Report Proposal Research Articles

Priorities in Medical Research: elite dynamics in a pivotal episode for British health research.

Priorities in Medical Research (PMR) was published in 1988 by a select committee of the House of Lords. The report ushered in an era of NHS research and development (R & D) that lasted from 2001 to 2006. The inquiry's origins lay in concerns about academic medicine in the United Kingdom, yet PMR gave relatively little attention to this subject. Instead the report focused critically on the disconnect between the Department of Health and the NHS in R & D. This, the committee argued, had led to the neglect of research into health services and public health. To sidestep the report's unwelcome proposal for a National Health Research Agency, the department eventually grafted R & D management onto structures created as part of wider NHS reforms. The Medical Research Council successfully pursued a strategy of keeping the committee's attention away from sensitive aspects of its own programme. The final focus of PMR was shaped by an alignment between committee members with an industrial view of research and champions of health services research. The actions of the various actors involved are interpreted using elite models of the state, and the applicability of these models is critically examined.

Is there an alternative way to avoid another eurozone crisis to the Five Presidents' Report?

Abstract The EU Commission's Five Presidents' Report proposes new rules for the eurozone covering fiscal policy, banking and financial markets designed to avert another eurozone crisis. This paper examines the causes of the current eurozone crisis and discusses whether the Report's proposals are likely to succeed. It is argued that the main causes of the crisis were EMU and the failure of financial markets to price risk correctly. It is claimed that the Report may not solve these problems. Having already lost their monetary policy instrument, the Report's fiscal proposals would remove countries' fiscal policy instrument too and deprive countries of the means of economic stabilisation. The proposals would also transfer to an undemocratic and unaccountable Commission important national competences.

Call for action plan on FGM

The home affairs committee has published a report calling for a national action plan on female genital mutilation. Catrin Gosby, researcher at Coram Children's Legal Centre, examines the report's proposals

Looking for Intel? … or Looking for Answers? Reforming Military Intelligence for a Counterinsurgency Environment

We analyze the recent Flynn Report and assess its implications for the future of military intelligence in Afghanistan. In particular, we argue that the report seeks to expand the substantive tasks of the military intelligence practitioner, while collapsing non-trivial aspects of existing organizational hierarchies. We argue that implementation of the Flynn Report's proposals would match poorly with the traditional nature of military intelligence and the realities of human resources constraints in the military. Further, the resulting scale of unfiltered data such a system would produce might serve to overwhelm rather than assist decision-makers. Finally, we conclude that the problems expressed in the Flynn Report should not be traced to the military intelligence apparatus per se, but rather to the inability of US political leadership to map out a clear vision for current operations – both in Afghanistan, and in the counterinsurgency environment in general.

Convertible Securities and Bankruptcy Reforms: Addressing Too Big to Fail and Reducing the Fragility of the Financial System*

Eliminating too big to fail should be the first priority of any regulatory reform. But this is easier said than done. As the crisis has taught us, when the systemic risks are perceived to be large, regulators will be very reluctant to close down insolvent firms or impose losses on creditors. So how do we reduce these risks so that regulators can credibly commit to a policy of allowing financial companies to fail and not resort to rescues or bailouts?The author proposes two complementary approaches to this problem: The first is to design capital structures with corrective mechanisms that kick in when a financial firm displays signs of trouble, but still has positive economic capital. To this end, the author endorses the Squam Lake Report's proposal that encourages financial firms to issue convertible debt with an “automatic” provision for converting to equity. In contrast to the Squam Lake proposal, however, the author argues that the conversion to equity should not depend on regulators' decisions and should take place before individual banks and the financial system are in full crisis mode.The second approach is to design a resolution mechanism that will close failing financial firms when early intervention has not led to the firm's recovery. The author argues that the best model for this mechanism is bankruptcy, because of its resolution of claims according to predetermined rules rather than regulatory discretion. However, certain forms of early intervention can also help to lower the costs of permitting firms to fail. For example, the Squam Lake idea that financial institutions be required to develop living wills should make it easier to unwind these firms in an orderly fashion and provide regulators with insight into the degree of systemic risk that these firms impose. The author notes that the challenges associated with getting the executives of healthy banks to plan for their own bankruptcy may indicate that a better use of regulatory resources might be to view the living will as one of the tools of prompt corrective action for firms that become undercapitalized but are still solvent. Once a firm has been declared undercapitalized, regulators would have greater bargaining power to insist on a serious plan for bankruptcy.

