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The article presents a memorandum of the Royal Medico-Psychological Association on the Second Green Paper on the future of the National Health Service in Great Britain. The association aims to coordinate the National Health Service and the Local Government services and welcome the participation of legal professionals and consumers. Policies concerning the management are given more importance rather than the daily administration activities. Furthermore, a single authorities should be recognized in each areas of the Health Service, including the social work and medical services.

The article examines the issues surrounding White Paper's uncovering of the proposal to reforming the health professionals' Trust, Assurance and Safety regulation in Great Britain. The White Paper expressed that to reform, the importance of perceptions must be rightly emphasized as public needs to perceive that the regulatory system is operating in the interests of patients. It also stresses that the General Medical Council's (GMC) four functions must be integrated in the regulatory framework.

The article focuses on the White Paper on community care titled "Caring for People" in relation to the 1990 National Health Service and Community Care Bill pending in the House of Lords. Criticisms levelled against the White Paper, particularly the issue of grant aid, are misplaced. The White Paper's outstanding value is that it outlines a clear structure and a set of general principles which should grant local authorities greater autonomy, authority and responsibility in healthcare administration.

The UK National Health Service (NHS) is changing. Consecutive UK industrial strategies have supported the shift from an NHS that provides free‐at‐point‐of‐delivery healthcare to one that also facilitates research. Said to promote healthcare's triple aim of 'better health, better healthcare, and lower cost' (Wachter, 2016, 3), the digitisation of patient records is a core part in opening routine aspects of the health system to potential research. In this paper, we thematically analyse 11 policy documents and ask, how does the NHS discuss its decision to digitise patient records and what are the implications of such practices on the citizen? We document how (1) digitisation is presented as a collective endeavour for patients and NHS professionals, offering new possibilities for patients to participate in their own health and that of the population through research and, (2) digitisation contributes to the building of an efficient health system. Through this analysis we reflect on how discussions of digitisation present uncritically the potential of Electronic Health Records and big data analytics to improve care and generate wealth through research, and reconfigure patienthood, by placing research participation as a routine part of accessing NHS healthcare. [ABSTRACT FROM AUTHOR]

Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how financial incentives are used in district nursing, an area of care which is particularly difficult to measure and monitor. [ABSTRACT FROM AUTHOR]

Background: There are many challenges in delivering and evaluating knowledge for healthcare, but the lack of clear routes from knowledge to practice is a root cause of failures in safety within healthcare. Various types and sources of knowledge are relevant at different levels within the healthcare system. These need to be delivered in a timely way that is useful and actionable for those providing services or developing policies. How knowledge is taken up and used through networks and relationships, and the difficulties in attributing change to knowledge-based interventions, present challenges to understanding how knowledge into action (K2A) work influences healthcare outcomes. This makes it difficult to demonstrate the importance of K2A work, and harness support for its development and resourcing. This paper presents the results from a project commissioned by NHS Education for Scotland (NES) and Healthcare Improvement Scotland (HIS) to create an evaluation framework to help understand the NHS Scotland Knowledge into Action model.Methods: The team took a developmental approach to creating an evaluation framework that would be useful and practical. This included a literature review to ensure the evaluation was evidence-based; adaptation of contribution analysis for K2A project; action research with K2A project leads to refine the work and develop suitable measures.Results: Principles for evaluation and an evaluation framework based on contribution analysis were developed and implemented on a trial project. An outcomes chain was developed for the K2A programme and specific projects. This was used to design, collect and collate evidence of the K2A intervention. Data collected routinely by the intervention was supplemented with specific feedback measures from K2A project users.Conclusions: The evaluation approach allowed for scrutiny of both processes and outcomes and was adaptable to projects on different scales. This framework has proved useful as a planning, reflecting and evaluation tool for K2A, and could be more widely used to evidence the ways in which knowledge to action work helps improve healthcare outcomes. [ABSTRACT FROM AUTHOR]

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. [ABSTRACT FROM AUTHOR]

