Online research in philosophy

A response is given to the claim by Claxton and Culyer, who stated that the policies of the National Institute for Health and Clinical Excellence (NICE) do not evaluate patients rather than treatments. The argument is made that the use of values such as quality of life and life-years is ethically dubious when used to choose which patients ought to receive treatments in the National Health Service (NHS).

The United Kingdom's coalition government has just begun the most sweeping overhaul of the National Health Service since its inception.1 Under the reforms, 80 percent of the NHS budget will be handed over to about five hundred local consortia of primary care physicians, who will be empowered to make medical spending and allocation decisions for their patients. The 152 existing Primary Care Trusts (PCTs), which purchase hospital and community care for patients and oversee primary care physicians in their regions, will close their doors, leaving local doctors with the power to decide which interventions are appropriate, and which too expensive.2 Hospitals and community service providers will have greater freedom ..

Politicians will go to any lengths to persuade the voting public that the National Health Service is safe in their hands. Alternative policy models cannot be placed before the electorate unless political parties take huge risks. Yet, at the same time, we see even a Labour government drawing private finance into the health service and giving patients rights to use the private sector. This groundbreaking new study shows that, although politicians do not feel confident in proposing radical new models of healthcare, elite opinion in the media, in political circles, in academia and in policy think tanks has fallen out of love with the idea of a centrally planned health service provided and financed by government. Elite opinion does not, as yet, warm to a free market in healthcare. Although aspects of a market-based system are accepted, ideas of 'market failure' loom large - especially amongst the political class. Nevertheless, the author shows how some groups of opinion formers are prepared to be more radical. These groups, she believes, may in time be effective in promoting a vision of a market in healthcare that is free from government interference and from the stifling power of government-granted professional monopolies.

The NHS is an institution of great importance to everybody in the UK - not only doctors, nurses and other health professionals, but also to patients, carers and their families. However, problems within the NHS are regularly reported in the media and we are all anxious about waiting lists, about whether potential illnesses will be identified treated in time, about bleeding to death on trollies in corridors or being struck down by antibiotic-resistant superbugs. This engaging book aims to explore and simplify the issues from both sides of the NHS - professionals and patients - and to improve mutual understanding of the problems, which will hopefully spark an open debate about the future of health service provision. The book uses an innovative fictionalized account of the experiences of 'case study' individuals in the healthcare system, including a GP with depression, a woman with MS and a hospital manager whose wife has cancer. This book will be essential and enjoyable reading for anyone workingwithin the healthcare system, as well as patients and their families and anyone interested in the workings of the NHS.

The Private Finance Initiative (PFI) is a specific example of health care privatization within the British National Health Service. In this essay, I critically assess the ways in which various Private Finance Initiatives have increased health care efficiency and effectiveness, as well as encouraged medical innovation. Indeed, as the analysis will demonstrate, significant empirical evidence supports the conclusion that Private Finance Initiatives are a driving force of innovation within the British Health Care System.

Value in the British National Health Service have shifted away from patient care towards financial control. However, in the quest for efficiency , huge amounts of NHS money have been wasted on computer system which failed. In this paper, I draw on a case study to explore some of the ethical issues which underlie this kind of waste of resources. Issues include the gap between public pronouncements and personal experience, the chaos of which lies behind the facade of rationality, and the systematic silencing of people, usually women, who question the viability of computer systems which are created for private gain rather than public service.

Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on ‘consent’, look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of ‘choice’, focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations.

Last year (1998) saw the celebration of the 50th Anniversaryof the British National Health Service (NHS). One ofthe few completely nationalised systems of health carein the world, the NHS is seen by many as a moralbeacon of what it means to provide equitable medicaltreatment to all citizens on the basis of need andneed alone. However, others argue that it has failedto achieve the overall goals for which it was created.Because of scarce resources, some urgently needed careis not available at all, while that which is receivedis sometimes second class. For these reasons, it isclaimed that the NHS should be scrapped and replacedby other systems of health care delivery.This paper outlines the history of the NHS,indicating some of the problems and innovations whichhave led to its current organization and structure.The philosophical foundations of the NHS are then articulated and defended on the grounds that it stillrepresents a morally coherent and economicallyefficient approach to the delivery of health care.Scarce resources are the key problem facing the NHS,making rationing inevitable and it is shown thatthis is not incompatible with the moral foundations ofthe service. However, there can be little doubt thatthe NHS is now becoming dangerously under-funded. Thepaper concludes with arguments about why this is soand what might be done about it.

The UK government is setting up a new kind of organisation as part of the National Health Service, the foundation trust. Foundation trusts will be more distanced from government than existing NHS bodies, and will have closer community links. In this paper I identify the importance of legitimacy in health care and explore the potential situation of foundation trusts in terms of the bases of their legitimacy as organisations. Relationships with community, stakeholders and government are all considered as sources of legitimacy for foundation hospitals, and comparisons are made with other organisations, state, voluntary and private. I conclude that the blueprint of the foundation hospital creates a set of relationships which are incoherent and mutually conflicting, and conceals a crucial relationship with the state. I argue that these problems are likely to weaken the legitimacy of the foundation trust.