Ticking Boxes and Changing the Social World: Data Collection and the New UK General Practice Contract

The new General Medical Services contract was introduced into general practice in the UK in 2004, and it links pay to performance far more than in the past. As a result, accurate data collection about patients and the care that they receive is now not only important for good patient care but also to prove that targets are being met. The use of electronic records and information technology has thus become much more sophisticated. This article reports the results from an ethnographic study of the early stages of the new contract in two general practices. As expected, electronic data collection had increased in importance in both practices, with consequences both for clinician–patient interactions and for the structures and processes in the practices, as uniform data collection instruments are put in place that privilege ‘hard’ biomedical data that can be easily coded above ‘softer’, more patient-centred information. Roles and responsibilities had been changed to reflect the needs of the new systems, and new software applications allowed increased surveillance of both doctors’ and nurses’ performance; both of these had an impact on patterns of authority in our study practices. Furthermore, the structural changes that were found acted to embed the new ways of working, ensuring their reproduction in the future. In spite of these effects, we found little opposition to or critical reflection on the changes, and the doctors in our study continued to view their improved computer systems as neutral recording devices. The implication of these findings is discussed.     

Quacks and Clerks: Historical and Contemporary Perspectives on the Structure and Function of the British Medical Civil Service

The British government's requirement for expert medical advice from the 1850s led to the development of a medical civil service, which reached its peak in size and authority in the 1970s. By this time the Chief Medical Officer (CMO) had direct management of a staff of over 170 medically qualified civil servants, who provided expertise on the development and implementation of new medical treatments as well as on broader health protection and promotion issues. The successive Whitehall efficiency reviews from 1979 onwards culminated in 1994 in the merger of the parallel medical and civil service reporting hierarchies in the Department of Health, effectively reducing the CMO's ability to call upon the support of medical civil servants, at a time of increasing new health threats such as AIDS and MRSA. This article uses government reports to chart the rise and fall of the British medical civil service. It discusses how, in the last ten years, the British government has become more imaginative in its use of temporary specialist medical advisers (tsars) brought in from the NHS, in relaxing the formal civil service hierarchies, and quietly abandoning the statutory Standing Medical Advisory Committee (SMAC). This article suggests that when the government has failed to give adequate support to its CMOs, the medical civil service has suffered from poor morale, experienced recruitment difficulties, and the ability to respond to health crises has been compromised. It highlights the chronic lack of historical awareness in the development of health policy in Britain.     

Research as Profession and Practice: Frameworks for Guiding the Responsible Conduct of Research

Programs in the responsible conduct of research (RCR) vary between institutions, demonstrated by disparate structures and goals. These variations may be attributed to the absence of grounding frameworks within which to examine research and RCR education programs. This article examines research as a practice and a profession, using these frames to draw out defining features of research and the moral obligations entailed. Situating research within virtue ethics can clarify how researchers might cultivate the virtues necessary for meeting its obligations and aims. By elucidating these features, these perspectives can serve to guide the development of RCR education programs.     

契约法和国家的伦理中立:关于自由主义和社群主义的几点想法

在国家应该如何对待道德多元现象的方式上,社群主义者和自由主义者的意见不一致。自由主义者认为,国家必须在竞争的善的概念之间保持中立,社群主义者则争辩说,国家应该强化在社群内部占主导地位的道德观念。论文通过对契约法的讨论,阐述了自由主义国家和社群主义国家对待契约法的不同态度。     

我国医疗保障事业发展的历程和经验

我国医疗保障事业建立、改革、发展经过了计划经济体制下的单位保障、市场化改革背景下的医疗保险、全面建设小康社会目标中的全民医疗保障。发展我国的医疗保障事业必须以科学发展观为指导,将保障人民健康作为根本宗旨;医疗保障事业建设必须立足国情,与经济发展水平相适应;各项医疗保障必须要协调发展,积极推进医疗保障制度一体化;医疗保障与医药卫生服务体系建设必须要全面推进,深化医药卫生体制改革。     

劳动合同经济补偿金的功能、性质和制度完善

劳动合同经济补偿金具有制约功能、补充功能和补偿功能。就其性质而言,我国的劳动合同经济补偿金因其补偿项目的不同,分别具有补贴、制裁和法律制约的性质。补偿金存在两个方面的问题：一是没有考虑劳动合同是否有持续性;二是对劳动合同变更制度考虑不足。应根据合同的性质和时间确定无固定期限合同的要求;对解除或终止无固定期限合同给予经济补偿,对固定期限合同的终止则不予补偿;此外,还应赋予用人单位更大的用人安置权。     

Organization and Professionalism: The Social Work Agenda in the 1990s

Dr R. Hugman. Dept. of Applied Social Science. Cartmel College. Lancaster University. Lancaster LAI 4YL. Summary The professionalization of social work in the UK during thiscentury has led to an occupational unity, but one in which therehas been continued struggle over the form and content of professionalism.This paper summarizes the key points of developments in thelast two decades, in which debates between professionalism andanti-professionalism and between specialization and localizationcan be discerned. Further changes in the welfare state haveprovided the impetus for continuing developments which, it isargued, integrate aspects from opposing sides of the previousdebates. The failure of social work to address issues of genderand of racism is considered, and related to the possibilitiesof greater service user participation. The implications forsocial work professionalism are outlined.     

