Click here to skip to content

Welfare Reform on the Web (August 2006): National Health Service - reform - general

60% of NHS trusts admit care failings

J. Carvel

The Guardian, July 10th 2006, p.1

Self assessments by 570 health trusts reveal widespread non-compliance with official minimum standards of care. The most common breaches are:

  • Failure to decontaminate reusable medical equipment
  • Lack of systematic control of patient records
  • Inability to conform with national guidelines on diagnosis and treatment
  • Uncertainty about whether staff have taken part in mandatory training.

Only a third of trusts claimed to meet all of the Healthcare Commission’s 44 core standards of basic competence. Ten trusts were failing in at least 14 standards- which is considered a failed trust. The minimum standards were introduced in 2004 and are seen as ‘a light-touch’ method of regulation that encourages health trusts to own up to their shortcomings. However the Healthcare Commission will compare the self-assessments against other data to judge the true performance of health trusts.

Consultant clinical activity is key to improving productivity

A. Maynard and K. Bloor

Health Service Journal, vol.116, July 6th 2006, p.18-19

Researchers at York University have developed a comparative tool based on Hospital Activity Statistics (HES) for analysing activity levels of consultants in five medical and five surgical specialities relative to national activity distribution. It is hoped that the information this tool produces can be used to improve consultant productivity.

Continuing care

S. Burke and M Kohler

Community Care, July 20th-26th 2006, p.28-29

The Department of Health is proposing a national framework for assessing eligibility for NHS continuing care to replace the local criteria used by individual health trusts. Under the new system, an assessment will be made using four key indicators of need, which will be read across nine care domains using a decision-support tool. The authors present cases for and against the new system.

Does it compute?

M. Cross

Public Finance, June 16th-21st 2006, p.16-20

Reports on the progress of the huge programme for modernising IT systems in the NHS. Over the past two years the programme’s achievements include installing a core infrastructure, connecting NHS organisations securely and enabling the beginning of electronic appointment booking and prescribing. However implementation has been delayed by “scope creep”, e.g. the metamorphosis of the original electronic appointment booking system into Choose and Book, and difficulties with the design and function of the electronic patient records system.

Falling through the net of stroke care

F. Mold, C. Wolfe and C. McKevitt

Health and Social Care in the Community, vol.14, 2006, p.349-356

Numerous studies of service use have shown that provision of health services to those with defined needs differs among specific sociodemographic groups. The professionals’ accounts reported in this paper suggest that decision-making about provision of stroke care is a complex process involving the need to balance demand and supply in order to make best use of limited resources. This entails applying current knowledge of best clinical practice, local knowledge and cultural rules about what makes a “good” patient. Individuals who cannot easily be matched up to an implicit template of the ideal service user may be at risk of not receiving specific components of care. In other words, it appears that users are required to fit the service as currently organised and resourced.

Health policy in Wales: making a difference in conditions of difficulty

M. Drakeford

Critical Social Policy, vol.26, 2006, p.543-561

Devolution transferred responsibility for health policy and the NHS in Wales to the National Assembly. This paper explores the context in which Assembly health policy making has taken place, looking at economic, administrative and political dimensions. It concludes that while health policymaking has shown radical tendencies in its approaches to issues of population ill-health, inequality, funding, and acute sector problems and proposed far-reaching changes, implementation of that policy agenda has proved problematic.

How the push for choice in childbirth is foundering

A. Moore

Health Service Journal, vol.116, July 20th 2006, p.14-15

Despite government pledges to provide expectant mothers with a range of options on where and how they give birth, the closure of many midwife-led birthing units, the trend towards centralisation of maternity services, and shortages of midwives have combined to limit available choices.

Inspectors to make tighter checks on NHS trust doctors

J. Laurance

Independent, July 15th 2006, p.8

Reports proposals for medical inspectors to be appointed in every NHS trust to police performance. Doctors will be subject to five-yearly competence checks. With the introduction of the new regime the General Medical Council will lose much of its existing power, including powers to prosecute and judge doctors accused of misconduct. However the new inspectors will be GMC affiliates.

