The NHS faces a crisis in terms of staffing and recruitment. Many of the ethnic minority GPs in inner city areas throughout the UK are coming up to retirement age, and there is an insufficient supply of trainees to fill estimated vacancies. Over 2,000 nursing vacancies exist across the UK, and recruitment to the profession and retention within the profession are poor. Nurses have been recruited from overseas for the past 40 years, and are currently being recruited from Finland, Malaysia, and the West Indies, whilst doctors are being sought in India, Pakistan and Africa. Overseas recruitment is not a new phenomenon, and numerous studies have been carried out to examine equal opportunities and racial discrimination within the NHS. The aim of this paper was to examine ethnicity and equal opportunities within the Scottish NHS and record the levels of organisational awareness of ethnicity and equal opportunities' issues. The paper also examines the link between health service delivery to ethnic minorities and internal cultural attitudes to staff.
Best Value was introduced as a local government policy in 1997, after the election of a New Labour administration. The policy was designed to reconfigure service delivery by local government, with local authorities assuming the role of enablers rather than service providers. In order to help achieve this change, Best Value was constructed around a balanced scorecard approach. As a result, local authorities are examining organisational structure for a number of reasons. Internal management information requirements have changed. Best Value has also occurred at the same time as a number of other local government reforms, which are emphasising strategic decision making; accountability; transparency; sound governance and an awareness of the citizen’s perspective. Consequently, the traditional committee structure is being examined in many local authorities. This paper examines organisational changes within one local authority as a result of Best Value, which are designed to produce a more efficient, citizen focussed, and quality‐driven organisation.
This article aims to answer a number of linked questions. The first involved a detailed recording of management behaviour and management skills as demonstrated within the General Practitioner Fundholding (GPFH) practice. The purpose for doing this was to determine whether or not GPFHs had acquired management skills, and whether or not these skills had been used to benefit primary care. If GPFHs demonstrated such skills, the second objective was to determine the use to which these skills would be put in the proposed reorganisation of primary care. In order to do this, we examined the proposed structure of primary care in Scotland, and asked GPFHs about the consultation process and their role in the proposed structure.
Restructuring the Scottish water industry has changed the way in which both project appraisal and capital investment decisions are performed. This article examines the project appraisal and subsequent capital investment decision in the case of a reed bed sewage treatment scheme which is compared with a more traditional scheme. Although the capital profiles of the schemes are similar there are major differences in the revenue costs. In addition, there are potential public benefits to the reed bed scheme. A comparison is made of management mechanisms in the pre‐1996 water industry with that of restructured water authorities. In the pre‐1996 water industry, local authorities had a broad remit which encouraged them to value these factors, in effect an implicit social account. The creation of water authorities with narrow remits and specific performance measures, constructed a framework that does not support the integration of social accounts into the decision making process. The paper demonstrates that investment appraisal is a product of the institutional framework in which the decisions are made. As that framework changes, mechanisms and measures of accountability shift in parallel.
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