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The article discusses the cost and effectiveness of in vitro fertilization (IVF) technique in Great Britain. The development of IVF presents the providers of health care with several problems. Inequality of distribution will become a problem if the new technique would be taken up by the private sector. In the present financial climate of the country it appears that National Health Service funding will be available to meet the demand for IVF.

There is an expectation that all occupational therapists will be evidence-based practitioners. This paper reports on an education intervention that has helped therapists working in clinical practice to respond to the challenges posed by evidence-based practice. The intervention was developed for a group of clinicians who had already undertaken an evidence-based practice course. The aim was to enable them to apply evidence-based practice skills to their practice settings. The intervention, which used the problem of evidence-tinged practice as a focus, is described and the ten commandments generated by the clinicians involved are presented for others as a potentially useful tool. [ABSTRACT FROM AUTHOR]

This brief paper contextualises the reform of health care in the UK National Health Service, before introducing the papers in this special edition. [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 Health Service in Britain has recently undergone a major reorganization. It has moved away from being a planned system of health care delivery to a demand driven system organized on the principles of (quasi-) market competition and quality assurance. These changes are intended by government to `empower' the consumer (patient) with real choice and to incorporate the health professionals within a more effective and efficient system of hospital management. It is in this context that the paper examines the usefulness of `postmodernity' as an explanation for the emergence of new `flexible' organizational forms within the hospital service. The paper will concentrate on the ideological and organizational contradictions between state policy and local practice, especially in relation to issues of managerial vs professional autonomy and control. [ABSTRACT FROM AUTHOR]

The article discusses the relevance of diagnosis in general practice to implications for quality of care in Great Britain. It examines studies that concentrate on respiratory and non-respiratory illnesses which reveal the factors that affect the making of diagnostic and management decisions in general practice. It notes the policies enacted to improve public health in the area which include a strong focus on the long-term health needs of patients.

Rationing of National Health Service expenditure is inevitable, difficult, controversial, and it is unusual for the public to have a direct say in setting healthcare spending priorities at the local level. This paper presents a case study of public involvement in the allocation of some £60 million by a Primary Care Trust in North West London. Market research based techniques were used to demonstrate that the public are indeed capable of making these rationing decisions, given the right support. The results of a collective decision making process are reported, as are the effects on healthcare spending in this locality. [ABSTRACT FROM AUTHOR]

Situation Reports (SitReps) is an internal Department of Health performance data collecting system. Although intended primarily for internal use, the data are also used to answer parliamentary questions, brief ministers and to inform national performance indicators. This paper reviews the data collection system and data-set, and shows how it can be used to evaluate delays in hospital discharge under the Community Care (Delayed Discharges etc.) Act 2003. However, limitations in the data include the fact that the data have only recently been extended to National Health Service (NHS) non-acute settings and do not include NHS patients in the private acute sector. Further, as the data-set derives from a weekly aggregate return rather than from individualized person-based records, it cannot be used to evaluate length of delay, or to link to other relevant data such as emergency readmissions. The provision of individualized data to facilitate linkage and extending coverage would increase its potential future use. Categories of delay should be further refined to facilitate monitoring of delays due to disputes about eligibility. [ABSTRACT FROM AUTHOR]

Despite the criticality of nurse rostering practices, there is a surprising lack of attention paid to this managerial activity both in practice and in the health-service management literature. This paper reports the results of an inductive, empirical study of rostering practices in the UK National Health Service with a view to developing a shared understanding of roster planning processes and of what constitutes rostering effectiveness. A survey of rostering practices in 50 wards, followed by five in-depth, longitudinal case studies, revealed the complexity of rostering activities, and identified the main design parameters, which were used to specify rostering systems and to prepare periodic rosters. Rostering activities were perceived to directly impact upon service delivery, resource utilization and nurse retention. A number of poor rostering practices were identified, which could lead to dysfunctional behaviour. This analysis points to a clear managerial imperative to improve local competencies in roster planning and control, recognizing their strategic significance in contributing to hospital effectiveness. A 'Strategic Roster Planning and Control (SRPC)' model is proposed, which may provide a framework for evaluating rostering effectiveness, and a platform for the sharing of best practice, in order to stimulate organizational learning and achieve nationwide improvements in hospital performance. [ABSTRACT FROM AUTHOR]

