Does ownership matter? Case studies of healthcare employee-ownership and the implications for alternative organisations

Since 2014, new employee-owned Public Service Mutuals in the UK have been created by transferring £1 shares to staff. Much current research draws upon conventional approaches to evaluating policy implementation and falls short in understanding the implications of such new ownership arrangements. Utilising insights from the critical scholarship of alternative organisations, this thesis offers to redress this absence. Long standing academic, as well as policy debates testify to the importance of talking about ownership, even if there is no consensus amongst social scientists about what it means and whether it is important as a replacement for state or private models. The capacity of employee owners to control management is doubted while organisational hierarchies’ use of co-option to seduce workers to self-discipline highlighted. This thesis investigates the dynamics of implementing employee-ownership in the context of the English healthcare sector, underpinned by a critical realist theoretical framework. Employing qualitative methods including interviews, group discussions and non-participant observations to compare four case studies the thesis asks several key questions about employee-ownership and the possibilities of alternative organising. Namely, how ownership was embraced or contested by staff; whether shareholding gave staff greater control; and how resistance to managerialism was manifested. Major observations and contributions were identified: 1) Interpretations of employee-ownership amongst local actors multiplied and became uncontrolled with managerial and individualist forms challenged by democratic-collective versions; 2) The transfer of shares initiated a new debate, creating space for arguments driven by ideals of democracy, justice and equality leading to tangible differences to management prerogatives. However, new forms of staff control over the organisation and management were limited and dependent on employees valuing ownership as more than the possession of property; 3) Staff showed substantial differences in responding to management’s version of employee-ownership. While non-ownership and indifference to shareholding were common; others embraced being an owner as they sought to radicalise its conceptualisation in their efforts to resist managerialism. The study suggests that despite shortcomings, employee-ownership in the healthcare sector has tangible (but partial) merit as an alternative organisational form. Drawing on a critical realist approach, the interaction between discursive contestation over the notion of ownership as well as the importance of non-discursive changes in organisational structure and economic roles is emphasised

An observational study of individual child journeys through autism diagnostic pathways, and associated costs, in the UK National Health Service

BackgroundDemand for diagnostic assessment in children with possible autism has recently increased significantly. Services are under pressure to deliver timely and high-quality diagnosis, following National Institute and Care Excellence multidisciplinary assessment guidelines. This UK National Health Service study aimed to answer: how many hours of health professional time are required to deliver autism diagnostic assessment, and how much does this cost?.MethodCase notes of 20 children (1–16 yrs.) from 27 NHS trusts, assessed through an autism diagnostic pathway in the previous year, were examined retrospectively. Data included: hours of professional time, diagnostic outcome. Assessment costs calculated using standardised NHS tariffs.Results488 children (aged 21–195 months, mean 82.9 months, SD 39.36) from 22 Child Development Services (CDS), four Child and Adolescent Mental Health Services (CAMHS) and one tertiary centre; 87% were either under 5 (36%) or 5 to 11 years (51%). Children seen by CDS were younger than CAMHS (mean (SD) 6.10 (2.72) vs. 10.39 (2.97) years, p < 0.001). Mean days to diagnosis were 375 (SD 235), with large variation (range 41–1553 days). Mean hours of professional time per child was 11.50 (SD 7.03) and varied substantially between services and individuals. Mean cost of assessment was £846.00 (SD 536.31). 339 (70.0%) children received autism diagnosis with or without comorbidity; 54 (11%) received no neurodevelopmental diagnosis; 91 (19%) received alternative neurodevelopmental diagnoses. Children with one or more coexisting conditions took longer to diagnose, and assessment was more costly, on average 117 days longer, costing £180 more than a child with no neurodevelopmental diagnosis. Age did not predict days to diagnosis or assessment costs.ConclusionTypical assessment took 11 h of professional time and over 12-months to complete, costing GB£850 per child. Variation between centres and children reflect differences in practice and complexity of diagnostic presentation. These results give information to those delivering/planning autism assessments using multi-disciplinary team approach, in publicly funded health systems. Planning of future diagnostic services needs to consider growing demand, the need for streamlining, enabling context appropriate services, and child/family complexity

Contesting ownership:employee-ownership, staff participation in the English care sector

