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The authors reflect on the effectiveness of independent treatment centers which have been developed by Great Britain's National Health Service. They suggest that there is no definitive evidence which supports the continued funding of the centers. They argue that concerns from patients, lawyers and healthcare professionals about the quality and safety of the centers are being ignored by the government.

Focuses on Great Britain's National Health Service (NHS) and the Health and Social Care Bill of 2003. Definition of foundation trusts; How the secretary of state is obligated to promote a comprehensive, free health service to improve the health of the people; Problems of the inequity increasing through local generation of income.

Abstract Objectives To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Design Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Main outcome measures Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. Results By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P < 0.001). Conclusion The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1. [ABSTRACT FROM AUTHOR]

Discusses the use of private finance to build National Health Service (NHS) hospitals in Great Britain. Idea that private finance initiative (PFI) brings no new capital investment into public services and is a debt which has to be serviced by future generations; Topic of a value for money assessment, costs of PFI, and risk transfer; Assertion that PFI more than doubles the cost of capital as a percentage of NHS trusts' annual operating income.

Focuses on independent nursing homes for the elderly in Great Britain. Examples of poor care in privatised nursing homes in the United States and Australia; Question whether the regulatory framework for nursing home in Great Britain offers adequate protection for patients; Suggestion that regulators, public bodies, and private providers must be directly accountable to the public and service users to ensure quality care.

Discusses the reasons why private finance is moving primary care into corporate ownership. Reasons for the establishment of the National Health Service (NHS) of Great Britain, to integrate primary care and health and social services in health centers; How the aim was compromised by the absence of public capital and the reluctance of the Treasury to buy out practice premises owned by general practitioners; Question about the extent to which planning, population needs and accountability are incorporated into the procurement process.

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 the argument concerning the potential of the licence conditions imposed by Monitor on National Health Service (NHS) foundation trusts in reducing the hospital services. Topics include the introduction of the NHS foundation trusts under conditions set out in "authorisations" in 2003, the assertion of Monitor regarding the power of arbitration, and the legal duty of commissioners for the arrangement of services.

Discusses issues on Britain's private finance initiative and the National Health Service (NHS). Arguments on the private finance initiative; Cost of the third wave of private finance initiative hospital schemes on planned private sector investment in the health service; Condition of creating alternative sources of funding with the NHS. INSET: Summary points.

Assesses the challenges of devolution on public health Wales and Scotland. Structure of the assemblies and their powers; Inequalities in health and wealth in both countries; Overview of public health in both countries; Party policies on health services.

Argues against local authorities taking over the British National Health Service. Shift from the public to private sector provision; Capping public sector spending; Removing publicly financed services from public control.

Cites a study which investigated the relationship between deprivation and emergency admission for cancer in south east England. Associations between social deprivation and cancer survival; Reorganization of cancer services in England and Wales. INSETS: Data on finished consultant episodes retrived from the Office...;Therapeutic and palliative surgical procedures;Key messages.

Discusses the advantages and disadvantages of the proposed privatization of hospital services for the British National Health Service. Case studies under the private finance initiative; Determination of bed numbers; Interpretation of trends in bed availability.

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.

The article looks at the extent of the changes to community pharmacy in Great Britain under the revision of the National Health Service (NHS) community pharmacy contract. Reforms were implemented by the British government in 2005 aimed at increasing access and patient choice, reduce general practitioner workload and lower costs to the NHS. An overview of the community pharmacy market is presented, as well as changes to control of entry regulation and an analysis of its implications for primary care.

Examines the factors affecting the outbreak of food poisoning caused by Clotridium perfringens in hospitals. Emphasis on the quality of care; Importance of high standards of ancillary provision in preventing outbreaks of food poisoning; Reasons for the outbreak of food poisoning in hospitals.

