"Healthy Eating - Healthy Action": evaluating New Zealand's obesity prevention strategy.

BACKGROUND: New Zealand rates of obesity and overweight have increased since the 1980s, particularly among indigenous Maori people, Pacific people and those living in areas of high deprivation. New Zealand's response to the obesity epidemic has been The Healthy Eating-Healthy Action: Oranga Kai - Oranga Pumau (HEHA) Strategy ('the Strategy'), launched in 2003. Because the HEHA Strategy explicitly recognises the importance of evaluation and the need to create an evidence base to support future initiatives, the Ministry of Health has commissioned a Consortium of researchers to evaluate the Strategy as a whole. METHODS: This paper discusses the Consortium's approach to evaluating the HEHA Strategy. It includes an outline of the conceptual framework underpinning the evaluation, and describes the critical components of the evaluation which are: judging to what extent stakeholders were engaged in the process of the strategy implementation and to what extent their feedback was incorporated in to future iterations of the Strategy (continuous improvement), to what extent the programmes, policies, and initiatives implemented span the target populations and priority areas, whether there have been any population changes in nutrition and/or physical activity outcomes or behaviours relating to those outcomes, and to what extent HEHA Strategy and spending can be considered value for money. DISCUSSION: This paper outlines our approach to evaluating a complex national health promotion strategy. Not only does the Evaluation have the potential to identify interventions that could be adopted internationally, but also the development of the Evaluation design can inform other complex evaluations.

Waiting times for hospital admissions: the impact of GP fundholding.

Waiting times for hospital care are a significant issue in the UK National Health Service (NHS). The reforms of the health service in 1990 gave a subset of family doctors (GP fundholders) both the ability to choose the hospital where their patients were treated and the means to pay for some services. One of the key factors influencing family doctors' choice of hospital was patient waiting time. However, without cash inducements, hospitals would get no direct reward from giving shorter waiting times to a subset of patients. Using a unique dataset, we investigate whether GP fundholders were able to secure shorter waiting times for their patients, whether they were able to do so in cases where they had no financial rewards to offer hospitals, and whether the impact of fundholding spilled over into shorter waiting times for all patients.

The use of contracts in the management of infectious disease related risk in the NHS internal market.

The paper reports a unique study of contracting for infectious disease control in the English National Health Service internal market. New-institutional economic and socio-legal theories are used to predict that it will not be possible to make contracts for the control of infectious disease which are complete with respect to either the allocation of financial risk or the specification of quality standards. Socio-legal theory predicts that in some circumstances informal relationships (known as networks or relational contracts) can evolve to compensate for some of the deficiencies of incomplete contracts. NHS policy makers are shown to have expected and continue to expect that contracts can be complete. The study comprised five in-depth case studies of contracting in different local areas in England and a national survey of all infection control professionals. The results confirm the theoretical predictions. Contracts were not complete, and some of the elements of relational contracts were present. These elements did not, however, fully compensate for the lack of clear accountability caused by contractual incompleteness.

Health professionals' views of contracting for infection control in the NHS internal market.

This paper reports a national study which investigated the involvement of infection control professionals in (and their views about) the formal processes of contracting for health care in the NHS internal market. Health care professionals needed to be involved contracting, if it was to be effective. The study found that many infection control professionals were not, in fact, involved in contracting, while the importance of both contracts and informal professional networks were recognised But respondents did not think that their professional networks entirely compensated for their lack of involvement in contracting. As formal agreements continue to be central to achieving quality of care in the post-internal market NHS, infection control professionals need to be involved in specification and implementation of these arrangements.