Risks, Contracts and Infectious Disease in the UK NHS Managed Market, 1997-1999

This is a mixed methods study, comprising both qualitative and quantitative data. The aim of this study was to determine how risk associated with infections and the control of infectious diseases were managed and distributed in the NHS quasi market, the specific objectives were:<br> 1. to evaluate the effectiveness of formal contracts, regulations and informal practices relating to risks of infection and the likely effectiveness of these clauses;<br> 2. to consider how agency relationships within professional and managerial systems affect the implementation of programmes to reduce risk and cope with outbreaks of infections;<br> 3. to consider how contracting agents perceive risks associated with infectious disease and the values placed on risk avoidance practices compared with preventive practices;<br> 4. to consider how risk, financial, social and psychological, are distributed amongst NHS agencies, other agencies, patients and families; to consider how initial allocation of risk in the contracting process affects the eventual distribution of this burden; and consider attempts to pool risks.<br> Objectives 1-3 were achieved in full. In objective four, distribution of risks amongst NHS agencies and budgets arising from unforeseen events and allocation of risks in contracts is addressed. But risks to patients and their families was not possible due to logistical difficulties and resistance from Trusts to approaching infected patients. The objective was revised to include a survey of all outbreaks reported six months following site visits.<br>