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Health Service Journal
Opinion

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  • 1997 and all that: Blair remembered

    The NHS has transformed remarkably since Tony Blair entered Number 10 in May 1997, reinvigorating a struggling monolith with record investment.

  • A different kind of day at the office

    The HSJChallenge offers managers the opportunity to escape their day jobs and pit their wits against their peers in a in a multi-agency health economy with more than its fair share of problems. The good news is that it's not for real. Jennifer Taylor reports

  • A 'fixed' financial system will bring a legacy of control

    One of the worst-kept secrets of the last few months has been that the much-despised resource accounting and budgeting system, which penalised trusts twice for their deficits, would be scrapped at the end of the financial year.

  • A formula for unfairness

    With a significant proportion of NHS trusts in financial difficulty and many of those reporting ward closures and job losses, the financial health of the NHS emerged as one of the key political issues of 2006.

  • A freedom framework will unite former foes

    With the debate about freedom from political interference raging, strategic health authority chief executive Mark Britnell outlines his model for compromise and wonders what an NHS charter might contain

  • A new realism needed on CJD

    Surely the time has come to end the monthly issue of CJD statistics. Last year's returns showed there were only five deaths from vCJD (7.5 per cent of total) compared with 62 deaths from non-vCJD. Peak mortality from vCJD was reached in 2000 when 28 deaths (34 per cent of total) occurred and it has fallen steadily since then.

  • A prescription for professionalism

    What ideas like NHS independence lack is not the eye-catching headline or even the fine detail but the implementation and local connection

  • A welcome bid to put PECs at the heart of decision-making

    If a commissioning revolution is vital to making a success of the new NHS landscape, we must know who will be making the decisions. In too many cases members of primary care trusts' professional executive committees have found themselves - or placed themselves - well away from the issue.

  • A year in review: catching up with the excess in 12 turbulent months

    2006 has been dominated by efficiency drives and government reforms. Financial problems began to bite and the public took to the streets over attempts to revamp local services. Amid the financial storm, NHS chief executive Sir Nigel Crisp resigned and only two trusts got top marks in the Healthcare Commission's first annual healthcheck. In a year that even Tony Blair said was challenging, HSJ's Managers Make the Difference campaign recognised the achievement of managers increasingly under sie

  • Adrian Ashurst on making a real difference

    'In order to make a real difference, managers and staff need to make a personal commitment to their customers. It is worth remembering that we are all customers - we should be prepared to treat others as we would like to be treated ourselves.'

  • All our yesterdays

    17 January 1969, British Hospital and Social Service Review

  • An ode to the Daily Mail?

    Michael White's 800-word bansturbation (opinion, page 10, 26 July) to the thought of stricter discipline and control of drugs, drinking, gambling and advertising included a stout defence of the Daily Mail. Will HSJ soon have a Daily Mail editor as its political columnist?

  • An online service tailored to your needs

    This week, HSJgets personal. Today we have launched a new online service free to registered users of the website, designed to bring you the most relevant content direct to your desktop.

  • And so to bed The problem with mental health inpatients

    Mental healthcare faces a problem of bed shortages for inpatient care, but while a large part of the solution might be stronger community support rather than increasing the number of available beds, there is still a need in some places to boost their number. Mat Kinton and Suki Desai explain

  • Andrew Castle on effective procurement

    'I think that there are enormous opportunities to obtain easy financial wins through the simple use of best practice supply chain management'

  • Andrew Jones on aligning incentives

    'After a few cycles in the policy washing machine, you would have thought we would all have come out looking the same colour and trying to iron out the same creases'

  • Andrew Jones on clinical management

    A lack of understanding on either side only contributes to ludicrous meetings where the only obvious collective truth is self-preservation.

  • Andrew Jones on conspiracy or cock-up

    'It could be kindly argued that, by general lack of enthusiasm, a third of the country is yet to churn out any meaningful health activity data, yet alone customise or dynamise it to specific local goals. Perhaps more telling is that two-thirds have yet to even put together a simple budget concentrating on core activity.'

  • Andrew Jones on getting the NHS recipe right

    'We have a centrally run, demand-driven, hospital-orientated system for an ageing, consumer society with untreated long-term conditions. This recipe will be unsustainable.if the 2007-08 spending round produces a big squeeze'

  • Andrew Jones on independence day

    'The conundrum is simply how to devolve day-to-day responsibility to an independent board with the benefits of efficient delivery, local decisions and avoidance of political interference'

  • Andrew Jones on which way now?

    'I assume in chess terms the ploy was to bewilder the electorate and most senior managers into second guessing the next steps. I have no hidden insights at this point but then I am told the Brown team didn't have many either'

  • Angela Coulter on the national patients survey

    'Access to GPs has dramatically improved!' claims the government. 'Nonsense, it's got worse!' yells the Daily Express.

  • Anna Donald

    'I had the tea lady from hell. I woke to be greeted by a short, angry person wielding a large trolley'

  • Anna Donald on consumer information

    'Patients must indeed be patient. The term 'patient-led' invites disbelief that patients are going to lead the NHS'

  • Anna Donald on doctors' motives

    'The NHS needs doctors firing on all cylinders, not retreating to their duvets'

  • Anna Donald on drugs in the headlines

    'Given the avalanche of research and new products, it is not surprising that the 'best buy' list of products keeps changing'

  • Anna Donald on lessons from Australia

    'The NHS can't avoid political controversy, because what it does is too important, complex, and subject to debate'

  • Anna Donald on turning cogs in a blancmange

    'Most doctors would struggle to conceive of a hospital in anything other than descriptive terms'

  • Appointments Commission

    I was interested to see (page 8, 14 September 2006) that the Appointments Commission was insisting that previous experience as a chair was not excluded from candidate assessment even though HSJ had seen letters from that same commission which confirmed that such experience was indeed not to be taken into account.

  • Asset-sharing will limit the scope for dispute between the NHS and local government

    'The commissioning process must have an injection of public involvement at every stage but particularly at the very beginning when need is assessed'

  • At your service

    The government and PCTs are contemplating the benefits of community foundation trusts, but are they really the future for provider services, asks Kaye McIntosh

  • Autonomy is key to applying lessons from private sector

    'Do NHS managers really believe the 'myth' that public sector values are at odds with what Tony Blair called 'proper business management techniques'?'

  • Back innovation and good judgement in primary care

    Primary care trusts.are bound to weigh proposals fairly, but they cannot be compelled by entrepreneurs to make reckless decisions.

  • Back to the ward: back-to-front thinking

    Even when financial pressure is being felt so heavily up and down the country, it still seems odd that some trusts are asking senior nurses (in at least one case, at director level) to go back to the wards to help out on a regular basis. Read more >>

  • Back to the wards

    A selection of reader responses about our story on senior nurses going 'back to the wards' to save trusts money

  • Barometer - Mental health April 07

    With the start of the new financial year comes a new record in this Barometer survey of mental health chief executives. The highest result has been recorded, with a confidence score of 9.47 for achieving break even by the end of the financial year.

  • Barometer acute trusts March 2007

    There was a late surge in confidence at the end of February about reaching financial break-even or surplus, according to the latest Barometer survey of acute trust chief executives.

  • Barometer: acute trusts jan 2007

    Confidence in achieving the 18-week target was high among our panel of acute trust chief executives, with the average figure rising from 6.2 to 6.72 since October 2006.

  • Barometer: acute trusts May 2006

    The latest HSJ Barometer survey of acute trust chief executives showed significant recovery in confidence, with only two indicators displaying statistically relevant falls.

  • Barometer: mental health September 2006

    Mental health chief executives surveyed for Barometer report high levels of confidence on recruitment of medical, nursing and therapy staff.

  • Barometer: mental health, February 2007

    With the end of the financial year looming, chief executives of mental health providers are very confident this month that they will end the year in financial balance. A score of 9.26 is the highest ever recorded for this measure and the highest score of this barometer.

  • Barometer: PCTs April 2007

    Primary care trust chief executives expect continuing wrangles over negotiating contracts with acute trusts, according to the latest Barometer survey.

  • Barometer: PCTs January 2007

    The latest Barometer survey of primary care trust chief executives showed growing confidence in negotiating power with acute providers, with the indicator score up again to 6.88 out of 10.

  • Barometer: PCTs June 2006

    The only significant fall was in confidence in hitting the choose and book deadline

  • Barometer: Public Health April 2007

    While confidence in sexual health services has continued its rise in the latest Barometer survey of public health directors, the most significant increase for April is public health funding for 2007-08, with the overall number up from 3.85 to 4.85 out of 10.

  • BBC-style management model will not work in the NHS

    In response to your article - BBC-style management could save NHS from 'political ice', I can't think of a much worse model to aim for than the BBC. It is effectively funded as a tax on all TV owners, irrespective of whether they actually use the service or not. And growing issues of choice in broadcasting are making this a very hard principle to follow. Users cannot opt out of the TV license fee, which would be entirely reasonable if they did not consume the service.

  • Bear the burden of getting care just right

    As patients demand more, it is vital to control variation while preserving truly personalised delivery, argue Geraint Lewis and Phyllis Shelton

  • Bed day costs

    The Department of Health productivity indicators (click herefor story) detail how much each trust can save by reducing bed stay.

  • Bed-blocking does not tell the full story

    I read the article on bed-blocking with interest as my mother has been a patient in a foundation trust in the North West for nearly six months following a severe stoke.

  • Bill exposes flaws in plans for greater patient involvement

    'One of the strengths of the local involvement networks was supposed to be that, rather than examining the services in a particular institution, they could range across a whole area to gain a rounded view of all aspects of services users' experiences'

  • Blair interview: 'A pound wasted is one not spent on NHS values'

    System reform and good management are the only ways to deliver the NHS's values in the modern world, the prime minister tells Nick Edwards in an exclusive interview

  • 'Blame culture' is driving staff errors underground

    Managers must eliminate the blame culture in the NHS to prevent under-reporting of safety breaches, the chief executive of the National Patient Safety Agency has warned.

  • BMA must engage, not take cheap shots

    'Shouting from the sidelines will secure more newspaper column inches than engagement, but it will achieve less'

  • BMA's failure to support medical training

    NHS Confederation chief executive Gill Morgan may believe that the British Medical Association has recently been playing a 'constructive role' in policy development ('Resignation over MTAS row 'could weaken' BMA').

  • Born under a bad sign

    Perinatal depression is gaining a higher profile, with. a drive to increase awareness and provide wider access. to specialist provision. Emma Dent reports

  • Breaking even must not mean trusts losing focus on money

    The NHS should manage to hit its forecast position of a small surplus at the end of this year, according to this week's Department of Health figures. Not that it will be thanked or even believed. Within a few hours of the report being released on Tuesday, the protests began - basically that it was a dodgy figure achieved by slash and burn tactics.

  • Brown finally begins to reveal his blueprint for health reform

    As the surreal spectacle of Gordon Brown campaigning for victory in a contest he has already won continues, his interviews and speeches are finally shedding light on his health policies.

  • Brown's equality drive must begin at birth

    More low-weight babies are born in Britain than anywhere else in Europe. This should be at the front of the next prime minister’s mind as he strives to give every child an equal chance, says Louise Bamfield

  • BUPA and choice

    I would like to make it plain that BUPA Hospital Leeds does not charge a 'premium to tariff' when treating NHS patients under choose and book. It is understandable that the complex system you outlined (HSJ, 22 February) could leave readers thinking otherwise.

  • Burden of unbundling the tariff falls on quality of local data

    This week's 'road testing' of the payment by results tariff for 2007-08 will, the Department of Health hopes, result in considerably less noise than the late and broken one released in January. The DoH says it is not looking for any comment or complaint about what the tariff should or should not be; it wants the service to restrict its attention to whether it works correctly or not.

  • Cameron speech: Tories elbow their way to the front on independence agenda

    'Strategic health authorities will be less happy with the inference that they will become a local arm of the Department of Health, much reduced in power.'

  • Care UK chief urges swift ISTC take-up

    Chief executive Mike Parish sounds a cautionary note that government must move quickly to ensure a local ownership care system takes route

  • Carers must be treated with dignity

    Lord Darzi has been asked by the health secretary.to review the main challenges facing the NHS, including ensuring that care for people with long-term conditions is joined-up, patient focused, offers best value and is delivered with dignity in the best location for each patient, which for many will be their own homes.

  • Carruthers hit the right note; now follow up with clarity

    'What managers need is clarity on what is expected of them and what they can expect from the centre'

  • Case managers make all the difference

    When my mother was near death from kidney failure in Massachusetts General Hospital in Boston, US, I was amazed that she was stabilised and transferred to an excellent rehab centre in one week. I was amazed again when the rehab centre had her mobile, on a stable dialysis regime and ready to return home in two weeks.

  • Charles Core on Hepatitis C

    1 October brings World Hepatitis Awareness Day, but on the domestic stage the NHS is struggling to cope, writes Charles Gore

  • Chiefs reveal frustrations over doctors' contracts in HSJ survey

    Most chief executives would cap GPs' pay, abolish clinical excellence awards for consultants and write off historic debts if they had the power.

  • Chris Ham on integrating to compete in the NHS

    'Instead of separating the roles of buyers and sellers in the NHS, the government needs to encourage closer integration between hospitals and GPs'

  • Chris Rudge on why the NHS needs to raise its game on transplants

    'The NHS is spending nearly £190m a year on dialysis for the 6,278 patients waiting for a kidney transplant. If every one of these patients currently had a functioning transplant, the annual saving would be £160m'

  • Christmas comes early, so must planning

    Last year most primary care trust chief executives polled by HSJthought their local delivery plans were badly flawed by an operating framework delivered late and with significant errors in the tariff.

  • Christopher Newdick on treatment abroad and the law

    Should PCTs be alarmed by the European Court of Justice's ruling on covering the cost of treatment abroad? Christopher Newdick explains

  • Chronic disease management: Welsh framework will cut through boundaries

    With evidence mounting that chronic illness represents the principal burden on health and social care services, effective management of long-term conditions is a priority. Helen Howson and colleagues explain

  • Cliff Prior profile: 'The only thing you can't predict is where it will go'

    In his new job heading a group of not-for-profit organisations, former Rethink chief executive Cliff Prior will have a key role in reshaping community services. But first he has to explain what it is all about

  • Clinical coding

    Regarding thr piece in HSJ by Tim Kelsey of Dr Foster Intelligence: 'Clinical record taking has been left to coders for too long.' Excuse me? Clinical information is recorded by clinicians. Coders then translate this information into clinical codes in accordance with National Standards.

  • Clinical engagement: the beginning of reform is the end point

    The fall-out from Sir Gerry Robinson's TV programme on NHS management continues, and this week two very different commentators address the central issue of what is holding back managers and clinicians from working together properly.

  • Clinical governance

    While I agree with using data for decision making (Click here to read the full story), for this to happen effectively we need greater management leverage of clinical governance.

  • Clinicians and trust

    Katzenbach is close (Anna Donald, Opinion, 8th March), but Onora O' Neill is closer. Her Reith lectures in 2002, 'A Question of Trust', pointed not to a crisis of trust but to a pervading culture of suspicion, directed particularly at the professions.

  • Clive Savory on Gerry Robinson and NHS fixes

    Sir Gerry Robinson's bid to 'save the NHS' sparked much debate. But is outside help really a prerequisite for progress? Clive Savory investigates

  • Closing the skills gap with the private sector

    Just a quick feedback on the excellent article by Neil Goodwin which made points that need to be explored by NHS managers when providing patient-led services.

