Helen Dickinson

Interprofessional Education and Training

Introduction What is interprofessional education and why does it matter? What does research tell us? Hot topics and emerging issues Useful frameworks and concepts Recommendations for policy and practice.

Why Partnership Working Doesn't Work

Abstract English public services in general (and health and social care in particular) have become increasingly dominated by the notion of partnership working. Despite this, more recent years have seen something of a reaction against partnerships. This article reviews lessons learned from a case study of a forensic mental health partnership, arguing that the service in question reveals a number of common pitfalls in terms of the way that partnerships are established and put into practice. In many ways, this was not the fault of the case study partnership, but the product of the wider institutional context in which health and social care partnerships have been developed and promoted. Ultimately, the article suggests some additions to the partnership theoretical literature, before concluding that the current concept of partnership working may lose credibility without additional work to clarify its meaning and contribution.

Doctors who become chief executives in the NHS: from keen amateurs to skilled professionals:

Summary Objectives To investigate the experiences of doctors who become chief executives of NHS organizations, with the aim of understanding their career paths and the facilitators and barriers encountered along the way. Design Twenty-two medical chief executives were identified and of these 20 were interviewed. In addition two former medical chief executives were interviewed. Information was collected about the age at which they became chief executives, the number of chief executive posts held, the training they received, and the opportunities, challenges and risks they experienced. Setting All NHS organizations in the United Kingdom in 2009. Results The age of medical chief executives on first appointment ranged from 36 to 64 years, the average being 48 years. The majority of those interviewed were either in their first chief executive post or had stepped down having held only one such post. The training and development accessed en route to becoming chief executives was highly variable. Interviewees were positive about the opportunity to bring about organizational and service improvement on a bigger scale than is possible in clinical work. At the same time, they emphasized the insecurities associated with being a chief executive. Doctors who become chief executives experience a change in their professional identity and the role of leaders occupying hybrid positions is not well recognized. Conclusions Doctors who become chief executives are self-styled ‘keen amateurs’ and there is a need to provide more structured support to enable them to become skilled professionals. The new faculty of medical leadership and management could have an important role in this process.

Rationing in health care: The theory and practice of priority setting

Foreword by Chris Ham Introduction The ethics of priority setting Public participation in priority setting Priority setting and economic evaluation Multi criteria decision analysis and priority setting processes The politics of priority setting Leadership in priority setting Disinvestment as a priority setting case study Conclusions and key lessons.

Managing and Leading in Inter-Agency Settings

Leadership and management are increasingly considered important drivers of organizational performance. Yet despite the fact that they are viewed as essential components of integrated working, or partnerships, there is relatively little thoughtful work analyzing the relationship between the two sets of ideas. Until now. This updated second edition provides realistic, robust guidance for the leadership and management of interagency collaborative endeavors. It summarizes recent trends in policy, establishes what we can learn from research and practice, and sets out useful frameworks and approaches to address a range of problems that collaborations face.

Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency

BackgroundIn recent years joint commissioning has assumed an important place in the policy and practice of English health and social care. Yet, despite much being claimed for this way of working there is a lack of evidence to demonstrate the outcomes of joint commissioning. This paper examines the types of impacts that have been claimed for joint commissioning within the literature.MethodThe paper reviews the extant literature concerning joint commissioning employing an interpretive schema to examine the different meanings afforded to this concept. The paper reviews over 100 documents that discuss joint commissioning, adopting an interpretive approach which sought to identify a series of discourses, each of which view the processes and outcomes of joint commissioning differently.ResultsThis paper finds that although much has been written about joint commissioning there is little evidence to link it to changes in outcomes. Much of the evidence base focuses on the processes of joint commissioning and few studies have systematically studied the outcomes of this way of working. Further, there does not appear to be one single definition of joint commissioning and it is used in a variety of different ways across health and social care. The paper identifies three dominant discourses of joint commissioning – prevention, empowerment and efficiency. Each of these offers a different way of seeing joint commissioning and suggests that it should achieve different aims.ConclusionsThere is a lack of clarity not only in terms of what joint commissioning has been demonstrated to achieve but even in terms of what it should achieve. Joint commissioning is far from a clear concept with a number of different potential meanings. Although this ambiguity can be helpful in some ways in the sense that it can bring together disparate groups, for example, if joint commissioning is to be delivered at a local level then more specificity may be required in terms of what they are being asked to deliver.

