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Welfare Reform on the Web (September 1999): National Health Service - Reform - General

AVON CALLING

L. Ewles
Health Service Journal, vol.109, June 24th 1999, p.24-25

Reports on how the Avon Health Authority set about developing its Health Improvement Programme (HIMP). Organising a Health Improvement Programme proved a huge task. It was a challenge to meet participants' expectations, and many were disappointed that much day-to-day work of the NHS and social services was not included. The process offered an opportunity to bring together people from different organisations and to form new partnerships. It took longer than expected.

A BITTER PILL

P. Hammond
Health Review, Spring 1999, p. 21-22

Attacks the Labour's prescription for NHS reform, and argues that the government has committed itself to an agenda of centralising control, distorting clinical priorities, reducing choice and creating the mechanism for organised rationing without acknowledging it. In dismantling GP fundholding, it has destroyed the foundation on which a truly modern health service could have been built.

BURYING BEVAN

B. Goss
Health Review, Spring 1999, p. 32-33

Argues that there is public support for taxation to support free services for serious diseases and emergencies, but no willingness to pay for the convenient service of others. There will continue to be a high-technology safety net NHS service which should deliver technical services to a good standard in case of genuine clinical need. Primary care in the NHS is likely to be increasingly nurse-led. The patient contacting NHS Direct with a problem will be given advice or transferred to accident and emergency or GP care. Some GP care will be delivered by nurse practitioners who will only refer to doctors where necessary. Open access to a doctor-led service will increasingly become the preserve of private practice, available to those able and willing to pay for quality time with their doctor.

CLINICAL GOVERNANCE AND THE ROLE OF HEALTH AUTHORITIES: A CONTRIBUTION TO THE DEBATE

J. C. Pearson-Moore
Healthcare Quality, vol.1, issue 4, 1999, p. 9-14

Describes a framework approach to the development of clinical governance by Health Authorities. This framework approach demonstrates how some of the key elements of the success of clinical governance can be identified and addressed according to organisational, clinical and individual need. Illustrates how this framework approach can be supported by the accreditation programme 'Health Quality Service' (HQS) in association with the King's Fund and the level of clinical governance attainment evaluated by using the 'Scally and Donaldson Wheel'.

CLINICAL GOVERNANCE UNDER CONSTRUCTION

S. Dewar
London: King's Fund, 1999

Report argues that clinical governance, as defined by the Health Bill, is inadequate since it focuses on processes and not results and is being introduced without the extra resources needed. Trust executives will not be liable for disastrous outcomes, if current procedures had been correctly followed.

DANGERS OF TARGET PRACTICE

D. Hunter
Health Service Journal, vol.109, June 24th 1999, p. 16-17

Argues that the focus on hierarchy and top-down central control evident in the government's NHS reforms risks stifling the creativity and innovation which the government wants to release.

THE DENYING GAME: POLITICS VS ECONOMICS

R. Royce
British Journal of Health Care Management, vol.5, 1999, p. 223-227

Final article in a series exploring in-depth the philosophies and prejudices stimulating the rationing debate. Concludes that Health Authorities have neither sufficient resources nor a clear mandate from government to undertake a systematic rationing process. They can make rationing decisions provided that these conform broadly to society/clinicians views of what should and should not be provided by the NHS. Practical criteria for making rationing decisions might include: documentary evidence of effectiveness; benefit to a large number of patients; high profile pressure group involvement; alternative methods of funding available; evidence of significant health gain; political sensitivity; subject to central directive/objectives; subject of written complaints to Authority; and proposal adopted by other health authorities.

DOCTORS' LONG WAIT FOR 48 HOUR WEEK

S. Bates
Guardian, May 26th 1999, p. 9

Junior doctors will have to wait 13 years before their working hours are reduced to 48 hours a week after the government unexpectedly gained the agreement of the 15 European Union member states to the delay.

(See also Independent, May 26th 1999, p. 6; Financial Times, May 26th 1999, p. 1; Daily Telegraph, May 26th 1999, p. 1+2).

ELIGIBILITY CRITERIA AND ENTITLEMENTS: DEFINING NEEDS FOR NHS CONTINUING CARE

J. South
Social Policy and Administration, vol.33, 1999, p. 132-149

Paper examines whether the development of eligibility criteria has led to a loss of entitlements to NHS care. Analysis of empirical evidence from a study of the policies of six health authorities found that criteria for fully funded care were well defined and restricted access to these with very intense specialist needs, thereby constituting a loss of rights. In contrast, the eligibility for community-based services was dependent on professional discretion, but the relationship. between individual need and levels of service provision was not clarified.

FROM DEMON TO DARLING

M. McHale
Public Finance, June 4th-10th 1999, p. 20-21

Profiles Shadow Health Secretary Ann Widdecombe and outlines the policies she advocates, which include privatisation of health services, promotion of private health insurance and a voluntary return to GP fundholding.

INDEFINITE ARTICLES

W. Outhwaite
Health Service Journal, vol.109, 27th May 1999. Law Supplement, p. 9-11

The expected implementation of the Human Rights Act 1998 next year is likely to have far reaching implications for health authorities and trusts who will have a legal duty to respect the rights of NHS patients. The most significant consequence is that lack of money will not excuse lack of treatment. There will undoubtedly be an increase in applications for judicial review from patients relying on their convention rights to obtain treatment, facilities, drugs and information. They will also be seeking to prevent discrimination and unwitting experimentation.

LEADING US A MERRY DANCE

B. Hudson
Health Service Journal, vol.109, June 17th 1999, p. 18-19

The NHS is being required to enter into partnerships with local authorities for service delivery. However local authorities themselves are undergoing massive structural reform. Many councils are combining functions into new super-directorates which cut across traditional boundaries. At the same time new regional bodies are being established in England in the shape of Regional Development Agencies and Regional Chambers. The NHS will need to find ways of joint-working with these new/restructured bodies.

