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Showing papers on "White paper published in 1997"



Journal ArticleDOI
01 Jun 1997-Area
TL;DR: In this article, it is argued that the state is pulling back from a universalist, welfare role, which entailed comprehensive governance of the whole national territory, and a much more selective form of government is coming into being, concerned with community, diversity, and locality.
Abstract: Summary In this paper it is proposed that the territory of governance is currently being reconfigured by the state. The state is pulling back from a universalist, welfare role, which entailed comprehensive governance of the whole national territory. Now a much more selective form of government is coming into being, concerned with ‘community’, ‘diversity’ and ‘locality’. This is not, however, simply a belated recognition by the state that these are ever more important features of socio-spatial life: rather, it is part of the reconfiguration of the territory of government as the state invokes these characteristics in order to modify its ways of governing. Using Foucault's concept of governmentality–that is the means used by the state to ‘problematise’ life within its territorial borders and then act on the basis of these problematisations—the recent case of the Rural White Paper is examined. It is proposed that this is a very clear example of a governmental retreat from a comprehensive role in the governance of rural areas and shows how the state now seeks to govern ‘through communities’.

75 citations


Journal Article
TL;DR: The authors examines educational policies in South Africa in respect of the moves toward greater democracy and participation in the education system and argues that current policies proposed in the policy texts do not necessarily enhance participation and may, in fact, contradict moves towards equity.
Abstract: In current policy debates in South Africa there is continuous reference to the democratisation of the educational system (NEPI, 1992; 1993a; 1993b; ANC National Education and Training Policy Framework, 1994a; 1994b; Education White Paper, 1995). Central to the notion of educational democracy in South Africa is the idea that democracy entails, and should enhance, greater participation. This article critically examines educational policies in South Africa in respect of the moves toward greater democracy and participation in the education system. It does so by examining key policy texts which have been issued by the Ministry of Education in South Africa in 1996 with particular reference to the South African Schools Act (SASA). The examination of the policy texts focuses on key recommendations pertaining to school governance, highlighting, inter alia, the tensions and contradictions in them and the different and contradictory notions of participation. The article argues that current policies proposed in the policy texts do not necessarily enhance participation and may, in fact, contradict moves towards equity. The article concludes by arguing that policy development in South Africa essentially represents a compromise between white privilege and black redress that is precarious and likely to rupture.

57 citations


Journal ArticleDOI
23 Aug 1997-BMJ
TL;DR: The white paper Choice and Opportunity envisages, perhaps optimistically, new entrants into the community care market for health care with respect to geriatric care in the contracting process.
Abstract: Responsibility for the medical management of elderly people in community institutional care (residential or nursing) remains poorly defined. It currently rests by default rather than by design on the heavily burdened shoulders of general practitioners. The number of patients in private or voluntary homes in Britain has risen from 18 200 in 1983 to 148 500 in 1994.1 The management of frail elderly people in nursing homes has also been regarded as beyond the scope of the general medical services contract and as a non-core activity.2 To add to this uncertainty, the role of geriatricians has undergone major changes. Increasing responsibilities for acute services have meant less time for continuing care and community care generally. These changes are partly due to the reduction of NHS long term beds, the withdrawal from acute admission duties by some medical specialities, and the lack of understanding and appreciation of geriatric care in the contracting process. The white paper Choice and Opportunity envisages, perhaps optimistically, new entrants into the community care market for health care.3 Generally, the lack of national benchmark standards has contributed to these difficulties. Some aspects of these issues have …

