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Welfare Reform on the Web (March 2004): National Health Service - Reform - General

BRAND DESIGNS

S. Mathieson

Health Service Journal, vol.114, Feb.19th 2004, p.36-37

The past two years have seen a steadily more consistent brand identity for the NHS. Branding will become more important as foundation status and PCT commissioning make acute hospitals more competitive. This has put pressure on some trusts to create their own strong identities.

CHANGING THE SKILL-MIX OF THE HEALTH CARE WORKFORCE

B. Sibbald, J. Shen and A. McBride

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.1, p.28-38

Changing workforce skill-mix is one strategy for improving the effectiveness and efficiency of health care. Article summarises research findings on the success or failure of skill-mix change in achieving planned outcomes.

CUT DOWN TO SIZE

S. Ward

Public Finance, Jan.30th-Feb.5th 2004, p.22-25

The Department of Health is pulling back from day-to-day control of the NHS and is consequently being downsized. Staff will be cut by 38%, although half of these posts are not being lost but transferred to arm's length bodies such as the Modernisation Agency. With fewer staff and functions, the Department should be able to pass more money on to frontline services.

EDUCATING THE FUTURE WORKFORCE: BUILDING THE EVIDENCE ABOUT INTERPROFESSIONAL LEARNING

D. Humphris and S. Hean

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.1, p.24-27

Paper outlines the policy drivers for interprofessional education of health and social care practitioners in the UK. Goes on to explore the operational implications of creating opportunities for students of health and social care to learn with and about each other. Calls for research investment that will build up the evidence base on the impact of interprofessional education on professional outcomes and health and social care services.

EXODUS AS NURSES CALL TIME ON SHIFTS

J. Carvel

The Guardian, February 9th 2004, p.6

Thousands of nurses are being driven out of the profession by an archaic system of compulsory shift work that plays havoc with their personal lives and family responsibilities, the Royal College of Nursing has warned. The exodus poses a serious threat to the government's plans to expand NHS services, as the recruitment of overseas nurses begins to dry up. In a survey of 10,000 members, the RCN found that 29% would quit the profession if they could. This rose to 39% among those on the variable shift system that operates in most NHS hospitals. The RCN said the problem was rooted in the "internal rotation" system. In it a full-time nurse most commonly works two or three early shifts and two or three late shifts, followed by three or four night shifts in one week. The survey found two-thirds of nurses under 30 work on internal rotation, compared with 19% of those in their 50s. The desire to escape rotation was a primary reason for staff switching to agency work.

FERTILITY: ASSESSMENT AND TREATMENT FOR PEOPLE WITH FERTILITY PROBLEMS

National Institute for Clinical Excellence

London: 2004 (Clinical guideline; 11)

Guidelines recommend that all women with fertility problems aged between 23 and 39 should be offered three cycles of IVF and/or six cycles of intrauterine insemination free on the NHS. No more than two embryos should be transferred during any one IVF cycle to reduce the chances of a multiple pregnancy.

(For government response offering one free cycle see Times, Feb.25th 2004, p.4; Guardian, Feb. 25th 2004, p.4)

HOSPITAL STAR RATINGS TO BE SCRAPPED

O. Wright

The Times, February 9th 2004, p.1

The controversial system of star ratings to assess hospital performance is to be scrapped. Ministers, stung by criticism that the scheme is politically manipulated and does not reflect patient care, have agreed to bring it to an end. Instead, there will be a looser assessment scheme that will no longer pit trust against trust. John Reid, the Health Secretary, will launch a consultation paper this week that recommends abandoning all 62 key targets that determine hospitals' star ratings in favour of 24 broad "quality objectives". Hospitals would no longer have to meet key waiting times targets, as much more emphasis is placed on quality of care and overall clinical outcomes. The Commission for Healthcare Audit and Inspection, the independent body that will take responsibility for assessing NHS performance from April, is also likely to end the existing regime of regular hospital inspections. In future hospitals would be inspected only when specific problems arose.

"IF WE DON'T REFORM, WE WILL BETRAY OUR VALUES"

P. Wintour and M. White

Guardian, Feb.16th 2004, p.6

Report of an interview with Health Secretary John Reid in which he reiterates his commitment to patient choice in the NHS. Hospital star ratings and the elaborate system of targets will be dropped as central control of the NHS is relaxed.

INTERNATIONAL RESCUE? THE DYNAMICS AND POLICY IMPLICATIONS OF THE INTERNATIONAL RECRUITMENT OF NURSES TO THE UK

J. Buchan

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.1, p.10-16

Paper reports on the significant growth in the number of nurses entering the UK from abroad, using registration data. In 2001/02, over 16,000 nurses entered the UK nursing register from overseas, exceeding the number of home-trained nurses for the first time. Concludes by examining the policy implications of this growing reliance on international recruitment, including the effect of the ethical guidelines on recruiting nurses from developing countries introduced by the Department of Health.

KIDNEY COMPLAINT

A. Dix

Health Service Journal, vol.114, Feb.26th 2004, p.30-33

Presents a critique of the newly launched Renal National Service Framework. Argues that it will not lead to change as it is not accompanied by extra funding and lacks hard-hitting targets for service improvement.

LEARNING FROM MISTAKES

S. Williams

Health Which?, February 2004, p.10-13

The article discusses the role that patients can play in preventing medical errors. It is unclear how they can input into patient safety at a strategic level. More than two years after it was set up the National Patient Safety Agency is still undecided about how it will gather information about errors from patients.

