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The article examines the issues surrounding White Paper's uncovering of the proposal to reforming the health professionals' Trust, Assurance and Safety regulation in Great Britain. The White Paper expressed that to reform, the importance of perceptions must be rightly emphasized as public needs to perceive that the regulatory system is operating in the interests of patients. It also stresses that the General Medical Council's (GMC) four functions must be integrated in the regulatory framework.

In the UK, individuals with limited English-language proficiency (LEP) self-report poorer health and face challenges accessing health and social care support. Health and social care policies in English speaking countries provide practitioners with guidance that ensures access to public service interpreters for individuals who require them. The guidance simultaneously discourages the use of informal language brokers, including family and friends, suggesting that they are not educated or objective enough to conduct this role, and that they present unmanageable risks. This poses a challenge, as research exploring patient and service user choices, finds that individuals consistently prefer an informal language broker. The paper explores the contradiction between a legislative shift towards empowerment and choice within social work and the policies that restrict these rights in relation to interpretation. Exploring these challenges with a focus on policy and practice, leads to the suggestion that individuals should be empowered to choose who provides their language support. In contrast, existing policies increase the power imbalance between professionals and users of services, significantly affecting the life chances of those with LEP. [ABSTRACT FROM AUTHOR]

In this article the author comments on the various aspects of the National Health Service (NHS) reforms proposed by the government of Great Britain. It mentions that the government intends to reform the NHS in England based on the White Paper "Equity and Excellence: Liberating the NHS." It mentions the Challenge Committee, headed by the British cabinet's policy guru Oliver Letwin, formed in order to oversee developments. It also discusses the various objectives of the proposed reforms.

Since the advent of political devolution in the UK, it has been widely reported that markedly different health policies have emerged. However, most of these analyses are based on a comparison of health care policies and, as such, only tell part of a complex and evolving story. This paper considers official responses to a shared public health policy aim, the reduction of health inequalities, through an examination of national policy statements produced in England, Scotland and Wales respectively since 1997. The analysis suggests that the relatively consistent manner in which the `policy problem' of health inequalities has been framed combined with the dominance of a medical model of health have constrained policy responses. Our findings differ from existing analyses, raising some important questions about the actuality of, and scope for, policy divergence since devolution. [ABSTRACT FROM PUBLISHER]

There are substantial inequities within the current National Health Service (NHS), with people in lower socioeconomic groups (SEGs) using a wide range of services less relative to their needs than people in higher SEGs. These inequities are likely to arise due to factors on both the demand and the supply side of the system. On the demand side, they could arise from differences in patients' beliefs, knowledge, costs, resources and capabilities. On the supply side, professional beliefs and attitudes, and risk selection or cream-skimming by providers may result in inequities. This paper discusses whether these factors are at play within the English NHS and analyses whether current policy to extend patient choice of provider is likely to reduce or increase these inequities. It shows that extending patient choice may leave unchanged inequity due to differences in health beliefs (because choice does not affect these directly), increase inequity due to unequal resources (because patients may have to travel further), and decrease inequity due to unequal capabilities (because the poor will have access to a new and, for them a more effective, source of leverage over health service professionals). On the supply side, there will be little change. The paper then discusses policy options for dealing with factors that contribute to greater inequity on the demand side. It proposes a package of supported choice whereby individuals from lower SEGs would receive assistance in making choices, including an identified key worker to act as patient care adviser and help with transport costs. The paper concludes that policies for extending patient choice can enhance equity – so long as they are properly designed. [ABSTRACT FROM AUTHOR]

The role of organizational factors in the generation of adverse events, and the manner in which such factors can also inhibit an organization's abilities to learn, have become important agenda items within health care. The government report 'An organization with a memory' highlighted many of the problems facing health care and suggested changes that need to be made if the sector is to learn effective lessons and prevent adverse events from occurring. This paper seeks to examine some of these organizational factors in more detail and suggests issues that managers need to consider as part of their wider strategies for the prevention and management of risk. The paper sets out five core elements that are held to be of importance in shaping the manner in which the potential for risk is incubated within organizations. Although the paper focuses its attention on health care, the points made have validity across the public sector and into private sector organizations. [ABSTRACT FROM AUTHOR]

This paper focuses on one global aspect of the current health sector workforce policy agenda – the international recruitment and migration of health workers. It does so primarily by using a case study of the recruitment of nurses to the UK, as a means of exploring the policy challenges and associated research questions. The paper highlights the limitations in comparing national data on the nursing workforce, illustrating the extent to which currently collated national data can present a misleading picture of staff:population ratios in different countries. It then reports on the significant growth in the numbers of nurses entering the UK from other countries, using registration data. In 2001/02, more than 16 000 nurses entered the UK nursing register from non-UK sources. In this year, for the first time, the number exceeded the number of home-trained nurses. An analysis of postcode data highlights that these non-UK nurses have a younger age profile than home-based registered nurses and are more likely to report a postcode in London and south-east England. The paper also examines the push and pull factors that contribute to the international mobility of health workers. The paper concludes by examining the policy implications of this growing reliance on international recruitment, including the effect of the ethical guidelines on international recruitment introduced by the Department of Health in England. [ABSTRACT FROM AUTHOR]

