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The authors describe the incremental approach to the marketisation of the English National Health Service (NHS) since the introduction of an 'internal market' in 1990 until the 2010 White Paper, 'Equity and Excellence: Liberating the NHS', and the subsequent Health and Social Care Bill published in January 2011. The introduction of a competitive market for a universal, tax-financed health system requires fundamental changes in regulation in order that market bureaucracy can be substituted for direct management. The components of reform are insufficiently captured by the framework of hierarchies and networks in new public management theories of decentralisation. [ABSTRACT FROM AUTHOR]

Abstract The objective of this study was to compare hospitalisation rates by cause of admission, hospital death rates and length of stay for residents from nursing and residential care homes with those in the community. This is a retrospective study of acute hospital emergency admissions in one health district, Merton, Sutton and Wandsworth between April 1996 and March 1997. Data linkage and manual look up were used to derive emergency hospital admissions for residents of care homes aged 65 and over. Admission rates were calculated for cause, length of stay and hospital death for residents of care homes and in the community with relative risks. The relative risk of emergency admission from a care home compared with the community was 1.39 for all diagnoses, 2.68 for all injuries, and 3.96 for fracture of neck of femur. The relative risk of dying in hospital for care home residents was 2.58 overall, and 3.64 in the first 48 hours of a hospital stay (all P -values <0.0001). Admission rates were higher from residential than from nursing homes. There was some increase in admissions from homes during holiday periods and over Christmas. In conclusion, there are major difficulties in monitoring admissions from nursing and residential care homes due to poor quality recording and inaccuracies in NHS coding. This was compounded by an absence of data on the age and sex profile and healthcare needs of the resident population in care homes. Prospective studies are required to ascertain when admission is avoidable and when it is appropriate. The information strategy needs to ensure that routine data sources are capable of monitoring the use of hospital services by residents of care homes. [ABSTRACT FROM AUTHOR]

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.

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 authors discuss the impact of the Health and Social Care Bill of 2011 on the National Health Service (NHS) in England. They note the bill's movement toward eliminating the NHS through the British Parliament, and facilitating the introduction of a U.S.-style health system. Moreover, the authors cite significant legal consequences of Bill which include weakening the accountability of the Secretary of State to Parliament for the provision of services to patients in the NHS.

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 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.

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]