Medical Negligence and Resource Allocation in the NHS

The recent growth in medical malpractice claims and in awards for damages has created concern both amongst doctors and health administrators. Steps which have been taken by the Review Body on Doctors’and Dentists’Remuneration and policy now advocated by the BMA suggest a movement away from the current system of negligence and towards a stricter no-fault system of liability. Under the current system, medical negligence occurs when doctors have not met the standards of treatment expected by reference to current professional standards. Under a no-fault system patients would be entitled to compensation for losses which arise from treatment, irrespective of whether negligence had occurred; although the implication is that the amounts of compensation would necessarily be limited. While there are reasons to believe that financial difficulties for doctors and pressures on NHS budgets may be ameliorated by a no-fault system, there are other criteria against which the current system of negligence should be judged. This article attempts to provide a framework within which a negligence system may be assessed. In particular, attention is drawn to the educative role of a negligence system and to the provision of information which may improve decisions on resource allocation. A critique of the current system of medical negligence in the UK suggests that a package of reforms to improve the system would be better than further movements towards non-market solutions.     

Obstacles to involving children and young people in foster care research

ABSTRACT Despite increasing recognition of the importance of including the perspectives of children and young people in care in alternative care research, in practice this is not always a straightforward matter. This paper describes the recruitment of disruptive young people in care under the jurisdiction of the South Australian statutory authority to three studies on placement instability. Non‐response rates of 72.5% and 82% are reported. A large number of subjects were excluded because agency social workers did not cooperate with the project, and more subjects were excluded for reasons which suggest high levels of distress in this population. The dilemma of providing a voice to distressed subjects when distressed subjects are excluded from research is discussed, and the appointment of an independent representative for children in care to review research proposals and to negotiate research access to children is proposed.     

Psychosocial Interventions for Maltreated and Violence-Exposed Children

Child sexual, physical, and emotional abuse as well as child neglect and domestic violence, community violence, and Childhood Traumatic Grief may result in significant and long-lasting emotional and behavioral difficulties. This article reviews randomized controlled studies that have assessed child mental health outcomes for maltreated and violence-exposed children. Key points of this review include the following: (1) maltreated and violence-exposed children typically experience more than one of these types of traumas; (2) effective psychosocial treatments are available to address Posttraumatic Stress Disorder (PTSD), depression, anxiety, and behavioral problems in these children; (3) it is likely that treatments which effectively reduce mental health symptoms in children exposed to one type of child maltreatment or violence exposure will also be effective for other or multiple types; and (4) mental health outcomes are not the only important outcomes to address in future treatment or intervention efforts. These future directions for treatment intervention research are addressed.     

The hard and soft sides of union political money

We reach several conclusions. First, to the extent that soft money per se and issue advertising are the primary targets of campaign-finance reformists, unions contribute little, overall, to the perceived or real problem. Union soft money pales in comparison not only to total interest-group expenditures of this type but also to the hard money that labor dispenses. Moreover, with their relatively limited treasuries, unions are in no position to compete with the corporate sector. It has been estimated that the total assets of labor unions, at the combined local, regional, and national/international levels, barely exceeded $10 billion in 1995 (Masters and Atkin, 1997). Revenues were less than $13 billion.     

Voices From the Front Line: State Social Workers and New Labour

Summary The article explores the condition of state social work in Englandtoday. It is based on interviews with experienced social workersemployed by local authority social services departments acrossthe north of England. These front line state social workersprovide a penetrating insight into the diverse ways in whichtheir work has been transformed and degraded and the mannerin which the needs of clients have been largely ignored. Fromtheir perspective, the election of a Labour government in 1997proved to be a massive disappointment and many social workersreported that it has further undermined state social work practice,workers and clients. The paper seeks to offer an explanationby noting the neo-liberalism of Labour's social policy and thedire consequences which flow from New Labour's fixation withwaged work as the principal solution to social exclusion andpoverty. Above all, it seeks to provide an opportunity for theviews of front-line state social workers to be heard.     

The derivation of a brief Student Nurse Stress Index

The lack of an adequate measure of perceived sources of stress for student nurses led to the construction of the Student Nurse Stress Index (SNSI). Responses from 235 first-year student nurses to 35 items from the Beck and Srivastava Stress Inventory (Beck, and Srivastava, 1991), and 15 new items, were subjected to exploratory factor analysis using principal components analysis and oblimin rotation. A reliable 22-variable solution with a simple oblique structure including Academic load, Clinical sources, Interface worries, and Personal problems factors was obtained in this initial sample, and confirmed at an exploratory level in a further independent validation sample of 188 first-year students. Confirmatory factor analysis established the four-factor model in the first sample, but required that three variables load onto more than one factor. This more complex four-factor model was confirmed using independent data from the validation sample, and the total invariance of factor loadings and factor covariances of this more complex four-factor model was established in both data sets simultaneously using multi-sample techniques. The SNSI shows cross-sample factor congruence, good internal reliabilities, and concurrent and discriminant validity across a range of reporting conditions.