Co-operation, collaboration and competition – inside the mindset of NHS managers

After two and a half decades of marketization, Pauline Allen argues that the attitudes of NHS managers towards competition in our health services are changing. Whilst in general NHS managers remain committed to co-operation and collaboration, pockets of pro-competitive thinking are present. However, a lack of clear policy direction leaves many managers preoccupied first of all with preserving their own organisation’s interests and identities

Educational bearing of the recent industrial changes upon the women of Japan

Thesis (M.A.)--Boston Universit

Pricing in the English NHS quasi market: a national study of the allocation of financial risk through contracts

The authors investigated how the formal national provisions for pricing in the National Health Service (which are a form of prospective payment, known as ‘Payment by Results’) are operationalized at local level. Transactions costs theory and existing evidence predict that actual practice often does not comply with contractual rules. A national study of pricing between 2011 and 2015 confirms this and indicates that such payment systems may not be appropriate to address the current financial and organizational challenges facing the NHS. As the NHS struggles radically to reconfigure services, it is necessary to reconsider the appropriateness of a wider range of pricing mechanisms to facilitate moving care out of hospitals

Views of NHS commissioners on commissioning support provision. Evidence from a qualitative study examining the early development of clinical commissioning groups in England

Objective: The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to create a vibrant market of competing providers of such services (from both for-profit and not-for-profit sectors). Until this market develops, however, commissioning support units (CSUs) have been created from which CCGs are buying commissioning support functions. This study explored the attitudes of CCGs towards outsourcing commissioning support functions during the initial stage of the reform. Design: The research took place between September 2011 and June 2012. We used a case study research design in eight CCGs, conducting in-depth interviews, observation of meetings and analysis of policy documents. Setting/participants: We conducted 96 interviews and observed 146 meetings (a total of approximately 439 h). Results: Many CCGs were reluctant to outsource core commissioning support functions (such as contracting) for fear of losing local knowledge and trusted relationships. Others were disappointed by the absence of choice and saw CSUs as monopolies and a recreation of the abolished PCTs. Many expressed doubts about the expectation that outsourcing of commissioning support functions will result in lower administrative costs. Conclusions: Given the nature of healthcare commissioning, outsourcing vital commissioning support functions may not be the preferred option of CCGs. Considerations of high transaction costs, and the risk of fragmentation of services and loss of trusted relationships involved in short-term contracting, may lead most CCGs to decide to form long-term partnerships with commissioning support suppliers in the future. This option, however, limits competition by creating ‘network closure’ and calls into question the Government's intention to create a vibrant market of commissioning support provision

The Multiple Purposes of Policy Piloting and Their Consequences: Three Examples from National Health and Social Care Policy in England

AbstractIn England, policy piloting has become firmly established in almost all areas of public policy and is seen as good practice in establishing ‘what works’. However, equating piloting with evaluation can risk oversimplifying the relationship between piloting and policy-making.Using three case studies from health and social care – the Partnerships for Older People Projects (POPP) pilots, the Individual Budgets pilots and the Whole System Demonstrators (WSD) – the paper identifies multiple purposes of piloting, of which piloting for generating evidence of effectiveness was only one. Importantly, piloting was also aimed at promoting policy change and driving implementation, both in pilot sites and nationally. Indeed, policy makers appeared to be using pilots mainly to promote government policy, using evaluation as a strategy to strengthen the legitimacy of their decisions and to convince critical audiences. These findings highlight the ambiguous nature of piloting and thus question the extent to which piloting contributes to the agenda of evidence-based policy-making.</jats:p

Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients

Cross-language information seeking behaviour English Vs Arabic

Purpose – The purpose of this paper is to report the results and the methods of a study which applied grounded theory to the information-seeking behaviour of social scientists when searching Arabic and English academic databases using both languages. Design/methodology/approach – The research applied the grounded theory approach using search experiments and semi-structured interviews. Think-aloud protocol during the experiment was used to capture the data from the subjects to allow a detailed analysis for the experiment. The semi-structured interviews followed each experiment and were analysed using the Strauss and Corbin (1990) version of the grounded theory, as were the think-aloud protocols. Findings – The results of the think-aloud protocols and the semi-structured interviews suggest that the information needs of the subjects varied depending on the language used. In addition, it was discovered that social scientists followed more tactics in searching the Arabic database for the same tasks searched in English during the experiment. This allowed more search strategies and search tactics to appear in seeking information in Arabic language. The study also proposed a model to account for the cross-language information-seeking behaviour. Research limitations/implications – This study identifies and compares the information-seeking behaviour of the social scientists in Jordanian universities in searching both Arabic and English academic databases. Therefore, the findings of this study cannot be generalized to other Arab countries, unless there was similar context. Originality/value – Few studies have investigated information-seeking behaviour using academic Arabic databases and proposed information-seeking behaviour models. No studies have compared information-seeking behaviour when using Arabic and English academic databases. The value of the current study arises by being the first study to identify and compare the information-seeking behaviour of social scientists by using grounded theory and proposing a cross-language information-seeking behaviour model. </jats:sec

Community Nursing Services in England

This open access book provides an historical account of the ways in which community nursing services in England have been shaped by policy changes, from the inception of the NHS in 1948 to the present day. Focusing on policies regarding the organisation and provision of community nursing services, it offers an important assessment of how community nursing has evolved under successive governments. The book also provides reflections on how historic policies have influenced the service of today, and how lessons learnt from the past can inform organisation and delivery of current and future community nursing services. It is an important resource for those researching community nursing and health services, as well as practitioners and policy makers

The public image of the social worker.

Thesis (M.S.)--Boston Universit