LOOKING INWARDS, LOOKING OUTWARDS: DISMANTLING THE "BERLIN WALL" BETWEEN HEALTH AND SOCIAL SERVICES?

J. Hiscock and M. Pearson
Social Policy and Administration, vol.33, 1999, p. 150-163

Findings from a study of two health districts reveal a paradox, that the organisational and professional turbulence generated by the nature and pace of the implementation of market-style reforms in both health and social care frustrated a key requisite of the policy, that joint working be developed between health and social practitioners in the field. In both health and social services workloads, stress and the amount and pace of organisational turbulence increased, so that changes within the practitioners' own organisations precluded and reduced efforts to look outwards to partner agencies.

MEASURE FOR MEASURE: BUT WHO WILL BENEFIT?

E. Caines
British Journal of Health Care Management, vol.5, 1999, p. 232-234

Assesses the NHS Executive's recently published Performance Assessment Framework and asks whether it will prove an effective tool for managers and a meaningful way of satisfying the expectations of the public.

NEW FACETS OF ACCESS TO HEALTHCARE: NEW LEGAL CHALLENGES

Anon
Health Law, vol.4, May 1999, p. 1-4

Summarises the latest developments in the NHS Direct and walk-in health centres initiatives. Emphasises that these will not be free from legal difficulties, and that there needs to be careful monitoring of all new systems.

NEW MEDICAL SCHOOLS WILL SERVE POOR AREAS

I. Murray
Times, June 23rd 1999, p. 6

Three new medical schools are to be opened to cover deprived areas as part of a drive to recruit more doctors to serve poorer populations. The new schools will provide 282 of the 1,000 extra training places the government has agreed to set up by 2002.

(See also Financial Times, June 23rd 1999, p. 13).

NURSES AND DOCTORS AT WORK: RETHINKING PROFESSIONAL BOUNDARIES

D. Wicks
Buckingham: Open University Press, 1998

Author looks at nurses and their relations with doctors at work. Book uncovers the tension between structure and agency in nursing work, and explores the ways in which nurses demonstrate their capacity as knowledgeable actors within the constraints of gendered institutional structures. Argues that nurses are constantly involved in both undermining and constructing the sexual division of labour with doctors.

PATIENTS' HEALTH IS ON THE LINE

M. Byatt
Public Finance, June 11th-17th 1999, p. 38-40

Describes two pioneering services in the vanguard of the government's push towards electronic service delivery, NHS Direct and Employment Service Direct. Early evaluations indicate that these telephone hotlines are a success in relieving pressure on the core services.

PATIENTS, POWER AND POLITICS: FROM PATIENTS TO CITIZENS

C. Hogg
London: Sage, 1999

Book outlines how individuals as patients, healthy people and research subjects relate to health services and how the public, as citizens, influence health care and public policies at local, national and international levels. It also shows what health services might look like if they were based on the concerns and experiences of their users.

QUALITY AND PERFORMANCE IN THE NHS: HIGH LEVEL PERFORMANCE INDICATORS AND CLINICAL INDICATORS

NHS Executive
1999

Consists of six clinical indicators (deaths in hospital following surgery, a fractured hip and a heart attack, readmission to hospital following discharge, and returning home following treatment for a stroke or a fractured hip) and 41 high level performance indicators covering issues such as length of wait for treatment, incidence of disease, cancer survival rates, and tooth decay among children. Initial comment has been critical, questioning the accuracy of some of the figures and alleging the tables to be difficult to interpret and use. The purpose of the tables is to allow poor performers to scrutinise and improve their procedures.

(For comment see Guardian, June 17th 1999, p. 10-11; Health Service Journal, vol.109, June 17th 1999, p. 2-3; Times, June 17th 1999, p. 16-17; Daily Telegraph, June 17th 1999, p. 14-15; Independent, June 17th 1999, p. 12-13).

RATIONING OF NHS CARE BY AREA 'IS WIDESPREAD'

J. Laurance
Independent, June 8th 1999, p. 10

The extent of 'postcode rationing' in the NHS is revealed in a survey which shows health authorities are restricting access to up to 20 treatments, using their own rules to decide who will be eligible.

THE RHYTHM OF QUALITY MANAGEMENT

P. R. Holt
British Journal of Health Care Management, vol.5, 1999, p. 242-246

Article draws on Welsh experiences to outline potential operational arrangements for clinical governance. It seeks to identify ways in which appropriate systems can be firmly embedded within day to day management.

SELF-REGULATION OF PROFESSIONALS IN HEALTH CARE: CONSUMER ISSUES

National Consumer Council
London: 1999

Report finds the current regulatory system for health professionals is 'patchy, risky and inadequate', and in urgent need of reform. Loopholes identified include the fact that some groups of practitioners are not regulated by their association, and have received different standards of training. Some professional titles are not legally protected so that anyone may call themselves a nurse, psychotherapist or hypnotherapist. Doctors who have been disqualified from the National Health Service can still practise privately or as NHS locums.

A SUCCESSFUL NATIONAL HEALTH SERVICE: FROM ASPIRATION TO DELIVERY

N. Bosanquet
London: Adam Smith Institute, 1999

Claims that nationalisation of funding, decision-making and provision means that the NHS is inherently inefficient and unable to meet its aspiration of ensuring equal access to high quality healthcare for all. Argues that there should be a move towards a system of 'managed pluralism' in which government sets a framework for maximising access to services, whatever their source. Commissioners could enter into a range of partnerships for delivery of care, including use of voluntary and private sector sources.

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