Biomedical health services and health systems research require timely, complete, accurate and accessible data relating to geographical populations in order to facilitate needs assessment and planning of medical care, new medicines and technology. The international trend towards competition and privatisation has largely proceeded as if data generation were immune to market fragmentation and loss of universal coverage. By examining recent reforms to the English National Health Service, the authors show that this is not the case. Routine and population data are products of administrative systems and the nature, completeness and quality of data available to clinical and public health researchers are substantially impaired by market reforms. [ABSTRACT FROM AUTHOR]

The authors reflect on issues concerning private finance initiative (PFI) in Great Britain. They note the controversy over hospital bed reductions in Britain related to PFI in 2000. They cite the problem of higher interest rate charges and risks involving PFI, leading to the claim that PFI is even less affordable. Also noted is the number of PFI projects that had been signed to the British National Health Service (NHS).

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.

The article focuses on the UK Department of Health's "Best Research for Best Health," a report which sets up an organizational and funding framework for National Health Service and associated university medical schools in England. The report outlines the implementation of a National Institute for Health Research, which will centralize governance, staff, facilities and infrastructure needs of medical research.

Discusses new community care regulations which mean that older people may not be able to choose where they are treated. Claims of improvement of access to health care for poor and disadvantaged by health secretary John Reid versus the Community Care (Delayed Discharge) Act which comes into force in January 2004; Details of the Community Care Act; The possible undermining of the 1948 National Assistance Act, known as the Direction on Choice.

Reports on the supposed resolution of the issue of giving poor countries access to essential medicines without breaching laws on intellectual property by the World Trade Organization (WTO). Past agreements; Allowance of drug companies to charge monopoly prices for essential drugs; Provisions for over-riding of patent protection for public health purposes; 2001 declaration stating the WTO's intention of finding an interpretation that squared the interest of pharmaceutical industries and poor countries; Description of the deal as a historical agreement by WTO director general Supachai Panitchpakdi; Grounds for scepticism; Basic problems with trade related aspects of intellectual property (TRIPS); Questions from the United Kingdom Commission on Intellectual Property Rights and Development Policy.

Discusses a decision by the United Kingdom's Competition Commission that could make all contracting out and commissioning of health care by N.H.S. and social services subject to European Union competition law, rather than a matter for national public health policy. Tensions between the European Union's economic constitution and national control over healthcare policy because of healthcare reforms; Judgment by the United Kingdom tribunal that shows how the courts are moving the dividing line between economic and social activities; Implications of the judgment.

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.

Editorial. Discusses the decision by the Scottish government regarding how long term medical care challenges the National Health Service (NHS) of Great Britain. Reasons why the Scottish Executive decided not to charge elderly people for personal and social care, and how the decision impacts one made by the United Kingdom's Westminster government; Details of the decision; How Scotland has the lowest life expectancy and highest all cause standardised mortality ratio in the U.K.

Editorial. Discusses the funding of the intermediate care plan proposed by Great Britain's National Health Service (NHS). Details of the budgets of care trusts for the delivery of community health care and social care; Questions regarding the NHS definition of nursing care; Impact of altered funding mechanisms on health care quality in Great Britain.

The article presents the authors' view on the fate of the government agency the National Health Services (NHS). Topics discussed include the authors' opinion on the 2012 Health and Social Care Act and its impact in the government's healthcare services, the similarity of the care organizations created by the U.S. Affordable Care Act of 2010 to the clinical commissioning groups of Great Britain and the authors' call for the creation of a legislative bill to restore the NHS in Great Britain.

Discusses the advantages and disadvantages of community oriented primary care as a method of teaching and applying public health skills in Great Britain. Description of King's Fund pilot project; Factors for needs assessment; Support for health authorities.

Focuses on significance of public opinion to the people running the National Health Service (NHS) in Great Britain. Opinion of National Association of Health Authorities and Trusts on public consultation; Implications of threats to health services on NHS; Processes affecting the central tenets of NHS.

The article discusses three reports on the future of medical care in Great Britain namely, "Future Direction of Health Care," from the National Association of Health Authorities and Trusts, "Future Health Care Options," released by the Institute of Health Services Management and the survey of health policy makers. The first paper focused on how the National Health Service (NHS) deliver health care in the nation. The second report gave out suggestions for medical care such as social insurance and local taxation.

Evaluates 'Local Voices,' a publication of the National Health Service (NHS) Management Executive. Emphasis on the consumerism in health service; Presentation on the democracy of the consultation process of NHS; Discussion on the ministerial management of health care.

