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Welfare Reform on the Web (March 2000): National Health Service - Reform - General

APART AT THE SEAMS

J. McClenahan

Health Service Journal, vol. 109, Nov. 18th 1999, p. 22-23

More than a fifth of trusts in England are involved in mergers. Department of Health has not revealed the rationale for its drive on mergers. Small potential cost savings are often outweighed by the expense of the merger process and loss of morale and productivity. Many NHS consultants are not involving themselves in redesigning services following mergers because they cannot see a way forward in the fact of so many contradictory central demands. Support for this massive change programme is not adequate.

BEST VALUE IN NHS BANISHED TO BACK ROOM

S. Brown

Public Finance, Nov. 5th-11th 1999, p. 7

Reports that Best Value in the NHS will not be applied to clinical services but will focus on back room support such as catering, cleaning and laundry.

CANCER DEATHS IN BRITAIN 'NO WORSE THAN ELSEWHERE'

J. Laurance

Independent, Nov. 10th 1999, p. 5

Reports challenges to claims that Britain has one of the worst records in the western world for cancer survival. In fact the system for registering cancer deaths is much tighter in Britain than elsewhere. A cancer patients who dies of a heart attack will be registered as a cancer death in the UK, while other countries cancer registries tend to understate their death rates.

CONSULTANTS APPRAISED BY TRUST'S PILOT SCHEME

M. Stamp and J. Sanger

British Journal of Health Care Management, vol. 5, 1999, p. 502-505

Paper outlines the piloting of an appraisal system for consultants at the Norfolk and Norwich Health Care NHS Trust. Now in its second year, the system comprises a 3600 approach to all aspects of a consultant's professional practice.

THE DEATH OF FLORENCE NIGHTINGALE

M. Harris

Daily Telegraph, Dec. 9th 1999, p. 30

Argues that the abuse of elderly patients within the NHS stems from changes in nurse training introduced in the 1980s. This reform made training more academic and less practical.

DEMOGRAPHY: ANALYSING TRENDS AND POLICY ISSUES IN BIRTHS, DEATHS AND DISEASES IN THE UK POPULATION IN 2015

C. Dargie

London: Nuffield Trust, 1999 (Policy futures for UK health: 1999 technical series; no. 3)

Paper highlights how general improvements in the health of the UK population hide worrying in equalities with respect to income and membership of social class groupings. Poverty, unemployment and poor housing lead to poor health outcomes. An older UK population is expected in 2015 and, in the longer term, an increasing dependency ratio is expected. These demographic shifts will have policy consequences for the UK population in terms of maintaining and improving the health and well-being of older people and financing health care services in the future.

DOCTORS IN THE DOCK: IS SELF-REGULATION WORKING?

J. I. Baeza

British Journal of Health Care Management, vol. 5, 1999, p. 466-469

The Bristol case and other 'dangerous doctors' stories have dented public confidence in health care professionals, and the regulatory mechanisms in place to protect the public have been found wanting. Article argues for a coherent multiprofessional framework for professional self-regulation.

DRUG SAVINGS

M. Verdin

Health Review, Autumn 1999, p. 18-19

Discusses the tension between limited NHS resources and rising published expectations and demand for health care. Argues that the rationing of treatments is inevitable, and that a public debate is required about how state health care should be funded and where investment should be made.

EDUCATING

B. Millar

Health Service Journal, vol. 109, Dec. 2nd 1999, p. 12-13

Reports responses to the health secretary's plans to reform nurse education and integrate it with changes to professional roles and the pay system.

ELDERLY PATIENTS 'LEFT STARVING TO DEATH IN NHS'

S. Laville and C. Hall

Daily Telegraph, Dec. 6th 1999, p. 1, 10 and 11

Presents anecdotal evidence that elderly patients are neglected and starved to death in the NHS through an unspoken policy of 'involuntary euthanasia' designed to relieve pressure on the service. Also produces statistical evidence that in the treatment of cancer, heart disease and strokes, elderly people are not receiving equal treatment.

