms of the NHS planned by Alan Milburn will involve:

  • merger of the 95 existing Health Authorities to form about 28 strategic authorities;
  • abolition of regional authorities;
  • making Primary Care Trusts responsible for commissioning;
  • giving patients more choice.
There are concerns that the fledgling Primary Care Trusts will be unable to cope with their responsibilities for commissioning care, and that the health service as a whole will be unable to cope with this degree of upheaval.

NEW CLINICS MAY END OUTPATIENTS' LONG WAITS

C. Hall

Daily Telegraph, Dec. 31st 2001, p. 7

Describes innovative approaches to cutting the numbers of people waiting for outpatients' appointments in the UK. These include allowing GPs to book patients in for surgery directly for minor conditions such as hernia; an increase in consultants who work in the community and see patients in their own homes; an increase in specialist GPs who run clinics in the community and perform minor surgery; and improvements in diagnostic equipment which mean that patients can be tested and treated the same day.

(See also Times, Dec. 31st 2001, p.6; Guardian, Dec. 31st 2001, p.4)

NHS CANCER CARE IN ENGLAND AND WALES

Commission for Health Improvement and Audit Commission

London: TSO, 2001 (National Service Framework Assessments; no.1)

Report finds that cancer care has made a patchy improvement over the past six years. More than 90% of patients urgently referred to hospitals by their GP are seen within two weeks, survival rates for most cancers are better and there are more specialist surgeons. However the service is still inconsistent, with wide variations between hospitals in waiting times for diagnosis, treatment and access to beds. Shortcomings were found to be caused in some cases by poor organisation rather than by a lack of money.

NHS EMERGENCY PRESSURES: MAKING PROGRESS

NHS

2001

Report summarises the real progress made by the NHS and its partners in local government and the private and voluntary sectors in improving emergency care in 2001. Improvements include an increase in NHS beds available, more use of spare capacity in private hospitals to relieve pressure on the NHS, extra funding allocated to the NHS and social care system to tackle bed blocking, an increase of over 10,000 in the number of nurses and more use of NHS Direct.

NHS IS WORSE THAN EVER, SAYS PUBLIC

P. Johnston

Daily Telegraph, Jan. 14th, 2002, p.1

A special Gallup survey for The Daily Telegraph suggests that nearly two thirds of the public believe the NHS is in poor shape. 40 per cent of people say they would prefer to go private if they could. Gallop conducted 1,000 telephone interviews with adults across Britain between Dec 11 and Dec 20 2001.

THE NHS PLAN: A PROGRESS REPORT: THE NHS MODERNISATION BOARD'S ANNUAL REPORT 2000-01

London: Department of Health, 2002

Report lauds progress made in improving patient care, recruiting staff and investing in hospitals, but warns that unless the NHS can do better it will lose public support. Admits that achieving key targets such as reducing waiting times and recruiting staff will be a "challenge".

(For comment see Guardian, Jan. 23rd 2002, p.18)

NO-SHOW PATIENTS TO BE STRUCK OFF THE WAITING LIST

N. Hawkes and D. Carter

Times, Dec. 20th 2001, p.5

Article discusses the "one strike and you are out" approach towards patients who fail to show up for appointments as a method of cutting hospital waiting lists.

(See also Independent, Dec. 19th 2001, p.4)

ONE IN FIVE JOBS VACANT AS RECRUITMENT CRISIS HITS CASUALTY UNITS

T. Judd

Independent, Jan. 3rd 2002, p.5

A survey of 20 hospital trusts by Nursing Times magazine has shown about one-fifth of nursing posts to be vacant in some accident and emergency departments. The problem is particularly acute in London and the South East where agency or bank nurses make up as much as 40% of staff on some shifts.

PAPERLESS PRACTICE

F. Porritt

Health Which? Dec. 2001, p.16-19

Describes plans for the introduction of an electronic health record (EHR) in England by 2005. Electronic records would improve efficiency within the NHS, but issues of consent, access and confidentiality need to be dealt with before the system is launched.

PATIENTS PACK PASSPORTS FOR FRENCH SURGERY

N. Hawkes

The Times, Jan. 11th 2002, p.6

The first ten NHS patients to be given routine operations aboard will travel to Lille at the end of next week. The group are the first in a new programme designed to cut NHS waiting lists.

POLICY AND POLITICAL FADS: THE RHETORIC AND REALITY OF MANAGERIALISM

T. Marmor

British Journal of Health Care Management, vol.8, 2002, p.16-23

Discusses the impact of marketisation and managerialism on health care systems in the UK and the US.