  • Comment: Anger as fitness for purpose programme fails on fairness

    'Rather than PCTs being helped to consider and work on weaknesses in a supported way, they are in effect invited to merely record what they already know.'

  • Comment: Boards and charters are not simple politics-free fixes

    'Without a link to elected people, the board would feel adrift and vulnerable.'

  • Comment: Confidence in achievement shines through from HSJ awards

    'There is sometimes concern that being seen to celebrate success is akin to bad taste when there are so many pressures in the system and on individuals'

  • Comment: Greater Manchester's health inequality woes resonate widely

    'The Audit Commission report makes clear that reconfiguration 'is damaging the potential for more successful joint developments,' creating rifts and instability.'

  • Comment: Hopes for surplus pinned on turnaround in forecasting

    It would be a bold stroke to pull off - delivering even a small surplus at the end of this financial year given the situation that NHS acting chief executive Sir Ian Carruthers inherited in March.

  • Comment: Keeping afloat in a topsy-turvy market

    'Central and Greater Derby primary care trust deserve congratulation for innovating in a way that promises to improve the quality of services.'

  • Comment: managing demand without the command

    'It is not disagreeing but dissembling that really annoys doctors.'

  • Comment: muddle on primary care pilot delays

    'There seems to be a distinct waning of enthusiasm on both sides, with private providers complaining about inflexibility and complexity and primary care trusts feeling financial pressures.'

  • Comment: National directors sign up to reform

    No-one ever argues with the case that clinicians at every level are integral to successful service reform. But it is a truth observed more in the intention than the action. It is therefore welcome, although a little late in the day, for the government to wheel out two national clinical directors to make the case for reconfiguration.

  • Comment: New NHS chief executive lays plans for funding revolution

    'Mr Nicholson wants to look at how funding can be released so trusts have to rely less on a system which is in effect designed to produce a deficit.'

  • Comment: PCT recruitment cannot afford to pay tribute to the old regime

    'To what extent is the success of current primary care trust chief executives in winning the top jobs in the new organisations a verdict on the success of the whole sector?'

  • Comment: PCTs need certainty of consultations to innovate

    'You cannot be certain of a consultation's outcome, however important to you, but that makes it all the more vital you are certain of the process.'

  • Comment: Referrals must soar for ITCs to fulfill intended role

    'Concerns will be increased by the fact that the second wave of ITCs will not, as previously indicated, be risk-free to commissioners.'

  • Comment: Responsibility and beliefs key to next stage of choice

    'The government believes the 'where' of care resonates with the public at least as much as the 'how?'.'

  • Comment: the HSJ50, an index of ideas and influence

    'This is very deliberately a snapshot of influence, and already the sands are shifting'

  • Comment: Trusts feel squeeze from PCTs' tight grip

    'Foundations should not be surprised if PCTs prove fierce negotiators this year. However, their complaint is about a lack of planning.'

  • Comment: Why a US management guru has vital questions for the NHS

    'Michael Porter's book has caught the imagination of many of the most influential voices in NHS reform and has been occupying minds at the highest level throughout this year.'

  • Comment: Win some and lose some - our verdict on the conferences

    So as this year's party conferences recede over the horizon, who had a good or bad time of it?

  • Commissioning and clinicians

    The ideals of commissioning are mocked. One may sympathise with policy-making born of frustration, but when rhetoric begets sham and folly, then challenge should be clearly heard.

  • Commissioning: Practices may need a fairy godmother to make PBC work

    Practice-based commissioning is the 'Cinderella' policy reform of the NHS.

  • Communicating with patients

    I've always enjoyed Hilary Thomas's articles and admire her courage at writing about her breast cancer, but I was quite saddened to read what she said about not realising what her patients had to go through until she had experienced it herself.

  • Competence Application Tools

    Competence Application Tools

  • Complaints and Criticisms.

    During my years as a CHC Chief Officer, I was repeatedly aggravated by letters from NHS managers in reply to individual complaints or to CHC comments on local plans that said, in essence, that what was being done was in accordance with policy and/or guidance.

  • Confessions of an NHS chief executive

    'I do not follow rhyme or reason, only the secretary of state'

  • Consistency and agreement are needed to spread success

    'The MPs' committee calls for lessons learned from the turnaround programme to be shared. But evidence for its effectiveness is opaque'.

  • Coping with redundancy

    Adding to what Ken Jarrold has said, I've been through redundancy a couple of times and these are some of the lessons I've learned:

  • Criticism of Dr Foster JV masks the real story about poor data

    The National Audit Office report on the Department of Health joint venture with health information provider Dr Foster does little to combat the notion that government is still feeling its way when doing deals with private companies.

  • Czars face the axe as policy shifts

    The Department of Health looks set to phase out the 14 national czars in a move that will signal a further devolution of NHS power to the front line, HSJ understands.

  • Darzi's review shows who has the power in the new top team

    'Most ministers can be brought to heel by threat of the sack, but not one with a global reputation well beyond politics'

  • Data briefing

    A&E admissions by diagnosis and SHA

  • Data Briefing

    Day-case rate variations by SHA

  • Data Briefing - John Appleby on climate change and health

    The Department of Health and the Health Protection Agency have recently published an update to their seminal 2002 report Health Effects of Climate Change in the UK.

  • Data briefing: Better Care, Better Value indicators

    The NHS Institute for Innovation and Improvement recently published the Better Care, Better Value indicators for the second quarter of this financial year. They can be analysed to give some insight into what is happening across the country.

  • Data Briefing: cost benchmarking for foundations

    With many foundation trusts having to save 15 per cent over three years, the Foundation Trust Network joined consultant McKinsey to develop a benchmarking tool. This aims to enable trusts to analyse costs at healthcare resource group level.

  • Data briefing: deficit forecasts, financial reality

    The recent quarterly financial report from the Department of Health provides some encouraging signs as the NHS gets to grips with previous years' overspends. But the detail looks patchy.

  • Data Briefing: Did the extra money go on new staff?

    A new analysis of the reason for and distribution of NHS deficits published by the Department of Health, Explaining NHS Deficits, contains an interesting analysis of what the extra funding from 2000-04 was spent on. The answer, apparently, is that nearly 80 per cent was consumed by the costs of employing extra staff.

  • Data briefing: How length of stay varies by SHA area

    There is growing demand for new and innovative indicators to measure variations in performance between acute trusts. Length of stay measures include indicators of excess bed days, analysis over time and giving lengths of stay for specific diagnoses or procedures.

  • Data briefing: prescribing variations by PCT

    In 2004-05, prescribing cost nearly £8bn in England - over 681 million items at an average of nearly 13 per GP list patient and £150 per year.

  • Data briefing: Scottish tariffs

    Following publication last year of Professor David Kerr?s Building a Health Service Fit for the Future, a Wanless-style review of Scottish health services, the NHS in Scotland is now implementing Delivering for Health reforms, which includes a new system of paying hospitals.

  • Data briefing: the truth behind the A&E target

    A recent analysis from Les Mayhew and David Smith at City University's Cass Business School has suggested some theoretical reasons - backed by data - why achievement of the accident and emergency maximum four-hour wait by 98 per cent of hospitals was probably not all it seemed.

  • Data Briefing: Variations in length of stay

    Length of hospital stay remains one of the greatest variables between acute trusts. By reviewing and influencing discharges commissioners can aim to improve the patient experience and save bed days, increasing capacity and saving money.

  • Data briefing: variations in spending in HRGS

    Some trusts could have some explaining to do in their negotiations with the new PCTs

  • Data briefing: what affects same-day discharge rates?

    Over recent years there has been a growing trend in the number of non-elective patients discharged on the same day as they were admitted.

  • Data protection

    'The DoH said... that data processing agreements were being put in place to comply with the Data Protection Act'. (Click herefor story.) Agreements with whom?

  • Datamonitor: steady progress for acute productivity

    The NHS Institute for Innovation and Improvement has published the Q3 2006-07 Better Care, Better Value indicators. As the indicators have been published for the first time on the basis of the 152 new primary care trusts (previous quarters reported on the 303 PCTs that existed until Q2 end) the discontinuity in data at PCT level makes trend comparisons difficult to identify. However, stability in the acute sector allows us to gain some insight as to what is happening in our hospitals across the

  • David Baker on the maze of choice

    While a.wider choice of services is a good thing.for patient care, the public needs more guidance on where to go for non-emergency urgent care, says David Baker.

  • David Lawrence offers some words of advice to Mr Brown

    'Yes, Mr Brown, as you well understand, the NHS is a business operation in that it is an input-output system with desired outcomes'

  • David Lock on an independent NHS

    An independent NHS board would be good news for ministers - but what about managers, wonders David Lock

  • David Lock on continuing care liability

    'The dividing line between healthcare and social care has been the subject of numerous legal cases, endless guidance, appeals to and reports by the parliamentary ombudsman and more than a few scratched managers' heads over the years'

  • David Lock on making sense of insurance claims

    'When the pressure comes on from the 'care co-ordinator' employed by the insurers to provide the patient with a grade seven nurse, 24-hour care for incontinence and horse riding lessons as part of the overall package, PCTs can dig their heels in and refuse'

  • David Mobbs on health inequalities and the market

    Nuffield Hospitals' David Mobbs argues that those who rail against the market stand to make health inequalities worse

  • David Moon on resource efficiency in construction projects

    Over the past few years, trusts have placed growing pressure on contractors to improve their sustainability credentials and significant progress towards setting minimum requirements for recycled content in the health sector has already been made.

  • David Nicholson on service transformation

    'We can only deliver genuine transformation of health care services if our staff understand what we are trying to do'

  • David Peat on choice

    I suppose it's a generation thing. Choice, that is. And come to think of it, consumer power in general.

  • David Peat on fitness for purpose

    'Fitness for purpose has given us intelligence, new understandings and insights into the changing role of being a fully fledged commissioner in the new NHS. It has.helped us respond to the new realities and changes that have taken place in our relationships in and outside the NHS'

  • David Peat on letting go

    'As soon as the SS Rest and Relaxation draws near another port, you can see groups of slightly anxious-looking passengers veering to the landward side of the vessel and proclaiming: 'Houston, we have a signal!''

  • David Peat on Life on Mars (NHS-style)

    'Much has been achieved in medicine and health, yet we have major issues surrounding obesity, alcohol abuse, sexual behaviour and drugs. We can't moralise, but some of the difficulties of 1970s society have morphed into new and sometimes exaggerated forms'

  • David Peat on lost baggage and fielding complaints

    'I always try to acknowledge a complaint

  • David Peat on lost baggage and fielding complaints

    'I always try to acknowledge a complaint myself when it arrives on our doorstep, and I always sign off our response. It helps me keep in touch with patients' perceptions - their sense of grievance, injustice or perplexity.'

  • David Peat on snipers and Special Ones

    I believe that in the fullness of time we will look back at these months of uncertainty and see it as a short diversion from the grand task in hand.

  • David Woodhead on gardening for the mind

    'She was clear that picking up a spade and plunging it into the ground enabled her to channel some of the anger she had felt the previous week at work.'

  • David Woodhead on gathering evidence

    'Science might come up with some interesting ideas, but ultimately the likelihood of adopting evidence is driven by our values. Mass sterilisation of young men might be an effective method of reducing teenage pregnancies, although for good reasons it would not be considered practical'

  • David Woodhead on lessons from Peru

    'I met a group of local women who were trained in contraception and hygiene; they each had trained six women, who in turn were training others. The process had increased their confidence. And in the basement was a co-operative bakery which provided affordable bread but also made a profit.'

  • David Woodhead on love and understanding

    'If love is all around us, why is it seldom discussed? What is the exact role of love in promoting health? And if love were a desired outcome, how would we recognise it?'

  • David Woodhead on public health

    'Vicky was patronised by health professionals unwilling to listen to her views or take note of her experiences'

  • David Woodhead on social marketing

    'It is naive to suggest that the effectiveness of interventions alone is the only issue we face in seeking to change behaviour. There are wider challenges in terms of respecting diversity and ensuring our work is culturally appropriate'

  • David Woodhead on the qualities of commissioners

    'Driving change in numerous organisations demands particular skills. We no longer spoke of what people needed to know, or what their qualifications might be, but of the qualities they had and how they approached their work'

  • Day case rates

    Marc Farr says day-case rates over the last three years have shown little sign of improvement

  • Deborah O'Dea on coping with change

    'Change is no less difficult when our intentions are absolutely right and serving patients' best interests.'.

  • Decade of mental healthcare defined by unproductive debate

    Mental health trust chief executives give their views of ten years under New Labour

  • Deficit crisis: ground won for training must be held in face of cash battles

    'The government's service-level agreement - a response to criticism of the 10 per cent cut in training by SHAs last year - looks to be a dead letter within days of being published'

  • Delayed dicharge can hinder patient safety

    In response to your article on bed-blocking (12 April) Alison Moore is right to highlight the problems of delayed transfer of care, but fails to convey the problems that patients experience.

  • Delayed discharge brought back in focus

    Bed blocking is back and, at least in mental health, it is joint working with social care teams where the most effort needs to be applied.

  • Devolving central budgets

    David Nicholson needs to ensure that Cinderella services have ring-fenced funding when he devolves 90 per cent of the NHS funds to local budgets.

  • Dianne Leyland on the lack of clarity over local involvement networks

    Voluntary and community groups must be actively involved if LINks are to work. Yet the sectors' goodwill, undermined by the botched creation of patient forums, is eroding further.

  • Disaffection rules as chiefs mourn Alan Milburn's vision

    Alan Milburn is the most popular New Labour health secretary, according to HSJ's survey of trust chief executives - not surprising when the same survey reveals the light that still burns brightly in people's hearts for the NHS plan.

  • Dispatching the New Labour ideal

    As a participant in the Dispatches programme The NHS - Where did all the money go?, may I offer the following reflections to your correspondent Donald.Reid. He is right that there have been improvements in key areas, including waiting times.

  • Doctors have feelings too

    I read Anna Donald's article on doctors' motives with interest (opinion, page 17, 8 March 2007). In terms of what doctors need, it is about finding an acceptable means of emotional release.

  • DoH plans mark rewriting of relationship with professions

    If one image of the dole queue helped finish off Labour in 1979, just imagine what might happen if the jobless wore white coats. The prospect of making large numbers of consultant posts redundant is one rarely articulated in public. That changes this week with HSJrevealing the Department of Health's draft long-term workforce strategy.

  • DoH rejig indicates future direction of policy

    After many tremors below the surface, the detail of the restructuring of the Department of Health has emerged this week. NHS chief executive David Nicholson has created a new NHS leadership team, with new posts, and some clear water from the rest of the department (read news item on Nicholson's new team)

  • DoH targets deaths from clots

    All hospital patients should be assessed for risk of developing potentially fatal blood clots, an expert working group has recommended.

  • Don't leave unhappy medics to stew

    'And there will be more points of conflict to come, such as the issue of where doctors work as opposed to where they are needed.'

  • Dr David Jenner on the workability of PBC

    Are primary care trusts and strategic health authorities really encouraging GPs to get to grips with practice-based commissioning? Or are some of them encouraging this policy to fade away?

  • Dr Maire Smith on nurturing innovation

    'NHS staff have a wealth of ideas and a number of these could be translated into tangible benefits, not only for the patient, but also for the organisation'

  • Dr Marc Farr on understanding preventable injury

    In February, the National Audit Office called the number of accidental injuries across the country a 'disgrace', with 2 million children a year visiting accident and emergency due to an accident.

