Search results

The purpose of this paper is to explore the impact of the Health and Social Care Act, 2012 on London’s rough sleepers as seen from the perspective of one former homeless service user (currently working as a support worker in a day centre providing outreach and “drop in” facilities for people who are street homeless and other vulnerable adults including female sex workers). The discussion centres on some of the unintended impacts of changes to healthcare commissioning; the new arrangements for patient, public representation; and the enhanced role of local councils.

This paper is grounded in front line practitioner reflection/opinion and draws on practical experience and observation at Spires, as well as research and government papers published by other service providers. The aspirations of the Health and Social Care Act, 2012 are set out before its practical application are examined from the rough sleeper’s dimension.

Putting clinicians and GPs centre stage in the commissioning and purchasing of healthcare may have some benefits for individual patient choice, but it can also dilute patient public involvement in health and social care with negative effects for vulnerable and excluded groups, including rough sleepers. The terms of reference ascribed to Local Healthwatch Organisations, the official representatives of the people, are narrower than previously and limit their ability to influence official policy. The Act centralises control whilst devolving operational responsibility, especially for public health provision on which rough sleepers often rely. It is suggested that local voluntary organisations and specialist “inclusion” health groups are increasingly being expected to take over responsibility for delivering health and social care and that mainstream collaboration is much reduced rather than enhanced by this fragmentation.

This review is based on the opinion of an “expert by experience” which may not be representative.

This is one of few papers which present a front line service user/practitioner perspective on the impact of clinical commissioning on services for marginalised groups.

A policy of surveillance which interferes with the fundamental right to a private life requires credible justification and a supportive evidence base. The authority for such interference should be clearly detailed in law, overseen by a transparent process and not left to the vagaries of administrative discretion. If a state surveils those it governs and claims the interference to be in the public interest, then the evidence base on which that claim stands and the operative conception of public interest should be subject to critical examination. Unfortunately, there is an inconsistency in the regulatory burden associated with access to confidential patient information for non-health-related surveillance purposes and access for health-related surveillance or research purposes. This inconsistency represents a systemic weakness to inform or challenge an evidence-based policy of non-health-related surveillance. This inconsistency is unjustified and undermines the qualities recognised to be necessary to maintain a trustworthy confidential public health service. Taking the withdrawn Memorandum of Understanding (MoU) between NHS Digital and the Home Office as a worked example, this chapter demonstrates how the capacity of the law to constrain the arbitrary or unwarranted exercise of power through judicial review is not sufficient to level the playing field. The authors recommend ‘levelling up’ in procedural oversight, and adopting independent mechanisms equivalent to those adopted for establishing the operative conceptions of public interest in the context of health research to non-health-related surveillance purposes.

An inquiry into the constitution of the experience of patienthood. It understands “becoming a patient” as a production of a subjectivity, in other words as a process of individuation and milieu that occurs through an ontology of production. This ontology of production can, of course, also be understood as a political ontology. Therefore, this is, first of all, an inquiry into a mode of production, and, secondly, an inquiry into its relation to the issue of social justice – because of effects of digital divisions. In these terms, it also reflects on how expert discourses, such as in medical sociology and science studies (STS), can (and do) articulate their problems.

An integrative mode of discourse analysis, strongly related to discursive institutionalism, called semantic agency theory: it considers those arrangements (institutions, informal organizations, networks, collectivities, etc.) and assemblages (intellectual equipment, vernacular epistemologies, etc.) that are constitutive of how the issue of “patient experience” can be articulated form its position within an ontology of production.

The aim not being the production of a finite result, what is needed is a shift in how “the construction of patient experience” is produced by expert discourses. While the inquiry is not primarily an empirical study and is also limited to “Western societies,” it emphasizes that there is a relation between political ontologies (including the issues of social justice) and the subjectivities that shape the experiences of people in contemporary health care systems, and, finally, that this relation is troubled by the effects of the digital divide(s).

A proposal “to interrogate and trouble” some innovative extensions and revisions – even though it will not be able to speculate about matters of degree – to contemporary theories of biomedicalization, patienthood, and managed care.

The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service.

The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community “hub” meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship.

Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care.

This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the “spread” of logics between macro-, meso-, and micro-level influences on inter-organizational change.

The purpose of this paper is to consider the possible implications for health scrutiny in England of changes being made/consulted upon resulting from the Health and Social Care Act 2012.

Analysis of the Health and Social Care Act 2012, associated secondary legislation and a review of the existing literature on health scrutiny over the last 10 years.

Health scrutiny legislation is in need of review, especially since the changes to the health care system introduced by the recent Health and Social Care Act 2012. The Department of Health has recently consulted on possible changes to be implemented from April 2013. If health scrutiny can become embedded in local commissioning processes, there is potential for health services appropriate to local populations to be more effectively provided within the current financially challenging environment.

Little has been written on health scrutiny in recent years. This article looks at the potential impacts on and opportunities for health scrutiny under the Health and Social Care Act 2012.