(See also Times, July 15th 2006, p.4; Financial Times, July 15th 2006, p.2; Daily Telegraph, July 15th 2006, p.8; Guardian, July 15th 2006, p.4)

A national template

M. Henwood

Community Care, June 29th-July 5th 2006, p.30-31

Comments positively on the national framework for NHS continuing care recently issued for consultation. The new framework should help to clarify the distinction between fully funded NHS continuing care and means-tested social care. Under the new framework, eligibility for fully funded NHS care depends on overall needs, not the particular disease or condition. If an individual’s primary need is for health care, the NHS should be responsible for commissioning all care, including accommodation in a residential home. Eligibility is not dependent on who provides the care or the location in which it is provided. The framework will use national tools to help decision-makers assess need to ensure consistency.

NHS ‘fails to treat strokes properly’

G. Roberts

The Independent, July 11th 2006, p.11

Five hundred people die unnecessarily every year in the UK because of failure by the NHS to give sufficient priority to stroke victims and ensure that patients are treated in specialist units.

NHS ‘not learning from errors’

S. Lister

The Times, July 6th 2006, p.29

A report by the Committee of Public Accounts describes the performance of the National Patient Safety Agency, which was set up to improve safety in health settings, as “extremely weak” and “dysfunctional”. The report concludes that the “culture of secrecy and inadequate safety regulation is preventing error reductions in the NHS”.

Parkinson’s disease: what’s the diagnosis?

A. Nolan (editor)

Health Service Journal, vol.116, July 27th 2006, supplement, 9p

This special supplement considers new National Institute for Clinical Excellence guidance on treatment of patients with Parkinson’s disease. The guidance recommends that G.Ps should be encouraged to refer patients with suspected Parkinson’s disease to a specialist for diagnosis so that they will be treated quickly and their medicines managed by an expert. Multidisciplinry working and coordination between different pars of the care pathway are key to improving services. Benefits include care continuity and increased sharing of skills between professionals.

Private practice in the health service

Northern Ireland Audit Office

London: TSO, 2006 (House of Commons papers, session 2005/06; HC1088)

The report examines the issues surrounding the interaction between public and private health care in Northern Ireland following the introduction of a new consultants contract in 2004. Part 1 of the report focuses on how the Department of Health, Social Services and Public Safety and Trusts have monitored and managed consultants to date to ensure that they fulfil their commitments to the health service. Part 2 examines how successful the Trusts have been in recovering the full costs of services provided to patients receiving private care and identifies opportunities for enhancing the cost recovery process.

Regaining trust in medicine: professional and state strategies

J. Allsop

Current Sociology, vol.54, 2006, p.621-636

In recent years individual doctors, the medical profession and the system of self-regulation that holds doctors accountable in the UK have all been widely criticised. This may be due to a number of factors: social and political changes that have brought a shift in relations between patients, doctors and the state; a general decline in social and public trust; and an apparent increase in failures by individual doctors. The evidence presented in this article suggests that, while people in general continue to trust their doctors, confidence in their regulation by the General Medical Council has decreased. The article finally looks at the reforms introduced by the government and the General Medical Council and considers whether these are sufficient to restore trust.

A stronger local voice

Department of Health

London: 2006

Proposes new “local involvement networks” (LINks) to replace patient forums. There will be one for each local authority with social services responsibilities. The LINks will be responsible for gathering, analysing and sifting information from local patients before making recommendations to commissioners, providers and local authority overview and scrutiny committees. Funds will be given to councils to consult with local organisations such as voluntary groups and social enterprises to identify the most appropriate arrangements for hosting them. Extra responsibilities will be introduced for local NHS bodies and oversight and scrutiny committees to ensure that they co-operate with LINks.

“Yes”, “No” or Yes, but”? Multinomial modelling of NICE decision-making

H.A. Dakin, N.J. Devlin and I.A.O. Odeyemi

Health Policy, vol.77, 2006, p.352-367

The National Institute for Health and Clinical Excellence was established in 1999 to appraise the clinical benefits and costs of health care interventions and make recommendations. However, the exact factors considered in NICE appraisals, their relative importance and tradeoffs between them are not made explicit. This study categorised NICE decisions as “recommended for routine use”, “recommended for restricted use” or “not recommended”. The NICE appraisal process was modelled as a single decision between the three categories. Multinomial logistic regression techniques were used to evaluate the impact of: quantity/quality of clinical evidence; cost effectiveness; decision date; existence of alternative treatments; budget impact; and technology type. Results suggest that interventions supported by more randomised controlled trials are more likely to be recommended for routine use. Pharmaceuticals, interventions appraised early in the NICE programme and those with more systematic reviews were also less likely to be rejected, while patient group submissions made a recommendation for routine rather than restricted use more likely.

Search Welfare Reform on the Web