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

ACHIEVING TIMELY, SIMPLE, DISCHARGE FROM HOSPITAL: A TOOLKIT FOR THE MULTI-DISCIPLINARY TEAM

NHS

Department of Health, 2004

About 80% of hospital discharges can be classed as "simple" meaning that the patients have relatively simple ongoing health needs that can be met without complex planning. This new toolkit includes a 10 step guide to improving the discharge processes, case studies showing how improvements have already been made, and useful fact sheets helping staff to identify what action they need to take.

AGAINST THE FLOW

J. Dixon

Health Service Journal, vol.114, Sept.9th 2004, p14-15

Argues that the NHS can improve the health of the nation in three ways: firstly, by effective treatment of the sick, secondly, by improving the management of chronic disease in the community so that hospital admissions are avoided; and thirdly, through its behaviour as a large employer and procurer of supplies.

ARRAY OF HOPE

P. Brice

Health Service Journal, Vol.114, Sept. 16th 2004, p.24-25

Genetic profiling could revolutionise cancer therapy by identifying the best treatment for individual patients. However, its application will require substantial public investment in development of diagnostic tools, setting up an infrastructure for collection and storage of cancer tissue samples, and improvements in NHS IT to cope with the increased data from clinical research and practice.

CAN WE BUILD IT?

E. Forrest

Health Service Journal, Vol.114, Sept. 16th 2004, p.26-27

Alder Hey Hospital is determined to move on after the organ retention scandal, and has overhauled its relationship with the public. New forums for parents, staff, carers and children have been set up. A newly formed communications team stresses openness and transparency.

CHOICE MAKES ITS ENTRANCE

D. Carlisle

Health Service Journal, Vol.114, Sept. 16th 2004, p. 10-13

All patients waiting six months or more for elective surgery are now being given the option of being treated by an alternative provider. The article consists of comments by frontline staff who have implemented the patient choice programme. It goes on to look at the implications of the next stage of the reforms, choice at the point of referral, for GPs, primary care trusts and strategic health authorities.

CHOICE, PARTICIPATION AND ACCOUNTABILITY: ASSESSING THE POTENTIAL IMPACT OF LEGISLATION PROMOTING PATIENT AND PUBLIC INVOLVEMENT IN HEALTH IN THE UK

B. Sang

Health Expectations, vol.7, 2004, p.187-190

Recent legislation enabling increased patient and public involvement in health decision-making will increasingly interact with the patients' movement to force NHS organisations to be more publicly accountable. Lay people will develop new roles, building on learning from the independent advocacy sector, self-management, and wider active participation. This means a profound cultural change for both citizens and health care organisations as they begin to understand the implications of new policies such as patient choice.

"CHOOSE & BOOK" - PATIENT'S CHOICE OF HOSPITAL AND BOOKED APPOINTMENTS: POLICY FRAMEWORK FOR CHOICE AND BOOKING AT POINT OF REFERRAL.

Department of Health

London: 2004

Sets out the policy for offering patients choice at referral and deals with many of the common questions raised about how choice should work, including whether patients can book beyond waiting time targets and the role of Clinical Assessment Services and other extended primary care service.

DRIVING FORCE

A. Dix

Health Service Journal, Vol.114, Sept 2nd 2004, p.26-27

Hepatitis C is a potentially fatal virus, but as many as 90% of people with it are unaware that they are infected. A government campaign to be launched Autumn 2004 is likely to increase demand for testing. Much work on Hepatitis C is done by drug and alcohol action teams in isolation, but work in the South West is heading towards a more co-ordinated approach.

EXPLAINING DIFFERENCES IN HOSPITAL PERFORMANCE: DOES THE ANSWER LIE IN THE LABOUR MARKET?

S. Burgess and others

Bristol: University of Bristol, Department of Economics, 2004

Hospitals in the North of England generally perform better than those in the South. NHS pay rates are set nationally, but the cost of living is lower in the North. This means that hospitals in the North are able to attract the best quality staff. Results suggest that pay flexibility, allowing hospitals in areas where the cost of living is high to pay more, may improve their performance.

