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Welfare Reform on the Web (February 2000): National Health Service - Reform - General

CANCER DEATHS AN NHS DISGRACE

A. Hibberd

Daily Telegraph, Oct. 21st 1999, p. 12

Reports claims that the failure of the NHS to provide resources for state-of-the-art cancer treatments was leading to "disgraceful" cancer mortality figures in the UK. These are probably the worst in Western Europe and certainly worse than the US.

CANCER TSAR TO END HOSPITAL LOTTERY

N. Watt

Guardian, Oct. 25th 1999, p. 4

Announces the appointment of a 'cancer tsar' to co-ordinate services within the NHS and to ensure that patients receive the same level of treatment throughout the country.

(See also Times, Oct. 25th 1999, p. 11; Financial Times, Oct. 25th 1999, p. 2; Daily Telegraph, Oct. 25th 1999, p. 2)

CHOICE IN THE NHS IS A TORY ISSUE

P. Lilley

Times, Nov. 3rd 1999, p. 23

Attacks Labour's abolition of the right of GPs to refer patients for treatment in a different area. The complete abolition of extra-contractual referrals has removed the last vestiges of patient choice within the NHS.

CONTRACTING FOR QUALITY: DOES LENGTH MATTER?

M. Goodard, B. Ferguson and D. Dawson

Journal of Health Services Research and Policy, vol. 4, 1999, p. 220-225

Study examined whether long-term contracts for health services will shift attention away from concern for finance and activity levels and towards the achievement of better quality services. Analysis of 288 NHS contracts and 12 semi-structured interviews with staff from NHS hospital trusts and health authorities showed no relationship between the duration of a contact and the duration of service specifications or quality frameworks. It is optimistic to expect long-term contracts automatically to produce a greater focus on quality. However this may not mater as quality issues are being addressed by a variety of other routes within the NHS.

CO-OPERATIVE SOCIETY

J. Dale and C. Salisbury

Health Service Journal, vol. 109, Oct. 21st 1999, p. 24-27

The last decade has seen a bargaining of out-of-hours services in a movement characterised by experimentation and innovation that may have implications for all health services. The system needs to be more integrated to remove duplication and fill existing gaps, but resistance from healthcare professionals is a major barrier. A shift from an out-of-hours emerging service towards 24-hour access to routine healthcare would be unsustainable and have limited health gain. NHS Direct should be the single point of access, with open access to Accident and Emergency Services restricted to people unable to telephone and who require urgent specialist care.

DOBSON PLAN FOR 'VIRTUAL DOCTORS' TO CUT CASUALTY DEPARTMENT DELAYS

R. Sylvester

Daily Telegraph, Sept. 23rd 1999, p. 23

Emergency patients arriving at hospital casualty departments are to be diagnosed by computers operated by nurses under radical government plans to cut waiting times.

EVIDENCE TO THE REVIEW BODY FOR 2000

Royal College of Nursing

London: 1999

Analysis of labour market data and the response to a membership survey show:

  • the substantial 1999 pay award for nurses in the entry grade has begun to change perceptions of nursing as a career, and has had a positive impact on the morale of nurses at grade D;
  • this process of improvement needs to continue, and a low award in 2000 would sweep away the gains made in 1999;
  • experienced nurses are very disillusioned by the 1999 pay award, and feel that they have been inadequately rewarded.

FITNESS FOR PRACTICE

UKCC Commission for Nursing and Midwifery Education

London: United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1999

Recommends that:

  • courses should be made more flexible and the entry gate widened to attract a wider range of recruits;
  • responsibility for student recruitment and selection should be shared by health trusts and universities, which should work in partnership to achieve a shift to competency-based education;
  • that there should be earlier and longer clinical placements and at least 3 months' supervised hands-on experience towards the end of the course.

GENERAL PRACTITIONER OPEN ACCESS TO DIAGNOSTIC SERVICES FOR CANCER

C. Davies

Coventry Warwick Business School, 1999

Results of a survey of 42 trusts offering open access for at least one form of cancer show that, while the waiting time for diagnosis may be reduced by this approach, there is no evidence that this leads to earlier treatment. The system can become overloaded and unable to respond quickly, while boundaries between rapid access and screening can become blurred.

