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PubMed2005

Homeopathy service in a National Health Service community menopause clinic: audit of clinical outcomes.

Sheffield's National Health Service community menopause clinic has run a homeopathy service since 1998. The service provides an alternative treatment option for those women who cannot take hormone replacement therapy, do not want it, have found it ineffective, or have been advised to stop it. Patients receive homeopathic treatment (monthly consultations plus individualized homeopathic medicines) for up to six sessions. An audit was undertaken of all patients referred to this service between 2001 and 2003, in which patients completed the Measure Yourself Medical Outcome Profile. Patients reported significant benefit from the service. The greatest response was seen in those reporting headaches, vasomotor symptoms, emotional/psychological symptoms and tiredness/fatigue as their primary symptoms.

Aged↗
PubMed1993

Visibility and the just allocation of health care: a study of age-rationing in the British National Health Service.

The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to 'universalize the best'. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalize care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the 'done thing' without explicit policy directives and in a manner largely invisible to patients, to Parliament, and to the public. The invisibility of the practice, however, violates the publicity principle that John Rawls and other philosophers believe essential to fairness. BNHS invisible age-rationing practices are thus a test case of the principle that fairness presupposes publicity; they raise the question: is it possible to preserve equitability in a system that uses non-public criteria to allocate scarce resources? To seek an answer, published data on access to end-stage renal disease (ESRD) treatment in Britain and the European Community (EC) are analysed. Among the findings are: that BNHS age-rationing acts as an excuse for denying care to those most likely to need ESRD treatment; and is, moreover, arbitrary and inequitable. It is further argued that no age-rationing policy can sustain visibility, and that, if the BNHS is to be fair to its patients, it must reform its present age-rationing practices, replacing them by a publicly visible, outcome-based rationing policy that rations either in terms of QALYs or triage categories.

Age Factors↗
PubMed1995

Epidemiology and the Italian national health service.

The Italian national health services is under criticism. Although recent legislative changes are intended to introduce managed competition, there is no clear epidemiological view of the health care needs and priorities. Several inconsistencies and inequalities (particularly between the northern and the southern regions) are obvious, both in the health status of the population and in the provision of health care. Problems that should be addressed by future governments are: the uneven distribution of medical technology; the persistence of large inequalities, documented by outcomes such as rheumatic fever, between northern and southern regions; the large variability in clinical practices; the lack of an explicit policy as far as the diffusion of advanced technology is concerned; the ensuing "hidden" rationing; and the peculiar relationship between public and private health structures. Both the current ideological shift towards a market economy for health care and the traditional lack of epidemiological input in health care planning could threaten a rational approach to these problems.

Breast Neoplasms↗
PubMed1979

The functions of the nurse in an integrated national health service.

The British National Health Service was reorganized in 1974 when the hospital services and the community health services, previously administered separately, were brought together into one organization: the Area Health Authority. The reorganization was a culmination of developments triggered off as long ago as 1589 when the first Poor Law Act was passed, but more particularly, the reorganization was the natural outcome of a number of important government and professional nursing reports published during the past 30 years. From 1974 the community and hospital nursing services have, therefore, been amalgamated under the direction of one head of the nursing services: a district (or area) nursing officer, who, together with medical, administrative and financial colleagues, manages the health services on a day-to-day basis in a team managing by consensus. The nurse's role in the management teams is both executive and professional: the nurse's unique contribution is that he/she brings a nursing perspective to management. The new nursing service organization has provided new opportunities for reorientating middle nurse managers to a clinical role. It has also provided opportunities for innovating integrated teams of community and hospital nurses and for developing specialist nursing roles. Nurses are also now able to make other additional contributions to health care by their involvement in health care planning team activities and by their membership of the statutory area and regional nursing and midwifery advisory committees. But, on the whole, changes and influence on health care have been brought about chiefly by changes in the managerial structure of British nursing, which is a perspective of the British nursing profession that seems to have been all pervasive since Florence Nightingale's reforms and which is perpetuated by the powerfully socializing agent of British nurse training. As health care and nursing service organizations should be means towards the end of good patient care, it may be timely to focus on the suggestion of autonomous nurse practitioners supported by a separately organized administrative structure.

Continuity of Patient Care↗
PubMedDate not supplied

[Role of specialized care services of the national health service in the new framework for the prevention of occupational risks (I)].

