ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00189.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe public sector in Britain has been subjected to over a decade of major reform aimed at breaking up public service monopolies, at containing costs while at the same time opening services up to greater consumer choice. Health and social services have not been exempt from this revolution in the organization and management of public sector services. The long‐standing policy of care in the community is being subjected to market principles and the introduction of a ‘contract culture’ very similar to the NHS reforms introduced in 1991.This paper reviews the origins of these developments in the doctrines of ‘new public management’, a movement which has proved attractive to policy‐makers in many countries. Local authority social services departments have been identified as the lead agency for the development of a mixed economy of care following a review of community care policy by the government's health adviser, Sir Roy Griffiths, and a subsequent white paper. This paper examines the limited empirical evidence available on how managers and providers are meeting the challenge bestowed upon them, and concludes that most authorities are moving ahead cautiously if at all. Only a handful of authorities studied have embraced the reforms with any degree of enthusiasm.The paper concludes with an assessment of the reforms from two perspectives: a pessimistic one and an optimistic one. There are many worrying features of the reforms, not least among these being a lack of clarity over their intended purpose. Tensions and contradictions are plentiful, which places in jeopardy the certainty of the reforms in becoming user led rather than provider driven. A more optimistic scenario is that the changes are leading to a loosening up of services and practices which have often suffered from sclerotic tendencies, paternalism and sometimes complacency. If the reform process is skilfully handled and not rushed and if the ends are clearly established and communicated then users and carers could prove to be the principal be

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00190.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe objective of this paper is to map out the changes in the public, private and voluntary provision of long‐stay care for elderly people and younger people with a physical handicap, people with a mental handicap and people with a mental illness in Britain over the period 1970–1990. It is also designed to bring together in a convenient form all the relevant data which are not readily available because they are published in several disparate sources. The effects on the social security budget of the expansion of private residential and nursing homes are described.National trends in provision show a marked increase in private residential and nursing homes and indicate how private provision has taken up an increasing number of people aged 65 years or over and has substituted for public provision with the closure of the hospitals for people with a mental illness or a mental handicap. The income support payments to people in independent homes increased, at 1990 prices, from $33 million in 1980 to $1390 million in 1990.The implications of this changing balance of care in terms of choice, efficiency and equity are examined in the concluding section. There is some evidence that the growth of the independent sector has increased consumer choice and improved efficiency in the provision of long‐stay care but at some cost to those people who would have been provided with free NHS facilities but now have to contribute to the costs of their

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00191.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThere have been a number of systematic investigations of alternative ways of delivering psychiatric care, a number of studies of so‐called ‘alternatives’ to psychiatric care, and some studies of community care services received after in‐patient care. This paper reviews research evidence which suggests that when general psychiatric services are located in community settings, for example psychiatric out‐patient services in primary care settings, or multidisciplinary teams in a community base, the use of psychiatric beds in hospital can b

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00192.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractA new nursing specialism has emerged over the last 10 years, that of the continence adviser. Many posts, however, were set up without adequate planning and resources and the service grew without central coordination or guidance. As a result, the continence advisory role is interpreted differently from post to post. Incontinence is regarded as a stigmatizing condition which is denied the status of true ‘illness’ and its management is traditionally relegated to the responsibility of low‐status and junior staff. In attempting to gain professional recognition, continence advisers have adopted a variety of strategies to overcome these prejudices. In this paper a number of tensions in the role are identified. It is suggested that the service needs to present a more coherent profile both in the interests of its own survival and those of its client

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00193.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractHealth care behaviour studies have tended to focus on health beliefs and other influences on decisions to consult professional health services. The practicalities, task scheduling and negotiations required to implement such decisions have received comparatively little attention. Whereas the role of kin and others as advisers in the lay referral network has been explored, their practical role in enabling or constraining the implementation of health care decisions has received scant attention.Research in low‐income areas of Merseyside identified the decisions and social arrangements underpinning the use of primary health care services. The coordination and scheduling of tasks and related activities involved is considerable, demanding creativity and negotiation. Respondents’ accounts indicate that kin living in other households are more reliable and frequent sources of substitute care or transport than neighbours who may live in closer proximity. There are striking gender differences in the resources ‘borrowed’ from kin: women are more likely to provide substitute care, whilst men help with transport. These valuable, yet invisible, resources are not employed lightly, however. Their use is carefully measured and ‘saved up’ for emergencies, and on behalf of vulnerable dependants.As health services restructure, concentrating facilities in fewer locations and shifting care increasingly onto the ‘community’, more elaborate negotiations and strategies will be required of women as household managers and coordinators. In responding to local needs, health and social policy and professional practice will need to be flexible to take account of the complex realities of peopl

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00194.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00195.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00196.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00197.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1993.tb00198.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY