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

BLAIR 'FORCING DOCTORS TO WORK AT UNSAFE PACE'

I. Murray

Times, July 6th 1999, p. 4

Reports widespread criticism by doctors at the BMA's annual conference in Belfast of the government's reforms of the NHS. The Government was condemned for underfunding, failure to provide enough beds, perpetuating health inequalities, borrowing private money to build public hospitals, and failure to have a public debate on rationing healthcare. A speech by Ian Bogel, Chair of the BMA, condemned the Prime Minister for introducing policies without consultation, perpetuating unnecessary bureaucracy and forcing doctors to work at a pace that was contrary to safe medical practice.

(See also Daily Telegraph, July 6th 1999, p. 8; Independent, July 6th 1999, p. 11; Guardian, July 6th 1999, p. 1; Financial Times, July 6th 1999, p. 12)

BMA OUT OF TOUCH WITH DOCTORS, SAYS BLAIR

S. Boseley

Guardian, July 8th 1999, p. 5

Tension continues to run high between the Blair government and the medical profession over private funding of hospitals, lack of consultation, and scarce resources spent on populist initiatives like NHS Direct that pander to wants rather than needs. The government, in reply, is claiming that doctors' leaders are out of touch with the grass roots of the profession which supports NHS modernisation.

(See also Times, July 8th 1999, p. 10; Independent, July 8th 1999, p. 6)

BROTHERS GRIM

M. Crail

Health Service Journal, vol. 109, July 1st 1999, p. 12-13

GPs at the recent Local Medical Committees Conference voiced concerns about the extra work they were expected to undertake to make primary care groups function, the lack of reward for doing it, and threats to their 'gatekeeper' role.

CAN A NICE DISTINCTION END A MESSY NHS?

S. Boseley

Public Finance, July 9th - 15th 1999, p. 16-19

Discusses the role of the National Institute of Clinical Excellence which has been launched to assess new drugs coming on to the market and to advise prescribers whether they are both clinically effective and cost-effective. Where a cheaper drug that works equally well already exists, doctors will be told not to prescribe the new one. NICE will put an end to 'postcode prescribing' where individual health authorities and trusts have to decide whether they can afford a drug, and then face flak from aggrieved patients who can't get it without moving house.

CLINICAL EFFECTIVENESS. PART 2, FINDING THE BEST EVIDENCE

C. Adams

Community Practitioner, vol. 72, 1999, p. 205-207

Explains how to access the research literature, evaluates available information sources and gives guidance on searching electronic databases.

COMMISSION ON REPRESENTING THE PUBLIC INTEREST IN THE HEALTH SERVICE

Draft interim report

London: ACHCEW, 1999

Calls for a complete radical reform of the Health Service to make it more accountable to the public. Unless the trust gap between the institution and the public is bridged, patients will increasingly turn to the courts for redress. Options for change could include handing over the health service to local authorities or removing the NHS Executive from the Department of Health.

COMMUNITY PARTICIPATION AND CITIZENSHIP IN BRITISH HEALTH CARE PLANNING: NARRATIVES OF POWER AND INVOLVEMENT IN THE CHANGING WELFARE STATE

T. Milewa, J. Valentine and M. Calnan

Sociology of Health and Illness, vol. 21, 1999, p. 445-465

Article considers changing conceptions of local citizenship with particular reference to 'community participation' in the planning of state healthcare in Britain. Aims to gauge the extent to which a political rhetoric of community participation in the 1990s constituted an attempt to redefine the relationship between health authorities and local communities.

COUNT THE COST

D. Tomalin and M. Renshaw

Health Service Journal, vol. 109, May 27th 1999, p. 28-29

A system for calculating the cost of clinical audits in terms of money and staff time has been in operation at Brighton Health Care trust since 1995. The information has proved useful in cost benefit analysis. At the end of each audit an action plan is agreed with the lead clinician over required changes. Making the cost of audits explicit increases the likelihood of recommendations being implemented.

DOCTORS UNDER THE MICROSCOPE

S. Ward

Public Finance, June 18th-24th 1999, p. 16-18

Reports that next year the third and final part of the English Health Service's corporate governance agenda, clinical controls, will come into being, joining the financial and organisational controls already in place. Doctors will have to submit to internal performance appraisal and an external audit programme accredited by the new Commission for Health Improvement.

GUIDING LIGHTS

J. Wright, J. Bibby and J. Hughes

Health Service Journal, vol. 109, July 29th 1999, p. 30-31)

Traditional methods of implementing clinical guidelines and changing professional practice endure despite evidence that they are ineffective. The increasing demand for guideline implementation will have to be met within existing resources. Work in Bradford Health Authority, which marries the methods of changing practice shown to be effective with the limited resources available, is already paying dividends.

HEALTH AND EXCLUSION: POLICY AND PRACTICE IN HEALTH PROVISION

M. Purdy and D. Banks (editors)

London: Routledge, 1999

Presents a sample of the policies and practices of exclusion currently experienced by patients and users of health services in Britain, and by nurses and other health professional providing those services.

