Showing papers on "White paper published in 1990"

The White Paper

Abstract: Points:  Research shows that soil properties vary widely within 2.5 ac (1 ha) grids and USDA soil types  Variable rate lime and seed prescriptions based on inaccurate maps can result in economic loss  On-the-go soil sensors are able to accurately map soil texture, organic matter, and pH, along with topography at a very high resolution  Two multi-state studies examined the economics of increased map accuracy. One compared pH maps based on grid sampling and Veris pH maps and found the increased density of pH data improved lime application accuracy by more than $14/ac. The other study found precise OM maps had nearly a $10/ac advantage over grid sampling and over $23/ac over USDA surveys in seed prescription accuracy.  The economic returns from high-resolution soil maps are significant, considering the long-term usage of the maps and the number of applications that can be optimally managed.

The dynamics of British health policy

Abstract: The authors' primary purpose is to analyze the forces that have shaped British health policy over the last two decades, but they have also provided up-to-date factual information. Areas covered include the funding of the service, resources, allocation, health care priorities, organization and management, industrial relations, medical careers, and the evaluation of the NHS's performance. The government white paper "Working for Patients" and its possible impact are integrated into the text, and a second feature is the use of political theory to produce an integrated explanation for the policy trends observed. The authors are all leading specialists in the fields of health policy and management.

Community care in the 1990s: the community care White Paper: 'Caring for People'

Abstract: This article summarises the main proposals of the government's November 1989 White Paper Caring for People. It traces the background to the cur rent drive towards community care, emphasising the ph...

Hospital Behaviour and Competition

Abstract: This chapter provides a review of work done by economists in modelling the behaviour of hospitals under competition and draws on such empirical results as are available. It is written in a non-technical fashion and later sections draw on the literature review in order to make an assessment of the kind of constraining/regulatory environment that is likely to be suitable in a National Health Service (NHS) provider market following the implementation of the White Paper Working for Patients (Department of Health, 1989).

Statutory Sentencing Principles: The 1990 White Paper

Abstract: The Government has published its plans for a far-reaching reform of the English criminal justice system in its White Paper, Crime, Justice and Protecting the Public.' There can be no doubt that it is an important document.2 It is appropriate to say from the outset that this set of proposals, unlike a number of earlier ones emanating from the same Government, is distinguished by the enunciation of a set of reasonably clear basic principles, notably the acceptance of 'desert'3 or proportionality as being the appropriate guiding principle for sentencing. Explicitly, deterrent thinking is rejected as a means of determining the incidence and duration of custodial sentences.4 There is also a new willingness to address issues of consistency and fairness within the criminal justice system, rather than presenting a rag-bag of proposals which reflect short-term considerations and have little inherent coherence.5 We find ourselves

Caring for People: a critical review of British Government policy for the community care of the mentally ill*

Abstract: The development of ‘community care’ for the elderly, mentally ill, mentally handicapped and physically disabled has been Government policy in Britain since the 1950s. Problems with implementation of this policy led the Audit Commission (1986) to conclude that “the one option that is not tenable is to do nothing about present financial, organisational and staffing arrangements”. Sir Roy Griffiths was commissioned to review “the way funds are used to support community care policy …”. Radical solutions were proposed and subsequently incorporated in the Government White Paper Caring for People (Department of Health, 1989a). However, two very significant measures were not accepted: the ‘ring-fencing’ of community care monies and the creation of a ministerial post within the Department of Health with specific responsibility for community care.

Which internal market? the nhs white paper and internal markets

Abstract: Much of the discussion surrounding the publication of the NHS White Paper ‘Working for Patients’ has centred on proposals for an ‘Internal Market’. However, the term ‘Internal Market’ embraces two quite distinct concepts, both of which are found within the White Paper. These two types of Internal Market have very different implications for cost, equity, priorities and the planning and delivery of health care. The pattern of health and health care will be strongly influenced by the relative strengths of the two types of Internal Market in the future NHS.

