Are we nearly there yet? A study of the English National Health Service as professional bureaucracies

PurposeThe purpose of this paper is to explore issues of medical engagement in the management and leadership of health services in the English National Health Service (NHS). The literature suggests that this is an important component of high performing health systems, although the NHS has traditionally struggled to engage doctors and has been characterised as a professional bureaucracy. This study explored the ways in which health care organisations structure and operate medical leadership processes to assess the degree to which professional bureaucracies still exist in the English NHS.Design/methodology/approachDrawing on the qualitative component of a research into medical leadership in nine case study sites, this paper reports on findings from over 150 interviews with doctors, general managers and nurses. In doing so, the authors focus specifically on the operation of medical leadership in nine different NHS hospitals.FindingsConcerted attention has been focussed on medical leadership and this has led to significant changes to organisational structures and the recruitment and training processes of doctors for leadership roles. There is a cadre of doctors that are substantially more engaged in the leadership of their organisations than previous research has found. Yet, this engagement has tended to only involve a small section of the overall medical workforce in practice, raising questions about the nature of medical engagement more broadly.Originality/valueThere are only a limited number of studies that have sought to explore issues of medical leadership on this scale in the English context. This represents the first significant study of this kind in over a decade.</jats:sec

Understanding and improving transitions of older people: a user and carer centred approach

This project focuses on older people and their transition between different services and agencies in health and social care. Research studies and reports from inspectors have shown that older people experience many problems before, during and after transitions. This project will be conducted in four local areas and has two key aims. First, it will explore what information, support and care is needed by older people (and their carers) as they go through a transition. Second, the project team will work with people and organisations in the four local areas to put the findings into practice.It is increasingly recognised that older people should be involved in improving the quality of services for their use. In this project, older people who are service users and carers will be recruited, trained and supported to participate in the research. They will work with academic researchers to conduct in-depth interviews in order to find out about older people's experiences of a recent care transition. Analysis of the data and presentation of the findings will be carried out jointly by academic and user/carer researchers.The project team will feed back the findings of the interviews in each of the local areas. It will also provide support to people and organisations in these areas to put the findings into practice, in order to improve transitions for older people. In each area, a local advisory group, which include service users and carers, will lead this process. The findings from the in-depth interviews and the local implementation activities will be shared with NHS, social care and other organisations nationally

Liberating the NHS: orders of change?

Ever since the NHS White Paper was published in July 2010, debate has raged as to whether this is a revolutionary or evolutionary policy programme. At the time, the government was keen to demonstrate the radical and innovative nature of its proposals, but as opposition has increased the language seems to have changed, with policy makers stressing the way in which proposals build on previous policy. As the Health and Social Care Bill goes to the House of Lords in forthcoming months, a policy paper from the Health Services Management Centre analyses this new reform programme. Overall, the paper suggests the reform proposals represent a large degree of continuity or evolution from previous reform agendas. However, they also raise the point that the combined impact of the reforms when implemented may have the potential to bring about radical change as the scale and speed of the proposed changes take effect. They reflect on the contextual factors likely to affect the implementation of the policy proposals and raise some practical implications for researchers and practitioners to consider in relation to this new reform agenda