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

ARMCHAIR FAN

A Cowdell, B Lees and M Wade

Health Service Journal, vol. 112, May 30th 2002, p. 28-29

The establishment of a discharge lounge is believed to have reduced pressure on beds in wards. All adult wards refer patients to the lounge, where the average wait is two hours. The establishment of the lounge has reduced delays for ambulance crews who no longer have to collect patients from several areas of the hospital. Running costs for the first year £30,000.

CHANGING THE BATTLE LINES

T Shifrin

Health Service Journal, vol. 112, June 13th 2002, p. 14

The contracting out of NHS services to private providers could bring the health service under the jurisdiction of the General Agreement on Trade in Services (GATS). Under GATS, the government could not restrain the commercial presence of overseas firms wanting to provide health care in the UK.

GO-AHEAD FOR FOREIGN STAFF TO CUT NHS WAITING LISTS

J Carvel

The Guardian, June 7th 2002, p. 2

Ministers have conceded they are not likely to meet the government's targets for cutting NHS waiting times without importing foreign doctors and nurses.

The Department of Health has told hospitals to sign contracts with clinics and agencies in Europe to send their surplus clinical teams to aid the NHS. The doctors and nurses would not be expected to become NHS employees and might combine contract work with their jobs in other parts of Europe.

HANDLING CLINICAL NEGLIGENCE CLAIMS IN ENGLAND

Public Accounts Committee

London: TSO, 2002 (House of Commons papers, session 2001/02; HC 280)

Expresses concern that the rise in NHS funding might encourage more dissatisfied patients to sue for compensation for clinical negligence. Criticises NHS trusts for not meeting basic risk management standards set by the Clinical Negligence Scheme to reduce the likelihood of wrong treatment. Many trusts also mishandle initial complaints, provoking litigation when patients might have been satisfied with an apology. There are also inordinate delays of up to eight years in settling genuine claims, and in two-thirds of cases involving payments of less than £50,000 the costs of reaching the settlement are greater than the compensation. Report expects the Chief Medical Officer's current working group to look at alternative solutions.

HEART SURGEONS STALL BLAIR'S DRIVE TO SLASH WAITING LISTS

A Miles, T Baldwin and D Charter

Times, June 13th 2002, p1

Hospitals are withdrawing from a scheme headed by the pioneering heart specialist Sir Magdi Yacoub to hire cardiac surgeons from overseas.

HOW NURSE RECRUITING IS TIED UP IN MONTHS OF RED TAPE

J Carvell

The Guardian, June 10th 2002, p 6

The Newspaper reports an extreme example of an overseas candidate's year - long wait for registration after he was offered a nursing job at Hull Royal Infirmary. The lengthy formalities eventually choked him off. Last month, the Nursing and Midwifery council issued an apology for the backlog of registration work.

MEDICAL BLUNDER FIGURES MAY BE TOO LOW, HEALTH CHIEFS WARN

J Meikle

The Guardian, June 18th 2002, p.3

The government believes that a new study which attempts to calculate the numbers of accidents in hospitals might understate the problem. A pilot reporting scheme for the new National Patient Safety Agency has recorded more than 70,000 adverse incidents in six months in 28 NHS trusts. Extrapolating that to all NHS trusts in England would take the figure to more than 500,000, half some earlier estimates. This has led the government to question the new figures.

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MODERNISING SUPPLY IN THE NHS

Purchasing and Supply Agency

2002

Key skills shortages and under-investment in IT are hampering the Health Service's ability to achieve value for money in equipment and supplies procurement. Up to half of the £11bn the NHS spends on supplies in a year is unlikely to be delivering best value. The Agency plans to tackle these problems by raising from 20% to a third the proportion of expenditure covered by national supply arrangements and by building collaborative schemes between trusts.

THE MORALE MAJORITY

P Spurgeon and F. Barwell

Health Service Journal, vol 112, June 7th 2002, p.22-24

Since April 2000, it has been mandatory for all NHS organisations to conduct annual surveys of staff morale. Analysis of staff attitude surveys in 18 trusts and 20 health authorities in 2001 showed that most health groups were not happy with their pay or the recognition they received. Managers were happy with all aspects of their jobs, but doctors and nurses were concerned about their safety. All employing organisations must act on these results to improve employment practice and help to develop motivation.

