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

Bringing user experience to healthcare improvement: the concepts, methods and practices of experience-based design

P. Bate and G. Robert

Oxford: Radcliffe, 2007

Experience Based Design (EBD) is a new way to bring about improvements in healthcare services by being user-focused. Facilities, healthcare professionals, carers, family and friends are all involved in the patient experience and systems and policies need to adapt to take this into consideration. By exploring the underlying concepts, methods and practices of EBD, the book offers a unique approach to healthcare customer satisfaction. Additionally, it offers recommendations for the future and many interesting points for discussion. It illustrates a new approach to redesigning health systems so that they truly meet the needs of patients and staff, the very people who are experiencing them.

Communication skills are key as Johnson takes over health

O. Evans

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

The newly appointed Secretary of State for Health has the support of the unions and is regarded as a good negotiator who will listen to people. However he is a modernising Blairite and not a stalwart of the old left. Critics say he is a puppet devoid of radical ideas.

Dignity in Care for older people in hospital: measuring what matters

R. Elaswarapu

Working with Older People, vol.11, June 2007, p. 15-19

An analysis of complaints and findings of a report on older people's services made it clear to the Healthcare Commission that dignity and respect for older patients in hospital is an area of service in urgent need of improvement. The Commission has been developing a methodology to check the extent to which NHS hospital trusts are meeting the standards relating to dignity in care in an inpatient setting.

Eyes on storks

D. Carlisle

Health Service Journal, vol.117, July 5th 2007, p. 24-26

The government has pledged that by 2009 all women will be able to choose where and how they have their baby and what pain relief they use, depending on their circumstances. This is a national choice guarantee. In addition, every woman will be supported by a midwife she knows and trusts throughout her pregnancy and afterwards to provide continuity of care. Critics of this new policy fear it will be 'pie in the sky' due to lack of resources. Services are crumbling due to poor pay, frozen budgets and frozen posts. One proposed solution, the introduction of maternity support workers, has raised safety fears.

Forging ahead with lessons from the future

A. Liddell, L. McMahon and S. Harvey

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

Windmill 2007 is a behavioural simulation of stakeholders' reactions to radical changes that might be introduced in a hypothetical but realistic health system in England in 2008-09 and 2011-12. Windmill participants provided insights into how this system would react to some of the major challenges of healthcare reform, including competition and contestability, localising of services, commissioning, reductions in funding, changes to the tariff system, patient choice and voice, and the regulatory regime.

A Framework for action

A. Darzi

NHS London, 2007

The eminent surgeon Sir Ara Darzi presents proposals for the reform of healthcare services in London. His blueprint for 'cradle to grave healthcare' proposes the creation of polyclinics offering a wide range of primary care services to replace GP surgeries. The polyclinics would also have a 24 hour urgent care centre to act as the gateway to accident and emergency care. Health services would also be delivered in patients' homes; in local hospitals providing non-complex care; in elective care centres for straightforward surgical procedures; in major acute hospitals providing complex care; in specialist hospitals (more would be needed); and via academic health and science centres.

Governing UK medical performance: a struggle for policy dominance

B. Salter

Health Policy, vol. 82, 2007, p. 263-275

In the UK, policy on the governance of medical performance is characterised by a continuing struggle between state and profession for control. Since 1998 both sides have continued to produce policies in response to highly visible political pressures, but have yet to agree on how those policies should be implemented at the level of the individual practitioner. For the state, clinical governance forms the lynchpin of its drive to increase managerial control over doctors while, for the profession, revalidation is seen as the means for ensuring the quality of medical performance while preserving medicine's historic autonomy. Both policies aim at addressing the central issue of the protection of the patient and the decline of public trust in doctors. As yet, neither the state nor the profession has achieved a lasting dominance of this arena of policy making.

Government health warning

G. Jones and J. Stewart

Public Finance, July 6th-12th 2007, p. 24-25

The Conservatives are promoting the idea of establishing an independent board to run the NHS free from government interference. The authors argue that this is unworkable because politicians would be unable to resist the temptation to meddle when subjected to public pressure. Decisions about health care are essentially political because they involve conflicts of needs and values. Instead it is proposed that local authorities should be given control of health services in their area and made responsible for funding them through local taxation.

Health advice for Gordon Brown

J. Dixon and others

British Journal of Healthcare Management, vol. 13, 2007, p. 239-246

A range of key figures in healthcare gave their views on the top priorities for health under a new administration. A consensus emerged that three main areas are vital priorities for Gordon Brown:

  1. communicating with and engaging clinical staff in NHS reforms
  2. no more structural change
  3. improving commissioning - the design and funding of NHS services based on assessments of need.

Hewitt should not be a patsy for the health service's mistakes

N. Dickson

Health Service Journal, vol. 117, July 12th 2007, p. 14-15

The author presents an overview of Patricia Hewitt's record as Health Secretary. Failures include: her ill-judged intervention over the anti-cancer drug Herceptin; her destruction of NHS staff morale; and failure to stem the rising tide of hospital acquired infections. To balance these failures, positive achievements include: beginning to regain control of NHS finances; banning smoking in public places; and proposals to move more patient care out of hospitals and into the community.

