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

ACUTE DISTRESS

B. Vaughan and G. Withers

Health Service Journal, vol. 112, May 9th 2002, p. 24-27

A study of bed occupancy in 21 hospitals over the past two years showed an average 29% of patients no longer needed acute care. Two-thirds of this group had been in hospital for more than 28 days, and about a fifth were under 65. The main reasons for delayed discharges were waits for social services assessment or home care packages.

AND NE'ER THE TWAIN SHALL MEET

J. Deffenbaugh

Health Service Journal, vol. 112, May 16th 2002, p. 28-29

The differences between the English and Scottish health systems are widening. The star grading system for acute trusts in England has led to a "winners and losers" model, whereas Scotland has opted for a more collective approach. England has emphasised partnership with the private sector, but Scotland has reached out to voluntary organisations and local councils. Both systems will increasingly rely on staff involvement to deliver improvements.

BLOCKBUSTER OF A WATCHDOG

S. Ward and D. Harding

Public Finance, May 3rd-9th 2002, p.20-24

The proposed Commission for Health Care Audit and Inspection (Chai) will bring together the work of the Commission for Health Improvement (Chi) and the Audit Commission's health value-for-money work. It will also take over responsibility for private hospitals' inspection from the National Care Standards Commission.

CLAIMING THE HEALTH DIVIDEND

A. Coote (editor)

London: King's Fund, 2002

Report examines what the NHS can achieve through better employment practices, purchasing policies, food buying, waste management, travel, energy, and building. It urges trusts to invest in tackling local unemployment and boosting local business. Sustainable practices and investment in local communities would improve health and reduce demand for healthcare.

CONSUMER AS KING IN THE NHS

S. C. Bolton

International Journal of Public Sector Management, vol. 15, 2002, p. 129-139

New public management in the NHS has redefined patients as consumers and has attempted to imbue health service employees with a new deference to their needs. Nurses are expected to fulfil their professional role, while presenting a smiling face to patients who now behave as demanding consumers. Nurses perform this role with polish but cynically, and the required smiling face masks feelings of resentment and disillusion.

CONTRIBUTORY FACTORS

I. Brittain, B. Taylor and S. Tyler

Health Service Journal, vol. 112, May 2nd 2002, p.30-31

Presents a case study of a shadow patients' forum set up jointly by a primary care trust, a community health council, and GPs. The project identified more than 100 people keen to participate. GPs and practice managers have proved important in involving the local population.

COSTING DEAR

D. Lee

Health Service Journal, vol.112, May 2nd 2002, p.12-13

Warns that a proposed new law on corporate killing could present a serious threat to the NHS. Corporate killing will apply to the organisation, but other related offences of reckless killing or killing by gross carelessness may apply to doctors or nurses.

DELIVERING THE NHS PLAN: NEXT STEPS ON INVESTMENT, NEXT STEPS ON REFORM

Department of Health

London: TSO, 2002 (Cm 5503)

Proposes integration of audit and inspection of public and private health care and more use of the private sector to provide services for the NHS under contract. There will be a financial incentive scheme for hospitals, which will be paid by results. Promises 8,000 more nurses each year leaving training by 2008, and 1,900 extra medical graduates a year. The government envisages an increase in treatment capacity equivalent to over 10,000 beds. By 2007/08, 42 new hospitals should be built, with 13 more under construction. Around 750 primary care one stop centres, an increase of 500, will offer a broader range of services. On the basis of increased investment, the plan promises a maximum wait of three months for impatient treatment by 2008 and a maximum waiting time in Accident and Emergency Departments of four hours.

DEVIL IN THE DETAIL

A. McGauran

Health Service Journal, vol. 112, May 9th 2002, p.13

Government plans to allow high performing hospitals, primary care trusts and care trusts to opt for foundation status. These foundation trusts would operate as not-for-profit mutual organisations. They will be able to borrow money, to set up private subsidiary companies to market services, and to enter into joint ventures with the private sector.

THE EFFECT OF NEW PUBLIC MANAGEMENT ON INTENSIVE CARE UNIT STAFF

R. Kowalczyk

International Journal of Public Sector Management, vol. 15, 2002, p.118-128

Prior to the introduction of new public management in the NHS, intensive care doctors had a less powerful position in the medical hierarchy while intensive care nurses were at the top of their profession. Staff within intensive care appear to have been unaffected by the introduction of general management, the purchaser/provider split and GP fund holding. However the development of directorates in NHS trusts reduced the insularity of the intensive care unit and the development of the role of directorate nurse reduced the isolation of the nursing staff in intensive care. In addition, the changing status of anaesthetists, the main group of doctors involved in intensive care, and the development of intensive care as a speciality in its own right, may change the balance of power between intensivists and other doctors.