51 citations


Journal ArticleDOI
TL;DR: For example, Nkondo et al. as mentioned in this paper examined South Africa's educational progress generally and that of its women specifically, especially African women, along with a discussion of the factors affecting the education of women in South Africa and possibilities for future redress.
Abstract: Creating a system that provides quality education and training for all -young and old, regardless of race, class, or gender-is probably the greatest developmental challenge facing the South African government today. Women (and girls), particularly those of African origin, have been largely excluded from analyses of South African education. This article seeks to address this gap in the literature by examining South Africa's educational progress generally and that of its women specifically, especially African women, along with a discussion of the factors affecting the education of women in South Africa and possibilities for future redress. INTRODUCTION Many in the international community and in South Africa itself are still amazed by that country's transition from an apartheid regime to a multiparty, democratic state. Local and international leaders agree, however, that the battle has only just begun. South African leaders currently face the challenge of transforming their society into one in which all segments of the population have truly equal access to resources and can fully participate in the democratic process. Education is one of the critical areas in need of change. Under the apartheid regime, basic elementary and secondary education was not widely available to all. Indeed, with 19 redundant administrative structures, separate-but-unequal education was the norm. As the Republic of South Africa Department of Education (1995) notes in its first White Paper on Education and Training, the post-democratic election period marks "the first time in South Africa's history that the government has the mandate to plan the development of the education and training system for the benefit of the country as a whole and all its people" (p. 2). Thus, it is not surprising that the task of developing equitable educational policies is currently of primary significance. As South Africa's educators and educational policymakers wrestle with the vestiges of a bureaucratically unwieldy and racially biased educational system, they must also strive to create a system that provides quality education and training for all South Africans-young and old, regardless of race, class, or gender. Indeed, the redress of educational inequities is probably the greatest developmental challenge facing the South African government today. Gessler Nkondo, vice chancellor of the historically Black University of Venda, has argued that the process of empowerment for the nation's African students should occur as a result of changing the content of curricula, rather than on symbolic changes of structures. As he notes, "[Only] having a few Africans in positions of power without changing the rules of the game would only guarantee frustration" (quoted in Khosa, 1996, p. 5). A similar argument must be made for the introduction of curricula that are gendersensitive, particularly in the sciences, where the presence of women' is minimal. In addition to the inequities created by apartheid, gender-based discrimination has confronted Black women. This represents a trend that bears careful watching, given that it could easily lead to a system of gendered apartheid. To counter this trend, the present article considers three broad areas of research on education for African women in South Africa: (a) primary and secondary education; (b) higher education; and (c) the relationship between gender, education, and occupational opportunities. The available literature on the first dimension is rather limited. Until recently, researchers practically excluded consideration of Black South Africans' early educational experiences, much less that of Black girls. The literature on higher education is more abundant, although likewise constrained by its focus on race and its near-exclusion of gender. In this area, several scholars have provided excellent critiques of the inequities between South Africa's historically Black and historically White universities, but few have explored the double jeopardy Black women have experienced in South African institutions of higher education. …

45 citations


Journal ArticleDOI
Hornblow Ar1
28 Jun 1997-BMJ
TL;DR: The establishment of a purchaser-provider split, which introduced the mechanisms of the market into a publicly funded health system, proved a major challenge to long accepted values and assumptions underlying the universal and freely accessible public health system established 50 years ago.
Abstract: To reshape a health system without due regard for cultural imperatives is to risk failure, as has proved to be the case with New Zealand's health reforms of 1993. New Zealanders take pride in their claim to be the first to introduce a universal healthcare system, in 1938, as part of a post-depression welfare state. The recent, market oriented health reforms proved a major challenge to long accepted values and assumptions underlying the universal and freely accessible public health system established 50 years ago. In response to public opposition and polarisation of clinical and commercial cultures, the new coalition government is planning to remove the commercial and competitive basis of the reforms. The health reforms were announced in the minister of health's green and white paper of July 1991.1 Before the health reforms hospital care was coordinated by 14 area health boards financed according to a population based funding formula. Some hospital services were (and still are) available privately, but as health insurance contributed only 6% to total health expenditure private hospital care was restricted effectively to such areas as elective surgery. In primary care, general practice consultations carried various government subsidies, though the value of these subsidies had been reduced steadily and markedly over a decade or more. At the core of the health reforms was the establishment of a purchaser-provider split, which introduced the mechanisms of the market into a publicly funded health system. The government claimed that this would increase effectiveness and efficiency, improve access to care, create greater flexibility in the use of services, reduce waiting time for prioritised services, and better integrate primary and secondary care. It was considered that restructuring public hospitals as businesses would provide the necessary tension and incentives to enhance performance. The reforms were implemented in July 1993. The Ministry …

44 citations


Journal ArticleDOI
TL;DR: In this paper, the extent to which self-governing schools have contributed to diversification of the system and argues that there is little evidence that they have provided programmes which are innovative or mould breaking.
Abstract: The 1996 education White Paper on self‐governance confirms the government's long‐standing commitment to diversify educational provision and to employ grant‐maintained schools to take that agenda forward. This paper considers the extent to which self‐governing schools have contributed to diversification of the system and argues that there is little evidence that they have provided programmes which are innovative or mould breaking. Why this is the case is explored through interviews with headteachers of nine grant‐maintained schools. It suggests that school responses are crucially shaped by the headteachers’ interpretations of the conflicting demands of national policy frameworks and local competitive markets in education. In curriculum terms they show a propensity to consolidate their schools’ identities around what the schools have done in the past rather than embrace the opportunities to modernise presented through the government's funding priorities.

