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This paper describes an ethnographic study of the care pathway community. Qualitative data generated through attendance at the annual care pathways conference and a regional group network are assembled in order to present an interpretation of the spread of pathways across the health-care field and identify the stakeholders involved, as well as their interests, aspirations and alignments. The growing popularity of care pathway methodology can be explained by its effectiveness in reconciling clinical and management interests in offering a single solution to shared health service problems. However, this breadth of appeal disguises tensions between clinical and management agenda which creates challenges in inscribing this multiplicity of interests into the pathway design. This helps to explain the challenges of pathway development and the range of interventions to which the term 'pathway' is applied. In a second, companion paper, I consider how the community has responded to these concerns and draw on social sciences concepts to offer an alternative approach. [ABSTRACT FROM AUTHOR]

This paper examines some fundamental issues pertaining to the use of, as well as to the distinctive characteristics of, information technology in relation to the development of information systems within the UK National Health Service (NHS). The paper refers to the current Resource Management initiative in the NHS, which involves the fabrication of information systems to connect medical activity to resource usage, and thus to costs. Examining the features of some of the rival inscriptions undergoing development of make this connection visible, the paper highlights the properties of information technology in enhancing their mobilization. It also addresses the immutability and combinability of these inscriptions, and discusses some of the implications, in terms of medical practice and knowledge, which may follow from their use. [ABSTRACT FROM AUTHOR]

The Health and Social Care Bill proposes clinically led commissioning. The new Clinical Commissioning Groups will become statutory bodies and replace the old primary care trusts. This primary legislation will transfer accountability for health care spending to clinicians who will have a duty to meet the health needs of a population as well as balance a budget. This change gives rise to a number of ethical issues which are explored in this article. [ABSTRACT FROM AUTHOR]

The New Labour government would have appeared to have demonstrated a strong commitment to the state health care sector since coming to power in 1997. It has more than doubled spending on the National Health Service, and this investment is projected to rise over the next four years. However, whether this 'modernization strategy' will be able to deliver a more equitable health care service in New Labour's third term in office is open to question. In addition, the expanding role of the private health care sector in a revived 'internal market' in health care raises serious concerns about the future direction of state health care provision. [ABSTRACT FROM AUTHOR]

NHS Direct, the 24-hour telephone helpline, uses modern communications technology to offer easier and faster access to advice about health, illness and the NHS so that people are better able to care for themselves and their families. In-depth interviews with callers to the service show that they bring with them discourses of the 'deserving' and 'undeserving' familiar in the provision of other welfare services. The figure of the 'time-waster' is the NHS equivalent of the welfare 'scrounger', acting as a mechanism to problematize entitlement. NHS Direct dispels such fears and legitimizes demand. At the same time, ever-rising levels of service use constitute a threat to what callers value most about it. [ABSTRACT FROM AUTHOR]

Background Evidence suggests that cluster randomized trials are often poorly designed and analysed. There is little recent research on the methodologic quality of cluster randomized trials and none focuses on primary health care where these trials are increasingly common. Methods We conducted a systematic review of recent cluster randomized trials in primary health care, searching the Cochrane Controlled Trials Register. We also searched for unpublished trials in conference proceedings, and the UK National Research Register. We assess methodologic quality using a checklist, articulate problems facing investigators conducting these trials, and examine the extent to which carrying out a cluster randomized trial (as opposed to an individually randomized trial) in primary care may reduce power. Results We found 367 trial reports. Many trials were reported more than once. We characterize 152 independent cluster randomized trials in primary health care published between 1997 and 2000, and briefly describe 47 trials unpublished at December 2000. The quality of design and analysis was variable. Of published trials reporting sample size calculations 20% accounted for clustering in these calculations, 59% of published trials accounted for clustering in analyses. Unpublished trials were more recent and of higher quality. Reporting quality was better in journals reporting more cluster randomized trials. Many trial investigators reported problems with adherence to protocol, recruitment and type of intervention. Conclusions Methodologic quality of cluster randomized trials in primary health care is variable and reporting needs improvement. The use of cluster randomization should be indicated in the title or abstract so these kinds of trials are easier to identify. Communicating appropriate methodology to health care researchers continues to be a challenge. Cluster randomized trials should always be piloted and information from pilots and unsuccessful trials shared more widely. [ABSTRACT FROM AUTHOR]

The article comments on a number of inquiries set up by the government of Great Britain to look into a variety of national disasters where there has been serious public disquiet. Some of the inquiries have concerned the Health Service and the provision of health care in Great Britain. One inquiry investigated the killing of a musician, Jonathan Zito, in 1992.

Will healthcare be drowned by the grey Tsunami or sunk by the demographic iceberg? Or will new and radical, economic, medical, nutritional, exercise and life style developments, produce a better economic model for future healthcare. A properly funded Health Service rather than an over Politicised Failing Sickness service. [ABSTRACT FROM AUTHOR]

The article presents information on the systems of accountability in the context of the National Health Service (NHS) of Great Britain. The NHS has introduced initiatives in response to pressures of accountability. General practitioners play an important role in the nation's health care system. A number of NHS trusts are run by boards of directors. There are several methods of accountability practiced in Great Britain.