Showing papers on "White paper published in 1989"

NHS resource allocation after the 1989 white paper: a critique of the research for the RAWP review.

Abstract: The Government White Paper on the NHS, 'Working for Patients', abolished the Resource Allocation Working Party (RAWP) formula in name, but retained its general approach of ensuring geographical equity through funding health authorities by a system of weighted capitation. As a result, the longstanding debate about the appropriate need indicators to include in RAWP, which was tackled afresh in the recent NHS Management Board review of RAWP, will remain highly pertinent to NHS resource allocation in the 1990s. Yet, the research carried out for the RAWP review, on which its principal proposals for change to the need indicators were based, is inadequate for developing a new method of resource allocation after RAWP. The paper describes the research and sets out its main conceptual limitations and problems of method.

Education and change.

Abstract: The Government's White Paper 'Working for patients' amounts to a managerial, structural and financial upheaval for the National Health Service and has, in turn, major implications for nurse education.

Pity the poor gatekeeper: a transatlantic perspective on cost containment in clinical practice.

Abstract: BrMedJ 1989;299:1323-5 The inevitable effects of demographic changes and the escalating expectations raised by high technology medicine are that health costs are rising all over the developed world. The issues being debated in relation to the white paper Working with Patients are the same ones facing the Canadian and American health care systems.M Limits have to be set on health care expenditure. But setting limits means setting priorities and making choices. This is not new: renal dialysis units have faced such limits for decades, and doctors differ widely in the factors they take into account in selecting patients for dialysis.5 Most of the discussion in the BMJ has focused on policy, political, and administrative issues.6 8 Although undesirable effects on the doctor-patient relationship have been predicted in discussions on the white paper, they have not been studied systematically. As part of the ongoing debate on practice budgets and cost restraint I recorded the experiences of primary care doctors who had acted as gatekeepers in a large health maintenance organisation.

The new general practitioner contract: is there an alternative?

Abstract: There is evidence of widespread agreement with these statements from the Prime Minister, among both the receivers and providers of health care. The increasing negative reaction that has been generated by the white paper Working for Patients1 and the new general practitioner contract2 does not appear to have been based on a reluctance to consider change but rather on a deep concern that the proposals will not only fail to achieve their stated objectives for patient care but, on the contrary, will be harmful to the functioning of the health services. There is no place for complacency about the delivery of health care in the United Kingdom, and the publication of these documents provides a valuable and perhaps necessary stimulus for urgent rethinking. The challenge that faces all of those concerned with the delivery of health care is to ensure that the result of this process is an improvement in the services provided. The Secretary of State has indicated that, although he will not accept procrastination, he will accept positive proposals, and it is with this in mind that I make the following proposals from the perspective of general practice.

NHS review. Improving clinical effectiveness in the NHS: an alternative to the white paper.

Abstract: BrMed3 1989;299:448-50 The government's argument in support of its white paper Workingfor Patients' has relied partly on the lack ofany other articulated strategy for reform. No one can quarrel with the need to improve the efficiency or effectiveness of the NHS, but there are distinct alternative strategies for that reform. A clinical effectiveness reform is presented as a sounder and more plausible means for improving the NHS.

Terminating Conscription? The British National Service Controversy 1955-56

Abstract: In April 1957, the annual British Defence White Paper made public the Macmillan government's intention of emphasizing nuclear deterrence at the expense of conventional force levels. Like the 1954 American New Look, this policy sought to take advantage of technological developments specifically the hydrogen bomb in order to secure major economic savings. Central to this enterprise was the termination of the expensive and unpopular conscription programme. Many commentators on the British New Look of 1957 have traced its roots to tendencies long prevalent in defence thinking,2 and, indeed, objections to conscription had been a constant factor in British politics since the beginning of discussions leading up to the National Service Act's promulgation in 1949. However, the contents of recently released documents indicate that in the period immediately prior to the drawing-up of the 1957 White Paper the armed services remained strongly opposed to the total ending of conscription, while little effort was made by the proponents of an all-volunteer force to link the termination of national service to a focus on nuclear deterrence a

Working for Patients? The Right Approach?

Abstract: This paper is a slightly revised version of a Memorandum requested by the House of Commons Social Services Select Committee to assist the Committee in its analysis of the White Paper Working for Patients (Cm 555). It was submitted to the Committee on 28 February 1989. The paper follows up the authors’earlier study of the reform of the NHS (Barr, Glennerster and Le Grand, 1988), prepared at the request of the Select Committee prior to the publication of the White Paper. The success or failure of the White Paper depends crucially on the precise details of the way in which its proposals are implemented. The Working Papers, although providing some more information as to how the White Paper's proposals will be implemented, do not in the main address the issues that concern us here. Given the inescapable tension between cost and quality, quality control will be absolutely critical if the incentives to economize on the use of resources are not on occasion to lead to unacceptable reductions in quality — reductions which might well apply differentially by socioeconomic group.

