|Health Insight May 1999|
Health in the news
The big news, for those who work in the NHS, has been the launch this month of a series of major reforms, which the government began planning even before it came to power. The new system of primary care groups has begun and GPs' surgeries have reportedly been overwhelmed with crates of new paperwork representing substantial changes in the way in which they operate. Also up and running is the new National Institute for Clinical Excellence. NICE got off to a quiet start; the Health Service Journal reported that on its first day it had no staff except its chairman and a part-time finance director, and there was no one to answer the phone. Nevertheless, NICE is a major move forward in the key area of clinical guidance.
The popular media has remained strangely silent on the revolution in the way in which the nation's healthcare will be delivered. The press did cover each of the various reforms when they were first announced but their launch this month has been eclipsed by other matters considered more newsworthy. The best source of information on what has been taking place is undoubtedly the Health Service Journal. Its website is www.hsj.co.uk
But further change is already on the way. New initiatives announced during a very busy month for healthcare included: free eye tests for the elderly, expansion of the 'NHS Direct' help line, a pilot series of walk-in clinics, new performance indicators for health authorities, and the addition of a further condition (diabetes) to the list of those that will have a 'national service framework' to ensure consistent levels of care.
NHS reforms get under way
The UK's primary care groups came into being on 1st April. The new approach to providing primary care replaces the reforms of the previous government eight years ago – when fund holding and the concept of the internal market were introduced. A survey by the Health Service Journal found that one in four of the new PCGs in England had no chief executive. Health authorities have been unable to find suitable people to fill these key posts as the NHS takes what the HSJ describes as 'a step into the unknown'. Some health authorities have advertised twice and have increased the salaries on offer. The NHS PCG Alliance has said it is 'concerned' that the amount allocated for management of the new groups varies arbitrarily from £2 to £5 per head.
Thursday 1 April also saw the merger of many NHS Trusts; 56 trusts have disappeared and 28 have been created. In Scotland 46 trusts were reduced to 28, and Wales 26 to 16. A new special health authority has also been established – the NHS Information Authority – responsible for the delivery of key national programmes of work from the NHS information strategy, including the development of national clinical information standards and electronic patient records. Nevertheless, April also saw the publication of a report criticising the record of the NHS to date on managing its information strategy – see 'National Audit Office takes NHS to task on IT' in this issue of Health Insight.
The National Institute for Clinical Excellence (discussed in previous issues of Health Insight) was launched on 1st April by Health Secretary Frank Dobson, who said NICE would be, 'dedicated to ensuring that every NHS patient gets fair access to quality treatment'. It would also tell ministers which new and existing treatments were both clinically and cost-effective. During the month it was announced that the Chief Executive of NICE would be Andrew Dilllon who moves from the chief executive post at St George's Healthcare Trust in London. The Chairman of the institute is Sir Michael Rawlins, former Chair of the Committee on Safety of Medicines.
'NHS Direct' helpline will cover all England
Nine pilot projects, in which the public has been able to phone nurses for advice using an NHS telephone helpline, have worked sufficiently well for the government to decide to extend the scheme to the whole of England by the end of next year. 'NHS Direct' – a 24-hour, 365-days-a-year service – was found by independent research by the University of Sheffield to have achieved a high level of user satisfaction.
Tony Blair announced the expansion of NHS Direct personally, saying that the scope of the scheme was also be extended to include, for example, health promotion activities. NHS Direct nurses would also become more proactive and make calls to people who might be in need of help or advice. Mr Blair said the scheme was one of the most successful of the approaches the government had adopted to modernise the NHS. The BMA is sceptical about NHS and has pointed out that the volume of calls has been lower than anticipated and that there is, as yet, no information on the impact of NHS Direct on the nature and volume of demand for healthcare. The BMA fears that expenditure on NHS Direct might divert resources away from other aspects of primary care.