FIVE-YEAR HEALTH CHECK: A REVIEW OF HEALTH POLICY, 1997-2002

J. Appleby and A. Coote (editiors)

London: King's Fund, 2002

Gives the government credit for its commitment to a health care system free at the point of use and funded out of general taxation. More resources have been put into the NHS through increased funding and staffing levels and through greater use of the private sector. However, the government's reforms of long term care have failed and its commitment to the use of private finance to build new hospitals is leading to their being put up in the wrong places with the wrong configuration.

GOING ROUND IN CIRCLES

J. Davies

Health Service Journal, vol. 112, May 2nd 2002, p.26-28

Discusses the massive extra investment that the NHS making in press and public relations and in improving communications internally with staff and patients.

HEALTH CHECK

P. Butler

Guardian Society, Mar 27th 2002, p.4

The NHS is badly prepared for the latest round of structural reorganisation which will see over 300 PCTs take over responsibility for the majority of health care next week, according to the leading primary care representative body the NHS Alliance. May have yet to appoint key staff, and they will hamstring by inherited debt and widespread apathy.

HEALTH NEEDS ASSESSMENT AND NEEDS-LED HEALTH SERVICE CHANGE: A SURVEY OF PROJECTS INVOLVING PUBLIC HEALTH DOCTORS.

J. Jordan and others

Journal of Health Services Research and Policy, vol.7, 2002 p.71-80

This paper examines the criteria that define an effective health needs assessment and explores which factors are important for the delivery of effective health needs assessments in the English National Health Service.

HOW TO CHANGE THE NATIONAL HEALTH SERVICE

C. Powell

Independent, May 15th 2002, p.19

Argues that efforts to reform the NHS to make it more customer focused must be led by senior doctors rather than managers to be effective. The role of management would be to organise and fund the implementation of the doctors' ideas.

IT'S GOOD TO TALK

C. Williams

Health Service Journal, vol. 112, May 23rd 2002, p.30-31

Feedback from patients in Mayday Healthcare Trust in Croydon found concerns centred on a lack of information, staff attitudes, cleanliness and lack of privacy. Improvements introduced include calmer mealtimes, more ward cleaning, a new style hospital night-gown and offering a free toiletries bag for emergency admissions. Including patients and carers at ward sisters' development days has proved a powerful tool in influencing staff attitudes.

LOOKING BEYOND THE NUMBERS GAME

R. Lissauer

Public Finance, May 3rd-9th 2002, p.19

Argues that if the NHS is to improve, it needs to develop a multi-skilled workforce. Professionals will need to combine elements of the roles of doctors, nurses and social workers to effectively meet patients' needs.

MEANINGS OF IMMEDIATE: THE PRACTICAL USE OF THE PATIENT'S CHARTER IN THE ACCIDENT AND EMERGENCY DEPARTMENT

L. C. Sbaih

Social Science and Medicine, vol. 52, 2002, p.1345-1355

This paper, based on a study of the work of accident and emergency (A&E) nurses in the UK, argues that the expectation of immediate assessment raised by the Patients' Charter Standards fails to take into account the ways in which A&E nurses do their work on a routine, daily basis.

MILBURN'S FOUNDATION FOR SERIOUS NHS REFORM

N. Blackwell

Times, May 23rd 2002, p.20

Argues that greater autonomy for hospitals should be balanced by greater freedom of choice for patients. Citizens should be allowed to take a portion of their NHS entitlement out of the NHS purchasing structure and place it with the Community Mutual Insurer (CMI) of their choice. CMIs would be non-profit mutual organisations, which would undertake to ensure access to essential care for their members. They would negotiate with hospitals on a contract or fee-for-service basis.

MORE PURSUIT OF BETTER PERFORMANCE

A. Cowper

British Journal of Health Care Management, vol.8, 2002, p. 172-175

Reports second part of an interview with Lord Hunt of King's Heath, covering the Private Finance Initiative (PFI) in the NHS, funding for the implementation of National Institute of Clinical Excellence advice and the National Service Frameworks, the development of Primary Care Trusts, and the regulation of NHS managers.