MILBURN, POWELL AND HAYEK: FOR AND AGAINST PLANNING IN THE NHS

J. Mohan

Journal of Health Services Research and Policy vol.9, 2004, p.54-58

Paper contrasts the policies of Enoch Powell and Alan Milburn on the ways in which the distribution of hospital services should be organised. Powell was a champion of central planning, while Milburn rejected central control in favour of patient choice and foundation hospitals controlled by an independent regulator. New Labour appears to be returning to the mixed economy of health care and consequent variations in provision of the pre-NHS era.

NATIONAL CLINICAL INDICATORS: MORE QUESTIONS THAN ANSWERS

M. Narayan-Lee, V. Aylett and K. Donaldson

British Journal of Health Care Management, vol.10, 2004, p.44-47

Publication of national clinical performance indicators is intended to improve the quality of clinical care. Presenting such information in the form of a league table is misleading. Experience in Leeds demonstrates the difficulties of taking the published data at face value. The use of statistical process control charts to show comparative performance should be explored further.

PAST ITS SELL-BY DATE

L. Donnelly

Health Service Journal, vol.114, Feb.5th 2004, p.10-13

Under the "franchising" scheme, chief executives from high-performing hospitals have been brought in to reform failing acute trusts. Article assesses the impact of the scheme, which has fallen out of political favour.

PATIENTS TAKE THEIR PICK IN BERKSHIRE'S CHOICE PILOT

R. Mills

Primary Care Report, vol.6, no.2, Feb.11th 2004, p.16-17

The Berkshire pilot scheme has been successful in offering choice to patients who have waited six months for treatment. It is now working towards offering choice at the point of referral.

THE POLITICS OF REGULATION WITHIN THE "MODERNIZED" NHS: THE CASE OF BETA INTERFERON AND THE "COST EFFECTIVE" TREATMENT OF MULTIPLE SCLEROSIS

I. Crinson

Critical Social Policy, vol.24, 2004, p.30-49

A case study is presented which examines the political and organisational processes associated with the attempt by the Department of Health, through its appraisal body NICE, to regulate the introduction of a new drug treatment (beta interferon) for patients with multiple sclerosis on "cost-effectiveness" grounds. The Department of Health is shown to have failed in its goal of regulating the introduction of beta interferon because it involved social and economic factors beyond its direct control. These factors included the clinical needs of patients, the prescribing activities of doctors, and the refusal of drug companies to reduce their profits.

RATIONING THE FINAL SOLUTION?

D. Kernick

British Journal of Health Care Management, vol.10, 2004, p.54-56

Against a background of increasing consumer demand, medical advances are putting pressure on limited health care budgets. This pressure will be increased by the demands of an ageing population. Article discusses ways in which demand could be managed through implicit or explicit rationing and even through rejection of some of the most costly advances.

RECRUITING AND DEVELOPING AN EFFECTIVE WORKFORCE IN THE BRITISH NHS

R. Pearson, P. Reilly and D. Robinson

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.1, p.17-23

The NHS faces major challenges in recruiting, motivating and retaining staff in a period of sustained growth and change. Article considers a number of approaches to pay which are being suggested or used to attract, motivate and retain staff. These include performance pay, team pay and local pay determination.

REGULATING THE HEALTH CARE WORKFORCE: NEXT STEPS FOR RESEARCH

C. Davies

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.1, p.55-61

Article explores the recent debate about professional self-regulation in medicine and other health professions. It begins by considering definitions, acknowledging the complex regulatory maze in UK health care, of which self-regulation is only one part. Goes on to review academic writing, at present dispersed among the disciplines, and the emergence of consumer pressure to rethink regulation in the wake of the Bristol case. Finally sets out an agenda for research.

SECURING GOOD HEALTH FOR THE WHOLE POPULATION

D. Wanless

London: Treasury, 2004

Report recommends making the public fully engage with looking after its own health, saving the NHS billions of pounds. The NHS should shift from being a sickness service that treats disease to preventing illness from developing in the first place. Urges action to halt the rise in obesity, followed by setting targets for its reduction and a ban on smoking in the workplace. Also suggests that lack of exercise, which costs the economy £8.2bn annually in lost production and sickness absence, should be addressed.

(For summary and comment see Health Service Journal, vol.114, Mar.4th 2004, p.10-15)

SHOULD THE ENGLISH NATIONAL HEALTH SERVICE BE FREED FROM POLITICAL CONTROL?

N. Black and N. Mays

Journal of Health Services Research and Policy, vol.9, 2004, p.1-3

Presents arguments for and against the NHS being run by an arm's length agency instead of by the Department of Health.

STANDARDS FOR BETTER HEALTH: HEALTH CARE STANDARDS FOR SERVICES UNDER THE NHS: A CONSULTATION

Department of Health

London: 2004

Consultation document introduces a series of key standards for the quality of care the government aims to deliver across the NHS in England. Their purpose is twofold:

  • to lay the foundations for a common high quality of healthcare throughout England
  • to clarify what the NHS can and should be aspiring to in its ambitions both for the public and for health care professionals.

WE WISH WE HAD WAYS OF MAKING YOU HEALTHIER

A. Miles

The Times, February 25th 2004, p.22

Discusses options open to the government to force or persuade people to adopt a healthy lifestyle with the aim of reducing demands on the NHS. Proposes a campaign to change attitudes to diet.

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