British Health Policy Research Articles

A Brief account of british health policies in assam under colonial government

Public health has become another important area of research in recent years and many studies have been done on endemic diseases like cholera, smallpox, kala-azar, plague etc in the British India. Response to the epidemic diseases both within the colonial administration and in different sections of the indigenous population–have also attracted the social historians. Historians have treated epidemics as an important event of the mid of the 19th century because it had created major transformation in the society. At first colonial government adopted some policies mainly to serve the needs of the colonizers and soldiers and were extended to urban areas to safeguard the Europeans in mines, plantations, factories and administrative centers. Later they realized that if their surrounding area remained diseased and unclean, it was difficult to protect them. So they adopted some health policies in India as well as in Assam. This paper focuses on public health policies that were adopted by British. This paper also focuses on impact of these policies on society.

From "Honeymoon Period" to "Stable Marriage": The Rise of Management Consultants in British Health Policymaking.

Since the creation of the National Health Service in 1948, different groups of experts have competed to inform the development of British health policy. This article analyzes the long-term rise of one of these groups-management consultants. The scale and regularity of their engagement has increased considerably over time, strikingly in recent years, and the functions fulfilled by consultants have become ever more diverse. At important moments they were often seen by policymakers-particularly when there was understood to be a lack of internal expertise-as possessors and imparters of important knowledge. Firms and individuals worked consciously to integrate themselves into emerging health policy networks. But there has often been relatively little consideration of their real suitability for work in the health field. Many debates around the use of external consultants today-accountability, value for money, dependency-were foreshadowed during earlier periods, with implications for current policymakers.

Pandemic policy making: the health and wellbeing effects of the cessation of volunteering on older adults during the COVID-19 pandemic

Purpose This policy-orientated commentary aims to provide a perspective on the effects of policy changes designed to reduce the risk of infection as a result of COVID-19. The example of the abrupt cessation of volunteering activities is used to consider the policy and practice implications that need to be acknowledged in new public service research to deal with the on-going implications of the COVID-19 pandemic and for future preparedness. Design/methodology/approach The paper will provide a critical challenge to English pandemic health policy making, in particular, the national instruction “to stop non-essential contact with others” without a strategy on how to remedy the serious side effects of this instruction, in particular on older adults. Findings The abrupt cessation of volunteering activities of and for older people because of the COVID-19 pandemic is highly likely to have negative health and wellbeing effects on older adults with long-term and far-reaching policy implications. Originality/value The paper combines existing knowledge volunteering of and for older adults with early pandemic practice evidence to situate an emerging health and wellbeing crisis for older adults. It emphasises the importance of immediate further detailed research to provide evidence for policy and practice following the lifting of COVID-19 related restrictions and in preparation for future crises.

The Principle of Restraint: Public Reason and the Reform of Public Administration

Normative political theorists have been growing more and more aware of the many difficult questions raised by the discretionary power inevitably left to public administrators. This article aims to advance a novel normative principle, called ‘principle of restraint’, regulating reform of established administrative agencies. I argue that the ability of public administrators to exercise their power in accordance with the requirements of public reason is protected by an attitude of restraint on the part of potential reformers. Specifically, they should refrain from any reform of an administrative agency that involves a switch to a considerably more loosely interconnected system of values underlying the work of that agency. To illustrate the importance of the principle of restraint, I examine a case from British health policy, showing that a recent reform of the National Institute for Health and Care Excellence well exemplifies the serious problems brought by any violation of that principle.

How effective is the integration of sport and exercise medicine in the English National Health Service for sport related injury treatment and health management?

Regular participation in sport, exercise and physical activity (PA) is associated with positive health outcomes and form a mainstay of British public health policies. However, regular participation in sport and exercise can result in sport related injury (SRI) which, in turn, is a key cause of exercise cessation. The integration of Sport and Exercise Medicine (SEM) in the English National Health Service (NHS) aims to provide a specialist service for public populations and thus reduce the impact of SRI on exercise cessation and associated negative health outcomes. More broadly it aims to both support PA health promotion policies and improve healthcare organisations efficiencies through providing the most condition-appropriate treatment. This qualitative interview study examines patients' (N.=19) experiences of accessing and receiving SEM treatment within the English NHS. The research demonstrates that referral pathways into SEM were often prolonged, characterised by multiple general practitioner (GP) visits and referrals into other musculoskeletal services, demonstrating an inefficient use of healthcare resources. Prolonged pathways fostered only limited recovery back to previous PA levels and other negative health behaviours, yet on accessing the SEM clinic, patients experienced progressive rehabilitation back into sport and exercise participation. This study highlights the importance of more fully integrating SEM services into public healthcare as a way of improving the organisational capacity of healthcare in treating SRI and ensuring that citizens comply with state interventions which orchestrate health management through raising PA levels across the population.