Nonlinear dynamics systems theory, also referred to as chaos theory, is infiltrating the biomedical and social sciences, including the practice of occupational therapy. Consequently, the Neuro-occupation model has emerged for the treatment of different illnesses, in which a therapist strives to apply the benefits of this theory. This model provides occupational therapists with a method of anticipating the natural flux between underlying or hidden order and chaos in occupations, which allows individuals to function at their highest level. These occupations typically involve the interaction of numerous variables over time. By considering a nonlinear dynamics approach in illnesses such as alcoholism, occupational therapists may understand how meaningful occupations serve as a catalyst to facilitate change, which may assist in better understanding the effect of the therapeutic relationship with the clients they serve. This paper explains the nonlinear dynamics of the interventions in a single case study on alcoholism using the Neuro-occupation model. [ABSTRACT FROM AUTHOR]

Parents who are wheelchair users face the practical problem of manoeuvring a wheelchair at the same time as pushing a pushchair. The Bath Institute of Medical Engineering (BIME) has designed a pushchair to attach to a manual wheelchair. This paper describes the rationale behind the project and how disabled parents have been integral to the design process. The process and findings of the evaluation programme are reported. Evaluation is important to designers to understand the outcomes of their work. 'It's as simple as needing to know whether assistive technology works' (Smith 1998, p20). This process also provides insights to occupational therapists to guide them in their professional judgements about whether an equipment solution can meet user requirements. [ABSTRACT FROM AUTHOR]

The UK National Health Service (NHS) is facing recruitment challenges that mean it will need to become an 'employer of choice' if it is to continue to attract high-quality employees. This paper reports the findings from a study focusing on allied health professional staff (n = 67), aimed at establishing the expectations of the NHS inherent in their current psychological contract and to consider whether the government's drive to make the NHS a model employer meets those expectations. The findings show that the most important aspects of the psychological contract were relational and based on the investment made in the employment relationship by both parties. The employment relationship was one of high involvement but also one where transactional contract items, such as pay, were still of some importance. Although the degree of employee satisfaction with the relational content of the psychological contract was relatively positive, there was, nevertheless, a mismatch between levels of importance placed on such aspects of the contract and levels of satisfaction, with employees increasingly placing greater emphasis on those items the NHS is having the greatest difficulty providing. Despite this apparent disparity between employee expectation and the fulfilment of those expectations, the overall health of the psychological contract was still high. [ABSTRACT FROM AUTHOR]

Explicit priority setting in healthcare, which often involves multiple criteria and value judgements, has come to prominence in a number of different healthcare systems over the past decade. Drawing on the results of a survey of priority setting in practice in the UK National Health Service, this paper analyses issues associated with quantification in priority setting, focusing on techniques for eliciting and aggregating values, the criteria and form of models used and their application in priority setting. The findings reveal a clear focus on equity, a strong concern to demonstrate openness, consistency and transparency in priority setting—leading to greater use of explicit multi-criteria models—and a notable focus on the quality of 'evidence'. However, reported difficulties in weighting over-long lists of non-commensurate and overlapping criteria, the inclusion of inappropriate criteria, and attributes of the form of models employed, lead to the conclusion that the implications of the methods are not always appreciated, the resulting priority 'scores' sometimes misunderstood and, in some cases, the concern for transparency and explicitness appears to outweigh concern for methodological understanding—leading to an illusion of transparency. [ABSTRACT FROM AUTHOR]

Objectives: All health care providers in England are required to conduct surveys of their patients' experience of health care. Data from such surveys contribute to the 'star rating' performance indicators. However, there are concerns that these subjective measures may be influenced more by characteristics of patients than by true variations in the quality of care. The purpose of this paper is threefold: to determine the relationship between demographic characteristics and an index measure of patients' reported experience; to explore the extent to which patients' experiences may be accounted for by the particular National Health Service (NHS) trust they attended; and to assess how meaningful a summary index is in terms of its ability to discriminate between providers. Methods: Data from patients in the National Survey of National Health Service Patients treated for coronary heart disease in 194 NHS trusts. Patients were sent questionnaires after discharge, with a covering letter and a prepaid stamped addressed envelope. Up to two reminders were sent to non-responders. Multi-level linear regression models were used to estimate the extent to which patients' experiences differed between trusts and the association of demographic variables with the summary index. Results: In total, 116 872 patients were sent questionnaires, but 3399 proved to be ineligible for the survey. Responses were gained from 84 310 (74.3% of eligible respondents). Age and sex were most strongly associated with reported patients' experiences. However, the actual impact of age and sex on patients' experience is small, accounting for less than 3% of the variance. The proportion of the variance that was accounted for by the hospital trust in which patients were treated was only 5%. Conclusions: Demographic characteristics do not appear to account for differences between hospital trusts in patients' experience of health care. However, there is considerable variation in patients' experience within each provider. This would suggest that summary indices of patients' experience should not be used to rank providers, although detailed information from patient surveys have a useful role in determining priorities for quality improvement within individual hospitals and for assessing changes over time. [ABSTRACT FROM AUTHOR]

