Search

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

The recent reform of the English National Health Service (NHS) through the Health and Social Care Act of 2012 introduced important changes in the organization, management, and provision of public health services in England. This study aims to analyze the NHS reforms in the historical context of predominance of neoliberal theories since 1980 and to discuss the "liberalization" of the NHS. The study identifies and analyzes three phases: (i) gradual ideological and theoretical substitution (1979-1990) - transition from professional and health logic to management and commercial logic; (ii) bureaucracy and incipient market (1991-2004) - structuring of the bureaucracy focused on administration of the internal market and expansion of pro-market measures; and (iii) opening to the market, fragmentation, and discontinuity of services (2005-2012) - weakening of the territorial health model and consolidation of health as an open market for public and private providers. This gradual but constant liberalization has closed services and restricted access, jeopardizing the system's comprehensiveness, equity, and universal healthcare entitlement in the NHS.

The NHS plan announced sustained increases in funding accompanied by wide ranging reform, the success of which would be measured by targets set across the board, including increases in numbers of beds, staff, hospitals and equipment. In this article we assess progress towards the target of 7,000 extra beds in hospitals and intermediate care to be achieved by 2004. Summary points are as follows. (1) Although the 2003/2004 target for availability of general and acute NHS beds in England was achieved, the increase did not offset the overall decrease in all categories of beds. Bed availability fell by 2083, from 1,86,290 in 1999/2000 to 1,84,207 in 2003/2004, following a fall of 12,558 from 1996/1997 to 1999/2000. (2) Lack of standardized definitions and data collection systems both within the NHS and for the independent sector, compounded by ambiguity over the funding of extra capacity for the NHS, call into question the accuracy of data collected about intermediate care beds. (3) Systems for collecting data about intermediate care should be made subject to the same code of practice as official NHS statistics in order to monitor future targets and plan for provision of care. (4) Changes in definitions, lack of detail about criteria used in setting targets and lack of data about private sector care, make it impossible to monitor the overall capacity available to the NHS and assess whether bed availability targets have been met.

Addresses concerns in the United Kingdom of whether primary care trusts leads to United States-style health care. Ability of a National Health Service (NHS) body to charge for personal care and hotel costs; How government guidance on intermediate care restricts entitlement to NHS care to six weeks except in exceptional circumstances; Details of the incentive structure of the new system, which will force care trusts to find ways of constraining expenditure through rationing, user charges, and commercial activities.

The article discusses developments in the health care sector in Great Britain as of January 2014, particularly the role of special administrators in the reduction of National Health Service (NHS) hospital services. It focuses on the amendment for the Health and Social Care Act of 2012 that is being tackled by the British Parliament. The amendment aims to restore a partial planning function of the government in the health services sector.

The article reports that the U.S. Health and Social Care Act 2012 will replace the administrative structure of the NHS in England and its implications on existing routine data systems and the production of routine statistics. As stated, under the Act, unlike primary care trusts (PCTs), commissioning groups will no longer have responsibility for geographical areas and their practices will be able to recruit patients living anywhere in England. It also states that some health services for which PCTs are responsible will be out of the health service entirely or may be provided under the new public health system.

The article focuses on the effect of legislative amendments to the Health and Social Care Bill to the health services in Great Britain. It states that the duty of primary care trusts (PCT) will be abolished to secure everyone's health services in a defined area. It mentions the establishment of a parallel health service in the local authority sector and restrictions for clinical commissioning groups (CCGs). It concludes that the amended bill fails to discuss clearly who will be responsible for the health services of the people and creates new charging powers. INSET: PUBLIC HEALTH FUNCTIONS THAT ARE SUBJECT TO NEW CHARGING POWERS.

This article focuses on a plan by the British coalition government to open up the market in the National Health Service (NHS). It notes the growing scepticism about the merit of the private sector in U.S. health care, as well as the proposal in Great Britain to devolve financial risk to general practice consortiums through market competition and a reimbursement system. It points out the risk posed by mentally ill patients due to their higher overall health costs and unpredictable care. It also notes the development of the competitive market of mixed providers, as well as the effect of competition in the NHS on quality and efficiency.

Discusses the choice extended to patients to choose among public and private health providers in Great Britain. Effort of Great Britain's National Health Service to engage more constructively with private sector; Implications for national control over health policy; Role of Great Britain's National Agreement on Trade in Services; Failure of Great Britain to protect its health policy.

A letter is presented in response to the article "Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012" by Allyson M. Pollock, Alison Macfarlane and Sylvia Godden in the April 2012 issue; a response by Pollock and colleagues to this letter is also included.

A letter to the editor is presented in response to the article "Equity, Waiting Times, and NHS Reforms: Retrospective Study," by Z. N. Cooper and colleagues in the September 3, 2009 issue.