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

BACK-SEAT DRIVER

S. Grant

Health Service Journal, vol. 113, July 24th 2003, p.18-19

The new chair of the British Medical Association, Dr James Johnson, gives his views on the new consultant contract, government targets for the NHS, foundation hospitals and service funding.

BEAT THE CLOCK

N. Edwards

Health Service Journal, vol.113, July 10th 2003, p.24-25

Report of an interview with Professor Carol Black, president of the Royal College of Physicians, covering the impact of the European Working Time Directive on junior doctors' hours, the rejected consultants contract and engaging doctors with targets.

BLAIR'S MAJORITY SLUMPS TO 35 IN HOSPITALS VOTE

M. White

The Guardian, July 9th 2003, p.2

The government last night saw its Commons majority collapse to 35, after Labour backbenchers joined forces with the opposition in an attempt to block NHS foundation hospitals.

(See also The Independent, July 9th 2003, p.8; The Times, July 9th 2003, p.1; The Daily Telegraph, July 9th 2003, p.1)

BMA HEAD ATTACKS WAITING LIST POLICY

J. Carvel

The Guardian, July 1st 2003, p.5

The leader of Britain's 124, 000 doctors warned Tony Blair yesterday that the government would not be able to keep its promise to cut the maximum waiting time for an NHS operation to six months by 2005 without causing unnecessary suffering to the sickest patients.

(See also The Independent , July 1st 2003, p.6; The Daily Telegraph, July 1st 2003, p.2)

DIVIDED CARE AND THE THIRD WAY: USER INVOLVEMENT IN STATUTORY AND VOLUNTARY SECTOR CANCER SERVICES

J. Q. Tritter and others

Sociology of Health and Illness, vol.25, 2003, p.429-456

Paper presents initial findings from a three-year study of user involvement in cancer services. Using both case study and survey data, authors explore the variation in the definition, aims, usefulness and mechanisms for involving users in the evaluation and development of cancer services across three health authorities in the South West of England. The findings have important implications for understanding shifts in power, autonomy and responsibility between patients, carers, clinicians and health service managers.

DON'T LOOK NOW

L.Whitfield

Health Service Journal, vol.113, July 24th 2003, p.12-13

Reports views of NHS IT professionals on the current modernisation programme. This will hand out national contracts for network improvements, electronic prescribing, booking and records, and, in addition, five contracts for local service providers to improve IT on the ground.

ENDING PENDING

H. Mooney

Health Service Journal, vol.113, July 17th 2003, p.14-15

Reports on the widespread anger and confusion over the patchwork of provision for patient involvement in NHS decision-making, monitoring and scrutiny that will replace Community Health Councils when they are abolished in December 2003.

EQUAL ACCESS TO HEALTH CARE AND THE BRITISH NATIONAL HEALTH SERVICE

M. Powell and M. Exworthy

Policy Studies, vol.24, 2003, p.51-64

Argues that the NHS has always paid lip service to the principle of "equality of access for equal need", but few policies have aimed to achieve this in any meaningful sense. Prior to 1997 policies were largely concerned with equality of geographical provision, with some later moves towards equal expenditure for equal need. Under new Labour, policies stress both fair access and a more ambitious aim of reducing health inequalities. However little attention has been paid to issues such as which variations are unacceptable, how much variation should be tolerated, and the potential trade-offs between concepts such as equity and efficiency.

EU LAWS WILL BRING CHAOS TO HOSPITALS, SAY DOCTORS

C. Hall

The Daily Telegraph, July 14th 2003, p.7

Hospitals will grind to a halt when European rules on young doctors' working hours come into force next year, the British Medical Association has warned. Thousands of hours will be lost when 40,000 junior doctors switch from a 72-hour week to a 58- hour week in line with European Working Time Directives which come into force in August 2004

(See also The Independent, July 14th 2003, p.6)

EXCHANGE VISIT

T. Goodfellow and M. Patel

Health Service Journal, vol. 113, July 24th 2003, p.32-33

In order to improve its cancer services, an NHS trust organised an on-going visiting/research programme with two New York institutions. Notable strengths of the US services were greater resourcing and influence of clinicians, better pathway design and increased IT investment. Specific recommendations for the trust include more clinical nurse specialists, more emphasis on research for clinicians and better communication within the network.

FOUR TRUSTS CUT FROM FOUNDATION HOSPITAL LIST AFTER MISSING TARGETS

J. Laurance

The Independent, July 16th 2003, p. 4)

Four NHS trusts were removed from the shortlist for the first wave of foundation hospitals after failing to make the grade in league tables. Each of the four - Aintree, Walsall, Newcastle upon Tyne and Essex Rivers - slipped from the three stars needed for foundation status after missing targets. The trusts questioned the basis of the judgement.

