Explicit rationing within the NHS quasi-market: the experience of health authority purchasers, 1996-97

This thesis analyses the findings of empirical research carried out in three case study UK health authorities in 1996-97, using repeat interviewing of senior managers. It aimed to test three competing hypotheses: i. Markets are one possible system for allocating scarce resources. The process of contract specification in a complex quasi-market is likely to make rationing more explicit than it would be in a hierarchical system ii. In the complex context of the NHS the quasi-market may fail to produce clear contracts and unambiguous allocations, because of prohibitive transaction costs, political costs and ethical costs of greater explicitness iii. Other pressures in favour of explicitness (e.g. rising expenditure, effectiveness evidence and the Patient's Charter) may be irresistible, whatever structural form the NHS takes. The complex relationship between explicit rationing, the internal market and other factors is discussed. Results suggest the quasi-market has contributed to the growth in explicit rationing, notably by decoupling purchasers and providers from their previously shared responsibility to manage resources. In other respects the market has speeded up or magnified the effect of other factors which would or could have happened anyway. Concern to control rising expenditure has led to more explicit decisions but is now rekindling interest in the value of fixed budgets for providers and implicit clinical decision-making. Factors such as the Patient's Charter have also had an independent effect on greater explicitness. Implicit rationing remains significant. The implications for health care rationing of government proposals to abolish the internal market are examined. The results suggest that explicit rationing will probably continue to grow, but with a greater emphasis on explicit criteria to guide clinicians in determining who gets treatment, rather than the exclusion of whole services. The retention of some form of commissioner provider split may also exercise continuing pressure towards explicitness

Partner Experiences of “Near-Miss” Events in Pregnancy and Childbirth in the UK : A Qualitative Study

Funding: This article presents independent research funded by the National Institute for Health Research (NIHR) under the “Beyond maternal death: Improving the quality of maternity care through national studies of ‘near-miss’ maternal morbidity” programme (Programme Grant RP-PG-0608-10038). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Acknowledgments The authors are grateful to all the women and men who contributed to the study, and the reviewers’ comments on the previous version of this article.Peer reviewedPublisher PD

Maternal critical care: what can we learn from patient experience? A qualitative study.

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From waste product to blood, brains and narratives : developing a pluralist sociology of contributions to health research

Funded by National Institute for Health Research (NIHR) Oxford Biomedical Research CentrePeer reviewedPublisher PD

Drawing straight lines along blurred boundaries : qualitative research, patient and public involvement in medical research, co-production and co-design

Biomedical research policy in many countries has adopted the principle of active involvement in research. However, how different approaches to involvement such as patient and public involvement/engagement (PPIE), qualitative research, participatory research, co-design and co-production sit alongside each other, is contentious and unclear. There has also been a subtle shift in the discourse, with the language of co-design and co-production used more widely in debates about involvement. This shift has surfaced once again debates about what counts as meaningful involvement. In this paper we seek to contribute to this debate by exploring boundaries and overlaps between them. We suggest that they share some underpinning philosophies and all are prone to be challenged on the grounds of tokenism despite avowed good intentions. We argue that these different approaches are not necessarily as distinct as is often advocated and question whether there is merit in this family of marginalised approaches working more collaboratively to give patient voices greater traction. At the same time, we recognise that this creates challenges and tensions

Life ‘on high alert’:How do people with a family history of motor neurone disease make sense of genetic risk? Insights from an online forum

Open access via Taylor and Francis agreement Acknowledgements We wish to thank the MND Association for allowing us to use the publicly available information on the MND Association Forum for this research, and for their overall support of the study. We are grateful to Karen Forrest Keenan and Gabrielle King for feedback on an earlier version of the paper. Jade Howard is funded by a doctoral studentship provided by the Institute of Applied Health Sciences, University of Aberdeen. Funding Jade Howard is funded by a doctoral studentship provided by the Institute of Applied Health Sciences, University of Aberdeen. Louise Locock is supported by funding from the Scottish Chief Scientist Office.Peer reviewedPublisher PD

'Valuing place in doctors’ decisions to work in remote and rural locations

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'Valuing place in doctors’ decisions to work in remote and rural locations

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"This illness diminishes me. What it does is like theft" : A qualitative meta-synthesis of people's experiences of living with asthma

ACKNOWLEDGEMENTS This review was funded through a Seed Grant from the Centre for Research Excellence in Severe Asthma, Australia. The Healthtalk resources included in the systematic review were produced by two of the co-authors on the systematic review (SK and LL). LL is supported by NIHR Oxford Biomedical Research Centre.Peer reviewedPublisher PD

Wild Data::How Frontline Hospital Staff Make Sense of Patients’ Experiences

Acknowledgements The authors would like to thank the ward teams and senior management teams at the six participating case study sites, as well as the US‐PEx team of investigators and lay panel members. All authors were employed by the Nuffield Department of Primary Care Health Sciences at the University of Oxford at the time of undertaking the research. The views expressed are those of the authors and do not necessarily reflect the views and opinions of the authors' institutions. This research was funded by the NIHR Health Services and Delivery Research Programme 14/156/06, with scholarship by CM supported in part by the Wellcome Trust through (grant number 209519/Z/17/Z). LL was supported by Oxford NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.Peer reviewedPublisher PD