Welfare Reform on the Web (October 2002): National Health Service - Reform - General
BENEFITS OF THE DOUBT
H Lustgarten, C Cowley and S Scobie
Health Service Journal, vol. 12, Aug 8th 2002, p. 28-30
Interviews and workshops with the public, health professionals and managers have revealed dissatisfaction with the current system of NHS performance indicators. The public were mostly unaware of the star rating system for hospitals. Public priorities were waiting times, treatment experience, staffing and patient environment. The public, patients and health professionals were agreed that performance data should be:
- collected by an independent body;
- focused on improvements;
- be focused on patient experience and pathways;
- be about services as well as performance.
BEST HOSPITALS REWARDED WITH BONUSES OF UP TO £1M
L Duckworth
Independent, July 25th 2002, p. 8
The 2001/02 performance ratings show that 47 NHS acute trusts have improved since the previous year while 36 have deteriorated. The table gives 46 trusts a three star rating, 77 two stars and 35 a single star. Eight trusts are judged to provide such a poor service that they are given a zero-rating. This year hospitals were judged against tougher criteria and twice as many factors were assessed as last year. Three star trusts will be rewarded with special grants, while the worst trusts will be given three months to come up with an improvement plan. If this fails they could be taken over by new management.
(See also Times, July 25th 2002, p. 16; Daily Telegraph, July 25th 2002; p. 10; Guardian, July 25th 2002, p. 10; Health Service Journal, vol. 112, July 25th 2002, p. 4-9)
BETTER PREVENTION, BETTER SERVICES, BETTER SEXUAL HEALTH; THE NATIONAL STRATEGY FOR SEXUAL HEALTH AND HIV IMPLEMENTATION ACTION PLAN
Department of Health
London: Dept of Health Publications, 2002
Document looks at how the national strategy for sexual health can be implemented successfully through a broad partnership between the Department of Health, other government departments and local government.
BMA ANGER OVER JUNIOR DOCTOR ROTAS
L Duckworth
Independent, August 8th 2002, p. 7
Reports that up to one third of junior hospital doctors are still working more than 56 hours a week due to senior staff shortages, according to the British Medical Association. The Department of Health disputes the figure.
THE CANCER NSF: A SUITABLE CASE FOR TREATMENT
M R Baker
British Journal of Health Care Management, vol. 8, 2002, p. 294-297
Cancer outcomes in the UK are poorer than in many other developed countries. The Calman/Hine report, "Improving Outcomes Guidance", and the NHS Cancer Plan together provide a framework to bring UK cancer performance up to the best standards in Europe. Risks to achievement include availability of specialist staff and financial resources for new diagnostic facilities and treatments. Earlier referral and a higher index of suspicion in primary care will be central to improving cancer outcomes.
CLEARER PICTURE OF IT WILL HELP FUNDING HIT TARGETS
S Brown
Primary Care Report, vol. 4, July 24th 2002, p. 8-9
IT in the NHS has historically been under-resourced but government is now pumping in more funding. Four key targets for investment have been identified: infrastructure, electronic patient records, booked admissions and e-prescribing. With the extra funding comes more central control, with local health services choosing IT solutions from nationally pre-approved short lists.
(See also Primary Care Report, vol. 4 July 29th 2002, p. 14-16)
DELAYED DISCHARGES
Health Committee
London: TS0, 2002 (House of Commons papers, session 2001/02; HC 617)
Report recommends fining local authorities responsible for the delayed discharge of older people from hospital. Multi-agency teams should be set up to manage discharges, led by a patient discharge liaison manager appointed jointly by the NHS and the local authority. A named person should coordinate the patient's journey to and beyond discharge. Discharge procedures should be a key element in clinical governance and should figure in every CHI review. Other health professionals should be trained to compensate for the shortage of occupational therapists that delays assessments.
DELIVERING 21ST CENTURY IT SUPPORT FOR THE NHS: NATIONAL SPECIFICATION FOR INTEGRATED CARE RECORDS SERVICE: CONSULTATION DRAFT
Department of Health
2002
Document considers the requirements for an Integrated Care Records Service and the national standards and specification to be used. It aims to provide an initial review of electronic records in the NHS.
THE DRAFT NATIONAL HEALTH SERVICE (WALES) BILL
Welsh Affairs Committee
London: TS0, 2002 (House of Commons papers, session 2001/02; HC 959)
The draft Bill has three distinct purposes:
- the retention and reform of Community Health Councils in Wales;
- the establishment of a Wales Centre for Health;
- the creation of a statutory body, Health Professions Wales.
