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

Council expertise with social care providers may help win role in health commissioning

M. Samuel

Community Care, Sept.15th-21st 2005, p.10-11

Local authorities are seeking a larger role in the commissioning of health services in their areas. This brief article discusses whether this is feasible, and finds that the idea is not as outlandish as it seems, especially in the domain of public health.

Failure is not an option

A. Dix

Health Service Journal, vol.115, Sept.22nd 2005, p.30-32

The deadline for achieving targets to start treatment for cancer within 31 days of a decision to treat and 62 days of an urgent GP referral is at the end of 2005. The Health Secretary is concerned about lack of progress towards hitting the targets. Problems hampering progress include data collection issues and overly complicated waiting lists. However, Whittington Hospital and University of Leicester Hospitals Trust have made marked progress by redesigning the care pathway.

The implementation and impacts of the hospital at night pilot projects

A. Mahon and others

London: Department of Health, 2005

The effective and safe management of patients in hospitals during the out-of-hours period has emerged as a key challenge for the NHS in recent years. At night, hospitals have relied on resident specialist "on call" doctors. This model has been subject to increasing debate amid concerns about the impact of excessive working hours on the health of doctors and the quality of patient care. The European Working Time Directive (EWTD) has also acted as a catalyst for changing the working patterns of junior doctors. One approach to supporting the implementation of the EWTD, while maintaining the quality of patient care, has been the Hospital at Night model.

Implementing health scrutiny: meeting the challenge in one local authority

J. Wistow and S. Banaras

Journal of Integrated Care, vol.13, Aug.2005, p.34-42

Article investigates how health scrutiny functions were implemented in a unitary authority in the North of England, through a case study of an inquiry into health inequalities.

Innovation & improvement

A. Nolan (editor)

Health Service Journal, vol.115, Sept. 29th 2005, Suppl., 9p

Supplement sponsored by the new NHS Institute for Innovation and Improvement covers organisational redesign, exploiting inventions, the NHS graduate training scheme for managers and workforce development.

Inspection focus will shift to commissioners by 2008

M.-L. Harding

Health Service Journal, Sept. 29th 2005, p.5

By 2008 primary care trusts will procure services for their populations instead of providing them directly. At that point the Healthcare Commission proposes to judge them on the quality of the services they buy for their local population. There will be fewer inspections of providers, as contract terms should be enforced to keep them in line.

Let's wait and see

A. Harrison and J. Appleby

Public Finance, Aug.19th-Sept 1st 2005, p.24-25

Government has set a target that, by 2008, no patient should wait more than 18 weeks for treatment after being referred by their GP. Authors identify three factors that will help the NHS to meet the target: availability of extra capacity commissioned from the private sector, the impact of patient choice, and the financial incentives for improvement offered by Payment by Results. Other factors that will make it difficult to meet the target include shortages of skilled staff, financial constraints and a possible rise in demand.

Medical error

National Patient Safety Agency


This document is designed to raise awareness of patient safety and includes 14 interviews with leading doctors on mistakes they have made, case studies and expert advice. It provides practical advice on how to reduce risk, and highlights the importance of reporting mistakes and the need to change systems to protect doctors from error.

National Health Research Strategy

Department of Health


Consultation document proposes setting up a virtual National Institute for Health Research to manage the NHS research infrastructure. Funding of £100m would be allocated to a "premier league" of 10 research hospitals, to be known as academic medical centres. New funding streams, open to all trusts, will prioritise applied research and frontline services. These will replace the current system whereby funds are largely allocated on a historical basis.

Reflected glory

P. Stanton

Health Service Journal, vol.115, Sept.1st 2005, p.18-19

Under Standards for Better Health, the successor to star ratings, trust boards will be required to assess their organisations' performance against a set of core requirements. Based on this assessment they then have to declare whether or not there have been significant lapses from standards. Evidence on which the assessments are based should come from rigorous and robust systems of clinical governance.

Remains of the day

R. Coombes

Health Service Journal, Vol.115, Sept. 1st 2005, p.22-24

The Healthcare Commission has found that 45% of theatre time allocated to day surgery is being wasted. Not having dedicated facilities is no excuse for not increasing day surgery. Process change is more important, together with leadership from the top. Trusts need an "opt-out" culture in day surgery, where all surgical patients are considered eligible unless proven otherwise.

Thanks for all the cash, but…

R. Coombes

Health Service Journal, vol.115, Sept.22nd 2005, p.18-21

Reports the results of a poll of the most influential UK health organisations about the key challenges facing the government and the NHS. Respondents agreed that the most pressing health issues over the next few years are a total ban on smoking in public places, managing patients with chronic diseases, and the creation of a truly patient-led NHS. While praising the government for increased funding for the NHS, respondents were critical of the continuing uncertainties around primary care restructuring and the introduction of new market mechanisms.

When F is for failure

L. Donnelly

Health Service Journal, vol.115, Sept 29th 2005, p.14-15

Article discusses the impact of patient choice and payment by results on hospitals. These reforms raise the possibility of unpopular hospitals being forced to close due to lack of business. Experts suggest that some basic services such as emergency care and specialist treatment would have to be protected so that providers could not withdraw for economic reasons. Networks of hospitals could be developed, collaborating to provide a range of services across a number of sites while competing with other networks. Faced with competition for elective surgery from independent treatment centres, district general hospitals will almost certainly lose business and will have to be drastically re-engineered.

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