Suchergebnisse

"Health systems everywhere are experiencing rapid change in response to new threats to health, including from lifestyle diseases, risks of pandemic flu, and the global effects of climate change. At the same time, health inequalities continue to widen despite efforts to halt and reverse them. Such developments have profound implications for the future direction of public health policy and practice. The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time and what the origins of long-standing dilemmas in public health practice are. The book will therefore appeal to public health professionals and students of health policy and may also encourage them to become fully engaged in political and social advocacy alongside the traditional skills of reasoned analysis and sound evidence."--Publisher's description

Context: Policy implementation is an often overlooked stage when policy is introduced. Too often the result is policy failure caused by overly optimistic expectations, implementation in dispersed governance, inadequate collaborative policy-making, and the vagaries of the political cycle. The Care Act 2014 introduced the most significant change in social care law in England for 60 years. Given the complexity of the changes, the Department of Health and Social Care and its key partners introduced an Implementation Support Programme (ISP) to increase the likelihood of smooth implementation. Objective: To assess the impact of the ISP on local implementation of the Care Act and develop a framework for understanding the requirements of a successful ISP. Methods: Analysis was undertaken of the relevant theoretical and conceptual literature in addition to a review of support programmes for other national policies. The empirical study of the impact of the Care Act's ISP, conducted in six local authorities, focused on three levels of activity that shaped outcomes: national, regional and local. Data were collected through interviews with key stakeholders at each level. Findings: The ISP enjoyed several successes including: helping to secure policy legitimacy, developing stakeholder engagement, sustaining political support, and ensuring the readiness of local implementation agencies. Limitations: The empirical research was confined to six English local authorities which limits drawing general conclusions applicable to the whole country. Implications: Little evidence exists on the value of ISPs. The research goes some way to closing the gap and offers provisional messages on their value to policy-makers and practitioners.

The Griffiths report of 1983 resulted in radical changes (to which the label 'general management' has been applied) to the formalities of organization and management in the national health service. We report the findings of a major study (involving more than 300 interviews) of the impact of these changes up to 1988. Although general management has been widely accepted in the service, and seems to have resulted in some improvements to management processes, there has been no substantial change in organizational culture. We conclude that the impact of the Griffiths model of management has been limited in comparison with the continued influence of medical autonomy and financial limitations.

NHS reform continues to be a topical yet contentious issue in the UK. Reforming healthcare: What's the evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics. It explores work considering the Conservative internal market of the 1990s and New Labour's healthcare reorganizations, including its attempts at performance management and the reintroduction of market-based reform from 2004 to 2010. It then considers the implications of this research for current debates about healthcare reorganization in England, and internationally. As the most up-to-date summary of what research says works in English healthcare reform, this essential review is aimed at anyone interested in the wide-ranging debates about health reorganization, but especially students and academics interested in social policy, public management and health policy

This study reviewed the use in primary care of national surveillance data for children to determine the data's potential utility to inform policy and practice decisions on how to prevent and treat childhood obesity. We reviewed the 28 countries identified by the World Obesity Federation as having high-quality comparable body mass index data for children. Literature published from any period up to December 2013 was included. Peer review literature was searched using Web of Science (Core Collection, MEDLINE). Grey literature was searched using the Internet by country name, programme name and national health and government websites. We included studies that (i) use national surveillance obesity data in primary care, or (ii) explore practitioner or parent perspectives about the use of such data. The main uses of national surveillance data in primary care were to identify and recruit obese children and their parents to participate in school and general practice-based research and/or interventions, and to inform families of children's measurements. Findings indicate a need for school staff and practitioners to receive additional training and support to sensitively communicate with families. Translation of these findings into policy and practice could help to improve current uses of national child obesity surveillance data in primary care.

Partnership working has been a central feature of New Labour's approach to the delivery of health and social policy since 1997. A number of partnership-based initiatives have centred on reducing health inequalities and improving health. This article reports on the findings from a systematic review of the impact of partnership working on public health, and considers whether these partnerships have delivered better health outcomes for local/target populations. It finds that there is little evidence that partnerships have produced better health outcomes for local/target populations or reduced health inequalities.

