Welfare Reform on the Web (August 1999): National Health Service - Reform - Genaral

CLINICAL GOVERNANCE - MAKING IT HAPPEN

M. Lugon and J. Secker-Walker
London: Royal Society of Medicine, 1999.

Practical guide which describes all the inter-related elements that make up clinical governance. Covers organisational framework for clinical governance, patient expectations, clinical effectiveness and EBM, clinical audit, clinical risk management, claims management, how to handle complaints, legal aspects of clinical governance, the role of the medical director and integrated care.

CLINICAL GOVERNANCE IN DEFINITION AND PRACTICE.

J. McFadyen and C. Armitage
British Journal of Health Care Management, vol. 5, 1999, p. 145-147

Article seeks to define the concept of clinical governance and determine its core principles. Clinical governance enshrines the principles of integrity, honesty, equability, efficiency, effectiveness, accessibility, acceptability and appropriateness.

COLLABORATION BETWEEN HEALTH AND SOCIAL CARE: COTERMINOSITY IN THE 'NEW NHS'

M. Exworthy and S. Peckham
Health and Social Care in the Community, vol. 7, 1999, p. 229-232

Article defines coterminosity as the alignment of organisational boundaries between health and social care agencies. Then reviews recent policy changes towards it and interprets the role that it might play in the future. Concludes that coterminosity offers an important contribution, especially at local levels, but is insufficient in resolving all inter-agency issues.

COLLABORATION IS CRUCIAL FOR NEW TYPE OF MANAGER SAYS TASKFORCE

P. Healy
Health Service Journal, vol. 109, May 13th 1999, p. 6-7

Ministers are being urged to spearhead a leadership drive to create NHS managers with the skills to work in a 'collaborative and involving' environment. Key recommendations of the taskforce on staff involvement include promotion of good industrial relations, promotion of good practice through the NHS's website, investment in personal development, monitoring of performance and progress through NHS Executive Regional Offices, development and use of a self-assessment tool for NHS bodies and contractors to encourage more staff involvement, and development of local statements of staff rights and responsibilities.

DISTILLING THE ESSENCE OF PROFESSIONALISM

J. McFadyen and C. Armitage
British Journal of Health Care Management, vol. 5., 1999, p.191-193

Paper explores the contribution directors of clinical governance will be expected to make in terms of developing professionalism and monitoring quality in the field of mental health care.

DOCTORS CLAIM BETRAYAL OVER LONGER WORK HOURS

P. Newton, C. Hall and T. Helm.
Daily Telegraph, May 5th 1999, p. 1

Under the European Commission's proposals, Britain would be allowed a 7 year transition period to bring NHS junior doctors' hours in line with the 48 hour working week provided for under the Working Time Directive. During the transitional phase, junior doctors could work up to 54 hours. British officials have proposed alternative limits of 65 hours for the next eight years and 60 hours for the seven years after that.

(See also Guardian, May 5th 1999, p. 12; Independent, May 5th 1999, p. 9; Financial Times, May 5th 1999, p. 10)

FAIR GAME

A. Phillips
Health Service Journal, vol. 109, May 20th 1999, p. 26-27

Argues that doctors in the NHS are in a position of power over their colleagues and patients rather than one of partnership. NHS doctors wield enormous political clout in a system set up to ensure that doctors are unmanaged and unmanageable, and their demands are adhered to. While the balance of power lies with the doctors, no other voice is heard and anarchy reigns within the health service.

"FASTER ACCESS TO MODERN TREATMENT": HOW NICE APPRAISAL WILL WORK: A DISCUSSION PAPER

Leeds: NHS Executive, 1999.

For new interventions the NHS Executive and the Department of Health will arrange for intelligence to be gathered systematically. Companies developing interventions likely to have a significant impact on the NHS will be invited to submit research evidence. The appraisal process will then be carried out by a multi-professional appraisal group within NICE and with a dedicated Secretariat. Advice will then be issued directly to the NHS by NICE.

