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1 – 10 of over 27000Carol Atkinson and Sarah Crozier
The purpose of this paper is to examine the marketization of domiciliary care, its consequences for employment practice, specifically fragmented time, and the implications for care…
Abstract
Purpose
The purpose of this paper is to examine the marketization of domiciliary care, its consequences for employment practice, specifically fragmented time, and the implications for care quality.
Design/methodology/approach
Focus groups and face-to-face or telephone interviews were conducted with care commissioners, service providers and care workers across Wales. There were 113 participants in total.
Findings
These demonstrate fragmented time’s negative consequences for service providers, care workers and, ultimately, care quality.
Research limitations/implications
No care recipients were interviewed and care quality was explored through the perceptions of other stakeholders.
Social implications
For policy makers, tensions are evidenced between aspirations for high-quality care and commissioning practice that mitigates against it. Current care commissioning practices need urgent review.
Originality/value
The research extends the definition of fragmented time and integrates with a model of care quality to demonstrate its negative consequences. Links between employment practice and care quality have only previously been hinted at.
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Judith Strobl and Rajan Madhok
The purpose of this paper is to describe the experiences of Manchester Primary Care Trust (PCT) of driving improvement in quality and patient safety as commissioners in the…
Abstract
Purpose
The purpose of this paper is to describe the experiences of Manchester Primary Care Trust (PCT) of driving improvement in quality and patient safety as commissioners in the English National Health Service (NHS). After the PCT's establishment in late 2006, considerable work was undertaken to develop and promote the role of Commissioner as the custodian of standards of services for its resident population. This required engagement with internal PCT stakeholders and a range of external stakeholders locally, regionally and nationally. The authors' experience should be of interest in the UK, and beyond given that many health systems have, or are moving towards, a commissioner: provider model.
Design/methodology/approach
This is a case study using self‐reported observational approach.
Findings
The authors' experience showed that commissioners can and should provide the leadership in driving quality improvements and patient safety, within their health systems. However, the challenges must not be underestimated, and the authors share some of the methods they used and lessons they learned.
Research limitations/implications
There is a considerable interest in promoting quality through better commissioning of health care services. However, there is limited research into the impact and effectiveness of using commissioning as a lever. Given that in the NHS, and elsewhere in the world, commissioning is seen as the organising principle for health systems, such research and evaluation should be a priority.
Practical implications
This case study has valuable lessons for the new NHS and the findings are relevant to other health systems. There is a danger that the new NHS will repeat some of the mistakes of the past, and hopefully this case study can help avoid, or limit, the risks.
Originality/value
To the authors' knowledge there is no comparable piece of work, and the data/findings have not been published or reported comprehensively before. The paper should be of value to not just the NHS but to health systems generally, since commissioning seems to be the prevailing model for organising them.
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The purpose of this paper is to present findings from face-to-face interviews undertaken with 16 care and nursing home managers employed in homes situated in two English local…
Abstract
Purpose
The purpose of this paper is to present findings from face-to-face interviews undertaken with 16 care and nursing home managers employed in homes situated in two English local authorities. The research sought to explore managers’ perceptions of the role of contract monitoring in the prevention of abuse.
Design/methodology/approach
Semi-structured interviews were undertaken with 16 care and nursing home managers.
Findings
Though personnel employed by the local authority who conducted contract monitoring were generally thought of positively by care home managers on a personal level, their effectiveness was perceived to be limited as a result of their lack of experience and knowledge of providing care, and the methods that they were required to use.
Research limitations/implications
Though the research draws upon the experiences of only 16 care and nursing home managers in two local authorities, data suggest that current contract monitoring activity is of limited utility in determining the true nature of care and the presence of abuse.
Originality/value
Unusually, the paper explores care and nursing home managers’ perceptions of contract monitoring processes in terms of how they perceive their effectiveness in preventing abuse.
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The aim of this paper is to set out the role of clinical governance within the new commissioning framework. It starts by considering the historical development of clinical…
Abstract
Purpose
The aim of this paper is to set out the role of clinical governance within the new commissioning framework. It starts by considering the historical development of clinical governance and lays out ideas for the new arrangements around the concept of the primary care home and concludes with challenging questions for the future.
Design/methodology/approach
The paper draws on the author's role and experience as a senior policy maker in the UK Department of Health.
Findings
If we are to fulfil the defined attributes of clinical governance the NHS needs to adopt a more reflective self‐auditing leadership culture. Whether that supposition is accepted or not, a set of questions arises. Why, given for instance the gross failures of care for the frail elderly, have the principles of clinical governance not been systematically embedded? Why, given the NHS can no longer be described as poorly resourced, are clinical outcomes for many conditions lagging behind equivalent international healthcare systems? Why have the improved access and clinical outcomes of recent years been dependent on political rather than NHS leadership? And why in our publicly funded NHS is there frequently a culture of regarding patients as grateful supplicants rather than true partners to whom we should account? Clinical governance for personal, population and system care. Does this represent a coming of age?
Originality/value
This article provides a contribution to the emerging policy debate around clinical governance in the new commissioned NHS, rooted in experience from both the clinical front line and the heart of national health policy making.
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Securing better health and better care outcomes for people by effective use of public resources is at the heart of the commissioning agenda. Commissioning should ensure that the…
Abstract
Securing better health and better care outcomes for people by effective use of public resources is at the heart of the commissioning agenda. Commissioning should ensure that the needs and wishes of people are well understood, and the market managed, so there are a range of local supports and provision available at a reasonable price. This is particularly important for people with intellectual disability whose behaviour is challenging, where effective clinically informed leadership is essential. Although models of good practice have been demonstrated for more than 20 years, making this happen on a wider scale remains the real challenge. Common wisdom about positive practice is not common practice in meeting identified needs. This paper aims to demystify the ‘commissioning’ role, and highlights the case for change in current practice, exploring some of the key barriers that must be addressed and suggesting ways to achieve better outcomes.