This article presents personal stories from a participatory biographical arts-based study with a specific category of racialised migrants: individuals seeking asylum in the North East of England. Responding to the important questions posed by this special issue, the article explores individual experiences of navigating the UK's hostile environment with a focus on the threefold punitive 'threat' of dispersal, detention, and destitution (Bloch and Schuster, 2005). Adopting an intersectional lens, the discussion highlights the impact of such policies and their compound effect of creating (un)safe and exclusionary everyday spaces, while also outlining the potential for resistance as illustrated by participants' actions and their creative (re)actions as part of the study's arts-based approach. [ABSTRACT FROM AUTHOR]

This paper concerns the use of photo-elicitation interviews in constructing migrant narratives of health and well-being. It argues that photo-elicitation can be particularly effective in producing nuanced understandings about relationships among culture, place and health. It explores how, through this method, subject-centred understandings of health and well-being are able to challenge dominant discursive constructions that tend to ‘other’ and potentially stereotype minority groups in explanations of health behaviour. The paper includes discussion of issues of power and representation in research with marginalized populations, which further elaborates the value of photo-elicitation in developing a non-essentializing view of minority groups. The paper concludes with comment on the potential value of this method in the formulation of health and social policies aiming to incorporate the views and needs of marginalized or minority groups. [ABSTRACT FROM PUBLISHER]

Delayed hospital discharges have been identified as a problem for the English National Health Service and have prompted several policy and service development responses in the last decade. However, bedblocking is an issue surrounded by rival interpretations on how and why hospital delays occur and the way in which they are measured. To better understand this contested concept, this paper provides a brief description of the historical accounts that framed the emergence of delayed hospital discharges as a phenomenon. Three key features of the bed-blocking concept are also analysed: the reduction of patients' length of stay to improve efficiency, the intrinsic methodological difficulties of measuring hospital delays and the most common reasons for delayed discharges. A description of the characteristics of the patients frequently labelled as delayed discharge, their common traits and how these have been examined by previous research is also provided. Finally, this paper argues that the presence of hospital delays in a health system tends to be considered as an indicator of two possible system inefficiencies: a failure in the discharge planning process, which generally blames social services departments for not ensuring timely services, or a shortage of alternative forms of care for this group of patients. [ABSTRACT FROM AUTHOR]

Objectives: The UK Patient Safety Research Portfolio (PSRP) commissioned 38 studies investigating the threats to patient safety in various clinical settings and evaluating safety-related service interventions. This paper reviews 27 of these studies, drawing out emergent and cross-cutting themes in terms of theory, research methods and thematic findings. Methods: Given the diversity of PSRP studies, the paper takes a narrative approach that allows for qualitative description, interpretation and synthesis of the studies and their findings. Results: The theoretical review shows the majority of PSRP studies draw upon a patient safety 'orthodoxy', developed from the concepts and models associated with the human factors approach. The methodological review shows that a diverse range of research designs and techniques have been utilized. Although many follow in the 'scientific' tradition, interpretative, mixed and innovative methods have been integral to research. The thematic review of findings highlights significant contributions to knowledge in the areas of 'people', 'organizations', and 'technology'. As well as identifying the various sources of risk in the organization and delivery of patient care, the studies also evaluate and make recommendations about service change and improvement. Conclusions: The PSRP has provided the foundations for significant theoretical, methodological and empirical advances in the area of patient safety. The findings and recommendations make important contributions to policy formulation and implementation as well as professional and managerial practice. Through this body of research the PSRP has supported the formation and growth of a thriving research community across academic, policy and professional communities. [ABSTRACT FROM AUTHOR]

This paper addresses the use of economic evaluation to inform resource allocation decisions within health care systems about which interventions to reimburse and whether additional research should be funded. A social decision-making view of economic evaluation, that is to maximize health gains subject to an exogenous budget constraint, is adopted. A brief overview of the components of an economic evaluation is presented. Particular attention is paid to how uncertainty is inherent to decisions about resource allocation, the consequences of that uncertainty and how it can be incorporated informatively into economic evaluation. A Bayesian approach to uncertainty is used as it meets the needs of social decision-making, allowing analysts to quantify the probability that an intervention is cost-effective given the available evidence and to quantify the expected value of further research. The discussion covers methods to represent parameter and structural uncertainty and considers the role of formal elicitation of expert judgements. The association between decisions to approve interventions for reimbursement and decisions about future research funding, and how value of information analysis can be used to formalize this link, is explained. Recent developments in the UK highlight the evolving policy environment for economic evaluation, such as the Cooksey report on the funding of UK health research, the review of the Pharmaceutical Price Regulation Scheme by the Office of Fair Trading and the update of the methodological guidelines issued by the National Institute for Health and Clinical Excellence. The paper concludes by describing ongoing methodological work designed to meet the challenges of undertaking decision analysis for resource allocation in health care. [ABSTRACT FROM AUTHOR]