Sources: Press release (DoH), BMJ 24th April
The Prime Minister also personally announced a further new initiative for primary health care – the development of walk-in centres where patients will be able to get immediate treatment for minor health problems or injuries. The first 20 centres will open later this year. Mr Blair said, 'Our proposed new centres will offer people the opportunity to see a doctor or a nurse face to face. They will open from 7 am to 10 pm weekdays and weekends, to provide information and treatment for minor conditions with or without appointments. But we need to make sure that these new services genuinely build on what is taking place already, not duplicate or replace them. What we introduce should go with the grain of the NHS'.
Source: Press release (DoH)
How will the NHS cope as the new millennium dawns? The question is starting to receive considerable attention in the media. Experience shows that many people with minor health problems descend on casualty departments during holiday periods instead of waiting for their GP's surgery to re-open. This alone will mean that hospitals are stretched at the turn of the millennium. It is also likely that New Year's Eve revelries, which always produce a fair crop of casualties, will take place on a particularly wide and energetic scale.
It has now emerged that many couples have been seeking to conceive during April in order to have a 'millennium baby', despite warnings from the Royal College of Obstetricians & Gynaecologists that the risk of complications is always higher when babies are born in holiday periods and may well be higher still for this particular period. The Royal College of Midwives has predicted that births on the days leading up to and immediately after 1st January will be 20 per cent more than normal, although the scale of this predicted 'baby boom' will not become clear for another three months or so!
Concerns about the ability of hospital computers to cope with the year 2000 date change still persist despite vigorous and continuing efforts by the NHS to address the situation. Alistair Liddell, NHS Executive Director of Planning, said, 'The monitoring process that the NHS employs is giving us good information about the state of readiness in the service. Most organisations are doing well but we are intensifying the monitoring and focusing our work on those organisations who are behind the majority'.
The NHS is taking other action too. It is intended to stop all non-urgent work over the New Year holiday and there will be close co-operation with the Red Cross and St John's Ambulance Brigade. However, the NHS Executive has decided that there will no special national arrangements on staff pay over the 'millennium weekend'. There are fears that this will make it harder for NHS trusts to ensure adequate staffing levels.
Chris Gundry, DoH's emergency planning adviser, said the health service had been working hard for the last two and a half years to address the challenge which the turn of the millennium would pose. Asked whether the NHS would 'call in the army', he said there would be no wholesale reliance on military support although it was an option that could be considered at a local level in a 'worst case' situation.
Standards will be set for diabetes care
New standards for the provision of care to people with diabetes will be set within a 'National Service Framework'. The standards will be developed over the next two years leading to publication of the NSF in 2001. The government's Commission for Health Improvement will have powers to visit health facilities to ensure that the standards are being met. Other NSFs are already in preparation for coronary heart disease, mental health, and older people. Health Secretary Frank Dobson said, 'NSFs aren't statements of pious hope. They will improve services all over the country and make sure that the NHS delivers top quality services for everybody, no matter where they live'.
The government's new moves on diabetes have been welcomed by the British Diabetes Association. The BDA's Chief Executive, Paul Streets, said, 'Until now diabetes care has been something of a lottery depending on where you live. The BDA will work with the government to ensure that the national service framework is a success and delivers high and consistent standards of care'. The BDA estimates that 3 per cent of people in the UK have diabetes, only half of whom have been diagnosed.
Sources: Press releases (DoH, BDA)
Avoidable stroke deaths
Stroke services are also said to be provided haphazardly in the UK. The mortality rate following a stroke is 25 per cent less in patients admitted to a specialist stroke unit, but under half of stroke victims receive such care. The result, according to the Stroke Association, is around 2000–3000 unnecessary deaths every year. A further 2500–4000 patients each year require long-term institutional care which the Association says would not be the case if they had received adequate treatment immediately after their stroke. A study conducted for the Association found that there more special stroke units in Northern Ireland, Scotland and Wales than in England. A stroke patient in Ireland has twice the chance of receiving specialist care compared with a patient in the southwest of England.
Stroke is the third commonest cause of death in Britain, following cancer and heart disease; there are 100,000 new cases each year. However, there are, as yet, no plans to develop a National Service Framework for stroke.
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