In this paper we are concerned with the study of the changing balance of power in the health care services between professionalism, unionism and the state within the British National Health Service. Our approach is macro-sociological and historical. Ours is a structural analysis in which we explore the importance of class and sexual divisions in relation to the formation of occupational associations and to modes of occupational control: specifically, professionalism and unionism. [ABSTRACT FROM AUTHOR]

The primary role of genitourinary medicine (GUM) services in the UK is the treatment and control of sexually transmitted diseases (STDs). The origins of the service lie in its public health function, yet measuring outcomes locally and nationally is not straightforward. Difficulties arise from the complex interactions between sexual behaviour, the biology of STDs and the role of clinical services; from the potential consequences of the National Health Service (NHS) internal market on national STD control; and from the limitations of information and surveillance systems. This paper considers each of these areas in turn and concludes with some proposals for measuring GUM outcomes locally and nationally which might potentially satisfy the concerns of commissioners and providers. [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 British National Health Service and other publicly funded health systems operate on the principle that health care should be provided solely on the basis of need. Yet the literature abounds with reports of bias in health care use. In order to defend such a charge, two conditions must be met. The first condition is that treatment decisions must be shown to be unfair in that they are not made solely on the basis of need. This paper demonstrates the importance of considering the fair distribution of health care from two, related, perspectives. The first is that people with equal needs should be treated the same (equal use for equal need). This is referred to as the achievement of horizontal equity. The alternative perspective is that people with greater needs should have more treatment than those with lesser needs (unequal use for unequal need). This is referred to as the achievement of vertical equity. Although these perspectives are logically linked, demonstration of equal use for equal need does not necessarily indicate unequal use for unequal need. This is because it cannot be assumed that equal use occurs at every level of need. The second condition that must be met is that clinical judgement must be shown to be influenced by prejudicial notions about patients. Such research is fraught with methodological difficulties, and the charge of biased clinical decision-making is usually made as a result of a process of exclusion. Methods that could be used to examine the extent to which inequalities in health care use are due to bias are described. [ABSTRACT FROM AUTHOR]

In the United Kingdom during the past decade, individuals and groups have increasingly tested the extent to which NHS and private health providers can be held to account through principles of judicial review, or the Human Rights Act (HRA) for failure to provide access to publicly funded health care. Moreover a range of non judicial mechanisms have been developed, for monitoring standards and promoting transparency, participation and equality in the provision of NHS services. This article recognises that an important symbiosis has developed between administrative law courts and non-judicial mechanisms to enhance equality of opportunity and transparency in the distribution of health care resources. However, it also argues, that the unimpeded advance of corporate providers into NHS clinical services reflects a critical gap in the potential to hold government to account for failure to provide access to publicly funded health services, in accordance with commitments in Article 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR). [ABSTRACT FROM AUTHOR]

The article presents information on the issues related to the government policy for public health and the efficient production of hospital services. The promotion of consumer choice and the provision of information to the public are the main principles of the current government policy in Great Britain. The performance of hospital is manifested in the National Health Service.

The article discusses the use of syndromic surveillance in the Emergency Care Data Set (ECDS) project initiated by the Royal College of Emergency Medicine in England. Topics covered include the goal of improving the collection and quality of data in emergency departments, the mandated changes to national clinical emergency care data sets and the driving factors for implementation of ECDS.

The author reflects on the proposed changes by Prime Minister Tony Blair within the National Health Service that involved the establishment of new patterns of health care in Great Britain. He shared his solution in dealing with other aspects of patients' problems through the creation of an extended team that included a practice counselor, a psychologist and a community psychiatric nurse.

