Social citizenship of Polish migrants in London: engagement and non-engagement with the British welfare state

This thesis offers an account of how social citizenship is understood and actualised by ordinary citizens engaged in international mobility. It is based on an analysis of in-depth interviews with 62 Polish migrants conducted within their family and/or household context in London in 2007/2008. The interviews explored how participants satisfied their welfare needs in areas of housing, health and securing an adequate standard of living during their stay in Britain, and to what extent the satisfaction of those needs took place via welfare state or alternative institutions. The eligibility constraints of EU and UK policies on the social entitlements of Polish migrants are reflected in statistical data such as the UK Labour Force Survey. Nevertheless the interviews show that engagement and non-engagement with the British welfare state depend considerably on the participants‟ perceptions of their position in British society. The needs, desert and membership logics of engagement and the market, care and indeterminate logics of non-engagement have been identified. For instance, the self-image of a contributing citizen with a strong work ethic underpins the desert-based logic of engagement. In contrast, the self-image of a pure migrant worker attains to the market-based logic of non-engagement. Furthermore this thesis explains interactions that arise in the processes of engagement and non-engagement with London-based welfare state institutions and traces the consequences for the agent. Methodologically, the study follows the principles of the constructivist reworking of grounded theory. The emerging theoretical perspective emplaces agency in the tension between the ideational and actual levels of individualised experience of social reality, and suggests a sequential interplay between structure and agency. By relaying migrants‟ views and practices of social citizenship, the research identifies the non-national foci of solidarity and legitimacy rooted in the norms of conditionality and local citizenship which redefine the boundaries of modern welfare communities

Commissioning through Competition and Cooperation. Interim Report

Policy background A wide ranging set of reforms is being introduced into the English NHS. The reforms are designed to increase the market-like behaviour of providers of care with a view to improving efficiency, quality and responsiveness of services (DH, 2005; Health and Social Care Act, 2012; ‘HSCA 2012’) and they span the New Labour government and current Coalition government regimes. The idea behind these reforms is that competition between a wider range of providers will produce the desired results such as improved quality and greater efficiency. At the same time, it is still necessary for providers of care to cooperate with each other in order to deliver high quality care. There are many aspects of care quality where cooperation is needed, such as continuity of care as patients move between organisations, and sharing of knowledge between clinicians. Documents such as the Principles and rules for cooperation and competition (DH, 2010) (and more recently, HSCA 2012) explained how the NHS was required to deal with competition and cooperation simultaneously. The principles included the requirement for ‘providers and commissioners to cooperate to deliver seamless and sustainable care to patients’ (principle 4), while also prohibiting commissioners and providers from reaching ‘agreements which restrict commissioner or patient choice against patients’ or taxpayers’ interests’ (principle 6). Similar principles are enshrined in the HSCA 2012, as supplemented by guidance issued by Monitor. Moreover, a Statutory Instrument was issued under the HSCA 2012 which set out the rules governing procurement of health services by NHS commissioners , indicating that competitive procurement is to be preferred (The National Health Service Procurement Patient Choice and Competition No 2 Regulations 2013). A national panel was established to interpret the principles (the Cooperation and Competition Panel, CCP) and advise the NHS on what behaviours were acceptable. Under the HSCA 2012, Monitor (as the new economic regulator) took over some of the functions of the CCP and along with the national competition authorities (being, since April 2014 the Competition and Markets Authority, and prior to that, The Office of Fair Trading, OFT, and the Competition Commission (CC) has powers to enforce competition law to prevent anti-competitive behaviour. At the same time Monitor is also responsible for promoting co-operation. HSCA 2012, section 66 (2) (e) states that Monitor must have regard to ‘the desirability of persons who provide health care services for the purposes of the NHS co-operating with each other in order to improve the quality of health care services provided for those purposes’. It is the role of NHS commissioners (including Clinical Commissioning Groups ‘CCGs’), however, to ensure that the appropriate levels of competition and cooperation exist in their local health economies (HSCA, 2012). Need for research While studies have noted that incentives for competition and cooperation exist in healthcare (Goddard and Mannion, 1998; Kurunmaki 1999), few have researched the interaction between the two. Although there is research about the effects of competition in the NHS reforms introduced by New Labour (e.g. Cooper et al, 2010; Gaynor et al, 2011), there remains a need to investigate the way in which local health systems are managed to ensure that cooperative behaviour is appropriately coexisting with competition. Some specific forms of cooperation have been evaluated 5 (such as integrated care organisations, DH 2009, and clinical networks, e.g. Ferlie et al, 2010), but it does not appear that the general manner in which local health systems are being managed to balance competition and cooperation under the current reforms is being investigated. Study of commissioning through competition and cooperation For this reason, PRUComm is undertaking a project to investigate how commissioners in local health systems manage the interplay of competition and cooperation in their local health economies, looking at acute and community health services (CHS). The research questions are: How do commissioners and the organisations they commission from understand the policy and regulatory environment, including incentives for competition and co-operation? In the current environment, which encourages both competition and cooperation, how do commissioning organisations and providers approach their relationships with each other in order to undertake the planning and delivery of care for patients? In particular, how do commissioning organisations use or shape the local provider environment to secure high quality care for patients? This entails examining how CCGs’ commissioning strategies take account of the local configuration of providers and the degree to which they seek to use or enhance competition and/or encourage cooperation to improve services. This interim report deals with the first research question concerning commissioners’ and providers’ respective understandings of the policy and regulatory environment in which they operate

