Search

ABSTRACT: In this paper we argue that national accounting categories provide an inadequate basis for evaluating differences between public and private sector services. This is because accounting categories rely on economic concepts such as market price but do not take account of substantive public policy goals such as universality. The argument has important consequences for the structures and systems of delivery especially where nonprofit providers and social enterprise models are substituted for public bodies formerly integrated into the government's delivery system. Using an example taken from the UK's National Health Service, we show that the mechanisms for ensuring universality through redistribution are not sufficiently taken into account for classification purposes. [ABSTRACT FROM AUTHOR]

This article outlines and critiques the main fiscal and economic rationales for the Private Finance Initiative – by far the dominant form of public-private partnership in the United Kingdom (UK) – and examines the impact of the policy on the long term financial viability of the National Health Service. It shows that the interest rate on private finance contains a significant element of ‘excess return’ to investors, and there is no evidence that this ‘excess cost’ to the public sector is offset by greater efficiency through the contracting process. It concludes that the private financing of public capital investment is highly problematic – and can have a serious impact on the finances and capacity of public authorities. [ABSTRACT FROM AUTHOR]

This article outlines and critiques the main fiscal and economic rationales for the Private Finance Initiative and examines the impact of the policy on the long-term financial viability of NHS trusts. It concludes that the PFI funding of capital investment is highly problematic. Its high costs can have a negative impact on the finances of health systems. [ABSTRACT FROM AUTHOR]

Situation Reports (SitReps) is an internal Department of Health performance data collecting system. Although intended primarily for internal use, the data are also used to answer parliamentary questions, brief ministers and to inform national performance indicators. This paper reviews the data collection system and data-set, and shows how it can be used to evaluate delays in hospital discharge under the Community Care (Delayed Discharges etc.) Act 2003. However, limitations in the data include the fact that the data have only recently been extended to National Health Service (NHS) non-acute settings and do not include NHS patients in the private acute sector. Further, as the data-set derives from a weekly aggregate return rather than from individualized person-based records, it cannot be used to evaluate length of delay, or to link to other relevant data such as emergency readmissions. The provision of individualized data to facilitate linkage and extending coverage would increase its potential future use. Categories of delay should be further refined to facilitate monitoring of delays due to disputes about eligibility. [ABSTRACT FROM AUTHOR]

The government's main justification for using private finance is that it provides value for money by transferring project risks to the private sector. However, of the 622 PFI deals signed by October 2007, the National Audit Office (NAO) has examined the relationship between risk transfer and risk premiums in only three. The government's justification for the policy is largely unevaluated and unscrutinized by Parliament, raising wider issues of public accountability for public expenditure. [ABSTRACT FROM AUTHOR]

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.

UK government procurement policy rests on Treasury claims that the private finance initiative (PFI) has reduced cost and time overruns. We review the five studies cited by the Treasury in support of this claim and find that only one purports to compare PFI with traditional procurement. The results of this single study are uninterpretable because of selection bias, small sample size (only 11 out of 451 PFI projects are included) and fundamental flaws in the analysis. There is thus no evidence to support the Treasury cost and time overrun claims of improved efficiency in PFI. We conclude that Treasury appraisal guidance, the ‘Green Book’ which compares PFI with other methods of procurement, is not evidence based but biased to favour PFI. [ABSTRACT FROM AUTHOR]

Background: Reviews of peer-reviewed health studies have highlighted problems with their methodological quality. As published health studies form the basis of many clinical decisions including evaluation and provisions of health services, this has scientific and ethical implications. The lack of involvement of methodologists (defined as statisticians or quantitative epidemiologists) has been suggested as one key reason for this problem and this has been linked to the lack of access to methodologists. This issue was highlighted several years ago and it was suggested that more investments were needed from health care organisations and Universities to alleviate this problem. Methods: To assess the current level of methodological support available for health researchers in England, we surveyed the 25 National Health Services Trusts in England, that are the major recipients of the Department of Health's research and development (R&D) support funding. Results and discussion: The survey shows that the earmarking of resources to provide appropriate methodological support to health researchers in these organisations is not widespread. Neither the level of R&D support funding received nor the volume of research undertaken by these organisations showed any association with the amount they spent in providing a central resource for methodological support for their researchers. Conclusion: The promotion and delivery of high quality health research requires that organisations hosting health research and their academic partners put in place funding and systems to provide appropriate methodological support to ensure valid research findings. If resources are limited, health researchers may have to rely on short courses and/or a limited number of advisory sessions which may not always produce satisfactory results. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM PUBLISHER]

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.

