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

AILING NATION

F. Nelson
Public Finance, Mar. 25th - Apr. 4th 2002, p. 20-23

Spending on healthcare in Scotland was running at 8% of GDP in 2001, above the EU average of 7.8%. In spite of these high levels of spending, Scots have the worst health record in the UK. This may be due to the avoidance of structural reform of the NHS by the Scottish Parliament.

ALL THINGS NICE

S. Williams
Health Which?, Apr. 2002, p. 20-21

Discusses ways in which the National Institute for Clinical Excellence involves the public in its technology appraisals process. It needs to do more to support patient groups taking part in its decisions and to encourage patient representatives onto its Collaborating Centres. It must stop relying on the Internet to communicate its work on appraisals and guidelines to the public.

BRITAIN 'WILL LAG BEHIND ON HEALTHCARE FOR YEARS'

N. Timmins
Financial Times, March 26th 2002, p.4

Britain will not reach continental European levels of healthcare until the end of the decade at the earliest according to an international analysis of healthcare spending by World Market Research Centre. That will apply whatever method of healthcare funding is adopted. Britain ranks at 23 in the analysis.

CANCER RESEARCH: A FOLLOW-UP

Science and Technology Committee
London: TSO, 2002 (House of Commons papers, session 2001/02; HC 444)

Reports that funds intended for the improvement of cancer services have been siphoned off by trusts to reduce their debts. Attacks the government for not ensuring that the money reached the intended areas. Also expresses concern that £190m which government claims to have spent on cancer research may have been re-directed into generalised cancer services. Finally expresses disappointment at the lack of measurable progress in recruiting cancer specialists.

E - NOVATION

Health Service Journal, vol. 112, Mar. 21st 2002, Supplement, 20 p.

Supplement covers the role of telemedicine, the advantages and disadvantages of centralised IT procurement, progress in development of the electronic health record, the benefits of electronic prescribing, and application of military technology to ambulance services.

EDUCATING AND TRAINING THE FUTURE HEALTH PROFESSIONAL WORKFORCE FOR ENGLAND: TWENTIETH REPORT OF SESSION 2001-02

Committee of Public Accounts
London: TSO, 2002 (House of Commons papers. Session 2001/02; HC 609)

Delivering the NHS Plan depends on recruiting more nurses and other health professionals. The key to success in providing extra staff is partnership working between the NHS and the higher education sector and through membership of the new Workforce Development Confederations. This means jointly tackling barriers to the expansion of training, reducing student attrition and developing new contracting arrangements with providers. Health Improvement Programmes should address the development needs of existing staff and with statutory and professional bodies review their continuing training requirements. This should ensure they remain fit for practice and up to date in their knowledge.

ETHNICITY, EQUALITY OF OPPORTUNITY AND THE BRITISH NATIONAL HEALTH SERVICE

P. Iganski and D. Mason
Aldershot: Ashgate Publishing Limited, 2002

Based on the results of research carried out for the English National Board for Nursing, Midwifery and Health Visiting and drawing on additional original research, this book evaluates NHS equal opportunity policies. It examines the prospects for a national strategy linking the business and justice cases for greater equity in employment with service delivery.

FROM 'MARKET UMPIRES' TO 'RELATIONSHIP MANAGERS'? THE FUTURE OF THE NHS REGIONAL OFFICES IN A TIME OF TRANSITION

B. Kewell, C. Hawkins and E. Ferlie
Public Management Review, vol. 4, 2002, p.3-22

Article considers the theoretical and management implications of the recent reorganisation of UK cancer services on network lines in which the in which the intermediate tier of the regional office has played an important implementation role. Empirical evidence from the first stage of a national evaluation of the Calman-Hine report of 1995 is used to explore regional approaches to the setting up of cancer care networks. Service reorganisation appears to be leading towards a possible convergence around a model of the "delivery network" which is "instrumental" in nature.

GROUND ZERO

J. Traynor
Health Service Journal, vol. 112, Mar. 21st 2002, p. 14-15

The Northern Ireland Health Service is in a state of crisis due to chronic underfunding, slow decision-making and inappropriate organisational reforms such as the replacement of GP fundholding with a network of Local Health and Social Care Groups.

THE HEALTH OF THE PEOPLE OF SCOTLAND IS BEYOND PRICE

M. Linklater
Times, Apr. 17th 2002, p. 20

In spite of higher spending, the health of the people of Scotland is poor compared to England. This is due to historic deprivation and an unhealthy diet. The problems need to be tackled through better co-ordination of government policies and initiatives.

