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The 1944 Wartime Coalition White Paper, "A National Health Service" is unlikely to be celebrated among the spate of golden anniversaries of welfare reforms in the 1990s. However, a study of this document may be of interest for two main reasons. First, it has some parallels with the reformed National Health Service of the 1990s and, second, there have been recent calls for a local government-based health service, as was envisaged in 1944. The White Paper is examined in the context of evolving plans for the NHS, and is compared with the actual shape of the NHS as introduced by the Labour Minister of Health, Aneurin Bevan, in 1948. Four themes are drawn out. First, the White Paper should not be seen as the embodiment of a political consensus. Second, a Conservative Health Service would have differed from the NHS in fundamental aspects. Third, the conceptual advantages of a local government-based health service were outweighed by practical politics. Fourth, although the Labour Party made a difference to the shape of the NHS, that shape did not simply follow from party policy. This implies that medical pressure was successful, to some extent, in defining the limits of the new service. [ABSTRACT FROM AUTHOR]

Introduction: There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health. Methods: A public consultation was undertaken with people of any gender aged 18–50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers. Results: Fifty‐four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18–30 years, 30% 31–40 years, 15% 41–50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender‐sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well‐being during the childbearing years', 'health and well‐being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School‐based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness. Conclusion: This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co‐development of public awareness campaigns and guidance for healthcare professionals. Patient or Public Contribution: This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co‐authors of the paper. [ABSTRACT FROM AUTHOR]

Introduction: A range of nonpharmaceutical public health interventions has been introduced in many countries following the rapid spread of Covid‐19 since 2020, including recommendations or mandates for the use of face masks or coverings in the community. While the effectiveness of face masks in reducing Covid‐19 transmission has been extensively discussed, scant attention has been paid to the lived experience of those wearing face masks. Method: Drawing on 40 narrative interviews with a purposive sample of people in the United Kingdom, with a particular focus on marginalised and minoritized groups, our paper explores experiences of face mask use during the pandemic. Results: We find that face masks have a range of societal, health and safety impacts, and prompted positive and negative emotional responses for users. We map our findings onto Lorenc and Oliver's framework for intervention risks. We suggest that qualitative data offer particular insights into the experiences of public health interventions, allowing the potential downsides and risks of interventions to be more fully considered and informing public health policies that might avoid inadvertent harm, particularly towards marginalised groups. Patient or Public Contribution: The study primarily involved members of the public in the conduct of the research, namely through participation in interviews (email and telephone). The conception for the study involved extensive discussions on social media with a range of people, and we received input and ideas from presentations we delivered on the preliminary analysis. [ABSTRACT FROM AUTHOR]

This paper is based on Shalini Weerasooriya's Masters dissertation in Public Health at the University of Sheffield. A literature review was conducted to understand the role that orphan drug policies have played in the development of new treatments for rare diseases. The impacts of the policies were categorised as 'tangible' or 'intangible' and further synthesis identified 10 main themes such as incentives for investment, criteria for eligibility and assessment of drug applications and further guidance to industry during the drug development cycle. The review concludes that whilst policies have contributed positively towards improving the research and development of orphan drugs it has not exhausted its uses and must now shift its focus to facilitating greater accessibility and affordability of the treatments and that stakeholders are essential to the success of this process. Implications for practice are identified, for example the need to further update and refine the policy with changing demographics and advancing technologies and, in particular, greater collaboration and involvement through, for example, evidence based training programmes is recommended. It is concluded that focus must shift to address the gap between having available drugs and being able to access and afford them. F.J. [ABSTRACT FROM AUTHOR]

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

Background and Aim: Public health policy development is subject to a range of stakeholders presenting their arguments to influence opinion on the best options for policy action. This paper compares stakeholders' positions in the discourse networks of two pricing policy debates in the United Kingdom: minimum unit pricing for alcohol (MUP) and the soft drinks industry levy (SDIL). Design Discourse analysis was combined with network visualization to create representations of stakeholders' positions across the two policy debates as they were represented in 11 national UK newspapers. Setting: United Kingdom. Observations: For the MUP debate 1924 statements by 152 people from 87 organizations were coded from 348 articles. For the SDIL debate 3883 statements by 214 people from 175 organizations were coded from 511 articles. Measurements Network analysis techniques were used to identify robust argumentative similarities and maximize the identification of network structures. Network measures of size, connectedness and cohesion were used to compare discourse networks. Findings The networks for both pricing debates involve a similar range of stakeholder types and form clusters representing policy discourse coalitions. The SDIL network is larger than the MUP network, particularly the proponents' cluster, with more than three times as many stakeholders. Both networks have tight clusters of manufacturers, think‐tanks and commercial analysts in the opponents' coalition. Public health stakeholders appear in both networks, but no health charity or advocacy group is common to both. Conclusion: A comparison of the discourse in the UK press during the policy development processes for minimum unit pricing for alcohol and the soft drinks industry levy suggests greater cross‐sector collaboration among policy opponents than proponents. [ABSTRACT FROM AUTHOR]

