Dorota Osipovič

Lifestyle monitoring as a predictive tool in telecare

Six people with multiple health problems living in an extra care housing scheme for older people with vision impairment agreed to take part in a telecare trial. An average of 14.8 sensors was installed in each of the flats. The monitoring period began in January 2006 and lasted for 10 months. The data acquired by the sensors installed in each flat was transmitted from the home unit to a central computer. Four interviews were conducted with each participant. Halfway through the study we created a number of case studies of sensor activity at the time of known events in the lives of the participants, together with an attempt to interpret these patterns of activity with the benefit of available contextual information. Although our investigation showed that sensors are capable of identifying some changes in daily routines at the time of important events, the interpretation of such changes requires a large amount of contextual information and the involvement of participants themselves. Various technical and operational difficulties will need to be resolved before it will be possible to use lifestyle monitoring predictively.

Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS.

Objectives To explore the ‘added value’ that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP ‘added value’ in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the ‘added value’ that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services.

The regulation of competition in the National Health Service (NHS): what difference has the Health and Social Care Act 2012 made?

This article examines the impact of the Health and Social Care Act 2012 on the regulation of competition in the English National Health Service (NHS), by focussing on the change it marked from a system of sector-specific regulation to one which is clearly based in competition law. It has been suggested that the Act and its associated reforms would significantly alter accountability in the NHS, and would change decisions from the remit of public policy to that of the law. To assess the impact the Act has had in practice, the article compares the interpretation of the rules regarding competition in the NHS by the regulators of competition immediately before, and following, the passing of the Act. It argues that, whilst the reforms have the potential significantly to alter the way competition in the NHS is regulated, the impact of the reforms in this area is limited by the development of systems within the NHS to manage and resolve issues internally where possible.

Conceptualisations of Welfare Deservingness by Polish Migrants in the UK

The issue of reconciling ethnic diversity with the welfare state is a subject of long-standing theoretical debate. In particular, it remains unclear to what extent a shared national identity is necessary for endorsing claims to welfare at the individual and societal levels. Surveys show that migrants are seen as the least deserving category of welfare recipients. Yet migrants’ own views are rarely considered. Based on a qualitative study, this paper explores how Polish migrants residing in London conceptualised their deservingness to British welfare benefits and social housing. It finds a strong preference for conditionality of welfare predicated on contributions through work, payment of taxes and law abidance. Such conditionality applied to both in-group and out-group members thus transcending identity-based claims. These contributions were seen as both necessary and sufficient for laying claims to the British welfare system. Solely needs-based claims were seen as problematic.