21 results
Polygenic association between attention-deficit/hyperactivity disorder liability and cognitive impairments
- Isabella Vainieri, Joanna Martin, Anna-Sophie Rommel, Philip Asherson, Tobias Banaschewski, Jan Buitelaar, Bru Cormand, Jennifer Crosbie, Stephen V. Faraone, Barbara Franke, Sandra K. Loo, Ana Miranda, Iris Manor, Robert D. Oades, Kirstin L. Purves, J. Antoni Ramos-Quiroga, Marta Ribasés, Herbert Roeyers, Aribert Rothenberger, Russell Schachar, Joseph Sergeant, Hans-Christoph Steinhausen, Pieter J. Vuijk, Alysa E. Doyle, Jonna Kuntsi
-
- Journal:
- Psychological Medicine / Volume 52 / Issue 14 / October 2022
- Published online by Cambridge University Press:
- 03 February 2021, pp. 3150-3158
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
A recent genome-wide association study (GWAS) identified 12 independent loci significantly associated with attention-deficit/hyperactivity disorder (ADHD). Polygenic risk scores (PRS), derived from the GWAS, can be used to assess genetic overlap between ADHD and other traits. Using ADHD samples from several international sites, we derived PRS for ADHD from the recent GWAS to test whether genetic variants that contribute to ADHD also influence two cognitive functions that show strong association with ADHD: attention regulation and response inhibition, captured by reaction time variability (RTV) and commission errors (CE).
MethodsThe discovery GWAS included 19 099 ADHD cases and 34 194 control participants. The combined target sample included 845 people with ADHD (age: 8–40 years). RTV and CE were available from reaction time and response inhibition tasks. ADHD PRS were calculated from the GWAS using a leave-one-study-out approach. Regression analyses were run to investigate whether ADHD PRS were associated with CE and RTV. Results across sites were combined via random effect meta-analyses.
ResultsWhen combining the studies in meta-analyses, results were significant for RTV (R2 = 0.011, β = 0.088, p = 0.02) but not for CE (R2 = 0.011, β = 0.013, p = 0.732). No significant association was found between ADHD PRS and RTV or CE in any sample individually (p > 0.10).
ConclusionsWe detected a significant association between PRS for ADHD and RTV (but not CE) in individuals with ADHD, suggesting that common genetic risk variants for ADHD influence attention regulation.
Impact of brief education on healthy seniors’ attitudes and healthcare choices about Alzheimer's disease and associated symptoms
- Robyn E. Waxman, Barbara J. Russell, Oscar C. T. Iu, Benoit H. Mulsant
-
- Journal:
- International Psychogeriatrics / Volume 30 / Issue 12 / December 2018
- Published online by Cambridge University Press:
- 03 May 2018, pp. 1889-1897
-
- Article
- Export citation
-
Objective:
The primary objective of this study was to determine whether a brief education session about Alzheimer's disease (AD) stages and associated behavioral and psychological symptoms of dementia (BPSD) changes healthy seniors’ treatment choices. A secondary objective was to determine whether pharmacotherapy to reduce BPSD would be preferred over other potentially more restrictive interventions.
Methods:Participants (n = 32; 8 men; aged > 64years; no self-reported dementia diagnosis) were assigned to one of ten group sessions during which they received information about AD and BPSD. Our a-priori hypotheses were: (1) education about AD stages significantly changes care preferences in moderate and severe stages, i.e. less active treatment options (no CPR/hospitalization) are chosen as the disease progresses; and (2) most participants prefer pharmacotherapy over restraints and seclusion to manage BPSD. The main outcome measure was a change in the interventions chosen including CPR and hospitalization. Participants completed three questionnaires and two decisional grids before and after the information session. Qualitative data were derived from discussions during the session.
Results:Participants expressed a wide range of attitudes about AD, BPSD, and their management. Those who are born in Canada, had a proxy, and a university education, each have around half of the odds of receiving treatment compared to those in the complementary group. (OR 0.47, 0.40, 0.43) Finally, not knowing someone with AD increases the odds of wanting a treatment by around six times (OR 6.4). Pharmacological measures were preferred over restraints.
Conclusions:Education about dementia and advance directives should consider the person's educational background and experience with dementia. Discussing BPSD may impact a person's advance directives and preferences.
