Search

In Scotland, in 2002, the National Waiting Times Unit was launched to reduce NHS waiting times. This was accompanied by a series of waiting time targets across the NHS in Scotland. The purpose of this study is to analyse changes in equality of access to treatment by socioeconomic deprivation associated with this initiative. Trends in annual cataract rates were calculated using secondary care admissions' Scottish Morbidity Record (SMR01) data on NHS funded elective cataract procedures for patients treated in Scotland from 01 April 1997 to 31 March 2019. An interrupted time series model was used to analyse socioeconomic differences in waiting times by deprivation quintile over three time periods; pre and post waiting time initiative, and post austerity. Cataract Surgical Rates more than doubled from 3,723 per million population in 1997/1998 to 7,896 per million population in 2018/2019. Mean waiting time fell from 129.5 days in 1997/1998 to 87.7 days in 2018/2019. Inequality in mean waiting time between most and least deprived cataract patients increased by 1.34 days per quarter between 01 April 1997 and 30 June 2002 and following the waiting time initiative fell by 0.41 days per quarter through to 31 March 2010; and then decreased by 0.002 days per quarter between 01 April 2010 and 31 March 2019. The waiting time initiative had a major impact on reducing inequality in waiting times between socioeconomic groups. The onset of austerity in 2010 was associated with a very small and insignificant increase in inequality. [ABSTRACT FROM AUTHOR]

Background: Essential medicines (EMs) are those that satisfy the basic healthcare needs of the population. However, access to EMs remains a global health challenge. The World Health Organization (WHO) and the East African Community (EAC) manufacturing plan 2017–2027 support local production of EMs as a strategy to improve access to medicines. The aim of this study was to determine for each therapeutic class on the national essential medicine lists (NEMLs) of Kenya, Tanzania and Uganda, the number of EMs produced in each country. Methods: In 2018, we analysed NEMLs and national drug registers (NDRs) in each country to identify local manufacturers and local products by EM status. For each local manufacturer we determined the number of EM products and individual EMs, and analysed EMs in each therapeutic class by registration status and whether produced locally. Results: There were nine companies manufacturing locally in Kenya, four in Tanzania and six in Uganda. Most local medicine products were non-EM products. Of the 946 locally produced products in Kenya, 310 were EM products; of the 97 locally produced products in Tanzania, 39 were EM products; and of the 181 locally produced products in Uganda, 100 were EM products. Many local EM products were duplicate. Only a small proportion of EMs on each NEML were produced locally: 21% (92/430) in Kenya, 5% (24/510) in Tanzania, and 10% (55/526) in Uganda. Kenya, Tanzania and Uganda had no local EM products in 13/32, 17/28 and 15/32 therapeutic classes, respectively. The proportion of EMs that were registered varied across the countries from 327 (76%) in Kenya, 269 (53%) in Tanzania, and 319 (60%) in Uganda. Conclusions: This study highlights the importance of auditing NDRs and NEMLs for local production to inform regional and national local manufacturing strategies. EMs should be prioritized for local production and drug registration to ensure that production is aligned with local health needs. [ABSTRACT FROM AUTHOR]

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]

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.

Trade ministries from the World Trade Organization's (WTO's) 144 member states are presently deciding which public services to open to foreign competition under the complex liberalisation rules of the general agreement on trade in services (GATS). A frequent criticism of the WTO system is that it reduces national autonomy over public policy. However, respect for national sovereignty is asserted in the GATS treaty. Here, we examine claims made by the WTO and others that GATS exempts public services and does not require their privatisation. We discuss trade treaty processes that can subject public services to commercial rules, the treaty's flexibility with respect to national autonomy, and the effect of GATS in situations in which national autonomy is not protected. We conclude that national autonomy over health policy is not preserved under GATS, and that accordingly, there is a role for international standards that protect public services from the adverse effect of trade and market forces. [ABSTRACT FROM AUTHOR]

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.

