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

ACCESS TO PUBLIC DOCUMENTS IN A STUDY OF THE NHS INTERNAL MARKET: OPENNESS VS SECRECY IN CONTRACTING FOR CLINICAL SERVICES.

D Hughes and L Griffiths

International Journal of Social Research Methodology, vol. 2, 1999, p.1-16

Paper describes problems in gaining access to signed contracts in a qualitative study of the NHS internal market in Wales. Health Authorities were concerned that public scrutiny of contracts would reveal inconsistencies in their dealings with different hospital trusts, particularly regarding the level of penalties to be levied for poor performance. Trusts were concerned that scrutiny would show that they were ignoring NHS pricing rules and charging different Health Authorities different tariffs for the same services.

ASSESSING PERFORMANCE OF NHS HOSPITAL

Trusts: The Role of 'hard' and 'soft' Information

M Goddard, R Mannion and P C Smith

Paper explores the use of formal quantitative 'hard' information and informal, subjective 'soft' information in the assessment of the performance of NHS Trusts by external organisations. Argues that 'soft' information plays a valuable role in the assessment of performance of NHS trusts and notes that this is also current practice in the private sector. One of the main functions of 'hard' information in performance assessment is to act as a safety net in order to identify laggards by highlighting poor performance. It is rarely used to encourage good performance or identify best practice. If the new national performance framework for the NHS is to achieve its aim of promoting good performance, the limitations of quantitative measures have to be taken into account.

CHANCE WOULD BE A FINE THING

M Foolchand

Health Service Journal, vol. 109, August 26th 1999, p.25

The Project 2000 nurse education scheme was launched in the late 1980s to produce a workforce of 'knowledgeable doers'. Its successful implementation was scuppered by other policy initiatives, including introduction of the internal market, implementation of the Community Care Act and the imposition of a new grading structure for nurses.

CLINICAL AUDIT SYSTEMS AND LIFELONG LEARNING

J Wilson

British Journal of Health Care Management, vol. 5, 1999, p. 332-333.

Clinical audit is a crucial tool for ensuring improvements in patient care. One of the key components of clinical governance is for all clinicians to participate in clinical audit systems, which will provide a comprehensive framework for quality improvement and the monitoring of clinical care using effective information and clinical record systems.

COMPETITION AND CONTAINMENT IN HEALTH CARE

B. Griffith

New Left Review, no. 236, 1999, p. 24-52

Article assesses the impact of attempts to impose 'internal markets' in health care alongside new procedures for rationing treatment, except for the wealthy. Emphasis is given to the British experience, although reference is also made to developments in the US and elsewhere.

Also analyzes the health care policies of current centre-left administrations, including the impact of two years of New Labour on Britain's NHS.

CONSULTANT PHYSICIANS WORKING FOR PATIENTS

Royal College of Physicians

London: 1999

Estimates a shortfall of around 2,000 consultants in the NHS, which implies an additional 40% are required. Recommends that there should be one consultant per 80,000 population, except for geriatrics, where the ratio should be one consultant in 50,000 population.

THE CUSTOMER IS SOMETIMES RIGHT

B Sang

Health Service Journal, vol. 109, August 19th 1999, p. 22-23

Patients' groups and service user organisations have grown enormously in the past 20 years. The NHS is beginning to take the principle of patients managing their own conditions seriously. However, sustained service user involvement in planning of local services is still some way off.

FILLING IN TIME

S Silvester et al

Health Service Journal, vol. 109, Sept. 9th 1999, p. 22-23

A national survey of 1,000 dentists revealed an increase in the amount of private work undertaken. Many thought that fees for NHS dentistry compromised quality, and a high proportion believed that the government planned to privatise dentistry.

THE IMPACT OF A QUASI-MARKET ON SEXUALLY TRANSMITTED DISEASE SERVICES IN THE UK

D Evans

Social Science and Medicine, vol. 49, 1999, p. 1287-1298

Article reports the results of a study of the impact of quasi-market reforms on sexually transmitted disease (STD) services in one UK health region. Study adopted a qualitative case-study approach to examine Health Authority commissioning of STD services. Results showed that the introduction of the NHS quasi-market did not equip HAs with mechanisms for bringing about change in STD service provision or STD-related health outcomes. Findings are consistent with other recent studies of HA commissioning and provide further evidence of the limits to HA-leverage in the NHS quasi-market.

IMPLICATIONS OF THE HUMAN RIGHTS ACT 1998 FOR PATIENTS AND HEALTH SERVICE BODIES

Anon

Health Law, vol. 4, July/Aug. 1999, p. 1-3

Implementation of the Human Rights Act 1998 may make it possible for:

  • patients to challenge the non-provision of expensive treatments and the NHS complaints procedure;
  • persons whose homes are affected to challenge environmental pollution caused by the NHS;
  • Jehovah's Witnesses to refuse blood transfusions and organ transplants;
  • relatives to challenge refusal of visitation rights to incapacitated people;
  • for learning disabled adults to challenge the rights of carers to prevent them having consensual sexual relations.

INCENTIVES AND HEALTH POLICY: PRIMARY AND SECONDARY CARE IN THE BRITISH NATIONAL HEALTH SERVICE

D Hausman and J Le Grand

Social Science and Medicine, vol. 49, 1999, p.1299-1307

Article addresses the question of how institutions should be structured so that GPs are motivated to make decisions that are both socially efficient and equitable. Paper begins with a general discussion of the motivation and incentives of GPs. Following sections discuss how GP motivations and incentives changed with the introduction into the NHS of GP fundholding, and how they might change further in the new Primary Care Groups.

THE INDEPENDENT SECTOR

British Journal of Health Care Management, vol. 5, August 1999. Supplement.

Supplement looks at the changing relationship between the NHS and the private sector. In the first article, it is argued that the NHS must give managers new powers to use private providers more effectively if it is to deliver its goals. Subsequent articles argue that the NHS and the private sector will have to work more closely together to ensure that a comprehensive service can be delivered, and look at the proposed regulatory framework for private health care.

LEADERSHIP FOR HEALTH

Guidance setting out a new agenda for Health Authorities warns against a drive towards mergers once functions have been devolved to primary care groups. Says that Has will play a key role in managing the local health economy, including PCGs and PCTs, will set priorities, will produce and ensure the implementation of, Health Improvement plans, will control access to development funds, and will drive the process of reorganising local services.

(See also Health Service Journal, vol. 109, Sept. 9th 1999, p. 9-10)

NHS IS BOUND TO FAIL

Community Care, no. 1287, 1999, p. 10

Children with Downs syndrome can be denied medical treatment because of scare resources within the NHS. In a tax-financed system there will never be enough resources to go round, so the gain of one patient is always at the expense of another. The solution lies in a new approach to health care in which the state becomes one of a number of providers and in which treatment is funded from a variety of sources, including private insurance, mutual aid schemes and charitable funding.

NHS TOLD TO CUT OUT-PATIENT WAITS

N Timmins

Financial Times, Sept. 7th 1999, p. 10

Health authorities have been told to identify and tackle particularly long waits for out-patient treatment, as the government yesterday moved to counter claims that in-patient waiting lists have been cut at the expense of longer waits for out-patient appointments.

(See also Health Service Journal, vol. 109, Sept. 9th 1999, p. 2-3)

ON THE CRITICAL LIST

P Healy

Health Service Journal, vol. 109, August 26th 1999, p. 10-11

Profiles Dame Deirdre Hine and Dr Peter Homa, the newly appointed chair and director of the Commission for Health Improvement.

ORGANISATION OF ACUTE GENERAL HOSPITAL SERVICES

Joint Consultants Committee

London: 1999

Presents a model for the future of acute services suggesting that hospitals serving populations of about 500,000 people would be ideal in terms of training specialists, providing round-the-clock cover, and specialist care for emergencies. However, for the forseeable future the District General Hospital serving a population of 200,000 - 300,000 is likely to continue as the basic unit providing the majority of emergency and elective services.

PRIME MINISTER'S QUESTION TIME

K McIntosh

Health Service Journal, vol. 109, Sept. 16th 1999, p. 11-13

Reports on the package of measures launched by the government to tackle growing outpatient waiting lists. Health Authorities must identify, target and tackle local outpatient problems. Monitoring of outpatient performance must be stepped up, and regular reports to the Health Secretary will be required. The National Patients Access Team, charged with cutting long waits, will undertake an extended programme of visits to promote best practice.

RICHLY DESERVING

N Pettinger

Health Service Journal, vol. 109, Sept. 9th 1999, p. 20-21

Reports research showing that the poor wait longer on NHS waiting lists and have less access to elective treatment than more affluent groups. Hospitals have a long way to go if they are to ensure a more equitable system. Managing waiting lists to discriminate in favour of the poor should be considered.

SENIOR STAFF FIDDLED NHS WAITING LIST

P Waugh

Independent, Sept. 1st 1999, p. 2

Redbridge Health Care Trust suspended a manager and a surgeon after investigating allegations that patients in need of treatment had been kept off waiting lists to meet government guidelines. The case is the first proof of Tory claims that Labour's tough targets on waiting lists have caused fiddles.

(See also Times, Sept. 1st 1999, p. 2; Daily Telegraph, Sept. 1st 1999, p. 2)

SO YOU THINK YOU KNOW IT ALL?

S McIver

Health Service Journal, vol. 109, Sept 16th 1999, p. 22-23

The government's proposals to set up an expert patients programme to enable those with chronic illnesses and disabilities to manage their condition is a welcome step towards greater user involvement. The programme should avoid a medical model and take account of patients' social circumstances. The programme must include evaluation. Health professionals in the UK have yet to embrace patient self-management. To date they have been reluctant to refer service users to self-help groups.

TESTING TIMES FOR DOCTORS

S Boseley

Public Finance, July 30th-August 12th 1999, p. 18-19

Predicts the introduction of revalidation, which will force every doctor in the country, from consultant to GP to junior, to establish their fitness to practise to the satisfaction of their peers every five years.

WAITING LISTS RISE 65% IN TWO YEARS

J Laurence

Independent, August 27th 1999, p. 2

The number of patients waiting more than 13 weeks for hospital out-patient appointments rose to 85,000 by the end of June, up 29,000 on the previous quarter. Ministers reacted by announcing extra spending of £30 million to try to reduce the growing queues to see a consultant.

(See also Daily Telegraph, August 27th 1999, p. 1+2; Financial Times August 27th 1999, p. 8; Times, August 27th 1999, p. 2)

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