The Institutional Construction of Collective Contracts under the Labor Contract Law: Dilemma and Solution

The Labor Contract Law classifies collective contracts as special labor contracts, ignoring the fundamental differences between collective contracts and labor contracts. This has plunged it into jurisprudential obstacles and institutional difficulties. In terms of the main entities, efficacy, dispute settlement mechanisms, etc. collective contracts have their own institutional characteristics. They should be incorporated into the legislative framework for collective labor relations in future legislation, and should link up with trade unions, collective consultation and collective dispute settlement to form a complete system of collective labor law.     

Welfare and the unemployment crisis: Sweden in the 1990s

In the 1990s Sweden went through a deep economic recession accompanied by a massive increase in unemployment and a rapidly growing budget deficit. The crisis had large repercussions for the welfare of many citizens and it generated cutbacks in virtually all social policy programmes. This halted a welfare-state expansion that had been going on for decades. It also caused great concern about the state of welfare of the nation. In 1999 the Swedish Government appointed a 'Welfare Commission', a team of academic researchers who were assigned the task of drawing up a balance sheet for the development of welfare in the 1990s. The Commission delivered its final report in October 2001. This article is a condensed account of one of the more central issues for the Commission; namely, how the unemployment crisis affected already socially and economically vulnerable groups. Looking at the development over the entire decade, three groups stand out as particularly disadvantaged in terms of individual welfare resources: young adults, immigrants and single mothers. The downturn for these groups was especially accentuated in terms of employment and income. Young people and immigrants trying to get into the labour market during the crisis years faced the problems of newcomers to the systems of social protection. The poor economic development for single mothers could essentially be attributed to the shortage of work in general and of full-time work in particular that followed from the unemployment crisis. As a consequence, the importance of selective benefits increased and the relative size of all public transfers – despite rationing measures – stayed fairly unchanged. The results highlight the great influence of macroeconomic conditions and policy making for the welfare of vulnerable groups in society.     

合同法定形式效力比较及我国立法的完善

《合同法》在合同形式方面做出了许多与市场经济相适应的新规定 ,但由于对法定形式的法律性质和效力缺乏明确规定 ,引起法学理论和审判实践上的诸多不同理解和做法。借鉴国外的有关规定 ,补充规定“缺少法定书面形式的合同无效” ,修改第三十六条的“合同成立”为“合同有效” ,删除第四十四条关于批准、登记生效的规定 ,使我国合同形式的法律趋于完善成为必要。     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

论合同托运人的定义与识别

托运人是海上货物运输合同重要的一方 ,我国《海商法》关于托运人的规定历来存在着很大的争议。对此提出了将我国《海商法》第四十二条所规定的两类托运人分别规定为“合同托运人”和“实际托运人”的观点 ,并重点探讨了合同托运人的定义与识别 ,试提出了识别合同托运人的标准     

论合同法的诚实信用原则

诚实信用原则是市场经济活动中所形成的一项法律化的道德规范,其本质上是一种为寻求市场利益公平的法律伦理,具有道德规范性、法律规范性和双重功能性等主要特征.作为一种基本的商业道德和合同法的基本原则,诚实信用原则贯穿于合同订立、合同履行、合同终止和合同解释等合同行为的全过程.     

Intention to Leave the Profession: Welfare Social Workers Compared to Health Care and Community Social Workers in Israel

ABSTRACT

This study aimed to compare specific work related-factors (personal factor: length of work experience; structural factors: personal subjection to violence and fear of being subjected to violence; and psychological factors: professional quality of life—compassion satisfaction, burnout, and compassion fatigue) between welfare social workers (SWs) (n = 200) and health care and community SWs (n = 173). Furthermore, since the issue of turnover among SWs has important implications for the provision and programming of social services, the study also aimed to assess the relationship between these factors and SW intention to leave the profession. For the purpose of this study, online questionnaires were distributed to SWs working at social agencies and services. The findings suggest that the two categories of SWs showed a similarity with regard to the association between the personal and structural factors and intention to leave the profession. However, with regard to the psychological factors, the components of professional quality of life were found to operate differently in each category of SWs. It is suggested that future research examine other work-related factors and explore the intention to leave the profession among other social work specializations and employment sectors.     

医科院校社会工作专业实习机构建设探索

社会工作作为一门助人专业和学科,是建立在专业理论和专业实习基础上的应用型专业。文章从笔者所在院校已开设6年的医务社会工作专业出发,分析了医科院校社会工作专业实习机构的现状及问题;同时,也阐述了其在不断探索中取得的成就;最后探索出一条适合我国医科院校社会工作专业实习机构建设的有效模式。     

法律变迁的结构性制约——国家、市场与社会互动中的中国律师职业

对改革开放以来中国法律体系变迁根源的探讨,通常遵循国家主义的认识论,即国家意志主导甚至决定了法律体系变迁的所有方面。这种认识论虽然能够较好说明改革开放初期法律体系在中国的再造,但是未能全面把握当前的复杂情况。本文以律师职业在改革开放时期的变迁为例,利用定量数据和实证方法说明国家、市场和社会对法律体系的多重动态影响,提出法律变迁的“结构性制约”理论框架。改革开放以来中国法律体系变迁已逐步由国家主导的格局,演变成国家、市场、社会和法律体系之间相互直接和间接影响的格局。