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Welfare Reform on the Web (January 2003): National Health Service - Reform - General

ACCESS TO CARE: EAR, NOSE, THROAT AND AUDIOLOGY SERVICES

Audit Commission

London: 2002

Survey found wide variations in waiting times for ear nose and throat (ENT) treatments, which could not be explained by the level of GP referrals or by shortages of consultants. The wide differences appeared to be caused by administrative problems and differing prioritisation of cases among consultants.

ALL SYSTEMS GO

R. Dobson

Health Service Journal, vol 112, Nov 21st 2002, p11

On April 1st 2003 health authorities in Wales will be abolished and replaced by 22 local health boards. These will be coterminous with local authorities to facilitate joint working

ANY SPARE CHANGE?

J. Trueland

Health Service Journal, vol. 112, Nov 27th 2002, p.14

Through an interview with its director, article reports on the work of Scotland's new centre for change and innovation. This is the equivalent of England's NHS Modernisation Agency, and brings together two former units, which dealt with service redesign and management development.

APPRAISE WHERE DUE

A. Ledgard and others

Health Service Journal, vol. 112, Nov. 21st 2002, p.28-29

A study of consultant appraisal in Welsh trusts revealed concerns about lack of protected time and uncertainty about how issues raised should be handled. The research showed that it is important that issues raised are addressed by the organisation. Resources must also be made available to trusts to offer protected time for the process, and adequate training.

BACK TO SCHOOL

K. Bush and F. Kelly

Health Service Journal, vol. 112, Nov 28th 2002, p27-29

Describes the training and development programme for modern matrons put in place by East and North Hertfordshire Trust. Participants expressed a need to share experiences and develop leadership and team-building skills. Personality tests and receiving individual feedback were seen as helpful.

BUGS AND BLUNDERS "HARM ONE IN 10 PATIENTS"

R. Highfield

The Daily Telegraph, Oct 31st 2002 p1.

One patient in 10 who enters a British hospital ends up suffering "measurable harm" according to the World Health Organisation report World Health 2002.

CONSULTANTS REJECT MILBURN'S NHS REFORMS

P. Wintour and J. Carvel

The Guardian, November 1st 2002, p.4

The Health Secretary, Alan Milburn, is preparing to offer individual deals to meet waiting targets after NHS consultants overwhelmingly rejected the proposed new contract.

(See alsoThe Times, November 1st 2002, p.1; Financial Times, November 1st 2002, p.4; The Independent, November 1st 2002, p.4)

"DEEP-ROOTED RACISM" IN MERIT AWARDS FOR NHS CONSULTANTS

J. Carvel

The Guardian, November 7th 2002, p.13

A study by the Medical Practitioners Union has found evidence of deep-rooted institutional racism in the allocation of merit awards worth £250m a year to NHS consultants. White consultants were three times more likely than those from ethnic minorities to get distinction awards, which can add up to £62,815 a year to salaries.

THE EVALUATION HANDBOOK FOR HEALTH PROFESSIONALS

A. Lazenbatt

London: Routledge, 2002

This easy to use resource is aimed at health professionals involved in processes of evaluation in a variety of situations within the world of healthcare. It provides guidelines on how to design and evaluate an intervention; gives examples of good practice; identifies reliable and easy-to-use measures and provides advice on how to work effectively

FINDING YOUR FORM

K. Hansed

Health Service Journal, vol. 112, Nov 7th 2002, p.28-29

Ward staffing is the largest single component of acute trusts' budgets and should attract the attention of senior managers. Many trusts have inflexible arrangements which do not take account of patient dependency and skill mix. Trusts should consider employing more part-time staff and introducing more flexible working for ward clerks.

FREEZE FRAME

D. Carlisle

Health Service Journal, vol. 112, Nov 14th 2002, p.10-11

Suspension of NHS doctors is costly and leads to long drawn out proceedings. Cases often involve personality clashes, whistleblowing, and arguments over private practice earnings rather than incompetence.

THE FUTURE'S IN THE STARS

A. McLellan

Health Service Journal, vol. 112, Nov 21st 2002, p.18-19

Report of an interview with Dr P Homa, Head of the Commission for Health Improvement. Covers planning for the establishment of CHI's successor body, the Commission for Healthcare Audit and Inspection. Includes discussion of the evolutionary development of star ratings for hospitals based on measures of the patient experience and outcomes for particular diseases.

