English National Health Service (english + national_health_service)

Distribution by Scientific Domains


Selected Abstracts


Explaining trends in concentration of healthcare commissioning in the English NHS

HEALTH ECONOMICS, Issue 8 2008
Mark Dusheiko
Abstract In recent years there have been marked changes in organisational structures and budgetary arrangements in the English National Health Service, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and hospitals. We show that elective admissions from PCOs and practices became significantly more concentrated across hospitals between 1997/98 and 2002/03. There was a reduction in the average number of hospitals used by PCOs (16.7,14.2), an increase in the average share of admissions accounted for by the main hospital (49,69%), and an increase in the average Herfindahl index (0.35,0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations as 100 health authorities were replaced by 303 primary care trusts. Most of the remainder was probably due to hospital mergers. Fundholding general practices that held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their PCO. Around 1/10th of the increase in concentration at practice level was due to the abolition of fundholding in April 1999. Our results have implications for the effects of the recent reintroduction of fundholding and the halving of the number of PCOs. Copyright © 2007 John Wiley & Sons, Ltd. [source]


Using Soft Systems Methodology for Performance Improvement and Organisational Change in the English National Health Service

JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 4 2004
Brian Jacobs
The Soft Systems Methodology (SSM) advocated by Checkland and Scholes (1990) has considerable potential. It can provide policy makers, professionals, and managers in complex health organisations with a valuable addition to management approaches leading to practical improvements through innovative organisational change. With reference to the English National Health Service (NHS), this author argues that SSM can enable managers and others to address problem situations holistically, identify critical issues, and reach an accommodation of different viewpoints as a basis for improvement. The SSM approach can usefully compliment strategic frameworks, such as the Balanced Scorecard, in achieving clarity of thinking about performance and change issues'. [source]


Exploring new advanced practice roles in community nursing: a critique

NURSING INQUIRY, Issue 1 2008
Kay Aranda
Attempts to ,modernize' the English National Health Service (NHS) have included significant workforce re-design, including the development of new, advanced roles in nursing. There is a wealth of evidence documenting and evaluating such roles in hospital and, to a lesser extent, in community settings. This paper builds on this work, drawing on recent post structural and sociological analyzes to theorize these roles, locating them within broader social and cultural changes taking place in healthcare and exploring how understandings of new roles in community nursing are in the process of being constructed. Building on a literature review, the paper draws out what an analysis of new advanced nursing roles in the community reveals about competing conceptualizations of the nursing mandate, the ambivalence and ambiguity that practitioners experience in shaping ,new' identities (the shaping of subjectivities), and the often implicit ideological positions that underpin such developments. [source]


The regulatory state and the UK Labour Government's re-regulation of provision in the English National Health Service

REGULATION & GOVERNANCE, Issue 4 2009
John S. F. Wright
Abstract Following its election in 1997, the UK Labour Government embarked upon a 10 year program of reform of the National Health Service (NHS). By 2005, Labour had doubled the NHS budget and dramatically transformed the shape of the Service. In England, a basic characteristic of the NHS is the organizational split between provider and commissioning agencies. In this article I argue that Labour's re-regulation of NHS provision is a coherent representation of the influence of the "regulatory state" in restructuring arrangements between government, market, and society. The article offers an account of the regulatory state based on a discussion of five key theses: The Audit Society, Regulation Inside Government, The New Regulatory State, The British Regulatory State, and Regulatory Capitalism. The article unfolds Labour's program of reform across themes common to these accounts: the division of labor between state and society, the division of labor within the state, the formalization of previously informal controls, and the development of meta-regulatory techniques of enforced self-regulation. It concludes that the key themes of the regulatory state are at work in Labour's transformation of NHS provision and it offers a discussion of the implications for both scholars of regulation and the UK and European health policy literature. [source]