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In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.

The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.

The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.

PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.

The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.

As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.

Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons?

An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above.

The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways.

This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations.

Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary.

Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research.

This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.

The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.

The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.

This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.

Changes in demographics and disease patterns are challenging health and care systems across the world. In England, national policies have reset the direction of travel for the NHS. Collaboration, integration and personalisation are intended to become prime principles and drivers for new models of care. Central to this is the concept of population health management. This has emerged, internationally, as a method to improve population health. Fundamental for population health management to succeed is the use of integrated data, analytics combined with professional insight and the adoption of a learning health system culture. This agenda reaches beyond the NHS in England and the public health profession to embrace a broad range of stakeholders. By drawing on international experience and early experience of implementation in the United Kingdom, the potential for health and care systems in England to become world leading in population health management is explored.

A viewpoint paper.

Population health management is a major change in the way health and care systems look at the challenges they are facing. It makes what is happening to individuals, across the continuum of care, the essence for insight and action. The NHS has the components for success and the potential to become world leading in delivery of population health management as part of its integrated care agenda.

This is the first viewpoint paper to set out how population health management contributes to the integrated care agenda in the NHS.

Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

The purpose of this paper is to expose the playout of power dynamics when a new business intelligence (BI) system is implemented in a central pharmacy department in a National Health Service (NHS) hospital. The authors aim to explore the assumptions, experiences and actions of organisational stakeholders and ascertain how different professional groups obtain influence, power and control during this process.

In this research the authors employ structuration theory (ST), to establish how and where domination is achieved. To achieve this, the authors investigate the production and reproduction of structure as part of a longitudinal assessment using interviews and questionnaires.

Constant renewal and evolution are crucial in the implementation of a BI system. During the process of implementation and change many stakeholders resent the change. Disempowering these users leads to new power structures led by BI analysts.

The findings from this paper can help strengthen implications of BI systems implementation and better understand the impact these systems have on wider stakeholders. With coherent communication and an engaged attitude new BI systems can be implemented without alienating the key user stakeholders.

This paper differs from other papers by advocating that new systems and processes alter individual power structures in organisations, disrupting internal dynamics and introducing new aspects of control and dominance.

The purpose of this study is to develop new type of reverse mortgage contract. How to provide adequate services and housing for an increasing number of people that are dependent on the help of others is a crucial question in the European Union (EU). The housing stock in Europe is not fit to support a shift from institutional care to the home-based independent living. Some 90% of houses in the UK and 70%–80% in Germany are not adequately built, as they contain accessibility barriers for people with emerging functional impairments. The available reverse mortgage contracts do not allow for relocation to their own adapted facilities. How to finance the adaptation from housing equity is discussed.

The authors have extended the existing loan reverse mortgage model. Actuarial methods based on the equivalence of the actuarial present values and the multiple decrement approach are used to evaluate premiums for flexible longevity and lifetime long-term care (LTC) insurance for financing adequate facilities.

The adequate, age-friendly housing provision that is appropriate to support the independence and autonomy of seniors with declining functional capacities can lower the cost of health care and improve the well-being of older adults. For financing the development of this kind of facilities for seniors, the authors developed the reverse mortgage scheme with embedded longevity and LTC insurance as a possible financial instrument for better LTC services and housing with care in assisted-living facilities. This kind of facilities should be available for the rapid growth of older cohorts.

The numerical example is based on rather crude numbers, because of lack of data, as the developed reverse mortgage product with LTC insurance is a novelty. Intensity of care and probabilities of care in certain category of care will change after the introduction of this product.

The model results indicate that it is possible to successfully tie an insurance product to the insured and not to the object.

The introduction of this insurance option will allow many older adult with low pension benefits and a substantial home equity to safely opt for a reverse mortgage and benefit from better social care.

While currently available reverse mortgage contracts lapse when the homeowner moves to assisted-living facilities in any EU Member State, in the paper a new method is developed where multiple adjustments of housing to the functional capacities with relocation is possible, under the same insurance and reverse mortgage contract. The case of Slovenia is presented as a numerical example. These insurance products, as a novelty, are portable, so the homeowner can move in own specialised housing unit in assisted-living facilities and keep the existing reverse mortgage contract with no additional costs, which is not possible in the current insurance products. With some small modifications, the method is useful for any EU Member State.

The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital settings, to overcome the fragmented and episodic nature of non-emergency patient care.

The authors used a rapid review to assess the literature on integrated clinical care in hospital settings and critical analysis of links between Mayo Clinic’s care model and the organisation’s performance and associated patient outcomes.

The literature directly concerned with Mayo Clinic’s distinctive ethos and approach to patient care is limited in scope and largely confined to “grey” sources or to authors and institutions with links to Mayo Clinic. The authors found only two peer-reviewed articles which offer critical analysis of the contribution of the Mayo model to the performance of the organisation.

Mayo Clinic is not the only organisation to practice integrated, in-hospital clinical care; however, it is widely regarded as an exemplar.

There are barriers to implementing a Mayo-style model in English NHS hospitals, but they are not insurmountable and could lead to much better coordination of care for some patients.

The study shows that there is an appetite among NHS patients and staff for better coordinated, multi-specialty care within NHS hospitals.

In the English NHS integrated care generally aims to improve coordination between primary, community and secondary care, but problems remain of fragmented care for non-emergency hospital patients. Use of a Mayo-type care model, within hospital settings, could offer significant benefits to this patient group, particularly for multi-morbid patients.

The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care.

Through a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars.

The wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected.

To the best of the authors’ knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.

Health-care systems around the globe share several pressing challenges – including increasing costs and patient outcomes. Innovative arrangements, such as public–private partnerships (PPP) can be adopted to help address these challenges. Although the promise of PPPs is great, so are its peril if the arrangements are not managed and regulated adequately through the contracting process. Yet, PPP arrangements can introduce their own unique set of problems. This paper aims to analyze how PPPs contracting accounts for three major problems identified reviewing the: performance measurement and audit; determination of compensation and risk management–related issues.

The authors used a case study approach to analyze contracting among health-care PPPs in two countries: Italy and the USA. With a structured review performed on Scopus database using a keywords Boolean research, the authors identified three recurring major issues to investigate in two selected cases, one per country. For each major issue, the authors defined several sub-issues retrieved from a widely used institutional framework. In each sub-issue, a documental analysis on all published information related to the signed contract has been performed identifying the approaches used by the two organizations.

The authors find that PPP contracting in the USA case seems to be oriented more toward managing institutional change as well as more flexibility in the deductibility and compensation determination for organizations and providers, suggesting this organization is more oriented to change in general. The authors find that PPP contracting in Italy more clearly delineate the allocation of risk between organizations that engage in PPPs, suggesting a more practical approach.

PPP is complex. Contracting helps manage the complexity of these arrangements. This case study approach to PPP contracting highlights the variation in contracting approaches across two different countries. Policymakers and health-care managers need to ensure that PPP contracting clearly delineates auditing and performance measurement, compensation and risk management.

The authors’ analysis sheds light on the different approaches to arranging health-care PPPs in two different country settings. More research should be done to connect these different approaches to important outcomes, such as patient and organizational finances, as well as expanding the scope of countries adopting PPP in health care.