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

Calls grow to halt NHS reforms


Labour Research, vol.95, Nov. 2006, p.12-13

Private contracts for provision of NHS services are now worth £7bn per year. Private contractors provide the NHS with services ranging from PFI hospitals to cleaning, catering and medical support. Health trade unions have joined forces to protest about the speed of change and the growth of outsourcing of services.

Choice, voice and the parlous state of public health

A. Cowper

British Journal of Health Care Management, vol.12, 2006, p.297-301

This article reports an interview with Prof. David Hunter, chair of the UK Public Health Association, focusing initially on the implications of the government’s patient choice agenda for public health. The interview also covers the impact on public health services of the current financial crisis in the NHS and the case for prioritising population health improvement.

Exploring the determinants of NHS performance ratings: lessons for performance assessment systems

R. Jacobs and others

Journal of Health Services Research and Policy, vol.11, 2006, p.211-217

Performance management systems should evaluate managerial performance by reference to what managers can and cannot control. Some managers in NHS trusts believe that their performance ratings fail to take into account a range of local contingencies and mitigating factors seen as being beyond their control, for example the physical layout of a hospital or performance of social services. The analysis reported in this article shows that a non-trivial proportion of the variation in the indicators used in the performance assessment system was associated with factors outside of management control.

Gathering data for health care regulation: learning from experience in England and Wales

J. Attride-Stirling and others

Journal of Health Services Research and Policy, vol.11, 2006, p.202-210

In the last two decades there has been a shift away from direct state control of public services towards indirect control through regulation. Health organizations are among the most heavily regulated entities. Between 2000 and 2004, the Commission for Healthcare Improvement (CHI) undertook a comprehensive programme of reviews of progress with clinical governance in NHS trusts in England and Wales. This article presents the results of an internal evaluation of the main instruments and processes used to gather evidence for these reviews which was undertaken to identify lessons for the future development of healthcare regulation.

Health inequalities

N. Edwards (editor)

Health Service Journal, vol.116, Nov. 23rd 2006, supplement, 19p.

This supplement presents an overview of a range of approaches to reducing health inequalities between socially disadvantaged and affluent sections of the population, including smoking cessation services, prevention of cardiovascular disease, improving cancer detection in deprived communities, use of health trainers, and raising aspirations to good health among people living in poor areas.

Healthier lives but ever-widening inequalities: what price progress?

D. Carlisle

Health Service Journal, vol.116, Nov. 16th 2006, p.14-15

London’s 11 spearhead local authorities report that they are on course to meet national targets to reduce health inequalities by 2010. Much of this overall improvement has been achieved by tackling cancer. However, the spearhead areas have no chance of meeting the target for reducing inequalities due to heart disease and stroke by 40%. This is due in part to the fact that initiatives have had to be put on hold because of cuts to funding for public health promotion.

Hewitt under pressure over mixed wards chaos

M. Frith

The Independent, Nov. 24th 2006, p.2-3

This article is part of the Independent’s feature on the ‘Mixed-Sex wards scandal’. In it the writer reports that Health Secretary Patricia Hewitt is under pressure to investigate the continued existence of mixed-sex wards, despite government assurances that they no longer exist. Hewitt has stated that evidence gathered by the Independent did not tally with the reports that she had received from individual trusts. She maintains that segregation was not feasible in A&E departments but a crackdown on mixed wards is needed.

(See also The Daily Telegraph, Nov. 24th 2006, p.1)

How middle England turned into a nation of reconfiguration rebels

T. Shifrin

Health Service Journal, vol.116, Nov. 23rd 2006, p.14-15

There is widespread anger across England at proposals to reconfigure hospital provision and move services out into the community. The changes are perceived as being driven by the need to cut costs and management assurances to the contrary are not believed.

How to be top

L. Greenwood

Health Service Journal, vol.116, Nov.9th 2006, p.22-25

Only two NHS organisations, both foundation trusts, received top marks for both quality of care and use of resources in the Healthcare Commission’s first annual healthcheck. This article reports on how the Royal Marsden Hospital and the Harrogate and District foundation trust achieved success.

The impact of ethnicity and diversity on doctors’ performance and appraisal

A. Esmail and P. Abel

British Journal of Health Care Management, vol.12, 2006, p.303-307

A disproportionate number of ethnic minority clinicians working in the NHS are either suspended or referred to the General Medical Council. Racism may be a factor in this state of affairs. Understanding the impact of racial discrimination requires consideration of the role of institutional racism, the ways in which racism can lead to stress, and the role of organisations in inadvertently accentuating the problem. Diversity management provides a model for change which has direct relevance for healthcare organisations in the UK.

New localism in the English National Health Service: what is it for?

P. Allen

Health Policy, vol.79, 2006, p.244-252

In its second term in office starting in 2001 the New Labour government moved towards decentralisation of decision making in the English NHS. This policy shift appears to be driven firstly by the idea that public services will be better in terms of quality, responsiveness and efficiency if decisions are made locally and secondly by the idea that it is inherently desirable to involve the community in local service development. This paper discusses how these ideas are articulated and what the evidence to date shows about the likelihood of success in the case of the NHS, focusing particularly on foundation trusts.