HEALTH POLICY IN WALES: DISTINCTIVE OR DERIVATIVE?

S. McClelland

Social Policy and Society, vol 1, 2002, p.325-333

Article looks at the impact of devolution on health policy in Wales. The NHS in both Wales and England remains dominated by hospitals, and appears to be in crisis due to long waits for treatment.

HOSPITALS ARE FAILING HEART ATTACK VICTIMS

S. Boseley

The Guardian, November 20th 2002, p.8

Three quarters of hospitals in England are failing to give heart attack victims fast enough life-saving care, according to the first audit of their performance. The audit, by the Royal College of Physicians, claims only 33 out of 214 hospitals met all the targets laid out in national service framework for coronary heart disease.

HOSPITALS "WOULD NOT COPE WITH CHEMICAL ATTACK"

B. Russell

The Independent, November 15th 2002, p.1

Large parts of the NHS would be unable to cope with a chemical, biological or nuclear terrorist attach, according to a National Audit Office report. Poor planning, inadequate training and a lack of specialised equipment has left many NHS trusts unprepared.

IMPROVEMENT, EXPANSION AND REFORM: THE NEXT THREE YEARS PRIORITIES AND PLANNING FRAMEWORK 2003-2006

Department of Health

2002

This key policy document builds on strategies announced since new money was allocated to the NHS and social services in the 2002 budget. Priority services for improvement are those for cancer, coronary heart disease, mental health, older people and children. Introduces three year plans for health and social services instead of the current annual plan. The three-year planning process will include identifying targets, agreeing necessary capacity, determining specific responsibilities and monitoring progress. National priorities and targets will be the basis of local delivery plans created by primary care trusts in collaboration with local authorities. Each organisation will have its own system for monitoring and performance management.

IN THE LOOP

L. Eaton

Health Service Journal, vol. 112, Nov 28th 2002, p.12-13

In order to improve communication with patients, by April 2004 the government wants them to receive copies of all correspondence between doctors about their case. This could prove costly in terms of administration and postage, and will require doctors to compose letters more carefully.

IS IT TIME LHCCs STARTED THROWING THEIR WEIGHT AROUND?

A. Scott and S. Simoens

Primary Care Report, vol 4, Nov 13th 2002, p.36, 38-39

Local health care co-operatives in Scotland are likely to face further integration in 2003 as services are restructured to mesh primary and secondary care.

LAW SPECIAL REPORT

Health Service Journal, vol. 112, Nov 7th 2002, p.31-37

Discusses alternatives to litigation over claims for clinical negligence. These include fixed tariffs, non-financial compensation such as daily nursing visits, and a move away from lump sum awards to "structural settlements" under which people would receive a smaller lump sum plus regular annual payments. Subsequent articles cover Arnold Simanowitz's career as medical accident victims' champion and the impact of the Dignity at Work Bill.

LOCAL HEALTH GROUPS GIVE GREEN LIGHT TO WELSH SHAKE-UP

M. Pownall

Primary Care Reports, vol. 4, Oct 30th 2002, p.14-15

Strategies for implementing Improving Health in Wales should be agreed by Local Health Groups (Local Health Boards from 2003) and local authorities and in place by the end of 2004. The strategies will cover:

  • economic development;
  • agriculture and rural affairs;
  • training and education;
  • health and social care;
  • transport and the environment;
  • culture;
  • the arts;
  • sport;
  • communities;
  • housing.

Article discusses progress to date.

LOCAL PEOPLE TO RUN ELITE HOSPITALS

D. Charter and R. Bennett

The Times, November 14th 2002, p.1

Patients will be urged today to become co-owners of the best performing NHS hospitals under plans to let local people take control. Everyone who wants to become involved in running "foundation hospitals" will be issued with a membership card. The hospitals will be governed by a council elected by local people and NHS staff. The Health Department will relinquish control.

LOOKING THE WRONG WAY

M. McIsaac and J. Dix

Health Service Journal, vol. 112, Oct 31st 2002, p.31

Clinical networks, in which professionals work across organisational boundaries to improve services are a key part of the government's modernisation programme. In order for them to work effectively, existing NHS organisations will need to cede some of their power and control of services.

