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In this article, the author focuses on the impact of the British National Health Service (NHS) health care guidelines restraints on clinical commissioning groups (CCGs) in England. He informs that four CCGs have implemented the National Institute for Health and Care Excellence (NICE) guideline for in vitro fertilisation and the general practitioner (GP) referral service management guideline has restricted the flow of patients in CCGs. It states that a white paper released by the NHS in 2010 has revealed that NHS has planned to abolish primary health care trusts. It also mentions that the guidelines have impacted both the budget and responsibilities of CCGs. INSETS: BOX 1: CCGS FAIL TO IMPLEMENT NICE GUIDANCE ON IVF;BOX 2: CLOSING THE GATES¿NEW REFERRAL MANAGEMENT SYSTEMS;COMMISSIONING GROUPS ¿ HOW THEY CAME INTO BEING;BOX 3: FAMILY DOCTOR¿PATIENTS¿ ADVOCATE OR GUARDIAN OF THE PUBLIC

England was the first European country to pursue a systematic policy to reduce socio-economic inequalities in health. This paper assesses whether this strategy has worked, and what lessons can be learnt. A review of documents was conducted, as well as an analysis of entry-points chosen, specific policies chosen, implementation of these policies, changes in intermediate outcomes, and changes in final health outcomes. Despite some partial successes, the strategy failed to reach its own targets, that is, a 10% reduction in inequalities in life expectancy and infant mortality. This is due to the fact that it did not address the most relevant entry-points, did not use effective policies and was not delivered at a large enough scale for achieving population-wide impacts. Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the overall targets. [ABSTRACT FROM AUTHOR]

Objectives To explore similarities and differences in policy content and the political context of the three main English government reports on health inequalities: the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010). Methods Thematic policy and context analysis of the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010) in terms of: (i) underpinningtheoretical principles; (ii) policy recommendations; (iii) the political contexts in which each was released; and (iv) their actual or potential influence on research and policy. Results There were great similarities and very few differences in terms of both the theoretical principles guiding the recommendations of these reports and the focus of the recommendations themselves. However, there were clear differences in terms of the political contexts of each report, as well as their subsequent impacts on research and policy. Conclusion The paper calls into question the progress of health inequalities research, the use of evidence and of the links between research, politics and policy. [ABSTRACT FROM AUTHOR]

Objectives Emergency Department (ED) use is known to be related to both socio-economic deprivation and distance to hospital. However, hospitals are often located in urban areas close to deprived populations. The objective of this study is to investigate the relationship between distance and attendance at EDs, net of deprivation. Method Multiple linear regression models were used to explore the relationship between deprivation and distance to hospital with age-sex standardised ED attendance rates at neighbourhood level. Distance to a Minor Injury Unit (MIU) was also included. Interaction between distance and deprivation was investigated. Separate models for children and adults were used because some populations had access to a dedicated children's ED. Setting The Government Office Region of the West Midlands, in central England (population 5.4 million). Population Attendances of West Midlands residents to EDs in acute hospitals in financial year 2007/08 (n=1 465 355) within 3482 Lower Level Super Output Areas (LSOA), each containing approximately 1600 residents. Outcome Measures The response variable was the directly age-sex standardised ED attendance rate for each LSOA (square-root transformed). Predictor variables were distance from LSOA centroid to nearest ED and nearest MIU in kilometres and income deprivation score (high score=high deprivation). Results There was a significant positive relationship between attendance and deprivation, β coefficient=0.96 (p<0.001) in adults and 0.68 (p<0.001) in children. There was a significant negative relationship between attendance and distance, the β coefficient=−0.24 (p<0.001) in adults and −0.37 (p<0.001) in children. Child attendance appeared more sensitive to distance than adult attendance but less sensitive to deprivation. Attendance in deprived neighbourhoods was more sensitive to distance than in less deprived ones. For adults, at the third quartile of deprivation, √ attendance rate=−0.32 per km +19.50 compared to −0.18 per km +15.86 at the fist quartile. For children, at the third quartile of deprivation, √ attendance rate=−0.49 per km +21.30 compared to −0.30 per km +17.95 at the first quartile. The paper goes on to describe the models in greater detail, (including the effect of MIUs). Conclusion Attendance at EDs is sensitive to income deprivation at neighbourhood level but distance from hospital appears to modify this relationship differently in deprived areas than in affluent ones. Also, children's attendance appears to be more sensitive to distance than that of adults. This is useful to understand when comparing ED attendance between and within populations. [ABSTRACT FROM PUBLISHER]

Background Reducing geographical inequalities in cancer survival in England was a key aim of the Calman-Hine Report (1995) and the NHS Cancer Plan (2000). This study assesses whether geographical inequalities changed following these policy developments by analysing the trend in 1-year relative survival in the 28 cancer networks of England. Methods Population-based age-standardised relative survival at 1 year is estimated for 1.4 million patients diagnosed with cancer of the oesophagus, stomach, colon, lung, breast (women) or cervix in England during 1991-2006 and followed up to 2007. Regional and deprivation-specific life tables are built to adjust survival estimates for differences in background mortality. Analysis is divided into three calendar periods: 1991-5, 1996-2000 and 2001-6. Funnel plots are used to assess geographical variation in survival over time. Results One-year relative survival improved for all cancers except cervical cancer. There was a wide geographical variation in survival with generally lower estimates in northern England. This north-south divide became less marked over time, although the overall number of cancer networks that were lower outliers compared with the England value remained stable. Breast cancer was the only cancer for which there was a marked reduction in geographical inequality in survival over time. Conclusion Policy changes over the past two decades coincided with improved relative survival, without an increase in geographical variation. The north-south divide in relative survival became less pronounced over time but geographical inequalities persist. The reduction in geographical inequality in breast cancer survival may be followed by a similar trend for other cancers, provided government recommendations are implemented similarly. [ABSTRACT FROM AUTHOR]

Ten years' experience of paediatric outreach clinics is reviewed and evaluated. The advantages and disadvantages of paediatric outreach and its possible place in the new era of contracting and more developed community paediatric services are discussed. It is concluded that paediatric outreach increases parental and professional choice and access to paediatric consultant services, increases service flexibility, reduces unnecessary hospital visits, and enables more rational and relevant clinical decision making. Outreach is particularly relevant in areas of deprivation where paediatric needs are greatest. [ABSTRACT FROM AUTHOR]