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Recent changes in the English National Health Service (NHS) have introduced new complexities into the accountability arrangements for healthcare services. This commentary describes how the new organizational structures have challenged the traditional centralized accountability structures by creating a more dispersed system of governance for local health-care commissioners. It sets the context of discussions about accountability in the UK NHS and then describes the key changes in England following the implementation of the NHS reforms in April 2013. The commentary concludes that while there is increased complexity of accountability within a more decentralized and fragmented healthcare system, the government's goal of achieving increased local autonomy and greater control by general practitioners (GPs) will probably not be realized. In particular, the system will continue to have strongly centralized aspects, with increased regulation and central political responsibility.

Recent changes in the English National Health Service (NHS) have introduced new complexities into the accountability arrangements for healthcare services. This commentary describes how the new organizational structures have challenged the traditional centralized accountability structures by creating a more dispersed system of governance for local health-care commissioners. It sets the context of discussions about accountability in the UK NHS and then describes the key changes in England following the implementation of the NHS reforms in April 2013. The commentary concludes that while there is increased complexity of accountability within a more decentralized and fragmented healthcare system, the government's goal of achieving increased local autonomy and greater control by general practitioners (GPs) will probably not be realized. In particular, the system will continue to have strongly centralized aspects, with increased regulation and central political responsibility.

In recent years, the frequency and diversity of public health ethical dilemmas in the areas of health care and policy making have grown considerably. This book examines the principles and values that support an ethical approach to public health practice

Examines the relationship between welfare and health and includes discussion of policy issues, including changes in health care delivery and the tackling of health and social inequalities. This book also emphasises the significance of social policy in preventing ill health and disability, as well as supporting the sick and disabled people

Abstract The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. 'Patient choice' policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of 'choice' might not necessarily be the 'local' provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients' access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio‐economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients' willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice.

Alford's theory of structural interests in health care has been used as a heuristic device both in the USA and the UK. Despite concerns about its heuristic power it provides a lucid analytical framework and is helpful in exposing the structural interests that underpin political processes in health systems. To date its application in the UK has been primarily in relation to an NHS dominated by health authorities and hospital providers. Recent reforms in the UK have created a new context dominated by primary care organizations. In this paper we identify the key players in English primary care groups as they relate to Alford's structural interest groups: the professional monopolizers, corporate rationalizers and community. The paper outlines the context of the involvement of the key groups and then analyses the relationships between them. In doing so it raises concerns about the structure and purpose of primary care groups and the probability that key tensions between general practitioners who adopt a corporate rationalizer role and those who retain a professional monopolizer role will be damaging to the progress and development of PCGs. Our analysis also highlights the continuing weakness of the community as an interest group despite the emphasis on involving patients and the public. Importantly, we would suggest that the professional monopolizers among GPs will retain a powerful voice, countering the new corporate rationalizers and continuing to claim that they represent the community's interests.

There is an increasing awareness that policies do not succeed or fail on their own merits. Within complex messy systems, it is unclear how best to ensure effective policy design and implementation. However, rather than just let policies drift into full or even partial failure, governments are now beginning to take an interest in ways in which the policy process – especially the implementation phase – can be strengthened and supported. This article contributes to the debate in three ways: by unpicking the key factors behind policy failure; by exploring different approaches to policy support; and by identifying key messages for policy practitioners.

There is an increasing awareness that policies do not succeed or fail on their own merits. Within complex messy systems, it is unclear how best to ensure effective policy design and implementation. However, rather than just let policies drift into full or even partial failure, governments are now beginning to take an interest in ways in which the policy process–especially the implementation phase–can be strengthened and supported. This article contributes to the debate in three ways: by unpicking the key factors behind policy failure; by exploring different approaches to policy support; and by identifying key messages for policy practitioners.

AbstractThis paper is concerned with the language of policy documents in the field of health care, and how 'readings' of such documents might be validated in the context of a narrative analysis. The substantive focus is on a comparative study of UK health policy documents (N= 20) as produced by the various assemblies, governments and executives of England, Scotland, Wales and Northern Ireland during the period 2000–09. Following the identification of some key characteristics of narrative structure the authors indicate how text-mining strategies allied with features of semantic and network analysis can be used to unravel the basic elements of policy stories and to facilitate the presentation of data in such a way that readers can verify the strengths (and weaknesses) of any given analysis – with regard to claims concerning, say, the presence, absence or relative importance of key ideas and concepts. Readers can also 'see' how the different components of any one story might fit together, and to get a sense of what has been excluded from the narrative as well as what has been included, and thereby assess the reliability and validity of interpretations that have been placed upon the data.