  • Dr Nick Griffin on clinical input in the development of HRG4

    In 2002, the Department of Health developed a policy to fund healthcare by a national tariff applied to patient level activity. This policy, payment by results, required a new currency for the grouping of activity.

  • Dr Pat Troop on managing the Polonium-210 outbreak

    Staff have learned what it is like to work intensively at that speed under public and political scrutiny, and it has been useful training for future events, such as pandemic flu

  • Drug dilemma

    I was puzzled by David Lock's advice in NICE rulings to PCTs to have a policy to refuse to fund emerging treatments except in exceptional circumstances.

  • Early consultation with scrutiny committees is key

    Your article about health scrutiny (opinion, page 20, 31 May) made the point that it is helpful to involve councillors on health overview scrutiny committees when considering.service changes at an early stage. That is absolutely right.

  • Early learners

    Thirteen health communities have volunteered to be 'early achievers' for the tough new 18-week target. Alison Moore hears lessons from the pioneering trusts

  • Early learning is key weapon in obesity war

    Concerns are mounting over rising obesity, but is enough being done to slim down the problem, asks Liz Kendall

  • Effective health messages

    For some people, being classified as ill or disabled is not such a bad thing

  • Efficiency drive lies at the heart of PM's uncompromising message

    The prime minister's interview with HSJ this week poses important questions for health service managers. Among the familiar - the NHS is important, managers do a good job - are some more subtle but pointed messages.

  • Efficiency indicators

    The 'Better care, Better Value' indicators are an important step forward. The sickness absence rate in the NHS has never been below 4.5 per cent in the past decade. Despite investment to 'improve working lives' and the health of NHS employees it has remained resistant to change in almost all trusts.

  • Efficiency indicators and Christie trust

    Nick Edwards is quite right to suggest that efficiency indicators do not tell the story behind the numbers ( Click here to read the comment). So why did HSJcompound this by labelling Christie Hospital trust the worst in England for day surgery rates?

  • Efficiency indicators do not tell the story behind the numbers

    The comprehensive spending review is no longer the distant event it once seemed - the coming financial squeeze makes a numbers game out of the next 18 months or so.

  • Electronic health records - cutting through the hysteria

    There is a lot of hysteria about electronic health records. Those of us who have worked inside health institutions have no illusions about the safeguards applied to paper records. Paper records are often not available when needed, even in the institution where they are created. And there is almost no system for making records available to other institutions. Any decisions on electronic records need to be put in that context. However imperfect, are likely to be an immense improvement on what exis

  • Electronic staff record

    I was interested to read the letter from Ken Hutchinson, managing director of HR Strategic Solutions, which characterised the electronic staff record as a failed Department of Health initiative (Feedback, page 19, 28 September).

  • Emergency czar backs A&E closure

    National emergency access director Professor Sir George Alberti has backed controversial proposals to shut a north east London accident and emergency department.

  • Emma Dent

    'Any man willing to keep you company in a room full of hormonal women is a keeper'

  • Emma Dent

    There are some people who you cannot imagine using a nickname. I used to date a man whose first name you would no sooner shorten than suggest he ditch wine and earnest films in favour of bitter and rugby league.

  • Emma Dent

    'I had my cards stolen once but the culprits were not the most ambitious thieves'

  • Emma Dent

    'Little about this environment helps relieve the stress staff and parents are under'

  • Emma Dent

    'Malawi has.only 700 healthcare workers for the whole country. One nurse can be in charge of 100 patients in rural clinics. It has the third worst maternal mortality rate in the world. Not even disposable gloves are available.'

  • Emma Dent

    'I would like to know how organic food is ever supposed to appeal to any but the well-heeled middle class when a small loaf costs well over a pound and a nectarine a staggering 89 pence'

  • Emma Dent

    'Negotiations continue on the purchase of flowery sofas and the use of pink paint on the walls'

  • Emma Dent

    'With the ludicrous amount of NHS reorganisation and reconfiguration last year, either the mighty Binley's gave up, or simply stopped sending them to HSJ'

  • Emma Dent

    I have told readers before that I cannot ride a bike. This is a piece of information that never fails to attract shrieks of disbelief from friends, colleagues and acquaintances far more at home on two wheels than I am. I should add that I can't drive either. I do not, in fact, 'do' wheels unless they belong to a bus, car or taxi that someone else is driving.But I digress. I have for some time been pondering whether I should rectify this state of affairs and take to the road - although

  • Emma Dent

    'I have never had such a strong reaction as I did when I told people I was visiting the high-secure former special hospital Broadmoor.'

  • Emma Dent

    Last week was a trip down memory lane. For the first time in nearly 20 years I found myself at the site of the hospital where both my parents worked.

  • Emma Dent

    'Are managers walking round with clipboards counting smiles and small talk exchanges?'

  • Emma Dent

    'I realise my whingeing sounds rather feeble compared to the fate of, say, poisoned former KGB spies, but I remain perturbed'

  • Emma Dent

    'And how could I get fit? I loathe gyms. I always have'

  • Emma Dent

    If everyone went to a particular hospital for certain procedures, others would not be able to

  • Emma Dent

    'Getting drunk in front of your mum is too embarrassing to contemplate'

  • Emma Dent on days off

    'It's as if working in education, health or social care should be some kind of prolonged, low-level punishment rather than a fulfilling, rewarding experience.'

  • Emma Dent on publishing pictures of NHS demonstrations

    A regular point of discussion at HSJTowers is whether we should publish pictures of demonstrations against NHS cuts and closures.

  • Emma Dent on slim pickings

    Overhearing 17-year-olds fixating on how much weight you can gain and still look 'normal' has made me distinctly uncomfortable of late

  • Emma Dent on teenage kicks

    'Our sex education was adequate although we did not get onto the juicy stuff until, frankly, it was too late for some. I thank the pages of teen mag Just Seventeenfor my best information.'

  • Emma Dent on the dreaded lurgy

    I have written before about my non-scientfic diagnosis of this condition, where tired bodies succumb to bugs and germs. I think it might be a sign that I should take a holiday

  • Emma Dent on the unhealthy English

    'I knew that sales of Superkings are kept afloat by our friends in the North, but was hoping that, these days, the death rate would not differ so much from north to south.'

  • Emma Dent on warding off germs

    'At the risk of sounding like a 'man flu'-affected member of the opposite sex, I am a bit alarmed that, as I write, it is well over a week since I first woke up feeling ropey and yet I am still coughing and spluttering like a 60 a day-er.'

  • Emma Dent's Malawi diary

    When HSJ senior features writer Emma Dent was asked to join an Oxfam and Unison delegation to poverty-stricken Malawi, she got a lot more than she bargained. Read her day-by-day account of the trip here.

  • Emma Dent's Malawi diary - day 1

    International overnight flights should have been banned under the Geneva Convention. The 15-hour journey from Heathrow to Kamuzu airport, with a dash across Johannesburg airport to catch a connecting flight, was my first flight either outside Europe or lasting more than four hours. Although the tiny time difference means that we are thankfully not jet lagged, I am completely exhausted.

  • Emma Dent's Malawi diary - day 2

    An early start today. Contrary to my preconceptions about laid back African living, Malawi seems to be an early to bed early to rise kind of place; perhaps not surprisingly when it goes dark (and by dark I mean pitch black as there are no street lights; even city dwellers rarely have electricity) soon after 6pm.

  • Emma Dent's Malawi diary - day 3

    At breakfast in the hotel we are joined by Alex, a freelance journalist who used to work as a media officer for Oxfam after being a journalist and returned to the third estate a few years ago. (He was once a war correspondent after starting out as an arts writer - interesting career move).

  • Emma Dent's Malawi diary - day 4

    I am woken at dawn by the muezzin from the Lilongwe mosque and prevented from getting back to sleep by the cleaners, whose stockroom is on the same floor, not long after starting work with a great deal of bucket clattering..

  • Emma Dent's Malawi diary - day 5

    This morning we head in different directions; we say goodbye to Claire as she heads home and Alex and Abbey go back to Bwaila to sweet talk its management into letting them take photos there, Karen and I to meet the Water Employees Trade Union.

  • Emma Dent's Malawi diary - day 6

    Before the flight Karen and I have time to go for a walk into Lilongwe, round the central market (just as busy, noisy and chaotic as London's Petticoat Lane market and selling the same hotch potch of goods) and do some shopping. I buy wooden bowls, pottery made in Dedza, some wooden trinkets, postcards and a bottle of Malawian gin.....

  • 'Emotional blackmail' of nursing staff

    I do not have a problem with teamwork and continuing part-time care. However, this excuse is trotted out every time money has to be saved. It's a form of emotional blackmail of already hard-pressed nursing staff.

  • Equality and recruitment

    The NHS has a bad reputation when it comes to equality of opportunity. Historically it was slow to move from a colourblind approach to race, and many health organisations only introduced equal opportunity polices when they were required to by legislation.

  • Exclusive interview: David vs the Goliaths of bossy government

    He wants the NHS freed from political control, he would not have voted for the smoking ban and he thinks Patricia Hewitt is the worst health secretary ever. Conservative leader David Cameron opens up to HSJ

  • Ex-offenders should not be excluded from volunteering

    As the national volunteering development agency, we were very alarmed by the tone of the article 'Criminal checks fail to exclude staff', and the related editorial in a recent issue of HSJ. There appeared to be little understanding of vetting procedures, Criminal Record Bureau guidelines or accepted good practice in balancing the safety of vulnerable people with the right of ex-offenders to integrate back into society.

  • Falls in patients being added to waiting lists

    John Appleby (Data briefing, HSJ, 22 February) highlighted the 'strange' improvements there have been in reducing the number of people on NHS waiting lists between 1997 and 2006.

  • Feedback on efficiency indicators

    Nick Edwards is quite right to suggest that efficiency indicators do not tell the story behind the numbers ( Comment, page 3, 26th October) so why did the HSJ compound this by labelling us the worst Acute Trust in England for day surgery rates?

  • Feedback on Peter Degeling's article on integrated care pathways.

    We write in relation to the recent article written by Peter Degeling on integrated care pathways. The claim that '30 clinicians walked out of a recent presentation' in Swansea is entirely false.

  • Feedback to 'A formula for unfairness'

    I read with interest the article in your 16 thNovember edition ' A formula for unfairness'. It confirms the views that many of us have had that there is something wrong with the grant distribution formula used by Government.

  • Feedback to 'A Formula for Unfairness'

    This is a response to 'A formula for Unfairness' article.

  • Fewer targets means more accountability

    'The reduction in targets does not mean data collection will be weakened. For example, health inequalities cannot be monitored without understanding smoking cessation, obesity and infant mortality'

  • Final fitness for purpose results name at-risk PCTs

    Cumbria and Western Cheshire primary care trusts are at the greatest risk of being unable to meet baseline performance goals in the next six to 12 months, according to the third and final wave of primary care fitness for purpose results.

  • Forging ahead with lessons from the future

    Imagine being able to see the future and assess health needs and the repercussions of policy initiatives. Windmill 2007 did that and found some valuable pointers, as Alasdair Liddell and colleagues explain

  • Foundations could provide multi-community services

    Community foundation trusts could combine the provider arms of more than one primary care trust to avoid them being unviable as stand-alone organisations.

  • Frank message in Whitehall report card: must try harder

    'That three people signed off the DoH's response to a report highlighting poor leadership has caused much merriment in Whitehall'

  • Funding formula

    I am delighted that you reported calls to scrap the NHS funding formula on the evidence given to the health select committee by Professors Asthana, Stone and McCormick.

  • Funding formula and fairness

    I read with interest the article by Sheena Asthana and Alex Gibson (HSJ 16 November 2006). The article sets out some interesting data which we would be unwise to ignore in terms of what it means for the NHS. However, I do believe that the conclusions drawn from the data analysis are erroneous and I would give you an alternative take on what may be the underlying issues.

  • Gay-friendly employers

    Stonewall is right in asserting the NHS has 'a long history of employing gays and lesbians' but unlike other minority groups, most remain invisible to their employers.

  • General Practictioners

    To all General Practitioners.

  • Gerry Robinson and media coverage

    The Gerry Robinson TV programme illustrated the differing systems in NHS and private hospital operating theatres. In the private sector time is money, and so the rate tha cases are moved through theatres is much greater. There are no hold-ups, such as waiting for the porter to bring a patient from the ward. They just get on with it. It also brought out the 'institutionalised inefficiency' of the NHS. The operating theatres at Rotherham General are unused on Friday afternoons, and Sir Gerry was t

  • Gerry Robinson and the NHS

    Management guru Sir Gerry Robinson's televised stint at Rotherham foundation trust to reduce waiting lists might have worked better in a trust that has not already achieved so much to place it on a more business-like footing.

  • Get reform back on track and finance will follow

    The NHS financial crisis was not caused by too much reform too quickly, but by too little too late, argues Keith Palmer. Efforts to restore balance should not be allowed to delay it further

  • Get together

    A new inspection regime - the comprehensive area assessment - is to be rolled out for a range of local services. HSJ and sister title LGC collected the great and the good to discuss how it will affect their work

  • Giving patients the cost of treatment

    Having had first hand experience of this in the USA, when my father lay dying in ITU and we kept getting bills from the insurance company 'for information only' I would urge the Minister to give this proposal serious consideration.

  • Good and bad targets

    Malcolm Lowe-Lauri's carefully worded article emphasised the processes that may be provoked by a target culture. It is surely right that these are the clue to any improvement in performance associated with targeting, other than thrashing the horses. However, the article colludes with the general statement of 'Targets Work', without really considering the less attractive side, the inappropriate pressure, demoralisation and waste of resource that may also accompany poorly considered target declara

  • Good buy to all that: the need for procurement focus

    With the government set to become a major purchaser of public services far more attention must be paid to the procurement process, warns Ann Rossiter of the Social Market Foundation

  • Happiness is... getting to grips with the intangible

    As the NHS has become sophisticated about the need to measure outcomes, it inevitably raises questions about what is actually measured, and therefore what matters. By necessity, the focus in the early years of this government has been on the utterly tangible - mortality rates, waiting lists and so on.

  • Harry Cayton on better management

    Good management should be invisible, but good managers should be highly visible, argues Harry Cayton

  • Healthcare inspection comes under scrutiny of its own

    'Numbers do not impart wisdom in themselves, you have to learn how to select and use them'

  • Healthcheck ratings: tougher test means story must be retold

    The Healthcare Commission said it would be a tougher test - and so it has proved. In the first national healthcheck ratings only two dozen organisations were rated excellent for service quality, and even fewer for their use of resources. Only half of NHS organisations met all the core standards, which clearly shows they are far from core for the NHS as a whole. Primary care trusts fared particularly badly.

  • Helen Rowntree on using patient safety indicators

    The past few months have seen the beginnings of a shift in the prevailing NHS wisdom about patient safety and how best to promote and improve it. The emphasis is moving firmly towards greater openness and accountability - a point well made by Frank Burns in his recent HSJ piece (opinion, p16, 12 April). The appetite amongst the public for assurance that hospital care is delivered safely is reflected in the media with the.ever present interest in MRSA stories.

  • Helping middle managers

    One of the ills plaguing the NHS that seem to be overlooked by senior managers is middle managers that stay in one job, one position, same department for years. This includes ward sisters in acute hospitals, managers in community and primary care and those in primary care trusts.

  • Herts bags early winner with stadium bid

    As the football season cranks into action, Watford have scored an early goal in a PFI partnership with West Hertfordshire Hospitals trust.

