Since the formation of the NHS, all UK citizens have been entitled to access a universal health s... more Since the formation of the NHS, all UK citizens have been entitled to access a universal health service, but radical changes to the NHS are now occurring. Although recent NHS policy claims that 'the NHS belongs to us all' and 'the NHS is a social movement', these collectivist rhetorical claims appear when such communitarian discourse is under threat, as NHS England's (2014) Five Year Forward View tries to square the circle of efficiency, quality and equity. Historically, patients and user-groups have formed support networks and social movements, and collectively campaigned for their voices to be heard by policy makers, clinicians and managers. In contrast to the discourse of user movements, the field of marketing and public relations generally relies on the idea of the public as consumers rather than citizens. As complex governance arrangements blur the lines between public and private, concerns have been raised about how 'spin' associated with public relations might contravene accountability, communicative rationality and deliberative or participatory democracy. Using qualitative methods, we conducted empirical research in two localities to explore the role of communications and engagement staff as they worked to 'transform' the NHS in line with the vision of the Five Year Forward View. We gathered documentary data and interview data from people whose roles required them to 'do engagement'. These staff came from a range of backgrounds, including professional marketing backgrounds, and many were unaware of emancipatory goals or user-led involvement and activism. Our analysis examines the competing logics of marketing and patient empowerment within a key stakeholder matrix document and that surfaced in participants' accounts of their engagement practices.
This symposium grew out of the sub-theme, ' New Modes of Governance in Public Sector Organiz... more This symposium grew out of the sub-theme, ' New Modes of Governance in Public Sector Organizations ' , of the European Group for Organizational Studies (EGOS) Conference held in Ljubljana in July 2004. Our aim was to provide a forum to discuss the policy and practice and the ...
This chapter examines the impact of the various waves of new public management (NPM) and governan... more This chapter examines the impact of the various waves of new public management (NPM) and governance on hospital doctors in Britain — and more recently in England. NHS England became a separate entity in April 2013, and while much of the material discussed here will also apply to Wales, Northern Ireland and Scotland, there are differences which would take too long to properly look into here. I have chosen to concentrate on the acute hospital sector on the grounds that, historically, this is where professional power and dominance been concentrated. There is also an important and interesting story to be told about doctors working in general practice, but there the dynamic of the new managerialism and governance followed a different trajectory (Pollock 2005, pp. 132–164). General practitioners (GPs) are generally independent contractors, who see themselves often as ‘partners with the state’ in delivering health services (Harrison 2004, pp. 52–53), although this situation has changed som...
Remodelling Hospitals and Health Professions in Europe, 2003
Sweden has spent more than any other country in Europe on its public sector, at least until recen... more Sweden has spent more than any other country in Europe on its public sector, at least until recently. Health care spending in 1987 stood at 8.6 per cent of GDP, although this had declined to 7.7 per cent by the mid 1990s according to the 1996 OECD Health Data (Kanavos and McKee, 1998:27). The Netherlands spent comparable proportions on health services: 8.1 per cent in 1987 rising to 8.8 per cent in 1995 (ibid.). By 1998, however, Sweden’s health expenditure at 8.4 per cent (European Observatory – Sweden 2001:25) was nearly at the same level it was in the 1980s. While the proportion spent on health services appears similar, the organisation of the funding of these two countries’ health systems is quite different. In terms of Esping-Andersen’s (1990) typology, The Netherlands is an example of Conservative Corporatism and Sweden represents an example of a Social Democratic welfare regime. Yet, as Pollitt and Bouckaert (2000:61) have observed, despite their differences, ‘[they] share a general disposition towards consensual, often meso-corporatist styles of governance’. This of itself would make the comparison of the two countries’ health systems and professional organisation interesting. But there are additional and possibly better reasons why they are particularly useful comparators with which to start this series of paired case studies (Chapters 3–6).