34 citations


Book ChapterDOI
01 Jan 1997
TL;DR: One of the key objectives of the white paper Caring for People was ‘to promote the development of a flourishing independent sector alongside good quality public services’.
Abstract: One of the key objectives of the white paper Caring for People was ‘to promote the development of a flourishing independent sector alongside good quality public services’. The statutory mechanism to enable this development to take place for both health authorities and local social services authorities is contained in section 23 and sections 28, 28A and 28B of the National Health Service Act 1977 and in sections 21, 22 and 30 of the National Assistance Act 1948 and subsequent legislation.

33 citations


Journal ArticleDOI
TL;DR: This paper provided an exposition, analysis and critique of post-election policy concerning state schooling in South Africa, focusing on the White Paper on the Organisation, Governance and Funding of Schools.
Abstract: This article provides an exposition, analysis and critique of post‐election policy concerning state schooling in South Africa. In particular the article focuses on the White Paper on the Organisation, Governance and Funding of Schools. Policy is analysed at three levels, namely the economic, ideological/discursive and the political. At the economic level it is argued that although the White Paper makes provision for redress of past inequalities, limitations in government expenditure are limiting the possibilities for reform. It will also be argued that the White Paper must be seen as the outcome of contestation between different discourses concerned with race, culture and education. Finally the White Paper has been shaped by the interim constitution as well as by political struggles within the state and civil society.

28 citations


Journal ArticleDOI
TL;DR: In this paper, the current thinking about educational management at the legislative level accurately assesses the legacy of apartheid and offers a viable alternative framework for reconceptualizing educational management development in South Africa.
Abstract: Three key conceptual issues related to educational management development demand the immediate attention of South African policymakers. First, apartheid engendered a particular understanding of education and educational management among school administrators; second, movement toward a democratic educational system requires policies that enable rapid transformation; and third, successful transformation requires new approaches. This article critiques recent educational management policy reports, highlighting the possibilities and constraints of their recommendations. It considers whether the current thinking about educational management at the legislative level accurately assesses the legacy of apartheid and offers a viable alternative framework for reconceptualizing educational management development in South Africa. INTRODUCTION In 1994, voters in South Africa elected a democratic government. The majority of the nation's population had long regarded the formerly entrenched apartheid system as illegitimate, hierarchical, and authoritarian. A key demand of the antiapartheid movement inside and outside South Africa was that officials democratize both the system of educational governance and the management of schools. Thus, among its first initiatives, the newly elected democratic government reviewed educational governance in South Africa and made key recommendations. This committee's work laid the foundation for the new Republic of South Africa Department of Education's [RSADE] (1996a) White Paper 2 on educational transformation; for the passage in 1996 of the South African Schools Act (SASA), which declared public schools open to all citizens (RSADE, 1996c); and for the National Education Policy Act (NEPA) (RSADE, 1996b). In addition to various committee reports, other policy proposals and legislation focused more on planning and management of the educational system. The government appointed the National Task Team on Education Management Development (NTTEMD) (1996), which recommended in its Changing Management to Manage Change in Education document a framework for fostering professional management development in South African schools. As South Africa enters a period of rapid political and social transformation, renewed focus on educational management development is especially crucial. Inherent in this statement are three key conceptual issues: (a) apartheid engendered a particular understanding of education and educational management among school administrators; (b) movement away from the apartheid system toward a democratic system of education demands policies that enable rapid transformation; and (c) a successful transformation process requires development of a new educational management approach. The present article addresses each of these issues and critiques the Department of Education and NTTEMD reports, highlighting the possibilities and constraints of their recommendations as they affect primary and secondary education. Specifically, this article addresses two questions: (1) Does the current thinking about educational management at the legislative level take into account the legacy of apartheid upon education management development? and (2) Does the NTTEMD report offer a viable alternative framework for reconceptualizing educational management development in South Africa? EDUCATIONAL MANAGEMENT DEVELOPMENT IN SOUTH AFRICA: AN OVERVIEW The South African educational system during apartheid employed a highly centralized decision-making process and well-developed decentralized structures through which to implement policy. Critics have argued, however, that the apartheid-era system's "topdown" administration typically proceeded without the consultation or participation of those who implemented the decisions. Principals, for example, particularly those in schools serving Black students, were viewed merely as implementers of decisions, not as administrators with "the opportunity to formulate or construct their own school policies, vision or mission" (Gallie, 1996, p. …

24 citations



Book ChapterDOI
01 Jan 1997
TL;DR: A growing emphasis on value for money via competition and contract specifications has more recently provided a focus around which a common definition has become established as mentioned in this paper, which has become particularly important in the light of the political commitment to promote housing companies and the potential extension of Social Housing Grant to private developers.
Abstract: Although this book is about housing management, as the above quotes indicate, there has in the past been little clear consensus as to what such a term actually means. A growing emphasis on value for money via competition and contract specifications has more recently provided a focus around which a common definition has become established. It has concentrated largely on output-related landlord functions, crystallised within the concept of the ‘Social Housing Product’ (see Chapter 11) introduced in the 1995 White Paper Our Future Homes (DoE, 1995b). The motivation has been to develop a series of measurable performance standards which might appropriately be applied to an increasingly diverse range of landlord organisations. This has become particularly important in the light of the political commitment to promote housing companies and the potential extension of Social Housing Grant (the replacement for HAG) to private developers. A common set of standards would in theory allow the establishment of a level playing field on which services might realistically be compared, irrespective of the organisation delivering them. However, this has generated a growing concern amongst existing housing associations that the future allocation of grant may be heavily influenced by, or directly linked to, performance comparisons achieved by the production of league tables of measured output.

Journal Article
TL;DR: The Land Transport Authority (LTA) as mentioned in this paper is a statutory board under the Ministry of Communications, established in 1995 to spearhead improvements to the land transport system, integrating land use, town and transport planning, expanding the road network, managing demand for road use, and providing quality public transport choices.
Abstract: Singapore, in 1995, experienced a merging of several government agencies involved in land transport. This formed the Land Transport Authority (LTA), a statutory board under the Ministry of Communications, established to spearhead improvements to the land transport system. Agencies currently subject to the LTA include: the Roads and Transportation Division (formerly of the Public Works Department, Ministry of National Development); the Registry of Vehicles; the Mass Rapid Transit Corporation; and the Land Transport Division (formerly separate agencies under the Ministry of Communications). Soon after its formation, the LTA was requested by the government to prepare a White Paper detailing how Singapore could have a world-class land transport system. The White Paper described four ways to realize a world-class transport system in ten to fifteen years' time. These were: (1) Integrating land use, town and transport planning; (2) Expanding the road network and maximizing its capacity; (3) Managing demand for road use; (4) Providing quality public transport choices.

Journal ArticleDOI
TL;DR: In this article, the authors outline the build-up of the National Lottery launch, from the government 1992 white paper, the subsequent Parliamentary procedures leading to the national lottery Act, the choice of Camelot as the operator in May 1994 and the nationwide launch of the lottery in November 1994.
Abstract: This paper outlines the build-up of the National Lottery launch, from the government 1992 white paper, the subsequent Parliamentary procedures leading to the National Lottery Act, the choice of Camelot as the operator in May 1994 and the nationwide launch of the lottery in November 1994. The paper outlines the achievements of the lottery and some longer-term issues that it faces.

DOI
01 Jan 1997
TL;DR: In this paper, the authors analyse the period in England leading up to the Dearing Review and suggest that there is a need to build a consensus on the vision of the future English education and training system.
Abstract: This chapter analyses the period in England leading up to the Dearing Review. It outlines the historical development of 14-19 qualifications since 1991 and sets the Review within this context. It argues that for most of this period, actual changes to the system were largely determined by the relationship between the low levels of participation and achievement for 16-19 year olds, the qualifications system and arguments for the reform of the education and training system. The authors suggest that there is a need to build a consensus on the vision of the future English education and training system.

