Self‐governance flows from the decision to fund NHS Services on the basis of agreed contracts. A self‐governing trust represents an extension of the accepted principle of…
Self‐governance flows from the decision to fund NHS Services on the basis of agreed contracts. A self‐governing trust represents an extension of the accepted principle of maximum devolution; it is not pursuing a separate course. In the South East Thames Region potential first‐wave trust candidates will have decided by the end of September 1989 whether to proceed with a formal bid. The Regional Health Authority has set up a project group to consider how best to take forward proposals for self‐governing trusts.
Indigenous peoples are often alienated from their lands and culture. This has arguably resulted in Indigenous peoples figuring disproportionately in the social and…
Indigenous peoples are often alienated from their lands and culture. This has arguably resulted in Indigenous peoples figuring disproportionately in the social and economic statistics. The right of self-determination is often touted as a panacea to these statistics. The focus of this paper is to rethink the notion of self-determination and examine whether the process afforded by the United Nations Decolonization Committee can assist or whether the sway of State politics and State power impedes this right for Indigenous peoples.
Fundamental hospital management reforms, enacted in 1990, focus oncompetition for National Health Service (NHS) contracts between publicand private hospitals and the…
Fundamental hospital management reforms, enacted in 1990, focus on competition for National Health Service (NHS) contracts between public and private hospitals and the option of self‐governing trust status for NHS hospitals. The need to challenge the status quo in the NHS is discussed. Initiatives leading to self‐governance are reviewed. The Freeman Hospital′s model for the cultural change which is prerequisite to self‐governance is presented. The Freeman Hospital, Newcastle upon Tyne, a national pilot site selected by the NHS Management Executive to develop new management systems and practices, is among the first self‐governing hospital trusts in the NHS.
Looks at industrial relations developments in the “first wave” of self‐governing trusts in the National Health Service. It finds that many are departing from the NHS′s traditional industrial relations model. There is a move from national to local bargaining and the predominant pattern is single table bargaining, as opposed to separate Whitley Councils for each functional group. In addition, to simplify the complex traditional model, negotiations in many trusts will be carried out effectively by representatives of only some of the staff organizations with members in the trust. Moreover unitarist exceptions to this still essentially pluralist pattern can be found in trusts, with examples of no union recognition, a single union deal and pay deals unilaterally determined by management.
The organization of the corporate marketing function has attracted increasing attention from marketers in the 1990s. This reflects both the significant conceptual…
The organization of the corporate marketing function has attracted increasing attention from marketers in the 1990s. This reflects both the significant conceptual developments in marketing theory and a questioning of the role of the centralized marketing department to organizations operating in post‐industrial service economies. Drawing on data from a broader research project into marketing activity in the acute health care sector in the United Kingdom, the paper examines the organizational solutions adopted by self‐governing hospitals in managing the marketing function. The core theme to emerge from the research is the imperative for such professional service organizations to facilitate the development of flexible, project focused marketing teams, effectively mirroring the notion of the buying centre, capable of integrating core technical professionals directly into the marketing process. Coupled to this is the notion of marketing professionals having to abdicate ownership, and even dominance, of the corporate marketing process.
The authors refer to their research into the role of facilities management (FM) within the National Health Service and local government in England and Wales. They compare…
The authors refer to their research into the role of facilities management (FM) within the National Health Service and local government in England and Wales. They compare the levels of FM awareness within these public bodies, the ability of FM managers to influence the decision‐making process, the relationship between these factors and the delivery of effective facilities management services and the relative importance given to FM in recent Government guidelines on best value in these two public services. Based on the findings of five research projects the authors have conducted in both sectors it illustrates how FM is not just a business opportunity but a rapidly expanding function that is gaining status as an important profession that warrants a high status in the strategic make‐up of both NHS Trusts and local government authorities.
Examines recent reforms of the UK′s National Health Service (NHS),and explores the pressures for change in the pursuit of an efficient NHSand the conflicts which this…
Examines recent reforms of the UK′s National Health Service (NHS), and explores the pressures for change in the pursuit of an efficient NHS and the conflicts which this causes in an organization which was based on the aim of equity. In particular, addresses the “false revolutions” of managerial change introduced after the Griffiths Report (1983) and the accounting changes introduced in the wake of the Griffiths proposals. Evidence shows that these intended revolutions were limited in impact. The result of these failures has been the introduction of the “real revolution” – the internal market in health care. This is a radical change in both the NHS management arrangements and in service delivery, with the division of the NHS into purchasers (health authorities and GP fund holders) and providers (hospital and community services, whether provided by private, voluntary or state‐owned facilities).
Considers the claims that the management standards developed by the Management Charter Initiative (MCI) reflect what is required of managers for effective job performance…
Considers the claims that the management standards developed by the Management Charter Initiative (MCI) reflect what is required of managers for effective job performance and that using the standards to train managers will lead to business benefits for organizations. Contends, however, that empirical evidence to support these substantial claims is not apparent. Argues that this evidence is necessary at a national policy level, at an organizational investment level and at the human resource functional level. Uses the example of a self‐governing hospital trust’s adoption of the management standards to illustrate the need to evaluate the MCI’s work rigorously. Presents a framework for evaluating the effectiveness of management training based on the management standards.
The purpose of this paper is to provide an overview of health priority setting structures in Germany. It reflects on how and which social values may influence decision…
The purpose of this paper is to provide an overview of health priority setting structures in Germany. It reflects on how and which social values may influence decision making, and in particular investigates the role of the Institute for Quality and Efficiency in Health Care (IQWiG) in integrating evidence‐based decision making into the German system.
The paper applies Clark and Weale's framework of analysis for Social Values and Health Priority Setting to the German context. Placing German health care decision making into Clark and Weale's framework allows for an analysis of the role and content of social values in different dimensions of decision making.
Germany has witnessed significant changes in its health care decision‐making procedures in recent decades. The establishment of the Institute of Quality and Efficiency in Health Care (IQWiG) represents an effort to introduce health technology assessment (HTA) as a formal element of decision making in health care. In doing so, Germany has made unique methodological and structural choices that reflect the social values and institutional traditions that underpin its self‐governing statutory health insurance (SHI) system. The empirical evidence suggests that the principle of solidarity is upheld as a core value in health priority setting in Germany.
The German case of health priority setting highlights some of the challenges involved when introducing centralised HTA structures to a self‐governing SHI system. As such, this paper contributes to an understanding of the different forms that HTA can take, what social values they embody and how they can affect health priority setting in different ways.
The UK Government′s White Paper on the National Health Service, 1989, defined a programme of action aimed at achieving two objectives: give patients, wherever they live, better health care and greater choice of the services available; and produce greater satisfaction and rewards for NHS staff who successfully respond to local needs and preferences. The Paper defines seven key measures, each designed to make its own vital contribution to those objectives. One of these was the introduction of self‐governing hospital trusts, and one of the primary concerns of the Boards of Directors set up to run each of the new Trusts will be the development of a clear customer service strategy; one which combines clinical excellence with the highest standards of customer care. The customer care element of that strategy must combine the best of tried and tested management and organisation theory, with common sense, realism and pragmatism.