The continuing global increase in the prevalence of overweight and obesity, particularly amongst children, attracts widespread public and political attention. Obesity is a complex condition, with multi‐faceted determinants, and prevention strategies require consideration of dietary and lifestyle patterns alongside a range of environmental factors. Reduction in intake of sugar‐sweetened beverages and foods is advised around the world as part of healthier dietary patterns to help reduce energy intakes, obesity risk and obesity‐related disorders. Current intakes indicate that this is challenging and will likely require a concerted approach with a broad range of interventions including fiscal measures. In recent years, after some notable success with salt and trans fats, there has been considerable focus on food reformulation to support the reduction in population intakes of free sugars from manufactured foods, often without need for consumer behaviour change. In some products, particularly sugar‐sweetened beverages, reformulation is relatively easy and has been widely achieved, as the sweetness of sugars can be replaced with low‐calorie sweeteners. However, other products, in which sugar delivers a variety of functional properties, are more challenging to reformulate to maintain consumer acceptance and achieve a reduction in energy, alongside sugar, content. This paper will look at current definitions and recommendations for free (or added) sugars, as well as key dietary sources and trends in intakes, and explore various strategies to promote population reductions in intake of sugars for public health, including the opportunities and challenges presented by reformulation using low‐calorie sweeteners. Ultimately strategies to promote sugar reduction, including reformulation, should adopt a holistic approach that considers wider dietary recommendations. [ABSTRACT FROM AUTHOR]

Griffith Edwards played an important role in cannabis policy debates within government advisory committees in the United Kingdom from the early 1970s until the early 1980s. This has largely been hidden from public knowledge by the confidentiality of these committee discussions. The purpose of this paper is to use Griffith's writings and the results of recent historical scholarship to outline the views he expressed, the reasons he gave for them, and to provide a brief assessment of his contribution to the development of British cannabis policy. [ABSTRACT FROM AUTHOR]

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

Introduction: With the rapid growth of urbanization globally and in the UK, increasing attention is now being directed towards urban green spaces (UGS). The appeal of UGS to policymakers lies in their capacity to address multiple policy objectives, including improving physical and mental wellbeing, mitigating noncommunicable diseases (NCDs), combating climate change through carbon sequestration, providing climate adaptation measures, and enhancing biodiversity. Method: This narrative review gives an overview of the current literature and UK policy relating to urban green and blue spaces, with a particular focus on the use of UGS to increase physical activity levels. Results: UGS have a profound impact on public health, with evidence indicating their positive effect on both physical and psychological health. Thirty‐eight percent of adults in the UK do not live within 15 minutes of UGS, so policy makers at national and international level are aiming to address this gap. One reason for the health benefits of UGS is associated increased physical activity, a vital component needed to address the burden of non‐communicable disease. To effectively harness UGS to promote physical activity various factors must be considered; proximity and diversity of urban green spaces, and the presence of suitable infrastructure features. Tailoring UGS to meet the needs and preferences of different population demographics is essential, as is ensuring safety, and addressing barriers to access particularly for lower socio‐economic groups. The careful planning of UGS must avoid potential gentrification effects and displacement of vulnerable communities, whilst utilising the equigenic nature of UGS. Conclusions: To create a brighter future and capitalize on the potential of UGS, a collaborative approach is needed, involving communities, local governments, and national authorities. Primary‐care professionals, represented by organizations like the Royal College of General Practitioners (RCGP), can play a crucial role in advocating for UGS and physical activity, promoting their use, and providing guidance and support. [ABSTRACT FROM AUTHOR]

The article discusses a meeting organized by the Food and Health Forum of the Royal Society of Medicine that was held in Great Britain on March 27, 2014. At the meeting various papers on dietary guidelines are presented by several professors including Jayne Woodside, Tom Sanders and Peter Aggett. It also informs that attendees at the conference are welcomed by Anthony Mander, President of the Food and Health Forum.