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.

Abstract Over the last decade there has been consistent pressure for the healthcare services in the UK to become more accountable to users. Now over half the healthcare beds in England are in the privatised nursing home sector, and regulation of the sector is under reform. Yet requirements for user accountability have not been reflected in these reforms. In other sectors, consumer involvement in regulatory agencies and processes is seen as important to the success of the regulatory enterprise. But in the care sector neither users nor their representatives have been given legal rights of involvement in the National Care Standards Commission or in regulatory processes. This paper argues that failure to involve users not only places the regulation enterprise at risk of capture by the industry, but will also weaken the legitimacy of the new Commission. [ABSTRACT FROM AUTHOR]

The authors describe the complexity of the financing arrangements of primary care premises. They explain how the early vision of integrating health and social services within local health centres failed to be realized, with GP-owned practice premises remaining as the dominant model. There was a switch to private finance when the government loan body (General Practice Finance Corporation) was privatized in 1989. Although capital can now be freely raised by the private sector for investment in the National Health Service (NHS), these debts have to be repaid through NHS funds or user charges. The complexity, combined with demographic factors, makes it likely that as GPs opt for the Personal Medical Services (PMS) scheme and a salaried service, the trend towards for-profit corporations owning and buying out GP premises will accelerate. [ABSTRACT FROM AUTHOR]

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.

The neo-liberal assault on the welfare state has not always been direct. The acknowledged popularity of the UK NHS has resulted in governments using covert means to undermine its core principles, namely universality and equity. Long-term care with its vulnerable client base is an important example of how care has become a private responsibility with little or no debate or discussion. Using the social security regulations, the Conservative government of the early 1980s pump-primed with public funds the massive expansion of private nursing and residential care, to the extent that the past 20 years has witnessed the evolution of a significant new economic market sector. This article charts the trajectory and structure of the market in long-term care provision, from its 'cottage industry' beginnings to increasing dominance by generic, often publicly-quoted multinational corporations. It shows how the privatization of funding was accompanied by transferring responsibility for payment of care from central government to local authorities in 1993, and how the introduction of eligibility criteria and the shrinking of public provision has made care a private and personal responsibility. Government is now encouraging companies to diversify into higher-cost specialist areas such as diagnostics, acute psychiatric care and acute hospital and intermediate care, with long-term care increasingly seen as a lower profit 'core' industrial package predicated on basic services and casualized, low wage labour. The commodification of the care process is now being extended to other parts of the NHS and has serious implications for the health and well-being of the whole population and not just for the most frail and vulnerable. [ABSTRACT FROM AUTHOR]

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 recent general election in Britain saw healthcare as the dominant issue amongst voters. The victorious Labour Party responded to this concern with a set of reforms designed to introduce greater private-sector involvement in the delivery of healthcare. These reforms are ill-thought-out. The standard of care in British private hospitals is below that found in public hospitals, whilst new contracting arrangements are likely to increase the administration costs within the system. Faith in private-sector management techniques is misplaced at a time when the real problem facing the NHS is that of capacity. The Labour Party is also committed to redefining some aspects of healthcare as a personal responsibility and not a right, moving Britain towards a more market-based healthcare system. [ABSTRACT FROM AUTHOR]

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.

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.

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.

Presents several letters on medical care in Great Britain. Impact of local managerial target setting in achieving improvements in health; Specification of the cut off point used in quoting years of life lost; Efficacy of using fluoxetine in suicidal patients .

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 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.

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.

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 authors look at the policy of the Department of Health in England on confidential commercial data. They cite that the changes made by the department to the British National Health Service (NHS) allow it to avoid scrutiny. They note that the assessments of six commuter walk-in centre pilot programs published within the issue of "British Journal of General Practice" were limited due to a lack of access to contract and patient data. They argue that commercial confidentiality is aimed at concealing the failure of the policy of the department.

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.

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.

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.

Opinion. Focuses on the impact of the British government's private finance initiative (PFI) on the structure and operations of the National Health Service (NHS). Items of NHS expenditure eligible for PFI; Terms of the PFI capital costs agreements; Advantages to the NHS of transferring the risks of capital costs to the private sector.

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.

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.

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.

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.