FAST FORWARD

A. Moore

Health Service Journal, vol.114, Sept.9th 2004, p.26-27

Postgraduate medical training is about to change radically, with newly qualified doctors spending just a year as senior house officers instead of the present three. Innovative approaches will be needed to fill consequent gaps in service provision.

FEAR OF REVOLTS DELAYS HOSPITAL SHAKE-UPS

J. Carvel and P. Hetherington

The Guardian, Sept. 24th 2004, p.9

The article reports that potentially unpopular hospital reorganisation plans are being put on hold to avoid antagonising voters at the next election.

HEALTH SERVICE ORGANISATION IN THE UK: A POLITICAL ECONOMY APPROACH

I. Greener

Public Administration, Vol.82, 2004, p.657-676

The paper revisits Harrison and Wood's 1999 account of the development of the design of health service reorganisation in the UK since 1968, and reconsiders their analysis from a more explicit political economy perspective. It suggests that health service reforms are part of a movement from a Keynesian Welfare National State to a Schumpterian Workfare Post-national Regime. It argues that New Labour's approach to health service design involves reviving various past models of organisation. It is at present focused on reviving a form of the internal market introduced by the Conservatives in the early 1990s and making patient choice the driver of reform.

IMPROVING PATIENT CARE BY REDUCING THE RISK OF HOSPITAL ACQUIRED INFECTION: A PROGRESS REPORT

National Audit Office

London: TSO, 2004 (House of Commons papers, session 2003/04; HC876)

The paper follows up an earlier report, The Management and Control of Hospital Acquired Infection in NHS Acute Trusts in England (HC 230, session 1999-2000), to ascertain the extent to which the Committee's recommendations had been implemented, whether the management and control of hospital acquired infection had improved and whether there had been any discernable changes in patient outcomes. It finds that implementation of the report's recommendations has been patchy and that change is constrained by lack of data, limited progress in implementing a national surveillance programme that meets the needs of the NHS, and a lack of evidence of the impact of different intervention strategies. Further recommendations are made to the Department of Health, the Healthcare Commission and NHS trusts.

MAKING PARTNERSHIPS WORK FOR PATIENTS, CARERS AND SERVICE USERS: A STRATEGIC AGREEMENT BETWEEN THE DEPARTMENT OF HEALTH, THE NHS AND THE VOLUNTARY AND COMMUNITY SECTOR

Department of Health

London: 2004

Under the new strategic agreement, the voluntary and community sector will have a more central role in supporting and providing NHS services. Increasing the role of the voluntary sector will create more capacity and give patients a wider choice of services to meet their needs.

NHS MERGERS COMPARED WITH THE PRIVATE SECTOR

L. Furniss

British Journal of Health Care Management, Vol.10, 2004, p.206-209

The article reports the results of a small study of the merger of health and social care organisations to form a care trust. The findings show that success factors for mergers appear to be broadly similar in the public and private sectors. However, mergers are very disruptive and there was very little evidence that the formation of the care trust had improved services.

NHS TO OFFER 1 MILLION PATIENTS PRIVATE SURGERY

S. Lister and D. Charter

The Times, Sept. 20th 2004, p.1

Documents from the Department of Heath reveal that under the government's policy of offering patients a choice of four or five hospitals at referral, there is an "expectation" that one of the options will be a private sector provider. This has led to fears that the independent sector could be swamped with patients while NHS beds lie empty.

NHS "UNIVERSITY" GIVEN AN EDUCATION IN HUMILITY AT SCHOOL OF HARD KNOCKS

M. L. Harding

Health Service Journal, Vol.114, Sept. 23rd 2004, p.12-13

The NHSU was intended to address the skills gaps within the NHS workforce and give disfranchised parts of the workforce access to further education. However, there is currently widespread confusion within the NHS about how it is funded and what it is for.