Cancer is a major cause of death and ill health, accounting for roughly one in four deaths in the UK. Concern with cancer services was expressed in the 1990s when it was reported that the quality of cancer care was patchy and variable, and clinical outcomes varied in different parts of the country. The Calman-Hine Report (1995) produced specific recommendations for the reorganizing and reconfiguring of cancer services, but although the Conservative government, which commissioned the report, endorsed its suggestions no additional funding was provided to implement the proposed changes, and consequently there remained variations in provision across geographical areas and between patients with different cancer types. However, since 1997 the Labour government has targeted cancer, appointing a Cancer Tsar, announcing a package of measures to“fight the war against cancer”, including the publication of a) and with Tony Blair pledging to end the postcode lottery for cancer treatment. This paper explores the concept of the“postcode lottery of cancer care”, why it exists and whether measures taken since the Calman-Hine Report and the Cancer Plan will address it. [ABSTRACT FROM AUTHOR]

This is an opportune moment to be producing an issue on the sociology of health inequalities. Almost 20 years after the Black Report, the classic document which was commissioned by the last Labour administration in the UK in the late 1970s and shelved by the Conservative successors in 1980, a new Labour administration has commissioned the Independent Inquiry into Health Inequality. In the interim, many nations have followed the Great Britain in turning away from social democratic corporatism towards a greater emphasis on free market economics. These changes took place through the ballot box, and were widely thought to signal public disenchantment with redistributive social policies. At the same time, some commentators have pronounced the death of social class as a force in economy, society and human biology. Those who continued to do research on social inequality in health were therefore under a heavy obligation of rigour in their work. It was a lonely time to be doing such work in many ways, but also a highly challenging one, in which all assumptions were questioned and sometimes tested to destruction. Two of the assumptions to come under attack were that health inequalities existed at all and that there was any causal relation between social conditions and health.

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.

This article explores the dynamics between fat shaming, neoliberalism, ideological constructions of health and the 'obesity epidemic' within the UK, using the UK Government's recent Tackling Obesity campaign in response to Covid‐19 as an illustration. We draw attention to how fat shaming as a practice that encourages open disdain for those living with excess weight operates as a moralising tool to regulate and manage those who are viewed as 'bad' citizens. In doing so, we begin by outlining how the ideological underpinnings of 'health' have been transformed under neoliberalism. We then consider the problematic use of fat shaming discourses that are often used as tools to promote 'healthy' lifestyle choices by those who view it as not only an acceptable way of communicating the health risks associated with obesity but also a productive way of motivating people with obesity to lose weight. Drawing on Graham Scambler's theoretical framework regarding shame and blame (2020), we discuss how 'heaping blame on shame' has become a 'wilful political strategy' under neoliberalism, particularly as it relates to individuals with obesity, and how the Tackling Obesity campaign leverages concerns around 'choices' and 'costs' as a means through which to encourage normative models of self‐care and self‐discipline. [ABSTRACT FROM AUTHOR]

The role of shared identity in predicting both ingroup helping behaviour and adherence to protective norms during COVID‐19 has been extensively theorized, but remains largely under‐investigated. We build upon previous Social Identity research into community resilience by testing the role of pre‐existing local community (or 'neighbourhood') identity as a predictor of these outcomes, via the mediator of perceived social support. Community residents in the UK completed a longitudinal online survey four months before lockdown (T1; N = 253), one month before lockdown (T2; N = 217), and two months into lockdown (T3; N = 149). The cross‐lagged panel analysis shows that T1 community identification predicts T3 giving and receiving of pandemic‐related support, and that these effects occur via the perception of community support at the second time point (while the alternative pathway from T1 support via T2 identification is non‐significant). Moreover, we show that T1 community identification also directly predicts lockdown adherence at T3. Our findings point to the pivotal role played by community identity in effective behavioural responses to the pandemic, and the need to support and foster community development to facilitate local community resilience as the crisis continues to unfold. [ABSTRACT FROM AUTHOR]

