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

After the storm

D. Carlisle

Health Service Journal, vol. 117, Sept. 13th 2007, p. 22-24

In spite of the uproar over the new centralised and computerised Medical Training Application Service (MTAS), all but a handful of hospital doctors' posts have been filled by good quality applicants. Improvements to the system planned for the next recruitment round include greater involvement of human resources professionals. NHS Employers wants to see online job advertising and national eligibility screening followed by a locally managed process. The oversupply of candidates for training posts in 2007 was due to the large number of overseas doctors applying in competition with home grown clinicians. This issue needs to be addressed and efforts need to be made to repair damaged relationships with the medical profession and medical trainees. Experts warn that MTAS failures should not be allowed to undermine the work of Modernising Medical Careers.

Beyond comprehensive critical care - to quality

S.J. Harper, S. Shepherd and S. Brookfield

British Journal of Healthcare Management, vol. 13, 2007, p. 327-332

Acute hospitals cannot function without intensive care units and staff to run them. Despite an injection of funding into intensive care in 2000 and a subsequent increase in capacity, transfers of critically ill patients for non-clinical reasons still occur, and elective surgery is frequently cancelled for lack of a critical care bed. This article describes the state of critical care in 2006, based on a survey of hospitals in England.

Colleges back clinical case for acute service centres

O. Evans

Health Service Journal, vol.117, Sept. 20th 2007, p. 5

A report compiled by the Academy of Medical Royal Colleges and seen by Health Service Journal supports the centralisation of acute specialist services such as paediatrics and obstetrics, but says that there is no evidence to support centralisation of treatment of non-complex high-volume cases. It adds that most district hospitals should keep an accident and emergency department.

Health hotel

M. White, H. Mooney and A. O'Dowd

Health Service Journal, vol.117, Sept. 27th 2007, p. 24-29

The Health Hotel is becoming one of the major fringe events at the annual party conferences as the home of debates on healthcare services. Mooney and O'Dowd look at hot topics for debate in 2007, focusing on public health improvement and hospital service reconfiguration, while Michael White reflects on fringe events at past conferences.

Intelligence

R. Allmark (editor)

Health Service Journal, vol.117, Sept. 6th 2007, supplement, 12p.

This supplement looks at how patients with chronic illnesses are being empowered to manage their own conditions through telehealth. Pilot schemes offer the prospects of multi-million pound savings from reductions in emergency hospital admissions and bed use. It also investigates how the 18-wwek referral to treatment target will be measured, with pioneer sites looking at how existing systems can generate the necessary data.

Is the medical brain drain beneficial? Evidence from overseas doctors in the UK

M. Kangasniemi, L.A. Winters and S. Commander

Social Science and Medicine, vol. 65, 2007, p. 915-923

The beneficial brain drain hypothesis suggests that skilled migration can be good for a sending country if the possibility of emigration encourages more people to acquire qualifications than actually leave. This hypothesis can only work if the possibility of working abroad significantly affects decisions to undertake medical training and if migrants are not closely screened by the host country, so that weaker applicants can still gain entry. This survey of overseas doctors in the UK in 2002 suggests that neither condition is likely to be fulfilled. The results showed, however, other benefits to sending countries through remittances and return migration.

Is the NHS becoming more patient centred?

N. Richards and A. Coulter

Picker Institute Europe, 2007

Results from five years' of patient surveys show that the rhetoric of patient-centredness is hollow. The number of patients who said that they were closely enough involved in decisions on their care has fluctuated by only 1% from 2002 to 2006. Surveys also show that patients' satisfaction with involvement in their care fell by 4% and that 22% of patients in 2006 could not find a member of staff to discuss concerns with, up 5% from 2002.

Knee-jerk leadership: who is leading NHS reform and where?

B. Sang

British Journal of Healthcare Management, vol. 13, 2007, p. 333-334

The push towards NHS reconfiguration in 2006/07 arose from the emergence of politically embarrassing financial deficits and has resulted in the Brown government promoting a 'clinician-led' approach, with 'clinical champions' being recruited in every strategic health authority to drive reform. Unfortunately clinicians are deeply divided and some opportunistically stir up local popular opposition to reform. This will make the task of managers seeking to implement reforms more challenging.

Making your mind up on the NHS's next step

H. Mooney

Health Service Journal, vol.117, Sept. 27th 2007, p.14-15

The government has launched a huge public consultation exercise on the future of the NHS in England through citizen 'juries' convened in major cities. This article describes the event in Birmingham. Participants were asked to debate questions such as 'What are your main concerns for healthcare in the future?' and 'What actions would you like to see to tackle the spread of infections in hospital?'

The NHS wasted its big chance: will it learn from its mistakes?

N. Edwards

Health Service Journal, vol.117, Sept 20th 2007, p. 14-15

Sir Derek Wanless found in his latest report that the NHS had made lacklustre progress since spending on it increased dramatically in 2002. The report reveals a failure to collect data that would give a real picture of what is happening across the system. Policy-making has also failed to come up to the government's standard of being forward-looking, innovative, evidence-based, inclusive, joined up and evaluated. There have been missed opportunities in respect of workforce planning, pay and contracts and a disappointing lack of progess in engaging the public with health improvement.

One year on, the message from Nicholson is that he's listening

R. Evans

Health Service Journal, vol.117, Sept. 13th 2007, p. 14-15

Report of an interview with NHS chief executive David Nicholson one year after his appointment, in which he seeks to offer reassurance that there will be no new restructuring of the NHS and no major change in the direction of reform under the Brown government. The current Darzi review of the NHS will come up with a national framework for progress, but its recommendations will be implemented regionally in the light of local needs. Nicholson also pledged to seek to reduce the bureaucratic and reporting burdens faced by managers and to give frontline staff more control over what happens locally.