ETHICS: RECONCILING CONFLICTING VALUES IN HEALTH POLICY

M. Evans

London: Nuffield Trust, 1999

(Policy futures for UK health: 1999 technical series; no. 9)

Paper highlights the conflicting value that are played out in modern health debates. Chief among them is the tension between individual choice and collectivism or collective welfare. This is to be found in many conflicts and debates, including in reproductive technology, in euthanasia and in tackling inequalities in health.

EXCELLENCE MODEL RIGHT TOOL FOR MANAGEMENT

S. M. Jackson

British Journal of Health Care Management, vol. 5, 1999, p. 506-510

Article examines why the government has endorsed the European Foundation for Quality Management's Excellence Model as the most expedient management tool for implementing its clinical governance agenda.

THE GLOBAL CONTEXT: A REVIEW OF PRIORITY GLOBAL HEALTH ISSUES FOR THE UK

K. Lee

London: Nuffield Trust, 1999. (Policy futures for UK health: 1999 technical series; no. 1)

Paper addresses the unstoppable forces of globalisation and warns that policymakers ignore global forces in health at their peril. Express the consequences of globalisation for health in the UK, including the need for policy makers and health professionals to be made aware of global health issues, the need for national health institutions to adopt to globalising forces, and the consequences for policy and practice of the different levels of government that result from globalisation and devolution.

GOVERNMENT DIRECTIVES AND CHANGES: THE POTENTIAL IMPACT ON CLINICAL PRACTICE

D. Cunningham

Journal of the Royal College of Physicians of London, vol. 33, 1999, p. 454-457

Paper examines the impact of NHS reform and modernisation on clinicians and clinical practice. Argues that while the government's overall vision is sound, the speed of implementation of the reforms is starting to create problems. Identifies the main problems as:

  • gaining local commitment;
  • the lack of time and resources to carry out changes;
  • the speed at which the changes themselves are being pushed through.

This combination is a recipe for staff burnout.

HEALTH POLICY IN BRITAIN 4th ED.

C. Ham

Macmillan, 1999

Book falls into two main sections. The first part provides a narrative account of the development of health policy from the 19th century to the present day. Includes a chapter on New Labour and the NHS which discusses primary care groups, clinical governance, and the comprehensive spending review. The second part focuses on the policy process, with chapters on making and changing, implementing, monitoring and evaluating policy.

HEALTH WARNINGS ARE A LITTLE OFF COLOUR

N. Timmins

Financial Times, Dec. 8th 1999, p. 29

Argues that falling public satisfaction with the NHS risks undermining support for a tax-funded health care system. Government initiatives to raise user satisfaction include NHS Online, NHS Direct, an ambitious building programme, the National Institute of Clinical Excellence (to end the lottery of post-code prescribing) and the introduction of clinical governance. Unfortunately these improvements are expensive, and the health spending may need to rise significantly to cover the costs.

IN PURSUIT OF AN IMPROVING NATIONAL HEALTH SERVICE

A. Enthoven

London: Nuffield Trust, 1999

Argues that the internal market in the NHS was never really implemented because the public continued to hold the government responsible for health services, and so purchasers never had the 'political space' to drive poor providers out of business. Finds that the NHS is under pressure from the oft-cited combination of new technology, an ageing population and rising expectations. There is also a crisis of confidence in quality which demands the introduction of continuous quality improvement and much better audit. Doubting that it is possible to create a culture of innovation, efficiency good customer service in a public sector monopoly, author suggests reinventing the internal market and encouraging people who can afford to do so to pay for premium services through insurance schemes part-funded by the public.

IN SEARCH OF SPECIALIST ADVICE

M. Rigge

Health Service Journal, vol. 109, 9th Dec. 1999, p. 20-21

Calls for more openness in the NHS about the qualifications and experience of its doctors.

