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

Adaptive regulation or governmentality: patient safety and the changing regulation of medicine

J. Waring

Sociology of Health and Illness, vol.29, 2007, p. 163-179

Patient safety is now a major international health policy priority. In England and Wales, the National Patient Safety Agency (NPSA) has been created to lead policy development in this area and champion service-wide learning, while the National Reporting and Learning System has been introduced to enable this learning. The patient safety agenda enables managers to challenge clinicians’ traditional rights of self-regulation and to oversee medical performance using the bureaucratic systems of scrutiny embodied in the National Reporting and Learning System. However, a case study of one hospital’s experience of implementing the reforms shows the potential for doctors to resist, subvert, and capture managerial prerogatives in order to maintain professional authority.

Board should run NHS, academics believe

N. Timminsv

Financial Times, Apr. 17th 2007, p.4

Birmingham University’s Health Services Management Centre has proposed a new framework for an NHS independent from government ministers. The report envisages that the role of departmental ministers would be confined to raising money, setting targets and holding NHS commissioners to account. An NHS board, which would be governed by a charter reviewed every three years, would allocate money, set clinical standards and decide on the best organisational structure for delivery. The board would be made up of clinicians, NHS leaders, patients and members of the public. Ministers could sack the chief of the board and have recourse to external monitoring organisations to maintain standards. Gordon Brown has shown interesting the plan. The authors claim that the arrangement should bring an end to endless reorganisations within the NHS.

Building bridges

L. Greenwood

Health Service Journal, vol. 117, Apr. 12th 2007, p. 20-22

Reconfiguration of NHS services proceeds more smoothly if it is well planned and well managed. Good management includes effective communication of the plans to, and consultation with, the public. This article presents case studies of the management of reconfiguration in three primary care trusts.

The Conservative future: the policy prescriptions

A. Lansley

British Journal of Healthcare Management, vol. 13, 2007, p. 111-113

This author outlines the Conservative Party’s health policy, emphasizing its commitment to competition between providers. The Party favours clinician-led commissioning of services, with GPs holding actual budgets and receiving financial rewards based on the quality of the services they purchase for their patients. They want to see the national tariff introduced by the Labour government evolve into a list of maximum prices against which providers can offer discounts. Finally, in order assure service quality, a three-pronged regulatory framework for healthcare providers is proposed.

The costs of choice give more power to the people

V. Cable

British Journal of Healthcare Management, vol. 13, 2007, p. 114-117

This article explores the limits of patient choice in the NHS. Firstly, individuals cannot be allowed to exercise choice at the expense of the common good, that is, if their choices undermine the service as a whole. Secondly, patients need reliable information on which to base their choices, and there are concerns that the educated middle classes may use their social capital to monopolise the best hospitals. The author concludes by considering the possible role of direct payments in enabling patients with complex needs to purchase their own care.

Doc around the clock

N. Plumridge

Public Finance, Mar. 30th-Apr. 5th 2007, p. 18-21

Prime Minister Tony Blair has suggested that using operating theatres for elective surgery round the clock would help the NHS to meet the target of a maximum wait of 18 weeks from GP referral to start of treatment by March 2008. The author argues that there is no need for surgeons to operate around the clock as there is plenty of capacity in the NHS thanks to investment in independent sector treatment centres. Bottlenecks in the patient pathway typically occur elsewhere, particularly in diagnostics.

Don’t let’s forget, we’re in it for the long term

B. Sang

British Journal of Healthcare Management, vol. 13, 2007, p. 122-125

Argues that the core business of the NHS is providing long-term care to patients with chronic illnesses and complex needs. In order to carry out this task the NHS needs to work in partnership with social care and housing services. Failure to recognise these priorities contributes to the deep dysfunctions seen in the current system, including financial problems, the absence of useful data, and resistance to reform from interest groups.