Fiscal Instruments in Environmental Policy

Abstract: Environmental problems now figure prominently on the policy agenda in both london and Brussels. The recent Environment White Paper, This Common Inheritance, has signalled the British Government's intention that policy in a wide range of areas should reflect environmental concerns, and both Britain and the European Community have been active participants in international negotiations on cross-country and global environmental problems.

Evaluating the Reform of the NHS

Abstract: Much speculation has taken place over exactly how the proposed changes to the NHS, advocated in the White Paper Working for Patients (DoH, 1989), will be implemented. This chapter steps back from the detailed debate to take a strategic look at the White Paper proposals in the context of basic objectives and the range of available methods of financing and organising health services. These are described in Section 2 and used in Section 3 to classify the schemes advocated by various interest groups prior to the publication of the White Paper. Section 4 discusses the criteria by which the success or failure of reform proposals might be judged. In Section 5 these criteria are used to assess three of the major changes proposed in the White Paper.

Health visiting: a withering profession?

Abstract: Over the past 2 years, community nursing appears to have been quietly marginalized within successive government health documents. The health visiting profession in particular looks to be under the greatest threat, and it is to that issue that the discussion will be addressed. The argument will be made that changing the content of health visiting practice in an attempt to solve the apparent problems, is not sufficient in itself to both protect and allow development of the profession for the 21st century. It is of more relevance to determine the direction for health visitors within the rapidly changing context of primary health care provision. The potentially worrying changes in the community health agenda for health visitors will be demonstrated by some analysis of the Cumberlege Report 1986, the 1987 White Paper Promoting Better Health, the Griffiths Report on Community Care 1988, and the NHS Review 1989 Working for Patients. Potential avenues for action are explored, including neighbourhood nursing, and a serious attempt at membership of primary health care teams within general practice. The conclusion is that health visitors need to indulge in some painful decision-making, in order to prevent the withering away of their profession within the newly emerging context for primary health care delivery.

Community Care for the Elderly — Rhetoric and Reality

Abstract: This paper investigates the management and delivery of care for 176 elderly people receiving both community health and social services. These people represent a crucial group if the community care policy is to become a reality, and they receive high services levels. The study provides both quantitative and qualitative evidence of inadequate case management and lack of co-ordination in providing care. Assessment, determining servi ces, and review were all inefficiently managed. Liaison was non-existent for the majority, and opportunities for substitution were missed. There could be conflict over role, particu larly in relation to personal care. Innovations designed to tackle these problems remain limited in scale. These difficulties are recognized and addressed by the 1989 White Paper 'Caring for People' which makes a number of proposals to clarify responsibilities and accountability. The different professional assumptions and work practices among the plurality of agencies providing care will need to be resolved if community care is ever to offer a realistic alternative to care in institutions for increasing numbers of people with high levels of dependency.

Internal market: an acceptable means to a desirable end

Abstract: This Discussion Paper argues that the government has been right both in its rejection of market solutions to health insurance and in its injection of competition into provider markets. The particular advantages of the latter are that the collective expression of dk,idand maintained, with impetus being given to the better identification of health care needs and the most effective ways of meeting them. The ill effects of provider competition in the United States are outlined and reasons for not expecting them to be replicated in Britain explained. Emphasis is laid on the powerful moral rase for efficiency in the provision of health care, and clear definitions of this much-abused term are offered. The reforms of the White Paper are likely to strengthen the hands of ministers in securing a larger share of the public expenditure cake a for health care. The changes post no threat to the traditional pursuit of equity in the NHS and are appropriate means of attaining what Professor Culyer called "communism in health" (to each according to her need; from each according to financial ability). Difficulties are anticipated both from the speed of implementation and, in particular, from the fragmentation of the demand side between health authorities, general practitioners, and local authorities. The need for further change and rationalisation is anticipated here.

Private higher education in Australia

Abstract: In the post World War Two era and prior to the mid 1980s Australia has been characterised by exclusive public provision, financing and regulation of higher education. The 1980s, however, have been marked by considerable turmoil which culminated in the 1988 White Paper. Circumstances provided by the reform of the higher education system, the booming overseas student market and unmet domestic demand have provided a window of opportunity for private providers. This paper charts the growth of private provision, federal and state government responses and the pressures for subsidy and regulation. The paper concludes that the policies of both levels of government are hastening the development of what Geiger (1988) defines as a 'peripheral private sector' of higher education in Australia.

