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Welfare reform on the Web (January 2007): National Health Service - reform - general

Clear water must flow into the goldfish bowl

J. Crowe

Health Service Journal, vol.116, Dec. 14th 2006, p.20-21

The NHS is currently held to account by a confusing plethora of bodies, including patient forums, local authority overview and scrutiny committees, foundation trust governors and members, clinical governance committees, inspectors and regulators. The author calls for a more coherent system, that would address tensions between:

  1. National and local accountability
  2. Patients as consumers of healthcare and patients as citizens
  3. Representative and participative systems of democracy operating side by side in the NHS
  4. Outcomes versus processes

Direction of travel for urgent care: a discussion document

Department of Health

London: 2006

The document defines urgent care as “the range of responses that health and social care services provide to people who require - or perceive the need for - urgent advice, care, treatment or diagnosis. People using services should expect 24/7 consistent and rigorous assessment of the urgency of their care need and an appropriate response to that need”. There are a number of concerns about the present situation, including:

  1. Confusion about what services are available locally and how to access them
  2. Lack of prompt access to a consistent and rigorous assessment of need
  3. Lack of services for particular groups such as people with mental health problems or learning difficulties
  4. Users and carers being asked to repeat information

The discussion document seeks to address these difficulties by identifying six principles that are defined from the user’s viewpoint:

  1. My voice as a service user is clearly heard and acted upon
  2. I know how to access services if I have an urgent need
  3. If I have an urgent need, I can access care quickly and simply
  4. My safety is paramount to everyone who cares for me
  5. I can rely on getting the right care whenever I need it and whoever I am
  6. The care that I receive meets my needs appropriately

(For comment see Community Care, Nov. 23rd -29th 2006, p.36-37)

From rhetoric to reality: a systemic approach to understanding the constraints faced by Health for All initiatives in England

D. Berkeley and J. Springett

Social Science and Medicine, vol.63, 2006, p. 2877-2889

Action to tackle the socio-economic determinants of health has been a central plank of government policy in the UK since New Labour came to power in 1997. However health promotion and improvement initiatives were expected to produce results while embedded within structure , cultures and governance arrangements which had been set up with the bio-medical model of illness in mind. This article analyses the constraints imposed on health promotion initiatives by the national, inter-organisational, organisational and government policy environments in which they are nested, through a case study of English Healthy Cities and Health Action Zones.

Health impacts: a strategy across government

Council for Science and Technology

London: 2006

Argues that improving the health of the whole population whilst reducing health inequalities, especially for those with the poorest health, should be an overall objective for the whole of government. Health impact assessments provide an important means for achieving this outcome, but need to focus on the most important issues. Skills gaps also need to be addressed, both in terms of officials outside the Department of Health being able to identify the expert advice they require and of those inside the DoH being able to influence policy-makers in other departments on the health impacts of their policies.

Health technology adoption and the politics of governance in the UK

T. Milewa

Social Science and Medicine, vol.63, 2006, p.3102-3112

The manner in which clinical and cost-effectiveness data are used to inform policy decisions on the public funding and availability of medical treatments is of fundamental importance to patient groups, clinicians, health technology manufacturers and citizens. The National Institute for Health and Clinical Excellence (NICE) was established by the British government in 1999 to reach transparent, evidence-based decisions on whether selected health technologies should be made available by the NHS in England and Wales. This role has been accompanied by requirements for consultation with stakeholder constituencies, the involvement of “lay” individuals in decision-making, and reasoned, minuted deliberation. Decision-making within NICE thus involves a tension between these requirements.

Hospital closures will save lives, Government says

J. Laurance

The Independent Dec. 5tth, 2006, p.11

A report published by the Institute for Public policy research (IPPR) claims that the campaign to keep local Accident & Emergency (A&E) units open may cause more than 1000 unnecessary deaths a year. The report says that deaths could have be prevented if patients were treated in specialist centres, rather than in their local A&E departments. The report strengthens the government’s arguments for closing small local A&E departments across the country. The government’s chief medical officer and the national clinical director for emergency care argue that “concentrating services in fewer, larger hospitals will mean longer travelling time for patients but safer care once they get there.”

(See also Daily Telegraph, Dec. 1st 2006, p.12)

In control and ready to share: hope emerges from tragedy

D. Carlisle

Health Service Journal, vol.116, Dec.7th 2006, p.14-15

Dysfunctional maternity services at Northwick Park hospital led to 10 deaths between 2002 and 2005. Problems arose from a combination of staff shortages, a breakdown in relationships between clinicians and midwives, the stress of a merger with another smaller unit, and disruption caused by refurbishment of the building. Changes introduced to turn the service around included regular staff meetings, a multidisciplinary training programme, new clinical guidelines, and an improved clinical governance structure.

Information prescription pilots

Department of Health


Information prescriptions will direct patients and their carers to relevant and personal sources of information about services and treatments that they will need at key points in their care journey, for example at diagnosis, at different stages of their treatment, and when they are discharged from hospital. They will provide people with a long-term condition with information about where to find advice and support, how to make contact with others with the same illness, and how to claim benefits. The Department of Health is inviting proposals from health and social care bodies interested in piloting information prescriptions before their national launch in 2008.

Is the NHS ready for a US business guru’s strategy?