Contributors
-
- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
-
- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
-
- Chapter
- Export citation
Contributors
-
- By Andrew Adesman, Lenard A. Adler, Samuel Alperin, Kira E. Armstrong, L. Eugene Arnold, Amy F. T. Arnsten, Russell A. Barkley, Craig W. Berridge, Joseph Biederman, F. Xavier Castellanos, Barbara J. Coffey, Alison M. Cohn, C. Keith Conners, Joan M. Daughton, Stephen V. Faraone, John Fayyad, Lisa G. Hahn, Laura Hans, Elizabeth Hurt, Gagan Joshi, Rahil Jummani, Jesse M. Jun, Ronald C. Kessler, Scott Haden Kollins, Kimberly Kovacs, Christopher J. Kratochvil, Beth Krone, Nicholas Lofthouse, Michael J. Manos, Francis Joseph McClernon, Joel E. Morgan, Nicholas R. Morrison, Sonali Nanayakkara, Jeffrey H. Newcorn, Phillip L. Pearl, Juan D. Pedraza, Guy M. L. Perry, Steven R. Pliszka, Jefferson B. Prince, J. Russell Ramsay, Anthony L. Rostain, David M. Shaw, Mary V. Solanto, Mark A. Stein, Jonathan R. Stevens, Brigette S. Vaughan, Margaret Weiss, Roy E. Weiss, Timothy E. Wilens, Janet Wozniak
- Edited by Lenard A. Adler, New York University School of Medicine, Thomas J. Spencer, Timothy E. Wilens
-
- Book:
- Attention-Deficit Hyperactivity Disorder in Adults and Children
- Published online:
- 05 February 2015
- Print publication:
- 08 January 2015, pp vii-x
-
- Chapter
- Export citation
List of tables
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp iv-iv
-
- Chapter
- Export citation
one - Introduction
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 1-10
-
- Chapter
- Export citation
-
Summary
I used to pore over the latest offerings from various highly reputable academic or scholarly quarters, and find nothing of any real practical help. (Tony Blair, cited in Powell, 2011)
During the 2000s there was a great deal of rhetoric about evidencebased policy and evidence-based policy-making (Davies et al, 2000; Perkins et al, 2010). However, policy and policy-making often appear to be rather more based on the existing ideas (or even prejudices or ideologies) of those in positions of power rather than on research evidence. And there are several reasons for this.
Policy-makers may believe they already know what needs to be done, and so do not need to examine what research says. Equally, those in positions of power may find research inaccessible in terms of its place of publication, or that it is written in dense, academic language they find difficult to understand. They may also find research to be too equivocal, too concerned with trying to consider both sides of a problem than coming to a conclusion or solution that they can get on with turning into a workable policy. Policy-makers may also have strong views about what needs to be done by government, regardless of what researchers are telling them, often seeming to put their own political goals ahead of research, and their ideology ahead of evidence.
When looking back at NHS reorganisations, it does seems to be the case that since the 1980s policy-makers have been unable to resist changing organisational structures, not even waiting to see if the last changes they attempted to put into place had worked or hadn’t. Secretaries of State for Health have sometimes seemed as if they are intent on leaving their own impression on the NHS organisation without considering whether what they are planning to change has any real chance of working.
From the perspective of academics and researchers, on the other hand, policy-makers and politicians often appear to have short attention spans and do not want to engage with the complexities of the area they are trying to change. Politicians can sometimes look as if they have decided what needs to be done without looking at lessons from the past or from other countries.
Frontmatter
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp i-ii
-
- Chapter
- Export citation
Reforming Healthcare
- Ian Greener, Barbara E. Harrington, David J. Hunter, Russell Mannion, Martin Powell
-
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014
-
Reforming Healthcare: What's the Evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics.
Contents
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp iii-iii
-
- Chapter
- Export citation
three - Reorganising the NHS, 1990–2010
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 29-52
-
- Chapter
- Export citation
-
Summary
Chapter Two explored the Conservative government's attempts to reorganise healthcare in the 1980s, taking this account up to the introduction of the internal market at the end of that decade.
Having outlined the political and ideational context into which the internal market was being introduced at the end of Chapter Two, we now consider the programme theory for it. How was the internal market meant to work?
This chapter first considers the programme theory of the effects of the 1990s internal market reorganisation, before taking the story on to the change in government in 1997and New Labour's various attempts to reorganise healthcare in the 2000s. Chapters Four and Five then consider the evidence from Labour's healthcare reorganisations, before turning to the coalition government's 2010 Health and Social Care Bill.