Journal ArticleDOI
15 Feb 1997-BMJ
TL;DR: Concern has been growing about the consequences of the imminent break up of the general practitioners' professional monopoly and about the risks of allowing hospitals or commercial organisations to provide primary care.
Abstract: The 1996 primary care white paper, Choice and Opportunity , offers scope for a wide range of new organisations to enter the market for NHS primary care. If the new law is implemented it will sweep away many of the existing legislative, budgetary, and procedural barriers to innovation, initially through a range of pilot schemes. Full implementation could end general practitioners' monopoly of general medical services and permit experimental alternatives to the single national contract for general practitioners. Such pilots have the potential for creating better primary care, especially in inner cities, through new employment options, such as salaried posts. There are, however, considerable risks. For example, the legislation will allow piloting of new forms of vertically integrated provider organisations, thereby eroding the purchaser-provider separation established by the NHS changes of 1991. The proposals in the white paper also require local health authorities to develop primary care and regulate the pilot schemes at a time when they have lost many staff. To ensure equity of innovation pilots must emerge where primary care most needs improving and pilots must be evaluated thoroughly before they are applied widely. ADRIAN TAYLOR/THE INKSHED The launch of the primary care white paper, Choice and Opportunity ,1 last October was accompanied by a rash of newspaper headlines heralding a revolution in primary care provision. Reports said that pharmacy chains such as Boots and UniChem, American managed care organisations, and even the supermarket chains Tesco, Asda, and Safeway were considering offering primary care services.2 3 4 5 Since October, concern has been growing about the consequences of the imminent break up of the general practitioners' professional monopoly and about the risks of allowing hospitals or commercial organisations to provide primary care.6 7 8 Despite this, ministers have attempted to downplay the headlines and have …

Journal ArticleDOI
TL;DR: A new cohort of managers, skilled as change agents for linking-pin organizations, will be necessary to assure accountable management in an environment where no one unit, department, organization, and perhaps no system possesses all of the competencies necessary for provision of care.
Abstract: Advancing and managing individual organizational priorities and favorably positioning the organization within the wider system, while remaining within the system's vision, values, mission and strategic plan, constitutes the great the paradox of modern health care management. A new cohort of managers, skilled as change agents for linking-pin organizations, will be necessary to assure accountable management in an environment where no one unit, department, organization, and perhaps no system possesses all of the competencies necessary for provision of care.

Journal ArticleDOI
TL;DR: In this paper, the authors argue that equity should not be interpreted as strict equality, but rather in terms of improved fitness to purpose and relevance, with the goal of enhancing HBUs'status.
Abstract: This article examines equity relative to South Africa's historically Black universities (HBUs) in changing global and local circumstances. It argues that equity should not be interpreted as strict equality, but rather in terms of improved fitness to purpose and relevance in terms of global and basic development, with the goal of enhancing HB Us ' status. Small but significant innovations HBUs have made in community-oriented teaching, research, and outreach provide the basis for conceptualizing an alternative to the "market" university model. The multiple disadvantages suffered by HBUs under apartheid are described, and cross-national comparisons with U.S. universities are made. INTRODUCTION National development in the contemporary South African context involves a set of dual but competing challenges. On the one hand, it entails enhancing the country's participation in the high-technology, information-led global competitive arena. It also involves facilitating socioeconomic reconstruction and development to meet the basic needs of the majority of the nation's population. Higher education institutions in South Africa currently face formidable challenges as well as some promising opportunities amidst the context of transformation and reconstruction. As part of the broad changes preceding and following the first democratic elections in 1994, a legislative and policy framework for the restructuring of higher education was developed and outlined in the new government's "White Paper" policy document the transformation of higher education (Republic of South Africa Department of Education [RSADE], 1997) and the Higher Education Act of 1997. This new framework provides for a single, coordinated, programs-based system geared toward reversing the disparities, disadvantages, and dysfunctionality that characterize the present system. To this end, two main policy goals have been identified: first, the reduction within the system of apartheid-generated inequalities based on race, gender, and location; and second, the maximization of the contribution of higher education toward national and regional development. South Africa's 11 historically Black universities (HBUs)l have a crucial role to play in relation to these recent developments and policy goals. Established under apartheid as separate institutions for Black students, the intended purpose of the HBUs was to perpetuate the racially defined divided social order. Their primary function was to provide personnel for the separate homelands civil service structures and for the small, emerging Black middle class. Accordingly, they assumed particular institutional characteristics and academic cultures in which the overwhelming emphasis was (and has largely remained) on undergraduate teaching, concentrated in a narrow range of fields associated with the racial division of labor under apartheid-namely, health, education, social work, law, and public administration. The vast majority of HBU student enrollments comprised underprepared Black students. Faculty were generally junior and underqualified, and student success rates were comparatively low. Under the discriminatory and repressive conditions of apartheid, the HBUs were subject to severe financial and other disadvantages, with the result being that their institutional infrastructures are generally poor. Relative to the proposed national and institutional planning framework, a number of interrelated challenges face South Africa's HBUs. Among these are: redefining their institutional missions and functions; strategically identifying specialized and niche teaching and research programs; academically supporting underprepared students; developing appropriate curricula; promoting quality, effectiveness, and efficiency in all aspects of institutional life; and building academic, planning, and managerial capacity. Additionally, they face difficult financial planning choices under conditions of severe fiscal constraint. …