  • Hewitt confirms orthopaedic 'free choice'

    Patients waiting for orthopaedic operations will be able to choose to have their operation at any acute trust, foundation trust, or independent sector provider in the next few months.

  • High Court drugs ruling marks latest skirmish in war of words

    The High Court ruling upholding the National Institute for Health and Clinical Excellence's decision over medication for Alzheimer's is just the latest skirmish in what promises to be protracted manoeuvring over drug use and pricing.

  • Hilary Thomas on being half-way through radiotherapy

    Soon I can put radiotherapy and my emotional reaction to it behind me and enjoy Harry Hill's advice: 'My auntie used to say, what you can't see won't hurt you. She died of radiation poisoning'

  • Hilary Thomas on clinical management

    'My unwanted effects present a long, weary list of moans. These demonstrate just how much my uncomplaining patients have been through'

  • Hilary Thomas on clinical management

    'The gap - often a tribal or cultural one - between doctors and managers seems to be widening again, not helped by the current, and inevitable, obsession with finance.'

  • Hilary Thomas on her honeymoon period

    'I am like a pig in the proverbial. I am no longer part of a demoralised, cynical workforce, ground down by the inevitability of stasis and rigidity'

  • Hilary Thomas on living with cancer

    Becoming a patient has been a salutary, levelling experience

  • Hilary Thomas on living with cancer

    'Acupuncture and ginger beer have been as effective as any the anti-emetics I've been doling out for years'

  • Hilary Thomas on reconfiguration and supercasinos

    So far this year I've enjoyed a st

  • Hilary Thomas on talking about illness

    'Two messages from old friends began 'What terrible news about your health' and 'Not good news!' and then switched subject in the next line'

  • Hilary Thomas on trust and safety

    'Imagine hearing: 'This is your junior pilot speaking. I have no particular interest in your safety.''

  • Hospital closure is not an option

    This letter is in response to.'Super kids in bid to save hospital' (news, page 6, 2 August).

  • How doctors learned to stop worrying and love data

    The NHS has never lacked information, but, says Dr Foster Intelligence's Tim Kelsey, only now are managers and clinicians harnessing its power to change services. Public access is the next big challenge

  • HR managers must forge new staff model

    The pay and workforce draft strategy documents seen by HSJpaint a picture of just how demanding 2007 will be for the human resources profession.

  • HSJ Barometer: acute trusts October 2006

    Confidence has leapt up in our acute trust chief executives about the chances of achieving financial break-even this year - the score out of 10 rose from 5.78 to 6.80.

  • HSJ Barometer: mental health December 2006

    Mental health chief executives are increasingly confident this month that they will achieve financial balance.

  • HSJ Barometer: PCT chief executives, August 2006

    There were falls across all but one of the confidence indicators

  • HSJ Barometer: PCTs Oct 2006

    There were significant rises in a number of key indicators in the latest Barometer survey of primary care trust chief executives. Faith in the national IT programme has continued to rise, and there has been a big boost in optimism on keeping a grip on elective activity. The only noticeable fall was a lack of confidence in the benefits of plurality.

  • HSJ barometer: public health June 2006

    Directors of public health tended to be less confident about hitting their local targets for 2006-07 than they were for last year, with scores falling against drug treatment and alcohol dependency, although scores for smoking cessation rose slightly.

  • HSJ debate: So you want to be a director?

    HSJ 'Managers make a difference' Campaign: Whether it's the art of fostering effective relationships with clinicians, non-executives and politicians or demonstrating empathy with staff, what does the next generation of high-quality managers need? HSJ brought together six chief executives to provide some answers

  • HSJ got it wrong over acute trust 'hitlist'

    I was shocked and disappointed to read allegations in HSJ that Surrey and Sussex Healthcare trust could be merging with or have its services taken over by Frimley Park Hospital foundation trust. There is absolutely no truth in this suggestion as reported by Helen Mooney (news, page 5, 19 April. Click here for HSJ's correction to this story.)

  • 'I say what I think - it can be uncomfortable'

    Emergency access czar Professor Sir George Alberti has spent his career as an outspoken agent of change. Here he reveals how he prefers to eschew politeness and tackle controversy

  • Ideas man

    I was pleased to read Andrew Castle's article on listening to ideas as I know about the culture at Toyota from my current masters course in public administration.

  • In a challenging year, our success is yours

    Tonight, HSJis hosting its biggest-ever awards ceremony - this year we received more than 900 entries across 18 categories and more than 1,000 people will attend our prize-giving event in central London. In this, the Awards' 25th anniversary year, the success of the event is a success story for the NHS.

  • In defence of e-patient records

    It hasn't been often over the last few years that I have found myself agreeing with ITRichard Granger (News, 3 May) but here here!

  • In defence of primary care data

    Although I am usually a fan of Alan Maynard (HSJ Intelligence supplement, page 8, 15 March).his assertion that 'primary care is still largely a data-free domain' is clearly tosh. NHS primary care probably has the best primary care information in the world.

  • In defence of Whipps Cross trust

    I take issue with the accuracy and comment made in your article on the DoH 'hit-list' of trusts that cannot survive under payment by results (news, page 5, 19 April).

  • Increased activity may put bright future at risk

    While health service investment has soared, the pressure on organisations to secure financial control may be driving down productivity. Peter Smith unravels the paradox

  • Independent sector falls down on data

    A level playing field is the holy grail of trust managers who see themselves as competing with the private sector for clinical work. Key to that is confidence that patients and their GPs will be able to make informed choices about where they should go for treatment.

  • Independent treatment centre move redefines choice

    'The DoH appears to be considering pushing PCTs to use independent sector treatment centres.- even to the extent of trying to steer patient choice'

  • Inequalities: the plain truth

    Thank you Ruth Hussey for your plain speaking about tackling inequality. Commissioners need to take note, but we need to innovate not replicate.

  • Information for GPs and search engines

    Conservative MP Grant Shapps' 'Name and Shame' website is the latest publicity stunt to put patient appointment targets back into the headlines. While political parties continue to wrangle with one another, GPs must continue to run their practices under the significant pressure placed on them by these targets.

  • International development: 'Go and tell people what it's like here'

    In the midst of grinding poverty, Malawi's tiny nursing workforce is fighting to meet the country's healthcare needs. Emma Dent reports

  • Ipswich's spinal success story

    I applaud the work undertaken in Ipswich in transforming services for people with spinal pain. It demonstrates the real success of multi-disciplinary working across organisations' boundaries in quality and efficiency of care.

  • Is flu testing really necessary?

    I have to question whether the Department of Health's flu pandemic testing is really the best use of UK.taxpayers' money.

  • Is this really the end of under-capacity?

    Financial incentives and technology mean inpatient demand and length of stay are falling, although the population is ageing. In 10 years waiting lists will be a thing of the past say Celine Druilhe and Eric Louie

  • IT project accused of bullying

    I wish to respond to the article IT project accused of bullying.

  • It was a difficult journey, but under Blair the NHS was saved

    Ten years ago this week, Tony Blair told the country that it had 24 hours to save the NHS. Now that the remainder of his premiership can be measured in days, what can be concluded on whether he delivered on that bold claim?

  • It's a question of trust: will the new ministers devolve power?

    'Central control is a far more natural response from Brown than trusting local freedom and competition'

  • It's up to executive teams to champion productive wards

    Do ward staff need the encouragement and support of their executive team to get on and make changes to improve everyday processes?

  • Janet Askham on the need to improve patient feedback

    'If we continue to ask patients to give up their time to provide valuable feedback on their doctor's performance, surely we owe it to them at least to ask the right questions?'

  • Jasbir Sunner on academic health science centres

    Our vision and strategy for an AHSC, strongly supported by clinicians, bodes well for the future of hospital services in north west London

  • Job cuts at Hillingdon

    Having seen your article today, I am sure I am not going to be the only person sounding totally aghast at what is being proposed in Hillingdon PCT.

  • John Appleby: New thinking on health variations

    Arguments about what we get for our billions of NHS pounds rumble on. The Department of Health's latest analysis - noted here last month - claims the extra billions have essentially been spent on extra staff. We could take it to be a good thing - if the job of the NHS was simply to provide employment for doctors, nurses and managers. But wouldn't it be better to know what outcomes it bought other than extra labour?

  • John Coulthard on patient safety

    'Healthcare faces many of the same challenges as commercial businesses; the need for effective information solutions to drive better decision-making has never been more important than it is today'

  • John Murray on a joined-up service

    'Devolution in the NHS means local priorities increasingly drive allocation of resources. While this development has many benefits, it can unfairly disadvantage patients with specialised conditions, who will inevitability be smaller in number and therefore have less of a voice locally'.

  • John Seddon on lean times

    The clearest indication that the 'tool heads' don't understand the problem is their assertion that the lean tools will help the NHS meet its targets

  • Johnson leads Brown's charm team as ministers start to listen

    'Sir Ara keeping one foot in the operating theatre should encourage clinicians to have confidence that their views are listened to'

  • Join a study on cancer and insurance

    Have you recovered from cancer but still have trouble getting travel insurance? Were you quoted an excessive premium or treated insensitively? If so, we would like to invite you to take part in our research.

  • Joint working: more power for councils will test relations

    The government has proposed that councils and primary care trusts sign up to joint 'strategic assessments' of local health needs and, potentially, 'a single regime' to meet them (news, page 5). The details will emerge next month, but already a number of things are clear.

  • Jonathan Andrew on measuring value

    A system that compares value for money across healthcare systems is vital, argues Jonathan Andrew

  • Just the end of the beginning for Monitor

    With 62 members, the foundation movement is coming of age. Monitor chair Bill Moyes offers a compelling picture of where foundation trusts are heading, and outlines his vision for the regulator's future

  • Kaiser beacons shine light on NHS practice

    A little like 'golden generation' of English footballers', the phrase Kaiser Permanente has all but disappeared from the health policy lexicon as a byword for innovation.

  • Key themes for change

    The NHS has lost a great deal of talent in recent years. As a result it's lost much of its corporate memory

  • Kieran Walshe on professional regulation

    'It will be much easier for NHS organisations to deal effectively and constructively with clinical performance problems'

  • Lack of can-do exposed by Sir Gerry

    Clive Savory makes some valid points about Sir Gerry Robinson's much-publicised troubleshooting visit to Rotherham General Hospital.

  • Laura Donnelly on honesty and political risks

    'Admitting that the NHS does not always offer a 'world-class service' is a high political risk'

  • Laura Donnelly on overlooking talent

    I heard a good story once about David Nicholson. Along with the rest of the 28 strategic health authority chief executives, he was waiting to meet health secretary Patricia Hewitt for the first time. A colleague turned to him: 'Well, David, when you met John Reid you told him you used to be a communist. What are you going to tell Patricia?'

  • Laura Donnelly on primary care leaders

    One argument is that new strategic health authority chief executives, keen to assert authority and be seen to do so, are indulging in an exercise otherwise known as 'don't think much of yours?'

  • Laura Donnelly on the spirit of debate

    Bananarama's advice may ha

  • Leak reveals plan for Ofcare regime of fines and closures

    Underperforming trusts will face fines and closure under powers given to new health and adult social care regulator Ofcare, HSJ has learned.

  • Leaked DoH report

    Predicting workforce requirements accurately always presents huge challenges but it appears the AHP/scientist estimates are crude in the extreme

  • Lean thinking

    While there is evidence supporting a case management approach to the care of patients in the greatest need of healthcare, this has been less convincing than some seem to believe. Also, the creation of structures that are separate from general practice is both counter-intuitive and seems to run contrary to lean principles.

  • Learning disability and language

    Letters from Sam Smith, executive director, C-Change for Inclusion, Glasgow; Val Rowlands, superintendent physiotherapist, Stockport Learning Disability Service; and Rod Campbell, director of communication and development, The Regard Partnership, Kingston-upon-Thames

  • Lessons from history

    'I was to learn later in life that we tend to meet any new situation by reorganising'

  • Letters about cleaning contracts

    The comments by Andy Burnham ( read the story here) are not surprising as he has made them on a number of other occasions, but it is disappointing to see a government minister publicly taking such a short-sighted view.

  • Letters about NEDs

    I write as an non-executive director from a disbanded primary care trust. Seen from here, the appointment process to the new PCTs was a farce.

  • LINks must ensure vulnerable people are protected

    Regarding your article.'LINks scrutiny system to bar patient networks from access to key services', patient networks have access to the establishments described. These are the very places where high-profile problems sometimes arise with vulnerable people. It cannot be too difficult to ensure people are checked. There must be some deep-seated dislike of their work that has brought this about.

  • LINks must respect patients' wishes when conducting visits

    The Department of Health's.limitations on visits to care homes by local involvement networks.(LINks) is, in my view,.a patently obvious ploy to reduce the power of the public to have their rightful say (see 'LINks scrutiny system to bar patient networks from access to key services').

  • Lisa Rodrigues on managing change

    'Some people think the quiet revolution in mental health, with the closure of the asylums and the introduction of community care alternatives, is a model for the rest of the NHS. But I am the first to admit that we did not.always get it right'

  • Listening to complaints

    David Lee's article on listening to complaints was engaging. What would have been really useful is a sense of what has actually changed in the day-to-day operation of services and the impact on patient care, efficiency and staff relations.

  • Local authority role will mark out networks as a new voice

    It makes more sense for elected representatives to concern themselves with how health services are planned than how they are provided

  • London bombs: team NHS deserves better on comms

    'Adversity fuels learning faster than most other things'

  • London review: everyday problems at heart of proposals

    'Darzi argues that his approach to this study - listening to Londoners, building a clinical consensus, providing evidence for the recommendations, working with the mayor and London boroughs - provides the foundations for success'

  • Look to the long term for 2020 vision on climate change

    With front-page headlines this week warning that the UK's policies on climate change are set to achieve their 2020 milestone 30 years too late, the scale of the environmental challenge ahead becomes yet more daunting.

  • Lords a-leaping to the wrong conclusion

    In the last few days two lords with fingerprints on health policy reform - one a new minister and one a former one - both criticised the NHS's attitude to innovation.

  • Lots of turnaround, but no new direction

    Is turnaround working? The latest figures from the Department of Health suggest there is little evidence yet that it is. Read the news story here. While the number of affected trusts has risen from an original 52 to a current 143, there are few clear signs that turnaround is bringing real change. The weight of that long tail of financial problems remains heavy.

  • Louis Appleby on reaching out to BME communities

    'The term Positive Steps is an important one. The words and the actions coming from services must be positive. There is only so long that we can talk about the problem before talking about it gets in the way of tackling it.'

  • Malcolm Lowe-Lauri on a year of imagination

    'I'd like us to look back on a time when people came to a big shed and had 10 minutes with the expert'

  • MALCOLM LOWE-LAURI on Boards and Barricades

    The best boards are where the debate involves all the players, is messy but retains a sense of form

  • Malcolm Lowe-Lauri on clinical engagement

    'A meeting of minds gets enormous impetus when the fog of data is converted into information'

  • Malcolm Lowe-Lauri on getting safety on board

    'Accounts of long and complex journeys give a sense of inevitability of error'

  • Malcolm Lowe-Lauri on going back to the floor

    There's often no holding back. I got short shrift once from the cardiac nurses over agency staff policy.

  • Malcolm Lowe-Lauri on teaching hospitals

    'It is likely that the teaching hospital group will segment into different roles'

  • Malcolm Lowe-Lauri on the right targets

    Once upon a time the word target used to have many in healthcare reaching for their crucifixes, or whatever else was needed to ward off evil spirits.