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 National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe how NHS Sutton Clinical Commissioning Group (Sutton CCG) is working with nursing homes, residential homes and other health and social care organisations in Sutton to improve the quality of provision for residents in nursing and residential homes “care homes”. Design/methodology/approach – The paper explains how Sutton CCG engaged with care homes initially to seek their views on whether they wanted support and what support they would value. It describes what arrangements Sutton CCG put in place for managers and staff in local care homes to provide support face-to-face. The paper outlines the key areas for improvement that Sutton CCG and the care homes are focusing on. It includes examples of work carried out jointly by the care homes and Sutton CCG to improve the quality of care for residents. It goes on to describe joint-working arrangements between the CCG, London Borough of Sutton and other health and social care organisations to ensure the overall quality of care homes in Sutton. Findings – The paper outlines feedback from care home managers and staff who were invited to share their views about what support they wanted from Sutton CCG. It includes early feedback from care homes about the support put in place and the areas where they have found it most useful. Practical implications – In the UK many older people live in care homes. Britain has an ageing population so the need for residential and nursing homes and the numbers of people living in care homes is only likely to increase. Our ageing population also places additional demands on the NHS, with residents in care homes often spending time in A&E and lengthy spells in hospital. This paper highlights how CCGs and other health and social care organisations can work with care homes to improve the health and wellbeing of older residents in care homes and reduce pressures on other health services. Originality/value – Sutton CCG has put in place new arrangements for working with care homes that aim to support carers to improve the lives of their older residents. The paper shares practical examples of support that the CCG has provided which has successfully improved care and decision making in care homes; early indications show this has reduced 999 calls and conveyances to hospital. Sutton CCG, London Borough of Sutton and other statutory organisations with responsibility for care homes in Sutton have also set up a joint intelligence group to gain an overall picture of the quality of the borough’s care homes. [ABSTRACT FROM AUTHOR]

The role of the independent sector in the provision of clinical services on behalf of the NHS in England is often misunderstood and is perceived by some stakeholders as offering the NHS little more than marginal additional capacity. Indeed, some NHS organisations have been accused of 'obstructive, disruptive and protectionist behaviours' towards non-traditional 'NHS family' service providers. This paper outlines the development of the independent sector's role in the provision of clinical healthcare services over recent years. The first part of the paper considers the historical context, including the impact of both the changing role of the state over the past 50 years and the change of government at the end of the last century. Consideration is then given as to the position today, and the impact of current policy drivers for the use of the independent sector in the provision of NHS clinical services. The final part of the paper uses the specialty of orthopaedics, for the purposes of illustration, in order to explore the contribution of the independent sector to the delivery of the last remaining major access target, 18 weeks referral to treatment, and the development of a range of responsive services in the community. [ABSTRACT FROM AUTHOR]

A key element of the United Kingdom (UK) health policy reform in relation to chronic disease management is the introduction of a national programme seeking to promote self-care from within the National Health Service (NHS). The mainstay of the Expert Patients Programme (EPP) is a sixweek training course that provides the opportunity for anyone with a long-term condition to develop new skills to manage their condition better on a day-to-day basis. The course forms part of the NHS self-care support programme, is administered by Primary Care Trusts (PCTs) and delivered by people who have personal experience of living with a long-term condition. The NHS' official Expert Patients Programme website presently states that, "Pilot EPP courses began at 26 NHS PCT sites across England in May 2002, and by May 2004 approximately 300 PCTs had either actively implemented pilot courses or had committed to joining. The majority of PCTs are now coming to the end of the pilot phase, with many implementing plans to make EPP sustainable for the long-term." The NHS website heralds the pilot "a success." A national, postal survey of PCT EPP Leads was undertaken in order to examine both the evolvement of EPP during its pilot stage and future plans for the programme. A questionnaire was sent out to the 299 PCTs known to have committed to the EPP pilot, and an excellent 100% response rate was obtained over a 3-month period (April-July 2005). One marker of success of the Expert Patients Programme implementation is the actual running of courses by the Primary Care Trusts. This paper explores the extent to which the implementation of the pilot can indeed be viewed as a "success," primarily in terms of the number of courses run, and considers the extent to which PCTs have carried out all that they were committed to do. Findings suggest that the more time an EPP Lead dedicates to the Programme, the more likely it is that EPP has run successfully in the past, and the more likely it is that it will continue to run successfully in the future. Other factors indicating future EPP success include collaborating across PCTs to share co-ordinators, tutors, and funding. [ABSTRACT FROM AUTHOR]