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]

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]

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]

The World Trade Organisation (WTO) is drawing up regulatory proposals which could force governments to open up their public services to foreign investors and markets. As part of the General Agreement on Trade in Services (GATS) negotiations, the WTO working party on reform of domestic regulation is developing a regulatory reform agenda which could mark a new era of compulsion in international trade law. Article VI.4 of the GATS is being strengthened with the aim of requiring member states to show that they are employing least trade-restrictive policies. The legal tests under consideration would outlaw the use of non-market mechanisms such as cross-subsidisation, universal risk pooling, solidarity, and public accountability in the design, funding, and delivery of public services as being anti-competitive and restrictive to trade. The domestic policies of national governments will be subject to WTO rules, and if declared illegal, could lead to trade sanctions under the WTO disputes panel process. The USA and European Union, with the backing of their own multinational corporations, believe that these new powers will advantage their own economies. Health-care professionals and public-health activists must ensure that this secretive regulatory reform process is opened up for public debate. [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.

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.

High up on the agenda of the World Trade Organisation (WTO) is the privatisation of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services. Governments in Europe and the US link the expansion of trade in public services to economic success, and with the backing of powerful medico-pharmaceutical, insurance, and service corporations, the race is on to capture the share of gross domestic product that governments currently spend on public services. They will open domestic European services and domestic markets to global competition by government procurement agreements, dispute-settlement procedures, and the investment rules of global financial institutions. The UK has already set up the necessary mechanisms: the introduction of private-sector accounting rules to public services; the funding of public-sector investment via private-public partnerships or the private finance initiative; and the change to capitation funding streams, which allows the substitution of private for public funds and services. We explain the implications of these changes for European public-health-care systems and the threat they pose to universal coverage, solidarity through risk-pooling, equity, comprehensive care, and democratic accountability. [ABSTRACT FROM AUTHOR]

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.

Limitations of health care systems surveys and the advantages of collecting data directly from health care providers and payers. Comparison with the developments of health care in United Kingdom; Standardization of data collection; Requirements for the developments in managed care.

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.

Examines the impact of decentralization of long-term health care programs in the United States and Great Britain. How management responsibilities have shifted in both countries to state and local government; Increased privatization; Final goal of policy changes; Details about the provision of care in both countries; Government policies and their effects.

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 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.

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.

Background: In India, states have licensed the manufacture of large numbers of fixed-dose combination (FDC) drugs without the required prior approval of the central regulator. This paper describes two major regulatory initiatives to address the problem, which began in 2007 and 2013, and examines whether they have been sufficient to remove centrally unapproved systemic antibiotic FDCs from the market. Methods: Information was extracted from documents published by the central regulator and the ministry of health, including the National List of Essential Medicines (NLEM), and court judgments, and analysed alongside sales volume data for 2008–2020 using PharmaTrac market dataset. Results: The regulatory initiatives permitted 68 formulations to be given de facto approvals ('No Objection Certificates') outside the statutory regime, banned 46 FDCs and restricted one FDC. Market data show that FDCs as a proportion of total antibiotic sales increased from 32.9 in 2008 to 37.3% in 2020. The total number of antibiotic FDC formulations on the market fell from 574 (2008) to 395 (2020). Formulations with a record of prior central approval increased from 86 (2008) to 94 (2020) and their share of the antibiotic FDC sales increased from 32.0 to 55.3%. In 2020, an additional 23 formulations had been permitted de facto approval, accounting for 10.6% of the antibiotic FDC sales. Even in 2020, most marketed formulations (70.4%, 278/395) were unapproved or banned, and comprised a 15.9% share of the antibiotic FDC sales. The share of NLEM-listed antibiotic FDC sales increased from 21.2 (2008) to 26.7% (2020). Conclusion: The initiatives had limited impact. Regulatory enforcement has been slow and weak, with many unapproved, and even banned, FDCs remaining on the market. [ABSTRACT FROM AUTHOR]

The author reflects on the declined trust in the protection of confidential patient data in England due to recent breaches. He examines the Care Bill, the exceptions for uses of confidential patient data, and the 2012 Health and Social Care Act. He talks about the Health and Social Care Information Centre and the entitlement that allows sharing of patient data with private companies. Also included are three amendments recommended for the Care Bill.

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.