INQUIRY INTO BRITAIN'S POOR CANCER CARE RECORD

C. Hall

Daily Telegraph, Nov. 9th 1999, p. 9

An investigation is to be launched into the state of Britain's cancer services after evidence that the NHS is failing to provide the best treatment and care.

(See also Guardian, Nov. 9th 1999, p. 9; Times, Nov. 9th 1999, p. 4)

INSPECTION OF WARDS FOR ELDERLY 'TO BE A PRIORITY'

C. Hall and R. Sylvester

Daily Telegraph, Dec. 13th 1999, p. 1

Reports that the Commission for Health Improvement will be asked to focus on geriatric wards when it starts work, following reports of neglect and abuse of elderly patients.

INVOLVING THE PUBLIC IN RATIONING DECISIONS! THE EXPERIENCE OF CITIZENS JURIES

J. Lenaghan

Health Policy, vol. 49, 1999, p. 45-61

Paper reviews an innovative new technique for involving the public in health care decisions, called citizens' juries. Despite some limitations, the experience of a number of pilots suggests that, given enough time and information, the public is willing and able to join in debates about the allocation of finite resources in health care. As there are no right or wrong answers in health care choices, it is vital that the decision-making process has legitimacy, and that the public has an opportunity to be involved.

LIMITS TO RATIONALITY: ECONOMICS, ECONOMISTS AND PRIORITY SETTING

R. Robinson

Health Policy, vol. 49, 1999, p. 13-26

There have been many calls for priority setting in health care to be based on rational and explicit criteria. Economists using methods of economic evaluation seem to have an approach that satisfies these requirements. Obstacles to the take-up of the economic approach centre on:

  • limitations in the theory and practice of economic evaluations;
  • the nature of the wider context within which decisions on priority setting take place.

Thus, if explicit divisions on priority setting, although based on strong economic evidence, are felt to be politically unacceptable they are unlikely to be implemented.

MEASURED RESPONSE

B. Hollingsworth, N. Maniadakis, and E. Thanassoulis

Health Service Journal, vol. 109, Nov. 25th 1999, p. 28-29

An analysis of the activity of 75 acute hospitals over the period 1991-96 using data development analysis showed that, while overall productivity increased, the efficiency of individual hospitals did not. A small decrease in the efficiency of individual hospitals was found in the last four years studied. An analysis of quality of care over the same period suggests that gains in the volume of services may have been at the expense of quality of care. Results suggest that incentives for increasing hospital efficiency have a one-off impact rather than a sustained effect.

MISSING THE VOTE

P. Butler

Health Service Journal, vol. 109, Dec. 2nd 1999, p. 9-10

Analyses the growth and role of unelected task forces and advisory groups in the NHS. These may be regarded either as examples of collaboration and inclusive government or as a means of keeping dissenters sweet and delaying heavy expenditure.

NATIONAL SENTINEL AUDIT FOR STROKE: A TOOL FOR RAISING STANDARDS OF CARE

A. G. Rudd et al

London: Royal College of Physicians, 1999

Large scale national audit of almost 7000 stroke patients reveals the appalling standards of care that exist in many parts of the country.

NHS AND THE ELDERLY

C. Hall and S. Laville

Daily Telegraph, Dec. 8th 1999, p. 4

Further anecdotal evidence of the prevalence of abuse and neglect of elderly patients in the NHS.

(See also Daily Telegraph, Dec. 7th 1999, p. 14 and 15 and Dec. 9th 1999, p. 10

NURSES TO TAKE OVER DOCTORS' ROLE

C. Brown

Independent, Nov. 19th 1999, p. 1

Reports government plans to speed up treatment of priority cases within the NHS by removing demarcation lines between health workers, including nurses, assistants and physiotherapists. This would allow nurses to take on duties currently performed only by doctors such as administering powerful drugs, including chemotherapy for cancer patients.

