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This chapter discusses the NICE IP (interventional procedures) Programme, which is intended to introduce new interventional procedures safely into the NHS. The basic requirements for achieving this remain the same as they were when it was formally established by the Department of Health in 2003: where there are uncertainties about the evidence on a new interventional procedure, clinicians should take special care to inform their trust clinical governance lead that they are planning to undertake it, tell the patient about those uncertainties, audit and publicize their results.

This chapter introduces PRUComm, the English national policy research unit in commissioning and the healthcare system funded by the Department of Health and Social Care Policy Research Programme and itsresearch programme on that subject. It then discusses the concept of commissioning in respect of healthcare in the English National Health Service. The theoretical basis for the research, being principally realist approaches to policy analysis; socio legal theory and institutional economics is then expounded and related to the research. Each subsequent chapter is then summarised.

This chapter examines funding and bureaucracy issues that may influence the operation of palliative care teams in acute hospitals in Great Britain. It describes the bureaucratic structure of the National Health Service (NHS) and explains the roles of the NHS Hospital Trusts, the Healthcare Commission, the Acute Trusts, and the Foundation Trusts relevant to the palliative care team. It suggests that a detailed understanding of the structure of the wider NHS as well as the way the team's hospital, locality, and network function operates at a strategic level is essential if the team is going to develop its service effectively.

Most of the history of communication skills knowledge and teaching derives from work and studies done in general medicine, or further afield, rather than in cancer care. Cancer care has been advanced in attempting, as this book reflects, to codify the processes required to accomplish some key goals: to help cancer patients to accept their diagnosis and prognosis; to accept or reject tests and difficult treatments according to their core preferences; to participate in studies; to enable them to participate meaningfully when curative care is futile; and to facilitate dying with dignity. The importance of communication in medicine generally was understood by prehistoric human healers. In 1995, the American Academy on Communication in Healthcare published its authoritative reference text, which covered clinical care, education, and research as an exposition of communication training for internal and family medicine. Since then, although there have been serial syntheses and consensus efforts (always a moving target), the core principles of communication skills training have remained quite stable, once one translates the babble of new language for common concepts.

A case study is presented of three countries that followed the Cuban model and provided an assessment of the needs of the disabled. Venezuela, Bolivia, and Ecuador are studied in some depth, and an analysis is provided of the impact of Cuban-led nationwide campaigns for healthcare reform to assist the disabled.

This chapter considers the legal status of the human embryo in vitro. It begins by considering the legal categories available and concludes that there are two: person or chattel. It then considers the force of an analysis classifying the embryo as a person and the weaknesses of some contrary analyses classifying the embryo as property or as akin to property. It analyses two leading cases, the US case of Davis v Davis and the English case of Evans v Amicus Healthcare, both of which effectively adopted a property classification. It criticises the judgments for failing adequately to address the ontological status of the embryo. It also criticises the judgments for basing themselves on the current criminal law relating to abortion and the civil law relating to negligently inflicted pre-birth injury, instead of on the criminal law’s historical purpose of protecting human life from its beginning.

This chapter examines the internal divisions within the labor movement that jeopardized workers’ chances to win their union at Santa Rosa Memorial Hospital (SRMH). More specifically, it considers the internecine struggle between the Service Employees International Union (SEIU) and the National Union of Healthcare Workers (NUHW) as hospital workers fought a third and final round for their union. It also discusses the different visions of unionism represented by the two sides in the conflict, visions that map onto an ongoing debate within labor scholarship between “top-down” and “bottom-up” unionism. Finally, it explores how the trusteeship undermined the St. Joseph Health System campaign and forced SRMH workers to take ownership of the campaign in ways they had not been asked to before. It suggests that the two visions represented in the conflict were not mutually exclusive; indeed, a successful labor movement likely requires their convergence.

This chapter examines frauds instigated by major hospitals. A company's fixation on financial performance, especially bottom-line profits and stock market prices, may lead to overcharges, false billings, upcoding, and kickbacks as well as accounting and financial fraud. Accounting fraud occurs when accounting documents and journal entries are manipulated to hide the embezzlement or the misappropriation of funds. Accounting fraud also forms the foundation for financial fraud. This chapter considers three cases of health care fraud and abuse involving Tenet Healthcare Corporation, the Hospital Corporation of America, and HealthSouth. It also discusses anti-trust violations that drive up costs and reduce the quality of health care, with particular attention to frauds committed by both large and small health care institutions. The chapter concludes with an analysis of organized crime's involvement in health care fraud.