  • Managing a merger? Don't lose the plot

    A new era of NHS mergers is upon us. But lessons from the business world show that they can be painful and uncomfortable. Steve Downing outlines a theatrical route to tackling the problems

  • Manchester inequalities missing

    Letter from David Regan, director, Manchester Joint Health Unit

  • Mark Britnell on starting life as an SHA chief exec

    'I recently chaired a conference where it was put to me that I would be neither a poacher nor a gamekeeper but rather the pheasant!'

  • Martin Pearson on warm glows and icy winds

    'Directors and managers of today's organisations need to recognise that they are there not only to create cost-efficient and financially successful health businesses but also to lead services in a way that saves the world from further degradation and climate chaos'

  • Maternity care: eyes on storks

    Government pledges on choice in maternity care are at odds with widespread reports of midwives crumbling under the pressure of slashed budgets, writes Daloni Carlisle

  • Maternity services are everyone's baby

    Labour's most recent election manifesto promised that by 2009 all women would have choice on where and how they have their baby.

  • McKinsey bid: controversy but no scandal

    'The suspicion will be that the people who shaped the market will profit from its creation'

  • Media watch

    Cleaning queens for Ealing 'comedy'

  • Media watch

    'Hats must come off for the clever combining of deficit and superbug'

  • Media watch

    The irony is that 'taking politics out of the NHS' is sure to be mired in political speculation

  • Media Watch

    Flinging a 'small morsel of red meat' to the pack would only make them salivate even harder for more

  • Media Watch

    'As junior doctors struggle to find work The Sunday Times claimed that the Department of Health survey on GP workload would show that family doctors were earning more and working less'

  • Media Watch

    'A Sunday Times.article quoted a survey commissioned by health insurer BUPA, which found 55 per cent of senior doctors pay for medical insurance'

  • Media Watch

    News emerged over the weekend that the 'inflexible' hours of GP surgeries were costing the economy an estimated £1bn a year.

  • Media Watch

    'The backlash came fast and furious. Leading doctors? Bully boys intent on pushing homeopathy out of the NHS, said the What Doctors Don't Tell You website'

  • Media Watch

    Given the arrival of a new prime minister and health secretary, most papers offered their advice to Gordon Brown and Alan Johnson.

  • Media Watch

    'Sack prat Pat' urged The Sun's leader as the paper told readers at the end of last week that 'if there's any justice, Pat Hewitt is not long for this political world'.

  • Media Watch

    What Gordon Brown's premiership will mean for the health service has yet to be seen, but one thing is certain: the NHS is bound for more tumultuous times.

  • Media Watch

    Another week, another government attack on fatties and smokers as The Sun told readers that the 'fatties' op' ban is 'fair'. It quoted health secretary Patricia Hewitt who said it was 'perfectly legitimate' for trusts to refuse some treatments to heavy smokers and obese patients.

  • Media Watch

    A pledge made 10 years ago by Tony Blair returned to haunt him this week.

  • Media watch

    'We are supposed to be a nation of dog lovers, but was this a step too far?'

  • Media Watch

    Your caring, sharing News of the Worldthis week chose to reveal that David Beckham's son Romeo suffers from epilepsy by splashing with a front-page picture of the four-year-old cowering from the paparazzi's flash guns.

  • Media watch

    Even if they do not come up with any new policy, they've got an awful lot of ammunition with which to bombard the government

  • Media watch

    And there you were thinking he seemed like such a quiet chap, but last week health minister Andy Burnham came out all guns blazing as he took at a swipe at people who 'get out their placards' when their local hospitals face closure.

  • Media watch

    The surrounding media coverage has led to yet another round of NHS manager bashing

  • Media Watch

    'The focus has well and truly turned to the NHS, as it once again becomes the battleground for the next election'

  • Media Watch

    Thousands of junior doctors are to be shipped abroad, The Daily Telegraph said this week as it claimed 'up to 10,000 young doctors unable to find NHS jobs could be offered voluntary work overseas'.

  • Media Watch

    'The Daily Express claimed nurses were 'close to working to rule', saying: 'The move comes after nurses in England were denied the full 2.5 per cent pay rise given to colleagues in Scotland, Wales and Northern Ireland for doing exactly the same work''

  • Media Watch

    The Department of Health is the second worst-performing government department, The Times told its readers at the weekend. It reported that the review by business leaders and public sector chiefs commissioned by cabinet secretary Sir Gus O'Donnell was damning about the DoH's 'lack of direction'.

  • Media Watch

    'Ding dong as hospital bans carollers,' said The Daily Telegraphas it revealed that the Torbay Gospelaires had been banned from entering Torbay hospital wards.

  • Media Watch

    So began the week of blanket coverage of the British Medical Association’s annual whinge-fest conference

  • Media Watch

    'Don't play god' The Sun protested last week as it quoted campaigners warning that abortions 'will soar' if parents are allowed to use a 'revolutionary' home test that can reveal the sex of their baby at six weeks.

  • Media watch

    EMPTY

  • Media Watch

    Everyone was looking the other way on 16 June when the Financial Timesbroke the story that the government was advertising for private sector primary care trust management services.

  • Media watch

    Its conclusion: the 'glitzy 'joined-up' NHS remains a low-tech hotch-potch'

  • Mediawatch

    New year, new resolutions, and even the media is backing smokers on their quest to kick the habit.

  • Mediawatch

    .

  • Meldrum unconvinced by BMA's 'cosy' reform plans

    The new chairman of the British Medical Association has distanced himself from one of the union's major recommendations for health service reform.

  • Mental health and ministerial promises

    Why should the Government be believed when it hints at non-statutory answers to some of the issues around reform of mental health law (Michael White column, 4 January, page 10). The evidence tells us that we should be very wary of trusting them.

  • Mental health farce cannot go on

    The present deplorable state of affairs in mental health facilities is easily explained. Between 1970 and 1999 some 87,000 mental health beds were closed, according to the Department of Health.

  • Merit awards

    Dr Giles Croft's lament about the inaccuracy of Hospital Episode Statistics and their inappropriateness as a means of managing the performance of doctors (HSJ, November 2nd) raises the nice issue of why there are some problems with HES accuracy. Surely such inaccuracies are the product of failures by clinicians to take such recording seriously?

  • Michael Mandelstam imagines the confessions of a chief executive

    'I follow neither rhyme nor reason, only the health secretary. I am a member of an elite, a new breed of NHS chief executive, ruthless and efficient - not like the old softies, few of whom now remain'

  • Michael White on politics

    'Insiders already knew that the cash figure which health officials cite includes local IT costs which replace existing local IT costs'

  • Michael White on politics

    'It would have taken a chainsaw to separate Ms Hewitt from the job, despite everything'

  • Michael White on politics

    'The charges problem boils down to a classic dilemma of democratic politics in a market-orientated society'

  • Michael White on politics

    The end of the road for Blair

  • Michael White on politics

    My conclusion, Watson, is that it is what street urchins call a cock-up, not a conspiracy

  • Michael White on Politics

    I think Hewitt will leave the DoH, not something I would have confidently stated a. month ago

  • Michael white on politics

    Devolving power to the front line is a crucial test for Brown, an instinctive centraliser.

  • Michael white on politics

    'Mr Dorrell cited that withering phrase used in school reports that Ms Hewitt is 'too easily satisfied with her own work''

  • Michael White on politics

    'Labour MPs like Johnson, indeed they would have made him deputy leader'

  • Michael White on politics

    'Alan Johnson is keen on neglected causes like stroke so his startling brevity in the debate implies no disrespect'

  • Michael White on politics

    'It is hard for health professionals to admit it, but the Daily Mail is not always wrong'

  • Michael White on politics

    'The key is persuading voters that many changes are driven by medical purposes, said Gordon Brown'

  • Michael White on politics

    I spoke to Lord Hunt at the weekend, probably for the first time since he returned to government via the Department for Work and Pensions after resigning with quiet dignity over the Iraq war in 2003.

  • Michael White on Politics

    Many Scots assume an SNP-led team would have to modify policies in the face of harsh realities

  • Michael White on politics

    In Oz there is tension over the public sector losing out in budget tussles with private-sector providers

  • Michael White on politics

    'Voters are losing patience with Labour's performance - and its excuses'

  • Michael White on politics

    'There's no point replacing meddling by national politicians with meddling by local ones.'

  • Michael White on politics

    'The McElephant in the corner, of course, is devolved Scotland, where personal care is free'

  • Michael white on politics

    'Don?t think, Mr or Ms Finance Director, that you can force Ms Hewitt out by hiring some extra doctors or buying a fleet of scanners'

  • Michael White on politics

    What made me flinch wasn't those weekend reports that UK cancer patients are turning to Canadian online pharmacies for drugs they cannot yet get on the NHS.

  • Michael white on politics

    'NHS managers planning new hospitals or services might start thinking greener than they have done up to now'

  • Michael White on politics

    In my youth the old Liberal Party could squeeze into Margate or magnificent Scarborough

  • Michael White on politics

    'All's fair in love and politics and Labour used to say 'Tory cuts' when it really meant smaller increases'

  • Michael White on politics

    ' The DoH is officially saying nothing, but my chums tell me they have no qualms about the quality of the iSoft product'

  • Michael White on politics

    'Alan Johnson's been put there to talk to staff and take people with him, explains one ally'

  • Michael White on politics

    'One insider said Gordon Brown is obsessed with the NHS and he'll have his hands all over it. That figures'

  • Michael White on politics

    Sunday night is usually quietly un-newsy and health politics is no exception. But not last Sunday night, when it emerged that British Medical Association chair James Johnson had fallen on his scalpel over the medical fiasco.

  • Michael White on politics

    It is the Hewitt-Blair vision of US-style competing hospitals which causes offence to activists in Wales

  • Micheal White on Maggie's handbag and other stories

    Thirty years after filing his first column, HSJ political commentator Michael White looks back at how the landscape has changed

  • Mike Cooke on mental health

    'The reason? A lost couple of inches of trouser protection over my backside. My local notoriety was re-established.'

  • Mike Cooke on mental health

    'For mental health and related illness, problems and conditions one needs to be convinced about the who, what and why of the choices on offer.'

  • Mike Cooke on mental health

    'Yes, I am a service user as well as a chief executive. I am in recovery. I have experienced depression, and view this as a strength.'

  • Mike Cooke on mental health

    'Cross-cutting government initiatives on respect, anti-social behaviour, mental health and social inclusion and incapacity benefit are all beginning to emerge.'

  • Mike Cooke on mental health

    'We have to dance, sing and juggle, often at the same time - and now we need more proof we are accountable'

  • Mike Cooke on mental health

    We have made me

  • Mike Cooke on succession planning

    'I came back with gusto, lungs full, laptop (and pencil) poised and with best away-visit intentions started with my job. I am delighted to say we did fill my job with a great internal candidate'

  • Mike White on politics

    'Would an NHS constitution require primary legislation? How would an arm's-length board be accountable? Tricky'

  • Mike White on politics

    'The Lansley policy is that an independent body should allocate resources to each PCT according to need, largely age-related; that health inequality budgets should be paid to directors of public health; and that the shift to a new weighted capitation formula should be done over several years to prevent budget cuts.'

  • Mike White on politics

    'Handy Andy Burnham urges respect for NICE's independent experts and insists that complementary medicines (another regular bugbear) must be a matter for 'local determination'.'

  • Mike White on politics

    'Mr Blair retains a lot more drive and determination than Mr Major had (ever), but his authority is fading'

  • Mike White on the Lords

    'You cannot expect a nurse to handle 50 staff and a £1.5m budget without training'

  • Minister puts onus on trusts to negotiate unbundled tariff

    Primary care and acute trusts need to negotiate their own ways to unbundle the payment by results tariff, health minister Lord Warner said as he launched the 'road test' of next year's tariff.

  • Ministerial support and local MPs

    So the Home Secretary, Labour Party Chairman and Labour Chief Whip are all campaigning against the implementation of NHS policy in their constituencies. Hazel Blears will be able to give the threatened maternity unit in Salford meaningful and persuasive support, in due course, through Patricia Hewitt.

  • Ministers must win battle on provision to fulfil early promise

    'While other parts of the public sector have learned to work with a mixed economy, the NHS still flinches at the idea of private involvement'

  • Minor injuries units are valuable for predicting outcomes

    Geraint Lewis's comments on using clinicians' knowledge to predict.outcomes was very interesting ('Tapping into staff knowledge').

  • Model contract and foundation trusts

    Two issues highlighted in HSJrecently - the model contract ( HSJ, page 5, 1 February 2007) and an NHS charter ( HSJ, opinion, pages 18-19, 2007) - show how current NHS reform is engendering contradictory expectations.

  • Money no excuse for hampering progress

    As a medic and former White House adviser, Dr Mark McClellan is a natural opinion leader on health policy. He explains his vision

  • Monitor criticised for data demand

    The foundation trust regulator Monitor must not seek to 'enhance' its regulatory role, Foundation Trust Network director Sue Slipman has warned.

  • More readers responses to Gerry Robinson TV programme.

    I appreciate the disappointment Brian felt about the programme and the programme makers. However, I would argue that there are some critical defects with the approach that says much about the 'Gerry Robinson' style.

  • Mortality rate calculations are 'highly inappropriate and contentious'

    Anyone picking up last week's Daily Telegraph will have seen the shock-horror headline on hospital mortality rates. This was typical media hype that did nothing to assist the discussion about encouraging improvement in the NHS, nor how we reduce inequalities across the country.

  • Moving down the line to financial stability

    The recent merger of two acute trusts hints at things to come as struggling organisations are forced to re-examine their options. Chris Ham surveys the new structural landscape of the health service

  • MP wants medics in uniforms to cut infection

    Doctors should change into uniforms on entering hospital to help stop the spread of infections, according to an MP whose local hospital became the first to be served with a hygiene improvement notice.

  • MPs cannot be beaten, so try taming them

    Whether they are sat on Commons select committees or stood outside your offices with a banner, MPs can seem like fierce and unpredictable beasts. Many seem to take unwholesome delight in raking their claws across health service plans, particularly at a local level, and even when they have secretary of state for health on their CV.

  • Much-needed campaign brought cheer in the midst of gloom

    'Andy Burnham makes some thoughtful points about how managers can improve their own publicity'

  • Name of the game is not 'no blame'

    A 'no blame' culture may be useful but is not an end in itself. Frank Burns argues that evidence of real progress is needed.

  • NAO and Dr Foster

    Your editorial ('Criticism of Dr Foster JV masks the real story about poor data', 8 Feb) portrays the National Audit Office as worrying over a relatively technical issue of competitive tendering when the real story is about the lack of good data in the NHS. This is to misunderstand our report.

  • Neil Goodwin on apologising

    The two most important words in organisational life may be 'I apologise', but saying sorry can be counterproductive unless the sentiment is backed with service delivery changes

  • Neil Goodwin on politicians, customer care and a portfoilo life

    'I confess to not missing the grind of the job; 36 years is long enough for anyone. I also do not miss politicians who have a tendency to be personally abusive'

  • Neil Goodwin on public service reform

    'If there is one lesson to be learnt.from the past 10 years, it is to pay much more attention to implementing change. Far better to implement half-a-dozen change strategies effectively than to fire off a dozen in a scattergun way, hoping some will hit the mark'

  • Neil Goodwin on Serbian princes and American cousins

    'Mixing with Europeans always reminds me how European we are in the UK and how much less we have in common with the USA'

  • Neil Goodwin on the importance of partnerships

    'With the little wisdom, insight and maturity that I hope I have developed with age and experience, I am able to confess that some inter-organisational relationships suffered as I pursued system-wide strategic change'

  • Neil Goodwin on the training challenge for NHS managers

    'Foundation trusts will need to lead the way in learning to establish effective working relationships with their investors, namely primary care trusts and practice-based commissioners, and being proactive in discussing future strategy.'

