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

The aim is good …

A.U. Sale

Community Care, Jan.18th-24th 2007, p.24-26

The health and social care White Paper Our Health, Our Care, Our Say proposed more preventative services, greater user choice, improved access to community services, and more support for people with long term needs. Financial instability and organisational upheavals within the NHS are having an adverse impact on delivering change.

Building a world class NHS

I. Smith

Reform, 2006

Argues that cultural change is necessary to reform the NHS, which needs to focus on “patient value” - clinical outcomes for medical conditions over a full cycle of care. The achievement of “patient value” involves competition between health care providers in a market dominated by foundation trusts and underpinned by detailed published data on clinical outcomes. In order to bring about this change, the system needs to be decentralised and depoliticised, with the Department of Health being downsized or closed.

The business of reform and the future market

A. Cowper

British Journal of Health Care Management, vol.12, 2006, p.361-366

Report of an interview with Simon Stevens, President of UnitedHealth Europe, ranging over most aspects of NHS reform. UnitedHealth Europe works with the NHS in the fields of primary care, management of long-term conditions, and commissioning of services.

Code of practice for promotion of NHS services

Department of Health


This draft Code aims to encourage healthcare providers (NHS and independent sector) to use promotional activities, including advertisements, to kick start patient choice. However, it warns against disproportionate spending on marketing without setting any limits. Although TV promotion is discouraged, trusts will be able to use celebrities to endorse their services. Providers will pay fees to a secretariat set up to enforce the Code, and will have to employ staff to ensure compliance.

(For comment see Health Service Journal, vol.117, Jan. 18th 2007, p.14-15)

Crucial decision looms on the future of the IT programme

L. Whitfield

Health Service Journal, vol.117, Jan. 25th 2007, p. 14-15

The current NHS national IT programme has run into trouble in delivering patient administration and clinical systems to trusts to form the local end of the care records service. Its focus may now shift to setting national IT standards, leaving trusts to procure local systems in line with these.

The European Working Time Directive 2009

Y. Ahmed-Little and M. Bluck

British Journal of Health Care Management, vol.12, 2006, p.373-376

In 2004 junior doctors’ working hours were reduced to 56 per week to meet the requirements of the European Working Time Directive (EWTD). Full implementation of the EWTD requires the introduction of a 48 -hour working week by 2009. The EWTD 2004 targets led to many junior doctors in training having to move away from traditional on-call rotas to predominantly shift working. This paper examines the current and future impact of these changes on junior doctor availability during the normal working day, where most service delivery and training occurs.

Exploring the human resource implications of clinical governance

C. V. Som

Health Policy, vol.80, 2007, p.281-296

The Labour government introduced clinical governance into the NHS in 1998 as a major policy initiative to improve the quality of clinical care. The success of the initiative is crucially dependent on the commitment, motivation and enthusiasm of NHS staff, but its implications for human resource management have been little explored. This study draws on data from interviews with a purposive sample of 33 staff to identify seven major HR implications of clinical governance:

  1. The role of human resources in improving risk management
  2. Managing people to deliver patient-focused clinical care
  3. Supporting health care staff to adopt evidence-based practice
  4. Role of HR in facilitating clinical audit
  5. Managing HR information to support clinical governance
  6. Systematic appraisal to manage individual performance
  7. HR problems in the implementation of the new governance framework


How doctors learned to start loving data

T. Kelsey

Health Service Journal, vol.117, Jan. 25th 2007, p.18-19

This article presents examples of how clinicians and health service managers have used statistical data to identify poor hospital performance and take remedial action. It goes on to discuss how much of this information about specialised services should be put in the public domain.

“I say what I think - it can be uncomfortable”

N. Goodwin

Health Service Journal, vol.117, Jan 11th 2007, p.20-21

Report of an interview with NHS Emergency Access Czar Sir George Alberti, in which he criticises the new consultant contract and makes the case for hospital reconfiguration. He advocates the creation of large specialist regional hospitals supported by a network of community services delivered by multi-disciplinary teams.

Is it new hope for “No Hope” as cliffhanger reaches final reel?

H. Mooney

Health Service Journal, vol.117, Jan. 11th 2007, p.14-15

Birmingham’s Good Hope Hospital trust has struggled with financial deficits over the last six years. It is now proposed that the neighbouring Heart of England foundation trust should take over Good Hope and save its services. This article chronicles the hurdles that have stood in the way of this solution and asks if the move is likely to be replicated.

Next era of reform will hinge on Brown being as bold as Blair

D. Martin

Health Service Journal, vol.117, Jan. 4th 2007, p.14-15

With Gordon Brown likely to take over as prime minister in 2007, a range of experts speculate on the direction of health policy under the new regime. It is predicted that Mr Brown is unlikely to abandon flagship Blairite initiatives such as foundation trusts and the patient choice agenda, as they are now deeply embedded in the NHS. He is thought likely to prioritise medical research and population health improvement.

