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

APPRAISE WHERE DUE

S. Hobson

Health Service Journal, vol.114, Mar.18th 2004, p.26-27

Report of an interview with Sir Graeme Catto, President of the General Medical Council, in which he defends its systems for handling complaints and for appraisal and revalidation of doctors.

CAN OF WORMS

M. Thursz and K. Moore

Health Service Journal, Vol. 114, Mar. 4th 2004, p.28-29

There have been massive increases in the incidence of liver diseases in the UK, reaching epidemic levels. The development of liver services has been haphazard, and there is no national service framework for liver disease, disadvantaging patients. In response, interest groups have come together to formulate a national plan for the organisation of liver services around 20-25 clinical networks.

CHANGING WORDS, CHANGING TIMES

I. Greener

British Journal of Health Care Management, Vol. 10, 2004, p.86-88

The change of Health Secretary from Milburn to Reid has been marked by a significant change in organisational emphasis. Milburn's language was dominated by the need for centrally controlled reform and standards and was not especially concerned with fairness or equity. In contrast, Reid talks of organisational values, access and equality. He seldom mentions reform or performance. The change in Health Secretary may lead to the realisation of a locally run health service.

CLINICAL GOVERNANCE IN HEALTH CARE PRACTICE, 2ND EDITION

T. Swage

London: Butterworth Heinemann, 2004

This book explains the concept of clinical governance and its application to the UK health care system, using examples from different health care settings. This second edition has been updated to include the new organisations that support clinical governance (the Modernisation Agency, the National Patient Safety Agency, and the Commission for Healthcare Audit and Inspection), and issues that impact on clinical governance, such as consent and initiatives in continuous professional development.

THE END IS CHI

L. Donnelly

Health Service Journal, vol.114, Mar.25th 2004, p.10-13

Article reflects on the achievements of the Commission for Health Improvement (CHI) on the eve of its abolition. CHI aimed to support the NHS through a period of change and did not act as a punitive inspectorate. It lacked powers to investigate trusts' finances, and could make, but not enforce, recommendations for improvements.

AN END TO THE BLAME GAME?

R. Lingham

Community Care, Mar.11th-17th 2004, p.40-41

The NHS National Patient Safety Agency is to operate a new system for investigating failures of health and social care. Investigations will use root cause analysis to identify the causes of failure in operational systems and the actions needed to prevent a repetition.

EU RULES TO COST NHS WORK OF 3,700 DOCTORS

M. Woolf

The Independent, March 22nd 2004, p.1

The NHS is facing a crisis over medical cover because new EU rules restricting doctor's working hours which come in this Summer, will reduce the contribution of thousands of junior doctors. EU restrictions limiting doctors' working hours to 58 a week, which will come into effect in August, will cost the NHS the equivalent of the work of at least 3,700 junior doctors. The British Medical Association says the loss of manpower means operations will be cancelled and queues for treatment will grow.

FEWER LONG TROLLEY WAITS AS NHS HAS 'BEST WINTER EVER'

N. Timmins

Financial Times, March 24th 2004, p.5

The National Health Service had its best ever winter with long trolley waits becoming a thing of the past, according to Sir George Alberti, the Health Service's emergency care chief. Fewer than 10 per cent of patients now wait more than four hours in accident and emergency departments.

(See also The Times, March24 2003, p.2; Daily Telegraph March 24th 2004, p.10;)

FOUNDATION TRUSTS: THE GOOD, THE BAD AND THE UGLY

R. Lewis

Primary Care Report, Vol. 6, Issue 3, 2004, p.8-12

The article explores the implications of foundation hospitals for primary care trusts. It focuses especially on financial issues, and how PCTs can ensure that patients receive the integrated care that they need while foundation hospitals, released from the performance management by strategic health authorities, are free to pursue their own agenda.

FOUR WAY BET: HOW DEVOLUTION HAS LED TO FOUR DIFFERENT MODELS FOR THE NHS

S. Greer

University College London, Constitution Unit, 2004

The report demonstrates how, since devolution, the four health systems of the UK are rapidly diverging. They are identifying different problems and dealing with them differently. In England, the NHS has become market-led, with priority given to patient choice, diversity of provision, and competition between acute trusts. In Scotland, the NHS is now run as 15 large organisations, with professional networks in a key role. Wales has opted to reorganise its system so that commissioning is integrated with local government and priority is given to improving population health in the long term. Northern Ireland has not seen much devolution, and its politics are not about health, leading to policy standstill and low-key local divergence.

GROWING PAINS

P. Smith

Health Service Journal, Vol. 114, Mar. 11th 2004, p.10-14

Strategic Health Authorities in England were set up to oversee the direction of healthcare development, to manage the performance of acute and primary care trusts, and to build up capacity. The article addresses their progress to date.

THE HARDEST MILE

A. Moore

Health Service Journal, vol.114, Mar.18th 2004, p.10-13

Most English hospital trusts are confident of hitting the government's target that no patient should have to wait more than nine months for elective treatment by March 2004.

HARNESSING THE MOUN

K. Harmond

British Journal of Health Care Management, Vol. 10, 2004, p.76-77

In the 1990s manufacturing models were introduced to increase NHS productivity. More recently the modernisation agenda has focused on process redesign and improving the patient pathway. Proponents of the two approaches can cause chaos by promoting contradictory priorities within organisations. Currently, the new patient choice agenda is introducing a democratic element into healthcare planning and delivery.