Patient perspectives on information and choice in cancer screening: a qualitative study in the UK

R.G. Jepson and others

Social Science and Medicine, vol.65, 2007, p.890-899

The principle of informed choice has recently been incorporated into cancer screening policy in the UK. Current strategy tends to focus on provision of information about the benefits and limitations of screening as a basis for patient choice. This qualitative study aimed to explore the information needs of people invited for screening, and to gain insight into the relationship between the information they wanted and the choices they made. Findings suggest that lay people conceptualise informed choice differently from policymakers, and that information about the disease itself is as important to them as information about the risks and limitations of screening. However, information may have little part to play in the choices people make, but may impact more on outcomes such as satisfaction and anxiety.

A Quality chart book: patient and public experience in the NHS

S. Leatherman and K. Sutherland

Health Foundation, 2007

This report highlights four areas in which improvements are needed to create a truly patient-centred NHS:

• Better engagement of patients in decision-making and self-care
• Prevention of hospital-acquired infections
• Need for more predictable access to timely and technologically advanced clinical interventions
• Reduction in variation of healthcare outcomes such as life expectancy and infant mortality

Re-thinking the relationship between long-term condition self-management, education and the utilisation of health services

C. Gately, A. Rogers and C. Sanders

Social Science and Medicine, vol.65, 2007, p. 934-945

Encouraging serf-management has been viewed as one means of reducing health service use and controlling costs. However a randomised controlled trial of a patient education programme for people with chronic conditions found no statistically significant reductions in health service use. Findings of an embedded qualitative study which ran alongside the controlled trial suggest that the capacity of any formulaic training package to have an impact on health service use depends to a large degree on the social context and pre-existing relationships people have with services and health professionals.

Safety first as government gets tough on causes of super bugs

R. Evans

Health Service Journal, vol. 117, Sept 27th 2007, p. 5

The prime minister and health secretary pledged at the 2007 Labour Party Conference to take stronger action against hospital-acquired infections. The prime minister promised a deep clean of all hospitals and said that numbers of modern matrons with powers to order additional cleaning would be increased to 5,000. He is also understood to be looking at how failing long-term cleaning contracts could be terminated. The health secretary promised that the new regulator, Ofcare, would be given tough powers to intervene where hospitals were failing to meet hygiene standards.

Scotland under the searchlight as executive begins its reforms

J. Trueland

Health Service Journal, vol.117, Sept. 6th 2007, p. 12-13

In its first 100 days in power, the Scottish Nationalist Party has introduced some popular NHS reforms, including:

• Reversing decisions to close accident and emergency units at Monklands and Ayr hospitals
• Promise of independent scrutiny of all service change proposals
• Pledge of increases in payments for nursing and personal care from April 2008
• Promise that plans to phase out prescription charges will be laid before the Scottish Parliament in Autumn 2007
• Promise of proposals for a Local Healthcare Bill including direct elections to health boards
• Opposition to funding the private section to help it compete with the NHS
• Full Implementation of the NHS pay award

In this article, experts comment on whether the programme represents a significant policy shift or political opportunism

'Tough decisions are needed fast'

D. Carlisle

Health Service Journal, vol.117, Sept. 27th 2007, p. 9

Intense interest among overseas-trained doctors in applying for NHS training posts is leaving home grown physicians unemployed and unable to advance their careers. The government must either restrict applications to UK trained doctors and face accusations of unfairness or face another year with too many doctors applying for too few posts.

Visible hand or invisible fist?: the new market and choice in the English NHS

C. Paton

Health Economics, Policy and Law, vol. 2, 2007, p. 317-325

The author argues that four incompatible streams have emerged from recent health policymaking in England: 1) the continuation of the purchaser-provider split introduced by the Thatcher government; 2) the promotion of so-called local collaboration (in which collaborators are in practice at each others' throats); 3) neo-'command and control' based on various targets promulgated down vertical silos from the Department of Health; and 4) the introduction of patient choice underpinned by 'Payment by Results'. The article goes on to examine choice in the English NHS with reference to Hirschman's 1970 book on the impact of 'exit' and 'voice'in different organisational and political settings.

(For comment see Health Economics, Policy and Law, vol. 2, 2007, p. 327-339)

Wanless warns of spending 'hell'

O. Evans

Health Service Journal, vol. 117, Sept. 13th 2007, p. 6-7

Report of an interview with Sir Derek Wanless at the point of publication of his report on how well the NHS has spent the extra £43.2bn invested since 2002. He warns that structural change, worse than expected benefits from the national IT programme, poor value for money from new staff contracts, uncertain and slow policy implementation, and inadequate measures to improve public health have hampered progress. However, he believes that the right policy levers are now in place to deliver improvements, although some managers lack the skills to use them effectively.

Young people living with cancer: implications for policy and practice

A. Grinyer

Maidenhead: Open University, 2007

The book uses original data gathered from in-depth research to present an account of what it is like to be an adolescent or young adult living with cancer. These first hand accounts contribute to the insight necessary to the provision of age appropriate quality care. The implications of these research findings for policy and practice are also related to NICE Guidance (2005). Though primarily based on a thematic analysis of interview data, the book also provides contextual and statistical information on the current incidence of cancer in young adults.