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

ACUTE ACCENT

A. Cole

Health Service Journal, Vol. 114, June 3rd 2004, p.28-29

There is urgent need for reform in the care of acutely ill medical patients. Problems are being compounded by rising admissions, the reduction in junior doctors' hours and changes in training. The Royal College of Physicians is calling for care to be delivered in acute medical or assessment units by dedicated teams specialising in acute care.

ASSAULT ON THE EARTH

J. Griffiths

Health Service Journal, Vol. 114, July 1st 2004, p.30-31

The NHS needs more incentives to take sustainable development to heart. Achievements by trusts are largely due to personal commitment and are not systematic. A centrally backed programme of sustainable development could save money and would benefit staff, patients and visitors.

BRINGING WALES BACK TO HEALTH

C. Grace and B. Harris

Public Finance, May 21st-27th 2004, p.22-23

The NHS in Wales is performing poorly compared to England. This is due to inadequate primary care, ineffective demand management, and operational inefficiencies within the hospital sector. The article goes on to outline the steps needed to tackle these problems.

BRITAIN 'STILL POACHING' THIRD WORLD'S DOCTORS

C.Hall

The Daily Telegraph, June 29th 2004, p.8

The health service stands accused of shameful exploitation for poaching doctors from overseas because it failed to produce enough of its own. James Johnson, the chairman of the council of the British Medical Association, said Britain still did not have enough doctors despite the 32,000 extra appointments since 1997.

ENDEMIC PREJUDICE BLIGHTS NHS CAREERS

N. Hawkes

The Times, June 28th 2004, p.2

Doctor's careers are being blighted by discrimination on grounds of race, gender, disability and sexual orientation, a report from the British Medical Association has found. The report, based on statistics and interviews with doctors, suggests that, despite NHS claims that it is an equal opportunity employer, 70 per cent of consultants are white, while 60 per cent of those on staff grades - those denied access to the consultant ladder - have qualifications from outside Britain.

FREEDOM TO DO WHAT YOU ARE TOLD: SENIOR MANAGEMENT TEAM AUTONOMY IN AN NHS ACUTE TRUST

K. Hoque, S. Davis and M. Humphreys

Public Administration, Vol. 82, 2004, p.355-375

The government hopes to encourage improved performance in NHS Trusts by promising "earned autonomy" for those attaining 3-star status. The article argues that this can only be achieved if Trust managers view such freedom both as desirable and realistic. Through a case study of the senior management team at the Delta Trust, a medium sized NHS hospital, it evaluates the extent to which senior management perceive themselves as autonomous and the factors that are likely to restrict the ability of the Trust to be able to operate more freely. These factors include the power and influence of medical professionals, the extent to which clinician managers have been inculcated with managerialist values, clinician managers' management skills and their commitment to the management role, and the extent to which Trust-level managers view autonomy as a desirable outcome. Results show that autonomy was frequently restricted by centrally dictated targets. Lack of managerial skills and conflicting professional interests also restricted the Trust's potential to operate more autonomously and few managers believed that greater freedom would allow services to be delivered more effectively. The article concludes that if the government's strategy is to be achieved, it must develop a greater appreciation of the challenges faced by senior Trust managers and the factors that restrict the ability of Trusts to operate more autonomously.

HANG ON IN THERE

B. Page

Health Service Journal, Vol. 114, July 1st 2004, p.16-18

Some of the factors which influence patient satisfaction are outside of the control of the NHS. These include population age, with older people being less demanding, and ethnic diversity, with homogeneous populations being easier to please. If their customer base is demanding, even efficient hospitals can score low on patient satisfaction.

INVESTIGATING PATIENT SAFETY INCIDENTS (UNEXPECTED DEATH OR SERIOUS UNTOWARD HARM): A PROTOCOL FOR LIAISON AND EFFECTIVE COMMUNICATION BETWEEN THE NATIONAL HEALTH SERVICE, ASSOCIATION OF CHIEF POLICE OFFICERS AND HEALTH AND SAFETY EXECUTIVE

London: Department of Health, 2004

This protocol is intended to help the three agencies:

• meet their responsibility for the safety of patients and nhs staff;
• set out their own operational needs and requirements;
• prompt early decisions about necessary investigations and a dialogue about their implications;
• provide an effective approach to investigation management;
• develop and strengthen partnership working;
• save time and resources.

LABOUR PROMISES TO CUT WAITING TIME FOR HOSPITAL TO 18 WEEKS

J. Sherman and D. Charter

The Guardian, June 18th 2004, p.1

The Government is to fight the general election pledging to cut the time that people wait from seeing their GP to getting hospital treatment from a maximum of 13 months to 18 weeks by 2008.

LAW SPECIAL REPORT

N. Edwards (Ed.)

Health Service Journal, Vol. 114, June 24th 2004, p.47-54

The article looks at clinical negligence litigation, the pitfalls of employing staff from the expanded European Union, parental consent to the medical treatment of children and the correct way to handle staff stress.

LIB-FLAB PACT

H. Mooney

Health Service Journal, Vol. 114, June 10th 2004, p.24-25

A report of an interview with Liberal Democrat health spokesman Paul Burstow, in which he calls for responsibility for health service commissioning to be transferred to local authorities. He argues that the Department of Health should focus on the task of improving public health. He also calls for the prohibition of smoking in public and the abolition of foundation trusts.