THE IMPLEMENTATION OF EVIDENCE BASED HEALTHCARE IN SCOTTISH HEALTH BOARDS

Accounts Commission for Scotland

Edinburgh: 1999

Clinical evidence is far more likely to influence health service commissioning than the views of patients or clinicians, but not if it runs counter to government initiatives. Managers are concerned about the lack of evidence available, which may be due to limited access to libraries and electronic information sources.

IMPLEMENTING CLINICAL GUIDELINES: A PRACTICAL GUIDE

D. Humphris and P. Littlejohns

Radcliffe Medical Press, 1999

Describes the attempts of the ACE (Assisting Clinical Effectiveness) programme to implement five sets of guidelines in six districts within a health region.

THE INFORMATION REVOLUTION, HEALTH REFORM AND DOCTOR-MANAGER RELATIONS

B. Wood

Public Policy and Administration, vol. 14, 1999, p. 1-13

In the 1980s and 1990s in both Britain and the US the computerisation of patient data led to a raft of comparative performance indicators. At the same time health reform in Britain saw the introduction of quasi-market and improved management systems, while in the US it centred on managed care, cost controls and hospital managers. This case study of an American general hospital uses the classic Alford framework of three groups of structural interests (doctors, managers and patients) to assess the impact of these changes on doctor-manager relations in Britain and the US.

MAKING A DIFFERENCE: STRENGTHENING THE NURSING, MIDWIFERY AND HEALTH VISITING CONTRIBUTION TO HEALTH AND HEALTHCARE

Department of Health

London: 1999

Proposals include

• new nurse consultant posts with salaries up to £40,000 a year;
• a radical overhaul of nurse education and training, including 'take a break' arrangements to spread training over more than three years and national vocational qualifications to provide new pathways into nursing;
• enhanced roles for midwives so they can advise and help women throughout their lives;
• a national campaign to ensure implementation of family friendly employment policies;
• a Partners Council including patients to provide a focus for post-registration training and continuing professional development.

(For comment see Health Service Journal, vol. 109, 15th July 1999, p. 2-3)

MAKING INCISIONS INTO GOVERNANCE DECISIONS

J. J. H. Harrison

British Journal of Health Care Management, vol. 5, 1999, p. 290-293

If clinical governance is actually to improve clinical care, the potential confusion concerning individual and organisational responsibilities must be avoided. Article models these new and complex lines of accountability from an operational perspective.

NEW DEAL FOR NURSES

D. Brindle and M. White

Guardian, July 9th 1999, p. 1

Announces plans for a new four-tier structure for nursing. There will be a basic grade of health care assistant, a main grade of qualified nurse, a further grade for qualified staff who have obtained advanced qualifications, and a fourth grade of consultant practitioner. There will be a new emphasis on the quality of nursing, using a system of 'competencies' to run periodic checks on staff after they qualify. The strategy will retain three year basic training, accredited by universities. But it will set out to make the system for more flexible, enabling health care assistants to progress to become qualified nurses without having first to overcome the usual academic hurdles.

NEW INSTITUTE TO EVALUATE CANCER DRUGS

N. Timmins

Financial Times, August 6th 1999, p. 8

Drug to treat breast and ovarian cancer, multiple sclerosis and schizophrenia will be among the first to be evaluated by the National Institute for Clinical Excellence (NICE). At the same time NICE will produce a study on hip replacements, guidelines on treatment of back pains, pressure sores and extraction of wisdom teeth, and an assessment of influenza vaccinations.

(See also Guardian, August 6th 1999, p. 8)

PUT THIS MUTT OUT OF ITS MISERY

S. Ainsworth

Health Service Journal, vol. 109, July 1st 1999, p. 18-19

Argues that Community Health Councils cannot be effective watchdogs because they are part of the Health Service and accountable to the NHS Executive's Regional Offices.

STATS AND STYLE CAN'T MATCH THE HUMAN TOUCH

I. MacWhirter

Public Finance, July 2nd - 8th 1999, p. 30-31

In the new NHS hospitals are judged by how well they manage resources and meet targets set by government. In this environment, there is efficiency but no concern. The balance sheet, rather that the patient, is the centre of attention.

THE THIRD WAY IN HEALTH CARE REFORM: DOES THE EMPEROR HAVE ANY CLOTHES?

C. Ham

Journal of Health Services Research and Policy, vol. 4, 1999, p. 168-173

Argues that the Labour government has adopted an approach to NHS reform that combines central control and local autonomy, sanctions and incentives, and planning and competition. The third way therefore entails a cocktail of different approaches and is both eclectic and pragmatic. In pursuing these policies, the government is seeking to resolve dilemmas which are as old as the NHS itself and is seeking a synthesis between approaches which have in the past been seen as mutually exclusive.

UNKNOWN QUANTITY

P. Healy

Health Service Journal, vol. 109, July 22nd 1999, p. 9-10

Reports on plans for a pilot programme to establish the competences needed to practise as a consultant nurse, to set up a means of identifying them and to implement a support and development programme for nurses who intend to take on the role.