Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.     

Medicine and the Aesthetic Invalidation of Disabled People

Contemporary disability discourse is marked by a struggle between medical and social meanings and models. The latter reflects the aspirations and youthful radicalism of the disability movement, while the former regards itself as the legitimate voice of truth in all matters associated with bodily function and process. This paper argues that the battle lines between these two camps need not be redrawn. Despite hints to the contrary, the proposed extension of the social model to accommodate a sociology of impairment does not involve a rapprochement with the medical model. On the contrary, a sociological account of impairment seeks to augment the armoury of the social model by developing one of its weaknesses, namely the cultural critique of medicine. This paper examines some of the ways in which medicine has been involved in the 'aesthetic invalidation' of disabled people and proposes that 'geneticization' is an important current contributor to this form of disability discrimination.     

The Shag‐Band Menace: Tracing the Spread of a Contemporary Legend

The internet enables analysts to better track rumors and contemporary legends through time and space. Comments about sex bracelets reveal waves of concentrated attention; the spread of particular variants display a similar pattern. The diffusion of such stories reflects constructions of childhood and adolescent sexuality as social problems.     

Queer Intimacies: A New Paradigm for the Study of Relationship Diversity

Recognition of sexual and gender diversity in the 21st century challenges normative assumptions of intimacy that privilege heterosexual monogamy and the biological family unit, presume binary cisgender identities, essentialize binary sexual identities, and view sexual or romantic desire as necessary. We propose a queer paradigm to study relationship diversity grounded in seven axioms: intimacy may occur (1) within relationships featuring any combination of cisgender, transgender, or nonbinary identities; (2) with people of multiple gender identities across the life course; (3) in multiple relationships simultaneously with consent; (4) within relationships characterized by consensual asymmetry, power exchange, or role-play; (5) in the absence or limited experience of sexual or romantic desire; (6) in the context of a chosen rather than biological family; and (7) in other possible forms yet unknown. We review research on queer relational forms, including same-sex relationships; relationships in which one or more partners identify as transgender, gender nonbinary, bisexual, pansexual, sexually fluid, “mostly” straight, asexual, or aromantic; polyamory and other forms of consensual nonmonogamy; kink/fetish relationships; and chosen families. We argue that a queer paradigm shifts the dominant scientific conception of relationships away from the confines of normativity toward an embrace of diversity, fluidity, and possibility.     

From an “outside group” to a catalyst for corporate change: Examining activists’ legitimation strategies

Activist organizations use issues management when pressuring corporations to alter practices and policies that these groups find problematic. Throughout this process, activists must establish legitimacy for their issue concerns, organizations, and proposed solutions to gain public support for their activities. This study qualitatively analyzes the communication practices of 21 activist organizations to understand the strategies that these unique groups harness as they seek to build legitimacy as part of the issues management process. The findings contribute to a growing body of public relations research on activist communication by introducing a new legitimation strategy that underscores the importance of ongoing issues monitoring for activists and illustrates how activist organizations can co-opt extant narratives to build legitimacy for their existing issue arguments.     

Supervision in the helping professions a practical approach

Abstract

This article is based on an ethnographic study undertaken to explore whether eight people diagnosed with terminal cancer and their families drew on aspects of their cultural identities to make sense of their journey towards death, and if so, how. Ethnographic methods were supplemented by semistructured interviews. Most participants received medical treatments until close to death and invested much effort, time, and hope in these. Consequently, they made little sense of their palliative referrals. Instead, they accommodated the biomedical cultures of treatment-oriented services, thus delaying their own and their family's preparation for death. Only three participants appeared well prepared one month prior to death. An ecological perspective helped to explain the systemic factors involved in this prioritisation. The authors make recommendations for greater involvement of social workers in palliative care, and for more attention to supporting dying people and their families to make culturally meaningful decisions in the journey toward death.     

A statistical framework for strategic decision making with AHP: Probability assessment and Bayesian revision

A probability assessment framework is outlined for an organizational decision involving a conditioning event (CE). The decision may, for example, involve a new-product launch (strategic decision) dependent on the outcome of market research (CE). The framework illustrates how Bayesian revision could be employed as related “news” arrives intermittently to revise current probabilities prior to decision implementation. A unique contribution of this paper is its utilization of the analytic hierarchy process to ascertain a set of consistent and coherent probabilities for the event/sample spaces at all stages of the decision process.     

The future of forms of data communications

The first section of the paper is a review of current and planned data communications services. This covers the current state of the art in these services, identifies the need for change and surveys what plans have been made for new services. It looks at what forms of data communications have been established in various countries including the U.K., Germany, U.S.A. and Australia. The second part of the paper poses some key questions. These are broadly similar to those involved in planning other major new investments in utilities or public transportation involving a high degree of technical innovation. They cover the problems of designing a new technology, the pricing of data communications utilities, how to evaluate new services and what the role of the monopoly supplier should be. The paper does not set out to answer these questions but to expose them as areas where controversy is centred, and new research work required.     

The cost of poor quality: an opportunity of enormous proportions

In all organizations, the state of finance is routinely reported in sublime detail for study and action. And yet, anywhere from 20 to 50 percent of the monies involved in that report are never identified as unnecessary and nonproductive. These monies, referred to as the Cost of Waste (COW), are the result of actions that have been taken or must be taken because quality is not served--inappropriate actions are being performed or appropriate actions are not being performed right the first time, every time. Proactively determining, reporting, and monitoring the COW brings a degree of objectivity to the quality management process and provides a powerful internal driver for performance improvement. A 10 step Cost of Waste system is proposed.     

A medicare adult day care model: proposed criteria and available supply

The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting them were: services to be provided directly, 14.6%; multi-disciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings, implications for Medicare funding policy are discussed.