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

5,000 JOBS TO GO AS LABOUR AIMS TO CUT HALF OF ALL NHS QUANGOS

D. Derbyshire

The Daily Telegraph, May 21st 2004, p.4

More than 5,000 National Health Service jobs will be axed in a cull of "unnecessary and overlapping" quangos. John Reid, the Health Secretary, said half of the 42 bodies, including many created by the Government in the last few years, would be abolished or merged. A list of the doomed quangos will be announced next month.

(See also The Guardian, May 21st 2004, p.15)

AT LEAST FIVE A WEEK: EVIDENCE ON THE IMPACT OF PHYSICAL ACTIVITY AND ITS RELATIONSHIP TO HEALTH: A REPORT FROM THE CHIEF MEDICAL OFFICER

London: Department of Health, 2004

The report argues that up to two-thirds of men and three-quarters of women don't take enough exercise for a healthy life. A quarter of adults and 6% of 2-20-year-olds are obese. This inactivity costs the country £8.2bn a year in medical treatment and sickness absence from work. It goes on to make recommendations about the levels of physical activity needed for a healthy lifestyle.

CANCER SERVICES: IT'S MAKE OR BREAK FOR WAITING LIST SERVICES

S. Hobson

Health Service Journal, Vol. 114, May 13th 2004, p.10-11

By December 2005 all urgent cancer patients should have started to receive treatment within two months of referral. A survey by Cancer BACUP has revealed that the NHS is unlikely to meet this target due to staff shortages, problems in data collection and lack of funding.

CARING IN MANY WAYS: THE NHS MODERNISATION BOARD'S ANNUAL REPORT 2004

Department of Health, 2004

The NHS Modernisation Board advises the government on implementation of the NHS Plan reforms that are transforming the NHS into a patient-centred service. Report describes the cultural and attitudinal changes which have taken place since the launch of the NHS Plan as well as documenting more gradual structural and process-based improvements.

CHOOSING HEALTH? CHOOSING A BETTER DIET: A CONSULTATION ON PRIORITIES FOR A FOOD AND HEALTH ACTION PLAN

Department of Health

London: 2004

The paper presents proposals for:

  • food production and manufacture;
  • supply by retailers and caterers;
  • nutrition in schools, the NHS and local communities.

Specific proposals include reducing the salt, sugar and saturated fat content of food, promotion of healthier portion sizing and provision of healthy meals in school canteens.

CHOOSING HEALTH? CHOOSING ACTIVITY: A CONSULTATION ON HOW TO INCREASE PHYSICAL ACTIVITY

Department of Health

London: 2004

The paper proposes encouraging employers to create active workplaces by providing incentives and support. It goes on to explore how to develop opportunities for older people, disabled people, unemployed people and parents with young families to become more physically active. Finally it argues that physical activity needs to be encouraged in early year settings and schools during play and lunch breaks.

COMPLEXITY AND HEALTHCARE ORGANIZATION: A VIEW FROM THE STREET

D. Kernick

Oxford: Radcliffe Medical Press, 2004

Describes the practical applications of complexity theory within healthcare organisations. It explores how the insights gained can help to provide a better understanding of how healthcare organisations operate as eco-systems rather than along mechanical lines. These insights can offer useful perspectives for further organisational evolution. By removing existing barriers and facilitating interactions, application of complexity theory can help new cultures emerge, ensuring that organisations can respond to the changing demands placed on them.

CONSULTED, BUT NOT HEARD: A QUALITATIVE STUDY OF YOUNG PEOPLE'S VIEWS ON THEIR LOCAL HEALTH SERVICE

K. Curtis and others

Health Expectations, vol.7, 2004, p.149-156

Study explored the views of children and young people on their healthcare in general and the health services they receive. Participants emphasised the need for continuity of care, age-appropriate facilities, good food, and staff with good communication and interpersonal skills.

THE EVIDENCE OF EFFECTIVENESS OF PUBLIC HEALTH INTERVENTIONS - AND THE IMPLICATIONS

M.P. Kelly

Health Development Agency, 2004 (Briefing Paper)

The paper outlines the policy and practice implications, at national, regional, local and school level, of the evidence about effective public health interventions that has been collected, synthesised and reviewed by the Health Development Agency since 2000. It covers drug and alcohol misuse, smoking, nutrition and obesity, accidental injury, physical activity, community regeneration and housing.

THE HEALTH SERVICE IS ON THE UP WITHOUT 'RADICAL REFORM'

P. Toynbee

The Guardian, May 19th 2004, p.22

The author believes Tony Blair, the Prime Minister, should trumpet the NHS revival, not threaten more disruption. She believes the new money is working and the results are gathering pace, yet Tony Blair is talking about turning over the whole NHS to various private, voluntary or independent trusts.