The double danger of English as a global language

Why Australia still needs to learn Asian languages. Language learning in Australia has at times been a much debated and somewhat controversial topic. A new episode in this debate began recently with the publication of a report entitled Building an Asia-Literate Australia: An Australian Strategy for Asian Language Proficiency, which argues for a significant expansion and intensification of the learning of Asian languages and cultures at all levels of education. Much of the reaction to this report has focused on the role of English as the global language and its implications for language education. The main argument made against the report's proposals can be summarised as the ‘English is the global language’ view, a position which claims that because English is the global language, there is no need for Australia to implement a large-scale Asian languages and cultures education programme. This paper aims to refute this argument. Drawing on a range of theoretical and empirical work, it demonstrates that there is a double danger in the ‘English is the global language’ view as it both exaggerates the current number of speakers and extent of use of English in Asia, and misinterprets the likely outcomes of any further spread of English.

Thou Good and Faithful Servant

Lawmakers are stewards of social resources. A current debate--over newborns for genetic disorders--illuminates dilemmas of that stewardship that have particularly plagued bioethics. Recently in the Report, Mary Ann Baily and Thomas Murray told the story of little Ben Haygood. He died from MCADD, a genetic disorder that can make long fasting fatal. (1) Screening at birth would have let doctors alert Ben's parents. After Ben died, Baily and Murray wrote, father became a passionate advocate for expanding Mississippi's newborn program add MCADD and other disorders. Soon, the Ben Haygood Comprehensive Newborn Screening Act increased the number of genetic disorders covered by the state's program from five forty and provided teams follow up positive tests. Is this a prudent and productive way make public policy? Certainly it is understandable. Mr. Haywood knew that parents suffered and children died in ways newborn could prevent. He acted on his knowledge. The legislature knew that suffering and death could be prevented. It acted on its knowledge. Was it supposed let Tiny Tim die? Who could say yes? But was the legislature a good steward? In its first year, as Baily and Murray reported, Mississippi's expanded identified three cases of MCADD along with twelve cases of other new disorders, out of a total of 116 newborn diagnoses. But to help pay for the expansion, the state doubled the [screening] fee seventy dollars. This meant that a substantial share of the resources for expansion came from Mississippi's funds, since covers more than half of Mississippi births. Around this time, Mississippi's infant mortality rate had been increasing, Medicaid eligibility requirements were tightened, and some programs were cut. One county's infant mortality rate, however, fell sharply after a private charity began providing intensive in-home visits using local women as counselors and busing pregnant black women pre- and postnatal classes. If resources spent had instead been spent on such a program, would more lives have been saved and more suffering averted? When legislators are confronted with the tragedy and passion of a parent like Mr. Haygood, such questions are painful and seem pointless. But if they are not asked, several anonymous Tiny Tims may die save one whose story lawmakers hear. The American College of Medical Genetics proffers a somewhat more systematic way make policy. (2) Its expert panel identified 29 conditions for which should be mandated. An additional 25 conditions were identified because they are part of the differential diagnosis of a condition in the core panel or are clinically significant and revealed by the technology but lack an efficacious treatment ... or because there are incidental findings for which there is potential clinical significance. The ACMG report is a stride toward more orderly stewardship, and most states have implemented a version of the report's proposals. But like Mr. Haygood, the ACMG has purposes and passions that lead it see a world in which is indispensable. Its report does address the issue of cost and benefit, but in such a cautiously qualified way that it's hard embrace its conclusions. Furthermore, the report enthusiastically says that screening is more than testing. It is a coordinated and consisting of education, screening, follow-up, diagnosis, treatment and management, and program evaluation. How would a comprehensive system affect costs and benefits? Finally, the report does not ask whether there are yet more rewarding ends which resources could be put. In a recent white paper, the President's Council on Bioethics sees from yet another perspective. (3) It finds the cost question harder than the ACMG. Few infants actually benefit: Of four million babies screened annually, about 5,000 are identified as having serious heritable disorders, most of which are, in varying degrees, amenable treatment. …

Affirmative Action for Muslims in the Indian Jurisprudential, Social, Economic and Political Context: A Constitutional Conundrum?

