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

ALIEN LIFE FORM: NO SIGN OF A HAPPY LANDING FOR ITC POLICY

H. Mooney

Health Service Journal, Vol. 114, Apr. 22nd 2004, p.10-11

The article discusses progress with the letting of contracts for running independent treatment centres (ITCs), following the "de-selection" of Anglo-Canadian, the preferred bidder for the London chain of centres. ITCs had been intended to boost NHS capacity for elective surgery.

AN ARRANGED MARRIAGE

H. Mooney

Health Service Journal, Vol. 114, Apr. 22nd 2004, p.28-29

The article discusses the process which led up to the opening of the first privately run diagnostic and treatment centre. Setting up the centre required nine months of complex negotiations between BUPA, Surrey and Sussex Healthcare trust and the strategic health authority. The contract cost more than if the service had been run by the trust, but the NHS benefited from instant access to additional capacity and a transfer of risk to the private sector.

AUTO ACTION LEARNING: A TOOL POLICY FOR CHANGE. BUILDING CAPITAL ACROSS THE DEVELOPING REGIONAL SYSTEM TO IMPROVE HEALTH IN THE NORTH EAST OF ENGLAND

A. Learmonth and M. Pedler

Health Policy, Vol. 68, 2004, p.169-181

Health policy research has always focused on health care systems. The World Health Organisation's "health for all" approach introduced principles of equity, with the focus being social rather than individual. Its Investment for Health policy built on these foundations, seeing health as both an outcome of, and an asset for, sustainable economic and social development. The paper explores the development of these policies in the North East of England between April and November 2002, advocating their implementation through the development of a systemic approach to health improvement which helps existing systems to work together. It explains this approach in four stages: the context and tools used, the data gathered, reflections on the data and learning from the process.

CHOOSING HEALTH: A CONSULTATION TO IMPROVE PEOPLE'S HEALTH

Department of Health

London: 2004

Seeks views on the role that individuals, national and local government, the NHS, the public sector, the voluntary sector and industry can play in improving people's health.

COMMISSION CONTROL

K. Walshe, L. Benson and A. Boyd

Health Service Journal, Vol. 114, Apr. 1st 2004, p.18-19

The article reports on research drawing lessons for the new Healthcare Commission from the experience of its predecessor, the Commission for Healthcare Improvement. The new inspectorate needs to:

• review performance of NHS trusts against set national standards, while also allowing space for the professional judgement of reviewers;
• focus more on improving the patient experience;
• follow up its inspections and make sure that improvements materialise;
• have more continuous involvement with organisations than its predecessor.

CONFLICT OF INTEREST FEARS SPARK CALLS FOR MAJOR REVIEW OF DRUG REGULATION

A. Taylor

Community Care, Mar. 25th-31st 2004, p.18-19

There are concerns that the bodies responsible for regulation of drugs, the Medicines and Healthcare Products Regulatory Agency and the Committee on the Safety of Medicines, are both packed with members with vested financial interests in the pharmaceutical industry. There is insufficient input from consumers, whose evidence is regarded as anecdotal and unscientific.

DANGER MONEY

D. Lock

Health Service Journal, Vol. 114, Apr. 8th 2004, p.33

Patients may have few legal rights to compensation if treatment purchased by the NHS from an independent provider goes wrong. They may not be protected by the NHS Litigation Authority scheme.

DOCTORS' LEADERS WARNS OF RISE OF TWO-TIER NHS

J. Carvel

The Guardian, April 19th 2004, p.10

The leader of Britain's doctors warned yesterday that the government is creating a two-tier NHS where getting high-quality treatment will depend more on luck than clinical need. James Johnson, who chairs the British Medical Association, said ministers were in danger of destroying the character of the health service in their zeal for promoting patient choice and political targets. He said John Reid, the Health Secretary, had embarked on a series of reforms which could result in large variations in standards of hospital care, depending on where patients lived and which consultant they happened to see.

DRIVE TIME

N. Edwards

Health Service Journal, Vol. 114, Apr. 15th 2004, p.24-25

A report of an interview with Health Development Agency chief executive Paul Streets in which he discusses his plans for dissemination of the evidence on "what works" in public health improvement to practitioners.

EYE OF THE BEHOLDER

E. Scrivens

Health Service Journal, Vol. 114, Apr. 22nd 2004, p.16-18

The article presents a critique of the new "standards for better health" proposed by the Department of Health. They focus on the key components of safe, clinically effective, patient-centred healthcare, good governance and accessible and responsive care. They are written to reflect high-level policy, and their application in practice would vary to reflect local circumstances.

HEALTH SCRUTINY: THE IMPACT OF NHS REFORMS

A. Coleman

Primary Care Report, Vol. 6, No. 5, March 25th 2004, p.14

The challenges facing local authorities in getting to grips with their new role of scrutinising health services are described. These include coping with a very large number of consultations about NHS reform and with cross-boundary scrutiny where local authority and health service boundaries do not match. NHS bodies and local authorities also have to agree a working definition of what constitutes a "substantial variation of service" about which councils should be consulted.

