Department of Health steering group on the statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems practised in the UK was established in summer 2006 by Jane Kennedy, then Minister of State at the Department of Health, and was invited to prepare the ground for the regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems practised in the UK.

In particular, the Steering Group was asked to identify issues and propose options in relation to education and training, registration, fitness to practise and other essential aspects of regulation.  This is their report.

Third Sector Investment Programme: Strategic Partners 2009-10 - information pack for third sector organisations provides third sector organisations with information about the Department of Health Third Sector Investment Programme’s Strategic Partner Programme.

Organisations should read the information carefully as there are changes to the funding streams available from 2009-10 following the Strategic Review of Department of Health funding of third sector organisations.

The document will provide third sector organisations with information to help them decide if the Strategic Partner Programme is applicable to their organisation. It details the outcomes and activities that the Department of Health is seeking to invest in through more strategic relationships with third sector organisations for 2009-10 and the criteria we will use for assessing applications.

Third Sector Investment Programme: Innovation Excellence and Service Development Fund 2009-10 - information pack for third sector organisations provides third sector organisations with information to help them decide if this funding stream is applicable to both their organisation and the proposed activity they are seeking funding for. It details the funding themes for 2009-10, the priority areas for each theme and the criteria we will use for assessing applications. A timetable is provided for the whole process from application through to decision.

• Impact assessment of the third strategic funding and investment review

Consultation document on proposals to introduce powers of suspension, and a single approach to the removal of chairs and non-executives of Strategic Health Authorities and other health bodies.

The consultation on removing or suspending chairs and non-executives of Health Bodies sets out a single approach to considering whether and if so how, a chair or non-executive member of a Strategic Health Authority (SHA), Special Health Authority (SpHA) or Health Body should be removed from office. The process may involve either seeking resignation or the termination of appointment and also introduces the potential use of a suspension function, as well as proposals for temporary non-executive member(s) or director(s) to be appointed during the period of suspension.

These proposals represent the second phase of a programme to introduce a legal framework for the Secretary of State to direct the Appointments Commission (AC) to suspend chairs and non-executive members or directors from office.

The first phase involved introducing powers of suspension to chairs and non-executives of Primary Care Trusts (PCTs) and NHS Trusts. Following a separate consultation and amendments to regulations, the Secretary of State directed the AC to operate a new suspension function for chairs and non-executives of NHS Trusts and PCTs from 16 June 2008.
Now in phase two, this consultation sets out proposals to extend powers of suspension to chairs and non-executive members of SHAs, SpHAs and other Health Bodies.

Modernising allied health professions (AHP) careers is a workforce initiative to maximise the contribution AHPs can make to transforming health and social care.

There was a need to develop a flexible and responsive approach to allied health professions careers that reflects the diversity of the professions and the location and sectors they work in whilst, at the same time, maximising their potential to contribute to transforming patient care and promoting health and well-being.

The MAHPC project has three areas of delivery in order to facilitate the development of a flexible and responsive AHP workforce. These are to:

• develop national workforce competences and ensure they are relevant to the work of AHPs and their staff irrespective of grade or location or sector
• map AHP roles on to the career framework
• encourage the use of the learning design principles in any development of awards and qualifications for the work of AHPs and their staff.

The web-based tools (available on the Skills for Health website) are not mandatory. However, they will be of value to:

• commissioners in redesigning services around the patient (focusing on what, rather than who)
• clinicians in planning more flexible career pathways to ensure their employability and also in supporting them in planning their CPD
• service managers in ensuring they have the right competences within their teams to deliver the care required.

This project commenced in 2005 and has been project managed by Skills for Health. MAHPC has been sponsored by the Chief Health Professions Officer for England (CHPO) on behalf of the four CHPOs in the devolved administrations.

Changing times Sustaining long-term performance against ‘Call Connect’ for NHS ambulance services aims to provide ambulance services with performance improvement tools and best practice examples. Its key purpose is to provide trusts with working solutions that aid sustainable performance improvement against the clock start measurement of ‘Call Connect’, and helps to enhance the delivery of service to patients through improved quality of care.

