Donald Evans, Martyn Evans and David Greaves
Health planners in Wales are developing the notion of “health gain” as the key to shaping health care provision in Wales over the coming decade. One of the twin components of…
Abstract
Health planners in Wales are developing the notion of “health gain” as the key to shaping health care provision in Wales over the coming decade. One of the twin components of “health gain”, the idea of “adding life to years”, is both crucial and controversial. The assumptions behind, and the planning implications arising from, the notion of “adding life to years” are examined and it is argued that health gain is essentially plural, diverse and contested. It is concluded that planning for health gain offers both moral dangers and moral gains.
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Clive Bingley, Edwin Fleming and Sarah Lawson
REGULAR READERS of this column will have noted, perhaps with relief, the self‐restraint I have applied in recent months in connection with the game of cricket, not a word about…
Abstract
REGULAR READERS of this column will have noted, perhaps with relief, the self‐restraint I have applied in recent months in connection with the game of cricket, not a word about which have I imparted to you throughout the summer.
The unacknowledged and obscure mechanisms which “inflate” demand for health care provisions, thereby exacerbating the persistent gap between demand and the resources available to…
Abstract
The unacknowledged and obscure mechanisms which “inflate” demand for health care provisions, thereby exacerbating the persistent gap between demand and the resources available to meet it, are considered. It is suggested that the structural scrutiny of emergent medical research ‐ alongside health promotion measures ‐ could be used as a means to moderate health care demand. It is argued that anti‐utilitarian objectives to this approach may be equally levelled at laissez‐faire justifications for unfettered research.
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Michael Clark, David Jolley, Susan Mary Benbow, Nicola Greaves and Ian Greaves
The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a…
Abstract
Purpose
The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).
Design/methodology/approach
The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.
Findings
NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.
Research limitations/implications
The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.
Practical implications
NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.
Social implications
NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.
Originality/value
This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.
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Michael Clark, Neil Moreland, Ian Greaves, Nicola Greaves and David Jolley
The purpose of this article is to discuss the policy developments of integration and personalisation within the context of Primary Care, specifically an innovative Memory Service…
Abstract
Purpose
The purpose of this article is to discuss the policy developments of integration and personalisation within the context of Primary Care, specifically an innovative Memory Service provided within a General Practice. It examines how these policies work together in this context to deliver a high quality service that is responsive to individual needs in an area of care: memory disorder or dementia, which has often relied heavily on secondary care services.
Design/methodology/approach
The article is a case study analysis of integration and personalisation in Primary Care, allowing for examination and elaboration of both concepts as applied in this setting; and their contribution to a better quality care Memory Service. The analysis is produced by independent researchers (MC and NM), background and facts by service personnel (IG, NG and DJ).
Findings
The innovative Memory Service operates as a person‐centred facility, integrating into the surgery, expertise that would traditionally be locked into secondary care health services. It makes maximum use of locally available knowledge of the patient, their family and formal and informal sources of support and therapy through links which cross agency boundaries. These links are identified and utilised in tailored support for individuals by the practice‐based Dementia Advisor. Outcomes include improved dynamics of identification, diagnosis and after care, high satisfaction amongst patients and families and reduced utilisation and expenditure of other healthcare facilities.
Practical implications
Personalisation and integration can be united in the development of innovative and improved Memory Services centred in Primary Care.
Social implications
Maintaining a focus on the needs of people within their social contexts (being person‐centred) is a powerful means of driving better integrated care in Primary Care for people living with dementia and related disorders.
Originality/value
This is the first examination of personalisation and integration as coupled concepts to lead the improvement of care, specifically a Memory Service, in Primary Care.
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Inequalities in English schools stem from numerous factors be they educational, social or economic. Thatcherite policies reshaped the education agenda in the 1980s and…
Abstract
Inequalities in English schools stem from numerous factors be they educational, social or economic. Thatcherite policies reshaped the education agenda in the 1980s and inequalities were ignored by successive governments until 1997 when New Labour included social objectives in its approach with measures, such as Education Action Zones and Excellence in Cities. The following Conservative-Liberal Democrat coalition and Conservative governments of David Cameron maintained such objectives through the Pupil Premium and the Universal Infant Free School Meals scheme. Theresa May’s government seems to have adopted a different policy since July 2016, focusing on meritocracy. Methodological obstacles are inherent to studies on the evolution of inequalities at school level and it may be argued that successive Cabinets since 1997 have not implemented structural reforms designed to tackle economic inequalities, thus limiting the effect of their educational reforms.
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John F. Sacco and Gerard R. Busheé
This paper analyzes the impact of economic downturns on the revenue and expense sides of city financing for the period 2003 to 2009 using a convenience sample of the audited end…
Abstract
This paper analyzes the impact of economic downturns on the revenue and expense sides of city financing for the period 2003 to 2009 using a convenience sample of the audited end of year financial reports for thirty midsized US cities. The analysis focuses on whether and how quickly and how extensively revenue and spending directions from past years are altered by recessions. A seven year series of Comprehensive Annual Financial Report (CAFR) data serves to explore whether citiesʼ revenues and spending, especially the traditional property tax and core functions such as public safety and infrastructure withstood the brief 2001 and the persistent 2007 recessions? The findings point to consumption (spending) over stability (revenue minus expense) for the recession of 2007, particularly in 2008 and 2009.
This paper briefly examines the nature of residential valuations, questions the professional vigour with which such instructions are handled and raises a number of fundamental…
Abstract
This paper briefly examines the nature of residential valuations, questions the professional vigour with which such instructions are handled and raises a number of fundamental points that residential valuers need to be able to answer in the near future, if not to‐day. It concludes with the view that a statistical approach may be necessary in the future but will only be acceptable if based on accurate base data.