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

200 NHS hospitals to be declared ‘weak’

J. Carvel

The Guardian, Oct. 11th, 2006, p.1-2

A report by the Healthcare Commission has officially branded 200 NHS trusts as ‘weak’. Using ‘lie-detection’ software, the inspectorate found that 42% of trusts “embroidered the truth and gave misleading accounts” in their self-assessments. The report is the first in an annual series of “health checks” on the NHS and “paints an entirely different picture to the previous system of ‘star ratings’, which measured trusts on their ability to meet government targets. Trusts had difficulty complying with a third of the required standards, with the main areas of underperformance being in management and patient care. The NHS Confederation has suggested that the results may damage morale amongst health service staff. However Anna Walker, the chief executive of the Healthcare Commission, said that despite the ‘scary’ results, she found that the trusts’ willingness to recognise their weaknesses was ‘incredibly positive’.

(See also: The Daily Telegraph, Oct. 12th, 2006, p.17, The Times, Oct.12th 2006, p.29)

Equal, but not the same

G. Fleming

Health Service Journal, vol.116, Oct.19th 2006, p.24-26

From April 2007, NHS trusts will have a statutory duty to demonstrate gender equity across all areas of service provision. Good practice in gender equity tends to exist in small projects, with little evidence of national progress. The Department of Health says that trusts should already be working towards fulfilling the duty and will have “no excuse”.

Extending choice in English health care: the implications of the economic evidence

C. Propper, D. Wilson and S. Burgess
Journal of Social Policy,vol.35, 2006, p.537-557

Choice in health care is currently popular among English politicians. Those promoting choice appeal to a simple economic argument. Competitive pressure helps make private firms more efficient. They cut costs and improve their goods and services in order to attract customers. Consumer choice thus acts as a major driver for efficiency. Politicians are attracted to the idea that applying competitive pressure to health care providers through consumer choice will cause them to improve their services in order to attract business. This article looks at economic theory and current empirical evidence on the impact of choice on health care provision to see if either suggests that greater consumer choice will improve health outcomes. It focuses on four topics that are relevant to current UK government policy: the impact of competition in health care markets, the responsiveness of consumers to greater choice, the use of information, and the effects of using centrally set prices.

Five years and billions of pounds later, has anything changed?

D. Martin

Health Service Journal, vol.116, Oct.19th 2006, p.16-17

Sir Derek Wanless has been commissioned by the King’s Fund to review progress in implementing the recommendations of his key 2002 report on NHS reform. While the investment recommended in the 2002 report has gone into the service, productivity appears not to have improved and spending on public health promotion has been cut. Rising levels of obesity and binge drinking will have a disastrous impact on the NHS in the future, as it will have to treat far greater numbers of people with diabetes and heart disease.

“Hot and cold” hospitals plan gets a chilly public reception

M. Gould

Health Service Journal, vol.116, Oct. 6th 2006, p.14-15

Momentum is growing for a radical reorganisation of acute services in England, which could mean extensive hospital closures. The NHS appears to be moving towards a model based on large super-centres for critical care and obstetric emergencies and smaller local hospitals delivering elective procedures and community services. However, the reforms are expected to encounter vociferous public opposition.

Independent sector treatment centres

Health Committee

London: TSO, 2006 (House of Commons papers, session 2005/06; HC 934)

At the end of 2002, the Government decided to commission a number of independent sector treatment centres (ISTCs) to treat NHS patients who required relatively straightforward elective or diagnostic procedures. Their objectives were: to increase patient choice, to encourage best practice, and to increase elective capacity in order to reduce waiting lists. This report examines whether the objectives of the programme have been met. It concludes that ISTCs have not made a major direct contribution to increasing capacity although they have increased patient choice by offering more locations and earlier treatments.

Jostling parties reignite debate on limiting Whitehall meddling

D. Carlisle
Health Service Journal, vol.116, Oct. 12th 2006, p.18-19

At their 2006 conferences, all three major national political parties made proposals for giving the NHS greater independence from central government control. This article presents comment, mostly unfavourable, on Chancellor Gordon Brown’s proposals for the creation of an independent board to manage the NHS.

NHS credits would empower poorest patients, says Milburn

P. Wintour

The Guardian, Oct. 24th 2006, p.13

Speaking at the Care Continuum Congress in Washington, former Health Secretary Alan Millburn proposed a plan to give patients NHS credits to choose some of their healthcare. The programme would initially focus on people with long-term care needs living in disadvantaged areas, but would eventually be offered to others with chronic conditions. Patients would be given a choice between receiving care from the NHS and being given a budget in the form of NHS credits that they could use on private care. The initiative would be funded by the taxpayer and upwards adjustments would be granted to older and poorer people. Milburn claims that the proposal would drive down NHS costs and democratise primary care, introducing an era of bottom-up accountability for the NHS.

The NHS foundation trust code of governance



This non-mandatory code covers the following areas: 1) effective operation of boards of directors; 2) effective operation of boards of governors; 3) the role of a nominations committee in the appointment of directors; and 4) mechanisms for the timely supply of information to the boards and for good communication between governors and trust members.

Number of cancelled NHS ops hits 1,000 a day

G. Wilson

The Daily Telegraph, Oct. 16th 2006, p.1

Tory MP Grant Shapps has revealed that nearly 1000 operations at NHS hospitals are cancelled per day. The MP gained the information from Freedom of Information requests to every NHS trust in the country. According to the report, the majority were cancelled as a result of administrative errors, miscommunication and patients not receiving notification of their operations. 7,704 operations were cancelled in 2005 due to equipment that was missing, unsuitable or unclean.

Only two top scorers in first year of health check ratings

D. Carlisle

Health Service Journal, vol.116, Oct. 12th 2006, p.5

Many NHS organisations performed poorly under the new health check system of performance ratings introduced by the Healthcare Commission. The new dual system covers quality of care and use of resources and is based on self-assessment by trusts, with 10% subject to a spot check. NHS performance was particularly poor in the use of resources category, which covers areas such as financial management, control and value for money. Quality of services covers performance against minimum standards, existing targets, improvement reviews and the acute hospital portfolio. This article presents a brief summary of the scores.

(See also Health Service Journal, vol.116, Oct.12th 2006, p.6-7)

Patient choice and medicine in health care: responsibilization, governance and proto-professionalization

M. Dent

Public Management Review, vol.8, 2006, p.449-462

This essay explores the implications for the medical profession of making patient choice central to health policy in the UK. The author concludes that some more vociferous groups of patients will lose all trust in the medical profession in general. They will use information gleaned from the Internet to seek out the specialist who will provide them with what they themselves consider to be the best treatment.

Why the bedside has a place in the boardroom

W. Wells

Health Service Journal, vol.116, Oct. 26th 2006, p.18-19

The author argues that clinical and patient care are not adequately discussed at NHS trust board level. In a more market driven NHS, customer care and patient satisfaction need equal ranking on board agendas with finance , targets and outputs. Good care can improve the financial performance of hospitals, as satisfied patients get better more quickly, avoid complications and leave hospital sooner.

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