Purchaser–provider split and the internal market
The logic underlying the programme theory of the purchaser–provider split was that it would allow purchasers to use their funding decisions to reward good providers of care with contracts, giving all providers a funding incentive to improve the quality of their service, and creating the opportunity for successful services to expand (Day and Klein, 1991). The internal market was also meant to incentivise purchasers to find the best value and best quality care for the people they were serving. The government believed that the introduction of market-like governance into the NHS would improve its performance by increasing efficiency and productivity, while at the same time raising quality and reducing the wasted ‘resources on excessive administration’ (Le Grand, 1991, p 1262) that they regarded as coming from a traditional public sector bureaucracy. The internal market represented an internal or wholesale market (in contrast to New Labour's later external, retail market) in that NHS managers were supposed to be working on behalf of patients as their agents, rather than patients being responsible for driving the process of choosing care for themselves. Patients, however, had limited choice or say in their healthcare apart from through GP fundholding and a very limited number of ‘extra contractual referrals’ (ECRs), which were quasi-individual contracts rather than making use of the more usual block contacting process.
References
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 155-178
-
- Chapter
- Export citation
six - The prospects for NHS reorganisation post-2010
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 113-146
-
- Chapter
- Export citation
-
Summary
Introduction
But of all the changes that were enacted by the 2012 Health and Social Care Act, the decision to abolish a large proportion of the organisations that comprise the NHS in order to replace them with a whole new set of organisations that only those with the most arcane interest in NHS management structures will ever be able to tell apart is probably the least useful. (Taylor, 2013, pp 85-6)
Chapter One opened with a quote from Roger Taylor suggesting that NHS reorganisations have achieved little other than changes in ‘letterheads and job titles’. What the evidence presented in the first five chapters suggests is that the common currency of healthcare reorganisation contains rather fewer examples of successful change than we might hope. There are, however, also some successes from which we can learn.
This book has considered research examining the NHS reorganisations of the 1980s and 1990s, and in more depth, those attempted by Labour, especially during the 2000s, elaborating the central control and local dynamic programme theories that underpinned their reorganisations of the NHS in England during that decade, to produce more detailed accounts of what appears to work, and also how, and under what circumstances.
Although central control mechanisms have been shown to be problematic in hospital settings, the QOF in the area of general practice has shown there is potential for their adaptation. Local dynamic mechanisms, such as patient choice and competition, and PPI, demonstrate isolated examples of working well, but are areas where it is far more difficult to produce a detailed programme theory that shows how reorganisation can work well because of the significant problems they have encountered in both policy design and implementation.
This chapter explores what these elaborated programme theories can tell us about NHS reform after 2010. Following the general election that year, the coalition government put in place a radical programme of reorganisation for the NHS in England, courting significant controversy in the process, and resulting in changes that have been referred to as the most significant in the history of the NHS (Hunter, 2011). This chapter considers the nature of the coalition government's reorganisation, and the prospects for it working based on research evidence from previous chapters.
four - ‘Central control’ reorganisation in the NHS in the 2000s
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 53-82
-
- Chapter
- Export citation
-
Summary
The context of health policy in the 2000s
Attempting to reorganise the NHS so that there is a stronger means of managing the performance of healthcare organisations is not a new idea. Performance indicators were first introduced in the 1970s and were extended during the 1980s, with the first comprehensive national performance data set disseminated in September 1983 to local health authorities in a series of ‘grey books’ (Pollitt, 1985). In 1991, and marking the creation of the internal market, these performance indicators were relabelled health service indicators. By the end of the decade their use was still largely an ‘external’ exercise where ratings were published once a year and league tables constructed, apparently mostly with the public (or at least the media) as their intended audience, but with few penalties for NHS trusts rated as the worst performers, and few rewards for those graded as performing well.
This chapter considers how Labout put in place a series of organisational changes based around the goal of achieving greater ‘central control’ over implementation (or ‘delivery’, as it became known) during the 2000s. It considers the use of performance management systems in both hospitals and GP surgeries, but with, we will argue, very important differences that affected the relative successes of such systems in those different contexts. Because the context here has already been outlined to some extent in Chapter Three, there is necessarily some repetition in order both to be clear about the policy environment of the 2000s, but also to try and make each chapter as free-standing as possible in terms of content. We hope that presenting the material in this way adds to clarity without putting readers off.
