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  • Author or Editor: Mark Exworthy x
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This paper examines the personal experience of illness and healthcare by health managers through their illness narratives. By synthesising a wider literature of illness narratives and health management, an analytical framework is presented, which considers the impact of illness narratives, comprising the logic of illness narratives, the actors involved and strategies, including the contexts in which those illness narratives are used and the impact they have. The framework incorporates conceptual and categorical approaches to the interactions between their narratives and health management. This framework advances understandings of illness narratives in healthcare: why this narrative was given in this way to this audience. However, as such narratives constitute crucial evidence about health services that is unobtainable elsewhere, the need for more research in this field is pressing. As data on such narratives are poorly collated, the paper calls for more research in this field and presents the analytical framework to shape such empirical inquiry.

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General Managers (GMs) represent a relatively new cadre in the British National Health Service (NHS) who have become closely aligned with central government policy in recent years. GMs have increasingly been appointed to local levels in the NHS which could potentially lead to a clash with other professional domains. This paper uses the example of a decentralisation policy to trace the contest between GMs and professionals during its implementation. The paper focuses on Community Health Services (CHS) where the negotiated order of the hospital does not apply, where professional interests are more fluid and where organisational boundaries are ill-defined. It concludes that, at the local level, GMs are not simply agents of the centre but actively negotiate with other stakeholders and modify the policy according to local exigencies. The conclusion explores the implications for CHS of locally and centrally inspired policy initiatives and the place of CHS in the emerging mixed economy of welfare.

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This chapter introduces the prevalence of NHS reforms since its inception and the lack of discussion and evaluation of these reforms following their implementation. The chapter offers a brief summary of the Coalition government health reforms, and introduces the concept of ‘reform fatigue.’ The authors state that in the remainder of the book, four themes will be used to explain the significance of Coalition health reforms in their analysis. The first theme is the re-organisation within fiscal constraints. The second is centralisation and localism. The third is marketization, and the fourth is health care quality and patient safety. The authors give further descriptions of these themes. The chapter concludes by offering an overview of the organisation of the remainder of the book.

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This chapter takes retrospective and prospective perspectives on health reforms in English NHS. Retrospectively, we offer a precis of the preceding chapters, taking stock of the cumulative lessons from the significant body of evidence that has been presented in this book. Moreover, we seek to explain the ‘how and why’ of these reforms, using a specific conceptual model (multiple streams approach (MSA)). Prospectively, we consider the direction of health policy in the English NHS, and the research agenda which might inform this process.

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Despite repeated reorganisations, the NHS continues to be under severe pressure as it faces profound challenges in terms of growing patient demand, shrinking resources and a rise in external competition. Managing the healthcare workforce was a central focus for Coalition government reforms and it continues to present several challenges; not least that demand for workers often exceeds supply and workforce is often the single most expensive budget item. This chapter identifies recent trends in staffing across the NHS and specifically builds on a growing body of research on NHS managers and NPM. The authors take a broad sweep from the 1980s but focus mainly on the 2010 – 2015 period of the Coalition government. They frame their argument in terms of the shift towards entrepreneurialism. The chapter is divided in to two sections. The first examines the context of and background to recent reforms of NHS staffing. The second examines the state of NHS management and identifies the challenges that remain.

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The NHS has often been seen as a ‘sickness’ service, not least because most determinants of health lie outside healthcare. Yet, the NHS has sought, over its 75 years, to address health inequalities, often through resource allocation and access to services. The analytical axes and evaluative perspectives (from Chapter 1) are then applied to the ways in which the NHS has address health inequalities.

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Hierarchies, markets and networks are well-established ‘models of coordination’ or ‘governing structures’, with different coordinating mechanisms. “If it is price competition that is the central coordinating mechanism of the market and administrative orders that of hierarchies, then it is trust and cooperation that centrally articulates networks” (Thompson et al, 1991, p 15).

New Labour’s main operating code rejects both state hierarchies, or the ‘command-and-control’ of Old Labour, and the market mechanisms of the last Conservative government, and favours instead a Third Way of ‘intermediate’ or ‘network’ forms of organisation (for example, Clarence and Painter, 1998; Exworthy et al, 1999; Kirkpatrick, 1999; Powell, 1999a, 1999b; Rhodes, 2000). However, this is a rather stylised picture of markets, hierarchies and networks. The claim that the original post-war classic, and the Conservative restructured, welfare states can be seen as hierarchies and markets respectively, represents something of an oversimplification; ‘pure’ forms of hierarchy and market were rare (Exworthy et al, 1999). In a path-breaking account, Le Grand and Bartlett (1993) argued that much of Conservative social policy was more accurately seen in terms of ‘quasi-markets’ that differed from ‘real’ markets in a number of important respects. Exworthy et al (1999) followed this line in claiming that it is more accurate to talk in terms of ‘quasi-hierarchies’ and ‘quasi-networks’.

Sako (1992, pp 22-3) claims that networks, strategic alliances and other intermediate forms of organisation have become a fashionable topic, but also that this area of study has recently suffered from excessive neologism. Although New Labour rarely uses the term ‘network’, there have been many references to the key characteristics of networks (for example, Rhodes, 1997, 2000; Clarence and Painter, 1998).

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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.

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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.

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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.

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