Given the increasing importance of performance indicators in current UK health policy, this paper provides a systematic review of empirical and theoretical writings concerning their use to improve health care quality. The paper outlines potential problems and explores how best to derive, implement and use performance indicator data, presenting results thematically. The two principal uses of indicator systems are as summative mechanisms for external accountability and verification, and as formative mechanisms for internal quality improvement. In the UK, the use of performance indicators in assurance and performance management systems has heavily influenced debate over their value. Major problems reported include the potential to undermine the conditions required for quality improvement, perverse incentives and the difficulty of using data to promote change. Technical problems include indicator selection; the availability, validity and reliability of data; confounding; and problems with robustness, sensitivity and specificity. Factors that help in the derivation, implementation and use of indicator systems include clear objectives, involvement of stakeholders in development, and use of 'soft' data to aid interpretation. [ABSTRACT FROM AUTHOR]

This article considers how specialist hospital services in the UK fared under Conservative health policy, with its emphasis on market-like arrangements, and what looks likely under the New Labour era, where new shibboleths (cooperation, quality, etc.) supposedly are in place. There appeared inherent in the Conservative health policy threats to specialist services from local competition, and purchaser agendas for local health needs of equity and prioritization. Moreover, small providers grappled with costs and the bureaucracy engendered by market-like arrangements and with their inability to make economies of scale. From the policy rhetoric since the New Labour election victory of May 1997, one might expect such specialist services to be 'coming in from the cold', but the reality seems quite different. In particular, this paper will outline the policy context for specialist providers for the period in the 1990s when the Conservative government undertook to reform the NHS. We also, through the Unit that is the subject of the case study, examine the actual effects of those reforms on this specialist service. Finally, we reflect further upon the resonances for specialist services in the New Labour era that can be gleaned from the case study. [ABSTRACT FROM AUTHOR]

The disclosure of adverse events to patients or their families who have been affected is considered to be a central feature of high quality and safer patient care, but despite this, as few as 30% of harmful errors may currently be disclosed to patients. Advocates of open disclosure propose that failing to communicate effectively with patients following adverse events may have negative repercussions for all stakeholders. The disclosure of adverse events and errors to patients and their families is partly fulfilling the duty of candour advocated in the numerous recent reports into the quality and safety within the NHS. This paper considers why disclosure remains challenging for organisations and professionals alike, despite guidance and in a clear moral imperative and commitment from stakeholders to transparency in healthcare. [ABSTRACT FROM AUTHOR]

The future health-care workforce and the changing skill-mix within occupational teams is a current topic of discussion. This paper contributes to the skill-mix debate by focusing on UK primary care dentistry, revealing unintended as well as intended consequences of a modularized, technocratic view of dentistry.In part one, relevant literature about dental therapists and skill-mix in dentistry is organized into a framework used to review factors operating at macro, meso and micro levels. Part two considers the role that education and training may play in realizing skill-mix change. Part three synthesizes conditions required for modifying skill-mix in UK primary dental care and sets out the dimensions of seven factors: funding focus, the profession's response, workforce, the practice, dentist's knowledge, dental therapist'smotivations and patient attitude. A review of these factors could be used to inform the policy decisions ofmanagers operating at the macro level, as well as more local staffing decisions. Without consideration ofthe complex interplay of these factors, skill-mix in dentistry will be slow to develop and could bring unwelcome consequences. [ABSTRACT FROM AUTHOR]

In recent years, the English NHS has achieved substantial reductions in waiting times for hospital treatment. This paper considers first whether the data used by the Government provide an accurate description of changes in waiting times and identifies some of the limitations of the measures used. It then attempts to identify how reductions have been achieved. It argues that some features of central government policy have been important - such as the use of targets - others, such as the introduction of new private sector capacity have not. It also shows that changes at local level have been critical to achieving the recorded improvements, but the precise impact of these is hard to identify. [ABSTRACT FROM AUTHOR]

Interest in consumer involvement in health services research started to gain momentum at around the same time that the MRC Health Services Research Collaboration (HSRC) was established. Consumer involvement was not the focus of a formal research programme within the HSRC, but HSRC members took opportunities to conduct three projects relating to consumer involvement in research agenda-setting activities. These were: (1) a comparison of the focus of published research relating to the management of osteoarthritis of the knee with clinicians' and patients' ideas about research priorities; (2) a survey that examined the consumer involvement policies of public- and voluntary-sector organizations that fund health services research in the UK; and (3) a citizens' jury that was convened to develop priorities for research relating to primary health and social care in the Bristol area. This paper reviews the findings of these projects and highlights the continued need for attention to underlying values in the development and evaluation of future efforts to involve consumers in research agenda setting. [ABSTRACT FROM AUTHOR]

Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere. [ABSTRACT FROM AUTHOR]

Introduction: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and 'modernizing' project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. Methods: Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. Results: The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses. Conclusion: Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and 'sold' to the nursing profession as enhancing its status compared with medicine. [ABSTRACT FROM AUTHOR]

The recent acute budgetary pressures within the English National Health Service (NHS) have accentuated calls for targeted disinvestment thereby eliminating ineffective or low-value services to provide resources that can be reallocated toward more cost-effective purposes. This challenge extends beyond allocating new resources wisely, a goal that has been, since its inception, the primary focus of the National Institute for Health and Clinical Excellence (NICE). But on 6 September 2006, the Department of Health announced a new mandate for NICE to help the NHS identify interventions that are not effective. This paper discusses current NICE efforts to support value in the NHS and then explores the policy options available to the Institute as it prepares to launch a programme to meet the NHS request for guidance on disinvestment. All of the possible options present challenges. NICE will need to collaborate in new ways with partners inside, and perhaps outside, the NHS. However, the Institute has an established reputation for rigour, transparency and political durability that makes it well qualified to sustain public support in the face of difficult decisions. Disinvestment will provide a stern test of these qualities. [ABSTRACT FROM AUTHOR]

In this paper, I aim to re-establish the meaning and importance of the concept of 'evidence-based policy making' (EBP) in health care. The term EBP is often misunderstood as being either vacuous (who thinks that public policy should not be based on evidence?), unrealistic (the naive product of ivory tower thinking) or conservative (an excuse permanently to delay reform). It need be none of these things. EBP should be thought of as a set of rules and institutional arrangements designed to encourage transparent and balanced use of evidence in public policy making. As well as controlled trials and observational studies, a broad range of theoretical and empirical evidence about human behaviour may be relevant to predicting policy outcomes - including stakeholder opinions and other sources of intelligence that might not qualify as scientific research. Gradual progress towards EBP, properly understood, has the potential to facilitate open democracy and to improve policy outcomes. The argument is illustrated using examples based on large-scale policies of health care reform in England, where progress towards EBP over the last decade has been real but modest. [ABSTRACT FROM AUTHOR]

This paper compares the development of genetic testing for breast cancer (BRCA testing) in the USA and the UK. It argues that national political cultures played an important role in how these genetic testing technologies were shaped, and that the shapes of these technologies had important implications for the users of these systems. In order to demonstrate the roles of national social and political elements in the development of new genetic testing technologies, I introduce the concept of a technology's architecture, which is made up of component and the specific ways in which these components are assembled to fulfill particular functions. In the USA, four very different BRCA testing systems initially emerged. However, one biotechnology company, Myriad Genetics, eventually used its legal and economic position to become the sole provider of testing. It offered BRCA testing the way many other laboratory tests were provided in the USA, available to anyone through any physician. The shape of this testing service had important implications for its participants, defining the client as a consumer who could demand access to any of Myriad's laboratory services, but could not choose among testing systems. In the UK, the government-run National Health Service provided testing through regional genetics clinics, using family history information to assess risks and triage care. Clients in the UK were defined as citizens and patients, who had the right to equal access to the testing system but could not demand any specific services. [ABSTRACT FROM AUTHOR]

The Vulnerable Persons Resettlement Scheme (VPRS) comprised the UK government's primary response to persons forcibly displaced by the Syrian civil war. Recipients were granted immediate recourse to public funds and a locally-based 12-month integration support plan, designed at the discretion of practitioners. Drawing on forty in-depth interviews with refugees and practitioners in two areas with contrasting local approaches, this article explores the tensions that emerged when broader central government policies (distinct from the VPRS), intersected with resettlement support in recipients' lives. Two current welfare reforms are identified and evaluated as having impacted resettled families' housing experiences: firstly; the Two-Child Limit and secondly; the Benefit Cap. The article demonstrates how the financial precarity produced by both policies undermined local practitioners' resettlement support. In doing so, the article challenges dominant policy narratives of exceptionality, locating those resettled within the routinised systems of precarity and conditionality embedded in the welfare system. [ABSTRACT FROM AUTHOR]

This article examines the way numbers, often concerning risk, were communicated by politicians, covered by the news media and interpreted by the public during the early stages of the COVID-19 crisis in the United Kingdom. To explore this topic, we adopted a mixed-methods approach that included content analysis, comparative thematic analysis and a series of focus groups. Whilst coherency and consistency are touted as essentials in public health messaging, our textual analysis highlighted the disconnect between political communication and news media coverage. Whereas the UK government relied on vague references to curves and peaks to underpin a narrative of consistency and certainty in public health policy, the UK news media referred to specific numbers from within and outside the UK to criticise the government's approach as haphazard and lacking. This disconnect gained even more significance during our focus groups. When discussing numbers, participants referred to news media coverage rather than political messaging, using these figures to challenge the timing and nature of the UK lockdown. These findings present a significant critique of the UK government's communication during this health crisis. Instead of putting forward a coherent, homogenous and clear message to the public, the discourse around numbers and risk was diffracted, disconnected and opaque. This was largely due to the competing narratives presented by the news media. [ABSTRACT FROM AUTHOR]

This paper contrasts the views of two prominent politicians on the ways in which the distribution of hospital services should be organised, and relates them to the views of Hayek on the nature of planning. It is argued that, in relying on an independent regulator to supervise access to health care under the new 'foundation' hospitals regime in the English National Health Service (NHS), not only is the Labour government distancing itself clearly from old-style top-down planning, it also risks greater variability in the definition of fair access to health care. There are relevant historical parallels with the mixed economy of the pre-NHS era that policy-makers should make explicit. [ABSTRACT FROM AUTHOR]

Objective To review the evidence on commissioning schemes involving clinicians in the United Kingdom National Health Service, between 1991 and 2010; report on the extent and impact of clinical engagement; and distil lessons for the development of such schemes both in the UK and elsewhere. Methods A review of published evidence. Five hundred and fourteen abstracts were obtained from structured searches and screened. Full-text papers were retrieved for UK empirical studies exploring the relationship between commissioners and providers with clinician involvement. Two hundred and eighteen published materials were reviewed. Results The extent of clinical engagement varied between the various schemes. Schemes allowing clinicians to act autonomously were more likely to generate significant engagement, with ‘virtuous cycles’ (experience of being able to make changes feeding back to encourage greater engagement) and ‘vicious cycles’ (failure to influence services generating disengagement) observed. Engagement of the wider general practitioner (GP) membership was an important determinant of success. Most impact was seen in GP prescribing and the establishment of services in general practices. There was little evidence of GPs engaging more widely with public health issues. Conclusion Evidence for a significant impact of clinical engagement on commissioning outcomes is limited. Initial changes are likely to be small scale and to focus on services in primary care. Engagement of GP members of primary care commissioning organizations is an important determinant of progress, but generates significant transaction costs. [ABSTRACT FROM AUTHOR]

Aims: Considerable progress in public health is expected to occur from the application of genomic knowledge and technologies. This is the subject of a newly emerging field of public health genomics. In this paper we analyze differences in how public health genomics is developing in the Netherlands, the UK and Germany through the definition and diagnosis of familial hypercholesterolaemia (FH), an inherited predisposition for coronary heart disease. Methods: We analyzed the emergence of public health genomics within the framework of a project on the incorporation of genetics in western European healthcare schemes. Our analysis is based on document analysis and in-depth interviews. Results: In the Netherlands, public health genomics takes shape through a genetic screening programme for FH, looking for mutations on two specific genes; in the UK it emerges through a strategy of ‘‘mainstreaming’’ genetics in health care that aims to identify hereditary predispositions by means of phenotypic diagnosis; and in Germany public health genomics is elaborated at a conceptual level, leaving a diagnosis of FH to individual physicians who occasionally prescribe genetic testing. Conclusions: Our analysis shows how public health genomics gets constituted differently in different countries and, moreover, produces particular patterns of inclusion and exclusion from care. These patterns indicate a paradox in public health genomics, which consists of an inverse relationship between the use of advanced molecular genetic testing technologies and the number and variety of individuals at risk included in the target population. This paradox presents a challenge for professionals and policy makers in public health genomics. [ABSTRACT FROM PUBLISHER]

This paper explores the health care complaints handling reforms enacted in Britain, Australia and Taiwan. A documentary search for policy documents, reports and studies related to the reforms of the health care complaints handling system was conducted. A keyword search was performed within PubMed and ProQuest for the period 1985-2009 to identify relevant articles. The study found that the major difference in health care complaints handling systems between countries, is the mechanism for running a complaints system. Both Britain and Australia have attempted to incorporate patient complaints into their national quality systems. Their intention was to set up mechanisms to create an effective bridge, at a national policy level, between the patient complaints management system and the quality management system. [ABSTRACT FROM AUTHOR]

Employing a policy-as-discourse approach, we explore how the language of choice, risk and responsibilisation influences cardiovascular disease policy. We analyse four key pieces of public health literature produced in the UK between 1999 and 2013 that consider the prevention and treatment of coronary heart disease: Saving Lives: Our Healthier Nation; National Service Framework for Coronary Heart Disease; Mending Hearts and Brains and Cardiovascular Disease Outcomes Strategy. This critical discourse analysis problematises how neoliberal discourses of responsibilisation, risk and choice operate to govern health practices. Textual analysis reveals there are multiple dimensions evident in the way that responsibility for health is framed. Organisations are considered responsible 'for' illness prevention strategies and service provision, while individuals are conceptualised as responsible 'to' maintain healthy lifestyles. Conceptualising individuals as responsible health-conscious consumers enables a backward-looking narrative that holds individuals to account. Furthermore analysis reveals assumptions and messages that demonstrate the operation of moral discourses around patient behaviour. We suggest moral dimensions to public health strategies obscure the structural disparities that influence healthy life chances, imposing a system of limitations and exclusions that lead to allocation of liability and attributing blame for illness. [ABSTRACT FROM AUTHOR]

UK policy has increasingly promoted early intervention and permanence planning for children who experience, or are at risk of experiencing, abuse or neglect, raising the question of whether these practices have actually increased ‘on the ground.’ There is already evidence of growing early intervention in the form of out of home care, in England as well as Australia and Canada. However, we do not yet know whether this trend also exists in Scotland. Furthermore, there is no research investigating whether rates of permanence planning have changed anywhere in the UK or globally. The current study addressed these gaps through a comparison of two samples of children in Scotland: 110 children born in 2003 and 117 born in 2013, all of whom were placed under compulsory measures of supervision prior to three years of age. The 2013 cohort was significantly more likely than the 2003 cohort to be removed from their parents at birth, to reside away from parents throughout the first three years of life and to live apart from parents at three years of age. Significantly more of the 2013 cohort than the 2003 cohort had a plan for permanence by three years. These findings are consistent with the view that policy changes in the UK are affecting practice (although practice changes may have resulted from other sources as well/instead). The fall in parental care was largely compensated by an increase in the use of foster care, which has resource implications. Children removed from their parents at birth were usually not returned in the first three years of life, not raised by extended family members, and were separated from one or more siblings. This typically reduced instability for young children, but also entailed substantial birth family fragmentation. The impact on children and families of early removal into foster care must therefore be carefully assessed in light of the increasing prevalence of this practice in Scotland and elsewhere. [ABSTRACT FROM AUTHOR]

Breastmilk is widely considered as the optimum nutrition source for babies and an important factor in both improving public health and reducing health inequalities. Current international/national policy supports long-term breastfeeding. UK breastfeeding initiation rates are high but rapidly decline, and the numbers breastfeeding in the second year and beyond are unknown. This study used the concept of liminality to explore the experiences of a group of women breastfeeding long-term in the United Kingdom, building on Mahon-Daly and Andrews. Over 80 breastfeeding women were included within the study, which used micro-ethnographic methods (participant observation in breastfeeding support groups, face-to-face interviews and online asynchronous interviews via email). Findings about women's experiences are congruent with the existing literature, although it is mostly dated and from outside the United Kingdom. Liminality was found to be useful in providing insight into women's experiences of long-term breastfeeding in relation to both time and place. Understanding women's experience of breastfeeding beyond current usual norms can be used to inform work with breastfeeding mothers and to encourage more women to breastfeed for longer. [ABSTRACT FROM AUTHOR]

The article discusses a study undertaken as part of the Evaluation of Care Across Borders (ECAB) project on cross-border care collaborations with the aim of describing pediatric cross-border care pathways and identifying factors that support or hinder its operation. Topics discussed include the Malta-Great Britain agreement that provides for free treatment of up to 180 Maltese patients in Great Britain every year where patients referred above this quota incur a charge to the Maltese government.

Across the United Kingdom, large numbers of crisis resolution and home treatment services have been established with the aim of providing intensive, short-term care to people who would otherwise be admitted to mental health hospital. Despite their widespread appearance, little is known about how crisis resolution and home treatment services are organised or how crisis work is done. This article arises from a larger ethnographic study (in which 34 interviews were conducted with practitioners, managers and service users) designed to generate data in these and related areas. Underpinned by systems thinking and sociological theories of the division of labour, the article examines the workplace contributions of mental health professionals and support staff. In a fast-moving environment, the work which was done, how and by whom, reflected wider professional jurisdictions and a recognisable patterning by organisational forces. System characteristics including variable shift-by-shift team composition and requirements to undertake assessments of new referrals while simultaneously providing home treatment shaped the work of some, but not all, professionals. Implications of these findings for larger systems of work are considered. [ABSTRACT FROM PUBLISHER]

The article presents a study which assessed the cost-effectiveness of conducting a randomized controlled trial (RCT) of medical screening for glaucoma within the framework of the National Health Service (NHS) in Great Britain. The researchers revised the Glaucoma Screening Model, conducted sensitivity analyses and calculated quality adjusted life years (QALY). The test paradigms for glaucoma were either optic nerve photography (ONP) or screening mode perimetry.