PALLIATIVE CARE

Health Committee

London: TSO, 2004 (House of Commons papers, session 2003/04; HC454)

Although only 20% of people die at home, the majority would like to. The report considers the potential cost benefits that would arise from more people being able to die at home, and examines carers' rights and training needs and geographical inequalities in provision of services. It highlights the need for palliative services in the community and recommends the implementing of local champions to address the needs of those receiving palliative care. Funding issues are also addressed. The report concludes by emphasising people's right to a good death and the need to change social attitudes in order to achieve this.

PATIENT SURVEY REPORT 2004: YOUNG PATIENTS

Healthcare Commission

London: 2004

The survey asked young patients from 150 acute and specialist NHS trusts across England about their recent experience of inpatient or day case care. Uncovered perennial complaints about hospital food, a demand for more information and involvement in decisions, frustration about delays in being discharged from hospital, and distress at changes in admission dates.

PROMOTING MORE ACCESSIBLE CANCER CARE SERVICES

S. Richards

British Journal of Health Care Management, Vol.10, 2004, p.182-184

Despite the NHS cancer plan people still experience problems accessing cancer services. The article examines the physical, professional, emotional and social barriers people face while dealing with cancer before detailing the MacMilliam Cancer Relief guidelines for service deliverers.

THE ROAD TO PERFECTION

C. Laurent and N. Edwards

Health Service Journal, Vol.114, Sept. 23rd 2004, p.30-32

The Pursuing Perfection Programme which has been piloted in four areas by the Modernisation Agency aims to bring together chief executives of acute and primary care trusts, and directors of social services to work together to improve healthcare. This involves agreeing strategic goals, developing system level measures, putting national targets in local context, and creating cross-boundary projects to deliver on them. These are each led by an "executive sponsor" (a senior manager or clinician). The authors interviewed four chief executives involved in the programme about this work.

TEACH TO HIS OWN

A. Dix

Health Service Journal, Vol.114, Sept. 30th 2004, p.28-29

A course developed by an Isle of Wight diabetes consultant teaches patients to become peer advisors to help others manage the condition. Supporters claim that the training is more relevant to diabetes than the expert patients programme. Health professionals' wariness of the scheme has reduced take-up of the service.

TEN WAYS TO SHAKE THE WORLD

Health Service Journal, Vol.114, Sept. 9th 2004, supplement, 13p

Presents an overview of 10 organisational changes that can transform a hospital's performance:

• treat day surgery as the norm for elective surgery;
• improve patient flow through better access to diagnostic tests;
• manage variations in patient admission and discharge;
• avoid unnecessary follow-up appointments;
• increase the reliability of therapeutic interventions through a "care bundle" approach;
• apply a systematic approach to care for patients with chronic conditions;
• optimise patient flow through service bottlenecks using process templates;
• redesign and extend staff roles in line with efficient patient pathways;
• improve patient access by reducing the number of queues.

THIS SUPPORTING LIFE

G. Morgan

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

NHS managers and support staff are likely to be the object of political attacks in the run up to the general election. In reality they are the backbone of the service, which would be paralysed if their numbers are cut too severely.

WHITE MEN SHY AWAY FROM LIFE AS DOCTORS

N. Hawks

The Times, Sept. 3rd 2004, p.8

The UK Medical Careers Research Group at Oxford University has found that minority ethnic students are over-represented in medical schools. Ethnic minorities comprise 8-12% of the population aged 20-24, but 21% of the medical students. Young white men comprise 43.5% of the population of Britain, but only 26% of the medical students.

WHY MORE THAN ONE IN TEN PEOPLE IN WALES ARE WAITING FOR TREATMENT

L. Whitfield

Health Service Journal, Vol.114, Sept 2nd 2004, p.10-11

NHS waiting lists and times are considerably longer in Wales than in England, despite funding increases by the Assembly government. Reasons for this include failure by the government to set and enforce targets, and lack of pressure from the electorate.