For thirty years it has been government policy to shift the balance of mental health care from institutional to community care. But progress towards the objectives of ‘normalisation’ and integration of individuals with a mental health problem in the wider community has been slow. The...

The general aim of this one-year project, funded by the Department of Health and in collaboration with CASPE, has been to investigate the relationship between case-mix and nursing workload measures. Specifically, this report focuses on the underlying issue of examining methodologies and...

A pilot scheme for general practitioner open-access to physiotherapy began with the Tormorden practice in June 1985. This pilot scheme was studied by the authors for a thirteen-month period between August 1985 and September 1986 to establish the main cost-benefit implications of providing such a...

It is remarkable how health care systems, created over decades and influenced by very different cultures exhibit similar problems. Most health care systems are compartmentalised with managers at margins responding to perverse incentives and seeking to shift patients and costs onto rival...

The NHS embodies the statutory package of health care services and is subject to a considerable quantity of legislation, regulation and guidance. We provide an overview of the benefit basket in England, clarifying the actors and decision making framework involved by describing the principles...

The introduction of competition between health care providers in the NHS has been advocated as a means of promoting efficiency. In this paper we review one model of competition, internal markets, in which health authorities would be able formally to contract to buy and sell clinical services...

The use of postmenopausal hormone replacement therapy (HRT) has received much attention both in the medical and lay press in recent years. There is considerable pressure to extend the use of HRT both as a method for relieving the distressing symptoms of menopause and also as a prophylactic...

The total number of nursing and midwifery staff rose by 17 per cent from 1976 to 1982. The aim of this paper is to provide a detailed analysis of what this substantial investment actually meant in terms of grades, types of hospital and region. Total numbers in the general hospitals rose by 24...

This paper consists of the report of an option appraisal. It is exactly in the form in which it was presented to the Management Team and the Authority in the DIstrict to which it relates. The only changes are that ficticious names have been substituted for the originals to maintain anonymity....

We report estimates of output growth for the National Health Service in England over the period 2003/4 to 2006/7. Our output index is virtually comprehensive, capturing as far as possible all the activities undertaken for NHS patients by both NHS and non-NHS providers across all care settings....