Public health specialists can be described as leaders of the ‘upstream health workforce’, concerned with preventing unnecessary and ‘revolving door’ contact with health services. Achieving this requires working to promote good health, improve health services and protect populations from infectious disease and environmental risks. Public health work is based upon the recognition that populations are complex constructions of groups of individuals, who may or may not seek help for health problems or be able effectively to take action to improve their own health. This article will define key areas of public health practice giving specific examples of the role of the public health specialist in the UK, as well as how and why primary care professionals might access specialist advice. The examples demonstrate the great potential for improving population health through the complementary efforts of primary care and public health professionals. [ABSTRACT FROM PUBLISHER]

General practitioner fundholding (GPFH) in the English National Health Service was abolished by the Blair administration in 1999 amid concerns that it was inequitable, helped to foster a "two-tier" health service, and incurred high transaction costs. In April 2005 in an apparent volte face, the Blair government reintroduced delegated budgets to individual GP practices under the banner of Practice Based Commissioning (PBC). As PBC bears many similarities to GPFH it is timely to take stock of evidence-based policy lessons from the earlier initiative in the NHS. Based on a review of the latest empirical evidence, the aim of this article is to help inform the development and implementation of PBC by identifying the policy lessons of GPFH. To do this the discussion focuses on three main areas: it (1) reviews key ideas and conceptual frameworks for understanding stability and change in health systems; (2) summarizes the origins and evolution of primary care commissioning in the NHS; and (3) examines the latest literature and empirical analysis on the impact of GPFH and assesses the success of GPFH in meeting a range of health policy objectives. The article concludes with an examination of the policy implications of the present review and a look forward at the emerging research agenda. [ABSTRACT FROM AUTHOR]

The law in England allows that both parents and competent minors concurrently have the right to consent to medical treatment of the minor. This means that while competent minors may consent to treatment their refusal of consent does not act as an effective veto of treatment and treatment remains lawful if given with parental consent. This approach has been heavily criticized as inconsistent with the House of Lords decision in the Gillick case and damned as 'palpable nonsense'. In this article, I examine these criticisms and conclude that, far from being illogical, it is entirely consistent with the essential asymmetry between consent to treatment and refusal of treatment. I examine the two metaphors of keyholders and flak jackets used to explain this approach and I suggest that both have value but only when used in combination. I also explain why, contrary to the criticism, it is consistent with Gillick. [ABSTRACT FROM AUTHOR]

The article presents the third series of cases provided and discussed by clinical ethics committees in Great Britain. It states the tertiary services provided by Great Ormond Street Children's Hospital (GOSH) National Health Service (NHS) Trust to children in the region. In addition, it highlights questions regarding referral for a second opinion and the application of hysterectomy to prevent menstruation.

Hospital Episode Statistics (HES) are widely used in the UK for audit and research. This often includes comparisons between different geographical regions, but there is some doubt as to the reliability of comparisons made using these data. Previous studies have focused on the quantitative accuracy of the coding, but not the full data chain. This study is a qualitative examination of the production of HES in a small hospital in Guernsey, which is not part of the NHS. Interviews were conducted with key participants in the production of HES to determine how the data were created, and the strengths and weaknesses of this system. We found that face-to-face communication between administrative and clinical staff was felt to contribute to the accuracy of the HES codes, and that a lack of detail in the case-notes was felt to be more problematic than the accuracy of the coders themselves. These findings have implications for the comparison of HES between NHS Trusts, since the processes involved in producing the data will be different in larger hospitals with less contact between coders and clinicians. It is therefore important to bear this in mind when making comparisons between such diverse sources of HES. [ABSTRACT FROM AUTHOR]

Achieving lasting performance improvement in health care is a demanding challenge. Service delivery processes are frequently fragmented with many symptoms of poor behaviour observable. Competing vested interests within the National Health Service (NHS) and experiences of muddled and muddied top-down government exhortation suggest the need for a balanced perspective in which the expectations of patients, staff, management and government can be considered, agreed and enabled. Our conclusion is that effective innovation is best achieved by establishing a 'Train-Do-Train-Do' cycle in which all 'players' in the system must be actively involved. The particular methodology of 'managing by projects' for effective bottom-up step-by-step innovation in NHS practice is described. It takes a holistic and systematic view of health-care delivery as a service business process to be optimized via a five-step procedure. The core tool element of this methodology is the multidiscipline natural-group task force used to execute the change process in an enterprise. When properly constituted, motivated and driven, it is very capable of transforming a 'mess' into an effective health-care delivery process. [ABSTRACT FROM AUTHOR]