Competence, european community law and nationals of non-member states

Abstract: THE Commission's White Paper of 1985 entitled "Completing the Internal Market"' announced that practical steps would be taken to realise the ambition expressed at the Fontainebleau European Council: "the abolition of all police and customs formalities for people crossing intraCommunity borders". The White Paper was quite explicit on the point that these proposals would apply to nationals of non-member States. In the words of that document: "the abolition of checks at internal frontiers will make it much easier for nationals of non-Community countries to move from one Member State to another". As a first step the Commission undertook to make proposals, in 1988 at the latest, to achieve the co-ordination of the rules on residence, entry and access to employment applicable to nationals of non-Community countries. It contemplated that problems might arise over the question of the change of residence of non-Community citizens between the member States and it undertook to address those problems. Measures would be proposed, also in 1988 at the latest, on the right of asylum and the position of refugees. The White Paper envisaged a common visa policy for adoption by 1990 and a common extradition policy for adoption by 1991. It is notorious that progress on these issues has been slow. The Commission complained of the lack of progress in its report to the Rhodes European Council. In a separate communication to the Council and the Parliament2 the Commission again drew attention to this unsatisfactory state of affairs, and in particular to the existence of a number of fora competent in this area of activity, which often failed to co-ordinate their activities. Under the Spanish presidency some progress was made towards the establishment of common rules governing the attribution of responsibility for examining an asylum request but the approval of a text on these subjects has been frustrated by differences of opinion on the question of competence. Do these matters fall within the scope of the Treaty of Rome at all? Are they, rather, suitable for determination by the 12 States or by some of the 12 States, acting collectively? If the

Information Systems and the White Paper Proposals

Abstract: The implementation of many of the proposals in the White Paper depends crucially on the availability of relevant, accurate and timely information. Two particular developments in the White Paper will have significant information requirements (Department of Health, 1989): a. The establishment of self-governing hospitals (or hospital trusts) requires that the existing system of direct control by district health authorities will be significantly changed, so that control of such hospitals will in future be by means of contract. Hitherto it has been possible for authorities to control resources by pragmatic responses to local pressures. Where work is placed with hospital trusts this will no longer be possible, as control will be by means of explicit contract. b. The introduction of practice budgets will require a revolution in the management of general practice. Practices will have to introduce budgetary control mechanisms, and will also require explicit information about the costs and quality of care in institutions to which they refer patients.

Economic restructuring and the reform of the higher education system

Abstract: The main argument advanced in favour of the Hawke government's reform of higher education, as contained in the recent White Paper, relates to the imperatives of economic restructuring. A more ‘relevant’ and ‘responsive’ higher education system is, according to the government, the necessary basis of a more advanced and internationally competitive economy. We argue below, however, that the reforms are premised on a false assumption: that the private sector in Australia is capable of and/or interested in exploiting the expected boost in graduates and research for the purposes of developing new technologies and competitive advantages. Indeed, the government has found it necessary to intervene in a centralist manner to induce the appropriate response in the private sector. This is justified as market‐facilitating. In reality it is an act of faith which contradicts both the capacity and agenda of the private sector in Australia.

Contracts and quality of care.

