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Introduction: Collaboration was legislated in the delivery of integrated care in the early 2000s in the UK. This research explored how the reality of practice met the rhetoric of collaboration. Theory: The paper is situated against a theoretical framework of structure, agency, identity and empowerment. Collectively and contextually these concepts inform the proposed model of 'collaborative agency' to sustain integrated care. The paper brings sociological theory on structure and agency to the dilemma of collaboration. Methods: Participative action research was carried out in collaborative teams that aspired to achieve integrated care for children, young people and families between 2009 and 2013. It was a part time, PhD study in collaborative practice. Results: The research established that people needed to be able to be jointly aware of their context, to make joint decisions, and jointly act in order to deliver integrated services, and proposes a model of collaborative agency derived from practitioner's experiences and integrated action research and literature on agency. The model reflects the effects of a range of structures in shaping professional identity, empowerment, and agency in a dynamic. The author proposes that the collaborative agency model will support integrated care, although this is, as yet, an untested hypothesis. [ABSTRACT FROM AUTHOR]

Mental ill health is a universal phenomenon: that is, it is seen across all cultures and societies, even though the presentation may be culture-specific and affected by cultural norms and more. Governments have a moral and ethical duty to develop mental health services which are accessible, appropriate, and non-discriminatory. Equity in funding mental health services is critical. As globally services and their quality vary dramatically, one should be proposing and agreeing on minimum standards of care. In this paper the basic components and minimum standards of care are described. It is imperative that services are non-discriminatory. It is important that governments work with psychiatrists, other mental health professionals, and individuals with mental illness, their families, and carers to plan, develop, and deliver services with adequate funding. Employers and psychological first aid must also be remembered. Services must be geographically accessible. In this endeavour primary care services have a major role to play. Training and clinical decision-making must be part of the change in service delivery. It is imperative that every effort is made to keep the population mentally as well as physically healthy, and people who develop mental illness must have access to evidence-based treatment at the earliest possible opportunity. [ABSTRACT FROM PUBLISHER]

There are substantial inequities within the current National Health Service (NHS), with people in lower socioeconomic groups (SEGs) using a wide range of services less relative to their needs than people in higher SEGs. These inequities are likely to arise due to factors on both the demand and the supply side of the system. On the demand side, they could arise from differences in patients' beliefs, knowledge, costs, resources and capabilities. On the supply side, professional beliefs and attitudes, and risk selection or cream-skimming by providers may result in inequities. This paper discusses whether these factors are at play within the English NHS and analyses whether current policy to extend patient choice of provider is likely to reduce or increase these inequities. It shows that extending patient choice may leave unchanged inequity due to differences in health beliefs (because choice does not affect these directly), increase inequity due to unequal resources (because patients may have to travel further), and decrease inequity due to unequal capabilities (because the poor will have access to a new and, for them a more effective, source of leverage over health service professionals). On the supply side, there will be little change. The paper then discusses policy options for dealing with factors that contribute to greater inequity on the demand side. It proposes a package of supported choice whereby individuals from lower SEGs would receive assistance in making choices, including an identified key worker to act as patient care adviser and help with transport costs. The paper concludes that policies for extending patient choice can enhance equity – so long as they are properly designed. [ABSTRACT FROM AUTHOR]

The article presents information on the future of public health in Great Britain. This paper reviews the government's early commitment to, and initiatives in, public health which formed the foundations of its present policy, and examines the reasons for public health becoming an issue of almost unprecedented prominence. Finally, it looks ahead to anticipate what public health might look like in the aftermath of the White Paper expected in November 2004. Public health underwent something of a renaissance following the election of the Labor government in 1997.

Study objective: To explore the role of history in public health and its relevance to current practice and professional development. Design: An analysis of the issues surrounding the poor attention paid to the history of public health by its current practitioners. Setting: The paper is written from the perspective of practitioners in the UK but has wide applicability. Main results: The paper makes the case that the current neglect of public health history is to the detriment of public health practice. Conclusions: There is a strong case for more attention to be paid to public health history in professional formation, development, and communication. [ABSTRACT FROM AUTHOR]

This paper focuses on the reforms to the British National Health Service (NHS) undertaken by the Labour government of Tony Blair. It is argued that these reforms do not seem to be delivering the improvements in services that might be expected, given the large increase in NHS resources that the government has also provided. The paper discusses some possible explanations for this, focusing on capacity constraints and on conflicting incentive structures for the key actors. [ABSTRACT FROM AUTHOR]

Health promotion specialists and health promotion services within the health service have been neglected by policy makers and medical sociologists. This is perhaps surprising, given the high profile of health promotion on the health policy agenda. This paper presents the findings of an exploratory sociological study into the nature and function of health promotion services within the 'reformed' British National Health Service. The analysis draws on qualitative interviews with health promotion specialists, directors of public health and other health workers whose work involves the promotion of health. The paper argues that health promotion services do not fit easily into the purchaser provider divide and that they have experienced considerable organisational change and uncertainty. Four factors have further compounded this lack of fit: a lack of consensus as to what health promotion specialists work should be about; a lack of any secure knowledge base; prevailing images of health promotion and of health promotion specialists; and feelings of vulnerability about the future of health promotion. Furthermore, health promotion specialists are finding it difficult to shed their principles and values and take on the dominant enterprise culture which is characteristic of the new public management. The paper concludes by suggesting three further reasons why health promotion specialists have been marginalised: their insecure occupational status which in turn is linked to a lack of jurisdiction associated with the content of their work; the contradictions which are inherent in the knowledge base of health promotion, and the increasing application of 'modernist' evaluative frameworks, derived from economics, to health promotion interventions. [ABSTRACT FROM AUTHOR]

