Dismantling the NHS?

This book provides an in-depth analysis of the NHS reforms ushered in by UK Coalition Government under the 2012 Health and Social Care Act, arguably the most extensive reforms ever introduced in the NHS. Contributions from leading researchers from the UK, the US and New Zealand examine the reforms in the contexts of national health policy, commissioning and service provision, governance and others. Collectively, the chapters presents a broader assessment of the trajectory of health reforms in the context of marketisation, the rise of health consumerism and the revelation of medical scandals. This is essential reading for those studying the NHS, those who work in it, and those who seek to gain a better understanding of this key public service.

Author(s):  
Esme Choonara

The emergence of the Black Lives Matter movement in 2020 in the context of a COVID-19 pandemic that was already disproportionally impacting on the lives of people from black, Asian and other minority ethnicities in the UK and the US has provoked scrutiny of how racism impacts on all areas of our lives. This article will examine some competing theories of racism, and ask what theoretical tools we need to successfully confront racism in health and social care. In particular, it will scrutinise the different levels at which racism operates – individual, institutional and structural – and ask how these are related. Furthermore, it will argue against theories that see racism as a product of whiteness per se or ‘white supremacy’, insisting instead that racism should be understood as firmly bound to the functioning and perpetuation of capitalism.


Author(s):  
Joyce Liddle

Globally there are many innovative, citizen driven initiatives at grass roots level which are aimed at invigorating local politics and improving public service provision (www.oneworldaction.org/indepth/project. jsp?project.209). There has also been recognition that civil society rather than public bureaucracies are capable of providing public services and satisfying social needs. Devolving leader ship and innovation from bureaucrats to grassroots individuals willing to create and lead projects or organisations to solve social problems and fulfil public purposes is becoming a key feature in many states (Van Ryzin, Burgrud and Di Padova, 31st May, 2007). Indeed the Sloan Foundation in the US since 1997, at least , has sponsored numerous citizen driven projects to foster interactions between citizens, municipal managers and elected officials to assess and improve their own communities ... There are examples worldwide of strategic plans being developed by citizens driving the systems to achieve desired results, by performance reporting of council municipalities and service contractors and making them more accountable for service provision (Epstein and Fass Associates, New Jersey, 2007).


Author(s):  
Kath Checkland ◽  
Anna Coleman ◽  
Imelda McDermott ◽  
Stephen Peckham

One of the key elements of the Health and Social Care Act 2010 (HSCA 2012) was the transfer of responsibility for commissioning healthcare services from managerially led Primary Care Trusts (PCTs) to newly established Clinical Commissioning Groups (CCGs), led by General Practitioners. In this chapter, the authors explore what can be learned from previous attempts to involve GPs in commissioning care. They then apply that learning to the provisions of the HSCA 2012, highlighting the correspondences and discontinuities between what is known from history and what was proposed. They then present evidence from their research on CCGs, exploring what happened in practice when CCGs were established. Finally, the authors discuss the continuing evolution of health policy in the UK in the light of both historical evidence and their current findings.


2020 ◽  
Author(s):  
Henry Aughterson ◽  
Alison McKinlay ◽  
Daisy Fancourt ◽  
Alexandra Burton

AbstractObjectivesTo explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic.DesignThis was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding.ParticipantsThis study involved 25 participants from a range of frontline professions in health and social care.SettingInterviews were conducted over the phone or video call, depending on participant preference.ResultsFrom the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth, and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life.ConclusionsThis study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions.Strengths and limitations of this studyThis is the first study in the UK to interview both health and social care professionals working in a range of settings on their experiences working through COVID-19.This study used a strong theoretical approach to inform the topic guide, and one-to-one interviews allowed in-depth analysis of the psychosocial experiences of health and social care professionals, complementing the wider availability of quantitative evidence.We interviewed a wide range of professions, which provided breadth of experience but might limit the specificity of findings.Given the fluctuating nature of the pandemic, attitudes of health and social care professionals may change over time. This can be challenging to capture during a single interview, however we did ask questions on how their experience had progressed longitudinally.Our sample may have been biased towards people who had more free time to participate and so were coping better than others. However, our sample still described a number of stressful experiences during the pandemic, and it is also possible that workers who were frustrated or stressed wished to express their views.


BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e047353
Author(s):  
Henry Aughterson ◽  
Alison R McKinlay ◽  
Daisy Fancourt ◽  
Alexandra Burton

ObjectivesTo explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic.DesignThis was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding.ParticipantsThis study involved 25 participants from a range of frontline professions in health and social care.SettingInterviews were conducted over the phone or video call, depending on participant preference.ResultsFrom the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life.ConclusionsThis study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions.


2016 ◽  
Vol 22 (4) ◽  
pp. 263-268 ◽  
Author(s):  
Jennifer Perry ◽  
Fiona L. Mason

SummaryThe health and social care landscape in the UK is changing, and there is now, more than ever, a real need for doctors to embrace leadership and management. Evidence shows that medical leadership is associated with better outcomes for patients. Psychiatrists are particularly well suited to such roles, given the interpersonal skills and self-awareness that they develop in their training. In this article, we examine the role of the psychiatrist in leading at a patient, team and organisational level and the impact this has. We also discuss different leadership and management styles.


2010 ◽  
Vol 18 (1) ◽  
pp. 7-18 ◽  
Author(s):  
Janet Marsden ◽  
Mary E. Shaw ◽  
Sue Raynel

This paper compares the results of studies of ophthalmic advanced practice in two similar but distinct health economies and integrates the effects of the setting, health policy and professional regulation on such roles. A mixed method questionnaire design was used, distributed at national ophthalmic nursing conferences in the UK and in New Zealand. Participants were nurses undertaking advanced practice who opted to return the questionnaire. Data were analysed separately, and are compared here, integrated with national health policy and role regulation to provide commentary on the findings. The findings suggest that health policy priorities stimulate the areas in which advanced practice roles in ophthalmic nursing emerge. The drivers of role development appear similar and include a lack of experienced doctors and an unmanageable rise in healthcare demand. Titles and remuneration are different in the two health economies, reflecting the organisation and regulation of nursing. In clinical terms, there are few differences between practice in the two settings and it appears that the distinct systems of regulation have minimal effect on role development. Ophthalmic nursing, as a reactive, needs based profession and in common with nursing in general, evolves in order that practice reflects what is needed by patients and services.


2017 ◽  
Vol 80 (5) ◽  
pp. 302-309
Author(s):  
Stephanie Best

Introduction Integrating services is a key tenet to developing services across the United Kingdom. While many aspects of integration have been explored, how to facilitate integration of services remains unclear. Method An exploratory qualitative study was undertaken in 2015 to explore occupational therapists’ perceptions on integrating service provision across health and social care organisational boundaries. The views of practitioners who had experienced integration were sought on a range of aspects of integrating services. This paper focuses on the facilitators for delivering integration and the essential enablers are identified. Findings Numerous factors were noted to facilitate integration and three essential enablers were highlighted. Leadership, communication and joint education were recognised as playing a central role in integrating services across organisational boundaries; without these three essential enablers, integration is liable to fail. Conclusion Integration is a process rather than an event; continued emphasis will be required on leadership, communication and joint education to progress integration achievements made to date.


Author(s):  
David Hughes

A volume on health reforms under the Coalition must necessarily expand its focus beyond Westminster to consider the larger UK policy context. Legislation enacted in 1998 established devolved assemblies in Scotland, Wales and Northern Ireland with power to make law or issue executive orders in certain specified areas, including health services. This meant that an English NHS overseen by the Westminster Parliament now existed alongside separate NHS systems accountable to devolved governments in the other UK countries. Thus, the major Coalition health reforms heralded by the Health and Social Care Act 2012 applied in the main to England only. However, devolved administrations needed to formulate appropriate policy responses that either maintained differences or moved closer to the English policies. This chapter describes the divergent approaches between the four UK NHS systems, but also sheds light on the nature of coalition policy making.


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