Click here to skip to content

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

At risk: the safety agency that failed to set the world on fire

J. Lyall

Health Service Journal, vol.116, Sept.28th 2006, p.14-15

The National Patient Safety Agency was launched in 2001 with the remit of collecting and analysing information on adverse events from NHS bodies, staff and patients themselves. It has been criticised by the Commons Public Accounts Committee for delays in delivering the national reporting system and for providing limited feedback to NHS trusts on best practice in avoiding serious mistakes. It has also failed to demonstrate that it has made any headway in improving patient safety, and has a very low profile among NHS staff. Its future is now under review.

Clinical systems: using IT to improve care

A. Mangalampalli and others

British Journal of Health Care Management, vol.12, 2006, p.277-281

Manual paper patient health records are giving way to electronic health records (EHRs) internationally. In turn, electronic health record systems have been developed using information technologies such as databases and data warehouses. This article describes the use of IT tools such as clinical data warehouses, data mining techniques, and clinical decision support systems to develop and exploit electronic patient records. It also describes the role of EHRs in clinical trials and the use of IT systems for patient education through the Internet and specially configured kiosks in hospitals.

Exploring the involvement and perceptions of professional stakeholders on NICE clinical guidelines

I. Llott and others

Evidence and Policy, vol.2, 2006, p.333-356

This article presents the results of a study of the involvement of some professional stakeholders in the development of National Institute for Health and Clinical Excellence (NICE) guidelines, and their perceptions of their impact on the process. It gives an insight into the ways in which professional bodies and individual members responded to the opportunities afforded by stakeholder engagement. Larger professional bodies invested time and resources in the guideline development process, while smaller organisations, with minimal infrastructure and reliant on volunteers, had difficulty in participating.

Halt out-of date treatments to save NHS millions, minister tells doctors

S. Boseley

The Guardian, Sept. 7th 2006, p.13

Health Minister Andy Burnham is launching a programme to identify obsolete practices and ineffective treatments in order to save millions for the NHS. The programme is to be conducted by the government expert advisory group, the National Institute for Clinical Excellence (NICE). NICE is responsible for approving new medicines and preventing use of “unnecessary and ineffective treatments.” Its new programme identifies treatments that are of “doubtful effectiveness”, including unnecessary surgical procedures such as tonsil removal. NICE will also make recommendations on efficient drug therapy for hospitals and GPs.

Hungry to be heard: the scandal of malnourished older people in hospital

Age Concern England

London: 2006

Six out of ten older people are at risk of becoming malnourished, or their situation getting worse, in hospital. Tackling this persistent problem does not need more legislation or guidance, but requires cultural change within the NHS. Malnutrition in hospitals could be ended by measures such as: staff listening to older people’s concerns and acting on what they say; ward staff becoming “food aware”; regular assessment of older patients for signs of malnourishment; introduction of protected mealtimes and/or a “red tray” system; and use of volunteers to help feed patients.

Improving the use of temporary nursing staff in NHS acute and foundation trusts

National Audit Office

London: TSO, 2006 (House of Commons papers, session 2005/06; HC 1176)

The report reviews progress made by the NHS since the introduction of NHS Professionals, a national temporary staffing service. Since 2001 the NHS has reduced its expenditure on agency nursing staff. However trusts have poor management information and a lack of understanding of the drivers of demand for temporary nursing staff. This report examines the extent and impact of use of temporary nursing staff and says that improvements need to be made to assure better quality of care. Finally it looks at initiatives which the Department of Health, NHS trusts and other NHS bodies have taken to improve procurement and supply of temporary nursing staff.

Lofty ambitions

J. Taylor

Health Service Journal, vol.116, Sept. 21st 2006, p.30-31

Some experts argue that patient choice in the NHS should involve choice of treatment rather than choice of provider. Choice of provider potentially destabilises the local health economy, caters to the articulate middle classes, and does not help people with long term conditions. In order to make sensible choices about treatment, patients will need to be provided with reliable information about alternatives.

No easy answers on Difficile

A. Nolan

Health Service Journal, vol.116, Sept. 14th 2006, p.23-24

A recent damning report has found that dysfunctional governance and concentration on hitting government targets rather than on patient safety contributed to two outbreaks Clostridium Difficile at Stoke Mandeville Hospital between 2003 and 2005. Tackling the growing problem of hospital acquired infections (HAI) as a whole will require that patient safety is put before other objectives, including hitting government targets and control of finances. Government is launching a new statutory code of practice for HAI prevention and control to be published in October 2006. It is essential that all staff are involved in measures to tackle HAIs.

Plan for wave of closures of NHS services

J. Carvel

The Guardian, Sept. 13th 2006, p.1

David Nicholson, new chief executive of the NHS, has said that there will be up 60 “reconfigurations” of services in the UK. Most changes will be aimed at improving efficiency in service delivery by concentrating key activities in fewer hospitals. Accident & Emergency, paediatric and maternity services are to be drastically overhauled. Some modifications however are aimed at tackling the £512m deficit accumulated in the last financial year. Opposition from local MPs and pressure groups is expected, says Nicholson, but he is optimistic that the public will accept the new plans if “the NHS could win doctors’ support and explain the advantages of reform to patients”.

Safe as houses

A. Moore

Health Service Journal, vol.116, Sept. 21st 2006, p.32-33

This article explores the tensions between achieving financial balance and maintaining patient safety and quality of care in the NHS. It is argued that improved patient safety and delivery of high quality care may in fact reduce costs. The paper goes on to explore possible tensions between patient safety and patient choice which may arise if patients insist on receiving sub-optimal treatments.

Scepticism greets plans to take politics out of NHS

HSJ Reporters

Health Service Journal, vol.116, Sept.28th 2006, p.5

Chancellor Gordon Brown has floated plans to hand over day-to-day running of the NHS to an independent board along the lines of the BBC’s governors or the Bank of England’s Independent Monetary Policy Committee. At the same time Health Minister Andy Burnham has proposed a written NHS constitution, setting out the values of the service. The NHS has reacted sceptically.

What about the workers?

J. Davies

Health Service Journal, vol.116, Sept. 21st 2006, p.28-29

This article looks at the implications of welfare reform and population ageing for the NHS. It argues that the NHS needs to respond more sensitively to the needs of staff members experiencing mental health problems in order to enable them to continue to work.. The article goes on to consider the general implications for the NHS of the government’s drive to get people with disabilities off benefits and into employment. The success of this drive will depend on improved diagnosis and timely treatment by the NHS. There will also be increased future demand for rehabilitation and home care for growing numbers of older people as longevity increases.

What’s measured is what matters: targets and gaming in the English public health care system

G. Bevan and C. Hood

Public Administration, vol.84, 2006, p.517-538

From 2001, the Department of Health introduced a system for publishing “star ratings” for health organisations in England. English health care managers were exposed to an increased risk of being sacked as a result of poor performance on measured indices, and, through publication of star ratings, to naming and shaming. This article investigates the extent to which governance by targets and terror led to real improvements as opposed to cheating by managers and other actors. Although there were indeed dramatic improvements in reported performance, we do not know the extent to which these were genuine or offset by gaming that resulted in reductions in aspects of performance that were not measured.

Why the NHS must wake up to the medical technology gap

J. Rafferty, P. White and G. Marchand

Health Service Journal, vol.116, Sept. 7th 2006, p.20-21

The NHS is lagging behind most other OECD countries in providing access to MRI and CT scans. More investment in these technologies is needed. However, if the NHS is to put into practice its policy of developing alternatives to hospital provision, it needs also to provide better access to imaging and other diagnostics in primary and community settings.

Search Welfare Reform on the Web