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Welfare Reform on the Web (July 2006): National Health Service – reform – general

Access, choice and travel: implications for health policy

M. Exworthy and S. Peckham

Social Policy and Administration, vol.40, 2006, p.267-287

In England, the government aims to provide patients needing elective treatment with a choice of 4-5 providers at the point of referral by the GP. This article examines the relationship between patient choice and their willingness to travel in terms of access to health care services in order to illustrate emergent policy dilemmas. Evidence suggests that about two-thirds of the public would be willing to travel beyond their immediate area. However, the policy raises the strong likelihood that inequalities in access will widen. Those without cars, who are elderly or generally less mobile will not be able to exercise such choice as freely as others. Capacity will also need to be increased if patients are to make effective choices of alternative providers, probably involving more use of the private sector. Access to information about alternative providers will be crucial in shaping patients’ choices. Providers will need to communicate with GPs and their patients about their strengths and specialisations.

Design for living

D. Carlisle

Health Service Journal, vol.116, June 1st 2006, p. 24-26

By the end of March 2006, 91% of cancer patients started treatment within two months of referral, compared to 70-80% in 2005. These improvements are being driven by senior clinical and management engagement, reliable information about where patients are in the system, and meticulous planning of care pathways.

Diffusion of innovations in health service organisations: a systematic literature review

T. Greenhalgh and others

Oxford: Blackwell, 2005

  • Approaches to researching diffusion of innovation in organisations
  • What are innovations in service delivery and organisation?
  • Why do individuals adopt (or fail to adopt) innovations?
  • Spreading good ideas: passive diffusion and active dissemination
  • Organisational influences on innovation
  • Environmental influences on innovation
  • Implementing and sustaining innovation in organisations
  • Case examples
  • Practical advice on applying the model
  • Recommendations for future research

Doctors reject Labour’s NHS reforms

N. Hawkes

The Times, June 27th, 2006, p.8

Speakers at the annual conference of the British Medical Association accused the government of “incompetence, muddle, rushed and ill-considered reforms, and a secret desire to break up and privatise the NHS”. There was also a vote of no confidence in the leadership of the BMA due to its failure to oppose ill-conceived government reforms.

(See also: The Daily Telegraph, June 27th 2006, p.8, The Guardian, June 27th 2006, p.8)

Free NHS of politics, says top doctor

C. Hall

The Daily Telegraph, June 7th, 2006, p.1

Dr. Paul Miller, the chairman of the British Medical Association consultants committee has called for the NHS to be run by an independent body, in order to “depoliticise it”. According to Miller, Labour’s reforms, political interference and general financial mismanagement have brought the health service to a state of serious disarray and “patients and staff are paying the price.” Miller recommends that the government:

  • stops reorganising the NHS
  • stops interfering in the local planning of services
  • stops using external management to dominate decision making in NHS service delivery

A furore too far: the widespread disquiet undermining NICE

D. Carlisle

Health Service Journal, vol.116, June 22nd 2006, p.14-15

There is mounting criticism of the National Institute for Clinical Excellence, which was set up to provide guidance on the clinical and cost-effectiveness of treatments. Its methodology relies on scrutiny of randomised controlled trials, and it flounders in areas where none exist. It also gives emphasis to physical conditions, taking no account of carers’ priorities in relation to conditions such as dementia. There is also concern that it has been undermined by the Secretary of State’s intervention regarding herceptin, where she put pressure on primary care trusts to prescribe the drug in advance of its appraisal by NICE. The organisation responded by putting in place a fast track appraisal process for promising new treatments.

The go-between

S. Gainsbury

Public Finance, June 2nd-8th 2006, p.28-29

Report of an interview with Bernard Crump, chief executive of the NHS Institute for Innovation and Improvement. The Institute has been given four top priorities, hospital infections, chronic disease care, productivity and access issues. It identifies organisations which have been successful in tackling those or analogous issues. They are studied and good practice lessons are promoted throughout the NHS. At a time when NHS managers are focused on achieving financial balance, the Institute can help by showing how improvements can be achieved without increases in funding.

Half-baked NHS reforms could harm patients, says think-tank

B.Hall

The Financial Times, June 5th, 2006, p.1

A report published by the King’s Fund think tank attacks the government’s reforms that intend to establish a market system for healthcare supply. The report claims that despite a government commitment to introducing competition and giving private providers a bigger role; patients would not win the full benefits due to ‘muddled’ administration. The report recommends that the government should highlight the ‘split between commissioning healthcare and its supply’. The government should set guidelines but should not interfere in day-to-day management which should be handled by local NHS bodies and private suppliers. To this end the King’s Fund report recommends that the Department for Health should be split into three bodies:

  • An overseeing body that sets the NHS budget and general policy
  • A commissioner of services to buy care for patients
  • A separate entity overseeing NHS services, which would eventually be dominated by private providers.