(For summary see Health Service Journal, vol. 109, Oct. 28th 1999, p. 11-12)

GRATING EXPECTATIONS

R. Klein

Guardian Society, Oct. 20th 1999, p. 8-9

Argues that the Labour governments reforms will raise public expectations of what the NHS can deliver. At the same time, their thrust towards central government control will mean that ministers cannot escape blame when things go wrong. As the Treasury is unlikely to be willing to significantly increase spending on health care to meet rising public expectations, a second term Labour government may have second thoughts about its commitment to the NHS in its present form.

INSTITUTIONAL CHANGE IN UK HEALTH AND LOCAL AUTHORITIES

R. McMaster

International Journal of Social Economics, vol. 26, 1999, p. 1441-1454

Article looks at the impact of compulsory competitive tendering on health services and local authorities in the UK.

IT'S MAKE YOUR MIND UP TIME

G. Ainsworth

Health Service Journal, vol. 109, Sept. 23rd 1999, p. 16-17

Argues that, since resources are not infinite, the need to ration health care will always exist. The real debate can only be about selection criteria. These should be determined by what the majority of society believes to be acceptable.

I'VE STARTED SO I'LL FINISH

P. Butler

Health Service Journal, vol. 109, Oct. 21st 1999, p. 11-12

  • Alan Milburn has been appointed Health Secretary just when pressure to deliver on election pledges is mounting. he will be expected to:
  • extract more money from the Treasury;
  • cut waiting lists;
  • push forward primary care groups and trusts while keeping GPs on side;
  • renegotiate the consultants contract;
  • implement a new pay system;
  • manage hard decisions that emerge from NICE.

MILBURN IN NHS STRATEGY U-TURN

A. Grice

Independent, Oct. 18th 1999. p. 1

In a radical shift in policy, Labour's drive to cut hospital waiting lists will be downgraded in favour of targeting treatment on heart disease and cancer. The NHS will be set targets to recruit more cardiac surgeons and perform more heart operations. A review of cancer services will examine the feasibility of issuing a guarantee that no cancer sufferer should wait more than 14 days after being referred to a specialist by a GPs. National Service frameworks for heart disease and cancer will be produced, setting out blueprints for prevention, treatment, care and specialist services.

(See also Daily Telegraph, Oct. 18th 1999, p. 1+2; Times, Oct, 18th 1999 p. 2; Guardian, Oct. 18th 1999, p. 1+2).

MILBURN'S GOAL IS A FASTER, FAIRER NHS

P. Webster

Times, Nov. 4th 1999, p. 14

Reports an interview with Health Secretary Alan Milburn in which he sets out his agenda for modernising the NHS so that it provides a consistently high quality of care nationwide.

MODERNISING THE NHS: BOOKING PATIENTS FOR HOSPITAL CARE

P. Meredith, C. Ham and R. Kipping

Birmingham: Health Services Management Centre, University of Birmingham, 1999

Study of 24 pilot schemes introducing airline-style booked admission systems to the NHS. The pilots have cut waiting times to see a consultant, improved patient attendance at appointments and been well-received all round. However implementation of the system across the NHS would require changes in working practices and the curtailment of some long-held clinical freedoms.

THE NEW NURSING AGENDA

Unison

[London]: [1999]

Calls for a substantial pay rise for nurses, together with a restructuring of key grades to boost salaries of the lowest grade nurses and of those on E-grade. Results of a survey reported in the document showed that 63% of nurses had considered leaving the NHS, mainly because of dissatisfaction with pay or because they felt undervalued. Frequent staff shortages were reported by 55% of nurses, while 86% said workload and stress levels had increased.

NHS INSPECTORS SET FOUR-YEAR DEADLINE

S. Boseley

Guardian, Oct. 29th 1999, p. 11

Announces the launch of the Commission for Health Improvement which will send inspectors to every hospital and Primary Care Group over the next four years to review standards of care and ensure complaints are properly dealt with. It will ensure that doctors are using clinically sound, cost-effective treatments and the latest technologies. It will review treatments across whole disease areas, beginning with cancer, and will troubleshoot when a major problem comes to light. The Commission can order a hospital or PCG to implement changes, and if there is insufficient improvement, it can sack a board and report doctors to their professional bodies.