Hepatitis B virus (HBV) is a highly infectious bloodborne virus, which remains endemic in large geographic areas and represents a major global healthcare challenge. HBV transmission from healthcare workers, who perform exposure prone procedures (EPP), to patients is a recognized transmission risk, which varies widely globally. Although the risk is small in developed countries, it increases significantly in high‐prevalent, low‐resource countries, representing a major challenge to these healthcare systems and underlining the necessity for robust guidance to be in place. The HBV landscape has evolved as a result of global vaccination programs, implementation of standard precautions and the advent of new generation antiviral agents (3rd generation nucleos(t)ide analogues). In light of the progress in the field, the UK Advisory Panel for Healthcare Workers Infected with Bloodborne Viruses (UKAP) recently issued updated guidance, which essentially removes past barriers, restricting healthcare workers from performing EPPs solely on the basis of HBV DNA level, regardless of hepatitis B 'e' antigen and/or treatment status. Although the current recommendations remain conservative compared to those of other developed healthcare systems, UK practice is now in line with other high‐income countries, while ensuring patient safety remains paramount, without unduly restricting HCWs from clinical practice. The current article presents the latest UKAP guidance, considers its implications for HCWs and compares it with the guidance from major international scientific societies and governing bodies. [ABSTRACT FROM AUTHOR]

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]

Health policy at national level is the product of a series of continuous and complex interactions between interest groups operating both inside and outside government. It is generally thought that these consultative processes are closed, elitist and dominated by the prestigious medical specialties. Yet there has been a rapid growth in the number of groups representing various interests, professions and care groups. Drawing on recent examples from the national health service, the paper explores the extent to which consultative processes in health policy have remained closed or have been opened up to new influences. The analysis suggests that consultation within the health department is more pluralistic than is usually appreciated. Also, while the closed, elitist mode of consultation with external interests has been eroded marginally, it remains more or less intact. Nevertheless, the ability of powerful medical interests to get their own way to the exclusion of other interests depends on the resources and sanctions available to other groups and on the particular policy issue. It can no longer just be assumed. [ABSTRACT FROM AUTHOR]

Policy PointsNudges steer people toward certain options but also allow them to go their own way. "Dark nudges" aim to change consumer behavior against their best interests. "Sludge" uses cognitive biases to make behavior change more difficult.We have identified dark nudges and sludge in alcohol industry corporate social responsibility (CSR) materials. These undermine the information on alcohol harms that they disseminate, and may normalize or encourage alcohol consumption.Policymakers and practitioners should be aware of how dark nudges and sludge are used by the alcohol industry to promote misinformation about alcohol harms to the public. Context: "Nudges" and other behavioral economic approaches exploit common cognitive biases (systematic errors in thought processes) in order to influence behavior and decision‐making. Nudges that encourage the consumption of harmful products (for example, by exploiting gamblers' cognitive biases) have been termed "dark nudges." The term "sludge" has also been used to describe strategies that utilize cognitive biases to make behavior change harder. This study aimed to identify whether dark nudges and sludge are used by alcohol industry (AI)–funded corporate social responsibility (CSR) organizations, and, if so, to determine how they align with existing nudge conceptual frameworks. This information would aid their identification and mitigation by policymakers, researchers, and civil society. Methods: We systematically searched websites and materials of AI CSR organizations (e.g., IARD, Drinkaware, Drinkwise, Éduc'alcool); examples were coded by independent raters and categorized for further analysis. Findings: Dark nudges appear to be used in AI communications about "responsible drinking." The approaches include social norming (telling consumers that "most people" are drinking) and priming drinkers by offering verbal and pictorial cues to drink, while simultaneously appearing to warn about alcohol harms. Sludge, such as the use of particular fonts, colors, and design layouts, appears to use cognitive biases to make health‐related information about the harms of alcohol difficult to access, and enhances exposure to misinformation. Nudge‐type mechanisms also underlie AI mixed messages, in particular alternative causation arguments, which propose nonalcohol causes of alcohol harms. Conclusions: Alcohol industry CSR bodies use dark nudges and sludge, which utilize consumers' cognitive biases to promote mixed messages about alcohol harms and to undermine scientific evidence. Policymakers, practitioners, and the public need to be aware of how such techniques are used to nudge consumers toward industry misinformation. The revised typology presented in this article may help with the identification and further analysis of dark nudges and sludge. [ABSTRACT FROM AUTHOR]

The United Kingdom now has one of the most comprehensive tobacco control policies in the world, a far cry from its status two decades ago. Some influential public health voices have called for a similar campaign against alcohol consumption. But is the comparison appropriate? We identify the factors which were important in the relatively successful campaign for tobacco control, then analyze the obstacles and opportunities facing the movement for more stringent alcohol control. Alcohol policy today often bears a striking resemblance to tobacco policy pre-1990s, when the UK started on its path to becoming a leading regulatory on this policy. [ABSTRACT FROM AUTHOR]

