Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency

Background: In recent years joint commissioning has assumed an important place in the policy and practice of English health and social care. Yet, despite much being claimed for this way of working there is a lack of evidence to demonstrate the outcomes of joint commissioning. This paper examines the types of impacts that have been claimed for joint commissioning within the literature. Method: The paper reviews the extant literature concerning joint commissioning employing an interpretive schema to examine the different meanings afforded to this concept. The paper reviews over 100 documents that discuss joint commissioning, adopting an interpretive approach which sought to identify a series of discourses, each of which view the processes and outcomes of joint commissioning differently. Results: This paper finds that although much has been written about joint commissioning there is little evidence to link it to changes in outcomes. Much of the evidence base focuses on the processes of joint commissioning and few studies have systematically studied the outcomes of this way of working. Further, there does not appear to be one single definition of joint commissioning and it is used in a variety of different ways across health and social care. The paper identifies three dominant discourses of joint commissioning – prevention, empowerment and efficiency. Each of these offers a different way of seeing joint commissioning and suggests that it should achieve different aims. Conclusions: There is a lack of clarity not only in terms of what joint commissioning has been demonstrated to achieve but even in terms of what it should achieve. Joint commissioning is far from a clear concept with a number of different potential meanings. Although this ambiguity can be helpful in some ways in the sense that it can bring together disparate groups, for example, if joint commissioning is to be delivered at a local level then more specificity may be required in terms of what they are being asked to deliver

How In-Home Technologies Mediate Caregiving Relationships in Later Life

In-home technologies can support older adults' activities of daily living, provide physical safety and security, and connect elders to family and friends. They facilitate aging in place while reducing caregiver burden. One of older adults' primary concerns about in-home technologies is their potential to reduce human contact, particularly from cherished caregivers. In this exploratory in-situ study, we provided an ecosystem of networked monitoring technologies to six older adults and their caregivers. We analyzed the amount and content of communication between them. The amount of non-computer-mediated communication did not decrease through the six week study. The content of communication coalesced into four themes: communication about the technologies, communication facilitated by technologies, intrusiveness of technologies, and fun and playfulness with the technologies. Results suggest that in-home technologies, designed with sensitivity to older adults' primary motivations, have the potential to shape and tailor important relationships in later life.Update copyright statement and embargo date when published version is available - OR 19/02/201

Inter-national benchmarking of road safety: State of the art

Road traffic injuries and fatalities have nowadays been recognized as one of the most important public health issues that requires concerted efforts for effective and sustainable prevention. Given the fact that more and more countries are taking steps to improve their road safety situation, there is a growing need for these countries to work together more closely, because there are quite a number of common problems that can be identified in close cooperation, and improvement can be expected by learning lessons from existing best practices in other countries. As a consequence, comparison between a range of countries in terms of their road safety performance and development or using state-of-the-art terminology inter-national benchmarking of road safety, is currently widely advocated by most countries and international bodies as an emerging methodology for road safety improvement. However, performing a successful road safety benchmarking practice is by no means easy. Challenges exist from the definition of benchmarking framework at the very beginning to the final decisions in terms of identification of best practices and establishment of a continuous process of mutual learning. In this paper, the theoretical background of the benchmarking approach is introduced, and a specific benchmarking cycle for road safety is established which consists of five core activities. Moreover, as a valuable benchmarking tool, the development of a road safety index is highlighted, and some theoretical and practical issues on this subject are discussed. (C) 2014 Elsevier Ltd. All rights reserved.road safety; benchmarking; inter-national comparisons; composite indicators; road safety inde