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Focuses on the final session of the Chichester Conference of the National Health Service organization in Great Britain. Discussion on the status of natural units of health organization; Sense of professional identification among the members; Delegation to divisions and working units.

Focuses on the white paper negotiations of the General Medical Service Committee in Great Britain. Completion of the Health and Medicine Bill committee stage; Review of the long term funding of the National Health Service (NHS); Reference term of the prime minister on the internal review of the NHS.

Focuses on the medical issues presented at the meeting of the Association of Community Health Councils in Great Britain. Emphasis of John Patter, health minister on the services of physician to patients; Arguments related to pay awards initiated by the National Health Services; Controversies concerning termination of pregnancy practices.

BACKGROUND: Smoking is one of the biggest avoidable causes of morbidity and mortality in the United Kingdom. This paper quantifies the current health and economic burden of smoking in the UK. It provides comparisons with previous studies of the burden of smoking in the UK and with the costs for other chronic disease risk factors. METHODS: A systematic literature review to identify previous estimates of National Health Service costs attributable to smoking was undertaken. Information from the World Health Organization’s Global Burden of Disease Project and routinely collected mortality data were used to calculate mortality due to smoking in the UK. Population-attributable fractions for smoking-related diseases from the Global Burden of Disease Project were applied to NHS cost data to estimate direct financial costs. RESULTS: Previous studies estimated that smoking costs the NHS about £1.4 billion to £1.7 billion in 1991 and has been responsible for about 100 000 deaths per annum over the past 10 years. This paper estimates that the number of deaths attributable to smoking in 2005 was 109 164 (19% of all deaths, 27% deaths in men and 11% of deaths in women). Smoking was directly responsible for 12% of disability adjusted life years lost in 2002 (15.4% in men; 8.5% in women) and the direct cost to the NHS was £5.2 billion in 2005–6. CONCLUSION: Smoking is still a considerable public health burden in the UK. Accurately establishing the burden in terms of death, disability and financial costs is important for informing national public health policy. [ABSTRACT FROM AUTHOR]

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. [ABSTRACT FROM AUTHOR]

Decisions on which new health technologies to provide are controversial because of the scarcity of healthcare resources, the competing demands of payers, providers and patients and the uncertainty of the evidence base. Given this, additional information about new health technologies is often considered valuable. One response is to make access to a new health technology conditional on further research. Access can be restricted to patients who participate in a research study, such as a randomised controlled trial; alternatively, a new treatment can be made generally available, but only on condition that further evidence is collected (eg, on long-term outcomes and adverse events, in patient registries). The National Institute for Health and Clinical Excellence (NICE), which provides guidance on which new health technologies to make available under the UK's NHS, for example, has made some research conditional recommendations, and the current interest in such options suggests that they are likely to become more prevalent in the future. This paper identifies and discusses the main ethical issues created by this distinctive range of recommendations. We argue that decisions to put research conditions on access to new technologies are compatible with widely accepted values, principles and practices relevant to resource allocation. However, there are important features of these distinctive judgements that must be taken into account by resource allocation decision-making bodies and research ethics committees, and that require new sorts of empirical data. [ABSTRACT FROM AUTHOR]

There is currently an unrecognised conflict between the utilitarian nature of the overall NHS and the basic deontology of the doctor-patient interaction. This conflict leads to mistrust and misunderstanding between managers and clinicians. This misunderstanding is bad for both doctors and managers, and also leads to waste of time and resources, and poorer services to patients. The utilitarian thinkers (mainly managers and politicians) tend to value finite, short term, evidence based technical interventions, delivered according to specifications and contracts. They appear happy to break care up into smaller pieces, which can then be commissioned from multiple providers. The deontological thinkers (mainly doctors and other clinicians) tend to think about care delivered through a long term continuous relationship, and regard that relationship as therapeutic and salutogenic in itself. To them breaking care up into smaller fragments is a denial of what caring is really about. Very rarely are either or both sides of this debate fully aware of where their powerfully felt and often well argued positions start from. In this paper we offer an appraisal of the strengths and weaknesses of both moral viewpoints as applied in the UK NHS context and we suggest a way in which they can be reconciled, provided neither is pushed too far or too hard against the other. We believe this reconciliation would be good for patients, doctors, managers and improve the service as a whole. [ABSTRACT FROM AUTHOR]