INFLUENCING THE NATIONAL POLICY PROCESS: THE ROLE OF HEALTH CONSUMER GROUPS

K. Jones, R. Baggott and J. Allsop

Health Expectations, Vol. 7, 2004, p.18-28

The paper investigates the role of health consumer groups in representing the collective interests of patients, users and carers in the UK national policy process. A postal survey of 123 health consumer groups and semi-structured interviews with policy actors and consumer group representatives showed that they had developed a number of approaches to influencing policy. Groups had formed alliances with other stakeholders and developed relationships with civil servants, MPs, Ministers and peers. It concludes that health consumer groups are becoming increasingly influential.

LESSONS FROM CHI INVESTIGATIONS 2002-2003

Commission for Health Improvement

London: TSO, 2004

The report analyses 11 investigations into failing NHS organisations between 2000 and 2003. The study showed that in 8 of the 11, CHI found that staff shortages, poor team work, weak risk management and poor incident reporting were all present. Nine out of the 11 organisations were not adequately monitoring performance. Inadequate leadership from trust and management boards, a recent history of mergers or significant organisational change, and serious financial problems were also common features. The second part of the report looks at the local and national impact of the investigations.

LIFE IN THE NHS: VIOLENCE, STRESS - AND PRIDE

J. Carvel

The Guardian, March 10th 2004, p.7

The first comprehensive survey of NHS staff experiences reveals that Europe's biggest employer is riddled with violence, bullying, work-related stress, accidents and excessive overtime. But pride in the organisation and its mission to provide free healthcare is so strong that 73% of the 1.3 million staff in England are generally satisfied with their jobs. The Commission for Health Improvement (Chi), the NHS Inspectorate which commissioned the survey, said morale was surprisingly high, given working conditions which most people would find uncomfortable.

(See also full text of the report, NHS national staff survey 2003: summary of key findings in PDF format)

MALNUTRITION IN HOSPITAL: AN INDICTMENT OF THE QUALITY OF CARE?

S. Holmes

British Journal of Health Care Management, Vol. 10, 2004, p.82-85

More than 40% of patients are malnourished on admission to hospital, but this rises to 75% by the time of discharge. Nutrition has been seen as a "hotel service" rather than as integral to good clinical care. In reality, effective nutritional care and/or nutritional support will reduce complications, shorten patient stays and reduce readmission rates. This will result in significant cost savings.

NEW DAWN FOR THE NHS

N. Plumridge and P. Kemp

Public Finance, Mar.12th-18th 2004, p.24-25

Three major reforms are being introduced in the NHS in England in April 2004: the establishment of foundation trusts, the implementation of patient choice, and the introduction of payment by results.

PROTECTING CHILDREN AND YOUNG PEOPLE: RESULTS OF A SELF-ASSESSMENT AUDIT OF NHS ORGANISATION IN WALES

Commission for Health Improvement

London: 2004

As the first comprehensive audit of process on child protection in the Welsh NHS, the investigation found many examples of good practice. It also found that most NHS organisations have a senior staff member at board or director level responsible for child protection. Unlike England, Wales has a dedicated body to support organisations in the implementation of child protection measures, the Child Protection Service's National Public Health Service, which the audit demonstrates is having a positive impact. However, the audit also unearthed concerns about inadequate staff training, irregular clinical performance monitoring and poor record keeping.

THE REFORM CLUB

N. Edwards

Health Service Journal, vol.114, Mar.18th 2004, p.31-33

The Improvement Partnership for Hospitals is in the vanguard of Modernisation Agency work. It involves using statistical process control to eliminate variations in performance, especially in elective services.

TACKLING INEQUALITIES IN HEALTH IN ENGLAND: REMEDYING HEALTH DISADVANTAGES, NARROWING HEALTH GAPS OR REDUCING HEALTH GRADIENTS

H. Graham

Journal of Social Policy, Vol. 33, 2004, p.115-131

The paper explores how the goal of reducing socio-economic inequalities in health has been represented in English national policy documents. There appears to be a range of understandings of what it means to tackle health inequalities. These understandings can be placed on a continuum which runs from improving the health of poor groups, through closing the health gaps between those in the poorest circumstances and better off groups, to addressing the associations between socio-economic position and health across the population.

TRAIL BLAZERS

S. Menser

Health Service Journal, Vol. 114, Mar. 4th, 2004, p.34-35

Following the creation of the Health Professionals Council in 2002, titles such as physiotherapist and radiographer became protected, meaning that practitioners must re-register every two years. From 2005, in order to improve standards, they will be required to have undertaken continuing professional development in order to re-register.

WHAT FOLLOWS TARGETS?

A. Cowper

British Journal of Health Care Management, Vol. 10, 2004, p.74-75

Recent government policy announcements have signalled a move away from centrally imposed targets for the NHS. Instead, government is developing a set of standards to which NHS bodies will aspire. The core standards are intended to establish a level of quality of care which can be expected by all NHS patients wherever they are treated. Developmental standards are designed to enable the overall quality of healthcare to rise as additional resources are pumped into the NHS.

WHY TOO MUCH CONTROL IS FREAKING OUT THE NHS

J. Shapiro

Primary Care Report, vol.6, no.4, Mar.11th 2004, p.12-13

The NHS is currently risk averse, punitive and highly disempowering to its professional staff. They must be allowed greater freedom to exercise their own judgement if they are to remain committed to the NHS.

WINTER AND THE NHS 2003-2004

G. Alberti

London: DH Publications, 2004

Traditionally winter is the season when the NHS is under greatest pressure due to a rise in respiratory ailments, flu, and accidents due to bad weather. However increased investment and capacity has meant that this winter has been managed successfully by the NHS. More than nine out of ten patients in Accident and Emergency were seen within four hours of admission and over 70% of older people were immunised against flu. Trusts and their staff have re-examined and changed working practices to improve quality of care and have worked with social services to reduce bed blocking.

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