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The 1989 White Paper 'Working for Patients' continued the process begun by Griffiths of managerial reform and the introduction of private sector concepts into the NHS. One of the new proposals was to change the composition and constitution of health authorities, both to avoid the assumed weaknesses of the existing format and to emulate the pattern found in the private sector.
The essence of the change was the removal of the representational elements on authorities, both of medical professionals and nominees from the local authority. The health authorities were reduced in size to just eleven members and for the first time executives were included. Previous attempts at reform within the NHS have been judged to have resulted in more continuity than change. This article examines in detail who the new members are and assesses the balance between continuity and change.
Despite a high level of continuity of membership, there are signs of more fundamental change. There is a significant increase in the proportion of non-executive members from the private sector and with the inclusion of executives, a stronger managerial role is emerging. The article concludes by assessing what the implications of these changes maybe. 相似文献
The essence of the change was the removal of the representational elements on authorities, both of medical professionals and nominees from the local authority. The health authorities were reduced in size to just eleven members and for the first time executives were included. Previous attempts at reform within the NHS have been judged to have resulted in more continuity than change. This article examines in detail who the new members are and assesses the balance between continuity and change.
Despite a high level of continuity of membership, there are signs of more fundamental change. There is a significant increase in the proportion of non-executive members from the private sector and with the inclusion of executives, a stronger managerial role is emerging. The article concludes by assessing what the implications of these changes maybe. 相似文献
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Catherine E. Ross 《Journal of Quantitative Criminology》1993,9(2):159-175
Fear of victimization may have consequences for subjective well-being. I develop and test a model linking fear of victimization to subjective health. I hypothesize that two processes link fear to subjective health-psychological and behavioral. Specifically, I hypothesize that fear of victimization increases psychological distress, and fear decreases outdoor physical activity, especially walking. High levels of psychological distress and low levels of walking, in turn, are associated with poor self-reported health. I find empirical support for the hypothesized processes in a representative national sample of 2031 adults aged 18 to 90 interviewed by telephone in 1990. The negative association between fear and health is explained largely by psychological distress and walking. However, a significant direct effect remains. I conclude with suggestions for future research linking crime and health, focusing on the need for collecting information on community disorganization. Community context is likely the ultimate exogenous variable-the one that sets in motion the destructive cycle of fear, distress, inactivity, and poor health described here. 相似文献
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Community-based delinquency prevention programs, designed to work with youth and families before they become involved with the official court process, are relatively rare. Likewise, few studies have been published concerninge valuative research on such programs. This article reviews some background on program concepts, describes the operations of the Oakland County Probate Court Youth Assistance casework services program, and reports the results of a comprehensive program evaluation project. The findings suggest that prevention programming is one effective strategy to aid in reducing the likelihood of more costly court interventions. Recommendations for program development are offered. 相似文献