MENTAL HEALTH AND EMPLOYMENT IN THE NHS

Department of Health

London: Department of Health Publications, 2002

Guidance provides advice to NHS employers on the retention and future employment of people with mental health problems with a view to rooting out discrimination.

MILBURN DELAYS SURGEON AND CONSULTANT REFORMS

N. Timmins

Financial Times, November 26th 2002, p.4

The fire-fighters dispute has put back plans by Alan Milburn, the Health Secretary, to announce a new junior consultant grade and of other incentives to surgeons to clear National Health waiting lists.

MINUTE STAKES

A. McGauran

Health Service Journal, vol 112, Oct 31st 2002, p.12-13

The phased implementation of the EU working Time Directive is leading to a reduction in junior doctors hours of work. The shortfall could be made up by increasing consultants' hours, use of non-qualified personnel such as surgeon's assistants, and employment of more specialist registrars.

MODERNISING PATIENT AND PUBLIC INVOLVEMENT IN THE NHS

B. Sang

British Journal of Health Care Management, vol 8, 2002, p.380-385

Discusses the new structures which the government has put in place to ensure NHS accountability to local communities. Central to the reforms are the creation of a national Commission for Patient and Public Involvement in Health and the implementation of local Patients' Forums. These will facilitate active public participation in the planning of services, monitoring and scrutiny, and service redesign.

MONITORING NATIONAL CLINICAL OUTCOMES: A CHALLENGING PROGRAMME

A Vallance-Owen and S. Cubbin

British Journal of Health Care Management, vol. 8, 2002, p.412-417

Article considers the challenges involved in implementing a national clinical outcomes programme. Proposes the Short Form-36 (SF-36) questionnaire as a suitable tool. A national programme to monitor clinical effectiveness in the independent sector using SF-36 was introduced by BUPA in 1998. Data are collected from patient completed SF-36 questionnaires before and three months after elective surgery. Principle obstacles to introducing the programme were:

  • resource implications;
  • data presentation;
  • consultant attitude;
  • tool selection.

A NASTY KICK IN THE BALLOTS

A. McLellan

Health Service Journal, vol. 112, Nov 14th 2002 p.18-19

Reports interview with Dr Ian Bogle, Chair of the British Medical Association, on the ramifications of the recent rejection by hospital consultants of a proposed new employment contract. Argues that the contract was rejected because doctors feared being forced by managers to work unsocial hours to meet government targets, and not for the overall benefit of patient care.

NEW MODEL ARMY

T. Shifrin

Health Service Journal, vol. 112, Oct 31st 2002, p.10-12

Service reconfiguration is synonymous in the public mind with loss of hospitals and is deeply unpopular. Article outlines various approaches to finding sustainable solutions for local hospitals in the face of centralising pressures. arising from safety concerns and the impact of the EU Working Time Directive on staffing.

NEW PUBLIC MANAGEMENT AND THE THATCHER HEALTHCARE LEGACY: ENOUGH OF THE THEORY, WHAT ABOUT THE IMPLEMENTATION?

P. Cairney

British Journal of Public and International Relations, vol 4, 2002, p. 375-398

Article challenges the widely held view that Margaret Thatcher's healthcare reforms were unsuccessful because they failed to challenge the autonomy of the medical profession. Argues that the reforms resulted in the successful, long-term implementation of the purchaser-provider split within the NHS. The increasing use of the purchasing function to minimise individual clinical autonomy demonstrates a power shift from clinical provision to financial demand. A case study of the implementation of AIDS policy in Lothian is used to illustrate the effects of the introduction of the internal market.

NHS MANAGERS' NEW CODE OF PROFESSIONAL CONDUCT

A. Wall

British Journal of Health Care Management, vol 8, 2002, p.418-419

The Department of Health's new Code of Conduct for NHS Managers is reviewed and crucial differences from the Institute of Healthcare Management code are considered. The new code attempts to reconcile good conduct with accountability to the government of the day, a dilemma which it imperfectly resolves.

NHS SCHOLARSHIP TO BE OFFERED TO YOUNGSTERS FROM POOR HOMES

J, Carvel

The Guardian, November 22nd 2002, p.7

The NHS will offer scholarships to 14 to 16 year-olds from poor homes to encourage young people to consider a career in the health service. The government will start by offering 3,000 secondary students each year the chance of work experience in hospitals and GP surgeries.