Medical authorities have historically either been silent or circumspect about the role of candour in clinical relationships. Hippocrates told doctors to abstain from doing harm, not entertaining the possibility that they might be negligent, while in 1847 the American Medical Association declared that doctors have: ‘a sacred duty … to avoid all things which have a tendency to discourage the patient and depress his spirits’. Being candid about an injurious mistake in the course of treatment would no doubt discourage even the worldliest of 19th century patients. However, in recent years, the focus has shifted: doctors in 21st century have an obligation to disclose even the most depressing of mistakes. This modern ‘duty of candour’ is found in a mish-mash of moral principles, regulatory guidelines and contractual agreements but following the Francis Report it will be buttressed by statute. [ABSTRACT FROM AUTHOR]

The mass media, by communicating with people in large numbers, can have a huge impact on the public’s knowledge, beliefs, perceptions, attitudes and behaviours, not only as individuals but also as families, communities and wider society. The power and reach of the mass media can influence all aspects of people’s lives, including health and well-being, and can be harnessed to promote health by informing, motivating and empowering people to change behaviour and by providing a platform for advocating healthier policies and civic action. This article considers some of the basic principles and approaches of using the mass media to promote health. It looks at the changing media landscape including the advent of social networking tools and signposts readers to practical advice on how to get involved and develop their skills. [ABSTRACT FROM AUTHOR]

Shortly following the Second World War, and under the medical direction of ex-army psychiatrist T. F. Main, the Cassel Hospital for Functional Nervous Disorders emerged as a pioneering democratic ‘therapeutic community’ in the treatment of mental illness. This definitive movement away from conventional ‘custodial’ assumptions about the function of the psychiatric hospital initially grew out of a commitment to sharing therapeutic responsibility between patients and staff and to preserving patients’ pre-admission responsibilities and social identities. However, by the mid-1950s, hospital practices had come to focus pre-eminently on patients’ relationships with family members, and staff had developed a social model of mental health that focused on the family as the irreducible unit of mental treatment. By the late 1950s, this culminated in the in-patient admission of entire families for mental treatment, even when only one family member was exhibiting symptoms. At the heart of this growing post-war social-psychiatric preoccupation with the family was a new emphasis on the close relationship between mental health and individuals’ successful development toward mature responsible adulthood. The family came to be conceived as the quintessential space where both were forged. This article examines the process through which the Cassel’s social-psychiatric commitment to ‘therapeutic community’ became focused on the family as a key therapeutic site. While the family had become a central point of focus in social, political and psychological discussions of the foundation for stable democratic culture and political peace in post-war Britain, the Cassel Hospital actively experimented with these connections in therapeutic practice. This article thus illuminates the important, but frequently overlooked, role of psychiatric practices in the development of a post-war psychopolitics that established important links between the nuclear family, mental health and democratic social life. [ABSTRACT FROM PUBLISHER]

The Health and Social Care Bill proposes clinically led commissioning. The new Clinical Commissioning Groups will become statutory bodies and replace the old primary care trusts. This primary legislation will transfer accountability for health care spending to clinicians who will have a duty to meet the health needs of a population as well as balance a budget. This change gives rise to a number of ethical issues which are explored in this article. [ABSTRACT FROM AUTHOR]

In recent years a proliferation of reality based media focusing on the body, diet and exercise have sought not only to entertain audiences, but also to operate as pedagogical sites through which to encourage populations to undertake surveillance of their own and others’ bodies in order to address a so-called ‘obesity epidemic’ sweeping across western society. This article examines how reality media function within a broader ‘surveillant assemblage’ (Haggerty and Ericson, 2000) of obesity. Specifically, the article explores how this assemblage functions through interdependent connections between parenting, social class and broader political discourses of parenting and health risks which produce affective relationalities of the body. [ABSTRACT FROM PUBLISHER]

A new Department of Health policy in England, published in 2007, recommended changes to the pre-employment health checks performed on health care workers before taking up their employment. The policy proposed that all new health care workers should receive immunization against TB and hepatitis B and should be offered testing for hepatitis C and HIV. It also advanced a new requirement that staff who perform exposure-prone procedures must be tested for TB, hepatitis B and C and HIV and must test negative for these diseases. Essentially mandatory HIV testing has been introduced for a large number of health care workers. The aim of the recommendations is to protect patients from contracting serious communicable diseases from health care professionals. Secondary objectives of the directive are to maintain confidence in the workforce and reduce the burden of patient notification exercises. This essay explores some of the shortcomings of this policy and examines the reasons why this policy will fail to meet its objectives. The justification for this new guidance is questioned and some of the ethical issues are highlighted. [ABSTRACT FROM AUTHOR]

The study, the first part of which was published in 2008, looked at, prospectively, how effective and safe new, nontraditional connectors were for use in spinal connector equipment such as spinal needles and infusion lines. The researchers analysed existing evidence on adverse incidents in this area, held workshops to discuss the problem, tested new devices with a simulator, and evaluated them in clinical practice trials at four different hospitals in England. [ABSTRACT FROM AUTHOR]

In this article, the authors present their views about the funding of health services research in Great Britain. They say that the applied research is being funded by the Medical Research Council's (MRC) Health Services Research Collaboration (HSRC) in the country. They further say that one of the successes of the HSRC was its ability to develop good training and capacity development programmes throughout the country.

