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

After Eden, things look rosy in the social enterprise garden

J. Davies

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

Social enterprises are businesses run with a social aim and not just to make a profit. The government is strongly promoting their use to deliver NHS services and has funded 25 pathfinder projects. It is hoped that these organisations will help the NHS to become more responsive to users and give communities a stronger voice in how health services are delivered.

The big C

A. Moore

Health Service Journal, vol. 117, Feb. 15th 2007, p.22-24

C difficile is endemic in some hospitals and is difficult to eradicate as its spores can survive indefinitely. There is a strong incentive for trusts to reduce cases as each one extends length of stay and costs £4,000. Isolating infected patients has been shown to be effective but can be tricky to achieve.

Come back, bowler brigade, all is forgiven

S. Greer

Health Service Journal, vol.117, Feb. 8th 2007, p.18-19

The Department of Health has been reformed by Conservative and Labour governments since the 1980s to become focused on delivery, willing to respond to central direction, and staffed by professional managers and subject specialists rather than career civil servants. It largely works through agencies and implements policies devised by a mixture of special advisers and outside consulting firms. These factors combine with high staff turnover and consequent loss of organisational memory to produce a department which is unable to deliver coherent joined-up policy.

Doctors attack Blair’s waiting list pledge

G. Jones

The Daily Telegraph, Feb. 20th 2007, p.4

Doctors have attacked a new government plan to cut NHS waiting lists by asking hospitals to carry out operations in the evenings and at weekends. The Prime Minister has promised to cut waiting times for operations to an average of seven to eight weeks, within two years. A number of primary care trusts (PCTs) are now committing themselves to offering almost 24/7 services. Together with one day clinics, Mr Blair expects these pilots to form a ‘framework’ on which to build. The BMA and opposition politicians have ridiculed the plans and believe them to be completely unworkable in the face of nationwide staff shortages and the current crisis in PCT funding.

Doctors in NHS biased against over-65s

C. Hall

The Daily Telegraph, Feb. 14th 2007, p.1

Reports the claims of a BMA study that half of doctors regularly discriminate against people over 65 and deny them some treatments routinely offered to younger patients. Older doctors were found to be more likely to discriminate than younger ones. A number of possible reasons are given for what on the surface seems like ageist attitudes. A Senior BMA official cites ‘locked in behaviour’ based on prejudices that doctors may not even be aware of. It is also possible that doctors may deem a procedure too risky for the elderly. The charity Help the Aged has condemned what appears to be a prevalent attitude as ‘backward’.

Few remember why they hated Tories so much

N. Hawkes

The Times, Feb. 19th 2007, p.7

Nigel Hawkes’ comment piece warns that compliance to Labour Health reforms cannot s be bought from medical practitioners by simply ‘crossing their palms with sacks of silver’. Hawkes’ comment on an online poll of doctors claims that, in practice, the government has treated the medical establishment as an ‘obstacle’ to progress. The Government’s commitment to ‘patient choice’ can be perceived as an attempt to break the medical profession’s hold on the NHS. The new IT system is also highlighted as an alienating as well as a ‘clumsy’ move. Hawkes also criticises a common belief amongst doctors in a past ‘golden age’ that he argues never existed. The author concludes that the recent poll has demonstrated that the ‘[government] has lost the support of the very people it needs to make reforms work’.

(See also: The Times, Feb.10th 2007, pp.6-7)

A freedom framework will unite former foes

M. Britnell

Health Service Journal, vol.117, Feb. 1st 2007, p.18-19

In the light of the current debate about whether the NHS should be freed from political control, the author suggests that it is legitimate for government to demand specified returns on its investment in the health system. Returns demanded from an independent NHS could include:

  • A rise of 1-2% in average life expectancy across the population as a whole
  • A reduction in health inequalities by at least 20% for the most deprived
  • That all health and social care services should receive acceptable, good or excellent ratings through an independent quality assurance system
  • That public and patient satisfaction levels exceed 75 and 80 per cent respectively for general approval of the NHS and clinical services
  • That the health system should produce an annual surplus of 1-3% to be reinvested in public health and patient care.

