The National Institute for Clinical Excellence is appealing to GPs, managers and nurses to come forward with schemes they have devised locally for improving the referral of patients to hospital. The appeal results from pressure to reduce hospital waiting lists and at the same time cope with the growing demand for services. Last year an extra half million people were treated in hospital.Analysis of waiting lists has shown a significant number of unnecessary and incorrect referrals resulting from a communication failure between GPs and hospital specialists. In situations where GPs are aware of the treatment they can start it immediately. In such cases referral would only be necessary where the treatment did not work. The Institute plans to give guidance on the best way of treating specific conditions and of referring patients to hospital where that is necessary.
Frustration at the slow movement towards modernised and improved public services has surfaced again. Cabinet Enforcer Jack Cunningham has plans to lever a culture change in the planning and other departments of local councils responsible for enforcing regulations. Almost 75% of councils have failed to sign up to the Enforcement Concordat, a code of practice drawn up by central and local Government in consultation with consumer and business groups. The Concordat requires a new approach to enforcement with the emphasis on prevention before prosecution and dialogue between businesses and enforcers.The difficulty for councils is that they have to redesign procedures and persuade their staff to think differently about the job they are doing. Because the change involves costs with limited benefits, signing up to the Concordat is low down on the change agenda. Jack Cunningham intends to make ‘signing up’ a change priority by introducing legislation that would compel use of a code of good practice. The effect of the regulation would be that failure to comply could result in a court or tribunal refusing to allow costs to the council. This could significantly alter the cost benefit equation.
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