End of Life Strategy - promotes high quality care for all adults at the end of life . It is the first for the UK and covers adults in England. Its aim is to provide people approaching the end of life with more choice about where they would like to live and die. It encompasses all adults with advanced, progressive illness and care given in all settings.

• Impact assessment of the end of life care strategy

HELICON accredition today, we get visited by Linda F., Shan and the man who will forever be to the library WIGBOL Dave. Come out as a Level 3 service. Congratulations to Faders everywhere!

Journal of Management and Marketing in Healthcare 1(4)

Effective people management in an ever-changing NHS environment

Editorial
Contract management and monitoring in healthcare

The principles for commissioning in the national and independent healthcare systems are largely similar and much of BUPA’s 60 years’ experience in contracting and provider management of UK healthcare is applicable to the NHS as well. This paper discusses some of BUPA’s current practices in demand and supply analysis, contracting and provider management. The paper provides examples of BUPA’s ongoing work in quality monitoring and improvement, and describes how these are relevant for the NHS. Investment in commissioning competencies, tools and systems has paid off for BUPA, and there are great opportunities for continuously improving customer value in terms of cost, quality and service in both the public and private sectors.

Evolving patient safety strategies: A comprehensive solutions-based approach

The movement toward demonstrable quality and value in medical care is on a fast track because payers, weary of mediocre service, are tying payment to the reliability of excellent outcomes. The challenge for healthcare leaders is increasing as complexity and poor management causes variation in care with extraordinary medical error rates. Highly reliable work environments have specific characteristics. Leaders must embrace values of non-negotiable respect and appropriate accountability. Teamwork training is essential as is ongoing measurement of cultural indices. A linked strategy, structure and execution is necessary. This paper describes the steps to achieve a learning and reliable healthcare culture.

Exploring technological innovation in health systems: Is Canada measuring up?

The societal and economic benefits of technological innovations are indisputable. However, the race for knowledge and talent to develop and commercialise health innovations has never been so fierce. Countries traditionally seen as leaders in health innovation — countries such as the UK — are being challenged by newer players. This study examines how technological innovation is encouraged, and discouraged, in Canada and other selected Organisation for Economic Cooperation and Development (OECD) countries, including the UK, France and the USA. The research uses The Conference Board of Canada’s Innovation Framework as an analytical tool in benchmarking the performance of Canada and other OECD countries in several areas of health innovation, including the innovation environment, and the creation, diffusion, transformation and use of knowledge. The results of this study are discouraging for Canada as it scores poorly in many important areas of technological health innovation. Substantial efforts are needed, and needed now, to revitalise health innovation systems and to refuel the capacity to commercialise health innovations. Action in four key areas is recommended.

Implementation of a hospital-based wellness programme: Do cash incentives promote healthier behaviour?

In 2004, the Florida Hospital Zephyrhills developed an employee-based, volunteer programme known as the Lifestyle Incentives For Employees (LIFE) Plan to encourage weight management, exercise and cessation of tobacco use. The purpose of this study is to: (a) compare the health expenditure costs of 41 employees with continuous enrolment in the LIFE Plan and 32 employees who never enrolled in the LIFE Plan; and (b) describe the Wellsource Personal Wellness Profile data of the 620 LIFE Plan members since the inception of the programme, with emphasis on chronic medical conditions affecting number of sick days and hospital days. The data show a downward trend in the annual healthcare expenditures for LIFE Plan members. For the most commonly reported medical conditions from the profile data, individuals with hypertension, arthritis, back pain and joint pain have more sick days and more hospital days than individuals without these medical conditions. The LIFE Plan shows the possibility of reducing high health insurance costs using an employee-based health programme. By incorporating clear worksite health education messages to encourage behaviour changes that remedy chronic conditions, the longitudinal results are expected to contribute to greater cost reductions in the future.