Improving the use of temporary nursing staff in NHS acute and foundation trusts

Committee of Public Accounts

London: TSO, 2007 (House of Commons papers, session 2006/07; HC 142)

Temporary nurses are employed across the NHS to meet fluctuations in activity levels and to cover vacancies and short-term staff absences. NHS acute and foundation trusts obtain temporary nurses from their own nursing bank, from private nursing agencies or from NHS Professionals (an NHS run temporary staffing service). Properly managed, temporary nurses play an important role in helping hospitals achieve flexibility. Excessive use can be costly, particularly when trusts are heavily reliant on agency nurses. This report examines the cost and extent of use of temporary nurses in the NHS; whether the NHS has taken a planned approach to controlling and managing the supply and demand of temporary nurses; and the safety and quality issues associated with the use of temporary nurses. The Committee took evidence from the Department of Health and NHS Employers.

Is this really the end of under-capacity?

C. Druilhe and E. Louie

Health Service Journal, vol.117, July 12th 2007, p. 18-19

Company Sg2 forecasts that by 2017 demand for NHS inpatient services in England will have declined by nearly 1 percent and average length of stay will have fallen from seven to 6.5 days. This means that, if inpatient provision remains at current levels, there will be over-capacity in the acute health sector. It bases its forecast on:

  • A growing emphasis on disease prevention and better management of chronic conditions in the community
  • New forms of treatment and care offered by new medical technologies

Johnson promises to limit private sector in the NHS

R. Smith

The Daily Telegraph, 25th July 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 British Medical Association 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 but that the current contracts did not offer value-for-money.

Just what the doctor ordered?

S. Ward

Public Finance, July 13th-19th 2007, p. 20-22

The new Health Secretary Alan Johnson is facing serious problems, including staff discontent over pay, job cuts and use of the private sector to treat NHS patients, public alarm over hospital acquired infections, and severe financial deficits at some trusts. In response, Johnson has announced a review of the NHS led by Sir Ara Darzi and begun a charm offensive to win over the unions.

Monitor to government: do not let foundations trusts slip

H. Mooney

Health Service Journal, vol.117, July 19th 2007, p. 5

Report of an interview with Bill Moyes, chair of the foundation trust regulator Monitor, in which he warns the new ministerial team appointed by Gordon Brown against re-imposing central control on foundation trusts. He also raises concerns that the regulator Ofcare could be given powers to deregister foundation trusts, and calls for strategic health authorities to encourage competition among providers.

The National Programme for IT in the NHS

Committee of Public Accounts

London: TSO, 2007 (House of Commons papers, session 2006/07; HC 390)

The NHS needs modern Information Technology (IT) to help it to provide high quality services to patients. The National Programme for IT in the NHS ('the Programme') was set up to provide such services, using centrally managed procurement to provide impetus to the uptake of IT and to secure economies of scale. It constitutes the largest single IT investment in the UK to date, with expenditure on the Programme expected to be 12.4 billion over ten years to 201314. The central vision of the Programme is the NHS Care Records Service, which is designed to replace local NHS computer systems with more modern integrated systems and make key elements of a patient's clinical record available electronically throughout England (e.g. NHS number, date of birth, name and address, allergies, adverse drug reactions and major treatments) so that it can be shared by all those needing to use it in the patient's care. The Programme also includes other services, such as electronic prescriptions, an email and directory service for all NHS staff, computer accessible X-rays and a facility for patients to book electronically first outpatient appointments. The report draws four overall conclusions:

  1. The piloting and deployment of the shared electronic patient clinical record is already running two years behind schedule. In the meantime the Department of Health (DoH) has been deploying patient administration systems to help Trusts urgently requiring new systems, but these systems are not a substitute for the vision of a shared electronic patient clinical record and no firm plans have been published for deploying software to achieve this vision.
  2. The suppliers to the Programme are clearly struggling to deliver, and one of the largest, Accenture, has now withdrawn. The DoH is unlikely to complete the Programme anywhere near its original schedule.
  3. The DoH has much still to do to win hearts and minds in the NHS, especially among clinicians. It needs to show that it can deliver on its promises, supply solutions that are fit for purpose, learn from its mistakes, respond constructively to feedback from users in the NHS, and win the respect of a highly skilled and independently minded workforce.
  4. Four years after the start of the Programme, there is still much uncertainty about the costs of the Programme for the local NHS and the value of the benefits it should achieve.

The rise and fall of the Patient Forum

P. Warwick

British Journal of Healthcare Management, vol. 13, 2007, p. 250-254

Six new bodies, including Patient Forums, were set up to replace Community Health Councils in 2003. The government now plans to introduce a new system of patient and public involvement in health in England in 2007. Patient and Public Involvement Forums will be abolished, wasting the experience of current members. Local government Overview and Scrutiny Committees will be at the centre of the new arrangements, supported by local involvement networks (LINks). It remains doubtful that changing the structure of patient and public involvement will lead to a significant improvement in the degree to which members of the public can influence health policy.

Safe crackers

D. Morgan and others

Health Service Journal, vol.117, July 26th 2007, p. 22-29

Key NHS leaders debate how patient safety can be improved. Recommendations arising from the discussion include:

  1. making patient safety a core NHS value and an organisational priority
  2. engaging clinicians by avoiding blame while introducing systems of corporate responsibility
  3. design and use of technology as a tool to guide staff through the safety process
  4. getting evidence of where problems lie and creating a sense of urgency about solving them
  5. engaging patients and the public in healthcare safety issues.

What lies ahead for partnership working? Collaborative contexts and policy interventions

B. Hudson

Journal of Integrated Care, vol.11, June 2007, p. 29-36

While partnership working seems to be high on both the English and Scottish policy agendas for health and social care, policy in England appears to be more characterised by competing discourses and imperatives than is the case in Scotland. In particular, the English emphasis on patient choice, contestability and competition does not lie easily with the equal emphasis on partnership working. A number of policy tensions around the NHS and social care can be identified.

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