Pipped at the post

R. Brooks

Public Finance, Nov. 3rd-9th 2006, p.26-27

Despite a doubling of public spending on the NHS, public perception is one of a cash-strapped organisation in crisis. The author finds two reasons for this situation: 1) public expectations are rising faster than the NHS can satisfy them; and 2) there is no explicit formal mechanism for setting priorities and rationing care.

Safe in their hands?

D. Carlisle

Health Service Journal, vol.116, Nov. 30th 2006, p.24-26

Although childbirth in the UK may not be statistically less safe than it used to be, there are concerns about safety in some failing maternity units. Research has shown that service failure arises from a combination of inadequate professional communication, poor teamwork, low staffing levels, and non-adherence to guidance.

Scotland motors into the future as England gears up for change

J. Trueland

Health Service Journal, vol.116, Nov.2nd 2006, p.16-17

Hospital reconfiguration and health service redesign are well advanced in Scotland compared to England. There is a national plan which has broad cross-party support and the professions, unions and citizens in Scotland are in favour. The path of reform has been smoothed by: 1) time spent building consensus; 2) support for senior management; and 3) clinical engagement.

Skilled analysts of little use to the NHS

J. Shapiro

Health Service Journal, vol.116, Nov. 30th 2006, p.20-21

In the past the strategic direction of the NHS was set by central government. Following reforms introduced by New Labour, responsibility for strategic commissioning of services for their populations has been devolved to primary care trusts, while providers are encouraged to compete for business. A culture change is required within NHS organisations which have in the past been actively discouraged from determining their own destinies. This problem has been addressed in two ways: by bringing in senior managers from the private sector and by using external consultants.

Structure and logic of regulation and governance of quality of health care: was OFSTED a model for the Commission for Health Improvement?

G. Bevan and J. Cornwell

Health Economics, Policy and Law, vol.1, 2006, p.343-370

The Labour government elected in 1997 sought a “third way” for public services in Britain based on the introduction of regulatory agencies with statutory powers to shape the behaviour of organisations so that performance is in a preferred subset, but responsibility for corrective action is left with the organisation. This paper considers how the model was developed to remedy failings in the NHS. It shows how the Labour Government’s policy response reflected that of the Conservative government to perceived failures in teaching in schools in the early 1990s. It compares the two new inspectorates created to monitor performance, Ofsted for schools and the Commission for Health Improvement for the NHS.

Suitable case for treatment

J. Hirst

Public Finance, Nov. 3rd-9th 2006, p.18-23

Despite a doubling in public spending and improvements in waiting times and clinical outcomes, there is widespread public dissatisfaction with the NHS. A range of negative indicators on productivity, efficiency and financial management has recently added to the sense of gloom. This article reports on the deliberations of a group of experts brought together to explore some of the major challenges in NHS reform.

“We do not use the word “crisis” lightly … “: sexual health policy in the United Kingdom

D. Evans

Policy Studies, vol.27, 2006, p.235-252

UK sexual health policy has for many years followed a cyclical pattern of general neglect interspersed with occasional “crises” such as the emergence of HIV, which resulted in narrowly disease focused incremental change. Sexual health is a policy problem at present in the UK because of changes in sexual attitudes and behaviours which have led to increased incidence of STIs and continuing high levels of teenage pregnancy. In response, government has put in place some improvements in wider policy related to sexuality (eg equal age of consent) and services (eg greater availability of emergency contraception). However sexual health overall remains a low priority and current strategy does not address the needs of some of the most vulnerable groups such as prostitutes, children in care and victims of domestic violence.

What’s made Banbury cross?

L. Whitfield

Public Finance, Oct. 20th-26th 2006, p.18-21

Extensive reconfigurations of NHS services are triggering local protests across England. This article explains that service redesign is being driven by: 1) financial crises within the NHS; 2) concerns about the safety and sustainability of services offered by small local hospitals; and 3) the emergence of the “gradated services” model. This is based on the argument that patients should be able to access escalating levels of support, from telemedicine to super-hospitals dealing with trauma and emergency surgery, via local “polyclinics” doing routine and minor injuries work.

When Norma, Dot and Beckie had their say about NHS care …

J. Davies

Health Service Journal, vol.116, Nov.9th 2006, p.14-15

Describes a consultation event in Liverpool organised by the primary care trust which brought together 100 members of the public, 25 health professionals and 25 representatives of voluntary organisations to debate the development of health services in the city. Primary care trusts across the country may need to stage similar events if they are to engage with the people they serve.

Where managers fear to tread, myths and legends may rush in

A. Moore

Health Service Journal, vol.116, Nov. 30th 2006, p.16-17

The strategic health authority and primary care trusts in Surrey and Sussex have engaged in a protracted pre-consultation exercise on service redesign, without presenting specific plans. This has allowed opposition time to mobilise, especially as there is a strong perception that the redesign is being driven by the need to cut costs.

Why real patient involvement means real market research

S. Williams

British Journal of Health Care Management, vol.12, 2006, p.312-313

This article looks at the current state of public and patient involvement in NHS decision-making, covering the anticipated demise of the Commission for Public and Patient Involvement in Health, the changing role of patient interest groups, and the implications of the government’s current promotion of social enterprises in the delivery of services.

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