As noted in Chapter Three, there were signs from 1997 and 1998 that Labour wanted to tighten central control over policy implementation, but it was not until the publication of the NHS Plan in 2000 (Secretary of State for Health, 2000) that the new direction became fixed. The NHS Plan marked the beginning of a period of increased investment in the NHS, raising the proportion of gross domestic product (GDP) spent on healthcare in the UK to around the European Union (EU) average from being around 2 percentage points below.
Acknowledgements
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp v-vi
-
- Chapter
- Export citation
Index
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 179-186
-
- Chapter
- Export citation
two - The NHS in 1990
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 11-28
-
- Chapter
- Export citation
-
Summary
Introduction
The aim of this chapter is to provide the context for the rest of the book, exploring the NHS in 1990 in terms of its organisational structure and dynamics at that time. In an institution like the NHS, where understanding history is important to get a sense of why particular structures were put in place or what kinds of relationships exist between policy-makers and staff, this necessarily involves going back before 1990. However, we attempt to include only the elements of NHS history that are most relevant to understanding the material in the rest of the book.
The chapter proceeds by presenting the background to health organisation and policy in 1990 to provide a starting point for the account of subsequent reorganisations, exploring in more depth attempts at reorganisation during the 1980s (especially the Griffiths management reforms and the Working for patients internal market) in order to construct the ‘shared version’ of health politics in 1990s which provides the starting point, and context, for the book's analysis.
Background
The central organisational relationship in health policy and politics in the first decades of the NHS was that which existed between the state (broadly speaking, the government of the day) and the medical profession. Klein (1990) captures the relationship in characteristically vivid terms as being a ‘double bed’ of mutual dependence, with the medical profession dependent on the state which was effectively the monopoly employer of their services (outside of a very small private sector), and the state, at the same time, dependent on the medical profession to both run the NHS, and to ration its care within the resources available. Although the relationship was one of dependence, that did not mean that conflict could not occur or even become public (as it certainly did during negotiations over medical contracts in the 1960s and during industrial disputes in the 1970s), but it did mean that both the state and the medical profession had little alternative but to try and work with one another to make the best of the situation.
The period 1948–81 was, in retrospect, one of remarkable continuity and relative calm in respect of NHS organisation and policy.
five - Local dynamic reform in the NHS since 2000
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 83-112
-
- Chapter
- Export citation
-
Summary
Introduction
For much of the history of the NHS, individual hospitals, GP surgeries and community health providers have been only indirectly linked to the Department of Health. The government has set the budget of the NHS, and put in place new organisational structures (as it did in 1974 and 1990), but for the most part, the day-to-day activities of most health organisations have been remarkably insulated from the control of influence of the organisational tiers above them, or from government itself. The previous chapter explored how this changed during the 2000s, when a performance management system was put in place that imposed a great deal more central control on both hospitals and GP practices, to varying degrees of success. This chapter explores how policy-makers attempted to get health organisations to improve by putting in place what we have called ‘local dynamic’ mechanisms to attempt to drive improvements.
‘Local dynamic’ mechanisms differ from central control reform mechanisms in that, although they are imposed centrally by government, they attempt to create locally based dynamics that may vary in operation from context to context, but that seek to generate improvement in a self-sustaining way. Central control mechanisms such as performance management require a central department to put in place incentives to improve by monitoring the activities of organisations, measuring them, and responding appropriately by either rewarding good performance or penalising bad. Local dynamic mechanisms, in contrast, attempt to generate mechanisms by which organisations can become selfimproving, and so do not need the continual intervention of a central department.
The two mechanisms are summarised below, in Table 5.1.
Chronologies of health policy during the 2000s, and indeed the accounts of government advisers (Warner, 2011), suggest that the early part of the decade was dominated by central control measures, after which a more concerted attempt was made to introduce local dynamic mechanisms (often alongside the central controls) (Greener, 2004b; Stevens, 2004). The director of the Prime Minister's Delivery Unit suggested that by the mid-2000s top-down performance management systems (central control) were running up against their limits, and further improvements needed a new, bottom-up philosophy of improvement instead (local dynamic) (Barber, 2007).
seven - Conclusion
- Ian Greener, Barbara E. Harrington, Northumbria University, David J. Hunter, Newcastle University, Russell Mannion, University of Birmingham, Martin Powell
-
- Book:
- Reforming Healthcare
- Published by:
- Bristol University Press
- Published online:
- 25 February 2022
- Print publication:
- 03 June 2014, pp 147-154
-
- Chapter
- Export citation
-
Summary
But rather than looking – again – for a structural answer that will work the same way everywhere right across the country, maybe it's time for more emergent models, more experimentation, and more diversity. (Stevens, 2011)
Introduction
In July 2013, the government withdrew its plans to put in place minimum unit alcohol pricing and plain tobacco packaging in England on the grounds that there was insufficient evidence to support these proposals, and despite Scotland already progressing such ideas. As such, three years after the general election of 2010, the government was still claiming that its approach to healthcare was evidence-based, albeit in the face of (in relation to these plans at least) considerable scepticism from the media and public.