Early learners

A. Moore

Health Service Journal, vol.117, Apr. 5th 2007, p. 22-24

The government's target that no more than 18 weeks should elapse between referral and treatment comes into effect from December 2008. Thirteen 'early achiever' trusts have volunteered to deliver the new target a year ahead of schedule. The pioneer trusts have found meeting the target in the specialities of orthopaedics, audiology and endoscopy particularly challenging. However, the target should be seen as a step towards a “no unnecessary delay” system of working and thinking.

The fall guys

E. Dent

Health Service Journal, vol.117, Apr. 19th 2007, p. 24-26

Almost a third of NHS staff experience violence or abuse from patients and their relatives every year. Incidents may be under-reported because staff do not believe that their employer will take action if they are physically assaulted. It is argued that the NHS should adopt a zero tolerance approach to violence towards staff, ensuring that all incidents are reported to the police.

Health inequalities in Scotland and England: the contrasting journeys of ideas from research into policy

K. E. Smith

Social Science and Medicine, vol. 64, 2007, p. 1438-1449

Both the UK’s Labour government and Scotland's devolved Labour-Liberal Democrat coalition have committed themselves to reducing health inequalities. Furthermore, both have emphasized the importance of using evidence to inform policy decisions. Yet only limited attention has been paid by researchers to exploring how key actors involved in research-policy dialogues understand the processes involved. In an attempt to fill this gap, this article draws on interviews with 58 key actors in the field of health inequalities research and policy making in the UK to argue that it is ideas, rather than research evidence, which have travelled from research into policy-making. The descriptions of the journeys of these ideas fit three types, successful, partial and fractured, each of which is outlined and illustrated with one example.

Health Secretary’s verdict: we have stopped the rot

A. Cowper

British Journal of Healthcare Management, vol. 13, 2007, p. 107-110

Report of an interview with Health Secretary Patricia Hewitt, in which she discusses the financial position of the NHS, commissioning reforms, and variations in clinical practice.

Improving maternity services: small is beautiful – lessons from a birth centre

D. Walsh

Oxford: Radcliffe, 2007

The book offers insight into and understanding of, a special birth environment – a midwife-run birth centre. It demonstrates the difference between a quality environment for birth where a woman can create her own ‘nest’, and a bureaucratically controlled, highly medicalised and risk-oriented birth culture dominated by the clock, which is most women’s experience today. Furthermore, it shows how small scale maternity provision has a profound clinical and organisational advantage over large scale hospital provision, including saving of time and money by reducing intervention rates.

In feelbad Britain we want it all from the NHS, and we want it now

P. Toynbee

The Guardian, Apr. 27th 2007, p.31

Polly Toynbee outlines New Labour’s achievement in the NHS and describes a successful service. However she argues that the NHS makes progress only to have its achievements undermined by clinicians with vested interests in their own positions, a 'consumer mentality' from the public and unrealistically raised public expectations fostered by the Blair government’s mantra of 'choice'. Although Toynbee recognises the current NHS faults and problems in the organisation of primary care, and the role and structure of primary care trusts, she maintains that criticisms are fuelled by media distortion and the interests of health professionals, who despite not representing the interests of patients, add weight to the argument that the NHS is failing its public. The reader is reminded that 'the NHS is nothing like a market. It is a collective agreement to spend a set amount of money as efficiently and as fairly as possible.' The public has to be educated in this regard. Toynbee advises that a new government will have to compromise with professional clinicians despite the high likelihood of professional vested interests overshadowing that of the public. However the likelihood of an NHS run by an independent board should help in the long term.

Name of the game is not 'no blame'

F. Burns

Health Service Journal, vol. 117, Apr. 12th 2007, p. 16-17

The National Patient Safety Agency established in 2000 set up a national reporting system for clinical errors. Trends are analysed and advice on improving patient safety is fed back to NHS trusts. Unfortunately this system has not succeeded in reducing the number of patients harmed or killed by medical errors. This article suggests that the reporting/learning approach to patient safety needs to be backed up with robust disciplinary action on individual failings.

