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

"CONSTRAINED INNOVATION" AND THE NHS PLAN

J. Eyres and S. Dewar

British Journal of Health Care Management, vol. 8, 2002, p. 101-103

The present approach to delivering the NHS Plan has two strands:

  • emphasis on the use of a centralised "command-and-control" approach to reform;
  • devolution of power and autonomy to frontline staff.

Article discusses the tensions between them.

COPING WITH PRESSURES IN ACUTE MEDICINE: THE THIRD RCP CONSULTANT QUESTIONNAIRE SURVEY

H. M. Mather and H. Connor

London: Royal College of Physicians, 2002

A survey of 1548 members of the Royal College of Physicians has revealed concern over standards and availability of locum cover, low job satisfaction, and dissatisfaction about increasing workloads, lack of trainees and decreasing continuity of patient care.

CURTAIN CALL

A. McGauran

Health Service Journal, vol. 112, February 21st 2002, p. 14-15

Reports on the recruitment of a team of managers to act as troubleshooters in and to cut the numbers of cancelled operations. All zero and one-star trusts and the three two-star trusts deemed to have the worst problems will be assigned a troubleshooter.

DATA REMEMBER

Audit Commission

Audit Commission Publications, 2002

Report casts serious doubt on the reliability of NHS management information on the basis of which national and local policy decisions are made. For example, less then 45% of hospital trusts have satisfactory procedures for recording waits in accident and emergency departments. Only 10% of trusts follow correct procedures for suspending patients from waiting lists.

THE FUTURE HEALTHCARE WORKFORCE

Health Policy and Economic Research Unit, British Medical Association

London: 2002 (Discussion paper: 9)

Proposes a model in which nurses co-ordinate care around a patient. In primary care, the first port of call for most patients could be a nurse practitioner, who would guide the patient to the relevant service. In secondary care, a clinical nurse specialist would be responsible for co-ordinating the care given by other professionals including doctors. The community nurse could also have an expanded clinical role and undertake a wider range of interventions.

GERMAN DOCTORS 'CAN END NHS WAITING LISTS'

J. Carvel

The Guardian, March 4th 2002, p. 1

A radical plan to use German doctors to eliminate NHS waiting lists for day-case surgery will be presented this week by the former Labour minister Frank Field.

GET YOUR KIT OFF

Ray Shannon

Health Service Journal, vol. 112, Feb. 28th 2002, p. 24-28

An interesting article which looks at changes made to the South Yorkshire Ambulance Service to improve response time standards and a dilapidated vehicle fleet.

HALF THE BATTLE

B. Alimo-Metcalfe and J. Allan-Metcalfe

Health Service Journal, vol. 112, Mar. 7th 2002, p. 26-27

A study of private and public sector managers, including 2000 from the NHS, revealed consensus on the qualities of an effective leader. These included:

  • concern for others;
  • approachability;
  • intellectual ability;
  • communication skills;
  • charisma and the ability to unite people.

Integrity was seen as particularly important by public sector managers. However, research evidence shows that team effectiveness is reliably correlated with subordinates' ratings of a manager's performance. In this study, public sector managers were rated significantly higher by their staff than those in the private sector. The results point to the need for caution in introducing private sector managers to the NHS.

HOME AND AWAY HEART OPERATIONS TO CUT WAITS

M. Kite

Times, Mar. 7th 2002, p. 11

Reports proposals to invite hospitals with spare capacity to bid for funding to undertake extra heart operations in a bid to drive down waiting lists. All patients who have been waiting for more than 6 months will be offered the opportunity of treatment outside of their local hospital. The programme will be run through a central clearing house, the National Cardiac Co-ordination Unit, which will match patient demand for heart surgery with spare capacity.

MORE PATIENTS SENT HOME EARLY RETURN AS EMERGENCIES

C. Hall

Daily Telegraph, Feb. 20th 2002, p. 8

Hospital performance indicators for England issued by the Department of Health show a rise in emergency readmissions following early discharge, due the drive to reduce waiting lists to meet government targets. The statistics also show that more than one hospital bed in every 16 (about 6,000 in all) is blocked every day by patients well enough to leave who cannot be discharged because of lack of provision by social services. Deaths from cancer fell overall by just over 2%, but rose in 12 health authority areas between 1997/1999 and 1998/2000.

(See also Guardian, Feb. 20th 2002, p. 12-13; Times, Feb. 20th 2002 p. 1 & 4; Independent, Feb. 20th 2002, p. 8)

NHS ENVOY SIR MAGDI TO RECRUIT WORLDWIDE

C. Hall

Daily Telegraph, Feb. 28th 2002, p.13

Reports launch of an International Fellowships scheme to encourage eminent foreign doctors to spend two years working in the NHS. The new scheme is aimed at recruiting 450 specialists in the disciplines of heart and chest surgery, psychiatry, radiology and histopathology, where there are shortages of consultants. They will be offered an attractive remuneration package worth £100,000 a year as an inducement.

