Market welfare incorporates provision of services by organisations independent of the state, finance from private business, and individuals purchasing services from their personal resources as ‘welfare consumers’. While the ‘state’ elements of welfare often receive the greatest attention in policy and academic contexts, most developed countries will also have market elements to their welfare funding and provision. In many cases such funding and provision will in fact have pre-dated that from the state (see Chapter Two). Market welfare can exist in parallel to the public elements or be integral within the overall welfare system overseen by policy makers. Burchardt and Obolenskaya (2016) estimate that in England in 2007/8 public welfare spending accounted for £396 billion and private spending £221 billion – so almost a third of the total welfare spend was from private sources. In some countries market welfare may be a voluntary option which those with sufficient resources can access in place of or alongside state provision. In others it is the only option, unless the individual or family meets a low-income or other threshold such as age or disability. For example individuals may need to meet their social care costs from their personal income or savings following financial assessment of their personal resources, or to pay for out-of-pocket expenses such as school meals, uniforms or trips (Table 4.1). It is rare, in the UK at least, for individuals to have no call on any aspect of public welfare support, but there are those who largely do so – a group that Burchardt and Propper (1999) categorise as the ‘private welfare class’.
Seeking greater integration in the delivery of health and social care has been a longstanding aim of different governments over time, yet deep-seated and seemingly intractable barriers remain. While the Coalition has stressed the importance of integrated care and introduced a number of new initiatives, it remains open to question as to whether health and social care are more or less joined up than they were in 2010. Against this background, this chapter begins by summarising the state of play at the end of the New Labour governments of 1997 – 2010 and the main reforms introduced under the Coalition government of 2010-15. The chapter considers the emerging evidence about the impact of the Coalition’s policies, and offers some thoughts on how such developments might be interrupted. The chapter draws on both formal and informal sources of knowledge and seeks to combine a review of the published data with some more personal reflections. In the process, a ‘three stream multidimensional policy implementation framework’ is used to critique the implementation of integration policy by the Coalition.
By their very nature social enterprises can be interpreted as hybrid organisations, as they seek to combine the independence from government and social mission traditionally connected with the third sector, with business principles developed within the private sector. Successive governments have sought to promote this hybrid form of third sector organisation, through extolling their virtues to commissioners and encouraging public sector workers to ‘spin-out’ core public services into social enterprise mutuals. Central government enablers have included dedicated funding, business development support, and mentoring schemes for future leaders. The chapter considers the contexts, motivations and assumptions behind recent policy interests related to social enterprise in general and spinning out in particular, and reviews current evidence regarding their impact in practice.
Social care is the largest area of activity for the third sector in public service delivery. Recent years have seen a rapidly shifting policy and service delivery environment characterised by increased competition and contracting, moves towards preventative and community based services, and greater integration between health and social care. Personalisation has featured as an overriding policy narrative to these changes and underpinned government agendas for social care reform. This chapter assesses the impact of personalisation on the third sector in adult social care. It reviews the third sector’s role in developing and promoting the principles of personalisation, critically examines the maturation of personalisation in government policy, reviews its implementation, and assesses the implications and impacts of personalisation for the third sector, paying particular attention to effects on staff working patterns, operational and financial challenges, and the changing nature of the relationship between third sector organisations, local authorities, and service users.
The English National Health Service introduced the Right to Request (RtR) scheme in 2008, which enabled healthcare staff working in the public sector to ‘spin out’ community health services into social enterprises. Staff wanting to spin out had to apply to their primary care trust board, which was required to consider their requests and if accepted to guarantee initial contracts of between three and five years. This article reviews the RtR scheme and provides an overview of the organisations that have been launched to date. It then considers the implications of the scheme in relation to its implied objectives of improving patient care and empowering staff, as well as the impact on the health and social care system and on the third sector more widely.
The reforms proposed in the 2010 UK National Health Service (NHS) White Paper hold the potential for major changes to the landscape of the NHS. Although the third sector is not mentioned very much in this document, the implications for the sector are significant. This paper sets out the recent history of NHS reform and the detail of the changes before outlining some of the potential implications of these changes for the third sector.
Teams are an important component of everyday life. If you are employed it is likely that you sit in some form of team; if you are studying you will at some point engage in teamwork for a particular project or activity; and in your leisure time you may play in a sports team or support at least one team. Teamworking is an activity that most of us engage in on a regular basis without even consciously thinking about it. Teams can be incredibly important to us on a human level and contribute to our identity, wellbeing, sense of belonging and community. Similarly, in the context of public services, teams are thought to be important in terms of driving organisational and system performance.
At present, local health and social care communities are under significant pressure as challenges arising from the impacts of austerity measures combine with greater citizen expectations, the vestiges of repeated reorganisations of different government agencies and functions and changes to balances of professional power. Government and non-government organisations alike are tasked with achieving the holy trinity of doing more with fewer resources and in a more joined-up and user-centric way. Dealing with complex and cross-cutting issues while there is such turbulence in the system is no easy thing to achieve, and many individuals and organisations have sought to identify the means through which to improve the performance of their organisations and also the broader systems in which they are embedded.
At least part of the answer to this challenge is effective teamwork. As Glasby and Dickinson argue in the introductory book in this series (see Partnership working in health and social care, 2014a), it is not easy to make partnerships work.
As we saw in the last chapter, various claims have been made concerning the impacts that effective teamworking may have on both individuals and organisations, but similarly there are several reports where these assumed benefits have not always been fully realised. As Salas et al (2000, p 340) note, ‘many organisations have, in the past, assumed that a team is a mere collection of individuals and, as such, assumed that merely putting members together would result in effective performance, but this is not true.’ While there is a range of potential mitigating factors that might blunt the impact of teamworking, some commentators have also questioned the degree to which these presumed benefits have been demonstrated within a health and social care context. Zwarenstein and Reeves (2000, p 1022) describe this context as replete with rhetoric about the value of teamworking, but a lack of evidence to support the notion that it is necessarily a ‘good thing’ – hence their conclusion, ‘what’s so great about collaboration?’
In this chapter we consider the extent to which the aspirations of teamworking set out in Chapter 1 are reflected in the research evidence. As well as considering the findings of teams in health and social care in general, we focus in particular on the research evidence regarding teams in which professionals and practitioners from different disciplines and/or organisations work together. Increasingly professionals and practitioners are formally situated within teams that require interdisciplinary collaboration, and indeed, for many (for example, surgical teams), this has traditionally been the case.
As suggested earlier, teamworking is a diverse field, and the potential literature that may be drawn on is significant and increasing in both breadth and depth. Space means that we cannot talk in detail about all areas that may be important in the future, such as geographically dispersed teams, self-managed teams and team coaching. Changes in the ways we commission and provide services is creating teams that are geographically dispersed away from the main organisational hub, not just across local borders, but in other parts of the country. This provides a range of challenges regarding the support for these teams and their alignment with the host organisation. Self-managed teams come in and out of fashion, but cuts to management layers, a greater understanding of how people engage with services, the need for people to take responsibility for their actions, and decisions being made as close to service users as possible, are again driving an interest in self-managed teams. There is much written about coaching as an intervention for individuals. The art of real team coaching is about enabling teams to improve performance, functioning, wellbeing and engagement (Hawkins, 2014), and it is being recognised as an intervention that can have a tangible impact and accelerate the learning and development of a team.
In this chapter we have chosen to concentrate on three key areas that are most salient to health and social care teams, and will likely remain central regardless of the rapidly shifting context in which we find ourselves: