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Welfare Reform on the Web (September 2005): National Health Service - Reform - General

Accident and emergency

Healthcare Commission

London: 2005 (Acute hospital portfolio)

Report says that while the majority of patients are happy with the standard of care they receive in A&E departments in England, performance varies widely. Some patients in some emergency departments are not receiving the standard of care that A&E consultants recommend. In particular, some children and older people do not receive pain relief for fractures quickly enough. The report also found that there had been substantial staffing increases since 2000, but there was no association between waiting time reduction and increases in staff at department level. There is more use of bank and agency staff in London hospitals, which may partly account for survey results showing less satisfaction with London departments.

Are Health Inequalities really intractable?

M. Greener

British Journal of Healthcare Management, Vol. 11, 2005, p. 216 - 218

While education remains the main strategy to address well-evidenced socio-economic health inequalities, these problems are likely to remain intractable where conventional strategy promotes a hierarchical flow of knowledge. The author stresses the need for researching, recognising and addressing diverse local and cultural factors influencing inequalities, and the importance of not overestimating the power of education in the face of external pressures such as lack of personal resources with which to respond to learned lessons.

Commissioning a patient-led NHS

Department of Health 2005

Document focuses on creating a step-change in the way services are commissioned by front-line staff to reflect patient choices. There will be some changes in function for primary care trusts and strategic health authorities. In future both will concentrate on:

  • promoting health improvement and reducing inequalities
  • securing safe and high quality services for their population
  • emergency planning. The document asks strategic health authorities to work
with their local health communities to consider roles and responsibilities of organisations in their areas and sets out criteria for assessing local proposals for change.

District general hospital model may be on its last legs

N. Timmins

Financial Times, August 8th 2005, p.3

District general hospitals - the mainstay of acute National Health Service care for 40 years - face a future so uncertain that it may amount to the "death of the hospital" at least as currently configured, according to health care analysts. Increasing amounts of non-emergency surgery are set to be moved out to freestanding treatment centres, some run by the private sector. More care for chronic conditions is to be shifted out of hospital to family doctor-based services, and more diagnostic facilities are set to be provided in primary care rather than in hospital. The result could be the "hollow hospital", with analysts saying that one outcome is likely to be fewer but bigger accident and emergency departments.

Do English NHS waiting time targets distort treatment priorities in orthopaedic surgery?

J. Appleby and others

Journal of Health Services Research and Policy, vol.10, 2005, p.167-172

Study investigated whether or not UK government-imposed waiting time targets led to less urgent patients who had been waiting longer for surgery displacing urgent cases. The approach adopted was a before-and-after study comparing waiting time distributions for waiting list and booked trauma and orthopaedic in-patients and day cases admitted in 2001/02 with the equivalent distributions in 1997/98, when there were no maximum waiting time targets. While the 2001/02 waiting time target changed admission patterns and was a major contributor to the reduction in long waits, the extent to which this represents a distortion of clinical priorities is questionable given the lack of widely accepted admission criteria.

Engaging the intermediate tier in 'A Patient –Led NHS'

J. Keep and Bob Sang

British Journal of Healthcare Management, Vol. 11, 2005, p. 204 - 208

Article reflects on the authors' recent work with the Engaging Communities Learning Network, which involved supporting the patient, public and staff participation capabilities of primary care trusts working in collaboration with Strategic Health Authorities. It explores how this work sheds light on how present organisational development challenges facing the NHS can be managed as it implements the government's patient choice, payment by results, connecting for health and agenda for change initiatives.

Feel the power

C. Shannon

Health Service Journal, vol.115, Aug.11th 2005, p.23-24

Article introduces local area agreements, which are seen as the next advance in partnership working between the NHS, local authorities, the police, the voluntary sector and business. They are negotiated between the partners and regional government offices, and specify a range of agreed outcomes, with associated indicators, targets, and funding streams. Supporters say they cut through red tape and allow partners to access resources normally outside of their individual control.

Foundations 'need clarity' over policy

S. Ward

Public Finance, July 8th - 14th , 2005, p.7

Short news item on key points of, and reactions to, the Healthcare Commission's recent report on the first twenty foundation trusts. It highlights the need for policy clarity from government regarding practice based commissioning, patient choice, payment by results and the national tariff. While Health Secretary Hewitt reportedly promises to consider the recommendations, the Foundation Trust Network calls for greater regulatory freedom and franchising possibilities.

Handbrake turns and u-turns over cost pressures

N. Timmins

British Journal of Healthcare Management, Vol. 11, 2005, p. 198 - 199

This news item and opinion piece following the NHS Confederation's annual conference warns of the consequences if the NHS doesn't recognise that it is running a business and wake up to the real world in the next eighteen months. It looks at:

  • contradictory government messages on NHS reform
  • health managers' views on inadequate funding for reforms despite record spending
  • future reality and the bite of the health market
  • dismantling or system reform of the NHS
  • the end of PFI

HIV infected health care workers: guidance on management and patient notification

Department of Health

London: 2005

It is no longer necessary to notify every patient who has undergone an exposure prone procedure by an HIV infected health care worker because of the low risk of transmission and the anxiety caused. However, the long-standing restriction on HIV infected healthcare workers carrying out exposure prone procedures remains. It is recommended that a decision on whether a patient notification exercise should be carried out should be made on a case-by-case basis using a criteria-based framework as set out in this document.

Hospital to publish its death rates

C. Hall and J. Burleigh

Daily Telegraph, August 25th 2005, p.2

St George's Hospital in Tooting, South London, one of Britain's main hospitals, has become the first in the country - possibly in the world - to publish mortality rates online for all its specialities.

(See also The Times, August 25th 2005, p.1)

NHS turns league table on reporters

J. Carvel

The Guardian, August 22nd 2005, p.7

Not content with measuring the performance of doctors and hospital managers, the Department of Health has begun publishing statistics on the output and perceived "slant" of the journalists writing most frequently about the condition of the NHS. In a move expected to be followed by other government departments, it has hired media consultants to assess every article in the national and regional press, and categorise it is positive, negative or neutral.

No end in sight to NHS waiting

N. Hawkes

The Times, August 4th 2005, p.23

The Government is on course to achieve its 18-week waiting time target for NHS hospital treatment by 2008, a report form an independent health body has concluded. But there could still be problems caused by increasing demand, staff shortages and the destabilising effects of new policies. Even if the target is achieved, the report from the King's Fund said, it will not be "the end of waiting". The report questioned whether waiting times should remain a central policy issue , suggesting that inequities will increase as waiting times are reduced.

Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors’ response to clinical governance

C.V. Som

International Journal of Public Sector Management, vol.18, 2005, p.463-477

Data gathered through interviews with a heterogeneous group of 33 persons with important responsibilities for clinical governance demonstrate that doctors are not enthusiastic about this initiative, which is seen as an assault upon their professional autonomy and freedom. It is also seen as a management initiative, imposed without consultation, which creates paperwork without improving patient care.

A patient-led NHS requires citizen-led medical regulation

B. Sang and G. Catto

Health Service Journal, vol.115, Aug.18th 2005, p.16-17

Sang and Catto agree that the case for meaningful public involvement in medical regulation is overwhelming. They debate whether the regulatory system should be led by health care professionsls or by citizens.

Promoting equality and human rights in the NHS: a guide for non-executive directors and trust boards

NHS Appointments Committee, NHS Confederation [and] Department of Health.

London: DoH, 2005

The guide contains details of current and imminent legislation, vital statistical information on communities, patients and the workforce, and a set of 15 prompts to enable Boards to embed good human rights and equality practises in their decision-making and their organisations. As a result, the NHS will be able to maintain its commitment to providing fairer, faster and personalised services to communities and patients and to recruiting, developing and retaining the best talent in its workforce.

Reimbursement decisions in health policy: extending our understanding of the elements of decision making

V. Wirtz, A. Cribb and N. Barber

Health Policy, vol.73, 2005, p.330-338

Article explores some of the personal and political factors which influence decisions about whether to make a given treatment available free on the NHS, using sildenafil, rivastigmine and statins as examples. Interviews with a purposive sample of 20 regional and national policy makers and stakeholders revealed two dimensions of decision-making that extend beyond the rationales conventionally cited. The first dimension relates to the role of subjectivity in decision-making, including personal experience of the condition and excitement about the novelty or potential benefit of the technology. The second dimension relates to social and political factors such as maintaining relationships, avoiding organisational burden, generating politically and legally defensible decisions and demonstrating willingness to care.

Role play

A. Dix

Health Service Journal, vol.115, July 28th 2005, p.30-32

Addenbrooke's Trust in Cambridge had an acute staff shortage in radiotherapy four years ago. The Trust signed up to a Department of Health New Ways of Working programme for developing radiographers. New roles and a new career structure helped to bring the radiography department up to nearly full staffing.

The Rough guide to the foundation programme

NHS and British Medical Association

London: TSO, 2005

This new two-year foundation programme for junior doctors replaces the existing pre-registration house officer year and the first year of senior house officer training. It will give trainees exposure to a range of career placements over a broad spectrum of specialities. All trainees will have access to an educational supervisor as well as a clinical supervisor for each placement. The programme focuses on patient safety, and progression will be based on the achievement of competence rather than time served. Junior doctors will have to demonstrate that they are competent in areas such as communication and consultation skills, patient safety and teamworking as well as more traditional clinical skills.

Sea-change in assessment puts new onus on trusts

I. Lloyd

Health Service Journal, vol.115, July 28th 2005, p.14-15

In October 2005 all NHS trust boards in England will be expected to sign a draft public declaration proclaiming whether or not they have complied with 24 core standards that will form the bedrock of the new health service ratings. Once trusts have made their declaration, the Healthcare Commission will start a cross-checking process. The Commission's own surveys and information from other regulators will feed into a traffic light system which either confirms or contradicts a trust's statement of compliance. Trusts for which cross-checking identifies a high risk of an undeclared lapse in core standards will receive an inspection by the Commission. The final rating received by a trust will be based on performance against existing targets and use of resources as well as against the 24 core standards.

Tackling health inequalities: status report on the programme for action

Department of Health

London: 2005

The status report provides a review of developments since the publication of the Programme for Action to Reduce Health Inequalities in 2003. It considers progress against the Public Service Agreement target, the national headline indicators and government commitments. Unfortunately inequalities between manual groups and the rest of the population have worsened in the key areas of life expectancy and infant mortality. TESTING TIMES A. Moore Health Service Journal, vol.115, Aug.11th 2005, p.26-28 Describes how Pennine Acute Hospitals Trust has reorganised its pathology services, which serve its four district general hospitals. It plans to build a new central laboratory to be located at Royal Oldham Hospital, backed by three essential services laboratories which will deal on site with tests requiring a quick turnaround.

Testing times

A. Moore

Health Service Journal, vol.115, Aug.11th 2005, p.26-28

Describes how Pennine Acute Hospitals Trust has reorganised its pathology services, which serve its four district general hospitals. It plans to build a new central laboratory to be located at Royal Oldham Hospital, backed by three essential services laboratories which will deal on site with tests requiring a quick turnaround.

Towards a wireless patient: chronic illness, scarce care and technological innovation in the United Kingdom

C. May and others

Social Science and Medicine, vol.61, 2005, p.1485-1494

Telemedicine's proponents aimed to use the power of information technologies to bring doctors and patients closer together in areas underserved by health care providers. Instead, the concept has been hijacked by NHS management and turned into a tool for managing chronic conditions in the community. This shift from telemedicine to telecare provides a technological framework for the domestic management of chronic illness because monitoring performance data enables quality control over the expert patient's self-care and illness management, while its inbuilt parameters, which frame the patient as a minimum data set, govern points of entry into formal care systems.

'Working the system': achieving change through partnership working: an evaluation of cancer partnership groups

A. Richardson, J. Sitzia and P. Cotterell

Health Expectations, vol.8, 2005, p.210-220

Study investigated the characteristics and achievements of the cancer partnership groups (collaborative service improvement groups formed of NHS staff and patients) that were established in association with most of the 34 cancer networks in England. Interviews with group members revealed that common early activities included work to establish the group and develop its aims, serving as a reference group for consultation exercises, providing representatives for other groups, and developing information for patients. A few well-established groups were also proactively influencing substantial service developments.

Yobs pay price for attacks on NHS workers

C. Hall

The Daily Telegraph, August 20th 2005, p.1

The number of successful prosecutions of patients and relatives who physically abuse NHS staff has jumped nearly 15 fold in a year as the Department of Health's "zero tolerance" policy starts to bite.

Young adults’ (16-25 years) suggestions for providing developmentally appropriate diabetes services: a qualitative study

G. Dovey-Pearce and others

Health and Social Care in the Community, vol.13, 2005, p.409-419

This qualitative, user-involvement study aimed to describe and understand the views of 19 young adults with diabetes who were receiving secondary care services about the provision of age-appropriate services for young people. Participants suggested key issues to address when developing services for young people, including staff consistency, civility, clinic structures which help a person navigate the health care system, provision of age-specific information, and support in relation to a range of health, emotional, social and developmental needs. Health-care professionals can help young people meet the expectations placed upon them as autonomous service users by modelling appropriate relationships, helping them to acquire skills and knowledge, and overcoming barriers to their becoming active participants in their own health care.

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