Remodelling Hospitals and Health Professions in Europe, 2003
In this chapter I describe and compare the Polish and Greek health systems and their medical and ... more In this chapter I describe and compare the Polish and Greek health systems and their medical and nursing professions, and the implications of their position on the periphery of Europe. The notion of periphery being used here not only refers to geography but has another meaning too: Poland was part of the post-1945 Soviet Empire and Greece has strong links with the Balkans and strong Orthodox religious traditions (Mouzelis 1986); both lie outside the welfare regimes identified by Esping-Andersen (1990) and yet are, or are about to be, part of the European Union. Economically neither country is yet in the same league as the other countries discussed in this book. This is, in part, but not solely, because they have been politically and industrially late developers, due in part to their both being victims of imperial domination, Poland from the European and Russian powers and Greece from the Ottoman Empire. Now, however, the political, economic and social aspirations of both countries are focused much more towards the European Union, which has important implications for the countries health systems and professions of medicine and nursing. To the degree to which this is happening one can assert that ‘convergence’ is taking place (Saltman 1997). Political and policy reorientation within the health care system of a country does not, however, automatically lead to a complete adherence to the new regime. No reforms work on a clean slate – pre-existing social and cultural practices are typically strongly embedded (Granovetter 1992). These may be eventually erased and replaced by (or incorporated within) the new practices or they may co-exist with the new arrangements and continue to exert a strong influence.
Journal of health services research & policy, 2017
Objectives Calls for major reconfigurations of health services have been accompanied by recommend... more Objectives Calls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public involvement is fraught with challenges, and little research has focused on involvement in the health service transformation initiatives. This paper examines the design and function of public involvement in reconfiguration of health services within the English NHS. Methods Qualitative data including interviews, observation and documents were collected in two health service 'transformation' programmes; interviews include involved public and professional participants. Data were analysed using parallel deductive and inductive approaches. Results Public involvement in the programmes was extensive but its terms of reference, and the individuals involved, were restricted by policy pressures a...
Background: Since the early 1980s all European countries have given priority to reforming the man... more Background: Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are reshaping the relationship between medicine and management remains limited. Most studies have tended to be nationally specific, located within a single discipline and focused primarily on describing new management practices. This article serves as an Introduction to a special issue of BMC Health Services Research which seeks to address these concerns. It builds on the work of a European Union funded COST Action (ISO903) which ran between 2009 and 2013, focusing specifically on the changing relationship between medicine and management in a European context. Main text: Prior to describing the contributions to the special issue, this Introduction sets the scene by exploring four main questions which have characterised much of the recent literature on medicine and management. First is the question of what we understand by the changing relationship between medicine and management and in particular which this means for the emergence of so called 'hybrid' clinical leader roles? A second question concerns the forces that have driven change, in particular those relating to the wider project of management reforms. Third, we raise questions of how medical professionals have responded to these changes and what factors have shaped their responses. Lastly we consider what some of the outcomes of greater medical involvement in management and leadership might be, both in terms of intended and unintended outcomes. Conclusions: The paper concludes by summarising the contributions to the special issue and highlighting the need to extend research in this area by focusing more on comparative dimensions of change. It is argued that future research would also benefit theoretically by drawing together insights from health policy and management literatures.
Journal of Health Organization and Management, 2015
Purpose – The purpose of this paper is to compare user involvement in the case of assisted reprod... more Purpose – The purpose of this paper is to compare user involvement in the case of assisted reproductive technologies in England and Portugal through the concepts of voice, choice and co-production, assessing the implications for user empowerment. Design/methodology/approach – This qualitative study draws primarily on policy review and uses exploratory semi-structured interviews with key informants as a way of illustrating points. Data on the following themes was compared: voice (users’ representativeness on licensing bodies and channels of communication between users and doctors); choice (funding and accessibility criteria; choice of fertility centres, doctors and level of care); and co-production (criteria through which users actively engage with health professionals in planning the treatment). Findings – Inter- and intra-healthcare systems variations between the two countries on choice and co-production were identified. Differences between funding and accessibility, regions, publi...
