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A new contract for hospital consultants, introduced in October 2003, delivered many of the expected benefits. This was in exchange for a significant increase in consultants' pay. By 2011-12, there were around 40,000 hospital consultants employed at a cost to the NHS of £5.6 billion, 97 per cent of whom were on the 2003 contract. Of the expected benefits that could be measured, all have been either fully or partly achieved. More could be done, however, to achieve better value for money by fully realising the benefits set out in the Department's business case. Despite, for example, the contract providing a clear structure for paying for additional work at contractual rates, most trusts still use locally agreed rates of pay for additional work outside job plans, which ranges from £48 to £200 per hour. Pay progression is also the norm and not linked to consultant performance. According to an NAO survey, only 41 per cent of consultants thought that their trust motivated them to achieve the trust's objectives. While most trusts monitor consultant performance, only 43 per cent of trusts (27 per cent of consultants) thought that information was good enough to assess individual consultant performance. Trusts also reported that nearly a fifth of consultants have not had an appraisal in the last 12 months. Many trusts are not implementing the good practice job planning guidance published jointly by NHS Employers and the British Medical Association in 2011.
Productivity in hospitals has been falling by around 1.4 per cent a year since 2000 whilst NHS expenditure has increased by over two thirds in ten years. The Department of Health has achieved significant improvements in such areas as waiting times, healthcare associated infection rates, patient outcomes, reduced cancer mortality and the patient experience. However, the NHS pay contracts introduced since 2003 have increased costs but are not always used effectively by hospitals to drive productivity improvements. The NHS needs to deliver between £15 billion and £20 billion of efficiency savings per year by 2013-14. Around 40 per cent of these savings are expected to come from increasing efficiency in hospitals, requiring productivity gains of approximately six per cent per annum. The 'Payment by Results' system of setting national tariffs has promoted some efficient practice, but there is still substantial variation between hospitals. If all hospitals performed at the level of the top 25 per cent in respect of staff costs, use of estate, control of emergency admissions and bed management, the NAO estimates that the NHS could save around £1.6 billion a year. The Department has launched a national initiative (QIPP) to help the NHS deliver annual savings of up to £20 billion. There are risks to the delivery of the initiative, which is the responsibility of Strategic Health Authorities and Primary Care Trusts, whose focus may be distracted by the proposals for their closure by 2013.
This Handbook provides an authoritative overview of current issues and debates in the field of health care management. It contains over twenty chapters from well-known and eminent academic authors, who were carefully selected for their expertise and asked to provide a broad and critical overview of developments in their particular topic area. The development of an international perspective and body of knowledge is a key feature of the book. The Handbook secondly makes a case for bringing back a social science perspective into the study of the field of health care management. It therefore contains a number of contrasting and theoretically orientated chapters (e.g. on institutionalism; critical management studies). This social science based approach is a refreshing alternative to much existing work in this domain and offers a good way into current academic debates in this field. The Handbook thirdly explores a variety of important policy and organizational developments apparent within the current health care field (e.g. new organizational forms; growth of management consulting in health care organizations). It therefore explores and comments on major contemporary trends apparent in the practice field.
The only available compendium of management topics, written by practising doctors for doctors of all grades and all specialties.
What is the relationship between general practitioners (GPs) and hospital consultants in the United Kingdom? How does government health policy impact upon GPs and hospital consultants? What influence does the medical profession have upon policy makers in the United Kingdom? The medical profession occupies a dominant position within the British health care system and as such is able to influence the development and implementation of health policy. The main division within the medical profession lies between general practitioners and hospital consultants.This book provides a comprehensive analysis of British health policy over the past twenty-five years. Drawing on data from case studies, it provides empirical evidence of the impact of recent health policies upon the National Health Service (in general) and the medical profession (in particular). The case studies provide an analysis of the impact of the 1991 NHS reforms, as well as examining the ongoing influence of the post 1999 NHS reforms upon these intraprofessional relations. What emerges is that the relationship between GPs and hospital consultants is transforming from a collegial to a more managerial relationship. This book sheds light on the resulting development of intraprofessional relations between GPs and hospital consultants within the NHS. Restructuring the Medical Profession is key reading for undergraduate and postgraduate students, researchers and professionals in the fields of social policy and health policy. It is also of interest to health service practitioners, health service researchers and health policy makers.
