Suchergebnisse

Why is there so much discontent about the current plans to reform the National Health Service in England? What is the government trying to do, and are the critics right to want to block reform? This paper traces the genesis of the current proposals in the Health and Social Care Bill, currently in the Lords, and why the Government has had to water down significant parts of it to appease the critics. The paper argues that the case for change has not been made to public or the 1.3 million staff in the NHS, the extent and timing of the reform is far from ideal given the need to make unprecedented efficiencies in the NHS, and that the political process to gain support has been weak. Yet many elements of the Bill push the NHS in the right direction, and without effective reform the original settlement—to provide equal access to care on the basis of need—is put at risk.

Under the recent Conservative and current Labour Governments it appears that the NHS is moving in two different directions at once. Some commentators claimed that the national character of the health service was undermined while others argued that the NHS was effectively nationalised. One reason for these apparently contradictory positions is that there are no clear criteria of what a National Health service is. This article presents three main characteristics of a national health system, with illustrations from the NHS. Recent events seem to confirm that the NHS has never been clearly a national or a local service, and existing trends seem to lead to the worst of all worlds: the disadvantages of central control, and local differentiation without any genuine local autonomy. As the NHS is arguably the most national service in the British welfare state, it is possible that the heyday of the national welfare state may be over.

The NHS in 1991 launched an equality programme for women, setting
eight goals to be achieved by 1994. Shows that at least some of the
goals are not being met and suggests reasons falling into four
categories. First is the NHS context, including trusts′ autonomy which
is incompatible with a national equality plan. Second, there is a
failure of implementation, Third, the programme is inherently flawed:
Its business rationale is less than convincing to many health
professionals who attach a high value to ethics, Fourth, the reasons for
failure relate to all equality programmes for women, including a value
system which sees the male career pattern as the norm. Concludes that
movement towards equality for women in the NHS is only likely to be made
if a different approach to goal setting is adopted.

WITH THE EXCEPTION OF SOME NOTABLE DISSENTING VOICES, IT IS NOW GENERALLY RECOGNIZED THAT THE RATIO OF CONSULTANTS AND GP PRINCIPALS TO JUNIOR DOCTORS SHOULD BE RADICALLY INCREASED. NOW THE DEBATE IS MORE ABOUT HOW THIS MAY BE ACHIEVED AND WHAT ARE THE IMPLICATIONS FOR THE ORGANIZATION AND MANAGEMENT OF MEDICAL WORK, ESPECIALLY IN HOSPITALS. WHAT IS, PERHAPS, STILL NOT SUFFICIENTLY RECOGNIZED IS THAT THE PRESENT CAREER STRUCTURE WAS ONLY ABLE TO CONTINUE BECAUSE SUCH A HIGH PROPORTION OF JUNIOR DOCTORS WERE FROM OVERSEAS.