New models of care: the policy discourse of integrated care

New models of care are being pursued throughout England to balance increasing demand for improved health and social care services against reducing public expenditure. A dominant discourse has emerged about the value of community-based integrated care, despite failures of integrated care programmes to consistently demonstrate reductions in hospital admissions. Discourse analysis of integrated care policy establishes how issues of aging, hospital admissions and fragmentation are problematised, and how solutions of integrated care are made possible by the argumentative structures of the policy. These findings are discussed in relation to historical and political accounts of English health policy to identify the discursive conditions that contribute to making this discourse possible. It is argued that the policy of integrated care works as a discourse to manage tensions associated with health and social care funding, rather than as an intervention that can achieve a reduction in hospital admissions.

General practitioners’ views of clinically led commissioning: cross-sectional survey in England

ObjectivesInvolving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility...

Women's mental health during pregnancy: A participatory qualitative study.

British public health and academic policy and guidance promotes service user involvement in health care and research, however collaborative research remains underrepresented in literature relating to pregnant women's mental health. The aim of this participatory research was to explore mothers' and professionals' perspectives on the factors that influence pregnant women's mental health. This qualitative research was undertaken in England with the involvement of three community members who had firsthand experience of mental health problems during pregnancy. All members of the team were involved in study design, recruitment, data generation and different stages of thematic analysis. Data were transcribed for individual and group discussions with 17 women who self-identified as experiencing mental health problems during pregnancy and 15 professionals who work with this group. Means of establishing trustworthiness included triangulation, researcher reflexivity, peer debriefing and comprehensive data analysis. Significant areas of commonality were identified between mothers' and professionals' perspectives on factors that undermine women's mental health during pregnancy and what is needed to support women's mental health. Analysis of data is provided with particular reference to contexts of relational, systemic and ecological conditions in women's lives. Women's mental health is predominantly undermined or supported by relational, experiential and material factors. The local context of socio-economic deprivation is a significant influence on women's mental health and service requirements.

Healthcare professionals’ assertions and women’s responses during labour: A conversation analytic study of data from One born every minute

ObjectiveCommunication during labour is consequential for women’s experience yet analyses of situated labour-ward interaction are rare. This study demonstrates the value of explicating the interactional practices used to initiate ‘decisions’ during labour. MethodsInteractions between 26 labouring women, their birth partners and HCPs were transcribed from the British television programme, One Born Every Minute. Conversation analysis was used to examine how decisions were initiated and accomplished in interaction. FindingsHCPs initiate decision-making using interactional practices that vary the ‘optionality’ afforded labouring women in the responsive turn. Our focus here is on the minimisation of optionality through ‘assertions’. An ‘assertive’ turn-design (e.g. ‘we need to…’) conveys strong expectation of agreement. HCPs assert decisions in contexts of risk but also in contexts of routine activities. Labouring women tend to acquiesce to assertions. ConclusionThe expectation of agreement set up by an assertive initiating turn can reduce women’s opportunities to participate in shared decision-making (SDM). Practice implicationsWhen decisions are asserted by HCPs there is a possible dissonance between the tenets of SDM in British health policy and what occurs in situ. This highlights an educational need for HCPs in how best to afford labouring women more optionality, particularly in low-risk contexts.

Influence of Social Deprivation on Outcome of Open Arterial Surgery in Tertiary Care: An Observational Study

ABSTRACTBackground and Objective: Health equity is playing an increasing role in British government health policy. Evidence of social deprivation affecting outcomes in surgery is poor. This study aimed to assess the influence of social deprivation on the outcome of major arterial surgery. Materials and Methods: A retrospective cohort study was undertaken in patients undergoing elective or emergency open surgery for abdominal aortic aneurysms or lower limb arterial reconstruction over an eight and a half year period within one institution. Patient deprivation was calculated for each patient with the Index of Multiple Deprivation (IMD) score. This was then entered into multivariate models to determine its effect on mortality and postoperative length of stay after adjustment for confounders. Results: Five hundred and six patients were included in the study. There were 45 deaths (8.9%) and median (IQR) postoperative length of stay was 8 (4–15) days. The median (IQR) IMD score was 46.4 (28.3–64.5). IMD score correlated with ASA grade and was significantly higher in smokers, patients with respiratory disease and those with left ventricular failure. IMD (OR = 1.01; 95% CI = 0.99-1.03; p = .45) did not affected mortality, which was associated with aortic surgery, emergency surgery, and high ASA grade. Postoperative length of stay, which was longer with/after aortic surgery, tissue loss, emergency surgery, high ASA grade, low haemoglobin, and age over 80 years was also independent of deprivation (Spearman's rho = −0.49, p = .28). Discussion: No effect of social deprivation on mortality or length of stay in patients undergoing major arterial surgery was identified.