  • Neil Goodwin...with the Beckhams in Venice

    'Nothing would be worse for Beckham, Venice and the NHS to hear people say that they were once great but that was a long time ago'. Our new online-only columnist brings us the first of his regular diary piece charting life after NHS management

  • New day, same old reforms

    I haven't had any first hand experience of this latest round of organisational change in the English NHS, having left it to work in Scotland some years ago in horror at the Tory internal market 'reforms' that resulted in the mass-sacking of almost everyone I respected in NHS administration.

  • NHS complaints

    I read David Peat's article on lost baggage and fielding complaints with great interest. His comments in the penultimate paragraph are particularly encouraging.

  • NHS independence: removing politicians will leave a hole that must be filled

    Would an 'independent' NHS create a worse provider monopoly than British Leyland or set it lose from the targetitis of Whitehall? Who would hold the reins of scrutiny - regulators, Parliament or local councils? Where are the models - the BBC, Scandinavia, Oregon or New Zealand? Is independence even a coherent goal or a continuum to be judged against different functions and organisations?

  • NHS managers have a key role in local politics

    'The NHS too often guards its plans for too long and too fiercely'

  • NHS Partners Network respond to commission report

    I read with concern your article of January 18 reporting on the leaked Healthcare Commission draft report into data on clinical quality of independent sector treatment centres (ISTCs).

  • NHS set for £13m net surplus despite rising levels of debt

    The NHS is predicted to make a £13m surplus this financial year, according to the latest Department of Health forecasts.

  • NICE and value for money

    I am currently denied a particular course of medication, in the sense that NICE has determined that the NHS would not receive value for the £2,000 per month that it would cost.

  • Nicholson: let local managers drive health service reforms

    The NHS chief executive's advice to any incoming health secretary is to steer clear of further structural upheaval and allow managers to drive reform locally.

  • Nicholson: mixed reviews but the right idea

    Six weeks into the job, NHS chief executive David Nicholson has had a few days in which he will have felt the full force of the pressure he must withstand in his role at the centre of the increasingly heated debate about the future of the NHS.

  • Nick Summerton and colleagues on what topics should NICE consider

    Last September NICE took over the topic suggestion and selection process from the Department of Health. Six months on it is clear that the new processes are working: topics are being collected, sifted, and prioritised speedily.

  • Nicolaus Henke on Michael Porter's partial answer

    The Harvard Business School guru's book Redefining Healthcareis a fascinating but flawed study of reform from which the NHS could learn, says McKinsey's head of global health systems

  • No need for foundations to get in a stew if the mix is right

    The new governance code provides the five key ingredients with which foundation trusts can help boards develop effective leadership and cultivate roots in the community. Monitor chair Bill Moyes explains

  • No quick fixes but Sir Gerry did find room for improvement

    Last week's BBC2 programme, Can Gerry Robinson fix the NHS?, may not have fixed anything by itself but has certainly got the NHS talking. Inevitably there is a range of views about both the diagnosis and cure put forward by the business guru during his stint at Rotherham foundation trust.

  • Noel Plumridge on disinvestment and decluttering

    What would NHS managers dump on the hospital lawn ready for the crusher or eBay?

  • Noel Plumridge on finance

    'I couldn't resist it: 'Have you thought of taking up golf?' I quipped'

  • Noel Plumridge on payment by results

    I'm sorry, local currency and price is not payment by results in. a meaningful sense

  • Noel Plumridge on PFI passions running high

    'Call a handyman to fit a notice board? Oh no, you'll need a quote from the PFI company'

  • Noel Plumridge on questioning commissioning

    As HSJreaders will be aware, the Department of Health is keen to improve standards of commissioning in the NHS.Much has been written in recent months about demand-management techniques (or rationing, as we used to call it) being the route to financial happiness. About the attractions of innovative 'spend to save' schemes built around the skills of newly recruited commercial experts and advisers. About why the modern GP should spend more time in commissioning meetings rat

  • Noel Plumridge on the non-exec conundrum

    'How can one challenge yet remain part of the team? That's the non-executive dilemma'

  • Noel Pumridge on workforce planning

    Or, in simple terms, why should the NHS pay a nurse in Workington almost as much as a nurse in Wimbledon? She'll only fritter it away anyway.

  • NPSA and menus

    Your article 'NPSA attacks meaningless glossy menus' (news, 12 October, page 16) misrepresents my comments at the patient safety fringe event during the Conservative Party conference.

  • Nursing chief is good and bad cop all in one

    The Royal College of Nursing's general secretary, Peter Carter,.has altered its stance on reconfiguration, plurality and the wisdom of heckling Hewitt. But he promises fierce opposition to poor management and short-term cuts

  • o/p19/061130

    'My local supermarket does not call me an inappropriate shopper - ever'

  • o1/p20/070426

    With European law and the emphasis on work-life balance already shaking things up, what does the future hold for medical education? Three experts predict the shape of things to come

  • Occupational therapists in the picture

    I write with reference to the photograph on page 9 of HSJ on 15 February, 'Airedale gets rehabilitation down to a tea'.

  • Occupational therapy

    I read with great delight the article by David Woodheadreferring to the virtues of working on an allotment and how beneficial it is.

  • Ofcare: 'Ambitions and metrics' mark launch of a new regulatory era

    'Ofcare's performance framework commences with mea culpa, admitting what healthcare professionals have been telling the Department of Health for years - top-down targets undermine innovation, motivation and accountability to communities'

  • Open or shut case as service shake-ups hinge on SNP result

    An SNP victory in next week's Scottish elections would take a hatchet to a host of Labour's NHS reforms north of the border, writes Jennifer Trueland

  • Order in the house: will legislation strike the right balance?

    The supervised community treatment order is the latest legislative tool aimed at tackling 'revolving door' patients. But does it go too far? Mark Gould hears the pros and cons

  • Organisational energy

    I agree totally with Helen Bevan's article on organisational energy but can't help thinking about the amount of energy being wasted in primary care trusts across the country as they grapple with the Commissioning a Patient-Led NHS.reconfiguration.

  • Outspoken Wanless returns to judge a dream deferred

    It comes as no surprise that Sir Derek Wanless believes that the promise laid out in his seminal 2002 report is becoming a dream deferred.

  • Overtime is out of line

    It was interesting to compare your headline - 'Thousands doing unpaid overtime' with the Healthcare Commission's press release on the topic. The latter did not mention in its commentary on the survey results the huge amount of unpaid overtime done by NHS staff, only reporting details in the sector breakdown at the end of the press.release.

  • Overtime work and incentivising doctors

    I am slightly amused that the '75 per cent.NHS workers do unpaid overtime' article is in the 'news' section. I qualified in 1983 and it has certainly been the norm for me for the last 24 years.

  • Pace of reform

    Keith Palmer argues persuasively that there is a need to maintain the momentum of reform (Opinion, page 22, 12 October) but his analysis illustrates a fundamental difficulty. He focuses largely on secondary care and the only reference to general practices is about their referrals to other services, although he does discuss practice-based commissioning elsewhere.

  • Pandering to protests won't find answers

    'The system Mr Cameron is proposing would produce a health service reflecting local wants, not needs'

  • Partnership working needs financial conviction

    'Anxious to move on from rows over cost-shunting, the Association of Directors of Adult Social Services has pledged to champion partnership working, pooled budgets and joint commissioning'

  • Patient and public involvement: clear water must flow into the goldfish bowl

    Looking for a place to hide? Try the massed ranks of organisations currently holding the NHS to account. Jessica Crowe suggests clarity lies in resolving what it is accountability structures should be delivering

  • Patient choice online

    Although the Minister's announcement of a new supersite supporting patient choice is something to look forward to, personal experience of the system leaves deep misgivings about just how effectively a web based service will work with a paper-based mind set.

  • Patient involvement

    A current exemplar of the way the government misjudges citizen engagement is the proposal to introduce LINks and abolish Patient and Public Involvement Forums.

  • Patient safety: Avoiding blame will not remove danger

    Is the desire to establish a 'no blame' culture around patient safety becoming dangerously close to being seen as an end in itself rather than as a necessary aid to progress?

  • Patient safety: err on the side of caution

    I wish to add a mental health service perspective to the debate prompted by Frank Burns' insightful article 'Name of the game is not no blame' and his challenging assertions (opinion, p16, 12 April)..

  • Patient safety: the blame game

    I find HSJ's reporting of the concept of 'no blame' in patient safety incidents.incredibly disappointing and disquieting (opinion, page 16, 12 April).

  • Patients' memory of offer of choice

    It has been nearly a year since choice at the point of referral to hospital by GP was to be formally offered to all patients. Are the poor now getting the choices that have always been available to the rich (to paraphrase former health secretary John Reid)? And through their choices, are patients exerting pressure on providers to improve the quality of services (to paraphrase Tony Blair)?

  • Patricia Hewitt's letter regarding Monitor Compliance

    Your article on 7 December ( Monitor will demand service level figures from foundation trusts) refers to general comments I made during last month's NHS Alliance conference about the importance of effective partnership working in the NHS.

  • Paul Cooper on emergency ward nine and a half

    'Our local doctor is as good as anyone else's, I suppose, although I don't really know that as I have little choice'

  • paultestsecurity1

    paultestsecurity1

  • Pay and workforce reforms

    I read with great interest your coverage of the leaked DH report on the pay and workforce strategy for 2007.

  • Pay and workforce strategy 2008-11

    There is currently great confusion among hospital doctors as to how best to respond to the many changes in employment conditions that are affecting our working conditions

  • Pay and workforce: GP contract delay is the first staff salvo

    The government will still be desperate not to see another staff group set itself against reform, particularly given the crucial role primary care will play

  • Payment by results and productivity

    Noel Plumridge is perplexed by the dilemma of paying for payment by results-induced productivity within a closed, cash-limited system (HSJ, 22 February). I.thought the answer to that was price. As the volumes go up so unit prices go down.

  • Payment by results and South Yorkshire

    Noel Plumridge states (HSJ, 22 February) that there was 'never really payment by results; it was always payment for activity' and highlighted the need for incentives for clinicians.

  • PBC needs to look at the big picture

    In response to Simon Stevens' article on practice-based commissioning (opinion, page 17, 3 May), PBC has to be for all practices. If nothing else, PBC is about raising the eyes of GPs and practice management to understand the wider commissioning impact of their actions.

  • PBR versus payment for performance

    Mike Farrar ('PbR to become 'payment for performance' in NHS North West', HSJ 1 February) is right - there is no reason why pay for performance (P4P) can't be introduced into the NHS.

  • PCT autonomy plans dropped

    The Department of Health has backed away from proposals to give primary care trusts complete autonomy to set policies on NHS funding for continuing care.

  • PCT network to 'manage creative tensions'

    Tensions between acute and primary care trusts could be soothed by the new NHS Confederation PCT network, its chair has said.

  • PCTs already share local service knowledge

    I was saddened on reading your article 'PCTs criticised for lacking local service knowledge', (News, p13, 26 April) as it makes no mention at all of PALS (Patient Advice and Liaison Services).

  • Peter Cardy on rewriting the cancer plan

    As cancer care shifts out of hospital, more cancer patients risk poverty as the associated costs rise. Now is the time to tackle the financial distress of the diseas

  • Peter Crutchfield on the end-of-life experience

    'If there is any such thing as a good death, I believe John had one. It was a very special experience for him to be able to stay at home with us until the end'

  • Peter Mason on social enterprise - the new punk rock?

    'Social enterprises have crashed onto the scene with the same energy and style as punk rockers, the new kids on the block full of passion and hope'

  • Peter Penson on one way to cut the NHS drugs budget

    In recent months, the media has reported numerous cases of patients campaigning to be given expensive anti-cancer drugs such as Herceptin by the NHS despite a lack of NICE approval. Difficult decisions must be made about how money should be spent and where economies can be made.

  • Petitions can a play role in local engagement

    EM Forster famously gave democracy two cheers; the NHS seems rather less enthused.

  • Pick-and-mix NHS will serve all customers

    Having the right people involved in the right discussions is the key to keeping the NHS in check, says Anna Coote, while Jessica Crowe argues for a wide form of accountability that leaves no voice unheard

  • Pioneers race on but progress is measured by the backmarkers

    'It is notable that not one of the 13 early achiever sites comes from NHS London or NHS East of England'

  • Political accountability for health

    Congratulations on you superb and balanced debate on politics in healthcare! It was clear from your panel that strategic direction and accountability must lie with politicians when public money is being spent - a very welcome stance, it is just a shame that it does not happen now.

  • Political bias on Dispatches

    I am writing to complain about the recent Channel 4 Dispatches programme on the NHS, which was politically biased...

  • Power to close NHS organisations gives super-regulator super-teeth

    A long delay can create its own sense of drama - such is the case with the regulatory review which has been promised for the best part of a year and gone through various drafts (including a complete overhaul by McKinsey). In the event, the result published this week makes important changes but leaves some questions unanswered (Read news story here).

  • Predicting the future

    We were interested to read the article on telephone based health coaching for patients with long term conditions (Predicting the Future), though it was not clear how many patients were actually receiving such care.

  • Predicting unplanned admissions

    Your article 'Long Term Conditions: Predicting the Future' (2 November 2006) showed the value of measuring the risk of patients experiencing unplanned admissions to hospital, and I thought it would be helpful to highlight other work that is underway

  • Pret a Porter?: what a US business guru has to teach the NHS

    An academic tome about the US health system, even one co-authored by one of the world's most renowned business theorists, seems an unlikely hit for an NHS audience. But Redefining Healthcare: creating value-based competition on results, by Michael Porter and Elizabeth Olmsted Teisberg, has caught the attention of UK policy-makers, commentators, reformists and politicians for its diagnosis and prescription for a health system high on cost and low on quality; heavy on process and light on measurem

  • Primary care: what will improve discharge summaries?

    GPs are complaining this week that they are 'plagued by delays' and errors in the quality of discharge summaries many of them are sent by hospitals (see news story). According to an NHS Alliance survey, almost 60 per cent say clinical care has been compromised as a result and almost 40 per cent say patient safety has been affected.

  • Privacy in hospitals

    I have always had a problem with issues of privacy in acute hospitals. I started my career as a clinical psychologist working with people with learning disabilities and being very aware that I was going into people's homes - even when they were in NHS care.

  • Private sector's role is irrelevant for efficient commissioning

    You report on a possible deceleration in NHS commissioning of private sector healthcare provision ('Private slow-down expected as service prepares for Brown'). It may seem odd to hear a private sector organisation saying this, but if such a phenomenon occurs, it will not necessarily be a bad thing. This is provided that it does not undermine the idea of efficiency through competition..

  • Professor David J Hunter and Jeffrie Strang on public health and organisational reform

    The justification for the current reorganisation of strategic health authorities and primary care trusts is to strengthen the commissioning function of PCTs and to save £250m in management costs. But are these good enough reasons and will the mergers create a period of stasis?

