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

1997 and all that: Blair remembered

M. Britnell and others

Health Service Journal, vol.117, May 10th 2007, p. 16-17

The NHS has changed radically since Tony Blair became prime minister in 1997. Blair’s reforms have always been controversial, and marked by a determined pursuit of market solutions. A number of key players in health reform assess his record.

Betraying the NHS: health abandoned

M. Mandelstam

London: J. Kingsley, 2007

The book analyses fundamental changes being made to the National Health Service in England during 2005 and 2006. During this time the government introduced a number of new policies which included: giving patients more choice, keeping services more local, transferring NHS provision to the private sector, and introducing a new system called payment by results. The book sets out this range of policies and then considers empirically, step by step, the direct effect they had on local communities. Focusing in particular on West Suffolk, the book shows that instead of health service improvements and expansion, it was severe cutbacks that came to the fore. The new policies resulted in ward closures, bed and job losses and community hospital closures. Overall, these government policies were having harmful effects as change was being achieved mainly at the expense of vulnerable groups, including older people with more complex needs, younger adults with disabilities and people with mental problems. In addition, local services more generally from accident and emergency to maternity had suffered. The book concludes that the government has abandoned the principles of the NHS and ignored the needs of communities while pursuing financial targets regardless of the consequences.

A different kind of revolution

D. Carlisle

Health Service Journal, vol.117, May 3rd 2007, p. 22-24

This article outlines the planned reform of the health service in Northern Ireland. The Department of Health, Social Services and Public Safety would be slimmed down, have responsibility for developing strategic policy and set long-term targets, and performance manage a new Health and Social Services Authority (HSSA). The HSSA would replace the four local health and social services boards, and would take responsibility for commissioning and performance managing health and social services. The final tier would be seven local commissioning groups with responsibility for local commissioning of services, working with GPs and other health professionals as well as the voluntary sector. However, the new structure will have to be approved by the resurrected Northern Ireland Assembly.

Don't forget, we’re in it for the long term. [Part 2]

B. Sang

British Journal of Healthcare Management, vol. 13, 2007, p. 160-161

Argues that the main customers of the NHS in the longer term are people with chronic illnesses and disabilities. They will increasingly demand non-institutionalised service solutions, including end-of-life care. Three fresh developments will be crucial in meeting their needs:

  • Holistic commissioning of integrated service systems
  • Refocusing NHS Connecting for Health on the data requirements of people with chronic illnesses and the multi-disciplinary teams that work with them
  • A shift in the healthcare narrative away from consumerism and tariffs towards citizenship, stewardship and co-production.

Imperial leads merger on hunt for joined-up research

V. Vaughan

Health Service Journal, vol. 117, May 10th 2007, p. 12-13

Article describes ambitious plans for the creation of the UK’s first academic health science centre. The process will begin with the merger of Hammersmith Hospitals trust and St Mary’s trust. Imperial College London will then “integrate” with the new organisation. The resulting centre will bring together the best teaching, research and clinical excellence to create and test knowledge before disseminating it through the medical profession.

In pursuit of happiness

M. Gould

Health Service Journal, vol.117, May 10th 2007, p. 22-24

Quality and performance indicators that have not been captured in the past, such as patient satisfaction and the health service’s impact on commerce are being measured by the Office of National Statistics. A new Centre for the Management of Government Activity will attempt to measure how much the NHS increases public well-being. A number of theorists suggest that happiness is as key to good health as more clinical interventions.