Non-urgent use of the emergency department: A quantitative evaluation from a patient perspective

The objectives of this study are twofold: to investigate the reasons why patients considered as non-urgent by physicians visit the emergency department, and to explore the relationship between patients’ perceived urgency and the factors in the behavioural model of utilisation. This cross-sectional study develops a survey instrument to assess the predisposing, enabling and need factors affecting patients’ perceived urgency. In order to identify the independent variables associated with the perceptions of urgency, a multiple logistic regression model is used. According to the results, two-thirds of patients perceive their problem as urgent. Level of pain and duration of complaint are found to be significant factors affecting patients’ perceptions. For patients perceiving their problem as non-urgent, the most common reasons for visiting an emergency department include infections, dressings and the like. The findings support the general conclusion that the definition of urgency differs for patients and health professionals. The reasons why patients with non-urgent problems use emergency departments in Turkey include problems attached to primary healthcare facilities, crowded outpatient clinics, difficulty getting outpatient appointments and accessibility problems due to working hours.

Payment by Results as a lever for NHS reforms

Payment by Results (PbR), the English prospective payment system of paying healthcare providers, was introduced to respond to concerns that the previous system of financing was not providing sufficient incentives to NHS service providers to deliver efficiency and productivity. Initially targeted at acute, elective activity, the policy’s ambition included improved access to care, efficiency gains, transparent and fair financing, and facilitating the key reform of choice and plurality. PbR has, by and large, contributed to the implementation and gains derived from these reforms. Much of the emphasis has been on the technical mechanisms of PbR. Little attention has been given to the consequential behavioural responses, and potential perverse incentives that it can create. On balance, it can be seen to have been a helpful tool. This paper will give a clear sense of the strength and limitations of the policy. It will make clear the pragmatic amendments to policy that have been needed to move from a purist Prospective Payments Model to one that seeks to maintain the major policy drivers, but is workable within the NHS. It concludes that even with these changes, PbR can become a powerful lever for reforms in the delivery of healthcare.

Proactive recruitment in local government

New ways of partnership working, new organisational structures, and new role and skill demands are among the challenges facing organisations engaged in commissioning and/or delivering services to local communities. Within this context, local councils have the additional challenges of an ageing workforce, and recruitment and retention difficulties in key service areas and leadership roles. As the pool of appropriately qualified and experienced people shrinks, a competitive market for key professionals has emerged, creating retention problems throughout the UK. Radical changes beyond the scope of individual councils have been required to tackle these shortages and workforce and succession planning have become increasingly important as a result. Supported by national activities, collaboration rather than competition is now occurring to increase supply locally and regionally. Individual employers are also reviewing their existing workforce and creating new pathways to progression in line with new ways of working. Examples of national activities and case studies from social care, environmental health and planning are offered as illustrations of these proactive steps.

The assessment of doctors’ performance: Tools and techniques

There has been increasing organisational and research interest regarding the assessment of the performance of medical practitioners. Much of this progress has already been implemented in both the UK and internationally. This change is being driven both by statutory requirements and by the desire of the profession to improve practice and promote excellence. The process of developing an assessment system is well described. There are several steps including defining the content to be assessed, setting standards, defining the purpose of the assessment, identifying the tools to be used, implementation and making decisions with the results. Many methods of performance assessment have been suggested; some have been extensively evaluated and their psychometric properties are well known. For others, much less data are available. Some of the key steps in designing assessment systems will be described along with a more detailed discussion of selected assessment methods. The effective implementation of performance assessment continues to be a challenge for all those involved in the provision of quality healthcare.

The productive efficiency of blood banks: Using data envelopment and simple ratio analyses to measure the performance of health services

Simple ratio analysis (SRA) and data envelopment analysis (DEA) are widely used in benchmarking to identify organisations with best practice. This study tests the consistency of the two methods by investigating whether they could substitute for each other in performance measurement. To evaluate the relative precision of the two techniques, the paper studies comparative data from 31 second class blood banks in Greece for the year 2003. Optimality is investigated based on four performance outcomes: donor recruitment, blood sufficiency, wasted blood units and transfusion reactions. Comparison of SRA and DEA is employed in pair-wise efficiency scores. Results yield high statistical significance under assumptions of both constant returns to scale and variable returns to scale. The results confirm that the two measuring techniques are closely related and consistent.

On the State of Public Health: Annual Report of the Chief Medical Officer 2007 draws attention to major health challenges requiring immediate action and details progress made in key areas identified in previous annual reports.

It calls for a new focus on teenage health, and urges health services to take better account of the specific health needs of young people. It highlights the nature of risks inherent in surgery and that more attention should be given to reducing errors in surgery. Additionally, it indicates the rising levels of oesophageal cancer, the importance of vaccination in improving public health and the issue of racism in medicine.