  • Progress is about perception as headlines and reality clash

    While optimism over the NHS is low, the public's feelings about services and choice are more positive. These contradictory perceptions mean GPs, managers and the DH have their work cut out ensuring patients 'interpret' reforms favourably, write MORI's Ben Page and Jonathan Nichols

  • Protecting public and patient involvement

    The blind drive to force the introduction of local involvement networks and abolish patient and public involvement forums is dangerous and misguided.

  • Public health

    Professor David Hunter's piece was an excellent, balanced article with a clear conclusion. I couldn't agree more on the need for a moratorium on organisational reform and its negative impact on public health, particularly public mental health.

  • Public health and organisational reform

    Professor David J Hunter and Jeffrie Strang story on public health and organisation reform was an excellent, balanced article with a clear conclusion - I couldn't agree more on the need for a moratorium onorganisational reform, and its negative impact on public health, particularly public mental health, my area of particular interest.

  • Public health Barometer, February 2007

    The single biggest rise in confidence in the latest Barometer survey of public health directors was for the access target on sexual health services, the overall number up from 6.08 out of 10 to 7.09. At the other end of the scale, optimism on the 2010 childhood obesity target has fallen to an all-time low, down from 3.33 out of 10 in December to 3.15.

  • Public health barometer: Dec 2006

    Faith in national targets on child obesity and teenage pregnancy continued to fall, according to results from the latest HSJ Barometer survey of primary care trust public health directors.

  • Public health must move in 'corridors of power'

    The voice of public health must become less 'fragmented', according to new Faculty of Public Health president Professor Alan Maryon Davis.

  • RAB is on its last legs, but trusts must look to a future in surplus

    Resource accounting and budgeting has no friends left and its days are numbered; we just do not know what that number is yet.

  • 'Radical rethink' needed to cope with staffing crisis

    One in five school leavers will have to make the NHS their employer of first choice if future vacancies are to be filled and services maintained.

  • Raj Persaud: Mind games

    If we get too good at explaining away our failures then maybe there is little motivation to succeed

  • Readers responses to Gerry Robinson TV programme

    We would like to address the recent programme 'Can Gerry Robinson fix the NHS?' and the comments made in return by Brian James, Chief Executive of Rotherham Foundation Trust.

  • Reform and instability

    'Why instability is inevitable' - Simon Stevens' article on the NHS and the J curve (page 19, 19 October) reminded me of a classic false syllogism: 'It always gets worse before it gets better.It certainly is getting worse. Therefore it will get better.'

  • Report condemns 'information overload'

    Trust boards are drowning in 'Amazonian' levels of useless information, the latest Intelligent Board report from Dr Foster has found.

  • Report ignores Queen Mary's progress

    I object to the description of Queen Mary's Sidcup trust as a 'struggling' organisation. In fact, we are an example of a hugely successful turnaround

  • Report points to NHS culture of bullying and bureaucracy

    'Middle managers need more support to survive in the treacherous terrain between their bosses and clinicians'

  • Response to Gerry Robinson and Brian James

    Comments on Gerry Robinson's contribution and the programme in general seem to reflect comments in almost any discussion about 'NHS' and 'management'. The issues are so emotional for so many people that it's difficult to overcome bias. As a change manager, with some experience of the NHS, my bias will be towards what I know management canachieve.

  • Responses to independence roundtable

    It appears that participants in the roundtable discussion on independence of the NHS pulled their punches. Let me not pull mine.

  • Responsibility for tackling violence lies with all of us

    I found your article on violence in the NHS (16 April) excellent and refreshing. I work as a local security management specialist in Dorset and agree that tackling violence and crime in the NHS is a multi-agency task.

  • Restoring confidence requires an end to financial fudges

    .'With the NHS moving .towards a more transparent. market, top-down decisions. on the distribution of funds. must not become the norm.'.

  • Return to the windmill - behavioural modelling and the future

    The lack of a 'big picture' of where reforms will take us means investment and strategic planning are severely hampered. Alasdair Liddell and Laurie McMahon describe a behavioural modelling approach that can help

  • Richard Barker on why the IT programme is never going to come right

    'NPfIT will never get back on track; it was never on track in the first place. It breaks every rule of project management - from scoping to delivery - and is patently failing to take into account the actual requirements of clinicians across the NHS.'

  • Richard Bourne on rethinking the role of local government

    'Local government may not be brilliant at commissioning but they are better than the NHS. They have been at it longer, they have already embraced provider plurality, commissioning, market management, best value, overview and scrutiny and public engagement'

  • Richard Bourne on the price of better performance

    The NHS.occupies a special place in the national psyche. It is a huge organisation with the major economic consequences implied. It is at the heart of politics, with the perceived state of the NHS being a proxy for the popularity of a government.

  • Richard Morgan and Allison Thorpe on social marketing

    'Social marketing recognises that, all things being equal, people will choose behaviours that keep them in good health. But all things are rarely equal; most people have to make choices and compromises'

  • Rights and responsibilities is the issue on the Cabinet table

    The government believes it has to reassert its power to make policy in response to the Brown-Blair faction-fighting of the autumn. Public services is one of six policy areas under debate (the others include the role of the state, crime and security) and the first to arrive on the Cabinet table last week. We understand that key themes are already emerging.

  • Ringfencing is only a short-term cash fix

    'Local flexibility is a principle that needs defending. Ringfencing is only convenient so long as the political wind is blowing in your direction'

  • Robert Greene and Paul Ray on foundation finances

    Patient choice presents particular challenges for foundation trusts, so good revenue forecasting is needed, say Robert Greene and Paul Ray

  • Robina Shah on a day in the life of Patricia Hewitt

    Trust chair Robina Shah spends an exhausting day in the shadow of health secretary Patricia Hewitt

  • Roger Noon on six immediate steps to better change management

    I don't envy the leaders of PCTs. Following the recent rationalisation programme, they are under more pressure than ever to deliver improvements in healthcare within tight budgets and aggressive timescales. This against a backdrop of continuous political, policy, regulatory and clinical change.

  • Rotherham chief executive Brian James on why Gerry Robinson can't fix the NHS

    'Disappointingly, Sir Gerry never seized the opportunity to explore and challenge consultants as to how they could be more efficient and productive, which is ultimately the key to eradicating waiting times. The opportunity was sacrificed for a much simpler story of consultants versus managers, with both sides presented as stereotypes.'

  • Ruth Harrison responds to Healthcare Commission on C-Dif

    I am writing with reference to your article on Healthcare Commission.standards published on the 15 March 2007 on page 5 that referred to me by name.

  • Safe crackers

    Putting patient safety at the heart of NHS services needs a significant cultural shift. HSJ and Microsoft brought together key leaders to ask how to make this happen

  • Separating provision and commissioning

    Jennifer Taylor's piece entitled 'PMs unit pushes more, but 'fairer', competition' was an important news article however does raise a fundamental question about whether entrenching a more explicit separation of commissioner and provider functions is indeed the right policy.

  • Service at Nuffield Hospitals gets 'better and better'

    I note with interest the views of Michael White.and his 'Whitehall chum' on the competitive merits of Nuffield Hospitals and others, who have apparently been 'found wanting' in the process of market reform.

  • Service link economics

    Can Monitor chair Bill Moyes and KPMG consultant Kate Barber explain what is new about the 'The new economics' and justify the statement: 'Treating individual services as profit and loss units promises to transform financial management and clinical engagement' ( HSJ, 16 November 2006)?

  • Service link economics

    Letter from Angie Jezard, senior consultant, AJ Financial and Strategic Healthcare

  • Service reconfiguration

    While there may well be a case for focusing resources on a smaller number of acute sites, there is a huge issue about accessibility and convenience, which doesn't sit well with the supposedly consumer-friendly modern NHS.

  • Service redesign consultations

    I worry we have lost the plot. In the last two weeks I have received four different letters from solicitors offering me advice on consultation. Post Derbyshire some colleagues have become obsessed with what we need to satisfy our legal friends. How grim. Have we really got to the point where we call our solicitors before we chat to patients?

  • Service-line economics goes to the heart of patient care

    As we reveal this week, foundation regulator Monitor will be consulting trusts on compliance guidance to push the adoption of service-line economics (feature, page 22).

  • SHAs told they must plug shortfall of 14,000 nurses

    It is outrageous that there are still significant cuts in education budgets and educational training for our community nurses

  • Shelved report exposes PFI management problems

    An unpublished report into private finance initiative hospitals has highlighted the problems trusts face in performance managing and enforcing contracts.

  • Sickness absence rates

    The NHS Partners findings neatly sidestep the probability of false sickness absenteeism, or 'pulling a sickie', being a component of the 4.6 per cent absenteeism figure ( click here to read the full story).

  • Silence can mean fear, not support

    'One can understand why anxiety, uncertainty and fear rule'

  • Simon Stevens on a summer of discontent

    'So as we head into TUC and party conference season, by comparison things actually look pretty tame here. Part of the problem is the way international health comparisons are used - and abused.'

  • Simon Stevens on engagement and alienation

    'Clinical engagement has to be approached critically. It cannot be pursued as an end in its own right'

  • Simon Stevens on happiness and health

    'Six factors apparently explain 80 per cent of the variation in happiness... Not all of these can be tackled by a typical primary care trust.'

  • Simon Stevens on long tails and J curves

    'Bremmer's book turns in a clever explanation for why things often get worse before they get better'

  • Simon Stevens on powering reforms

    Almost everywhere you look, it is possible to see the NHS equivalent of electricity transmission losses

  • Simon Stevens on the case for independence

    It now seems likely that, regardless of political party, our next prime minister will toy with some version of 'independence' for the NHS. Independence for the Bank of England is seen as one of the government's more important reforms, so an NHS parallel could resonate. And shadow health secretary Andrew Lansley told the NHS Confederation conference that the time has come 'to take politicians out of the day-to-day management' of the service.

  • Simon Stevens on the great pbc debate

    PBC is desirable but sadly not workable as a universal mechanism. It wasn't in the 1990s, and it isn't now

  • Simon Stevens on the lost art of analysis

    'Explaining NHS Deficits detonates many of the most powerful urban myths surrounding the NHS'.

  • Simon Stevens on winning hearts and minds

    'NHS targets have not yet been tough enough (yes you read that right) to alter public perception'

  • Six of the best on health inequalities

    Despite its presence on the so-called Selbie Six list of NHS priorities for 2006-07, tackling health inequalities is proving a significant challenge for many primary care trusts.

  • Skilled analysts of little use to the NHS

    Do external consultants working in NHS organisations really deliver the goods? Birmingham University's Jonathan Shapiro argues that they may know how to diagnose problems, but cultural signposts pass them by

  • Smoking battle heats up as age law targets the cool kids

    Raising the legal age for buying tobacco is the government's latest salvo in the war on smoking, and it is working hard to ensure maximum impact. Helen Mooney reports

  • Social marketing: a view from the front

    Social marketing seems to be a confusing term that actually means both understanding people and keeping their needs at the fulcrum of all organisational activity.

  • Social services are at last fighting back

    David Lock stated in your.article ('David Lock on continuing care liability'): 'A line must be drawn somewhere between health and social care... the social services lobby appears to have been highly effective at persuading the team designing the new eligibility criteria that 'care needs' can usually mean 'healthcare needs', and therefore the NHS should pick up the bill.'

  • Sophia Christie on challenging acute trusts

    'A trust has never pointed out where the tariff gives a generous cross-subsidy to other activity'

  • Sophia Christie on health and employment

    The publication of the Commissioning framework for health and well being is a welcome reminder that 13 months ago the government published white paper Our Health, Our Care, Our Say. For many of us it is a long-awaited statement about the future direction for the 90 per cent of NHS activity that takes place outside hospital and, in particular, for our relationship with social care.

  • Sophia Christie on helping the NHS to learn

    'The Canadian system rather than the NHS may benefit from our learning about the value of purposeful development'

  • Sophia Christie on national and local tensions

    Despite a bad press, national targets have challenged our complacency about poor health in poor people and poor services to support them.

  • Sophia Christie on primary care

    'The challenge of the last three years has been demand management. The focus for the next two years must be a considered challenge to activity attribution.'

  • Sophia Christie on the power of targets

    'The concern is shifting from absolute targets to the rather more difficult to track agenda of respect and values'

  • Sophia Christie on treating adults like kids

    Outcomes for children generate emotional engagement; those for adults are dull in their worthiness

  • Sophia Christie on why tenders need loving care

    Community foundation trusts reproduce the organisations we disbanded five years ago

  • Sounding off

    With the incidence of mental illness among deaf people high and specialised services almost non-existent, getting help can be difficult. Emma Dent explores the gaps in care

  • Speak out

    The IPPR's Joe Farrington-Douglas says private companies may be able to give valuable support to commissioners - but decisions about who gets what healthcare must remain public and accountable

  • Speak Out

    The drive for private involvement in the NHS ignores the fundamental principles of healthcare

  • Speak out

    'Choice is more complicated for cancer care than for a single surgical operation'

  • Statutory control on decisions is not enough to allay fears

    All over the country, primary care trust chief executives are sitting hot and sweaty in their best suits, fighting for their future careers.

  • Sue Slipman on foundation trusts and the healthcheck ratings

    'Having strengthened their financial management without comprising service quality, foundation trusts are now in a position to step up their investment in providing first class patient care'

  • Superbug memo: scale of problem in no doubt as MRSA paper admits failure

    The memo considers - and rightly rejects - the case for primary care trusts to fine acute trusts for MRSA rates

  • Support is vital to change

    It is at the front line where the drive for financial recovery overwhelms any opportunity to invest in the means to change the dynamics

  • Surgical spirit soars in defence of the clinician

    Royal College of Surgeons president Bernie Ribeiro is on a mission to stand up for education and to set up a national audit of clinical outcomes to convince commissioners of ISTCS' shortcomings

  • Target-driven department is off the mark

    'Reforming the DoH to make it an effective and respected department is an important step on the road to rebuilding NHS confidence in the government'

  • Tariff system will reshape specialist trust landscape

    'If the Michael Porter view won converts in this country it would mark a major and highly controversial change in the specialist infrastructure.'

  • Ten leaders who could put reform progress back on track

    What do we know of the chief executives who will be running the new strategic health authorities from next week?

  • The age of uncertainty: new Audit Commission chair speaks out

    New Audit Commission chair Michael O'Higgins has a lot on his plate as he waits for the health regulatory review and oversees the transition to a new inspection era ushered in by the local government white paper

  • The figures are standardised, but the care certainly is not

    Research published by Dr Foster this week shows unequivocally that addressing the problem of variation in quality is one of the biggest priorities facing the service this year (see news, page 7).

  • The history of hospital administrators

    What is the earliest reference to hospital administrators?In his book The Crusades through Arab Eyes(2006, Saqi Books) Amin Maalouf refers to the severe wounding of Buri, the leader of Damascus and son of Tughtigin, in 1131.

  • The importance of manager-doctor relationships

    Training row emphasises the importance of collaboration

  • The maths behind real case management

    It seems a deceptively simple plan - if you can identify the relatively small number of patients likely to use acute services intensively, you can concentrate on simpler, cheaper and more effective preventative care. It was a promise first held out in work by Kaiser Pemanente in the US and then imported by international healthcare companies such as UnitedHealth Europe.

  • The 'misery' of eliminating waste

    I thought Noel Plumridge's description of the 'miserable territory of hunting down and eliminating waste' a little trite (HSJ, 22 February)..

  • The MTAS failure is no ripple in a teacup

    The cuts in funding for junior doctors' pay and study leave were very bad management and smacked of panic measures when they were announced half-way through the financial year.