HEARING VOICES

J. Allsopp, R. Baggott and K. Jones
Health Service Journal, vol. 112, Mar. 28th 2002, p. 28-29

The new structures for public and patient involvement in the NHS appear to be more robust than the current system of community health councils. A Commission for Patient and Public Involvement in Health (CIPPH) will oversee a network of patients' forums and will itself be accountable to Parliament. It is likely to be made up of members from local bodies, the voluntary health sector (health consumer groups) and the NHS. Patients' forums will also have clearly delineated tasks, including inspection of NHS premises and monitoring of primary care commissioning.

INTERNATIONAL RESCUE

D. Carlisle
Health Service Journal, vol. 112, Mar. 21st 2002, p. 16

The international fellowship scheme for the NHS aims to tempt 450 top specialists from abroad to work in the UK on short term contracts. Benefits include a salary of £52, 640 a year, accommodation and a pension worth 12% of pay.

JOKING APART

J. Hoeksma and L. Davidson
Health Service Journal, vol. 112, Mar. 28th 2002, p. 13-14

Outlines latest government thinking on modernising the NHS IT. A four pronged approach is proposed, addressing:

  • IT infrastructure;
  • electronic health records;
  • booked admissions;
  • e-prescribing.

National standards and common specifications will be drawn up for key systems centrally, together with a shortlist of authorised suppliers.

LABOUR INITIATIVES 'OVERWHELM' NHS

J. Carvel
The Guardian, April 12th 2002, p. 8

According to the King's Fund think tank the NHS is being overwhelmed by well-meaning initiatives from an over-centralising government. PCTs in particular are struggling to meet all the policy imperatives Labour has set them. Although the NHS was enjoying a record increase in resources, the government "has not yet developed a coherent set of criteria to guide its decisions"

LOGISTICS: A CATALYST FOR CHANGE IN THE NHS

P. Kidd
British Journal of Health Care Management, vol.8, 2002, p. 142-144

Article looks at how the Central Middlesex Hospital developed a public-private partnership with a leading logistics company which streamlined the hospital's supply chain and also achieved considerable cost savings. The company spend two years carrying out a comprehensive analysis of hospital supply chains, and compared them to supply chain models used in the automotive and retail industries. Health care supply chains were then re-engineered and a new distribution channel was developed for hospitals from best practice models of logistics in other industries.

THE MANAGEMENT OF SURPLUS PROPERTY BY TRUSTS IN THE NHS IN ENGLAND

National Audit Office
London: TSO, 2002 (House of Commons papers,. session 2001-2002; HC 687)

Examines how well the strategic environment in which NHS trusts operate promotes the effective identification and disposal of surplus property and how far value is achieved in actual sales.

THE MEDICAL ASSESSMENT OF INCAPACITY AND DISABILITY BENEFITS

Public Accounts Committee
London: TSO, 2002, (House of Commons papers,. session 2001/02; HC 683)

Report identifies weaknesses in the contract which outsourced medical examinations for disability benefits claimants to a private company, Schlumberger Sema. Continuing problems with the Benefits Agency's side of the operation, a shortage of doctors, and a contract which incentivized Sema to invite too many people to medical examinations have produced a poor service. More than 17,000 claimants annually have been turned away from booked appointments for examination and half of all decisions have resulted in appeals.

MILBURN HAILS CUTS IN TREATMENT WAITING TIME

N. Timmins
Financial Times, Apr. 11th 2002, p. 4

Newly published figures show that the NHS is improving and beginning to hit targets for cutting waiting times, reducing bed blocking, and improving treatment for certain critical conditions such as cancer.

(See also Times, Apr. 11th 2002, p. 4; Independent, Apr. 11th 2002, p. 8)

MILBURN ORDERS STUDY ON TREATMENT OF PATIENTS

N. Timmins
Financial Times, March 28th 2002, p. 4

An urgent study into how and where NHS patients are being treated has been ordered by Alan Milburn, the Health Secretary. The move comes as the latest figures show that fewer waiting list cases were treated by the health service last year, despite the billions of pounds extra spent on the NHS. NHS spending in England rose by more than £4bn last year but the number of in-patient admissions fell. Mr Milburn said the figures hid changes in the pattern of service. Some treatments are moving from in-patient to our-patient, others are moving from out-patient to doctors' surgeries.