Capital accounting and charging in the national health service

Abstract: Before very long, the National Health Service may be required to use full capital asset accounting. Whatever else might be said about the White Paper reforms, this proposal — which the Government is introducing as one means of achieving a more efficient use of resources — appears to be conceptually sound.

Preventive medicine and screening.

Abstract: The preventive aspects of primary care have become increasingly important in the past decade and the new contract and the White Paper 'Working for patients' have focused further attention on them. A question in the MRCGP exam is almost inevitable.

The NHS reforms. Conditions for successful change.

Abstract: The NHS Review has proposed the most radical organisational change in health care since the inception of the service itself in 1948. Yet, the problems entailed in gaining acceptance for reforms of such magnitude are scarcely touched on in the white paper. The scale and strength of opposition which the proposals have subsequently met within the NHS have shown clearly that the issue of the management of change is likely to be central in the acceptance or otherwise of the proposals and subsequently their success or failure. Donald Forster and Roger Hadley outline the framework within which the issues posed by change can be analysed and assessed. In keeping with the government's preference for a management perspective, they emphasise insights from the literature on the management of change rather than the detail of the white paper.

What does equity in health mean

Abstract: The question of what rules should be used in determining access to health and health care has been hardly addressed in the public debate on the future of the health service In the UK, as in other countries, the goal of efficiency (production of output using least cost-methods) has dominated official pronouncements Far from the public view, however, another controversy has raged on the “other objective” of economic policy: equity, which implies that economic and social goods should be distributed fairly across individuals Curiously, this debate has been characterised by an immense production of empirical facts and parallel disregard for the precise specification of equity objectives However, unless the objectives of the health system are clearly specified, empirical research can do little to reveal the reasons why equity is important, the extent to which specific types of inequality are compatible with equity, how the concept should be measured and how efficient policies to achieve equity goals may be formulated and monitored To answer these questions it is necessary to specify a normative framework that may guide positive analysis in relation to policy-specific equity objectives The paper reviews a wide range of literature by firstly identifying a number of criteria for evaluating the diverse concepts of equity which have appeared in the literature This is followed by a critical appraisal of six well-established approaches: egality, entitlement, the decent minimum, utilitarianism, Rawlsian maximin and envy-free allocations All of these distribution rules are found wanting in some respect when applied to the health sector Given the shortcomings of traditional concepts, health economists have proposed alternative and novel formulations The two most important contributions to date are Le Grand’s notion of ‘equity as choice’ and the health maximisation account, associated with economists at York University Though these rules afford important insights into the question of what equity in the health domain entails, they too are problematic In the final part of the paper, an approach which strangely has been virtually ignored by economists and others who share an interest in the health-equity problem is examined Sen’s ‘capabilities’ concept, it is argued, comes closer to achieving all the specified assessment criteria than any other formulation previously discussed As such it could prove an effective framework within which to organise research and policy formation in the area of health and healthcare inequality All European governments are seeking to reform their health care systems All too often this process gives little attention to the primary goals of health care policy Unless these are carefully specified and reforms carefully related to them, it will be impossible to determine whether changes in policy, such as those envisaged in the NHS White Paper, can meet the designated objectives

Responses by general practitioners in Avon to proposals for general practice in the white paper Working for Patients.

Abstract: OBJECTIVE--To determine the views of Avon's general practitioners about the general practice proposals within the government's white paper Working for Patients. DESIGN--Postal questionnaire survey. SETTING--A county in south west England. SUBJECTS--All general practitioner principals (n = 537) under contract with Avon Family Practitioner Committee. MEASUREMENTS AND MAIN RESULTS--492 doctors (92%) responded to the survey. More than three quarters of the respondents were opposed to the government's proposals on budgets for specific surgical procedures, prescribing, and diagnostic tests; and between 63% and 93% felt negative about advantages that might accrue from the proposals. Over three quarters of general practitioners were in favour of family practitioner committees monitoring work load, prescribing, and referrals. General practitioners in large, potentially budget holding practices held similar views to doctors in smaller practices. CONCLUSIONS--Avon's general practitioners substantially reject most of the government's proposals about general practice in the white paper Working for Patients.