INTRODUCTION: The Spanish constitution and other legal provisions reflect the need to guarantee the health and security of workers at work. The Prevention of Industrial Risks Act incorporates this mandate and suggests a new model of prevention based on continued control of risk, participation of the workers and their education, and different modes of prevention management are set out. DEVELOPMENT: The objective of occupational medicine covers four areas: environment (evaluation of posts, teams, dangerous substances, etc.), health (vigilance of professional illness), emergencies and information and documentation (confidentiality). At present the task of the occupational doctor is hampered by (a) The polarization of prevention: the effort to reduce the high rate of accidents and permissiveness with regard to professional illness. (b) Complementary investigations: the lack of specialist reference services which supervise the health of the workers. (c) Minimal development in small and medium size businesses: The National Health System phagocytes industrial diseases, erroneously labelled as ordinary illness. CONCLUSIONS: (1) The medical training of all specialists should include a period dedicated to the study of occupational diseases and work as a source of health problems. (2) To improve the coordination between the occupational doctor and the Primary Care doctor, the creation of specialist reference services for occupational illnesses, by means of the National Health Service or the Mutual Aid Societies of occupational accidents and professional illnesses so as to refer suspected cases to them. (3) To emphasize the clinical history, evaluating the principle of Hipocrates. (4) To take into account sentry pathology in conditions of unknown origin. (5) To make a specific control of the health of all workers, particularly those who work with dangerous products or substances.

Forecasting↗
PubMedDate not supplied

Analysing the 'new' British National Health Service.

The British National Health Service (NHS) has seen a proliferation of confusing and sometimes conflicting labels in recent years. It has been claimed that during the Conservative Government's period of office the 'classic' NHS was 'restructured' and then turned into the 'new' NHS. The New Labour Government of 1997 has claimed that it will deliver a 'new' NHS. If all these claims are correct, it should be possible to identify four distinct periods, with three clear 'breaks of slope' with significant changes in important indices on moving from one label to another. This paper attempts to look behind these labels by critically examining what has changed in the NHS since 1979. In simple terms, what has been 'restructured'? What is new about the 'new' NHS? Why are these changes important? It is concluded that while the NHS has certainly undergone significant changes in the past 20 years or so, the appearance of a 'new' NHS may be premature as in many areas it is possible to see the marks of continuity as well as change, and policy impact is characterised by greater incrementalism than policy rhetoric.

Economic Competition↗
PubMed2001

Equal opportunities policies and nursing employment within the British National Health Service.

AIMS: The National Health Service (NHS) is the largest employer in Western Europe and the largest employer of minority ethnic workers in Britain. This paper is concerned primarily with an examination of the experiences of nurses from minority ethnic groups. BACKGROUND: Recent research evidence suggests that many minority ethnic nurses face racial harassment from patients and colleagues and that there are continuing problems in recruitment and promotion. The Macpherson Report on the enquiry into the murder of black teenager Stephen Lawrence has stimulated a wide ranging discussion of institutional racism throughout the public sector in the UK, including the NHS. DISCUSSION: This paper discusses the continuing failure of equal opportunities policies to have a sustained impact on the experiences of minority ethnic nurses and discusses a number of reasons for the lack of progress of such policies. It examines the reasons why health care organizations might adopt equal opportunities policies and the pragmatic reasons why implementation has been both slow and patchy. It goes on to consider the concepts of managing diversity and ethnic managerialism as new tools to theorize equal opportunities and considers some of the continuing problems inherent in current strategies.

Employment↗
PubMed2001

Workforce productivity and incentive structures in the UK National Health Service.

The UK National Health Service (NHS) is a labour-intensive service, yet the productivity of one of the largest labour forces in the world has been relatively ignored over the last 50 years. The data available to measure productivity over time are limited and focus on inputs and activity, not outcome. However, what data there are indicate that, despite major increases in NHS funding and staffing, changes in technology and continuous reorganisation of structures, productivity tends to show little or no change over successive decades. The challenges to policy-makers are how to improve the measurement of productivity and how to alter the behaviour of hospital clinicians and general practitioners by reform of incentive structures in the UK NHS.

Efficiency, Organizational↗
PubMedDate not supplied

Competition, cooperation, or control? Tales from the British National Health Service.

The British National Health Service (NHS) recently underwent a massive social experiment, inspired in large part by the ideas of U.S. experts. This involved the creation of an internal or quasi-market, separating purchaser from provider and encouraging competition among providers. After reviewing the evidence concerning the impact of this experiment, I conclude that the impact in fact was minimal, partly because of the retention of central government control and partly because the experiment was based on an inadequate understanding of professional and managerial motivations. The paper draws out general lessons of the experiment for other market-oriented health care systems and examines whether the lessons are reflected in the new batch of NHS reforms initiated by the recently elected Labour Government.

Cooperative Behavior↗
PubMedDate not supplied

In pursuit of an improving National Health Service.

The British National Health Service (NHS) before its 1990s internal-market reforms was a gridlock of perverse incentives. The internal market, an attempt to introduce some market incentives, stimulated much innovation in primary care commissioning and practice improvement and led to increased efficiency. However, its effects were quite limited, because the essential conditions for a market to operate were not fulfilled. There now exists a crisis of confidence in the quality of care in the NHS. It is doubtful whether a culture of innovation, efficiency, and good customer service is possible in a public-sector monopoly whose services are in excess demand and whose units do not get more resources for caring for more patients. It also is doubtful whether the NHS can modernize without consumer choice, competition, and more resources.