Since the formation of the NHS, all UK citizens have been entitled to access a universal health s... more Since the formation of the NHS, all UK citizens have been entitled to access a universal health service, but radical changes to the NHS are now occurring. Although recent NHS policy claims that 'the NHS belongs to us all' and 'the NHS is a social movement', these collectivist rhetorical claims appear when such communitarian discourse is under threat, as NHS England's (2014) Five Year Forward View tries to square the circle of efficiency, quality and equity. Historically, patients and user-groups have formed support networks and social movements, and collectively campaigned for their voices to be heard by policy makers, clinicians and managers. In contrast to the discourse of user movements, the field of marketing and public relations generally relies on the idea of the public as consumers rather than citizens. As complex governance arrangements blur the lines between public and private, concerns have been raised about how 'spin' associated with public relations might contravene accountability, communicative rationality and deliberative or participatory democracy. Using qualitative methods, we conducted empirical research in two localities to explore the role of communications and engagement staff as they worked to 'transform' the NHS in line with the vision of the Five Year Forward View. We gathered documentary data and interview data from people whose roles required them to 'do engagement'. These staff came from a range of backgrounds, including professional marketing backgrounds, and many were unaware of emancipatory goals or user-led involvement and activism. Our analysis examines the competing logics of marketing and patient empowerment within a key stakeholder matrix document and that surfaced in participants' accounts of their engagement practices.
This symposium grew out of the sub-theme, ' New Modes of Governance in Public Sector Organiz... more This symposium grew out of the sub-theme, ' New Modes of Governance in Public Sector Organizations ' , of the European Group for Organizational Studies (EGOS) Conference held in Ljubljana in July 2004. Our aim was to provide a forum to discuss the policy and practice and the ...
This chapter examines the impact of the various waves of new public management (NPM) and governan... more This chapter examines the impact of the various waves of new public management (NPM) and governance on hospital doctors in Britain — and more recently in England. NHS England became a separate entity in April 2013, and while much of the material discussed here will also apply to Wales, Northern Ireland and Scotland, there are differences which would take too long to properly look into here. I have chosen to concentrate on the acute hospital sector on the grounds that, historically, this is where professional power and dominance been concentrated. There is also an important and interesting story to be told about doctors working in general practice, but there the dynamic of the new managerialism and governance followed a different trajectory (Pollock 2005, pp. 132–164). General practitioners (GPs) are generally independent contractors, who see themselves often as ‘partners with the state’ in delivering health services (Harrison 2004, pp. 52–53), although this situation has changed som...
Remodelling Hospitals and Health Professions in Europe, 2003
Sweden has spent more than any other country in Europe on its public sector, at least until recen... more Sweden has spent more than any other country in Europe on its public sector, at least until recently. Health care spending in 1987 stood at 8.6 per cent of GDP, although this had declined to 7.7 per cent by the mid 1990s according to the 1996 OECD Health Data (Kanavos and McKee, 1998:27). The Netherlands spent comparable proportions on health services: 8.1 per cent in 1987 rising to 8.8 per cent in 1995 (ibid.). By 1998, however, Sweden’s health expenditure at 8.4 per cent (European Observatory – Sweden 2001:25) was nearly at the same level it was in the 1980s. While the proportion spent on health services appears similar, the organisation of the funding of these two countries’ health systems is quite different. In terms of Esping-Andersen’s (1990) typology, The Netherlands is an example of Conservative Corporatism and Sweden represents an example of a Social Democratic welfare regime. Yet, as Pollitt and Bouckaert (2000:61) have observed, despite their differences, ‘[they] share a general disposition towards consensual, often meso-corporatist styles of governance’. This of itself would make the comparison of the two countries’ health systems and professional organisation interesting. But there are additional and possibly better reasons why they are particularly useful comparators with which to start this series of paired case studies (Chapters 3–6).
