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In Scotland, in 2002, the National Waiting Times Unit was launched to reduce NHS waiting times. This was accompanied by a series of waiting time targets across the NHS in Scotland. The purpose of this study is to analyse changes in equality of access to treatment by socioeconomic deprivation associated with this initiative. Trends in annual cataract rates were calculated using secondary care admissions' Scottish Morbidity Record (SMR01) data on NHS funded elective cataract procedures for patients treated in Scotland from 01 April 1997 to 31 March 2019. An interrupted time series model was used to analyse socioeconomic differences in waiting times by deprivation quintile over three time periods; pre and post waiting time initiative, and post austerity. Cataract Surgical Rates more than doubled from 3,723 per million population in 1997/1998 to 7,896 per million population in 2018/2019. Mean waiting time fell from 129.5 days in 1997/1998 to 87.7 days in 2018/2019. Inequality in mean waiting time between most and least deprived cataract patients increased by 1.34 days per quarter between 01 April 1997 and 30 June 2002 and following the waiting time initiative fell by 0.41 days per quarter through to 31 March 2010; and then decreased by 0.002 days per quarter between 01 April 2010 and 31 March 2019. The waiting time initiative had a major impact on reducing inequality in waiting times between socioeconomic groups. The onset of austerity in 2010 was associated with a very small and insignificant increase in inequality. [ABSTRACT FROM AUTHOR]

The authors describe the incremental approach to the marketisation of the English National Health Service (NHS) since the introduction of an 'internal market' in 1990 until the 2010 White Paper, 'Equity and Excellence: Liberating the NHS', and the subsequent Health and Social Care Bill published in January 2011. The introduction of a competitive market for a universal, tax-financed health system requires fundamental changes in regulation in order that market bureaucracy can be substituted for direct management. The components of reform are insufficiently captured by the framework of hierarchies and networks in new public management theories of decentralisation. [ABSTRACT FROM AUTHOR]

The government's main justification for using private finance is that it provides value for money by transferring project risks to the private sector. However, of the 622 PFI deals signed by October 2007, the National Audit Office (NAO) has examined the relationship between risk transfer and risk premiums in only three. The government's justification for the policy is largely unevaluated and unscrutinized by Parliament, raising wider issues of public accountability for public expenditure. [ABSTRACT FROM AUTHOR]

The public expenditure implications of PFI projects in Scotland's NHS are substantial. This article compares PFI capital expenditure with projected unitary charges, examines the annual cost of existing PFI schemes and looks at future costs arising from the planned expansion of PFI. Unless the new Scottish National Party-led administration applies the breaks, the annual cost of PFI to Scotland's NHS is to increase almost five-fold, from £107.1 million in 2005/06 to £500 million by the early part of the next decade. [ABSTRACT FROM AUTHOR]

UK government procurement policy rests on Treasury claims that the private finance initiative (PFI) has reduced cost and time overruns. We review the five studies cited by the Treasury in support of this claim and find that only one purports to compare PFI with traditional procurement. The results of this single study are uninterpretable because of selection bias, small sample size (only 11 out of 451 PFI projects are included) and fundamental flaws in the analysis. There is thus no evidence to support the Treasury cost and time overrun claims of improved efficiency in PFI. We conclude that Treasury appraisal guidance, the ‘Green Book’ which compares PFI with other methods of procurement, is not evidence based but biased to favour PFI. [ABSTRACT FROM AUTHOR]

The authors describe the complexity of the financing arrangements of primary care premises. They explain how the early vision of integrating health and social services within local health centres failed to be realized, with GP-owned practice premises remaining as the dominant model. There was a switch to private finance when the government loan body (General Practice Finance Corporation) was privatized in 1989. Although capital can now be freely raised by the private sector for investment in the National Health Service (NHS), these debts have to be repaid through NHS funds or user charges. The complexity, combined with demographic factors, makes it likely that as GPs opt for the Personal Medical Services (PMS) scheme and a salaried service, the trend towards for-profit corporations owning and buying out GP premises will accelerate. [ABSTRACT FROM AUTHOR]

The authors explain how the Private Finance Initiative (PFI) has raised the costs of infrastructure development in the health service. They demonstrate that the assumption that higher capital costs would be offset by savings resulting from the involvement of the private sector is wrong rather, NHS trusts and health authorities have been obliged to make savings on other budgets in order to make the high costs of investment affordable. There is no reason to believe that these problems will disappear as the volume of PFI investment increases. [ABSTRACT FROM AUTHOR]