India, due to its uniquely multicultural history, has for long cherished the ideal of Unity in Diversity, believing in the value of an egalitarian social order within a tolerant pluralistic framework. Recently, however, the controversial Sachar Committee Report has revealed the appallingly widespread social, economic and educational backwardness of the Muslim community in India: their minimal access to education, their abysmal representation in public services, and their consequent ghettoization and alienation from the national socio-economic mainstream. Affirmative Action, in various forms, including (but not limited to) Reservations, the Report suggests, is the means of addressing this socio-economic problem by enhancing diversity in the educational and public service landscape of the national mainstream.While proponents have argued that the same will reaffirm and invigorate the egalitarian and multicultural nature of the secular Indian polity, opponents have used the same secular paradigm of the Indian Constitution to challenge the Report's proposals, on the basis that the same would be violative of the Constitutional prohibition on discrimination on the basis of religion. With both sides using the rhetoric of the Constitutional ideal of secularism to pursue their own political ends, it becomes necessary to analyse the Report, and its proposals, not only in light of the Constitution, but also in light of the ideals on which it is based, in a non-partisan manner. In the above context, the proposed paper seeks to explore the nebulous precincts of the constitutionality of Affirmative Action for Muslims in India.

Improper Diagnosis, Reckless Treatment

IN THE June Kappan, Marc Tucker summarized the Tough Choices report. We (and others) critiqued it, and he responded. We charged Tucker with trying to stampede policy makers into adopting reckless school reform recommendations by asserting, without evidence, that an emerging international economy made our K-12 schools obsolete and by claiming that adoption of the report's proposals could prevent middle-class living standards from falling. International digital competition is real, but increasing the supply of college graduates will not make wages rise for a group whose earnings are already stagnant. Tough Choices insists that our future competitiveness requires 95% of all students to be college-ready at a new, higher academic standard, but it provides no justification for contradicting the Bureau of Labor Statistics (BLS) projection that fewer than one-third of future jobs will require college degrees at today's lower standard. BLS also expects not more than another quarter or so of new jobs to require some college training. (1) Tough Choices is the sequel to a report issued in 1990 by a predecessor group, which attributed the nation's low productivity growth in the 1970s and 1980s to inadequate American schools. But in the June Kappan we showed that this analysis proved to be spectacularly wrong. Since the mid-1990s, the productivity of American workers (educated in the 1970s and 1980s) has accelerated at historically unprecedented levels and indeed has been rising faster than in any other industrialized nation. This productivity renaissance relied upon the very work force whose skills were criticized in the earlier report. If American middle-class living standards are threatened, we argued, it cannot be because workers lack competitive skills. Rather, the richest Americans have commandeered the fruits of this productivity growth and denied fair shares to the workers, educated in American schools, who have created increased national wealth. (2) middle class, in short, is threatened not by lack of skills but by poor pay for skilled jobs. Social and economic policy reform, not school transformation, must be the remedy for this middle-class squeeze. As we said in June, we are not satisfied with our schools. We are concerned about the academic, cultural, civic, and moral preparedness of today's young people; we consider it urgent to reduce gaps in outcomes that fall along lines of race, ethnicity, and income. But school inadequacies are not generating economic crisis, and so school reforms motivated by false expectations of economic collapse are bound to be misguided. In any field, proper diagnosis is a precondition for effective treatment. In his June response, Tucker belittled our analysis, claiming that Mishel only wanted to deflect attention to economic policies advocated by his institute and that Rothstein only represented the views of educators who resented being blamed for national economic failures. We will not use our space here to respond in kind to this attack on our motives but urge him to stick to the issues in his rejoinder to this article. Tucker also denied our charge that his report sees skill development as virtually the only policy lever for shaping the economy. But here is how he himself summarized the report: The fact is that education holds the key to personal and national economic well-being, more now than at any time in our history (emphasis added). (3) We judge our summary of this theme to be fair. Tucker next claimed that the past decade's productivity surge does not reflect the skills of workers graduating from contemporary American schools; rather, he attributes it to returning World War II veterans educated by the GI Bill and to education advances during the 1950s and 1960s. There is a 50-year lag, he asserted, between educational improvement and productivity growth. While technological change certainly accumulates over many years, returning World War II veterans were in their prime working years back in the 1950s and 1960s. …

Turning right at the crossroads: The Nelson Report's proposals to transform Australia's universities

During 2002, the Australian Education Ministerconducted a year-long review of tertiaryeducation under the title Higher Educationat the Crossroads. The policy statementarising from that review was released on 13 May2003. It incorporates a combination of newfinancial incentives on students anduniversities, potential expansion of full-feeplaces, and increased intrusion into universitypriority setting. The policy statement promised a $A1.5bexpansion in funding over four years, with morefully-funded university places, and an emphasison improving the quality of teaching andlearning. The strategy is market-driven and could createa `fee-culture' in Australian universities. Implementation of the new policy is not assuredas it has to pass a hostile Senate. Theimplementation process also carries risks forgovernment and universities. This paperdescribes the government's proposals andanalyses their premises and effects.