IMPROVING PATIENT ACCESS TO HEALTH SERVICES: A NATIONAL REVIEW AND CASE STUDIES OF CURRENT APPROACHES

L. Hamer

London: Health Development Agency, 2004

The report provides a summary of national policies and local action to improve patient access to health services. Government is now seeking to address the problems people on low incomes experience in making the journey from their homes to health services. The report summarises national developments in accessibility planning and provision of specialist transport to health services. It also gives case studies of local approaches to improving patient access such as taxi schemes and improved park-and-ride facilities.

LESSONS FROM NEW ZEALAND FOR ENGLAND'S NHS FOUNDATION TRUSTS

B. Howell

Journal of Health Services Research and Policy, Vol. 9, 2004, p.104-109

Building on lessons from the devolution of public hospital governance in new Zealand during the 1990s to boards at arm's length from central control, the paper analyses the introduction of foundation trusts in the English NHS. Whilst local political accountability and competition between hospitals indicate that the English reforms may be more successful in meeting patients' needs efficiently than the New Zealand reforms, the English proposals may be compromised by the ability of staff to become members of Trusts, boards bearing risks of decisions outside their control whilst simultaneously being insulated from the consequences of their decisions by a "soft budget constraint" and conflicts of interest as boards act as agents of both central regulators and local beneficiaries.

THE MOTIVATION AND BEHAVIOUR OF HOSPITAL TRUSTS

T. Crilly and J. Le Grand

Social Science and Medicine, Vol. 58, 2004, p.1809-1823

The article focuses on what motivates UK hospital trusts. It explores the motivation of individuals within trusts, showing how this translates into dominant goals of groups and drives the behaviour of organisations. The results of an attitude survey of 1,500 consultants and managers, and a statistical analysis of the behaviour of 100 trusts over three years, showed that:

• consultants regarded service goals as being more important than meeting financial objectives, and considered quality to be more important than service volume;
• managers on average were motivated by the need to meet financial targets;
• managers closest to service delivery considered maintaining quality to be their main priority.

Maintaining service quality, rather than meeting government financial targets, emerged as the main objective of the trusts.

REGULATION OF HEALTH CARE STAFF IN ENGLAND AND WALES: A CONSULTATION DOCUMENT

Department of Health

London: 2004

Sets out government's proposals for the regulation of healthcare assistants, therapy assistants, all sectors of the healthcare science workforce, and assistant practioners.

REGULATION OF HERBAL MEDICINE AND ACUPUNCTURE: PROPOSALS FOR STATUTORY REGULATION

Department of Health

Leeds: 2004

The document presents government proposals for the statutory regulation of the herbal medicine and acupuncture professions through a compulsory registration scheme.

THE SCANDAL THAT PERSUADED MINISTERS TO "LET GO" OF THE NHS

P. Smith

Health Service Journal, Vol. 114, Apr. 1st 2004, p.12-13

The article gives an overview of the development of the foundation hospital policy.

SHAPING THE NSF FOR LONG TERM CONDITIONS: THE VIEWS OF SERVICE USERS, CARERS AND VOLUNTARY ORGANISATIONS

K. Hardy

Long Term Medical Conditions Alliance, 2004

A national survey of people with long-term medical conditions found concerns focused on basic failings in services such as:

• poor access to health and social care;
• poor quality information;
• lack of understanding of needs by health and social care staff.

People complained of discrimination and of having their needs and wishes ignored.

UNEASY RIDERS?

N. Summerton

Health Service Journal, Vol. 114 Apr. 15th 2004, p.26-27

The NHS needs to form new alliances to address the public health challenges posed by the second Wanless report and the government's consultation paper on public health. Public health physicians need to engage with the clinical community, academic and commercial organisations such as the pharmaceutical industry, and private healthcare providers.

VARIATION IN THE ACTIVITY RATES OF CONSULTANT SURGEONS AND THE INFLUENCE OF REWARD STRUCTURES IN THE ENGLISH NHS

K. Bloor, A. Maynard and N. Freemantle

Journal of Health Services Research and Policy, Vol. 9, 2004, p.76-84

The study explored variations in the NHS activity rates of consultant surgeons, and examined whether activity is dependent on the type of contract held, and/or bonus payments, after accounting for age and other consultant and hospital characteristics. It found that the "maximum part-time contract" which up to 2003 was held by surgeons with substantial private practices alongside their NHS work, is associated with higher absolute activity rates among NHS surgeons. Discretionary points, forms of bonus payments to NHS consultants, are also associated with higher in-patient clinical activity.

WHAT THEY REALLY, REALLY WANT

B. Page

Health Service Journal, Vol. 114, Apr. 8th 2004, p.16-19

A Mori poll has found that public perceptions of NHS performance are not influenced by star ratings, mortality rates or hospital waiting times. Levels of satisfaction are associated with:

• whether or not patients live in a deprived area;
• whether or not patients come from a fragmented multi-ethnic community;
• whether or not patients live in or near London.

WORTH THE WAIT?

M. Gould

Guardian Society, April 21st 2004, p.10

Patient forums, previously community health councils, were created so that communities could scrutinise local health authorities. The author, however, finds a lack of resources, accessibility and awareness. Moreover some critics say patient scrutiny of, and involvement in, the NHS have in some areas come to a virtual standstill.