(See also Independent, Oct. 29th 1999, p. 6; Times, Oct. 28th 1999, p. 4)

NICE WORK

A. Earl-Slater

Health Service Journal, vol. 109, Nov. 4th 1999, p. 24-25

The National Institute for Clinical Excellence has announced the drugs and medical devices it will be considering in its first work programme. Trusts and PCGs should take action now to disseminate the list of topics being investigated by NICE. Each organisation should carry out an audit to establish how many patients are being treated in areas looked at by NICE and what their current treatments are. Such information is essential to inform and defend treatment decisions, following guidance from NICE.

PATIENT AND PUBLIC INVOLVEMENT IN THE NEW NHS

Department of Health

London: 1999

Intended to stimulate further action to involve patients, users, carers and the public in health services, highlighting the opportunities which the NHS reforms offer to develop effective patient and public partnership. Document restates the aims and benefits of public and patient involvement, identifies key areas for action and offers examples of good practice.

POSTCODE PRESCRIBING BETTER THAN NO PRESCRIBING

T. McKillop

Daily Telegraph, Oct. 11th 1999, p. 24

Argues that NICE (the National Institute for Clinical Excellence) will be used as a key instrument to slow down the introduction of new medicines to the NHS.

PRIVATE THOUGHTS, PUBLIC SERVICE

D. Hunter

Health Service Journal, vol. 109, Oct. 14th 1999, p. 18-19

Speculates that the government may be moving towards a system in which public funds would be used to purchase health care from private sector providers.

PUTTING LIFE BEFORE LISTS

S. Boseley

Public Finance, Oct. 22nd - 28th 1999, p. 18-19

Argues that the high priority the government is now giving to the treatment of cancer and heart disease should not preclude it from fulfilling its general election pledge to cut waiting lists by 100,000.

QUIETLY DOES IT

J. Keen and J. Apply

Health Service Journal, vol. 109, Oct. 28th 1999, p. 24-26

The forthcoming legislation on freedom of information is likely to be less radical than originally envisaged. Decisions over what information to release will rest with civil servants. In the health context, the legislation is likely to require primary care groups to respond to requests for information about allocation of resources between services. Authors argue that access to the workings of government and the evidence underlying policy decisions would enable people to become active citizens. It would also stimulate sympathy for managers' and clinicians' rationing dilemma. The current culture of secrecy is at odds with government policy to modernise the NHS.

SLY AND THE FAMILY SLOANES

P. Butler

Health Service Journal, vol. 109, Oct. 14th 1999, p. 14-15

Reports speech in which Liam Fox sought to explain Conservative Health policy at the party conference. At the heart of the new policy is the Patients' Guarantee, an initiative in which patients would not be put on a waiting list, but be given a maximum waiting time determined by the severity of their illness as judged by their doctor. Health Authorities would be required to treat patients within the specified time, or arrange for them to be treated in another HA or independently.

TORIES PLAN PRIORITY LISTS FOR OPERATIONS

P. Newton

Daily Telegraph, Sept. 20th 1999, p. 4

Conservatives propose laying down of maximum waiting times for every type of operation so that people with serious medical conditions are treated more quickly than those with minor ailments. Any health authority that cannot meet a target would be expected to send the patient to another area for the necessary surgery within the given time. If it cannot find an NHS hospital where the treatment can be carried out, it will have to fund private treatment.

(See also Times, Sept. 20th 1999, p. 2)

TRUST CHIEF EXECUTIVES' REFLECTIONS ON SELF-GOVERNING

J. Cauldwell and I. Reid

Policy Studies, vol. 20, 1999, p. 187-196

A survey of self-governing hospital trusts in 1996 sought the views of chief executives on their experience of, and reasons for, their care facility opting out of health authority control. Responses show a general satisfaction with SGT status, especially with regard to the greater freedom in managing their own affairs and a belief that the service had become more responsive to patients. Perceived problems arose from uncertainty over income, pressure on staff, and vulnerability to political change.

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