Cases of syphilis have been increasing in the UK and it remains an important public health problem. Here, we provide an overview of syphilis, its presentation, diagnosis and management. [ABSTRACT FROM AUTHOR]

The National Health Service is currently striving to deliver evidence-based, effective and efficient services. In this climate, it is important to enable new graduates to develop their knowledge, skills and confidence to meet these exacting demands, in an effective and supportive environment. This is of particular importance because there is growing concern over the retention of new graduates. If new graduates do not receive effective support to complete the transition to a competent professional, then the concern is that they may choose to leave the profession and/or seek new roles. This opinion piece argues for an academic/practice partnership to provide the needed support structures to allow graduates to become competent professionals. Two examples are provided, which embrace such partnership working. [ABSTRACT FROM AUTHOR]

Interprofessional learning and the development of teamworking skills are recognised as essential for patient care and are also a government priority for undergraduate education. Sixteen occupational therapy students worked on an interprofessional training ward as part of their practice placement and three of them participated in an evaluation using the nominal group technique. Despite this small number, the evaluation identifies the value of this learning experience in giving the students an opportunity to appreciate the importance of interpersonal skills; to learn about other team members' roles; and to experience the challenges of working on a busy rehabilitation ward for older people. [ABSTRACT FROM AUTHOR]

Informal multiagency guidelines had been developed in Wolverhampton in an attempt to provide a pathway for clients to return to work following a period of rehabilitation. This resulted in a successful bid for European Social Funding, which enabled a dedicated occupational therapist and a project coordinator to be appointed for a 3-year period. This report discusses the process of setting up the project and evaluates the success of the project in assisting clients to return to work or retraining. [ABSTRACT FROM AUTHOR]

Newly qualified health care practitioners generally have high expectations of practice. Stress, value conflict and role uncertainty ('reality shock') can result where such expectations remain unmet. Good quality professional supervision can mitigate the deleterious effects of such change. Agenda for Change initiatives have the potential to improve the new practitioners' lot in this area by mandating a year-long period of 'preceptorship' support. Such support pairs newly qualified individuals (preceptees) with senior colleagues as role models and resources (preceptors). This article reports a questionnaire-based survey conducted with 45/74 (61%) newly qualified occupational therapists based in London. The respondents reported high initial expectations of their first posts, particularly with regard to professional supervision and client care, which varied according to their age and education. Most (76%) received weekly professional supervision, focused on primarily clinical issues, although this did not always reflect the respondents' desired time use. Although varied development opportunities were cited, the respondents spent little time with their senior colleagues. This study showed that the respondents' expectations and experience of supervisory practice varied. A structured approach to the respondents' personal and professional development, and/or supervision, was not always apparent. Given this, preceptorship seemingly has much to offer newly qualified occupational therapists in the United Kingdom. [ABSTRACT FROM AUTHOR]

Older people are major users of health and social services and, in the United Kingdom, the proportion of the population over 65 years is set to rise in the coming decades (Audit Commission 2000) with growing numbers of long-term conditions. In response, the National Health Service (NHS) must also change if it is to meet the needs of the nation. Whether in the public or the private sector, organisations must have leaders with the skills necessary to implement change if the organisation is to be successful (Landrum et al 2000). In the health care environment, leaders with the capacity to influence, shape and deliver services will enable the NHS to realise its organisational vision (Scottish Executive 2006). Partnership for Care (Scottish Executive 2003) provides direction to achieve this goal by devolving power to frontline staff and promoting a culture of continuous improvement in the NHS. Occupational therapists form part of the frontline power responsible for implementing change and are in an ideal position to do so (Grady 1991). The author describes four theories of leadership - trait theory, motivational theories, transformational leadership and emotional intelligence - and reflects on their strengths and weaknesses and their relevance to occupational therapists currently working in the NHS. [ABSTRACT FROM AUTHOR]