Throughout the legislative odyssey of federal policy on comparative effectiveness research from 2002 to 2008, the specifics of the policy took many different forms. While opponents to federally-mandated comparative effectiveness research objected to the policy entirely, proponents of the policy were divided as to where the function should be housed (inside the federal government or outside); how it should be financed (congressional appropriations or fees levied on public and private health insurers and health plans), and how it should be governed (how much representation should each stakeholder have on a governing board). Every specification has its advantages and disadvantages. The two federal mandates currently in force for comparative effectiveness research—the 2003 Medicare Modernization Act and the 2010 Affordable Care Act—differ markedly in placement, financing, governance, research priority-setting methods, and processes, illustrating the fact that every alternative is a balance between advantages and disadvantages.

Hong Kong’s economic problems since 2000 are the official excuse for cuts in social spending. But the problems themselves are the outcome of deliberate choices made by Chief Executives and Financial Secretaries. These decisions were not forced on the SAR government by business leaders, even though their main aim was to promote business interests regardless of the adverse consequences for ordinary families and for the needy and disabled individuals. These policies were a legacy from the colonial era and reflect a deeply-rooted culture shared by the business and professional classes as well as the civil service.

When a political system is as dominated by business interests as it is in Hong Kong and where social expenditure is not permitted to hinder the pursuit of profits, the credibility of both the policy makers and their decisions must always be in danger. However, this chapter shows that the community does not judge the government and its merits by the social benefits which it provides. Income inequality does not provoke unrest, and the affluent do not arouse envy, however unfairly the workforce is rewarded for its sustained high productivity and its resilience. Incompetence is criticised, but is not politically fatal. The real test of Chief Executives and their ministers turns out to be mostly about their ethics.

Housing is the single biggest factor in determining a family’s quality of life and is for most people their single biggest investment. Hong Kong housing standards have long been disgraceful. The SAR government has slashed public housing budgets, and the private sector has become increasingly unaffordable in this century. The current crisis is the predictable but preferred outcome of official policies. It can also be shown to be an unnecessary concession to the developers.

Efforts to increase social expenditure by professionals in the health and welfare sectors were beleaguered by the financial and bureaucratic barriers erected by the colonial administration. The more generous funding allocated to health, education and welfare in the 1990s was too little to make up for earlier decades of under-spending. The future major social services were under serious threat as British rule was coming to an end. Opposition to social expenditure was gathering strength because of the growing prestige of the business model as the key to public sector efficiency. The social reforms had come so late in the colonial era that they were easily reversed.

The chapter reviews a catalogue of policy decisions which aggravated rather than relieved the physical and mental distress of those least able to care for themselves. In both the health and the welfare fields, individuals and their families, suffered from mistreatment that ranged from uncaring to callous. The government-business nexus was convinced that social expenditure was a luxury that threatened even the world’s richest economies with ruin and which Hong Kong could not afford. Nevertheless, the poverty created by Hong Kong’s Third World legacy and the current shortfalls in social expenditure could not be dismissed indefinitely.

Comprehensive Social Security Assistance (CSSA) is widely mistrusted by the community as a whole. Most of the opposition to social security is based on myths - that CSSA encourages workers to give up their jobs - something shamelessly created by the government and business leaders and supported by respected academic opinion. The system is designed to be as unpleasant and demeaning as possible for applicants and their children. The two largest groups of beneficiary – the elderly and the unemployed - have no alternative to CSSA because of the government-business collaboration since 1967 to prevent or postpone the introduction of a universal scheme for retirement (the Mandatory Provident Fund) and unemployment (social insurance).

This chapter shows how the community came to give overriding priority to the preservation of Hong Kong’s unique combination of personal freedom, social stability and open and honest government, In the process, the deprived, disadvantaged and disabled lost their traditional defenders, and the advocates of social reform declined in numbers and influence. Yet, there was still a collective conscience at work in Hong Kong, whose indignation at revelations of mistreatment of victims of life’s tragedies was usually prompt and politically too overwhelming for officials to ignore.

From a nearly imperceptible start, federal policy on comparative effectiveness research gained substantial momentum over its eight-year odyssey and got several legislative toeholds. The story starts in May 2002 with a short bill introduced into the US House of Representatives by Representative Thomas Allen (D-Maine). This bill focused solely on prescription drugs and would have authorized the appropriation of $25 million for comparative effectiveness research to the Agency for Healthcare Research and Quality. It died in committee. The next year Representative Allen and a Republican co-sponsor JoAnn Emerson (R-Missouri) introduced a more ambitious bill that encompassed all treatments, not just drugs. By means of a circuitous path involving Senate Majority Leader Bill Frist (R-Tennessee) many elements of the 2003 Allen-Emerson bill became law as part of the 2003 Medicare Modernization Act passed by the Republican-held Congress and signed by Republican President George W. Bush.