Significant changes are proposed for the research ethics system governing the review of the conduct of medical research in the UK. This paper examines these changes and whether they will meet the aimed-for goal of improving the efficiency of the research ethics system. The author concludes that, unfortunately, they will not and thus should be rejected. [ABSTRACT FROM AUTHOR]

The objective of this paper is to apply a framework for country-level performance assessment to the cities of Montreal, Canada, and Barcelona, Spain, and to use this framework to explore and understand the differences in their health systems. The UK National Health Service Performance Assessment Framework was chosen. Its indicators went through a process of selection, adaptation and prioritisation. Most of them were calculated for the period 2001-3, with data obtained from epidemiological, activity and economic registries. Montreal has a higher number of old people living alone and with limitations on performing one or more activities of daily life, as well as longer hospital stays for several conditions, especially in the case of elderly patients. This highlights a lack of mid-term, long-term and home care services. Diabetes-avoidable hospitalisation rates are also significant in Montreal, and are likely to improve following reforms in primary care. Efficient health policies such as generic drug prescription and major ambulatory surgery are lower in Barcelona. Rates of caesarean deliveries are higher in Barcelona, owing to demographics and clinical practice. Waiting times for knee arthroplasty are longer in Barcelona, which has triggered a plan to reduce them. In both cities, avoidable mortality and the prevalence of smoking have been identified as areas for improvement through preventive services. In conclusion, performance assessment fits perfectly in an urban context, as it has been shown to be a useful tool in designing and monitoring the accomplishment of programmes in both cities, to assess the performance of the services delivered, and for use in policy development. [ABSTRACT FROM AUTHOR]

The UK government has recently taken steps to exclude certain groups of migrants from free treatment under the National Health Service, most controversially from treatment for HIV. Whether this discrimination can have any coherent ethical basis is questioned in this paper. The exclusion of migrants of any status from any welfare system cannot be ethically justified because the distinction between citizens and migrants cannot be an ethical one. [ABSTRACT FROM AUTHOR]

Background: Despite evidence that physical inactivity is a risk factor for a number of diseases, only a third of men and a quarter of women are meeting government targets for physical activity. This paper provides an estimate of the economic and health burden of disease related to physical inactivity in the UK. These estimates are examined in relation to current UK government policy on physical activity. Methods: Information from the World Health Organisation global burden of disease project was used to calculate the mortality and morbidity costs of physical inactivity in the UK. Diseases attributable to physical inactivity included ischaemic heart disease, ischaemic stroke, breast cancer, colon/rectum cancer and diabetes mellitus. Population attributable fractions for physical inactivity for each disease were applied to the UK Health Service cost data to estimate the financial cost. Results: Physical inactivity was directly responsible for 3% of disability adjusted life years lost in the UK in 2002. The estimated direct cost to the National Health Service is £1.06 billion. Conclusion: There is a considerable public health burden due to physical inactivity in the UK. Accurately establishing the financial cost of physical inactivity and other risk factors should be the First step in a developing national public health strategy. [ABSTRACT FROM AUTHOR]

Presently, there is a movement in the UK research governance framework towards what is referred to as proportional ethical review. Proportional ethical review is the notion that the level of ethical review and scrutiny given to a research project ought to reflect the level of ethical risk represented by that project. Relatively innocuous research should receive relatively minimal review and relatively risky research should receive intense scrutiny. Although conceptually attractive, the notion of proportional review depends on the possibility of effectively identifying the risks and ethical issues posed by an application with some process other than a full review by a properly constituted research ethics committee. In this paper, it is argued that this cannot be achieved and that the only appropriate means of identifying risks and ethical issues is consideration by a full committee. This implies that the suggested changes to the National Health Service research ethics system presently being consulted on should be strenuously resisted. [ABSTRACT FROM AUTHOR]

Research ethics review is an important process, designed to protect participants in medical research. However, it is increasingly criticised for failing to meet its aims. Here, two researchers reflect on their experiences of applying for ethical approval of observational research in clinical settings. They highlight some problems faced by reviewers and researchers and propose a two-stage ethical review process that would alert researchers to the committee's concerns and allow them to give a more considered response. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Implementation of the Healthcare Recommendation Arising from the Victoria Climbié report" that was published within the issue. The author questions the real commitment of British health organizations in protecting children, considering the constantly changing format of the National Health Service.