Germinators look to Europe for the next ideas in the super bug war

A. Moore

Health Service Journal, vol.117, Feb. 8th 2007, p.14-15

In Dutch hospitals, MRSA is kept in check through a “search and destroy” approach that goes beyond the containment methods used in the UK. The programme involves isolating and screening high risk patient groups, screening low-risk groups, strict isolation of carriers, and treatment of people carrying MRSA. Implementation of such an approach would be prohibitively costly for the NHS, as it would involve hospitals running at less than full capacity for some time.

In or out: contractors braced for a domestic over cleaning

A. Moore

Health Service Journal, vol.117, Feb. 1st 2007, p.14-15

The Health Minister Andy Burnham has suggested that hospitals should return to employing cleaners directly instead of contracting the service out in order to improve standards. Contractors claim that poor standards are due to badly specified contracts and to cash strapped hospitals being unwilling to pay for a quality service.

Is NHS reform policy better in practice than in theory?

A. Foster

British Journal of Health Care Management, vol. 13, 2007, p. 55-57

Government is currently relying on four policy instruments to improve the NHS: patient choice, activity-based remuneration (payment by results), competition from private providers and strong local commissioning of services. The introduction of competition is forcing NHS hospitals to reduce their costs and become more customer oriented.

Learning and development

N. Edwards (editor)

Health Service Journal, vol. 117, Feb. 15th 2007, Supplement, 37p.

This supplement covers training for neglected groups such as estates staff, practice managers and clinical coders, the advantages of involving clinicians in financial and management skills training, the role of healthcare improvement advisers in the USA, how to run a successful social enterprise, and the need to embed a culture of service improvement in the NHS.

Patients’ big chance to call the shots

V. Nathanson and J. Crowe

Health Service Journal, vol.117, Feb. 15th 2007, p. 18-19

The Local Government and Public Involvement in Health Bill currently before Parliament seeks to establish local involvement networks (LINks) and to formalise their relationship with local authority overview and scrutiny committees (OSCs). There will be one LINk per social services authority area. They will be able to inform the NHS, social services departments and overview and scrutiny committees on public and user views on health and social care services. The Bill also requires Primary Care Trusts to show how they have responded to the views of those they consult. The article also explores how overview and scrutiny committees currently listen to the public voice.

Patient, carer and public involvement: measuring success

C. Sykes and others

British Journal of Health Care Management, vol. 13, 2007, p. 50-54

Involving patients and carers aims to be empowering and broadens stakeholder participation in decision-making. However, the creation of adequate structures and processes for involvement is still in its infancy. Clarity about the meaning of involvement can guide a patient, carer and public involvement strategy and help monitor progress.

Six of the best

K. Sikora and others

Health Service Journal, vol.117, Feb. 22nd 2007, p. 22-25

Eminent clinicians offer innovative proposals for revolutionising the NHS, including: 1) provision of small, welcoming outpatient “hotels” for all non-surgical cancer care; 2) creation of integrated care pathways; 3) devolution of budgets to clinical directors in hospitals; and 4) introduction of multidisciplinary and dual surgery.

Talking up the NHS

D. Carlisle

Health Service Journal, vol.117, Feb. 8th 2007, p.23-25

Negative perceptions of the NHS by the public at large contrasts with positive feedback from patients. Opinions of the service among the general public are coloured by political persuasion, age, and the attitudes of friends, family and acquaintances who work for it. Other factors leading to dissatisfaction include people feeling that targets are valued more highly than quality of care, and a deep-seated negativity among doctors.

Will is the way to win the patient safety war

D. Berwick

Health Service Journal, vol.117, Feb. 22nd 2007, p.18-19

Inadequate systems, rather than incompetent staff, jeopardise patient safety. In order to reduce medical errors, the NHS needs to move away from its present blame culture, confront the problems, look for alternative ways of working, and implement.

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