MAKING A FIST OF IT

R. Coombes

Health Service Journal, Vol.114, June 17th 2004, p.32-33

Domestic violence is a major public health problem but the NHS, particularly GPs has a poor reputation for dealing with it. There is a lack of evidence about what approaches work in the health service context. Screening programmes modestly increase disclosure of abuse, but few studies measure other outcomes. Healthcare professionals need to be alert to the possibility of domestic violence and trained in how to deal with it.

MARGINAL POINTS

N. Edwards

Health Service Journal, Vol. 114, June 3rd 2004, p.24-25

Report of an interview with people's peer Lord Adebowale in which he argues that statutory services are failing the most deprived communities. He calls for the state to commission bespoke services tailored to the needs of each community or estate from the voluntary sector.

MUSCLE POWER

P. Gray and S. Haywood-Giles

Health Service Journal, Vol. 114, June 24th 2004, p.32-33

The article shows how physiotherapy can offer a practical alternative to hospital-based orthopaedic treatment. Waiting times for orthopaedic surgery can be cut by reducing the number of unnecessary referrals. Physiotherapy-led services can also extend patient choice and reduce GP workload.

THE NHS IMPROVEMENT PLAN: PUTTING PEOPLE AT THE HEART OF PUBLIC SERVICES

Department of Health

London: TSO, 2004, (Cm 6268)

The document set outs government plans for:

• sustaining high levels of investment in theNHS;
• empowering patients and offering greater choice;
• improving public health, targeting inequalities and promoting prevention as well as cure;
• further reducing waiting times to a maximum of 18 weeks from referral to treatment by 2008;
• greater personalisation of community-based care and support for people with chronic conditions through provision of thousands of community matrons and rolling out of the expert Patients programme across the country.

NHS TRUSTS BULLIED INTO PRIVATE CONTRACTS

J.Carvel

The Guardian, June 1st 2004, p.5

The Department of Health used bully-boy tactics to force local NHS trusts

to sign contracts with foreign healthcare corporations for treatment centres they did not need, according to the chairman of a primary care trust who lost his job for resisting the temptation.

RAISE A GLASS TO PUBLIC HEALTH

A. Walker

Health Service Journal, Vol. 114, June 17th 2004, p.16-17

The new Healthcare Commission will be reviewing progress in reducing health inequalities. In its first year it will:

• look at public health delivery within PCTs;
• develop a system of annual review for all NHS organisations;
• weave public health into its review of other services such as cancer treatment;
• work with other inspectorates such as the audit commission to align processes as much as possible.

REFORMING BRITAIN'S HEALTHCARE: PRIVATE PATIENTS GAIN AS THE NHS IMPROVES

Financial Times June 11th 2004, p.18

Editorial congratulates the government on improving the patients' lot in both public and private sectors. By introducing overseas providers to run treatment centres for National Health Service patients, the paper believes the government has, at a stroke, transformed a significant chunk of the country's health care.

(See also The Times, June 11th 2004, p.4)

SHARING THE CHALLENGE, SHARING THE BENEFITS: EQUALITY AND DIVERSITY IN THE MEDICAL WORKFORCE

Workforce Directorate, Department of Health

London: Department of Health Publications, 2004

The document outlines the key equality and diversity challenges facing the medical workforce over the next five years, highlights good practice where it exists and seeks views from stakeholders on how best to tackle these issues. It focuses on improving access to medical education, removing career barriers and establishing open and equitable disciplinary systems.

TACKLING CANCER IN ENGLAND: SAVING MORE LIVES

National Audit Office

London: TSO, 2004 (House of Commons papers, session 2003/04: HC 364)

The paper finds that cancer survival and mortality rates are improving in England despite increasing incidence of cancer. Good practice is being introduced to build further on improvements in outcomes realised in the 1990s, but progress varies by cancer and locality.

TORIES WOULD ABOLISH NHS TARGETS AND GIVE MORE MONEY TO HOSPITALS

B. Russell

The Independent, June 22nd 2004, p. 18

The Conservatives will today promise a bonfire of up to 700 NHS targets as they outline radical proposals aimed at giving more power to individual hospitals. Andrew Lansley, the shadow Health Secretary, will pledge to scrap all government central health targets, instead arguing that the power of patient choice will drive up health standards.

VARIATIONS IN USAGE OF CANCER DRUGS APPROVED BY NICE: REPORT OF THE REVIEW UNDERTAKEN BY THE NATIONAL CANCER DIRECTOR

[Department of Health, 2004]

The report finds that:

• overall usage of cancer drugs generally increases following positive appraisals by NICE;
• variation in usage does exist across the country and cannot be accounted for by differences in casemix, and, for most drugs, is unlikely to be accounted for by cross boundary flows alone. However, variation does not appear to lessen over time once a positive appraisal from NICE has been published;
• reasons for variations are complex but do not appear to be associated with direct funding restrictions on the use of these drugs. Instead, the main impact on usage seems to be constraints in service capacity and differences in clinical practice.

ZAP IT TO 'EM

R. Coombes

Health Service Journal, Vol. 114, June 24th 2004, p.38-39

The advent of patient choice means that NHS bodies will have to pay more attention to reputation management and public relations using similar techniques to those employed by supermarkets such as Asda.