This article comments on two different papers on neonatal care in great Britain by S.J. Oddie and G.J. Escobar. The studies differ significantly in their objectives and methods, so direct numerical comparisons may not be valid. Oddie looked at over 11 000 births in the Northern National Health Services region of Great Britain in 1998, excluding infants less than 35 weeks gestation. They concentrated on factors associated with early neonatal discharge, and then looked at what influenced readmission to hospital within 28 days. Escobar looked at a different range of factors influencing readmission in the first two weeks. As in the British study lower gestations were more likely to be readmitted including those that had avoided the neonatal intensive care unit, as were those who were sicker at birth.

The article focuses on the first five of the 24 recommendations that outline the British Medical Association (BMA) proposals for the high-level governance of the British National Health Service (NHS). These include a recommendation which suggests that a constitution for the NHS should settle an agreement between the government, the NHS and the public. Another implies that an independent board of governors must be established in order to divide national politics from day-to-day running of the NHS.

Focuses on the health expenditure in Great Britain National Health Services (NHS). Description on the Government 1976 Public Expenditure White Paper; Problem on the NHS expenditure; Hope of NHS for the revision of the White Paper.

Comments on the proposed white paper as extension of the Family Doctor Charter of 1966 implemented in Great Britain. Scrutiny on the rationale of the proposal; Conflicts between the report issued by the House of Commons Social Service Committee and the primary health care stated in the white paper; Insufficiencies identified in the proposal.

Reports the solicitation for papers seeking views on the professional advisory rearrangements in the reorganized National Health Service in Great Britain. Ways to achieve an effective management for the medical practice; List of the main recommendations for the paper.

Focuses on issues related to medical ethics in Great Britain. Public health implications of immigrations and asylum seekers; Discussion on issues of abortion legislation; Review of the Human Fertilisation and Embryology Act; Details of the criminalisation of HIV; Information on National Health Services guidelines on chaplaincy and the provision of spiritual care.

Presents the consultant contract presented by Mr. D.E. Bolt, chairman of the Negotiating Subcommittee of CCHMS during the session of the National Conference of Hospital Medical Staffs in 1972. Overview of the negotiation coverage; Features of the contract paper; Commitments of the organization with NHS.

The history of the National Health Service research ethics system in the UK and some of the key drivers for its change into the present system are described. It is suggested that the key drivers were the unnecessary delay of research, the complexity of the array of processes and contradictions between research ethics committee (REC) decisions. It is then argued that the primary drivers for this change are and will be replicated by the systems of research ethics review being put in place at UK universities in response to the Economic and Social Research Council research ethics framework. It is argued that this is particularly problematic for multi-centre review and for researchers who switch institutions. Finally, some potential solutions to this problem and their feasibility are discussed. [ABSTRACT FROM AUTHOR]

Background: Priority setting is necessary in current healthcare services. 0iscussion of fair process has highlighted the value of developing reasons for allocation decisions on the basis of experience gained from real cases. Aim: To identify the reasons that those with experience of real decision-making concerning resource allocation think relevant in deciding on the priority of a new but expensive drug treatment. Methods: Semistructured interviews with members of committees with responsibility for making resource allocation decisions at a local level in the British National Health Service, analysed using modified grounded theory. Results: 22 interviews were carried out. 14 reasons were identified. Four reasons were almost universally considered most important: cost effectiveness; clinical effectiveness; equality and gross cost. No one reason was considered dominant. Some considerations, such as political directives and fear of litigation, were thought by many participants to distort decision-making. There was a substantial lack of agreement over the relevance of some reasons, such as the absence of alternative treatment for the condition. Conclusions: There is a clear consensus on the importance and role of a limited number of reasons in allocation decisions among participants. A focus on the process of decision-making, however, does not obviate the need for those involved in the process to engage with problematical ethical issues, nor for the importance of further ethical analysis. [ABSTRACT FROM AUTHOR]

Recently, commentators close to and within the UK government have claimed that patient choice can increase equity in the context of the National Health Service. This article critically examines the basis for this claim through analysis of recent speeches and publications authored by secretaries of state for health and their policy advisers. It is concluded that this claim has not developed prospectively from an analysis of the causes of healthcare inequity, or even with a consistent normative definition of equity. The limited justification that is "framed in causal explanations" of inequity has suffered from an apparent disregard of the available evidence. [ABSTRACT FROM AUTHOR]