This article investigates how care workers understood ownership and experienced employee-ownership through the exercise of workplace participation and control. To date much of the scholarly work has focused on formal governance arrangements, types of participation and the limitations of worker control, in particular debating the validity of the degeneration thesis. Furthermore, studies tend to be concentrated on small-scale cooperatives or specific marginal examples, but employee-owned enterprises have also been introduced in other sectors, including in English health, social care and well-being sectors. By drawing on two case studies providing care services, this study brings new insights by centring on how staff understood, embraced, and subsequently contested the foundational concept of ownership. The subsequent implications for intraorganisational conflict and the lived experience of staff are explored within a theoretical framework based on (1) how different social science disciplines embrace the concept of ownership, (2) workplace participation within employee-owned entities and (3) the unique characteristics of care services. The paper’s originality lies in combining new empirical data in the context of these three areas. This contribution enhances our understanding of how employees interpret being “an owner”, as well as informing scholarly and public-policy debates about the future models for care provision

Contesting ownership: employee-ownership, staff participation in the English care sector

This article investigates how care workers understood ownership and experienced employee-ownership through the exercise of workplace participation and control. To date much of the scholarly work has focused on formal governance arrangements, types of participation and the limitations of worker control, in particular debating the validity of the degeneration thesis. Furthermore, studies tend to be concentrated on small-scale cooperatives or specific marginal examples, but employee-owned enterprises have also been introduced in other sectors, including in English health, social care and well-being sectors. By drawing on two case studies providing care services, this study brings new insights by centring on how staff understood, embraced, and subsequently contested the foundational concept of ownership. The subsequent implications for intraorganisational conflict and the lived experience of staff are explored within a theoretical framework based on (1) how different social science disciplines embrace the concept of ownership, (2) workplace participation within employee-owned entities and (3) the unique characteristics of care services. The paper’s originality lies in combining new empirical data in the context of these three areas. This contribution enhances our understanding of how employees interpret being “an owner”, as well as informing scholarly and public-policy debates about the future models for care provision.</p

Bailed out and burned out? The financial impact of COVID-19 on UK care homes for older people and their workforce

A review of the impact of COVID-19 (and our response) to adult care home organisations and their workforce

Bailed out and burned out? The financial impact of COVID-19 on UK care homes for older people and their workforce

Care homes provide an essential public service to hundreds of thousands and employ over 600,000 people across the UK. Their financial stability matters: poor financial health can put pressure on staff and managers, lead to deteriorating service quality, or cause home closures, which can lead to very serious disruption for residents and staff and reduce the overall number of care homes available to meet the population’s growing needs. The financial health of the UK’s 8,700 care homes for older people – 80% of them provided by for- profit companies – is, therefore, a significant matter of public interest. Although many residents in the UK’s care homes are required to pay for their own care, public funding still makes up half of the sector’s annual income, and so the functioning of the care home sector is highly dependent on financial support from government, particularly during a public health emergency. Ensuring the financial viability of the care home sector and the well being of the care workforce must therefore be a key part of any pandemic response, particularly given the high vulnerability of people living in care homes. This report examines how the UK’s care homes for people aged 65 and over have been affected by the economic shock caused by the COVID-19 pandemic. It reviews the extent and effectiveness of government support prior to, during and after the peak of the pandemic, as well as the way care home companies responded to this challenge. It also explores how staff experienced these financial impacts in terms of their workload, their well being, and the quality of care they were able to deliver in the various phases of the pandemic. In general our research finds that despite clear warnings that the financial impact of a pandemic on the care home sector would prevent care home services from functioning effectively, there is no evidence that government had any contingency plans in place to address this challenge. This meant that care home companies did not know how much financial support they could expect or how it would be administered, which added avoidable burdens of stress on care home owners and managers at a time of significant trauma. Financial support provided by the government during the first year of the pandemic mitigated the worst effects of the pandemic on the financial viability of the care home sector. However, the decision by government to end financial support for care home companies after the peak of the pandemic had passed has likely contributed to the current financial and operational difficulties experienced by the care home sector, with wider consequences for older people and the healthcare system. The financial viability of the care home sector was partly dependent on care workers working harder and longer. However, there was no general increase in hourly pay. Some even faced reduced income as benefits were cut if they worked more hours. Very little of the additional financial support for the care home sector from government was dedicated to supporting staff and improving their health and well being, despite the immense pressure they were under both at work and in their personal lives. It is therefore not surprising that the care home sector has struggled to both recruit and retain staff since lockdown restrictions were removed and the wider economy re-opened