National Health Service Provision Research Articles

Health status and clinical diagnoses of 3000 UK Gulf War veterans.

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged "well", of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21-63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.

Health status and clinical diagnoses of 3000 UK Gulf War veterans

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged "well", of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21-63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.

National Health Service provision for the management of infertility: The case for funding and reorganization of fertility services in the UK

National Health Service provision for the management of infertility: The case for funding and reorganization of fertility services in the UK

Market share in a post-entry game

This paper investigates the dynamics of market share within a contemporary, real life, entry deterrence situation in the provision of National Health Service (NHS) pathology services. The major conclusion is that the previous Government's initiatives did not succeed in promoting competition in markets where existing NHS providers were operating significantly more efficiently than their neighbours. Evidence suggests managers were influenced more by potential competition from a new private sector entrant than by actual competition among existing providers. The effect of a new entrant is modelled as a perturbation of a pre-existing stable equilibrium in a seeming oligopoly influenced by market forces subject to Government regulation. Economic analysis of the market share which a new entry might gain shows that, on the assumptions made and contrary to expectations, the likely impact of Government regulation of NHS prices would be an increase in price per test in most of the market. Nevertheless the policy objective of improving quality at value for money prices was achieved for the near-monopoly provider within our case study area.

From Consumerism to Partnership? Britain's National Health Service at the Turn of the Century

It has been argued that "consumerism" has been one of the main influences on health policy in many countries over the last decade or so. This article focuses on the role of consumerism in U.K. health policy during this period through the introduction of changes in National Health Service provision such as introduction of the quasi-market, creation of the new managerialism, and new organizational structures set up under the recent Labour government. It considers the consequences of these changes for the users of health care and for citizenship rights, in particular the extent to which the changes have empowered these users and citizens.

The Changing Nature of Rationing in the UK National Health Service

This paper presents findings from empirical research exploring recent developments in healthcare rationing in the UK, and how far these were influenced by the National Health Service (NHS) internal market. Results suggest explicit rationing has continued to spread, but the focus has shifted from exclusions of whole treatments from NHS provision towards a reconciliation of implicit and explicit approaches. There is growing interest in explicit criteria to guide decision making, within which clinicians exercise discretion in indi‐vidual cases. The market contributed to the growth in explicit rationing, notably by decoupling healthcare purchasers (health authorities and GP fundholders) and providers (hospital and community health services) from their previously shared responsibility to manage resources. However, other factors have been influential, especially concern to control rising expenditure. Having originally prompted more explicit decisions (especially exclusions), resource pressures are now rekindling interest in fixed provider budgets and implicit clinical decision making. The paper concludes by considering the implications for rationing of proposals to abolish the NHS internal market.

Funding changes in NHS research and development

Research and development (R&D) within the National Health Service (NHS) has undergone rapid change over the past 5 years. In response to the Culyer report, an R&D levy has been demarcated from health care funding and mechanisms set up for its allocation. Access to the R&D levy now extends more widely within the NHS with the objective of encouraging broader participation in research. New arrangements have also been made for the ‘hosting’ of externally-funded research within NHS providers. Researchers and other interested readers are directed to sources of detailed guidance on these changes.

The development of medical consumerism in South Africa

Private medical practice is increasingly perceived as an entrepreneurial activity by private patients. Accordingly, enlightened and assertive medical consumers can be expected to demand satisfaction in exchange for their health‐care purchases. Vociferous patients, reacting to dissatisfaction and inequities, may launch an association as a countervailing force to the powerful doctors’ associations. Structural imbalances and the sophisticated yet critical nature of medical care have hitherto precluded the existence of medical consumerism. However, in an environment of individual and community sovereignty, such a force is imminent where adversarial doctor‐patient relationships develop, or where patients’ rights are infringed. Once this force has been established, its influence will spread to public health care, especially when patients believe their basic rights are being infringed. This article, therefore, enlightens practitioners and National Health Service providers on the possible areas of conflict.

Mentally Abnormal Killers in the UK Health Care System: Issues Facing the Multidisciplinary Team

In the UK, mentally ill offenders can be assessed and given treatment and rehabilitation in a secure health care setting rather than in a correctional facility. Beds in such health care facilities are limited and evidence suggests that only the most serious offenders, such as those who have committed a homicide, are given priority. This paper examines the role of the Regional Secure Unit, a National Health Service provision, in the assessment and treatment of these offenders. A number of issues facing the multidisciplinary team are raised. A case study is presented to illustrate some of these points.

Health care for the homeless in a national health program.

To assess the impact of adoption of a national health program on homeless care in the United States, care for this group in Britain's National Health Service (NHS) was evaluated. Although hospital and medication charges are eliminated, primary care for the homeless lacks central government directive, suffers from overlap of statutory agencies and mechanistic biases, is disproportionately delivered in emergency rooms, and has relied on advocacy by the non-profit sector. Disadvantages of this void in NHS provision are marginalization of the homeless and continuation of a two-class care system. Removal of financial barriers to care by enactment of a national health program in the US would not solve all issues related to delivery of quality care for the homeless unless its structure addressed the special needs of disenfranchised groups.

How stroke patients spend their days. An observational study of the treatment regime offered to patients in hospital with movement disorders following stroke.

A number of studies have suggested that early intensive rehabilitation will promote recovery after stroke. If this is so then how far does current National Health Service provision succeed in delivering this? This observational study looks at how 15 stroke patients in a general hospital spent their days. Only 12.9% of the working day, or 62 minutes, were spent in therapy. Patients spent most of their working day, 38.6%, in 'recreation', and most of this time was spent on the ward. For much of this time they could have been available for therapy sessions or involved in self-directed exercise. The impact of a new regime aimed at increasing intensity of therapy for the hemiplegic arm is examined.