Perspectives on telecare: implications for autonomy, support and social inclusion

This book is about the ways digital technology can contribute to the welfare of older people. The Internet, mobile phones and other technologies have changed how we live and work. Such technologies also shape how services for older people are organised in ways that potentially place carers and older people at the centre of service provision. Telecare can make homes ‘smart’ so that they are more comfortable and less risky for people who can take advantage of devices that help make them independent members of their community. Digital Welfare is part of the broader project in Britain and elsewhere to adopt new information and communications technologies (ICTs) to organise and deliver health and social welfare services. This includes mundane technologies like an alarm to call for help to complex telecare ‘smart homes’ and electronic patient records. The intended and unintended consequences of such new technologies must be explored if we are to benefit from these innovations. Based on recent research this book seeks to highlight and examine the new opportunities and dilemmas that confront older people and all those concerned with their welfare in the network society. This edited collection provides original contributions from leading academics and researchers in the field to access the evidence for improved professional integration and user-centred health and social care services for older people arising from health informatics. Digital Welfare for the Third Age will be of interest to all those working with older people

'If I Get Ill, It's onto the Plane, and off to Poland.' Use of Health Care Services by Polish Migrants in London

This paper explores a range of health care seeking actions adopted by Polish migrants living in London. It is based on the in-depth interviews with 62 Polish migrants who resided in London in 2007 and 2008. The study reflects experiences of a diverse group of participants encompassing individuals of different ages, family circumstances and employment statuses. It uncovered a number of actions such as avoiding contact with any health services, self-medication, utilising Polish private doctors in London, and accessing public health services in Poland and London. These services and strategies were often used successively, concurrently or interchangeably depending on individual’s assessment of their situation and circumstances at the time of experiencing a particular medical need. The research uncovered a prominence of transnational health care seeking practices as most participants continued to access at least some form of health care in Poland. It also noted the impact of the length of stay, knowledge of English and labour market position on patterns of health care use. Engagement with the British National Health Service (NHS) was characterised initially by lack of knowledge of the system resulting in meandering between different institutions. There was also a sense of cultural unease and mismatch of expectations characterising doctor-patient encounters. However, the pathways of access and attitudes towards the NHS began to change as migrants learned their way through the English health care system. This underlines an importance of taking into account a longitudinal dimension in studies of migrant health care seeking behaviour

Social citizenship of Polish migrants in London: engagement and non-engagement with the British welfare state.

This thesis offers an account of how social citizenship is understood and actualised by ordinary citizens engaged in international mobility. It is based on an analysis of in-depth interviews with 62 Polish migrants conducted within their family and/or household context in London in 2007/2008. The interviews explored how participants satisfied their welfare needs in areas of housing, health and securing an adequate standard of living during their stay in Britain, and to what extent the satisfaction of those needs took place via welfare state or alternative institutions. The eligibility constraints of EU and UK policies on the social entitlements of Polish migrants are reflected in statistical data such as the UK Labour Force Survey. Nevertheless the interviews show that engagement and non-engagement with the British welfare state depend considerably on the participants‟ perceptions of their position in British society. The needs, desert and membership logics of engagement and the market, care and indeterminate logics of non-engagement have been identified. For instance, the self-image of a contributing citizen with a strong work ethic underpins the desert-based logic of engagement. In contrast, the self-image of a pure migrant worker attains to the market-based logic of non-engagement. Furthermore this thesis explains interactions that arise in the processes of engagement and non-engagement with London-based welfare state institutions and traces the consequences for the agent. Methodologically, the study follows the principles of the constructivist reworking of grounded theory. The emerging theoretical perspective emplaces agency in the tension between the ideational and actual levels of individualised experience of social reality, and suggests a sequential interplay between structure and agency. By relaying migrants‟ views and practices of social citizenship, the research identifies the non-national foci of solidarity and legitimacy rooted in the norms of conditionality and local citizenship which redefine the boundaries of modern welfare communities.

Making sense of sensors: older people's and professional caregivers' attitudes towards telecare

This book is about the ways digital technology can contribute to the welfare of older people. The Internet, mobile phones and other technologies have changed how we live and work. Such technologies also shape how services for older people are organised in ways that potentially place carers and older people at the centre of service provision. Telecare can make homes ‘smart’ so that they are more comfortable and less risky for people who can take advantage of devices that help make them independent members of their community. Digital Welfare is part of the broader project in Britain and elsewhere to adopt new information and communications technologies (ICTs) to organise and deliver health and social welfare services. This includes mundane technologies like an alarm to call for help to complex telecare ‘smart homes’ and electronic patient records. The intended and unintended consequences of such new technologies must be explored if we are to benefit from these innovations. Based on recent research this book seeks to highlight and examine the new opportunities and dilemmas that confront older people and all those concerned with their welfare in the network society. This edited collection provides original contributions from leading academics and researchers in the field to access the evidence for improved professional integration and user-centred health and social care services for older people arising from health informatics. Digital Welfare for the Third Age will be of interest to all those working with older people