Government spending on the NHS has increased by 70%, from £60 billion in 2000-01 to £102 billion in 2010-11., with around 40% spent on services provided by acute and foundation hospitals. There have been significant improvements in the performance of the NHS, particularly in those areas targeted by the Department of Health (the Department) such as hospital waiting times and outcomes for patients with cancer and coronary heart disease. But productivity has actually fallen over the last decade. The Office for National Statistics estimates that, since 2000, total NHS productivity fell by an average of 0.2% a year, and by an average of 1.4% a year in hospitals. The trend of falling productivity will need to be reversed if the NHS is to meet the Department's productivity challenge, to deliver up to £20 billion of efficiency savings a year, by 2014-15, without compromising services. The Payment by Results approach (a tariff for procedures) has driven some improvements, but it only covers 60% of hospital activity and there is substantial variation in hospital costs and activity. The tariff system could, though, prioritise price over quality. National pay contracts have not yet been used to manage staff performance effectively, and consultants' productivity has fallen at the same time as they have had significant pay rises. There are risks to the NHS being able to deliver up to £20 billion savings annually, for reinvestment in healthcare, alongside implementing a substantial agenda of reform. Productivity improvements will be key to delivering these savings.
A comprehensive guide to help practitioners diagnose the cause of pain based on symptoms presented, and facilitate its management with appropriate treatment. Beginning with an introduction to clinical examination and radiology, the following sections each examine pain in a different part of the body and possible causes and treatment. The final sections discuss alternative pain management with physiotherapy, psychotherapy and allied therapy.
This guide helps undergraduate medics and junior doctors, as well as experienced doctors taking on new managerial responsibilities, to become effective leaders and managers by introducing both management and clinical leadership theory and practice, and the challenges facing medical managers in today's NHS. Despite growing recognition of the importance of leadership and management to doctors in meeting their clinical responsibilities, training in medical schools and foundation years remains patchy.
The NHS came into existence in an atmosphere of conflict centred on the strong ideological commitment of the Post-war Labour Government and the opposition of the Conservative Party of that time to the idea of a universally available and centrally planned medical care service. There was also opposition from some sections of the medical establishment who feared the loss of professional autonomy. Setting health policy in both an historical and modern context (post 1997) Carrier and Kendall weigh up the successes and failures of the National Health Service and examine the conflicts which have continued for over sixty years, in spite of efforts to solve financial problems in the NHS through increases in funding as well as structural and organisational change. After looking at recent responses to supposed failures of the NHS, they conclude that the NHS has successfully faced the challenges before it and is likely to continue to meet the changing health needs of the population. Financial stresses, concerns about the quality of care and demographic change, with consequent issues for the elderly and the chronically ill, continue to be urgent and politically contentious issues. This book is appropriate for a wide range of undergraduate and postgraduate students studying health policy and the NHS.
Evidence shows that a multidisciplinary approach to Parkinson's care provides better patient outcomes and is more cost effective. This new title provides a practical guide to this approach, with the perspective of the person living with Parkinson's firmly at its core. Written by experts in their field and firmly grounded in up-to-date evidence, Parkinson's Disease: A Multidisciplinary Guide to Management addresses multidisciplinary intervention through the various stages of disease, rather than by discipline. It covers all aspects of care, from pharmacological management to non-drug interventions that are helpful for Parkinson's symptoms. This book is unique in its holistic approach to the patient and their family, and will help all members of the team to implement a biopsychosocial model of health that puts the person with Parkinson's at the centre of care. - Clinician-led content provides perspectives of different members of the interdisciplinary team, including medics, nurses, physiotherapists, occupational therapists and psychologists - Includes practical advice and top tips enhance management of common problems - Includes best practice for Parkinson's as well as Atypical Parkinsonian Syndromes - Progressive Supranuclear Palsy, Corticobasal Syndrome and Multiple System Atrophy - Includes management of falls and bone health, palliative care, management of inpatients - Provides practical advice on delivering services remotely by telephone or video