HOSPITALS IN ENGLAND - IMPACT OF THE 1990 NATIONAL-HEALTH-SERVICE REFORMS

OBJECTIVES. This article aims to describe recent changes in English ho spitals, with particular reference to the impact of the National Healt h Service (NHS) and Community Care Act of 1990. METHODS. Significant p olicies that have affected the functioning of the hospital sector of t he British NHS are reviewed. Data from the NHS Department of Health ar e used to describe trends in utilization. RESULTS. The NHS and Communi ty Care Act of 1990 radically changed the financial and organizational framework within which hospitals operate. By creating separate purcha sing organizations, the act opened the way for competition between hos pitals. In practice, such competition has been very limited. Central d irectives aimed at reducing waiting times for nonurgent admissions, as well as at raising the volume of work done relative to the finances a vailable have been more significant influences. These changes, combine d with rising numbers of emergency admissions, have put the physical a nd human resources of English hospitals under intense pressure. Admiss ions have risen, lengths of stay have fallen across all age groups, an d ambulatory care has grown rapidly. CONCLUSIONS. There is little cons ensus on the future direction regarding the role and structure of acut e-care hospitals. There is evidence, though, that improvements in the process and outcomes of care are possible within the current financial and organizational framework of the hospital sector.