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

Acute chiefs: NHS vision lost in political mire

H. Mooney

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

A group of acute trust chief executives were asked to share their experiences of a decade of New Labour stewardship of the NHS. They believe that they are not given enough support in implementation of change; that they are made scapegoats by the government when things go wrong; and many are highly critical of the perceived incompetence of colleagues in primary care trusts.

Are foundation trusts a good thing? Issues for community stakeholders

F. Lusk

Journal of Integrated Care, vol. 15, Feb. 2007, p. 14-19

Foundation trusts differ from other NHS trusts in that they are obliged to involve all their stakeholders in shaping services, are free from direct central government control, and have significant financial freedoms. This article surveys the development of foundation trusts, covering community engagement, financial stability, quality of care and value for money.

Born unequal: why we need a progressive pre-birth agenda

L. Bamfield

Fabian Society, 2007

Poorer parents in the UK are 1.5 times more likely to have a low birth weight baby than parents in professional or managerial jobs. In order to give these children a better start in life the government needs to:

  • Improve ante-natal outreach services to women most at risk of having a low birth weight baby, probably through cutbacks in services to the general population rather than an increase in spending on maternity care
  • Ensure that every sick, premature or underweight baby has access to appropriate neonatal care
  • Make a reduction in the numbers of low birth weight babies a national priority
  • Provide added financial support through increased benefits to vulnerable pregnant women, such as teenagers who receive less income support than those aged 25 and above.

Clinical engagement: so why should you bother?

K. Harmond

British Journal of Health Care Management, vol. 13, Mar. 2007, p. 77-80

This article reviews the process and results of involving clinical leaders in management in an acute trust. Results show that clinical leaders can make a significant contribution to the corporate health of a hospital. Facilitated development for clinicians can result in immediate and continuing improvements. Collaboration between executive and clinical directors helps improve communication and knowledge. By developing a collegiate approach, clinicians can make a positive contribution to management.

Cooking up a storm

K. McIntosh

Health Service Journal, vol.117, Mar. 8th 2007, p. 22-24

As one of the world's largest organisations, the NHS should make sustainable development a top priority. However, with a target driven culture and ongoing financial pressure, it tends to struggle for a place on the agenda of senior NHS managers. The Department of Health has signalled its intention to push trusts to deliver on sustainable development, and it may form part of future Healthcare Commission assessments.

Improvement for 18-weeks

A. Nolan (editor)

Health Service Journal, vol.117, Mar. 8th 2007, Supplement, 9p

Delivering a maximum wait of 18 weeks from referral to treatment by March 2008 is a difficult but not impossible challenge for the NHS. Achieving the target will involve total service redesign, including more provision of tests and treatments by GPs and in community settings. The key to success is accurate measurement of waiting times to identify bottlenecks along the patient pathway and the ability to rapidly redeploy funds to clear them. The whole patient pathway, not just parts of it, needs to be analysed and managed to reduce delays. The supplement ends with a case study of success in South Devon.

Improving services for children in hospital

Healthcare Commission

London: 2007

Despite the publication of the National Service Framework for Children and Young People in 2003, the review found that trusts have made poor progress in meeting the broader needs of children. There has been progress in meeting environmental standards, such as separate areas for children and appropriate security and play facilities, but this needs to be reflected more widely across different hospital services. The review also highlighted serious concerns about the quality of care at a small number of trusts.

Intelligence supplement

N. Edwards (editor)

Health Service Journal, vol. 117, Mar. 15th 2007, 8p

This issue of the quarterly supplement on information technology in the NHS focuses on the question of demonstrating that investment is delivering value for money. The Comprehensive Spending Review and restructuring of the national IT programme will tighten the focus on being able to demonstrate benefits at a local level. The supplement also looks at the future of the national IT programme, how trusts can manage the information challenges of cross-border treatment, and why the NHS finds it difficult to work smarter as well as work harder.

Keeping high standards in UK medical training

D. Stewart

British Journal of Health Care Management, vol. 13, Mar. 2007, p. 82-86

The NHS is treating more patients than ever before. However due to shift systems, limitations on working hours, and the reduced duration of training, the number of patients per trainee followed through completely has fallen, and practical exposure has become more fragmented. If the system cannot give trainees sufficient time to experience the management of the majority of diseases they will encounter as consultants, with sufficient exposure to treating rare conditions to allow for the development of expertise in this area, the quality of the end product will diminish. In order to maintain standards in medical education, an increase in the efficiency of training is necessary, which could be helped by the introduction of simulation technology.

