Service user involvement in the NHS in England: genuine user participation or a dogma-driven folly?

AIM: This paper will catalogue and debate the recent policies that seek to extend the role of health Service Users in England. For operational purposes, the term 'Service User' refers collectively to individual patients and also to the public at large. BACKGROUND: The provision of principal features of user involvement are twofold. First, it concerns more personalized services to individuals. Second, it represents recognition that the 60 million potential users of health services have a rightful role in determining the design of service development and delivery. KEY ISSUES: The paper will review the conceptual and ideological basis for current policy in relation to users. For a while, involvement policies began as benign benevolence, users now find themselves as the means to distributing resources in a way that was originally unintended. CONCLUSIONS: The dilemmas raised by these policies for both users and providers will be explored and analysed. IMPLICATION FOR NURSING MANAGEMENT: The challenge for managers resides in the empirical evidence. This indicates despite undoubted improvements in the service as a whole, data suggests that at the operational level, care is still far from user centred. The task for policy makers and managers as far as user involvement is concerned, is to move from aspiration to reality.

Optimising Regionalisation Techniques: Identifying Centres of Endemism in the Extraordinarily Endemic-Rich Cape Floristic Region.

We used a very large dataset (>40% of all species) from the endemic-rich Cape Floristic Region (CFR) to explore the impact of different weighting techniques, coefficients to calculate similarity among the cells, and clustering approaches on biogeographical regionalisation. The results were used to revise the biogeographical subdivision of the CFR. We show that weighted data (down-weighting widespread species), similarity calculated using Kulczinsky's second measure, and clustering using UPGMA resulted in the optimal classification. This maximized the number of endemic species, the number of centres recognized, and operational geographic units assigned to centres of endemism (CoEs). We developed a dendrogram branch order cut-off (BOC) method to locate the optimal cut-off points on the dendrogram to define candidate clusters. Kulczinsky's second measure dendrograms were combined using consensus, identifying areas of conflict which could be due to biotic element overlap or transitional areas. Post-clustering GIS manipulation substantially enhanced the endemic composition and geographic size of candidate CoEs. Although there was broad spatial congruence with previous phytogeographic studies, our techniques allowed for the recovery of additional phytogeographic detail not previously described for the CFR.

Modernizing the British National Health Service (NHS) -- some ideological and policy considerations.

The British National Health Service (NHS) is undergoing a seemingly unprecedented reorganization. The present Government is attempting to modernize a system of care that has been relatively unchanged for over 50 years amid a great deal of its own publicity about its achievements. This paper begins by briefly examining the ideological basis of these reforms. It proceeds to interrogate the rationale for current health policy from the perspective of the Government. It then analyses the arguments of the detractors who oppose the form these changes are taking. The paper concludes that modernization of the NHS is mainly cosmetic but its significance concerns the stimulation of a broader and radical debate about the future funding and delivery of health care in Britain.

Developing scholarship in nursing - steps within a strategy.

This paper seeks to share with the reader some of the mechanisms currently being used to generate scholarship in academic nursing, both at the institutional and individual levels. It then goes on to explore other ways in which educational managers might encourage scholarly activity. Finally, it presents the crystallization of ideas generated during discussions conducted with lecturers focusing on their selection of a workable path towards a future of scholarship, for them as an academic. It is intended as food for thought for managers of educational programmes and individual nurse academics as they scan the horizons of the future in an attempt to make the 'best' decisions for the profession of nursing and individuals within it.