(See also The Guardian, July 16th 2003, p. 10; The Daily Telegraph, July 16th 2003, p.8)

FRONT MAN

S. Grant

Health Service Journal, vol.113, July 31st 2003, p.14-15

The front line forum initiative will attempt to sell the NHS modernisation agenda to clinicians. Members of the NHS Modernisation Agency will team up with national and local health service leaders to hold a series of around 100 meetings across the country over the next two years.

THE FUTURE HEALTH WORKER

L. Kendall and R. Lissauer

Institute for Public Policy Research, 2003

Calls on government to lose its obsession with structural change in the NHS and concentrate instead on transforming working practices. It recommends:

• patient-professional contracts to help people take control of their own health;
• developing new roles for existing staff such as that of consultant pharmacist and new types of professional working across traditional boundaries by generic "healthcare practitioners";
• reviewing whether doctors' pay negotiations should be included in "Agenda for Change".

GOVERNING THE NHS: A GUIDE FOR NHS BOARDS

NHS Appointments Commission

2003

Guidance aims to reinforce the importance of good governance and leadership in a time of major NHS reform. Covers:

• the duty of NHS boards;
• the role of the Chair, the non-executives and the Chief Executive;
• board committees;
• the role of the inspectorate and regulatory systems;
• the role of the Appointments Commission.

HEALTH DEPARTMENT ADMITS RATINGS ERRORS

J. Burns

Financial Times, July 18th 2003, p.5

The Department of Health has been forced to apologise to two NHS trusts whose performance was appraised on the basis of mistaken data. The two trusts - Chelsea and Westminster Healthcare and Oxfordshire Learning Disability - have been given three stars, which could make them eligible for foundation status after earlier being

given ratings of two stars and one star respectively.

HOSPITALS SET TO FACE SNAP INSPECTIONS IN SHAKE-UP

N. Timmins

Financial Times, July 17th 2003, p. 4

Hospitals are set to face snap visits in a radical change to the way the National Health Service is inspected. The Commission for Healthcare Audit and Inspection - which in April 2004 is due to take over inspection of all NHS organisations- aims in time to drop the routine, four yearly inspections of NHS hospitals and bring in a "much more targeted and focused approach" aimed at health providers setting their own targets for improvement.

AN INSPECTOR CALLS

P. Smith

Health Service Journal, vol.113, July 3rd 2003, p.26-28

Describes the process of a Commission for Health Improvement inspection using Oxleas Trust as a case study.

MAKING AMENDS: A CONSULTATION PAPER SETTING OUT PROPOSALS FOR REFORMING THE APPROACH TO CLINICAL NEGLIGENCE IN THE NHS

Chief Medical Officer

London: Department of Health Publications, 2003

The report describes the origins, strengths and weaknesses of the present system of medical litigation, analyses the issues and concerns which arise from the present arrangements and sets out proposals for reform. These aim to ensure that:

• the emphasis of the NHS is on preventing harm, reducing risks and enhancing patient safety;
• there is a better co-ordinated response when harm resulting from health care does occur, including investigation, support, remedial treatment where needed and fair recompense;
• the system for providing redress acts as an incentive on health care organisations and their staff to improve quality of care and patient safety.

MPs ATTACK LABOUR'S TARGET-SETTING CULTURE

N. Timmins

Financial Times, July 22nd 2003, p.3

The target-setting culture at the heart of government needs "root and branch" reform to stop it from leading to professional demoralisation, cheating over figures and perverse incentives, MPs said yesterday. A critical report by the Commons Public

Administration Committee called for the number of targets to be reduced and for more emphasis on key outcomes.

(See also The Times, July 22nd 2003 P.1; The Daily Telegraph, July 22nd 2003, p.9; The Guardian, July 22nd 2003, p.6)

NATIONAL HEALTH SERVICE REFORM (SCOTLAND) BILL

Edinburgh: TSO, 2003 (SP bill;6)

The key provisions in the Bill would:

• remove NHS trusts;
• establish new community health partnerships;
• place a duty on Health Boards to involve the public more closely in planning, developing and operating the NHS;
• set up a new Scottish Health Council;
• oblige Health Boards to co-operate in improving regional planning of health services;
• give ministers more powers to intervene in failing services;
• give ministers and Health Boards a new, direct responsibility for public health.

NHS HOSPITALS TO MARKET SERVICES TO PATIENTS

N. Timmins

Financial Times, July 14th 2003, p.3

National Health hospitals are likely to start advertising for business as the health service gives patients the right to choose which hospital to go to for routine surgery. The big debate is currently foundation hospitals but confidential findings from the Health Department's Strategy Unit concludes that it is the introduction of choice, and a bigger mix of public and private providers, that will have "profound consequences for the management of health services in England and Wales"

NHS RANKS 'BETWEEN SLOVENIA AND POLAND FOR PATIENT CHOICE'

J. Laurance

The Independent, July 7th 2003, p.2

The biggest survey of public attitudes to health across Europe has found that Britain's NHS is among the worst for offering choice to patients, ranked seventh out of eight.