Structures and processes for priority-setting by health-care funders: a national survey of primary care trusts in England

Although explicit priority-setting is advocated in the health services literature and supported by the policies of many governments, relatively little is known about the extent and ways in which this is carried out at local decision-making levels. Our objective was to undertake a survey of local resource allocaters in the English National Health Services in order to map and explore current priority-setting activity. A national survey was sent to Directors of Commissioning in English Primary Care Trusts (PCTs). The survey was designed to provide a picture of the types of priority-setting activities and techniques that are in place and offer some assessment of their perceived effectiveness. There is variation in the scale, aims and methods of priority-setting functions across PCTs. A perceived strength of priority-setting processes is in relation to the use of particular tools and/or development of formal processes that are felt to increase transparency. Perceived weaknesses tended to lie in the inability to sufficiently engage with a range of stakeholders. Although a number of formal priority-setting processes have been developed, there are a series of remaining challenges such as ensuring priority-setting goes beyond the margins and is embedded in budget management, and the development of disinvestment as well as investment strategies. Furthermore, if we are genuinely interested in a more explicit approach to priority-setting, then fostering a more inclusive and transparent process will be required.

BRIDGING THE DIVIDE - COMMERCIAL PROCUREMENT AND SUPPLY CHAIN MANAGEMENT: ARE THERE LESSONS FOR HEALTH CARE COMMISSIONING IN ENGLAND?

Current English health policy is focused on strengthening the ‘demand-side’ of the health care system. Recent reforms are designed to significantly enhance the capability and status of the organisations responsible for commissioning health care services and, in so doing, to address some of the perceived problems of a historically provider/supplierled health system. In this context, commissioning organisations are being encouraged to draw on concepts and processes derived from commercial procurement and supply chain management (SCM) as they develop their expertise. While the application of such principles in the health sector is not new, existing work in the UK has not often considered the role of health care purchasers in the management of health service supply-chains. This paper describes the status of commissioning in the NHS, briefly reviews the procurement and SCM literature and begins to explore the links between them. It lays the foundations for further work which will test the extent to which lessons can be extracted in principle from the procurement literature and applied in practice by health care commissioners.

Integration: work still in progress

PURPOSE The purpose of this paper is to set the context for this special issue and provide an introduction to the individual contributions. DESIGN/METHODOLOGY/APPROACH This paper uses a literature survey and analysis. FINDINGS Integration remains both a central goal and a field of limited but possibly developing achievement. Multiple meanings and usages are themselves sources of confusion and contestability that contribute to poor performance, as does an emphasis on process over outcome. This special issue provides an opportunity for the limitations and possibilities of integration to be explored from a wide range of disciplinary perspectives and international settings. Individual papers draw on a wide and innovatory range of theoretical approaches in addressing reasons for limited progress and opportunities for taking it further. Nonetheless, how far we have a good fit between this area of study and the tools we use for its evaluation remains an issue for concern and further exploration. RESEARCH LIMITATIONS/IMPLICATIONS This editorial is not a systematic review, though it draws on findings from a number of such reviews. PRACTICAL IMPLICATIONS The various contributions all have practical implications for the strategies to develop integration and its evaluation. ORIGINALITY/VALUE The special issue as a whole was designed to encourage fresh perspectives and approaches to be brought to bear on understanding, conducting and evaluating integration. This editorial introduces each of these themes.

Disinvestment in health— the challenges facing general practitioner (GP) commissioners

The economic downturn is placing increasing pressure on the financing of health care. For many health care providers, this means difficult decisions need to be made over what will and will not be funded. The NHS has not typically been good at decommissioning and disinvesting in services. The recent proposed changes to the commissioning function will mean that clinicians will have a leading role in population-based priority-setting. This could well enhance the quest for legitimacy in relation to difficult resource allocation decisions. However, it is unlikely that GPs alone will be able to meet the challenges ahead, and reasonable disinvestment decisions will require GPs to engage with a number of stakeholders including government, interest groups and the wider civic society.