Explaining dynamics without change: a critical subsector approach to financial policy making

This article uses a case study of financial sector policy making in East Asia in the post 2000 period to examine and help to resolve questions surrounding the origins of the phenomenon of ‘dynamics without change’ in public policy making; that is, the appearance of policy activity and alteration without affecting the overall nature and orientation of policy outputs or outcomes. This is a phenomenon which has challenged existing notions of policy dynamics which associate enhanced policy activity with fundamental changes in outputs and outcomes and is an issue which has concerned policy studies since Robert Alford’s seminal study of British health policy dynamics first noted the phenomenon in the mid-1970s. The article develops and extends the ideas put forward by Rayner et al. (2001, Privileging the sub-sector: critical sub-sectors and sectoral relationships in forest policy-making, Forest Policy and Economics, 2 (3–4), 319–332) that ‘critical subsectors’ or subsets of actors within a subsystem which control whether or not fundamental change occurs. Evidence from recent developments in the Asian financial sector is put forward supporting the argument that the uneven structuration and non-reciprocal nature of the relationships existing between components of a policy subsystem explain that policy’s propensity for change and stability. The discussion moves the general analysis of policy change, policy subsystems and their role in policy change forward from the existing orthodoxy of ‘dynamics with change’ and provides the foundation for a new research programme analysing intra-sectoral policy dynamics in an empirically robust manner.

Commentary: our children deserve better

Purpose – The purpose of this paper is to comment on “Early intervention for children with learning disabilities: making use of what we know.” Design/methodology/approach – Narrative review and discussion. Findings – The arguments presented by Nick Gore, Richard Hastings and Serena Brady are fully consistent with the broader scientific literature on prevention and the required future direction of English health policy. Originality value – This commentary places the arguments made by Gore et al. in a broader scientific and policy context.

The primacy of politics: the rise and fall of evidence-based public health policy?

This editorial reflects on the apparent rise and the potential fall of the use of evidence in English public health policy. Over the last 20 years, there has been increasing reference to evidence within policy circles both nationally and locally. However, in 2013, a series of national decisions about plain packaging, alcohol pricing and the NHS Health Checks scheme, as well as the move of public health into local authorities, have acted as reminders of the long-standing cultural differences between researchers and policy-makers and the primacy of political priorities. This editorial reflects on these issues and concludes by discussing the future prospects of evidence-based public health policy and the normative relationship between evidence and politics in a democratic system.... Language: en

Creating enterprise efficiencies in the NHS

This review of the literature examines how political ideologies have converged around English health policy and why command and control management techniques using performance indicators and targets are used to achieve policy and judge its efficacy. Performance indicators and their role in an enterprise culture, which health policy has introduced to replicate the efficiency successes from the private sector, is evaluated in this article. The article concludes that although performance indicators are valuable for efficiency improvement, the way they are implemented and managed in the English NHS does not assure the successes seen in the private sector but can lead to damaging defensive management actions.

Layard Mark II and the re-medicalisation of mental health policy

While the first Layard Report about improving access to psychological therapies is well known to British clinical psychologists, many may not be aware of a second one issued from the London School of Economics and dominated by academic psychiatrists from the Institute of Psychiatry. This article explores the change in character of Lord Layard’s group and the aspirations issuing from it about a cradle to grave British mental health policy.

Recent Evidence on the Changing Mix of Providers of Healthcare in England

English health policy has promoted the diversity of providers of health care to NHS patients in recent years. Little research has been done to map the extent of actual and possible supply. Using data from four local health economies England the authors found that there was a low supply of such organisations, but that it is growing. Despite the greater emphasis placed by policy makers and researchers on non-profits, there were substantially more for-profits. This suggests they should be subject to further scrutiny, as the pressure to increase diversity of supply increases under the Coalition government.

How much should be paid for specialised treatment?

