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English NHS (english + nh)

Distribution by Scientific Domains

Medical Sciences	50%

Selected Abstracts

THE SEARCH FOR A PROPORTIONATE CARE LAW BY FORMULA FUNDING IN THE ENGLISH NHS

FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 4 2009
Gwyn Bevan
Although the National Health Service was created to achieve equity of access to health care in 1948, over twenty years later an ,inverse care law' was seen to operate. The 1976,Report of the Resource Allocation Working Party,laid the principles of formula funding to achieve an equitable distribution of resources, to move, over time, towards the operation of a proportionate care law. These principles have been applied ever since in England. This paper describes the context, governance and subsequent development of formulas and three persistent problems: accounting for populations, their needs and variations in the unavoidable costs of providers. The paper concludes by outlining continuing problems from the past and new challenges of formula funding in England to reduce ,avoidable' inequalities in health. [source]

ALIGNING INCENTIVES AND MOTIVATIONS IN HEALTH CARE: THE CASE OF EARNED AUTONOMY

FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 4 2007
Russell Mannion
Delegating greater authority and decision making power to front line organisations, including devolution of control through the system of ,Earned Autonomy' is a key component of the UK Government's modernisation agenda for the public services. The principle of Earned Autonomy is that the highest performing organisations are subject to less central control and allowed increased operating freedoms. This paper explores the implementation of Earned Autonomy in the English NHS and addresses the question of whether the incentives implicit within Earned Autonomy are both sufficiently powered and aligned to the motivations of senior hospital managers to secure the desired improvements in organisational performance. [source]

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]

New labour and reform of the English NHS: user views and attitudes

HEALTH EXPECTATIONS, Issue 2 2010
Andrew Wallace PhD
Abstract Background, The British National Health Service has undergone significant restructuring in recent years. In England this has taken a distinctive direction where the New Labour Government has embraced and intensified the influence of market principles towards its vision of a ,modernized' NHS. This has entailed the introduction of competition and incentives for providers of NHS care and the expansion of choice for patients. Objectives, To explore how users of the NHS perceive and respond to the market reforms being implemented within the NHS. In addition, to examine the normative values held by NHS users in relation to welfare provision in the UK. Design and setting, Qualitative interviews using a quota sample of 48 recent NHS users in South East England recruited from three local health economies. Results, Some NHS users are exhibiting an ambivalent or anxious response to aspects of market reform such as patient choice, the use of targets and markets and the increasing presence of the private sector within the state healthcare sector. This has resulted in a sense that current reforms, are distracting or preventing NHS staff from delivering quality of care and fail to embody the relationships of care that are felt to sustain the NHS as a progressive public institution. Conclusion, The best way of delivering such values for patients is perceived to involve empowering frontline staffs who are deemed to embody the same values as service users, thus problematizing the current assumptions of reform frameworks that market-style incentives will necessarily gain public consent and support. [source]