Background: This paper outlines the principal characteristics of a learning organisation and the organisational features that define it. It then compares these features with the organisational conditions that currently obtain, or are being created, within the British NHS. The contradictory development of recent British health policy, resulting in the NHS becoming both more marketised and more bureaucratised has correspondingly ambiguous implications for attempts to implement a 'learning organisation' model. Methods: Texts that define and debate the characteristics of a learning organisation were found by snowballing references from the founding learning organisation books and published papers, and then by searching a database specifically devised for a literature review on organisational structures and processes in health care. COPAC and ABI-Info databases for subsequent peer-reviewed publications that also appeared relevant to the present study were searched. Results: The outcomes of the above search are summarised and mapped onto the current constituent organisations of the NHS to identify the extent to which they achieve or approximate to a learning organisation status. Conclusion: Because of the complexity of the NHS and the contradictory processes of marketisation and bureaucratisation characterising it, it cannot, as a whole system, become a learning organisation. However, it is possible that its constituent organisations may achieve this status to varying degrees. Constraints upon NHS managers to speak their minds freely place an ultimate limit on learning organisation development. This limitation suggests that current British health service policy encourages organisational learning-but not too openly and not too much. [ABSTRACT FROM AUTHOR]

This article considers how specialist hospital services in the UK fared under Conservative health policy, with its emphasis on market-like arrangements, and what looks likely under the New Labour era, where new shibboleths (cooperation, quality, etc.) supposedly are in place. There appeared inherent in the Conservative health policy threats to specialist services from local competition, and purchaser agendas for local health needs of equity and prioritization. Moreover, small providers grappled with costs and the bureaucracy engendered by market-like arrangements and with their inability to make economies of scale. From the policy rhetoric since the New Labour election victory of May 1997, one might expect such specialist services to be 'coming in from the cold', but the reality seems quite different. In particular, this paper will outline the policy context for specialist providers for the period in the 1990s when the Conservative government undertook to reform the NHS. We also, through the Unit that is the subject of the case study, examine the actual effects of those reforms on this specialist service. Finally, we reflect further upon the resonances for specialist services in the New Labour era that can be gleaned from the case study. [ABSTRACT FROM AUTHOR]

AIM: The purpose of this paper is to outline and critically appraise the NHS reforms that were operationalized in April 1999. DISCUSSION: The paper recognizes that there are important differences between England and Scotland in the design and implementation of change. Differences are discernible in terms of the organization of the commissioning role and of the acute hospital sector, but more significant differences are evident in terms of the nature and organization of primary care. CONCLUSIONS: The paper concludes by indicating that a major challenge exists in the change management agenda with reference to primary care. Thus, while differences exist both north and south of the border, a shared feature is that the change management agenda in both England and Scotland is formidable. The main element of this challenge is that GPs have, in different ways, had to be drawn into the mainstream of the NHS. [ABSTRACT FROM AUTHOR]

This paper presents findings from empirical research exploring recent developments in healthcare rationing in the UK, and how far these were influenced by the National Health Service (NHS) internal market. [ABSTRACT FROM AUTHOR]

The core of this paper' is a case study of how a District Health Authority (Paddington and North Kensington, now Parkside DHA following a recent merger with Brent DHA) in Inner London responded to a major new health care issue of the 1980s-Aids, but the paper also seeks to locate this case study material within wider debates. What theories are there of organisational change which could be used to illuminate policy and service change in the health care sector? How, indeed, do we best study change in health care organisations? The paper is thus in three parts. In the first section we identify some streams of literature which act as a frame of reference defining our initial research question and discuss implications for methodology. The second section presents the case itself, while the last section discusses some emerging findings. [ABSTRACT FROM AUTHOR]

