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The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is [...]

Summary This article attempts to summarise and interpret recent quality initiatives from the Department of Health to improve tissue viability nursing services across England. It is directed towards nurses responsible [...]

The United Kingdom's National Health Service (NHS) is investing considerable resources in reducing patient waiting times for elective treatment. This paper describes the development of a waiting list model and its use in a simulation to assess management options. Simulation usually assumes that waiting is adequately described by simple queuing disciplines, typically first-in-first-out. However, waiting in the United Kingdom's NHS is a more complex phenomenon. The waiting list behaviour is explored through an analysis of the changes in waiting time distributions for elective orthopaedics in one Scottish Health Board, NHS Fife. The evolving distributions suggest that there have been substantial changes in priorities in response to the various NHS targets. However, in the short or medium term, the form of the distribution appears reasonably stable, providing a basis for estimating future waiting times in different scenarios. A model of the waiting behaviour and prioritization in the appointment allocations was embedded in a simulation of the complete elective orthopaedic patient journey from referral, through outpatients and diagnostics to surgery. The model has been used to explore the consequences of various management options in the context of the NHS target that no patient should wait more than 18 weeks between referral and treatment. Journal of the Operational Research Society (2010) 61, 246-254. doi: 10.1057/jors.2008.149 Published online 7 January 2009 Keywords: health service; simulation; queuing

Alford's theory of structural interests has been used as a framework within which to analyse health systems across the world. However, authors have often been uncritical in their acceptance of Alford's original analytic categories. In this article we use data from a detailed qualitative study of the introduction of Practice Based Commissioning in the UK NHS to interrogate Alford's work more critically. Disrupting Alford's original categories of 'professional monopolisers' as dominant interests, challenged by management 'corporate rationalisers', we suggest that the new structures established in the NHS since 2002 systematically privilege an interest that we call 'corporate monopolisers', and that this is under challenge from 'professional rationalisers'.

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.

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 demonstrating that unplanned and fragmented outsourcing of services lead to 'imbalanced' supply markets, explained through the example of the National Health Services, is presented.

Northgate and Prudhoe NHS Trust is a specialist trust catering for people with disability, including learning disability. As one of the UK's largest providers of care for people with a [...]

Keywords * Outpatient's department * carers * communication These keywords are based on the subject headings from the British Nursing Index. This article has been subject to a double-blind review. [...]

TACKLING HEALTH inequalities when managing people with long term conditions (LTCs) requires the courage to work in new ways. It means setting national standards for services but also giving those [...]

THERE HAVE ALWAYS BEEN differences in terms of churchmanship, law, education and therefore culture between Scotland and the rest of the UK. Political devolution, which included the establishment of NHS [...]

Summary This article describes the process to formally accredit existing in-house education courses in a continuing professional development (CPD) framework. The partnership was between two Lothian NHS organisations and a [...]

The economic issues that formed a part on the reform of public sector institutions on the basis of the development in the National Health Service (NHS) especially in case of Foundation hospitals were examined. The Government has aimed to expand the role of primary health care, which would reduce the pressure on hospitals by switching service provision to General Practitioners (GP) and introducing new services like NHS walk-in centers and NHS Direct.

An assessment is presented on the use of geographic information systems (GIS) within the UK's National Health Service to address supply-and-demand issues in health care services distribution. It is argued that GIS are not being used as extensively or effectively as they might be.

The expansion of GP fundholding (GPFH) is central to the British government's attempt to maintain the revolution under way in the National Health Service (NHS). Evaluations of the NHS reforms have portrayed GPFH as an important mechanism for competition, and GPFH's bargaining power is reported to have secured significant changes in health service provision. However, these developments have been acknowledged to be less applicable in relation to community health services (CHS) than acute hospital services. On the basis of case studies of the process of contracting for CHS, GPFHs are shown to display ambivalent and sometimes contradictory views which have to be related to broader policy developments in general practice and primary care. Although this paper focuses on the British situation, many of the issues raised by reforms in primary and community health services have implications for developments in other Western health care systems. Key words - primary care, GP fundholding, community health services

A study of the geographical variations in contracting out of hospital ancillary services of National Health Services (NHS), England and Wales during 1985 to 1991 reveals that legislation, public attitudes, financial resources, and people's awareness of their roles play an important role in these contracting processes. Structuration theory provided an effective method for analyzing the contracting processes. Study was conducted on the two urban district health authorities with similar conditions in the Northern England.

The policy of compulsive competitive tendering for support services in the National Health Service may be considered a success because it has reduced costs, despite the intitial costs of establishing the system and making redundancies. Changes in working practices led to increased productivity and costs were reduced by cutting wages and conditions of service. In some cases the NHS has found it difficult to interest outside firms in bidding for a contract, or could provide the service more cheaply in-house.

IT SEEMS a long time since, back in January 2008, Gordon Brown announced that people will be eligible for a free checkup for heart attacks and strokes. This announcement evolved [...]

The different methods used for reforming and improving the National Health Service (NHS) to achieve better value for patients are discussed. The physician leadership and competitions on outcomes do not seem to be sufficient for providing proper health care to patients.

Mental health crises and emergencies need rapid and effective intervention for the safety of patients, their carers and the general public. Yet the National Service Framework for mental health (Department [...]

Echoing the sentiments of many in the largest group of NHS service users, this comment was made by a participant in the patient workshops run by Epping Forest Primary Care [...]

Health secretary John Reid opened the doors of National Health Services to private sector and effectively transferred 5% of NHS surgery to it. The progress in this private public cooperation and the prospects thereof are discussed.

The proposed public and patient interaction in the local NHS services has not become a reality yet. Public and patient involvement, which is still in a nascent stage, needs to be streamlined to reap results for the community in general.