HIP REPLACEMENTS: AN UPDATE

Committee of Public Accounts

London: TSO 2004 (House of Commons papers, session 2003/04; HC40)

The report calls for:

  • production of a list of prostheses which meet the NICE standard;
  • encouragement of wider participation in the new National Joint Registry;
  • phasing out incentives offered to trusts by hip prosthesis manufacturers;
  • action to reduce inappropriate GP referrals;
  • reduction in cost variations between trusts;
  • universal use of care pathways for hip replacement cases.

HOW IS PATIENT CENTRED CARE UNDERSTOOD BY THE CLINICAL, MANAGERIAL AND LAY STAKEHOLDERS RESPONSIBLE FOR PROMOTING THIS AGENDA?

R. Gillespie, D. Florin and S. Gillam

Health Expectations, vol.7, 2004, p.142-148

Study explored through interviews how health service managers, educationalists, professional leaders and officers of patient bodies understand and promote patient centred care among practitioners. Patient centred care covers a range of activities from patient involvement in individual care to their inputting into public policymaking. The The Department of Health has prioritised patient centred care, but has not defined it clearly. Therefore health professionals, educationalists, managers and patient representatives have all developed different understandings of patient centred care to reflect their own background and roles.

IMPROVING COMMUNICATION BETWEEN SERVICE USERS AND PROFESSIONALS VIA THE INTERNET

R. Hughes and others

Practice Development in Health Care, Vol. 3, 2004, p.27-34

The article explores how the Internet can improve communication between health service users and healthcare providers, with particular reference to patients with motor neurone disease. It presents a case study of the Building User InvoLvement on motor neurone Disease (BUILD) project, detailing the development of a virtual forum for sufferers and their families and healthcare professionals. The study illustrates how communication was enhanced though participation in the virtual forum and the article concludes that the Internet offers a unique opportunity to improve communications between health professionals and those who use their services.

INVOLVING PATIENTS AND THE PUBLIC: HOW TO DO IT BETTER. [2ND ED.]

R. Chambers

Oxford: Radcliffe, 2004

Patient and public involvement in health and social care has become a key element of government policy, and the need to listen and act on the views of patients and the public is an increasingly integral part of the planning and delivery of healthcare. The new edition of this book has been revised and updated, providing practical information on the new responsibilities under clinical governance and Health Improvement Programmes. It provides an introduction to the new structures and processes being set up to enable patients and the public to be more influential in designing and delivering health care services.

LOCAL PARTICIPATORY DEMOCRACY IN BRITAIN'S HEALTH SERVICE: INNOVATION OR FRAGMENTATION OF A UNIVERSAL CITIZENSHIP?

T. Milewa

Social Policy and Administration, Vol. 38, 2004, p.240-252

The New Labour government has encouraged citizen participation in NHS decision-making through Patient Forums and membership of foundation trusts etc. However, the government has also intermittently proposed linking care entitlement to obligations on the part of those reliant on the NHS. This may be of considerable significance in a system where access to care has traditionally been seen as a right of citizenship.

NHS IS OFF THE CRITICAL LIST, SAY ADVISERS

C. Hall

The Daily Telegraph, May 19th 2004, p.4

The body set up to advise ministers on the modernisation of the NHS has informed the Prime Minister that the service was getting better but that improvement was patchy and that staff were too slow to change in certain areas. The NHS Modernisation Board, made up of senior health service staff, leaders of charities and royal colleges, which reports directly to Mr Blair, told him that more effort was needed to put patients first. It said that patient surveys showed high levels of satisfaction with services "even though the public in general continues to be sceptical".

NURSING CHIEF CRITICISES FEW 'TOO POSH TO WASH'

J. Carvel

The Guardian, May 11th 2004, p.6

The younger generation of specialised nurses is in danger of breaking with the basic principles of the profession by "becoming too posh to wash", the Royal College of Nursing was warned during its annual congress in Harrogate. Beverly Malone, the College's general secretary, said that nurses who did not want to give patients intimate personal care were missing the whole point of the profession. They should not think they could delegate all the work of bathing patients and changing their dressings to healthcare assistants who had fewer qualifications and worked for less pay, she said. Under the government's NHS reform plans, nurses are to take on about 20% of junior doctors' work and to cope with this additional workload they are expected to delegate about 12% of their existing work to healthcare assistants.

OAR INSPIRING

J. Fielden

Health Service Journal, vol.114, Apr.29th 2004, p.18-19

The article describes best practice for implementing the new consultants' contract. Successful implementation involved starting to plan the change early, good communication, consultant involvement and engagement, and a flexible approach.

