This chapter assesses the implications of the Coalitions’s plans to restructure the National Health Service (NHS) in England. It explains that the plans involve taking another big step towards an NHS based on a publicly funded regulated market, by abolishing strategic health authorities and replacing primary care trusts with GP-led commissioning consortia. It evaluates the evidence on the market changes introduced by New Labour governments, arguing that these have had some success compared to the impact of additional resources and the setting and enforcement of targets. It notes however, that the absence of any regional intermediary organisations in the Coalition’s plans may lead to inefficient duplication, fragmentation and destabilization, given the tendency towards market failure in healthcare. It opines that undertaking the scope and pace of reform envisaged in a context of restricted financial resource is a risky process, and a more complete, more competitive, NHS market could have negative effects on equity.
This article analyses the relationship between different modes of accountability in New Zealand's publicly funded health sector since 2001. It adopts a ‘multiple modes of governance’ framework, drawing on the findings of an evaluation of health system restructuring conducted between 2001 and 2005. In broad terms, governance of the health system has moved from a combination of hierarchy and market to a mixture of hierarchy and collaboration. This article assesses the degrees to which hierarchical and collaborative accountability regimes have clashed with or complemented each other. We also identify areas in which none of these modes of accountability operate.
This article explores the process of policy learning from abroad from a knowledge utilisation perspective, using examples of health policy making in the Department of Health in England. It argues that information about policy abroad is often heterogeneous and difficult to obtain systematically and therefore does not fit easily with notions of evidence-based policy making. While some officials interviewed for this study did regard policy examples from other countries as a substitute for evidence, especially in areas in which research evidence was insufficient, others appeared to be less confident about its validity and generalisability. Department of Health officials reported a great variability in strategies to obtain such information, with processes often constrained by pressures on time and resources. They were also highly selective in exploring policy examples from abroad, with most respondents stating that they were largely interested in generating ideas to address domestic policy problems, often relating to details of policy. The iterative process of using this information thus raises questions about the extent to which looking abroad contributed to genuine policy learning.
In this paper we reflect on our experience of providing a rapid response facility for international healthcare policy comparisons to the English Department of Health. We examine the challenges of developing sustained relationships with policy officials while providing an ‘on-demand’ service in an environment with high turnover of policies and staff. It may be easier for policy makers to draw on researchers in such a setting than for researchers to foster ‘linkage and exchange’ relationships with policy makers. Under the facility, knowledge transfer has mostly been from researchers to policy officials, affording us little insight into the policy process or the impact of our work.
The personalisation of residential care services is based on three broad principles of valuing personal identity, empowering resident decision-making and fostering care relationships. We analysed 50 Care Quality Commission care home inspection reports to identify factors that the reports indicate facilitate or hinder the delivery of personalised residential care in England. Findings suggest that the provision of personalised services is affected by staff skills, attitudes and availability, as well as the quality of care home leadership. Future care policy should consider addressing external pressures facing the care home sector, including inadequate funding and too few staff, to mitigate barriers to delivering high-quality, personalised care.
This article reports findings from the evaluation of the Direct Payments in Residential Care Trailblazers in England (2014–16). It focuses on the perspective of residential care providers on implementing direct payments, which aimed to improve the level of choice and control over care available to their residents. The article explores the views of providers, using interviews and survey responses of care home managers and owners. Concerns expressed by providers include issues that have arisen in domiciliary care but also issues specific to residential care, especially challenges in facilitating greater choice and control in settings that provide care collectively for substantial numbers of residents.