Presents the views of the Committee on the draft legislation.
GOING PLACES
J Buchan
Health Service Journal, vol. 112, Aug 1st 2002, p.22-24
Overseas nurses now account for 40% of all new registrations in the UK and this may rise to 50%. International recruitment is set to become part of the NHS's long term strategy. However Britain will face increasing competition from other countries including the USA which needs to recruit an extra million nurses of its own.
OSPITALS HARK BACK TO THE PRE-NHS ERA
H
A Browne
Times, Aug 7th 2002, p. 2
Discusses the proposed new foundations hospitals. These will be free standing legal entities with freedom to set staff pay rates and borrow money from banks. They will not be directly managed from Whitehall, but will have to meet the same standards and targets as other NHS hospitals. They will compete with each other for contracts which will be awarded by primary care trusts.
(See also Guardian, Aug 7th 2002, p.2)
IN THE SHORT TERM
A Moore
Health Service Journal, vol. 112, Aug 1st 2002, p. 13
Discusses progress in meeting the targets set out in the NHS Plan in cancer, heart and mental health services.
LABOUR DUEL THREATENS REVIVAL OF AILING NHS
A Miles
Times, Aug 8th 2002, p. 18
Discusses fundamental disagreements between the Chancellor and the Health Secretary about NHS reform. The Health Secretary wishes to give successful NHS hospitals more autonomy and financial freedom. The Chancellor is concerned that trusts could borrow money unwisely and put the public finances at risk.
"MAKING A DIFFERENCE": REDUCING BURDENS IN HOSPITALS
Public Sector Team, Regulatory Impact Unit, Cabinet Office
London: 2002
Report sets out practical ways of reducing bureaucracy and paperwork in hospitals in the fields of inspection and review, information flows and the patient journey through the healthcare system.
NEW LABOUR, MODERNISATION AND THE MEDICAL LABOUR PROCESS
S. Harrison
Journal of Social Policy, vol.31, 2002, p.465-485
Paper addresses three questions, all in the context of health policy. Firstly, the author suggests New Labour is adopting a model of medicine characterised by Fordist labour processes. Secondly, 'modernisation', it is suggested, denotes the characteristic of 'modernity'. Finally the third question has significance in a social context (often termed postmodernity) characterised by trends towards post-Fordist labour processes.
NHS DENTISTRY: OPTIONS FOR CHANGE
Department of Health
London: 2002
Proposes that NHS dentists should receive a salary or be paid according to the number of registered patients they have, instead of per treatment as now. Also suggests replacing the present five minute check-up with a 25 minute oral hygiene session. The current £5.00 cost of an NHS check-up is expected to rise to £12.00. Other proposed changes include a national electronic patient record, introduction of a clear cost system, and super dental nurses who will take over some procedures from dentists.
NHS MERGERS FAIL TO BOOST SERVICE, SAY RESEARCHERS
J Meikle
The Guardian, August 2nd 2002, p.6
Mergers of hospital and other NHS services delay improvements for patients by at least 18 months, fail to deliver promised savings and do nothing to improve staff recruitment or retention, according to researchers at the London School of Hygiene and Tropical Medicine.
NHS REFORM AND HEALTH CARE PROFESSIONS ACT 2002
London: TSO, 2002
Brings in changes to the structure of the NHS in England and Wales. Primary Care Trusts in England and Local Health Boards in Wales take over most of the functions previously performed by Health Authorities. Expands the role of the Commission for Health Improvement to inspect hospitals as well as monitoring their clinical governance arrangements. Abolishes Community Health Councils in England and replaces them with Patients' Forums and creates a new Council for the Regulation of Health Care Professionals with the remit of ensuring that the individual health professional regulatory bodies act consistently and in patients' interests.
ON DEFINING AMBULATORY CARE IN PRACTICE
J Bowers, S Jeffrey and G Mould
British Journal of Healthcare Management, vol. 8, 2002, p.305-309
Ambulatory care can be conceptualised as a health factory, capable of producing routine, high quality treatment in an efficient manner. Paper explores the different definitions of ambulatory care in established and proposed centres in an attempt to isolate its essential features. Characteristics of ambulatory care include:
- a strong emphasis on adopting protocol driven care;
- more specialised training for nurses;
- greater collaboration with primary care;
- the development of IT systems to facilitate exchange of patient information.
PATIENTS WIN RIGHT TO REFUSE CARE
C Johnston
The Times, Aug 20th 2002, p.2
Doctors have been told to let patients refuse care under new guidelines designed to help decisions on when to withhold or withdraw treatment. The General Medical Council guidance gives doctors a legal and ethical framework when treating terminally ill patients. It comes after prominent cases such as that involving "Miss B", who was given the right to die in a High Court ruling in March.