MODERNISING THE NHS: SHIFTING THE BALANCE OF POWER IN LONDON

Department of Health
London: 2001

This consultation document has been provided to summarise the views of local people, stakeholders and people who work in the NHS on the proposal to establish five Strategic Health Authorities in London. The proposed strategic Health Authorities will be new organisations, different in function and style from the existing Health Authorities. PCTs will take on responsibility for most of the current functions of Health Authorities allowing the formation of fewer, larger strategic Health Authorities.

NEITHER MORE MONEY NOR A STRUCTURAL OVERHAUL WILL SWIFTLY TRANSFORM THE NHS

B. Thwaites
Times, Mar. 21st 2002, p.22

Argues that it is impractical for the government to radically change the NHS funding system or to immediately increase the number of doctors in post. The NHS will therefore continue to fall short of public expectations. Demand for healthcare is infinite and can never be satisfied.

NURSES WARN BLAIR OVER NHS REVIVAL PLAN

J. Carvel
The Guardian, April 22nd 2002, p. 8

Nurses' leaders have warned that plans to revive the NHS will fail without action to improve the job satisfaction of staff in NHS hospitals. Delegates at the Royal College of Nursing annual congress welcomed the promise to recruit 35,000 more nurses by 2008 but heard that the real problem was retaining staff already working for the NHS.

OVERSEAS RECRUITS TO NHS 'SUFFER LOW PAY, POOR CONDITIONS AND EXPLOITATION'

L. Duckworth
The Independent, April 23rd 2002, p. 2

Foreign nurses have to endure low pay, poor conditions and exploitation despite the dependence of the health services on overseas recruits to ease it staffing crisis, a survey by the Royal College of Nursing has found.

PARTY READY TO DISSOLVE NATIONAL HEALTH SERVICE

M. Kite
The Times, March 22nd 2002, p. 12

Liam Fox, the Shadow Health Secretary, will tell the Tory spring conference in Harrogate that the NHS in its present form will never work. In a clear signal that the Tories plan to dismantle the NHS monopoly and expand private healthcare, Dr Fox will promise "a historic decentralisation coupled with increased choice for patients". Dr Fox will describe the NHS as "a product of the 1940's"

PFI HOSPITAL MOVE ATTACKED AS "POLITICAL FIX"

N. Timmins
Financial Times, Mar. 19th 2002, p. 7

Reports that the government has decided that ancillary staff will remain NHS employees in all future private finance initiative deals. However their managers will be transferred to the private partner. Government remains interested in buying complete clinical services from the private sector, and intends all new hospital buildings to be financed by it.

(See also Times, Mar. 19th 2002, p. 16)

POWERS OF OBSERVATION

D. Bradshaw and K. Walshe
Health Service Journal, vol.112, Apr. 18th 2002, p. 28-29

Local authority scrutiny of the NHS, which comes into effect in January 2003, will bring health services into local politics more directly than even before. The scrutiny committees will be able to call chief executives and directors to account and review service decisions. Health organisations should become involved in setting up scrutiny arrangements as early as possible.

THE PURSUIT OF BETTER PERFORMANCE

A. Cowper
British Journal of Health Care Management, vol.8, 2002, p. 132-135

Lord Hunt of Kings Heath answers questions on public health, performance management of the NHS, turning it into a public corporation, and its relationship with social care.

SCHOOL DAZE

L. Mackay and J. Elliott
Health Service Journal, vol.112, Apr.18th 2002, p. 30-31

School pupils from ethnic minorities do not see the NHS, and nursing in particular, as offering attractive job opportunities, even in an area of high unemployment. Nursing is perceived as menial, very poorly paid and stressful. Trusts need to improve their literature and send staff into schools to improve recruitment.

SIGN HERE PLEASE

S. Williams
Health Which? Apr. 2002, p. 14-15

Discusses the new national medical consent forms which are being introduced in the NHS in 2002. The new consent forms cover only agreement to examination or treatment. They do not cover consent to taking part in research, to being photographed or filmed for medical research or teaching purposes, or to being examined or treated by students.

SINGING THE BLUES

B. Finlayson
Health Service Journal, vol. 112, Apr. 4th 2002, p. 30-31

Focus groups of clinical directors, doctors and nurses felt that morale and motivation were generally low in their organisations. They thought that staff no longer felt valued by politicians, and that this had adversely affected the public's perception of the NHS. A mismatch between central initiatives and what the local service required was seen as a source of stress. A sense of being valued was seen as the key motivator for staff.