PRESCRIPTION FOR CHANGE

D. Carlisle

Health Which?, Dec. 2001, p.30-32

There is a clear case for a review of the prescription system covering exemptions, charges and how repeat prescriptions are managed.

RESPONSIVE HEALTHCARE: MARKETING FOR A PUBLIC SERVICE

R. Sheaff

Buckingham: Open University Press, 2002

This book focuses on how conventional marketing methods can be adapted for use in healthcare and publicly funded systems responsible for health promotion and health service planning. It is organised according to the different marketing tools found in the British health system although it could well be of interest to health service managers and clinicians worldwide.

A REVOLUTION IN THE NHS

N. Timmins

Financial Times, Jan 21st 2002, p.15

The author comments on Health Secretary Alan Millburn's strategy for changing the way healthcare is delivered, noting it will transform the role of the private sector.

SHIFTING THE BALANCE OF POWER: THE NEXT STEPS

Department of Health

London: 2002

Sets out the way forward on implementing the policy of putting patients and staff at the heart of the NHS by giving them greater authority and decision making power and changing organisational roles and relationships. Discusses the roles and responsibilities of primary care trusts, strategic health authorities, NHS trusts and the Department of Health. Covers public health, service commissioning, performance management, local representative committees, staff development and finance.

A SOCIO-LEGAL AND ECONOMIC ANALYSIS OF CONTRACTING IN THE NHS INTERNAL MARKET USING A CASE STUDY OF CONTRACTING FOR DISTRICT NURSING

P. Allen

Social Science and Medicine, vol.54, 2002, p.255-266

The introduction of an internal market in the NHS necessitated the use of contracts between purchasers and providers. Policymakers appear to have assumed that such contracts could conform to the classical, complete model. Paper uses socio-legal and economic theories of contract (which provide an alternative model of relational contracts, in contrast to classical contracts) to explore how realistic that assumption was. Contracting by health authorities and GP fundholders is examined, using the results of a recent case study of contracting for district nursing services carried out in a health authority in London. Results show that classical contracting is an inappropriate model for NHS contracts, but that relational contracting is not entirely appropriate either.

THEIR FATE LIES IN THE STARS

S. Ward

Public Finance, Jan. 18th-24th 2002, p.24-25

Managers of the 12 poorest performing hospital trusts were given 3 or 12 months to improve from September 2001, depending on how long the chief executive had been in post. Managers of trusts that failed to improve were to be axed. Article reports progress by the failing trusts in raising their service standards.

UKCC CONSULTATION ON STANDARDS FOR HEALTH VISITOR EDUCATION

S. Forester

Community Practitioner, vol.75, 2002, p.14-15

Article discuss the consultation document entitled, "Requirements for Programmes Leading to Registration as a Health Visitor" which will shape the future content of health visitor education. It discusses the Community Practitioners' and Health Visitors' Association (CPHVA) comments on this document. These include points raised on:

  • the length of preparation needed to give practitioners the necessary knowledge, skills and attitudes; the level of teaching and support in practice; the individual/family/community focus;
  • leadership and management; cultural and ethnicity issues;
  • research and evaluation competencies;
  • entry gates;
  • the professional development of other public health nurses and community practitioners;
  • return to practice programmes;
  • the requirements relating to maintaining registration.

A VERY PUBLIC FAILURE: LESSONS FOR QUALITY IMPROVEMENT IN HEALTH CARE ORGANISATIONS FROM THE BRISTOL ROYAL INFIRMARY

K. Walshe and N. Offen

Quality in Health Care, vol.10, 2001, p.250-256

Concludes that the following five main factors reduced the effectiveness of clinical audit and quality improvement arrangements at the United Bristol Healthcare Trust and contributed to their failure to detect and address problems in paediatric cardiac surgery:

  • leadership and direction at a corporate or trust level:
  • the way in which resources and support for clinical audit were used;
  • a tendency towards confidentiality or even secrecy about audit and quality issues;
  • the audit approaches, methods and techniques used; and
  • the way in which arrangements for monitoring and reporting on progress in audit worked.

WORLDS APART

P. Berman and J. Higgins

Health Service Journal, vol.112, Jan 10th 2002, p.24-26

The government has been propelled by a European Court of Justice ruling into allowing NHS patients to be treated on the continent to speed up access to care. Better educated and informed patients are likely to benefit most. The move will encourage comparisons between health services in the UK and other European countries even if take-up is limited.

Search Welfare Reform on the Web