Table Of ContentNavigating the NHS
core issues for clinicians
Edited by
PETER LEES
Senior Lecturer in Neurosurgery
Director of Research and Development
Southampton University Hospitals NHS Trust
Foreword by
Sir Kenneth Caiman
Chief Medical Officer
Department of Health
MJM
THE BRITISH ASSOCIATION
OF MEDICAL MANAGERS
CRC Press
Taylor & Francis Group
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
First published 1996 by Radcliffe Publishing
Published 2016 by CRC Press
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© 1996 Peter Lees
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No claim to original U.S. Government works
ISBN 13: 978-1-85775-106-2 (pbk)
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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Navigating the NHS: core issues for clinicians/edited by Peter Lees;
foreword by Kenneth Caiman.
p. cm.
Includes bibliographical references and index.
ISBN 1-85775-106-X
1. National Health Service (Great Britain). 2. Health care reform — Great Britain
I. Lees, Peter.
[DNLM: 1. National Health Service (Great Britain). 2. State Medicine — organization &C
administration — Great Britain. 3. Health Care Reform - history — Great Britain.
W 225 FA1 N3 1996]
RA395.G6N376 1996
362.1'0941-dc20
DNLM/DLC
for Library of Congress 96-13731
CIP
Typeset by Marksbury Multimedia Ltd, Midsomer Norton, Avon.
Contents
List of contributors v
Foreword vii
Preface viii
Acknowledgements ix
1 Introduction 1
Peter Grime
2 Where are we now? The NHS in the mid-1990s 7
Tim Scott
3 An introduction to priority setting in the NHS 17
Richards and Tony Lockett
4 What is NHS purchasing, and where is it going? 27
Tony Shaw and Murray Cochrane
5 Marketing in the NHS 39
Andrew Boon
6 Casemix, coding and contracting: a beginner's guide 51
Peter Lees and Paul Stafford
7 Shared care or integrated care? Managing clinical services for
chronic disease across the interfaces 63
Bob Young
8 Managing quality through outcome measurement and audit 73
Sue Lydeard and Steve George
9 Towards evidence-based practice: the role of research and
development, training and education 87
Stephen Holgate
CONTENTS
10 Continuing medical education: a fundamental balancing act 101
Jenny Simpson
11 Management arrangements in NHS Trusts 109
Peter Beck
12 The medical director: corporate player, not representative role 119
Tim Scott
13 The clinical director: poacher turned gamekeeper? 129
Celia Cramp
14 The future 137
Tim Scott
Index 147
List of contributors
PETER BECK, Medical Director, Kotherham District General Hospital,
Moorgate Road, Oakwood, Kotherham, South Yorkshire S60 2UD
ANDREW BOON, Consultant Pathologist, Department of Cytopathology, St
James' University Hospital, Leeds LS9 7TF
MURRAY COCHRANE, Director of Developments, Cornwall and the Isles of
Scilly Health Authority, John Keay House, St Austell, Cornwall PL25
4NQ
CELIA CRAMP, Clinical Director, St Helens and Knowsley Hospitals, Whiston
Hospital, Warrington Road, Prescot, Merseyside L35 SDR
STEVE GEORGE, Lecturer in Public Health Medicine, Southampton University
Hospitals NHS Trust, Tremona Road, Southampton, Hants SO16 6 YD
PETER GRIME, Senior Registrar in Oral and Maxillo-facial Surgery, South-
ampton University Hospitals NHS Trust, Tremona Road, Southampton,
Hants SO16 6 YD
STEPHEN HOLGATE, MRC Clinical Professor of Immunopharmacology,
Southampton University Hospitals NHS Trust, Tremona Road, South-
ampton, Hants SO16 6YD
PETER LEES, Senior Lecturer, Honorary Consultant Neurosurgeon and
Director of Research and Development, Wessex Neurological Centre,
Southampton University Hospitals NHS Trust, Tremona Road, South-
ampton, Hants SO16 6YD
TONY LOCKETT, Associate Director, Corning Besselaar Ltd, 7 Roxborough
Way, Maidenhead, Berks SL6 3UD
SUE LYDEARD, Quality Development Manager, Southampton University
Hospitals NHS Trust, Tremona Road, Southampton, Hants SO16 6YD
JOHN RICHARDS, Head of Performance and Development, Southampton and
South West Hampshire Health Authority, Oakley Road, Southampton,
Hants SO9 4WQ
TIM SCOTT, Senior Fellow, BAMM, Barnes Hospital, Kingsway, Cheadle,
Cheshire SK8 2NY
LIST OF CONTRIBUTORS
TONY SHAW, Chief Executive, Southampton and South West Hampshire
Health Authority, Oakley Road, Southampton, Hants SO16 4GX
JENNY SIMPSON, Chief Executive, BAMM, Barnes Hospital, Kingsway,
Cheadle, Cheshire SK8 2NY
PAUL STAFFORD, Director, Secta Management Consulting, Shelley Farm,
Shelley Lane, Ower, Hants SO51 6AS
BOB YOUNG, Consultant Physician, Department of Endocrinology, Salford
Royal Hospitals NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD
Foreword
The title of this book intrigued me. It conjured up nautical images of charts,
maps, shoals, rocks, wind, rain and storms. It suggested instruments to deter-
mine course and direction, compass and sextant. And of course it is a good
metaphor. Understanding the NHS is about knowing where you are going and
how to get there. The image of the course of a large tanker being changed by
many tugs also came to mind. The NHS does need to change, but it will only do
so if there are a number of willing and powerful forces at work.
But the image also begs several questions. The first and most obvious, is what
is the destination? This is a key question, and the answer to it sets the tone for the
chapters in the book. Is it about financial issues? Is it about career progression for
staff? Is it about managing the workforce? For me the answer relates to the
primary purpose of the NHS which is to meet the needs of patients and the
population, and to put them first. It means involving patients and the public
more in determining what is required and how best it can be achieved. It is first
and foremost about values. This is of course simplistic and such an objective has
within it a series of contraindications and conflicts. But at least it gives a sense of
purpose and direction to the organization.
But what do we need to get there? Again to stretch the nautical example, there
is a need for good management, teamwork and leadership. Without these the
ship will not function effectively and mutiny may even occur! Working together
in partnership is crucial, as is the recognition of the skills and expertise of all
members of the crew. In particular the captain needs to earn respect and ensure
that all members of the team are pulling in the same direction.
Then, there is the issue of instruments available to chart the course, monitor
performance, measure the distance travelled and identify problems ahead. The
radar function is important (intelligence) as is the need to continually improve
the methods available to control the direction (research). In addition the
members of the crew need to be regularly updated on these matters (education)
and be helped to do so.
This book sets out to chart some of these issues. It provides practical solutions
to problems, and gives examples for others to take up or reject.
Finally, it is perhaps important to stress that navigation and nautical
manoeuvres are not always easy. In doing so, particularly when the environment
is changing rapidly, the quality of life of the crew also needs to be considered.
The staff are our most important asset, we need to think of them too. This book
also gives some insights into how that might be done.
Sir Kenneth Caiman
March 1996
Preface
In just over a decade the NHS has undergone the most widespread changes
since its inception. Such has been the pace of change that unless you were at
the heart of the 'reforms' in the early 1980s you would be forgiven for
wondering where we came from and probably why. If proof of that
confusion were needed it can be found regularly among my senior registrar
colleagues when applying for consultant posts. Those clinicians perceived to
have a leaning towards 'medical management' seldom enjoy much interest
until that fateful time and will be very familiar with the oft-posed request,
'tell me something about management, I have an interview tomorrow'.
The stimulus for this book was to help medical trainees understand the
huge health care management 'industry' which has developed so rapidly and
which nowadays impacts upon us all, but such is the calibre of my co-
authors' contributions that this book has relevance to anyone trying to
negotiate their way around 'today's NHS'.
Using the history of the reforms as a backdrop, we have chosen discrete
topics (presented in broadly logical order) representing the major new
initiatives, with a bias towards the secondary care sector. The authors were
asked to make their chapters stand-alone, accessible for the uninitiated and
to imagine they were on the train en route to 'the interview' and had the
sudden urge to 'mug-up' on a pertinent topic quickly.
I conclude with an invitation. With the current pace of change, further
editions of this book are anticipated and ideas for inclusion next time would
be warmly welcomed.
Peter Lees
March 1996
Acknowledgements
This was not a solo effort and I am grateful for help and encouragement
from a number of people. All the authors are busy professionals but still kept
perfectly to deadlines. Sir Kenneth Caiman, the Chief Medical Officer, has
kindly written the Foreword and Dr Jenny Simpson and Tim Scott (of the
British Association of Medical Managers (BAMM)) have not only
contributed directly but have also given inestimable advice on the subject
areas and whom to approach as contributors. Peter Grime and Tim Lees,
trainees at the time, gave invaluable comment upon whether the objectives of
the book were being met. Gillian Nineham and her colleagues at Radcliffe
Medical Press have taught me a lot and with great patience. The speed that
Radcliffe turn such a tome into the printed book has impressed me
enormously. Those of you who, like me, are fortunate enough to work with
an outstanding secretary will appreciate the huge contribution of my
personal assistant, Clair Wilkinson.