N. Edwards

Health Service Journal, vol.116, Dec. 7th 2006, p.23-25

Redefining Healthcare by M. Porter and E.O. Teisberg has caught the attention of UK health policymakers and commentators for its diagnosis and prescription for reform of the US health system. The book’s central argument is that the US health system in inefficient because it has the wrong sort of competition. Health plans compete on price and avoiding risk. Providers try to shift costs and maximise income. The solution proposed is a market where care is focused on single medical conditions with clearly defined outcomes. Competing providers would offer care for such conditions and consumers would have price and outcome data to inform their choices. Six leading healthcare experts debate whether this diagnosis and solution could be applied to the NHS.

Leading on change

N. Edwards (editor)

Health Service Journal, vol.116, Dec. 14th 2006, Supplement, 15p

Change is a permanent feature of the NHS, and managers must learn to cope with a state of permanent revolution. This supplement covers: the role of the unions in reform; successful management of organisational mergers; the importance of clear communication with staff and consideration of their feelings; and the impact of payment by results and the purchaser/provider split.

Looked after children: caring for health

H. Payne

ChildRight, issue 231, 2006, p.18-21

Looked after children have higher levels of physical and mental health need than the general population, and must be offered timely assessment and management of any health deficits, with the aim of preventing long-term problems in adulthood. They now receive a more appropriate multidisciplinary health care service, focused on facilitating access to care and improving their well-being. Health services for looked after children require specific skills and expertise in doctors and nurses and a high level of coordination between agencies and across geographical and service boundaries.

The new politics of the NHS: from creation to reinvention. 5th edition

R. Klein

Oxford: Radcliffe, 2006

The book provides an up-to-date, impartial overview of the NHS, its processes and paths of influence. It concentrates on the policy-making process in the NHS and the accompanying political debates over the past 60 years. It examines the influence of ideology and the role of interest groups in shaping policy. Other key issues explored include: centralisation, management, structure, funding, economic performance and rationing.

The NHS in England: the operating framework for 2007/08

[London]: Department of Health


This document sets out the specific business and financial arrangements for the NHS in 2007/08. It describes delivery priorities, payment by results and tariff details, and expectations about the development of commissioning, including practice based commissioning. It also stresses the need for primary care trusts to work with local authorities to improve the health of the population, reduce inequalities and achieve a shift towards prevention

NHS trusts may close 29 A&E units as record deficits bite

G. Wilson

The Daily Telegraph, Dec. 1st, 2006, p.12

A survey conducted by the Conservatives shows that a total of 26 Accident & Emergency (A&E) units are facing closure as the NHS struggles to cope with record deficits. The Tory study said that the planned reorganisation “would seriously undermine patient care”. As well as the NHS’s £1.3bn deficit, the study blamed the cuts on the European working time directive, which will cut the numbers of hours doctors can work per week from 56 to 48 by 2009 adversely impacting on the ability of hospitals to provide round-the-clock cover. The Conservative shadow health secretary claims that people in rural areas will have to travel longer distances to reach their nearest A&E departments.

Obese may be denied priority NHS care

A. Grice

The Independent, Dec. 26th 2006, p.1

A government review committee on health is discussing plans to deny smokers, obese people and people with alcohol problems priority treatment on the NHS. Before any decision is made a sample group of 100 people from across the country will be asked to participate in a consultation exercise. If the proposals are implemented it would mean changing NHS guidelines that currently state that people should not be discriminated against even if their illnesses are self-inflicted. The article claims that experts say that the NHS could be bankrupt if the costs of treating smoking and obesity related illnesses are left unchecked: Obesity costs the NHS £7bn a year and smoking related illnesses cost an estimated £1.7bn. However, the proposals have been attacked by tobacco industry lobbyists who claim that the national income from tobacco far outweighs the £7bn cost for treating smoking related diseases.

Policy through procurement: the introduction of digital signal process (DSP) hearing aids into the English NHS

W. Phillips and others

Health Policy, vol.80, 2007, p.77-85

The adoption and diffusion of new technologies within the English NHS has been variable, unpredictable and subject to the whim of local power groups. In response, the Healthcare Industry Task Force established a working group to investigate how procurement processes might promote the uptake of new technologies. This paper aims to provides a case study of the role of the NHS Purchasing and Supply Agency in the introduction of DSP hearing aids into the NHS, using a systems of innovation approach as an analytical framework.

Root and branch reform

S. Mathieson

Health Service Journal, vol.116, Dec. 14th 2006, p.24-25

The Conservative Party is opposed to the centralised approach embedded in the NHS IT modernisation programme, calling it a £20bn shambles. Conservative MP Richard Bacon has called for health trusts to be allowed to opt out and choose their own systems within a slimmed down national structure. The centralised system is also being criticised by some experts in information security.

Variations in the experiences of patients using NHS services in England: analysis of the Healthcare Commission’s 2004/2005 surveys of patients

Healthcare Commission

London: 2006

This report analyses surveys of users of community mental health services, local health services, emergency departments, and outpatient departments. There were a number of recurring themes from all four surveys:

  • Older patients consistently reported more positive experiences than younger patients
  • Patients from black and minority ethnic communities were more likely than White patients to report negative experiences
  • Patients with a disability or in poor health were more likely to respond negatively than those in good health.
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