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Activity-based funding of hospital services has been introduced progressively since 2003 in the National Health Service (NHS) in England, under the name 'Payment by Results' (PbR). It represents a major change from previous funding arrangements based on annual "block" payments for large bundles of services. We interviewed senior local NHS managers about their experience and expectations of the impact of PbR. A high degree of 'NHS solidarity' was apparent, and competition between NHS hospitals was muted. PbR has been introduced against a background of numerous other efficiency incentives, and managers did not detect a further PbR-specific boost to efficiency. No impact on care quality, either positive or negative, is yet evident.

Purpose: The purpose of this paper is to report the findings of a study that examined the development of an assessment framework for public involvement., Design/methodology/approach: The paper has adopted a multi-method approach that includes: a focused review of literature relating to tools that might be used to provide valid and reliable assessments of public involvement; key informant interviews with people with experience from various perspectives of efforts to involve the public in the planning and development of health services; and a detailed study of a specific public involvement initiative involving a range of "stakeholder" interviews., Findings: The paper finds that there are uncertainty and a lack of consensus about how assessment of public involvement should be undertaken. The findings emphasise the need to recognise the diverse nature of public involvement, which may require assessment to be employed flexibly at each individual NHS Board level., Research Limitations/implications: The paper is a small-scale study, in which it was only possible to probe a limited number of stakeholders' views due to practical and time restrictions., Originality/value: The paper adds value to the discussions taking place at Scottish Government level as to the best approach in assessing public involvement in health service decision making.

This paper considers whether resource management (RM) as currently constituted in the National Health Service (NHS) is likely to fulfil its aim of efficiency. For the individual hospital RM has two key features: changes in managerial structure and changes in information systems. The paper assesses the extent to which the hospital behavioural model that implicitly underlies RM can be judged to reflect well the actual behaviour of hospitals. It is noteworthy that in the RM literature there is no explicit statement about the assumed underlying behaviour of the NHS hospital. Here the author selects the Harris model of hospital behaviour as providing the best explanation of internal hospital organisation. Harris represents the two lines of authority, physicians and administrators (managers in the present-day NHS), as two firms within the hospital structure, each with its own managers, objectives and constraints, making this model particularly appealing as a basis for analysing RM. Using this model the paper concludes that RM alone and as currently constituted will not be successful in promoting efficiency, because the structural and cultural mechanisms put in place by RM will not sufficiently affect physician behaviour.

Health authorities and health boards in the UK are required under the provisions of the NHS Act, 1990, to assess the needs of their resident populations for health care and, through contracting, to act as purchasers of services informed by those needs. This paper presents an economic approach to informing the purchaser on priority setting for contracting. For illustrative purposes, the technique is applied to services for elderly people with dementia. The paper demonstrates that an economic approach to needs assessment is both desirable and practicable.

In this paper the implications of the support of undergraduate medical education and research for the new NHS market are examined. Inaccuracies in current methods of distribution of the Service Increment for Teaching and Research (SIFTR) and Additional Cost of Teaching and Research (ACTR) monies will have adverse effects. Receipt of too much money results in providers' care being unfairly subsidised while receipt of too little results in providers bearing an unfair burden of the cost of teaching and research. Results are reported from a study in the north east of Scotland with regard to the feasibility of obtaining more accurate estimates of the costs to the NHS of supporting teaching and research. The choice is between potentially accurate, but cumbersome and costly, systems of data collection or the continuation of the current, more arbitrary, approach of allocating monies. A combination of the two is recommended.