NHS will not meet MRSA target next year - or possibly ever

V. Vaughan

Health Service Journal, vol.117, Jan. 11th 2007, p.5

A leaked Department of Health memo warns that the NHS is not on track to hit the target of halving the incidence of MRSA infection in hospitals from its 2004 rate by April 2008 and may never achieve that goal. The memo goes on to set out five options for ducking negative publicity when news about the missed target breaks. These include dropping the target altogether, extending the timescale by a year to April 2009, switching to locally set targets, changing the target to cover hospital infections generally, without mentioning specific ones, and extending the target by adding Clostridium difficile.

(See also Health Service Journal, vol.117, Jan. 11th 2007, p.6-7)

Public health: evolution, devolution or dud?

S. Griffiths and D. Hunter

British Journal of Health Care Management, vol.13, 2007, p.24-26

This article reviews to progress made by the New Labour government in improving the health of the population and reducing inequalities associated with poverty. It concludes that progress in attaining public health objectives has been slowed by the government’s prioritisation of structural reform of the NHS.

Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence

A. Culyer and others

Journal of Health Services Research and Policy, vol.12, 2007, p.56-58

There has been discussion about whether the National Institute for Health and Clinical Excellence (NICE) should set a “threshold” figure for the cost of an additional quality-adjusted life-year above which a treatment will not be recommended for use. The authors argue that the setting of such a “threshold” is the responsibility of Parliament. The role of NICE should be to seek out treatments which are not cost-effective according to the “threshold” set by Parliament and have their use discontinued.

Telling cultures: “cultural” issues for staff reporting concerns about colleagues in the UK National Health Service

K. Ehrich

Sociology of Health and Illness, vol.28, 2006, p.903-926

Recent UK health policy initiatives promote a “no blame culture” and learning from adverse events to enhance patient safety in the NHS. This article uses three recent statutory inquiries into medical errors and misconduct to explore the cultural factors which inhibit staff from reporting problems. These include fears about retaliation and social ostracism, the gendered division of labour in health care, and a reluctance to criticise senior colleagues.

Value for money in the English NHS: summary of the evidence

S. Martin, P.C. Smith and S. Leatherman

London: Health Foundation, 2006

Since 1999 the volume of activity within the English NHS has increased, but productivity has changed only marginally. This is because the NHS has had the resources to treat marginal patients who would previously have been written off. The health gains from treatment (relative to costs) will be modest for these patients, who are likely to be elderly or require treatments with poor cost effectiveness ratios. The inclusion of such marginal patients in NHS activity depresses its productivity relative to periods when resources were more constrained.


We can work it out

A. Moore

Health Service Journal, vol.117, Jan. 11th 2007, p.24-26

The ageing of the “baby boom” generation born after World War II means that from 2026 the NHS will have to care for rising numbers of people with dementia, while the number of informal carers will drop due to smaller family sizes and increased family breakdown. It is anticipated that more unplanned admissions will incentivise the NHS to ensure that joint commissioning of services with social care works. Observers also believe that acute staff are currently poorly trained in identifying and dealing with patients with dementia.

Workforce planning

N. Plumridge
Health Service Journal, vol.117, Jan. 18th 2007, p.17

In 2000 the NHS needed to recruit more staff urgently to meet promises on shorter waiting times. The Department of Health therefore improved NHS pay to boost recruitment, brought in staff and private providers from overseas, destabilised the NHS culture of professional silos and encouraged workforce flexibility. At the same time it began to flood the labour market with trainees, in order to, in due course, bear down on pay and make the other measures superfluous.

Workforce plans predict “bitter opposition” and “volatility”

H. Mooney and L. Donnelly
Health Service Journal, vol.117, Jan. 4th 2007, p.5

A leaked draft of the NHS pay and workforce strategy for 2008-11 forecasts significant problems in matching supply of health professionals to demand. The forecast for workforce capacity by 2010/11 shows: 1) an excess of 3,200 consultants “which we cannot afford to employ”; 2) an excess of 16,200 allied health professionals, scientists and technicians; 3) a shortage of 14,000 nurses; 4) a shortage of 1,200 GPs; and 5) a shortage of 1,100 junior doctors. Solutions discussed include:

  1. Encouraging foundation trusts to create cheaper sub-consultant roles
  2. Encouraging more doctors to train as GPs
  3. Boosting investment in nurse training
  4. Managing down the supply of allied health professionals, scientists and technicians
  5. Encouraging more use of fixed term appointments and temporary staff to cope with fluctuations in demand


The draft strategy also sets out a number of controversial options for reducing increases in the national pay bill, including the use of unemployment to create downward pressure on wages.

(See also Health Service Journal, vol.117, Jan. 4th 2007, p.6-9)

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