Total quality management in the NHS

In 1989, the Department of Health embarked upon a programme to encourage the introduction of a managed approach to quality in the NHS. In 1990 it extended this programme to include 23 sites ranging from departments within units to total districts. The criteria for inclusion in the programme were loose, but all successful pilots marched under the banner of total quality management (TQM), a clearly defined concept with a well-documented history. Tessa Brooks summarises TQM and considers its place in the NHS.     

Nutrition in the 1980s

The 1970s were a decade of achievement in child nutrition in Britain. Substantial changes in infant feeding practices occurred and they were followed by measurable improvements in child health. The 1980s have not maintained this momentum. Infant nutrition is often still seen solely in terms of the breast/bottle debate. Doubtful practices, such as the use of skimmed milk and goats' milk early in life, have become more common. Many weanlings still experience frank nutritional deficiencies. For the 1990s there are 3 priorities: effective continuing measurements of the state of nutritional health in British children are required; among the many methods for promoting nutritional wellbeing health education is vital but professionally we need to deliver the same not conflicting messages; mechanisms for applying any method must acknowledge that nutrition is only one aspect of child health to be promoted and that other agencies such as the food industry and central government can make a valuable contribution when we all act in concert.     

Normalized management of HIV prevention services in an advanced liberal NHS in the 1990s

This paper examines how responsibility for the planning of state-funded HIV prevention services shifted from UK central government to local commissioners during the ‘era of normalization’ in the 1990s. It explores whether according to literature from the period these changes experienced were those that would be predicted by theories of ‘advanced liberalism’, i.e. delegation of operational planning, centralization of strategic target setting, and increased scrutiny of ‘expert’ providers. The paper examines the changes that were described in power relations among key players, using advanced liberalism to structure this examination. The paper concludes that many but not all of the reported changes conformed to these predictions. Although the government did set targets, these targets did not function as effective levers on local activity. Although delegation of planning to local commissioners did occur, their authority was restrained by the retention of specific earmarked HIV prevention funding. Although scrutiny was applied to those with expert status providing services, some—especially those in the voluntary sector—appear to have been scrutinized more than others, such as various clinical practitioners.     

The 1980s and 1990s: moving forward

This year marks the American College of Healthcare Executives' 60th year of service as a professional society. To celebrate this occasion, the column "In Review" has been featured in Healthcare Executive throughout 1993. This final column features highlights from the 1980s and a preview of the 1990s.     

Apartheid and health in the 1980s

The last 5 years have seen dramatic developments in South Africa, with wide-based internal political struggles and international pressure forcing the government into a well publicized if temporary series of reforms. Yet this has not been paralleled by any substantial improvement in the health conditions of the majority of the population. Apart from improvements in black infant mortality in some urban areas, the health gap remains, a material expression of the social inequality that is part of the definition of apartheid. Black children continue to die from preventible afflictions at about 10 times the rate of their white counterparts. Maternal deaths among women classified as black, coloured or Asian continue to occur, mostly due to septic abortions. At national level, blacks are nearly 30 times more at risk of being diagnosed to have tuberculosis than whites, with some age groups being at still worse risk. Black children under the age of 4 years in Cape Town in 1984 were 205 times more likely to have tuberculosis than their white counterparts. The last 5 years has also seen a revival of rhetoric echoing the international support for primary health care in the 1970s, but health care processes have not been modified to cope with the continuing racial stratification of disease and access to health care. A move towards privatization of the health services has only benefited a few.     

Podiatry: critical issues in the 1980s.

As part of a larger study on the place of podiatry within the American health care system, this report suggests four critical issues facing podiatry as an independent health profession in the 1980s. The four concerns are: low visibility and credibility, lack of a strong professional self-image, struggle for more liberal hospital privileges, and the threat of loss of federal financial support.     

Socioeconomic inequalities in childhood mortality: the 1970s to the 1980s

The last three decades have witnessed substantial reductions in childhood mortality in most developing nations. Despite this encouraging picture, analysis of WFS and DHS survey data shows that socioeconomic disparities in survival chances have not narrowed between the 1970s and 1980s, and in some cases, have widened. Changes in mother's education and father's occupation contributed only modestly to secular declines in mortality. In most countries studied, no more than 20 per cent of the national trend could be accounted for by compositional improvements. The median contributions of improvements in mother's education and father's occupation were ten and eight per cent, respectively.