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

Bear the burden of getting care just right

G. Lewis and P. Shelton

Health Service Journal, vol.117, June 14th 2007, p. 16-17

One of the key challenges facing the NHS is ensuring that patients receive no less than the care they need and no more than the care they want. Where differences are seen between the amount of healthcare resources one patient receives compared with another, the variation is either warranted (explained by differences in clinical need) or it is not. Promoting warranted variation leads to truly personalised care. Reducing unwarranted variation could be the key to more equitable care and re-establishing financial control over a system where demand, costs and competition are all set to rise.

The challenges of leadership

NHS Confederation

London: the Confederation, 2007

NHS managers interviewed for this book identified a number of areas for improvement, including technical skills, such as using data, strategic planning and commissioning and use of evidence to inform decision-making. However they also face complex challenges arising from the structure of the NHS and the impact of government initiatives. In particular they have to struggle with problems related to hierarchy, which distorts communication and leads to time lags in decision-making and to the creation of a culture of dependency.

Clinical governance: a guide to implementation for healthcare professionals. 2nd ed.

R. McSherry and P. Pearce

Oxford: Blackwell, 2007

Clinical governance enables healthcare professionals to reduce clinical risks, enhance clinical quality via the application of evidence-based practice and deliver good quality care. The book provides a comprehensive overview of what is meant by clinical governance and how it can be implemented in practice. It provides step-by-step practical advice, facilitating better understanding of the key principles of clinical governance. This second edition has been updated to reflect recent legal changes and developments in patient involvement and continuing professional development. Each chapter includes reflective questions, activities and case studies taken from clinical practice.

Decentralisation? No evidence it works

S. Peckham

British Journal of Healthcare Management, vol. 13, 2007, p. 203-209

The English NHS continues to develop new structures in response to the government's policy of decentralising the health services. It is assumed that local, decentralised organisations will be more effective at meeting health care needs and more efficient than a centralised bureaucracy. However this literature review highlights the uncomfortable facts that there is little theoretical support for these assumptions and even less empirical evidence to support them. There is clearly a lack of good quality relevant evidence to support the link between decentralisation and organisational performance.

Do NHS clinicians and members of the public share the same views about reducing inequalities in health?

A. Tsuchiya and P. Dolan

Social Science and Medicine, vol.64, 2007, p.2499-2503

Inequalities in life expectancy across the five socioeconomic classes, defined in terms of occupational groups, have been a main public health policy concern in the UK since the publication of the Black report in 1980. In this context it is important to compare the views of members of the public with those of NHS staff on how healthcare resources should be allocated. This paper is based on a postal survey that directly compared how members of the public and NHS clinicians trade-off the maximisation of life expectancy against reducing inequalities in health across the socioeconomic groups. The results indicate that the two samples have different preferences, with the general public showing a greater willingness than NHS clinicians to sacrifice total health (measured in terms of life expectancy) for a more equal distribution of health across the highest and lowest social classes.

DoH to bar patient networks from access to key services

V. Vaughan

Health Service Journal, vol.117, June 14th 2007, p.5

Local Involvement Networks (LINks), which are to replace public and patient involvement forums in 2008, will be unable to visit and inspect mental health facilities, children's care homes and residential homes for older and disabled people. There is concern that the Department of Health is deliberately designing a system that will exclude the public from effective monitoring of the NHS.

Healthy differences

N. Plumridge

Public Finance, June 1st-7th 2007, p. 18-21

Since devolution in 1998 there has been a steady divergence in health policies and priorities in the UK. England has maintained the purchaser-provider split and since 2002 has become increasingly preoccupied with market-oriented models of provision. Both Scotland and Wales have emphasised integration and co-operation more than competition. In Northern Ireland health and social care policy has, since 2002, been determined by direct rule administrations rather than by a devolved assembly and has reflected English preoccupations and preferences. However, in spite of policy differences, there is much that binds the NHS together across the UK, including common staff contracts and a commitment to delivering care free at the point of use.

Involving people in healthcare policy and practice

S. Green

Oxford: Radcliffe, 2007

The book explores the link between the 'corridors of power' where healthcare policy is made and the hospital, health centre or clinic where it is carried out. It describes recent UK health policy relating to public and user involvement and presents a case study of how this has been applied in one particular NHS Trust. One of the chapters identifies and describes some of the service user policy obligations for healthcare organisations such as: Patients' Advice and Liaison Services, Patient and Public involvement Forums, the Independent Complaints and Advisory Service, Overview and Scrutiny Committees, patient surveys and patient prospectuses. The last part of the book contains accounts of experiences of service users who have worked within the NHS and have first-hand experience from both sides of the fence.

Johnson promises to limit private sector in the NHS

R. Smith

The Daily Telegraph, July 25th 2007, p.14

The Health Secretary stated at his first appearance before the Commons Health Select Committee that the government will not expand the role of the private sector in NHS healthcare delivery. There are currently 21 independent sector treatment centres (ISTCs) in the country that are contracted to carry out general surgery and a handful of contracts are still to be completed. However this article notes that Gordon Brown's government is making a clear break with the previous Blair reforms by limiting competition between the NHS and the private sector. The BMA welcomed the announcement and has always argued that ISTCs were in fact being paid in advance for procedures that were not actually carried out. The Conservatives called the new plans 'confusing' and the shadow Health Secretary claimed that greater competition in healthcare provision was not the problem rather that the current contracts are not value-for-money.

Leak reveals plan for Ofcare regime of fines and closures

O. Evans

Health Service Journal, vol.117, June 7th 2007, p. 5

The new Office of Health and Adult Social Care (Ofcare), which will replace the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission in 2009, could impose a regime of fines and closures on underperforming trusts, according to draft plans seen by HSJ. All trusts will be required to register with Ofcare, and could be closed down by losing their registration. Trusts will be assessed through a regime of ongoing monitoring and special investigations triggered by serious concerns.

NHS autonomy and accountability

Conservative Party


Outlines plans for a more autonomous NHS, free from political interference and with more power devolved to GPS. Under these proposals, GPs would receive real as opposed to indicative budgets and would be responsible for most primary care commissioning. The NHS would be run by an independent board that would oversee the commissioning and allocation of services as well as the delivery of objectives to improve outcomes for patients, as agreed with the Health Secretary. Standards would also be driven up by patient choice and public voice through HealthWatch, a new national body for patient and public involvement.

Power to the people? The true costs of choice

V. Cable

British Journal of Healthcare Management, vol. 13, 2007, p. 200-202

This article reviews, from a Liberal Democrat point of view, what greater patient choice may mean for the NHS. It argues that the NHS should focus on improving customer care, flexibility and the personalisation of services. A degree of competition between providers can be a useful stimulus for improvement, especially if allied to redistributive measures such as voucher schemes.

Public involvement: an inconvenient truth

B. Sang

British Journal of Healthcare Management, vol. 13, 2007, p. 216-217

This article emphasises the importance of effective consultation with local people about plans for service reconfiguration. Unfortunately patient and public involvement is not taken seriously as 'core business' by NHS managers at board and executive levels. The function therefore remains fragmented and poorly implemented across the NHS.

Skills for Health

A. Nolan (editor)

Health Service Journal, vol.117, June 21st 2007, Supplement, 9p

Skills for Health is the employer-led sector skills council for the healthcare industry and was set up in 2002. This supplement surveys its role in the development of the health workforce, focusing on:

  • The implementation of the national health Sector Skills Agreement at regonal level
  • Development and use of a competence search tool, that will enable managers and clinicians to create team and role profiles
  • Development of 14-19 diplomas which should enable the creation of a workforce with the skills required for a career in healthcare when they are introduced in 2008. These diplomas will provide an alternative to GCSEs and A-Levels and will include sector-specific content developed by employers through sector skills councils.

Social accountability and audit in UK hospitals: an investigation of stakeholder perspectives

J. Zhang

Journal of Finance and Management in Public Services, vol.6, 2007, p. 57-78

Social audit consists of a systematic assessment of the performance of a given organisation in meeting its declared social, community or environmental objectives through a dialogue with stakeholders. Engaging stakeholders in direct dialogue and listening to their voice are the most salient features of social audit. This paper investigates the perceptions among hospital stakeholders of their involvement in social audit with a view to understanding how the latter could be used to improve the quality of patient care. The research attempts to:

  • assess how stakeholders view the importance of their involvement in a variety of decisions about activities such as 'monitoring patient waiting times', 'implementing the patients' charter' or 'evaluating hospital performance'
  • investigate stakeholders' views on methods of involvement in social audit applicable to NHS hospitals, including focus groups, questionnaire surveys, and interviews
  • explore their views on methods of disclosing social accountability information, including hospital league tables and NHS audit reports.

Take the medicine

P. Corrigan

Public Finance, June 8th-14th 2007, p. 26-27

The author argues that, if the NHS is to succeed in the 21st century, it will need to:

  • Embrace technological change
  • Encourage self-management of chronic illness by patients in the community
  • Encourage competition among providers to control costs
  • Spread best practice through National Frameworks for the treatment of major diseases

Tide turns on health secretary's 'undermining' local influence

O. Evans

Health Service Journal, vol.117, June 7th 2007, p. 14-15

The independent reconfiguration panel considers disputes over redesign of local hospital services referred to it and gives objective advice which is supposed to be heeded by the local NHS. However, the Secretary of State for Health has a power of veto over whether matters referred by council overview and scrutiny committees should go to the reconfiguration panel for advice, and later, over whether the advice should be accepted. This has undermined public trust and confidence in the procedure. The Institute for Public Policy Research has recently proposed that local councils should have the right to refer matters directly to the panel, and that advice should go to the local NHS for final decision.

Wanted: doctors to help redesign services

P. Dash and P. Garside

Health Service Journal, vol.117, June 7th 2007, p. 20-21

It is generally agreed that more doctors should take on leadership and management roles within the NHS, but progress has been slow. This article identifies three barriers to greater management involvement by clinicians:

  1. lack of training in management skills
  2. poor financial rewards
  3. inflexible design of managerial roles, which leads clinicians to fear that they will lose their medical skills.

Winning over NHS staff could be Brown's first big challenge

R. Vize

Health Service Journal, vol.117, June 21st 2007, p. 14-15

A survey of 1,964 NHS staff has shown that, in spite of a decade of record government investment, morale is low, belief in a better future is thin on the ground, and trust in politicians is so depleted that two-thirds of respondents think that control of the NHS should be handed over to an independent board. Staff were particularly afraid that Gordon Brown would introduce more reorganisation, more privatisation and more targets.

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