SO WHAT WOULD YOU DO THEN, ANDREW WALL

A. Wall
British Journal of Health Care Management, vol.8, 2002, p.151-153

The author presents his personal blueprint for NHS reform. He proposes making primary care trusts responsible for both service commissioning and provision. The role of managers would be redefined to focus on smoothing patients' care pathways, and patient records would be computerised. Finally, new buildings would be financed by the Treasury instead of through private finance initiative schemes.

STIGMA AND SOCIAL EXCLUSION IN HEALTHCARE

T. Mason (ed) et al.
London: Routledge, 2001

This book looks at the ways in which healthcare professionals contribute to increasing social exclusion. It reveals the hidden processes of prejudice and ideologies that permeate contemporary culture. From a grassroots point of view, authors examine the issues surrounding hearing, sight, sexuality, HIV and AIDS, drug use, teenage pregnancy, breastfeeding and old age.

STRUGGLING HOSPITALS FLIRT WITH CATASTROPHE

N. Hawkes
Times, Mar 27th 2002, p. 5

Describes the chaos reigning at East Kent Hospitals Trust with overcrowding and long trolley waits in the accident and emergency departments, waiting times for treatment of twice the national average, and acute bed shortages.

(See also Independent, Mar. 27th 2002, p.2)

TUNNEL VISION

P. Smith
Health Service Journal, vol.112, Mar. 21st 2002, p. 12-13

A leaked report published in the Observer newspaper shows that the numbers of cancer patients beginning treatment within the target time of two weeks had fallen from 68% in 1998 to 32% in 2000. The deterioration is due to staff and equipment shortages.

THE VISION IN PRACTICE

NHS Alliance
Retford, 2002

Report focuses on the service commissioning process, the divide between primary and secondary care in the NHS, and professional boundaries. Proposes moving away from adversarial commissioning of secondary care by primary care and having Primary Care Trusts explicitly commissioning both primary and secondary care based around the patient journey. Also suggests that, instead of offering trusts autonomy only when they have earned it through good performance, managers should be offered those freedoms first, with micro-management from the centre only used should they fail.

WANTED: 80,000 STAFF FOR NHS

J. Carvel, M. White and L. Elliott
The Guardian, April 19th 2002, p.1

The Health Secretary, Alan Milburn, yesterday promised to recruit 15,000 extra GPs and consultants, 35,000 more nurses and 30,000 other health professionals by 2008. Mr Milburn also plans a bank to aid hospitals. His plans for greater choice also mean a bigger role for private health providers.

(See also Independent, April 19th 2002, p.1; Times, April 19th 2002, p. 1)

WHAT PATIENTS REALLY THINK OF THE NHS

KPMG Consulting and New Health Network
London: 2002

A survey of 2000 people across England, Wales and Scotland has shown that 82% of respondents were satisfied with their GP and 60% were satisfied with NHS hospitals. However the results also showed that dissatisfaction with the NHS increases sharply in case of a long wait for treatment. Fifty-nine per cent of respondents said they would travel anywhere in the UK if they could cut the wait for treatment from 12 to three months. Almost a third said they would go anywhere in Europe.

WHERE'S THE BEEF

J. Appleby and A. Harrison
Health Service Journal, vol.112, Mar. 21st 2002, p. 22-23

The scope for franchising in the NHS seems limited. Franchising is most appropriate in services that can be simply defined, like selling branded beef burgers. Most hospitals outside London are natural monopolies, where management could be franchised out for a fee. However its introduction would raise issues of accountability, and the franchisees might require managerial freedoms and opt-outs from central directives.

WHO NOSE BEST?

P. Day and K. Klein
Health Service Journal, vol.112, Apr. 4th 2002, p.26-29

The Commission for Health Improvement (CHI) is the fastest growing institution in the NHS. Over the two years of its existence it has developed a methodology for evaluating NHS trust performance that is a compromise between looking at clinical governance mechanisms and testing whether they deliver in practice. It has been generally accepted as an ally rather than an adversary within the NHS, but it remains to be seen what effect it will have on improving patient care.

WILL THE RETENTION OF EMPLOYMENT MODEL WORK?

L. Davies
British Journal of Health Care Management, vol.8, 2002, p.137-141

Under the retention of employment model, staff who provide domestic, catering, laundry, portering or security services would remain NHS employees but would be seconded to any private contractor running the service. Their pay and conditions would be determined by the NHS Trust. Disciplinary procedures would be determined by the Trust but implemented by the private provider. Only supervisors and managers of such staff would be transferred to the private contractor under TUPE.

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