Public Participation in the New NHS: No Closer to Citizen Control?

Over the last decade support for increasing public participation in decisions regarding the planning and delivery of health services has become a familiar feature of the policy agenda for the UK National Health Service. This paper reviews current Labour policy towards public participation and reports on the response of primary care groups (PCGs) to recent Labour directives to make patient and public involvement an integral part of the way they work, presenting the findings of a survey conducted in one English health region. The experience of these PCGs suggests that, despite the diverse backgrounds of board members, there is marked consensus between local and central decision makers as to their understanding of public participation. Whilst academic debates have tended to conceptualize participation in dualist terms as a form of consumerism or of citizenship, the survey data suggest that in the context of local implementation public participation is framed within a new public management perspective which values it as an aid to organizational learning. The findings of this study highlight obstacles to securing effective public participation, including a lack of substantive guidance regarding policy implementation that produces uncertainty amongst local decision makers as to how best to proceed. The inherent limitations of public participation within the new public management paradigm suggest that democratic renewal, one of the goals of the government's modernization agenda, is unlikely to be achieved.     

Statistics at Liberal Arts Colleges

Statisticians and others who teach statistics at liberal arts colleges enjoy opportunities and encounter difficulties that are unique to the liberal arts setting. In July 1987 a small group of statisticians participated in a workshop at which discussion focused on three major issues: statistics in the liberal arts, the teaching of statistics, and the role of a statistician at a liberal arts college. By summarizing our discussion in this report we hope to provide support for statisticians at liberal arts colleges and to initiate discussion directed toward giving statistics education a prominent position in the liberal arts curriculum.     

Professional Distance and Social Work: Stretching the Elastic?

Abstract

Professional distance and the parallel concept of models of practice reliant on professional objectivity have been major platforms in professional education. In social work, these ideas are often seen as contentious, unreasonable and, in some cases, unrealistic. Radical, feminist and rural social work approaches, for example, suggest that the expert role is not only inappropriate, but can be counter-productive and disrespectful of the people with whom we work. Postmodern approaches call for a deconstruction of professionalism in favour of context-specific partnerships between worker and client. How can workers ensure good, professional practice within a more flexible approach to professional distance and expertise? What are the issues and how may they be resolved? Are the boundaries of the professional relationship elastic and, if so, what are the consequences for practice and the individual worker? The present article explores the notion of flexible, elastic boundaries using literature and research from radical, postmodern, feminist and rural social work approaches.     

Networking Through Loose and Strong Ties: An Australian Qualitative Study

Given the significant role attributed to community organizations by many social capital scholars, it is appropriate to investigate the dynamics of that process. In particular, Woolcock and Narayan (World Bank Res. Obs. 15(2): 225–249, 2000) have suggested that bridging and bonding are two different types of connections, whereby bridging is associated with loose ties across communities and bonding is associated with strong ties within a limited group. This qualitative study explores the loose and strong ties of 39 participants connected through community organizations in rural and urban New South Wales. The results suggest that loose and strong ties are not synonymous with bridging and bonding. In general loose and strong ties differ in degree rather than in kind and people prefer to bridge through their strong ties. The interesting exceptions were ties to professionals, which were highly trusted but defined as loose ties. It is suggested that a model for a high social capital society might be a chain of well-bonded groups each with strong links to some other groups.     

Volunteer and coordinator perspectives on managing women volunteers

Recent changes in Australia, such as the new public management and national competition policy, have affected the way that human services are provided and have complicated the role of volunteer coordinators. However, because volunteers are free to choose their level of contribution, it is the volunteers' perspective that is the ultimate yardstick against which their coordination is assessed. The aim of the research examined here was a deeper understanding of women volunteers' and their coordinators' views of their work. The research was conducted within a qualitative paradigm, employing individual and focus group interviews. The analysis identified eight areas of concern for volunteers around their management. The analysis of the coordinators' interviews revealed three coordination styles—horizontal, nurturing, and managerial—of which the managerial was most in conflict with the volunteers' perspective.     

Profiles of behavioral problems in children who witness domestic violence

Unlike previous investigations of shelter-based samples, our study examined whether profiles of adjustment problems occurred in a community-program-based sample of 175 school-aged children exposed to domestic violence. Cluster analysis revealed three stable profiles/clusters. The largest cluster (69%) consisted of children below clinical thresholds for any internalizing or externalizing problem. Children in the next largest cluster (18%) were characterized as having externalizing problems with or without internalizing problems. The smallest cluster (13%) consisted of children with internalizing problems only. Comparison across demographic and violence characteristics revealed that the profiles differed by child gender, mother's education, child's lifetime exposure to violence, and aspects of the event precipitating contact with the community program. Clinical and future research implications of study findings are discussed.     

Issues in understanding quality volunteering in human services

Organisations providing human services are under increasing pressure to demonstrate quality from a range of sources such as new legislation and new requirements for government funding. Four dimensions for examining quality, derived from program evaluation theory, illustrated some of the contradictions surrounding these expectations. The research used a qualitative and grounded approach to exploring clients', volunteers' and coordinators' notions of quality service. The clients' and volunteers' perceptions of quality were highly experiential, related to the specific context and focussed on strong trusting personal relationships. Clients were also very conscious of their lack of power. Coordinators used a combination of approaches to try to satisfy the demands of clients, volunteers and bureaucracy.     

Gender as an element in the intersubjective field: The female therapist and the male patient

Gender identity is a fundamental component of core identity and it lays the ground plan for the creation of the specifics of the individual's self representation through varied early self- and object experience. This paper seeks to illuminate some of the unconscious dynamics emerging out of profound developmental differences between women and men. The effects of these unconscious dynamics upon the relationship between the male patient and the female therapist are examined, drawing upon transferential and extratransferential phenomena. Illustrations are presented, demonstrating interpretive work directed toward resolution of conflicts around male identity and aimed at fostering self-object differentiation.Revised version of a paper presented at the Third National Clinical Conference of the Committee on Psychoanalysis