The essay discusses the radical health reforms that have been developed and implemented in the National Health Service (NHS) in England. It focuses on the development of the said reforms with particular reference to the reforms needed to improve the health care provided to patients with chronic illness. It also focuses on the methods used to identify and evaluate appropriate interventions.

Objectives: To compare the distances travelled for inpatient treatment in England between electoral wards prior to the introduction of a policy to extend patient choice and to consider the impact of patients' socio-economic status. Methods: Using Hospital Episode Statistics for 2003–04, the distance from a patient's residence to a National Health Service hospital was calculated for each admission. Distances were summed to electoral ward level to give the distribution of distances travelled at ward level. These were analysed to show the distance travelled for different admission types, ages of patient, rural/urban location, and the socioeconomic deprivation of the population of the ward. Results: There is considerable variation in the distances travelled for hospital admission between electoral wards. Some of this is explained by geographical location: individuals living in more rural areas travel further for elective (median 27.2 versus 15.0 km), emergency (25.3 versus 13.9 km) and maternity (25.0 versus 13.9 km) admissions. But individuals located in highly deprived wards travel less far, and this shorter distance is not explained simply by the closer location of hospitals to these wards. Conclusions: Before the introduction of more patient choice, there were considerable differences between individuals in the distances they travelled for hospital care. An increase in patient choice may disproportionately benefit people from less deprived areas. [ABSTRACT FROM AUTHOR]

The article presents information related to the assessment of safety standards of medical devices. Medical devices are grouped into four product classes on the basis of potential risks associated with the use of them. The Medical Device Directives (MDD) of Great Britain analyze safety and risk associated with the medical products.

Objective: Government policies and initiatives in England have promoted the involvement of patients in the management of their own health care. Copying clinical letters to patients may improve patients' understanding of their health and the care they receive. Although the National Health Service (NHS) Plan describes copying letters to patients as a 'right', the process of copying letters to patients remains an example of good practice rather than a requirement. We review the literature to explore whether letters should be copied to patients and in what circumstances. Methods: Review of published literature and evidence from 12 pilot projects funded by the Department of Health (DH) for and against copying letters to patients from the perspective of patients and health professionals. Results: Patients generally find copies of letters beneficial, and tend to be more satisfied with their consultation and report benefits in terms of involvement in their own health care when letters are copied. Health professionals generally have concerns about the relative benefits to the patient and remain concerned about the resource implications of copying letters. Conclusions: On balance, the limited evidence on copying clinical letters to patients favours copying letters, or at least offering copies, although health professionals are less keen than patients. [ABSTRACT FROM AUTHOR]

Objectives: To explore the views of UK stakeholder group representatives about genetic tests for complex disease risks, and in particular the regulation of public access to genetic testing in order to assess the capacity of public consultations to represent the views of the public and representative groups accurately. Methods: A purposive sample of 16 people was selected who had responded to a previous consultation by the Human Genetics Commission (a UK government body), or who were known to have relevant interests. Interviews were undertaken in June and July 2003, and recorded, transcribed and analysed thematically. Results: Interviewees believed that genetic information is not inherently different from other health risk information, such as family histories or body mass indices. However, they tended to think that members of the public are unable to take a similarly informed view and that special regulation is therefore required. Individuals acting as representatives of organizations tended to express opinions more in favour of protective regulation and professionally controlled access to genetic testing for complex disease risks than those they held as individuals. Conclusions: Stakeholder representatives' perceptions of public vulnerability may give rise to precautionary regulatory policies on genetic testing that limit public access to potentially valuable information. This could undermine other public health policies aimed at encouraging individuals to act independently to reduce risks to their health. 'Stakeholder consultations' may generate biased findings. Further rigorous research is needed to validate and explain the opinions and assumptions of individuals asked to contribute to such consultations. [ABSTRACT FROM AUTHOR]

The article presents an interview with Liam Donaldson, chief medical officer of the British Department of Health, about patient safety. The interview begins with an assessment of the report "An Organisation With a Memory" which stimulated a lot of awareness about patient safety. Donaldson then discusses the approach to cover ups or failure to comply with the being open policy. In addition, Donaldson talks about the role of the National Health Service Litigation Authority.