OBESITY

Health Committee

London: TSO, 2004 (House of Commons papers, session 2003/04; HC23)

About two-thirds of the population of England are overweight or obese. Obesity has grown by almost 400% in the last 25 years and at present trends will soon surpass smoking as the greatest cause of premature death. Report highlights inactivity and poor diet as root causes. To improve nutrition, the Committee recommends a sustained public information campaign, more practical food education for children, and legislation to promote a simple food classification and labelling system to encourage a healthy diet. To increase physical activity, the Committee recommends raising its profile in schools, improving conditions for cyclists and encouraging walking.

OFF THE WALL

M. Davies

Health Service Journal, vol.114, May 27th 2004, p.34-35

Trusts negotiating job plans for consultants have encountered the following problems:

  • a history of poor relations between consultants and trust management;
  • failure to communicate strategic objectives clearly to consultants;
  • blurred interfaces between medical, HR and general management;
  • unwillingness to address productivity improvement issues;
  • funding concerns which have led to reluctance in some trusts to devolve authority to medical managers to sign off job plans.

ON REFLECTION

J.C. Archer and H. Davies

Health Service Journal, vol.114, Apr.29th 2004, p.26-27

There is an urgent need for validated tools for the assessment of doctors' performance. Article describes the Sheffield Peer Review Assessment Tool (SPRAT). SPRAT is ideal for revalidation purposes and performs well in areas that are traditionally difficult to assess. It can also inform personal development planning.

'PEOPLE TRAFFICKING' PROPPING UP NHS

J. Carvel

The Guardian, May 12th 2004. p.8

The expansion of the NHS is being achieved by the surreptitious poaching of nurses from developing countries that is tantamount to people trafficking, leaders of the Royal College of Nursing have warned. They told their annual conference in Harrogate that NHS managers have found loopholes in government regulations banning the overt recruitment of nurses from South Africa and other countries with a staffing shortage. Thousands are joining the NHS by the back door after being tempted to come to Britain by private recruitment agencies to work initially for private hospitals and homes. Without them the government could not have increased the NHS nursing workforce by 18,800 over the past year.

PUBLIC HEALTH POLICY

David J. Hunter

London: Polity, 2004

This volume provides a new overview of the key debates relating to public health policy in the UK at a time when concern has never been greater. There is public disquiet over a number of crises, such as foot and mouth, BSE and other food safety issues, pollution, obesity and the environment. Yet health policy remains preoccupied with health-care services. In this book the author explains that, while they are important, health-care services are not the principle determinants of health. Why then do they absorb the bulk of resources and attention of policy-makers? The reasons for the extraordinary difficulties encountered in putting public health before health care are multiple and complex. Separate chapters cover a range of issues, including:

  • the relationship between health and healthcare;
  • health-care management and the powerful interests at work which prevent policy aspiration from becoming reality;
  • attempts in the UK since 1992 to pay greater attention to public health issues;
  • examples from Europe and Canada, where similar policy imbalance exists.
  • In conclusion the author offers a way forward based on the concept of managing for health.

SCRUTINY PUTS PRIVATE HEALTHCARE DATA ON A PLATE

E. Forrest

Health Service Journal, Vol. 114, Apr. 29th 2004, p.12-13

Comments on a new publication which offers quality data for independent acute hospitals for the first time, the Quality Indicator Project annual report. The report only covers hospitals which are members of the Independent Health Care Forum and so does not offer a complete picture of standards in the sector. There are no benchmark figures for comparison, and growing numbers of hospitals joining the scheme mean that it is not possible to monitor trends over time.

SECONDARY HEALTHCARE AND LEARNING DISABILITY: RESULTS OF CONSENSUS DEVELOPMENT CONFERENCES

S. Cumella and D. Martin

Journal of Learning Disabilities, Vol. 8, 2004, p.30-40

The study used consensus development conferences of people with learning difficulties, their supporters, family, professionals and hospital managers. The conferences identified several ways of improving hospital care for people with learning difficulties including:

  • improved information to hospitals about patients;
  • training programmes for healthcare professionals in communication;
  • improved information about choices while in hospital;
  • more collaborative working with family carers who support inpatients;
  • pre-admission preparation;
  • use of specialist support teams.

WAY TO GO

M. Davis

Health Service Journal, Vol. 114, May 13th 2004, p.24-25

Integrated care paths (ICPs) are local care plans that recommend steps in the care of patients with a specific condition and detail their expected progress. The article gives tips for success in drafting a viable ICP.

WHEN A TRUST CHIEF EXEC CAME TO BLOWS WITH HER SHA SOMETHING HAD TO GIVE

L. Donnelly

Health Service Journal, Vol. 114, May 20th 2004, p.10-12

West Hertfordshire Hospitals Trust had been struggling to meet government targets on waiting times in Accident and Emergency and for cancer treatment. The article analyses the consequent breakdown in the relationship between the chief executive of the Trust and its parent Strategic Health Authority, which led to the former's resignation.

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