As a result of NHS reorganisation and national strategies to tackle sexual ill health, genitourinary medicine (GUM) and family planning (FP) services will be required to work more closely together. Rather than reinvent the wheel, relevant insight may be gained from the experiences of units where convergence of service providers has already taken place. This paper offers qualitative data gained from bringing together established GUM and FP services in a large UK urban centre. The following lessons will be illustrated by examples from the unit where convergence took place. Service integration must produce visible gains for all partner organisations and added value for patients. However, short term evaluations within 1 to 2 years will hinder rather than advance the process, and should be resisted. Convergence of services will incur start up and recurrent costs, including those for staff training, addressing differences in terms and conditions, and estates. These will be exacerbated if services relocate from acute to community based organisations owing to difficulty in extracting fixed costs. Key individuals are required to champion and lead the process, however, robust managerial and human resources support are also needed. If possible, GUM and FP staff should be located and work in close physical proximity to reduce anxiety of a "take-over" by the other service. Efforts need to be made to ensure that linked GUM and FP units remain gender sensitive and ore not stigmatised by being incorrectly perceived as VD or abortion clinics, by either health professionals or the public. [ABSTRACT FROM AUTHOR]

Objective: To assess the cost effectiveness of primary angioplasty, compared with medical management with thrombolytic drugs, to achieve reperfusion after acute myocardial infarction (AMI) from the perspective of the UK NHS. Design: Bayesian evidence synthesis and decision analytic model. Methods: A systematic review was conducted and Bayesian statistical methods used to synthesise evidence from 22 randomised control trials. Resource utilisation was based on UK registry data, published literature and national databases, with unit costs taken from routine NHS sources and published literature. Main outcome measure: Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs). Results: For the base case, the incremental cost-effectiveness ratio of primary angioplasty was £9241 for each additional QALY, with a probability of being cost effective of 0.90 for a cost-effectiveness threshold of £20 000. Results were sensitive to variations in the additional time required to initiate treatment with primary angioplasty. Conclusions: Primary angioplasty is cost effective for the treatment of AMI on the basis of threshold cost- effectiveness values used in the NHS and subject to a delay of up to about 80 minutes. These findings are mainly explained by the superior mortality benefit and the prevention of non-fatal outcomes associated with primary angioplasty for delays of up to this length. [ABSTRACT FROM AUTHOR]

The article presents a case depicting the refusal of granting a declaration that medical staffs in Great Britain could withdraw all forms of ventilation and provide palliative care to a child with severe form of spinal muscular atrophy. It is stated that a National Health Service (NHS) trust in the region has sought a declaration that the child lacked the capacity to make decisions regarding his future treatment and that it shall be lawful, despite the parents' refusal to consent, for medical staff to withdraw the child's treatment. However, the judge on the case has refused the request and stresses that the widest sense in the case concerns the Children Act 1989 stated that the child's welfare shall be the court's paramount consideration.

Objectives: To evaluate the impact the National Service Framework (NSF) far coronary heart disease has had on emergency treatment and outcomes in patients presenting with acute coronary syndromes. Design: Retrospective cohort study. Setting: Coronary care units of two district general hospitals. Results: Data from 3371 patients were recorded, 1993 patients in the 27 months before the introduction of the NSF and 1378 patients in the 24 months afterwards. After the introduction of the NSF in-hospital mortality was significantly reduced (95 patients (4.8%) v 43 (3.2%), p = 0.02). This was associated with a reduction in the development of Q wave myocardial infarction (40.6% v 33.3%, p < 0.0001) and in the incidence of left ventricular failure (15.9% v 12.3%, p = 0.003). The proportion of patients receiving thrombolysis increased (69.4% v 84.7%, p < 0.0001) with a decrease in the time taken to receive it (proportion thrombolysed within 20 minutes 12.1% v 26.6%, p < 0.0001 ). The prescription of 13 blockers (51.9% v 65.8%, p < 0.0001), angiotensin converting enzyme inhibitors (37% v 66.4%, p < 0.0001), and statins (55.2% v 72.7%, p < 0.0001) improved and the proportion of patients referred far invasive investigation increased (18.3% v 27.0%, p < 0.0001). Trend analysis showed that improvements in mortality and thrombolysis were directly associated with publication of the NSF, whereas the improvements seen in prescription of β blockers and statins were the continuation of pre-existing trends. Conclusions: In the two years that fallowed publication of the NSF the initial treatment and outcome of patients presenting with acute coronary syndromes improved. Some of the improvements can be attributed to the NSF but others are continuations of pre-existing trends. [ABSTRACT FROM AUTHOR]