Health Care Sector↗
PubMed1987

Regional distribution of family practitioner services: implications for National Health Service equity and efficiency.

In this study the total expenditure on family practitioner services in England was analysed in terms of its distribution between National Health Service regions. Expenditure was then allocated on the basis of estimated regional needs, taking into account the demographic mix of the population and the differentials in health between regions. A comparison between the two regional distributions highlighted the inequalities and inefficiencies in the current system of financing and providing family practitioner services. A coordinated approach to the planning of the separate elements of NHS provision is required which recognizes the interface between primary and secondary health care.

Family Practice↗
PubMed2004

Meeting the challenge of cardiovascular care in the new National Health Service.

The National Service Framework (NSF) established coronary heart disease as a priority area for the government and for the National Health Service (NHS). In the three and a half years since its launch, good progress has been made and the NSF is already delivering real improvements for patients, demonstrated by a near 25% reduction in the death rate from circulatory diseases. Prescribing of cardiovascular drugs for secondary prevention has increased, acute myocardial infarction is being treated more promptly, and there is improved access to revascularisation procedures. However, there is still a notable class differential in cardiovascular deaths. There has been exponential growth in use of statins but the drugs are still not being used to optimum effect. Heart failure has now been identified as a priority for action.

Coronary Care Units↗
PubMed1995

Health care utilization in the British National Health Service.

Four national surveys of primary care services in England and Wales demonstrate that utilization rates have not continued to increase significantly since the initiation of the National Health Service in 1948, despite an initial surge in demands for medical services. The author examines morbidity surveys, consultation patterns, and referrals to secondary care and examines the ethical dilemma of basing services on costs.

Dental Staff, Hospital↗
PubMed1995

Good allergy practice--standards of care for providers and purchasers of allergy services within the National Health Service. Royal College of Physicians and Royal College of Pathologists.

Allergic diseases affect at least 15% of the population and are the cause of much ill-health. 'Clinical immunology and allergy', the term used by the Department of Health in England and Wales for this area of specialization, is recognized as a separate specialty of medicine under the National Health Service. Many organ-based hospital consultants (e.g. chest physicians) have allergy as a special interest or subspecialty. Allergists deal largely with 'itch, sneeze, cough and wheeze' and so are experts in: summer hay fever (seasonal, allergic, conjunctivorhinitis); perennial rhinitis (symptoms of a 'permanent cold'); allergic asthma (including occupational asthma); allergy to stinging insects (especially wasps and bees); allergy to drugs; allergy-related skin disorders, i.e. urticaria, angioedema, atopic eczema and contact dermatitis; food allergy and food intolerance; anaphylaxis (acute generalized allergic reaction); evaluating the role of allergy in non-specific/polysymptomatic illness. Children with allergic disease should be under the overall care of a paediatrician since the progression of allergies in children differs from that in adults. Good allergy practice involves teamwork by doctors, nurses and dietitians. The investigation of allergy patients includes skin tests and challenge procedures (e.g. food allergy tests) as well as various specialized laboratory investigations. Good clinical practice by providers and the effective use of allergy services by purchasers should improve prognosis and cut costs of treatment in allergic disease.

Adult↗
PubMed1996

Minority physicians serving in rural National Health Service Corps sites.

Providing National Health Service Corps (NHSC) scholarships to under-represented minorities has been an important federal mechanism to bolster the numbers of minority physicians. Little is known about how minorities fare during their NHSC commitment periods. In 1991, questionnaires were mailed to all primary care physicians placed in rural communities from 1987 through 1990 in the NHSC scholarship program, in a retrospective cohort study. One hundred and twenty-two of the 398 eligible NHSC physician respondents (31%) indicated they were minorities. National Health Service Corps physicians were found to be well matched by race to the sites where they served, and minority NHSC physicians worked in counties and practices with greater proportions of minority inhabitants and patients. Minorities among rural NHSC physicians were less likely to have been raised in rural areas and were less interested in rural practice during medical school and when placed in their rural NHSC sites. The relative urban preferences of minority physicians in large part explains why this group was more dissatisfied with their work and personal lives while serving their obligations. Minority physicians also reported lower satisfaction for their families. Minority and nonminority NHSC physicians reported comparable acceptance by their communities, and demonstrated similarly low retention rates. The NHSC plays a significant role in the careers of many young minority physicians and in promoting the temporary availability of minority physicians for rural health professional shortage areas. However, as of 1991, many minority NHSC physicians placed in rural areas would have preferred urban sites, which resulted in their lower satisfaction.

Adult↗