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

PHOENIX: Public Health and Obesity in England – the New Infrastructure eXamined First interim report: the scoping review

The PHOENIX project aims to examine the impact of structural changes to the health and care system in England on the functioning of the public health system, and on the approaches taken to improving the public’s health. The scoping review has now been completed. During this phase we analysed: Department of Health policy documents (2010-2013), as well as responses to those documents from a range of stakeholders; data from 22 semi-structured interviews with key informants; and the oral and written evidence presented at the House of Commons Communities and Local Government Committee on the role of local authorities in health issues. We also gathered data from local authority (LA) and Health and Wellbeing Board (HWB) websites and other sources to start to develop a picture of how the new structures are developing, and to collate demographic and other data on local authorities. A number of important themes were identified and explored during this phase. In summary, some key points related to three themes - governance, relationships and new ways of working - were: The reforms have had a profound effect on leadership within the public health system. Whilst LAs are now the local leaders for public health, in a more fragmented system, leadership for public health appears to be more dispersed amongst a range of organisations and a range of people within the LA. At national level, the leadership role is complex and not yet developed (from a local perspective). Accountability mechanisms have changed dramatically within public health, and many people still seem to be unclear about them. Some performance management mechanisms have disappeared, and much accountability now appears to rely on transparency and the democratic accountability that this would (theoretically) enable. The extent to which ‘system leaders’ within PHE are able to influence local decisions and performance will depend on the strength of relationships principally between the LA and the local Public Health England centre. These relationships will take time to develop. Many people have faced new ways of working, in new settings, and with new relationships to build. Public health teams in LAs have faced the most profound of these changes, having gone from a position of ‘expert voice’ to a position where they must defend their opinions and activities in the context of competing demands and severely restricted resources. Public health staff may require new skills, and may need to seek new ‘allies’ to thrive in the new environment. HWBs could be crucial in bringing together a fragmented system and dispersed leadership. The next phase of data collection will begin in March with the initiation of case study work. National surveys will be conducted in June/July this year (2014), and at the same time the following year. In this work, we will further explore the following themes: relationships, governance, decision making, new ways of working, and opportunities and difficulties

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

Views of public health leaders in English local authorities – changing perspectives following the transfer of responsibilities from the National Health Service to local government

This paper reports on the findings of a research project that examined the changes to the public health system in England introduced in 2013. Drawing on case study research and two national surveys the findings explore the impact of organisational change on the composition and role of public health teams. Views and experiences were obtained from public health leaders involved in the transfer of staff and functions from the National Health Service in England to local authorities. National surveys at two points in time aimed to compare and contrast views on the evolving changes. The new organisational and managerial arrangements had enabled public health professionals to widen their work and influence, and public health skills and budgets were welcomed by those in local government. Initially, in some areas, directors of public health were less certain of the benefits of the transfer to local government compared to high levels of confidence expressed by elected members, but perspectives changed over time and moved closer together. National headline figures were found to mask high levels of turbulence and churn being experienced by individual authorities identified in the case study research, and the trend of reducing capacity through cuts to staff, budget and services was a cause for serious concern

Planning and managing primary care services: lessons from the NHS in England

High quality primary care services are an essential part of a successful health service. However, the planning and management of such services is complex. Using evidence from a study of recent extensive changes in the English NHS we highlight the need for local service oversight by managers who understand local conditions and needs. We also suggest that the recent English experience supports an incremental policy adjustment approach rather than wholesale organisational change