How six of the best helped turn round a failing trust

I. Lloyd

Health Service Journal, vol.116, June 1st 2006, p.12-13

A long history of problems including a £50m debt and fundamental flaws in its management structure contributed to Mid Yorkshire Hospitals trust being the first to be put under special measures by the Healthcare Commission in December 2004. This article explores how new clinical management structures, investment in workforce development, and a new team of directors have helped turn the ailing trust around.

Law

A. Nolan (editor)

Health Service Journal, vol.116, June 1st 2006, p.29-32

This special report on legal issues covers recent developments in case law regarding prescription of unlicensed drugs in exceptional circumstances, the legal position of community enterprises, and the legal implications of turnaround plans for financial recovery developed by NHS bodies.

Patient advice and liaison services: strengthening the voices of individual service users in health-care organisations

Abbott and other

Health Expectations, vol.9, 2006, p.138-147

Every NHS provider in England now has a patient advice and liaison service (PALS) which provides service users with information and help in resolving concerns and complaints. Data from 27 semi-structured interviews shows that PALS personnel adopt seven roles in order to support their clients: information provider, listener, messenger (passing on information from service users to staff), go-between (passing information forward and back), supporter (helping service users to present their own views), mediator in dispute resolution, and resource mobiliser (when the support of senior staff or other agencies is needed to resolve a problem).

Policy as narrative: New Labour’s reform of the National Health Service

K. Morrell

Public Administration, vol.84, 2006, p.367-385

Through an analysis of the policy literature, this article examines how the New Labour government has presented NHS reform, focussing on patient choice, the emancipatory promises made to foundation trusts, and the different meanings of clinical governance of staff. The policy documents emphasize the self-evident need for change and the promise of liberation, while signalling the importance of moral duties and responsibility.

“A pound wasted is one not spent on NHS values”

N. Edwards

Health Service Journal, vol.116, June 15th 2006, p.22-25

Prime Minister Tony Blair argues that efficiency and sound management are key to delivering high quality care in the NHS. He says that the structures are now in place to deliver improved care, but in a fast-moving world those structures will need to be flexible and able to respond quickly to change. Managers will need to take tough decisions to both achieve financial balance and reduce waiting times for treatment. The introduction of financial incentives and competition into the system will encourage innovation and efficiency, and NHS managers can learn from the business world.

Scrutiny and the bounty

N. Edwards

Health Service Journal, vol.116, June 1st 2006, p.18-19

The overview and scrutiny committees run by councils are making an impact on how local changes to NHS services are debated and implemented. This article reports results of a survey of local authority oversight and scrutiny committee chairs which explored their attitudes to NHS managers, their experiences and what they thought could improve the relationships.

Seagull management and the control of nursing work

H. Cooke

Work, Employment and Society, vol.20, 2006, p.223-243

This article uses data from a study of discipline and management of the problem nurse to examine the impact of recent NHS reforms on the control of nursing work. Changes have led to an intensification of nurses’ workloads through the delegation of routine medical tasks and operational management. This work intensification has been presented in policy pronouncements as empowerment. At the same time management control of nurses’ work has been tightened. This has led to the emergence of a breed of “seagull” managers characterised by their remoteness, destructive criticism of staff, and concern for self-protection and blame avoidance.

Skills development

A. Nolan (editor)

Health Service Journal, vol.116, June 15th 2006, supplement, 9p

The sector skills agreement for health will be launched across England in July 2006, six months later than originally planned. It uses a competence-based approach, meaning standardisation across organisations. Competencies will be used to develop new roles, such as emergency care practitioner, assistant radiographer and cancer care practitioner. Skills gaps are being identified and staff will be trained and equipped to deliver the services that are needed. Career frameworks will set out pathways so that staff know what qualifications are needed for specific roles. The NHS will not only need to change the behaviour of existing staff, but also to target young people in the 14-19 age range to begin to build the competencies needed to fill the health worker roles of the future.

Take it from the top

S. Ward

Public Finance, May 26th-June 1st 2006, p.26-28

Article examines recent changes to the ministerial team and top civil servants in post at the Department of Health. It predicts that a new NHS chief executive will be recruited from a US-based healthcare organisation. It goes on to look at appointments to chief executive posts in the newly merged Strategic Health Authorities, which are now coterminous with Government Offices for the Regions.

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