NORTH-SOUTH DIVIDE IN PATIENT CARE REVEALED

N. Timmins

Financial Times, Nov 28th 2002, p.4

The Commission for Health Improvement has found, based on its first 175 inspections, that hospitals in the North and Midlands offer better patient care that those in London and the South. This could be due to staff recruitment difficulties in the South. The Commission also found that learning tended not to be shared across organisations.

NORTHERN LIGHTS

L Jackson

Guardian Society, November 27th 2002 p.2-3

Article asks why patients in the North of England and the Midlands can expect better healthcare despite budget constraints and staff shortages facing most NHS trusts. It reports on the CHI's (Commission for Health Improvement) findings, from inspections it has carried out at 175 NHS trusts, that there is a clear geographical difference in the quality of care because hospital trusts in the North are more willing to embrace innovative ideas.

NURSING AND THE DIVISION OF LABOUR IN HEALTHCARE

D. Alten and D. Hughes et al

Basingstoke: Palgrave Macmillan, 2002

By examining the division of labour between nurses and other health professions and occupations this book connects sociological concerns with practical problems affecting the contemporary NHS. It illustrates points using case studies.

PATHOLOGY LABS "FACE CASH AND RECRUITMENT CRISIS"

J. Melke

The Guardian, November 20th 2002 p.8

Patient's lives will be put at risk because of a recruitment and funding crisis within the NHS laboratory services responsible for identifying and monitoring diseases.

SCANDAL OF NHS AND THIRD WORLD NURSES

J. Laurance

The Independent, November 26th 2002 p.1

Britain has broken its pledge to halt the recruitment of nurses from developing countries to shore up the NHS, figures from the Nursing and Midwifery Council reveal.

(See also The Independent, November 26th 2002, p.18)

SHORTER DOCTORS' HOURS LEAD TO MORE DEATHS, SAYS STUDY

J. Laurance

The Independent, November 12th 2002, p.8

Serious lapses in the care of patients including missed diagnoses, drug errors and a lack of intensive care are identified in a report by the National Confidential Inquiry into Perioperative Deaths. The report, reviewing 20,000 deaths after surgery, concludes that modern ways of working, with shorter hours and shift systems, mean that doctors are becoming 'transient acquaintances' of patients during their illness, undermining continuity of care and contributing to unnecessary deaths.

STRONG-ARM TACTICS

J. Davies

Health Service Journal, vol 112, Nov 21st 2002, p.24-27

Describes the work of NHS workforce development confederations. These are partnership organisations which consist of local NHS bodies, social services departments, voluntary sector employers, education institutions, learning and skills councils and government bodies with a health provider role. They aggregate NHS and other health and social care employers' workforce plans and make sure they align closely with service planning. In so doing they work closely with the seven multi-agency care group workforce teams which support integrated service and workforce development in the areas of cancer, child and maternity services and coronary heart disease.

SUSPENDED ANIMATION

J. Traynor

Health Service Journal, vol 112, Oct 24th 2002, p.17-18

There are fears that the suspension of the Northern Ireland Assembly may lead to urgent health service reforms being put on ice.

TAKE ME TO YOUR LEADER

A. Cole.

Health Service Journal, vol 112, Nov 28th 2002, p.24-29

Reports that government plans to reintroduce the post of matron in NHS hospitals have been greeted with enthusiasm and are proceeding ahead of schedule. Modern matrons support ward sisters in improving the quality of care at ward level. Presents a number of case studies showing how the role of modern matrons is being developed on the ground.

web link TOOLKIT FOR PRODUCING PATIENT INFORMATION (PDF format)

Centre for Health Information Quality

2002

Information is an important part of the patient journey through the NHS. This toolkit has been produced to help organisations improve patient information.

[NB: the above link is to Version 2.0, 2003]

UNDER PRESSURE

A. McLellan

Health Service Journal, vol. 112, Nov 7th 2002, p.11-13

Report of an interview with Prime Minister Tony Blair in which he sets out his views on pay modernisation, foundation trusts, primary care trusts, and the rejected consultants contact.

WHAT'S IN A NAME?

S. Ward

Public Finance, Nov 1st-7th 2002, p.26-27

Twenty-six health action zones were established in England in 1998-99 with the aim of tackling health inequalities and modernising services in areas of deprivation. Their work is now to be "mainstreamed", probably by incorporating their activities into primary care trusts or the council-led Local Strategic Partnerships

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