King’s Fund briefing on Healthcare-associated infections that provides some background on the infections that give most concern, their causes, prevalence and impact. It also summarises the policies and strategies being deployed in England to reduce infections, and offers some analysis of their likely effectiveness.

In the beginning: Determinants of Health a brifing from the King’s Fund considers the early years of the NHS and the challenges it faced, from long waiting lists to shortages of staff. It also looks forward to what the next 60 years might hold for the NHS.

Visions for care in strategic health authorities is a briefing from the King’s Fund that provides a thematic summary of some of the key features of the nine SHA plans in response to the Darzi Review, for the North West, North East, Yorkshire and the Humber, West Midlands, East Midlands, East of England, South East Coast, South Central and South West.

Themes emerging are identified as:

• Waiting times
• Patient Choice
• Commissioning
• Shifting care from hospitals to community settings
• Primary care and community services
• Long term conditions, care co-ordinators and direct payments
• Centralising care
• Care pathways
• Public health

The next leg of the journey: How do we make High Quality Care for All a reality? is the NHS Institute’s review of the outputs of the Next Stage Review.  It focus’ on the the ‘how’ of executing and delivering the anticipated changes, not on the ‘what’ of the specific proposals. It describes recent evidence and experience in healthcare regarding execution of large scale change, and provides critical recommendations of things to consider as we move on from the current milestone.

Health informatics review report builds on the Next Stage Review by considering the support role that informatics offers for the delivery of better, safer care of patients, improving the NHS through better research, and planning and management.  For patients it should empower them to make more informed choices about health and care.

The value of new public transport in deprived areas: Who benefits, how and why? evaluates the contribution of public transport to regeneration. It considers the benefits – both monetary and quality of life – of transport services to the people who use them and to the local practitioners responsible for the wider regeneration of these neighbourhoods.

It covers:

• the policy context;
• Characteristics of the four case study areas (Braunstone, Leicester; Camborne, Pool, and Redruth, Cornwall; Wythenshawe, Manchester and Walsall, West Midlands);
• key findings from interviews with local professionals;
• information on use of the services and their value to local people;
• an evaluation of the social benefits of the services;
• key messages for local and central government.

Innovative mechanisms for tackling antibacterial resistance, from the Royal Society criticises policies that only focus on infection control measures and restrictions on antibiotic use.   It warns that the fight against some superbugs and other bacteria is in danger of returning to a pre-antibiotic era’ due to increasing resistance to medicines.  The report highlights the need for a sustained commitment to research and development to deliver new diagnostic tools for early identification of infections and new treatments.

Key improvements suggested in the report include:

• A more realistic market valuation needs to be put on antibacterials to reflect the fact that they are life-saving drugs
• The need to create regulatory conditions that will encourage venture capitalists and biotech companies as well as pharmaceutical companies to invest in antibacterials
• The need to develop more efficient diagnostic tools to enhance the rapid identification of bacteria causing an infection as well as identifying what treatments might be most effective
• The need to continue to develop traditional antibiotics, alongside the investigation of different approaches to develop antibacterial agents that act on bacteria in novel ways.
• The establishment of centres of excellence for antibacterial therapeutics.  The success of such centres can be seen in the cancer sector where diverse expertise has been brought together to develop very specific targeted therapies involving partners such as patient groups and medical research charities.

As part of HealthExecTV’s Long Term Conditions programme series, David Colin-Thomé discusses ways to improve services for people with chronic conditions.

He explores opportunities presented by the recently published NHS Next Stage Review and advises on how Trusts should begin implementing the recommendations to achieve maximum benefit for patients.

To view, click: http://www.healthexec.tv/cgi-bin/details.pl?action=pre&id=471

A minimum income standard for Britain: what people think from the Joseph Rowntree Foundation who in this study devise a minimum income standard for Britain based on what members of the public have said, and  that shows the cost of covering basic goods and services for different household types.

The project blends the best elements of the two main methods that have been used to develop budget standards in Britain in recent years. It reconciles the views of experts with those of ordinary people, allowing budgets based on social consensus to be tested against expert knowledge and research. As such, the MIS represents a new and important tool for informing social policy in order to promote fairness and well-being in Britain.