Objectives: To investigate how general medical practices in the UK react to bureaucratic initiatives, such as National Health Service (NHS) National Service Frameworks (NSFs), and to explore the value of the metaphor of 'barriers to change' for understanding this. Methods: Interviews, non-participant observation and documentary analysis within case studies of four practices in northern England. Results: The practices had not actively implemented NSFs. At interview, various 'barriers' that had prevented implementation were listed, including the complexity of the documents and lack of time. Observation suggested that these barriers were constructions used by the participants to make sense of the situation in which they found themselves. Conclusion: The metaphor of 'removing barriers to change' was of limited use in a context where non-implementation of policy was an emergent property of underlying organizational realities, likely to be modifiable only if these realities were addressed. [ABSTRACT FROM AUTHOR]

The article examines the concept of the payment by results policy of the National Health Service (NHS) in Great Britain. The healthcare system in Great Britain is undergoing a series of organizational reforms with the introduction of new concepts such as choose and book, practice-based commissioning, and payment by results.

The article considers the place of minority ethnic health in the priorities of the British National Health Service (NHS). It identifies some of the NHS priorities, such as the promotion of health and the prevention and management of disease. The extent to which the NHS address the health needs of minority ethnic groups in the country is examined. It stresses the need for a balanced and considered approach to priority setting within the NHS.

In this article, the authors reappraise the evidence regarding general practice within the British National Health Service (NHS) in 2006. The authors reflect on the contribution, inherent advantages and shortcomings of the NHS. They think that British general practice should be measured against four dimensions: equity, quality of clinical care, responsiveness to patients, and efficiency. Moreover, the authors believe there are three characteristics that above all others contribute to a medical care success: co-ordination, continuity and comprehensiveness.

It has been suggested in the light of mortality and morbidity rates, and men's reluctance to seek medical help and advice, that there is a crisis in men's health. Little is known about men's experiences of using health care services, despite an emergent UK men's health movement. NHS Direct, the new telephone advice line, was designed to be more accessible, convenient and responsive to the public's needs for health care. In-depth interviews with male callers to the service, aged between 29 and 59, reveal that they sought help in their roles as fathers, partners and on their own behalf. Having used it once, they anticipated doing so again. Their learning about health matters, from both the formal structure and the informal agenda of the telephone consultation, suggests the potential of men's use of this service for ‘normalizing’ help seeking by men, and thereby for longer-term improvements in men's health. [ABSTRACT FROM AUTHOR]

Provides an overview on implications of the historical and international development of health psychology and the changing nature of public health to strengthen the establishment of public health psychology. Historical and international context of public health psychology; Changing nature of public health in Great Britain; Public health psychology theory.

Patient confidentiality has been a matter of concern in the English National Health Service (NHS) for many years. A number of recent events have triggered the demand for a more concerted programme of change to eliminate the use of patient-identifiable data and to devise more acceptable alternatives. The Caldicott Committee, in 1997, set out the case for change and legislation in 1998 (the Data Protection Act and Human Rights Act) and emphasised the need for urgent action. A number of public inquiries into failures of care in the NHS (at Bristol Royal Infirmary and Alder Hey Hospital) pointed to the failure to seek consent as a major issue for the NHS. Whilst accepting the need for change, the Government, in drafting the Health and Social Care Act 2001, allowed for the fact that some organisations and individuals would need time to move towards anonymisation of data (reversible or irreversible) or to obtain patient consent. Under Section 60 of the Act it established the Patient Information Advisory Group (PIAG). PIAG advises government ministers on circumstances in which the continued use of patient-identifiable data should be permitted, as a temporary measure. PIAG faces a number of challenges as it develops its programme of work: how to maintain the pace of change towards anonymisation, how to ensure compliance with the law, how or whether to share information across organisational boundaries in the interests of citizens, how consent should be obtained and how to achieve 'joined up' working across those organisations that are charged with promoting confidentiality and privacy. [ABSTRACT FROM AUTHOR]