Quel système de santé à l'horizon 2020 ? Présentation du rapport sur l'avenir du système de santé français

The development of frameworks for public services gave rise to an overall consideration of the development of health services across France over a twenty year period. Considerable attention is given to a prospective analysis of the issues to be faced by our health system over the next 20 years and of their territorial aspects. The summary presents a synthesis of the currently recognized factors and possible scenarios for: -the changing economic context and social safety net, -the evolution of needs, -dynamics of supply. The report's proposals to enable the French health system to adapt to these changes revolve around four main aspects: -the space of health services, -prevention and health promotion as an overriding priority, -organization of health services, -the system's capacity to adapt and evolve. Finally, the report examines the assessment of the implementation of the health services framework.

The Increasing Use of Non‐Executive Directors: Its Impact on UK Board Structure and Governance Arrangements

The last decade has seen a sharp increase in the number of non‐executive directors (NEDs) on the boards of UK listed firms. Using a sample period spanning the publication of the Cadbury Report (1992), this paper evaluates the implications of this increase. The main findings can be summarised as follows. First, the increased demand for NEDs has been more pronounced for firms classified as having proportionately too many executive board members in the pre‐Cadbury period. Secondly, the probability of compliance with the Cadbury Report's proposal for a minimum of three NEDs is positively related to the magnitude of the expected net benefits of adding further non‐executives to the board. Finally, there is little evidence that the increased use of NEDs caused firms to make costly adjustments to other elements of their control systems in an attempt to re‐equilibrate their governance portfolios. These findings are consistent with claims that the recent trend towards greater NED representation on UK boards may have helped to raise general governance standards.

Blue Ribbon Power: Independent Commissions and UN Reform

Blue Ribbon Power: Independent Commissions and UN Reform

Assessing Aid: A Manifesto for Aid in the 21st Century?

The World Bank report Assessing Aid argues that aid can have positive effects on growth and infant mortality, but only when good policies are being followed by the recipient. It follows, especially since aid is fungible, and so cannot be targeted to particular uses, that donors should focus their aid on low-income countries with good policies (i.e. apply greater selectivity). This paper explores a number of weaknesses in these arguments. The growth regressions are not robust, so that different results can be obtained with relatively minor variations in model specification. In particular, the argument that aid only works when policies are right is not supported in other studies - and even the World Bank's evidence can be interpreted as saying policies work better when supported by aid inflows. The choice of which policies are good policies is also problematic, and the analysis in the report ignores the likely presence of threshold effects and other non-linearities; others would, anyhow, propose a different set of right policies, especially if the focus is poverty reduction rather than growth. The importance of fungibility may be over-stated so that donors can in fact target poverty-reduction activities, suggesting that the selectivity rules proposed in Assessing Aid are misleading. Even if the report's proposals are to be accepted it is silent on a number of important issues-such as whether to use the level or change in the index-that face the aid manager in practice.

A Brief Rejoinder to Michael Zander

about it?) They equate more guilty pleas with more miscarriages of justice (p 90) a proposition for which there is no evidence.10 They say that the system's 'overall presumption of guilt' would be 'reinforced . . . by greater powers for the police to obtain evidence from suspects' (p 90), when the evidence in question is mainly physical or real evidence, such as samples for DNA analysis, which ought to be better evidence of guilt (or for that matter, non-guilt) than is usually available. They speak of 'new limitations on the Court of Appeal' (p 90), when the Report's proposals regarding the Court of Appeal are mainly in the direction of better protection of the defendant. They suggest that the Report's recommendations provide a useful 'law and order' agenda, when they could equally well have pointed to the longer (indeed, much longer) list of useful reforms to aid the defence. On each topic Bridges and McConville present only what serves their thesis and ignore everything to the contrary. In short, this is not so much a review worthy of a scholarly journal as a hatchetjob.