Remodelling Hospitals and Health Professions in Europe, 2003
In this chapter I describe and compare the Polish and Greek health systems and their medical and ... more In this chapter I describe and compare the Polish and Greek health systems and their medical and nursing professions, and the implications of their position on the periphery of Europe. The notion of periphery being used here not only refers to geography but has another meaning too: Poland was part of the post-1945 Soviet Empire and Greece has strong links with the Balkans and strong Orthodox religious traditions (Mouzelis 1986); both lie outside the welfare regimes identified by Esping-Andersen (1990) and yet are, or are about to be, part of the European Union. Economically neither country is yet in the same league as the other countries discussed in this book. This is, in part, but not solely, because they have been politically and industrially late developers, due in part to their both being victims of imperial domination, Poland from the European and Russian powers and Greece from the Ottoman Empire. Now, however, the political, economic and social aspirations of both countries are focused much more towards the European Union, which has important implications for the countries health systems and professions of medicine and nursing. To the degree to which this is happening one can assert that ‘convergence’ is taking place (Saltman 1997). Political and policy reorientation within the health care system of a country does not, however, automatically lead to a complete adherence to the new regime. No reforms work on a clean slate – pre-existing social and cultural practices are typically strongly embedded (Granovetter 1992). These may be eventually erased and replaced by (or incorporated within) the new practices or they may co-exist with the new arrangements and continue to exert a strong influence.
Journal of health services research & policy, 2017
Objectives Calls for major reconfigurations of health services have been accompanied by recommend... more Objectives Calls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public involvement is fraught with challenges, and little research has focused on involvement in the health service transformation initiatives. This paper examines the design and function of public involvement in reconfiguration of health services within the English NHS. Methods Qualitative data including interviews, observation and documents were collected in two health service 'transformation' programmes; interviews include involved public and professional participants. Data were analysed using parallel deductive and inductive approaches. Results Public involvement in the programmes was extensive but its terms of reference, and the individuals involved, were restricted by policy pressures a...
Background: Since the early 1980s all European countries have given priority to reforming the man... more Background: Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are reshaping the relationship between medicine and management remains limited. Most studies have tended to be nationally specific, located within a single discipline and focused primarily on describing new management practices. This article serves as an Introduction to a special issue of BMC Health Services Research which seeks to address these concerns. It builds on the work of a European Union funded COST Action (ISO903) which ran between 2009 and 2013, focusing specifically on the changing relationship between medicine and management in a European context. Main text: Prior to describing the contributions to the special issue, this Introduction sets the scene by exploring four main questions which have characterised much of the recent literature on medicine and management. First is the question of what we understand by the changing relationship between medicine and management and in particular which this means for the emergence of so called 'hybrid' clinical leader roles? A second question concerns the forces that have driven change, in particular those relating to the wider project of management reforms. Third, we raise questions of how medical professionals have responded to these changes and what factors have shaped their responses. Lastly we consider what some of the outcomes of greater medical involvement in management and leadership might be, both in terms of intended and unintended outcomes. Conclusions: The paper concludes by summarising the contributions to the special issue and highlighting the need to extend research in this area by focusing more on comparative dimensions of change. It is argued that future research would also benefit theoretically by drawing together insights from health policy and management literatures.
Journal of Health Organization and Management, 2015
Purpose – The purpose of this paper is to compare user involvement in the case of assisted reprod... more Purpose – The purpose of this paper is to compare user involvement in the case of assisted reproductive technologies in England and Portugal through the concepts of voice, choice and co-production, assessing the implications for user empowerment. Design/methodology/approach – This qualitative study draws primarily on policy review and uses exploratory semi-structured interviews with key informants as a way of illustrating points. Data on the following themes was compared: voice (users’ representativeness on licensing bodies and channels of communication between users and doctors); choice (funding and accessibility criteria; choice of fertility centres, doctors and level of care); and co-production (criteria through which users actively engage with health professionals in planning the treatment). Findings – Inter- and intra-healthcare systems variations between the two countries on choice and co-production were identified. Differences between funding and accessibility, regions, publi...
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Papers by Mike Dent