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

A&E services at risk from NHS changes

J. Carvel

The Guardian, October 11th 2005, p.1

Hospitals are being destabilised and emergency services could be put at risk by the introduction of market pressures into the NHS, the health service's spending watchdog warned yesterday. The Audit Commission said a new system of payment by results - rewarding NHS trusts directly for every job done - was so extreme that hospital departments could be forced to close. (See also The Times, October 11th 2005, p.1)

Are QALYS a fatally flawed measuring tool?

M. Greener

British Journal of Health Care Management, vol.11, 2005, p.303-307

Quality Adjusted Life Years (QALYs) are the measurement system that allows purchasers and politicians to compare the health benefits of investing in different treatments. They underpin NICE assessments and guidance on the value for money offered by different treatments. Critics of QALYs suggest that they are ageist, discriminate against some illnesses and fail to fully capture society's values. However, in spite of their flaws, they are the the only viable means of comparing competing health care technologies.

Competing for your medics

M. Britnell

Health Service Journal, vol.115, Oct.27th 2005, p.17

Government has chosen private companies only to compete for contracts to provide diagnostic and imaging services to the NHS. Article discusses the impact of this policy on NHS consultants, who may be lured to work for these companies part time. It explores ways in which NHS employers could prevent this.

Fit for purpose

R. Coombes

Health Service Journal, vol.115, Oct. 6th 2005, p.22-24

Care for people with epilepsy has been dogged by lack of services and long waiting lists. However, the introduction of NICE guidelines and a National Service Framework for long-term neurological conditions may lead to progress. These aim to transfer services from hard-pressed hospitals to primary care. There have been some pockets of improvement, aided by GPs with special interests and networks of specialists. Experts believe that GPs will have a key role in providing better services for epilepsy sufferers.

'Information is power' say patients

D. Martin

Health Service Journal, vol.115, Oct.6th 2005, p.9

The current public consultation about the future of the NHS has shown general concern about difficulties in accessing health services and a demand for better information about what is available.

NHS Redress Bill [HL]

London: TSO, 2005 (HL Bill 22)

The NHS Redress Bill gives the Secretary of State power to establish an NHS Redress Scheme and places a duty on providers and commissioners of hospital services to ensure patients receive a more speedy and appropriate response to clinical negligence claims. The Scheme will cover low monetary value claims, with the initial upper limit expected to be set at £20,000. It is designed to offer patients a real alternative to litigation, avoiding the long delays and legal costs typical of the current system. Other key elements of the Bill include: " Provision for patients to receive redress in the form of care " A more proactive approach to clinical negligence, with the onus no longer on patients to initiate a claim. All scheme members will be required to review adverse incidents and trigger the scheme themselves where appropriate. " A duty on all scheme members to appoint an appropriate person responsible for learning from mistakes.


I. Lloyd

Health Service Journal, vol.115, Oct 6th 2005, p.14-15

With the advent of patient choice expected in December 2005, hospitals are gearing up to market themselves to potential patients and GPs. Family doctors will be key in directing patients, as many will simply ask their GP to choose for them.

Setting national targets proves a tonic for English health services

N. Timmins

Financial Times, October 21st 2005, p.2

The government's controversial use of targets, performance management and now increasing doses of competition in the National Health Service in England appears to be producing appreciably better results - at least on some measures - than in Scotland, Wales and Northern Ireland, according to the British Medical Journal. Since devolution in 1998, the countries have pursued very different health policies. The result, say the BMJ figures, has been a "striking divergence" in waiting times.

Shop 'til you drop

R. Rosen

Health Service Journal, vol.115, Oct.27th 2005, p.22-24

It is unclear whether the public will embrace choice of NHS provider with enough enthusiasm to drive improvement. A series of focus groups has confirmed there is general support for choice, but also concern about how patients would get information to inform their decisions. Many people would act against one of the drivers of the policy and would in fact choose to wait in order to see the best clinician! There was also an understanding that choice and easier access to services may stoke demand in relation to minor ailments and may not be the best use of resources.

Sweet dreams and harsh realities

A. Maynard

British Journal of Health Care Management, vol. 11, 2005, p.318

Author argues that introducing patient choice and easier access to primary care could stoke demand for treatment for trivial ailments as has happened in France. Expanding diagnostic capacity through increased use of private providers could lead to a replication of the German problem of expensive excess capacity which is underused.

Technology appraisals: how are they done?

A. Dix (editor)

Health Service Journal, vol.115, Oct.20th 2005, supplement, 13p

Special supplement on the work of the National Institute for Health and Clinical Excellence (NICE) covers: " Different approaches to technology appraisal across the UK. Both Scotland and Wales do swift appraisals of drugs close to launch based on evidence submitted by pharmaceutical companies. The NICE, on the other hand, only looks at drugs at the request of the Department of Health following a selection process that can last months. " The process of selecting drugs for scrutiny by NICE " The NICE's new role of developing evidence-based public health guidance

Unknown quantities

A. Dix

Health Service Journal, vol.115, Oct.20th 2005, p.26-28

Poor performance on cancer waiting time targets has been partly blamed on the government only recently pushing them to the top of the agenda. The first priority for trusts is to improve data collection, as poor management information is preventing a clear picture of progress and areas of vulnerability emerging. Article presents a series of case studies of how some trusts are tackling the problem.

Why nurses won’t help

D. Birkett

Health Service Journal, vol.115, Oct.13th 2005, p.17

Argues that nurses have become too over-qualified and over-specialised to offer basic personal care to patients. Unfortunately no other NHS staff have assumed this role, and patients who are unable to help themselves are consequently being neglected and not having their basic needs met.

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