Welfare Reform on the Web (November 2002): National Health Service - Reform - General
AVERAGE LENGTH OF STAY, DELAYED DISCHARGE AND HOSPITAL CONGESTION
D. Black
British Medical Journal, vol. 325, 2002, p. 610-611
Most of the answers to the complex problems of delayed discharge lie in combined medical and managerial approaches at local level that result in realistic and achievable recommendations within clear national planning. The challenge is to ensure the framework, incentives and resources are in place to allow such partnerships to flourish. The National Service Framework for Older People could help by providing leadership and the right incentives.
BREAKING DOWN IN TIERS
T. Shifrin
Health Service Journal, vol. 112, Aug. 22nd 2002, p. 11-12
Reports on opposition from unions and local MPs to a possible application from University College Hospital for foundation trust status. There are concerns that this could lead to UCH leaching personnel from other local hospitals because it can pay them more, and to the ruin of partnership working.
THE CANCER PLAN TWO YEARS ON
C. Lewis
Health Service Journal, vol. 112, Sept. 12th 2002, p. 29-34
Reviews progress in implementing the government's plan for improving cancer services. Waiting times for radiotherapy and radiology have lengthened due to increased demand and delays in replacing out-of-date equipment. There have also been problems with money intended for cancer services being diverted to cover existing debts and deficits. However, the introduction of cancer networks is leading to improved multidisciplinary working and better co-ordination of services across organisational and geographic boundaries. At the same time the Cancer Services Collaborative is having success in encouraging the redesign of services.
DEFENCE MECHANISMS
D. Carlisle
Health Service Journal, vol. 112, Sept. 26th 2002, p. 16
The government's high-profile bid to bring teams of overseas doctors to the UK to increase NHS capacity has stalled. This is due to consultant opposition, shaky economics, and lack of capacity in the NHS to do the extra treatments.
DENTISTRY: PRIMARY DENTAL CARE SERVICES IN ENGLAND WALES
Audit Commission
Audit Commission Publications, 2002
Report criticises poor access to NHS dental services in some areas, failures of the existing remuneration system and waste of resources on inappropriate activity such as scaling and polishing.
DOBSON STEPS UP ATTACK ON NHS PLANS
L. Ward and A. Perkins
Guardian, Sept. 13th 2002, p. 6
Former Health Secretary Frank Dobson has criticised plans to allow top-performing hospitals freedom from central control. He argues that the policy will create a two-tier NHS with successful hospitals able to poach staff from poorly performing neighbours, as well as spending more on better equipment.
E-NOVATION
Heath Service Journal, vol. 112, Sept. 26th 2002, Supplement. 24p
Looks at the impact of the electronic entitlement cards being proposed by the government on access to NHS treatment. Goes on to discuss the development of web-based electronic patient records, use of Voice over IP as an alternative method of delivering telephone services, and the planned introduction of a national finance and e-commence service.
HIGHER STAFF TURNOVER HITTING NHS, STUDY WARNS
N. Timmins
Financial Times, Sept. 6th 2002, p. 2
A study by the Kings Fund has warned that the National Health Service (NHS) hospitals in Central London are losing nursing staff at a rate of 38 per cent a year. This trend is pushing up costs, increasing workloads for staff, lowering morale and could affect patient care.
HITTING THE WALL
P. Smith
Health Service Journal, vol. 112, Sept. 19th 2002, p. 11-12
Discusses why it is proving so difficult to achieve a sustained, long-term reduction in waiting lists/times in the NHS. Apparent short term gains may be due to manipulation of the figures. Long term reductions may be elusive because any increased capacity in secondary care simply encourages more GP referrals.
HOSTILE ENVIRONMENT
T. Shifrin
Health Service Journal, vol. 112, Sept. 26th 2002, p. 10-14
Discusses how chief executives of NHS trusts are coping with the pace of reform, managing performance and hitting government targets. In order to meet centrally set targets, many are reverting to "command and control" style management.
HOW NURSES THE NHS NEEDS ARE ENTANGLED IN RED TAPE
J. Carvel
Guardian, Sept. 9th 2002, p. 9
Reports on the delays experienced by foreign nurses applying to the Nursing and Midwifery Council for registration to work in the UK. There is currently a backlog of 6,800 applications from overseas nurses who are desperately needed to ease staff shortages in the NHS.
