Do general practitioner deliveries constitute a perinatal mortality risk?

In recent years local perinatal mortality experience has been on the agenda of most health district management teams. Nationally available data have been criticised for failing to take into account determinants beyond the influence of existing health services such as lethal congenital malformations. In response to local concern about perinatal mortality rate in Oxfordshire AHA(T) the crude data were refined by using simple epidemiological techniques. This failed to show that a high proportion of general practitioner deliveries constituted a major perinatal risk.

Tales of the expected: a case-study in health service management

Scientific approaches, such as operational research and health economics, have failed to resolve many of the problems confronting managers of health services. This is partly because of assumptions about the value-free nature of information and partly through paying little regard to power conflicts in care systems. The case-study method offers a means of understanding some aspects of these conflicts and could therefore improve the effectiveness of scientific methods in influencing decisions. An example of a case-study involving perinatal care in an English health district is described in an attempt to demonstrate the practical benefits that could accrue to managers hoping to see their macro-study findings effecting change.

Recipe for cleaner kitchens

The replacement of much old equipment and improvements in the maintenance of such items as heated trolleys were prominent among the recommendations of two food hygiene surveys carried out in Oxfordshire AHA(T). The surveys and the circumstances that led up to them, are described by Dr Nicholas Black of the AHA(T)'s department of community medicine.