The meaning of patient involvement and participation in health care consultations: a taxonomy

A.G.H. Thompson

Social Science and Medicine, vol. 64, 2007, p. 1297-1310

In the UK, neo-liberal governments since 1979 have made citizen dependency on the State and the paternalism of health care practitioners a target for reforms to encourage a more active consumerist ethos within welfare services. This article reviews the current models of patient involvement in health care delivery as derived from studies of professional views of current and potential practice, prior to examining empirical evidence from a large-scale qualitative study of the views of citizens as patients, members of voluntary groups, or neither. Among the extensive range of views expressed, five distinct levels of patient involvement in consultations are identified. These levels range from basic demands for more information to the ability to share or control decisions about health care. Many patients support greater involvement in service delivery, but they want professionals to realise that this needs to be optional and varies according to context and over time. Maintenance of trust appears to be crucial, with its erosion likely to lead to greater demand for involvement. Participation, when it is the ideal form of relationship, requires professionals to engage in two-way communication and effectively share the power they have with their patients on the basis of mutual respect and openness.

New Labour's state of health: political economy, public policy and the NHS

C. Paton

Aldershot: Ashgate, 2006

The book provides an assessment of the political economy and the politics of current health policy in order to explain the underlying causes of problems in the NHS. It uses debates from political theory, political economy and public administration to examine health policy made and implemented by New Labour since 1997. The book argues both that the fundamental nature of health policy in dependent upon the prevailing regime political economy and also that 'policy overload', contradictions and confusion have rendered the task of coherent implementation very difficult.

Opportunity knocks

A. Mullins, S. Black and P. Osborne

Health Service Journal, vol.117, Mar. 29th 2007, p. 26-28

Independent treatment centres (ISTCs) introduce competition and choice into the NHS and these can stimulate service innovation and improvement. In order to encourage new players to enter the market, ISTCs have been given some financial incentives. However, schemes will eventually have to operate at tariff if they are to survive beyond the initial five-year contracts. ISTCs' independence also means that they are better placed than NHS bodies to use international best practice.

Surgical spirit soars in defence of the clinician

N. Edwards

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

Report of an interview with Berne Ribeiro, President of the Royal College of Surgeons, in which he argues that clinicians have been excluded from policy-making in the ten years since New Labour came to power. He is particularly critical of the new Independent Sector Treatment Centres introduced by the government, and of cutbacks in training for junior doctors. He calls for budgets to be devolved to a new generation of clinical leaders with powers to hire, fire and incentivise staff.

The sustainability and spread of organizational change: modernizing healthcare

D. A. Buchanan, L. Fitzgerald and D. Ketley (editors)

Abingdon: Routledge, 2007

The NHS Plan (Department of Health, 2000) established an ambitious organization development programme, providing an opportunity to rethink, redesign and thereby to improve patient care. The size and challenge of the change agenda were unparalleled anywhere in the private or public sector. This book focuses on two issues emerging from the programme: sustainability and spread of change. Considering the potential threats to modernization with regard to sustainability and spread, the objectives of this book concern:

  • The sustainability or improvement evaporation problem: it explores the processes through which new working practices are maintained and developed in some settings, while they regress and decay in others.
  • The spread or best practice puzzle: it explores the processes through which new working practices in healthcare are either contained where they were first implemented, or are adapted, and subsequently transferred to other units.
  • Implications: it identifies the theoretical, practical, and national policy implications of this experience of major organizational transformation in healthcare.

Time to tear ourselves away from paper

R. McIndoe

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

The author argues that the NHS's management of historic medical records is a national scandal. Trusts are wasting huge amounts of public money on storage of patients' historic paper records when the technology exists to digitise them. Digitisation would make the records available at the point of care delivery. The whole NHS should be using electronic document records management to solve the problems of burgeoning paper patient records archives.

Two tribes

V. Shaw

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

Relationships between clinicians and senior managers are often characterised by mutual misunderstanding and suspicion. This article offers five key tactics for breaking the cycle of mistrust based on an in-depth study of these relationships by the Centre for Innovation in Health Management at Leeds University:

  • Creation of a shared identity and collective responsibility for outcomes
  • Encouragement of open communication
  • Ensuring that clinicians and managers both develop collaborative leadership styles
  • Making decisions at all levels with greater clinical input
  • Investment in organisational leadership and development.
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