The introduction of individual budgets into English health care is a recent example of the pervasive drive towards personalisation in welfare sector organisation and delivery. As a heavily centralised and highly bureaucratic institution, the National Health Service (NHS) is an obvious target for personalisation. On the other hand, as a symbol of solidarity and nationhood it retains a powerful place within the collective psyche, such that radical reform might expect to encounter resistance. This paper analyses the assumptions that are inherent in personalisation and raises concerns over its ability to transform health-care services. At the heart of these concerns is the tension between appeals to tailored service provision and empowerment on the one hand, and promotion of a strong social contract, public trust in institutions, and collective identity on the other. Lessons are drawn for personalisation in other sectors and settings. [ABSTRACT FROM AUTHOR]

Unwarranted variations in healthcare services are variations that cannot be explained by public health needs or medical needs. The NHS has introduced several policy initiatives aimed at reducing unwarranted variations, but there are barriers to their effectiveness. In recent years, efforts to address unwarranted variations in England and Wales have led to the Department of Health setting standards via agencies such as the National Institute for Health and Clinical Excellence, with implementation and service development left to local health services. The implementation of centrally set standards has brought about greater transparency in the variations in healthcare provision across the UK. The key task for policymakers, managers and clinicians is to determine which of these variations are justifiable - or warranted - and which are unwarranted. This paper examines the extent of unwarranted variations as well as their implications for patient care and public confidence in the UK health system. It suggests that some local variation is warranted, provided minimum care standards are maintained. [ABSTRACT FROM AUTHOR]

Objective The aim of this paper is to explore variations in lay perceptions of user involvement in clinical governance. Context The English National Health Service has sought to build a dependable health service through enhanced effectiveness, responsiveness and consistency. Clinical governance, a policy for improving service quality, is a key pillar of these reforms. It is a statutory duty of primary care organizations to ensure that users are involved in all service planning and decision making, including clinical governance. Yet surveys indicated that user involvement in clinical governance was underdeveloped and underutilized. Design Focus groups were conducted with different types of lay people to explore their perceptions around public involvement in different aspects of clinical governance policy. Results Content analysis of the transcripts reveals that different groups of lay people varied in their desired role perspective and preferred type of involvement in different aspects of clinical governance policy. Drawing upon existing models of user involvement, we identified three role perspectives that lay people could take in user involvement – consumer, advocate and citizen. We compared our findings regarding the desired type of involvement with existing models of user involvement, and identified a new type of involvement, overseeing, that is relevant to clinical governance policy. Conclusions These findings suggest that to facilitate user involvement in clinical governance, it would be necessary to use different strategies to accommodate the differing role perspectives and types of involvement desired by different groups of lay people. [ABSTRACT FROM AUTHOR]

An increase in the participation rates of British South Asian Muslim communities in sport and physical activity is a high priority in both the sport and health sectors. Interventions emanating from the sport development sector have to date achieved little significant growth of activity. However, interventions within the health sector appear to be more successful in engaging South Asian communities in activity. This paper is based on field research in a Healthy Living Centre in Blackburn, a town with a large South Asian Muslim community. The research suggests that within such communities a mode of delivery grounded in physical activity and personal health is likely to be more successful than one based on sport and competition. However, it also identifies other cultural factors that will need to be addressed if participation rates are to be further increased. [ABSTRACT FROM AUTHOR]

The marketing of pharmaceuticals is one of the most highly regulated marketing environments in any industry. A variety of codes of practice operate in different countries, some voluntary and others statutory. In all, however, healthcare managers and practitioners are becoming prominent in raising concerns with the regulatory authorities. With the development of competition for the provision of healthcare in the UK, healthcare managers may find themselves challenging the marketing approaches employed by their competitors and colleagues. The planned introduction of the Code of Practice for the Promotion of NHS Services in the UK could have resource implications for these managers that they have not accounted for in their current business plans and skill maps. Although this is a very broad subject and the Code and its clauses are still in draft form, this paper will briefly explore three pertinent questions: What processes are required to support the proposed Code? What is the level of scrutiny to which promotion will be subject? What are the implications for skill mix and resources? [ABSTRACT FROM AUTHOR]

