The Legacy of ERA, Privatization and the Policy Ratchet

This article explores the ways in which the neo-liberal impetus toward the privatization of state schooling signalled in the Education Reform Act 1988 (ERA) has become embedded in the English school system. Four main points are made. First, that ERA itself was of huge strategic rather than substantive importance as far as privatization is concerned. Second, by tracing the lineage of privatization from ERA onwards a 'ratchet' effect of small and incremental policy moves can be identified, which have disseminated, embedded and naturalized privatization within public sector provision. Third, that while privatization has been taken up and taken much further by New Labour than it had been by the Conservatives there are differences between the two sets of governments in the role of privatization in education policy and the role of the state. Fourth, the participation of private providers in the planning and delivery of state services has put the private sector at the very heart of policy. At points the article draws upon interviews conducted with private sector providers. © 2008 Sage Publications

Introducing the Care Certificate evaluation (innovative practice)

Although investment in staff development is a prerequisite for high quality and innovative care, the training needs of unregistered care staff have often been neglected, particularly within dementia care provision. The Care Certificate, which was fully launched in in England in April 2015, has aimed to redress this neglect by providing a consistent and transferable approach to the training of the front line health and social care workforce. In order to optimise its impact, the implementation of the Care Certificate is now being evaluated through an 18 month study funded by the Department of Health Policy Research Programme. It is the purpose of this article to outline this evaluation

Mental health care and resistance to fascism

Mental health nurses have a critical stake in resisting the right-wing ideology of British fascism. Particularly concerning is the contemporary effort of the British National Party (BNP) to gain credibility and electoral support by the strategic re-packaging of a racist and divisive political manifesto. Evidence that some public sector workers are affiliated with the BNP has relevance for nursing at a series of levels, not least the incompatibility of party membership with a requirement of the Professional Code to avoid discrimination. Progressive advances, though, need to account for deep rooted institutionalized racism in the discourse and practice of healthcare services. The anomalous treatment of black people within mental health services, alongside racial abuse experienced by ethnic minority staff, is discussed in relation to the concept of race as a powerful social category and construction. The murder of the mentally ill and learning disabled in Nazi Germany, as an adjunct of racial genocide, is presented as an extreme example where professional ethics was undermined by dominant political ideology. Finally, the complicity of medical and nursing staff in the state sanctioned, bureaucratic, killing that characterized the Holocaust is revisited in the context of ethical repositioning for contemporary practice and praxis

Trade unions and work-life balance: changing times in France and the UK?

The mixed empirical findings to date have indicated that some, but not all, unions in industrialized countries are actively involved in campaigning and bargaining around work–life balance (WLB) issues, as part of a modernization agenda linked to feminization and to ‘positive flexibility’. This article seeks to identify factors that might encourage or inhibit trade unions from involvement in WLB issues, within a cross-national comparative perspective focusing on two countries (France and the UK) that have contrasting working time regimes and approaches to WLB. It draws on original research carried out in two sectors — insurance and social work — in these two countries. The article links the emergence of union WLB programmes and bargaining agendas to genderequality concerns within the union and to the gender composition of the sector, as well as to the working time regime, including the mode of action, partnership being a significant corollary of WLB campaigning in the UK. We find support for the modernization thesis in the UK, particularly in the public sector, but within severe constraints defined by employer initiative

Putting the squeeze on "Generation Rent": housing benefit claimants in the private rented sector - transitions, marginality and stigmatisation

The term 'Generation Rent' has gained currency in recent years to reflect the fact that more 25 to 34 year olds in Britain now live in rented accommodation rather than owner-occupation. The term also conveys the extent to which age-related divisions in the housing market are becoming as significant as longer standing tenure divisions. However, this portmanteau term covers a wide array of different housing circumstances - from students, young professionals and transient households to the working and non-working poor. This paper focuses on the position of a specific category of this age cohort - those 25 to 34 year olds living in self-contained accommodation in the private rented sector who are in receipt of Housing Benefit. On the basis of survey evidence and qualitative interviews with landlords and housing advisers, the paper considers how the marginal economic and housing market position of this age group is being reinforced by the stigmatising attitudes of landlords which formerly applied to tenants in their late teens and early 20s and are now being extended further along the age band. The paper suggests that the use of a 'housing pathways' approach to signify the housing transitions of young adults needs to be revisited, to give greater weight to collective and creative responses to constraints in the housing market and to recognise the key role played by gatekeepers such as landlords in stigmatising groups according to assumed age-related attributes

