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

The direction of health policy in New Labourís third term

I. Crinson

Critical Social Policy, vol.25, 2005, p.507-516

Article discusses whether New Labour's modernisation strategy for the NHS will have any impact on reducing health inequalities. It focuses on the introduction of patient choice, the reinstatement of the internal market through payment by results and the establishment of foundation trusts, and the reliance on a combination of market forces and regulation to drive improvement.

ER-style doctors' aides for NHS

J. Carvel

Guardian, November 5th 2005, p.4

The NHS plans to recruit more than 2,000 science graduates to become US-style doctors' assistants, with a wide range of responsibilities for diagnosis, treatment and prescribing. They will work under the general supervision of GPs or consultants, but will be able to practice without a qualified doctor in attendance.

[See also Daily Telegraph, Nov.5th 2005, p.11]

Fast-track system of appraisal will speed up access to new NHS drugs

N. Tmmins

Financial Times, November 3rd 2005, p.5

A new appraisal system to be introduced by the National Institute for Health and Clinical Excellence will run an assessment of the cost-effectiveness of a drug in parallel with its application for a licence. This should cut the wait for a decision as to whether a new drug should be adopted by the NHS from 18 months to six. NICE approval should come within eight weeks of a licence being granted.

[See also Financial Times, Nov.4th 2005, p.4]

Hewitt's apology aims to calm NHS nerves over privatisation plans

J. Carvel

Guardian, November 12th 2005, p.12

Poor, under-doctored areas may benefit from the introduction of a competitive market, but competition ambitions will be watered down in the forthcoming white paper on healthcare outside hospitals. Health Secretary Hewitt apologised about "prescriptive" primary care proposals issued in July 2005, and reassured professionals at a health conference yesterday that the NHS would not become simply a commissioner of services.

Measure for measure

A. Moore

Health Service Journal, vol.115, Nov. 3rd 2005, p.24-26

Lack of capacity in the field of physiological monitoring (PM) may compromise hospitals' ability to hit government waiting time targets. Physiological monitoring tests cover everything from heart monitoring to urodynamics and hearing tests. A Department of Health PM leadership group has been set up to shape a strategic response to the problem. Trusts will have to report waiting times for tests to the group. Possible solutions include moving testing into the community, more direct referral by GPs, buying in private sector capacity and developing extended staff roles and skill mix.

More hospitals to apply for trust status in ratings change

N. Timmins

Financial Times November 7th 2005, p.2

Health Minister Patricia Hewitt is expected to announce that two-star hospitals will be able to apply for foundation status. She will also unveil the national roll out of a financial management tool aimed at better preparing trusts for financial viability assessments from regulator Monitor. The moves may be seen as accelerators towards reaching the government's 2008 target of foundation status for all hospitals, while Monitor asserts that the stringency of its assessments will not be reduced.

[See also Guardian, November 8th 2005, p.4; Daily Telegraph, November 8th 2005, p.6]

Screening system for cancer drugs to be streamlined

J. Laurance

Independent, November 4th 2005, p.11

Five cancer drugs including Herceptin will be fast tracked in a new streamlined treatment assessment scheme. The process, which cuts down the evidence reviewed by the National Institute of Clinical Excellence, expects to reduce the wait for approval from 14 to 8 months. While doctors may prescribe unlicensed or unapproved drugs, Primary Care Trusts (PCTs) will not necessarily fund them, and this reform, though bold, will not tackle problems of PCT resources or cancer drug approval backlogs.

Shake-up needed in hospitalsí drive for autonomy

N. Timmins

Financial Times, November 8th 2005, p.4

Rationalisation of local healthcare provision is needed for to help hospitals achieve government targets for gaining foundation status according to regulator Monitor. Underlying deficits, number of specialities, and site numbers are listed as problem issues that hospitals may not be able to resolve on their own. Deloitte and McKinsey have contracts to help. Conservative and NHS Alliance opinions are reported.

Simulation analysis of the consequences of shifting the balance of health care: a system dynamics approach

K. Taylor, B. Dangerfield and J. Le Grand

Journal of Health Services Research and Policy, vol.10, 2005, p.196-202

The balance of health care in many systems is shifting towards the primary sector. These changes include the development of outreach clinics, near patient testing and GPs undertaking minor surgery. This trend has been motivated by a broad desire to improve services by reducing pressure on hospitals. However, efforts to improve services overall may be undermined if improvements in access stimulate demand. This paper presents empirical evidence of shifts in services stimulating demand.

Sir Nigel: PCTs must prove worth before 2008 autonomy

L. Donnelly

Health Service Journal, vol.115, Nov.10th 2005, p.5

Reports on the contents of a leaked internal memo from the NHS chief executive in which he sets out an expanded role for the new strategic health authorities from April 2006. They will be charged with managing the rollout of acute foundation trusts and commissioning of services by primary care trusts. They will also exercise strict financial oversight over primary care, acute and foundation trusts and ensure they break even by the end of 2006/07. Primary care trusts must demonstrate financial competence before being given full control of their budgets in 2008.

Specialist shortage puts women at risk in childbirth

J. Laurance

Independent, November 7th 2005, p.8

A shortage of obstetricians, of which only 12% qualifying in 2004 were UK graduates, is threatening mother and child safety as surgical interventions in childbirth increase. Article reports comment following the Annual Still Birth Inquiry which linked 77% of still births to poor care standards.

Understanding clinical governance and quality assurance: making it happen

D. Sale

Basingstoke: Palgrave Macmillan, 2005

Clinical governance has been at the top of the agenda for the NHS since 1999, with the aim of setting in place systems that assure good-quality care for patients and their carers and families. The book gives practical guidance about making the principles, philosophies and methodologies of quality assurance a reality. It covers the key techniques, skills and approaches to make it happen, including:

  • Evidence-based practice
  • Integrated care pathways
  • Clinical risk management
  • Project management
  • Writing a strategy
  • Facilitating groups

Union protests at sale of NHS agencies

N. Timmins

Financial Times, November 4th 2005, p.2.

A new NHS Business Services Authority is to commission services from the private sector which were previously provided by NHS agencies. The business sense of this move affecting the NHS Pensions Agency, the Prescription Pricing Authority, NHS Logistics and the Dental Practice Board is questioned by sources cited.

What's in a care pathway? Towards a cultural cartography of the new NHS

R. Pinder and others

Sociology of Health and Illness, vol.27, 2005, p.759-779

Paper draws on the work of contemporary cultural cartographers to pose some critical questions about the increasing use of care pathways in the NHS. It urges awareness of the fact that they inevitably reproduce the very tensions between efficiency and effectiveness, patient-centredness and organisational imperatives that they strive to resolve. Care pathways may be regarded as Taylorist devices for standardising care and treating each individual patient in the same way. Moreover, the pathways are controlled by the experts (managers and clinicians); the voice of patients is muted.

Warning over short cuts to new drugs

N. Timmins

Financial Times, November 11th 2005, p.6

Patient pressure to prescribe new drugs based on limited clinical trial reports that are insufficient to establish efficacy and safety, along with Health Secretary Hewitt's intervention over Herceptin, threaten to short circuit drug regulatory systems which use much more extensive data to establish effectiveness and protect patients.

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