This study examines the location of British health visiting in contemporary policy discourses concerned with public health and safeguarding children. It argues that professional identity and orientation can be understood through health visiting's long history of public health work with children and families, which has included an engagement with protecting children. The expansive safeguarding children agenda, which includes the requirement to undertake a progressive universal approach to service provision and which incorporates a broad concept of risk and requires early intervention, has created tensions, particularly given current workforce constraints. The location and visibility of British health visiting in the academic and practice worlds also shape how the profession is understood. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To provide an overview of gambling and problem gambling in Britain, including historical background, current regulations and the recognition, prevalence and treatment of problem gambling. Methods A new theory, Gambling Restraint Erosion Theory (GRET), is used as a framework for understanding the history of gambling regulation in Britain in the 20th century and evidence about the prevalence of gambling and problem gambling, as well as public attitudes towards gambling, in Britain in the first decade of the 21st century. Findings Restraints on gambling were progressively dismantled as regulation moved from partial prohibition, to tolerance, and then to liberalization by the turn of the millennium. British adult gambling prevalence surveys carried out in 1999/2000, 2006/07 and 2009/10 suggest that the British public is still relatively restrained in its engagement in gambling, and is still suspicious of gambling. There is evidence from the last of those surveys that engagement in some forms of gambling, and the prevalence of problem gambling, have risen, and that attitudes have become less negative towards gambling. Conclusions Restraints which kept British gambling circumscribed, and the prevalence of problem gambling low, may be in the process of being eroded. Meanwhile, an effective public health response to problem gambling is constrained by lack of Department of Health interest and a failure to develop a research and treatment base independent of the gambling industry. [ABSTRACT FROM AUTHOR]

Introducing market-like structures to public services is a key aspect of New Public Management. The restructuring of the NHS into an internal market of the 1990s is an example. Recent policies have further developed this notion. A new aspect of the restructuring is a focus on increasing the diversity of types of provider of healthcare organisations. The objectives of the restructuring policy entailing the increase in supply side diversity are examined, and the challenges raised by these changes are discussed. It is argued that the government is too optimistic about the benefits, and insufficiently concerned about possible undesirable consequences. [ABSTRACT FROM AUTHOR]

Rationale, aims and objective UK public health policy requires hospitals to deliver health promotion services to patients for healthy lifestyles (i.e. health education), but there are currently few data on the health education delivered within hospitals. This audit aimed to collect data on the routine health education activities delivered to hospitalized patients to assess whether the following standards were met: 100% of hospitalized patients screened for smoking, alcohol use and obesity, 70% of smokers offered health education for smoking cessation and 50% of patients identified as misusing alcohol, obese, consuming an unhealthy diet and/or physically inactive delivered the appropriate health education. Methods An audit of data contained in hospitalized patients' written medical case notes for evidence that the above standards were met. Nine hospitals in Greater Manchester in England participated. Results Four hospitals screened all patients for smoking. None of the hospitals met the standards for screening alcohol or obesity. For health education delivery, all hospitals met the standard for diet, four for alcohol misuse and four for physical activity. None of the hospitals met the standards for smoking or obesity. Conclusions Improvements in practice for screening of alcohol and obesity are required. While some hospitals appeared to meet standards for health education delivery for alcohol, diet and physical activity, given the poor screening procedures for these risk factors, we can not conclude that health education delivery was adequate. [ABSTRACT FROM AUTHOR]

Systematic reviews have become an important methodology in the United Kingdom by which research informs health policy, and their use now extends beyond evidence-based medicine to evidence-based public health and, particularly, health inequalities policies. This article reviews the limitations of systematic reviews as stand-alone tools for this purpose and suggests a complementary approach to make better use of the evidence. That is, systematic reviews and other sources of evidence should be incorporated into a wider analytical framework, the public health regime (defined here as the specific legislative, social, political, and economic structures that have an impact on both public health and the appropriateness and effectiveness of public health interventions adopted). At the national level this approach would facilitate analysis at all levels of the policy framework, countering the current focus on individual interventions. It could also differentiate at the international level between those policies and interventions that are effective in different contexts and are therefore potentially generalizable and those that depend on particular conditions for success. [ABSTRACT FROM AUTHOR]

The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. ‘Patient choice’ policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of ‘choice’ might not necessarily be the ‘local’ provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients’ access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio-economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients’ willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice. [ABSTRACT FROM AUTHOR]

