The White Paper for Wales

The White Paper on the NHS in Wales had some important comments about he future direction of Clinical Effectiveness. We quote:

3.9  Improving clinical effectiveness is at the core of the quality agenda and will remain one of the key priorities for NHS Wales. In future, health authorities will be required to work with trusts and Local Health Groups and publish a strategy and action plan for clinical effectiveness to deliver a rolling programme of work which will form part of the local strategy for improving health and be monitored for progress.

3.10  Much work has been done on the production of guidelines at national and local levels and the development, publication and maintenance of guidelines will remain the responsibility of the appropriate professional body. But the production of guidelines and evidence-based material needs better planning and targeting if the full potential is to be achieved. To streamline and strengthen these activities the Welsh Office proposes to work with the professions by being party to arrangements for a new National Institute for Clinical Excellence. This professionally-led body will work to a programme agreed by the health departments and will produce and disseminate:

There is also evidence that patients with hip fractures do better in specialist centres.

On the other hand there has been evidence to suggest that hospitals with more than 600 beds do less well than smaller hospitals. There is also a concern among community trusts about to be swallowed by their hospital neighbours that winter emergencies and pressures on waiting lists will swallow all of their development money for years to come.

• clinical guidelines which draw on relevant evidence of clinical and cost effectiveness;
• associated clinical audit methodologies and information on good practice in clinical audit.

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The winter crisis - well it may yet happen

The heralded winter crisis for beds has, so far, not materialised. 

Data so far suggests that Bro Taf has longer lengths of stay for medicine than the other authorities in Wales and the length of stay is greater than the English overall average. This is odd, for as a teaching authority, Bro Taf might be expected to have shorter stays than the other authorities.

Further work on this difference, especially differences between the trusts may help to clarify this.

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Inappropriate psychiatric outpatient referrals

Dr Mary Webb, a tireless campaigner for better clinical effectiveness has done a small study on patients referred to East Glamorgan Hospital psychiatric out-patients over three weeks. The figure below shows the results of this study. There appear to be a large number of inappropriate referrals, but also a very large number of patients who did not attend the outpatients.

This suggests the need for protocols for referring general practitioners and some thought about improving the way that patients are contacted.

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NHS Service Review

The NHS service review, carried out in December 1997 by reported on the satisfaction patients felt with the services they receive in the different health authorities.

There are considerable problems with satisfaction surveys but we in Bro Taf might have hoped to score better, in comparison with our sister authorities.

The figure at the top of the next column suggests that the trust hospitals need to look into the figures in detail.

The review is worthy of some study, especially the disparity between the costs of health care in Wales compared with England.