(See also Daily Telegraph, Nov. 23rd 1999, p. 17; Times, Nov. 23rd 1999, p. 11)

ORGANISATION AND MANAGEMENT: ARCHETYPE CHANGE IN THE ORGANISATION AND MANAGEMENT OF HEALTH CARE?

E. Ferlie

London: Nuffield Trust, 1999 (Policy futures for UK health: 1999 technical series; no. 7)

Paper examines long-term trends in the organisation and management of health care and assesses whether there is evidence for an 'archetype' shift taking place in organisations that will develop over the next 20 years. Cites factors such as the change from a professionally dominated to a more managed and externally regulated system, a move to more private-sector-style organisations, and the promotion of business-like value that stress efficiency ad entrepreneurship within health care organisations in support of the shift. Also looks at the possible consequences of the change, including the control and accountability implications of the expansion of the private finance initiative the new roles that ministers, politicians and local agents will play in the changed organisations and the effect of changing value systems on organisational style.

THE PHYSICAL ENVIRONMENT: A REVIEW OF TRENDS IN THE NATURAL AND BUILT ENVIRONMENT

S. Palmer

London: Nuffield Trust, 1999 (Policy futures for UK health: 1999 technical series; no. 2)

Paper reflects the increasing realisation that health and the environment are linked. Author addresses the links in terms of globalisation, and trends in leisure activities, housing and air quality. Advocates an evidence-base linking environmental hazards to health, resulting in an integrated policy approach involving the public.

POINTS MAKE PRIZES

P. Adams

Health Service Journal, vol. 109, Nov. 25th 1999, p. 30-31

Assessing patients for non-urgent surgery according to a numeric priority system has rationalised waiting times in three specialisms in a pilot project. Traditional scoring systems result in little relationship between urgency and waiting times.

POLICY FUTURES FOR UK HEALTH: PATHFINDER

C. Dargie

London: Nuffield Trust, 1999

Identifies a set of 6 issues which represent the key areas that need to be addressed by UK health policy in order to deal with the future. These are: people's expectations and financial sustainability; demographic change and the ageing population; information and knowledge management; scientific advance and new technology; workforce education and training; and system performance and quality (efficiency, effectiveness, economy and equity)

PROMISES, PLEDGES AND PROPAGANDA: LABOUR'S 99

C. Webster

British Journal of Health Care Management, vol. 5, 1999, p. 516-517

In the course of 1999, all the outpourings of the Labour governments propaganda machinery have failed to stem the erosion of confidence in its interventions in health care.

PUBLIC EXPECTATIONS: FROM PATERNALISM TO PARTNERSHIP; CHANGING RELATIONSHIP IN HEALTH AND HEALTH SERVICES

M. Barnes

London: Nuffield Trust, 1999 (policy futures for UK health: 1999 technical series; no. 10)

Addresses the rising public expectations that are driving health debates in the UK. Documents the increased public involvement in decision-making in health policy and health care services that has been a feature of the last 20 years. Posits user or consumer involvement in health as a challenge to professional and expert authority, which will have further consequences for the organisation and administration of health care services if there is to be real partnership between users and professionals in the future.

PUBLIC VIEWS ON HEALTH CARE RATIONING: A GROUP DISCUSSION STUDY

R. Cookson and P. Dolan

Health Policy, vol. 49, 1999, p. 63-74

Small-scale study for investigating which ethical principles of health care rationing the public support after discussion and deliberation. Results show that the public accept three main principles of justice: 1) a broad 'rule of rescue' giving priority to those in immediate pain or facing an immediate threat to life; 2) maximising the health of the whole community; and 3) reducing inequalities in people's lifetime experience of health. The public do not appear to accept the view that improving population health is the primary goal of the health care system or that treatment should be allocated only on the basis of clinical need.

