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Welfare Reform on the Web (March 2006): National Health Service - Reform - General

N. Edwards

Health Service Journal, vol.116, Feb. 23rd 2006, p.7

The Prime Minister, speaking at a briefing on the healthcare outside hospitals White Paper, has assured NHS managers that they will be supported by national politicians if they have to make unpopular decisions about restructuring local services in order to balance their books.

A. Miles

Times, February 1st 2006, p.18

The Citizens’ Summit and Advisory Panel were heralded as the largest ever public consultations, while prolific task force reports inform the recent health white paper. The article looks at the rhetoric, and questions the value and integrity of the research, highlighting the health MOT, and the problems of how to gain the political sanction needed to realise change.

P. Curtis

Guardian, February 13th 2006, p.6

More than 400,000 people were admitted as emergencies to hospitals at least three times last year, constituting a quarter of total of such admissions nationally according to research. While no one suggests the visits were unnecessary, the fact that many such incidences relate to conditions like asthma and diabetes suggests that admissions could be avoided by providing support and care outside hospitals to enable people to manage their own illnesses. The urban poor are most likely to fall into the “frequent flyer” category. The article touches on the importance of information gathering and access for health improvement.

Health services management: what are the ethical dimensions?

C. Palfrey, P. Thomas and C. Phillips

International Journal of Public Sector Management, vol.19, 2006, p.57-66

Paper considers the validity of claims from some quarters that managers in the NHS are not motivated by ethical concerns, assesses the cogency of the argument that managers should become more like clinicians in their attitude towards prioritising resource allocation, and examines the appropriateness of applying quality adjusted life years as an ethically sound approach to decision-making in the context of infinite demand for finite resources. It recognises that the challenge faced by NHS managers of providing high quality, accessible services while remaining within budgets is formidable and ethically complex.

N. Timmins

Financial Times, January 26th 2006, p.2

As financial “turn around” teams are announced for the 18 NHS trusts at greatest financial risk, the Health Secretary has stated the need for closures and service reconfigurations in some parts of the country where, she says, too many services are being delivered from too many places. The extension of payment by results was also confirmed.

[See also Times, January 26th, 2006, p. 1& 2; Daily Telegraph, January 26th 2006, p. 4; Guardian, January 26th 2006, p.10]

N. Timmins

Financial Times, February 21st 2006, p.10

While advertising direct to patients is against Health Secretary Hewitt’s instinct, the Department of Health, the independent sector and NHS trusts see it as inevitable in the future as private providers start to target GPs and managers. The article looks at the outlook for health service marketing in the light of recent changes. Examples are given of the UK independent sector raising awareness of their services, and an understanding GP referral patterns becoming part of marketing Bristol Royal Infirmary.

G. Currie and O. Suhomlinova

Public Administration, vol.84, 2006, p.1-30

There appears to be a shift in the NHS from the “old” institutional template, which combined the bureaucratic boundaries of the pre-Thatcherite NHS with the organisational firm-like boundaries engendered by the internal market policies of the Conservative government, to a “new” institutional template. This new template is designed to reduce those boundaries and to promote collaboration across organisations. However specific government regulations in fact strengthen boundaries within the field and run against the logic of cooperation inherent in the new template. Centralised command and control structures remain in place and frustrate partnership working as they require organisation to meet short term targets and realise efficiency savings. Furthermore old boundaries, such as the divergence in the career paths of medical researchers and medical practitioners, remain alive and well and show no signs of abating.

A. Nolan (editor)

Health Service Journal, vol.116, Feb. 23rd 2006, Supplement, 40p

Supplement covers:

  • The continuing role of the former NHSU Core Learning Unit in developing and managing training programmes for NHS staff
  • The merits of MBAs versus increasingly popular MPA (Master of Public Administration) courses
  • A development programme for commissioners which encourages them to form networks
  • A mentoring programme for black and minority ethnic managers aimed at increasing their representation in senior NHS management
  • Regulation of NHS clinical support workers
  • The training needs of non-clinical NHS managers

D. Joselin

Independent, January 31st 2006, p.27

Restricted numbers of consultants, who have NHS and private practices, are standing in the way of a first-class NHS according to this critical opinion piece which looks at Canadian comparisons and historical background.

The NHS in England: the operating framework for 2006/7

Department of Health

Leeds: 2006

This publication sets out the next steps in creating a patient-led NHS, including the introduction of more patient choice through new providers, more say for frontline staff such as GPs in service commissioning, and the extension of payment by results. Six specific areas requiring particular attention are identified, including reducing health inequalities, cutting cancer treatment waiting times and MRSA incidence, and improving sexual health. It outlines plans to ensure that the NHS recovers any overspend from 2005/06 and generates a surplus in 2007/08 and sketches management arrangements to ensure the smooth transition to the new primary care trusts and strategic health authorities.

National Audit Office

London: TSO, 2005 (House of Commons papers, session 2005/6; HC 452)

Stroke is one of the top three causes of death in England and a leading cause of adult disability. The report examines whether NHS is providing effective and high quality stroke care services in England, in terms of acute response, rehabilitation and prevention, and whether the Department of Health is managing and supporting the programme of stroke care well. It recommends that the Department and NHS must now focus on removing the barriers to the delivery of responsive, integrated stroke care, in order to save lives, reduce disability and reduce the cost of stroke to the health service.

A. Moore

Health Service Journal, vol.116, Feb.16th 2006, p.8

Greater Manchester Strategic Health Authority has started three public consultations on radical redesigns of health services. There is concern that politicians may intervene and veto the proposals if there is a public outcry. To guard against such interventions, it is important that local authorities and MPs are engaged in the consultation process and are convinced of the logic of the proposals.

M. Frith

Independent, February 20th 2006, p.4

While one in ten midwifery posts are vacant for more than three months in London and the South East, research shows an increased likelihood of maternal complications and interventions amongst those left alone or without continuous care during labour. Britain has a low but slightly rising rate of maternal mortality. With a Labour manifesto pledge promising maternity improvements, the Department of Health states that 2,500 more midwives are employed than in 1997 while the government claims to be addressing affordable housing and childcare barriers to recruitment.

S. Ward

Public Finance, Feb.10th-16th 2006, p.22-24

Hospital trusts face serious challenges in balancing their books in 2006/07 as government moves to reduce demand for elective treatment and to cut emergency admissions. They will also face competition from primary care services and the independent sector for any work available.

H. Mooney

Health Service Journal, vol.116, Feb.9th 2006, p.13

The government is to give trusts a “level of tolerance” in achieving the new target of treating all patients within 18 weeks of referral by 2008. The Department of Health has accepted that a small proportion of patients who require a series of diagnostic tests before treatment might need to be excluded from the national target. The flexibility would work in the same way as trusts are only required to treat 98% of patients within four hours in accident and emergency.

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