Bibliographic record
Abstract
This chapter describes and analyses the three phases, and contrasting models, of reform of the UK NHS that have occupied governments, principally key ministers and their advisers, from 1997 up to 2015. They have been articulated by one of the last Labour government’s most influential health policy advisers, Simon Stevens, who labelled the phases as follows: benign producerism command and control new localism. Stevens left his position as adviser to former prime minister, Tony Blair, to take up a new post as president of United Health in Europe, a major US health care provider, which over the years has competed for work in the UK, including providing general practitioner services in parts of the country. In April 2014, Stevens returned to the UK to take over as NHS chief executive. Although his phases of reform were developed during the Labour government’s term of office, they remain relevant to the more recent changes introduced by the coalition government in 2013. Britain is something of a market leader in health care reform, having been at it longer than most countries and with a determination and persistence not evident to quite such an extent anywhere else. One eminent commentator, Rudolf Klein, argued that although health care reform ‘has been one of the worldwide epidemics of the 1990s … Britain stands out from the rest’ (Klein 1995: 299). Moreover, since 1999, and as is described later, post-devolution Britain has created growing interest as a laboratory for the study of differences emerging in the health systems taking shape in England, Wales, Scotland and Northern Ireland (Connolly et al 2010; Timmins 2013; Bevan et al 2014).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.004 | 0.022 |
| Scholarly communication | 0.010 | 0.011 |
| Open science | 0.003 | 0.006 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.029 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".