This chapter considers what it means to be concerned about evidence and health reorganisation, and restates the book's central ideas and findings.
Evidence and policy
The ideal model of the link between evidence and policy has the former informing the latter, with policy then being carefully evaluated before creating new evidence on which new policy is based, in a virtuous circle stretching off into the future. But we know this doesn't happen. Policy-makers can come with their own ideas, evidence can be more equivocal or technical than policy-makers might like, and the best of intentions on both sides may be derailed by miscommunication and the urgency of problems of the day taking priority over a more careful, reflective approach. Health policy, be it at the local or national level, often appears to be as much about the influence and importance of particular individuals over the process as their mastery of research evidence (Oliver et al, 2012).
Equally, assuming that evidence-gathering and synthesis is a purely technical process that can produce unequivocal answers that are guaranteed to work is both to deny human agency and to raise the expectations of policy-makers and the public to a level that cannot possibly be met. Researchers have an obligation to be measured and cautious in their recommendations, as well as being aware of the limitations of their own work. Making recommendations for policy is too important to not contain caveats and make clear the need for contextualisations. If this frustrates policy-makers, who might want simple answers about ‘what works’, then perhaps the fault lies with those seeking simple answers to complex problems rather than with researchers attempting to better understand the world.
Limb distribution, motor impairment, and functional classification of cerebral palsy
- Jan Willem Gorter, Peter L Rosenbaum, Steven E Hanna, Robert J Palisano, Doreen J Bartlett, Dianne J Russell, Stephen D Walter, Parminder Raina, Barbara E Galuppi, Ellen Wood
-
- Journal:
- Developmental Medicine and Child Neurology / Volume 46 / Issue 7 / July 2004
- Published online by Cambridge University Press:
- 07 July 2004, pp. 461-467
- Print publication:
- July 2004
-
- Article
- Export citation
-
This study explored the relationships between the Gross Motor Function Classification System (GMFCS), limb distribution, and type of motor impairment. Data used were collected in the Ontario Motor Growth study, a longitudinal cohort study with a population-based sample of children with cerebral palsy (CP) in Canada (n=657; age 1 to 13 years at study onset). The majority (87.8%) of children with hemiplegia were classified as level I. Children with a bilateral syndrome were represented in all GMFCS levels, with most in levels III, IV, and V. Classifications by GMFCS and ‘limb distribution’ or by GMFCS and ‘type of motor impairment’ were statistically significantly associated (Pearson's χ2p<0.001), though the correlation for limb distribution (two categories) by GMFCS was low (tau-b=0.43). An analysis of function (GMFCS) by impairment (limb distribution) indicates that the latter clinical characteristic does not add prognostic value over GMFCS. Although classification of CP by impairment level is useful for clinical and epidemiological purposes, the value of these subgroups as an indicator of mobility is limited in comparison with the classification of severity with the GMFCS.
Health-Care Rationing: Critical Features, Ordinary Language, and Meaning
- Barbara J. Russell
-
- Journal:
- Journal of Law, Medicine & Ethics / Volume 30 / Issue 1 / Spring 2002
- Published online by Cambridge University Press:
- 01 January 2021, pp. 82-87
- Print publication:
- Spring 2002
-
- Article
- Export citation
-
The purpose of this article is to re-visit how rationing is defined for a health-care context, Two reasons justify returning to this topic. First, the variability as to how rationing has been defined in the legal, medical, and philosophical literature justifies a careful examination to identify its critical features. Second, I believe that if the definitions typically employed in the literature, several of which are discussed below, are compared to those that would be offered by the American public, ethically weighty dissimilarities would be apparent. Disparate characterizations are worrisome because serious “disconnections” between policymakers’ understandings, rhetoric, and priorities and those of the general public are more likely.