In this paper, I aim to re-establish the meaning and importance of the concept of 'evidence-based policy making' (EBP) in health care. The term EBP is often misunderstood as being either vacuous (who thinks that public policy should not be based on evidence?), unrealistic (the naive product of ivory tower thinking) or conservative (an excuse permanently to delay reform). It need be none of these things. EBP should be thought of as a set of rules and institutional arrangements designed to encourage transparent and balanced use of evidence in public policy making. As well as controlled trials and observational studies, a broad range of theoretical and empirical evidence about human behaviour may be relevant to predicting policy outcomes - including stakeholder opinions and other sources of intelligence that might not qualify as scientific research. Gradual progress towards EBP, properly understood, has the potential to facilitate open democracy and to improve policy outcomes. The argument is illustrated using examples based on large-scale policies of health care reform in England, where progress towards EBP over the last decade has been real but modest. [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]

In September 1983 the government introduced a first package of performance indicators for all District and Regional Health Authorities. These indicators were claimed to 'enable health service managers to compare their local performance with other health districts and with the country as a whole'. This paper examines the origins of this major initiative, and goes on to analyse its main technical, organisational and political characteristics. Questions are raised concerning the usefulness of the present indicators, and the presence of the necessary organisational and political conditions for the exercise to succeed. The independence of the medical profession is argued to be one crucial factor, the lack of adequate integration with streams of decision-making on key policy and resource issues another. The paper concludes with an appraisal of the scope for further development of performance indicators within the National Health Service. [ABSTRACT FROM AUTHOR]

Recent years have witnessed a growing concern in the NHS to devise and implement policies which explicitly recognise that certain client groups and services should receive a higher priority. The paper points to problems arising from the formulation and implementation of the Scottish health priorities documents, drawing where appropriate on related developments in England. Three areas are highlighted for analysis: the policy ambiguity inherent in the documents: problems of collaboration in implementing the policies: and problems posed by central-local relations. The paper concludes that there is a need for a more sophisticated response to the present fiscal squeeze than simply defending the status quo and suggests that the squeeze could provide the necessary stimulus for change. [ABSTRACT FROM AUTHOR]

The success ofIn this paper, key changes taking in the development of the UK health sector from the 1940s to the mid-1990s are briefly sketched. The changes originating from a variety of socio-economic and political circumstances have largely been responsible for the current shape and position of the NHS. In a forthcoming paper, we will review the status of the NHS under the new Labour Government and examine implications of new changes for the future of the NHS. [ABSTRACT FROM AUTHOR]

This paper tests for possible effects of the implementation of the British National Health Service (NHS) upon the health of the British population. Although analysis does reveal statistically significant improvements in Great Britain's infant mortality rate con-current with the implementation of the NHS, a comparison with other western European nations reveals similar improvements simultaneously with the British policy intervention. Thus, we cannot conclude that the NHS had a significant effect upon British health. A more important result, however, is the demonstration of the utility of both the Box-Jenkins techniques and, in conjunction, the nonequivalent control group quasi-experimental design as important tools for performing policy evaluations. [ABSTRACT FROM AUTHOR]

The article focuses on a paper issued by the Department of Health in Great Britain in December 2009, titled, "NHS 2010-2015: From Good to Great, Preventative, People Centered, Productive." The report outlines the government's vision for the British National Health Service (NHS) over the next five years. The six major areas of challenge facing the NHS at the beginning of 2010 are discussed.

Drugs account for around 12 per cent of NHS costs and have been the major driver of health innovation over the past 50 years. However, many of the mechanisms that govern the relationship between the NHS and the pharmaceutical industry date back decades and are no longer fit for the purpose. This paper examines the current arrangements for distribution, selling and pricing, and discusses how the interests of the health system could be better aligned with those of the pharmaceutical industry. [ABSTRACT FROM AUTHOR]

This article offers a look at healthcare proposals in Great Britain as of October 2006. A consultation green paper was launched by the Cancer Campaign Group that asks the public, patients and healthcare professionals for feedback on proposals for a second national cancer plan for England. The government is seeking responses to its National Health Service Emergency Planning Guidance 2005. The Nursing and Midwifery Council has proposed an increase in registration fees.