Interesting times: education and broadcasting in the 1990s

Abstract: The agenda of the Education Reform Act (1988) and the White Paper Broadcasting in the '90s: Competition, Choice and Quality is to reorganise the way that the social goods of education and broadcasting are dis tributed, and so to change the ways in which govemment/citizen relations are instituted and regulated. Much of the opposition to these changes renders itself ineffective by speaking in the terms of a cultural 'welfare statism: New alternatives based on notions of a public sphere, a radical democracy, and a republican citizenship are critically reviewed.

Performance review, motivation and organisational culture.

Abstract: In this article David Wigley argues that the system of Individual Performance Review (IPR) must take more account of individual motivational patterns and link these into programmes of organisational development in order to produce the organisational cultures required for the successful implementation of the proposals in the NHS white paper "Working for Patients".

Medical audit in psychiatry or Fear and loathing on the White Paper trail

Abstract: The Government White Paper, Working for Patients (1989), although presented as a discussion document, should be seen as a position paper. It is clear that the government intends to implement the major proposals, and will be able through its control of general management, enhanced by a stream-lined management structure (Working for Patients para 2.3–2.11), to put pressure on health authorities to take action accordingly.

Creation of the Nuclear-Free New Zealand Myth: Brinkmanship without a Brink

Abstract: The New Zealand Labour Party was elected to office in 1984 with the promise of keeping nuclear ships out but preserving the ANZUS alliance. When the USS Buchanan was refused permission to call at a New Zealand port in 1985, the Americans initiated a series of retaliatory measures culminating in the formal withdrawal of the U.S. security guarantee to New Zealand in August 1986. This forced the government's hand in regard to reviewing defense options. The review was conducted in three stages: a discussion booklet released in December 1985, a public inquiry by a four-member Defence Committee which published its report in August 1986, and a formal White Paper on Defence published in 1987.1 The thinness and insubstantiality of the official White Paper was an embarrassment even to supporters of the government's policy. Nevertheless, the perception of a firmly antinuclear, Labour-led New Zealand colliding with a bullying United States has become part of conventional wisdom. The government of David Lange (July 1984 to August 1989) is commonly perceived to have acted with courage in opposing the wishes of a superpower; the United States is perceived as having acted against the democratic preferences of a small ally that was adopting a moral and independent international posture, and further is accused of refusing to accept a policy that it had previously found tolerable during the third Labour government of New Zealand (1972-75) and presently finds tolerable in Denmark, a NATO ally.

The Sandys White Paper of 1957 and the move to the British new look : an analysis of nuclear weapons, conventional forces and strategic planning 1955-57

Abstract: THE SANDYS WHITE PAPER OF 1957 AND THE MOVE TO THE BRITISH NEW LOOK: AN ANALYSIS OF NUCLEAR WEAPONS. CONVENTIONAL FORCES AND STRATEGIC PLANNING 1955-57 This study seeks to analyse the significance of the 1957 Defence White Paper in the context of British strategic planning during the mid-1950s. Claims that the White Paper represented a culmination of trends already prevalent in British defence planning are assessed while continuities and discontinuities in strategic policies are identified. This is done by highlighting the main features of the document and then tracing their development in the 1955-57 period. A major theme throughout is the relationship between the growing declaratory emphasis on nuclear deterrence and the determination of the shape and size of conventional forces and capabilities. It is contended that the defence decision making process that was in place prior to January 1957 was incapable of generating a British New Look that is a consistent set of declaratory and action policies which reflected a cutback in conventional forces accompanied by a greater reliance on the threat of nuclear retaliation. Prior to Duncan Sandys becoming Minister of Defence, the inability of that ministry to readily impose itself on the service departments meant that the latter's attachment to preparations for global war and the national service programme could not be overruled. It is also unclear whether during the 1955-56 period the basis for a truly independent deterrent was being established. An analysis of the negotiations surrounding the 1957 White Paper indicates that Sandys was able to overrule traditional service preferences. The result was a policy which rejected the imposition of a conventional strategy on a nuclear one in favour of a British New Look. Consequently, conventional forces were reduced, greater relative importance was placed on the nuclear deterrent, but once more the requirements of a unilateral independent deterrent did not receive priority.

"Scottish Enterprise" : the creation of a more effective development agency of the pursuit of ideology?

Abstract: This paper presents an assessment of the ideas contained in the recent White Paper "Scottish Enterprise: A New Approach to Training and Enterprise Creation" (Industry Department for Scotland, 1988).