IN A DAY'S WORK
P. Stephenson
Health Service Journal, vol. 112, Aug. 29th 2002, p. 9-10
Reports government plans to open 10 more fast-tack diagnosis and treatment centres and to expand day surgery to cover 75% of elective work.
JUST THE TICKET
A. Moore
Health Service Journal, vol. 112, Sept. 19th 2002, p. 22-25
Presents a series of case studies of patients sent abroad for treatment at NHS expense.
MAKE OR BREAK TIME? A COMMENTARY ON LABOUR'S HEALTH POLICY TWO YEARS INTO THE NHS PLAN
K. Calman, D. J. Hunter and A. May
Durham: University of Durham School for Health, 2002
Argues that the current use of traditional command-and-control mechanisms for management and regulation of the NHS is actually undermining the conditions for change. The government's costly structural reforms are continually diverting managers and professionals away from their key task of delivering high quality health care. The changes in culture and behaviour needed to create a 21st century health service require a climate of continuous learning, feedback and improvement. The NHS is a complex, interconnected system and imposing targets from the centre is likely to produce unintended consequences.
MANAGING AND LEADING INNOVATION IN HEALTH CARE
E. Hawkins, C. Thornton and S. Mullally (eds)
London: Bailliere Tindall, 2002
Focusing on the importance of leadership and innovation for effective nursing practice, this book looks at the cultural shift that is needed to drive the modernisation of healthcare in the UK.
MANAGING AND MARKETING HEALTH SERVICES
A. Laing et al
London: Thomson, 2002
This book provides a critical overview of the key challenges facing health care policy makers. It looks at the service design process, the management of inter-organisational relationships, understanding health care consumers and evaluating service quality in the context of the NHS.
MINISTERS APPOINT CLOSE ADVISER TO END A&E CHAOS
J. Laurance
Independent, Sept. 11th 2002, p. 4
The government has appointed Sir George Alberti, former president of the Royal College of Physicians, as national service manager to improve access to emergency medical care.
(See also Times, Sept. 11th 2002, p. 3)
NATIONAL SUICIDE PREVENTION STRATEGY FOR ENGLAND
Department of Health
London: Dept. of Health Publications, 2002
Strategy aims to cut deaths by suicide by 20% by 2010. Recommendations include widespread advertisement of helpline phone numbers, restricting GP prescriptions of anti-depressants to two weeks' supply, and ensuring that patients at risk are seen by a health professional within seven days of discharge from hospital. Training, support and research programmes are also planned including improved monitoring of suicide rates.
NURSE RECRUITMENT STILL ON TARGET, BUT AT WHAT COST?
C. Deeming
British Journal of Health Care Management, vol. 8, 2002, p. 334-335
The recruitment of 20,000 more nurses was a key objective of the NHS Plan. It has been achieved by plundering the nursing resources of developing countries.
PHARMACEUTICAL INDUSTRY: FRIEND OR FOE?
J. Cornell, N. Kelly and R. Wilson
British Journal of Health Care Management, vol. 8, 2002, p. 336-340
Article considers the successful partnership between Doncaster Health Authority and two major pharmaceutical companies. Concludes that true partnerships between the NHS and the pharmaceutical industry can work but require: 1) explicit probity and contractual agreements; 2) open and honest acknowledgement of the needs of all parties; and 3) a working relationship based on trust.
PROGNOSIS FOR PAPERLESS PRACTICE IN PATHOLOGY
S. Pattinson
British Journal of Health Care Management, vol. 8, 2002, 341-344
Article explores ways in which IT modernisation in pathology services can help to directly improve patient care. Pathology is central to the delivery of NHS priorities, as 60-70% of diagnoses are based on pathology results. Many IT focused initiatives are currently under way to ensure more efficient and secure exchange of pathology results through electronic transfer.
RECORD MAKERS
J. Hoeksma
Health Service Journal, vol. 112, Aug. 22nd 2002, p. 12-13
The Department of Health has set out an ambitious vision of integrated records services which would cover health and social care. The concept of electronic records is extended to include nationally defined clinical care pathways, complex resource scheduling, e-booking and e-prescribing. A patient's records should be available to all authorised health and social care providers, and their progress along a care pathway should mean the automatic scheduling of required resources and events such as tests and appointments. Article reports professional's doubts about the feasibility of the proposals.