01 Jan 1997
TL;DR: This work from the "Personal Social Services Research Unit" looks back to the early stages of community care, comparing them with today's emerging policy with a view to improving community care still further.
Abstract: This work from the "Personal Social Services Research Unit" looks back to the early stages of community care, comparing them with today's emerging policy with a view to improving community care still further. The book describes the first stages of the local development of the community care policy reforms laid out in the 1989 Caring for People white paper and the subsequent 1990 NHS and Community Care Act. It spans the period between the mid-80s, when the policy initially began to crystallize, and the beginning of 1993, when the reforms were formally implemented. By "vision" the authors mean the underlying logic and content of policy in the broadest sense - about what might be potentially achieved, and by what means. "Reality" on the other hand refers to those elements of the community care world which are adapted and used to achieve the policy ends - structures,procedures, resources, values and commitments - the "real" world.

Journal ArticleDOI
TL;DR: A task group was formed to develop this white paper with representatives from the Manufacturing Engineering Laboratory, the Information Technology Laboratory, and Technology Services with a wide spectrum of experiences and perspectives on testing and measuring physical and IT quantities and suggested a scope and a conceptual basis for IT metrology.
Abstract: : In May 1996, NIST management requested a white paper on metrology for information technology (IT). A task group was formed to develop this white paper with representatives from the Manufacturing Engineering Laboratory (MEL), the Information Technology Laboratory (ITL), and Technology Services (TS). The task group members had a wide spectrum of experiences and perspectives on testing and measuring physical and IT quantities. The task group believed that its collective experience and knowledge were probably sufficient to investigate the underlying question of the nature of IT metrology. During the course of its work, the task group did not find any previous work addressing the overall subject of metrology for IT. The task group found it to be both exciting and challenging to possibly be first in what should be a continuing area of study. After some spirited deliberations, the task group was able to reach consensus on its white paper. Also, as a result of its deliberations, the task group decided that this white paper should suggest possible answers rather than assert definitive conclusions. In this spirit, the white paper suggests: a scope and a conceptual basis for IT metrology; a taxonomy for IT methods of testing; status of IT testing and measurement; opportunities to advance IT metrology; overall roles for NIST; and recapitulates the importance of IT metrology to the U.S. The task group is very appreciative of having had the opportunity to produce this white paper. The task group hopes that this white paper will provide food for thought for our intended audience: NIST management and technical staff and our colleagues elsewhere who are involved in various aspects of testing and measuring IT.



01 Jan 1997
TL;DR: The concept of Indian control of Indian education and the establishment of band-controlled schools developed at this time out of many public discussions and private negotiað fions.
Abstract: I Resume The period between the publication ofthe federal White Paper of 1969 and the acceptance of a new education policy by the government in 1973 was ofgreat importance to First Nations educators. The concept ofIndian control of Indian education and the establishment of Band-controlled schools developed at this time out of many public discussions and private negotia­ tions. This paper provides an overview of this development, and explores the oxymoron of Band control. The author argues that Band-controlled schools are simply a means for the perpetuation of the federal policy of assimilation.

Journal ArticleDOI
TL;DR: In this article, it was shown that resources went where the benefits to patients were greatest and, second, resources were appropriately allocated in terms of their opportunity cost once provision exceeded certain thresholds.