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]

Across the UK, mental health professionals are strongly objecting to threats to their roles. Against this background we use ethnographic data from a study of roles and responsibilities in community care, undertaken across two contrasting sites in Wales, to demonstrate how work is sensitive to local organizational features and to show how gaps can grow between the public claims professions make about their contributions and the actual roles which their members fulfil in the workplace. We reveal how, in one of our two research sites, immediate contextual features shaped the work of nurses and social workers towards the fulfilment of expanded packages of activity. We then show how subsequent policy (including 'new ways of working'), combined with new pressures arising from the economic downturn, carry the potential to accelerate the wider creation of workplaces of this type. We examine some implications of these processes for nurses and others, and for the system of mental health care as a whole, and conclude with a call for closer attention to be paid to the potential, wider, impact of current developments. [ABSTRACT FROM AUTHOR]

Abstract: Resource considerations have meant that brevity in health care interventions is a high priority, and have led to a constant striving after ever more impressive time efficiency. The UK''s National Health Service may be described as a kind of ‘fast healthcare’, where everyone is task busy, time is money, bed spaces are frenetically shuffled so as to accommodate the most needy and there appears to be ‘no time to talk’. Indeed, a great many health care encounters are taking place in short ‘blips’ often of 5min or less across a range of sites and involving a vast number of practitioners. In this paper we explore how brief communication can both alienate and be therapeutic for patients. We theorise brief interactions by considering a number of traditions of work in anthropology, linguistics and sociology and conclude that health care providers need to invest much more in the skills and strategies for how best to communicate briefly if it to retain its core tradition of caring for others. [Copyright &y& Elsevier]

The Royal Commission on the NHS published its report in July 1979 after three years deliberation. This paper discusses developments taking place in the NHS prior to the appointment of the Royal Commission and identifies four major causes of unrest. Subsequently the article describes the way in which the Commission worked, the evidence submitted, the research commissioned and visits made in the UK and abroad. Some of the salient features of the report are identified and the immediate reactions to it assessed. [ABSTRACT FROM AUTHOR]

An important feature of the post-Working for Patients National Health Service is the introduction of quasi-markets in health care to be created by separating the 'purchasar' and 'provider' functions formerly conflated in the role of District Health Authorities. This paper presents data from a study of the first few months of operation of the new system, focusing upon the role of purchasing authorities in rationing health care and in legitimising their decisions about how to do this. [ABSTRACT FROM AUTHOR]

The article focuses on the 1982 reorganisation of the National Health Service (NHS) to provide assessment of the aspects for the modification of health planning in Great Britain. The new health planning was essayed to deliver a more rational and comprehensive approach, more accents on prevention and community care and focus priorities on services for the elderly, mentally disabled and children. The article cites that "Patients First," a consultative paper on NHS' structure and management published in December 1979, straightly headed the 1982 NHS modification. Moreover, it concludes that the revision of NHS in 1982 renders significant chances in the health service planning practice advancement.

The paper examines some inter-relationships between dentistry and the national health service, particularly the way in which it was slotted into the management arrangements in 1974. The aspirations of dentists during the pre-1974 period are compared with government intent and the management structure achieved. Analysis of the managerial or officer structure at each level of the service highlights the ways in which the patterns laid down for dentistry varied from the norm. Dentists' expectations and the officially declared intent were seldom synonymous; both were very different from the final system. In some ways dentists lost out in relation to the management arrangements. Their major organization was at area level rather than in the health districts. Whether or not this unusual structure was to the disadvantage of the profession and of dental care, time alone would have told. However, no such assessment is now possible. In April 1982 area health authorities disappeared: area dental officers have therefore been abolished. [ABSTRACT FROM AUTHOR]