THE NATIONAL CARE STANDARDS COMMISSION

J. Easterbrook and R. Rees

British Journal of Health Care Management, vol. 8, 2002, p.191-193

Article looks at the role of the National Care Standards Commission in the regulation of private and voluntary sector homes and hospitals. Increased regulation for private hospitals means they will have to comply with strict NHS-level standards of care. Private care providers will see a direct impact on their budgets due to increased staffing requirements among other things.

NEW HEALTH MANAGERS CHIEF URGES REDUCTION IN NUMBER OF TARGETS

N. Timmins

Financial Times, May 22nd 2002, p.3

The new chief executive of the NHS Confederation has called for a cut in the number of targets the government has set for the NHS and for a period of organisational stability.

NHS 'HINDERED NOT HELPED' BY TARGETS

J. Carvel

The Guardian, May 20th 2002, p.7

Demos, the Blairite think tank, has warned the government that its NHS reforms will fail if ministers persist with a centralised regime of target set by Whitehall. Ministers have yet to understand that reforming large organisations such as the NHS is subject to the "law of unintended consequences". For example, star-rating for grading hospitals means hospitals lost incentives to pool their resources for handling accidents and emergencies.

NHS TRUSTS SET FREE TO USE PRIVATE SECTOR

N. Timmins

Financial Times, May 1st 2002, p.4

Primary care trusts have been given the freedom to commission care from the private sector. The cap on their management budgets has been lifted, and they are to be given three year rather than annual funding allocations.

NHS "WILL MISS TIME TARGET" DESPITE SPENDING

N. Timmins

Financial Times, Apr. 25th 2002, p.6

Professor Nick Bosanquet of Imperial College has predicted that the NHS will fail to meet its target of a maximum waiting time of six months for in-patient treatment by 2005. In spite of extra spending, shortages of consultant time and operating theatre space, the pressures of emergency care and the increasing complexity of treatment will defeat managers' efforts.

OPERATING THEATRES: A BULLETIN FOR HEALTH BODIES

Audit Commission

Wetherby: Audit Commission Publications, 2002

Reports that the average hospital cancels 10% of available operating theatre sessions, but in some poorly managed trusts the cancellation rate is more than 30%. Cutting cancellations by 5% would allow hospitals to treat an extra 150,000 patients a year. Reasons for cancellations include staff turning up late for operations, consultants double booking theatre time, staff taking leave at short notice without arranging cover, and a lack of reliable information on which to plan and manage the theatres.

THE POWER OF ONE

D. Carlisle

Health Service Journal, vol. 112, Apr. 25th 2002, p.14

Reports that a planned new Commission for Healthcare Audit and Inspection will take over the inspection role of the Commission for Health Improvement, the audit function of the Audit Commission and the registration and inspection of private and voluntary hospitals carried out by the National Care Standards Commission.

PRESCRIPTIONS MAY BE DROPPED ON 50 DRUGS

N. Timmins

Financial Times, May 2nd 2002, p.4

Fifty more prescription-only drugs could be made available over the counter at pharmacies in the next five years. Although the move will free patients to buy more drugs over the counter, the government has insisted that the aim is not to cut the NHS drug budget.

"PRIVATISE NHS" ADS SCORNED BY UNIONS

J. Carvel and T. Macalister

Guardian, May 9th 2002, p.9

The Health Secretary has placed advertisements in national newspapers inviting private companies to bid to run failing NHS hospitals under contract. This has provoked fierce criticism from unions and left wing politicians.

(See also Times, May 9th 2002, p. 15; Financial Times, May 8th 2002, p.8)

RIDING HIGH

A. Moore

Health Service Journal, vol. 112, May 16th 2002, p.11-12

Strategic health authorities are supposed to performance-manage the hospitals and primary care trusts on their patch and liaise with the Department of Health and local authorities. Article reports on progress on the ground.

RIPPED UNTIMELY

J. Trueland

Health Service Journal, vol. 112, May 16th 2002, p. 12-13

The risk of litigation arising from problems during childbirth is rising, as is the number of Caesarean sections. Article investigates whether doctors, fearful of litigation, are relying on technology to make births safer.

THE RISE OF REGULATION IN THE NHS

K. Walshe

British Medical Journal, vol. 324, Apr. 20th 2002, p.967-969

In the past four years the British government has created five new national agencies to regulate the NHS. If politicians can be persuaded to let go, these new regulators could provide a genuinely new approach to improving performance and management. They could learn from regulators in other sectors and adopt a responsive approach to regulation.