RATIONING HEALTH CARE: AN EXPLORATION

A. Maynard

Health Policy, vol. 49, 1999, p. 5-11

Demand for health care normally exceeds supply and it has to be rationed using monetary (ability to pay) or 'need' criteria. Rationing takes place when an individual is deprived of care which would be of benefit and which is desired by the patient. In European systems, rationing, decisions are made by balancing considerations of clinical need, cost effectiveness and fairness (equity). Accountability for rationing choices also requires careful regulation and monitoring of doctors, who are the chosen agents of society for judging the health needs of competing patients.

RATIONING RATIONALE

J. Hirst

Community Care, no. 1299, 1999, p. 22-23

As expensive new drugs emerge that can treat mental illnesses with fewer side-effects, article explores the question of whether the gauge of clinical effectiveness being applied to them is just a mechanism for reining in NHS costs.

SCIENCE AND TECHNOLOGY: TRENDS AND ISSUES FORWARD TO 2015: IMPLICATIONS FOR HEALTH CARE

G. Robert

London: Nuffield Trust, 1999 (Policy futures for UK health: 1999 technical series; no. 4)

On the one hand expects a greater concentration of specialist expertise and equipment in a smaller number of larger centres. At the same time, it will be possible to treat more conditions locally in small centres, and there is likely to be an increase in self-diagnosis and self-treatment or home care. Policy makers have to work with the growing demands and expectations of the public, the need to evaluate new health care technologies, and ensure that the health infrastructure and workforce can cope with new developments.

SISTER ACT

R. Boyle

Health Review, Autumn 1999, p. 4-5

Describes ways in which nurses are expanding their role in primary care through initiatives such as NHS Direct, nurse consultancy and nurse prescribing.

SOCIAL TRENDS: THE SOCIAL CONTEXT OF HEALTHY LIVING

R. Pahl

London: Nuffield Trust, 1999 (Policy futures for UK health: 1999 technical series; no. 6)

Highlights advances in society and the way people live their lives, and the consequent demands placed on health care services. Examples of societal changes include changes in working patterns and changing household arrangements including growth of single person households. Discusses some negative effects of developments, including polarisation between those that are able to take advantage of developments and those that are not, and the effects of changing arrangements and lifestyle on alcohol abuse and mental disorders that provide challenges for health care service.

Department of Health

London: 1999

Green paper proposes that health authorities be given power to suspend poorly performing GPs. Consultants could also lose their right of appeal directly to the Health Secretary. All doctors would be required to submit to external monitoring of their work, including an annual appraisal. HAs and trusts would be able to refer doctors suspected of bad practice to independent and impartial assessment and support centres. The centre will decide if doctors can be retrained and advise employers and the General Medical Council if not.

TWO-WEEK CANCER TARGET "BACKFIRES"

M. Thompson

Health Service Journal, vol. 109, Dec. 2nd 1999, p. 4

Information collected by the British Association of Surgical Oncology shows that up to a third of breast cancers are detected in women referred 'urgently' who do not have cancer and who have been sent by GPs simply wishing to cover themselves. This means that the wait for a non-urgent appointment has soared from 6 weeks to between 14 and 18 weeks.

UNDER NEW MANAGEMENT

R. Boyle

Health Review, Autumn 1999, p. 16-17

Outlines the support that Health Authorities will need if they are to succeed in their new roles of overseeing the planning and delivery of service improvement at a local level, of providing strategic leadership in improving public health and tackling inequality, of providing effective performance management, and of ensuring co-operation between all parts of the NHS.

WORKFORCE: ANALYSING TRENDS AND POLICY ISSUES FOR THE FUTURE HEALTH WORKFORCE

C. Dargie

London: Nuffield Trust, 1999 (Policy futures for UK health: 1999 technical series; no. 8)

On the basis of advice from committees, the UK government plans the number of medical and nursing staff by controlling the number of places in education and training. Paper looks at the system and pressures for the future, such as the ageing population and the internationalisation of both health services and health workers. Also looks at changing professional roles in health, implications for future training, and pressures coming from outside the health service in the form of increasingly flexible career patterns and developments in information and communication technology.

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