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The Report on the Consultation on the Review of No Secrets, published by the Department of Health in 2009 highlighted the need for commissioners to take more responsibility, in…
Abstract
Purpose
The Report on the Consultation on the Review of No Secrets, published by the Department of Health in 2009 highlighted the need for commissioners to take more responsibility, in partnership with regulators, for safeguarding people who use services. This article aims to focus on resources that support the role of commissioners to maintain or improve the quality of services to reduce the likelihood of abuse, neglect or harm.
Design/methodology/approach
The article is based on the content of two SCIE resources. The first looks at all of the monitoring mechanisms a commissioner can draw upon to monitor good quality without overlap with inspectors or overburdening the provider. The second looks at common areas of practice that lead to safeguarding referrals in care homes. Working with a group of 30 practitioners, comprising largely commissioners and providers, a guide to preventing some of the problems that frequently lead to safeguarding referrals from care homes was developed.
Findings
The first SCIE product on which the article is based outlines the mechanisms available to care home commissioners that can be utilised to improve safeguarding. The second, based on work with practitioners, highlights some of the issues that frequently lead to safeguarding referrals from care homes. These are often the result of poor quality services and poor practice rather than malicious intent. The work demonstrates that commissioners could improve the quality of residential services through better partnership working and better use of available intelligence to reduce the risk to those in residential care.
Practical implications
There are numerous steps that both commissioners and providers can take to improve the prevention of abuse, neglect and harm towards people in residential care.
Social implications
The guides highlighted in this article have the potential to improve practice in commissioning and, as a consequence, to provide better quality and safer residential care services.
Originality/value
The value of the paper is to support commissioners to better safeguard people in residential care.
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The purpose of this paper is to present a review of some of the fundamental theoretical and contextual components of commissioning and regulatory processes as applied to care home…
Abstract
Purpose
The purpose of this paper is to present a review of some of the fundamental theoretical and contextual components of commissioning and regulatory processes as applied to care home services, revisiting and examining how they impact on the potential prevention of abuse.
Design/methodology/approach
By revisiting a number of the theoretical bases of commissioning activity, some of which may also be applied to regulatory functions, the reasons for the apparent limited impact on the prevention of the abuse that occurs in care homes by these agencies are analysed.
Findings
The paper demonstrates how the application of commissioning and regulatory theory may be applied to the oversight of care homes to inform proposed preventative strategies.
Practical implications
The paper offers strategies to improve the prevention of abuse in care homes for older people.
Originality/value
A factual and “back to basics” approach is taken to demonstrate why current strategies that should contribute to tackling abuse in care homes are of limited efficacy.
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The existing social care system is riddled with complexity ‐ an unfair system of means testing to determine payment plus a postcode lottery of funding and standards ‐ providing…
Abstract
The existing social care system is riddled with complexity ‐ an unfair system of means testing to determine payment plus a postcode lottery of funding and standards ‐ providing little support for family carers. It is important that the principle of having a tax‐funded national care service is properly considered by the newly established Dilnot Commission on the Funding of Care and Support as a future option, but it will not be enough to simply look at the issue of funding without also addressing the quality, standards and availability of care services.
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Strategic socio-political views are notably scarce among contemporary discourses on the causes of abuse of vulnerable older people in care and nursing homes. This paper aims to…
Abstract
Purpose
Strategic socio-political views are notably scarce among contemporary discourses on the causes of abuse of vulnerable older people in care and nursing homes. This paper aims to catalyse higher order consideration and discussion of one socio-political characteristic that has relevance to the issue of abuse, that is, the market-like environment in which care and nursing homes in England operate. In doing so, the paper argues that the now firmly established but imbalanced “quasi-market” of care that has developed over many years fosters conditions under which both poor care and abuse are more likely to occur. The evidence presented in the paper focusses primarily on the rise to dominance of for-profit care home provision and the contraction of public sector provision. The paper does not examine in detail the characteristics and market presence of the not-for-profit sector because it has not held a numerically significant market share either historically or contemporarily.
Design/methodology/approach
Outcomes of the marketisation of the care home sector that has its origins in the political landscape prevailing in 1979 and thereafter, along with the concurrent development of its regulation and oversight, are narrated and analysed. From this, a mythos of the motives behind the transition to a market-like economy that has taken place over four decades is developed and used to explain how prevailing market conditions contribute to the perpetuation of poor care and abuse.
Findings
In the opinion of the author, there are identifiable consequences arising from the evolution of the current care economy that dispel the beliefs that providing care by means of current market-like arrangements is advantageous, that the independent regulation and monitoring of such a market is unproblematic and effective, and that the “consumers” in this market are exercising personal choice, in accord with classical economic theory.
Practical implications
The paper offers the opportunity for the reader to consider how the development of a “quasi” market of care and nursing home services that has come to be dominated by for-profit private providers, and that is subject to ineffective oversight, may have contributed to conditions where abuse is more likely to occur and endure.
Originality/value
This is a conceptual paper that explores the consequences of the creation of the market-like economy of care in which care and nursing homes now operate and suggests that it is time for prevailing market conditions to be re-visited and subjected to remedial strategic intervention.
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Randall Smith, Robin Darton, Ailsa Cameron, Eleanor K. Johnson, Liz Lloyd, Simon Evans, Teresa June Atkinson and Jeremy Porteus
The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the…
Abstract
Purpose
The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing.
Design/methodology/approach
The review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings.
Findings
The core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings.
Originality/value
Addressing the implementation of OBC in adult social care in England in the context of extra care housing.
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