REDESIGN FOR LIFE
S. Killigrew
Health Service Journal, vol. 112, Aug. 22nd 2002, p. 26-27
The success of the government's modernisation agenda in the NHS will depend on services being considered from the point of view of the patient journeying through the system. Restructuring organisations does not, on its own, improve care. Services cannot be improved without the involvement of staff who may well be demoralised by constant organisational upheavals.
REGISTER RULES
C. Harris
Health Service Journal, vol. 112, Aug., 22nd 2002, p. 14-15
The newly launched Health Professionals Council is developing new rules for regulating the professionals allied to medicine. The new regulations are likely to include a requirement for continuing professional development for those on the register. There are concerns about delays in processing registration application and a likely hike in fees.
STARS OF WONDER
D. Dawes
Health Service Journal, vol. 112, Sept. 12th 2002, p. 26-27
Analysis of acute trusts that have changed their star rating over the past two years indicates that a change of chief executive was not a significant factor. The length of time in post and the experience of the chief executive were also insignificant. These findings have serious implications for the theory that franchising out the management of failing trusts would immediately improve performance. Holding chief executives to account for the organisation's performance within their first 12 months in post is unlikely to be effective.
STRATEGIC HEALTH AUTHORITIES: THE SHAVIOURS OF IT?
N. Bosanquet and R. Kitney
British Journal of Health Care Management, vol. 8, 2002, p. 331-333
Article argues that the new strategic health authorities will have a key role in the co-ordination and management of IT modernisation in the NHS. System compatibility is essential, but local motivation is also vital for successful IT implementation. The Strategic Health Authority could become a key player through the local action plan. The key issue in modernising the IT infrastructure is not technical but raising local motivation.
A SUITABLE CASE FOR TREATMENT
R. Siddall
Health Service Journal, vol. 112, Aug. 22nd 2002, p. 16
Reports that in its final recommendations the National Institute for Clinical Excellence has authorised the use of the drug Glivec for the chronic as well as the accelerated phases of myeloid leukaemia. This decision has been applauded by doctors and patients, and overturns the previous provisional recommendation that the drug should be used for the accelerated phase only. This was likened to calling the fire brigade when the house was already ablaze.
TORY PLEDGE TO BREAK NHS MONOPOLY ON STATE CARE
D. Hencke
Guardian, Sept. 24th 2002, p. 8
The Conservative spokesman for health, Liam Fox, has pledged the party to break the monopoly of the National Health Service so hospitals in both private and public sectors can compete for patients.
TREATMENT FOR RARE ILLNESSES THREATENED BY NHS CHANGES
N. Hawkes
Times, Sept. 20th 2002, p. 8
There are concerns among health charities that the new primary care trusts will omit to commission specialist services from hospitals for rare illnesses. An unpublished Department of Health review also shows that little progress has been made in planning for the commissioning of specialist services such as dermatology or endocrinology under the new system.
UNFINISHED BUSINESS: PROPOSALS FOR REFORM OF THE SENIOR HOUSE OFFICER GRADE
L. Donaldson
London: Dept. of Health, 2002
Proposes that all doctors should have an integrated and planned two-year foundation programme of general training in core skills. The first year would equate to the current pre-registration year. The second year would build on the first by providing further generic training. During their second year, trainees would compete to enter broadly-based, time-limited specialist training programmes, including one for general practice. This would lead to the award of an earlier Certificate of Completion of Specialist Training (CCST) for those who successfully completed a course in the "generalist" elements of their speciality. They could then apply for a consultant post, for example in general paediatrics or internal medicine.
VETTING CHAOS HITS HOSPITALS
S. Womack and L. Lightfoot
Daily Telegraph, Sept. 4th 2002, p. 1
Article reports that hospitals, social services and care homes are all being affected by the backlog in police checks at the Criminal Records Bureau.
WHO'S GOT THE MASTER CARD
R. Robinson
Health Service Journal, vol. 112, Sept. 26th 2002, p. 22-24
The last decade has seen huge shifts away from the command and control model which dominated health policy from the foundation of the NHS. The current Labour government initially favoured a system based on collaboration and partnership working but the incentives to achieve this were not sufficiently strong. Competition is now openly cited as being the driver for improved performance. Political demands mean that command and control are likely to remain key features of government health policy. This, however, will place major limits on the local autonomy pledged by the government.