Search

The English NHS has been repeatedly restructured since 1991. Drawing on multiple case studies in English primary health care from 1998 to 2005 and on (other) published studies, this article uses Therborn's theory of power to make a framework analysis of how these reforms redistributed power between medicine and management in NHS primary care. Legal changes ended the GP monopoly of primary medical care provision and, with greater managerial discretion in NHS spending, allowed more diverse organisational forms of primary care provision to appear, although general practice remained predominant. Changes in managerial and professional ideologies relaxed the restrictions on managerial decisions about general practice. Re-negotiations between the medical profession and the state mostly tended to increase managerial power. Evidence-based medicine has tended to weaken the impersonal sources of medical power. On balance, these events have tended to increase managerial power over medical practice. They also suggest adjustments to Therborn's conceptualisation of power.

Summary The measurement of health-related quality of life (HRQoL) is being increasingly advocated in healthcare practice, particularly in relation to cancer care. The use of patient-reported health instruments has been [...]

This paper uses the recent history of marketization and privatization in the UK National Health Service as a case study through which to explore the relationship between health-care organization and health-care goods. Phases and processes of marketization are briefly reviewed in order to show that, although the scope of both marketization and privatization reforms have, until recently, been very heavily circumscribed (and can only be understood in the context of the rise of managerialism), they have nonetheless had a major impact on the 'value field' of UK health services. The second half of the paper draws upon the concerns of the critics of market-style reforms to set out and explore the ways in which organizational reform and the shifts in institutional norms consequent upon it construct health-care goods and argues that the investigation of this organization-goods axis ought to have a central place in health-care ethics. Keywords: health-care goods, managerialism, markets, organizations

The founding vision of St Christopher's Hospice was based on a recognition that permeating mainstream health care services would be essential and an emphasis on an adaptable philosophy rather than a building. Today, demographic and disease related changes mean that need and demand for end-of-life care will inevitably outstrip professional and financial resource. Hospices must engage with the development of cost-effective models of service delivery and rational planning. Only partnership working with the National Health Service, care homes, and others will ensure that appropriate care is available to everyone wherever the bed in which they die, regardless of diagnosis. Only collaboration and active engagement will ensure that future strategy in end-of-life care retains the original insight that its focus rightly includes not only patients but also the social context that will be affected by their death. Cost and patient choice dictate an emphasis on care at home. Health-promoting, public education and family-focused strategies will be essential. At a pivotal moment for the delivery of health care generally, hospices can play a vital part by marrying the role of 'insistent conscience' of the health care service with continued cost-effective clinical innovation.

MOST LEADERS and managers understand that, the safer the workplace, the more harmonious the workforce and the better the service delivery. Union safety representatives can help managers improve workplace safety, [...]

The health care policy makers are developing a design science thinking approach that will help in bringing a large-scale organizational change. The English National Health Service (NHS) is used as a case study to show how design sciences will help in understanding the organizational theory and practice and also offer organization development (OD) some new approaches and processes for large-scale changes.

Soft systems methodology (SSM) includes several ways of gaining a rich appreciation of the problem situation addressed. 'Analysis One', exploration of the intervention itself, is the subject here, since it is sparsely covered in the literature. The analysis is conducted in terms of three roles: 'client', 'problem solver' and 'problem owner'. Whoever is in the role of 'problem solver' is free to define a list of possible 'problem owners', which brings many perspectives to bear on the situation. It was realized that 'client' and 'problem solver' should themselves feature in the 'problem owner' list. The 'problem' owned by the 'problem solver' is that of undertaking the intervention. This led to a realization that SSM is relevant to both the content of a perceived situation (SSMc) and the process of dealing with that content (SSMp). This development is described and illustrated by work in the National Health Service. The focus of the SSM use was to define the intellectual process for a service specification project which NHS professionals would themselves carry out. Journal of the Operational Research Society (2006) 57, 1435-1441. doi:10.1057/palgrave.jors.2602118 Keywords: methodology; SSM; intervention; process; praxis

The government's program for transforming the UK's National Health Service (NHS) and an analysis of the nature of the present crisis at NHS with respect to the government policies and its implementation process is discussed. The government's new model to improve efficiency should show a balance between the efficiency gains and increased demands, between destruction and creation by end of fiscal year 2007.

The hostile atmosphere around most of the National Health Service's organizations' as they prepare to lay off workers in large numbers, due to Prime Minister Tony Blair's assumption that these organizations were working inefficiently, is discussed. Public on their part are concerned about the quality of service coming down or disappearing all together.

A study examining the organizational changes implemented in the United Kingdom National Health Service (NHS) based on Patient Advice and Liaison Services (PALS) that was created under NHS Plan for gathering information from patients and solving them, is presented.

The National Health Service (NHS) Plan, had its fifth birthday without any celebrations. The role of the Plan in reforming the National Health Service, is discussed.

A critique of the British National Health Service (NHS) reveals the end of nationalized healthcare and suggests that only denationalization can bring about any progress in the field. Reforms within and outside the established system are discussed, which are though feasible in medical, financial and administrative areas, it is only political will and visionary leadership that can bring about a better health care system.

The issues relating to UK's public sector services market and the regulations required to monitor them are discussed. The management of National Health Services is examined in depth to analyze the problems of and solutions for such quasi-markets.

The increasing significance of the role of the general practitioner (GP) in the British National Health Service, evolving from a provider to purchaser and now a key player in the organisation of Primary Care Groups, suggests the need for GPs to possess more and more information about their registered population. GP catchment areas, though an essential basis for providing GPs with important information such as levels of accessibility to surgery, are rarely clearly or accurately defined. Previous approaches towards the definition of GP catchments have been confined to single regionalisation methods, such as mean distance measures, and are prone to problems of either overestimating or underestimating medical service areas. This problem is compounded by a lack of acknowledgement that the application of contrasting catchment methodologies to a common service population has the potential to yield vastly different results which can have serious implications for health care planning and resource allocation. The lack of sophistication in the definition of medical service areas calls for a new methodology to be considered. In this paper, attention is given to the adaptation of multidimensional regional analytical techniques developed outside the health domain and applied in a Regional Health Authority in Northern Ireland. The technique involves the creation of a Synthetic Data Matrix (SDM) which compares patient to GP flow (affiliation) information aggregated at the Census Enumeration District level across a number of catchment areas created using different methodologies. The SDM is then analysed using a modified version of the European Regionalisation Algorithm to create an optimal set of nonoverlapping regions according to pre-defined population size and self-containment criteria. The results, a set of compact, robust and highly self-contained catchments, are extremely encouraging. The paper considers the future potential use of such a methodology for health care planning and highlights areas for further research in this field. Keywords: GP Catchments; Regionalisation; Medieal service areas; GIS; UK

This paper is based on a study of overseas black and minority ethnic nurses in the NHS. Following a critical and analytical discussion of the principles of systematic reviewing, Obrey [...]

The UK Department of Health is reducing its control over National Health Services (NHS) as a cost control measure.

Changes in the UK National Health Service are discussed.