Nursing chief is good and bad cop all in one

O. Evans

Health Service Journal, vol. 117, Apr. 19th 2007, p. 20-21

Report of an interview with Peter Carter, the new chief executive of the Royal College of Nursing, in which he promises that the RCN will support service redesign in the NHS which improves patient care, but will oppose reconfigurations that seek only to achieve cash savings. He also argues that primary care trusts should focus on improving commissioning and should contract out directly provided services to the private and voluntary sectors.

Open or shut case as service shake-ups hinge on SNP result

J. Trueland

Health Service Journal, vol.117, Apr. 26th 2007, p. 14-15

If the Scottish National Party comes to power after the May 3rd elections, it has promised to reverse decisions to close two accident and emergency departments and to introduce a “presumption against” centralising core hospital services. This article explores the tensions that could develop between a Scottish National Party led government at Holyrood and the national government in Westminster, and their implications for the NHS.

Pick-and-mix NHS will serve all customers

A. Coote and J. Crowe

Health Service Journal, vol.117, Apr. 5th 2007, p. 18-19

The authors debate the relationship between patient involvement in the NHS and its external accountability. At the level of groups of service users, for example people with diabetes, patients can be involved in service design and planning and then asked if implementation works for them. This constitutes accountability to people who are using the service. This form of involvement and accountability should be complemented by independent external scrutiny of strategic decisions, for example distribution of resources across a local health economy, such as that provided by local authority oversight and scrutiny committees.

Productive ward

A. Nolan (editor)

Health Service Journal, vol.117, Apr. 19th 2007, supplement, 19p

This supplement focuses on the NHS Institute for Innovation and Improvement’s Releasing Time to Care: Productive Ward Programme. This programme is designed to help ward staff spend more time on direct patient care by reorganising their routines using techniques from industry. The main tasks taking place on a ward are redesigned to ensure that they are patient focused and easier for staff.

Race equality and health service management: the professional interface

P. Franklin

Community Practitioner, vol. 80, Apr. 2007, p. 10-11

Racism is endemic in the NHS and Black and Minority Ethnic people are underrepresented in its senior management. This article describes the work of the Amicus/CPHVA Equalities Committee in educating the workforce about equity and diversity issues.

Skills for a rosy future

P. Streets, J. Hilborne and I. Cumming

Health Service Journal, vol.117, Apr. 26th 2007, p. 20-21

Three experts discuss future developments in medical education. The training that doctors receive in the future will be shaped by changed patient expectations, advances in technology, implementation of clinical governance, reduced working hours due to EU law, and service reconfiguration so that treatment takes place in community settings rather than in hospitals.

Social policy, professional regulation and health support work in the United Kingdom

M. Saks and J. Allsop

Social Policy and Society, vol. 6, 2007, p.165-177

The number of health workers in support roles has been growing rapidly in the UK and is now believed to be over one million. This paper presents data from a study which mapped the range of health support work, and considered how such support work should be regulated.

Why bed-blocking is making an unwelcome comeback

A. Moore

Health Service Journal, vol.117, Apr. 12th 2007, p. 12-13

Incidence of delayed discharges of patients from hospitals were initially reduced in 2004 through the introduction of fines levied on social services departments which failed to arrange timely home or residential care. However numbers of delayed discharges show signs of rising again. Increases are due to waits for NHS resources or to choices and decisions made by patients and their carers, not to delays in social services assessing or placing people.

Why doctors' selection process ended in tears

G. Caldwell

British Journal of Healthcare Management, vol.13, 2007, p. 120-121

In 2007 the government introduced a new internet-based centralised application process for recruiting junior doctors to specialist posts for training as consultants. The new process totally failed in its task of selecting junior doctors for interview. The author explores the reasons for the failure, including the fact that those involved in short listing candidates for interview never saw their whole applications.

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