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Summary points The NHS does not seem to have a single, identifiable leader, and perhaps it should in order to hasten the pace of improvement The problem of the NHS [...]

Abstract Objective To compare the utilisation of hospital beds in the NHS in England, Kaiser Permanente in California, and the Medicare programme in the United States and California. Design Analysis [...]

Abstract Problem NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available. Design 18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate. Background and setting 24 pilot sites in England with relatively short waiting times and some experience of booking appointments. Key measures for improvement Proportion of patients with booked or 'to come in' date during and after pilot programme, proportion not attending for admission, and proportion waiting ≥ 6 months. Comparison of pilot sites with non-pilot sites. Strategies for change National Patients' Access Team established to help pilot sites enable patients to book admission dates. Provision of 9.9m £ to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology. Effects of change Proportion of patients with booked or 'to come in' date increased from 51.1% to 72.7% between end of March 1999 and end of March 2000, and then fell to 66.2% by end of March 2001. Over the same periods, the proportion of patients waiting ≥ 6 months fell from 10.9% to 10.5% and then increased to 11.9%. The proportion of patients failing to attend fell from 5.7% to 3.1% between the first quarter of 1999 and the first quarter of 2000, and then increased to 4.0% in the first quarter of 2001. Pilot sites varied widely in performance during and alter the pilot phase. Pilot sites had higher proportions of patients with booked or 'to come in' date than non-pilot sites at end of each period. Lessons learnt Increasing the proportion of patients who book their date of hospital admission is possible, but there are difficulties in sustaining this. Several factors facilitated or hindered the implementation of booking, and the roll out of the programme across the NHS is seeking to incorporate these factors., ********** Background Successive governments have sought to reduce the time patients wait for surgery as part of a policy of improving access in the NHS. In the past five years, [...]

Summary points The NHS was established on the basis of an implicit compact between the government, the medical profession, and the public This implicit compact has been undermined over the [...]

A decade ago the state of Oregon attracted worldwide interest when it began an ambitious attempt to set priorities for health care on a systematic basis. Stimulated by the death [...]

District health authorities must make choices on the use of their funds and the priorities that should be pursued. In future they may be able to place greater weight on [...]

The purpose of the present NHS reforms is to introduce a managed market; developing some of the incentives for greater efficiency that are often found in markets while still being [...]

Policies towards the NHS in the postwar period reveal a variety of assumptions on the part of politicians about the motivations of managers and clinicians. For much of this period, [...]

Summary points The Child B case showed that decisions on funding experimental and costly treatments raise ethical and practical dilemmas Concern to use resources for the benefit of the whole [...]

Learning from the NHS Internal Market: A Review of the Evidence Julian Le Grand, Nicholas Mays, Jo-Ann Mulligan King's Fund, 17.95 £, pp 196 ISBN 1 8571 7215 9 Rating: [...]

The Child B case offered important lessons about accountability and rationing in the NHS. Three years on, they've not been learnt Three years ago the case of 'Child B', Jaymee [...]

The white paper sets out a bold and imaginative vision for the organisation and provision of health care. The unanswered question is whether the money will be available to turn [...]

The British government is working on a white paper to be published by the end of the year outlining its plans for replacing the NHS market. The likely flavour of [...]

In common with several other countries, New Zealand has embarked on a far reaching programme of market oriented reforms in recent years. These reforms involved separating purchaser and provider responsibilities [...]

Reorganisation fatigue has set in; now for service development By publishing its white paper on the future of the NHS at this point in the election cycle,[1] the British government [...]

It is a fact universally acknowledged that primary care is one of the great strengths of the British health care system. The NHS reforms initiated by Margaret Thatcher in 1989 [...]

Quietly in the night, competition in British health care has slipped away, its passing unremarked and little noticed by those who brought it into this world. The death sentence was [...]

The recent decision of Cambridge Health Authority not to fund a second bone marrow transplant operation for a 10 year old girl has brought to public attention what has long [...]

Ever since the inception of general practice fundholding in 1991 ministers have insisted that it is a voluntary scheme. This approach has resulted in a rapid expansion of fundholding: the [...]

The NHS is on the verge of a change that could have profound implications in the longer term. That change goes under the name of the private finance initiative. Its [...]

That politics is driven more by values than facts is not open to dispute. But at a time when ministers are arguing that medicine should be evidence based,[1] is it [...]

At last week's Conservative party conference the government's plans for the future of fundholding were unveiled.(1) To understand the significance of these it is important to remember the history of [...]

Last week saw the publication of a series of reports on the role of the Department of Health and the management of the new NHS (see p 357).(1) These reports [...]

Labour throws its new health plans open to debate The publication of Health 2000,[1] the Labour party's document on health and health services in Britain, indicates the outlines of an […]

Three different modes of financing and delivering health care scrutiny In common with many other countries, Sweden is reviewing options for reforming its health services. The report of an expert [...]

Will succeed if it establishes an equilibrium between competition and management After months of speculation, leaks, and rumour the government last week published its plans for the future structure of [...]

More substantial changes on the way The future direction of the NHS reforms is currently under scrutiny by a review team established by Virginia Bottomley. The decision to appoint the [...]

Health care systems seem to come in all shapes and sizes, but at least in developed countries several common models can be identified. As a recent study from the Organisation [...]

Despite some progress they have done little to compensate for long term NHS underfunding Implementing the NHS reforms has reached a critical stage. With hospitals all over Britain restricting admissions, [...]

Only a single agency makes sense As the NHS reforms move into their second year the key question is, how will the market be managed? Little competition occurred in 1991-2 [...]