Aim: To obtain a comprehensive overview of current patterns of psychosocial support provided by National Health Service (NHS) paediatric oncology treatment centres across the UK. Methods: A postal questionnaire was sent to co-ordinators in the UK Children's Cancer Study Group (a professional body that is responsible for the organisation of treatment and management of childhood cancer in the UK) in 21 treatment centres and three separate Teenage Cancer Trus units. A range of psychosocial topics were explored, including ratio of staff providing support to patients; facilities provided for children and families; psychosocial support services such as support groups; information provision; and transition support. Results: There were many good areas of support provided by centres, but there was also a lack of standard practices and procedures. All centres employed social workers, play specialists, and paediatric oncology outreach nurses, but patient to staff ratios varied across centres. The poorest staff provision was among psychologists, where patient to staff ratios ranged from 132:1 to 1100:1. Written information was standard practice, while provision of other types of information (audiovisual, online) varied; none of the centres provided audio information specifically for children/young people. Conclusion: This variability in practices among centres frequently occurred, as centres rarely had procedures formally agreed or recorded in writing. British government policy currently seeks to develop standards and guidelines of care throughout the National Health Service. This study further demonstrates the importance of standards and the need to agree guidelines for the provision of psychosocial support for children/young people and their families throughout the course of the illness. [ABSTRACT FROM AUTHOR]

Objective: To define the role and responsibilities of the sports medicine specialist using a recognised research technique. Methods: A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants. Results: There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant. Conclusion: Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway. [ABSTRACT FROM AUTHOR]

Ethics committees now require that individuals give informed consent to much health services research, in the same way as for clinical research. This is misguided. Existing ethical guidelines do not help us decide how to seek consent in these cases, and have allowed managerial experimentation to remain largely unchecked. Inappropriate requirements for individual consent can institutionalise health inequalities and reduce access to services for vulnerable groups. This undermines the fundamental purpose of the National Health Service (NHS), and ignores our rights and duties as its members, explored here. Alternative forms of community consent should be actively pursued. [ABSTRACT FROM AUTHOR]

Objectives: To establish the extent of Occupational Health (OH) service provision in the National Health Service (NHS).Methods: Two postal questionnaires were used to obtain information from purchasers and providers in the NHS in England and Wales.Results: 99.6% of trust and health authority employers claim to provide some form of OH service to their employees indicating widespread recognition of need, but virtually no service is provided to other staff such as general practitioners (GPs), general dental practitioners (GDPs), and their staff. There is a wide variability in the range and quality of OH services, suggested by the enormous differences in medical staffing levels, and the contractual restrictions where the OH service is provided by another NHS employer. Only about a third (highest estimate) to a quarter (lowest estimate) of NHS staff have access to a specialist occupational physician.Conclusions: Substantial inequality of access to OH services exists for the NHS workforce, despite previous guidance. There is no real evidence to suggest why the extent of provision of OH services varies so greatly between institutions. [ABSTRACT FROM AUTHOR]

Focuses on issues related to medical care in Great Britain. Ideas tackled in the white paper Promoting Better Health; System of payment for doctors advocated by Tony Newton, British minister of health; Controversies concerning the budget for National Health Services.

Reports developments related to medical care in Great Britain as of September 1986. Strategies implemented by the National Health Service; Launch of a series of Labour Party papers on health; Proposals for a community nursing review.

Presents a personal view on the medicopolitical events in Great Britain. Effects of nuclear war on medicine; Recommendations of an increase in the salaries on National Health Service physicians; Reference to a consultative paper issued by the government on a review body proposed by nurses.

Focuses on the allocation of budget for the National Health Services (NHS) in Great Britain. Publication of White Paper on public expenditure; Plans of the NHS in the financial year; References of capital for the project.