Towards better births: A review of maternity services in England from the Healthcare Commission identifies that

• Women are positive about services with 89 percent rating care during birth and labour as good or better
• Improvements still needed on pathway from antenatal to postnatal care

The report identifies key overall improvements that are still needed, saying that in some trusts:

• levels of staffing were well below average, indicating that they may not have been adequate
• consultant obstetricians did not spend the time on labour wards recommended by their professional body
• doctors and midwives did not attend in-service training courses
• there was not adequate continuity of care
• recommendations for antenatal care were not adequately adhered to, particularly in the case of women whose pregnancies were likely to be more risky
• there was poor communication, care and support after women had their babies
• there were too few beds and bathrooms, particularly in labour wards
• information was not always being compiled to assess services.

Local Involvement Networks (LINks) have been introduced to help strengthen the system that enables communities to influence local health and care services. Stronger voice, better care: Local Involvement Networks (LINks) explained explains more about LINks and how people can make their voice heard by getting involved (it supersedes previous versions of the ‘LINks explained’).

LINks aim to:

• provide everyone in the community – from individuals to voluntary groups - with the chance to say what they think about local health and social care services
• give people the chance to influence how services are planned and run
• feedback to services what people have said about services so that things can be improved.

Delivering care closer to home: meeting the challenge is a resource for commissioners and others interested in shifting care closer to home. It aims to share local emerging practice, how national enablers can support shifting care, and highlights new products developed to support local commissioners and providers.

Conlusions of a three-year research project to evaluate the effects of the policy change in social work education and the move from a 2 year Diploma to a 3 year honours degree as the professional qualification in social work. focussing on the impact of the new three-year social work degree on the quality and quantity of recruits to the professional social care workforce.

• Evaluation of the new social work degree qualification in England Volume 1: Findings
• Download Evaluation of the new social work degree qualification in England Volume 2: Technical appendix

The Health Select Committee published House of Commons Health Committee: Modernising Medical Careers: Third Report of Session 2007–08: Volume I Report, together with formal minutes on 8th May 2008. The Government response to the Health Select Committee report ‘modernising medical careers’ details response to the to the conclusions and recommendations of that report.

You can see our orignal post on the health committee’s report which followed publication of the Tooke Report Aspiring to Excellence: Final report of the Independent Inquiry into Modernising Medical Careers which we posted about earlier in the year with the final report, the draft report and the government response.

Impact Assessment of a national screening programme for abdominal aortic aneurysms considers the impact both financial and clinical of developing this national screening programme.

Research and development work relating to assistive technology 2007-08. Presented pursuant to section 22 of the Chronically Sick and Disabled Persons Act 1970 covers research and development work carried out by or on behalf of any government department in relation to equipment that might increase the range and independence of older and disabled people.

The report places such research in the context of theNational Service Framework for Long-term conditions and the White Paper on Health and Social Care. The report describes the wide range of government-funded projects supporting the development, introduction and evaluation of assistive technology. Relevant projects funded by the EU are also listed.

Making the difference: The Pacesetters beginner’s guide to service improvement for equality and diversity in the NHS considers service improvement approaches for those working within the Pacesetters programme. Service improvement is concerned with testing ideas, sustaining and sharing best practice to make a tangible difference in outcomes and experience for staff and service users. It is primarily intended for NHS organisations who are part of the Pacesetters programme; however, will also be useful for other organisations.

The North West Fluoridation Evaluation Group (hosted by ALW PCT) has drafted a Paper to the North West PCT Chief Executives Meeting – June 2008 on behalf of all 24 PCTs in the north west.  PCTs in the north west in the coming months will be considering whether to ask the North West Strategic Health Authority to explore the possibility of fluoridation, and the report provides information to help PCTs make this decision.  The decision PCTs need to make is not a decision to put fluoride in the water, nor is it a decision to request a consultation.  It is a decision to ask the SHA to explore the possibility of fluoridation.

The report identifies 4 possible fluoridation schemes, but these are only included as examples so demonstrate how any future Scheme needs to reflect water flows, water treatment works, dental health, and PCT boundaries.  Details of the possible Schemes are available from individual PCTs, but they are examples only - the responsibility to construct a technically feasible scheme is matter for the North West Strategic Health Authority..