Public service innovation and multiple institutional logics: the case of hybrid social enterprise providers of health and wellbeing

Public sector organisations are confronted with growing health and social care needs in combination with severe resource constraints, prompting interest in innovative responses to such challenges. Public service and social innovation is poorly understood, particularly where innovators must navigate between the norms, practices and logics of public, private and civil society sectors. We contribute to the understanding of how innovating hybrid organisations are able to creatively combine co-existing logics. Case study evidence from newly established social enterprise providers of health and wellbeing services in England is utilised to examine how innovations are shaped by (i) an incumbent state or public sector logic, and two ‘challenger’ logics relating to (ii) the market and increasing competition; and (iii) civil society, emphasising social value and democratic engagement with employees and service users. The analysis shows how a more fluid and creative interplay of logics can be observed in relation to specific strategies and practices. Within organisations, these strategies relate to the empowerment of staff to be creative, financial management, and knowledge sharing and protection. The interplay of logics shaping social innovation is also found in relationships with key stakeholders, notably public sector funders, service users and service delivery partners. Implications are drawn for innovation in public services and hybrid organisations more broadly

The crisis of public sector trade unionism: evidence from the Mid Staffordshire hospital crisis

This article contends that there is a growing, if uneven, crisis in public sector trade unionism masked by relatively high membership figures that obscure a weakening of trade unions in the workplace, leaving hollowed out organisation vulnerable to further legislative and employer-led onslaughts. The weakening is not inevitable but to overcome it requires a refocusing of organising efforts on the everyday concerns of members such as understaffing and the provision of better public services. Only with an engaged membership will national issues and wider campaigns have material force. Having outlined a general argument, the article takes as illustrative the nature and performance of trade unions, and particularly UNISON, during the Mid Staffordshire hospital crisis

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

Introduction: Safe staffing and coercive practices are of pressing concern for mental health services. These are inter-dependent and the relationship is under-researched. Aim: To explore views on staffing levels in context of attempting to minimise physical restraint practices on mental health wards. Findings emerged from a wider dataset with the broader aim of exploring experiences of a restraint reduction initiative Methods: Thematic analysis of semi-structured interviews with staff (n=130) and service users (n=32). Results: Five themes were identified regarding how staffing levels impact experiences and complicate efforts to minimise physical restraint. We titled the themes – ‘insufficient staff to do the job’; ‘detriment to staff and service users’; ‘a paperwork exercise: the burden of non-clinical tasks’; ‘false economies’; and, ‘you can’t do these interventions’. Discussion: Tendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative, and organisational developments that would enable reductions in use of restraint are labour intensive and vulnerable to derailment by insufficient and poorly skilled staff. Implications for Practice: Restrictive practices are unlikely to be minimised unless wards are adequately staffed. Inadequate staffing is not independent of restrictive practices and reduces access to alternative interventions for reducing individuals’ distress

The roles, responsibilities and practices of healthcare assistants in out-of-hours community palliative care: A systematic scoping review

Background: Access to community palliative care ‘out-of-hours’ – defined as care provided after the normal hours of work – is advocated globally. Healthcare assistants, who provide care under the direction of a qualified professional, are increasingly employed to help deliver such care, yet there is a little understanding regarding their role, responsibilities or contribution. Aim: The aim of this study was to identify the roles, responsibilities and contributions of healthcare assistants in out-of-hours community palliative care.Design: Scoping review Data sources: Five bibliographic databases (CINAHL, MEDLINE, EMBASE, PsycINFO and Scopus) and grey literature were searched using a predefined search strategy. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. Results: The search yielded six papers using quantitative, qualitative and mixed methods. Results highlighted a lack of recognition of the role and contribution of healthcare assistants. A concurrent theme was that healthcare assistants continually monitored and responded to patient’s and family’s physical and emotional needs; there was also self-reported evidence indicating patient and family benefit, such as maintaining a sense of normality and support to remain at home. Discussion: This review highlighted a dearth of evidence relating to the healthcare assistant role in out-of-hours palliative care. Limited evidence suggests they play a role, but that it is hidden and undervalued. Such invisibility will have a significant impact on the planning and delivery of out-of-hours palliative care. Future research is needed on role development for the benefit of patients and caregivers.</p