Suchergebnisse

Partnership working in health presents the findings from a detailed study of public health partnerships in England which are used to explore the government's changes in public health now being implemented.

The UK government's reforms of the NHS and public health system require partnerships if they are to succeed. Those partnerships concerned with public health are especially important and are deemed to be a 'good thing' which add, rather than consume, value. Yet the significant emphasis on partnership working to secure effective policy and service delivery exists despite the evidence testifying to how difficult it is to make partnerships work or achieve results. Partnership working in public health presents the findings from a detailed study of public health partnerships in England. The lessons from the research are used to explore the government's changes in public health now being implemented, most of which centre on new partnerships called Health and Wellbeing Boards that have been established to work differently from their predecessors.The book assesses their likely impact and the implications for the future of public health partnerships. Drawing on systems thinking, it argues that partnerships can only succeed if they work in quite different ways. The book will therefore appeal to the public health community and students of health policy

This article updates a review submitted to the Department of Health (DH) in the light of the House of Commons Health Select Committee report on Elder Abuse. The review drew on recent research about elder abuse in the UK, including research published after the Select Committee's hearings, that made specific recommendations for areas of development in research and policy. The aim of this paper is to address specific questions posed by the Select Committee in light of developments up to mid 2005.

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.

This paper reports on the findings of a research project that examined the changes to the public health system in England introduced in 2013. Drawing on case study research and two national surveys the findings explore the impact of organisational change on the composition and role of public health teams. Views and experiences were obtained from public health leaders involved in the transfer of staff and functions from the National Health Service in England to local authorities. National surveys at two points in time aimed to compare and contrast views on the evolving changes. The new organisational and managerial arrangements had enabled public health professionals to widen their work and influence, and public health skills and budgets were welcomed by those in local government. Initially, in some areas, directors of public health were less certain of the benefits of the transfer to local government compared to high levels of confidence expressed by elected members, but perspectives changed over time and moved closer together. National headline figures were found to mask high levels of turbulence and churn being experienced by individual authorities identified in the case study research, and the trend of reducing capacity through cuts to staff, budget and services was a cause for serious concern.

This article reports on the views of 92 social workers about their practice in adult protection in England and Wales as part of a wider study of adult protection working and regulation that took place between 2004‐2007 in 26 sample local authorities. The article explores social workers' reported experiences of partnership or multiagency working and how this, along with overarching regulatory frameworks, affected their practice within and across agencies. Among findings from the study were that social workers considered that sharing information and responsibilities led to positive outcomes for service users and that the incorporation of different agency perspectives supplemented sharing of best practice.

This article examines the effectiveness of the multi‐agency approach in adult protection and draws on findings from research that examined the effectiveness of both partnership working and perceptions of the regulatory framework to protect vulnerable adults. The research findings were collected through the use of a survey of all local councils with social services responsibilities in England and Wales. Examples of good practice in partnership working were found. However, resource pressures, insufficient information sharing and a lack of clarity about roles and responsibilities were reported to hinder a multi‐agency approach.

Objective: The Health and Social Care Act 2012 ('HSCA 2012') introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England's policy document, The Five Year Forward View ('5YFV') of 2014 placed less emphasis on competition without altering the legislation. We explored how commissioners and providers understand the complex regulatory framework, and how they behave in relation to competition and cooperation. Design: We carried out detailed case studies in four clinical commissioning groups, using interviews and documentary analysis to explore the commissioners'and providers' understanding and experience of competition and cooperation. Setting/participants: We conducted 42 interviews with senior managers in commissioning organizations and senior managers in NHS and independent provider organisations (acute and community services). Results: Neither commissioners nor providers fully understand the regulatory regime in respect of competition in the NHS, and have not found that the regulatory authorities have provided adequate guidance. Despite the HSCA 2012 promoting competition, commissioners chose mainly to use collaborative strategies to effect major service reconfigurations, which is endorsed as a suitable approach by providers. Nevertheless, commissioners are using competitive tendering in respect of more peripheral services in order to improve quality of care and value for money. Conclusions: Commissioners regard the use of competition and cooperation as appropriate in the NHS currently, although collaborative strategies appear more helpful in respect of large-scale changes. However, the current regulatory framework contained in the HSCA 2012, particularly since the publication of the 5YFV, is not clear. Better guidance should be issued by the regulatory authorities.

OBJECTIVE: The Health and Social Care Act 2012 ('HSCA 2012') introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England's policy document, The Five Year Forward View ('5YFV') of 2014 placed less emphasis on competition without altering the legislation. We explored how commissioners and providers understand the complex regulatory framework, and how they behave in relation to competition and cooperation. DESIGN: We carried out detailed case studies in four clinical commissioning groups, using interviews and documentary analysis to explore the commissioners' and providers' understanding and experience of competition and cooperation. SETTING/PARTICIPANTS: We conducted 42 interviews with senior managers in commissioning organisations and senior managers in NHS and independent provider organisations (acute and community services). RESULTS: Neither commissioners nor providers fully understand the regulatory regime in respect of competition in the NHS, and have not found that the regulatory authorities have provided adequate guidance. Despite the HSCA 2012 promoting competition, commissioners chose mainly to use collaborative strategies to effect major service reconfigurations, which is endorsed as a suitable approach by providers. Nevertheless, commissioners are using competitive tendering in respect of more peripheral services in order to improve quality of care and value for money. CONCLUSIONS: Commissioners regard the use of competition and cooperation as appropriate in the NHS currently, although collaborative strategies appear more helpful in respect of large-scale changes. However, the current regulatory framework contained in the HSCA 2012, particularly since the publication of the 5YFV, is not clear. Better guidance should be issued by the regulatory authorities.

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.