English health policy has moved towards establishing specialist multi-disciplinary teams to care for patients suffering rare or particularly complex conditions. But the healthcare resource groups (HRGs), which form the basis of the prospective payment system for hospitals, do not explicitly account for specialist treatment. There is a risk, then, that hospitals in which specialist teams are based might be financially disadvantaged if patients requiring specialised care are more expensive to treat than others allocated to the same HRG. To assess this we estimate the additional costs associated with receipt of specialised care. We analyse costs for 12,154,599 patients treated in 163 English hospitals in fiscal year 2008/09 according to the type of specialised care received, if any. We account for the distributional features of patient cost data, and estimate ordinary least squares and generalised linear regression models with random effects to isolate what influence the hospital itself has on costs. We find that, for nineteen types of specialised care, patients do not have higher costs than others allocated to the same HRG. However, costs are higher if a patient has cancer, spinal, neurosciences, cystic fibrosis, children's, rheumatology, colorectal or orthopaedic specialised services. Hospitals might be paid a surcharge for providing these forms of specialised care. We also find substantial variation in the average cost of treatment across the hospital sector, due neither to the provision of specialised care nor to other characteristics of each hospital's patients.

Making the cut

‘Deliberate self-harm’, ‘self-mutilation’ and ‘self-injury’ are just some of the terms used to describe one of the most prominent issues in British mental health policy in recent years. This article demonstrates that contemporary literature on ‘self-harm’ produces this phenomenon (to varying extents) around two key characteristics. First, this behaviour is predominantly performed by those identified as female. Second, this behaviour primarily involves cutting the skin. These constitutive characteristics are traced back to a corpus of literature produced in the 1960s and 1970s in North American psychiatric inpatient institutions; analysis shows how pre-1960 works were substantially different. Finally, these gendered and behavioural assertions are shown to be the result of historically specific processes of exclusion and emphasis.

Beyond the Berlin Wall?: Investigating joint commissioning and its various meanings using a Q methodology approach

Joint commissioning has been extensively alluded to in English health and social care policy as a way of improving services and outcomes. Yet there is a lack of specificity pertaining to what joint commissioning actually is and what success would look like. In this paper we adopt a Q methodology approach to understand the different meanings of joint commissioning that those involved in these arrangements hold. In doing so we get beyond the more orthodox interpretations of joint commissioning found in the literature although the appeal of joint commissioning as a ‘good thing’ is still prominent across these accounts.

“…Keep mobile, I think that’s half the battle.” A qualitative study of prevention of knee pain in symptomless older adults

BackgroundThe emphasis on prevention in English health policy continues to centre predominantly on major diseases such as coronary heart disease and diabetes. A number of key documents detailing self-management techniques and prevention of osteoarthritis (OA) are currently available, including the NICE guidelines and the Arthritis Foundation’s National Public Health Agenda for Osteoarthritis. However, few investigations have explored preventative knowledge of knee OA amongst the population. In particular, asymptomatic members of the population may use further information in considering how to prevent knee pain. This study considers perceptions around the prevention of knee pain amongst an asymptomatic population; this target population may provide alternative insights by which to stimulate preventative behaviours.MethodsA sample of thirteen patients with no current knee pain was selected from responders to a population survey. Each interview was tape recorded and fully transcribed. Qualitative computer software package NVivo8 was used to manage the data. Thematic analysis was conducted using the constant comparative method.ResultsThe definition and causes of knee pain were interpreted in a multitude of ways. The importance of prevention was recognised by a sub-set, while a small proportion of participants negated the role of prevention. A range of social factors, including early adoption of actions, influenced the implementation and continuation of preventative behaviours. Individual responsibility for prevention was a key theme, although the role of society was also considered. Exercise was cited as a principal preventative strategy, although some participants viewed exercise as a destructive activity. A number of participants deemed pharmacotherapy to be harmful and at odds with normal physiology, instead preferring to adopt preventative behaviour over medication usage.ConclusionsThis asymptomatic population exhibit considerable breadth and variation in knowledge of preventative strategies for knee pain. Similarities in perceptions of prevention exist when comparing to the symptomatic population. These range from emphasis on individual responsibility, through to observations on the role of exercise and pharmacotherapy in knee pain. In general individuals are agreeable to act upon recommended treatments in line with NICE guidance. This receptiveness demands a greater consideration of preventative strategies in consultations, as well as wider availability and promotion of preventative strategies in order to improve the musculoskeletal health of the general population.