(See also Times, Feb. 28th 2002, p. 10; Independent, Feb. 27th 2002, p. 1)

NICE: STILL ADVANCING THE EXCELLENCE CURVE

A. Cowper

British Journal of Health Care Management, vol. 8, 2002, p. 92-95

Professor Sir Michael Rawlins, Chairman of the National Institute for Clinical Excellence (NICE), answers questions about its development, progress, successes and challenges.

OPENING THE DOORS ON NICE: THE NEXT STEPS

A. Dillon

British Journal of Health Care Management, vol. 8, 2002, p. 96-97

Describes how NICE is addressing concerns about the lack of openness in its appraisal process for new treatments and is taking steps to promote staff and patient involvement in guideline development.

SCALING NEW HEIGHTS

P. Smith

Health Service Journal, vol. 112, Mar. 7th 2002, p.18

NHS dentistry has been in decline since the early 1990s, with many dentists concentrating on private work. However the British Dental Association is optimistic about the current prospects for its reintegration with the NHS. Dentists now have formal representation on Primary Care Trusts' executive boards, and personal dental services schemes are reviving NHS dentistry in deprived areas.

SHIFTING THE BALANCE OF POWER: MANAGING CHANGE

M. Dixon

British Journal of Health Care Management, vol. 8, 2002, p. 104-107

The latest government policies for health service reform hand the lead role within the NHS to Primary Care Trusts (PCTs). Article presents on overview of the proposals and how they might be interpreted, discusses the relationships PCTs will need to forge with other organisations and explores the ways in which they may deliver their various roles (public health, service commissioning, and primary care provision)

SHIFTING THE BALANCE OF POWER WITHIN THE NHS: COMMUNICATIONS

Department of Health

London: 2002

Paper identifies the needs, functions and accountability arrangements of communications in different NHS organisations. It also begins to look at how social care can be better involved and supported as care trusts begin to come on stream. Communications work includes reputation management, media handling, public relations, public and patient information, internal communications, NHS publications and marketing.

URL: balance comms.pdf

SKIRTING THE ISSUE

C. Edwards et al

Health Service Journal, vol. 112, Feb. 21st 2002, p. 28-29

A study of part-time nurses in three London trusts found that they were concentrated in lower grades and less likely to be involved in management than full-time nurses. While senior management in the trusts was fully committed to flexible working, managers lower in the organisation felt that part-time working presented problems for continuity of care, and that part-time nurses were unwilling to work unsocial hours. A more strategic approach is needed to ensure that part-time nurses are employed most effectively at a time of acute nursing shortages.

TAKE A FAST TRAIN TO REDUCED WAITING TIMES

P. Huntley

Primary Care Report, vol. 4, no. 3, Feb. 20th 2002, p. 38-39

Article examines why patients are taking the Eurostar to Lille for surgery and why it is a giant leap for the NHS.

THE USE OF CONTRACTS IN THE MANAGEMENT OF INFECTIOUS DISEASE RELATED RISK IN THE NHS INTERNAL MARKET

P. Allen et al

Health Policy, vol. 59, 2002, p.257-281

Found that formal contracts in the field of infection control were incomplete in that they did not usually specify quality. Even when they did, high monitoring costs meant that formal contracts could not be used in isolation to ensure standards were met. Similarly, contracts did not in practice provide full advance allocation of risk. In some Health Authorities and Trusts, personal professional networks played an important role, providing information and a possible basis for inter-organisational co-operation in managing risk. These informal relationships compensated for some of the deficiencies of incomplete contracts.

WINGING IT

S. Dewar and C. Chantler

Health Service Journal, vol. 112, Mar. 14th 2002, p. 24-27

At present NHS managers are highly constrained, suffering excessive regulation and central control. More autonomy for trusts would mean fewer directives and less performance management. Giving trusts a new legal form, such as a public interest company or foundation hospital, might be reinvigorating and would not involve further reorganisation. These new freedoms should be accompanied by new accountabilities not only to politicians but to independent NHS regulators, local communities and patients. Devolved power and greater patient choice could produce a more responsive NHS. Its potential needs to be explored through experimentation and evaluation.

ZERO OPTIONS

M. Gould

Health Service Journal, vol. 112, Feb. 21st 2002, p. 13-15

Four hospital trusts which were awarded no stars in September 2001 are now to have their managements franchised. This announcement has been made in spite of evidence of improvement, and of the fact that guidance on franchising has not yet been issued.

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