Editorial. Discusses the introduction of capital charges to National Health Service (NHS) in Great Britain. Introduction of the charges in 1992; In-depth look at the NHS trusts; Assessment of the NHS trusts' performance; Value of NHS assets.

The article discusses the Francis inquiry into substandard care at Mid Staffordshire should make the government rethink its staffing policy. It mentions that Francis had strongly recommended training and regulation of staffing levels to improve the delivery of services. However, the Quality, Innovation, Productivity, and Prevention Programme (QIPP) is driving controversial service reconfigurations - cutting staff and closing emergency services and hospitals throughout England.

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.

The article offers information on Health and Social Care Bill. It mentions the significance of writing a letter to the House of Lords in the Great Britain to protect National Health Service (NHS) as the bill did not deliver quality and fairness. It mentions that the healthcare needs of the entire population has been evaluated by public health professionals. It also discusses several problems related to the bill which includes the abolishment of direct accountability.

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.

This article presents a letter to the editor in response to the article "Evidence not ideology," by Godlee that appeared in the October 8, 2005 issue of the "British Medical Journal."

The new research governance strategy marks a radical overhaul of the arrangements for medical research in the NHS and academic institutions with far reaching implications for all those taking part in research. As part of the reforms to NHS research and development strategy announced in 2000, the Department of Health published a research governance strategy for England. Care organisations must ensure that all research on NHS patients, their tissue, and their data, as well as research on NHS staff and research carried out in NHS premises, is conducted according to the framework. Research governance imposes new duties of care in the education and training of researchers and monitoring of research that have considerable financial implications for all organisations hosting research.

Background The communication of injury risk in rugby and other sports is underdeveloped and parents, children and coaches need to be better informed about risk. Method A Poisson distribution was used to transform population based incidence of injury into average probabilities of injury to individual players. Results The incidence of injury in schoolboy rugby matches range from 7 to 129.8 injuries per 1000 playerhours; these rates translate to average probabilities of injury to a player of between 12% and 90% over a season. Conclusion Incidence of injury and average probabilities of injury over a season should be published together in all future epidemiological studies on school rugby and other sports. More research is required on informing and communicating injury risks to parents, staff and children and how it affects monitoring, decision making and prevention strategies. [ABSTRACT FROM AUTHOR]

In this article the authors reflect on the possibility that the Joint Action on Monitoring Injuries in Europe (JAMIE), a project on collecting and monitoring injury data, will be left undone as the European Commission (EC), most European Union (EU) countries, including Great Britain, are not committed to continuing the project when it ends in 2014. It discusses the benefits of injury surveillance in terms of reducing the number of injuries at home and in road traffic collisions.

A systematic review of rugby union and league injuries among players under the age of 21 years was carried out to calculate probabilities of match injury for a player over a season and a pooled estimate of match injury incidence where studies were sufficiently similar. The probability of a player being injured over a season ranged from 6% to 90% for rugby union and 68% to 96% for rugby league. The pooled injury incidence estimate for rugby union was 26.7/1000 player-hours for injuries irrespective of need for medical attention or time-loss and 10.3/1000 player-hours for injuries requiring at least 7 days absence from games; equivalent to a 28.4% and 12.1% risk of being injured over a season. Study heterogeneity contributed to a wide variation in injury incidence. Public injury surveillance and prevention systems have been successful in reducing injury rates in other countries. No such system exists in the UK. [ABSTRACT FROM AUTHOR]