THE ROLE OF THE PRIVATE SECTOR IN THE NHS

Health Committee

London: TSO, 2002 (House of Commons papers. Session 2001/02; HC 308)

Raises a string of concerns about the long term use of private sector hospitals to treat NHS patients, and calls on the NHS to ensure that enough beds are available to cope with future demand. Expresses fears that consultants may be lured away from the NHS by more lucrative jobs in the private sector, but criticises the way in which they are allowed to treat private patients in NHS beds. Supports plans to force newly appointed consultants to work exclusively for the NHS for seven years, and calls for annual appraisals of senior consultants to see if their private work detracts from the NHS responsibilities. Finally calls for systems to be set up to prevent overcharging by private hospitals for NHS work.

RUNNING OUT OF JUICE

J. Raftery

Health Service Journal, vol.112, Apr. 25th 2002, p. 22-23

Little or no improvement has occurred in the past three years in the performance indicators of the day case rate, length of hospital stay and generic prescribing. Current indicators measure productivity and not quality, so improvements in services may show up as decreases in efficiency. Quality improvements should be included in productivity measurement.

SAFETY IN NUMBERS

C. Rapson and J. Halliday

Health Service Journal, vol. 112, Apr. 25th 2002, p. 24-25

A model for reviewing ward staffing and quality of care at Bedford Hospital Trust has led to extra nurses being appointed. The review found a correlation between low staffing and a high number of clinical incidents. The results have led to changes in practice and action to tackle sickness absence.

SCRAP NHS TARGETS, SAY DOCTORS

J. Carvel

Guardian, May 10th 2002, p.3

The British Medical Association has warned that doctors will not allow themselves to be made scapegoats if the latest cash injection fails to lead to NHS improvement. It has also called for the abolition of waiting times targets that distort clinical decisions and force doctors to give the longest waiters priority over the sickest patients.

(See also Independent, May 10th 2002, p.7)

SLEIGHT CHANGE

D. Brindle

Guardian Society, May 8th 2002, p.4

The government has "far exceeded" the Conservatives in moving towards what Labour had itself described as privatisation of health care, according to the leading historian of the NHS. In a new edition of his book, The National Health Service - A Political History, Charles Webster also warns that higher costs of privatised services will eat up much of the promised increase in health spending.

The National Health Service - A Political History is published by Oxford University Press at £12.99.

"SUPER HOSPITALS" START FEARS OF TWO TIER NHS

C. Hall

Daily Telegraph, May 23rd 2002, p.9

Reports that the first wave of foundation hospitals are expected to be up and running by the end of 2003. These hospitals will have the freedom to vary pay rates, borrow money and keep the proceeds of land sales. There is however concern that the scheme will give rise to a second division of hospitals, poor relations of the successful foundation trusts, some of which will be locked in a downward' spiral of failure.

(See also Financial Times, May 23rd 2002, p.4; Independent, May 23rd 2002, p.8; Guardian, May 23rd 2002, p. 7; Times, May 23rd 2002, p.14)

UP-DATING EVIDENCE-BASED CLINICAL GUIDELINES

M. Eccles, N. Rousseau and N. Freemantle

Journal of Health Service Research and Policy, vol.7, 2002, p.98-103.

This paper reports on the updating of two evidence-based guidelines within the North of England Evidence Based Guideline Development Programme. It examines methods, group composition, definition of the clinical area of the guidelines and guideline identification and synthesis.

WHY DIET IS CENTRAL TO THE EFFECTIVE DELIVERY OF THE DIABETES NSF

N. McGough

Primary Care Report, vol. 4, no. 6, Apr. 10th 2002, p.33-35

Diet has a key role to play in the management of diabetes. However, dietetic services are understaffed and under-resourced. With an increase in the prevalence of diabetes, it is essential that PCTs address dietetic provision.

WILL HIRING MORE DOCTORS MAKE YOU LIVE LONGER?

A. Oswald

Times, Apr. 24th 2002, p.20

Across industrial countries, there is no link between the number of doctors per head and length of life. Author therefore questions the need to increase public spending on the NHS in order to recruit and train more doctors.

THE WRONG PRESCRIPTION: A CRITIQUE OF LABOUR'S MANAGEMENT OF THE NHS

S. Evans and S. Williams

London: Conservative Party, [2002]

In order to improve the NHS, the Labour government plans to provide increased funding, reform NHS operations, and increase the involvement of the private sector. Report argues that increased funding without reform will not improve the NHS. Unfortunately Labour's operational reforms have been characterised by constant intervention and over-regulation, which have stifled local initiative and innovation. Involvement of the private sector has been chaotic and piecemeal, with no long term strategy.

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