Journal ArticleDOI
22 Nov 1997-BMJ
TL;DR: The government faces the tricky task of coming up with a formula which recognises the potential benefits of a purchaser-provider split—greater accountability and responsiveness to local needs—without the competition, fragmentation, and transaction costs of an internal market.
Abstract: A white paper is expected in the next few weeks which will set out the UK government's vision for the NHS—possibly the most important document for the service since Working for Patients in 1989.1 The government faces the tricky task of coming up with a formula which recognises the potential benefits of a purchaser-provider split—greater accountability and responsiveness to local needs—without the competition, fragmentation, and transaction costs of an internal market. The role of district health authorities and their performance since 1991 will be central in their considerations. Much attention has recently been paid to health authorities' capacity to commission specialised services, such as those for haemophilia2 and cochlear implants,3 which account for about £1.4bn (6%) of NHS expenditure. Before 1991 these services were funded centrally and managed at a regional level. Since then responsibility has largely been devolved to districts. Yet despite some transitional arrangements to ensure continuity, specialist providers have felt increasingly vulnerable. Is such concern justified? An …


Book ChapterDOI
01 Jan 1997
TL;DR: The UK remained below 3 per cent for the next 25 years as mentioned in this paper, spanning the periods of office of both Labour and Conservative governments, reflecting the success of the postwar consensus to achieve full employment.
Abstract: In its 1944 White Paper on Employment Policy the wartime Coalition Government committed its postwar successors to eliminate the disease of mass unemployment which had plagued the economies of the industrial countries in the interwar years. Speaking for the Government in the House of Commons in June 1944 while London was under attack by flying bombs, the Minister of Labour, Ernest Bevin, said that ‘we can start out on this road this week and begin to say that we have left the old vexed disease of unemployment behind us’. For a long time this hope was fulfilled. Unemployment in the UK remained below 3 per cent for the next 25 years. This bipartisan achievement, spanning the periods of office of both Labour and Conservative governments, reflected the success of the postwar consensus to achieve full employment.

Journal ArticleDOI
08 Nov 1997-BMJ
TL;DR: The British government is working on a white paper to be published by the end of the year outlining its plans for replacing the NHS market, and the ability of the authors to translate aspirations into practical proposals will be the test.
Abstract: The British government is working on a white paper to be published by the end of the year outlining its plans for replacing the NHS market. The likely flavour of the white paper has already been indicated in ministerial speeches that have emphasised the government's desire to avoid another reorganisation, to pilot its own policies before they are implemented across the NHS, and to encourage cooperation and team working. The test will be the ability of the white paper's authors to translate these aspirations into practical proposals. Three central questions have to be addressed: If competition is to be abolished, should the separation between purchasers and providers be maintained? What will happen to general practitioner fundholding? And, without competition, what incentives will there be to improve performance, especially when funding is tight? The argument for ending the separation between purchasers and providers rests on the view that these responsibilities are intrinsic to the NHS market and that a commitment to replace the market should logically result in the integration of health authorities and NHS trusts. As experience has …


Posted ContentDOI
01 Jan 1997
TL;DR: In this article, an Extension public policy economist at Iowa State University is scheduled to testify before the Senate Committee on Agriculture, Nutrition and Forestry regarding rural capital issues, and his comments are grounded in the Rural Policy Research Institute's (RUPRI) Rural Finance Task Force white paper "The Adequacy of Rural Financial Markets." cited as one of the four studies for review and discussion at today's hearing.
Abstract: Mr. Chairman and Committee Members, I appreciate the opportunity to testify before the Senate Committee on Agriculture, Nutrition and Forestry regarding rural capital issues. Several perspectives inform my comments today. I am an Extension public policy economist at Iowa State University. I serve as a member of the Rural Policy Research Institute's (RUPRI) Rural Finance Task Force. Many of my comments are grounded in the RUPRI Task Force background white paper "The Adequacy of Rural Financial Markets." cited as one of the four studies for review and discussion at today's hearing. At the request of the ISU Vice Provost for Extension, I am leading a dialogue with a diverse group of spark plug rural community economic development and financial leaders on innovative rural capital projects in western Iowa. I am also a partner in a rural community housing development project. Finally, I have served as a city council member for Boone, Iowa population 12,500--a city that is wrestling with issues of economic development, infrastructure and housing from a rural community perspective.