Background Children and adolescents who play rugby are at increased risk of concussion and its effects. Competitive rugby union and rugby league feature as major sports in the school sport curriculum in the UK. There is a need for a thorough understanding of the epidemiology of concussion in youth rugby, the mechanisms involved in injuries and predisposing risk factors. Data Sources The publication databases Pubmed, Embase and SportDISCUS were searched in April 2014 for primary research studies of child and adolescent rugby union and rugby league (under 20 years) in English language with data on concussion injuries. The review was conducted within a larger all injury systematic review on rugby union and rugby league where key words used in the search included rugby, injury and concussion with child, adolescent, paediatric and youth. Results There were 25 studies retrieved with data on child or adolescent rugby and concussion, 20 were on rugby union, three on rugby league and in two the code of rugby was unspecified. There was significant heterogeneity in the definitions of injuries and of concussion. The incidence of child and adolescent match concussion ranged from 0.2 to 6.9 concussions per 1000 player-hours for rugby union and was 4.6 and 14.7 concussions per 1000 player-hours for rugby league, equivalent to a probability of between 0.3% and 11.4% for rugby union and of 7.7% and 22.7% for rugby league. Conclusions There is a significant risk of concussion in children and adolescents playing rugby union and rugby league evident from the studies included in this systematic review. There is a need for reliable data through routine monitoring and reporting in schools and clubs and in hospital emergency departments in order to inform prevention. Concussion protocols should be implemented and tested. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents who play rugby are at increased risk of concussion and its effects. Competitive rugby union and rugby league feature as major sports in the school sport curriculum in the UK. There is a need for a thorough understanding of the epidemiology of concussion in youth rugby, the mechanisms involved in injuries and predisposing risk factors. Data Sources: The publication databases Pubmed, Embase and SportDISCUS were searched in April 2014 for primary research studies of child and adolescent rugby union and rugby league (under 20 years) in English language with data on concussion injuries. The review was conducted within a larger all injury systematic review on rugby union and rugby league where key words used in the search included rugby, injury and concussion with child, adolescent, paediatric and youth. Results: There were 25 studies retrieved with data on child or adolescent rugby and concussion, 20 were on rugby union, three on rugby league and in two the code of rugby was unspecified. There was significant heterogeneity in the definitions of injuries and of concussion. The incidence of child and adolescent match concussion ranged from 0.2 to 6.9 concussions per 1000 player-hours for rugby union and was 4.6 and 14.7 concussions per 1000 player-hours for rugby league, equivalent to a probability of between 0.3% and 11.4% for rugby union and of 7.7% and 22.7% for rugby league. Conclusions: There is a significant risk of concussion in children and adolescents playing rugby union and rugby league evident from the studies included in this systematic review. There is a need for reliable data through routine monitoring and reporting in schools and clubs and in hospital emergency departments in order to inform prevention. Concussion protocols should be implemented and tested. [ABSTRACT FROM AUTHOR]

A systematic review of rugby union and league injuries among players under the age of 21 years was carried out to calculate probabilities of match injury for a player over a season and a pooled estimate of match injury incidence where studies were sufficiently similar. The probability of a player being injured over a season ranged from 6% to 90% for rugby union and 68% to 96% for rugby league. The pooled injury incidence estimate for rugby union was 26.7/1000 player-hours for injuries irrespective of need for medical attention or time-loss and 10.3/1000 player-hours for injuries requiring at least 7 days absence from games; equivalent to a 28.4% and 12.1% risk of being injured over a season. Study heterogeneity contributed to a wide variation in injury incidence. Public injury surveillance and prevention systems have been successful in reducing injury rates in other countries. No such system exists in the UK. [ABSTRACT FROM AUTHOR]

Background This article describes the issues encountered when designing a study to evaluate recruitment of minority ethnic groups into clinical cancer research in order to monitor adherence to the principles for good practice set out in the Department of Health, Research Governance Framework, England. Methods (i) A review of routine data sources to determine whether their usefulness as a source of data on prevalence of cancer in the population by ethnic category. (ii) A local case study at one hospital trust to ascertain whether the ethnicity of cancer trial participants was representative of admitted cancer patients. Results (i) The lack of a comparator population makes it problematic to assess recruitment levels by ethnic group in clinical research. (ii) The odds of being in a trial were 30% lower for a member of a minority ethnic group compared to a white cancer patient after adjusting for disease, age and gender, OR 0.70 (0.53 to 0.94). These results differed for each ethnic group; Asian patients did not appear under-represented while Black and Chinese did so. However, there are important caveats to the findings based on the limited recording of ethnicity. Conclusions The lack of available data on the ethnicity of participants in clinical research and the prevalence of cancer in the population according to ethnicity makes it difficult to design a study to monitor representation of minority ethnic groups. This information is necessary to assess adherence to the Research Governance Framework principle that research evidence reflects the diversity of the population. [ABSTRACT FROM AUTHOR]