NHS TELLS PATIENTS TO CHANGE LIFESTYLE

J. Meikle

The Guardian, July 24th 3002, p.9

The first official guidance requiring doctors to advise patients to change their lifestyle was published yesterday. People with chronic heart failure must be told to play their part in managing the disease by giving up smoking, exercising regularly and abstaining or cutting down on alcohol, according to recommendations for treating the condition of 750,000 people. The national institute for clinical excellence (NICE), went further than any government body so far in suggesting that patients had a responsibility to make lifestyle changes to help professionals manage progressive diseases.

NO HOLDING BACK

K. Walshe

Health Service Journal, vol.113, July 10th 2003, p.18-19

Discusses the impact of the creation of foundation hospitals on the NHS. Foundation hospitals will bring an end to the centrally controlled health service. Healthcare will be state funded, but delivery will be in the hands of a diverse set of local institutions, free from direct government control.

ONE EYE ON HEALTH

A. Coleman

Community Care, June 19th-25th 2003, p.36-37

From January 2003 local authorities with social services responsibilities have had the right to scrutinise NHS bodies. Article discusses how this is working out in practice.

OVERVIEW AND SCRUTINY OF HEALTH: GUIDANCE

Department of Health

London: 2003

Guidance sets out the legal powers of local authority overview and scrutiny committees with regard to the NHS and the duties on the NHS to support those powers. It also offers good practice guidance on undertaking the scrutiny process in the context of health and social services.

PATIENT CHOICE "GAMING" LEAVES NHS BEDS EMPTY

D. Carlisle

Health Service Journal, vol.113, July 24th 2003, p.5-6

The new patient choice scheme is leaving hospitals with empty beds as consultants refer patients to private practice. In other areas hospitals are concerned that new independent Diagnostic and Treatment Centres will siphon off high volume, low complexity work, leaving them with spare capacity.

PATIENT RECORDS GO ON DATABASE

N. Hawkes

The Times, July 21st 2003, p. 8

Personal medical information on 50 million people will be put on a new national NHS database, whether those affected give their consent or not. Details have of the design of the system have not been disclosed publicly, however a 600-page set of documents issued to IT suppliers makes it clear that nobody can opt out of the system, which is designed to computerise all NHS patient records.

PATIENTS TO CHOOSE THEIR NHS HOSPITAL

J. Carvel

The Guardian, July 17 th 2003, p.5

Within two years all NHS patients will be given a choice of a least four hospitals for any treatment recommended by a GP, under plans for a huge injection of consumer values into the health service. Dr John Reid, the Health Secretary, said this would be the start of a drive to give all NHS patients the same rights and priviledges as those able to buy treatment in the private sector. By December 2005, GPs will be using an electronic booking service, identifying the best local hospitals with the shortest waiting lists for any given treatment.

(See also The Times, July 17th 2003, p.1; Financial Times, July 17th 2003, p.4)

PATIENTS' VIEWS OF EXPLICIT RATIONING: WHAT ARE THE IMPLICATIONS FOR HEALTH SERVICE DECISION-MAKING?

N. Devlin, J. Appleby and D. Parkin

Journal of Health Services Research and Policy, vol. 8, 2003, p.183-186

Authors assess the validity of objections raised by the Multiple Sclerosis Society to the decision-making processes of the National Institute for Clinical Excellence (NICE), the body responsible for rationing NHS treatments. Five key issues were identified by the MS Society regarding NICE appraisals and guidance:

• they focus too narrowly on costs to the NHS;
• quality-adjusted life years are an inadequate measure of health gain, especially for long-term conditions;
• NICE takes too conservative a view of long-term benefits from treatments;
• NICE's cost-effectiveness threshold is inappropriate;
• NICE evaluations fail to take account of patients' experiences of their illness and treatment.

POLLS APART

J. Hobden

Health Service Journal, vol.113, July 10th 2003, p.28-29

Gives health service managers some practical tips on dealing with local politicians on NHS oversight and scrutiny committees.

PROVISION OF MATERNITY SERVICES

Health Committee

London: TSO, 2003 (House of Commons papers, session 2002 /03; HC464)

Report looks at maternity services available to women in England to-day, at the variation in those services across the country, and at four issues of particular concern. These are: the collection of data from maternity units, caesarian section rates, the staffing structure of maternity care teams, and the provision of training for health professionals who advise pregnant women and new mothers. Expresses concern that many women are undergoing caesarian sections unnecessarily. This may be due to staff shortages and limited training.

