Purchasing power

*Primary care trusts need to be better commissioners to balance provider strength and develop new services. *The private sector has commissioning skills lacking in the NHS that need to be tapped into. *FESC provides a list of companies for PCTs to use.     

Parent power

Giving parents responsibility for holding their children's health records has improved the quality of information, Jo Tew and Nadia Deadman discover.     

Green power

The NHS has a unique environmental role in the UK and managers need to be eco-conscious. Simon Hodgkinson and Erica Ison provide a checklist for environmental audit.     

Rethinking family power

The family power literature, in its macrolevel focus on marital decision-making, has emphasized the kind of family power that is generally conferred on men and is based on extrafamilial roles and performances. Kranichfeld argues that for the last 2 decades, reviews of family power literature have been fundamentally shaped by the abiding interest in the relative power of men and women, rather than in power in the family per se. Researchers have continued to assume that family power is generated by acquiring skills, resources, and status outside the family rather than by acquiring skills for relating to others within the family. Much of the family power literature has focused on marriage and marital decision-making, but Kranichfeld argues that it is power within the parent-child relationship that is more complex, enduring, and significant. An understanding of the depth and reach of the kind of power that women hold, taken together without knowledge of how men's relationships to families are changing in our society, allows the possibility that women's positions are more secure than they sometimes seem. Many of the painful life situations that women experience because their powerlessness at a more macro level of society (desertion, physical abuse, teenage pregnancy) occur within the context of the romantic tie, and women's investment and power in vertical bonds are a source of support that reduces women's dependence on and vulnerability to the horizontal tie. Women occupy positions at the very center of the family, in contrast to men, who are becoming increasingly isolated from the family. From this perspective, the normally male power to make the decision about what kind of car to buy or where to spend the family vacation is nearly reduced to insignificance. The message seems to be that when it comes to securing family power, nothing can substitute for investment, attention, connection, and care.     

Towards user power

In the first of two articles, Vivien Lindow says managers of mental health services should consult their users by facilitating some form of patients' group.     

The power gap: freedom, power and mental illness

Up to one in four individuals in the US meet the diagnostic criteria for a mental illness in any given year and a significant proportion have severe or recurring illnesses (e.g. schizophrenia). Despite this prevalence, mental health services remain poorly funded, mental illness remains misunderstood and individuals with recurring illness are constrained to live lives characterized by isolation, under-employment, stigma and denial of rights. Here I examine the idea that this situation is attributable, at least in part, to the ways in which the freedom and power of the mentally ill are undermined by a range of factors, including: (i) dispersion of political power amongst interest groups, which, combined with the relatively wide distribution of the 'interest' of mental illness, has the paradoxical result that mental health interest groups do not command political power proportional to the number affected; (ii) systematic exclusion of the mentally ill from full participation in civic, social and political life (structural violence), resulting in a lack of emphasis on mental health on political agendas and the exclusion of certain policy options as possible responses and (iii) difficulties the mentally ill may experience recognizing or articulating their own needs the absence of effective health-care systems, and the absence of knowledge about alternative systems. I argue that the enhancement of individual agency is central to efforts to address this power gap, including: (i) rights-based approaches, involving the enhancement of national mental health legislation, improvement of advocacy, empowerment and guardianship processes and development of governance, accountability and quality procedures in mental health services; (ii) approaches based on enhancing direct political participation, including voter-registration programmes and development of larger, more effective interest groups and (iii) additional approaches, including increasing accountability throughout services, recognizing the effects of socio-political change on the context of care and adapting the concept of 'soft power' to strengthen advocacy programmes.