Abstract: RrMedJ 1990;300:919-22 What conditions should be included in contracts between hospitals and district health authorities to safeguard the quality of patient care? The white paper Working for Patients outlines (para 4.13) that "in future, each DHA's (District Health Authority) duty will be to buy the best service it can from its own hospitals, from other authorities' hospitals, from self governing hospitals, or from the private sector."1 Hospitals for their part will have to satisfy districts that they are delivering the best and most efficient service. Working paper 22 expands these concepts and gives guidance on pricing block contracts, cost and volume, and cost per case contracts (paras 2.10 to 2.19). The only reference to quality of care in these contracts is in working paper 2 (para 2.20) that "it will be the responsibility of those placing contracts to monitor the performance of hospitals in providing agreed services. In order to ensure that patients' personal as well as clinical needs are being met, health authorities will wish to monitor patient satisfaction by such means as the systematic use of questionnaires and follow up surveys. As a quality control measure, contracts could require the hospital to provide reports on all com? plaints received and the action taken to remedy them." The competitive market that is likely to be intro? duced when the white paper is enacted means that without adequate safeguards performance within the contract is likely to be driven by price rather than quality. In 1982 a prospective payment system was introduced in the United States, after which payment for hospitalisation of the Medicare population was linked to diagnosis (diagnosis related groups (DRGs)). There is evidence that after the change in contractual arrangements patients were discharged "quicker and sicker."-4 We are concerned that similar changes may occur in the United Kingdom and also by the emphasis on patient satisfaction as the sole measure of quality mentioned in the white paper. Although we agree that monitoring patient satisfaction and complaints is an essential feature of quality assurance, satisfaction is clearly only one dimension of outcome and does not necessarily reflect the quality of technical aspects of care?badly treated patients with poor medical out? comes may still feel satisfied. Admittedly, official thinking is taken a step further in a later working paper, Contracts for Health Services: Operational Principles,1" which recognises (in para 4.11) the im? portance of quality measures of appropriate care and clinical outcome as well as of patient satisfaction. As the working paper goes on to say (para 4.12), "It will take time to develop a range of quality measures. ..." In the light of the primitive audit systems presently in place in the United Kingdom, one safeguard of the quality of care is that future contracts between hos? pitals and district health authorities should specify Perspectives in drawing up health contracts

Social Policy and the New Right — The Strange Case of the Community Care White Paper

Abstract: (1990). Social Policy and the New Right — The Strange Case of the Community Care White Paper. Local Government Studies: Vol. 16, No. 6, pp. 15-34.

Home Country Control and Mutual Recognition

Abstract: The European Commission has worked for nearly thirty years on the integration of banking and financial markets. Freedom of establishment and entry was achieved in 1973, but further efforts to harmonize banking regulations and promote cross-border services proved to be very slow. This process led to a genial idea, incorporated in the 1985 White Paper on the Completion of the Internal Market, the opening of markets prior to harmonization. Regulation and supervision are guided by the principles of home country control and mutual recognition according to which each country will accept the regulation and supervision enforced by other countries on their domestic firms operating abroad. These principles are very broad: they apply to all products, banking and financial services included. The issue raised in this paper concerns the application of these two principles to banking services. Is there anything special in banking that would justify a different approach?

Ethics, Clinical Freedom and the Doctors’ Role

Abstract: In her Foreword to the NHS White Paper Working for Patients (DoH, 1989) the Prime Minister offers us two forthright assurances. The first is that: ‘The National Health Service will continue to be available to all,regardless of income, and to be financed mainly out of general taxation’.

THE CULTURE OF THE WHITE PAPER: Academic Labour for and as Commodity Production

Abstract: ∗Prepared for the Institute for Cultural Policy Studies Conference, Griffith University, 1-4 December 1988 Thanks to Lesley Johnson, Michael Bartos, Ralph Hall, Di Zetlin, Simon During, Graham McCulloch, and especially Gary Wickham for their helpful comments on an earlier version of this argument

Australia's Defence: White paper in the red

Abstract: (1990). Australia's Defence: White paper in the red. Australian Journal of International Affairs: Vol. 44, No. 2, pp. 101-118.

Students and Social Security Benefits.

Abstract: Since the publication of the Goverment's White Paper, Top‐up Loans for Students in November 1988, public debate has been confined to the merits of the loans proposals. The proposal to exclude full‐time students from the social security system has been neglected in the media and in Parliament alike. This article examines the origins and development of this proposal from its first appearance in a DHSS Green Paper through to its appearance in the loans White Paper. The author looks at the Government's reasons for wishing to exclude students from the benefits system and uses Government statistics to build up a true picture of students' use of the social security system. He also places the proposal in the context of the Government's general social security and housing policies and concludes that the effect of the withdrawal of social security benefits from students will be to undermine the stated aims of the White Paper. If the loss of social security is greater than the ‘top‐up’ loan, then students dependency...