Search

The manner in which clinical and cost-effectiveness data are used to inform decisions about the funding and availability of drugs, therapies and medical devices is inherently politicised within collectively financed systems of health care. The National Institute for Health and Clinical Excellence (NICE) was established by the British government in 1999 to reach evidence-based decisions on whether selected health technologies should be made available by the National Health Service in England and Wales. But NICE is also required to involve a broad range of interested parties in the decision-making process, provide detailed rationales for its rulings and defend appeals from aggrieved parties. Debates about the emergence of 'deliberative' forms of policy governance--based upon participation by a broad range of stakeholders rather than reliance on scientific, bureaucratic or political expertise alone--are thus particularly apposite. This article draws on a study of decision-making within NICE by focusing upon the tenor and orientation of deliberation about the adoption of health technologies. Does such deliberation take place upon a level playing field for different interests? Or do implicit parameters and understandings in the deliberative process tend to privilege some interests by structuring debate and attendant outcomes? Findings suggest that deliberative assumptions and parameters pertaining to fluid and contestable ideas of transparent reasoning and domain competence both reflect and shape relationships of influence and marginality among participants. Broader analytical implications centre on a distinction between 'deliberative democracy' and 'democratic deliberation'. The extent to which this distinction is acknowledged and addressed in policy and practise will have marked implications for the substantive nature of attempts to broaden involvement in decision-making within public sector bodies such as NICE. Keywords: UK; Health policy; Health technology appraisal; Health technology assessment; NICE; Public involvement

Decisions by patients upon when to use health care services are a major influence on the consumption of health care resources. Patient education - often based upon written information on how to identify symptoms of common illnesses, when to seek help and how to self-treat - is an increasingly popular strategy to rationalise demand. A large body of literature, in evaluating the impact of such written information, has though overlooked the possession or acquisition of comparable publications by respondents in the course of the studies. This study attempted to overcome this limitation in considering the impact of a prominent patient education booklet that makes reference to over 40 common ailments. Questionnaire data from a cohort sample of residents (n = 495) in an area within which the booklet was circulated and that from a comparison area (n = 509) suggests that such literature exerts a modest influence in orienting patients towards 'appropriate' self-referral and self-care behaviour. Reasons for this limited impact emerged however in semi-structured interviews with a sub-sample of respondents (n = 85). These data show that understanding of the way in which written advice for patients is perceived has to focus upon the ways in which diverse sub-populations process and attribute meaning to 'official' and 'unofficial' sources of advice. More fundamentally, the increasingly sophisticated and specialised nature of medical and scientific knowledge may be distancing expert knowledge from individuals and society such that 'lay' responses to 'expert' advice now reflect a continuing process of risk assessment, trust or the withholding of trust.

Community participation in health care planning in Britain is discussed, with a focus on the connection between political rhetoric and health authorities' relationship with local communities. Topics include the new discourse of community participation, mediation of official discourse, concepts of community and local citizenship, active management, and the welfare system.

Discusses the `Health for All' policy program of Great Britain which was endorsed by the World Health Organization Assembly in 1977. Background and goals of the program; Political debates on health; Influence of the British local government on health care.

The issue of “out of hours” provision of primary care services by family doctors has excited particularly marked debate in the UK. This article considers the implications for this debate of results from a project designed to elicit the views of users of out of hours primary care provision. Focus groups were used to gauge definitions of “out of hours” services, factors governing the use of some services rather than others and influences on the evaluation of different options. The centrality accorded by patients to the social dimensions of a more “traditional” relationship with family doctors was central to the selection and evaluation of alternative provision. Any significant initiative in the reconfiguration of local health care services might thus be regarded as much a social enterprise as a technical challenge based on the most equitable and efficient application of resources. [ABSTRACT FROM AUTHOR]

Focuses on the results of a project, which examined the debate over the issue of `out of hours' provision of primary care services by family doctors in the Great Britain. Methodology used in the project; Number of focus groups that participated in the project; Factors governing the use of `out of hours' services.