Organizational researchers studying well-being – as well as organizations themselves – often place much of the burden on employees to manage and preserve their own well-being. Missing from this discussion is how – from a human resources management (HRM) perspective – organizations and managers can directly and positively shape the well-being of their employees. The authors use this review to paint a picture of what organizations could be like if they valued people holistically and embraced the full experience of employees’ lives to promote well-being at work. In so doing, the authors tackle five challenges that managers may have to help their employees navigate, but to date have received more limited empirical and theoretical attention from an HRM perspective: (1) recovery at work; (2) women’s health; (3) concealable stigmas; (4) caregiving; and (5) coping with socio-environmental jolts. In each section, the authors highlight how past research has treated managerial or organizational support on these topics, and pave the way for where research needs to advance from an HRM perspective. The authors conclude with ideas for tackling these issues methodologically and analytically, highlighting ways to recruit and support more vulnerable samples that are encapsulated within these topics, as well as analytic approaches to study employee experiences more holistically. In sum, this review represents a call for organizations to now – more than ever – build thriving organizations.

The planning and provision of care for older people in the lesbian, gay, bisexual and trans (LGBT) communities is an increasing challenge to traditional welfare systems. The purpose of this paper is to explore the potential of the newly implemented Care Act 2014 in England for developing an anti-discriminatory approach.

The review draws on existing research and conceptual literature to identify how key provisions of the new act can be interpreted in light of current knowledge.

Overall the provisions of the Care Act lend themselves well to positive interpretation in relation to the needs of older LGBT people and their support networks. A potential tension, however, arises in the locality focus of the legislation that could constrain good practice with geographically dispersed communities. There is also a need to challenge both heteronormative and ageist assumptions that lead to older LGBT people remaining unrecognised.

Applied with imagination and commitment, the provisions of the new act could enable new forms of person-centred care to emerge to support older LGBT people.

Social workers are in a key position to influence how the Care Act is interpreted and applied in practice and can act as change agents for a societal move towards older LGBT people having greater choice and control over their well-being.

This review presents examples of how the provisions of the legislation can be utilised to support positive change for older LGBT people.

According to the Centers for Disease Control and Prevention (CDC), the number of children diagnosed with autism has increased dramatically, especially over the past decade. Most recently, the CDC estimates that an average of one in 88 children have an autism spectrum disorder (ASD). In terms of numbers, this translates into approximately 730,000 people between the ages of 0 and 21 who have ASD. While the primary cause(s) of increases in the identification of autistic students continue to generate debate school officials across the nation need to be prepared for the changing legal landscape associated with children diagnosed with ASD. The primary purpose of this chapter is to provide a detailed legal/policy update of the leading legal considerations and concerns involving K-12 students with autism. The chapter will discuss four specific legal topics involving the identification and eligibility of K-12 students with autism. These four legal topics include: Changes in the New DSM-5 Diagnostic Manuel and its Impact on Legal Definitions of Autism; Insurance Reform and Autism Coverage: A Comparison of the States; Developing Legally Compliant Individualized Education Plans (IEPs) for High-Functioning Students with Autism, and; Recent Legal Developments in Case Law Involving K-12 students who are autistic. The chapter will conclude with a detailed discussion of how today’s school officials can become more legally literate and better serve the legal needs of students with autism in their schools.

While the Affordable Care Act (ACA) promised to reduce inequalities in insurance coverage between Latinos and non-Latinos by expanding coverage, it also excluded a large portion of noncitizen immigrants. Past research has demonstrated that among Latinos, further inequalities have developed between citizens and noncitizens after the ACA took effect, but it is unclear if this pattern is unique to Latinos or is evident among non-Latinos as well. I use data from the 2011 to 2016 waves of the National Health Interview Survey (NHIS) (n = 369,386) to test how the relationship between citizenship status (native citizen, naturalized citizen, or noncitizen) and insurance coverage changed after the ACA, adjusting for health, demographic, and socioeconomic factors. I disaggregate the analysis by ethnicity to test whether this change differs between Latinos and non-Latinos. The analysis finds that after the ACA, naturalized citizens across ethnic groups moved toward parity with native citizens in health insurance coverage while the benefits of the ACA for noncitizens were conditional on ethnicity. For non-Latinos, lacking citizenship became less disadvantageous for predicting insurance coverage while for Latinos, lacking citizenship became even more disadvantageous in predicting insurance coverage. This bifurcation among noncitizens by ethnicity implies that while the ACA has strengthened institutional boundaries between citizens and noncitizens, this distinction is primarily affecting Latinos. The conclusion offers considerations on how legal systems of stratification influence population health processes.

Legal standards that allow teens to make health care decisions, or any important decisions, must account for the contingency and variability of minors’ capacity. Traditional law denied minors’ legal authority to make any decisions, giving all power to parents. This rule goes too far; the Supreme Court has held that minors have constitutionally protected autonomy-based rights, and modern views about adolescence are inconsistent with the rule. The question is how and where to draw lines.

Legal standards are based on minors’ evolving maturity, policy favoring decisions that follow medical advice, and policy supporting parental authority. This paper uses four hard cases to show how these considerations factor into legal rules.