Objectives: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups.Design: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales.Subjects: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria.Results: Ethical dilemmas experienced during the previous six months were reported by 118 occupational and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used.Conclusion: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists. [ABSTRACT FROM AUTHOR]

The principle of informed consent is now well established within the National Health Service (NHS) in relation to any type of medical treatment. However, this ethical principle appears to be far less well established in relation to medical screening programmes such as Britain's national cervical screening programme. This article will critically examine the case for health care providers vigorously pursuing women to accept an invitation to be screened. It will discuss the type of information which women would need in order to make an informed decision about whether or not to be screened. The lack of such information in current patient leaflets on the "smear test" will then be documented. Finally, the article will explore possible ways of maximising women's autonomy in relation to the cervical screening programme without sacrificing any of its main benefits. [ABSTRACT FROM AUTHOR]

Opinion. Asserts that consumerism can be objectionable both within and beyond the health care market. How consumerist reforms in Great Britain have affected the provision of medical care; Goals of policy-making reflected in the reforms of the National Health Service; How medical care operates in theory; Nature of the internal market and patient's rights under consumerist reforms.

Examines the argument focusing on the smokers' rights to health care. Opposition based on the principles founded by the British National Health Service; Difficulties created by advocating smokers' health.

The article offers information about the Medicines for Children Research Network (MCRN), a research strategy initiated by the Great Britain Department of Health. This research strategy is coordinated by a consortium of university, National Health Services (NHS), and charitable organizations, which aims to support and promote research on medicines for children in NHS sites in the country. Moreover, MCRN also aimed to increase investment by the pharmaceutical industry in clinical research to insure that research will be conducted rigorously, efficiently, and according to good clinical practice that are relevant to the development of effective health programs for children.

Harris' reply to our defence of the National Institute for Clinical Excellence's (NICE) current cost-effectiveness procedures contains two further errors. First, he wrongly draws a conclusion from the fact that NICE does not and cannot evaluate all possible uses of healthcare resources at any one time and generally cannot know which National Health Service (NHS) activities would be displaced or which groups of patients would have to forgo health benefits: the inference is that no estimate is or can be made by NICE of the benefits to be forgone. This is a non-sequitur. Second, he asserts that it is a flaw at the heart of the use of quality-adjusted life years (QALYs) as an outcome measure that comparisons between people need to be made. Such comparisons do indeed have to be made, but this is not a consequence of the choice of any particular outcome measure, be it the QALY or anything else. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of Working Time Directive (WTD) in doctors' training and practice. The directive contains the 58 working hours per week with minimum rest requirements in Great Britain. This would be applied to nurses and other National Health Services (NHS) staff including consultants and grade doctors. In this regard, several radical changes would be undertaken, which include the changing workforce agenda and modernizing medical careers (MMC).

The recently published Report of the AHAG on the Operation of NHS Research Ethics Committees (the Warner Report) advocates major reforms of the NHS research ethics committees system. The main implications of the proposed changes and their probable effects on the major stakeholders are described. [ABSTRACT FROM AUTHOR]

The article presents a discussion on public health policy of Great Britain. Public health in the British National Health Service has lost its way. It has been, or has allowed itself to be, driven down the narrow, and ultimately self defeating, road of health service performance management and finds itself unable to step back and examine the root causes of ill health in the populations served. Part of the problem may result from a lack of clarity over the public health function. Public health will only regain its core purpose by forging partnerships with local communities.

This article reports that working from a rights base perspective is important to the author's personal and professional accountability in her role as a nurse and manager within the National Health Service in Great Britain. All rights are applicable in health care but it is the application of the participation rights that are perhaps the most challenging because they challenge the power and authority. A rights based approach requires that one examine and understand one's power and influence in the roles one have with children. As a health professional the author hold power and authority by the nature of her specific nursing/medical knowledge and skills. The author has access to resources and she can define what happens where, when, how, and by whom to a lesser or greater degree as can other professionals.

The article offers information on consideration of social factors by National Health Service (NHS), taking into account the allocation of scarce resources. It states that the primary care trust (PCT) allows for patients to make claims for exceptional treatment by means of an individual funding review.

The article examines the budget allocated to the National Health Services (NHS) by the government and its expenditures, and the impact of NHS deficits on children's health services in Great Britain. The author suggests that NHS is not broke despite a deficit of £800 million, but NHS needs to tighten its expenses and to balance them rather than asking more budget from the government. Children's health services receives less attention from the government.

The article cogitates on the significance of establishing the National Service Framework (NSF) for coronary heart disease in improving cardiac services in Great Britain. The framework was introduced in March 2000 by Alan Milburn, the then Secretary of State for Health. The NSF was greeted with much critical acclaim and enthusiasm.