The North West Strategic Health Authority will receive the views of PCTs by the Autumn and will consider whether to explore the possibility of fluoridation.

Additional documents:

• Appendix 1 - Terms of Reference
• Appendix 2 - OPM Final Report
• Appendix 3 - Opinion Poll Report
• Appendix 4 - United Utilities Costs
• Appendix 5
  • DMFT Overview Scheme 1
  • DMFT Overview Scheme 2
  • DMFT Overview Scheme 3
  • DMFT Overview Scheme 4a
  • DMFT Overview Scheme 4b
  • Prevalence Overview Scheme 1
  • Prevalence Overview Scheme 2
  • Prevalence Overview Scheme 3
  • Prevalence Overview Scheme 4a
  • Prevalence Overview Scheme 4b

Forever cool: the influence of smoking imagery on young people considers the effect of smoking imagery on young people. It begins by examining trends in smoking prevalence and initiation, goes on to review the different forms of pro-smoking imagery and the evidence for how they can affect behaviours and attitudes among young people. It concludes by exploring effective ways of reducing young people’s exposure to positive images of smoking – and increasing their exposure to positive images of health.

Best Before: How the UK should respond to food policy challenges considers the growing number of increasingly thorny and sometimes urgent food-related challenges facing UK policymakers against a backdrop of rising food prices, concerns about environmental impacts of agricultural production and worrying levels of obesity.

Ensuring a safe, affordable, sustainable and healthy supply of food is one of the most fundamental challenges facing policymakers in the UK and, indeed, around the world.

Private Spending on Healthcare examines the role of private spending in health. The think tank IPPR conclude the private sector plays a valuable role in the UK health system. However, attempts to meet the challenge of sharply rising healthcare budgets by shifting costs from the public to the private purse – for instance by greater use of co-payments and top-ups or a move to more private insurance - are unlikely to make the health service more efficient. Public funding for the NHS is likely to have to continue increasing to reflect public preferences for improved levels of healthcare.

Governments who have tried to shift costs from the public to private purse rarely save, and sometimes increase, costs. For example:

• France’s system of high charges for services like seeing a doctor or outpatient treatment has not controlled rising costs. France has recently had to increase tax funding and abolish charges for poor and long-term sick patients.
• The Dutch and German experiments, excluding richer people from public healthcare or allowing them to opt out, resulted in increased costs and worsened equity.
• In the UK local areas with higher levels of private insurance tend not to have lower NHS costs.
  Countries with higher levels of private health insurance tend to have more expensive health systems and also cost more to public sector.
• ippr say that the NHS 60th anniversary provides an opportunity to win a renewed cross-party commitment to guarantee the future of Britain’s healthcare from public funding.

The report states that the Government should:

• Ensure that the recently-announced review of ‘top-up’ payments allows patients to purchase specific treatments under specific circumstances and prevents a ‘two-tier’ health service.
• Fulfil its commitment to review NHS charges to ensure that they prevent over-use of drugs but do not put off poorer patients from accessing the care they need.
• Monitor and evaluate innovations in privately funded healthcare - including waiting times, choice and new treatments – to ensure the NHS keeps up with the best practices of the private sector; and
• Develop new partnerships between the NHS and local employers to improve health for working people, especially in small businesses, including better guidance and pilots of jointly-funded health improvement programmes like free gyms and physiotherapy.

In addition it recommends:

• New moves to ensure that the rapidly growing private cosmetic healthcare market is sufficiently regulated to provide adequate consumer protection;
• Implementing reforms to the private dentistry market to ensure effective competition, and improve access to NHS dentistry where dentists have opted out of publicly-funded provision;
• Maintaining rules restricting NHS GPs’ private practice;
• Improving monitoring and implementation of the NHS Consultants’ Contract to ensure consultants fulfil their NHS commitments before seeing private patients;
• Reducing constraints on the number of medical and other staff available to work in the NHS to reduce the impact of private healthcare on the availability and price of NHS staff; and
• Encouraging patients with minor ailments and chronic conditions to use community pharmacies when appropriate.