International audience ; Background: This paper explores similarities and differences in policy content and the political context of the three main English government reports on health inequalities: the Black Report (1980), the Acheson Inquiry (1998), and the Marmot Review (2010). Methods: Thematic policy and context analysis of the Black Report (1980), the Acheson Inquiry (1998), and the Marmot Review (2010) in terms of: (i) underpinning theoretical principles; (ii) policy recommendations; (iii) the political contexts in which each was released; and (iv) their actual or potential influence on research and policy. Results: We found that there were great similarities and very few differences in terms of both the theoretical principles guiding the recommendations of these reports and the focus of the recommendations themselves. However, there were clear differences in terms of the political contexts of each report, as well as their subsequent impacts on research and policy. Conclusion: The paper calls into question the progress of health inequalities research, the use of evidence and of the links between research, politics and policy.

Health and wellbeing Boards (HWBs) were established in England in 2013, bringing together partners from local government, health services and consumer champions, to ensure strategic planning based on local needs. Similar partnership-working arrangements have achieved limited success, particularly in terms of engaging members of the public in decision-making. Drawing on data collected in five heterogeneous case study sites, we examined the role of HWBs in enhancing local democracy and accountability. Interviews, focus groups and observations were used to explore relationships and interactions between HWB members and the public or their representatives. A dramaturgical perspective was then applied in analysing the data. HWBs were generally not perceived to have achieved their well-intentioned aims; instead, meetings represented carefully staged and scripted performances that tended to inhibit rather than enhance democratic accountability. Our dramaturgical analysis highlights key deficits in the governance of HWBs, which are explored in the paper.

Objectives The paper reports on an empirical study of Health and Wellbeing Boards (HWBs) in England. Established by the Health and Social Care Act 2012, HWBs act as place-based hubs for leaders in health, social care, local government and other sectors to come together to address health improvement and the wider determinants of health. Methods We conducted a three-year study of HWBs (2015–2017) in five localities across England. This involved collecting qualitative data from semi-structured interviews with key actors in the HWBs at strategic and operational levels, and focus group sessions with voluntary-sector participants at each HWB. Results HWBs have largely followed the path of previous partnerships in terms of a lack of clear aims and objectives, lack of ownership and accountability by partners, and an absence of any significant impact on health outcomes. Conclusions Many of the features of unsuccessful partnership working were largely displayed by HWBs. Boards require more executive power and ownership from the bottom up if they are to have any real impact.

Purpose – The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. Design/methodology/approach – The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.'s "receptive contexts for change" and four of the eight factors stood out as especially important and form the basis of the paper. Findings – The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the outcomes in respect of transformational change. Research limitations/implications – The chief limitation is the credibility and authenticity of the interviews captured at particular points in time. These formed the datebase for subsequent analysis. The authors sought to guard against possible bias by supplementing interviews with observational studies and focus groups as well as running two dissemination events at which emerging findings from the study were subjected to independent external scrutiny and comment. These events provided a form of validation for the key study findings. Practical implications – The research findings demonstrate the importance of context for the likely outcome and success of complex transformational change initiatives. These require time to become embedded and demonstrate results especially when focused on changing culture and behaviour. But, in practice, allowing sufficient time during which the organisation may remain sufficiently stable to allow the change intervention to run its course and become embedded and sustainable is highly problematic. The consequence is that bold and ambitious efforts like the NETS are not given the space and stability to prove themselves. Too often, politics and external environmental pressures intrude in ways that may prove dysfunctional and negative. Social implications – Unless a different approach to transformational change and its leadership and management is adopted, then changing the NHS to enable it to appear more responsive to changing health care needs and expectations will remain a cause for concern. Ultimately the public will be the losers if the NHS remains insensitive to changing needs and expectations. The patient experience was at the centre of the NETS programme. Originality/value – The study is original insofar as no other has sought to evaluate the NETS independently and over a reasonable time period. The research design, based on a mixed-methods approach, is unusual in evaluations of this nature. The study's conclusions are not so original but their value lies in largely confirming and reinforcing the findings from other studies. It perhaps goes further in stressing the impact of politics on health policy and the negative consequences of constant organisational change on attempts to achieve deep change in the way the NHS is organised and led.