THE NATIONAL STRATEGIC PROGRAMME: DELIVERING 21ST CENTURY IT SUPPORT FOR THE NHS

Department of Health

2002

Paper sets target deadlines for installing new NHS information systems. The three main deliverables are:

  • a national e-bookings service, to be implemented by December 2005;
  • a national e-prescriptions service, to be 50% implemented by December 2002;
  • an electronic health records service to be available throughout England by December 2002.
Underpinning the new services will be a broadband network carrying encrypted, secure messages to all NHS staff. Further targets for telemedicine, electronic images, telemonitoring and combined electronic records run to 2007 and 2010.

NATIONAL SUICIDE PREVENTION STRATEGY FOR ENGLAND: CONSULTATION DOCUMENT

Department of Health

London: 2002

Consultation document sets out the components of a national suicide prevention strategy for England. It proposes measures to reduce access to lethal methods of self-harm; reduce risk in key vulnerable groups; promote mental well-being in the wider population; improve media reporting of suicidal behaviour; promote research; and improve monitoring.

ON THE RECORD

S Ward

Public Finance, May 24th-30th 2002 p. 28-29

The NHS is moving towards the creation of electronic health records which would enable medical professionals to access patients' health histories via NHSNet. The system would allow patients to access their own records and enable the transmission of test results from pathology labs to a GP's desktop.

OVERSEAS PROVIDERS ISSUED WITH NHS PROSPECTUS

N Timmins

Financial Times, June 25th 2002, p. 2

Alan Milburn will today issue a "prospectus" aimed at attracting overseas healthcare companies to set up in England to treat NHS patients. Health Department officials said the prospectus "would set up the ground rules for a new sector in health care provision". Unlike UK private hospitals, which are being used to cut NHS waiting lists, the new units would be solely for NHS use.

PARTNERSHIP AND MULTI-UNIONISM IN THE HEALTH SERVICE

N. Heaton, B. Mason and J Morgan

Industrial Relations Journal, vol 33, 2002, p.112-126

Paper explores the development and implementation of "workplace social partnerships" at two NHS trusts. Workplace social partnership may be defined as employers and trade unions working together to achieve common goals such as fairness in the employment relationship.

PATIENTS "ARE BEING WAREHOUSED" IN A&E WARDS FOR DAYS

L Duckworth

Independent, May 28th 2002, p.4

The annual "Casualty Watch" survey of Accident and Emergency Departments by the Association of Community Health Councils has revealed that unacceptably long waits for admission to wards continue. There was particular concern about the inappropriate use of so-called observation wards to accommodate patients. These were often little more than cordoned-off areas of A&E.

(See also Guardian, May 28th 2002, p. 6; Daily Telegraph, May 28th 2002, p.9)

PATIENTS ARE DENIED LIFE-SAVING CANCER DRUG

N Hawkes

Times, May 28th 2002 p.3

Reports that National Institute for Clinical Excellence has recommended in an interim report that the cancer drug Glivec should only be used to treat patients in the "accelerated" phase of the disease. The drug costs £19,000 to £28,000 per patient per year, but results of trials suggest that it is a lifesaver. There is serious concern among doctors about this decision.

(For comment see Times, May 28th 2002, p. 18)

POWER WITH RESPONSIBILITY

K Walshe

Health Service Journal, vol. 112, June 7th 2002, p. 25

The new Commission for Healthcare Audit and Inspection faces the challenge of developing common standards for regulating the NHS and the independent healthcare sector. It is billed as a tough inspectorate and may adopt a punitive, sanctions based approach to regulation. It is also intended to be more independent of both the NHS and the Department of Health than its predecessor bodies.

"THE PUBLIC IS TOO SUBJECTIVE": PUBLIC INVOLVEMENT AT DIFFERENT LEVELS OF HEALTH-CARE DECISION MAKING

A Litva and others

Social Science and Medicine, vol. 54, 2002, p. 1825-1837

Research uses focus groups and in-depth interviews to explore the extent to which the public would wish to be involved in various types of decision about rationing healthcare in the NHS. Results showed a strong desire for public involvement at the system and programme levels, with much less willingness to be involved at the individual patient level.

PUBLIC PARTICIPATION IN THE NEW NHS: NO CLOSER TO CITIZEN CONTROL

R Rowe and M Shepherd

Social Policy and Administration, vol. 36, 2002, p. 275-290

Paper reviews current Labour government policy towards public participation in the NHS and reports on the response of primary care groups (PCGs) to recent directives to make patient and public involvement an integral part of the way they work. The results of a survey conducted in one English health region are presented and suggest a marked consensus between central and local decision-makers in their understanding of public participation. Data suggests that at local level public participation is framed within a new public management perspective which values it as an aid to organisational learning.

