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

Copying letters to patients: the view of patients and health professionals

C. Harris and R. Boaden

Journal of Health Services Research and Policy, vol.11, 2006, p.133-140

Government policy in England increasingly promotes the involvement of patients in the management of their own healthcare. Copying clinical letters to patients has been promoted as a way of improving patients’ understanding of their health and the care they receive. Evidence from both the patient and health professional perspective is presented in this paper, drawn from the literature and a series of pilot studies commissioned by the Department of Health. This evidence suggests that patients find copies of letters beneficial, although health professionals are less keen.

Cut and thrust: how Wales went its own way

J. Williams and C. Ham

Health Service Journal, vol.116, Aug.3rd 2006, p.18-19

This article reviews the development of the NHS in Wales since the birth of the Welsh Assembly in 1999. Health policy in Wales initially focused on reducing health inequalities and tackling the determinants of ill health with less emphasis on improving service performance. This emphasis on health inequalities reduction at the expense of service modernisation led to sustained criticism of the performance of NHS Wales. In response the Welsh Assembly government has proposed a radical agenda to transform health and social care.

Good doctors, safer patients

L. Donaldson

Department of Health, 2006

This report proposes the most radical reform of medical regulation in the UK for 150 years. It recommends that:

  1. The burden of proof or General Medical Council (GMC) proceedings should change from the criminal law standard of “beyond reasonable doubt” to the civil standard of “the balance of probability”
  2. The GMC should no longer be prosecutor and judge. Instead it should investigate and present cases where a doctor is accused of being unfit to practice. A new independent tribunal should judge the case.
  3. GMC powers should be devolved to local level through experienced doctors working as licensed GMC affiliates to operate fitness-to-practice procedures
  4. A twin-track system of regular checks on doctors’ competence should be set up, involving re-licensing for all doctors and re-certification for those on specialist or GP registers
  5. Procedures should focus on the rehabilitation of poorly performing doctors who are not deliberately seeking to harm patients
  6. There should be greater public and patient involvement with regulatory procedures.

Is greater patient choice consistent with equity? The case of the English NHS

A. Dixon and J. Le Grand

Journal of Health Services Research and Policy, vol.11, 2006, p.162-166

There are inequities in utilisation of health services in England with people from lower socio-economic groups making less use of services relative to their needs than the middle classes. On the demand side of the system, these inequities could be due to differences in patients’ beliefs, knowledge, resources and capabilities. On the supply side, professionals’ beliefs and attitudes, and cream-skimming by providers may result in inequities. This paper discusses the extent to which these factors are at play in the English NHS and whether current policies to extend patient choice of provider are likely to increase or decrease them. It shows that patient choice is likely to leave unchanged inequities due to different health beliefs, increase inequities due to unequal resources (because patients may have to travel further), and decrease inequities due to unequal capabilities (because the poor will have access to a new source of leverage over health professionals). In order to help people from disadvantaged groups make effective use of this new leverage, it proposes a package of supported choice measures whereby they would receive help with exercising their rights, including the services of a patient care adviser and assistance with transport costs.

The kids are alright, but are they ready to be governors?

K. McIntosh

Health Service Journal, vol.116, Aug. 31st 2006, p.12-13

Specialist hospitals and the Foundation Trust Network are arguing that children should be able to serve as governors. Foundation trust regulatory body, Monitor, is unimpressed and says that young people under 16 are not mature enough to shoulder the responsibilities of a governor.

Monitoring progress: foundation trusts in the new NHS

A. Cowper

British Journal of Health Care Management, vol.12, 2006, p.201-204

Report of an interview with Dr William Moyes, chair of Monitor, the independent regulator of NHS foundation trusts. The interview covers the state of NHS finances, focusing on deficits, the role of boards of governors in foundation trusts, the impact of independent treatment centres, and the extent to which the introduction of payment by results is increasing clinical engagement.

Nicholson: the service insider who puts taxpayers first

L. Donnelly

Health Service Journal, vol.116, Aug. 3rd 2006, p.14-15

This article profiles David Nicholson, the newly appointed NHS chief executive. Mr Nicholson has worked in the NHS for 25 years and is committed to opening up health care provision to a range of private and voluntary sector providers, in the belief that the market will deliver equity.

Piloting the uptake of patient choice in a single trust

P. Spurgeon, C. Hicks and R. Richards

British Journal of Health Care Management, vol.12, 2006, p.214-218

This study looked at the extent to which patients at a large teaching hospital exercised their right to choose an alternative provider after waiting six months for elective surgery. Over the four-month study period, only 5% of patients took up the choice option. A comparison of patients who opted to choose an alternative provider with those who declined revealed no differences between them on a range of variables; the only differentiating factor was the greater level of debilitation reported by patients who opted for choice. The results suggest that the issue of choice may not be as salient for patients or as effective in managing waiting lists as is currently assumed by the government.

Planning a treatment centre’s outpatient services

J. Bowers and others

British Journal of Health Care Management, vol.12, 2006, p.210-213

Treatment centres have been brought in to remove the most routine procedures from acute trusts’ operating schedules and perform them in a more “assembly line” setting. This article looks at how an independent treatment centre to be based at the Queen’s Medical Centre in Nottingham has gone about planning its outpatient services. Data on the resources required for the delivery of outpatient services were compiled from a number of sources within the hospital and the community. An Excel-based model was then constructed to enable resource requirements to be estimated for a variety of configurations of outpatient services.

Progress is about perception as headlines and reality clash

B. Page and J. Nichols

Health Service Journal, vol.116, Aug. 31st 2006, p.16-17

In spite of recent adverse media coverage, people remain supportive of the NHS in principle and are for the most part satisfied with local health services. They are also broadly in favour of the expansion of patient choice. GPs are key to presenting reforms to the public in a favourable light.

Targets have failed the NHS

R. Tallis

The Times, Aug. 10th 2006, p.18

This opinion piece essentially argues for the exclusion of politics from the NHS. The author claims that the culture of setting ‘targets’ is essentially a political one and is to the detriment of the patient.  In the struggle to meet ministerial demands, clinical care suffers. Prioritising one clinical treatment over others inevitably leads to slow delivery of treatments that have not been prioritised. The author also claims that targets are also a corrupting force, comparing the current state of a demoralised NHS to a Soviet production line factory.

(See also The Daily Telegraph, Aug. 10th 2006, p.11)

There’s nothing national about the National Health Service

B. Johnson

The Daily Telegraph, 31st Aug, 2006, p.18

Columnist Boris Johnson relates a personal story involving one of his constituents to illustrate the ‘injustice’ of a national health policy that is organised in such a way that some Primary Care Trusts can afford life-saving treatments while others cannot. His argues that devolution further compounds this problem by fragmenting and decentralising the NHS so that English patients lose out to Scottish residents because the Scottish government makes independent decisions on healthcare while utilising the same central resources.

Warning: health service research can damage your health

D. Kernick

British Journal of Health Care Management, vol.12, 2006, p.246-249

Academic health service research has had little or no impact on practitioners. The response has been to examine why research is not being translated into practice and how barriers to implementation can be removed. No-one has considered the possibility that the research is not being taken up because it is irrelevant to its target audience.

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