The field of men's health has grown markedly over the past few decades. Increased activity specifically relating to men's health promotion in both Australia and the UK has been noted during this period. There has, however, been a reticence to critically examine men's health promotion work within a broader discourse relating to gender and gender relations. Indeed, the vast majority of health-related gender discussion to date has been focused on women's health experiences and their health practices. In this paper, we argue that grounding men's health within this broad gender discourse is important for building an evidence base in, and advancing, men's health promotion work at a range of levels. We specifically explore the research, practice and policy contexts relating to men's health in Australia and the UK, and describe the facilitators for, and barriers to, promoting men's health. We conclude by suggesting that a critical gender lens ought to be applied to current men's health promotion work and provide strategies for researchers, practitioners and policy makers to move towards this new frontier. [ABSTRACT FROM AUTHOR]

Offers a paper presented at a congress of experts on global health and health policies which was held at Trinity College in Cambridge, UK. Exploration of moral values as they impact public health policies; Use of ethics and moral values to mobilise support for global health initiatives; Presentation of four schools of moral thought used to justify health programmes; Humanitarianism, utilitarianism, equity and rights; Definition of each school of morality; Influence that the selection of information has on ethical assessments of programmes; Different ways that moral values can support global health initiatives.

Explores how various approaches can be integrated to help someone create an effective person-centered health action plan, a key component of the British government's “Valuing People” White Paper. Key principles underpinning person-centered planning (PCP); Interface between PCP and health action planning (HAP); Advantages and disadvantages of different PCP models in relation to HAP; Examples of health action plans.

Abstract Objectives The impact of economic evaluation studies on health-care decision makers has been shown to be rather limited. However, there is an increasing requirement for the cost-effectiveness of health-care interventions to be considered in formulating and implementing guidelines for clinical practice. This paper reports the findings of recent focus group research among UK health authorities, which examined the usefulness of published economic evaluations within the decision-making processes. The findings are presented and discussed in light of other studies that have addressed this issue. Methods Focus group research was conducted with decision makers from a sample of two UK health authorities using the National Health Service Economic Evaluation Database (NHS EED) as a research vehicle to locate and report the findings of relevant economic studies. The study sample was initially invited to respond to questionnaires exploring the usefulness of published economic evaluations in the decision-making process and to outline particular topics that it felt would benefit from similar economic evidence. Following this, a detailed search was undertaken to retrieve structured NHS EED abstracts on these topics such that the usefulness and limitations of economic evaluations to decision making could be determined. Results Decision makers generally recognized the usefulness and necessity of published economic evaluations in informing their decision-making processes. However, the value of studies was often limited because of the poor generalizability of results, the narrowness of research questions, and the lack of methodological rigor common to many published studies. A total of 237 NHS EED full abstracts were retrieved in the specified areas of interest, which, within specified caveats, were generally found to be useful as decision-making tools. There was a general consensus among decision makers in favor of developing a quality-scoring system for studies, thereby... [ABSTRACT FROM AUTHOR]

This paper examines the right to health care. Various expressions of this right may be distinguished. These include both individual rights and social rights which could be based upon international treaties and constitutional rights. They may be found in national health legislation and, in some cases, in jurisprudence. To analyze the consequences of limiting the right to health care, a framework for judicial review has been developed which encompasses these expressions of the right to health care. The framework was used to examine legal and health policy developments in three Western and two Eastern European countries. In Italy and the Netherlands the right to health care is protected constitutionally (but on differing legal bases) while the United Kingdom does not have a written constitution. In contrast, Hungary and Poland have for many years seen the state take responsible for the provision, administration and allocation of health care services and the right to health care was guaranteed theoretically but not in practice because of the lack of (financial) means. However, the Polish Constitution explicitly anticipates possible limitations of the right to health care. What all these countries have in common is a cost containment perspective where the future will bring even tighter limits on what resources patients may consume. Despite differences in legal structure between these countries, where they seem to converge is on the consequences of putting limitations on the right to health care. The courts in Italy, the Netherlands and the UK have formulated conditions drawn from the acceptance that this right has to be judged within the context of limited resources. It may be concluded that finding a compromise between the right to health care and cost containment policies could also be an issue, Eastern European countries will have to face in the future. [ABSTRACT FROM AUTHOR]

This paper contrasts the views of two prominent politicians on the ways in which the distribution of hospital services should be organised, and relates them to the views of Hayek on the nature of planning. It is argued that, in relying on an independent regulator to supervise access to health care under the new 'foundation' hospitals regime in the English National Health Service (NHS), not only is the Labour government distancing itself clearly from old-style top-down planning, it also risks greater variability in the definition of fair access to health care. There are relevant historical parallels with the mixed economy of the pre-NHS era that policy-makers should make explicit. [ABSTRACT FROM AUTHOR]

The article considers the difficulties implementing the British government's new white paper on the future of primary, community and social care. The plan heralds more emphasis on preventive care, a greater selection of services, reduced health inequalities and more support for long term care patients. Patients will gain more power within the National Health Service. Questions remain over the means by which this comprehensive plan will be implemented. Implementation will depend on competition, new financial incentives and strengthened commissioning.

Discusses the efforts of the government to improve general medical services for the promotion of sexual health in Great Britain. Components of sexual health; Information on the 2004 public health White Paper promises regarding sexual health services; Developments in sexual health policy.