RALLYING THE TROOPS

J Buchan

Health Service Journal, vol. 112, May 30th 2002, p. 24-26

The government's plan for the NHS will not be fulfilled simply by meeting its targets for staffing. More attention needs to be given to retention and a fairer pay system. The introduction of new roles and skill mix will be the biggest test of the human resources agenda. Success is more likely to come from developing the roles of current health professionals than from introducing new types of workers.

REFORMING EMERGENCY CARE

Department of Health

London: 2002

Proposes reforms to reduce waiting times for treatment and to make it easier for people to access the right service. Measures include:

  • increasing staffing levels in Accident and Emergency Departments;
  • reducing bed blocking;
  • separating elective and emergency workloads;
  • breaking down barriers between professionals.

REFORMING PUBLIC SECTOR DENTISTRY IN THE UK

A Oliver

British Journal of Health Care Management, vol. 8, 2002, p. 212-216

The article, by a research officer at the London School of Economics, argues that the way NHS dentistry is financed generates inappropriate incentives for dentists. Partly, as a consequence, the Government has pledged to increase investment in this sector. However what is really required is a fundamental reform of the way in which dentists are remunerated.

SO WHAT WOULD YOU DO THEN, MICHAEL DIXON?

M Dixon

British Journal of Health Care Management, vol. 8, 2002, p. 223-226

Dr Michael Dixon, a General Practitioner, PCT leader and Chairman of the NHS Alliance, puts forward the reforms that he believes would most suit the NHS. They are:

  • sufficient funding into the system now!
  • pay for national targets and imperatives upfront
  • development of more robust commissioning systems
  • reducing waits and disorganisation in secondary care
  • faster development of the new tier between primary and secondary care
  • improving access to primary care by developing a new mind set
  • support for the return of holistic/integrated practitioners within primary care
  • encouragement of the concept of the 'NHS' citizen

STAR OR BLACK HOLE?

T Cutler

Community Care, May 30th -June 5th 2002, p. 40-41

Presents a critique of the star ratings system for NHS trusts. The system is flawed because:

  •  it is not clear how the measures should be interpreted;
  • the measures are not related to the context in which the organisation is working;
  • the data are unreliable;
  • it is unclear how the ratings were arrived at;
  • it is not clear how the key targets were chosen.

NHS star ratings do not therefore increase service accountability to users.

THE STATES WE'RE IN

A McGauran

Health Service Journal, vol. 112, June 7th 2002, p. 10-11

The government is showing an increased interest in contracting out NHS services to American Health Maintenance Organisations such as Johnson & Johnson and Kaiser Permanente. Kaiser is interested in working with the NHS to train clinical teams while Johnson and Johnson has signed a deal to build and manager diagnostic and treatment centres for NHS patients.

THE SAME GAME

J Hoeksma

Health Service Journal, vol. 112, June 7th 2002, p. 13

New investment in IT in the NHS is likely to be heavily centrally controlled. Procurements will be streamlined, national standards set, and lists of accredited suppliers drawn up, while a new IT Programme Directorate will provide central management and only release investment funds for approved systems. Development partnerships with consortia of suppliers will be introduced. These would produce a limited number of compliant systems that could be implemented at regional and local levels. Strategic out-sourcing to consortia would effectively ring fence future investments in NHS IT and shift risk and responsibility for delivery onto the private sector.

SYSTEMS FAILURE

J Chapman

London: Demos, 2002

Warns that NHS service targets that are linked to funding and set without taking account of their knock on effects can have damaging consequences. For example, an A&E Department that is meeting its trolley wait targets has a disincentive to help out a neighbouring casualty department that is struggling. Taking its neighbours patients would make its own figures look worse.

WINNING HIS SPURS

L Donnelly

Health Service Journal, vol. 112, June 7th 2002, p. 12-13

Profiles the newly appointed Junior Health Minister David Lammy

YOU MUST LOSE SIGHT IN ONE EYE BEFORE THE NHS WILL TREAT YOU

D Derbyshire and C Hall

Daily Telegraph, June 13th 2002, p. 1

The National Institute for Clinical Excellence has ruled that photodynamic therapy can only be used for NHS patients with age-related macular degeneration who have already lost the sight of one eye. This act of meanness has been greeted with fury by medical charities.

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