  • The new economics

    Treating individual services as profit-and-loss units promises to transform financial management and clinical engagement. With plans imminent for foundation trusts, Monitor chair Bill Moyes puts the case for a fresh approach

  • The NHS is far from 'saved'

    I am astonished to see your comment piece claiming current policies have 'saved the NHS'. It certainly doesn't seem like it to me or any of my colleagues, and I wonder which planet the author has been on.

  • The public needs reassurance that it is in the safest hands

    'Such big jumps need analysis. Are employers becoming more lax in their approach? Or is it just a statistical anomaly?'

  • The real best value

    Dr Andy Jones writes on the reality of best value primary care and seems to conclude that clinical engagement is the key. However, it is unclear where the best value is to come from and in particular the role that he envisages for GPs and their teams.

  • The real story about Wales' ambulances

    I enjoyed the Your Humble Servant column on 15 March. In fact, I have it framed on my office wall. But, I really can't let Michael White's Welsh travelogue pass without comment.

  • The role of individual responsibility

    The Association of Directors of Adult Social Services has stressed.that joint working should be the first, not the last, option considered by local authorities and primary care trusts.

  • The trouble with cancer services

    I read with interest the article by Anna Donald (opinion, page 15, 12 April). I to have been diagnosed with breast cancer and totally agree with her comments. The medical treatment I received was second to none but as Ms Donald.says it is the relationships that matters.

  • There's life in patient forums yet

    The patient forum concerned in the North Eastern Derbyshire primary care trust.versus Pam Smith, is far from dead or in danger of passing away ('moribund' is your term for it).

  • Thinking long term on treatments

    News that government action to tackle the effects of heart disease in the UK population through better care and statin drugs has to be welcomed. Yet it also leads to questions about why this strategy could not be adopted for other conditions which blight lives and cost the NHS (and the taxpayer) billions.

  • Thinking long term on treatments

    News that government action to tackle the effects of heart disease in the UK population through better care and statin drugs has to be welcomed. Yet it also leads to questions about.why this strategy could not be adopted for other conditions which blight lives and cost the NHS (and the taxpayer) billions.

  • Thumbs up to Monitor's business plan

    I am referring to Monitor's business plan announced last month ('Monitor takes tougher line to prepare for wave of FT plans'). Personally, I think this approach is absolutely right. Having just been deferred at Birmingham and Solihull mental health trust for a few months, we have worked hard to have a sustainable economic case -.which we have done.

  • Tim Gilling on why scrutiny committees will become more important

    'We should be encouraged by evidence that shows a collaborative, improvement-driven approach'

  • Time to break the circle of negativity

    There's no row like a family row and the NHS family is not an exception. It has long been recognised that the NHS's own staff can often be the worst ambassadors for what is happening in the service, nationally and locally.

  • Time to draw a line under Granger era

    The national programme for IT is reeling from its most damning verdict yet - this week's report from the Commons public accounts committee that condemns uncertainty over the schedule of implementation and value for money (see news, page 9).

  • Time to tear ourselves away from paper

    Trusts' reluctance to store patient records electronically is a national scandal which is draining resources, harming patient care and limiting the potential of historical archives, argues Capita's Robert McIndoe

  • To solve a problem, first you must admit you have one

    Managing demand will be a major issue this year and also a major test of the maturity of relationships between acute and primary care trusts. Variability is an acknowledged reality but poor access to and grasp of information means that it too often remains amorphous.

  • Top thinkers hail power of imagination

    If clinicians are the likely generators of the ideas that will transform NHS performance, managers need the confidence to create the space for them to blossom. Our main feature this week looks at a group of very different ideas with the potential to make a huge difference locally and nationally.

  • 'Top up' fees not 'equitable' funding system

    The Doctors for Reform study published yesterday argues - through the use of only 20 case studies - that more patients are paying 'top-up' fees and that 'the fundamental NHS principle - that care should be universally and equitably available ' no longer applies'.

  • Tough decisions still need to make a case

    Managers attempting to restructure services across Bedfordshire and Hertfordshire strategic health authority may feel they have at last got friends in the right places.

  • Transplant dilemmas

    Chris Rudge writes of the need to increase donors for organ transplants, yet 20 years ago the Royal Devon and Exeter Hospital was successfully doing this and the process was stopped.

  • Transplants policy

    Chris Rudge writes of the need to increase donors for organ transplants, yet 20 years ago the Royal Devon & Exeter Hospital was successfully doing this and the process was stopped. I was then a junior staff nurse on the intensive care unit there, which ran a protocol called 'elective ventilation'. Relatives of patients admitted to the hospital with severe cerebral haemorrhages, and for whom the prognosis was non-survival, were asked if they would consider donating the organs.

  • Tristan Reuser on clinical engagement

    The re-engineering of health systems requires traditional barriers between primary and secondary care to come down, writes Tristan Reuser

  • Trust battles with council over 'disastrous' A&E closure plans

    West Sussex primary care trust is heading for a battle with the county council over plans to close two accident and emergency departments.

  • Trust websites

    I don't know which is more alarming about your Working Lives article ('In on the act', page 26, 28 September), the idea that some unfortunate employee of the Healthcare Commission spent 285 hours studying NHS websites, or the reported remark that scanning a website for 30 minutes is only a superficial survey.

  • Trusts may lose secure hospitals

    Control of England's three high-security hospitals could be removed from local NHS control, HSJ has learned.

  • Turnaround consultants

    I am sure Malcolm Lowe-Lauri's opinion column on management consultants must have struck a chord with PCT colleagues who have been subjected to the turnaround process in recent months (page 17, 5 October). Although the consultants input has been valuable in some areas the benefits were not apparent in many others.

  • Turnaround help for a third of acutes as deficits reach £1.2bn gross

    More than one-third of all acute trusts and a quarter of all primary care trusts are receiving turnaround support as it was revealed that deficits in the NHS are climbing again.

  • Turnaround tales from the edge

    The second in our three-part series on turnaround success stories shows how three more trusts took radical action to stop the rot

  • 'Turnaround teams' - a sticking plaster for a severed limb?

    The ability to commission effective and efficient services is completely divorced from strategies to implement and provide cost-effective services, argue Angela Bate and Cam Donaldson

  • Turning curves

    In the first part of our series on organisational turnaround, HSJ writers quiz three NHS trusts on how they fought their way back from the brink of financial Armageddon

  • 'Unacceptable risk' to acutes exposed by PCTs' contract

    The final model contract released last week has provoked fierce resistance from hospital providers, which have little time for the argument that it rebalances the power levels between primary care trusts and acutes. For more, read New model contract threatens survival, foundations warn.

  • Unity will unlock gateway to success

    Sir Ian Carruthers' two-month review of England's reconfiguration proposals urges much greater co-ordination of effort - a more united front to replace a series of skirmishes.

  • Unjust social care funding

    'One in four people over the age of 85 in Oxfordshire are in receipt of a high cost package of care'

  • Use of management consultants

    I always enjoy the wit and irony of the inside back cover. How delighted I was to see that you have now carried it into the body of your journal under the headline 'SHA pays £2m for firm to size up PCT commissioning' as the independent and objective firm chosen is PricewaterhouseCoopers.

  • Variance in primary care HRG spending

    This data briefing from Dr Foster Intelligence shows how primary care spending on healthcare resource groups varies across strategic health authorities. The research covers year-on-year changes in the first quarter of 2006. It is based on the number of spells coded with HRGs and covered by payment by results.

  • Variance in primary care HRG spending

    This data briefing from Dr Foster Intelligence shows how primary care spending on healthcare resource groups varies across strategic health authorities. The research covers year-on-year changes in the first quarter of 2006. It is based on the number of spells coded with HRGs and covered by payment by results.

  • Variation in A&E admissions

    Across England the rise in emergency admissions to hospital shows no sign of abating. Alongside it, bed days also continue to rise. The year-on-year rise in emergency admissions in the first quarter of 2006 was 7 per cent, while the corresponding rise in bed days was 5.9 per cent.

  • Victory for NICE as High Court rejects drugs firm complaints

    The National Institute for Health and Clinical Excellence has had its integrity upheld after fending off its first High Court legal challenge.

  • Volunteering and mental health

    Separate independent research adds to the mounting evidence that volunteering has important health benefits. Preliminary studies indicate that volunteering can have positive outcomes for 85 per cent.of mental health service users who participate. (see 'The health benefits of volunteering').

  • Vulnerable patients and carers need to be recognised

    According to David Lock's article ('David Lock on continuing care liability'): 'There is a serious danger that the new single national criteria for NHS continuing care will result in a substantial number of high-cost care packages being transferred from local authorities to the NHS.'

  • Wanted: doctors to help redesign services

    The need for more doctors to take on a management role has almost become a mantra, yet progress has been painfully slow. Penny Dash and Pam Garside examine the challenges and opportunities

  • Water fluoridation

    I was interested to read that Jessica Crowe uses water fluoridation as an example of a public health intervention that might provoke local protests, and that therefore overview and scrutiny committees (OSCs) might assist.

  • We can work it out: dementia and the baby boomers

    As the baby boomer generation ages, it will present some expensive challenges to services for people with dementia. Alison Moore reports

  • What's driving the admissions rise

    In last week's Data Briefing I raised some issues about the increase in emergency admissions to acute hospitals over the last five years. The increase has primarily been in accident and emergency, and there has been a dramatic increase in the number of patients turned around on the day. While there was no indication of patients being more or less sick, the tariff income per patient has been reducing.

  • Whitehall shake-out rumbles more change

    'The DoH will not comment on whether posts such as director-general of commissioning will disappear rather than be filled, but is it likely that much of the spate of high-profile leavers, so far and to come, is part of a coming restructuring.'

  • Who can make the health service listen?

    With the rejection of local restructuring proposals raising eyebrows, will the independent reconfiguration panel and overview and scrutiny committees fill the democratic deficit?

  • Why binning bad habits will take the fudge out of finance

    The Audit Commission's recommendations on redesigning the NHS's management of finance marks a fundamental shift in accountability, culture, planning and spending, argues Andy McKeon

  • Why can't LINks have access to care homes?

    In your.article on local involvement networks (LINks),.a spokesman from the Commission for Social Care Inspection was reported as.saying they had concerns about giving LINks right of entry to care homes (see.'LINks scrutiny system to bar patient networks from access to key services').

  • Why minorities still stand out from the primary care crowd

    High levels of dissatisfaction among black and minority ethnic patients have prompted the health secretary to take steps to discover what is behind unequal primary care access. But, as Rebecca Evans reports, ethnicity is not the only factor at play

  • Why the bedside has a place in the boardroom

    Imagine sitting through a board meeting at Tesco. The meeting lasts three hours and at no time do chair Sir Terry Leahy and his directors talk about their customers or how satisfied those customers might be with the products and stores. It's a ridiculous notion, isn't it?

  • Why the NHS must wake up to the medical technology gap

    If the UK is to match other advanced countries, major investment in technology is essential. But predicting real demand can be difficult. Joe Rafferty and colleagues may have the answer

  • Why the talking cure can help ease the reconfiguration blues

    A list is circulating - despite Department of Health denials - of 18 trusts that have been deemed unviable in their present form and on which strategic health authorities will be acting. There will probably be few surprises in the names and no surprise that major restructuring of acute services is coming - the government has been flagging it up for the best part of a year.

  • Will it be Independence Day 5 July 2008?

    You cannot expect to get the politician off your back while keeping the consumer at arm's length

  • With friends like Milburn...

    I have some sympathy with the chief executives of acute trusts surveyed in your report. The Department of Health.may end up paying a high price for its game of 'central credit and local blame'.

  • Your Humble Servant: a primary care-bled NHS

    ‘Life carries on without GPs. In fact it’s a lot simpler’

  • Your Humble Servant: back from Biarritz

    To: Don Wise, chief executive

  • Your Humble Servant: Cyborgs on order

    'This was the latest shipment of cyborgs destined for NHS Direct, which included a model that could put over a thousand calls on hold per minute.'

  • Your Humble Servant: dead man walking

    ‘It’s difficult to know who to ingratiate yourself with, which policies might survive and which we should backpedal on.’

  • Your Humble Servant: disaster planning

    ‘Four black Mercedes limousines with police outriders screeched to a halt outside trust HQ heralding the arrival of the McKashsky consultants’

  • Your Humble Servant: do as I say

    To: Don Wise, chief executiveFrom: Paul Servant, assistant chief executiveRe: Do as I say not as I doDear DonI gather your factfinding summer visit to South Africa with Mrs Wise and the children went well. Your thoughts on ambulance response times on safari have given our colleagues down there much food for thought. Nor have we been wasting time in your absence. I have been ploughing through some light summer readi

  • Your Humble Servant: domestic inspection

    ‘The terror of arbitrary censure and pointless planning is taking its toll’

  • Your Humble Servant: future imperfect

    ‘MRSA is discovered to have hidden properties which eliminate the H5N1 avian flu virus and patients now choose hospitals with high bacteraemia rates’

  • Your Humble Servant: grand theft NHS

    Dear Don‘Bullies who threaten NHS staff will be shown the red card’ press release from the DoH finally confirms what we have suspected since February.

  • Your Humble Servant: home births

    To: Don Wise, chief executive

  • Your Humble Servant: how do you solve a problem like Patricia...?

    To: Don Wise, chief executive

  • Your Humble Servant: life on Mars

    ‘The ambulance would be at least an hour and that they should do what first aid they could until the paramedics arrived’

  • Your Humble Servant: London SHA

    ‘They’ve come up with a whizzo plan to keep Londoners happy. They are going to build lots more hospitals. At the moment they are calling them polyclinics, but that’ll change’

  • Your Humble Servant: musical chairs

    To: Don Wise, chief executive

  • Your Humble Servant: non-executive joy

    ‘As for selection processes, we still can’t fathom them. It used to be so simple: either failed politicians found a way to boost their pension or successful ones got their wives out of the way a few days a month’.

  • Your Humble Servant: Project Stepford

    ‘You are either in a lot of trouble or are just the sort of twisted mind we need’

  • Your Humble Servant: public health and wine receptions

    ‘A fight has broken out between a couple of balding, geeky, thin male strategy directors who are trying to stab each other with Montblanc pens’

  • Your Humble Servant: rave with Dave

    ‘It must be what the Baghdad Green Zone is like, hermetically sealed and full of the commentariat issuing orders devoid of any sense of reality’

  • Your Humble Servant: regime change

    ‘We need to start stockpiling resources for a long fight now. We have started buying up poster sites and newspaper advertising space to deny it to the opposition.’

  • Your Humble Servant: say hello to the new boss

    'He is also an inspiration in separating bonuses from performance, exposing incompetent auditors who have overlooked some of his imaginative enterprises, and spending vast sums on management consultants.'

  • Your Humble Servant: the new SHA

    To: Don Wise, chief executiveFrom: Paul Servant, assistant chief executiveRe: Strategic hip authority

  • Your Humble Servant: the NHS marketplace

    To: Don Wise, chief executive

  • Your Humble Servant: the NHS Regatta

    To: Don Wise, chief executive

  • Your Humble Servant: Tory policy

    To: Don Wise, chief executive

  • Your Humble Servant: washing your hands of it

    ‘Pathology will be exported to Belgium, mental health will now fall under the council’s community support officers and treated with ASBOs.’

  • Youth offending

    The continual inability of the NHS to engage with this group of young people is a core reason why inequalities will never be adequately tackled (HSJ 9 November). The NHS is governed by moral choices and offenders do not score highly on the morality stakes.

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