FROM THE MARGINS TO THE MAINSTREAM: THE PUBLIC HEALTH POTENTIAL OF MENTAL HEALTH PROMOTION

L. Friedli
International Journal of Mental Health Promotion, vol. 1, April 1999, p. 30-36.

A mental health promotion strategy can contribute to social cohesion and foster a sense of belonging, responsibility and overall mental well-being. Mental health needs will be met through repairing fragmented communities, through rebuilding the social and civic networks that enable people to live successfully in modern society.

PATIENTS MAY BE ASKED TO ASSESS THEIR DOCTORS

C. Hall
Daily Telegraph, May 25th 1999, p. 7

General Medical Council proposes that patients' opinions of their doctors should be canvassed to help ensure that all members of the medical profession remain competent.

RATIONING DEBATE: DOCTRINES AND DOGMAS. PART 1 - CLASHES BETWEEN THE ARG AND THE MILITANT UTILITARIANS.

R. Royce
British Journal of Health Care Management, vol. 5, 1999, p. 135-137

Article considers views on rationing of health care held by militant utilitarians and a small but vocal minority, the Anti Rationing Group (ARG). The latter believes in essence that rationing is unnecessary because the NHS wastes money. It it wasn't so inefficient there would be sufficient services to meet current patient demands. Militant utilitarians argue that the purpose of the NHS is to improve the health of the population (with health being defined as length and quality of life) and that the NHS budget should be allocated using the benefit principle (that patients should be prioritised in relation to their capacity to benefit from care per unit of cost).

RATIONING'S HOLY GRAIL: FAIR EXPLICIT CRITERIA.

R. Royce
British Journal of Health Care Management, vol. 5, 1999, p. 171-172

Explores the problems of balancing the needs of the many and the rights of the individual.

THE REALITIES OF RATIONING: 'PRIORITY SETTING' IN THE NHS

J. Spiers
London: IEA Health and Welfare Unit, 1999

Argues that rationing and scarcity are built into the structure of the NHS. It embodies the collectivist assumptions of the 1940s which have become increasingly irrelevant in the modern world. By removing the price mechanism and stifling competition, it has disenfranchised the patient as consumer in the face of an all-powerful producer. Proposes that the NHS be denationalised and given to local communities as charitable trusts along the lines of many hospitals in Europe. This would transfer responsibility for the renewal of assets from the public domain to local owners. A framework of regulation for quality and service would ensure standards while the state's role would be restricted to protecting freedom of local choice.

SOLD A PUP

C. Dabbs
Health Service Journal, vol. 109, May 20th 1999, p. 22-23

Community Health Councils have changed little since their inception in 1974. There are huge variations in their effectiveness. National policy is needed to set out their remit and lines of accountability. Future roles might be: 1) to scrutinise the commissioning and provision of health and social services, 2) to facilitate and co-ordinate the participation of lay people in the commissioning and provision of health and social services, 3) to scrutinise the impact of services, plans and proposals on public health, and 4) to facilitate effective citizen participation in improving public health and well-being.

TWO PLACES AT THE SAME TIME

D. Hunter
Health Service Journal, vol. 109, May 6th 1999, p. 14-15

Argues that the role and ethos of the Commission for Health Improvement need to be defined. Is it to be an inspectorate, monitoring performance on behalf of the wider society, or is it to have a supportive, developmental role in improving management performance?

UNION'S CONSTITUTION IS IN WEAKENING STATE

R. Hazell and P. Jervis
British Journal of Health Care Management, vol. 5, 1999, p. 183-189

Article outlines the constititutional frameworks within which the post-devolution health services will operate and identifiessome of the pressure points which may cause tension in the new devolved system. These include decision-making over medical education, financing of the NHS, terms and conditions of staff, relationships with the EU and other international issues. While commitment to a set of core values and principles will be shared by Health Services in England, Scotland and Wales, there is room for much greater experimentation and divergence in matters of organisation and management in the devolved system.

USE IT OR LOSE IT

R. Paxton
Health Service Journal, vol. 109, May 13th 1999, p. 27

The benefits of the NHS research and development strategy could be lost if its findings are not used to implement genuinely research-based practice.