A QUESTION OF CHOICE

R. Lewis

Health Service Journal, vol.113, July 17th 2003, p.18-19

Discusses a contradiction at the heart of New Labour healthcare policy. On the one hand, we are told that the NHS will fund universal healthcare provision, which will be delivered by a mix of public, private and voluntary bodies. It is argued that ownership is unimportant provided that services are of good quality and free at the point of use. On the other hand, however, we are told that it is crucial that healthcare providers are truly owned by their communities and that the public sector is to be reinvented for the 21st century.

RECORD NUMBER OF DOCTORS BANNED FOR SERIOUS MISCONDUCT

J. Laurance

The Independent, July 29th 2003, p.4

A record number of doctors were banned from practising medicine last year after being found guilty of serious misconduct by the General Medical Council, the doctors' disciplinary body. Figures show that 72 doctors were struck off or suspended in 2002 compared with 53 in 2001, an increase of 36 per cent.

REID GOES "EXTRA MILE" FOR CONSULTANT COMPROMISE

D. Carlisle

Health Service Journal, vol.113, July 24th 2003, p.6-7

Reports that the British Medical Association (BMA) and the Department of Health have negotiated a revised draft consultant contract. Concessions to the BMA include:

• non-emergency weekend and evening work made voluntary and better paid;
• a new appeals mechanism to resolve disputes over job plans and pay progression;
• clarification of what constitutes appropriate management control;
• no distinction between new and established consultants.

RIDING THE FOUNDATION TRUST HOBBY HORSE

A. Wall

British Journal of Health Care Management, vol.9, 2003, p.233-236

Discusses objections to the proposed introduction of foundation status for hospitals. The reform represents yet another disruptive structural change for the NHS, is contrary to the NHS Plan's declared policy to focus the service on primary care, will create a whole new bureaucracy, further complicating partnership arrangements, and shows an over-optimistic faith in local democracy.

SAFE AND SOUND

J. Raynsford

Health Service Journal, vol.113, July 3rd 2003, p.36-37

Refugee nurses form a pool of talent largely untapped by the NHS. To tap into this, there is a need to identify their skills and bring these to the attention of employers. The key lies in developing databases with information about refugee nurses linking to employers' databases.

SHARING CARING

J. Davies

Health Service Journal, vol.113, July 10th 2003, p.12-13

Describes how some NHS bodies are reducing their overhead costs by use of shared services in areas like human resources and finance.

SPOILED FOR CHOICE

P. Convery

Primary Care Report, vol.5, July 23rd 2003, p.20-21

By December 2005, patients and their GPs will be able to choose from a menu of up to five different treatment options at the point of referral. There are concerns that this could lead to cream skimming of high volume, low complexity work by private providers, destabilising local NHS hospitals. Points out that patient choice will not of itself reduce waiting lists unless capacity is increased overall, but will lessen waiting times.

[STAR RATINGS]

Health Service Journal, vol.113, July 17th 2003, p.5-9

News of winners and losers in the 2003 league tables of NHS acute and primary care trusts.

TACKLING HEALTH INEQUALITIES: A PROGRAMME FOR ACTION

Department of Health

London: 2003

Programme provides the basis for meeting the 2010 national health inequalities targets for life expectancy (by geographical area) and infant mortality (by social class). It is organised around four themes to enable action on a broad front:

• supporting families to ensure that children have the best possible start in life;
• engaging communities and individuals to ensure relevance, responsiveness and sustainability;
• preventing illness and providing effective care and treatment through the NHS;
• addressing the underlying determinants of ill health.

TARGETS 'COST PATIENTS THEIR SIGHT'

B. Hencke

The Guardian, July 22nd 2003, p.6

Twenty five people in one city have lost their vision because of the government's obsession with forcing unrealistic targets on the NHS without examining the consequences, a committee of MPs has revealed. The accusation, made by Richard Harrad, clinical director of the Bristol Eye Hospital, was reported by the Commons Public Administration Committee.

TURN OF THE TIDE

D. Hunter

Health Service Journal, vol.113, July 31st 2003, p.18-19

Discusses the feasibility of improving the public health and reducing inequalities through individual lifestyle changes and choices of active and informed citizens. Argues that the state must have a role in tackling the structural determinants of ill health.

UNIONS URGE LABOUR REVOLT ON HOSPITAL REFORM

C. Adams and N. Timmins

Financial Times, July 8th 2003, p.1

Two of the country's biggest unions, GMB and Unison, have told Labour MPs to oppose the government's plan to free hospitals from central control. They are being urged to oppose those parts of the Health and Social Care Bill that deal with foundation trusts.

WHEN THE GOING GETS TOUGH …

P. Gosling

Public Finance, June 20th-26th 2003, p.18-21

Discusses whether the new Health Secretary, ex-communist John Reid, will steer the NHS by his command-and-control instincts or endorse devolution and local autonomy.