THE ICC REPORT

The Royal Institute of British Architects' Inner Cities Committee was formed in May 1986 at the invitation of His Royal Highness the Prince of Wales. It had the following terms of reference: ‘To promote a report recommending actions that can be taken to assist in alleviating the problems of our inner cities, with particular emphasis on the future form of the cities and on effective means of attracting private investment and the greater participation of people in their own environment.’ The Committee published its report in May 1987 and its appearance coincided with the first days of the general election campaign. All three major parties featured the inner cities as important elements of their manifestos, but none was in any way specific about the mechanisms by which regeneration could be achieved. The report's detailed proposals for a national approach to the organisation and funding of renewal, are in sharp contrast to the generalities of many of the political speech‐writers. This paper briefly summarises the report. Shortly after it was submitted for publication, the newly‐returned Conservative Government announced that its priorities for inner cities would include planning, housing, education, rates and improving derelict environments.

Labour's defence of NHS

Labour's decision to take the government to task over its plans for the future of the National Health Service as platform from which to show off the debating skills of its new leader, Mr Neil Kinnock, paid off. The Grenada affair led to the debate being delayed for day, but that proved no disadvantage and Mr Kinnock came up with exactly what was needed?a good, fighting speech that greatly enthused his backbenchers by staking out reasonable claim for Labour to be the defender of the NHS. He argued that the NHS could not be dismembered or dismantled by British prime ministers or foreign economists, because it was not theirs to get rid of. It belongs to the British people and they will strive to retain their proud possession, he said. He also accused the Prime Minister, who had decided not to take part, of treating the service with contempt. Her approach and that of the health rninisters to the NHS was a mixture of private profiteering and Victorian philanthropy, he said. The NHS was already the most efficient health service in the world, with adrninis trative costs only 6% of the budget, far less than in France, Italy, or the United States, while the government's claim of 17% increase in spending on it was only true in relation to the retail price index and did not take into account the rise in the price of medical supplies. Its policies amounted to an unmitigated crime against the people of this country. The point is it got his side cheering, which was the purpose of the exercise. The government's tactic for the week was to announce decisions to define Labour's attack. First came acceptance of the Griffiths report's proposals for new management structure (p 1391), and then in the debate itself decision at long last on the Acheson report.

From the CCHMS: Short Report's manpower proposals sharply criticised

From the CCHMS: Short Report's manpower proposals sharply criticised

A Strategy for World Economic Development: Comments on Graham Bird's paper, "Beyond the Brandt Report: A Strategy For World Economic Development" published in Millennium, Vol. 9, No. 1, (Spring 1981)

The Report of the Independent Commission of International Development Issues (The Brandt Report) published early in 1980, made a global analysis of North-South relations and suggested a range of policy proposals. In his article Graham Bird endeavoured to identify the economic reasoning that underlies the Report's proposals on finance and devised an international financial strategy to alleviate the world's economic problems. Published below are comments received on this strategy from H. W. Singer and A. Federman.

Some aspects of child health care: contacts between children, general practitioners and school doctors

Since the Report of the Committee on Child Health Services1 there has been discussion of the child health services from professionals but not from parents. In a survey carried out in 1977 parents were asked about their children's use of the health services and their views about this. The parents' general practitioners were also questioned about children's health care. The children's contact with the services is described, and the relationship between general practitioners and school doctors. A similar survey was carried out in 1964 and changes in children's use of the services over the intervening years are examined. In 1977 nearly all children (91 per cent) were registered with a ‘family doctor’ who also looked after the parent interviewed, and most parents were registered with a doctor who looked after all their children. The concept of a family doctor conflicts with the Court Report's proposal for a specialist paediatrician in primary care. However, nearly a third of parents would prefer a specialist. The idea was not popular with doctors, of whom 81 per cent said they preferred the present system. Three-quarters of the children had seen their general practitioner in 1977, and this proportion had not changed since 1964. The main change was a striking drop in home visits which had its most marked effect on children of pre-school age. Children aged under 5 had a lower consultation rate than in 1964. The overall consultation rate for other age groups had not changed. Similar proportions of children had seen a school doctor in 1977 as in 1964, but communication between the school doctor and general practitioner did not appear to have improved. Parents attended less than half the school medicals and were less likely than in 1964 to discuss with their general practitioner a problem about which the school doctor had offered them advice. The introduction of specialist care might jeopardize vital parts of the primary care system. However, to ensure that relevant information is directed to where it is needed, some integration of health services for children, or of their medical records, seems essential.