In this article, our point of departure is the 'compassion crisis' in the National Health Service in the UK and the initiatives introduced in the aftermath of scandals that were intended to strengthen healthcare professionals' ability to show compassion. We look at the two main strategies, which we term the 'recruitment and staff development strategy' and the 'amelioration of the quality systems strategy' and the debate that has arisen related to them. Based on this analysis, we question whether compassion really is a helpful concept to understand the crisis and hence to underpin relevant strategies. We introduce the concept of discretion as an alternative and better concept to comprehend the situation. One of the benefits of the concept of discretion is that it clarifies how problems can be addressed, both as structural problems and as epistemic problems and how these aspects are intertwined. It also helps us to see how solving these problems is complicated and demands comprehensive, in-depth approaches, involving formative aspects related to healthcare education, as well as development of new healthcare policies. [ABSTRACT FROM AUTHOR]

Historical perspectives can be embedded into policy initiatives through a process of 'past-proofing'--ensuring new policies take the study of the past into consideration. We describe how this was done in a project looking at patient access to general practice in the NHS. We argue that current preoccupations with timeliness which have led to the marginalisation of other dimensions of access are connected to a broader process of neo-liberal reform since the 1970s. This reflection can support a reframing of the terms of current debates on a major issue in British health care. It has wider implications for the policy relevance of history. [ABSTRACT FROM AUTHOR]

The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision-making power. Most recently, a significant reorganisation of the NHS in 2012–13 was built around the creation of new and supposedly more autonomous commissioning organisations (Clinical Commissioning Groups – CCGs). Using Bossert's (1998) concept of ‘decision space’, we explored the experiences of local commissioners as they took on their new responsibilities. We interviewed commissioning staff from all of the CCGs in two regional health care ‘economies’, exploring their perceptions of autonomy and their experiences over time. We found significant early enthusiasm for, and perceptions of, increased autonomy tempered in the vertical dimension by increasingly onerous and prescriptive monitoring regimes, and in the horizontal dimension by the proliferation of overlapping networks, inter-organisational groups and relationships. We propose that, whatever the balance between central and local control that is adopted, complex public services require some sort of meso-level oversight from organisations able to ‘hold the ring’ between competing interests and to take a regional view of the needs of the local health system. This suggests that local organisational autonomy in such services will always be constrained. [ABSTRACT FROM PUBLISHER]

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.

Editorial. Comments on the paper 'Delivering the NHS Plan,' which discusses the government's strategy for Great Britain's National Health Service. Commitment to a tax based system that provides free care to all; Plans to create institutions to set, monitor, and ensure national service standards; Earned autonomy of local organisations.

The article discusses three reports on the future of medical care in Great Britain namely, "Future Direction of Health Care," from the National Association of Health Authorities and Trusts, "Future Health Care Options," released by the Institute of Health Services Management and the survey of health policy makers. The first paper focused on how the National Health Service (NHS) deliver health care in the nation. The second report gave out suggestions for medical care such as social insurance and local taxation.

Health systems that have fixed budgets and a coherent organizational structure generally have found it valuable to have a dedicated primary research capacity to answer decision-oriented value-for-money questions of particular importance to the system. The UK NHS is one example of such a system. Here, we review the historical evolution of building comparative effectiveness research (CER) capacity in the NHS, describe the current situation, with a focus on how this research is used to inform decisions, and discuss present and emerging challenges. We draw some possible lessons for the US, which is currently considering using CER to inform healthcare policy and practice decisions. [ABSTRACT FROM AUTHOR]

In recent years UK government policy has been drawing private companies into the operation of the British National Health Service as providers of health care. Hitherto the National Health Service has been the main employer of health care practitioners, but this may change as a result of this development. There is an issue as to whether professional health care practitioners owe the same moral commitment to an employer in the private sector as they would owe to an employer that is part of the state-run National Health Service. I explore some arguments around this issue, focusing on ways of identifying organisational commitment to good health care. With regard to the practitioners commitment to the organisation I consider two strengths of commitment, normative and calculative. I then undertake an analysis of performance, regulatory regimes, and organisational obligations for both sectors. I conclude that while performance and regulatory regimes show little difference between sectors, there is a reasonably compelling argument in favour of a stronger moral commitment to state bodies based on organisational obligations. [ABSTRACT FROM AUTHOR]