Objective To explore the process of public involvement in planning primary health care. Background Recent policy in the UK promotes public involvement in planning health but there have been difficulties in engaging communities in the process. Surveys of health service organizations have found that there has been a failure to adapt to new approaches. It has become important to understand why this has occurred if policy initiatives to encourage involvement are to succeed. Design Qualitative study. Data collected through individual interviews and focus groups. Setting Two new primary healthcare developments in deprived areas in Bristol and Weston-Super-Mare. Participants Thirty-six professionals and 23 local residents in Bristol; six professionals and three local residents in Weston-Super-Mare. Results Three themes were identified: process, partnership and power. The main findings were that exceptional people with a shared commitment to public involvement were necessary to motivate others and develop partnerships. Local people were drawn into the process and with increased confidence became powerful advocates for their community. Creative and varied methods to involve the public were important in achieving balance between professionals and lay people. However, conflicts over practical decisions arose from a lack of clarity over who had power to influence decisions. Conclusion Most of the participants were enthusiastic about their experience of public involvement in planning primary health care. Features crucial to sustainable involvement included a commitment from leaders within statutory agencies, support over a long period to build the confidence of local people, willingness to use informal approaches that are in tune with local culture, and a recognition of the concerns of both service users and providers. [ABSTRACT FROM AUTHOR]

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence-based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre-eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision-making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision-making. [ABSTRACT FROM AUTHOR]

Focuses on the National Institute for Clinical Excellence (NICE), a government-funded, independent body established in 1999 in Great Britain. NICE's provision of national guidance on treatments and care of people using the British National Health Service; Functions of NICE that are of immediate relevance to urologists; NICE notifications; Process of assessment; NICE policy on patient consent.

Goal. Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities. Objectives. (1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the "policy windows" model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere. Data Sources. Official documents, secondary analyses, and interviews with policymakers. Study Design. Qualitative, policy analysis. Data Collection. 2001–2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case‐studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policy‐makers and documentary analysis. Principal Findings. (1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The "policy windows" model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities. Conclusions. Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids understanding and points to ways of sustaining and extending the recent progress and overcoming pitfalls. [ABSTRACT FROM AUTHOR]

The article focuses on the British Conservative government policy concerning prescription charges in the National Health Service (NHS). The Conservative government defers to the market-driven demand anent prescription charges in the NHS. For the government, the previous use of pharmaceutical charges while raising some meager amount of income and thus decreasing the public sector burden must be seen through ideological prism. The success of future NHS reforms is dependent on the specific incentives their operation will encourage.

The introduction of the internal market to the National Health Service in Britain marks a major change in the form of provision of health care interventions. This article reports the findings of independent research into the development of the purchasing process in eight purchasing authorities (which collectively purchase health care for 5 per cent of the population of Britain), and considers the extent to which this has led to an explicit politics of rationing in British health care. The structure and organization of purchasing organizations is described, along with their relationship with providers of health care. The ability of purchasing organizations to assess the health needs of the populations for which they purchase health care services, and their ability to influence change in the nature of the services provided, is also examined. [ABSTRACT FROM AUTHOR]

This article presents information on medical care received by mothers and their newly born infants. Until the late 1880s, when voluntary hospitals began to accept single mothers for the first time, unmarried mothers formed the largest group of women seeking maternity care from the guardians. Concern for infant and maternal morbidity and mortality, together with developments in maternity care as a whole in the early twentieth century, such as the regulation of midwives and the increasing adoption of antisepsis and ante-natal care in voluntary teaching hospitals, spurred many parishes to improve provision for expectant mothers. Parish relief always allowed for some form of medical assistance for the very poor during illness or childbirth, but its character changed over time and was linked to the nature of poor law provision as a whole. This had implications not only for the types of maternity care offered, but also for their accessibility. In 1834 parish relief was transformed by the Poor Law Amendment Act, which drastically restricted outdoor relief. Taking east London as its focus! this article examines the development of parish medical care for mothers and infants; a subject which has hitherto received very little attention from historians working on the poor law or on maternal and infant welfare.

Reports on the change in the government policy towards the National Health Service (NHS) in Great Britain. Commitment to a public provision of health care; Medical policy of Prime Minister Margaret Thatcher; Role of the affairs of the NHS in Parliamentary proceedings.

Focuses on the level of preparation in Great Britain for a possible outbreak of foot-and-mouth (FMD) disease. Separate reports from the British Department of Environment, Food & Rural Affairs and the Royal Society on the government's FMD contingency planning; Importance of effective communication during a disease outbreak; Plans for disease surveillance.