PRESCRIBING POWER
R McQuarrie
Community Practitioner, vol. 75, 2002, p.289-291
Describes progress in the extension of independent prescribing rights to nurses in the UK.
PUBLIC INVITED TO ADVISE MEDICINES WATCHDOG
J Carvel
The Guardian, August 20th 2002, p.7
The government's medicines watchdog is trying to recruit 30 people with "good old fashioned common sense" to make basic moral judgements about which types of drugs should be available on the NHS.
RADIOLOGY
Audit Commission
Audit Commission Publications, 2002. (Acute Hospital Portfolio; 7)
Finds that old equipment, staff shortages and "nine-to-five" services in many radiology departments are leading to excessive delays for patients. About 250,000 people are queuing for ultrasound and MRI scans, with average waits of eight and 20 weeks respectively. These delays are creating a bottleneck in the system and holding up treatment.
ROLE REHEARSAL
C Grainger and N Manek
Health Service Journal, vol. 112, Aug 1st 2002, p.26-27
Most newly appointed consultants have no management training. Article describes an induction training scheme for newly appointed consultants and GP principals designed to equip them with skills in risk management, appraisal, conflict resolution and multidisciplinary working.
RUNNING THE FINE LINE
Z Morris
Health Service Journal, vol. 112, July 25th 2002, p.12-13
Reports on progress made by government in gaining the support of the medical workforce for its policies as set out in the NHS Plan. Without doctors' engagement the Plan will fail to improve services.
"SAFETY RISK" IN NHS HIRING FOREIGN DOCTORS
N Martin
Daily Telegraph, July 25th 2002, p.2
The President of the Royal College of Surgeons has attacked government plans to recruit foreign doctors to work in the NHS, expressing fears that overseas medical staff may be unable to communicate with patients.
SIMPLE MINDS
J Hoeksma
Health Service Journal, vol. 112, Aug 15th 2002, p.14-15
Describes the radical new procurement strategy for NHS IT systems. This relies on consortia led by a new species of contractor, the prime service provider (PSP). There will be two breeds of PSP. Implementation PSPs will work with strategic health authorities to implement the three core applications of electronic records, e-booking and e-prescribing. Their key tasks will be to integrate local systems with the three big national applications and to deliver the accompanying change management programme. "Domain" PSPs will be chosen for national components of the strategy such as e-booking and infrastructure.
A SPECIALIST OPINION
Z Morris
Health Service Journal, vol. 112, July 25th 2002, p.12-13
Discusses professionals' concerns about the new NHS consultants' contract. This will require them to work evenings and weekends and to reveal details of their private practice to their managers. Mandatory job plans will link pay progression to meeting management-set targets.
SPECIALIST STROKE CARE COULD SAVE 6,000 LIVES
J Wheldon
Independent, July 24th 2002, p.5
An audit by the Royal College of Physicians has found that only 36% of stroke patients were cared for in a specialist unit. Evidence suggests that 19% fewer people would die if they were treated in a specialist unit. This amounts to 6,000 people a year dying unnecessarily. The government has set a target for all stroke patients to be treated in a specialist unit by 2004.
(See also Times, July 24th 2002, p.10; Guardian, July 24th 2002, p.9)
STARS IN THEIR EYES
P Smith
Health Service Journal, vol. 112, Aug 1st 2002, p.10-11
Discusses the role of Commission for Health Improvement clinical governance reviews in determining the "star ratings" of hospital trusts in England.
TREATING MORE PATIENTS AND EXTENDING CHOICE: OVERSEAS TREATMENT FOR NHS PATIENTS: GUIDANCE FOR PRIMARY CARE AND ACUTE TRUSTS
Department of Health
2002
Guidance on organisation of overseas treatment says that the opportunity to go abroad should be limited to patients facing long waits who are fit to travel. The NHS will pay travel costs for the patient but not for any companions, unless medically necessary. No extra funding will be allocated to PCTs and Trusts to cover costs of overseas treatment. Pre-assessment clinics will normally be run in the UK by doctors from the relevant providers, who will need to be registered with the General Medical Council.
UNKNOWN QUANTITIES
P Stephenson
Health Service Journal, vol. 112, Aug 8th 2002, p.10-12
There are concerns about the quality of the foreign clinical terms to be used to increase capacity in the NHS. These concerns centre on issues of short and long-term post-operative care.