Objectives: The governments of many countries are undertaking initiatives to assess the extent to which health care organisations fulfil important objectives of health care, such as health improvement, fair access and efficiency. However, the extent to which these health care organisations can influence these objectives is unclear. The purpose of this study is to examine the potential influence of English National Health Service territorial health authorities on 14 indicators of system performance. Methods: The study uses performance data relating to approximately 5000 small geographical areas with average populations of 10 000. Multi-level statistical models are used to attribute variation in the indicators to three hierarchical levels - small areas, district health authorities and regional health authorities - after controlling for socio-demographic characteristics. Variations in indicators attributable to district or regional level give an indication of the extent to which health authorities may influence performance. Results: After adjusting for socio-demographic characteristics, the proportion of variation in performance attributable to district health authorities varies from about 8% (for standardised mortality ratios) to about 76% (for waiting time for elective surgery). Variation at the regional level is smaller than at the district level. Conclusions: There appear to be very large variations between indicators in the extent to which health care organisations can influence health system performance. Choice of performance indicators and the managerial incentive regime based on the indicators should recognise this variability, as it is highly dysfunctional to hold managers accountable for measures of performance that are beyond their control. [ABSTRACT FROM AUTHOR]

The article presents the second part of a series of articles about the British National Health Service (NHS). In this study, researchers describe moves toward explicit prioritization of patients in other countries, particularly New Zealand. Experiences suggest new directions for the NHS and pitfalls to avoid. New Zealand introduces a nation-wide system for explicitly prioritizing and booking patients for elective surgery.

Examines the reform of health systems in Europe. Challenge for all health systems; Types of health care system in Europe; Information on the British national health system; Discussion on labour utilization and work reorganisation.

Market disciplines and incentives were expected to improve efficiency in the UK National Health Service following the introduction of an 'internal market' in 1991. An exploratory survey of all Health Authorities and Trusts in the UK was undertaken to investigate whether players in the NHS managed market are behaving as economic theory predicts they should. The focus was on how and to what extent marginal costing has been used in the contracting process and on whether in some instances an inappropriate use of marginal costing may be resulting in inappropriate investment decisions. Twenty of 29 responding Health Authorities (69%) and 16 of 39 Trusts (41%) stated that they had considered purchasing/providing services on a marginal-cost basis and all of these led to contracts. Marginal-cost contracting appears to be fairly commonplace and the process does not appear to be causing insurmountable conflicts between players. Most marginal-cost contracts were specifically to meet waiting-list initiative targets. Overall results suggest that economic principles are not being particularly adhered to, with expansion in output rarely being related to available capacity. As increased responsibility for commissioning passes to primary care teams and local health groups, there are lessons for those involved in this more disaggregated approach to service shaping and service delivery. [ABSTRACT FROM AUTHOR]

The article focuses on the public health outputs from the British Paediatric Surveillance Unit and similar clinician-based systems. The unit is therefore conceived as an active surveillance mechanism and an efficient way of focusing reporting through a single channel. The public health outputs include, informing policy decisions on screening, providing information for clinical governance, monitoring the progress of public health interventions and responding to public health emergencies.

The author points out that emphasis on personal services and costs has tended to obscure the need of Great Britain's National Health Service for policy and practice revisions. According to him, the Service needs to reach an appropriate balance of emphasis between delivery of health care and the promotion of health. Physicians and other medical leaders are in a position to redress imbalances between these two components of public health.

There has been increasing interest in the development of hospital-at-home within the National Health Service (NHS) as a way of shifting resources from secondary to primary care. We describe the development of hospital-at home schemes in London and draw on data from an evaluation of five such schemes to discuss support for hospital-at-home within the NHS. The study has identified a small but important group of patients who do not want hospital-at-home, as well as resistance to it from some health care professionals and managers, particularly in hospitals. These organizational issues must be taken into account in any evaluation of hospital-at-home, along with issues of quality, outcome and cost. Feasibility studies are needed to identify possible organizational barriers to hospital-at-home and the development work that is required. This service innovation should not be considered in isolation from other services, but rather within the context of a wider debate about the pattern of acute care. [ABSTRACT FROM AUTHOR]

The article examines the gradual privatization of the National Health Service (NHS) in Great Britain which started during the leadership of Margaret Thatcher. The primary rationale was market competition and that the absence of competitive market forces in the NHS has led to large production costs, little choice for the users, and variable quality. At the present time, the NHS may find it increasingly hard to resist the pressures of further change.

The article accesses the role of general practitioner in Great Britain to fight alcoholism, a public health problem. According to the author, asking patients about alcohol and recording consumption should become a normal part of healthcare. She says that general practitioners could give health education advice to patients who have excessive alcohol consumption.