Intelligence Supplement

R. Allmark (editor)

Health Service Journal, vol.117, May 24th 2007, supplement, 9p

This supplement on IT developments in the NHS looks at: 1) the new flagship website that aims to enable the NHS to embrace interactivity, personalisation and user-generated content; 2) successful trials of mobile access services to patient records for GPs; 3) the new wave of e-learning programmes for NHS staff; and 4) creation of summary patients records for “out-of-town” emergencies

Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization

A. Dixon and others

Journal of Health Services Research and Policy, vol. 12, 2007, p. 104-109

This paper reviews recent evidence from studies of NHS utilisation as a whole based on household surveys (macro studies) and from studies of the utilisation of particular services in particular areas (micro studies). The principal conclusion from the majority of these studies is that, while the distribution of use of general practitioners is broadly equitable, that for specialist treatment favours the better off. Recent micro studies of cardiac surgery, elective surgery, cancer care, preventive care and chronic care support the findings of an earlier review that use of services was higher relative to need among higher socio-economic groups.

Just the end of the beginning for Monitor

N. Goodwin

Health Service Journal, vol.117, May 3rd 2007, p. 18-19

There are now 62 foundation trusts, and the movement is coming of age. This article reports an interview with Bill Moyes, executive chair of the foundation trust regulator Monitor, in which he outlines his vision for its future role.

Monitor takes tougher line to prepare for wave of FT plans

V. Vaughan

Health Service Journal, vol. 117, May 31st 2007, p. 5

Applying for foundation trust status is to become harder as regulator Monitor responds to an expected rise in acquisitions and mergers and deters “overly ambitious applications”.

Patient and public involvement: what next for the NHS?

C.N.L. Hogg

Health Expectations, vol. 10, 2007, p. 129-138

This article reviews the various arrangements for patient and public involvement that have been used in the English NHS since the 1970s. It considers the remit and experiences of Community Health Councils, Patient Forums and the Commission for Patient and Public Involvement in Health, and discusses the prospects for the proposed Local Involvement Networks (LINks). It is argued that while the LINks present an opportunity to integrate patient and public involvement into wider initiatives for local democracy, they face many challenges, and resources may be wasted if lessons from previous initiatives are not learned.

Private slow down expected as service prepares for Brown


Health Service Journal, vol.117, May 24th 2007, p. 5

Health experts predict that less emphasis on the use of the private sector and a slow-down in market-based reforms could be the hallmark of Gordon Brown’s premiership for the NHS. Enthusiasm for the introduction of an independent NHS board also seems to be waning.

Sea of change

S. Strong

Health Service Journal, vol. 117, May 31st 2007, p. 20-21

The Health and Social Care Act 2001 gave local authorities power to scrutinise local health provision through overview and scrutiny committees. A lack of guidance means there is some confusion over the committees’ role. Experts recommend early involvement in decisions so that they are better informed, and to reduce animosity.

'A spoonful of regulation helps the medicine go down': the changing face of medicine regulation

A. Edgley

Social Theory and Health, vol. 5, 2007, p. 145-160

This paper explores the significance of current UK government policy of reclassifying increasing numbers of medicines from prescription only (POM) to over-the-counter availability. It focuses on the recent reclassification of statins from prescription only to over-the-counter availability, exploring the impetus and interests involved in such a development. It is argued that the direction of travel of these changes supports the government’s promotion of self-care and aim of reducing dependency on GPs. (For comment see Social Theory and Health, vol. 5, 2007, p. 161-185)

Things can only get better? The argument for NHS independence

H. Dickinson and others

University of Birmingham, Health Services Management Centre, 2007

The report argues that, in order to deliver, world-class, safe and cost-effective services, the NHS requires a high degree of independence from central government, along the lines of the Bank of England and the BBC. Politicians should determine levels of funding for the NHS and priorities for the use of resources. All other responsibilities should rest with NHS organisations at a local level and an NHS board operating independently of the government. The board would operate under a charter negotiated with central government that would set out the high level objectives it would be expected to achieve with the resources available. The authors suggest that the charter should cover five main areas: improving the health of the population; ensuring that patients are satisfied with services; ensuring that staff are satisfied; improving clinical quality and safety; and using resources efficiently. Within each area, a range of targets could be set, and the NHS would be required to perform to a specific level and improve results year-on-year.

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